Validity of the Wide-range Assessment of Vision-related Essential Skills in Japanese Children with Learning Problems.

SIGNIFICANCE: Our study revealed that the validity of a new Japanese visual-perceptual test was acceptable. Visual-perceptual abilities are important to activities of daily living; thus, accurate assessment of visual perception is especially important for children with neurodevelopmental disorders and particularly so for those with learning problems. PURPOSE: Visual perception refers to the process by which one receives visual information through sensory impulses and then translates those impulses into meaning based on a previously developed view of the environment. A problem in Japan is the paucity of visual perception tests that use normative data from children who are native Japanese. The Wide-range Assessment of Vision-related Essential Skills (WAVES), which measures visual perception and eye-hand coordination skills and is based on Japanese normative data, was recently published in Japan. The validity of this test has not been comprehensively established. METHODS: To investigate the validity of the WAVES, we used the Pearson correlation coefficient to calculate the degrees of association among WAVES scaled and index scores compared with Developmental Test of Visual Perception, Third Edition, scores from 108 elementary school children with symptoms of learning problems. Participants were recruited at Osaka Medical College Learning Disability Center and Sakai Seikeikai Learning Disability Center. RESULTS: The concurrent validity of the WAVES was supported by moderate correlation (r = 0.67, P < .01) between the total scores for visual perception and eye-hand coordination index from the WAVES and general visual perception index from the Developmental Test of Visual Perception, Third Edition, even though a correlation analysis of subtests found differences between the two tests. CONCLUSIONS: Our results showed that the indices from the two tests measured nearly the same underlying visual-perceptual constructs and indicated that the WAVES had acceptable levels of concurrent validity.

Factors Influencing Low Prevalence of Neurodevelopmental Disabilities Among US Hispanic/Latino Children.

OBJECTIVES: Hispanic/Latino (H/L) children have lower prevalence of neurodevelopmental disabilities (NDD) than other groups. The explanations for this are complex, but may be related to nativity, language barriers, and lack of access to and utilization of healthcare. Previous research focused on how these factors affect children with NDD, but little research has jointly examined whether these factors predict NDD. This study examines whether social and environmental factors explain low prevalence of NDD in this population. METHODS: This study uses nationally representative Integrated Public Use Microdata Series National Health Interview Survey data (N = 200,622) and multivariate logistic regression analysis to compare NDD prevalence in white and H/L children (average age of 10.2), and examines whether nativity, healthcare access, healthcare utilization, and language barriers explain this disability disparity. RESULTS: Findings reveal that the H/L NDD disparity is not explained by differences in access to or utilization of healthcare, or as a result of language differences that may create barriers to NDD diagnosis. While H/L children whose sampled adult was born in the USA have lower rates of NDD than whites, H/Ls whose sampled adult were not born in the USA have even lower probability of NDD than H/Ls who were born in the USA. CONCLUSIONS: These findings may be a result of cultural differences in knowledge or understanding of what constitutes a disability or the result of differential treatment within the healthcare system among H/Ls. The findings underscore the importance of accessible and culturally appropriate health and clinical care interventions among H/L communities.

Multivariate Base Rates of Low Scores and Reliable Decline on ImPACT in Healthy Collegiate Athletes Using CARE Consortium Norms.

OBJECTIVES: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. METHODS: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. RESULTS: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. CONCLUSIONS: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

A Decade of Disproportionality: A State-Level Analysis of African American Students Enrolled in the Primary Disability Category of Speech or Language Impairment.

Purpose This study aimed to determine if African American students were disproportionately represented between the years of 2004 and 2014 in the primary disability category of Speech or Language Impairment (S/LI) under the 2004 reauthorized Individuals with Disabilities Education Improvement Act. Method S/LI enrollment data from the Office of Special Education Programs and general enrollment data from the National Center for Education Statistics were analyzed to compare the risk of primary S/LI category enrollment of African American students to that of all other students. Risk ratios with 99% confidence intervals were calculated for each state across the 10 years studied. Results An average of 75% of states disproportionately represented African American students in the S/LI category each year; on average, 62% underrepresented African American students, and 14% overrepresented them. A post hoc analysis of the relationship between African American student representation and population densities revealed that states with high African American population densities almost exclusively underrepresented African American students and states with low densities tended toward a proportionate representation. Conclusions African American students were largely underrepresented in the category of S/LI in the years studied. These findings, alongside historic and chronic overrepresentation in other categories of special education, are discussed in the context of the fragmented harm theory ( Payne, 1984 ; Voulgarides, 2018 ; Voulgarides, Zwerger, & Noguera, 2013 ) and the disability rights and critical race theory ( Annamma, Connor, & Ferri, 2013 ). Supplemental Material https://doi.org/10.23641/asha.7967024.

Attitudes of Primary School Teachers in Three Western Countries Toward Learning Disabilities.

In recent years, teachers in Western countries have developed beliefs and attitudes related to working with students with specific learning disabilities (LD) that may be critical in shaping their educational practices with them; however, their beliefs and attitudes differ across political and geographical contexts and may be influenced by specific contextual circumstances and national legislation. This study examines these issues by comparing beliefs and attitudes among 557 primary school teachers from specific areas of three countries (Italy, Spain, and the United States). Results from this study support the hypothesis that, in general, teachers in these areas are sufficiently well informed about students with LD and are in favor of policies supporting these students' needs. However, substantial differences emerge among countries about the etiology of LD; teachers' and specialists' roles in managing LD students; intervention planning, inclusion, and compensatory provisions; and the range of emotional attitudes that teachers exhibit. These differences have implications for intervention and suggest that efforts should be made to increase collaboration and promotion of common policies across countries.

Influences of early child nutritional status and home learning environment on child development in Vietnam.

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam (n = 1,458). The Bayley Scales of Infant Development-III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (-0.11 to -0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high-quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high-quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development.

Pediatric ophthalmology and childhood reading difficulties: Overview of reading development and assessments for the pediatric ophthalmologist.

Reading difficulties are common in the pediatric population, and large socioeconomic disparities exist. In the United States 46% of white children achieved expected reading proficiency by the end of fourth grade, while only 21% of Hispanic and 18% of African American children were reading at the expected level. Reading is an involved cognitive process with many subskills; likewise, development of reading proficiency is a complex and continuous process. Failure to achieve reading proficiency or even early difficulty with reading can affect a child's academic performance for years to come. Some studies suggest reading proficiency may be related to later success in life. Although many problems with reading are not related to vision, a vision assessment is recommended for children with reading difficulties and a suspected vision problem. The process of reading development as well as the varied educational assessments of reading are presented here for pediatric ophthalmologists.

An Intervention Supporting the Mental Health of Children with a Refugee Background.

This contribution proposes an intervention methodology that provides improved access to and effectiveness of mental health care facilities in Brussels, Belgium, for children and their families with a refugee and migration background. Migration is a complex process that involves several potential risk factors, and referral to mental health facilities is often ineffective. Consequently, optimal developmental opportunities for refugee children are hampered. The intervention is underpinned by a broad-based contextual perspective that seeks to bring to the surface and tackles the many challenges faced by these families. It takes into account the unique developmental context of refugee children, as well as the interplay with broader systems.

22q11.2 deletion syndrome in diverse populations.

22q11.2 deletion syndrome (22q11.2 DS) is the most common microdeletion syndrome and is underdiagnosed in diverse populations. This syndrome has a variable phenotype and affects multiple systems, making early recognition imperative. In this study, individuals from diverse populations with 22q11.2 DS were evaluated clinically and by facial analysis technology. Clinical information from 106 individuals and images from 101 were collected from individuals with 22q11.2 DS from 11 countries; average age was 11.7 and 47% were male. Individuals were grouped into categories of African descent (African), Asian, and Latin American. We found that the phenotype of 22q11.2 DS varied across population groups. Only two findings, congenital heart disease and learning problems, were found in greater than 50% of participants. When comparing the clinical features of 22q11.2 DS in each population, the proportion of individuals within each clinical category was statistically different except for learning problems and ear anomalies (P < 0.05). However, when Africans were removed from analysis, six additional clinical features were found to be independent of ethnicity (P ≥ 0.05). Using facial analysis technology, we compared 156 Caucasians, Africans, Asians, and Latin American individuals with 22q11.2 DS with 156 age and gender matched controls and found that sensitivity and specificity were greater than 96% for all populations. In summary, we present the varied findings from global populations with 22q11.2 DS and demonstrate how facial analysis technology can assist clinicians in making accurate 22q11.2 DS diagnoses. This work will assist in earlier detection and in increasing recognition of 22q11.2 DS throughout the world.

Clinical Profile of Attention Deficit Hyperactivity Disorder: Impact of Ethnic and Social Diversities in Israel.

BACKGROUND: Despite the increased worldwide recognition of attention deficit/hyperactivity disorder (ADHD), there is a variability in the diagnostic rate of both ADHD and its co-morbidities. These diversities are probably related to the methodology and instruments used for the diagnosis of ADHD and to awareness and cultural interpretation of its existence. OBJECTIVES: To identify consistent differences in the clinical profile of Arab and Jewish children with ADHD in Israel who differ in cultural, ethnic and socioeconomic background. METHODS: We analyzed the data of 823 children and adolescents with ADHD (516 Jews and 307 Arabs) and compared the clinical characteristics between these two ethnic groups. All patients were evaluated in two neuropediatric and child development centers in northern Israel: one in Haifa and one in Hadera. Children with autism and intellectual disabilities were excluded. RESULTS: The distribution of ADHD subtypes was similar in both populations. However, learning disorders and psychiatric co-morbidities (behavioral difficulties and anxiety) were reported more frequently in the Jewish population. The most commonly reported adverse effects to psychostimulants were mood changes, anorexia, headache, insomnia and rebound effect, and were more frequently reported in the Jewish population (42.0% vs.18.0%, P < 0.05). CONCLUSIONS: We assume that these differences are related to cultural and socioeconomic factors. We suggest that the physician take cultural background into consideration when treating patients with ADHD.

Learning Problems in Children of Refugee Background: A Systematic Review.

CONTEXT: Learning problems are common, affecting up to 1 in 10 children. Refugee children may have cumulative risk for educational disadvantage, but there is limited information on learning in this population. OBJECTIVE: To review the evidence on educational outcomes and learning problems in refugee children and to describe their major risk and resource factors. DATA SOURCES: Medline, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Education Resources Information Center. STUDY SELECTION: English-language articles addressing the prevalence and determinants of learning problems in refugee children. DATA EXTRACTION: Data were extracted and analyzed according to Arksey and O'Malley's descriptive analytical method for scoping studies. RESULTS: Thirty-four studies were included. Refugee youth had similar secondary school outcomes to their native-born peers; there were no data on preschool or primary school outcomes. There were limited prevalence data on learning problems, with single studies informing most estimates and no studies examining specific language disorders or autism spectrum disorders. Major risk factors for learning problems included parental misunderstandings about educational styles and expectations, teacher stereotyping and low expectations, bullying and racial discrimination, premigration and postmigration trauma, and forced detention. Major resource factors for success included high academic and life ambition, "gift-and-sacrifice" motivational narratives, parental involvement in education, family cohesion and supportive home environment, accurate educational assessment and grade placement, teacher understanding of linguistic and cultural heritage, culturally appropriate school transition, supportive peer relationships, and successful acculturation. LIMITATIONS: Studies are not generalizable to other cohorts. CONCLUSIONS: This review provides a summary of published prevalence estimates for learning problems in resettled refugee children, highlights key risk and resource factors, and identifies gaps in research.

Chronic conditions, functional difficulties, and disease burden among American Indian/Alaska Native children with special health care needs, 2009-2010.

The purpose of this study was to determine the prevalence of chronic conditions and functional difficulties of American Indian/Alaska Native (AIAN) children with special health care needs (CSHCN). We conducted bivariate and multivariable analysis of cross-sectional data on 40,202 children from the 2009-2010 National Survey of Children with Special Health Care Needs aged birth through 17 years, including 1,051 AIAN CSHCN. The prevalence of AIAN CSHCN was 15.7 %, not significantly different from the prevalence of US white CSHCN (16.3 %). As qualifiers for special needs status among AIAN children the use of or need for prescription medication was the most frequent (70 %), compared to the lower rates of need for elevated service use (44 %) and emotional, mental, or behavioral treatment/counseling (36 %). Asthma (45 %), conduct disorder (18 %), developmental delay (27 %), and migraine headaches (16 %) were significantly more common chronic conditions among AIAN CSHCN compared to white CSHCN, as were functional difficulties with respiration (52 %), communication (42 %), anxiety/depression (57 %), and behavior (54 %). AIAN CSHCN were also more likely to have 3 or more chronic conditions (39 vs. 28 %, respectively) and 3 or more functional difficulties (70 vs. 55 %, respectively) than white CSHCN. Results indicated a greater impact on the daily activities of AIAN CSHCN compared to white CSHCN (74 vs. 63 %). Significantly greater disease burden among AIAN CSHCN suggests that care must be taken to ensure an appropriate level of coordinated care in a medical home to ameliorate the severity and complexity of their conditions.

Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial.

Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B12, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

Culturally responsive instruction for english language learners with learning disabilities.

This case study describes the culturally responsive instruction of one special education teacher with Latino English language learners (ELLs) with learning disabilities in an urban elementary school setting. This study was situated in a social constructivist research based framework. In investigating this instruction with ELLs, this study focused on how one teacher's knowledge of culturally responsive pedagogy affected her special education instruction. Findings resulted in three major themes that were aligned with the current literature in this area: Cultural Aspects of Teaching Reading, Culturally Relevant Skills-Based Instruction, and Collaborative Agency Time. The results indicated that the success of special education with ELLs at the elementary education level might be dependent on how well the special education teacher integrates culturally responsive instruction with ELLs' cultural and linguistic needs.

The care needs of Pakistani families caring for disabled children: how relevant is cultural competence?

OBJECTIVE: To identify factors that Pakistani parents living in the UK and caring for children with learning disabilities felt were important components of their care and to discuss the relevance of the concept of cultural competence in the light of these findings. DESIGN: A qualitative study taking a constructivist approach to gain insight into participants' experiences of health care provision. In depth interviews were used to explore the ways in which personal understandings and life experiences shaped the characteristics of the therapeutic encounter that participants identified as important. Data were analysed thematically. SETTING: A Northern city in England. Interviews took place in participant's homes or work places. PARTICIPANTS: Eleven Pakistani parents and one grandparent from nine different families, all caring for children with learning disabilities. FINDINGS: The study identified features of the therapeutic encounter that were important to Pakistani parents and highlighted that there is nothing to suggest that these are different to those of the majority population. CONCLUSIONS: The utility of the concept of cultural competence may be limited where it depends on concepts of ethnic groups as relatively fixed cultural groups with distinct and clearly defined sets of health beliefs and behaviours. Physiotherapists cannot prejudge health status and behaviours from an individual's ethnic status. Instead there is a need to actively seek the understandings that are relevant to practice. In addition health service providers must develop and operate systems that ensure access, use and quality of care are the same at the point of delivery regardless of patient ethnicity.

Lower birth weight and diet in Taiwanese girls more than boys predicts learning impediments.

Possible links between lower birth weight, childhood diet, and learning in Taiwan are evaluated. The population representative Elementary School Children's Nutrition and Health Survey in Taiwan 2001-2002 and the national birth registry were used to examine school and social performance using the modified Scale for Assessing Emotional Disturbance questionnaires in relation to diet quality by the Youth Healthy Eating Index-Taiwan and birth weight of children aged 6-13 years (n=2283). Lower birth weight (≤15th percentile: ≤2850 g for boys and ≤2700 g for girls) children were mostly from mountainous areas and of indigenous descent. Compared to normal birth weight, lower birth weight girls experienced greater inability to learn and weaker overall competence. Better diet quality predicted more favorable emotional and behavioral outcomes in lower birth weight girls, and this persisted with adjustment for covariates. None of these findings were evident among boys. Girls' cognitive and social development appears to be susceptible to diet quality and birth weight, such that the adverse risk of lower birth weight on school performance may be offset by improved diet.

Coping strategies used by Pakistani parents living in the United Kingdom and caring for a severely disabled child.

PURPOSE: This study explores the coping strategies of Pakistani parents living in the UK and caring for children with severe learning disabilities. It examines factors that influenced participants' choice or ability to use the different strategies identified. METHOD: Qualitative design using in-depth interviews. RESULTS: Coping strategies included sharing care with others, using external support and recognizing and enjoying the rewards of caregiving. Parents used different strategies according to their appraisal of resources available and the perceived consequences of their action within their social milieu. CONCLUSIONS: Findings relating to cultural difference fit with a universalist approach. Coping strategies are not specific to the Pakistani population but certain characteristics of the strategies may be distinct to those used by parents with a different heritage. Antonovsky's work suggests that maintaining a sense of coherence makes a key difference to staying psychologically healthy in an apparently disordered world. Findings from this study fit with this theory. Parents derived meaning and a sense of purpose from the idea that their child's disability was from God. The rewards of caregiving and the strong moral imperative to care for one's own child contributed to understandings of caregiving as an activity worthy of investment.

Black-white differences in self-reported disability outcomes in the U.S.: early childhood to older adulthood.

OBJECTIVE: We examined black-white differences in activities of daily living (ADLs), functional limitations (FLs), vision/hearing/sensory impairment, and memory/learning problems in a large, nationally representative sample of community-dwelling and institutionalized people across the lifespan. METHODS: Data are from the 2006 American Community Survey (n=2,288,800). We included data on non-Hispanic black respondents (125,985 males and 145,780 females) and non-Hispanic white respondents (977,792 males and 1,039,243 females) ≥5 years of age. We used logistic regression to examine the black-white odds for each disability outcome. The overall response rate was 97.5%. RESULTS: For FLs, ADL limitations, and memory/learning problems, black people experienced higher odds of disability across the adult lifespan compared with white people. Black-white differences narrowed in older age. For vision/hearing problems, a black-white crossover was found in older age (≥85 years), where odds of vision/hearing problems were lower among black people than among white people. For all disability outcomes, black-white differences peaked in midlife (50-69 years of age), with black people having approximately 1.5 to two times the odds of disabilities as their white peers. CONCLUSIONS: The study findings suggest the need to address black-white disparities across a range of disability outcomes throughout the lifespan. Future work identifying the factors accounting for this pattern of disparities will help inform the development of appropriate prevention strategies.

The social adjustment, academic performance, and creativity of Taiwanese children with Tourette's syndrome.

The purpose was to describe the social adjustment, academic achievement, and creativity of 127 Taiwanese children with Tourette's Syndrome and a control group of 138 Taiwanese children with typical development and reports of the parents of both groups. The Tourette's Syndrome group had significantly more disruptive behaviors than the controls; most parents reported their children with Tourette's Syndrome had high academic achievement although the children scored significantly lower than controls on the Elaboration subtest of Creative Thinking.