Using Coding to Improve Executive Functioning in Children with Sickle Cell Disease: A Multiple-Baseline Single-Case...

Executive function (EF) impairments are common in children with intellectual and developmental disabilities and have a significant impact on learning and daily life. Cognitive training programs aimed at strengthening EFs may show limited feasibility and generalization. However, recent studies suggest that ecological, curriculum-embedded problem-solving activities may be more promising. This multiple-baseline single-case study tested the feasibility and efficacy of a short computational thinking and coding intervention based on problem-solving for children with sickle cell disease, a hemoglobinopathy associated with cognitive decline and EF deficits. The trial followed the What Works Clearinghouse (WWC) Version 5 guidelines for single-case research. Three 7-8-year-old children with lower-range IQ (71-82) and EF impairments completed 11 coding sessions over 5-6 weeks using code.org, with pre/post assessments of non-verbal EF (planning, inhibition, and switching), and verbal EF skills (verbal working memory, phonological fluency and semantic fluency). Results showed 100% adherence to the intervention, significant improvement in coding (IRD range = 0.69-0.79), with positive transfer effects on nonverbal planning skills (gains > 2 z-scores) and also verbal fluency (z-score gains ranging from 0.47 to 1.04). Inter-individual variability in effects was related to the child's individual cognitive profile. Findings suggest that problem-solving, coding-based activities can be feasible and potentially beneficial for children with significant EF impairments.