Significant Learning Difficulties Research Articles

13 Verbal Memory and Learning Strategies in an Autistic Sample Using the CVLT

Objective:The present study aims to better understand learning strategies and difficulties in autistic youth. Previous studies have found that autistic youth have difficulties with executive function skills and poorer performance in memory and learning tasks, especially those that require spontaneous retrieval of information compared to memory tasks that provide external retrieval cues. Additionally, it has been theorized that autistic youth employ a serial approach rather than a semantic approach to learning. The current study hypothesized that the autistic sample will have (a) significant difficulties in learning and memory, (b) employ a serial approach more frequently and a semantic approach less frequently than the CVLT normative sample, and (c) will benefit significantly when provided with external retrieval cues.Participants and Methods:Archival data from a mixed clinical and research database were examined for this study. Participants include 740 autistic individuals between the ages of 5.50 and 24.3 (M = 10.90, SD = 2.98). The sample consisted of 22.2% girls and 34.0% Black, Indigenous, and people of color (BIPOC). All individuals had a FSIQ > 70 (M = 99.91, SD = 16.09) and were clinically diagnosed with autism using DSM-IV-TR or DSM-V criteria by a clinician at an autism diagnostic center. Participants completed the age-appropriate California Verbal Learning Test (CVLT, Delis et al. 1987) which is a neuropsychological measure that examines verbal memory and learning. One-sample t-tests were used to examine the sample's verbal memory abilities and their learning strategies. A paired sample t-test was used to evaluate the sample's performance before and after an external retrieval cue was given.Results:Results from the one-sample t-tests indicate that the autistic sample performed worse than the CVLT normative data with a large effect size (t(739)= -9.440, p <.001, Cohen's d = 1.292). Secondly, the autistic sample was less likely to use a semantic learning approach (t(739) = -1.841, p = .033, Cohen's d = 1.234), but not more likely to use a serial approach (t(739)=-.040, p=.484) compared to the normative sample. Lastly, the paired sample t-test results show that the sample performed significantly better after receiving the external retrieval cue (t(739)=-2.570, p=.005, Cohen's d = .770).Conclusions:The data supported the first hypothesis; autistic individuals have increased difficulties with learning and verbal memory. However, the data only partially support the second hypothesis. The sample was less likely to use a semantic approach to learning but was not more likely to use serial learning. This finding is opposed to the Weak Central Coherence (WCC) theory, which suggests that autistic individuals are more likely to have detail-oriented, bottom-up cognitive thinking styles, consistent with a serial learning strategy. Lastly, data showed improvement when autistic individuals received a retrieval cue. This result supports the Task Support Hypothesis (TSH) and indicates that autistic individuals benefit from cues for memory recall, particularly those that capitalize on their areas of strength. This study did not use a control group and is limited in ethno-racial diversity; therefore, these are preliminarily findings that require further replication.

Description of Main Innovative and Alternative Methodologies for Mathematical Learning of Written Algorithms in Primary Education.

The traditional way of teaching mathematics generates significant learning difficulties in students that are reflected in their academic performance. In recent years, the number of teachers and researchers interested in finding innovative, flexible and comprehensible methodologies has increased. The main objective of this article has been to carry out a theoretical review of the methodologies for learning/teaching mathematics at school level. Central elements of international and national method initiatives have been highlighted. The empirical evidence on the Singapore method and the Algorithm Based on Numbers (ABN) method confirms the need to include innovative and manipulative strategies in the classroom. The Singapore method has been shown as a source that improves students′ problem solving skill, mathematical competence, boosting reasoning, and a higher motivation. Some studies focused on the effectiveness of the ABN method and its influence on mathematical cognition. The use of this methodology and learning in flipped classroom have obtained significant results in teacher training. These results could provide guidance about how to improve pre-service education in Primary Bachelor’s Degree. The findings presented in the manuscript could be a basis for opening new lines of quantitative research, with the aim of analysing problem solving and the use of manipulative materials in mathematics. Thus, future research should focus on analysing the cognitive processes involved in mathematical learning, carrying out empirical studies in schools. In addition, it is necessary to improve future teachers’ training, so that they can learn about new alternatives for mathematical teaching and the available resources to be able to put it into practice. Moreover, alternative methodologies are a necessary driver for the improvement of mathematical performance both inside and outside the classroom, and also for the technological and economic development of countries.

Attention deficit hyperactivity disorder and associated learning difficulties among primary school children in district Dehradun, Uttarakhand, India.

BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a considerably common childhood-onset neurodevelopmental disorder, often associated with socio-behavioral and academic difficulties. There is an increased risk for development of a range of future problems such as psychiatric disorders, difficulties in employment, and relationships. The aim of this study was to know the prevalence and determinants of ADHD among primary school children in district Dehradun and to assess the learning difficulties and classroom behavior in these students.MATERIALS AND METHODS:In this cross-sectional study, overall, 228 students (aged 6–12 years) studying in a primary school were assessed for ADHD after seeking the written informed consent from their parents. The data were analyzed using Excel sheet and SPSS software (22.0 version). For all qualitative measures, frequency and percentages were calculated, and for quantitative measures, mean and standard deviation were calculated. For analysis of categorical values, Chi-square test was used. P < 0.05 was considered statistically significant.RESULTS:The prevalence of ADHD was found to be 11.8% based on the teacher tool only and 1.75% based on the parent and teacher tools combined. ADHD was found to be significantly more in males. Inattention was the most prevalent subtype of ADHD, and children screened positive for ADHD had significant learning difficulties at various levels.CONCLUSION:The possibility of ADHD in students with academic difficulties should not be ignored as children with ADHD usually face significant problems at school such as learning difficulties and have been shown to be at increased risk for a broad range of negative outcomes. Early identification and treatment of ADHD can significantly reduce the rates of some of these poor outcomes. Screening these children in the early years will help the parents, children, teachers, and community at large.

Effect of remedial teaching on academic performance of poorly performing students in pharmacology: a quasi experimental study

Background: Significant learning difficulties requiring remediation has been observed to be experienced by many medical trainees. Research with regard to individualized remedial teaching based on pedagogical diagnosis is a strong need of the time. The objectives of this study were to assess the effect of remedial teaching in improving academic performance among poorly performing students in pharmacology and to assess factors that could affect academic performance.Methods: The study was conducted in 2019. Academically poor performing students (&lt;50 % marks in pharmacology first sessional exam) were selected after getting informed consent. After obtaining baseline information and study skills self-assessment inventory information from all students, academically poor performing students (53 students) were identified and they were randomized into two groups. One group (26 students) received academic support alone. The second group (27 students) received academic support, sessions on study skills, stress-coping strategies and counselling regarding their academic and non-academic problems.Results: The improvement in test scores among all participants of remedial sessions was statistically significant. Mean pre-test mark was 5.27±3.6, post-test was 14.63±1.24 and the difference is statistically significant. Though apparently high 10.02±3.25 versus 8.59±3.55, the post intervention gain in scores is not statistically significant between academic support+special package group versus academic support alone group (p value 0.16).Conclusions: Tailored or individualized remediation measures can greatly enhance the academic performance of undergraduate medical students and help them make satisfactory progress on the course.

Representational Trajectories in the Understanding of Mendelian Genetics

Understanding genetics is one of the most significant learning difficulties faced by students. To improve teaching genetics and the students’ representational competence within the classroom have been proposed using multiple representations. This study presents an analysis of representational levels used by high school students learning Mendelian genetics and determining the construction trajectories of these representations. An assessment instrument was used to analyse the representational levels of 186 students with three different teaching strategies. The levels were used to analyse and classify students’ answers, written texts, and drawings and diagrams. The result shows that learning Mendelian genetics is a gradual process in which students appeal to various levels of representations that can determine different trajectories and demonstrate progress on comprehension. We identify five trajectories, ranging from responses that rely on descriptions of observable traits to responses from students who could integrate processes or use models.

Adolescent gynaecology: anaesthetic and peri-operative care implications.

Adolescents represent a quarter of the world's population, yet their specific healthcare needs have often not been acknowledged. Whilst many operations in this population will be performed in specialist tertiary centres and children's hospitals, it is likely that care will be sought in a variety of healthcare settings, and so it is important to have an understanding of the particular approach to this age group. Paediatric and adolescent gynaecology emerged as a speciality in 2000 with the inauguration of the British Society for Paediatric and Adolescent Gynaecology, a specialist society of the Royal College of Obstetricians and Gynaecologists. This is a multidisciplinary group, comprising paediatricians, paediatric surgeons, psychologists and nurses, although the majority of the members are gynaecologists. In this review, we will describe the peri-operative implications of adolescent gynaecological surgery and the considerations that need to be applied to this specific age group, such as consent, the operative setting and key personnel. We will also discuss specialist situations which are likely to fall to an adolescent gynaecology setting, such as management of those with Mullerian abnormalities, which often present with pelvic pain in adolescence. We discuss those with a history of ritual female genital cutting (female genital mutilation), trans men and those with significant learning difficulties. In all circumstances, teamwork, reflection and pragmatism are key.

Psychosocial Factors Influencing Learning Difficulties Among Individuals with Special Needs

Abstract This study examined the influence of psychosocial factors on learning difficulties among adolescents with special needs. A cross-sectional survey design was utilized. One hundred and twenty adolescents comprising 56.7% males were purposively selected among students at a facility for special needs individuals in Ilorin, Nigeria. Data were collected with a structured questionnaire containing perceived stigma of intellectual disability scale, social support questionnaire and Colorado learning difficulties questionnaire. Only individuals who voluntarily consented to participate were included in the study. Data were subjected to statistical analysis utilizing the SPSS v20. There was no significant gender difference on learning difficulties among individuals with special needs (t (118) =. 138, p&gt;.05). Individuals with high perceived stigma reported significant higher learning difficulties compared to their peers with low perceived stigma (t (118) = 15.70; p˂.05). There was a significant influence of type of disability on learning difficulty (F (2, 117) =9.152, p&lt; .01); individuals with intellectual impairment exhibited more learning difficulty compared with those with visual impairment (8.09) and those with hearing impairment (11.62). The study recommends that government should reinforce law that protect individuals living with disability and enhance their learning in schools. It is also important that sufficient support services are made available for these students to reinforce their motivation for school learning.

Integration of Neuro-Oncology and Pediatric Palliative Care at Diagnosis in the Outpatient Setting. (FR436)

•Gain knowledge about the common types of life-threatening brain tumors seen in children, cutting edge treatments for these tumors, and why an understanding of neuro-oncology is critical to pediatric palliative care providers.•Describe the barriers to introducing palliative care at the time of diagnosis of a high grade pediatric brain tumor and how the pediatric neuro-oncology and palliative care teams negotiated a patient/family-focused approach that overcame the barriers.•Weigh the advantages and disadvantages of several different models for overcoming the logistical challenges of integrating palliative care into a pediatric neuro-oncology clinic.•Be able to quote data that supports the benefits of early introduction of palliative care in the management of pediatric neuro-oncology patients diagnosed with life-threatening tumors. Brain tumors are the second most common tumor in children accounting for about 1 in 4 tumors. They are also the leading cause of cancer-related death in children. The tumors and their treatments are associated with significant physical symptoms, psychological strain, learning difficulties, and mortality. For these reasons, it is imperative that children with brain tumors have access to palliative care starting at the time of diagnosis. Unfortunately, access to palliative care for these children is not universal and when available is often indroduced late in the couse of disease. The prognosis and treatment of the most common life-threatening brain tumors will be reviewed by a neuro-oncology team. The neuro-oncology team will also share five years of experience embedding palliative care into the pediatric oncology clinic at a large tertiary care hospital. In this setting, it has been shown that families are very open to and appreciative of early palliative care when it is framed by the oncology team as an essential part of the care of children with brain tumors. The neuro-oncology team and the palliative care team will dialogue about the sources of resistance to early introduction of palliative care and how this resistance can be overcome. The practical considerations involved in the implementation of clinic-based palliative care will also be discussed. This will include staffing and the advantages of different clinic models including 1) embedded clinics, 2) floating clinics, and 3) free standing clinics. Finally, a retrospective review of 5 years of clinical data collected on over 60 pediatric neuro-oncology patients concurrently followed in palliative care clinic will be presented. The data will include type of brain tumor, time from diagnosis to palliative consult, symptom frequency, time from POLST completion to death, time from hospice referal to death, and location of end of life care.

Deletion of chromosomal regions 13q21 detected by genetic tests in a boy with special learning disorder: A case report

Specific learning disorder (SLD) is defined as significant and persistent learning difficulties leading to unexpected academic underachievement in terms of the subjectÂ’s age and cognitive ability, and the level of education provided. SLD has a biological basis determined by genetic and environmental factors. Neurobiological hypotheses have been proposed to account for SLD, and genetic factors have been proved to have a major effect on the etiology. Findings of specific language impairment (SLI), such as speech delay, are frequently seen in early childhood in SLD cases. Recent studies of the etiology of SLI have also focused on genetic causes and have suggested a genetic inheritance. We report the case of a nine-year-old SLD patient with 13q21 deletion, who was a prior diagnosed with language impairment in early childhood. The case is discussed in the light of the current literature.

Management of Cochlear Nerve Hypoplasia and Aplasia.

Approximately 2% of congenital profound deafness cases are due to cochlear nerve (CN) deficiency. MRI is essential to confirm if the nerve is deficient, but because of limitations with resolution, especially when the internal auditory canal is narrowed, it is often unable to distinguish between hypoplasia and aplasia. A full audiometric test battery should always be performed, even if the MRI suggests CN aplasia, as there will sometimes be evidence of audition. Electrically evoked auditory brainstem response testing can be carried out transtympanically via the round window or using an intracochlear test electrode to help determine the status of the CN. If any test suggests the presence of a CN, then cochlear implantation (CI) should be considered. Children should be followed up closely with audiometric, electrophysiological and language assessments to determine the benefits. They may initially show benefit but fail to progress. CI results are variable and often result in poor outcomes with Categories of Auditory Perception scores of <5. Auditory brainstem implantation (ABI) can be considered when CI is contraindicated or fails to provide adequate benefit. This may provide better outcomes, but this form of surgery has greater risks and future device replacement (in case of device failure) may be complicated. Careful patient selection is required when considering ABI as significant learning difficulties make programming extremely challenging. Patients should be given the option of CI first and then ABI. A small minority of patients presenting late (around 2-3 years of age) may be candidates for simultaneous CI and ABI.

Oral Administration of Clinical Stage Drug Candidate SENS-401 Effectively Reduces Cisplatin-induced Hearing Loss in Rats.

SENS-401, an oral clinical-stage drug, may reduce cisplatin-induced hearing loss and cochlear damage in an in vivo model. Cisplatin is commonly associated with hearing loss, causing significant learning and behavioral difficulties in the pediatric cancer population, and for which there are currently no clinical solutions. SENS-401 has previously been shown to improve acoustic trauma-induced hearing loss in vivo. The effect of SENS-401 (R-azasetron besylate) on cisplatin IC50 values was evaluated in a panel of cisplatin-sensitive cell lines (NIH:OVCAR-3, SK-N-AS, NCI-H460, FaDu). Auditory brainstem response and distortion product otoacoustic emission tests were performed in a rat model of cisplatin-induced hearing-loss (8 mg/kg, day 1) at baseline, and after 14 days of SENS-401 (6.6, 13.2, 26.4 mg/kg/d). Cochlear outer hair cells were counted after immunolabeling for myosin-VIIa. Cisplatin cytotoxicity was not impacted by the addition of SENS-401 (up to 10 μM) in any of the cell types evaluated. In vivo, all SENS-401 doses significantly improved auditory brainstem response threshold shift (up to 30 dB) and distortion product otoacoustic emission amplitude loss (up to 19 dB) over placebo. Body weight and survival were not significantly different between rats receiving placebo and those receiving 26.4 mg/kg SENS-401. Significantly more surviving outer hair cells were present after SENS-401 treatment compared with placebo (p < 0.001), with up to 11-fold more in the basal turn of the cochlea. In vivo and in vitro data support the otoprotective potential and tolerability of SENS-401 without impacting chemotherapeutic potential. Oral SENS-401 is a promising candidate for treating cisplatin-induced ototoxicity.

A systematic review of interventions for children presenting with dyscalculia in primary schools

The acquisition of numerical competency is regarded as imperative for quality of life and economic well-being. Many children have significant mathematical learning difficulties known as dyscalculia. The aim of this research was to systematically review the available literature for interventions with children presenting with dyscalculia in primary schools, in order to provide an evidence base of filtered information assessed for methodological rigour and coherence. The study evaluated literature from 2004 to 2014 that reported on interventions for primary school children presenting with dyscalculia. Specific databases were accessed to highlight literature for inclusion in the study. The studies were assessed at title, abstract and full text levels for quality based on the inclusion and exclusion criteria. The findings provide a base of effective interventions that can be used in the school setting for individual development with a holistic focus and present various methods of instruction for children presenting with dyscalculia.

Impact of Attention Training on Academic Achievement, Executive Functioning, and Behavior: A Randomized Controlled Trial.

Children with intellectual and developmental disabilities (IDD) experience significant difficulties in attention, learning, executive functions, and behavioral regulation. Emerging evidence suggests that computerized cognitive training may remediate these impairments. In a double blind controlled trial, 76 children with IDD (4-11 years) were randomized to either an attention training (n = 38) or control program (n = 38). Both programs were completed at home over a 5-week period. Outcome measures assessed literacy, numeracy, executive functioning, and behavioral/emotional problems, and were conducted at baseline, post-training, and 3-month follow-up. No training effects were observed at post-training; however, children in the training group showed greater improvements in numeracy skills at the 3-month follow-up. These results suggest that attention training may be beneficial for children with IDD; however, the modest nature of the intervention effects indicate that caution should be taken when interpreting clinical significance.

Intervention in reading processes in pupils with Specific Language Impairment (SLI).

Children with Specific Language Impairment (SLI) encounter significant difficulties in learning to read. The aim of this research was to determine the efficacy of an intervention program on reading processes (letter identification, lexical processes, syntactic processes and semantic processes) in children with SLI. The sample consisted of a total of 34 pupils diagnosed with SLI and 34 children with typical language development. For the selection of the sample, the CELF-3 test, the Peabody test, the Hearing Association and Visual Association subtests of the ITPA and the K-BIT Intelligence test were used. The intervention program consisted of 144 sessions of 40 minutes each, in which oral language activities were combined with other activities related to the automation of basic reading processes and reading sentences and texts. Significant gains were also made in the group of children with SLI versus controls in lexical, syntactic, and semantic reading processes. A combined program of both oral language and reading skills improves reading achievement in pupils with SLI.

The strengths and weaknesses in verbal short-term memory and visual working memory in children with hearing impairment and additional language learning difficulties

ObjectivesTo compare verbal short-term memory and visual working memory abilities of six children with congenital hearing-impairment identified as having significant language learning difficulties with normative data from typically hearing children using standardized memory assessments. MethodsSix children with hearing loss aged 8–15 years were assessed on measures of verbal short-term memory (Non-word and word recall) and visual working memory annually over a two year period. All children had cognitive abilities within normal limits and used spoken language as the primary mode of communication. The language assessment scores at the beginning of the study revealed that all six participants exhibited delays of two years or more on standardized assessments of receptive and expressive vocabulary and spoken language. ResultsThe children with hearing-impairment scores were significantly higher on the non-word recall task than the “real” word recall task. They also exhibited significantly higher scores on visual working memory than those of the age-matched sample from the standardized memory assessment. ConclusionsEach of the six participants in this study displayed the same pattern of strengths and weaknesses in verbal short-term memory and visual working memory despite their very different chronological ages. The children’s poor ability to recall single syllable words in relation to non-words is a clinical indicator of their difficulties in verbal short-term memory. However, the children with hearing-impairment do not display generalized processing difficulties and indeed demonstrate strengths in visual working memory. The poor ability to recall words, in combination with difficulties with early word learning may be indicators of children with hearing-impairment who will struggle to develop spoken language equal to that of their normally hearing peers. This early identification has the potential to allow for target specific intervention that may remediate their difficulties.

Learning disabilities and social problem solving skills

Recent studies showed that children with learning disabilities present significant difficulties in learning as well as in social skills (Siperstein, 2009).Therefore, it was observed how it is difficult for these children to establish adequate relationships, especially to advise coping strategies to face interpersonal conflicts (Oliva & LaGreca, 1988). Accordingly to this argument and with reference to Agaliotis e Kalyva (2004, 2009), this study examines the preferences for strategies to solve an hypothetical conflict on a sample of children with LD in comparison to typical developing peers. They used the method of social story to conduct this research. In fact, researchers asked to the children, after they have listened a short story describing an interpersonal conflict interaction between adult and peers, which strategies they would have chosen if they were in the same situation and the strategies that would be most appropriate to resolve a conflict. Results obtained from the experiment corroborated literature data and demonstrated that children with LD, in comparison to typical developing peers, use and prefer dysfunctional coping strategies, aggressive or passive, also in relation to the partner interaction (adult or peers) to face interpersonal conflict.

An Analysis of a Single Case of Comorbidity between Learning Disability and Borderline Intellectual Functioning

In this study we explored a case of comorbidity between DSA and Borderline Intellectual Functioning. The girl was fourteen years old, ninth grade of school in Palermo, with significant learning difficulties. Two interviews were conducted, one with parents and one with teachers, to investigate the history of the girl's learning. In the pre-test phase the following cognitive areas were investigated: Q.I. (Level of Intelligence), decoding ability, reading comprehension and writing skills. Motivational-emotional profile was also evaluated: school motivation, self-handicapping strategies, self esteem and school anxiety. To assess these cognitive areas we used: Reading Comprehension Test(Cornoldi & Colpo, 2001), Reading Decoding Test (Cornoldi & Colpo, 2001), Dyslexic and Disorthographic Evaluation Test (Sartori, Job, & Tressoldi, 1995), Wechsler Intelligence Scale for Children, Revised (Wechsler, 1974), Self-Esteem Scale by the TMA (Bracken, 1992), School Motivational Profile (Alesi, Pepi & Rappo, 2011), Self-Handicapping Scale for Children (Waschbusch, Craig, Pelham, & King, 2007) and School Anxiety by the Psychiatric scales of Self-administration for children and adolescents (Cianchetti & Fancello, 2001). After this pre-test phase, the girl took part in T.I.R.D. Multimedia Training for the Rehabilitation of Dyslexia (Rappo & Pepi, 2011), aimed at improving decoding abilities. This training has involved the girl for three months. It consisted of specific tasks to rehabilitate both visual and phonological strategies: sound blending, word segmentation, alliteration test and rhyme test, letter recognition, digraph recognition, trigraph recognition and word recognition are samples of visual tasks. The first four are samples of phonological tasks, while the remaining four are samples of visual tasks. At last, in post-test phase, reading and writing ability were revalued. The emotional-motivational profile to monitor trends was also reappraised. Results show significant improvements from pre-test to post-test in cognitive, emotional and motivational areas investigated.

Saethre–Chotzen phenotype with learning disability and hyper IgE phenotype in a patient due to complex chromosomal rearrangement involving chromosomes 3 and 7

The authors describe on a Brazilian girl with coronal synostosis, facial asymmetry, ptosis, brachydactyly, significant learning difficulties, recurrent scalp infections with marked hair loss, and elevated serum immunoglobulin E. Standard lymphocyte karyotype showed a small additional segment in 7p21[46,XX,add(7)(p21)]. Deletion of the TWIST1 gene, detected by Multiplex Ligation Probe-dependent Amplification (MPLA) and array-CGH, was consistent with phenotype of Saethre-Chotzen syndrome. Array CGH also showed deletion of four other genes at 7p21.1 (SNX13, PRPS1L1, HD9C9, and FERD3L) and the deletion of six genes (CACNA2D2, C3orf18, HEMK1, CISH, MAPKAPK3, and DOCK3) at 3p21.31. Our case reinforces FERD3L as candidate gene for intellectual disability and suggested that genes located in 3p21.3 can be related to hyper IgE phenotype.

Perceived usefulness of learning strategies by children with Tourette syndrome plus, their parents and their teachers

Objective: Children with Tourette syndrome and other co-morbidities (abbreviated hereafter to TS+) experience significant learning difficulties. We wished to identify educational strategies that these students, their parents and teachers considered useful. Design: An ‘educational toolkit’ was compiled of 84 strategies identified by teachers of TS+ children. Setting: Children attending the TS+ clinic of a university hospital in Edmonton, Alberta. Method: The educational toolkit was administered to 30 randomly selected TS+ children attending the clinic, their teachers, and their parents. Results: 13 strategies were endorsed by ≥ 50% of the students, 53 by ≥ 50% of parents, and 42 by ≥ 50% of teachers. The 10 strategies students most strongly endorsed were: (1) computers; (2) calculators; (3) spell-checkers; (4) extra time in class; (5) less homework; (6) information from the teacher; (7) feedback on how to improve work; (8) printed assignments; (9) TS+ explained to their teacher; and (10) not being punished or suspended because of TS+ behaviours. The 10 strategies most frequently endorsed by parents were: (1) the student paying attention and being informed; (2) computers; (3) the teacher telling the whole class ‘listen carefully’ when discussing important ideas; (4) providing ideas about organizing work; (5) providing printed assignments; (6) telling students when they are being helpful; (7) encouraging students for good behaviour and signaling incorrect behaviour; (8) checking students understand each idea the teacher presents; (9) outside experts explaining TS+ to the teacher; and (10) exchanging notes with the teacher. The 10 items most strongly endorsed by teachers were: (1) providing information and direction; (2) feedback on how to improve work; (3) checking students wrote down homework assignments; (4) helping students start work assignments; (5) computers; (6) spell-checkers; (7) monitoring time and work; (8) extra time; (9) feedback about the student’s behaviour and advice if misbehaving; and (10) the teacher explaining to the class how students can help students with learning challenges. Conclusions: There is considerable agreement among parents and teachers about how to help children with TS+ with their schoolwork and behaviours.

Epilepsy is different

Epilepsy is different: a neurological disease that is common and treatable; a chronic disorder that is intermittent and not progressive; a common condition with no diagnostic test yet highly stigmatizing; and much more. We ask that epilepsy and epilepsy services be recognized as different from other chronic disorders, with inherent complexities that historically have perpetuated problems with patient care. Epilepsy is the propensity for spontaneous seizures. There is no ‘test’ for epilepsy in the way that an HbA1c, FEV1 or ECG may define and monitor other chronic disorders. Thus misdiagnosis rates, even in specialist centres, approach one-fifth – the error trending towards over- rather than under-diagnosing events as seizures.1 The epilepsy ‘tests’ – MR brain scan and EEG – can each be normal despite an absolute confidence in an epilepsy diagnosis. With no test, the clinician must rely solely upon the patient's report in assessing seizure control, usually with no way to verify this. The physical examination, though important, is quite secondary to listening to the patient and witness describing the event. The witness account is essential, as a period of unconsciousness is indescribable. However, so much surrounding the seizure is difficult to articulate: deja vu, an epigastric aura, an absence, a myoclonic jerk. How can anyone record an accurate history from someone with significant learning difficulties (30% of whom have epilepsy), or in a second language? Having the time to listen carefully to what is described and how it is said helps to differentiate an epileptic seizure from vasovagal syncope, cardiac arrhythmia, and psychogenic non-epileptic attacks. As a syndrome of symptoms (the seizures) with many causes, the management approach is analogous to that for pain. After settling that the events are indeed seizures, with no serious or progressive cause, the aim is to mask the symptoms with tablets: only rarely is it possible to remove the root cause. A trial of treatment is perfectly reasonable in most chronic conditions; indeed, it might almost be negligent to withhold it. But a trial of anti-epilepsy treatment for ‘blackouts’ risks a lifetime of unnecessary medication. Furthermore, the medication itself reinforces and even imprints a label of epilepsy. With no clear diagnostic test, it is a common temptation to start medication with insufficient evidence of epilepsy. The problem then is to know at what time-point a trial of anti-epileptic treatment has succeeded. When confidence is re-built and/or a driving licence returned, withdrawing anti-epilepsy medication in adults proves so much harder than starting it. Unlike many chronic conditions in adults, epilepsy is almost as likely at any age, and perhaps becomes more common in older age. However, there is a UK-wide dearth of older-age epilepsy specialists. We need to encourage and nurture elderly care physicians towards specializing in epilepsy. Some epilepsies remit at puberty, but most are long-term and so anti-epileptic drug treatment must often be lifelong. Broadly speaking, all available anti-epileptic drugs work for all epilepsies, yet least one-fifth of people continue to have seizures despite best available treatment.2 Young women with epilepsy must be managed with an eye to possible future effects on any unborn child. Valproate is physically3 and cognitively4 teratogenic and so women with idiopathic generalized epilepsy – for which valproate would otherwise be best5 – often must cope with suboptimal seizure control on inferior treatment. Epilepsy's intermittent nature permits its concealment, something impossible for most chronic conditions: stigma and driving ineligibility are the main motivators for non-disclosure. Epilepsy is poorly understood by the general public and generally perceived far more negatively than other chronic conditions. The lack of high-profile celebrity champions for such a common condition (though there must be many) reflects and reinforces epilepsy's perceived stigma. Its stigma may be felt more harshly by older people following exposure to (almost) Dickensian values in their youth; for example in the film, Dr Kildare's Crisis (1940), epilepsy's prognosis is ‘gradual disintegration of the brain … and wretched living death’.6 In the developing world, prevalent misconceptions about associations with the devil, witchcraft, contagion and family misfortune are the major reason for non-declaration of seizures and an astonishing (80–90% in many parts of the world) failure to access treatment.7 People with epilepsy may have missed out on education and employment opportunities, and therefore may not graduate to a position to make a difference for others with epilepsy. This contrasts with educated and eloquent advocates with multiple sclerosis or motor neurone disease, where highly motivated and wealthy people in the public eye can raise their profile.