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[00:00:00] Dr. Sharp: Hello everyone. Welcome to the Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. Psychologists need assessment tools for a more diverse population these days, PAR is helping by making many of their Spanish print forms available online through PARiConnect. Learn more at parinc.com\spanish-language-products.

Hey everyone. Welcome back to the Testing Psychologist podcast. Glad to be with you today as always, and glad to have my guests here today. I have Dr. Jennifer Puig and Dr. Lisa Drozdick. We’re talking all about memory.

Let me tell you a little bit about them and then I’ll tell you a little bit about the episode.

So [00:01:00] Jennifer Puig is a research director at Pearson. She obtained her Ph.D. in child psychology from the Developmental Psychopathology and Clinical Science Program at the University of Minnesota, where she was trained as both a developmental scientist and a clinical psychologist.

Jennifer’s research and graduate school focused on the impact of infant attachment on adult physical health outcomes. Pre-doctoral internship and post-doctoral fellowship were completed at the University of Minnesota Medical Center and focused on pediatric neuropsychology. She is a licensed psychologist in the state of Minnesota with specializations in child and adolescent psychology and pediatric neuropsychology.

Dr. Lisa Drozdick is the principal research director at Pearson. She’s a licensed clinical psychologist, researcher, and published author. She received her clinical training at West Virginia University and the South Texas Veterans Healthcare System. She currently leads the development of neuropsychological and [00:02:00] cognitive measures across the lifespan. Lisa has led the development efforts on products assessing memory, executive functioning, cognitive ability, adaptive functioning, and behavior. She currently spearheads an initiative within Pearson focused on engaging with the research community.

Just a few things that we get into today.

Memory is such a huge area. We just try to go over some of the foundational information across the lifespan. We talk about what is memory, and how does it develop? What’s it look like in kids? Do kids actually have memory problems or is it something different? We talk about the overlap with executive functioning. We talk about assessing memory and the different ways that we do that. And we talk about the transition to adulthood when we are looking at the age-appropriate decline in memory and what might not be so appropriate. [00:03:00] So lots of content here.

This is one of those topics that we could do 12 podcasts on and probably still only scratch the surface. But the hope is to give you just some foundational knowledge around memory and how that comes into play in our practices.

If you are a business owner or a private practice owner, and you’d like some group coaching, accountability, and support as you grow your practice, you can check out testingpsychologist.com/consulting and see if a mastermind group might be appropriate for you.

I’ve been leading these groups for probably five years now, several cohorts, and just love seeing the connection and progress that folks make when they’re in a group with their peers and getting some help reaching those goals in their practices. So, if that sounds cool to you, you can schedule a pre-group call at thetestingpsychologist.com/consulting [00:04:00] and we’ll see if it’s a good fit.

All right, let’s get to my episode on memory.

Jen, Lisa, welcome to the podcast.

Dr. Lisa: Thank you.

Dr. Jennifer: Thank you for having us.

Dr. Sharp: Absolutely. I’m excited to have you. I’ve been doing a lot of interviews here lately. It seems like I repeat this every time and I cannot believe we have not gone into this topic in detail on a podcast before, a podcast called The Testing Psychologist, and we haven’t talked explicitly about memory.  So, I am super excited to be chatting with you.

Just to help the audience orient a little bit to who you are and your voices here since they can’t see you like I can, can you just do very brief [00:05:00] introductions and say a little bit about yourself so that the audience knows who’s talking? Jennifer, maybe you could go first.

Dr. Jennifer: Sure. Hey everyone, I’m Jennifer Puig. I’m trained as a pediatric neuropsychologist. I’m currently a research director at Pearson and have been for about five years now.

Dr. Sharp: Awesome.

Dr. Lisa: I am Lisa Drozdick. I am trained as a clinical psychologist with a specialization in neuropsychology. I’ve been in the test development business and a research director at Pearson for roughly 21 years. I have worked on several of the memory measures that we put out. So excited to be here and talk about memory.

Dr. Sharp: Yeah. Well, thank y’all for being here. I’ll say that a lot, but always nice to start with some thanks. As we get going, people who’ve been listening to the podcast know that I typically lead with this question of why this work is important to you. Why care about it? Out of all the things that you could research or practice or think about in psychology and assessment, why [00:06:00] memory?

Dr. Lisa: Let me kick off because I’m more in the adult realm and memory has always been your back pocket assessment with the adult world because of all of the neurological disorders that can occur throughout the adult lifespan. I know they occur in children too, and Jennifer will talk about that, but memory assessment has always been personal to me because, in the geriatric world, it’s one of the number one concerns and complaints by older adults as they age- What is normal memory versus something I need to worry about and talk to my doctor about? So definitely in the adult world, it is a mainstay of assessment.

I’ll pass that to Jennifer to talk about kiddos.

Dr. Jennifer: I think in working with kids, it’s very important too because some of the common referral questions or reasons for a referral you get are memory related. So [00:07:00] I’ll ask my kiddo to do something and he turns around in five minutes later, he doesn’t remember what I said. Or a teacher will say, we’re talking about something in class. And then I called on the kiddo and didn’t seem to register anything at all.

So all of these things appear as memory issues to observers but what it’s really important to do is differentiate between things like attention problems or executive function problems versus memory problems. There are memory problems that do happen in children, but they’re usually associated with medical conditions and you know about those diagnoses well ahead of time. But for pretty typically developing kids or kiddos frequently seen by school psychologists or neuropsychologists, there’s usually a lot of attention and executive functioning problems that appear like memory problems. So it’s often important to do assessments around memory to [00:08:00] rule that out.

Dr. Sharp: Yeah. You’re already touching on a few things that I’m excited to talk about. Memory in kids. I’m a pediatric-focused person myself, and so I think about those issues a lot that kids don’t typically have true “memory problems” like you said, unless they’re secondary to some medical concern but it’s still important to look at. So we’ll definitely touch on that here as we go along.

Before we totally dive into it though, I would love to do some just basic education around what we mean when we say memory. I mean, that’s such a big term. There are lots of varieties of memory and some of us may have forgotten what we learned in graduate school and what we may have learned over the years. So let’s just start and do some basics. When you say memory, what are we talking about?

[00:09:00] Dr. Jennifer: You’re right. Memory is something that everybody has an informal definition of. And then it really gets difficult when you start to operationalize it. But I really like a quote from Squire 1987 about the definition of learning and memory. It says that learning is the process of acquiring new information while memory refers to the persistence of learning in a state that can be revealed at a later time.

I like how concise that definition is. It highlights the differences between learning and memory, and also how they’re linked. So that’s often what I think about memory and learning, especially in the context of assessment.

Dr. Sharp: Yeah. Lisa, did you want to add anything?

Dr. Lisa: Yeah. I just want to orient folks to two terms we’ll probably be using throughout this talk because we[00:10:00] are in the memory area all the time so these words seem second nature to us, but I also understand they’re very new to a lot of people if you’re just coming onto memory assessment. I want to cover a few terms you guys are going to hear.

The first is short-term memory and long-term memory. I think vernacular confuses what we mean by that because I think when people say I have bad short-term memory, they’re not using clinical-term short-term memory.

When we talk about short-term memory on measures, it’s typically, immediate recall. So what do you do within a few seconds or minutes of hearing information? Are you able to recall that? And we then use long-term memory to mean longer term, past 15 minutes, maybe an hour, days, and years whereas I think those terms mean something a little different in cultural terms, but when we’re talking about assessments, that’s what we’re [00:11:00] using those terms for.

And then we split that often into visual memory and auditory memory just based on the information the child or examinee is hearing or seeing. And that’s important because the process of memory when you’re looking at it, we can’t assess just memory alone. They have to see something or hear something or touch something sometime to actually get that information from somewhere. So there are lots of areas that you need to assess along with memory, as Jennifer alluded to a little earlier.

And then some three terms that you’ll probably hear us say, because we don’t even think about them, are encoding, consolidation and retrieval. Often you see these in reports. They have different meanings for interpreting results and where a child might need intervention.

Encoding is just taking in information. How is that information getting in and is that [00:12:00] child. I keep saying child, but it can be any age or person, getting that information into their systems and just having it register? Once that is encoded and gotten inside the system, it’s consolidated. Not all information is consolidated. Your attention varies based on different things. Some information is consolidated or taken in from short-term memory into long-term memory. And then we get into retrieval, which is more the process of accessing stuff that isn’t external anymore. It’s internal. We’re pulling up our memories.

And so, when we say there’s an encoding problem, we’re talking about that initial registration and short-term memory. We’re talking about retrieval problems. That’s more on the long term. Are you able to pull it back up once you have encoded it?

So just some terms that you might hear today so that we all are on the same beginning stance here.

Dr. Sharp: Sure. And then [00:13:00] can you nest some of these different types of memory in there in terms of, I mean, there’s working memory, there’s episodic memory, there’s declarative memory, how does all this fit together?

Dr. Lisa: You can have a whole lecture on how all those fit together. But typically in the assessment, it is episodic memory. We actually have two types of major memory. It’s episodic memory and procedural memory. We don’t have a whole lot of procedural learning measures in our assessment toolbox. There are a few. If you look at some of the Rivermead measures, they have some procedural, but procedural is learning just how things go.

So like when you’re learning to ride a bike or drive a car, there’s a lot of learning that you’re going through and memory involved in those activities that you can’t really then state explicitly. Whereas, episodic memory and declarative memory all fall into the words that are the [00:14:00] language that we use. It can also be visual. You can redraw images and things like that, but there’s a difference between episodic and procedural memories. Jennifer, do you want to add anything there?

Dr. Jennifer: Yeah, I’m trying to think back to the original question. So we mostly assess declarative memory. The other thing to differentiate between is the difference between recall and recognition memory. We assess generally most memory assessments, assess two forms of long-term memory, and that’s the free recall, or your ability to just pull information out of your mind and show what you know versus recognition, which is more like a multiple choice thing. So you have a queue in front of you and you’re asked to recognize what you’ve seen before.  And those two involve… free recall in particular [00:15:00] requires a lot of organization in addition to actual memory, whereas the recognition component is more straightforward memory, like what is actually in there without having to organize it individually. So that’s another component of memory assessments.

The other thing that you asked about was working memory. So getting back to that working memory. Working memory is interesting because it has memory in the name and it involves some memory, but it’s mostly considered an executive function.

There are a lot of definitions about it but the way that I conceptualize it during assessments is your ability to take in information and manipulate it in some way to adaptively respond to the task. So for example, on some of our memory tests, you would be read a list of words, reorganize the words somehow, and then respond to the question with the reorganized list of words. [00:16:00] You have this core of information that you take in, you change the order and then you have to respond. The organization component is the executive function component, and that is what makes it a little bit different from memory. But it’s still very much related and it’s that deeper level of processing.

It’s an assessment of a deeper level of processing that gets into how well a memory is stored and how well information can be retrieved in the mind. So that’s why it’s often a component of memory assessments, but it’s also a component of executive functioning assessments as well.

Dr. Sharp: Sure. Well, I’ll ask an off-the-cuff question, which is, if you could be the queen of assessment forever, would you go back and rename working memory if you had the opportunity, or do you think it fits?

Dr. Jennifer: It’s a really good question because I’ve never tried to think about it any other way.

[00:17:00] Dr. Lisa: I like the term working memory because it captures where the information is that you’re manipulating. I think what happens sometimes is a lot of other things get thrown in with the term working memory. So it’s not always the manipulation of information. It’s sometimes just recall thrown in there.

And so I think not necessarily the term, I like the term working memory, I don’t always like attentional measures and other things like that get thrown into that whole area. And I think that’s something we’re still struggling with as a field what is this attention? Where does it go from intentional to manipulation and working memory? And I do think we have measures that fall under the same domain that measure completely different things.

Dr. Sharp: You said earlier there’s a whole series of lectures we could do on these topics. I feel [00:18:00] like that one is so huge. Like what is the role of attention and memory and where do they separate and do they separate? And all those questions. So I know that we can’t answer that today, but thanks for indulging in that question. I always wonder about what we might change if we could rename things.

So I wanted to do a little more education or groundwork here before we get a little deeper. Could you talk a little bit. There have been different models or theories about memory development over the years and what is actually happening in our brains when we store and try to retrieve things. Can y’all give just a summary of where we’re at right now with the literature and what we think is happening in our brain when we talk about memory- what is actually going on?

Dr. Lisa: You [00:19:00] split the question there and I wasn’t sure which one we’d go with because you had asked what happens developmentally as this goes on and then what happens actually in memory. And I think there’s a ton of research right now going on with various aspects of where does the encoding occur. Where does the consolidation occur? Where does the retrieval come from?

And I think the more we study, the more we find out how integrated memory is with so many other pieces, that it starts getting confounded pretty quickly. I hate to go down a rabbit hole of anatomy right now because every time I read a new one it seems like, oh, and this too.

I think that of many things. Memory is one of those things that really is a whole brain engagement. So if you’re taking in visual information, you’re obviously using various parts of the brain that [00:20:00] may not be used in auditory memory, but there are overlaps. I do think that we’re learning more and more about that, particularly as a lot of our imaging has become more sophisticated. But I think the functionality of it is actually more interesting. Well, for me, I know there are some people that would argue that.

Jennifer, why don’t you talk about how the brain develops with memory and how that functionally looks across testing? Because I do think what can be confusing is how memory assessments change from something like The Bayley where it’s very simple memory measures, almost attentional in aspects, and then we change. And that may be confusing for folks because why is DAS-II early years different in its memory measurement? WRAML goes across the ages and we have different things. [00:21:00] So Jennifer, can you speak to that? That’ll answer the developmental part of that question.

Dr. Jennifer: Yeah. When I was thinking about the development of memory, in general, I think everyone who works with kids knows that their memory improves over time. But I was really thinking about like, where does it start almost. And if you consider humans to be just hardwired for learning, then it starts really when you’re a newborn. So the architecture for developing memories is there, I would argue from the beginning.

You see, newborns have preferential attuning to their mother’s birth parent’s voice. You also have preferential attuning to the birth parent or mother’s smell from very early on. And then [00:22:00] in thinking about like even an assessment as that’s done as early as one year old, I think about, this is not a neuropsychology measure, but I think about the strange situation. Attachment theory tells us a lot about how much memory is consolidated in that first year of life because that entire strange situation is based on the idea that infants have developed a way to respond to stressful situations based on their previous experience of stressful situations with their caregiver.

So they changed their behavior to maximally have their parent around. And that’s a form of learning. That’s like, in a sense, the child remembers what happened in the past. This is how I keep my parent here to ensure my safety going in a stressful situation. That’s a form of learning and memory.

I think our ability to assess children’s memory [00:23:00] changes over time as their other cognitive functions develop. So, like Lisa was saying, the way we assess memory is really like behavioral in the Bayley, versus when we get to WRAML. WRAML starts at age five. We get to be more language based and more structured like picture drawing and things like that with more things that are associated with like academics in school. And that’s because children’s language is developing. Their fine motor skills are developing. They’re able to show you what they know and what they remember in a more complex way.

So really the other thing that influences how much children are able to remember is the amount that they learn and their experience in school because a lot of what we teach kids in school, especially early on in the elementary school years, is how to remember things. They’re building up that infrastructure to that context to really be able to absorb information and be able to repeat it later on. So, [00:24:00] there are all these other things that are happening in a child’s life that help to improve their memory or helps to allow us to assess it more precisely.

Dr. Sharp: Sure. Go ahead. 

Dr. Lisa: I think an interesting change when you are assessing children, is you’re always looking, are they gaining at the speed that you’d expect them to? And so if you’re doing reassessments, you’re looking for did they learn or gain the skills that they needed to overtime. The interesting flip when you start hitting 40 to 50-year-old adults is you’re not looking for gain anymore. You’re looking for, are they losing skills?

And so there are differences in the assessments that we use, and there’s sensitivity to that gain versus loss, which is an important aspect to think about too because you’re actually looking for different [00:25:00] results on a test, kind of retest events in those particular situations. An interesting discussion that Jennifer and I frequently have is gain-loss since we look at them a little bit differently.

Dr. Sharp: Right. That hits close to home. I’m certainly in the loss category at this point, and it’s an existential crisis. I know there are differences of course in kids and adults. I’d like to keep going with the pediatric topic, I suppose, and talk a little bit about just how we think about memory in kids, how we assess memory in kids, like what are we looking for? There are a lot of questions wrapped up in this, but maybe we could just start with an extension of [00:26:00] a comment you made earlier, Jennifer, about this intersection of attention and memory and how those overlap so much in kids. Could we start there?

Dr. Jennifer: Yeah. Attention is a gatekeeper for a lot of what we assess in our testing because if you’re not paying attention, you’re just not going to be able to respond in the way you need to for testing. So I really think of it as if you’re not paying attention, you’re not going to be able to remember something. It’s really important to be able to differentiate whether or not you’re assessing attention or actual memory.

And one of the challenging things, to be able to see that in one-to-one testing sessions is you generally are able to see when a child’s zoning out and redirecting them. But that’s why we have other measures of attention to really, [00:27:00] differentiate with that, like continuous performance tests and things like that where the child has to actively regulate their own attention as often. But I think a lot of times, what parents and teachers are seeing and they’re labeling is memory problems or frequently attention problems in kiddos because it’s just very difficult to remember what you were supposed to do or what someone said previously if you’re zoning out or if it’s going in one year and out the other, kind of thing.

Dr. Lisa: We frequently look at, in terms of the assessments, sometimes we don’t have time to keep giving additional, additional, additional. Some ways that you can look at that in a memory measure are on the ones that have multiple exposures. So there are many memory measures out there and they’re all relatively [00:28:00] good.

But if you look at measures where they have multiple exposures, either of a design, like WRAML has a multiple design memory measure where the same image is shown multiple times or in ones like AVLT, CVLT, and actually, WRAML has a word list as well, where they read a word list repeatedly. You can look at the first trial, the first time the person heard or saw the image in relation to the learning curve. And if it seems much lower on that initial trial than on later trials there is learning or there’s a giant jump from trial one to trial two.

That’s a little unexpected. You might want to follow up with some attention measures to see if were they paying attention to the first one, and did the encoding even occur at that one.

There are some interesting things that we’re seeing in our children now. I know we saw it on CVLT-III’s [00:29:00] re morning. There was a paper put out recently, and I’m trying to remember the person’s name, but I know it was Dean Ellis’ group that did it, saw that from the 20-year gap between the 16-year-olds in 2000 that were normed for the CVLT-II and then 2017 for the CVLT-III, you actually saw a decline in that trial one performance on kids.

There are a lot of theories around why you see that. The kids don’t practice memory in the same way that they used to. Digital devices provide a lot of support for memory. I know whenever I told my 16 year old remember this, he’d go take a picture of it and he’d be like, okay, I can remember, he didn’t and then he would remember to look at the picture which is a great ability. But there was definitely… He does not practice memory in the same way that we all had to [00:30:00] memorize phone numbers or passages, just because it’s very easy to Google.

Now, that’s just one theory of why that might be lower, but it was definitely a trend that we’re seeing a little bit of on some other measures that we’re now collecting. I think we’re going to see some more literature on that soon.

Dr. Sharp: Yeah. That is interesting. I think folks have made that comment. I’ve made that comment just in passing about how our memories are probably “getting worse” because we aren’t forced to remember phone numbers or addresses or whatever it might be. I’m just curious if you know off the top of your head, Lisa, what are some of the other theories about why kids’ memories seem to be getting worse?

Dr. Lisa: Well, for this particular research that we saw it was almost all attributable to trial one and trial two type learning things. So something is going on differently [00:31:00] with attention and encoding abilities. I remember in school I was strategies for remembering things- do repetition, do all different ways to remember things. I don’t think that that’s actively taught in the same way that it has historically been. There’s a lot more information that kids are taking in now too. 

So, it just could be that we are not practicing quite as well and our focused attention as you know because there’s just so much. These are all theoretical. I think it could be very individually different for each child, what’s going on. But I do think we just don’t, memory is differently used now than I think it has been.

That said, we didn’t see this as much in the adult populations. We did not see the shift. It was really in that 16 [00:32:00] to 24-year-old group, the group that has now had access to digital tools for 10, 15. I mean, how long have smartphones been out now? They’ve had it for a while and we’ll see.

The nice thing though is when you see what they do on the trial, four or five, depending on what instrument you’re looking at, they’re doing just as well. It’s just they aren’t learning. That first exposure is just not as salient as it used to be. Where the difference is when you look at total scores is almost always in that first or second trial when they’re just getting that encoding down. So they’re able to encode and hold on and retain that information, but maybe just not as quickly as historically we’ve seen in that age group.

Dr. Sharp: Yeah. That immediately makes me think about instruction and whether instruction in school has [00:33:00] adapted to fit that pattern, or is it a matter of adapting or trying to teach those skills a little bit better or what? But that’s where my mind goes have we evolved, I suppose, to match these patterns and do more repetition or maybe get over that hump of initial encoding that seems to be there now. So, I know we’re going to talk about intervention later, but if you have thoughts now on that, we can always dive into it.

Dr. Lisa: I’m a big fan of multimodal teaching. I think lots of kids benefit from hearing it and seeing it in different ways. But I do think that over the past few years we’ve seen a lot more multimodal with switch to having more virtual options for kids. So I’m curious to see if that holds over time, but it’s interesting. I do think [00:34:00] kids are really good at the intervention aspects of memory though. I think we could learn a lot for people who struggle with memory problems from watching kids and how they do hold onto memories.

Like, I never took pictures of blackboards at school to remember what the teacher wrote down as important points. I just noted them down in a book and if I didn’t write it down that day, I missed it. So I do think kids have some skills that they’re using to replace those memory pieces that are really interesting and have some good impact, I think, for potential interventions for other people.

Dr. Sharp: Yeah. That’s really cool. Let me ask a question that maybe I could have asked a little bit earlier, but I think it’s still topical. Is it safe to say that without attention it’s not even worth assessing memory or is that too much of an amplification?

Dr. Jennifer: I’m trying to actually formulate an answer before I talk. [00:35:00] I think it’s still important to assess memory, especially with children because it’s just such a low base rate phenomenon that when it does occur, you want to know about it. And you want to be able to put those interventions in place because it’s really not something that people who work with children frequently think about and it can often be misconstrued as willful behavioral defiance. And you want to be able to separate those two things out and really help the people who are involved in the child’s life to understand what’s going on for that child and to really support that child in helping them either develop memory strategies to enhance their ability to form memories or really just putting supports in place if it’s the thing where perhaps their memory and other cognitive functions are not going to get better.

[00:36:00] So I think it’s a really important thing for pediatric assessments. I know Lisa can speak to the importance for the adult and older adult assessments.

Dr. Lisa: Yeah. It’s pretty much the same. And the adult measures, it’s really important to, I think they answer a slightly different question. I think attention is absolutely required for you to be able to encode the information. And a lot of measures capture that. But I think it’s often important to understand the impact of the loss of attention. And that’s what the memory measures can show. And even in college assessments that are being done, they’re like, I’m not just not learning.

And when you do it, you find out it’s an assessment issue or not an assessment, sorry, an attention issue. That doesn’t always [00:37:00] reflect to the professor what the issue is. Oh, well, they have problems attending, well, they just need to attend better as opposed to actually including the memory measure that’s showing that this is the impact of that attentional problem. Their attention problem is resulting in a huge loss of encoding and retention of the material.

So I do think it’s important to assess both, but I do think you got to keep in mind when you’re interpreting the memory measures, that attention may be the underlying key issue that needs to be addressed.

Dr. Sharp: Yeah. I think that’s such an important point. In our practice, we do a lot of CVLTs and a lot of Reys. Rey–Osterrieth Complex Figure. We talk a lot about what role is attention playing [00:38:00] in this person’s performance on those measures, especially in those initial trials. And it’s like, if you don’t have good attention, then it’s going to have a lot of downstream effects. But it’s easy to also just get wrapped up in the numbers and say, oh, their recognition or recall is pretty bad. So their memory must just be short but attention plays such an important role there.

I’m glad that we’re spending some time on that. I’m going back to kids. I’m trying to progress developmentally here, but we’re spending a lot of time on kids. You mentioned the base rate, Jennifer, and I wonder about do you have a sense of how many kids actually have, I don’t know if it’s even possible to call them pure memory issues independent of poor attention or some medical concern. [00:39:00] Is that very common?

Dr. Jennifer: I don’t actually have a good sense of that. My training was working with children that do have medical conditions that result in memory problems. So I have a skewed view of how many children are out there that experience those difficulties. And then the other side is you typically see a lot of kids who are coming in for like, ADHD or learning disability referrals. I do not have a good sense of how many kids have I guess, idiopathic memory issues. I’d have to go back and do a little research on that.

Dr. Sharp: That’s fair. I’m totally putting you on the spot. So let’s maybe talk about some of those medical conditions that we might want to look out for. What are some of the things that can actually lead to memory problems in kids secondary to medical concerns?

[00:40:00] Dr. Jennifer: I think probably traumatic brain injury is probably the biggest one that most practitioners will see. And then that’s an issue where as Lisa was saying before, your memory issues are closely tied to the disruption of like, attention, and executive functioning skills that are associated with the brain injury. Those are other cognitive skills that you’re going to want to assess along with memory for kids who have traumatic brain injuries.

Dr. Sharp: Yeah, that makes sense.

Dr. Jennifer: The other medical conditions are really like rare genetic conditions that typically, you see in a hospital setting. And usually, the hospital is a center of excellence for those conditions. Frequently, you won’t really, unless you’re working in that hospital and you have that specialization, you probably won’t see those kiddos very often.

[00:41:00] Dr. Sharp: Sure. That sounds good. TBIs or suspected TBIs are super common, at least in our practice.

Dr. Lisa: And concussion as well. I mean, you probably see a lot of concussions in kiddos as well, but that frequently within you’ll see lots of immediate issues that maybe resolve a little better over time than a mild or moderate TBI has more lasting effects.

Dr. Jennifer: And I think I should say, this popped into my head after I said this, I think seizure disorders is probably the other one. Most kids are seen in specialty clinics for that. But those are the ones that other practitioners might see either in private practice and a school psychologist will certainly see it.

Dr. Sharp: Yeah, of course. Well, I know we could probably do a whole episode or three on concussion and [00:42:00] TBI and seizures and medically induced memory concerns, but I appreciate you just touching on it just to know that that’s out there and we need to be on the lookout. Let’s talk about the actual assessment process if we can.

So we have all memory measures, right? And they seem to be pretty similar in many ways. There’s usually a list learning task and there’s usually a picture learning task and maybe there’s a facial recognition task and there’s always immediate and delayed. Could we walk through why are all these different conditions or sub-tests important in assessing memory?

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All right, let’s get back to the podcast.

Dr. Jennifer: Yeah, what you’re describing is accurate because I think most memory assessments follow the information processing model. It’s very easy to see because like you said, you usually have immediate recall tasks, then delayed recall tasks, and then recognition tasks. And we just have a lot of data backing those tasks up in the diagnosis of memory issues.

So like Lisa said before, often times with our immediate recall tasks, we can look at the encoding aspects of [00:44:00] memory. With our long-term memory tasks or long-delay memory tasks, we look at consolidation and organization of information for free recall. The recognition tasks are often measures of memory without the organizational piece. So really assessing how much information has gotten into long-term storage without the kiddo or the adult having to put it all in order and tell it to you.

The reason why we have, well, it’s basically the breakdown between verbal and nonverbal tests, your description of list memory, and then picture drawing tasks is that they follow different pathways in the brain. So it really can get into kiddos who have weaknesses in verbal memory tasks. They might have hearing problems or language delays that may explain that. Or for our [00:45:00] nonverbal tasks, there might be visual problems or fine motor problems that contribute to that.

So we’re really looking at two different skill sets that we can compare. And really it’s never are they doing poorly on a list learning task or a drawing task? It’s the pattern of results that you see across verbal tasks and across nonverbal tasks that really tells you whether or not a kiddo is struggling in one area or the other.

Dr. Sharp: Can jump in real quick and just stop you for a second and backtrack a bit? You mentioned a lot of these measures follow the information processing model. Just real quick for anyone who may not be familiar with that, could you give us a little definition of the information processing model?

Dr. Jennifer: Yes. The information processing model states that information is, it’s really just like a workflow for how information [00:46:00] comes into the brain and gets processed into memories. So information is either primarily in this model processed visually with the visual sketchpad or auditorily with the, there’s a word for it and I’m going to forget it. Lisa, do you remember what it is?

So information’s brought in auditorily and then you have a specific amount of time which that information can be held in the brain. Then some information is lost and some information moves on to a short-term memory where you can show what you know immediately after hearing it. Then some information is lost and that information is consolidated into long-term storage phonological loop. Thank you. That’s what it is when you hear information. So that information is consolidated into long-term storage where [00:47:00] it is rehearsed over and over again to really further consolidate that information. And then it just moves on into the longer-term storage areas of the brain. So you can retrieve it to show what you know and then it just goes back into storage.

It’s just a way of conceptualizing how information is absorbed and processed into memories.

Dr. Sharp: That’s great. Thanks. Just a little bit of basic information to refresh folks if they need it. So let’s jump back ahead to the point that you’re making in terms of the different types of assessment that we’re doing, and that makes me think of this, I don’t know if you could even call it a debate anymore, but this idea that individuals are either like “verbal learners” or “visual learners”. [00:48:00] I know that we’ve wrestled with that a little bit over the years and now maybe it’s more of a myth. Could you speak to that just a bit if that’s like a real thing that we should be thinking about?

Dr. Lisa: I think you’re hitting something that there is still a lot of debate about right now, so I don’t know if I could say, is it a real thing? I do think that people have strengths in one or the other. I don’t know if that makes them all exclusively one type of learner versus another type of learner. But I mentioned earlier, I like the multimodal approaches because they hit different pathways into learning. And I think, people, not just kids learn differently.

So I don’t know if we’re going to get to a point where we’ll be able to say, okay, this person’s exclusively a visual learner and they should learn that way because I do think people learn in different ways but I don’t know if it’s exclusive to those two [00:49:00] categories if that makes sense.

Dr. Jennifer: I think where you might run into trouble is saying, oh, this person’s a strong verbal learner, so we’re just going to teach them that way instead of using those strengths to support certain weaknesses in nonverbal learning or visual learning and vice versa. So, it’s really when you’re thinking about strengths and weaknesses, using those strengths to compensate for those or to bolster those weaknesses instead of just solely focusing on developing something that kiddos are already good at.

Dr. Sharp: Yeah. That makes sense. Let’s see. I wanted to ask a little bit about working memory. We’ve gone through a few different other types of memory here, but it seems like working memory got a lot more of the spotlight just by virtue of being included in the WAIS and the WISC. And I’m just curious. [00:50:00] Why are we focusing on working memory so much and why did it make it into our IQ test versus any of the other types of memory?

Dr. Lisa: That’s a great question. Working memory, and Jennifer did a nice job of differentiating working memory from what we typically call memory, it’s highly g-loaded. It just is interesting historically how it’s fallen in with intelligence and you’re actually seeing in many cases it getting pulled out when you look at GAI versus FSIQ in some situations. But I think it has such a strong part of daily functioning that it really historically has just always been part of our cognitive measures.

What’s interesting is some of historically, if you look at things like the DAS-II, it included memory measures. So does KABC as well historically have also included memory, but it really does [00:51:00] differentiate a little bit when you look at things factorially. Memory is not as highly g-loaded as working memory. And I think it’s that manipulative executive function component is just needed for your general cognitive abilities much more than memory, which is a little bit removed from that processing part of the brain. I mean, processing is definitely involved in memory. I don’t want to say that, but it factors differently when you look at it as a group. Anything to add there, Jennifer?

Dr. Jennifer: Nope. I think that pretty much summarizes it. It’s interesting that a lot of the working memory tests from the WISC and the WAIS have been with those assessments since the beginning. So it was just a [00:52:00] subtest looking for a construct for a while, and then they landed in working memory.

Dr. Lisa: And I like how you said that Jennifer, because originally they weren’t called working memory. Originally, Freedom from Distractability was one of their first index names, and it’s only been the more recent additions that landed on working memory because it had some more attentional aspect to it early on.

Dr. Sharp: That’s interesting. I did not know that. Or maybe forgot it along the way. That’s great. Well, I am curious about intervention. That’s pretty important. Why else do we do what we do if we can’t help folks?

Before we totally move to intervention, is there anything that I may have missed or anything that you feel is important in terms of just background or the assessment component or why we are assessing memory? I just want to make sure we’re covering [00:53:00] all of our bases before we switch over to intervention.

Dr. Lisa: I don’t think so. I think that memory is such a key element of existence. What your experiences are, and what you recall from them help build who you become. I think that the philosophical side often gets forgotten. What makes it so hard for folks who are declining in memory it’s so connected to your identity.

So I think that’s important when you’re thinking about feedback to someone is how concerned they are about memory or how concerned a parent might be about the child’s potential learning trajectory if memory is a concern- to keep in mind that that’s so close to who we are as human beings and how we define ourselves as our [00:54:00] experiences. And if you’re having difficulty recalling information or encoding information, that does have lifelong implications for you.

Dr. Sharp: Of course. I’m glad you brought that up. Well, speaking for myself, that’s one of my biggest fears, I think, is losing the ability to remember things and losing that identity. It also makes me think about environmental factors that can impact memory. I know this could be a huge discussion but maybe we could talk about that just a bit before we move to intervention.

And when I say environmental factors, I mean things like, we know trauma affects how we remember things. We know that I other factors, yeah, stress. There was another one that I [00:55:00] forgot, but it was really good. Now, I can’t imagine, but other factors that impact how we remember things. Could we talk about some of those big environmental factors and how they might affect memory just before we move on?

Dr. Lisa: Let me just say, these factors definitely impact differently when they occur during the lifespan too because some exposures later in life may not have the same impact as a child’s exposure to certain things. But I mean, anything that impacts the brain can impact memory. So starting even from in utero exposure to toxins or to alcohol, drugs, or stress on a mom. Stress hormones impact brain development. All of those factors through development, through aging.

[00:56:00] There’s a whole body of literature out there. I’m trying to remember, it’s called brain health. And it talks even about the nutrition of folks throughout their lifespan, and their exposure to various life stressors. The childhood adverse experiences have become a big one, we talked about trauma, but just constant exposure to various things in your life. If you’re constantly in an unstable environment, that impacts as well. So, absolutely anything that you think affects the brain definitely affects memory because they’re intimately tied, Jennifer?

Dr. Jennifer: Yeah. There’s a huge literature on what’s called toxic stress on the impact on the cognitive development of children. A lot of it focuses on the extent to which cortisol is released in the brain. [00:57:00] So children who are exposed to stress, it activate the HPA access which releases a lot of cortisol in the brain, which influences the development of certain areas of the brain including the hippocampus, which is directly involved in the consolidation of memories.

So we know that children who are exposed to toxic levels of stress, which is extremely high levels of stress, well sometimes not even extreme, just consistent levels of stress without the presence of like a caregiver to buffer that stress really, those children are bathing their brains in cortisol and it influences how the brain’s developed.

I mean that level of stress influences memories and IQ and all those things. And I think that it’s related to, but separate from what you were talking about with discreet traumatic events influencing memories and [00:58:00] how those events are remembered. So there are a lot of time factors when stress occurs in development, there’s the chronicity of the stress, there’s the presence of a caregiver to buffer that stress. There are just a lot of things that influence brain development across childhood.

Dr. Sharp: Yeah, of course. Well, go ahead.

Dr. Jennifer: Oh, sorry. I was just even thinking, it even influences adults. We’ve had this experience of the pandemic and there’s been a lot of articles about brain fog and cognitive fog for people who have been exposed to covid, but even just dealing with these constant levels of stress for the past two years. So I think a lot of people are feeling the ways in which stress influences the way we think even now.

Dr. Sharp: Yeah. That’s such a good point. There are so many paths that we could go down. Again, another episode just on covid and [00:59:00] cognitive effects from that, but suffice it to say, well it seems like maybe y’all could summarize what we know so far just about the impact of covid on folks’ memory. Is there anything that’s emerging so far that we could summarize quickly?

Dr. Lisa: Well, there is definitely some impact on memory. I don’t know if we can quickly summarize because the underlying mechanisms aren’t really fully understood and whether that’s attentional issues that are related to that or if it’s more longer-term memory type encoding but it is one of the common complaints that’s being seen. There are a lot of really good researchers looking at it. I’m curious to see what comes out and we’re going to see stuff over the following years, I’m sure. But it definitely seems to impact memory, whether or not that’s [01:00:00] attention focused or actual bathing of whatever it is that we’re getting in covid.

One big factor that does impact memory for sure is heart health because the more oxygen you’re getting in your brain, the better your brain is doing. And so any cardiovascular health risk factors also impact the brain and thus memory and Covid has a very strong, particularly in people with longer-term effects, seems to have a strong impact on the cardiovascular system, which is going to impact the brain. So it’s hard to tease out what each individual is experiencing in these group numbers as to what the ideology of some of the impact is.

Dr. Jennifer: I think the thing to remember for kiddos in particular is just what you were talking about, what we were talking about earlier with the environment. So not only do you have the stress of the pandemic, [01:01:00] the stresses associated with like parental job loss. We know more kids have been exposed to traumatic or just sometimes abusive situations being home for as long as they have and then also not being in school.

So they’re missing out on those social interactions in school, but they’re also missing out on those ways in which strategies for memorizing are taught in school and also just learning experiences of getting more information to create those contexts, which to embed information to help them remember things later on down the road. So there’s just been a huge effect of children’s experience in the being very abnormal in the past two years that we’re just not sure how that’s going to play out from an environmental standpoint and also from whether or not that kid has been infected with [01:02:00] Covid.

Dr. Sharp: Right. There are so many factors. I keep thinking about when to do a podcast about the effects of covid on kids. And it’s like, how long do you wait? And maybe it’s multiple points, maybe that’s the right answer, but it’s hard to know when are we actually going to have good data on some of this stuff.

Dr. Jennifer: Going to have a Covid series- just follow the data longitudinally.

Dr. Sharp: A longitudinal podcast here. Updates every year.

Dr. Jennifer: Your covid update.

Dr. Sharp: Is that a bad idea? It also makes me think, I know I keep throwing in random questions and information here, but it makes me think too, a long-distance runner and there’s that information about you do tend to remember better when you’re exercising as far as I know. And that’s I guess related to just having more blood flow, more oxygen, and all those good [01:03:00] neurotransmitters going on whenever you’re exercising. So the flip side of the poor cardiovascular health point that you made a little bit ago.

Maybe that leads us into intervention, and things that we can do to help. I’m not sure how to tackle intervention, to be honest. I might look to y’all as far as where we might start and how might we approach this intervention category here.

Dr. Lisa: I will say, this is very different for adults and kids because in adults, you’re typically, again, dealing with loss of previous function. And probably the first intervention, once people are experiencing that, is to get an external memory system going in some way. Because immediately they need some ability to remember immediate appointments. [01:04:00] When is your doctor’s appointment next? If you don’t write it down or put it in a phone, it’s lost. You have that ability to hold on to some of that information when you’re younger and you’re not losing function. But those external memory aids really are key in early memory recovery because the strategies are usually pretty known in the adult world. It’s not a matter of trying to rebuild memory skills. It’s a matter of rehabbing those skills. And that starts with external memory aids.

Whereas I think, Jen, hopefully, you can speak to this, in the children’s world and in the rehab world with younger folks who may have an acute issue that led to a memory problem, there are decent memory strategy programs that teach, start literally at the beginning where they’re like, let’s talk about attention. What are the things to help you aid [01:05:00] encoding abilities? How do we focus on attention issues? So how do you teach attention skills? Those are often the very first interventions in people who can recover the loss that they’ve had or that are developing those skills too.

And then you start more into the memory strategies. Repeat information, rephrase information. Don’t try to remember the exact same words. Do deeper encoding of information. So embellish it a little bit so that it stays with you as opposed to just to, hey, I’m just going to keep repeating information over and over and that will help you remember it, but it’s not always the most pleasant experience, as we’ve all done with flashcards at some point, I’m sure in our life, just go over and over the same information.

And then you get into how do you help someone retrieve if retrieval really is the problem. It’s getting in there. And a lot of that is executive function [01:06:00] skill teaching. How do we encode information in a way that’s more organized and able to retrieve? And there are a lot of really good assessments out there where you have lots of different scores that are coming out.

And sometimes I will say measurement tests often give you so many scores. Sometimes it’s hard to interpret, but the beauty of that is the ability to see where is it actually breaking down in the process. And then you can focus the interventions on that. So in one way, intervention is so tied to where the actual deficit is. So you need to really look at that. And I will say a quick search online of memory intervention, you’ll find all sorts of good ones. Make sure you’re looking for ones that actually have some evidence on them.

Dr. Sharp: I was going to say, maybe that’s a nice way that we could structure the intervention conversation is thinking [01:07:00] about, okay, so we have kids and we have adults. Let’s simplify that into maybe like acquisition and improving skills versus stop loss skills. And then there’s encoding, consolidation, and retrieval. So these are three stages of memory if you want to say that.

Maybe we could start with kids and that encoding piece. So if the problem is in encoding, what might we think about as an intervention or two?

Dr. Jennifer: Oftentimes, a lot of the interventions we have around, I think school interventions because these are often the recommendations that we make. So things that help reduce distractions in a classroom are often helpful, like having kids sit in an area of the classroom where [01:08:00] it’s easier for them to focus and also easier for the teacher to keep an eye on them. Knowing whether or not they have strengths or weaknesses in verbal or nonverbal abilities.

And then really helping to provide support in those areas. Like if they can audio record lectures or they can get audiobooks, and audio versions of the textbooks, that’s often helpful. People who are more visual learners being able to draw things out or make pictures. Also having more visual schedules or agendas than just writing things out is often helpful.

I can recall recommending things like helping children develop a method of loci, I don’t know which is the correct pronunciation of that word, but really helping kids connect [01:09:00] memories to different things along a visual path, like if they walk to school, helping them to connect memories to certain things that they see along the way. It really works. It sounds very strange, but it really works, especially for kiddos who are good at visualizing things.

So really having all of those supports in place that might not already be present in the classroom. And then also, if you’re able to justify like a 504 plan or even an IEP for the kids, that really communicates to teachers that this is a kid who is struggling in a certain area and this is what they need for help. Because then it just communicates the difficulties in a way where teachers aren’t expected to figure it out themselves.

So those can often be things to help more information get in for the [01:10:00] child. I think in terms of problems of consolidation, we often find that helping organize information, helping to rehearse anything that helps keep that information in mind and in contact, like multimodal ways of learning. So if you can attach verbally presented information visually with sensory, that is often helpful in helping the most information to get in for the kiddo into long-term storage. And then also helping to organize that information so that they can retrieve it later.

And sometimes it’s often helpful to structure the way children can show what they know. If you have a kiddo that’s struggling with free recall, don’t give them an essay format test. Perhaps multiple choices are better for that kid. Or for children who might have a longer [01:11:00] processing time, maybe extra time for tests and things like that. I mean, a lot of the recommendations that we give for kiddos with attention problems can often help with those memory issues as well.

Dr. Sharp: Yeah. Are there any specific recommendations even for the retrieval part that is worth mentioning separately that we may have missed?

Dr. Jennifer: I’m trying to think. So, for a kiddo who has a hard time consolidating information, maybe they’re not the kiddo that you wanna call on in class after you’ve just said something. So making sure that kids have additional time to process information and to take it in is helpful.

Dr. Lisa: I’m going to touch on the adult world a little bit here with retrieval because we frequently use queuing [01:12:00] in retrieval because if you know that it’s gotten in the difficulty, the client is having is getting it back out. So trying alternate ways to queue or elicit that information in some way other than just repeating the question is often that, so it might be a visual queue that sometimes people will recall something differently when they see a visual queue related to the material they’re trying to recall versus an auditory queue.

You might describe instead of just using a single word, for example, describe what you’re trying to get them to remember. So it may be involving some creative queuing ideas. I do want to mention one thing that we haven’t really talked about a lot of the more recent interventions involve some self-awareness training for the kids or the adults because [01:13:00] often they don’t perceive their own memory issues. They may be concerned about them, but understanding the basics about encoding consolidation, where that breakdown is occurring, and teaching self-awareness about okay, you having difficulty within encoding. So one of the things that might make that easier is attentional skills. So really working with that person on their self-awareness of those skills so that they actually recognize when they’re having the difficulty and thus can implement these strategies.

One of the problems that we frequently see is they learn the strategies really well, but then don’t apply them because at the moment those skills don’t come to mind. So teaching that self-awareness of how do you know when you’re not attending well, how do you know when information is going in one ear and out the other? How do you know when you’re not retrieving information that you should have [01:14:00] gotten in?

Just that self-awareness can help them then start to apply any strategies they’re taught more effectively because it comes to mind when you practice that self-awareness piece too.

Dr. Sharp: Right. So are we talking about mindfulness interventions? Is that what we’re getting at here?

Dr. Lisa: Yep.

Dr. Sharp: It seems like the more we learn about mindfulness, the better it gets. It seems like it’s getting to be an intervention for many things, and that’s really cool.

Dr. Lisa: Yeah. I think we’re all better at intervening with ourselves when we know we’re having a problem than when it’s occurring.

Dr. Sharp: Absolutely. Well, since we’ve transitioned over maybe a little bit to the adult side. We can talk about adult interventions as well. Are there different interventions we could speak to at the encoding level that you’d like to mention?

[01:15:00] Dr. Lisa: Well, a lot of the encoding issues are strategies like Jen had mentioned, the method of loci, repetition of information, a multimodal presentation of information- so that it’s going in different pathways, are all part of the encoding. And again, the external memory aids are huge if you’ve lost some of the abilities and it’s organic in nature. The intervention is really how do we supplement now for this loss but mindfulness so that people are aware of what they’re needing to work on. And that actually has to go into the memory aid.

Writing goals down for folks often helps them recall, oh yeah, this is why I’m keeping this memory notebook, or why I have to have my calendar on Google, or whatever platform you’re using filled out. [01:16:00] But there is an increasing number of just digital aids to medication taking and things like that where it’s programmed. And if you’re having someone who’s having difficulty remembering when to take their medication, they can put it in one of these boxes and it actually signals and will tell, oh, you’ve already taken it today, you don’t take it again. And so, allowing people to be independent a little bit longer with even longer and longer or more severe memory issues.

There are some great group programs. And of course, I’m going to totally forget the name of it, but there’s a group in Canada that does an eight-week memory rehabilitation, but it’s encompassed within mindfulness training. Then they focus on some attentional aspects and memory training. But that group aspect where people can brainstorm together too also greatly helps because it’s going to fit into your daily routine. It’s real easy [01:17:00] to try and get, oh, here’s this great intervention and you got to do this, and here are these steps. But if it doesn’t fit with the normal habits that people have it often won’t work for very long. You have to build in that new habit that takes some time.

Dr. Sharp: Yeah. That makes sense. I appreciate it.

Dr. Lisa: In terms of intervention, before there are problems. I said that whole brain health literature: Exercising, keeping your heart healthy, good nutrition, all the things that we know we should be doing are great for your brain health and continue. They are good physically, but they’re also great to maintain your brain health, which is going to directly tie to your memory as well as many other cognitions. So keep running, Jennifer.

Dr. Sharp: Keep running. I feel like people get disappointed when I make these recommendations [01:18:00] for like, sleep, diet, and exercise, but I lean on those. I’m like, these are free for the most part. They’re easy, they’re convenient, and they will get you a lot of mileage in terms of just baseline brain health and attention and learning and well-being. Just another shout-out to the basic lifestyle.

Dr. Lisa: There are some factors that can’t be modified. You have genetic predispositions to various types of things, but there are definitely things that we can modify in our lives and these lifestyle changes are just a huge impact on longer-term brain health. You may not see it today, but you’ll see it 5 or 10 years down the road.

Dr. Jennifer: The key is when you don’t see things.

Dr. Lisa: That’s true.

Dr. Jennifer: When you don’t see memory loss.

Dr. Sharp: You don’t want to see that.

Dr. Lisa: You don’t see the decline. That’s good.

Dr. Sharp: Yeah. Well, let me ask, as we start to wrap up here [01:19:00] there’s always this question of software technology apps, could we touch on that just briefly, I’m curious what y’all know or what the research may be saying about any of that that may be helpful in memory intervention. Like is there anything out there that is actually helpful that generalizes to the real world that we want to be aware of and maybe recommend either on the kids’ side or the adult’s side?

Dr. Jennifer: Well, I think the kids are already using their cell phones as their memory aids.

Dr. Sharp: Yeah, that’s true.

Dr. Jennifer: Just from the research that Lisa was talking about previously on attention, I think, one thought that came to mind is do kids really need to memorize as much as they used to, or do they just need to know where to go to look for it? And I think they’re probably already pretty good at that. But in terms of specific memory apps, I think Lisa might probably know more.

Dr. Sharp: Lisa’s like, No.

[01:20:00] Dr. Lisa: Well, I think there are some big ones that get a lot of attention in the media, like Luminosity brain, gosh, what is the other one? It’s like brain train or something. And there are a lot of apps out there that originally came out and promised big, hey, this is going to stop cognitive decline. I do think that the research is very limited on the long-term effects of those types of things, but what we do know is keeping your brain active, keeps your brain healthier.

So, if Lumosity is what you enjoy doing and you sit there and do that for a half hour and your brain’s engaged and you’re actually thinking, it probably does help your brain health if you’re continuously doing it. I don’t know if that’s Lumosity. I think that’s just keeping your brain busy. People who do crossword puzzles or read books, keep reading and don’t rely on just media sources for your information. Actually [01:21:00] read a book or read the newspaper if there still is a newspaper in your area. Or read the articles online. And read longer in-depth things. Not the five-minute articles, but read a book that has a little more thinking to it so that you’re actively engaging elements of your brain that you’re not using in other areas.

And then talk about those with other people. We know that social activity and interactions with people require memory. You’re bringing up the information you’re discussing. Oh, you brought up a good point. Now, I’m going to be thinking about this down here that I had some experience with. Social interaction is huge for memory because you’re practicing it when you converse with people. So social activity, physical activity, and intellectual activity, all are important for long-term brain health.

And so whether you get that from an app, whether you get that from something you’ve done your whole life, admitting engages a [01:22:00] different part of your brain, so just keep engaging your brain, I think.

Dr. Jennifer: You’re talking about Lumosity and got me thinking about the other digital memory training and rehabilitation products that are out there. They’re not apps, but they are things like Cogmed. There are interventions out there that have pretty good support for improving. I’m more familiar with the Cogmed literature. Improving working memory skills in the short term. The more long-term and the generalizability of it is not as… Literature’s not as strong on that, but there are computerized interventions out there to help with these things. And I know they’re probably more in development at other companies.

Dr. Sharp: Oh, sure. I know there’s a lot of money people are trying [01:23:00] to put into this area to find anything that works. This is where all the money’s going these days. It seems like, is into digital assets and technology and apps and software. So I know people are working on it. Just a matter of whether will it be effective.

Dr. Lisa: So there is some interesting literature that came out just on small things you can do too. Like if you are a right-handed person, using your left hand for things, it’s a small change. But even if you scroll with your right hand, you hold your phone and scroll, switch to your left hand, again, it’s a different pathway that you’re activating. It doesn’t have to be huge lifestyle changes, just use your left hand every once in a while. And there are just small changes that lead to bigger changes. So start with small things.

Dr. Sharp: That is fascinating that you bring that up. This is maybe six months ago, [01:24:00] maybe a year ago. I got it in my mind for some reason that I needed to do more things with my opposite hand. So I like to brush my teeth with my left hand for maybe a month. It is very hard. It’s very hard to use your opposite hand. So I’m glad to hear that maybe that is something.

Dr. Lisa: Keep doing it.

Dr. Sharp: Yeah. I need to get back to it. Well, I really appreciate y’all coming on and trying to cover such a big topic in this limited amount of time. I know we could have gone deep on any number of these areas, but I think this is a nice general discussion with some deep dives into two specific areas. Thank y’all for your time. This was great.

Dr. Lisa: Thank you for having us.

Dr. Jennifer: Yeah, thank you for having us.

Dr. Sharp: All right, y’all, thank you so much for tuning into this episode. Always grateful to have you here. [01:25:00] I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify, or wherever you listen to your podcast.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out the Testing Psychologists mastermind groups. I have mastermind groups at every stage of practice development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, and we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.

Thanks so [01:26:00] much.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or [01:27:00] medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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