(PS11-A11) Response to Time out in Children Receiving Intensive Behavioral Intervention: Does Working Memory Play a Role?

Behavior modification (BM) remains the primary psychosocial intervention for youth with disruptive behaviors. However, despite large effect size magnitudes, not all children respond similarly to BM; thus, it is critical to identify for whom BM works. Consideration of cognitive processes (e.g., working memory [WM]) as moderators of treatment represents a promising approach given the primacy of these processes in extant etiological models of attention-deficit/hyperactivity disorder (ADHD). However, only one study to date examined the role of cognitive processes in responsiveness to behavioral treatment and found that higher child WM at baseline was associated with greater reductions in parent-reported inattention. Further, in a study examining the relation between parent-reported WM and observed behavior in a behavioral intervention, post hoc analyses revealed associations of the WM subscale of the Kidde Sluggish Cognitive Tempo (KSCT) with increases in time out (TO) at the end of BM likely reflecting a failure to comply with commands issued by counselors involved in the treatment program. Collectively, we expect that children with worse PHWM and VSWM performance are less likely to respond to TOs for repeated noncompliance (RNC) in an ongoing intensive behavioral intervention. Forty children presenting with disruptive behavior disorder symptoms and participating in an eight week intensive BM completed two reliable and valid tasks assessing WM (visual spatial WM [VSWM] and phonological WM [PHWM]) as part of a larger battery of tasks administered at the start of treatment (i.e., weeks 1 and 2). Furthermore, each child’s TO data was recorded as soon as a TO was assigned for the duration of an intensive behavioral intervention lasting 8 weeks. Specifically, TO for repeated noncompliance (RNC) was assigned and recorded when a child failed to initiate execution of a command within ten seconds after the second time it was issued. Responsiveness to TO was examined at two distinct time periods – time point 1 reflected responsiveness during the first three weeks of the STP (i.e., baseline TO) and time point 2 during the last three weeks of the STP (i.e., end of treatment TO), consistent with our past work. Number of TOs were summed across each three-week period for each child. Data was reduced in R software and negative-binomial poisson regressions were conducted to examine the relationship between WM and TO for RNC given the count nature of the latter variable. Results indicated that VSWM was marginally related to TO for RNC at time point 2 after controlling for time point 1 (b = -.85, p</em> = .07). PHWM was unrelated to TO for RNC (b = .21, p = .67) at time point 2 after controlling for TO at time point 1. The current study examined the role of WM and its relation to responsiveness to TO for RNC. Results indicate that VSWM is marginally associated with TO for RNC whereas PHWM is unrelated to TO for RNC. This result may likely be due to a larger proportion of variance in the central executive being accounted for by VSWM tasks rather than a distinct contribution of the VS storage/rehearsal loop given the verbal nature of the commands.