Running Head: Working Memory and ADHD

Working Memory in Children with ADHD

Ashlyn Hill
Bridgewater College

Running Head: Working Memory and ADHD

The following review examines literature pertaining to the subtypes, symptoms, and
working memory of Attention Deficit Hyperactivity Disorder. With this review I hope to answer
the inquiry questions: How can the working memory be enhanced in children with ADHD; and
how can this be used in classrooms to better aid the kids learning? To answer this questions I had
to look at working memory and ADHD individually, and then compare them so I have a better
understanding of the conditions.

ADHD
Now a days more and more kids are being diagnosed with ADHD and are being placed in
special needs classes to help them stay focus and learn better. Sadly once in these classes they
are usually preeminently there, and majority of the time they never learn to read on grade level.
So these kids enter the world with a disability that has limited there studies and chances to do
something great in the world.
Noggle, Thompson, and Davis did an experiment on working memory in children with
ADHD and studied a lot about their learning disability. A persons processing speed has to do
with their reading efficiency (Noggle, Thompson, & Davis, 2014). Average people can decode
and recognize words accurately, some children with ADHD can decode words just as well
(2014). However children with ADHD reading fluency is slower than normal. This shows that
children with ADHD has a problem with their processing speed, which includes response
selection (2014). With a slower reading react and process the children with ADHD need more
time than the average student. One thing that Noggle and many other researchers didnt take into
account was the different subgroups in ADHD.

Running Head: Working Memory and ADHD

Wu and his colleagues however did take the subtypes into account. They did an experiment with
97 boys with LD and ADHD, 97 without LD but ADHD, and 97 health boys as the control (Wu,
Wang, Qian, Yang, & Liu, 2014). They grouped them based on IQ, age, and ADHD subtypes
(2014). The subjects were separated by IQ scores, one was 80 and above while the other was 80
and below (Westerberg, Hiryikoski, Forssberg, & Klingberg, 2004). They used the Wechsler
Memory Scale to access the characteristics of several memory domains (2014). WMS-IV is
made up of seven subtests: Spatial Addition, Symbol Span, Design Memory, General Cognitive
Screener, Logical Memory(I & II), Verbal Paired Associates(I & II), and Visual Reproduction(I
& II) (2014). A person's performance is reported as five Index Scores: Auditory Memory, Visual
Memory, Visual Working Memory, Immediate Memory, and Delayed Memory (2014). In
conclusion Boys with ADHD and a learning disability show deficits in overall memory function
and long-term memory while short-term memory is partially damaged (2014). However there is
no impairment in the immediate memory (2014). With this knowledge it would be safe to say
that most boys in classes that have test over a large piece of time will have a much harder time
recalling that knowledge. In a sense they are relearning everything just for the test.
Another person that focused on subtypes of ADHD was Dovis and Van der Oord, they
explained that there were two different groups, ADHD-I and ADHD-C. ADHD-C is combined
which means the child is inattentive and hyperactive, making it very difficult for them to focus
on any one thing. While ADHD-I were inattentive but not hyperactive, they had trouble in class
as well, but not as much as ADHD-C (Dovis, Van der Oord, Huizenga, Wiers, & Prins, 2014).
When you take in account the sub groups of ADHD you notice that ADHD-C is more impaired
in WM than ADHD-I. In their experiment they used the Chessboard task which is a visuospatial
WM based off two WM tasks: Corsi Block Tapping Task and subtest Letter-Number Sequencing

Running Head: Working Memory and ADHD

(Dovis, Van der Oord, Huizenga, Wiers, & Prins, 2014). This task causes them to have to
maintain and reorganize visuolspatial information. They have to follow the light of squares and
remember them. There results showed that there was a WM impairment in the combined group
more than in the inattentive one. I think this is good information to have so that teachers can
realize that not ADHD kid is the same and that they need different teaching styles depending on
the subgroup.
While Dovis and Van der Oord did and found that children with ADHD-C had more
problems with WM that kids with just ADHD-I. They also took into account that children with
ADHD need more or higher rewards to get them to actually do the task at hand (Dovis, Van der
Oord, Huizenga, Wiers, & Prins, 2014). Many kids arent motivated like they should be because
parents believe the only cure is medication. Holmes and his colleagues focused on medication
and WM training in their experiment (Holmes, Susan, Place, Dunning, Hilton, & Elliott, 2009).
The called the medication psychostimulant medication and stated it was the primary treatment
option for reducing the behavioral symptoms of ADHD (Holmes, Susan, Place, Dunning, Hilton,
& Elliott, 2009). The psychostimulant medication in the form of methylphenidate or
amphetamine compounds, and this has been found to enhance visuo-spatial WM.
Nonpsychostimulant treatment for ADHD, includes tasks computerized training that consists of
20-25 daily tasks that help improve working memory. The medicine that they use increase
dopamine receptors to help with working memory (Westerberg, Hiryikoski, Forssberg, &
Klingberg, 2004).
Research has shown that hte prefrontal cortex plays a very important part in working
memory (Westerberg, Hiryikoski, Forssberg, & Klingberg, 2004). It is also well known that
WM functioning is dependent on dopamine, which is consistent with the association of ADHD

Running Head: Working Memory and ADHD

with atypical dopaminergic transmission (Westerberg, Hiryikoski, Forssberg, & Klingberg,

2004). The medicine that they use increase dopamine receptors to help with working memory
(Westerberg, Hiryikoski, Forssberg, & Klingberg, 2004).
Working Memory
There has been twenty-two studies published between 1986 and 2012, together they
provided data for 905 children and adolescents over the age of five years from nine different
countries (Dieter, Alber,Renner, Lichtenauer, & Von Kries, 2013). The discontinuation rate of
this experiments were an average of 5.6% (2013). The duration of most experiments were
between 1 to 6 months (2013). With the experiments running longer showing significant results
when it came to training the working memory.
Working memory is composed of a central coordinating executive system and one or
more subsidiary system (Siegel & Ryan, 1989). The central executive is assumed to exert control
functions, and the subsidiary systems are assumed to store specific information about items being
processed (1989). ADD was tested in this experiment, which is very similar to ADHD. ADD
stands for attentional deficit disorder, while ADHD contains hyperactivity as well (1989). They
separate the poorly achieving children and normally achieving children with ADD (1989). First
time this was done so they couldnt predict what the outcome would be. In the end ADD children
did have trouble with the working memory tasks, but as the age group got older they tended to do
better then stopped around 9 11 (1989).
Working Memory defined as a brain system that provides temporary storage and
manipulations of the information necessary for complex cognitive tasks (Melby-Lervag &
Hulme, 2013). Working memory evolved from earlier concepts of short-term memory (MelbyLervag & Hulme, 2013). A number of studies have shown that measures of short-term memory

Running Head: Working Memory and ADHD

like digit span correlate modeslty with measures of higher IQ, reading, and arithmetic skills
(2013). Also measures of working memory consistently show higher correlations with measures
of high level cognitive function. With all this in mind, children with ADHD that have an
impaired working memory have a negative correlation with IQ, reading, and arithmetic skills.
Some of the working memory training programs they discussed was CogMed and Jungle
Memory, both of these sites claimed that they can help improve the working memory (2013).
These sites tend to have a lot of different tasks that caused a loading like effect which can
increase working capacity overtime. It tends to strength the muscles over time. So in a sense
these programs can help a little. However they believe that there is no true evidences to justify
working memory training can help improve working memory.
Executive functioning are proposed to play a pivotal role in explaining the problems
individuals with ADHD encounter in daily life. Executive functions allow individuals to regulate
their behavior, thoughts and emotions and thereby enable self-control (Dovis, Van der Oord,
Huizenga, Wiers, & Prins, 2014). WM is a core executive process in ADHD, and is described as
the ability to maintain, control and manipulate goal-relevant information (2014). Since WM is
impaired in ADHD children it accounts for their deficits in attention, hyperactivity, and
impulsivity (2014). WM is a multicomponent system consisting of two storage subsystems and
central executive (2014). The subsystems consist of the phonological and visuospatial short-term
memory (2014). While the central executive is a mental control system with limited attentional
resources that is responsible for supervising, controlling, and manipulating information (2014).
Dovis believed that children with ADHD show more impairment in the visuospatial WM than in
the phonological WM. Children with ADHD tend to need more rewards to actually do something
than those without ADHD (Dovis, Van der Oord, Huizenga, Wiers, & Prins, 2014).

Running Head: Working Memory and ADHD

Many of the tests done to help improve working memory was started by Klingberg. He
had a lot of steps in his experiment to ensure that he was testing what he said he would test and
also to make sure that kids werent just getting good at taking the tests. He believed that WM is a
permanent trait and closely related to g, a proposed measure of general cognitive ability
(Klingberg, Forssberg, & Westerberg, 2010). Children with attention deficit hyperactivity
disorder (ADHD) represent one group of subjects with a WM deceit, attributed to an impairment
of the frontal lobe (Klingberg, Forssberg, & Westerberg, 2010). The ability to retain and
manipulate information in WM depending on the prefontal cortex and underlies several cognitive
abilities, including logical reasoning and problem-solving (2010).
Klingberg defined ADHD as inattention, impulsivity, and hyperactivity. WM is one of
the most impaired cognitive trait in this disorder (Klingberg, Forssberg, & Westerberg, 2010).
This has been associated with the impaired function of the frontal lobe. This experiment hopes to
show that by increasing WM in ADHD kids they would have less symptoms (Klingberg,
Forssberg, & Westerberg, 2010). Past research showed moderate success, because they didnt
have adapting difficulty levels in the trails (Klingberg, Forssberg, & Westerberg, 2010). The
experiment only increased reaction time, but not the capacity of WM. There were some case
studies done to help learn strategies for learning large numbers, however that didnt help WM or
reasoning tasks. So this wasnt helpful.
In his experiment was a new type of computerized, cognitive training to see if it would
reduce motor activity in children with ADHD (Klingberg, Forssberg, & Westerberg, 2010). They
adapted two key features of a previous experiment, which were used to enhance sensory
discrimination and induce cortical plasticity in sensory and motor cortices (2010). They used an
adaptive staircase method that adapted to each individuals needs and it was performed at least 20
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Running Head: Working Memory and ADHD

minutes a day, 4-6 days a week, for at least 5 weeks. Ravens Progressive Matrices was one of
the tasks completed by the children to test their WM capacity and prefrontal functioning (2010).
It is a common education test given to 5 year olds and up, it has a total of 60 questions, listed in
the order of difficulty. It is a test that measures the test-takers reasoning ability, which is a
component of Spearmans g (general intelligence), which is a variable that summarized positive
correlations among different cognitive tasks, reflecting the fact that an individuals performance
on one cognitive tasks tends to be comparable to their performance at other kinds of cognitive
tasks (2010). So if you do badly on one test you will tend to do badly on all the tests even if the
subject changes. In the test item the subject is asked to identify the missing element that
completes a pattern, most of which are done in matrix, which is why it is called the Ravens
Matrices test (2010). It was used to estimate general nonverbal mental ability.
There were 5 cognitive tasks pre and post training evaluations. 1) A visuo-spatial WM
tasks: Circles are presented one at a time on a four-by-four grid (Klingberg, Forssberg, &
Westerberg, 2010). After a delay the subjects indicated the positions of the circle (2010). They
can only get two in a row wrong after that the task is over if they miss one and get the next they
get half a point. 2) Span Board: Ten blocks are arranged in an irregular pattern in front of the
subject (2010). The tester pointed to a pattern and the subject then repeated that pattern (2010). It
could be asked for in reverse or the same pattern, it is measured the same way as the first. 3)
Stroop task: The color and word test, where the word green in printed in yellow ink and you have
to say either the color related to the word or to the ink. For this task they named the color of the
ink. 4) The Ravens Colored Progressice Matrices. 5) Choice reaction time task. This is the
computerized task that displays the visual stimuli. A yellow circle would appear on one of two
places, you were to press a button when the yellow dot appeared (Klingberg, Forssberg, &

Running Head: Working Memory and ADHD

Westerberg, 2010). A grey circle would appear after each yellow dot for 1-4 s before the next
yellow dot. The next task was the choice task where the yellow dot would appear on the left or
right at random and you had to click with the hand that fits the spot (2010). Measures reaction
time for one choice trails; increase in reaction time for two choices and variance of reaction
times (2010). They also tested head movement so when the head moved 1.0 mm or more from
resting location (2010). The number of movements were recorded for 15 minutes while the child
performed a task were they had to respond to a target and withhold response to nontargets, with
no requirement of holding any information in WM (2010).
In then in the end there was a final computerized part that consisted of four different tests
, 1) the visuo-spatial WM task which was used in the pre test, the circle one with grids. 2)
Backwards digit-span A keyboard with numbers was shown and digits read aloud. The subject
then marked the digits but in reverse. 3) Letter-span task, letters were spoken out loud in an
order, a lamp is light and whichever number lamp is lit tells them which letter to repeat back. 4)
wasnt a working memory task, (yellow circle reaction time). Many other like Westerberg also
did similar experiments, their study focus on visuo-spatial WM and choice time rate in ADHD
(Westerberg, Hiryikoski, Forssberg, & Klingberg, 2004). There was a significant difference in
age with the results of the VSWM (2004). Attention deficit/hyperactivity disorder (ADHD) is
defined as age-inappropriate behavior, with symptoms of inattention, impulsivity and
hyperactivity (2004). In the end this seemed like the best way to improve WM in children with
ADHD.
Conclusion
In the end majority of the studies have shown that with and intense and long period of
WM training a child with ADHD can not only WM improved but also attention, inhibition, and
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Running Head: Working Memory and ADHD

problem solving skills (Westerberg, Hiryikoski, Forssberg, & Klingberg, 2004). With this in
mind I believe more schools should be giving programs like Jungle Memory and COgMed a
chance (Melby-Lervag & Hulme, 2013). Parents would need to start this process early so that
children can start to improve as they develop more. Since ADHD is a dopamine blocker children
with ADHD need to be motivated properly to do such tasks. This usually means having nicer
rewards than you would have to give to a child without ADHD. I believe that there should be
more research done for this disability so that they can get the same learning experience as anyone
else. I think that more tests in the classroom should be done, along with an experiment to see just
what rewards work the best to motivate kids with ADHD. This way teachers can bring those
things into the classroom to help aid their learning.

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Running Head: Working Memory and ADHD

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