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Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial


ADHD affects working memory (WM) and other executive functions (EFs) and thereby negatively impacts school performance, clinical symptoms and functional impairment. The main aim of this study was to analyse the efficacy of computerized WM training (CWMT) on EF rating scales. A secondary objective was to assess its efficacy on performance-based measures of EF (PBMEF), learning, clinical symptoms and functional impairment. 66 children with combined-type ADHD between 7 and 12 years of age from the Child and Adolescent Psychiatric Unit (Spain) were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. The participants were randomized (1:1) to an experimental group (EG) (CWMT) (n = 36) or a control group (CG) (placebo training). Assessments were conducted at baseline (T0), 1–2 weeks (T1), and 6 months post-intervention (T2) with the administration of EF rating scales, PBMEF, measures of academic achievement, and questionnaires regarding clinical symptoms and functional impairment. Participants, parents, teachers and professionals who performed the cognitive assessments were blinded. Adjusted multiple linear regression analysis showed significant improvements in EF scales-parent version, from T1 to T2, on the metacognition index [p = 0.03, d′ = −0.78 (95 % CI −1.28 to −0.27)] and on WM (also significant at T2–T0) and plan/organize subscales. Significant improvements were also noted in EF scales-teacher version, from T0 to T1 and T2, on the metacognitive index [p = 0.05, d′ = −0.37 (95 % CI −0.86 to 0.12) T1–T0, p = 0.02, d’ = −0.81 (95 % CI −1.31 to −0.30) T2–T0] and on the initiate, WM, monitor and shift subscales. There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment. CWMT had a significant impact on ADHD deficits by achieving long-term far-transfer effects.

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  1. 1.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn: DSM-5. 5 edition. Washington, DC: American Psychiatric Publishing

  2. 2.

    Barkley RA, Murphy KR (2006) Attention-deficit hyperactivity disorder: a clinical workbook. Guilford Press, New York

    Google Scholar 

  3. 3.

    Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF (2005) Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 57(11):1336–1346

    Article  PubMed  Google Scholar 

  4. 4.

    Barkley RA, Murphy KR (2010) Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol 25(3):157–173

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Baddeley A (2003) Working memory: looking back and looking forward. Nature Rev Neurosci 4(10):829–839

    CAS  Article  Google Scholar 

  6. 6.

    Martinussen R, Hayden J, Hogg-Johnson S, Tannock R (2005) A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44(4):377–384

    Article  PubMed  Google Scholar 

  7. 7.

    Hervey AS, Epstein JN, Curry JF (2004) Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18(3):485–503

    Article  PubMed  Google Scholar 

  8. 8.

    Morrison AB, Chein JM (2010) Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Psychon Bull Rev 18(1):46–60

    Article  Google Scholar 

  9. 9.

    Shipstead Z, Redick TS, Engle RW (2012) Is working memory training effective? Psychol Bull 138(4):628–654

    Article  PubMed  Google Scholar 

  10. 10.

    Shipstead Z, Redick TS, Engle RW (2010) Does working memory training generalize? Psychol Belg 3(4):245–276

    Article  Google Scholar 

  11. 11.

    Toplak ME, Connors L, Shuster J, Knezevic B, Parks S (2008) Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev 28(5):801–823

    Article  PubMed  Google Scholar 

  12. 12.

    Chacko A, Feirsen N, Bedard A-C, Marks D, Uderman JZ, Chimiklis A (2013) Cogmed working memory training for youth with ADHD: a closer examination of efficacy utilizing evidence-based criteria. J Clin Child Adolesc Psychol 42(6):769–783

    Article  PubMed  Google Scholar 

  13. 13.

    Rapport MD, Orban SA, Kofler MJ, Friedman LM (2013) Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? a meta-analytic review of cognitive, academic, and behavioral outcomes. Clin Psychol Rev 33(8):1237–1252

    Article  PubMed  Google Scholar 

  14. 14.

    Sonuga-Barke EJS, Brandeis D, Cortese S et al (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 170(3):275–289

    Article  PubMed  Google Scholar 

  15. 15.

    Hodgson K, Hutchinson AD, Denson L (2014) Nonpharmacological treatments for ADHD: a meta-analytic review. J Atten Disord 18(4):275–282

    Article  PubMed  Google Scholar 

  16. 16.

    Melby-Lervåg M, Hulme C (2012) Is working memory training effective? a meta-analytic review. Dev Psychol 49(2):270–291

    Article  PubMed  Google Scholar 

  17. 17.

    Coghill DR, Hayward D, Rhodes SM, Grimmer C, Matthews K (2014) A longitudinal examination of neuropsychological and clinical functioning in boys with attention deficit hyperactivity disorder (ADHD): improvements in executive functioning do not explain clinical improvement. Psychol Med 44(5):1087–1099

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Klingberg T (2010) Training and plasticity of working memory. Trends Cogn Sci 14(7):317–324

    Article  PubMed  Google Scholar 

  19. 19.

    Holmes J, Gathercole SE, Dunning DL (2010) Poor working memory: impact and interventions. Adv Child Dev Behav 39:1–43

    Article  PubMed  Google Scholar 

  20. 20.

    Brehmer Y, Rieckmann A, Bellander M, Westerberg H, Fischer H, Bäckman L (2011) Neural correlates of training-related working-memory gains in old age. Neuroimage 58(4):1110–1120

    Article  PubMed  Google Scholar 

  21. 21.

    Olesen PJ, Westerberg H, Klingberg T (2004) Increased prefrontal and parietal activity after training of working memory. Nature Neurosci 7(1):75–79

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Astle DE, Barnes JJ, Baker K, Colclough GL, Woolrich MW (2015) Cognitive training enhances intrinsic brain connectivity in childhood. J Neurosci 35(16):6277–6283

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Stevens MC, Gaynor A, Bessette KL, Pearlson GD (2015) A preliminary study of the effects of working memory training on brain function. Brain Imaging Behav. doi:10.1007/s11682-015-9416-2

  24. 24.

    McNab F, Varrone A, Farde L et al (2009) Changes in cortical dopamine D1 receptor binding associated with cognitive training. Science 323(5915):800–802

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Barnett SM, Ceci SJ (2002) When and where do we apply what we learn? a taxonomy for far transfer. Psychol Bull 128(4):612–637

    Article  PubMed  Google Scholar 

  26. 26.

    Jonides J (2004) How does practice makes perfect? Nat Neurosci 7(1):10–11

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Green CT, Long DL, Green D et al (2012) Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder? Neurotherapeutics 9(3):639–648

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Klingberg T, Fernell E, Olesen PJ et al (2005) Computerized training of working memory in children with ADHD-a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 44(2):177–186

    Article  PubMed  Google Scholar 

  29. 29.

    Chacko A, Bedard AC, Marks DJ et al (2014) A randomized clinical trial of cogmed working memory training in school-age children with ADHD: a replication in a diverse sample using a control condition. J Child Psychol Psychiatry 55(3):247–255

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Steeger CM, Gondoli DM, Gibson BS, Morrissey RA (2015) Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial. Child Neuropsychology. doi:10.1080/09297049.2014.994485

  31. 31.

    Van der Donk M, Hiemstra-Beernink A-C, Tjeenk-Kalff A, van der Leij A, Lindauer R (2015) Cognitive training for children with ADHD: a randomized controlled trial of cogmed working memory training and ‘paying attention in class’. Front Psychol 6:1081

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Beck SJ, Hanson CA, Puffenberger SS, Benninger KL, Benninger WB (2010) A controlled trial of working memory training for children and adolescents with ADHD. J Clin Child Adolesc Psychol 39(6):825–836

    Article  PubMed  Google Scholar 

  33. 33.

    Egeland J, Aarlien AK, Saunes B-K (2013) Few effects of far transfer of working memory training in ADHD: a randomized controlled trial. PLoS ONE 8(10):e75660

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Gray SA, Chaban P, Martinussen R et al (2012) Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD; a randomized controlled trial. J Child Psychol Psychiatry 53(12):1277–1284

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Klingberg T, Forssberg H, Westerberg H (2002) Training of working memory in children with ADHD. J Clin Exp Neuropsychol 24(6):781–791

    Article  PubMed  Google Scholar 

  36. 36.

    Mezzacappa E, Buckner JC (2010) Working memory training for children with attention problems or hyperactivity: a school-based pilot study. Sch Ment Health 2(4):202–208

    Article  Google Scholar 

  37. 37.

    Ulloa RE, Ortiz S, Higuera F et al (2006) Interrater reliability of the Spanish version of the schedule for affective disorders and schizophrenia for school-age children—present and lifetime version (K-SADS-PL). Actas Esp Psiquiatr 34:36–40

    CAS  PubMed  Google Scholar 

  38. 38.

    Von Bastian CC, Oberauer K (2013) Effects and mechanisms of working memory training: a review. Psychol Res 78(6):803–820

    Article  Google Scholar 

  39. 39.

    Lövdén M, Bäckman L, Lindenberger U, Schaefer S, Schmiedek F (2010) A theoretical framework for the study of adult cognitive plasticity. Psychol Bull 136(4):659–676

    Article  PubMed  Google Scholar 

  40. 40.

    Gioia GA, Isquith PK, Guy SC, Kenworthy L (1996) Behavior rating inventory of executive function: professional manual. Psychological Assessment Resources Inc, Lutz

    Google Scholar 

  41. 41.

    Conners CK (1997) Conners’ rating scales: revised. Multi- Health Systems, Toronto

    Google Scholar 

  42. 42.

    Achenbach TM (1991) Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Department of Psychiatry, University of Vermont

  43. 43.

    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Weiss MD, Wasdell MB, Bomben MM (2000) Weiss functional impairment rating scale (WFIRS-P): parent report. University of British Columbia, Vancouver

    Google Scholar 

  45. 45.

    Wechsler D (2005) WISC-IV. Escala de Inteligencia de Wechsler para niños. TEA Ediciones, Madrid

    Google Scholar 

  46. 46.

    Wechsler D (2004) WMS-III. Escala de memoria de Wechsler-III. Manual de aplicación y puntuación. TEA Ediciones, Madrid

    Google Scholar 

  47. 47.

    Conners CK (2000) CPT II conners’ continuous performance test II for windows. Multi-Health Systems Inc., Canada

    Google Scholar 

  48. 48.

    Culbertson WC, Zillmer E (2009) Tower of London-Drexel University, 2nd edn. Multi-Health Systems Inc., Canada

    Google Scholar 

  49. 49.

    Heaton RK (1990) WCST-64: computer version 2-research edition. Psychological Assessment Resources, Inc., Lutz

    Google Scholar 

  50. 50.

    Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment. Oxford University Press, Oxford

    Google Scholar 

  51. 51.

    Canals R, Bosch A, Monreal P, Parera S (2002) Proves psicopedagògiques d’aprenentatges instrumentals. Onda, Barcelona

    Google Scholar 

  52. 52.

    Cohen J (1988) Statistical power analysis for the behavioral sciences. Routledge, London

    Google Scholar 

  53. 53.

    Miller EK, Cohen JD (2001) An integrative theory of prefrontal cortex function. Annu Rev Neurosci 24(1):167–202

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Rapport MD, Chung KM, Shore G, Isaacs P (2001) A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy. J Clin Child Psychol 30(1):48–58

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    Spencer-Smith M, Klingberg T (2015) Benefits of a working memory training program for inattention in daily life: a systematic review and meta-analysis. PLoS ONE 10(3):e0119522

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Hardy KK, Willard VW, Allen TM, Bonner MJ (2013) Working memory training in survivors of pediatric cancer: a randomized pilot study. Psychooncology 22(8):1856–1865

    Article  PubMed  Google Scholar 

  57. 57.

    Kronenberger WG, Pisoni DB, Henning SC, Colson BG, Hazzard LM (2010) Working memory training for children with cochlear implants: a pilot study. J Speech Lang Hear Res 54(4):1182–1196

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Harwood MD, Eyberg SM (2006) Child-directed interaction: prediction of change in impaired mother-child functioning. J Abnorm Child Psychol 34(3):323–335

    Article  Google Scholar 

  59. 59.

    Sonuga-Barke EJ, Daley D, Thompson M, Laver-Bradbury C, Weeks A (2001) Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample. J Am Acad Child Adolesc Psychiatry 40(4):402–408

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Van Dongen-Boomsma M, Vollebregt MA, Buitelaar JK, Slaats-Willemse D (2014) Working memory training in young children with ADHD: a randomized placebo-controlled trial. J Child Psychol Psychiatry 55(8):886–896

    Article  PubMed  Google Scholar 

  61. 61.

    Shipstead Z, Hicks KL, Engle RW (2012) Cogmed working memory training: does the evidence support the claims? J Appl Res Mem Cogn 1(3):185–193

    Article  Google Scholar 

  62. 62.

    Wilson BA (2008) Neuropsychological rehabilitation. Annu Rev Clin Psychol 4:141–162

    Article  PubMed  Google Scholar 

  63. 63.

    Isquith PK, Roth RM, Gioia G (2013) Contribution of rating scales to the assessment of executive functions. Appl Neuropsychol: Child 2(2):125–132

    Article  Google Scholar 

  64. 64.

    Holmes-Bernstein J, Waber DP (1990) Developmental neuropsychological assessment: the systemic approach. In: Holmes-Bernstein J, Waber DP (eds) Neuropsychology. Humana Press, Totowa, pp 311–371

    Chapter  Google Scholar 

  65. 65.

    Lyn S, Turkstra CC (2005) The use of standardized tests for individuals with cognitive-communication disorders. Semin Speech Lang 26(4):215–222

    Article  Google Scholar 

  66. 66.

    Goldberg E, Podell K (2000) Adaptive decision making, ecological validity, and the frontal lobes. J Clin Exp Neuropsychol 22(1):56–68

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Gioia GA, Isquith PK (2004) Ecological assessment of executive function in traumatic brain injury. Dev Neuropsychol 25(1–2):135–158

    Article  PubMed  Google Scholar 

  68. 68.

    Barkley RA, Murphy KR (2011) The nature of executive function (EF) deficits in daily life activities in adults with ADHD and their relationship to performance on EF tests. J Psychopathol Behav Assess 33(2):137–158

    Article  Google Scholar 

  69. 69.

    Daneman M, Carpenter PA (1980) Individual differences in working memory and reading. J Verbal Learn Verbal Behav 19(4):450–466

    Article  Google Scholar 

  70. 70.

    Foy JG (2014) Adaptive cognitive training enhances executive control and visuospatial and verbal working memory in beginning readers. Int Educ Res 2(2):19–43

    Article  Google Scholar 

  71. 71.

    Gathercole SE (2014) Commentary: working memory training and ADHD - where does its potential lie? reflections on Chacko et al. (2014). J Child Psychol Psychiatry 55(3):256–257

    Article  PubMed  Google Scholar 

  72. 72.

    Hovik KT, Saunes B-K, Aarlien AK, Egeland J (2013) RCT of working memory training in ADHD: long-term near-transfer effects. PLoS ONE 8(12):e80561

    Article  PubMed  PubMed Central  Google Scholar 

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Maribel Ahuir, Llanos Artigao, Clara Barba, Andrea Bracho, Bernat Carreras, Noemi Carrillo, Marta Doñate, Cristina Enero, Alejandra Escura, Adrian Gaitan, Javi Sanchez, Pablo Vidal-Ribas, Maria Teresa Ordeig, Sylva-Astrik Torossian. This study has received financial support through the Award 22è PREMI FERRAN SALSAS I ROIG—Salut Mental i Comunitat granted by the City Council of Rubi (Spain) in 2010.

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Bigorra, A., Garolera, M., Guijarro, S. et al. Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial. Eur Child Adolesc Psychiatry 25, 853–867 (2016).

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  • Attention-deficit/hyperactivity disorder (ADHD)
  • Working memory
  • Computerized cognitive training
  • Cogmed
  • Randomized controlled trial
  • Far-transfer effect