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Original Investigation |

Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory A Randomized Clinical Trial Online Only

Gehan Roberts, MPH, PhD1; Jon Quach, PhD2; Megan Spencer-Smith, PhD3; Peter J. Anderson, PhD4; Susan Gathercole, PhD5; Lisa Gold, PhD6; Kah-Ling Sia6; Fiona Mensah, PhD7; Field Rickards, PhD8; John Ainley, PhD9; Melissa Wake, MBChB, MD, FRACP1
[+] Author Affiliations
1Population Health, Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children’s Hospital, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
2Population Health, Murdoch Childrens Research Institute, Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia
3School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
4Clinical Sciences, Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
5Medical Research Council Cognition and Brain Sciences Unit, Cambridge, England
6Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
7Data Science, Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
8Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia
9Australian Council for Educational Research, Camberwell, Victoria, Australia
JAMA Pediatr. 2016;170(5):e154568. doi:10.1001/jamapediatrics.2015.4568.
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Importance  Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking.

Objective  To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching.

Design, Setting, and Participants  Population-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses.

Intervention  Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes’ duration at school.

Main Outcomes and Measures  Directly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs.

Results  Of 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, −3.0 [95% CI, −5.4 to −0.7]; P = .01). Intervention costs were A$1035 per child.

Conclusions and Relevance  Working memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm.

Trial Registration  anzctr.org.au Identifier: ACTRN12610000486022

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