Psychophysiological evaluation of the Smartick method in children with reading and mathematical difficulties

Introduction

Assistive technologies for learning are aimed at promoting academic skills, such as reading and mathematics. These technologies mainly embrace mobile and web apps addressed to children with learning difficulties. Nevertheless, most applications lack pedagogical foundation. Additionally, the task of selecting suitable technology for educational purposes becomes challenging. Hence, this protocol posits the psychophysiological assessment of an online method for learning (OML) named Smartick. This platform comprises reading and math activities for learning training. In this protocol, individual monitoring of each child is proposed to determine the progress in learning caused by Smartick.

Methods and analysis

One hundred and twelve children aged between 8 and 12 who present reading or math difficulty after a rigorous psychometric evaluation will be recruited. The study comprises four sessions. In sessions 1 and 2, collective and individual psychometric evaluations will be performed, respectively. Reading and mathematical proficiency will be assessed, as well as attentional levels and intellectual quotient. Subsequently, each child will be semi-randomly assigned to either the experimental or control groups. Afterward, a first EEG will be collected for all children in session 3. Then, experimental groups will use Smartick for 3 months, in addition to their traditional learning method. In contrast, control groups will only continue with their traditional learning method. Finally, session 4 will consist of performing a second psychometric evaluation and another EEG, so that psychophysiological parameters can be encountered that indicate learning improvements due to the OML, regardless of the traditional learning method at hand.

Discussion

Currently, few studies have validated learning improvement due to assistive technologies for learning. However, this proposal presents a psychophysiological evaluation addressed to children with reading or math difficulties who will be trained with an OML.

Weekend Headaches in School-Age Children

Children commonly encounter primary headaches, with various factors playing a role in their onset. The daily routine notably contributes to the occurrence of primary headaches in children. This study aims to profile children experiencing headaches on weekends (WH) in comparison to those primarily having headaches midweek (MWH). Out of 109 children visiting a pediatric headache clinic, 60 prospectively filled out questionnaires regarding their headaches. The average age was 11.8 years, and 63% were of female sex. Most of the children suffered from migraine headaches (60%), while the rest suffered from tension-type headaches (TTH, 15%), mixed headaches (17%), or undetermined headaches (8%). None of the children suffered from a headache only on the weekend. In contrast, 14 (23%) children suffered from a headache exclusively in midweek. Children with learning difficulties were similarly distributed between the WH and the MWH groups (48% and 52%, respectively). Children without learning difficulties suffered significantly more from MWH compared to WH (79% vs. 21%, respectively). In conclusion, children did not suffer from WH alone. Self-reported triggers were not significantly different in WH and MWH patients. Proper profiling of headache types and triggers may lead to more accurate management of these patients.

Development of reading fluency and metacognitive knowledge of reading strategies during reciprocal teaching: do these changes actually contribute to reading comprehension?

The study examined the effect of reciprocal teaching on students' reading comprehension, reading fluency, and metacognitive knowledge of reading strategies, especially among students with learning difficulties. The special focus was to assess how the increase in reading fluency and metacognitive knowledge during the intervention contributes to the reading comprehension outcome. The sample consisted of 301 Grade 3 students, of whom 77 had learning difficulties. Analyzes of (co)variances were used for estimating the effects of reciprocal teaching on the development of reading comprehension, reading fluency, and metacognitive knowledge. Multigroup path analysis was used for testing the effect of increase in reading fluency and metacognitive knowledge on reading comprehension. We found reciprocal teaching had a positive effect on reading comprehension, especially for students with learning difficulties. Reading fluency and metacognitive knowledge improved significantly, but similarly in both the intervention and control groups. However, the increase in metacognitive knowledge only contributed to reading comprehension in the intervention group, not in the control group. The study sheds light on the cognitive and metacognitive mechanisms underlying students' reading comprehension process, emphasizing metacognitive knowledge and especially the systematic practice of reading strategies as key factors in improving reading comprehension.

Severe Pandemic Learning Loss and the Promise of Remotely Delivered Intervention in Students With Comorbid Reading and Mathematics Learning Difficulty

Analyses were conducted with second graders, drawn from an ongoing multi-cohort randomized controlled trial (RCT), who had been identified for RCT entry based on comorbid reading comprehension and word-problem solving difficulty. To estimate pandemic learning loss, we contrasted fall performance for 3 cohorts: fall of 2019 (pre-pandemic; n = 47), 2020 (early pandemic, when performance was affected by the truncated preceding school year; n = 35), and 2021 (later pandemic, when performance was affected by the truncated 2019 to 2020 school year plus the subsequent year's ongoing interruptions; n = 75). Across the 2 years, declines (standard deviations below expected growth) were approximately 3 times larger than those reported for the general population and for students in high-poverty schools. To estimate the promise of structured remote intervention for addressing such learning loss during extended school closures, we contrasted effects in the RCT's 2018 to 2019 cohort (entirely in-person intervention delivery; n = 66) against the same intervention's effects in the 2020 to 2021 cohort (alternating periods of remote and in-person delivery; n = 29). Large intervention effects were not moderated by pandemic status, suggesting potential for structured remote intervention to address student needs during extended school closures.

Do Children Think it is Important to Predict Learning and Behaviour Problems, and Do They Think Genetic Screening Has a Role to Play in This?

This study explores how capable young children are of thinking about a potential future that uses DNA screening to assess an individual's likelihood of experiencing learning or behaviour difficulties. Puppets and a scenario-based approach were used to ask children aged 4-10 (n = 165) whether they thought DNA screening might be helpful or harmful. A content analysis derived six categories: (1) 'Worried about being - and being seen as - different'; (2) 'Beliefs about the origins of learning and behaviour'; (3) 'Testing is harmful'; (4) 'Testing could help'; (5) 'How soon is too soon for testing?'; and (6) 'What's the point?'. Findings indicate young children, as key stakeholders, can make useful contributions to public debate in this important and controversial area.

[Perception of anxiety and learning difficulties according to the criteria of the family and teachers of children with Attention Deficit Hyperactivity Disorder]

Both Attention Deficit Hyperactivity Disorder (ADHD) and anxiety are two of the disorders that are most evident in the infant-juvenile population and there is a correlation between the two, as shown in numerous studies. The combination of both disorders affects the child's teaching-learning processes, causing learning difficulties (LD). The aims of the present study were based on assessing the criteria evidenced by parents and teachers in children with ADHD to characterize the degree of adequacy of perception and to evaluate whether this is in line with reality or insufficient, whether there are differences in this perception between parents and teachers, and to analyze their awareness of the possible AD they may present, in order to provide appropriate guidelines for favourable intervention and evolution. The sample consisted of 137 subjects aged between 9 and 15 years with a Total IQ (TIQ) between 80 and 120. The instruments used were: the Wechsler Intelligence Scale for Children-V (WISCV), the State-Trait Anxiety Questionnaire for Children (STAI-C), the Child and Adolescent Assessment System (SENA) and the Inventory of Problems at School (IPE). As a result, it is observed that the anxiety perceived by these children is not related to the anxiety perceived by parents and teachers, although the latter do coincide in their assessment.

Dimensions of cognition, behaviour, and mental health in struggling learners: A spotlight on girls

Background

Fewer girls than boys are identified as struggling at school for suspected problems in attention, learning and/or memory. The objectives of this study were to: i) identify dimensions of cognition, behaviour and mental health in a unique transdiagnostic sample of struggling learners; ii) test whether these constructs were equivalent for boys and girls, and; iii) compare their performance across the dimensions.

Methods

805 school-aged children, identified by practitioners as experiencing problems in cognition and learning, completed cognitive assessments, and parents/carers rated their behaviour and mental health problems.

Results

Three cognitive [Executive, Speed, Phonological], three behavioural [Cognitive Control, Emotion Regulation, Behaviour Regulation], and two mental health [Internalising, Externalising] dimensions distinguished the sample. Dimensions were structurally comparable between boys and girls, but differences in severity were present: girls had greater impairments on performance-based measures of cognition; boys were rated as having more severe externalising problems.

Conclusions

Gender biases to stereotypically male behaviours are prevalent among practitioners, even when the focus is on identifying cognitive and learning difficulties. This underscores the need to include cognitive and female-representative criteria in diagnostic systems to identify girls whose difficulties could go easily undetected.

Annual Research Review: The transdiagnostic revolution in neurodevelopmental disorders

Practitioners frequently use diagnostic criteria to identify children with neurodevelopmental disorders and to guide intervention decisions. These criteria also provide the organising framework for much of the research focussing on these disorders. Study design, recruitment, analysis and theory are largely built on the assumption that diagnostic criteria reflect an underlying reality. However, there is growing concern that this assumption may not be a valid and that an alternative transdiagnostic approach may better serve our understanding of this large heterogeneous population of young people. This review draws on important developments over the past decade that have set the stage for much-needed breakthroughs in understanding neurodevelopmental disorders. We evaluate contemporary approaches to study design and recruitment, review the use of data-driven methods to characterise cognition, behaviour and neurobiology, and consider what alternative transdiagnostic models could mean for children and families. This review concludes that an overreliance on ill-fitting diagnostic criteria is impeding progress towards identifying the barriers that children encounter, understanding underpinning mechanisms and finding the best route to supporting them.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

Acquisition of Mathematical and Linguistic Skills in Children With Learning Difficulties

Comorbid learning difficulties in linguistic and mathematical skills often emerge in primary school age. The cause of coinciding of both learning difficulties during children's development spanning pre- and primary-school age is not yet well understood. To address this research gap, we used data from the German National Educational Panel Study (NEPS; n = 301) of four groups of children which were categorized according to their skill levels in pre-school age: children with learning difficulties isolated in linguistic skills (LD), children with learning difficulties isolated in mathematical skills (MD), children with learning difficulties combined in linguistic and mathematical skills (MD/LD), and children with typical development in both skills (TA). Computing univariate and repeated measures ANCOVAs we compared the mathematical and linguistic development of the four groups of children (LD, MD, LD/MD, and TA) spanning age four to ten. Results reveal a partial catch-up in linguistic skills (lexical, grammatical) for children with LD. In contrast, children with MD did not overcome their mathematical competence gap in comparison with TA and LD. Moreover, children with MD showed a decrease in grammatical skills during transition in primary school. Further, children with MD/LD displayed the weakest performance in linguistic and mathematical skills during pre- and primary-school age in general. However, after controlling for working memory, initial performance differences between the groups decreased in favor of MD/LD. The relation between linguistic skills and mathematical skills in persisting learning difficulties as well as the specific role of working memory are discussed.

Exploring the predictive properties of the Hayes Ability Screening Index subtest background information in identifying individuals with MBID among in-patients with SUD

INTRODUCTION

For individuals with substance use disorder (SUD), mild to borderline intellectual disability (MBID) goes undetected in treatment clinics. The Hayes Ability Screening Index (HASI) has been found to be a valid, time-saving screening instrument for MBID in SUD treatment. MBID can have significant implications for treatment planning and outcomes. Therefore, it is important to have methods for the early recognition of these comorbid conditions. Because of less sensitivity to recent or ongoing substance use, the HASI subtest background information may be particularly valuable as an early screening of MBID. The main aim was to investigate the convergent, predictive, and discriminant validity of the HASI subtest background information in identifying in-patients with SUD as MBID or non-MBID.

METHODS

Eighty-four in-patients with SUD aged 19-64 participated in this multicentre study. MBID was diagnosed according to the ICD-10 using WAIS-IV, Vineland II, and self-reported childhood learning difficulties.

RESULTS

The main finding was that, among the HASI subtests, background information was the strongest predictor. A HASI background information cut between 6 and 7 showed a sensitivity of 78% and a specificity of 72%.

CONCLUSION

The HASI subtest background information has acceptable convergent, predictive, and discriminant validity as a screening for MBID among in-patients in SUD treatment.

Daily Behaviors, Worries and Emotions in Children and Adolescents with ADHD and Learning Difficulties during the COVID-19 Pandemic

The aim of the present study was to investigate the effects of the coronavirus crisis on behavioral and emotional parameters in children and adolescents with ADHD and Learning Difficulties. A total of 101 children, 5–18 years old, were included in the study, 63 (44 boys) of which were diagnosed with ADHD and learning difficulties (ADHD/LD) and 38 were healthy children (19 boys). The CRISIS questionnaire for parents/caregivers was used. The questionnaire was completed during the first national lockdown in Greece and the data referred to two time-points: 3 months before, and the past 2 weeks. A significant deterioration in the “Emotion/Worries (EW)” symptoms was observed during the pandemic in the control group (2.62 ± 0.16 vs. 2.83 ± 0.18, p < 0.001). No such differences were noted in the ADHD group: 3.08 ± 0.25 vs. 3.12 ± 0.29, p = 0.12. Provision of educational and activities support was related to increased EW before the crisis. In ADHD/LD children, higher parental education and child’s younger age were related to increased symptoms of EW. In the entire group, previous mental health conditions, increasing stress due to restrictions, and increased COVID-related worries were positively associated with the EW symptoms during the crisis. Less affected relations with friends and less reduction in contact with people outside the home were negatively related with EW during the crisis. The study revealed specific parameters that negatively affected the emotional and behavioral variables of children with ADHD and learning difficulties.

Anxiety, Motivation, and Competence in Mathematics and Reading for Children With and Without Learning Difficulties

Knowledge of the relations among learners' socio-emotional characteristics and competencies as they engage in mathematics and reading is limited, especially for children with academic difficulties. This study examined the relations between anxiety, motivation, and competence in mathematics and reading, within and across domains, in an academically-diverse set of 8-13-year-old learners (n = 146). To measure anxiety and motivation across domains, we paired existing measures of math anxiety and reading motivation with researcher-developed analogs for reading anxiety and math motivation. Participants completed standardized assessments of mathematics and reading, anxiety and motivation surveys for math and reading, and a measure of nonverbal cognitive ability. Results showed high internal consistency for all anxiety and motivation scales (Cronbach's alpha = 0.76-0.91). Pearson correlations showed that within and across domains, participants with higher competence had lower anxiety and higher motivation. Higher anxiety was also associated with lower motivation. Regression analyses showed that for both math and reading, within-domain motivation was a stronger predictor of competence than anxiety. There was a unidirectional across-domain relation: socio-emotional characteristics for reading predicted math competence, after accounting for nonverbal cognitive ability, age, gender, and within-domain anxiety and motivation. Results contribute to knowledge of the socio-emotional characteristics of children with and without learning difficulties in association with reading and math activities. Implications of a unidirectional socio-emotional link between the two domains can advance research and theory of the relations among socio-emotional characteristics and competence for academically-diverse learners.

Learning Difficulties and Loneliness in College and Beyond: The Mediating Role of Self-Efficacy, Proactive Coping, and Hope

Following the conservation of resources, social-cognitive and hope theories, the goals of this study were to identify the role of self-efficacy, proactive coping, and hope as mediators in the relations between learning difficulties and loneliness distress. A questionnaire was sent to current and past students. The sample consisted of 498 participants. The results demonstrated that individuals with learning difficulties reported higher levels of loneliness compared with individuals without learning difficulties. Moreover, self-efficacy, proactive coping, and hope mediated the relations between levels of learning difficulties and loneliness. Specifically, the final model emphasized the important role of hopeful beliefs, since hope mediated the relations between learning difficulties, self-efficacy, and proactive coping with loneliness. In terms of practical implications, professionals' awareness as well as psychoeducational programs could be tailor-made to enhance hopeful beliefs and reduce loneliness.

Spatial Cognition in Children With Physical Disability; What Is the Impact of Restricted Independent Exploration?

Given the developmental inter-relationship between motor ability and spatial skills, we investigated the impact of physical disability (PD) on spatial cognition. Fifty-three children with special educational needs including PD were divided into those who were wheelchair users (n = 34) and those with independent locomotion ability (n = 19). This division additionally enabled us to determine the impact of limited independent physical exploration (i.e., required wheelchair use) on spatial competence. We compared the spatial performance of children in these two PD groups to that of typically developing (TD) children who spanned the range of non-verbal ability of the PD groups. Participants completed three spatial tasks; a mental rotation task, a spatial programming task and a desktop virtual reality (VR) navigation task. Levels of impairment of the PD groups were broadly commensurate with their overall level of non-verbal ability. The exception to this was the performance of the PD wheelchair group on the mental rotation task, which was below that expected for their level of non-verbal ability. Group differences in approach to the spatial programming task were evident in that both PD groups showed a different error pattern from the TD group. These findings suggested that for children with both learning difficulties and PD, the unique developmental impact on spatial ability of having physical disabilities, over and above the impact of any learning difficulties, is minimal.

Cognitive Dimensions of Learning in Children With Problems in Attention, Learning, and Memory

A data-driven, transdiagnostic approach was used to identify the cognitive dimensions linked with learning in a mixed group of 805 children aged 5 to 18 years recognised as having problems in attention, learning and memory by a health or education practitioner. Assessments included phonological processing, information processing speed, short-term and working memory, and executive functions, and attainments in word reading, spelling, and maths. Data reduction methods identified three dimensions of phonological processing, processing speed and executive function for the sample as a whole. This model was comparable for children with and without ADHD. The severity of learning difficulties in literacy was linked with phonological processing skills, and in maths with executive control. Associations between cognition and learning were similar across younger and older children and individuals with and without ADHD, although stronger links between learning-related problems and both executive skills and processing speed were observed in children with ADHD. The results establish clear domain-specific cognitive pathways to learning that distinguish individuals in the heterogeneous population of children struggling to learn.

Comparison on Well-Being, Engagement and Perceived School Climate in Secondary School Students with Learning Difficulties and Specific Learning Disorders: An Exploratory Study

Reading and writing skills influence the social status of students, exerting effects not only on learning, but also on wellbeing. This study aimed to assess the impact of diagnosis of specific learning disorder on well-being in secondary-school students, comparing students with a diagnosis of specific learning disorder (SLD-group), students showing learning difficulties without diagnosis (LD-group) and students without learning difficulties (control-group). Students were tested with neuropsychological screening tests in order to identify learning difficulties and were further assessed by means of psychological and school well-being questionnaires. The results show that LD group perceive themselves as having a low sense of mastery and autonomy, less interest and engagement in daily activities and low peer social support than their schoolmates. This result highlights, for the LD group, a low well-being experience, which is not observed in the SLD and control groups. On the contrary, SLD group students do not differ from control group students in any dimensions except for the perceived parents' support and involvement in school life, in which the SLD group show the highest scores. This work underlines the importance of having a diagnosis as it seems to work as a protective factor for both the psychological and school well-being of the student.

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.

How Cognitive Strengths Compensate Weaknesses Related to Specific Learning Difficulties in Fourth-Grade Children

The goal of the present study was to investigate whether children's cognitive strengths can compensate the accompanied weaknesses related to their specific learning difficulties. A Bayesian multigroup mediation SEM analysis in 281 fourth-grade children identified a cognitive compensatory mechanism in children with mathematical learning difficulties (n = 36): Children with weak number sense, but strong rapid naming performed slightly better on mathematics compared to peers with weak rapid naming. In contrast, a compensatory mechanism was not identified for children with a comorbid mathematical and reading difficulty (n = 16). One explanation for the latter finding could relate to the lack of ability to compensate, because of the difficulties these children experience in both academic domains. These findings lead to a new direction in research on learning difficulties in mathematics and/or reading by suggesting that children with a learning disability each have a unique profile of interrelated cognitive strengths and weaknesses. Children might compensate with these strengths for their weaknesses, which could lead to (small) learning gains in the affected domain.

Preschool Children's Social Information Processing Mediates the Link between the Quality of the Parent-Child Relationship and the Child's Learning Difficulties

(1) Background: This study aims to explore children's social information processing (SIP) as an explanatory mechanism in the link between parent-child relationship and children's learning difficulties in kindergarten; (2) Methods: The sample included 115 kindergarteners (62 girls; 53 boys; Mage = 68.5 months, SD = 6.04), their parents and the school teacher. Parents reported on relationship quality with the child and teachers reported on children's learning difficulties and school achievements. Children's SIP was assessed with the social information processing interview-preschool version (3) Results: Mother and father relationship quality with the child associated with children's SIP; however, only the father's but not the mother's quality of relationship with the child was associated with children's learning difficulties and school achievements. Children's SIP mediated this latter link; (4) Conclusions: Parents' relationship quality with the child and children's SIP are pertinent factors in children's learning in the early years. The father-child relationship seems to be a strong determinant of a child's approach to learning and achievement and may have long lasting effects on children's mental health.

Cognitive function of children and adolescent survivors of acute lymphoblastic leukemia: A meta-analysis

Pediatric cancer and its treatment may have an impact on the neurocognitive functions of childhood cancer survivors (CCS). The aim of the present meta-analysis was to compare the intelligence quotient (IQ) scores between CCS of acute lymphoblastic leukemia (ALL) and controls. A comprehensive electronic search identified original research articles that reported scores of the Wechsler Intelligence Scale (WISC; WISC-III, WISC-IV and WISC-R) for children and adolescents, aged 6-16 years at evaluation, survivors of ALL and healthy controls. The included CCS had completed anticancer treatment and were in remission at the time of assessment. A total of 16 studies were included in the meta-analysis, out of 128 extracted studies, and involved a total of 1,676 children and adolescents: 991 CCS (ALL) and 685 healthy controls. Among the studies, a random effects model revealed a moderate estimate of effect size [standardized mean difference (SMD), -0.78; 95% CI, -1.05 to -0.50], indicating that the WISC scores for total IQ were significantly lower in the CCS than in the controls. The mean total IQ range was 85.2-107.2 in the CCS and 88.4-114.1 in the controls. The difference in the mean total IQ between controls and CCS ranged from -13.8 to 20.6. As regards the WISC scores for verbal IQ, 11 studies were included. A random effects model revealed a moderate estimate of effect size (SMD, -0.71; 95% CI, -1.05 to -0.38), indicating that the WISC scores for verbal IQ were significantly lower in the CCS than in the controls. Among the 9 studies that had available data for performance IQ scores, a fixed effect model revealed a moderate estimate of effect size (SMD, -0.80; 95% CI, -1.09 to -0.52), indicating that the WISC scores for performance IQ were significantly lower in the CCS than in the controls. As the survival rates of children and adolescents with ALL are steadily increasing, regular, lifelong follow-up for neurocognitive late effects is imperative in order to improve their education and employment prospects and overall, their quality of life.

Early Detection of Academic Performance During Primary Education Using the Spanish Primary School Aptitude Test (AEI) Battery

The aim of this study was to assess the predictive capacity of some of the most relevant cognitive skills pertaining to the academic field as measured by the Spanish Primary School Aptitude Test Battery. This psychometric tool was applied to all students who were enrolled in the final year of Early Childhood Education (631 students) in the public schools of the province of Alicante (in the South-East of Spain) and a follow-up of their academic progress was carried out when they completed Primary Education (6 school years). The results obtained show that medium-high and high scores in Verbal Aptitude and Numerical Aptitude tests in Early Childhood Education (5 years of age), can predict academic success at the end of Primary Education (12 years of age) in instrumental subjects such as: (1) Language (Verbal Aptitude Odds Ratio = 1.39 and Numerical Aptitude Odds Ratio = 1.39) and (2) Mathematics (Verbal Aptitude Odds Ratio = 1.47 and Numerical Aptitude Odds Ratio = 1.52). We have determined the importance of developing pedagogical programs that stimulate the development of these skills during Early Childhood Education, while implementing support strategies during Primary Education, for those students who present underdeveloped aptitudes in these areas. In this way, school difficulties would be prevented in the instrumental subjects that provide access to other academic areas.

Speaking like a scientist: A multiple case study on sketch and speak intervention to improve expository discourse

PURPOSE

This descriptive multiple case study examined the effects of a contextualized expository strategy intervention on supported and independent note-taking, verbal rehearsal, and reporting skills for three elementary students with language disorders.

METHOD

Two 9-year-old fourth grade students and one 11-year-old sixth grade student with language disorders participated. The intervention was delivered as sixteen individual 20-minute sessions across nine weeks by the school speech-language pathologist. Students learned to take written and pictographic notes from expository texts and use verbal formulation and rehearsal of individual sentences and whole reports in varied learning contexts. To explore both emergent and independent accomplishments, performance was examined in final intervention session presentations and pre/post intervention testing.

RESULTS

Following the intervention, all three students effectively used notes and verbal rehearsal to prepare and present fluent, organized, accurate, confident oral reports to an audience. From pre- to post-test, the students showed a range of improvements in the quality of notes, use of verbal rehearsal, holistic quality of oral and written reporting, and strategy awareness.

CONCLUSIONS

Sketch and Speak shows potential as an expository intervention for students who struggle with academic language learning. The results support further examination of this intervention for supported strategy use by younger students and independent use by older students.

Teaching addition strategies to students with learning difficulties

BACKGROUND & AIMS

In recent years, there has been an increased interest in analyzing the mathematical performance of students with learning difficulties in order to provide them with teaching methods adapted to their needs. In particular, the importance of studying the type of informal strategy that students use when solving problems has been highlighted. Observing how these strategies emerge and develop in children with learning difficulties is crucial, as it allows us to understand how they develop a subsequent understanding of arithmetic operations. In this paper we study the effect of explicit instruction in addition strategies, focusing on the minimum addend strategy, and analyze the difficulties that arise during this process.

METHODS

An adapted multiple-probe design across students with a microgenetic approach was employed to assess the effectiveness of the teaching instruction and the acquisition of the minimum addend strategy while solving addition word problems. The participants were three primary-school children (two boys and one girl) with learning difficulties, one of them diagnosed with autism spectrum disorder. The instruction on the minimum addend strategy was sequenced into levels of abstraction based on the addends represented with and without manipulatives.

RESULTS

The results show that the three participants were able to acquire the minimum addend strategy and transfer it to two-step problems. They all showed difficulties during the instructional process, with quantity comparison difficulties predominating. The instruction provided to address these and other difficulties is detailed for each participant.

CONCLUSIONS

The teaching of the minimum addend strategy has proven effective, and all three students acquired it throughout the instruction. The results concerning the student diagnosed with autism spectrum disorder are especially interesting given the lack of studies that focus on the strategies employed by students with this disorder to solve arithmetic problems. In this sense, the use of the microgenetic approach was especially useful to observe the type of spontaneous strategies used by this participant, and how they varied in response to the instruction.

IMPLICATIONS

Each study participant faced different difficulties and needed different periods of time to assimilate the new strategy. Conclusions are drawn for educators to help children with learning difficulties advance to more sophisticated strategies, so they can acquire these and subsequent mathematical concepts.

Comorbid Learning Difficulties in Reading and Mathematics: The Role of Intelligence and In-Class Attentive Behavior

The goal was to identify the domain-general cognitive abilities and academic attitudes that are common and unique to reading and mathematics learning difficulties that in turn will have implications for intervention development. Across seventh and eighth grade, 315 (155 boys) adolescents (M age = 12.75 years) were administered intelligence, verbal short-term and working memory, and visuospatial memory, attention, and ability measures, along with measures of English and mathematics attitudes and mathematics anxiety. Teachers reported on students' in-class attentive behavior. A combination of Bayesian and multi-level models revealed that intelligence and in-class attentive behavior were common predictors of reading accuracy, reading fluency, and mathematics achievement. Verbal short-term memory was more critical for reading accuracy and fluency, whereas spatial ability and mathematics self-efficacy were more critical for mathematics achievement. The combination of intelligence and in-class attentive behavior discriminated typically achieving students from students with comorbid (D = 2.44) or mathematics (D = 1.59) learning difficulties, whereas intelligence, visuospatial attention, and verbal short-term memory discriminated typically achieving students from students with reading disability (D = 1.08). The combination of in-class attentive behavior, verbal short-term memory, and mathematics self-efficacy discriminated students with mathematics difficulties from their peers with reading difficulties (D = 1.16). Given the consistent importance of in-class attentive behavior, we conducted post hoc follow-up analyses. The results suggested that students with poor in-class attentive behavior were disengaging from academic learning which in turn contributed to their risk of learning difficulties.

The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners

Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.

De novo missense variants in the RAP1B gene identified in two patients with syndromic thrombocytopenia

We present two independent cases of syndromic thrombocytopenia with multiple malformations, microcephaly, learning difficulties, dysmorphism and other features. Exome sequencing identified two novel de novo heterozygous variants in these patients, c.35G>T p.(Gly12Val) and c.178G>C p.(Gly60Arg), in the RAP1B gene (NM_001010942.2). These variants have not been described previously as germline variants, however functional studies in literature strongly suggest a clinical implication of these two activating hot spot positions. We hypothesize that pathogenic missense variants in the RAP1B gene cause congenital syndromic thrombocytopenia with a spectrum of associated malformations and dysmorphism, possibly through a gain of function mechanism.

Learning difficulties and auditory processing deficits in a clinical sample of primary school-aged children

Objective: The current study examined the relationship between learning and auditory processing (AP) ability in a clinical sample of children with and without learning difficulties (LD).Design: A non-randomised, cross-sectional, single measure research design was used.Study sample: The participants consisted of 50 children (7.7-10.8 years) who had been referred for a clinical AP assessment based on having been referred from a school-based AP screening. These children had previously been identified as having (n = 14) or not having (n = 36) LD.Results: Children with LD performed significantly worse than children without LD on frequency patterns with linguistic reports (FP_linR and FP_linL), dichotic digits (DD) and Auditory Word Memory - Forward (ANM_F) tests, with significant correlations being observed between these variables and the learning score. The multiple linear regression showed that FP_linR, DD_R and ANM_F scores explained 50% of the variance in the learning score.Conclusion: The present study's results are most consistent with risk factor models linking AP to learning abilities in children where reduced AP abilities could put children at greater risk for LD. Further investigations into the potential relationships between AP, cognition, speech and language development, and learning ability in children are warranted.

MENTAL HEALTH IN KENYAN SCHOOLS: TEACHERS' PERSPECTIVES

INTRODUCTION

This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them.

METHOD

The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes.

RESULTS

Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems.

CONCLUSION

Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems.

Relationship between executive functions and academic performance among Moroccan middle school students

Executive functions (EF) play a central role in the development of social and cognitive skills and academic learning.

Objective

For this reason, this study aims to determine the relationship between executive functions and academic performance among middle school students in the Middle Atlas of Morocco.

Methods

This study focuses on 137 middle school students studying at four colleges located in the Middle Atlas of Morocco. The sample studied was divided into two groups: the first consisting of students with learning difficulties; and the second considered a control. To assess EF, three tests were administered to learners in both groups (Tracking Test, Stroop Test and Number Span Test).

Results

In the sample, average age of the learners was 14.5±1.3 years and sex ratio was balanced. The students with learning difficulties had lower performance on tests measuring cognitive flexibility, inhibitory processes and working memory compared to the control group.

Conclusion

From these results, it can be concluded that students with learning disabilities performed poorly on the three basic components of executive functions. Therefore, thorough neuropsychological diagnosis would be desirable to identify learners who may have cognitive or behavioural disorders and allow adequate intervention to improve their executive functions and subsequently their academic success.

Transdiagnostic Brain Mapping in Developmental Disorders

Childhood learning difficulties and developmental disorders are common, but progress toward understanding their underlying brain mechanisms has been slow. Structural neuroimaging, cognitive, and learning data were collected from 479 children (299 boys, ranging in age from 62 to 223 months), 337 of whom had been referred to the study on the basis of learning-related cognitive problems. Machine learning identified different cognitive profiles within the sample, and hold-out cross-validation showed that these profiles were significantly associated with children's learning ability. The same machine learning approach was applied to cortical morphology data to identify different brain profiles. Hold-out cross-validation demonstrated that these were significantly associated with children's cognitive profiles. Crucially, these mappings were not one-to-one. The same neural profile could be associated with different cognitive impairments across different children. One possibility is that the organization of some children's brains is less susceptible to local deficits. This was tested by using diffusion-weighted imaging (DWI) to construct whole-brain white-matter connectomes. A simulated attack on each child's connectome revealed that some brain networks were strongly organized around highly connected hubs. Children with these networks had only selective cognitive impairments or no cognitive impairments at all. By contrast, the same attacks had a significantly different impact on some children's networks, because their brain efficiency was less critically dependent on hubs. These children had the most widespread and severe cognitive impairments. On this basis, we propose a new framework in which the nature and mechanisms of brain-to-cognition relationships are moderated by the organizational context of the overall network.

Joint production of research priorities to improve the lives of those with childhood onset conditions that impair learning: the James Lind Alliance Priority Setting Partnership for 'learning difficulties'

OBJECTIVES

To engage children and young people with conditions that impair learning, their parents/carers and the health, education, social work and third sector professionals to identify and prioritise research questions for learning difficulties.

DESIGN

Prospective surveys and consensus meeting guided by methods advocated by the James Lind Alliance.

SETTING

Scotland.

METHODS

The Priority Setting Partnership came together through discussion and collaboration between the University of Edinburgh, Scottish charity The Salvesen Mindroom Centre and partners in the National Health Service, education services and the third sector. A steering group was established. Charity and professional organisations were recruited. Suggested questions were gathered in an open survey and from research recommendations by the National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network Guidance. Suggested questions and recommendations were summarised into 40 indicative research questions. These indicative questions were verified as uncertainties from research evidence. Respondents each nominated up to 10 questions as research priorities in an interim survey. The 25 highest-ranked questions from the interim survey were prioritised at the final priority setting workshop.

PARTICIPANTS

367 people submitted suggestions (29 individuals affected by learning difficulties, 147 parents/carers and 191 professionals). 361 people participated in the interim prioritisation (41 individuals, 125 parents/carers and 195 professionals). 25 took part in the final workshop (5 young people, 6 parents and 14 professionals).

RESULTS

Top three research priorities related to (1) upskilling education professionals, (2) best education and community environment and (3) multidisciplinary practice and working with parents. Top 10 included best early interventions, upskilling health, social and third sector professionals, support for families, identifying early signs and symptoms, effective assessments and strategies against stigma and bullying and to live independent lives.

CONCLUSIONS

Results will now be a resource for researchers and funders to understand and resolve learning difficulties and improve the lives of those affected with childhood onset conditions that result in learning difficulties.

Mild-to-Moderate Gestational Iodine Deficiency Processing Disorder

This synopsis paper aims to identify if a common pattern of learning and social difficulties can be conceptualized across recent longitudinal studies investigating the influence of mild-to-moderate gestational iodine deficiency (GID) on offspring's optimal cognitive and psycho-social development. The main studies investigated are: The Southampton Women's Study (SWS)-United Kingdom; the Avon Longitudinal Study of Parents and Children (ALSPAC)-United Kingdom; the Gestational Iodine Cohort Longitudinal Study-Tasmania, Australia, and the Danish National Birth Cohort Case-Control Study-Denmark. In contrast to severe GID where there is a global negative impact on neurodevelopment, mild-to-moderate intrauterine iodine deficiency has subtler, but nonetheless important, permanent cognitive and psycho-social consequences on the offspring. This paper links the results from each study and maintains that mild-to-moderate GID is associated with a disorder that is characterized by speed of neural transmitting difficulties that are typically associated with working memory capacity difficulties and attention and response inhibition. The authors maintain that this disorder is better identified as Gestational Iodine Deficiency Processing Disorder (GIDPD), rather than, what to date has often been identified as 'suboptimal development'. The Autistic Spectrum Disorder (ASD), Attention Deficit, Hyperactivity Disorder (ADHD), language and literacy disorders (learning disabilities and dyslexia) are the main manifestations associated with GIDPD. GIDPD is identified on IQ measures, but selectively and mainly on verbal reasoning IQ subtests, with individuals with GIDPD still operating within the 'normal' full-scale IQ range. Greater consideration needs to be given by public health professionals, policy makers and educators about the important and preventable consequences of GID. Specifically, more emphasis should be placed on adequate iodine intake in women prior to pregnancy, as well as during pregnancy and when lactating. Secondly, researchers and others need to further extend, refine and clarify whether GIDPD, as a nosological (medical classification) entity, is a valid disorder and concept for consideration.

Anxiety as a Common Biomarker for School Children With Additional Health and Developmental Needs Irrespective of Diagnosis

Currently very little evidence is available regarding the biological characteristics and common comorbid behaviors that are associated with children characterized by learning difficulties who require additional support at school. These children are usually referred to as having Additional Health and Developmental Needs by the Australian Government and the associated public education system more broadly though the problems may arise from academic, social and/or emotional stressors and may or may not include children with clinically diagnosed Neurodevelopmental Disorders. Thus, the aim of this study was to investigate the relationship between anxiety levels (Spence Children's Anxiety Scale- Parent Report), autism traits (Autism Spectrum Quotient - Child Version) and sleep quality (Sleep Disturbance Scale for Children) in children with Additional Health and Developmental Needs without an intellectual disability, but with either a diagnosis of Autism Spectrum Disorder (ASD) (N = 25), Speech and Language Impairment (N = 37) or Other Diagnosis (N = 22). Our results demonstrated that these children with Additional Health and Developmental Needs showed atypically high levels of anxiety and impaired sleep quality, with the ASD group reporting more impairments associated with comorbid anxiety and sleep quality than either of the other clinically diagnosed groups. In fact, greater anxiety level was associated with a greater number of autism traits and poorer sleep quality regardless of diagnostic group suggesting that anxiety is a common experience for children with Additional Health and Developmental Needs. It is suggested that assessment of anxiety, sleep behaviors and autism traits may be useful markers for early identification of children within this population, thus providing scope for early and targeted intervention.

The Social Impact of Musical Engagement for Young Adults With Learning Difficulties: A Qualitative Study

There is evidence that music interventions can offer opportunities for creative, psychological, and social developments for individuals with mild to profound learning disabilities, addressing the disadvantages they face in respect of social outcomes. This paper reports on a qualitative study investigating a community music intervention for such a population. Thirty-seven adult service users (12 female, 25 male) took part in weekly music workshops for 10 weeks. Their learning difficulties ranged from mild to profound, and their levels of independence ranged from requiring constant one-to-one care to living alone in sheltered accommodation. Interviews were conducted at multiple time points with music and resource center staff as well as participants and members of their families and other center users; researchers also observed all workshops, taking field notes. Thematic analysis of the data informed understanding of the disadvantages facing participants, their experience of the workshop program and its immediate and wider social outcomes, as well as suggesting key mechanisms for effects. Disadvantages and barriers facing participants included: limited access to enjoying or learning music; boredom, isolation, and limited networks; lack of experience of new social contexts; and an associated lack of confidence, low mood or self-esteem. Participants were found to enjoy and sustain engagement with a program of dedicated group music workshops delivered by staff trained in an empathic and inclusive approach. Impacts included an ongoing enthusiasm to engage in music; wider recognition of musicality; increased self-confidence; being happier, more relaxed, and/or enthusiastic after the workshops; better ability to interact with unfamiliar situations and people; and participation in social activities for an unprecedented length of time. Key factors in achieving those impacts are that participants: had fun and interacted socially; felt secure, welcomed, and involved at all times; exercised choice; worked with others in nonverbal tasks; and encountered challenge while engaging and progressing at their own rate.

The Role of Learning Difficulties in Adolescents' Academic Emotions and Academic Achievement

The present study examines associations between learning difficulties (LD), academic emotions, and academic achievement among 845 Grade 6 adolescents (455 girls, 390 boys). Reading difficulties (RD) and math difficulties (MD) were identified based on tested reading and math skills in the fall semester of Grade 6. At this time, the students also rated their hope, enjoyment, and anxiety regarding literacy and math. Information on students' achievement in literacy and math, as well as their overall academic achievement, was gathered using questionnaires in both the fall and spring semesters of Grade 6. The results show, first, that students with RD had lower hope and higher anxiety toward reading than those without RD. Also, students with MD reported lower enjoyment, lower hope, and higher anxiety than those without MD. Furthermore, the results show that hope partly played a mediating role between LD and academic achievement in both the literacy and math domains. In addition, enjoyment played a mediating role in the math domain. The present study's results indicate that subject-specific academic emotions should be taken into account when considering relations between LD and academic achievement.

Expanding the clinical phenotype of individuals with a 3-bp in-frame deletion of the NF1 gene (c.2970_2972del): an update of genotype-phenotype correlation

PURPOSE

Neurofibromatosis type 1 (NF1) is characterized by a highly variable clinical presentation, but almost all NF1-affected adults present with cutaneous and/or subcutaneous neurofibromas. Exceptions are individuals heterozygous for the NF1 in-frame deletion, c.2970_2972del (p.Met992del), associated with a mild phenotype without any externally visible tumors.

METHODS

A total of 135 individuals from 103 unrelated families, all carrying the constitutional NF1 p.Met992del pathogenic variant and clinically assessed using the same standardized phenotypic checklist form, were included in this study.

RESULTS

None of the individuals had externally visible plexiform or histopathologically confirmed cutaneous or subcutaneous neurofibromas. We did not identify any complications, such as symptomatic optic pathway gliomas (OPGs) or symptomatic spinal neurofibromas; however, 4.8% of individuals had nonoptic brain tumors, mostly low-grade and asymptomatic, and 38.8% had cognitive impairment/learning disabilities. In an individual with the NF1 constitutional c.2970_2972del and three astrocytomas, we provided proof that all were NF1-associated tumors given loss of heterozygosity at three intragenic NF1 microsatellite markers and c.2970_2972del.

CONCLUSION

We demonstrate that individuals with the NF1 p.Met992del pathogenic variant have a mild NF1 phenotype lacking clinically suspected plexiform, cutaneous, or subcutaneous neurofibromas. However, learning difficulties are clearly part of the phenotypic presentation in these individuals and will require specialized care.

Pre- and In-Service Teachers' Attitudes Toward Students With Learning Difficulties and Challenging Behavior

The implementation of inclusive policies is largely dependent on teachers' willingness to accommodate students with special educational needs (SEN) in mainstream classrooms, which is affected by their perceived competence and attitudes. This study investigated attitudes of pre- and in-service teachers toward students with two types of SEN: challenging behavior and learning difficulties. The three components of attitudes (affective, cognitive, and behavioral) were assessed using indirect and direct measures. Results revealed that teachers held negative implicit attitudes toward challenging behavior and learning difficulties, however, implicit attitudes did not vary as a function of the type of SEN. Ratings of the stereotypical dimensions warmth and competence and overall ratings of scholastic achievement were affected by professional status and type of SEN. Professional status, implicit attitudes, and stereotypical knowledge together explained 52 and 43% of the variance in teachers' ratings of academic proficiency for students with challenging behavior and learning difficulties, respectively. Results are interpreted within the theoretical framework and implications for teacher training are discussed.

Remapping the cognitive and neural profiles of children who struggle at school

Our understanding of learning difficulties largely comes from children with specific diagnoses or individuals selected from community/clinical samples according to strict inclusion criteria. Applying strict exclusionary criteria overemphasizes within group homogeneity and between group differences, and fails to capture comorbidity. Here, we identify cognitive profiles in a large heterogeneous sample of struggling learners, using unsupervised machine learning in the form of an artificial neural network. Children were referred to the Centre for Attention Learning and Memory (CALM) by health and education professionals, irrespective of diagnosis or comorbidity, for problems in attention, memory, language, or poor school progress (n = 530). Children completed a battery of cognitive and learning assessments, underwent a structural MRI scan, and their parents completed behavior questionnaires. Within the network we could identify four groups of children: (a) children with broad cognitive difficulties, and severe reading, spelling and maths problems; (b) children with age-typical cognitive abilities and learning profiles; (c) children with working memory problems; and (d) children with phonological difficulties. Despite their contrasting cognitive profiles, the learning profiles for the latter two groups did not differ: both were around 1 SD below age-expected levels on all learning measures. Importantly a child’s cognitive profile was not predicted by diagnosis or referral reason. We also constructed whole-brain structural connectomes for children from these four groupings (n = 184), alongside an additional group of typically developing children (n = 36), and identified distinct patterns of brain organization for each group. This study represents a novel move toward identifying data-driven neurocognitive dimensions underlying learning-related difficulties in a representative sample of poor learners.

Screening for intellectual disabilities: a validation of the Hayes Ability Screening Index for in-patients with substance use disorder

BACKGROUND

There is a reason to believe that many individuals with substance use disorder (SUD) in contact with services have an undiagnosed intellectual disability (ID). Assessing ID in persons with SUD can be challenging due to the influence of substances, time consumption, and specific requirements for the education of the assessor. On the other hand, an undiagnosed condition may lead to a lack of treatment adjustment and may result in drop-out from treatment or lack of treatment effect. There is a need for a time-saving, valid instrument to detect possible ID among people with SUD.

AIMS

To validate the Hayes Ability Screening Index (HASI) as a screening instrument for identifying ID in a population of in-patients with SUD using all three ICD-10/DSM5 criteria in classifying ID as the validation criterion.

METHODS

Eighty-four SUD in-patients aged 19-64 participated in this multicenter study. An ID was diagnosed according to the ICD-10 using WAIS-IV, Vineland II, and self-reported childhood learning difficulties.

RESULTS

HASI correlated well with both the WAIS-IV and Vineland II. At the recommended cut-off score, the HASI had a sensitivity of 100% and a specificity of 65.4%. A large number of the false positives had IQ or both IQ and adaptive scores in the borderline range.

CONCLUSIONS

The HASI has good convergent, discriminant, and overall construct validity in detecting ID in in-patients with SUD.

Working Memory Updating Training Improves Mathematics Performance in Middle School Students With Learning Difficulties

Working memory (WM) deficit is considered the key cause of learning difficulties (LDs). Studies have shown that WM is plastic and thus can be improved through training. This positive effect is transferable to fluid intelligence and academic performance. This study investigated whether WM updating ability and academic performance in children with LDs could be improved through WM updating training and explored the effects of this training on the children’s brain activity. We used a running memory task lasting approximately 40 min per day for 28 days to train a group of 23 children with LDs (TLDs group). We also selected two control groups of 22 children with LDs (CLDs group) and 20 children without LDs (normal control [NC] group). The behavioral results of a pretest indicated that WM updating ability and academic performance in the TLDs and CLDs groups were significantly lower than those in the NC group before training. Compared with the CLDs group, the TLDs group exhibited significant performance improvement in a 2-back WM task, as well as in mathematical ability. Event-related potentials (ERPs) results suggested that the amplitudes of N160 (representative of visual recognition) and P300 (representative of updating processing, which is a valid index for updating WM) in the TLDs and CLDs groups were markedly lower than those in the NC group before training. In the TLDs group, these two components increased considerably after training, approaching levels similar to those in the NC group. The results of this study suggest that WM updating training can improve WM updating ability in children with LDs and the training effect can transfer to mathematical performance in such children. Furthermore, the participants’ brain activity levels can exhibit positive changes. This article provides experimental evidence that WM updating training could mitigate the symptoms of LDs to a certain degree.

How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review

Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy.

Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains.

Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.

Academic and social concerns of students in higher education

BACKGROUND

Engaging in higher education poses challenges for students facing the multiple demands of work, learning and personal life. Evidence for occupational therapy (OT) practice within learning support centers (LSC) in higher education is lacking.

OBJECTIVES

1) to examine areas of difficulties that students experience based upon age, gender, work and faculty; 2) to validate the Trinity Student Profile (TSP) in Israel.

METHODS

The TSP contains 75 items that result in three factors: person, occupation and environment. It is reliable and valid in the Irish sample. It was translated into Hebrew with permission. Participants in the current study included 150 second-year college students.

RESULTS

A significant difference within the person factor for age was found (p < 0.009). Significant interactions were found for person and occupation factors ranging from (p < 0.045 to 0.009) within different groups, and none for the environmental factor.

CONCLUSIONS

These findings suggest the importance of the person and occupation components of student concerns in the students' experience. Further studies with the TSP and other measures in the field of OT should be conducted in different countries. OT within LSC would benefit from further use of the TSP such an instrument.

Attention Functioning Among Adolescents With Multiple Learning, Attentional, Behavioral, and Emotional Difficulties

Attention-deficit/hyperactivity disorder (ADHD) is characterized by high levels of inattention, hyperactivity, and impulsivity; however, these symptoms can result from a variety of reasons. To obtain a comprehensive understanding of the various difficulties of individuals with ADHD, especially when co-occurrence difficulties are present, it is essential to combine neuropsychological and subjective assessment tools. In the present field study the authors investigated a group of adolescents with multiple deficits (MD) using neuropsychological and subjective measures. Teachers' ratings verified extremely high levels of symptoms of oppositional behavior, inattention, hyperactivity-impulsivity, social problems, and emotional problems in this group. As expected, MD group participants showed decreased abilities to maintain attention on task for a long period of time, focus attention and effectively inhibit adjacent distractors, and resist conflicting irrelevant information. Importantly, although significant differences in the attention measures were observed at the group level, not all MD participants displayed deviant performance. Thus, we conclude that the heterogeneous group of adolescents with MD comprises individuals with primary attention deficits as well as those with other nonattentional deficits that show equivalent behavioral symptoms. Using neuropsychological tools can be useful in differentiating between different core deficits and in guiding appropriate interventions.

Strategic Development for Middle School Students Struggling With Fractions: Assessment and Intervention

Research has suggested that different strategies used when solving fraction problems are highly correlated with students' problem-solving accuracy. This study (a) utilized latent profile modeling to classify students into three different strategic developmental levels in solving fraction comparison problems and (b) accordingly provided differentiated strategic training for students starting from two different strategic developmental levels. In Study 1 we assessed 49 middle school students' performance on fraction comparison problems and categorized students into three clusters of strategic developmental clusters: a cross-multiplication cluster with the highest accuracy, a representation strategy cluster with medium accuracy, and a whole-number strategy cluster with the lowest accuracy. Based on the strategic developmental levels identified in Study 1, in Study 2 we selected three students from the whole-number strategy cluster and another three students from the representation strategy cluster and implemented a differentiated strategic training intervention within a multiple-baseline design. Results showed that both groups of students transitioned from less advanced to more advanced strategies and improved their problem-solving accuracy during the posttest, the maintenance test, and the generalization test.

A model to support nursing students with dyslexia

Dyslexia is one of the most commonly declared disabilities in higher educational institutions in the UK. This article explores the effects of specific learning difficulties, in particular dyslexia, on pre-registration nursing students on practice placements in clinical environments. The author proposes use of the OPEL model, which provides a simple, structured framework for supporting nursing students with specific learning difficulties in practice placements. This model could be applied to clinical situations where constructive support is necessary to enable the student to achieve the standards and requirements set by the Nursing and Midwifery Council.

Therapeutic safe holding with children and young people in hospital

This article demonstrates how a strategy to improve patient safety and the patient experience in hospital health care was implemented in a large tertiary children's hospital. A children and young people's therapeutic safe holding policy and training programme for all clinical nursing staff was developed and introduced. The strategy aimed to define best practice and equip healthcare professionals with the appropriate tools to deliver care safely, effectively and in the best interests of the child or young person.

Executive Functioning Deficits Increase Kindergarten Children's Risk for Reading and Mathematics Difficulties in First Grade

Whether executive functioning deficits result in children experiencing learning difficulties is presently unclear. Yet evidence for these hypothesized causal relations has many implications for early intervention design and delivery. We used a multi-year panel design, multiple criterion and predictor variable measures, extensive statistical control for potential confounds including autoregressive prior histories of both reading and mathematics difficulties, and additional epidemiological methods to preliminarily examine these hypothesized relations. Results from multivariate logistic regression analyses of a nationally representative and longitudinal sample of 18,080 children (i.e., the Early Childhood Longitudinal Study-Kindergarten Cohort of 2011, or ECLS-K: 2011) indicated that working memory and, separately, cognitive flexibility deficits uniquely increased kindergarten children's risk of experiencing reading as well as mathematics difficulties in first grade. The risks associated with working memory deficits were particularly strong. Experimentally-evaluated, multi-component interventions designed to help young children with reading or mathematics difficulties may also need to remediate early deficits in executive function, particularly in working memory.

Choline Kinase Beta-Related Muscular Dystrophy, Appearance of Muscle Involvement on Magnetic Resonance Imaging

BACKGROUND

Clinical presentation with motor delay, proximal weakness, and learning difficulties raise the possibility of a dystrophinopathy, dystroglycanopathy, or myotonic dystrophy. This differential should also include the more recently described choline kinase beta-related muscular dystrophy. This condition is typically characterized by large and abnormally distributed mitochondria on muscle biopsy, which can distinguish this condition from the other muscle conditions in the differential.

METHODS

We present a boy with choline kinase beta mutations with relatively mild clinical manifestations, including proximal weakness, learning difficulties and elevated creatine kinase. Investigations included muscle magnetic resonance imaging (MRI) with T1 axial sequences through thigh and calves, and needle muscle biopsy of the left vastus lateralis muscle.

RESULTS

MRI showed involvement mainly of the quadriceps femoris, sartorius, and adductor magnus, with selective sparing of the gracilis, hamstrings, and adductor longus and brevis. Muscle biopsy revealed chronic dystrophic features. Oxidative stains demonstrated enlarged mitochondria accentuated peripherally or present diffusely in a few fibres giving a coarsely stippled appearance. A homozygous C.722A>G (p.Asn241Ser) mutation was detected in exon 6 of the CHKB gene.

CONCLUSION

This selective pattern of skeletal muscle involvement might be helpful for identifying other patients with this condition, even in the absence of diagnostic muscle pathology.