Effect of Motor Interference Therapy on Distress Related to Traumatic Memories: A Randomized, Double-Blind, Controlled Feasibility Trial.

INTRODUCTION: Traumatic memories (TM) are a core feature of stress-related disorders, including posttraumatic stress disorder (PTSD). Treatment is often difficult, and specific pharmacological interventions are lacking. We present a novel non-pharmacological intervention called motor interference therapy (MIT) as a promising alternative for these symptoms. AIMS: To determine the feasibility of MIT, a brief, audio-delivered, and non-pharmacological intervention that uses cognitive and motor tasks to treat TM. METHODS: We designed a randomized, double-blind trial. Twenty-eight participants from an outpatient clinic with at least one TM were included to receive either MIT or progressive muscle relaxation (PMR). Spanish versions of the PTSD symptom severity scale (EGS), visual analog scale for TM (TM-VAS), and quality of life (EQ-VAS) were applied prior to intervention, 1 week, and 1 month following intervention. RESULTS: Mean scores on all measures improved from baseline to posttest for both groups. MIT participants showed significantly more positive scores at 1 week and 1 month (TM-VAS baseline: 9.8 ± 0.4; immediate: 6.0 ± 2.0; 1 week: 3.8 ± 3.1 [d = 1.57]; 1 month 2.9 ± 2.8 [d = 1.93]) than PMR participants on measures of distress due to TM, trauma re-experiencing, anxiety, and a composite measure of PTSD. CONCLUSION: MIT is a simple, effective, and easy-to-use tool for treating TM and other stress-related symptoms. It requires relatively few resources and could be adapted to many contexts. The results provide proof-of-principle support for conducting future research with larger cohorts and controls to improve clinical effectiveness and research on brief interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03627078.

Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.

BACKGROUND: Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families. METHODS: We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages. RESULTS: We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98-1.35), Family Healthy Lifestyle 1.17 (0.99-1.38), and Family Recreation 1.12 (0.95-1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06-1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours). CONCLUSIONS: Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.

Refining the quantitative pathway of the Pathways to Mathematics model.

In the current study, we adopted the Pathways to Mathematics model of LeFevre et al. (2010). In this model, there are three cognitive domains--labeled as the quantitative, linguistic, and working memory pathways--that make unique contributions to children's mathematical development. We attempted to refine the quantitative pathway by combining children's (N=141 in Grades 2 and 3) subitizing, counting, and symbolic magnitude comparison skills using principal components analysis. The quantitative pathway was examined in relation to dependent numerical measures (backward counting, arithmetic fluency, calculation, and number system knowledge) and a dependent reading measure, while simultaneously accounting for linguistic and working memory skills. Analyses controlled for processing speed, parental education, and gender. We hypothesized that the quantitative, linguistic, and working memory pathways would account for unique variance in the numerical outcomes; this was the case for backward counting and arithmetic fluency. However, only the quantitative and linguistic pathways (not working memory) accounted for unique variance in calculation and number system knowledge. Not surprisingly, only the linguistic pathway accounted for unique variance in the reading measure. These findings suggest that the relative contributions of quantitative, linguistic, and working memory skills vary depending on the specific cognitive task.

The protocol for the Families First Edmonton trial (FFE): a randomized community-based trial to compare four service integration approaches for families with low-income.

BACKGROUND: Families with low incomes experience an array of health and social challenges that compromise their resilience and lead to negative family outcomes. Along with financial constraints, there are barriers associated with mental and physical health, poorer education and language. In addition, vulnerable populations experience many services as markedly unhelpful. This combination of family and service barriers results in reduced opportunities for effective, primary-level services and an increased use of more expensive secondary-level services (e.g., emergency room visits, child apprehensions, police involvement). A systematic review of effective interventions demonstrated that promotion of physical and mental health using existing service was critically important. METHODS/DESIGN: The Families First Edmonton Trial (FFE) tests four service integration approaches to increase use of available health and social services for families with low-income. It is a randomized, two-factor, single-blind, longitudinal effectiveness trial where low-income families (1168) were randomly assigned to receive either (1) Family Healthy Lifestyle plus Family Recreation service integration (Comprehensive), (2) Family Healthy Lifestyle service integration, (3) Family Recreation service integration, or (4) existing services. To be eligible families needed to be receiving one of five government income assistance programs. The trial was conducted in the City of Edmonton between January 2006 and August 2011. The families were followed for a total of three years of which interventional services were received for between 18 and 24 months. The primary outcome is the number of family linkages to health and social services as measured by a customized survey tool "Family Services Inventory". Secondary outcomes include type and satisfaction with services, cost of services, family member health, and family functioning. Where possible, the measures for secondary outcomes were selected because of their standardization, the presence of published norming data, and their utility as comparators to other studies of low-income families. As an effectiveness trial, community and government partners participated in all committees through a mutually agreed upon governance model and helped manage and problem solve with researchers. DISCUSSION: Modifications were made to the FFE trial based on the pragmatics of community-based trials. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00705328.

The role of executive attention in the acquisition of mathematical skills for children in Grades 2 through 4.

We examined the role of executive attention, which encompasses the common aspects of executive function and executive working memory, in children's acquisition of two aspects of mathematical skill: (a) knowledge of the number system (e.g., place value) and of arithmetic procedures (e.g., multi-digit addition) and (b) arithmetic fluency (i.e., speed of solutions to simple equations such as 3+4 and 8-5). Children in Grades 2 and 3 (N=157) completed executive attention and mathematical tasks. They repeated the mathematical tasks 1 year later. We used structural equation modeling to examine the relations between executive attention and (a) concurrent measures of mathematical knowledge and arithmetic fluency and (b) growth in performance on these measures 1 year later. Executive attention was concurrently predictive of both knowledge and fluency but predicted growth in performance only for fluency. A composite language measure predicted growth in knowledge from Grade 2 to Grade 3. The results support an important role for executive attention in children's acquisition of novel procedures and the development of automatic access to arithmetic facts.

Pathways to mathematics: longitudinal predictors of performance.

A model of the relations among cognitive precursors, early numeracy skill, and mathematical outcomes was tested for 182 children from 4.5 to 7.5 years of age. The model integrates research from neuroimaging, clinical populations, and normal development in children and adults. It includes 3 precursor pathways: quantitative, linguistic, and spatial attention. These pathways (a) contributed independently to early numeracy skills during preschool and kindergarten and (b) related differentially to performance on a variety of mathematical outcomes 2 years later. The success of the model in accounting for performance highlights the need to understand the fundamental underlying skills that contribute to diverse forms of mathematical competence.

Knowledge of counting principles: how relevant is order irrelevance?

Most children who are older than 6 years of age apply essential counting principles when they enumerate a set of objects. Essential principles include (a) one-to-one correspondence between items and count words, (b) stable order of the count words, and (c) cardinality-that the last number refers to numerosity. We found that the acquisition of a fourth principle, that the order in which items are counted is irrelevant, follows a different trajectory. The majority of 5- to 11-year-olds indicated that the order in which objects were counted was relevant, favoring a left-to-right, top-to-bottom order of counting. Only some 10- and 11-year-olds applied the principle of order irrelevance, and this knowledge was unrelated to their numeration skill. We conclude that the order irrelevance principle might not play an important role in the development of children's conceptual knowledge of counting.

Executive functioning in children with Fetal Alcohol Spectrum Disorders: profiles and age-related differences.

The goal of this project was to examine the profile of executive function (EF) deficits and age-related differences among children with FASD. Twenty-nine children with FASD (8 to 16 years of age) completed 8 tests from the Delis-Kaplan Executive Function System (D-KEFS). They had difficulty on many components of EF including cognitive flexibility, inhibition, some measures of verbal fluency, abstract thinking, deductive reasoning, hypothesis testing, problem solving, and concept formation. A distinctive profile emerged with performance being poorest on the card sorting test and relatively high on category fluency, design fluency, and the tower test, indicating relative strengths on some visual-spatial EF tasks. Older children with FASD showed more difficulty (relative to the norm) on some verbal tests of EF than younger children with FASD, suggesting that difficulty on some verbal EF tasks appears to become more pronounced with increasing age.

Computational skills, working memory, and conceptual knowledge in older children with mathematics learning disabilities.

Knowledge and skill in multiplication were investigated for late elementary-grade students with mathematics learning disabilities (MLD), typically achieving age-matched peers, low-achieving age-matched peers, and ability-matched peers by examining multiple measures of computational skill, working memory, and conceptual knowledge. Poor multiplication fact mastery and calculation fluency and general working memory discriminated children with MLD from typically achieving age-matched peers. Furthermore, children with MLD were slower in executing backup procedures than typically achieving age-matched peers. The performance of children with MLD on multiple measures of multiplication skill and knowledge was most similar to that of ability-matched younger children. MLD may be due to difficulties in computational skills and working memory. Implications for the diagnosis and remediation of MLD are discussed.

Is the Chinese number-naming system transparent? Evidence from Chinese-English bilingual children.

Chinese-speaking children have been shown to have an advantage over English-speaking children in a variety of mathematical areas, including counting. One possible explanation for the advantage in counting is that the Chinese number-naming system is relatively transparent, compared to English, in that number names typically are directly indicative of base-10 structure (e.g., 12 is named "ten-two" rather than "twelve"). To determine whether the transparency of the Chinese number-naming system influences counting in bilingual children, we tested 25 Chinese-English bilingual children between the ages of 3 and 5 years, both in English and in Chinese. Children were asked to count as high as they could (abstract counting) and also to count objects in small, medium, and large arrays (object counting). No evidence was found for transparency or for transfer from one language to the other. Instead, relative proficiency in the two languages influenced counting skill. These results are discussed in terms of linguistic and cultural variables that might account for cross-linguistic differences in counting.

What counts as knowing? The development of conceptual and procedural knowledge of counting from kindergarten through Grade 2.

The development of conceptual and procedural knowledge about counting was explored for children in kindergarten, Grade 1, and Grade 2 (N = 255). Conceptual knowledge was assessed by asking children to make judgments about three types of counts modeled by an animated frog: standard (correct) left-to-right counts, incorrect counts, and unusual counts. On incorrect counts, the frog violated the word-object correspondence principle. On unusual counts, the frog violated a conventional but inessential feature of counting, for example, starting in the middle of the array of objects. Procedural knowledge was assessed using speed and accuracy in counting objects. The patterns of change for procedural knowledge and conceptual knowledge were different. Counting speed and accuracy (procedural knowledge) improved with grade. In contrast, there was a curvilinear relation between conceptual knowledge and grade that was further moderated by children's numeration skills (as measured by a standardized test); the most skilled children gradually increased their acceptance of unusual counts over grade, whereas the least skilled children decreased their acceptance of these counts. These results have implications for studying conceptual and procedural knowledge about mathematics.

Representation and working memory in early arithmetic.

Working memory has been implicated in the early acquisition of arithmetic skill, but the relations among different components of working memory, performance on different types of arithmetic problems, and development have not been explored. Preschool and Grade 1 children completed measures of phonological, visual-spatial, and central executive working memory, as well as nonverbal and verbal arithmetic problems, some of which included irrelevant information. For preschool children, accuracy was higher on nonverbal problems than on verbal problems, and the best and only unique predictor of performance on the standard nonverbal problems was visual-spatial working memory. This finding is consistent with the view that most preschoolers use a mental model for arithmetic that requires visual-spatial working memory. For Grade 1 children, performance was equivalent on nonverbal and verbal problems, and phonological working memory was the best predictor of performance on standard verbal problems. For both age groups, problems with added irrelevant information were substantially more difficult than standard problems, and in some cases measures of the central executive predicted performance. Assessing performance on different components of working memory in conjunction with different types of arithmetic problems provided new insights into the developing relations between working memory and how children do arithmetic.

Developmental change and individual differences in children's multiplication.

Age-related change and patterns of individual differences in children's knowledge and skill in multiplication were investigated for students in Grades 4 and 6 (approximately ages 9 and 11, respectively) by examining multiple measures of computational skill, conceptual knowledge, and working memory. Regression analyses revealed that indexes reflecting probability of retrieval and special problem characteristics overshadow other, more general indexes (problem size and frequency of presentation) in predicting solution latencies. Some improvement in the use of conceptual knowledge was evident between Grades 4 and 6, but this change was neither strong nor uniform across tasks. Finally, patterns of individual differences across tasks differed as a function of grade level. The findings have implications for understanding developmental change and individual differences in mathematical cognition.

Use of the mathematical principle of inversion in young children.

An important issue in the development of mathematical cognition is the extent to which children use and understand fundamental mathematical concepts. We examined whether young children successfully use the principle of inversion and, if so, whether they do so based on qualitative identity, length, or quantity. Twenty-four preschool children and 24 children in Grade 1 were presented with three-term inversion problems (e.g., 3+2-2) and standard problems of similar magnitude (e.g., 2+4-3). Problems were presented in three conditions to determine whether children used inversion at all and, if so, whether their decisions were based on quantitative or nonquantitative features of the problems. Both preschool and Grade 1 children showed evidence of using inversion in a fully quantitative manner, indicating that this principle is available in some form prior to extensive formal instruction in arithmetic.