Project CLASS Project CLASS “Children Learning Academic Success Skills”“Children Learning Academic Success Skills”

This work was supported by IES Grant# R305H050036 to David RabinerThis work was supported by IES Grant# R305H050036 to David Rabiner

Computerized Attention Training for Young Children:

Results of a Randomized Controlled Trial and Considerations for Future Research

Desiree W. MurrayDuke Medical Center

Background and RationaleBackground and Rationale

Attention problems uniquely predict academic deficitsAttention problems uniquely predict academic deficits

Attention problems affect approximately 16% of Attention problems affect approximately 16% of elementary school childrenelementary school children

Existing attention interventions are limited primarily to Existing attention interventions are limited primarily to students diagnosed with ADHD, and do not appear to students diagnosed with ADHD, and do not appear to translate into long-term gains in achievementtranslate into long-term gains in achievement

Limitations of previous attention training work (prior to Limitations of previous attention training work (prior to 2006):2006):– 4 small studies totaling less than 100 trained subjects 4 small studies totaling less than 100 trained subjects

– All clinical ADHD samples All clinical ADHD samples

– Little evidence of generalization to classroom functioning and Little evidence of generalization to classroom functioning and achievement outcomes achievement outcomes

– Maximum of 3 month follow up Maximum of 3 month follow up

Study GoalStudy Goal Evaluate the efficacy of two promising computer learning Evaluate the efficacy of two promising computer learning

activities on the attention and academic performance of activities on the attention and academic performance of inattentive 1inattentive 1stst graders graders

– Computerized Attention Training (CAT) via BrainTrain’s Computerized Attention Training (CAT) via BrainTrain’s Captain’s LogCaptain’s Log

– Computer Assisted Instruction (CAI) via Riverdeep’s Computer Assisted Instruction (CAI) via Riverdeep’s Destination Reading and MathDestination Reading and Math

***Both programs require children to sustain attention to ***Both programs require children to sustain attention to progressively more challenging cognitive tasksprogressively more challenging cognitive tasks

Study DesignStudy Design

Screened all 1Screened all 1stst graders at 5 public schools for attention graders at 5 public schools for attention problems problems

Randomly assigned 77 consented students to CAT, CAI, Randomly assigned 77 consented students to CAT, CAI, or wait-list controlor wait-list control

Collected behavior & academic ratings from teachers; Collected behavior & academic ratings from teachers; administered KBIT2, WJIII subtests and DIBELSadministered KBIT2, WJIII subtests and DIBELS

14 weeks of intervention during the spring14 weeks of intervention during the spring

End of school year achievement testing and teacher End of school year achievement testing and teacher ratingsratings

Follow up mid-2Follow up mid-2ndnd grade (~6 months) grade (~6 months)

Sample CharacteristicsSample CharacteristicsPredominantly male (72%)Predominantly male (72%)

Predominantly minorityPredominantly minority

– 54% African American; 24% Hispanic54% African American; 24% Hispanic

Predominantly low-income (~ 70% on free/reduced lunch)Predominantly low-income (~ 70% on free/reduced lunch)

Below Average IQ (KBIT2 = 87); baseline WJ-III reading Below Average IQ (KBIT2 = 87); baseline WJ-III reading average (SS=97)and math below average (SS=87)average (SS=97)and math below average (SS=87)

Academic Performance Rating Scale (APRS) Success and Academic Performance Rating Scale (APRS) Success and Productivity significantly below averageProductivity significantly below average

Elevated hyperactive (T=65) and oppositional (T=60) behaviorElevated hyperactive (T=65) and oppositional (T=60) behavior

13 diagnosed with ADHD and 7 on medication13 diagnosed with ADHD and 7 on medication

Intervention ImplementationIntervention ImplementationStudents received 2 50-minute training sessions per week Students received 2 50-minute training sessions per week after school for 14 weeks (total training about 23 hrs)after school for 14 weeks (total training about 23 hrs)– Average attendance = 88% (about half attended all but Average attendance = 88% (about half attended all but

one session)one session)RAs and school staff monitored groups of 4-6 students RAs and school staff monitored groups of 4-6 students Rewards provided to promote good effort, behavior, and Rewards provided to promote good effort, behavior, and task masterytask mastery

Analysis planAnalysis planTested for differences in % of intervention and control Tested for differences in % of intervention and control participants who showed at least a .5 SD change in participants who showed at least a .5 SD change in desired direction.desired direction.

Tested for differences from baseline to post-intervention Tested for differences from baseline to post-intervention & baseline to 2& baseline to 2ndnd grade follow-up. grade follow-up.

Accounted for nesting of children within teachers & Accounted for nesting of children within teachers & teachers within schools.teachers within schools.

Race, sex, and IQ included as covariates.Race, sex, and IQ included as covariates.

Impact on Classroom AttentionImpact on Classroom AttentionTeacher Ratings of Inattention (CTRS-R)

% students improved by .5 SD

16

44*

56*

0

10

20

30

40

50

60

Control CAT CAI

Percent with Normalized Attention Percent with Normalized Attention Following Intervention Following Intervention

0

5

10

15

20

25

Control CAT CAI

Teacher Ratings of Academic SuccessTeacher Ratings of Academic Success

0

5

1015

20

25

30

35

Control CAT CAI **

Reading FluencyReading Fluency

0

10

2030

40

50

60

70

Control CAT CAI **

Other behavioral resultsOther behavioral results

No effects for any other CTRS scale.No effects for any other CTRS scale.– Suggests effects specific to attention.Suggests effects specific to attention.

Results not related to teachers’ knowledge Results not related to teachers’ knowledge of intervention vs. control status.of intervention vs. control status.

Now the bad news…Now the bad news…

50% did not meet improvement criteria for 50% did not meet improvement criteria for attention and over 75% were not attention and over 75% were not ‘normalized’.‘normalized’.

No effects for WJIII Reading or Math.No effects for WJIII Reading or Math.

No significant effects at 2No significant effects at 2ndnd grade follow- grade follow-up. up.

Percent with improved attention Percent with improved attention from baseline to second gradefrom baseline to second grade

01020304050607080

Control CAT CAI

What about the most What about the most inattentive students?inattentive students?

Identified 37 of 77 students with at least 6 Identified 37 of 77 students with at least 6 inattentive symptoms (threshold for ADHD inattentive symptoms (threshold for ADHD diagnosis) at baseline.diagnosis) at baseline.

What proportion were largely symptom What proportion were largely symptom free the following year (free the following year (<<1 symptom)?1 symptom)?– and did this differ between intervention and and did this differ between intervention and

controls?controls?

Percent with 6 or more symptoms in 1Percent with 6 or more symptoms in 1st st grade (n=37) grade (n=37) who had 0 -1 symptoms in 2who had 0 -1 symptoms in 2ndnd grade grade

0

10

2030

40

50

60

70

Control CAT ** CAI **

Summary and ConclusionsSummary and Conclusions

Interventions yielded gains in attention that transferred Interventions yielded gains in attention that transferred to the classroom for a very high-need sample. to the classroom for a very high-need sample. For For some children, attention can be improved with some children, attention can be improved with trainingtraining..

Suggestive evidence of longer-term benefits for most Suggestive evidence of longer-term benefits for most highly symptomatic children.highly symptomatic children.

More effective interventions for children with persistent More effective interventions for children with persistent attention problems are needed. attention problems are needed.

Questions for Future Questions for Future Attention Training ResearchAttention Training Research

What subgroups of children with attention What subgroups of children with attention problems are most likely to benefit from attention problems are most likely to benefit from attention training?training?– Severity, age, demographics, other risk factors?Severity, age, demographics, other risk factors?

What intervention parameters are necessary to What intervention parameters are necessary to obtain improvements in attention that translate obtain improvements in attention that translate to achievement?to achievement?– Duration of training, booster sessions?Duration of training, booster sessions?

How does computerized academic instruction How does computerized academic instruction improve attention?improve attention?

AcknowledgementsAcknowledgements

David Rabiner (PI)David Rabiner (PI)Center for Child and Family Policy, Duke UniversityCenter for Child and Family Policy, Duke University

Patrick Malone (statistician)Patrick Malone (statistician)Currently at University of South CarolinaCurrently at University of South Carolina

Ann Skinner (coordinator)Ann Skinner (coordinator)Center for Child and Family Policy, Duke UniversityCenter for Child and Family Policy, Duke University

Durham Public SchoolsDurham Public Schools