Research

Proposal

School Breakfast, Cogni7on, Emo7on and

Behavior

Presented by: Melissa Mar7n, Gabe Mandel & Maria Soubbo7na

Outline
1. Literature Review
2. Ra7onale & Hypothesis
3. Methods
4. Ethical Considera7ons
5. Limita7ons

Literature Review

In Canada, there are several charity programs that oer breakfast programs at a na7onal
level:

In the United States, the School Breakfast Program (SBP) was created by Congress in 1966
through the Child Nutri7on Act to provide a morning meal to low-income children who would
otherwise have none. However, in 1980, a na7onal survey found that a lunch program was
available to 96% of public school children while the SBP was only available to 39% (Meyers et
al., 1989).


1023 children in grades 3 to 6 in Lawrence, MassachuseZs public schools
Compared performance on standardized achievement tests aZendance
before and a\er SBP

RESULTS:
Low-income children had a signicant
associa7on with improved standardized
scores and declining rates of absences and
tardiness.
Unclear if the academic improvements
could be due to an immediate eect of a
morning meal eaten at the start of a school
day or if there is a long-term eect due to
improved nutri7on.
Greater measureable eects may have
occurred for longer than the 3 month
period that tes7ng took place a\er the SBP
started.

Cromer et al. (1990) studied the cogni7ve func7on and metabolic status in a group of 9th grade
students
18 healthy adolescents were fed through the SBP in comparison to a control group of 16
adolescents who were fed a low calorie meal.
Metabolic measures monitored the students glucose and Beta-hydroxybutyrate levels to compare
the metabolic rates of the body a\er ea7ng the dierent meals.

Peabody Picture Vocabulary Test-Revised (PPVT-R), Rey Auditory-Verbal Learning Test (AVLT),
Matching Familiar Figures Test (MFFT), and the Con7nuous Performance Test (CPT) measured short
term-auditory memory, vigilance, impulsivity, and mood.

Anxiety levels of the students were measured using the State-Trait Anxiety Inventory for Children
(STAIC).

Bro et al. (1994) examined the eects of the SBP in regards to on-task behavior and
aZendance among 10 male high school students, ranging in ages from 14 to 18
years old, in a welding class at a voca7onal high school secng in Spokane,
Washington.

These students were iden7ed as at-risk according to these deni7ons:

Living alone
Living with one parent
Living with someone other than biological parents and/or
Being a teen single parent
Days 1-10
No breakfast

Days 11-20
In-class
breakfast

Days 21-30
No breakfast

Days 31-40
In-class
breakfast

RESULTS:
There were no signicant dierences in aZendance during baseline and
SBP periods. However, there was a signicant increase in observed on-
task behaviors during the in-class SBP

Increased energy, alertness, mo7va7on, and comple7on of tasks were

observed.

Studied the rela7onship of school breakfast to psychosocial and academic func7oning in one
public school in Philadelphia, Pennsylvania and two public schools in Bal7more, Maryland
(1627 students in total) before and a\er 4 months of the breakfast program.
The breakfast program was provided universally free (UF) to everyone to help prevent social
s7gma and increase par7cipa7on.

Before UF Breakfast Program

A\er UF Breakfast Program

SCHOOL-RECORDED MEASURES

SCHOOL-RECORDED MEASURES
- Math Grades
- Absence and Tardy Rates

INTERVIEW MEASURES

- Math grades in the spring-term increased signicantly for those who

par7cipated in the program regularly.
- Children who increased their rate of par7cipa7on decreased their
rate of absence and tardiness.

INTERVIEW MEASURES

- Child adjustment scores were determined using Child Depression

Inventory (CDI), Revised Childrens Manifest Anxiety Scale (RCMAS),
Pediatric Symptom Checklist (PSC), and Connors Teacher Ra7ng
Scale-39 (CTRS-39)

-For those who increased their par7cipa7on in the breakfast program,

their mean CDI score decreased by 2.3 points and their RCMAS and
PSC scores decreased signicantly.

HYPERACTIVITY

HYPERACTIVITY

- Child report of hyperac7vity was reported using the mean CTRS-39

Hyperac7vity Index t score.

- Children who increased their par7cipa7on in the breakfast program

had signicantly greater decreases in their total CTRS-39 Hyperac7vity
Index scores.

San7ago et al. (1998) studied a group of 54 elementary school boys who were determined to be
nutri7onally not at risk or at risk in terms of their height-weight ra7o. AZen7on, memory func7ons, and
glucose levels were measured a\er they were given a breakfast, placebo, or no breakfast at all. The
nutri7onally at-risk boys were found to decline more signicantly in their performance of aZen7on and
memory tasks when fas7ng and less so when they received a placebo.

Wesnes et al. (2003) tested 29 school children in the mornings in a laboratory secng where they were
given a dierent breakfast each day (Cheerios, Shreddies, glucose drink, or no breakfast). They were
given computerized tests that measured aZen7on, working memory, and episodic secondary memory in
30, 90, 150, and 210 minutes a\er they ate. The most signicant declines in all of the 7me intervals
occurred in the students who had no breakfast or the glucose drink.

Cheng et al. (2008) focused their study on the parent and childs actude of breakfast skipping in 426
students ages 10-14. They determined that breakfast consump7on habits could stem from the students
beliefs and percep7ons that it will not help concentra7on in class and lack of reinforcement from parents.
The usual reason is because they did not have enough 7me. Low SES was not found to be a signicant
factor.

Mhurchu et al. (2010) also focused their study on breakfast skipping among 400 students aged 5-13 years
old in New Zealand. Their par7cipants took part in a school breakfast program and were assessed a\er
they ate in the morning. Students were found to have improvement in aZendance, academic
achievement, a self-reported increase in their grades, improved psychosocial func7on, less feelings of
hunger, improved dietary habits outside of school, and a signicant increase in a sense of belonging.

Monteagudo et al. (2012) focused on the quality of nutri7on and the amount of consump7on that school
aged children in Granada and Balearic Islands were having for breakfast. A Breakfast Quality Index (BQI)
was developed that evaluated students breakfast according to the amount of cereals, fruits, vegetables,
dairy, simple sugars, fats, and compliance with recommended nutri7onal recommenda7ons. They found
that as children got older, their BQI score would decrease in terms of health and the breakfast
consump7on would also decrease. They also found that those with higher (healthier) BQI scores would
feel more sa7sed and have benecial cogni7ve eects and reduced feelings of 7redness.

 Adolphus et al. (2013) completed a comprehensive literature review from

1950 to 2013 on the eects of breakfast programs on behavior and academic
performance in children and adolescents. They included 36 studies and found
the following:
Not enough studies focusing on breakfast and its eect on cogni7ve/academic performance
More research suggests posi7ve outcomes for children in terms of behavior, cogni7on, and
school performance but less of it examines the eects of breakfast on in-class behavior as well
as academic inuence on school grades or standardized tests
Most of the research examines the short-term eects of the rela7onship of ea7ng breakfast
on cogni7ve performance and not the long-term eects.
Behavior changes are mainly measured in a laboratory secng and not in the classroom or
school environment.
Behavior was more dicult to measure than academic performance.
Diculty with low SES as a possible confounder in some studies
Overall, the evidence suggests that there are benecial eects of SBPs for on-task behavior in
the classroom, mainly on children 13 years or younger regardless of a childs nutri7on level or
SES. A posi7ve eect on school performance, par7cularly in mathema7cs, was found in those
children who are undernourished or from a low SES background.

Purpose and Ra7onale

Purpose
Inves7gate rela7onship between breakfast program and
cogni7ve, behavioral and emo7onal outcomes

Ra7onale
1. No long term studies
2. No Canadian studies
3. Compare before/a\er
4. No studies with control groups

Hypothesis
1. Par7cipa7on in breakfast program will be associated with a
posi7ve improvement on students cogni7ve, emo7onal, and
behavioral well-being.
2. Improvement in cogni7ve, emo7onal and behavioral
func7oning following par7cipa7on in breakfast program will
be signicantly higher for at-risk students, as compared to
students without as-risk designa7on.

METHODS
Par7cipants and Sampling

Children in grades 2-6

Recruited from 2 urban schools
Informa7on leZer and consent forms sent
to all parents
Children of consen7ng parents will be
included in par7cipants pool
All consen7ng parents will complete
demographic ques7onnaire
Overall pool divided as at risk and not
at risk category
Par7cipants randomly selected from each
category
Minimum required sample n20; N= 80
(Simonson et al 2011)
Desired sample N=200

RANDOMLY SELECTED
FINAL SAMLE
AT RISK & NOT AT RISK
GROUP DESIGNATION

CHILDREN WITH CONSENT

ALL GRADE 2,3 & 4 CHILDREN

Evalua2on Design
Quasi-experimental design
2 x 2 Pretest-PosZest Control Group
9 months, September 2014 to June 2015
Independent Variables
Breakfast Program / No Breakfast Program
At-risk / Not at-risk
Dependent Variables
Cogni7ve measure (WISC-IV scores)
Emo7onal measure (EQ-i:YV)
Behavioral measure (BASC-2 scores)

Procedures

Pretest

Gather samples & groups (Schools, At-Risk Ques7onaire)

Gather pretest baseline data (Cog., Emo., Beh. Measures)
End of September, 2014

Introduce Breakfast Program (BP) to experimental school

Interven7on Experimental group, BP at-risk & not at-risk students
Control group, No BP at-risk & not at-risk students

PosZest

Gather posZest data

End of June, 2015
Analyze/compare pre- & post-test data

Sample Criteria
At-risk Measure
General At-Risk Basis Evalua7on (GABE)
Ques7onnaire format
Demographic Informa7on
Socio-economic status (family income, parents level of
educa7on, parents occupa7on)

Minority status
Geographic loca6on

Individual Informa7on
Student background info (mental & physical history,

developmental history, past trauma, school history, extracurricular

ac7vi7es, strengths and weaknesses, interests)

Dependent Variable Measures

Cogni1ve Measure
Wechsler Intelligence Scale for Children, Fourth Edi7on
(WISC-IV)
Standard Score

Ages 6:0 to 16:11 years

Standardized, Level C
High reliability (e.g., coecients composite scores range .
90 to .96, test-retest .70s to .94)

High validity (e.g., factor analysis, comparisons bw CAN &

US, WISC-IV & other measures, etc.)

Scaled Score

Classica2on

130+

16+

Very Superior

120-129

14-15

Superior

110-119

12-13

High Average

90-109

8-11

Average

80-89

6-7

Low Average

70-79

4-5

Borderline

69 and below

3 and below

Extremely Low or
Intellectually Decient

Dependent Variable Measures

Emo1onal Measure
Bar-On Emo7onal Quo7ent Youth version (EQ-i:YV)

Ages 7 to 18 years
Standardized, Level B
Acceptable reliability (e.g., coecients domain scales range .65 to .90, test-retest .77 to .89)
Low to moderate validity (e.g., factor analysis , inter-correla7ons of domain scores)

Dependent Variable Measures

Behavioral Measure
Behavior Assessment System for Children Second
Edi7on (BASC-2)
3 Forms

Parent Ra7ng (PRS)

Teacher Ra7ng Scale (TRS)
Self-Report of Personality (SRP)
(PRS & TRS) 2 to 21 years;

(SRP-I) 6 to 7 years;
(SRP) 8 to 25 years

Standardized, Level B
High reliability (e.g., internal

consistency .80s to .90s & test-

retest .61 to .99 across all 3 Forms)

Strong validity (e.g., scale inter-

correla7ons, factor analyses,
concurrent validity )

Data Analysis
Chi Square - test group equivalence (age,
gender, race)
ANOVA compare groups on outcomes
variables

ETHICAL CONSIDERATIONS
Research Ethics Board approval
School Board approval
Adequacy of parental consent
Obtaining child assent
Introducing breakfast only in one school
Not able to use WISC-IV in other secngs
Addressing diagnos7cally signicant assessment ndings

LIMITATIONS

Findings generaliza7on limited to grade 2-6 children

Did not control for other concurrent interven7ons
Do all children eat breakfast?
Par7cipant selec7on bias
At-risk designa7on confounded with developmental problems?
Cogni7ve variables are aggregate variables
School variables are not assessed

References
Adolphus, K., Lawton, C.L., & Dye, L. (2013). The eects of breakfast on and academic
performance in children and adolescents. Fron6ers in Human Neuroscience, 7, 1-28. doi:
10.3389/fnhum.2013.00425
Bar-On, R. & Parker, J. D. A. (n.d.). Emo7onal quo7ent inventory: Youth version. Mental
Measurements
Yearbook with Tests in Print, 15. Retrieved from hZp://web.a.ebscohost.com.ezproxy.lib
.ucalgary.ca/ehost/detail?vid=4&sid=b8f6530d-z70-4f04-9c4f-b1751551d3fc%40
sessionmgr4003&hid=4109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=mmt&AN=TIP070
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Bar-on, R. & Parker, J. D. A. (n.d.). Emo7onal quo7ent inventory: Youth version. Mul7-Health
Systems. [website]. Retrieved from hZp://www.mhs.com/product.aspx?
gr=edu&prod=eqiyv&id=overview
Bro, R.T., Shank, L., Williams, R., & McLaughlin, T.F. (1994). The eects of an in-class breakfast
program on aZendance and on-task behavior of high school students. Child & Family
Behavior Therapy, 16(3), 1-8.

References, con7nued
Cheng, T.S., Tse, L.A., Yu, I.T., & Griths, S. (2008). Childrens percep7ons of parental actude
aec7ng breakfast skipping in primary sixth-grade students. Journal of School Health, 78(4),
203-208.
Cromer, B.A., Tarnowski, K.J., Stein, A.M., Harton, P., & Thorton, D.J. (1990). The school breakfast
program and cogni7on in adolescents. Developmental and Behavioral Pediatrics, 11(6),
295-300.
Cueto, S., Jacoby, E., & Pollit, E. (1998). Breakfast prevents delays of aZen7on and memory
func7ons among nutri7onally at-risk boys. Journal of Applied Developmental Psychology,
19(2), 219-233.
Meyers, A.F., Sampson, A.E., Weitzman, M., Rogers, B.L., & Kayne, H. (1989). School breakfast
program and school performance. American Journal of Diseases of Children, 143(10),
1234-1239.
Mhurchu, C.N., Turley, M., Gorton, D., Jiang, Y., Michie, J., Maddison, R., & Hace, J. (2010).
Eects of a free school breakfast programme on school aZendance, achievement,
psychosocial func7on, and nutri7on: a stepped wedge cluster randomized trial. BMC Public
Health, 10(1), 738-744.

References, con7nued
Monteagudo, C, Palacin-Arce, A., del Mar Bibiloni, M., Antoni, P., Tur, J.A., Olea-Serrano, F., &
Mariscal-Arcas, M. (2012). Proposal for a breakfast quality index (BQI) for children and
adolescents. Public Health Nutri7on, 16(4), 639-644. doi: 10.1017/S1368980012003175.
Murphy, J.M., Pagano, M.E., Nachmani, J., Sperling, P., Kane, S., & Kleinman, R.E. (1998). The
rela7onship of school breakfast to psychosocial and academic func7oning. Archives of
Pediatrics & Adolescent Medicine, 152(9), 899-907.
Kamphaus, R. W. & Reynolds, C. R. (2004). Behavior assessment system for children Second
edi7on. Pearson Canada Assessment. [website]. Retrieved from hZp://pearsonassess.ca/
haiweb
/Cultures/en-CA/Products/Product+Detail.htm?CS_ProductID=BASC-2&CS_Category
=psychological-behaviour&CS_Catalog=TPC-CACatalog
Reynolds, C. R. & Kamphaus, R. W. (n.d.). Behavior Assessment System for Children (Second
Edi7on). Mental Measurements Yearbook with Tests in Print, 17. Retrieved from hZp://web.a
.ebscohost.com.ezproxy.lib.ucalgary.ca/ehost/detail?vid=8&sid=c11cb821-3e41-4a01-a5c9-
989136ebb1ab%40sessionmgr4002&hid=4109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db
=mmt&AN=TIP17193192

References, con7nued
Simmons, J. P., Nelson, L. D., & Simonsohn, U. (2011). False-Posi7ve Psychology: Undisclosed
Flexibility in Data Collec7on and Analysis Allows Presen7ng Anything as Signicant.
Psychological Science, 22(11), 1359 -1366. doi:10.1177/0956797611417632
Wesnes, K.A., Pincock, C., Richardson, D., Helm, G., & Hails, S. (2003). Breakfast reduces declines
in aZen7on and memory over the morning in schoolchildren. Appe6te, 41, 329-331. doi:
110.1016/j.appet.2003.08.009
Wechsler, D. (2004). Wechsler intelligence scale for children Fourth edi7on. Pearson Canada
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Wechsler, D., (n.d.). Wechsler intelligence scale for children Fourth edi7on. Mental
Measurements Yearbook with Tests in Print, 16. Retrieved from
hZp://web.a.ebscohost.com.ezproxy.lib.ucalgary.ca/ehost/detail?vid=3&sid=b8f6530d-
z70-4f04-9c4f b1751551d3fc
%40sessionmgr4003&hid=4109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
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