The duration of the orthostatic blood pressure drop is predictive of death.

BACKGROUND: Orthostatic hypotension (OH) affects 6% of community-dwelling older people. This increases to 60% when non-invasive, continuous blood pressure (BP) monitoring is used, due to identification of transient drops in BP which recover rapidly. AIM: To determine the clinical relevance of these transient orthostatic BP drops. DESIGN: Five-year clinical observational study. METHODS: One hundred three consecutive new patients attending a Falls and Syncope Clinic in the UK from 1 February 2009 underwent continuous BP monitoring during an active stand. BP profiles were analysed to quantify all reductions in BP, measuring the duration of any drop below diagnostic criteria. Five-year follow-up data were extracted from hospital clinical records to assess clinical outcomes. RESULTS: Systolic BP (sBP) dropped ≥20 mmHg in 76 (74%) individuals, with 65 (63%) having ≥10 mmHg drop in diastolic BP. However, only 22 (21%) cases were diagnosed clinically with OH. A sustained reduction in BP (≥30 s) had a sensitivity of 0.91 and specificity of 0.88 for a clinical diagnosis of OH, being more accurate than absolute BP reduction alone. A sustained reduction in sBP was associated with greater use of vasopressors (36%,P0.001) and an independent, significantly greater risk of death (45% at 5 years,P0.009). CONCLUSION: An orthostatic reduction in sBP lasting ≥30 s improves accuracy of diagnosis. Moreover, given the significant adverse outcomes with a sustained reduction, clinicians should consider this when diagnosing and treating patients, as transient OH does not appear to be clinically significant.

Adults with language-learning disabilities: new challenges and changing perspectives.

As children and adolescents mature into adult life, their language-learning disabilities continue. Consequently, the view that language-learning disabilities are limited to the school years must be changed. This article reviews our understanding of adults with language-learning disabilities. Ecological and context-specific perspectives are presented to provide a framework for understanding the chronic and persistent nature of these disabilities across the lifespan. Descriptors of language-learning disorders in adults are provided that focus the clinician on observable behaviors to guide the process of assessment and intervention planning.

Children with language disorders: natural history and academic success.

Children with developmental language disorders pose specific and unique problems for educators. This article addresses the continuing academic vulnerability of these children during the school years. We advance the position that their academic vulnerability results from the lifelong need to acquire language, to learn with language, and to apply language knowledge for academic learning and social development. Issues are addressed that relate to persistence of language deficits and learning in school.

Conversational skills of individuals with fragile-X syndrome: a comparison with autism and Down syndrome.

The conversational skills of 18 individuals with fragile-X syndrome (FXS) were compared with those of two other matched groups with autism and Down syndrome. The FXS group used more eliciting forms in conversation than those with Down syndrome, and also used partial self-repetition more often than the other two groups. The Down syndrome group had more speech dysfluencies than those with autism, but not more than those with FXS. The autistic group used more inappropriate phrases. Qualitative analysis of behavioral phenotype may reveal differences in communicative organization among subgroups whose retardation is based on different genotypes. In addition, analysis of verbal strategies during conversation suggests important differences between individuals with FXS and autism.

Oral and written language abilities of XXY boys: implications for anticipatory guidance.

Previous studies of XXY boys suggest that they are at risk for certain communication disorders involving oral and written language. In this study, the language, reading, and spelling skills of a group of 14 XXY boys identified during neonatal cytogenetic screening were compared with those of a group of 15 control children. The two groups were matched for age, grade, race, parity, birth weight, parental age and education, and socioeconomic status. The mean age of the XXY group was 9 years 7 months and that of the control group was 9 years 3 months. The mean academic grade level for both groups was at the transition between third and fourth grade. There was selective reduction in verbal IQ scores for the XXY group and no significant differences apparent between groups for performance IQ scores. The decrease in verbal IQ was associated with a reduced full-scale IQ and also with significant problems in expressive language, auditory processing abilities, and auditory memory. Word-finding difficulties and problems in the production of syntax were major components of the specific expressive language deficit. Except for difficulties in the understanding of complex sentence structures, the receptive language skills of XXY boys did not differ significantly from those of the control group. These reductions in speech and language abilities correlated with decreased achievement by the XXY group on a variety of reading and spelling tasks. These results suggest that difficulty learning how to read and spell may be due to a preexistent language disability. Early attention to such expressive language problems may be essential to ameliorate secondary maladaptive behaviors due to chronic language-related learning disabilities.

Language disorders in childhood and adolescence: implications for learning and socialization.

Children and adolescents with language disorders encounter disruption in the fluency of social interaction. Because of the chronic nature of language disabilities, problems in academic achievement and success become the hallmark of the disorders during the school years. Since adolescence represents a time of experimentation and definition of the self, individuals with language disorders are at high risk for the development of fragmented and inappropriate perspectives about themselves. Treatment must address, in a functionally coordinated manner, the acquisition of essential linguistic and basic academic skills, the learning of curriculum content, and the development of appropriate perspectives of the self and the environment.

Preliminary observations on language and learning in XXY boys.

Difficulties with processing, storing and retrieving, and producing linguistic information were particularly evident among the XXY boys. These decrements in abilities were associated with decreased achievement in a variety of reading and spelling tasks in this study as well as in that of Graham et al [4]. The data suggest that a continuum of language disability is present throughout the early life of these children and is associated with the XXY anomaly. Furthermore, when considered in relation to cross-sectional observations on older Turner syndrome patients, these data suggest the possibility that pathologic variations in sex chromosome complements may differentially affect brain development and subsequent functioning of the children.

Election criteria for the adoption of an augmentative communication system: preliminary considerations.

Criteria for determining candidacy for an augmentative communication system are reviewed. Included is a consideration of cognitive, oral reflex, language, motor, intelligibility, emotional, chromological age, previous therapy, imitative, and environmental factors. The multiple factors are arranged on a branching type decision matrix, which yields a decision to either elect, reject, or delay implementation of an augmentative communication system. Case data demonstrating application of the decision matrix are presented.