Interventions to Enhance Development Flashcards
Define
Cochrane Review
systematic reviews of primary research in human health care and health policy and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation
Define
CogMed Program
an “evidence-based”, computerized training program designed by leading neuroscientists to improve attention by effectively increasing working memory capacity over a 5 week training period
Define
Preterm
babies born alive before 37 weeks of pregnancy are completed
Definition
systematic reviews of primary research in human health care and health policy and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation
Cochrane Review
Definition
an “evidence-based”, computerized training program designed by leading neuroscientists to improve attention by effectively increasing working memory capacity over a 5 week training period
CogMed Program
Definition
babies born alive before 37 weeks of pregnancy are completed
Preterm
What is considered late preterm and very preterm?
Late preterm: 32-36 weeks GA
Very preterm: <32 week GA
What is considered Extremely preterm?
<28 week GA
What is the survival rate of babies born at 22 weeks?
1/20 (5%)
What sensory outcomes are preterm babies at risk for?
Blindness
Deafness
What health outcomes are preterm babies at risk for?
Respiratory issues (asthma)
Cardiovascular
Metabolic
Growth (delay)
Sensory
What motor outcomes are preterm babies at risk for?
Cerebral palsy
Developmental Coordination Disorder
What cognitive outcomes are preterm babies at risk for?
Decreased general intelligence
Decreased language
Decreased attention
Decreased memory
Decreased executive function
How is the general intelligence of an extremely preterm baby different to a full-term baby?
Extremely preterm babies have a general intelligence of 1 SD lower than full term
What education outcomes are preterm babies at risk for?
Decreased reading
Decreased spelling
Decreased maths
Increased grade repitition
What academic area is particularly effected by preterm birth?
Maths
What psychopathology outcomes are preterm babies at risk for?
Increased behavioural problems
Increased anxiety
Increased depression
Increased ADHD
Increased autism
True or False:
Most preterm babies lead a typical life
True
Early intervention of what leads to the greatest benefits in developmental outcomes?
Interventions in parenting and family environment
What is the difference in depression symptoms of parents of VPT children and full term children?
Depression symptoms are ~8 times more likely in parents of VPT children
What parenting factors predict positive 2 year outcomes in cognitive and social development?
Positive affect
Sensitivity
Synchrony
How does positive affect, sensitivity and synchrony from parents affects 7 year outcomes in educational areas?
Increased IQ
Increased language
Increased reading
Increased spelling
Increased maths
Why do most kids never receive early intervention?
Severe symptoms are required for early intervention to be implemented
What do studies say about the effects of early interventions post discharge on cognition?
It improves cognitive development in short to medium term
Less evidence on the long term effect
What do studies say about the effects of early interventions post discharge on motor skill?
Improves motor outcome in the short term but limited evidence on the medium and ling term effect
What is VIBeS Plus?
An intervention developed for familes with very preterm infants that aims to improve child development and parent mental health through psychologists/physiotherapists visiting families over the first 12 months
How does the VIBeS Plus program effect parent mental health outcomes at 2 years?
It decreases depression and anxiety in parents
How does the VIBeS Plus program effect parent mental health, cognitive and behavioural outcomes at four years?
Reduces anxiety and depression symptoms
Does not effect cognitive outcomes
Improves internalising behavioural problems
How does the VIBeS Plus program affect children 8-years after it was implemented?
There is no significant benefit
What type of children benefit the most from early intervention?
Children from higher social risk backgrounds
What are the limitations of VIBeS Plus?
Cost
Location
Stigma
What are the clinical implications and future research directions based on the research on the VIBeS Plus program?
- Early intervention is beneficial for children born preterm and their families
- Commence intervention ASAP - in NICU
- Involve parents and families
- Research into dosage, frequency and length
- Interventions should be targeted to populations
- Outcome measures and timing
True or False:
Cogmed training is based on explicit learning rather than implicit learning
False
Cogmed training is based on implicit learning rather than explicit learning
What levels of evidence is needed to support individual brain training programs?
- Real-life benefits
- Magnitude of effect
- Duration of effect
- Cost effectiveness
Does Cogmed result in immediate benefits in working memory?
Yes, there is a large effect
Does Cogmed result in immediate benefits in reasoning ability?
No significant effect
Does Cogmed result in immediate benefits in impulse control?
Probably not
Does Cogmed result in immediate benefits in everydat attention (as reported by parents)?
Probably however these results are subjectively biased
Does Cogmed result in ongoing benefits in everyday benefits (as reported by parents)?
Maybe, there is a small decrease in inattention
How does Cogmed affect working memory at 6 month, 12 month and 24 months following intervention?
6 months: improved
12 months: improved slightly
24 months: no significant effect
Why does the non-Cogmed group perform better than the Cogmed group on educational outcomes?
The kids are focusing less on school and more on Cogmed
Who wrote this paper?
Importance Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking.
Objective To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching.
Design, Setting, and Participants Population-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses.
Intervention Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes’ duration at school.
Main Outcomes and Measures Directly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs.
Results Of 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, −3.0 [95% CI, −5.4 to −0.7]; P = .01). Intervention costs were A$1035 per child.
Conclusions and Relevance Working memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm.
Roberts et al. (2016)
Summarise Roberts et al. (2016)
Importance Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking.
Objective To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching.
Design, Setting, and Participants Population-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses.
Intervention Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes’ duration at school.
Main Outcomes and Measures Directly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs.
Results Of 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, −3.0 [95% CI, −5.4 to −0.7]; P = .01). Intervention costs were A$1035 per child.
Conclusions and Relevance Working memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm.
