It consisted of ten min sessions. The authors showed a significant improvement of the memory span. This study showed a significant improvement of the average memory span. With this strategic approach, Bussy et al.
Hand Function in the Child: Foundations for Remediation, Second Edition
Finally, improvements were observed in the verbal short-term memory of 33 children suffering from fetal alcohol syndrome In the field of meta-memory, Kendall et al. This group showed higher scores than the control one as far as recalling items were concerned. This program is used in groups and aims at teaching metacognitive strategies anticipation, planning, and control and more specific strategies helping, for example: to better use working memory so as not to overload memory.
DELF proved to be effective with teenagers suffering from intellectual disability when associated with a regular teaching program Within this experimental group, inductive thinking abilities were improved. Few studies focus on the use of virtual reality for the treatment of people with intellectual disabilities Rose et al. Handling a joystick enabled the subjects to better memorize the environment visuospatial data. Thus, development of virtual reality programs would enable patients to improve their visuospatial abilities. Galbiati et al.
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The program used targeted attentional abilities by using metacognitive strategies. Visuospatial ability refers to the capacity to identify visual and spatial relationships among objects. How subjects imagine objects, perceive global shapes, and how they locate small components or understand the similarities and differences among objects are major cognitive functions. Visuospatial and visuoperceptual skills play a key role in everyday life. Visual information and complex visual stimuli are analyzed with a complete unawareness of the visuoperceptual process or the complexities of the stimuli involved.
This process becomes conscious in a context of learning. Repetition and familiarity enable a more spontaneous approach and turn the conscious and effortful process into an automatic one. If this ability is impaired, many types of deficits can occur, ranking from a failure to process the basic elements of a visual stimulus i. These deficits can include social cognition defects, especially in the area of facial emotion recognition.
Impairments in this field may largely underlie social dysfunctions and reduce adaptive skills.
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Moreover, social cognitive disabilities contribute more or less directly to behavioral disturbances and psychiatric symptoms e. Yet, depressive and anxious symptoms are often found in children with intellectual disabilities 31 , Behavioral and psychiatric symptoms are also correlated to intellectual disability in adults, as shown by Deb et al.
Children with externalizing behavioral problems provide aggressive responses to hypothetical vignettes more spontaneously than children with intellectual disability without any behavioral problems Cognitive dysfunctions explain the hardship children encounter in the treatment of social information Indeed, social cognition dysfunction appears like a core symptom The theory of mind and facial emotion recognition seem to be central for social adaptation to the environment As far as social cognition is concerned, the facial emotion recognition is well documented.
Children with intellectual disability fail to recognize and match emotional facial expressions from a series of photographs depicting various facial expressions This deficit is correlated with an abnormal behavior 40 and underlain by visuospatial and attentional deficits This approach would complete the methods already available. Thus, neurocognition, social cognition, as well as metacognition are routinely evaluated.
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The exercises of the attentional and visuospatial modules were selected in the SBT software database. First, the selected exercises were proposed to children with normal cognitive functioning in order to appreciate the technical feasibility. Second, each exercise was adapted levels one to nine in order to be proposed to children with intellectual disability.
The third step was the development of a facial emotion recognition task. Therapists make use of techniques known to benefit the rehabilitation of cognitive syndromes. This new cognitive remediation program was elaborated with two main goals in mind. A complete and detailed neuropsychological assessment prior to the cognitive remediation treatment seems necessary This evaluation will also determine the severity of the impairments and their impact on everyday life.
Currently, consensus lacks concerning attentional and visuospatial evaluations, so they reflect the heterogeneity of the performances. This assessment must help establish the global degree of intellectual disability by using standardized tools such as the Wechsler scales. In intellectual disability, the IQ is most often evaluated without a thorough evaluation of the different cognitive domains.
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However, a detailed cognitive assessment is necessary to establish a detailed neuropsychological profile by identifying the cognitive impairments and also the preserved abilities of the person. In the first part of this session, the therapist, the parents and the child go through the previously administered assessment together. The last session of the preparation phase provides psychoeducation via two specific documents.
A specific comic strip has been elaborated for children explaining the main goals of attentional and visuospatial functions Appendix 1 in Supplementary Material. Then, 16 1-h-sessions of cognitive remediation with the therapist are proposed, each session is composed of three parts:. Each of the 16 sessions deals with a specific attentional and visuospatial stimulation. The computer-based tasks are ranked in increasing order of difficulty, with nine levels of complexity.
Similarly, pen-and-paper exercises will help the child to develop compensatory strategies when it comes to visuospatial or attentional tasks. The rhythm is progressive, as must be the difficulty of each exercise. This exercise was developed in order to establish a concrete link between visuospatial functions and facial emotion recognition. The drawings are designed in order to encourage the person to focus on the eyes.
People with intellectual disabilities often study the mouth area to recognize emotions. The strategy developed in this tool will help children determine an emotion by using relevant information. By highlighting the eye area, the strategy can be automated by the child. Six universal emotions are represented without neutral condition : happiness, fear, anger, disgust, surprise, and disgust.
Mediation by a therapist is one of the key factors to the success of psychological treatment.
Individual care helps maintain the collaboration over time between the child and the therapist. Verbalization plays an active part in the training of a new strategy. The therapist helps the child find sense when a problematic situation arises. The development of the new skills will be transferred to daily life. The structuration of the sessions is required in order to help the child deal with the notion of delay and waiting.
This can be done by presenting the program of each session at the beginning and by estimating the time to be spent on each task. After each task, the therapist will remark on the time spent on the exercise to improve the perception of chronological indicators. Children with an intellectual disability will find it easier to transfer memory strategies to daily life when it has been explicitly verbalized during the cognitive remediation sessions The cognitive remediation session with the therapist finishes with a proposal of a home task.
Exercises take into account both the level of performance of the child, the collaboration of the parents, and are related to the concrete objectives defined at the beginning of the therapy. The outstanding idea of the program is to establish a weekly link between cognitive remediation and daily life. For example, at the beginning of the therapy, it could be suggested that the child should shop at the local supermarket and find a given item in a department.
Later, specific attentional and visuospatial home tasks can be proposed to the child and analyzed with the parents and the therapist. Finally, tasks such as the planning of a daily route can be suggested. Home exercises are useful to promote the transfer of strategies to daily life and their subsequent automation. This is consistent with learning theories. Indeed when cognitive remediation is reinforced in real-world settings, the learning process is facilitated and then generalization and transfer are promoted The child and the therapist will go through the home task together at the beginning of the next remediation session.
In order to promote motivation during the home task, the use of a personalized exercise book allows a concrete weekly evaluation of the degree of achievement of the task.