Working memory: The The ability to simultaneously hold and … Files/Cog… · Working memory: The ability to simultaneously hold and manipulate information in the mind Cogmed Coach

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The Research behind

Cogmed

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Working memory:

The ability to simultaneously hold and manipulate information in the mind

Cogmed Coach Conference 05/09/14 Dr Izabela Walters

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Short term memory & working memory

Short term memory – the ability to hold information over a period of secondse.g.: repeat a sequence of digits or blocks

Working memory – the ability to hold and manipulate information

Short term memory capacity limits working memory performance: you need to be able to hold information before you can manipulate it

Cogmed Coach Conference 05/09/14 4

Executive function and working memory

Executive functionThe ability to:• start and stop behaviour

• Inhibit inappropriate behaviour• Change behaviour

• Plan and organise behaviour• Adjust behaviour in response to the environment

• Use feedback• Control attention (direct, ignore, shift)• Behave in a socially appropriate manner

Working memory is needed for some executive functions, e.g. planning, controlling attention

Cogmed Coach Conference 05/09/14

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Impulsivity and working memory

ImpulsivityReacting to stimuli without forethought.

Can be the result of executive dysfunction (inability to control attention), and be present without working memory dysfunction

Can co-exist with working memory impairment• controlled/top-down attention and working memory areas

overlap in the brain• Impulsive behaviour can result from the

inability/unwillingness to exert cognitive effort (working memory tasks are effortful)

Cogmed Coach Conference 05/09/14

Fluid intelligence and working memory

Fluid intelligence:Capacity to reason and solve problems in novel situations

Intelligence:• ‘What the intelligence tests measure’• it is correlated with academic capacity and the ability to solve

problems.

Consists of fluid intelligence, crystallised intelligence (fund of acquired knowledge), working memory, and speed of information processing.

• Working memory is related to intelligence – it is a part of it• Working memory can help with fluid intelligence tasks (bigger

space for reasoning), but it is not the same thing

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What it is not:

”..working memory capacity is the same as central executivecapability, controlled attentionand general fluid intelligence”

(Engle, Kane, Tuholski, 1999)

If you define working memory as all of the above, you lose the ability to clearly describe it, to assess it and to selectively treat it. Working memory is related to all these functions, but it is NOT these functions.

Cogmed Coach Conference 05/09/14 Dr Izabela Walters

Newer Views of WM• Modality specific views of WM are beginning to change - There may

not be different WM functions for visual or verbal stimuli

• Capacity size and time dependent views of WM are changing…It is not about “size of WM space”, nor “decay of memory traces”

• Cognitive control mechanisms are the new keys to WM – ability to overcome interference from distracting stimuli and successfully complete the steps of the reasoning process, monitor their own performance, backtrack from wrong paths, etc. • This suggests that individuals with low WM may be able to

compensate through sustained effort • Must refresh and retrace their steps in the reasoning process

more frequently)• Requires “drive to task mastery”, and persistence or “grit”.

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Working memory is limited

Working memory can be improved with focused, specific and intensive training

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Not all computerised wmtraining programs are the sameMany programsCogmed (Klingberg et al 2005)Jungle Memory (Alloway 2012)CogniFit (2008)N‐back training (Jaeggi et al 2008)Complex span training (Chein & Morrison 2010)

12 September 2014

Not all computerised wmtraining programs are the same

Many reviews:

A working memory training program can improve performance on non‐trained working memory tasksSystematic reviews: Chacko et al 2013, Melby‐Lervåg & Hulme 2013Narrative reviews: Morrison & Chein 2011, von Bastian & Oberauer 2013Meta‐analysis on Cogmed and inattention, Spencer‐Smith et al 2015Review in Science Diamond & Lee 2011, Interventions shown to aid executive function development in children 4 to 12

Understanding the ResearchCogmed (vs. everything else)

What sets Cogmed apart?• Solely simple and complex WM span tasks

o vs. mixed bag, unfocused training• Defined, sustained, and intense training protocol

o vs. train as you like• Coach driven methodology/professional support

o vs. poor or undocumented compliance and motivation

Melby-Lervåg & Hulme (2012) conducted a meta-analysis about WM training –just 8 out of 30 group comparisons were from Cogmed studies.

Measure Effect Size (d)

Mean VS WM 0.52

Cogmed VS WM 0.86

Mean Verbal WM 0.79

Cogmed Verbal WM 1.18

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Bacon Causes Cancer? Sort of. Not Really. Ish.

http://www.wired.com/author/sarahzhang/

Key questions1. What does it mean to be “evidence-based”?

2. Does training improve working memory?

3. Does the training generalise beyond trained tasks to non-trained tasks?

4. Are the gains sustained?

5. Can working memory training improve literacy and numeracy outcomes?

• Based on a scientific discovery

• Validated by independent researchers

• Data presented worldwide at conferences

• Studies published in peer-reviewed journals

• Validated by use in clinical (real world) setting

Embracing the term: What do we mean by evidence-based cognitive training?

Cogmed and the world of academic research: An important relationship

Original idea, prototype and funding from Karolinska Institute• Company founded by research team: Klingberg, Westerberg and developers

Company was funded by Karolinska Development AB (2001- 6/28/2010)• A fund investing only in products stemming from academic research

Klingberg independent of Pearson• Professor of Cognitive Neuroscience at Karolinska

The research published to date generates much interest• Cogmed gets research proposals from around the world

Research collaborations are a key part of strategy• Simple relationship: no payments from Cogmed, publishing freely

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How Cogmed is different to other “brain training” programs that claim to be evidence-based

• Cogmed is very careful about aligning claims with evidence

• The cognitive effects associated with Cogmed training have been demonstrated in 80+ peer reviewed published studies by many independent research groups from around the world

• Those studies all involve testing the efficacy of Cogmed – the same program used by clinicians and schools

• NOT: quote from a single scientist, “developed by neuroscientists”, based in findings from a single study, based on proprietary in-house studies

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General quality of research

For a study to be considered to be of sufficient quality to contribute to a claim, the criteria listed below must be met

• Reliable and valid outcome measures• Design that supports the hypothesis• Statistical methods that support the question being investigated• Study on recommended population according to Cogmed training

manual - exclusions• Implementation with high fidelity to Cogmed recommendations

regarding coaching method, study population, and high quality of training

What does Cogmed Claim?1) CWMT leads to sustained improvements in working memory, from childhood to

adulthood

2) CWMT leads to sustained improvements in attention seen in both subjective and

objective measures of attention

3) Improvements in working memory following CWMT are associated with changes in

functional brain activity related to working memory and functional connectivity at rest

4) Learning outcomes in reading and math improves for many students following CWMT

5) In clinical trials, CWMT has been shown to improve attentional problems in many with

ADHD

6) Research studies of CWMT report improved cognitive functioning in daily life 7) Adults

with acquired brain injury report reductions of symptoms after CWMT in clinical trials

8) Improvements on measures of cognitive control have been demonstrated in studies

after CWMT

How do you measure the efficacy of an evidence-based program?

Performance on the training tasks

Performance on tasks similar to the training tasks

Performance on tasks that rely on skills trained

Performance in daily life

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Research discovers working memory can be improved

Led by neuroscientist T.Klingberg, MD, PhD

The findings challenged for the first time the long-held assumption that working memory is a fixed characteristic, unable to be changed.

ReplicationKlingberg replicates first study in placebo controlled,

multicenter trial - drawing attention to WM training(Klingberg et al., 2005)

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Population: N = 53 children with ADHD (combined & inattentive), ages 7 -12 years,

no stimulant medication

n = 24 in adaptive Cogmed training group n = 26 in non-adaptive (placebo) Cogmed training groupn = 3 withdrew

Design: Multi-site, randomized, placebo controlled, double-blinded, test-retest

T1= Baseline, T2 = Post-test, T3 = 3 month follow up

Results:

Treatment group improved significantly over active control on outcomes measures:1) Non practiced visuo-spatial WM task (Span Board; WAIS-RNI)2) Non practiced verbal WM task (Digit Span; WISC-III)

Computerized training of working memory in children with ADHD: a randomized, controlled trial

Klingberg et al., 2005

Computerized training of working memory in children with ADHD: a randomized, controlled trial

Klingberg et al., 2005

“…This study shows that WM can be improved by training. In addition, we saw effects on reasoning, response inhibition, and a

decrease in parent-rated symptoms of ADHD.…”

1. Expands on Klingberg et al.,2002 – replication

2. Placebo condition (low dose training)

3. Multi-site, Randomized, Double -blinded, Placebo controlled

4. Published in leading peer-reviewed journal (JAACAP)

5. Shows results remain after 3 months

6. Shows effects on parent ratings (blinded)

7. Shows effects on neuropsychological tests (attention and impulse control)

8. Shows improvement on complex problem solving

9. Does not show significant effects on teacher ratings or head movement

SummaryKlingberg et al., 2005

Other Studies showing generalised effects of CWMT

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Does training improve working memory?

• ’’ . . . results of individual studies encourage optimism regarding the value of WM training as a tool for general cognitive enhancement’’ (Morrison & Chein, 2011, p. 46).

• Diamond and Lee (2011) specifically described Cogmed as both the most researched approach of computerized training and ‘‘one repeatedly found to be successful’’ and concluded that Cogmed improves WM and executive functions.

• ‘‘WM training programs produced reliable short-term improvements in both verbal and visuospatial WM skills’’ (Melby-Lervag & Hulme, 2013, p. 270).






How do we monitor progress? Questionnaire

Sources:- 4-17yo: DSM-IV ADHD (attention) scale- Intrinsic Motivation Inventory (IMI)

Pre: Prior to Day 1 CPI and Training, during Start-Up Session with CoachPost: Available to complete after 80% of training has been completed

Captures users perspective of their Attention in everyday life

Expectations for CWMT, Areas they would like to improve

Training Details

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Cogmed Progress Indicator (CPI)

• Protocol– Math, Working memory, Instructions tasks– Embedded in program, PRIOR to training– Math challenge (auto/manual removal)– CPI has cognitive load– Best performance out of Days 1 and 2 used as

Baseline Measure – Occurs on 6 sessions (occurrence depends on

training protocol selected)

• Purpose– Provides quantitative measure of training effect– Assess with non-trained working memory tasks– Track cognitive change as it occurs

Day 1 & 2 10 15 2520

Children improve math, attention and instruction-following up to six months after Cogmed

Holmes et al., 2009

Forty-two children screened for working memory deficits were randomly assigned to high or low intensity training conditions.

Holmes, J., Gathercole, S.E., & Dunning, D.L. (2009). Adaptive training leads to sustained enhancement of poor working memory inchildren. Developmental Science, 12(4), F9 -F15. doi: 10.1111/j.1467-7687.2009.00848x

• 42 children, aged 8-11 years, with low working memory – Identified via routine screening of 345 children on two verbal wm tasks (Listening

Recall and Backward Digit Recall) as per Gathercole et al., 2006– Scores <86 on both tasks (bottom 15th centile)

• Controlled– Adaptive, standard version of training program

• training at maximum span level– Non-adaptive, control condition

• training at fixed span level of two

• Assessments: Pre- and post-training– Working Memory (AWMA; Alloway, 2007), – IQ (WASI; Wechsler, 1999), – basic reading ( WORD; Wechsler, 1993), – mathematical reasoning (WOND; Wechsler, 1996), – following instructions task (Gathercole et al., in press)

Adaptive training leads to sustained enhancement of poor WM in childrenHolmes et al., 2009

Enhancing poor WM in children with low WM Developmental Science Holmes et al., 2009

Instruction task (Gathercole et al.): practical, real world assessment of WM capacity in classroom setting

Child placed in front of an array of props (rulers, pencils, etc.) in a range of colors and asked to follow set of instructions

Instructions designed to mimic span method with increasing number of instructions until child cannot perform task accurately.

Take home: Cogmed improves WM capacity, attention, instruction following and math ability in school children with low WM.

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Restricted Academic Situations Task (RAST)

• 5 categories of behavior associated with ADHD scored at 30 sec intervals

• Given toys to play with for 5 minutes; examiner puts toys to the side , participants asked to complete easy math packet for 15 minutes while videotaped

• Good indicator of behavioral responses to ADHD stimulant medication

• Consistent with externalizing teacher ratings and actometer measures of ADHD

• Objective measure and sensitive to moment-to-moment changes in “off-task” behavior

Will working memory training generalize to improve off-task behavior in children with Attention-Deficit/

Hyperactivity Disorder?Green et al. 2012

Green et al 2012Publication: Neurotherapeutics Institution: University of California, Davis Investigator(s): Chloe T. Green, Debra L. Long, David Green, Ana-Maria Iosif, J. Faye Dixon, Meghan R. Miller, Catherine Fassbender, Julie B. Schweitzer

• Randomized, placebo controlled, double-blinded study of 26 children with ADHD first known research to demonstrate the impact of WM training on an ecologically valid measure of observable ADHD-associated behaviours - RAST

• Children who trained with the standard Cogmed program (adaptive WM training) improved significantly over children in the placebo group (non-adaptive WM training) on non-trained, widely used, standardized measures of WM (Digit Span and Letter-Number Sequencing; WISC) and on measures of the Restricted Academic Setting Task (RAST) that related to attention.

Reciprocal Relationship between WM, Anxiety and Learning

• 5% of children and young people experience clinical levels of anxiety

• Negative emotional states are associated with lowered performance

• Strong association between anxiety and executive functions (i.e. inhibition, set-shifting and updating information in working memory)

• Negative affect and academic performance in school is mediated or moderated by WM functioning or attentionalprocessing

>> Increasing academic performance via improvements in WM may reduce feelings of negative affect

The impact of working memory training in young people with social, emotional and behavioural difficulties L. Roughan, J.A. Hadwin / Learning and Individual Differences 21 (2011)

This study examined the impact of working memory training in 65 typically developing 4-5 year-old children.

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Training and transfer effects of executive functions in preschool children Thorell et al., 2009

Population: N =65 typical children, ages 4-5 years

n = 16 children in Cogmed training group(Cogmed JM – visuo-spatial only)

n = 17 children in inhibition training group

n = 13 children in active control group(commercial video game)

n = 16 children in passive control group

* 3 children excluded

Design: Random assignment by school, active controlled, double-blinded, test-retest

Compare training methods (all 5 days/week, 15 min/day, 5 weeks)

T1 = baseline, T2 = post-test

Go/No-Go:

Inhibition of a prepotent motor

responseStop-Signal:

Stopping of an ongoing response

Flanker: Interference control

Training and transfer effects of executive functions

in preschool children (II)

Thorell et al., 2009

Cogmed training group improved significantly over the control groups on:

1) Trained and non-trained visuo-spatial WM tasks (Span Board (ES = .89) ; WAIS-R-NI )

2) Trained and non-trained verbal WM task (Word Span (ES = 1.15))

3) Attention (Go/No Go – omission (ES = .74) & Auditory CPT – omission (ES = .52))

No significant difference between Cogmed and control groups on problem solving, inhibition or response speed

Training and transfer effects of executive functions in preschool children (III)

Thorell et al., 2009

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12 September 2014

A systematic review and meta-analysis of the benefits of Cogmed for inattention in daily life

Megan Spencer-Smith & Torkel Klingberg

Identified studies

12 September 2014

Study Participants Risk of bias Control group

Training site

Time of testing post‐training

Outcome measures

Age in years

Status Recruitment source Design Blindinga) Rater b) Tester

Immediate

Delayed Inattention in daily life (rater)

Visuospatial WM Verbal WM

Bjorkdahl2013+*

22‐63 Brain Injury + impaired WM

Outpatient rehabilitation clinic

RCT a) NRb) NR

Passive NR 1 week 3 months Working memory questionnaire (self)

none WAIS‐III Digit span backward

Beck 2010* 7‐17 ADHDb Private school for students with ADHD and/or LD

RCT a) pre trainingb) NR

Wait‐list Home 1 month 4 months DSM‐IV Inattention (parent)

none none

Brehmer2012

a) 20‐30b) 60‐70

Healthy Newspaper advertisement RCT a) yes b) yes

Active and non‐adaptive

Home NR 3 months CFQ (self) WAIS‐R Span board backward

WAIS‐R Digit span backward

Chacko 2013a 7‐11 ADHD Newspaper advertisements

RCT a) yesb) yes


Home 3 weeks none DBD Inattention (parent)

AWMA Spatial recall AWMA Listening recall

Egeland 2013 10‐12 ADHDb Outpatient clinics at two hospitals

RCT a) NRb) Yes

Wait‐list School NR 8 months DuPaul Inattention (parent)

none none

Green 2012 7‐14 ADHDb, c Advertising, psychologists, psychiatrists, institute tracking

RCT a) yesb) Yes


Home NR none Connors ADHD (parent)

none none

Gropper 2013 19‐52 LD/ADHDb Student Disability services at 3 post‐secondary institutions

RCT a) NRb) NR

Wait‐list Home 3 weeks 2 months CFQ (self) CANTAB Spatial WM (errors)

WISC‐IV Digit span

Grunewaldt 2013

5‐6 VLBW Admission records of a hospital NICU

RCT a) NRb) Yes

Wait‐list Home 1 month none DuPaul Inattention (parent)

Spatial span backwarda

Digit span backwarda

Hardy 2013 8‐16 Cancer Patients of the hospital Division of Pediatric Hematology‐Oncology

RCT a) yesd

b) YesActive and non‐adaptive

Home NR 3 months Connors Inattention (parent)

WRAML Symbolic WM

WRAML Verbal WM

Klingberg 2005

7‐12 ADHD Referrals from pediatricians, psychiatrists, special school teachers

RCT a) yesb) yes


Home or school

NR 3 months DSM‐IV Inattention (parent)

WAIS‐R Span board WAIS‐R Digit span

Roughen 2011

15‐17 SEB Schools RCT a) nob) NR

Passive School 3 weeks 3 months DuPaul AttentionalControl (teacher)

none none

Westerberg 2007

34‐65 Stroke Stroke Rehabilitation Unit RCT a) pre training b) pre training

Passive Home NR none CFQ (self) WAIS‐R Span board WAIS‐R Digit span

Benefits of a Working Memory TrainingProgram for Inattention in Daily Life: ASystematic Review and Meta-Analysis

"Benefits of a WM training program generalise to improvements in everyday functioning. Initial evidence shows that the Cogmed method has significant benefits for inattention in daily life with a clinically relevant effect size"

Megan Spencer-Smith, Torkel Klingberg. PLoS ONE 10(3): e0119522

• Efficacious method with meaningful results: not all WMT approaches/programs are the same.

• The Gold Standard of Research: clear information about the inclusion criteria for the study. Analyses summarizing the effects from 12 randomized controlled trials, studying the effects related to Cogmed working memory training.

• Relevant size: Cogmed WMT has a significant (i.e. moderate) effect on inattention in daily life, an important piece of far transfer. Effects were in the moderate range (0.40-0.66), considered relevant in the education domain .

• Sustained effects: Effects on everyday attention are shown to be largely sustained.

• Cogmed is good for all: (not just ADHD)

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Children improve math, attention and instruction-following up to six months after CogmedHolmes et al., 2009

Forty-two children screened for working memory deficits were randomly assigned to high or low intensity training conditions.

Holmes, J., Gathercole, S.E., & Dunning, D.L. (2009). Adaptive training leads to sustained enhancement of poor working memory inchildren. Developmental Science, 12(4), F9 -F15. doi: 10.1111/j.1467-7687.2009.00848x

Pre- training WM scores for non-adaptive (placebo) group

Holmes et al., 2009

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Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM

Pre- Post-

Slide courtesy of Dr. Joni Holmes

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Verbal STM Visuo-spatialSTM

Verbal WM Visuo-spatialWM

Pre- Post-

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Pre- training to post-training WM scores for non-adaptive (placebo) group

Holmes et al., 2009

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Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM

Pre-Post-


Pre-training WM scores for adaptive (treatment) group

Holmes et al., 2009

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Pre-Post-Follow-up

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Pre- training to post-training WM scores for adaptive (treatment) group

Holmes et al., 2009

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Pre-

Post-

Follow-up*

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Slides courtesy of Dr. Joni Holmes

Pre- training to follow up WM scores for adaptive (treatment) group

Holmes et al., 2009

Children with low WM improve attention and math up to six months after training

Holmes et al., 2009

“…This study provides the first demonstration that these commonplace deficits and

associated learning difficulties can be ameliorated, and

possibly even overcome, by intensive adaptive training

over a relatively short period: just 6 weeks, typically…”

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Are the gains sustained? Is it realistic to expect that gains are sustained beyond 6-12 months?Compare to • Medication• CBT• ExericiseYou do use your working memory all the timeFocus on how you make the best of that opportunity

“Cogmed 'creates an opportunity for change' but the ultimate benefit depends on how that opportunity is used - e.g. to build literacy, social skills, lifestyle habits, resilience and so on. The extent to which it works cannot be separated from the support, the rewards, the matching content that the school and/or coaching environment can provide”.






WM is important for successful learning in individual classroom activities (Gathercole & Alloway, 2008):

WM loads of many classroom activities are too high, so children with poor WM: forget crucial information & fail to successfully complete tasks

This leads to frequent lost learning opportunities and consequently slow rates of learning

Why study WM in children? Joni Holmes Ph.D

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Improving Working Memory – Supporting Student learning – Tracy Packiam Alloway 2011

Interconnected Systems Supporting Learning

Knowledge base (LTM)

*largely mediated by language

Performance‐based factors

*working memory

Immediate and delayed effects

In recent years, academic performance has been measured in an increasing number of studies following CWMT. • Some studies have shown significant academic improvements

directly following CWMT (13, 35, 43)

• while others have not seen any effects (7) or not shown statistical significance of the effects (32, 33), compared to a non-adaptive WM training group.

However, for those studies including follow up measures, there seems to be a pattern emerging showing delayed effects on learning outcomes following CWMT• RCT by Dunning et al (33), the effect size on reading rate went

from non-existent (d= 0.04) directly following training, to medium (d = 0.66) at the follow up one year later, compared to controls.

[Far transfer] Skill/behaviour

[Near transfer]Affects

Executive functions

Rate of learning Remembering directions

Attention/Concentration

Working memory Planning

Reading comprehension Maths skills On-task

behaviour

Initiate

Manipulating information

Task monitoring Organise

Language development

Working memory training acts on underlying levels

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Psychological Processes associated with academic learning (Dehn 2012)

Interactive Effects of Educational & Cognitive Deficits

Presentation Title runs here l 00/00/0066

• A synergistic model of cognitive information processing suggests that impairments which interfere with the rapid processing of information may burden the person’s working memory structures, and reduce his or her capacity for comprehension and new learning.

• These students fatigue easily, do not study long, and avoid stressful learning environments.

• This reduces access to the curriculum, and leads to falling further behind

[Dr Larry Weiss WISC-5 Handbook 2016]

Population: N =57 children w/ special needs, ages 9 – 12 years (grades 3 - 5)

n = 42 in adaptive Cogmed training groupn = 15 in passive control group [special needs class]*n = 25 w/ ADHD in non-adaptive Cogmed training group**

*Comparison of special needs students in adaptive Cogmed training group to passive control group of special needs students on literacy measures

** Comparison of special needs students in adaptive Cogmed training group to non-adaptive Cogmed training group from Klingberg et al., 2005 on cognitive measures

Design: Randomized, controlled, blinded, test-retestT1 = baseline, T2 = post-test (5-6 week after), T3 = 6-7 month follow-up

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I. Adaptive Cogmed training group improved significantly over non-adaptiveCogmed training group from Klingberg et al., 2005 :

1) Visuo-spatial WM tasks (Span Board – backwards and forwards; WAIS –NI) (T2 & T3)

2) Verbal WM tasks (Digit Span – backwards and forwards; WISC-III) (T2)

3) Nonverbal reasoning task (Raven’s Coloured Progressive Matrices (RCPM)) (T2)

4) Cohen’s d ranging from 0.67 to 0.98 (T2)

II. Adaptive Cogmed training group improved significantly over passive controlgroup on reading comprehension (Reading narrative texts & answering questions) (T2& T3) (d = 0.88 and 0.99 respectively)

III. Adaptive Cogmed training group improved significantly over passive controlgroup on a measure of math (Basic Number Screening TEST (BNST) at T2 (d = 0.69)and for boys only, at T2 and T3 (d = 0.74 and 0.90 respectively)

Summary: Dahlin (2011) and Dahlin (2013) Few Effects of Far Transfer of Working Memory Training in ADHD: A Randomized Controlled Trial Jens Egeland , Anne Kristine Aarlien, Brit-Kari Saunes 2013

Objective• Studies have shown that children with ADHD profit from working memory

training, although few studies have investigated transfer effects comprehensively. The current Randomized Controlled Trial analyses transfer to other neuropsychological (NP) domains, academic performance and everyday functioning at home and school.

Method• Sixty-seven children with ADHD were randomized into a control group or

a training group. The training group underwent Cogmed’s program. All participants were assessed pre-training, immediately after and eight months later with a battery of NP tests, measures of mathematical and reading skills, as well as rating scales filled out by parents and teachers.

Results• There was a significant training effect in psychomotor speed, but not to

any other NP measures. Reading and mathematics were improved. There were no training induced changes in symptom rating scales either at home or at school. The increased reading scores remained significant eight months later.

Conclusion• The study is the most comprehensive study of transfer effects to date,

and with mixed results compared to previous research. More research is needed regarding how to improve the training program and the conditions and thresholds for successful training.

2014 Update: Taking Working Memory training from the laboratory into schoolsJoni Holmes and Susan Gathercole, Educational Psychology 2013

• Whole class groups of students completed training at school• Groups chosen for low working memory>>>> Both groups showed same gains in working memory as 2009 Lab studies

Training gains for BOTH groups transferred to improvements in National Curriculum assessments in English and Maths

>>>> Working Memory training has the potential to transfer to educationally relevant measures of academic ability. “Educational gains and cost-savings of using working memory training as an early intervention could be immense”

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Working Memory Training is Associated with Long Term Attainments in Math and ReadingStina Söderqvist* and Sissela Bergman Nutley

Followed the academic performance of two age-matched groups during 2 years. As part of the curriculum in grade 4 (age 9–10), all students in one classroom (n = 20) completed Cogmed Working Memory Training (CWMT) whereas children in the other classroom (n = 22) received education as usual. Performance on nationally standardized tests in math and reading was used as outcome measures at baseline and two years later.

At baseline both classes were normal/high performing according to national standards.

At grade 6, reading had improved to a significantly greater extent for the training group compared to the control group (medium effect size, Cohen’s d = 0.66, p = 0.045).

For math performance the same pattern was observed with a medium effect size (Cohen’s d = 0.58) reaching statistical trend levels (p = 0.091).

Moreover, the academic attainments were found to correlate with the degree of improvements during training (p < 0.053).

>> Results suggest improved working memory boosts student’s capacity to learn

Roberts study 2016

Roberts, G., Quach, J., Spencer Smith, M., Anderson, P., Gathercole, S., Gold, L., Sia, KL., Mensah, F., Rickards, F., Ainley, J. & Wake, M. (2016). Working memory intervention does not improve long-term academic outcomes: A school-based population randomised controlled trial. JAMA Pediatrics

Objective: to investigate whether 6 year-old children at risk for academic underachievement, for whom approximately 20-25 hours of formal teaching was substituted with Cogmed working memory training (CWMT), would outperform children receiving formal teaching as usual on measures of academic performance two years later.

Important highlights

• Method – good numbers and controls – we need more studies like this• Feasibility – population based assessment and training can be administered• Sustained effects on memory – yes to 12 months, not significant at 2 years• Academic outcomes – training group did not outperform control group on academic measure (WRAT4)• Importance of age – Is 6-7 a good age for training?

Limits to consider

• How school outcomes measured – strong conclusions? Based on one academic measure, variability of baseline at age 6 not measured but very important

• Intent is not to replace classroom learning• Screening - Academic performance was in the normal range, Was WM perhaps not the only bottleneck for

academic growth in a large portion of the sample?• Reported on completion of training vs quality and intensity of training – coaching and effort matters• Choice of product and protocol

Q1. Did students in this study, who trained with Cogmed at school, improve their working memory?Yes. Students that trained with Cogmed RM had significantly higher verbal WM visuo-spatial short term memory compared to the passive control at 6 months following training. Gains in visuospatial short term memory were also maintained at 12 months post-training but these improvements were no longer statistically significant 24 months post training.

Q2. If the students in this research did not experience improvements in maths or reading, does this mean Cogmed does not lead to gains in academic performance in general? This study does not answer that question. Neither does any single study. Results need to be replicated in order to be generalisable.

Further research will be done by this group to explore who training was successful for. 6 year olds may differ more in their early learning of reading and maths for other reasons (e.g. phonological awareness, vocabulary, number and letter knowledge etc.) than their different WM capacities.

Cogmed and academic change?

Factors that determine improvements on academic performance after training with Cogmed are yet not entirely understood • age at which the training is implemented • instruments used to assess the academic change

(school tests or ability tests) • the comparison condition (in this case the control group

received >20 hours more of formal education) • the degree to which working memory is taxed in those

particular tests • the maintenance of the improved working memory and

how it is utilized in learning post training

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Clinical and real world data counts too72% of schools who used Cogmed in ANZ in 2014 renewed in 2015

5/3/201678 Cogmed Coach Conference 19/07/13CogCon AUNZ 201378

Time Taken (Initial Review to Completion 8.2, 8.5)

Dr Jason McGowan, Child Development Centre

5/3/201679 Cogmed Coach Conference 19/07/13CogCon AUNZ 201379

Gain in Reading Age (20, 25 months)

Dr Jason McGowan, Child Development Centre 5/3/201680 Cogmed Coach Conference 19/07/13CogCon AUNZ 201380

Change in Reading Rate (2.6, 3.2 months / month)

80 Dr Jason McGowan, Child Development Centre

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+

Design: Randomized, Controlled, Test-Retest, 6 Month Follow Up

Sample: N = 245, 7th graders, at least 1 year behind in reading

Additional Data: SAT 10 (Reading), STAAR (Texas State Assessment), Demographics

T1April 2014

Intervention Phase I

T2 May 2014

T3 August 2014

InterventionPhase II

T4December 2014

CPI/CQBASC-2ParentBASC-2 TeacherBASC-2 StudentGRADE (Reading)

Cogmed CPI/CQBASC-2Student

CPI/CQBASC-2 ParentBASC-2TeacherBASC-2 StudentGRADE (Reading)

iLit CPI/CQBASC-2 ParentBASC-2TeacherBASC-2 StudentGRADE (Reading)

Passive iLit

Passive Passive

Cogmed Slide Library 2014

https://www.youtube.com/watch?v=8UXLSvXF8vQ

Future research – questions Do benefits persist?

Can the benefits be enhanced?e.g. Cogmed Plus

Can a reduced training schedule produce benefits?

What individual characteristics are important for benefits? Motivation (Martinussen et al 2005, Nymberg et al under review) ADHD comorbidity such as ODD (Chacko et al 2013) Age (Brehmer et al 2012)

12 September 2014

Implementing a Working Memory Program At Your School

Next webinar: Tuesday 21 June @ 12.30-1.30 (AEST)

See a recording of webinar at:www.pearsonclinical.com.au/archive

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Presentation Title runs here l 00/00/0085

Perth – Pan Pacific HotelFriday 19th August

Brisbane – Pullman HotelWednesday 17th August

Register by 24th June to receive the early bird price of $379 (Incl. GST)

Go to pearsonacademy.com.au

Documents

Working memory: The The ability to simultaneously hold and … Files/Cog… · Working memory: The ability to simultaneously hold and manipulate information in the mind Cogmed Coach