ADHD-PI SYMPTOMS ARE IMPROVED BY WORKING MEMORY TRAINING

The question of whether ADHD-PI, symptoms are improved by Working Memory training is a good one. 

I was recently asked that question by one of my readers.
The answer is yes! ADHD-PI symptoms are improved by working memory training.

Specifically the reader wanted to know if there were studies that showed that working memory training, and the Multitasking Test Tools that I have been posting about have been found, in research studies, to help people with ADHD Predominantly Inattentive.

The short answer is yes.  The longer answer involves three parts.  The first part is showing that a randomized controlled trial showed improved working memory performance in kids with ADHD-PI (and the other ADHD subtypes as well) after computerized working memory training.  The second part is showing that in people with ADHD-PI symptoms the main problems that they have are related to working memory issues.  The third part of the answer involves showing that computerized working memory, divided attention, and multitasking test tools help cognitive function.

The studies performed by Torkel Klingberg on children with ADHD-PI using a computerized working memory program report improvements in working memory deficits after working memory training.  The abstract of the Klingberg ADHD-PI randomized control study is the first study cited below.

There are numerous studies that indicate that working memory issues are the core problem in people with ADHD-PI.  The fairly recent study published in the journal School Psychology Review and cited as #2 below found that the combined type of ADHD scored poorly on the subscales of: 1) Attention Problems; (2) Oppositional; (3) Attention Deficit/Hyperactivity Problems scale; (4) Inattention sub-scale; (5) Hyperactivity-Impulsivity subscale; and (6) Externalizing.

The ADHD-PI type and the Combined type scored lower than those clinically referred without ADHD on WISC-IV Working Memory Index and Full Scale Intelligence Quotientiffers.  So from this study we can see that while the Combined type has other issues, the main issue in ADHD-PI may be working memory.

The third study cited below was published this month in Pyschonomic Bulletin and Review and reports on the "growing body of literature showing that one's working memory (WM) capacity can be expanded through targeted training."

Computerized multitasking test tools otherwise knows as working memory training tools can help people with ADHD Predominantly Inattentive because working memory deficits may be the core deficit in people with this diagnosis and because these computerized programs have been found to strengthen the weakened working memory capacity of people with working memory deficits.

1. 

JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY. 2005 Feb;44(2):177-86.

Computerized training of working memory in children with ADHD--a randomized, controlled trial.

Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlström K, Gillberg CG, Forssberg H, Westerberg H.

Unit of Neuropediatrics, Department Women and Children's Health, Karolinska Institute, 17176 Stockholm, Sweden. torkel.klingberg@kbh.ki.se

Abstract

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

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

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

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

2. 

SCHOOL PSYCHOLOGY REVIEW. 2009 Jan 1;38(1):45-66.

Standardized Observational Assessment of Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes. I. Test Session Observations. McConaughy SH, Ivanova MY, Antshel K, Eiraldi RB.

University of Vermont.

Abstract

Test examiners used the Test Observation Form (McConaughy & Achenbach, 2004) to rate test session behavior of 177 6- to 11-year-old children during administration of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and Wechsler Individual Achievement Tests-Second Edition (WIAT-II). Participants were assigned to four groups based on a parent diagnostic interview and parent and teacher rating scales: attention deficit hyperactivity disorder (ADHD)-Combined type (n = 74); ADHD-Inattentive type (n = 25); clinically referred without ADHD (n = 52); and controls (n = 26). The ADHD-Combined type group scored significantly higher than the other three groups on six Test Observation Form scales: (1) Attention Problems; (2) Oppositional; (3) Attention Deficit/Hyperactivity Problems scale; (4) Inattention sub-scale; (5) Hyperactivity-Impulsivity subscale; and (6) Externalizing. The two ADHD groups also scored significantly lower than controls on all WISC-IV and WIAT-II composites and lower than those clinically referred without ADHD on WISC-IV Working Memory Index and Full Scale Intelligence Quotient. Implications are discussed regarding the discriminative validity of standardized test session observations for identifying children with ADHD and differentiating between the two ADHD subtypes.

3.

PSYCHONOMIC BULLETIN AND REVIEW. 2011 Feb;18(1):46-60.

Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Morrison AB, Chein JM.

Department of Psychology, Temple University, 6th floor Weiss Hall, Philadelphia, PA, 19122, USA.

Abstract

A growing body of literature shows that one's working memory (WM) capacity can be expanded through targeted training. Given the established relationship between WM and higher cognition, these successful training studies have led to speculation that WM training may yield broad cognitive benefits. This review considers the current state of the emerging WM training literature, and details both its successes and limitations. We identify two distinct approaches to WM training, strategy training and core training, and highlight both the theoretical and practical motivations that guide each approach. Training-related increases in WM capacity have been successfully demonstrated across a wide range of subject populations, but different training techniques seem to produce differential impacts upon the broader landscape of cognitive abilities. In particular, core WM training studies seem to produce more far-reaching transfer effects, likely because they target domain-general mechanisms of WM. The results of individual studies encourage optimism regarding the value of WM training as a tool for general cognitive enhancement. However, we discuss several limitations that should be addressed before the field endorses the value of this approach.