Working memory: The Research behind Cogmed. The ability to simultaneously hold and manipulate information in the mind 3/05/2016

Transcription

1 Working memory: The Research behind Cogmed The ability to simultaneously hold and manipulate information in the mind Cogmed Coach Conference 05/09/14 Dr Izabela Walters Short term memory & working memory Executive function and working memory Short term memory the ability to hold information over a period of seconds e.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 Executive function The 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 3 Cogmed Coach Conference 05/09/14 4 Cogmed Coach Conference 05/09/14 1

2 Impulsivity and working memory Fluid intelligence and working memory Impulsivity Reacting 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) 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 5 Cogmed Coach Conference 05/09/14 6 What it is not:..working memory capacity is the same as central executive capability, controlled attention and 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. 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. 7 Cogmed Coach Conference 05/09/14 Dr Izabela Walters 8 2

3 Working memory is limited Working memory can be improved with focused, specific and intensive training Not all computerised wm training programs are the same Many programs Cogmed (Klingberg et al 2005) Jungle Memory (Alloway 2012) CogniFit (2008) N back training (Jaeggi et al 2008) Complex span training (Chein & Morrison 2010) 9 12 September 2014 Not all computerised wm training programs are the same Many reviews: A working memory training program can improve performance on non trained working memory tasks Systematic reviews: Chacko et al 2013, Melby Lervåg & Hulme 2013 Narrative reviews: Morrison & Chein 2011, von Bastian & Oberauer 2013 Meta analysis on Cogmed and inattention, Spencer Smith et al 2015 Review in Science Diamond & Lee 2011, Interventions shown to aid executive function development in children 4 to 12 Understanding the Research Cogmed (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

4 Bacon Causes Cancer? Sort of. Not Really. Ish. Key questions 1. What does it mean to be evidence-based? 2. Does training improve working memory? 3. Does the training generalise beyond trained tasks to nontrained tasks? 4. Are the gains sustained? 5. Can working memory training improve literacy and numeracy outcomes? 13 Embracing the term: What do we mean by evidencebased cognitive training? 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 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 4

5 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 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 17 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 5

6 Key questions 1. What does it mean to be evidence-based? 2. Does training improve working memory? 3. Does the training generalise beyond trained tasks to nontrained tasks? 4. Are the gains sustained? 5. Can working memory training improve literacy and numeracy outcomes? Research discovers working memory can be improved Replication Klingberg replicates first study in placebo controlled, multicenter trial - drawing attention to WM training(klingberg et al., 2005) Led by neuroscientist T.Klingberg, MD, PhD The findings challenged for the first time the longheld assumption that working memory is a fixed characteristic, unable to be changed. 6

7 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 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 group n = 3 withdrew Design: Multi-site, randomized, placebo controlled, double-blinded, testretest 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) Summary 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. Other Studies showing generalised effects of CWMT 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 7

8 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). Key questions 1. 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? How do we monitor progress? Questionnaire Training Details Captures users perspective of their Attention in everyday life Expectations for CWMT, Areas they would like to improve Sources: yo: DSM-IV ADHD (attention) scale - Intrinsic Motivation Inventory (IMI) Pre: Prior to Day 1 CPI and Training, during Start-Up Session with Coach Post: Available to complete after 80% of training has been completed 8

9 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) Day 1 & Purpose Provides quantitative measure of training effect Assess with non-trained working memory tasks Track cognitive change as it occurs 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 in children. Developmental Science, 12(4), F9 -F15. doi: /j x Adaptive training leads to sustained enhancement of poor WM in children Holmes et al., 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 15 th 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) 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. 9

10 Will working memory training generalize to improve off-task behavior in children with Attention-Deficit/ Hyperactivity Disorder? Green et al 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 Green et al 2012 Publication: 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 ADHDassociated 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 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) 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 attentional processing This study examined the impact of working memory training in 65 typically developing 4-5 year-old children. >> Increasing academic performance via improvements in WM may reduce feelings of negative affect 10

11 Training and transfer effects of executive functions in preschool children Thorell et al., 2009 Population: N =65 typical children, ages 4-5 years Training and transfer effects of executive functions in preschool children (II) Thorell et al., 2009 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 Go/No-Go: Inhibition of a prepotent motor response Stop-Signal: Stopping of an ongoing response Flanker: Interference control 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 Training and transfer effects of executive functions in preschool children (III) 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 11

12 A systematic review and meta-analysis of the benefits of Cogmed for inattention in daily life Megan Spencer-Smith & Torkel Klingberg 12 September 2014 Identified studies Study Participants Risk of bias Control Training Time of testing Outcome measures group site post training Age in Status Recruitment source Design Blinding Immedia Delayed Inattention in daily Visuospatial WM Verbal WM years a) Rater te life (rater) b) Tester Bjorkdahl Brain Injury + Outpatient rehabilitation RCT a) NR Passive NR 1 week 3 months Working memory none WAIS III Digit span 2013+* impaired WM clinic b) NR questionnaire (self) backward Beck 2010* 7 17 ADHD b Private school for students RCT a) pre training Wait list Home 1 month 4 months DSM IV Inattention none none with ADHD and/or LD b) NR (parent) Brehmer a) Healthy Newspaper advertisement RCT a) yes Active and Home NR 3 months CFQ (self) WAIS R Span board WAIS R Digit span 2012 b) b) yes non adaptive backward backward Chacko 2013a 7 11 ADHD Newspaper RCT a) yes Active and Home 3 weeks none DBD Inattention AWMA Spatial recall AWMA advertisements b) yes non adaptive (parent) Listening recall Egeland ADHD b Outpatient clinics at two RCT a) NR Wait list School NR 8 months DuPaul Inattention none none hospitals b) Yes (parent) Green ADHD b, c Advertising, psychologists, RCT a) yes Active and Home NR none Connors ADHD none none psychiatrists, institute b) Yes non adaptive (parent) tracking Gropper LD/ADHD b Student Disability services RCT a) NR Wait list Home 3 weeks 2 months CFQ (self) CANTAB Spatial WM WISC IV Digit span at 3 post secondary b) NR (errors) institutions Grunewaldt 5 6 VLBW Admission records of a RCT a) NR Wait list Home 1 month none DuPaul Inattention Spatial span Digit span 2013 hospital NICU b) Yes (parent) backward a backward a Hardy Cancer Patients of the hospital RCT a) yes d Active and Home NR 3 months Connors Inattention WRAML Symbolic WRAML Verbal Division of Pediatric b) Yes non adaptive (parent) WM WM Hematology Oncology Klingberg 7 12 ADHD Referrals from RCT a) yes Active and Home or NR 3 months DSM IV Inattention WAIS R Span board WAIS R Digit span 2005 pediatricians, b) yes non adaptive school (parent) psychiatrists, special school teachers Roughen SEB Schools RCT a) no Passive School 3 weeks 3 months DuPaul Attentional none none 2011 b) NR Control (teacher) Westerberg Stroke Stroke Rehabilitation Unit RCT a) pre training Passive Home NR none CFQ (self) WAIS R Span board WAIS R Digit span 2007 b) pre training 12 September 2014 Benefits of a Working Memory Training Program for Inattention in Daily Life: A Systematic Review and Meta-Analysis Megan Spencer-Smith, Torkel Klingberg. PLoS ONE 10(3): e "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" 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 ( ), 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) 12

13 Key questions 1. What does it mean to be evidence-based? Children improve math, attention and instruction-following up to six months after Cogmed Holmes et al., Does training improve working memory? 3. Does the training generalise beyond trained tasks to nontrained tasks? 4. Are the gains sustained? 5. Can working memory training improve literacy and numeracy outcomes? 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 in children. Developmental Science, 12(4), F9 -F15. doi: /j x Pre- training WM scores for non-adaptive (placebo) group Holmes et al., 2009 Pre- Pre- training to post-training WM scores for nonadaptive (placebo) group Holmes et al., Pre- Post- Post * * Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM Slide courtesy of Dr. Joni Holmes Slide courtesy of Dr. Joni Holmes 13

14 Pre-training WM scores for adaptive (treatment) group Holmes et al., 2009 Pre- training to post-training WM scores for adaptive (treatment) group Holmes et al., * Pre- Post- Pre- Post- Follow-up * * * Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM Slide courtesy of Dr. Joni Holmes Slide 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., Pre * * * * Post- Follow-up 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 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM Slides courtesy of Dr. Joni Holmes 14

15 Are the gains sustained? Is it realistic to expect that gains are sustained beyond 6-12 months? Compare to Medication CBT Exericise You do use your working memory all the time Focus 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. Key questions 1. What does it mean to be evidence-based? 2. Does training improve working memory? 3. Does the training generalise beyond trained tasks to nontrained tasks? 4. Are the gains sustained? 5. Can working memory training improve literacy and numeracy outcomes? Why study WM in children? Joni Holmes Ph.D 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 15

16 Improving Working Memory Supporting Student learning Tracy Packiam Alloway 2011 Interconnected Systems Supporting Learning Performancebased factors Knowledge base (LTM) *working memory *largely mediated by language 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. [Far transfer] Skill/behaviour Working memory training acts on underlying levels Reading comprehension Maths skills Language development On-task behaviour 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. [Near transfer] Affects Executive functions Rate of learning Working memory Manipulating information Planning Remembering directions Initiate Task monitoring Attention/ Concentration Organise 16

17 Psychological Processes associated with academic learning (Dehn 2012) Interactive Effects of Educational & Cognitive Deficits 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] 66 Presentation Title runs here l 00/00/00 Population: N =57 children w/ special needs, ages 9 12 years (grades 3-5) n = 42 in adaptive Cogmed training group n = 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 nonadaptive Cogmed training group from Klingberg et al., 2005 on cognitive measures Design: Randomized, controlled, blinded, test-retest T1 = baseline, T2 = post-test (5-6 week after), T3 = 6-7 month follow-up 17

18 Summary: Dahlin (2011) and Dahlin (2013) I. Adaptive Cogmed training group improved significantly over non-adaptive Cogmed 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) 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. II. Adaptive Cogmed training group improved significantly over passive control group 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 control group 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) 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 Update: Taking Working Memory training from the laboratory into schools Joni Holmes and Susan Gathercole, Educational Psychology 2013 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. 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 18

19 Working Memory Training is Associated with Long Term Attainments in Math and Reading Stina 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 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 Cogmed and academic change? 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. 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 19

20 Clinical and real world data counts too Time Taken (Initial Review to Completion 8.2, 8.5) 72% of schools who used Cogmed in ANZ in 2014 renewed in Cogmed Coach Conference 19/07/13 5/3/2016 CogCon AUNZ 2013 Dr Jason McGowan, Child Development Centre Gain in Reading Age (20, 25 months) Change in Reading Rate (2.6, 3.2 months / month) Cogmed Coach Conference 19/07/13 5/3/2016 CogCon AUNZ 2013 Dr Jason McGowan, Child Development Centre Cogmed Coach Conference 19/07/13 5/3/2016 CogCon AUNZ 2013 Dr Jason McGowan, Child Development Centre 20

21 + T1 April 2014 Intervention Phase I T2 May 2014 T3 August 2014 Intervention Phase II T4 December 2014 CPI/CQ BASC-2 Parent BASC-2 Teacher BASC-2 Student GRADE (Reading) Cogmed Passive Passive CPI/CQ BASC-2 Student CPI/CQ BASC-2 Parent BASC-2 Teacher BASC-2 Student GRADE (Reading) ilit ilit Passive CPI/CQ BASC-2 Parent BASC-2 Teacher BASC-2 Student GRADE (Reading) Design: Randomized, Controlled, Test-Retest, 6 Month Follow Up Sample: N = 245, 7 th graders, at least 1 year behind in reading Additional Data: SAT 10 (Reading), STAAR (Texas State Assessment), Demographics Cogmed Slide Library 2014 Future research questions Implementing a Working Memory Program At Your School 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) Next webinar: Tuesday (AEST) See a recording of webinar at: 12 September

22 Brisbane Pullman Hotel Wednesday 17 th August Perth Pan Pacific Hotel Friday 19 th August Register by 24 th June to receive the early bird price of $379 (Incl. GST) Go to pearsonacademy.com.au 85 Presentation Title runs here l 00/00/00 22