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Lay Abstract: Finding a job can be hard for autistic adults. No studies have been completed that look into whether having difficulties learning and troubles finding a job are related in this population. The current study did so by evaluating the Learning Needs Screening Tool, a measure of learning challenges used in vocational rehabilitation settings, or places meant to help people find work. A total of 401 autistic adults completed this study online. Specifically, the study evaluated (a) the characteristics of the Learning Needs Screening Tool, including the relationships between questions that ask about similar learning challenges, and (b) the ability of the measure to relate to real-world outcomes that are associated with learning difficulties, namely prior special education receipt and difficulties finding a job. Evaluation of the questions asked on the Learning Needs Screening Tool revealed that they were highly related and that learning difficulties fell into different categories. Fifty-six percent of the people in the study showed learning challenges on the measure. People who were identified as having learning difficulties on the Learning Needs Screening Tool had higher rates of receiving special education services in the past and lower rates of current employment. These results suggest that the Learning Needs Screening Tool may help to identify autistic job seekers who have learning difficulties and may have more challenges finding a job., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The aim of this study was to investigate the effects of brain-based instruction on executive function and habits of mind among young children at-risk for learning disabilities., Method: This study employed a quantitative approach using a quasi-experimental, pretest, post-test, and follow-up design. Analysis of covariance (ANCOVA), repeated-measures, pre-, post-, and follow-up testing design was used. Total number of participants were 40 children: treatment group ( n  = 20, 8 males, 12 females) and control group ( n  = 20, 9 males, 11 females). Accordingly, 40 students were chosen from four kindergartens in Qassim, Saudi Arabia. The sampling methodology employed used convenience sampling., Results: The results found that using brain-based instruction to improve functions and habits of mind indicate the effectiveness of this method for children at-risk with learning disabilities., Conclusions: Using multisensory instructional techniques to actively engage students presents a channel for magnifying student learning experiences. Brain-based learning is a constructivism teaching method where in the brain constructing learning process finds and structures knowledge by means of association with previous experiences and knowledge.

Background: In recent years, the exploration of innovative interventions for addressing problems of children and adolescents with specific learning disabilities (SLD) has garnered significant attention within the realm of neurocognitive research. Transcranial electrical stimulation (TES) has emerged as a promising tool for enhancing cognitive skills in children, offering a non-invasive and safe method that may particularly benefit those with learning difficulties. We aimed to appraise the extent and the quality of studies about impact of TES on cognitive skills including academic skills in children and adolescents with SLD., Methods: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published between January 2000 and January 2024 were searched in PubMed, Embase, Scopus, Web of Science and Google Scholar. The study eligibility criteria were previously established according to the PICO model. The Physiotherapy Evidence Database (PEDro) scale and Cochrane Collaboration tool (ROB2) were used to assess the methodological quality and the risk of bias of the included studies, respectively., Results: The initial search yielded 1571 studies among which 30 studies were systematically reviewed. The total number of participants was 224 individuals (intervention: 114; control: 110). Findings showed significant improvements in reading skills such as text reading, high-frequency word reading speed and efficiency and mathematical skills. Conversely, other cognitive skills such as working memory were not improved in people with dyslexia and dyscalculia., Discussion: TES interventions can positively affect cognitive skills in children and adolescents with SLD; However, due to the small number of studies, medium methodological quality and high risk of bias, caution should be taken when interpreting the results., (© 2024 John Wiley & Sons Ltd.)

Despite decades of research efforts, data-based instruction (DBI) for students with intensive intervention needs are not being widely used in practice as anticipated, and many educators have difficulties in implementing it. This systematic review aimed to examine what kinds of implementation drivers and strategies have been used to support educators implementing DBI and what kinds of implementation outcomes researchers have measured. Eighteen studies were synthesized using the Implementation Drivers framework and Implementation Outcomes taxonomy and were quality appraised. We found that the majority of studies primarily used competency drivers to increase teachers' DBI expertise, while a limited number of studies focused on organizational and leadership drivers. Acceptability and fidelity were frequently assessed as implementation outcomes. We discussed the implications of the findings, including the need for researchers to incorporate implementation drivers and outcomes at diverse levels to best support educators' implementation of DBI, as well as the limitations of this review, such as the limited generalizability of the findings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Parents raising children with Learning Disabilities (LDs) often face multiple challenges and high levels of parenting stress, especially in societies with intense academic competitions. Mindful parenting (MP) is an emerging approach that brings mindful awareness to parent-child interactions and is found effective in reducing parenting stress in various parent populations., Aims: This study examined the effectivenesss of an 8-week online MP program on Chinese parents of children with LDs., Methods and Procedures: A MP program was adapted and implemented in an online format with 69 parents of children with LDs. A randomized controlled trial design was used to examine the efficacy of the mindful parenting group compared with a wait-list control group. Parenting stress, mindful parenting and self-compassion were assessed pre- and post-intervention., Outcomes and Results: Compared with the wait-list control group, the MP group participants showed decreased parenting stress (d = 0.62, p < 0.05), improved mindful parenting (d = 0.63, p < 0.05), and increased self-compassion (d = 0.61, p < 0.05)., Conclusions and Implications: These findings support the effectiveness of an online MP intervention in reducing parenting stress and increasing mindful parenting and self-compassion among Chinese parents of children with LDs. The behavioral and intrapersonal aspects of MP are more amenable to improvement, whereas the attitudinal and interpersonal aspects, particularly non-judgmental acceptance and compassion towards the child, are resistant to change. Future studies should explore strategies to enhance these attitudinal aspects and interpersonal processes of MP., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Although children with language-based learning disabilities (LLD) demonstrate significant difficulties with writing, empirical evidence to support interventions is sparse. Therefore, the purpose of this pilot study was to examine the feasibility and promise of a writing intervention for fourth- and fifth-grade students with LLD (WILLD: writing in students with LLD). The intervention components included word-, sentence-, and discourse-level writing processes and instructional practices using self-regulation strategies., Method: Participants for this study were 15 students with LLD, recruited from three different schools. Students' writing was assessed using a sentence probe task and obtaining an informative paragraph writing sample as a measure of proximal writing outcomes. Trained speech-language pathologists (SLPs) and special educators delivered the intervention in a small-group format over 12 weeks. Using a within-group pre-post design, we examined changes in writing outcomes before and after the intervention., Results: Results indicated that the intervention helped students improve their informative writing skills; students' writing quality showed a statistically significant increase, and grammatical errors showed a significant decrease., Conclusions: Evidence from this pilot effort indicates that WILLD was feasible and appears to show promise for improving writing outcomes for fourth- and fifth-grade students with LLD when delivered by SLPs and special educators in a small-group format. Implications of the results and directions for future research are discussed., Supplemental Material: https://doi.org/10.23641/asha.26053132.

Background: Physically active learning (PAL) is a potentially valuable method to stimulate academic performance and physical activity (PA) in children with learning disorders (LD) attending special-needs schools. It is yet unknown whether PAL can be successfully implemented in special-needs schools., Aims: This study aimed to evaluate a PAL-program in special-needs schools by examining teacher's dose delivered, children's dose received, and associations of children's characteristics with dose received., Methods: Children (N = 37) from two special-needs schools participated in a six-week PAL-program. Dose delivered was evaluated based on PAL-lessons' implementation rate and duration. Dose received was assessed through time-on-task observations (n = 23) and PA (n = 37). To assess the association between dose received and children's characteristics (sex, behavioral disorders, motor skills, and physical fitness), Mann-Whitney U tests and Spearman's rho correlations were used., Results: For teacher's dose delivered, the implementation rate exceeded 95%, and the PAL-lessons lasted the intended 12 minutes. For dose received, children's on-task behavior was above 79%, and children spent 43% of the time in moderate-to-vigorous PA during PAL. Motor skills were positively related to on-task behavior related to the movements, and physical fitness was positively related to moderate-to-vigorous PA., Conclusions: PAL was successfully implemented in terms of dose delivered and dose received for children with LD attending special-needs schools., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: During the COVID-19 pandemic, France faced a 2-month lockdown in 2020, marked by numerous restrictions. This study aimed to examine the experience and management of children aged 6-17 years with learning and/or attention disorders during the first lockdown., Methods: We conducted an observational, retrospective study, with data collection from March 1 to May 31, 2021, by means of an anonymous digital qualitative questionnaire completed by parents. The experience of confinement as well as the children's behavior, schooling, and level of progress during rehabilitation were assessed by parents through a Likert scale. Data were compared according to two groups: negative experience and positive or neutral experience of the child's confinement., Results: A total of 251 questionnaires were collected and 217 were analyzed. Overall, 47 children (21.7 %) reported a negative experience of the confinement period. In total, 164 (75.6 %) of the children had their schooling monitored throughout the period; half of the parents reported a course format unsuited to their child's disorders and a lack of motivation, and 46.5 % a refusal by their child to study. Only 16.8 % of parents reported a regression in their child's rehabilitation. These last three results were significantly associated with a poor experience of confinement (p < 0.05)., Conclusion: The period of confinement was experienced relatively well by the children, and the rehabilitative management seemed to have been minimally impacted during this period. The therapeutic education of children, their parents, and also teachers is a major axis of improvement for better care and support of children with these disorders., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Masson SAS.)

The studyMcCarthy M, Bates C, Elson N, Hunt S, Milne-Skillman, Forrester-Jones R. 'Love makes me feel good inside and my heart is fixed': What adults with intellectual disabilities have to say about love and relationships. J Appl Res Intellect Disabil 2021;00:1-11.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/romantic-relationships-adults-with-learning-disabilities/., Competing Interests: Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests is here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests, (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Learning disabilities are due to genetic and/or neurobiological factors that alter brain functioning by affecting one or more cognitive processes related to learning. This study aimed to assess the efficacy of cognitive telerehabilitation in adolescents with learning disabilities to overcome the treatment problems related to the COVID-19 pandemic lockdown., Methods: Twenty-four patients diagnosed with Unspecified Learning Disability (mean ± SD age: 18.2 ± 2.9 years; 50% male) were enrolled in this study. The patients were assessed by a neuropsychological evaluation at the beginning and at the end of the program. All patients received cognitive treatment via a specific telehealth app to stimulate the cognitive skills related to learning. The treatment lasted four weeks, with a daily training (lasting up to 60 min), for five days a week., Results: Our young patients reported a statistically significant improvement in the main cognitive domains that are usually compromised in learning disabilities, including sustained and selective attention, shifting of attention, control of interference, memory and speed of information processing. Moreover, the patients showed a good usability and motivation during the training., Conclusions: Our study has shown that telerehabilitation could be a valid tool for the rehabilitation of specific cognitive skills in adolescents with learning difficulties., (Copyright © 2021 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: Assistive technology has been used to mitigate reading disabilities for almost three decades, and tablets with text-to-speech and speech-to-text apps have been introduced in recent years to scaffold reading and writing. Few scientifically rigorous studies, however, have investigated the benefits of this technology., Purpose: The aim was to explore the effects of assistive technology for students with severe reading disabilities., Method: This study included 149 participants. The intervention group received 24 sessions of assistive technology training, and the control group received treatment as usual., Results: Both the intervention and control groups improved as much in 1 year as the normed population did. However, gains did not differ between the groups directly after the intervention or at 1 year of follow-up., Conclusions: The use of assistive technology seems to have transfer effects on reading ability and to be supportive, especially for students with the most severe difficulties. In addition, it increases motivation for overall schoolwork. Our experience also highlights the obstacles involved in measuring the ability to assimilate and communicate text.Implications for rehabilitationsAssistive technology (AT) can be useful for children with reading disabilities to assimilating text as well as boosting their reading.Children with reading disability using AT increased reading performance as much as a norm group, i.e. the students enhanced their reading ability despite no training in traditional reading remediation.Children's and adolescents' motivation for schoolwork can be boosted when using AT as a complement for those with reading and writing disabilities.

Background: While COVID-19 outbreak has had adverse psychological effects in children with special needs, the mental state and burden on their caregivers during this pandemic has yet to be reported., Aims: The objectives of this study were to describe the mental health status and the change in perceived strain among caregivers during the COVID-19 outbreak., Methods and Procedures: Two hundred sixty four caregivers completed an online survey that assessed demographics, use and perspective on tele-rehabilitation, homecare therapy, caregiver's strain and mental health., Outcomes and Results: The prevalence of depression, anxiety and stress symptoms were found to be 62.5 %, 20.5 % and 36.4 % respectively. A significant difference in caregiver strain (p <  0.001, effect size = 0.93) was observed during the outbreak compared to levels pre-outbreak (pre-outbreak strain was measured retrospectively). Caregivers not using tele-rehabilitation along with a perception of it being a poor medium for rehabilitation were at greater risks for poor mental health whereas a negative perception on homecare therapy were strongly associated with higher psychological symptoms and strain., Conclusions and Implications: This study identified a high prevalence of depression and significant change in strain displayed by caregivers during the COVID-19 outbreak. We identified several factors associated with poor mental health and perceived strain that can be used to help safeguard caregivers., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Response to intervention (RTI) has been promoted for nearly 20 years as a valid supplement to or alternative method of learning disability (LD) identification. Nevertheless, important unresolved questions remain about its role in disability identification. We had two purposes when conducting this study of 229 economically and racially diverse poor readers in Grades 4 and 5 in 28 public elementary and middle schools in Nashville. First, we examined predictors of the children's response to a reading comprehension tutoring program. Second, we explored the utility of different methods (growth vs final status) and measures (near- and mid-transfer vs far-transfer) in operationalizing "response," and whether these contrasting methods and measures identified similar children. Findings indicated students with higher pretreatment scores on expressive vocabulary, nonverbal IQ, teacher ratings of attention, and reading comprehension measures were more likely classified as responsive with final status methods. Students with lower pretreatment comprehension scores were more likely identified as responsive with growth methods. These and other findings suggest "response" is strongly context dependent, raising questions about the validity of RTI as a means of disability identification.

Response to intervention (RTI) has evolved from its first decade of implementation. Because states guide and regulate policy and practice at the state and local education agency levels, it is important to understand their critical role in RTI implementation. A systematic review of all 50 state education agency websites was conducted to provide an updated "snapshot" of states' interpretation of RTI a decade after IDEA regulations were finalized. Findings revealed substantive progress towards developing approaches to systematic supports to students, with a major trend in adoption of multi-tiered system of support (MTSS) models. Findings also documented continued variation in how states are communicating about tiered systems on such matters as the roles of tiered systems in schoolwide prevention frameworks, meeting special education requirements, and aligning multiple systems within schools. Implications for special education services for students with learning disabilities are discussed.

Purpose This systematic review synthesized a set of peer-reviewed studies published between 1985 and 2019 and addressed the effectiveness of existing narrative and expository discourse interventions for late elementary- and middle school-aged students with language-related learning disabilities. Method A methodical search of the literature for interventions targeting expository or narrative discourse structure for students aged 9-14 years with group experimental designs identified 33 studies, seven of which met specific criteria to be included in this review. Results An 8-point critical appraisal scale was applied to analyze the quality of the study design, and effect sizes were calculated for six of the seven studies; equivocal to small effects of far-transfer outcomes (i.e., generalizability to other settings) and equivocal to moderate near-transfer outcomes (i.e., within the treatment setting) were identified. The most effective intervention studies provided explicit instruction of expository texts with visual supports and student-generated learning materials (e.g., notes or graphic organizers) with moderate dosage (i.e., 180-300 min across 6-8 weeks) in a one-on-one or paired group setting. Greater intervention effects were also seen in children with reading and/or language disorders, compared to children with overall academic performance difficulties. Conclusions A number of expository discourse interventions showed promise for student use of learned skills within the treatment setting (i.e., near-transfer outcomes) but had limited generalization of skills (i.e., far-transfer outcomes). Supplemental Material https://doi.org/10.23641/asha.12449258.

Data from a small randomized control trial of teachers' use of Data-Based Instruction (DBI) for early writing were analyzed to determine the influence of teacher knowledge, skills, and treatment fidelity on student Curriculum-Based Measurement (CBM) slope. Participants included 11 elementary grade teachers who delivered intensive intervention in early writing and their students ( n = 31), all identified as either at risk for or with disabilities that affect their writing. Teachers received professional development and ongoing coaching to support the implementation of DBI for improving their students' early writing skills. Results from a multiple regression analysis suggest that teacher knowledge and skills in DBI was strongly related to student CBM slope in early writing ( p < .01) and a small but significant relation between fidelity of writing instruction and student CBM slope ( p < .01). Implications for instructional coaching and improving student writing progress are discussed.

The purpose of this study was to examine the effectiveness of video-based mathematics instruction for seven middle school students with specific learning disability (SLD), using an augmented reality-based training package. The dependent variable was the percentage of steps students performed correctly to solve each type of mathematics problem. The independent variable was the augmented reality video-based intervention, which used video to model the individual steps for solving four types of multistep mathematics problems: (a) addition and subtraction of integers, (b) multiplication and division of integers, (c) using ratio reasoning to convert measurement units, and (d) using multiplication and division to calculate rate of change. Results indicated a functional relation between the video-based mathematics intervention and the percentage of steps completed correctly for each type of problem. All seven participants showed significant gains immediately after receiving the intervention and maintained improved problem-solving skills in at least three out of the four problem categories.

Background: Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education., Aims: The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group., Methods: Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected., Results: Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group., Conclusions: Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Early and Intensive Behavioral Treatments are considered to be evidence-based interventions for children with Autism Spectrum Disorder (ASD). Nevertheless, children with ASD might not always have the opportunity to benefit from intensive treatment; new, more accessible and alternative treatment options need to be tested. The aim of this study was to evaluate the effectiveness of the Combined Low-intensive Psychoeducational Intervention (CLI-PEI) delivered to preschoolers with ASD at the end of the pre-primary school day. Methods: A quasi-experimental design study, namely a pretest-posttest alternative-treatment comparison groups design, was used. Treatment sessions were carried out over a period of 12 months. Forty-three individuals with autism were included in the study: 24 received the CLI-PEI and 19 were administered the Treatment As Usual. A pre- and posttreatment assessment was carried out using the Psychoeducational Profile-Third edition and the Vineland Adaptive Behavior Scale. Results: The children who received the CLI-PEI showed better gains in both developmental and maladaptive behaviors; furthermore, increased skills were found in all adaptive domains. Conclusions: The CLI-PEI might seems to be a viable treatment option for children with ASD, when intensive behavioral treatments are not accessible.Implication for rehabilitationChildren with ASD might not always have the opportunity to benefit from intensive treatment.The identification of more accessible, less intensive and less expensive evidence-based psychoeducational interventions might represent an appealing challenge for rehabilitation therapists.Less intensive and less expensive evidence-based interventions might also represent a viable option for children and their families, especially in communities with limited resources for autism.A pragmatic approach including components from evidence-based treatments might guarantee flexibility and the possibility to implement an intervention well-tailored to the specific child needs.CLI-PEI for preschoolers with ASD seems to be a promising pragmatic approach, promoting improvements in developmental, adaptive and maladaptive domains.

Children with normal intelligence may experience varying degrees of mathematics learning disabilities (MD). This study aims to conduct training to improve the brain's cognitive ability for mathematics learning by focusing on two important mathematical cognitive abilities. This was a prospective study of 70 children in grades 2-5 from two primary schools in Changzhou and with MD enrolled from June 2015 to February 2017. The children were randomized 1:1 to the training and control groups. A training cycle included 40 sessions (5/weeks) (30 min each session). The efficacy of learning was assessed by assessing number learning and graph reasoning, and by using the Raven standard reasoning test score. In the training group, backward number memory (from 6.1 ± 1.8 to 6.7 ± 1.3, P  = 0.02), number sequential connection (from 54.4 ± 14.5 to 47.1 ± 12.1, P  < 0.01), and rapid graph judgment (from 531.9 ± 76.3 to 557.8 ± 85.7, P  = 0.04) were improved by training, while there was no effect on forward number memory ( P  = 0.13). There were significant differences in total score and scores of b, c, and e series before and after training (all P  < 0.05). The children in the control group had no improvement after 8 weeks. There was a correlation between the ability of rapid graphic judgment before and after training and the score of the Raven E series ( r  = 0.384, P  = 0.024), and between the score of the Raven C series and the score of the Raven D series ( r  = 0.468, P  = 0.013). Cognitive correction training improved the sensitivity to numbers and mathematics learning in children with MD.

Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.

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.)

Assistive technology (AT) was recognized by Congress as a viable need for people with disabilities when it passed the Tech Act in 1988. The legislation, which was reauthorized in 1994, has resulted in numerous programs and services that have helped people with disabilities access and use AT devices. The Tech Act's implications for people with learning disabilities is discussed in this article.

Objectives: Appropriate outcome measures are required for deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD). This paper describes the development and structure of the Nottingham Early CaLL Framework and via a series of case-studies, demonstrates its effectiveness in tracking progress over time. Methods : The materials were developed in-house in 2011-2012 and refined through the exploration of established approaches in health and education, an inter-rater reliability study and an extended pilot of the draft materials. Results : The Framework quantifies the long term benefit of cochlear implantation by recording the amount of functional sound processor use achieved, alongside incremental changes in auditory behaviours, in the context of cognition, interaction and communication development. The case-studies demonstrate how it can provide evidence of measurable changes and help to explain some of the underlying reasons for the range of long-term outcomes. Discussion : Within this population, the key predictive, within-child factors of post cochlear implant listening and spoken language outcomes, are an individual's cognitive and physical capacities and their engagement in social communication. Conclusion : The Early CaLL Framework supports expectation counselling and decision-making in the assessment phase and post cochlear implantation provides monitoring tool, which encourages collaboration between families and professionals.

Objectives: In 2018, routine data of the five year outcomes from a cohort of 46 children, (18 PMLD and 28 SLD, including nine SLD children with an additional diagnosis of ASD), was analysed to investigate the type and amount of benefit provided by cochlear implantation and to examine any differences in outcome patterns across the populations. Methods: The level of functional sound processor use achieved over time was reviewed in relation to listening and spoken language outcomes, alongside social engagement, communicative and cognitive development. The extent to which children were able to close the gap between their overall development and their listening abilities was quantified. The outcomes of the children with an additional diagnosis of ASD, was compared to those of the SLD population as a whole. Results: Although equipment management presented long term challenges, after five years, 80% of children were able to attach some meaning to sound. Children with SLD acquired more auditory skills and spoken language than those with PMLD. Most of the children used a mix of augmentative and alternative communication approaches (AAC), with 7%, all SLD children, acquiring some simple spoken language. An additional diagnosis of ASD had a negative effect on outcomes. Discussion: For 80% of the patients, the provision of cochlear implants provided benefits, although changes were slow to develop and required high levels of adult persistence. Conclusion: Outcomes measures which are population specific and acknowledge challenges, alongside providing ways to recognise individual achievements, by matching them against individual capacity, are of great value to families and practitioners.

Emotional-associative learning represents a translational model for the development, maintenance and treatment of anxiety disorders such as panic disorder (PD). The exact nature of the underlying fear learning and extinction deficits however, remains under debate. Using a three-day paradigm to separate the distinct learning and consolidation processes, we aimed to gain insights into the neurofunctional substrates of altered fear conditioning, extinction training and recall in PD. In contrast to studies employing one-session fear conditioning paradigms, a differential fear conditioning and delayed extinction task was conducted for the purpose of disentangling neural networks involved in fear acquisition, extinction training and recall of extinction memories. Using functional magnetic resonance imaging (fMRI), quality-controlled datasets from 10 patients with PD and 10 healthy controls were available from three consecutive days (day 1: acquisition; day 2: extinction training; day 3: extinction recall) with neutral faces serving as CSs and an aversive auditory stimulus (panic scream) as US. PD patients showed heightened fear circuitry (e.g. right amygdala and left insula) activation during early acquisition and prolonged activation in the right insula, left inferior frontal operculum and left inferior frontal gyrus during extinction recall compared to healthy controls. Stronger neural activation in structures conferring defensive reactivity during early acquisition and extinction recall may indicate the accelerated acquisition of conditioned responses, while extinction recall may be attenuated as a function of PD pathophysiology. Future studies should investigate the predictive value of experimental measures of extinction recall for clinical relapse., (Copyright © 2018. Published by Elsevier B.V.)

Background: Research-based evidence points to the efficacy and value of applied behavior analysis (ABA) in meeting the needs of individuals with learning disabilities and autism. Nonetheless, public, government, and professional perception of ABA can be negative. The current study was designed to measure the impact of a short intervention on professionals' attitudes toward, and knowledge of, ABA., Method: Teachers and classroom assistants from two separate schools for children with severe learning difficulties completed a self-report survey on knowledge of and attitudes toward ABA. They were then presented with a 90-min training module designed to increase their knowledge of the history of ABA and their functional assessment skills. Following training, the self-report was readministered., Results: The mean scores for each group increased only after the training had been delivered. Discussion and conclusions: Further research is needed to address the impact of training on classroom practice.

Including students with learning disabilities (SWLDs) in general education classrooms is a priority nationwide. Consequently, now more than ever before in our nation's history, university teacher education programs face increased responsibility to ensure general education teaching candidates receive adequate preparation to educate SWLDs. Many stakeholders believe that edTPA-a performance assessment used as a credential requirement-can be an important tool in helping to fulfill this goal. Utilizing survey data from a large, research university, the authors investigated how perceptions of preparation programs, including edTPA, related to general education teacher candidates' perceptions of their preparation for educating SWLDs. Candidates reported feeling more prepared for disability policies if they believed their program was cohesive in its goals and expectations. Candidates who rated edTPA as beneficial for entering the teaching profession also believed that edTPA improved their abilities to educate SWLDs.

This paper reviews findings from four research syntheses that report the effects of academic language and/or reading interventions on language and reading outcomes for English learners who have or are at risk for learning difficulties. Studies included in the syntheses varied in research design and addressed multiple areas of reading and language. There was disagreement between syntheses as to the extent of research evidence in favor of particular instructional practices. For ELs with learning difficulties in kindergarten and first grade, however, there was strong consensus that multiple-component reading instruction that includes phonological awareness and phonics instruction is associated with improved word reading outcomes. It may also be beneficial to provide oral language, vocabulary, and reading comprehension instruction; nevertheless, there is a need for future research on instructional interventions that aim to improve reading comprehension outcomes for this population., (© 2019 Wiley Periodicals, Inc.)

Background: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change., Methods: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change., Results: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff., Conclusion: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness., (© 2019 John Wiley & Sons Ltd.)

Background: Evidence suggests that people with learning disabilities are less likely to have an up-to-date eye examination as sight loss is characteristically underdiagnosed in people with complex needs., Method: A retrospective study of records from 576 Service Users of RNIB UK Vision, learning disability and Complex Needs Services was carried out., Results: The record review found a higher prevalence of spectacle prescription in a learning disability (LD) population in agreement with findings from other LD studies. There was a higher prevalence of severe myopia in people with LD compared with a general adult population., Conclusion: This study found a higher prevalence of spectacle prescription in people with learning disabilities compared to a general adult population, which has implications for people with learning disabilities to ensure that they have access to eye care and regularly attended eye tests. It also has implications for healthcare professionals working with people with complex needs to ensure they have access to eye care., (© 2019 John Wiley & Sons Ltd.)

Objective: To determine the role of pain catastrophizing (PC) in neuropsychological functioning in veterans with a history of mild traumatic brain injury (TBI)., Participants: Thirty-nine Iraq and Afghanistan combat veterans evaluated in the post-acute phase following mild TBI., Methods: Participants underwent psychiatric and TBI clinical interviews, neuropsychological tests, and self-report assessments of PC, pain intensity, depression, and posttraumatic stress disorder symptoms. Cognitive functioning composite scores of executive functioning, processing speed, and learning and memory were created. Composites were entered as dependent variables into separate linear regressions to examine relations with PC., Results: Greater PC was associated with worse executive functioning and processing speed even when controlling for confounding variables., Conclusions: One's interpretation of pain, in addition to pain intensity, has implications for cognitive functioning. Future research is encouraged to determine whether adaptive pain coping mechanisms improve cognitive functioning or, alternatively, whether cognitive rehabilitation strategies reduce PC.

Methods: The study included semi-structured interviews comprised of nine Behavioural Specialists in three focus groups across two health boards. A descriptive thematic analysis study., Findings: Three major themes and 11 minor themes were identified illustrating how people with learning disabilities and behaviours that challenge were involved in developing their PBS plan. Significantly, the themes illustrated the complexity of truly involving service users in the process., Conclusion: Inclusion of people with a learning disability and behaviours that challenge in their PBS plan poses significant challenges. Person-centred care struggles to be truly embedded in the PBS model.

Competing Interests: Competing interestsThe BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests

In this commentary, I highlight key insights from research on learning disabilities (LD) reported in this special issue. Authors of each article describe innovative work that is expanding frontiers of LD knowledge, by focusing on vulnerable and understudied populations, using multiple methodologies and data sources, and building and refining theory. Insights that emerge from this work relate to defining and identifying LD; estimating prevalence rates of LD subgroups; and understanding the role of cognitive, language, genetic, and environmental factors and their implications for assessment and intervention. I conclude that findings of this work promise to have a significant and lasting impact on the lives of children and youth with LD., (© 2019 Wiley Periodicals, Inc.)

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities. This study aimed to evaluate the outcomes defined for children with education, health and care plans in England. 236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age. The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes. Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children's main need. There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We used longitudinal data from Washington State to investigate the relationships among career and technical education (CTE) enrollment, inclusion in general education, and high school and postsecondary outcomes for students with learning disabilities. We replicated earlier findings that students with learning disabilities who were enrolled in a "concentration" of CTE courses had higher rates of employment after graduation than observably similar students with learning disabilities who were enrolled in fewer CTE courses. We also found that students with learning disabilities who spent more time in general education classrooms in high school had higher rates of on-time graduation, college attendance, and employment than observably similar students with learning disabilities who spent less time in general education classrooms in these grades.

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?

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.)

Purpose This preliminary study investigated an intervention procedure employing 2 types of note-taking and oral practice to improve expository reporting skills. Procedure Forty-four 4th to 6th graders with language-related learning disabilities from 9 schools were assigned to treatment or control conditions that were balanced for grade, oral language, and other features. The treatment condition received 6 30-min individual or pair sessions from the school of speech-language pathologists (SLPs). Treatment involved reducing statements from grade-level science articles into concise ideas, recording the ideas as pictographic and conventional notes, and expanding from the notes into full oral sentences that are then combined into oral reports. Participants were pretested and posttested on taking notes from grade-level history articles and using the notes to give oral reports. Posttesting also included written reports 1 to 3 days following the oral reports. Results The treatment group showed significantly greater improvement than the control group on multiple quality features of the notes and oral reports. Quantity, holistic oral quality, and delayed written reports were not significantly better. The SLPs reported high levels of student engagement and learning of skills and content within treatment. They attributed the perceived benefits to the elements of simplicity, visuals, oral practice, repeated opportunities, and visible progress. Conclusion This study indicates potential for Sketch and Speak to improve student performance in expository reporting and gives direction for strengthening and further investigating this novel SLP treatment. Supplemental Material https://doi.org/10.23641/asha.7268651.

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.)

Objective To investigate the incidence of successful rehabilitation, defined as 90 successive days in employment, within individuals with disabilities receiving occupational/vocational training (OVT) service. Method The follow-up records between January 1, 2004 and December 31, 2012 of 5313 individuals aged 15-55 who obtained OVT in the vocational rehabilitation (VR) program of the State of Illinois were examined. Cox regression models were used to analyze the effect of study factors on VR outcomes. Results After controlling for the other factors, males (incidence ratio [IR] 1.11, 95% CI 1.03-1.20), individuals with learning disability (IR 1.14, 95% CI 1.03-1.26), had existing employment (IR 1.40, 95% CI 1.26-1.56), and persons who were referred from educational institutions (IR 1.17, 95% CI 1.01-1.36) or community agencies (IR 1.30, 95% CI 1.14-1.48) appeared to have a relatively high incidence of successful rehabilitation. In contrast, those who lived in densely populated areas (IR ranged from 0.56 to 0.89), had physical disability (IR 0.77, 95% CI 0.68-0.88), had disability of most significant degree (IR 0.85, 95% CI 0.79-0.93), and persons with Supplemental Security Income/Social Security Disability Insurance supports (IR 0.84, 95% CI 0.76-0.94), tended to have a lower incidence of rehabilitation than their counterparts. Conclusion The incidence of successful rehabilitation seems to be related to the demographic, disability, and pre-service characteristics, but not necessarily the provider factors.

Purpose: We examined the association between language experience and elementary students' eligibility for special education in Massachusetts., Method: A secondary descriptive data analysis was conducted on the anonymized demographic data obtained from the Massachusetts Department of Elementary and Secondary Education. Third, 4th, and 5th grade students were categorized into native English speakers, English-proficient bilinguals, and emerging bilinguals. Eligibility for free or reduced lunch was also considered. Proportions of students eligible for autism, communication disorders, and specific learning disabilities (including those with dyslexia) were calculated., Results: A strong association was observed between students' language background and whether they were eligible for free/reduced lunch. Children eligible for free/reduced lunch were more likely to be eligible for special education. Relative to native English speakers, English-proficient bilingual students were less likely to be considered eligible for special education. However, for emerging bilinguals, eligibility was lowest in 3rd grade and highest in 5th grade. This observation was most apparent in the category of specific learning disabilities., Conclusions: Students from diverse language and low-income backgrounds were disproportionately represented in special education. More substantial research-practice partnerships are warranted to understand how bilingual experience and socioeconomic status interact with eligibility for special education services in public school settings.

Purpose: The purpose of this narrative review of the literature is to provide a description of intensive interventions for elementary grade students with dyslexia, students with learning disabilities, and students with intensive reading and writing needs., Method: First, we provide a brief overview of response to intervention. Second, we explain our theoretical framework for the review. Third, we describe evidence-based interventions, which are divided into predominantly reading or writing interventions. Fourth, we explain data-based individualization for these programs based on a taxonomy of intensity, and we provide an illustrative case study., Conclusion: We conclude by describing a set of links to websites and technical assistance resources that may be helpful for speech-language pathologists, teachers, and other interventionists to stay current with this research base and to lead professional learning communities.

Purpose: Reading skills continue to develop into adolescence and adulthood. Difficulties in reading have lifelong repercussions. Many speech-language pathologists who work with older individuals in the school setting face significant issues, including those mandated by recent changes in legislation. Theoretical topics related to reading development and disorders include the variety of orthographic systems across languages and the ways in which adults who are literate in an alphabetic orthographic system experience changes to their spoken and written language processing. In addition, older readers with intellectual or developmental disabilities may benefit from the use of leveled books and the inclusion of illustrations or drawings along with text., Method: I completed a focused literature review regarding typical reading skills, dyslexia in adolescence and adulthood, recent changes in legislation, orthography, and the use of leveled books for adolescents and adults with intellectual or developmental disabilities., Conclusions: Further study of reading in older individuals may lead to important theoretical and clinical applications. Speech-language pathologists should keep in mind the various components of reading (such as decoding and comprehension), how these factors relate to oral language, and how they may be addressed in therapy.

Purpose: Speech sound disorders (SSDs) can have a negative impact on literacy development, social-emotional well-being, and participation across the life span. Despite this, many public schools do not provide appropriate or timely services to this population of children. In large part, this is a result of variation in how state and local agencies interpret "educational performance" as outlined within the Individuals With Disabilities Education Act. The purpose of this study was to explore which educational performance factors speech-language pathologists (SLPs) consider when determining eligibility for children with SSDs., Method: This study surveyed public school SLPs to investigate how educational performance is interpreted for children with SSDs. Data from 575 SLPs across the United States are included., Results: Results supported variability in interpretation of educational performance within a nationwide sample of SLPs. Specifically, SLPs appear to consider educational performance as multidimensional. We also found within-state and between-states variability, indicating ambiguity in interpreting federal mandates. Finally, caseload size and number of years of experience were significantly related to which educational performance factors SLPs chose., Conclusion: There is significant variability across the United States with respect to factors considered part of educational performance for children with SSD. This variability reflects the general quality and specificity of guidelines and/or special education code published by individual states. Clinical and legislative recommendations are included.