Cogmed Working Memory Training Research Articles

Targeting self-regulation and academic functioning among preschoolers with behavior problems: Are there incremental benefits to including cognitive training as part of a classroom curriculum?

ABSTRACTThe purpose of this study was to examine the additional benefit of an adaptive Cogmed working memory training (CWMT) to a social-emotional/self-regulation classroom curriculum for preschoolers with externalizing behavior problems (EBP). Participants for this study included 49 children (71% boys, Mage = 4.52) with at-risk or clinically elevated levels of EBP. Children participated in an 8-week summer treatment program for Pre-Kindergarteners (STP-PreK), where they were randomly assigned to either adaptive CWMT (n = 24), or nonadaptive CWMT (n = 25). Multiple repeated measures analyses were conducted to examine the impact of adaptive versus nonadaptive CWMT on pre and posttreatment parent-/teacher-reported behavioral functioning, parent-/teacher reported and child task performance of executive functioning, and standardized academic achievement measures. Repeated measures analyses found that children in both groups improved on all measures (d’s = .23-.86). However, there were no significant time X condition effects for parent or teacher-reported behavior, reported or observed executive functioning, or standardized academic measures. These findings suggest that CWMT does not appear to provide any incremental benefits to children’s executive functioning, behavior, or academics when implemented within a comprehensive behavioral modification intervention.

Long-Term Academic Functioning Following Cogmed Working Memory Training for Children Born Extremely Preterm: A Randomized Controlled Trial

To assess the effectiveness of Cogmed Working Memory Training compared with a placebo program in improving academic functioning 24 months post-training in extremely preterm/extremely low birth weight 7-year-olds. A multicenter double-blind, placebo-controlled randomized controlled trial was conducted across all tertiary neonatal hospitals in the state of Victoria, Australia. Participants were 91 extremely preterm/extremely low birth weight 7-year-old children born in Victoria in 2005. Children were randomly assigned to either the Cogmed or placebo arm and completed the Cogmed or placebo program (20-25 sessions of 35-40 minutes duration) at home over 5-7 weeks. Academic achievement (word reading, spelling, sentence comprehension, and mathematics) was assessed 24 months post-training, as well as at 2 weeks and 12 months post-training, via standardized testing inclusive of working memory, attention, and executive behavior assessments. Data were analyzed using an intention-to-treat approach with mixed-effects modeling. There was little evidence of any benefits of Cogmed on academic functioning 24 months post-training, as well as on working memory, attention, or executive behavior at any age up to 24 months post-training compared with the placebo program. We currently do not recommend administration of Cogmed for early school-aged children born extremely preterm/extremely low birth weight to improve academic functioning. Australian New Zealand Clinical Trials Registry: ACTRN12612000124831.

Cogmed Working Memory Training Presents Unique Implementation Challenges in Adults With ADHD.

Cogmed Working Memory Training (CWMT), an online cognitive training program developed for children, is an increasingly popular non-pharmacological intervention for ADHD amongst all ages, despite limited supporting evidence. The initial objective of the present work was to examine the short- and long-term impacts of CWMT on brain function in adults with ADHD. However, during the conduct of our study, we experienced multiple levels of failures in recruitment and retention that signaled potential concerns about the suitability of CWMT for adults with ADHD. This perspective piece aims to describe the difficulties we encountered in the context of studies examining the efficacy of CWMT in comparable populations. We trace these difficulties to the limited tolerability of the current CWMT structure for adults with ADHD, and review similar limitations in the literature. We suggest that efficacy of CWMT in children may be due in large part to close monitoring and scaffolding provided by clinicians and caregivers. For CWMT to have viability for widespread use in adults, greater support and structure will be needed for users to improve the likelihood of adherence. We discuss implications and considerations for future efforts in both research and clinical practice.

Working Memory Training Following Neonatal Critical Illness: A Randomized Controlled Trial.

To test the immediate and long-term effectiveness of Cogmed Working Memory Training following extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. A nationwide randomized controlled trial assessing neuropsychologic outcome immediately and 1 year post Cogmed Working Memory Training, conducted between October 2014 and June 2017. Researchers involved in the follow-up assessments were blinded to group allocation. Erasmus MC-Sophia Children's Hospital, Rotterdam, and Radboud University Medical Center, Nijmegen, the Netherlands. Eligible participants were neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia survivors (8-12 yr) with an intelligence quotient greater than or equal to 80 and a z score less than or equal to -1.5 on at least one (working) memory test at first assessment. Cogmed Working Memory Training, comprising 25 45-minute training sessions for 5 consecutive weeks at home. Participants were randomized to Cogmed Working Memory Training (n = 19) or no intervention (n = 24) (two dropped out after T0). Verbal working memory (estimated coefficient = 0.87; p = 0.002) and visuospatial working memory (estimated coefficient=0.96, p = 0.003) significantly improved at T1 post Cogmed Working Memory Training but was similar between groups at T2 (verbal, p = 0.902; visuospatial, p = 0.416). Improvements were found at T2 on long-term visuospatial memory following Cogmed Working Memory Training (estimated coefficient = 0.95; p = 0.003). Greater improvements in this domain at T2 following Cogmed Working Memory Training were associated with better self-rated school functioning (r = 0.541; p = 0.031) and parent-rated attention (r = 0.672; p = 0.006). Working memory improvements after Cogmed Working Memory Training disappeared 1 year post training in neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia survivors. Gains in visuospatial memory persisted 1 year post intervention. Cogmed Working Memory Training may be beneficial for survivors with visuospatial memory deficits.

Abstract P-526: CEREBRAL WHITE MATTER MICROSTRUCTURE CHANGES AND MEMORY IMPROVEMENT FOLLOWING WORKING-MEMORY TRAINING IN SURVIVORS OF NEONATAL CRITICAL ILLNESS: A RANDOMIZED CONTROLLED TRIAL

Aims & Objectives: Children treated with neonatal extracorporeal membrane oxygenation (ECMO) and/or with congenital diaphragmatic hernia (CDH) are at risk of long-term neurodevelopmental deficits. We assessed the effects of Cogmed Working-Memory Training (CWMT) in school-age survivors of neonatal ECMO and/or CDH. Methods A nationwide, single-blind randomized controlled trial assessing white matter microstructure and neuropsychological outcome before(T0) and immediately(T1) after CWMT. CWMT, an adaptive computerized training program, comprised 25 sessions of 45 minutes for five consecutive weeks at home. Participants were neonatal ECMO and/or CDH survivors (8–12 years) with an IQ≥80 and a z-score≤-1.5 on at least one (working)memory test at T0. Diffusion Tensor Imaging was used to asses white matter microstructure. Results Of 34 participants, 27 children with useable data at both T0 and T1 were randomly assigned to CWMT(n=12) or no-training(n=15)(Figure 1). Training-induced changes were found in global white matter microstructure at T1 (estimated coefficient=.007, p=.015) and the left superior longitudinal fasciculus (estimated coefficient=.009, p=.033). Changes in the superior longitudinal fasciculus were significantly associated with the improvements in verbal working-memory in the CWMT group at T1, F(1,13)=7.13, p=.026, partial eta square=.44. No other associations between training-induced changes in white matter microstructure and neuropsychological improvement were found (p>.05). Conclusions Our findings demonstrate that neurobiological plasticity exists in survivors of neonatal ECMO and/or CDH and that, despite significant brain alterations found in these children, their neurodevelopmental outcome is changeable. Given the high risk of long-term neuropsychological deficits and subsequent school problems following neonatal critical illness, these results are of great significance.

Effects of Cogmed working memory training on cognitive performance.

Research on the cognitive benefits of working memory training programs has produced inconsistent results. Such research has frequently used laboratory-specific training tasks, or dual-task n-back training. The current study used the commercial Cogmed Working Memory (WM) Training program, involving several different training tasks involving visual and auditory input. Healthy college undergraduates were assigned to either the full Cogmed training program of 25, 40-min training sessions; an abbreviated Cogmed program of 25, 20-min training sessions; or a no-contact control group. Pretest and posttest measures included multiple measures of attention, working memory, fluid intelligence, and executive functions. Although improvement was observed for the full training group for a digit span task, no training-related improvement was observed for any of the other measures. Results of the study suggest that WM training does not improve performance on unrelated tasks or enhance other cognitive abilities.

Working-memory training following neonatal critical illness

__Objective__ To test the immediate and long-term effectiveness of Cogmed Working-Memory Training (CWMT) following ECMO and/or CDH. __Design__ A nationwide randomized controlled trial assessing neuropsychological outcome immediately and one year post-CWMT, conducted between October 2014-June 2017. Researchers involved in the follow-up assessments were blinded to group allocation. __Setting__ Erasmus MC-Sophia Children’s Hospital, Rotterdam and Radboud University Medical Center, Nijmegen, the Netherlands. __Patients__ Eligible participants were neonatal ECMO and/or CDH survivors (8-12 years) with an IQ ≥ 80 and a z-score ≤ -1.5 on at least one (working)memory test at first assessment. __Interventions__ CWMT, comprising 25 sessions of 45 minutes for five consecutive weeks at home. __Measurements and Main Results__ Participants were randomized to CWMT (n = 19) or no intervention (n = 24) (two dropped out after T0). Verbal working-memory (estimated coefficient = 0.87; p = .002) and visuospatial working-memory (estimated coefficient = 0.96, p = .003) had significantly improved in the CWMT group at T1, but was similar between groups at T2 (verbal, p = .902; visuospatial, p = .416). Improvements were found at T2 on long-term visuospatial memory following CWMT (estimated coefficient = 0.95, p = .003). Greater improvements in this domain at T2 following CWMT were associated with better self-rated school functioning (r = .541, p = .031) and parent-rated attention (r = .672, p = .006). __Conclusions__ Working-memory improvements after CWMT disappeared one year post-training in neonatal ECMO and/or CDH survivors. Gains in visuospatial memory persisted one year post-intervention. CWMT may be beneficial for survivors with visuospatial memory deficits.

The clinical use of Cogmed Working Memory Training (CWMT): A clinician survey

This project was supported by generous grants from the Henry Smith Charity and Action Medical Research.

Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children

ABSTRACTThe present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent–child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study’s limitations, and future directions for research are further discussed.

How Is Working Memory Training Likely to Influence Academic Performance? Current Evidence and Methodological Considerations

Working memory (WM) is one of our core cognitive functions, allowing us to keep information in mind for shorter periods of time and then work with this information. It is the gateway that information has to pass in order to be processed consciously. A well-functioning WM is therefore crucial for a number of everyday activities including learning and academic performance (Gathercole et al., 2003; Bull et al., 2008), which is the focus of this review. Specifically, we will review the research investigating whether improving WM capacity using Cogmed WM training can lead to improvements on academic performance. Emphasis is given to reviewing the theoretical principles upon which such investigations rely, in particular the complex relation between WM and mathematical and reading abilities during development and how these are likely to be influenced by training. We suggest two possible routes in which training can influence academic performance, one through an effect on learning capacity which would thus be evident with time and education, and one through an immediate effect on performance on reading and mathematical tasks. Based on the theoretical complexity described we highlight some methodological issues that are important to take into consideration when designing and interpreting research on WM training and academic performance, but that are nonetheless often overlooked in the current research literature. Finally, we will provide some suggestions for future research for advancing the understanding of WM training and its potential role in supporting academic attainment.

A cluster-randomised, controlled trial of the impact of Cogmed Working Memory Training on both academic performance and regulation of social, emotional and behavioural challenges.

We explored whether school-based Cogmed Working Memory Training (CWMT) may optimise both academic and psychological outcomes at school. Training of executive control skills may form a novel approach to enhancing processes that predict academic achievement, such as task-related attention, and thereby academic performance, but also has the potential to improve the regulation of emotion, social problems and behavioural difficulties. Primary school children (Mean age=12years, N=148) were cluster-randomised to complete active CWMT, a nonadaptive/placebo version of CWMT, or no training. No evidence was found for training effects on task-related attention when performing academic tasks, or performance on reading comprehension and mathematics tasks, or teacher-reported social, emotional and behavioural difficulties. CWMT did not improve control of attention in the classroom, or regulation of social, emotional and behavioural difficulties.

Parental Perceptions of the Efficacy of Cogmed Working Memory Training

Many articles have been written about the effectiveness of Cogmed Working Memory Training (CWMT). As Cogmed licensees, we have provided CWMT to more than 350 trainees and have collected pre- and post-training assessment data and parental feedback from about 280 child and adolescent trainees and their parents. On all nine measures of working memory and other selected executive functions, we have found statistically significant improvement. We also offer many of the comments and feedback that we have received from families about the changes they have experienced. There are limitations to the one group pre-test post-test design used in this study that need to be considered as the results are reviewed.

Longitudinal data on cortical thickness before and after working memory training.

The data and supplementary information provided in this article relate to our research article “Task complexity and location specific changes of cortical thickness in executive and salience networks after working memory training” (Metzler-Baddeley et al., 2016) [1]. We provide cortical thickness and subcortical volume data derived from parieto-frontal cortical regions and the basal ganglia with the FreeSurfer longitudinal analyses stream (http://surfer.nmr.mgh.harvard.edu [2]) before and after Cogmed working memory training (Cogmed and Cogmed Working Memory Training, 2012) [3]. This article also provides supplementary information to the research article, i.e., within-group comparisons between baseline and outcome cortical thickness and subcortical volume measures, between-group tests of performance changes in cognitive benchmark tests (www.cambridgebrainsciences.com [4]), correlation analyses between performance changes in benchmark tests and training-related structural changes, correlation analyses between the time spent training and structural changes, a scatterplot of the relationship between cortical thickness measures derived from the occipital lobe as control region and the chronological order of the MRI sessions to assess potential scanner drift effects and a post-hoc vertex-wise whole brain analysis with FreeSurfer Qdec (https://surfer.nmr.mgh.harvard.edu/fswiki/Qdec [5]).

Computerized Working-Memory Training for Children Following Arterial Ischemic Stroke: A Pilot Study With Long-Term Follow-Up

Cognitive deficits in the domains of working memory (WM) and executive function are well documented following childhood arterial ischemic stroke (AIS). However, there are currently no evidence-based cognitive interventions for this population. Computerized, implicit WM training has been demonstrated to generate generalized cognitive gains for children with WM and attention deficits and for adults following brain injury. This study used a pilot design to investigate the efficacy and feasibility of such an intervention program (Cogmed WM Training) for a childhood AIS population. Outcomes were measured via psychometric assessment at preintervention and postintervention and again at 1-year follow-up. At longitudinal follow-up, participants were found to have significant and persistent cognitive difficulties, particularly with attention and response inhibition. Following the computerized, implicit WM intervention, a significant improvement in phonological-loop WM was seen; however, this improvement was not maintained after 12 months. No additional significant improvements on standardized psychometric outcome measures were seen either immediately or at 12-month follow-up. Findings of this pilot study therefore do not currently support Cogmed as an effective intervention for children with AIS but highlight the need for further research, including randomized, controlled trials, to investigate cognitive interventions for the childhood AIS population.

Predictors and Moderators of Treatment Outcome in Cognitive Training for Children With ADHD

Objective: To explore whether clinical variables and initial cognitive abilities predict or moderate (far) transfer treatment outcomes of cognitive training. Method: A total of 98 children (aged 8-12 years) with ADHD were randomly assigned to Cogmed Working Memory Training or a new cognitive training called “Paying Attention in Class.” Outcome measures included neurocognitive assessment, parent and teacher rated questionnaires of executive functioning behavior and academic performance. Predictor/moderator variables included use of medication, comorbidity, subtype of ADHD, and initial verbal and visual working memory skills. Results: Parent and teacher ratings of executive functioning behavior were predicted and moderated by subtype of ADHD. Word reading accuracy was predicted by subtype of ADHD and comorbidity. Use of medication and initial verbal and visual spatial working memory skills only predicted and moderated near transfer measures. Conclusion: Cognitive training can be beneficial for certain subgroups of children with ADHD; individual differences should be taken into account in future trials.

Neural correlates of working memory training in HIV patients: study protocol for a randomized controlled trial.

BackgroundPotent combined antiretroviral therapy decreased the incidence and severity of HIV-associated neurocognitive disorders (HAND); however, no specific effective pharmacotherapy exists for HAND. Patients with HIV commonly have deficits in working memory and attention, which may negatively impact many other cognitive domains, leading to HAND. Since HAND may lead to loss of independence in activities of daily living and negative emotional well-being, and incur a high economic burden, effective treatments for HAND are urgently needed. This study aims to determine whether adaptive working memory training might improve cognitive functions and neural network efficiency and possibly decrease neuroinflammation. This study also aims to assess whether subjects with the LMX1A-rs4657412 TT(AA) genotype show greater training effects from working memory training than TC(AG) or CC(GG)-carriers.Methods/Design60 HIV-infected and 60 seronegative control participants will be randomized to a double-blind active-controlled study, using adaptive versus non-adaptive Cogmed Working Memory Training® (CWMT), 20–25 sessions over 5–8 weeks. Each subject will be assessed with near- and far-transfer cognitive tasks, self-reported mood and executive function questionnaires, and blood-oxygenation level-dependent functional MRI during working memory (n-back) and visual attention (ball tracking) tasks, at baseline, 1-month, and 6-months after CWMT. Furthermore, genotyping for LMX1A-rs4657412 will be performed to identify whether subjects with the TT(AA)-genotype show greater gain or neural efficiency after CWMT than those with other genotypes. Lastly, cerebrospinal fluid will be obtained before and after CWMT to explore changes in levels of inflammatory proteins (cytokines and chemokines) and monoamines.DiscussionImproving working memory in HIV patients, using CWMT, might slow the progression or delay the onset of HAND. Observation of decreased brain activation or normalized neural networks, using fMRI, after CWMT would lead to a better understanding of how neural networks are modulated by CWMT. Moreover, validating the greater training gain in subjects with the LMX1A-TT(AA) genotype could lead to a personalized approach for future working memory training studies. Demonstrating and understanding the neural correlates of the efficacy of CWMT in HIV patients could lead to a safe adjunctive therapy for HAND, and possibly other brain disorders.Trial registrationClinicalTrial.gov, NCT02602418.

Working Memory Training is Associated with Long Term Attainments in Math and Reading.

Training working memory (WM) using computerized programs has been shown to improve functions directly linked to WM such as following instructions and attention. These functions influence academic performance, which leads to the question of whether WM training can transfer to improved academic performance. We 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). This is the first study of long-term (>1 year) effects of WM training on academic performance. We found performance on both reading and math to be positively impacted after completion of CWMT. Since there were no baseline differences between the groups, the results may reflect an influence on learning capacity, with improved WM leading to a boost in students’ capacity to learn. This study is also the first to investigate the effects of CWMT on academic performance in typical or high achieving students. The results suggest that WM training can help optimize the academic potential of high performers.

EEG alpha power during maintenance of information in working memory in adults with ADHD and its plasticity due to working memory training: A randomized controlled trial

ObjectiveThe present study examined whether neural indices of working memory maintenance differ between young adults with ADHD and their healthy peers (Study 1), and whether this neural index would change after working memory training (Study 2). MethodsStudy 1 involved 136 college students with ADHD and 41 healthy peers (aged 18–35years) and measured their posterior alpha activity during a visual delayed-match-to-sample task using electroencephalography (EEG). Study 2 involved 99 of the participants with ADHD who were randomized into a standard-length or shortened-length Cogmed working memory training program or a waitlist control group. ResultsThe ADHD group tended to be less accurate than the peers. Similarly, the ADHD group exhibited lower posterior alpha power at a trend level compared to their healthy peers. There were no training effects on participants’ performance and only marginal increases in posterior alpha power in training groups compared to the waitlist group. ConclusionsConsidering that the training effects were small and there was no load and dose effect, we conclude that the current study provides no convincing evidence for specific effects of Cogmed. SignificanceThese findings provide unique insights into neuroplasticity, or lack thereof, with near-transfer tasks in individuals with ADHD.

Cognitive training for children with ADHD: a randomized controlled trial of cogmed working memory training and 'paying attention in class'.

The goal of this randomized controlled trial was to replicate and extend previous studies of Cogmed Working Memory Training (CWMT) in children with Attention-deficit/hyperactivity disorder (ADHD). While a large proportion of children with ADHD suffer from academic difficulties, only few previous efficacy studies have taken into account long term academic outcome measures. So far, results regarding academic outcome measures have been inconsistent. Hundred and two children with ADHD between the age of 8 and 12 years (both medicated and medication naïve) participated in current randomized controlled trial. Children were randomly assigned to CWMT or a new active combined working memory- and executive function compensatory training called ‘Paying Attention in Class.’ Primary outcome measures were neurocognitive functioning and academic performance. Secondary outcome measures contained ratings of behavior in class, behavior problems, and quality of life. Assessment took place before, directly after and 6 months after treatment. Results showed only one replicated treatment effect on visual spatial working memory in favor of CWMT. Effects of time were found for broad neurocognitive measures, supported by parent and teacher ratings. However, no treatment or time effects were found for the measures of academic performance, behavior in class or quality of life. We suggest that methodological and non-specific treatment factors should be taken into account when interpreting current findings. Future trials with well-blinded measures and a third ‘no treatment’ control group are needed before cognitive training can be supported as an evidence-based treatment of ADHD. Future research should put more effort into investigating why, how and for whom cognitive training is effective as this would also potentially lead to improved intervention- and study designs.

A feasibility trial of Cogmed working memory training in fragile X syndrome.

Individuals with fragile X syndrome (FXS) often present with an array of neurocognitive deficits, particularly in working memory (WM) and other executive functions. Evidence is accumulating that WM training can be effective in certain clinical populations in improving WM abilities and decreasing attention deficit hyperactivity disorder symptoms. We report preliminary findings evaluating the feasibility of Cogmed JM program, a computer-based WM intervention, within the FXS population. Twenty-five participants were evaluated for training. Seventeen were deemed eligible, of whom eight enrolled in the 5-wk training. Baseline characteristics were analyzed, as well as training progress and parental impressions. We conclude that Cogmed JM is a feasible intervention in FXS, though a certain baseline level of ability is required, and urge future controlled trials to determine efficacy.