Background & Aim: Children with mental health issues, such as anxiety, experience school related difficulties, with lower performance on schoolwork and tests, decreased attendance, higher dropout, and decreased likelihood of pursuing further education. Attentional processes are increasingly the focus of cognitive models of anxiety, such as Attentional Control Theory (ACT). This model stresses the importance of associations between anxiety and executive functions (ie., WM, inhibition, shifting) in understanding task performance. Research has also shown that negative affect and academic performance is moderated by working memory (WM) function. Thus, one approach for improving academic performance in children with negative impact might be to increase their WM ability and attention. The aim of this study was to examine the impact of Cogmed on children with social, emotional and behavioral difficulties (SEBD) on IQ, anxiety, attention, inhibition and behavior. Population & Sample Size: N = 17 children with SEBD, mean age 12.94 years, children with co-morbid ADHD and on medication were excluded • n = 7 children in adaptive Cogmed training group • n = 9 children in passive control group Design: Randomized, controlled, test-retest T1 = baseline, T2 = post-test, T3 = 3 month follow-up
Results: I. Treatment group improved significantly over control group on: 1) Composite WM score (Backward Digit Span & Spatial Span) 2) IQ (Raven’s Standard Progressive Matrices & Mill Hill Vocabulary Scale (MHVS)) 3) Teacher report of emotional symptoms (Strengths and Difficulties Questionnaire (SDQ)) 4) Teacher report of behavioral and attention control (Strengths and Difficulties Questionnaire (SDQ))
II. A trend towards significant improvement for the treatment group over the control group was observed for: 1) Inhibition (Go/No-Go task) 2) Self-report test anxiety (Children’s Test Anxiety Scale (CTAS))
III. Gains in WM maintained at 3 month follow-up. No significant group difference on IQ, emotional symptoms, behavioral control, inhibition or test anxiety at 3 month follow-up. IV. No significant group differences on trait anxiety (Beck Youth Inventory – 2nd Edition)
Summary and Implications: Children with SEBD, including anxiety, struggle with attention and academic performance issues that may be mediated by WM ability. This study found that after training with Cogmed, children with SEBD improved on WM and these gains were maintained at 3 month follow-up. Researchers also observed short-term positive change on IQ, teacher reports of behavior, attention and emotional symptoms, as well as inhibition and self-report test anxiety. These results are consistent with other studies investigating the impact of WM training on IQ and inhibition (Klingberg et a., 2005; Jaeggi et al., 2008). Lack of significant group differences on all measures except WM at 3 month follow-up imply that WM training may only improve affect in the short term and that other factors are influencing IQ, negative affect, and behavior. For example, the loss of group difference at 3 months may partially be due to improvements in all measures by the passive control group and indicates a lack of stability in anxious affect. It is also possible that the significant group difference in affect at post-test was due to the other factors involved in training such as positive feedback and coach support. Limitations to interpreting the results here may be countered in the future by inclusion of a larger sample size, blinding of teachers and/or inclusion of a placebo control group. In summary, the findings from this study provide preliminary evidence to suggest that WM training may reduce negative affect in young people. Research with a larger sample could further elucidate whether anxiety is mediated or moderated by improved WM and whether other interventions such as CBT might complement the short term improvements in affect as observed in this study. Funding: This research was supported by Action Medical Research, the leading UK-wide medical research charity dedicated to helping babies and children and the Clinical Psychology Doctorate Programme, at the University of Southampton.