Not so enthusiastic

As excited as I have been about using CogStateTM to independently baseline A-Ones's cognitive functioning, and getting ready to try him out with C8 - Kids Cognitive Cross Training, I don't exactly have an enthusiastic partner in my venture.

Last night A-One went to bed early.  His sleeping patterns have become more erratic lately because he's been playing WOW on and off both day and night. However, after last night I thought 'You beaudy!  He's had a really good night's sleep.  His brain will be fresh. What a golden opportunity to begin the CogStateTM practice tests!'  I had been 'warming' him up to them over the last couple of days. Waking him up mid-morning:

Mum: Hi A-One. Time to get up. After such a good night's sleep, let's get started with your round of practice tests today.  How about you get up, eat, have a shower (it's been several days), and we can get started.

A-One: OK, I'll get up, but we'll see about the practice tests.

Later on as he was having breakfast ...

Mum: When will we get started? This afternoon sometime?

A-One: No! I'm not doing it today!

Mum: A-One, this is a golden opportunity because you had such a good night's sleep! Your brain will be on fire!

A-One: I'm not doing it today! 

Mum: The scientists have proven that you need adequate sleep, nutrition, physical exercise, as well as mental exercise for your brain to be healthy, so it's important that you've had adequate sleep to do the tests.

A-One: How do they know that? I'll prove that I can be fine without even 5 hours sleep!

Mum: Do you see that this brain training work is about helping you be able to have a job, and not just a job, but a good job? What will you do instead today?

A-One: Other things.

Mum: Do you think your WOW friends would be happy for you to spend some time away from them, improving things for yourself?

A-One: Yes.   

Mum: Well, can we do it tomorrow?

A-One: Yes.

Mum: What time?

A-One: I don't know!

Mum: How about 10am?

A-One: OK.

Mum: It may take about 3 hours all up.

A-One: Three hours! How come?

Mum: The practice will take about an hour or more, so that you get used to what you have to do.  Then we do the real baseline test, which will take just as long.

A-One: No, we're doing only the first part.

Mum: So when will we do the second part?

A-One: The next day, Sunday.

Mum: I can't do it Sunday because Dad and I have something on Sunday morning.

A-One: Well, whenever is the next time!

Mum: You do realise, don't you, that improving things for yourself can start right now?

So instead today, I'm blogging ... and he's WOW'ing.

Under his own steam

Over the last month I have not been overseeing A-One's brain training too closely.  Under his own steam he has averaged training 3 times a week, which I'm very pleased about. 

At 53.6th percentile, his Flexibility has now finally passed the 50th percentile which is great news too! 

His Problem Solving is the only area that still lags under 10th percentile.

Over the last month we have been learning more about his WOW friends because he talks to them frequently, using his headphones and microphone. When playing, he sits in our family room so that he can use the internet cable instead of our unreliable wireless - we can't help overhearing his end of the conversations.  His sitting in our family area helps to include his online life with ours.

Not bored. Disappointed.

Over the last few weeks A-One's overall Lumosity BPI has stayed pretty steady at around 1000 or 43rd percentile.  He's been playing on average about three to four times a week.  The exciting part is that he is almost at the 50th percentile for Flexibility, and almost, almost at the 10th percentile for Problem Solving.  I'm still trying to convince him to re-prioritise his training preferences with Problem Solving at the top so that he can give himself a good workout in that area.

I asked him today if he was getting bored with Lumosity, because there are other exercises he could try, for example CogniFit.

A-One: It's not so much that I'm bored, but that only a few of the games have a 'Pause' button.  They flash up things so fast that it doesn't give me time to get it right. And sometimes I get only one thing wrong, and it gives me a low score - which is disappointing.  And the Penguin still goes faster than I can, which is cheating. Do they have a feedback section where I can tell them?

Mum: Some of the games might be testing your speed, just above your current level of skill, so that it's stretching you to get better.  Do you know what happens when you play any game against someone better than you?  Like tennis?

A-One: You lose?

Mum (laughing): Yes, probably.  But you get better!  They help you to lift your game. 

A-One: Sometimes you need to pause to do something else, like answer the door or something, and then for that day, you get a low score.

Mum: Well, after your official training for that day you could always do the game again to see how well you could really do without taking a break.  It wouldn't count in your official score, but you'd know how well you've really done.  And that's what really important isn't it?

A-One: Yes, I could do that.

Mum: If you want to send in some feedback, why don't you and see what they say?

A-One: I will, but not now.

I'm just not that into it Mum

Mum: A-One, I want to get your scores on the last couple of Lumosity games you've played.

A-One: No, not now!

Mum: I told you about an hour ago that I'd be coming to get your scores.

A-One: Not until I've done my games today.

Mum: I'm not waiting until midnight to get your scores for the last couple of days.

A-One: It won't be midnight.

Mum: All you need to do is 'brb' to your WOW mates!  I'm not waiting until tonight! I've given you plenty of notice.

Under sufferance he logged on to get his scores.

Mum: You're now at 40th percentile overall!

A-One (dully): Yes.

Mum: And you are in the 40s for both Attention and Flexibility!  All you need to do is relearn your tables and number facts and your Problem Solving would shoot up too.

A-One: I know what I have to do Mum.

Mum: Sigh.

A Centrelink appointment ... for?

We visited Centrelink this morning to attend an appointment for people on disability pensions who are looking for less than a specified number of hours of work per week. At our last meeting with A-One's Disability Employment Services provider, A-One's target hours per week were recorded as 8-16.  He had received a phone call from Centrelink inviting him to attend an appointment to talk about how he's going; to make sure he's not falling through society's cracks; that he is making progress with his employment goals, and has some engagement with community.

A-One: I'm nervous about this appointment.  I hope they don't ask me any questions I'm uncomfortable with.

Mum: What type of questions might they be?

A-One: If they ask me what else I'm doing besides looking at emails for work.

Mum: How would you answer?

A-One: That I watch some TV, do some reading, play some X-Box games, play computer games.

From where I stand, he seemed to have reversed the order, but I let it pass. Instead I posed some questions he might get.

Mum: What about friends?

A-One: Yes, I talk to them.

Mum: How do you talk to them - call? email? Facebook?

A-One: Facebook.

Mum: When was the last time you talked to them?

A-One: It's been a little while.

Mum: How long is 'a little while'?  Before? After? Christmas?

A-One: After Christmas was the last time.

He observed the security people in the Centrelink office so we went on to discuss why they might be there, when his name was called.

The Centrelink officers were friendly, but the process for the interview seemed to be very perfunctory.  We were advised that this was a new initiative of the federal government, and that his participation was entirely voluntary; that they had a set list of questions to ask and that the outcome would be a plan which he would sign.  The timeframe for any plan could be long term, for example five years.

My impressions?  Accepting A-One's responses at face value with no insightful questioning as to what might really constitute barriers to employment.  In response to A-One's stated goal of becoming a sound engineer or assistant DJ, there was some brief discussion about a TAFE course, but they simply noted that A-One was not doing it. They stressed to A-One that he share his employment goals with his Disability Employment Services (DES) provider.  They gave A-One a glossy package containing a pen, a notebook, and a copy of his signed 'plan' which stated his employment goal which, as he said, is already on his resume anyway. I came away with the feeling that they could tick off another box in 'assisting' people; it seemed more like a bureaucratic overhead.

Our discussion on the way home seemed to provide more insight that I thought such an interview might have drawn out.

A-One: I don't  mind doing study that is hands on, like making sure that everything is connected properly, but I'd struggle if I had to do assignments that required writing.  Even games testing would be good, but I'd have difficulty writing reports of the tests.  There are problems with WOW, but I don't know if the WOW developers would think they are problems.

Mum: There's a website where you can submit problems with WOW - perhaps you could start small by practising reporting bugs there?

A-One: You see, in WOW my character is at level 90 and I've been trying to get a recipe for food for health - you can restore the health of your character with food.  It's at level 60, which should be really easy for me, but I've been trying for years to get it and still haven't - that's very frustrating. You see I like to collect full sets of things, and ...

... and so on for the rest of our trip home.

60th percentile for Speed!

A-One finally got to his Friday game before he went to bed Saturday morning - when? Don't know.  He's had the same pair of pyjama pants on night and day for the last week.

The exciting news is that he's hit 60th percentile for Speed, and is almost cracking 50th percentile for Memory. He was served an information processing game, but no working memory.  Nevertheless, he gained another PB for the cafe game for remembering names, faces and orders. I suggested to him that once he's hit 50th percentile for Memory, he might adjust his training priorities so that he gets more intensive work on Attention and Flexibility.  He didn't protest, so we'll see once he hits the mark.

Also, through SharpBrains again, I saw a reference to a paper published in Nature, by two professors advocating for games developers and neuroscientists to collaborate to produce digital games that train the brain.  Yeh! When you think that children's game play is how they learn and grow, why not digital games too?  One of the scientists spoke at a TED talk last November.

ESCoNS Cognitive Neurotherapeutics - a new field of gaming

A-One seems to have reached a plateau in his Lumosity brain training over the last couple of days, sitting at overall percentile of  31.9.  His games have included information processing and working memory on most of the last three days with several PBs on Wednesday.  However, yesterday (Thursday) he achieved a PB for Penguin Pursuit! This is the speed game where he complains that the penguin is cheating because it goes faster than he can. Nevertheless he completed level 15 of the game, and commented that he hasn't cracked level 16 yet.

Through SharpBrains I was alerted to an exciting symposium happening at the University of Southern California, Los Angeles this month. It's the second annual conference and meeting of The Entertainment Software and Cognitive Neurotherapeutics Society.  The press release states that it fosters collaboration to advance development of video game therapy to diagnose and combat mental disorders and improve cognitive learning, brain capacity and function. 

The society seems to have developed the whole new and exciting field of “cognitive neurotherapeutics.” What got me really excited was that the founder of the society is a past Executive of Activision Blizzard which publishes World of Warcraft!  So that means that there are others who recognise the potential of combining the disciplines of good game design with neuroscientific brain training!  It makes me feel hopeful about the increasing availability of online brain training exercises.  We just need to ensure that it's clear how to assess which games address which cognitive dysfunctions.

It takes time to be handsome

With no WiFi at present, A-One has connected his laptop into the last spare cable internet connection in the study.  As I have been working at my laptop too, we have been spending more time in each other's company.  In fact, I spent several days engrossed in some work of my own, and A-One beat me to bed one night! Or more accurately, one morning.  I well understand the draw of some kinds of work, just to see it completed - as A-One finds with campaigns in WOW.  These days I usually avoid activities that hook me in this way because there are many other things that also need my attention.  So for me, I'm glad my work of last week is over and that I've returned to the land of the living.

A-One played his brain training exercises Tuesday, Wednesday, Thursday and Friday. On several days he played in his pyjamas at the eleventh hour, knowing now that if he waits until after midnight, it doesn't count for that day.

• His best score for Speed was on Tuesday, achieving his highest yet, coming in at 56.2nd percentile.  Since then he's been steady at 54.4th percentile, with a slight drop on Friday to 54.1st percentile.

• He has also been steady on Memory at 47.8th percentile with working memory played most days, rising to 48.8th percentile on Friday.

• Very few Attention games were offered this last week, so A-One has been steady there too at 33.4th percentile.

• Of late his program seems to have been exercising mainly his Flexibility, particularly brain shift, which has seen a good improvement last week, rising to 28.2nd percentile. I'm hoping these exercises will help him with his rigidity - in helping formulate options when considering courses of action.

• No change in problem solving (only a couple of games last week), at 9.1st percentile.

• His overall percentile is now 31.2nd percentile - still his highest yet.

A-One and I reviewed his results each day, and if information processing and working memory were not offered, I suggested additional games.  However with my own busy-ness I did not push it, and A-One did not play any additional games last week.

Nevertheless on Friday I felt like celebrating, so on Friday morning I raised the idea of going out for a low key dinner that night.  A-One seemed open to the idea.  I reminded him that he'd need to be ready by 6:30pm so that we could pick up his sister from work on the way.

I was very pleased to see him stop playing WOW at 5pm, with no prompting, to have a shower. At about 5:30pm he came downstairs wrapped in a towel to check with me again about the leaving time.  I told him that he needed to be ready by 6:30pm in case his sister rang for an early pickup, as she sometimes does, but that if she doesn't ring, we'd be leaving at 6:45pm. He then went back upstairs.

At 6:45pm he was still in the bathroom.

Mum: We have to leave now A-One.  Your sister has just called too.

A-One: I'll only be a couple of minutes.

Mum: But we have to leave now - as I told you this morning.  You've had all that notice!

A-One: I won't be long.

At 6:53pm:

Mum: A-One, we have to leave!

A-One: Okay. I'll only be a couple of minutes.

Mum: We have to go!

At 6:55pm, he came out of the bathroom looking very smart - he had shaved and put on nice clothes. I was pleased that he had taken care with his appearance, but I was also very conscious that his (younger) sister was waiting on a city street. At night. On her own.

Mum: I was really looking forward to being able to tell you what a great job you did being ready on time.  You stopped playing WOW at 5 o'clock which was great, but then you were still almost half an hour late!

A-One: If you must know, I was cutting my nails.  I've only done one hand.

(A-One's beard and nails get quite long when he plays WOW for weeks on end.)

Mum: Well, that's great too that you want to spruce up for going out - you look very handsome - but if you need more time to do that, then you need to start earlier.  You might say sorry to your sister for being late.

He didn't say sorry when we picked up his sister, but we did have a lovely meal.  With a little encouragement he tried something new to eat - and he finished it all before the rest of us, saying that's what he'll have every time he comes here!

Both a tortoise and a hare

It's been over a week and A-One has had no calls about going back to work. Despite our urging to make contact to show his interest, he has heard nothing and has not been willing to make the phone call.

So I did.

He has been registered with a disability employment service for several years, and they found him his current job.  I spoke to his consultant.  I had wanted to call her anyway to let her know about A-One's brain training work, and to let her know how it has been going.  I also mentioned the Arrowsmith program and how I have joined an advocacy group to bring the program to Australia.  It was not one with which she was familiar.

Of most interest to me was the feedback she gave about A-One's work.  She found that A-One worked really well on some days, but was very slow on others.  He worked best when there was someone there all the time encouraging him with 'You can do it A-One'.  When there wasn't anyone there he was very easily distracted, or would do the same thing over several times when it wasn't really required.  His work buddy was able to complete the whole job sooner on his own than when they worked together and was not returning to the job. So A-One's job is on hold until they can find someone else to be his work buddy.

That certainly consolidated for me the consistency of our experience of A-One:

• at home
• his first job after he left school (Life since school)
• this job (It's all in the timing)

I spoke with A-One about it.

A-One: Why did you phone up? That's not your business!

Mum: Because Dad and I wanted to know what was going on.  We wanted some idea as to when you might be going back to work.

Mum: We're hearing again that even though you know the job very well, it's the inconsistency in your pace that is difficult for employers.  You often tell me 'I know' when I remind you about doing things, and it's clear to me that you can readily learn a job, but you need help in doing it at a consistent pace.

A-One: My work buddy probably got sick of me.

Mum: I don't know anything about that.

A-One resumed playing WOW  as I was speaking to him.

Mum: Could you take your character to a safe place and pause the game while we're talking about this?

A-One: I can listen to you while I do this.  See I'm responding to you?

Mum: That's pretty amazing seeing your auditory processing is somewhat impaired ....

Mum: Remember your cooking plan which includes the times of when to do things (It's all in the timing)?  What if you do that for other jobs so that you can do them at a more consistent pace, and improve your work prospects?  Use the clock as your friend to check things off against the time on the plan. Remember how I tell you to take note of the time when you start and finish jobs? We've been trying to tell you this, but you haven't wanted to know.

A-One: I get it Mum.





Later on A-One came downstairs and asked me which additional games he should play today.

That's a first. 

New priorities for the new year?

A-One's laptop came back from repair on Tuesday (2 days ago), so he has been able to resume his online brain training yesterday and today. We're finally back into the swing of things after a long vacation period.

The most challenging aspects of the vacation period was when I needed A-One to do some jobs by a certain time, especially being ready to go away on holidays. I still haven't struck the magic formula for having him co-operate in that respect, which heightens the stress levels all round. Nevertheless, once we do get away, he is more willing to do as asked by those not from his immediate family.  So I'm thinking I need to more actively pursue brain training alternatives this year which involve people outside his immediate family, who may be more successful in having him give it higher priority.

It has been almost two months since he has logged on for anything. For a while he had access to another PC in the office, but his sister decided to reformat her external hard drive, and it seems she included its C: drive because it no longer boots up.  So A-One occupied his time mostly with X-Box and DVDs while eagerly awaiting his laptop repair.

Happily, when I went into his room yesterday, he was logging in to his Lumosity training (after some reminders).

A-One: Mum, see how the dot in the calendar appears in the middle of the week? Isn't it better to start next Monday so that the calendar shows dots for a full week of exercises?

Mum: No, it doesn't matter.  It's better that you resume your training as soon as possible.

I had to go out, and when I returned, he was happy to show me how he'd gone.  He was given all new games to do, so all were personal bests (PBs). He had dropped 43 in his overall Brain Performance Index (BPI) from 737 in December, mainly due to a drop in speed.  I wondered how long it would take him to recover his former scores.

His conversation however was all about a slight glitch he had encounted while playing World of Warcraft (WOW). He was keen to describe, at length, the glitch and his attempts to fix it including posting a question to a game master.  Today he received a reply, and spent many hours following the tips, which resulted in his now being unable to log on (hooray!).

Mum: How has your brain training gone today?

A-One: Fixing this is more important!

Mum: ... a repeat of a conversation we've had many times ... my patience is waning ...

I wish!

Nevertheless, by the time I came back to 'remind' him again, he had logged on.

Several hours later when I was free again to see how he went, he had almost recovered his former BPI score!  He had again gained PBs for all games, including the old 'cafe' game where he had to remember people's names from way back in December!  He was also keen to show me how to play the new games, so I was happy to see his willingness to play them again.

Lumosity has games specifically for working memory, so I've started encouraging him to add in some additional games each day, just for that.  Now I have to think about how I'll get him to do it ...





 

No pause, so I'll restart

As A-One did his Lumosity today he was grumbling that some games did not let him hit the pause button (so that he could mentally catch up with the game.) I barely heard his comments over the music playing in the study. It was too loud for me to concentrate, so I don't know how he does.

He was willing to add a logical problem solving exercise to his usual set of games and is working at a level where his comment was something like 'I don't know why it's wrong.  I can't figure it out.' He restarted the game three times mid-game.

No PBs today.

5-handed clocks

With A-One being turned off the clocks exercise, I re-read Norman Doidge's summary of the Arrowsmith school approach. A-One had been zooming through the 3-handed clocks, and had elected to go straight to Legendary level for his latest X-Box game, so I thought he might respond more positively to a greater challenge.

I decided to create a page of 5-handed clocks with the hands already on them.  That meant that A-One had to read the times rather than write the times.  Where the Arrowsmith school uses 1/60th second for the 4th hand, I instead used milliseconds and microseconds on two 'sub-' clocks within the main clock, because milliseconds and microseconds have practical application. I showed them to A-One after I had printed them out, and he once again stated emphatically that he wasn't going to do them.

I let that go so that A-One could do his Lumosity training first.  I noticed that he's starting to use the 'pause' button on some of the games. Even though the image disappears during a pause, it gives him time to think.  Also for one of the games, whenever he made a mistake, instead of continuing on with the game he went back to the start each time.  So it seems to me that he is becoming 'hooked' on achieving good scores.

He's now over the 15th percentile overall, and his speed is over the 45th percentile. Memory and attention are around the 20th percentile, and flexibility a bit lower than that.  Today he went down in problem solving, to less than the 2nd percentile.  I've told him he needs to relearn his tables and number facts to improve on this one. 

When he and his sisters were young, I used to play songs of tables in the car to school every day, and once upon a time he knew them all. At school the children weren't drilled on their tables like we were when I was at school, and I don't think any of my children would have learnt their tables but for those songs. For them it seems to have been use it or lose it.





I raised the new clocks exercise again:

A-One: No! I don't need to do them! I'm not going to do them! Two hands are all you need to read a clock ... I'm going to the toilet.

Fifteen minutes later (I measured it this time), he came back to resume his computer game.

Mum: Can I just show you how these clocks work, without you doing the exercises?

A-One: Alright.

I explained a millisecond, and a microsecond.

A-One: What do you need those for?

Mum: They are usually used in science, in laboratories, and sometimes to measure how long it takes to access data on computer discs.

Using the first clock as the training example, he made an error reading the hour hand but was able to correct himself when I pointed it out.  He was willing to read the time on the second clock too.

Mum: How about the next one?

A-One: No! No more today!

Mum: How many milliseconds in a second?

A-One: 1000

Mum: How many microseconds in a millisecond?

A-One: 1000

Mum: Fantastic! You know, you're not slow in picking this up. Do you remember when you first started this only a couple of weeks ago that you didn't even know how to read the half hour? And look what you can do now! All you need is practice so that you can do it quickly. Like swimmers - most people know how to swim, but it's those who train and train who swim really fast.

By that stage I was talking to one ear - the other was already under the headset.

Clocks are only for telling the time!

A-One duly completed his Lumosity training this morning.  He gained a new personal best for the flexibility game which requires him to recognise shapes, but continues to plateau (down actually) on memory and problem solving.  His speed is now over the 40th percentile, memory and attention up around the 20th percentile, but problem solving remains doggedly around the 2nd percentile. Overall he is over the 14th percentile for his age group.

When I mentioned moving on to the clocks and reading comprehension:

A-One: No! I know the clocks! I don't need to do any more clocks!

Mum: The next stage is to add a 4th hand.

A-One: No! I'm not doing any more clocks!

Mum: You realise it's about training that part of your brain that is good not just for reading clocks, but for other things too?

A-One: No! I don't need to do that!

Mum: OK. Well let's move on to some reading.

A-One: No! I don't need to do that either!

Mum: The reading this morning is different from last week's.  (I had planned to use the first paragraph from the Inquirer section of The Weekend Australian.)

A-One: No! My reading's OK.

Mum: Do you realise why we're doing this?  To improve your chances of getting a job so that you can keep yourself - especially after we're gone? What will you do then?

A-One: I don't know. I don't want to talk about it anymore!  Stop trying to make me do it!

A-One immediately brought up RuneScape and started telling me more about a feature that he'd pointed out to me yesterday.

Games, games & bills

Over the weekend A-One completed his daily brain training with Lumosity.  His BPI continues to steadily increase, with improvements in speed, memory, attention, and flexibility, but his problem solving remains determinedly around the 2nd percentile. By Sunday, his speed was almost at the 40th percentile, although he may be plateauing for memory.

 

He was telling me about his progress with his latest game purchase, Halo 4.  Playing it on the X-Box because his laptop is still out of action, he was explaining that there are four levels: Basic, Standard, Heroic, and Legendary.  He decided to start at Legendary and is already up a couple of levels! (Although he says it takes longer to complete a game.) Not content with restricting himself to the X-Box, he is also using another computer to play the online game Runescape.

As an aside, he was asking about how some online payments work, and noticed his board payment in  the transaction statement for his bank account.  We took this opportunity to talk about some living costs, using a household bill as an example. I don't have much confidence that any of it registered, however we'll keep trying to share cost of living realities with him, hopefully to provide increased motivation for brain training.