Situating word deafness within aphasia recovery: A case report

Word deafness is a rare neurological disorder often observed following bilateral damage to superior temporal cortex and canonically defined as an auditory modality-specific deficit in word comprehension. The extent to which word deafness is dissociable from aphasia remains unclear given its heterogeneous presentation, and some have consequently posited that word deafness instead represents a stage in recovery from aphasia, where auditory and linguistic processing are affected to varying degrees and improve at differing rates. Here, we report a case of an individual (Mr. C) with bilateral temporal lobe lesions whose presentation evolved from a severe aphasia to an atypical form of word deafness, where auditory linguistic processing was impaired at the sentence level and beyond. We first reconstructed in detail Mr. C's stroke recovery through medical record review and supplemental interviewing. Then, using behavioral testing and multimodal neuroimaging, we documented a predominant auditory linguistic deficit in sentence and narrative comprehension-with markedly reduced behavioral performance and absent brain activation in the language network in the spoken modality exclusively. In contrast, Mr. C displayed near-unimpaired behavioral performance and robust brain activations in the language network for the linguistic processing of words, irrespective of modality. We argue that these findings not only support the view of word deafness as a stage in aphasia recovery but also further instantiate the important role of left superior temporal cortex in auditory linguistic processing.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Long-term outcome from a medium secure service for people with intellectual disability

BACKGROUND

The purpose of this paper is to describe long-term outcomes for patients discharged over a 12-year period from a medium secure service for people with intellectual disabilities (ID).

METHODS

A cohort study using case-notes analysis and a structured interview of current key informants.

RESULTS

Eleven per cent of the sample was reconvicted. Fifty-eight per cent of the sample showed offending-like behaviour that did not lead to police contact. Twenty-eight per cent of the sample was currently detained in hospital under the Mental Health Act. The presence of a personality disorder, a history of theft or burglary, and young age increased the risk of reconviction. Contact with the police was less likely in those with schizophrenia. Re-admission to hospital was associated with the presence of offending-like behaviours, rather than any specific diagnosis.

CONCLUSION

In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced. Declaration of interests Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.

Attitude to medication of parents/primary carers of people with intellectual disability

OBJECTIVE

To investigate the influence of attitudes of carers of people with intellectual disability (ID) towards giving medication.

METHOD

Ninety-three carers of service users who are currently attending outpatients clinic (Harrow Learning Disability service) were interviewed, using the RAMS (Rating of Attitude to Medication Scale) interview schedule.

RESULTS

A significant association was found between relationship of the carer to the service user and overall positive or negative attitude towards medication, with a disproportionate number of parents expressing a negative attitude in comparison with professional carers (46% vs. 11%).

CONCLUSION

This study suggests more work needs to be done with family carers than with professional carers to improve compliance with medication. Stigma is still associated with ID and psychiatric disorders. The family carers responses may be projecting their feelings related to the impact of having a child not only with ID, but also with additional psychiatric problems. The implication of the study for psychiatrists is the identification of a number of areas that could be usefully explored before writing a prescription.

A comparison of costs and data quality of three health survey methods: mail, telephone and personal home interview

Three survey modes--a self-administered mailed questionnaire, a telephone interview, and a home interview--were assessed for survey costs, adequacy of completion, test-retest reliability, validity of responses to medical questions and estimates of morbidity. Costs per household for each mode were $A42.75, $A74.33, and $71.89, respectively. Item omission was confined virtually to the mail mode and averaged 5.5% over 84 questions assessed, while telephone and home interview modes averaged 0.4% and 0.2%, respectively. "Don't knows" were virtually absent for all questions except those about precise details (names, places, etc.) of events occurring often 10-15 years before the survey; no mode differences were observed. The mail mode produced less reliable responses to questions about environmental exposure to hazardous chemicals or activities when considered question-by-question, but differences were not significant among modes when all questions were grouped. Reliability was high to medical questions and no mode differences were observed. Medical conditions which would require a medical diagnosis for subjects to be able to report them were more reliably answered than conditions described in broad or lay terms. Validity of answers to medical questions varied across modes and types of questions; underreporting of medical conditions was highest in the mail mode and was lowest for conditions requiring a diagnosis. Overreporting was lowest in the mail mode and highest for conditions requiring a diagnostic opinion.

Competitive employment: assessing employee reactivity to naturalistic observation

This study assessed the work behavior of five mentally retarded dishwashers. An ABCBC design was utilized with special educators initially observing the dishwashers (Overt measures). During the B phases these educators observed the same dishwashers' work behavior while a second group of observers, posing as kitchen laborers (coworkers), assessed work behavior, during other periods of the day (Overt or Covert). Finally, during C phases, special educators and coworkers recorded dishwashers working at the same time (Overt and Covert). Results indicated dishwashers worked more when educators observed them. Dishwashers spent less time working when these educators were absent. During the "Overt and Covert" observation phases (Phase C), where covert measures were taken in addition to overt measures (i.e., at the same time and on the same person), covert measures covaried with educators' measures of work performance. These results are discussed with suggestions to initiate a program of research to investigate the use of coworkers in the administration of behavior change methods, in work settings.