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Learning disabilities and central auditory dysfunction.

Hearing loss, whether peripheral or central, compounds the communication and educational problems of the learning disabled student. A central auditory processing disorder uniquely interferes with both the input and integration of verbal information, further resulting in a potentially permanent cognitive dysfunction during the developmental period of acquisition of language. Illustrative cases are presented that indicate the panorama of cognitive dysfunction associated with the learning disabled status. Methods of evaluation and identification and diagnostic criteria are correlated with auditory, visual, and academic performance. Comments regarding clinical awareness, prompt recognition, and ensuing individualized remediation are submitted.

Adult↗

Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning.

The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder (ADHD) symptoms and functional impairments at school and at home. Participants were 153 children (age 8 to 12 years) diagnosed with attention-deficit hyperactivity disorder who were randomized to double-blind treatment with either atomoxetine (n = 101) or placebo (n = 52). Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy. Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents. No significant effects were revealed for the teacher ratings of academic productivity. Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD. The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest, albeit less compelling for this particular investigation, than for the effects on overt symptom display.

Adrenergic Uptake Inhibitors↗

Special considerations in the treatment of seasonal allergic rhinitis in adolescents: the role of antihistamine therapy.

The symptoms of seasonal allergic rhinitis often develop during adolescence. Teen-age students with seasonal allergic rhinitis may experience decreased academic performance and productivity from the disease or because of the sedative effects of some antihistamines. The pharmacologic effects of nonsedating second-generation antihistamines are compared with those of classical antihistamines. The effects of antihistamines on sedation and motor and cognitive function are discussed. The role of antiinflammatory agents, decongestants, and combination products is reviewed. Potential drug interactions must be considered along with factors such as drug-induced weight gain and the use of antihistamines in potentially pregnant patients in selecting appropriate antihistamine therapy for adolescent patients.

Adolescent↗

The effect of academic self-concept on ADHD and antisocial behaviors in early adolescence.

Using structural equation modeling techniques, we evaluated the effect of academic self-concept (ASC) on the development of attention-deficit/hyperactivity disorder (ADHD) and antisocial behaviors in early adolescence. Participants (n = 445) were recruited from the Dunedin Multidisciplinary Health and Development Research study. Eligibility was determined by the presence of complete data for the following variables at the specified time periods: reading at age 7, teacher reports of ADHD and antisocial behaviors at age 7, self-ratings of ASC at ages 9 and 11, and teacher reports of ADHD and antisocial behaviors at age 13. The results indicated that ASC is an important construct that directly contributes to the development of antisocial behaviors rather than to symptoms of ADHD. The results also indicated that children's early history of behavioral problems and academic performance contribute to the development of a more robust understanding of the impact of ASC on the development of disruptive behaviors in early adolescence.

Adolescent↗

College students classified with ADHD and the foreign language requirement.

The conventional assumption of most disability service providers is that students classified as having attention-deficit/hyperactivity disorder (ADHD) will experience difficulties in foreign language (FL) courses. However, the evidence in support of this assumption is anecdotal. In this empirical investigation, the demographic profiles, overall academic performance, college entrance scores, and FL classroom performance of 68 college students classified as having ADHD were examined. All students had graduated from the same university over a 5-year period. The findings showed that all 68 students had completed the university's FL requirement by passing FL courses. The students' college entrance scores were similar to the middle 50% of freshmen at this university, and their graduating grade point average was similar to the typical graduating senior at the university. The students had participated in both lower (100) and upper (200, 300, 400) level FL courses and had achieved mostly average and above-average grades (A, B, C) in these courses. One student had majored and eight students had minored in an FL. Two thirds of the students passed all of their FL courses without the use of instructional accommodations. In this study, the classification of ADHD did not appear to interfere with participants' performance in FL courses. The findings suggest that students classified as having ADHD should enroll in and fulfill the FL requirement by passing FL courses.

Adult↗

School-based assessment of attention deficit-hyperactivity disorder.

Schools are uniquely situated to provide information relevant to the assessment and treatment of Attention Deficit-Hyperactivity Disorder (ADHD) across a variety of tasks, settings, and observers. The importance of the school setting to the assessment and treatment of ADHD has resulted in the development of numerous measures appropriate for such assessment, but few guidelines for their use. The purpose of this article is to describe school-based assessment procedures and their relationship to ADHD. These procedures include teacher rating measures, direct observations in classrooms and on playgrounds, peer rating and sociometric measures, and permanent product measures such as academic performance. It is recommended that school-based assessment of ADHD involve the concurrent use of multiple measures to assess adequately the wide variety of symptoms associated with this disorder. It is further recommended that assessment serve the purpose of determining treatment efficacy to avoid unwarranted preoccupation with diagnostic issues that are as yet unresolved. The components of a comprehensive school-based assessment of ADHD are described, and their relationship to school-based treatment is discussed.

Attention Deficit Disorder with Hyperactivity↗

Mathematical outcomes of attention-deficit hyperactivity disorder.

We assessed the academic performance and behavior of 121 nondisabled elementary boys and 107 boys with attention-deficit hyperactivity disorder (ADHD), ages 7.4 through 14.5 years. Students completed computer-generated tasks of reading, computation, and math problem solving, and we recorded two performance measures (accuracy and speed) and three behavioral measures (vocalizations, head movements, and bottom movements). Our purpose was to determine the effects of ADHD on conceptual and computational math. For greater precision than has been available in past math research, we held reading and problem structure constant, while recording speed of processing, number recognition, and motor response. Our analysis yielded significantly lower problem-solving scores in specific math concepts and slower computational performance for the boys with ADHD. These findings demonstrated the educational implications of attention deficit disorders for mathematical skill and the need for interventions that are geared more specifically to these deficits, and that also provide accommodations for reading complexity and length, visual-motor skill, feedback, and self-pacing.

Attention Deficit Disorder with Hyperactivity↗

Achievement-related perceptions of children with learning disabilities and normal achievement: group and developmental differences.

Self-perceptions of teacher feedback, social comparison of reading competence, reading satisfaction, and general self-worth were assessed among third and sixth graders with learning disabilities and normal achievement (n = 247). Relations among these variables and mean differences were examined within the and across grades. As predicted, in both grades teacher feedback was the most common criterion children used to judge their academic performance. In both achievement groups, perceived teacher feedback and reading satisfaction were less favorable among sixth than third graders. Hierarchical regression analyses showed that perceived teacher feedback was the best predictor of reading satisfaction; however, in sixth grade, social comparison also contributed significantly to the prediction. The importance of perceived feedback also was demonstrated in the relation to self-worth, which was generally positive among both achievement groups and within each grade. Through its relation to reading satisfaction, perceived teacher feedback contributed significantly to prediction of self-worth. Developmental differences and classroom factors that may explain these findings are discussed.

Achievement↗

Information overload in the teaching of pharmacology.

Medical students are usually drawn from the best of students, but it is not unusual to see these brilliant students fail their exams or even dismissed from medical school because of poor academic performance. Information overload has been recognized as one of the major contributing factors to this problem. The situation is expected to get worse, with the ever-present technology-induced exponential growth in information. In discussing this issue, the authors echo the concerns of several experts regarding the content overload of medical school curricula, particularly in pharmacology. It is the increasing awareness of this problem that led the Association of American Medical Colleges and the General Medical Council of Britain to promote the concept of a core curriculum for each of the principal disciplines in medicine. Several medical schools have adopted the concept and also the problem-based learning approach, which focuses on ameliorating the complex problems associated with information growth in medical education. Based on the authors' experience as medical students, medical practitioners, and pharmacology teachers, they discuss the factors that contribute to information overload, from psychological and nonpsychological perspectives. Issues such as the design and structure of the curriculum, the quality of training and effectiveness of the teachers (clinically qualified vs. nonclinically qualified teachers), and the psychological preparedness of the students are discussed. The authors make suggestions for improvement.

Curriculum↗

Conduct disorder: a biopsychosocial review.

OBJECTIVE: To review published works on the epidemiology, risk factors, protective factors, typologies, and genetic aspects of conduct disorder (CD). METHOD: Findings from refereed journal articles and current texts in the field are briefly summarized. RESULTS: CD is commonly encountered in clinical practice. Factors strongly predictive of future delinquency include past offenses, antisocial peers, impoverished social ties, early substance use, male sex, and antisocial parents. Factors that moderately predict recidivism include early aggression, low socioeconomic status (SES), psychological variables such as risk taking and impulsivity, poor parent-child relationships, poor academic performance, early medical insult, and neuropsychological variables such as poor verbal IQ. Mildly predictive variables include other family characteristics such as large family size, family stress, discord, broken home, and abusive parenting, particularly neglect. Protective factors include individual factors such as skill competence (in social and other arenas), adult relationships, prosocial and proeducational values, and strong social programs and supports. CONCLUSIONS: We know a great deal about psychosocial risk factors for CD. Some research into protective factors and genetic contributions exists but is in its early stages. Future work will increase our knowledge about subtypes, developmental pathways, and CD treatment.

Adolescent↗

Fact versus fancy concerning the multimodal treatment study for attention-deficit hyperactivity disorder.

Findings from the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA, have been much discussed but frequently misinterpreted or mischaracterized. Misinterpretations regarding the specific nature of and rationale for the study design, the effectiveness of the behavioural treatment arm, the possible advantages of combined treatments over single-component (medication management or behavioural therapy) interventions, and the feasibility and applicability of MTA treatments for "real-world" practitioners are addressed. Careful interpretation of the MTA findings suggests that for ADHD symptoms, carefully crafted medication-management approaches are superior to behavioural treatment and to routine community care that includes medication. For non-ADHD areas of functioning (for example, social skills, academic performance), combined treatments may offer modest advantages over single-component approaches. Longer-term outcomes past 14 months of intensive MTA treatments (as well as their relative effectiveness with respect to each other) remain unknown, pending further MTA analyses. The MTA treatments by and large consisted of evidence-based "best practices." Thus, rather than characterizing these treatments as infeasible, the substantially superior outcomes of these treatments (versus routine clinical care) across diverse settings should help set the standard for future treatment practices in real-world settings. Despite important study limitations, the MTA study, by virtue of its size, scope, and length; parallel-groups design; explicit use of manualized, evidence-based treatments; and comprehensive range of outcome assessments sets an important benchmark for future trials testing new treatments for childhood ADHD and defines a new standard for optimal outcomes that can be achieved with the best of clinical care.

Attention Deficit Disorder with Hyperactivity↗

Lamotrigine treatment in childhood drug resistant epilepsy.

The clinical response to lamotrigine has been evaluated in a group of 63 drug resistant epileptic children in an open add-on trial. A negative response was observed in 30 subjects. In 11 patients, after an initial improvement lasting a mean period of 8 months, seizures recurred with the same frequency present before the beginning of the treatment. Twenty-two patients responded to lamotrigine treatment. Period of observation in the responsive group ranged from 1 year to 3 years. Response was complete in 16 patients and in the other 6 a 50% to 90% decrease of seizures was obtained. A complete normalization of the electroencephalogram (EEG) was registered in 10 cases after a mean period of 5 months of therapy. Side effects were mild and limited to 12 patients. Improvement was obtained in social and academic performance. Writing ability improved in one case. Lamotrigine can be considered a useful drug in the therapeutic armamentarium for childhood drug resistant epilepsy.

Adolescent↗

Asymmetries in brain maturation and behavioral disturbances: multivariate electroencephalogram and P300 studies.

If behavior results from brain function, some evidence of dysfunction could be expected in children with major behavioral problems. Yet, neurophysiologic studies in these children are frequently normal. We hypothesized a relationship between maturational asymmetry and behavior, given the role of hemispheric imbalance in adult psychopathology. The purpose of this study was to investigate whether age-sensitive neurophysiologic measures could identify behaviorally relevant maturational asymmetries in otherwise healthy children. Ninety-five children were studied; reasons for testing were behavioral (19), academic (12), medical nonneurologic (16), and mixed (28), along with 20 control subjects. Academic, behavioral (Child Behavioral Checklist), and psychometric (Wechsler Intelligence Scale for Children-Revised; WISC-R) measures were analyzed in relation to four neurophysiologic parameters: P300 Latency, P300 Latency Asymmetry, Maturational Z-score, and Maturational Z-score Asymmetry, within a canonical design. The highest correlation was behavior with Maturational Z-score Asymmetry. Academic scores were predicted by the three-variable interaction of P300 Latency,Maturational Z-score, and Maturational Z-score Asymmetry. We concluded that behavior was strongly influenced by maturational asymmetry, while academic performance depended on both global maturation and maturational asymmetry. Our results suggest that behavioral disturbances can have a neural substrate despite apparently normal electroencephalograms (EEGs) and event-related potentials (ERPs). They open the possibility for specific therapeutic interventions to improve behavior and performance, and, perhaps, prevent major psychopathology in later life.

Achievement↗

Game-Based Intervention for Bullying: Assessing the Efficacy of the REThink Therapeutic Game in Primary School Children.

Children's mental health issues can have a lasting effect into adulthood, including enhanced risks for their social and emotional development, as well as their academic performance and overall behavior. Worldwide nearly 1 billion children are affected by the bullying phenomenon, with social, emotional, and economic consequences. In this vein, our study aimed to analyze the effect of the therapeutic game REThink on the improvement of emotion regulation abilities and the reduction of both bullying behavior and victimization in primary school children. Our sample consisted of 75 children who were voluntarily enrolled by their parents, and randomly assigned to the intervention group (n = 38) or to the control group (n = 37). They completed the baseline assessment consisting of emotion regulation, irrationality, bullying and victimization behavior measurements, then the children from the intervention group played the therapeutic game REThink. Four weeks later, after completing each level twice, every participant had completed the same questionnaires at the post-test assessment. The results indicated significant changes across victimization for children who were exposed to verbal, physical or social bullying, increased emotional control and lower levels of irrationality, low frustration tolerance to work and demandingness, with small to medium effect size improvements for the REThink game group compared to the control group. The REThink therapeutic game proved to be a promising intervention tool for reducing victimization effects and irrationality, and improving emotion regulation abilities in primary school children. Future research could improve on these results by addressing the timeline stability limit.

Humans↗

Small group intervention for children with attention disorders.

Children with attention disorders can experience adverse long-term effects on academic performance, vocational success, and socioemotional development. They experience some level of functional impairment that extends across settings, including the home and school. In combination with medication, group interventions with school-age children were found to be effective for enhancing social behavior. This article describes two practice improvement projects that provided group experiences for children with attention-deficit/hyperactivity disorder (ADHD) symptoms, including disruptive behavior. Four skill domains were addressed: communication, friendship, self-control, and social problem solving. One project provided activities for early school-age children with ADHD who were treated with medication only. Another provided a support group on self-management for freshman boys with ADHD who were also treated with medication only. In both projects, the disruptive behavior of the participants decreased by the end of the group sessions.

Adolescent↗

Depression in children and adolescents.

During the past 20 years, depression has been recognized widely in children and adolescents. However, even with what is known today about depression, many children and adolescents remain undiagnosed. Early recognition is imperative to prevent further episodes that may continue into adulthood. Depression in children and adolescents affects social development, academic performance, and ultimately, success as an adult. This article describes risk factors for depression, diagnostic criteria, medications, psychosocial interventions, and implications for school nursing practice.

Adolescent↗

Victimization of obese adolescents.

Peer victimization of obese adolescents has been associated with low self-esteem, body dissatisfaction, social isolation, marginalization, poor psychosocial adjustment, depression, eating disorders, and suicidal ideation and attempts, not to mention poor academic performance. Weight-based peer victimization is defined as unsolicited bullying and teasing as a result of being overweight or obese. The victimization may be overt or relational. Obese adolescents are at risk of victimization, because their peers view them as different and undesirable. Although peer victimization occurs commonly among adolescents, obese adolescents are more susceptible than their average-weight peers. Because school nurses are often the first line of defense for obese adolescents, they are in an excellent position to identify forms of peer victimization and be prepared to intervene with the victims. School nurses can potentially preserve the psychosocial integrity of obese adolescents by promoting healthy peer interactions and experiences.

Adolescent↗

Management of the child with sickle cell disease within the school setting.

Children with Sickle Cell Disease have health risk factors that can affect their academic performance as well as school attendance. The information in this article is designed to assist the school nurse to develop an individualized health care plan (IHP) for the child with sickle cell disease. A case study, with a sample IHP, is provided. In addition, an Action Plan is provided to assist with the identification and management of symptoms that may occur.

Anemia, Sickle Cell↗