ARTICLES
Computerized Training of Working Memory in Children With ADHD-A Randomized, Controlled Trial

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ABSTRACT

Objective

Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks.

Method

Included in the trial were 53 children with ADHD (9 girls; 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program.

Results

For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up.

Conclusions

This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

Section snippets

Subjects

Referral sources included pediatricians, child psychiatrists, and special teachers in schools. We included only nonmedicated children because they were thought to have more room for clinical improvement of ADHD symptoms than children on medication and therefore give a better chance of detecting significant treatment effects. Furthermore, in Sweden, only a minority of children with ADHD receives medication.

Inclusion criteria were (1) diagnosis of ADHD of either combined or predominantly

RESULTS

The flow of participants is shown in Figure 1. Of the 53 subjects, three withdrew: two because of computer problems and one because of social problems not related to the study. Fifty children attended the postintervention visit. The criterion for sufficient compliance was defined before the study to be 20 or more days of program use. Forty-four of the 50 subjects met these criteria. Mean number of days was 26.6 (SD = 2.6) in the comparison group and 25.2 (SD = 2.2) in the treatment group.

In the

DISCUSSION

In this study, the treatment group that undertook high-intensity training of WM improved significantly more than the comparison group on the main outcome measure: the span-board task, which was a nonpracticed measure of visuospatial WM. This effect also remained at follow-up. In addition, there were treatment effects for response inhibition (Stroop task), verbal WM (digit-span), complex reasoning (Raven's task), and for parent ratings of ADHD symptoms.

The span-board task differs from the

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  • Cited by (0)

    This study was supported by the Swedish Research Foundation (Vetenskapsrådet), the Wallenberg Global Learning Network, and Cogmed Cognitive Medical Systems AB. The authors thank Anna-Karin Adler, Gunilla Berglund, and Sven östlund for performing the neuropsychological testing, Jonas Beckeman and David Skoglund for their significant contribution to task design, Maria Andersson for managing the patient calls, and Johan Bring for statistical analyses.

    Disclosure: Drs. Forssberg and Klingberg and Ms. Westerberg own stock in Cogmed. Ms. Olesen had a consultancy agreement with Cogmed. The other authors have no financial relationships to disclose.

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