Working memory training in children with neuropsychiatric disorders and borderline intellectual functioning.

1. The measured difference in behavioral problems before and after training;<br>
2. The measured difference in neurocognitive functioning before and after training;<br>
3. The measured difference in schoolachievement before and after training.
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Study procedure from A-Z:<br>
In the following part, we will describe the whole study procedure from start to follow- up, including the rationale for the proposed measurements. In sum, there will be a selection phase, pre- and post-assessments and a follow-up. Note that an assessment in our “clinical care as usual” includes;<br>
1. A clinical interview with the parents and the child (an intake);<br>
2. A structural developmental interview;<br>
3. A comprehensive set of questionnaires;<br>
4. A neuropsychological assessment with an average duration of 2 – 2 ½ hours;<br>
5. An appointment for instruction of the training;<br>
6. An appointment for evaluation.<br>
So in sum, the post-assessment and the follow-up will be extra for the research project compared to our daily care as usual. To be comprehensive, below, we will describe the whole procedure.
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Part one: Selection phase.<br>
Scales and Questionnaires.<br>
An extensive clinical diagnostic procedure including a structural developmental interview and a clinical interview with the parents and the child, supervised by a child and adolescent psychiatrist will be scrutinized by a clinical diagnostic procedure including:<br>
1. In case of ADHD and/or ASS, the ADHD and/or ASS criteria according to the DSM-IV will be checked and filled out by an experienced psychologist;<br>
2. For assessment of other comorbid psychiatric disorders, the Diagnostic Interview Schedule for Children (DISC-IV), a highly structured diagnostic instrument designed for use by non-clinicians (Berument et.al., 1999) will be included;<br>
3. The intellectual disabilities will also be checked before participation, through five subtests of the WISC-III-NL (Information, Vocabulary, Picture Completion, Block Design, Digit Span), (Kort et al., 2005).
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Part two: Pre-treatment-assessment.<br>
Scales and Questionnaires.<br>
The following parameters will be assessed before treatment (45 minutes):<br>
1. For baseline measurement of clinical improvement, the investigator will fill out the Clinical Global Impression-Global severity scale (CGI-S), a widely used instrument to assess clinical effects in intervention studies (Shaffer et.al., 2000);<br>
2. To evaluate psychosocial functioning of the child, the Children’s Global Assessment Scale (C-GAS; Shaffer et.al., 1983) will be completed;<br>
3. The Vragenlijst voor Inventarisatie van Sociaal gedrag van Kinderen (VISK; Luteijn, Minderaa, & Jackson, 2002) in case of ASS, and the ADHD rating scale in case of ADHD will be filled out by parents and teacher;<br>
4. For baseline measurement of improvement of executive functioning, the Behavior Rating Inventory of Executive Function checklist (BRIEF; Smidts et al., 2009), will be filled in by the parents and teachers;<br>
5. A side-effects checklist will be filled in.
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Neurocognitive functioning:<br>
We will test 3 domains of neurocognitive functioning and academic achievements. This will take about 2 to 2 ½ hours. After each training session training children will be questioned about the quality of training (how much fun was it to do) and about their motivation, both scaled from 0 - 10.
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1. (Working) Memory (WM):<br>
A. Visual (spatial) short term memory: Blok recall, (Pickering et al., 2001) & Visual patterns test, (Della Sala, Gray, Baddeley, & Wilson, 1997);<br>
B. Verbal short term memory: Digit recall, (Pickering et al., 2001) & Nonword list recall, (Pickering et al., 2001);<br>
C. Visual (spatial) working memory: Spatial span, (Alloway, 2007);<br>
D. Verbal working memory: Listening recall, (Pickering et al., 2001) & Backward digit recall, (Pickering et al., 2001).<br>
2. Executive Functioning (EF):<br>
A. Response inhibition: Go-Nogo, Amsterdamse Neuropsychologische Taken (GNG/ANT; De Sonneville, 2009);<br>
B. Attention: Sustained Attention Dots, Amsterdamse Neuropsychologische Taken (SAD/ANT; De Sonneville, 2009).<br>
3. Fluid intelligence (non-verbal): Raven Standard progressive matrices, (Raven, Court, & Raven, 1996);<br>
4. Academic achievements: Tempo Toets Rekenen (arithmetic), (TTR; De Vos, 1992), Brus 1 minuut (reading), (Brus & Voeten, 1973) & Story recall (daily memory), (Van der Molen, 2007).
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Part three: Post-treatment assessment.<br>
We will repeat the following questionnaires and scales and the neurocognitive tasks of the pre-treatment 1 week after the last session: ADHD and/or Autism spectrum disorder criteria according to DSM-IV, the VISK and ADHD rating scale, C-GAS, CGI-C and BRIEF.<br>
There will be an evaluation for parents and children to discuss experiences of the treatment and answering questions with the researchers.
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Part four: Follow-up.<br>
To determine if treatment effects are lasting, decrease or increase over time, we will perform a follow-up at 6 months after the end-point of study to observe possible clinical improvements by assessing the severity of behavioral problems through the same selection of scales and questionnaires used in the post-treatment assessment. Also a selection of neurocognitive measures will be assessed: verbal and visual working memory, fluid intelligence (Raven), attention and academic achievements (see above for details of the measures).