Remédiation cognitive portant sur les aspects fluide et cristallisé de l’intelligence auprès d'adolescents présentant un fonctionnement intellectuel limite : approche par le jeu

The main objective of this study was to create, implement and assess the efficacy of a cognitive intervention program targeting both fluid (Gf) and crystallized (Gc) aspects of intelligence in a clinical population of adolescents presenting with borderline intellectual functioning (BIF). Considering the high prevalence of BIF, the GAME (“Gains et Apprentissages Multiples pour Enfants”, or “Multiple Gains and Learning for Children”) cognitive intervention was developed using commercially available games, to allow for application of this program to different settings. The first article of this thesis consists of a systematic review of the literature pertaining to the use of game in paediatric cognitive rehabilitation. Efficacy and global methodological quality were assessed for all reviewed studies and recommendations for the design and reporting of game-based cognitive interventions were proposed. Some methodological issues raised in this article allowed us to improve the overall quality of the cognitive program developed in this thesis. Considering the limited number of studies in the current literature regarding BIF (70<IQ<85), it was important to develop a better understanding of the cognitive, adaptive, behavioural and psychiatric profile of adolescents with BIF who participated in the GAME program. This second study helped to empirically develop a better understanding of this population’s profile. A strength regarding verbal abilities for receptive vocabulary and verbal fluency was identified in this population. Moreover, some aspects of attention seemed well preserved, possibly through the effect of psychostimulant medication. Surprisingly, adaptive functioning was not directly linked to overall intellectual functioning and appeared to be heterogeneous. This underscores the importance of directly assessing adaptive functioning in this population to obtain a better estimate of their daily living skills, rather than relying solely on cognitive profiles. Adolescents with BIF also exhibited a much higher prevalence of both internalized and externalized behavioural and psychiatric manifestations than their peers. These manifestations explained an important proportion of parental stress levels. These findings may be helpful in guiding academic orientation, clinical, and family management of youth with BIF and highlight the importance of carrying out systematic and extensive neuropsychological assessments in these youth. The main focus of this thesis consisted in creating a cognitive intervention program targeting Gf and Gc, a rehabilitation domain that has long been overlooked, because of the presumed stability of intellectual processes. The GAME cognitive program was intended for adolescents presenting with either pure or partial BIF (either both of the main reasoning indices were in the borderline range or only one) and addressed two aspects of intelligence: GAME-c (targeting crystallized intelligence) and GAME-f (targeting fluid intelligence). The program lasted for sixteen hours over the course of eight weeks. Results show that adolescents following GAME-f improved on Gf; while adolescents following GAME-c improved on both Gc and Gf. This study sheds further doubt on the so-called stability of intellectual functioning. This is also the first time that intellectual improvements have been identified in a population of clinical interest through direct training. Finally, additional analyses were conducted to identify possible cognitive, adaptive, behavioural and psychiatric factors susceptible of influencing improvements after training. The results indicate that the GAME program may be suitable for other clinical population (e.g., intellectual deficiency).  This thesis underlines the interest of using games as a cognitive remediation tool because of their versatility, accessibility and low cost. It also highlights the necessity to develop a better understanding of individuals presenting with BIF and to provide them with exhaustive neuropsychological assessment (cognitive, adaptive, behavioral and psychiatric). Finally, it indicates that improvements of both fluid and crystallized intelligence can be achieved through direct training in individuals with below-average IQ, suggesting that cognitive deficits could also be addressed in other populations, such as in youth with intellectual disability. Future research and clinical avenues are discussed in relation to the project findings.

Keyphrases: Intelligence, Cognitive training, Fluid reasoning, Crystallized intelligence, Borderline intellectual functioning, Game