Non Computerised Circadian Interventions for Improving Working Memory Performance among Children

Working memory provides a mental workspace for tasks requiring both processing and storage. Working memory is a cognitive system whose essential function is to facilitate and beautify the potential of encoding, storage, and retrieval functions that are imperative for gaining knowledge and processing of facts. It has been prompted that various mediations applied within day-to-day contexts of children have the potential to improve working memory and generate transfer to real-world skills, anyway little is known about the effectiveness of these interventions among children. This review focuses to detect deliberately the adequacy of intervention or interventional package on working memory performance of children to identify their effects on Working memory, advantages extended to near-and far-transfer capability of interventions, and gains sustained overtime and dosage of it. Literature searches were conducted across 10 electronic data bases using consistent keywords. Papers were screened by h3 and abstract (n=964) and judged against predefined eligibility criteria (n=63). Eighteen papers were included in the appraisal. Different working memory interventional approaches were included such as adapting the surroundings to decrease working memory loads; direct working memory training with and without tactics mandate and coaching competencies which circuitously effect on working memory (athletics, lexical apprehension, astonishing man-made play, and self-possession). Both direct training on working memory undertakings and rehearsing certain abilities that may likewise affect randomly on working memory which delivered refinement on working memory errands. Hardly, any research articulated dosage impact, estimated outlying shift of outcomes (n=4), or tried the solidness of valid statements after added time (n=4). The absence of an unmistakable hypothetical structure brought about uncertain forecasts about instructing and switch impacts. Methodological difficulties likewise compel the intensity of the proof, including: small-scale sample sizes; oversight of blinding of members and result assessors; and shortfall of active control group.

Different cerebrum forms are associated with learning to such an extent that disturbances in any one procedure may bring about a learning difficulty. Learning difficulties are characterised as a noteworthy inconsistency in any case clarified by physical or tactile hindrances between the children’s scholarly working and scholastic exhibition. There is no single known reason for learning difficulties, however a few examinations have recognised hereditary components, sensorimotor framework mix impedances, and prematurity as hazard factors [1].

According to National Center of Learning Disability survey conducted in 2012, 12% adults have learning disability [2]. In India, reported prevalence of learning disability ranges from 1.6-15%, fluctuating dependent on age-orbit, study strategy, apparatus utilised and region of the country [3-6]. The general predominance of dyslexia in various pieces of the world is variable, (3.6-8.5% in Italy versus 4.5-12.0% in the United States) [7]. Dyslexia is the most widely recognised learning disability, affecting 80% of all those identified as learning-disabled [8]. The incidence of dyslexia in Indian primary school children has been reported to be 2-18%, dysgraphia 14%, and dyscalculia 5.5% [9].

Continuous examinations have focused on the part of working memory in learning difficulties. These investigations have discovered that working memory is a significant indicator of learning capacity [10]. Working memory appraisal can be useful in deciding learning capabilities in the child [11]. There is a speculation that diverse intervention applied within young children’s everyday contexts has the potential to improve their working memory skills such as attention, language, and academic attainment [12].

Working memory is the ability to hold in mind and manipulate information over short periods in the face of distraction. It develops more in the first 10 years of life and reaches adult capacity levels around the age of 14 years [13]. Working memory is a significant component of directorial functioning and is accepted to be indispensable for critical thinking. Accordingly, working memory is quintessential to the procurement of new understanding and abilities. Anatomically, working memory is directed by means of the frontal flap [3].

Working memory supports many everyday activities and is strongly linked with attention, language learning, mental math, understanding advancement, and receptive skills and dexterity. Subsequently, poor working memory is connected with a huge scope of learning challenges, alongside unique vocabulary weakness, dyslexia (translation troubles), dyscalculia (impairment to represent and process numerical magnitude of mathematics) [14]. Children with poor working memory aptitudes experience issues adapting to practically all study related exercises including, recollecting and completing guidelines, critical thinking, and arranging, sorting out and keeping track of tasks. Instructors often portray such children as careless and distracted [13]. Youngsters with poor working memory wrestle to adapt to the substantial working memory heap of the study hall. They are at risk for dropping out of school prematurely and failing to achieve their potential in life [12].

There are various theoretical models of the structure and functions of working memory. The multicomponent model of working memory is driven by the central executive, which is capable of retrieving information from the store in the form of conscious awareness [Table/Fig-1]. The episodic buffer is assumed to be a limited capacity storage system and controlled by central executive that is capable of integrating information from a variety of sources. It can store any kind of data-acoustic, visual and spatial. Visual-spatial sketchpad stores non verbal visual and spatial data like items and numbers. Phonological circle stores set number of discourse sounds for a brief period [15,16].

[Table/Fig-1]:

Baddeley’s (2000) working memory model [16].

LTM: Long-term memory

Research into the effectiveness of working memory training has stemmed from two perspectives, theoretical and applied perspectives [17]. The goal of a theoretical perspective is to understand underlying cognitive processes and also to identify variables that mediate the effects of training and transfer to other cognitive functions. The focus of an applied perspective is to investigate the impact of working memory training on outcomes relating to real-world skills such as attention, language and academic attainment. The most rigorous studies, meta-analyses and systematic reviews suggest that computerised training advances profit from the instructed tasks and untrained activities but far-transfer effects are small and not sustained over time [18-23]. The lack of consistent evidence for far-transfer effects of computerised working memory training has marked the need for alternative intervention approaches. The composed tasks need to be set as typical activities in children’s day-to-day schedule [24]. It has been reflected that a diverse range of activities may impact on working memory but little is known about their effectiveness.

Hence, the present review aimed to examine systematically the effectiveness of intervention or interventional package on working memory performance of children to identify; their effects on working memory, advantages extended to near-and-far transfer capacity of interventional package and gains sustained overtime and dosage of it.

A literature search was performed in the following electronic database: PubMed, CINHAL plus, Google Scholar, Research gate, Science direct, EBSCOhost, PsycINFO, SCOPUS, Web of Science, Shodhganga were used to search the literature for all publications from 1994 to 2019. Final searches were conducted using the terms “working memory” OR “short term memory” OR “executive function*” AND “child*" AND “(training OR intervention* OR treatment OR therapy OR program*)”.

Inclusion criteria

“PICO” framework

Exclusion criteria : Computerised working memory training studies were excluded.

[Table/Fig-2] portrays that from above listed search engines, total 964 articles were received; from that 368 articles were excluded based on exclusion criteria. So total retrieved articles were 596, among which 111 duplicate articles, 63 review articles and 359 abstracts were excluded on the basis of outcome measures. Final retrieved articles were 63; among them 45 full text articles were excluded; reasons were age of participants not included 4-11 years of children (n=1), did not implement non computerised working memory intervention approach (n=14), did not have randomised-controlled, quasi-experimental, or single-case experimental design (n=5), and did not include atleast one pre and post intervention measure of the trained task (n=25). Finally, 18 full text articles were included in the review.

[Table/Fig-2]:

Flow diagram of search strategy with reasons of exclusion.

All included studies have been categorised into four different patterns of intervention [Table/Fig-3]:

Adapting the surroundings (n=1): Just one research study [25] looked into the adequacy of the methodology which does never again require direct intercession with children. Rather, educators are prepared about how to contemplate children with functioning memory challenges and talented in how to adjust picking up information on activities limit working memory loads for these children. By diminishing working memory stacks in the study hall, children with poor working memory may strongly increase additional information on undertakings.

Direct working memory training without tactics mandate (n=3) [26-28]: Three intercessions included rehashed practice on verbal or visuospatial errands requiring transient memory (stockpiling just assignments) or executive stacked working memory (stockpiling in addition to an extra consideration or preparing load).

Direct working memory training with tactics mandate (n=5) [29-33]: Five research contemplates examined the viability of unequivocally teaching children to utilise intellectual strategies. The utilisation of systems to help the usefulness of working memory rises during adolescence. For example verbal practice (rehashing the to-be-recollected information boisterous or in your mind) creates at around seven years. Different techniques, for example, affiliation and gathering and piecing data develop subsequently. It has been recommended that youngsters can furthermore advantage higher from this system.

Coaching competencies which circuitously effect on working memory (n=9): A wide scope of exercises including judo, athletics, yoga, circumspection, music, sports and customary youth games can effect on executive function abilities including working memory. Nine research studies actualised assortment of intercessions: athletics (n=5) [34-38], lexical apprehension (n=2) [39,40], astonishing man-made play (n=1) [41] and self-possession (n=1) [42].

The aim of this review was to look methodically at the viability of intercessions concentrated on working memory performance of children in their everyday contexts. The first research objective was to identify the effects of interventions targeting working memory in children’s everyday contexts on each aspect of working memory. A systematic search of the literature resulted in 18 studies being reviewed, encompassing a range of intervention approaches including: adapting the surroundings to reduce working memory loads; direct working memory training without tactics mandate; direct working memory training with tactics mandate; and coaching competencies which circuitously effect on working memory (athletics, lexical apprehension, astonishing man-made play and self-possession). In majority of the studies, the aspect of working memory being trained or measured was not elucidated. Nonetheless, a significant outcome of this review is that working memory skills can be altered through diverse interventions, particularly in relation to verbal working memory skills which were more frequently measured than the visuospatial domain.

The second research objective was to identify near-and-far-transfer effects of working memory intervention package. The evidence here was limited because few studies measured these outcomes. However, there is preliminary evidence suggesting that certain direct and indirect working memory interventions applied within children’s everyday contexts have the potential to produce: near-transfer effects on similar working memory tasks [27,33]; and far-transfer effects on areas such as reading comprehension [27], numeracy skills [33], attention and behaviour [42].

The final research objective was regarding the durability and optimum dosage requirements for working memory interventions applied in children’s everyday circumstances. Reflection on the potential of these varied interventions to produce training and transfer effects leads to questions about which children may benefit most and the impact of individual differences. The age of participants varied within each intervention type, making it difficult to draw strong conclusions about age effects. A number of the interventions reviewed showed significant benefits for younger children (4-5-year-old) [28,40-42], reinforcing the idea that non computerised approaches might be more suitable for younger children.

The majority of studies were with typically developing children, meaning it was not possible to evaluate the effectiveness of the interventions for children with identified working memory difficulties, neurodevelopmental difficulties or at-risk groups such as those from low socio-economic backgrounds persist. Nonetheless, it would be beneficial in future reviews to evaluate the effect of differences in baseline abilities and other individual differences. The optimum dosage required to produce training effects remains uncertain because dosage variables were often unreported or showed significant variation across studies. However, relatively short interventions of five to six weeks in total duration were shown to be effective [27,41,42]. There is still a great deal to learn about optimal levels of dosage for interventions in the area of child language and development [43].

From both theoretical and applied perspectives, many questions about the utility of working memory training approaches remain unanswered. This review provides suggestive evidence for the effectiveness of diverse working memory interventions applied within children’s everyday context, when the trained tasks are executive loaded. Evidence has emerged of what might be possible and there are several advantages to the types of interventions reviewed here in comparison to computerised working memory training. These include: greater flexibility in how the tasks are presented; less of a requirement for young children to sit still for long periods of time; and opportunities to promote social and emotional development in activities embedded within the child’s own environment [44]. The considerable challenges of conducting further research in applied settings must also be acknowledged. It may eventually be possible to develop a hybrid intervention approach that integrates the benefits of computerised training and face-to-face training in everyday contexts. For example, education professionals could deliver practice trials on executive loaded working memory tasks in schools and record responses on a portable device (laptop or tablet) with software informing the facilitator about levels of difficulty.

Future studies need to present a clear theoretical account of how and why the intervention should impact working memory in hypothesis driven research. It will be important to apply greater rigour in study methodology, including the use of active control groups and randomised controlled designs. In order to develop a greater understanding of the relationship between intervention ingredients, working memory outcomes and real world skills, outcome measurement must be comprehensive. Greater attention must also be paid to intervention dosage. There is a need to look more closely within interventions, to distil them and identify exactly which ingredients and dosages act as optimal mechanisms of change.

Clarifying for whom non computerised working memory interventions may be most effective, and in what circumstances should be a goal of further research, future studies should target children from understudied sub-groups such as those with identified working memory difficulties, neurodevelopmental difficulties or at-risk groups such as those from low socio-economic backgrounds. Greater consideration should be given to the role of individual differences that could influence the effectiveness of interventions e.g., cognitive level motivation [45].

Only the non computerised interventions for improving working memory bases studies were included. Studies in which children aged 4-11 years whose working memory improved by non computerised interventions were included, so these are the main limitations for the study.

Varied interventions applied within young children’s everyday contexts, have produced improvements on their working memory skills and have the potential to produce near and far-transfer effects. Both direct training on working memory tasks and practicing certain skills that may indirectly impact on working memory (athletics, astonishing man-made play and self-possession) were beneficial. The strength of the evidence is tempered by rigorous methodology and consideration of dosage of working memory interventions. Further well-designed and controlled studies with comprehensive outcome measurement, comparing carefully-considered dosages, are required to expand and enhance the evidence base.

[1]. Wiguna T, Noorhana Setyawati WR, Kaligis F, Belfer ML, Learning difficulties and working memory deficits among primary school students in Jakarta, Indonesia Clin Psychopharmacol Neurosci 2012 10(2):105-09.10.9758/cpn.2012.10.2.10523431060  [Google Scholar]  [CrossRef]  [PubMed]

[2]. Cortiella C, Horowitz SH, The State of Learning Disabilities: Facts, Trends and Emerging Issues 2014 New YorkNational Center for Learning Disabilities  [Google Scholar]

[3]. Mogasale VV, Patil VD, Patil NM, Mogasale V, Prevalence of specific learning disabilities among primary school children in a South Indian city Indian J Pediatr 2012 79:342-47.10.1007/s12098-011-0553-321887581  [Google Scholar]  [CrossRef]  [PubMed]

[4]. Padhy SK, Goel S, Das SS, Sarkar S, Sharma V, Panigrahi M, Prevalence and patterns of learning disabilities in school children Indian J Pediatr 2016 83:300-06.10.1007/s12098-015-1862-826334861  [Google Scholar]  [CrossRef]  [PubMed]

[5]. Dhanda A, Jagawat T, Prevalence and pattern of learning disabilities in school children Delhi Psychiatry Journal 2013 6:386-90.  [Google Scholar]

[6]. Arun P, Chavan BS, Bhargava R, Sharma A, Kaur J, Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India Indian J Med Res 2013 138:89  [Google Scholar]

[7]. Lindgren SD, De Renzi E, Richman LC, Cross-national comparisons of developmental dyslexia in Italy and the United States Child Dev 1985 56(6):140410.2307/11304603878269  [Google Scholar]  [CrossRef]  [PubMed]

[8]. Goswami U, Learning difficulties: Future challenges. In: Cooper CL, Field J, Goswami U, Jenkins R, Sahakian BJ editors Mental capital and wellbeing 2008 UKJohn Wiley and Sons:727-66.  [Google Scholar]

[9]. Karande S, Kulkarni M, Specific learning disability: The invisible handicap Indian Pediatr 2005 42:05-09.  [Google Scholar]

[10]. Swanson HL, Siegel L, Learning disabilitiesas a working memory deficit Issues in Education: Contributions from Educational Psychology 2001 7(1):01-48.10.1179/2047387711Y.0000000011  [Google Scholar]  [CrossRef]

[11]. Malekpour M, Aghababaei S, Abedi A, Working memory and learning disabilities Int J Dev Disabil 2013 59(1):35-46.  [Google Scholar]

[12]. Rowe A, Titterington J, Holmes J, Henry L, Taggart L, Interventions targeting working memory in 4-11-year-old within their everyday contexts: A systematic review Dev Rev 2019 52:01-23.10.1016/j.dr.2019.02.00131417204  [Google Scholar]  [CrossRef]  [PubMed]

[13]. Alloway TP, Gathercole SE, Kirkwood H, Elliott J, The working memory rating scale: A classroom-based behavioral assessment of working memory Learn Individ Differ 2009 19(2):242-45.10.1016/j.lindif.2008.10.003  [Google Scholar]  [CrossRef]

[14]. Archibald LM, Gathercole SE, Nonword repetition in specific language impairment: More than a phonological short-term memory deficit Psychonomic Bulletin & Review 2007 14:919-24.10.3758/BF0319412218087960  [Google Scholar]  [CrossRef]  [PubMed]

[15]. Baddeley AD, Hitch G, Working memory Psychology of Learning and Motivation 1974 8:47-89.10.1016/S0079-7421(08)60452-1  [Google Scholar]  [CrossRef]

[16]. Baddeley AD, The episodic buffer: A new component of working memory? Trends in Cognitive Sciences 2000 4(11):417-23.10.1016/S1364-6613(00)01538-2  [Google Scholar]  [CrossRef]

[17]. Wass SV, Scerif G, Johnston MH, Training attentional control and working memory-is younger better? Developmental Review 2012 32:360-87.10.1016/j.dr.2012.07.001  [Google Scholar]  [CrossRef]

[18]. Gathercole SE, Dunning DL, Holmes J, Norris D, Working memory training involves learning new skills Journal of Memory and Language 2019 105:19-42.10.1016/j.jml.2018.10.00331235992  [Google Scholar]  [CrossRef]  [PubMed]

[19]. Barnett SM, Ceci SJ, When and where do we apply what we learn? A taxonomy for far transfer Psychological Bulletin 2002 128:612-37.10.1037/0033-2909.128.4.61212081085  [Google Scholar]  [CrossRef]  [PubMed]

[20]. Noack H, Lövdén M, Schmiedek F, Linderberger U, Cognitive plasticity in adulthood and old age: Gauging the generality of cognitive intervention effects Restorative Neurology and Neuroscience 2009 27:435-53.10.3233/RNN-2009-049619847069  [Google Scholar]  [CrossRef]  [PubMed]

[21]. Soveri A, Antfolk J, Karlsson L, Salo B, Laine M, Working memory training revisited: A multi-level meta-analysis of n-back train-ing studies Psychonomic Bulletin & Review 2017 24:1077-96.10.3758/s13423-016-1217-028116702  [Google Scholar]  [CrossRef]  [PubMed]

[22]. Sprenger AM, Atkins SM, Bolger DJ, Harbison JI, Novick JM, Chrabaszcz JS, Training working memory: Limits of transfer Intelligence 2013 41:638-63.10.1016/j.intell.2013.07.013  [Google Scholar]  [CrossRef]

[23]. Von Bastian CC, Oberauer K, Effects and mechanisms of working memory training: A review Psychological Research 2014 78:803-20.10.1007/s00426-013-0524-624213250  [Google Scholar]  [CrossRef]  [PubMed]

[24]. Dunning D, Holmes J, Does working memory training promote the use of strategies on untrained working memory tasks? Memory and Cognition 2014 2:854-62.10.3758/s13421-014-0410-524748348  [Google Scholar]  [CrossRef]  [PubMed]

[25]. Elliott JG, Gathercole SE, Alloway TP, Holmes J, Kirkwood H, An evaluation of a classroom-based intervention to help overcome working memory difficulties and improve long-term academic achievement J Cogn Educ Psychol 2010 9(3):227-50.10.1891/1945-8959.9.3.227  [Google Scholar]  [CrossRef]

[26]. Banales E, Kohnen S, McArthur G, Can verbal working memory training improve reading? Cogn Neuropsychol 2015 32(3-4):104-32.10.1080/02643294.2015.101433125734525  [Google Scholar]  [CrossRef]  [PubMed]

[27]. Henry AL, Messer DJ, Nash G, Testing for near and far transfer effects with a short, face-to-face adaptive working memory training intervention in typical children Infant Child Dev 2014 23:84-103.10.1002/icd.1816  [Google Scholar]  [CrossRef]

[28]. Passolunghi MC, Costa HM, Working memory and early numeracy training in preschool children Child Neuropsychol 2016 22(1):81-98.10.1080/09297049.2014.97172625366543  [Google Scholar]  [CrossRef]  [PubMed]

[29]. Caviola S, Mammarella IC, Cornoldi C, Lucangeli D, A metacognitive visuospatial working memory training for children Int Electron J Elem Educ 2009 2(1):122-36.  [Google Scholar]

[30]. Comblain A, Working memory in Down syndrome: Training the rehearsal strategy Down Syndr Res Pract 2007 2(3):123-26.10.3104/reports.42  [Google Scholar]  [CrossRef]

[31]. Cornoldi C, Carretti B, Drusi S, Tencati C, Improving problem solving in primary school students: The effect of a training programme focusing on metacognition and working memory Br J Educ Psychol 2015 85(3):424-39.10.1111/bjep.1208326099785  [Google Scholar]  [CrossRef]  [PubMed]

[32]. Peng P, Fuchs D, A randomised control trail of working memory training with and without strategy instruction J Learn Disabil 2017 50(1):62-80.10.1177/002221941559460926156961  [Google Scholar]  [CrossRef]  [PubMed]

[33]. Witt M, School based working memory training: Preliminary finding of improvement in children’s mathematical performance Adv Cogn Psychol 2011 7(1):07-15.10.2478/v10053-008-0083-321818243  [Google Scholar]  [CrossRef]  [PubMed]

[34]. Alesi M, Bianco A, Luppina G, Palma A, Pepi A, Improving children’s coordinative skills and executive functions: The effects of a football exercise program Percept Mot Skills 2016 122(1):27-46.10.1177/003151251562752727420304  [Google Scholar]  [CrossRef]  [PubMed]

[35]. Davis CL, Tomporowski PD, Gregoski M, Boyle CA, Waller JL, Miller PH, Effects of aerobic exercise on overweight children’s cognitive functioning: A randomised controlled trial Res Q Exerc Sport 2007 78(5):510-19.10.5641/193250307X1308251281766018274222  [Google Scholar]  [CrossRef]  [PubMed]

[36]. Kamijo K, Pontifex MB, O’Leary KC, Scudder MR, Wu CT, Castelli DM, The effects of an afterschool physical activity program on working memory in preadolescent children Dev Sci 2011 14(5):1046-58.10.1111/j.1467-7687.2011.01054.x21884320  [Google Scholar]  [CrossRef]  [PubMed]

[37]. Koutsandréou F, Wegner M, Niemann C, Budde H, Effects of motor versus cardiovascular exercise training on children’s working memory Med Sci Sports Exerc 2016 48(6):1144-52.10.1249/MSS.000000000000086926765631  [Google Scholar]  [CrossRef]  [PubMed]

[38]. Van Der Niet AG, Smith J, Oosterlaan J, Scherder EJA, Hartman E, Visscher C, Effects of a cognitively demanding aerobic intervention during recess on children’s physical fitness and executive functioning Pediatr Exerc Sci 2016 28(1):64-70.10.1123/pes.2015-008426252883  [Google Scholar]  [CrossRef]  [PubMed]

[39]. Melby-Lervåg M, Hulme C, Serial and free recall in children can be improved by training: Evidence for the importance of phonological and semantic representations in immediate memory tasks Psychol Sci 2010 21(11):1694-700.10.1177/095679761038535520921571  [Google Scholar]  [CrossRef]  [PubMed]

[40]. van Kleeck A, Gillam RB, Hoffman LM, Training in phonological awareness generalizes to phonological working memory: A preliminary investigation J Speech Lang Pathol- Appl Behav Anal 2006 1(3):228-43.10.1037/h0100201  [Google Scholar]  [CrossRef]

[41]. Thibodeau RB, Gilpin AT, Brown MM, Meyer BA, The effects of fantastical pretend-play on the development of executive functions: An intervention study J Exp Child Psychol 2016 145:120-38.10.1016/j.jecp.2016.01.00126835841  [Google Scholar]  [CrossRef]  [PubMed]

[42]. Volckaert AMS, Noël MP, Training executive function in preschoolers reduce externalising behaviors Trends Neurosci Educ [Internet] 2015 4(1-2):37-47.10.1016/j.tine.2015.02.001  [Google Scholar]  [CrossRef]

[43]. Justice LM, Conceptualising “dose” in paediatric language interventions: Current findings and future directions International Journal of Speech-Language Pathology 2018 20(3):318-23.10.1080/17549507.2018.145498529788772  [Google Scholar]  [CrossRef]  [PubMed]

[44]. Diamond A, Lee K, Interventions shown to aid executive function development in children 4 to 12 years old Science 2011 333(6045):959-64.10.1126/science.120452921852486  [Google Scholar]  [CrossRef]  [PubMed]

[45]. Melby-Lervåg M, Redick TS, Hulme C, Working memory Training does not improve performance on measures of intelligence or other measures of “far transfer”: Evidence from a meta-analytic review Perspectives on Psychological Science 2016 11(4):512-34.10.1177/174569161663561227474138  [Google Scholar]  [CrossRef]  [PubMed]