Strategic verbal rehearsal in adolescents with mild intellectual disabilities: A multi-centre European study

Sketch and Speak Expository Intervention for Adolescents: A Single-Case Experiment via Telepractice

PURPOSE

This study investigated the effects of Sketch and Speak strategy intervention on expressive and receptive expository discourse for adolescents with language-related learning disabilities (LLD).

METHOD

Three participants completed baseline and twelve 45- to 60-min individual treatment sessions in a multiple-baseline across participants design. In treatment, participants learned to take notes using pictography and conventional bulleted notes, orally generate sentences from their notes, and orally practice full sentences and oral reports. Session tests with varied levels of instructional support were used to collect outcome data on free-recall oral reports, short-answer question responses, and participant notes. A distal, age- referenced expository task and social validity questionnaires were administered pre-/postintervention.

RESULTS

Visual and statistical analyses revealed significant effects of treatment on the primary outcome measure of Oral Report Quality and on secondary outcomes of Note Quantity and Quality. There was no significant effect of treatment on Short-Answer Recall questions. Two participants generalized strategies during the treatment phase to independent performance on Oral Reports and one improved on Note Quality. All three participants improved on the distal expository measure. Social validity questionnaires showed participant awareness and buy-in of taught strategies, with potential for generalization at the high school level.

CONCLUSIONS

These adolescent students benefited from explicit instruction in note-taking strategies and systematic oral practice of expository discourse even within the challenging delivery setting of telepractice. This study provides evidence for the use of Sketch and Speak expository intervention with adolescents with LLD to improve comprehension and expression of grade-level material.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23681505.

Neurocognitive functioning of children with mild to borderline intellectual disabilities and psychiatric disorders: profile characteristics and predictors of behavioural problems

BACKGROUND

The aim of the current study was twofold: first, to uncover a neurocognitive profile of normative and relative strengths and weaknesses that characterises an extremely vulnerable group of children with mild to borderline intellectual disabilities (MBID) and co-morbid psychiatric disorders, and second, to investigate the relevance of these neurocognitive functions explaining internalising and externalising symptoms.

METHOD

We recruited 45 children (M_age  = 9.5, SD_age  = 1.7; range 6-13 years) with MBID (Full-Scale IQ 50-85) and at least one psychiatric disorder. Neurocognitive functioning was examined utilising the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) indices and the Cognitive Task Application (COTAPP), a comprehensive computerised self-paced task designed in such a manner that 'g' (an overall tendency of children with MBID to execute tasks with a slower reaction time and a higher error rate) has been corrected for in the administration of the task (i.e. completely self-paced) and in the operationalisation of outcome measures. Behavioural problems were measured using the CBCL and TRF. One-sample t-tests and binomial tests were carried out to compare performance with normative data. Regression analyses were used to examine the relationship between neurocognitive parameters and mental health.

RESULTS

Compared with normative data, very small to very large effect sizes were found, indicating clear heterogeneity amongst neurocognitive domains relevant for children with MBID. Two prominent neurocognitive weaknesses emerged: processing speed - characterised by slowness and unstableness combined with a high drift rate and delayed processing of the previous trial, particularly under higher cognitive demands - and working memory - in terms of a weaker central executive and 'slave' systems to temporarily store information. Both domains were not clearly predictive of internalising or externalising problems.

CONCLUSION

Children with MBID and psychiatric disorders are hampered by a strongly diminished processing speed and working memory capacity, together resulting in an overall limited processing capacity that may underlie the general developmental delays on domains that depend on fast and parallel processing of information (i.e. language, reading, mathematics and more complex forms of social cognition). Neurocognitive vulnerabilities are neither necessary nor sufficient to explain internalising and externalising problems; rather, a mismatch between the support needs and adaptations these children need, arising from their diminished processing capacity, and the inadequacy of the environment to compensate for this vulnerability may be of relevance.

Feasibility of a Tablet-Based Program for Training Everyday Planning in Adolescents With Intellectual Disabilities

Background

Individuals with intellectual disabilities (ID) show difficulties with everyday planning. A tablet-based training program for everyday planning may be a suitable intervention, but its feasibility must be evaluated. This study evaluated how behavior changes during training and if individuals with ID can use technology by themselves.

Method

Thirty-three adolescents with ID and 30 younger children with a typical development were recruited. The participants were instructed to train in school for a total of 300 minutes. After the intervention, the participants were matched on mental age (MA).

Results

Only 16% of the participants trained for all 300 minutes. Participants in the MA group trained for a longer time than the ID group. Both groups made fewer errors per task at the end compared to the beginning. Individuals with ID started off making less attempts per task and increased their activity during the training. This pattern was not seen in the comparison group.

Conclusions

Both groups used the program independently, without adult supervision. However, a large group of participants in the ID group had a low usage time. Thus, the program might not have been feasible for that subgroup. The ID group increased their activity during the training which might mirror a strategy development of how to use the program. The change in behavior in activity on task attempts can be interpreted such that individuals with ID need a longer time to get familiarized with the technology. Tablet-based training programs are feasible for individuals with ID, but it is necessary to follow up on usage time.

Using Vocal Production to Improve Long-Term Verbal Memory in Adults with Intellectual Disability

Individuals with intellectual disability (ID) typically show weak long-term memory (LTM) skills. Understanding verbal LTM processes and searching for effective mnemonics in this population is important, to improve intervention programs. The current study aimed to assess verbal LTM abilities of adults with mild ID of mixed etiologies, and to offer a simple memorization technique based on vocal production. Participants (n = 55) learned lists of different study materials (images of familiar and unfamiliar objects, written words, and sentences) by vocal production (saying or reading aloud) or by no-production (looking, listening, or reading silently). Memory tests followed. Better memory was found for vocally produced images of familiar objects, written words, and sentences. The results show that adults with mild ID can benefit from the relative distinctiveness of items at study. Hence, vocalization may be used in educational and therapeutic contexts for this population, improving memory performance.

Verbal Working Memory Processes in Students With Mild and Borderline Intellectual Disabilities: Differential Developmental Trajectories for Rehearsal and Redintegration

In verbal working memory, two processes serve to retain a fading memory trace: subvocal rehearsal and lexical redintegration. While recent studies on students with mild and borderline intellectual disabilities (MBID) have yielded mixed results on rehearsal, redintegration has not been researched in MBID, yet. Furthermore, most studies have used a group-matched design which, due to methodological constraints, can only distinguish between two different development patterns. Thus, we study both rehearsal and redintegration in students with MBID using developmental trajectories that have greater potential for identifying differential developmental patterns than traditional group-matching approaches. We investigate whether three aspects in working memory develop differently in students with MBID in comparison to typically developing students: (a) the general capacity of the phonological loop, and the effectiveness of (b) rehearsal, and (c) redintegration. We use three different developmental indicators to compare trajectories: chronological age, cognitive capacity, and vocabulary size. N = 210 students (87 students with MBID, 123 typically developing students) completed working memory span tasks with short and long (1- vs. 3-syllable) real words and pseudowords. The effect for word length (short vs. long) measures rehearsal, and the lexicality effect (real words vs. pseudowords) measures redintegration. Results show that developmental trajectories reveal an intercept difference but no slowed rate in rehearsal, and no impairment in redintegration. However, concerning the developmental relation between redintegration and vocabulary size, students with MBID reveal a differential pattern as redintegration appears higher for students with small vocabulary size, but unexpectedly decreases as vocabulary size increases. We conclude that students with MBID show a delayed onset in the development of capacity of the phonological loop and rehearsal and that they do not catch up in their development. Redintegration does not seem to be impaired in relation to age and cognitive capacity. However, the differential relation of redintegration with vocabulary size calls for further research. While impaired subvocal rehearsal appears to be connected to the developmental problems of students with MBID, lexical redintegration seems to be intact in relation to chronological age and cognitive capacity, making it a possible area of strength.

Do children use different forms of verbal rehearsal in serial picture recall tasks? A multi-method study

Use of verbal rehearsal is a key issue in memory development. However, we still lack detailed and triangulated information about the early development and the circumstances in which different forms of rehearsal are used. To further understand significant factors that affect children's use of various forms of rehearsal, the present study involving 108 primary school children adopted a multi-method approach. It combined a carefully chosen word length effect method with a self-paced presentation time method to obtain behavioural indicators of verbal rehearsal. In addition, subsequent trial-by-trial self-reports were gathered. Word length effects in recall suggested that phonological recoding (converting images to names - a necessary precursor for rehearsal) took place, with evidence of more rehearsal among children with higher performance levels. According to self-paced presentation times, cumulative rehearsal was the dominant form of rehearsal only for children with higher spans on difficult trials. The combined results of self-paced times and word length effects in recall suggest that "naming" as simple form of rehearsal was dominant for most children. Self-reports were in line with these conclusions. Additionally, children used a mixture of strategies with considerable intra-individual variability, yet strategy use was nevertheless linked to age as well as performance levels.

Memory and linguistic/executive functions of children with borderline intellectual functioning

Children with Borderline Intellectual Functioning (BIF) have received a minimal amount of research attention and have been studied in conjunction with Intellectual and Developmental Disabilities. The present study intends to broaden the knowledge of BIF, by analyzing domains such as verbal memory and visual memory, as well as tasks that rely simultaneously on memory, executive functions, and language. A cross-sectional, comparison study was carried out between a group of 40 children with BIF (mean age = 10.03; 24 male and 16 female), and a control group of 40 normal children of the same age, gender, and socioeconomic level as the BIF group. The WISC-III Full Scale IQs of the BIF group ranged from 71 to 84. The following instruments were used: Word List, Narrative Memory, Rey Complex Figure, Face Memory, Rapid Naming (both RAN and RAS tests), and Verbal Fluency. The results showed deficits in children with BIF in verbal short-term memory, rapid naming, phonemic verbal fluency, and visual short-term memory, specifically in a visual recognition task, when compared with the control group. Long-term verbal memory was impaired only in older children with BIF and long-term visual memory showed no deficit. Verbal short-term memory stands out as a limitation and visual long-term memory as a strength. Correlations between the WISC-III and neuropsychological tests scores were predominantly low. The study expands the neuropsychological characterization of children with BIF and the implications of the deficits and strengths are stressed.