Improving working memory in children with low language abilities

Understanding divergence: Placing developmental neuroscience in its dynamic context

Neurodevelopment is not merely a process of brain maturation, but an adaptation to constraints unique to each individual and to the environments we co-create. However, our theoretical and methodological toolkits often ignore this reality. There is growing awareness that a shift is needed that allows us to study divergence of brain and behaviour across conventional categorical boundaries. However, we argue that in future our study of divergence must also incorporate the developmental dynamics that capture the emergence of those neurodevelopmental differences. This crucial step will require adjustments in study design and methodology. If our ultimate aim is to incorporate the developmental dynamics that capture how, and ultimately when, divergence takes place then we will need an analytic toolkit equal to these ambitions. We argue that the over reliance on group averages has been a conceptual dead-end with regard to the neurodevelopmental differences. This is in part because any individual differences and developmental dynamics are inevitably lost within the group average. Instead, analytic approaches which are themselves new, or simply newly applied within this context, may allow us to shift our theoretical and methodological frameworks from groups to individuals. Likewise, methods capable of modelling complex dynamic systems may allow us to understand the emergent dynamics only possible at the level of an interacting neural system.

Speech-Language Pathology Interventions for Children With Executive Function Deficits: A Systematic Literature Review

PURPOSE

The purpose of this synthesis was to systematically review the research and guidance for school-based speech-language pathologists (SLPs) who provide intervention to children with developmental executive function (EF) deficits, particularly those children with co-occurring developmental language disorder (DLD).

METHOD

We conducted a structured search of four major electronic databases, as well as a manual review of references and journals, which yielded 4,571 nonduplicate articles. We screened first titles and abstracts and then full texts to identify peer-reviewed articles, dissertations, and theses containing research or guidance for SLPs' interventions for children with co-occurring DLD and EF deficits; this process yielded 27 articles for analysis. We categorized these studies by type of publication and synthesized their contents to assess the evidence base for EF interventions in children with DLD and to evaluate the guidance for SLP-implemented direct and indirect interventions.

RESULTS

A small body of research explores the efficacy of SLPs' intervention for children with co-occurring DLD and EF deficits, generally finding modest but inconsistent effects of cognitive interventions and strategy training to improve language outcomes. Meanwhile, nonempirical articles (e.g., tutorials) offer guidance to SLPs to support students with EF deficits through direct and indirect services.

CONCLUSIONS

A growing body of literature equips SLPs with the principles and strategies of EF intervention. Many of these articles are sourced from literature about children with EF deficits or attention-deficit/hyperactivity disorder, but few empirical studies measure the efficacy of these interventions for children with co-occurring DLD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21401901.

Working memory training in children with developmental language disorder: Effects on complex syntax in narratives

This study assesses the impact of a working memory training program on the syntactic complexity of the spontaneous speech of French-speaking children with Developmental Language Disorder (DLD). Thirty-nine 6- to 12-year-old children with DLD were allocated to a WM training (DLD^MM, N = 20) or an active control group (DLD^SQULA, N = 19). The computerized training sessions took place three times a week, yielding 12 training hours per participant. Syntactic complexity was assessed in storytelling, measuring mean length of utterances, use of embedded clauses and rate of errors in complex utterances. The performance of participants with DLD was first compared to previous spontaneous data of 40 typically-developing (TD) children of the same age. Then, intragroup (pre- vs. post-test) and intergroup (DLD^MM vs. DLD^SQULA) comparisons were made to assess the impact of the working memory training on the language measures. Global results confirmed syntactic impairment in children with DLD, as opposed to TD children, with large differences for the use of embedded clauses. Findings also suggested gains in the mastery of embedded clauses in children who participated in the WM training, whereas no gains were observed in the DLD control group. These findings confirm deficits in complex syntax in children with DLD, in particular in embedded clauses, and may encourage the clinical use of language sample analysis, which provides an ecological account of children's language performance. While our results should be replicated on a larger scale, they also suggest positive transfer effects of working memory training on the capacity of participants with DLD to produce embedded clauses, in line with previous studies showing a positive effect of WM training on tasks of expressive syntax. It thus seems that working memory training can yield benefits for language, which leaves open the door to new therapeutic approaches for children with DLD.

A Short and Engaging Adaptive Working-Memory Intervention for Children with Developmental Language Disorder: Effects on Language and Working Memory

Recent research has suggested that working-memory training interventions may benefit children with developmental language disorder (DLD). The current study investigated a short and engaging adaptive working-memory intervention that targeted executive skills and aimed to improve both language comprehension and working-memory abilities in children with DLD. Forty-seven 6- to 10-year-old children with DLD were randomly allocated to an executive working-memory training intervention (n = 24) or an active control group (n = 23). A pre-test/intervention/post-test/9-month-follow-up design was used. Outcome measures included assessments of language (to evaluate far transfer of the training) and working memory (to evaluate near transfer of the training). Hierarchical multiple regression analyses controlling for pre-intervention performance and age found the group to be a significant predictor of sentence comprehension and of performance on six untrained working-memory measures at post-intervention and 9-month follow-up. Children in the intervention group showed significantly higher language comprehension and working-memory scores at both time points than children in the active control group. The intervention programme showed the potential to improve working memory and language comprehension in children with DLD and demonstrated several advantages: it involved short sessions over a short period, caused little disruption in the school day, and was enjoyed by children.

A classroom intervention targeting working memory, attention and language skills: a cluster randomised feasibility trial

Background

International debate around the best models of speech and language therapy provision for children with language disorders has highlighted the need for research into classroom-based approaches and intervention dosage. Working memory (WM) is a cognitive skill linked to attention and language. ‘Recall to Enhance Children’s Attention, Language and Learning’ (RECALL) is a novel, 6-week, classroom-based intervention delivered by health professionals (HPs) and teachers. It is designed to target WM and enhance attention and language skills in 4–5 year olds.

Methods

A cluster randomised feasibility trial was conducted to investigate aspects of the feasibility of a definitive trial to evaluate RECALL: (i) recruitment and sampling procedures; (ii) compliance and fidelity; (iii) the acceptability of RECALL to HPs and teachers; (iv) the appropriateness of the outcome measures. Six classes of 4–5 year olds participated: two received RECALL, two received an existing intervention targeting attention skills (not underpinned by WM theory), and two received education as usual (no intervention). Ten children in each class (n = 60) were sampled to assess the appropriateness of the outcome measures. Classroom observations were conducted to measure fidelity and semi-structured interviews with HPs, and teachers explored the acceptability of RECALL.

Results

The recruitment targets were met, and all six schools completed the trial, but the sampling procedures require modification. Compliance was good (95% of RECALL sessions were delivered), but fidelity to the intervention protocol varied between 76% and 45% across the two schools. This was influenced by large class sizes, child factors, and facilitator factors, e.g., their understanding of the theory underpinning the intervention. The lack of fidelity reduced the dose (number of practice items) accessed by individual children, particularly those most at risk. There were mixed findings regarding the acceptability of RECALL and the appropriateness of the outcome measures.

Conclusions

The trial protocol could be easily scaled-up in a future definitive trial, with an amended sampling procedure. RECALL should be repackaged as a small group intervention to enhance the fidelity of its delivery and its acceptability to HPs and teachers. This study highlights the need for thorough training for professionals who deliver classroom-based interventions for children with language disorders.

Trial registration

ISRCTN13633886. Registered on 7 September 2018

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00771-w.

Dissociable effects of attention vs working memory training on cognitive performance and everyday functioning following fronto-parietal strokes

Difficulties with attention are common following stroke, particularly in patients with frontal and parietal damage, and are associated with poor outcome. Home-based online cognitive training may have the potential to provide an efficient and effective way to improve attentional functions in such patients. Little work has been carried out to assess the efficacy of this approach in stroke patients, and the lack of studies with active control conditions and rigorous evaluations of cognitive functioning pre and post-training means understanding is limited as to whether and how such interventions may be effective. Here, in a feasibility pilot study, we compare the effects of 20 days of cognitive training using either novel Selective Attention Training (SAT) or commercial Working Memory Training (WMT) programme, versus a waitlist control on a range of attentional and working memory tasks. We demonstrate separable effects of each training condition, with SAT leading to improvements in spatial and non-spatial aspects of attention and WMT leading to improvements on closely related working memory tasks. In addition, both training groups reported improvements in everyday functioning, which were associated with improvements in attention, suggesting that improving attention may be of particular importance in maximising functional improvements in this patient group.

The Effect of Working Memory Training on a Clinical Marker of French-Speaking Children With Developmental Language Disorder

Purpose Our work investigates the production of 3rd-person accusative clitic pronouns in French-speaking typically developing (TD) children and children with developmental language disorder (DLD) following a novel working memory (WM) training program (12 hrs of effective training) that specifically targets the components of WM that have been shown to be impaired in children with DLD and to be directly related to the mastery of clitics (Delage & Frauenfelder, submitted for publication; Durrleman & Delage, 2016). Method Sixteen TD children aged 5-12 years and 26 age-matched children with DLD completed our 8-week WM training program. Furthermore, an age-matched control group of 16 TD children and 17 children with DLD followed a scholastic training regime matched for intensity and frequency. Syntax and WM were assessed prior to and following the WM/scholastic training. Results Significant posttraining WM gains were found in TD children and children with DLD who took part in the WM training, and the production rate of 3rd-person accusative clitics significantly increased in children with DLD following the WM training. No significant WM or syntax gains were observed in the control group. Conclusion These findings are noteworthy as Melby-Lervåg and Hulme's (2013) meta-analysis concluded that existing WM training programs show short-lived generalized effects to other comparable measures of WM, but that there is no evidence that such training generalizes to less directly related tasks. That our study led to gains in skills that were not trained (i.e., syntax) suggests that a WM training regime that is firmly grounded in theory and that targets the specific mechanisms shown to underpin the acquisition of syntax may indeed provide effective remediation for children with DLD.

Mapping differential responses to cognitive training using machine learning

We used two simple unsupervised machine learning techniques to identify differential trajectories of change in children who undergo intensive working memory (WM) training. We used self‐organizing maps (SOMs)—a type of simple artificial neural network—to represent multivariate cognitive training data, and then tested whether the way tasks are represented changed as a result of training. The patterns of change we observed in the SOM weight matrices implied that the processes drawn upon to perform WM tasks changed following training. This was then combined with K‐means clustering to identify distinct groups of children who respond to the training in different ways. Firstly, the K‐means clustering was applied to an independent large sample (N = 616, M_age = 9.16 years, range = 5.16–17.91 years) to identify subgroups. We then allocated children who had been through cognitive training (N = 179, M_age = 9.00 years, range = 7.08–11.50 years) to these same four subgroups, both before and after their training. In doing so, we were able to map their improvement trajectories. Scores on a separate measure of fluid intelligence were predictive of a child's improvement trajectory. This paper provides an alternative approach to analysing cognitive training data that go beyond considering changes in individual tasks. This proof‐of‐principle demonstrates a potentially powerful way of distinguishing task‐specific from domain‐general changes following training and of establishing different profiles of response to training.

A classroom-based intervention targeting working memory, attention and language skills in 4-5 year olds (RECALL): study protocol for a cluster randomised feasibility trial

BACKGROUND

There is international recognition of the need for creative, classroom-based interventions to support children at risk of low academic achievement and well-being, due to poor attention and language skills on school entry. Working memory (WM) is a cognitive skill that is strongly associated with attention and language skills. There has been speculation that WM training, embedded within typical educational activities, may improve children's WM skills and produce transfer effects to real-world skills such as attention and language. However, little is known about the effectiveness of this approach.'Recall to Enhance Children's Attention, Language and Learning' (RECALL) is a novel, 6-week, classroom-based intervention targeting WM, attention and language skills in 4-5 year olds. RECALL was co-produced with health professionals, teachers and parents. This protocol describes the rationale, methods and analysis plan for a proposed cluster randomised feasibility trial of this RECALL programme.

METHODS

This is a three-arm, cluster randomised feasibility trial comparing RECALL to an existing programme (active control), and no-intervention (education as usual). We will recruit six schools in socially disadvantaged areas in one region of the UK. Two schools will be randomly allocated to each arm of the trial. In each school, one class of children (ages 4-5 years) of approx. 30 children will be involved in this study. Ten children in each class will be sampled purposefully for outcome measurement including: standardised assessments of WM, language and attention skills; teacher ratings of attention; and parent ratings of functional communication skills. These will be administered at baseline and 1-week post-intervention in order to test the acceptability of the measures. A process evaluation using semi-structured interviews with participants will explore the acceptability of RECALL and the procedures employed in this trial.

DISCUSSION

This feasibility study will explore the acceptability of RECALL to the health professionals and teachers who will deliver it and inform the optimal design of the programme. The inclusion of an active control group and the blinding of outcomes assessors enhance rigour in this study. The findings will determine whether this study can be scaled-up into a definitive cluster randomised trial to evaluate the effectiveness of RECALL.

TRIAL REGISTRATION

ISRCTN13633886. Registered 7 Sept 2018.

Interventions targeting working memory in 4-11 year olds within their everyday contexts: A systematic review

It has been suggested that diverse interventions applied within children's everyday contexts have the potential to improve working memory (WM) and produce transfer to real-world skills but little is known about the effectiveness of these approaches. This review aims to examine systematically the effectiveness of non-computerised interventions with 4-11 year olds to identify: (i) their effects on WM; (ii) whether benefits extend to near- and far-transfer measures; (iii) if gains are sustained over time; (iv) the active ingredients; and (v) the optimum dosage. Searches were conducted across 12 electronic databases using consistent keywords. Papers were screened by title and abstract (n = 6212) and judged against pre-defined eligibility criteria (n = 63). Eighteen papers were included in the review. They used a range of non-computerised WM intervention approaches that included: (i) adapting the environment to reduce WM loads; (ii) direct WM training with and without strategy instruction; and (iii) training skills which may indirectly impact on WM (physical activity, phonological awareness, fantastical play and inhibition). Both direct training on WM tasks and practicing certain skills that may impact indirectly on WM (physical activity, fantastical play and inhibition) produced improvements on WM tasks, with some benefits for near-transfer activities. The common ingredient across effective interventions was the executive-loaded nature of the trained task i.e., training on a task that taps into attentional and processing resources under executive control and not just the storage of information. Few studies reported dosage effects, measured far-transfer effects (n = 4), or tested the durability of gains over time (n = 4). The lack of a clear theoretical framework in many of the included studies resulted in ambiguous predictions about training and transfer effects, and inadequate use of outcome measures. Methodological issues also constrain the strength of the evidence, including: small samples sizes; an absence of blinding of participant and outcome assessors; and lack of active control groups. Further well-designed and controlled studies with clear theoretical underpinnings are required to expand and enhance the evidence base. The heterogeneity of the interventions and of the study designs (randomised and non-randomised) in the included papers limited the synthesis of evidence across studies. However, this diversity enabled the identification of key ingredients, notably the training of executive-loaded WM tasks, which can help inform novel approaches to WM intervention in everyday contexts.

Brain Training in Children and Adolescents: Is It Scientifically Valid?

Background: Brain training products are becoming increasingly popular for children and adolescents. Despite the marketing aimed at their use in the general population, these products may provide more benefits for specific neurologically impaired populations. A review of Brain Training (BT) products analyzing their efficacy while considering the methodological limitations of supporting research is required for practical applications. Method: searches were made of the PubMed database (until March 2017) for studies including: (1) empirical data on the use of brain training for children or adolescents and any effects on near transfer (NT) and/or far transfer (FT) and/or neuroplasticity, (2) use of brain training for cognitive training purposes, (3) commercially available training applications, (4) computer-based programs for children developed since the 1990s, and (5) relevant printed and peer-reviewed material. Results: Database searches yielded a total of 16,402 references, of which 70 met the inclusion criteria for the review. We classified programs in terms of neuroplasticity, near and far transfer, and long-term effects and their applied methodology. Regarding efficacy, only 10 studies (14.2%) have been found that support neuroplasticity, and the majority of brain training platforms claimed to be based on such concepts without providing any supporting scientific data. Thirty-six studies (51.4%) have shown far transfer (7 of them are non-independent) and only 11 (15.7%) maintained far transfer at follow-up. Considering the methodology, 40 studies (68.2%) were not randomized and controlled; for those randomized, only 9 studies (12.9%) were double-blind, and only 13 studies (18.6%) included active controls in their trials. Conclusion: Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. There is a lack of double-blind randomized trials which include an active control group as well as a passive control to properly control for contaminant variables. Based on our results, Brain Training Programs as commercially available products are not as effective as first expected or as they promise in their advertisements.

Effectiveness of a working memory intervention program in children with language disorders

The aim of this study was twofold: first, to obtain a neuropsychological characterization of children with language disorders, and second, to evaluate the effectiveness of an intervention program on working memory. We used a pretest-instruction-posttest design, carefully identifying a sample of 32 children with language disorders whom we then evaluated for short-term verbal and visuospatial memory, verbal and visuospatial working memory, attention, processing speed, and lexical-semantic skills. We then implemented an intervention program on working memory consisting of 72 sessions of 15 minutes each, after which we repeated the neuropsychological assessment of these functions. Children with language disorders performed worse than children in the control group in all memory tasks evaluated and in the lexical-semantic processing task. After the intervention, children with language disorders showed a significant increase over their own previous performance in all variables. Children with language disorders show significant cognitive deficits and not just linguistic impairment. We offer conclusive findings on the effectiveness of the intervention program used. Finally, we obtained partial support for the existence of a causal link between improved performance on memory tasks and performance in a lexical-semantic task.

Syntactic Versus Memory Accounts of the Sentence Comprehension Deficits of Specific Language Impairment: Looking Back, Looking Ahead

Purpose

Compared with same-age typically developing peers, school-age children with specific language impairment (SLI) exhibit significant deficits in spoken sentence comprehension. They also demonstrate a range of memory limitations. Whether these 2 deficit areas are related is unclear. The present review article aims to (a) review 2 main theoretical accounts of SLI sentence comprehension and various studies supporting each and (b) offer a new, broader, more integrated memory-based framework to guide future SLI research, as we believe the available evidence favors a memory-based perspective of SLI comprehension limitations.

Method

We reviewed the literature on the sentence comprehension abilities of English-speaking children with SLI from 2 theoretical perspectives.

Results

The sentence comprehension limitations of children with SLI appear to be more fully captured by a memory-based perspective than by a syntax-specific deficit perspective.

Conclusions

Although a memory-based view appears to be the better account of SLI sentence comprehension deficits, this view requires refinement and expansion. Current memory-based perspectives of adult sentence comprehension, with proper modification, offer SLI investigators new, more integrated memory frameworks within which to study and better understand the sentence comprehension abilities of children with SLI.

Transcranial Random Noise Stimulation Does Not Enhance the Effects of Working Memory Training

Transcranial random noise stimulation (tRNS), a noninvasive brain stimulation technique, enhances the generalization and sustainability of gains following mathematical training. Here it is combined for the first time with working memory training in a double-blind randomized controlled trial. Adults completed 10 sessions of Cogmed Working Memory Training with either active tRNS or sham stimulation applied bilaterally to dorsolateral pFC. Training was associated with gains on both the training tasks and on untrained tests of working memory that shared overlapping processes with the training tasks, but not with improvements on working memory tasks with distinct processing demands or tests of other cognitive abilities (e.g., IQ, maths). There was no evidence that tRNS increased the magnitude or transfer of these gains. Thus, combining tRNS with Cogmed Working Memory Training provides no additional therapeutic value.

Working memory training involves learning new skills

We present a new framework characterizing training-induced changes in WM as the acquisition of novel cognitive routines akin to learning a new skill. Predictions were tested in three studies analyzing the transfer between WM tasks following WM training. Study 1 reports a meta-analysis establishing substantial transfer when trained and untrained tasks shared either a serial recall, complex span or backward span paradigm. Transfer was weaker for serial recall of verbal than visuo-spatial material, suggesting that this paradigm is served by an existing verbal STM system and does not require a new routine. Re-analysis of published WM training data in Study 2 showed that transfer was restricted to tasks sharing properties proposed to require new routines. In a re-analysis of data from four studies, Study 3 demonstrated that transfer was greatest for children with higher fluid cognitive abilities. These findings suggest that development of new routines depends on general cognitive resources and that they can only be applied to other similarly-structured tasks.

Working Memory Training Does Not Improve Performance on Measures of Intelligence or Other Measures of "Far Transfer": Evidence From a Meta-Analytic Review

It has been claimed that working memory training programs produce diverse beneficial effects. This article presents a meta-analysis of working memory training studies (with a pretest-posttest design and a control group) that have examined transfer to other measures (nonverbal ability, verbal ability, word decoding, reading comprehension, or arithmetic; 87 publications with 145 experimental comparisons). Immediately following training there were reliable improvements on measures of intermediate transfer (verbal and visuospatial working memory). For measures of far transfer (nonverbal ability, verbal ability, word decoding, reading comprehension, arithmetic) there was no convincing evidence of any reliable improvements when working memory training was compared with a treated control condition. Furthermore, mediation analyses indicated that across studies, the degree of improvement on working memory measures was not related to the magnitude of far-transfer effects found. Finally, analysis of publication bias shows that there is no evidential value from the studies of working memory training using treated controls. The authors conclude that working memory training programs appear to produce short-term, specific training effects that do not generalize to measures of "real-world" cognitive skills. These results seriously question the practical and theoretical importance of current computerized working memory programs as methods of training working memory skills.

Neurocognitive factors in sensory restoration of early deafness: a connectome model

Progress in biomedical technology (cochlear, vestibular, and retinal implants) has led to remarkable success in neurosensory restoration, particularly in the auditory system. However, outcomes vary considerably, even after accounting for comorbidity-for example, after cochlear implantation, some deaf children develop spoken language skills approaching those of their hearing peers, whereas other children fail to do so. Here, we review evidence that auditory deprivation has widespread effects on brain development, affecting the capacity to process information beyond the auditory system. After sensory loss and deafness, the brain's effective connectivity is altered within the auditory system, between sensory systems, and between the auditory system and centres serving higher order neurocognitive functions. As a result, congenital sensory loss could be thought of as a connectome disease, with interindividual variability in the brain's adaptation to sensory loss underpinning much of the observed variation in outcome of cochlear implantation. Different executive functions, sequential processing, and concept formation are at particular risk in deaf children. A battery of clinical tests can allow early identification of neurocognitive risk factors. Intervention strategies that address these impairments with a personalised approach, taking interindividual variations into account, will further improve outcomes.

A debate on working memory and cognitive control: can we learn about the treatment of substance use disorders from the neural correlates of anorexia nervosa?

BACKGROUND

Anorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour. Intriguingly, people with AN are less likely to engage in substance use, whereas those who suffer from an ED with a bingeing component are more vulnerable to substance use disorder (SUD).

DISCUSSION

This insight into a beneficial consequence of appetite control in those with AN, which is shrouded by the many other unhealthy, excessive and deficit symptoms, may provide some clues as to how the brain could be trained to exert better, sustained control over appetitive and impulsive processes. Structural and functional brain imaging studies implicate the executive control network (ECN) and the salience network (SN) in the neuropathology of AN and SUD. Additionally, excessive employment of working memory (WM), alongside more prominent cognitive deficits may be utilised to cope with the experience of negative emotions and may account for aberrant brain function. WM enables mental rehearsal of cognitive strategies while regulating, restricting or avoiding neural responses associated with the SN. Therefore, high versus low WM capacity may be one of the factors that unites common cognitive and behavioural symptoms in those suffering from AN and SUD respectively. Furthermore, emerging evidence suggests that by evoking neural plasticity in the ECN and SN with WM training, improvements in neurocognitive function and cognitive control can be achieved. Thus, considering the neurocognitive processes of excessive appetite control and how it links to WM in AN may aid the application of adjunctive treatment for SUD.