Co-occurring Learning Research Articles

Neurocognitive Concussion Test Performance for Student Athletes on the Autism Spectrum.

To examine baseline neurocognitive functioning among adolescent athletes on the autism spectrum based on self-reported level of academic performance. Participants in this cross-sectional, observational study were 6,441 adolescent athletes with a self-reported diagnosis of autism who completed pre-season neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); 4,742 reported a co-occurring learning disorder (LD), and 6,612 individuals without autism or LD were included as a control group. The majority (57%) self-reported Average Academic Performance, 39% Above Average, and 4% Below Average performance. Athletes with self-reported autism (with or without LD; 12.2%) were 2.74x (95% CI: 2.17-2.82) more likely to fall below cutoffs for ImPACT Embedded Invalidity Indicators (EVIs), with a significant interaction between self-reported Diagnosis and Academic Performance; individuals with co-occurring autism and LD who reported Below Average Academic Performance had the greatest likelihood of scoring below cutoffs (22%), followed by ASD without LD (14.8%) and Controls (14.6%) with Below Average Academic Performance. Analyses of variance (ANOVAs) revealed main effects of Diagnosis and Academic Performance on neurocognitive performance, with interactions on all ImPACT Composite Scores except Processing Speed. Athletes with self-reported ASD are more likely to fall below ImPACT EVIs and score worse on ImPACT, with greater likelihood/worse performance related to level of academic functioning. Academic performance should be considered when interpreting neurocognitive testing data, to best index neuropsychological functioning associated with concussion in this population. The current findings highlight the importance of individual participant baseline neuropsychological testing for individuals on the autism spectrum.

Needs-based assessment of twice-exceptional gifted students: The S&W-Heuristic

Misdiagnoses and missed diagnoses of gifted students with co-occurring learning-, developmental and behavioural disorders are often mentioned in literature and practice. Consequently, these Twice-Exceptional (2E) students often fall between two stools regarding appropriate psycho-educational interventions. This article offers a research and practice informed assessment procedure, namely the Strengths and Weaknesses Heuristic (S&W-Heuristic), that can help to tackle such problems in case giftedness or any 2E is suspected. This S&W-Heuristic was developed via the method of design research. Initially the S&W-Heuristic was developed to assess students with (suspicion of) the co-occurrence of intellectual giftedness (IG) and autism in a needs-based way, though, subsequently to assess (potential) 2E-students in general. The systematicity of the S&W-Heuristic may help psychologists and special remedial educationalists to reveal hitherto camouflaged strengths or weaknesses in underachieving smart students and to understand their ambivalent psycho-educational needs. Being the product of design research, this article also offers a prelude to new theoretical perspectives regarding the concepts IG and 2E. By shifting from a ‘classification-based’ to a dynamic ‘dimensional-based’ definition of 2E, camouflaged talent will be recognised more effectively and will get more opportunity to flourish. Accordingly, it is proposed to consider IG and 2E as constructs on a continuum.

Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in childhood. The major components of this disorder are developmentally inappropriate levels of inattention and hyperactivity/impulsivity, which result in functional impairment in 1 or more areas of academic, social, and emotional function. In addition to the propensity for children to have some compromise of academic and emotional function, children with ADHD also have a higher frequency of co-occurring learning, cognitive, language, motor, and mental health disorders. Similarly, children with developmental disorders have a higher risk of co-occurring ADHD. The diagnosis of ADHD can be ascertained by a review of the risks for the condition, consideration of masquerading conditions, a careful history and physical examination, and the recognition of co-occurring disorders. The signs and symptoms of co-occurring disorders and the management of ADHD differ across early childhood, middle childhood, and adolescence. Management is largely limited to behavioral and pharmacologic interventions, and it favors behavioral strategies in early childhood, pharmacologic and behavioral strategies in middle childhood, and pharmacologic interventions in adolescence. This article offers an approach to the evaluation, presentation, and management of ADHD with a focus on guiding primary care pediatricians.

Recalled Experiences of Bullying and Victimization in a Longitudinal, Population-Based Birth Cohort: The Influence of ADHD and Co-Occurring Psychiatric Disorder

Objective: To describe bullying experiences throughout childhood of people with and without childhood ADHD and co-occurring learning and psychiatric disorders from a population-based birth cohort. Methods: In a secondary data analysis of 199 childhood ADHD cases and 287 non-ADHD referents (N = 486), reported experiences of peer interactions during elementary, middle, or high school were classified as “bully,” “victim,” “neither,” or “both.” Associations were assessed with multinomial logistic regression. Results: Adjusted for male sex, the odds of classification as victim-only, victim/bully, or bully- only (vs. neither) were 3.70 (2.36–5.81), 17.71, and 8.17 times higher for childhood ADHD cases compared to non-ADHD referents. Victim-bullies (62.5%) and bullies (64.3%) had both childhood ADHD and other psychiatric disorders versus 38.4% of victims-only and 17.3% of those classified as “neither.” Conclusion: The list of serious lifetime consequences of having ADHD also includes bullying. We offer future research directions for determining potential causal pathways.

Reward Devaluation in Autistic Children and Adolescents with Complex Needs: A Feasibility Study.

Rewards act as a motivator for positive behavior and learning. Although compounding evidence indicates that reward processing operates differently in autistic individuals who do not have co-occurring learning disabilities, little is known about individuals who have such difficulties or other complex needs. This study aimed first to assess the feasibility of using an adapted reward devaluation paradigm to examine basic reward processes in this underrepresented population, and second to investigate whether autistic children and adolescents with complex needs would show dynamic behavioral changes in response to changes in the motivational value of a reward. Twenty-seven autistic children and adolescents with complex needs and 20 typically developing 5-year-old children took part in the study. Participants were presented with two visual cues on a touchscreen laptop, which triggered the delivery of a video, music, or physical reward. One of the rewards was then presented in abundance to decrease its motivational value. Participants showed decreased interest in the video and music rewards after devaluation. The experimental setup was found to be suitable to test individuals with complex needs, although recommendations are made for the use of physical rewards. The results suggest that autistic participants with complex needs demonstrate goal-directed behavior and that it is feasible to develop experimental paradigms that can shed important light on learning processes that are fundamental to many education and intervention strategies for this population. Autism Res 2020, 13: 1915-1928. © 2020 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: We adapted an experimental task to conduct research with autistic children and adolescents with complex needs, who remain grossly underrepresented in autism research. We found that once a reward was presented in great quantity, participants were less motivated to obtain it, showing that they adapted their behavior to changes in the value of that reward. This is an important finding to help promote learning and design better interventions for this population.

Attention-Deficit/Hyperactivity Disorder Mimics the Post-concussion Syndrome in Adolescents.

The objective of this study was to evaluate concussion-like symptom reporting among uninjured adolescents with Attention-deficit/hyperactivity disorder (ADHD), stratified by several cooccurring conditions, and to examine the base rate and predictors of uninjured adolescents with ADHD meeting diagnostic criteria for the International Classification of Diseases, 10th Revision (ICD-10) post-concussional syndrome (PCS). Participants in this cross-sectional, observational study, were drawn from a cohort of 48,834 adolescent student athletes from Maine (ages 13–18) with no concussion in the past 6 months who completed a preseason, baseline testing program between 2009 and 2015. The final sample included 3,031 students with ADHD, 2,146 (70.8%) boys and 885 (29.2%) girls. They were 15.2 years old on average (SD = 1.3). Concussion-like symptom reporting was more common in girls than boys. Most students with ADHD reported one or more symptoms (69.3% of boys and 81.1% of girls). The presence of an additional, co-occurring condition or comorbidity was associated with increased symptom reporting. In the absence of a recent concussion, 28.8% percent of boys and 47.1% of girls with ADHD endorsed symptoms resembling an ICD-10 diagnosis of post-concussional syndrome (PCS). Adolescents with pre-existing conditions were even more likely to endorse symptoms that resembled PCS (28–47% of boys and 45–69% of girls). Prior treatment for a psychiatric condition was the strongest independent predictor for meeting PCS criteria in boys, followed by treatment for migraines and co-occurring learning disorder. For girls, the only independent predictor was prior treatment of a psychiatric condition. In uninjured adolescent student athletes, ADHD appears to mimic the post-concussion syndrome. Adolescents with ADHD commonly endorse concussion-like symptoms in the absence of a recent concussion. Demographic characteristics (sex) and the presence of co-occurring conditions are related to symptom reporting in adolescents with ADHD. Understanding factors associated with baseline symptom reporting, such as pre-existing ADHD, is important when evaluating youth who have persistent symptoms following concussion as well as making both return to school and return to athletics decisions.

Academic Testing Accommodations for ADHD: Do They Help?

This study investigated the effectiveness of five commonly administered academic testing accommodations on reading and math performance in children with attention deficit hyperactivity disorder (ADHD). A total of 96 parents of 3rd-8th grade students with ADHD participated. More than half of the sample also had parent-reported learning difficulties in reading and/or math. Individually administered cognitive and achievement test scores, types of testing accommodations received, and Maryland School Assessment (MSA) reading and math scores were obtained from these students' school records. Taking into account grade level and co-occurring learning difficulties, none of the five accommodations investigated were associated with better MSA scores among students with ADHD who received the accommodations versus comparable students who did not. Additionally, individual variation in processing speed performance did not moderate the association between receipt of accommodations and reading or math performance. Common testing accommodations, as presently administered, may offer little benefit for students with ADHD, regardless of co-occurring learning difficulties.

Psychosocial Treatments for ADHD

Objective: Children with learning disabilities often experience comorbid ADHD, impacting on the effectiveness of interventions for those children. In addition to pharmacologic intervention, clinicians and educators employ a variety of psychosocial methods to address the behavioral and social issues that arise in children with ADHD, including those with co-occurring learning disabilities. Numerous systematic reviews and meta-analyses have been conducted examining treatment studies using psychosocial interventions for children with ADHD. Because of the importance of such reviews to evidence based clinical and educational practice, it is essential that reviews be conducted with rigorous methodologies to avoid bias in conclusions (Schlosser, Wendt, & Sigafoos, 2007). The purpose of this study was to evaluate the quality of systematic reviews and meta-analyses conducted for psychosocial treatments of ADHD in children. Method: Electronic databases were searched for peer-reviewed, English language studies of psychosocial treatments for ADHD in children up to 18-years-old from 1998 to 2010. Twenty-one studies were identified that met inclusion criteria (13 systematic reviews, 8 meta-analyses). Independent examiners used the quality rating scale proposed by Auperin, Pignon, and Pynard (1997) to rate the characteristics of good systematic reviews and meta-analyses. Results: Results indicated that certain methodological characteristics were common across trials reviewed, yet shortcomings were common among most reviews, including inadequate descriptions of data extraction methods and lack of quality ratings for trials included in the reviews. Conclusion: Synthesis of findings from the five top-rated reviews and the literature on ADHD suggest that psychosocial treatments contribute to improvements on behavioral and social outcomes. How ADHD and LD interplay in treatment outcomes is largely unexplored.

Self-Esteem of Young Adults with Chronic Health Conditions

The relationships between selected condition characteristics and self-esteem were investigated in a randomly drawn, community-based sample of 286 young adults with chronic illnesses and disabilities. Whether appraisals of the impact of the condition mediated relationships between condition characteristics and self-esteem, as measured by the Rosenberg Self-Esteem Scale, was also measured. As a group, the youth in this sample reported positive self-esteem. When sociodemographic and condition-related variables were considered simultaneously, maternal education, unpredictability of symptoms, prognosis, sensory impairment, and the presence of a co-occurring learning disability were found to have direct effects on esteem. Perceived impact mediated the relationship between condition characteristics and self-esteem. The results are discussed in relation to the role of impact appraisal in determining the emotional well-being of young adults with chronic illnesses.

Do attention deficit hyperactive disorders cause reading problems?

Children diagnosed as attention deficit hyperactive disordered (ADHD) do not comprise a unitary homogeneous group. Despite considerable research attempting to establish the validity of ADHD as a diagnostic entity, a number of researchers question whether the distinction between ADHD and other child disorders such as oppositional defiant disorder (ODD) or conduct disorder (CD) can be clearly established (Prior & Sanson, 1986; Werry, Reeves & Elkind, 1987). Short attention span, poor concentration and poor memory may also occur in both ADHD and reading-disabled (RD) children. Academic underachievement is also reported in a substantial proportion of ADHD children (Carlson, Lahey & Neeper, 1986). August and Garfinkel (1990), for example, found that 39% of children diagnosed ADHD were also found to have a co-existing reading disorder. A study by McGee and Shore (1988) estimated that 80% of children with ADHD had a co-occurring learning disability in reading, writing and spelling. This conclusion is also supported by other studies which have found a higher than normal incidence of academic problems existing with significant attention problems (Barkley, 1990; Barkley, Fisher, Edelbrock & Smallish, 1990).As the two disorders occur so frequently together it has consequently become very difficult to disentangle the degree to which ADHD and learning disorder contribute to each other or are in fact separate entities. The issue regarding comorbidity or causality remains perplexing - is the learning disability a secondary cause arising from inattention and hyperactivity, or is the child inattentive and hyperactive because they are frustrated at their inability to succeed academically (August & Garfinkel, 1990)?

Research on the Educational Implications of Attention Deficit Hyperactivity Disorder

This article summarizes the major academic problems of students with attention deficit hyperactivity disorder (ADHD) and addresses the extent to which these problems are secondary to ADHD, rather than a part of a co-occurring learning or cognitive disability. The article delineates the academic problems of students with ADHD in relation to their primary characteristics—how one influences the nature of the other. Treatment implications are discussed to indicate how educators might modify classroom settings to enhance the academic achievement of students with ADHD.

Methodological Issues and Learning Disabilities Diagnosis in Clinical Populations

Previous research suggests that the diagnosis of a comorbid learning disability is dependent on the method used for making the LD diagnosis. This study investigated that proposition by studying the effects of using three approaches to the assessment of learning disabilities in a sample of 177 six- to thirteen-year-old boys referred to outpatient mental health clinics for behavior problems. The use of these three procedures to diagnose comorbid learning problems produced significantly different results. All methods identified significant numbers of children in the clinical population as learning disabled; however, each method identified children with differing characteristics. Consistent with predictions from measurement theory, the commonly used simple standard score discrepancy method was more likely to identify children with above-average IQs as learning disabled, whereas a regression approach identified learning disabilities more consistently across the ability range. These results were interpreted as supporting the use of regression approaches to diagnose co-occurring learning disabilities, as that method is less likely to be biased by the child's intelligence test score. The implications of the use of each method in research investigations is also discussed.