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PubMed2002

Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD).

BACKGROUND: The Health of the Nation Outcomes Scales (HoNOS) have been developed to measure outcomes in people with mental health problems. AIMS: Frequent impaired social functioning, problems with communication and associated physical conditions meant that a bespoke instrument was needed for people with learning disabilities. We describe the development of the Health of the Nation Outcomes Scales for People with Learning Disabilities (HoNOS-LD). METHOD: HoNOS-LD was piloted at 26 sites. Two raters, at two points in time, rated 372 subjects. Analysis determined acceptability, ease of use, interrater reliability, sensitivity to change and reliability with the Aberrant Behavior Checklist (ABC). RESULTS: The resulting 18-item instrument demonstrated good reliability and validity characteristics and is generally acceptable to clinicians. CONCLUSIONS: HoNOS-LD is an appropriate instrument for measuring outcome in people with learning disabilities with additional mental health needs.

England↗
PubMed2000

A comparison of patients admitted to two medium secure units, one for those of normal intelligence and one for those with learning disability.

Differences between patients being treated in two different medium secure units, one for those of normal intelligence and one for those with learning disability, were investigated. Sociodemographic, psychiatric, medical and medicolegal data were recorded for all inpatients in both secure units. Patients in the medium secure unit for those of normal intelligence were older at the time of the study and at conviction for the index offence, more likely to have been admitted from the penal system, and more likely to suffer from a psychotic disorder, particularly schizophrenia or a mood disorder. Their index offence was more likely to be homicide, attempted murder, manslaughter or grievous bodily harm, while that of the patients with learning disability was more likely to be a sexual offence. A need for separate medium secure unit facilities for those of normal intelligence and those with learning disability is supported by differing psychiatric and behavioural requirements.

Adult↗
PubMed1995

People with learning disabilities and challenging behaviour: the characteristics of those referred and not referred to specialist teams.

The characteristics of two samples of people with learning disabilities and severely challenging behaviour were examined. The experimental sample comprised subjects who had been referred to two specialist challenging behaviour services in separate counties. The comparison sample comprised subjects from the same counties who were not referred or accepted for specialist intervention. No significant differences were found between the samples in terms of age, gender, social impairment, dependency characteristics, ability levels and mental health. Significant differences between them were found in the nature and severity of aberrant behaviour presented, as assessed by their carers. The implications of these findings are discussed with regard to how the term 'severely challenging behaviour' is defined in practice.

Activities of Daily Living↗
PubMed1993

Gender differences in locus of control scores for students with learning disabilities.

The present investigation examined gender differences on locus of control scores for students with learning disabilities. Scores from two measures of locus of control, the adult version of the Nowicki-Strickland Internal-External Scale and the Intellectual Achievement Responsibility Questionnaire, were compared for 77 boys (M age = 16.3 yr., M IQ = 89.5) and 27 girls (M age = 16.4 yr. and M IQ = 91.2). As groups were of unequal sizes, differences between scores were assessed by an analysis of unweighted means, creating a single harmonic mean and homogeneous subsets for all tests. Significant differences were found by gender on the Nowicki-Strickland inventory. On all assessments girls' means were more external than boys'. These results are discussed in light of recent findings concerning gender and positive adult outcomes for learners with learning disabilities and in relation to gender stereotyping and discrimination.

Adolescent↗
PubMed1979

Learning disabilities: the role of the developmental optometrist.

The role of the optometrist in treating children experiencing learning disabilities embraces numerous areas beyond the customary optometric services. Etiological, diagnostic and therapeutic factors are discussed stressing visual functional disorders, perceptual-motor and developmental lags and cognitive style. Their effects on the learning disabled child are analyzed; and the rationale of optometric procedures frequently used in treating LD children is reviewed. The optometrist may also be helpful in counseling patients who have learning readiness problems, reading disorders, psychological difficulties and nutritional deficits.

Child↗
PubMed1999

Neuropsychological, learning and psychosocial profile of primary school aged children with the velo-cardio-facial syndrome (22q11 deletion): evidence for a nonverbal learning disability?

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.

Attention↗
PubMed1992

The perspectives of mothers whose children are in special day classes for learning disabilities.

This article presents information about the attitudes and beliefs of mothers concerning their children in learning disabilities classes. Four mothers were interviewed over a 1-year period. Their comments about services provided by educational and mental health professionals indicated high levels of frustration and dissatisfaction. Parental expectations and perspectives differed from those of educators. Participants and educators were found to view learning disabilities differently.

Adolescent↗
PubMedDate not supplied

Health of the Nation for people with learning disabilities.

This article explores issues related to the health of people with learning disabilities, with particular reference to the Department of Health (1995a) document The Health of the Nation: A Strategy for People with Learning Disabilities. This publication has stimulated care staff across all agencies to take a fresh look at this client group and their health needs in the five key areas: coronary heart disease and stroke; cancers; HIV/AIDS and sexual health; accidents; and mental health.

Health Priorities↗
PubMed2001

Metachromatic leukodystrophy and nonverbal learning disability: neuropsychological and neuroradiological findings in heterozygous carriers.

Metachromatic leukodystrophy (MLD) is an autosomal recessive neurodegenerative disorder due to deficiency of the enzyme arylsulfatase A that leads to progressive, diffuse demyelination. The syndrome of nonverbal learning disability has been attributed to white matter abnormality and has been reported in children with this disorder and in some healthy family member carriers of gene. We examined the neuropsychologic profiles and MRIs of eight members of the family of a 7-year-old girl with this disease, all of whom were heterozygous carriers of the mutation and five of whom were also carriers of the MLD pseudodeficiency gene. All had low normal levels of arylsulfatase A, and seven of the eight had average or better profiles across all assessed neuropsychological domains. The patient's younger sister had a profile with features of the syndrome of nonverbal learning disability despite a normal MRI, whereas two members with minor white matter findings did not. This family does not provide evidence for the syndrome of nonverbal learning disability in heterozygous carriers of the gene for MLD, even when associated with the MLD pseudodeficiency gene.

Adolescent↗
PubMed1994

Event-related potentials to an "oddball" auditory paradigm in children with learning disabilities with or without attention deficit hyperactivity disorder.

Event Related Potentials (ERP) were recorded during a two-tone discrimination task in 18 children with Learning Disabilities (LD) and 36 children with Learning Disabilities and Attention Deficit Hyperactivity Disorder (LD-ADHD). Twenty-seven normal children served as a control group. P3 wave amplitude was significantly smaller in the LD and LD-ADHD groups compared with normal children. There was no difference between the LD and LD-ADHD groups. It is suggested that the smaller P3 amplitude in children with LD-ADHD syndromes reflects cognitive and processing difficulties, which frequently coexist with ADHD in these children and is not specifically related to an attention deficit.

Attention Deficit Disorder with Hyperactivity↗
PubMed1980

The effect of reinforcement and verbal rehearsal on selective attention in learning-disabled children.

A central-incidental task of selective attention was administered to 100 learning-disabled boys--48 younger children (8 1/2-10 1/2 years) and 52 older children (10 1/2-12 1/2 years). Subjects at both age levels were assigned to one of four conditions: (a) a standard condition; (b) a rehearsal condition, in which subjects were taught a verbal rehearsal strategy; (c) a reinforcement condition, in which correct responses were rewarded; and (d) a combined rehearsal-reinforcement condition. Older subjects recalled more central task but not more incidental task information than younger subjects. A measure of selective attention efficiency was also greater for older than for younger subjects. Central recall in the rehearsal-reinforcement condition was greater than in any other condition. Central recall was greater in the rehearsal condition than in the standard and reinforcement conditions. Selective attention efficiency was greater for both rehearsal conditions than for both nonrehearsal conditions. Incidental recall was higher for reinforcement subjects than for rehearsal subjects. Results suggest that induced verbal rehearsal improves central recall and selective attention in learning-disabled children. Reinforcement alone does not improve central recall but may when paired with rehearsal.

Attention↗
PubMed1989

Longitudinal research on the behavioral characteristics of children with learning disabilities.

This paper summarizes a program of research on the behavioral characteristics of children with learning disabilities (LD) compared to average achievers. Longitudinal studies over a 3-year period beginning in the first and second grades showed that children with LD, as a heterogeneous group, displayed a persistent pattern of maladaptive classroom behavior that distinguished them from average achieving peers and that was associated with continued underachievement over time. Subsequently, children with LD in the longitudinal sample were clustered into seven different subtypes that represented attention problems, conduct and classroom management problems, withdrawn-dependent behavior, and normal behavior. Although no differences in achievement were found initially between behavioral subtypes, children in the attention and conduct problem subtypes had poorer academic outcomes 3 years later compared to those in the withdrawn subtype and those who had no significant behavior problems. The collective findings from this research are discussed in terms of the developmental relationship between learning disabilities, attention disorders, and social/emotional problems, and implications are drawn for a greater focus on behavioral interventions in special education and prevention efforts in the early grades.

Adjustment Disorders↗
PubMed2005

Disruption of a brain transcription factor, NPAS3, is associated with schizophrenia and learning disability.

A mother and daughter diagnosed with schizophrenia and schizophrenia co-morbid with mild learning disability, respectively, possess a balanced reciprocal translocation t(9,14)(q34.2;q13). Fluorescence in situ hybridization (FISH) with YAC, BAC, and cosmid probes indicate that the chromosome 14q13 breakpoint disrupts a large gene, NPAS3, encoding a CNS expressed transcription factor of the basic helix-loop-helix PAS (bHLH-PAS) gene family. By analogy with other members of the bHLH-PAS family, the putative truncated protein generated from the disrupted gene locus may have a dominant negative effect. The 14q13 region was previously identified by a linkage study of an inherited neurodegenerative condition, idiopathic basal ganglia calcification (IBGC or Fahr syndrome, OMIM:213600/606656), which is often co-morbid with psychosis. Sequencing of the gene in a third patient diagnosed with IBGC, schizophrenia, and mild learning disability did not reveal functional mutations.

Abnormalities, Multiple↗
PubMed1996

Clinical examples of cross-cultural work in a community learning disability service.

The debate on the correct application of the terms race and ethnicity continues while community care takes place in a multicultural society. The impact of mental illness and mental handicap (currently referred to as learning disability) on different ethnic groups partly depends on societal influences which also determine the policy for service organisation. As the treatment and support of the mentally handicapped has moved away from the custodial care of yesteryear, professionals must ensure that their practice is sensitive to the religion, ethnicity and languages of the communities they serve. This paper describes examples of psychiatric clinical practice with two families of Greek and Kuwaiti background, in the setting of a community learning disability team.

Adult↗
PubMed1992

Tourette syndrome and learning disabilities.

We reviewed the records of 42 consecutive cases of children with Tourette Syndrome (TS) who had IQs above 70, and contrasted the reading, reading comprehension, math, and spelling quotients with IQ scores to determine how many would meet criteria for a learning disability. The mean IQ of the 35 males and 7 females was 94.4 and was higher than the mean math score (82.8), spelling score (90.4), reading score (87.4), and reading comprehension score (85.3). Using a 1.5 standard deviation discrepancy, 51% met criteria for learning disability in at least one academic area; 21% had a 2-standard-deviation discrepancy. Children with TS frequently have learning disabilities, and assessment of academic achievement should be a routine aspect in the evaluation of such children.

Achievement↗
PubMedDate not supplied

Variables related to the decision of young adults with learning disabilities to participate in postsecondary education.

This article examines the relationship between specific factors and the decision to participate in postsecondary education by young adults with learning disabilities. Data concerning 539 subjects with learning disabilities were included in this study. T test and chi square indicated that involvement in extracurricular activities while in high school, use of community resources, intelligence quotient, and reading and mathematics grade equivalent scores were important factors that differentiated between subjects choosing to participate or not to participate in postsecondary education during the year after high school. Implications and recommendations for secondary school curriculum are discussed.

Adaptation, Psychological↗
PubMed2000

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities.

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities This paper provides a discussion of some of the professional and policy outcomes associated with implementing clinical supervision within a community service for adults with learning disabilities. It is based upon a small qualitative study whose aim was to examine how clinical supervision was operating, its strengths, its weaknesses and where improvements might be made. The study followed the introduction of clinical supervision 9 months earlier for nurses and carers employed in three community homes and one community multiprofessional team. The method consisted of direct observation of individual and group supervision and staff completing critical incident questionnaires, followed by semi-structured, audio-taped interviews with seven registered nurses and four community team members, including a social worker, psychologist and physiotherapist. Outcomes were expressed in two ways: in terms of the benefits of clinical supervision or of its ambivalence. The range of matters brought for discussion, or resolution, in supervision reflected some of the difficulties or dilemmas staff faced working in this area, for example promoting empowerment and assisting clients to make choices, and dealing with clients' challenging and inappropriate behaviours. As for the role of supervisor there was some evidence of nurses expressing apprehension or unpreparedness, also a perceived general concern over the relatively low status of clinical supervision, thought to be due to absence of visible management approval or failure to articulate properly the objective of supervision. A limitation of the study was its small subject sample although considerable data were gathered in each of the units through relatively long-term contact.

Adult↗
PubMed1998

Frontal systems dysfunction in children with attention-deficit/hyperactivity disorder and learning disabilities.

Tests of attention, inhibition, working memory, motor learning, and problem solving--functions associated with the brain's frontal systems--were administered to 26 children with attention-deficit/hyperactivity disorder and learning disabilities (ADHD + LD), 22 children with LD only, and 10 with ADHD only. Percentages of abnormal test results and significantly impaired scores were higher for the two groups with LD than for the ADHD-only group. The groups differed significantly on some tests of attention-inhibition-cueing, working memory, and problem solving, with the ADHD + LD and LD groups performing worse than the ADHD-only group. Abnormalities of frontal systems tests are not exclusive ADHD characteristics and are also present in LD children, implying a strong connection between centers of "processing" and centers of "executive" functions.

Analysis of Variance↗