Neuropsychopathological comorbidities in learning disorders

Telerehabilitation of Developmental Dyslexia: Critical Considerations on Intervention Methods and Their Effectiveness

Paper-based or IT tools can be used in telerehabilitation mode to improve the skills of children with developmental dyslexia (DD), seeking to increase reading speed and reduce errors. Telerehabilitation is the provision of remote treatments in which the patient works autonomously in a familiar environment under the remote monitoring, through telecommunication means, of an expert operator. Through telerehabilitation, children with DD can receive treatments outside the specialist clinic, at home or school, via internet connections, and through advanced technological platforms. These procedures allow adequate communication with the family, intensity of treatment, self-adaptivity of exercises, and child engagement; these factors are crucial for a high intervention efficacy. Recent studies have supported the effectiveness of the telerehabilitation of reading in children with DD, with some studies reporting no differences in efficacy between remote and in-person methods. Nevertheless, many points remain to be clarified about the procedures and methods required by telerehabilitation, the variables linked to its effectiveness (e.g., the impact of the intensity of the training and the neuropsychological profile of the child), and the comparative validity of different tele-treatment paths. These aspects are discussed in the present paper.

A Family-Based Intervention for Early Elementary Students With Reading and Behavioral Difficulties: A Pilot Study

We created and tested a family-based intervention with families of children in Grades 1 and 2 with reading and behavioral difficulties to investigate its impact on text comprehension. Developed with input from parents, reading experts, and behavior specialists, Family-RISE (Reading Intervention with Supports for Engagement) integrates evidence-based practices for enhancing students' knowledge of narrative texts with effective behavioral supports to maximize student engagement and minimize disruptive behaviors to help parents engage successfully in shared storybook reading. We assessed the effects of Family-RISE on children's narrative text comprehension using a multiple-baseline design. A functional relation was established between Family-RISE and narrative text comprehension, indicating Family-RISE substantially improved narrative text comprehension. Furthermore, nonoverlap of all pairs, Tau-U, and standard mean difference effect sizes were all considered large in favor of the intervention. Family members reported that the intervention was highly usable, feasible to implement, and socially valid. These findings underscore the promise of the Family-RISE intervention and the value of developing interventions that simultaneously support reading and behavior for children with co-occurring difficulties in these areas.

The COVID generation: Online dyslexia treatment equally effective as face-to-face treatment in a Dutch sample

Due to pandemic-induced lockdown(s) in 2020, dyslexia treatment was forced to move to online platforms. This study examined whether Dutch children who received online treatment progressed as much in their reading and spelling performance as children who received the usual face-to-face treatment. To this end, 254 children who received treatment-as-usual were compared to 162 children who received online treatment with Bayesian methods. The advantage of a Bayesian approach is that it can provide evidence for and against the null hypothesis whereas frequentist approaches only provide evidence against it. We found that children in the online treatment condition received slightly fewer treatment sessions but progressed equally after controlling for the number of sessions compared to the treatment-as-usual condition. These results have clinical and practical implications as they show that reading treatment can be successfully delivered online.

Anxiety and coping strategies among dyslexics in Ethiopia

Individuals with dyslexia have been shown to have an increased risk for developing internalizing problems. Various studies have revealed the powerful role that culture plays in determining the type of anxiety and coping strategies adopted by various groups of individuals. However, compared to the vast number of studies conducted in individualistic cultures, knowledge on collectivistic cultures with respect to this issue is still limited. This study examined anxiety and coping strategies of children with and without dyslexia in Ethiopia, where the majority of its cultural dimensions could be regarded as collectivistic. A total of 126 children with (n = 63) and without (n = 63) dyslexia, aged 8-11 (41 boys and 22 girls, in each group; and age: M = 9.43 years; SD = 1.14 and M = 9.46; SD =1.11), participated. Dyslexia was assessed using an Amharic dyslexia assessment battery, while anxiety level and coping strategy were respectively measured using the Spence Children's Anxiety Scales (SCAS) and the Children's Coping Questionnaire (CCQ), both translated into Amharic. Results indicated that dyslexia was associated with higher levels of anxiety (especially generalized anxiety) and lower levels of support-seeking coping strategies. We discuss these results in the light of the cultural and institutional context in Ethiopia.

The shared genetic architecture and evolution of human language and musical rhythm

Rhythm and language-related traits are phenotypically correlated, but their genetic overlap is largely unknown. Here, we leveraged two large-scale genome-wide association studies performed to shed light on the shared genetics of rhythm (N=606,825) and dyslexia (N=1,138,870). Our results reveal an intricate shared genetic and neurobiological architecture, and lay groundwork for resolving longstanding debates about the potential co-evolution of human language and musical traits.

Compounding Effects of Domain-General Cognitive Weaknesses and Word Reading Difficulties on Anxiety Symptoms in Youth

This study examined whether domain-general cognitive weaknesses in processing speed (PS) or executive functioning (EF) moderate the relation between word reading scores and anxiety such that lower word reading scores in combination with lower cognitive scores are associated with higher anxiety symptoms. The sample consisted of 755 youth ages 8-16 who were recruited as part of the Colorado Learning Disabilities Research Center twins study. Lower scores on PS (R2 = .007, p = .014), EF (R2 = .009, p = .006), and word reading (R2 = .006-.008, p = .010-.032) were associated with higher anxiety scores. In addition, the word reading × cognitive interactions were significant such that lower scores on PS (R2 = .010, p = .005) or EF (R2 = .013, p = .010) combined with lower word reading were associated with higher-than-expected anxiety symptoms. Results suggest that weaknesses in PS, EF, and word reading are modestly associated with higher anxiety symptoms, and these anxiety symptoms may be compounded in youth with both PS or EF weaknesses and word reading difficulties. These findings can guide assessment approaches for identifying youth with word reading challenges who may be at increased risk for anxiety.

Analysis of Psychological and Social Functioning in Undergraduate Students with a Specific Learning Disorder (SLD)

It is considered to be particularly interesting to enrich the scientific overview investigating the comorbidities of specific learning disorders (SLDs) in young adults. Therefore, this study aims to investigate the psychosocial and relational profiles associated with the presence of learning difficulties in a population of university students. The hypothesis is that young adults with SLDs have lower psychological and socio-relational functioning than their typical-development peers. We further hypothesized that the socio-relational difficulties of students with SLDs could be explained not only by referring to the presence of a learning disorder, but also by considering some variables that may follow the experience of students with SLDs. The results highlighted that students with SLDs, compared to their typical-development peers, have low self-efficacy, high academic anxiety scores, emotional problems, and issues with peers. We finally suggest considering these aspects as early as the diagnostic process to facilitate an effective treatment plan for learning disorders to prevent, in terms of developmental trajectory, the manifestation of these aspects in adulthood.

Associations between dyslexia and children's mental health: Findings from a follow-up study in China

Dyslexia is a common learning difficulty that can lead to adverse health outcomes and socioeconomic difficulties. Evidence from longitudinal studies on the association between dyslexia and psychological symptoms in children is limited. Moreover, the psychological trends of children with dyslexia are unclear. In this study, we enrolled 2,056 students in Grades 2 to 5, including 61 dyslexic children, who participated in three mental health surveys and dyslexia screening. All the children were surveyed for symptoms of stress, anxiety and depression. We used generalized estimating equation models to estimate changes in psychological symptoms of children with dyslexia over time and the association between dyslexia and psychological symptoms. The results showed that dyslexia was associated with stress and depressive symptoms in children in both crude (β = 3.27, 95% confidence interval [CI] [1.89∼4.65], β=1.20, 95%CI: [0.45∼1.94], respectively) and adjusted models (β = 3.32, 95%CI: [1.87∼4.77], β=1.31, 95%CI: [0.52∼2.10], respectively). In addition, we found no significant differences in the emotional status of dyslexic children in either survey. Dyslexic children are at risk for mental health issues, and persistent emotional symptoms. Therefore, interventions regarding not only reading ability but also psychological conditions should be pursued.

Telerehabilitation Pathways in Specific Learning Disorders: Improving Reading and Writing

Telerehabilitation has proved to be a useful tool for neurodevelopmental disorders in allowing timely and intensive intervention and preventing relapses; it is also widely used for specific learning disabilities (SLD), showing significant effects on reading abilities, but variables linked to its effectiveness have not been studied yet. The present study was aimed at testing the effectiveness of telerehabilitation on reading and writing in SLD children, comparing different treatment pathways, and considering the impact of training intensity and executive functions. Seventy-three children were enrolled (telerehabilitation group: 48 children, waiting list group: 25 children). The results showed significant improvements in reading fluency, text dictation, and executive functions in the training group. Children attending a combined training including reading tasks and rapid automatized naming processes improved in word reading fluency and text dictation. The number of training sessions and the change in executive functions significantly correlated with changes in reading accuracy. Here we show a new contribution to telerehabilitation research in SLD: telerehabilitation significantly enhanced learning abilities and executive functions. Training based on the learning task and the underlying processes significantly increased not only reading speed, according to previous studies, but also writing accuracy. The findings' implications in clinical research and practice are discussed.

Specific Learning Disabilities and Emotional-Behavioral Difficulties: Phenotypes and Role of the Cognitive Profile

Specific Learning Disabilities (SLD) are often associated with emotional-behavioral problems. Many studies highlighted a greater psychopathological risk in SLD, describing both internalizing and externalizing problems. The aims of this study were to investigate the emotional-behavioral phenotype through the Child Behavior Checklist (CBCL), and evaluate the mediating role of background and cognitive characteristics on the relationship between CBCL profile and learning impairment in children and adolescents with SLD. One hundred and twenty-one SLD subjects (7-18 years) were recruited. Cognitive and academic skills were assessed, and parents completed the questionnaire CBCL 6-18. The results showed that about half of the subjects manifested emotional-behavioral problems with a prevalence of internalizing symptoms, such as anxiety and depression, over externalizing ones. Older children showed greater internalizing problems than younger ones. Males have greater externalizing problems compared to females. A mediation model analysis revealed that learning impairment is directly predicted by age and familiarity for neurodevelopmental disorders and indirectly via the mediation of the WISC-IV/WAIS-IV Working Memory Index (WMI) by the CBCL Rule-Breaking Behavior scale. This study stresses the need to combine the learning and neuropsychological assessment with a psychopathological evaluation of children and adolescents with SLD and provides new interpretative insights on the complex interaction between cognitive, learning, and emotional-behavioral phenotypes.

Attention-Deficit Hyperactivity Disorder and Learning Disabilities Modify Recovery and Sport Behavior Following Sport-Related Concussion

Limited evidence exists concerning how a diagnosis of attention-deficit hyperactivity disorder and/or learning disabilities (ADHD/LD) modifies recovery and behavior following sport-related concussion (SRC). To understand how ADHD/LD modifies the post-SRC experience, we conducted a retrospective cohort study of concussed young athletes through phone interviews with patients and guardians. Outcomes included time until symptom resolution (SR) and return-to-learn (RTL), plus subjective changes in post-SRC activity and sports behavior. Multivariate Cox and logistic regression was performed, adjusting for biopsychosocial characteristics. The ADHD/LD diagnosis was independently associated with worse outcomes, including lower likelihood to achieve SR (hazard ratio [HR] = 0.62, 95% confidence interval [CI] = [0.41-0.94]; P = .02) and RTL (HR = 0.55, 95% CI = [0.36-0.83]; P < .01) at any time following injury, and increased odds of changing sport behavior after concussion (odds ratio [OR] = 3.26, 95% CI = [1.26-8.42], P = .02), often to a safer style of play (62.5% vs 39.6%; P = .02) or retiring from the sport (37.5% vs 18.5%; P = .02). These results provide further evidence of the unique needs for athletes with ADHD/LD following SRC.

Discovery of 42 genome-wide significant loci associated with dyslexia

Reading and writing are crucial life skills but roughly one in ten children are affected by dyslexia, which can persist into adulthood. Family studies of dyslexia suggest heritability up to 70%, yet few convincing genetic markers have been found. Here we performed a genome-wide association study of 51,800 adults self-reporting a dyslexia diagnosis and 1,087,070 controls and identified 42 independent genome-wide significant loci: 15 in genes linked to cognitive ability/educational attainment, and 27 new and potentially more specific to dyslexia. We validated 23 loci (13 new) in independent cohorts of Chinese and European ancestry. Genetic etiology of dyslexia was similar between sexes, and genetic covariance with many traits was found, including ambidexterity, but not neuroanatomical measures of language-related circuitry. Dyslexia polygenic scores explained up to 6% of variance in reading traits, and might in future contribute to earlier identification and remediation of dyslexia.

Evaluation of social cognition, autistic traits, and dysmorphology in comorbid specific learning disorder and attention-deficit/hyperactivity disorder

Research on areas such as social cognition, autistic traits, and minor physical anomalies in comorbid Specific Learning Disorder (SLD) and attention-deficit/hyperactivity disorder (ADHD) is limited. In this study, we compared these areas in children aged between 8 and 14 with comorbid SLD and ADHD and their typically developed peers. Emotion recognition and social cognition were evaluated by Faces Test, Reading the Mind in the Eyes Test, Comprehension Test, and Difficulties in Emotion Regulation Scale. Autism Spectrum Screening Questionnaire and Social Responsiveness Scale were used for screening of autism spectrum disorder in children. Furthermore, autistic traits in parents were measured by Autism-Spectrum Quotient. The MPAs of all the subjects were determined by pediatric geneticists. We detected that children with comorbid SLD and ADHD performed worse than controls in all social cognition tests and maternal AQ score had a strong correlation with the Faces Test, DERS, and SRS scores. Also, the total ASSQ score in the comorbid SLD and ADHD group was significantly higher than controls. Finally, MPAs were significantly more frequent in the comorbid SLD and ADHD group. Impairment in social cognition and evaluation of autistic traits and dysmorphology in children with comorbid SLD and ADHD may provide useful information on neurodevelopmental disorders.

Specific Learning Disorder in Children and Adolescents, a Scoping Review on Motor Impairments and Their Potential Impacts

Mastering motor skills is important for children to achieve functional mobility and participate in daily activities. Some studies have identified that students with specific learning disorders (SLD) could have impaired motor skills; however, this postulate and the potential impacts remain unclear. The purpose of the scoping review was to evaluate if SLD children have motor impairments and examine the possible factors that could interfere with this assumption. The sub-objective was to investigate the state of knowledge on the lifestyle behavior and physical fitness of participants with SLD and to discuss possible links with their motor skills. Our scoping review included preregistration numbers and the redaction conformed with the PRISMA guidelines. A total of 34 studies published between 1990 and 2022 were identified. The results of our scoping review reflected that students with SLD have poorer motor skills than their peers. These motor impairments are exacerbated by the complexity of the motor activities and the presence of comorbidities. These results support our sub-objective and highlight the link between motor impairments and the sedentary lifestyle behavior of SLDs. This could lead to deteriorating health and motor skills due to a lack of motor experience, meaning that this is not necessarily a comorbidity. This evidence emphasizes the importance of systematic clinical motor assessments and physical activity adaptations.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Maternal multiple sclerosis is not a risk factor for neurodevelopmental disorders in offspring

Background

Childhood neurodevelopmental disorders (NDDs), including specific learning disorders (SLD), attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are pathogenically linked to familial autoimmunity and maternal immune-mediated diseases during pregnancy.

Objective

We studied maternal MS as a potential risk factor for NDDs occurrence in offspring.

Methods

MS and control mothers were subjected to questionnaires to ascertain NDD diagnosis in their progeny and the occurrence of both autoimmune and neurodevelopment disorders in their families. Suspected NDD cases were evaluated to confirm or rule out the diagnosis.

Results

Of the 322 MS women, 206 (64%) have 361 children; of these, 27 (7.5%) were diagnosed with NDD (11% ADHD; 22% ASD; 67% SLD). NDD-risk in offspring was associated to family history of autoimmunity and to NDDs both in MS and non-MS mother families (r = 0.75; p = 0.005) whereas it was not associated to maternal MS.

Conclusions

For the first time, we demonstrate that maternal MS does not predispose children to higher risk for NDD. On a mechanistic view, we suggest that the intrinsic organ-specific nature of MS does not impair the mother–child cross-talk in decidua nor does it influence fetal neurodevelopment.

Retrospective symptoms and learning difficulties predicting ADHD in adults: Differences between prison inmates and the clinical population

People who suffer from ADHD in their childhood are more likely to be involved in criminal acts in late adolescence and adulthood. This study analyses the association between retrospective ADHD symptoms and associated problems (somatic and learning difficulties), and current symptoms in a sample of adults from imprisoned and clinical populations. Four hundred and fifty-seven participants, aged between 17 and 69 years, were divided into four groups: ADHD prison group without clinical history of symptoms (n = 61), prison group (n = 162), ADHD clinical group (n = 176) and clinical group (n = 58). The ADHD-IV scale and Wender Utah Rating Scale (WURS) were administered to the four groups and demonstrated high rates of persistence of ADHD symptoms into adulthood. ADHD groups reported significantly higher impairment both during childhood (symptoms, somatic and learning difficulties) and at present, with the ADHD clinical group being the most severely impaired. Finally, current symptoms of ADHD, along with childhood ADHD symptoms and learning difficulties, significantly predicted current impairments, but only in the clinical group. These findings represent some initial steps into the identification of predictors of ADHD symptomatology in adulthood in order to elucidate its etiopathogenesis and better identify high-risk groups for targeted prevention.

Defining quality of life for individuals with neurodevelopmental disorders: Challenges within an inpatient population

PURPOSE

The concept of Quality of Life (QoL) for people with neurodevelopmental disorders primarily focuses on deinstitutionalisation and community inclusion. This population, however, often presents with comorbid diagnoses and is sectioned to treatment facilities under the Mental Health Act. The aim of this paper is to review the existing literature on QoL and discuss the consideration of this specialised population and the environment when measuring QoL.

METHODS

Databases were searched using specific inclusion and exclusion criteria to ensure literature reviewed was relevant to the defined population. The challenges identified from the literature were categorised into interpersonal and intrapersonal factors.

RESULTS

A total of 30 articles were retrieved and considered in this review.

CONCLUSIONS

This paper discusses how these individuals present with different behaviours and opportunities, which subsequently make it difficult to apply existing knowledge of QoL. The need to further examine the QoL in this specific population is discussed.

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.

The contribution of motor functions to academic achievement in primary school: State of the art and future directions

This review is intended to point out the role played by motor skills proficiency in the academic achievement of typically and atypically developing pupils who are attending primary school. First, the interplay between motor and cognitive development will be presented. Next, the cognitive phenotype, not yet deeply investigated, of a neurodevelopmental condition associated with the atypical development of motor functions (known as Developmental Coordination Disorder) will be illustrated. Thus, the contribution of motor functions to academic learning and the impact of motor difficulties for pupils attending primary school will be discussed. In addition, the importance of developing observational tools to be used in educational settings and the need for effective interventions designed to empower motor functioning and academic achievement of atypically developing pupils with motor deficits will be highlighted. Finally, future directions within the educational agencies for the early detection of the atypically developing motor trajectories and their treatment will be traced.

Associations between Learning and Behavioral Difficulties in Second-Grade Children

Learning and behavioral difficulties often emerge during the first years of primary school and are one of the most important issues of concern for families and schools. The study was aimed at investigating the co-occurrence of difficulties between academic learning and emotional-behavioral control in typically developing school children and the moderating role of sex. A sample of 640 second-grade school children participated in the study. This study used the Strengths and Difficulties Questionnaire to measure the emotional and behavioral difficulties and a battery of objective and standardized tests to evaluate the learning skills in children. In this sample 7% to 16% of children performed below the normal range in reading and/or arithmetic tests. Mixed models showed that children’s hyperactive behaviors were positively related to both reading and math difficulties, and emotional problems correlated negatively with reading accuracy. The more children displayed behavioral difficulties, the more they were exposed to the risk of worsening reading and math performance, especially for girls. The result that among different emotional-behavioral problems within the school setting, hyperactivity behaviors and emotional difficulties are related to learning difficulties with a moderate effect of sex, needs to be taken into account in screening and prevention programs for learning difficulties in order to not disregard the complexity of the associated profiles.

The prevalence and comorbidity rates of specific learning disorder among primary school children in Turkey

Purpose: The aim of the present study was to investigate the prevalence of specific learning disorder (SLD), comorbid disorders, and risk factors in primary school children for the first time in two-stage design in Turkey.Materials and methods: Participants were 1041 pupils in 28 primary schools and aged from 7 to 11. The Mathematics, Reading, Writing Assessment Scale (MOYA) teacher and parent forms were used in the screening stage and parents and teachers of each child completed MOYA. Ninety-five children were screen positive and eighty-three of these children participated in the interview. SLD diagnoses were based on DSM V criteria. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used for the comorbid psychiatric disorders.Results and conclusions: The prevalence rate of the SLD was 6.6%, impairment in reading was 4%, in mathematics was 3.6%, and in written expression was 1.8%. About 62.75% of children with SLD had one or more comorbid diagnoses. ADHD was the most common comorbid mental disorder in SLD (54.9%). SLD prevalence was higher among males. The prevalence of SLD in primary school children in Turkey is consistent with previous studies.

Educational fMRI: From the Lab to the Classroom

Functional MRI (fMRI) findings hold many potential applications for education, and yet, the translation of fMRI findings to education has not flowed. Here, we address the types of fMRI that could better support applications of neuroscience to the classroom. This 'educational fMRI' comprises eight main challenges: (1) collecting artifact-free fMRI data in school-aged participants and in vulnerable young populations, (2) investigating heterogenous cohorts with wide variability in learning abilities and disabilities, (3) studying the brain under natural and ecological conditions, given that many practical topics of interest for education can be addressed only in ecological contexts, (4) depicting complex age-dependent associations of brain and behaviour with multi-modal imaging, (5) assessing changes in brain function related to developmental trajectories and instructional intervention with longitudinal designs, (6) providing system-level mechanistic explanations of brain function, so that useful individualized predictions about learning can be generated, (7) reporting negative findings, so that resources are not wasted on developing ineffective interventions, and (8) sharing data and creating large-scale longitudinal data repositories to ensure transparency and reproducibility of fMRI findings for education. These issues are of paramount importance to the development of optimal fMRI practices for educational applications.

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.

Intellectual functioning and executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD)

Several studies have shown neuropsychological deficits across multiple domains in attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD), but differences and similarities between these disorders have been little considered. We were interested in analyzing the intellectual and executive profiles in a sample of children and adolescents, divided according to the diagnosis into the ADHD group and the SLD group, and in identifying the differences and similarities between these disorders. The sample included two clinical groups: the first included 36 children and adolescents with a diagnosis of ADHD (5-15 years; mean = 9.42; SD = 2.22) while the second included 36 children and adolescents with a diagnosis of SLD (7-15 years; mean = 9.43; SD = 2.25). The WISC-IV was used to measure intellectual ability and the NEPSY-II was employed to measure executive functions. The results showed that the SLD group had significantly higher scores than the ADHD group on the NEPSY-II in the inhibition, cognitive flexibility, short-term verbal memory and verbal working memory domains. The ANCOVA showed differences regarding the FSIQ of WISC-IV, in that the SLD group obtaining higher scores than ADHD group. Findings showed that ADHD children are more impaired than SLD children, in particular in cognitive inhibition, cognitive flexibility, verbal memory, working memory and intellectual functioning. The recognition of the strengths and weaknesses of children and adolescents with ADHD and SLD allows to outline an educational and clinical intervention focused on their specific executive and intellectual functioning.

Genome-wide association scan identifies new variants associated with a cognitive predictor of dyslexia

Developmental dyslexia (DD) is one of the most prevalent learning disorders, with high impact on school and psychosocial development and high comorbidity with conditions like attention-deficit hyperactivity disorder (ADHD), depression, and anxiety. DD is characterized by deficits in different cognitive skills, including word reading, spelling, rapid naming, and phonology. To investigate the genetic basis of DD, we conducted a genome-wide association study (GWAS) of these skills within one of the largest studies available, including nine cohorts of reading-impaired and typically developing children of European ancestry (N = 2562-3468). We observed a genome-wide significant effect (p < 1 × 10-8) on rapid automatized naming of letters (RANlet) for variants on 18q12.2, within MIR924HG (micro-RNA 924 host gene; rs17663182 p = 4.73 × 10-9), and a suggestive association on 8q12.3 within NKAIN3 (encoding a cation transporter; rs16928927, p = 2.25 × 10-8). rs17663182 (18q12.2) also showed genome-wide significant multivariate associations with RAN measures (p = 1.15 × 10-8) and with all the cognitive traits tested (p = 3.07 × 10-8), suggesting (relational) pleiotropic effects of this variant. A polygenic risk score (PRS) analysis revealed significant genetic overlaps of some of the DD-related traits with educational attainment (EDUyears) and ADHD. Reading and spelling abilities were positively associated with EDUyears (p ~ [10-5-10-7]) and negatively associated with ADHD PRS (p ~ [10-8-10-17]). This corroborates a long-standing hypothesis on the partly shared genetic etiology of DD and ADHD, at the genome-wide level. Our findings suggest new candidate DD susceptibility genes and provide new insights into the genetics of dyslexia and its comorbities.

Trends in Prevalence and Management of Childhood Anxiety by Australian Pediatricians

OBJECTIVE

Rising anxiety rates and equity of care are ongoing concerns. Through 2 pediatric practice audits conducted 5 years apart, we aimed to determine the change in 1) anxiety diagnoses; 2) associated comorbid diagnoses; 3) variance in management by location; and 4) child, family, and pediatrician predictors of management.

METHODS

Members of the Australian Paediatric Research Network (APRN) were invited to participate in patient-level prospective national pediatric practice audits in 2008 and 2013. Pediatricians were asked to complete standardized forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first. Demographic data, diagnoses, medications, and referrals were collected. Logistic regressions were conducted, clustered at the pediatrician level.

RESULTS

Of eligible APRN pediatricians in 2013 and 2008, 48% and 66% participated and contributed 7102 and 8345 consultations, respectively. Anxiety diagnoses increased over the 5-year period (4.4% vs 7.6%; P < .001), as did proportions with comorbid autism spectrum disorder (18.4% vs 29.5%; P < .001) and sleep problems (5.1% vs 9.5%; P = .02). There was an increase in the prescription of core anxiety medications, with prescription of selective serotonin reuptake inhibitors increasing from 2.0% to 27.7% (P = .01). Children were more likely to be referred to a psychologist if they were seen in metropolitan practices (odds ratio = 2.0; 95% confidence interval, 1.1-3.9; P = .03) or had learning difficulties (odds ratio = 2.1; 95% confidence interval, 1.1-3.9; P = .03).

CONCLUSIONS

Prevalence of anxiety among children and adolescents attending pediatricians nearly doubled over the 5-year period. Children in regional and remote locations are less likely to be referred to psychological services, prompting concerns about inequity in access to care.

Applying a network framework to the neurobiology of reading and dyslexia

Background

There is a substantial literature on the neurobiology of reading and dyslexia. Differences are often described in terms of individual regions or individual cognitive processes. However, there is a growing appreciation that the brain areas subserving reading are nested within larger functional systems, and new network analysis methods may provide greater insight into how reading difficulty arises. Yet, relatively few studies have adopted a principled network-based approach (e.g., connectomics) to studying reading. In this study, we combine data from previous reading literature, connectomics studies, and original data to investigate the relationship between network architecture and reading.

Methods

First, we detailed the distribution of reading-related areas across many resting-state networks using meta-analytic data from NeuroSynth. Then, we tested whether individual differences in modularity, the brain’s tendency to segregate into resting-state networks, are related to reading skill. Finally, we determined whether brain areas that function atypically in dyslexia, as identified by previous meta-analyses, tend to be concentrated in hub regions.

Results

We found that most resting-state networks contributed to the reading network, including those subserving domain-general cognitive skills such as attention and executive function. There was also a positive relationship between the global modularity of an individual’s brain network and reading skill, with the visual, default mode and cingulo-opercular networks showing the highest correlations. Brain areas implicated in dyslexia were also significantly more likely to have a higher participation coefficient (connect to multiple resting-state networks) than other areas.

Conclusions

These results contribute to the growing literature on the relationship between reading and brain network architecture. They suggest that an efficient network organization, i.e., one in which brain areas form cohesive resting-state networks, is important for skilled reading, and that dyslexia can be characterized by abnormal functioning of hub regions that map information between multiple systems. Overall, use of a connectomics framework opens up new possibilities for investigating reading difficulty, especially its commonalities across other neurodevelopmental disorders.

Electronic supplementary material

The online version of this article (10.1186/s11689-018-9251-z) contains supplementary material, which is available to authorized users.

Neural signatures of co-occurring reading and mathematical difficulties

Impaired abilities in multiple domains is common in children with learning difficulties. Co-occurrence of low reading and mathematical abilities (LRLM) appears in almost every second child with learning difficulties. However, little is known regarding the neural bases of this combination. Leveraging a unique and tightly controlled sample including children with LRLM, isolated low reading ability (LR), and isolated low mathematical ability (LM), we uncover a distinct neural signature in children with co-occurring low reading and mathematical abilities differentiable from LR and LM. Specifically, we show that LRLM is neuroanatomically distinct from both LR and LM based on reduced cortical folding of the right parahippocampal gyrus, a medial temporal lobe region implicated in visual associative learning. LRLM children were further distinguished from LR and LM by patterns of intrinsic functional connectivity between parahippocampal gyrus and brain circuitry underlying reading and numerical quantity processing. Our results critically inform cognitive and neural models of LRLM by implicating aberrations in both domain-specific and domain-general brain regions involved in reading and mathematics. More generally, our results provide the first evidence for distinct multimodal neural signatures associated with LRLM, and suggest that this population displays an independent phenotype of learning difficulty that cannot be explained simply as a combination of isolated low reading and mathematical abilities.

Specific learning disability

Specific learning disabilities (SLD) have an impact on discrete areas of academic function. They result in a level of difficulty that is unexpected when considered in the context of a student's overall intellectual and academic competence. A common example is dyslexia, an SLD that affects the acquisition of literacy. Medical professionals have an important role to play in the evaluation and management of SLD. The medical role is founded on the fact that these conditions are biologically based and have the potential to cause significant harm for the developing child. Even if details of biological causation are not possible to demonstrate for individual children, medical professionals may, nevertheless, make an important judgement call regarding the likelihood of aetiology. When learning problems are medically based, it is clearly unreasonable to expect children to do more than they are able and to learn faster than is reasonable. Advocacy around these biological presumptions and their implications is a major contribution to the well-being of children who have SLD.

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.

Amygdala sub-regional functional connectivity predicts anxiety in children with reading disorder

Pediatric reading disorder (RD) is associated with an increased risk of anxiety symptoms, yet understudied are the neurobiological factors that might underlie anxiety in children with RD. Given the role of the amygdala in anxiety, we assessed resting state functional connectivity of amygdalar subregions in children with RD to identify functional correlates of anxiety and reading impairment. We collected resting state functional MRI data from 22 children with RD and 21 typically developing (TD) children, ages 7 to 13 years. We assessed group differences in resting state functional connectivity (RSFC) from amygdalar subregions. Associations of amygdalar RSFC and volume with reading impairment, reading fluency scores, and anxiety symptoms were explored. Relative to TD children, those with RD showed increased RSFC from amygdalar nuclei to medial prefrontal cortex. Across all subjects, RSFC from right centromedial amygdala to left medial prefrontal cortex positively predicted both reading impairment and self-reported anxiety, and anxiety mediated the relationship between RSFC and reading impairment. These findings are consistent with amygdalar functional abnormalities in pediatric anxiety disorders, suggesting a common neurobiological mechanism underlying anxiety and reading impairment in children. Thus, aberrant patterns of RSFC from amygdalar subregions may serve as potential targets for the treatment of anxiety symptoms that typically co-occur with RD. Our dimensional approach to studying anxiety in RD revealed how amygdalar connectivity underlies anxiety and reading impairment across a continuum from normal to abnormal.

[Learning disorders in ADHD: How are they related?]

Learning difficulties in general and learning disabilities in particular are almost constant in attention deficit disorder with or without hyperactivity (ADHD). Despite a major research effort, the extent and diversity of these comorbid events still raise many questions about the exact nature of their pathogenetic condition (simple consequences of ADHD or specific related disorders?) and consequently the best way to support them. This article aims to present a brief review of the current data.

A Brief Measure of Language Skills at 3 Years of Age and Special Education Use in Middle Childhood

OBJECTIVE

To test whether a language screener administered during early childhood predicts special education referrals and placement in middle childhood.

STUDY DESIGN

A series of logistic regressions was conducted in a longitudinal study of 731 children. Predictor variables included scores on the early language screener (Fluharty Preschool Speech and Language Screening Test-Second Edition [Fluharty-2]) at ages 3 and 4 years, a standardized measure of academic achievement at age 5 years, and parent report of special education services at ages 7.5, 8.5, and 9.5 years.

RESULTS

Results showed that higher scores on the Fluharty-2 predicted a reduced likelihood of having an individualized education program (OR 0.48), being referred for special education (OR 0.55), and being held back a grade (OR 0.37). These findings did not vary by sex, race, or ethnicity, and remained significant after controlling for male sex, behavior problems, parental education, and family income. The Fluharty-2 remained predictive of special education outcomes even after controlling for children's academic skills at age 5 years.

CONCLUSIONS

Results suggest that structured, brief assessments of language in early childhood are robust predictors of children's future engagement in special education services and low academic achievement. Primary care physicians may use a multipronged developmental surveillance and monitoring protocol designed to identify children who may need comprehensive evaluation and intervention. Early intervention may reduce the need for costly special education services in the future and reduce comorbid conditions.

Attention-memory training yields behavioral and academic improvements in children diagnosed with attention-deficit hyperactivity disorder comorbid with a learning disorder

BACKGROUND

Recent studies have suggested that children with attention-deficit hyperactivity disorder (ADHD) may benefit from computerized cognitive training. Therapy implementation is especially complicated when ADHD is associated with learning disorders (LDs). This study tested the efficacy of a computer-based cognitive training program, namely, computerized cognitive training (CCT), in children with ADHD comorbid with an LD (ADHD-LD), with or without psychostimulant medication.

MATERIALS AND METHODS

After diagnostic evaluations, 27 children with ADHD-LD (8 unmedicated and 19 medicated) participated in CCT, which is intended to improve attention, memory, reasoning, visual processing, and executive functioning. The participants completed 24 1-hour sessions over 3 months. Neuropsychometric and standardized academic test results before and after training were compared to assess treatment efficacy. Shapiro-Wilk normality tests were applied, and subsequent Wilcoxon tests were used to identify significant differences in pre-versus post-training performance.

RESULTS

After CAT, children diagnosed with ADHD-LD showed 1) improvements in trained skills, measured directly within the software and indirectly by external psychometric tests; 2) improvements in attention, memory, and some executive functioning; 3) improvements in academic performance, particularly in mathematics; and 4) reductions in maladaptive behavioral features.

CONCLUSION

The present findings suggest that cognitive training programs should be explored further as potential adjunctive therapies to improve outcomes in children with ADHD-LD.

Behavioral traits of the nursing students with special educational needs in Japan

Nursing students with tendencies toward developmental disorders or special educational needs could face difficulties while studying nursing. The study examined the behavioral traits of nursing students with special educational needs who graduated in Japan in March 2011. Nurse educators from 341 programs provided information concerning students who had been identified as difficult to teach while enrolled in nursing programs. Behavioral traits were examined in students with special educational needs (n = 139) and those who did not have special needs but were identified as difficult to teach by the nurse educators (n = 84). The most prevalent behaviors in students with special needs were "making excessive excuses" in unstressful situations and "lapsing into silence" under stressful circumstances. The number of students with special needs who were prone to "blaming others" and "disappearing" was higher relative to that of students without special needs under unstressful circumstances. Under stressful circumstances, "blaming others," "disappearing," and "staying at home" were reported more frequently for students with special needs than they were for students without special needs. Nurse educators should pay attention to these behaviors in students facing difficulties while studying nursing.

Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes

BACKGROUND

The Sport Concussion Assessment Tool-3 (SCAT3) facilitates sideline clinical assessments of concussed athletes. Yet, there is little published research on clinically relevant metrics for the SCAT3 as a whole.

PURPOSE

We documented the psychometric properties of the major SCAT3 components (symptoms, cognition, balance) and derived clinical decision criteria (ie, reliable change score cutoffs and normative conversation tables) for clinicians to apply to cases with and without available preinjury baseline data.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 2.

METHODS

High school and collegiate athletes (N = 2018) completed preseason baseline evaluations including the SCAT3. Re-evaluations of 166 injured athletes and 164 noninjured controls were performed within 24 hours of injury and at 8, 15, and 45 days after injury. Analyses focused on predictors of baseline performance, test-retest reliability, and sensitivity and specificity of the SCAT3 using either single postinjury cutoffs or reliable change index (RCI) criteria derived from this sample.

RESULTS

Athlete sex, level of competition, attention-deficit/hyperactivity disorder (ADHD), learning disability (LD), and estimated verbal intellectual ability (but not concussion history) were associated with baseline scores on ≥1 SCAT3 components (small to moderate effect sizes). Female sex, high school level of competition (vs college), and ADHD were associated with higher baseline symptom ratings (d = 0.25-0.32). Male sex, ADHD, and LD were associated with lower baseline Standardized Assessment of Concussion (SAC) scores (d = 0.28-0.68). Male sex, high school level of competition, ADHD, and LD were associated with poorer baseline Balance Error Scoring System (BESS) performance (d = 0.14-0.26). After injury, the symptom checklist manifested the largest effect size at the 24-hour assessment (d = 1.52), with group differences diminished but statistically significant at day 8 (d = 0.39) and nonsignificant at day 15. Effect sizes for the SAC and BESS were small to moderate at 24 hours (SAC: d = -0.36; modified BESS: d = 0.46; full BESS: d = 0.51) and became nonsignificant at day 8 (SAC) and day 15 (BESS). Receiver operating characteristic curve analyses demonstrated a stronger discrimination for symptoms (area under the curve [AUC] = 0.86) than cognitive and balance measures (AUCs = 0.58 and 0.62, respectively), with comparable discrimination of each SCAT3 component using postinjury scores alone versus baseline-adjusted scores (P = .71-.90). Normative conversion tables and RCI criteria were created to facilitate the use of the SCAT3 both with and without baseline test results.

CONCLUSION

Individual predictors should be taken into account when interpreting the SCAT3. The normative conversion tables and RCIs presented can be used to help interpret concussed athletes' performance both with and without baseline data, given the comparability of the 2 interpretative approaches.