School-based intervention to address self-regulation and executive functioning in children attending primary schools in remote Australian Aboriginal communities

Bree Wagner; Jane Latimer; Emma Adams; Heather Carmichael Olson; Martyn Symons; Trevor G Mazzucchelli; Tracy Jirikowic; Rochelle Watkins; Donna Cross; Jonathan Carapetis; John Boulton; Edie Wright; Tracy McRae; Maureen Carter; James P Fitzpatrick

doi:10.1371/journal.pone.0234895

School-based intervention to address self-regulation and executive functioning in children attending primary schools in remote Australian Aboriginal communities

PLoS One. 2020 Jun 24;15(6):e0234895. doi: 10.1371/journal.pone.0234895. eCollection 2020.

Authors

Bree Wagner¹, Jane Latimer², Emma Adams¹, Heather Carmichael Olson^{3

4}, Martyn Symons^{5

6}, Trevor G Mazzucchelli^{7

8}, Tracy Jirikowic⁹, Rochelle Watkins⁵, Donna Cross^{6

10

11}, Jonathan Carapetis^{6

12}, John Boulton¹³, Edie Wright¹⁴, Tracy McRae¹, Maureen Carter¹⁵, James P Fitzpatrick¹

Affiliations

¹ Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
² Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Seattle Children's Research Institute, Seattle, Washington, United States of America.
⁴ University of Washington School of Medicine, Seattle, Washington, United States of America.
⁵ National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Western Australia, Australia.
⁶ Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
⁷ Child and Family Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia.
⁸ Brain, Behaviour and Mental Health Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia.
⁹ Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.
¹⁰ Health Promotion and Education Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
¹¹ CoLab-Collaborate for Kids, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
¹² Perth Children's Hospital, Perth, Western Australia, Australia.
¹³ The University of Newcastle, Newcastle, New South Wales, Australia.
¹⁴ Western Australian Department of Education Kimberley Education Region, Broome, Western Australia, Australia.
¹⁵ Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia.

Abstract

Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children's executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children's behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children's executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children's exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Child
Child, Preschool
Executive Function / physiology*
Faculty
Female
Health Services, Indigenous*
Humans
Male
Native Hawaiian or Other Pacific Islander*
Parents
School Health Services*
Schools*
Self-Control*
Students*
Surveys and Questionnaires

Grants and funding

This project was funded by the National Health and Medical Research Council project grant (1086145) https://nhmrc.gov.au/. BW is supported by an Australian Government Research Training Program (RTP) Scholarship https://www.education.gov.au/research-training-program. MS received support through the National Health and Medical Research Council FASD Research Australia Centre of Research Excellence (1110341). DC is supported by a National Health and Medical Research Council Research Fellowship (1119339). Community researcher training was supported by a philanthropic grant from 100 Women https://100women.org.au/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.