Evaluating methodology for assessing and training attention for youth with neurodevelopmental conditions using multiple object-tracking

The challenge in measuring and training attention is demonstrated by the cognitive construct’s divergent definitions and hierarchical nature. This program of research argues that a measure of an individual’s ability to complete everyday tasks and learning capability can serve as a functional assessment of attention. Specifically, Attention Resource Capacity (ARC), or an individual’s capability to allocate attentional resources from their limited reserve to relevant information while suppressing the allocation of resources to irrelevant information, is typically associated with competency. Thus, the foundation of this dissertation is based on repurposing the traditional Multiple Object-Tracking (MOT) paradigm to (i) characterize the attention-learning dynamic across deficits in attention, learning, and intelligence as well as (ii) improve attention in youth with neurodevelopmental conditions (NDC). Manuscript 1 (Chapter 2) examines the use of the MOT task as a descriptor of individual differences in ARC and learning for youth diagnosed with an NDC. Parameters within a linear trajectory, consisting of day 1 performance as the intercept and the rate of change across fifteen repeated practice sessions as the slope, were conditioned as a function of diagnosis-specific deficits in attention (i.e., ADHD), learning (i.e., Specific Learning Disorder; SLD), and intelligence (i.e., Intellectual Developmental Delay; IDD). Individuals with an IDD diagnosis demonstrated decreased baseline MOT capability (i.e., decreased ARC), whereas participants with ADHD and/or SLD diagnosis exhibited a decreased rate of change in MOT capability (i.e., decreased learning capability; N = 101). The MOT paradigm’s ability to define and isolate condition-specific differences in ARC and learning demonstrates its potential to train attention. Manuscript 2 (Chapter 3) evaluates the feasibility to conduct a school-based, randomized controlled (RCT) trial assessing MOT’s capability to improve attention in youth diagnosed with an NDC (N = 129). The results suggested that training on a specific, accurate, adaptable and accessible task, such as MOT, is feasible in a school-setting and provides preliminary evidence of efficacy. Here, an improvement on the non-trained, objective, and clinically validated targeted outcome measure (i.e., Conners Continuous Performance Task; CPT-3) was exclusive for those training with MOT compared to passive and active controls. Finally, Manuscript 3 (Chapter 4) evaluates the efficacy of training attention with MOT, using the gold-standard, randomized controlled crossover trial (RCCT) design (N = 96). The results demonstrate an improvement in CPT-3 performance for those training on MOT; that is, before and after the crossover. In addition to replicating the results of the aforementioned feasibility study (Manuscript 2), Manuscript 3 provides evidence of efficacy for MOT training to improve attention. The approach and design used in the study exemplify the significance of experimental and methodological considerations needed to reconcile the inconsistency in the field of cognitive training. The findings from the dissertation advocate for the use of the MOT paradigm as an accessible and effective platform to both assess and improve attention in youth diagnosed with an NDC. Whereas more research is necessitated to further parse the unexplained variance exhibited across the diverse atypically developing population evaluated, a discussion of areas of opportunity to further the current work outlines the need for mechanistic and effectiveness studies. Taken together, the evaluation of viability, feasibility, and efficacy of assessment and intervention-based protocols, conducted in real-world settings, and with a population typically underserved and underrepresented in research, will advance the field of research and offer methods to improve the quality of life for individuals with attention-related challenges

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