Cognitive training involves completing a variety of computerized exercises specifically designed to improve cognitive functioning in areas such as sustained attention, thinking before acting, visual and auditory processing, listening, reading - areas in which ADHD, brain-injured, and learning disabled individuals experience difficulties. The principle underlying cognitive training is to help improve the "core" abilities and self-control necessary for an individual to succeed academically. Some research indicates it may help create new neural pathways.

Since cognitive training requires repetition and one-to-one instruction, the computer is tailor made for this activity. Successful use of the computer also fosters improved self-esteem and makes learning fun. Children get immediate reinforcement, which works best for children with ADHD; the Counselor gets immediate scoring and the ability to record progress. Computerized cognitive training provides structured exercises and a reward system in the form of games.

We utilize the Captain's Log system that contains a wide range of exercises designed to improve visual and auditory attention, concentration, inhibition, memory and visual-motor coordination. Many clinicians consider it to be the most sophisticated software cor cognitive training program on the market. Exercises can be incorporated within a broader clinical framework in the following ways:

• Training individuals who are impulsive, impatient and frustrated to learn to wait repeatedly while engaging in a positive stress reducing behavior such as muscle relaxation techniques or diaphragmatic breathing.
   
• Utilizing distracters to reinforce focused attention in a distracting environment.
   
• Improve self-esteem and help develop a positive attitude towards learning.
   
• Pushing a client to the limit. Tasks can then be broken down into easier components, and the individual can practice each of these. Using this approach, the therapist can help the individual learn to work through anger and frustration and achieve a breakthrough toward enhanced emotional stability and greater cognitive efficiency.
   
• Individuals can be taught to engage in brainstorming, problem-solving techniques and to reflect on how they can improve. This clinically reinforces the value of stopping, thinking and then proceeding with a strategy based on a better understanding of what the task requires. Through these efforts, an individual can learn that "if you continue to try you can succeed."
   
• Cognitive training can now even be combined with neurofeedback to maximize learning.

In addition, McCarthy Counseling Associates, PA uses another software program called SoundSmart to help improve phonemic awareness, listening skills, working memory, mental processing speed, and self-control. These game-like brain-training exercises speak to the user in a realistic human voice, making the individual feel as if they are playing a real person who encourages, praises, and challenges them to do their best.

Similarly, SmartDriver® is a stimulating, entertaining, non-violent driving game designed to build cognitive skills and self-esteem in individuals, ages 5 through adult, who have difficulty processing information due to brain injuries, ADHD, visual processing disorders or learning disabilities. To win the game, you must drive your car successfully through progressively more difficult roads and driving situations.

You must keep your car on the road, watch the speed limit, stop for red lights and trains, be helpful by picking up passengers, and avoid potholes and other obstacles. Other cars can act wild and reckless, bumping into you for no good reason, so you must learn to drive defensively. You win prize money by following the rules of the road and being a careful, defensive driver. SmartDriver® uses a Racing wheel to make the experience more realistic.

The purpose of SmartDriver® is to teach the concepts and attitudes necessary for smart, safe driving plus a few of the basic rules of the road. It is designed to be fun while improving visual tracking skills, hand-eye coordination, planning, attention to detail, concentration, memory and patience.

While lively and entertaining, the exercises contain no violence and are not frenetic or overwhelmingly stimulating. Goals are clearly defined, and the player can learn to succeed and to be proud of newly acquired skills and capabilities. SmartDriver® consists of thirty progressive levels of difficulty, which are divided into Beginner, Intermediate and Advanced stages.

To pass from one level to the next, you must drive well enough to avoid getting too many damage or penalty points. You may opt to begin at the Beginner 1 Level, or if you prefer, you may elect to start at any level you wish. Although the program is game-like, it provides detailed record-keeping.

Cognitive training sessions at-a-distance worldwide and in-home evaluation and treatment is available for non-ambulatory patients.