Intervention Effectiveness Study of BEtter AT LEarning (BEATLE)- Digital Neuropsychological Rehabilitation Program

The purpose of this study is to evaluate the effectiveness of BEATLE with clinical samples of patients diagnosed with DLD, dyslexia, and Mixed specific developmental disorder. A randomized controlled trial with a waitlist design will be employed. The objective is to assess potential changes in perceived self-efficacy, self-compassion, executive functioning, and attitudes towards learning as reported by the participants, their guardians (parents), and teachers. Additionally, this study aims to examine the correlation between the usage of the DTP and its effectiveness.

BEATLE (BEtter AT LEarning) is a neuropsychological digital rehabilitative program (Digital Treatment Path, DTP) developed at the Department of Phoniatrics,University Hospital of Helsinki and Uusimaa region (HUS). The purpose of this DTP is to provide knowledge on meta-skills and tools for learning to 12-16-year-olds who have learning problems due to developmental language disorder, dyslexia, or other developmental issues.

The aforementioned developmental disorders can have long-lasting impacts on individuals' lives. For instance, children with DLD have been reported to have lower quality of life than typically developing children according to parent evaluations. Self-evaluation is a crucial aspect of individual performance and well-being. Albert Bandura's social cognitive theory posits that individuals are proactive and reflective beings who simultaneously shape and are shaped by their environment (Reciprocal determinism). According to Bandura, individuals constantly evaluate and form beliefs about their capabilities to perform in given situations (Self-efficacy). The theory of self-efficacy is often employed in educational sciences, where students with higher self-efficacy beliefs have been found to exert more effort in schoolwork, perform better academically, and have a more positive attitude towards school. Primary school students with specific learning difficulties have been reported to have lower self-efficacy beliefs than their peers.

Another perspective on self-evaluation and one's perception of difficulties can be explored through the concept of self-compassion. Neff defines self-compassion as a multifaceted construct that encompasses how individuals emotionally respond to suffering, cognitively understand their predicament, and pay attention to their suffering. A longitudinal study found that ninth-grade students with low self-esteem but high self-compassion exhibited better psychological health one year later compared to those with low self-compassion. Self-compassion has demonstrated its utility as a framework for interventions.

The aim of the BEATLE is to provide understanding, inspiration, and tools for better learning in adolescents. This study aims to 1) analyze the effectiveness and feasibility of the BEATLE online rehabilitative course in three clinical groups (DLD, dyslexia, and Mixed specific developmental disorder) and 2) explore the potential differences in effectiveness among these diagnostic groups. For example, could participants with dyslexia report better and more lasting outcomes than participants with DLD or Mixed specific developmental disorder, considering that the DTP includes several tips on how to use digital tools, such as dictation and text-to-speech, which can aid with their primary difficulty (reading and writing)?

The purpose of this study is to evaluate the effectiveness of BEATLE with clinical samples of patients diagnosed with DLD, dyslexia, and Mixed specific developmental disorder. A randomized controlled trial with a waitlist design will be employed. The objective is to assess potential changes in perceived self-efficacy, self-compassion, executive functioning, and attitudes towards learning as reported by the participants, their guardians (parents), and teachers. Additionally, this study aims to examine the correlation between the usage of the DTP and its effectiveness.

The samples will be gathered from 12-16-year-old patients referred to HUS Phoniatrics or HUS Pediatric neurology. We aim for 52 (26+26) subjects per sample. In total, 156 complete participants should be anticipated. A conservative drop-out rate of 50% taken into account total 312 participants could be required for the study. Another DHP on acquired brain injury patients on adults has acquired a drop-out rate of around 20%.

Participants will be recruited by neuropsychologists in respective clinics where forms of agreement will be signed after willingness to participate in the research has been reported. Upon signing the agreement the participant is given an envelope of material and an agreement form to be given for her/his teacher to sign up for the research. Participation in the study does not supersede any other treatment.

Agreement to participate in the study is then delivered to the researcher who will randomize the participants into either the intervention group or the waitlist. Randomization will be conducted using an algorithm provided by HUSeCRF to minimize the risk of bias. Participants in the intervention group will receive their invitation to the DTP a few days after signing the agreement and completing the pre-intervention questionnaires. Waitlist group participants will first be given waitlist questionnaires, after which they will have to wait for 10 weeks before entering the cross-over phase and getting the opportunity to participate in the DTP.

Eligibility Criteria:
For inclusion, the ICD-10 (WHO, 2018) diagnostic criteria accompanied with Finnish Current Care Guidelines will be used as follows:

Developmental Language Disorder Verbal reasoning skills 1.5 standard deviations lower than average (VCI\<78) Intact non-verbal reasoning skills (PRI\>84) Normal or fixed to normal hearing and vision Finnish as a native or major household language

Dyslexia Measured reading accuracy and comprehension two standard deviations (-2SD) lower than anticipated when the chronological age and IQ have been taken into account Normal of fixed to normal hearing and vision Finnish as a native or major household language

Mixed Developmental Disorder Wide developmental and learning difficulties (69\<PRI\<84, 69\<VCI\<84) Normal or fixed to normal hearing and vision Finnish as a native or major household language

Exclusion Criteria:

All exclusion criteria will be addressed individually. If a respondent fulfills one or more of the exclusion criteria, the respondent will be dropped out. Exclusion criteria are formed as follows:

Suspicion of mild intellectual disability Both verbal and non-verbal reasoning skills more than two standard deviations lower than average (VCI \& PRI \<70) Weak (-2SD) performance on both subtests representing fluid intelligence (WISC-IV: Matrix reasoning and Picture concepts)

Diagnosis of Autism Spectrum Disorder

Diagnosis of Attention-Deficit Hyperactivity Disorder

Unable to adequately use a a computer and/or a smartphone