Academic journal article Iranian Journal of Psychiatry

Working Memory Training in the Form of Structured Games in Children with Attention Deficit Hyperactivity Disorder

Academic journal article Iranian Journal of Psychiatry

Working Memory Training in the Form of Structured Games in Children with Attention Deficit Hyperactivity Disorder

Article excerpt

Attention deficit hyperactivity disorder (ADHD) have been observed in 3 to 5% of school-age children and resulted in impaired academic performance and social function and usually persist into adulthood (1, 2). This research on ADHD children is mostly based on two theoretical approaches: Working memory (WM) (3-9), and motivational variables (10, 11).

According to the applied studies, WM is introduced as a core deficit in ADHD (12). WM is a limited capacity system for briefly storing and manipulating information. WM underlies the capacity to perform complex tasks such as learning, comprehension and planning (13, 14). WM is usually regarded as a fundamental function for other executive functions. Deficiencies in WM are mostly associated with some disorders and problems such as learning disabilities (15, 16), hyperactivity (9), lower academic

performance (17-19), mathematical difficulties and classroom inattention (20).

Recently, a computerized-training program has been developed to improve working memory deficits in children with ADHD, which consists of a number of computerized exercises (21-23). Motivation is a key component in memory training so the coach helps the person to maintain motivation throughout the training by continuous feedback and support (24). Computerized-training has only achieved moderate success in faster reaction times(25), retaining a large number of digits (26), improving WM in children with ADHD and ameliorating ADHD symptoms (23, 27) and in teaching rehearsal strategies to children with learning disabilities (2) and children with fetal alcohol spectrum disorder (28). However, no increase has been reported in WM capacity, long-lasting effects and generalization from trained tasks to non-trained tasks (23, 27).

A second approach to ADHD assumes an unusual sensitivity to reinforcement and reward (29-31). In fact, given the correct degree of external incentive during a potentially boring task may increase activation and effort resulting in cortical stimulation and helps children with ADHD to optimize their motivational state which lead to improve their performance (32) and withholds impulsive and inappropriate behaviors (33). Based on the cognitive-energetic model, ADHD causes defects at three levels: Cognitive mechanisms, energetic mechanisms and management system deficits. The cognitive-energetic model contains three levels. The first level of the cognitive-energetic model contains four general stages of encoding, search, decision and motor organization, which are cognitive mechanisms of attention. The second level comprises effort, arousal and activation, which are energetic mechanisms (34). The third level of the model is a management system associated with planning, monitoring and error detection and correction. These levels are depressed in ADHD (35). Based on cognitive-energetic model, children with ADHD suffer from non-optimal energetic behaviors (33). Reinforcement and motivation by means of games (36) or providing a game format for each task may stimulate the essential energy for completing the tasks (37, 38), and result in improvement in person's performance of the cognitive tasks (33). Providing external motivating contingencies in children with ADHD increase the activation/arousal state and consequently promote their optimal cognitive performance (39, 40). These motivational variables were used in this study as basic features for ADHD children. In fact, the therapist- child relationship was one of the important variables, which was considered in this study. It might be assumed that this relationship plays a role in reinforcing and motivating children during the therapeutic process .

In this study, we examined the effect of a novel WM training in the form of structured games in ADHD children in which the participants practiced structured games for twelve weeks. The key features of this training were using various techniques involving WM and executive functions on the one hand and the therapist -subjects' relationship to encourage them to complete the games on the other. …

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