Interventions to Enhance Development

Question 1

Define

Cochrane Review

Answer 1

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

Question 2

Define

CogMed Program

Answer 2

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

Question 3

Define

Preterm

Answer 3

babies born alive before 37 weeks of pregnancy are completed

Question 4

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

Answer 4

Cochrane Review

Question 5

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

Answer 5

CogMed Program

Question 6

Definition

babies born alive before 37 weeks of pregnancy are completed

Answer 6

Preterm

Question 7

What is considered late preterm and very preterm?

Answer 7

Late preterm: 32-36 weeks GA

Very preterm: <32 week GA

Question 8

What is considered Extremely preterm?

Answer 8

<28 week GA

Question 9

What is the survival rate of babies born at 22 weeks?

Answer 9

1/20 (5%)

Question 10

What sensory outcomes are preterm babies at risk for?

Answer 10

Blindness

Deafness

Question 11

What health outcomes are preterm babies at risk for?

Answer 11

Respiratory issues (asthma)

Cardiovascular

Metabolic

Growth (delay)

Sensory

Question 12

What motor outcomes are preterm babies at risk for?

Answer 12

Cerebral palsy

Developmental Coordination Disorder

Question 13

What cognitive outcomes are preterm babies at risk for?

Answer 13

Decreased general intelligence

Decreased language

Decreased attention

Decreased memory

Decreased executive function

Question 14

How is the general intelligence of an extremely preterm baby different to a full-term baby?

Answer 14

Extremely preterm babies have a general intelligence of 1 SD lower than full term

Question 15

What education outcomes are preterm babies at risk for?

Answer 15

Decreased reading

Decreased spelling

Decreased maths

Increased grade repitition

Question 16

What academic area is particularly effected by preterm birth?

Answer 16

Maths

Question 17

What psychopathology outcomes are preterm babies at risk for?

Answer 17

Increased behavioural problems

Increased anxiety

Increased depression

Increased ADHD

Increased autism

Question 18

True or False:

Most preterm babies lead a typical life

Answer 18

True

Question 19

Early intervention of what leads to the greatest benefits in developmental outcomes?

Answer 19

Interventions in parenting and family environment

Question 20

What is the difference in depression symptoms of parents of VPT children and full term children?

Answer 20

Depression symptoms are ~8 times more likely in parents of VPT children

Question 21

What parenting factors predict positive 2 year outcomes in cognitive and social development?

Answer 21

Positive affect

Sensitivity

Synchrony

Question 22

How does positive affect, sensitivity and synchrony from parents affects 7 year outcomes in educational areas?

Answer 22

Increased IQ

Increased language

Increased reading

Increased spelling

Increased maths

Question 23

Why do most kids never receive early intervention?

Answer 23

Severe symptoms are required for early intervention to be implemented

Question 24

What do studies say about the effects of early interventions post discharge on cognition?

Answer 24

It improves cognitive development in short to medium term

Less evidence on the long term effect

Question 25

What do studies say about the effects of early interventions post discharge on motor skill?

Answer 25

Improves motor outcome in the short term but limited evidence on the medium and ling term effect

Question 26

What is VIBeS Plus?

Answer 26

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

Question 27

How does the VIBeS Plus program effect parent mental health outcomes at 2 years?

Answer 27

It decreases depression and anxiety in parents

Question 28

How does the VIBeS Plus program effect parent mental health, cognitive and behavioural outcomes at four years?

Answer 28

Reduces anxiety and depression symptoms Does not effect cognitive outcomes Improves internalising behavioural problems

Question 29

How does the VIBeS Plus program affect children 8-years after it was implemented?

Answer 29

There is no significant benefit

Question 30

What type of children benefit the most from early intervention?

Answer 30

Children from higher social risk backgrounds

Question 31

What are the limitations of VIBeS Plus?

Answer 31

Cost Location Stigma

Question 32

What are the clinical implications and future research directions based on the research on the VIBeS Plus program?

Answer 32

* 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

Question 33

True or False: Cogmed training is based on explicit learning rather than implicit learning

Answer 33

False Cogmed training is based on **implicit** learning rather than **explicit** learning

Question 34

What levels of evidence is needed to support individual brain training programs?

Answer 34

* Real-life benefits * Magnitude of effect * Duration of effect * Cost effectiveness

Question 35

Does Cogmed result in immediate benefits in working memory?

Answer 35

Yes, there is a large effect

Question 36

Does Cogmed result in immediate benefits in reasoning ability?

Answer 36

No significant effect

Question 37

Does Cogmed result in immediate benefits in impulse control?

Answer 37

Probably not

Question 38

Does Cogmed result in immediate benefits in everydat attention (as reported by parents)?

Answer 38

Probably however these results are subjectively biased

Question 39

Does Cogmed result in ongoing benefits in everyday benefits (as reported by parents)?

Answer 39

Maybe, there is a small decrease in inattention

Question 40

How does Cogmed affect working memory at 6 month, 12 month and 24 months following intervention?

Answer 40

6 months: improved 12 months: improved slightly 24 months: no significant effect

Question 41

Why does the non-Cogmed group perform better than the Cogmed group on educational outcomes?

Answer 41

The kids are focusing less on school and more on Cogmed

Question 42

Who wrote this paper? ## Footnote 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.

Answer 42

Roberts *et al.* (2016)

Question 43

Summarise Roberts *et al.* (2016)

Answer 43

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.