Cognitive Rehabilitation Therapy Remastered: How strategies we used for stroke patients are making a difference in treatment of ADHD and language deficits
During graduate school, our lead clinician, Lauren, found a part-time job working at a cognitive skills training clinic called LearningRx. She was surprised to see many of the activities incorporated strategies that she was using during clinicals with stroke patients to improve executive function skills. After graduation, Lauren began working full time as a speech therapist and noticed immediately that most of her clients had executive functioning deficits that impeded progress on their speech and language goals. Often, children lacked the “grit” to try a different communication approach. Frustration and tantrums were frequent. Lauren was spending precious treatment time managing behaviors. But then a switch flipped— what if these behaviors, tantrums, and general fixed mindset were rooted in weak executive function and cognitive skills? Speech and language competency require so many cognitive skills: working memory and sustained attention (what are we talking about?), quick processing speed (can I process the speech of my communication partner quickly enough to understand what was said? Can my brain make quick assumptions about words or topics I may not know? Do I have the meta-cognitive skills to recognize that I don’t understand and ask for clarification?), and inhibitory control (Can I talk about this topic that I find boring because it’s important to my communication partner? Can I resist interrupting?).
Lauren found that clients enjoyed working on these cognitive skills as “breaks” from more traditional speech therapy, and that clients made faster progress in their speech goals when they had stronger cognitive skills. Now, Lauren is passionate about helping all clients have strong executive function skills. In a world where many college graduates lack the attention span to read a book (https://www.theatlantic.com/magazine/archive/2024/11/the-elite-college-students-who-cant-read-books/679945/), targeting cognitive skills is more important that ever. Educators have expressed that a growth mindset (“I’m still learning about this: if I work hard, I can get better”) vs fixed mindset (“I’m not good at this, I give up”) is one of the most important qualities for a student to find success in the classroom. Strengthening cognitive skills is one way to promote a growth mindset in students.
In this post, we’ll explore how cognitive skills training works, the science behind it, and how it can make a meaningful difference in managing ADHD symptoms. An important note: even clients without a formal ADHD diagnosis will benefit from improved cognitive functioning skills.
What Is Cognitive Skills Training?
Cognitive skills training involves targeted exercises designed to strengthen specific brain functions such as attention, memory, processing speed, logic, and reasoning. These exercises are often delivered through structured activities, games, or computer-based programs and are rooted in the principles of neuroplasticity—the brain’s ability to change and adapt in response to experience.
For individuals with ADHD, this training helps to build up the brain’s “executive functions”—the skills that allow us to plan, organize, manage time, and regulate emotions.
Key Cognitive Skills Affected by ADHD
People with ADHD often struggle with one or more of the following:
Working Memory: The ability to hold and manipulate information in your mind.
Sustained Attention: The ability to maintain focus over time.
Processing Speed: How quickly and accurately the brain processes information.
Inhibitory Control: The ability to think before acting or resist distractions.
Cognitive Flexibility: The ability to switch between tasks or adapt to new rules.
Cognitive skills training targets these weak spots, aiming to improve overall brain efficiency and executive function.
How Cognitive Skills Training Helps
Improves Attention and Focus: Structured activities can gradually increase a person's ability to concentrate for longer periods without becoming distracted.
Enhances Memory: Repetition and practice can strengthen working memory, helping individuals keep track of tasks, instructions, and daily responsibilities.
Builds Self-Regulation: Exercises that involve delayed gratification or resisting impulses can help improve emotional and behavioral control.
Boosts Confidence: As cognitive skills improve, individuals often experience fewer academic or workplace struggles, leading to greater self-esteem and motivation.
Examples of Cognitive Training Tools
Digital Platforms: Programs like Interactive Metronome, Brain Balance, and BrainTap can be used to amplify the effects of therapist-lead interventions (we use some of these platforms as a part of intervention in the clinic)
Therapist-Guided Interventions: At Sagepath, we use a variety of games and multi-modal activities to help clients increase sustained attention, selective attention, processing speed, and impulse control. In our clinical experience, we have also found that many clients with ADHD also have weak auditory processing skills, and that targeting those weaknesses can improve attention and decrease anxiety.
Home-Based Activities: Simple strategies like memory games, attention-building exercises, and rhythm work (like learning a musical instrument) can reinforce cognitive development.
Does It Really Work?
Research on cognitive skills training for ADHD shows promising results. Some studies have found significant improvements in attention and executive functioning, while others emphasize that it may work best as part of a broader treatment plan. Cognitive training is not a quick fix, but for many, it offers a valuable way to reduce reliance on medication and improve daily functioning.
Tips for Getting Started
Book a consultation: We would be honored to be a part of your journey to better focus and attention and decreased reliance on medications.
Be consistent: Like physical exercise, brain training requires regular practice.
Integrate into daily life: Combine in-clinic therapy with real-world applications and home-program exercises.
Final Thoughts
Cognitive skills training isn't a silver bullet, but it can be a powerful ally in managing ADHD. By targeting the brain’s core functions, it offers individuals a proactive, non-invasive way to strengthen their attention, memory, and self-regulation—skills that are essential not just for managing ADHD, but for thriving in everyday life.
If you're exploring options beyond medication or looking to supplement existing ADHD treatment, cognitive training might be the missing piece in your puzzle. Schedule a consultation with us and see if Sagepath could help you or your child thrive— both in and out of the classroom or work environment.