Adults with learning disabilities want loving relationships, but may need support.

The studyMcCarthy M, Bates C, Elson N, Hunt S, Milne-Skillman, Forrester-Jones R. 'Love makes me feel good inside and my heart is fixed': What adults with intellectual disabilities have to say about love and relationships. J Appl Res Intellect Disabil 2021;00:1-11.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/romantic-relationships-adults-with-learning-disabilities/.

Improving cognitive functions in adolescents with learning difficulties: A feasibility study on the potential use of telerehabilitation during Covid-19 pandemic in Italy.

INTRODUCTION: Learning disabilities are due to genetic and/or neurobiological factors that alter brain functioning by affecting one or more cognitive processes related to learning. This study aimed to assess the efficacy of cognitive telerehabilitation in adolescents with learning disabilities to overcome the treatment problems related to the COVID-19 pandemic lockdown. METHODS: Twenty-four patients diagnosed with Unspecified Learning Disability (mean ± SD age: 18.2 ± 2.9 years; 50% male) were enrolled in this study. The patients were assessed by a neuropsychological evaluation at the beginning and at the end of the program. All patients received cognitive treatment via a specific telehealth app to stimulate the cognitive skills related to learning. The treatment lasted four weeks, with a daily training (lasting up to 60 min), for five days a week. RESULTS: Our young patients reported a statistically significant improvement in the main cognitive domains that are usually compromised in learning disabilities, including sustained and selective attention, shifting of attention, control of interference, memory and speed of information processing. Moreover, the patients showed a good usability and motivation during the training. CONCLUSIONS: Our study has shown that telerehabilitation could be a valid tool for the rehabilitation of specific cognitive skills in adolescents with learning difficulties.

Effects of assistive technology for students with reading and writing disabilities.

BACKGROUND: Assistive technology has been used to mitigate reading disabilities for almost three decades, and tablets with text-to-speech and speech-to-text apps have been introduced in recent years to scaffold reading and writing. Few scientifically rigorous studies, however, have investigated the benefits of this technology. PURPOSE: The aim was to explore the effects of assistive technology for students with severe reading disabilities. METHOD: This study included 149 participants. The intervention group received 24 sessions of assistive technology training, and the control group received treatment as usual. RESULTS: Both the intervention and control groups improved as much in 1 year as the normed population did. However, gains did not differ between the groups directly after the intervention or at 1 year of follow-up. CONCLUSIONS: The use of assistive technology seems to have transfer effects on reading ability and to be supportive, especially for students with the most severe difficulties. In addition, it increases motivation for overall schoolwork. Our experience also highlights the obstacles involved in measuring the ability to assimilate and communicate text.Implications for rehabilitationsAssistive technology (AT) can be useful for children with reading disabilities to assimilating text as well as boosting their reading.Children with reading disability using AT increased reading performance as much as a norm group, i.e. the students enhanced their reading ability despite no training in traditional reading remediation.Children's and adolescents' motivation for schoolwork can be boosted when using AT as a complement for those with reading and writing disabilities.

Efectividad de un programa estructurado de integración sensorial con un grupo de escolares con dificultades de aprendizaje: estudio retrospectivo en Bogotá / Development of a structured procedure of clinical observations of the sensory modulation and the performance of two clinical samples of children with and without tactile defensiveness: retrospective study in Bogotá

Las relaciones entre las dificultades de aprendizaje y las disfunciones de integración sensorial están reportadas en la literatura norteamericana, aunque en Latinoamérica la información disponible es limitada. Por lo anterior, se orientan los objetivos de este estudio a aportar a la literatura que describe los problemas sensoriales en niños con dificultades de aprendizaje y del impacto del tratamiento basado en la teoría de integración sensorial. El método de tipo retrospectivo utilizó el análisis anónimo de datos de diecisiete estudiantes derivados a terapia ocupacional por presentar dificultades en el entorno escolar. Se aplicaron evaluaciones estandarizadas: el test de Integracion Sensorial y Praxis; y el Perfil Sensorial, que al inicio reconocieron disfunciones entre 53% y el 88% y en reevaluación entre el 27% y el 88% reflejando cambio positivo después del programa. El análisis de varianza ANOVA permitió precisar el efecto del programa y contribuyó a explicar la relación de los déficits del procesamiento sensorial con las dificultades académicas y de comportamiento.

The relationships between learning difficulties and sensory integration dysfunctions are reported in American literature, in Latin America the information available is limited, guiding the objectives of this study to contribute to literature describing sensory problems in children with learning difficulties and the impact of treatment based on sensory integration theory. The retrospective method, I use anonymous analysis of data from seventeen students derived to occupational therapy because they present difficulties in the school environment. The Sensory Integration and Praxis test and sensory profile were applied as a standardized evaluation, which initially recognized dysfunctions between 53% and 88% and in re-evaluation between 27% and 88% reflecting positive change after the program. The ANOVA variance analysis allowed to specify the effect of the program and helped explain the relationship of sensory processing deficits with academic and behavioral difficulties.

Impact of COVID-19 outbreak on mental health and perceived strain among caregivers tending children with special needs.

BACKGROUND: While COVID-19 outbreak has had adverse psychological effects in children with special needs, the mental state and burden on their caregivers during this pandemic has yet to be reported. AIMS: The objectives of this study were to describe the mental health status and the change in perceived strain among caregivers during the COVID-19 outbreak. METHODS AND PROCEDURES: Two hundred sixty four caregivers completed an online survey that assessed demographics, use and perspective on tele-rehabilitation, homecare therapy, caregiver's strain and mental health. OUTCOMES AND RESULTS: The prevalence of depression, anxiety and stress symptoms were found to be 62.5 %, 20.5 % and 36.4 % respectively. A significant difference in caregiver strain (p <  0.001, effect size = 0.93) was observed during the outbreak compared to levels pre-outbreak (pre-outbreak strain was measured retrospectively). Caregivers not using tele-rehabilitation along with a perception of it being a poor medium for rehabilitation were at greater risks for poor mental health whereas a negative perception on homecare therapy were strongly associated with higher psychological symptoms and strain. CONCLUSIONS AND IMPLICATIONS: This study identified a high prevalence of depression and significant change in strain displayed by caregivers during the COVID-19 outbreak. We identified several factors associated with poor mental health and perceived strain that can be used to help safeguard caregivers.

Video-supported assessment as a method of bridging families and caregivers with professionals in Early Intervention / Evaluación respaldada por vídeo como método para vincular a familias, cuidadores y profesionales en la intervención temprana

BACKGROUND AND OBJECTIVE: Parent participation in the child assessment process works to improve parent-child interaction while building a sense of competence, self-efficacy and empowerment in the parents. The goal of this article is to underline the importance of the full participation of parents in the assessment process, using an assessment method that facilitates their participation in the assessment of their child. MATERIALS AND METHODS: We describe a three-step analysis of a video taken of the parent interacting with the child: (1) to chart what is observed in the video, such as the facial expressions of both parent and child; (2), to reflect on the parent-child interaction seen in the video; and (3) to intervene by creating an intervention tool based on the combined information gathered in the first two steps. RESULTS AND CONCLUSIONS: Video supported assessment creates opportunities for the full participation of parents and improves the relationship between families and professionals, increasing wellbeing in families and transforming times of assessment into a positive experience

ANTECEDENTES Y OBJETIVO: La participación de los padres en el proceso de evaluación del niño contribuye a mejorar la interacción entre padres e hijos, mientras que crea un sentido de competencia, autoeficacia y empoderamiento en los padres. El objetivo de este artículo es subrayar la importancia de la participación plena de los padres en el proceso de evaluación. Para ello, es importante utilizar una metodología de evaluación que facilite su participación en la evaluación de su hijo. MATERIALES Y MÉTODOS: Describimos una metodología de análisis de vídeo en 3 pasos para grabaciones de padres que interactúan con el niño. Esta metodología permite, en un trabajo conjunto con los padres: (1) delimitar lo que se observa en el video, como las expresiones faciales de ambos padres e hijos; (2) reflexionar sobre la interacción padre-hijo vista en el video, y (3) intervenir a partir del conjunto de información reunida en los primeros 2 pasos. RESULTADOS Y CONCLUSIONES: La evaluación respaldada por video crea oportunidades para la plena participación de los padres y mejora la relación entre las familias y los profesionales, aumentando el bienestar de las familias y transformando los momentos de evaluación en una experiencia positiva

A Systematic Review of Academic Discourse Interventions for School-Aged Children With Language-Related Learning Disabilities.

Purpose This systematic review synthesized a set of peer-reviewed studies published between 1985 and 2019 and addressed the effectiveness of existing narrative and expository discourse interventions for late elementary- and middle school-aged students with language-related learning disabilities. Method A methodical search of the literature for interventions targeting expository or narrative discourse structure for students aged 9-14 years with group experimental designs identified 33 studies, seven of which met specific criteria to be included in this review. Results An 8-point critical appraisal scale was applied to analyze the quality of the study design, and effect sizes were calculated for six of the seven studies; equivocal to small effects of far-transfer outcomes (i.e., generalizability to other settings) and equivocal to moderate near-transfer outcomes (i.e., within the treatment setting) were identified. The most effective intervention studies provided explicit instruction of expository texts with visual supports and student-generated learning materials (e.g., notes or graphic organizers) with moderate dosage (i.e., 180-300 min across 6-8 weeks) in a one-on-one or paired group setting. Greater intervention effects were also seen in children with reading and/or language disorders, compared to children with overall academic performance difficulties. Conclusions A number of expository discourse interventions showed promise for student use of learned skills within the treatment setting (i.e., near-transfer outcomes) but had limited generalization of skills (i.e., far-transfer outcomes). Supplemental Material https://doi.org/10.23641/asha.12449258.

Are Individual Differences in Response to Intervention Influenced by the Methods and Measures Used to Define Response? Implications for Identifying Children With Learning Disabilities.

Response to intervention (RTI) has been promoted for nearly 20 years as a valid supplement to or alternative method of learning disability (LD) identification. Nevertheless, important unresolved questions remain about its role in disability identification. We had two purposes when conducting this study of 229 economically and racially diverse poor readers in Grades 4 and 5 in 28 public elementary and middle schools in Nashville. First, we examined predictors of the children's response to a reading comprehension tutoring program. Second, we explored the utility of different methods (growth vs final status) and measures (near- and mid-transfer vs far-transfer) in operationalizing "response," and whether these contrasting methods and measures identified similar children. Findings indicated students with higher pretreatment scores on expressive vocabulary, nonverbal IQ, teacher ratings of attention, and reading comprehension measures were more likely classified as responsive with final status methods. Students with lower pretreatment comprehension scores were more likely identified as responsive with growth methods. These and other findings suggest "response" is strongly context dependent, raising questions about the validity of RTI as a means of disability identification.

A Snapshot of RTI Implementation a Decade Later: New Picture, Same Story.

Response to intervention (RTI) has evolved from its first decade of implementation. Because states guide and regulate policy and practice at the state and local education agency levels, it is important to understand their critical role in RTI implementation. A systematic review of all 50 state education agency websites was conducted to provide an updated "snapshot" of states' interpretation of RTI a decade after IDEA regulations were finalized. Findings revealed substantive progress towards developing approaches to systematic supports to students, with a major trend in adoption of multi-tiered system of support (MTSS) models. Findings also documented continued variation in how states are communicating about tiered systems on such matters as the roles of tiered systems in schoolwide prevention frameworks, meeting special education requirements, and aligning multiple systems within schools. Implications for special education services for students with learning disabilities are discussed.

Dificuldades na aprendizagem escolar, atraso motor e prática de atividade física: revisão sistemática / Difficulties in school learning, motor delay and the practice of physical activity: a systematic review

O processo humano do aprendizado é marcado pelo dinamismo e complexidade, estruturado a partir do ato motor e da percepção, dando origem à cognição. Contudo, a influência da prática de atividade física e das aulas de educação física no desenvolvimento da função cognitiva ainda não são consenso entre os pesquisadores. Sendo assim, este estudo tem como objetivo verificar se crianças com problemas na aprendizagem escolar apresentam maior atraso motor e se a prática de atividade física contribui para melhora do processo cognitivo de aprendizagem. Foram selecionados neste estudo 8 artigos que investigaram (n=835) escolares de 6 a 12 anos. Os resultados demonstraram que a dificuldade na aprendizagem escolar está relacionada ao maior atraso motor e que grupos que participaram de atividades físicas e das aulas de educação física melhoraram o desempenho das funções cognitivas de aprendizagem. Portanto, torna-se fundamental a prática de atividade física e a participação das aulas de educação física, devido sua contribuição no processo de fortalecimento do desenvolvimento infantil.

Human learning is marked by dynamism and complexity. It is structured from the human motor skills and perception, and thus originating cognition. However, there is no agreement among researchers on the influence of physical activity and physical education classes on the development of cognitive function. Therefore, this work aims at verifying if schoolchildren with learning disabilities present greater human motor delay and if physical activity contributes towards a better cognitive leaning process. Moreover, this study also aims at verifying if physical activity improves cognitive learning. In this study, a total of eight (8) journal articles were chosen, which investigated (n=835) students aged from 6 to 12 years old. The results showed that learning disability is related to a higher human motor delay. It also demonstrated that groups which participated in physical activities and in physical education classes presented better human motor skills and better performance of the cognitive functions in learning. Thus, it can be concluded that physical activity and physical education classes play an important role on the progress of children development.

Exploring the Relation Between Teacher Factors and Student Growth in Early Writing.

Data from a small randomized control trial of teachers' use of Data-Based Instruction (DBI) for early writing were analyzed to determine the influence of teacher knowledge, skills, and treatment fidelity on student Curriculum-Based Measurement (CBM) slope. Participants included 11 elementary grade teachers who delivered intensive intervention in early writing and their students (n = 31), all identified as either at risk for or with disabilities that affect their writing. Teachers received professional development and ongoing coaching to support the implementation of DBI for improving their students' early writing skills. Results from a multiple regression analysis suggest that teacher knowledge and skills in DBI was strongly related to student CBM slope in early writing (p < .01) and a small but significant relation between fidelity of writing instruction and student CBM slope (p < .01). Implications for instructional coaching and improving student writing progress are discussed.

The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder.

BACKGROUND: Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education. AIMS: The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group. METHODS: Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected. RESULTS: Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group. CONCLUSIONS: Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.

Using Video-Based Instruction via Augmented Reality to Teach Mathematics to Middle School Students With Learning Disabilities.

The purpose of this study was to examine the effectiveness of video-based mathematics instruction for seven middle school students with specific learning disability (SLD), using an augmented reality-based training package. The dependent variable was the percentage of steps students performed correctly to solve each type of mathematics problem. The independent variable was the augmented reality video-based intervention, which used video to model the individual steps for solving four types of multistep mathematics problems: (a) addition and subtraction of integers, (b) multiplication and division of integers, (c) using ratio reasoning to convert measurement units, and (d) using multiplication and division to calculate rate of change. Results indicated a functional relation between the video-based mathematics intervention and the percentage of steps completed correctly for each type of problem. All seven participants showed significant gains immediately after receiving the intervention and maintained improved problem-solving skills in at least three out of the four problem categories.

Republication of The Technology-Related Assistance to Individuals with Disabilities Act: Relevance to Individuals with Learning Disabilities and Their Advocates.

Assistive technology (AT) was recognized by Congress as a viable need for people with disabilities when it passed the Tech Act in 1988. The legislation, which was reauthorized in 1994, has resulted in numerous programs and services that have helped people with disabilities access and use AT devices. The Tech Act's implications for people with learning disabilities is discussed in this article.

An analysis of the five year outcomes of a cohort of 46 deaf children with severe (SLD) or profound and multiple learning difficulties (PMLD) and associated complex needs, including autism (ASD), tracked using the Nottingham Early Cognitive and Listening Links (Early CaLL): This framework monitors the relationship between sound processor use and listening, spoken language, cognition and communicative development, following cochlear implantation.

Objectives: In 2018, routine data of the five year outcomes from a cohort of 46 children, (18 PMLD and 28 SLD, including nine SLD children with an additional diagnosis of ASD), was analysed to investigate the type and amount of benefit provided by cochlear implantation and to examine any differences in outcome patterns across the populations.Methods: The level of functional sound processor use achieved over time was reviewed in relation to listening and spoken language outcomes, alongside social engagement, communicative and cognitive development. The extent to which children were able to close the gap between their overall development and their listening abilities was quantified. The outcomes of the children with an additional diagnosis of ASD, was compared to those of the SLD population as a whole.Results: Although equipment management presented long term challenges, after five years, 80% of children were able to attach some meaning to sound. Children with SLD acquired more auditory skills and spoken language than those with PMLD. Most of the children used a mix of augmentative and alternative communication approaches (AAC), with 7%, all SLD children, acquiring some simple spoken language. An additional diagnosis of ASD had a negative effect on outcomes.Discussion: For 80% of the patients, the provision of cochlear implants provided benefits, although changes were slow to develop and required high levels of adult persistence.Conclusion: Outcomes measures which are population specific and acknowledge challenges, alongside providing ways to recognise individual achievements, by matching them against individual capacity, are of great value to families and practitioners.

The development and implementation of the Nottingham early cognitive and listening links (Early CaLL); A framework designed to support expectation counselling and to monitor the progress, post cochlear implantation, of deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD) and associated complex needs.

Objectives: Appropriate outcome measures are required for deaf children with severe (SLD) and profound and multiple learning difficulties (PMLD). This paper describes the development and structure of the Nottingham Early CaLL Framework and via a series of case-studies, demonstrates its effectiveness in tracking progress over time.Methods: The materials were developed in-house in 2011-2012 and refined through the exploration of established approaches in health and education, an inter-rater reliability study and an extended pilot of the draft materials.Results: The Framework quantifies the long term benefit of cochlear implantation by recording the amount of functional sound processor use achieved, alongside incremental changes in auditory behaviours, in the context of cognition, interaction and communication development. The case-studies demonstrate how it can provide evidence of measurable changes and help to explain some of the underlying reasons for the range of long-term outcomes.Discussion: Within this population, the key predictive, within-child factors of post cochlear implant listening and spoken language outcomes, are an individual's cognitive and physical capacities and their engagement in social communication.Conclusion: The Early CaLL Framework supports expectation counselling and decision-making in the assessment phase and post cochlear implantation provides monitoring tool, which encourages collaboration between families and professionals.

Use of cognitive correction training improves learning for children with mathematics learning disability.

Children with normal intelligence may experience varying degrees of mathematics learning disabilities (MD). This study aims to conduct training to improve the brain's cognitive ability for mathematics learning by focusing on two important mathematical cognitive abilities. This was a prospective study of 70 children in grades 2-5 from two primary schools in Changzhou and with MD enrolled from June 2015 to February 2017. The children were randomized 1:1 to the training and control groups. A training cycle included 40 sessions (5/weeks) (30 min each session). The efficacy of learning was assessed by assessing number learning and graph reasoning, and by using the Raven standard reasoning test score. In the training group, backward number memory (from 6.1 ± 1.8 to 6.7 ± 1.3, P = 0.02), number sequential connection (from 54.4 ± 14.5 to 47.1 ± 12.1, P < 0.01), and rapid graph judgment (from 531.9 ± 76.3 to 557.8 ± 85.7, P = 0.04) were improved by training, while there was no effect on forward number memory (P = 0.13). There were significant differences in total score and scores of b, c, and e series before and after training (all P < 0.05). The children in the control group had no improvement after 8 weeks. There was a correlation between the ability of rapid graphic judgment before and after training and the score of the Raven E series (r = 0.384, P = 0.024), and between the score of the Raven C series and the score of the Raven D series (r = 0.468, P = 0.013). Cognitive correction training improved the sensitivity to numbers and mathematics learning in children with MD.

Early results from a combined low-intensive psychoeducational intervention for preschoolers with autism spectrum disorder.

Purpose: Early and Intensive Behavioral Treatments are considered to be evidence-based interventions for children with Autism Spectrum Disorder (ASD). Nevertheless, children with ASD might not always have the opportunity to benefit from intensive treatment; new, more accessible and alternative treatment options need to be tested. The aim of this study was to evaluate the effectiveness of the Combined Low-intensive Psychoeducational Intervention (CLI-PEI) delivered to preschoolers with ASD at the end of the pre-primary school day.Methods: A quasi-experimental design study, namely a pretest-posttest alternative-treatment comparison groups design, was used. Treatment sessions were carried out over a period of 12 months. Forty-three individuals with autism were included in the study: 24 received the CLI-PEI and 19 were administered the Treatment As Usual. A pre- and posttreatment assessment was carried out using the Psychoeducational Profile-Third edition and the Vineland Adaptive Behavior Scale.Results: The children who received the CLI-PEI showed better gains in both developmental and maladaptive behaviors; furthermore, increased skills were found in all adaptive domains.Conclusions: The CLI-PEI might seems to be a viable treatment option for children with ASD, when intensive behavioral treatments are not accessible.Implication for rehabilitationChildren with ASD might not always have the opportunity to benefit from intensive treatment.The identification of more accessible, less intensive and less expensive evidence-based psychoeducational interventions might represent an appealing challenge for rehabilitation therapists.Less intensive and less expensive evidence-based interventions might also represent a viable option for children and their families, especially in communities with limited resources for autism.A pragmatic approach including components from evidence-based treatments might guarantee flexibility and the possibility to implement an intervention well-tailored to the specific child needs.CLI-PEI for preschoolers with ASD seems to be a promising pragmatic approach, promoting improvements in developmental, adaptive and maladaptive domains.

Autobiographical memory and future thinking impairments in multiple sclerosis: Cognitive and neural mechanisms, functional impact and rehabilitation.

Learning and memory impairments are common in individuals with multiple sclerosis (MS) and have pervasive effects on everyday life functioning. Hence, memory and learning have received particular attention in the cognitive rehabilitation literature in MS. The effectiveness of memory rehabilitation on memory performance is supported by several studies, but the generalisability of the benefits to daily life and memory for real-life events has rarely been examined. Recently, a new line of research focusing on memory for personal life events (i.e., autobiographical memory) has emerged in the MS literature. This approach is complementary to classical learning and memory paradigms and also allows for approaching memory in a broader context, one that considers memory as the ability to remember past episodes and imagine events that may occur in one's personal future (i.e. future thinking). This review provides an overview of the findings in this line of work. The first part summarises current evidence regarding the cognitive and neural mechanisms underlying autobiographical memory and future thinking impairments in MS. It points out that these domains are frequently and early impaired in individuals with MS because of an executive/frontal-related deficit. Individuals with MS are generally aware of these deficits and their negative impact on everyday life, so the development of strategies to alleviate such deficits seems of paramount importance. Thus, in the second part, I present the main outcomes of a cognitive intervention developed by our research group, which has been specifically designed to alleviate autobiographical memory and future thinking impairments in individuals with MS. The implications of these findings for neuropsychological care and well-being of individuals with MS are discussed in the final section, with an emphasis on the functional role of autobiographical memory and future thinking in various domains, including personal identity.

Academic Achievements of College Graduates With Learning Disabilities Vis-a-Vis Admission Criteria and Academic Support.

Postsecondary entrance examination scores are generally low predictors of college achievement (grade point average [GPA]) for students with learning disabilities (LD). The difficulties with meeting academic requirements have raised the awareness of the needs of students with LD for support services. The present study examined the adequacy of entrance criteria to academic studies for students with LD and the effectiveness of three support levels during their academic studies in increasing their academic gains. Data were collected for 315 college graduates with LD and 955 graduates who do not have LD (NLD) who completed their BA studies in a college in Israel. Although the admission scores of graduates with LD were lower than those of NLD graduates, their GPA was higher than the GPA of NLD graduates. The psychometric score had a low correlation with final college GPA of graduates with LD. There was no difference in the final GPA of the graduates with LD in the different support programs. The findings suggest that academic support can be an effective way to help students with LD to eliminate or close the gap between them and NLD students and to earn an academic degree, regardless of what if any admission criteria were applied to them.