Low academic achievement, such as poor literacy, is a common and serious problem, and affects between 10-20% of the population [1
]. The adverse social and economic long-term outcomes of these difficulties are clear. They include grade repetition, behavioural disorders, mood and self-esteem difficulties and school failure during the school years, [3
] and unemployment and poverty in adulthood [6
Learning during childhood is a transactional process between the child and their environment [7
]. A poor reader is less likely to read for pleasure and more likely to avoid practice, so that the gap with peers gradually widens until the child starts to fail in school. By the time academic difficulties are evident, which is often not before Grade 3,[1
] they may already be entrenched. For example, in the Connecticut Longitudinal Study, 70% of children with reading disabilities in 3rd
Grade still struggled in 12th
Societies address health and developmental problems using a range of strategies, from the least intensive and most generic (universal prevention) through to the most costly, complex and limited (long-term care for end-stage conditions). From the population perspective, effective prevention
is the optimal approach for reasons of both cost and benefit,[10
] although evidence as to optimal timing is often meagre [11
]. In turn, common problems that develop slowly and thus pose identification challenges - like academic underachievement - may need graded prevention approaches. Thus Mrazek & Haggerty propose that population prevention should range from universal (delivered to whole populations) through selective (population sub-groups at high risk) to indicated (smaller groups with early signs of problems, not yet meeting diagnostic criteria) [12
]. As problems crystallise, approaches then move to the individual by case finding, early intervention, treatment and, finally, end-stage care.
Unfortunately, this spectrum of prevention is not yet optimised for academic difficulties. In Australia, universal prevention is offered throughout the preschool years, for example early-life social initiatives to minimise inequalities, promoting shared book-reading with toddlers, and a universal preschool year. In school, children who are identified with early academic difficulties may receive indicated prevention strategies, for example, programs such as Reading Recovery. However, little progress has been made with selective prevention - the crucial intermediate stage when help could be targeted to very young school children at high risk of academic underachievement but who have not yet fallen behind. Systematically delivering a brief, semi-tailored selective prevention intervention to school entry children at risk of academic failure would be a major advance, but, as yet, clear targets for intervention have not been identified.
Working memory has recently been identified as a cognitive process that is vital for learning and may be causal in academic underachievement and learning difficulties, as well as a range of other problems [13
]. Working memory is strongly associated with literacy and numeracy skills,[14
] and children with poor working memory at school entry are unlikely to reach expected levels of attainment in literacy, maths and science three years later [15
]. In population studies, > 80% of primary school children with working memory difficulties on screening (scores < 15th
percentile for age) failed to achieve expected levels of achievement in reading and/or maths [13
]. Over 90% of 6-11 year-old children with reading difficulties have low working memory skills [16
Working memory refers to the ability to temporarily store and manipulate information in a 'mental workspace'. Current theory, based on functional activation and brain lesion studies,[13
] describes working memory as a multi-component, limited-capacity network linking different cortical centres. It comprises verbal and visuo-spatial short-term memory and a 'central executive' involved in higher level mental processes, attention and executive function [13
]. Children with working memory difficulties often make poor academic progress because they become overloaded by classroom demands: they forget crucial task information, fail to follow instructions, and do not complete activities. Learning is thus seriously impeded [13
]. Overcoming working memory overload, either by enhancing capacity or by reducing demands, could therefore boost learning. The strong predictive relation between working memory and learning typically persists even after IQ is taken into account,[17
] indicating that working memory is more than a mere proxy for intelligence.
Until recently, working memory was considered highly heritable and fixed [18
]. However, it is now known that it can improve with adaptive training tasks that encourage individuals to work continuously at their personal working memory capacity [20
]. This concept has recently been developed into a game-style computerised training program suitable for children as young as 5 years of age by Klingberg and colleagues [20
]. Following this program, children with ADHD generalised their new skills and sustained the treatment effect [20
]. Functional imaging showed increased activation in the frontal and parietal areas of the brain that are strongly implicated in working memory [21
]. A non-randomised trial of 8-11 year-old children in six schools in north-east England reported that this adaptive training can improve both working memory and academic outcomes in the short term [22
]. Intervention children also improved in mathematical reasoning by six months (effect size 0.5 SD, p = 0.01), indicating that better working memory may translate directly into more effective learning [22
]. IQ scores changed very little. Nor did literacy scores, suggesting that reading problems that are present at age 8-11 years may need more specific and individualised remediation.
Working memory, therefore, now appears to be a strong candidate for a selective prevention intervention for young children at risk of academic underachievement. We now propose to determine whether these benefits translate to younger children screened in the Australian school setting- the next step in determining the true prevention potential of this promising intervention.