, Volume 9, Issue 3, pp 639–648 | Cite as

Will Working Memory Training Generalize to Improve Off-Task Behavior in Children with Attention-Deficit/Hyperactivity Disorder?

  • Chloe T. Green
  • Debra L. Long
  • David Green
  • Ana-Maria Iosif
  • J. Faye Dixon
  • Meghan R. Miller
  • Catherine Fassbender
  • Julie B. SchweitzerEmail author
Original Article


Computerized working memory and executive function training programs designed to target specific impairments in executive functioning are becoming increasingly available, yet how well these programs generalize to improve functional deficits in disorders, such as attention-deficit/hyperactivity disorder (ADHD), beyond the training context is not well-established. The aim of this study was to examine the extent to which working memory (WM) training in children with ADHD would diminish a core dysfunctional behavior associated with the disorder, “off-task” behavior during academic task performance. The effect of computerized WM training (adaptive) was compared to a placebo condition (nonadaptive) in a randomized, double-blind, placebo-controlled design in 26 children (18 males; age, 7 to 14 years old) diagnosed with ADHD. Participants completed the training in approximately 25 sessions. The Restricted Academic Situations Task (RAST) observational system was used to assess aspects of off-task behavior during the completion of an academic task. Traditional measures of ADHD symptoms (Conners’ Parent Rating Scale) and WM ability (standardized WM tests) were also collected. WM training led to significant reductions in off-task ADHD-associated behavior on the RAST system and improvement on WM tests. There were no significant differences between groups in improvement on parent rating scales. Findings lend insight into the generalizability of the effects of WM training and the relation between deficits in WM and off-task behavioral components of ADHD. These preliminary data suggest WM training may provide a mechanism for indirectly altering academic performance in children with ADHD.


Attention academic behavior treatment RAST children ADHD cognitive training. 



We would like to thank the families for their participation, Joan Gunther, Psy.D., Gary Ho, M.A., Danielle Mizuiri, B.S., Tseng-Mei Yip, B.S., Christina Blake, B.S., and Kyle Rutledge for their assistance, and Cogmed for providing us with the software licenses at no cost. We have no financial disclosures. We declare that there is no real or perceived conflict of interest for the authors. Full conflict of interest disclosures are available in the electronic supplementary material for this article.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

13311_2012_124_MOESM1_ESM.pdf (516 kb)
ESM 1 (PDF 516 kb)


  1. 1.
    Chronis AM, Jones HA, Raggi VL. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clin Psychol Rev 2006;26:486–502.PubMedCrossRefGoogle Scholar
  2. 2.
    Pelham WE Jr., Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. J Clin Child Psychol 1998;27:190–205.PubMedCrossRefGoogle Scholar
  3. 3.
    Anastopoulos AD, Guevremont D, Shelton T, DuPaul GJ. Parenting stress among families of children with attention deficit hyperactivity disorder. J Abnorm Child Psychol 1992;20:503–520.PubMedCrossRefGoogle Scholar
  4. 4.
    Abikoff H. ADHD psychosocial treatments: generalization reconsidered. J Atten Disord 2009;13:207–210.PubMedCrossRefGoogle Scholar
  5. 5.
    Hale TS, Bookheimer S, McGough JJ, Phillips JM, McCracken JT. Atypical brain activation during simple & complex levels of processing in adult ADHD: an fMRI study. J Atten Disord 2007;11:125–140.PubMedCrossRefGoogle Scholar
  6. 6.
    Krauel K, Duzel E, Hinrichs H, Santel S, Rellum T, Baving L. Impact of emotional salience on episodic memory in attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study. Biol Psychiatry 2007;61:1370–1379.PubMedCrossRefGoogle Scholar
  7. 7.
    Schweitzer JB, Faber TL, Grafton ST, Tune LE, Hoffman JM, Kilts CD. Alterations in the functional anatomy of working memory in adult attention deficit hyperactivity disorder. Am J Psychiatry 2000;157:278–280.PubMedCrossRefGoogle Scholar
  8. 8.
    Sheridan MA, Hinshaw S, D'Esposito M. Efficiency of the prefrontal cortex during working memory in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007;46:1357–1366.PubMedCrossRefGoogle Scholar
  9. 9.
    Fassbender C, Schweitzer JB. Is there evidence for neural compensation in attention deficit hyperactivity disorder? A review of the functional neuroimaging literature. Clin Psychol Rev 2006;26:445–465.PubMedCrossRefGoogle Scholar
  10. 10.
    Burgess GC, Depue BE, Ruzic L, Willcutt EG, Du YP, Banich MT. Attentional control activation relates to working memory in attention-deficit/hyperactivity disorder. Biol Psychiatry 2010;67:632–640.PubMedCrossRefGoogle Scholar
  11. 11.
    McNab F, Varrone A, Farde L, et al. Changes in cortical dopamine D1 receptor binding associated with cognitive training. Science (New York) 2009;323:800–802.CrossRefGoogle Scholar
  12. 12.
    Baddeley A. The fractionation of working memory. Proc Natl Acad Sci 1996;26:13468–13472.CrossRefGoogle Scholar
  13. 13.
    Alloway TP, Gathercole SE, Elliott J. Examining the link between working memory behaviour and academic attainment in children with ADHD. Dev Med Child Neurol 2010;52:632–636.PubMedCrossRefGoogle Scholar
  14. 14.
    Barkley RA. Attention Deficit hyperactivity disorder: a handbook for diagnosis and treatment, 3rd ed. New York: Guilford Press, 2006.Google Scholar
  15. 15.
    Gropper RJ, Tannock R. A pilot study of working memory and academic achievement in college students with ADHD. J Atten Disord 2009;12:574–581.PubMedCrossRefGoogle Scholar
  16. 16.
    McLean A, Dowson J, Toone B, et al. Characteristic neurocognitive profile associated with adult attention-deficit/hyperactivity disorder. Psychol Med 2004;34:681–692.PubMedCrossRefGoogle Scholar
  17. 17.
    Karatekin C, Asarnow RF. Working memory in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder. Psychiatry Res 1998;80:165–176.PubMedCrossRefGoogle Scholar
  18. 18.
    Kempton S, Vance A, Maruff P, Luk E, Costin J, Pantelis C. Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children. Psychol Med 1999;29:527–538.PubMedCrossRefGoogle Scholar
  19. 19.
    Kuntsi J, Oosterlaan J, Stevenson J. Psychological mechanisms in hyperactivity: I. Response inhibition deficit, working memory impairment, delay aversion, or something else? J Child Psychol Psychiatry 2001;42:199–210.PubMedCrossRefGoogle Scholar
  20. 20.
    Mariani M, Barkley R. Neuropsychological and academic functioning in preschool boys with attention deficit hyperactivity disorder. Dev Neuropsychol 1997;13:111–129.CrossRefGoogle Scholar
  21. 21.
    Martinussen R, Hayden J, Hogg-Johnson S, Tannock R. A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2005;44:377–384.PubMedCrossRefGoogle Scholar
  22. 22.
    Rapport MD, Bolden J, Kofler MJ, Sarver DE, Raiker JS, Alderson RM. Hyperactivity in boys with attention-deficit/ hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? J Abnorm Child Psychol 2009;37: 521–534.PubMedCrossRefGoogle Scholar
  23. 23.
    Schweitzer JB, Hanford RB, Medoff DR. Working memory deficits in adults with ADHD: is there evidence for subtype differences? Behav Brain Funct 2006;2:43.PubMedCrossRefGoogle Scholar
  24. 24.
    Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 2005;57:1336–1346.PubMedCrossRefGoogle Scholar
  25. 25.
    Aronen ET, Vuontela V, Steenari MR, Salmi J, Carlson S. Working memory, psychiatric symptoms, and academic performance at school. Neurobiol Learn Mem 2005;83:33–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Gathercole SE, Pickering SJ. Working memory deficits in children with low achievements in the national curriculum at 7 years of age. Br J Educ Psychol 2000;70(part 2):177–194.PubMedCrossRefGoogle Scholar
  27. 27.
    Rapport MD, Scanlan SW, Denney CB. Attention-deficit/hyperactivity disorder and scholastic achievement: a model of dual developmental pathways. J Child Psychol Psychiatry 1999;40:1169–1183.PubMedCrossRefGoogle Scholar
  28. 28.
    Jarvis HL, Gathercole SE. Verbal and non-verbal working memory and achievements on national curriculum tests at 11 and 14 years of age. Educational and Child Psychology 2003;20:123–140.Google Scholar
  29. 29.
    Biederman J, Petty CR, Ball SW, et al. Are cognitive deficits in attention deficit/hyperactivity disorder related to the course of the disorder? A prospective controlled follow-up study of grown up boys with persistent and remitting course. Psychiatry Res 2009;170:177–182.PubMedCrossRefGoogle Scholar
  30. 30.
    Kremen WS, Jacobsen KC, Xian H, et al. Genetics of verbal working memory processes: a twin study of middle-aged men. Neuropsychology 2007;21:569–580.PubMedCrossRefGoogle Scholar
  31. 31.
    Holmes J, Gathercole SE, Dunning DL. Adaptive training leads to sustained enhancement of poor working memory in children. Dev Sci 2009;12:F9-F15.PubMedCrossRefGoogle Scholar
  32. 32.
    Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. J Clin Exp Neuropsychol 2002;24:781–791.PubMedCrossRefGoogle Scholar
  33. 33.
    Klingberg T, Fernell E, Olesen PJ, et al. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child and Adolesc Psychiatry 2005;44:177–186.CrossRefGoogle Scholar
  34. 34.
    Kurtz MM, Seltzer JC, Fujimoto M, Shagan DS, Wexler BE. Predictors of change in life skills in schizophrenia after cognitive remediation. Schizophr Res 2009;107:267–274.PubMedCrossRefGoogle Scholar
  35. 35.
    Olesen PJ, Westerberg H, Klingberg T. Increased prefrontal and parietal activity after training of working memory. Nat Neurosci 2004;7:75–79.PubMedCrossRefGoogle Scholar
  36. 36.
    Klingberg T. Training and plasticity of working memory. Trends Cogn Sci [Review]. 2010;14:317–324.CrossRefGoogle Scholar
  37. 37.
    Holmes J, Gathercole SE, Place M, Dunning DL, Hilton KL, Elliott JG. Working memory deficits can be overcome: impacts of training and medication on working memory in children with ADHD. Appl Cogn Psychol 2010;24:827–836.CrossRefGoogle Scholar
  38. 38.
    Beck SJ, Hanson CA, Puffenberger SS, Benninger KL, Benninger WB. A controlled trial of working memory training for children and adolescents with ADHD. J Clin Child Adolesc Psychol 2010;39:825–836.PubMedCrossRefGoogle Scholar
  39. 39.
    Schweitzer JB, Lee DO, Hanford RB, et al. Effect of methylphenidate on executive functioning in adults with attention-deficit/hyperactivity disorder: normalization of behavior but not related brain activity. Biol Psychiatry 2004;56:597–606.PubMedCrossRefGoogle Scholar
  40. 40.
    Fassbender C, Schweitzer JB, Cortes CR, et al. Working memory in attention deficit/hyperactivity disorder is characterized by a lack of specialization of brain function. PloS One 2011;6:e27240.PubMedCrossRefGoogle Scholar
  41. 41.
    Westerberg H, Klingberg T. Changes in cortical activity after training of working memory — a single-subject analysis. Physiol Behav 2007;92:186–192.PubMedCrossRefGoogle Scholar
  42. 42.
    Olson IR, Berryhill M. Some surprising findings on the involvement of the parietal lobe in human memory. Neurobiol Learn Mem 2009;91:155–165.PubMedCrossRefGoogle Scholar
  43. 43.
    Wager T, Smith E. Neuroimaging studies of working memory: a meta-analysis. Cogn Affect Behav Neurosci 2003;3:255–274.PubMedCrossRefGoogle Scholar
  44. 44.
    Hoekzema E, Carmona S, Tremols V, et al. Enhanced neural activity in frontal and cerebellar circuits after cognitive training in children with attention-deficit/hyperactivity disorder. Hum Brain Map 2010;31:1942–1950.CrossRefGoogle Scholar
  45. 45.
    Volkow ND, Wang GJ, Newcorn J, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2007;64:932–940.PubMedCrossRefGoogle Scholar
  46. 46.
    Milich R, Loney J, Landau S. Independent dimensions of hyperactivity and aggression: a validation with playroom observation data. J Abnorm Psychol 1982;91:183–198.PubMedCrossRefGoogle Scholar
  47. 47.
    Milich R, Loney J, Roberts MA. Playroom observations of activity level and sustained attention: two-year stability. J Consult Clin Psychol 1986;54:272–274.PubMedCrossRefGoogle Scholar
  48. 48.
    Roberts MA. A behavioral observation method for differentiating hyperactive and aggressive boys. J Abnorm Child Psychol 1990;18:131–142.PubMedCrossRefGoogle Scholar
  49. 49.
    Loney J, Carlson GA, Salisbury H, Volpe RJ. Validation of three dimensions of childhood psychopathology in young clinic-referred boys. J Atten Disord 2005;8:169–181.PubMedCrossRefGoogle Scholar
  50. 50.
    Breen MJ. Cognitive and behavioral differences in AdHD boys and girls. J Child Psychol Psychiatry 1989;30:711–716.PubMedCrossRefGoogle Scholar
  51. 51.
    Schweitzer JB, Sulzer-Azaroff B. Self-control in boys with attention deficit hyperactivity disorder: effects of added stimulation and time. J Child Psychol Psychiatry 1995;36:671–686.PubMedGoogle Scholar
  52. 52.
    Breslau J, Miller E, Breslau N, Bohnert K, Lucia V, Schweitzer J. The impact of early behavior disturbances on academic achievement in high school. Pediatrics 2009;123:1472–1476.PubMedCrossRefGoogle Scholar
  53. 53.
    Raggi VL, Chronis AM. Interventions to address the academic impairment of children and adolescents with ADHD. Clin Child Fam Psychol Rev 2006;9:85–111.PubMedCrossRefGoogle Scholar
  54. 54.
    Hinshaw SP. Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention. J Consult Clin Psychol 1992;60:893–903.PubMedCrossRefGoogle Scholar
  55. 55.
    Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child and Adolesc Psychiatry 2006;45:192–202.CrossRefGoogle Scholar
  56. 56.
    Polderman TJ, Boomsma DI, Bartels M, Verhulst FC, Huizink AC. A systematic review of prospective studies on attention problems and academic achievement. Acta psychiatrica Scandinavica 2010;122:271–284.PubMedCrossRefGoogle Scholar
  57. 57.
    Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB. Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. J Psychiatr Res 2011;45:295–301.PubMedCrossRefGoogle Scholar
  58. 58.
    World Medical Association. Declaration of Helsinki, Finland, 2008.Google Scholar
  59. 59.
    Barkley RA. Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment. New York: The Guilford Press, 1990.Google Scholar
  60. 60.
    Barkley RA, McMurray MB, Edelbrock CS, Robbins K. The response of aggressive and nonaggressive ADHD children to two doses of methylphenidate. J Am Acad Child Adolesc Psychiatry 1989;28:873–881.PubMedCrossRefGoogle Scholar
  61. 61.
    Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–130.PubMedCrossRefGoogle Scholar
  62. 62.
    Volkow ND, Wang GJ, Fowler JS, et al. Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. Am J Psychiatry 1998;155:1325–1331.PubMedGoogle Scholar
  63. 63.
    Volkow ND, Wang GJ, Kollins SH, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA 2009;302:1084–1091.PubMedCrossRefGoogle Scholar
  64. 64.
    Johansen EB, Killeen PR, Russell VA, et al. Origins of altered reinforcement effects in ADHD. Behav Brain Funct 2009;5:7.PubMedCrossRefGoogle Scholar
  65. 65.
    Waltz JA, Schweitzer JB, Gold JM, et al. Patients with schizophrenia have a reduced neural response to both unpredictable and predictable primary reinforcers. Neuropsychopharmacology 2009;34:1567–1577.PubMedCrossRefGoogle Scholar
  66. 66.
    Swanson J. Compliance with stimulants for attention-deficit/hyperactivity disorder: issues and approaches for improvement. CNS Drugs 2003;17:117–131.PubMedCrossRefGoogle Scholar
  67. 67.
    Weiss MD, Gadow K, Wasdell MB. Effectiveness outcomes in attention-deficit/hyperactivity disorder. J Clin Psychiatry 2006;67(suppl 8):38–45.PubMedGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2012

Authors and Affiliations

  • Chloe T. Green
    • 1
    • 2
  • Debra L. Long
    • 2
  • David Green
    • 3
  • Ana-Maria Iosif
    • 4
  • J. Faye Dixon
    • 1
  • Meghan R. Miller
    • 1
    • 5
  • Catherine Fassbender
    • 1
  • Julie B. Schweitzer
    • 1
    Email author
  1. 1.Department of Psychiatry and Behavioral Sciences and MIND InstituteUniversity of California Davis School of MedicineSacramentoUSA
  2. 2.Department of PsychologyUniversity of California, DavisDavisUSA
  3. 3.Walnut CreekUSA
  4. 4.Department of Public Health SciencesUniversity of California, DavisDavisUSA
  5. 5.Department of PsychologyUniversity of California, BerkeleyBerkeleyUSA

Personalised recommendations