Learning disabilities

Review of the Brain's Behaviour after Injury and Disease for Its Application in an Agent-Based Model (ABM)

The brain is the most complex organ in the human body and, as such, its study entails great challenges (methodological, theoretical, etc.). Nonetheless, there is a remarkable amount of studies about the consequences of pathological conditions on its development and functioning. This bibliographic review aims to cover mostly findings related to changes in the physical distribution of neurons and their connections-the connectome-both structural and functional, as well as their modelling approaches. It does not intend to offer an extensive description of all conditions affecting the brain; rather, it presents the most common ones. Thus, here, we highlight the need for accurate brain modelling that can subsequently be used to understand brain function and be applied to diagnose, track, and simulate treatments for the most prevalent pathologies affecting the brain.

Assessment of the Functional Level of Independence in Individuals with Mental Disabilities as Part of Special Education Diagnostics: Case Studies

In this study we focus on the application of standardized tests aimed at evaluating the functional degree of independence in children (client 1, WeeFIM test; and client 2, FIM test) in special education diagnostics. The target group consisted of two clients with a diagnosis of mental functional diversity (n = 2; client 1: mild mental retardation, according to ICD-10: F70, aged 6.5 years; and client 2: moderate mental retardation, according to ICD-10: F71, aged 13.4 years). Special pedagogical intervention was primarily applied to the clients, focusing on identified deficits in the areas of cognitive, motor, and social skills. The presented results demonstrate the importance of the application of these tests in special pedagogy. An improvement in the observed indicators of the given tests was demonstrated for both probands after the intervention. The aim of this article was to draw attention to the suitability of using functional independence tests in special pedagogical practices. The authors discuss the further implications of this application for future practice.

Prevalence of Specific Learning Disorders (SLD) Among Children in India: A Systematic Review and Meta-Analysis

Background:

Specific learning disorders (SLD) comprise varied conditions with ongoing problems in one of the three areas of educational skills–reading, writing, and arithmetic–which are essential for the learning process. There is a dearth of systematic reviews focused exclusively on the prevalence of SLD in India. Hence, this study was done to estimate the prevalence of SLD in Indian children.

Methods:

A systematic search of electronic databases of MEDLINE, Embase, PsycINFO, and CINAHL was conducted. Two authors independently assessed the eligibility of the full-text articles. The third author reassessed all selected studies. A standardized data extraction form was developed and piloted. The pooled prevalence of SLDs was estimated from the reported prevalence of eligible studies, using the random-effects model.

Results:

Six studies of the systematic review included the diagnostic screening of 8133 children. The random-effects meta-analysis showed that the overall pooled prevalence of SLD in India was 8% (95% CI = 4–11). The tools used to diagnose SLD in the studies were the National Institute of Mental Health and Neurosciences (NIMHANS)-SLD index and the Grade Level Assessment Device (GLAD).

Conclusions:

Nearly 8% of children up to 19 years have SLD. There are only a few high-quality, methodologically sound, population-based epidemiological studies on this topic. There is a pressing need to have large population-based surveys in India, using appropriate screening and diagnostic tools. Constructing standardized assessment tools, keeping in view the diversity of Indian culture, is also necessary.

Utility of medical record diagnostic codes to ascertain attention-deficit/hyperactivity disorder and learning disabilities in populations of children

BACKGROUND

To develop and evaluate machine learning algorithms to ascertain attention-deficit/hyperactivity (ADHD) and learning disability (LD) using diagnostic codes in the medical record.

METHOD

Diagnoses of ADHD and LD were confirmed in cohorts of children in Olmsted County of Minnesota based on validated research criteria. Models to predict ADHD and LD were developed using ICD-9 codes in a derivation cohort of 1057 children before evaluated in a validation cohort of 536 children.

RESULTS

The ENET-MIN model using selected ICD-9 codes at prior probability of 0.25 has a sensitivity of 0.76, PPV of 0.85, specificity of 0.98, and NPV of 0.97 in the validation cohort. However, it does not offer significant advantage over a model using a single ICD-9 code of 314.X, which shows sensitivity of 0.81, PPV of 0.83, specificity of 0.98, and NPV of 0.97. None of the models developed for LD performed well in the validation cohort.

CONCLUSIONS

It is feasible to utilize diagnostic codes to ascertain cases of ADHD in a population of children. Machine learning approaches do not have advantage compared with simply using a single family of diagnostic codes for ADHD. The use of medical record diagnostic codes is not feasible to ascertain LD.

An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan

OBJECTIVE

Dealing with Dyslexia, Dysgraphia and Dyscalculia symptoms is a major challenge for teachers and school psychologists while addressing students' issues. The present study was designed to examine the prevalence and comorbidity of specific learning disabilities (SLD) symptoms such as dyslexia, dysgraphia and dyscalculia in public and private schools of Lahore, Pakistan.

METHODS

This cross-sectional study was conducted in four schools of Lahore from June, 2019 to December 2019. We examined 666 participants (boys= 384, girls= 282) from two public (n=409) and two private (n=257) schools of Lahore with a mean age of 13 years (SD±1.44). Participants were assessed on Learning Disabilities Checklist (LDC) along with a demographic sheet. The data were analyzed by using descriptive statistics (frequencies and percentages) and inferential analyses of Chi Square test of association and Cohen's Kappa by using SPSS version 24.

RESULTS

Findings indicated that 39% participants showed SLD symptoms, 33% dyslexia, 48% dysgraphia and 45% dyscalculia symptoms. Significant co-morbidities were seen, such as 30% for dyslexia and dysgraphia symptoms, dyslexia and dyscalculia 26% and dysgraphia and dyscalculia as 36%. Variations in SLD, dyslexia, dysgraphia and dyscalculia symptoms were also seen across gender and schools with significant higher prevalence in public schools.

CONCLUSION

High prevalence of SLD symptoms and comorbidity in students was found which is alarming, particularly in public sector schools in Pakistan. SLD and dyslexia were higher for boys, whereas girls scored high on dysgraphia and dyscalculia. Therefore, there is great need of introducing screening measure of assessment of SLD and management strategies to deal with these issues.

Psychiatric Comorbidities in Children with Specific Learning Disorder-Mixed Type: A Cross-sectional Study

Background Specific learning disorder (SLD) is a neurodevelopmental condition which frequently exhibits with comorbidities of other disorders, including attention deficit hyperactivity disorder (ADHD), conduct disorder, anxiety, and depression. SLD with any comorbidity may affect the expression and severity of the SLD and may make its management difficult. Thus, the present cross-sectional study was planned to examine the psychiatric comorbidities among children with SLD.

Materials and Methods The sample consisted of 41 patients aged between 7 and 12 years with a diagnosis of SLD-mixed type. Clinical and psychological assessment included the following tests for behavioral, anxiety, mood, and interpersonal problems: child behavior checklist, Mini-international Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and Conner’s 3 Parent Short form-45.

Results The mean age of the participants was 9.8 years (standard deviation [SD] = 1.5). About 75.6% of participants were male, and their mean years of education was 5 years (SD = 1.5). Twenty-four percent of children had a history of delayed developmental milestones. Among comorbidities of SLD, association with attention deficit disorder (ADD)/ADHD has been found to be significant along with difficulties in executive function, peer relation, and aggression.

Conclusion Children with SLD are likely to exhibit signs of ADHD/ADD and dysfunction in executive function, peer relation, and aggression. The management of comorbid conditions is recommended along with remediation of learning problem to overall educational and behavioral achievements and development of child.

Specific Learning Disabilities and Psychiatric Comorbidities in School Children in South India

BACKGROUND

Specific learning disabilities (SLDs) are an important cause of academic underachievement in children and are also associated with comorbidities like attention deficit hyperactivity disorder (ADHD) which further have an impact on the child's education.

AIMS

To estimate the prevalence and psychosocial profile and psychiatric comorbidities in children with SLD in two settings, i.e., on special (remedial) education and schools and to compare the findings with normal children.

MATERIALS AND METHODS

This study was carried out in schools situated in urban and semi-urban areas and special education schools. A total of 96 children were chosen for the study. After taking informed consent from the parents, the details about socioeconomic status, family, developmental history, and school history of the children were collected on a semi-structured pro forma and then the children were screened for SLD. They were administered colored/standard progressive matrices and Malin's intelligence scale for assessing their intelligence quotient and NIMHANS SLD index and developmental psychopathology checklist to study psychopathology. Chi-square test and ANOVA were done.

RESULTS

The prevalence of SLD in schools is found out to be 6.6%. There was a significant association with prematurity, cesarean section, delayed speech, and family history of SLD. Among comorbidities of SLD, association with ADHD alone has been found to be significant.

CONCLUSION

The most common type of SLD is combined type comorbid with ADHD. There is a need for early identification of learning disabilities in schools so that with early recognition and remedial intervention children can be helped with to cope with studies.

Is anxiety more common in school students with newly diagnosed specific learning disabilities? A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India

Background and Objectives:

School students with specific learning disabilities (SpLDs) experience chronic academic underachievement and resultant stress. The present study aimed to determine if school students with newly diagnosed SpLD were more likely to have anxiety than their regular peers.

Materials and Methods:

The study cases (aged 8-15 years) were recruited from our institute's learning disability clinic. The matched controls were recruited from four schools in Mumbai, Maharashtra, India. Anxiety was measured using the Spence Children's Anxiety Scale (SCAS)-child self-report version questionnaire. Median SCAS scores and the proportion of students with an SCAS score in the “clinical anxiety” range were compared between the groups.

Results:

SCAS scores were significantly higher in 8-11-year-old learning-disabled male and female students (P < 0.0001 for both groups) and 12-15-year-old female students (P = 0.004), as compared with matched controls. A significantly higher number of learning-disabled students were found to have “clinical anxiety” [24.64% vs 4.35%, crude odds ratio (OR) = 7.19, 95% confidence interval (CI) 2.91-17.78, P = 0.0001], as compared with the controls regardless of gender, age group, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), or associated medical conditions. A significantly higher proportion of 8-11-year-old learning-disabled students, especially males, were found to have “clinical anxiety” as compared with 12-15-year-old learning-disabled students (crude OR = 4.38, 95% CI 1.94-9.92, P = 0.0004). Gender, presence of comorbid ADHD or associated medical conditions, and type of school attended or curriculum did not impact the prevalence of “clinical anxiety” in learning-disabled students.

Interpretation and Conclusions:

Students with newly diagnosed SpLD have greater odds of being “clinically anxious” relative to their regular peers. We recommend screening for anxiety in children with SpLD immediately after diagnosis so that their optimum rehabilitation can be facilitated.

The Interpretation of Emotion from Facial Expression for Children with Visual Processing Problems

A significant proportion of people with learning difficulties have social problems, which are often considered to be the product of school failure. However, a number of studies have suggested that these social skill problems may relate to the inability to decode subtle visual cues of body language and facial expression. The majority of studies of facial expression, however, have viewed learning disability as a unitary condition, without taking account of specific sub‐types which may have more difficulty in processing visual cues, especially for facial emotion. This study investigated children aged 8 to 12 years who were divided into three learning disability sub‐groups: 1) a visual‐perceptual sub‐type called Irlen Syndrome (n=41); 2) a group with learning disabilities, but no indications of Irlen Syndrome (n=30); and 3) a normally achieving control group (n=31). The Irlen Syndrome sub‐group had significantly lower scores for interpreting emotion from facial expression than the two other groups. The learning disabled non‐lrlen sub‐group also had significantly lower scores than the control group, but with much smaller levels of significance than those between the Irlen and control groups.

Auditory perception of non-sense and familiar Bengali rhyming words in children with and without SLD

BACKGROUND

Rhyming ability is among the earliest metaphonological skills to be acquired during the process of speech and language acquisition. Metalinguistic skills, particularly metaphonological skills, greatly influence language learning during early, school grades and reportedly children with learning disorders are poor at these skills.

AIM AND OBJECTIVES

To develop and validate a Bengali rhyming checklist and study the auditory perception of non-sense and familiar Bengali rhyming words in children with and without specific learning disability (SLD).

METHOD

60 children, age range 8-11years, participated in two groups; group-A included children with SLD and group-B, typically developing children (TDC). All participants were native Bengali speakers, attending regular school, with hearing sensitivity less than 25dBHL, no history of ear discharge and middle socioeconomic background. A rhyming checklist was developed in Bengali, consisting of familiar (section-A) and non-sense (section-B) words. Test-retest reliability and validity measures were obtained. The items on the checklist were audio recorded and presented to the participants in a rhyming judgment task in one to one set up. Scores were obtained and statistically analyzed using SPSS software (version-11.0).

RESULT

Children with SLD scored significantly low on the rhyming judgment task as against TDC (p<.05) for both familiar and non-sense words. Children with SLD performed significantly better on familiar word rhyming judgment task against non-sense words (p<.05). TDC showed no significant difference on familiar and non-sense words rhyming judgment tasks (p>.05).

CONCLUSION

Semantic content influences rhyming perception in children with SLD but has no significant effect on TDC. The developed rhyming checklist may be used as a screening tool for children at risk of SLD at primary school grades. Rhyming activities may be utilized by teachers and parents, to promote language learning in young learners.

Health-related quality of life of children with newly diagnosed specific learning disability

The objective of this study was to measure health-related quality of life (HRQL) of children with newly diagnosed specific learning disability (SpLD) using the Child Health Questionnaire-Parent Form 50. We detected clinically significant deficits (effect size > or = -0.5) in 9 out of 12 domains: limitations in family activities, emotional impact on parents, social limitations as a result of emotional-behavioral problems, time impact on parents, general behavior, physical functioning, social limitations as a result of physical health, general health perceptions and mental health; and in both summary scores (psychosocial > physical). Multivariate analysis revealed having > or = 1 non-academic problem(s) (p < 0.0001), attention-deficit hyperactivity disorder (p = 0.005) or first-born status (p = 0.009) predicted a poor psychosocial summary score; and having > or =1 non-academic problem(s) (p = 0.006) or first-born status (p = 0.035) predicted a poor physical summary score. HRQL is significantly compromised in children having newly diagnosed SpLD.

A review of association and linkage studies for genetical analyses of learning disorders

Learning disorders (LD) commonly comprise of a heterogeneous group of disorders manifested by unexpected problems in some children's experiences in the academic performance arena. These problems especially comprise of a variety of disorders which may be subclassified to attention-deficit hyperactivity disorder (ADHD), reading disability (RD), specific language impairment (SLI), speech-sound disorder (SSD), and dyspraxia. The aim of this review is to summarize the current molecular studies and some of the most exciting recent developments in molecular genetic research on LD. The findings for the association and linkage of LD with candidate genes will help to set the research agendas for future studies to follow.

Lifetime prevalence of learning disability among US children

OBJECTIVE

Our goal was to examine the lifetime prevalence of learning disability by sociodemographic and family-functioning characteristics in US children, with particular attention paid to the children with special health care needs.

METHODS

By using data from the National Survey of Children's Health, we calculated lifetime prevalence of learning disability using a question that asked whether a doctor or other health care or school professional ever told the survey respondent that the child had a learning disability. Children with and those without special health care needs were classified on the basis of how many of 5 definitional criteria for children with special health care needs they met (0-5). Bivariate and multivariate statistical methods were used to assess independent associations of selected sociodemographic and family variables with learning disability.

RESULTS

The lifetime prevalence of learning disability in US children is 9.7%. Although prevalence of learning disability is lower among average developing children (5.4%), it still affected 2.7 million children compared with 3.3 million (27.8%) children with special health care needs. As the number of definitional criteria children with special health care needs met increased from 1 to 5, so did the prevalence of learning disability (15.0%, 27.1%, 41.6%, 69.3%, and 87.8%, respectively). In the adjusted logistic regression model, in addition to the number of definitional criteria the children met, variables associated with the increased odd ratios of learning disability were lower education, all categories of poverty <300% of the federal poverty level, being male, increasing age, having a 2-parent stepfamily or other family structure, being adopted, presence of a smoker, respondent's higher responses on aggravation in parenting scale, sharing ideas with the child less than very well, and never, rarely, or sometimes discussing serious disagreements calmly.

CONCLUSIONS

Although more than half of lifetime prevalence of learning disability occurred in children with special health care needs, it is a significant morbidity in average-developing children as well. Learning disabilities represent important comorbidities among children with special health care needs.

Educational provisions and learning disability

OBJECTIVE

To assess the impact of the provisions of the Maharashtra government on the academic performance of children with specific learning disability (SpLD) at the Secondary School Certificate (SSC) board examination.

METHODS

The academic performance of 60 children (45 boys, 15 girls) at the SSC board examination with benefit of chosen provisions was compared with their performance at their last annual school examination before diagnosis of SpLD.

RESULTS

There was a significant improvement in their mean percentage (%) total marks scored at the SSC board examination as compared with the mean % total marks scored by them at their last annual school examination before the diagnosis (63.48 +/- 7.86 vs. 40.95 +/- 7.23) [mean +/- SD, mean % difference = 22.53, 95% CI = 19.8 - 25.26, P.

CONCLUSION

Children with SpLD who availed the benefit of provisions showed a significant improvement in their academic performance at the SSC board examination.

Cognition in specific learning disability

OBJECTIVE

To compare the cognition abilities of children with specific learning disability (SpLD) viz. dyslexia, dysgraphia and dyscalculia with those of non-impaired children.

METHODS

The study group consisted of 95 newly diagnosed SpLD children (aged 9-14 years) and the control group consisted of 125 non-impaired children (aged 9-14 years). An academic achievement of two years below the actual grade placement on educational assessment with a Curriculum-Based test was considered diagnostic of SpLD. A battery of 13 cognition function tests based on Guilford's Structure of Intellect Model was administered individually on each child in four areas of information viz. figural, symbolic, semantic and behavioral. Mean scores +/- SD obtained in these four areas were calculated in both groups and compared using Independent Samples t-test. A P value < 0.05 was considered significant.

RESULTS

Children with SpLD had significantly lower scores (mean +/- SD) in all four areas of information: maximally in the symbolic area (18.66 +/- 4.83 vs. 28.30 +/- 4.29, mean difference 9.64, P < 0.0001, df = 218, 95% CI 8.43-10.86), followed by semantic (18.72 +/- 5.07 vs 27.36 +/- 4.17, mean difference 8.64, P < 0.0001, df = 218, 95% CI 7.40-9.87), figural (17.10 +/- 5.24 vs 25.14 +/- 3.36, mean difference 8.04, P < 0.0001, df = 218, 95% CI 6.89-9.19), and behavioral (5.68 +/- 2.10 vs 7.54 +/- 1.46, mean difference 1.86, P < 0.0001, df = 218, 95% CI 1.39-2.33) areas.

CONCLUSION

Cognition abilities are significantly impaired in children with SpLD.

Poor school performance

Education is one of the most important aspects of human resource development. Poor school performance not only results in the child having a low self-esteem, but also causes significant stress to the parents. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes. The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis. However, a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical psychologist, special educator, and child psychiatrist is usually necessary before making the final diagnosis. It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential.

Readiness for school entry: a community survey

This study assessed the development of 4-5-year-old children in an urban low-income community in Sri Lanka, with the aim of investigating their readiness for formal education. A modified Denver developmental screening test was used to determine the presence of age-appropriate motor, cognitive (including language) and social skills in 295 children. Of these children, 17.8% were unable to perform more than 50% of the tasks correctly. Children with motor problems were more likely to have difficulties with cognitive tasks than children without motor problems. Children who attended preschool did significantly better in most tasks compared with those who did not. The level of maternal education did not show a direct association with the competencies of the children. This assessment schedule can be used as a quick screening method in the community for early recognition of children with the potential for learning problems in school.

Attention deficit hyperactivity disorder: comorbidity and medication use

Children evaluated for attention deficit hyperactivity disorder (ADHD) may have other disorders resembling ADHD leading to inappropriate stimulant medication use. This study was completed to identify relationships between referral complaints of ADHD, behavior problems or learning problems and age, gender, final diagnosis, and medication use. One hundred eighty-nine children ages 2 to 15 years referred for evaluation of ADHD, behavior or learning problems were evaluated by an interdisciplinary team. Diagnoses of ADHD, specific learning disability (SLD), mental retardation (MR), developmental language disorders (LANG), and other behavior disorders (DIS) were established. Medication use pre- and post-evaluation was reviewed. Forty-three percent of all subjects had a final diagnosis of ADHD. Forty percent referred specifically for presumed ADHD did not have it. More children older than 5 years were diagnosed as having ADHD than those 5 years old or younger (p < 0.0001). More subjects 5 years old or younger were diagnosed as having LANG than those older than 5 years (p < 0.0001). Fewer subjects with a chief complaint of ADHD were diagnosed with MR than those with behavior or learning problems (p = 0.001). In subjects 5 years old or younger, 35% were diagnosed with MR and 49% with other DIS. In children older than 5 years, 41% were diagnosed with SLD. Ten percent of subjects without ADHD were using stimulants. Only 48% of subjects with confirmed ADHD took stimulants. Children presenting with behavior problems or those 5 years old or younger are at higher risk for MR, LANG, and DIS and less likely to have ADHD. Children presenting with learning problems or those older than 5 years are more likely to have SLD or ADHD. Multiple diagnoses were common for all ages and presentations. Ten percent of children without confirmed ADHD used stimulants before evaluation.

Identifying and classifying children with chronic conditions using administrative data with the clinical risk group classification system

OBJECTIVE

To identify and categorize children with chronic health conditions using administrative data.

METHODS

The Clinical Risk Groups (CRGs) system is used to classify children, aged 0-18 years, in a mid-sized health plan into mutually exclusive categories and severity groups. Enrollees are categorized into 9 health status groups--healthy, significant acute, and 7 chronic conditions--and are then stratified by severity. Utilization is examined by category and severity level based on eligibility and claims files for calendar year 1999. Only children enrolled for at least 6 months (newborns at least 3 months) are included.

RESULTS

This analysis of 34544 children classifies 85.2% as healthy, including 19.6% with no claims; 5.2% with a significant acute illness; 4.6% with a minor chronic condition; and 4.9% with a moderate to catastrophic chronic condition. The average number of unique medical care encounters per child increases by chronic condition category and by severity level. Compared to national prevalence norms for selected conditions, CRGs do well in identifying patients who have conditions that require interaction with the health care system.

CONCLUSIONS

CRGs are a useful tool for identifying, classifying, and stratifying children with chronic health conditions. Enrollees can be grouped into categories for patient tracking, case management, and utilization.

Approach to learning disability

Learning disabilities (LD) is one of the important causes of poor academic performance in school going children. Learning disabilities are developmental disorders that usually manifest during the period of normal education. These disabilities create a significant gap between the true potential and day to day performance of an individual. Dyslexia, dysgraphia and dyscalculia denote the problem related to reading, writing and mathematics. Perinatal problems are certain neurological conditions, known to be associated with LD; however, genetic predisposition seems to be the most probable etiological factors. Evaluation of a child suspected to be having LD consists of medical examination, vision and hearing test analysis of school performance. The psycho-behaviour assessment and education testing are essential in the process of diagnosis. The experienced persons in the field of LD should interpret the results of such tests. With Individualized Remedial Education Plan (IEP) most children learn to cope up with disability and may get integrated in a regular steam.

Adolescents with learning disabilities: risk and protective factors associated with emotional well-being: findings from the National Longitudinal Study of Adolescent Health

PURPOSE

To identify differences in emotional well-being among adolescents with and without learning disabilities and to identify risk and protective factors associated with emotional distress.

METHODS

Cross-sectional analysis of adolescent in-home interview data of the National Longitudinal Study of Adolescent Health. A total of 20,780 adolescents were included in this study of whom 1,301 were identified as having a learning disability. Initially, emotional distress, suicidal behaviors, and violence involvement were compared among those adolescents with and without learning disabilities using Student's t-test for the continuous or semicontinuous variables and Chi-square for the dichotomous variables. Subsequently, logistic regression analyses were conducted to identify which variables were most strongly associated with risk and protective factors for emotional distress.

RESULTS

Adolescents with learning disabilities had twice the risk of emotional distress, and females were at twice the risk of attempting suicide and for violence involvement than their peers. While educational achievement is below that of peers, connectedness to school is comparable. So, too, is connectedness to parents. Connectedness to parents and school was identified as most strongly associated with diminished emotional distress, suicide attempts, and violence involvement among adolescents with learning disabilities.

CONCLUSIONS

Given the increased association with emotional distress, suicidal attempts, and violence involvement, clinicians need to assess social and emotional as well as educational and physical functioning of these young people. We also need to be aware of the role protective factors play in the lives of young people with learning disabilities.

Scotopic sensitivity/Irlen syndrome and the use of coloured filters: a long-term placebo controlled and masked study of reading achievement and perception of ability

This study investigated the effects of using coloured filters on reading speed, accuracy, and comprehension as well as on perception of academic ability. A double-masked, placebo-controlled crossover design was used, with subjects being assessed over a period of 20 mo. There were three treatment groups (Placebo filters, Blue filters, and Optimal filters) involving 113 subjects with "reading difficulties", ranging in age from 9.2 yr. to 13.1 yr. and with an average discrepancy between chronological age and reading age of 1.8 yr. The 35 controls (who did not use coloured filters) ranged in age from 9.4 yr. to 12.9 yr., with an average discrepancy between chronological age and reading age of 2.1 yr. The treatment groups increased at a significantly greater rate than the control group in reading accuracy and reading comprehension but not for speed of reading. For self-reported perception of academic ability, two of the three treatment groups showed significantly greater increases than the control group. The larger improvements for treatment groups in reading comprehension may be related to a reduction in print and background distortions allowing attention to be directed to the processing of continuous text rather than to the identification of individual words. A reduction in print distortion, however, may not be sufficient to generate improved word-identification skills without additional remedial support, and this may be indicated by the nonsignificant increase in rate of reading.

Attention-deficit disorder. A paradigm for psychotropic medication intervention in pediatrics

Pediatricians frequently encounter patients with behavioral or academic problems in clinical practice. Assessing and managing these patients requires awareness of the numerous physical, emotional, and psychological causes. Because of their limited contact with these patients during a routine visit, pediatricians as a minimum, should rely on careful parental and social history, teachers' evaluations by checklist, achievement test scores and grades, and the clinicians' own gestalt regarding patients' behavior. This article provides a framework that practitioners can incorporate into their routine office practices. Practitioners must also be knowledgeable about different forms of ADD and learning disabilities, differential diagnosis, and frequently encountered comorbidities. A modest armamentarium of psychotropic drugs potentially useful in the treatment of ADD are available; however, they must be aware of indications, subtle differences in pharmacokinetics, rates of efficacy, and adverse effects for these medications. Appropriate behavioral intervention, educational assessment, and placement when necessary are also essential for optimal management. Enabling the child or adolescent to achieve successfully in school, to experience positive social interactions, and to regain self-esteem are the more rewarding facets of pediatric care.

Persistent school dysfunction: unrecognized comorbidity and suboptimal therapy

To determine reasons for continued school dysfunction in children previously diagnosed as having attention deficit hyperactivity disorder (ADHD) or enrolled in a special education program (spec. ed.), a retrospective chart review of patients referred for interdisciplinary evaluations at a tertiary center for hyperactivity and learning problems was completed. Interdisciplinary clinical recommendations were used to define reasons for treatment failure in 116 children with prior diagnosis of ADHD or spec. ed. placement. Results showed 45% of children enrolled in spec. ed. had previously undiagnosed ADHD. Thirty-one percent of those with ADHD, 55% of those in spec. ed., and 55% of those diagnosed with ADHD and in spec. ed. (Both) received a new educationally handicapping diagnosis. Psychiatric comorbidity was present in 28% of those with ADHD, 18% of those in spec. ed., and 23% of Both subjects. Thirteen percent of those in spec. ed. had significant coexisting medical conditions. Special education services were insufficient in 55% of children in spec. ed. and 55% of Both subjects. A significant difference (P < 0.01) in medication use was noted between the groups with 56% of the ADHD group, 55% of the Both group, and none of the spec. ed. group treated with medication. Of all subjects with ADHD, 76% were receiving insufficient or no medication. This review suggests the following: (1) Comorbidity in children with school dysfunction is frequently not recognized. (2) Educational therapy alone may not be sufficient treatment for school dysfunction, and in cases where the treatment program is failing, the appropriateness of the program should be reviewed. (3) ADHD is commonly seen in conjunction with other educationally handicapping conditions. Therefore, in cases of continuing school dysfunction, children previously diagnosed has having ADHD should be assessed for other educationally handicapping conditions; those previously diagnosed as educationally handicapped should be assessed for ADHD. (4) Suboptimal medication use may be associated with treatment failure.