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Learning and memory impairments are common in individuals with multiple sclerosis (MS) and have pervasive effects on everyday life functioning. Hence, memory and learning have received particular attention in the cognitive rehabilitation literature in MS. The effectiveness of memory rehabilitation on memory performance is supported by several studies, but the generalisability of the benefits to daily life and memory for real-life events has rarely been examined. Recently, a new line of research focusing on memory for personal life events (i.e., autobiographical memory) has emerged in the MS literature. This approach is complementary to classical learning and memory paradigms and also allows for approaching memory in a broader context, one that considers memory as the ability to remember past episodes and imagine events that may occur in one's personal future (i.e. future thinking). This review provides an overview of the findings in this line of work. The first part summarises current evidence regarding the cognitive and neural mechanisms underlying autobiographical memory and future thinking impairments in MS. It points out that these domains are frequently and early impaired in individuals with MS because of an executive/frontal-related deficit. Individuals with MS are generally aware of these deficits and their negative impact on everyday life, so the development of strategies to alleviate such deficits seems of paramount importance. Thus, in the second part, I present the main outcomes of a cognitive intervention developed by our research group, which has been specifically designed to alleviate autobiographical memory and future thinking impairments in individuals with MS. The implications of these findings for neuropsychological care and well-being of individuals with MS are discussed in the final section, with an emphasis on the functional role of autobiographical memory and future thinking in various domains, including personal identity., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Aim: To examine key outcomes in the education of young people with and without neurodisabilities, and to investigate additional disparities in educational achievement in relation to socio-economic background., Method: Data were collected on 2488 Canadian children (age range 10-11y) in 1994 and 1995 from the National Longitudinal Survey of Children and Youth whom were followed for 14 years. We performed separate, discrete-time survival analysis to investigate the effects of having a neurodisability on high school completion, enrolment in post-secondary education (PSE), and PSE completion., Results: The baseline prevalence of neurodisabilities was 12%. Fewer children with neurodisabilities completed high school or enrolled in PSE, compared to children without neurodisabilities, irrespective of parental education. The likelihood that students with neurodisabilities completed PSE differed according to their parents' education: students with neurodisabilities living in less-educated families were about half as likely to complete PSE themselves., Interpretation: Children with neurodisabilities receive less education than children without neurodisabilities. Children from families with low educational attainment appear to be particularly vulnerable., What This Paper Adds: Twelve per cent of children in Canada aged 10 years to 11 years have a neurodisability. High school completion rate was 70% for children with neurodisabilities versus 94% for children without neurodisabilities. Children with neurodisabilities from less-educated families are particularly vulnerable to lower educational achievement., (© 2018 Mac Keith Press.)

Introduction: This randomised controlled trial (RCT) examines treadmill walking exercise training effects on learning and memory performance, hippocampal volume, and hippocampal resting-state functional connectivity in persons with multiple sclerosis (MS) who have objective impairments in learning new information., Methods and Analysis: Forty fully ambulatory persons with MS who demonstrate objective learning and memory impairments will be randomly assigned into either the intervention or active control study conditions. The intervention condition involves supervised, progressive treadmill walking exercise training three times per week for a 3-month period. The active control condition involves supervised, progressive low-intensity resistive exercise that will be delivered at the same frequency as the intervention condition. The primary outcome will involve composite performance on neuropsychological learning and memory tests, and the secondary outcomes involve MRI measures of hippocampal volume and resting-state functional connectivity administered before and after the 3-month study period. Outcomes will be administered by treatment-blinded assessors using alternate test forms to minimise practice effects, and MRI data processing will be performed by blinded data analysts., Ethics and Dissemination: This study has been approved by a university institutional review board. The primary results will be disseminated via peer-reviewed publications and the final data will be made available to third parties in applicable data repositories. If successful, the results from this study will eventually inform subsequent RCTs for developing physical rehabilitation interventions (ie, treadmill walking exercise training) for improving learning and memory and its relationship with hippocampal outcomes in larger samples of cognitively impaired persons with MS. The results from this early-phase RCT will further lay preliminary groundwork for ultimately providing clinicians and patients with guidelines for better using chronic treadmill walking exercise for improving cognition and brain health. This approach is paramount as learning and memory impairment is common, burdensome and poorly managed in MS., Trial Registration Number: NCT03319771; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To report the frequency of binocular vision (BV) anomalies in children with specific learning disorders (SLD) and to assess the efficacy of vision therapy (VT) in children with a non-strabismic binocular vision anomaly (NSBVA)., Methods: The study was carried out at a centre for learning disability (LD). Comprehensive eye examination and binocular vision assessment was carried out for 94 children (mean (SD) age: 15 (2.2) years) diagnosed with specific learning disorder. BV assessment was done for children with best corrected visual acuity of ≥6/9 - N6, cooperative for examination and free from any ocular pathology. For children with a diagnosis of NSBVA (n=46), 24 children were randomized to VT and no intervention was provided to the other 22 children who served as experimental controls. At the end of 10 sessions of vision therapy, BV assessment was performed for both the intervention and non-intervention groups., Results: Binocular vision anomalies were found in 59 children (62.8%) among which 22% (n=13) had strabismic binocular vision anomalies (SBVA) and 78% (n=46) had a NSBVA. Accommodative infacility (AIF) was the commonest of the NSBVA and found in 67%, followed by convergence insufficiency (CI) in 25%. Post-vision therapy, the intervention group showed significant improvement in all the BV parameters (Wilcoxon signed rank test, p<0.05) except negative fusional vergence., Conclusion: Children with specific learning disorders have a high frequency of binocular vision disorders and vision therapy plays a significant role in improving the BV parameters. Children with SLD should be screened for BV anomalies as it could potentially be an added hindrance to the reading difficulty in this special population., (Copyright © 2017 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To assess the health-related quality of life (HRQOL) of children with specific language impairment (SLI)., Study Design: In a prospective sample at a Learning Disabilities Reference Center, proxy-rated HRQOL (KIDSCREEN-27) was assessed for children with SLI and unaffected children from January 1, 2014 to March 31, 2015. Quality of life predictors for children with SLI were evaluated by recording the length and number of speech therapy and psychotherapy sessions and the specific school organization that the children had participated in. The KIDSCREEN scores of the two groups were compared using nonparametric statistics., Results: The questionnaires were completed by the parents of 67 children with SLI and 67 unaffected children. For children with SLI, the mean HRQOL scores were significantly lower for physical and psychological well-being, autonomy and parent relation, social support, and school environment compared to the reference group, controlling for age and parental education (β = -6.7 (-12.7;-.7) P = 0.03, β = -4.9 (-9.5;-.3) P = 0.04, β = -8.4 (-14.2;-2.6) P = 0.005, β = -11.6 (-19.5;-3.7) P = 0.004, β = -7.1(-12.4;-1.7) P = 0.010, respectively). Multivariate analyses in the group of children with SLI found that children who had undergone psychotherapy sessions or who had been enrolled in specific schooling programs had reduced HRQOL scores in social support and school environment and that children who were in a special class had higher scores in physical well-being., Conclusion: Children with SLI had significantly lower HRQOL scores as compared to unaffected children. Measurement of HRQOL could serve as one of the strategies employed throughout the follow-up of these individuals to provide them with the most appropriate and comprehensive care possible., Competing Interests: The authors have declared that no competing interests exist.

Objective: To examine the efficacy of the modified Story Memory Technique (mSMT) to improve learning (ie, acquisition) and memory in participants with TBI. The mSMT is a behavioral intervention that teaches context and imagery to facilitate learning within 10 sessions over 5 weeks., Methods: A total of 69 participants with moderate-severe Traumatic Brain Injury (TBI), 35 in the treatment group and 34 in the placebo control group, completed this double-blind, placebo-controlled randomized clinical trial. A baseline neuropsychological assessment was administered, including questionnaires assessing everyday memory. Repeat assessments were conducted immediately posttreatment and 6 months following treatment. Participants in the treatment group were randomly assigned to a booster session or a non-booster session group after completion of treatment with the mSMT to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time., Results: The treatment group demonstrated significant improvement on a prose memory task relative to the placebo group posttreatment (η(2) = 0.064 medium effect). Similar results were noted on objective measures of everyday memory, specifically prospective memory (Cohen's w = 0.43, medium effect), and family report of disinhibition in daily life (η(2) = 0.046, medium effect)., Conclusion: The mSMT is effective for improving learning and memory in TBI., Classification of Evidence: Based on widely accepted classification systems for treatment study design, this study provides class I evidence that the mSMT behavioral intervention improves both objective memory and everyday memory in persons with TBI over 5 weeks. Thus, this study extends the evidence for efficacy of the treatment protocol to a sample of persons with TBI., (© The Author(s) 2015.)

Aim: The efficacy of two different goal-setting approaches (children's self-identified goals and goals identified by parents) were compared on a goal-directed, task-oriented intervention., Method: In this assessor-blinded parallel randomized trial, 34 children with disabilities (13 males, 21 females; mean age 9y, SD 1y 4mo) were randomized using concealed allocation to one of two 8-week, goal-directed, task-oriented intervention groups with different goal-setting approaches: (1) children's self-identified goals (n=18) using the Perceived Efficacy and Goal-Setting System, or (2) goals identified by parents (n=16) using the Canadian Occupational Performance Measure (COPM). Participants were recruited through eight paediatric rehabilitation centres and randomized between October 2011 and May 2013. The primary outcome measure was the Goal Attainment Scaling and the secondary measure, the COPM performance scale (COPM-P). Data were collected pre- and post-intervention and at the 5-month follow-up., Results: There was no evidence of a difference in mean characteristics at baseline between groups. There was evidence of an increase in mean goal attainment (mean T score) in both groups after intervention (child-goal group: estimated mean difference [EMD] 27.84, 95% CI 22.93-32.76; parent-goal group: EMD 21.42, 95% CI 16.16-26.67). There was no evidence of a difference in the mean T scores post-intervention between the two groups (EMD 6.42, 95% CI -0.80 to 13.65). These results were sustained at the 5-month follow-up., Interpretation: Children's self-identified goals are achievable to the same extent as parent-identified goals and remain stable over time. Thus children can be trusted to identify their own goals for intervention, thereby influencing their involvement in their intervention programmes., (© 2015 Mac Keith Press.)

Aim: Working memory deficits are frequently found in children born preterm and have been linked to learning disabilities, and cognitive and behavioural problems. Our aim was to evaluate if a computerized working memory training program has long-term positive effects on memory, learning, and behaviour in very-low-birthweight (VLBW) children at age 5 to 6 years., Method: This prospective, intervention study included 20 VLBW preschool children in the intervention group and 17 age-matched, non-training VLBW children in the comparison group. The intervention group trained with the Cogmed JM working memory training program daily for 5 weeks (25 training sessions). Extensive neuropsychological assessment and parental questionnaires were performed 4 weeks after intervention and at follow-up 7 months later. For most of the statistical analyses, general linear models were applied., Results: At follow-up, higher scores and increased or equal performance gain were found in the intervention group than the comparison group on memory for faces (p=0.012), narrative memory (p=0.002), and spatial span (p=0.003). No group differences in performance gain were found for attention and behaviour., Interpretation: Computerized working memory training seems to have positive and persisting effects on working memory, and visual and verbal learning, at 7-month follow-up in VLBW preschool children. We speculate that such training is beneficial by improving the ability to learn from the teaching at school and for further cognitive development., (© 2015 Mac Keith Press.)

Specific language and learning disorders concern about 5 %l of the population and explain a significant proportion of educational difficulties and schoolfailure in France. If they are not recognized in time, they can lead to school exclusion if not illiteracy. Reference Centers for specific language and learning disorders were created in the 2000's and improved consis- tently diagnosis and management of such disorders but there remain many difficulties: appointment's delay in these centers, professional training, limited care access in some areas and financial support for specific checkups and cares insufficiently refunded by the Health services, excluding low-income people. Another problem is the lack of care for teenagers and adults after the period covered by Reference Centers. This subject should be a national public health priority to avoid lifelong consequences in social and professional integration. Measures are evoked to improve this situation.

Background: Epilepsy is the most common neurological problem that affects people with learning disabilities. The high seizure frequency, resistance to treatments, associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities. The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life. Our aim is to conduct a randomized controlled feasibility trial exploring key methodological, design and acceptability issues, in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy., Methods/design: We will use a two-arm, single-centre randomized controlled feasibility design, over a 20-month period, across five epilepsy clinics in Hertfordshire, United Kingdom. We will recruit 40 eligible adults with learning disabilities and a confirmed diagnosis of epilepsy and will randomize them to use either the Books Beyond Words booklet plus usual care (intervention group) or to receive routine information and services (control group). We will collect quantitative data about the number of eligible participants, number of recruited participants, demographic data, discontinuation rates, variability of the primary outcome measure (quality of life: Epilepsy and Learning Disabilities Quality of Life scale), seizure severity, seizure control, intervention's patterns of use, use of other epilepsy-related information, resource use and the EQ-5D-5L health questionnaire. We will also gather qualitative data about the feasibility and acceptability of the study procedures and the Books Beyond Words booklet. Ethical approval for this study was granted on 28 April 2014, by the Wales Research Ethics Committee 5. Recruitment began on 1 July 2014., Discussion: The outcomes of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the impact of the Books Beyond Words intervention to improve the management of epilepsy in people with learning disabilities., Trial Registration: http://ISRCTN80067039 (Date of ISRCTN assignation: 23 April 2014).

Dementia is a major cause of morbidity in the western society. Pharmacological therapies to delay the progression of cognitive impairments are modestly successful. Consequently, new therapies are urgently required to improve cognitive deficits associated with dementia. We evaluated the effects of physical and cognitive activity on learning and memory in a rat model of vascular dementia (VasD). Male Sprague-Dawley rats (6 months old) were exposed to either regular chow or a diet rich in saturated fats and sucrose and chronic bilateral common carotid artery occlusion or sham surgery. First, this model of VasD was validated using a 2 × 2 experimental design (surgery × diet) and standard cognitive outcomes. Next, using identical surgical procedures, we exposed animals to a paradigm of cognitive rehabilitation or a sedentary condition. At 16 weeks post surgery, VasD animals demonstrated significant learning and memory deficits in the Morris water maze, independent of diet. Rehabilitation significantly attenuated these cognitive deficits at this time point as well as at 24 weeks. Further, rehabilitation normalized hippocampal CA1 soma size (area and volume) to that of control animals, independent of cell number. Importantly, these findings demonstrate beneficial neuroplasticity in early middle-aged rats that promoted cognitive recovery, an area rarely explored in preclinical studies.

Dyslexia is a specific learning disability characterized by difficulties with accurate and/or fluent word recognition and by poor spelling abilities. The absence of other high level cognitive deficits in the dyslexic population has led some authors to propose that non-strategical processes like implicit learning could be impaired in this population. Most studies have addressed this issue by using sequence learning tasks, but so far the results have not been conclusive. We test this hypothesis by comparing the performance of dyslexic children and good readers in both implicit and explicit versions of the sequence learning task, as well as in another implicit learning task not involving sequential information. The results showed that dyslexic children failed to learn the sequence when they were not informed about its presence (implicit condition). In contrast, they learned without significant differences in relation to the good readers group when they were encouraged to discover the sequence and to use it in order to improve their performance (explicit condition). Moreover, we observed that this implicit learning deficit was not extended to other forms of non-sequential, implicit learning such as contextual cueing. In this case, both groups showed similar implicit learning about the information provided by the visual context. These results help to clarify previous contradictory data, and they are discussed in relation to how the implicit sequence learning deficit could contribute to the understanding of dyslexia.

Deficits in attention and executive control are some of the most common, debilitating and persistent consequences of brain injuries. Understanding neural mechanisms that support clinically significant improvements, when they do occur, may help advance treatment development. Intervening via rehabilitation provides an opportunity to probe such mechanisms. Our objective was to identify neural mechanisms that underlie improvements in attention and executive control with rehabilitation training. We tested the hypothesis that intensive training enhances modulatory control of neural processing of perceptual information in patients with acquired brain injuries. Patients (n=12) participated either in standardized training designed to target goal-directed attention regulation, or a comparison condition (brief education). Training resulted in significant improvements on behavioural measures of attention and executive control. Functional magnetic resonance imaging methods adapted for testing the effects of intervention for patients with varied injury pathology were used to index modulatory control of neural processing. Pattern classification was utilized to decode individual functional magnetic resonance imaging data acquired during a visual selective attention task. Results showed that modulation of neural processing in extrastriate cortex was significantly enhanced by attention regulation training. Neural changes in prefrontal cortex, a candidate mediator for attention regulation, appeared to depend on individual baseline state. These behavioural and neural effects did not occur with the comparison condition. These results suggest that enhanced modulatory control over visual processing and a rebalancing of prefrontal functioning may underlie improvements in attention and executive control.

With the reauthorization of the Individuals with Disabilities Education Act in 2004, Response to Intervention (RTI) was officially introduced. Unlike the discrepancy model, which determines eligibility in special education with a discrepancy between achievement and ability, RTI was designed to provide intensive instruction to students in the general classroom as soon as difficulties in acquiring requisite reading skills are detected. The proposed goals of RTI include the improvement of reading achievement and the identification of students with learning disabilities (LD). Although RTI holds promise for the former goal when certain conditions are met, the latter goal is more elusive. The Component Model of Reading (CMR) is described in the current paper as an alternative to the discrepancy model and RTI. CMR, which consists of three domains, evaluates a poor reader's performance multidimensionally, so the most appropriate instruction for the reader can be designed to ensure reading success. Empirical evidence of CMR is presented.

Response to Intervention (RTI) is being used in districts and states around the United States (U.S.) as a means to enhance learning opportunities and address the needs of struggling learners. Increasing attention to RTI in the research community and the recent creation of a large national technical assistance center reflect its growing visibility. Because equity issues for ethnic and linguistically diverse students are purportedly addressed in RTI models, we conduct a sociocultural analysis of its building blocks, namely the definitions and assumptions embedded in the notions of "response" and "intervention". We used interdisciplinary theoretical and empirical insights about the cultural nature of learning and development to inform our analysis. We discuss how the assumptions of RTI might unintentionally create blind spots for researchers and practitioners about how to design, conduct, and assess learning environments, particularly for diverse students. We conclude with reflections about future directions in this research area.

Response to Intervention (RtI), a cyclical process that incorporates assessment and instruction, is both an approach to prevent learning difficulties and to establish student eligibility for special education. Assessment results are used to determine students' initial knowledge and skill, their need for successively more intensive levels of instruction, and to gauge their response to the intervention provided. Although this process is preferable to the IQ/achievement discrepancy model for determining the presence of specific learning disabilities, there are still a number of unresolved issues related to the assessment procedures in use. A pressing issue is the identification of measures and procedures that identify students with the greatest precision thus reducing inappropriate identification.

The purpose of this study was to examine the effectiveness of second tier intervention at-risk readers within the context of a Response to Intervention approach. The study was conducted in the Canary Islands (Spain), directed by research team ¨Dificultades de Aprendizaje, Psicolingüística y Nuevas Tecnologías¨ (DEA&NT) from University of La Laguna, and supported by the Government of the Canary Islands. A sample of 1.123 Spanish children from fourteen schools districts were given the Spanish adaptation of The Hong Kong Specific Learning Difficulties Behavior Checklist and children who scored at or above the 75th percentile on the test were classified as "at risk" for early reading difficulties. Half of the students were randomly assigned to a project-based intervention condition where they received small group supplementary intervention for 30 minutes daily using the Prevención de las Dificultades Específicas de Aprendizaje (PREDEA) curriculum from mid to late December and continued until mid June. The other half received whatever remedial services were available at their schools. Results indicated that children who received the PREDEA curriculum had higher scores on the Early Grade Reading Assessment Test (EGRA) on initial sound identification, listening comprehension, letter sound knowledge and oral reading fluency compared to the control group.

The main purpose of this study was to analyze the effects of computer-assisted practice on reading and spelling in children with learning disabilities (LD). We compared three practice conditions, one with reading and two with spelling, in order to test whether computer-based reading and spelling practice has an influence on the development of reading and spelling ability in children with LD. A sample was selected of 85 children with LD, with age range between 8 years and 10 years (age, M=111.02, SD=9.6), whose spelling performance was two years below grade level. The participants were randomly assigned to one of four groups: 1) Copy the target word from the computer screen (n=22), 2) Memorize the target word and write it from memory (n=21), 3) Word reading (n=21), and 4) the untrained control group (n=21). We administered measures of pseudoword reading, phonological awareness, phonological word decoding and orthographical word decoding tasks. We examined the learning effects and transfer effects on words classified as a function of length, consistency, and complexity of syllable structure. Overall, the results showed that reading training did not improve spelling; however, the children who participated in the copy training condition improved their spelling skills.

Objective: This study explored the experiences of adults with learning disabilities in the mental health system., Methods: Thirty-seven participants were clients at one of two community-based mental health agencies. Participants completed a standardized tool for assessment of a possible learning difficulty. Nineteen individuals met criteria, and nine participated in semistructured interviews., Results: The quantitative results indicated that participants were challenged by limited education, long-term mental illness, and homelessness. Qualitative themes concerned challenges in the areas of job skills, education, comprehension of paperwork, housing, social skills, comprehension of agency literature, low self-esteem, and accessing services., Conclusions: The findings may help inform social service providers about the service gap between the education and mental health systems. People with co-occurring disorders and learning disabilities represent a segment of the treatment population that may experience limited access to social services without modifications to service delivery.

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.

The effectiveness of a behavioral skills training package that consisted of modeling, rehearsal, and feedback was evaluated to increase correct implementation of guided compliance by caregivers of 3 children who exhibited noncompliance. Results showed that the training package improved performance of guided compliance. Generalization probes indicated that the skills learned were exhibited in different settings 3 to 6 weeks after training ended.

Background: Individuals with chronic stroke demonstrate sleep-dependent off-line motor learning of a continuous tracking task. However, it remains unclear which aspects of learned movements are preferentially enhanced by sleep (ie, spatial accuracy and/or the time lag of tracking)., Objective: . The purpose of this study was to investigate whether spatial tracking accuracy, temporal tracking accuracy, or both are enhanced by sleep during off-line motor learning after stroke., Methods: . Individuals with chronic stroke and control participants either practiced a continuous tracking task in the evening and underwent retention testing the following morning (sleep groups) or practiced the task in the morning and underwent retention testing in the evening (no-sleep groups)., Results: . Individuals with stroke who slept between practice and retention testing demonstrated off-line improvements in both spatial and temporal elements of tracking at retention. Participants with a stroke who stayed awake between practice and retention testing did not demonstrate off-line improvements in either spatial tracking accuracy or the time lag of tracking. Control participants did not demonstrate sleep- or time-dependent enhancement of either component of the movement task. Time of day of testing was not a factor in practice related changes in motor performance., Conclusion: This study provides the first evidence that sleep enhances motor learning through both improved spatial tracking accuracy and anticipation of upcoming movements, as demonstrated by a reduction in the time lag of tracking in individuals following stroke. We propose that the cerebellum and hippocampus are likely important neural correlates associated with sleep-dependent off-line motor skill learning.

Increasingly, commissioners and providers of services for people with intellectual disabilities are turning to assistive technology and telecare as a potential solution to the problem of the increased demand for services, brought about by an expanding population of people with intellectual disabilities in the context of relatively static or diminishing resources. While there are numerous potential benefits of assistive technology and telecare, both for service providers and service users, there are also a number of ethical issues. The aim of this paper is to raise these issues and to set them within the ethical framework proposed by Beauchamp and Childress. There is a need for a wider debate as a first step in the development of strategies to address the issues raised in the paper.

As girls with severe cognitive developmental delay progress into puberty and become young women with learning disabilities, concerns about menstruation are common amongst carers and health care professionals are often consulted for advice. Very little, however, has been published on this area to guide the practitioner and studies are almost exclusively confined to the gynaecological literature. We aim to give an account of the various therapeutic options available and current practice within the paediatric endocrinology unit at our institution.

The aims of this study were to determine the motor outcome of extremely-low-birthweight (ELBW; <1000g) or very preterm (<28wks) children compared with normal birthweight (NBW) children, to establish the perinatal associations of developmental coordination disorder (DCD) and its cognitive and behavioural consequences. Participants were consecutive surviving ELBW or very preterm children and randomly selected NBW(>2499g) children born in the state of Victoria, Australia, in 1991 or 1992. Main outcomes were: (1) results of the Movement Assessment Battery for Children (MABC) at 8 years of age; (2) cognitive function; (3) academic progress; and (4) behaviour. Of 298 consecutive ELBW/very preterm survivors, 255 (85.6%; 117 males, 138 females) had the MABC at a mean age of 8 years 8 months. More ELBW/very preterm children (9.5%) had DCD than the NBW group (2%, p=0.001). Only male sex increased the likelihood of DCD in ELBW/very preterm children (p=0.017). ELBW/very preterm children with DCD had worse cognitive function and academic test scores (up to 1SD below those without DCD); they also had more adaptive behaviour and externalizing problems, but not internalizing problems. DCD is more common in ELBW/very preterm children, has few perinatal correlates, and is associated with poor cognitive and academic performance as well as increased behaviour problems.

The aim of this study was to determine the interrater reliability and stability over time of the Capacity Profile (CAP). The CAP is a standardized method for classifying additional care needs indicated by current impairments in five domains of body functions: physical health, neuromusculoskeletal and movement-related, sensory, mental, and voice and speech, in children from 3 to 18 years of age. The intensity of care in each domain is defined from 0 (no need for additional care) to 5 (needs help with every activity). The intensity of additional care in each of the five separate domains indicates the CAP for the individual child. We developed the CAP to inform the parents and other caregivers of children with non-progressive, permanent neurodevelopmental disabilities, such as cerebral palsy and myelomeningocele, about the consequences of these conditions. To determine interrater agreement and stability over time, the CAPs of 67 children (39 males, 28 females) with a neurodevelopmental disability (mean age 18y [SD 1.2y]; range 14-22y) were assessed based on a semi-structured interview. In addition, the CAPs of the same individuals at the age of 3 years were determined based on a chart review. Interrater agreement of the CAP at the age of 3 was good to very good (weighted kappa 0.64-0.92). Agreement between the CAP at the age of 18 and the CAP at the age of 3 (providing evidence for stability over time) was also good (weighted kappa 0.68-0.77), except for the domain 'physical health functions', about which agreement was relatively poor (0.47). We conclude that the CAP is a reliable instrument for classifying the additional needs of a child with a non-progressive, permanent neurodevelopmental disability. The preliminary evidence for the stability over time of such needs according to the CAP should be validated in a prospective study.

Background: Fetal Alcohol Spectrum Disorders (FASD) affect a significant number of children in this country. This article addresses diagnostic issues related to fetal alcohol syndrome (FAS) and other alcohol-related disabilities, discusses associated features and behaviors of FASD, and introduces interventions to support children with FASD in school settings., Methods: A comprehensive review of FAS and FASD literature as it relates to school functioning was conducted., Results: Prenatal alcohol exposure can result in a broad range of negative developmental consequences, including deficits in cognitive and academic functioning, psychological disorders, behavioral problems, and difficulties with independent living. Children with prenatal alcohol exposure are at risk for a spectrum of difficulties at school., Conclusions: This topic is of considerable relevance to all professionals in a school setting, including teachers, administrators, school psychologists, special education providers, special service providers, and school nurses who interact with children who may be prenatally exposed to alcohol. Successful interventions will need to balance the use of environmental modifications, immediate and meaningful positive and negative consequences for behaviors, and opportunities to teach children skills to monitor and modify their behavior.

Sixty-three school-age children of low socioeconomic status and exposed to adverse environmental factors (malnutrition, familiar distress and low familiar incomes) were submitted to neuropsychological tests to investigate possible cognitive impairments. Classical neuropsychological test battery was employed (Raven test, Bender Gestalt copy of complex figures, draw-a-man Goodenough test). Low intellectual level was found on 30% and 74% showed higher cognitive disorders (visuoperceptual skills and/or perseverations and/or global shapes perception and/or draw-a-man disturbances). These children attended to a school with semi-boarding regimen which receives children under personnel and social adverse factors. School program was enriched with learning activity program based on Piaget and psychomotor exercises based on Lambert for at least one year. They also had some other activities, as painting, singing, computer training, English and Spanish classes. Twenty children were newly accepted and 43 attended at school for one, two or three years. We found significant correlations (p < or =0.05) between superior intellectual performances, bigger periods of attendance at school and methods for cognitive development. There was no association between other brain cognitive functions examined, the attendance to the teaching programs and the years of permanence at school.

Purpose: The aim of this study was to determine the clinical, social, and/or professional and cognitive outcomes in adulthood of the continuous spike-waves during slow sleep (CSWS) and Landau-Kleffner syndromes, which are two rare epileptic syndromes occurring in children., Methods: We enrolled seven young adults, five who had a CSWS syndrome, and two, a Landau-Kleffner syndrome in childhood. We evaluated their intellectual level as well as their oral and written language and executive functions., Results: This study confirmed that the epilepsy associated with these syndromes has a good prognosis. Only one patient still had active epilepsy. However, the neuropsychological disorders particular to each syndrome persisted. Only two patients had followed a normal pathway in school. Three of the five patients with a CSWS syndrome during childhood remained globally and nonselectively mentally deficient. We found no evidence of the persistence of a dysexecutive syndrome in this study group. The intellectual functions of the two patients with Landau-Kleffner syndrome were normal; however, their everyday lives were disrupted by severe, disabling language disturbances. We discuss the role of some prognostic factors such as the location of the interictal electric focus and the age at onset of CSWS., Conclusions: These two epileptic syndromes of childhood are very similar in many respects, but their clinical outcomes in adulthood are different.

Purpose: To investigate relevant adults' perceptions of behavioral problems in 66 children with newly diagnosed "epilepsy only" and in 63 healthy gender-matched classmates., Methods: Parents' and teachers' perceptions of the children's behavioral problems were quantified by using the Total Problem score of the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF), after correction for epilepsy-related item ambiguity. Questionnaires were filled out immediately after diagnosis and 3 and 12 months later. Relations with demographic and educational variables, school attitudes, and interview-derived prior adversities were analyzed., Results: As a group, children with cryptogenic rather than those with idiopathic epilepsy have more behavioral problems than do healthy classmates. Family troubles and long-standing behavioral and learning problems are associated with more behavioral problems. The child's adaptation to the adversity of epilepsy onset is important. No adverse effect of antiepileptic drug (AED) treatment was found. Although the percentages of patients with clinically relevant (mean of controls + 2 SD) behavioral problems are consistently 25% (parents) and 22% (teachers), at each assessment, different children contribute to these percentages. In not a single child did parents and teachers agree on the presence of clinically relevant behavioral problems., Conclusions: (a) Behavioral problems are common in "epilepsy only," but are not persistent. (b) Agreement between parent's and teacher's perceptions of behavior is low. (c) Behavioral problems are perceived to occur already in the earliest stage of the disease.

Background and Purpose: As the survival rate of infants who are born prematurely increases, the need for accuracy in early identification and prediction of developmental outcome in these infants is imperative. This study examined the predictive validity of the Test of Infant Motor Performance (TIMP) and the relationship between perinatal risk and motor performance in children who are of school age., Subjects and Methods: A stratified, random sample of 35 children was selected from subjects who had been examined using the TIMP and the Problem-Oriented Perinatal Risk Assessment System (POPRAS). The subjects were between 32 weeks gestational age and 4 months postterm (mean age=10 days postterm). The stratification was based on age at the time of TIMP administration (AGE) and on POPRAS scores. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered to the children at a mean age of 5.75 years. Predictive values were calculated and correlation and regression analyses were conducted to examine the relationship between the TIMP and POPRAS scores and the BOTMP score., Results: Using the receiver operating characteristic curve and a cutoff z score of -1.6, the TIMP's sensitivity, specificity, and positive and negative predictive values were.50, 1.00, 1.00, and.87, respectively. The correlation between TIMP and BOTMP scores, with AGE controlled, was.36, and the correlation between POPRAS and BOTMP scores was -.55. Thirty-seven percent of BOTMP variance was accounted for collectively by POPRAS scores, TIMP scores, and AGE., Discussion and Conclusion: The TIMP and POPRAS may be viable instruments that can be used together to identify infants who are at risk for poor long-term motor performance.

This article presents evidence of the importance of multidisciplinary assessment of students with learning disabilities. Multidisciplinary collaboration between different professions provides a more complete picture of each person's unique requirements, thereby facilitating more appropriate teaching. A critical attitude toward diagnosing students with learning disabilities may result in exaggeration of psychosocial problems, thereby running the risk that genuine learning disabilities, neurological problems or other disorders are being overlooked.

This paper describes an itinerant medical evaluation (IME) project and reports on the outcome of 108 consecutive referrals made in the first year. Subjects were of ages 5 to 17 years. Most students had been evaluated by the schools but were not receiving special education or related services. IME led to clinical diagnosis of ADHD in 70% of the sample, and specific learning disabilities were diagnosed in 26%. Several other clinically significant and educationally relevant diagnoses were made. As a result of the IME, many students were placed in special education and/or began to receive related services. At three-month follow-up, classroom accommodations were being made for 97% of the students. Teachers reported they felt more capable of teaching challenging students as a result of the IME. Significant improvements occurred in hyperactivity, conduct problems, and inattention, and grades improved in 31% of the sample. Reasons for the project's success are discussed.

Multiple baseline designs were used to examine the effects of an instructional package on accuracy of performance in solving multiplication facts by 3 students with learning disabilities. The instructional package included the following components: (a) a modified instructional sequence in which multiplication facts were grouped into the zeros, ones, doubles, fives, and nines categories, and those remaining; (b) identification of the category in which each fact belonged; (c) mnemonic strategies associated with solving facts in each category; and (d) steps to be completed for solving facts in each category. Results indicated that the instructional package produced substantial and immediate effects. After receiving instruction, a participant's accuracy was often 100%, and this was maintained throughout the evaluation even as other strategies were introduced. Comparable results occurred across students, demonstrating replication of the effects of the instructional package.

This study compared the effects of immediate self-correction, delayed self-correction, and no correction on the acquisition and maintenance of multiplication facts by a fourth-grade student with learning disabilities. Data from daily and maintenance tests indicated that both correct response rate and accuracy were higher when self-correction was immediate rather than delayed or absent.

People with learning disabilities often have seizures in addition to other disorders. Precise diagnosis may be difficult, but accuracy can be improved using electroencephalographic and video investigations. Following the establishment of a diagnosis of epilepsy, individually tailored care is necessary taking into account other health, behavioural and therapeutic issues. Neuroimaging may indicate a need for surgery which should not be automatically excluded as a treatment option. Rational antiepileptic drug use is advised, with emphasis upon the newer agents due to their better tolerance and ease of use. A programme of regular review will prevent over-medicating. Drug therapy may be withdrawn in a seizure-free patient. Realistic goals should be established for each individual coupled with an optimistic approach to care. However, future developments require a solid evidence base combined with rationality in all aspects of management. The community learning disability epilepsy nurse specialist is the key health-care professional who can ensure that a learning disabled individual with epilepsy is able to take full advantage of all available services. Education, closer collaboration and the mutual recognition of skills will ensure more cohesive and comprehensive care for this disadvantaged patient population.