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Poor working memory affects approximately 15% of children. It is characterized by inattentive, distractible behavior that is accompanied by failures to complete everyday activities that require focused or sustained attention. Typically, children with poor working memory have normal social integration, normal levels of emotional control, and self-esteem. They may appear reserved in large group situations. Over 80% of children with low working memory struggle in reading and mathematics, and it has been suggested that they are likely to be those children who make poor academic progress, but who fall below the radar of recognition for special educational needs. Beyond poor learning, children with poor working memory have a range of other cognitive problems that extend to low IQ and deficits in other executive functions, including monitoring and planning, problem solving, and sustained attention. Although the direction of causality is uncertain, it is possible that limited working memory resources underpin this wide range of deficits. There are three main approaches to alleviating the difficulties faced by children with poor working memory—a classroom intervention, strategy training, or direct working memory training.
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From: Joni Holmes, Susan E. Gathercole, and Darren L. Dunning, Poor Working
Memory: Impact and Interventions. In Joni Holmes, editor: Advances in Child
Development and Behavior, Vol. 39, Burlington: Academic Press, 2010, pp. 1-43.
ISBN: 978-0-12-374748-8
© Copyright 2010 Elsevier Inc.
Academic Press.
POOR WORKING MEMORY: IMPACT AND
INTERVENTIONS
Joni Holmes,*Susan E. Gathercole,
{
and Darren L. Dunning
{
* DEPARTMENT OF PSYCHOLOGY, NORTHUMBRIA UNIVERSITY, NEWCASTLE UPON
TYNE, UNITED KINGDOM
{
DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF YORK, YORK, UNITED KINGDOM
I. INTRODUCTION
II. COGNITIVE PROFILE
A. POOR WORKING MEMORY AND LEARNING IMPAIRMENTS
B. LOW WORKING MEMORY AND IQ
C. WORKING MEMORY DEFICITS AND PERVASIVE EXECUTIVE
FUNCTION IMPAIRMENTS
D. WORKING MEMORY AND DEVELOPMENTAL DISORDERS OF
LEARNING
E. COGNITIVE PROFILESUMMARY
III. SOCIAL AND BEHAVIORAL PROFILE
IV. INTERVENTIONS
A. CLASSROOM INTERVENTION
B. STRATEGY TRAINING
C. WORKING MEMORY TRAINING
D. INTERVENTIONSSUMMARY
V. SUMMARY AND FUTURE DIRECTIONS
REFERENCES
I. Introduction
Poor working memory is not yet a recognized developmental disorder.
However, children with poor working memory function are at very high risk
of educational underachievement (e.g., Gathercole & Alloway, 2008)andit
has recently been suggested that decits in working memory might be a
cognitive phenotype for children who make slow progress at school,
but who do not have general learning difculties (Gathercole, 2010).
Moreover, working memory impairments are associated with a wide range
of developmental disorders of learning, including attention-decit hyperac-
tivity disorder (ADHD), dyslexia, specic language impairment (SLI),
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Advances in Child Development and Behavior Copyright ©2010 Elsevier Inc. All rights reserved.
Patricia Bauer : Editor
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Down syndrome, and reading and mathematical difculties (see Alloway &
Gathercole, 2006). The early recognition of working memory difculties
and the provision of effective educational support and targeted intervention
are therefore paramount to improving the long-term outcomes for a vast
number of children.
So, what is working memory and how can we identify children with
poor working memory? The term working memory describes our ability
to hold in mind and manipulate information for brief periods of time dur-
ing complex cognitive activities. There are several theoretical models of
working memory which differ in their views of the nature, structure, and
function of the system (for a review, see Conway, Jarrold, Kane, & Towse,
2007; Miyake & Shah, 1999). The primary distinction between these
models is whether working memory is conceived as a distinct entity
(e.g., Baddeley, 2000; Baddeley & Hitch, 1974) or a limited capacity pro-
cess of controlled attention that acts to activate existing representations in
long-term memory which then become the current contents of working
memory (e.g., Anderson & Lebiere, 1998; Barrouillet, Bernardin, &
Camos, 2004; Cowan, 2005; Engle, Kane, & Tuholski, 1999; Kintsch,
Healy, Hegarty, Pennington, & Salthouse, 1999). Most accounts of work-
ing memory distinguish between the storage-only capacities of short-term
memory (STM) and the storage and processing functions of working
memory. They also agree that the capacity of working memory is limited,
meaning there is an upper limit to the amount of information that can be
stored and processed at any given moment in time.
According to one of the most widely accepted models (Baddeley, 2000;
Baddeley & Hitch, 1974), working memory is a multicomponent system.
There are two domain-specic STM stores, the phonological loop and the
visuospatial sketchpad, that are specialized for the temporary maintenance
of verbal and visual and spatial information, respectively. These are governed
by a domain-general central executive system linked to attentional control,
responsible for holding and manipulating information from long-term mem-
ory, coordinating performance on dual tasks, switching between retrieval
strategies, and inhibiting irrelevant information (e.g., Baddeley, 1996;
Baddeley, Emslie, Kolodny, & Duncan, 1998; Engle & Kane, 2004; Engle
et al., 1999; Kane, Conway, Hambrick, & Engle, 2007, Kane & Engle, 2000;
Kane, Hambrick, & Conway, 2005). The fourth component, the episodic
buffer, is responsible for integrating information from the subcomponents
of working memory and long-term memory (Baddeley, 2000).
An individual's working memory capacity can be assessed using both
simple and complex span tasks. Simple span tasks, also known as STM
tasks, involve the storage of either verbal or visuospatial material. These
assess the phonological loop and visuospatial sketchpad components of
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the Baddeley and Hitch (1974) working memory model, respectively.
Complex memory span, or working memory,tasks impose signicant
demands on both storage and processing, and require the support of both
the central executive, plus the respective storage components of working
memory. Thus, verbal working memory tasks such as reading and listening
span (Daneman & Carpenter, 1980; Daneman & Merickle, 1996) rely on
both the central executive and the phonological loop, whereas working
memory tasks involving visuospatial material draw upon the central
executive and the visuospatial sketchpad (Alloway, Gathercole, &
Pickering, 2006; Kane et al., 2004).
There are currently two standardized test batteries designed to assess
children's working memory capacities, the Automated Working Memory
Assessment (Alloway, 2007) and the Working Memory Test Battery for
Children (Pickering & Gathercole, 2001). Both provide multiple
assessments of the different aspects of short-term and working memory
and, because age norms are available, can be used to identify children
who have poor working memory for their age. In our own research, we
typically classify children as having poor working memory skills if their
standard scores on two separate tests of working memory are at least
one standard deviation below the mean (bottom 15th centile, standard
scores <86). It is these children who we know are at substantial risk of
poor educational progress. When diagnosing a child with poor working
memory, it is important to take into account potential non-memory causes
of low test performance. For example, factors such as speech-motor dys-
function and hearing or sight problems might give rise to inaccurate
encoding or recall, which will affect performance negatively. The Working
Memory Rating Scale (Alloway, Gathercole, & Kirkwood, 2008) can also
be used to identify children with working memory impairments. This is a
behavioral rating scale consisting of 22 statements, which are rated by a
child's teacher. It provides a quick and efcient method for the early iden-
tication of working memory problems in a school setting.
II. Cognitive Prole
Poor working memory is associated with a wide range of cognitive
difculties that primarily relate to learning, but which we have recently seen
extend to other executive functions including planning, problem solving,
and sustained attention (Gathercole et al.,2010). Low working memory is
also related to below-average intelligence (IQ) and decits in working
memory are key markers of a number of developmental disorders of
learning. Each of these issues is considered in the following sections.
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A. POOR WORKING MEMORY AND LEARNING IMPAIRMENTS
Working memory skills are highly associated with children's abilities to
learn in key academic domains such as reading, mathematics, and science
(Gathercole & Pickering, 2000; Geary, Hoard, Byrd-Craven, & De Soto,
2004; Holmes & Adams, 2006; Jarvis & Gathercole, 2003; Swanson &
Saez, 2003). Children's performances on tests of working memory are also
signicantly associated with the developmental precursors of reading,
writing, and mathematics as children commence formal schooling
(Gathercole, Brown, & Pickering, 2003) and are excellent prospective
indicators of academic performance, predicting children's attainment on
National achievement tests at 7, 11, and 14 years of age (Gathercole,
Pickering, Knight, & Stegmann, 2004; Jarvis & Gathercole, 2003).
Working memory is used to process and store information during complex
and demanding activities (Just & Carpenter, 1992). It therefore supports
many activities children routinely engage in at school. Imagine, for example,
attempting to read and comprehend a passage of text. The process of
reading sentences, holding them in mind, and integrating the information
to uncover the meaning relies heavily on the ability to simultaneously pro-
cess and store information over the short term. Similarly, solving a mathe-
matics problem, such as multiplying two numbers together, involves the
temporary storage of digits whilst simultaneously retrieving learned rules
of multiplication and stored number facts from long-term memory.
Beyond support for everyday mental activities, working memory also pro-
vides vital support for learning across the school years. Children with poor
working memory characteristically underachieve at school (Gathercole &
Alloway, 2008) and, conversely, children who underperform at school typi-
cally have working memory impairments. Gathercole and colleagues found
that 41% of children who achieved below-average scores on National
English tests at 6 and 7 years of age had working memory scores in the decit
range, as did 52% of children who achieved the same low levels in National
Mathematics tests at this age. Similar proportions were reported for
adolescents who scored in the below-average range on National tests in
English, Mathematics, and Science at 14 years of age, with more severe
working memory impairments associated with below-average performance
in Science and Mathematics. Across both age groups, STM scores for low
achievers did not differ signicantly to average and high achievers,
suggesting it is working memory rather than STM that limits learning
opportunities (Gathercole et al., 2004). Overall, these data show that the
incidence of poor working memory is more than three times higher in low
achievers compared to the normal school population, in which approxi-
mately only 16% would be expected to show working memory decits.
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At the extreme end of the school distribution, distinctive working mem-
ory proles characterize children with special educational needs (SEN).
Pickering and Gathercole (2004) reported that children with general
learning difculties in English/literacy and mathematics were six times
more likely to have both poor verbal and visuospatial STM and verbal
working memory scores than children without SEN. Children with SEN
specically related to language were also impaired on tasks that measured
short-term and working memory, although their STM decits were limited
to the verbal domain. Conversely, children with noncognitive SEN such as
behavioral problems had working memory skills in the normal range.
These distinctive proles suggest that children with SEN have decits in
working memory that compromise their educational progress.
The severity of a child's SEN in literacy or mathematics is associated
with the severity of their memory impairment. Children whose needs are
of the greatest severity, indexed by requiring additional resources to sup-
port their learning, show commensurately greater cognitive decits than
children with milder learning difculties. Their decits are particularly
marked in tasks measuring verbal working memory (Alloway, Gathercole,
Adams, & Willis, 2005).
Studies of children identied solely on the basis of poor working
memory, rather than poor educational progress or SEN, show that they
are very likely to struggle at school. Gathercole and Alloway (2008)
recently examined the academic proles of a large group of children
with poor working memory. Over 300 children aged 5 or 6 and 9 or
10 with scores in the bottom 10th centile were identied. Of these chil-
dren, 75% of the 5 and 6 year olds and 83% of the 9 and 10 year olds
had difculties in both reading and mathematics. An additional 5% of
the 5 and 6 year olds were struggling in mathematics only. These gures
clearly illustrate impaired rates of learning in children with poor working
memory.
These children also struggle to successfully complete a range of tasks
that are designed to aid learning at school. Common classroom activities
that require large amounts of information to be held in mind are particu-
larly challenging for children with poor working memory. One of the most
crucial aspects of classroom learning is following spoken instructions given
by the teacher, and this is particularly difcult for children with small
working memory capacities. Teacher instructions are often multistep,
directing children where they or their classroom objects should be, contain
vital information about learning activities, or relate to a sequence of
actions that must be carried out. To perform these actions, children must
be able to remember the different parts of the instruction whilst carrying
out the various steps to complete the action successfully. Children with
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poor working memory typically either carry out the rst command of a
multistep instruction, skip straight to the last step, or simply abandon
the task all together as they are unable to remember all the necessary
parts of the sequence (Gathercole & Alloway, 2008; Gathercole, Lamont,
& Alloway, 2006). Children with low working memory have also been
shown to be poorer in laboratory tasks that involve carrying out the
actions described by a multistep instruction and remembering the content
of the instruction (Gathercole, Durling, Evans, Jeffcock, & Stone, 2008).
These children also experience difculties in classroom activities that
require information to be both processed and stored. For example, writing
activities that require children to count the number of words in a sentence,
write down the sentence, and then check that what they have written
contains the same number of words as were originally counted require
children to store the number of words in mind, remember the sentence,
and also engage in the mentally challenging processing of writing down
the sentence (Gathercole & Alloway, 2008).
Children with poor working memory also make characteristic errors in
their classroom work. These include failing to keep track of their place
in demanding and complex activities and mistakes in writing and counting.
In their written work, they miss out letters, skip whole words, or blend
parts of different words from different sentences. So, for example, if they
were asked to copy the title of a piece of work My Holidayand the date
17th June,they might write down My Holune.In counting tasks, they
lose track of which numbers they are working with and where they are
in the calculation. For example, if they were adding the numbers 28, 7,
and 11, they might miss out the 7 and only add together the numbers 28
and 11. In most cases, children fail to self-correct which ultimately leads
to failure (Gathercole & Alloway, 2008).
These kinds of activities, which are common place in the classroom, typ-
ically overload the working memory capacities of many children. This
memory overload causes problems in following teacher instructions,
remembering information vital to individual tasks, and keeping track in
structured learning activities (Gathercole & Alloway, 2008; Gathercole
et al., 2006). Over time, these frequent missed learning opportunities
amount to slow educational progress and poor academic attainment
(Gathercole & Alloway).
B. LOW WORKING MEMORY AND IQ
There is considerable overlap between performance on tests of working
memory and IQ, with correlations as high as 0.8 reported between
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working memory and reasoning tasks (Kyllonen & Christal, 1990) and
similarly high levels of association observed between executive function
and IQ tests (Miyake, Friedman, Shah, Rettinger, & Hegarty, 2001).
One explanation is that the two domains are overlapping but dissociable
and that the shared variance between working memory and IQ occurs
because methods of assessing IQ are strongly inuenced by working mem-
ory (e.g., Jurden, 1995). Carpenter, Just, and Shell (1990) rst suggested
that working memory capacity may be a main factor underpinning individ-
ual differences on the Raven's Progressive Matrices test, a commonly used
nonverbal IQ test, in the early 1990s. Since then, working memory has
been reported to predict performance on various tests of general IQ
(Engle et al., 1999; Kane et al.,2004) and assessments of working memory
are now an integral part of one of the most widely used IQ assessments,
the Wechsler Intelligence Scales for Children IV (Wechsler, 2004).
There are, in fact, clear distinctions between IQ and working
memory. First, working memory tasks assess different aspects of a single,
well-understood memory system. IQ assessments, however, aggregate per-
formance across a wide range of abilities, which includes language and non-
verbal reasoning. The two domains are also separate in the extent to which a
child's prior knowledge and experiences contribute to performance. Verbal
IQ assessments rely heavily on a child's knowledge of words and language,
which are inuenced by background factors such as their home language
environment and level of education (Brooks-Gunn, Klebanov, & Duncan,
1996; Hoff & Tian, 2005; Huttenlocher, Haight, Bryk, Seltzer, & Lyons,
1991). Working memory tasks, however, are equally unfamiliar to all
children, conferring no obvious advantages or disadvantages to children
from different backgrounds. Studies have shown that children from minority
ethnic groups and poor economic circumstances score poorly on tests of
vocabulary knowledge but not on measures of either verbal STM
(Campbell, Dollaghan, Needleman, & Janosky, 1997; Ellis Weismer et al.,
2000; Engel, Santos, & Gathercole, 2008; Santos & Bueno, 2003) or verbal
working memory (Engel et al., 2008).
Working memory and IQ also make distinct contributions to learning.
Working memory predicts unique variance in children's attainment above
and beyond what can be predicted by IQ (Gathercole, Alloway, Willis, &
Adams, 2006). Furthermore, associations between working memory and
attainment persist after differences in performance IQ or verbal IQ have
been statistically controlled both in children with and without learning
difculties (e.g., Cain, Oakhill, & Bryant, 2004; Siegel & Ryan, 1989;
Swanson & Sachse-Lee, 2001). For these reasons, working memory tests
appear to provide culture-fair indices of a child's cognitive potential.
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Despite differences between working memory and IQ, children with
poor working memory typically have low range IQ, and vice versa. In a
recent comparison of the cognitive proles of 50 children with low work-
ing memory (standard scores below 86 on two tests of working memory)
and 50 age-matched children with average working memory (standard
scores over 90 on two working memory assessments), we found signicant
group differences in both verbal and performance IQ. In both cases, the
average working memory group had signicantly higher scores than the
low memory group (see Figure 1).
Of the low working memory group, 14% had verbal IQ scores in the
extremely low range (standard scores below 70), 30% scored in the poor
range (standard scores in the 7080 range), 54% in the average range
(scores between 86 and 115), and a further 2% scored above average
(standard scores in excess of 116). For performance IQ, 6% scored in
the extremely low range, 50% in the poor range, and 44% in the average
range. Overall, these data show that the majority of children with poor
working memory have IQ scores in the poor average range, with very
few in the extremely low IQ category (Gathercole et al., 2010).
75
85
95
105
Verbal IQ Performance IQ
Low working
memory
Average working
memory
Fig. 1. Verbal and performance IQ scores of 50 children with poor working memory and
50 age-matched children with average working memory, from Gathercole et al. (2010).
8Joni Holmes et al.
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C. WORKING MEMORY DEFICITS AND PERVASIVE
EXECUTIVE FUNCTION IMPAIRMENTS
Working memory is one of several executive functions that support exi-
ble goal-directed behavior. Others include inhibition, switching, planning,
and problem solving (Pennington & Ozonoff, 1996). Inhibition involves
controlling an overlearned or prepotent response (Stroop, 1935);
switching/shifting is involved in changing between mental sets, multiple
tasks, or from one situation, or aspect of a situation, to another (e.g.,
Monsell, 1996); planning involves setting goals, developing appropriate
steps ahead of time, and anticipating future events; and problem solving
allows us to initiate behavior to solve tasks by engaging in exible thinking.
The extent to which problems in working memory extend to other
executive functions is not at present well understood. In children as in
adults, individual differences studies have distinguished working
memory from inhibitory control and set-shifting behavior (Miyake et al.,
2000; St. Clair-Thompson & Gathercole, 2006). However, behavioral
ratings of children with poor working memory include executive
function difculties such as monitoring the quality of their own work
and generating new solutions to problems (Gathercole, Alloway, et al.,
2008).
To investigate whether the working memory problems faced by children
with poor working memory are part of a more pervasive pattern of
impaired executive function, we recently assessed 50 children with work-
ing memory decits, and a comparison group of 50 age-matched children
with average working memory, on a range of tests of executive function
(Gathercole et al., 2010). All children completed standardized tests of cog-
nitive inhibitory control, set-shifting, planning, motor inhibition, and
sustained attention. Where appropriate, measures of basic information
processing were taken for comparison with higher level executive control.
Performance for both groups on the primary higher level tasks is
summarized in Table I.
Overall, we found that children with poor working memory had
difculties that extended to other executive functions, but which did not
reect higher level executive impairments in set-shifting or inhibition.
Children with poor working memory were characterized by signicantly
higher error rates on a set-shifting task and an inhibition task, a greater
number of rule violations on a planning task, and a higher incidence of
omissions on a sustained attention task in comparison to the average
working memory group. They also had signicantly slower completion
times on the inhibition task and were signicantly impaired relative to
the comparison group on measures of motor inhibition and problem
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solving. However, their performance on the inhibition and set-shifting
tasks was not disproportionately greater in conditions that required exec-
utive intervention compared to their performance on tasks that tapped the
basic cognitive processes necessary for completion of the higher level task.
For example, although they performed poorly on the Stroop-like inhibi-
tion task, their performance on this higher level task was not dispropor-
tionately poorer than on the basic color naming and word reading
aspects of the task. Thus, their weaknesses in basic processing under-
pinned their impairments in the higher level executive tasks. These data
show that children with low working memory have decits that are mani-
fest in a variety of cognitively demanding activities, but that they do not
have selective impairments in high-level executive functions of inhibition
or set-shifting.
In summary, there is evidence from these standardized cognitive
assessments that executive function impairments that extend beyond work-
ing memory are present in these children. This is also strongly reected in
teacher ratings of classroom behavior, which point to problems in monitor-
ing and planning, problem solving, and shifting (Gathercole, Alloway,
et al., 2008). Although they struggle in cognitive tasks designed to measure
planning, problem solving, and sustained attention, children with poor
working memory do not have specicdecits in inhibition and set-shifting
(Gathercole et al., 2010).
Working memory and executive difculties might co-occur because
limited working memory capacities constrain performance on tasks that
Table I
Mean Executive Function Scores for Low and Average Working Memory Children,
from Gathercole et al. (2010)
Measure
Low WM Average WM
MSDMSD
Set-shifting Time 9.50 3.11 10.56 2.92
Errors 30.17 21.62 45.51 18.31
Inhibition Time 9.38 3.02 11.68 2.92
Errors 44.30 27.37 65.00 25.07
Planning Total 12.54 4.88 12.94 3.83
Errors 38.60 39.33 61.54 41.11
Sustained attention Omissions 40.56 29.40 23.36 21.21
Commissions 74.40 74.36 48.04 51.65
Motor inhibition Total 4.14 3.57 9.28 3.69
Note: Set-shifting, inhibition time scores, and planning and motor inhibition total scores are scaled
scores (M¼10, SD¼3); set-shifting, inhibition, and planning error scores are cumulative centiles-lower
scores indicate a higher number of errors; sustained attention scores are counts.
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explicitly require the storage and processing of information. For example,
problems in planning and monitoring may result from the loss of task
information and goals from working memory. It is also possible that the
inattentive prole of children with poor working memory results from
the loss of goal-critical information from working memory (this is
discussed in detail later in this chapter). By this account, poor working
memory function underpins decits in a range of executive tasks. How-
ever, the issue of causality is one that needs further exploration as it is
equally possible that executive function failures may be the cause rather
than the consequence of poor working memory.
D. WORKING MEMORY AND DEVELOPMENTAL
DISORDERS OF LEARNING
The cognitive proles of children with poor working memory overlap
with a number of developmental disorders of learning. These include
reading and mathematical difculties, dyslexia, SLI, Down syndrome,
William's Syndrome, and ADHD.
Very low levels of performance on working memory tasks are common
in children with specic difculties in reading (Gathercole, Alloway, et al.,
2006; Pickering & Gathercole, 2004; Swanson, 1993, 2003). Verbal STM is
signicantly associated with reading development during the early years
(Gathercole & Baddeley, 1993) and decits in this component of the
memory system are common among children with reading difculties
(Siegel & Ryan, 1989; Swanson & Siegel, 2001). Verbal working memory
skills have also been found to be consistently associated with children's
reading skills (e.g., de Jonge & de Jong, 1996; Engle, Carullo, & Collins,
1991) and explain unique variance in reading comprehension over and
above verbal STM, word reading, and vocabulary knowledge (e.g., Cain
et al., 2004; Swanson & Jerman, 2007). Furthermore, impairments in com-
plex span tasks that tap working memory extend across both the verbal
and nonverbal domain, indicative of a modality-general impairment in
working memory in poor readers (Chiappe, Hasher, & Siegel, 2000; de
Jong, 1998; Gathercole, Alloway, et al., 2006; Palmer, 2000; Swanson,
1993).
Individuals whose reading problems satisfy the more stringent criteria
for dyslexia also perform below average on both short-term and working
memory tasks in the verbal domain (Jeffries & Everatt, 2003, 2004).
Children with SLI show the same pattern of highly specicdecits in
the verbal domain, with severe impairments in both verbal STM
(Archibald & Gathercole, 2006; Edwards & Lahey, 1998; Ellis Weismer,
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Evans, & Hesketh, 1999; Gathercole & Baddeley, 1990; Montgomery,
1995) and verbal working memory (Archibald & Gathercole, 2007; Ellis
Weismer et al., 1999; Montgomery, 2000a, 2000b). It has been suggested
that poor verbal storage skills underlie impairments in verbal working
memory in this group (Archibald & Gathercole).
Children with mathematical difculties also show signs of working
memory decits (Bull & Scerif, 2001; Geary, 1993; Mayringer & Wimmer,
2000; Passolunghi & Siegel, 2004; Siegel & Ryan, 1989; Swanson & Beebe-
Frankenberger, 2004). These children typically perform poorly on
measures of visuospatial STM and working memory (Gathercole &
Pickering, 2000; Geary, Hoard, & Hamson, 1999; McLean & Hitch,
1999; Siegel & Ryan), but not on measures of verbal STM (McLean &
Hitch; Passolunghi & Siegel).Working memory appears to play an impor-
tant role in the development of counting, with children with poor working
memory using primitive nger-counting strategies that have relatively low
working memory demands (Geary et al., 2004). Their continued use of
these early strategies prevents them establishing networks of arithmetic
facts in long-term memory, which are necessary to support the use of ef-
cient retrieval-based strategies analogous to those used in adulthood (e.g.,
Hamann & Ashcraft, 1985; Kaye, 1986). Thus, poor working memory
impedes the learning of number facts (Geary, 2004), the learning and ef-
ciency of number transcoding (Camos, 2008; McLean & Hitch) and
computational skills (Wilson & Swanson, 2001). It also causes difculties
in solving mathematical problems expressed in everyday language
(Swanson & Sachse-Lee, 2001).
Impairments in working memory are also associated with a variety of
genetic pathologies, including Down syndrome and William's syndrome.
There is considerable evidence for marked decits in verbal STM among
children with Down syndrome (e.g., Jarrold, Baddeley, & Hewes, 1999).
These children typically perform at age-appropriate levels on visuospatial
STM tasks and do not appear to have decits in working memory when
compared to controls (Numminen, Service, Ahonen, & Ruoppila, 2001;
Pennington, Moon, Edgin, Stedron, & Nadel, 2003). In marked contrast,
children with William's syndrome have much stronger verbal STM than
visuospatial STM skills (Jarrold, Baddeley, Hewes, & Phillips, 2001). This
pattern of impairment is most likely related to the double dissociation
between verbal and visual processing skills in William's syndrome.
Children with behavioral difculties such as ADHD are also
characterized by poor working memory function (Martinussen, Hayden,
Hogg-Johnson, & Tannock, 2005; Willcutt, Doyle, Nigg, Faraone, &
Pennington, 2005). Children with ADHD perform poorly on tests of
visuospatial STM (Barnett et al., 2001; Martinussen et al.; Mehta, Goodyear,
12 Joni Holmes et al.
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& Sahakian, 2004) and both verbal and visuospatial working memory tasks
(Martinussen & Tannock, 2006; Martinussen et al.; McInnes, Humphries,
Hogg-Johnson, & Tannock, 2003; Roodenrys, 2006; Willcutt, Doyle, et al.,
2005). Their verbal STM appears to be relatively preserved, suggesting that
verbal storage problems are not fundamental features of the disorder (e.g.,
Martinussen & Tannock). Our own data from a sample of 83 children aged
811 years with a clinical diagnosis of combined type ADHD concur with
this pattern of impairment. We found that whilst verbal STM was
relatively intact in this sample, visuospatial STM scores were in the low aver-
age range with substantial decits in verbal and visuospatial working
memory (Holmes, Gathercole, Place, Alloway, Elliott, & Hilton, 2009;
Holmes, Gathercole, Alloway, et al., 2010see Figure 2). Of the total
sample, 19.8% had impairments in verbal STM, which is close to the level
of 16% that we would expect in the normal population. However, 38.6%
had decits in visuospatial STM, over half had impairments in verbal work-
ing memory (50.6%) and 63.9% had very poor visuospatial working
memory.
It is possible that working memory problems may be the cause of the
inattentive and distractible behavior associated with ADHD. To complete
a task successfully, working memory resources support the maintenance of
task goals as well as the different elements of the ongoing mental activity
to achieve the goalit enables us to stay on task and focus on the salient
aspects of the task. Poor working memory function may therefore cause
attention to shift away from the task at hand, resulting in the loss of part
or all of the necessary information needed for task completion. This will
70.00
80.00
90.00
100.00
Verbal STM Visuo-spatial WMVerbal WMVisuo-spatial STM
Fig. 2. Working memory proles of 50 children with ADHD, from Holmes et al. (2010).
13Poor Working Memory
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result in task failure, and as a consequence, individuals with ADHD may
well appear to have short attention spans and to be distractible (Holmes,
Gathercole, Alloway, et al., 2010).
In summary, impairments in working memory are associated with a
broad range of genetic and neurodevelopmental disorders of learning,
with markedly distinct proles of decit characterizing different disorders.
Decits in the verbal domain are associated with specic language
difculties, such as SLI and dyslexia and are also characteristic of
individuals with Down syndrome who experience severe language delays
and difculties. Conversely, children with William's syndrome exhibit
domain-specic impairments in visuospatial memory. Unlike the other dis-
orders discussed here, ADHD is associated with a domain-general
impairment in working memory combined with decits in visuospatial
STM. There is now abundant evidence that tasks that require storage
but no further processing of visuospatial material depend signicantly on
the domain-general resources of working memory (Miyake et al., 2001;
Wilson, Scott, & Power, 1987), rather than a distinct visuospatial store.
This is particularly true in young children (Alloway et al., 2006). Thus,
the memory prole of children with ADHD corresponds to a singular
impairment in the domain-general working memory system, which may
cause the inattentive behavior that is characteristic of the disorder
(Holmes, Gathercole, Alloway, et al., 2010). Children with general reading
difculties have decits in all aspects of working memory, whereas chil-
dren with mathematical difculties have severe impairments in verbal
and visuospatial working memory and visuospatial STM, but not verbal
STM. Children with poor working memory also have pervasive domain-
general working memory decits, akin to children with reading difculties,
mathematical difculties, and ADHD. These are twinned with substantial
impairments in visuospatial STM and poor verbal STM (see Figure 3).
E. COGNITIVE PROFILESUMMARY
To summarize, due to the key role working memory plays in supporting
learning, both in classroom activities and in online mental activities, over
80% of children with small working memory capacities struggle in reading
and mathematics (Gathercole & Alloway, 2008). Related to this, poor
working memory function is characteristic of a number of developmental
disorders of learning, including language, mathematical, and behavioral
difculties. Children with poor working memory also have decits that
are manifest in a variety of cognitively demanding activities, such as
planning, sustained attention, problem solving, and IQ tasks. It is
14 Joni Holmes et al.
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suggested, however, that they do not have selective impairments in
high-level executive functions. Rather, limited memory resources con-
strain performance on a range of executive tasks (Gathercole et al., 2010).
III. Social and Behavioral Prole
Poor working memory is associated with relatively normal social inte-
gration, self-esteem, and emotional control. However, high levels of inat-
tentive and distractible behavior accompany working memory problems
and individuals with poor working memory have difculties maintaining
focused behavior in practical situations.
It is now widely recognized that the majority of problems in individuals
with poor working memory are related to inattentive and distractible
behaviors. Both children and adults with low memory experience difculties
in practical situations that require maintained and focused attention. Kane,
Brown, McVay, Silvia, Myin-Germeys, & Kwapil, (2007) found that typi-
cally developed adults with low working memory spans were more likely
to zone outwhen engaged in demanding ongoing activities than
individuals with higher working memory spans. They asked individuals to
rate their behavior on several dimensions at eight random points during
the day. Those with higher working memory spans were less likely to
report instances of mind wandering and were able to maintain on task
thoughts better during challenging cognitive tasks than those with poor
working memory.
60.00
70.00
80.00
90.00
100.00
Verbal STM Visuo-spatial WMVerbal WMVisuo-spatial STM
Fig. 3. Working memory proles of 50 children with poor working memory,
from Gathercole et al. (2010).
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Poor working memory function is also closely associated with inatten-
tive behavior in children. In a nonclinical sample, Aronen and colleagues
found children with low working memory performance were reported by
teachers to have more academic and attentional difculties at school than
children with good working memory performance (Aronen, Vuontela,
Steenari, Salmi, & Carlson, 2005). Similarly, children identied solely on
the basis of poor working memory skills have high levels of inattentive
and distractible behavior. Teachers often describe them as having short
attention spans and rarely say that they have memory problems
(Gathercole, Alloway, et al., 2006). Furthermore, when asked to rate
behavior on commonly used checklists such as the Conner's Teacher
Rating Scales (Conners, 1997), teachers typically judge children with poor
working memory to be highly inattentive with high levels of distractibility.
Over 70% of children aged 5 or 6 years with low working memory
have markedly atypical scores on the cognitive problems/inattention sub-
scale of the Conner's checklist (75% reported in Alloway et al., 2009a,
2009b studies of 53 children; 79% reported in Gathercole, Alloway,
et al.'s (2008) and Gathercole, Durling, et al.'s (2008) studies of 29
children). Figures for older children range from 58% (Alloway et al.,
2009a, 2009b) to 70% (Gathercole, Alloway, et al., 2008). Gathercole,
Alloway, et al. (2008) found that the majority of elevated scores were
largely due to high ratings on problem behaviors that relate to inattention
and short attention spans. In stark contrast, they found that none of the
children in a comparison group of 20 children with typical working
memory had atypically high levels of inattentive behavior.
ADHD in childhood is also characterized by both working memory
decits and inattentiveness (Holmes, Gathercole, Alloway, et al., 2010;
Klingberg et al., 2005; Martinussen & Tannock, 2006; McInnes et al.,
2003; Willcutt, Doyle, et al., 2005; Willcutt, Pennington, et al., 2005). The
co-occurrence of working memory and attentional problems in poor work-
ing memory and ADHD groups suggests there may be substantial overlap
in the behavioral characteristics of the two groups. In a recent study, we
directly compared teacher behavior ratings for 59 children with a diagno-
sis of ADHD and 27 children of the same age with low working memory
(see Alloway, Gathercole, Holmes, Place, & Elliott, 2009). Teachers were
asked to rate the extent to which a child has shown problem behaviors in
school over the past month on the Conners' Teacher Rating Scale Revised
Short-Form (Conners, 1997). Overall, teacher ratings of oppositional and
hyperactive behaviors were signicantly elevated in the ADHD group,
while ratings of cognitive problems/inattention were elevated in both the
ADHD and low working memory groups. As a consequence of high
16 Joni Holmes et al.
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ratings on individual subscales, scores for both groups were also elevated
on the ADHD index of the Conners' scale (Conners; see Figure 4). The
inattentive symptoms observed in children with working memory decits,
which are also commonly associated with ADHD, most likely occur when
overloaded working memory systems enable interference from irrelevant
information to disrupt goal-directed behavior.
Beyond attentional problems, children with low working memory are
typically reserved in group discussions in the classroom, but integrate well
with friends and peers in less formal situations outside of the classroom
(Gathercole, Alloway, et al., 2008). Outgoing and humorous children with
poor working memory rarely volunteer information in the classroom or
raise their hand to answer questions, possibly because their poor memory
skills make it hard for them to participateteachers typically ask
questions about recent activities which they may be unable to answer
because they have forgotten the relevant information (Gathercole,
Alloway, et al., 2008).
Related to this, poor working memory function is not strongly
associated with low self-esteem. Of 113 children with low memory ability,
Alloway et al., 2009a, 2009b found that overall levels of self-esteem were
either at the good or vulnerable levels (43% and 39% of the sample,
respectively). Only 12% scored at the very low end of the scale, which is
characterized by those who may be depressed and need constant support
40.00
50.00
60.00
70.00
Oppositional
Cog probs/inattentive
Hyperactive
ADHD index
ADHD
Poor working memory
Fig. 4. Behavioral proles of children with ADHD and children with poor working
memory, from Holmes et al. (2010).
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and encouragement (Morris, 2002). This demonstrates that very few
children with poor working memory, who typically have poor academic
success, have low self-esteem and is consistent with literature showing lit-
tle association between global self-esteem and academic performance
both in the general population (Baumeister, Campbell, Krueger, & Vohs,
2003; Marsh & Craven, 2006) and in those with learning difculties
(e.g., Snowling, Muter, & Carroll, 2007).
Emotional problems are not a hallmark characteristic of children with
poor working memory, although studies that have examined teacher
ratings report that approximately 50% of children identied as having
poor working memory are also perceived to have problems with emo-
tional control and regulation. Alloway et al. reported that 38% of their
sample of 113 children had levels of emotional control problems that
reached clinical signicance (Alloway et al., 2009a, 2009b). Likewise,
Gathercole, Alloway, et al. (2008) reported that 45% of children aged 5/
6 years with low working memory and 48% of children aged 9/10 years
with low working memory obtained high ratings of problem behaviors
relating to emotional control. It is possible that the incidence of emotional
problems associated with poor working memory is a consequence of the
number of children with poor working memory who have other comorbid
disorders, such as ADHD or oppositional deance disorder, which are
more commonly associated with emotional and behavioral difculties.
Consistent with this view, children with low working memory have mildly
elevated levels of oppositional and hyperactive behaviors in comparison
to normative samples (Alloway et al.), and there is substantial overlap
between the behavioral characteristics of children with low working mem-
ory and ADHD (e.g., Alloway et al., 2009; Aronen et al., 2005; Lui &
Tannock, 2007).
Teachers of children with poor working memory rate them as having
problem behaviors relating to a range of executive functions. In particular,
they experience problems in monitoring the quality of their work, in
generating new solutions to problems, planning/organizing written work,
and large amounts of information, and in being proactive initiating new
tasks (Alloway et al., 2009, 2009a, 2009b; Gathercole, Alloway, et al.,
2008). As discussed earlier in this chapter, poor working memory may
underpin this range of difculties.
In summary, the key behavioral difculties observed in children with
poor working memory relate to inattention. Teachers view them as highly
inattentive and distractible and judge them to have problem behaviors
related to poor executive functioning. These behaviors are most likely
the consequence of memory overload during complex and challenging
18 Joni Holmes et al.
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mental activities, although further research is needed to test the direction
of causality between poor attention, executive function problems, and
working memory difculties. In terms of social proles, children with poor
working memory are typically socially integrated, although they can be
reserved in large group situations.
IV. Interventions
Three principal methods have been employed to reduce the difculties
that arise from poor working memory. One approach is to adapt the
child's environment to minimize memory loads to facilitate classroom
learning (e.g., Elliott, Alloway, Gathercole, Holmes, & Kirkwood, 2010;
Gathercole & Alloway, 2008). The other two methods focus on improving
working memory directly; one involves teaching children to use memory
strategies to improve the efciency of working memory (e.g., St. Clair-
Thompson, Stevens, Hunt, & Bolder, 2010), the other involves directly
training working memory through repeated practice on working memory
tasks (e.g., Holmes, Gathercole, & Dunning, 2009; Holmes, Gathercole,
Place, Dunning, Hilton, & Elliott, 2009; Klingberg et al., 2005).
A. CLASSROOM INTERVENTION
This approach focuses on increasing teacher awareness of working
memory problems and encouraging them to adapt their approach to
teaching to reduce memory loads in the classroom. It also encourages tea-
chers to help children with poor working memory to use strategies to
overcome their cognitive weaknesses. Developed by Gathercole and col-
leagues, it is guided by seven key principles that are designed to decrease
task failures, improve condence, and accelerate rates of learning in chil-
dren with low working memory.
The rst stage of the intervention is to educate teachers about
working memory and assist them in recognizing children who may be
experiencing working memory failures. Teachers are often unaware that
children with poor working memory have memory difculties
(Gathercole, Alloway, et al., 2008). It is therefore paramount to teach
them about the concept of working memory, to illustrate the contexts in
which working memory plays a role in everyday classroom activities,
and to emphasize the fact that working memory failures are often
associated with inattentive behavior. This increased understanding can
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then be used to detect children who may have poor working memory
(Gathercole & Alloway, 2008).
An integral part of supporting children with poor working memory in
the classroom is to monitor how they cope with mentally challenging
activities. This principle is closely related to detecting warning signs of
memory overload, but goes further in that teachers and support assistants
are encouraged to monitor whether children have forgotten crucial
information during different activities. They can do this by asking simple
questions such as What were you going to write down?
The third principle focuses on teachers evaluating learning activities to
identify those that will be problematic for children with small working
memory capacities. These include activities that place heavy demands on
working memory, such as those that are overly long or include excessively
long sequences, those that include large amounts of meaningless or
unfamiliar material, and those that are complex and involve signicant
mental processing.
Directly related to this, the fourth aspect involves teachers developing
and restructuring learning activities to reduce working memory loads. This
can be done by reducing the amount of information a child has to remem-
ber, increasing the familiarity and meaningfulness of the material children
are working with, and simplifying complex activities. So, for example,
teachers might consider reducing the number of steps in an activity or
breaking a long activity into several shorter activities, relating new mate-
rial to previously acquired knowledge, simplifying linguistic structures,
and reducing the length of sentences used to explain complex activities.
The fth principle targets the profound difculties children with poor
working memory experience when trying to remember instructions and
task information. It encourages teachers to frequently repeat important
information, including classroom management instructions, task-specic
instructions, and detailed information intrinsic to an activity. Teachers
are encouraged to foster an environment in which children with poor
working memory can ask for information to be repeated and to pair
children with low working memory with those who do not struggle to
remember informationthis enables them to ask for information to be
repeated in a less conspicuous way.
The nal two principles involve teachers encouraging children to help
themselves. First, teachers should provide and promote the use of memory
aids such as wall charts and posters, lists of useful spellings and per-
sonalized dictionaries, counters, number lines, multiplication grids,
calculators, memory cards, and audio recorders. Second, children with
poor working memory should be encouraged to develop their own
strategies to support their weak memory skills. These strategies include
20 Joni Holmes et al.
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asking for help, rehearsing important information, note-taking, making
links between new and previously learned information to activate support
from long-term memory, and place-keeping and organizational strategies
such as using ow-charts and diagrams.
Elliott and colleagues recently evaluated the effectiveness of this
approach for boosting the learning outcomes of children with poor work-
ing memory (Elliott et al., 2010). They found that the extent to which
teachers implemented the principles of the working memory intervention
predicted the children's literacy and mathematical skills and that teachers
were enthusiastic about the ways in which their understanding and prac-
tice had improved as a result of the intervention. The long-term benets
for learning are not yet known, but this approach offers a practical starting
point for teachers who are keen to help children with poor working
memory.
B. STRATEGY TRAINING
The second approach to alleviating problems associated with poor work-
ing memory is to enhance working memory through training children to use
strategies. Strategies are mentally effortful, goal-directed processes that
improve the efciency of working memory. These mechanisms include
repeatedly rehearsing the to-be-remembered information aloud or in one's
head, creating a sentence or story from the words, or generating visual
images of the information. Individuals with high memory spans use
strategies more than individuals with low spans (e.g., Engle, Cantor, &
Carullo, 1992; Friedman & Miyake, 2004) and individual differences in
strategy production account for individual differences in working memory
task performance in adults (Dunlosky & Kane, 2007). Strategy use emerges
during childhood, leading to the suggestion that developmental increases in
working memory are at least partly mediated by their onset (Gathercole,
1999). For example, rehearsal does not emerge until about 7 years of age
(e.g., Gathercole, 1998), with other strategies, such as organization and
grouping (e.g., Bjorkland & Douglas, 1997) and chunking (e.g., Ottem,
Lian, & Karlsen, 2007) developing later. Although strategy use is not spon-
taneous in young children, they will attempt to employ them when explicit
instructions are given (e.g., Ornstein, Baker-Ward, & Naus, 1988; Ornstein
& Naus, 1985). This has led to the suggestion that training children to
employ memory strategies could facilitate their working memory
functioning (e.g., St. Clair-Thompson & Holmes, 2008).
Training adults to use strategies facilitates their short-term and working
memory abilities. Improvements in STM tasks have been reported when
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participants engage in strategies, such as rehearsal (e.g., Broadley,
MacDonald, & Buckley, 1994; Gardiner, Gawlick, & Richardson-Klavehn,
1994; Rodriguez & Sadoski, 2000), visual imagery (e.g., De La Iglesia,
Buceta, & Campos, 2005), grouping or chunking information (e.g., Black
& Rollins, 1982; Carr & Schneider, 1991; Lange & Pierce, 1992), or creat-
ing stories from the to-be-remembered information (e.g., McNamara &
Scott, 2001). Rehearsal, story generation, and visual imagery strategies also
improve performance on working memory span tasks (Turley-Ames &
Whiteld, 2003; McNamara & Scott). These gains, however, often do not
extend beyond trained tasks and are not sustained, meaning they are
unlikely to yield substantial benets for the multiplicity of situations in
which we depend on working memory.
Recently, St. Clair-Thompson and colleagues have shown that
providing memory strategy training signicantly improves working mem-
ory in children (St. Clair-Thompson & Holmes, 2008; St. Clair-Thompson
et al., 2010). In their rst two studies, they measured the impact of strategy
training on short-term and working memory in small groups of 6 and 7
and 7 and 8 year olds (St. Clair-Thompson & Holmes, 2008). The strategy
training was provided in the form of a computerized adventure game
called Memory Booster (Leedale, Singleton, & Thomas, 2004), which
taught and encouraged the use of rehearsal, visual imagery, story genera-
tion, and grouping. Children completed two training sessions per week,
each lasting approximately 30 minutes, for 68 weeks. In the rst study,
children were assessed on measures of verbal and visuospatial STM and
verbal working memory both before and after training. There were no sig-
nicant gains in STM for either age group. There were, however, signi-
cant gains in verbal working memory for the younger group of children
(6 and 7 year olds). This pattern of improvement was reected in a second
study, in which a measure of children's ability to remember and follow
instructions was also included. Again, there was no impact of training on
STM for either age group, but both verbal working memory and perfor-
mance on the following instructions task improved in the younger children
(St. Clair-Thompson & Holmes).
Together, these initial studies demonstrated that working memory could
be improved in young children through strategy training and there was
preliminary evidence that gains generalized to a working memory-loaded
classroom activity. There were no benets of strategy training for older
children, who were aged 7 and 8 years. It is possible that these children
were already using efcient memory strategies meaning strategy training
was unlikely to benet their memory performance.
In a more recent study, St. Clair-Thompson and her colleagues
investigated the potential usefulness of memory strategy training further
22 Joni Holmes et al.
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(St. Clair-Thompson et al., 2010). A total of 254 children aged 58 years
participated in the study. Half of the children completed Memory Booster
strategy training and half received no intervention. All children were
tested on measures of verbal and visuospatial STM and verbal working
memory before and after training and subgroups completed a following
instructions task, a mental arithmetic task and standardized assessments
in reading, arithmetic, and mathematics. This time, signicant training
gains were found in verbal short-term and working memory, but not in
visuospatial STM. Signicant improvements were also reported in mental
arithmetic and following instructions, but no improvements were found
in standardized ability measures either immediately after training or
5 months later. The same patterns of gains were observed both in children
aged 5/6 and 7/8 years, and also in children with average working memory
and poor working memory (in this case classed as standard scores below
70; see St. Clair-Thompson et al. for further details).
This recent work on memory strategy training in children suggests it
could provide a means of improving working memory in children. How-
ever, the transfer of benets to other tasks seems limited. Although there
is some evidence of transfer to tasks that allow for the use of memory
strategies, such as following instructions, there is no evidence that gains
transfer to standardized ability measures.
C. WORKING MEMORY TRAINING
The nal approach to remediating poor working memory function is to
train it through repeated practice on working memory tasks. Studies that
attempted to improve working memory using this method in the 1970s
and 1980s only reported moderate training gains, which were in the form
of faster reaction times, not increases in working memory capacities per se,
and there was no evidence that gains were transferable to nontrained
working memory tasks or to other cognitive measures (Kristofferson,
1972; Phillips & Nettlebeck, 1984). Other training studies, such as those
conducted by Hulme and Muir (1985), have demonstrated that training
processes crucial to efcient processing in working memory such as artic-
ulation and rehearsal rate improve memory span, although only very
slightly. More recent evidence indicates that intensive adaptive working
memory training specically on tasks that tax working memory may lead
to more dramatic gains on trained and nontrained working memory tasks
and also on other cognitive measures.
Jaeggi and colleagues found improvements on trained working memory
tasks that transferred to marked increases in performance on a general
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IQ test in healthy adults, using a paradigm known as n-back. This involves
the continuous presentation of sequence of stimuli. Participants are
required to indicate whether the current stimulus matches the one that
was presented nsteps earlier in the sequence. The task can be adjusted
by increasing or decreasing the number of steps to make the task more
or less difcult. Jaeggi and colleagues used an extremely cognitively
demanding version of this task in which participants were presented with
two rows of stimuli simultaneously. The top row showed individual spatial
locations marked in a box, the bottom showed a string of individual
letters. Participants were required to decide for each string whether the
current stimuli matched the one presented nitems back in the series.
The number of items back varied according to participants' performance,
increasing by one if performance improved and decreasing by one if
performance dropped (Jaeggi, Buschkuel, Jonides, & Perrig, 2008).
Five groups of participants were included. Four groups completed
between 8 and 19 training sessions and a fth group was not trained. IQ
was assessed pre- and post-training. Overall, there was a signicant train-
ing effect, with all four training groups improving on the working memory
tasks. Importantly, there was a transfer effect to performance on the gen-
eral IQ test. This was strictly training related and could not be attributed
to individual differences in pre-training working memory or IQ scores,
gains in working memory as measured by changes on complex span tasks,
or to the training itself. The gains in general IQ were dose dependent,
with more training equating to bigger gains.
Jaeggi et al. (2008) suggest the transfer effect may result from the
shared features between the training tasks and IQ measure, such as atten-
tional control and the requirement to hold multiple goals in mind. How-
ever, they also propose that changes in performance on the IQ test may
result from improvements in skills that were not working memory capacity
related but that were also trained by the dual n-back task, for example,
multiple-task management skills. It should be noted, however, that other
researchers have proposed these ndings do not represent a true transfer
effect; rather they are a consequence of testing procedure used to
administer the IQ test (see Moody, 2009).
Using a similar but less cognitively challenging program, Jaeggi and
colleagues have also demonstrated that working memory can be improved
through training in older adults (Buschkeuhl et al., 2008). In this study,
13 women aged 80þyears trained on three working memory tasks
and two speed of processing tasks two times a week for 3 months. The
working memory tasks included recalling sequences of colors or
animals in the correct order. Some of the tasks included an explicit pro-
cessing element, which, for example, required participants to decide if
24 Joni Holmes et al.
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the animals were in the correct orientation prior to recalling the sequence.
The processing speed tasks were forced reaction time tasks in which
participants had to make a decision and respond as quickly as possible
to stimuli presented on the screen. A control group of 19 women aged
80þyears formed an active control group who completed a physical inter-
vention, training on a bicycle ergo meter for the same amount time as the
memory training group. Working memory and episodic memory were
assessed before, immediately after and 1 year after training for both
groups.
Performance on the trained tasks improved signicantly for those in the
memory training condition. There was evidence of transfer to nontrained
visual working memory tasks immediately after training, although these
transfer effects did not extend to a digit span task or measures of episodic
memory. There were no signicant differences between the memory and
physical training groups 1 year after training. These results suggest it is
possible to improve visual working memory in oldold adults through
training in the short-term, but that it is unlikely these gains will be
sustained. Furthermore, due to the complex nature of the training, which
included both speed of processing and working memory training, it is
difcult to determine the source of the gains in visual working memory.
An alternative method that has also produced positive results is the
Cogmed Working Memory Training Program (CWMT), which was devel-
oped by Klingberg and colleagues at the Karolinska Institute in Sweden.
In this program, individuals train intensively over several weeks on adap-
tive working memory tasks. The training tasks require the immediate
serial recall of either verbal or visuospatial information, with some of
the tasks requiring explicit processing prior to recall. Participants train
for 2025 days, each day completing 8 different tasks selected from a bank
of 13, which takes approximately 3045 minutes. The tasks vary across
training days to maintain interest and positive verbal and visual feedback
is given on some trials. The difculty of the training tasks is automatically
adjusted on a trial-by-trial basis to match the participant's current working
memory capacity, which maximizes the training benets.
The Cogmed program is perhaps the most widely validated memory
training program, with studies showing dramatic improvements in working
memory following training in both children and adults. Crucially, it is the
only program to date that has been used to directly train working memory
in children. In the very rst trials, Klingberg's team used an early form
of the training program that included only four training tasks: a Corsi
block-like visuospatial memory task; two verbal tasksbackward digit
and letter span; and a choice reaction time task. In a double-blind,
placebo-controlled study, this primitive form of intensive and adaptive
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working memory training signicantly improved performance on non-
trained STM tasks, digit recall and Corsi block, and a test of nonverbal
reasoning in a small sample of children with ADHD (treatment group
n¼7, control group n¼7). Motor activity, as measured by the number
of head movements during a computerized test, was signicantly reduced
in the treatment group, and performance on a response inhibition task
also signicantly improved following training. There were no signicant
changes in performance for the control group, who completed a placebo
version of the program in which the difculty of the training tasks was
set a low level throughout the training period (span of 2 or 3 items for
each task). In a second experiment, they used the same adaptive training
program with four healthy adults. Signicant improvements in perfor-
mance were reported both on the trained tasks and on a nontrained visuo-
spatial memory task, a Stroop task and a nonverbal reasoning task
(Klingberg, Forssberg, & Westerberg, 2002).
Klingberg's team later extended their work to evaluate the effects of
training in a larger group of children with ADHD (n¼53) in a
randomized controlled trial. The intensity of the treatment training pro-
gram was increased to 90 trials per day on three working memory tasks
(remembering the position of objects in a 4 4 grid or remembering
phonemes, letters, or digits) for 2025 days. As before, the placebo ver-
sion included an identical set of tasks to the treatment program, which
were set at a low level throughout training. Children were randomly
assigned to each condition, with 27 completing the adaptive treatment
program and 26 completing the placebo version. Overall, the treatment
group improved signicantly more than the comparison group on a non-
trained measure of visuospatial STM. These effects persisted 3 months
after training. In addition, signicant treatment effects were observed in
response inhibition, complex reasoning, and verbal STM, and there were
signicant reductions in parent ratings of inattention and hyperactivity/
impulsivity following training. Reductions in ratings of cognitive problems
following training were also reported in a pilot study with 18 adults more
than 1 year after a stroke. As before, there were signicant improvements
in trained and nontrained working memory tasks and there was also a
signicant decrease in the patients' self-ratings of cognitive problems in
daily life (Westerberg et al., 2007).
The team at the Karolinska Institute has now extended their work on
memory training to preschool children (Thorell, Lindqvist, Bergman,
Bohlin, & Klingberg, 2009). On the basis of the strong theoretical connec-
tion between inhibition and working memory (see Engle & Kane, 2004;
Roberts & Pennington, 1996), the overlapping areas of neural activation
during working memory and inhibition tasks (McNab et al., 2008) and
26 Joni Holmes et al.
Author's personal copy
the transfer of training effects to the Stroop task in their early studies, they
decided to compare the effects of visuospatial working memory training
and inhibition training in very young children.
Four groups of preschool children aged 4 and 5 years were included in
the study. One group completed visuospatial working memory training
(n¼17). A second group completed inhibition training (n¼18), the third
(n¼14) completed a placebo version of the memory training, as per pre-
vious studies, and a fourth group formed a passive control group
(n¼16). Those in the training groups completed adaptive training of
either visuospatial working memory or inhibition for 15 minutes a day
every day that they attended preschool over a 5-week period. Each day
they completed three of ve possible tasks, which rotated across the train-
ing period to maintain interest. The ve visuospatial working memory
training tasks required children to recall sequences of nonverbal informa-
tion in the correct order. The inhibition training consisted of ve tasks that
mirror well-known inhibition paradigmstwo go/no-go tasks and two stop
signal tasks designed to train response inhibition and a anker task
designed to train interference control. Outcome measures for all groups
included nontrained measures of interference control, response inhibition,
forward and backward Corsi block, forward and backward digit recall,
sustained attention, and problem solving.
Children in the working memory training group improved signicantly
on all trained tasks, whilst those in the inhibition training group improved
only on the trained go/no-go and interference control tasks. Working
memory training led to signicant gains in both nontrained verbal and
visuospatial memory tasks and attention, but there was no signicant
transfer to performance on nontrained inhibition tasks. There was no sig-
nicant change in performance on nontrained tasks for children in the
inhibition training, placebo, or passive control groups. Overall, the data
from this study show that working memory can be trained in typically
developing children as young as 4 years and, perhaps most importantly,
demonstrates that different cognitive functions vary in how easily they
can be modied by intensive practice (Thorell et al., 2009). The results
of this study point to generalized benets of training working memory,
but of limited effects of training other executive functions such as
inhibition.
On the basis of the early success of working memory training with
children, we have recently conducted our own independent eva-
luations of the CWMT program. Like Klingberg, our rst study was
with children with ADHD, who we know have signicant and sub-
stantial decits in working memory (Holmes, Gathercole, Alloway, et al.,
2010; Holmes, Gathercole, Place et al.,2010;Martinussen et al.,2006).
27Poor Working Memory
Author's personal copy
The primary treatment option for reducing the behavioral symptoms of
ADHD is psycho stimulant medication in the form of methylphenidate
or amphetamine compounds, which also enhance visuospatial working
memory (Bedard, Jain, Hogg-Johnson, & Tannock, 2007). The aim of
our rst study was to therefore compare the impacts of working memory
training and psycho stimulant medication on the separate subcomponents
of working memory. We recruited 25 children aged 811 years with a clin-
ical diagnosis of combined type ADHD, who were receiving quick release
medication for their ADHD symptoms. All children completed
assessments of verbal and visuospatial STM and working memory both
before and after training and on and off medication. The training para-
digm consisted of 2025 sessions on the adaptive program developed by
Cogmed, which this time consisted of 10 different working memory tasks.
Children trained on 8 of the 10 tasks every day, completing 115 trials per
session.
Both interventions had a signicant impact on children's working mem-
ory, but differential patterns of change were associated with each
approach. While medication led to selective improvements in visuospatial
working memory, training led to improvements in all aspects of working
memory. Crucially, these gains were sustained 6 months after training
ceased (see Figure 5).
Children's IQ was not affected by either intervention. The impact of
medication on nonverbal aspects of working memory only most likely
reects the predominant inuence of medication on right hemisphere
brain structures that are associated with visuospatial working memory
(e.g., Bedard et al., 2007). The generalized impact of working memory
training in this group may have very practical benets for learning in chil-
dren with ADHD. Although medication helps to control the adverse
behavioral symptoms of the disorder, providing improved working mem-
ory resources through working memory training holds the promise of
providing improved support for learning for in this group (Holmes,
Gathercole, Place, Dunning, et al., 2009).
We also have encouraging preliminary data to suggest that working
memory training benets other groups of children. In a recent study, we
trained 25 typically developing children aged 9/10 years in a large group
in school and found signicant improvements in the aspects of working
memory that are most strongly associated with learning, namely visuospatial
STM and verbal and visuospatial working memory (Holmes, Dunning, &
Gathercole, 2010a;seeFigure 6).
Furthermore, we have some indication that memory training will benet
children with dyslexia (Holmes, Dunning, & Gathercole, 2010b). Figure 7
summarizes data showing the impact of working memory training on the
28 Joni Holmes et al.
Author's personal copy
60.00
70.00
80.00
90.00
100.00
110.00
120.00
Verbal STM
*
*
*
*
*
Visuo-spatial
WM
Verbal WMVisuo-spatial
STM
T1 off medication T2 pre-training on medication
T3 post-training T4 6 month follow-up
Fig. 5. Impact of medication and training on different aspects of working memory, from
Holmes, Gathercole, Place, Dunning, et al., 2009.Note. Asterisk above a bar denotes a
signicant change in scores from the previous testing point.
60
80
100
120
Verbal STM Verbal WM
Pre
Post
*
*
*
Visuo-spatial
STM
Visuo-spatial
WM
Fig. 6. Impact of working memory training in a group of typically developing children, from
Holmes et al. (2010a).Note. Asterisk above a bar denotes a signicant change in scores from
the previous testing point.
29Poor Working Memory
Author's personal copy
reading skills of a group of 19 children aged 811 years with dyslexia.
In this study, we found signicant improvements in both single word
reading and reading comprehension following adaptive training, with
reading comprehension scores improving from the decit to average
range. There was no signicant improvement in spelling post-training.
Thus far, the benets of focused working memory training have been
discussed in terms of improvements in adults, typically developing
children and children with developmental disorders such as ADHD and
dyslexia. So, the big question remainsis this intervention benecial to
children who are selected solely on the basis of poor working memory?
The answer is yes.
In a direct test of the utility of working memory training for this group,
we identied 42 children aged 9/10 years with low working memory skills
and assessed them on measures of working memory, IQ, and academic
attainment before and after training either on the standard adaptive pro-
gram or the placebo non-adaptive program used by Klingberg et al.
(2005). We also included a measure of children's performance on a follow-
ing instructions task pre- and post-training, which was included as a more
practically based measure of working memory use in the classroom.
Immediately after training, there were signicant gains in all aspects of
working memory and on the following instructions task for children in
the adaptive condition (n¼20). In all cases, the gains were signicantly
greater for the adaptive than the nonadaptive group (n¼22). There was
60
70
80
90
100
Basic readin
g
Pre
Post
*
*
Spellin
g
Comprehension
Fig. 7. Impact of working memory training on the language skills of a group of children with
dyslexia, from Holmes et al. (2010b).Note. Asterisk above a bar denotes a signicant change in
scores from the previous testing point.
30 Joni Holmes et al.
Author's personal copy
no immediate impact of training on standardized reading and mathematics
tests or on IQ. Follow-up assessments revealed the training gains were
sustained in the adaptive group 6 months after training, at which point
performance on the standardized mathematics test also improved signi-
cantly. These results provide the rst solid evidence that commonplace
decits in working memory and associated learning difculties can be
ameliorated, and possibly even overcome, by intensive adaptive training
over a relatively short period (Holmes, Gathercole, & Dunning, 2009).
So, what is driving the changes in working memory following training?
One possibility is that intensive training induces long-term plasticity in
the brain regions that serve working memory. In two neuroimaging
studies, Olesen, Westerberg, and Klingberg (2004) showed increased
activation in the parietal and prefrontal cortices following memory train-
ing. In their rst study, they reported an increase in brain activity in both
of these regions in three subjects following training on both verbal and
visuospatial working memory tasks. In the second study, eight adults were
scanned ve times during training on three visuospatial working memory
tasks over a 5-week period. Again, increases in neuronal activity were
observed in the prefrontal and parietal regions. In a single-subject analy-
sis, Westerberg and Klingberg (2007) showed training-induced changes
were not due to activations of any additional area that was not activated
before training. Rather, they observed that areas where task-related activ-
ity was seen increased in size following training. Related to this, changes
in the density of prefrontal and parietal cortical dopamine receptors have
been reported after memory training. Either too much or too little stimu-
lation of D1 receptors results in impaired working memory task perfor-
mance (Cai & Arsten, 1997; Lidow, Williams, & Goldman-Rakic, 1998;
Vijayraghavan, Wang, Birnbaum, Williams, & Arnsten, 2007; Williams
& Goldman-Rakic, 1995). Thus, training-induced decreases in the binding
potential of the receptor D1 associated with increases in working memory
capacity were interpreted as demonstrating a high level of plasticity of the
D1 receptor system (McNab et al., 2009).
Overall, Klingberg's team has shown that training induces changes in
two brain regions, the parietal and prefrontal cortices, which are both
associated with working memory. Prefrontal activation is positively
correlated with children's working memory capacity (Klingberg et al.,
2002; Kwon, Reiss, & Menon, 2002) and fronto-parietal networks are
related to success on working memory tasks (Pessoa, Gutierrez,
Bandettini, & Ungerleider, 2002; Rypma & D'Esposito, 2003). Their work
suggests cortical and biochemical changes result from practice on working
memory tasks.
31Poor Working Memory
Author's personal copy
The working memory training program may also promote self-awareness
and the development of compensatory strategies to overcome areas of
weakness. Introspective reports from children in our own training studies
support this notion. When asked what they thought had helped them
to improve on the training activities, 27% of children with low working
memory and 27% of children with ADHD reported focusing more on the
presented information or concentrating harder. A further 37% of children
with low working memory and 67% of children with ADHD reported
using a variety of other strategies, including rehearsal or tracing the
patterns on the computer screen with their eyes (Holmes, Gathercole, &
Dunning, 2009; Holmes, Gathercole, Place, Dunning, et al.,2009). These
verbal reports support the idea that training may enhance attentional focus
and stimulate the development of a range of strategies that capitalize on rel-
ative cognitive strengths.
The data presented in this section demonstrate that it is possible to train
working memory through repeated practice on working memory tasks.
Importantly, they provide an early indication that the learning difculties
that so often accompany working memory decits can be ameliorated, to
some extent, by training. This nding is highly relevant to professionals
looking for effective interventions for children with poor working memory
and also for children with a wide range of disorders that are associated
with both low working memory and poor academic performance.
Although we have some insight into the nature of the cognitive and neural
changes that underpin the gains in working memory, further research is
needed in this area.
D. INTERVENTIONSSUMMARY
The difculties faced by children with low working memory can be
targeted in different ways: (i) by adjusting the child's environment to
reduce working memory loads, (ii) by training and promoting the use of
effective strategies to improve the efciency of working memory, and
(iii) by training working memory directly using an adaptive, computerized
program. The latter approach appears to be the most direct, useful,
and well-validated method for boosting both poor working memory and
learning in children. Strategy training has also been shown to boost work-
ing memory, both in children with low and average working memory, but
the evidence for transfer effects to improved academic outcomes is far less
persuasive. The classroom-based intervention, which focuses on changes
in the ways children with poor working memory are taught, is perhaps
the most practical approach as it builds upon and promotes good teaching
32 Joni Holmes et al.
Author's personal copy
practice. Although the extent to which teachers apply the principles of the
intervention correlates with attainment, the benet of this method for
improving learning outcomes is as yet somewhat unclear. All three
approaches require further investigation to determine the long-term
effects on working memory and learning.
V. Summary and Future Directions
In conclusion, poor working memory affects approximately 15% of chil-
dren. It is characterized by inattentive, distractible behavior that is
accompanied by failures to complete everyday activities that require
focused or sustained attention. Typically, children with poor working
memory have normal social integration and normal levels of emotional
control and self-esteem. They may, however, appear reserved in large
group situations. Over 80% of children with low working memory struggle
in reading and mathematics and it has been suggested that they are likely
to be those children who make poor academic progress, but who fall
below the radar of recognition for SEN.
Beyond poor learning, children with poor working memory have a
range of other cognitive problems that extend to low IQ and decits in
other executive functions including monitoring and planning, problem
solving, and sustained attention. Although the direction of causality is
uncertain, it is possible that limited working memory resources underpin
this wide range of decits.
There are three main approaches to alleviating the difculties faced by
children with poor working memory: a classroom intervention, strategy
training, or direct working memory training. Of these, direct training is
the most widely used and successful method. Dramatic gains in working
memory have been reported following training in typically developing chil-
dren and adults, adults following a stroke, children with developmental dis-
orders such as ADHD and, most pertinent to this chapter, children with
poor working memory. Importantly, the memory gains in children with poor
working memory sustain over a 6-month period, at which point they transfer
to gains in learning. This nding holds the promise for improving the
long-term educational outcomes of children with poor working memory.
Although we now have a fairly comprehensive understanding of the
social, behavioral, and cognitive proles of children with poor working
memory, there are a number of challenges for the future. The rst is to
investigate the long-term consequences of poor working memory. Do
working memory problems persist into adolescence and adulthood? If
so, how do they impact on everyday functioning? Do children with poor
33Poor Working Memory
Author's personal copy
working memory go on to develop compensatory strategies as they age?
The second challenge is to investigate further the future impacts of differ-
ent interventions. For example, is there a long-range benet to learning
from the classroom intervention? Do the dramatic training-induced gains
in working memory endure? Related to this, the third challenge lies in
determining what is driving the changes in working memory following
direct training. Finding that working memory can be improved through
intensive practice poses a challenge to theories that suggest working mem-
ory has a relatively xed capacity (e.g., Engle, Cantor, & Carullo, 1992), is
highly heritable (Kremen et al., 2007), and is relatively impervious to sub-
stantial differences in environmental experience and opportunity
(Campbell et al., 1997; Engel et al., 2008). Although there is evidence that
training may induce neural plasticity in the brain regions supporting work-
ing memory, or the development of compensatory strategies, further neu-
roimaging, cognitive, and behavioral research is needed to fully
understand what underpins the changes in working memory performance.
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... Kurangnya penglibatan dalam aktivti fizikal menyebabkan tahap kesihatan dan kognitif otak terjejas (de Greeff et al., 2018). Kanak-kanak yang mempunyai masalah kognitif iaitu daya ingatan dan penumpuan yang rendah mempunyai kesukaran membaca, memahami dalam subjek Matematik dan Sains yang mengakibatkan mereka memperolehi pencapaian akademik rendah (Holmes et al., 2010;Geary et al., 2011;Henry & Botting, 2016). ...
... Classroom adaptations focus on increasing teachers' awareness of working memory problems and encouraging them to adapt their teaching approaches to reduce learners' working memory load (Yang et al., 2017). Teachers are also encouraged to use instructional strategies that help learners with poor working memory overcome cognitive weaknesses Holmes et al., 2010). This approach is based on principles designed to motivate learners with low working memory by helping them reduce errors and increase self-confidence. ...
... Classroom adaptations focus on increasing teachers' awareness of working memory problems and encouraging them to adapt their teaching approaches to reduce learners' working memory load (Yang et al., 2017). Teachers are also encouraged to use instructional strategies that help learners with poor working memory overcome cognitive weaknesses Holmes et al., 2010). This approach is based on principles designed to motivate learners with low working memory by helping them reduce errors and increase self-confidence. ...
... We obtained a cluster mainly composed of children with a developmental disorder (DD, DCD, and co-occurrence) and a cluster mainly composed of children with typical development, with these clusters having, respectively, poor and good working memory performance. This finding supports the idea that working memory deficits can be considered as "key markers of a number of developmental learning disabilities" (Holmes et al., 2010). For example, 80% of children with poor working memory performance had difficulties in reading and mathematics (Gathercole & Alloway, 2008). ...
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Objective Many studies report a deficit in working memory in children with Developmental Dyslexia (DD) and Developmental Coordination Disorder (DCD) compared to children with Typical Development (TD). In this study, we questioned the working memory profile of children with co-occurring Developmental Dyslexia and Developmental Coordination Disorder (DD-DCD). First, we hypothesized that children with DD would have a more substantial deficit in verbal working memory, while children with DCD would have a more substantial deficit in visuospatial working memory. For the comorbid group, we postulated a deficit in both the verbal and visuospatial domains. Second, we determined whether we could correctly distinguish between the four groups based on their working memory profiles. Method 47 children with DD, 22 children with DCD, 27 children with DD-DCD, and 42 TD children aged from 7.6 to 12.6 years were tested on the phonological loop, the visuospatial sketchpad, and the central executive using the Digit Span and Wechsler’s Block-tapping tests. Results Children with DD had a deficit in verbal working memory including a specific deficit in the phonological loop and children with DCD had a deficit in visuospatial working memory. Comorbid children had poorer performance in verbal working memory (like group with DD) and in visuospatial working memory (like group with DCD). Exploratory cluster analysis resulted in four subgroups: (1) one cluster with good working memory performance made up of most of the TD children; (2) one cluster with a phonological loop deficit mainly made up of the children with DD; (3) one cluster with poor visuospatial working memory capacities mostly made up of the children with DCD (± DD) and (4) one cluster with average performance made up of children from all the groups. Conclusion Our results underline the importance of taking comorbidity into account when testing working memory in children with learning disabilities.
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Working memory - the ability to keep important information in mind while comprehending, thinking, and acting - varies considerably from person to person and changes dramatically during each person's life. Understanding such individual and developmental differences is crucial because working memory is a major contributor to general intellectual functioning. This volume offers an understanding variation in working memory by presenting comparisons of the leading theories. It incorporates views from the different research groups that operate on each side of the Atlantic, and covers working-memory research on a wide variety of populations, including healthy adults, children with and without learning difficulties, older adults, and adults and children with neurological disorders. Each research group explicitly addresses the same set of theoretical questions, from the perspective of both their own theoretical and experimental work, and from the perspective of relevant alternative approaches. Through these questions, each research group considers their overarching theory of working memory, specifies the critical sources of working memory variation according to their theory, reflects on the compatibility of their approach with other approaches, and assesses their contribution to general working-memory theory. This shared focus across chapters unifies the volume and highlights the similarities and differences among the various theories. Each chapter includes both a summary of research positions and a detailed discussion of each position.