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  • Visuo-spatial working memory: a sensitive measurement of cognitive deficits in ADHD. Child Neuropsychology 10 (3) 155-61.
  • Not just SEN, but across the board WM related to attainment and WM scores in deficit range for children with the lowest attainment in reading and math and KS2
  • Time: ADHD sig faster, violations and commissions: ADHD more errorful

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  • Working Memory and LearningDifficultiesDr Joni HolmesMRC Cognition and Brain Sciences UnitDyslexia Action Summer Conference, 28th June 2012
  • Overview• Introduction to working memory and its development• Poor working memory as a risk factor for learning difficulties• Interventions
  • WM: Key features• Capacity to hold material in mind and manipulate as necessary for brief period• Mental workspace• Limited in capacity - varies between individuals• Catastrophic loss• Impervious to environmental factors such as SES, ethnicity (Engel, Dos Santos & Gathercole, 2008)
  • WM: Development• WM capacity (amount of information we can hold in mind) varies across the lifespan 8 7 6 Working memory span 5 4 3 2 1 0 0 5 10 15 20 25 30 35 40 45 50 55 60 Age
  • WM: Development• In childhood, capacity increases steadily from 4 to 14 years• BUT great variability in capacity between children of the same age 20.00 18.00 16.00 14.00 12.00 Mean score 10.00 8.00 6.00 4.00 2.00 0.00 5 6 7 8 9 10 11 12 13 14 15 Mean scores on listening recall test from Age in years WMTB-C as a function of age, with 10th and 90th centiles
  • WM and DevelopmentalDisorders• Deficits in WM are a common feature in many acquired and genetic developmental disorders of learning • ADHD (Martinussen & Tannock, 2006) • Reading difficulties (Swanson, 2003) • Mathematical difficulties (Geary et al., 2004) • Specific Language Impairment (Archibald & Gathercole, 2007) • Dyslexia (Jeffries & Everatt, 2003, 2004) • Down syndrome (Jarrold, Baddeley & Hewes, 1999) • Williams syndrome (Jarrold, Baddeley, Hewes & Phillips, 2001)
  • WM and DevelopmentalDisorders• Illustration of atypical WM development in ADHD Control Working Memory ADHD 95 85 75 65 Correct 55 45 35 25 15 5 7.5 8.5 9.5 10.5 11.5 12.5 13.5 14.5 15.5 Age WM development in childhood for individuals with ADHD from Westerberg et al. (2004)
  • WM and Developmental Disorders • WM scores of children with ADHD compared to an age-matched comparison group 120 110Mean standard score 100 ADHD 90 Average WM 80 70 60 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM From Holmes et al. (2012)
  • WM as a primary cause forslow learning• Deficits are common in many developmental disorders, but• Poor working memory is a high risk factor for slow rates of learning that: • warrants detection in its own right • requires and benefits from intervention
  • WM as a predictor of specificlearning difficulties• 46 children aged 7-11 with SEN in reading (Gathercole et al., 2006)• Completed a wide range of cognitive assessments • IQ, short-term memory, WM, phonological awareness, maths, language • Statistical analysis to compare these skills as predictors of reading and maths performance
  • WM as a predictor of specificlearning difficulties• Reading performance • Predicted only by working memory and language (not IQ or phonological awareness)• Maths performance • Predicted only by working memory
  • WM as a function of attainment • Working memory scores as a function of maths and English attainment at Key Stage 2 SATs (from Gathercole et al., 2004) 120 120 110 110 100Mean score 100 90 Mean score 90 80 80 70 70 60 60 Low Average High Low Average High English attainment group Maths attainment group
  • Characteristics of childrenwith poor WM• Observations of over 300 children with poor working memory function, reported in • Gathercole, Lamont & Alloway (2006) • Gathercole & Alloway (2008) • Gathercole, Alloway, Kirkwood, Elliott, Holmes & Hilton (2008)
  • Characteristics of childrenwith poor WM• Poor academic progressMore than 80% of children with poor working memory fail to achieve expected levels of attainment in both reading and maths
  • Characteristics of childrenwith poor WM• Poor academic progress• Reserved in groups (normal social integration) Ross (6 years) is a reserved and quiet child who tends not to volunteer responses and rarely answers direct questions, particularly in the whole-class situation. He is sometimes becomes more vocal when working in small groups although he isn’t necessarily discussing the task in hand
  • Characteristics of childrenwith poor WM• Poor academic progress• Reserved in groups (normal social integration)• Difficulties in following instructions “Put your sheets on the green table, arrow cards in the packet, put your pencil away and come and sit on the carpet.” John (6 years) moved his sheets as requested, but failed to do anything else. When he realized that the rest of the class was seated on the carpet, he went and joined them, leaving his arrow cards and pencil on the table.
  • Characteristics of childrenwith poor WM• Poor academic progress• Reserved in groups (normal social integration)• Difficulties in following instructions• Place-keeping difficultiesWhen the teacher wrote on the board Monday 11th November and, underneath, The Market, which was the title of the piece of work, Nathan lost his place in the laborious attempt to copy the words down letter by letter, writing moNemarket
  • Characteristics of childrenwith poor WM• Poor academic progress• Reserved in groups (normal social integration)• Difficulties in following instructions• Place-keeping difficulties• Short attention span and distractibilityAdam (5 years) struggles to maintain attention, particularly during whole-class teaching when the pupils join together on the carpet. Hence, he sits directly in front of the teacher and is frequently prompted to sit correctly and to pay attention as he regularly fidgets, looks around the classroom and distracts other children near him.
  • Why do children with poorWM struggle to learn?• Learning is a step-by-step process, based on successes in individual learning activities.• Children with WM impairments often fail in the classroom because the WM loads of each activity are excessive for them.• WM failure leads to inattentive behaviour, simply because the child forgets what s/he is doing.• This leads to frequent lost learning opportunities, and consequently slow rates of learning
  • Interventions• Can WM problems be overcome? • Classroom-based support • WM training
  • 1. Classroom-based support• Be aware of the warning signs of WM failure• Monitor the child• Reduce amount of information to be stored• Reduce difficulty of processing• Be prepared to re-present important information• Encourage the use of memory aids• Help the child to use strategies
  • 1. Classroom-based support:Evaluation• Teachers say: • relatively easy to implement as they can work with existing curriculum activities • enabled them to understand that many task failures are due to forgetting • the child benefits from working within own capacity, with greater rates of task successFor more information:Gathercole SE & Alloway TP (2008). Working memory and learning: A practical guide for teachers. Sage PublishingElliott, J., Gathercole, S.E., Alloway, T.P., Holmes, J., & Kirkwood, H. (2010). An Evaluation of a Classroom-Based Intervention to Help Overcome Working Memory Difficulties and Improve Long-Term Academic Achievement. Journal of Cognitive Education and Psychology, 9, 227-250
  • 2. WM training• Surge in developing methods to improve WM to overcome adverse consequences• Number of studies have now demonstrated that repeated practice on WM tasks consistently boosts performance on non- trained WM tasks across a range of populations • Array of WM tasks (e.g. Klingberg et al., 2005; Holmes et al., 2009) • N-back paradigm (e.g. Dahlin et al., 2008; Jaeggi et al., 2008; Schweizer, Dalgliesh et al., in press)
  • 2. WM trainingCogmed Working Memory Training – Pearson• Computerised memory training program• Game-style environment designed to train working memory• Train on working memory tasks for 25 sessions over a 6-8 week period• Adaptive: individual works at span level
  • 2. WM training Training environment
  • 2. WM training Stills from two training tasks
  • 2. WM trainingChildren with ADHD (Holmes et al., 2010)• 25 children with clinical diagnosis of ADHD-C• Assessed off medication, on medication, after training and 6 mth follow up (medicated)• IQ and WM
  • Training children with ADHD (Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010)120.00110.00100.00 Off meds 90.00 On meds, pre-training Post-training Follow-up 80.00 70.00 60.00 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM
  • Training children with ADHD (Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010)120.00110.00100.00 * Off meds 90.00 On meds, pre-training Post-training Follow-up 80.00 70.00 60.00 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM
  • Training children with ADHD120.00 * (Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010) *110.00 * *100.00 * Off meds 90.00 On meds, pre-training Post-training Follow-up 80.00 70.00 60.00 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM
  • Training children with ADHD120.00 * (Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010) *110.00 * * *100.00 * Off meds 90.00 On meds, pre-training Post-training Follow-up 80.00 70.00 60.00 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM No impact on IQ
  • 2. WM trainingChildren with poor WM (Holmes et al., 2010)• 42 children, 8-11 years, with low WM (scores <86 on two verbal WM tasks, bottom 15th centile)• Two groups • Adaptive, standard version of training programme • training at maximum span level • Non-adaptive, control condition • training at fixed span level of 2• Assessed WM, IQ, maths, reading and ability to follow spoken instructions • Instruction span: Touch the blue pencil then pick up the yellow ruler and put it in the red box
  • Training children with poor WM (Holmes, Gathercole & Dunning, 2009) 25 Verbal STM Visuo-spatial STM 20gain in standard scores Verbal WM Visuo-spatial WM 15 * * 10 5 0 Non-adaptive training Adaptive training Adaptive training 6 month delay Significant improvement in maths scores for the adaptive group six months after training had ceased
  • Training children with poor WM: replication in a large-scale randomised controlled trial (Dunning, Gathercole & Holmes, 2012) 20 Adaptive training Non-adaptive training No training 15 * * 10 5 0 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial SWM -5
  • Field Trials• Training is effective in tightly-controlled research studies• Can it be extended to children at high educational risk, or whole classes, without extensive research support?• 2 field trials, one with a whole class of children and another with children with low academic performance Holmes, J., & Gathercole, S E. (2012). Taking working memory training from the laboratory to schools, Manuscript under review
  • Field Trials• Training is effective in tightly-controlled research studies• Can it be extended to children at high educational risk, or whole classes, without extensive research support?• 2 field trials, one with a whole class of children and another with children with low academic performance Holmes, J., & Gathercole, S E. (2012). Taking working memory training from the laboratory to schools, Manuscript under review
  • Field Trial 1: Whole class• 22 children aged 8/9yrs• Training in school with a class teacher and classroom assistant, as a single group• Assessed before and after training on standardised working memory measures by a researcher blind to the intervention
  • Field Trial 1: Working Memory * *120 * *110100 Pre 90 Post 80 70 60 VSTM VSSTM VWM VSWM
  • Field Trial 2: Children with Low AcademicPerformance• 50 children, 9-11 years, with lowest English and maths scores in Teacher Assessments at the end of previous school year • 25 Year 5 (9/10), 25 Year 6 (10/11) • Completed training in groups in school, supervised by teachers• Matched on age, gender and Teacher Assessment scores to 50 children from previous Year 5 and Year 6 cohorts who did not undergo training• Assessed progress across relevant academic year, measured by improvement in National Curriculum sublevels • National targets are 2 sublevels per year
  • Field Trial 2: Children with Low AcademicPerformance Mean sublevel gains (SDs) in attainment as a function subject and school year Year 5 Year 6 Trained Comparison Trained Comparison Group Group d Group Group dEnglish 1.48 (1.56) 2.36 (1.58) 0.56 2.00 (1.44) 1.12 (1.20) 0.67Maths 1.36 (1.29) -1.04 (2.88) 1.15 2.12 (1.13) 1.32 (1.55) 0.60• Children in Year 6 who received training made significantlygreater progress in both English, F(1,48)=5.49, p=.023, andmaths, F(1,48)=4.36, p=.042.• In Year 5, trained children made significantly greaterprogress in maths, F(48)=14.44, p<.001.
  • Field Trials: Compliance % Completed 20+ Cogmed Improvement Index: All Cogmed Improvement Index: Trial Sessions Trainees Completed 20+ Session 1 91 21.95 (8.71) 22.72 (7.66)2 Year 5 80 22.56 (7.31) 21.70 (6.38)2 Year 6 80 25.60 (8.45) 25.60 (8.69)
  • Field Trials: Summary• Good rates of compliance and completion• Cogmed Index improvements within the range of those reported in research trials• Transfer to non-trained standardised working memory tasks• Associated with greater progress across the academic year in English and maths, but only for the older children
  • 2. WM trainingSummary• Training consistently boosts WM scores in children with ADHD and poor WM.• Extended to adults and typically developing children.• Some benefits for academic outcomes, but functional transfer of any gains is not yet understood and it is unclear at this stage how training works.For more information on Cogmed visit: http://www.psychcorp.co.uk/Education/BestsellingInterventions/CogmedSchools/ CogmedWorkingMemoryTrainingSchools.aspx
  • ConclusionsSummary• Poor working memory skills place a child at extremely high risk of poor academic progress• May be a primary cause of slow learning• Problems may be ameliorated through effective classroom management and cognitive training• Extent of functional transfer yet to be established.
  • Thank you for listeningTo find out more…Gathercole & Alloway (2008) Working memory and learning: A practical guide for teachers. Sage.Contact me: joni.holmes@mrc-cbu.cam.ac.uk
  • ADDITIONAL SLIDES
  • Do children with poor WM have attention deficits?
  • ADHD:DSM-IV symptoms of inattentionAt least 6 of the following:• Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities• Often has trouble keeping attention on tasks or play activities• Often does not seem to listen when spoken to directly• Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace• Often has trouble organizing activities• Often avoids, dislikes, or doesnt want to do things that take a lot of mental effort for a long period of time• Often loses things needed for tasks and activities• Is often easily distracted• Is often forgetful in daily activities
  • Symptoms displayed by children with poor working memory (in red) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities Often has trouble keeping attention on tasks or play activities Often does not seem to listen when spoken to directly Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace Often has trouble organizing activities Often avoids, dislikes, or doesnt want to do things that take a lot of mental effort for a long period of time Often loses things needed for tasks and activities Is often easily distractedGathercole forgetful in (2008), Gathercole, Alloway, Elliott, Is often & Alloway daily activities Kirkwood , Holmes & Hilton (2008)
  • ADHD: DSM-IV symptoms of hyperactivity/ impulsivityAt least 6 of the following: Often fidgets with hands or feet or squirms in seat Often gets up from seat when remaining in seat is expected Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless) Often has trouble playing or enjoying leisure activities quietly Is often "on the go" or often acts as if "driven by a motor" Often talks excessively Often blurts out answers before questions have been finished Often has trouble waiting ones turn Often interrupts or intrudes on others (e.g., butts into conversations or games)
  • Do children with poor WM have attention deficits?• Holmes, Gathercole, Alloway, Hilton, Place & Elliott (in prep)ADHD group: Combined sub-type only71 boys, 12 girls, mean age 9y 9moAll children on fast-release stimulant medication, ceased 24 hours prior to testingLow working memory group27 boys, 23 girls, mean age 9y 9moSelected on basis of standard scores <=85 on 2 verbal WM measures (listening recall & backward digit recall)Average working memory group30 boys, 20 girls, mean age 9y 10 mosWM scores >85
  • Teacher ratings: Conner’s T 70 scores 60Mean T-score ADHD Low WM Average WM 50 40 Oppositional Inattentive Hyperactive ADHD
  • Attainment and IQ: standard scores 110 100Mean standard scores ADHD 90 Low WM Average WM 80 70 60 Maths Reading Verbal IQ Performance IQ
  • Working memory 120 110Mean standard score 100 ADHD 90 Low WM Average WM 80 70 60 Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM
  • Executive function: effect sizes(d) compared to control groupMeasure ADHD Low WM Verbal STM -0.81 -1.15 Verbal WM -1.05 -1.66 Visuo-spatial STM -0.97 -1.08 Visuo-spatial WM -1.02 -1.19 Trials accuracy -0.63 -0.79 Stroop errors -0.74 -0.75 Walk - dont walk -1.24 -1.15 Stroop time -0.47 -0.74 Card sort no.sorts -0.80 -0.95 Tower rule violations -0.92 -0.50 CPT commissions 0.79 0.22
  • Do children with poor WM have attention deficits?• Summary:• Children with poor working memory and those with ADHD share deficits in working memory and other executive functions, and are highly inattentive.• Children with ADHD are distinguished by elevated levels of hyperactivity and rule-breaking behaviour.• Low working memory = inattentive form of ADHD?
  • WM as a predictor of specificlearning difficulties• Predictors of reading performance Predictor Stand. b Working memory .347* Verbal IQ -0.159 Performance IQ 0.026 Phon. awareness 0.206 Language .427* * Significant predictor at .05 level
  • WM as a predictor of specificlearning difficulties• Predictors of maths performance Predictor Stand. b Working memory .339* Verbal IQ .280 Performance IQ .024 Phon. awareness .181 Language .072 * Significant predictor at .05 level