NESCA News & Notes: Study: Adaptive Working Memory Training ...

From SHARPBRAINS.com

By Dr. David Rabiner
July 18, 2012

For a num?ber of rea?sons, there remains an impor?tant need to develop research sup?ported treat?ments for ADHD in addi?tion to med?ica?tion and behav?ior therapy.

Regard?ing med?ica?tion, not all chil?dren ben?e?fit from tak?ing it, some expe?ri?ence intol?er?a?ble side effects, and many con?tinue to strug?gle even when med?ica?tion pro?vides some ben?e?fit.

Behav?ior ther?apy can be dif?fi?cult for par?ents and teach?ers to con?sis?tently imple?ment, and often helps but does not elim?i?nate a child?s behav?ioral prob?lems.

Fur?ther?more, nei?ther treat?ment yields pos?i?tive changes that per?sist when the treat?ment is dis?con?tin?ued. Finally, despite numer?ous stud?ies doc?u?ment?ing the short? and inter?me?di?ate term ben?e?fits of these treat?ments, evi?dence of their impact on children?s long-term suc?cess is less evident.

One rel?a?tively recent devel?op?ment in the realm of ADHD treat?ments is work?ing mem?ory train?ing. Work?ing mem?ory (WM) refers to the abil?ity to hold and manip?u?late infor?ma?tion in mind for sub?se?quent use and is crit?i?cally impor?tant for a vari?ety of learn?ing activ?i?ties. For exam?ple, when a child is asked ques?tions about a story he has read, work?ing mem?ory allows the child to retain and review the story infor?ma?tion in mind to answer the ques?tions.

In doing men?tal math, work?ing mem?ory is used to hold the dig?its in mind and manip?u?late them, e.g., add or sub?tract, to gen?er?ate the answer.

Work?ing mem?ory is also impor?tant in the con?trol of atten?tion and is a strong pre?dic?tor of aca?d?e?mic suc?cess. It is defi?cient in many indi?vid?u?als with ADHD; in fact, some researchers believe that work?ing mem?ory deficits are cen?tral to ADHD and under?line the inat?ten?tive and hyperactive-impulsive behav?ior that char?ac?ter?izes the dis?or?der. You can learn more about work?ing mem?ory and ADHD here.

Sev?eral years ago, I reviewed a study of work?ing mem?ory train?ing for ADHD that yielded promis?ing find?ings. Chil?dren were ran?domly assigned to receive either high inten?sity (HI) or low inten?sity WM train?ing. The HI treat?ment involved per?form?ing com?put?er?ized WM tasks, e.g., remem?ber?ing the sequence in which lights appeared in dif?fer?ent por?tions of a grid, recall?ing a sequence of num?bers in reverse order, where the dif?fi?culty level was reg?u?larly adjusted to match the child?s per?for?mance by increas?ing or decreas?ing the items to be recalled.

This is described below as ?adap?tive? train?ing because the dif?fi?culty level adapts to match the child?s capa?bil?ity. In this train?ing con?di?tion, chil?dren are con?sis?tently chal?lenged to expand their work?ing mem?ory capacity.

In the LI con?di?tion, the tasks were sim?i?lar but the dif?fi?culty remained low through?out, i.e., the num?ber of items did not increase when chil?dren responded cor?rectly. For these chil?dren, their work?ing mem?ory capac?ity was not con?sis?tently chal?lenged and was not expected to grow as a result. This served as the con?trol condition.

Train?ing was con?ducted 5 days a week over a 5 week period; each ses?sion lasted approx?i?mately 30 to 40 min?utes. Fol?low?ing treat?ment, chil?dren who received high inten?sity train?ing showed stronger work?ing mem?ory per?for?mance than chil?dren in the con?trol con?di?tion; these gains were evi?dent on work?ing mem?ory tasks that had not been trained and remained evi?dent 3 months after train?ing ended.

Fur?ther?more, only chil?dren who received high inten?sity train?ing showed sig?nif?i?cant declines in par?ent rat?ings of ADHD symp?toms showed sig?nif?i?cant and mean?ing?ful declines for chil?dren. These declines remained evi?dent 3 months later.

Although these were very pos?i?tive find?ings, a lim?i?ta?tion was that no treat?ment effects were found for teacher rat?ings of children?s behav?ior. Thus, there was no indi?ca?tion that ben?e?fits observed by par?ents, and mir?rored in the work?ing mem?ory assess?ments, had gen?er?al?ized to the class?room.

Given the need to improve behav?ior at school for chil?dren with ADHD, it is con?cern?ing that sim?i?lar find?ings, i.e., train?ing-related gains in work?ing mem?ory per?for?mance and in par?ent rat?ings of children?s behav?ior, but less?observation of ben?e?fits by teach?ers, have emerged in sub?se?quent studies.

Newly Pub?lished Study

A study pub?lished online recently in Neu?rother?a?peu?tics [Green et. al., (2012). Will work?ing mem?ory train?ing gen?er?al?ize to improve off-task behav?ior in chil?dren with attention-deficit/hyper?ac?tiv?ity dis?or?der? DOI 10.1007/s13311-012?0124-y] is encour?ag?ing in that it pro?vides that strongest evi?dence to date that ben?e?fits from work?ing mem?ory train?ing can gen?er?al?ize to aca?d?e?mic settings.

Par?tic?i?pants were 26 chil?dren (18 males; ages 7 to 14 years old) who were ran?domly assigned to receive adap?tive work?ing mem?ory train?ing or the low inten?sity con?trol train?ing. Ten chil?dren were on med?ica?tion and remained on meds dur?ing the study; this was con?trolled for in the analyses.

The train?ing pro?gram used was Cogmed Work?ing Mem?ory train?ing (the researchers had no affil?i?a?tion with Cogmed). The stan?dard train?ing pro?to?col of 5 ses?sions per week over 5 weeks was employed. Per stan?dard Cogmed pro?ce?dures, train?ing was done at home and was mon?i?tored remotely by a qual?i?fied coach to help ensure the pro?to?col was followed.

The main study out?come was children?s behav?ior dur?ing the Restricted Aca?d?e?mic Sit?u?a?tions Task (RAST). Dur?ing the RAST, which takes place in a lab set?ting, chil?dren are instructed to com?plete a series of aca?d?e?mic work sheets for 15 min?utes, and not to leave their seat, or touch any of the toys or games in the room, dur?ing that time. The child is left alone to com?plete the work and their behav?ior is observed from behind a one-way mir?ror. The child?s behav?ior is coded for the amount of off task behav?ior, e.g., look?ing away from the paper, get?ting out of his or her seat, fid?get?ing, vocal?iz?ing, or play?ing with objects unre?lated to the task.

The task thus allows for highly con?trolled behav?ioral obser?va?tions and is fre?quently used to eval?u?ate the effect of med?ica?tion on ADHD behav?iors in phar?ma?ceu?ti?cal tri?als. It is sen?si?tive to moment to moment off task behav?ior that a teacher or par?ent might not detect.

The main ques?tion asked in this study was whether chil?dren who received adap?tive train?ing would show less off task behav?ior dur?ing the RAST than chil?dren in the con?trol con?di?tion. If so, it would indi?cate a pos?i?tive treat?ment effect of work?ing mem?ory train?ing that gen?er?al?ized to a set?ting highly rel?e?vant to behav?ior in school. Obser?va?tions of treat?ment and con?trol chil?dren was made by a trained observer who did not know which group ? adap?tive treat?ment or con?trol ? each child was in.

In addi?tion to the RAST, children?s work?ing mem?ory per?for?mance on tasks that dif?fered from those used in train?ing (the Work?ing Mem?ory Com?pos?ite from the WISC-IV) and par?ent behav?ior rat?ings were obtained.

Results

Impact on Work?ing Mem?ory - Con?sis?tent with what has been reported in prior work?ing mem?ory train?ing stud?ies, chil?dren receiv?ing adap?tive train?ing showed a sig?nif?i?cant increase in the work?ing mem?ory score on the WISC-IV after train?ing; chil?dren in the con?trol con?di?tion did not.

Rat?ing Scales - Both groups showed a decline on par?ents? rat?ings of ADHD behav?iors and this did not dif?fer between the groups. Base?line scores for chil?dren in the adap?tive train?ing group were lower than in the con?trol group so they may have had less room for improvement.

Behav?ior dur?ing the RAST - The main out?come mea?sure from the RAST was the amount of off task behav?ior, i.e., look?ing away from the work sheet rather than focus?ing on it, dur?ing the 15 minute seat work period. At base?line, scores for each group were equiv?a?lent. Fol?low?ing train?ing, when the RAST was read?minin?stered, off-task behav?ior for chil?dren in the con?trol group remained at their base?line level.

For the adap?tive train?ing group, there was a pro?nounced and sta?tis?ti?cally sig?nif?i?cant decline. Adap?tively trained chil?dren were also less likely to play with objects dur?ing the task. Dif?fer?ences in the other behav?ior cat?e?gories ? fid?get?ing, leav?ing the seat, and vocal?iz?ing ? were not significant.

Sum?mary and Implications

This is an impor?tant study ? both for Cogmed Work?ing Mem?ory Train?ing specif?i?cally and the cog?ni?tive train?ing field in gen?eral. The results strongly sug?gest that work?ing mem?ory train?ing can yield reduc?tions in off task behav?ior dur?ing aca?d?e?mic work for chil?dren with ADHD. This has not been pre?vi?ously demon?strated and begins to address an impor?tant gap in the research base on work?ing mem?ory train?ing for ADHD, i.e., the lim?ited indi?ca?tion of train?ing effects that gen?er?al?ize to the class?room.

While the RAST reflects a con?trolled obser?va?tion set?ting rather than an actual class?room, behav?ior dur?ing the RAST does cor?re?late with in class behav?ior. And, it is a fre?quently used and accepted mea?sure for deter?min?ing med?ica?tion treat?ment effects for ADHD.

The study has sev?eral strengths includ?ing a care?fully diag?nosed sam?ple, the use of ran?dom assign?ment, an appro?pri?ate con?trol group, the use of mul?ti?ple out?come mea?sures, and observers who were blind to children?s treat?ment assign?ment. These are all key ele?ments of a care?fully designed inter?ven?tion trial.

As with any sin?gle study, there are also lim?i?ta?tions to note. Key among these is a rel?a?tively small sam?ple size. Thus, repli?ca?tion with a larger sam?ple would cer?tainly be war?ranted. And, although the RAST pro?vides a valid and highly con?trolled set?ting to observe behav?ior, future stud?ies should also include obser?va?tions of children?s behav?ior in their actual class?room. Although this makes for a more com?plex study, the class?room is ulti?mately the set?ting where increases in focused, on task behav?ior dur?ing aca?d?e?mic work needs to occur. Finally, this study did not fol?low par?tic?i?pants beyond the end of treat?ment so the dura?tion of ben?e?fits observed is not known.

These lim?i?ta?tions not with?stand?ing, the authors have pre?sented impor?tant new data on the poten?tial ben?e?fits of work?ing mem?ory train?ing by demon?strat?ing gen?er?al?iza?tion of train?ing ben?e?fits to a rel?e?vant set?ting for aca?d?e?mic work. Given the grow?ing inter?est in work?ing mem?ory train?ing ? and other forms of cog?ni?tive train?ing ? it is likely that results from a num?ber of addi?tional stud?ies on these approaches will become avail?able over the next sev?eral years.

About Dr. David Rabiner

Dr. David Rabiner is a child clin?i?cal psy?chol?o?gist and Direc?tor of Under?grad?u?ate Stud?ies in the Depart?ment of Psy?chol?ogy and Neu?ro?science at Duke Uni?ver?sity. His research focuses on var?i?ous issues related to ADHD, the impact of atten?tion prob?lems on aca?d?e?mic achieve?ment, and atten?tion train?ing. He also pub?lishes Atten?tion Research Update, a com?pli?men?tary online newslet?ter that helps par?ents, pro?fes?sion?als, and edu?ca?tors keep up with the lat?est research on ADHD.

Pre?vi?ous arti?cles by Dr. Rabiner

Source: http://nesca-news.blogspot.com/2012/07/study-adaptive-working-memory-training.html

saints vs 49ers vanessa marcil 49 ers frank gore frank gore nfl games jesus montero