Therapeutic effect assessment of integrated intervention for learning difficulties in children / 中国组织工程研究

ABSTRACT

BACKGROUND:Children with learning difficulty often present with cognitive impairments and imbalanced development of intelligence accompanied by emotional and behavioral problems.OBJECTIVE:To evaluate the therapeutic effects of integrated interventions in multiple aspects for children with learning difficulties.DESIGN:A case-control study of children with learning difficulties.SETTING:Department of Pediatric Internal Medicine, Union Hospital Affiliated to Fujian Medical University.PARTICIPANTS:This study involved school-age children of 6 to 12years old with learning difficulties who came to the department specialized in pediatric psychology for consultation from July 1998 to July 2001. The diagnosis of learning difficulties conformed to the diagnostic criteria for special learning disability in ICD-10 with IQ ＞ 70 as an essential condition. Children with emotional disorders, mental deficiency, hyperactivity,visual and auditory dysfunctions and organic cerebral diseases were excluded. The diagnosis was further verified by a professor specialized in neuropsychology. The children voluntarily participated in the cognitive training, behavioral intervention and comprehensive trainings of senses and those who fulfilled the one-year treatment were included in this study. The ratio of therapists to the children was 12, and each session of treatment lasted for 90-120 minutes given 2-3 times a week, and a treatment course consisted of 24 sessions. The children were supposed to complete 4 consecutive treatment courses. Totally 31 children completed the treatment courses, including 24 boys and 7 girls with the mean age of(7.7±1.2)years who had an average IQ of 87.5±8.6.grated interventions for one year consisting of cognitive training, behavioral intervention and comprehensive training of the senses. Raven's Deductive Reasoning test and Beery Visual-Motor Integration Test were use to examine the deductive reasoning ability and visual-motor integration of the children, and visual attention test and auditory attention test, as well as sequential and reverse-sequence memory tests were employed to test their attentions. Achenbach children behavioral scale was applied to evaluate the children's behavioral problems, and Conners' questionnaire for children's behavioral problem was used to measure their attention-deficit/hyperactivity disorder (ADHD) index.MAIN OUTCOME MEASURES:Changes in the deductive reasoning ability, capability of visual-motor integration, attention and psychological behaviors after one year of intervention.RESULTS:All the 31 patients children entered the result analysis with no loss. After one year of integrated intervention, the children had significantly improved scores for Raven's Deductive Reasoning Test (87.51 ±8.64 vs 90.03±8.70, t=-9.610, P ＜ 0.001) and Beery Visual-Motor Integration Test (6.75±1.74 vs 8.27±1.94, t=-9.002, P ＜ 0.001). Obvious improvement was also seen in the visual attention test (15.90±20.11 vs 2.74±3.67), scope of auditory attention and memory (7.70±1.60 vs 11.23±1.23for sequential memory and 3.52±0.93 vs 6.97±0.16 for reversed-sequence memory, P ＜ 0.01). The total scores for ADHD assessment declined to different extents at 3 and 6 months during the treatment and upon the completion of the treatment (22.65±3.53 vs 18.87±4.14 at month 3, 5.65±3.92at month 6 and 12.65±3.36 at one year, t=7.35-15.36, P ＜ 0.01). The scores for 9 psychobehavioral items in Achenbach children behavioral scale obviously declined were also reduced significantly during the therapy,and 87% (26/31) of the children had obviously improved academic performance.CONCLUSION:Interventions integrating cognitive training, behavioral intervention and comprehensive training of the senses may produce good and persistent effect on the cognitive and emotional symptoms of children with learning difficulties, resulting in obviously improved visual, auditory and brain functions.