The Broad Autism Phenotype-International Test (BAP-IT): A two-domain-based test for the assessment of the broad autism phenotype.

LAY ABSTRACT: The broad autism phenotype refers to a group of behaviors related to autism spectrum disorder, but that appear to a lesser extent. Its assessment has been performed through outdated broad autism phenotype/autism spectrum disorder definitions and tests. To address this problem, this study presents the development of a new test, the Broad Autism Phenotype-International Test, a 20-item measure consisting of two dimensions, SOCIAL-BAP and RIRE-BAP, targeting the two-domain operationalization of autism spectrum disorder in Spain and the United Kingdom. Unlike the Broad Autism Phenotype Questionnaire, this test received empirical support as a quick and effective broad autism phenotype measure that can facilitate both broad autism phenotype/autism spectrum disorder research and interventions. This is the first step to studying the BAP in several Spanish and English-speaking countries.

The role of the differential outcomes procedure and schizotypy in the recognition of dynamic facial expressions of emotions.

Emotional facial expression recognition is a key ability for adequate social functioning. The current study aims to test if the differential outcomes procedure (DOP) may improve the recognition of dynamic facial expressions of emotions and to further explore whether schizotypal personality traits may have any effect on performance. 183 undergraduate students completed a task where a face morphed from a neutral expression to one of the six basic emotions at full intensity over 10 s. Participants had to press spacebar as soon as they identified the emotion and choose which had appeared. In the first block, participants received no outcomes. In the second block, a group received specific outcomes associated to each emotion (DOP group), while another group received non-differential outcomes after correctly responding (NOP group). Employing generalized linear models (GLMs) and Bayesian inference we estimated different parameters to answer our research goals. Schizotypal personality traits did not seem to affect dynamic emotional facial expression recognition. Participants of the DOP group were less likely to respond incorrectly to faces showing Fear and Surprise at fewer intensity levels. This may suggest that the DOP could lead to better identification of the main features that differentiate each facial expression of emotion.

Mental rotation and schizotypal personality traits: A Bayesian approach.

People diagnosed with schizophrenia exhibit mental rotation differences, suggesting that clinical levels of positive symptoms, such as psychotic hallucinations, are related to disruptions in their monitoring and manipulation of mental representations. According to the psychosis continuum, findings in people with a high level of schizotypal personality traits are expected to be qualitatively similar, but research concerning this topic is scarce. A spared mental imagery manipulation in this population only could suggest that this ability might be a possible protective factor, or that the emergence of clinical-level positive symptoms could be paired with disruptions in this capacity. To explore this issue, 205 undergraduate students (122 women) completed a novel mental rotation task identifying the stimulus that was a 90, 180, or 270° rotation of a black circle with colored portions and were assessed with the Schizotypal Personality Questionnaire. Men performed better in most conditions. No relationship was detected between schizotypal personality traits and accuracy in the task. These results do not support that mental imagery manipulation disruptions may be related to schizotypal personality traits in non-clinical populations. Thus, they might instead be associated with the onset of psychosis disorders as mental representation handling is hindered. However, additional research is required including the general population, as well as those with higher levels of psychotic symptoms and psychosis disorders. Future research could also focus on working memory processes related to mental representation manipulations of different sensory modalities such as auditory mental representations and their relationship with schizotypal personality traits and clinical populations.

Schizotypal personality traits and the social learning of fear.

Schizotypy can be defined as a combination of traits qualitatively similar to those found in schizophrenia, but milder in their expression, that can be found in clinical and non-clinical populations. In this research, we explore, to our knowledge, for the first time, whether schizotypal personality traits may affect the acquisition of conditioned fear by social means only. Apart from being an essential capacity to ensure learning in safe environments, social fear learning shares important characteristics with direct fear acquisition, which also makes it a great candidate for developing successful extinction procedures. Undergraduate students (n = 72) performed a task of social fear learning. In this task, participants watched a video of a person that simulated to receive electric shocks (unconditioned stimulus; US) paired with a coloured square (conditioned stimulus plus; CS+), while another coloured square was never paired (conditioned stimulus minus; CS-) with the shock. After that, they were presented with a similar sequence of coloured screens. Their Skin Conductance Responses (SCRs) were registered during the whole process. Once they finished, they completed the Schizotypal Personality Questionnaire (SPQ). Our results revealed that participants with a low score in the Cognitive-Perceptual factor of the SPQ exhibited higher SCRs when they saw the US than when they saw the CS- (all ps < 0.01) during the learning phase. Nevertheless, those with higher scores did not present any difference in their SCRs toward both stimuli (all ps > 0.05), a pattern that has been similarly found in schizophrenia. During the final trials of the test phase, participants with the highest scores in the Disorganized factor were the only ones that maintained a higher SCR towards the CS+ than towards the CS- (p = 0.006), which could be associated with an impairment in their extinction processes.

Implicit outcomes expectancies shape memory process: Electrophysiological evidence.

The simple manipulation of pairing specific outcomes with the sample stimuli strongly affects discriminative learning and memory processes. This procedure has been named the Differential Outcomes Procedure (DOP) and is usually compared to a control condition (the non-differential procedure, NOP) consisting in the random administration of the outcomes after each correct response. Recent research has revealed that the DOP effect arises even under unconscious conditions. In this study, we explored the temporal dynamics of short-term memory processes in both the DOP and the NOP in the absence of awareness of either the outcome (Experiment 1A) or the initial sample stimulus (Experiment 1B) through the evoked-related potentials technique. Results showed distinctive electrophysiological activation patterns in the DOP compared with the NOP at encoding, maintenance and retrieval phases. The present findings provide electrophysiological evidence of implicit-prospective processes involved in the DOP. They elucidate the processes that result in improved visual recognition memory.

Differential outcomes, schizotypy, and improvement of the recognition of emotional facial expressions: a preliminary study

Schizotypy is defined as a combination of traits qualitatively similar to those found in schizophrenia, though in a minor severity, that can be found in the nonclinical population. Some studies suggest that people with schizotypal traits have problems recognising emotional facial expressions. In this research, we further explore this issue and we investigate, for the first time, whether the differential outcomes procedure (DOP) may improve the recognition of emotional facial expressions. Participants in our study were students that completed the ESQUIZO-Q-A and were set in two groups, high schizotypy (HS) and low schizotypy (LS). Then, they performed a task in which they had to recognise the emotional facial expression of a set of faces. Participants of the HS group and the LS group did not differ in their performance. Importantly, all participants showed better recognition of emotional facial expressions when they were trained with differential outcomes. This novel finding might be relevant for clinical practice since the DOP is shown as a tool that may improve the recognition of emotional facial expressions

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Discriminative learning and associative memory under the differential outcomes procedure is modulated by cognitive load.

Working memory (WM) has been thought to be the cause of associative memory deficits in older adults. Previous research has demonstrated the benefits of a discriminative learning procedure, the differential outcomes procedure (DOP), to ameliorate such associative-memory maintenance deficits in situations that simulate adherence to medical prescriptions in both healthy and pathological ageing. Specifically, the DOP involves rewarding each correct response to each stimulus-stimulus association with a distinct and unique outcome (reinforcer). The aim of the present study was to explore the limits of this procedure by testing the amount of cognitive load at which the DOP improves discriminative learning and associative memory in a task that simulates adherence to medical treatment in undergraduate students. During the training phase, participants were asked to learn three pill/name (low-load condition) or four pill/name associations (high-load conditions) under the DOP in comparison with a control condition (the non-differential outcomes condition, NOP). Long-term retention of such learned associations was tested 1h and 1week after completion of the training phase. Participants showed a better accuracy and long-term retention of the learned associations when the DOP was used, but just in the high-load condition. These results suggest that when WM is overtaxed, the DOP plays a fundamental role in the long-term maintenance of the learned stimulus-stimulus associations, rendering such learning procedure as a useful technique to enhance people's discriminative learning and associative memory.

Electrophysiological correlates of the differential outcomes effect in visual short-term memory.

The differential outcomes procedure (DOP) consists in applying a specific outcome after each discriminative stimulus-correct response pairing, leading to improved performance in both memory and learning tasks (faster acquisition and/or higher response accuracy), compared to the non-differential outcomes procedure (NOP). The main aim of this study was to explore the electrophysiological correlates (ERPs) of the DOP in a visual short-term memory task, and to test whether a differential activation pattern would be observed depending on the outcomes condition (DOP vs. NOP). The ERP signals showed differences between both outcomes condition in all three phases of the short-term memory task: encoding, maintenance and retrieval. Our results are in accordance with the view that in the DOP condition the probe stimulus triggers a representation of the unique outcome, which remains active over the maintenance period (prospective process). In the NOP condition, in contrast, a representation of the probe stimulus is maintained (retrospective process). In addition, these results suggested that stimuli associated with unique outcomes captured attention involuntary at retrieval, decreasing the interference from distractor stimuli in the retrieval phase.

Enhanced learning and retention of medical information in Alzheimer's disease after differential outcomes training.

BACKGROUND: Adherence to treatment is a crucial factor for patients who have chronic illnesses or multiple morbidities and polypharmacy, which is frequently found in older adults. The non-adherence to medications has important economic and social consequences as well as impacts on the health of the patients. One of the reasons that can explain the low adherence to treatment, is the memory deficits that are characteristics of this population and that are even more evident in cases that involve neurodegenerative diseases. METHODS AND FINDINGS: In this study, we explore whether the differential outcomes procedure (DOP), which has been shown to be useful in improving discriminative learning and memory in different populations, may facilitate learning and retention of medical recommendations in older adults who have been diagnosed with Alzheimer's disease. The results demonstrate that when this procedure was applied, the patients showed improvements in learning and long-term retention of two pill/time of day associations in a situation that simulates adherence to medical prescriptions. CONCLUSIONS: These findings contribute new data about the potential benefits of the DOP in patients with neurodegenerative disorders, highlighting the important role that this procedure could play in addressing important issues related to the health and quality of life of older adults, with or without neurodegenerative diseases, such as low adherence to medical treatments.

Does the implicit outcomes expectancies shape learning and memory processes?

Does the explicit or implicit knowledge about the consequences of our choices shape learning and memory processes? This seems to be the case according to previous studies demonstrating improvements in learning and retention of symbolic relations and in visuospatial recognition memory when each correct choice is reinforced with its own unique and explicit outcome (the differential outcomes procedure, DOP). In the present study, we aim to extend these findings by exploring the impact of the DOP under conditions of non-conscious processing. To test for this, both the outcomes (Experiment 1A) and the sample stimuli (Experiment 1B) were presented under subliminal (non-conscious) and supraliminal conditions in a delayed visual recognition memory task. Results from both experiments showed a better visual recognition memory when participants were trained with the DOP regardless the awareness of the outcomes or even of the stimuli used for training. To our knowledge, this is the first demonstration that the DOP can be effective under unconscious conditions. This finding is discussed in the light of the two-memory systems model developed by Savage and colleagues to explain the beneficial effects observed on learning and memory when differential outcomes are applied.

Enhancement of Visuospatial Working Memory by the Differential Outcomes Procedure in Mild Cognitive Impairment and Alzheimer's Disease.

In the present study we investigated the efficacy of the differential outcomes procedure (DOP) to improve visuospatial working memory in patients with Alzheimer's disease and mild cognitive impairment (MCI). The DOP associates correct responses to the to-be-remember stimulus with unique outcomes. Eleven patients diagnosed with Alzheimer's disease, 11 participants with MCI, and 17 healthy matched controls performed a spatial delayed memory task under the DOP and a control condition (non-differential outcomes -NOP-). We found that performance (terminal accuracy) was significantly better in the DOP condition relative to the NOP condition in all three groups of participants. AD patients performed worse, and took longer to benefit from the DOP. In line with previous animal and human research, we propose that the DOP activates brain structures and cognitive mechanisms that are less affected by healthy and pathological aging, optimizing in this way the function of the cognitive system.

A Pilot Randomized Controlled Trial to Explore Cognitive and Emotional Effects of Probiotics in Fibromyalgia.

It has recently been found that microbes in the gut may regulate brain processes through the gut microbiota-brain axis, which modulates affection, motivation and higher cognitive functions. According to this finding, the use of probiotics may be a potential treatment to improve physical, psychological and cognitive status in clinical populations with altered microbiota balance such as those with fibromyalgia (FMS). Thus, the aim of the present pilot study with a double-blind, placebo-controlled, randomised design was to test whether a multispecies probiotic may improve cognition, emotional symptoms and functional state in a sample of patients diagnosed with FMS. Pain, impact of FMS, quality of life, anxiety and depressive symptoms were measured during the pre- and post-intervention phases; participants also completed two computerised cognitive tasks to assess impulsive choice and decision-making. Finally, urinary cortisol concentration was determined. To our knowledge, this is the first study that explore the effect of a multispecies probiotic in FMS patients. Our results indicated that probiotics improved impulsivity and decision-making in these patients. However, more research is needed to further explore the potential effects of probiotics on other cognitive functions affected in FMS as well as in other clinical populations.

Learning and Recall of Medical Treatment-Related Information in Older Adults Using the Differential Outcomes Procedure.

It has recently been reported that the differential outcomes procedure (DOP) might be one of the therapeutical techniques focused at promoting autonomy in the elderly to deal with their medical issues. Molina et al. (2015) found that a group of healthy young adults improved their learning and long-term retention of six disorder/pill associations when each relationship to be learned was associated with a particular reinforcer (the differential outcomes condition) compared to when they were randomly administered (the non-differential outcomes condition). In the present study, we extend these findings to older adults who usually show difficulties to remember to take their medications as prescribed. Participants were asked to learn the association between three pills and the specific time at the day when they had to take each medication. Two memory tests were also performed 1 h and 1 week after completing the training phase. Results showed a faster learning of the task and long-term retention of the previously learned associations (pill/time of day) when differential outcomes were used. Furthermore, the older adults' performance in the learning and memory phases did not differ from that of the younger adults in the DOP condition. These findings demonstrate that this procedure can help elderly people to ameliorate not only their learning, but also their long-term memory difficulties, suggesting the potential for the DOP to promote adherence to treatment in this population.

Differential Outcomes Training Ameliorates Visual Memory Impairments in Patients With Alzheimer's Disease: A Pilot Study.

It is well known that Alzheimer's disease (AD), the most common form of dementia, is associated with deficits in cognitive processes including visual memory impairments. One technique that might be used to ameliorate these impairments is the differential outcomes procedure (DOP) that involves associating each to-be-remembered stimulus with a specific outcome. Objective: Previous research has demonstrated that the DOP can be used to reduce or eliminate the learning and memory deficits associated with animal models of amnesia and dementia. Furthermore, this procedure has been shown to improve delayed facial recognition in healthy older adults as well as in patients diagnosed with AD. The main aim of the present study is twofold: to extend these findings to other types of visual stimulus and to investigate the effect of the DOP in memory retention in AD patients. Method: Ten patients diagnosed with AD and 10 healthy controls participated in this study. The experiment included two phases. In the first one, they had to perform a delayed matching-to-sample task. In the second phase, participants performed a recognition memory task, designed to assess long-term retention, 1 h and 1 week after the training. Results: Participants showed a better memory-based performance as well as a higher long-term retention of the information when trained under the differential outcomes condition, relative to the non-differential outcomes condition. Conclusions: The DOP seems to be an effective, easy-to-implement, technique to enhance visual memory in AD patients.

Psychometric Properties of the Spanish Version of the Broad Autism Phenotype Questionnaire: Strengths, Weaknesses, and Future Improvements.

The Broad autism phenotype (BAP) refers to a set of subclinical behavioural characteristics qualitatively similar to those presented in Autism spectrum disorders (ASDs). The BAP questionnaire (BAPQ) has been widely used to assess the BAP both in relatives of ASD people and within the general population. The current study presents the first Spanish version of the BAPQ (BAPQ-SP) and analyses its psychometric properties, including validity evidences based on the BAPQ scores relationship with other variables. Our results only support the use of the Aloof and Rigid sub-scales to assess this phenotype, whereas Pragmatic Language sub-scale seems to be the main source of misfit. This research represents a first step in the study of the BAP features in the Spanish population.

Probiotics for fibromyalgia: study design for a pilot double-blind, randomized controlled trial.

BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic, generalized and diffuse pain disorder accompanied by other symptoms such as emotional and cognitive deficits. The FMS patients show a high prevalence of gastrointestinal symptoms. Recently it has been found that microbes in the gut may regulate brain processes through the gut-microbiota-brain axis, modulating thus affection, motivation and higher cognitive functions. Therefore, the use of probiotics might be a new treatment that could improve the physical, psychological and cognitive state in FMS; however, no evidence about this issue is available. METHODS: This paper describes the design and protocol of a double-blind, placebo-controlled and randomized pilot study. We use validated questionnaires, cognitive task through E-Prime and biological measures like urine cortisol and stool fecal samples. The trial aim is to explore the effects of eight weeks of probiotics therapy in physical (pain, impact of the FMS and quality of life), emotional (depression, and anxiety) and cognitive symptoms (attention, memory, and impulsivity) in FMS patients as compared to placebo. CONCLUSION: This pilot study is the first, to our knowledge, to evaluate the effects of probiotics in FMS. The primary hypothesis was that FMS patients will show a better performance on cognitive tasks, and an improvement in emotional and physical symptoms. These results will contribute to a better understanding in the gut-brain axis. Here we present the design and protocol of the study.

Probiotics for fibromyalgia: study design for a pilot double-blind, randomized controlled trial / Probióticos en fibromialgia: diseño de un estudio piloto doble ciego y randomizado

Background: Fibromyalgia syndrome (FMS) is a chronic, generalized and diffuse pain disorder accompanied by other symptoms such as emotional and cognitive deficits. The FMS patients show a high prevalence of gastrointestinal symptoms. Recently it has been found that microbes in the gut may regulate brain processes through the gut-microbiota-brain axis, modulating thus affection, motivation and higher cognitive functions. Therefore, the use of probiotics might be a new treatment that could improve the physical, psychological and cognitive state in FMS; however, no evidence about this issue is available. Methods: This paper describes the design and protocol of a double-blind, placebo-controlled and randomized pilot study. We use validated questionnaires, cognitive task through E-Prime and biological measures like urine cortisol and stool fecal samples. The trial aim is to explore the effects of eight weeks of probiotics therapy in physical (pain, impact of the FMS and quality of life), emotional (depression, and anxiety) and cognitive symptoms (attention, memory, and impulsivity) in FMS patients as compared to placebo. Conclusion: This pilot study is the first, to our knowledge, to evaluate the effects of probiotics in FMS. The primary hypothesis was that FMS patients will show a better performance on cognitive tasks, and an improvement in emotional and physical symptoms. These results will contribute to a better understanding in the gut-brain axis. Here we present the design and protocol of the study (AU)

Antecedentes: el síndrome de fibromialgia (FMS) es un trastorno crónico, generalizado y difuso que produce dolor acompañado de otros síntomas emocionales y cognitivos. Así mismo, los pacientes con FMS muestran una alta comorbilidad de síntomas gastrointestinales. En este sentido, recientemente se ha encontrado que la microbiota intestinal es capaz de regular procesos cerebrales a través del eje intestino-microbiota-cerebro, modulando así a nivel afectivo, emocional, motivacional y de funciones cognitivas complejas. Por lo tanto, el uso de probióticos podría ser una nueva estrategia terapéutica para mejorar el estado físico, psicológico y cognitivo en pacientes con FMS. Sin embargo, aún no hay evidencia disponible sobre este tema. Métodos: este artículo describe el diseño y el protocolo de un estudio piloto doble ciego, controlado con placebo y aleatorizado. Se utilizan cuestionarios validados, tareas cognitivas a través de E-Prime y medidas biológicas como cortisol de orina y muestras de heces. El objetivo del estudio es explorar el efecto de un tratamiento multiespecies probióticas durante ocho semanas en la sintomatología física (dolor, impacto del FMS y calidad de vida), emocional (depresión y ansiedad) y cognitiva (atención, memoria e impulsividad) en pacientes con FMS. Conclusión: el protocolo de este estudio piloto, a nuestro conocer, es el primero que pretende evaluar los efectos de los probióticos en FMS. La hipótesis de partida es que los pacientes con FMS mostrarán un mejor desempeño en las tareas cognitivas y una mejoría en los síntomas emocionales y físicos. Estos resultados contribuirán a una mejor comprensión del eje intestino-cerebral (AU)

Mejora del aprendizaje discriminativo en niños: consecuencias diferenciales y administración manual de diferentes formas de refuerzo / Improvement of discriminative learning in children: differential outcomes and manual administration of different types of reinforcement

Diversos estudios han mostrado que el aprendizaje discriminativo puede ser mejorado mediante la asignación de una consecuencia única para cada asociación que ha de ser aprendida (procedimiento de consecuencias diferenciales, PCD). El objetivo de este estudio fue comprobar si el PCD mejoraría el aprendizaje de discriminaciones simbólicas en niños de 5 y 7 años de edad, mediante una tarea de lápiz y papel en la que se usaron diferentes tipos de entrenamiento: 1) administración de reforzadores tras las respuestas correctas (+), 2) retirada de reforzadores tras los errores (-), o 3) una combinación de ambas (+/-). En los Experimentos 1a y 1b se utilizaron reforzadores primarios y secundarios, mientras que en los Experimentos 2a y 2b se utilizaron solo reforzadores primarios. Los participantes mostraron una mejor ejecución en las tareas cuando se administraron consecuencias diferenciales independientemente del tipo de reforzador (primario y secundario o sólo primario) y del tipo de entrenamiento empleado (+, -, o +/-). Estos resultados se suman a los encontrados en estudios previos (Martínez, Estévez, Fuentes y Overmier, 2009; Martínez, Flores, González Salinas, Fuentes y Estévez, 2013) demostrando, además, que el efecto beneficioso del PCD sobre el aprendizaje discriminativo es independiente del medio por el cual presentamos los estímulos y las consecuencias, lo que facilita su posible utilización en contextos aplicados

In recent years, several studies have demonstrated that discriminative learning is facilitated when each association to be learned is always followed by a unique outcome. This way of providing outcomes was called the differential outcomes procedure (DOP). The aim of the study reported here was to assess whether the DOP could improve learning of symbolic conditional discriminations in 5- and 7-year-old children when performing a paper-and-pencil task using different types of training in which: 1) reinforcers were given after correct choices (+), 2) reinforcers were withdrawn when errors were made (-), or 3) a combination of both (+/-). In Experiments 1a and 1b secondary reinforcers were used along with primary reinforcers, while in Experiments 2a and 2b only primary reinforcers were used. Participants showed better performance when differential outcomes were arranged regardless of the type of reinforcers (secondary plus primary or only primary) and the different strategies of reinforcement (+, -, or +/-). These results add to those found by Martínez et al. (2009, 2013) and demonstrate that the beneficial effect of the DOP on discriminative learning is also independent of the way in which the stimuli and the outcomes are presented, facilitating its use in applied contexts

The differential outcomes procedure can overcome self-bias in perceptual matching.

There are biases in perceptual matching between shapes and labels referring to familiar others, compared with when the labels refer to unfamiliar people. We assessed whether these biases could be affected by differential feedback (using the differential outcomes procedure [DOP]) compared with when feedback is provided using a nondifferential outcomes procedure (NOP). Participants formed associations between simple geometric shapes and labels referring to people the participant did or did not know (self, best friend, other). Subsequently, the task was to match a label to one of two shapes shown on a trial. When feedback for correct responses was given following the NOP condition, matches were faster to known people (self and friend) compared with those to an unknown person (stranger). However, this advantage for known personal relations was eliminated when participants were given feedback for correct responses following the DOP condition. The data are consistent with prior work showing that the DOP can facilitate the learning of taxing associations (for the stranger stimuli relative to the familiar self and friend stimuli). In addition, the results suggest that the facilitated perceptual matching for stimuli associated to individuals known personally may reflect better individuation of the association between the shape stimulus and the label, a process enhanced by using a DOP for associations with unfamiliar people.

Spatial working memory is enhanced in children by differential outcomes.

Working memory (WM) is essential to academic achievement. Any enhancement of WM abilities may improve children's school performance. We tested the usefulness of the differential outcomes procedure (DOP) to enhance typically developing children's performance on a spatial WM task. The DOP involves a conditional discriminative learning task in which a correct choice response to a specific stimulus-stimulus association is reinforced with a particular reinforcer (outcome). We adapted a spatial memory task to be used with the DOP. Participants had to learn and retain in their WM four target locations of eight possible locations where a shape could be presented. Two groups of 5- and 7-year-old children performed the low-attentional version of the spatial task, and an additional group of 7-year-old children performed the high-attentional version. The results showed that compared with the standard non-differential outcomes procedure (NOP), the DOP produced better memory-based performance in 5-year-old children with the low-attentional task and in 7-year-old children with the high-attentional task. Additionally, delay intervals impaired performance in the NOP but not in the DOP. These findings suggest that the DOP may be a useful complement to other WM intervention programs targeted to improve children's academic performance at school.