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Working Memory Problem Form

The following statements can be used by parents and professionals as a support tool when considering if a child is a candidate for Cogmed’s Working Memory Training Program.

Note: Children’s concentration difficulties are seldom manifested in exactly the same way. It is therefore likely that you won’t get a YES to all of the statements. However, if the answer is YES on several statements, the child could probably benefit from working memory training.  If you are unsure, you can consult a Cogmed-qualified coach through A Working Mind at (440) 842-4462.

Please mark the statements that are correct for the child and note when the child has significantly more difficulties than his or her peers.

o  He/she has difficulties remembering long instructions or a chain of instructions.

o  He/she has a hard time staying focused on schoolwork if he/she isn’t extremely motivated.

o  He/she has difficulties keeping up in particular subjects, for example math or English.

o  He/she makes more mistakes than his/her peer group when trying to complete schoolwork in a hurry.

o  He/she is very particular – so much so that everything takes a long time.

o  He/she often daydreams during class.

o  He/she has problems starting tasks in school.

o  He/she has difficulties remembering a written text, and needs to read it several times to remember and understand the content.

o  He/she has a hard time with math problems that require keeping information in your head, such as math word problems or mental arithmetic.

o  He/she has problems following the thread of a conversation or story.

o  He/she has difficulties organizing his/her studies, for example planning in which order particular tasks should be done and how long they will take.

o  He/she has trouble organizing details of everyday life, such as completing activities, taking the right materials home and bringing them back to school.

o  He/she is easily distracted.

o  He/she is uncertain about time. For example, he/she has a poor understanding of how long an hour is or difficulties being on time. (This does not apply to young children whose peer group does not yet have a sense of time.)

o  There is something else in his/her home or school environment that better explains the child’s concentration difficulties. (If the answer is yes, please consider different  efforts before Cogmed Working Memory Training.)

(Source: DSM-IV)

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