Impact of home-based cognitive or academic intervention on working memory and mathematics outcomes in pediatric brain tumor survivors: the Keys to Succeed pilot randomized controlled clinical trial.

Pediatric brain tumour survivors experience deficits in mathematics and working memory. An open question is whether it is most optimal to target direct cognitive skills (i.e. working memory) or focus on specific academic outcomes (i.e. mathematics) for in remediation. We conducted a pilot randomized controlled trial to determine the feasibility of comparing a working memory versus mathematics intervention. Pediatric brain tumor survivors (7-17 years) were randomly assigned to Cogmed or JumpMath interventions, or an Active Control/Reading group. All participants received Educational Liaison support and completed ~12-weeks of home-based intervention with weekly, telephone-based consultation in one of the three conditions. Standardized assessments of auditory and visual working memory, mathematics calculation and reasoning were completed pre- and post- intervention. Twenty-nine participants completed the interventions; 94% of parents reported a high degree of satisfaction with the interventions and ease of implementation. Participants in JumpMath demonstrated improved mathematics calculation from pre- to post- intervention (p=0.02). Further, participants in both Cogmed and JumpMath showed evidence of pre- to post- intervention improvements in auditory working memory relative to controls (p=0.01). The Cogmed group also showed improvements in visual working memory (p=0.03). Findings suggest that targeted intervention is feasible in survivors of pediatric brain tumors, though with a relatively low recruitment rate. With preliminary findings of improved calculation and working memory following JumpMath and working memory following Cogmed, this pilot trial lays the groundwork for future programs that investigate different inteCognitiveRehabilitationrventions that may be applied to target the unique needs of each survivor.

A cluster-randomized controlled trial of the effectiveness of the JUMP Math program of math instruction for improving elementary math achievement.

Students in many western countries struggle to achieve acceptable standards in numeracy despite its recognition as an important 21st century skill. As commercial math programs remain a staple of classroom instruction, investigations of their effectiveness are essential to inform decision-making regarding how to invest limited resources while maximizing student gains. We conducted a cluster randomized-controlled trial of the effectiveness of JUMP Math, a distinctive math program whose central tenets are empirically supported, for improving elementary math achievement (clinical trial.gov no. NCT02456181). The study involved 554 grade 2 (primary) and 592 grade 5 (junior) students and 193 teachers in 41 schools, in an urban-rural Canadian school board. Schools were randomly assigned to use either JUMP Math or their business-as-usual, problem-based approach to math instruction. We tracked student progress in math achievement on standardized and curriculum-based measures of computation and problem solving, for 2 consecutive school years. Junior students taught with JUMP Math made significantly greater progress in computation than their non-JUMP peers but the groups did not differ significantly in problem solving. Effects took hold relatively quickly, replicating the results from an earlier pilot study. Primary students in the non-JUMP group made significantly greater gains in problem solving and computation in year 1. But those taught with JUMP Math made significantly greater gains in problem solving and the groups did not differ in computation, in year 2. The positive effects of JUMP Math are noteworthy given that the JUMP Math teachers were likely still adjusting to the new program. That these positive findings were obtained in an effectiveness study (i.e. in real-world conditions), suggests that JUMP Math may be a valuable evidence-based addition to the teacher's toolbox. Given the importance of numeracy for 21st century functioning, identifying and implementing effective math instruction programs could have far-reaching, positive implications.

A Cluster Randomized-Controlled Trial of the Impact of the Tools of the Mind Curriculum on Self-Regulation in Canadian Preschoolers.

Early self-regulation predicts school readiness, academic success, and quality of life in adulthood. Its development in the preschool years is rapid and also malleable. Thus, preschool curricula that promote the development of self-regulation may help set children on a more positive developmental trajectory. We conducted a cluster-randomized controlled trial of the Tools of the Mind preschool curriculum, a program that targets self-regulation through imaginative play and self-regulatory language (Tools; clinical trials identifier NCT02462733). Previous research with Tools is limited, with mixed evidence of its effectiveness. Moreover, it is unclear whether it would benefit all preschoolers or primarily those with poorly developed cognitive capacities (e.g., language, executive function, attention). The study goals were to ascertain whether the Tools program leads to greater gains in self-regulation compared to Playing to Learn (YMCA PTL), another play based program that does not target self-regulation specifically, and whether the effects were moderated by children's initial language and hyperactivity/inattention. Two hundred and sixty 3- to 4-year-olds attending 20 largely urban daycares were randomly assigned, at the site level, to receive either Tools or YMCA PTL (the business-as-usual curriculum) for 15 months. We assessed self-regulation at pre-, mid and post intervention, using two executive function tasks, and two questionnaires regarding behavior at home and at school, to capture development in cognitive as well as socio-emotional aspects of self-regulation. Fidelity data showed that only the teachers at the Tools sites implemented Tools, and did so with reasonable success. We found that children who received Tools made greater gains on a behavioral measure of executive function than their YMCA PTL peers, but the difference was significant only for those children whose parents rated them high in hyperactivity/inattention initially. The effect of Tools did not vary with children's initial language skills. We suggest that, as both programs promote quality play and that the two groups fared similarly well overall, Tools and YMCA PTL may be effective curricula choices for a diverse preschool classroom. However, Tools may be advantageous in classrooms with children experiencing greater challenges with self-regulation, at no apparent cost to those less challenged in this regard.

Minding the gap: Children's difficulty conceptualizing spatial intervals as linear measurement units.

Understanding measurement units is critical to mathematics and science learning, but it is a topic that American students find difficult. In 3 studies, we investigated the challenges underlying this difficulty in kindergarten and second grade by comparing performance on different versions of a linear measurement task. Children measured crayons that were either aligned or shifted relative to the left edge of either a continuous ruler or a row of discrete units. The alignment (aligned, shifted) and the measuring tool (ruler, discrete units) were crossed to form 4 types of problems. Study 1 showed good performance in both grades on both types of aligned problems as well as on the shifted problems with discrete units. In contrast, performance was at chance on the shifted ruler problems. Study 2 showed that performance on shifted discrete unit problems declined when numbers were placed on the units, particularly for kindergarteners, suggesting that on the shifted ruler problems, the presence of numbers may have contributed to children's difficulty. However, Study 3 showed that the difficulty on the shifted ruler problems persisted even when the numbers were removed from the ruler. Taken together, these findings suggest that there are multiple challenges to understanding measurement, but that a key challenge is conceptualizing the ruler as a set of countable spatial interval units.

Maternal depression mediates the link between therapeutic alliance and improvements in adolescent externalizing behavior.

The current study: (1) examined the relation between therapeutic alliance and changes in adolescent externalizing behavior in Multisystemic Therapy; (2) tested whether maternal depression mediates this relation; and (3) determined whether mothers' and clinicians' perceptions of the alliance differentially predicted outcomes. Alliance was rated near the end of the first month of treatment. At pre-, mid- and posttreatment, maternal depression and adolescents' externalizing behavior were assessed via mother reports, and by clinicians at pre- and posttreatment only. Mediational analyses showed that therapist-rated alliance was related to improvements in maternal depression, which, in turn, was associated with reductions in adolescent externalizing behavior as rated by mothers. There was no association between mothers' and therapists' perceptions of the therapeutic alliance.

Paternal involvement in Multisystemic Therapy: effects on adolescent outcomes and maternal depression.

The association between paternal involvement in therapy, adolescent outcomes and maternal depression was examined within the context of Multisystemic Therapy (MST), an empirically supported, family- and community-based treatment for antisocial adolescents. Ninety-nine families were recruited from five mental health agencies providing MST. We compared families with paternal involvement in therapy (PIT) to families with no paternal involvement in therapy (NPIT) in pre-post change in adolescents' externalizing and internalizing behaviours and also in maternal depression. There was a significant reduction in both groups in externalizing and internalizing behaviours. However, the magnitude of improvement was significantly greater for the PIT families. Both groups saw a significant reduction in maternal depression but no significant group differences were found. Results suggest that if possible, paternal figures should be encouraged to actively participate in therapy, as adolescents outcomes are enhanced when mothers and paternal figures participate in MST together.

Adults' social cues facilitate young children's use of signs and symbols.

Three experiments investigated the effect of an adult's social cues on 2- and 3-year-old children's ability to use a sign or symbol to locate a hidden object. Results showed that an adult's positive, engaging facial expression facilitated children's ability to identify the correct referent, particularly for 3-year-olds. A neutral facial expression and the presence of the adult's hand also facilitated performance, but to a lesser degree than did an engaging facial expression. The effect of the adult's social cues was greater for relatively unfamiliar signs and symbols (replica or arrow) than it was for a more familiar sign (pointing finger). These findings indicate that non-directional social cues such as facial expression help to convey communicative intent and facilitate children's comprehension of signs and symbols.