Working Memory Training in Deaf Children with Cochlear Implants

  • William G. KronenbergerEmail author
  • David B. Pisoni


Verbal working memory is significantly delayed in many prelingually deaf children who receive cochlear implants. Because of the importance of working memory for language, learning, and daily functioning, these delays present a significant challenge to cognitive development and quality of life. In order to address the consequences of working memory delays in normal-hearing children, several computer-based, game-like programs have been developed with the goal of improving working memory. Research on these working memory training programs using normal-hearing samples has demonstrated improvement on measures of abilities that are similar to the trained working memory tasks. Findings have been suggestive but less consistent about improvement in other abilities such as fluid intelligence, attention, concentration, and academic skills. In a pilot study of a working memory training program in a sample of prelingually deaf, early implanted children and adolescents with cochlear implants, we found improvement after training on measures of working memory and sentence repetition. Results were less robust for measures of fluency/speed, and the magnitude of improvement (with the notable exception of sentence repetition skills) declined during a 6-month follow-up period. Larger samples and randomized, controlled designs are recommended as a next step to develop and evaluate novel working memory training interventions for children with cochlear implants.


Cochlear implant Working memory Working memory training Executive functioning Intervention 


  1. Adams W, Sheslow D. Wide range assessment of memory and learning. 2nd ed. Wilmington, DE: Wide Range, Inc.; 2003.Google Scholar
  2. Alloway TP. Improving working memory: supporting students’ learning. London: Sage; 2011a.Google Scholar
  3. Alloway TP. Training your brain for dummies. West Sussex: Wiley; 2011b.Google Scholar
  4. Bäckman L, Nyberg L, Soveri A, Johansson J, Andersson M, Dahlin E, et al. Effects of working-memory training on striatal dopamine release. Science. 2011;333(6043):718.CrossRefPubMedGoogle Scholar
  5. Baddeley A. Working memory, thought, and action. New York, NY: Oxford University Press; 2007.CrossRefGoogle Scholar
  6. Barkley RA. ADHD and the nature of self-control. New York, NY: Guilford Press; 1997.Google Scholar
  7. 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(6):825–36.CrossRefPubMedGoogle Scholar
  8. Beer J, Kronenberger WG, Pisoni DB. Executive function in everyday life: implications for young cochlear implant users. Cochlear Implants Int. 2011;12 Suppl 1:S89–91.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Burkholder RA, Pisoni DB. Speech timing and working memory in profoundly deaf children after cochlear implantation. J Exp Child Psychol. 2003;85(1):63–88.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Cepeda NJ, Blackwell KA, Munakata Y. Speed isn’t everything: complex processing speed measures mask individual differences and developmental changes in executive control. Dev Sci. 2013;16(2):269–86.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.CrossRefPubMedGoogle Scholar
  12. Cohen M. Children’s memory scale. San Antonio, TX: The Psychological Corporation; 1997.Google Scholar
  13. Conway CM, Pisoni DB, Kronenberger WG. The importance of sound for cognitive sequencing abilities: the auditory scaffolding hypothesis. Curr Dir Psychol Sci. 2009;18(5):275–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Cowan N. The differential maturation of two processing rates related to digit span. J Exp Child Psychol. 1999;72(3):193–209.CrossRefPubMedGoogle Scholar
  15. Cowan N, Wood NL, Wood PK, Keller TA, Nugent LD, Keller CV. Two separate verbal processing rates contributing to short-term memory span. J Exp Psychol Gen. 1998;127(2):141–60.CrossRefPubMedGoogle Scholar
  16. Dahlin E, Neely AS, Larsson A, Bäckman L, Nyberg L. Transfer of learning after updating training mediated by the striatum. Science. 2008;320(5882):1510–2.CrossRefPubMedGoogle Scholar
  17. Diamond A, Lee K. Interventions shown to aid executive function development in children 4 to 12 years old. Science. 2011;333(6045):959–64.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Engle RW, Tuholski SW, Laughlin JE, Conway ARA. Working memory, short-term memory, and general fluid intelligence: a latent-variable approach. J Exp Psychol Gen. 1999;128(3):309–31.CrossRefPubMedGoogle Scholar
  19. Epstein JN, Tsal Y. Evidence for cognitive training as a treatment strategy for children with Attention-Deficit/Hyperactivity Disorder. J ADHD Relat Disord. 2010;1(2):49–64.Google Scholar
  20. Figueras B, Edwards L, Langdon D. Executive function and language in deaf children. J Deaf Stud Deaf Educ. 2008;13(3):362–77.CrossRefPubMedGoogle Scholar
  21. Gathercole SE, Baddeley AD. Working memory and language. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1993.Google Scholar
  22. 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(Pt 2):177–94.CrossRefPubMedGoogle Scholar
  23. Gathercole SE, Dunning DL, Holmes J. Cogmed training: let’s be realistic about intervention research. J Appl Res Mem Cogn. 2012;1:201–3.CrossRefGoogle Scholar
  24. Geers AE. Speech, language, and reading skills after early cochlear implantation. Arch Otolaryngol Head Neck Surg. 2004;130(5):634–8.CrossRefPubMedGoogle Scholar
  25. Geers AE, Sedey AL. Language and verbal reasoning skills in adolescents with 10 or more years of cochlear implant experience. Ear Hear. 2011;32(1 Suppl):39S–48.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Gibson BS, Kronenberger WG, Gondoli DM, Johnson AC, Morrissey RA, Steeger CM. Component analysis of simple span vs. complex span adaptive working memory exercises: a randomized, controlled trial. J Appl Res Mem Cogn. 2012;1(3):179–84.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Gibson BS, Gondoli DM, Kronenberger WG, Johnson AC, Steeger CM, Morrissey RA. Exploration of an adaptive training regimen that can target the secondary memory component of working memory capacity. Mem Cognit. 2013;41(5):726–37.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Gioia GA, Isquith PK, Guy SC, Kenworthy L. BRIEF: behavior rating inventory of executive function professional manual. Lutz, FL: Psychological Assessment Resources; 2000.Google Scholar
  29. Golden CJ, Freshwater SM. The Stroop color and word test: a manual for clinical and experimental uses. Wood Dale, IL: Stoelting; 2002.Google Scholar
  30. Green CT, Long DL, Green D, Iosif A-M, Dixon JF, Miller MR, et al. Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder? Neurotherapeutics. 2012;9(3):639–48.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Harris MS, Kronenberger WG, Gao S, Hoen HM, Miyamoto RT, Pisoni DB. Verbal short-term memory development and spoken language outcomes in deaf children with cochlear implants. Ear Hear. 2013;34(2):179–92.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Holmes J, Gathercole SE, Dunning DL. Adaptive training leads to sustained enhancement of poor working memory in children. Dev Sci. 2009;12(4):F9–15.CrossRefPubMedGoogle Scholar
  33. Hunt AD, Kronenberger WG, Dunn DW, Gibson BS, Gondoli DM. ADHD symptoms predict response to working memory training. 60th Annual Meeting of the American Academy of Child and Adolescent Psychiatry; 2013 Oct; Orlando, FL; 2013.Google Scholar
  34. Jaeggi SM, Buschkuehl M, Jonides J, Perrig WJ. Improving fluid intelligence with training on working memory. Proc Natl Acad Sci U S A. 2008;105(19):6829–33.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Jaeggi SM, Buschkuehl M, Jonides J, Shah P. Short- and long-term benefits of cognitive training. Proc Natl Acad Sci U S A. 2011;108(25):10081–6.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Klingberg T. Training and plasticity of working memory. Trends Cogn Sci. 2010;14(7):317–24.CrossRefPubMedGoogle Scholar
  37. Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. J Clin Exp Neuropsychol. 2002;24(6):781–91.CrossRefPubMedGoogle Scholar
  38. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlström K, et al. Computerized training of working memory in children with ADHD—a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005;44(2):177–86.CrossRefPubMedGoogle Scholar
  39. Kronenberger WG, Pisoni DB, Henning SC, Colson BG, Kirk A, Phillips L. Verbal rehearsal and memory scanning speed in children with cochlear implants following working memory training. 2010 Cogmed Conference; 2010 Sep 24; Chicago, IL; 2010.Google Scholar
  40. Kronenberger WG, Pisoni DB, Henning SC, Colson BG, Hazzard LM. Working memory training for children with cochlear implants: a pilot study. J Speech Lang Hear Res. 2011;54(4):1182–96.CrossRefPubMedGoogle Scholar
  41. Kronenberger WG, Pisoni DB, Henning SC, Colson BG, Nguyen A. Parent-reports of executive functioning skills in long-term cochlear implant users. 2012 Midwest Regional Conference in Pediatric Psychology; 2012 Apr 26–28; Milwaukee, WI; 2012.Google Scholar
  42. Kronenberger WG, Pisoni DB, Henning SC, Colson BG. Executive functioning skills in long-term users of cochlear implants: a case control study. J Pediatr Psychol. 2013a;38(8):902–14.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Kronenberger WG, Pisoni DB, Harris MS, Hoen HM, Xu H, Miyamoto RT. Profiles of verbal working memory growth predict speech and language development in children with cochlear implants. J Speech Lang Hear Res. 2013b;56(3):805–25.CrossRefPubMedGoogle Scholar
  44. Lucas C, Abikoff H, Petkova E, Gan W, Sved S, Bruett L, et al. Training of visuo-spatial working memory improves behavior in kids with ADHD. 2008 Meeting of the American Psychiatric Association; 2008 May 3–8; Washington, DC; 2008.Google Scholar
  45. 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(4):377–84.CrossRefPubMedGoogle Scholar
  46. McNab F, Varrone A, Jucaite A, Bystritsky P, Forssberg H, Klingberg T. Change in cortical dopamine D1 receptor binding associated with cognitive training. Science. 2009;323(5915):800–2.CrossRefPubMedGoogle Scholar
  47. Melby-Lervåg M, Hulme C. Is working memory training effective? A meta-analytic review. Dev Psychol. 2013;49(2):270–91.CrossRefPubMedGoogle Scholar
  48. Morrison AB, Chein JM. Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Psychon Bull Rev. 2011;18(1):46–60.CrossRefPubMedGoogle Scholar
  49. Niparko JK, Tobey EA, Thal DJ, Eisenberg LS, Wang N-Y, Quittner AL, et al. Spoken language development in children following cochlear implantation. JAMA. 2010;303(15):1498–506.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Nutley SB, Söderqvist S, Bryde S, Thorell LB, Humphreys K, Klingberg T. Gains in fluid intelligence after training non‐verbal reasoning in 4‐year‐old children: a controlled, randomized study. Dev Sci. 2011;14(3):591–601.CrossRefGoogle Scholar
  51. Oba SI, Fu Q-J, Galvin III JJ. Digit training in noise can improve cochlear implant users’ speech understanding in noise. Ear Hear. 2011;32(5):573–81.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Oba SI, Galvin III JJ, Fu Q-J. Minimal effects of visual memory training on auditory performance of adult cochlear implant users. J Rehabil Res Dev. 2013;50(1):99–110.CrossRefPubMedPubMedCentralGoogle Scholar
  53. Olesen PJ, Westerberg H, Klingberg T. Increased prefrontal and parietal activity after training of working memory. Nat Neurosci. 2004;7(1):75–9.CrossRefPubMedGoogle Scholar
  54. Owen AM, Hampshire A, Grahn JA, Stenton R, Dajani S, Burns AS, et al. Putting brain training to the test. Nature. 2010;465(7299):775–8.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Pisoni DB, Cleary M. Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation. Ear Hear. 2003;24(1 Suppl):106S–20.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Pisoni DB, Conway CM, Kronenberger WG, Horn DL, Karpicke J, Henning SC. Efficacy and effectiveness of cochlear implants in deaf children. In: Marschark M, Hauser PC, editors. Deaf cognition: foundations and outcomes. New York, NY: Oxford University Press; 2008. p. 52–101.CrossRefGoogle Scholar
  57. Pisoni DB, Conway CM, Kronenberger W, Henning S, Anaya E. Executive function, cognitive control, and sequence learning in deaf children with cochlear implants. In: Marshark M, Spencer PE, editors. The Oxford handbook of deaf studies, language, and education, vol. 2. New York, NY: Oxford University Press; 2010. p. 439–57.Google Scholar
  58. Pisoni DB, Kronenberger WG, Roman AS, Geers AE. Measures of digit span and verbal rehearsal speed in deaf children after more than 10 years of cochlear implantation. Ear Hear. 2011;32(1 Suppl):60S–74.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Rabiner DL, Murray DW, Skinner AT, Malone PS. A randomized trial of two promising computer-based interventions for students with attention difficulties. J Abnorm Child Psychol. 2010;38(1):131–42.CrossRefPubMedGoogle Scholar
  60. Redick TS, Shipstead Z, Harrison TL, Hicks KL, Fried DE, Hambrick DZ, et al. No evidence of intelligence improvement after working memory training: a randomized, placebo-controlled study. J Exp Psychol Gen. 2013;142(2):359–79.CrossRefPubMedGoogle Scholar
  61. Schneiders JA, Opitz B, Krick CM, Mecklinger A. Separating intra-modal and across-modal training effects in visual working memory: an fMRI investigation. Cereb Cortex. 2011;21(11):2555–64.CrossRefPubMedGoogle Scholar
  62. Shipstead Z, Hicks KL, Engle RW. Cogmed working memory training: does the evidence support the claims? J Appl Res Mem Cogn. 2012a;1:185–93.CrossRefGoogle Scholar
  63. Shipstead Z, Redick TS, Engle RW. Is working memory training effective? Psychol Bull. 2012b;138(4):628–54.CrossRefPubMedGoogle Scholar
  64. Thorell LB, Lindqvist S, Nutley SB, Bohlin G, Klingberg T. Training and transfer effects of executive functions in preschool children. Dev Sci. 2009;12(1):106–13.CrossRefPubMedGoogle Scholar
  65. Wechsler D, Kaplan E, Fein D, Kramer J, Morris R, Delis D, et al. Wechsler intelligence scale for children—fourth edition integrated. San Antonio, TX: Harcourt Assessment; 2004.Google Scholar
  66. Westerberg H, Klingberg T. Changes in cortical activity after training of working memory—a single-subject analysis. Physiol Behav. 2007;92(1–2):186–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2016

Authors and Affiliations

  1. 1.Department of Psychiatry, Riley Child and Adolescent Psychiatry ClinicIndiana University School of MedicineIndianapolisUSA
  2. 2.DeVault Otologic Research Lab, Department of Otolaryngology—Head & Neck SurgeryIndiana University School of MedicineIndianapolisUSA
  3. 3.DeVault Otologic Research Lab, Department of Otolaryngology—Head & Neck SurgeryIndiana University School of MedicineIndianapolisUSA

Personalised recommendations