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Adaptive training leads to sustained enhancement of working memory

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Title: Adaptive training leads to sustained enhancement of working memory Author: Place Last modified by: isabeller Created Date: 7/6/2009 9:51:51 AM – PowerPoint PPT presentation

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Title: Adaptive training leads to sustained enhancement of working memory


1
Working Memory ADHD
Prof Maurice Place
maurice.place_at_northumbria
.ac.uk
2
Disclosure Currently member of the
speakers panel of
AstraZeneca Eli
Lilly Janssen Cilag
Shire
3
  • The executive function
  • comprises those mental functions involved in
  • formulating goals,
  • planning how to achieve
    them,
  • carrying out the plans,
  • and revising those plans in the event of failure

  • (Lezak, 1982)

4
  • The executive function
  • comprises those mental functions involved in
  • formulating goals,
  • planning how to achieve
    them,
  • carrying out the plans,
  • and revising those plans in the event of failure
  • Executive functioning becomes engaged
  • for the more high level tasks

5
  • Working Memory
  • a dynamic, short-term storage
  • of information to be actively used or manipulated
  • and is a localised function

  • (Alloway et al., 2006)

6
   
How Memory Works Sensory inputs are held through
transient functional changes in the strength of
pre-existing synaptic connections The basal
ganglia and pre-frontal cortex analyze sensory
inputs and decide if they're worth remembering
 
7
   
How Memory Works Sensory inputs are held through
transient functional changes in the strength of
pre-existing synaptic connections The basal
ganglia and pre-frontal cortex analyze sensory
inputs and decide if they're worth remembering
If SO - create stable and permanent changes in
neural connections throughout the brain by the
synthesis of new protein and the growth of new
connections. (Malenka Nicoll 1999 Kandel
2000 McNab Klingberg 2007)
 
8
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9
   
How Memory Works Sensory inputs are held through
transient functional changes in the strength of
pre-existing synaptic connections The basal
ganglia and pre-frontal cortex analyze sensory
inputs and decide if they're worth remembering
If SO create stable and permanent changes in
neural connections throughout the brain by the
synthesis of new protein and the growth of new
connections. Especially during sleep
(Diekelman Born 2010)
 
10
  • Short-term memory is the term for
  • short-term storage of information
  • with no manipulation or
  • organizational element
  • Working memory is
  • the structures and processes
  • used for temporarily storing
  • and manipulating
    information.

11
(No Transcript)
12
  • Professionals use working memory for
  • Getting to work on time
  • Meeting deadlines at work
  • Multi-tasking and prioritizing
  • Working effectively in pressure situations
  • Remembering important names and phone numbers
  • Interaction with co-workers
  • Writing emails, memos, or summaries

13
Rehearsal
Storage
  • (Baddeley 2000)

14
  • Anatomical and imaging studies indicate
  • Working Memory use frontal-parietal
  • circuitry
  • (Paulesu et al., 1993
    Smith Jonides 1998)
  • The processes are significantly dependent
  • upon dopamine

  • (Goldman-Rakic 1998).

15
  • Children who have been treated for PKU
  • tend to have a deficit in prefrontal dopamine

  • (Diamond
    2007)
  • These children have Working Memory problems
  • even when the primary symptoms
  • of the disorder are successfully treated
  • (Topakas et al.,
    2010 Bik-Multanowski et al., 2011)

16
  • Children who have been treated for PKU
  • tend to have a deficit in prefrontal dopamine

  • (Diamond
    2007)
  • These children have Working Memory problems
  • even when the primary symptoms
  • of the disorder are successfully treated
  • (Topakas et al.,
    2010 Bik-Multanowski et al., 2011)
  • Similarly
  • patients with Fragile X
  • show specific deficits in Working
    Memory

  • (Hooper et al., 2008

  • Cornish et al., 2009

  • Baker et al.,
    2011)

17
  • Working Memory deficiency plays
  • a central role in schizophrenia
  • (Lewis et al., 2005 Lewis
    Gonzalez-Burgos, 2006).
  • Memory impairment is one of the earliest
  • and most consistent manifestations of the disease
  • Working Memory impairment is stable over time
  • and is independent of psychotic symptoms

  • (Zhang Luck 2008 Gold et al., 2010)

18
  • Working Memory deficiency plays
  • a central role in schizophrenia
  • (Lewis et al., 2005 Lewis
    Gonzalez-Burgos, 2006).
  • Memory impairment is one of the earliest
  • and most consistent manifestations of the disease
  • Working Memory impairment is stable over time
  • and is independent of psychotic symptoms

  • (Zhang Luck 2008 Gold et al., 2010)
  • It probably uses GABA pathways

  • (Timofeeva Levin 2011)

19
  • Working Memory performance is heritable

  • (Ando et al., 2001 Chen et al., 2009)
  • And although no genetic correlation between
  • gray matter density
  • and Working Memory
    performance,
  • inheritance of white matter structure
  • is likely to be one of the mechanisms of
  • genetic transmission

  • (Karlsgodt et al., 2010)

20
  • Indicators that a working memory needs improving
  • Frequently late to work
  • Underestimates time required to complete a task
  • Problems breaking a project down into manageable
  • steps or dealing with more than one task
    at a time
  • Cant concentrate under pressure prone to
    panicking
  • Cant remember clients names or numbers after
  • meeting them or hanging
    up the phone
  • Difficulty creating neat and coherent emails,

  • memos, or summaries

21
Working Memory
  • assessed using simple cognitive tasks
  • 4 aspects of memory
  • verbal and visuo-spatial storage (simple span)
  • verbal and visuo-spatial processing
  • and storage
    (complex span)

22
Working Memory
  • verbal short term memory
  • ability to hold verbal information in memory
    for a short period
  • eg new telephone number
  • problems mean slow to acquire new
    vocabulary
  • verbal working memory
  • to hold and manipulate verbal information
  • links to academic ability including
    literacy and numeracy
  • visuo-spatial short term memory
  • holding visuo-spatial information
  • .problems with mathematics, and word
    problems.
  • visuo-spatial working memory
  • to hold and manipulate visuo-spatial
    information
  • links to academic ability including
    literacy and numeracy
  • and is predictor of
    poor scholastic attainment.

23
Working Memory
  • assessed using simple cognitive tasks
  • WMI of the WAIS or WISC
  • Automated Working Memory Assessment

  • (Alloway, 2008)

24
Verbal STM/Verbal simple span tasks
839251
839251
DIGIT RECALL
25
Visuo-spatial STM/ Visuo-spatial simple span tasks
MAZES MEMORY
26
Visuo-spatial STM/ Visuo-spatial simple span tasks
MAZES MEMORY
27
Visuo-spatial STM/ Visuo-spatial simple span tasks
MAZES MEMORY
28
Verbal STM/Verbal Complex span tasks
bananas have teeth
chairs lay eggs
false
false
LISTENING RECALL TASK
29
Verbal STM/Verbal Complex span tasks
bananas have teeth
chairs lay eggs
false
false
eggs, teeth
LISTENING RECALL TASK
30
Visuo-spatial WM/Complex visuo-spatial tasks
SPATIAL SPAN TASK
31
Visuo-spatial WM/Complex visuo-spatial tasks
SPATIAL SPAN TASK
32
Visuo-spatial WM/Complex visuo-spatial tasks
SPATIAL SPAN TASK
33
Visuo-spatial WM/Complex visuo-spatial tasks
SPATIAL SPAN TASK
34
Visuo-spatial WM/Complex visuo-spatial tasks
SPATIAL SPAN TASK
35
Associations with Specific Disorders
36
  • Specific Working Memory problems
  • evident in various disorders
  • PKU
  • Schizophrenia

37
  • Specific Working Memory problems
  • evident in various disorders
  • PKU
  • Schizophrenia
  • Depression
  • deficits in working memory
  • for both visual and verbal
    material
  • even in young adulthood

  • (Castaneda et al., 2008)
  • Deficits which appear to persist
  • even in the remitted
    state

  • (Hasselbalch et al., 2010)

38
  • Specific Working Memory problems
  • evident in various disorders
  • PKU
  • Schizophrenia
  • Depression
  • PTSD
  • (Yehuda et al.,
    1995Vasterling et al., 2002

  • Liberzon Sripada, 2008).
  • with structural imaging
  • correlating with
    predicted deficits

  • (Liberzon Sripada, 2008

  • Woodward et al., 2009).


39
  • Specific Working Memory problems
  • evident in various disorders
  • PKU
  • Schizophrenia
  • Depression
  • ODD
  • substantial deficits in information
    storage
  • and verbal and spatial
    domains
  • of Working
    Memory.
  • - Verbal WM less damaged in ADHD

  • (Rhodes et al 2012)


40
  • In childhood abuse
  • emotional forms of abuse/neglect show
  • visual memory and emotional processing
    deficits.
  • sexual abuse most associated with
  • spatial working memory deficits,
  • Not seen in other types
    of abuse.
  • physical forms of abuse/neglect most strongly
  • linked to processing speed
  • and emotional processing
    deficits.

  • (Gould et al., 2012)

41
Working Memory Capacity Learning
42
Working Memory Capacity Learning
  • Important for successful learning
  • in individual classroom
    activities

  • (Gathercole Alloway, 2008)

43
Working Memory Capacity Learning
  • Associated with reading and mathematics ability
  • (Gathercole
    Pickering, 2000 Geary et al., 2004)

44
Working Memory Capacity Learning
  • One specific function important in reading
  • comprehension is processing speed.
  • (Willcutt
    et al. ,2001 Laasonen et al., 2009)
  • Commonly associated with ADHD
  • with a correlation of 0.7 between the two
    disorders.

  • (Shanahan et al., 2006)

45
Working Memory Capacity Learning
  • Most of the time when Im reading assignments
  • In my textbooks, Im just licking the words
    rather
  • than chewing them. Thats why I have to keep
  • going back to read it all over again.

  • (Brown et al., 2011)

46
Working Memory Capacity Learning
  • IN ADHD can be relatively situation specific
  • little impairment in ability when doing tasks
  • which hold strong personal interest
  • or anxiety for them,
  • though show significant impairment
  • in most other
    situations.

  • (Brown 2009 Anmarkrud Braten 2009)

47
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48
Working Memory Capacity Learning
  • Message from the research
  • low working memory educational underachievement

49
Working Memory ADHD
50
What are the Academic and Educational Characterist
ics of Children with ADHD? Children with ADHD
show significant academic underachievement
poor academic performance
educational problems
(Hinshaw, 1992

Fergusson Horwood 1995

Rapport et al., 1999

Sayal 2008
Galéra
et al., 2009)
51
What are the Academic and Educational Characterist
ics of Children with ADHD? IQ - compared with
controls score on average within the normal
range (Biederman et al.,
1996) BUT score significantly lower on reading
and arithmetic achievement tests than controls.

(Biederman et al.,
1996) Children with ADHD are 4 to 5 times more
likely need special educational services.
(LeFever et al.,
2002 Jensen et al., 2004)
52
What are the Academic and Educational Characterist
ics of Children with ADHD?
Academic difficulties begin early in life.
Symptoms are common in children aged 3 to 6
years,
(Gadow et al.,
2001) preschool children with ADHD are more
likely to be behind in basic academic readiness
skills.
(Mariani Barkley 1997 DuPaul, et al.,
2001) have impaired handwriting performance
characterized by illegible written material
and/or inappropriate speed of execution

(Racine et al., 2008)
53
What are the Academic and Educational Characterist
ics of Children with ADHD?
In adolescence achieve lower ratings
on all school subjects have lower class
rankings perform poorly on standardized
academic
achievement tests
(Gittelman et al., 1985

Barkley et al., 1990

Weiss et al., 1999). x2
likely to repeat a grade
(Currie Stabile 2006 Beiderman et al.,
2006) x2 - 4 to have lower than expected grades

(Todd et al.,
2002)
54
What are the Academic and Educational Characterist
ics of Children with ADHD?
School histories indicate persistent
problems in social participation more
years to complete high school lower rates
of college attendance lower rates of
college graduation
(Mannuza et
al., 1993
Weiss et al.,
1999
Barkley
2002).
55
What are the Academic and Educational Characterist
ics of Children with ADHD?
  • In College
  • relative to other students
  • have lower GPAs
  • more academic concerns
  • depressive symptoms
  • social concerns
  • emotional instability
  • and substance use.
  • BUT most said were coping.

  • (Blase et al., 2009)

56
What are the Academic and Educational Characterist
ics of Children with ADHD?
longitudinal studies into young adulthood
Initial symptoms of hyperactivity
distractibility
impulsivity
aggression tend to
decrease in severity over time BUT
remain present and increased in
comparison to controls

(Weiss et al.,
1999).
57
  • For instance.

58
  • 26 ADHD individuals and 31 controls
  • (paired for gender, age, intelligence)
  • Using mathematics and language scores
  • academic underachievement was
  • 2.98 times higher in students with ADHD

  • (Pastura et al., 2009)

59
  • Ethnically diverse cohort of 823 assessed at 6
    years for behavioural problems and IQ
  • and at 17 years of age for academic
    achievement in math and reading, and other
    parameters.

60
  • Ethnically diverse cohort of 823 assessed at 6
    years for behavioural problems and IQ
  • and at 17 years of age for academic
    achievement in math and reading, and other
    parameters.
  • Attention problems predicted poor maths and
    reading
  • achievement with little benefit from
    intervention.
  • Whereas reducing externalizing and internalizing
  • problems materially reduced academic
    problems.

  • (Breslau et
    al., 2009)

61
What are the Academic and Educational Characterist
ics of Children with ADHD?
3 main groups of outcome as young adults (1)
approximately 25 eventually function
comparably to matched normal controls
(2) the majority show continuing
functional impairment, limitations in
learning and applying knowledge
restricted social participation,
particularly poor progress through school (3)
about 25 develop significant, severe
problems, including psychiatric and/or
antisocial disturbance (Hechtman
2000)
62
  • Academic difficulties associated with
    inattention are cross-cultural and not
  • specific to the Western countries.

  • (Norvilitis et al., 2010)

63
  • People with ADHD have difficulties with
  • planning, organization,
  • reasoning,
  • response inhibition,
  • decision-making,
  • set-shifting
  • working memory
  • (Tranel et al.,
    1994

  • Pennington and Ozonoff 1996

  • Barkley 1997

  • Geurts et al., 2004)

64
  • ADHD symptom severity is associated with
  • magnitude of impairment in executive
    functions
  • BUT this relationship can be obscured by the
  • presence of comorbid
    disruptive disorders.

  • (Barnett et
    al., 2009)

65
  • The Impact of Medication

66
   
Methylphenidate improves the transmission of
signal versus noise by
reducing response to the noise. AND improves
concentration by
increasing dopamine levels in
fronto-striatal pathways
(Williams
Goldman-Rakic, 1995).
The Impact of Medication
 
67
The Impact of Medication
  • Neuroimaging studies have also shown
  • methylphenidate blocks up to 70 of transporters
  • in these pathways improving dopamine
    availability

  • (Krause 2008)
  • Continued use of stimulants tends to normalise
    deficits

  • (Shaw et al., 2009

  • Bledsoe et al., 2009

  • Nakao et
    al., 2011)

68
The Impact of Medication
medication improves academic productivity as
indicated by improvements in the quality
of note-taking scores on quizzes and
worksheets the amount of written-language
output homework completion.

(Evans et al., 2001) methylphenidate
increases in dopamine with improved interest and
motivation to do maths tasks

(Volkow et al., 2004)
69
The Impact of Medication
However, stimulants are not associated with
normalization of skills in the domain of
learning and applying knowledge.

(Rapport et al., 1994)
70
Early Childhood Longitudinal Study
  • 1195 children were tested at 5 points
  • compared the academic performance of treated
  • with untreated children at each
    testing node.
  • medicated gained 2.9 points in mathematics
  • performance between the first and final
    testing
  • reading performance medicated gained 5.4 points

  • above unmedicated

71
Early Childhood Longitudinal Study
  • 1195 children were tested at 5 points
  • compared the academic performance of treated
  • with untreated children at each
    testing node.
  • medicated gained 2.9 points in mathematics
  • performance between the first and final
    testing
  • reading performance medicated gained 5.4 points

  • above unmedicated
  • Despite this improvement the performance
  • of the medicated children with ADHD
  • lagged their peers
    without ADHD.

  • (Scheffler et al.,
    2009)

72
177 ADHD effectively medicated vs 95
untreated ADHD and 101 normal
controls. Neuro Cognitive Index - computed as
the average of the z scores of five domains
(memory, psychomotor
speed, reaction time, complex attention,
and shifting
attention flexibility) untreated ADHD patients
perform 15
lower than normals.
73
177 ADHD effectively medicated vs 95
untreated ADHD and 101 normal
controls. Neuro Cognitive Index - computed as
the average of the z scores of five domains
(memory, psychomotor
speed, reaction time, complex attention,
and shifting
attention flexibility) untreated ADHD patients
perform 15
lower than normals. However, treated
ADHD patients perform 10 lower than normals.
(Gualtieri Johnson 2008)
74
The Impact of Medication
In longitudinal studies subjects consistently
demonstrate poor outcomes compared with
controls whether or not they
receive medication.
(Gittelman et al.,
1985
Barkley et al., 1990

Hechtman Greenfield 2003

Fischer et al., 2002

Loe Feldman 2007

Powers et al., 2008)
75
The Impact of Medication
  • and in UK studies
  • Despite medication, ADHD
  • association with poor attainment in GCSEs

  • (Daley et al., 2009)

76
The Impact of Medication
  • "Given their well-established benefit for
    increasing attention and concentration, it seems
    counterintuitive that ADHD medications are not
    more effective in improving academic and
    occupational attainment,"

  • (Advokat 2009)

77
  • Anatomical and imaging studies indicate
  • Working Memory use frontal-parietal
  • circuitry
  • (Paulesu et al., 1993
    Smith Jonides 1998)

78
  • Anatomical and imaging studies indicate
  • Working Memory use frontal-parietal
  • circuitry
  • (Paulesu et al., 1993
    Smith Jonides 1998)

there are only few dopamine transporters in the
prefrontal cortex probable that dopamine
uptake in this part of the brain is via
noradrenaline sites.
(Nutt
Fone 2005)
79
   
BUT consistency-impulsivity managed
through noradrenaline pathway

(Sweitzer et al., 2006) methylphenidate has
only a modest impact upon
noradrenaline
(Berridge Waterhouse, 2003)
IN ANIMALS - greater enhancement of
working memory function is achieved
with a2 noradrenaline agonists

(Arnsten, 2001).
 
80
  • SO methylphenidate
  • increases dopamine which improves
  • concentration and some cognitive elements
  • BUT working memory more dependent
  • upon noradrenaline pathways
  • in prefrontal cortex
  • SO methylphenidate alone will
  • not greatly improve working memory

81
How do children with ADHD compare with children
with low working memory on testing?
82
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83
(No Transcript)
84
HMS Trincomalee, built in Bombay for the
Admiralty in 1817 the oldest
ship afloat in the UK
85
(No Transcript)
86
(No Transcript)
87
The monkey won on a free bananas
platform
88
Working memory comparisons
(Holmes et al., 2009)
89
Improving Working Memory
  • A computerised training programme developed
  • by Klingberg et al. (2002)

Robo Memo
90
(No Transcript)
91
Does it work?
92
Hartlepool Study (1)
  • Participants
  • 42 children, aged 8-11 years,
  • with low working
    memory
  • Identified via routine screening of 345 children
    on two verbal wm tasks (Listening Recall and
    Backward Digit Recall)
  • Scores lt86 on both tasks (bottom 15th centile)
  • Two groups
  • Adaptive, standard version of training programme
  • training at maximum span level
  • Non-adaptive, control condition
  • training at fixed span level of 2

(Holmes et al., 2009)
93
  • Working Memory Training
  • working on memory tasks on a computer
  • 20 minutes
  • everyday for 20-25 days

94
Results from non-adaptive

95
Results from adaptive




96
  • Working Memory Training
  • and at 6 mth follow-up

97
Results from adaptive Follow up




98
IQ, Reading Maths Scores - adaptive
Pre-training Pre-training Post-training Post-training 6mth follow-up 6mth follow-up
Measure M SD M SD M SD
Verbal IQ 88.73 11.14 90.86 11.52 92.78 9.10
Performance IQ 88.05 13.09 90.68 12.96 87.11 9.07
Reading 83.68 12.35 83.00 15.06 82.83 14.1
Mathematics 84.27 12.28 85.68 12.70 89.94 9.88
Following inst. 14.45 4.02 18.27 4.37 16.5 3.82
No significant improvements for
non-adaptive group
99
Hartlepool Study (2)
  • Impact of Medication Robo Memo
  • on Working Memory in children with ADHD
  • Participants
  • 25 children (21 boys, 4 girls), clinical
    diagnosis
  • of ADHD-C
  • receiving quick release stimulant medication
  • (methylphenidate n22,
    dexamfetamine n3)
  • aged 8-11 years
  • diagnosis for at least 6 months
  • no co morbid ASD

  • (Holmes et al., 2010)

100
Effect of medication on IQ
101
Effects of medication on working memory

102
  • Research on Working Memory Medication
  • Stimulant medication mainly improves
  • visuo-spatial simple span tasks

  • (Bedard et al., 2004)

103
Does RoboMemo make a difference?
104
Effects of medication and training on working
memory







105
Effects of training on behaviour ratings
On Meds Post training ( on meds)
Inattentivity (teacher) 69.84 (23.33) 58.21 (20.27)
Hyperactivity (teacher) 81.15 (21.69) 70.31 (23.87)
Working memory problems (child) 17.60 (5.72) 13.25 (6.00)
106
Sustainability of training effects 6 mth
follow-up




107
  • Working Memory Intervention
  • Significant gains in non-trained working memory
    tasks, which extended across all four aspects of
    working memory. Substantial increases in scores
  • (low-average to
    average range).
  • Significant reduction in ratings of problem

  • behaviours
  • No effect on IQ
  • Unlikely to result from practice effect
  • Comparison group showed no test re-test effect
  • Consistent gains in both the repeated and non-
  • repeated AWMA tasks in the ADHD group

108
  • SO
  • Working memory deficits associated with ADHD
  • can be overcome by two different interventions
  • RoboMemo intervention led to more generalized
  • gains in WM, and reductions in problem behaviours
  • Medication led to specific gains in visuo-spatial
    WM, and improves concentration
  • and improves academic productivity

  • (Holmes et al., 2010)

109
  • How is training enhancing working memory?
  • there are only few dopamine transporters in

    the prefrontal cortex
  • probable that dopamine uptake in this part
  • of the brain is via noradrenaline sites.

  • (Nutt Fone 2005)

110
  • How is training enhancing working memory?
  • SO not a high density of dopamine receptors in
  • prefrontal
    cortex
  • Training changes the density of prefrontal
  • parietal cortical dopamine D1 receptors.

  • (McNab et al., 2009)
  • may stimulate the development of WM strategies
  • that compensate for weaknesses in basic processes

  • (Holmes et al., 2010)

111
The Research Team Joni
Holmes Senior Lecturer in Experimental
Psychology Maurice Place Professor of
Child Family Psychiatry Torkel Klingberg
Professor in Cognitive Neuroscience Joe
Elliott Professor of
Education Sue Gathercole Unit
Director,
Professor of Cognition Neuropsychology
112
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113
Working Memory ADHD
Prof Maurice Place
maurice.place_at_northumbria
.ac.uk
114
General classroom advice
115
children with ADHD are more likely to complete
more problems and complete them accurately
when high levels of engaging stimuli are
included within the task.
(Jitendra
et al 2008)
116
children with ADHD are more likely to complete
more problems and complete them accurately
when high levels of engaging stimuli are
included within the task.
(Jitendra
et al 2008) Pacing of tasks with periods to
release energy Clarity of goals Instant
feedback Novel rapidly changing rewards
117
children with ADHD are more likely to complete
more problems and complete them accurately
when high levels of engaging stimuli are
included within the task.
(Jitendra
et al 2008) Pacing of tasks with periods to
release energy Clarity of goals Instant
feedback Novel rapidly changing rewards Time
out DOES NOT work
118
  • Draw or create vivid pictures depicting
    information that needs to be memorized. Since
    memory is enhanced by exaggeration, emotion,
    action, and color, the more ridiculous and
    detailed the image, the better.
  • Teach memory strategies. Such as mnemonics e.g.
    Dead Monsters Smell Bad (steps for long division
    divide, multiply, subtract, bring down).
  • 3. Create acrostics or whole sentences. Every
    Good Boy Does Fine is an excellent way to help
    recall the sequence of lines in the treble clef
    (EGBDF).
  • 4. Try melody and rhythm to teach a series or
    sequence. There are raps, rhymes, and songs to
    help attention deficit students memorize
    multiplication tables, days of the week, etc.
  • 5. Use songs specially created to teach content.
    Musically Aligned (musicallyaligned.com) creates
    music and lyrics geared to teach a science
    curriculum. For physical science, there are songs
    like Electromagnets and Heat, Light, and
    Motion. For teaching concepts in life science,
    there are Food Chain Gang and Decomposers.
  • 6. After the lesson, have ADHD students list the
    things they remember. Ask them to do so as fast
    as they can, to increase memory recall.

    (Sandra Rief 2009)

119
Improved by reading interventions focused on
basic skills e.g., decoding
such as activities to promote phonological
awareness and alphabetic understanding

(Blachman et al 2000). and maths strategies
e.g. problem solving using schema-based
instruction
(Jitendra et al
2007). And strengthened by
Peer mediated interventions
Computer assisted instruction

(Jitendra et al 2008) Task modification and
varying classroom function
(Daley Birchwood
2010) Teaching parents homework strategies

(Raggi Chronis 2006).
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