Project CLASS “Children Learning Academic Success Skills” This work was supported by IES Grant# R305H to David Rabiner Computerized Attention Training for Young Children: Results of a Randomized Controlled Trial and Considerations for Future Research Desiree W. Murray Duke Medical Center

Background and Rationale Background and Rationale Attention problems uniquely predict academic deficits Attention problems affect approximately 16% of elementary school children Existing attention interventions are limited primarily to students diagnosed with ADHD, and do not appear to translate into long-term gains in achievement Limitations of previous attention training work (prior to 2006): –4 small studies totaling less than 100 trained subjects –All clinical ADHD samples –Little evidence of generalization to classroom functioning and achievement outcomes –Maximum of 3 month follow up

Study Goal Evaluate the efficacy of two promising computer learning activities on the attention and academic performance of inattentive 1 st graders Evaluate the efficacy of two promising computer learning activities on the attention and academic performance of inattentive 1 st graders –Computerized Attention Training (CAT) via BrainTrain’s Captain’s Log –Computer Assisted Instruction (CAI) via Riverdeep’s Destination Reading and Math ***Both programs require children to sustain attention to progressively more challenging cognitive tasks

Study Design Screened all 1 st graders at 5 public schools for attention problems Randomly assigned 77 consented students to CAT, CAI, or wait-list control Collected behavior & academic ratings from teachers; administered KBIT2, WJIII subtests and DIBELS 14 weeks of intervention during the spring End of school year achievement testing and teacher ratings Follow up mid-2 nd grade (~6 months)

Sample Characteristics Predominantly male (72%) Predominantly minority –54% African American; 24% Hispanic Predominantly low-income (~ 70% on free/reduced lunch) Below Average IQ (KBIT2 = 87); baseline WJ-III reading average (SS=97)and math below average (SS=87) Academic Performance Rating Scale (APRS) Success and Productivity significantly below average Elevated hyperactive (T=65) and oppositional (T=60) behavior 13 diagnosed with ADHD and 7 on medication

Intervention Implementation Students received 2 50-minute training sessions per week after school for 14 weeks (total training about 23 hrs) –Average attendance = 88% (about half attended all but one session) RAs and school staff monitored groups of 4-6 students Rewards provided to promote good effort, behavior, and task mastery

Analysis plan Tested for differences in % of intervention and control participants who showed at least a.5 SD change in desired direction. Tested for differences from baseline to post-intervention & baseline to 2 nd grade follow-up. Accounted for nesting of children within teachers & teachers within schools. Race, sex, and IQ included as covariates.

Impact on Classroom Attention

Percent with Normalized Attention Following Intervention

Teacher Ratings of Academic Success Teacher Ratings of Academic Success

Reading Fluency

Other behavioral results No effects for any other CTRS scale. –Suggests effects specific to attention. Results not related to teachers’ knowledge of intervention vs. control status.

Now the bad news… 50% did not meet improvement criteria for attention and over 75% were not ‘normalized’. No effects for WJIII Reading or Math. No significant effects at 2 nd grade follow- up.

Percent with improved attention from baseline to second grade

What about the most inattentive students? Identified 37 of 77 students with at least 6 inattentive symptoms (threshold for ADHD diagnosis) at baseline. What proportion were largely symptom free the following year (<1 symptom)? –and did this differ between intervention and controls?

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

Summary and Conclusions Interventions yielded gains in attention that transferred to the classroom for a very high-need sample. For some children, attention can be improved with training. Suggestive evidence of longer-term benefits for most highly symptomatic children. More effective interventions for children with persistent attention problems are needed.

Questions for Future Attention Training Research What subgroups of children with attention problems are most likely to benefit from attention training? –Severity, age, demographics, other risk factors? What intervention parameters are necessary to obtain improvements in attention that translate to achievement? –Duration of training, booster sessions? How does computerized academic instruction improve attention?

Acknowledgements David Rabiner (PI) Center for Child and Family Policy, Duke University Patrick Malone (statistician) Currently at University of South Carolina Ann Skinner (coordinator) Center for Child and Family Policy, Duke University Durham Public Schools