The CALM clinic: Data from the first 100 Children with problems in Attention, Learning and Memory Susan Gathercole, Francesca Woolgar, Duncan Astle, Tom Manly, & Joni Holmes Understanding and helping children with problems in attention, learning and memory, 16 th June 2015

The Centre for Attention, Learning & Memory Aims to: understand cognitive and brain processes involved in learning develop ways of identifying and overcoming problems that might emerge in childhood provide an information hub for researchers and professionals in children’s services

Cognitive developmental disorders: Problems of diagnosis High prevalence of ADHD, dyslexia, language impairment and dyscalculia (1-7% population) Co-morbidity rates 20-80% Diagnoses have low: specificity (high symptom variability) & sensitivity (high symptom overlap with other diagnoses)

Cognitive developmental disorders: Problems of diagnosis High prevalence of ADHD, dyslexia, language impairment and dyscalculia (1-7% population) Co-morbidity rates 20-80% Diagnoses have low: specificity(high symptom variability) & sensitivity (high symptom overlap with other diagnoses) Dimensional approach: identify meaningful dimensions of cognitive/ behavioural profiles that cut across diagnoses

The CALM clinic Research-informed assessment of children with problems in attention, learning, and/ or memory, with the aims of: identifying cognitive dimensions linked to impairments of learning (reading, maths, language) illuminating the neural and genetic characteristics of these dimensions improving diagnosis and tailoring support for individuals establishing a research panel of children with known cognitive profiles for fundamental and translational research

Possible dimensions Phonological processing STM Nonverbal Reasoning STM Executive functions attention shifting planning WM Episodic memory?

Recruitment and assessment Referrals from children’s service providers (SENCos, Ed psychs, SLTs, CAMHS) Any child aged 5-18yrs with problems in reading, maths, language, attention, learning, and/ or memory No diagnosis necessary, no co-morbidity exclusions Families visit CALM for 2.5 hour assessment: IQ, reading, maths, vocabulary, phonological processing, working memory, attention & EFs, episodic memory behaviour ratings (Conners, BRIEF, SDQ, CCC) saliva sample MRI Reports to referrers to inform ongoing support

The first recruits 104 children tested October 2013-April 2014 Excluded: incomplete data (n=12) outliers (n=1) Core data set analysed (n=91), mean age 9;06 yrs, 5;11 -15;08 years, 57 male

Referral information Referrern SENCo55 Specialist teacher7 Ed psych2 SLT14 Clin psych9 Paediatrician2 total89 Primary reason for referraln attention14 memory11 language13 literacy20 maths5 literacy & maths22 total85 Diagnosisn ADHD4 ADD1 DAMP0 Dyscalculia2 Dyslexia5 Dyspraxia3 Depression1 OCD1 Anxiety0 FAS3 GDD1 ASD5 None57

1. The whole sample

Learning and cognitive skills: mean z-scores LearningNonverbalVerbal

Nonverbal ns Correlations between learning measures and cognitive skills

Regression: standardised beta coefficients Nonverbal Verbal * * * *

TestSubscaleMeanSD Conners (T)Inattention Hyperactivity Learning problems Aggression BRIEF (T)Inhibit Shift Emotional control Initiate WM Planning Organisation Strengths & Difficulties Q (raw) Behaviour ratings

Correlations with learning scores MeasureSubscaleVocabReadingMaths ConnersInattention * Hyperactivity Learning problems-.371**-.530**-.426** Aggression * BRIEFInhibit * Shift * Emotional control Initiate * WM ** Planning * Organisation Strengths & Difficulties Q (raw) *

2. Sample subgroups

Higher learners: mean z-scores VerbalNonverbal

vocab mathsreading Numbers of children with scores <85

vocab mathsreading Numbers of children with scores <85

Mean z-scores for subgroups with learning scores below 85

3. Dimensions

Correlated factorsRotated factors F1F2F1F2 Alliteration Alliteration Digit recall Digit recall Backward digits Backward digits Story recall Story recall Matrix reasoning Matrix reasoning Dot matrix Dot matrix Mr X Mr X % variance4713% variance4713 Exploratory factor analyses: cognitive measures

Chi-square = 9.271, Degrees of freedom = 12, Probability level =.680 RMR GFI AGFI PGFI Confirmatory factor analyses: Cognitive measures

Rotated factors F1F2 Vocab Reading Maths Correlated factors F1F2 Vocab Reading Maths Exploratory factor analyses: Learning measures

Chi-square = , Degrees of freedom = 32, Probability level =.671 RMR GFI AGFI PGFI Pathways to learning: Model 1

Chi-square = , Degrees of freedom = 33, Probability level =.589 RMR GFI AGFI PGFI Pathways to learning: Model 2

4. Overview

Key findings so far Vocabulary problems rarely found in isolation in this sample Reading difficulties typically accompanied by maths problems … … but specific maths difficulties relatively common 20-30% of children have no detected learning difficulties Two dimensions identified: Verbal -> general learning Nonverbal -> maths Episodic memory strongly associated with learning, esp. vocabulary causal or not?

Further developments Further assessments Trails switching & Tower planning for 8+ Visual search, TEA-Ch2 (vigilance, sustained attention, switching, simple RT) CNRep MRI Cortical volume and thickness, white matter connectivity, reating state Mental health data Parent & child reports of anxiety, depression, etc Recruiting more children with diagnoses ADHD, language impairment

Special thanks to … Sara Gharooni Sarah Bishop Gemma Crickmore Amy Johnson Agnieszka Jaroslawska Sally Butterfield Joe Bathelt Andrew Gadie Ayla Humphrey