How do SSRIs affect working memory

Working memory problems are one of the most common learning issues that we come across in our clinic.

Working memory difficulties often co-exist with other issues, such as dyslexia, dyspraxia and AD/HD but they can also be a stand-alone problem.

It can be hard to get your head around what working memory actually is, let alone how to go about reducing the impact of a working memory problem on your child’s learning.

Here’s a brief overview to help to clear up some of the mystery.

What is Working Memory?

Most people think of memory in terms of short-term and long-term memory. So what’s so different about working memory?

In a nutshell, working memory involves our ability to hold information in our mind for short periods (that’s the memory part) in order to do something with it (that’s the working part).

Peter Doolittle sums it up brilliantly in this TED talk.

Some examples might help:

Mental Arithmetic

Say you are asked to solve some addition problems without using paper and pencil. The numbers you are given to add up are 16, 12 and 23.

In order to solve this problem we need to hold those three numbers in our mind, but at the same time we need to use information about how to perform arithmetic to do the required sum.

Everyone might have a different way of doing this but, if you are like me, you’ll first add 16 + 12 = 28. (And you’ll also mentally double-check that answer because you don’t trust your brain to do things without a calculator these days!).

Okay, so we’re halfway there. Now, what was the other number again? 23, right? We now add 28 to 23.

Then you add 20 + 20 first (=40) and then add 8 + 3 (+11). We arrive at an answer of 51.

Now what were those three original numbers again?

Verbal Instructions

What about when you asked to follow certain instructions that your personal trainer has given you? First, do 20 push-ups, then do 3 sets of 10 squats, and finish with 4 hill sprints where you run to the third tree and back.

Most of us would require this information to be given at least a second time in order to ensure we know what we’re supposed to do (partly because the first time the information is given, we’re too busy groaning and grimacing at how much all this exercise is going to hurt!).

Rehearsal – repeating the information to ourselves – is a big part of helping our working memory do it’s job. And, unsurprisingly, fatigue (from all the push-ups) and other distractions reduce how well our working memory functions.

Remembering Directions

This is another instance which requires working memory. Say you are on holidays and ask a friendly passerby how to get to the big ol’ famous church.

You are told to go straight up the main road, turn left at the little bookshop, walk down a narrow street and turn right at the square with all the pigeons. The church is about 20 metres past the square before you get to the bridge.

Great, you repeat it a few times to yourself and then set off. Squares, bookshops, bridges, pigeons….oh my!

With all the fascinating things to see in a new city, you are having to work overtime to avoid all the distractions and keep your working memory focused on the task at hand!

It is hopefully not hard to see how anybody might find the tasks above quite challenging – partly because of the amount of information they are expected to remember, maybe because they are engaging in a challenging task and also because of distractions in the environment.

There is a limited capacity to our working memory and it is often necessary for us to block out other extraneous information, or use a memory strategy (such as rehearsal) in order for it to work more efficiently.

The bad news is that once information is lost from the working memory, it is generally gone for good. The information has not yet cemented itself in our long-term memory so we have little chance of retrieving it from the deep recesses of our mind.

What Might I Notice if my Child Has a Working Memory Problem?

As a general rule, the capacity of our working memory increases with age over childhood, so have a think about the kinds of tasks you are asking of your child and whether these are age-appropriate. For example, you wouldn’t ask a three year-old to remember a long list of tasks they need to do to get ready in the morning but it might be reasonable to ask a nine year-old to remember to do the same list of tasks.

Teachers often describe children with Working Memory problems as having poor listening skills, seeming “lost”, or having attentional issues. They are rarely identified as having memory problems, although they may also have difficulty consolidating learning into their long-term memory if can’t first use their working memory to practice the skills they are taught.

Things you might notice in children who have limitations to their Working Memory:

Difficulty getting started on tasks in the classroom. This is often because the child’s working memory has been overloaded with all the instructions they have just received. Even if the task itself involves only one or two steps, the child may have also heard a myriad of other information, such as which book to use, how long they have to work on the task, what kinds of pens/pencils to use and how to start things off. It is great if children can learn to ask questions when they are unsure of what to do but, in many cases, they end up guessing or watching what their classmates are doing in order to find out.

Slow to copy things down from the board. This is because the child may find it hard to remember more than one or two words at a time so they frequently need to check and recheck the original sentence. A slower speed of copying words is exacerbated in younger children because they will also have to remember the spelling of individual words and may only be able to write a few letters at a time before checking the board again.

Answering questions in class. These children are often reserved when answering questions or participating in class. They may have forgotten part or all of the question, be unsure whether some of the information they are volunteering has already been discussed or have forgotten parts of the topic that everyone is discussing (such as vital parts of a book that has just been read out loud to the class).

Trouble following through on instructions, especially when more than one instruction is being given at a time. This relates to activities at home and at school, such as packing up and then sitting quietly on the carpet, or brushing your teeth and then choosing a story to read before bedtime.

Older children and adolescents may struggle to take notes in class because, again, they can only remember a short amount of information in the time it takes to write it down. Unfortunately, this often means that they are missing out on new information that is coming in because they are still trying to remember the important thing that was mentioned two minutes ago.

Taking longer to write original pieces. It is often necessary for those with a poor working memory to go back and re-read over what they have written because they can tend to lose track of their train of thought in the middle of a sentence. Failure to go back and refocus what they were trying to say can mean they tend to create incomplete sentences or run-on sentences that are not well-written. This is obviously a big factor when it comes to speed and coherency of writing in the later years of secondary school.

Unfortunately, all of the difficulties above can mean that a student falls behind across many different areas of the curriculum. They may suffer from self-esteem issues when they compare themselves to other students and wonder why they’re not sure what they should be doing in the classroom or take a long time to get things done.

And, over time, students may become less likely to ask questions because they may be concerned about being labelled “lazy” or being told that they weren’t listening.

What Can we do About it?

Studies show that most children with limitations to the capacity of their working memory don’t catch up to their peers over time. Genes appear to play a role in having a poor working memory capacity but this is not well understood at this stage.

However, there are strategies that can help people use their working memory more efficiently:

  1. Educate the person! Explain to them what is going on with their working memory and why they are having difficulty with certain tasks. Help them come up with quick one-liners that they can use if they need to ask for help or ask for things to be repeated.
  2. Rehearse. Repeating the information to yourself can be a useful way to hold it in the forefront of the mind until the person has an opportunity to write things down. This can be especially useful when the person is asked to carry out a number of tasks in a row.
  3. Manage distractions. The less distractions, the more likely the person is to be able to use rehearsal and other strategies without having their thought process interrupted. The student can be taught to recognise and avoid these distractions as much as possible.
  4. Don’t try to do too many things at once! This is all part of knowing your limitations. The student can be encouraged to tell others to slow down or to give less instructions at once to enable them to keep up.
  5. Chunking and other memory strategies. Chunking up information – especially numbers – into bite-sized pieces can significantly reduce the pressure on our working memory because we are effectively reducing the number of things we are trying to store. Remembering 79 and 61 is much easier than remembering 7-9-6-1.
  6. Mnemonic strategies and other memory tricks. Make up a song or an acronym to help you remember – often the more ridiculous, the better!
  7. Make meaningful connections. Try to help the child build new information into existing or logical knowledge and they will be more likely to remember things. For example, when asking your child to brush their hair, do their teeth and get dressed, try to tell them in an order that relates to head-to-toe or some other logical sequence.

And, then there are things that parents and teachers can do to help…

  1. Reduce how much information you are giving. Summarise the most important parts and repeat the information.
  2. Encourage the child to repeat back important information before getting started on a task.
  3. Reduce the need to copy things from the board unless it is necessary.
  4. Write things down (or encourage the student to) if it is important information.
  5. Teach the child memory strategies such as those discussed above – mnemonics, chunking and so forth.
  6. Encourage the child to ask questions if they forget what to do. Try to stay calm and avoid getting frustrated – it is better that they ask than try to guess!
  7. Monitor times when the child might find it harder to use their working memory and help them notice this. There may be obvious distractions that you can help them avoid and they are also more likely to have problems when they are tired.

There are various programs out there that claim to improve working memory but it is important to carefully evaluate these before investing time and money.

Brain training activities (such as those offered on websites like Lumosity) may be modestly useful because they help children with certain aspects of learning such as maintaining attention, problem-solving, visual skills, and managing distractions.

All of these tactics can help working memory to function more efficiently but the jury is still out as to whether the capacity of a person’s working memory can actually be increased by engaging in particular activities.

If you are concerned about your child’s working memory you might like to consider booking a learning profile assessment with an experienced Educational and Developmental Psychologist. This will give you a detailed understanding of your child’s individual learning profile (their strengths and weaknesses) and you’ll receive specific recommendations to improve your child’s learning at school and home.

Categories Learning Difficulties