Clinician-delivered cognitive training for children with attention problems: effects on cognition and behavior from the ThinkRx randomized controlled trial

Figures & data

Table 1 Brief description of Woodcock–Johnson III tests and constructs measured

Construct measured	Name of measure	Description of test
Associative memory	Visual auditory learning test	Participant learns a rebus and then recalls and recites the association between the pictures and the words.
Visual processing	Spatial relations test	Participant visually matches individual puzzle pieces to a completed shape.
Auditory processing	Sound blending test	Participant hears a series of phonemes and then blends them to form a word.
Logic and reasoning	Concept formation test	Participant applies inductive rules to a set of shapes and indicates the rule that differentiates one set of shapes from the others.
Processing speed	Visual matching test	In 3 minutes, participant identifies and circles pairs of matching numbers in each row.
Working memory	Numbers reversed test	Participant hears a list of numbers and repeats them in the reverse order.
Long-term memory	Visual auditory learning-delayed test	Participant recalls verbal–visual associations learned earlier by reading rebus passages.
Attention	NIH Cognition Toolbox Flanker test	In this 3-minute test of accuracy and reaction time, participant identifies the direction of an arrow flanked by other arrows on a computer screen.
GIA	Composite score for g	GIA is a weighted composite of tests 1–7 on the WJ III.

Note: All measures except for attention were from the WJ III – tests of cognitive abilities.

Abbreviations: GIA, General Intellectual Ability; NIH, National Institutes of Health; WJ III, Woodcock–Johnson III.

Figure 1 Example of a clinician-delivered working memory training procedure.

Figure 2 Comparison of treatment and control groups on median pretest to posttest change in test scores.

Abbreviation: GIA, General Intellectual Ability.

Table 2 Descriptive statistics for pretest to posttest change scores and overall difference between groups

Variable	Treatment				Control				Difference
	Median	Mean	CI	SD	Median	Mean	CI	SD	Median difference (treatment – control)
Associative memory	32.5	29	13–44	14.9	6.0	10.3	1–19	10.5	26.5
Visual processing	1.5	5.8	(−4)–16	9.7	2.0	5.3	(−3)–14	9.9	−0.50
Auditory processing	13.5	14.8	2–28	12.7	−1.0	−2.7	(−11)–5	9.3	14.5
Logic and reasoning	29.0	27.5	10–44	15.9	−7.0	−9.2	(−21)–3	13.4	36.0
Processing speed	15.0	16.3	4–28	11.4	8.0	7.6	2–12	5.1	7.0
Working memory	22.5	20.3	8–32	11.3	−6.0	−12.8	(−23)–(−2)	11.7	28.5
Long-term memory	37.5	34.5	18–50	15.3	0.00	6.3	(−5)–18	13.2	37.5
Attention gain	6.0	7.4	(−2)–17	9.7	2.4	2.0	(−5)–9	7.9	3.6
IQ gain	24.5	25.7	18–33	7.0	−4.0	−6.3	(−13)–1	7.9	28.5

Abbreviation: IQ, intelligence quotient.

Table 3 Statistical comparisons between treatment and control groups for each construct measured

Variable	U	p-value	r
Associative memory	9.0	0.10	−0.47
Visual processing	19.5	0.83	0.06
Auditory processing	5.0	0.02	−0.63
Logic and reasoning	2.0	0.005	−0.75
Processing speed	10.5	0.14	−0.42
Working memory	0.50	0.001	−0.80
Long-term memory	2.5	0.005	−0.72
IQ	0.00	0.001	−0.83
Attention	16.0	0.53	−0.20

Abbreviations: IQ, intelligence quotient; p, probability; r, effect size; U, Mann–Whitney U value.

Table 4 Cut score thresholds and clinically significant change in Woodcock–Johnson W scores

Variable	Cut score	Case A		Case B		Case C		Case D		Case E		Case F
		Pre	Post	Pre	Post	Pre	Post	Pre	Post	Pre	Post	Pre	Post
General Intellectual Ability	503	506	527a	507	528a	497	514a	494	510a	507	517a	513	528a
Associative memory	500	489	509a	506	521a	497	498	499	521a	509	527a	499	527a
Visual processing	502	502	515a	505	509a	503	502a	503	515a	504	504a	503	502a
Auditory processing	510	503	532a	554	564a	518	528a	512	509	506	525a	536	564a
Logic and reasoning	502	526	548a	494	548a	476	518a	496	523a	492	530a	526	530a
Processing speed	498	495	504a	507	528a	484	505a	481	495	505	507a	500	507a
Working memory	495	496	539a	462	502a	489	516a	470	502a	502	502a	516	549a
Long-term memory	502	492	517a	510	539a	510	520a	501	524a	512	520a	497	515a
Attention	94	93.6	86.1	90.1	114a	87	122.5a	80	84.4	98.7	112.6a	89.5	93.2

Notes:

a Posttest scores met cut score threshold for clinically significant change. Case A: 11y male, Case B: 9y female, Case C: 10y female, Case D: 10y male, Case E: 11y male, Case F: 11y female.

Table 5 Magnitude of change by case and construct measured

Variable	Case A	Case B	Case C	Case D	Case E	Case F
General Intellectual Ability	11.4a R	11.4a R	9.2a R	8.7a R	5.4a R	8.1a R
Associative memory	6.9a R	4.1a R	0.29 U	6.5a R	6.3a R	9.8a R
Visual processing	19.7a R	6.9a R	−2.4 D	29.3a R	0 U	−2.1 D
Auditory processing	2.8a R	0.95 U	0.98 U	−0.29 U	1.8 U	2.7a R
Logic and reasoning	3.4a R	9.3a R	6.5a R	4.2a R	5.9a R	0.62 U
Processing speed	1.6 U	4.8a R	4.6a R	3.0a R	0.36 U	1.2 U
Working memory	4.2a R	3.8a R	3.0a R	3.5a R	0.0 U	3.3a R
Long-term memory	8.3a R	9.7a R	3.3a R	7.7a R	2.7a R	6.0a R
Attention	−1.1 U	3.7a R	5.5a R	0.67 U	2.1a R	0.57 U

Notes:

a Significant reliable change index >1.96. Case A: 11y male, Case B: 9y female, Case C: 10y female, Case D: 10y male, Case E: 11y male, Case F: 11y female.

Abbreviations: D, deteriorated; R, recovered; U, unchanged.