Changes in intellectual and academic performance of children following computer-based training: Preliminary results.

BACKGROUND: The aim of this pilot study was to assess the effectiveness of a computer-based intervention on children who were average in academic performance.
MATERIALS AND METHODS: Twenty-one children aged between 8 and 11 years, in classes 3(rd), 4(th) or 5(th) formed the sample with 12 in the experimental (who underwent the computer-based training) and 9 in the control group (who did not undergo the training). Pre- and post-assessment was done for all children using a battery of intelligence tests, and the marks obtained by the child at school. The difference in performance of the two groups was compared using the t test. RESULT: There was significant improvement within the performance of the experimental group in cognitive functioning (P<0.05) and school marks (P<0.05), as compared with the children in the control group. The limitations of the study include the small sample size, non-random allocation to groups and the (pre and post) assessments being carried out by the researcher. However, the trend of results is promising.
CONCLUSION: Thus, a brief computer-aided intervention for improving neuropsychological functions such as attention and working memory has had a positive impact on the cognitive and academic skills of children who were average in scholastic performance.

RCT Entities:   Population Interventions Outcomes

INTRODUCTION

Studies in India[12] report that at least 10% of school-going children have scholastic difficulties. The most frequently used method for identifying learning problems in children is discrepancy between ability and achievement; this model has often been criticized.[2] The present system of education and the shortage of trained manpower have often resulted in the under-identification of learning difficulties in children. This problem, unattended to, can have serious fallouts in the mental health of the growing child. Clinic-based studies by Karande et al.[23] have highlighted the need for early identification and intervention for children with learning problems.

There have been several studies on neuropsychological reasons for problems in school-related skills.[4] Attention[5] and working memory[6] are functions that have been extensively researched. Information processing deficits[7] have been identified in children with adequate achievement. Remediation for children with academic difficulties has traditionally concentrated on strategies such as multi-sensory teaching, overlearning, auditory rehearsal and aids such as charts, maps and electronic notebooks. The use of computers[8-10] and video games[11] has been recent advancements in rehabilitation.

Scholastic problems in children are a significant source of stress for the child and the family and may thus be a good starting point for intervention.

This pilot study tries to assess the usefulness of a computer-based intervention program for children identified as being average in academic performance. The program targets the enhancement of neuropsychological functions, such as attention, visual recognition, working memory, and response inhibition, through training. The effect of this intervention was assessed on variables such as cognitive functioning and academic performance of the child. The results of the study will help in deciding the protocol for the final study.

This is also an exploratory attempt to find out whether training in one cognitive skill can affect performance in another. It is expected that strengthening the core neuropsychological functions through various tasks would provide the child with better organization, processing, and storage skills. This “functional readiness” would in turn help the child cope better at academic tasks with positive social and emotional fallouts.

The study was also planned to devise simple but effective ways of secondary prevention at the level of the school. Computers are increasingly available in schools and harnessing them for therapeutic purposes would help address some of the gaps in the delivery of services for children with difficulties in learning.

MATERIALS AND METHODS

Research design

A before–after experimental design with controls was adopted for the present study. This involved a pre assessment of the dependant variables in the two matched groups, an intervention for one of the groups and a post assessment of the same variables in both the groups. The dependant variables under study were cognitive functions of the children and marks obtained by them in the school exams.

The study was approved by the ethics committee of the hospital.

Objective

The major objective of the study was to assess the effect of a computer-based cognitive enrichment program on the intellectual and scholastic performance of children.

Hypothesis

It was hypothesized that there would be an improvement in the intellectual and scholastic performance of children who underwent the computer-based intervention, as compared to the group which did not undergo the training.

Sample

This study was carried out between June 2005 and March 2006.

The training was to take place in the hospital, and hence, 15 schools within a radius of 5–6 km from the hospital were selected. The schools authorities were contacted by telephone, and a letter detailing the program was sent to the respective principals. Based on this information, parents of 34 children contacted the researcher; 18 matched the criteria for inclusion and these children were included after obtaining written informed consent from their parents. These children enrolled in the program at different points in time and six dropped out after the initial sessions. The reasons cited for non-continuance included difficulty of regularly bringing the children to the hospital, employment in parents and illnesses in the family. Twelve children (average age = 9.5 years), who completed 20 sessions of training over 4 months, formed the experimental group. For the control group, data from nine children (average age = 10 years), matched for age and class, were taken; this group did not undergo the intervention. Random allocation of children into the two groups was not possible due to the high drop-out rate. However, every attempt was made to match the groups in terms of age and socioeconomic status.

Inclusion criteria

Students of class 3rd, 4th or 5th

Age between 8 and 11 years

Average marks obtained in the school assessment, between 40 and 60%.

Exclusion criteria

Prior diagnosis of a medical or psychiatric condition

Use of devices such as spectacles, hearing aid, calipers

Repetition of a class

Use of medication for a chronic or long-standing problem.

Tools used

Malin's Intelligence Scale for Indian Children to assess the cognitive abilities of the child. This scale has 11 sub-tests which generate a verbal IQ, performance IQ and a total IQ score.[12]

Computer-based cognitive enrichment program (Brain Functions Therapy) developed by Dr. C. R. Mukundan,[913] which is commercially available and used in various clinical groups. The program is aimed at multiple neuropsychological functions such as visual recognition (characters, words, and numbers), spatial comparison, response inhibition, continuous performance and sequencing (temporal and alphanumeric). The tasks are presented by the computer, which facilitates to increase the difficulty level of each task in a measured and preset manner. The program allows increasing the difficulty level by small quantities every day/session so that the subject gradually learns to perform more and more difficult cognitive tasks. Seven such tasks were chosen, each with duration of 5–7 minutes. Each training session lasted for 35–40 minutes. The seven tasks were word identification, alphabet presentation, working memory, continuous performance, visuo-spatial comparison, temporal sequencing and response inhibition.

Record of marks obtained from the respective schools, based on which an average mark was calculated.

Procedure

The children in the experimental group were assessed prior to intervention and within a month of completing the training. The children in the control group were assessed after they were selected and then reassessed after 3 months. The assessments were carried out by the researcher.

The marks scored by the children during the period of the study, were obtained from their respective schools. For the purpose of analysis, the average of the marks obtained in four subjects – English, Mathematics, Science and Social Studies was used.

RESULTS

There was no significant difference between the two groups in terms of age and IQ (P>0.05), prior to intervention, indicating homogeneity of groups [Table 1].

Table 1

Difference in performance within the two groups (paired sample t)

There was a significant improvement within the experimental group in marks, total IQ and performance IQ (P<0.05) following intervention. A similar trend was not seen in the control group, indicating that intervention did have a significant effect on performance. However, a between-groups comparison did not reveal any significant difference as a result of intervention (P>0.05), except in performance IQ (P=0.02*). This may be due to the small sample size in the two groups. However, the increase in the values of all the variables, on an average, was more in the experimental group compared to that in the control group.

DISCUSSION

Intelligence is a reliable predictor of academic success[14] and may be improved by strengthening the fundamental processes that form the basis of intelligent behavior.[1516] A few studies have used computer-based training and demonstrated improvement in intelligence,[1017] but results have been mixed, with little or no effect on other outcome variables.[1819]

In this study, intelligence seemed to have improved within the experimental group; however, the overall range of scores was below average. When the groups were compared with each other, no significant differences emerged. A similar trend was noticed in academic performance, where the improvement within the experimental group was not found to be significant when the groups were compared. The absence of statistical significance between groups could have been due to heterogeneity (in terms of age and class) of the group and the small group size. The use of computers in the experimental group could be a potential placebo, as the motivation of the children and their active involvement in the intervention could have contributed to the difference. The use of computer games or computer-aided academic programs in the control group would have minimized this effect. However, this was not considered ethical and hence the use of passive controls was used.

The results of the study are promising because a brief computer-aided training appears to have resulted in some improvement in intellectual and academic performance within the group that was trained.

The results of this pilot study have helped in deciding the protocol for the main study – procedure for selection, intervention tasks and sample. It has also helped establish the usefulness of computer-based intervention in children. Apart from the standardized administration, level of control, accuracy in recording of responses and cost-effectiveness, it is an intervention where children are active participants in the training process. If similar trends are replicated in the main study, it has the scope of being used at a more inclusive level, to minimize learning problems in young children. Such interventions will help to at least partially address the learning needs of children who struggle at school and are not readily identified as potentially at risk.

The study has several limitations – small sample size, lack of active controls, assessment by the researcher rather than by a person who was blind to the purpose of the study and heterogeneity of schools the children studied in. However, it is a preliminary attempt to offer an innovative intervention program for children who perform at an average scholastic level in the younger classes.