title: Working memory and cognitive flexibility-training for children with an autism spectrum disorder: a randomized controlled trial.
abstract: BACKGROUND
  People with autism spectrum disorders (ASDs) experience executive function (EF) deficits. There is an urgent need for effective interventions, but in spite of the increasing research focus on computerized cognitive training, this has not been studied in ASD. Hence, we investigated two EF training conditions in children with ASD.
  
  
  METHODS
  In a randomized controlled trial, children with ASD (n = 121, 8-12 years, IQ > 80) were randomly assigned to an adaptive working memory (WM) training, an adaptive cognitive flexibility-training, or a non-adaptive control training (mock-training). Braingame Brian, a computerized EF-training with game-elements, was used. Outcome measures (pretraining, post-training, and 6-week-follow-up) were near-transfer to trained EFs, far-transfer to other EFs (sustained attention and inhibition), and parent's ratings of daily life EFs, social behavior, attention deficit hyperactivity disorder (ADHD)-behavior, and quality of life.
  
  
  RESULTS
  Attrition-rate was 26%. Children in all conditions who completed the training improved in WM, cognitive flexibility, attention, and on parent's ratings, but not in inhibition. There were no significant differential intervention effects, although children in the WM condition showed a trend toward improvement on near-transfer WM and ADHD-behavior, and children in the cognitive flexibility condition showed a trend toward improvement on near-transfer flexibility.
  
  
  CONCLUSIONS
  Although children in the WM condition tended to improve more in WM and ADHD-behavior, the lack of differential improvement on most outcome measures, the absence of a clear effect of the adaptive training compared to the mock-training, and the high attrition rate suggest that the training in its present form is probably not suitable for children with ASD.
authors.affiliation: Univeristy of Amsterdam, Amsterdam, the Netherlands; Dutch Autism and ADHD Research Center, Amsterdam, the Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: de Vries
authors.forename: Pier J M
authors.initials: PJ
authors.lastname: Prins
authors.forename: Ben A
authors.initials: BA
authors.lastname: Schmand
authors.forename: Hilde M
authors.initials: HM
authors.lastname: Geurts
mesh_terms: D000067877:Autism Spectrum Disorder / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D003194:Computer-Assisted Instruction / Q000379:methods*; D056344:Executive Function / Q000502:physiology*; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology*; D014163:Transfer, Psychology / Q000502:physiology*; D016896:Treatment Outcome
keywords: Executive functioning; autism; cognitive training; flexibility; working memory