Evidence-Based Interventions for Students with Memory Problems

Milton J. Dehn, Ed.D., NCSPNASP Summer Conference

July 2014

Notice of Copyright 2014

This PowerPoint presentation and accompanying materials are copyrighted by Milton J. Dehn and Schoolhouse Educational Services, LLC. The PowerPoint and materials are not to be reprinted, copied, presented, or electronically disseminated without written permission. To obtain permission, email milt@psychprocesses.com.

Workshop Information Sources

1. Working Memory and Academic Learning2. Long-Term Memory Problems in Children3. Helping Students Remember4. Chapter in Essentials of Planning, Selecting, and

Tailoring Interventions for Unique Learners5. References in handout packet 6. www.psychprocesses.com7. www.SchoolhouseEducationalServices.com8. www.workingmemoryonline.com9. Presenter Contact: milt@psychprocesses.com

Workshop Topics

1. Working memory details and components2. Neuroanatomy of working memory3. Classroom supports for working memory4. Working memory exercises5. Working memory strategies

Need for WM Interventions

1. 10% have a WM impairment-Alloway2. Half of LD have a memory deficit (Dehn)3. Under-identified in children & adolescents4. Intervention expertise is lacking; identified

children not served5. Mistaken for attention problems6. “The elephant in the classroom”

Working Memory Definition

1. ST retention + processing = WM2. “WM: the limited capacity to retain

information while simultaneously manipulating the same or other information for a short period of time”

3. Keeping information in mind from moment to moment

4. STM is part of WM; WM “manages” STM as needed

WM Capacity

1. STM adult span of 7; Digit span of 80?2. WM limit of 4 “chunks”3. Can be as little as one chunk in children4. Processing & storage use same WM resource5. Processing referred to as “cognitive load”6. Concurrent processing lowers span7. Strategies can increase span8. Duration affected by rehearsal & amount of

interference

Cognitive Load Theory

1. Processing & storage both use WM capacity2. “Cognitive Load” is the processing portion3. The greater the processing demands, the less

that can be retained in WM/STM (linear rel.)4. In experiments with very high load, children

can typically retain one item of information5. Environmental distractions and irrelevant

thoughts adds to cognitive load6. Also, instructional and content variables

Retention as a Function of Cognitive Load

Task Switching (Time Sharing)

1. To retain info. in WM, one must frequently switch from processing to refreshing the info.

2. If the processing (cognitive load) is demanding, there will be less switching and more info. will be lost

3. Theoretically, when cognitive load consumes all of WM; all info. is lost (Barrouillet, 2011)

4. Switching is difficult for young children under age 75. Example: remember steps while completing an

online task

Phonological STM (Auditory)

1. Holds & manipulates speech-based info.2. The coding is phonological3. A loop of about 2 seconds4. Span equals amount articulated in 2 sec.

1. Span increases with speech rate increases

5. Includes a subvocal rehearsal process6. Similarity/rhyming reduces span (interference)7. Related to phonological processing & language

development & basic reading skills

Visuospatial STM

1. Visual (object) and spatial (location); these are separate neurologically, e.g. dorsal (spatial) and ventral (visual) stream and thus should be considered separately

2. Is automatically updating3. Concrete, nameable images are consciously

recoded verbally after age 8; tendency to “abandon” visual-spatial

Verbal Working Memory

1. Processing plus storage; complex span2. Effortful processing, manipulating,

transforming, while maintaining verbal information

3. Meaningful processing, semantic information4. Examples: Taking notes, reading

comprehension, mental arithmetic

Visuospatial Working Memory

1. Both mental imagery and visual stimuli2. Maintaining visual images during processing3. Manipulating, restructuring images4. Necessary for dealing with rotation5. Example: On-going awareness of location of

automobiles in motion on a crowded freeway

6. Related with math

Executive WM

1. The essence of working memory2. Combines storage and processing3. Integrates visual and verbal4. Controls and coordinates other components 5. Allocates/focuses attention 6. Inhibiting, shifting, updating7. Involves strategy use8. Often where the deficiency lies 9. Close relationship with executive functions

WM Deficits and Academic Skills

1. Of children with WM abilities in the bottom 10 percentiles, over 80% have substantial problems in either reading or math, or most commonly both (Gathercole)

2. Their academic learning is frequently hindered by WM overload

3. Also necessary for successful academic performance

WM and Learning

1. WM capacity is a general limiting factor for academic learning; specifically, it is necessary for the generation and modification of knowledge stored in LTM

2. Direct access and maintenance of several separate elements is necessary to construct new relations in episodic WM and LTM

WM and Academic Learning

1. Language and listening comprehension2. Following directions3. Learning vocabulary4. Note taking5. Reasoning6. All academic skills and complex learning7. Moderate correlations up to .5 range8. WM more important than STM

Neuroanatomy

Prefrontal Cortex Image

Brain Lobes and STM & WM

1. Frontal (Dorsolateral Prefrontal Cortex): Executive WM

2. Temporal: Episodic WM (especially during LTM encoding and retrieval)

3. Parietal Lobes: Phonological STM and Verbal WM in language processing areas

4. Occipital Lobes: Visuospatial STM and WM

Neuropsychology of WM

• “working memory can be viewed as neither a unitary nor a dedicated system. Thus, working memory is not localized to a single brain region but probably is an emergent property of the functional interactions between the PFC and the rest of the brain” (D’Esposito, 2007)

• WM is related to integrity (strength) and extent of myelinated axons

• Adequate dopamine is required

Some WM Deficit Risk Factors

1. Concussion/head injury2. Alcohol/drug abuse3. Diet/obesity4. Anxiety/depression5. Epilepsy6. Language impairment

Approaches to Improving WM

1. Reduce the “cognitive load” imposed on the student (Tier I)

2. Directly increase WM capacity through the use of training exercises (Tiers II and III)

3. The student can make more effective use of existing WM capabilities by learning to use strategies (Tiers 1 – 3))

4. Accommodations

Reducing Cognitive Load

1. Well designed instruction reduces load2. Or, allow processing without need to

remember; e.g. facts in writing are available3. Or, processing reminders are available4. Teach students to alternate between

processing and refreshing/rehearsing 5. Students learn under low load conditions6. Automaticity/mastery reduces load

Reducing Cognitive Load

1. Only one step, process at a time2. Allow time for processing and rehearsal 3. Allow self-paced processing4. Provide external memory aids5. Quite learning environment6. Organized materials and presentations7. Worked, partially-completed examples

1. Keep adding more for student to complete

Reducing Cognitive Load

1. Sequence material from simple to complex2. Present material in an integrated way3. Include visual presentation4. Side by side information (being able to see as

all the information in an integrated fashion) better than stacked information

5. Avoid load that is not related or necessary to the learning (extraneous load)

Working Memory Training

1. These are exercises, not strategies2. They work because of brain plasticity3. To effect the brain, training must have

sufficient difficulty (at the limits of capacity) and intensity; and be repetitive and daily

Cogmed Training Details

1. Adaptive, game-like, internet-based training, records everything

2. Has preschool, school age, and adult levels3. 25 sessions, 30 minutes each with 8

exercises out of 12, over 5 weeks4. Child can do without assistance5. Does not encourage use of strategies6. See Video

Research on Cogmed Training

1. Improved WM, especially visual-spatial2. Fluid reasoning sometimes improves3. Math sometimes improves4. Parents report reduction in motor activity5. ADHD children improved in WM6. Holmes et al. found substantial and sustained gains in

WM and math7. But two recent reviews have concluded that the

claims are “largely unsubstantiated”8. Recent study with proper design: WM improved

Lumosity

• Numerous exercises; more than memory• Has N-Back exercises• Exercises based on research• Are adaptive and appropriate• Affordable plans, such as yearly• Can monitor learner’s progress• Best to select appropriate games rather than allow

Lumosity to control individual’s program• Officially, should be 13 years of age to use

Brain HQ

• Affordable plans, such as yearly• Variety of WM exercises• Well designed, challenging, cover a wide range

of ability and age• Has verbal WM exercises, e.g., listening to a

conversation

Hands-On, WM Exercises

1. Compliance with online training is a concern2. Oral responding not allowed with online

training3. A trainer, parent, or peer administers these4. With all exercises, require a longer span as

progress is made

Exercises: Using Math to Build WM

• Complete calculations• Remember the answers in sequence

4 + 3 = 79 – 3 = 6Response: 7, 6With groups, call on one student randomly for responsePractice

N-Back Task (Exec. WM)

1. Found to have corresponding growth in brain2. Challenging task but easily administered3. Remember stimulus n-items back4. Do it repetitively5. Deck of cards ideal; prevents practice effects6. Parents and children can practice at home7. n-back task PracticeN-Back Practice.docx8. What strategy would you teach the child for

succeeding at this?9. Improvement will be slow at this task

N-Back Procedures

1. Display items one at a time for 1-2 seconds2. Start over after 1st error3. Should get 10 consecutive correct 3 times before going

to next N4. 5 – 10 minutes, 4 times per week5. More challenging: A double n-back6. Establish baseline 7. Encourage strategy use8. What other materials can be used? 9. See App

Oral WM Exercises

1. Letters, numbers, words, sentences 2. Non-words are ideal3. Pointing as directed4. Remember last word in sentence5. Require aloud rehearsal when child

can not maintain sequence

Guidelines for Selecting WM Apps

1. Consistent high cognitive workloads2. Processing and storage required during task3. Program is adaptive; keeps records4. Extensive practice time5. Evidence base cited6. More than visual-spatial; some kind of verbal

processing and retention required7. Encourages/requires a conscious strategy

Why WM Brain Training Works

“the experience of taxing WM to its limits over a sustained period of time may induce long-term plasticity through either improving the efficiency of neuronal responses or extending the cortical map serving WM. The training program may also promote self-awareness and the development of compensatory strategies.” Westerberg et al., 2007).

WM Training Impact on Brain

1. Takeuchi et al. (2010)2. Adaptive training with 2 N-Back visual tasks3. Increase in white matter correlated with

amount of training & improved performance4. Mainly adjacent to the corpus callosum and

in white matter parietal region5. Increased transfer of info, at the dorsolateral

prefrontal cortex, location of executive WM

Rehearsal Strategies

1. Most have by age 10; 1st graders can learn2. Serial and cumulative repetitive process3. First aloud, then subvocal4. Increase length of list as student improves5. Good maintenance if overlearned6. Academic benefits7. Students with severe memory problems can not

maintain sequence during verbal rehearsal

Three Ways of Practicing Rehearsal

1. Say entire span and then have student practice saying entire span 4-5 times

2. Student repeats first word until next delivered then adds next word to the repetition (cumulative method)

3. Use nonwords for practice (reduces support from long-term memory)

4. See Training Manual; Helping Students; Practice

WM Accommodations

1. Extended testing time2. Repeating information3. Repeating information in a simplified manner4. Providing written checklists and reminders of

step-by-step procedures5. One task at a time6. Slow down presentation7. Preferential seating to reduce distraction8. Provide prompts and cues

Memory Interventionist Training

• For school psychologists and related professionals• Taught by Dr. Dehn• Taught once per year, beginning in fall• CEU’s from Kids, Inc.• 36-hour course• Includes neuropsych assessment of memory• Case study with supervision• Details: email milt@psychprocesses.com• www.SchoolhouseEducationalServices.com