Do preschool children have modality specific recall abilities? - A cross-sectional pilot study

Abstract Little is explored regarding the modality-specific differences in recall abilities of preschool children. Understanding modality-specific differences in the recall at an early age might give an insight into age-linked trends, which can lay a foundation for later development. The current study used a cross-sectional design to investigate the modality-specific differences in recall abilities of preschool children using a story and story stimulus. A total of 20 typically developing children between the ages of 3.6 to 5.5 years were presented with a story followed by a story recall task across auditory, visual, and auditory-visual modalities to determine modality-specific recall abilities. The results were analyzed using mixed ANOVA, which revealed higher recall ability in the auditory-visual modality than in other modalities. The findings are explained based on Dual coding theory, Multimedia effect, Mental imagery skills, Visual superiority effect, Attentional behavior, and Comprehension skill. The study implies the importance of Auditory-Visual modality in facilitating better recall in story-based tasks among preschool children.


PUBLIC INTEREST STATEMENT
Recall, a cognitive communicative ability, is one of the key components that underpin literacy and is found to be dependent on the modality of presentation of contents. The current study explores the influence of modality on recall abilities of preschool children, as the preschool period is critical for language, cognitive, and affective development that underpins literacy. The study findings show that preschoolers recall better in the auditory-visual modality than in the auditory or visual modality. The findings are explained based on Dual coding theory, Multimedia effect, Mental imagery skills, Visual superiority effect, Attentional behavior, and Comprehension skill. The study implies the use of auditory-visual modality for presenting contents or information to yield better recall in children as young as preschool age. The study findings can be considered while designing curriculum and learning resources for preschoolers.

Introduction
Recall, a cognitive communicative ability (Mridula et al., 2017), is one of the key components that underpin literacy which involves attention, vocabulary, recognition of language patterns, retrieving and storing information in working memory and long-term memory, in addition to the knowledge about the world, culture, and emotions (Rao, 2014). Research demonstrates that the recall ability is dependent on the modality of presentation of the information (Maher et al., 2006). More specifically, the modality of presentation, such as auditory, visual, or auditory-visual, tends to influence the recall abilities in children (Maher et al., 2006). As modality of presentation influences recall, it is essential to understand its role to plan and design age-appropriate curriculum and learning resources for children.
Literature has focused on the influence of modality predominantly in school-aged children. Studies report that school-aged children prefer auditory-visual modality over other modalities in recall and learning (Heikkilä & Tiippana, 2016;Rooha et al., 2021). However, the effect of modality on recall abilities among preschool children is limited. It is essential to have an insight into these abilities as the preschool period is critical for language, cognitive, and affective development that underpins literacy (Tomasello, 2000). The existing literature on preschoolers' modality preference in recall reveals diverse findings. Schneider and Dubé (2005) reported that children in kindergarten demonstrated a significant influence of modality on the ability to retell the story with a higher preference for the auditory-visual modality. Noles and Gelman (2012) observed a visual modality preference among preschool children; however, Sloutsky and Napolitano, in 2003, found an auditory dominance among preschool children. Greenhoot and Semb (2008) suggested that younger preschoolers show auditory dominance and older preschoolers show auditory-visual dominance. Since the modality preference shown across the studies are diverse, there exists an inconclusive understanding regarding the modality preference among preschool children, i.e., whether they prefer an auditory modality since the auditory system matures earlier than the visual system (Sloutsky & Napolitano, 2003) or they prefer visual modality due to familiarity, or they prefer auditory-visual modality due to the dual-modality benefits. Such diverse findings in the existing literature could be due to the variations in the intrinsic nature of the task considered and the complexity of the stimuli incorporated. For instance, some studies used switch design of tones and images (Noles & Gelman, 2012;Sloutsky & Napolitano, 2003), whereas others have preferred using story-based tasks to assess the effect of modality on recall abilities in preschoolers (Greenhoot & Semb, 2008;Schneider & Dubé, 2005).
Many researchers have emphasized that recall abilities in preschool children should be assessed using age-appropriate and suitable stimuli (Isquith et al., 2005;Skarakis-Doyle & Dempsey, 2008). Stories seem to meet these requirements as they are a common element in the lives of preschool children (Skarakis-Doyle & Dempsey, 2008). Stories are a part of preschoolers' academic curriculum and are reported to be a flexible and appropriate cognitive tool (Gerdt et al., 2001). Assessing recall abilities using a story-based task is a sensitive measure (Baek et al., 2011) with supporting evidence among children (Rooha et al., 2021) and adolescents (Anil & Bhat, 2021). During the presentation of story contents through auditory modality (narration), children are required to store the auditory inputs in Short-term memory, process them, integrate them with the upcoming units, then relate them with real-world and story structure knowledge (Mayer, 2009;Schneider, 1996). Whereas through visual modality (pictures), an addition of translating the visual information to verbal auditory information is also required (Schneider, 1996). While presenting story contents through auditory-visual modality (narration with pictures), both the auditory and visual information are processed simultaneously and then integrated (Mayer, 2009).
Though story-based tasks have been used to assess the influence of modality on preschoolers' recall abilities, there are two significant issues. Firstly, the recall demands posed over preschool child's capacity during the recall of the story might impact the modality effects. A study by Greenhoot and Semb (2008)) reported that young children show poor processing capacity required for a story narrative. They explained that the whole story recall task might increase the recall load on the participants as the probe questions would be asked after the entire story had been presented. In such a scenario, it would be difficult to determine if the length and content-based demand of the story dilute the findings. Though their findings did not agree with previous literature that had used simpler stimuli with lesser demands on memory, they emphasized the importance of manipulations concerning story complexity. Recall of smaller story contents may adjust the load factor and provide a better insight into recall abilities. The second issue is the research design followed by the existing studies. The studies using stories have either used story-based tasks to assess recall abilities through a single modality or have performed multiple group comparisons (separate groups per modality) to derive modalityspecific influence. Therefore, it presently remains challenging to understand the influence of modality on recall abilities among preschool children as this information should be extracted either through multiple modality-specific studies or from a single study with multiple modalityspecific groups (Greenhoot et al., 2014;Greenhoot & Semb, 2008;Schneider & Dubé, 2005). The influence of modality on recall abilities among preschoolers might be better understood if given research incorporates a single story and story stimulus where contents are balanced and presented across auditory, visual, and auditory-visual modalities to a single group of participants and assessed for the respective content accordingly. Hence, the present study was carried out on a single group of preschoolers using a novel story and story stimulus wherein smaller story contents were used with the stimulus presentation balanced across auditory, visual, and auditory-visual modalities.
The study aimed to assess the modality-specific influences on the recall abilities of preschoolers using a novel story and story stimulus. The objectives of the study were to construct and validate a novel story and story stimulus (recall task) for preschoolers and use it to assess the differences in recall abilities, across the three modalities, among the younger and older preschoolers.

Materials and methods
The study followed a cross-sectional experimental design adhering to STROBE guidelines, and the samples were collected using convenient non-random sampling. The study commenced post approval from the Institution Ethical Committee of Kasturba Medical College, Mangalore (IEC KMC MLR 02-2020/62). The study was carried out between February 2021 to June 2021 at English medium schools in Dakshina Kannada district.

Participants
Twenty typically developing preschool children were selected as participants. The participants were separated into two groups based on their age as Group I: 3.6-4.5 years (Mean age = 4.1 years, Standard Deviation = 0.18) and Group II: 4.6-5.5 years (Mean age = 5 years, Standard Deviation = 0.42), with each group comprising of 10 participants having equal gender representation. The age range was determined considering the critical development period of cognitivecommunication skills and the entry and exit age of children to preschools in the Dakshina Kannada district. The participants were selected from the middle socioeconomic status, ascertained using the Modified Kuppuswamy Socioeconomic Scale (Mohd Saleem, 2019). Only those children who had attended nursery school before joining preschool were included in the study to maintain the homogeneity of exposure to literacy skills and the English language. Ten Questions Screen (Durkin et al., 1995) and Assessment of Language Development (Lakkana et al., 2007) were used to select participants with typical development. All the participants were native speakers of either Kannada or Malayalam and had the second language as English. The English language proficiency of the children was screened using Child Language Experience and Proficiency Questionnaire (LEAP-Q-Child version; Marian et al., 2007;Rochanavibhata & Marian, 2021). Children who scored seven or greater on a 10-point rating scale of speaking and understanding English language proficiency rated by parents were considered for the study.

Story and story stimulus construction and validation
A novel story was constructed for the study than choosing an existing story from textbooks/ storybooks to ensure that the familiarity of the story content does not affect the recall abilities of the participants. Thus, a story titled "A Day at Grandparents House" was designed after an extensive literature survey, textbook analysis, and storybook review. The literature survey paved the way for creating a real story than fantasy stories, as the preschoolers are reality prone, whereas fantasy elements might depict something impossible (Weisberg & Sobep, 2013). Studies also emphasized constructing the story by following a logical structure and psychological causality while adhering to the story grammar, which could lead to better understanding and recall (Curenton, 2010;Hudson & Nelson, 1983). The researcher carried out the textbook analysis and review of storybooks, which provided information on types of cognitive communication activities, sequence of story events, characters of the story, and age-appropriate vocabulary, which facilitated the story structure. The story's vocabulary was consistent with preschool children's language and literacy development.
The story contained three illustrations corresponding to the story contents, which were designed as attractive, interesting, and engaging for the children. The story was divided into three sections, with a recall task performed after the presentation of every section. The sections of the story revolved around specific themes of the story, and the salient elements were presented across auditory (Narration), visual (Illustration), and auditory-visual modalities (Narration & Illustration). The number of story elements across the modalities in a given section was equally distributed. For example, the first section of the story revolved around the theme of "boy visiting grandparents house and getting scared by the dog" comprised a total of 21 story elements wherein seven elements each were presented in auditory (e.g.: "Parents dropped Virat at his grandparent's house at Malli" presented in narration), visual (e.g.: "Dog was outside the cage" depicted in Illustration), and auditory-visual modality (e.g.: "Grandparents were waiting for him at the gate" presented in Narration and Illustration), respectively. Likewise, story sections two and three consisted of six and five-story elements across each modality. Content analysis was performed to balance these story elements across the three modalities, which was counterbalanced.
Three recall questions with one question from each of the presentation modes were asked after each section. For example: In the first section, "Where was grandparents" house?' was asked as an auditory content-based recall question, "Where was the dog when Virat came to grandparents' house?" was asked as a visual content-based recall question, and "Where were the grandparents waiting for Virat?" was asked as an auditory-visual content based recall question. A total of nine such recall questions were constructed, which had to be asked by the examiner after each section in the story. These recall questions were in closed set forced-choice format with three choices: Correct Answer (CA), Thematically Related Answer (TRA), and Incorrect Answer (IA). The order of presentation of the three recall questions under each section was randomized for each participant through a random number generator. This ensured that the findings on modality effects on recall abilities do not affect the order effects.
The initial draft of the story and story stimulus was content validated by three preschool teachers and three Speech-Language Pathologists with subject expertise in cognitivecommunication on a five-point rating scale. The content validity index was calculated by dividing the number of experts rated 4 or 5 by the total number of experts. The content validity index of greater than 0.78 was considered significant and was included in the study. Following the content validation, the final story was simplified in terms of length and complexity of vocabulary from 355 to 254 words, and no modifications were suggested for the story stimulus. The details regarding the questions and story content elements across the modalities are shown in Table 1 (Table 1 here). The story stimulus was designed in English, considering the medium of the school's instruction, and to maintain uniformity across the participants from different native languages.

Procedure
The administration of the final version of the story and story stimulus commenced after obtaining written consent from school authorities and the parents of all the participants. The participants were selected based on the inclusion and exclusion criteria. The participants were made to sit comfortably across the researcher and engage in conversation to build a rapport. The participants were assessed in a quiet room on the school premises individually, and the recorded story was narrated using a Laptop and headphones. The assessment took an average of 20 minutes per participant.

Data analysis
The responses to the nine recall questions were scored on a three-point rating scale, as "2" for the correct answer, "1" for the thematically related answer, and "0" for the incorrect answer. Each participant could obtain a maximum score of "6" for each modality. The results obtained for each participant were subjected to statistical analysis using SPSS 17 software. Mixed ANOVA was used to analyze the effect of modality on recall scores between the younger and older preschoolers.

Results
The validated form of the story comprised nine Short Term Recall questions which were equally distributed across the three modalities. All the questions were formulated on concrete and core elements of the story with comparable difficulty in maintaining the homogeneity across the modality. The story's form, content, and modality distribution and all the modality-specific recall questions obtained a content validity index of greater than 0.78, suggesting suitability for the study.
All the twenty participants completed the assessment, and data were statistically analyzed to ascertain how the recall scores differed with the modality of story content. The mean and standard deviation of recall scores obtained under each modality of story content by the two age groups are depicted in the figure below (Figure 1).
A comparison of the mean score revealed that the recall scores in auditory-visual modality were higher than recall scores in visual and auditory modality among preschoolers. Mixed ANOVA results showed a statistically significant difference (F (2,36) = 19.52, p < 0.05) across the modalities of story content. Post hoc pairwise comparison with Bonferroni correction revealed that recall scores under visual and auditory-visual modality were significantly higher than recall scores for auditory modality (p < 0.01). However, there was no statistically significant difference between the scores obtained for auditory-visual and visual modality (p = 0.30).
Further analysis was performed to understand whether the modality preference is specific to one of the two groups of preschoolers. Though the results revealed that the mean recall scores of the older group of preschoolers (Group II) were higher than the younger group (Group I) across all the modalities of story content, the modality preference observed in both the groups were similar (F (2,36) = 0.81, p = 0.50), i.e., preschoolers of both the groups recalled significantly greater through auditory-visual modality as compared to visual and auditory modality respectively.

Discussion
The present study intended to seek clarity on modality-specific effects on recall abilities among preschoolers by addressing two significant issues in the existing literature, i.e., using a novel story and story stimulus which is balanced across the modalities on a single group of participants and using smaller story contents for the recall tasks to optimize the recall load.
The study's first objective was executed by constructing a story and story stimulus appropriate for the preschooler's age, culture, and language proficiency and balanced across the three modalities. The story and story stimulus met the content validation criteria (Almanasreh et al., 2019) and have used smaller story contents for the recall tasks to optimize the recall load. The second objective was carried out by analyzing the recall scores across the three modalities, which revealed three significant findings. Firstly, preschool children's recall abilities were observed to depend on the modality of story content presentation, consistent with the findings obtained by Schneider and Dubé (2005). Secondly, among the modalities, preschool children had a better recall of stories presented through auditory-visual modality followed by visual and auditory modality. This is in line with the findings obtained by Maher et al. (2006), wherein they compared the role of auditory, visual, and auditory-visual modalities in Recall and Recognition of advertisement content and found that auditory-visual content resulted in better Recall and Recognition in children. Similar findings were also reported by Schneider and Dubé (2005) about the story grammar retrieval units on modality differences. They observed that younger children recalled higher story grammar units in the auditory-visual condition when compared to the visual-only condition. A bimodal (auditory and visual) advantage was also observed in a difficult numerical comparison task among preschoolers by Posid and Cordes (2019) on comparing the unimodal, cross-modal, and bimodal influence of numerical judgments. Similar findings were also observed in a recent study focusing on the modality effect in the recall of multimedia information among older children between the age range of 6 years to 9 years 11 months, wherein auditory-visual modality-based benefits using a story-based task were reported (Rooha et al., 2021). The present study's findings indicate that preschool children could also benefit from auditory-visual modality during the recall, like schoolaged children. Lastly, the present research also demonstrated improved recall abilities with increasing age among the preschoolers, with bimodality preference remaining the same for both the age groups.
The higher recall scores in auditory-visual modality as compared to visual and auditory modality could be supported through the following explanations:

Dual coding theory and multimedia learning
The visual information (pictures) in the auditory-visual modality presentations have been reported to create either a facilitatory or a distractor effect on the recall abilities. The facilitatory effect could be due to the benefit of dual coding, as explained by the Dual Coding theory (Baddeley, 2003;Kanellopoulou et al., 2019;Paivio, 1986). This theory states that the information is simultaneously processed in both auditory and visual modalities. At the same time, encoding helps retain it more effectively than if it is processed in a single modality. More specifically, a combination of auditory (narration) and visual (pictures) information might enable forming easily retrievable memory traces than it would have on being exposed to a single modality (Kanellopoulou et al., 2019). The multimedia principle (Mayer, 2002) also supports the perspective that people learn better in auditory-visual content than in auditory content alone. On the other side, the distractor effect of visual information (pictures) in auditory-visual processing is the impedance of pictures in the attention and processing of auditory stimuli in simultaneous processing, which affects the recall. The present study results reveal that preschoolers are observed with facilitatory effects of auditory-visual processing. In both the facilitatory and distracter effects, the auditory-visual processing increases the demand over the working memory capacity and is dependent on it (Baddeley, 2003;Mayer & Moreno, 1998). Auditory-visual processing involves selecting the auditory and visual information, organizing it into a separate mental model, and integrating it by creating connections between the prior knowledge and corresponding events in auditory and visual models (Mayer, 2009). These explanations depict the importance and benefit of working memory in processing dual-modality information. Literature and theoretical aspects demonstrate that better recall abilities indicate better working memory capacity (Unsworth et al., 2012). Hence the findings of the current study suggest that children as young as preschool age are equipped to integrate auditory and visual information to benefit their working memory capacity.

Mental imagery skill
Mental imagery skills are the ability to create images of the information in the mind's eye (Algozzine & Douville, 2004). It has been suggested that pictures, along with auditory content, can create better mental imagery skills, which in turn can result in better recall (Boerma et al., 2016). Hence the auditoryvisual story content in the current study would have facilitated the creation of better mental images and thus reflected as better recall scores. The reduced recall scores in the auditory modality of story content could be due to the difficulty in creating mental images in the absence of a picture in young preschool children. Greenhoot and Semb, in 2008, opined that younger children might have difficulty generating mental images of the auditory contents.

Attention and motivation
The improved recall for auditory-visual story content could also be due to the increased allocation of attentional and motivational resources by preschool children towards the auditory-visual stimuli. Pictures, along with auditory information, can capture more attention and motivation, thus better recall (Greenhoot & Semb, 2008;Houts et al., 2006;Mayer, 2014). Motivation is the internal state that initiates, maintains, and energizes the learner's effort toward the stimuli. The presentation of balanced multimedia stimuli in the present study might have facilitated motivation (Mayer, 2014) and thereby recall. Besides, the Visual superiority effect (Hayes & Birnbaum, 1980;Houts et al., 2006) could also be a potential contributing factor for preschool children to attend more closely to visual content than auditory content.

Comprehension skill
The facilitatory effect of pictures in the comprehension of the content (Tompkins et al., 2013) could be another potential explanation for auditory-visual benefits. A study done by Verhallen et al. (2006) found that preschool children could better comprehend and recall linguistic information with multimedia storybooks. Hence such a facilitatory effect of pictures and other media in inferencing and comprehending might also have resulted in better recall of auditory-visual content for preschool children in the current study.
The contrary findings in the literature suggesting auditory modality preference in preschoolers (Greenhoot & Semb, 2008) could be because of the difference in the study design, nature of stimuli, and comparison groups as against the present study. Napolitano and Sloutsky (2004) opined that preschool children show the flexible nature of dominancy based on tasks. It is crucial for researchers, clinicians, and educators that the rationale, study design, and research framework should always be considered when drawing any conclusions regarding modality preference in preschoolers' recall abilities.
The study implies that the use of auditory-visual modality for presenting contents or information yields better recall in children as young as preschool age. As recall is one of the important cognitive communicative abilities that underpin literacy, present findings should be considered while designing curriculum and learning resources for preschoolers. More specifically, the resources presented in the auditory-visual modality may lead to better recall and learning in preschoolers.
However, the present study does possess certain limitations. Present findings show a preliminary trend from a relatively smaller group of preschoolers. Therefore, similar studies on a larger group collected over different stimuli may provide additional inputs. Research considering the story grammar elements, type of recall concepts, and manipulating the picture complexity might give better clarity on the auditory-visual benefit in preschool children.

Conclusion
The study aimed to assess the modality-specific influences on recall abilities among preschoolers.
The study was carried out on a single group of preschoolers using a novel story and story stimulus wherein smaller story contents were used with the stimulus balanced across auditory, visual, and auditory-visual modalities. The study's findings showed that recall abilities in preschoolers depend on the modality of story content presentation with an auditory-visual preference over visual and auditory modality, warranting a need to avoid overgeneralization while estimating memory using a single modality. Thus, the present study provides an insight into the development of age-linked modality-specific differences in recall abilities among preschoolers. The trend is similar among both younger and older preschoolers, though the recall abilities improved with age. It also gives a baseline to explore the development of age-linked modality differences in recall abilities. The study explains using contents in auditory-visual modality among preschool children to facilitate better recall and learning. Hence, the modality preference evident in the present study may be considered while designing diverse learning resources for preschoolers.