Cogmed Working Memory Training for Youth with ADHD: A Closer Examination of Efficacy Utilizing Evidence-Based Criteria

Abstract

The current review applied the evidence-based treatment criteria espoused by the Society for Clinical Child and Adolescent Psychology (Silverman & Hinshaw, 2008) to specifically evaluate the short-term and longer term efficacy of Cogmed Working Memory Training (CWMT) as a treatment for youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Utilizing a systematic literature search, 7 studies that employed the school-age version of CWMT were identified for this review. The data reviewed herein suggest mixed findings regarding the benefit of CWMT for youth with ADHD. Two randomized controlled studies have demonstrated that CWMT led to improvements in neuropsychological outcomes and parent-rated ADHD symptoms relative to wait-list control and placebo treatment conditions. Another study demonstrated effects of CWMT relative to a placebo condition on an analog observation of behavior during an academic task, although this study did not find an effect of CWMT on parent-rated ADHD. Finally, an additional study utilizing an active comparison control condition did not find incremental benefits of CWMT on parent- or teacher-rated ADHD. Critical issues in interpreting existing studies include lack of alignment between demonstrated outcomes and the hypothesized model of therapeutic benefit of CWMT, issues with equivalence of control conditions, and individual differences that may moderate treatment response. Collectively, the strengths and limitations of the studies reviewed suggest that CWMT is best defined as a Possibly Efficacious Treatment for youth with ADHD. We suggest future directions for research and conclude with clinical implications of our findings for the treatment of youth with ADHD.

Acknowledgments

Support during the preparation of this manuscript was provided through Award Number R34MH088845 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. We acknowledge Dr. Torkel Klingberg for his helpful assistance in reviewing this manuscript.

Notes

Note. ADHD = attention deficit/hyperactivity disorder; DSM = Diagnostic and Statistical Manual of Mental Disorders; CT = combined type; IT = inattentive type; ODD = oppositional defiant disorder; CD = conduct disorder; ANX = anxiety disorder; SES = socioeconomic status; LD = learning disorder; H/I = hyperactive/impulsive type.

Note. DSM = Diagnostic and Statistical Manual of Mental Disorders; ADHD = attention deficit/hyperactivity disorder; CRS = Conners Rating Scale; BRIEF = Behavior Rating Inventory of Executive Function; WISC = Wechsler Intelligence Test for Children; CANTAB = Cambridge Neuropsychological Testing Automated Battery; WM = Working Memory; WMR = Working Memory Rating Scale; D2 = The D2 Test of Attention; WRAT-PM = Wide-Range Achievement Test-4-Progress Monitoring Version; SWAN = Strengths and Weakness of ADHD-symptoms and Normal-behavior Scale; IOWA = ; WISC = ; WMI = Working Memory Index; RAST = Restricted Academic Situations Task; AWMA = Automated Working Memory Assessment; WASI = Wechsler Abbreviated Scale of Intelligence; CRTT = Choice Reaction Time Task; Raven's = Raven's Colored Progressive Matrices; WAIS-RNI = Wechsler Adult Intelligence Scale – Revised as a Neuropsychological Instrument; WRAML = Wide Range Assessment of Memory and Learning; ADHD-RS IV = Attention Deficit/Hyperactivity Disorder Rating Scale, Fourth Edition.

^a Cohen's d reported for each domain. Average effect size calculated for domains where there are multiple measures.

^b Effect size calculated only for continuous data as other categories were coded as binary outcomes.

^c Effect size determined by difference between no medication condition and CWMT.

^d Standard deviations were not reported in study in order to calculate effect sizes.

*Significant difference between groups in favor of Cogmed Working Memory Training.