Zhao and Zhang BMC Psychology (2024) 12:59 BMC Psychology

https://doi.org/10.1186/s40359-024-01539-6

RESEARCH Open Access

The effects of working memory training

on attention deficit, adaptive and non‑adaptive
cognitive emotion regulation of Chinese
children with Attention Deficit/Hyperactivity
Disorder (ADHD)
Dan Zhao1,2 and Jifang Zhang3*

Abstract
Background Attention Deficit/Hyperactivity Disorder (ADHD) poses cognitive and emotional challenges for Chinese
children. This study addresses the potential benefits of Working Memory Training for ADHD-affected children. Under-
standing its impact on Attention, cognitive regulation, and emotional responses is crucial for tailored interventions
in the Chinese context. The Trial Registration Number (TRN) for this study is [TRN-2023-123,456], and it was officially
registered on July 15, 2023, by Changchun Normal University.
Objectives This study investigated how Working Memory training influences Attention, adaptive cognitive regu-
lation, and non-adaptive cognitive emotion regulation in Chinese children with ADHD. It also assessed changes
in attentional focus, improvements in adaptive cognitive regulation, and alterations in non-adaptive cognitive emo-
tion regulation strategies.
Methodology This quasi-experimental study aimed to assess the impact of working memory training on Chinese
children with ADHD. Using pretest-posttest measures, 120 female students underwent Cogmed software training,
targeting attention deficits and cognitive emotion regulation. Three reliable instruments measured outcomes. The
procedure involved informed consent, questionnaires, 25 training sessions, and a two-month follow-up. Statistical
analyses, including repeated measures ANOVA, assessed training effects.
Results ANOVA revealed a significant impact of Working memory training on attention deficit. Repeated meas-
ures ANOVA for cognitive emotion regulation indicated positive changes in adaptive and non-adaptive strategies
over time, with sustained improvements in self-blame, rumination, catastrophizing, and blaming others. Bonferroni
follow-up tests showed significant differences between pre-test, post-test, and follow-up, favoring the post-test
and follow-up tests.
Conclusions In summary, this research sheds light on the positive impact of memory training on Attention
and cognitive emotion regulation in children with ADHD. The study underscores the potential of working memory

*Correspondence:
Jifang Zhang
[email protected]
Full list of author information is available at the end of the article

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Zhao and Zhang BMC Psychology (2024) 12:59 Page 2 of 12

interventions, particularly software-focused approaches, in enhancing attention levels and improving cognitive emo-
tion regulation. The findings align with existing literature emphasizing the role of working memory deficits in ADHD.
Implications Practically, incorporating memory training interventions into educational settings emerges as a viable
strategy to support children with ADHD. This includes integrating memory training programs into both classroom
activities and home-based interventions. Additionally, sustained implementation and long-term follow-up assess-
ments are crucial for maximizing the effectiveness of memory training interventions. Tailoring interventions to specific
ADHD subtypes and seamlessly integrating memory training activities into daily routines offer practical and personal-
ized solutions for managing ADHD symptoms in diverse settings.
Keywords Working memory training, Attention deficit, Adaptive emotion regulation, Cognitive emotion regulation,
Non-adaptive cognitive emotion regulation, Attention Deficit/Hyperactivity Disorder (ADHD)

Introduction approximately 9.4% of children aged 2 to 17 (6.1 million

Working memory is precisely characterized as a cognitive children) diagnosed with the disorder [13]. Gender-spe-
system that temporarily holds limited information amid cific prevalence rates in 2010 indicated higher ADHD
competing cognitive activities [1–8]. Correspondingly, rates in males compared to females across various eth-
the capacity of working memory represents the boundary nicities [14]. The significant impairments associated with
of an individual’s ability to retain pertinent information ADHD, affecting academic performance, social interac-
amidst cognitive distractions, influenced by the competi- tions, and overall well-being, underscore the need for
tion for limited cognitive resources [2]. Previous research effective interventions [15].
has established that working memory capacity is not spe- Cognitive alterations, including deficits in executive
cific to a particular domain and is connected to various functions, are characteristic of ADHD [16]. Central to
cognitive activities. Importantly, individuals with high ADHD are impairments in verbal and spatial working
working memory capacity outperform those with low memory (WM), planning, Attention, vigilance, temporal
capacity in tasks requiring the suppression of distracting processing, inhibition, emotional regulation, preference
information. For instance, in the Stroop task, participants for immediate rewards, and overall decision making [2,
with higher working memory capacity find it easier to 17–20]. While effective in the short/medium term, tradi-
disregard the automatic response to color words, dem- tional pharmacological interventions present limitations
onstrating the significance of understanding working such as adverse effects, uncertainty about long-term ben-
memory for cognitive development and processing. Fur- efits, poor adherence, and negative attitudes [2, 17–19].
thermore, working memory deficits are a plausible expla- In recent years, working memory (WM) training has
nation for various developmental cognitive disorders. emerged as a potential non-pharmacological interven-
Emotional regulation, a higher-level cognitive ability, tion for ADHD [21]. WM training involves adaptive
involves conscious efforts to regulate and override emo- brain games targeting Attention, concentration, verbal
tional states, forming a system where individuals manage and visual WM, processing speed, and inhibition [19, 20,
and control their emotionally charged states [3–11]. Rec- 22]. Adaptive models, adjusting difficulty based on per-
ognizing the impact of emotional regulation is crucial, as formance, have shown gains in cognitive and WM tasks
chronic deficits negatively affect physical well-being and after 20 hours of intervention, with maintained improve-
contribute to psychopathology. Given that emotion regu- ments observed over 6 months [23, 24]. Notably, n-back
lation and emotional working memory both fall within tasks have effectively decreased WM deficits over time
the domain of social cognition, it is imperative to investi- [25, 26]. The potential of WM training extends to aca-
gate their relationship, especially considering the scarcity demic skills, with studies demonstrating improvements
of research in this area. Additionally, exploring the effec- in reading and math [27, 28].
tiveness of working memory training on emotion regula- While promising, the effectiveness of WM training var-
tion is essential. ies based on factors like duration, baseline performance,
Working memory training has also been found use- supervision, game elements, motivation, and the types of
ful for enhancing the Attention and hyperactivity of academic skills measured [29–33]. This prompts a closer
Children with Attention Deficit/Hyperactivity Disor- examination of the main characteristics of WM training
der (ADHD). ADHD is a neurodevelopmental disor- and its impact on the quality of life and psychological
der persisting across the lifespan, characterized by core well-being in individuals with ADHD.
symptoms of inattention, hyperactivity, and impulsivity A child must manifest at least 6 9 symptoms, and
[12]. The prevalence of ADHD has risen over time, with adolescents must exhibit at least 5 of the 9 symptoms
Zhao and Zhang BMC Psychology (2024) 12:59 Page 3 of 12

clustered before the 3 subtypes [12]. Previous research information in the dichotic listening task. Existing find-
has shown that symptoms related to hyperactivity tend to ings highlight the significant role of working memory
decrease as the child ages, while inattentiveness remains in goal-relevant processing amid irrelevant information
relatively unchanged [13, 14]. Barkley identified the pri- and distractions [2]. Current research trends primar-
mary characteristic of ADHD as difficulty in behavioral ily concentrate on enhancing working memory through
inhibition [15]. visual, verbal, auditory, and cross-modal memory tasks.
Unintentional behavior displayed by children diag- Despite working memory being considered domain-gen-
nosed with ADHD appears to impact their academic eral, research indicates that training yields narrow gains
achievement throughout their academic careers. Addi- on specific functions. Consequently, ongoing research
tionally, these children often encounter challenges with focuses on developing more effective training programs
social skills and communication due to frustrations that target specific cognitive tasks or employ improved
stemming from academic performance [16]. The DSM-V methods for better generalization and far-transfer effects.
notes a higher rate of ADHD in males than in females, In emotional regulation research, current trends
with a ratio of nearly 2:1 in children and 1.6:1 in adults involve categorizing different emotion regulation strate-
[11]. gies specifying how individuals manage unwanted emo-
Diverse theories exist regarding the causes of attention tions. Three distinct strategies include need-oriented,
deficit, involving a combination of biologically deter- goal-oriented, and person-oriented emotion regulation.
mined nervous system reactivity, self-regulation failures, Need-oriented strategies focus on experiencing hedoni-
and environmental disturbances (17, 18). Students strug- cally rewarding states, while goal-oriented strategies
gling with focus may experience impatience and negative align with achieving specific goals. Person-oriented emo-
responses from their environment, potentially leading to tion regulation emphasizes holistic bodily functioning.
a perception of social rejection. The persistent experience However, limited research has explored the relation-
of rejection at school, combined with the vulnerability of ship between working memory and emotion regulation,
the child/adolescent nervous system, is believed to gen- Attention, and hyperactivity of children with ADHD.
erate negative perceptions, prompting compensatory Moreover, there needs to be more investigation into the
behaviors like aggressive comic behavior, feelings of iso- potential of working memory training involving emo-
lation, and depressive states. Establishing and maintain- tional regulation as an intervention for various men-
ing a supportive and caring home environment is crucial tal disorders. This study aims to investigate the effects
in alleviating such symptoms. This can be particularly of WM training on emotion regulation, Attention, and
challenging if parents themselves display symptoms simi- hyperactivity of 8–13 year-old Chinese girls attending
lar to their child. ADHD indicators are not confined to primary schools and psychological center in Changchun
childhood, and the dynamic nature of this disorder may China. More specifically, it attempts to answer the fol-
contribute to its persistence. lowing research questions:
Drawing on prior studies, the primary treatments for
ADHD have centered on medication, behavioral, cog- 1. Does working memory training have a significant
nitive, cognitive-behavioral, and neural interventions impact on the attention of children with attention-
(19–24). A literature review spanning from 2000 to 2013 deficit/hyperactivity disorder?
highlighted multimodal treatments for ADHD in chil- 2. Does working memory training have a significant
dren and adolescents. These combination treatments impact on adaptive/ cognitive emotion regulation of
encompass self-control, self-regulation, cognitive, cog- children with attention deficit/hyperactivity disor-
nitive-behavioral, cognitive play, behavioral play, motor- der?
perceptual rehearsal, functions management training, 3. Does working memory training have a significant
verbal self-education training, parent education, positive impact non-adaptive cognitive emotion regulation
therapy, parent training, constructive parental programs, of children with attention deficit/hyperactivity disor-
and stress coping skills training. These studies demon- der?
strated that the mentioned treatments were more effec-
tive and had longer-lasting effects on attention deficit,
social skills, and behavioral problems in ADHD com- Working memory and attention of children with ADHD
pared to singular medication or behavioral therapy [17– ADHD is a neurodevelopmental condition characterized
20, 22, 25, 26]. by inappropriate inattention, hyperactivity, and impul-
Current research on working memory has explored its sivity [12–14]. Children with ADHD exhibit cognitive
connection to cognitive activities such as language pro- alterations that can impact mental health, social skills,
cessing, visual attention control, and filtering irrelevant behavioral performance, and academic achievement,
Zhao and Zhang BMC Psychology (2024) 12:59 Page 4 of 12

potentially persisting into adulthood [16]. One key memory capacity, based on attention control, and emo-
affected aspect is working memory (WM), an executive tion regulation ability, particularly relying on the execu-
function vital for storing and manipulating information, tive function processes in working memory [27, 28, 38].
crucial in everyday functions like Attention, problem- Individuals with higher working memory capacity have
solving, learning, and decision-making [17]. Deficiencies been reported to be more successful in down-regulation
in working memory are commonly observed in ADHD, tasks and experience fewer emotional responses [28].
predicting challenges in academics, impulsive decision- Furthermore, a positive correlation has been observed
making, and inattention symptoms [2, 15, 16]. between individual differences in reappraisal ability and
Recent interest has emerged among healthcare pro- working memory capacity [29]. The relationship between
fessionals, parents, and researchers for interventions working memory and emotion regulation is likely medi-
targeting WM. WM training is linked to cognitive ated by attention control, with working memory being
improvements, general life functioning benefits, and a universal processing ability and its domain-general
enhanced ADHD-related inattention [10–12]. The effec- aspect being attention control [30, 31].
tiveness of WM training is believed to involve neuro- Working memory capacity is crucial for processing
plastic changes in the pre-frontal and frontal brain target-related information and eliminating interference
systems responsible for attentional control and higher- from distractions [28]. Attention control, encompassing
level executive functions [16]. However, studies indicate alerting, orientation, and executive control functions,
that interventions focusing solely on a single cognitive is integral to working memory capacity [32]. Individu-
domain, such as WM, often fail to positively affect other als with attention control deficits may face challenges in
cognitive functions or domains, termed ‘far transfer.’ The allocating attention resources, leading to susceptibility to
mechanisms behind cognitive interventions’ transfer and negative emotional information and difficulties in emo-
generalization effects remain unclear [19]. tion regulation [33]. Negative emotional stimuli, simi-
lar to distractions, can interfere with cognitive tasks for
Working memory and emotion self‑regulation individuals with low attention control ability [39, 40].
Emotions play a crucial role in the daily lives of indi- The present study hypothesized that improving working
viduals, and regulating emotions significantly impacts memory capacity through training could enhance atten-
the quality of life. Consequently, there has been a con- tion control ability, subsequently improving emotion
certed effort by researchers and practitioners to enhance regulation ability. Attention control was considered a
humans’ emotion regulation abilities as a preventive shared component and bridge between working memory
measure against emotional disorders [34]. While devel- and emotion regulation [41]. The study utilized a running
oping effective intervention methods for promoting memory task and the attentional network test (ANT) to
emotion regulation remains challenging [35], several enhance working memory and evaluate changes in atten-
promising studies have been conducted. Wadlinger and tion control, respectively. Additionally, changes in emo-
Isaacowitz [36] proposed that gaze pattern training, par- tion regulation were measured, and correlations were
ticularly in a dot-probe task, is a valuable technique for calculated to assess the relationship between ANT com-
enhancing emotion regulation. This type of training aims ponents and emotion regulation outcomes. In related
to modify the attention network functions of alerting studies [42–55], researchers often use specific emotional
and orientation, requiring attention disengagement from situations and experimental manipulations to assess par-
negative information and redirection towards positive ticipants’ emotion regulation tasks and analyze changes
or neutral information [36]. Meditative practices, such in emotion regulation ability based on various indices,
as concentration meditation, mindfulness-based stress such as electrocardiogram, electroencephalography, and
reduction, cognitive therapy, and integrative body–mind behavioral performance results.
training, have been explored as methods to promote
emotion regulation [21, 37]. These practices likely engage Research method
the entire attention network, including alerting, orienta- To achieve the objectives of the study, we employed a
tion, and executive control [23]. quasi-experimental research approach, incorporating
According to the Selection, Optimization, and Com- pretest-posttest and a follow-up test with repeated meas-
pensation with Emotion Regulation (SOC-ER) frame- ures. The study focused on 120 female students enrolled
work [24, 38], successful emotion regulation relies in the third and fourth grades at an elementary school in
on internal resources. This framework’s frequently Changchun, Jilin, China. Specifically, 30 students from
adopted internal resource is the ability to control Atten- the third and fourth grades, selected from a psychologi-
tion, known as “working memory capacity [24]. Recent cal center in Changchun, participated in the study. Inclu-
studies have shown a correlation between working sion criteria included obtaining conscious consent and
Zhao and Zhang BMC Psychology (2024) 12:59 Page 5 of 12

demonstrating proficiency in reading and writing, while intervention for ADHD. Working memory is vital in
exclusion criteria encompassed a lack of willingness to helping individuals remember instructions, solve prob-
continue participation and attendance in neurofeedback lems, control impulses, and maintain focused Attention.
therapy sessions. In alignment with ethical principles, Cogmed is designed to enhance the working memory
post-research educational sessions were provided for the capabilities of those facing challenges in retaining infor-
control group, and participants were assured of confiden- mation or remembering tasks. Cogmed operates as a
tiality. The analysis of the data employed t-tests for inde- computer program comprising 25 online training ses-
pendent samples using SPSS software version 23. sions, each lasting 10 to 45 minutes. Users are recom-
mended to complete five sessions per week in a setting
Instruments of their choice, at home, school, work, or any other com-
In this study, three instruments were employed to gather fortable location.
data. Initially, a Cogmed provider interviews each patient
to assess the potential benefits of the training. Subse-
a) The SNAP-IV questionnaire quently, a Cogmed coach facilitates the first online ses-
sion and maintains weekly calls to discuss the patient’s
The SNAP-IV in Children Displaying ADHD Symp- progress, enhance motivation, and provide feedback.
toms [19] comprises 18 items categorized into two fac- Cogmed coaches and trainees can review the results of
tors: inattention and hyperactivity/impulsivity. Reliability each session online. During each session, the logged-
assessment was conducted using Cronbach’s alpha. The in participant engages in exercises resembling video
reliability of the questionnaire and its subscales, which games. These exercises include recalling and repeating
was estimated through Cronbach’s alpha, exceeded 0.82. the sequence in which a panel of lights or a field of aster-
oids is illuminated. The system responds to correct and
b) Conners Comprehensive Behavior Rating Scale incorrect answers, adjusting the difficulty level to chal-
lenge the limits of working memory for accurate choices
The second scale was the Conners Comprehensive and reducing difficulty for incorrect responses to prevent
Behavior Rating Scale [56], a questionnaire targeting frustration. The exercises evaluate both visual and verbal
behavioral, social, and academic aspects in children aged working memory, and players typically complete around
6–18 years, aiding in the diagnosis of attention deficit eight different exercises in each session. Upon comple-
hyperactivity disorder (ADHD). This scale, widely uti- tion of the training, the coach offers feedback during
lized by parents, encompasses 21 questions assessing a concluding session and conducts a follow-up after 6
ADHD symptoms, including attention deficits, hyperac- months to evaluate the achieved results.
tivity or impulsivity, sleep difficulties, social challenges,
and emotional experiences. Completed by mothers, it Procedure
features four subscales: Oppositional, Cognitive Prob- In the initial stage of the study, participants were identi-
lems – Inattention, Hyperactivity, and the ADHD Index. fied based on specific inclusion criteria, research objec-
Cronbach’s alpha was used for estimating the reliability of tives, and ethical considerations. The research purpose
the test, and the reliability index was 0.85. and participant education methods were then clarified,
addressing any queries they might have had. Consent was
c) Cognitive Emotion Regulation Questionnaire obtained in writing from participants, their parents, and
center officials. Before the commencement of emotional
Finally, the Cognitive Emotion Regulation Ques- working memory training sessions, participants were
tionnaire, developed by Garnefski and Kraaij [57], was required to complete three questionnaires: the Cogni-
employed to evaluate participants’ cognitive emotion tive Emotion Regulation Questionnaire, SNAP-IV (which
regulation. Comprising 36 items on a 5-point Likert scale, includes inattention and hyperactivity/impulsivity fac-
this questionnaire includes nine subscales, five focus- tors), and the Conners Comprehensive Behavior Rating
ing on adaptive cognitive emotion strategies and four on Scale. Subsequently, participants underwent the train-
non-adaptive strategies. The reliability of the scale was ing sessions, and they filled out the questionnaires again
estimated using Cronbach’s alpha and the obtained alpha before each session.
exceeded 0.89, which is acceptable. Before each working memory training session, partici-
pants were given written test instructions, and research-
Software for memory training ers verbally explained the training software to ensure
Cogmed stands as a working memory training soft- better comprehension. The training sessions, conducted
ware program commonly utilized as a supplementary over 25 consecutive days (excluding Saturdays and
Zhao and Zhang BMC Psychology (2024) 12:59 Page 6 of 12

Sundays), ranged from 10 to 45 minutes each. After com- underscores the importance of the Attention factor in
pleting the 25 sessions, participants once again filled out influencing the observed outcomes. The mentioned dif-
the questionnaires. To evaluate the lasting effects of the ferences were examined through Bonferroni follow-
training, participants retook the questionnaires without up tests, and the results of these tests are presented in
any additional training or intervention for a period of 2 Table 3. Results showed that the difference between the
months. Following the collection of data, SPSS software pre-test, post-test, and follow-up test was significant,
version 25 was utilized for analysis, employing statisti- favoring the post-test. However, the difference between
cal tests such as repeated measures analysis of variance the post-test and follow-up test was not significant.
(ANOVA) and the Bonferroni follow-up test.

Findings Research question 2

Research question 1 The second research question investigated the effect of
The first research question investigated the effect of WM on adaptive cognitive emotion regulation. As shown
working memory training on the attention deficit of chil- in Table 4, the means of the cognitive emotion regula-
dren with ADHD. Table 1 shows the Mean and SD of the tion subscales changed across the pre-intervention, post-
participants on pre-test, post-test, and follow-up tests. intervention, and follow-up stages compared to before
As shown in Table 1, the means of deficit attention the intervention.
changed across the pre-intervention, post-intervention, As shown in Table 4, the means of all dimensions
and follow-up stages compared to before the interven- changed across the pre-intervention, post-intervention,
tion. The analysis utilized repeated measures analysis and follow-up stages compared to before the interven-
of variance (ANOVA). In this analysis, deficit attention tion. The analysis utilized repeated measures analysis of
was entered into the model as a separate dependent vari- variance (ANOVA). In this analysis, the subscales were
able measured at three-time points. However, the test entered into the model as a separate dependent vari-
assumptions were also examined before conducting the able measured at three-time points. However, the test
repeated measures ANOVA. The results of Mauchly’s assumptions were also examined before conducting the
sphericity test, assessing the assumption of homogeneity repeated measures ANOVA. The results of Mauchly’s
of variance-covariance matrices deficit attention, indi- sphericity test, assessing the assumption of homogeneity
cated that the assumption was met (p < 0.15). Therefore, of variance-covariance matrices deficit attention, indi-
no degrees of freedom adjustment is necessary for inter- cated that the assumption was met (p < 0.15). Therefore,
preting the F-test. Results are presented in Table 2. no degrees of freedom adjustment is necessary for inter-
The analysis of variance (ANOVA) was conducted to preting the F-test. Results are presented in Table 5.
assess the impact of the training on the children’s atten- The analysis of various cognitive regulation strate-
tion. The results revealed a significant effect of Attention gies reveals significant effects on the dependent variable.
on the outcome, as evidenced by a substantial F-statistic Positive Refocusing, Refocus on Planning, Positive Reap-
of 4.56 (p = 0.001). The Eta value of 0.62 further empha- praisal, Putting Things into Perspective, and Acceptance
sizes the practical significance of this relationship, sug- all demonstrate substantial impacts, as indicated by their
gesting that approximately 62% of the variability in respective F-statistics of 4.56, 5.66, 6.23, 5.26, and 4.23,
the dependent variable can be explained by variations
in the Attention variable. This substantial effect size
Table 3 Bonferroni test for comparing deficit attention in pre-
test, post-test, and follow-up tests
Table 1 Mean and Standard Deviation of Pre-test, Post-test, and Dependent Variable (I) (J) Mean p.
follow-up Scores for Children’s Attention Deficit Difference
Variable / Time Pre-test Post-test Follow-up Attention pretest Posttest 17 .001
(Mean ± SD) (Mean ± SD) (Mean ± SD)
Follow up 18 .001
Attention deficit 73 ± 15.1 56 ± 14.61 55 ± 16.14 Post-test Follow up 1 0.58

Table 2 Repeated measures ANOVA for the children’s deficit attention

Sum of Squares df Mean Square F P Eta

Attention 32.92 2 16.40 4.56 0.001 0.62

Zhao and Zhang BMC Psychology (2024) 12:59 Page 7 of 12

Table 4 Mean and Standard Deviation of Pre-test, Post-test, and follow-up Scores for Children’s adaptive cognitive emotion regulation
Variable / Time Pre-test (Mean ± SD) Post-test (Mean ± SD) Follow-up (Mean ± SD)

Positive Refocusing 10.80 ± 3.20 12.80 ± 2.60 12.56 ± 2.23

Refocus on Planning 7.56 ± 1.24 10.23 ± 2.25 10.25 ± 2.31
Positive Reappraisal 8.70 ± 1.92 10.25 ± 2.30 10.36 ± 2.32
Putting Things into Perspective 7.80 ± 3.13 9.90 ± 2.23 10.12 ± 2.56
Acceptance 8.20 ± 2.23 10.10 ± 3.20 9.95 ± 2.21

Table 5 Repeated measures ANOVA for adaptive cognitive emotion regulation sub-scales
Sum of Squares df Mean Square F P Eta

Positive Refocusing 32.92 2 16.40 4.56 0.001 0.62

Refocus on Planning 62.53 2 31.23 5.66 0.001 0.69
Positive Reappraisal 27.73 2 13.86 6.23 0.001 0.68
Putting Things into Perspective 27.63 2 13.56 5.26 0.001 0.59
Acceptance 32.56 2 12.25 4.23 0.001 0.42

each associated with a p-value of 0.001, underscoring the Table 6 Bonferroni test for comparing subscales of adaptive
statistical significance of these effects. cognitive emotion regulation in pre-test, post-test, and follow-up
Examining effect sizes (Eta), Refocus on Planning test
stands out with a notable value of 0.69, followed closely Dependent Variable (I) (J) Mean p.
by Positive Reappraisal at 0.68, Putting Things into Per- Difference
spective at 0.59, Positive Refocusing at 0.62, and Accept-
Positive Refocusing pre-test Post-test 2 .001
ance at 0.42. These Eta values suggest varying degrees of
Follow up 1.76 .001
influence, with Refocus on Planning having the most sub-
Posttest Follow up 0.24 0.58
stantial impact on the dependent variable, while Accept-
Refocus on Planning pretest Posttest 2.67 .001
ance shows a moderate effect. The mentioned differences
Follow up 2.70 .001
were examined through Bonferroni follow-up tests, and
Posttest Follow up 0.03 0.58
the results of these tests are presented in Table 6. Results
Positive Reappraisal pre-test Post-test 2.69 .001
showed that the difference between the pre-test, post-
Follow up 2.78 .001
test, and follow-up test was significant, favoring the post-
Posttest Follow up 0.09 0.58
test. However, the difference between the post-test and
Putting Things into Perspective pre-test Post-test 2.10 .001
follow-up test was not significant.
Follow up 2.22 .001
Posttest Follow up 0.12 0.58
Research question 3 Acceptance pre-test Post-test 1.90 .001
The third research question investigated the effect of Follow up 1.75 .001
WM on non-adaptive cognitive emotion regulation. As Posttest Follow up 0.15 0.58
shown in Table 7, the means of the non-adaptive cogni-
tive emotion regulation subscales changed across the
pre-intervention, post-intervention, and follow-up stages the follow-up period. Specifically, rumination decreased
compared to before the intervention. from 12 (± 1.11) to 10.30 (± 2.23), catastrophizing from
Table 7 shows the effectiveness of WM on non-adaptive 9.20 (± 2.23) to 6.10 (± 1.80), and blaming others from
cognitive emotion regulation across various strategies 7.80 (± 3.39) to 5.70 (± 1.30). Repeated measures ANOVA
over time. Participants demonstrated notable improve- was used; the results are presented in Table 8.
ments in adaptive strategies, as seen in self-blame reduc- As seen in Table 8, the ANOVA results for comparing
tion from an initial mean of 9.60 (± 2.1) to 6.25 (± 2.12) at group scores on non-adaptive cognitive emotion regu-
follow-up. Similarly, non-adaptive rumination, catastro- lation strategies indicate statistically significant differ-
phizing, and blaming others exhibited positive changes ences among the groups in self-blame (F = 5.56, p = 0.001,
post-intervention, with sustained improvements during
Zhao and Zhang BMC Psychology (2024) 12:59 Page 8 of 12

Table 7 Mean and Standard Deviation of Pre-test, Post-test, and follow-up Scores for Children’s non-adaptive cognitive emotion
regulation
Variable / Time Pre-test (Mean ± SD) Post-test (Mean ± SD) Follow-up (Mean ± SD)

Self-blame 9.60 ± 2.1 6.00 ± 1.12 6.25 ± 2.12

Rumination 12 ± 1.11 10.20 ± 9.16 10.30 ± 2.23
Catastrophizing 9.20 ± 2.23 6 ± 1.70 6.10 ± 1.80
Blaming others 7.80 ± 3.39 6.20 ± 1.23 5.80 ± 1.30

Table 8 ANOVA test for comparing the groups’ scores on non-adaptive cognitive emotion regulation
Sum of Squares df Mean Square F P Eta

Self-blame 30.92 2 15.40 5.56 0.001 0.67

Rumination 60.53 2 30.23 7.69 0.001 0.70
Catastrophizing 30.56 2 15.23 8.26 0.001 0.65
Blaming others 28.63 2 14.25 9.30 0.001 0.65

Table 9 Bonferroni test for comparing subscales of non- difference between the post-test and follow-up test was
adaptive cognitive emotion regulation in pre-test, post-test, and not significant.
follow-up test
Dependent Variable (I) (J) Mean p.
Difference Discussion
The first research question aimed to investigate the
Self-blame pretest Posttest 3.6 .001
impact of memory training on improving Attention in
Follow up 3.35 .001
children with ADHD. The results of the t-test indicated
Posttest Follow up 0.25 0.69
that the memory training software led to an increase in
Rumination pretest Posttest 1.80 .001
attention levels. Furthermore, the findings of this study
Follow up 1.70 .001
were consistent with other research, emphasizing the
Posttest Follow up 0.10 0.50
significant role of working memory deficits in Attention
Catastrophizing pre-test Post-test 3.20 .001
Deficit/Hyperactivity Disorder (ADHD) (Durat, Woods,
Follow up 3.10 .001
2012).
Posttest Follow up 0.10 0.98
Cognitive interventions, such as memory training, have
Blaming others pre-test Post-test 1.60 .001
shown notably positive results, aligning with the results
Follow up 2 .001
of other studies [1–14]. The role of executive functions,
Post-test Follow up 0.40 0.78
particularly inhibitory control, working memory, and
planning, is crucial in individuals with ADHD. Con-
tinuous and robust deficits in these executive functions,
Eta = 0.67), rumination (F = 7.69, p = 0.001, Eta = 0.70), including inhibitory response, working memory, and
catastrophizing (F = 8.26, p = 0.001, Eta = 0.65), and blam- planning, have been reported [15, 16]. In this context,
ing others (F = 9.30, p = 0.001, Eta = 0.65). These findings memory training software, by providing training in goal-
underscore the significance of group variations in non- directed skills, inhibitory response, and multi-step tasks,
adaptive cognitive strategies, with rumination demon- can enhance inhibitory response and working memory
strating the highest effect size. It suggests that addressing skills in these children.
these maladaptive strategies is crucial for understanding Memory training focusing on auditory and visual com-
and potentially mitigating group differences in cogni- ponents can effectively enhance the memory of chil-
tive emotion regulation. The differences were examined dren with ADHD. Computerized programs designed
through Bonferroni follow-up tests, and the results are to improve various executive functions in children with
presented in Table 9. Results showed that the differ- ADHD are essential. The justification for the effectiveness
ence between the pre-test, post-test, and follow-up test of memory training on memory and inhibitory response
was significant, favoring the post-test. However, the in hyperactive children can be attributed to the fact that
Zhao and Zhang BMC Psychology (2024) 12:59 Page 9 of 12

this software teaches goal-directed skills and multi-step with ADHD. The findings indicate that memory train-
tasks. ing, particularly software targeting working memory,
It is crucial to note that memory training tasks involve can enhance attention levels in children with ADHD.
performing activities simultaneously, leading to cogni- These results align with existing research highlight-
tive interference and attentional demands. In this sense, ing the significant role of working memory deficits in
the capacity of working memory, a limitation in an indi- ADHD. Moreover, the study demonstrates the positive
vidual’s ability to retrieve information repeatedly from influence of working memory training on cognitive emo-
memory distorted and interfered with due to Attention tion regulation strategies, revealing an increase in adap-
to other cognitive activities, is considered. Therefore, tive strategies and a decrease in maladaptive strategies
memory training can improve these children’s inhibitory across various stages of assessment. This underscores the
response and working memory [7, 9, 11]. potential of working memory interventions to positively
It can be inferred that memory training and similar contribute to emotional regulation skills in children with
interventions can serve as complementary therapeutic ADHD.
approaches in the treatment of ADHD, potentially even The results suggest that memory training, focusing on
as alternatives to pharmacological interventions. Due to goal-directed skills, inhibitory response, and multi-step
time constraints, the limited number of sessions, and the tasks, can be a promising complementary or alternative
lack of long-term follow-up in this study, future research therapeutic approach for managing ADHD symptoms,
with increased session numbers and a more extensive potentially serving as an adjunct to pharmacological
sample size is recommended. Additionally, exploring interventions. However, it is essential to acknowledge
the differential effects of treatment based on subtypes of study limitations, including time constraints and the
ADHD could provide valuable insights. The second and absence of long-term follow-up, necessitating further
third research questions aimed to investigate the impact research with extended sessions and larger sample sizes.
of working memory (WM) on cognitive emotion regula- Additionally, exploring the nuanced effects of working
tion strategies in children with ADHD. The results of this memory interventions based on ADHD subtypes could
research indicated that working memory training led to offer valuable insights into tailored interventions for dif-
an increase in adaptive strategies and a decrease in mala- ferent presentations of the disorder.
daptive strategies (such as blaming others, catastrophiz-
ing, and self-blame) in the cognitive emotion regulation Implications
of participants. The evaluation encompassed the pre-test, The practical implications of the study suggest action-
post-test, and follow-up stages. able strategies for supporting children with ADHD.
The findings of this study align with previous research The incorporation of memory training interventions,
that demonstrated the potential of emotional working especially through educational software, emerges as a
memory training to enhance individuals’ abilities in emo- practical approach to enhancing attention levels and
tion regulation and emotional improvement [58–61]. cognitive emotion regulation. This implies that educa-
These results indicate a positive relationship between tors and clinicians may find value in integrating memory
working memory capacity and emotion regulation skills training programs into classroom activities and home-
[62]. Consistent with theoretical foundations, individuals’ based interventions, providing ongoing support for chil-
emotion regulation skills change as their working mem- dren with ADHD. Furthermore, the study emphasizes
ory capacity increases. This translates to a reduction in the potential of memory training as a complementary
maladaptive strategies and an increase in adaptive strat- tool alongside pharmacological intervention. This dual
egies. Individuals with higher working memory capacity approach, combining memory training with medica-
tend to suppress emotional states more effectively and tion or considering memory training as an alternative
can adopt a non-emotional approach when faced with for those seeking non-pharmacological interventions,
emotional stimuli [27, 61, 62]. Studies suggest that train- aligns with practical considerations for a holistic ADHD
ing working memory using emotional stimuli in adoles- management strategy. The findings also advocate for the
cents facing social and emotional challenges results in sustained implementation of memory training over an
improved emotional regulation abilities and reduced extended period for enduring benefits. This highlights
behavioral difficulties [7, 29, 62]. the practical importance of ongoing support and long-
term follow-up assessments to monitor and maximize
Conclusions the effectiveness of memory training interventions.
In conclusion, the research has provided valuable Recognizing the heterogeneity within ADHD, tailor-
insights into the impact of memory training on Attention ing memory training interventions to specific subtypes
and cognitive emotion regulation strategies in children becomes a practical consideration. Addressing the unique
Zhao and Zhang BMC Psychology (2024) 12:59 Page 10 of 12

cognitive and emotional challenges associated with dif- Availability of data and materials
No datasets were generated or analysed during the current study.
ferent ADHD presentations ensures a more personalized
and effective approach in practical settings. Practically,
memory training activities, particularly those encom- Declarations
passing both auditory and visual components, could be Ethics approval and consent to participate
seamlessly integrated into the school curriculum. This The ethical approval committee of Changchun Normal University approved
this study and issued a letter indicating the study has no side effects on the
incorporation into daily routines offers continuous cog- participants of the study. All experiments were performed under relevant
nitive stimulation and support for working memory guidelines and regulations. All methods were carried out by relevant guide-
skills, facilitating a practical and sustainable intervention lines and regulations. The Trial Registration Number (TRN) for this study is
[TRN-2023-123456], and it was officially registered on July 15, 2023, by Chang-
for children with ADHD. chun Normal University. Informed consent was obtained from the parents of
the subjects.

Implications and suggestions for further studies Consent for publication

While the present study sheds light on the potential ben- Not applicable.

efits of Working Memory Training (WMT) for Chinese Competing interests

children with Attention Deficit/Hyperactivity Disor- The authors declare no competing interests.
der (ADHD), certain limitations warrant consideration.
Author details
Firstly, the sample size in this study was relatively mod- 1
School of Philosophy and Sociology, Jilin University, Changchun, Jilin 130012,
est, which might limit the generalizability of the find- China. 2 School of Education, Changchun Normal University, Changchun,
ings. Future studies could benefit from larger and more Jilin 130032, China. 3 The 964th Hospital No.4799 XianRoad, Lvyuan District,
Changchun 130012, China.
diverse samples to enhance the external validity of the
results. Additionally, the study’s duration and the number Received: 29 November 2023 Accepted: 12 January 2024
of WMT sessions were relatively short, hindering a com-
prehensive understanding of the long-term effects of the
intervention. Extending the duration of the intervention
and conducting follow-up assessments over an extended References
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