Working Memory Problems in Dyslexia and their Remediation

1. Working Memory Problems in Dyslexia and their Remediation • Eric Falke, MD • Director of Research

2. Part 1: Introduction to working memory • Part 2: Cognitive profiling • Part 3: Benefits of working memory training Overview

3. Carroll students struggle with multiple aspects of language based instruction including decoding, reading fluency, reading comprehension, and writing. • Carroll students face additional learning difficulties which are being addressed by innovative programs in math and cognitive development. • Impairment in multiple academic domains is consistent with students’ high incidence of weaknesses in working memory. Overview: Part 1

4. Working memory has the highest correlation of any psychological measure with academic performance, including reading, writing, and math. • Similarly, working memory is an important component of multiple general cognitive measures such as attention, processing speed, and reasoning, that are weaker in dyslexic students. Overview: Part I

5. Children with ADHD and children with dyslexia have problems with working memory and attention. • Working memory and attention problems in dyslexia and ADHD have the same brain basis in the frontal and parietal lobes. Overview: Part I

6. Working memory can be improved by Cogmed training , a group of neuroscience based remediation exercises initially developed for ADHD. • Cogmed training should improve Carroll students’ performance in multiple academic and cognitive domains. Overview: Part I

7. Working memory has the highest correlation of any psychological measure with academic performance. Working Memory and Academics

8. Cognitive Processes and Learning Disabilities

9. Neuropsychological testing: dyslexics have deficits in multiple measures of general cognition including processing speed, working memory, and attention. • ~80% of Carroll students have working memory or processing speed weakness on WISC-IV (70% have working memory weakness). • Up to 50% of dyslexic students have ADHD. Cognition and Dyslexia

10. Working memory is often called the “mental workspace”: it stores and manipulates information. • Working memory provides brief storage (a few seconds) with limited capacity. • Working memory networks connect brain areas for storage and brain areas for manipulation of information. Working Memory Network

11. Sensory specific. • Verbal Short-Term Memory: brief retention of speech. • Visual-spatial Short-Term Memory: brief retention of visual and spatial information. Brain areas for storage

12. Multi-sensory. • Called the central executive. • Combines information in verbal and visual-spatial short-term memory with long-term knowledge in a task specific way. • Mediates the storage of new information in long-term memory. Brain area for manipulation

13. Working Memory Components

14. Central Executive and Related Cognitive Processes Cognitive Processes Overlap

15. 1. Attention 2. Executive processes 3. Fluid Reasoning 4. Long-term memory 5. Phonological processing 6. Planning 7. Processing speed (less so in adults) 8. G Central Executive and Related Cognitive Processes

16. Improving the central executive component will improve working memory and improve related processes. Domain-General Intervention

17. Cogmed offers a focused, intensive central executive intervention. • Its effectiveness is well documented in science literature. • It was developed for ADHD. • Training tasks involve the storage and manipulation of sequences of verbal or visual-spatial information or both. Training takes 35 minutes a day, 5 days a week, for 5 weeks. Cogmed

18. Cogmed normalizes working memory of people with ADHD symptoms. • Cogmed training transfers to decreased inattentive ADHD symptoms, improved reading comprehension and math ability. • The effect magnitude of Cogmed training is similar to stimulant medications on visual working memory, superior on other measures. • On fMRI scans, Cogmed training normalizes fronto-parietal lobe function, the same central executive brain area altered in dyslexics. Working Memory Can Be Improved

19. Cogmed improves working memory and attention in ADHD. • Dyslexics have the same working memory and attention problems as in ADHD. • The brain basis of these working memory problems is the same in both ADHD and dyslexia. • Cogmed training should improve multiple academic and neuropsychological measures in Carroll students. Summary: Part 1

20. All Carroll 6thgrade students were tested prior to Cogmed training. • 70 students were profiled on working memory. Part 2: Cognitive Profiling

21. AWMA reports

22. What profile(s) do you expect? Preliminary Results

23. ½ of Carroll 6th graders have a weakness on AWMA. • There are roughly equal numbers of Carroll 6th graders with either verbal or visual-spatial memory problems. • Note WISC-IV does not profile visual-spatial working memory. AWMA Pre-test Results

24. 6th Grade Visual-Spatial and Verbal Weaknesses

25. Most 6th graders have only 1 weakness

26. Distribution of 6th grade weaknesses

27. Student 1 Working Memory and Attention Student 2

28. There are focal weaknesses within the working memory networks which may also be targeted for intervention. • Different patterns of distraction on Cogmed exercises reflect an individual’s working memory strengths and weaknesses. Conclusions: Part 2

29. Does Cogmed training improve working memory? • Will working memory improvements transfer to improvements in attention, processing speed, executive function, and other working memory related cognitive measures? • Will working memory improvements transfer to academic skills such as reading and math? Cogmed Pilot Questions: Part 3

30. Does Cogmed training improve working memory? • Yes! • Will working memory improvements transfer to attention, processing speed, executive function, and other working memory related cognitive measures? • Yes! • Will working memory improvements transfer to academic skills such as reading and math? • Preliminary reading comprehension data indicate yes. Need to look at more data over time. Cogmed Pilot Answers

31. Students who responded Pre Post

32. Psychomotor Speed Students who responded Reaction Time

33. Cognitive Flexibility Students who responded Processing Speed

34. Executive Functioning Students who responded Non- Verbal Reasoning

35. Sustained Attention Students who responded: CNVS

36. Randomized and blind assortment to groups • Experimental group: 104 trials per day • Control group: 56 trials per day • Key point: we expect improvement in both groups • Hypothesis: we expect more improvement with more training Study Design

37. Group Data: AWMA P=0.014

38. Preliminary Post-test Data • Experimental group did better than control group on measures of reading comprehension. • Groups did not differ on reading comprehension measures before testing. • Response to Cogmed varied between individuals. Half of the experimental Cogmed group had high reading comprehension scores (Score of 90% or above) after training. • No student in the control Cogmed group had a score of 90% or above after training.

39. Does Cogmed training improve working memory? • Yes, for 3/5 of Carroll 6th graders. • Will working memory improvements transfer to attention, processing speed, executive function, and other working memory related cognitive measures? • Yes, for 70% of Carroll 6th graders • Will working memory improvements transfer to academic skills such as reading? • Yes, on preliminary reading comprehension tests. Need to look at more data over time and include additional reading and math measures. Cogmed Pilot Answers

40. Follow students for 1 year to determine persistence of benefits. • Look at effects of additional 5 weeks of training: more generalization? • Look at more academic data. Future Directions

41. Acknowledgements: • Thanks to • the more than 50 faculty, who administered the training and testing, • and the nearly 100 students who participated!