the calm clinic: data from the first 100 children with problems in attention, learning and memory...

The CALM clinic:

Data from the first 100 Children with problems in Attention, Learning and

Memory

Susan Gathercole, Francesca Woolgar, Duncan Astle,

Tom Manly, & Joni Holmes

Understanding and helping children with problems in attention,

learning and memory, 16th June 2015

The Centre for Attention, Learning & Memory

Aims to:

• understand cognitive and brain processes involved in learning

• develop ways of identifying and overcoming problems that might emerge in childhood

• provide an information hub for researchers and professionals in children’s services

Cognitive developmental disorders:Problems of diagnosis• High prevalence of ADHD, dyslexia, language

impairment and dyscalculia (1-7% population)• Co-morbidity rates 20-80%• Diagnoses have low:

• specificity (high symptom variability) &• sensitivity (high symptom overlap with other

diagnoses)

Cognitive developmental disorders:Problems of diagnosis• High prevalence of ADHD, dyslexia, language

impairment and dyscalculia (1-7% population)• Co-morbidity rates 20-80%• Diagnoses have low:

• specificity(high symptom variability) &• sensitivity (high symptom overlap with other

diagnoses)• Dimensional approach:

• identify meaningful dimensions of cognitive/ behavioural profiles that cut across diagnoses

The CALM clinic

Research-informed assessment of children with problems in attention, learning, and/ or memory, with the aims of:

• identifying cognitive dimensions linked to impairments of learning (reading, maths, language)

• illuminating the neural and genetic characteristics of these dimensions

• improving diagnosis and tailoring support for individuals• establishing a research panel of children with known

cognitive profiles for fundamental and translational research

Possible dimensions

Phonological

• processing• STM

Nonverbal

• Reasoning• STM

Executive functions

• attention• shifting• planning• WM

Episodic memory?

Recruitment and assessment

• Referrals from children’s service providers (SENCos, Ed psychs, SLTs, CAMHS)

• Any child aged 5-18yrs with problems in reading, maths, language, attention, learning, and/ or memory

• No diagnosis necessary, no co-morbidity exclusions• Families visit CALM for 2.5 hour assessment:

• IQ, reading, maths, vocabulary, phonological processing, working memory, attention & EFs, episodic memory

• behaviour ratings (Conners, BRIEF, SDQ, CCC)• saliva sample• MRI

• Reports to referrers to inform ongoing support

The first recruits

104 children tested October 2013-April 2014Excluded:• incomplete data (n=12)• outliers (n=1) Core data set analysed (n=91), mean age 9;06 yrs, 5;11 -15;08 years, 57 male

Referral information

Referrer nSENCo 55Specialist teacher 7Ed psych 2SLT 14Clin psych 9Paediatrician 2

total 89Primary reason for referral nattention 14memory 11language 13literacy 20maths 5literacy & maths 22total 85

Diagnosis nADHD 4ADD 1DAMP 0Dyscalculia 2Dyslexia 5Dyspraxia 3Depression 1OCD 1Anxiety 0FAS 3GDD 1ASD 5None 57

1. The whole sample

Learning and cognitive skills: mean z-scores

Vocab

Readi

ng

Mat

hs

Alliter

atio

n

Rapid

nam

ing

Digit

reca

ll

Backw

ard

digi

t rec

all

Stor

y re

call

Mat

rix re

ason

ing

Dot m

atrix

Mr X

-1.6

-1.4

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

n=91

Learning NonverbalVerbal

Verbal Nonverbal

ns

Correlations between learning measures and cognitive skills

0

0.1

0.2

0.3

0.4

0.5

0.6

Vocab

Reading

Maths

-0.2

-0.1

0

0.1

0.2

0.3

0.4

0.5

Vocab Reading

Maths

Regression: standardised beta coefficients

NonverbalVerbal

**

*

*

Test Subscale Mean SDConners (T) Inattention 74.3 12.7

Hyperactivity 64.4 14.6Learning problems 73.0 12.0Aggression 54.9 13.8

BRIEF (T) Inhibit 60.9 14.3Shift 63.1 15.3Emotional control 59.3 13.3Initiate 64.9 11.1WM 72.8 9.8Planning 70.7 10.8Organisation 59.6 10.6

Strengths & Difficulties Q (raw) 15.8 7.5

Behaviour ratings

Correlations with learning scores

Measure Subscale Vocab Reading MathsConners Inattention 0.068 -0.109 -.239*

Hyperactivity -0.089 -0.175 -0.098Learning problems -.371** -.530** -.426**Aggression -0.205 -0.127 -.224*

BRIEF Inhibit -0.172 -0.183 -.258*Shift 0.005 -0.004 -.214*Emotional control -0.143 -0.085 -0.137Initiate 0.002 0.021 -.253*WM 0.004 -0.01 -.283**Planning -0.004 -0.078 -.208*Organisation 0.118 -0.035 -0.094

Strengths & Difficulties Q (raw) -0.155 -0.056 -.261*

2. Sample subgroups

Allit

erat

ion

Rapid n

aming

Digit

span

Back

ward

digits

Stor

y re

call

Mat

ix re

ason

ing

Dot m

atrix

Mr X

-.60

-.40

-.20

.00

.20

.40

.60

.80

1.00all learning>80, n=31

all learning>85, n=23

all learning>90, n=12

Higher learners: mean z-scores

Verbal Nonverbal

vocab

mathsreading

161 5

1

6

19

20

23

Numbers of children with scores <85

vocab

mathsreading

161 5

1

6

19

20

23

Numbers of children with scores <85

Allit

erat

ion

Rapid n

aming

Digit

span

Back

ward

digits

Stor

y re

call

Mat

ix re

ason

ing

Dot m

atrix

Mr X

-2.5

-2

-1.5

-1

-0.5

0

vocab,maths&read <85,n=16

maths&read<85,n=19

maths<85,n=20

Mean z-scores for subgroups with learning scores below 85

3. Dimensions

Correlated factors Rotated factors

F1 F2 F1 F2

Alliteration 0.76 -0.35 Alliteration 0.81 0.21

Digit recall 0.72 -0.20 Digit recall 0.69 0.29

Backward digits 0.80 0.02 Backward digits 0.61 0.52

Story recall 0.64 -0.43 Story recall 0.76 0.07

Matrix reasoning 0.61 0.09 Matrix reasoning 0.42 0.45

Dot matrix 0.59 0.67 Dot matrix 0.04 0.90

Mr X 0.65 0.33 Mr X 0.30 0.67% variance 47 13 % variance 47 13

Exploratory factor analyses: cognitive measures

Chi-square = 9.271, Degrees of freedom = 12, Probability level = .680RMR GFI AGFI PGFI 5.252 .971 .932 .416

Confirmatory factor analyses:Cognitive measures

Rotated factorsF1 F2

Vocab 0.92 0.13Reading 0.71 0.45Maths 0.22 0.96

Correlated factorsF1 F2

Vocab 0.80 -0.48Reading 0.83 -0.10Maths 0.77 0.60

Exploratory factor analyses: Learning measures

Chi-square = 27.963, Degrees of freedom = 32, Probability level = .671

RMR GFI AGFI PGFI 8.741 .938 .894 .546

Pathways to learning:Model 1

Chi-square = 30.565, Degrees of freedom = 33, Probability level = .589

RMR GFI AGFI PGFI 9.587 .934 .890 .560

Pathways to learning:Model 2

4. Overview

Key findings so far

• Vocabulary problems rarely found in isolation in this sample

• Reading difficulties typically accompanied by maths problems …

• … but specific maths difficulties relatively common• 20-30% of children have no detected learning difficulties• Two dimensions identified:

• Verbal -> general learning• Nonverbal -> maths

• Episodic memory strongly associated with learning, esp. vocabulary• causal or not?

Further developments

Further assessments• Trails switching & Tower planning for 8+• Visual search, TEA-Ch2 (vigilance, sustained attention,

switching, simple RT)• CNRep

MRICortical volume and thickness, white matter connectivity, reating state

Mental health dataParent & child reports of anxiety, depression, etc

Recruiting more children with diagnosesADHD, language impairment

Special thanks to …

Sara GharooniSarah BishopGemma CrickmoreAmy JohnsonAgnieszka Jaroslawska

Sally ButterfieldJoe BatheltAndrew Gadie

Ayla Humphrey