Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands.
Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands.
J Intellect Disabil Res. 2023 Sep;67(9):842-859. doi: 10.1111/jir.13047. Epub 2023 Jun 14.
Working memory training (WMT) can offer therapeutic benefits to patients with neurodevelopmental disorders (NDD) and mild to borderline intellectual disability (MBID). However, consistent evidence for treatment benefits of WMT over placebo training is missing. So far, participants in double-blind research designs did receive non-specific coaching, whereas active coaching based on individual training results might increase the efficacy of WMT. Furthermore, the intensity and duration of WMT is often too stressful for these children. This study therefore investigated whether a less intensive but more prolonged WMT, with active personalised coaching and feedback, would reduce behavioural symptoms and improve neurocognitive functioning and academic achievements in children with NDD and MBID.
A double-blind randomised controlled trial in children (aged 10;0-13;11) with MBID (60 < IQ < 85) and ADHD and/or ASD evaluated the effects of a less intensive but prolonged version of the original Cogmed WMT (30 min a day, 4 days a week, 8 weeks in total). Eighteen participants received active, personalised coaching and feedback, based on their actual individual performance during training. Twenty-two received general non-personalised coaching for the same amount of time. Executive functioning, academic achievements and several behavioural measurements were administered, before and after training, with a 6-months follow-up.
We observed a significant effect of time on both primary and secondary outcome measures, indicating that all children improved in working memory performance and other neurocognitive and academic outcomes. The interaction between time and group was not significant.
This study was unable to document superior effects of active personalised coaching and feedback compared with general non-personalised coaching and no feedback in an adaptive WMT in children with MBID and NDD. The objectively documented changes over time suggest that for these vulnerable children, a regular, structured and structural contact with a coach and adapted exercises is enough to develop therapy fidelity, boost motivation and improve neurodevelopmental task performance. Further research is needed to examine which possible subgroups within this heterogenic group of children profit more from WMT compared with other subgroups.
工作记忆训练（WMT）可为神经发育障碍（NDD）和轻度至边缘智力障碍（MBID）患者提供治疗益处。然而，缺乏 WMT 相对于安慰剂训练的治疗益处的一致证据。到目前为止，双盲研究设计的参与者确实接受了非特异性辅导，而基于个体训练结果的主动辅导可能会增加 WMT 的效果。此外，WMT 的强度和持续时间对这些孩子来说往往压力过大。因此，本研究旨在探讨一种强度较低但持续时间较长的 WMT，结合主动个性化辅导和反馈，是否会减轻行为症状并改善 NDD 和 MBID 儿童的神经认知功能和学业成绩。
一项针对患有 MBID（60 < IQ < 85）和 ADHD 和/或 ASD 的儿童（年龄 10 岁；0-13 岁；11 岁）的双盲随机对照试验评估了一种较不密集但持续时间较长的原始 Cogmed WMT 版本的效果（每天 30 分钟，每周 4 天，共 8 周）。18 名参与者根据他们在训练期间的实际个体表现接受了主动的个性化辅导和反馈。22 名参与者接受了相同时间的一般非个性化辅导。在训练前后，进行了执行功能、学业成绩和几项行为测量，并进行了 6 个月的随访。
我们观察到主要和次要结果测量的时间都有显著影响，表明所有儿童的工作记忆表现和其他神经认知和学业成绩都有所提高。时间和组之间的相互作用不显著。
本研究未能证明在 MBID 和 NDD 儿童的适应性 WMT 中，主动个性化辅导和反馈与一般非个性化辅导和无反馈相比具有优越的效果。随着时间的推移，客观记录的变化表明，对于这些脆弱的儿童，与教练进行定期、结构化和结构性接触以及适应性练习足以发展治疗一致性，提高动力并改善神经发育任务表现。需要进一步研究，以检查在这个异质儿童群体中，哪些可能的亚组从 WMT 中受益更多，而哪些亚组受益较少。
