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Case: Charles is a 10-year-old African-American male who presents to the Developmental Behavioral Pediatrics Clinic for evaluation of his learning. His primary care provider (PCP) was concerned that his developmental delays were negatively affecting his ability to engage in his homeschooling curriculum and also that his mother seemed unaware of the severity of his delays. Neuropsychological evaluation had been recommended by the PCP several times in the past, but the family declined. At one point, the PCP had considered potential child protective services (CPS) referral for medical neglect because of missed appointments and lack of follow-through on recommendations, which motivated the parent to bring him to this appointment.Medical history was significant for failure to thrive and hypotonia in infancy. Charles received physical therapy through early childhood for hypotonia and motor coordination deficits. His mother removed him from public school and initiated homeschooling in kindergarten after he suffered a dental injury at recess of which she was not notified. The current homeschooling (fourth grade) approach was described as "off and on" activities for 3 hours daily. His mother acknowledged that she struggled to get him to participate as he preferred using the computer and tablet rather than doing school work, and they also argued regularly about his impulsive eating. The patient's mother also described her own medical conditions that contributed to a high degree of stress and fatigue, which she felt made homeschooling more difficult.On examination, the patient was obese and had widely set, almond-shaped eyes; a wide-based gait; an immature pencil grasp; and a mild truncal and appendicular hypotonia. Performance on the Kaufman Brief Intelligence Test, second edition, was below average for the verbal scale (78) and low average for the nonverbal scale (89). On the Wechsler Individualized Achievement Test, third edition, he was unable to perform any multiplication, could not write his own last name (was practicing tracing at home per maternal report), and read at a below first-grade reading level (standardized scores could not be calculated). His conversations with the examiner were mainly limited to the topic of video games. He spoke in short sentences with approximately 85% intelligibility but with coordinated gaze. He appeared mentally exhausted as testing progressed.Feedback to the parent included concern for a learning disability possibly associated with a genetic condition such as Prader-Willi syndrome (because of the history of hypotonia and impulsive eating), and genetic testing was recommended. Because of Charles' difficulty accessing the homeschool curriculum, a special education evaluation through the local public school district was also recommended, but his mother resisted, stating that she felt public special education "keeps children like him down" by focusing primarily on African-American children and stigmatizing their differences.The mother does not return phone calls made 1 month later to follow-up on considering a special education evaluation, and team members raise concern about medical neglect. What would you do next?

The aim of this study was to present the development of an instrument to collect disability information in school settings, based on the International Classification of Functioning, Disability and Health, Children and Youth version (ICF-CY): the ICF-PEI Schedule (ICF-CY-based schedule for Individualized Education Plan). Through an action-research process, a group of 14 teachers participated in the definition of a comprehensive list of ICF-CY categories, which were then used in a pilot test: categories relevant in at least 30% of the cases were retained. Teachers also reported the most relevant difficulties they had in using the ICF-CY questionnaires: these were discussed in plenary. On the basis of a pilot test and teachers' difficulties, a set of structured, easy to use and feasible questions for the school context were developed. A total of 118 ICF-CY categories were included in the preliminary list and 67 were retained. The most relevant difficulties in using ICF-CY questionnaires were as follows: obtaining reliable information on bodily impairments; using capacity in activities and participation; using qualifiers in 'borderline situations'; and identifying systems and policies as barriers or facilitators. The ICF-PEI Schedule is composed of 62 items, with a simplified rating scale. Teachers are asked to rate performance, which is directly observed, and to address which environmental factors impact it; thus, environmental factor rating is simplified. The ICF-PEI Schedule was drafted as a feasible instrument for school settings to collect and exploit functioning and disability data. Teachers can fruitfully employ it to assist in the definition of educational objectives and verify them longitudinally.

Purpose: This series of case reports documents the response of 3 children with developmental coordination disorder to a group intervention program., Summary of Key Points: The 3 children, 9-11 years old, who participated in the 6-week group exercise program, illustrate the heterogeneity of this population. Two group sessions per week and a home program included a core stability program, fitness activities, and task-specific intervention based on child-chosen goals. The effect of the program on motor skills, self-perceived adequacy for physical activity and balance, strength, and core stability activities was examined. Each child improved in 1 or more areas of motor skill, self-efficacy for physical activity, and core stability outcome measures. Possible reasons for the range of outcomes are discussed., Conclusions and Implications for Clinical Practice: Physical activity promotion in this population has the potential to improve the quality of life and reduce health risks associated with sedentary lifestyles.

Purpose: To examine educational and occupational outcomes among survivors of childhood cancer and peers during the transition from adolescence to emerging adulthood., Methods: Families were recruited when children with cancer were 8 to 15 years old and receiving initial treatment for a malignancy that did not primarily affect the central nervous system (CNS). At that time, each child with cancer was matched to a classmate of similar age, gender, and race for inclusion in a comparison group. For the current follow-up (7.29 years postdiagnosis), 56 survivors, 60 peers, and their parents completed questionnaires soon after the youth's 18th birthday. Severity of treatment and late effects were rated by healthcare providers., Results: Survivors and peers were similar on a variety of outcomes, including family background, scholastic and occupational self-concept, and academic competence. However, survivors were more likely to report repeating a grade and having more school absences. The proportion of participants who graduated from high school, were working, and expressed plans to attend postsecondary education or seek employment were similar between groups. Initial treatment intensity, time since diagnosis, and severity of late effects were associated with several indices of educational and occupational attainment., Conclusions: Despite being more likely to repeat a grade and miss school, survivors of nonCNS cancer were similar to peers on most educational and occupational outcomes during the transition from adolescence to emerging adulthood. Interventions to assist academic or occupational functioning may not be necessary for all survivors, but additional research is needed to identify subgroups at risk for difficulties.

Amnesic patients can acquire new semantic knowledge despite a profound deficit of episodic memory. Although retrospective studies have been carried out on adults and children, prospective studies have been restricted to adults. The aim of the present work was to assess the acquisition of new semantic knowledge in amnesic children. The semantic protocol, composed of short, illustrated texts, was based on an original methodology which included an assessment of episodic memory on two occasions. Two amnesic children acquired new concepts despite major episodic disturbance, illustrated notably by a lack of recollection in episodic tasks. Our findings lend weight to the assumption that forming new semantic knowledge does not necessarily involve episodic memory, and provide methodological pointers for children's neuropsychological rehabilitation.

Ten patients with acquired brain injury were recruited over an 18 month period in the south-western health care region of Sweden in order to evaluate the costs and effectiveness of a multidisciplinary community outreach intervention programme. An experienced multidisciplinary project team was involved and patients underwent detailed functional, cognitive and motor assessments following initial contact within two weeks of injury, within six weeks of injury and at a 12-month follow-up. An individualized counselling programme was also offered. Of an expected recruitment number of 50 patients (based on epidemiological and population based figures) 10 children were reached, evaluated and followed; eight patients with traumatic brain injury (five severe, two moderate and one mild), and two patients with non-traumatic brain injury (both severe). At follow-up there was a significant improvement in motor function. No significant changes were seen in other areas of functional assessment or on neuropsychological measures although there were mild improvements in communication and behaviour functions. The financial costs per patient in the programme were deemed relatively modest compared with cost estimates of shorter-term in-patient rehabilitation. Time intensive interventions included supporting caregivers and school staff and the direct and indirect patient interventions were shown to enhance support and promote active involvement of local services.

Section 504 of the Rehabilitation Act of 1973 is an antidiscrimination law that covers those persons with handicaps who are otherwise qualified to participate in and benefit from the programs or activities receiving Federal financial assistance. This article discusses the qualified handicapped applicant, especially individuals who have been identified as learning disabled, who meets the academic and technical standards requisite to admission to a school or college of optometry. The learning characteristics and handicaps that have been associated with this disability are discussed. The "reasonable accommodations" that educational institutions are expected (and not expected) to provide students are explained. Results of a survey of 15 colleges of optometry revealed that there are numerous inconsistencies in compliance with Section 504 involving reasonable accommodations in the classroom, clinic, and testing procedures involving learning disabled professional students. Recommendations to improve required services are proposed.

This paper describes a two year holistic transition programme for persons with a learning disability in Israel and a follow-up of the first cohort of trainees. The programme which was initiated by the National Insurance Institution and 'Nitzan' a parent voluntary organization was developed to provide these persons with the vocational, personal and social skills required for successful independent living and vocational adjustment. The training was carried out in a residential setting and included vocational training, activities of daily living, educational activities and personal adjustment counselling. The results indicated that two years after completing the programme the trainees were generally meeting the expectations of the goals of the project.

Although children with myelomeningocele often display atypical patterns on psychometric testing, this case study demonstrates the sensitivity of neuropsychological instruments to detect altered neurological functioning in a patient with spina bifida. The subject had a history of myelomeningocele at the lumbosacral level and placement of a ventriculoperitoneal shunt. During a routine neuropsychological evaluation, a 44-point discrepancy between his verbal (verbal IQ = 98) and nonverbal abilities (performance IQ = 54) on the Wechsler Intelligence for Children-Revised was found. In comparison to high average academic achievement, test findings suggested depressed memory skills and extreme slowing in psychomotor speed. A pattern of acute decline in overall cognitive functioning was suggested. Magnetic resonance imaging revealed a left frontoparietal brain mass, which was surgically removed. Follow-up neuropsychological testing 9 months postsurgery indicated an increase in nonverbal intelligence with improved psychomotor speed and information processing. This case study illustrates the importance of obtaining baseline evaluations in this neurologically high-risk population as well as the clinical usefulness of psychometric data in diagnostic workups.

This study compared the effect of sensory integration therapy (SI), perceptual-motor training (PM) and no treatment (NT) on the performance of 103 children with learning disabilities and sensory integrative dysfunction, aged 58 to 107 months, who were randomly assigned to one of the two treatment groups or to no treatment. After receiving a total of 72 1-hour sessions of therapy for 3 hours per week, PM-treated subjects showed significant gains over the other two groups, primarily in gross motor performance. SI-treated subjects showed an advantage in motor planning. There were no accompanying group differences in visual perception, handwriting readiness, copying ability, cognitive, academic, language and attentional skills or in self-concept. These findings demonstrate motor gains resulting from motor treatments without carry-over to functional skills and abilities more directly associated with school performance.

This study investigated patterns of neurodevelopmental dysfunction in children with writing disorders (WD). Records of children, ages 9 to 15 years, referred to a school problems clinic were examined. Using teacher questionnaire information, including ratings of writing legibility, mechanics, rate, linguistic sophistication, and spelling, 99 cases of WD were found. Sixty-three children without WD served as clinic controls. A cluster analysis revealed four discrete subtypes of WD and two non-WD control clusters. The four WD clusters were found to have different patterns of writing and reading characteristics. Neurodevelopmental tests discriminated among the clusters (F = 2.8, p less than .0001), and an examination of neurodevelopmental performance characteristics among the clusters showed different patterns of strengths and weaknesses. An empirically derived subtyping of WD is proposed: WD with fine motor and linguistic deficits, WD with visual-spatial deficits, WD with attention and memory deficits, and WD with sequencing deficits. This subtyping, if confirmed in a population study, may have important diagnostic and therapeutic implications.

There is little information available about the provision of supported employment services for individuals from diverse cultural, ethnic and economic backgrounds. To fill this gap, in relation to the specific experiences of urban youth with mental retardation, we initiated an agency based longitudinal study of our employment training programmes. Data from the first year follow up of 45 young adults with mental retardation is presented. Information regarding all phases of the job training and job placement process was examined. The major findings are that 71% of the trainees were employed during the first nine months post-training, with approximately 30% of the trainees working for six months or more. Overall, 75% of the trainees' placements were in service industries and the amount of direct support the trainees required decreased over time. Additional findings and their implications for programme development are discussed in relation to the unique needs of urban young adults with developmental disabilities.

A federally funded three year project to train parents of children with learning and behavior problems is discussed in terms of its ecological impact on parents, their children, their children's teachers, and on the community at large. The design of the project including the home intervention component, the school-based support group component, and the community component is briefly detailed. A comprehensive analysis of data on the effects of the various parent training components on parent, teacher and student perceptions of each other, as well as on student achievement, attendance and self-concept measures are reported. Overall, the data demonstrate the success of the project and support the ecological premise that making changes in one system surrounding a troubled child causes resultant changes in other systems surrounding the child.

The William T. Grant Foundation's Commission on Youth and America's Future was created to review existing research on problems facing young people in America today, and to make policy recommendations based upon the results of that research. The Commission found that fewer economic opportunities are available today, especially to non-college-bound young people, than was the case even a decade ago. This situation has had an adverse effect on the youths themselves, their families, and ultimately, on American society as a whole. Many problem behaviors have their origin in the reduced opportunities which young people face today. The Commission cites a number of programs that show promise to ameliorate behavioral and economic problems of youth, and urges government, business, and other private agencies to join together in implementing and expanding existing programs (such as the Job Training Partnership Program) and in creating new ones (such as the Youth Opportunities Demonstration Act). Society needs to recognize the important role which youth can play as good citizens by providing opportunities for them to give needed services to the community.