Etiology of persistent mathematics difficulties from childhood to adolescence following very preterm birth

Children born very preterm (VP; 0.05), with the exception of writing large numbers and conceptual understanding of arithmetic. In a previous study, 83 of the VP adolescents and 49 of the term-born adolescents were assessed at age 8–10years using measures of the same skills. Amongst these, the between-group difference in mathematics achievement remained stable over time. This study extends findings of a persistent deficit in mathematics achievement among VP children over the primary and secondary school years, and provides evidence of a deficit in factual, procedural and conceptual mathematics skills and in higher order mathematical operations among VP adolescents. We provide further evidence that VP children’s mathematics difficulties are driven by deficits in domain-general rather than domain-specific cognitive skills

Mathematics difficulties in children born very preterm: current research and future directions

Children born very preterm have poorer attainment in all school subjects, and a markedly greater reliance on special educational support than their term-born peers. In particular, difficulties with mathematics are especially common and account for the vast majority of learning difficulties in this population. In this paper, we review research relating to the causes of mathematics learning difficulties in typically developing children, and the impact of very preterm birth on attainment in mathematics. Research is needed to understand the specific nature and origins of mathematics difficulties in very preterm children to target the development of effective intervention strategies

Explaining the relationship between number line estimation and mathematical achievement: the role of visuomotor integration and visuospatial skills

Performance on number line tasks, typically used as a measure of numerical representations, are reliably related to children's mathematical achievement. However, recent debate has questioned what precisely performance on the number line estimation task measures. Specifically, there has been a suggestion that this task may measure not only numerical representations but also proportional judgment skills; if this is the case, then individual differences in visuospatial skills, not just the precision of numerical representations, may explain the relationship between number line estimation and mathematical achievement. The current study investigated the relationships among visuospatial skills, visuomotor integration, number line estimation, and mathematical achievement. In total, 77 children were assessed using a number line estimation task, a standardized measure of mathematical achievement, and tests of visuospatial skills and visuomotor integration. The majority of measures were significantly correlated. In addition, the relationship between one metric from the number line estimation task (R2 LIN) and mathematical achievement was fully explained by visuomotor integration and visuospatial skill competency. These results have important implications for understanding what the number line task measures as well as the choice of number line metric for research purposes

Conducting experimental research in marginalised populations: clinical and methodological implications from a mixed-methods randomised controlled trial in Kenya.

Experimental studies to test interventions for people living with HIV in low- and middle-income countries are essential to ensure appropriate and effective clinical care. The implications of study participation on outcome data in such populations have been discussed theoretically, but rarely empirically examined. We aimed to explore the effects of participating in a randomised controlled trial conducted in an HIV clinic in Mombasa, Kenya. We report qualitative data from the Treatment Outcomes in Palliative Care trial, which evaluated the impact of a nurse-led palliative care intervention for HIV positive adults on antiretroviral therapy compared to standard care. Participants in both arms attended five monthly quantitative data collection appointments. Post-trial exit, 10 control and 20 intervention patients participated in semi-structured qualitative interviews, analysed using thematic analysis. We found benefit attributed to the compassion of the research team, social support, communication, completion of patient reported outcome measures (PROMs) and material support (transport reimbursement). Being treated with compassion and receiving social support enabled participants to build positive relationships with the research team, which improved mental health and well-being. Open and non-judgmental communication made participants feel accepted. Participants described how repeated completion of the PROMs was a prompt for reflection, through which they began to help themselves and self-care. Participant reimbursements relieved financial hardship and enabled them to fulfil their social responsibilities, enhancing self-worth. These findings emphasise the importance of compassion, support and effective communication in the clinical encounter, particularly in stigmatised and isolated populations, and the potential of the integration of simple PROMs to improve patient outcomes. Participation in research has unexpected positive benefits for participants, which should be taken into account when designing research in similar populations. Researchers should be aware of the effects of financial reimbursement and contact with researchers in isolated and impoverished communities

Understanding arithmetic concepts: the role of domain-specific and domain-general skills

A large body of research has identified cognitive skills associated with overall mathematics achievement, focusing primarily on identifying associates of procedural skills. Conceptual understanding, however, has received less attention, despite its importance for the development of mathematics proficiency. Consequently, we know little about the quantitative and domain-general skills associated with conceptual understanding. Here we investigated 8 – 10-year-old children’s conceptual understanding of arithmetic, as well as a wide range of basic quantitative skills, numerical representations and domain-general skills. We found that conceptual understanding was most strongly associated with performance on a number line task. This relationship was not explained by the use of particular strategies on the number line task, and may instead reflect children’s knowledge of the structure of the number system. Understanding the skills involved in conceptual learning is important to support efforts by educators to improve children’s conceptual understanding of mathematics

Explaining the relationship between number line estimation and mathematical achievement: the role of visuomotor integration and visuospatial skills

Performance on number line tasks, typically used as a measure of numerical representations, are reliably related to children’s mathematical achievement. However, recent debate has questioned what precisely performance on the number line estimation task measures. Specifically, there has been a suggestion that this task may measure not only numerical representations but also proportional judgment skills; if this is the case, then individual differences in visuospatial skills, not just the precision of numerical representations, may explain the relationship between number line estimation and mathematical achievement. The current study investigated the relationships among visuospatial skills, visuomotor integration, number line estimation, and mathematical achievement. In total, 77 children were assessed using a number line estimation task, a standardized measure of mathematical achievement, and tests of visuospatial skills and visuomotor integration. The majority of measures were significantly correlated. In addition, the relationship between one metric from the number line estimation task (R2LIN) and mathematical achievement was fully explained by visuomotor integration and visuospatial skill competency. These results have important implications for understanding what the number line task measures as well as the choice of number line metric for research purposes

Mathematics difficulties in extremely preterm children : evidence of a specific deficit in basic mathematics processing

Background: Extremely preterm (EP, <26 wk gestation) children have been observed to have poor academic achievement in comparison to their term-born peers, especially in mathematics. This study investigated potential underlying causes of this difficulty. Methods: A total of 219 EP participants were compared with 153 term-born control children at 11 y of age. All children were assessed by a psychologist on a battery of standardized cognitive tests and a number estimation test assessing children’s numerical representations. Results: EP children underperformed in all tests in comparison with the term controls (the majority of Ps < 0.001). Different underlying relationships between performance on the number estimation test and mathematical achievement were found in EP as compared with control children. That is, even after controlling for cognitive ability, a relationship between number representations and mathematical performance persisted for EP children only (EP: r = 0.346, n = 186, P < 0.001; control: r = 0.095, n = 146, P = 0.256). Conclusion: Interventions for EP children may target improving children’s numerical representations in order to subsequently remediate their mathematical skills

Effect of participation in a randomised controlled trial of an integrated palliative care intervention on HIV-associated stigma

We conducted in Kenya a mixed-methods randomised controlled trial (RCT) of a nurse-led palliative care intervention integrated with anti-retroviral therapy (ART) provision for the management of HIV. Here we report qualitative findings showing increased resistance to HIV-associated stigma among trial participants. A mixed method design was chosen to enable identification of the active ingredients of the intervention and exploration of participants' experiences of receiving the intervention. The RCT was conducted from July 2011 to November 2012 in a community hospital in the city of Mombasa, Kenya, with a sample of 120 adults with HIV on ART. Thirty participants were purposively selected to take part in a qualitative exit interview, based on study arm and mental health outcome. Inductive thematic analysis revealed increased resistance to HIV-associated stigma in both the intervention and control groups. Specifically, patients in both groups described benefit from the social support, compassionate care, and open and respectful communication they received through study participation. Participants described improved self-image, increased access to social agency, and increased resistance to HIV-associated stigma. Our findings suggest that there is potential to increase resistance to stigma through simple mechanisms of support, compassion, and improved communication in routine care. The self-reported impact of trial participation on stigma also has implications for future trials in populations in resource-constrained settings where stigma is common