Cogmed Working Memory Training Research Articles

Effect of Cogmed Working Memory Training on Auditory Attention Span of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and/or impulsiveness. The studies on non-pharmacological treatment for ADHD are rather sparse. In India, usually, ADHD is assessed using rating scales, and not much importance is given on selective attention, that is, auditory and/or visual. Kofler 1 hypothesized a functional relationship between working memory (WM) and inattention. The current research was planned to study the effect of Cogmed Working Memory Training (CWMT) program on various parameters of the auditory attention span of children and adolescents having ADHD. Methods: A total of 30 children were taken for the current study. Parental consent was taken. Auditory attention span of the sample was measured by the Continuous Auditory Test of Attention (CATA). After pre-assessment, the children underwent CWMT program for 5 weeks. Cogmed is a scientifically researched program, which has been recommended to be used for improvement of WM and attention. At the end of the training, the children were reassessed by the abovementioned tool, CATA. t-test was used to analyze the pre-intervention and post- intervention data for auditory inattentiveness, impulsivity, sustained attention, and two age groups. Mann-Whitney U-test was used to analyze the comparison between male and female gender groups. Results: Results indicate the effectiveness of Cogmed Working Training Program on auditory attention span of children with ADHD. Conclusion: The results need to be validated if the improvement is sustained over a period of time with follow up assessment.

88 Considering Lateralization and Localization of Neurosurgical Intervention for Predicting Treatment Response to Computerized Cognitive Remediation (CCR) Targeting Attention and Working Memory: A Case Series

Objective:Lateralization and localization of neuropathology helps determine the extent to which eloquent cortex and diseased brain tissue share loci, important information for neurosurgical decision-making, and predicting neurocognitive outcomes. Emerging data suggest that lateralization and localization can inform specific neurorehabilitation approaches following acquired brain injury (ABI). In recent years, computerized cognitive remediation (CCR) of attention and working memory (WM) has been included among treatment guidelines to enhance cognition in post-acute recovery following ABI. Although CCR has shown promise for improving attention and executive functioning in ABI, it is unknown how treatment response may be predicted by locus of ABI. Even less is known about the effects of CCR following neurosurgery. The current study explores neurosurgical lateralization and localization as potential variables for predicting treatment response to CCR.Participants and Methods:Adult patients with a variety of neurological diagnoses (N = 17; ∼47% women) completed a full course of Cogmed Working Memory Training (CWMT) s/p neurosurgical intervention. All participants engaged in 30 sessions of CWMT over eight weeks, as well as neuropsychological (NP) assessment at pre-training baseline, immediate post-training, and at 3-month follow-up. Objective and subjective indices of attention, working memory, executive functioning, and emotional well-being were evaluated at three time-points. Neurosurgical loci included left-hemisphere frontal, temporal, and temporoparietal lobes, as well as right-hemisphere frontal, frontotemporal, and temporal lobes.Results:NP data were reviewed and yielded a clinical impression of cognitive and affective functioning for a cohort of patients with heterogeneous diagnoses (e.g., brain tumor, epilepsy, NPH). Preliminary NP findings suggested that treatment response to CCR for WM was consistent with extant literature on brain-behavior relationships according to lateralization and localization of neurosurgical intervention.Conclusions:Neurosurgical patients experience neurocognitive and affective dysfunction that may respond well to cognitive rehabilitation (CR) that includes CCR. Additionally, it is possible that lateralization and localization of surgical intervention may contribute to individual differences in treatment response. Further neurorehabilitation research is warranted to identify patients most likely to benefit from CCR and better tailor CR modalities to optimize recovery s/p neurological surgery.

Utilization of a Cogmed working memory training program in patients with neurocognitive impairment following the resection of intracranial meningioma: Case series and review of the literature

Meningioma is the most common primary brain tumor in adults. Patients may become symptomatic due to the resultant mass effect and the peritumoral vasogenic edema. The majority of existing research on neurocognitive impairment in patients with brain tumors has focused on gliomas while less research has been conducted on the effects of tumor and/or surgical intervention on neurocognitive function in patients with meningioma. We conducted a prospective study on the utilization of the Cogmed Working Memory Training (CWMT) program in patients who underwent surgical resection of WHO grade I intracranial meningioma and experienced neurocognitive impairment after surgery. All patients had a significant improvement in their post-CWMT neurocognitive function evaluation compared to their baseline post-surgical neurocognitive evaluation, and the improvement was maintained at a three-month follow-up. This study is the first to evaluate the effectiveness of a neurocognitive rehabilitation program in augmenting the neurocognitive functioning of patients with Intracranial WHO Grade I Meningioma. The results of this study demonstrate the efficacy of the CWMT program in improving postoperative impaired neurocognitive function and potentially improving the quality of life of our patients.

Feasibility and Efficacy of the Cogmed Working Memory Training in Forensic Mental Health Inpatients With Schizophrenia Spectrum Disorders: A Pilot Study

Introduction Schizophrenia spectrum disorders are characterised by notable deficits in executive function, working memory, attention and social cognition. Previous studies in cognitive remediation therapies, of various dose and duration, have shown behavioural and neurobiological improvements. The current pilot study will be the first to test the Cogmed Working Memory Training (CWMT) program in schizophrenia spectrum disorder. Methods This pilot study was conducted using purposive sampling of consumers with schizophrenia spectrum disorders from a forensic mental health inpatient unit in Australia was used. Eleven participants completed 30 sessions of CWMT over a 2-month period. One participant completed 28 sessions. The primary outcome measure was the CogState Schizophrenia Battery (CSB). Secondary measures included the Brock Adaptive Functioning Questionnaire (BAFQ) and the Allen Cognitive Level Screen (ACLS). Measures were taken before and after the intervention, and at 6-months follow-up to detect maintenance of improvements. Results Significant improvements were seen in social cognition and emotionality. Trends toward improvement in executive function and working memory were observed in younger participants, but were not significant. Conclusion Findings indicate that the CWMT may be a beneficial tool for improving social cognition in patients with schizophrenia. CWMT interventions of longer than 2 months may be required to see measurable improvements in other cognitive functions. Age-related cognitive impairment should be controlled for in future studies. Larger studies should be conducted to confirm these findings.

Independent Component and Graph Theory Analyses Reveal Normalized Brain Networks on Resting-State Functional MRI After Working Memory Training in People With HIV.

Cognitive training may partially reverse cognitive deficits in people with HIV (PWH). Previous functional MRI (fMRI) studies demonstrate that working memory training (WMT) alters brain activity during working memory tasks, but its effects on resting brain network organization remain unknown. To test whether WMT affects PWH brain functional connectivity in resting-state fMRI (rsfMRI). Prospective. A total of 53 PWH (ages 50.7 ± 1.5 years, two women) and 53 HIV-seronegative controls (SN, ages 49.5 ± 1.6 years, six women). Axial single-shot gradient-echo echo-planar imaging at 3.0 T was performed at baseline (TL1), at 1-month (TL2), and at 6-months (TL3), after WMT. All participants had rsfMRI and clinical assessments (including neuropsychological tests) at TL1 before randomization to Cogmed WMT (adaptive training, n=58: 28 PWH, 30 SN; nonadaptive training, n=48: 25 PWH, 23 SN), 25 sessions over 5-8 weeks. All assessments were repeated at TL2 and at TL3. The functional connectivity estimated by independent component analysis (ICA) or graph theory (GT) metrics (eigenvector centrality, etc.) for different link densities (LDs) were compared between PWH and SN groups at TL1 and TL2. Two-way analyses of variance (ANOVA) on GT metrics and two-sample t-tests on FC or GT metrics were performed. Cognitive (eg memory) measures were correlated with eigenvector centrality (eCent) using Pearson's correlations. The significance level was set at P < 0.05 after false discovery rate correction. The ventral default mode network (vDMN) eCent differed between PWH and SN groups at TL1 but not at TL2 (P=0.28). In PWH, vDMN eCent changes significantly correlated with changes in the memory ability in PWH (r=-0.62 at LD=50%) and vDMN eCent before training significantly correlated with memory performance changes (r=0.53 at LD=50%). ICA and GT analyses showed that adaptive WMT normalized graph properties of the vDMN in PWH. 1 TECHNICAL EFFICACY: 1.

COGMED working memory training in children with Attention Deficit/Hyperactivity Disorder (ADHD): A feasibility study in Saudi Arabia

Working memory training has been proven effective for improving cognitive functioning in patients with Attention Deficit/Hyperactivity Disorder (ADHD). However, the feasibility of this type of training for children in Saudi Arabia has not been previously explored. We investigated the feasibility of implementing Cogmed Working Memory Training (CWMT) in a sample of 29 Saudi children with ADHD. We found no significant demographic or clinical differences between compliant and noncompliant children. Although compliant children were initially better at following instructions and reported better improvements in working memory and math skills compared to those who did not complete the CWMT, all children who participated in the program showed improvements in performing the CWMT tasks. Most parents found the Cogmed training feasible for their children, were satisfied and keen to continue with the program, and felt the training helped them to address their problems. Most children did not encounter any difficulties in using the software, and many families were, therefore, likely to continue using the techniques from the program. We conclude that CWMT for children with ADHD is feasible in Saudi Arabia. Larger case-controlled studies are needed to thoroughly investigate the effects of CWMT compared to other interventions in Saudi children with ADHD.

Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD

Objective: This study evaluated a modified working memory training program, Cogmed, for ADHD youth. Method: Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later. Results: After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group. Conclusions: MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.

A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease.

Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design. 47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency. In the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.

Investigating the brain structural connectome following working memory training in children born extremely preterm or extremely low birth weight.

Children born extremely preterm (EP, <28weeks' gestation) or extremely low birth weight (ELBW, <1,000g) are a vulnerable population at high risk of working memory impairments. We aimed to examine changes in the brain structural connectivity networks thought to underlie working memory performance, after completion of a working memory training program (Cogmed) compared with a placebo program in EP/ELBW children. This was a double-blind, placebo-controlled randomized trial (the Improving Memory in a Preterm Randomised Intervention Trial). Children born EP/ELBW received either the Cogmed or placebo program at 7years of age (n=91). A subset of children had magnetic resonance imaging of the brain immediately pre- and 2weeks post-training (Cogmed n=28; placebo n=27). T1 -weighted and diffusion-weighted images were used to perform graph theoretical analysis of structural connectivity networks. Changes from pre-training to post-training in structural connectivity metrics were generally similar between randomized groups. There was little evidence that changes in structural connectivity metrics were related to changes in working memory performance from pre- to post-training. Overall, our results provide little evidence that the Cogmed working memory training program has training-specific effects on structural connectivity networks in EP/ELBW children.

Does cognitive training improve attention/working memory in persons with MS? A pilot study using the Cogmed Working Memory Training program

BackgroundCognitive deficits, especially in attention, are common in persons with MS (PwMS) and are associated with clinically meaningful outcomes, such as work disability and lower quality of life (QOL). In this study, we aimed to determine whether Cogmed Working Memory Training (CWMT) improves attention/working memory in PwMS displaying impairment in these domains. MethodsThis single blind, randomized controlled, pilot study compared the effects of CWMT, a five-week evidenced-based computer-assisted training program that is supported by weekly meetings with a coach, to standard medical care (treatment as usual). We recruited PwMS from one MS center (London (ON) Canada), aged 18-64, with an Expanded Disability Status Scale (EDSS) score of ≤ 7.0, and a visual acuity (corrected) of at least 20/70. Potential subjects had to demonstrate impaired attention on at least two of three measures (Paced Auditory Serial Addition Test [PASAT], Symbol Digit Modalities Test [SDMT], and/or DKEFS Color-Word Interference Test); these measures also served as the primary study outcomes. Subjects were randomized to either the CWMT or treatment as usual. Secondary cognitive outcomes included other measures of attention, memory, as well as a self-reported cognitive function measure. Self-reported measures of mood (depression and anxiety), pain, and QOL were also included as other secondary outcomes. Subjects received assessments at baseline, post-treatment, and 6-month follow-up, or an equivalent time period for the treatment as usual group. The two groups were compared at baseline on background measures using independent samples t-tests, Chi-Square tests, and Mann-Whitney U tests. To analyze primary and secondary outcomes, a non-parametric approach was used due the small sample size and that many of our outcomes did not meet assumptions for parametric analyses. Friedman's test was conducted followed by post hoc pairwise comparisons within each group using Wilcoxon Signed-Rank tests with Bonferroni corrected post hoc contrasts, which allowed us to examine for differences between time points. ResultsOf 30 subjects, 15 were assigned to CWMT. Significant training effects were noted in 1 of 3 primary attentional outcomes (DKEFS Color-Word Interference Test), 2 of 3 secondary attentional outcomes (Letter-Number Sequencing, Digit Span), and 1 mood scale (Hospital Anxiety and Depression scale (HADS) - Depression Subscale), ps < .025. No significant changes were observed in the treatment as usual group. ConclusionThis pilot study demonstrates that cognitive training with CWMT has the potential to improve attention/working memory in PwMS, as well as a potential positive effect on mood, in PwMS. Further exploration of this intervention in PwMS with attention/working memory impairment is warranted.

Working memory training in adults with trichotillomania: A 5-week, single-blind, randomized controlled study

ObjectiveThis randomized controlled study investigated the effect of the Cogmed Working Memory Training (CWMT) program on hair-pulling severity and working memory in trichotillomania (TTM). Methods36 adults with TTM were assigned to CWMT or active control (25 sessions, 5 weeks). Data from intention-to-treat [ITT] (CWMT: N = 21; control: N = 15) and per-protocol (CWMT: N = 16; control: N = 13) samples were analyzed. The primary and secondary outcomes were the totals on the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS) and the Digit Span (Backward) subtest of the Wechsler Adult Intelligence Scale. Assessments occurred at baseline, at 5 weeks, and 3 months post-training. A mixed-model repeated measures ANOVA was done, with the interaction of group x time as primary effect of investigation. ResultsRegarding hair-pulling severity, the interaction effect of group x time was not significant (p = 0.27). Regarding working memory, there was a significant group × time interaction in favour of CWMT (p = 0.03), with improvement in working memory from baseline to 5 weeks (p < 0.001, LS mean difference −1.98). ConclusionsCWMT is not superior to active control in reducing hair-pulling. Working memory improved significantly over the short term with CWMT. The findings are a novel contribution to work on cognitive training effects on problematic repetitive behaviours.

The Effectiveness of Working Memory Training for Children With Low Working Memory.

Subgroups of children may benefit more from working memory training than others. In this study, we aimed to examine whether response to the Cogmed Working Memory Training program differed for children with low IQ and elevated attention-deficit/hyperactivity disorder, emotional and behavioral symptoms, special health care needs, or by sex. We used data from the Memory Maestros trial, a population-based randomized controlled trial of the Cogmed program delivered at school (n = 226) compared to usual teaching (n = 226) in grade 1 children (mean age 6.9 years; SD 0.4) with low working memory. Cogmed comprises 20 to 25 sessions of 45-minute duration over 5 to 7 weeks. Children completed subtests from the Automated Working Memory Assessment to measure change in working memory from baseline to 6 months postrandomization. After training, improved working memory standard scores (>1 SD) from baseline to 6 months were observed for approximately one-third of the children, with more than half maintaining stable scores (within 1 SD). However, similar outcomes were observed for children receiving usual teaching. Differential effect of Cogmed versus usual teaching was evident for children with elevated hyperactivity and/or inattention, who were less likely to show improved visuospatial working memory, but not for other subgroups studied. Children with elevated hyperactivity and/or inattention were less likely to show clinically meaningful improvement after Cogmed; however, differential effects were not evident for children with low IQ and elevated emotional and behavioral symptoms, special health care needs, or by sex. More research is needed to determine if training can improve working memory and, if so, for whom.

A beneficial effect of a Cogmed working memory training on intelligence without an improvement in working memory capacity.

A Cogmed working memory training was done aimed to enhance intelligence in a group of adolescents at risk for school dropout and with below average IQ through an increase in working memory capacity. The adolescents came from poor families and 84% came from minority groups. The effect of the Cogmed working memory training was tested in a randomized control trial with a reading comprehension and a no-training control group. We took care that the amount of coaching to ensure treatment integrity was similar in both training groups. The trainings took five weeks but were followed two months later by a 1-week booster. Participants were 64 students (42 boys and 22 girls) with a mean age of 14,6 years (SD = 16.5 months). An intermediate-test was done after the 5 week training and a posttest at the end of the year, 3 months after the booster. Measures of working memory capacity were involved at pre-, intermediate and posttest. IQ and school achievement were included at pretest and posttest. We found short but no long-term effects on working memory capacity. Surprisingly, at posttest both trainings had an effect on IQ and school achievement in the absence of an increase in working memory capacity. We argue that these results might be due to more general aspects of these interventions, in particular the coaching and support that were provided to the students.

An investigation of Cogmed working memory training for neurological surgery patients

ObjectiveCognitive dysfunction is prevalent amongst individuals who have undergone neurosurgical intervention, significantly impacting daily functioning and quality of life. The aim of this pilot study was to investigate the impact of Cogmed Working Memory Training (CWMT), a five-week, home-based, computerized cognitive rehabilitation intervention, within a neurosurgical population. MethodThirty adult participants who underwent neurosurgical intervention, regardless of etiology, were included in this study. Participants were administered a neuropsychological battery at three time points post-neurosurgical intervention: (a) at baseline, prior to engaging in CWMT; (b) within two weeks of completing the training; and (c) after three months of completing the training. ResultsFollowing CWMT, participants demonstrated significant improvement on measures of attention, working memory, processing speed, verbal learning, and memory. In addition, participants reported significant improvement in quality of life (i.e., physical, social, emotional, and functional well-being), mood (i.e., anxiety and depression), and neurobehavioral functioning (i.e., apathy). ImplicationsResults suggest that CWMT may improve aspects of cognitive and functional outcomes for neurosurgical patients.

Suivi à long terme des effets d’un entraînement de la mémoire de travail (Cogmed) auprès d’enfants présentant un TDA/H

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder associated with working memory deficits. In that optic, new interventions designed to train working memory have been developed. Cogmed Working Memory Training (CWMT) is a popular online training program that is said to increase working memory (WM) and related skills in the ADHD population. However, follow-up measures are not systematically included, and long-term effects of CWMT are controversial. Also, the number of studies examining transfer of learning and controlling for medication or comorbidities are limited. ObjectivesThis study investigates the long-term effects of CWMT combined with psychostimulant medication on WM and related skills. MethodsThis study included 31 participants aged 7 to 13 years, diagnosed with ADHD (mixed subtype) associated with learning disorders, oppositional-defiant disorder and/or Tourette syndrome. Participants first completed CWMT and were evaluated at follow-up six months later. We used a randomized, double-blind, placebo-controlled design. ResultsThe results found no significant impact of CWMT at follow-up. There were no improvements of WM nor transfer effects on related skills, academic achievement or ADHD symptoms at six months’ follow-up. ConclusionLong-term efficacy of CWMT is not demonstrated. We can’t support CWMT as an effective complementary treatment for children with ADHD and associated comorbidities.

Virtual Reality Assessment of Classroom - Related Attention: An Ecologically Relevant Approach to Evaluating the Effectiveness of Working Memory Training.

Computerized cognitive interventions to improve working memory also purport to improve ADHD-related inattention and off task behavior. Such interventions have been shown to improve working memory, executive functioning, and fluid reasoning on standardized neuropsychological measures. However, debate continues as to whether such programs lead to improvement on ecologically relevant outcomes, such as classroom behavior. This study sought to propose a novel, ecologically relevant approach to evaluate the effectiveness of working memory training on real-world attention performance. Participants included 15 children, aged 6–15, identified as having attention problems were assessed via the virtual classroom continuous performance task (VCCPT) before and after completing 5 weeks of Cogmed working memory training. The VCCPT is a validated measure of sustained and selective attention set within a virtual reality (VR) environment. Several key areas of attention performance were observed to improve, including omission errors, reaction time, reaction time variability, and hit variability. Results suggest that working memory training led to substantial improvements in sustained attention in a real-life scenario of classroom learning. Moreover, the use of psychometrically validated VR measurement provides incremental validity beyond that of teacher or parent report of behavior. Observing such improvements on ecologically relevant measures of attention adds to the discussion around how to evaluate the effectiveness of working memory training as it pertains to real-life improvements and serves to inform consumer awareness of such products and their claims.

Investigating Effects of Working Memory Training on Foreign Language Development

AbstractThe current 2‐part study investigated the relative contributions of English language training (ELT) and computerized Cogmed working memory training (WMT) to improvements in English‐as‐a‐foreign language (EFL) proficiency and working memory capacity. In Study 1, Japanese undergraduate EFL learners were randomly allocated to 1 of 3 experimental groups (ELT only, WMT only, and both WMT and ELT) and a control group. The dual intervention (WMT + ELT) group, who received 5 weeks of both WMT and ELT, retained the training effects on verbal short‐term memory and working memory at 6 months post‐training. No significant gains were made, however, in a standardized EFL test of vocabulary, grammar, reading, and listening comprehension abilities. Addressing the absence of a measure of more productive skills in Study 1, Study 2 was carried out on a new cohort of Japanese undergraduate EFL learners comprising a WMT group and a control group. No significant far‐transfer effects (on the language‐based measures) were identified. Descriptive and correlational analyses revealed that the higher general oral proficiency scores tended to be associated with larger improvements in a verbal working memory task (involving storage and manipulation of letter sequences) completed during the Cogmed WMT program. These analyses indicate the possibility of more specialized WMT programs translating into more tangible gains in second or foreign language performance. Further insights into the limited far‐transfer effects of WMT could be gleaned by exploring a modular approach to studying working memory.

Training-induced white matter microstructure changes in survivors of neonatal critical illness: A randomized controlled trial

In a nationwide randomized controlled trial, white matter microstructure was assessed before and immediately after Cogmed Working-Memory Training (CWMT) in school-age neonatal critical illness survivors. Eligible participants were survivors (8–12 years) with an IQ ≥ 80 and a z-score of ≤ −1.5 on (working)memory test at first assessment. Diffusion Tensor Imaging was used to assess white matter microstructure. Associations between any training-induced changes and improved neuropsychological outcome immediately and one year post-CWMT were evaluated as well. The trial was conducted between October 2014–June 2017 at Erasmus MC-Sophia, Rotterdam, Netherlands. Researchers involved were blinded to group allocation. Participants were randomized to CWMT(n = 14) or no-intervention(n = 20). All children completed the CWMT. Global fractional anisotropy(FA) increased significantly post-CWMT compared to no-intervention(estimated-coefficient = .007, p = .015). Increased FA(estimated coefficient = .009, p = .033) and decreased mean diffusivity(estimated-coefficient = −.010, p = .018) were found in the left superior longitudinal fasciculus(SFL) post-CWMT compared no-intervention. Children after CWMT who improved with >1SD on verbal working-memory had significantly higher FA in the left SLF post-CWMT(n = 6; improvement = .408 ± .01) than children without this improvement post-CWMT(n = 6; no-improvement = .384 ± .02), F(1,12) = 6.22, p = .041, ηp2 = .47. No other structure-function relationships were found post-CWMT. Our findings demonstrate that white matter microstructure and associated cognitive outcomes are malleable by CWMT in survivors of neonatal critical illness.

Child Motivation and Family Environment Influence Outcomes of Working Memory Training in Extremely Preterm Children

Cognitive training can improve working memory in children at risk of working memory difficulties; however, response to training can vary and doubt exists if working memory improvements can be sustained long- term. This study aimed to explore whether child motivation and family environment are associated with working memory trajectories in children born extremely preterm or extremely low birth weight. Forty-five 7-year-old children completed Cogmed Working Memory Training® at home over 5–7 weeks. Children and their families completed working memory tests and child motivation and family environment questionnaires at baseline, with working memory further tested 2 weeks, 12 months and 24 months post-training. Latent growth modelling was used to explore whether child motivation and family environment factors were associated with working memory trajectories. Children’s desire for challenge, training competence, and being from a single-parent household were associated with short-term improvements in verbal short-term memory. Children from poorer functioning families were associated with short-term improvements in working memory. There was little evidence that child motivation or family environment was associated with long-term working memory changes. Child motivation and the training environment may be important for understanding training effects in children born extremely preterm or extremely low birth weight, and warrant closer examination in working memory training studies.

Cognitive training for children and adolescents with fragile X syndrome: a randomized controlled trial of Cogmed

BackgroundIndividuals with fragile X syndrome (FXS) typically demonstrate profound executive function (EF) deficits that interfere with learning, socialization, and emotion regulation. We completed the first large, non-pharmacological controlled trial for FXS, designed to evaluate the efficacy of Cogmed, a computer/tablet-based working memory (WM) training program.MethodsThe study was a randomized, blinded, parallel two-arm controlled trial in 100 children and adolescents with FXS (63 male, 37 female; 15.28 ± 3.36 yrs.). Participants were randomized equally to adaptive (difficulty level adjusted to performance) or non-adaptive (control) Cogmed training. Participants were assessed at home using objective measures of WM (primary outcome) and EF at baseline, following 20–25 caregiver-supported sessions over 5–6 weeks, and at follow-up 3 months after cessation of training. Parents and teachers provided ratings of WM, attention, and EF.ResultsThe WM composite and selective domains of EF (distractibility, cognitive flexibility), as well as parent- and teacher-reported attention and EF, significantly improved across the full study sample, with many changes maintained at follow-up. However, comparisons of improvement between adaptive and non-adaptive control conditions did not differ, showing that progressively challenging the WM system by expanding span length did not provide added benefit overall.ConclusionsFurther experimental comparisons are needed before Cogmed working memory training can be considered empirically validated for children with FXS, forming the basis of treatment recommendation. However, given that prior studies show no significant changes on these measures in FXS without treatment, that improvements were maintained for 3 months, and that blinded teachers reported improvements in the classroom, the modest benefits seen in both adaptive and non-adaptive groups overall are unlikely to be attributable to placebo or practice effects alone. Future analyses examining inter-individual differences (e.g., baseline capacity, training efficiency, co-morbidity, training environment, characteristics of training aide) may help to link this intervention to outcomes and potential transfer effects.Trial registrationUS National Institutes of Health (ClinicalTrials.gov), NCT02747394.