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David McGavock

Is working memory training the priority for ADHD patients? | SharpBrains - 0 views

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ADHD working memory training

shared by David McGavock on 28 Mar 14 - No Cached
  • Not all chil­dren ben­e­fit from med­ica­tion, some expe­ri­ence intol­er­a­ble side effects, and many con­tinue to strug­gle despite the ben­e­fits pro­vided by medication.
  • Behav­ior ther­apy can be dif­fi­cult for par­ents to con­sis­tently imple­ment, and does not gen­er­ally reduce behav­ior dif­fi­cul­ties to nor­ma­tive levels.
  • researchers have shown grow­ing inter­est in whether cog­ni­tive train­ing — gen­er­ally done via com­puter — can induce more last­ing changes in children’s abil­ity to focus and attend. One approach that has shown promise in help­ing youth with ADHD, and which is now widely avail­able, is Work­ing Mem­ory Training.
  • ...11 more annotations...
  • In one, chil­dren with ADHD were ran­domly assigned to high inten­sity (HI) or low inten­sity (LI) WM train­ing. The HI treat­ment involved per­form­ing com­put­er­ized WM tasks, e.g., remem­ber­ing the sequence in which lights appeared in dif­fer­ent por­tions of a grid, recall­ing a sequence of num­bers in reverse order, where the dif­fi­culty level was reg­u­larly adjusted to match the child’s per­for­mance by increas­ing or decreas­ing the items to be recalled.
  • Each group trained 30–40 min­utes per day, 5 days per week, for 5 weeks with train­ing super­vised by par­ents
  • A sub­se­quent study also used ran­dom assign­ment to HI vs. LI train­ing, and observed the impact on children’s behav­ior in a con­trolled class­room set­ting.
  • The authors con­clude that their find­ings cast “…doubt on the claims that CWMT is an effec­tive treat­ment in young chil­dren with ADHD.”
  • par­ent reports indi­cated sig­nif­i­cant reduc­tions in ADHD symp­toms, par­tic­u­larly inat­ten­tive symp­toms; these reduc­tions remained evi­dent at 3 months. How­ever, no ben­e­fits in ADHD symp­toms were evi­dent in reports pro­vided by children’s teach­ers.
  • A sig­nif­i­cant lim­i­ta­tion in the evidence-based for using CWMT to treat youth with ADHD is the absence of teacher reported ben­e­fits.
  • some have sug­gested that CWMT should be regarded as no more than a ‘pos­si­bly effi­ca­cious’ treat­ment for ADHD and not con­sid­ered a ‘first-line’ treat­ment like med­ica­tion and behav­ior therapy.
  • Two recently pub­lished stud­ies
  • Results indi­cated sig­nif­i­cant reduc­tions in off-task class­room behav­ior among chil­dren with ADHD who received HI train­ing. This par­tially addresses con­cerns about fail­ure to find teacher reported ben­e­fits in other stud­ies.
  • Results from these 2 randomized-controlled tri­als do not sup­port CWMT as a first-line treat­ment for ADHD.
  • What can we con­clude from this work? Despite promis­ing ini­tial reports sug­gest­ing that CWMT is a poten­tially effec­tive treat­ment for ADHD, these stud­ies sig­nif­i­cantly under­cut this con­clu­sion. This does not mean that there is no util­ity to CWMT, how­ever, par­tic­u­larly for indi­vid­u­als with demon­strated work­ing mem­ory deficits. If one’s treat­ment goal is to enhance work­ing mem­ory, CWMT may have real value. If the goal is to bring ADHD symp­toms under con­trol, how­ever, these find­ings indi­cate that for most chil­dren with ADHD, CWMT would not cur­rently be con­sid­ered a rea­son­able sub­sti­tute for med­ica­tion and/or behav­ior therapy.
  • David McGavock on 28 Mar 14
     
    What can we con­clude from this work? Despite promis­ing ini­tial reports sug­gest­ing that CWMT is a poten­tially effec­tive treat­ment for ADHD, these stud­ies sig­nif­i­cantly under­cut this con­clu­sion. This does not mean that there is no util­ity to CWMT, how­ever, par­tic­u­larly for indi­vid­u­als with demon­strated work­ing mem­ory deficits. If one's treat­ment goal is to enhance work­ing mem­ory, CWMT may have real value. If the goal is to bring ADHD symp­toms under con­trol, how­ever, these find­ings indi­cate that for most chil­dren with ADHD, CWMT would not cur­rently be con­sid­ered a rea­son­able sub­sti­tute for med­ica­tion and/or behav­ior therapy.
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