Working memory training in children with neuropsychiatric disorders and mild to borderline intellectual functioning, the role of coaching; a double-blind randomized controlled trial

Abstract

BackgroundWorking memory training (WMT) has been shown to offer therapeutic benefits to both patients with Attention-Deficit Hyperactivity Disorder (ADHD) and patients with mild to borderline Intellectual Disabilities (MBID; 60 < IQ < 85). However, robust evidence for transfer effects and treatment benefits of WMT over placebo training are lacking. Owing to the nature of double-blind research designs in RCTs, children have received non-specific coaching not based on their actual training performance. Active coaching based on individual training results (such as in clinical practice) might enhance the efficacy of Cogmed WMT. Furthermore, clinical experience and the general treatment approach to these vulnerable children has shown that the intensity and duration of WMT is often too stressful. This study therefore investigated the efficacy of a less intensive, but more prolonged Cogmed WMT (including active personalized coaching and feedback) in reducing behavioral symptoms and improving neurocognitive functioning and academic achievements in children with MBID and neuropsychiatric disorders.Methods/designA double-blind RCT with children (age 10.0–13.11) with neuropsychiatric disorders (ADHD and/or autism spectrum disorder (ASD)) and MBID (IQ: 60 < IQ < 85). Two groups (each n = 26) will receive Cogmed WMT (version R/M) at home or at school for 8 weeks, 4 days a week, at 30 min a day. One group will receive active personalized coaching and feedback based on their actual individual performance during Cogmed training. The other group will only receive general non-personalized coaching (i.e. no receive personalized coaching and feedback). Both groups will undergo a neurocognitive assessment (working memory, executive functioning, academic achievements) before and after training and complete several questionnaires (behavioral problems, parenting style) with a 6 months follow-up.DiscussionThis study will add to the literature since the role of coaching in Cogmed WMT has not been studied before. It will also provide opportunities to investigate an alternative version of WMT in a large group of vulnerable children, for whom few evidence-based treatments are available. Ultimately, this will allow us to advise mental health care professionals and special education schools about the use of this type of intervention for children with MBID and neuropsychiatric disorders.Trial registrationDutch Trial Register. NTR5223. Registration date 06–09-2015.

Neurocognitive functioning of children with mild to borderline intellectual disabilities and psychiatric disorders: profile characteristics and predictors of behavioural problems

“…This matches earlier findings about the information processing profiles of children with internalising and externalising problems (Brunnekreef et al 2007;Schuiringa et al 2017). Currently, researchers already made attempts in investigating the role of coaching as a possible beneficial component in the treatment of children with MBID (Roording-Ragetlie et al 2017;Favre et al 2018). Taken together, it is too imprecise to link a general weaker EF to MBID; poorer performance on tasks aimed to measure EF may be explained by a range of non-EF factors that are not taken into account.…”

“…Currently, researchers already made attempts in investigating the role of coaching as a possible beneficial component in the treatment of children with MBID (Roording‐Ragetlie et al . 2017 ; Favre et al . 2018 ).…”

Cognitive Working Memory Training (CWMT) in adolescents suffering from Attention-Deficit/Hyperactivity Disorder (ADHD): A controlled trial taking into account concomitant medication effects.

“…The degree of involvement of the coach and the quality of the relationships between professionals, parents and participants in CWMT is another aspect of the motivation and the involvements of the participants. Likewise, future researches should assess more specifically, the individual differences such as age, biological factors, neuropsychological profiles and broader ranges of functional outcomes (Cortese et al, 2015;Jaeggi et al, 2011;Jolles et al, 2012;von Bastian & Oberauer, 2014) as well as the role of coaching (Roording-Ragetlie et al, 2017) leading to the maximum benefits from CWMT.…”

“…Perhaps, cognitive training targeting multiple neuropsychological functions (Cortese et al, 2015) and focusing on metacognitive skills development approach (e.g., Franck et al, 2013) might help to enhance transfer of benefits to other cognitive functions. In this line, a study on the role of coaching in children with neuropsychiatric disorders (Roording-Ragetlie et al, 2017) showed that a less intensive version of CWMT with active coaching have benefits on other cognitive functions.…”

Working memory training in children with neurodevelopmental disorders and intellectual disabilities, the role of coaching: A double‐blind randomised controlled trial

“…The ethics approval was obtained from the Medical Ethical Committee (NL52647.091.15/METC2015-1618) at Radboud Academic Medical Centre in Nijmegen, the Netherlands. This trial is registered in the Dutch Trial Register, number NTR:5223, and the study protocol is published (Roording-Ragetlie et al 2017). After inclusion and exclusion criteria were checked (see section Participants), parents were asked for demographic and background information such as previous care and medication use.…”