Cogmed Working Memory Training
Increasing Working
Memory Capacity through
Computerized Training
Psychoeducational Clinic
NCSU
www.ncsu.edu/psychology/theclinic
Working memory is
The ability to keep information in your mind
for a short period of time (seconds)
and
be able to use this information in your thinking.
Working memory is essential for
 Controlling attention
 Reading comprehension
 Mathematical reasoning
 Planning and organizing activities
 Keeping instructions in mind
 Resisting distraction
 Problem solving and fluid intelligence
Signs of a poor working memory
 An inability of maintain attention
 Distractibility
 An inability to start projects or follow them through
to completion
 Problems remembering instructions
 A habit of interrupting or not waiting for one’s turn
 Difficulties getting organized
 Learning difficulties
©2007 Cogmed
Development of working
memory in ADHD
Test performance
Visuospatial Working Memory Capacity
Research hypothesis:
Can working memory
be improved by training?
If so, does improving working memory:
- affect other areas of cognition?
- affect symptoms of AD(H)D?
Torkel Klingberg, MD, PhD, Professor in Cognitive Neuroscience,
Karolinska Institute Director – Development Cognitive Neuroscience Lab,
Stockholm Brain Institute
Subjects:
 53 non-medicated children (9 girls, 44 boys)
- Randomized to the treatment or comparison programs
 7-12 years of age (mean 9.9 years)
 15 ADHD predominantly inattentive
 38 ADHD combined type
Klingberg et al. (2005) JAACAP
Intervention: computerized
training of working memory
Training group
 5 weeks training
 Verbal and visuospatial working memory trials
 Difficulty level automatically adjusted
- Matched WM span of child to each task
Control group
 5 weeks training
 Same exercises except difficulty level
 Remained on initial low level
- Did NOT match WM span of child to task
Klingberg et al. (2005) JAACAP
Intervention:
training procedures
 40 minutes per day
 5 days/week
 5 weeks
 Weekly calls by Cogmed Personal Coach
- Discuss technical difficulties
- Feedback on #days of data uploaded to server
The technology was later developed with the
Karolinska-based company Cogmed
Outcome measures:
 Evaluate executive functioning
- Span-board task measures visuospatial WM
- Digit-span measures verbal WM
- Stroop interference task measures response inhibition
- Raven’s Colored Progress Matrices measure
nonverbal reasoning ability
 Evaluate ADHD symptoms
-18 DSM-IV items used as a rating scale
- Conners Rating Scale for parents/teachers
Klingberg et al. (2005) JAACAP
Research Timeline
Klingberg et al. (2005) JAACAP
Outcome Measure Results
Treat
Control
Visuospatial
Klingberg et al. (2005) JAACAP
At follow up, the performance in the treatment group was
about as high as, or higher than, at post-intervention
Rating scores of
ADHD symptoms (DSM-IV)
Klingberg et al. (2005) JAACAP
Long-term effects
“How is the training effect now compared to directly after training:
Has it decreased, is it unchanged or has it increased?”
Of the 80% who have benefited after training:
On-going research
 Adults with ADHD
 Pre-schoolers
 Children
 Aging population
Gibson et al. (CHADD 2006)
U.S. Independent Replication Study:
Computerized Training
of Working Memory
Subjects
Children with ADHD (100%) treated with stimulate medication
prior to and during the study
Ages
12-14 years
Number of Subjects
N = 14
Gibson et al. (CHADD 2006)
U.S. Independent Replication Study:
Executive Task Results
Span Board
Gibson et al. (CHADD 2006)
Ravens
U.S. Independent Replication Study:
ADHD symptom ratings using
DSM-IV rating scales
Gibson et al. (CHADD 2006)
Working memory training
& school performance
Subjects
Children with special education needs
Ages
9-12
35% with ADHD diagnosis
Treatment
N = 42
Working memory training in school
Control
N = 15
Ordinary special education activities
Klingberg et al. (CHADD 2006)
Working Memory Training
& School Performance
Klingberg et al. (CHADD 2006)
Conclusion
Working memory can be improved with significant
improvements in:
- Improved ability to sustain attention
- Improved impulse control
- Better complex reasoning skills
- Better academic performance
Klingberg et al. (2005) JAACAP
In the clinical setting:
Cogmed Working Memory Training
The current program is designed especially for children
and adolescents with attention deficits.
 Software-based
 Five weeks long
 Home-based
 Supported by Cogmed
Personal Coaches
TM
RoboMemo software program
 Designed for children 7 and older
 Series of rotating exercises
 Trains the visuospatial and
the verbal working memory
 Adaptive algorithm continually adjusts
the level of difficulty
- Based on the real-time
performance of the user
The training process
1: Interview
2: Start-up session
3: Training for 5 weeks
4: Wrap-up session
5: Follow-up
Training can be started and completed
with or without an office visit.
How the program works
 The personal coach provides one-on-one support
 A parent or training aide supervises the child
during each session
 The program is rigorous and engaging
- 30-45 minutes each day
- 5 days a week
- 5 weeks
 A reward system provides encouragement
©2007 Cogmed
What’s needed to train?
 PC with Internet connection
 Headphones or speakers
 Separate, quiet room preferred
©2007 Cogmed
Tracking results
Time line
Index graph
8 out of 10 children
show measurable effects
 Improved ability to sustain attention
 Improved impulse control
 Better complex reasoning skills
 Better academic performance
©2007 Cogmed
New products
Adults
Children age 4-7
This Program was
released in the fall
of 2007
Currently in
Development
©2007 Cogmed
What they have said:
Child
Parent
“I can focus better
in school. I got all of
my math homework
correct.”
“He has felt better
within himself and
does his work more
quickly.”
Teacher
Psychologist
“She is able to hold
verbal information in
her head better, her
mental processing
has improved.”
“I have observed a
“maturity” in each
child, the ability to
remember better,
and be more
organized.”
References
 WM in children with diagnosed ADHD
(Westerberg, Child Neuropsychology, 2004)
 WM training for children with ADHD, pilot results
(Klingberg, J. of Clin. and Exp Neuropsychology, 2002)
 WM training for children with ADHD, multi-site clinical validation
(Klingberg, J. Am. Ac. Child & Adol. Psychiatry, 2005)
 Brain imaging analysis of change following WM training
(Olesen, Nature Neuroscience, 2004)