Working Memory Training Improves Cognitive Function in VLBW Preschoolers

Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, 7489 Trondheim, Norway. .
PEDIATRICS (Impact Factor: 5.47). 03/2013; 131(3):e747-54. DOI: 10.1542/peds.2012-1965
Source: PubMed


Preterm born children perform poorer than term peers on tests of attention and executive functions including working memory tests. Our aim was to evaluate if preterm born preschoolers with very low birth weight (VLBW) would benefit from a computerized working memory training program and if the training would have a generalizing effect on memory, learning, attention, behavior, and anxiety.
A prospective intervention study with a stepped wedge design where 20 VLBW preschoolers aged 5 to 6 years participated. The children trained with the Cogmed JM program for 10 to 15 minutes a day, 5 days a week over a 5-week period. Extensive neuropsychological assessment and parental questionnaires regarding behavior and anxiety were performed before and 4 weeks after intervention.
The children improved significantly on trained (mean Start Index 42.1 [SD 6.3]), mean Max Index 60.6 [SD 5.7]), and nontrained working memory tasks (Spatial Span backward; 2.3 [before] to 3.6 [after training] [confidence interval {CI} -2.2 to -0.4] and Spatial Span total score; 6.4-8.3 [CI -3.7 to -0.1]). A generalization effect was found on auditory attention (49.6-58.2 [CI -15.5 to -1.6]), phonological awareness (9.3-12.6 [CI -5.2 to -1.4]), visual (memory for faces 20.0-24.9 [CI -7.4 to -2.5]), as well as verbal memory (narrative memory; 12.9-17.5 [CI -7.1 to -2.0], and sentence repetition 15.7-17.7 [CI -3.3 to -0.7]).
This study shows that VLBW preschoolers benefit from a computerized working memory training program. We speculate that such training before starting school may prevent or reduce cognitive problems that impact educational achievement.

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Available from: Kristine Hermansen Grunewaldt, Dec 20, 2013
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    • "Egeland/Hovik et al., 2013 (combined) 0.10 [-0.39, 0.59] Alloway, 2012 0.12 [-0.90, 1.14] Dunning et al., 2013 0.16 [-0.27, 0.59] Bergman-Nutley et al., 2014 0.16 [-0.04, 0.36] Klingberg et al., 2002 0.33 [-0.73, 1.39] Grunewaldt et al., 2013 0.33 [-0.55, 1.21] Dongen-Boomsma et al., 2014 0.36 [-0.38, 1.10] Klingberg et al., 2005/ Dahlin, 2011 (combined) 0.50 [-0.11, 1.11] Gropper et al., 2014 0.55 [0.02, 1.08] Kroesbergen et al., 2014 0.78 [0.19, 1.37] mean ES 0.17 [0.05, 0.29] Lundqvist et al., 2010 0.43 [-0.18, 1.04] mean ES 0.43 [-0.18, 1.04] Verbeken et al., 2013 0.01 [-0.60, 0.62] Van der Molen et al., 2010 0.17 [-0.24, 0.58] Kesler et al., 2013 0.68 [0.05, 1.31] "
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    ABSTRACT: Deficits in working memory (WM) are commonly observed after brain injuries and cause severe impairments in patients' everyday life. It is still under debate if training can enhance or rehabilitate WM in case of malfunction. The current meta-analysis investigates this issue from a clinical point of view. It addresses under which conditions and for which target group WM training may be justifiable. Relevant WM training studies were identified by searching electronic literature databases with a comprehensive search term. In total, 103 studies, which added up to 112 independent group comparisons (N = 6,113 participants), were included in the analysis. Overall, WM training caused a moderate and long-lasting improvement in untrained WM tasks. Moreover, improvement of WM functioning led to sustainable better evaluation of everyday life functioning, however, effect sizes were small. Concerning transfer effects on other cognitive domains, long-lasting improvements with small effect sizes were observed in cognitive control and reasoning/intelligence. In contrast, small immediate, but no long-term effects were found for attention and long-term memory. Studies with brain injured patients demonstrated long-lasting improvements in WM functions with moderate to large effect sizes. A main moderator variable of intervention efficacy is the number of training sessions applied. WM training produces long-lasting beneficial effects which are strongly pronounced in patients with acquired brain injuries. This finding supports the application of WM training in clinical settings. To determine optimal training conditions, future studies must systematically investigate the characteristics of interventions as they are at present inevitably confounded. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Aug 2015 · Neuropsychology
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    • "Given the importance of WM for everyday functioning, including academic achievement22232425 and maintaining attention in daily activities [7], there has been increasing interest and debate about the generalising benefits of a WM training program [17,20] . Initial reports provide some suggestion that benefits of a WM training program can generalise, with some studies reporting far transfer effects, including: i) improved performance in the lab or clinic on tasks that require WM, such as reasoning [13] and reading comprehension [26], and ii) improved functioning in daily life, such as reducing symptoms associated with a disorder, such as inattention in daily activities [10,272829303132333435. Establishing generalising benefits for everyday functioning would have exciting implications with both theoretical and clinical significance, especially for ADHD where impaired WM and inattentive behaviour are considered core features of the disorder [3]. "
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    ABSTRACT: Background: Many common disorders across the lifespan feature impaired working memory (WM). Reported benefits of a WM training program include improving inattention in daily life, but this has not been evaluated in a meta-analysis. This study aimed to evaluate whether one WM training method has benefits for inattention in daily life by conducting a systematic review and meta-analysis. Methods: We searched Medline and PsycINFO, relevant journals and contacted authors for studies with an intervention and control group reporting post-training estimates of inattention in daily life. To reduce the influence of different WM training methods on the findings, the review was restricted to trials evaluating the Cogmed method. A meta-analysis calculated the pooled standardised difference in means (SMD) between intervention and control groups. Results: A total of 622 studies were identified and 12 studies with 13 group comparisons met inclusion criteria. The meta-analysis showed a significant training effect on inattention in daily life, SMD=-0.47, 95% CI -0.65, -0.29, p<.00001. Subgroup analyses showed this significant effect was observed in groups of children and adults as well as users with and without ADHD, and in studies using control groups that were active and non-adaptive, wait-list and passive as well as studies using specific or general measures. Seven of the studies reported follow-up assessment and a meta-analysis showed persisting training benefits for inattention in daily life, SMD=-0.33, 95% CI -0.57 -0.09, p=.006. Additional meta-analyses confirmed improvements after training on visuospatial WM, SMD=0.66, 95% CI 0.43, 0.89, p<.00001, and verbal WM tasks, SMD=0.40, 95% CI 0.18, 0.62, p=.0004. Conclusions: 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.
    Full-text · Article · Mar 2015 · PLoS ONE
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    • "The results of this study suggest that attention training transfers to fluid intelligence. The scientific evidence showing how computer learning can improve executive functions in young children is normally based on evaluating the effect of training by using psychological intelligence tests or by specific standardized tasks (Diamond and Lee, 2011; Grunewaldt et al., 2013; Thorell et al., 2009). However, ecological tasks are rarely used, such as the tasks or exercises performed during daily classroom activities. "
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    ABSTRACT: Improvements in executive functions appear to have a strong impact on preschool learning activities and academic performance. This paper presents some experiences in training working memory and attentional control supported by an educational software system called APRENDO. The aims were to assess the suitability of the APRENDO system as a computer-based learning system in terms of improvements in these two executive functions, and to establish whether the tasks help children - especially children with the poorest performance - in a school task requiring the use of both processes. The participants were 52 four-year-old children, divided into a control group and an experimental group. The experimental group trained with two types of APRENDO visuospatial exercises: “Find the different objects” and “Find the intruder”. Before and after the training phase, all the children performed a school task with similar psychological demands selected from their ordinary school materials. The results of both APRENDO exercises showed positive correlations between the same variables over the training sessions, demonstrating the suitability of the exercises. On the other hand, in the experimental group, there were significant differences between some of the variables analyzed, e.g., the time needed to complete the exercises (“Answering time”) or the number of clicks on the correct images (“Answer accuracy”) in both exercises during the sessions. The results indicate that the children who obtained lower scores in the pre-test phase were those who benefitted the most from training. The analysis of the errors made by the children in both tasks suggests that these errors are due to the incorrect application of the same cognitive abilities. The implications for educational practice are discussed.
    Full-text · Article · Mar 2015 · International Journal of Human-Computer Studies
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