Learning disorders with a special emphasis on reading disorders: a review of the past 10 years

Specific Learning Disorders (SLD) and Behavior Impairment: Comorbidity or Specific Profile?

INTRODUCTION

Specific Learning Disorder (SLD) is a neurodevelopmental disorder characterized by difficulties in perceiving and processing verbal and non-verbal information. It is usually accompanied by impaired academic skills leading to school dropout and emotional disturbances, resulting in significant distress and behavioral problems.

METHODS

A cognitive, academic, and emotional-behavioral assessment was performed at T0 and T1 in children and adolescents with SLD. Participants received psychotherapy and speech therapy treatment from T0 to T1.

RESULTS

In SLD, the most compromised cognitive functions were working memory and writing skills. An impact on academic abilities was found. Children and adolescents with SLD experience greater anxiety and depression levels compared to their control peers.

CONCLUSIONS

SLD may adversely influence psychological well-being. To counteract such a consequence, more specific cognitive and academic skill-oriented strategies should be taken into consideration.

The Role of Visual Factors in Dyslexia

What are the causes of dyslexia? Decades of research reflect a determined search for a single cause where a common assumption is that dyslexia is a consequence of problems with converting phonological information into lexical codes. But reading is a highly complex activity requiring many well-functioning mechanisms, and several different visual problems have been documented in dyslexic readers. We critically review evidence from various sources for the role of visual factors in dyslexia, from magnocellular dysfunction through accounts based on abnormal eye movements and attentional processing, to recent proposals that problems with high-level vision contribute to dyslexia. We believe that the role of visual problems in dyslexia has been underestimated in the literature, to the detriment of the understanding and treatment of the disorder. We propose that rather than focusing on a single core cause, the role of visual factors in dyslexia fits well with risk and resilience models that assume that several variables interact throughout prenatal and postnatal development to either promote or hinder efficient reading.

The effect of classroom environment on literacy development

The physical characteristics of a child's learning environment can affect health, wellbeing and educational progress. Here we investigate the effect of classroom setting on academic progress in 7-10-year-old students comparing reading development in "open-plan" (multiple class groups located within one physical space) and "enclosed-plan" (one class group per space) environments. All learning conditions (class group, teaching personnel, etc.) were held constant throughout, while physical environment was alternated term-by-term using a portable, sound-treated dividing wall. One hundred and ninety-six students underwent academic, cognitive and auditory assessment at baseline and 146 of these were available for repeat assessment at the completion of 3 school terms, allowing within-child changes across an academic year to be calculated. Reading fluency development (change in words read-per-minute) was greater for the enclosed-classroom phases (P < 0.001; 95%CI 3.7, 10.0) and the children who showed the greatest condition difference (i.e. slower rate of development in the open-plan) were those with the worst speech perception in noise and/or poorest attention skills. These findings highlight the important role classroom setting plays in the academic development of young students.

Parent, teacher, and nurse concerns and school doctor actions: an observational study of general health checks

OBJECTIVE

To evaluate the association between the concerns of parents, teachers, and nurses regarding each child's well-being and the school doctor actions conducted in routine general health checks.

DESIGN

A blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions.

SETTING

21 primary schools in four municipalities in Finland.

PARTICIPANTS

Between August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively.

OUTCOME MEASURES

Outcome measures were the respondents' concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to 'Quite a lot or a great deal of concern' by at least one respondent. The school doctor actions included instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals, and referrals to specialised care.

RESULTS

Altogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66-4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80-4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p&lt;0.0001).

CONCLUSIONS

Health checks by school doctors may lead to referrals of children to other professionals especially for children's psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals.

TRIAL REGISTRATION

NCT03178331.

Compensatory role of verbal learning and consolidation in reading and spelling of children with dyslexia

The present study investigated the compensatory role of verbal learning and consolidation in reading and spelling of children with (N = 54) and without dyslexia (N = 36) and the role of verbal learning (learning new verbal information) and consolidation (remember the learned information over time) on the response to a phonics through spelling intervention of children with dyslexia. We also took phonological awareness, rapid automatized naming, verbal working memory, and semantics into account. Results showed that children with dyslexia performed better in verbal learning and equal in verbal consolidation compared to typically developing peers. Regression analyses revealed that verbal learning did not predict reading but did predict spelling ability, across both groups; verbal consolidation did not predict reading, nor spelling. Furthermore, neither verbal learning nor verbal consolidation was related to responsiveness to a phonics through spelling intervention in children with dyslexia. Verbal learning may thus be seen as a compensatory mechanism for spelling before the intervention for children with dyslexia but is beneficial for typically developing children as well.

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study

BACKGROUND

In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors.

METHODS

Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child's physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression.

RESULTS

The participation rate was 75.5 %. According to all questionnaires, 20-25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41-5.17).

CONCLUSIONS

The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.

The prevalence of psychiatric comorbid disorders among children with specific learning disorders: a systematic review

Background

Understanding comorbidity of psychiatric disorders with specific learning disorders (SLD) is important because the presence of any additional disorder to the learning disability may affect the severity and prognosis of the SLD symptoms and requires specific treatments and interventions.

Main body of the abstract

The purpose of this systematic review was to describe the prevalence of comorbid psychiatric disorders among children with SLD between 6 and 18 years. English studies published between 2013 and 2018 were located through searches of PubMed and ScienceDirect. In this review, only 5 articles met the inclusion criteria. The quality of the included studies was assessed with the Cochrane risk of the bias assessment tool. The prevalence of ADHD and anxiety disorder was reported in 4 studies. Prevalence of conduct disorder (CD) and depression was reported by 3 studies, and 2 studies reported the prevalence of oppositional defined disorders (ODD). Although this review included a small number of studies that used a diversity of methods to diagnose psychiatric disorders, the results of the prevalence rates were homogenous.

Short conclusion

The included studies reported that ADHD had the highest prevalence rate among children with SLD followed by anxiety and depressive disorders. Both CD and ODD were the least prevalent and are linked to the existence of ADHD. Further worldwide future studies are needed to estimate the prevalence rate of such psychiatric disorders among children with SLD, taking into consideration the use of agreed assessment methods for diagnosing the psychiatric disorders and the SLD.

Identifying interactive biological pathways associated with reading disability

INTRODUCTION

Past research has suggested that reading disability is a complex disorder involving genetic and environment contributions, as well as gene-gene and gene-environment interaction, but to date little is known about the underlying mechanisms.

METHOD

Using the Avon Longitudinal Study of Parents and Children, we assessed the contributions of genetic, demographic, and environmental variables on case-control status using machine learning. We investigated the functional interactions between genes using pathway and network analysis.

RESULTS

Our results support a systems approach to studying the etiology of reading disability with many genes (e.g., RAPGEF2, KIAA0319, DLC1) and biological pathways (e.g., neuron migration, positive regulation of dendrite regulation, nervous system development) interacting with each other. We found that single nucleotide variants within genes often had opposite effects and that enriched biological pathways were mediated by neuron migration. We also identified behavioral (i.e., receptive language, nonverbal intelligence, and vocabulary), demographic (i.e., mother's highest education), and environmental (i.e., birthweight) factors that influenced case-control status when accounting for genetic information.

DISCUSSION

The behavioral and demographic factors were suggested to be protective against reading disability status, while birthweight conveyed risk. We provided supporting evidence that reading disability has a complex biological and environmental etiology and that there may be a shared genetic and neurobiological architecture for reading (dis)ability.

Psychiatric comorbidity among children and adolescents with dyslexia

Background

One of the most consistent findings in childhood psychopathology literature is that children with dyslexia frequently presented with additional psychiatric disorders. Over 60% of children with dyslexia meets criteria for at least one additional diagnosis.

Aim of results

Dyslexia shows high comorbidity with ADHD, ODD, and CD (18%, 14%, and 8%, respectively) than ccontrols that affect dyslexic boys more than girls. Dyslexic group show marked increase in internalizing and externalizing syndromes than control group. Dyslexic girls show more internalizing behaviors than dyslexic boys, unlike externalizing syndromes which was more evident in boys).

Conclusion

High comorbidity of other psychiatric disorders with dyslexia gets attention to evaluate students with dyslexia for other psychiatric comorbidity and referring them for psychiatric management.

Attention Deficit Hyperactivity Disorder and Psychiatric Comorbidities

Aim: This study aims to obtain current information on the clinical features of attention deficit hyperactivity disorder cases, comorbid psychiatric disorders and psychiatric drug use. Methods: All patients between the ages of 6 and 18 years who were admitted to our outpatient clinic and diagnosed with attention deficit hyperactivity disorder were included in the study. The files of the patients were examined and their demographic characteristics, symptoms, psychiatric diagnoses and drug profiles were recorded. The pattern of the psychiatric disorders accompanied by attention deficit hyperactivity disorder cases and the differences according to age and gender were analyzed. The differences were determined in patients with psychiatric comorbidity compared to those without. Result: The mean age of the 777 patients included in the study was 11.1±2.94 and 76.6% were boys. 60.9% of attention deficit hyperactivity disorder patients had comorbid psychiatric disorders. The most common psychiatric comorbidities were specific learning disability (23.6%), oppositional defiant disorder (12.9%) and conduct disorder (12.1%). There was no difference between the genders in terms of the incidence of psychiatric comorbidities. The rate of psychiatric comorbidity was significantly higher in adolescents than in children. A psychotropic medication was used in 86.4% of the cases and psychotropic polypharmacy was present in 31.5%. The rate of polypharmacy was significantly higher in the group with psychiatric comorbidity. Conclusion: Attention deficit hyperactivity disorder is frequently accompanied by other psychiatric disorders and the psychiatric comorbidity leads to a more complicated clinical profile. Approximately one-third of attention deficit hyperactivity disorder patients have psychiatric polypharmacy and these patients should be carefully monitored. Primary care physicians who are frequently confronted with attention deficit hyperactivity disorder cases should be careful about psychiatric comorbidities. Keywords: Child psychiatry, attention deficit hyperactivity disorder, mental disorders, Family practice

Internalizing Symptoms in Developmental Dyslexia: A Comparison Between Primary and Secondary School

Although the relationship between developmental dyslexia (DD) and the risk of occurrence of internalizing symptomatology has been widely investigated in the extant literature, different findings have been reported. In this study, two experiments with two general purposes are presented. The first study investigates whether the differences in the severity of internalizing symptoms between DD and controls are greater in students attending secondary school than in those attending primary school. Sixty-five DD and 169 controls attending primary and secondary school took part in the first study. The diagnosis of dyslexia was obtained from standardized reading tests; internalizing symptom severity was assessed with the Self Administrated Psychiatric Scales for Children and Adolescents questionnaire. The results showed that adolescents with dyslexia had an increased level of self-perceived anxiety, depression and somatic symptoms, whereas no significant differences between DD and controls emerged in childhood. In the second study, a cohort of adolescents attending secondary school (DD = 44; controls = 51) was closely analyzed to clarify whether contextual and subjective factors could contribute toward exacerbating the risk of internalizing symptomatology at that age. Internalizing symptom severity was assessed with the Child Behavior Checklist, Youth Self Report questionnaire, decision-making factors were measured with the Melbourne Decision Making Questionnaire, and student’s quality of life was gaged using the Clipper test. The results showed that high levels of internalizing symptoms in DD were associated with a low level of self-esteem and the tendency to react to problematic situations with hyperactivation. By contrast, positive relationships with peers were associated with low symptom severity. In conclusion, the intensified internalizing symptoms that could emerge in adolescents in association with the presence of dyslexia are predicted by social protective and risk factors that are associated with symptom severity. Accordingly, the results suggest that remediation programs for dyslexia should include implementing motivation strategies, self-esteem enhancement activities and building peers networks that, starting in childhood, can prevent the appearance of internalizing symptoms.

Are predictors of reading impairment in isolated cleft similar to those in idiopathic dyslexia?

Children with isolated cleft of the lip and/or palate (iCL/P) are at increased risk for reading impairment. The purpose of this study was to evaluate the impact of early risk factors (hearing, speech, and early literacy) on reading performance compared to unaffected participants with average (uAR) and impaired (uIR) reading. Reading achievement and early literacy skills were evaluated across three groups (27 iCL/P, 32 uAR, and 33 uIR). All participants were males, ages 8-11 years old. Those with history of head trauma/injury or major medical/mental health conditions were excluded. Group differences in achievement and early literacy skills were evaluated with ANCOVAs. Participants with impaired reading achievement (at or below 25th Percentile) were identified. Medical record reviews for participates with iCL/P were conducted and audiology and speech ratings recorded. Correlations were calculated between achievement, early literacy, hearing, and speech. Participants with iCL/P had significantly elevated risk for reading impairment (37%); this risk differed by cleft type (0% iCL, 55% iCLP, and 60% iCP). Achievement for participants with iCP was similar to the uIR group. Early literacy risk resulted in lower achievement scores for both iCL/P and unaffected participants. History of inadequate hearing and speech did not significantly impact early literacy or achievement measures. There is a high risk of reading impairment for children with iCL/P-highest for those with iCLP and iCP. Early literacy predictors of reading outcome are similar for iCL/P and idiopathic dyslexia. Current screening and intervention methods are supported.

Assessment of Psychiatric Comorbidity and WISC-R Profiles in Cases Diagnosed with Specific Learning Disorder According to DSM-5 Criteria

Introduction

In this study, the frequency of psychiatric comorbidity in children and adolescents who were diagnosed with specific learning disorder, the factors that affect the frequency of comorbidity, the subtypes of specific learning disorder and the effects on cognitive profile have been investigated.

Methods

Our study was performed among 80 cases with the age range 6-15 years who diagnosed with specific learning disorder Child and Adolescent Psychiatry Department between January and June 2015. In the study, DSM-IV Based Screening and Evaluation Scale for Child and Adolescent Behavioral Disorders, Specific Learning Disability Evaluation Scale and the WISC-R test were performed. During the interview, reading-writing-math abilities evaluation list (error analysis) was performed in order to define the specific learning disorder subgroup and to evaluate the detailed error profile of the specific learning disorder subgroup. Kiddie Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Turkish Version (KSADS) was performed to detect psychiatric comorbidity diagnoses.

Results

92.5% of the cases have a comorbid psychiatric disorder. The most frequent psychiatric comorbidity was attention deficit hyperactivity disorder (82.3%), followed by specific phobia (46.3%), oppositional defiant disorder (26.3%), enuresis (25%) and tic disorders (22.5%). Psychiatric comorbidity is detected more often in patients with specific learning disorder accompanied by attention deficit and hyperactivity disorder. The most frequent subtype of specific learning disorder is combined type disorder consisting of reading, writing and math disorder (37.5%). The WISC-R score of the patients who had math disorder were found to be lower than the others, and also it was detected that they learned reading and writing later, and have more comorbid psychiatric disorders.

Conclusion

The results of our study indicate that associated psychiatric disorders are frequent with specific learning disorder. Specific learning disorder should not be considered as a single disorder, but should be assessed and treated with comorbid psychiatric disorders.

Who benefit from school doctors' health checks: a prospective study of a screening method

BACKGROUND

School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors' skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors' assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors' routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors' routine health checks can be omitted using study questionnaires.

METHODS

This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor's assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor's health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor's appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors' interventions and follow-up plans.

DISCUSSION

The study will increase our knowledge of the benefits of school doctors' routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017.

Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder

Introduction

Access to cognitive assessments for children living remotely is limited. Telehealth represents a potential cost- and time-effective solution. A pilot study was conducted to determine the feasibility of telehealth to assess cognitive function in children with learning difficulties.

Methods

Thirty-three children (median age = 9 years 11 months), recruited from the New South Wales (NSW) Centre for Effective Reading, underwent assessment of intellectual ability. Comparisons were made between the intellectual ability index scores obtained by a psychologist sitting face-to-face with the children and another psychologist via telehealth using a web-based platform, Coviu.

Results

The telehealth administration method yielded comparable results to the face-to-face method. Correlation analyses showed high associations between the testing methodologies on the intellectual ability indices (correlation coefficient range = 0.981–0.997).

Discussion

Findings indicate that telehealth may be an alternative to face-to-face cognitive assessment. Future work in a broader range of cognitive tests and wider range of clinical populations is warranted.

Polyunsaturated fatty acids (PUFAs) for children with specific learning disorders

BACKGROUND

About 5% of school children have a specific learning disorder, defined as unexpected failure to acquire adequate abilities in reading, writing or mathematics that is not a result of reduced intellectual ability, inadequate teaching or social deprivation. Of these events, 80% are reading disorders. Polyunsaturated fatty acids (PUFAs), in particular, omega-3 and omega-6 fatty acids, which normally are abundant in the brain and in the retina, are important for learning. Some children with specific learning disorders have been found to be deficient in these PUFAs, and it is argued that supplementation of PUFAs may help these children improve their learning abilities.

OBJECTIVES

1. To assess effects on learning outcomes of supplementation of polyunsaturated fatty acids (PUFAs) for children with specific learning disorders.2. To determine whether adverse effects of supplementation of PUFAs are reported in these children.

SEARCH METHODS

In November 2015, we searched CENTRAL, Ovid MEDLINE, Embase, PsycINFO, 10 other databases and two trials registers. We also searched the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials (RCTs) or quasi-RCTs comparing PUFAs with placebo or no treatment in children younger than 18 years with specific learning disabilities, as diagnosed in accordance with the fifth (or earlier) edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5), or the 10th (or earlier) revision of the International Classification of Diseases (ICD-10) or equivalent criteria. We included children with coexisting developmental disorders such as attention deficit hyperactivity disorder (ADHD) or autism.

DATA COLLECTION AND ANALYSIS

Two review authors (MLT and KHT) independently screened the titles and abstracts of articles identified by the search and eliminated all studies that did not meet the inclusion criteria. We contacted study authors to ask for missing information and clarification, when needed. We used the GRADE approach to assess the quality of evidence.

MAIN RESULTS

Two small studies involving 116 children, mainly boys between 10 and 18 years of age, met the inclusion criteria. One study was conducted in a school setting, the other at a specialised clinic. Both studies used three months of a combination of omega-3 and omega-6 supplements as the intervention compared with placebo. Although both studies had generally low risk of bias, we judged the risk of reporting bias as unclear in one study, and as high in the other study. In addition, one of the studies was funded by industry and reported active company involvement in the study.None of the studies reported data on the primary outcomes of reading, writing, spelling and mathematics scores, as assessed by standardised tests.Evidence of low quality indicates that supplementation of PUFAs did not increase the risk of gastrointestinal disturbances (risk ratio 1.43, 95% confidence interval 0.25 to 8.15; two studies, 116 children). Investigators reported no other adverse effects.Both studies reported attention deficit hyperactivity disorder (ADHD)-related behaviour outcomes. We were unable to combine the results in a meta-analysis because one study reported findings as a continuous outcome, and the other as a dichotomous outcome. No other secondary outcomes were reported.We excluded one study because it used a cointervention (carnosine), and five other studies because they did not provide a robust diagnosis of a specific learning disorder. We identified one ongoing study and found three studies awaiting classification.

AUTHORS' CONCLUSIONS

Evidence is insufficient to permit any conclusions about the effect of PUFAs on the learning abilities of children with specific learning disorders. Well-designed RCTs with clearly defined populations of children with specific learning disorders who have been diagnosed by standardised diagnostic criteria are needed.

Growing Up with Dyslexia

Interviews with 75 teenagers and young adults were performed to investigate how young people with dyslexia experienced school in terms of well-being, educational achievement, self-esteem, peer relations and belief in their future. Results from earlier studies suggest that secondary emotional problems are common. The first six grades in school were experienced by the interviewees as full of distress and failure for a majority. Though peer relations were often good, many had experienced bullying. As they grew older, problems were more limited to reading and writing activities. This was thought to be an effect of acknowledgement and compartmentalization of the disability along with choices of school curricula and occupations in line with subjects' talents and capacities. Academic self-esteem seemed low, and most subjects had chosen vocational programmes in secondary school and had decided not to go to college. The most optimistic subjects were those who had finished school and were permanently employed. Early diagnosis along with careful explanation of the disability was recommended as well as the encouragement of dyslexic children in areas where they can do well and which makes them view themselves positively.

Psychological Co-morbidity in Children with Specific Learning Disorders

Children under 19 years of age constitute over 40% of India's population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind.

Specific learning difficulties: a retrospective study of their co morbidity and continuity as early indicators of mental disorders

BACKGROUND

Specific Learning difficulties constitute a continuity of complex disorders, which unfold across the lifespan and are associated with a wide range of mental disorders. In order to determine the importance of specific learning difficulties as an underlying factor in various mental disorders, we investigated associations between mental disorders and factors related to learning difficulties, poor family and school environment, and social and psycho-emotional disorders.

METHODS

This retrospective study is based on data from 835 case histories of adults who were treated at the Psychiatric Clinic of the University Hospital in Ioannina, Greece, between 1992 and 2008. The examination of the early (co-)occurrence of specific disorders was based on the ICD-10 classification of mental disorders. LogLinear analysis showed that all models retained 2nd or 3rd order effects with p-values >0.8 for all estimated likelihood ratios.

RESULTS

Patients with specific learning difficulties, who grew up in a socially disturbed environment, and manifested behavioral problems (aggression, alcoholism, and isolation or running away from home) were found to be more frequently diagnosed with schizophrenia than with any other mental disorder. In some cases, the profiles of these patients also included family problems such as parental loss or alcoholism.

CONCLUSIONS

Significant association between learning and other disorders in adult psychiatric patients' developmental profile has been indicated. Furthermore, a specific association between specific learning difficulties, environmental problems, and schizophrenia corroborates the continuity and complexity of these disorders at higher developmental stages. The results from this study can be utilized in the study of mental disorder etiology, raising the possibility that the early treatment of the learning or other disorders could reduce children's likelihood of developing mental disorders in adulthood.

The correlation between reading and mathematics ability at age twelve has a substantial genetic component

Dissecting how genetic and environmental influences impact on learning is helpful for maximizing numeracy and literacy. Here we show, using twin and genome-wide analysis, that there is a substantial genetic component to children’s ability in reading and mathematics, and estimate that around one half of the observed correlation in these traits is due to shared genetic effects (so-called Generalist Genes). Thus, our results highlight the potential role of the learning environment in contributing to differences in a child’s cognitive abilities at age twelve.

Understanding the genetic basis of cognitive traits could aid the development of numeracy and literacy skills in children. Here the authors show that reading and mathematics have a large overlapping genetic component and suggest that a child's learning environment has a key role in creating differences between them.

Association between childhood specific learning difficulties and school performance in adolescents with and without ADHD symptoms: a 16-year follow-up

OBJECTIVE

The authors investigated whether childhood specific learning difficulties (SLDs) predict later school performance in adolescents with ADHD symptoms (ADHDs) and how SLDs associate with educational aspirations.

METHOD

In the Northern Finland Birth Cohort 1986 (n = 9,432), data about children were collected using questionnaires for parents and teachers at ages 7 and 8 and for parents and adolescents at ages 15/16. Information on school performance was obtained from a national register.

RESULTS

The occurrence of SLDs at 8 years was 19.9% (n = 1,198), ADHDs at 15/16 years was 8.0% (n = 530), and comorbid ADHDs and SLDs was 3.0% (n = 179). Having ADHDs but not SLDs or having both was associated with a significantly lower mean value in school grades for theoretical subjects. Adolescents with comorbid ADHDs and SLDs repeated a grade more often, and their educational aspirations were less ambitious than those in other groups.

CONCLUSION

ADHDs and SLDs have a negative influence on academic achievements.

Polyunsaturated fatty acids (PUFAs) for children with specific learning disorders

BACKGROUND

About 5% of schoolchildren have a specific learning disorder, defined as an unexpected failure to acquire adequate abilities in reading, writing or mathematic skills not as a result of reduced intellectual ability, inadequate teaching or social deprivation. Of these, 80% are reading disorders. Polyunsaturated fatty acids (PUFAs), in particular omega-3 and omega-6 fatty acids, which are found abundantly in the brain and retina are important for learning. Some children with specific learning disorders have been found to be deficient in these PUFAs, and it is argued that supplementation of PUFAs may help these children improve their learning abilities.

OBJECTIVES

To assess the effects of polyunsaturated fatty acids (PUFAs) supplementation for children with specific learning disorders, on learning outcomes.

SEARCH METHODS

We searched the following databases in April 2012: CENTRAL (2012, Issue 4), MEDLINE (1948 to April Week 2 2012), EMBASE (1980 to 2012 Week 16), PsycINFO (1806 to April 2012), ERIC (1966 to April 2012), Science Citation Index (1970 to 20 April 2012), Social Science Citation Index (1970 to 20 April 2012), Conference Proceedings Citation Index-Science (1970 to 20 April 2012), Conference Proceedings Citation Index-Social Sciences and Humanites (1970 to 20 April 2012), Cochrane Database of Systematic Reviews (2012, Issue 4), DARE (2012, Issue 2) , ZETOC (24 April 2012) and WorldCat (24 April 2012). We searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov on 24 April 2012. We also searched the reference lists of relevant articles identified by the searches.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing polyunsaturated fatty acids (PUFAs) with placebo or no treatment in children aged below 18 years with specific learning disabilities diagnosed using DSM-IV, ICD-10 or equivalent criteria. We intended to include participants with co-existing developmental disorders such as attention deficit hyperactivity disorder (ADHD) or autism.

DATA COLLECTION AND ANALYSIS

Two authors (ML and KH) independently screened the titles and abstracts of the search results and eliminated all studies that did not meet the inclusion criteria. Authors were contacted for missing information and clarifications when needed.

MAIN RESULTS

We did not find any studies suitable for inclusion in the review. One study is awaiting classification as we were unable to get any information from the study author.

AUTHORS' CONCLUSIONS

There is insufficient evidence to draw any conclusion about the use of PUFAs for children with specific learning disorders. There is a need for well designed randomised studies to support or refute the use of PUFAs in this group of children.

Are externalizing and internalizing difficulties of young children with spelling impairment related to their ADHD symptoms?

Children with literacy difficulties often suffer from a variety of co-occurring externalizing and internalizing difficulties, as well as comorbid ADHD. Therefore, these externalizing and internalizing problems might be more related to comorbid ADHD, rather than being a correlate of literacy difficulties per se. In the present study, we investigated the occurrence of externalizing and internalizing difficulties in elementary school children (third grade) with and without spelling impairment. Taking the high rate of comorbidity between literacy difficulties and ADHD into account, we investigated whether co-occurring difficulties are associated with spelling impairment per se or with comorbid ADHD symptoms. Results indicated that these young children with spelling impairment showed more co-occurring difficulties compared with children without spelling impairment. Hierarchical regression analysis indicated that occurrence of externalizing symptoms is more strongly related to comorbid ADHD symptoms than to spelling impairment per se. The pattern of results concerning internalizing problems was not as distinct but showed a similar trend. Preferably, carers and educators should be aware of co-occurring socio-emotional and behavioural problems in children with spelling impairment. Particularly children with spelling impairment and comorbid ADHD symptoms seem to have an increased risk of encountering further co-occurring difficulties.

Relação entre variáveis psicossociais familiares e desempenho em leitura/escrita em crianças

Este artigo analisa a relação entre fatores psicossociais familiares e o desempenho em leitura e escrita a partir de um estudo comparativo realizado através de entrevista semiestruturada com 29 familiares de dois grupos de alunos de 2ª série do ensino fundamental. Por meio de avaliação neuropsicológica, os estudantes foram caracterizados em: com dificuldade de leitura e escrita e leitores e escritores competentes. As análises estatísticas evidenciaram associação significativa entre o grupo com dificuldade em leitura e escrita e as variáveis presença de transporte próprio na família, percepção dos familiares de que a criança teve dificuldades para aprender a ler e no desempenho da leitura, maior índice de repetência escolar e história familiar de dificuldade na leitura. Os resultados demonstram a importância da análise de fatores psicossociais familiares para a compreensão da complexidade que envolve o desenvolvimento de habilidades de leitura e escrita em crianças.

Language production strategies and disfluencies in multi-clause network descriptions: a study of adult attention-deficit/hyperactivity disorder

A prominent behavioral manifestation of impulsivity in children with attention-deficit/hyperactivity disorder (ADHD) is inappropriate language production, such as talking excessively, blurting out answers, and interrupting others.

OBJECTIVE

In this study, we examined language production in ADHD and non-ADHD controls to determine whether these types of language production problems are apparent in adults with ADHD.

METHOD

Participants (18-35 years old, 53.3% male) were asked to describe networks of colored dots that contained two branches that differed in length and complexity. According to the Minimal-Load Principle (Levelt, 1989), participants should prefer to describe a shorter and less complex branch first, in order to minimize planning and memory demands when formulating a description of the network. The dependent measures focused on which branch participants chose to describe first and the fluency of the descriptions. Four types of disfluency were examined: filled pauses, silent pauses, repetitions, and repairs.

RESULTS

There was no difference between ADHD participants and controls in the decisions they made when describing the networks (p > .10, η² = .004). Participants in both groups preferred to describe a short branch before describing a long branch and decisions were unaffected by complexity. However, ADHD participants did produce more words overall, t(73) = -2.33, p < .05, η² = .07, and they also produced more disfluencies, F(4, 70) = 2.98, p < .05, η² = .15, even after adjusting for number of words produced.

CONCLUSIONS

These findings suggest less language efficiency and reduced fluency in ADHD, and that language production issues remain in adults with ADHD, similar to the issues commonly reported in children with ADHD.

An epidemiological study on Finnish school-aged children with learning difficulties and behavioural problems

OBJECTIVES

To investigate the association between learning difficulties (LDs) and behavioural and emotional problems of 8-year-old children in the Northern Finland Birth Cohort 1986 (n=9432).

STUDY DESIGN

A cross-sectional study.

METHODS

Teachers assessed children's behaviour with a Rutter scale (RB2) and assessed their learning with questions about whether a child had difficulties in reading, spelling and mathematics.

RESULTS

Of the children, 21.4% (n=1774) had 1 or more learning difficulties (LDs): 12.3% (n=1026) had a verbal LD, 3.0% (n=248) a mathematical LD and 6.0% (n=500) a combined LD. For boys with LDs, an adjusted odds ratio of having behavioural problems was 3.1 (95% CI 2.5-4.0) and emotional problems 3.0 (2.0-4.6), and for girls 3.9 (2.6-5.8) and 5.3 (3.6-8.1), respectively. In boys and girls, verbal difficulties were associated with behavioural and emotional problems whereas mathematical difficulties were associated with behavioural problems in boys and with emotional problems in girls. Divorced and reconstructed family types were significant risk factors for LDs and behavioural problems, whereas a lifelong one-parent family type was a risk factor for behavioural problems, but not for LDs. A child's younger age compared to that of classmates, a mother's and a father's low education level and a low family SES were risk factors for having LDs.

CONCLUSION

More attention should be paid to children whose families are facing adverse circumstances, especially as it affects their preschool education, in order to support their learning and school attendance.

Learning disabilities and anxiety: a meta-analysis

This article presents the results of a meta-analysis of the empirical literature on anxious symptomatology among school-aged students with learning disabilities (LD) in comparison to their non-LD peers. Fifty-eight studies met inclusion criteria. Results indicate that students with LD had higher mean scores on measures of anxiety than did non-LD students. The overall effect size was statistically significant and medium in magnitude (d=.61) although substantial heterogeneity of results was found. Moderator effects were examined for informant type, gender, grade, publication status, and identification source. Informant type (i.e., self-, parent, or teacher report) explained a significant amount of variability in the sample of studies, and identification source (i.e., school identified or special school and clinic/hospital identified) approached statistical significance. Implications for assessment and intervention are discussed.

Minor neurological dysfunction in children with dyslexia

AIM

to improve understanding of brain function in children with severe dyslexia in terms of minor neurological dysfunctions (MNDs).

METHOD

one hundred and four children (81 males, 23 females; age range 7-12y; mean age 9y 7mo, SD 1y 2mo;) with severe dyslexia (the presence of a Full-scale IQ score of ≥ 85, retardation in single-word or text reading of ≥2y), assessed in a department of dyslexia of a third-level regional psychiatric centre, underwent a neurological examination according to Touwen and a multidisciplinary child psychiatric assessment. Special attention was paid to severity and type of MND. Data were compared with neurological morbidity data of children in the general population.

RESULTS

most children had MND (87%): 43% had simple MND, 44% complex MND. The incidence of MND was significantly higher (p<0.001) in the children with dyslexia than in the general population (simple MND 15%, complex MND 6%). Children with dyslexia showed especially fine manipulative disability and - to a lesser extent - mild dysfunction in muscle tone regulation and excessive presence of associated movements. A comorbid psychiatric syndrome was diagnosed in 66 children (63%): emotional disturbances (27%), adjustment disorder (42%), hyperkinetic disorder (15%), autism spectrum disorder (3%), specific disturbances of childhood not otherwise specified (13%). The neurological findings of children with dyslexia with and without psychiatric comorbidity were similar.

INTERPRETATION

our results demonstrate the importance of neurological and child psychiatric assessment in children with severe dyslexia. Our findings suggest that dysfunction of cortical structures plays a dominant role in dyslexia.

A thirteen-year follow-up study of young Norwegian adults with dyslexia in childhood: reading development and educational levels

As part of a larger follow-up study, 75 students were diagnosed with dyslexia at 10 years of age. At the end of secondary school, grades for the whole cohort of 16-year olds were examined. At age 23 the whole study group responded to a questionnaire and the subgroup with dyslexia who responded to this questionnaire were invited to come for testing and interviews. The persistence of dyslexia into young adulthood and educational levels were examined. The results showed that almost all students still suffered dyslexia and showed lower decoding ability. However, they only showed slightly lower educational attainment levels compared with a representative sample of half the cohort (n=530) they were part of.

Dyslexia and psycho-social functioning: an exploratory study of the role of self-esteem and understanding

Individuals with dyslexia may have lower self-esteem and exhibit more emotional and behavioural difficulties than those without reading problems. However, the nature of any relationship between self-esteem and psychopathology remains unknown. This exploratory study assessed levels of self-esteem using the Self-Perception Profile for Children (Manual for the Self-Perception Profile for Children. University of Denver, CO: Denver; 1985) and psycho-social adjustment using the Strengths and Difficulties Questionnaire (J. Child Psychol. Psychiatry, 1997; 38: 581-586) and examined child and parent understanding, attitudes and the perceived impact of reading difficulties on daily life. Sixty-eight children assessed as dyslexic on the basis of discrepancy scores (mean age 11.2 years; 44 male), and their parents, participated. No global self-esteem deficit was found, but the mean score for both child and parent-rated scholastic competence was significantly lower than that of the general population. Rates of social, emotional and behavioural difficulties were significantly higher than in the general population and were correlated with self-esteem. For children who had high global self-worth, both children and their parents had more positive attitudes towards their reading difficulties and were less likely to perceive a negative impact on relationships. The association between academic self-esteem and emotional symptoms is consistent with the proposed link between dyslexia and internalizing difficulties. Good self-esteem and a good understanding of dyslexia may help children avoid some of these difficulties. Further research with larger more representative samples is necessary as understanding the factors that promote successful psycho-social adjustment is essential to the development of effective prevention and intervention strategies.

Internalizing correlates of dyslexia

BACKGROUND

Over the last ten years a considerable amount of literature has described the socio-emotional discomfort that is often associated with learning disorders at all ages, but a comprehensive review about internalizing symptoms in dyslexia is needed.

DATA SOURCES

Medical and psychological search engines (PubMed, PsychArticles and Academic Search Elite) were used to identify all those studies published in peer-reviewed journals, relative to the association of reading difficulties, dyslexia, or learning disorders/disabilities, and internalizing symptoms, anxiety, or depression.

RESULTS

The present review of studies confirms dyslexia as a specific risk factor for an increased internalizing, anxious and depressive symptomatology. The severity of dyslexia, its comorbidity with attention deficit disorder/hyperactivity disorder, the level of perceived social support and female gender are some of the factors that mostly influence its psycho-social outcomes.

CONCLUSION

Findings of this review confirm that suitable social, health and school policies aimed at identifying and treating dyslexia as a cause of discomfort are called for, and confirm the clinical need to assess and contrast additional risk factors that may increase the probability of this suffering in dyslexic students.

Are reading and behavior problems risk factors for each other?

Two questions were investigated. First, are children with reading problems in first grade more likely to experience behavior problems in third grade? Second, are children with behavior problems in first grade more likely to experience reading problems in third grade? The authors explored both questions by using multilevel logistic regression modeling to analyze data from the Early Childhood Longitudinal Study-Kindergarten Class (ECLS-K). After statistically controlling for a wide range of potential confounds, they found that children with reading problems in first grade were significantly more likely to display poor task engagement, poor self-control, externalizing behavior problems, and internalizing behavior problems in third grade. They also found that children displaying poor task engagement in first grade were more likely to experience reading problems in third grade. Collectively, these findings suggest that the most effective types of interventions are likely to be those that target problems with reading and task-focused behaviors simultaneously.

Cognitive inhibition and working memory in attention-deficit/hyperactivity disorder

Studies of cognitive control in attention-deficit/hyperactivity disorder (ADHD) have emphasized the ability to suppress motor responses (i.e., behavioral inhibition) rather than the ability to actively suppress prepotent mental representations (i.e., cognitive inhibition). Further, working memory deficits are suspected in ADHD, yet their distinction from cognitive inhibition is unclear. Two hundred and eighty-eight adolescent and adult participants, 115 of whom met criteria for ADHD and 173 of whom were for non-ADHD comparison, completed a sentence processing task that required the suppression of an incorrect interpretation and a working memory task. The results failed to support cognitive inhibition problems in ADHD. Moreover, the ability to reanalyze sentences with a temporary misinterpretation was at least partially related to working memory performance. The results challenge a unitary inhibition problem in ADHD and suggest inhibition problems do not extend to cognitive suppression in this age range.

Emotional and behavioral characteristics over a six-year period in youths with persistent and nonpersistent dyscalculia

The authors examined behavior problems in a matched sample of 58 youths with persistent dyscalculia (PD) and nonpersistent dyscalculia (NPD). Participants were classified as having dyscalculia at age 10-11 years. Parents completed the Child Behavior Checklist for their children at ages 10-11, 13-14, and 16-17 years, while the youths did so at the last two age periods. Only at age 16-17 years were there significantly more problems, particularly attention problems and externalizing problems, reported by parents for PD youths compared to NPD youths. A higher percentage in the PD group than in the NPD group received scores in the clinical range for externalizing problems. However, the mean levels of behavior problems at this age and the earlier ages were within the normal range for both groups. For youth-reported problems, the only significant difference was for attention problems at 16-17 years. Therapeutic interventions should focus on the academic domain and improving and altering behavioral patterns.

Cognitive and psychological profile of males with Becker muscular dystrophy

Duchenne and Becker muscular dystrophy are allelic X-linked disorders causing progressive muscle weakness in males. Duchenne muscular dystrophy is caused by absence of dystrophin in muscle and brain; boys with Duchenne muscular dystrophy have a static cognitive impairment with mean Full Scale IQ approximately 1 standard deviation below the mean. Less is known of the cognitive profile of males with Becker muscular dystrophy, which is associated with variable alterations in the amount or size of the dystrophin protein. The aim of this study was to describe the cognitive and psychological profile of males with Becker muscular dystrophy. This was a prospective cohort study. Clinical data collected included age at diagnosis and assessment, socioeconomic status, serum creatine kinase level, and site of gene deletion/mutation (by exon number). The following psychological tests were used to assess general intellectual functioning, academic achievement, incidence and nature of behavioral problems: The Wechsler Intelligence Scales, The Wide Range Achievement Test-Revised, The Developmental Test of Visual-Motor Integration, The Child Behavior Checklist, and The Conner's Parent Rating Scale. Twenty-four males were enrolled. The Wechsler Full Scale IQ was normally distributed with a mean of 95.6 (SD 23.3), which did not differ significantly from the population mean. The frequency of learning difficulties for reading was 21%, for spelling was 32%, and for arithmetic was 26%, significantly higher than the frequency in the general population. The frequency of total behavioral problems in the clinical range was 67%, and the frequency of autism was 8.3%. Patients with Becker muscular dystrophy demonstrate a less homogeneous cognitive phenotype than that seen in Duchenne muscular dystrophy. Males with Becker muscular dystrophy have a high incidence of learning difficulties. Autism and behavioral and attention problems are also more common in Becker muscular dystrophy than in the general population.

Behaviour, attention and cognition in severe dyslexia

Information about coexisting problems in dyslexia may be vital for diagnostic and remedial procedures. There are few studies in this area, and to our knowledge none for the students in focus in this study. They all have phonological deficits and severely impaired reading abilities, in spite of prolonged educational remediation. The aim was to assess if these students have more behavioural/emotional problems than normal reading students. A clinical sample of 70 students, 59 males and 11 females, were compared to a normal reading control group. The groups were pair-wise matched on age, gender, cognitive level, and whether they lived in rural or urban areas. Mean age for the two groups was 150 months, and mean IQ scores approximately 100. Information on behaviour/emotions was obtained from parents, teachers and participants by means of the Child Behavior Checklist, Teacher's Report Form and Youth Self Report. The dyslexia group showed significantly more problems in all areas than the controls. This was reported from all three groups of informants. Parents reported most problems, internalizing behaviour for more than 50% of the participants and total problem behaviour for nearly 45%. Significantly more attention problems were also reported for the dyslexia group from all informants. Parents reported that nearly half the group demonstrated attention problems. Both groups of participants had more problems reported for those with IQ scores of 100 or lower. Further research is needed in this area, but the results clearly indicate that identifying additional behavioural/emotional problems may be imperative for students with severe reading problems.

Traditional and computer-based screening and diagnosis of reading disabilities in Greek

In this study, we examined the characteristics of reading disability (RD) in the seventh grade of the Greek educational system and the corresponding diagnostic practice. We presented a clinically administered assessment battery, composed of typically employed tasks, and a fully automated, computer-based assessment battery that evaluates some of the same constructs. In all, 261 children ages 12 to 14 were tested. The results of the traditional assessment indicated that RD concerns primarily slow reading and secondarily poor reading and spelling accuracy. This pattern was matched in the domains most attended to in expert student evaluation. Automatic (computer-based) screening for RD in the target age range matched expert judgment in validity and reliability in the absence of a full clinical evaluation. It is proposed that the educational needs of the middle and high school population in Greece will be best served by concentrating on reading and spelling performance--particularly fluency--employing widespread computer-based screening to partially make up for expert-personnel shortage.

Funções neuropsicológicas em crianças com dificuldades de leitura e escrita

Nos estudos sobre a relação entre dificuldades de leitura e escrita e fatores neuropsicológicos associados, controvérsias giram em torno de hipóteses de um possível desvio ou atraso de desenvolvimento. Para examinar esta polêmica, o presente estudo comparou o desempenho em tarefas neuropsicológicas de crianças de 2ª série com dificuldades de leitura e escrita (n=14) com o de dois grupos: um contrastando competência de leitura e escrita, mas não idade (n=15) e outro contrastando idade, mas não competência de leitura e escrita (1ª série; n=9). Os resultados revelaram que o grupo de 2ª série, com dificuldade de leitura e escrita, apresentou escores estatisticamente inferiores aos do grupo de 2ª série competente em leitura e escrita em consciência fonológica, linguagem oral e memória fonológica, não diferindo significativamente do grupo de 1ª série. Tais achados favorecem a hipótese de atraso de desenvolvimento destas funções neuropsicológicas em crianças com dificuldades de leitura e escrita.

Maternal stress in nonverbal learning disorder: a comparison with reading disorder

Maternal stress was assessed in mothers of children ages 8 to 11 years with learning disorders (LD). Age-, gender-, and IQ-matched children with reading disorders (RD; n = 31), children with nonverbal learning disorders (NVLD; n = 21), and typically developing control participants (n = 23) participated. Mothers of children with LD reported higher levels of stress, although the specific nature of the stress appeared to vary by disorder subtype: Mothers of children with RD reported higher levels of general distress, whereas mothers of children with NVLD reported higher levels of dysfunctional interactions with their child. The severity of the LD was strongly associated with maternal stress in the sample of children with NVLD but not in the sample of children with RD. In the sample of children with NVLD, the best predictors of maternal stress were 2 variables associated with the child: The lower the child's Performance IQ, the higher the level of maternal stress. Furthermore, the level of the child's internalizing symptoms was also a strong predictor of maternal stress in the sample of children with NVLD. In our sample of children with RD, the 3 best predictors were all variables associated with the mother, including her age, her level of reported psychiatric symptoms, and her overall level of social support.

Learning disabilities in juvenile offenders

The article briefly reviews the literature on the association between learning disabilities and conduct problems across correctional communities and clinical settings. It first reviews the literature on the prevalence of learning deficiencies among criminal offenders. It then discusses a number of relevant points from studies of the association between low academic achievement and conduct problems in nonincarcerated population samples. Third, it discusses studies of postrelease academic profiles of juvenile offenders. The article closes with a comment on possible future directions of the research linking reduced levels of academic achievement and delinquency.