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Attention deficits in children with intellectual and developmental disabilities: evaluating the potential of computerised cognitive training
thesisposted on 24.02.2017, 01:43 by Kirk, Hannah
Attention skills are strongly associated with academic attainment, social inclusion, peer relationships and mental health. Attention difficulties are commonly reported in children with intellectual and developmental disabilities (IDD), consequently increasing the already heightened risk of cognitive difficulties, behavioural problems and learning impairments. Despite acknowledgement of the core deficits in attention that characterise children with IDD, limited research has attempted to strengthen these skills. Current treatment options are sparse and largely comprise of pharmacological approaches. However, recent investigations have suggested that cognitive processes, such as attention, can be improved via targeted training. This non-pharmaceutical approach has yielded promising results in typically developing (TD) children and in clinical groups, such as children with attention deficit hyperactivity disorder (ADHD). However, to date, there is a significant dearth of studies that have assessed the efficacy of cognitive training interventions in children with IDD. The current thesis presents a series of papers that explore attention difficulties in children with IDD and assess the potential impact of cognitive training on these attention deficits, as well as broader domains. A total of 87 children aged 4-11 years with a formal diagnosis of intellectual disability were recruited to take part in a double blind randomised control trial. Children had a diagnosis of autism spectrum disorder (ASD: n = 24), Down syndrome (DS: n = 22), non-specific intellectual disability (NSID: n = 33) or another genetic based disorder (GBD: n = 8). Participants were randomly allocated to an adaptive attention training program or a non-adaptive active control program. Both conditions were completed at home on a touchscreen tablet over a 5 week period and consisted of 25 sessions, each of 20 minutes duration. Children were assessed at three time points (baseline; post-training and 3 month follow-up) on measures of attention, literacy and numeracy. Parents and teachers completed rating scales of attention, executive functioning and behavioural/emotional problems. Several key findings arose from the work. First, despite shared behavioural attention deficits, e.g. elevated inattentive and hyperactive behaviour, idiosyncratic cognitive attention deficits were displayed across different diagnoses (i.e. ASD, DS and NSID). In addition, cognitive attention difficulties were associated with weaknesses in literacy and numeracy, confirming the link between attention and learning. These findings are presented and discussed in Chapter 4. Second, the results from the randomised controlled trial revealed that selective attention abilities and numeracy skills were positively influenced by the attention training program. No further training effects were observed, indicating that the attention training program did not promote widespread gains across all attentional processes, or broader executive functions, literacy skills and problem behaviours. These outcomes are discussed in Chapters 5 and 6. The current findings make important contributions to the limited evidence-base on the potential impact of cognitive training for children with IDD. These data have wide-ranging theoretical and clinical implications regarding the treatment of attention deficits and the facilitation of educational engagement within this population. Considering the high number of children with IDD in the general population, it is imperative that future studies use the current data to guide the development and assessment of interventions that aim to improve the daily lives of children with intellectual and developmental disabilities.