Clinical trial NCT03261076: Reading Remediation and Outcomes in Detention
Official title: Severe LD in Juvenile Delinquents: Presentation, Course, and Remediation
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Specific Learning Disorder (MeSH Unique ID: D000067559)
Dyslexia (MeSH Unique ID: D004410)
Conduct Disorder (MeSH Unique ID: D019955)
Keywords: Specific Learning Disorder
Learning Disorders
Neurodevelopmental Disorders
Mental Disorders
Developmental Reading Disability
Reading Disorder
Conduct Disorder
Lead sponsor: Baylor College of Medicine
Sponsor class: OTHER
Collaborators: name: University of Houston
name: Harris County Juvenile Probation Department
name: Connecticut Court Support Services Division
name: MindTrust Labs
First posted: 2017-08-24
Enrollment: 192
Sex: MALE
Minimum age (years): 14
Maximum age (years): 16
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: This study uses a multiple baseline design, in which participants enter into the single-arm intervention at different times, yet have data collected at all time points. Approximately one third of participants will have their entry into the intervention shifted later by one week, and approximately another third will have their entry shifted by two weeks. This will happen on a rotating basis. All individuals will receive progress monitoring during the weeks that the other individuals are receiving intervention and/or assessments. The multiple baseline design allows for all individuals to receive the study intervention, and still provides a mechanism for monitoring change (or lack thereof) during non-intervention periods before and after intervention.
Primary purpose: TREATMENT

Brief summary: The current literature on academic skill difficulties, whether considered as part of the continuum of ability or as a specific learning disability (LD), indicates that these problems often coexist with conduct problems and juvenile delinquency, and are risk factors for initial law-breaking behavior and for its persistence. However, less is understood about how this relationship develops. It is these broad questions that this project seeks to address. First, what is the causal pathway? Does LD cause delinquency, delinquency cause LD, or are both caused by something else? And can big data analytics applied to statewide datasets of information about juvenile justice (JJ) involvement help to answer this question? Second, as it is known that learning to read and do math (and thus becoming more employable) increases the likelihood of desistance (i.e., not committing any more illegal acts), what are the necessary parts of an intervention designed to teach these skills? And what role might technology play in such an intervention? To answer these questions, we will implement a study that includes two components, (a) a big data component and (b) an intervention component. For (a), we will work with a large historical dataset from the Harris County Juvenile Probation Department. For (b), we will work, in total, with 192 (48 per year) delinquent youth with severe LD in residential placement. These individuals, in a nonconcurrent multiple baseline design, will be offered an educational therapy designed to address severe reading problems in juvenile detainees using a novel mixed media intervention in which the person-to-person intensive 1:1 component is completed while youth are in residential settings (24 sessions, delivered in 90 minute settings 3 times a week) and a "gamified" educational smartphone learning tool follow-up completed upon release (with appropriate network fidelity monitoring and participant reinforcement). The person-to-person component is developed specifically for juvenile offenders with severe LD, combining two well-established and highly-regarded intervention programs designed to systematically build students' repertoire of grapheme-phoneme correspondence rules as well as develop comprehensive reading skills, from beginning reading to proficiency.

Detailed description: Learning disabilities (LD) are among the most common types of disabilities in juvenile offenders that have been linked to delinquency. Nationwide, children and youth with special education needs are overrepresented in the US justice systems. Reports estimate delinquent juveniles with a disability to comprise about 30% to 60% of the entire delinquent population. A national survey in the US states an average prevalence rate of 33.4% of incarcerated juveniles with disabilities in correctional facilities. Moreover, concerns have long been raised on the recidivism rates of youth with disabilities and special education backgrounds. In general, regarding educational performance, academic deficits such as a lack of basic skills in reading, writing, and mathematics have been associated with recidivism. However, these studies largely neglect the dynamic nature of delinquent and criminal behavior that has been documented within the field of developmental criminology with a focus on the onset, continuity, and extinction of deviant behavior. In light of this research, the identification and remediation of LD as a risk factor for repeat offending has been a persistent challenge given the accumulation of and overlap with other risk factors such as poverty, familial patterns of criminality, influence of delinquent peers, and the differential impact of risk factors across an individual's developmental trajectory. Altogether, there is a challenge around the implementation of sophisticated methodology to model the complex longitudinal and reciprocal links between juvenile delinquency and educational problems such as LD, and how they relate to other risk factors over time. This challenge is intensified by the required large samples to detect robust and interpretable patterns and predictive relationships for groups of youth with severe LDs that, by definition, are small in size and censored with regard to various educational outcomes (e.g., academic performance). This research is conceived to contribute to the field's understanding of the connection between LD and delinquent behavior. We hope to generate unique findings capitalizing on the availability of the relevant big data, the clinical strengths of its members and their capacity to develop and administer educational therapy to juvenile offenders, and its embedment within communities empowering the creation and processing of multi-level longitudinal datasets, merging sociological (i.e., criminological), behavioral, neurophysiological, and genetic/genomic data.

Big Data:

The Big Data component seeks to address three objectives: (1) to conduct big data analytics and data mining to quantify/qualify the complexities of severe LD among juvenile justice (JJ)-involved youth using statistical methods applied to big datasets that capture multiple indicators (i.e., offending and educational outcomes) cross-sectionally (for one-time offenders) and longitudinally (for repeat offenders); (2) to utilize big data analytics to identify a group of youth with severe LD who will serve as a comparison group for individuals participating in a reading intervention; and (3) to evaluate the findings from the first two objectives based on the statistical assumptions underlying the models applicable to the big data at hand.

Hypotheses. Extending previous research, Big Data seeks to identify factors that relate LD to recidivism, frequency of re-offending and re-arrest, and the time to post-involvement recidivism. We hypothesize that (a) overall recidivism rates (i.e., regardless of the specific type of offense) will be higher among JJ-involved youth with severe LD (operationalization based on standardized achievement tests and special education status) than in youth without LD; (b) youth with severe LD will show more incidents of school-related problems after their first involvement (e.g., attendance problems, disciplinary incidents such as in-school and out-of-school suspensions and expulsions) than youth without LD; (c) youth with severe LD who had school-related problems prior to their first JJ involvement will be at higher risk of recidivism than youth without LD; (d) lower levels of reading achievement will be associated with shorter periods of time to repeated offending; and (e) participation in the intervention will significantly decrease recidivism risk compared to other youth with severe LD who did not participate in the intervention.

Intervention:

The intervention component seeks to address three objectives: (1) to improve the reading skills of an understudied, high-risk population (JJ-involved youth) using an educational therapy that has been specifically designed for JJ-involved youth, provided in a 1:1 setting, and expanded with technology, including material relevant to daily living skills and appropriate reinforcement that will extend the program into the post-release period; (2) to reinforce skills and maintain reading gains made during the educational therapy, and increase the automaticity of skill use by using a high-interest "gamified" learning tool that youth will play on a SmartPhone given to them when they leave detention; and (3) to investigate the individual response to therapy with respect to other variables (e.g., attention, executive functioning, impulse control, learning ability, other academic achievement) collected at baseline.

Hypotheses. The key hypotheses of the intervention component seek to identify the factors associated with response to therapy for severe LD relative to pre-therapy functioning. We hypothesize that (a) overall improvement in reading will be related to pre-therapy academic skills, attention, and executive functioning; (b) inclusion of a metacognitive component in the therapy will provide carry-over effects, improving other academic skills; and (c) the gamification of the learning tool will result in robust technology usage, with a dose-response relationship between time spent on task and improvement in skills trained (and measured) via game play.

Eligibility criteria: Inclusion Criteria:

* Between ages 14 and 16
* Conversational English ability (sufficient to benefit from the intervention program) based on the CASL-2 core score
* Reading below the 3rd grade level on the KTEA-3 pseudoword decoding subtest and the TOWRE-2 phonemic decoding efficiency subtest
* IQ at or above 70 on the KABC-II

Exclusion Criteria:

* Hearing or vision problem that would preclude the use of visual and auditory materials
* Developmental delay, autism spectrum disorder, or intellectual disability
* Known genetic syndrome
* Neurological disorder (e.g., epilepsy)
* Current psychosis or suicidal ideation
* Recent (within 6 months) traumatic brain injury

Primary outcomes:
measure: Change in Reading Skills from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
measure: Change in Decoding Skills from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
measure: Change in Reading Understanding from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
measure: Change in Comprehension from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
measure: Change in Reading Fluency from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
measure: Change in Other Academic Skills from pre-intervention (baseline) to the week after intervention
timeFrame: Assessment of change will take place at pre-intervention (baseline), the week before intervention, after four weeks of intervention, and the week after intervention.
Secondary outcomes:
measure: Recidivism within 1 year post-intervention
timeFrame: Within 1 year post-intervention
measure: Number of days to recidivism within 1 year post-intervention
timeFrame: Within 1 year post-intervention
measure: Detention within 1 year post-intervention
timeFrame: Within 1 year post-intervention
measure: Number of days to detention within 1 year post-intervention
timeFrame: Within 1 year post-intervention
measure: Adjudication within 1 year post-intervention
timeFrame: Within 1 year post-intervention
measure: Number of days to adjudication within 1 year post-intervention
timeFrame: Within 1 year post-intervention
Other outcomes:
measure: Changes in decoding skills as assessed by a SmartPhone App
timeFrame: Participants will use the SmartPhone App over a 14-week game-play period. Data will be collected during game play.
measure: Changes in word reading automaticity as assessed by a SmartPhone App
timeFrame: Participants will use the SmartPhone App over a 14-week game-play period. Data will be collected during game play.
measure: Changes in breadth of vocabulary as assessed by a SmartPhone App
timeFrame: Participants will use the SmartPhone App over a 14-week game-play period. Data will be collected during game play.
Locations:
city: Houston
country: United States
facility: Burnett-Bayland Rehabilitation Center (BBRC)
state: Texas
Study officials:
affiliation: BCM
name: Elena L Grigorenko, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Grigorenko EL. Learning disabilities in juvenile offenders. Child Adolesc Psychiatr Clin N Am. 2006 Apr;15(2):353-71, viii. doi: 10.1016/j.chc.2005.11.001.
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citation: Walker, H. M. & Sprague, J. R. The path to school failure, delinquency, and violence: Causal factors and some potential solutions. Intervention in School and Clinic 35, 67-73 (1999).
citation: Edmonds MS, Vaughn S, Wexler J, Reutebuch C, Cable A, Tackett KK, Schnakenberg JW. A Synthesis of Reading Interventions and Effects on Reading Comprehension Outcomes for Older Struggling Readers. Rev Educ Res. 2009 Mar 1;79(1):262-300. doi: 10.3102/0034654308325998.
citation: Wexler, J., Pyle, N., Flower, A., Williams, J. L. & Cole, H. A synthesis of academic interventions for incarcerated adolescents. Review of Educational Research 84, 3-46 (2014).
citation: U.S. Department of Education, O. o. E. T. Enhancing teaching and learning through educational data mining and learning analytics: An issue brief. (U.S. Department of Education, Washington, DC, 2012)
citation: Baker, R. S. J. D. & Yacef, K. The state of educational data mining in 2009: A review and future visions. Journal of Educational Data Mining 1, 3-16 (2009).