Assessing working memory in children with ADHD: Minor administration and scoring changes may improve digit span backward’s construct validity.

“1; Faul et al., 2007) to determine our sensitivity for detecting effects.”

“All children and their parents participated in a detailed, semi-structured clinical interview using the Kiddie Schedule for Affective Disorders and Schizophrenia for SchoolAged Children (K-SADS; Kaufman et al., 1997).”

“Working memory updating tasks involve the constant monitoring and rapid addition/deletion of working memory contents (Miyake & Friedman, 2012).”

“Overall, results replicated consistent findings from healthy and clinical child and adult samples (Egeland, 2015; Engle et al., 1999; Swanson & Kim, 2007; Tarle et al., 2017), and provided additional evidence that digit span backward does not capture individual differences in various working memory…”

“…pediatric ADHD sample and used the Unsworth and Engle (2006) modifications to assess the construct and predictive validities of digit span backward (derived from WISC-IV) relative to criterion measures of working memory, academic achievement, and fluid intelligence (Conway et al., 2005).”

“, 2015), and skill in strategy-based games such as chess and bridge (Baddeley, 2007).”

“Further, comparisons between clinical tests and criterion working memory measures have generally been limited to simple vs. complex span tasks despite meta-analytic evidence for three interrelated types of working memory (dual-processing, updating, serial reordering; Wager & Smith, 2003).”

“…sample (low1: 2-4 digits vs. high: 6-8 digits) given evidence that short-term memory and working memory are differentiated in children as young as 6 (Gathercole et al., 2004) and that short-term memory reaches an adult-like 4+1 chunk capacity during the current study’s age range (Cowan et al.,…”

“To do so, we selected a working memory test commonly used in clinical practice (digit span backward; Martinussen et al., 2005), and compared performance among children with ADHD based on traditional vs. alternate administration/scoring to a battery of criterion working memory (construct validity)…”

“…behavior (Rapport et al., 2009), inattention (Kofler et al., 2010), and mind wandering (Kane et al., 2007), and may be etiologically important for a broad range of psychopathologies including schizophrenia (Goldman-Rakic, 1994), depression (Joormann & Gotlib, 2008), and ADHD (Kasper et al., 2012).”

“…impaired working memory has been implicated in hyperactive behavior (Rapport et al., 2009), inattention (Kofler et al., 2010), and mind wandering (Kane et al., 2007), and may be etiologically important for a broad range of psychopathologies including schizophrenia (Goldman-Rakic, 1994),…”

“…assessment in general and pediatric ADHD in particular, working memory underlies learning skills such as math and reading attainment (Raghubar et al., 2010; Sesma et al., 2009; Swanson & Kim, 2007), science (Gathercole et al., 2004), written language (Alloway et al., 2005), oral…”

“This residual PRI score represents cognitive functions important for IQ test performance but unrelated to working memory, and was computed to improve construct specificity because PRI performance depends heavily on working memory, even for IQ subtests not reified as ‘working memory’ measures (Ackerman et al., 2005; De…”

“Moreover, the clinical literature has been criticized for using executive functioning tests that are not cognitively informed according to contemporary advancements (Snyder et al., 2015).”

“158) associated with the working components of working memory by removing task-specific demands associated with non-executive processes and the anatomically and functionally distinct short-term memory subsystems (Alloway et al., 2006; Fassbender & Schweitzer, 2006; Wager & Smith, 2003).”

“This residual PRI score represents cognitive functions important for IQ test performance but unrelated to working memory, and was computed to improve construct specificity because PRI performance depends heavily on working memory, even for IQ subtests not reified as ‘working memory’ measures (Ackerman et al., 2005; De…”

“, 2017), the test’s standardization sample (Wechsler, 2003), and healthy child samples (Monaco et al., 2013; St. Clair-Thompson & Allen, 2013) suggests confidence in their generalizability and confirms that list reversal is more cognitively demanding than rote recall (St.”

“In addition, these short-term and working memory factors predict non-overlapping variance in outcomes such as IQ (Unsworth & Engle, 2007).”

“…behavior (Rapport et al., 2009), inattention (Kofler et al., 2010), and mind wandering (Kane et al., 2007), and may be etiologically important for a broad range of psychopathologies including schizophrenia (Goldman-Rakic, 1994), depression (Joormann & Gotlib, 2008), and ADHD (Kasper et al., 2012).”

“The ratio of participants (34) to components (1) was deemed acceptable for each of the three computations (Hogarty et al., 2005).”

“In contrast, working memory refers to the active, top-down manipulation of information held in short-term memory, and includes interrelated functions of the mid-lateral prefrontal cortex that involve continuous updating (active addition and deletion of items from working memory), dualprocessing (diverse processes that…”

“…given that these abilities are associated with anatomically distinct cortical regions (Nee et al., 2013; Wager & Smith, 2003), support functionally distinct cognitive processes (Alloway et al., 2006), and show unique relations with important academic and functional outcomes (Rapport et al., 2013).”

“…sample is ideal for testing these effects because disrupted working memory may be implicated in the disorder’s developmental pathways (Halperin et al., 2008; Kasper et al., 2012; Rapport et al., 2013), and because ADHD is common disorder presenting for clinical assessment (Rowland et al., 2002).”

“…in general and pediatric ADHD in particular, working memory underlies learning skills such as math and reading attainment (Raghubar et al., 2010; Sesma et al., 2009; Swanson & Kim, 2007), science (Gathercole et al., 2004), written language (Alloway et al., 2005), oral language (McInnes et al.,…”

“Comparisons of ADHD and typically developing children indicate medium to large magnitude between-group differences on similar complex span tasks (Kuntsi et al., 2001; Willcutt et al., 2001).”

“Digit span is one of the most commonly used tests of working memory in clinical research and practice (Kasper et al., 2012).”

“Comparisons of ADHD and typically developing children indicate medium to large magnitude between-group differences on similar complex span tasks (Kuntsi et al., 2001; Willcutt et al., 2001).”

“This approach has been criticized for providing a relatively narrow range of scores (Tarle et al., 2017; Woods et al., 2011), such that score variability comes primarily from the shortest list-lengths because longer list-lengths are not routinely administered (Conway et al.”

“In particular, converging evidence questions the construct validity (Redick & Lindsey, 2013) and structural organization (Friedman & Miyake, 2016) of common neuropsychological tests used to assess working memory.”

“…underlies learning skills such as math and reading attainment (Raghubar et al., 2010; Sesma et al., 2009; Swanson & Kim, 2007), science (Gathercole et al., 2004), written language (Alloway et al., 2005), oral language (McInnes et al., 2003), and following directions (Jaroslawska et al., 2016).”

“…magnitude performance differences between ADHD and typically developing children (Patros et al., 2015), and performance predicts ADHD-related impairments in objectively-measured activity level (Rapport et al., 2009), attentive behavior (Kofler et al., 2010), and impulsivity (Raiker et al., 2012).”

“…pediatric ADHD sample is ideal for testing these effects because disrupted working memory may be implicated in the disorder’s developmental pathways (Halperin et al., 2008; Kasper et al., 2012; Rapport et al., 2013), and because ADHD is common disorder presenting for clinical assessment (Rowland…”

“…magnitude performance differences between ADHD and typically developing children (Patros et al., 2015), and performance predicts ADHD-related impairments in objectively-measured activity level (Rapport et al., 2009), attentive behavior (Kofler et al., 2010), and impulsivity (Raiker et al., 2012).”

“Thus, variability in scores is due primarily to performance at forward list-lengths that engage working memory in addition to short-term memory (Unsworth & Engle, 2006).”

“Conceptually, this process isolates “common and perfectly reliable variance” (Swanson & Kim 2007, p. 158) associated with the working components of working memory by removing task-specific demands associated with nonexecutive processes and the anatomically and functionally distinct short-term…”

“…Kim 2007, p. 158) associated with the working components of working memory by removing task-specific demands associated with nonexecutive processes and the anatomically and functionally distinct short-term memory subsystems (Alloway et al., 2006; Fassbender & Schweitzer, 2006; Wager & Smith, 2003).”

“term memory reaches an adult-like 4 ± 1 chunk capacity during the current study’s age range (Cowan, 2001; Cowan, Morey, & Gilchrist, 2010; Tillman, Eninger, Forssman, & Bohlin, 2011).”

“The N-back task is arguably the most commonly used continuous updating test and shows acceptable convergence with conceptually distinct measures of working memory, including complex span and serial reordering tasks (Schmiedek et al., 2014).”

“The evidence base for these critiques is substantial, and includes data from large samples of healthy and clinically referred children, adolescents, and adults (Bowden et al., 2013; Colom et al., 2005; Egeland, 2015; Perry et al., 2001; Tarle et al., 2017; Twamley et al., 2006).”

“Reliability evidence includes high internal consistency (α=.82-.97) and 1-3 week test-retest reliability (r=.76-.90; Sarver et al., 2015).”

“This latter observation is consistent with the current finding that digit span backward, a verbal task, correlated highly with non-verbal fluid reasoning (r=.49), as well as evidence that digit span backward cross-loads with visual-spatial memory tasks (Jaroslawska et al., 2016).”

“Comparisons of ADHD and typically developing children indicate large magnitude group differences on this task (Raiker et al., 2012).”

“Short-term memory involves the temporary storage and rehearsal of information, and reflects the memory component of working memory (Baddeley, 2007; Shelton et al., 2010; Unsworth et al., 2010).”

“…6-8 digits) given evidence that short-term memory and working memory are differentiated in children as young as 6 (Gathercole et al., 2004) and that short-term memory reaches an adult-like 4+1 chunk capacity during the current study’s age range (Cowan et al., 2001, 2010; Tillman et al., 2011).”

“…as a measure of working memory includes findings that children, adolescents, and adults tend to recall fewer trials correctly and recite shorter maximum lists of numbers on digits backward relative to digits forward tasks (Conklin et al., 2000; Gathercole et al., 2004; St. Clair-Thompson, 2010).”

“…Martinussen et al., 2005; Tarle et al., 2017), the test’s standardization sample (Wechsler, 2003), and healthy child samples (Monaco et al., 2013; St. Clair-Thompson & Allen, 2013) suggests confidence in their generalizability and confirms that list reversal is more cognitively demanding than…”

“Short-term memory involves the temporary storage and rehearsal of information, and reflects the memory component of working memory (Baddeley, 2007; Shelton et al., 2010; Unsworth et al., 2010).”

“The evidence base for these critiques is substantial, and includes data from large samples of healthy and clinically referred children, adolescents, and adults (Bowden et al., 2013; Colom et al., 2005; Egeland, 2015; Perry et al., 2001; Tarle et al., 2017; Twamley et al., 2006).”

“, 1999) in healthy adults (Colom et al., 2005), healthy children (Swanson & Kim, 2007), adults with psychopathology (Perry et al.”

“…6-8 digits) given evidence that short-term memory and working memory are differentiated in children as young as 6 (Gathercole et al., 2004) and that short-term memory reaches an adult-like 4+1 chunk capacity during the current study’s age range (Cowan et al., 2001, 2010; Tillman et al., 2011).”

“The evidence base for these critiques is substantial, and includes data from large samples of healthy and clinically referred children, adolescents, and adults (Bowden et al., 2013; Colom et al., 2005; Egeland, 2015; Perry et al., 2001; Tarle et al., 2017; Twamley et al., 2006).”

“Prerecorded stimuli were presented aurally (1000 ms presentation + ISI) to isolate phonological task demands by minimizing visuospatial influences (Alderson et al., 2015).”

“…chance levels, whereas criterion working memory tasks that include increased central executive demands, a greater number of trials, and partial-credit scoring methods demonstrate group classification accuracy at levels similar to or better than gold standard ADHD rating scales (Tarle et al., 2017).”

“90) and demonstration of the expected magnitude of relations with a 0-back version of the test (Denney et al., 2005).”

“These tasks demonstrate large magnitude performance differences between ADHD and typically developing children (Patros et al., 2015), and performance predicts ADHD-related impairments in objectively-measured activity level (Rapport et al.”

“…and validity evidence includes internal consistency (α = 0.82–0.97; Kofler et al. 2017), 1- to 3-week test-retest reliability (0.76–0.90; Sarver et al. 2015), and expected magnitude relations with criterion working memory complex span (r = 0.69) and updating tasks (r = 0.61) (Wells et al. 2018).”

“Improving task validity may thus increase sensitivity, and recent results demonstrate that slight protocol alterations can improve validity of tasks probing working memory in ADHD [40].”

“Reliability and validity evidence includes high internal consistency (α = .81–.97) and 1–3-week test-retest reliability (.76–.90; Kofler et al., 2019; Sarver et al., 2015), and expected relations with criterion working memory complex span (r = .69) and updating tasks (r = .61) (Wells et al., 2018).”

“In particular, studies finding lower effect sizes/impairment estimates were more likely to rely on estimates from single tasks that have been criticized for poor construct validity because they primarily assess short-term memory rather than working memory (e.g., backward digit span; Snyder et al., 2015; Wells et al.,…”

“The use of a more accurate digit-letter sequence task could be explored in this context [60].”

“In particular, most studies assessed working memory using simple span tasks that show poor construct validity (Wells et al., 2018) and to our knowledge all available studies relied at least in part on power-based metrics (e.”

“In addition to concerns regarding test content and the lack of specificity of most executive function tests used in the clinical literature 51,112,118,120,130 , the specific metrics used in these tests warrant scrutiny.”

“Reliability and validity evidence includes high internal consistency (α = .81-.97) and 1-3-week test-retest reliability (.76-.90; Kofler et al., 2019; Sarver et al., 2015), and expected relations with criterion working memory complex span (r = .69) and updating tasks (r = .61) (Wells et al., 2018).”

“The digit span task is commonly used to study memory, with arguments made that the forward digit span task more specifically measures short-term memory while the BDS task measures working memory (Wells et al., 2018).”

“Our results were consistent with the reduction in processing speed and working memory caused by the complexity of the task, as has been shown in a large amount of literature (Rovetti et al., 2021; Wells et al., 2018).”

“, 2012), however, evidence suggests that digit-span tasks may measure shortterm memory more than working memory because they do not introduce new stimuli within the primary storage set such as in reading span tasks (Conway et al., 2005; Wells et al., 2018).”

“2017), and show poor correspondence with criterion WM tests (Wells et al. 2018).”

“Although a relatively small number of studies have investigated the relationship between ADHD and working memory as well as self-control processes, findings indicated that ADHD is highly correlated with working memory impairment in children (Wells et al. 2018).”

“Consistent with best practice recommendations, stimuli correct per trial were used (Conway et al., 2005; Kasper et al., 2012; Wells et al., 2018), and separate scores at each working memory set size were derived.”

“Several research findings support the technical adequacy of both the original digits backwards [63,64] and its Greek version [42,65,66].”

“Its reliability and technical adequacy in children are supported for both its original [70,71] and Greek version [72–74].”

“To measure updating, n-back tasks might be more adequate compared to complex span tasks, because a simple reversal of order might not be sufficient to tap updating processes (e.g., Wells et al., 2018).”

“For instance, some “working memory” tasks are assumed to successfully elicit working memory by design, despite evidence that some tasks are more sensitive than others (Conway et al., 2005; Jusko et al., 2021; Wells et al., 2018).”

“Therefore, future research should employ more accurate working memory measurement tools, such as the digit-letter sequencing task ( Wells et al., 2018 ), to further investigate the effects of motor-cognitive training on working memory.”

“47 Additionally, no between-group differences were observed in MBEMA-s score, a task designed to assess rhythm and melody perception.”

“…consistency ( 𝛼 = 0.82–0.97; Kofler et al., 2018); 1-to 3-week (0.76–0.90; Sarver et al., 2015) and 10-week (0.73–0.84; Kofler, Wells et al., 2020) test-retest reliability; and expected magnitude relations with working memory updating and complex span tasks ( r = 0.61–0.69; Wells et al., 2018).”

“…two scoring methods were then compared with measures of working memory commonly used in cognitive psychology and measures of Gf. Previous research demonstrated that utilizing partial scoring increased the relationship of DSB with other measures of working memory in children (Wells et al., 2018).”

“However, previous studies have demonstrated that differences in the way in which the backwards digit is administered can facilitate the engagement of working memory by providing more opportunity for children to recall sequences of greater list length (Wells et al., 2018).”

“DS-B, such as DS-F, is a test of short-term memory, but is more related to working memory [72].”

“Consistent with best practice recommendations, stimuli correct per trial were considered (Conway et al., 2005; Kasper et al., 2012; Wells et al., 2018), and separate scores at each word set size condition were derived.”

“Partial scoring methods employed in past work have yielded similar results when evaluating neurocognitive abilities of youth with ADHD (Tarle et al., 2017; Wells et al., 2018).”

“…in scores, both of which yield more accurate impairment estimates and provide useful information for research purposes (Conway et al., 2005; Engle et al., 1999; Gignac et al., 2019; Kasper et al., 2012; Kofler et al., in press; Rapport et al., 2013; Tarle et al., 2017; Wells et al., 2018).”

“Short-term memory, working memory capacity, and attentional control were evaluated using the Digit Span Test (forward, backward, and total scores) [13].”

“1,57 Further, the resting state neurophysiological activity patterns differ in children with neurodevelopmental disorders and typically developing children.”

“…and validity evidence includes high internal consistency (α = 0.81–0.97) and 1–3-week test–retest reliability (0.76–0.90; Kofler et al., 2019; Sarver et al., 2015), and expected relations with criterion working memory complex span ( r = 0.69) and updating tasks ( r = 0.61) (Wells et al., 2018).”

“For both forward and backward digit spans, the score was the total number of correctly recalled sequences, with a higher score indicating better performance [48,49].”

“Previous studies have shown that the DB subtest is closely correlated with executive function working memory, and the DF subtest is more strongly correlated with transient working memory (Conklin et al., 2000; Twamley et al., 2006; Wells et al., 2018).”

“57”

“Wells et al. (2018) found that particularly digit span backward scores on the WISC-IV failed to predict working memory deficits in 34 children with ADHD ages 8–13 ( M = 10.41; 11 girls), specifically due to the impact discontinue rule.”

“Reliability and validity evidence includes high internal consistency ( a = .82-.97; 66); 1-to 3-week ( r = .76-.90; 67) and 10-week ( r = .73-.84; 30) test-retest reliability; and expected magnitude relations with working memory updating and complex span tasks ( r = .61-.69; 68).”

“We measured digit span (DS) scores at baseline (pre-test) and post-test using forward and backward DS tasks, a widely validated measure of memory capacity [23, 43, 88, 92, 93, 102].”

“Short-term memory capacity was assessed using an adaptive version of a forward digit span task (Wells et al., 2018).”

“…as within the A1–A2 and C1–C2 groups, no statistically significant relationship was found between age and either the Backward Digit Span score or the Matrix Test results ( p > .05). memory because it requires both temporary storage and mental manipulation of auditory-verbal information [28, 29].”

“The digit backwards span task assesses working memory (Wells et al., 2018).”

“Forward digit span primarily reflects short-term verbal maintenance, whereas back-ward digit span additionally involves information manipulation and executive updating (Baddeley, 2003; Wells et al., 2018).”

“Digit Span Backward requires both the maintenance and mental reordering of information and therefore places greater demands on working-memory manipulation than Digit Span Forward [54].”