Abstract
Deficits in Working Memory (WM) are related to symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). In children with ADHD visuospatial WM is most impaired. WM is composed of Short-Term Memory (STM) and a Central Executive (CE). Therefore, deficits in either or both STM and the CE may account for WM impairments in children with ADHD. WM-component studies investigating this find deficits in both STM and the CE. However, recent studies show that not only cognitive deficits, but also motivational deficits give rise to the aberrant WM performance of children with ADHD. To date, the influence of these motivational deficits on the components of WM has not been investigated. This study examined the effects of a standard (feedback-only) and a high level of reinforcement (feedback + 10 euros) on the visuospatial WM-, visuospatial STM-, and the CE performance of 86 children with ADHD and 62 typically-developing controls. With standard reinforcement the STM, CE, and WM performance of children with ADHD was worse than that of controls. High reinforcement improved STM and WM performance more in children with ADHD than in controls, but was unable to normalize their performance. High reinforcement did not appear to improve the CE-related performance of children with ADHD and controls. Motivational deficits have a detrimental effect on both the visuospatial WM performance and the STM performance of children with ADHD. Aside from motivational deficits, both the visuospatial STM and the CE of children with ADHD are impaired, and give rise to their deficits in visuospatial WM.
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Notes
Operationalizing central executive performance by using the difference between working memory performance and short-term memory performance is based upon the theorem of Engle et al. (1999) — which is consistent with other influential working memory models like those of Cowan (1995) and Baddeley and Hitch (1974) — that the working memory system consists of the contents of short-term memory plus the central executive. According to Engle et al. “working memory capacity = short-term memory capacity + central executive + the error of measurement” (p. 313).
Orders of presentation used in counterbalancing:
1.
FO: STM > WG
>
10 euros: STM > WG
2.
10 euros: STM > WG
>
FO: STM > WG
3.
FO: WG > STM
>
10 euros: WG > STM
4.
10 euros: WG > STM
>
FO: WG > STM
5.
FO: STM > WG
>
10 euros: WG > STM
6.
10 euros: STM > WG
>
FO: WG > STM
7.
FO: WG > STM
>
10 euros: STM > WG
8.
10 euros: WG > STM
>
FO: STM > WG
STM short-term memory; WM working memory; FO Feedback-only
If the 10 euros were given contingent upon performance (for instance after 20 correct trials) then the number of performed trials (i.e. the work load) in the 10 euros condition could differ between participants and groups (e.g., with some children needing 24 trials to reach 20 correct trials and other children needing 34 trials). This difference in work load between participants and groups in the 10 euro condition could then result in differences in task performance in the subsequent reinforcement condition (e.g. due to more fatigue in one group than in the other).
The task started at a very easy level (a sequence of two stimuli), and because the difficulty level of the task adapts gradually (see above), children typically needed the first 12 trials to reach their optimal difficulty level (a sequence length higher than 5 or 6 stimuli). Since the mean of these first 12 trials gave no relevant information on individual performance, and inclusion of these trials resulted in a more inaccurate representation of participant’s short-term memory and working memory capacity, these first trials were excluded from analysis (results did not change when the first 12 trials were included; see also Dovis et al. 2012).
Without covarying for IQ, gender, and weekly spendable income the pattern of the results was the same. Further, IQ, gender, and weekly spendable income did not significantly interact with Reinforcement condition or Task version.
However, note that such a strategy may cause a procedural confound when the impact of reward on performance is compared between groups: If the total amount of reward that can be earned is contingent upon cognitive performance (i.e. when better performance results in a higher reward), then a participant’s cognitive ability is likely to influence the maximum amount of reward this participant can earn. This means that a group characterized by cognitive impairments (e.g., ADHD) is likely to receive less rewards than a typically developing group. However, to properly compare the impact of reward on performance between two such groups, it is required that the amount of reward in both groups is the same. Otherwise, it cannot be determined whether a difference in the impact of reward on performance between these two groups is the result of the difference in symptomatology between these groups or of the difference in the presented amount of reward.
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Acknowledgments
We are grateful to Jeugdriagg Noord Holland Zuid, GGz Noord Holland Noord (Centrum voor Kinder- en Jeugdpsychiatrie), Regionaal Centrum voor Kinder en Jeugdpsychiatrie Gooi en Vechtstreek (RCKJP), Bosman GGz, Stichting De Praktijk, Stichting Kram, PuntP, Academisch Behandelcentrum UvA Minds, Kinderpraktijk VIS and the participating schools (OBS De Weidevogel, Amsterdam; OBS De Witte Olifant, Amsterdam; De Dr. E. Boekmanschool, Amsterdam; OBS Jules Verne, Alkmaar; PCBS Van der Brugghenschool, Huizen; Montessorischool De Boog, Nieuw-Vennep; and De Willemsparkschool, Amsterdam), to Thomas Gladwin for his comments and statistical advice, to Jasper Wijnen for programming the task, to Tim van den Broek, Josje de Bont, Annette Brouwer, Tycho Dekkers, Lucie van den Eertwegh, Roza van der Heide, Lisanne Klink, Astrid Nauta, Inge Meulenberg, Muriël Musa, Pascale Riaskoff, Elise Tilma, Marije Voermans, Ida de Vries, and Pamina Warmbrunn for their help with data collection, and to all participating children and families.
Disclosures
SvdO has been a paid consultant for Janssen pharmaceuticals in the development and evaluation of a serious game “Heelseeker” aimed at training cognitive functions.
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Appendix
Appendix
1. The reinforcement instruction for the first presented task version in the Feedback-Only condition (translated from Dutch):
2. The reinforcement instruction for the second presented task version in the Feedback-Only condition (translated from Dutch):
3. The reinforcement instruction for the first presented task version in the 10 euros condition (translated from Dutch):
4. The reinforcement instruction for the second presented task version in the 10 euros condition (translated from Dutch):
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Dovis, S., Van der Oord, S., Wiers, R.W. et al. What Part of Working Memory is not Working in ADHD? Short-Term Memory, the Central Executive and Effects of Reinforcement. J Abnorm Child Psychol 41, 901–917 (2013). https://doi.org/10.1007/s10802-013-9729-9
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DOI: https://doi.org/10.1007/s10802-013-9729-9