The detrimental effects of socioeconomic disadvantage on child cognitive development are well-documented. Children with NDDs facing such conditions experience a double burden. This study aimed to assess the effectiveness of a cognitive stimulation program on four children with NDDs (Specific Learning Disorder, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder) residing in impoverished areas of Guatemala. The high rates of poverty, violence, food insecurity, and social inequality in Guatemala create a challenging environment for children's development. Existing research establishes a link between low socioeconomic status (SES), characterized by factors like limited resources, parental education, and income, and negative impacts on children's cognitive, psychological, and social development. These conditions may affect brain structure and function, impairing cognitive processes such as language, memory, and executive functions. Furthermore, children from low SES backgrounds are at increased risk for NDDs due to factors like chronic stress and malnutrition. The study hypothesized that the cognitive stimulation program would improve the cognitive development of all children, particularly those with NDDs who often require specialized educational support.

Numerous studies demonstrate the negative effects of low SES on child development. These studies highlight the impact on various cognitive functions, including language, memory, and executive functions. A link between low SES and the increased prevalence of NDDs such as ADHD, SLD, and ASD has been established, potentially due to heightened stress and exposure to adverse environmental factors. Conversely, research suggests the positive effect of neuropsychological stimulation programs on children's cognitive, social, and emotional functioning, potentially enhancing brain plasticity. While some research indicates these programs might be particularly beneficial for low SES populations, focused research on this specific group remains limited. This study builds upon existing research to provide more evidence about this understudied population.

This descriptive case series study included four participants with NDDs and a control group of 126 neurotypical children. The neurotypical children were randomly assigned to an experimental (cognitive stimulation) or control (reading activities) group. Participants with NDDs were either in the experimental or control groups. The participants were all 5th grade students from vulnerable areas in Guatemala City. Detailed socio-economic, linguistic, and clinical questionnaires were administered to families. Pre- and post-intervention neuropsychological assessments measured language, attention, executive functions, and social cognition, using a battery of tests including the Token Test, verbal fluency tests, the Inter-American Reading series, Nesplora Aula School and Ice Cream, TONI-2, and the NESPY-II. The intervention, delivered using tablets via the NeuronUP platform, comprised a 24-session cognitive and emotional stimulation program for the experimental group, structured across three difficulty levels. The control group participated in regular reading activities for the same duration. Data analysis involved comparing pre- and post-intervention percentile scores to determine clinically significant changes using qualitative descriptions and delta scores (pre-post differences) compared to the reference groups using one standard deviation as a threshold for significance.

The experimental group showed significant improvements, particularly in executive functions (inhibition, flexibility, planning) and social cognition (emotion recognition, theory of mind). The two children with NDDs in the experimental group demonstrated larger improvements in social cognition than their neurotypical peers and the control children. Case 1 (SLD) showed improvements in phonological fluency, attention, response speed, executive functions, and emotion recognition. Case 2 (ASD) improved in phonological fluency, inhibitory control, impulsivity, planning, and theory of mind. When compared to their respective reference groups, Case 1 showed significant improvement in impulsivity, cognitive flexibility, and planning, while Case 2 had significantly higher working memory scores. The control group (reading activities) showed some improvements in language comprehension and reading skills but experienced decreases in other areas for the NDD participants. Case 3 (ADHD) improved in language comprehension, phonological fluency, and reading skills, but showed a decrease in inhibitory control and emotion recognition relative to the control group. Case 4 (SLD) improved in reading, working memory, and emotion recognition but declined in several other areas compared to the control group. The cognitive stimulation program seemed more effective for children with NDDs compared to the reading program.

The findings support the hypothesis that a comprehensive cognitive stimulation program is beneficial for children from disadvantaged backgrounds, especially those with NDDs. The superior performance of the experimental group, particularly in executive functions and social cognition, highlights the importance of targeted interventions. The significant gains in social cognition for children with NDDs suggest that the program effectively addressed their specific needs, particularly in areas like theory of mind. The lesser impact of the reading program underscores the limitations of generalized interventions for children with NDDs. The results support the need for specialized, evidence-based interventions tailored to the specific challenges faced by children with NDDs in vulnerable contexts. The study's focus on a group intervention, while a limitation in terms of individual adaptation, offers a practical and scalable approach for resource-constrained settings.

This study provides valuable evidence for the effectiveness of cognitive stimulation programs for children with NDDs from low SES backgrounds in Guatemala. The cognitive stimulation program proved more beneficial than a standard reading program, particularly for children with NDDs, yielding significant improvements in executive functions and social cognition. Future research should include larger sample sizes and more diverse NDD diagnoses to further validate these findings. Development and evaluation of more cost-effective and widely accessible interventions within resource-constrained settings are also important priorities.

The small sample size (four cases) limits the generalizability of the findings. Variations in testing environments across schools may have influenced the results. The use of Spanish norms for some assessments may also have introduced some limitations. Future studies should incorporate larger, more diverse samples and control for confounding variables more rigorously.