Diagnosis Of Learning Disabilities Research Articles

Identifying Gaps for Service Provision in Children and Young People With Learning Disability and Challenging Behaviours And/or Mental Health Needs

AimsChildren and adolescents with learning disability need multi-disciplinary input when they present with challenging behaviours or mental health disorders. This patient group needs specialist skills from the clinicians and professionals to support and meet their needs. There is no commissioned Child and Adolescent Learning Disability Mental Health Service (CAMHS) in Waltham Forest and support comes from Specialist Tier 3 generic CAMHS which comprises of Emotional Difficulties Pathway, Neurodevelopmental Disorders Pathway and recently developed Behaviour Pathway which mostly comprises of specialist parenting training/interventions. To identify gaps in service provision for children and young people with learning disability presenting with challenging behaviours and/or mental health needs in Waltham Forest as there is no formally funded CAMHS learning disability service in the locality.MethodsAll children and young people under 18 with learning disability under Waltham Forest CAMHS with ASD/ADHD and other neurodevelopmental disorders who meet the project criteria are included. Project criteria include 1) Main diagnosis of Learning Disability (Including clients with Learning difficulty (global), likely to have low IQ with cognitive impairment.), with or without associated other Neurodevelopmental disorders (e.g., ASD, ADHD or tics) or other mental health disorders and 2) Engages in challenging behaviours. Challenging behaviours defined as behaviours significantly limiting engagement in daily & family life, education and/or social activities, and have persisted for at least a period of 3 months. Data were collected from electronic recoding system of individual patients; using a data collection sheet on level of learning disability; comorbid neurodevelopmental or emotional and mental health disorders; profession of allocated clinician; joint working with discipline; involvement with social care; allied health professionals input; presenting difficulties and severity; CETR or hospital admissions; referral to National services; What interventions offered (Medications, Behaviour assessment and/or interventions); if medications offered, was it used as first line and how long for; parents’ view on medication management.ResultsAs we have expected, medication management were used as first line and there were limited offers of behaviour support. Joint working with social care, speech therapy and occupational therapy but with limited input especially occupational therapy in cases with high sensory needs. It was unclear with the cognitive assessment and diagnosing the learning disability in the population under 16s.ConclusionThere is a service gap for CAMHS learning disability population and more joint working needed among relevant health professionals.

Lessons Learned: Achieving Consensus About Learning Disability Assessment and Diagnosis

The current paper describes the process used for developing the Guidelines for Diagnosis and Assessment of Children, Adolescents, and Adults with Learning Disabilities-Consensus Statement and Supporting Documents, and the rationale for some of the decisions. The guidelines were developed by a cross-sectoral working group of psychologists who achieved a consensus on the criteria for diagnosis and the assessment process. We outline key features of the guidelines, describe topics where the group achieved consensus quickly and topics for which there was considerable debate (e.g., intelligence testing, ability/achievement discrepancy, and processing deficits). The group members shared information with each other about topics such as the advantages of early assessment, the importance of formally assessing effort and motivation, and assessment of culturally and linguistically diverse individuals. We conclude with the lessons learned and professional challenges regarding contextual influences on LD assessment and diagnosis and dissemination of research to practitioners.

Diagnostic evaluation and educational intervention for learning disabilities

Learning disabilities (LD), also known as learning disorders, refers to cases in which an individual experiences lower academic ability as compared to the normal range of intelligence, visual or hearing impairment, or an inability to peform learning. Children and adolescents with learning disabilities often have emotional or behavioral problems or co-existing conditions, including depression, anxiety disorders, difficulties with peer relationships, family conflicts, and low self-esteem. In most cases, attention deficit and hyperactivity disorder coexists. As learning disabilities have the characteristics of a difficult heterogeneous disease group that cannot be attributed to a single root cause, they are diagnosed based on an interdisciplinary approach through medicine and education, such as mental health medicine, education, psychology, special education, and neurology. In addition, for the accurate diagnosis and treatment of learning disabilities, the diagnosis, prescription, treatment, and educational intervention should be conducted in cooperation with doctors, teachers, and psychologists. The treatment of learning disabilities requires a multimodal approach, including medical and educational intervention. It is suggested that educational interventions such as the Individualized Education Plan (IEP) and the Response to Invention (RTI) should be implemented.

Examination of A Psychoeducational Program for Increasing Self-Esteem in Students with Diagnosed Learning Disabilities

Bu araştırmada, öğrenme güçlüğü tanılı öğrenciler için geliştirilen benlik saygısı artırma psikoeğitim programının etkililiği incelenmiştir. Araştırmada öğrenme güçlüğü tanısına sahip olan ve bir ilkokula devam etmekte olan dokuz öğrenciye dokuz haftalık benlik saygısı artırma psikoeğitim programı uygulanmıştır. Uygulanan psikoeğitim programının bir oturumu ebeveyn oturumu olarak planlanmıştır. Araştırmada deneysel işlemin etkisinin tek grup üzerinde test edildiği tek grup ön test son test araştırma deseni tercih edilmiştir. Öğrenme güçlüğü tanılı öğrencilerin benlik saygısı düzeylerinin belirlenmesinde Coopersmith Özsaygı Envanteri kullanılmıştır. Psikoeğitim programı öncesinde öğrenme güçlüğü tanılı öğrencilere ön test olarak uygulanan ölçek, psikoeğitim programının tamamlanmasının ardından son test olarak tekrar uygulanmıştır. Son test uygulamasından sekiz hafta sonra aynı ölçek öğrencilere izleme testi olarak yeniden uygulanmıştır. Araştırmada verilerin normal dağılım varsayımlarını yerine getirememesi nedeniyle ön test, son test ve izleme testinden elde edilen veriler arasında anlamlı olarak farklılaşma bulunup bulunmadığı Friedman testi ve aynı veri kaynağından edinilen veriler arasındaki farkın hangi gruplar arasında olduğu Wilcoxon işaretli sıra testi ile analiz edilmiştir. Elde edilen sonuçlar uygulanan psikoeğitim programının öğrenme güçlüğü tanılı öğrencilerin benlik saygısı düzeylerini artırmada kalıcı etki sağladığını ortaya koymaktadır. Bu doğrultuda araştırmadan elde edilen bulgular literatür ışığında tartışılmıştır.

Learning difficulties in the school performance

This paper is a study on the concept of learning disabilities and reading comprehension. Specifically, it studies the learning difficulties and the reading ability in terms of the school performance of the students of the first grades of primary school. In our work we try to analyze and present the following topics: The definition of the term "Learning Disabilities", their etiology and the correlation of learning difficulties and reading. What learning difficulties do we face in reading and writing and how do they affect the school context and students' performance. How to diagnose learning disabilities in reading ability and interventions that need to be implemented in the classroom to reduce them.

Peer support for discharge from inpatient mental health care versus care as usual in England (ENRICH): a parallel, two-group, individually randomised controlled trial

SummaryBackgroundHigh numbers of patients discharged from psychiatric hospital care are readmitted within a year. Peer support for discharge has been suggested as an approach to reducing readmission post-discharge. Implementation has been called for in policy, however, evidence of effectiveness from large rigorous trials is missing. We aimed to establish whether peer support for discharge reduces readmissions in the year post-discharge.MethodsWe report a parallel, two-group, individually randomised, controlled superiority trial, with trial personnel masked to allocation. Patients were adult psychiatric inpatients (age ≥18 years) with at least one previous admission in the preceding 2 years, excluding those who had a diagnosis of any organic mental disorder, or a primary diagnosis of learning disability, an eating disorder, or drug or alcohol dependency, recruited from seven state-funded mental health services in England. Patients were randomly assigned (1:1) to the intervention (peer support plus care as usual) or control (care as usual) groups by an in-house, online randomisation service, stratified by site and diagnostic group (psychotic disorders, personality disorders, and other eligible non-psychotic disorders) with randomly permuted blocks of randomly varying length to conceal the allocation sequence and achieve the allocation ratio. The peer support group received manual-based, one-to-one peer support, focused on building individual strengths and engaging with activities in the community, beginning during the index admission and continuing for 4 months after discharge, plus care as usual. Care as usual consisted of follow-up by community mental health services within 7 days of discharge. The primary outcome was psychiatric readmission 12 months after discharge (number of patients readmitted at least once), analysed on an intention-to-treat basis. All patients were included in a safety analysis, excluding those who withdrew consent for use of their data. The trial is registered with the ISRCTN registry, ISRCTN10043328. The trial was complete at the time of reporting.FindingsBetween Dec 1, 2016, and Feb 8, 2019, 590 patients were recruited and randomly assigned, with 294 allocated to peer support (287 included in the analysis after withdrawals and loss to follow-up), and 296 to care as usual (291 in the analysis). Mean age was 39·7 years (SD 13·7; range 18–75). 306 patients were women, 267 were men, three were transgender, and two preferred not to say. 353 patients were White, 94 were Black, African, Caribbean, or Black British, 68 were Asian or Asian British, 48 were of mixed or multiple ethnic groups, and 13 were of other ethnic groups. In the peer support group, 136 (47%) of 287 patients were readmitted at least once within 12 months of discharge. 146 (50%) of 291 were readmitted in the care as usual group. The adjusted risk ratio of readmission was 0·97 (95% CI 0·82–1·14; p=0·68), and the adjusted odds ratio for readmission was 0·93 (95% CI 0·66–1·30; p=0·68). The unadjusted risk difference was 0·03 (95% CI –0·11 to 0·05; p=0·51) in favour of the peer support group. Serious adverse events were infrequent (67 events) and similar between groups (34 in the peer support group, 33 in the care as usual group). Threat to life (self-harm) was the most common serious adverse event (35 [52%] of 67 serious adverse events). 391 other adverse events were reported, with self-harm (not life threatening) the most common (189 [48%] of 391).InterpretationOne-to-one peer support for discharge from inpatient psychiatric care, plus care as usual, was not superior to care as usual alone in the 12 months after discharge. This definitive, high-quality trial addresses uncertainty in the evidence base and suggests that peer support should not be implemented to reduce readmission post-discharge for patients at risk of readmission. Further research needs to be done to improve engagement with peer support in high-need groups, and to explore differential effects of peer support for people from different ethnic communities.FundingUK National Institute for Health Research.

Lessons on Learning in Later Life With the MIT AgeLab 85+ Lifestyle Leaders

Previous research has established the role of lifelong learning in promoting psychological wellbeing and active aging. Population aging necessitates an understanding of the unique opportunities and challenges around formal and informal learning in later life. This paper will share findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders, a panel comprised of octogenarians and nonagenarians from across the United States. Drawing on an online survey and virtual focus groups with 29 Lifestyle Leaders from January 2021, findings suggest the Lifestyle Leaders most often learned new things from talking with others (46%) and reading print (54%) or online (54%) sources. The majority were familiar with attending in-person lectures or classes (89.7%) and were now using videoconferencing to do these (78.6%). A majority (56.7%) had or are currently participating in a lifelong learning program. Most consider themselves lifelong learners and described this around remaining curious and engaged with life, choices around what one learns, and greater enjoyment of learning. In the survey, a plurality of Lifestyle Leaders indicated the top two challenges affecting their ability to learn were sensory burdens (e.g., hearing loss, declining eyesight) (35%) and their energy level (32.4%); focus group data revealed that recall also is a barrier. Focus group data further highlighted generational experiences around early life learning and career paths, specifically how gender roles, diagnoses of learning disabilities, and evolving digital technology have affected these and changed over the course of their lifetimes.

Early diagnosis and management of learning disabilities in children living in rural communities

Abstract Children with learning disabilities have been shown to experience complex emotional and conduct difficulties, poor self-esteem and school refusal due to late diagnosis and inappropriate management. The current project has been conceived in light of the unique circumstances found in Greece, with a tremendous shortage of diagnostic services for learning difficulties in children attending primary schools and a total lack of family support services for the management of these difficulties at home. A university mobil unit was set in mid 2020 with funds raised by the Region of Crete, aiming at diagnosing learning difficulties in children living in remote areas as well as offering tailor-made biopsychosocial counselling to their families, at no cost. Diagnosis is made on the basis of reliable tools (e.g. WISC VGR, etc) by a range of specialised professionals (e.g. child psychologists, speech therapists, nurses, social workers). Children diagnosed with a learning disability receive a personalised intervention plan and a package of educational and counselling services ranging from 8-12 one-to-one tutoring sessions. Preliminary analysis of 68 records indicates 54 children being diagnosed with some type of learning disability. Nearly 40.0% of them were older than 10 years (implying delayed treatment seeking) and 46.3% lived in rural areas (implying service accessibility). Prevalence was higher among males as compared with females (61.1% vs 38.9%). A high prevalence of emotional difficulties was identified in children with learning disabilities (32.4%). Out of 54 children assessed for intelligence level, 8(14.8%) scored very low (70-79units) and 4 (7.4%) scored extremely low (below 69units). Out of the 12 who scored low, 11 were males. Family-centred and community-oriented interventions are necessary for early diagnosis and holistic management of learning disabilities. The project bears useful insight for health policy and health services planning. Key messages Early diagnosis and targeted interventions can help children overcome their difficulties. Family-centred interventions are necessary for efficient management of learning disabilities.

External Validation of BMT-i Computerized Test Battery for Diagnosis of Learning Disabilities.

Background: Learning disabilities (LDs) are a major public health issue, affecting cognitive functions and academic performance for 8% of children. If LDs are not detected early and addressed through appropriate interventions, they have a heavy impact on these children in the social, educational, and professional spheres, at great cost to society. The BMT-i (Batterie Modulable de Tests informatisée, or “computerized Adaptable Test Battery”) enables fast, easy, reliable assessments for each cognitive domain. It has previously been validated in children ages 4–13 who had no prior complaints. The present study demonstrates the sensitivity of the BMT-i, relative to reference test batteries, for 191 children with cognitive difficulties.Materials and Methods: These 191 subjects were included in the study by the 14 pediatricians treating them for complaints in five cognitive domains: written language [60 (cases)]; mathematical cognition (40); oral language (60); handwriting, drawing, and visuospatial construction (45); and attention and executive functioning (45). In accordance with a predefined protocol, the children were administered BMT-i tests first, by their pediatricians, and reference tests later, by specialists to whom the BMT-i test results were not disclosed. Comparison of BMT-i and reference test results made it possible to evaluate sensitivity and agreement between tests.Results: For each of the five domains, the BMT-i was very sensitive (0.91–1), and normal BMT-i results were highly predictive of normal results for specialized reference tests [negative likelihood ratio (LR–): 0–0.16]. There was close agreement between BMT-i and reference tests in all domains except attention and executive functioning, for which only moderate agreement was observed.Conclusion: The BMT-i offers rapid, reliable, simple computerized assessments whose sensitivity and agreement with reference test batteries make it a suitable first-line instrument for LD screening in children 4–13 years old.

Lower dietary intake of magnesium is associated with more callous–unemotional traits in children

ABSTRACT Background: Although researchers increasingly recognize the role of nutrition in mental health, little research has examined specific micronutrient intake in relation to antisocial behavior and callous–unemotional (CU) traits in children. Vitamin B6 and magnesium are involved in neurochemical processes implicated in modulating antisocial behavior and CU traits. The current study examined dietary intakes of magnesium and vitamin B6 in relation to antisocial behavior and CU traits. Method : We enrolled 11–12 year old children (n = 446, mean age = 11.9 years) participating in the Healthy Brains and Behavior Study. Magnesium and vitamin B6 dietary intake were assessed with three 24-hour dietary recall interviews in children. CU traits and antisocial behavior were assessed by caregiver-reported questionnaires. We controlled for age, sex, race, total energy intake, body mass index, social adversity, ADHD or learning disability diagnosis, and internalizing behavior in all regression analyses. Results: Children with lower magnesium intake had higher levels of CU traits, controlling for covariates (β = −0.18, B = −0.0066, SE = 0.0027, p < 0.05). Vitamin B6 intake was not significantly associated with CU traits (β = 0.061, B = 0.19, SE = 0.20, p > 0.05). Neither magnesium (β = 0.014, B = 0.0020, SE = 0.0093, p > 0.05) nor vitamin B6 (β = 0.025, B = 0.33, SE = 0.70, p > 0.05) were significantly associated with antisocial behavior. Conclusions: Findings suggest that low dietary intake of magnesium may play a role in the etiology of CU traits but not general antisocial behavior. More studies are needed to determine if magnesium supplementation or diets higher in magnesium could improve CU traits in children.

The impact of COVID-19 related educational disruption on children and adolescents: An interim data summary and commentary on ten considerations for neuropsychological practice

Objective The coronavirus 19 (COVID-19) pandemic resulted in educational disruption of historic breadth and duration. The authors describe early studies and interim standardized assessment reports to highlight effects of educational disruption and present critical questions for neuropsychologists. Method A summary of pre-pandemic and interim literature was compiled, including analyses of national and local assessment data and preliminary studies on academic gains related to remote learning, educational and school services disruption, chronic absenteeism, and child and adolescent mental and physical health during 2020–2021. Ten major themes were identified in the early reports on impacts of educational disruption. Results Preliminary information indicates prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities: students of color, students with disabilities, English learners, and students from low-income households. There have also been increased mental and physical health challenges for some youth during the pandemic. Other literature highlights challenges such as diagnosis of learning disabilities, reliance on normative data and development of academic recovery programs. Conclusion The effects of prolonged educational disruption and psychological stressors on learning and mental health should be considered in the neuropsychological evaluation of children and adolescents, especially marginalized students. Normative data collected prior to the pandemic may be insufficient for interpretation of scores, and evaluation and treatment may be delayed due to backlog and increased demand. Clinical practice considerations are presented.

Writing from Multiple Source Texts: SRSD for Fifth Grade Learners in Inclusive Settings

AbstractWriting is an essential academic skill that proves challenging for many learners both with and without diagnosed learning disabilities. In this multiple probe across participants study, a fifth‐grade special educator in an inclusive setting implemented Self‐regulated Strategy Development for the informational genre. Eight Black students participated—five had IEPs, three were referred by teachers. Research questions explored fidelity of SRSD instruction following practice‐based professional development; social validity; and the impact on writing outcomes including genre elements, length, holistic quality, strategy use, and academic vocabulary. The teacher implemented SRSD with high fidelity. All writing outcomes increased following intervention. Instances of copying text directly from sources decreased. Both teacher and students rated SRSD high on measures of social validity.

Audit on antipsychotic prescribing in children and young people with a learning disability under the care of mental health services in Surrey

AimsTo check the extent to which National Institute of Clinical Excellence (NICE) guidelines were being followed in clinical practice with regards to prescribing antipsychotic medication to Child and Adolescent Mental Health Services (CAMHS) patients with a diagnosed learning disability (LD).MethodA data collection tool (based on a similar Royal College of Psychiatrists [RCPsych] audit) was filled out with retrospective data from patients’ clinical records, then analysed using Microsoft Excel and Microsoft Powerpoint.The agreed standards were the NICE guidelines.There were no ethical issues as the data were retrospective and anonymised.Sample size was 13, comprising 7 males and 6 females.All service users were less than 18 years of age.Result7 out of the 13 patients who were prescribed antipsychotics had a Severe/Profound LD.Among the 5 patients who had been prescribed antipsychotic medication, 4 were on Risperidone and 2 were on Aripiprazole. The reasons for starting antipsychotic medication were clearly documented for all 5, the most common reasons being overt aggressive behaviour and general agitation/anxiety.Only 1 patient had antipsychotic medication initiated in the previous 12 months. NICE guidelines had been generally followed for the management of this case, with good documented evidence.For the other 4 patients, in whom antipsychotic medication was initiated more than 12 months ago, there was a lack of documentation of the subsequent assessment of side effects, extra-pyramidal side effects, body weight, blood pressure, glycaemic control and lipid profile. 1 of these patients did not have a documented review of antipsychotic medication in the previous 6 months. For the other 3 patients, their medication reviews did not consider whether to reduce the dose or stop antipsychotic medication.1 patient had been transferred to primary care, with a clear transfer of prescribing responsibility and documented evidence that written guidance was provided to primary care which addressed all the necessary management details.ConclusionAlthough there was clear documentation of reasons for initiating antipsychotics, there appeared to be a lack of awareness of NICE guidelines for antipsychotic medication reviews, side effect and metabolic markers assessment, and their documentation. This is an area for potential change in practice to conform better to national guidelines and improve patient care.

The Effects of a Multicomponent Motivational System Intervention Using Peer-Tutoring for Implementation on the Automation of Single-Digit Addition Tasks of Four Struggling Elementary Students

Derived math fact fluency becomes more imperative across all mathematical content areas during a students’ mathematics development. However, many of them struggle to automate the most basic math facts sufficiently and therefore are not able to deal with more complex mathematical problems. This leads to the fact that many of them are already left behind in the early years of their school careers whether they have diagnosed learning disabilities or not. In this single-case research project, we evaluated a peer-tutoring approach designed to extend the number of automated single-digit addition tasks for four struggling elementary students through a multicomponent motivational system including immediate correction of errors, graphical feedback on performance, positive reinforcement, direct instruction flashcards, and a racetrack game. A multiple-baseline design (ABE) across subjects was applied to assess the effects of the treatment. The results indicate significant and large effects of the intervention on the number of automated math facts for the participants. This substantiates the assumption that the math-fact recall performance of struggling students can be improved through the method of peer tutoring even with the limited resources available in everyday school life.

Research on Professionalism and Support Needs of Teachers at Special Education Support Center for Learning Disabilities Diagnosis

Research on Professionalism and Support Needs of Teachers at Special Education Support Center for Learning Disabilities Diagnosis

Using a Technology-Based Graphic Organizer to Improve the Planning and Persuasive Paragraph Writing by Adolescents With Disabilities and Writing Difficulties

A multiple-probe design was used to investigate planning and persuasive paragraph writing by three secondary students with disabilities and writing difficulties. The intervention consisted of one-on-one explicit instruction in persuasive writing and the use of a technology-based graphic organizer (TBGO) with embedded strategies and supports. Dependent variables included the number of sentences and overall holistic writing quality. The results were mixed. Two adolescents with the primary diagnosis of learning disabilities improved their writing performance when using the TBGO and remained above baseline levels when the TBGO was removed. One more participant diagnosed with autism demonstrated modest changes in the quantity and quality of his writing. Students reported positive perceptions of the TBGO, indicating a socially valid intervention. Implications, limitations, and directions for future research are discussed.

Correlation between primary headaches and learning disabilities in children and adolescents.

Primary headaches (H) and learning disabilities (LD) are frequent in childhood and can coexist in the same subject, but their correlation is not always clear. The aim of our study was to evaluate this relationship considering also any psychopathologies and their influence on the quality of life by considering an aspect such as school absences. One hundred and ninety-three children (8-18y) with H and LD assessed consecutively at the Headache Center of L'Aquila, from 2013 to 2018 are the sample. School problems were evaluated by Italian batteries for LD; psychopathology screening by clinical interview and SAFA test. The sample was divided into 3 groups (group 1: patients with H [N.=122], group 2: patients with LD [N.=37], group 3: patients with H+LD [N.=34]) in order to compare subjects with H and LD vs. subjects having only one disorder. The most prevalent headache diagnosis was migraine without aura, but chronic tension headache (CTH) showed a stronger impact on quality of life. LD have a higher prevalence in our sample (9.44%) than in general Italian population (3.2%). In group 3 was higher prevalence of anxiety disorders (P=0.050) and 50% of patients with CTH was absent from school due to headache. LD can be related to headache chronicization and to a higher prevalence of psychopathologies and school absences, so an early diagnosis of LD in patients with H is crucial to prevent the worsening of the headache itself and of quality of life.

Together and apart: using Plasticine as a sensory therapeutic intervention for a service user diagnosed with severe learning disabilities

ABSTRACT Background The prevalence of mental illness among people diagnosed with severe learning disabilities is well documented, however limitations in verbal, cognitive, emotional and social skills are often used as reasons to withhold referrals for psychotherapeutic interventions within this client group. Context This paper describes the one-year art-therapy informed psychotherapeutic work carried out with Ioanna, a 61-year-old lady with a dual-diagnosis that took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. Approach Within the case-vignette the use of Plasticine as a therapeutic medium is presented. Concepts from psychodynamic and object-relations theory are also used as a framework for understanding the course of this therapeutic intervention. Outcomes The contribution of sensory materials appeared valuable in this psychotherapeutic intervention with an apparently ‘untreatable’ institutionalised service user, helping to build a trusting psychotherapeutic relationship, and enable Ioanna to regulate some of her challenging behaviours. Conclusions The use of Plasticine and play, and the development of a ‘together and apart’ game within a psychotherapeutic intervention, appeared to modify Ioanna's challenging behaviour, and improve her ability to relate and communicate with the therapist and her carers. Implications for research Research into the use of Plasticine as part of an art therapy programme for people with severe learning difficulties, would provide a useful addition to the knowledge in this area. A review of the current psychiatric services in Greece and of what constitutes ‘clinical progress’ also seems necessary. Plain-language summary This paper describes the one-year art-therapy informed psychotherapeutic work I undertook with Ioanna, a 61-year-old lady with a diagnosis of severe learning disabilities and mental illness. This took place in a Residential Unit providing psychosocial support for people with severe psychiatric disorders and/or learning disabilities in Athens Greece during 2018. At this time, I was also undergoing my art therapy training. The practice description in this paper describes the contribution of Plasticine as a sensory, therapeutic medium. Theories related to the relationship that a baby or child develops with its primary care giver are used as a framework for understanding the course of this therapeutic intervention. The relationship between learning disabilities and mental illness is well documented in clinical literature, however people with dual diagnosis or severe learning disabilities are often overlooked where referrals for psychotherapy are concerned, as it is believed that they cannot take part due to a perceived lack of communication skills. This paper describes how the use of Plasticine and playing a ‘together and apart' game appeared to contribute to Ioanna’s development of a trusting therapeutic relationship, the modification of challenging behaviour, and improved communication through the medium of Plasticine and play. Research into the use of Plasticine and the ‘together and apart game' with this client group is recommended. It is also important to rethink and reflect on the provision of psychotherapeutic services within the current psychiatric services in Greece for this client group, and consider what constitutes clinical ‘progress' from the client’s perspective.

Association between serum selenium concentrations and learning disability in a nationally representative sample of U.S. children

ABSTRACT Background Oxidative stress has been implicated in the pathogenesis of neurodevelopmental disorders. As an anti-oxidative agent, selenium plays an important role in human health. However, the relationship between selenium status and learning disability (LD), a common neurodevelopmental disorder, is unknown. Objective To examine the association between serum selenium concentrations and learning disability. Design Nationwide, population-based, cross-sectional study. Participants/setting Children aged 4–11 years who have available data on serum selenium concentrations and LD (N = 1,076) from the U.S. National Health and Nutrition Examination Survey 1999–2000. Exposure Serum selenium levels were measured using atomic absorption spectrometry. Main outcome measures Diagnosis of LD was reported by the children’s parents. Statistical analyses performed Logistic regression models with survey weights were conducted adjusting for age, race/ethnicity, family income, total energy intake, body mass index, and serum cotinine levels. Results In this study, 8.2% (95% confidence interval [CI] 5.2%–11.2%) of children had a diagnosis of LD. Serum selenium concentration was lower among children with LD than those without LD (geometric mean ± standard error, 107.7 ± 2.7 ng/mL vs. 112.8 ± 1.0 ng/mL, P for difference = 0.08). The adjusted odds ratio (OR) of LD comparing the highest with lowest tertile of serum selenium concentrations was 0.39 (95% CI 0.19–0.82). Each 10 ng/mL increment in serum selenium concentrations was associated with 31% (OR 0.69, 95% CI 0.51–0.93) lower odds of LD. Conclusions Higher serum selenium concentration was associated with a lower risk of LD in U.S. children. The causal relationship between selenium and LD and the underlying mechanisms warrant further investigation.

Elementary School Teachers' Perception of the Learning Disability Diagnosis Request Process: Focus Group Interview

Elementary School Teachers' Perception of the Learning Disability Diagnosis Request Process: Focus Group Interview