Home About us Contact
|
Home About us Contact | ||
|
|
||
Learning Disability (learning + disability)
Terms modified by Learning Disability Selected AbstractsTopiramate in Patients with Learning Disability and Refractory EpilepsyEPILEPSIA, Issue 4 2002Kevin Kelly Summary: ,Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre. Methods: Sixty-four patients (36 men, 28 women, aged 16,65 years) were begun on adjunctive TPM after a 3-month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6-month period at optimal TPM dosing. These were seizure freedom or ,50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study. Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on ,200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add-on therapy in learning-disabled people with difficult-to-control epilepsy. Seizure freedom is a realistic goal in this population. [source] Is Response to Intervention Good Policy for Specific Learning Disability?LEARNING DISABILITIES RESEARCH & PRACTICE, Issue 4 2008Kenneth A. Kavale We discuss several policy implications of these new regulations by considering the original construct of SLD, the still "experimental" status and implementation of RTI, the closer alignment of RTI objectives with No Child Left Behind than former IDEA regulations, and the shift in focus from serving as a special education identification procedure to a general education instructional procedure. We conclude by proposing several recommendations for the appropriate inclusion of both RTI and psychometric evaluation within the continuum of SLD identification procedures. [source] Kindergarten Predictors of Math Learning DisabilityLEARNING DISABILITIES RESEARCH & PRACTICE, Issue 3 2005Michèle M. M. Mazzocco The aim of the present study was to address how to effectively predict mathematics learning disability (MLD). Specifically, we addressed whether cognitive data obtained during kindergarten can effectively predict which children will have MLD in third grade, whether an abbreviated test battery could be as effective as a standard psychoeducational assessment at predicting MLD, and whether the abbreviated battery corresponded to the literature on MLD characteristics. Participants were 226 children who enrolled in a 4-year prospective longitudinal study during kindergarten. We administered measures of mathematics achievement, formal and informal mathematics ability, visual-spatial reasoning, and rapid automatized naming and examined which test scores and test items from kindergarten best predicted MLD at grades 2 and 3. Statistical models using standardized scores from the entire test battery correctly classified ,80,83 percent of the participants as having, or not having, MLD. Regression models using scores from only individual test items were less predictive than models containing the standard scores, except for models using a specific subset of test items that dealt with reading numerals, number constancy, magnitude judgments of one-digit numbers, or mental addition of one-digit numbers. These models were as accurate in predicting MLD as was the model including the entire set of standard scores from the battery of tests examined. Our findings indicate that it is possible to effectively predict which kindergartners are at risk for MLD, and thus the findings have implications for early screening of MLD. [source] Validity of the comprehensive receptive and expressive vocabulary test in assessment of children with speech and learning problemsPSYCHOLOGY IN THE SCHOOLS, Issue 6 2002Teresa Smith The current researchers investigated construct, predictive, and differential validity for the Comprehensive Receptive and Expressive Vocabulary Test (CREVT). Participants were 243 public school students, ages 5.5 to 17.25 years. They represented four primary disabilities: Learning Disability (n = 115), Learning Disability with Speech Impairment (n = 29), Mental Retardation (n = 40), and Speech Impairment (n = 59). Adequate construct validity for the CREVT was documented, using the Wechsler Intelligence Test for Children,III as a criterion. Also, the CREVT significantly predicted the scores on the Wide Range Achievement Test,3. Lastly, the CREVT effectively differentiated between students with disabilities. These findings suggest that the CREVT may be helpful in identifying the presence of learning problems. © 2002 Wiley Periodicals, Inc. Psychol Schs 39: 613,619, 2002. [source] Learning Disability and Social Inclusion: A review of Current Policy and Practice (Policy and Practice in Health and Social Care Series, No. 7)BRITISH JOURNAL OF LEARNING DISABILITIES, Issue 1 2009Sue DumbletonArticle first published online: 23 FEB 200 No abstract is available for this article. [source] Time to make up your mind: why choosing is difficultBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 1 2003John Harris Summary For many years, the promotion of choice has been a core objective for virtually every service provider working to support people with learning disability. This is confirmed by the 2001 English White Paper Valuing People, A New Strategy for Learning Disability for the 21st Century, which describes choice as one of four key principles at the heart of the UK Government's proposals, and the 2000 review of learning disability services commissioned by the Scottish Executive, People Like Us, which places a similarly high priority on the creation of choice. The present paper gives an overview of our current understanding of the concept of choice. It concludes that our aspirations to promote choice for people with learning disability are undermined by conceptual confusion about the meaning of choice, inappropriate methods for helping people to make choices and an absence of applied research to guide practice in service settings. This review is designed to establish a conceptual framework for examining choice and empowerment for people with learning disability, and to describe the implications for future research and practice. [source] Helping People with A Learning Disability Explore RelationshipsBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 3 2002David Thompson No abstract is available for this article. [source] Crossing Boundaries: Change and Continuity in the History of Learning DisabilityBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 2 2002Michael Solomon No abstract is available for this article. [source] Prevalence and correlates of mental disorders in Israeli adolescents: results from a national mental health surveyTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2010Ilana Farbstein Background:, The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence-based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004,2005 in a representative sample of 957 adolescents aged 14,17 and their mothers. Methods:, The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio-demographic and health correlates. Disorders were ascertained with the Development and Well-Being Assessment inventory and verified by child psychiatrists. Results:, The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. Conclusions:, The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society. [source] Psychology brings justice: the science of forensic psychology,CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2003Gisli H. Gudjonsson Professor of Forensic Psychology In this paper the focus is on one aspect of forensic psychology: the development of psychological instruments, a social psychological model and assessment procedures for evaluating the credibility of witnesses and police detainees during interviewing. Clinically grounded case work and research has impacted on police interviewing and practice, the admissibility of expert psychological testimony and the outcome of cases of miscarriage of justice. After describing the research that laid the foundations for advancement of scientific knowledge in this area, a brief review is presented of 22 high-profile murder cases where convictions based on confession evidence have been quashed on appeal between 1989 and 2001, often primarily on the basis of psychological evidence. The review of the cases demonstrates that psychological research and expert testimony in cases of disputed confessions have had a profound influence on the practice and ruling of the Court of Appeal for England and Wales and the British House of Lords. The cases presented in this paper show that it is wrong to assume that only persons with learning disability or those who are mentally ill make unreliable or false confessions. Personality factors, such as suggestibility, compliance, high trait anxiety and antisocial personality traits, are often important in rendering a confession unreliable. Future research needs to focus more on the role of personality factors in rendering the evidence of witnesses and suspects potentially unreliable. Copyright © 2003 Whurr Publishers Ltd. [source] The epidemiology of attention-deficit/hyperactivity disorder (ADHD): A public health viewDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2002Andrew S. Rowland Abstract Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. However, basic information about how the prevalence of ADHD varies by race/ethnicity, sex, age, and socio-economic status remains poorly described. One reason is that difficulties in the diagnosis of ADHD have translated into difficulties developing an adequate case definition for epidemiologic studies. Diagnosis depends heavily on parent and teacher reports; no laboratory tests reliably predict ADHD. Prevalence estimates of ADHD are sensitive to who is asked what, and how information is combined. Consequently, recent systematic reviews report ADHD prevalence estimates as wide as 2%,18%. The diagnosis of ADHD is complicated by the frequent occurrence of comorbid conditions such as learning disability, conduct disorder, and anxiety disorder. Symptoms of these conditions may also mimic ADHD. Nevertheless, we suggest that developing an adequate epidemiologic case definition based on current diagnostic criteria is possible and is a prerequisite for further developing the epidemiology of ADHD. The etiology of ADHD is not known but recent studies suggest both a strong genetic link as well as environmental factors such as history of preterm delivery and perhaps, maternal smoking during pregnancy. Children and teenagers with ADHD use health and mental health services more often than their peers and engage in more health threatening behaviors such as smoking, and alcohol and substance abuse. Better methods are needed for monitoring the prevalence and understanding the public health implications of ADHD. Stimulant medication is the treatment of choice for treating ADHD but psychosocial interventions may also be warranted if comordid disorders are present. The treatment of ADHD is controversial because of the high prevalence of medication treatment. Epidemiologic studies could clarify whether the patterns of ADHD diagnosis and treatment in community settings is appropriate. Population-based epidemiologic studies may shed important new light on how we understand ADHD, its natural history, its treatment and its consequences. MRDD Research Reviews 2002;8:162,170. © 2002 Wiley-Liss, Inc. [source] Outcome of severe unilateral cerebellar hypoplasiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010ANDREA PORETTI Aim, Complete or subtotal absence of one cerebellar hemisphere is exceptional; only single cases have been described. We aimed to assess the long-term outcome in children with severe unilateral cerebellar hypoplasia (UCH). Method, As part of a retrospective study we describe neuroimaging features, clinical findings, and cognitive outcomes of seven children with UCH (five males, two females; age at first magnetic resonance imaging [MRI]: median 1y 3mo, range 9d,8y 10mo; age at latest follow-up: median 6y 6mo, range 2y 3mo,14y 11mo). Results, One child had abnormalities on prenatal MRI at 21 weeks' gestation. The left cerebellar hemisphere was affected in five children, and the right hemisphere in two children. The vermis was involved in five children. The volume of the posterior fossa was variable. At the latest follow-up, neurological findings included truncal ataxia and muscular hypotonia in five children, limb ataxia in three patients, and head nodding in two patients. Three children had learning disability*, five had speech and language disorders, and one had a severe behavioural disorder. Interpretation, Severe UCH is a residual change after a disruptive prenatal cerebellar insult, most likely haemorrhagic. The outcome is variable, ranging from almost normal development to marked developmental impairment. Ataxia is a frequent but not a leading sign. It seems that involvement of the cerebellar vermis is often, but not consistently, associated with a poorer cognitive outcome, whereas an intact vermis is associated with normal outcome and no truncal ataxia. [source] Pervasive developmental disorders in individuals with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2009AYSE KILINCASLAN MD The aim of the present study was to describe the prevalence and associated factors of pervasive developmental disorders (PDD), including autistic disorder and PDD not otherwise specified (NOS), in a clinical sample of 126 children and adolescents (75 males, 51 females; age range 4,18y, mean 8y 8mo, SD 3y 8mo) with tetraplegic, hemiplegic, diplegic, dyskinetic, or mixed types of cerebral palsy (CP); 28% could not crawl or walk even with support, 29% could move with support, and 43% walked independently. Participants were examined for PDD in two stages. In the first stage, probable participants were determined by direct observation, Autism Behavior Checklist score, and medical reports. In the second stage, those with ,probable' symptoms underwent psychiatric examination and their autistic symptoms were scored on the Childhood Autism Rating Scale. The final diagnosis of autistic disorder or PDD-NOS was given according to DSM-IV criteria. Fourteen (11%) and five (4%) of the participants met the criteria for autistic disorder and PDD-NOS respectively. Children with CP and PDD differed from those without PDD in terms of type of CP (p=0.02), presence of epilepsy (p<0.001), intellectual level (p<0.001), and level of speech (p<0.001). PDD was more common in children with tetraplegic, mixed, and hemiplegic CP, and in children with epilepsy, learning disability,, and low level of speech. The findings corroborate the notion that CP is a complex disorder, often associated with additional impairments. PDD is not rare in CP and should be considered in patients with comorbid conditions such as epilepsy, learning disability, and language delay and in the presence of tetraplegic, mixed, and hemiplegic CP types. [source] Prevalence and characteristics of autistic spectrum disorders in the ALSPAC cohortDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2008Emma Williams MSc PhD The aim of this study was to determine the prevalence of autistic spectrum disorder (ASD) within a large representative population sample: the Avon Longitudinal Study of Parents and Children (ALSPAC). Cases of ASD were identified from the clinical notes of children in the ALSPAC with a suspected developmental disorder and from the Pupil Level Annual Schools Census (PLASC) for England in 2003. Seventy-one cases of ASD diagnosed after a multidisciplinary assessment were identified from health records. There were an additional 15 cases from PLASC data in which ASD was mentioned as a principal difficulty, thus giving a total of 86 children diagnosed by the age of 11 years. Prevalence of ASD per 10 000 population at 11 years was 51.1 for those with a multi-professional diagnosis, and 61.9 if cases from education were included, made up of 21.6 for childhood autism, 10.8 for atypical autism, 16.6 for Asperger syndrome, and 13.0 for unspecified ASD. The male:female ratio was 6.8:1. Median age at diagnosis ranged from 45 months in childhood autism to 116 months in Asperger syndrome. A comorbid developmental disorder was recorded in 33.8% of cases, including learning disability, in 14.7%, epilepsy in 10.3%, and mixed developmental disorder in 4.4%. We conclude that the prevalence of ASD diagnosed at 11 years in a UK representative population-based sample is at least 51.1/10 000. [source] Autism spectrum disorder and underlying brain mechanism in the oculoauriculovertebral spectrumDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2007Maria Johansson MD As part of a multidisciplinary study, the rate of autism spectrum disorder (ASD), learning disability (LD), and brain abnormalities was examined in 20 participants (12 males, 8 females; age range 8mo-17y, mean age 8y 1mo) diagnosed as falling within the oculoauriculovertebral spectrum (OAV). A neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Two individuals met diagnostic criteria for autism, one for autistic-like condition, and five for autistic traits. Four patients had mild LD, three severe LD, two profound LD, and two borderline intellectual functioning. Neuroimaging indicated cerebral abnormalities in more than half of the patients. Abnormalities of white/grey matter were found in more than half of examined individuals; enlargement of ventricles in more than a third. Results indicate that at least a subgroup of ASD may be associated with errors in early embryonic brain development. Awareness of the coexistence of OAV/ASD is important in habilitation care of individuals with OAV. [source] Ring chromosome 20 syndrome with intractable epilepsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2005Asude Alpman MD Ring chromosome 20 (r[20]) syndrome is characterized by mild to moderate learning disability*, behavioural disorders, epilepsy, and various dysmorphic features. Although still considered rare, r(20) syndrome is being increasingly diagnosed. More than 30 cases have been described in the literature since 1976. Here we report an additional case of a 14-year-old male with r(20). He had moderate to severe learning disability and epileptic seizures manifesting at about 18 months of age. During the 13 years' follow-up period he showed intractable epileptic seizures, behavioural disorders, and mild dysmorphological features including microcephaly, strabismus, micrognathia, down-slanting eyelids, and ear abnormalities. Frequent episodes of atypical absence or non-convulsive status associated with electroencephalogram changes were seen in follow-up. He was treated with several classical and new antiepileptic drugs, including intravenous immunoglobulin, corticotropin, and vagal nerve stimulation, with unsuccessful control of seizures. Finally, surgical treatment (corpus callosotomy) was performed at the age of 13 years; severity of tonic seizures was diminished, but frequency was unchanged. Although his behavioural problems, e.g. hyperactivity, were mild in early childhood they became more severe when he was 11 years old. Aggressiveness, compulsiveness with self-injury, and panic attacks developed at the age of 13 years, and were more pronounced after callosotomy. This case report provides the first description of deterioration in psychological situation in patients with r(20) intractable epilepsy. The patient was diagnosed with r(20) syndrome after 13 years of clinical follow-up. Karyotype analysis should, therefore, be performed in every patient with intractable epilepsy of unknown aetiology. [source] Ataxia, autism, and the cerebellum: a clinical study of 32 individuals with congenital ataxiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2005Ingegerd Åhsgren MD The suggested link between autism and cerebellar dysfunction formed the background for a Swedish clinical study in 2001. Thirty-two children (17 females, 15 males; mean age 12y, SD 3y 10mo; range 6 to 21y) with a clinical suspicion of non-progressive congenital ataxia were examined, and parents were interviewed about the presence of neuropsychiatric problems in the child. Twelve children had simple ataxia, eight had ataxic diplegia, and 12 had,borderline'ataxia. All but one of the 32 children had a mild to moderate gross motor disability according to Gross Motor Function Classification System (15 were categorized as level I,16 as level II, and one child as level IV). Neuroimaging and neuropsychological testing were achieved in most cases. There was a strong association between learning disability* and autism spectrum disorder (often combined with hyperactivity disorder) on the one hand, and both simple and borderline,ataxia'on the other, but a weaker link between ataxic diplegia and neuropsychiatric disorders. A correlation between cerebellar macropathology on neuroimaging and neuropsychiatric disorders was not supported. Congenital ataxia might not be a clear-cut syndrome of cerebellar disease, but one of many signs of prenatal events or syndromes, leading to a complex neurodevelopmental disorder including autism and learning disability. [source] One hundred males with Asperger syndrome: a clinical study of background and associated factorsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2004Mats Cederlund MD The objective of this study was to investigate the background and associated factors in a representative group of young males with Asperger syndrome (AS) presenting at a specialized autism clinic. One hundred males aged 5 years 6 months to 24 years 6 months, with a mean age of 11 years 4 months (SD 3y 10mo), who had a clinical diagnosis of AS were included in the study. An in-depth review of their medical records and neuropsychological test data was performed. There was a high rate (51%) of non-verbal learning disability (defined as Verbal IQ more than 15 points higher than Performance IQ), but otherwise there was little or no support for the notion of right-hemisphere brain dysfunction being at the core of the syndrome. There was a very high rate of close relatives with autism spectrum problems, but also high rates of prenatal and perinatal problems, including prematurity and postmaturity. In comparison with general population data, those with AS very often had a combination of genetic and prenatal and perinatal risk factors. Non-verbal learning disability test results applied in about half the group. There was a subgroup of individuals with AS who had macrocephalus. However, there was no support for an association of AS with low body mass index. [source] Autism spectrum disorders in children with active epilepsy and learning disability: comorbidity, pre- and perinatal background, and seizure characteristicsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2003Suzanne Steffenburg MD PhD The aim of this study was to examine the comorbidity pattern, seizure characteristics, and aetiology in a representative group of children with a combination of autism spectrum disorder (ASD), active epilepsy, and learning disability. Ninety children (47 males, 43 females; mean age 11 years 2 months, range 8 to 16 years at the time of psychiatric examination) with active epilepsy and learning disability, identified in a population-based study in Göteborg, Sweden, were subdivided into those with and those without ASD and compared with respect to aetiology, additional neuroimpairments, and seizure characteristics. In addition, the cohorts were examined for trends of prevalence over a period of time. Results indicated that established aetiology was much more often present in the prenatal period than in the peri- or postnatal periods in the ASD group. Cerebral palsy and visual impairment were under-represented in the ASD group. Partial seizures tended to be more common and generalized seizures less common in the ASD group compared with the non-ASD group. Seizure onset was later in the ASD group. Many of the significant differences were accounted for by a large group of psychiatrically unclassifiable participants in the non-ASD group. There was no trend towards an increase of affected children over the 12-year period. There was no increase in the prevalence of active epilepsy and learning disability nor in the rate of autism with active epilepsy and learning disability in children born between 1981 and 1986 compared with those born from 1976 to 1980, indicating no statistical association with the general measles-mumps-rubella vaccination introduced in the early 1980s. [source] Prevention in severe learning disability: lessons from a follow-up study of young adults with a history of childhood learning disabilityDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2003GREGORY O'BRIEN No abstract is available for this article. [source] Adult outcome of childhood learning disabilityDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2001Greg O'Brien FRCPsych FRCPCH MD First page of article [source] Findings from the International Adult Literacy Survey on the incidence and correlates of learning disabilities in New Zealand: Is something rotten in the state of New Zealand?,DYSLEXIA, Issue 2 2003James W. Chapman Abstract New Zealand data from the International Adult Literacy Survey were analysed to examine the incidence and correlates of self-reported specific reading learning disability (SRLD). The results showed that 7.7% of New Zealand adults reported having had a learning disability. The ratio of males to females with SRLD was 3:2. Between 40% and 50% of New Zealand adults performed below the minimum level of proficiency required for meeting the complex demands of everyday life in knowledge-based societies. For adults with SRLD, around 80% performed below the minimum level, and the literacy proficiency of adults with SRLD in younger age bands appears to have declined since the early 1960s. Almost 100% of adults with SRLD in the 16,20 years age range performed below the minimum level for document and quantitative literacy and 92% for prose literacy. Compared to non-SRLD adults, those with SRLD were found to leave school earlier, engage more often in manual occupations, are more frequently unemployed, and rely on more state assistance to bring their income levels closer to the levels enjoyed by non-SRLD adults. The results are discussed in terms of SRLD not being officially recognised or provided for in New Zealand, the lack of appropriate remedial provisions for children who experience difficulties with reading, and the effects of a strong whole language orientated approach to literacy instruction in schools that has been in place since 1963. Copyright © 2003 John Wiley & Sons, Ltd. [source] Levetiracetam in the Treatment of Idiopathic Generalized EpilepsiesEPILEPSIA, Issue 2005Richard Grünewald Summary:, Since its introduction into clinical practice in 1999, levetiracetam, the S enantiomer of piracetam, has rapidly found a secure place, initially in the therapy of partial onset seizures and subsequently in the treatment of idiopathic generalized epilepsies (IGE). It has many of the properties of an "ideal" antiepileptic drug, including rapid absorption, linear pharmokinetics, and sparse drug interactions. Tolerabiliy is generally excellent in both adults and children, although tiredness is a common dose-limiting adverse effect. Occasionally the drug can precipitate behavioral abnormalities, especially in patients with learning disability. There is a wide safety margin in overdose. In common with most antiepileptic drugs its mode of action remains uncertain. Levetiracetam binds to a specific site in the brain, influences intracellular calcium currents and reverses negative allosteric modulators of GABA- and glycine-gated currents in vitro. Its effectiveness has been demonstrated in animal models of epilepsy and in clinical trials of partial onset and IGE. Treatment of IGEs may be straightforward, with many patients demonstrating an excellent and robust response to valproate monotherapy. However, there remains a significant minority of patients for whom valproate is unsuitable, including those who experience unacceptable adverse effects (e.g., weight gain or hair loss) and women of childbearing age in whom the teratogenic potential of valproate is unacceptable. Therapeutic response to lamotrigine in this group is often disappointing, and many clinicians now are turning to the choice of levetiracetam. Efficacy in generalized tonic,clonic seizures and myoclonus is usually apparent and some patients experience improvement in typical absences. Experience of combinations of levetiracetam with other antiepileptic drugs is limited in IGE and the responses are largely anecdotal. In our hands, patients with refractory IGEs may respond to combinations of levetiracetam with valproate, lamotrigine, and phenobarbital, and adverse effects when they occur are usually limited to tiredness. Levetiracetam does not interact with the oral contraceptive pill, simplifying treatment in women of childbearing age. Although animal data look encouraging, questions over levetiracetam's teratogenic potential and overall safety in pregnancy will remain for many years to come. [source] Topiramate in Patients with Learning Disability and Refractory EpilepsyEPILEPSIA, Issue 4 2002Kevin Kelly Summary: ,Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre. Methods: Sixty-four patients (36 men, 28 women, aged 16,65 years) were begun on adjunctive TPM after a 3-month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6-month period at optimal TPM dosing. These were seizure freedom or ,50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study. Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on ,200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add-on therapy in learning-disabled people with difficult-to-control epilepsy. Seizure freedom is a realistic goal in this population. [source] NANDA and NIC: Mediators to Describe Irish Intellectual Disability NursingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Fintan Sheerin PURPOSE To identify the foci of interest specific to nursing interventions within residential, intellectual disability nursing through the use of the terms and meanings presented in NANDA and NIC. METHODS Data were collected using a Delphi approach involving a purposive sample of 8 individuals with relevant expertise, followed up by the conduct of three focus groups held with a total sample of 17 intellectual disability nurses working in three Irish service settings: traditional residential, community residential, and nurse education. Data were examined for contextual meaning as well as consensus of perceptions. FINDINGS Many potential interventions and diagnoses were identified for the field of residential learning disability nursing. Interventions that elicited a >50% consensus among participants across groups were examined for contextual meaning, based on the taped and noted responses, and potentially related NIC interventional labels were then applied. These led, through a reverse NIC-NANDA linkage exercise, to the identification of 8 potentially related interventions. The contextual aspect directed the analysis process to identify the nursing diagnoses associated with the interventions to be used, and 21 resultant diagnoses were identified. DISCUSSION Further analysis and study are needed to verify the relevance of these diagnoses and interventions to residential learning disability. A quick comparison of the results with those of studies carried out in other countries demonstrates that certain diagnoses have been identified by one or more authors in their studies. CONCLUSIONS This study identified a number of foci that have achieved various levels of consensus among the study participants. The ongoing study plan will further examine nurses' and managers' perceptions while also looking at these within the context of current service philosophy. [source] Zimmermann,Laband syndrome with bilateral developmental cataract , a new association?INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2004N. Shah Summary. An unusual case of Zimmermann,Laband syndrome in a young male child with an unreported association of bilateral developmental cataract is presented. The pathognomonic triad of gingival fibromatosis, aplastic or hypoplastic distal phalanges with absent nails, and enlargement of soft tissues of the face were obvious, besides the known moderate learning disability and mild hearing loss. The case is discussed in the light of relevant literature. To the best of our knowledge, this is the first report of early developmental cataracts in association with the Zimmermann,Laband syndrome. Besides detection and timely recognition of the syndrome to allow adequate dental care, ophthalmic screening at periodic intervals is merited to improve the overall quality of life for these patients. [source] The challenges for nurses communicating with and gaining valid consent from adults with intellectual disabilities within the accident and emergency care serviceJOURNAL OF CLINICAL NURSING, Issue 9 2007Margaret Sowney MSc Aim., This paper reports the challenges experienced by nurses within accident and emergency departments in communicating with and gaining valid consent from adults with intellectual disabilities. Background., Consent is both a legal requirement and an ethical principle required to be obtained by health-care professionals, prior to the start of any examination, treatment and/or care. Central to the process of seeking consent is effective communication. However, evidence shows that people with intellectual disabilities are not viewed by professionals within acute general hospitals as a vital source of information, neither are they often communicated with directly, nor involved in discussions or decisions about their health care and are frequently not directly asked for their consent. Method., A purposive sample of nurses working within the accident and emergency departments of five general hospitals was recruited to participate in this qualitative study. Data were collected from five focus groups. Findings., Effective communication was identified as the most challenging aspect in caring for adults with intellectual disabilities within this environment, having an impact on the assessment of needs, informing patients of their health status and seeking valid consent. Conclusions., Fundamental to the provision of quality care are the concepts communication, choice and control. However, these issues are perceived to be more challenging in the provision of health care to people with intellectual disabilities. Communication and consent, therefore, require further consideration within the educational and clinical areas to strengthen nurses' competence in caring for people with intellectual disabilities, with an emphasis and understanding that choice and control are key principles for all people, being central aspects to the provision of an inclusive service for people with intellectual disabilities. Relevance to clinical practice., All nurses need to have a greater awareness of learning disability, how to increase opportunities for effective communication and be very familiar with the issue and guidelines relating to consent, to ensure that people with learning disabilities have choice, control and are more active in decision making regarding their health. [source] Computer-assisted vs. teacher-directed teaching of numeracy in adultsJOURNAL OF COMPUTER ASSISTED LEARNING, Issue 3 2000Abstract, Whilst a good deal of research literature has been published on using Computer-Assisted Instruction (CAI) to help teach children with learning disabilities, there are fewer published studies examining the use of CAI with adults with a mild learning disability. This paper reports on an experiment comparing computer-assisted and teacher-implemented instruction in numeracy with this population, with a third group acting as a control group. All groups were pre-tested on two psychometric tests of numeracy, after which the experimental groups received one half-day per week training in numeracy, with all groups being reassessed after three months and after six months. It was found that overall the three groups improved in their numeracy scores, and that teacher-led and computer groups improved more as a function of time on the intervention than did the control group. The issue of how much teacher support is required when this population uses CAI is discussed, as are some of the strengths and weaknesses of the software used in the study. [source] Refining diagnoses: applying the DC-LD to an Irish population with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2005A. Felstrom Abstract Background The diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) is a diagnostic tool developed in 2001 to improve upon existing classification systems for adults with learning disability. The aim of this study was to apply the classification system described by the DC-LD to a residential intellectual disability (ID) population to examine whether it improved our diagnostic understanding of residents. Methods Chart reviews of 113 of 178 people in a residential ID service were conducted. For each resident, information was recorded according to the DC-LD multi-axial system. Each resident's case was then discussed with a member of nursing staff familiar with the resident. If diagnosis was unclear, the case was discussed with a senior clinical psychiatrist. Results The percentage of residents with a moderate to profound ID was 87.6%. In total, 94 diagnoses of psychiatric illness (Axis III, Level B, DC-LD) were made. Of those 94 diagnoses, seven new diagnoses were found because of DC-LD criteria. Of the total number of psychiatric diagnoses made, 72.3% were non-specific, residual category diagnoses. A total of 79 residents (69.9%) had at least one behaviour problem diagnosed on Axis III, Level D, Problem behaviours. Fifty-six (49.6%) of residents in this sample had co-morbid epilepsy. Conclusions In people with moderate to profound learning disabilities, diagnosis continues to be challenging. The DC-LD is a useful tool in helping to clarify diagnoses in this population by providing revised criteria and a system to classify problem behaviours. The DC-LD would be more helpful if specific axes were included to document medical and psychosocial problems independently from other diagnoses. Further research is warranted to determine whether the DC-LD hierarchical approach to diagnosis improves diagnostic validity. [source] Learning disabilities within mental health services: are we adequately preparing nurses for the future?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2007L. L. CLARK ba msc srn rn(ld) pgcap Current government policy dictates that where possible patients who have learning disabilities should be cared for within the framework of ordinary generic national health services, with specialist provision kept to a minimum. The mental health care of this client group may be problematic and diagnostic overshadowing can occur because of complex physical, emotional and behavioural issues. If the government agenda is to be followed, this will have an impact on both the pre- and post-registration education of mental health nurses and therefore this must be addressed by the nursing regulatory bodies. There is also an argument for people who have a learning disability in addition to mental health problems to be considered a specialist group within generic mental health services as are other specific groups because of the complexity of their conditions. [source] | |||||||||||||||||||||||||||||||