Specific Learning Disabilities Research Articles

TRANSTORNOS ESPECÍFICOS DE APRENDIZAGEM: DISLEXIA, DISGRAFIA, DISORTOGRAFIA E DISCALCULIA EM FOCO

Educational legislation emphasizes the need to promote the full development of reading, writing and calculation skills, highlighting these skills as essential for the individual’s insertion and meaningful action in society. However, it is not uncommon for students to complete elementary school without mastering these essential skills for professional life. This article aims to investigate the difficulties faced by some students in the process of learning reading, writing and mathematical skills. Based on theoretical research, the article addresses Specific Functional Learning Disorders — Dyslexia, Dysgraphia, Dysorthography and Dyscalculia — as possible factors that negatively interfere with the academic development of these students. Presenting a theoretical foundation on the topic contributes to the review of pedagogical practice, suggesting the need for collective work in the search for resources and procedures that promote students’ proficiency both in reading and writing and in learning mathematical concepts and operations.

Investigation of Association Between Expression of DYX1C1, KIAA0319, and ROBO1 Genes and Specific Learning Disorder in Children and Adolescents.

Specific learning disorder (SLD) is prevalent worldwide and is a complex disorder with variable symptoms and significant differences among individuals. Epigenetic markers may alter susceptibility to neurodevelopmental disorders (NDDs). Aberrant expression of protein-coding (mRNA) genes in this pathology shows that the detection of epigenetic molecular biomarkers is of increasing importance in the diagnosis and treatment of individuals with SLD. We compared gene expression level of dyslexia susceptibility 1 candidate gene 1 (DYX1C1), dyslexia-associated protein KIAA0319 (KIAA0319), and roundabout guidance receptor 1 (ROBO1) between children with SLD and healthy children by performing quantitative polymerase chain reaction (qPCR). In addition, we evaluated these gene expressions of severe children with SLD compared to non-severe and male SLD children compared to females. The expression of the DYX1C1, KIAA0319, and ROBO1 genes was statistically significantly upregulated in children with SLD (P < 0.05*). DYX1C1 was also upregulated in severe SLD children (P = 0.03*). In addition, KIAA0319 and ROBO1 genes were differentially expressed in male SLD children compared to females (P < 0.05*). Furthermore, we found that DYX1C1 and ROBO1 genes significantly affect the likelihood of the SLD (respectively, P < 0.001** and P = 0.007*). We expect that the findings provided from this study may contribute to the determination expression level of the relevant genes in the diagnosis, prognosis, and treatment of SLD. In addition, our findings could be a guide for future epigenetics studies on the use of the DYX1C1, KIAA0319, and ROBO1 in therapeutic applications in the SLD.

Is There an Association Between Cesarean Section Delivery with Specific Learning Disabilities (SLD) or/and Attention-Deficit/Hyperactivity Disorder (ADHD)? A Cross-Sectional Study in Greek Population

Background/Objective: Learning difficulties (LDs) are lifelong neurodevelopmental disorders with multifactorial causes, including perinatal factors like mode of delivery. This study aims to explore whether cesarean section (CS) delivery is linked to the occurrence of specific learning disabilities (SLDs), attention-deficit/hyperactivity disorder (ADHD), or their comorbidity. Methods: An online questionnaire was distributed via Google Forms to Greek mothers and parents of children with and without diagnoses, shared through school-related groups and various Greek pages focused on child development, special education, and learning difficulties. Conducted over eight months (October 2023–May 2024), this cross-sectional study involved 256 children, 137 with LDs diagnoses, and 119 controls. Results: In total, 59.9% of CS-born children had a diagnosis, compared to 40.1% of those born vaginally (X²(1) = 4.19, p = 0.045). CS delivery was associated with a 68% increased likelihood of LDs (OR = 1.68, 95% CI [1.02, 2.76]), with higher risks for ADHD (OR = 2.25, 95% CI [1.06, 4.79]) and comorbid SLD/ADHD diagnoses (OR = 2.75, 95% CI [1.17, 6.46]). Stratified analyses showed birthweight and gestational age as effect modifiers rather than confounders. Key postnatal risk factors identified were family history (OR = 4.65, 95% CI [2.41, 8.94]) and language acquisition difficulties (OR = 5.28, 95% CI [1.36, 20.47]). Conclusions: The findings suggest a possible association between CS and LDs, along with a novel link between CS and increased comorbidities. These results underscore the need for further research and provide valuable insights into how CS delivery may influence the risk of LDs, depending on the type of diagnosis.

The Inherent Shield: Learning-Based Stress Symptoms Among People Diagnosed with Specific Learning Disability and Its Relationship with Dispositional Mindfulness

Background: Past research suggests that individuals with learning disabilities experience higher levels of emotional difficulties. Objective: The aim of the current study was to investigate the relationships between specific learning disabilities (SLDs) and learning-based stress symptoms (LBSSs). Further, this study examines whether dispositional mindfulness (DM) can be used as a moderating factor for these symptoms resulting from the same stressful learning experience. Methods: The sample consisted of 133 participants (73 male) aged 23–44 years (M = 34.41; SD = 9.69). In this sample, 56 reported that they have been officially diagnosed with a SLD. Participants completed an online survey comprising a demographics questionnaire, self-report SLD questionnaire, school learning-based stress symptoms, and five-facet mindfulness questionnaire (FFMQ-24). Results: Results revealed that participants with an SLD had higher levels of LBSSs compared to the general population. Furthermore, findings revealed that DM significantly predicts LBSS levels. Conclusions: The present study provides further evidence on the impact of learning experiences on stress symptoms among individuals with SLDs, and this phenomenon we have termed as “learning-based stress symptoms”. Additionally, our findings introduce novel evidence that DM may influence the relationship between LBSSs and SLDs, suggesting that a high level of DM can serve as a protective factor against these learning-based stress symptoms.

Abstract 4144597: Cardiovascular Health Among Youth with Neurodevelopmental Disability: Analysis of National Survey of Children's Health (NSCH) – 2021

Introduction: The National Survey of Children's Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD). Hypothesis: Youth with NDD are more likely to have poor CVH status compared to non-NDD youth. Methods: We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD. Results: 12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3, p &lt;0.0001 ), smoking/exposure (94.5 vs. 90.7, p&lt;0.0001 ), diabetes mellitus (95.2 vs. 90.2, p &lt;0.0001 ), obesity (80.0 vs. 73.2, p &lt;0.0001 ), a heart condition (95.4 vs. 93.8, p=0.021 ), or dyslipidemia (98.1 vs. 95, p&lt;0.0001 ). Overall CVH status was (93.9 vs. 91.0, p&lt;0.0001 ) among non-NDD vs NDD participants. NDD participants had a greater odds of having a heart condition (OR=1.91, 95% CI: 1.51-2.42) and poor CVH status (OR=1.53, 95% CI: 1.45-1.62). Propensity score matching showed similar results. Conclusions: Neurodevelopmental disability is associated with poorer CVH status in youth. Efforts to improve CVH status in youth should include greater focus on youth with NDD.

PREVALÊNCIA DOS SINTOMAS DO TDAH EM CRIANÇAS COM BAIXO RENDIMENTO ESCOLAR SUBMETIDAS AO P.A.P.E. NO ANO 2022 EM PRESIDENTE PRUDENTE

Specific learning disorder impairs the brain's ability to process information, affecting around 30-40% of students. These disorders represent 35-45% of mental health visits and 35% of visits to pediatricians. In 2018, Presidente Prudente/SP launched the Specialized Pedagogical Support Program (PAPE) to offer support to students with learning difficulties in the Municipal Network. The study, including 136 students evaluated by MTA-SNAP IV, revealed that ADHD and ODD are common in the school age group, especially in elementary school and more frequent among boys, with inattention being the main characteristic. The research highlighted the effectiveness of the questionnaire in improving intervention and support methods, improving students' quality of life and academic performance. Greater involvement of the Municipal Health Department is recommended to enhance children's care and learning, preventing future problems such as school dropout and difficulties in adult life.

Thriving Beyond Adversity: A Prospective Longitudinal Cohort Study Using a Strength-Based Approach Depicts Indigenous Adolescents with Less Adverse Childhood Experiences (ACEs) Had Fewer Neurodevelopmental Disorders (NDDs)

Improving social and emotional well-being (SEWB) among Indigenous adolescents is crucial. Since neurodevelopmental disorders (NDDs) are common in Indigenous people and adverse childhood experiences (ACEs) are important contributors to negative health outcomes throughout the lifespan, we investigated whether limited ACE exposure is associated with reduced risk of NDDs in Australian Indigenous teens using the data from multiple waves (Wave 1 to Wave 9, and Wave 11) of the Longitudinal Study of Indigenous Children (LSIC). We also examined the role of other protective factors, such as Indigenous cultural identity and school connectedness, against NDDs. A strengths-based approach using mixed-effects logistic regression models examined the protective effect of limited ACE exposure (from LSIC waves 1–9) on NDDs (outcome from LSIC wave 11), adjusting for sociodemographic factors. The NDDs included autism, ADHD, intellectual, neurological, and specific learning disabilities. Of the 370 individuals analysed, 73.2% valued Indigenous cultural identity, and 70.5% were strongly connected at school. More than one-fourth (27.8%) reported limited ACE exposure, while the majority was not diagnosed with NDDs (93%). Longitudinal analysis revealed limited ACE exposure was 6.01 times (95% CI: 1.26–28.61; p = 0.024) more likely to be protective against NDDs compared to those exposed to multiple ACEs. Moreover, valuing cultural identity (aOR = 2.81; 95% CI: 1.06–7.39; p = 0.038) and girls (aOR = 13.88; 95% CI: 3.06–62.84; p = 0.001) were protective against NDDs compared to their respective counterparts. Our findings highlight the need to prevent ACE exposure and promote Indigenous cultural identity in preventing negative health outcomes and the exacerbation of health inequities to strengthen the SEWB of Indigenous communities.

A systematic review of studies with parent-involved interventions for children with specific learning disabilities

A systematic review of studies with parent-involved interventions for children with specific learning disabilities

A Comprehensive Investigation of Social Anxiety and Social Evaluative Stress in Autistic Children and Adolescents and Specific Learning Disorders.

The aim was to investigate trait social anxiety and social evaluative stress in autistic children and adolescents and Specific Learning Disorders (SLD). This was done by evaluating behavioral, subjective, and autonomic responses to the Trier Social Stress Test (TSST). Study 1 included 280 children and adolescents: 60 autistic without intellectual disability (ID), 70 SLD, and 150 non-diagnosed (ND) peers. Study 2 involved 55 participants: 15 autistic without ID, 15 SLD, and 20 ND. The sample was predominantly male. In Study 1, behavioral (quality of public speech) and subjective (valence, arousal, perceived competence, and worries) aspects of social stress were examined. Study 2 expands upon the first study, as physiological responses to social stress were also measured. Trait social anxiety was investigated using both parents' and children's reports in the two studies. Parents of autistic participants and with SLD reported higher trait social anxiety in their children than the parents of ND. No differences emerged from the participants' self-reports, though those autistic and with SLD were assigned lower scores in the public speech quality than ND. Autistic children and adolescents reported lower arousal and higher perceived competence than ND, while those with SLD reported a lower perception of competence. Autistic participants had a decreased cardiac reactivity across the TSST when compared to SLD and ND. Our findings show unique patterns of responses within each group, confirming that the combined investigation of trait anxiety and social stress responses could be a valuable insight in research and clinical practice.

Predictors of Reading and Spelling Difficulties in Italian Children: Specific Language and General Cognitive Skills

This study investigated the role of domain-specific and domain-general factors in predicting early literacy skills in Italian children. A sample of 239 first-grade students was evaluated using a broad neuropsychological battery to assess their cognitive skills. The results showed that phonological awareness, rapid automatized naming, speed of processing, and attentional control all played a role in predicting reading and writing abilities. These findings support the importance of considering not just domain-specific language skills, but also domain-general cognitive skills when identifying children at risk of difficulties in reading and writing. The study supports the adoption of a multifactorial-probabilistic model to accurately diagnose specific learning disorders.

Assessment of the level of health literacy in students with specific learning disorders

Abstract Background Specific Learning Disorders (SLDs) include dyslexia, dysorthography, dysgraphia, and dyscalculia and are referred to as specific educational learning disabilities. For students with SLDs, the issue of health literacy (HL) arises because understanding, evaluating and utilising health information are critical to making informed decisions about one’s health. This study aims to determine the level of HL in students with a certified SLD. Methods From November 2023 to April 2024, students with an SLD studying at the University of Udine (Italy) who agreed to participate, were surveyed using an online questionnaire on the EUSurvey platform. This consisted of the HLS-EU-Q47 to measure HL, followed by a socio-demographic section. The HLS-EU-Q47 classified HL into 4 levels: inadequate, problematic, sufficient and excellent; descriptive analysis was performed and the correlation with the sociodemographic data was examined using χ² test. Results 38 students participated (mean age 24 years, 60.5% female), 60% of whom are in an undergraduate degree program. 42% of the sample had a single SLD (26% dyslexia, 13% dysgraphia), while 58% of them have multiple SLDs. Overall, 42% of students were found to have a problematic HL level, 24% inadequate, only 24% sufficient and 11% excellent. No statistically significant association was found between) HL level and gender, number of SLDs, school attended at the time of SLD certification, and use of supports (all p-values&amp;gt;0.05). Conclusions The level of HL in students with SLDs appears to be consistent with data from the Italian population (58% inadequate or problematic) from the 2019-HLS19 Health Literacy Survey. This suggests that the presence of an SLD does not affect the level of HL and that it is likely that the university degree is able compensate for HL difficulties that could be related to the presence of an SLD. A larger sample is needed to see if it is confirmed that there is no association between the investigated variables. Key messages • Despite the presence of SLDs, the HL of academic students follows the same trend compared to the general Italian population. • The structural use of supportive measures by these students probably bridges the gap in access to and correct use of health information.

Social Cognitive Processes in Children With Specific Learning Disorder: The Importance of Language

Children with specific learning disorder (SLD) have poor academic skills, but they also experience difficulties with their peers, including an inability to recognize interpersonal conflict, infer emotion, and resolve social conflict. In addition, children with SLD are known to have problems with language. The importance of language to social cognition is well-established in research with children with typical and atypical development. Thus, we review literature that investigates language and social cognition in children with SLD compared with their peers. We also explore the link between language and social cognition in children with typical and atypical language development. Review of this literature suggests that the language deficits associated with SLD put children with SLD at a risk for deficits in social cognitive skill. The literature also points toward a critical need for early identification of SLD and research investigating social perspective taking in individuals with SLD across the lifespan. Last, we propose that clinicians should assess language before diagnosing and implementing intervention for the academic and social difficulties that children and adolescents with SLD experience.

Enhanced detection of suboptimal effort in psychoeducational assessments for dyslexia

Objective: Although performance validity tests (PVTs) are routinely administered in neuropsychological evaluations, they are employed less frequently in assessments for specific learning disabilities such as dyslexia, likely due, at least in part, to the limited availability of PVTs to evaluate effort on measures of academic achievement. This is troubling, as previous research suggests that up to 24% of postsecondary students undergoing learning disability assessments produce noncredible test scores indicative of symptom exaggeration or low effort. This paper discusses normative data collected for the revised Dyslexia Assessment of Simulation or Honesty- Revised (DASH-R), a PVT developed specifically to identify symptom exaggeration or magnification during dyslexia testing. Method: We administered the DASH-R to three groups of students: honest responding controls (n = 48), students with documented dyslexia (n = 232), and students coached to simulate dyslexia (n = 42). Students were also administered measures of reading and processing speed. Results: DASH-R scores differentiated simulators from both honest responding controls and those with dyslexia. Further, ROC curve analysis showed that a composite feigning index score derived from the DASH-R could be used diagnostically to detect low effort; an optimal cut score of ≥4 on a seven-variable index yielded high specificity (≥98%) and good sensitivity (71%), with positive predictive accuracy of 86%. Creation of a 9-variable index that included errors on an additional reading test produced improved positive predictive accuracy to 96% while retaining excellent specificity (99%). Conclusions: The DASH-R appears to be a promising disability-specific measure for detecting feigned reading problems in young adults undergoing evaluations for dyslexia.

Online peer mentoring for youth with learning differences.

Youth with learning differences (e.g., specific learning disorder and attention deficit hyperactivity disorder) encounter exacerbated psychological and behavioral challenges compared to typically developing peers. Peer mentoring has proven beneficial in addressing such challenges, yet there is limited research on the efficacy of online peer mentorship programs for this population. This study investigates the effects of an online peer mentoring program on mentees' mental health, wellbeing, and behavior across 10 outcomes: anxiety, depression, fear, cognitive challenges, behavioral concerns, executive function, sleep difficulties, self-care, interpersonal skills, and self-esteem/self- confidence. Parents retrospectively reported on their child's mental health, wellbeing, and behavior prior to and since receiving online mentorship. Results indicated significant improvements across all outcomes following online mentorship. These findings highlight the effectiveness of online peer mentorship programs, emphasizing its potential as a valuable tool for supporting youth with learning differences.

Discrepancy model to RtI: Gauging teacher preparedness for this shift in specific learning disability classification

AbstractThe Individuals with Disabilities Education Improvement Act (2004) allows alternate pathways for school districts to identify and classify students with a specific learning disability (SLD). Response to Intervention (RtI) is one of the frameworks schools can use when eliminating the use of the discrepancy model. The premise of RtI posits that tiered instruction can assist all students who are struggling through utilizing research‐based interventions. When these tiers of intervention services are exhausted with limited to no response to the intervention, a child can be classified under the SLD category. There are documented concerns with effective implementation of RtI frameworks. This qualitative exploratory study examined the perceptions of teachers in a graduate education program regarding the knowledge, usage and implementation of RtI to classify students with a SLD. Through thematic analysis, findings indicate a need for more training in districts, better preparation at the university level and more support in applying RtI in the classroom. Implications for practice and future research are discussed.

Do the Special Education Regulations in States Requiring RtI for SLD Identification Include or Omit Intervention Fidelity?

This study examined intervention fidelity (IF) and the extent to which this essential feature of response to intervention (RtI) was included within artifacts (laws and guidance documents) for states requiring RtI for specific learning disability (SLD) identification. Intervention fidelity is defined as the degree to which an intervention is implemented as planned. Artifacts from all U.S. states were reviewed. Twelve states were identified as requiring RtI for SLD identification, and they comprised the sample for the study. Using state department of education websites, artifacts for the 12 states were found and reviewed for any information on preferred terms (fidelity or integrity), definition, IF dimensions (adherence, exposure, interventionist quality, and participant response), and methods for assessing, reporting, and evaluating IF. We found nine states used the term fidelity, four states provided explicit guidance on assessing IF, and two states provided explicit information on how often to collect IF data and what level (percent) of IF was required for intervention decision-making. Implications for state policies and practices, future directions for improving IF knowledge, application, and evaluation, and study limitations are discussed.

What’s Hot in Literacy: Misguided Trends in a Divided Field

ABSTRACT The annual What’s Hot in Literacy survey identifies current priorities in literacy education, highlighting the evolving landscape of the field. A panel of twenty-five literacy leaders participate in interviews to identify the most emphasized, least emphasized, and most deserving topics of increased attention. The 2024 findings highlight three topics as “extremely hot:” banned books, phonics/phonemic awareness, and the science of reading and structured literacy. There are also six topics found to be “very hot,” including artificial intelligence in literacy, cultural and linguistic diversity and literacy for multilingual learners, dyslexia and other specific learning disabilities, early literacy, high-quality instructional materials, and social justice/equity/anti-racism in literacy. Overall, the literacy field has received unprecedented focus this year, driven by legislative mandates in 38 states, policies on the science of reading, book banning, and discussions on essential early literacy skills for long-term academic and career success. This article examines the highlighted topics and the possibility that some of these are misguided trends. Additionally, it addresses the ongoing division within the literacy field, between advocates of content-focused and child-focused approaches to teaching and learning.

Applying CO-OP Approach in Children With Specific Learning Disorder: Single-Subject Outcome Study.

This study aimed to evaluate the impact of the Cognitive Orientation to daily Occupational Performance (CO-OP) in enhancing motor-based occupational performance challenges in five children with specific learning disorders (SLDs). Five children with SLD aged 9 to 12 years, participated in a multiple-baseline single-subject experimental design. Outcome measures included the Canadian Occupational Performance Measure (COPM) and the Bruininks-Oseretsky Test of Motor Proficiency-Edition 2 (BOT-2). The CO-OP Approach comprised 12 sessions, conducted twice weekly. Based on the BOT-2 results, the intervention resulted in better motor performance scores in all five participants. Clinically significant improvement was found in both performance and satisfaction rating using the COPM after intervention as assessed by both parents and children. This study demonstrates the potential of the CO-OP Approach to enhance motor skills and achieve selected goals in five children with SLD.

Executive function in children with neurodevelopmental conditions: a systematic review and meta-analysis.

Executive function (EF) delays are well documented in paediatric neurodevelopmental conditions (NDCs). There is no consensus about whether EF delay represents a transdiagnostic feature of NDCs. This systematic review and meta-analysis synthesized 180 studies reporting two or more NDC comparisons on EF, examined differences between NDCs, and the moderating effects of gender, age, publication year, DSM editions and assessment types. Studies using established EF measures across seven domains (attention, fluency, set-shifting, set-switching, response inhibition, planning and working memory) in participants under 18 were included. Summary effects were compared: (1) for all reported NDCs relative to control, (2) for each individual NDC relative to control and (3) between NDC groups. Results confirmed that EF delay was a transdiagnostic feature of neurodevelopmental delay, with a moderate effect size of delay across all NDCs (g = 0.56, 95% confidence interval (CI) 0.49-0.63) compared with control. This effect increased with comorbidities (g = 0.72, 95% CI 0.59-0.86), DSM-5 criteria and informant measures. Comparisons between NDCs revealed few differences: children with tic disorders (TD) showed smaller EF delays, children with attention-deficit/hyperactivity disorder (ADHD) showed larger delays in attention, response inhibition, planning and working memory compared with TD and specific learning disorders, while children with autism spectrum disorders showed greater delays on set-switching compared with ADHD. Findings support transdiagnostic models of neurodevelopment to further a developmentally sensitive science that can reveal how EF delays contribute to brain circuitry, symptom profiles and functioning, and ultimately support early interventions and outcomes for all children with NDCs.

Evaluation of primary markers of inflammation and the systemic inflammation index in specific learning disabilities.

Aim: Specific learning disorder (SLD) is a term that refers to reading, writing and arithmetic difficulties. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and systemic inflammation index (SII) are affordable and accessible inflammatory biomarkers. This research aims to evaluate the relationship between NLR, PLR, SII and SLD to determine whether inflammation contributes to pathogenesis.Methods: This study included 90 SLD-diagnosed patients and 90 age-, sex- and ethnicity-matched healthy controls. Blood cell counts and NLR, PLR and SII values were obtained from medical records and compared between the two groups.Results: The NLR, PLR and SII were significantly higher (p=0.029, p=0.033 and p=0.018 respectively) and lymphocyte counts were significantly lower (p=0.041) in the SLD group. WISC-R total scores decreased with age in the SLD group (-1.988 coefficient, Beta=-0.247ß, p=0.041). Multivariate logistic regression analysis revealed that the SII was the only parameter independently associated with the diagnosis of SLD (Beta=0.003, p=0.023).Conclusion: Inflammation might play a role in SLD etiopathogenesis. NLR, PLR and SII may be potential biomarkers for SLD in children. Further research may lead to early diagnosis and additional anti-inflammatory pharmacological therapies for SLDs.