BACKGROUND: Working memory is a cognitive function involving storage and information processing while actively completing other complex cognitive tasks. Working memory is considered part of a larger system known as the executive system, and is related to reasoning, problem solving, planning, and attention. Working memory deficits are often a prominent feature noted in clinical disorders, such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Learning Disorders (LD); thus, there is a need for evidenced-based treatments that address the working memory challenges. In addition, there is evidence that working memory abilities subserve adaptive skill developments, such as communication, initiation, and self-care, substantiating the need for working memory focused interventions. The purpose of this study was to investigate the clinical utility of Cogmed, a 5-week computerized working memory intervention program, with youth commonly served at an outpatient training clinic. In addition, this dissertation aimed to address the generalization of effects of Cogmed beyond working memory capabilities. METHODS: Three female, elementary-aged youth completed a battery of verbal and visual working memory measures (WISC-IV/V, SB-5, WRAML2) as well as an adaptive behavior questionnaire (BASC-2) before and after completing the Cogmed intervention program. In addition, measures of progress that are built into the Cogmed program were used to evaluate performance over time (Training Index, Cogmed Progress Indicator, Level on Training Tasks). Caregivers of youth completed behavioral measures of adaptive functioning at the same pre- and post-Cogmed time points, as well as a post-Cogmed questionnaire regarding the usability, feasibility, and satisfaction with Cogmed. RESULTS: Comparisons of performance on working memory measures before and after Cogmed were variable across participants, with some reliable improvement shown on visual and verbal working memory with one participant and no changes shown with the other participant. The third participant prematurely terminated the intervention. Improvements in scores on Cogmed measures of progress were proportional to the number of days trained. There was no evidence of reliable change on measures of adaptive skills from before to after Cogmed. Though increased difficulty to complete Cogmed training each day was reported due to the intensity and duration of the program, youth and caregivers reported a generally positive view of the usability and feasibility of Cogmed. CONCLUSIONS: Overall, the results provided evidence for mixed improvement on working memory indices for the three participants. Improvement was noted on internal Cogmed indicators and on neuropsychological tests most similar to the Cogmed tasks. In contrast, less similar neuropsychological working memory tasks showed no change. Furthermore, there was no evidence to support the generalization of the results to adaptive skill development. Though Cogmed was a feasible treatment modality from an administration perspective, the time commitment, intensity, financial commitment, and necessary caregiver involvement suggests that Cogmed is a difficult intervention to implement in an outpatient student training clinic. Limitations of the current study and future directions for research are discussed.
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