Problems

Traumatic brain injury is the biggest killer of young adults and children in the U.S., and in a year more Americans suffer a TBI than are diagnosed with breast, lung, prostate, brain and colon cancer combined. There are many causes of TBI, but one of the more preventable is that of sports concussion.

This week Pennsylvania became the 35^th state in the U.S. to have a youth-concussion law. Since I recently uploaded a topic collection on TBI (traumatic brain injury), this seems an appropriate time to talk a little about sports concussions and their possible long-time repercussions.

In 2009, a study commissioned by the National Football League reported that Alzheimer’s disease or similar memory-related diseases had been diagnosed in the league’s former players dramatically more often than in the national population: five times the national average among those 50 and older (6.1%) and 19 times for those aged 30 through 49.

This follows a 2005 study that found retired National Football League players had a 37% higher risk of Alzheimer's than other U.S. males of the same age. Those who had experienced three or more concussions had a five-fold greater chance of having been diagnosed with mild cognitive impairment and a three-fold prevalence of reported significant memory problems compared to those players without a history of concussion.

Most recently, a follow-up of nearly 4,000 retired National Football League players surveyed in 2001 found that 35% appeared to have significant cognitive problems. When 41 of them were tested, they were found to have mild cognitive impairment that resembled a comparison group of much older patients from the general population.

Now, you might (if you’re a parent) console yourself with the thought that professional football players are likely to be involved in much greater impacts than those suffered by your child on the sport’s field. But unfortunately there is growing evidence that even mild concussions can produce long-lasting trauma to the brain.

For example, monitoring of 11 high school football players found that some players who hadn't been diagnosed with concussions nevertheless had developed changes in brain function following head impacts, and these changes correlated with cognitive impairment. Brain scans have also revealed abnormalities in white matter at all levels of severity in traumatic brain injury, even in those who had minimal or no loss of consciousness, and those with no self-reported cognitive deficit. And analysis of medical records on over 280,000 older U.S. military veterans found that severity of brain injury made no difference to the increased likelihood that they would develop dementia.

Not all impacts are equally bad. There’s some evidence that the area to the top and front of the head (just above the dorsolateral prefrontal cortex) is particularly vulnerable.

Another danger sign is headaches. A study found that young athletes who experienced migraine headache symptoms (even one week after concussion) were likely to have increased cognitive impairment, and shouldn’t return to play before the headache resolves.

Children exposed to lead early in life might also be especially vulnerable to the effects of head injury. Rat studies have found that young rats exposed to low levels of lead don’t recover from brain injury as well as those not so exposed.

Head trauma shouldn’t be accepted fatalistically. There are actions you can take to ameliorate its effects (if you don’t want to remove yourself from the risky situations). What these findings emphasize is the importance of treating even mild head injuries, of giving your brain time to repair itself, and of following a regime designed to mitigate damage: exercising, eating a healthy diet, reducing stress, and so on.

My recent report on transient global amnesia demonstrates the incredible ability of the brain to repair itself — but it must be given time to do so before subjecting it to more trauma. According to a leading tracker of youth sports injuries, returning to play too soon is a trend that occurs in roughly 40% of sports-related concussions of student football players.

The three main provisions of Washington state's Zackery Lystedt law, considered by the National Football League to be model youth-concussion legislation, are:

• a student-athlete's parent or guardian must sign a concussion-awareness information form before the student-athlete is eligible to participate in school athletics;
• any student-athlete suspected of a concussion must immediately be removed from play;
• any student-athlete who has a concussion must obtain medical clearance before being allowed to return to practice or competition.

Many states also require some form of concussion training for coaches.

I don't often talk about eyewitness testimony, but it's not because of the lack of research. It's a big field, with a lot of research done. When  I say I don't follow it because I regard the main finding as a done deal - eyewitness testimony is useless - that's not meant to denigrate the work being done. There is, clearly, a great deal of value in working out the exact parameters of human failures, and in working out how we can improve eyewitness testimony. I just arbitrarily decided to ignore this area of research until they'd sorted it all out! (I can't follow everything, I'm swamped as it is!)

Nevertheless, I do want to remark on a recent report in The Scientist, to the effect that a New Jersey court has decreed that all juries must be informed of the unreliability of eyewitness testimony. I want to raise a hearty cheer. I regard it as practically criminal that eyewitness testimony is given the weight it is. I think everyone should be taught, from a young age, that memory is completely unreliable. And, in particular, that the certainty you hold in any specific memory, and the vividness it has, are not nearly as good proofs of the accuracy of the memory as we tend to believe.

You may think a belief in the fallibility of memory would create an unpleasant state of uncertainty, but I believe it would bring about a useful decline in many individuals' dogmatic certainty, and encourage more empathy with other, fallible human beings.

You may ask how my emphasis on the fallibility of human memory squares with my frequent comments on the danger of believing that you have a bad memory or that your memory will inevitably get worse as you age. But believing in human fallibility is very different from believing you personally have a bad or deteriorating memory. You need to find a nice balance between these beliefs, and part of achieving that lies in understanding how memory works and what aspects are more reliable and which less. I hope my site helps you with that!

We all like simple solutions. However much we may believe we are ‘above’ black-&-white dichotomies, that of course we understand that every situation is complex, nevertheless we have a brain that can only think of a very very few things at once. So it's unsurprising that we are drawn to solutions that can be summed up simply, that can fit comfortably within the limitations of working memory.

Here’s something I read about in Scientific American the other day: Huntington’s disease — which is a terrible disease that eats away at your brain, causing both physical and cognitive disabilities that continue to deteriorate until the sufferer dies an untimely death — is linked to an excess of a brain chemical (the neurotransmitter glutamate) that is in fact vital for learning and memory. Intriguingly, a recent study has found that those with the genetic mutation for this disease, but who were as yet asymptomatic, were significantly quicker to learn than those without the mutation. Indeed, those with the greatest number of copies of the mutation were the fastest to learn.

This may not simply be a matter of disease progression — an earlier study found that Huntington’s patients did better on one cognitive task than healthy controls (detecting whether a tone was long or short). It may be, the researchers suggested, that it is simplistic to talk of a decline in cognitive function in Huntington’s, rather some functions might be enhanced while others are impaired.

Huntington’s Disease is hardly alone in this. We often talk about ‘normal’ memory aging, and there’s no denying the concept of normal is a useful one — in certain contexts. But not, perhaps, in all those contexts in which it is used.

Psychology, as I’ve mentioned before, has historically been a search for what is ‘normal’ in human behavior. What is not normal is deemed ‘abnormal’ — a nice black & white dichotomy. Of course this is simplistic, but it gives us a place to stand. But now that psychology is a mature discipline, it can look around, explore the variability in human behavior. However it is only very very recently that we have begun to realize that the search for normal is merely a starting point to the question of what it is to be human, and it has become a straight-jacket.

As an example, let’s look briefly at something discussed in a provocative article about autism that appeared in the journal Nature. The writer of the article, Dr. Laurent Mottron, leads a research team that includes several autistic individuals. As a consequence, he has grown to appreciate the strengths that such individuals can bring to research.

The main thrust of his argument is that autism is not simply a “suite of negative characteristics”. There are advantages in some autistic characteristics. But because autism is defined as a ‘disorder’, researchers and clinicians systematically interpret behaviors in terms of impairment and abnormalities. More useful would be to examine each behavior on its own merits, and consider whether the behavior might be adaptive in certain contexts.

Mottron says that although intellectual disability is routinely estimated to be about 75% among autistics, only 10% of autistics have an accompanying neurological disease that affects intelligence, and if researchers used only those tests that require no verbal explanation, the level of intellectual disability would be seen to be much lower. An interesting comparison: “In measuring the intelligence of a person with a hearing impairment, we wouldn't hesitate to eliminate components of the test that can't be explained using sign language; why shouldn't we do the same for autistics?”

Mottron’s research term have coined a telling word: normocentrism, meaning the preconception you have that if you do or are something, it is normal, and if autistic do or have it, it is abnormal — I think this term could be usefully applied more widely. Similarly, the rise of the concept of ‘neurodiversity’ in the autistic community (whereby a ‘normal’ is ‘neurotypical’ and someone with an autism spectrum disorder is ‘neurodiverse’) could also be applied more widely. Rather than distinguishing between the two types, we should see human diversity as represented by a spectrum, where ‘neurotypical’ covers a wide middle range, and other ‘disorders’, such as autism, dyslexia, and ADHD, similarly occupy a range along the spectrum.

Because this is the point, this is what research has been revealing over the past few years: there is no such ‘thing’ (as in a single thing) as autism, as dyslexia, as ADHD, as Alzheimer’s. They all have multiple variants — variable characteristics; variable causes. Because they reflect subtly different differences in the brain.

Which means we shouldn’t assume that because something has a label (“Alzheimer’s”), there is only one path (and relatedly, one set of dangerous factors). For example, we ‘know’ that high blood pressure is bad, and certainly it’s an important risk factor for cardio- and cerebro-vascular disorders (including Alzheimer’s). And yet, according to a recent study, this is not the complete story. For the very elderly (say, 85+), high blood pressure may be a sign of better health. This isn’t just because risk factors are worked out on the basis of group studies while you are an individual (there is always individual variation). It’s also because almost everything has trade-offs. Like the Huntington’s disease gene variant that improves learning. Like the neurodiverse who have exceptional visual skills.

Similarly, just because someone has put a label on you (“dyslexic”), you shouldn’t assume that means that everything you know about dyslexia applies to you. Nor should you assume that there are no positives about your particular brain.

In the same way, you shouldn’t assume that being a ‘genius’, or having a ‘photographic memory’, is all positive. Everything is a trade-off (don’t mistake me, I’m not suggesting that there is something positive about Alzheimer’s! but it may be that humans are vulnerable to Alzheimer’s because of our superior brains, and because we live so long).

The message is, don’t simply fall prey to a label. Think about it. If you or someone you care for has been labeled, focus on the individual manifestations, not the label. The label is a guide — treat it as one. But never forget that each manifestation will have its own particular characteristics, some of which may be positive.

And 'normal' is a label, too. Here's an issue that's only recently become realized in the cognitive research community: our idea of what is 'normal' is largely based on one cultural group. Most cognitive research has been undertaken on American undergraduate students (according to a recent analysis, 96% of research subjects in a sample of hundreds of psychology studies came from Western industrialized countries, and 68% came specifically from the U.S. — of these, 67% were psychology students). In recent years, it has become evident that WEIRD people (those from Western, Educated, Industrialized, Rich, and Democratic societies) respond significantly differently on a whole lot of domains compared to non-Western groups — even on something as seemingly basic as a visual illusion. (see Scientific American for a nice discussion of this)

As I said at the beginning, our preference for simple solutions and simple labels is rooted in our limited working memory capacity. The only real way around this is to build up your knowledge piece by piece, so that the items in working memory are merely the tips of richly elaborated items held in long-term memory. That isn't quick or easy, so there'll be many areas in which you don't want to gather such elaborated knowledge. In the absence of being able to stretch the limits of working memory, it helps to at least be aware of what is limiting your thinking.

In other words, as with memory itself, you need to think about your own goals and interests, and choose those that you want to pursue. Becoming expert (or at least, a little bit expert!) in some areas shows you how different your thinking is in those areas; you will then be able to properly appreciate the limitations in your thinking in other areas. That’s not a bad thing! As with memory failures of other kinds, it’s a big step just to be aware of your fallibilities. Better that than to be fooled (as some experts are) into thinking that their expert thinking in one area means that they think equally clearly in other areas.

We are all fallible. We all forget. We all have false memories and believe in them. We all sometimes fall victim to labels. The trick is to realize our fallibility, and choose the occasions and domains in which to overcome it.

In A Prehistory of Ordinary People, anthropologist Monica Smith argues that rather than deploring multitasking, we should celebrate it as the human ability that separates us from other animals.

Her thesis that we owe our success to our ability to juggle multiple competing demands and to pick up and put down the same project until completion certainly makes a good point. Yes, memory and imagination (our ability to project into the future) enable us to remember the tasks we’re in the middle of, and allow us to switch between tasks. And this is undeniably a good thing.

I agree (and I don’t think have ever denied) that multitasking is not in itself ‘bad’. I don’t think it’s new, either. These are, I would suggest, straw men — but I’m not decrying her raising them. Reports in the media are prone to talking about multitasking as if it is evil and novel, and a symptom of all that is wrong in modern life. It is right to challenge those assumptions.

The problem with multitasking is not that it is inherently evil. The point is to know when to stop.

There are two main dangers with multitasking, which we might term the acute and the chronic. The acute danger is when we multitask while doing something that has the potential to risk our own and others’ safety. Driving a vehicle is the obvious example, and I have reported on many studies over the past few years that demonstrate the relative dangers of different tasks (such as talking on a cellphone) while driving a car. Similarly, interruptions in hospitals increase the probability of clinical errors, some of which can have dire consequences. And of course on a daily level, acute problems can arise when we fail to do one task adequately because we are trying to do other tasks at the same time.

A chronic danger of multitasking that has produced endless articles in recent years is the suggestion that all this technology-driven multitasking is making us incapable of deep thought or focused attention.

But Smith argues that we do not, in fact, engage in levels of multitasking that are that much different from those exhibited in prehistoric times. ‘That much’ is of course the get-out phrase. How much difference is too much? Is there a point at which multitasking is too much, and have we reached it?

These are the real questions, and I don’t think the answer is something we can draw a line with. Research with driver-multitasking has revealed significant differences between drivers, as a function of age, as a function of personal attributes, as a function of emotional or physical state. It has revealed differences between tasks —e.g. talking that involves emotions or decisions is more distracting than less engaging conversation; half-overheard conversations are surprisingly distracting (suggesting that having a passenger in the car talking on a phone may be more distracting than doing it yourself!). These are the sort of things we need to know — not that multitasking is bad, but when it is bad.

This approach applies to the chronic problem also, although it is much more difficult to study. But these are some of the questions we need to know the answers to:

• Does chronic multitasking affect our long-term ability to concentrate, or only our ability to concentrate while in the multitasking environment?
• If it does affect our long-term ability to concentrate, can we reverse the effect? If so, how?
• Is the effect on children and adolescents different from that of adults?
• Does chronic multitasking produce beneficial cognitive effects? If so, is this of greater benefit for some people rather than others? (For example, multitasking training may benefit older adults)
• What are the variables in multitasking that affect our cognition in these ways? (For example, the number of tasks being performed simultaneously; the length of time spent on each one before switching; the number of times switching occurs within a defined period; the complexity of the tasks; the ways in which these and other factors might interact with temporary personal variables, such as mood, fatigue, alcohol, and more durable personal variables such as age and personality)

We need to be thinking in terms of multitasking contexts rather than multitasking as one uniform (and negative) behavior. I would be interested to hear your views on multitasking contexts you find beneficial, pleasant or useful, and contexts you find difficult, unpleasant or damaging.

A fascinating article recently appeared in the Guardian, about a woman who found a way to overcome a very particular type of learning disability and has apparently helped a great many children since.

As a child, Barbara Arrowsmith-Young had a brilliant, almost photographic, memory for information she read or heard, but she had no understanding. She managed to progress through school and university through a great deal of very hard work, but she always knew (although it wasn’t recognized) that there was something very wrong with her brain. It wasn’t until she read a book (The Man with a Shattered World: The History of a Brain Wound - Amazon affiliate link) by the famous psychologist Luria that she realized what the problem was. Luria’s case study concerned a soldier who developed mental disabilities after being shot in the head. His disabilities were the same as hers: “he couldn't tell the time from a clock, he couldn't understand bigger and smaller without drawing pictures, he couldn't tell the difference between the sentences ‘The boy chases the dog’ and ‘The dog chases the boy’.”

On the basis of enriched-environment research, she started an intensive program to retrain her brain — 8-10 hours a day. She found it incredibly exhausting, but after 3-4 months, she suddenly ‘got it’. Something had shifted in her brain, and now she could understand verbal information in a way she hadn’t before.

The ‘Arrowsmith Program’ is now available in 35 schools in Canada and the US, and the children who attend them have often, she claims, been misdiagnosed with ADD or ADHD, dyslexia or dysgraphia. She has just published a book about her experience (The Woman Who Changed Her Brain: And Other Inspiring Stories of Pioneering Brain Transformation - Amazon affiliate link).

I can’t, I’m afraid, speak to the effectiveness of her program, because I can’t find any independent research in peer-reviewed journals (this is not to say it doesn’t exist), although there are reports on her own website. But I have no doubt that intensive training in specific skills can produce improvement in specific skills in those with learning disabilities.

There are two specific things that I found interesting. The first is the particular disability that Barbara Arrowsmith-Young suffered from — essentially, it seems, a dysfunction in integrating information.

This disjunct between ‘photographic memory’ and understanding is one I have spoken of before, but it bears repeating, because so many people think that a photographic memory is a desirable ambition, that any failure to remember exactly is a memory failure. But it’s not a failure; the system is operating exactly as it is meant to. Remembering every detail is counter-productive.

I was reminded of this recently when I read about something quite different: an “inexact” computer chip that’s 15 times more efficient, “challenging the industry’s 50-year pursuit of accuracy”. The design improves efficiency by allowing for occasional errors. One way it achieved this was by pruning some of the rarely used portions of digital circuits. Pruning is of course exactly what our brain does as it develops (infancy and childhood is a time of making huge numbers of connections; then as the brain matures, it starts viciously pruning), and to a lesser extent what it does every night as we sleep (only some of the day’s events and new information are consolidated; many more are discarded).

The moral is: forgetting isn’t bad in itself. Memory failure comes rather when we forget what we want or need to remember. Our brain has a number of rules and guidelines to help it work out what to forget and what to remember. But here’s the thing: we can’t expect an automatic system to get it right all the time. We need to provide some direct (conscious) management.

The second thing I was taken with was this list of ‘learning dysfunctions’. I believe this is a much more useful approach than category labels. Of course we like labels, but it has become increasingly obvious that many disorders are umbrella concepts. Those with dyslexia, for example, don’t all have the same dysfunctions, and accordingly, the appropriate treatment shouldn’t be the same. The same is true for ADHD and Alzheimer’s disease, to take two very different examples.

Many of those with dyslexia and ADHD have shown improvement as a result of specific skills training, but at the moment we’re still muddling around, not sure of the training needed (a side-note for those who are interested — Scientific American has a nice article on how ADHD behavioral therapy may be more effective than drugs in long run). So, because there are several different problems all being lumped into a single disorder, research finds it hard to predict who will benefit from what training.

But the day will come, I have no doubt, when we will be able to specify precisely what isn’t working properly in a brain, and match it with an appropriate program that will retrain the brain to compensate for whatever is damaged.

Or — to return to my point about choosing what to forget or remember — the individual (or parent) may choose not to attempt retraining. Not all differences are dysfunctional; some differences have value. When we can specify exactly what is happening in the brain, perhaps we will get a better handle on that too.

In the meantime, there is one important message, and it is, when it comes down to it, my core message, underlying all my books and articles: if you (or a loved one, or someone in your care) has any sort of learning or memory problem, whatever the cause, think very hard about the precise difficulties experienced. Then reflect on how important each one is. Then try and discover the specific skills needed to deal with those difficulties that matter. That will require not only finding suggested exercises to practice, but also some experimentation to find what works for you (because we haven’t yet got to the point where we can work this out, except by trial and error). And then, of course, you need to practice them. A lot.

I’m not saying that this is the answer to everyone’s problems. Sometimes the damage is too extensive, or in just the wrong place (there are hubs in the brain, and obviously damage to a hub is going to be more difficult to work around than damage elsewhere). But even if you can’t fully compensate for damage, there are few instances where specific skills training won’t improve performance.

Sharing what works is one way to help us develop the database needed. So if you have any memory or learning problems, and if you have experienced any improvement for whatever reason, tell us about it!