Evidence-Based Working Memory Interventions

Dr. Milton J. DehnESC Webinar

April 2011

Notice of Copyright, 2012

This PowerPoint and accompanying materials are copyrighted by Milton J. Dehn and Schoolhouse Educational Services, LLC. All rights reserved. No photocopying, electronic display, or electronic dissemination of these materials is allowed without written permission.

Workshop Information Sources

• Dehn, M. J. (2008). Working Memory and Academic Learning: Assessment and Intervention. Wiley: 2008.

• Dehn, M. J. (2011). Helping Students Remember: Exercises and Strategies to Strengthen Memory

• Contact Info: Milton J. DehnSchoolhouse Ed. Servicescpps@psychprocesses.com

Approaches to ImprovingWM and Learning

1. Reduce the “cognitive load” imposed on the student (covered in previous session)

2. The student can make more effective use of existing WM capabilities by learning to use strategies

3. Directly increase WM capacity through the use of training exercises

4. Strengthen long-term memory

WM Workshop Content

1. WM strategies

2. WM exercises

3. LTM strategies that support WM

Memory Interventions Overview

1. They are evidence-based2. They are for educational environments3. One-on-one, small group, classroom wide4. Early elementary through adulthood5. Improvements are more in academic

performance rather than academic skills6. Related cognitive abilities may improve7. Recent evidence WM capacity can be increased,

by up to 15%

Concerns About WM Interventions

1. With multiple steps, strategies create too much cognitive load (a catch 22)

2. Exercises need to be daily for extended number of weeks

3. Some strategies difficult to generalize; content specific

4. Does improved WM transfer to improved academics?

How To Select AppropriateWM Interventions

1. Consider age and development2. Is metamemory high enough3. Do other cognitive processes support or add

to the problem, e.g. processing speed4. Match with specific WM strengths and

weaknesses, e.g. verbal vs visual-spatial5. Try to strengthen weaknesses directly but

also compensate by using strengths

How to Collect Data andDocument Progress

1. Pre and post standardized testing2. Measure changes in span directly, not with

standardized scores3. Rating scales before, during, and after, e.g.,

CPPS and WMRS4. Monitor acad. performance, e.g., homework 5. Assess attention/executive functions6. Collect classroom test scores

Rehearsal Strategies(For Phonological STM)

1. Most have by age 10; 1st graders can learn2. Serial and cumulative repetitive process3. Repeat first word until next delivered then add

next word to the repetition4. First aloud, then subvocal5. Good maintenance if overlearned6. Increase length of list 7. Example of 8-year old

Chunking Strategy

1. Pair items to be remembered2. Combining numbers or phonemes3. Chunks become patterns in LTM4. Direct student to chunk5. Make list longer as training proceeds6. Continue until chunking is automatic7. Spelling example, rehearse letters in syllable

chunks

Semantic Clustering

1. Grouping items by category (type of chunking)

2. Can be done with objects, pictures, words3. When recalling:

1. First recall the category2. Then how many items in category3. Then specific items4. For missing items, think of other items in this

category, in effect “recognizing” the response

Strengthening Executive Functions

1. Top-down approach2. WM is part of executive functions3. WM will improve when improved:

1. Focusing of attention; sustaining attention2. Self-awareness and self-monitoring3. Strategy use and appropriate strategy selection4. Planning and organization

Executive Aspect: Metamemory

1. Understanding memory functions (STM vs LTM)2. Self-awareness of strengths/weaknesses3. Knowing what you know

1. Judgments of learning4. Regulating/controlling memory5. Strategy knowledge and monitoring6. Conditional knowledge (why it works)7. Metamemory development is an essential

intervention component

Metamemory Training

1. Teach child how memory works and its limitations

2. Teach about how we can control memory3. Teach child self-awareness

1. Inform child of strengths and weaknesses

4. Necessary for effective strategy use5. Video I

Convincing Students of the Efficacy of Memory Interventions

1. Memorizing word list of objects verbally vs memorizing by creating an image of object

2. Organizational strategy1. Memorize random words2. Memorize words arranged in categories3. Dramatic improvement convinces student of

intervention efficacy

3. Important for maintenance I II

WM Exercises & the Brain

1. These are exercises, not strategies2. Brain plasticity should apply to WM3. To effect the brain, training must have

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

4. Klingberg claims working memory capacity can be increased in The Overflowing Brain

5. Cogmed: See YouTube Video

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, over 5 weeks4. Child can do without assistance5. Should not encourage use of strategies

Research on Cogmed

1. Documented growth in WM performance2. Fluid reasoning also improved in 1 study3. Parents report reduction in motor activity4. ADHD children improved in WM5. Holmes et al. found substantial and

sustained gains in WM and math6. More improvement on visual-spatial than

verbal; student example

Research On Cogmed Training

“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).

Jungle Memory

• Evidence-based for working memory• From UK researchers• Includes letters, words, and math facts• Only 3 exercises• More appropriate for elementary than older• Improvements in WM and academics• $49.99 for 8-week program• http://www.junglememory.com/

N-Back Task (Exec. WM)

1. Challenging task but easily administered2. Shown to improve WM capacity3. Remember stimulus n-items back4. Do it repetitively5. Deck of cards ideal; prevents practice effects6. Parents and children can practice at home7. n-back task8. What strategy would you teach the child for

succeeding at this?

N-Back Procedures

1. Display cards 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. 10-15 minutes of daily practice for 4 weeks5. More challenging: A double n-back6. Establish baseline 7. Encourage strategy use

Use Spans to Build STM/WM

• Visual– Counting Span---count dots on cards and keep

amounts in sequence– Block Tapping Span– Use locations on grid for spatial

• Verbal/Phonological– Letter, number, words– Listening---remember last word in sentence

• Encourages strategy development

Using Math to Build WM

• Complete calculations• Remember the answers in sequence– 4 + 3 = 7– 9 – 3 = 6

– Response: 7, 6

Visuospatial STM

• Place items on grid• Link• Verbalize what you see

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

LTM Interventions for WM Deficits

• When LTM structures are stronger, less WM processing (cognitive load) is required– Expertise– Automaticity

Verbal Memory Strategy: Elaboration

1. If a form of deeper processing2. Relate new info. with previous3. Facilitates encoding and LTM organization,

consolidation, retrieval4. Ties info. with appropriate schema5. Give it structure to make it manageable:

Example: Asking and answering the “Why does this make sense” question

Distributed/Spaced Practice1. More efficient than massed/daily review2. Strengthens neural pathways3. Increases learning by 15%4. Builds on remembered information5. Supports consolidation & semantic memory6. Information must actually be retrieved; best when

effortful retrieval needed7. Review should be about the time half of the

information has been forgotten1. E.g., 1, 2, 4 days, 1, 2, 4 week intervals

Periodic Testing

1. Extremely effective2. Works because retrieval is required3. Can be self-testing4. First quiz immediately or within a day5. Expanding intervals like periodic review6. Not limited to items actually tested7. Even more effective with corrective feedback8. Also works with self-testing

PQRST

1. Provides structure to reduce WM load and improve comprehension

2. Preview and skim the passage3. Generate questions and make predictions4. Actively read the passage while seeking

answers to the questions5. Study the information and state the answers

to the questions6. Self-test answers to the questions

Mnemonics

1. Allows use of visual memory strength2. Have structure to reduce load on WM 3. Visual mnemonics link information to

something already known that will not be forgotten1. Act as a scaffold or bridge

4. Verbal mnemonics not effective with verbal learning disabilities

Visual Mnemonics

1. Creates associations and meaning2. Best when student creates images3. Interactive images best4. Best when images are funny or unusual5. Ideal for those with verbal WM deficit6. Basic visualization without a mnemonic is

also beneficial

Keyword

1. Highly effective2. Combines auditory and visual3. First, the acoustical link (keyword)4. Then, image of linked items interacting5. To retrieve, think of keyword first6. LD do better when keyword and image

provided Video

Keyword Practice

• Use keywords for Denver, Colorado• Use keyword for these Spanish words:• Vaca = cow• Carta = letter• Escalera = ladderMake the images unique, interactive, but

focused on the keyword and meaning

WM Accommodations

• Extended testing time• Repeating information• Repeating information in a simplified manner• Providing written checklists and reminders of step-

by-step procedures• One task at a time• Slow down presentation• Preferential seating to reduce distraction• Provide prompts and cues

More Accommodations

• Inform student of exam dates well in advance to allow for periodic review

• Provide review sheets in same format as tests• Provide notes of lectures• Allow students procedural checklists• Recognition testing: word banks, etc.• Notes during test

External Memory Aids

• Diaries or journals• Memory books or memory notebooks Link• Alarms and timers• Reminders provided by computers• Schedules and assignment calendars• Checklists with step-by-step procedures• Folders for organizing notes and materials• Lists of activities that need to be completed• Step-by-step instructions for using a strategy

TBI Intervention Case• Fractured skull (parietal area) as infant• Surgery; surgeon predicted no LTM deficit• Normal development at age 3• Expressive language delays in kindergarten• Spec. Ed. by grade 3• Memory problems at home evident• Deficits in STM, WM, and LTM• Problems: Encoding, storing, retrieving• Delayed strategy development• Difficulties in reading and reading comprehension

TBI Case Test Scores• Phonological STM = 82• Verbal WM = 94• Executive WM = 92• Long-Term Retrieval = 82• Phonological Processing = 95• Fluid Reasoning = 83• Processing Speed = 101• Learning = 85

TBI Case Interventions

1. Phonics-based reading2. Reading comprehension strategies3. Metamemory4. Phonological STM rehearsal practice5. Organizational strategy---semantic grouping

of objects & words6. Visual imagery, e.g. picture the words

TBI Case WJ III COG Results

1. Long-Term Retrieval +102. Visual-Auditory Learning +12 3. Memory for Words +10 (Phono STM)4. Short-Term Memory Factor +35. Auditory Working Mem. +8 (Verbal WM)6. Numbers Reversed -5 (Executive WM)7. Working Memory Factor 0

TBI Classroom Recommendations

1. Organizational strategies2. Paraphrasing3. Context-episodic clues4. Dual encoding5. Elaboration6. Visual mnemonics7. Accommodation: Prompts & cues