# Improving Refugee Children: A Randomized Controlled Trial on the Impact of Cognitive Activity Training

## TL;DR

A study found that cognitive activity training improved cognitive skills, academic performance, and quality of life in refugee children.

## Contribution

This is the first randomized controlled trial demonstrating the effectiveness of cognitive activity training for refugee children's cognitive and academic outcomes.

## Key findings

- Cognitive Activity Training significantly improved cognitive skills in refugee children.
- The intervention enhanced academic performance, including reading speed and handwriting.
- Quality of life scores improved significantly in the study group compared to the control group.

## Abstract

Refugee children’s cognitive skills are negatively impacted by war and displacement, reducing school performance. Addressing these challenges requires developmentally appropriate and function-oriented approaches that align with occupational therapy’s focus on participation and skill-building. It was aimed to examine the effects of Cognitive Activity Training (CAT) on cognitive skills, academic performance and quality of life in refugees.

The study was designed as a randomized controlled study, including pre and post testing. A total of 34 refugee children in study group (14.29 ± 0.84years) and control group (14.41 ± 0.61years) were included. Children in the study group received the CAT program (10 weeks, 2 sessions per week), based on occupational therapy principles and implemented as part of a cognitive rehabilitation approach. Children in the control group received no intervention. Refugee children were assessed before and after the intervention using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Reading Speed Test (RST), Minnesota Handwriting Test (MHT), and Pediatric Quality of Life Inventory (PedsQL).

It was found that the school-based CAT given to the refugee children had a statistically significant effect on all cognitive skill parameters, reading speed and handwriting skills reflecting academic performance, and quality of life (p < .05). ANCOVA results showed that post-test adjusted means of LOTCA Total and LOTCA Visual Perception scores were significantly higher in study group compared to control group (p < .001). Similarly, Mixed Design ANOVA indicated significant interaction effects in cognitive skill subdomains, academic performance measures (RST and MHT), and PedsQL total and subdomain scores (p < .001). While there were no significant differences between pre-test scores of study and control groups, study group demonstrated significant within-group improvements post-intervention, whereas control group showed no significant changes.

This study demonstrated that CAT may support cognitive, academic, and quality of life outcomes in refugee children exposed to war. Thus, cognitive skills should be assessed in schools for refugee children and cognitive activity training to be applied within the scope of rehabilitation should be included in occupational therapy programs for this population.

ClinicalTrials.gov identifier: NCT05093738- 09/ 28/ 2021 (https://clinicaltrials.gov/study/NCT05093738?id=NCT05093738&rank=1).

The online version contains supplementary material available at 10.1186/s40359-025-03586-z.