Working memory training

Working memory training is intended to improve a person's working memory. Working memory is a central intellectual faculty, linked to IQ, ageing, and mental health. It has been claimed that working memory training programs are effective means, not only for treating attention-deficit/hyperactivity disorder (ADHD) and other cognitive disorders, but to improve intelligence and to enhance cognitive functioning in typically developing children and healthy adults. Extensive tests based on twenty three studies with 30 group comparisons, show that clinical memory training programs such as Cogmed produce reliable short-term improvements in working memory skills in children and adults with ADHD. Yet, the study results differ with regard to conclusive evidence that such effects can be maintained long-term without additional follow-up training. There is also no convincing evidence of the effect of working memory training to other skills such as nonverbal and verbal ability, inhibitory processes in attention, word decoding, and arithmetic. While most studies show clinical relevance of working memory training programs for ADHD population, they cast doubt that these program should be considered as methods of enhancing cognitive functioning in children and adults without working memory deficiencies.^[1]

Working memory

Working memory (WM) is the system which holds multiple pieces of transitory information in the mind - information that is needed for different tasks right now. WM is usually assessed by determining the number of pieces of information a person can hold in mind. For example, a person might be asked to listen to a series of digits and letters, sort them into order in mind, and then recall the sorted list aloud. The longest set of characters that can reliably be manipulated and recalled is the working memory capacity.

The capacity of working memory differs between people: a person able to recall 8 instructions has a greater working memory capacity than someone who can only recall a series of five. Numerous scientific studies have linked working memory capacity with strength in other fundamental cognitive abilities, including attention and intelligence.^{[2] [3]} Conversely, poor working memory is assumed to be one of the core deficits in ADHD as well as a number of learning disabilities.^{[4] [5]}

Working Memory Training Tasks

Working memory training tasks are conducted on computers and are often paired with positive reinforcement, feedback of the individual’s performance,^[6] and other motivational features such as displaying the individual’s current score beside their personal best score.^[7] Practicing these tasks demands numerous processes such as encoding, inhibition, maintenance, manipulation, shifting and controlling attention, and the ability to manage two tasks simultaneously or dividing attention.^[8] Possible forms of the tasks include recalling a series of locations of items on the screen, recalling digits or letters in either the order presented or reverse order,^[7] or recalling specifically where a particular number or digit was in a sequence.^[6] Computers are additionally programmed to adjust the difficulty of the task to the individual’s performance with each trial in order to maximize learning and overall improvement. If the individual does poorer on one trial, the difficulty will decrease. Similarly, if the individual excels on the next few trials, the difficulty will increase. Two ways of altering the difficulty is by adjusting the number of stimuli that is needed to be remembered, and adding visual distractions.^[9]

Strategies

Common strategies used in Working Memory Training include repetition of the tasks, giving feedback such as tips to improve one’s performance to both the parents and the individual, positive reinforcement from those conducting the study as well as parents through praise and rewarding,^[6] and the gradual adjustment of the task difficulty from trial to trial. More explicitly used strategies by the individual include rehearsal of material, chunking, pairing mental images with the material, mnemonics, and other meta-cognitive strategies. The latter strategies have been learned and there is a conscious awareness of their use.

Training Set-up and Evaluation

Before training commences participants complete pre-training verbal and visuo-spatial tasks, which are additionally completed in the study’s follow-up as post-training tasks. Pre-training and post-training tasks vary, some studies use verbal and visuo-spatial tasks along with slightly different tasks; referred to as “nontrained tasks.” Klingberg et al.^[9] used visuo-spatial tasks, a Span board, the Stroop task, Raven’s Coloured Progressive matrices, and a choice reaction time task, during pre-training and post-training. Holmes et al.^[7] used a nonword recall task, mazes memory task, listening recall, and the “odd one-out” task. By using tasks that differ from ones in the study, laboratory results can demonstrate transfer effects if high scores are achieved, since these were not learned during training.

The training itself is set up in studies so that participants attend a set amount of sessions over a given period of time that widely varies between studies. This can vary anywhere from two weeks to a span of eight weeks. The time spent in sessions also ranges, with some studies being as short as fifteen minutes to other studies lasting forty minutes. Studies can take place in the lab, or even at home with researchers keeping in touch through weekly phone calls.^[6] There is no universal way to set up the training schedule, since all schedules tended to vary to at least to some degree. The effects are tested immediately after training is completed and again a few months after, or even up to a year later, to see if the training outcomes are still in place. Testing and evaluation can be based on the measures of academic efficiency, ratings of the individual’s symptoms from teachers and parents, comparing the experimental to the control groups of the study, and self-report measures.

Transfer Effects

There are many possible transfer effects from working memory training. An increase in working memory capacity could make individuals more likely to take on tasks that have a higher working memory load, such as math and other challenging academics.^[10] Holmes et al.^[11] reported an improvement in mathematical reasoning, even six months after training was completed. Furthermore, there has been parent reported decreases of inattentive behaviours, hyperactivity, and impulsivity in children with ADHD,^[10] in addition to, a decrease in motor activity.^[9] However the majority of transfer effects are seen in lab-based nontrained tasks that are completed during follow-up and immediately after training is over. Findings from these results vary according which nontrained tasks the researcher chooses to use. The main general finding in these studies, confirm experimental groups improve on trained tasks in comparison to control groups, and that effects will need retraining to maintain.^[10]

History

The concept of working memory became widely accepted and its importance better understood across the 1970s. At this time, a number of attempts to improve working memory were also initiated.^[12] For instance, in one case, a college student practiced repeating numbers that were read to him aloud for an hour each day. ^[13] He did this three to five times a week for twenty months until he could repeat as many as 79 digits. While his capacity on this trained task had improved, his working memory: the ability to store information, as described above had not. This was most clearly demonstrated when, asked to repeat letters instead of numbers, this same student with over 320 hrs of practice at recalling digits could recall only six letters at a time: a normal to below average performance. The effect of the training was not to improve the working memory system but to change the information being stored: the student had learned multiple methods of grouping numbers and relating them to similar figures already in his long term memory. In reality, his working memory capacity had not increased. This study and others like it contributed to the prevailing assumption in the scientific community that working memory is a set characteristic that cannot be improved.

ADHD working memory training controversy

Many clinical studies published in 1990s and 2000s claim that working memory training is an efficient strategy for mitigating effects of ADHD and other cognitive disorders.^[14] Many studies also demonstrated that working memory training enhances episodic memory and could lead to better performance and improvements in fluid intelligence and processing speed tasks in the elderly^[15][16][17]

The majority of studies on effects of working memory training for children and adults with ADHD were conducted using Cogmed, a computerized working memory training program developed by Swedish neuroscientist Torkel Klingberg.^[18] Cogmed become known in 2002 when Klingberg presented results from a very small sample (14) of children with ADHD.^[19] In a follow-up study of 53 children with ADHD, he and co-authors concluded "WM can be improved by training in children with ADHD".^[20] By the end of 2014 there were more than 40 published research studies confirming effectiveness of Cogmed.^[21]

However, there are some researchers who question the effectiveness of working memory training. Georgia Institute of Technology researchers who reviewed 17 studies on WMT concluded that "the results are inconsistent" due to the fact that many studies had "inadequate controls" as well as "ineffective measurement of the cognitive abilities of interest."^[22]

In 2012, a systematic meta-analytic review was undertaken.^[1] Stringent criteria for inclusion ensured that all studies were either randomized controlled trials or quasi-experiments. All studies had to have a treatment and a treated or untreated control group. By this time, some twenty-three studies met these criteria, including both clinical samples typically developing children and adults. The results closely replicated the original finding by Ericcson et al. (1980):^[13] There were short-term improvements in practiced skills. While the results were conclusive for ADHD population, there was no convincing evidence for transfer or generalization effects (indicating improved capacity) in typically developing children and healthy adults."^[1]

Other researchers from universities around the world have also studied the effects of the Cogmed company's training on children with attention issues. Among them are NYU,^[23] and the University of York.^[24] In addition, many researchers are now exploring the use of working memory training for various new applications, with studies having been completed or launched on normal and aging adults,^[25] pediatric cancer survivors,^[26] and victims of stroke and traumatic brain injury.^[27]

In the February 2009 edition of Science, Klingberg and colleagues, led by F McNab, claimed that adaptive span training had led to changes in dopamine D1 and D2 receptors.^[28] In the same study, tests of "far transfer" - whether or not the skills in one test applied to very different intelligence-related skills - were made. The results were not reported.^[22] (see supporting online materials). Moreoever, research at the Wallenberg Neuroscience Center in Sweden indicates that working memory training may decrease hippocampal neurogenesis. When experimental medical scientists trained adult male rats in a working memory task for 4 or 14 days, rats trained for 2-weeks had fewer newborn hippocampal neurons than those that were only trained for 4 days. The report suggests that increased stress, caused by an intense training of working memory, can reduce the production of hippocampal neurons.^[29]

As Cogmed and other memory training programs gain popularity, there is an increasing negativity in popular media.^[30][31][32] The common pattern for all these publications is that the authors seem to disregard overwhelming research evidence supporting benefits of WMT and instead focus on a few outlier studies. Interestingly enough, all this negative publicity for Cogmed started after researchers from the University of York published results demonstrating effects of Cogmed working memory training vs. stimulant medication for ADHD.^[33] When compared performance on ADHD medication vs. performance after Cogmed working memory training, there was clear evidence that working memory training led to greater improvements than medication treatment alone. There were significant gains in all four memory scores such as visuo-spatial working memory, verbal short-term memory, verbal working memory, and visuo-spatial short-term memory.

References

Further reading

• Cowan N (2010). "Multiple concurrent thoughts: The meaning and developmental neuropsychology of working memory". Dev Neuropsychol 35 (5): 447–74. doi:10.1080/87565641.2010.494985. PMC 2925295. PMID 20721769. 
• Melby-Lervåg M, Hulme C (May 2012). "Is Working Memory Training Effective? A Meta-Analytic Review". Dev Psychol 49 (2): 270–91. doi:10.1037/a0028228. PMID 22612437. 

External links

• Working Memory Training