Program

Sep 29, 2017

OVERVIEW

Cogmed Working Memory Training (CWMT) is a computerized training program that aims to improve memory among children with Attention-Deficit Hyperactivity Disorder (ADHD). A randomized controlled trial conducted with seven- to 11-year-old school children, comparing children who participated in the CWMT program and with children participating in a low-level memory training control program, found that participation in CWMT was associated with improvements in recall of visual and auditory stimulants.

DESCRIPTION OF THE PROGRAM

Target population: School-age children with ADHD

Cogmed Working Memory Training (CWMT) is a computerized training program that aims to improve ADHD symptoms by impacting memory and storage plus processing, which is listening and recalling, of verbal and nonverbal working memory, through 30 to 45-minute-long trainings. The CWMT program consists of 25 trainings, with five trainings a week for five weeks. CWMT participants are paired with a coach who tracks individual progress, and parents or guardians are identified as training aides for the participants. The coach also provides weekly updates for the family by phone. The intervention is implemented to be adaptive to everyone’s level and the tasks difficulty levels are adjusted on a trial-by-trial basis.

EVALUATION OF PROGRAM

Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., … & Ramon, M. (2014). A randomized clinical trial of Cogmed working memory training in schoolage children with ADHD: A replication in a diverse sample using a control condition. Journal of Child Psychology and Psychiatry55(3), 247-255.

Evaluated population: The study recruited children who fit the following criteria: seven to 11 years old; ADHD diagnosis based on parent or teacher ratings on Disruptive Behavior Disorder Rating scales, the Impairment Rating Scale, and a parent interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS); fluent in English; and having internet access at home. The study recruited a total of 85 children, 44 in the intervention group and 41 in the control group. The children were 8.5 years old on average and predominantly male (81 percent in the intervention group and 73 percent in the control group). The children in the intervention and control groups were, respectively, 49 and 37 percent Caucasian, 14 and 20 percent African American, and 14 and 17 percent Asian. A quarter of children came from another racial or ethnic group.  Finally, most of the children (66 percent in the intervention group and 59 percent in the control group) had a combination of ADHD subtypes while 34 percent in the intervention and 41 percent in the control group had only the inattentive subtype. Fifty percent of the children in the intervention group and 39 percent of the children in the control group had also been diagnosed with Oppositional Defiant Disorder (ODD), while nine percent in the intervention and 15 percent in the control group have been diagnosed with Conduct disorder (CD) in addition to ADHD.

Approach: The study was a randomized control trial in which children were divided into two groups – one that participates in the CWMT Active and another participates in the CWMT Placebo. Two to four weeks before the start of the study, a clinician conducted an interview with the parents to determine psychiatric diagnoses including ADHD. At this time, parents and teachers were also asked to complete rating scales, which were also completed three weeks after the study ended. Children were randomly assigned to two groups: an intervention group participating in CWMT, and a control groups participating in CWMT Placebo, a low-level memory training program that does not adjust training difficulty level based on individual ability level.  Following randomization, CWMT staff were assigned students, all families took part in an introductory course on the CWMT, and the parents and CWMT staff developed a reward system for the children for on-time work completion. At the end of the training, the children’s outcomes were measured by parent and teacher report of ADHD symptoms using the Disruptive Behavior Disorders Rating Scale.  Their working memory was assessed using the Automatic Working Memory Assessment which focused on listening and recalling and recalling by itself. Attention, activity level, and impulse control were measured as the child played the games throughout the training process. Finally, academic achievement was measured using the Wide Range Achievement Test 4 Progress Monitoring Version, which evaluates reading, comprehension, spelling, and math skills.

Results: Compared with children in the control group, children in the intervention group did not show any statistically significant differences in parent- and teacher-reported measures of hyperactivity and inattention. Other ADHD symptoms measured by the game such as impulse control, attention, and activity level, also did not produce statistically significant differences when comparing those in the intervention group with those in the control group. In terms of working memory measures, children assigned to the intervention group had statistically significant higher nonverbal (d=1.17) and verbal (d=0.28) memory storage, or recall, compared with children who were in the control group. However, there were no statistically significant differences between the two groups for complex memory storage, processing and recalling information combined. Finally, compared to the control group, the intervention group did not have any statistically significant differences in academic measures of reading, math, spelling, and comprehension.

SOURCES FOR MORE INFORMATION

References:

Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., … & Ramon, M. (2014). A randomized clinical trial of Cogmed working memory training in school‐age children with ADHD: A replication in a diverse sample using a control condition. Journal of Child Psychology and Psychiatry55(3), 247-255.

KEYWORDS: Children (3-11), Males and Females, Computer-based, Reading/Literacy, Mathematics

Program last updated on 9/29/17.

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