How to enhance attentional capacity and inhibitory control to school-aged children with autism through digital learning: A developmental instructional design

How to enhance attentional capacity and inhibitory control to school-aged children with autism through digital learning: A developmental instructional design | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article How to enhance attentional capacity and inhibitory control to school-aged children with autism through digital learning: A developmental instructional design Tania Chasiotou, Symeon Retalis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8813748/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Taking into consideration the importance of executive functions (EF) in children’s development and the notion that these are hardly included in the official school programs, the aim of the current research was to develop a digital attention training for improving inhibitory control (IC) as a teaching practice for children with autism, including motion in the context of multi-level approach in autism education. For this purpose, the Kinems motion-based learning platform was applied during the regular program in a special primary school in Greece. A developmental instruction design implemented utilizing the principles of learning trajectories (LTs) and Curriculum Research Framework (CRF). Results indicate improvements in attention capacity and IC as well as in visuo-motor skills, suggesting that computer-based cognitive training combined with individualized and developmental instructional design could be effective in the school context for enhancing EF in children with autism. This research may give new insights to practitioners on how to integrate EF goals in their teaching practice. autism developmental instruction learning trajectories attention training inhibition Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Attentional capacity and inhibitory control in autism Autism is a neuro-developmental disorder that is characterized by deficits in social communication and interaction, as well as restricted, repetitive patterns of behaviour or interests (Diagnostic and Statistical Manual of Mental Disorders, DSM-5; American Psychiatric Association [APA], 2013). Given that attention has been widely viewed as pivotal to the construct of a central executive (Reynolds & Romano, 2016 ), we believe that attention along with goal-directed behavior is foundational for inhibitory control (IC). Our understanding regarding the fundamental role of attention in EF research and the mutual relation between attention, inhibition and WM is in complete line with Petersen’s and Posner’s (2012) framework of attention. In relation to atypical attention development in autism spectrum disorder (ASD), Posner’s and Petersen’s framework may give an efficient theoretical background for explaining attention and EF difficulties. Attention impairments in autism are obvious even at first level (alerting network) and are associated with the difficulty maintaining appropriate levels of alertness (hypo-or hyper-arousal) and reduced response to novel information (Keehn et al., 2013 ); although there is also evidence for intact alerting attention in school-aged children with ASD (Mutreja et al., 2015 ). Deficits in orienting network have been consistently observed in individuals with ASD, including impairments in disengagement and shifting attention to both social and non-social audio-visual stimuli (e.g. Keehn et al., 2021 ). Recent research confirms these findings in young children with autism, supporting the need for early intervention programs focusing on attentional shifting (Wang et al., 2025 ). Executive dysfunction theory of ASD, according to which several autism symptoms may arise from disruptions in EF (Damasio & Maurer, 1978 ), has been received increased attention in autism research previous years. Studies so far present mixed results urging the debate between researchers in the field whether executive dysfunction (particularly set shifting, WM & inhibition) is a primary deficit (e.g. Hill, 2004 ; Pennington & Ozonoff, 1996), or secondary to the development of ASD (e.g. Dawson et al., 2002 ; Yerys et al., 2007 ). In relation to inhibition, as a central EF, previous and recent studies (e.g. Mosconi et al., 2009 ; Schmitt et al., 2018 ) found associations between reduced inhibitory control and repetitive behaviors in ASD. In the question “how inhibition in autism is wired in brain and how is being developed throughout age”, fMRI and developmental studies might give some answers to this multidimensional aspect. For instance, a recent meta-analysis of 33 fMRI studies (Zhang et al., 2020 ), concludes that the brain network for inhibition in autism appears to follow similar patterns as this one of TD individuals (e.g. Padmanabhan et al., 2015), however, differences in brain activation are evident. Regarding the development of inhibition-specific brain networks, research in typical development demonstrates a progressive maturation from childhood to adulthood and particularly age-related increase of parietal activation in adolescence (McKenna et al., 2017 ). Autism studies, which show dominance of frontal activation in adolescence but not parietal and temporal activity, might indicate a slow maturation of inhibition-specific brain networks in ASD reaching adult levels later in life (Padmanabhan et al., 2015). Results from a large-scale study (Schmitt et al., 2018 ), including individuals from 5 to 28 years, are in line with Padmanabhan’s and colleagues’ findings (2015) suggesting typical age-related improvements in inhibitory control during late childhood or early adolescence are reduced in ASD. A conclusion could be that age-related improvement in ASD might be evident in certain ages where inhibitory processes are more mature or reach almost the same level as TD. Apart from each study characteristics which obviously affect findings, impairments seem to be heightened in late childhood to adulthood because of the increased differentiation of adult levels in TD; most tasks reach the adult level in TD until 11 years (Keehn et al., 2013 ). In adulthood differences may soften because of maturity in neural level and behavior. In studies with preschoolers, findings are more ambiguous because inhibitory abilities in TD are still developing, exhibiting a radical increase between 4 and 7 years of age. Thus, in preschool years (under 6) IC is not yet mature in both groups. Interventions for the development of executive functions in autism Previously, it was discussed how attention and inhibition are being developed in autism. The question that is set here concerns not only ways of intervening, but also how effective these could be. The approaches that have been extensively studied concern i) cognitive activities that are included in educational contexts as part of the educational program (curriculum-based training), ii) physical activities, and iii) digital training (computer-based). These approaches may be applied separately or in combination. In school settings curriculum-based interventions have been mostly applied in pre-school years, whereas physical activities and computer-based training although have a wide application, as far as the age range is concerned, they are mostly applied in clinical or research settings (Serpell & Esposito, 2016). Regarding their effectiveness, Serpell and Esposito (2016) claimed that the approach to achieving the most visible results is technology-based cognitive training. However, they conclude that for the most effective application, computer-based cognitive training should be included in the classrooms in combination with programs that enhance self-regulatory skills. Nevertheless, we barely know whether changes in behavioral level relate to changes in neural level and if these can be sustained in time. There is evidence though that the total time of exercise and the systematically increased level of difficulty consist as important indicators for the highest effect of EF training (Diamond & Ling, 2016 ). A developmental perspective of instruction A critical point of this research was an attempt to apply a developmental theoretical framework of cognitive training. For this purpose, we adopted Miyake’s and Friedman’s (2000) theoretical framework. They proposed a model in which the three most common EF variables (mental shifting, working memory {WM} and inhibition) are partially independent but still correlated. They also suggested that the degree of unity or diversity of EF varies from age to age exhibiting different developmental trajectories. In line with the Miyake’s “Unity and Diversity” model, we adopted too the Friedman’s and Miyake’s (2004) model of inhibition, in which prepotent response inhibition and resistance to distractor interference are closely related and count as a single latent variable. Although there is evidence that the two inhibition types (response inhibition & interference control) are developed differently in autism and they are affected differently by age and cognitive ability [IQ] (Geurts et al., 2014 ; Tonizzi et al., 2022 ), in our studies we could not separate them, as these skills are trained simultaneously through the visuo-motor digital activities we have used in the intervention. In addition, we took into consideration the studies by Garon and colleagues ( 2018 ) as well as Kouklari and colleagues ( 2018 , 2023 ) which indicate linear improvements in children with ASD throughout chronological and mental age in both functions of IC exhibiting a similar developmental pattern as in TD, although in autism the development is delayed. In addition to developmental trajectories of IC, we had to distinguish too which skills developmentally precede and which follow. For this reason, the developmental stages we set in our training are largely based on task-based research completed by Garon and colleagues ( 2008 ), utilizing previous developmental studies in early childhood (e.g. Carlon, 2005). Garon and colleagues ( 2008 ) first distinguished inhibition between the simple and complex response inhibition according to the dependance of each function to WM and then grouped tasks in these two categories. The same model was applied not only in TD children, but also in children with ASD (Garon et al., 2018 ), which is the focus group in our study. A primary goal of this work was to apply the developmental integrative framework within the teaching practice. For this purpose, the concept of learning trajectories (LT) was implemented. The term LT was first used by Simon ( 1995 ) to represent the stages or paths of learning when the students’ progress from their own starting points toward an intended learning goal. In our work for implementing the school-based digital cognitive training using a developmental approach, we adopted the concepts of the Curriculum Research Framework (CRF), initially proposed by Clements ( 2007 ). Based on the research of LTs, Clements initiated the CRF as an alternative model for building a scientific base on curriculum development, including 10 cyclic phases, which are structured into three categories; (1) building a research foundation ( a priori foundation ), (2) building LTs based on children’s cognition and learning ( learning model ) and (3) evaluating these in a formative and summative way ( evaluation ). Clements’ framework was recently tested in STEM education with useful implications in teaching practice (Guss et al., 2024 ). Aim and Rationale This research originates from the principles of action research. A crucial characteristic of action research is the cyclical process that includes, coming into agreement with the cyclic phases of CRF, and particularly: i) the observation of a practice or situation, ii) the identification of a problem, iii) the action for a successful change and iv) finally, the evaluation and modification (Efrat Efron & Ravid, 2019 ). In our case the need for change emerges from the ascertainment that school programs are not designed to offer EF training in their curriculum, although executive functioning is very important for children’s development and schools constitute the natural learning environment for children. Considering the lack of targeted interventions in schools for improving EF and the positive effects of game-based learning in autism (Mohd Iftitah et al., 2025 ), the purpose of the current study was to investigate whether visual attention and IC could be further developed in school-aged autistic children, through digital cognitive training that applies a developmental instruction design. Thus, the main goal of the study was to implement the Kinems online educational platform in the school program for improving attention capacity and IC in school-aged autistic children applying the principles of CRF (Clements, 2007 , Samara & Clements, 2024 ). In addition, large interactive board was used to integrate motion in our training within a context of low-level embodied learning (Rosales et al., 2025 , for a review ) and multi-level developmental approach in autism education (Iverson et al., 2023 ). Methods and Design Participants Five children (4 boys and 1 girl) with ASD and mean chronological age 7,10 years, participated in the study. The mean mental age of these children was 5,7 years (Table 1 ). Four children were initially included in the study. However, after a drop out of one child for medical reasons, two more children were included. Children attended four different classrooms with different functionality levels (including daily life skills/ adaptivity, academic skills). Inclusion criteria were an official ASD diagnosis made by registered psychiatrists in Greece, prior to their enter to the primary school, and having Greek as the first language. All children could use simple sentences to communicate and could understand simple verbal instructions. Child 4 used both spoken language and the PECS system to communicate (Frost & Bondy, 2002 ). Also, all children come from families with a middle-class socio-economic status in Greece. As excluding criteria, we set language barriers for children that did not speak and understand Greek and severe behavior problems, such as high rate of self-injurious behavior. Table 1 Raven’s: Colored Progressive Matrices (CPM) Participants Chronological Age (Years & months) Mental Age (Years & months) Non-verbal Mental Ability Child 1 8.9 6.6 90 Child 2 6.9 5 90 Child 3 7.3 6 95 Child 4 9.3 6 80 Child 5 7.5 5 85 Mean Ages 7.10 years 5.7 years 88 Collecting data and Measures Task of Selective Visual Attention (TSVA; Simos et al., 2007b ): TSVA measures selective and sustained attention. This pen and paper task illustrates on a single sheet of paper an array of images of well-known objects, and the child is asked to mark a certain image which appears a few times in the array under time restrictions through several distractors. The total score is derived by counting the cancellation errors. The test has been standardized for use in Greek population with good psychometric qualities (Chronbach’s α > .63). Raven’s Colored Progressive Matrices (CPM; Sideridis et al., 2015 ). This is a standardized non-verbal measure that assesses participants’ ability to reason by analogy. The CPM consists of three 12-item sets, which progressively increase the level of difficulty with set A being the easiest, set Ab moderate and set B presenting the most challenging items. Each item consists of an incomplete pattern, and the participant is asked to fill in the missing part by selecting a correct option from below. Raven’s CPM test-retest reliability was found with a coefficient of r >. 90 (Antoniou et al., 2022 ; for further psychometric analysis ). Psychometric Criterion of Perception Function for Children and Adolescents (CPF) (Stogiannidou, 2008 ). This is a standardized screening test assessing a range of skills, such as sensory-motor integration, executive functioning and the possibility of mild neurological atypicalities in children’s development. For the purposes of the study a selective administration was conducted, and particularly the scale of “Visuo-motor coordination” (VMC) and the scale of “Spatial perception” (SP) were used. These scales particularly assess visual attention and perception, fine-motor skills and hand-eye coordination. The internal validity of CPF was high in both VMC and SP scales (VMC: Cronbach’s a= .88 & SP: Cronbach’s a= .92). Also, a test-retest reliability was found for both scales (VCM: r=.52, p < .001 & SP: r=.76, p < .001) Learning and kinesthetic analytics : Kinems educational platform was used ( https://kinems.com ). This provides the potential of a dynamic assessment, while recording the learning performance and reaction time of each student in the form of tables, graphs and reports, and saved in a cloud-based system. The Kinems platform has been successfully tested in both mainstream schools (Aloizou et al., 2024 ; Kosmas et al., 2019 ) and special education in different population, such as children with ADHD (Retalis et al., 2014 ), children with motor impairments (Altanis et al., 2013 ) and children with ASD (Farsari & Nitsiou, 2025 ), even as a tele-education platform for children with special educational needs (SEN) during the COVID-19 lockdown (Aloizou et al., 2021 ). To this extent, we would like to point out that autism severity level was not assessed. Besides recent research supports no relationship between autism severity and inhibition (Memisevic et al., 2023 ). Procedure, Duration and Setting All data are anonymized and collected by the first author as a teacher at school unit in the context of educational practice. Prior to the implementation of EF training, an informed consent was given by the school principal according to the recent Greek Law (L.4823/2021; Article 88, Par. 1). A written informative and consent form was given to parents of the participants. Once the consent forms were selected, the pre-baseline phase was started. During that phase, we asked parents to complete the BRIEF rating scale (Gioia et al., 2013) and the Sensory Profile Questionnaire (Dunn, 1999 ) for having a more comprehensive profile of the children’s EF daily-life skills, sensory-motor skills as well as possible sensitivities, prior to starting the intervention. In addition, informal discussions with children’s teachers and therapists were held. Pre-intervention, post-intervention and follow-up assessments were conducted through the standardized tests described above. Children’s non-verbal ability was tested once, whereas attention and motor skills were reassessed. In the baseline phase, apart from the standardized measures, the learning analytics from the Kinems platform were also used to set the level of training for each child. During all phases the Kinems online learning platform was applied. Regarding the duration of the main phases per study (pre-intervention assessment, baseline, intervention and post-intervention assessment), this was about 18 weeks with the intervention lasting about 12 weeks (Table 2 ). The frequency was twice per week. However, the total duration and frequency of training for each child were heavily dependent on several factors, such as the school’s timetable and the classroom’s conditions, as research took place in authentic classrooms, each child’s distractibility during training, each child’s ability to correspond to the tests’ instructions and of course other reasons of absence at school, like health issues. The setting of the research was a special primary school in Athens. All the research phases were implemented there during the regular school program. Table 2 Duration per research phase Pre-intervention assessment (CPM, TSVA, CPF) 2–3 weeks Baseline (Kinems activities) 2 weeks Intervention (Kinems activities) 12 weeks Post-intervention assessment (TSVA, CPF) 2 weeks Follow-up assessment (TSVA, CPF) 2 weeks Follow-up assessment (Kinems activities) 2 weeks Experimental Design This single-case study followed a combined design according to WWC, 5.0 version (2022). However, changing criterion design was the main implementation of the study with embedded elements of multiple baseline design, such as concurrence and implementation across participants. The changing criterion design can be considered a special variation of multiple baseline designs in a way that each phase serves as a baseline for the subsequent one. The unique feature of changing criterion design is that the intervention phase is a set of several subphases (e.g. B1, B2 etc.). Another main feature of this design is that a criterion is set during the intervention phase. As performance meets that criterion, the criterion is made slightly more stringent for the next subphase until the final goal-behavior is achieved. Experimental control is demonstrated when behavior changes repeatedly to meet the new criterion, which is the level of the independent variable (Byiers et al., 2012 ). The changing criterion designs are ideal when a series of graduated steps is needed for shaping behavior. In our study, because the children’s level of distractibility was very high, we had to gradually shift the goal-performance, so greater levels of attention and IC could be achieved in each subphase. The baseline criterion that was set prior to the IC training was that each child should be able to sustain attention to the activity at least for 1’, without the need to inhibit distractors. Thus, the starting point criteria for each child (sustained attention training-Level 1) were to be able to complete a very short visuo-motor search activity without distractors and achieve a mean score of 75% or greater and at least 80% performance in two categories (e.g. find fruits and vegetables) in three different times. Once these two criteria were achieved, then the levels of distractors (1,2,3 and multiple distractors) were gradually modified to be more challenging for the children. The criteria that had to be achieved to advance the goal-behavior to the next level were the following: a) mean score of 70% or greater and b) 75% score in at least two categories. When the researcher wanted to challenge the child’s motion speed, then at least one out of two criteria had to be achieved. The final goal-behavior was children to be able to sustain attention in a short visuo-motor search activity, while inhibiting multiple distractors. The implemented design consisted of three phases in different time periods: baseline (phase A), intervention and post-intervention assessment (phase B) and follow-up (phase C), after 5 months of the last training session for the Children 1,2,3 and 4, whereas after 4 ½ months for the Child 5. During the intervention specific prompting techniques from the applied behavior analysis (see Bondy, 2011 ) such as physical, verbal prompt and delay prompting were used throughout training for enhancing children’s performance. The technique of modelling was used in the first session of each level during the intervention, and additionally physical prompting was given from the level of sustaining attention without inhibiting distractors to the level of inhibiting one distractor. Also, full physical prompts were given during the intervention and follow-up phases when children’s performance fell at the success rate of 50% or less. To control possible confounding factors, classroom teachers were also included in the intervention phase. Finally, for challenging children’s motor control, motion speed was increased when at least one of the two criteria was reached (i.e. a minimum mean score per level 70% or a minimum score of 75% in two categories). Analysis and Results Visual analysis was conducted using the Excel program for the graphics. Visual inspection from the Kinems learning analytics indicates higher level of IC exhibiting from the baseline to follow-up for all children. Specifically, Child 1 increased her attention and inhibitory skills by 2 levels through training (Fig. 1 ). Increase in the child’s performance was also apparent through TSVA (Table 3 ) and CPF (Tables 4 a & 4 b). Due to time limitations (school ending) post-intervention assessment was not able for the CPF in both sub-tests. Also, the child could not complete the spatial perception sub-test during the pre-intervention assessment, which was the most demanding test, however, this was completed during the follow-up. Additionally, because of fluctuation in performance during Follow-up 1, more testing in more categories was initially planned. Nevertheless, due to technical reasons with the interactive board, follow-up 2 completed with the use of tablet. Interestingly, much greater performance was achieved through tablet, giving evidence that full-body motor control ability challenged motor inhibition. Figure 2 shows slight increase (1 level) in IC for Child 2, however, marked rise is apparent through TSVA performance (Table 3 ) in post-intervention assessment. This difference again might indicate that motor control ability strongly affects motor inhibition. Also, performance in visuo-motor skills increased, especially in spatial perception (Table 4 b). For Child 2 two follow-ups were conducted, as level 2 reached none of the two criteria. Thus, he was tested at both levels during the follow-up phase. It is also noteworthy that Child 2, although exhibited high rate of challenging behaviors during typical learning at school, was very cooperative and with positive emotion while he was engaged with the Kinems activities. Children 3 and 4 exhibited the highest increase in performance throughout training. Child 3 particularly, who is also diagnosed with ADHD, increased his performance to 3 levels both in attention capacity and IC as well as in motion speed (Fig. 3 ). Increase in performance was also apparent in TSVA and CPF (Tables 3 , 4 a & 4 b). The increase of performance during follow-up in TSVA and CPF might come as aftereffect of the use of the Kinems platform after completing cognitive training or external factors might heighten the performance, such as less distractibility in the surrounding environment during testing, or other training/intervention that might affect attention capacity. To this extent, it is noteworthy to clarify that for ethical and pedagogical reasons all children continued their therapies while implementing the attention and IC training. Child 4 increased his performance to 4 levels in attention capacity and IC, and additionally one level in motion speed throughout training (Fig. 4 ). An increase in performance in TSVA and VSM (Tables 3 & 4 a) was also apparent. Interestingly, this marked rise in performance that is illustrated in the graph is not depicted in the TVSA. A possible explanation could be that paper-and-pencil tests did not motivate the child to pay more attention to that, whereas through computer training he was very engaged to actively participate. Child 5 completed the shortest period of intervention, as he started the attention training after the dropout of another child. Although he increased his performance from the baseline to the follow-up 1 phase (sustained attention without distractors), no criteria were reached in level 1 IC training. Thus, two follow-ups were planned to be conducted (Fig. 5 ). The follow-up 2 was completed with a different medium (tablet) due to technical reasons with the classroom’s interactive board. Similarly to Child 1, it was noticed that accuracy rate with the tablet (see follow-up 2 phase) was greater than the training with the interactive board (see phase level 1) where full-body motor control was needed. In this case, comparison between training and follow-up is not feasible, however, the high difference in performance gives evidence that motion control ability strongly affects child’s visual attention and inhibition. In addition, taking into consideration child’s performance from the baseline in TSVA (the highest in the study), it seems that for this child motion rather than inhibiting distractors was the greatest challenge (Table 3 ). Regarding performance in CPF, VSM increased 3 standard scores between pre-intervention and follow-up assessment and additionally the child completed the SP sub-test during follow-up, which he could not complete before the intervention (Tables 4 a & 4 b). Post-intervention assessment was not completed because of time limitations (school ending) and child’s absence from school the second week of post-intervention assessment. Table 3 Task of Selective Visual Attention (TSVA) Participants Pre-Intervention Post-Intervention Follow-up Final Score Standard Score Final Score Standard Score Final Score Standard Score Child 1 0,20 5 0,23 10 0,23 5 Child 2 0,07 < 5 0,22 30 0,23 25 Child 3 0,11 5 0,18 10 0,25 20 Child 4 0,08 < 5 0,20 5 0,24 10 Child 5 0,22 20 0,23 25 0,23 10 Table 4 . Psychometric Criterion of Perception Function for Children and Adolescents (CPF) Table 4 a. Sub- test I: Visuo-motor coordination (VSM) Participants Pre-Intervention Post-Intervention Follow-up Final Score Standard Score Final Score Standard Score Final Score Standard Score Child 1 14 7 - - 20 10 Child 2 9 5 10 5 11 6 Child 3 15 8 15 8 18 9 Child 4 13 6 21 10 17 8 Child 5 11 6 - - 18 9 Table 4 b. Sub- test II: Spatial perception (SP) Participants Pre-Intervention Post-Intervention Follow-up Final Score Standard Score Final Score Standard Score Final Score Standard Score Child 1 - - - - 16 1 Child 2 10 2 13 4 13 4 Child 3 13 6 13 6 18 7 Child 4 7 0 9 0 10 0 Child 5 - - - - 14 5 Discussion Findings suggest improvements in attention and IC in all children and better performance in visuo-motor skills to most children, even after five months of completing the digital cognitive training. In line with recent research (Mohd Iftitah, 2025; for review ) high engagement with the Kinems activities was observed with all children, especially those who are easily overwhelmed, exhibiting high rates of challenging behaviors (e.g. children 1,4) and those looking for intense visual stimuli (e.g. child 3). In addition, we found that the different medium (interactive board, tablet; Figs. 1 & 5 ) as well as motion speed (Fig. 3 ) strongly affected the accuracy rate (especially in child 1) and the stability in performance, suggesting that motor control ability affects the visuo-motor attention capacity and motor inhibition. Indeed, findings from a recent study (Liu et al., 2023 ) give evidence for a relationship between attention, impulse control and motor function impairment in school-aged children with ASD, suggesting that motor skill performance may reflect underlying difficulties in EF. Regarding the differentiation of performance between testing using static stimuli (TSVA) and the Kinems visuo-motor activities (e.g. see the case of child 5), research in the field of object motion and dynamic attention in ASD is not clear yet; although there is evidence for locomotor impairments (Gandotra et al., 2020 ; for review ). For instance, Koldewyn and colleagues ( 2013 ) previously found a decreased capacity of school-aged children with autism to select and maintain attention on multiple targets, but not deficits in dynamic attention even with increased object speed. On the contrary, Sheppard and colleagues ( 2016 ), found difficulties while judging the location of moving objects in adults with ASD. Findings from a more recent study (Zhou & Benson, 2025 ), support impairments in visual disengagement both in static and dynamic stimuli in young autistic children, with more delayed disengagement demonstrated when motion is presented. Our assumption is that when children need to process dynamic stimuli and simultaneously maintain attention on multiple targets within a context of full-body interaction and control, then the cognitive load is much challenged and therefore differences in performance may be exhibited. Also, research in typical development indicates an indirect link between WM capacity and multiple object tracking (MOT) expertise (Harris et al., 2020), which sets questions on how WM contributes to visual attention and MOT in autism. Concluding the findings above, we suggest that attention and IC training could be effective in school settings through the application of digital game-based learning combined with individualized and developmental instructional design. A possible implication of this in the teaching practice is the integration of EF goals in the students’ Individual Educational Plans (IEPs) utilizing new technologies with developmental instruction. Considering the teaching context and in accordance with earlier studies (Chen et al., 2023 ; Diamond & Ling, 2016 ), we also found that the total time of exercising with the activities and the total duration of training had a significant positive impact on children’s performance. However, we agree that for the children on the autism spectrum and additional learning disabilities only exercising with the activities was not efficient. We had to apply specific teaching strategies that are usually used in special education to improve children’s performance. Another critical point for the teaching practice concerns children’s developmental stage and readiness, following a developmental pattern from the less to more demanding cognitive skills. To the best of our knowledge, this is the first study using the concept of LTs for improving attention capacity and IC in children with autism in school setting through digital learning, offering new insights to practitioners. Several limitations to this pilot study need to be acknowledged. First, the sample size was limited to generalize our results and there was no statistical control regarding cognitive ability, age and IC for understanding possible moderators. Previous research (Geurts, 2014) using direct measures suggested age as a moderator for prepotent response inhibition, whereas IQ for interference control. However, more recently (Tonizzi et al., 2021) it was found a relative independence of IQ and age from interference control, suggesting that the ability to inhibit distractors and stay focused is not affected by chronological and mental age. Another possible limitation of our study regarding the developmental pattern that has been used might concern the comorbidity of ASD with other neurodevelopmental disorders, which is very frequent within classrooms in special schools. For instance, in our study one child has been diagnosed with ASD+ADHD. Recent research indicated greater difficulties in interference control in school-aged children with ASD and ADHD from those with ASD while inhibiting distracting information, whereas the profile of children with ASD and ADHD regarding motivational inhibition was comparable to those with ADHD (Cremone-Caira et al., 2021 ). These results give evidence for a unique profile of children with ASD and ADHD, which may follow a different developmental trajectory from this one of children with ASD. Nevertheless, the effect of comorbidity with ADHD was not statistically significant in the study by Tonizzi and colleagues (2021). Finally, taking into consideration the Greek educational context in which our studies conducted, we highlight the need for more appropriate standardized tests for measuring cognitive and motor skills that can be used in special education with children having the greatest difficulties. Also, the existing measuring tools have no indicators for developmental ages. This lack of information is rather important for designing personalized and developmentally suitable interventions in both TD and ASD. Lastly, no computerized Greek standardized tests are available for measuring EF and visuo-motor skills in children. Computerized tests could increase children’s engagement in comparison to the conventional measurement tools and might be more proper for testing children with moderate to profound difficulties, especially those that struggle most in receptive language minimizing in this way the language barriers. Declarations Competing Interests The authors declare that they have no conflict of interest. Ethics Approval All procedures were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards and approved by the school Principal according to national law. All children participated in the study with their parents’ written informed consent. Clinical trials were not conducted. Funding The authors received no specific funding for this work. Author Contribution Both authors agreed with the content and gave explicit consent to submit this manuscript. Also, both made essential contributions to the conception and design of this work, the analysis and interpretation of data. In addition, consent obtained from the responsible authorities of the institute where the research has been conducted before this work is submitted. Data Availability The data that support the findings of this study are available from the corresponding author, TC, upon reasonable request. References Aloizou V, Chasiotou T, Retalis S, Daviotis T, Koulouvaris P (2021) Remote learning for children with special educational needs in the era of Covid-19: Beyond tele-conferencing sessions. 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Child Neurophychology 10(8):1088–1114. https://doi.org/10.1080/09297049.2017.1391190 McKenna R, Rushe T, Woodcock KA (2017) Informing the structure of executive functioning in children: A meta-analysis of functional neuroimaging data. Front Hum Neurosci 11(154). https://psycnet.apa.org/doi/ 10.3389/fnhum.2017.00154 Liu T, Tongish M, Li Y, Martins Okuda PM (2023) Executive and motor function in children with autism spectrum disorder. Cogn Process 24(4):537–547. https://doi.org/10.1007/s10339-023-01156-y Memisevic H, Pasalic A, Saletovic A (2023) Autism severity level affects working memory and planning but not inhibition, shifting and emotional control. Autism Res 16:1335–1343. https://doi.org/10.1002/aur.2952 Miyake A, Friedman NP, Emerson MJ, Witzi AH, Howerter A (2000) The unity and diversity of executive functions and their contributions to complex frontal lobe tasks: A latent variable analysis. Cogn Psychol 41:49–100. https://doi.org/10.1006/cogp.1999.0734 Mohd Iftitah BJ, Zainuddin BI, Hawa Najihah BMB (2025) A review of game-based learning as a tool to stimulate learning process for autism spectrum disorder (ASD) children. J Creative Arts 2(1):1–10. https://ir.uitm.edu.my/id/eprint/113498 Mosconi MW, Kay M, D’Cruz A-M, Seidenfeld A, Guter S, Stanford LD, Sweeney JA (2009) Impaired inhibitory control is associated with higher -order repetitive behaviors in autism spectrum disorders. Psychol Med 39(9):1559–1566. https://doi.org/10.1017/s0033291708004984 Mutreja R, Craig C, O’Boyle MW (2015) Attentional network deficits in children with autism spectrum disorder. Dev Neurohabilitation 19(6):389–397. https://doi.org/10.3109/17518423.2015.1017663 Padmanabham A, Garver K, O’Hearn K, Nawarawong N, Liu R, Minshew N, Sweeney J, Luna B (2015) Developmental changes in brain function underlying inhibitory control in autism spectrum disorder. Autism Res 8(2):123–135. https://doi.org/10.1002/aur.1398 Pennigton BF, Ozonoff S (1996) Executive functions and developmental psychopathology, Journal of Child Psychology and Psychiatry, and Allied Disciplines , 37(1), 51–87. https://doi.org/10.1111/j.1469-7610.1996.tb01380. x Petersen SE, Posner MI (2012) The attention system of the human brain: 20 years after. Annu Rev Neurosci 21(35):73–89. https://doi.org/10.1146/anurev-neuro-062111-150525 Retalis S, Korpa T, Skaloumpakas C, Boloudakis M, Kourakli M, Altanis G, Siameti F, Papadopolou P, Lytra F, Pervanidou P (2014) Empowering children with ADHD learning disabilities with the Kinems Kinect learning games. Presented at the 8th European Conference on Games Based Learning, October 9–10, Berlin, Germany Reynolds G, Romano AC (2016) The development of attention systems and working memory in infancy. Front Syst Neurosci 10(15). https://doi.org/10.3389/fnsys.2016.00015 Rosales MR, Dodd Butera C, Wilson RB, Zhou J, Maus E, Zhao H, Chow JC, Dao A, Freeman J, Dusing SC (2025) Systematic review and meta-analysis of the effect of motor intervention on cognition, communication and social interaction in children with autism spectrum disorder. Phys Occup Ther Pediatr 4:1–13. https://doi.org/10.1080/01942638.2025.2498357 Samara J, Clements DH (2024) The curriculum research framework. In: Thompson DR, Huntley MA,Suurtamm,C. (eds) Lessons learned from research on mathematics curriculum. Information Age Publishing Inc, US Schmitt LM, White SP, Cook EH, Sweeney JA, Mosconi MW (2018) Cognitive mechanisms of inhibitory control in autism spectrum disorder. J Child Psychol Psychiatry Allied Discip 59(5):586–595. https://doi.org/10.1111/jcpp.12837 Serpel Z, Esposito AG (2016) Development of executive functions: Implications for educational policy and practice. Policy Insights Behav Brain Sci 3(2):203–210. https://doi.org/10.1177/2372732216654718 Sheppard E, van Loon E, Underwood G, Ropar D (2016) Difficulties predicting time-to-arrival in individuals with autism spectrum disorders. Res Autism Spectr Disorders 28:17–23. https://doi.org/10.1016/j.rasd.2016.05.001 Sideridis GD, Antoniou F, Mouzaki A, Simos P (2015) The Greek version of Raven’s Colored Progressive Matrices. Motivo Assessment, Athens Simon MA (1995) Reconstructing mathematics pedagogy from a constructive perspective. J Res Math Educ 26(2):114–145. https://psycnet.apa.org/doi/10.2307/749205 Simos P, Mouzaki A, Sideridis G (2007b) Attention and focus assessment battery for 1st -5th grade of primary school (EFA). Greek Ministry of Education. Research & Religion Affairs, Athens Stogiannidou A (2008) Criterion of Perceptual Function for Children and Adolescents (CPF). In: Tzouriadou M (ed) Psychometric-differential assessment for children and adolescents with learning difficulties. Aristotele University, Thessaloniki. Department of early years education and department of psychology Tonizzi I, Giofre D, Usai MC (2022) Inhibitory control in autism spectrum disorders: Meta-analyses on indirect and direct measures. J Autism Dev Disord 52(11):4949–4965. https://doi.org/10.1007/s10803-021-05353-6 Wang W, Cheng C, Xu Z, Xue L, Fu W, Zhao J (2025) Five-year-old children with autism spectrum disorders struggling with disengaging attention. Cogn Process 26(2):415–422. https://doi.org/10.1007/s10339-025-01256-x What Works Clearinghouse (2022) What Works Clearinghouse procedures and standards handbook, version 5.0. U.S. Department of Education, Institute of Education Sciences, National Center for Education Evaluation and Regional Assistance (NCEE). https://ies.ed.gov/ncee/wwc/Handbooks Yerys BE, Hepburn SL, Pennington BF, Rogers SJ (2007) Executive function in preschoolers with autism: Evidence consistent with a secondary deficit. J Autism Dev Disorders 37(6):1068–1079. https://doi.org/10.1007/s10803-006-0250-7 Zhang Z, Peng P, Zhang D (2020) Executive function in high-functioning autism spectrum disorder: A meta-analysis of fMRI studies. J Autism Dev Disord 50(11):4022–4038. https://doi.org/10.1007/s10803-020-04461-z Zhou L, Benson V (2025) Attentional differences in young children with autism: A comparative eye-movement study using static and dynamic stimuli. Res Autism 127. https://doi.org/10.1016/j.reia.2025.202686 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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12:39:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1370895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8813748/v1/102a3b39-bfef-4ede-b01a-1eb4f742204d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"How to enhance attentional capacity and inhibitory control to school-aged children with autism through digital learning: A developmental instructional design","fulltext":[{"header":"Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAttentional capacity and inhibitory control in autism\u003c/h2\u003e \u003cp\u003eAutism is a neuro-developmental disorder that is characterized by deficits in social communication and interaction, as well as restricted, repetitive patterns of behaviour or interests (Diagnostic and Statistical Manual of Mental Disorders, DSM-5; American Psychiatric Association [APA], 2013). Given that attention has been widely viewed as pivotal to the construct of a central executive (Reynolds \u0026amp; Romano, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), we believe that attention along with goal-directed behavior is foundational for inhibitory control (IC). Our understanding regarding the fundamental role of attention in EF research and the mutual relation between attention, inhibition and WM is in complete line with Petersen\u0026rsquo;s and Posner\u0026rsquo;s (2012) framework of attention.\u003c/p\u003e \u003cp\u003eIn relation to atypical attention development in autism spectrum disorder (ASD), Posner\u0026rsquo;s and Petersen\u0026rsquo;s framework may give an efficient theoretical background for explaining attention and EF difficulties. Attention impairments in autism are obvious even at first level (alerting network) and are associated with the difficulty maintaining appropriate levels of alertness (hypo-or hyper-arousal) and reduced response to novel information (Keehn et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e); although there is also evidence for intact alerting attention in school-aged children with ASD (Mutreja et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Deficits in orienting network have been consistently observed in individuals with ASD, including impairments in disengagement and shifting attention to both social and non-social audio-visual stimuli (e.g. Keehn et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Recent research confirms these findings in young children with autism, supporting the need for early intervention programs focusing on attentional shifting (Wang et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Executive dysfunction theory of ASD, according to which several autism symptoms may arise from disruptions in EF (Damasio \u0026amp; Maurer, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1978\u003c/span\u003e), has been received increased attention in autism research previous years. Studies so far present mixed results urging the debate between researchers in the field whether executive dysfunction (particularly set shifting, WM \u0026amp; inhibition) is a primary deficit (e.g. Hill, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Pennington \u0026amp; Ozonoff, 1996), or secondary to the development of ASD (e.g. Dawson et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Yerys et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In relation to inhibition, as a central EF, previous and recent studies (e.g. Mosconi et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Schmitt et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found associations between reduced inhibitory control and repetitive behaviors in ASD.\u003c/p\u003e \u003cp\u003eIn the question \u0026ldquo;how inhibition in autism is wired in brain and how is being developed throughout age\u0026rdquo;, fMRI and developmental studies might give some answers to this multidimensional aspect. For instance, a recent meta-analysis of 33 fMRI studies (Zhang et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), concludes that the brain network for inhibition in autism appears to follow similar patterns as this one of TD individuals (e.g. Padmanabhan et al., 2015), however, differences in brain activation are evident. Regarding the development of inhibition-specific brain networks, research in typical development demonstrates a progressive maturation from childhood to adulthood and particularly age-related increase of parietal activation in adolescence (McKenna et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Autism studies, which show dominance of frontal activation in adolescence but not parietal and temporal activity, might indicate a slow maturation of inhibition-specific brain networks in ASD reaching adult levels later in life (Padmanabhan et al., 2015). Results from a large-scale study (Schmitt et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), including individuals from 5 to 28 years, are in line with Padmanabhan\u0026rsquo;s and colleagues\u0026rsquo; findings (2015) suggesting typical age-related improvements in inhibitory control during late childhood or early adolescence are reduced in ASD. A conclusion could be that age-related improvement in ASD might be evident in certain ages where inhibitory processes are more mature or reach almost the same level as TD. Apart from each study characteristics which obviously affect findings, impairments seem to be heightened in late childhood to adulthood because of the increased differentiation of adult levels in TD; most tasks reach the adult level in TD until 11 years (Keehn et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In adulthood differences may soften because of maturity in neural level and behavior. In studies with preschoolers, findings are more ambiguous because inhibitory abilities in TD are still developing, exhibiting a radical increase between 4 and 7 years of age. Thus, in preschool years (under 6) IC is not yet mature in both groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInterventions for the development of executive functions in autism\u003c/h2\u003e \u003cp\u003ePreviously, it was discussed how attention and inhibition are being developed in autism. The question that is set here concerns not only ways of intervening, but also how effective these could be. The approaches that have been extensively studied concern i) cognitive activities that are included in educational contexts as part of the educational program (curriculum-based training), ii) physical activities, and iii) digital training (computer-based). These approaches may be applied separately or in combination. In school settings curriculum-based interventions have been mostly applied in pre-school years, whereas physical activities and computer-based training although have a wide application, as far as the age range is concerned, they are mostly applied in clinical or research settings (Serpell \u0026amp; Esposito, 2016). Regarding their effectiveness, Serpell and Esposito (2016) claimed that the approach to achieving the most visible results is technology-based cognitive training. However, they conclude that for the most effective application, computer-based cognitive training should be included in the classrooms in combination with programs that enhance self-regulatory skills. Nevertheless, we barely know whether changes in behavioral level relate to changes in neural level and if these can be sustained in time. There is evidence though that the total time of exercise and the systematically increased level of difficulty consist as important indicators for the highest effect of EF training (Diamond \u0026amp; Ling, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eA developmental perspective of instruction\u003c/h3\u003e\n\u003cp\u003eA critical point of this research was an attempt to apply a developmental theoretical framework of cognitive training. For this purpose, we adopted Miyake\u0026rsquo;s and Friedman\u0026rsquo;s (2000) theoretical framework. They proposed a model in which the three most common EF variables (mental shifting, working memory {WM} and inhibition) are partially independent but still correlated. They also suggested that the degree of unity or diversity of EF varies from age to age exhibiting different developmental trajectories. In line with the Miyake\u0026rsquo;s \u0026ldquo;Unity and Diversity\u0026rdquo; model, we adopted too the Friedman\u0026rsquo;s and Miyake\u0026rsquo;s (2004) model of inhibition, in which prepotent response inhibition and resistance to distractor interference are closely related and count as a single latent variable. Although there is evidence that the two inhibition types (response inhibition \u0026amp; interference control) are developed differently in autism and they are affected differently by age and cognitive ability [IQ] (Geurts et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Tonizzi et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), in our studies we could not separate them, as these skills are trained simultaneously through the visuo-motor digital activities we have used in the intervention. In addition, we took into consideration the studies by Garon and colleagues (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) as well as Kouklari and colleagues (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) which indicate linear improvements in children with ASD throughout chronological and mental age in both functions of IC exhibiting a similar developmental pattern as in TD, although in autism the development is delayed.\u003c/p\u003e \u003cp\u003eIn addition to developmental trajectories of IC, we had to distinguish too which skills developmentally precede and which follow. For this reason, the developmental stages we set in our training are largely based on task-based research completed by Garon and colleagues (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), utilizing previous developmental studies in early childhood (e.g. Carlon, 2005). Garon and colleagues (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) first distinguished inhibition between the simple and complex response inhibition according to the dependance of each function to WM and then grouped tasks in these two categories. The same model was applied not only in TD children, but also in children with ASD (Garon et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which is the focus group in our study.\u003c/p\u003e \u003cp\u003eA primary goal of this work was to apply the developmental integrative framework within the teaching practice. For this purpose, the concept of \u003cem\u003elearning trajectories\u003c/em\u003e (LT) was implemented. The term LT was first used by Simon (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) to represent the stages or paths of learning when the students\u0026rsquo; progress from their own starting points toward an intended learning goal. In our work for implementing the school-based digital cognitive training using a developmental approach, we adopted the concepts of the Curriculum Research Framework (CRF), initially proposed by Clements (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Based on the research of LTs, Clements initiated the CRF as an alternative model for building a scientific base on curriculum development, including 10 cyclic phases, which are structured into three categories; (1) building a research foundation (\u003cem\u003ea priori foundation\u003c/em\u003e), (2) building LTs based on children\u0026rsquo;s cognition and learning (\u003cem\u003elearning model\u003c/em\u003e) and (3) evaluating these in a formative and summative way (\u003cem\u003eevaluation\u003c/em\u003e). Clements\u0026rsquo; framework was recently tested in STEM education with useful implications in teaching practice (Guss et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e"},{"header":"Aim and Rationale","content":"\u003cp\u003eThis research originates from the principles of action research. A crucial characteristic of action research is the cyclical process that includes, coming into agreement with the cyclic phases of CRF, and particularly: i) the observation of a practice or situation, ii) the identification of a problem, iii) the action for a successful change and iv) finally, the evaluation and modification (Efrat Efron \u0026amp; Ravid, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In our case the need for change emerges from the ascertainment that school programs are not designed to offer EF training in their curriculum, although executive functioning is very important for children\u0026rsquo;s development and schools constitute the natural learning environment for children. Considering the lack of targeted interventions in schools for improving EF and the positive effects of game-based learning in autism (Mohd Iftitah et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), the purpose of the current study was to investigate whether visual attention and IC could be further developed in school-aged autistic children, through digital cognitive training that applies a developmental instruction design. Thus, the main goal of the study was to implement the Kinems online educational platform in the school program for improving attention capacity and IC in school-aged autistic children applying the principles of CRF (Clements, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2007\u003c/span\u003e, Samara \u0026amp; Clements, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In addition, large interactive board was used to integrate motion in our training within a context of low-level embodied learning (Rosales et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, \u003cem\u003efor a review\u003c/em\u003e) and multi-level developmental approach in autism education (Iverson et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods and Design","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFive children (4 boys and 1 girl) with ASD and mean chronological age 7,10 years, participated in the study. The mean mental age of these children was 5,7 years (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Four children were initially included in the study. However, after a drop out of one child for medical reasons, two more children were included. Children attended four different classrooms with different functionality levels (including daily life skills/ adaptivity, academic skills). Inclusion criteria were an official ASD diagnosis made by registered psychiatrists in Greece, prior to their enter to the primary school, and having Greek as the first language. All children could use simple sentences to communicate and could understand simple verbal instructions. Child 4 used both spoken language and the PECS system to communicate (Frost \u0026amp; Bondy, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e). Also, all children come from families with a middle-class socio-economic status in Greece. As excluding criteria, we set language barriers for children that did not speak and understand Greek and severe behavior problems, such as high rate of self-injurious behavior.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRaven’s: Colored Progressive Matrices (CPM)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eChronological Age\u003c/p\u003e \u003cp\u003e(Years \u0026amp; months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMental Age\u003c/p\u003e \u003cp\u003e(Years \u0026amp; months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNon-verbal\u003c/p\u003e \u003cp\u003eMental Ability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMean Ages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7.10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5.7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCollecting data and Measures\u003c/h2\u003e \u003cp\u003e \u003cem\u003eTask of Selective Visual Attention\u003c/em\u003e (TSVA; Simos et al., \u003cspan class=\"CitationRef\"\u003e2007b\u003c/span\u003e): TSVA measures selective and sustained attention. This pen and paper task illustrates on a single sheet of paper an array of images of well-known objects, and the child is asked to mark a certain image which appears a few times in the array under time restrictions through several distractors. The total score is derived by counting the cancellation errors. The test has been standardized for use in Greek population with good psychometric qualities (Chronbach’s α \u0026gt; .63).\u003c/p\u003e \u003cp\u003e\u003cem\u003eRaven’s Colored Progressive Matrices\u003c/em\u003e (CPM; Sideridis et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). This is a standardized non-verbal measure that assesses participants’ ability to reason by analogy. The CPM consists of three 12-item sets, which progressively increase the level of difficulty with set A being the easiest, set Ab moderate and set B presenting the most challenging items. Each item consists of an incomplete pattern, and the participant is asked to fill in the missing part by selecting a correct option from below. Raven’s CPM test-retest reliability was found with a coefficient of r \u0026gt;. 90 (Antoniou et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; \u003cem\u003efor further psychometric analysis\u003c/em\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePsychometric Criterion of Perception Function for Children and Adolescents (CPF)\u003c/em\u003e (Stogiannidou, \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e). This is a standardized screening test assessing a range of skills, such as sensory-motor integration, executive functioning and the possibility of mild neurological atypicalities in children’s development. For the purposes of the study a selective administration was conducted, and particularly the scale of “Visuo-motor coordination” (VMC) and the scale of “Spatial perception” (SP) were used. These scales particularly assess visual attention and perception, fine-motor skills and hand-eye coordination. The internal validity of CPF was high in both VMC and SP scales (VMC: Cronbach’s a= .88 \u0026amp; SP: Cronbach’s a= .92). Also, a test-retest reliability was found for both scales (VCM: r=.52, p \u0026lt; .001 \u0026amp; SP: r=.76, p \u0026lt; .001)\u003c/p\u003e \u003cp\u003e \u003cem\u003eLearning and kinesthetic analytics\u003c/em\u003e: Kinems educational platform was used (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kinems.com\u003c/span\u003e\u003cspan class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e).\u003c/span\u003e This provides the potential of a dynamic assessment, while recording the learning performance and reaction time of each student in the form of tables, graphs and reports, and saved in a cloud-based system. The Kinems platform has been successfully tested in both mainstream schools (Aloizou et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kosmas et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) and special education in different population, such as children with ADHD (Retalis et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e), children with motor impairments (Altanis et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e) and children with ASD (Farsari \u0026amp; Nitsiou, \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e), even as a tele-education platform for children with special educational needs (SEN) during the COVID-19 lockdown (Aloizou et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo this extent, we would like to point out that autism severity level was not assessed. Besides recent research supports no relationship between autism severity and inhibition (Memisevic et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure, Duration and Setting\u003c/h3\u003e\n\u003cp\u003eAll data are anonymized and collected by the first author as a teacher at school unit in the context of educational practice. Prior to the implementation of EF training, an informed consent was given by the school principal according to the recent Greek Law (L.4823/2021; Article 88, Par. 1). A written informative and consent form was given to parents of the participants. Once the consent forms were selected, the pre-baseline phase was started. During that phase, we asked parents to complete the BRIEF rating scale (Gioia et al., 2013) and the Sensory Profile Questionnaire (Dunn, \u003cspan class=\"CitationRef\"\u003e1999\u003c/span\u003e) for having a more comprehensive profile of the children’s EF daily-life skills, sensory-motor skills as well as possible sensitivities, prior to starting the intervention. In addition, informal discussions with children’s teachers and therapists were held. Pre-intervention, post-intervention and follow-up assessments were conducted through the standardized tests described above. Children’s non-verbal ability was tested once, whereas attention and motor skills were reassessed. In the baseline phase, apart from the standardized measures, the learning analytics from the Kinems platform were also used to set the level of training for each child.\u003c/p\u003e \u003cp\u003eDuring all phases the Kinems online learning platform was applied. Regarding the duration of the main phases per study (pre-intervention assessment, baseline, intervention and post-intervention assessment), this was about 18 weeks with the intervention lasting about 12 weeks (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The frequency was twice per week. However, the total duration and frequency of training for each child were heavily dependent on several factors, such as the school’s timetable and the classroom’s conditions, as research took place in authentic classrooms, each child’s distractibility during training, each child’s ability to correspond to the tests’ instructions and of course other reasons of absence at school, like health issues. The setting of the research was a special primary school in Athens. All the research phases were implemented there during the regular school program.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDuration per research phase\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePre-intervention assessment\u003c/p\u003e \u003cp\u003e(CPM, TSVA, CPF)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e2–3 weeks\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(Kinems activities)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIntervention (Kinems activities)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePost-intervention assessment\u003c/p\u003e \u003cp\u003e(TSVA, CPF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollow-up assessment\u003c/p\u003e \u003cp\u003e(TSVA, CPF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFollow-up assessment\u003c/p\u003e \u003cp\u003e(Kinems activities)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eExperimental Design\u003c/h3\u003e\n\u003cp\u003eThis single-case study followed a combined design according to WWC, 5.0 version (2022). However, changing criterion design was the main implementation of the study with embedded elements of multiple baseline design, such as concurrence and implementation across participants. The changing criterion design can be considered a special variation of multiple baseline designs in a way that each phase serves as a baseline for the subsequent one. The unique feature of changing criterion design is that the intervention phase is a set of several subphases (e.g. B1, B2 etc.). Another main feature of this design is that a criterion is set during the intervention phase. As performance meets that criterion, the criterion is made slightly more stringent for the next subphase until the final goal-behavior is achieved. Experimental control is demonstrated when behavior changes repeatedly to meet the new criterion, which is the level of the independent variable (Byiers et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e). The changing criterion designs are ideal when a series of graduated steps is needed for shaping behavior.\u003c/p\u003e \u003cp\u003eIn our study, because the children’s level of distractibility was very high, we had to gradually shift the goal-performance, so greater levels of attention and IC could be achieved in each subphase. The baseline criterion that was set prior to the IC training was that each child should be able to sustain attention to the activity at least for 1’, without the need to inhibit distractors. Thus, the starting point criteria for each child (sustained attention training-Level 1) were to be able to complete a very short visuo-motor search activity without distractors and achieve a mean score of 75% or greater and at least 80% performance in two categories (e.g. find fruits and vegetables) in three different times. Once these two criteria were achieved, then the levels of distractors (1,2,3 and multiple distractors) were gradually modified to be more challenging for the children. The criteria that had to be achieved to advance the goal-behavior to the next level were the following: a) mean score of 70% or greater and b) 75% score in at least two categories. When the researcher wanted to challenge the child’s motion speed, then at least one out of two criteria had to be achieved. The final goal-behavior was children to be able to sustain attention in a short visuo-motor search activity, while inhibiting multiple distractors.\u003c/p\u003e \u003cp\u003eThe implemented design consisted of three phases in different time periods: baseline (phase A), intervention and post-intervention assessment (phase B) and follow-up (phase C), after 5 months of the last training session for the Children 1,2,3 and 4, whereas after 4 ½ months for the Child 5. During the intervention specific prompting techniques from the applied behavior analysis (see Bondy, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e) such as physical, verbal prompt and delay prompting were used throughout training for enhancing children’s performance. The technique of modelling was used in the first session of each level during the intervention, and additionally physical prompting was given from the level of sustaining attention without inhibiting distractors to the level of inhibiting one distractor. Also, full physical prompts were given during the intervention and follow-up phases when children’s performance fell at the success rate of 50% or less. To control possible confounding factors, classroom teachers were also included in the intervention phase. Finally, for challenging children’s motor control, motion speed was increased when at least one of the two criteria was reached (i.e. a minimum mean score per level 70% or a minimum score of 75% in two categories).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Analysis and Results","content":"\u003cp\u003eVisual analysis was conducted using the Excel program for the graphics. Visual inspection from the Kinems learning analytics indicates higher level of IC exhibiting from the baseline to follow-up for all children. Specifically, Child 1 increased her attention and inhibitory skills by 2 levels through training (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Increase in the child’s performance was also apparent through TSVA (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) and CPF (Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ea \u0026amp; \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eb). Due to time limitations (school ending) post-intervention assessment was not able for the CPF in both sub-tests. Also, the child could not complete the spatial perception sub-test during the pre-intervention assessment, which was the most demanding test, however, this was completed during the follow-up. Additionally, because of fluctuation in performance during Follow-up 1, more testing in more categories was initially planned. Nevertheless, due to technical reasons with the interactive board, follow-up 2 completed with the use of tablet. Interestingly, much greater performance was achieved through tablet, giving evidence that full-body motor control ability challenged motor inhibition. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows slight increase (1 level) in IC for Child 2, however, marked rise is apparent through TSVA performance (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) in post-intervention assessment. This difference again might indicate that motor control ability strongly affects motor inhibition. Also, performance in visuo-motor skills increased, especially in spatial perception (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eb). For Child 2 two follow-ups were conducted, as level 2 reached none of the two criteria. Thus, he was tested at both levels during the follow-up phase. It is also noteworthy that Child 2, although exhibited high rate of challenging behaviors during typical learning at school, was very cooperative and with positive emotion while he was engaged with the Kinems activities.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eChildren 3 and 4 exhibited the highest increase in performance throughout training. Child 3 particularly, who is also diagnosed with ADHD, increased his performance to 3 levels both in attention capacity and IC as well as in motion speed (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Increase in performance was also apparent in TSVA and CPF (Tables \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ea \u0026amp; \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eb). The increase of performance during follow-up in TSVA and CPF might come as aftereffect of the use of the Kinems platform after completing cognitive training or external factors might heighten the performance, such as less distractibility in the surrounding environment during testing, or other training/intervention that might affect attention capacity. To this extent, it is noteworthy to clarify that for ethical and pedagogical reasons all children continued their therapies while implementing the attention and IC training. Child 4 increased his performance to 4 levels in attention capacity and IC, and additionally one level in motion speed throughout training (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). An increase in performance in TSVA and VSM (Tables \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ea) was also apparent. Interestingly, this marked rise in performance that is illustrated in the graph is not depicted in the TVSA. A possible explanation could be that paper-and-pencil tests did not motivate the child to pay more attention to that, whereas through computer training he was very engaged to actively participate.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eChild 5 completed the shortest period of intervention, as he started the attention training after the dropout of another child. Although he increased his performance from the baseline to the follow-up 1 phase (sustained attention without distractors), no criteria were reached in level 1 IC training. Thus, two follow-ups were planned to be conducted (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). The follow-up 2 was completed with a different medium (tablet) due to technical reasons with the classroom’s interactive board. Similarly to Child 1, it was noticed that accuracy rate with the tablet (see follow-up 2 phase) was greater than the training with the interactive board (see phase level 1) where full-body motor control was needed. In this case, comparison between training and follow-up is not feasible, however, the high difference in performance gives evidence that motion control ability strongly affects child’s visual attention and inhibition. In addition, taking into consideration child’s performance from the baseline in TSVA (the highest in the study), it seems that for this child motion rather than inhibiting distractors was the greatest challenge (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Regarding performance in CPF, VSM increased 3 standard scores between pre-intervention and follow-up assessment and additionally the child completed the SP sub-test during follow-up, which he could not complete before the intervention (Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ea \u0026amp; \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eb). Post-intervention assessment was not completed because of time limitations (school ending) and child’s absence from school the second week of post-intervention assessment.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTask of Selective Visual Attention (TSVA)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePre-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePost-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. Psychometric Criterion of Perception Function for Children and Adolescents (CPF)\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea. Sub- test I: Visuo-motor coordination (VSM)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePre-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePost-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb. Sub- test II: Spatial perception (SP)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePre-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePost-Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFinal\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eChild 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFindings suggest improvements in attention and IC in all children and better performance in visuo-motor skills to most children, even after five months of completing the digital cognitive training. In line with recent research (Mohd Iftitah, 2025; \u003cem\u003efor review\u003c/em\u003e) high engagement with the Kinems activities was observed with all children, especially those who are easily overwhelmed, exhibiting high rates of challenging behaviors (e.g. children 1,4) and those looking for intense visual stimuli (e.g. child 3). In addition, we found that the different medium (interactive board, tablet; Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) as well as motion speed (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) strongly affected the accuracy rate (especially in child 1) and the stability in performance, suggesting that motor control ability affects the visuo-motor attention capacity and motor inhibition. Indeed, findings from a recent study (Liu et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) give evidence for a relationship between attention, impulse control and motor function impairment in school-aged children with ASD, suggesting that motor skill performance may reflect underlying difficulties in EF.\u003c/p\u003e \u003cp\u003eRegarding the differentiation of performance between testing using static stimuli (TSVA) and the Kinems visuo-motor activities (e.g. see the case of child 5), research in the field of object motion and dynamic attention in ASD is not clear yet; although there is evidence for locomotor impairments (Gandotra et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; \u003cem\u003efor review\u003c/em\u003e). For instance, Koldewyn and colleagues (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) previously found a decreased capacity of school-aged children with autism to select and maintain attention on multiple targets, but not deficits in dynamic attention even with increased object speed. On the contrary, Sheppard and colleagues (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), found difficulties while judging the location of moving objects in adults with ASD. Findings from a more recent study (Zhou \u0026amp; Benson, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), support impairments in visual disengagement both in static and dynamic stimuli in young autistic children, with more delayed disengagement demonstrated when motion is presented. Our assumption is that when children need to process dynamic stimuli and simultaneously maintain attention on multiple targets within a context of full-body interaction and control, then the cognitive load is much challenged and therefore differences in performance may be exhibited. Also, research in typical development indicates an indirect link between WM capacity and multiple object tracking (MOT) expertise (Harris et al., 2020), which sets questions on how WM contributes to visual attention and MOT in autism.\u003c/p\u003e \u003cp\u003eConcluding the findings above, we suggest that attention and IC training could be effective in school settings through the application of digital game-based learning combined with individualized and developmental instructional design. A possible implication of this in the teaching practice is the integration of EF goals in the students\u0026rsquo; Individual Educational Plans (IEPs) utilizing new technologies with developmental instruction. Considering the teaching context and in accordance with earlier studies (Chen et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Diamond \u0026amp; Ling, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), we also found that the total time of exercising with the activities and the total duration of training had a significant positive impact on children\u0026rsquo;s performance. However, we agree that for the children on the autism spectrum and additional learning disabilities only exercising with the activities was not efficient. We had to apply specific teaching strategies that are usually used in special education to improve children\u0026rsquo;s performance. Another critical point for the teaching practice concerns children\u0026rsquo;s developmental stage and readiness, following a developmental pattern from the less to more demanding cognitive skills. To the best of our knowledge, this is the first study using the concept of LTs for improving attention capacity and IC in children with autism in school setting through digital learning, offering new insights to practitioners.\u003c/p\u003e \u003cp\u003eSeveral limitations to this pilot study need to be acknowledged. First, the sample size was limited to generalize our results and there was no statistical control regarding cognitive ability, age and IC for understanding possible moderators. Previous research (Geurts, 2014) using direct measures suggested age as a moderator for prepotent response inhibition, whereas IQ for interference control. However, more recently (Tonizzi et al., 2021) it was found a relative independence of IQ and age from interference control, suggesting that the ability to inhibit distractors and stay focused is not affected by chronological and mental age. Another possible limitation of our study regarding the developmental pattern that has been used might concern the comorbidity of ASD with other neurodevelopmental disorders, which is very frequent within classrooms in special schools. For instance, in our study one child has been diagnosed with ASD+ADHD. Recent research indicated greater difficulties in interference control in school-aged children with ASD and ADHD from those with ASD while inhibiting distracting information, whereas the profile of children with ASD and ADHD regarding motivational inhibition was comparable to those with ADHD (Cremone-Caira et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These results give evidence for a unique profile of children with ASD and ADHD, which may follow a different developmental trajectory from this one of children with ASD. Nevertheless, the effect of comorbidity with ADHD was not statistically significant in the study by Tonizzi and colleagues (2021).\u003c/p\u003e \u003cp\u003eFinally, taking into consideration the Greek educational context in which our studies conducted, we highlight the need for more appropriate standardized tests for measuring cognitive and motor skills that can be used in special education with children having the greatest difficulties. Also, the existing measuring tools have no indicators for developmental ages. This lack of information is rather important for designing personalized and developmentally suitable interventions in both TD and ASD. Lastly, no computerized Greek standardized tests are available for measuring EF and visuo-motor skills in children. Computerized tests could increase children\u0026rsquo;s engagement in comparison to the conventional measurement tools and might be more proper for testing children with moderate to profound difficulties, especially those that struggle most in receptive language minimizing in this way the language barriers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval\u003c/strong\u003e \u003cp\u003e All procedures were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards and approved by the school Principal according to national law. All children participated in the study with their parents\u0026rsquo; written informed consent. Clinical trials were not conducted.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBoth authors agreed with the content and gave explicit consent to submit this manuscript. Also, both made essential contributions to the conception and design of this work, the analysis and interpretation of data. In addition, consent obtained from the responsible authorities of the institute where the research has been conducted before this work is submitted.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, TC, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAloizou V, Chasiotou T, Retalis S, Daviotis T, Koulouvaris P (2021) Remote learning for children with special educational needs in the era of Covid-19: Beyond tele-conferencing sessions. 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Res Autism 127. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.reia.2025.202686\u003c/span\u003e\u003cspan address=\"10.1016/j.reia.2025.202686\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"autism, developmental instruction, learning trajectories, attention training, inhibition","lastPublishedDoi":"10.21203/rs.3.rs-8813748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8813748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTaking into consideration the importance of executive functions (EF) in children\u0026rsquo;s development and the notion that these are hardly included in the official school programs, the aim of the current research was to develop a digital attention training for improving inhibitory control (IC) as a teaching practice for children with autism, including motion in the context of multi-level approach in autism education. For this purpose, the Kinems motion-based learning platform was applied during the regular program in a special primary school in Greece. A developmental instruction design implemented utilizing the principles of learning trajectories (LTs) and Curriculum Research Framework (CRF). Results indicate improvements in attention capacity and IC as well as in visuo-motor skills, suggesting that computer-based cognitive training combined with individualized and developmental instructional design could be effective in the school context for enhancing EF in children with autism. This research may give new insights to practitioners on how to integrate EF goals in their teaching practice.\u003c/p\u003e","manuscriptTitle":"How to enhance attentional capacity and inhibitory control to school-aged children with autism through digital learning: A developmental instructional design","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 16:26:39","doi":"10.21203/rs.3.rs-8813748/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"20b961c7-96c6-4e20-a52c-72bd4da0f7e7","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-30T15:42:44+00:00","index":20,"fulltext":""},{"type":"reviewerAgreed","content":"238656982382016321506209634640761289583","date":"2026-04-30T14:50:33+00:00","index":19,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T16:26:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 16:26:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8813748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8813748","identity":"rs-8813748","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}