Sustained attention training in children with fetal alcohol spectrum disorder

Vernescu, Roxana M. (2008) Sustained attention training in children with fetal alcohol spectrum disorder. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Objective. Attentional difficulties are the most commonly observed behaviours in children with FASD, and Attention Deficit Hyperactivity Disorder (ADHD) is often cited as a central feature of the profile associated with FASD. Attention deficits can be noted as early as infancy, or during the preschool years, and become critical when children enter the school system. Deficits in learning and memory are often secondary to an inability to attend effectively, which is not surprising given that attention is necessary for orienting toward relevant concepts or events. Without appropriate intervention, even mild deficits in this domain can have a significant negative impact on a child's development, as children grow missing important information in their immediate environment, having difficulty recalling events, making mistakes in daily tasks, and having difficulty with higher level cognitive processing such as problem solving and reasoning. Intervention research for children with FASD is limited to two published reports, with a glaring dearth in the area of attention. The purpose of the current study was to implement a cognitive-based intervention strategy that targeted attentional processes directly. -- Participants and methods. Twenty Labrador Inuit children (ages 6.8-11.9) were divided into 2 groups matched for age and non-verbal reasoning and randomly assigned to attention process training that focused on sustained attention (SA), or contact control (CC) conditions that included academic support and games. Pre- and post-treatment assessments were conducted with direct standardized measures of verbal and non-verbal reasoning (KBIT2 and CTONI) and attention (KiTAP and TEA-Ch), and indirect measures of attention and executive functioning (ADDES-3-SV and BRIEF teacher checklists). There were no significant differences between the treatment and contact-control groups on pre-training measures of attention or verbal and non-verbal reasoning. Children were trained using materials from Thomson and colleagues' Pay Attention program. All children participated in 12 daily 30-min individual training or support sessions, for approximately 3 weeks. On average, children completed all assessment and training sessions during a 5-6 week period (approximately 18-20 individual sessions). -- Results. Significant treatment effects emerged on untrained visual and auditory sustained attention tasks, including improved performance on correct responses, errors of omission, and variability of response time. Gains from training generalized to a task tapping selective attention, with significant improvements in errors of commission following sustained attention training. In addition, training seems to have also generalized to higher-order alternating attention tasks, with increased correct response performance and reduced errors of commission. While teachers rated all children as having post-test improvements in attention and executive functioning behaviour, and hence reported no differential effects of treatment, significant treatment effects emerged on a widely utilized measure of non-verbal reasoning (CTONI), with a similar trend on the KBIT2 non-verbal performance subscale. -- Conclusions. Given the high prevalence of attention deficits for children with FASD and the impact that these deficits have on many aspects of development, early intervention is critical for a better outcome for these children. Should we be able to target basic attention deficits through direct early intervention, we may be able to alter some of the secondary deficits associated with FASD throughout the teenage and young adult years. Based on the work conducted in this exploratory dissertation, it is concluded that sustained attention process training may be beneficial for children with FASD. While all children made nonspecific gains from participating in the current study, children undergoing direct sustained attention training made significant gains as a function of treatment on various untrained measures of attention. These beneficial effects generalized to a functional measure of non-verbal reasoning ability, with children's performance significantly improving on a widely utilized school-based instrument. Thus, it appears that direct training of attentional processes might provide a useful technique for use with the pediatric FASD population.

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