Program

May 23, 2017

OVERVIEW

Parents and Children Making Connections – Highlighting Attention (PCMC-A) is an eight week intervention intended to improve selective attention in lower socio-economic status preschool children, thereby improving their school readiness and eventual learning.  Selective attention has been found to play a key role in all aspects of learning and memory. PCMC-A combines training sessions for parents with attention training exercises for children. An experimental evaluation of children in Oregon Head Start programs found that participating in PCMC-A resulted in significant positive impacts on selective attention as well as on standardized measures of language and cognition for children in the treatment group, compared with those who did not receive the treatment. In addition, parent reports indicated improvements in children’s behavior, along with positive changes for the parents assigned to participate in PCMC-A. These improvements were observed relative to both a Head Start-alone control group and a contrasting intervention that was more child-focused.

DESCRIPTION OF PROGRAM

Target population:  Lower socio-economic status preschool children

Parents and Children Making Connections – Highlighting Attention (PCMC-A) is a family based training program designed to improve the academic readiness of lower SES preschool children by improving their ability to pay attention selectively.  The PCMC-A approach is based on evidence that supports the central role of selective attention in all aspects of learning and memory, and school readiness in particular, and also the key role that family context plays in supporting children’s attention development.  The eight week training program includes both a child-directed component and a family based, parent directed component. Meals and childcare are provided at each weekly session. The child-directed portion consists of eight 50-minute sessions held concurrently with the adult sessions, but in a separate room.  The child component includes a set of 20 small group activities, developed and tested with input from Head Start teachers, designed to increase self-regulation of attention and emotion states. Activities target aspects of attention including vigilance, selective attention, and task switching. Activities also focus on learning emotional vocabulary and practicing recognizing emotional states using the facial expressions and body language of others. The practice in emotional awareness is followed by strategies for emotional communication and self-regulation in periods of emotional saturation. The instructional model follows the developmental sequence of attention, age and individual-specific developmental needs, the role of teacher scaffolding in learning, and shifts from externally to internally-mediated behavior. Children alternate roles so that each child is both attending and distracting in each session. Over the eight weeks, activities increase in their difficulty and level of attention demands.

The parent component consists of training in small groups, with parents attending eight weekly, evening or weekend, two-hour classes.  The curriculum is adapted from the Linking the Interests of Families and Teachers (LIFT) curriculum developed at the Oregon Social Learning Center, which was developed as a universal conduct disorder prevention program and emphasizes parenting techniques. The adapted LIFT intervention consists of 25 strategies that address: family stress regulation with consistency and predictability, planning, and problem solving strategies; contingency-based discipline; parental responsiveness and language use with child; and facilitation of child attention through explicit instruction on the development of attention and links to attention training exercises we employ with their children. The importance of positive adult models and responsiveness for optimized adult-child interactions is underscored and the strategies emphasize parent awareness and self-initiated change. Parent training includes collaborative-learning instruction techniques, progressive instruction, and hierarchically structured role-playing activities. The small group format is employed to provide parents with social support and to permit parents to engage in active discussion concerning their success in implementing strategies with their children, as well as to engage in role-play practice of the strategies taught, with immediate feedback. In addition, parents receive information on the attention activities their children are participating in, with suggestions for home-based modifications to provide further practice. The instruction is supplemented with weekly support calls with parents to confirm the correct implementation of home-practice activities, clarify instruction points, and provide family-specific suggestions in response to parents’ experiences.

EVALUATION OF PROGRAM

Neville, H. J., Stevens, C., Pakulak, E., Bell, T. A., Fanning, J., Klen, S., Isbell, E. (2013). Family-based training program improves brain function, cognition, and behavior in lower socioeconomic status preschoolers.  Proceedings of the National Academy of Science, 110, 12128-12143.

Evaluated Population: One hundred forty-one lower socioeconomic status preschoolers enrolled in Head Start were randomly assigned to participate in PCMC-A, Head Start alone, or an active control group.  The participants were recruited from 11 preschool Head Start sites in Oregon. All children were monolingual, native English speakers living at or below the poverty level. Of the 87 percent of participating families that reported race/ethnicity, 62 percent were White/Caucasian, 4 percent Black/African American, 4 percent American Indian, and 17 percent reported more than one race/ethnicity. The average age of the participating children was 4.5 years.  Children taking psychoactive medications, with diagnosed behavioral or neurological syndromes, or with Individualized Family Service Plans were excluded.

Approach: A total of 174 three-to-five-year old children were recruited. Of these, 19 were dropped prior to random assignment because they did not meet the requirements of the study, were unable to complete pretesting, or withdrew consent. The children were randomly assigned to PCMC-A, Attention Boost for Children (ABC), and Head Start alone (HS-alone) groups. After random assignment, six families withdrew from the PCMC-A group, five from the ABC group, and three from HS-alone group, due to health problems, moving out of town, or unresponsiveness to further contacts. The final sample totaled 141 children, with 66 in PCMC-A, 38 in HS-alone, and 37 in ABC.

Children in the HS-alone comparison group attended their regular half-day HS classes, which do not include any child attention training components. HS has a limited parent education component at the sites where this study was conducted.

The ABC program included many aspects of the PCMC-A, but placed more emphasis on the child component. Child sessions lasted 40 minutes/day, four days per week, for eight weeks, and were held as pullout sessions during the regular HS day.  During the eight week program, parents received three small group sessions and four support phone calls in alternating weeks. Although the parent component of ABC included all of the same strategies as PCMC-A, it did not allow for the same degree of in-depth instruction. The parent sessions lasted 90 minutes and were held in the evening or on weekends, with family dinner and childcare provided. Families received $150 for participation in the study ($50 at the completion of pretesting and $100 at the completion of post-testing).

While teachers could not be kept blind to the children’s random assignment condition, as children in the ABC group were pulled out during class time to receive the intervention, they were not informed about other children’s participation or group assignment. All study procedures were approved by the University of Oregon Institutional Review Board and informed consent was obtained from all parents. There were no significant differences between groups in age, parental education, or gender distribution.

Assessments were conducted at baseline and after the eight-week intervention. The primary outcome measure was a neural measure by electroencephalography (EEG) of selective attention, using Event Related brain Potential (ERP), which assesses the earliest stages of sensory processing affected by selective attention (within 100 ms).  The children were cued to attend selectively to one of two simultaneously presented stories differing in location (left/right speaker), narration voice (male/female), and content. ERPs were recorded to 100 msec probe stimuli embedded in stories. Half of the probe stimuli were linguistic (a syllable) and half were non-linguistic: the linguistic probe was the syllable /ba/ and the non-linguistic probe was a broad-spectrum ‘buzz’. With redundant attention cues and engaging stories, children as young as three years old can successfully attend selectively to one story and the effect of this selective attention is an increase in the mean amplitude of the neural response at 100 msec to probes embedded in stories.  This neural response can be detected by EEG.

In practice sessions, the children were introduced to the two voices and the sounds of the probe stimuli. The children received instruction on attending to a single story while ignoring the distracting story presented in the opposite audio channel. A researcher, blind to the children’s treatment status, sat next to each child at all times to monitor behavior, ensure the child remained equidistant between the two speakers and did not turn to face one of the speakers, and administer comprehension questions following each story. A camera transmitted the session so other researchers and the caregiver(s) could observe.

Within a session, children attended to a total of four narratives. Each attended story was read by a different narrator (two male / two female), with children attending twice to the story on the right side and twice to the story on the left side. For each participant, the same narrators occurred in both the attended and unattended position within a session (narrating different stories), and children attended to the same voices (but different stories) from pre-test to post-test. All test conditions were balanced across the three intervention groups, and identical probe stimuli were used in all sessions.

After each story, the experimenter asked the child three basic comprehension questions about the attended story, each question with at least two alternative answers. These questions were designed to reinforce to the child the goal of paying careful attention to a single story. As a criterion for inclusion in data analysis, all children answered a minimum of six questions correctly at baseline and at post-test.

The electroencephalogram (EEG) for each child was recorded from 32 scalp channels. Electrodes were also placed horizontally next to each eye and beneath the right eye in order to monitor eye movements and blinks.

Children were also assessed using a standardized assessment battery including nonverbal intelligence quotient (IQ) using the Stanford-Binet 5th Edition (SB-5) nonverbal IQ scale, receptive language using the Clinical Evaluation of Language Fundamentals – Preschool 2nd Edition (CELF-P:2), and pre-literacy skills using the Preschool Individual Growth and Development Indicators by testers blind to children’s experimental group.  The children were further assessed by parent and teacher reports of the children’s social skills and problem behaviors using The Preschool and Kindergarten Behavior Scales – Second Edition (PKBS-2). Parent assessments consisted of self-reports of parenting stress levels, and parenting confidence and ability using Parent Daily Report (PDR). In addition, a 7-minute video recording was taken of a play dyad between parent and child to quantify four aspects of parent–child interaction: parents’ turn-taking in conversation, lexical diversity, language modeling, and mean length of utterance.

Results: The study found that only children who participated in the PCMC-A group showed significant changes in their neural response to attended stimuli after training, compared with children in both the HS-alone group and the ABC group. The study found that children who participated in PCMC-A made significantly greater gains in nonverbal IQ scores, compared with children in the HS-Alone group (Effect Size d=0.40) and those in the ABC group (d=0.38).  Similarly with receptive language scores, those children who participated in PCMC-A showed significantly greater gains, compared with those in the HS-Alone group (d=0.22) and the ABC group (d=0.22).  The study also found that parents in the PCMC-A group reported significantly greater improvements in their preschoolers’ social skills, compared with HS-alone parents (d=0.34) and ABC parents (d=0.35).  The study found that for children who participated in PCMC-A, parents reported significantly greater decreases in their children’s problem behaviors, compared with HS-alone (d=-0.26) or ABC parents (d=-0.39). Teacher reports followed the same pattern, but did not show statistically significant differences between groups.

The study found that parents who participated in the PCMC-A group reported significantly reduced parenting stress, compared with those in the HS-alone group (d=-0.41). PCMC-A parents also showed favorable changes in language and interaction patterns during the parent–child play session; after the training period, PCMC-A parents had more balanced turn-taking interactions, compared with parents in both the HS-alone and ABC groups.

SOURCES FOR MORE INFORMATION

References

Neville, H. J., Stevens, C., Pakulak, E., Bell, T. A., Fanning, J., Klen, S., Isbell, E. (2013). Family-based training program improves brain function, cognition, and behavior in lower socioeconomic status preschoolers.  Proceedings of the National Academy of Science, 110, 12128-12143.

Supplementary Information: Family – based training program improves brain function, cognition, and behavior in lower socioeconomic status preschoolers, available from http://www.pnas.org/content/suppl/2013/06/26/1304437110.DCSupplemental/sapp.pdf

KEYWORDS: Children (3-11), Preschool, Males and Females (Co-ed), School-based, Parent or Family Component, Parent Training/Education, Academic Achievement/Grades, Social Skills/Life Skills

Program information last updated on 5/23/2017.

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