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PubMedDate not supplied

Self-management within a classroom token economy for students with learning disabilities.

Students with disabilities who are served in restrictive educational settings often display inappropriate behavior that serves to preclude their integration into the mainstream. One approach to managing difficult behavior is a levels system (Smith & Farrell, 1993), which typically consists of a hierarchy of levels in which students must meet increasingly demanding standards of behavior before advancing through the hierarchy. In the present study, two middle-school students with learning disabilities participated in a classroom-wide token economy based on a levels system. The levels system, which was used in a self-contained classroom, targeted the acquisition and maintenance of academic skills and social behaviors with the goal of integrating these students into an inclusive classroom. The two participants showed little or no progress within the levels system because of a very high rate of inappropriate verbalizations. Therefore, a self-management system that involved training on the accuracy of self-recording these verbalizations was added to the levels system for these students. In addition, the investigator discussed with these students the consequences of inappropriate behavior and socially appropriate behavioral alternatives. A multiple-baseline-across-subjects experimental design revealed that the intervention resulted in a substantive reduction in inappropriate verbalizations, as well as greater progress through the levels system. Implications of these findings for the use of self-recording within a token economy, the importance of students' accuracy of self-recording, and methodological issues are discussed.

Achievement↗
PubMed2005

Modified Sainsbury tool: an initial risk assessment tool for primary care mental health and learning disability services.

Risk assessments by health and social care professionals must encompass risk of suicide, of harm to others, and of neglect. The UK's National Confidential Inquiry into Homicide and Suicide paints a picture of failure to predict suicides and homicides, failure to identify opportunities for prevention and a failure to manage these opportunities. Assessing risk at 'first contact' with the mental health service assumes a special place in this regard. The initial opportunity to be alerted to, and thus to influence, risk, usually falls to the general psychiatric service (as opposed to forensic specialists) or to a joint health and local authority community mental health team. The Mental Health and Learning Disabilities Directorate of Renfrewshire & Inverclyde Primary Care NHS Trust, Scotland, determined to standardize their approach to risk assessment and selected a modified version of the Sainsbury Risk Assessment Tool. A year-long pilot revealed general support for its service-wide introduction but also some misgivings to address, including: (i) rejection of the tool by some medical staff; (ii) concerns about limited training; and (iii) a perceived failure on the part of the management to properly resource its use. The tool has the potential to fit well with the computer-networked needs assessment system used in joint-working with partner local authorities to allocate care resources.

Attitude of Health Personnel↗
PubMed1983

A proposed neuropathological basis for learning disabilities in children born prematurely.

This study aimed at providing understanding of the etiology and mechanisms responsible for the learning and behavioral disabilities in the increasing numbers of survivors of neonatal intensive care units who develop MBD/LD-type (minimal brain dysfunction, learning disabilities) complications. The brains of 16 premature infants who died within the first month of life were studied by microscopic examination. Significant neuropathological findings in gray-matter and white-matter were found in many areas, including both superficial cortical and deep basal brain structures. These lesions are postulated to be precursors to later LD and MBD syndromes in infants who survive, such that similar lesions of varying severity correlate with varying degrees of brain dysfunction. Premature infants who survive are known from other studies to be high-risk candidates for LD- and MBD- type developmental disabilities.

Brain↗
PubMed1996

Relationship between cholinergic dysfunction and discrimination learning disabilities in Wistar rats following chronic cerebral hypoperfusion.

The effects of chronic hypoperfusion of cerebral blood flow (CBF) on central cholinergic indices and intellectual functions were investigated in rats. Male Wistar rats, aged 9 weeks, were anesthetized with pentobarbital, and the bilateral common carotid arteries were permanently ligated. Cortical CBF in the hypoperfused rats was markedly decreased at 6 weeks after the operation. In the hypoperfused group, cholinergic indices were changed to consist two phases after the operation, before (acute) and after (chronic) 6 weeks after the operation. At 6 weeks, choline acetyltransferase activity was restored to the sham-operated level compared with the changes in the frontal cortex and thalamus + midbrain at 3 weeks. On the other band, the maximum number of muscarinic acetylcholine receptors was reduced in the frontal cortex, hippocampus and striatum at 6 weeks and thereafter remained at this low level. In discrimination learning task, the percentage of correct responses in the hypoperfused rats was generally reduced in contrast with that of the sham-operated rats, although the number of total responses were not changed. As a consequence, cholinergic dysfunctions correlate with discrimination learning disabilities in the hypoperfused rats. These findings suggest that the hypoperfused rat may be useful for the cerebrovascular type dementia model to clarify pathophysiology.

Analysis of Variance↗
PubMed1988

Communication breakdowns in normal and language learning-disabled children's conversation and narration.

The frequency and type of communication breakdowns occurring in the speech of 7 language learning-disabled children (LLD), aged 9:10-11:1 (years:months), were examined in two conditions, conversation and narration, and compared to a group of 7 normal peers matched for chronological age and 7 peers matched for mean length of communication unit in conversation. Types of communication breakdowns examined included stalls, repairs, and abandoned utterances. The LLD group incurred a significantly greater rate of communication breakdowns per communication unit in narration than conversation compared to control group differences. Mean length of communication unit was also significantly greater in narration than conversation for the LLD group compared to controls. For all groups, across both speech sample conditions, longer communication units contained more breakdowns than shorter ones. The groups did not differ in the types of breakdowns. Communication unit length and the nature of the narrative task may account for the increased dysfluencies in LLD children's speech.

Child↗
PubMed1989

Comparison of two methods of service delivery for students with learning disabilities.

Both the process and outcome of providing occupational and physical therapy services in the public school system to students with learning disabilities were examined. A therapist-directed group received a combination of large and small group therapy while a consultation group received large group therapy and teacher-led follow-up sessions. Group progress on three standardized tests was compared by analysis of covariance. The result indicated that the consultation group made a greater change in mean standard score on the Bruininks-Oseretsky Test of Motor Proficiency (p <.01). The therapist-directed group made a mean change in standard score of 19.4 on the Test of Visual-Perceptual Skills compared to 7.5 for the consultation group, a difference that was clinically but not statistically significant (p=.07). Both groups made comparable progress on the Test of Visual-Motor Skills. Progress within each group was examined by the proportional change index score for each test subscale and the results were favorable for both groups. Based on student progress, the therapy needs of each group, teacher satisfaction, and utilization of available resources, each method of service delivery was effective for the particular group of students served.

Journal Article↗
PubMedDate not supplied

Risk-taking for clients with learning disabilities.

The following paper examines conditions and influences that precipitate or inhibit risk-taking by nurses working with clients with learning disabilities. Practitioners may experience tensions between facilitating the independence of clients and avoiding negligence. Thus there is an incentive to not allow clients to take many risks. Clients who are denied the dignity of risk lose opportunities to experience ordinary living. More subtly, individuals can also be subjected to services that are relatively benign but also paternalistic.

Adult↗
PubMed2003

Carers' expressed emotion, appraisal of behavioural problems and stress in children attending schools for learning disabilities.

BACKGROUND: Expressed emotion (EE) has been found to be high in families with children suffering from conduct disorder as well as a variety of childhood psychiatric disorders. Expressed emotion has been associated with high levels of stress in carers. However, behavioural problems in children do not automatically lead to stress in carers. Carers' beliefs and behaviour could affect how they appraise and cope with their child's behaviour. Furthermore, the perceived adequacy of social support can also be an important factor in determining the family's level of stress. The study investigates the relationship between EE variables and carers' appraisal and coping with the child's behaviour, stress and social support. METHODS: Forty-seven carers were recruited from schools for moderate to severe learning disabilities. Carers filled in questionnaires and took part in the Camberwell Family Interview for EE status. Carers' EE status was determined by a rater blind to the carers' questionnaires scores. RESULTS: There was no difference between high and low EE groups in the descriptive information of the child's independence, communication skills, or the frequency of behavioural problems. However, high EE carers appraised more of their children's behaviour as definite problems and their available social support to be less adequate. High warmth was found to relate to more positive reappraisal and less escape-avoidance coping. A multiple regression analysis indicated that carers' EE, psychological well-being, appraisal of their children's behaviour, their children's communication skills and respite usage predicted 62% of the variance in their perceived stress scores. CONCLUSION: It is important to consider optimal use of respite care and psychosocial intervention to encourage positive appraisal and problem solving.

Adaptation, Psychological↗
PubMed1992

Academic achievement following childhood brain disease: implications for the concept of learning disabilities.

The present study examined three hypotheses regarding the consequences of early brain damage for academic achievement: First, early brain insults will have a negative impact on achievement, even in children with normal intelligence. Second, underachievement in these children will be at least partially independent of IQ (i.e., not fully accounted for by a lowering of IQ within the average range). Third, normally intelligent children with histories of brain insult will also manifest selective cognitive dysfunctions. To test these hypotheses, we compared two groups of children who had recovered from Haemophilus influenzae type b meningitis. The "complicated" group consisted of children who, as a consequence of having sustained neurologic complications during their illness, were more likely to have had brain insults. Children in the "uncomplicated" group did not have complications with their illness and were regarded as having escaped significant central nervous system (CNS) pathology. Only children with normal hearing and a prorated Full Scale IQ of at least 80 (WISC-R) were considered. Group differences on the Wide Range Achievement Test-Revised were consistent with the first two hypotheses. Although the two groups had similar Verbal IQs, the complicated group also had a lower mean Performance IQ and performed less well on perceptually demanding neuropsychological tasks. Findings suggest that learning disabilities may have selective, brain-related cognitive antecedents; but they challenge the practice of using IQ criteria for clinical diagnosis.

Achievement↗
PubMedDate not supplied

Developmental dyscalculia is a familial learning disability.

Whereas current evidence attests to a genetic component in the etiology of dyslexia and attention-deficit/hyperactivity disorder (ADHD), little is known about the role of genetics in developmental dyscalculia (DC). The objective of this study was to determine the familial aggregation of DC. Siblings and parents of children with DC were assessed for arithmetic, reading and attention disorders. The criteria for DC were an IQ higher than 85, poor performance in arithmetic, and a significant discrepancy between arithmetic achievement and IQ. The study group was composed of 39 children with DC, 21 mothers, 22 fathers, 90 siblings, and 16 second-degree relatives. We found that 66% of mothers, 40% of fathers, 53% of siblings, and 44% of second-degree relatives had DC. The intraclass correlation between the sib pairs was .27. A 95% confidential interval (CI) for the prevalence of DC among siblings of DC probands (see Note 1) ranged from 40% to 64%, indicating a familial prevalence almost tenfold higher than expected for the general population. IQ and attention problems were not risk factors for DC. We conclude that DC, like other learning disabilities, has a significant familial aggregation, suggesting a role for genetics in the evolution of this disorder.

Adolescent↗
PubMed2005

Specificity and characteristics of learning disabilities.

BACKGROUND: The specificity of impairments in specific reading disabilities (SRD) and specific language impairments (SLI) has recently been questioned, with many children recruited for studies of SRD and SLI demonstrating impairments in both reading and oral language development. This has implications for the results of SRD and SLI studies where both reading and oral language skills are not assessed. Thus there is a need to compare the profiles of children with both oral language and reading impairments to groups of children with SRD and SLI. METHODS: The reading, oral language, short-term auditory memory, phonological processing, spelling, and maths abilities of 151 children (aged between 7 and 12 years) drawn from a Learning Disabilities Clinic were assessed. RESULTS: Five groups were identified, including children who demonstrated either a specific reading disability or a specific language impairment and children who showed evidence of both reading and oral language impairments. Differences were found between the groups on maths, phonological processing, short-term auditory memory, and spelling measures, with the children displaying both language and reading deficits generally performing at a lower level than the children with specific reading or language deficits. CONCLUSIONS: It was concluded that more careful screening needs to be conducted in both clinical and research settings to accurately identify the nature of deficits in children with reading and oral language difficulties. Furthermore, a third and separate category of children with a mixed pattern of impairments needs to be considered.

Analysis of Variance↗
PubMedDate not supplied

A comparison of prescribed medication in learning disability patients before and after resettlement from hospital into the community.

The use of prescribed medication was examined in 34 people with learning disability who underwent a planned resettlement from a hospital into the community. No significant differences were found in the number of subjects receiving antipsychotic, antimuscarinic, antidepressant, and anticonvulsant medication, lithium preparations, and non-psychoactive medication, just prior to discharge and 1 year after discharge. This study indicates that long-stay hospitalised adults with moderate, severe or profound mental retardation can successfully be relocated into the community--in spite of suffering from behavioural and major psychiatric disorders--with the aid of appropriate medication, psychiatric follow-up, and community resources.

Adult↗
PubMed2001

General health status measures for people with cognitive impairment: learning disability and acquired brain injury.

BACKGROUND: Currently there is a wide range of health status measures that aim to assess general health status in people with cognitive impairment. However, the validity and/or applicability to this patient group are largely unknown. This has implications for the assessment of treatment outcomes and rehabilitation, for prognostic purposes, for planning services, and for determining the benefits and adverse effects of health technologies targeted at these patient groups. OBJECTIVES: (1) To identify the general health status measures that have been validated in patients with cognitive impairment. (2) To assess the extent to which these measures have been validated. (3) To draw out the implications of the findings for the use of existing measures and for future primary research in this area. METHODS. SELECTION CRITERIA: Studies that assessed general health status in people with cognitive impairment due to acquired brain injury (traumatic brain injury, cerebro-vascular accident or multiple sclerosis (MS)) or learning disability (LD) were included in the review. Studies that used general health status instruments measuring only one general health dimension, and studies that only featured participants with cognitive impairment due to dementia were excluded. METHODS. SEARCH STRATEGY: A wide range of relevant databases were searched for studies on cognitive impairment, general health status measures, and validation of health status measures. A handsearch of general health status bibliographies was also conducted. Data were collected on the general health status measure used, the population characteristics, aims of the study, validity details, and conclusions. RESULTS: The review includes data from 71 studies, reported in 83 separate publications. In total 34 different general health status measures were described in the 83 publications, with the Sickness Impact Profile (SIP) and the Short Form-36 (SF-36) the most frequently used measures (20 and 19 studies, respectively). These studies included a total of 98 instrument validations, 52 of which definitely or probably included people with cognitive impairment. Six measures were extensively validated (quality scores ranged from 0.25 to 0.5, on a scale from 0 to 1) in studies in which more than 50% of the respondents were people with cognitive impairment. A further three measures were also validated in studies in which more than 50% of the respondents were people with cognitive impairment, but their level of validation was more limited (quality scores ranged from 0.1 to 0.2). Five measures were validated in studies in which 20-50% of the respondents were cognitively impaired, which may limit their relevance to participants with cognitive impairment (quality scores ranged from 0.1 to 0.6). The SF-36 was also validated in two studies in which 20-50% of the respondents were cognitively impaired and the quality score was 0.3. Finally, nine of the measures were only validated in studies in which less than 20% of the respondents were cognitively impaired. For these measures it was unclear whether the findings applied to people with cognitive impairment. CONCLUSIONS: Very few measures have been validated specifically for cognitively impaired respondents. Studies where at least 50% of the respondents were cognitively impaired generally showed poorer validity results compared with studies with fewer cognitively impaired persons, indicating that general health status measures designed for the general population are not automatically suitable for people with cognitive impairment. The few measures that were specifically developed for people with cognitive impairment also reported poor validity results. Therefore, there are no validated instruments available for use in cognitively impaired respondents; existing measures, specifically designed for use in these populations, should be used with caution. The most promising measure is the MS-Quality of Life Interview (MS-QLI) for MS patients. The MS-QLI was thoroughly validated in 300 MS patients and the results were good, except for the 'social function' subscale. However, only 20-50% of the respondents in this study had cognitive impairment. Most information on the validity of general health status measures was found in studies among people with LD. For these patients, six measures were found that have been validated in a populations where more than 50% of the respondents were cognitively impaired LD patients. CONCLUSIONS: (1) Existing general health status measures should be used with caution in individuals with cognitive impairments. (2) There is no evidence to indicate the most suitable general health status measure for use in economic evaluations of cognitive impairment. (3) There is little evidence to support the validity of proxy assessments in cognitively impaired populations. (ABSTRACT TRUNCATED)

Brain Injuries↗
PubMed1992

Some issues in the assessment of epilepsy occurring in the context of learning disability in adults.

Epilepsy is a common condition in people with learning difficulties. The assessment of seizure disorders in this group requires special consideration of psychological and social, as well as medical, aspects. We consider an integrated approach assessing epilepsy and learning difficulties in parallel. Such meticulous assessment can lead to improved quality of life with treatment changes, and will avoid unnecessary medical and social costs.

Anticonvulsants↗
PubMed1999

Derivational suffix productivity for students with and without language-learning disabilities.

The effect of productivity (a correlate of suffix frequency) on students' derivational suffix use was investigated with students with and without language-learning disabilities (LLD). Sixty-nine elementary- to middle-school-age students participated in an elicitation task (in which they produced derived forms) and a forced-choice task (in which they selected derived forms) to label nonsense objects and events. In each task, students used highly productive suffixes to convey a given meaning. For example, students used the highly productive suffix er rather than the less productive suffix ant to convey an agentive meaning and used the more productive suffix let instead of the unproductive suffix kin to convey a diminutive meaning. Also, productivity appeared to guide accuracy of suffix use across meanings. For example, the agentive suffix er was produced with much higher accuracy than the less productive diminutive suffix let. In general, patterns of performance within and across meanings were the same for students with and without LLD. LLD students were less accurate in determining the meanings conveyed by derivational suffixes than typically achieving students matched for chronological age. However, their performance was similar to typically achieving students with comparable language skills.

Child↗
PubMedDate not supplied

Learning disabilities. Community homes: institutions in waiting?

This article explores the assumption that community care is better than care in an institution for people with learning disabilities. Parallels are also drawn with community provision of residential and nursing home accommodation for people who are elderly, those who have a physical handicap, and people with a mental illness. While community care is recognised as a valuable option, the authors argue that it must be correctly implemented, and identify the need to move further forward.

Community Mental Health Services↗
PubMed1994

'Alarming but very necessary': working with staff groups around the sexual abuse of adults with learning disabilities.

This study focused on the knowledge of front line staff, as individuals and in groups, in relation to the sexual abuse of adults with learning disabilities and was designed to inform staff training and policy initiatives and to explore gender dynamics. It showed that front line staff were alert to the possibility of sexual abuse but unclear about their roles and responsibilities making this an area of great concern to them. One third knew of people who had been abused but these had been dealt with haphazardly, leaving front line staff holding disproportionate anxiety on behalf of the service as a whole.

Adult↗