Can improving working memory prevent academic difficulties? a school based randomised controlled trial

Background: Low academic achievement is common and is associated with adverse outcomes such as grade repetition, behavioural disorders and unemployment. The ability to accurately identify these children and intervene before they experience academic failure would be a major advance over the current &lsquo;wait to fail&rsquo; model. Recent research suggests that a possible modifiable factor for low academic achievement is working memory, the ability to temporarily store and manipulate information in a &lsquo;mental workspace&rsquo;. Children with working memory difficulties are at high risk of academic failure. It has recently been demonstrated that working memory can be improved with adaptive training tasks that encourage improvements in working memory capacity. Our trial will determine whether the intervention is efficacious as a selective prevention strategy for young children at risk of academic difficulties and is cost-effective.Methods/Design: This randomised controlled trial aims to recruit 440 children with low working memory after a school-based screening of 2880 children in Grade one. We will approach caregivers of all children from 48 participating primary schools in metropolitan Melbourne for consent. Children with low working memory will be randomised to usual care or the intervention. The intervention will consist of 25 computerised working memory training sessions, which take approximately 35 minutes each to complete. Follow-up of children will be conducted at 6, 12 and 24 months post-randomisation through child face-to-face assessment, parent and teacher surveys and data from government authorities. The primary outcome is academic achievement at 12 and 24 months, and other outcomes include child behaviour, attention, health-related quality of life, working memory, and health and educational serviceutilisation.Discussion: A successful start to formal learning in school sets the stage for future academic, psychological and economic well-being. If this preventive intervention can be shown to be efficacious, then we will have the potential to prevent academic underachievement in large numbers of at-risk children, to offer a ready-to-use intervention to the Australian school system and to build international research partnerships along the health education interface, in order to carry our further studies of effectiveness and generalisability.<br /

Can improving working memory prevent academic difficulties? A school based randomised controlled trial.

BACKGROUND: Low academic achievement is common and is associated with adverse outcomes such as grade repetition, behavioural disorders and unemployment. The ability to accurately identify these children and intervene before they experience academic failure would be a major advance over the current 'wait to fail' model. Recent research suggests that a possible modifiable factor for low academic achievement is working memory, the ability to temporarily store and manipulate information in a 'mental workspace'. Children with working memory difficulties are at high risk of academic failure. It has recently been demonstrated that working memory can be improved with adaptive training tasks that encourage improvements in working memory capacity. Our trial will determine whether the intervention is efficacious as a selective prevention strategy for young children at risk of academic difficulties and is cost-effective. METHODS/DESIGN: This randomised controlled trial aims to recruit 440 children with low working memory after a school-based screening of 2880 children in Grade one. We will approach caregivers of all children from 48 participating primary schools in metropolitan Melbourne for consent. Children with low working memory will be randomised to usual care or the intervention. The intervention will consist of 25 computerised working memory training sessions, which take approximately 35 minutes each to complete. Follow-up of children will be conducted at 6, 12 and 24 months post-randomisation through child face-to-face assessment, parent and teacher surveys and data from government authorities. The primary outcome is academic achievement at 12 and 24 months, and other outcomes include child behaviour, attention, health-related quality of life, working memory, and health and educational service utilisation. DISCUSSION: A successful start to formal learning in school sets the stage for future academic, psychological and economic well-being. If this preventive intervention can be shown to be efficacious, then we will have the potential to prevent academic underachievement in large numbers of at-risk children, to offer a ready-to-use intervention to the Australian school system and to build international research partnerships along the health-education interface, in order to carry our further studies of effectiveness and generalisability.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Propagation of Epileptiform Events across the Corpus Callosum in a Cingulate Cortical Slice Preparation

We report on a novel mouse in vitro brain slice preparation that contains intact callosal axons connecting anterior cingulate cortices (ACC). Callosal connections are demonstrated by the ability to regularly record epileptiform events between hemispheres (bilateral events). That the correlation of these events depends on the callosum is demonstrated by the bisection of the callosum in vitro. Epileptiform events are evoked with four different methods: (1) bath application of bicuculline (a GABA-A antagonist); (2) bicuculline+MK801 (an NMDA receptor antagonist), (3) a zero magnesium extracellular solution (0Mg); (4) focal application of bicuculline to a single cortical hemisphere. Significant increases in the number of epileptiform events, as well as increases in the ratio of bilateral events to unilateral events, are observed during bath applications of bicuculline, but not during applications of bicuculline+MK-801. Long ictal-like events (defined as events >20 seconds) are only observed in 0Mg. Whole cell patch clamp recordings of single neurons reveal strong feedforward inhibition during focal epileptiform events in the contralateral hemisphere. Within the ACC, we find differences between the rostral areas of ACC vs. caudal ACC in terms of connectivity between hemispheres, with the caudal regions demonstrating shorter interhemispheric latencies. The morphologies of many patch clamped neurons show callosally-spanning axons, again demonstrating intact callosal circuits in this in vitro preparation

Physical Health, Media Use, and Mental Health in Children and Adolescents With ADHD During the COVID-19 Pandemic in Australia

Objective: To examine the impact of COVID-19 restrictions among children with attention-deficit/hyperactivity disorder (ADHD). Methods: Parents of 213 Australian children (5–17 years) with ADHD completed a survey in May 2020 when COVID-19 restrictions were in place (i.e., requiring citizens to stay at home except for essential reasons). Results: Compared to pre-pandemic, children had less exercise (Odds Ratio (OR) = 0.4; 95% CI 0.3–0.6), less outdoor time (OR = 0.4; 95% 0.3–0.6), and less enjoyment in activities (OR = 6.5; 95% CI 4.0–10.4), while television (OR = 4.0; 95% CI 2.5–6.5), social media (OR = 2.4; 95% CI 1.3–4.5), gaming (OR = 2.0; 95% CI 1.3–3.0), sad/depressed mood (OR = 1.8; 95% CI 1.2–2.8), and loneliness (OR = 3.6; 95% CI 2.3–5.5) were increased. Child stress about COVID-19 restrictions was associated with poorer functioning across most domains. Most parents (64%) reported positive changes for their child including more family time. Conclusions: COVID-19 restrictions were associated with both negative and positive impacts among children with ADHD

Randomised trial, nested in a population-based survey, of a behavioural sleep intervention to reduce sleep problems in new school entrants

© 2010 Dr. Jon QuachBackground: Sleep problems are common during childhood and are associated with poor outcomes such as increased behaviour problems and poorer social and emotional functioning and poorer academic achievement. Most of these child sleep problems are behavioural in nature. In addition, the school transition period is an important developmental stage for children and a poor transition has been linked to poorer academic and wellbeing outcomes for the child in later school life. Therefore, optimising child functioning during this period is important so that children can make a successful transition. One potential area is reducing child sleep problems. Aims: The thesis aimed to (i) determine the appropriate format for a brief behavioural sleep intervention to caregivers and schools (ii) determine the prevalence and population burden of sleep problems as children enter school (iii) determine the efficacy of a brief behavioural sleep intervention to reduce child sleep problems and improve child and caregiver outcomes. Registration: The intervention trial was registered with the International Standard Randomised Controlled Trial Number Register (ISRCTN56892832) Methodology/Design: The study for this thesis was conducted in three parts. For Aim 1, we conducted a pilot study in July to August 2007 at two schools conveniently located to the Royal Children’s Hospital, Melbourne, Australia to determine the most acceptable intervention format for schools and caregivers. We randomised eligible caregivers to either an ‘individual’ or ‘group’ intervention format. For Aim 2, we conducted a school survey of 1512 (response rate = 71%) children in their first six months of schooling from a convenience sample of 22 schools across three local government areas in metropolitan Melbourne, Australia in 2008 and 2009. For Aim 3, we conducted a randomised controlled trial to assess the impact of a brief behavioural intervention for child sleep problems in the first six months of school. The 108 participants in this ‘efficacy’ trial were all those in our school-based survey (Aim 2) whose caregivers reported a moderate or severe child sleep problem. We randomised care givers to either a usual care (control) or intervention group. We followed up participants at three and six months post-randomisation. Intervention: The intervention was designed for public health applicability and sustainability within the school system, informed by the pilot study to determine the most acceptable format for intervention delivery. We trained three research assistants over three x 2-hour sessions to deliver the intervention. Intervention caregivers individually attended an initial 45-minute appointment with a researcher at their child’s school. The session covered education about normal sleep requirements and importance of good sleep hygiene practices. After reviewing the child’s sleep pattern, the researcher then selected with the caregiver acceptable strategies for their child’s specific behavioural sleep problem, drawing on a menu of flexible yet standardised techniques. The researcher then conducted a 15 minute consultation telephone call two weeks after the intervention to consolidate and, where necessary, modify the selected strategies. When requested by the caregiver, a second 30-minute face-to-face appointment was organised one week later. Results: In the pilot study (Aim 1), it was determined that caregivers are more likely to participate in an individual intervention format then a group based intervention. In the school survey (Aim 2), 39% of caregivers reported a problem with their child’s sleep (28% mild, 11% moderate/severe). Moderate/severe child sleep problems were associated with markedly poorer outcomes for behaviour (effect size = 1.0, i.e. mean scores one standard deviation worse in children with than without sleep problems), health-related quality of life (effect size = 0.5) and caregiver mental health (effect size = 0.8). In the efficacy trial (Aim 3), we followed 85% of families to six months post–randomisation. This is the longest follow-up to date of a behavioural sleep intervention to improve school-aged children’s sleep. Our brief intervention improved sleep with an absolute reduction of 20% in intervention compared with the control group. It also improved children’s emotional and social functioning (effect size 0.4) as well as caregiver depressive symptoms (effect size 0.3). As well as the successful between-group outcomes noted above, intervention caregivers rated the strategies highly for treating and coping with the child’s sleep problem and ease of use. Thus the intervention was acceptable to caregivers and minimally disruptive to families. Conclusion: This thesis provides the first evidence that a behavioural sleep intervention is able to reduce sleep problems in children commencing their first year of school and that it has positive benefits for their social and emotional functioning and their caregiver’s mental health. The results of this trial point towards a larger effectiveness trial in which the intervention is delivered by an existing school health workforce and in a broader socio-economic sample

Sleep timing and child and parent outcomes in Australian 4-9-year-olds: a cross-sectional and longitudinal study

Objectives: The aim of this study is to use national Australian time-diary data to examine both (1) crosssectionally and (2) longitudinally whether being late versus early to sleep or wake is associated with poorer child behavior, quality of life, learning, cognition and weight status, and parental mental health. Methods: Design/setting: Data from the first three waves of the Longitudinal Study of Australian Children were taken. Participants: A national representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed up biennially, was taken; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave. Measures: Exposure: Parents completed 24-h child time-use diaries for one week and one weekend day at each wave. Using median splits, sleep timing was categorized into early-to-sleep/early-to-wake (EE), early-to-sleep/ late-to-wake (EL), late-to-sleep/early-to-wake (LE), and late-to-sleep/late-to-wake (LL) at each wave. Outcomes: The outcomes included parent-reported child behavior, health-related quality of life, maternal/ paternal mental health, teacher-reported child language, literacy, mathematical thinking, and approach to learning. The study assessed child body mass index and girth. Results: (1) Using EE as the comparator, linear regression analyses revealed that being late-to-sleep was associated with poorer child quality of life from 6 to 9 years and maternal mental health at 6-7 years. There was inconsistent or no evidence for associations between sleep timing and all other outcomes. (2) Using the count of the number of times (waves) at which a child was categorized as late-to-sleep (range 0-3), longitudinal analyses demonstrated that there was a cumulative effect of late-to-sleep pro- files on poorer child and maternal outcomes at the child age of 8-9 years. Conclusions: Examined cross-sectionally, sleep timing is a driver of children's quality of life and maternal depression. Examined longitudinally, there appears to be cumulative and adverse relationships between late-to-sleep profiles and poorer child and maternal outcomes at the child age of 8-9 years. Understanding how other parameters - such as scheduling consistency, sleep efficiency and hygiene - are also related to child and parent outcomes will help health professionals better target sleep management advice to families

Promoting evidence uptake in schools: A review of the key features of research and evidence institutions

This rapid evidence synthesis informed a Commonwealth review to achieve educational excellence in Australian Schools, chaired by the Gonski School review panel

Bidirectional associations between child sleep problems and internalizing and externalizing difficulties from preschool to early adolescence

Importance: Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions. Objective: To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties. Design, Setting, and Participants: Prospective cohort study using nationally representative data from the first 5 waves (2004, 2006, 2008, 2010, and 2012) of the kindergarten cohort (4983 children aged 4-5 years in 2004) collected for the Longitudinal Study of Australian Children. Associations were evaluated using cross-lagged structural equation model analyses performed from May 25, 2016, to September 20, 2017. Main Outcomes and Measures: Child sleep problems and internalizing and externalizing behavioral difficulties. Sleep problems were defined using parent-reported child sleep problem severity and specific difficulties (ie, difficulty getting to sleep at night, not happy sleeping alone, waking during the night, and restless sleep) on 4 or more nights of the week. Child behavioral difficulties were defined using the parent-reported Strengths and Difficulties Questionnaire for externalizing difficulties (conduct problems and hyperactivity/inattention subscales) and internalizing difficulties (emotional problems subscale). Results: The 4983 children enrolled in 2004 had a mean (SD) age of 4.7 (0.2) years and comprised a similar percentage of boys (2536 [50.9%]) and girls. In 2012, 3956 children (79.4%) aged 12 to 13 years were retained. Significant bidirectional associations were detected between sleep problems and externalizing difficulties during the elementary school transition period, with greater sleep problems associated with later externalizing behavior and vice versa (cross-lagged path coefficient, 0.04 [95% CI, 0.01-0.08] to 0.09 [95% CI, 0.06-0.13]). Although sleep was a significant driver of later internalizing difficulties (coefficient, 0.10 [95% CI, 0.07-0.14] to 0.16 [95% CI, 0.12-0.19]), the reverse association was not significant. In the final model that included all 3 constructs, the associations were attenuated but remained significant over time. Conclusions and Relevance: These results suggest that future studies should investigate whether implementing sleep problem intervention decreases the occurrence of both externalizing and internalizing difficulties. Interventions targeting externalizing, but not internalizing, difficulties may benefit childhood sleep

Cross-sectional sleep thresholds for optimal health and well-being in Australian 4-9-year-olds

Aim. Using national Australian time-diary data, we aimed to empirically determine sleep duration thresholds beyond which children have poorer health, learning, quality of life, and weight status and parents have poorer mental health. Methods. Design/Setting: Cross-sectional data from the first three waves of the Longitudinal Study of Australian Children. Participants: A nationally representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed biennially; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave. Main measures: Exposure: At each wave, a parent completed 24-h time-use diaries for one randomly selected weekday and one weekend day, including a "sleeping/napping" category. Outcomes: Parent-reported child mental health, health-related quality of life, and maternal/paternal mental health; teacher-reported child language, literacy, mathematical thinking, and approach to learning; and assessed child body mass index and girth. Results. Linear regression analyses revealed weak, inconsistent relationships between sleep duration and outcomes at every wave. For example, children with versus without psychosocial health-related quality of life problems slept slightly less at 6-7 years (adjusted mean difference 0.12 h; 95% confidence interval 0.01-0.22, p = 0.03), but not at 4-5 (0.00; -0.10 to 0.11, p = 1.0) or 8-9 years (0.09; -0.02 to 0.22, p = 0.1). Empirical exploration using fractional polynomials demonstrated no clear thresholds for sleep duration and any adverse outcome at any wave. Conclusions. Present guidelines in terms of children's short sleep duration appear misguided. Other parameters such as sleep timing may be more meaningful for understanding optimal child sleep