The Goal Is to Improve Learning Behaviors
On reviewing the individual studies included in the meta-analysis I noticed the wide range of ages. According to recent insights, the brain structurally matures until after adolescence (myelination, initially an increase, then a decrease, in gray matter) (1). Strong fluctuations in IQ have been observed in association with this in healthy adolescents aged 10–20 (by about 23 points in both directions) (2). It is therefore not surprising if no long term changes in IQ were noted as a therapeutic effect. The degree to which individual age groups in their cognitive development can be regarded as an collective at all remains up for discussion. Since cognitive functions are practically always activated in combinations rather than in isolate, the construct of a “specific effect” of cognitive performance training is in itself diffuse.
What is more important for the treating physician, however, are the effects termed “secondary nonspecific” effects. According to the Regulations Governing the Prescription of Remedies (Heilmittelrichtlinien) (3), cognitive performance training/neuropsychologically oriented treatment in occupational therapy is not an end in itself. The primary goal is not the improvement of a cognitive performance that is more or less specific but mainly the improvement of a patient’s competence. This includes explicitly the acquisition of the basic competence to work (analogous in children to school-related learning competence) and the improvement of independent life choices (in children: of independent learning behaviors). If cognitive performance training has affected behaviors then the requirements of the Regulations Governing the Prescription of Remedies were obviously met, and the physician can—as is confirmed by the present meta-analysis—continue to prescribe cognitive performance training/neuropsychologically oriented treatment for the benefit of the individual child.
Dr. med. Sabine Ladner-Merz
Akademie für Kognitives Training nach Dr. med. Franziska Stengel, Stuttgart
|1.||Giedd JN, Blumenthal J, Jeffries NO, et al.: Brain development during childhood and adolescence: A longitudinal MRI study. Nature Neuroscience 1999; 2: 861–3 CrossRef MEDLINE|
|2.||Ramsden S, Richardson FM, Goulven J, et al.: Verbal and non-verbal intelligence changes in the teenage brain. Nature 2011; 479: 113–6 CrossRef MEDLINE PubMed Central|
|3.||Richtlinie des Gemeinsamen Bundesausschusses über die Verordnung von Heilmitteln in der vertragsärztlichen Versorgung. www.g-ba.de/downloads/62–492–532/HeilM-RL_2011–05–19_bf.pdf. Last accessed on 9 December 2013.|
|4.||Karch D, Albers L, Renner G, Lichtenauer N, von Kries R: The efficacy of cognitive training programs in children and adolescents—a meta-analysis. Dtsch Arztebl Int 2013; 110(39): 643–52. VOLLTEXT|