Will Working Memory Training Generalize to Improve Off-Task Behavior in Children with Attention-Deficit/Hyperactivity Disorder?

Abstract

Computerized working memory and executive function training programs designed to target specific impairments in executive functioning are becoming increasingly available, yet how well these programs generalize to improve functional deficits in disorders, such as attentiondeficit/hyperactivity disorder (ADHD), beyond the training context is not well-established. The aim of this study was to examine the extent to which working memory (WM) training in children with ADHD would diminish a core dysfunctional behavior associated with the disorder, "offtask" behavior during academic task performance. The effect of computerized WM training (adaptive) was compared to a placebo condition (nonadaptive) in a randomized, doubleblind, placebo-controlled design in 26 children (18 males; age, 7 to 14 years old) diagnosed with ADHD. Participants completed the training in approximately 25 sessions. The Restricted Academic Situations Task (RAST) observational system was used to assess aspects of off-task behavior during the completion of an academic task. Traditional measures of ADHD symptoms (Conners' Parent Rating Scale) and WM ability (standardized WM tests) were also collected. WM training led to significant reductions in off-task ADHDassociated behavior on the RAST system and improvement on WM tests. There were no significant differences between groups in improvement on parent rating scales. Findings lend insight into the generalizability of the effects of WM training and the relation between deficits in WM and off-task behavioral components of ADHD. These preliminary data suggest WM training may provide a mechanism for indirectly altering academic performance in children with ADHD.

Cognitive Load Differentially Impacts Response Control in Girls and Boys with ADHD

“…With regards to our results, such assessment should examine response control and WM in boys and girls with ADHD as different neurocognitive profiles may emerge. As for treatment implications, in line with prior work that has suggested the benefits of cognitive training to address neuropsychological deficits in children with ADHD (Chacko et al 2014; Gray et al 2012; Green et al 2012; Klingberg et al 2005), our results support the use of cognitive remediation training with a focus on systematically increasing WM demands in children with ADHD, and while preliminary and in need of replication, our results may suggest such training could be particularly important for girls with ADHD. However, it will be important to replicate our findings in future studies adequately powered to detect sex differences.…”

Are Measures of Transfer Effects Missing the Target?

“…Another way of assessing effects in a more ecologically valid way is to assess classroom behavior as has been done in the study by Green and colleagues (Green et al 2012). This controlled WM training study included children with ADHD and had observers, who were blind to students' group belonging, rate students' behavior while performing an academic task (the Restricted Academic Setting Task).…”

A longitudinal study of neuropsychological functioning and academic achievement in children with and without signs of attention-deficit/hyperactivity disorder

“…Although a recent metaanalysis has suggested a lack of generalizable positive effect of computerized WM training (MelbyLervåg & Hulme, 2013), Green et al (2012) demonstrated that training in WM may impact off-task behavior. Future research can use the knowledge of cognition-academic relationships found here to target cognitive processes at optimal ages and predict academic impacts.…”