Does Enhancing Visual Perception in Mild Intellectually Disabled Children transfer to other skills?

Abstract

This work examines the effectiveness of two training programs (teacher-assisted versus computer-based) to enhance the visual perception of mild intellectually disabled children native Arabic children in Egypt. Subjects were randomly assigned to three groups: control group with treatment as usual (n=12), traditional/teacher-assisted training (n=12) and a computerized training (n=12). Groups were matched for socio-demographic variables controlling for age, gender, and the education of parents. The success of the different training procedures was evaluated by Frosting Developmental Test of Visual Perception and its transfer to other skills in the same modality (List of Reading Readiness Skills) and general improvement in cognitive abilities (The Stanford-Binet Test). Both programs significantly improved performances of the experimental groups compared to the control group. Yet, no significant differences were found between the two active training groups, suggesting that a computerized trainings may be an option to assist challenged children, particularly when there are no specialized teachers available for the highly time consuming trainings. These findings are discussed in terms of neurological plasticity as well as recommendations for integrated training programs.

Keywords: Visualtrainingmild retardationreadingIQ

Introduction

Mental dysfunctions may be aggravated by impaired perceptual functions such as problems in visual discrimination, especially during decisive developmental periods. Comparing normally developing children to intellectually disabled children showed that the latter were significantly more limited in their production of perceptual skills. To illustrate, they perform significantly worse in tasks of visual perception, motor-visual co-ordination, fine motor skills, visual memory and in visual matching and visual discrimination subtests (e.g., Aki & Atasavun, 2008). Substantial evidence indicates that deficient visual perceptual skills in intellectually disabled children could be enhanced by teacher-assisted training programs (Rice, 1967; Silverstein, 1964) and, later, by a computerized training (Fox, 1998; Lynch, 2002; Moreno& Saldan, 2005).

While traditional training procedures require significant human resources, more computer softwares have been developed to both assess and enhance perceptual deficiencies (Hall& Cope, 1995; Tam et al., 2005). For instance, Bice (1995), Green (1995), and Loar (1992) pointed out that, using computers as an instructional tool sustains the attention of children and provides both consistent auditory and visual reinforcement. In a recent study, Poon, Li-Tsang, Weiss & Rosenblum (2010) showed that visual perception and visual-motor integration computerized training appeared to be effective in improving the handwriting in children with respective motor difficulties. Computerized training programs provide not only cognitive and perceptual training especially for visual, auditory and motor difficulties, but may be designed to present immediate and highly contingent visual or auditory feedback (Cardona, Martinez, & Hinojosa, 2000; Li-Tsang et al., 2005), a type of reinforcement that may be particularly beneficial for the young or challenged. In addition, it has been argued that computerized intervention programs may reduce cognitive deficits (Lynch, 2002; Tam. et al., 2005) and stimulate neuroplastic modifications that – if the right software is employed - can be adaptive.

In the current study, two training programs (teacher assisted × computerized) were used to enhance the visual perception of mild intellectually disabled children. Also, the potential transfer of the training to other skills from the same modality was investigated. While evidence showed mentally handicapped have deficiencies in visually perceptual processes, the effectiveness of training programs to enhance these deficiencies remains under-explored.

Research Questions

1- What is the effect of two different training programs on the visual perception skills of the mild intellectually disabled children?

2- Could the training be transferred to other skills in the same modality?

Purpose of the Study

The purpose of this study was to examine the effectiveness of using two different training programs, namely a computerized and a teacher-assisted in enhancing the visual perception of educable mentally retarded children.

Research Methods

Findings

The statistical analysis was carried out using SPSS 21 and STATISTICA6 for Windows. The accuracy percentage has been calculated for each skill. A repeated measure ANOVA was, then, calculated for the skills of visual perception across time, using the general linear model with VISUAL PERCEPTION (Eye Motor Coordination, Figure Ground, Constancy of Shape, Position in Space, and Spatial Relationships.) and TIME (Pre-test, Post-test) as within factor, and GROUP (Control, traditional training, computer training) as between subjects’ factor. Bonferonni Post hoc-analyses revealed that both the traditional/teacher-assisted and the computerized training group performed significantly better than the control group in all the post-tests of visual perception skills (Bonferroni p<0.001). Further, only the teacher-assisted training group and the computer training (brain fitness program) performed significantly better in post-tests than in pre-tests (Bonferroni p<0.001), but not the control group (TAU). Interestingly, no significant differences were found between the two active training groups in any of the tests for the visual perception skills (Fig.1).

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Results showed a strong and highly significant improvement of test scores across time (pre to post-training) for the two active treatment groups with little changes for the control group, which gave rise to the interaction TIME × GROUP [(F (2, 33) =158.55, p<0.001 and to a main effect for TIME (Pre-Post) [(F (1,33) =76.91, p<0.001], and GROUP [(F (2,33) =35.68, p<0.001]. The effects VISUAL PERCEPTION SKILLS [(F (4, 132) =72.99, p<0.001], TIME x VISUAL PERCEPTION SKILLS [(F (4, 132) =23.91, p<0.001], and an interaction effect of TIME x VISUAL PERCEPTION SKILLS x GROUP [(F (8, 132) =5.77, p<0.001] indicated the specificity of training.

Further, a repeated measure ANOVA was calculated for Reading readiness and IQ independently across time. TIME (Pre-test, Post-test) served as within factor, while GROUP (Control, traditional training, computer training) served as the between subjects’ factor. For Reading readiness, results showed a significant effect for TIME (Pre-Post) [(F (1, 33) =359.41, p<0.001], GROUP [(F (2, 33) =46.87, p<0.001], TIME×GROUP [(F (2, 33) =90.76, p<0.001]. Bonferonni post hoc-analyses revealed that both the traditional and the computer training group significantly outperformed the treatment as usual control group in the post-tests (Bonferroni p<0.001). Again, no significant differences were found between the two active training groups in the post tests of reading readiness skills (Fig.2a). Even for IQ, results produced a significant effect for TIME (Pre-Post) [( F (1, 33) =127.59, p <0.001], GROUP [( F (2, 33) =4.32, p <0.05], TIME× GROUP [( F (2, 33) =24.60, p <0.001]. Only the two active training groups performed significantly better in post-tests than in pre-tests (Bonferroni p <0.001), but not the control group. As with the more specifically trained abilities, no significant differences were found between the traditional, teacher-assisted training group and the computer-training group in IQ post-tests (Fig.2b).

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Moreover, correlations between the psychometric measures after the intervention in the whole cohort are presented in Table 3 . The substantial positive correlations between post-tests of visual perception and reading readiness skills and IQ ranged from .57-.81, p < 0.01. Also, significant positive correlations were found between reading readiness skills and IQ.

The scatter plots in Figure 3a and 3b illustrate the relation between changes of scores (Delta) in visual perception, reading readiness skills and IQ. Obviously, enhancing visual perception helps to enhance both reading readiness skills and IQ.

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Finally, to investigate the long-term effects of the training program, we applied a repeated measure ANOVA for visual perception, reading readiness and IQ independently across time. TIME (Post-test, Follow- up test) served as within factor, while GROUP (traditional training, computer training) served as the between subjects’ factor. For visual perception and the list of reading readiness skills accuracy percentage has been calculated. For Reading readiness, results showed a significant effect for TIME (Pre-Post) [( F (1, 33) =359.41, p <0.001], GROUP [( F (2, 33) =46.87, p <0.001], TIME× GROUP [( F (2, 33) =90.76, p <0.001]. Bonferonni Post-hoc analyses revealed that both the traditional and the computer training group performed significantly better than the control group in the post-testing of reading readiness skills (Bonferroni p <0.001). Furthermore, only the traditional training group and the computer training performed significantly better in posttests than in pretests (Bonferroni p <0.001), but not the control group. Interestingly, no significant differences were found between the two active training groups in the post tests of reading readiness skills. For visual perception, results showed a significant effect for TIME (Post-Follow Up) [( F (1, 22) =5.63, p <0.05], but no significant effects were found for GROUP×TIME [( F (1, 22) =3.52, p =0.56]. No significant results were obtained for reading readiness or IQ.

Conclusions

The present study indicates that a considerable gain in specific skills and, with it, in general functioning can be achieved in mild intellectually disabled within a limited time period of intensive training. It is noteworthy, but not too surprising that the specific skills translate into enhanced reading skills and IQ. Substantial correlations between the specialized visual tests and the more complex reading ability and IQ have been reported earlier. For example, classical studies as Allen, Haupt & Jones (1965) investigated the correlates of visual perceptual functions and the mental efficacy (IQ) in a group of educable challenged children. Results showed that those children’s scores of Wechsler’s IQ test highly correlate with their scores on the visual perception test. Also, our results go in line with Shinkfield, Sparrow & Day (1997) showing that compared to normally developing children, intellectually disabled children have difficulties in visual perception as measured by both motor reproduction and visual discrimination abilities. There is a consensus that visual perception deficits may contribute to mental retardation (Groß-Selbeck, Dietze , Mau & Gutezeit, 1974; Fidler, Most & Guiberson, 2005).

Moreover, results showed that visual perception positively correlates with reading readiness. This was previously supported by results showing that visual perception is a good predictor of children’s reading level and their readiness to read (e.g., Sortor and Kulp, 2003). Importantly, studies on Semitic scripts showed predictive correlations between both visual and verbal ability and reading. This is might be attributed to complexity of the Semitic orthographies as they demand the manipulation of visual word recognition strategies and visuo-spatial processing to manipulate changes in letter shapes in a word (Myler & Breznitz, 1998; Abu-Rabia & Taha, 2004; Mohamed, Elbert & Landerl, 2011)

The current study reveals significant and clinically substantial effects for both, the traditional, teacher-assisted and the computerized training as compared to the control group. A number of early studies showed that the traditional training may enhance visual perception skills in the intellectually disabled (Hall& Deacon, 1970; Walsh& Dangelo, 1971; Forgnone, 1976). However, others could not obtain significant benefits (Wiederholt & Hammil, 1971; Kavale, 1984). Traditional training has included various skills such as guided drawing of curved and straight lines followed by unguided drawing, colouring both figure and background, identifying similar figures recruited from real life setting of children, which accordingly contributed to enhancing visual perception skills. The outcome of the traditional training procedures may, thus, depend on the particular exercises in conjunction with the skills of the trainers to motivate the children. On the other hand, the computerized training program does not take into account the personality of the child, but consider abilities of the child. Moreover, they can be programmed to consistently reward the child in a very consistent manner. The present results confirm previous findings showing that computer based training programs could enhance visual perception skills in intellectually disabled children (Dube, Moniz& Gomes, 1995). Specifically speaking, the InSight software was developed on the bases of findings on neuroplasticity. Therefore, the obtainable improvements could obviously be as large as the achievements of experienced and highly motivated teachers using the best forms of traditional training. In a research study, where the outcome is carefully monitored, the motivation of the trainers may be particularly high, and trainers were ambitious. This enthusiasm may be more varied in daily practice where the continuous training of intellectually disabled children may be demanding and tiring. According to Lynch (2002), one of the essential steps that determine the efficacy of computer based training programs is to design them such that they reorganize lesioned or otherwise dysfunctional cognitive circuits and improve the fidelity of the respective processing units. For instance, Insight speeds up and sharpens the brain’s visual system by encouraging faster, clearer communication step-by-step in along the hierarchy of the two visual processing streams, and thus trains the brain to process visual information more accurately. By improving visual processing, Insight improves a fundamental root of memory and other cognitive functions, helping intellectually disabled feel sharper and, accordingly, enhances their visual skills. It is worth noting that InSight presents a variety of visual and auditory stimuli through its different tasks such as Bird Safari , Jewel Diver , and others which helped to attract the attention of basically all children and keeps them motivated to participate in the training sessions. Moreover, using the mouse may enhance the visual motor coordination skills. In addition the program was characterized by the following: 1) assessing the preliminary level of the intellectually disabled child, 2) assessing the progress across training sessions, 3) providing individualized training that allows to continuously adjust the task levels to the child’s performance, promoting development of each individual with his own pace.

Moreover, results showed that each experimental group significantly outperformed the control group in the reading readiness. These are in agreement with previous studies showing that the readiness to read could be improved by training more basic visual perception processes (Cardozo & Allen, 1975; Fidler; Most & Guiberson, 2005; Wallbrown; Wallbrown & Engin, 1974; Wiederholt & Hammill, 1971). The reading skill starts with children being attracted to visual stimuli in magazines and picture books and is developed by training the eyes to trace and recognize the sequence of words in texts. Also, developing reading readiness includes skills such as perceptual discrimination, i.e., their ability to distinguish similarities and differences between objects. These skills are to be enhanced by the processing of visual materials and visual aids. As for the traditional training program, it was based on skills as eye-hand coordination, moving from right to left, figure copying, which accordingly, contributes to the enhancement of reading readiness of the experimental group. In the computerized training, children were trained to hold the mouse, pointing to the different positions of the visual stimuli, which positively sharpened their vision scope, and helped their eyes to follow the words later from right to left which is a requisite to read the Arabic language and rapidly recognize them and this contributed to enhancing reading readiness of the experimental group.

Finally, some improvements in the trained skills were expected, its substantial size, however, demonstrates considerable potentials for improvements in disabled children. To illustrate, although the scores of the Stanford-Binet IQ increased from pre- to post-tests in both experimental groups as opposed to the control group, the scores remained still in the very low range and did not indicate a higher mental age. However, it should also be noted, that these changes were observed in response to a compact training, limited in time.

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