Co-production of the 'EPIC' multidimensional tool-kit to support neurodivergent children and young people at home and school: a feasibility and pilot study.

BACKGROUND: Interventions focused on cognitive function in neurodivergent children typically focus on single functions, e.g. working memory training. They are often focused on 'deficit' models and lack an emphasis on understanding areas of individual strengths and difficulties as a prerequisite to appropriate support. The multidimensional nature and phenotypic variability of cognitive profiles in these children indicate a need for a multicomponent-tailored intervention programme focused on understanding and supporting an individual child's cognitive functioning. AIMS: The 'EPIC' intervention (Edinburgh Psychoeducation Intervention for Children and Young People) is focused on improving cognition, learning and behaviour in neurodivergent children such as those with attention deficit hyperactivity disorder (ADHD) or who are autistic. Building on our previous co-production work, this study aimed to use a participatory methods approach to develop EPIC practices and materials in relation to our key principles which include psychoeducation, multicomponent, individualised approach, strengths and difficulties profiling and pairing of a child's individual strengths and difficulties with internal and external strategies. We also set out to assess the feasibility and acceptability of EPIC, and pilot this novel tool-kit intervention with neurodivergent children and their parents and teachers. METHODS: The intervention practices, materials and strategies of EPIC were co-produced with neurodivergent children, their parents, teachers and clinicians taking a strengths and difficulties approach. Identification of psychoeducation activities and strategy practices (e.g. mind-maps, chunking), testing of feasibility and collection of pilot data were conducted over a bi-weekly 8-week programme. Eleven neurodivergent children aged 7 to 12 completed the 16-session individualised programme. Acceptability and feasibility were ascertained via qualitative reports elicited within child and teacher interviews and child ratings of enjoyment. Pilot evaluation data was collected pre- and post-intervention participation, and across cognitive assessments (CANTAB, BRIEF), educational attainment (WIAT) and parent and teacher questionnaires measuring clinical symptoms and behaviour (Conners, AQ, SDQ, self-perception). Data was compared with a matched neurodivergent treatment-as-usual control group (N = 9). RESULTS: The co-produced EPIC intervention was both feasible to deliver and acceptable to children, parents and their teachers. Pilot data identified that the 8-week intervention improved cognition (short-term and working memory) and literacy (receptive vocabulary, oral word fluency, listening comprehension). Improvements in the intervention group were also found for parent-reported child behavioural difficulties and aggression, and teacher-reported scholastic competence. Effect sizes generated (Cohen's d) ranged from 0.65 to 2.83. Parents reported continuing to use EPIC strategies when interviewed over a year after participating in the programme. CONCLUSION: The current study met our objectives fully. 'EPIC' (Edinburgh Psychoeducation Intervention for Children and Young People) is feasible in home and school contexts and improves a range of aspects of cognition, learning and behaviour in neurodivergent children. Our findings show EPIC is suitable to be assessed within a full-scale trial.

Cognitive Profiles are Better Predictors of Literacy Attainment Than Diagnostic Outcomes in Children with High ADHD Symptoms.

We examined whether cognitive profiles or diagnostic outcomes are better predictors of literacy performance for children being considered for an ADHD diagnosis. Fifty-five drug naïve children (Mage = 103.13 months, SD = 18.65; 29.09% girls) were recruited from an ADHD clinical referral waiting list. Children underwent assessment of IQ, Executive Functions (EF) and literacy attainment. Hierarchical cluster analysis was used to generate subgroups of children using EF scores. Data were then grouped based on presence of a clinical ADHD diagnosis and the results compared. Grouping participants by profiles of cognitive test scores led to groups which also differed on literacy scores. However, categorising by whether children had received an ADHD diagnosis or not did not differentiate either cognitive tests scores or literacy scores. Cognitive performance, rather than children's diagnostic outcomes, is more informative for identifying groups who differ in their literacy attainment which has important implications for remedial support.

Assessing the impact of LEGO® construction training on spatial and mathematical skills.

Lego construction ability is associated with a variety of spatial skills and mathematical outcomes. However, it is unknown whether these relations are causal. We aimed to establish the causal impact of Lego construction training on: Lego construction ability; a broad range of spatial skills; and on mathematical outcomes in 7-9-year-olds. We also aimed to identify how this causal impact differs for digital versus physical Lego construction training. One-hundred and ninety-eight children took part in a six-week training programme, delivered twice weekly as a school lunch time club. They completed either physical Lego training (N = 59), digital Lego training (N = 64), or an active control condition (crafts; N = 75). All children completed baseline and follow-up measures of spatial skills (disembedding, visuo-spatial working memory, spatial scaling, mental rotation, and performance on a spatial-numerical task, the number line task), mathematical outcomes (geometry, arithmetic, and overall mathematical skills) and Lego construction ability. Exploratory analyses revealed evidence for near transfer (Lego construction ability) and some evidence for far transfer (arithmetic) of Lego training, but overall transfer was limited. Despite this, we identified key areas for further development (explicit focus on spatial strategies, training for teachers, and embedding the programme within a mathematical context). The findings of this study can be used to inform future development of Lego construction training programmes to support mathematics learning.

Investigating the Mediating Role of Executive Function in the Relationship Between ADHD and DCD Symptoms and Depression in Adults.

This study was designed to test the effects of Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Co-ordination Disorder (DCD) on depression levels and investigate the mediating role of executive function (EF) in adults. Adults with ADHD, DCD, and ADHD + DCD (N = 139) completed self-report measures of ADHD, DCD, depression, and EF. There were distinct profiles of EF across diagnostic groups, and higher depression symptoms in adults with ADHD + DCD than DCD alone. All EF domains were predicted by ADHD symptoms, and several by DCD symptoms. ADHD and DCD symptoms, and most EF domains, predicted depression symptoms. Overall EF difficulties fully mediated the relationships between ADHD/DCD and depression symptoms. Several specific EF domains relating to behavioural regulation and metacognition also showed full/partial mediating effects. The mediating role of EF difficulties between these neurodevelopmental conditions and depression symptoms has implications for their understanding and treatment, suggesting that targeting EF may be important for preventing co-occurring depression.

Associations and indirect effects between LEGO® construction and mathematics performance.

There is a known association between LEGO® construction ability and mathematics achievement, yet the mechanisms which drive this association are largely unknown. This study investigated the spatial mechanisms underlying this association, and whether this differs for concrete versus digital construction. Between January 2020 and July 2021, children aged 7-9 years (N = 358, 189 female, ethnicity not recorded) completed spatial and mathematics tasks, and either a concrete or digital Lego construction task. Mediation analyses examining direct and indirect pathways (through spatial skills) between Lego construction ability and mathematics explained 8.4% to 26.6% of variance in mathematics scores. Exploratory moderated mediation analyses revealed that only the indirect path through mental rotation differed between Lego conditions. Findings are discussed in relation to theories of spatial-numerical associations and the potential of Lego training for mathematics improvement.

Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers.

Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6-11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child's strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.

[Formula: see text]The relationship between cognition and mathematics in children with attention-deficit/hyperactivity disorder: a systematic review.

Cognitive processes play an imperative role in children's mathematics learning. Difficulties in cognitive functioning are a core feature of Attention Deficit Hyperactivity Disorder (ADHD) in children, who also tend to show lower levels of mathematics attainment than their typically developing peers. This review (registration number: CRD42020169708) sought to aggregate findings from studies assessing the relationship between cognition and mathematics in children with a clinical ADHD diagnosis aged 4-12 years. A total of 11,799 studies published between 1992 and August 2020 were screened for eligibility using various database (PsycINFO, PubMed, SCOPUS, EMBASE, ERIC, Web of Science, and additional sources), from which four studies met inclusion criteria. A narrative synthesis was conducted on the correlations between mathematics and cognitive domains, including an evaluation of the risk of bias within the studies. Across four studies meeting inclusion criteria, memory, inhibitory control, and processing speed were assessed. The results showed a positive association between cognition and mathematics performance in this population. The strength of associations across these studies varied as a function of the cognitive domain in question, means by which mathematics performance was assessed, as well as whether confounding factors such as age and IQ were controlled for. Collectively, this review demonstrates a lack of research in this area and points to various methodological considerations for identifying the association between cognition and mathematics performance in ADHD.

Relationships between cognition and literacy in children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.

Evidence suggests that cognitive and literacy difficulties are common for children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current systematic review and meta-analysis investigated the relationship between cognition and literacy in children with ADHD. Ten thousand and thirty-eight articles were screened against the inclusion criteria and six eligible studies were retained for final review. Where two or more studies used comparable measures of cognition and literacy, a meta-analysis of the relationship between these measures was undertaken. A narrative synthesis of all included studies was also completed. There were medium effect sizes between working memory and aspects of reading, and small effect sizes between processing speed and reading. Inhibition and attention had differential relationships with aspects of literacy with varying effect sizes. This systematic review demonstrates differential relationships between aspects of literacy and cognition in children with ADHD. Further examination of these relationships is warranted to support intervention development.

Profiles of academic achievement and attention in children with and without Autism Spectrum Disorder.

BACKGROUND: Academic outcomes for autistic individuals are heterogeneous, but the reasons for this are unknown. Attention is known to predict learning in typical development, but there is less evidence about this relationship in Autism Spectrum Disorders (ASD), even though attention is reported as atypical in this group. AIMS: To investigate reading and maths achievement profiles for children with and without an ASD, focusing on the role of attention in these profiles and to enable a better understanding of individual differences. METHODS: Reading, maths and attention abilities of 22 autistic children (6-16 years) and 59 TD children (6-11 years) were measured using standardised assessments. RESULTS: A hierarchical cluster analysis that included all children (N = 81) revealed three distinct transdiagnostic subgroups, characterised by children with good, average, and poorer divided attention and academic achievement respectively. Children with poorer attention and achievement displayed relative weaknesses in maths, while children with average or above-average attention and achievement showed no such weakness. CONCLUSIONS: The findings provide a novel insight into the relationship between attention and achievement and understanding individual differences in ASD and typical development.