Can Children with Severe Cognitive Challenges Perform Cognitive Training?

Adolescents with severe cognitive challenges are often confronted with important obstacles both at home and school. Although cognitive training has come to the foreground in recent years, there has been a general absence of research investigating the potential benefits for children with neurodevelopmental conditions including intellectual disability, who also often present with difficulty with attention and staying on-task at school. The ability of these children to perform certain tasks is often underestimated, and current cognitive interventions developed for typically developing children are simply not accessible to them. This presents a key challenge, since these youngsters are perhaps most in need of such benefits. Falling behind at school has long term repercussions, both in terms of future opportunities and for social esteem. Here we cover research showing why cognitive interventions show a lot of promise for students with intellectual disability, defined in part by very low IQ.

The Challenge of Training Attention in Children with Learning Difficulties

Attention is known to be strongly correlated to student performance and behavior in the classroom. Accordingly, students typically have poor attention struggle academically. In recent years, studies have demonstrated that  attention can be improved with cognitive training interventions for adolescents diagnosed with a neurodevelopmental condition. However, very little research has been conducted with students who have very low cognitive and/or language abilities, often associated with conditions such as autism and Down Syndrome, for example.

There are a number of reasons debated as to why this is, including the practical issues related to whether a student with intellectual disability can understand task instructions, or the challenges with obtaining parental and school consent for participating in a study. However, perhaps the most likely reason is that children with very low IQ are assumed not to be capable of performing the cognitive training programs currently available, which are generally designed for typically developing adult or actively aging populations.

This seems a valid assumption, given that current intervention programs generally include a panoply of exercises which all have different rules to learn to perform them, often include lengthy verbal instructions, and/or are characterized by superfluous and possibly distracting stimuli that children with learning and cognitive challenges find difficult to process and engage.

Building on Attention Training Research

My research colleagues at McGill University and the University of Montreal previously published a study showing that a cognitive training based on the NeuroTracker software was effective at improving the attentional capacities of children with clinically significant attentional difficulties. This showed for the first time the potential to improve academic outcomes for children and adolescents with different neurodevelopmental conditions. However, in this study the student’s cognitive and language abilities were at a level where task comprehension was not an issue. The question remained if children with severe cognitive challenges – who represent a largely underserved part of students receiving special education - would be able to perform the task.  

About NeuroTracker

NeuroTracker is quite distinct from other cognitive training interventions, in that there is one core training exercise which is relatively simple to understand, yet challenging to do. The task involves remembering and tracking multiple balls moving in 3D space among distractions, and recalling them when they stop after 4-8 seconds of movement. This is repeated 20 times to complete a 6-minute session, with the difficulty of the task adapting on each repetition. Here is a 2D video introduction to the task.

The adaptability of this type of training to individual needs is broad, being used across diverse populations from elite athletes and US Airforce pilots, through to training for elderlies at risk of mild cognitive impairment and for clinical rehabilitation.

With these factors in mind, we decided to conduct a feasibility study in a classroom setting to see if this training intervention could be used successfully and independently by students who have very low IQ.  In comparison to efficacy and validation studies, feasibility studies are rarely conducted to in cognitive research, but can provide valuable insights on both the implementation and viability of a program in a applied setting and/or for a group of individuals with different capabilities.

What Was Studied

We worked with a school in Quebec that specializes in educating children with learning difficulties, and had supported previous research with NeuroTracker. At this school students are not separated according to specific learning difficulties, but instead they are grouped into small classes based on their level of academic ability and behavioral challenges. Each class is managed by a teacher and a student aid.

Students were given the opportunity to participate voluntarily with the consent of their parents. On each training day a research assistant provided the class with iPad tablets setup with the NeuroTracker software, along with custom anaglyph glasses to create stereoscopic 3D. To allow for maximum adaptability in the training difficulty, we opted for a NeuroTracker algorithm which autonomously modifies three variables of the task: number of targets, speed of movement, and duration of movement.

Each student was asked to perform 2 x 6-minute sessions back-to-back, 3 days each week. 15 training days (30 NeuroTracker sessions) were required to complete the overall intervention – approximately 3 hours of total training time on the NeuroTracker task. An active control group of students were also included, who instead of using NeuroTracker, played a simple browser game called Google Chrome Dino.

What Was Found

In terms of the total number of students and parents invited to participate in the study, 58% of parents asked if their child could be part of the study consented (a relatively good percentage). This demonstrated a clear interest in the potential of cognitive training interventions versus other intervention modalities, such as cognitive therapy or cognitive medications.

For the NeuroTracker training, the software adapted the difficulty down to tracking one target throughout the intervention for 53% of participating students. This was the first NeuroTracker study conducted at this low level of difficultly, and reflective of how the program can adapt to the cognitive abilities of participants. The rest of the students progressed to 2, 3, or 4 targets, demonstrating the need for high training adaptability with this population. The students also improved at the task overall, but again the results were unsurprisingly quite variable across participants. Importantly, 100% of students successfully completed all the 30 NeuroTracker sessions, with no missing data for any sessions. In total the sessions comprised 600 trials (or mini-tests), requiring each student to independently input their answers on every trial.

Takeaways

Contrary to the concerns raised over the feasibility of cognitive interventions for children with very severe cognitive challenges, this study showed very promising results. These students weren’t only able to understand and engage with NeuroTracker, they were also all motivated to train independently on this task, completing 5 weeks of distributed training with 100% compliance. Indeed, this training paradigm showed to be highly accessible to students with significant cognitive and language difficulties.

The results suggest that cognitive training that is simple to understand, yet challenging to perform, with a high degree of adaptability to individual needs, could be very suitable for adolescents who struggle to maintain even limited amounts of attention.

These findings show that it is possible to conduct cognitive studies with youth with very low intellectual abilities, and our experience will inform future larger studies to investigate the efficacy of NeuroTracker in terms of transfer to academic skills. If the results continue to be positive, this will open a new opportunity to improve low-functioning students at a neurodevelopmental level, hopefully with long term benefits.

Study Reference

Assessing the feasibility of a classroom-based attention training program targeting academics for students with extremely low IQ

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