Neuroscientist: ADHD Superior Learning Technique

ADHD cropped

Despite what you’ve been told, medicated to think, believe or feel, research scientists are learning quite a bit about… well, learning. Better yet, for many their findings might sound odd.

There is order in Attention Deficit Hyperactivity Disorder.

In unusual twist, the only deficit that exists really remains with those people who unlearned a natural skill… now being touted as the pinnacle of learning techniques. 

 

THE MYTH OF MASSED PRACTICE

 

Most of us believe learning is better when you go at something with single-minded purpose: the practice-practice-practice that’s supposed to burn a skill into memory. Faith in focused, repetitive practice of one thing at a time until we’ve got it nailed is pervasive among classroom teachers, athletes, corporate trainers, and students. Researchers call this kind of practice “massed,” and our faith rests in large part on the simple fact that when we do it, we can see it making a difference. Nevertheless, despite what our eyes tell us, this faith is misplaced.

Everywhere you’ll find examples of massed practice: colleges that offer concentration in a single subject with the promise of fast learning, continuing education seminars for professionals where training is condensed into a single weekend. Cramming for exams is a form of massed practice. It feels like a productive strategy, and it may get you through the next day’s midterm, but most of the material will be long forgotten by the time you sit down for the final. Spacing out your practice feels less productive for the very reason that some forgetting has set in and you’ve got to work harder to recall the concepts. It doesn’t feel like you’re on top of it. What you don’t sense in the moment is that this added effort is making the learning stronger.

If learning can be defined as picking up new knowledge or skills and being able to apply them later, then how quickly you pick something up is only part of the story. Is it still there when you need to use it out in the everyday world? While practicsing is vital to learning and memory, studies have shown that practice is far more effective when it’s broken into separate periods of training that are spaced out. The rapid gains produced by massed practice are often evident, but the rapid forgetting that follows is not.

Studies reveal how practice that’s spaced out, interleaved with other learning, and varied produces better mastery, longer retention, and more versatility. But these benefits come at a price: when practice is spaced, interleaved, and varied, it requires more effort. You feel the increased effort, but not the benefits the effort produces. Learning feels slower from this kind of practice, and you don’t get the rapid improvements and affirmations you’re accustomed to seeing from massed practice. Even in studies where the participants have shown superior results from spaced learning, they don’t perceive the improvement; they believe they learned better on the material where practice was massed.

Learning gained through the less challenging, massed form of practice is encoded in a simpler or comparatively impoverished representation than the learning gained from the varied and more challenging practice which demands more brain power and encodes the learning in a more flexible representation that can be applied more broadly. 

The benefits of spacing out practice sessions are long established, but for a vivid example consider this study of thirty-eight surgical residents. They took a series of four short lessons in microsurgery: how to reattach tiny vessels. Each lesson included some instruction followed by some practice. Half the docs completed all four lessons in a single day, which is the normal in-service schedule. The others completed the same four lessons but with a week’s interval between them.

In a test given a month after their last session, those whose lessons had been spaced a week apart outperformed their colleagues in all areas—elapsed time to complete a surgery, number of hand movements, and success at reattaching the severed, pulsating aortas of live rats. The difference in performance between the two groups was impressive. The residents who had taken all four sessions in a single day not only scored lower on all measures, but 16 percent of them damaged the rats’ vessels beyond repair and were unable to complete their surgeries.

It sounds just like a the behavior of a grade school child stuck in social studies after a pizza party & far too many M&Ms has suddenly hijacked the universe. What does this mean… switching tasks without finishing isn’t just impatience… it’s actually our brain begging for a break.

It seems, our minds know what’s best for us, even if we don’t. 

So, why is spaced practice & learning more effective than massed practice? It appears that embedding new learning in long-term memory requires a process of consolidation, in which memory traces (the brain’s representations of the new learning) are strengthened, given meaning, and connected to prior knowledge—a process that unfolds over hours and may take several days. Rapid fire practice leans on short-term memory. Durable learning, however, requires time for mental rehearsal and the other processes of consolidation. Hence, spaced practice works better. The increased effort required to retrieve the learning after a little forgetting has the effect of re-triggering consolidation, further strengthening memory.

 

INTERLEAVED PRACTICE

Interleaving the practice of two or more subjects or skills is also a more potent alternative to massed practice, and here’s a quick example of that. Suppose you’re a trainer in a company trying to teach employees a complicated new process that involves ten procedures. The typical way of doing this is to train up in procedure 1, repeating it many times until the trainees really seem to have it down cold. Then you go to procedure 2, you do many repetitions of 2, you get that down, and so on. That appears to produce fast learning.What would interleaved practice look like? You practice procedure 1 just a few times, then switch to procedure 4, then switch to 3, then to 7, and so on.

The learning from interleaved practice feels slower than learning from massed practice. Teachers and students sense the difference. They can see that their grasp of each element is coming more slowly, and the compensating long-term advantage is not apparent to them. As a result, interleaving is unpopular and seldom used. Teachers dislike it because it feels sluggish. Students find it confusing: they’re just starting to get a handle on new material and don’t feel on top of it yet when they are forced to switch. But the research shows unequivocally that mastery and long-term retention are much better if you interleave practice than if you mass it.

VARIED PRACTICE

Evidence that variable training versus massed learning is supported by recent neuro-imaging studies that suggest different kinds of practice engage different parts of the brain. The learning of motor skills from varied practice, which is more cognitively challenging than massed practice, appears to be consolidated in an area of the brain associated with the more difficult process of learning higher-order motor skills. The learning of motor skills from massed practice, on the other hand, appears to be consolidated in a different area of the brain that is used for learning more cognitively simple and less challenging motor skills.

Essentially, neuroscientists are not simply confirming long-term benefits, but the significant superiority of learning like you’ve Attention Deficit Disorder. Strangely, the pattern of acquiring a bit of information without fully grasping or mastering the topic, switching to another unrelated subject of and even interspersing many significant blocks of time between learning / practice sessions has been confirmed in numerous studies to produce greater retention, mastery, performance & recall.

This means, if you’ve a child on medication for attention deficit disorder, drugs like Ritalin, Adderall or the like… you’re essentially anesthetizing the natural traits of successful learning… right out of your child. One big-pharm-filled-prescription-pill at a time. It doesn’t take a giant leap to make this connection. Granted, not all children are savants who need better parents or teachers, but then again… most kids who act up or can’t focus have brains that are simply bored, and ready to move to the next subject… even if total comprehension has not occurred. Forcing this… simply seems wrong.

Based on the results of studies from researchers including Malcolm Gladwell, malcolm_gladwell2-620x412science supports the idea that students should intermix subjects with periods of time and with various other topics. This is especially troubling when considering that recent pharmaceutical companies have abandoned the idea of a person having a chemical imbalance. Quite frankly, the psychiatric-drug industry is in trouble with the chemical imbalance hypothesis.

“We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline they created has been allowed to run dry. Which is odd because sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.

Why would an industry beat a hasty retreat from a market that continues to boom? (Recent surveys indicate that mental illness is the leading cause of impairment and disability worldwide.) The answer lies in the history of psychopharmacology, which is more deeply indebted to serendipity than most branches of medicine—in particular, to a remarkable series of accidental discoveries made in the fifteen or so years following the end of the Second World War.

b-thumb-medicaljournal0202In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder.

In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.

By 1960, the major classes of psychiatric drugs—among them, mood stabilizers, antipsychotics, antidepressants, and anti-anxiety drugs, known as anxiolytics—had been discovered and were on their way to becoming a seventy-billion-dollar market. Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not).

That didn’t stop drug makers and doctors from claiming that they knew. Drawing on another mostly serendipitous discovery of the fifties—that the brain did not conduct its business by sending sparks from neuron to neuron, as scientists previously thought, but rather by sending chemical messengers across synapses—they fashioned an explanation: mental illness was the result of imbalances among these neurotransmitters, which the drugs treated in the same way that insulin treats diabetes.

The appeal of this account is obvious: it combines ancient notions of illness (specifically, the idea that sickness resulted from imbalanced humors) with the modern understanding of the molecular culprits that make us suffer—germs. It held out the hope that mental illness could be treated in the same way as pneumonia or hypertension: with a single pill. Drug companies wasted no time in promulgating it. Merck, the manufacturer of Elavil, commissioned the psychiatrist Frank Ayd to write a book called Recognizing the Depressed Patient,woman_blank_sign1 in which he extolled the “chemical revolution in psychiatry” and urged doctors to reassure patients they weren’t losing their minds, but rather suffering a “common illness” with a “physical basis” and a pharmacological cure. Merck sent Ayd’s book to fifty thousand doctors around the country.

In 1965, Joseph Schildkraut, a psychiatrist at the National Institute of Mental Health, reverse-engineered antidepressants and offered an actual theory: at least when it came to depression, the imbalances were to be found in the neurotransmitters he thought were affected by the drugs, dopamine and norepinephrine. Seven years after antidepressants were invented, and five years after Ayd asserted that depression was a chemical problem, psychiatrists finally had a precise, scientific explanation for why they worked. The paper quickly became one of the most cited articles in the medical literature.

The serotonin-imbalance theory, however, has turned out to be just as inaccurate as Schildkraut’s. While S.S.R.I.s surely alter serotonin metabolism, those changes do not explain why the drugs work, nor do they explain why they have proven to be no more effective than placebos in clinical trials. Within a decade of Prozac’s approval by the F.D.A. in 1987, scientists had concluded that serotonin was only a finger pointing at one’s mood—that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied. 24989438_sThe ensuing research has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.

Despite their continued failure to understand how psychiatric drugs work, doctors continue to tell patients that their troubles are the result of chemical imbalances in their brains. As Frank Ayd pointed out, this explanation helps reassure patients even as it encourages them to take their medicine, and it fits in perfectly with our expectation that doctors will seek out and destroy the chemical villains responsible for all of our suffering, both physical and mental. The theory may not work as science, but it is a devastatingly effective myth.

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Whether or not truthiness, as one might call it, is good medicine remains to be seen. No one knows how important placebo effects are to successful treatment, or how exactly to implement them, a topic Michael Specter wrote about in the magazine in 2011. But the dry pipeline of new drugs bemoaned by Friedman is an indication that the drug industry has begun to lose faith in the myth it did so much to create. As Steven Hyman, the former head of the National Institute of Mental Health, wrote last year, the notion that “disease mechanisms could … be inferred from drug action” has succeeded mostly in “capturing the imagination of researchers” and has become “something of a scientific curse.” Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist. And the result, as Friedman put it, is that “it is hard to think of a single truly novel psychotropic drug that has emerged in the last thirty years.”

Despite the BRAIN initiative recently announced by the Obama Administration, and the N.I.M.H.’s renewed efforts to stimulate research on the neurocircuitry of mental disorder, there is nothing on the horizon with which to replace the old story. Without a new explanatory framework, drug-company scientists don’t even know where to begin, so it makes no sense for the industry to stay in the psychiatric-drug business. And if loyalists like Hyman and Friedman continue to say out loud what they have been saying to each other for many years—that, as Friedman told Times readers, “just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease”—then consumers might also lose faith in the myth of the chemical imbalance.

Regardless of what you may think or feel… or whether or not you’re currently on medications, because you believed or still believe what doctors have sold/told you… one simply fact remains: Billions of dollars are banked by big-biz-drug-pushing-pharmaceutical companies who care only about their shareholders, profit & your continued pill popping.

If you can’t see the truth… you must be on drugs. 

Recommended Reading  |

The Book of Woe: The DSM and the Unmaking of Psychiatry

The Psychiatric Drug Crisis | The New Yorker

Psychiatry’s New Brain-Mind & The Legend of the Chemical Imbalance 

 

 

 

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