Changes in services for students with learning disabilities in U.S. and Canadian medical schools, 1991 to 1997.

PURPOSE: To determine the changes between 1991 and 1997 in the admission policies of and services offered by U.S. and Canadian medical schools to students with learning disabilities. METHOD: Between June 1 and August 31, 1997, the author surveyed 144 medical schools in the United States and Canada regarding their services and programs for learning-disabled medical students. The questionnaire was the same one as used in a 1991 study. RESULTS: Of the medical schools contacted, 106 responded (one Canadian school sent a letter but did not complete the questionnaire). Ninety-four of 96 U.S. schools and seven of the remaining nine Canadian schools said that they accept students with learning disabilities. All of the respondents that accept such students claimed to make some academic accommodations. Most indicated that they would administer non-standard (e.g., untimed) licensing examinations, and many reported that their affiliated postgraduate medical training programs would also make appropriate accommodations for students with learning disabilities. CONCLUSION: When compared with the results from the 1991 survey, the new data suggest that medical schools have improved their services for learning-disabled students in response to the Americans with Disabilities Act.

Primary care of the adolescent patient.

When examining an adolescent, clinicians should look beyond the presenting complaint and ask questions designed to illuminate such problems as social and emotional adjustment, nutrition, sexual health, smoking, and possible use of mood-altering substances. In addition, a number of adult chronic diseases that make their first appearance in the second decade of life should be diagnosed.

Carnitine palmitoyltransferase deficiency in a college athlete: a case report and literature review.

Type II carnitine palmitoyltransferase deficiency is the most common cause of exercise-induced rhabdomyolysis, myoglobinuria, and proximal muscle weakness and pain in young adults. A lack of this enzyme impairs mitochondrial oxidation of long-chain fatty acids and can lead to rhabdomyolysis, myoglobinuria, and renal failure. Carnitine palmitoyltransferase deficiency, unusual but not rare, is often detected by finding elevated creatine phosphokinase level in a routine blood chemistry panel. A case of carnitine palmitoyltransferase deficiency in a college athlete is presented, and the disorder is compared with defective myophosphorylation in McArdle's disease, the next most frequent cause of similar symptoms.

Attention deficit disorder during adolescence: a review.

Attention deficit disorder (ADD) in adolescents has received scant attention when compared with that given to children. With or without hyperactivity, ADD does not disappear at puberty and is an important factor in scholastic and social failure in adolescents. As a condition associated with decreased metabolism in the premotor and prefrontal superior cerebral cortex, ADD in adolescents responds well to treatment with stimulants, tricyclic antidepressants and monoamine oxidase inhibitors. Nonpharmacologic modalities such as behavior modification, individual and family therapy, and cognitive therapy are useful adjuncts to psychopharmacologic management. Without effective treatment, ADD often results in increased risk of trauma, substance abuse and conduct and affective disorders during adolescence, and marital disharmony, family dysfunction, divorce, and incarceration in adulthood. Properly treated with medication and counseling, adolescents with ADD succeed as well as their peers.

Attention deficit disorder in college students: facts, fallacies, and treatment.

Attention deficit disorder (ADD), with or without hyperactivity, is a common but highly misunderstood and frequently underdiagnosed condition in college students. It affects students' academic and social success and emotional development. ADD is an invisible impairment of cortical regulation of activity and impulse control that is often hereditary, is as common in women as in men, and does not subside or disappear at puberty. ADD increases the risk of drug abuse, delinquency, incarceration, job failure, marital discord, and divorce. In college students, ADD is amenable to treatment in a multimodal program combining medication; individual, family, and group psychotherapy; career counseling; and cognitive control, together with electronic prostheses and special accommodations in the college classroom.

Services for students with learning disabilities in U.S. and Canadian medical schools.

Between September 1, 1990, and March 31, 1991, 103 of the 142 medical schools in the United States and Canada responded to a questionnaire regarding their services and programs for learning-disabled medical students. Ninety-three schools accepted such students (and ten did not), but only two-thirds had support programs and half lacked the capacity to diagnose learning disability disorders. Twenty-five did not know they could administer licensing examinations in a nonstandard manner, and 19 had no senior administrator or faculty member coordinating learning disability services. The author concludes that these results suggest that medical schools are poorly informed about and unprepared to help learning-disabled students.

Screening college students for hypercholesterolemia.

Selective screening for children and mass screening for adults are the two strategies for detecting hypercholesterolemia and identifying individuals at risk for early heart attacks that have been recommended by the American Academy of Pediatrics and the American Medical Association. The interval marking the end of childhood and the beginning of adulthood is a time of transition without an unwavering demarcation line. It is a time when many adult disorders that demand attention and detection begin. Because of the close relationship of elevated cholesterol levels in youth to subsequent cardiovascular disease, a small liberal arts university began mandatory mass cholesterol screening for all full- or part-time students who matriculated in September 1977. More than thirty 18- and 19-year-old first-year students with unknown hypercholesterolemia were detected each year. The mean cost per case identified is estimated to have been $212. The author concluded that mass screening of students entering college can identify, at a reasonable cost, students who have high levels of cholesterol.

Emotional disorders in learning disabled adolescents.

We retrospectively reviewed patients discharged from the psychiatric inpatient adolescent service and correlated neuropsychological subtypes with the patient's psychiatric diagnoses. Depressed learning disabled patients had visual memory and processing deficits. Conduct or behaviorally disordered patients had expressive language deficits. Learning disability subtypes may affect psychotherapy and therefore should be known when planning psychotherapy.

The effect of beta blockade on stress-induced cognitive dysfunction in adolescents.

Test anxiety is severely disabling to students whose fear of examinations causes cognitive dysfunction that paralyzes their thinking the way stage fright impairs actors ability to act. In studies using subjective evaluations among actors and musicians, beta-blockade relieved stage fright and has been used informally to treat test anxiety in students without objective measures of effectiveness. The Scholastic Aptitude Test (SAT) was chosen as an objective test instrument to confirm the effect of beta-blockade on test anxiety and performance. Thirty-two high school students who had already taken the SAT before enrolling in this study and who had stress-induced cognitive dysfunction on exams were given 40 mg of propranolol one hour before they retook those tests. Mean SAT scores with beta-blockade were 130 points higher than on the initial SAT done before entering the study without medication (p = less than .01). A single dose of propranolol immediately before the SAT permitted improved performance in students prone to cognitive dysfunction due to test anxiety.

The relationship between urinary tract infections and the collegiate academic calendar.

College students believe that they are more likely to be ill during examination periods than at other times in the academic year. We in the health service hypothesized that urinary tract infections are not affected by the demands of the academic calendar. During a 4-year study, the university health service obtained urine culture data prospectively from 456 patients who had a total of 508 episodes of urinary tract infections. Each year, the number of urinary tract infections decreased during both midterm and final examination periods, but rebounded to higher-than-average levels in the second week following the midterm examination period, as well as during the second week of the second (spring) semester, immediately after the mid-winter recess. Mean duration of symptoms was 34 hours (range, from 12 to 60). Urinary tract infections were less common during examination periods, when students were preoccupied with academic responsibilities, but such infections increased in frequency in the period immediately after examinations, when sexual intimacy was resumed or when sexual intercourse with a new partner began. Urinary tract infections in college women, the study indicated, are primarily related to sexual intercourse, and susceptibility is only indirectly affected by the demands of the academic calendar.

Meningococcal urethritis.

Two to four percent of the population carry meningococcus in the nasopharynx. Pharyngeal infections may be the entry point for blood-borne metastatic lesions throughout the body. Primary infections in other tissues are rare, and proof of transmission from a known carrier to a specific patient is uncommon. We report a primary infection of the urethra with the meningococcus in a heterosexual male contracted during an act of fellatio.

Learning disabilities in adolescents with high IQ scores.

Between January 1, 1971 and December 31, 1980, 43 of 415 adolescents diagnosed as "learning disabled" when evaluated in an intensive 4-day diagnostic program were found to have a WISC-R verbal, performance, or full scale IQ score of 120 or higher. The 34 boys and 9 girls were 14.5 +/- 2 years old, were in grade 9.5 +/- 1, and had had overt symptoms of academic difficulty for 4 +/- 1.5 years at the time of diagnosis. None of the adolescents was achieving at an academic level consistent with the potential indicated by the WISC-R score. All of the adolescents were able to dissemble and disguise their disabilities. Only nine had previously been recognized as being disabled. All exhibited academic failure (which became apparent or increasingly severe on entering junior high school) and suffered from lack of self-esteem, depression, and withdrawal. Older adolescents had "given up" on school and were attempting to find alternative careers. Learning disabilities constitute an invisible handicap which affects 2 to 3% of all adolescents. Those who have very high intelligence may be able to hide the handicap until academic challenges become sufficiently difficult or complex to unmask them.

Late Social and psychological aftereffect of pregnancy in adolescence.

Pregnancy in midadolescence may continue to affect social and psychological competence long after the pregnancy ends. Most studies report the effects on the children of these young mothers while only a few have examined the mothers who kept their babies and none have looked past the first decade after the birth. Twenty men and women who became parents in midadolescence were interviewed 17 to 24 years later. All were first seen because of family discord and the breakdown of parent-child relationships due to the rebellious behavior during the adolescence of the child born in their own adolescence. All of these adolescents had been well-behaved in childhood, but, having begun to date, were viewed by the parents as being troublesome and in danger of repeating the parental "mistake". Mothers were found to overtly spy on their daughters and expressed distrust of their heterosexual relationships. Fathers were distant and distrustful of their children and doubtful of their own abilities to control behavior. All parents were unable to discuss sexuality with their children. Pregnancy in midadolescence may significantly affect parental relationships with the subsequent children, especially when those children become adolescents.