Effectiveness and Retention of Memory Strategy Training of Children with Autism Spectrum Disorder

Background: Although memory strategies are essential to executive functioning, attention, and learning, children with autism spectrum disorder (ASD) often have difficulty spontaneously using strategies like categorization (grouping items) and cumulative rehearsal (effortful repetition of items in a cumulative nature) when in new learning situations. When spontaneous strategies are observed, the same strategy is frequently used repeatedly or ineffectively (Andersen et al., 2013; Bebko & Ricciuti, 2000). Resulting memory limitations lead to challenges in learning critical new information, which can negatively impact the proper execution of daily functions (e.g., remembering appointments) and reduce academic and social functioning. Few studies have explored interventions for enhancing memory strategy use in children with ASD and the generalization of learned memory strategies to new situations.

Objectives: We examined the effectiveness of an intervention for enhancing categorization and rehearsal strategies strategy use by children with ASD. Of particular interest was the lasting effects of the teaching, specifically the maintenance of the learning after the intervention was finished, and the generalization of the strategies to new contexts.

Methods: Methods: A single-case research design with multiple participants was used where each child was his/her own control. Participants were nine children with ASD, ages 7-13 years (M = 10.25; SD = 1.75) with Full Scale IQs (WASI) > 60 and receptive vocabulary level ≥ 4 years. Participants were given a memory probe task using cards from eight distinct categories (e.g., food, furniture). During baseline, spontaneous categorization and rehearsal strategy use was assessed by inviting participants to do whatever they wished to help themselves remember the cards, following which they were turned down. Recall was assessed after a 30-second unfilled delay. Following baseline, there were 45-minute memory strategy training sessions given twice per week for three consecutive weeks. Important added components were metamemory awareness (the “why” and “how”” of strategy use) and attribution training (e.g., my gains in recall are due to my efforts vs external factors). Maintenance of training gains and generalization was observed two weeks following training. Categorization and rehearsal strategy use was measured during study time, along with two output variables, clustering (items grouped upon recall) and free recall.

Results: During Baseline, only two participants showed signs of memory strategy use, but these strategies were used inefficiently. The other seven participants showed no evidence of spontaneous categorization or rehearsal use. After receiving only two sets of training trials participants began using categorization and rehearsal successfully. By the final session, all nine participants showed evidence of using the categorization and rehearsal strategies and demonstrated improved clustering and free recall. Newly-learned skills were maintained at follow-up. “Far” generalization of the categorization strategy to a “Guess Who?™” game was limited.

Conclusions: Results have significant implications for educators and therapists. With a controlled procedure including metamemory awareness and attribution training, effective learning strategies can be readily taught in a limited number of sessions. This can lead to positive outcomes for children with ASD through improved performance in learning situations, with gains that are maintained well after training ends.