Correction: Benefits of a Working Memory Training Program for Inattention in Daily Life: A Systematic Review and Meta-Analysis

Telerehabilitation Pathways in Specific Learning Disorders: Improving Reading and Writing

Telerehabilitation has proved to be a useful tool for neurodevelopmental disorders in allowing timely and intensive intervention and preventing relapses; it is also widely used for specific learning disabilities (SLD), showing significant effects on reading abilities, but variables linked to its effectiveness have not been studied yet. The present study was aimed at testing the effectiveness of telerehabilitation on reading and writing in SLD children, comparing different treatment pathways, and considering the impact of training intensity and executive functions. Seventy-three children were enrolled (telerehabilitation group: 48 children, waiting list group: 25 children). The results showed significant improvements in reading fluency, text dictation, and executive functions in the training group. Children attending a combined training including reading tasks and rapid automatized naming processes improved in word reading fluency and text dictation. The number of training sessions and the change in executive functions significantly correlated with changes in reading accuracy. Here we show a new contribution to telerehabilitation research in SLD: telerehabilitation significantly enhanced learning abilities and executive functions. Training based on the learning task and the underlying processes significantly increased not only reading speed, according to previous studies, but also writing accuracy. The findings’ implications in clinical research and practice are discussed.

Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD

OBJECTIVE

This study evaluated a modified working memory training program, Cogmed, for ADHD youth.

METHOD

Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later.

RESULTS

After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group.

CONCLUSIONS

MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.

Executive Functions and Rapid Automatized Naming: A New Tele-Rehabilitation Approach in Children with Language and Learning Disorders

Executive function deficits are documented in many neurodevelopmental disorders and may contribute to clinical complexity or rehabilitation resilience. The present research was primarily aimed at presenting and evaluating the feasibility and effectiveness of a telerehabilitation program used during the pandemic period. MemoRAN (Anastasis), a computerised cognitive training to improve executive control during visual-verbal integration tasks was used in a sample of 42 children (5–11 years old) with specific learning or language disorders. The MemoRAN training was based on exercises of inhibition, cognitive flexibility and updating in working memory for three months, with a frequency of approximately three sessions per week. Afterwards, a comparison between a subgroup of children using Memo-RAN and an active control group, using a tele-rehabilitation program directed on reading was conducted. Effect size analysis in pre-post measurements suggests an average effect of MemoRAN in measurements that require control processes, such as accuracy in dictation, reading, inhibition and working memory testing. Comparison with the active control group and the clinical utility implications of these types of treatment will be discussed.

Can Neurocognitive Outcomes Assist Measurement-Based Care for Children with Attention-Deficit/Hyperactivity Disorder? A Systematic Review and Meta-Analyses of the Relationships Among the Changes in Neurocognitive Functions and Clinical Outcomes of Attention-Deficit/Hyperactivity Disorder in Pharmacological and Cognitive Training Interventions

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions among school-age children. Early intervention and ongoing evaluation of treatment effectiveness are essential to minimize the life-long negative impact of ADHD. Neurocognitive functions have been reported to improve with pharmacological and cognitive training interventions for children with ADHD. We evaluated the value of measuring change in neurocognitive functions following ADHD interventions as a treatment outcome. We systematically reviewed randomized control trials of two distinctive types of ADHD interventions-pharmacological treatments and cognitive training-and summarized the changes in neurocognitive and clinical outcomes using a series of meta-analyses. Both pharmacological and cognitive training interventions showed positive effects on some aspects of neurocognitive functions. However, there were no significant correlations between changes in neurocognitive function (e.g., inhibition) and changes in ADHD behavioral symptoms (e.g., impulsive behavior). Although the associations between changes in neurocognitive function and clinical outcomes are not well studied, based on current findings, it is not suitable to use change in neurocognitive outcomes as a proxy for change in ADHD clinical symptom-based outcomes. There is, however, notable value in monitoring changes in neurocognitive function associated with ADHD interventions to achieve the following aims: (1) understanding full treatment effect on children with ADHD, (2) identifying ancillary indicators of subclinical changes, and (3) provision of objective and less biased measures of treatment effects. These findings are important evidence that changes in neurocognitive function could be a co-occurring objective indication that parallels the clinical effects of ADHD treatments.

Alfa band power increases in posterior brain regions in attention deficit hyperactivity disorder after digital cognitive stimulation treatment

The changes triggered by pharmacological treatments in resting-state alpha-band (8–14 Hz) oscillations have been widely studied in attention deficit hyperactivity disorder. However, to date, there has been no evidence regarding the possible changes in cognitive stimulation treatments on these oscillations. This paper sets out to verify whether cognitive stimulation treatments based on progressive increases in cognitive load can be effective in triggering changes in alpha-band power in attention deficit hyperactivity disorder. With this objective, we compared a cognitive stimulation treatment (n = 13) to placebo treatment (n = 13) for 12 weeks (36 sessions of 15 min) in child patients (8–11 years old) with attention deficit hyperactivity disorder. Two magnetoencephalographic recordings were acquired for all the participants. In order to extract the areas with changes in alpha power between both magnetoencephalographic recordings, the differences in the power ratio (pre/post-condition) were calculated using an Analysis of Covariance test adjusted for the age variable. The results show an increase in the post-treatment power ratio in the experimental group versus the placebo group (P < 0.01) in posterior regions and the default mode network. In addition, these alpha changes were related to measures of attention, working memory and cognitive flexibility. The results seem to indicate that cognitive stimulation treatment based on progressive increases in cognitive load triggers alpha-band power changes in child attention deficit hyperactivity disorder patients in the direction of their peers without this disorder.

Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial

BACKGROUND

Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder.

OBJECTIVE

Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients.

METHODS

In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians.

RESULTS

In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship.

CONCLUSIONS

The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318.

Inhibitory control training in healthy and highly educated older adults

Executive function training is considered a promising tool for delaying the natural effects of aging on cognition. However, there are still few studies that propose a unimodal intervention with a focus on inhibitory control, and none of them has studied the effect of this type of intervention on older adults (OA).

OBJECTIVE

The aim of this study is to investigate the benefits of inhibitory control training in healthy OA by comparing the two assessment time points, namely, before and after training.

METHODS

Twenty-seven participants were included after interview and checking the inclusion criteria. The training was based on the stop-signal paradigm and carried out in 21 sessions.

RESULTS

Participants performed better after training by reducing the false alarm error rate (i.e., for stop-signal trials), reducing omission error rate, showing an increase in hit rate, Go response time (i.e., for go-signal trials), stop-signal response time, and showing a decrease in the level of anxiety. The executive function training had no significant impact on the scores obtained in the complementary neuropsychological tests.

CONCLUSIONS

These results are consistent with previous studies that support the viability and effectiveness of cognitive intervention for executive functions in OA and suggest a positive effect of the intervention, which may be related to the learning experience of a new and challenging task.

Efficacy of cogmed working memory training program in improving working memory in school-age children with and without neurological insults or disorders: A meta-analysis

This meta-analysis assessed the efficacy of the Cogmed Working Memory Training program in improving near-transfer measures (verbal and visuospatial working memory) and far-transfer measures (attention, executive function, and academic achievement) in school-age children with and without neurological insults or disorders. Relevant studies were searched in databases and clinical trial registries using the keyword Cogmed. Ten published studies and unpublished data from one study met the inclusion criteria. Hedges g was calculated for each outcome measure obtained at pre-intervention, post-intervention, and 3-6 month time points. Analysis compared outcome measures in the control versus experimental groups and examined the role of moderators on treatment effects (control group intervention, intervention environment). Data revealed significant medium-size effects of the Cogmed program in improving verbal and visuospatial working memory post-intervention and for verbal working memory only at the 3-6 month time point. However, the training did not generalize to the far-transfer measures. Analyses indicated that only the type of intervention provided for the control group moderated treatment effects on verbal and visual working memory. Meta-analytic findings suggest that the Cogmed program leads to short-term improvements and in some cases, long-term improvements in working memory in school-age children; however, these effects may not generalize to far-transfer measures.

Working Memory in Pediatric Epilepsy: A Systematic Review and Meta-Analysis

Working memory is a multicomponent system that is supported by overlapping specialized networks in the brain. Baddeley's working memory model includes four components: the phonological loop, visuo-spatial sketchpad, the central executive, and episodic buffer. The aim of this review was to establish the gravity and pattern of working memory deficits in pediatric epilepsy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided electronic searches. Sixty-five studies were included in the review. Meta-analyses revealed significant impairments across each working memory component: phonological loop (g = 0.739), visuo-spatial sketchpad (g = 0.521), and central executive (g = 0.560) in children with epilepsy compared to controls. The episodic buffer was not examined. The pattern of impairments, however, differed according to the site and side of seizure focus. This suggests that working memory components are differentially vulnerable to the location of seizure focus in the developing brain.

Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia

Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1–13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.

Executive function training in very preterm children: a randomized controlled trial

Objective of the current study was to assess whether game-formatted executive function (EF) training, is effective in improving attention, EF and academic performance in very preterm and/or extremely low birthweight children aged 8-12 years. A multi-center, double-blind, placebo- and waitlist controlled randomized trial (NTR5365) in two academic hospitals in The Netherlands was performed. Eighty-five very preterm children with parent-rated attention problems on the Child Behavior Checklist were randomized to one of three treatment conditions: EF training, placebo training or waitlist condition. EF or placebo training was completed at home (6 weeks, 25 sessions of 30-45 min each). At baseline, 2 weeks after training or being on the waitlist, and five months after first follow-up visit, children underwent assessments of primary outcomes (parent and teacher ratings of attention) and secondary outcomes (parent and teacher ratings of daily-life EF, computerized EF tasks and academic performance). Linear mixed model analyses were performed for all outcome measures. There were no significant differences in improvement over time on parent- and teacher ratings of attention, parent- and teacher ratings of daily-life EF, computerized EF tasks, and academic performance (arithmetic and reading) between the EF training, placebo training and waitlist condition. In conclusion, game-formatted EF training does not improve attention, EF or academic performance in very preterm children with parent-rated attention problems.

Dual n-back training improves functional connectivity of the right inferior frontal gyrus at rest

Several studies have shown that the benefits of working memory (WM) training can be attributed to functional and structural neural changes in the underlying neural substrate. In the current study, we investigated whether the functional connectivity of the brain at rest in the default mode network (DMN) changes with WM training. We varied the complexity of the training intervention so, that half of the participants attended dual n-back training whereas the other half attended single n-back training. This way we could assess the effects of different training task parameters on possible connectivity changes. After 16 training sessions, the dual n-back training group showed improved performance accompanied by increased functional connectivity of the ventral DMN in the right inferior frontal gyrus, which correlated with improvements in WM. We also observed decreased functional connectivity in the left superior parietal cortex in this group. The single n-back training group did not show significant training-related changes. These results show that a demanding short-term WM training intervention can alter the default state of the brain.

Empowering Executive Functions in 5- and 6-Year-Old Typically Developing Children Through Educational Robotics: An RCT Study

Educational Robotics (ER) is a new learning approach that is known mainly for its effects on scientific academic subjects such as science, technology, engineering, and mathematics. Recent studies indicate that ER can also affect cognitive development by improving critical reasoning and planning skills. This study aimed to quantify the ability of ER to empower Executive Functions (EF), including the ability to control, update, and program information, in 5- and 6-year-old children attending first grade, a crucial evolutionary window for the development of such abilities. A total of 187 typically developing children were enrolled and randomly allocated into two experimental conditions: A, for immediate ER training, and B, for waitlist. ER-Laboratories (ER-Lab) for small groups were organized at schools, using a child-friendly, bee-shaped robot called Bee-Bot^® (Campus Store). Activities were intensive, enjoyable, and progressively more challenging over the 20 twice-weekly sessions. Outcome measures, based on standardized tests, were used to quantify the effects of ER on EF. Compared to the control group, the ER-Lab group showed significantly better ability to actively manipulate information in short-term memory and suppress automatic responses in favor of goal-appropriate actions. This RCT study provides the first quantitative evidence of the positive effects of ER activities for improving working memory and inhibition in the early school years.

Effects of Executive Function Training on Attentional, Behavioral and Emotional Functioning and Self-Perceived Competence in Very Preterm Children: A Randomized Controlled Trial

OBJECTIVE

Very preterm children have poorer attentional, behavioral and emotional functioning than term-born children. Problems on these domains have been linked to poorer executive function (EF). This study examined effects of a game-formatted, comprehensive EF training on attentional, behavioral and emotional functioning and self-perceived competence in very preterm children.

STUDY DESIGN

Eighty-five children participated in a multi-center, double-blind, placebo and waitlist-controlled randomized trial. Children were recruited from neonatal follow-up units of two academic medical centers in The Netherlands. Eligible for inclusion were 8-12 year old children born very preterm (<30 weeks of gestation) and/or with extremely low birthweight (<1000 g) with parent reported attention problems. Children were randomly assigned to one of three treatment arms: EF training, placebo training or waitlist. The EF and placebo training involved a 6 weeks, 25 (30-45 min) sessions training program. Attentional functioning (Attention Network Test), behavioral and emotional functioning (parent and teacher Strengths and Difficulties questionnaire) and self-perceived competence (Self-Perception Profile for Children) were assessed at baseline, at the end of the training program and 5 months after the training was finished. Data analyses involved linear mixed model analyses.

RESULTS

Children in the EF training arm significantly improved on all training tasks over the course of the EF training program. Despite these improvements on the EF training tasks, there were no significant differences over time on any of the outcome measures between the three treatment arms, indicating that this computerized EF training program had no beneficial effects.

CONCLUSION

Although there were significant improvements in the EF training tasks, there was no generalization of these improvements to any of the outcome measures. Thus, our findings do not support the use of computerized EF training programs. Future research should investigate effectivity of more ecologically valid, real-world like EF training programs.

Executive function deficits in children born preterm or at low birthweight: a meta-analysis

AIM

To investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight.

METHOD

PubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures.

RESULTS

Thirty-five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta-regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth.

INTERPRETATION

Children born preterm/low birthweight since 1990 perform half a SMD below term-born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age.

WHAT THIS PAPER ADDS

Children born preterm/low birthweight perform below term-born children on core executive functions. Lower gestational age or male sex are not risk factors for poorer executive functions. Executive function difficulties in children born preterm/low birthweight remain stable across childhood. Executive function difficulties are similar for children born recently and children born in earlier eras.

Use of cognitive correction training improves learning for children with mathematics learning disability

Children with normal intelligence may experience varying degrees of mathematics learning disabilities (MD). This study aims to conduct training to improve the brain's cognitive ability for mathematics learning by focusing on two important mathematical cognitive abilities. This was a prospective study of 70 children in grades 2-5 from two primary schools in Changzhou and with MD enrolled from June 2015 to February 2017. The children were randomized 1:1 to the training and control groups. A training cycle included 40 sessions (5/weeks) (30 min each session). The efficacy of learning was assessed by assessing number learning and graph reasoning, and by using the Raven standard reasoning test score. In the training group, backward number memory (from 6.1 ± 1.8 to 6.7 ± 1.3, P = 0.02), number sequential connection (from 54.4 ± 14.5 to 47.1 ± 12.1, P < 0.01), and rapid graph judgment (from 531.9 ± 76.3 to 557.8 ± 85.7, P = 0.04) were improved by training, while there was no effect on forward number memory (P = 0.13). There were significant differences in total score and scores of b, c, and e series before and after training (all P < 0.05). The children in the control group had no improvement after 8 weeks. There was a correlation between the ability of rapid graphic judgment before and after training and the score of the Raven E series (r = 0.384, P = 0.024), and between the score of the Raven C series and the score of the Raven D series (r = 0.468, P = 0.013). Cognitive correction training improved the sensitivity to numbers and mathematics learning in children with MD.