Attention and working memory training: A feasibility study in children with neurodevelopmental disorders

ABSTRACT The current study investigated the efficacy of a game-based process specific intervention for improving attention and working memory in children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD). The Caribbean Quest (CQ) is a ‘serious game’ that consists of five hierarchically structured tasks, delivered in an adaptive format, targeting different aspects of attention and/or working memory. In addition to game play, the intervention incorporates metacognitive strategies provided by trained educational assistants (EAs), to facilitate generalization and far transfer to academic and daily skills. EAs delivered the intervention to children (ages 6–13) during their regular school day, providing children with instruction in metacognitive strategies to improve game play, with participants completing approximately 12 hours of training over an 8 to 12 school week period. Pre- and post-test analyses revealed significant improvement on measures of working memory and attention, including reduced distractibility and improved divided attention skills. Additionally, children showed significant gains in performance on an academic measure of reading fluency, suggesting that training-related gains in attention and working memory transferred to classroom performance. Exit interviews with EAs revealed that the intervention was easily delivered within the school day, that children enjoyed the intervention, and that children transferred metacognitive strategies learned in game play into the classroom. Preliminary results support this game-based process specific intervention as a potentially effective treatment and useful tool for supporting cognitive improvements in children with FASD or ASD, when delivered as part of an overall treatment plan.

[1]  Richard E. Mayer,et al.  Information Processing Variables in Learning to Solve Problems , 1975 .

[2]  E Courchesne,et al.  Attention function and dysfunction in autism. , 2001, Frontiers in bioscience : a journal and virtual library.

[3]  Ron Dumont,et al.  Wechsler Intelligence Scale for Children–Fourth Edition Integrated , 2014 .

[4]  James A. Rosenthal,et al.  Qualitative Descriptors of Strength of Association and Effect Size , 1996 .

[5]  L. Tamm,et al.  An Open Trial of a Metacognitive Executive Function Training for Young Children With ADHD , 2014, Journal of attention disorders.

[6]  J. Matson,et al.  The effects of inattention/impulsivity and ASD symptom severity on social skills in toddlers , 2010, Developmental neurorehabilitation.

[7]  K. A. Hayden,et al.  Research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder: revealing the gap. , 2007, Child: care, health and development.

[8]  G. Wallace,et al.  Impaired Consonant Trigrams Test (CTT) performance relates to everyday working memory difficulties in children with Autism Spectrum Disorders , 2011, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[9]  C. Rasmussen,et al.  PARENTAL RATINGS OF CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDER ON THE BEHAVIOR RATING INVENTORY OF EXECUTIVE FUNCTION (BRIEF) , 2007 .

[10]  H. Swanson,et al.  Age-related differences in learning disabled and skilled readers' working memory. , 2003, Journal of experimental child psychology.

[11]  Marnie Hutchison Executive Function Strategies used by Children and Adolescents with Fetal Alcohol Spectrum Disorder , 2011 .

[12]  C. Coles,et al.  An Evolution of Virtual Reality Training Designs for Children With Autism and Fetal Alcohol Spectrum Disorders , 2007, Topics in language disorders.

[13]  C. Rasmussen,et al.  The relation between theory of mind and executive functions in children with fetal alcohol spectrum disorders. , 2009, The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique.

[14]  E. Sowell,et al.  Executive function predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention-deficit/hyperactivity disorder. , 2012, Alcoholism, clinical and experimental research.

[15]  David A. Balota,et al.  Visual Word Recognition , 2015, Linguistics.

[16]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[17]  Mei-chun Cheung,et al.  Executive function deficits and neural discordance in children with Autism Spectrum Disorders , 2009, Clinical Neurophysiology.

[18]  B. Leventhal,et al.  The Autism Diagnostic Observation Schedule—Generic: A Standard Measure of Social and Communication Deficits Associated with the Spectrum of Autism , 2000, Journal of autism and developmental disorders.

[19]  Derek Besner,et al.  Reading aloud is not automatic: processing capacity is required to generate a phonological code from print. , 2006, Journal of experimental psychology. Human perception and performance.

[20]  A. Baddeley,et al.  Verbal short-term memory deficits in Down syndrome: a consequence of problems in rehearsal? , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[21]  F. Paas,et al.  A motivational perspective on the relation between mental effort and performance: Optimizing learner involvement in instruction , 2005 .

[22]  A. Couteur,et al.  Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders , 1994, Journal of autism and developmental disorders.

[23]  A. Neubauer,et al.  Intelligence and neural efficiency , 2009, Neuroscience & Biobehavioral Reviews.

[24]  M. H. Epstein,et al.  The Behavioral and Emotional Rating Scale: A Strength-Based Approach to Assessment , 2000 .

[25]  H. Forssberg,et al.  Computerized training of working memory in children with ADHD--a randomized, controlled trial. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[26]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[27]  M. Rutter Incidence of autism spectrum disorders: changes over time and their meaning. , 2005, Acta paediatrica.

[28]  I. Chasnoff,et al.  Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program®. , 2012, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[29]  M. Carter Diagnostic and Statistical Manual of Mental Disorders, 5th ed. , 2014 .

[30]  A. Diamond,et al.  Interventions Shown to Aid Executive Function Development in Children 4 to 12 Years Old , 2011, Science.

[31]  S. Calhoun,et al.  Learning, Attention, Writing, and Processing Speed in Typical Children and Children with ADHD, Autism, Anxiety, Depression, and Oppositional-Defiant Disorder , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[32]  P. Malone,et al.  A Randomized Trial of Two Promising Computer-Based Interventions for Students with Attention Difficulties , 2010, Journal of abnormal child psychology.

[33]  Xueliang Li,et al.  On a Relation Between , 2012 .

[34]  S. Faraone,et al.  Should the diagnosis of Attention-Deficit/ Hyperactivity disorder be considered in children with Pervasive Developmental Disorder? , 2001 .

[35]  D P Munoz,et al.  Executive function deficits in children with fetal alcohol spectrum disorders (FASD) measured using the Cambridge Neuropsychological Tests Automated Battery (CANTAB). , 2009, Journal of child psychology and psychiatry, and allied disciplines.

[36]  A. Chudley,et al.  Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis , 2005, Canadian Medical Association Journal.

[37]  Tracy Packiam Alloway,et al.  How does working memory work in the classroom , 2006 .

[38]  Hugh Garavan,et al.  A Review of Neuropsychological and Neuroimaging Research in Autistic Spectrum Disorders: Attention, Inhibition and Cognitive Flexibility. , 2008 .

[39]  E. Riley,et al.  Children with heavy prenatal alcohol exposure demonstrate deficits on multiple measures of concept formation. , 2008, Alcoholism, clinical and experimental research.

[40]  E. Sowell,et al.  Further development of a neurobehavioral profile of fetal alcohol spectrum disorders. , 2013, Alcoholism, clinical and experimental research.

[41]  M. Rutter,et al.  Adult outcome for children with autism. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[42]  Pier J. M. Prins,et al.  Does Computerized Working Memory Training with Game Elements Enhance Motivation and Training Efficacy in Children with ADHD? , 2011, Cyberpsychology Behav. Soc. Netw..

[43]  Joanne Azulay,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. , 2011, Archives of physical medicine and rehabilitation.

[44]  McKay Moore Sohlberg,et al.  Practice guidelines for direct attention training , 2003 .

[45]  Judith Oxley,et al.  Children's use of memory strategies: Relevance to voice output communication aid use , 2000 .

[46]  Herbert Roeyers,et al.  How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[47]  C. Rasmussen Executive functioning and working memory in fetal alcohol spectrum disorder. , 2005, Alcoholism, clinical and experimental research.

[48]  Sabine Kastner,et al.  Topographic maps in human frontal cortex revealed in memory-guided saccade and spatial working-memory tasks. , 2007, Journal of neurophysiology.

[49]  H. Faras,et al.  Autism spectrum disorders , 2010, Annals of Saudi medicine.

[50]  Elena Patten,et al.  Interventions targeting attention in young children with autism. , 2011, American journal of speech-language pathology.

[51]  James M. Royer Theories of the transfer of learning , 1979 .

[52]  J. Gurney,et al.  National Autism Prevalence Trends From United States Special Education Data , 2005, Pediatrics.

[53]  L. Kenworthy,et al.  Adaptive Skills and Executive Function in Autism Spectrum Disorders , 2002, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[54]  Joni Holmes,et al.  Adaptive training leads to sustained enhancement of poor working memory in children. , 2009, Developmental science.

[55]  B. Dritschel,et al.  Executive functions in children with Autism Spectrum Disorders , 2009, Brain and Cognition.

[56]  R. Abbott,et al.  Effects of Prior Attention Training on Child Dyslexics' Response to Composition Instruction , 2006, Developmental neuropsychology.

[57]  Patrizio E. Tressoldi,et al.  Visual Selective Attention and Reading Efficiency are Related in Children , 1998, Cortex.

[58]  M. Kinsbourne,et al.  Can Children with Autism Recover? If So, How? , 2008, Neuropsychology Review.

[59]  M. Rothbart,et al.  Contributions of Attentional Control to Socioemotional and Academic Development , 2010 .

[60]  J. Matson,et al.  Comorbid psychopathology with autism spectrum disorder in children: an overview. , 2007, Research in developmental disabilities.

[61]  Susanne M. Jaeggi,et al.  Short- and long-term benefits of cognitive training , 2011, Proceedings of the National Academy of Sciences.

[62]  Jin Fan,et al.  Comparing Attentional Networks in Fetal Alcohol Spectrum Disorder and the Inattentive and Combined Subtypes of Attention Deficit Hyperactivity Disorder , 2011, Developmental neuropsychology.

[63]  M. Kihlgren,et al.  Training of attention and memory deficits in children with acquired brain injury , 2009, Acta paediatrica.

[64]  C. Coelho,et al.  Self-regulation after traumatic brain injury: a framework for intervention of memory and problem solving. , 2005, Seminars in speech and language.

[65]  K. Kerns,et al.  Investigating the efficacy of an attention training programme in children with foetal alcohol spectrum disorder , 2010, Developmental neurorehabilitation.

[66]  E. Castelli,et al.  Attention remediation following traumatic brain injury in childhood and adolescence. , 2009, Neuropsychology.

[67]  J. Gerberding,et al.  Fetal alcohol syndrome: guidelines for referral and diagnosis , 2004 .

[68]  Susanne M. Jaeggi,et al.  Working memory training improves reading processes in typically developing children , 2012, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[69]  G. Koren,et al.  The burden of prenatal exposure to alcohol: revised measurement of cost. , 2009, The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique.

[70]  David M. Rocke,et al.  Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development , 2009, Psychiatry Research.

[71]  K. Antshel,et al.  Comorbid ADHD and Anxiety Affect Social Skills Group Intervention Treatment Efficacy in Children With Autism Spectrum Disorders , 2011, Journal of developmental and behavioral pediatrics : JDBP.

[72]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[73]  S. Dowsett,et al.  The development of inhibitory control in preschool children: effects of "executive skills" training. , 2000, Developmental psychobiology.

[74]  R. Vernescu Sustained attention training in children with fetal alcohol spectrum disorder , 2008 .

[75]  E. Riley,et al.  Evaluation of Psychopathological Conditions in Children With Heavy Prenatal Alcohol Exposure , 2007, Pediatrics.

[76]  P. Lachenbruch Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[77]  Ralph-Axel Müller,et al.  Attentional networks in children and adolescents with autism spectrum disorder. , 2010, Journal of child psychology and psychiatry, and allied disciplines.

[78]  T. Klingberg Training and plasticity of working memory , 2010, Trends in Cognitive Sciences.

[79]  Carmen Rasmussen,et al.  The effect of rehearsal training on working memory span of children with fetal alcohol spectrum disorder. , 2008, Research in developmental disabilities.

[80]  Jeremy W. Grabbe,et al.  Visual word recognition without central attention: evidence for greater automaticity with advancing age. , 2006, Psychology and aging.

[81]  G. Koren,et al.  Improving Executive Functioning in Children with Fetal Alcohol Spectrum Disorders using the Alert Program for Self Regulation , 2012 .

[82]  T. Klingberg,et al.  Prefrontal cortex and basal ganglia control access to working memory , 2008, Nature Neuroscience.

[83]  F. Bookstein,et al.  Risk Factors for Adverse Life Outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects , 2004, Journal of developmental and behavioral pediatrics : JDBP.

[84]  C. Coles,et al.  Games that "work": using computer games to teach alcohol-affected children about fire and street safety. , 2007, Research in developmental disabilities.

[85]  Sara A Stevens Social Cognition: Theory and Neuroscience in Fetal Alcohol Spectrum Disorders , 2012 .

[86]  Working Memory, Short-Term Memory, and Speech Rate as Predictors of Children's Reading Performance at Different Ages. , 2001 .

[87]  Beatriz Luna,et al.  Maturation of Executive Function in Autism , 2007, Biological Psychiatry.

[88]  S. Gathercole,et al.  The Working Memory Test Battery for Children. , 2001 .

[89]  Tracy Packiam Alloway,et al.  Computerized working memory training: Can it lead to gains in cognitive skills in students? , 2013, Comput. Hum. Behav..

[90]  Carroll W. Hughes,et al.  Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD , 2013, Developmental Cognitive Neuroscience.

[91]  B. Shaywitz,et al.  Paying attention to reading: The neurobiology of reading and dyslexia , 2008, Development and Psychopathology.

[92]  J. Wijers,et al.  Executive functions in children , 2014 .

[93]  Yehoshua Tsal,et al.  Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[94]  H. Hoyme,et al.  Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders , 2014, Pediatrics.

[95]  J. Kleim,et al.  Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. , 2008, Journal of speech, language, and hearing research : JSLHR.

[96]  G. Wallace,et al.  Are Executive Control Functions Related to Autism Symptoms in High-Functioning Children? , 2009, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[97]  Louis H. Falik,et al.  The Cognitive Elements of Neural Plasticity , 2013 .

[98]  Jennifer H. Green Fetal Alcohol Spectrum Disorders: understanding the effects of prenatal alcohol exposure and supporting students. , 2007, The Journal of school health.

[99]  E. Jonsson,et al.  Incidence and prevalence of fetal alcohol spectrum disorder by sex and age group in Alberta, Canada. , 2014, Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharamcologie clinique.

[100]  C. Coles,et al.  Socio-cognitive habilitation using the math interactive learning experience program for alcohol-affected children. , 2007, Alcoholism, clinical and experimental research.

[101]  I. V. Kooten,et al.  Understanding Autism from Basic Neuroscience to Treatment, Steven O. Moldin, John L.R. Rubenstein (Eds.). Taylor & Francis (2006), ISBN: 0849327326 , 2008 .

[102]  Laure Zago,et al.  Shifting from the Perceptual Brain to the Logical Brain: The Neural Impact of Cognitive Inhibition Training , 2000, Journal of Cognitive Neuroscience.

[103]  M. Corbetta,et al.  Control of goal-directed and stimulus-driven attention in the brain , 2002, Nature Reviews Neuroscience.

[104]  Sarah N. Mattson,et al.  Fetal Alcohol Spectrum Disorders: Neuropsychological and Behavioral Features , 2011, Neuropsychology Review.

[105]  H. Ouellette-Kuntz,et al.  The changing prevalence of autism in three regions of Canada , 2013, Journal of Autism and Developmental Disorders.

[106]  J. Bisanz,et al.  The Relation Between Mathematics and Working Memory in Young Children With Fetal Alcohol Spectrum Disorders , 2011 .

[107]  P. Kodituwakku,et al.  Cognitive and Behavioral Profiles of Children with Fetal Alcohol Spectrum Disorders , 2014, Current Developmental Disorders Reports.

[108]  Jillian M. Schuh,et al.  Working Memory, Language Skills, and Autism Symptomatology , 2012, Behavioral sciences.

[109]  M. O’Connor,et al.  Executive Functioning Predicts Social Skills Following Prenatal Alcohol Exposure , 2006, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[110]  K. Hardy,et al.  Computerized Cognitive Training in Survivors of Childhood Cancer , 2011, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.