Train Your Brain: A Pilot Project to Improve Memory and Decision Making

Study Overview
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Brief Summary
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The goal of this clinical trial is to pilot a computer-based working memory training program to improve delay discounting (DD) and prevent substance use among at-risk adolescents in a traditionally underserved area. Results from the study will inform future efforts substance use prevention efforts targeted at youth exposed to adverse childhood experiences. Findings will also refine future models of intervention delivery in traditionally underserved communities. The main question[s] it aims to answer are: Determine if the intervention can be delivered feasibly, acceptability, and at sufficient dosage Evaluate the utility of the recruitment and retention procedures as well as identify barriers to participation

Detailed Description
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Youth exposed to early childhood adversity are at increased risk for engaging in problematic substance use, leading to myriad negative health outcomes, including HIV exposure, injury, and impaired driving. Adolescents from low-resource communities evidence elevated rates of exposure to adverse childhood experiences, yet have limited access to evidence-based preventative interventions. Thus, there is a critical need for services that can feasibly target specific mechanisms linking early adversity to the onset and escalation of substance use in traditionally underserved communities. One such target is delay discounting (DD), the tendency to select small, immediately available rewards at the expense of larger, delayed, rewards. DD has been linked to early substance use initiation and more frequent and severe use across adolescence. Moreover, youth exposed to early childhood adversity evidence more problematic levels of DD, indicating that DD may be a pathway by which early trauma exposure leads to drug and alcohol use. Iterative pilot trials of approximately 10 youth participants + their parents/guardians will be conducted to examine effectiveness of procedures and initial implementation outcomes. Research from our team suggests that computer-based interventions targeting proximal cognitive skills, specifically working memory, can improve rates of DD. Moreover, computerized interventions are highly transportable and scalable, making them ideal for dissemination in low-resource communities. The current project proposes to pilot a computer-based working memory (WM) training program to improve DD and prevent substance use among at-risk adolescents in a traditionally underserved area.

Official Title
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Train Your Brain: A Pilot Project to Improve Memory and Decision Making to Improve Outcomes Among Youth

Conditions
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Behavior, Health

Intervention / Treatment
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* Behavioral: Computer-based Intervention


Participation Criteria
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Eligibility Criteria
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Youth Inclusion Criteria: Youth must be between the ages of 12 and 14 and have a parent/guardian willing to provide consent for their participation Youth must be proficient in English in order to validly complete all assessment measures and take part in the computer-based training Youth must be willing to commit to participate in two to three 20-30-minute computer-based trainings for five to seven weeks Youth must be willing to take part in assessments before and immediately following the intervention as well as a confidential interview with researchers after completing the computer sessions Youth Exclusion Criteria: Currently psychotic Currently suicidal or evidence active suicidal ideation Currently diagnosed with a substance use disorder Parent Inclusion Criteria: Parent of child participating in intervention and willing to provide consent for themselves and their children to participate Proficient in English in order to validly complete all assessment measures Willing to take part in assessments Parent Exclusion Criteria: Currently psychotic Currently suicidal or evidence active suicidal ideation Currently diagnosed with a substance use disorder

Ages Eligible for Study
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Minimum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single-Arm<br>All participants in this phase of the project will receive the active working memory training intervention (15, 20-30-minute computer-based training sessions over the course of 5 to 7 weeks). Additionally, key stakeholders will be asked to participate in a qualitative interview following the intervention to refine future models of intervention delivery in traditionally underserved communities. | Behavioral: Computer-based Intervention<br>* The current project proposes to pilot a computer-based working memory training program to improve delay discounting and prevent substance use among at-risk adolescents in a traditionally underserved area.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Delay Discounting 5 Trial Adjusted Measure | The computer based adjusting amount discounting task uses an adjusting algorithm to determine the amount of immediately available money that is equivalent to a large sum that is delayed by seven discrete durations of time presented in a randomized order (i.e., 1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years).At each delay, a choice is first presented between the delayed larger sum and a smaller sum available immediately. For each trial, the position of the delayed and immediate amounts are randomly assigned the left or right portion of the screen, and the participant chooses the preferred option by pressing the corresponding left or right response button. Change in the Delay Discounting score is measured by comparing baseline scores with scores at the intervention (baseline) and the post-intervention assessment (approximately 7 weeks after baseline) | Baseline, 7 weeks | 
| Change in Consideration of Future Consequences Scale | The Consideration of Future Consequences Scale1 (CFCS-14) is a 14-item self-report questionnaire that assesses active consideration of longer-term implications of an individual's actions. Lower scores on the CFCS-14 are associated with a greater focus on immediate needs and have been found to be associated with less engagement in health behaviors1819 and greater substance use. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Research suggests modest but significant correlations with the MCQ. Change in CFCS-14 score is measured by comparing baseline scores with scores at the post-intervention assessment (approximately 7 weeks after baseline) | Baseline, 7 weeks | 
| Change in Tower of Hanoi | Tower of Hanoi (TOH) is a measure of planning ahead. It requires the participant to move disks of varying sizes between three pegs in order to create a specified design. Participants are instructed to follow specific rules for play and are awarded points for making each design in the least number of moves. The current study will use the TOH measure from the Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan & Kramer, 2001). The test is normed on clinical and community samples of individuals ages 8 to 89 years old and demonstrates adequate reliability and validity (Delis et al. 2004). | Baseline, 7 weeks | 
| Change in Letter Number Sequencing | Letter Number Sequencing (LNS) is a measure of working memory. The participant is read a list of scrambled letters and numbers that they must then repeat back to the examiner in alphabetical and numeric order. The length of the target string increases over time until the participant is no longer able to correctly sequence three letter/ number stems in a row. We will utilize the LNS subscale from the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-5; Wechsler, 2014) for participants between 12 and 16, and the Wechsler Adult Intelligence Scale (WAIS-IV; Wechsler, 2008) for participants age 17. Both intelligence batteries are widely used and normed on community and clinical populations. | Baseline, 7 weeks | 
| Change in Iowa Gambling Task | Iowa Gambling Task (IGT; Bechara et al., 1994) evaluates experiential decision making. It is administered via a computer interface, in which participants are presented four decks of cards and asked to select one deck to flip a card from in order to win money. Each deck is associated with specific winning and losing probabilities and performance on the task is determined by computing relative preference for longer vs. shorter-term rewards. The IGT has been shown to be valid in child and adolescent populations (Beitz, Salthouse & Davis, 2014; Smith, Xiao & Bechara, 2012). | Baseline, 7 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Youth Risk Behavior Survey | The Youth Risk Behavior Survey (YRBS; CDC, 2001) is a self-report measure of the prevalence of real world risk behaviors, including compromised safety behaviors (e.g. not wearing a seat belt), substance use, risky sexual practices, and delinquent behaviors (e.g. gambling, theft). Because substance use has been associated with problematic behaviors more broadly (Bukstein, 2000), the YRBS will allow us to tap engagement in a variety of related risky behaviors. Consistent with previous research, we will create an aggregate of substance use and risk behaviors (e.g. Aklin et al., 2005) as an index of risky behaviors. Composite scores such as these have demonstrated adequate psychometric properties (e.g. Felton, et al., 2015). | Baseline, 7 weeks | 
| Change in Alcohol/Marijuana Effect Expectancies | The Alcohol Expectancy Questionnaire (AEQ; Brown, Christiansen, & Goldman, 1987) and the Marijuana Effect Expectancy Questionnaire (MEEQ; Schafer & Brown, 1991) are self-report questionnaires that tap youths' perception of positive and negative outcomes related to using alcohol and marijuana. Because our intervention is designed to orient youth towards longer-term (rather than immediate) rewards, we expect to see significant decreases in positive expectancies of alcohol and marijuana use and an increase in negative expectations. Both the AEQ and MEEQ have been found to be reliable and valid indicators of adolescents' perceptions of use (Aarons et al., 2001; Brown et al., 1987). | Baseline, 7 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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delay discounting, computer-based intervention, executive functioning, substance use, working memory