Evidence-Based Interventions for
Students with Memory Problems
Milton J. Dehn, Ed.D., NCSP
NASP 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
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Working Memory and Academic Learning
Long-Term Memory Problems in Children
Helping Students Remember
Chapter in Essentials of Planning, Selecting, and
Tailoring Interventions for Unique Learners
References in handout packet
www.psychprocesses.com
www.SchoolhouseEducationalServices.com
www.workingmemoryonline.com
Presenter Contact: milt@psychprocesses.com
Workshop Topics
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Working memory details and components
Neuroanatomy of working memory
Classroom supports for working memory
Working memory exercises
Working memory strategies
Need for WM Interventions
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10% have a WM impairment-Alloway
Half of LD have a memory deficit (Dehn)
Under-identified in children & adolescents
Intervention expertise is lacking; identified
children not served
5. Mistaken for attention problems
6. “The elephant in the classroom”
Working Memory Definition
1. ST retention + processing = WM
2. “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
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STM adult span of 7; Digit span of 80?
WM limit of 4 “chunks”
Can be as little as one chunk in children
Processing & storage use same WM resource
Processing referred to as “cognitive load”
Concurrent processing lowers span
Strategies can increase span
Duration affected by rehearsal & amount of
interference
Cognitive Load Theory
1. Processing & storage both use WM capacity
2. “Cognitive Load” is the processing portion
3. 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 information
5. Environmental distractions and irrelevant
thoughts adds to cognitive load
6. 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 7
5. Example: remember steps while completing an
online task
Phonological STM (Auditory)
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Holds & manipulates speech-based info.
The coding is phonological
A loop of about 2 seconds
Span equals amount articulated in 2 sec.
1. Span increases with speech rate increases
5. Includes a subvocal rehearsal process
6. 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 updating
3. Concrete, nameable images are consciously
recoded verbally after age 8; tendency to
“abandon” visual-spatial
Verbal Working Memory
1. Processing plus storage; complex span
2. Effortful processing, manipulating,
transforming, while maintaining verbal
information
3. Meaningful processing, semantic information
4. Examples: Taking notes, reading
comprehension, mental arithmetic
Visuospatial Working Memory
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Both mental imagery and visual stimuli
Maintaining visual images during processing
Manipulating, restructuring images
Necessary for dealing with rotation
Example: On-going awareness of location of
automobiles in motion on a crowded
freeway
6. Related with math
Executive WM
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The essence of working memory
Combines storage and processing
Integrates visual and verbal
Controls and coordinates other components
Allocates/focuses attention
Inhibiting, shifting, updating
Involves strategy use
Often where the deficiency lies
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
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Language and listening comprehension
Following directions
Learning vocabulary
Note taking
Reasoning
All academic skills and complex learning
Moderate correlations up to .5 range
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
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Concussion/head injury
Alcohol/drug abuse
Diet/obesity
Anxiety/depression
Epilepsy
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 load
2. Or, allow processing without need to
remember; e.g. facts in writing are available
3. Or, processing reminders are available
4. Teach students to alternate between
processing and refreshing/rehearsing
5. Students learn under low load conditions
6. Automaticity/mastery reduces load
Reducing Cognitive Load
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Only one step, process at a time
Allow time for processing and rehearsal
Allow self-paced processing
Provide external memory aids
Quite learning environment
Organized materials and presentations
Worked, partially-completed examples
1. Keep adding more for student to complete
Reducing Cognitive Load
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Sequence material from simple to complex
Present material in an integrated way
Include visual presentation
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 strategies
2. They work because of brain plasticity
3. 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 levels
3. 25 sessions, 30 minutes each with 8
exercises out of 12, over 5 weeks
4. Child can do without assistance
5. Does not encourage use of strategies
6. See Video
Research on Cogmed Training
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Improved WM, especially visual-spatial
Fluid reasoning sometimes improves
Math sometimes improves
Parents report reduction in motor activity
ADHD children improved in WM
Holmes et al. found substantial and sustained
gains in WM and math
7. But two recent reviews have concluded that the
claims are “largely unsubstantiated”
8. Recent study with proper design: WM improved
Lumosity
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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 concern
2. Oral responding not allowed with online
training
3. A trainer, parent, or peer administers these
4. 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=7
9–3=6
Response: 7, 6
With groups, call on one student randomly
for response
Practice
N-Back Task (Exec. WM)
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Found to have corresponding growth in brain
Challenging task but easily administered
Remember stimulus n-items back
Do it repetitively
Deck of cards ideal; prevents practice effects
Parents and children can practice at home
n-back task
PracticeN-Back Practice.docx
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 seconds
2. Start over after 1st error
3. Should get 10 consecutive correct 3 times
before going to next N
4. 5 – 10 minutes, 4 times per week
5. More challenging: A double n-back
6. Establish baseline
7. Encourage strategy use
8. What other materials can be used?
9. See App
Oral WM Exercises
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Letters, numbers, words, sentences
Non-words are ideal
Pointing as directed
Remember last word in sentence
Require aloud rehearsal when child
can not maintain sequence
Guidelines for Selecting WM Apps
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Consistent high cognitive workloads
Processing and storage required during task
Program is adaptive; keeps records
Extensive practice time
Evidence base cited
More than visual-spatial; some kind of verbal
processing and retention required
7. 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 tasks
3. Increase in white matter correlated with
amount of training & improved performance
4. Mainly adjacent to the corpus callosum and
in white matter parietal region
5. Increased transfer of info, at the dorsolateral
prefrontal cortex, location of executive WM
Rehearsal Strategies
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Most have by age 10; 1st graders can learn
Serial and cumulative repetitive process
First aloud, then subvocal
Increase length of list as student improves
Good maintenance if overlearned
Academic benefits
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
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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
Memory Interventionist Training
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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