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Open Access Study protocol

Preventing academic difficulties in preterm children: a randomised controlled trial of an adaptive working memory training intervention – IMPRINT study

Leona Pascoe1, Gehan Roberts124, Lex W Doyle1234, Katherine J Lee12, Deanne K Thompson15, Marc L Seal12, Elisha K Josev18, Chiara Nosarti6, Susan Gathercole7 and Peter J Anderson12*

Author Affiliations

1 Murdoch Childrens Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, Victoria, Australia

2 Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Flemington Road, Parkville, Victoria, Australia

3 Clinical Research Development, Royal Women’s Hospital, Grattan Street, Parkville, Victoria, Australia

4 Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women’s Hospital, Grattan Street, Parkville, Victoria, Australia

5 Centre for Neuroscience, The University of Melbourne, Grattan Street, Parkville, Victoria, Australia

6 Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK

7 MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, England, UK

8 Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, Victoria, Australia

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BMC Pediatrics 2013, 13:144  doi:10.1186/1471-2431-13-144

Published: 16 September 2013

Abstract

Background

Very preterm children exhibit difficulties in working memory, a key cognitive ability vital to learning information and the development of academic skills. Previous research suggests that an adaptive working memory training intervention (Cogmed) may improve working memory and other cognitive and behavioural domains, although further randomised controlled trials employing long-term outcomes are needed, and with populations at risk for working memory deficits, such as children born preterm.

In a cohort of extremely preterm (<28 weeks’ gestation)/extremely low birthweight (<1000 g) 7-year-olds, we will assess the effectiveness of Cogmed in improving academic functioning 2 years’ post-intervention. Secondary objectives are to assess the effectiveness of Cogmed in improving working memory and attention 2 weeks’, 12 months’ and 24 months’ post-intervention, and to investigate training related neuroplasticity in working memory neural networks 2 weeks’ post-intervention.

Methods/Design

This double-blind, placebo-controlled, randomised controlled trial aims to recruit 126 extremely preterm/extremely low birthweight 7-year-old children. Children attending mainstream school without major intellectual, sensory or physical impairments will be eligible. Participating children will undergo an extensive baseline cognitive assessment before being randomised to either an adaptive or placebo (non-adaptive) version of Cogmed. Cogmed is a computerised working memory training program consisting of 25 sessions completed over a 5 to 7 week period. Each training session takes approximately 35 minutes and will be completed in the child’s home. Structural, diffusion and functional Magnetic Resonance Imaging, which is optional for participants, will be completed prior to and 2 weeks following the training period. Follow-up assessments focusing on academic skills (primary outcome), working memory and attention (secondary outcomes) will be conducted at 2 weeks’, 12 months’ and 24 months’ post-intervention.

Discussion

To our knowledge, this study will be the first randomised controlled trial to (a) assess the effectiveness of Cogmed in school-aged extremely preterm/extremely low birthweight children, while incorporating advanced imaging techniques to investigate neural changes associated with adaptive working memory training, and (b) employ long-term follow-up to assess the potential benefit of improved working memory on academic functioning. If effective, Cogmed would serve as a valuable, available intervention for improving developmental outcomes for this population.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12612000124831.

Keywords:
Preterm; Extremely low birth weight; Cogmed; Cognitive training; Working memory; Academic outcomes; Neuroplasticity; Magnetic Resonance Imaging; Randomised controlled trial