Iranian Journal of Psychiatry 2016. 11(4):224-233.

Working Memory Training in the Form of Structured Games in Children with Attention Deficit Hyperactivity Disorder
Fatemeh Khalili Kermani, MohammadReza Mohammadi, Fariba Yadegari, Fatemeh Haresabadi, Seyed Mehdi Sadeghi


Objective: In this study, a new training method of working memory (WM) was used in the form of structured games, and the effect of training was evaluated with a controlled design. The training method of WM in the form of structured games includes 20 sets of structured games that can improve WM and performance of executive functions.

Method: Sixty children with attention deficit hyperactivity disorder (ADHD) aged 8.5 to 11.2 years (35 boys), using no stimulant medication were selected. We randomly assigned 30 participants to the experimental group and provided them with WM training. The training was in the form of structured games and was offered to the participants in two 60-minute sessions weekly for 12 weeks. Other participants were assigned to the control group, receiving no treatment. All the participants were also evaluated at follow-up 6 months later. The main measures were the Child Behavior Checklist (CBCL), the Digit Span and Symbol Search B subscale of the Wechsler Intelligence Scale for Children (WISC-IV); and scores of dictation and mathematics were used in terms of pre and post-test.

Results: The results of the t-test revealed a significant improvement in the post-test measures as well as a significant reduction of parents’ reports of inattentiveness, and improvement in academic performance in the experimental group. However, no significant changes were found in the control group.

Conclusion: The academic and working memory improvements were primarily due to the training method of WM. Our findings suggest that the training method of WM in the form of structured games may be a practical method for treating children with ADHD, but it needs to be further investigated.


Attention Deficit, Hyperactivity, Structured Games, Working Memory Training

Full Text:



Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000; 157: 816-818.

Rasmussen P, Gillberg C. Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry 2000; 39: 1424-1431.

Dowson JH, McLean A, Bazanis E, Toone B, Young S, Robbins TW, et al. Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects. Acta Psychiatr Scand 2004; 110: 45-54.

Karatekin C, Asarnow RF. Working memory in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder. Psychiatry Res 1998; 80: 165-176.

Kempton S, Vance A, Maruff P, Luk E, Costin J, Pantelis C. Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children. Psychol Med 1999; 29: 527-538.

Kuntsi J, Oosterlaan J, Stevenson J. Psychological mechanisms in hyperactivity: I. Response inhibition deficit, working memory impairment, delay aversion, or something else? J Child Psychol Psychiatry 2001; 42: 199-210.

Mariani MA, Barkley RA. Neuropsychological and academic functioning in preschool boys with attention deficit hyperactivity disorder. Dev Neuropsychol 1997; 13: 111-129.

Westerberg H, Hirvikoski T, Forssberg H, Klingberg T. Visuo-spatial working memory span: a sensitive measure of cognitive deficits in children with ADHD. Child Neuropsychology 2004; 10: 155-161.

Karatekin C. A test of the integrity of the components of Baddeley's model of working memory in attention-deficit/hyperactivity disorder (ADHD). J Child Psychol Psychiatry 2004; 45: 912-926.

Sagvolden T, Sergeant JA. Attention-deficit hyperactivity disorder-from brain dysfunctions to behaviour. Behav Brain Res 1998; 94: 1-10.

Prins PJ, Dovis S, Ponsioen A, ten Brink E, van der Oord S. Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw 2011; 14: 115-122.

Rapport MD, Scanlan SW, Denney CB. Attention-deficit/hyperactivity disorder and scholastic achievement: a model of dual developmental pathways. J Child Psychol Psychiatry 1999; 40: 1169-1183.

Baddeley A. Working memory: looking back and looking forward. Nat Rev Neurosci 2003; 4: 829-839.

Baddeley A. Working memory, thought, and action: OUP Oxford; 2007.

Hulme C, MacKenzie S. Working memory and severe learning difficulties. Hillsdale (NJ), England: Lawrence Erlbaum Associates, Inc; 1992.

Siegel LS, Ryan EB. The development of working memory in normally achieving and subtypes of learning disabled children. Child Dev 1989; 60: 973-980.

Rogers M, Hwang H, Toplak M, Weiss M, Tannock R. Inattention, working memory, and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol 2011; 17: 444-458.

Gathercole SE, Pickering SJ, Knight C, Stegmann Z. Working memory skills and educational attainment: Evidence from national curriculum assessments at 7 and 14 years of age. Applied Cognitive Psychology 2004; 18: 1-16.

Bull R, Johnston RS, Roy JA. Exploring the roles of the visual‐spatial sketch pad and central executive in children's arithmetical skills: Views from cognition and developmental neuropsychology. Dev Neuropsychol 1999; 15: 421-442.

Gathercole S, Alloway TP. Working memory and learning: A practical guide for teachers: Sage; 2008.

Holmes J, Gathercole SE, Place M, Dunning DL, Hilton KA, Elliott JG. Working memory deficits can be overcome: Impacts of training and medication on working memory in children with ADHD. Appl Cognit Psychol 2010; 24: 827-836.

Ivarsson M, Strohmayer S. Working memory training improves arithmetic skills and verbal working memory capacity in children with ADHD. Stockholm: Stockholm University; 2010.

Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, et al. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2005; 44: 177-186.

Truedsson E, Strohmayer S. Working Memory Training - theory and practice. Stockholm2010.

Schweizer S, Hampshire A, Dalgleish T. Extending brain-training to the affective domain: increasing cognitive and affective executive control through emotional working memory training. PLoS One 2011; 6: e24372.

Chase WG, Ericsson KA, Faloon S. Acquisition of a memory skill. DTIC Document, 1980.

Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. Journal of clinical and experimental neuropsychology 2002; 24: 781-791.

Loomes C, Rasmussen C, Pei J, Manji S, Andrew G. The effect of rehearsal training on working memory span of children with fetal alcohol spectrum disorder. Res Dev Disabil 2008; 29: 113-124.

Douglas VI. Cognitive control processes in attention deficit hyperactivity disorder. In: C. QH, E. HA, editors. Handbook of disruptive behavior disorders. New York: Kluwer Academic Publishing/Plenum; 1999.

Douglas VI, Parry PA. Effects of reward on delayed reaction time task performance of hyperactive children. J Abnorm Child Psychol 1983; 11: 313-326.

Sagvolden T, Johansen EB, Aase H, Russell VA. A dynamic developmental theory of ADHD predominantly hyperactive/ impulsive and combined type. Behav Brain Sci 2005; 28: 397-419.

Shanahan MA, Pennington BF, Willcutt EW. Do motivational incentives reduce the inhibition deficit in ADHD? Dev Neuropsychol 2008; 33: 137-159.

Luman M, Oosterlaan J, Sergeant JA. The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal. Clin Psychol Rev 2005; 25: 183-213.

Sergeant JA, Oosterlaan J, van der Meere J. Information processing and energetic factors in attention-deficit/hyperactivity disorder. Handbook of disruptive behavior disorders: Springer; 1999.

Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997; 121: 65-94.

Shaw R, Lewis V. The impact of computer‐mediated and traditional academic task presentation on the performance and behaviour of children with ADHD. Journal of Research in Special Educational Needs 2005; 5: 47-54.

Bayerl M, Dielentheis TF, Vucurevic G, Gesierich T, Vogel F, Fehr C, et al. Disturbed brain activation during a working memory task in drug-naive adult patients with ADHD. Neuroreport 2010; 21: 442-446.

Kobel M, Bechtel N, Specht K, Klarhofer M, Weber P, Scheffler K, et al. Structural and functional imaging approaches in attention deficit/hyperactivity disorder: does the temporal lobe play a key role? Psychiatry Res 2010; 183: 230-236.

Koepp MJ, Gunn RN, Lawrence AD, Cunningham VJ, Dagher A, Jones T, et al. Evidence for striatal dopamine release during a video game. Nature 1998; 393: 266-268.

Lawrence V, Houghton S, Tannock R, Douglas G, Durkin K, Whiting K. ADHD outside the laboratory: Boys' executive function performance on tasks in videogame play and on a visit to the zoo. J Abnorm Child Psychol 2002; 30: 447-462.

Hinshaw SP. Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention. J Consult Clin Psychol 1992; 60: 893-903.

Barkley RA. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 2nd ed ed. New York: Guilford Press; 1998.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4th ed., text rev. ed. Washington, DC: Author; 2000.

Achenbach TM, Rescorla LA. Manual for the ASEBA School-Age Forms and Profiles. Burlington, VT: University of Vermont, Research Centre for Children, Youth, & Families; 2001.

Minaei A. Confirmatory factorial analysis of Achenbach’s teacher report form. Research on exceptional children 2006; 6: 769-786.

Minaei A. Adaptation and Standardization of Achenbach’s teacher report form, self-report form, teacher report form. Research on Exceptional children 2006; 19: 529-558.

Wechsler D, Kaplan E, Fein D, et al. Wechsler Intelligence Scale for Children Fourth Edition-Integrated: Technical and interpretative manual. San Antonio: The Psychological Corporation; 2004.

Pham AV, Hasson RM. Verbal and visuospatial working memory as predictors of children's reading ability. Arch Clin Neuropsychol 2014; 29: 467-477.

Rapport MD, Alderson RM, Kofler MJ, Sarver DE, Bolden J, Sims V. Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes. J Abnorm Child Psychol 2008; 36: 825-837.

Dehn MJ. Working memory and academic learning: Assessment and intervention: John Wiley & Sons; 2011.

Shiffrin RM. 30 years of memory. In: Izawa C, editor. On human memory: Evolution, progress, and reflections on the 30th anniversary of the Atkinson-Shiffrin model Mahwah, NJ: Lawrence Erlbaum; 1999.

Gathercole SE. Cognitive approaches to the development of short-term memory. Trends Cogn Sci 1999; 3: 410-419.

Richardson JTE. Evolving concepts of working memory. In: Richardson JTE, Engle RW, Hasher L, Logie RH, R. SE, Zacks RT, editors. Working memory and human cognition. New York: Oxford University Press; 1996.

Carlson RA, Khoo BH, Yaure RG, Schneider W. Acquisition of a problem-solving skill: Levels of organization and use of working memory. J Exp Psychol-Gen 1990; 119: 194-214.

Davies GM. Can memory be educated? Educ Stud 1980; 6: 155-161.

Cook NM. The applicability of verbal mnemonics for different populations: A review. Appl Cogn Psychol 1989; 3: 3-22.

Congos D. 9 types of mnemonics for better memory 2005. Available from:

Mastropieri MA, Scruggs TE, Levin JR. Maximizing What Exceptional Students Can Learn A Review of Research on the Keyword Method and Related Mnemonic Techniques. Remedial and Special Education 1985; 6: 39-45.

Castellanos FX, Tannock R. Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci 2002; 3: 617-628.

Baddeley AD. Working memory: An overview. In: J. PS, editor. Working memory and education. Burlington, MA: Academic Press; 2006.

Clair-Thompson HL. The influence of strategies on relationships between working memory and cognitive skills. Memory 2007; 15: 353-365.

Hutton UM, Towse JN. Short-term memory and working memory as indices of children's cognitive skills. Memory 2001; 9: 383-394

Swanson HL, Beebe-Frankenberger M. The relationship between working memory and mathematical problem solving in children at risk and not at risk for serious math difficulties. Journal of Educational Psychology 2004; 96: 471-491.

Andersson U, Lyxell B. Working memory deficit in children with mathematical difficulties: A general or specific deficit? J Exp Child Psychol 2007; 96: 197-228.

Imbo I, Vandierendonck A. The development of strategy use in elementary school children: working memory and individual differences. J Exp Child Psychol 2007; 96: 284-309.

Imbo I, Vandierendonck A, Vergauwe E. The role of working memory in carrying and borrowing. Psychol Res 2007; 71: 467-483.

Feifer SG, DeFina PD. The neuropsychology of reading disorders: Diagnosis and intervention workbook. Middletown, MD: School Neuropsych Press; 2000.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.