IQ-Achievement Discrepancy for Identification of Disabilities in Spanish-speaking English Learners.

This article examines the validity of IQ-achievement discrepancy and low achievement as criteria for the identification of disabilities in Spanish-speaking English-language learners (ELs) and the factors that moderate the validity of these approaches as bases for identification. While there has been a long history of examining the validity of different approaches to disability identification in monolinguals, there are no systematic approaches taken for ELs. Data from Grades 1 and 2 of a large longitudinal data set consisting of young Spanish-speaking students attending schools in the United States were used to empirically examine criteria for disability identification among language minority children-one of the first large-scale attempts. Findings indicated significant overidentification when the language of assessment was not matched to the language of the instruction, although the effects varied predictably over time and by language of instruction. Validation of classifications using measures external to the classification found that low achieving and discrepant children differ from typically developing children, and from one another in predictable ways based on differences in IQ. The study highlights the importance of taking into account the language of instruction and the severity of the cut-off to reduce misidentification of typically developing children.

Identifying classes of persons with mild intellectual disability or borderline intellectual functioning: a latent class analysis.

BACKGROUND: Persons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics. METHODS: Latent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3-70) years. RESULTS: Five distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability. CONCLUSIONS: The identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.

The DSM and learning difficulties: formulating a genealogy of the learning-disabled subject.

The article examines the manner in which the learning-disabled subject is created as an object within contemporary psychiatric discourse by means of a genealogical analysis of the learning-disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It investigates how this pathology was formed historically in the text, what metamorphoses it underwent, and their epistemic significance. First, the theoretical underpinnings of the sociological discourse on DSM are presented, giving a brief background of the DSM status in the Israeli context. Many problematic characteristics in the text are unveiled, by means of critiques from sociology, anthropology and discourse studies. Second, the changing definitions and conceptualizations of learning-disorders in the seven editions of the Manual and the accompanying case studies (1952-2013) are examined. It becomes apparent that the disorders have undergone changes that have enabled the biomedical paradigm to triumph. The implications of these transformations are addressed.

'Learning disabilities' as a 'black box': on the different conceptions and constructions of a popular clinical entity in Israel.

This article aims to stimulate new thinking about learning disabilities than is customary in local literature. Previous educational and psychological studies concerning learning disabilities regarded them as if they were objective categories with formal definitions and criteria accepted in scholarly literature. Contrary to that, this article explores the various conceptions, constructions, and meanings of learning disabilities that comprise the narrative descriptions and explanations of didactic diagnosticians. For this purpose, 50 in-depth interviews were conducted. There are four sections. Part One lays out the theoretical and methodological background of the sociological and discursive debate about learning disabilities. Part Two explores the various main thematic aspects and narrative strategies that were used by the diagnosticians in their construction of their purportedly 'objective', 'a-historical', 'a-political' experts' narrative. The third part reveals the polyphonic multifaceted nature of the learning disabilities construct. The experts' narrative undermines the objective and homogeneous definitions in the literature by uncovering learning disabilities' heterogeneous meaning repertoire. This repertoire consists, among others, of conceptualizing disability as a 'disease', a 'symptom', a 'genetic defect', a 'disorder', an 'educational difficulty', a 'variance', and even a 'gift'. This part also reveals the experts' narrative reaction strategies to the aforementioned polyphonic spectacle. It is revealed that the interviewees' narrative deconstructs the 'scientific factual nature' of the clinical categories. The fourth part highlights a central paradox in the expert narrative: The tension between the narrative stigmatic-labeling aspects and the destigmatic-'liberating' aspects. The claim is made that this tension can partly explain the current popularity of the LD diagnosis. This article is the third in a series of papers that seeks to contribute to the creation of a more nuanced disability discourse by exposing its shaky scientific foundations.

[Specific learning disabilities - from DSM-IV to DSM-5]. / Spezifische lernstörungen.

The publication of the DSM-5 means changes in the classification and recommendations for diagnosis of specific learning disabilities. Dyslexia and dyscalculia have been reintroduced into the DSM. Three specific learning disorders - impairment in reading, impairment in the written expression, and impairment in mathematics, described by subskills - are now part of the DSM-5. Three subcomponents of the reading disorder are expressly differentiated: word reading accuracy, reading rate, and fluency and reading comprehension. Impaired subskills of the specific learning disorder with impairment in written expression are spelling accuracy, grammar and punctuation accuracy, and clarity and organization of written expression. Four subskills are found in the mathematics disorder: number sense, memorization of arithmetic facts, accurate or fluent calculation, and accurate math reasoning. Each impaired academic domain and subskill should be recorded. A description of the severity degree was also included. The diagnosis is based on a variety of methods, including medical history, clinical interview, school report, teacher evaluation, rating scales, and psychometric tests. The IQ discrepancy criterion was abandoned, though that of age or class discrepancy criterion was retained. The application of a discrepancy is recommended by 1 to 2.5 SD. All three specific developmental disorders are common (prevalence 5 %-15 %), occur early during the first years of formal schooling, and persist into adulthood.

Stress modulates the engagement of multiple memory systems in classification learning.

Learning and memory are supported by anatomically and functionally distinct systems. Recent research suggests that stress may alter the contributions of multiple memory systems to learning, yet the underlying mechanism in the human brain remains completely unknown. Using event-related functional magnetic resonance imaging, we asked in the present experiment whether stress may modulate the engagement of hippocampus-based "declarative" and striatum-based "procedural" memory systems during classification learning in humans and what brain mechanisms are involved in this effect. We found that stress reduced declarative knowledge about the learning task and changed the used learning strategy from a single-cue-based declarative strategy to a multicue-based procedural strategy, whereas learning performance per se remained unaffected by stress. Neuroimaging revealed that hippocampal activity correlated positively with task performance in the control condition, whereas striatal activity correlated with performance in the stress condition. After stress, hippocampal activity was reduced and even negatively correlated with learning performance. These findings show for the first time that stress alters the engagement of multiple memory systems in the human brain. Stress impaired the hippocampus-dependent system and allowed the striatum to control behavior. The shift toward "procedural" learning after stress appears to rescue task performance, whereas attempts to engage the "declarative" system disrupt performance.

The adverse influence of attention-deficit disorder with or without hyperactivity on cognition in neurofibromatosis type 1.

AIM: A substantial proportion of patients with neurofibromatosis type 1 (NF1) have attention-deficit disorder with or without hyperactivity (AD[H]D). This study explored the influence of AD(H)D symptoms on the intellectual profile of patients with NF1. METHOD: We retrospectively analysed neuropsychological data from 114 children (66 males, 48 females; age range 6-16y; mean age 9y 3mo [SE 3mo]) with NF1 from an NF1 outpatients department. Assessment included psychiatric diagnosis of AD(H)D (DSM-IV-TR criteria) and intelligence testing (Wechsler Intelligence Scale for Children, German version). Magnetic resonance images were available for all patients, intracranial findings being an exclusion criterion. The effects of AD(H)D symptoms on intelligence and on the cognitive profile were tested by analyses of variance. RESULTS: Patients with AD(H)D symptoms performed significantly worse than those without AD(H)D symptoms on all intelligence measures (main effects for Full-scale, Verbal, and Performance IQ; p<0.005). Subtests typically impaired in patients with NF1 (visuospatial skills and arithmetic) were not specifically influenced by AD(H)D symptoms. There were no differences between AD(H)D subtypes. INTERPRETATION: AD(H)D symptoms have a negative impact on the intellectual development of children with NF1. This impact seems to be of an unspecific nature, with a general attenuation of the cognitive profile.

The regression-based discrepancy definition of learning disability: a critical appraisal.

The regression-based discrepancy definition of learning disabilities has been suggested by Rutter and Yule as an improvement of the well-known and much criticized achievement-intelligence discrepancy definition, whereby the examinee's predicted reading attainment is substituted for the intelligence score in the discrepancy expression. Even though the regression-based discrepancy definition has been with us for more than 30 years, critical examination of this approach is scarce. This article fills this lacuna by examining the implications of two variables in the model on the diagnosis of learning disabilities: (a) the effect of predictive validity on the proportion of examinees identified as learning disabled, and (b) the effect of the predictor's identity on the identity of the examinees diagnosed with learning disabilities. Implications of these effects concerning the validity of the regression-based discrepancy model and of the results of its implementation are discussed.

[The concept of «multiple complex developmental disorder¼ - a disorder of social interaction, paranoid thinking and social anxiety in a 17-year-old boy]. / Das Konzept der «Multiple Complex Developmental Disorder¼ (MCDD).

OBJECTIVES: Multiple complex developmental disorder (MCDD) is a little-known disorder characterized by disturbances in the regulation of emotions, social interactions and thought disorders. Neither the classification system of ICD-10 nor the DSM-IV lists MCDD as an independent disorder. METHODS: The study presents an overview on diagnostic criteria, current research and illustration by a case report of a 17-year-old adolescent. RESULTS: MCDD, autistic disorders and schizophrenic disorders partially overlap. A clear classification or differentiation is currently not clearly possible. CONCLUSIONS: Many open questions remain, and further research is needed.

Abnormal explicit but normal implicit sequence learning in premanifest and early Huntington's disease.

Learning may occur with or without awareness, as explicit (intentional) or implicit (incidental) learning. The caudate nucleus and the putamen, which are affected early in Huntington's disease (HD), are thought to be essential for motor sequence learning. However, the results of existing studies are inconsistent concerning presence/absence of deficits in implicit and explicit motor sequence learning in HD. We assessed implicit and explicit motor sequence learning using sequences of equivalent structure in 15 individuals with a positive HD genetic test (7 premanifest; 8 early stage disease) and 11 matched controls. The HD group showed evidence of normal implicit motor sequence learning, whereas explicit motor sequence learning was impaired in manifest and premanifest HD gene carriers, with progressive decline with progressive disease. Explicit sequence learning may be a useful cognitive biomarker for HD progression.

A study to define: profound and multiple learning disabilities (PMLD).

This study aimed to define the term 'profound and multiple learning disabilities' (PMLD). A shared understanding of terminology or diagnostic terms describing groups of individuals is important for the purposes of strategic development, service planning, and the provision and equity of service delivery. A literature review provided different definitions and meanings associated with the term. The meaning attributed to the definitions was explored in focus groups and individual interviews (face to face and telephone) with service managers, commissioners, practitioners, frontline healthcare staff and family carers who provide services, support and care for people with PMLD. Further iterative discussions were held with a smaller group over the precise wording of the chosen definition to ensure there was a shared and common understanding. Personal characteristics for the purpose of this study are defined as diagnoses, disabilities, impairments, activity restrictions and other characteristics which represent a person with PMLD.

Procedural learning difficulties: reuniting the developmental disorders?

During the past 30 years, research into developmental disorders has fragmented, emphasizing differences rather than commonalities. We propose that reunification might be achieved by using a "neural-systems" approach. Deficits in dyslexia are attributed to an intact declarative learning system combined with an impaired procedural learning system--a network that includes prefrontal language systems and basal ganglia, parietal and cerebellar structures. A typology is provided for other prevalent learning disabilities; this framework focuses on different learning skills in the understanding of learning disabilities and emphasizes the diagnostic significance of "secondary" symptoms. This approach highlights the need for development of "neurocognitive" tests to probe the function of components of each neural system and improve strategies for explanation, diagnosis and support of developmental disorders.

Neurodevelopmental disorders: cluster 2 of the proposed meta-structure for DSM-V and ICD-11.

BACKGROUND: DSM-IV and ICD-10 are atheoretical and largely descriptive. Although this achieves good reliability, the validity of diagnoses can be increased by an understanding of risk factors and other clinical features. In an effort to group mental disorders on this basis, five clusters have been proposed. We now consider the second cluster, namely neurodevelopmental disorders. METHOD: We reviewed the literature in relation to 11 validating criteria proposed by a DSM-V Task Force Study Group. RESULTS: This cluster reflects disorders of neurodevelopment rather than a 'childhood' disorders cluster. It comprises disorders subcategorized in DSM-IV and ICD-10 as Mental Retardation; Learning, Motor, and Communication Disorders; and Pervasive Developmental Disorders. Although these disorders seem to be heterogeneous, they share similarities on some risk and clinical factors. There is evidence of a neurodevelopmental genetic phenotype, the disorders have an early emerging and continuing course, and all have salient cognitive symptoms. Within-cluster co-morbidity also supports grouping these disorders together. Other childhood disorders currently listed in DSM-IV share similarities with the Externalizing and Emotional clusters. These include Conduct Disorder, Attention Deficit Hyperactivity Disorder and Separation Anxiety Disorder. The Tic, Eating/Feeding and Elimination disorders, and Selective Mutisms were allocated to the 'Not Yet Assigned' group. CONCLUSION: Neurodevelopmental disorders meet some of the salient criteria proposed by the American Psychiatric Association (APA) to suggest a classification cluster.

Objective criteria for classification of postsecondary students as learning disabled: effects on prevalence rates and group characteristics.

This study examined the consequences of classifying postsecondary students as learning disabled (LD) using five objective sets of criteria: IQ-achievement discrepancies (1.0 to 1.49 SD, 1.5 to 1.99 SD, and >or= 2.0 SD), DSM-IV criteria, and chronic educational impairment beginning in childhood. The participants were 378 postsecondary students from two universities who had been previously classified as LD and were receiving instructional and/or testing accommodations. The agreement between diagnostic models was often low, both in terms of the proportion of students identified as well as which students were identified by the models. The discrepancy models identified the largest proportions of students as LD (10% to 42%), whereas fewer than 10% of participants met either of the other sets of criteria, and 55% of the participants were not classified as LD by any of the models. Implications for further research and practices in postsecondary settings are discussed.

[Disorders of socialization in children and adolescents].

UNLABELLED: According to psychiatric classification, problems in effective socialization adjustment are characteristic of Pervasive Developmental Disorder (PDD), autism and Asperger syndromes. However, working in a clinic divulges a significantly sizable section of the population that faces problems in social functioning but does not fit either of the two aforementioned psychiatric diagnoses. Over the years a number of informal diagnoses have been developed for this group. The current literature reviews these diagnoses and deals with the question of whether these diagnoses are indeed different or whether they constitute a different viewpoint of the same problem. Some authors claim that the scarcity of current knowledge makes it impossible to provide a proper and precise answer. Therefore, the correct and effective approach is to integrate all the different viewpoints. Such an integrative approach may assist in better understanding the developmental socializing difficulties at a later time. In attempting to characterize the developmental socializing difficulties beyond the mere diagnoses, three major research viewpoints were developed while studying this group: the biological viewpoint, the missing central viewpoint and the behavioral viewpoint. CONCLUSIONS: It is important for the primary treating physician to show vigilance with regard to symptoms of impaired social functioning, especially in children and adolescents.

Predicting long-term cognitive and neuropathological consequences of moderate to severe traumatic brain injury: Review and theoretical framework.

Prognostic modeling in moderate to severe traumatic brain injury (TBI) has historically focused primarily on the projection of crude outcomes such as the risk of mortality and disability. Initial work in this area has perpetuated the notion that prognosis after moderate to severe TBI can be measured as a single, static, and dichotomous outcome. However, more recent conceptualizations describe moderate to severe TBI as the initiation of a chronic disease state with high levels of inter-individual variability in terms of symptom manifestation and disease progression. Unfortunately, existing prognostic models provide limited insight into the extent of chronic cognitive and neurodegenerative changes experienced by moderate to severe TBI survivors. Though prior research has identified a variety of acute factors that appear to influence post-injury cognitive and neuropathological outcomes, an empirically supported framework for prognostic modeling of these injury-distal outcomes does not exist. The current review considers the literature on an expanded array of empirically supported predictors (both premorbid and injury-related) in association with long-term sequelae of moderate to severe TBI. We also provide a theoretical framework and statistical approach for prognostic modeling in moderate to severe TBI in order to unify efforts across research groups and facilitate important progress in this research area.

Women with learning disabilities and Read coding: lessons from a cohort study.

BACKGROUND: The aim was to examine any differences in the way that Read codes are applied to the records for female patients with learning disabilities across three PCT areas. To ascertain the most commonly used read codes for learning disability. METHODS: This was a retrospective cohort study carried out in Bury, Heywood-and-Middleton and Rochdale PCTs. All women in the eligible age-group (25-64) as of the 1st June, 2005, who were in contact with the Learning Disabilities Teams in the relevant PCT areas were identified from the Teams' lists. The appropriate Read Codes were then used to identify women on GP systems. Patient data is stored on the GP database systems (Vision, EMIS, EMIS PC4 and Torex) and it was possible to search for patients with learning disabilities. RESULTS: The use of Read Codes varies across the three areas. The most commonly used Read codes were E3 (Mental Retardation)--27%, PJ0. (Down's Syndrome)--14% and Eu81z (Learning Disabilities)--8%. In 24% of the records a Read Code had not been documented. CONCLUSION: Read codes application varies between GP surgeries--dependent on PCT policy and the surgery's approach and also as a result of staff time.

The shifting subtypes of ADHD: classification depends on how symptom reports are combined.

Research on the correlates of ADHD subtypes has yielded inconsistent findings, perhaps because the procedures used to define subtypes vary across studies. We examined this possibility by investigating whether the ADHD subtype distribution in a community sample was sensitive to different methods for combining informant data. We conducted a study to screen all children in grades 1-5 (N = 7847) in a North Carolina County for ADHD. Teachers completed a DSM-IV behavior rating scale and parents completed a structured telephone interview. We found substantial differences in the distribution of ADHD subtypes depending on whether one or both sources were used to define the subtypes. When parent and teacher data were combined, the procedures used substantially influenced subtype distribution. We conclude the ADHD subtype distribution is sensitive to how symptom information is combined and that standardization of the subtyping process is required to advance our understanding of the correlates of different ADHD subtypes.

Empirically derived subtypes of child academic and behavior problems: co-occurrence and distal outcomes.

The aim of this study was to identify classes of children at entry into first grade with different patterns of academic and behavior problems. A latent class analysis was conducted with a longitudinal community sample of 678 predominantly low-income African American children. Results identified multiple subclasses of children, including a class with co-occurring academic and behavior problems. Gender differences were found in relation to the number of identified classes and the characteristics of academic and behavior problems for children. Several of the identified classes, particularly the co-occurring academic and behavior problems subclass for both genders, predicted negative long-term outcomes in sixth grade, including academic failure, receipt of special education services, affiliation with deviant peers, suspension from school, and elevated risk for conduct problems. The finding that subclasses of academic and behavior problems predict negative long-term outcomes validates the importance of the identified classes and the need to target interventions for children presenting with the associated class characteristics. Implications for early identification, prevention, and intervention for children at risk for academic failure and disruptive behavior problems are discussed.