Attention Deficits in Children with Developmental Disorders:
The Efficacy of Cognitive Training
Children with developmental disorders, such as Fragile X syndrome, autism spectrum disorder and Down syndrome often share a common challenge – they all have difficulties with attention. Attention difficulties can manifest behaviorally as hyperactivity, distractibility, impulsivity, forgetfulness, an inability to maintaining focus and remain engaged with a task for a prolonged period. Unsurprisingly, a wealth of research highlights that attention difficulties have a significant and negative impact on academic attainment, social inclusion, peer relationships and mental health.
In the case of children who are especially vulnerable to learning impairments because of an underlying developmental disorder, attention difficulties will likely exacerbate existing cognitive and behavioral difficulties. As a result children experience a reduction in the ability to interact with the world around them and to engage in educational programs. Despite the high prevalence of attention difficulties in children with developmental disorder, treatment options are sparse.
Psychostimulant medication comprises the most common treatment option for attention difficulties in children with developmental disorder. Our team at Monash University in collaboration with Game Developers (Torus Games) and Software Engineers (Grey Innovation), designed, developed and evaluated a non-pharmaceutical intervention aimed at alleviating core attention difficulties, TALI Train TM.
TALI Train TM is a touchscreen training program that presents as a series of game based exercises designed to enhance attention skills. These exercises adapt in real time to the gameplay of the child and key parameters can be tailored to ensure that the program addresses the unique needs of each child.
Every facet of TALI-every colour, character, shape and sound-has a neuroscientific reason for being there. The program is designed to be completed 5 times a week over a period of 5 weeks, equating to a total of 25 training sessions. Training can be conducted at home, in the classroom or with a healthcare provider and takes approximately 20 minutes. Sophisticated analytics allow users the track their child performance across each exercise and across the duration of the training course.
The core attention skills that the exercises target are:
1) Selection: Selective attention refers to the ability to attend to relevant information whilst simultaneously ignoring irrelevant information. This skill is particularly important in early childhood and helps children to direct attention appropriately at home and within the classroom.
2) Focus: Sustained attention refers to the ability to maintain focus over a prolonged period of time. This skill is important to enable children to remain engaged with a task and to listen to instructions.
3) Impulsivity: Attentional control refers to the ability to shift attention and to prevent impulsive responding. This skill is more complex than the other two and as such develops later in childhood. This skill is important for regulating behaviour such as fidgeting and calling out in the classroom.
In order to assess whether the program was beneficial for children with developmental disorders we conducted a rigorous double blind randomized control trial – the ‘gold standard’ method of assessing interventions. The study involved 77 children with developmental disorders and an intellectual disability between the ages of 4 to 10 years. Children were randomly assigned to use TALI Train TM or a non-adaptive control program that was also delivered on a touchscreen platform. Children in both groups used their assigned program 5 times a week for a 5 week period.
After 5 weeks of using TALI Train TM children showed greater improvements in their ability to select relevant information and filter out distractors (selective attention), than children who used a control program for the same length of time. These attentional improvements were still present 3 months after children had stopped using the program. In addition TALI Train TM was also shown to promote benefits in untrained academic skills, such as numeracy at the 3 month follow-up assessment.
Conclusions & Implications
Collectively these findings highlight that this type of intervention may be beneficial for children with developmental disorders, such as Fragile x syndrome and offers the first step to a new approach of increasing attentional capacity in young children. These findings have considerable implications given the high number of children with disabilities entering the education system at a considerable disadvantage and struggling to remain in an inclusive setting as a result of attentional difficulties.