Math Interactive Learning Experience (MILE)
Study: Kable et al. (2007); Bertrand (2009); Coles et al. (2009)

Describe how students were selected to participate in the study:

To partake in the MILE study, students ages three-to-ten years of age were recruited from a medical clinic that provided diagnostics and interventions for children affected by prenatal exposures to alcohol and other substances. Students also were recruited from the community through advertisements in the local newspaper, mailings to school systems, pediatricians, and medical care providers. Children who participated in the initial MILE study (see Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009) were recruited from a multidisciplinary clinic that evaluated children to rule out the effects from prenatal alcohol and other exposures and from the larger community. To be considered for participation in the study, children had to be with the current caregiver for at least sixth months prior to enrollment and expected to remain with their current caregiver for the following sixth months. Children were excluded from the study if their cognitive abilities fell within the moderately intellectually impaired range (Intellectual Quotient <50) or if they exhibited significant mental health or other clinical or behavioral diagnoses (e.g., autism) that would interfere with benefitting from the intervention. However, children who had a dual diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) were included in the study. After the initial screening and consenting of the caregivers, all possible participants received a physical examination by a pediatric geneticist to assess for the physical characteristics associated with the effects from prenatal alcohol exposure. Also, all children received a neurobehavioral evaluation assessing cognitive abilities, visual-motor skills. visual attention, and a mathematics pre-test. To assess children’s behavior at home and at school, caregivers and children’s teachers completed behavioral checklists. All children enrolled in the study had a diagnosis of Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS), or significant alcohol-related dysmorphia.

Describe how students were identified as being at risk for academic failure (AI) or as having emotional or behavioral difficulties (BI):

Many children affected by prenatal alcohol exposure exhibit impairments in mathematics. Students were considered at risk for problems if they had a medical diagnosis of Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS), or significant levels of alcohol-related dysmorphia or changes to physical features associated with the effects from prenatal alcohol exposure. An interdisciplinary team consisting of a geneticist, clinical and pediatric psychologists, and an educational specialist conducted the evaluation to determine if physical abnormalities, cognitive impairments, learning problems, behavioral challenges, and difficulties with arousal regulation were due to the effects from prenatal exposure to alcohol. The interdisciplinary team followed the criteria established by the Institute of Medicine to confer a medical diagnosis of FAS, or pFAS. See Stratton K, Howe C, Battaglia F (Eds.) (1996) Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment. National Academy Press, Washington, DC. for a complete discussion on the diagnostic criteria used at the time of the 2007 MILE study. In Kable et al., 2007 it stated that children who received the math intervention had cognitive scores as measured by Differential Ability Scales, Second Edition, General Conceptual Ability standard score (mean of 100, standard deviation of 15 points) of 81.1 (SEM: 12.4) which would fall near the 10th percentile, when compared to the national standardization sample of children the same age. As noted in the Coles et al., 2009 article submitted with this document, the pre-test raw scores on the Test of Early Mathematics indicated that children in the math group answered on average 23 (SEM: 14.6) items correctly. On the Key Math pre-test, children in the math group answered on average 24.2 (SEM: 11.8) items correctly. The children in the control condition who received standard level of care had an average of cognitive scores as measured by the General Conceptual Ability from Differential Ability Scales, Second Edition, standard score (mean of 100, standard deviation of 15 points) of 83.1 (SEM: 14.9) which would fall at the 13th percentile when compared to age-matched peers.

ACADEMIC INTERVENTION: What percentage of participants were at risk, as measured by one or more of the following criteria:

• below the 30th percentile on local or national norm, or
• identified disability related to the focus of the intervention?

50.0%

BEHAVIORAL INTERVENTION: What percentage of participants were at risk, as measured by one or more of the following criteria:

• emotional disability label,
• placed in an alternative school/classroom,
• non-responsive to Tiers 1 and 2, or
• designation of severe problem behaviors on a validated scale or through observation?

%

Specify which condition is the submitted intervention:

The intervention or math group, consisted of children with a diagnosis of FAS, pFAS, or evidence of significant levels of physical anomalies related to the effects from prenatal alcohol exposure as determined by a trained geneticist. They participated in six weeks of one-on-one math intervention using MILE. Also, they received a neurodevelopmental evaluation, assistance with educational placement, and support to develop their Individualized Education Program (IEP) at their home school.

Specify which condition is the control condition:

The children with a diagnosis of FAS, pFAS, or had significant levels of alcohol-related dysmorphia who were not randomly assigned to the math intervention group, were assigned to the psychoeducational contrast group, or control group. The participants in the psychoeducational contrast group received the general standard of care (no math intervention using MILE). Similar to the children in the intervention group, the children in the psychoeducational contrast group received a neurodevelopmental evaluation, :assistance with educational placement, and support for the development of the Individualized Education Program (IEP) at their home school.

If you have a third, competing condition, in addition to your control and intervention condition, identify what the competing condition is (data from this competing condition will not be used):

N/A

Using the tables that follow, provide data demonstrating comparability of the program group and control group in terms of demographics.

Grade Level

Race–Ethnicity

Socioeconomic Status

Disability Status

ELL Status

Gender

What method was used to determine students' placement in treatment/control groups?

Random

Please describe the assignment method or the process for defining treatment/comparison groups.

Prior to random group assignment of either the treatment group or standard care group, all caregivers attended two workshops/trainings: 1) the first training covered the impact of prenatal alcohol exposure on development and learning, special education services, and advocating for their children, and 2) the second training covered building positive behavioral regulation skills in children. After the caregivers completed the two trainings, participants were randomly assigned to either the math intervention group or a psychoeducational contrast group who received the standard level of care and did not receive the MILE intervention.

What was the unit of assignment?

Other

If other, please specify:

Children. After caregivers attended the two trainings, children were randomly assigned either to the mathematical intervention group or to the psychoeducational contrast group representing a control group that did not receive the mathematical intervention.

Please describe the unit of assignment:

What unit(s) were used for primary data analysis?

Schools
Teachers
Students
Classes
Other
If other, please specify:
Children. Children with FAS, pFAS, or significant alcohol-related dysmorphia who received the math intervention as compared to children who received the standard level of care.

Please describe the unit(s) used for primary data analysis:

How was the program delivered?

Individually
Small Group
Classroom

What were the background, experience, training, and ongoing support of the instructors or interventionists?

The initial instructors for the MILE training were teachers who had completed at least a masters degree in special education or psychology, and post-doctoral fellows in psychology. Each instructor attended a two-day MILE workshop. Each instructor was observed by the trainer over three sessions using the MILE Fidelity Checklist to provide feedback regarding implementation of MILE.

Describe when and how fidelity of treatment information was obtained.

Using the MILE Fidelity Checklist , the program developers or MILE trainer would observe the instructors to provide information on areas needed to be improved or adjusted to maintain program fidelity. MILE instructors were observed working with a student over three sessions at different time points over the course of implementing the MILE program. During each observation, the trainer used the MILE Fidelity Checklist to rate the instructor in areas of preparedness for the session, use of the defined MILE instructional approaches, adherence to the MILE protocols, and positive interactions with the students. The trainer would assign 2 points for the instructor consistently demonstrating the protocol correctly, 1 point for partially or sometimes demonstrating the behavior during the session, and no points if the instructor did not demonstrate the behavior during the session. A total of 30 points would be obtained for each session. The objective was to have the instructor reach 30 points by the end of the last training observation.

What were the results on the fidelity-of-treatment implementation measure?

MILE instructors were trained by the developers of the program. Instructors were observed using the thirty-item Instructor Fidelity and Observation Checklist. Instructors were considered prepared to implement MILE when they exhibited all the teaching behaviors indicated on the Instructor Fidelity and Observation Checklist. A copy of the Instructor Fidelity and Observation Checklist can be provided upon request.

Was the fidelity measure also used in control classrooms?

N/A

For any substantively (e.g., effect size ≥ 0.25 for pretest or demographic differences) or statistically significant (e.g., p < 0.05) pretest differences, please describe the extent to which these differences are related to the impact of the treatment. For example, if analyses were conducted to determine that outcomes from this study are due to the intervention and not pretest characteristics, please describe the results of those analyses here.

As indicated in the 2007 article by Kable, Coles, and Taddeo, an analysis was conducted to determine if there were differences in characteristics of groups that might influence the results. The analysis indicated that that there were no differences between the Math intervention group and the Psychoeducational Contrast group, who did not receive the MILE intervention, regarding age, sex, race, socio-economic status, cognitive functioning. There was a difference regarding birth weight with the Math intervention group having significantly lower birth weight when compared to the Psychoeducational Contrast group [Math group birthweight 2084.4 grams, SD = 785 grams; Psychoeducation Contrast group birthweight 2677.7, SD = 818, p = .024]. Birth weight was not included in statistical analysis.

Please explain any missing data or instances of measures with incomplete pre- or post-test data.

N/A

If you have excluded a variable or data that are reported in the study being submitted, explain the rationale for exclusion:

The MILE study used an investigator created task to assess number writing skills called the Number Writing Task. Interrater reliability is unavailable for the Number Writing Task.

Describe the analyses used to determine whether the intervention produced changes in student outcomes:

MILE was designed to improve thinking skills embedded within the context of mathematics, an area often impaired in children affected by prenatal alcohol exposure. The program focused on basic mathematical skills such as counting, cardinality, number magnitude, basic arithmetic, and shape and size comparisons. This is reflected the test measures used to assess the effectiveness of the program. As stated in the article by Kable , Coles, and Taddeo (2007) To examine outcomes, the statistical analysis combined raw scores on the components from TEMA-2, Bracken, and the Key Math Revised -NU and conducted a principal component analysis with a varimax rotation. This gave a math development factor for the pretest that accounted for 92.7% of the variance between math measures. It also accounted for 90.2% of the variance for the post-test. A multivariate analysis of covariance was conducted on the post-math functioning scores while controlling for the pre-math functioning scores. The results indicated that a significant treatment effect was found for post-math functioning [F(3, 43)= 5.34, p = 0 .003] Children who did not receive the MILE intervention showed gains in mathematics; but less than those who received the MILE intervention [F(3, 43) = 2.97, p < 0.04, partial eta-squared = 0.17, medium effect size]. Additionally, students' pre-and-post test performance were coded as either "yes" to indicate a clinically significant gain defined as an increase of at least one standard deviation from the mean from pre-to-post test performance on any of the mathematical outcomes, or "no" indicating no statistically significant gain on any of the outcomes. A clinically significant gain was defined as a gain of >1 standard deviation on the post-test when compared to the pre-test on at least one of the mathematics outcome measures. Results showed that the children who received the MILE intervention were more likely to exhibit a clinically significant gain on the post-test after receiving intervention [ 58.6 vs 23.1%, X (1,55) = 7.1, p < 0.0008]. This finding suggests that MILE was an effective approach to improve mathematical skills in children affected by prenatal alcohol exposure.