Training of Working Memory in Children With ADHD

“…A1 (continued) Study author & year Age (years) E (C) Design Participant characteristics Control treatment Program type Training duration Klingberg et al. (2002) 11.0 (11.4) Pre–post nonrandomized ADHD (mix of medicated and nonmedicated) Treated with computerized program (but for…”

“…evidence in the literature with older children who suffer from attention deficit hyperactivity disorder (ADHD) that using attention training methods can produce improvement in the ability to concentrate and in general intelligence (Kerns et al. 1999, Klingberg et al. 2002, Shavlev et al. 2003).”

“Investigators are already beginning to take advantage of this approach in investigating the impact of behavioral and cognitive interventions on developmental disorders such as dyslexia [51,52] and attention deficit‐ hyperactivity disorder [ 53 ].”

“Adaptive and intensive training of working memory over a 5-week period leads to improved performance and a generalization of the training effect to nontrained tasks that are related to working memory and reasoning and are known to activate the prefrontal corte”

“Second, the computer training not only improved performance on the trained games but also transferred to novel EF tasks, including inhibition tasks (Klingberg et al., 2002, 2005; Olesen et al., 2004), and working memory tasks (Thorell et al., 2008).”

“The finding of a significant effect of WM training on non-trained WM tasks within both the spatial and the verbal domains is in line with previous studies of WM training in school-aged children (Klingberg et al. , 2002, 2005).”

“Klingberg, Forssberg, and Westerberg (2002) provided memory training to both children with attentiondeficit/hyperactivity disorder (ADHD) and to adults and found marked improvement in performance on Raven’s Progressive Matrices for both groups.”

“The largest effect size for working memory training on nonverbal ability came from the earliest study (d = 2.18; Klingberg et al., 2002), which included only 7 subjects in each of the training and control groups.”

“Other forms of attention training for children with ADHD have also improved performance on abstract reasoning as measured by Raven’s Progressive Matrices ( Klingsberg, Forssberg, & Westerberg, 2002 ), suggesting that training of attention may benefit cognitive functioning extending over a range of tasks.”

“01) but showed less gain in training [t(30) = 3.”

“Furthermore, the fact that changes in horizontal connectivity may be the basis of practice-related changes in primary cortex is concordant with the observation that experience produces increases in dendritic length in posterior cortex, as discussed above (Kolb and Gibb, 2002).”

“As mentioned earlier, there is evidence that core training can reduce the symptoms of ADHD (Klingberg et al., 2002, 2005).”

“An interesting new direction for improving the likelihood of transfer effects is the incorporation of neuroimaging data to identify core mental processes that operate in multiple task domains, which can then be targeted by cognitive interventions in one task context and assessed for improvement in another (Dahlin et a…”

“% ADHD-C ADHD Diagnostic method SES Eth S A Edu IQ O Kovner et al. (1998) 29 33.”

“Two of the significant transfer studies in the review (Klingberg et al., 2002; Olesen et al., 2004) had training group samples of n 4 and 3, respectively.”

“Because the functioning of the underlying neural systems is so intimately interconnected, improvements in one area may confer benefits to other areas of functioning (ie, cognitive, behavioral, or emotional functioning; see, for example, Klingberg, Forssberg, & Westerberg, 2002 ); conversely, deficits in one area may d…”

“Intervention and treatment studies have begun to take advantage of this approach, by examining how cognitive and pharmacological interventions influence neural recruitment in developmental disorders such as dyslexia [47 ,48] and attention deficit hyperactivity disorder [49,50].”

“Adaptive training (e.g., individualized adjustment of task difficulty levels) is known to contribute to the efficiency of memory training and to allow individuals to make optimal use of their latent potential (Baltes et al., 1989; Klingberg et al., 2002; Brehmer et al., 2007; Hertzog et al., 2009).”

“In a study by Klingberg, Forssberg, and Westerberg (2002), increased performance after training was seen for both trained and nontrained visuospatial working memory tasks, as well as for a “far” transfer test (i.e., a reasoning task that did not closely overlap with the criterion task in terms of…”

“…training studies with young children indicate that the training is associated with fluid cognitive gains as measured by Raven's matrices test (Klingberg et al. 2002) and the matrices section of the Kaufman Brief Intelligence Test (Posner & Rothbart 2004) but not on other aspects of cognition.”

“Earlier studies of the computerized method for WM training in children with attention deficit hyperactivity disorder (ADHD) [27, 28] and in healthy adults [29] showed that: (a) training can increase WM capacity [27–29], (b) training-induced changes in brain activity occur [29], and (c) that training effects can be gen…”

“…Jonides, & Shah, 2011a; Jaeggi, Studer-Luethi, Buschkuehl, Su, Jonides, & Perrig, 2010; Jausovec & Jausovec, 2012; Klingberg et al., 2005; Klingberg et al., 2002; Rudebeck, Bor, Ormond, O’Reilly, & Lee, 2012; Schmiedek, Lövdén, & Lindenberger, 2010; Schweizer, Hampshire, & Dalgleish,…”

“Brain activity in the superior frontal sulcus, intraparietal and inferior parietal cortex has previously been correlated with WM capacity in a subgroup of the subjects in this study [32].”

“Importantly, transfer of WM and EF training was not only present in healthy subjects but also in children suffering from ADHD (Holmes et al., 2009; Klingberg et al., 2002, 2005; Kray, Karbach, Haenig, & Freitag, 2012), intellectual disability (Söderqvist, Nutley, Ottersen, Grill, & Klingberg,…”

“Klingberg and colleagues for example were able to show that WM training with children diagnosed with attention deficit/hyperactivity disorder (ADHD) not only leads to performance improvements in the trained task but also improves other nontrained WM tasks and even matrix reasoning ( Klingberg et al, 2005 ; Klingberg,…”

“…1 Department of Psychology, ÅboAkademi University, Turku, Finland 2 Turku Brain and Mind Center, University of Turku, Turku, Finland 2008, 2010; Klingberg et al., 2002, 2005; Kundu, Sutterer, Emrich, & Postle, 2013; Lilienthal, Tamez, Shelton, Myerson, & Hale, 2013; Oelhafen et al., 2013;…”

“After removal of the effect sizes of the studies by Klingberg et al. (2002) and Schmiedek et al. (2010), there was a nonsignificant small effect, g D 0.01, 95% CI [¡0.03, 0.23], p D .13.”

“This may be particularly fruitful because cognitive rehabilitation programs can remediate executive dysfunction in ADHD (e.g., Klingberg et al. 2002), stroke (Westerberg et al. 2007), and aging (Richmond et al. 2011).”

“WM training studies on clinical samples such as individuals with ADHD (e.g., Holmes et al., 2010; Klingberg et al. 2002, 2005), acquired brain injury (Lundqvist, Grundström, Samuelsson, & Rönnberg, 2010), stroke (Westerberg et al., 2007), or problematic drinking behavior (Houben, Wiers, & Jansen,…”

“In contrast to Klingberg et al. (2002), they did not find significant improvements on motor activity.”

“Although some previous EF training studies in children with ADHD have found differential effects on interference control [23], [30] ([85] and [86] also found differential effects on the STROOP, but they only used the incongruent trials as outcome measure; baseline response times to congruent trials were not controlled…”

“Our results replicate previous findings that it is possible to train WM, and that it transfers to non-trained WM tests (Holmes et al., 2009; Klingberg et al., 2005; Klingberg et al., 2002; Thorell et al., 2009).”

“Several studies have provided evidence for the effectiveness of CogMed training in children with ADHD (e.g., Klingberg et al., 2002, 2005).”

“See Klingberg, Forssberg, and Westerberg (2002) and Olesen et al. (2004) for a detailed program description.”

“We have recently been able to show that this training could improve WM in children with Attention Deficit Hyperactivity Disorder (ADHD), and that this also ameliorated the ADHD symptoms [17,18].”

“Recent studies also show that children with ADHD (attention-deficit/hyperactivity disorder) may benefit in their behavior and school results from working memory training (Klingberg, Fernell, Olesen, Johnson, Gustafsson, Dahlstro ¨m, et al., 2005; Klingberg, Forssberg, & Westerberg, 2002 ).”

“However, in reference to the Stroop tasks that were used in several of these studies (i.e., Klingberg et al., 2005, 2002; Olesen et al., 2004), Klingberg (2010) states that " control congruent trials were not included . . . (p. 319) " .”

“Of the three studies involving ADHD, only two included measures of the ADHD symptoms that might have been alleviated by training (e.g. Klingberg et al, 2002; Klingberg et al., 2005).”

“A recently developed training method (Klingberg et al., 2005; Klingberg, Forssberg, & Westerberg, 2002) demonstrated that intensive computerized training of working memory (WM) gradually increased the amount of information that children with ADHD can keep in WM. Posner and Rothbart (2005)…”

“WM training has been repeatedly shown to lead to improvements on measures of reasoning/fluid intelligence (Jaeggi et al., 2008, 2010; Klingberg et al., 2002, 2005), although other groups have reported negative or only trend improvements (Chein & Morrison, 2010; Dahlin, Nyberg, Backman, & Neely,…”

“For example, recent attempts to use working memory interventions in old adults that have shown some success in young adults and children (e.g., Klingberg et al. 2002) seem to have only very limited success in old adults (see Mayr 2008).”

“…attention (Ben-Yishay et al. 1987 ) and more complex components of attention (Kerns et al. 1999; Sturm et al. 1997), as well as working memory (Klingberg et al. 2002, 2005), neuropsychological measures (Ethier et al. 1989; Gray et al. 1992; Sohlberg and Mateer 1987), and academic performance…”

“There are reports of successful transfer of WM training in patient groups with ADHD [54,60] or stroke [61], or in particularly younger or older populations (e.”

“A within-person replication of the training results with four typically developing adults also indicated posttest gains on the Raven's associated with the fluid skills training program (Klingberg et al., 2002).”

“The findings were later replicated in healthy adults (Olesen, Westerberg, & Klingberg, 2004; Westerberg & Klingberg, 2007), although both studies were unclear about the possibility of improvements due to test–retest effects (Shipstead, Redick, & Engle, 2010).”

“Thus, a test prior to programming education [48, 41] might reveal which students might struggle with learning programming.”

“Klingberg, Forssberg, and Westerberg (2002) and Klingberg et al. (2005) observed improvements in matrix reasoning tasks besides reduced inattentive symptoms in childrenwith Attention Deficit Hyperactivity Disorder (ADHD).”

“Rutledge KJ, van den Bos W, McClure SM, Schweitzer JB. Training cognition in ADHD: current findings, borrowed concepts, and future directions.”

“The mismatch hypothesis might therefore explain why adaptive training can be more successful than non-adaptive training (Klingberg et al., 2002, 2005; Holmes et al., 2009a; Bergman Nutley et al., 2011).”

“Such continuous engagement of executive processes, especially WM, during training has also been proposed to account for the transfer gains to Gf [6,23,27].”

“This suggests that training was responsible for the observed delayed transfer effect, a result that supports other work showing the utility of CT using adaptive WM training tasks to cause improvement in WM (Klingsberg et al., 2002; Olesen et al., 2004; Jaeggi et al., 2008).”

“A computerized training program (Robomemo) has been used to train WM in children and young people [29, 30].”

“…of EF (namely, working memory) have also been shown to be effective in reducing symptom severity and improving working memory in children with ADHD (Klingberg et al. 2002; Klingberg et al. 2005); one study showed increases in prefrontal and parietal activity during working memory tasks after…”

“Other studies have reported gains in fluid intelligence after training WM (Klingberg et al., 2002, 2005; Jaeggi et al., 2008) or non-verbal reasoning (Bergman Nutley et al., 2011; Mackey et al., 2011), although the transfer effects from WM to reasoning tests are smaller and inconsistent across…”