‘Paying Attention in Class’ A classroom contextual cognitive training

Marthe van der Donk

Case of Daniel

Problems that can be related to executive functions

• Deficits often seen in children with ADHD (Barkley, 1997; Willcutt et al., 2005)

• Important role in academic performance (Bull and Scerif, 2001)

• Especially working memory skills (Aronen et al., 2005; Gathercole et al., 2000).

Executive functions

Cognitive training

1) Processed based interventions (Sonuga-Barke et al.

2014)

2) Compensatory interventions (Dehn, 2008)

▫ Strategy training (Morrison & Chein, 2011)

▫ Modify environment (e.g. Holmes, Gathercole & Dunning,

2010)

Previous studies of CWMT in children with ADHD

Near transfer Far transfer

Critical notes

1) Theoretical concerns

o Near- and far transfer

2) Methodological concerns

o Inconsistent methods

o Lack of adequate control group

o Single tasks

3) Clinical implications

Aims of our study

• Determine the effects of CWMT and compare effects with active control group

• Extension with 6 months follow up and academic performance measures

102 children included • age 8-12 years

•Diagnosed with ADHD

Pre-assessment

N=52 Cogmed Working Memory Training

N=50 Paying Attention in Class

Post assessment

Follow-up 6 months

Methods Procedure

Methods Assessment

Primary outcome measures • Neurocognitive functioning

(attention, working memory, planning and inhibition)

• Academic performance

(word reading fluency, automated math, spelling)

•The Behaviour Rating of Executive Functions (BRIEF-P/T)

Secondary outcome measures • Behavior in class (Learning Condition questionnaire)

• Behavior problems (CBCL/TRF)

• Quality of Life (Kidscreen-27)

Cogmed Working Memory Training - RM

• Daily sessions

• During school hours

Paying Attention in Class

• 25 sessions of 45 minutes

• Contextual to classroom learning

• Three key ingredients Metacognition

Goal directed behavior

Working memory

Planning and initation

Selective attention

Paying Attention in Class (1) Psycho education

Pitfalls

Distraction

Too fast

Forgetful

Emotion

Repeat

Take time

Picture

Routine

Compensatory strategies

Paying Attention in Class (2) Working memory training

Visual spatial span

Instruction task

Listening recall span task

My table

• School related tasks

• Registration card

• Active involvement

teacher

Paying Attention in Class (3) Transfer to classroom

Demographics

CWMT (n=52)

Paying Attention in Class (n=50)

Age 9.88 (1.33) 10 (1.31)

boy/girl 34/15 36/13

Medication yes/no 20/25 18/29

ADHD-C/ADHD-I 55% / 43% 59% / 39%

Learning Disability 22% 40%

Type of education Regular/special primary/special education

89% / 4% / 7% 86% / 14% / 0% ***

Linear Mixed Model & Bonferonni correction

Results – post treatment

Attention

Verbal WM

Visual WM

Inhibition

Parents

• Behavior regulation •Metacognition • Attention

Teacher

• Attention

CWMT Attention

Verbal WM

Visual WM

Inhibition

Parents

• Behavior regulation •Metacognition • Attention

Teacher

• Attention

PAC d

0.87

Results – follow up

Verbal WM

Visual WM

Inhibition

Planning

Parents

• Attention

Teacher

• Attention •Metacognition

CWMT Verbal WM

Visual WM

Inhibition

Planning

Parents

• Attention

Teacher

• Attention •Metacognition

PAC d

0.49

Summary & discussion

1) Broad improvements in neurocognitive functioning

2) Confirmed by both parent and teacher ratings

3) CWMT outperformed only on visual spatial working memory

4) Limitedness of far transfer

Future research (1)

Why?

Attention

How and why?

Working memory

Trained function

Non-trained function

For whom?

ADHD

+ WM problems

Thanks to:

• Co authors and supervisors ▫ Anne-Claire Hiemstra, Ariane Tjeenk, Aryan van der Leij and

Ramón Lindauer

• Collaborators ▫ Marieke Krop, Carola Oosterveer, Jan Geelhoed, Jehanne Vieijra,

Julie Stoter, Maartje van Ballegoij and Marjolijn Glotzbach

• Funding ▫ Ministry of Education

Questions?

• Marthe van der Donk

m.vanderdonk@debascule.com