1. Working Memory and Learning
Difficulties
Dr Joni Holmes
MRC Cognition and Brain Sciences Unit
Dyslexia Action Summer Conference, 28th June 2012

2. Overview
• Introduction to working memory and its development
• Poor working memory as a risk factor for learning difficulties
• Interventions

3. 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)

4. 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

5. 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

6. WM and Developmental
Disorders
• 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)

7. WM and Developmental
Disorders
• 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)

8. WM and Developmental
Disorders
• WM scores of children with ADHD compared to an age-matched
comparison group
120
110
Mean 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)

9. WM as a primary cause for
slow 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

10. WM as a predictor of specific
learning 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

11. WM as a predictor of specific
learning difficulties
• Reading performance
• Predicted only by working memory and language (not IQ or
phonological awareness)
• Maths performance
• Predicted only by working memory

12. 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
100
Mean score
100
90 Mean score 90
80 80
70 70
60 60
Low Average High Low Average High
English attainment group Maths attainment group

13. Characteristics of children
with 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)

14. Characteristics of children
with poor WM
• Poor academic progress
More than 80% of children with poor working memory fail to
achieve expected levels of attainment in both reading and maths

15. Characteristics of children
with 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

16. Characteristics of children
with 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.

17. Characteristics of children
with poor WM
• Poor academic progress
• Reserved in groups (normal social integration)
• Difficulties in following instructions
• Place-keeping difficulties
When 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

18. Characteristics of children
with poor WM
• Poor academic progress
• Reserved in groups (normal social integration)
• Difficulties in following instructions
• Place-keeping difficulties
• Short attention span and distractibility
Adam (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.

19. Why do children with poor
WM 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

20. Interventions
• Can WM problems be overcome?
• Classroom-based support
• WM training

21. 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

22. 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 success
For more information:
Gathercole SE & Alloway TP (2008). Working memory and learning: A practical
guide for teachers. Sage Publishing
Elliott, 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

23. 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)

24. 2. WM training
Cogmed 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

25. 2. WM training
Training environment

26. 2. WM training
Stills from two training tasks

27. 2. WM training
Children 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

28. Training children with ADHD
(Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010)
120.00
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

29. Training children with ADHD
(Holmes, Gathercole, Place, Dunning, Hilton & Elliott, 2010)
120.00
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

30. Training children with ADHD
120.00
*
(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

31. Training children with ADHD
120.00
*
(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

32. 2. WM training
Children 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

33. Training children with poor WM
(Holmes, Gathercole & Dunning, 2009)
25
Verbal STM
Visuo-spatial STM
20
gain 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

34. 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

35. 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

36. 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

37. 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

38. Field Trial 1: Working Memory
* *
120 *
*
110
100
Pre
90
Post
80
70
60
VSTM VSSTM VWM VSWM

39. Field Trial 2: Children with Low Academic
Performance
• 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

40. Field Trial 2: Children with Low Academic
Performance
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 d
English 1.48 (1.56) 2.36 (1.58) 0.56 2.00 (1.44) 1.12 (1.20) 0.67
Maths 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 significantly
greater progress in both English, F(1,48)=5.49, p=.023, and
maths, F(1,48)=4.36, p=.042.
• In Year 5, trained children made significantly greater
progress in maths, F(48)=14.44, p<.001.

41. 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)

42. 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

43. 2. WM training
Summary
• 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

44. Conclusions
Summary
• 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.

45. Thank you for listening
To 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

46. ADDITIONAL SLIDES

47. Do children with poor WM have
attention deficits?

48. ADHD:
DSM-IV symptoms of inattention
At 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 doesn't 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

49. 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 doesn't 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
Gathercole forgetful in (2008), Gathercole, Alloway, Elliott,
 Is often
& Alloway daily activities
Kirkwood , Holmes & Hilton (2008)

50. ADHD:
DSM-IV symptoms of
hyperactivity/ impulsivity
At 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 one's turn
 Often interrupts or intrudes on others (e.g., butts into
conversations or games)

51. Do children with poor WM have
attention deficits?
• Holmes, Gathercole, Alloway, Hilton, Place & Elliott (in
prep)
ADHD group: Combined sub-type only
71 boys, 12 girls, mean age 9y 9mo
All children on fast-release stimulant medication, ceased
24 hours prior to testing
Low working memory group
27 boys, 23 girls, mean age 9y 9mo
Selected on basis of standard scores <=85 on 2 verbal WM
measures (listening recall & backward digit recall)
Average working memory group
30 boys, 20 girls, mean age 9y 10 mos
WM scores >85

52. Teacher ratings: Conner’s T
70
scores
60
Mean T-score
ADHD
Low WM
Average WM
50
40
Oppositional Inattentive Hyperactive ADHD

53. Attainment and IQ: standard
scores
110
100
Mean standard scores
ADHD
90 Low WM
Average WM
80
70
60
Maths Reading Verbal IQ Performance IQ

54. Working memory
120
110
Mean standard score
100
ADHD
90 Low WM
Average WM
80
70
60
Verbal STM Visuo-spatial STM Verbal WM Visuo-spatial WM

55. Executive function: effect sizes
(d) compared to control group
Measure 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 - don't 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

56. 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?

57. WM as a predictor of specific
learning 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

58. WM as a predictor of specific
learning 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