A couple of children sit in front of computers, concentrating hard. They’re looking at a beach scene, and their task is to click on a spade every time it appears on the screen. Real focus is required; the spade doesn’t appear often.
These pupils are autistic, and the programme they are taking part in is called Computerised Progressive Attentional Training (CPAT), which is designed to improve attention skills.
The programme is primarily used to support children with ADHD, but a new research project, funded by Erasmus+, Teacher Training and Attention in Autism (TTAA), has found that the training is worthwhile for autistic children, too.
There is a lot of evidence to show that problems with attention are common in autistic people, and that autism and ADHD commonly co-occur, says Dr Lila Kossyvaki, an associate professor in severe profound and multiple learning disabilities at the University of Birmingham, who is one of the leaders of TTAA.
And yet, she adds, these findings haven’t really filtered down into many of the interventions on offer for autistic pupils.
“A lot of people with autism have attention difficulties, and a lot of them also get an ADHD diagnosis. But in order to get an autism diagnosis, you don’t need, by definition, to have attention difficulties. I think this is the reason [attention] hasn’t been targeted [by interventions],” she says.
The autism diagnosis is instead often seen as being primarily about problems with social interaction and communication, so these are the areas that interventions traditionally target, she adds.
“Interventions in the autism field often focus on shared attention: how can I share with another person an event, a piece of information, something I’m interested in. There aren’t many interventions on basic core attention skills,” she explains.
That’s where CPAT comes in: Kossyvaki came across work by Dr Carmel Mevorach, an associate professor in cognitive neuroscience at the University of Birmingham, who developed the programme, with Professor Lilach Shalev from Tel Aviv University, and studied its positive impact on children with ADHD. She approached him and, together, they decided it was worth testing the effectiveness of CPAT with autistic pupils.
In 2017, the pair ran a study in which an intervention group of fifteen autistic 6- to 10-year-olds accessed CPAT twice a week for eight weeks. They found that these children showed cognitive and academic improvements over and above the active control group.
Having completed this initial trial, Mevorach then led a further study, in São Paulo, Brazil, the results of which were published in July last year. In the study, 26 autistic children took part in 45-minute training sessions twice a week for eight weeks. Half used CPAT and half were given ordinary computer games to play.
Immediately after completing the training, the CPAT group showed improvements in the number of isolated words they could correctly identify and read in 10 minutes (an increase from around 44 to around 53). They were also able to increase the number of words they could copy from around 18 to around 25.
There were also benefits in maths: the CPAT group improved their scores on regular in-class maths tests by more than 50 per cent.
And these improvements in both areas were maintained when the children were re-tested three months after completing the programme. In contrast, the control group showed no evidence of improvements.
Mevorach says that the programme has a positive impact on academic performance because it targets the basic attention functions that operate in tandem to underpin learning: the ability to focus on a specific input; to maintain focus for a prolonged period; and to control what we are paying attention to, including “when we disengage with what we are currently doing and shift our attention to something else”.
“All of these functions together are really critical for things like learning how to read, or listening in class, or retaining information, or doing maths,” he explains. “The research has shown the direct link between your attention functions and your maths ability, or your ability to learn in a classroom context.”
CPAT has been shown to improve those attention functions, and to improve academic performance, as a result.
So, what exactly does the training involve? And is it something that teachers can use themselves, in their classrooms?
According to Mevorach and Kossyaki, the programme is easy for schools to use. CPAT is self-contained, and requires no input from the teacher: children naturally move up the levels in the programme as they progress. The tasks range from activities such as clicking on a spade every time it appears to searching for a woman with a certain type of hat in a Where’s Wally? type activity.
However, they add, this programme is not a silver bullet that has to be used in a specific way to be effective.
“We are very against providing recipes for teachers. We are not saying you have to use it like medication, or for 10 minutes today and it will sort out all the problems,” says Kossyvaki.
Instead, she suggests, it’s up to teachers to use their professional judgement to decide how often they want pupils to use it, when and for how long.
“There isn’t a right or wrong way of doing this. Of course, as with most interventions, the more you’re able to use it, the more efficient it will be. But even if you use it for a little bit, it might have an important impact,” she says.
CPAT is available to all schools for free, and Mevoarch and Kossyvaki are hoping that more will start to use it. So far, they are working with four schools in Birmingham, four schools internationally, and with the education outreach team at Staffordshire local authority.
To help teachers make informed decisions around its use, Mevoarch and Kossyvaki have also developed a free online training course, which consists of four one-hour sessions.
Ultimately, the pair want teachers to be aware of the value of giving autistic children the opportunity to develop their attention skills. But, they stress, this teacher development piece is just as important as the programme itself.
“This isn’t just about a piece of software, it’s about the training too,” says Mevoarch.
There are other developments in the works, too. While the existing research around CPAT has been with primary and secondary pupils, colleagues of Mevoarch and Kossyvaki are now looking at how the programme could work in the early years.
For the youngest autistic children to benefit, changes will need to be made, says Kossyvaki: early years teachers won’t want their pupils exposed to screens for extended periods of time. However, the CPAT activities could be translated into physical learning.
“They could find Wally in a physical book, for example,” she explains. “We have no reason to believe that children couldn’t start their attention training in EYFS.”
And as the teachers across the pilot schools go through the training, and discover the value of the CPAT programme for themselves, Mevoarch and Kossyvaki are hoping that others will soon sit up and pay attention.
