Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD (original) (raw)
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Background: Cogmed Working Memory Training (CWMT) has received considerable attention as a promising intervention for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. At the same time, methodological weaknesses in previous clinical trials call into question reported efficacy of CWMT. In particular, lack of equivalence in key aspects of CWMT (i.e., contingent reinforcement, time-on-task with computer training, parent– child interactions, supportive coaching) between CWMT and placebo versions of CWMT used in previous trials may account for the beneficial outcomes favoring CWMT. Methods: Eighty-five 7-to 11-year old school-age children with ADHD (66 male; 78%) were randomized to either standard CWMT (CWMT Active) or a well-controlled CWMT placebo condition (CWMT Placebo) and evaluated before and 3 weeks after treatment. Dependent measures included parent and teacher ratings of ADHD symptoms; objective measures of attention, activity level, and impulsivity; and psychometric indices of working memory and academic achievement (Clinical trial title: Combined cognitive remediation and behavioral intervention for the treatment of Attention-Deficit/Hyperactivity Disorder; http:// clinicaltrials.gov/ct2/show/NCT01137318). Results: CWMT Active participants demonstrated significantly greater improvements in verbal and nonverbal working memory storage, but evidenced no discernible gains in working memory storage plus processing/manipulation. In addition, no treatment group differences were observed for any other outcome measures. Conclusions: When a more rigorous comparison condition is utilized, CWMT demonstrates effects on certain aspects of working memory in children with ADHD; however, CWMT does not appear to foster treatment generalization to other domains of functioning. As such, CWMT should not be considered a viable treatment for children with ADHD.
Journal of attention disorders, 2014
The aim of this study was to evaluate whether a shortened-length session of CogMed Working Memory Training (CWMT) would be a suitable active control group and evaluate study protocol to aid in design refinements for a larger randomized controlled trial (RCT). Thirty-eight post-secondary students diagnosed with ADHD were randomized into 25 sessions of standard (45 min/session) or shortened (15 min/session) CWMT, or into a waitlist control group. There was no significant difference in completion rate or training index score between the standard- and shortened-length groups indicating that both groups showed improvement and put forth good effort during training. Preliminary findings suggest that shorter training sessions may induce similar levels of engagement, motivation, and expectancy of improvement in participants. We conclude that a larger scale RCT that utilizes shortened-length training as an active control group is warranted, but that a few modifications to the study protocol w...
Child Neuropsychology, 2011
Adaptive training of working memory (WM) using the Cogmed-RM intervention has recently shown some efficacy as an alternative treatment for ADHD, but this intervention may not be optimally designed. A recent component analysis of WM has suggested that maintenance in primary memory (PM) appears to be largely intact whereas recall from secondary memory (SM) appears to be deficient in ADHD relative to age-matched controls. However, extrapolating from basic research, there is reason to believe that Cogmed-RM may target the PM component more than the SM component; though training with spatial exercises may target the SM component more than training with verbal exercises. To investigate, participants diagnosed with ADHD were randomly assigned to either a verbal training condition (n = 24) or a spatial training condition (n = 23) using a randomized, controlled design, and both groups were instructed to complete at least 20 days of training. The PM and SM components of WM were assessed immediately before and after training using both verbal and spatial free recall tasks. The main findings showed that both versions of the intervention enhanced the maintenance of information in PM regardless of test modality, but not the recall of information from SM. Therefore, the component of WM that is improved by Cogmed-RM is not the same component of WM that is deficient in ADHD.
The Effects of Working Memory Training on Adult ADHD Symptoms
Attention-Deficit/Hyperactivity Disorder (ADHD) is often regarded as a disorder of childhood and adolescence, but it affects millions of adults each year. For adults the symptoms of ADHD can include inattention, impulsivity and a poor working memory. Computerized cognitive working memory training has previously been used with children and adolescents with ADHD to see how it affects their symptoms with some success; however, this work had not been done yet with adults with ADHD. This study used a quantitative quasi- experimental design with an experimental group and a wait list control group to look at the effects of working memory training on ADHD symptoms on a sample of adults with ADHD. All participants met with this researcher for pretest and posttest measures, which consisted of two subtests from the Wechsler Memory Scales III (Spatial Span Board and Letter Number Sequencing) that were combined as one measure, and the overall ADHD score on the Attention of Variable’s Test (TOVA) as a second measure. The experimental group used a computerized working memory training program for a period of five weeks (or 25 sessions) in their homes. A MANOVA was used to look at within and between group differences on post test scores. A statistically significant improvement in working memory scores was seen in the experimental group from pretest to post-test. An improvement on TOVA scores was also seen, but not to a statistically significant degree.
Journal of Educational and Developmental Psychology
Commercial cognitive training programs have been proposed as a non-pharmacological treatment of ADHD-related outcomes, such as learning difficulties and academic achievement. Most of these programs focus on working memory, an essential cognitive ability sustaining nearly every conscious mental activity. In this article, we present and summarize the main studies assessing the effectiveness of such training programs on working memory. The reported studies have failed to show a positive far-transfer and long-term effect of cognitive training both in typically developing individuals and children with ADHD. In the end, we present emerging alternative approaches to the use of cognitive training to improve working memory functioning in children with ADHD.
Applied Cognitive Psychology, 2009
This study evaluated the impact of two interventions-a training program and stimulant medication-on working memory (WM) function in children with attention deficit hyperactivity disorder (ADHD). Twenty-five children aged between 8 and 11 years participated in training that taxed WM skills to the limit for a minimum of 20 days, and completed other assessments of WM and IQ before and after training, and with and without prescribed drug treatment. While medication significantly improved visuo-spatial memory performance, training led to substantial gains in all components of WM across untrained tasks. Training gains associated with the central executive persisted over a 6month period. IQ scores were unaffected by either intervention. These findings indicate that the WM impairments in children with ADHD can be differentially ameliorated by training and by stimulant medication.
Journal of Consulting and Clinical Psychology, 2018
Objective-Working memory deficits have been linked experimentally and developmentally with ADHD-related symptoms/impairments. Unfortunately, substantial evidence indicates that extant working memory training programs fail to improve these symptoms/impairments. We hypothesized that this discrepancy may reflect insufficient targeting, such that extant protocols do not adequately engage the specific working memory components linked with the disorder's behavioral/functional impairments. Method-The current study describes the development, empirical basis, and initial testing of central executive training (CET) relative to gold-standard behavioral parent training (BPT). Children with ADHD ages 8-13 (M=10.43, SD=1.59; 21 girls; 76% Caucasian/Non-Hispanic) were treated using BPT (n=27) or CET (n=27). Detailed data analytic plans for the pre/post design were preregistered. Primary outcomes included phonological and visuospatial working memory, and secondary outcomes included actigraphy during working memory testing and two distal fartransfer tasks. Multiple feasibility/acceptability measures were included. Results-The BPT and CET samples did not differ on any pre-treatment characteristics. CET was rated as highly acceptable by children, and was equivalent to BPT in terms of feasibility/