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Review of the Evidence on, and Fundamental Questions About, Efforts to Improve Executive Functions, Including Working Memory
Abstract
This systematic review of executive function (EF) interventions is the largest such review thus far, including 179 studies from all over the world, reported in 193 papers. It covers all the ways that have been tried to improve EFs, including computerized and noncomputerized cognitive training, neurofeedback, school programs, physical activities, mindfulness practices, and miscellaneous approaches (e.g., drama and Experience Corps), at all ages. A little studied approach—mindfulness practices involving movement (such as taekwondo and t’ai chi)—shows the best results for improving EFs. Promising school programs are second. Both approaches show better results than any cognitive training. Third best at improving EFs is noncomputerized cognitive training. Perhaps these three approaches show better results than computerized training because they involve more in-person trainer-trainee interaction. The best-performing computerized cognitive-training method for improving EFs is Cogmed®. Support was lacking for claims that N-back training improves fluid intelligence. Resistance training and “plain” aerobic-exercise interventions (e.g., running or walking) show the least evidence of benefit to EFs of all methods. Results for aerobic exercise with more cognitive or motor-skill challenges are only slightly better. This probably reflects how physical-activity interventions have been structured, rather than that physical activity does not benefit EFs. For any intervention, trainers’ ability to make the training activity enjoyable and to communicate their unwavering faith in participants and the program plus the activity being personally meaningful and relevant, inspiring commitment and emotional investment in participants to the activity and to one another is probably what is most important.
... Incorporating moderate to vigorous physical activity into a student's routine can have numerous benefits, such as improving cardiovascular health [12,13], mood, and reducing stress and anxiety [12,17]. Additionally, physical activity has been linked to improved academic performance, including better grades, higher test scores, and enhanced cognitive function [18,19]. ...
... Some students may not have access to a gym or other facilities that offer opportunities for physical activity or have financial limitations, which can limit their options for exercise [20,21]. Overall, students spend a significant amount of time sitting in lectures, studying, or working on assignments, which can make it difficult to break the cycle of sedentary behaviour and incorporate more physical activity into their daily lives Combining cognitive tasks with physical activity is gaining attention [18,23] and the integration of PA concurrent to cognitive work may represent a way to insert active time into the student's schedules. Active workstations such as cycling desks that generate light to moderate physical activity have become a strategy to combat sedentary behaviour in schools [24] and workplaces [25]. ...
... Growing evidence supports the benefit of moderated physical activity on executive function [18]. Shorts bouts of moderate physical activity may enhance attention, awareness, and memorization [51]. ...
... Inhibitory control (the ability to ignore distracting information and focus on work-related information) and working memory (the ability to maintain and manipulate information for a short period are two important components of executive functions [6]. Accordingly, given the importance of these components, the study of cognitive enhancement methods has expanded [7,8]. The logic of cognitive training derives largely from the concept of neuroplasticity, which asserts that the brain, similar to a muscle, can change and adapt to challenges, and targeted training produces sustained growth in the brain's structure or functional capacity [9]. ...
... While some research emphasizes the influence of exercise on biological factors related to cognition, such as structural and functional changes in the brain, other researchers consider the effects of exercise on behavioral variables to be important [9,[13][14][15]. However, the concept that is emphasized is the type of physical exercise [8,16,17]. In this regard, a factor called the cognitive need for physical exercises the effectiveness of exercises in improving cognitive functions increases with the increment in the level of complexity of the exercises and their cognitive challenges [18]. ...
... Although some studies have shown that brain training games are effective in cognitive functions (such as working memory and processing speed) in healthy adults [33], some studies show that the effect size for cognitive interventions is small [34]. On the other hand, some studies show that physical exercises sometimes cannot be effective enough to improve brain functions [8,16,17]. Therefore, according to the present findings, it may be possible to confirm this hypothesis that by combining cognitive and physical exercises, its effectiveness in improving cognitive functions can be increased. Evidence suggests that cognitive and physical exercise may complement each other and help improve brain structure and function and cognition [35]. ...
Purpose: Improving brain functions through physical exercises has been the focus of research in recent years. Accordingly, it is important to examine the kind of physical exercises and brain functions that are affected. This study aims to examine the effect of integrated physical cognitive exercises at home on the executive functions of adults. Methods: This was a field trial study, in which 28 people were examined in 2 groups. People in the experimental group participated in combined cognitive and physical exercises for 16 sessions, while the control group did their daily routines. Inhibition components were evaluated by the go/no-go test and working memory through the N-back test at the beginning and end of the training period. The data were analyzed via factorial analysis of variance through the SPSS software, version 19. Results: The findings indicated that the experimental condition, compared to the control condition, caused a significant improvement in the correct inhibition (P=0.002) and total correct response (P=0.047) components in the go/no-go test, along with the commission errors in the N-back test (P=0.003). Conclusion: The results showed that the combined physical and cognitive exercise had a positive effect on the core executive functions (attentional inhibition and working memory) and could prevent the performance decrement caused by quarantine and the reduction of daily activities that people were facing.
... Other reviews with elderly populations theorize that the combination of physical exercise and cognitive training may affect neuroplasticity additively, and multicomponent contexts may be more effective in improving EF than single-component cognitive or exercise training alone (Monteiro-Junior et al., 2016). Diamond and Ling's (2020) review on EF training across development state that exergames show encouraging results of improving EF and deserve further investigation. While there are well-documented beneficial effects of exergames on EF in elderly populations as forms of reactive maintenance and preventative measures of neurocognitive decline, further exploration on the impact of exergames in youth as forms of proactive maintenance and cognitive enhancement is needed. ...
... found studies examining acute exercise on EF in youth yielded mixed results, which the authors discuss were difficult to explain because the studies employed similar designs regarding exercise duration, physical activity intensity, and EF outcome measures but that the mixed results could be due to differences in the participants' cognitive strategies, and future research is needed to confirm this potential explanation. Diamond and Ling's (2020) review on EF training found that within the range of durations studied, longer durations of computerized cognitive training produced better results than shorter durations, and studies of enriched exercise with higher cognitive demands showed suggestive evidence of EF benefits compared to repetitive exercise, with more EF improvement from enriched exercise compared to repetitive exercise compared to control groups found on twice as many EF measures. ...
Exergames (video games that promote cognitive and physical activity simultaneously) benefit executive function (EF) in elderly populations. It has been suggested that exergames may induce larger effects than cognitive or exercise training alone, but few reviews have synthesized the causal factors of exergames on EF from experimental research with youth. This review investigates (a) the various types of exergames and associated comparison conditions; (b) the EF outcome assessments commonly utilized in exergame research with youth; (c) the efficacy of exergames by evaluating experimental studies that compared exergaming to cognitive, exercise, and passive control conditions inclusive of effect sizes; and (d) the potential mechanisms underlying the changes in EF induced from exergames. Eligible outcome data were available from 607 participants across 10 studies, with the age of participants ranging from 4 to 21 (Mage = 10.46). The findings indicate that exergames improve aspects of EF from both acute and chronic studies. Despite the high variability of exergame contexts, dosages, populations, and outcome assessments, improvements in EF comparing exergaming to passive control conditions were exhibited across all studies. While there is evidence of exergaming demonstrating advantages over passive control conditions, evidence is mixed when comparing exergaming to sedentary cognitive and exercise comparison conditions. Potential sources of these mixed results and future directions to address current gaps in the field are identified. As video game and technology use grows exponentially and concerns of childhood sedentary behavior and play deprivation increase, evidence-based practices that promote both physical and cognitive activity are needed.
... Cognitive training can be carried out in groups and developed by professionals who are not necessarily from the health area, but who are trained, with the purpose of increasing or maintaining specific cognitive functions, such as memory. Cognitive stimulation, as well as training, can be carried out in groups promoting involvement in activities that seek a general improvement in the cognitive and social status of those individuals, without the objective of stimulating only one area or function, being considered more complex and dynamic, requiring a health professional together coordinating the actions, which is what is usually done in computer workshops (Diamond and Ling, 2020;Clare and Woods, 2003;Blennow et al., 2010). ...
Objective: To evaluate the impact of cognitive stimulation via digital inclusion and the practice of video games on the cognition of the older population. Method: This is a randomized controlled intervention study, nested in a population cohort study. Based on the application of the Clinical Dementia Rating (CDR) test, individuals aged 60 years or older with scores 0 and 0.5 were included and randomly allocated in the Intervention Group (IG) or Control Group (CG). Initially, 160 participants met the selection criteria and underwent neuropsychological evaluation via the Montreal Cognitive Assessment (MoCA), applied before and after intervention. The IG (n = 62) participated in computer-based intervention once a week for one-and-a-half hours, for 4 months. The CG (n = 47) participated in the mindfulness workshops held in the same period. Results: The digital literacy intervention group averaged 2.6 points more in the MoCA after 4 months. The change in the final MoCA decreased in 0.46 points at each unit in the basal MoCA. Individuals with average schooling had an increase of 0.93 points in the change of the MoCA in relation to individuals with low or high schooling. Conclusion: Digital inclusion combined with the practice of video games has the potential to improve the cognition of the older population.
... The third example describes the main theories in educational psychology regarding the domain of the training of executive functions (see Andrés et al., 2021;Bialystok, 2017;Diamond & Ling, 2020;Goldstein & Naglieri, 2014, for overviews). Executive functions are defined as the cognitive control processes involved in balancing the mental resources in information processing (i.e., inhibitory control, working memory, and cognitive flexibility), and which encompasses (a) the explicit training of inhibitory control and cognitive flexibility, such as explicitly practicing social and emotional understanding in younger children and academic excellence in students, (b) stress reducing physical activities that also require body-mind coordination, such as sedentary mindfulness training, although this can vary per executive function, and (c) complex-span tasks (i.e., improving counting-, reading-, and operations-span), especially when they are practiced alongside reading, writing, calculating, and reasoning. ...
What is knowledge? Cognitive, social, and educational psychologists define it as a collection of information or facts and their meaning in relation to each other that is stored in the brain, but in each of these psychological areas, a different facet is highlighted. Cognitive psychologists study knowledge as the construction and representation of information in memory. Social psychologists study knowledge as the influence of feelings, beliefs, and attitudes on behavior. Educational psychologists study knowledge as the improvement of performance through training, instruction, and teaching. Currently, encouraged by the replication crisis and the epistemic philosophical views, more psychological researchers are beginning to shift their focus towards knowledge as an actual-world phenomenon, which especially has much ground in common with the discipline of cognitive science (i.e., artificial intelligence and the neurosciences). However, this anew direction in the psychological study of knowledge is complicated, in that researchers have to reckon with its dynamical nature in the actual world. The dynamical character of knowledge involves that it (a) changes over time in various manners, (b) is an experientially personalized construction, and (c) is capriciously interacting with situational influences. The difficulty in scientifically observing knowledge as an actual-world phenomenon encompasses (a) how individuals retrieve knowledge via cognitive, social, and emotional considerations, (b) how knowledge has an interaction with the individual's physique and behavioral expression modes, and (c) how knowledge has an interaction with the present situation or surrounding environment. In this article, I will discuss present theories, views, and scientific evidence and findings in psychology, philosophy, and cognitive science regarding knowledge as an actual-world phenomenon with the aim to provide for methodological suggestions for future psychological research.
... This instrument may be of interest to researchers and educational psychologists, since through its free use (see http://www.chexi.se), it can provide valuable information on the executive functioning of students. In fact, regarding skills that are critical for academic success, research has revealed that EF play a fundamental role (Cortés Pascual et al., 2019;Diamond & Ling, 2019;St Clair-Thompson & Gathercole, 2006;Usai et al., 2018;Zelazo et al., 2016). These EF have been shown to be a key element in the development of skills, as problem solving, reasoning or planning (Collins & Koechlin, 2012;Duncan et al., 2012), or skills related to reading (e.g., see Follmer, 2018;Gathercole et al., 2004). ...
Given the enormous influence of executive functions in school and life success, it is necessary to identify EF levels and address them in a reliable way with tools accessible to practitioners. Two studies were conducted. In study 1, the psychometric properties of the Spanish version Children's Executive Functioning Inventory (CHEXI) in a representative sample of 1230 primary school students from 9 to 12 years old was investigated. According to Barkley's hybrid model, CHEXI showed good fit indices on the two subscales: working memory and inhibition (Χ² =949.32, p < 0.001, CFI = 0.98, TLI = 0.98, SRMR = 0.06, RMSEA = 0.05), as well as excellent internal consistency (ω ≥ 0.84-0.91; α ≥ 0.84-0.91). In study 2, the efficacy of the CHEXI for the observation of EF deficits related to ADHD symptoms in children was analysed. Significant differences in parent-reported scores were observed between typically developing students and students diagnosed with ADHD (p = < 0.001, η2partial = 0.09-0.10). The results showed that the CHEXI is a reliable instrument for measuring EF in Spanish children, and, it could be a useful tool for the identification of ADHD in these ages. Resumen Validación y fiabilidad del Inventario de Función Ejecutiva Infantil (CHEXI) en alumnos españoles de primaria. Dada la enorme influencia de las fun-ciones ejecutivas (FE) en el bienestar y el éxito escolar del alumnado de Educación Primaria, resulta necesario utilizar instrumentos que midan tales variables que sean accesibles para todos los profesionales de la educación. Se realizaron dos estudios. En el estudio 1, se investigó las propiedades psicométricas de la versión española del Inventario de Funcionamiento Ejecutivo Infantil (CHEXI) en una muestra representativa de 1230 alumnos de primaria de 8 a 12 años. Siguiendo el modelo híbrido de Barkley, el CHEXI mostró unos buenos índices de ajuste en las dos subescalas: memo-ria de trabajo e inhibición (Χ ²=949.32, p < 0.001, CFI = 0.98, TLI = 0.98, SRMR = 0.06, RMSEA = 0.05), así como una excelente consistencia interna (ω ≥ 0.84-0.91; α ≥ 0.84-0.91). En el estudio 2, se analizó la eficacia del CHEXI para la observación de los déficits de EF relacionados con los síntomas del TDAH. Se observaron diferencias significativas en las puntuaciones informadas por los padres entre los estudiantes con desarrollo típico y los estudiantes diagnosticados con TDAH (p = < 0.001, η2partial = 0.09-0.10). Los resultados mostraron que el CHEXI es un instrumento fiable para medir las FEs en niños españoles, y podría ser una herramienta útil para la identificación del TDAH en estas edades. Palabras clave: funciones ejecutivas; CHEXI; inhibición; memoria de trabajo; TDAH.
Background: Executive function (EF) impairment is common in children with autism spectrum disorder (ASD). EF strategies are considered effective in improving therapeutic outcomes of children with ASD. This study primarily aims to explore whether integrating EF strategies combined with regular occupational therapy intervention is more effective in improving daily life skills (DLS) and sensory integration/processing (SI/SP) skillsthan regular occupational therapy alone in children with ASD and secondarily aimsto assess treatment outcomes on improving visual motor integration (VMI) skills.
Methods: A total of 92 children with ASD will be recruited and following baseline assessments randomly assigned to the treatment group (45-min once weekly individual occupational therapy plus EF strategies) and control group (45-min once weekly individual therapy sessions alone).
Discussion: All children will be evaluated systematically by assessing SI/SP, DLS, and VMI, skills at baseline, 7 weeks, and 14 weeks of treatment. Data will be analyzed using analysis of covariance and t-test. This single-blind randomized controlled trial will provide empirical evidence for the effectiveness of EF strategies when combined with regular occupational therapy programs. Based on trial results, EF strategies could be recommended in multidisciplinary programs for children with ASD.
Clinical trial registration: This trial has been registered on the clinicaltrail.gov for registry, protocol ID: MRC-01-22-509 ClinicalTrials.gov Identifier: NCT05829577, registered April 25, 2023.
The present article used a pilot study to determine the effectiveness of digital cognitive mindfulness training developed based on dialectical behavioral therapy (DBT) in reducing attention deficit hyperactivity disorder (ADHD) symptoms in children. The sample consisted of 90 children (8–10 years old) diagnosed with ADHD. The participants were randomized into two groups: an experimental group (n = 45) and a control group (n = 45). Results were assessed at three time points: before, after the study, and one month after the end of the study. Regarding ADHD symptoms, the ANCOVA results showed that there were no statistically significant differences between the study groups for inattention and hyperactivity/impulsivity after testing. One month after completion of the program, there was a significant alleviation in symptoms of inattention, executive functioning, learning problems, aggression, and peer relationships. Hyperactivity was the only variable that showed a decrease both post-test and during follow-up. These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children.
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