L’entraînement de la mémoire de travail par le programme Cogmed et le TDAH

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Inattention, hyperactivity, and impulsivity are key symptoms of ADHD. It is typically associated with working memory deficits at the cognitive level. For this reason, interventions have been designed to train working memory in ADHD. Currently, Cogmed Working Memory Training program is the most commonly used and studied program in clinical practice and research. This program is proposed as an intervention for ADHD that targets working memory deficits with specific exercises through intensive training sessions.ObjectivesThe goal of this literature review is to examine the effects of the Cogmed program in children and adolescents with ADHD on working memory, inhibition, non-verbal reasoning, attention functioning, ADHD symptoms and academic achievement. All existing studies on the subject that included a control group (n = 8) are reviewed.ResultsIt is clear from most studies that Cogmed training program increases and verbal and visuospatial working memory (or the phonological loop and visuospatial sketchpad in Baddeley's model (1986, 2007), among ADHD participants. However, transfer of learning is not demonstrated on other components of working memory that are not directly targeted by the program such as the central executive described in Baddeley's model or the secondary memory defined by Unsworth & Engle (2007). With regards to far transfer measures, results are controversial for inhibition, non-verbal reasoning, ADHD symptoms reported by parents, and reading abilities. No improvement is demonstrated for attentional capacities, ADHD symptoms reported by teachers and mathematic reasoning.ConclusionCogmed training improves verbal and visuospatial working memory, two cognitive functions that play an important role in ADHD. However, Cogmed's exercises need to be modified in order to train more complex working memory components such as the central executive (Baddeley, 1986, 2007) and the secondary memory (Unsworth & Engle, 2007), which are more impaired in ADHD than the phonological loop and visuospatial sketchpad. Another approach would be to design programs that can tackle a larger range of cognitive functions that are impaired in ADHD (e.g., inhibition). In future, studies evaluating such modified programs, direct observation instruments that are more sensitive to short-term changes need to be included. Follow-up measures should also be systematically included.     

Working memory deficits in boys with attention deficit/hyperactivity disorder (ADHD): An examination of orthographic coding and episodic buffer processes

The episodic buffer component of working memory was examined in children with attention deficit/hyperactivity disorder (ADHD) and typically developing peers (TD). Thirty-two children (ADHD = 16, TD = 16) completed three versions of a phonological working memory task that varied with regard to stimulus presentation modality (auditory, visual, or dual auditory and visual), as well as a visuospatial task. Children with ADHD experienced the largest magnitude working memory deficits when phonological stimuli were presented via a unimodal, auditory format. Their performance improved during visual and dual modality conditions but remained significantly below the performance of children in the TD group. In contrast, the TD group did not exhibit performance differences between the auditory- and visual-phonological conditions but recalled significantly more stimuli during the dual-phonological condition. Furthermore, relative to TD children, children with ADHD recalled disproportionately fewer phonological stimuli as set sizes increased, regardless of presentation modality. Finally, an examination of working memory components indicated that the largest magnitude between-group difference was associated with the central executive. Collectively, these findings suggest that ADHD-related working memory deficits reflect a combination of impaired central executive and phonological storage/rehearsal processes, as well as an impaired ability to benefit from bound multimodal information processed by the episodic buffer.     

Competing Core Processes in Attention-Deficit/Hyperactivity Disorder (ADHD): Do Working Memory Deficiencies Underlie Behavioral Inhibition Deficits?

The current study examined competing predictions of the working memory and behavioral inhibition models of ADHD. Behavioral inhibition was measured using a conventional stop-signal task, and central executive, phonological, and visuospatial working memory components (Baddeley 2007) were assessed in 14 children with ADHD and 13 typically developing (TD) children. Bootstrapped mediation analyses revealed that the visuospatial working memory system and central executive both mediated the relationship between group membership (ADHD, TD) and stop-signal task performance. Conversely, stop-signal task performance mediated the relationship between group membership and central executive processes, but was unable to account for the phonological and visuospatial storage/rehearsal deficits consistently found in children with ADHD. Comparison of effect size estimates for both models suggested that working memory deficits may underlie impaired stop-signal task performance in children with ADHD. The current findings therefore challenge existing models of ADHD that describe behavioral inhibition as a core deficit of the disorder.     

ADHD and Working Memory: The Impact of Central Executive Deficits and Exceeding Storage/Rehearsal Capacity on Observed Inattentive Behavior

Inattentive behavior is considered a core and pervasive feature of ADHD; however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory deficits and inattentive behavior. The current study investigated whether inattentive behavior in children with ADHD is functionally related to the domain-general central executive and/or subsidiary storage/rehearsal components of working memory. Objective observations of children’s attentive behavior by independent observers were conducted while children with ADHD (n?=?15) and typically developing children (n?=?14) completed counterbalanced tasks that differentially manipulated central executive, phonological storage/rehearsal, and visuospatial storage/rehearsal demands. Results of latent variable and effect size confidence interval analyses revealed two conditions that completely accounted for the attentive behavior deficits in children with ADHD: (a) placing demands on central executive processing, the effect of which is evident under even low cognitive loads, and (b) exceeding storage/rehearsal capacity, which has similar effects on children with ADHD and typically developing children but occurs at lower cognitive loads for children with ADHD.     

Objectively-Measured Impulsivity and Attention-Deficit/Hyperactivity Disorder (ADHD): Testing Competing Predictions from the Working Memory and Behavioral Inhibition Models of ADHD

Impulsivity is a hallmark of two of the three DSM-IV ADHD subtypes and is associated with myriad adverse outcomes. Limited research, however, is available concerning the mechanisms and processes that contribute to impulsive responding by children with ADHD. The current study tested predictions from two competing models of ADHD-working memory (WM) and behavioral inhibition (BI)-to examine the extent to which ADHD-related impulsive responding was attributable to model-specific mechanisms and processes. Children with ADHD (n?=?21) and typically developing children (n?=?20) completed laboratory tasks that provided WM (domain-general central executive [CE], phonological/visuospatial storage/rehearsal) and BI indices (stop-signal reaction time [SSRT], stop-signal delay, mean reaction time). These indices were examined as potential mediators of ADHD-related impulsive responding on two objective and diverse laboratory tasks used commonly to assess impulsive responding (CPT: continuous performance test; VMTS: visual match-to-sample). Bias-corrected, bootstrapped mediation analyses revealed that CE processes significantly attenuated between-group impulsivity differences, such that the initial large-magnitude impulsivity differences were no longer significant on either task after accounting for ADHD-related CE deficits. In contrast, SSRT partially mediated ADHD-related impulsive responding on the CPT but not VMTS. This partial attenuation was no longer significant after accounting for shared variance between CE and SSRT; CE continued to attenuate the ADHD-impulsivity relationship after accounting for SSRT. These findings add to the growing literature implicating CE deficits in core ADHD behavioral and functional impairments, and suggest that cognitive interventions targeting CE rather than storage/rehearsal or BI processes may hold greater promise for alleviating ADHD-related impairments.     

Are Episodic Buffer Processes Intact in ADHD? Experimental Evidence and Linkage with Hyperactive Behavior

Working memory deficits are present in a substantial proportion of children with ADHD, and converging evidence links these deficits with ADHD-related behavioral and functional impairments. At the same time, working memory is not a unitary construct, and evidence is lacking regarding the role of several components of this system in ADHD. Preclinical behavioral studies are needed to fractionate the multicomponent working memory system, determine which specific subcomponent(s) are impaired in ADHD, and more importantly link these subcomponent(s) with specific ADHD-related behavioral symptoms/functional impairments. The current study reflects one piece of that puzzle, and focuses on the episodic buffer component of working memory. Across multiple testing days, a well-characterized sample of 86 children ages 8–13 (M=10.52, SD=1.54; 34 girls; 64% Caucasian/Non-Hispanic) with ADHD (n=49) and without ADHD (n=37) completed three counterbalanced working memory tests that were identical in all aspects except the key subcomponent process (phonological, visuospatial, episodic buffer). Gross motor movement during these and control tasks were measured using 4 high-precision actigraphs. There was no evidence of group differences in gender, age, SES, or IQ. Bayesian mixed-model ANOVAs indicated that the ADHD group performed significantly worse on all three working memory tests (d=1.17–1.44) and was significantly more hyperactive than controls (d=0.66–1.05) during the visuospatial and episodic buffer tests. In contrast, the ADHD and Non-ADHD groups were equivalent with regard to effects of episodic buffer demands on performance and hyperactive behavior. The most parsimonious conclusion is that the episodic buffer is likely intact in ADHD, and unrelated to ADHD hyperactivity symptoms.     

Understanding Phonological Memory Deficits in Boys with Attention-Deficit/Hyperactivity Disorder (ADHD): Dissociation of Short-term Storage and Articulatory Rehearsal Processes

The current study dissociated and examined the two primary components of the phonological working memory subsystem--the short-term store and articulatory rehearsal mechanism--in boys with ADHD (n?=?18) relative to typically developing boys (n?=?15). Word lists of increasing length (2, 4, and 6 words per trial) were presented to and recalled by children following a brief (3 s) interval to assess their phonological short-term storage capacity. Children's ability to utilize the articulatory rehearsal mechanism to actively maintain information in the phonological short-term store was assessed using word lists at their established memory span but with extended rehearsal times (12 s and 21 s delays). Results indicate that both phonological shortterm storage capacity and articulatory rehearsal are impaired or underdeveloped to a significant extent in boys with ADHD relative to typically developing boys, even after controlling for age, SES, IQ, and reading speed. Larger magnitude deficits, however, were apparent in short-term storage capacity (ES?=?1.15 to 1.98) relative to articulatory rehearsal (ES?=?0.47 to 1.02). These findings are consistent with previous reports of deficient phonological short-term memory in boys with ADHD, and suggest that future attempts to develop remedial cognitive interventions for children with ADHD will need to include active components that require children to hold increasingly more information over longer time intervals.     

A visuospatial “phonological loop” in working memory: Evidence from American Sign Language

In two experiments, the question of whether working memory could support an articulatory rehearsal loop in the visuospatial domain was investigated. Deaf subjects fluent in American Sign Language (ASL) were tested on immediate serial recall. In Experiment 1, using ASL stimuli, evidence for manual motoric coding (worse recall under articulatory suppression) was found, replicating findings of ASL-based phonological coding (worse recall for phonologically similar lists). The two effects did not interact, suggesting separate components which both contribute to performance. Stimuli in Experiment 2 were namable pictures, which had to be recoded for ASL-based rehearsal to occur. Under these conditions, articulatory suppression eliminated the phonological similarity effect. Thus, an articulatory process seems to be used in translating pictures into a phonological code for memory maintenance. These results indicate a configuration of components similar to the phonological loop for speech, suggesting that working memory can develop a language-based rehearsal loop in the visuospatial modality.     

数学学习困难与工作记忆关系研究的现状与前瞻

工作记忆是一种对信息进行暂时加工和贮存的能量有限的记忆系统,在许多复杂的认知活动中起重要作用,工作记忆缺陷是造成数学学习困难的根本原因。数学学习困难儿童都存在视觉空间模板、语音回路以及中央执行器功能等方面的缺陷,工作记忆的各成分对数学困难者的影响不同。今后研究将以整体的、发展的视角,不断改进研究方法,将行为研究和神经加工机制研究相结合。     

What Part of Working Memory is not Working in ADHD? Short-Term Memory, the Central Executive and Effects of Reinforcement

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.     

Working Memory Deficits and Social Problems in Children with ADHD

Social problems are a prevalent feature of ADHD and reflect a major source of functional impairment for these children. The current study examined the impact of working memory deficits on parent- and teacher-reported social problems in a sample of children with ADHD and typically developing boys (N = 39). Bootstrapped, bias-corrected mediation analyses revealed that the impact of working memory deficits on social problems is primarily indirect. That is, impaired social interactions in children with ADHD reflect, to a significant extent, the behavioral outcome of being unable to maintain a focus of attention on information within working memory while simultaneously dividing attention among multiple, on-going events and social cues occurring within the environment. Central executive deficits impacted social problems through both inattentive and impulsive-hyperactive symptoms, whereas the subsidiary phonological and visuospatial storage/rehearsal systems demonstrated a more limited yet distinct relationship with children’s social problems.     

A structural analysis of working memory and related cognitive skills in young children

The aim of this study was to investigate the functional organisation of working memory and related cognitive abilities in young children. A sample of 633 children aged between 4 and 6 years were tested on measures of verbal short-term memory, complex memory span, sentence repetition, phonological awareness, and nonverbal ability. The measurement model that provided the best fit of the data incorporates constructs that correspond to the central executive, phonological loop, and episodic buffer subcomponents of working memory, plus distinct but associated constructs associated with phonological awareness and nonverbal ability.     

Working memory and individual differences in mathematics achievement: A longitudinal study from first grade to second grade

This longitudinal study examined the relationship between working memory and individual differences in mathematics. Working memory measures, comprising the phonological loop, the visuospatial sketchpad, and the central executive, were administered at the start of first grade. Mathematics achievement was assessed 4 months later (at the middle of first grade) and 1 year later (at the start of second grade). Working memory was significantly related to mathematics achievement in both grades, showing that working memory clearly predicts later mathematics achievement. The central executive was a unique predictor of both first- and second-grade mathematics achievement. There were age-related differences with regard to the contribution of the slave systems to mathematics performance; the visuospatial sketchpad was a unique predictor of first-grade, but not second-grade, mathematics achievement, whereas the phonological loop emerged as a unique predictor of second-grade, but not first-grade, mathematics achievement.     

Is working memory still working?

The current state of A. D. Baddeley and G. J. Hitch's (1974) multicomponent working memory model is reviewed. The phonological and visuospatial subsystems have been extensively investigated, leading both to challenges over interpretation of individual phenomena and to more detailed attempts to model the processes underlying the subsystems. Analysis of the controlling central executive has proved more challenging, leading to a proposed clarification in which the executive is assumed to be a limited capacity attentional system, aided by a newly postulated fourth system, the episodic buffer. Current interest focuses most strongly on the link between working memory and long-term memory and on the processes allowing the integration of information from the component subsystems. The model has proved valuable in accounting for data from a wide range of participant groups under a rich array of task conditions. Working memory does still appear to be working.     

Active maintenance of semantic representations

In research on verbal working memory, articulatory rehearsal, a maintenance mechanism for phonological representations, has undergone intensive and excellent study. Possible mechanisms for semantic representation have received less attention. However, several studies have reported a double dissociation in types of memory deficits (semantic memory difficulties vs. phonological memory difficulties). This suggests the separability of two maintenance mechanisms. The present study focused on this separability in individuals with normal memory abilities, using a dual-task interference paradigm. The results indicate a crossover interaction between memory and interference task effects: Preventing articulatory rehearsal more strongly disrupted the phonological memory task, whereas performing a tapping task that interfered with attentional control more strongly disrupted semantic memory. These results suggest that semantic representations are actively maintained by a mechanism other than phonological maintenance.     

Loss of Financial Capacity in Alzheimer's Disease: The Role of Working Memory

Recent research has demonstrated that loss of financial capacity is a common consequence of Alzheimer's disease (AD). While progressive cognitive decline is a defining feature of AD, the relationship between such decline and loss of financial capacity in AD remains unclear. Working memory may be strongly associated with financial abilities, as many financial tasks require temporary storage and manipulation of numerical and other data. The present study examined the relationship between financial capacity and working memory in AD patients. Participants included 20 AD patients and 23 cognitively intact older controls. Working memory was conceptualized using Baddeley and colleagues' model, which posits that the three components of the working memory system are the visuospatial sketchpad, phonological loop, and central executive system. The present study examined only the latter two components of working memory. Each participant was administered the Financial Capacity Instrument (FCI), an instrument that directly assesses eight domains of financial activity, and the WAIS-III Working Memory subtests (Digit Span, Arithmetic, Letter–Number Sequencing). AD patients as a group performed significantly below controls on the FCI Total Score and on each of the eight FCI domains and working memory subtests. Within the AD group, measures of the central executive component of working memory (WAIS-III Digits Backward, Arithmetic, and Letter-Number Sequencing tests) showed strong correlations with the FCI domains of basic monetary skills, checkbook management, bank statement management, and bill payment and FCI total score, while a measure of the phonological loop component of working memory (WAIS-III Digits Forward) was not significantly correlated with any FCI domains or with the FCI total score. The results suggest that the multiple domains of financial capacity are primarily correlated with the central executive component of working memory.     

Trait anxiety,visuospatial processing,and working memory

This experiment assessed the components of Baddeley's working memory system impaired by anxiety during performance of the Corsi Blocks Test. The Corsi task was performed concurrently with different secondary tasks (i.e., articulatory suppression; counting backwards; spatial tapping; simple tapping). Results showed Corsi performance depended mainly on the central executive and visuospatial sketchpad components of working memory. Adverse effects of trait anxiety on the Corsi task were observed on the central executive but not on the phonological loop or the visuospatial sketchpad. These effects were not mediated by state anxiety. The findings indicate for the first time that trait anxiety impairs central executive functioning on a nonverbal task, and that anxiety does not impair functioning of the “slave” systems (i.e., phonological loop; visuospatial sketchpad). Theoretical implications of these findings are discussed.     

Neuroanatomical correlates of processing in visual and visuospatial working memory

Working memory is traditionally seen as being organised in a modular way with a central executive orchestrating at least two slave systems (phonological loop and visuospatial sketch pad). Neuroanatomical correlates of the visual and visuospatial subsystems and the central executive are discussed in this article. A series of experiments are presented yielding evidence for a differentiation into active and passive processing in working memory as well as their neuroanatomical correlates in the prefrontal cortex. Data, yielding evidence for an interaction and separation of visual and visuospatial working memory are presented and discussed. Further results are presented which suggest a convergence of these two systems with increasing working memory demands. The discussed findings will give new insight in the organisation of visual and visuospatial working memory on the anatomical level.     

Applied Problem Solving in Children with ADHD: The Mediating Roles of Working Memory and Mathematical Calculation

The difficulties children with ADHD experience solving applied math problems are well documented; however, the independent and/or interactive contributions of cognitive processes underlying these difficulties are not fully understood and warrant scrutiny. The current study examines two primary cognitive processes integral to children’s ability to solve applied math problems: working memory (WM) and math calculation skills (i.e., the ability to utilize specific facts, skills, or processes related to basic math operations stored in long-term memory). Thirty-six boys with ADHD-combined presentation and 33 typically developing (TD) boys aged 8–12 years old were administered multiple counterbalanced tasks to assess upper (central executive [CE]) and lower level (phonological [PH STM] and visuospatial [VS STM] short-term memory) WM processes, and standardized measures of mathematical abilities. Bias-corrected, bootstrapped mediation analyses revealed that CE ability fully mediated between-group differences in applied problem solving whereas math calculation ability partially mediated the relation. Neither PH STM nor VS STM was a significant mediator. When modeled together via serial mediation analysis, CE in tandem with math calculation ability fully mediated the relation, explained 79% of the variance, and provided a more parsimonious explication of applied mathematical problem solving differences among children with ADHD. Results suggest that interventions designed to address applied math difficulties in children with ADHD will likely benefit from targeting basic knowledge of math facts and skills while simultaneously promoting the active interplay of these skills with CE processes.     

Written expression in boys with ADHD: The mediating roles of working memory and oral expression

The written expression difficulties experienced by children with ADHD are widely recognized; however, scant empirical evidence exists concerning the cognitive mechanisms and processes underlying these deficiencies. The current study investigated the independent and potentially interactive contributions of two developmentally antecedent cognitive processes – viz., working memory (WM) and oral expression – hypothesized to influence written expression ability in boys. Thirty-three boys with ADHD-Combined Presentation and 27 neurotypical (NT) boys 8–12 years of age were administered standardized measures of oral and written expression, and multiple counterbalanced tasks to assess WM central executive (CE) processes, WM phonological short-term memory (PH STM), and WM visuospatial short-term memory (VS STM). Bias-corrected bootstrapped mediation analyses revealed a significant mediation effect, wherein the independent and interactive effects of PH STM and oral expression collectively explained 76% of the diagnostic status to written expression relation. The implications of the obtained results for clinical practice suggest that children with ADHD may benefit by incorporating a blended approach that simultaneously strengthens PH STM capacity and oral expression abilities as antecedents to engaging in writing-related activities.