JMIR Publications

ABSTRACT

Background:

Reading is a critical skill to master during childhood. Yet, many children struggle with significant reading difficulties, particularly those with learning differences affecting language and reading, including dyslexia, which affects about 20% of children. Unfortunately, traditional intensive reading interventions are not always sufficient to address the challenges of all students, highlighting the need for complementary approaches to augment reading-focused instruction. Based on the Active View of Reading, executive function skills, in particular attentional control, support the development and use of word-recognition and language-comprehension skills needed for successful reading. Although attention is associated with reading performance, it remains unclear whether an intervention designed to directly strengthen attentional control can have downstream consequences in reading outcomes in students with learning differences.

Objective:

This pilot study examined whether individual differences in improvement during training with Engage, a closed-loop attention-training video game incorporating mindfulness-inspired features, were associated with changes in sustained attention and reading outcomes among middle-school students.

Methods:

In a single-arm, in-school pilot study, we examined the preliminary effectiveness of a custom closed-loop video game, Engage, in a heterogeneous cohort of 7th and 8th grade students (N = 28, age 11-14 years old) with learning differences impacting language and reading (including dyslexia). Training improvement was indexed by the individual slope of time spent in the game’s adaptive sustained-attention environment (Engage Mode) across sessions. Outcomes included response time on the sustained-attention condition of a computerized continuous performance task (CPT) and performance on reading-related measures, including timed sentence-level reading fluency, real-word and pseudoword reading fluency, rapid naming, and reading comprehension.

Results:

We found that students who showed greater improvement during Engage training also demonstrated larger Engage-related improvements in sustained attention (r=0.44; p=.02) and timed sentence-level reading fluency (r=0.41, p=.04). No significant associations were observed between Engage training improvement and changes in real-word or pseudoword reading fluency, rapid naming, or reading comprehension (all ps≥.16).

Conclusions:

These preliminary findings suggest that a closed-loop, game-based digital attention intervention may complement, rather than replace, reading-focused instruction for students with learning differences affecting language and reading. Students who showed greater improvement during training also showed larger improvements in sustained attention and timed sentence-level reading fluency. These findings provide an initial basis for testing whether attention-focused supports can be integrated with intensive reading instruction and tailored to students most likely to benefit in larger, controlled studies. Clinical Trial: ISRCTN10276661