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Background Although perceptual interventions focus on sensory and cognitive skills, they significantly enhance the effectiveness of motor interventions by improving coordination, decision-making, and overall engagement in physical activities. A comprehensive literature review has demonstrated that incorporating perceptual interventions into motor exercises is beneficial. While there are several treatment strategies for SLD-diagnosed children, the potential role of goal-directed perceptual-motor exercises has not been studied. This study examined the effectiveness of goal-directed perceptual-motor training on attention, motor skills, and quality of life in children with Specific Learning Disorder (SLD). Methods This was a randomized clinical study with 38 children diagnosed with SLD between September 2021 and April 2022. The control group ( n  = 19) received a standard intervention protocol, and the intervention group ( n  = 19) additionally received a perceptual-motor training program. Bourdon Attention Test, the Bruininks-Oseretsky Test 2–Short Form (BOT2- SF), and the Pediatric Quality of Life Inventory (PEDSQL) were used as outcome measures. Results The intervention significantly improved attention, fine and gross motor skills, and life quality as evidenced by the within- and between-group comparisons at the end of therapy. Conclusions Goal-directed perceptual-motor physical training with cognitive aspects may enhance academic performance, social participation, and life quality for children with SLD by improving basic motor skills. Therefore, the inclusion of physical and task-specific perceptual-motor exercises in educational programs may offer several avenues for cognitive skill development in SLD children. Trial registration The protocol is retrospectively registered with http://clinicaltrials.gov/ (16/August/2023, Clinical Trial, NCT05998083).

Virtual reality (VR) refers to an advanced technological communication interface in which the user is actively participating in a computer-generated 3-dimensional virtual world that includes computer sensory input devices used to simulate real-world interactive experiences. VR has been used within psychiatric treatment for anxiety disorders, particularly specific phobias and post-traumatic stress disorder, given several advantages that VR provides for use within treatment for these disorders. Exposure therapy for anxiety disorder is grounded in fear-conditioning models, in which extinction learning involves the process through which conditioned fear responses decrease or are inhibited. The present review will provide an overview of extinction training and anxiety disorder treatment, advantages for using VR within extinction training, a review of the literature regarding the effectiveness of VR within exposure therapy for specific phobias and post-traumatic stress disorder, and limitations and future directions of the extant empirical literature.

We examined whether problem-solving and diabetes self-management behaviors differ by depression diagnosis – major depressive disorder (MDD) and minor depressive disorder (MinDD) – in adults with Type 2 diabetes (T2DM). We screened a clinical sample of 702 adults with T2DM for depression, identified 52 positive and a sample of 51 negative individuals, and performed a structured diagnostic psychiatric interview. MDD (n=24), MinDD (n=17), and no depression (n=62) were diagnosed using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria. Health Problem-Solving Scale (HPSS) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaires determined problem-solving and T2DM self-management skills, respectively. We compared HPSS and SDSCA scores by depression diagnosis, adjusting for age, sex, race, and diabetes duration, using linear regression. Total HPSS scores for MDD (β=−4.38; p<0.001) and MinDD (β=−2.77; p<0.01) were lower than no depression. Total SDSCA score for MDD (β=−10.1; p<0.01) was lower than for no depression, and was partially explained by total HPSS. MinDD and MDD individuals with T2DM have impaired problem-solving ability. MDD individuals had impaired diabetes self-management, partially explained by impaired problem-solving. Future studies should assess problem-solving therapy to treat T2DM and MinDD and integrated problem-solving with diabetes self-management for those with T2DM and MDD.

Placebo effect represents a serious confounder for the assessment of treatment effect to the extent that it has become increasingly difficult to develop antidepressant medications appropriate for outperforming placebo. Treatment effect in randomized, placebo‐controlled trials, is usually estimated by the mean baseline adjusted difference of treatment response in active and placebo arms and is function of treatment‐specific and non‐specific effects. The non‐specific treatment effect varies subject by subject conditional to the individual propensity to respond to placebo. This effect is not estimable at an individual level using the conventional parallel‐group study design, since each subject enrolled in the trial is assigned to receive either active treatment or placebo, but not both. The objective of this study was to conduct a comparative analysis of the machine learning methodologies to estimate the individual probability of a non‐specific treatment effect. The estimated probability is expected to support novel methodological approaches for better controlling effect of excessively high placebo response. At this purpose, six machine learning methodologies (gradient boosting machine, lasso regression, logistic regression, support vector machines, k‐nearest neighbors, and random forests) were compared to the multilayer perceptrons artificial neural network (ANN) methodology for predicting the probability of individual non‐specific treatment response. ANN achieved the highest overall accuracy among all methods tested. A fivefold cross‐validation was used to assess performances and risks of overfitting of the ANN model. The analysis conducted without subjects with non‐specific effect indicated a significant increase of signal detection with significant increase in effect size.

Background For exposure therapy to be successful, it is essential that fear extinction learning extends beyond the treatment setting. d‐Cycloserine (DCS) may facilitate treatment gains by increasing generalization of extinction learning, however, its effects have not been tested in children. We examined whether DCS enhanced generalization of fear extinction learning across different stimuli and contexts among children with specific phobias. Methods The study was a double‐blind placebo‐controlled randomized controlled trial among dog or spider phobic children aged 6–14. Participants ingested either 50 mg of DCS (n = 18) or placebo (n = 17) before receiving a single prolonged exposure session to their feared stimulus. Return of fear was examined 1 week later to a different stimulus (a different dog or spider), presented in both the original treatment context and an alternate context. Avoidance and fear were measured with Behavior Approach Tests (BATs), where the child was asked to increase proximity to the stimulus while reporting their fear level. Results There were no differences in BAT performance between groups during the exposure session or when a new stimulus was later presented in the treatment context. However, when the new stimulus was presented in a different context, relative to placebo, the DCS group showed less avoidance (P = .03) and less increase in fear (P = .04) with moderate effect sizes. Conclusions DCS enabled children to better retain their fear extinction learning. This new learning generalized to different stimuli and contexts.

This pilot study investigated the efficacy of a game-based cognitive training program ( Caribbean Quest ; CQ) for improving attention and executive function (EF) in school-aged children with Autism Spectrum Disorder (ASD). CQ is a ‘serious game’ that uses a hybrid process-specific/compensatory approach to remediate attention and EF abilities through repetitive, hierarchically graded exercises delivered in an adaptive format. Game-play is accompanied by instruction in metacognitive strategies delivered by an adult trainer. Twenty children diagnosed with ASD (ages 6–12 years) completed 12 h of intervention in schools over 8–10 weeks that was facilitated by a trained Research Assistant. Pre-post testing indicated near transfer gains for visual working memory and selective attention and far transfer effects for math fluency. Exit interviews with parents and school staff indicated anecdotal gains in attention, EF, emotion-regulation, flexibility, communication, and social skills. Overall, this study provides preliminary support for the feasibility and potential efficacy of the CQ when delivered in schools to children with ASD.

Purpose This study extends the research on narrative intervention by evaluating the effect of a standard treatment protocol, (Petersen & Spencer, 2012), on personal narrative generations of school-age children with specific language impairment (SLI). Method Four second-grade, 8- to 9-year-old boys with SLI participated in this multiple baseline across behaviors, single-case design study that was repeated across participants. Each one-on-one intervention session involved eight steps across two intervention segments: story retell and personal story generation. The interventionist provided systematic scaffolding (visual and verbal supports) that was faded within each session. Three individualized story grammar elements per participant were targeted sequentially across the weeks of intervention based on each participant's needs identified in baseline. The dependent variable probe (personal narrative generation) was administered at the beginning of each twice-weekly session, and individualized story grammar elements were scored on a 4-point rubric (dependent variable). Results In this single-case research design study, a functional relation was evaluated for each participant (i.e., replication of an effect across three story grammar elements). A functional relation between intervention and the dependent variable was observed for two participants. Conclusion Results provide preliminary evidence for the efficacy of individually administered intervention for children with SLI.

Purpose: This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response. Method: An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures. Results: Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment. Conclusion: The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

Purpose: This study examines the absolute and relative effects of 3 different treatment programs for school-age bilingual children with primary or specific language impairment (PLI). It serves to expand the evidence base on which service providers can base treatment decisions. It also explores hypothesized relations between languages and cognition in bilinguals with PLI. Method: Fifty-nine school-age Spanish-English bilingual children with PLI were assigned to receive nonlinguistic cognitive processing, English, bilingual (Spanish-English), or deferred treatment. Participants in each of the 3 active treatments received treatment administered by nationally certified speech-language pathologists. Pre- and post-treatment assessments measured change in nonlinguistic cognitive processing, English, and Spanish skills, and analyses examined change within and across both treatment groups and skill domains. Results: All active treatment groups made significant pre- to post-treatment improvement on multiple outcome measures. There were fewer significant changes in Spanish than in English across groups. Between-group comparisons indicate that the active treatment groups generally outperformed the deferred treatment control, reaching statistical significance for 2 tasks. Conclusion: Results provide insight into cross-language transfer in bilingual children and advance understanding of the general PLI profile with respect to relationships between basic cognitive processing and higher level language skills.

Background: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. Aim: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. Method: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants’ heart rate response during VRET, and their experience post-VRET, were indexed. Results: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-to-treat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.61, p = 0.019, and Dental Fear Scale, F (1,8) = 10.53, p = 0.012], and behavioural avoidance in the VRET compared with the IP group [d = 4.2 and –1.4, respectively). There was no increase in average heart rate during VRET. Of the nine treatment completers, six (four from the VRET group and two from the IP group) no longer had dental phobia at 6-month follow-up. Four of the five VRET participants, but none of the IP participants, scheduled a dental treatment appointment following the intervention. Conclusion: VRET is a feasible alternative for patients with dental phobia.