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14 Changes in Service Delivery Models for Children with Neurodevelopmental Disorders During the Covid-19 Pandemic
- Buse Bedir, Sunny Guo, Brian Katz, Sarah Macoun
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 623-624
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Objective:
With the onset of the COVID-19 pandemic, many families face barriers in accessing critical services for their children. However, there is a disproportionate impact on families of children with Neurodevelopmental Disorders (NDDs), particularly those who are dependant on receiving regular services. The current study investigated how service delivery has changed for children and families with NDDs during the COVID-19 pandemic, to identify which groups are most at risk for service disruption and negative outcomes, and to provide actionable recommendations for community agencies that provide early interventions for future pandemics.
Participants and Methods:Data was collected in the fall and winter of 2020/2021 during the Covid-19 pandemic. Families were recruited from a local service provider in British Columbia whose Early Years Support services delivery model was changed to online delivery during the pandemic. Children had a diagnosis of NDD or were on the waitlist for an assessment. Overall, 26 families participated in a semi-structured interview that asked about their experiences of receiving services for their children during the pandemic. Of these families, 20 subsequently completed online questionnaires that asked about their parenting stress levels and their children’s behaviour throughout the pandemic. Families of a range of compositions were drawn from different ethnicities (30% white, 25% South Asian, 20% Filipino, and the remaining 5% identified as Indigenous, African or East Asian). The mean age of children was 3.80 years (SD =0.72).
Results:From the survey, we found that 58% of parents reported higher than average levels of mental health and behavioural challenges in their children during the Covid-19 pandemic. In addition, 45% of parents reported higher than average parenting stress levels. Qualitative interview data indicated that most parents reported positive experiences with receiving services during the Covid-19 pandemic and reported feeling supported even with social distancing measures. However, families also reported increased stress levels and isolation, particularly those who have children with Autism Spectrum Disorder, who rely on early funding (06 years) and early services. One of the themes that emerged from parents who were on the waitlist to receive an assessment was that wait times around assessments were very long, which contributed to parent stress levels. Parents also reported concerns around wait times to access services and difficulty of accessing online services due to internet and connection issues.
Conclusions:The current study identified central themes of stressors and barriers experienced by families and children with NDDs in service delivery. Overall, parents reported satisfaction in changes in service delivery in most ways; however, they also reported stresses and barriers that included wait times, increased isolation, and accessing online services. Actionable steps to reduce family stress include better communication between service providers and families for wait times, and more variability in appointment times. Specific recommendations for current and future pandemics will be expanded on in the poster.
90 School-based Implementation of Educational and Neurocognitive Interventions in Children with Neurodevelopmental Disorders.
- Yaewon Kim, Shelley Masters, Jessica M Lewis, Sunny Guo, Tom Arjannikov, John Sheehan, Buse Bedir, Peiman Haghighat, Brian Katz, Robyn Woods, Ryan D’Arcy, Sarah Macoun
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 190-191
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Objective:
Children with neurodevelopmental disorders (NDDs) commonly experience attentional and executive function (EF) difficulties that are negatively associated with academic success, psychosocial functioning, and quality of life. Access to early and consistent interventions is a critical protective factor and there are recommendations to deliver cognitive interventions in schools; however, current cognitive interventions are expensive and/or inaccessible, particularly for those with limited resources and/or in remote communities. The current study evaluated the school-based implementation of two game-based interventions in children with NDDs: 1) a novel neurocognitive attention/EF intervention (Dino Island; DI), and 2) a commercial educational intervention (Adventure Academy; AA). DI is a game-based attention/EF intervention specifically developed for children for delivery in community-based settings.
Participants and Methods:Thirty five children with NDDs (ages 5-13 years) and 17 EAs participated. EAs completed on-line training to deliver the interventions to assigned students at their respective schools (3x/week, 40-60 minutes/session, 8 weeks, 14 hours in total). We gathered baseline child and EA demographic data, completed pre-intervention EA interviews, and conducted regular fidelity checks throughout the interventions. Implementation data included paper-pencil tracking forms, computerized game analytic data, and online communications.
Results:Using a mixed methods approach we evaluated the following implementation outcomes: fidelity, feasibility, acceptability, and barriers. Overall, no meaningful between-group differences were found in EA or child demographics, except for total number of years worked as an EA (M = 17.18 for AA and 9.15 for DI; t (22) = - 4.34, p < .01) and EA gender (χ2 (1) = 6.11, p < .05). For both groups, EA age was significantly associated with the number of sessions played [DI (r = .847, p < .01), AA (r = .986, p < .05)]. EAs who knew their student better completed longer sessions [DI (r = .646), AA (r = .973)], all ps < .05]. The number of years worked as an EA was negatively associated with the total intervention hours for both groups. Qualitative interview data indicated that most EAs found DI valuable and feasible to deliver in their classrooms, whereas more implementation challenges were identified with AA. Barriers common to both groups included technical difficulties (e.g., game access, internet firewalls), environmental barriers (e.g., distractions in surroundings, time of the year), child factors (e.g., lack of motivation, attentional difficulties, frustration), and game-specific factors (e.g., difficulty level progression). Barriers specific to DI included greater challenges in motivating children as a function of difficulty level progression. Furthermore, given the comprehensive nature of training required for delivery, EAs needed a longer time to complete the training for DI. Nevertheless, many EAs in the DI group found the training helpful, with a potential to generalize to other children in the classroom.
Conclusions:The availability of affordable, accessible, and effective cognitive intervention is important for children with NDDs. We found that delivery of a novel cognitive intervention by EAs was feasible and acceptable, with similarities and differences in implementation facilitators/barriers between the cognitive and commercialized academic intervention. Recommendations regarding strategies for successful school-based implementation of neurocognitive intervention will be elaborated on in the poster.
83 Efficacy of a Tablet-Based Cognitive Flexibility Intervention in Youth with Executive Function Deficits
- Jessica M. Lewis, Shelley B. Masters, Yaewon Kim, Sunny Guo, John Sheehan, Buse Bedir, Tom Arjannikov, Peiman Haghighat, Sarah J. Macoun
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 184-185
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Objective:
Executive functions (EFs) are considered to be both unitary and diverse functions with common conceptualizations consisting of inhibitory control, working memory, and cognitive flexibility. Current research indicates that these abilities develop along different timelines and that working memory and inhibitory control may be foundational for cognitive flexibility, or the ability to shift attention between tasks or operations. Very few interventions target cognitive flexibility despite its importance for academic or occupational tasks, social skills, problem-solving, and goal-directed behavior in general, and the ability is commonly impaired in individuals with neurodevelopmental disorders (NDDs) such as autism spectrum disorder, attention deficit hyperactivity disorder, and learning disorders. The current study investigated a tablet-based cognitive flexibility intervention, Dino Island (DI), that combines a game-based, process-specific intervention with compensatory metacognitive strategies as delivered by classroom aides within a school setting.
Participants and Methods:20 children between ages 6-12 years (x̄ = 10.83 years) with NDDs and identified executive function deficits and their assigned classroom aides (i.e., “interventionists”) were randomly assigned to either DI or an educational game control condition. Interventionists completed a 2-4 hour online training course and a brief, remote Q&A session with the research team, which provided key information for delivering the intervention such as game-play and metacognitive/behavioral strategy instruction. Fidelity checks were conducted weekly. Interventionists were instructed to deliver 14-16 hours of intervention during the school day over 6-8 weeks, divided into 3-4 weekly sessions of 30-60 minutes each. Baseline and post-intervention assessments consisted of cognitive measures of cognitive flexibility (Minnesota Executive Function Scale), working memory (Weschler Intelligence Scales for Children, 4th Edn. Integrated Spatial Span) and parent-completed EF rating scales (Behavior Rating Inventory of Executive Function).
Results:Samples sizes were smaller than expected due to COVID-19 related disruptions within schools, so nonparametric analyses were conducted to explore trends in the data. Results of the Mann-Whitney U test indicated that participants within the DI condition made greater gains in cognitive flexibility with a trend towards significance (p = 0.115. After dummy coding for positive change, results also indicated that gains in spatial working memory differed by condition (p = 0.127). Similarly, gains in task monitoring trended towards significant difference by condition.
Conclusions:DI, a novel EF intervention, may be beneficial to cognitive flexibility, working memory, and monitoring skills within youth with EF deficits. Though there were many absences and upheavals within the participating schools related to COVID-19, it is promising to see differences in outcomes with such a small sample. This poster will expand upon the current results as well as future directions for the DI intervention.
89 A Pilot Study of a Parent-Delivered Game-Based Cognitive Intervention in Children Born Preterm
- Sunny Guo, Sarah J Macoun, Ella Ryan, Stella Heo, Amanda Ip, Mehak Stokoe, Daria Merrikh, John Sheehan, Signe Bray
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 189-190
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Objective:
Preterm birth (gestational age < 37 weeks) is associated with delays in the development of executive functions and their precursors, including controlling attention and retaining task-relevant information. In the current study, we aim to examine the potential therapeutic effects of a novel cognitive tablet game, Dino Island (DI), and its implementation through a parent-delivered intervention program on cognitive development in preterm children.
Participants and Methods:In total, 34 participants (M = 4.99 years old) were recruited from a perinatal follow-up clinic or through the community in Calgary, AB. Participants were randomly assigned to either the DI intervention (n = 20) or tablet-based educational control games (C; n = 14). Parents completed a 2-hour training program that included information about how to support their child through the intervention using behavioural supports and metacognitive strategies. Neuropsychological assessment was done prior to beginning the intervention and after 12 weeks of intervention. Various tests were used to assess near transfer measures of sustained attention, shifting attention, executive function, verbal working memory and inhibition, and to assess far transfer measures of language skills and early numeracy. Families tracked weekly progress using journals, with the goal of 3-4 30-minute sessions per week. Multiple ANCOVA analyses were run to analyze quantitative data using the pre-test score as a covariate.
Results:A total of 21 participants completed the 12 weeks of intervention (DI: n = 11 and C: n = 10). Those who did not complete the intervention withdrew from the study or were unable to make a follow-up assessment due to COVID-19 restrictions. Groups did not significantly differ in age (DI: M = 4.92, C: M = 4.61), sex (DI: Female = 6, C: Female = 6), or in weeks preterm (DI: M = 29.49 weeks, C: M = 32.7 weeks).
Multiple ANCOVAs were run to determine the effect of either the DI or Control intervention on the cognitive measures after controlling for the pre-intervention score of participants. As compared to the Control group, the DI intervention group showed near transfer gains in sustained attention (F(1,7) = 5.1, p = 0.043), and executive functions (F(2,18) = 5.41, p = 0.014), as well as far transfer gains in phonetic awareness (F(2,16) = 11.63, p = 0.001), vocabulary and oral language skills (F(2,7) = 5.54, p = 0.014), and number identification fluency (F(2,17) = 11.37, p = 0.001). Detailed analyses will be discussed in the poster.
Conclusions:This study provides preliminary support for the potential efficacy of the DI intervention when delivered by parents to children born preterm. Pre-post testing after 12 weeks of intervention indicated both near and far transfer gains. These results highlight the benefits of utilizing a tablet game format to facilitate collaborative parent-child interactions in cognitive intervention. This intervention provides a potential affordable and engaging alternative to existing cognitive interventions. Further investigation with a larger and more diverse sample is required.