In subsequent studies, the same authors demonstrated that the effects were maintained at a 6-month follow-up Steiner et al. The participants followed 40 NF sessions in a school environment and three measurements of each were obtained: baseline, post-test, and 5-month follow-up.
The results showed that following the intervention, improvements were observed in a continuous performance test and a shifting attention task. The results obtained from reading fluency tests revealed little change, although participants demonstrated gains in reading comprehension. In this case, it would be interesting to conduct a randomized controlled trial that included attentional measures, in order to support their findings. A study of typically-developing 4—5-year-old children was conducted by Thorell et al.
After 5 weeks of training they attended min sessions each day , the children who received WM training improved significantly in non-trained visuospatial WM tasks, as well as in attention tasks the children who were trained in inhibition did not display significant improvements in untrained tasks. In this case, Cogmed seemed to be effective for typically-developing children aged 4—5 years in terms of NT.
In another study with typically developed children of the same age, Bergman-Nutley et al. In their study, children who received WM training Cogmed standard protocol showed significant improvements in a word decoding test compared to the control group. The implication is that there is a WM requirement for initial readers when the decoding process is not yet automatized, and the training was effective in improving this component.
An experimental group received 25 sessions for 20 min over 5 weeks at school, while a control group continued as usual. Furthermore, the progress in both math and reading in the trained group was directly related to the amount of improvement seen in the WM tasks. These results demonstrate transfer effects of training with a long-term effect. Nevertheless, these results must be considered with caution due to the non-independent nature of the study the researchers have any kind of connection to the company or product.
In children aged 9—16, Gibson et al. Finally, Hitchcock and Westwell compared WM training in children aged 12 years adaptive vs. It seems that studies on typically-developing children support evidence of NT especially in preschoolers , yet there is no independent research to support FT for this population. Klingberg et al. Transfer in both studies is not only NT but also FT. However, these initial studies are not independent and therefore must be considered with caution.
In this controlled trial, the experimental group improved in the areas of inattention, the overall number of ADHD symptoms, initiation, planning, and WM as rated by parents.
Teacher ratings approached significance at posttreatment and at a 4-month follow-up in the area of initiative. Green et al. Other studies, such as Dahlin , relate WM training to school performance in math for an experimental group that received the Cogmed standard protocol. Compared to controls, the experimental group improved significantly in WM tasks and in math results.
However, because the sample was not randomized, the results should be taken with caution. Egeland et al. The experimental group's scores after undergoing Cogmed standard training significantly increased compared to the control group in visual and auditory WM.
A later study conducted by Bigorra et al. Holmes et al. The results demonstrated that WM training produced WM and central executive gains that were maintained 6 months after treatment; nevertheless, this is a comparative study not controlled. They valued not only cognitive outcomes and academic performance but also behavioral aspects including after 6 months of intervention. The authors concluded that CT produced improvements at a cognitive level in the different tests , but not in academic performance or behavior.
In the same way, Chacko et al. Similar results were obtained by Dongen-Boomsma et al. Gibson et al. They conceptualize WM in two aspects: 1 retention and maintenance of information during distractions, and, 2 recovering information from the secondary memory SM.
Likewise, in a later study Gibson et al. Their results showed WM training to be effective only for the first aspect of WM.
FT results are controversial due to a lack of consistent findings, failures to replicate, and methodological limitations. In children with low WM capability, Bergman-Nutley and Klingberg attempted to determine whether WM training Cogmed standard protocol could show FT on following instructions and arithmetic. They assessed WM five times during and after training , following instructions and arithmetic using tests developed by Pearson and Cogmed. The training group improved significantly more than the control group in all three transfer tests.
Using a regression model, transfer increased linearly with the amount of training time, and correlated with the amount of improvement on the trained tasks. It must be considered that this study is non-independent. Another study with low WM children aged 9—10 years was conducted by Holmes et al. The controlled trial results showed that adaptive WM training benefitted WM and mathematical reasoning, and those gains were maintained after 6 months.
Holmes and Gathercole , in a randomized controlled trial with children aged 8—11 with low academic achievement, showed that after WM training Cogmed standard protocol conducted by teachers at school , WM, math and literacy improved. No follow-up was available. Along the same lines, Dunning et al. The sample was divided in three groups adaptive training, non-adaptive, and passive control group.
The group who received adaptive training improved significantly in WM tests, maintaining this progress in visuospatial and verbal WM after 1 year.
However, they did not obtain significant results in relation to the other groups in other cognitive areas FT. In the same way, Ang et al. Finally, the results of a study by Roberts et al. FT was not found in reading, spelling or math. In this population, robust findings supported NT and long-term effects but not further than 6 months , while FT and longer-term effects were not replicated.
For children with low to moderate IQ, some partial benefits of training have been shown. After training, the female participants showed improvement in instruction comprehension but not in other areas reasoning, language, behavior rated by parents etc. After a 1-year follow-up there were no significant improvements. It seems that individual differences compromised results: only female participants without an additional diagnosis and with higher baseline performance showed greater progress.
In this sense, a minimum cognitive capacity seems necessary for the training to be beneficial, and a greater training time is required to reach sustainable training effects. Similar results were found in a pseudorandomized trial with children with low IQ Soderqvist et al.
A randomized controlled study on children with Down syndrome conducted by Bennett Bennett et al. Partanen et al. No transfer to arithmetic or reading and writing skills occurred in any of the two training conditions. In this population, only Dahlin has found FT; a controlled trial showed that children trained in WM Cogmed standard protocol at school increased scores in reading comprehension, and those gains were maintained at a 7-month follow-up.
Some variables, such as cognitive level in lower IQ children, might influence WM training effects, but few transfer benefits in WM and reading comprehension were found. Focusing on children with language learning disabilities, Holmes et al. There was no control group and both groups received intervention. They took part in 20 sessions of min over 8 weeks in small groups at school.
The results showed that both groups improved their visuospatial short-term memory. Exploratory analyses across the sample established that low verbal IQ scores were strongly and highly-specifically associated with greater gains in verbal span-like WM tasks, and those children with higher verbal IQs made greater gains in visuospatial STM following training.
In another study, children with cochlear implants received the standard Cogmed protocol Kronenberger et al. The researchers compared scores during wait time and training.
After training, children demonstrated a significant improvement in measures of verbal and nonverbal WM, sentence-repetition skills and parent-reported working memory behavior. Sentence repetition continued to show marked improvement at a 6-month follow-up.
In this area, randomized controlled trials would be crucial to replicate results. A number of studies using Cogmed have been conducted with a population at risk of learning disabilities. On the one hand, some studies have focused on low birthweight or preterm children. Grunewaldt et al. They showed that WM training Cogmed JM version: 10—15 min per session for 5 days per week over 5 weeks at home benefitted WM and auditory attention, phonological awareness, facial memory, narrative memory, spatial span, and sentence repetitions.
There were no effects on anxiety reduction. Later, Grunewaldt et al. An experimental group received the standard Cogmed JM protocol at home. After training, some gains or equivalent scores as the control group were found in facial memory, narrative memory and spatial span, which remained at a 7-month follow-up.
No group differences in performance gain were found for attention and behavior. It seems than FT to attention and behavior was not found in this case. A study conducted by Lee et al. In this population, NT and FT in memory has been demonstrated, nevertheless there have been no findings so far for attention or behavior. On the other hand, children with a low sociocultural level SES are also at risk of potential learning difficulties. Foy and Mann carried out a study in an attempt to prevent learning difficulties.
Through a sample of children aged 4—5 years pre-readers with a low socio-cultural level, they assessed whether WM training had some NT in WM, as well as FT on self-regulation and pre-literacy skills. For this purpose, one group received training in WM and another group did not receive any intervention. Their conclusions are that training favors the visuospatial memory of the trained children, as well as their self-regulation or executive control assessed in inhibition tasks , but not on the prerequisites of literacy e.
Another study on children with a low socioeconomic level was conducted by Mezzacappa and Buckner In this pilot study with a single group design, they compared WM and behavior symptoms of ADHD before and after training as rated by teachers.
After treatment, WM and behavior improved. Further research in this area is needed to provide more robust results. Some researchers have focused on populations with different diseases such as cancer. Immediately after treatment, the adaptive training group displayed significant improvements not at follow-up in their visual WM and in parent-rated learning problems, compared with those in the active control group.
Conklin et al. WM and processing speed gains were maintained at a 6-month follow-up. In this area, further research is required to better clarify the efficacy of Cogmed intervention.
For children and adolescents with epilepsy, Kerr and Blackwell conducted a randomized controlled trial, the results of which showed that the trained group had significant post-interventive treatment effects for visual attention span, auditory WM, and visual-verbal WM NT. Similar results were obtained by Fuentes and Kerr , nevertheless FT in fluid reasoning was not observed.
Indeed, further research is needed in this area to replicate results and to demonstrate the existence of any FT. Finally, in terms of brain damage, Eve et al. They receive the standard Cogmed WM Training at home, supervised by their parents. Measures of WM, attention, and mathematical achievement were conducted before and after intervention, and at a 1-year follow-up.
The results indicated that a significant improvement in phonological-loop WM was produced, however, this improvement was not maintained after 12 months. No additional significant improvements on standardized psychometric outcome measures were seen either immediately or at the month follow-up. Phillips et al. The results demonstrated a significant difference in favor of the adaptive training group in WM and reading reading comprehension and reading accuracy ; the latter was maintained at a 3-month follow-up.
However, no benefits were found in math. This finding may not support WM training for these patients; thus, further randomized controlled trials with children with brain damage would help to clarify this issue. Finally, some studies have been conducted on children and adolescents with behavioral problems. Regarding children with externalizing behavior problems, Graziano and Hart conducted a randomized trial on preschoolers.
In this study, the participants completed an 8-week intervention. The results suggested that, although all groups improved in behavioral functioning groups at a similar magnitude, children in the STP-PreK Enhanced group experienced greater growth over time.
This group and STT-PREK maintained improvements at a 6-month follow-up in academic achievement, emotional knowledge, emotion regulation, and executive functioning compared to children with PT only. In children with behavior problems aged 11—13 years, Roughan and Hadwin , in a randomized controlled trial, showed that the group trained in Cogmed standard protocol had better post-training scores in measures of IQ, inhibition, test anxiety, teacher-reported behavior, attention and emotional symptoms, compared with a non-intervention passive group; differences in WM were also evident at a 3-month follow-up.
In adolescents with high scores on anxiety questionnaires, Hadwin and Richards , in a randomized controlled trial, compared WM training Cogmed standard protocol vs. CBT intervention small group activities on feelings, thoughts, relaxation techniques, problem solving, and coping strategies in small groups.
After treatment, the WM training group showed significant gains in WM. Both groups reported fewer anxiety symptoms, demonstrated increased inhibitory control and a reduction in attentional biases to threat post intervention, and these results were maintained after 4 months.
In children with behavioral problems, the results are encouraging for better regulation of behavior though cognitive training of WM. This program, mentioned in section 1, is also supported by a study using psychometric tests to improve training efficacy.
These results were maintained at follow-up six months after intervention. As this is a non-independent research, the results must be considered with caution. In later studies, the same authors demonstrated that the effects were maintained at 6-month follow-up Steiner et al. This online platform is designed to train EF and was endorsed by a randomized, double-blind, placebo-controlled trial on children with ADHD aged 8—12 years Dovis et al.
The experimental group received 25 sessions of 30—35 min each. After training, the trained group significantly improved in EF trained skills NT. No FT on behavior or long-term effects were found. This online platform to train attention is supported by a study which tests NT Bikic et al.
In this randomized, controlled trial with children with ADHD aged 6—13 , the results showed that the trained group 40 min per day for 6 days per week over 8 weeks at home displayed significant improvements in the primary outcome of attention.
No long-term effect was confirmed. This application designed for autistic children is supported by a controlled study to test its efficacy. Following training, the results showed that the children improved in the areas of attention, association and categorization, and interaction NT.
Nevertheless, it must be considered that the assessment was designed by researchers. This program which aims to train attention is supported by a recent study on program efficacy in children with intellectual and developmental disabilities Kirk et al.
The children were randomly assigned to a training group or to a placebo control. The trained group received 25 sessions of 20 min. Although after training no significant effects were found, scores in numeracy increased at a 3-month follow-up. It must be considered that this study only assessed FT on academic achievement.
The present paper highlights and summarizes the current state of BT research focused on children in recent years. It also defines different commercially available BT programs for these children by type of method or research applied to test program efficacy. This summary should be particularly useful for psychologists, educators, and parents for practical purposes.
A necessary consideration is that many BT programs are commercially available for children, yet the majority have not been endorsed by empirical research results. Here we attempt to provide a better understanding of which of these programs are supported by research, including their shortcomings and suggestions for future research. BT or CT should attempt to produce some observable brain changes.
As we have found, only a few BT products that are commercially available have empirical data that support evidence of neuroplasticity. Some BT programs have shown neuroplasticity using neuroimaging techniques such as FastForWord for children with dyslexia Temple et al. These suggestive neural changes are meant to reflect some improvement in cognition or behavior.
Regarding FT, the results are more encouraging in the clinical population than for typically-developing children, however, due to the limitations of many of the studies, further research is required.
Despite this, most BT programs claim to be based on neuroplasticity, yet, the majority are not supported by sufficient empirical research. Furthermore, confirming the existence of a relationship between neuroplasticity and transfer would provide more robust results in terms of program efficacy, because the relation between neural changes and improvements in cognition or behavior is still largely unexplored.
One of the challenges for BT is not only to produce NT improvement in a task or skill similar to the one that was trained , but FT improvement in an untrained task or skill which may produce some significant difference in the user's daily life. Several studies have shown transfer of different available programs and in different populations.
Cogmed is supported by the largest number of research studies on children and BT. This program has been tested on typically-developing children, yet the ones showing positive NT and FT results in these populations are non-independent research: NT in Pre-schoolers Thorell et al.
Despite this, independent research has found inconclusive results in children aged 9—16 years related to WM Gibson et al. In this case, we may ask ourselves why should this program be used with general population when there is a lack of consistent results. Nevertheless, only a few of these studies have shown long-term effects on NT Dunning et al. It seems that the majority of studies do not demonstrate long-term effects of training. NT of Cogmed has been also shown in children with special needs Partanen et al.
Despite this, the authors of these studies did not find FT. Two studies have found FT on reading or instruction comprehension Soderqvist et al. In children with language disabilities or hearing problems, there are two attempts to demonstrate the efficacy of Cogmed, however, the studies have not been properly randomized and controlled.
NT has been shown to occur Holmes et al. With regard to children at risk of developing learning difficulties, for children born preterm, a few studies have been conducted recently, especially on preschoolers, which showed NT and FT to some language skills related to WM Grunewaldt et al. In the same population, Lee et al. Therefore, at this stage, the results for this at-risk group are inconclusive. Diseases which may impact cognition have also come under the scope of WM training, such as cancer, epilepsy, and brain damage.
The results for cancer patients seem to be inconclusive. Using samples within a wide age range from children to adolescents, NT was found by Conklin et al. Furthermore, a wide age range has been studied for children with epilepsy and only NT has been found Kerr and Blackwell, with maintenance after 3 months Fuentes and Kerr, Finally, in terms of brain damage, only a few NT effects have been demonstrated in preteens and teens, yet, these were not maintained at 1-year post-intervention Eve et al.
Adaptive training is more effective than non-adaptive as in previous findings. In a study by Phillips et al. In this last study, a passive control group should be added to better interpret results. Finally, encouraging results have been found for children with behavioral problems, especially for teenagers and in combination with other techniques.
Some results have shown NT at maintenance and at a 3-month follow-up, however gains of FT on IQ, inhibition, anxiety, attention and emotional symptoms were not maintained at follow-up Roughan and Hadwin, Treatment combinations have yielded better results and maintenance, for instance, on preschoolers; using Cogmed in combination with other techniques social skills, self-regulation strategies benefits WM NT as well as other FT academic achievement, emotion knowledge, emotion regulation, and executive functioning maintained at 6 months Graziano and Hart, In this case, as Cogmed is part of a wider treatment, we cannot directly attribute improvement in dependent variables to the program.
Finally, it seems that Cogmed may be as beneficial as traditional treatment for teenagers with a focus on anxiety reduction and self-control improvement , and demonstrated maintenance at a 4-month follow-up Hadwin and Richards, As this platform is quite new, future research will be needed to clarify its benefits. In contrast, for the TALI attention training program, another touchscreen intervention, the research provided only non-significant improvement in children with intellectual and developmental disability Kirk et al.
A number of other programs have been supported by empirical research presented at professional conferences, and we hope to find further research and publications on these programs in future major scientific reviews. For instance, Arrowsmith, one of the best-known computer-based interventions for children with specials needs, is supported by an intervention trial conducted with children with learning disabilities, showing NT after treatment Fitzer et al. In this case, despite the fact that it has been on the market for several years, there is little evidence on it efficacy.
Nevertheless, other well-known platforms and computer-based interventions, such as Cognifit, Brain Master, Happy Neuron, Neuron UP, Fit Brains, Sincrolab Kids, Gomins application, Beebrite Edu, Identifor, and the Nexxo application still lack published empirical research conducted with child populations.
Independent randomized controlled trials with proper follow-ups will aid us to clarify the efficacy of these emerging computer-based interventions for children. In general, we have found some limitations of commercially available BT products: 1 lack of scientific validity of many programs designed to train specific brain skills; 2 only 10 studies Considering the methodological designs in the total of 70 published articles included in this review, we found: 1 fewer of half of them 30 or Considering the research limitations discovered, we consider that further research is needed to scientifically validate the new BT programs available on the market, through double-blind randomized controlled trials, which include a passive control group and active control group, in addition to proper follow-up assessments.
As we have seen, the majority of studies do not include an active control group and any follow-up beyond 6 months. Furthermore, a combination of neuroimaging techniques and psychometrical tools could be a robust method to demonstrate neuroplasticity and transfer effects to everyday life. For research designs we recommend that researches review criteria proposed by the IoM report Mahncke and Merzenich, about how to evaluate a BT program. It is necessary to consider some study limitations such as sample sizes, lack of tasks to evaluate transfer Cortese et al.
Thus, some authors propose different study designs to test programs including micro-trials and single-case studies Granic et al. Having seen the limitations of many BT programs to produce FT and long-lasting effects, together with the methodological research limitations, a combination of treatments might potentially be more profitable; i. Thus, programs which involve not only BT but also other strategies, thereby offering a treatment combination, may be more beneficial for some populations, such as children with behavioral problems, and produce more sustainable effects, as suggested by Graziano and Hart , or in children with special needs, as indicated by Partanen et al.
These findings support the idea that a combination of methods may be more profitable to implement and maintain cognitive and behavioral improvements over time. Future research should aim to clarify whether a combination of strategy implementation and programs would have a more significant and sustainable effect. Despite finding the benefits of BT or a treatment combination, some authors remain unconvinced by the difficulties BT programs reported here e. These authors emphasize that these activities are natural forms of training in which several skills are practiced in parallel.
If there are common activities that foster children's skills, should BT be incorporated for typically-developing children? Is it necessary to use a BT program to improve cognitive skills in typically-developing children while there are other activities in their everyday lives that seem to benefit them as well?
Why should we aim to improve children's abilities beyond usual child development? The results obtained for child populations are controversial because there is a large proportion of non-independent research. Regarding neuroplasticity, independent research has yielded positive results Rueda et al.
Non-independent research has produced better results in these populations regarding transfer or long-term effects Temple et al. Despite the fact that BT marketing is aimed at the general population, considering the results, we believe that BT research should contribute to validate programs as treatment tools for neurologically impaired patients, such as children with ADHD, learning disabilities, and behavioral problems.
Further research is required to test the efficacy of BT and to ascertain for which populations it may be suitable, and what strategies can foster the efficacy and long-term effects of CT. Permission must be obtained for use of copyrighted material from other sources including the web.
Please note that it is compulsory to follow figure instructions. So which ones? Because both are based on brain training that is focused on improving processing speed—the speed and accuracy with which the brain processes information. The images are only on the screen for a brief period of time—well under a second. You then have to say whether you saw the car or the truck in the center of your vision, and then you have to show where you saw the image in your peripheral vision.
This challenges the speed and the accuracy of your visual system. And as you get faster and more accurate, the speed increases and the peripheral vision task gets more demanding—pushing your brain further. As your visual system is continually challenged by these specific tests, your brain will adapt through a process known as neuroplasticity.
These plasticity-based changes actually form new neuropathways in your brain—literally changing its shape. The new neuropathways can then be called upon to help you process stimuli beyond just the specific methods used in the brain training exercises. If you think about it, what you do, pretty much every waking moment, should be positively affected by a faster and more accurate brain.
Mahncke says that you can prime your brain for and spur it into plastic changes by challenging yourself in everyday life. Here are his four tips how to do that:.
My mom started harpsichord lessons—and practiced a lot! Despite what many apps and brain training companies will tell their customers, scientists have not uncovered the key ingredients that make an intervention effective, nor the recipes that would best address the diverse needs of those seeking help. Furthermore, most apps available to consumers have not undergone scientific validation at all. So how do we reconcile the mixed evidence in the field and at the same time cut through the hype?
We suggest that some of the confusion may result from the fact that little consideration has been given to who would benefit most from the brain training apps that are supported by research studies. Will it only be those who have some form of memory impairment, or can it also help those eager for self-improvement even though they are already functioning relatively well?
Although the jury is still out, there is evidence that short-term working memory training can provide benefits to relatively high functioning individuals, such as college students. For vision training, there are suggestions that even elite athletes can benefit. Still, whether one has a memory impairment or not, it is likely that, similar to diet or exercise, brain training does not benefit everyone in the same way.
We suggest that much of the debate, and the lack of consensus, revolves around the wrong scientific questions being asked. Specifically, the current paradigm is dominated by population health and research methods devoted towards group averages, when what most of us want to know is whether something is right for us. To illustrate the problem, consider the hypothetical situation in which one person in 10 gains a profound benefit from a particular memory training app.
In the population health model, outcomes are averaged across all individuals who received the intervention, and thus the profound benefit experienced by the few will be washed out by the lack of an effect in the many. Repeat this experiment across a number of different memory training apps, each potentially providing positive effects for different subgroups, and the collection of benefits experienced by some individuals will be hidden by the inappropriate research methods applied. The population health model, while highly appropriate when its assumptions are upheld, simply does not apply well in a diverse population where different people may interact with the training app in distinct ways and therefore show a range of benefits.
To overcome these limitations, our team is currently leveraging the power of citizen science. Similar to a large-scale study in the United Kingdom Brain Test Britain , promoted by Cambridge University and the BBC , we are seeking to recruit thousands of participants to help us uncover the potential merits of memory training.
To accomplish our goal, we have launched a new study funded by the National Institutes of Health that aims to recruit 30, volunteers to participate in a memory training study that compares multiple approaches to train working memory. The study will use a common set of assessment measures to evaluate potential training gains, and it will focus on individual differences.
Anyone older than 18 can join our study and help generate the data required to change the debate and move forward with a new paradigm of precision brain training. If you might be interested in joining our trial, go to the registration site at the University of California, Riverside.
Only by including a very large number of participants and evaluating how different training approaches and their outcomes relate to particular individuals can we address these controversies once and for all. It may be the case that most of the benefits will be found in those who have a condition that impairs their cognitive abilities, or we may find that high-functioning individuals may benefit from training.
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