Rett Patients Can Engage With, Benefit From Online Schooling

Marisa Wexler MS avatar

by Marisa Wexler MS |

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school with Rett | Rett Syndrome News | caring for children with rare diseases

Participating in school virtually — using a computer with a webcam — is socially and cognitively engaging for people with Rett syndrome, according to a study in Italy.

This finding “supports the idea that the children with RTT [Rett syndrome] can benefit from the use of technology-aided programs, such as teleconference platform plus cognitive and social tasks, to promote cognitive and social skills,” its researchers wrote.

The study, “Social and Cognitive Interactions Through an Interactive School Service for RTT Patients at the COVID-19 Time,” was published in the journal Frontiers in Psychology.

In March 2020, schools, universities, and centers helping people with disabilities shut down across Italy — and in many other countries — because of the COVID-19 pandemic. While such precautions were needed to keep people safe from the virus, they imposed a substantial burden on society, and people living with rare conditions like Rett syndrome were hit especially hard.

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As the pandemic continues to impose limits on interaction, using technology to connect without the risk of viral transmission has become critical, with many schools conducting classes online. However, online schooling may be less accessible for people with special needs, requiring accommodations.


“To our knowledge, no research exists addressing the question of how to promote social and cognitive interactions among SEND [special needs and disabled] children during the COVID-19 pandemic; there are only general recommendations and suggestions,” wrote the researchers.

To address these issues, a team of Italian investigators created a roughly two-month interactive school for Rett patients and their parents.

The school program contained two basic sections: a social task, where participants would see the face of their teacher and/or peers while given instructions (e.g., “introduce yourself”), and a cognitive task, where participants watched a short cartoon and then answered 10 questions about it. Schooling ran four days a week, Monday through Thursday, for about an hour each day.

To measure participants’ attention, the researchers used specialized equipment to track their eye movements, recording the time they spent focused on the task at hand (e.g., looking at their teacher’s face). Time spent doing stereotyping behavior — well-defined movements that are repeated over and over for no apparent reason — was also measured.

“The general objective of the present study was to evaluate the possibility of a virtual interaction between educators and patients with RTT, objectively measuring some outcomes in support of this possible interaction. Thus, the Interactive School for RTT was designed to catch RTT patients’ attention and curiosity,” the team wrote.

The study included 39 females with Rett syndrome, ages 3 to 24.

In the absence of a task, participants spent a mean of about nine minutes engaging in stereotyping behaviors. Conversely, average time spent stereotyping dropped significantly to just over six minutes during both the cognitive and social tasks.

“These results suggest that when patients with RTT are engaged in social or cognitive tasks they focus on them and reduce stereotyping behaviour; this means that multimedia presentations are motivational factors for subjects with RTT,” the researchers wrote.

Analyses of the two tasks separately indicated that, during social tasks, participants spent comparatively more time looking at their teacher’s face than at faces of their peers.

They generally scored well on the cognitive task; the average number of correct replies to questions was 6.8 out of 10. Statistical analyses showed that girls and women who spent more time watching the task were more likely to answer questions correctly, indicating that they retained more information when their attention was more occupied.

Scores on the cognitive task were also generally better when the cartoon characters being watched included a song.

“This indicates that auditory stimuli, such as songs, are significant motivational factors for patients with RTT,” the investigators wrote.

Collectively, these results suggest that people with Rett syndrome benefit from schooling online, they concluded.

“Thus, policy makers of public assistance healthcare could consider the use of teleconference platforms as a valid solution in providing treatment services during future lockdown or precautionary measures to face the Covid-19 pandemic,” the researchers wrote.

The team stressed, however, that more research is needed to devise the best way(s) to engage children with Rett in virtual schooling, noting that the present study is relatively small.

“This study aims at paving the way towards a more integrated and systematic application of telerehabilitation for RTT, introducing a novel online approach to rehabilitation that professionals can exploit to enhance and simplify their treatment programs,” they wrote.