Working Memory And Organizational Skills In Academic Functioning For Children With ADHD

Cole, A. M., Chan, E. S. M., Gaye, F., Harmon, S. L., & Kofler, M. J. (2024). The role of working memory and organizational skills in academic functioning for children with attention-deficit/hyperactivity disorder. Neuropsychology. Advance online publication. https://doi.org/10.1037/neu0000960

Working memory, a key executive function, is often impaired in individuals with ADHD. This cognitive process allows for the temporary storage and manipulation of information necessary for complex tasks.

In ADHD, working memory deficits can manifest as difficulties in following multi-step instructions, keeping track of tasks, or maintaining focus during activities.

These impairments are thought to stem from underlying neurobiological differences, particularly in the prefrontal cortex and its connections to other brain regions.

Working memory deficits can significantly impact daily functioning, contributing to academic struggles, disorganization, and challenges in social interactions for people with ADHD.

Key Points

• Working memory deficits and organizational skills difficulties each independently predict academic underachievement and underperformance in children with ADHD.
• Working memory deficits, organizational skills difficulties, and shared variance between them together accounted for 100% of academic achievement difficulties and 80.6% of academic performance difficulties in children with ADHD.
• Working memory deficits appear to have downstream effects on organizational skills and academic functioning in ADHD.
• After accounting for working memory and organizational skills difficulties, children with ADHD showed potential for slightly higher academic achievement than peers, suggesting they may work harder to overcome deficits.
• The findings support targeting both working memory and organizational skills in interventions for academic difficulties in ADHD.
• Limitations include the cross-sectional design and focus on overall academics rather than specific domains like math or reading.
• The study provides important insights into the cognitive mechanisms underlying academic difficulties in ADHD and informs potential intervention targets.

Rationale

Children with attention-deficit/hyperactivity disorder (ADHD) often experience significant academic difficulties, including both underachievement on standardized tests and underperformance in daily classroom activities (Loe & Feldman, 2007).

Prior research has identified working memory deficits and organizational skills problems as key factors associated with these academic struggles (Kofler et al., 2017; Langberg, Epstein, et al., 2011).

Working memory difficulties have been linked to both organizational skills deficits and academic functioning in ADHD through cross-sectional, longitudinal, and experimental studies (Ahmed et al., 2019; Chan et al., 2023; Singh et al., 2022).

Similarly, organizational skills training interventions have shown promise for improving academic performance in ADHD (Bikic et al., 2017).

However, the extent to which working memory and organizational skills independently versus jointly contribute to academic difficulties in ADHD remains unclear.

No prior study has examined all three constructs – working memory, organizational skills, and academic functioning – together in children with ADHD.

This study aimed to address this gap by investigating the unique and shared contributions of working memory and organizational skills to both academic achievement and academic performance difficulties in ADHD.

Understanding these relationships can inform more targeted interventions to support academic success for children with ADHD.

Method

Procedure

Sample

The sample comprised 309 children ages 8-13 years (M = 10.34, SD = 1.42; 123 girls) from the southeastern United States.

203 children met criteria for ADHD, while 106 did not. The sample was ethnically diverse: 69.6% White Not Hispanic or Latino, 13.3% Black, 6.8% Hispanic or Latino, 10.0% multiracial, and 0.3% Asian.

Measures

Working Memory:

• Rapport Working Memory Reordering Tests: Assess phonological and visuospatial working memory capacity and manipulation.
• Letter Updating task: Measures the ability to continuously update and manipulate information in working memory.

Organizational Skills:

• Children’s Organization Skills Scale (COSS): Parent and teacher ratings of children’s task planning, organized actions, and memory/materials management.

Academic Achievement:

• Kaufman Test of Educational Achievement (KTEA-3): Standardized measure of academic skills, specifically Reading and Math Composites.

Academic Performance:

• Academic Performance Rating Scale (APRS): Teacher ratings of students’ academic productivity and success in the classroom setting.

Statistical measures

Latent variable structural equation modeling was used to examine the relationships between ADHD, working memory, organizational skills, and academic functioning.

Bias-corrected bootstrapping with 5,000 resamples was used to test indirect effects.

Results

• Working memory deficits, organizational skills difficulties, and their shared variance accounted for 100% of academic achievement difficulties (d = -1.09) and 80.6% of academic performance difficulties (d = -0.58) in children with ADHD.
• Working memory uniquely accounted for large effects on academic achievement (d = -0.95) and small-to-medium effects on academic performance (d = -0.26).
• Organizational skills uniquely accounted for small effects on both academic achievement (d = -0.11) and performance (d = -0.30).
• Shared variance between working memory and organizational skills accounted for small effects on both achievement (d = -0.06) and performance (d = -0.13).

Insight

This study provides important new insights into the cognitive mechanisms underlying academic difficulties in children with ADHD.

The findings suggest that both working memory deficits and organizational skills problems play significant and largely independent roles in explaining academic underachievement and underperformance in ADHD.

Notably, working memory difficulties appear to have both direct effects on academic functioning and indirect effects via organizational skills problems.

This aligns with theoretical models proposing that working memory deficits may lead to downstream impairments in various functional domains for children with ADHD (Rapport et al., 2001).

An intriguing finding was that after accounting for working memory and organizational skills difficulties, children with ADHD showed potential for slightly higher academic achievement than their peers.

This suggests that children with ADHD may actually be working harder than their peers to overcome their cognitive deficits and achieve similar academic outcomes.

These results extend previous research by examining working memory, organizational skills, and academic functioning together in a large sample of children with and without ADHD.

The use of latent variable modeling allowed for a more precise estimation of these relationships while accounting for measurement error.

Future research should examine these relationships longitudinally to clarify the directionality of effects over time.

Additionally, investigating domain-specific academic outcomes (e.g., math vs. reading) could provide more nuanced insights into how working memory and organizational skills impact different areas of academic functioning in ADHD.

Strengths

This study had several methodological strengths, including:

• Large, well-characterized sample of children with and without ADHD
• Comprehensive assessment of working memory, organizational skills, and academic functioning using multiple measures and informants
• Use of latent variable modeling to reduce measurement error
• Examination of both academic achievement and classroom performance outcomes
• Inclusion of both ADHD and non-ADHD groups, allowing stronger conclusions about ADHD-specific effects

Limitations

This study also had several methodological limitations, including:

• Cross-sectional design limits causal inferences
• Sample from southeastern U.S. may not generalize to other regions or cultures
• Focus on overall academics rather than specific domains (e.g., math vs. reading)
• Inclusion of children with comorbid disorders may limit specificity to “pure” ADHD
• Reliance on parent/teacher ratings for organizational skills and academic performance

Implications

The findings have significant implications for understanding and addressing academic difficulties in children with ADHD:

1. Intervention targets: Both working memory and organizational skills appear to be important targets for improving academic outcomes in ADHD. Interventions that combine cognitive training (e.g., working memory) with behavioral strategies (e.g., organizational skills training) may be most effective.
2. Individualized approaches: The independent contributions of working memory and organizational skills suggest that some children may benefit more from interventions targeting one area versus the other. Assessing both domains could help tailor interventions to individual needs.
3. Effort recognition: The finding that children with ADHD may be working harder to achieve similar outcomes highlights the importance of recognizing their efforts and providing appropriate support and accommodations.
4. Early identification: Screening for working memory and organizational skills difficulties could help identify children at risk for academic problems before significant underachievement occurs.
5. Teacher education: Helping teachers understand the roles of working memory and organizational skills in academic functioning could improve classroom support for students with ADHD.
6. Parental support: Parents can be educated on strategies to support working memory and organizational skills at home to complement school-based interventions.

These implications are particularly relevant for clinical psychologists, educators, and other professionals working with children with ADHD.

By addressing underlying cognitive and behavioral mechanisms, interventions may be more effective in promoting long-term academic success for these children.

References

Primary reference

Cole, A. M., Chan, E. S. M., Gaye, F., Harmon, S. L., & Kofler, M. J. (2024). The role of working memory and organizational skills in academic functioning for children with attention-deficit/hyperactivity disorder. Neuropsychology. Advance online publication. https://doi.org/10.1037/neu0000960

Other references

Ahmed, S. F., Tang, S., Waters, N. E., & Davis-Kean, P. (2019). Executive function and academic achievement: Longitudinal relations from early childhood to adolescence. Journal of Educational Psychology, 111(3), 446.

Bikic, A., Reichow, B., McCauley, S. A., Ibrahim, K., & Sukhodolsky, D. G. (2017). Meta-analysis of organizational skills interventions for children and adolescents with Attention-Deficit/Hyperactivity Disorder. Clinical psychology review, 52, 108-123. https://doi.org/10.1016/j.cpr.2016.12.004

Chan, E. S., Gaye, F., Cole, A. M., Singh, L. J., & Kofler, M. J. (2023). Central executive training for ADHD: Impact on organizational skills at home and school. A randomized controlled trial. Neuropsychology. https://doi.org/10.1037/neu0000918

Kofler, M. J., Sarver, D. E., Harmon, S. L., Moltisanti, A., Aduen, P. A., Soto, E. F., & Ferretti, N. (2018). Working memory and organizational skills problems in ADHD. Journal of child psychology and psychiatry, 59(1), 57-67. https://doi.org/10.1111/jcpp.12773

Langberg, J. M., Epstein, J. N., Girio-Herrera, E., Becker, S. P., Vaughn, A. J., & Altaye, M. (2011). Materials organization, planning, and homework completion in middle-school students with ADHD: Impact on academic performance. School mental health, 3, 93-101. https://doi.org/10.1007/s12310-011-9052-y

Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of pediatric psychology, 32(6), 643-654. https://doi.org/10.1093/jpepsy/jsl054

Rapport, M. D., Chung, K. M., Shore, G., & Isaacs, P. (2001). A conceptual model of child psychopathology: Implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child & Adolescent Psychology, 30(1), 48-58. https://doi.org/10.1207/S15374424JCCP3001_6

Singh, L. J., Gaye, F., Cole, A. M., Chan, E. S., & Kofler, M. J. (2022). Central executive training for ADHD: Effects on academic achievement, productivity, and success in the classroom. Neuropsychology, 36(4), 330.

Keep Learning

Below are some Socratic questions for a college class to discuss this paper:

1. How might the relationship between working memory, organizational skills, and academic functioning differ for children with predominantly inattentive vs. predominantly hyperactive/impulsive ADHD presentations?
2. What are some potential explanations for why children with ADHD might show higher academic achievement than peers after accounting for working memory and organizational skills deficits?
3. How could the findings of this study inform the development of more effective academic interventions for children with ADHD?
4. What are some potential mediating or moderating factors that could influence the relationships between working memory, organizational skills, and academic functioning in ADHD?
5. How might the results of this study differ if conducted with adolescents or adults with ADHD? What developmental considerations are important to consider?
6. What are the ethical implications of identifying working memory and organizational skills deficits in children? How can we balance early intervention with avoiding stigmatization?
7. How might cultural factors influence the relationships between ADHD, working memory, organizational skills, and academic functioning? How could future research address this?
8. What are some alternative explanations for the observed relationships between working memory, organizational skills, and academic functioning that don’t involve causal effects?
9. How might different teaching methods or classroom environments interact with working memory and organizational skills to influence academic outcomes for children with ADHD?
10. What are the implications of these findings for our understanding of ADHD as a neurodevelopmental disorder? How do they align with or challenge current models of ADHD?