Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory

Abstract

IMPORTANCE Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking.OBJECTIVE To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching. DESIGN, SETTING, AND PARTICIPANTSPopulation-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses. INTERVENTION Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes' duration at school. MAIN OUTCOMES AND MEASURESDirectly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs. RESULTSOf 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, −3.0 [95% CI, −5.4 to −0.7]; P = .01). Intervention costs were A$1035 per child. CONCLUSIONS AND RELEVANCEWorking memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm.

Targeting the Three Stages of Retrieval from Secondary Memory in a Double-Blinded, Placebo-Controlled, Randomized Working Memory Training Study

“…Such mixed results are also apparent on academic outcome measures following Cogmed, with participants showing no improvement on academic achievement and classroom performance measures compared to controls in numerous reports (Bigorra et al 2016;Chacko et al 2014;Dunning et al 2013;Gray et al 2012;Partanen et al 2015;Roberts et al 2016;van der Donk et al 2015; van Dongen-Boomsma et al 2014). Although researchers have proposed other explanations for the lack of far transfer to academic performance following Cogmed (Bergman Nutley and Söderqvist 2017), it is worth noting that studies in which there has been non-significant far transfer to academic achievement are almost exclusively rigorously designed, randomized trials with active control groups.…”

Persistence and Fadeout in the Impacts of Child and Adolescent Interventions

“…Although performance on any particular intelligence test can be improved through training, some have argued that these gains rarely transfer broadly to cognitive performance in different domains (Haier, 2014; te Nijenhuis, van Vianen, & van der Flier, 2007), and tend to fade quickly after the conclusion of the intervention (Protzko, 2015). The existence of broad transfer resulting from cognitive training remains contested (see Au et al, 2015; Melby-Lervåg, Redick, & Hulme, 2016; Miles et al, 2016; Roberts et al, 2016). …”

Early and long-term outcome of infants born extremely preterm

“…In recent years, attention has turned to the potential for working memory training to improve cognitive and educational outcomes in preterm populations. However, although these might show short-term gain in terms of improved working memory, there is as yet no evidence of generalisation to other outcomes either in preterm children or those with working memory deficits 71 72. Given the heterogeneity in outcomes and the wide range of deficits experienced by EP children, interventions that are delivered during the school years and those that target the multiple cognitive processes affected by EP birth may be beneficial.…”