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Research has indicated that working memory is not only associated with academic achievement, but also behaviour in class and at home (Alloway et al., 2009; Aronen, Vuontela, Steenari, Salmi, & Carlson, 2005; Gathercole et al., 2008). Some have found that working memory underlies that ability to control attention and resist distraction from irrelevant stimuli (Kane et al., 2007), which are both important determinants for behaviour. In fact, many researchers have begun to investigate whether children with ADHD could benefit from working memory training (Dahlin, 2011; Klingberg et al., 2005; Klingberg, Forssberg, & Westerberg, 2002). Although Sally has not been formally diagnosed with ADHD, she does demonstrate many of the characteristics of ADHD such as difficulty in maintaining attention, distractibility, difficulties with emotional control, and difficulties planning her work and her actions. Therefore, it may be worthwhile looking at the research on ADHD and working memory to help determine whether working memory training will be beneficial for Sally. There is promising research with regards to working memory training and ADHD. For example, it has been found that working memory training may bring the working memory performance of children with ADHD within 0 to 0.3 standard deviations of normally developing children (Barnett et al., 2001; Westerberg & Klingberg, 2007). In addition, it has been shown that working memory training with children with ADHD improves response inhibition and reasoning. In the same study, parents reported a reduction in inattentive symptoms after the working memory training (Klingberg et al., 2005). Therefore, it was hypothesised that improving Sally’s working memory would result in improvements in her control of attention and ability to resist distractions thereby resulting in behaviour improvements. Improving her behaviour has the potential to improve her academics as she is then more likely to be on-task. Likewise, improving her academics has the potential to improve her behaviour as she may be more engaged in her academic work when she is able to carry out what is required of her.
Strategies for Improving Working Memory
There are generally two broad strategies for helping students with working memory deficits. The first is to make accommodations in the classroom and to provide the student with tools to reduce the working memory load (Gathercole & Alloway, 2004, 2008; Gathercole et al., 2006). It became evident that this strategy was already being used when the classroom observation was carried out. For example, directions were written down with a picture to illustrate each step, there were lots of pictorial prompts all over the classroom, the teacher would write what Sally wanted to write and then Sally would copy this, and multisensory or multimodal learning was evident. Therefore, the provisional psychologist determined that further intervention over and above this indirect method was required.
The second strategy for helping students with working memory deficits it to try to directly improve the capacity of the child’s working memory. Research has shown that working memory is not a static capacity. That is, the capacity of working memory can be changed (Gunther, Schafer, Holzner, & Kemmler, 2003; Jaeggi, Buschkuehl, Jonides, & Perrig, 2008; van’t Hooft et al., 2003). It has been suggested that this is due to the plasticity of the neural system. In fact, functional magnetic resonance imaging has shown that working memory training increases the brain activity in the dorsolateral prefrontal and parietal cortices, providing evidence for the plasticity of the neural system underlying working memory (Olesen, Westerberg, & Klingberg, 2004). Indeed, some studies have found by simply practicing working memory problems, working memory can be improved (Jaeggi et al., 2008; Mezzacappa & Buckner, 2010; Roughan & Hadwin, 2011). However, many of the programs used for this practice are expensive (for example, Cogmed) and may not transfer to other working memory tasks (Shipstead, Redick, & Engle, 2010). As a result, some research has looked at strategies which may have more broad-reaching effects.
Researchers have found that teaching children to use strategies such as mnemonics or elaborative rehearsal is useful for improving working memory (Ball et al., 2002; Craik & Rose, 2012; Dahlin, 2011; Harris & Qualls, 2000; Maccini, Mulcahy, & Wilson, 2007; Parente & Herrmann, 1996). One such program that does this is Memory Booster (available from http://www.lucid-research.com/memory-booster-classroom-home.htm ). This program teaches the child four memory strategies: maintenance rehearsal, imagery, creating stories, and grouping. There are a wide a range of mnemonic or elaborative rehearsal techniques that have been researched and can be used. However, the provisional psychologist assessed the techniques used in the Memory Booster program to be appropriate for Sally’s age and cognitive level. Indeed, the program has been found to be effective for six and seven year old children (H. St Clair-Thompson et al., 2010; H. L. St Clair-Thompson & Holmes, 2008). Therefore, it was decided that Memory Booster was an appropriate intervention for Sally. First an explanation of each technique will be presented, along with the supporting research. Then an explanation of how the intervention was carried out will take place.
The Memory Booster Program
The first technique taught by the Memory Booster program is maintenance rehearsal (referred to as repeating by the program). This involves continuously repeating a piece of information to ensure that it remains in conscious awareness (Harris & Qualls, 2000). As a result it is more likely to be encoded efficiently. Researchers have stated that learning maintenance rehearsal is a necessary precursor for more advanced strategies (Parente & Herrmann, 1996). Therefore, by Sally being taught this strategy first she should be more able to learn the more advanced strategies taught by the Memory Booster program.
The two techniques taught after maintenance rehearsal, imagery and creating a story, can both be considered as elaborative rehearsal. Elaborative rehearsal involves processing the information in a more meaningful way in order to ensure that the information is more memorable. By purposefully making the information more meaningful, the information becomes more distinctive, allowing it to be retrieved more easily at a later stage (Harris & Qualls, 2000). The technique of imagery involves creating pictures of objects or scenes in order to assist memory. Pictures are more meaningful to most people, and therefore when a person consciously transforms the information they are receiving into a picture, the information is more likely to be encoded efficiently (Craik & Rose, 2012). However, this technique may be difficult to employ for abstract concepts. Therefore, it is recommended that this technique be used when the information represents concrete objects or processes (Parente & Herrmann, 1996). The technique of creating a story involves inter-twining previously unrelated information into a story that it can be remembered by the child. This sentence or story can then be used to cue the child’s memory for lists of key words or instructions(Parente & Herrmann, 1996).
How the Intervention was carried out
Due to prior assessment, results from the WISC-IV and the BRIEF were already available for pre-measures. In the first session with Sally, a few subtests from the NEPSY-II were administered in order to gain information on other memory related narrow abilities. For example, the Sentence Repetition subtest provided another measure on Memory Span and the list memory subtest provided a measure for Free Recall Memory. Short-term memory, according to the Cattel-Horn-Carrol (CHC) model of intelligence, encompasses Memory Span and Working Memory (Flanagan, Ortiz, & Alfonso, 2007). By administering these additional tests, two measures were available for each (Letter-Number Sequencing and Arithmetic for Working Memory; Digit Span and Sentence Repetition for Memory Span). This would then allow the provisional psychologist to gauge whether the training in the use of memory techniques affected not only working memory but also memory span. By including a measure of long term memory (List Memory) the provisional psychologist was also able to see whether the training had even further reaching effects. All these results, in conjunction with the BRIEF results, classroom observation and work samples provided a variety of pre-measures.
The objectives of the first session were as follows: build rapport, administer NEPSY subtests, and begin training on Memory Booster (maintenance rehearsal technique). All of these objectives were achieved. Rapport had already started to develop during the classroom observation. Sally is a socially engaging child, and therefore, the process of building rapport was relatively quick. She engaged with the provisional psychologist and the computer program well, and picked up the maintenance rehearsal technique fairly quickly.
The objectives of the second session were to revise the maintenance rehearsal technique and learn the imagery technique. While learning the imagery technique, the provisional psychologist noticed that the computer program did not allow her enough time to develop a detailed image in her mind, and therefore she was performing very poorly. As the program cannot be paused or slowed down, the provisional psychologist decided to switch the program off and instead allow her to practice with words provided to her by the provisional psychologist. A word would be verbally presented to her, and then she would have to describe the picture she was creating in her mind. After she had done this for four words, the provisional psychologist would then ask her what the words were. Allowing her this time and the one-on-one interaction appeared to be far more beneficial for her. This session lasted for an hour.
The objectives of the third session were as follows: revise the maintenance rehearsal and imagery techniques and teach the creating stories technique. The maintenance rehearsal technique was revised in the following way: the provisional psychologist told Sally three actions to perform (for example: touch your nose, rub your tummy, and stick out your tongue). Sally was then required to verbally repeat these three actions over and over while the provisional psychologist slowly put down each of her fingers that she was holding up. Once all the fingers were down, Sally was then required to physically perform those three actions in order. Sally’s motivation increased with the addition of the physical aspect and she engaged well with the provisional psychologist during this revision session. Sally revised the imagery technique one-on-one with the provisional psychologist in the same was as previously described. Sally was then required to engage with the Memory Booster program again, which explained to her the concept of creating a story in order to remember information. It appeared that Sally understood the concept, however, once again when Sally was given the opportunity to practice this concept with the Memory Booster program not enough time was allowed for her to create a story. Therefore, once again, the program was turned off and Sally practiced the session one-on-one with the provisional psychologist. This was done in the following way: five words were told to Sally and she would then have to create a story which incorporated all five words. This would take place a number of times. Then the provisional psychologist would ask Sally which four words went with a certain word. Sally would then have to re-tell the story she had created for that word and identify the four target words. Sally learned this strategy very quickly and soon became proficient at creating stories. Her performance one-on-one with the provisional psychologist was very good. Again, this session lasted for an hour.
The objectives of the fourth session were for Sally to revise all three of the memory techniques which had been taught to her. The Memory Booster program was not used in this session because the provisional psychologist determined that the program did not allow Sally sufficient time to properly implement the techniques and that her attention and concentration was better when she was required to engage with the provisional psychologist rather than the computer. This session lasted for an hour.
The fifth session involved revising the three strategies one-on-one with the provisional psychologist, and then practicing with the Memory Booster program. The program was still at a level that was too advanced for her, however, she did show improvements compared to previous sessions when she had used the program. It should be noted here that although the Memory Booster program does teach a ‘grouping’ strategy (which encourages children to form conceptual links between pieces of information) this technique is only taught to children who are performing at a higher level than Sally currently is.
During all sessions, there were a number of processes which took place. Firstly, Sally was told that each of the strategies would improve her memory. This was because research has shown that a person is more likely to use a strategy if told that the strategy will improve their memory. In addition to this, the research also states that the person is even more likely to use the strategy if given the opportunity to practice with and without the strategy in order to assess the effectiveness of the strategy (Pressley, Levin, & Ghatala, 1984). Therefore, Sally was given the opportunity to remember information without the aid of any strategies and then opportunities to remember similar types of information with the use of a strategy. This then allowed her to compare her performance. However, the research also says that children require explicit feedback about how the strategy improved their performance(Pressley et al., 1984). Therefore, Sally was explicitly told that her performance was better when she implemented the strategy. In addition to this, Sally received a number of different types of rewards for using the techniques. This is because research has shown that interest and motivation are central to memory training (Parente & Herrmann, 1996). Sally would receive a tick on the board after each piece of information remembered correctly. After she received a certain number of ticks she would either receive a sticker or be allowed the opportunity to give the provisional psychologist information to be remembered. She really enjoyed the latter strategy which both rewarded Sally and built rapport as this narrowed the power gap between Sally and the provisional psychologist. The Memory Booster program has an inbuilt reward system which allowed her to watch some cartoons after each section that she completed. She enjoyed these cartoons and looked forward to being able to watch them.
After the five intervention sessions, the memory subtests of the WISC-IV and NEPSY were administered once again. By using the same measures for pre- and post-measurement, there is the risk of a practice effect taking place. However, due to the fact that Sally was experiencing memory difficulties, the provisional psychologist decided that it was unlikely that a practice effect would take place and that it would be more beneficial to use the same measures pre and post. The outcomes of each of the subtests post-intervention were exactly the same as the results pre-intervention. This shows that no practice effect was evident, and that the memory training did not translate to improved outcomes on these WISC-IV and NEPSY measures.
It should be mentioned that this does not necessarily mean that Sally’s quality of encoding was not improved. How well something has been encoded can only be measured by a test of retrieval. When information fails to be retrieved during the test it does not necessarily mean that the memory was not encoded or that the memory has been forgotten forever. It simply indicates that the test failed to elicit the wanted information (Craik & Rose, 2012).
The BRIEF was also readministered to Sally’s teacher. Once again, the results were very similar to the results pre-intervention, with working memory still being the teacher’s major concern. A class room observation was carried out once again. It was observed that Sally still required assistance to carry out directions.
The outcome of this intervention may be explained by findings of (Verhaeghen, Marcoen, & Goossens, 1992). This meta-analysis investigated the effects of 49 independent experiments with regards to the effectiveness of elaborative rehearsal memory training for older adults. It was found that there was a large and significant benefit of elaborative rehearsal training on ‘target’ memory tasks (tasks for which the learned technique could be easily employed) but no significant benefit to ‘non-target’ untrained memory tasks. Perhaps the techniques that Sally learned have set up a trajectory for memory gains which will only be evident sometime in the future, on tasks which these techniques can be implemented easily. However, the same authors suggested that the amount of benefit from memory training is mediated by individual differences such as processing speed, reasoning abilities, verbal abilities, general mental status, age, and initial working memory capacity (Verhaeghen et al., 1992). Perhaps the varied difficulties that Sally experiences, such as attention problems and receptive and expressive language problems, reduced the effectiveness of the training.
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