Remapping the cognitive and neural profiles of children who struggle at school

Abstract

Our understanding of learning difficulties largely comes from children with specific diagnoses or individuals selected from community/clinical samples according to strict inclusion criteria. Applying strict exclusionary criteria overemphasizes within-group homogeneity and between-group differences, and fails to capture comorbidity. Here we identify cognitive profiles in a large heterogeneous sample of struggling learners, using unsupervised machine learning in the form of an artificial neural network. Children were referred to the Centre for Attention Learning and Memory (CALM) by health and education professionals, irrespective of diagnosis or comorbidity, for problems in attention, memory, language, or poor school progress (n=530). Children completed a battery of cognitive and learning assessments, underwent a structural MRI scan, and their parents completed behaviour questionnaires. Within the network, we could identify four groups of children: i) children with broad cognitive difficulties, and severe reading, spelling and maths problems; ii) children with age-typical cognitive abilities and learning profiles; iii) children with working memory problems; and iv) children with phonological difficulties. Despite their contrasting cognitive profiles, the learning profiles for the latter two groups did not differ: both were around 1 SD below age-expected levels on all learning measures. Importantly a childs cognitive profile was not predicted by diagnosis or referral reason. We also constructed whole-brain structural connectomes for children from these four groupings (n=184), alongside an additional group of typically developing children (n=36), and identified distinct patterns of brain organisation for each group. This study represents a novel move towards identifying data-driven neurocognitive dimensions underlying learning-related difficulties in a representative sample of poor learners.\n\nAuthor NoteThe Centre for Attention Learning and Memory (CALM) research clinic is based at and supported by funding from the MRC Cognition and Brain Sciences Unit, University of Cambridge. The Principal Investigators are Joni Holmes (Head of CALM), Susan Gathercole (Chair of CALM Management Committee), Duncan Astle, Tom Manly and Rogier Kievit. Data collection is assisted by a team of researchers and PhD students at the CBSU. This currently includes: Sarah Bishop, Annie Bryant, Sally Butterfield, Fanchea Daily, Laura Forde, Erin Hawkins, Sinead OBrien, Cliodhna OLeary, Joseph Rennie, and Mengya Zhang. The authors wish to thank the many professionals working in childrens services in the South-East and East of England for their support, and to the children and their families for giving up their time to visit the clinic.\n\nResearch HighlightsO_LIfirst study to apply machine learning to understand heterogeneity in struggling learners\nC_LIO_LIlarge sample of struggling learners that includes children with multiple difficulties\nC_LIO_LIrich phenotyping with detailed behavioural, cognitive, and neuroimaging assessments\nC_LI