The CALM clinic: Data from the first 100 Children with problems in Attention, Learning and Memory...
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Transcript of The CALM clinic: Data from the first 100 Children with problems in Attention, Learning and Memory...
The CALM clinic:
Data from the first 100 Children with problems in Attention, Learning and
Memory
Susan Gathercole, Francesca Woolgar, Duncan Astle,
Tom Manly, & Joni Holmes
Understanding and helping children with problems in attention,
learning and memory, 16th June 2015
The Centre for Attention, Learning & Memory
Aims to:
• understand cognitive and brain processes involved in learning
• develop ways of identifying and overcoming problems that might emerge in childhood
• provide an information hub for researchers and professionals in children’s services
Cognitive developmental disorders:Problems of diagnosis• High prevalence of ADHD, dyslexia, language
impairment and dyscalculia (1-7% population)• Co-morbidity rates 20-80%• Diagnoses have low:
• specificity (high symptom variability) &• sensitivity (high symptom overlap with other
diagnoses)
Cognitive developmental disorders:Problems of diagnosis• High prevalence of ADHD, dyslexia, language
impairment and dyscalculia (1-7% population)• Co-morbidity rates 20-80%• Diagnoses have low:
• specificity(high symptom variability) &• sensitivity (high symptom overlap with other
diagnoses)• Dimensional approach:
• identify meaningful dimensions of cognitive/ behavioural profiles that cut across diagnoses
The CALM clinic
Research-informed assessment of children with problems in attention, learning, and/ or memory, with the aims of:
• identifying cognitive dimensions linked to impairments of learning (reading, maths, language)
• illuminating the neural and genetic characteristics of these dimensions
• improving diagnosis and tailoring support for individuals• establishing a research panel of children with known
cognitive profiles for fundamental and translational research
Possible dimensions
Phonological
• processing• STM
Nonverbal
• Reasoning• STM
Executive functions
• attention• shifting• planning• WM
Episodic memory?
Recruitment and assessment
• Referrals from children’s service providers (SENCos, Ed psychs, SLTs, CAMHS)
• Any child aged 5-18yrs with problems in reading, maths, language, attention, learning, and/ or memory
• No diagnosis necessary, no co-morbidity exclusions• Families visit CALM for 2.5 hour assessment:
• IQ, reading, maths, vocabulary, phonological processing, working memory, attention & EFs, episodic memory
• behaviour ratings (Conners, BRIEF, SDQ, CCC)• saliva sample• MRI
• Reports to referrers to inform ongoing support
The first recruits
104 children tested October 2013-April 2014Excluded:• incomplete data (n=12)• outliers (n=1) Core data set analysed (n=91), mean age 9;06 yrs, 5;11 -15;08 years, 57 male
Referral information
Referrer nSENCo 55Specialist teacher 7Ed psych 2SLT 14Clin psych 9Paediatrician 2
total 89Primary reason for referral nattention 14memory 11language 13literacy 20maths 5literacy & maths 22total 85
Diagnosis nADHD 4ADD 1DAMP 0Dyscalculia 2Dyslexia 5Dyspraxia 3Depression 1OCD 1Anxiety 0FAS 3GDD 1ASD 5None 57
1. The whole sample
Learning and cognitive skills: mean z-scores
Vocab
Readi
ng
Mat
hs
Alliter
atio
n
Rapid
nam
ing
Digit
reca
ll
Backw
ard
digi
t rec
all
Stor
y re
call
Mat
rix re
ason
ing
Dot m
atrix
Mr X
-1.6
-1.4
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
n=91
Learning NonverbalVerbal
Verbal Nonverbal
ns
Correlations between learning measures and cognitive skills
0
0.1
0.2
0.3
0.4
0.5
0.6
Vocab
Reading
Maths
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
Vocab Reading
Maths
Regression: standardised beta coefficients
NonverbalVerbal
**
*
*
Test Subscale Mean SDConners (T) Inattention 74.3 12.7
Hyperactivity 64.4 14.6Learning problems 73.0 12.0Aggression 54.9 13.8
BRIEF (T) Inhibit 60.9 14.3Shift 63.1 15.3Emotional control 59.3 13.3Initiate 64.9 11.1WM 72.8 9.8Planning 70.7 10.8Organisation 59.6 10.6
Strengths & Difficulties Q (raw) 15.8 7.5
Behaviour ratings
Correlations with learning scores
Measure Subscale Vocab Reading MathsConners Inattention 0.068 -0.109 -.239*
Hyperactivity -0.089 -0.175 -0.098Learning problems -.371** -.530** -.426**Aggression -0.205 -0.127 -.224*
BRIEF Inhibit -0.172 -0.183 -.258*Shift 0.005 -0.004 -.214*Emotional control -0.143 -0.085 -0.137Initiate 0.002 0.021 -.253*WM 0.004 -0.01 -.283**Planning -0.004 -0.078 -.208*Organisation 0.118 -0.035 -0.094
Strengths & Difficulties Q (raw) -0.155 -0.056 -.261*
2. Sample subgroups
Allit
erat
ion
Rapid n
aming
Digit
span
Back
ward
digits
Stor
y re
call
Mat
ix re
ason
ing
Dot m
atrix
Mr X
-.60
-.40
-.20
.00
.20
.40
.60
.80
1.00all learning>80, n=31
all learning>85, n=23
all learning>90, n=12
Higher learners: mean z-scores
Verbal Nonverbal
vocab
mathsreading
161 5
1
6
19
20
23
Numbers of children with scores <85
vocab
mathsreading
161 5
1
6
19
20
23
Numbers of children with scores <85
Allit
erat
ion
Rapid n
aming
Digit
span
Back
ward
digits
Stor
y re
call
Mat
ix re
ason
ing
Dot m
atrix
Mr X
-2.5
-2
-1.5
-1
-0.5
0
vocab,maths&read <85,n=16
maths&read<85,n=19
maths<85,n=20
Mean z-scores for subgroups with learning scores below 85
3. Dimensions
Correlated factors Rotated factors
F1 F2 F1 F2
Alliteration 0.76 -0.35 Alliteration 0.81 0.21
Digit recall 0.72 -0.20 Digit recall 0.69 0.29
Backward digits 0.80 0.02 Backward digits 0.61 0.52
Story recall 0.64 -0.43 Story recall 0.76 0.07
Matrix reasoning 0.61 0.09 Matrix reasoning 0.42 0.45
Dot matrix 0.59 0.67 Dot matrix 0.04 0.90
Mr X 0.65 0.33 Mr X 0.30 0.67% variance 47 13 % variance 47 13
Exploratory factor analyses: cognitive measures
Chi-square = 9.271, Degrees of freedom = 12, Probability level = .680RMR GFI AGFI PGFI 5.252 .971 .932 .416
Confirmatory factor analyses:Cognitive measures
Rotated factorsF1 F2
Vocab 0.92 0.13Reading 0.71 0.45Maths 0.22 0.96
Correlated factorsF1 F2
Vocab 0.80 -0.48Reading 0.83 -0.10Maths 0.77 0.60
Exploratory factor analyses: Learning measures
Chi-square = 27.963, Degrees of freedom = 32, Probability level = .671
RMR GFI AGFI PGFI 8.741 .938 .894 .546
Pathways to learning:Model 1
Chi-square = 30.565, Degrees of freedom = 33, Probability level = .589
RMR GFI AGFI PGFI 9.587 .934 .890 .560
Pathways to learning:Model 2
4. Overview
Key findings so far
• Vocabulary problems rarely found in isolation in this sample
• Reading difficulties typically accompanied by maths problems …
• … but specific maths difficulties relatively common• 20-30% of children have no detected learning difficulties• Two dimensions identified:
• Verbal -> general learning• Nonverbal -> maths
• Episodic memory strongly associated with learning, esp. vocabulary• causal or not?
Further developments
Further assessments• Trails switching & Tower planning for 8+• Visual search, TEA-Ch2 (vigilance, sustained attention,
switching, simple RT)• CNRep
MRICortical volume and thickness, white matter connectivity, reating state
Mental health dataParent & child reports of anxiety, depression, etc
Recruiting more children with diagnosesADHD, language impairment
Special thanks to …
Sara GharooniSarah BishopGemma CrickmoreAmy JohnsonAgnieszka Jaroslawska
Sally ButterfieldJoe BatheltAndrew Gadie
Ayla Humphrey