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

Abstract

BackgroundWorking memory training (WMT) can offer therapeutic benefits to patients with neurodevelopmental disorders (NDD) and mild to borderline intellectual disability (MBID). However, consistent evidence for treatment benefits of WMT over placebo training is missing. So far, participants in double‐blind research designs did receive non‐specific coaching, whereas active coaching based on individual training results might increase the efficacy of WMT. Furthermore, the intensity and duration of WMT is often too stressful for these children. This study therefore investigated whether a less intensive but more prolonged WMT, with active personalised coaching and feedback, would reduce behavioural symptoms and improve neurocognitive functioning and academic achievements in children with NDD and MBID.MethodA double‐blind randomised controlled trial in children (aged 10;0–13;11) with MBID (60 < IQ < 85) and ADHD and/or ASD evaluated the effects of a less intensive but prolonged version of the original Cogmed WMT (30 min a day, 4 days a week, 8 weeks in total). Eighteen participants received active, personalised coaching and feedback, based on their actual individual performance during training. Twenty‐two received general non‐personalised coaching for the same amount of time. Executive functioning, academic achievements and several behavioural measurements were administered, before and after training, with a 6‐months follow‐up.ResultsWe observed a significant effect of time on both primary and secondary outcome measures, indicating that all children improved in working memory performance and other neurocognitive and academic outcomes. The interaction between time and group was not significant.DiscussionThis study was unable to document superior effects of active personalised coaching and feedback compared with general non‐personalised coaching and no feedback in an adaptive WMT in children with MBID and NDD. The objectively documented changes over time suggest that for these vulnerable children, a regular, structured and structural contact with a coach and adapted exercises is enough to develop therapy fidelity, boost motivation and improve neurodevelopmental task performance. Further research is needed to examine which possible subgroups within this heterogenic group of children profit more from WMT compared with other subgroups.

Treatment, Education, and Prognosis of Slow Learners (Borderline Intelligence)

“…Additionally, a double-blind, RCT compared the effectiveness of WM training with and without personalized coaching in children with borderline intelligence or mild intellectual disability and comorbid neuropsychiatric disorders, such as ADHD and/or autism spectrum disorder (ASD) [ 11 ]. Both groups showed improvements in various indicators, but no significant differences were observed.…”

“…Medication therapy with MPH has been reported to be effective for children with borderline intellectual functioning and comorbid ADHD, although its efficacy decreases with lower intelligence [ 8 ]. For children with borderline intellectual functioning with comorbid ADHD and ASD, WM training was effective regardless of the presence of individual coaching, and no significant difference was found [ 11 ]. Consistent and structured programs showed significant improvements, indicating that these programs led to significant improvements.…”