Abstract: Background Impaired neurocognitive functioning is one increasingly recognized long-term consequence of childhood ALL treatment. However, research findings have been inconsistent regarding the domains affected and the degree to which they are compromised. Procedure A comprehensive meta-analytic review of the long-term neurocognitive effects of childhood ALL was conducted. Studies were included if they were published in English, reported original quantitative data on the post-treatment neurocognitive functioning of childhood ALL patients in first remission and control groups, and used neurocognitive measures with adequate psychometric properties and published normative data. Results Data from 28 empirical studies yielding 13 effect sizes across nine domains were extracted and analyzed. All effects were negative (g = −0.34 to −0.71), demonstrating that ALL survivors consistently experienced significant deficits in intellectual functioning, academic achievement, and specific neurocognitive abilities compared to control groups. The role of potential moderators, including treatment with cranial irradiation, age at time of diagnosis, and time since treatment ended, was examined. However, no effects emerged as clearly and consistently moderated by these variables. Conclusions The results from this meta-analysis suggest that declines in both global and specific areas of areas of neurocognitive functioning occur as a result of contemporary ALL treatment. Such deficits have significant implications for survivors' academic achievement and overall quality of life. Neurocognitive assessment plays a critical role in determining what remedial or specialized instruction is needed in childhood ALL survivors and should be included as a standard part of long-term follow-up care. Pediatr Blood Cancer 2007;49:65–73. © 2006 Wiley-Liss, Inc.

Abstract: The effectiveness of home-based early behavioral interventions for children (2:6–4:0 years old) with autistic spectrum disorders was studied over 9–10 months. Measures of autistic severity, intellectual, educational, and adaptive behavioral functioning were taken. There was no evidence of recovery from autism. High-intensity behavioral approaches (mean 30 h/week) produced greater gains than low-intensity programs (mean 12 h/week). Lovaas- and complete application of behavior analysis to schools approach-type interventions produced largest gains [similar to gains produced by longer-term clinic-based applied behavior analysis (ABA) programs]. Within the high-intensity groups, increased temporal input on the program was not associated with increased gains in the children. The results from clinic-based ABA trials were partially replicated on a home-based sample, using children with greater autistic and intellectual impairments.

Abstract: Parenting was examined among families of children with borderline intelligence in comparison to families of typically developing children and children with developmental delays. Parenting data were obtained at child age 5 via naturalistic home observation. Mothers of children with borderline intelligence exhibited less positive and less sensitive parenting behaviors than did other mothers and were least likely to display a style of positive engagement. Children with borderline intelligence were not observed to be more behaviorally problematic than other children; however, their mothers perceived more externalizing symptoms than did mothers of typically developing children. Findings suggest the importance of mothers' explanatory models for child difficulties and highlight children with borderline intelligence as uniquely at risk for poor parenting.

Abstract: Objective This study was designed to examine attention processes and executive functioning in adolescents with spina bifida, and to explore whether impairment in these domains contributes to problems with social adjustment. Methods A sample of adolescents with spina bifida (n = 68) and a matched comparison group (n = 68) and their families were followed longitudinally. All participants completed questionnaires, and the adolescent participants underwent neurocognitive testing. Results The spina bifida sample showed greater impairment on objective and subjective measures of attention and executive functioning, even when differences in intellectual functioning were controlled. Additionally, attention and executive deficits were found to be predictive of social adjustment difficulties. A mediational analysis suggested the neurocognitive deficits mediate associations between spina bifida status and social adjustment difficulties. Conclusions Adolescents with spina bifida appear to exhibit clear impairment in attention and executive functioning and this impairment may contribute to their well-established social difficulties.

Abstract: Purpose of review To examine the most recently published studies on the co-morbidity of medical and mental-health problems in people with intellectual disabilities. Recent findings Studies that have been published in the review period have advanced our understanding and strengthened the evidence base on how to meet the complex healthcare needs of people with intellectual disabilities more effectively and reduce their health inequalities, as compared with the general population. In particular, there is much emphasis on epidemiology, epilepsy, dementia, use of psychotropic medications and health-screening intervention. Summary In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.

Abstract: The fragile X-associated tremor/ataxia syndrome (FXTAS) is a recently identified phenotype associated with trinucleotide repeat expansions in the premutation range of the fragile X mental retardation 1 (FMR1) gene. In addition to progressive gait ataxia, action tremor, peripheral neuropathy, and parkinsonism, FXTAS involves impaired cognition. Our preliminary research suggests that executive cognitive functioning (ECF) is especially affected. In this study, a brief neuropsychological exam was administered to 33 men with FXTAS and 27 healthy controls. Compared with controls, individuals with FXTAS showed statistically significant impairments on measures from the Wechsler Adult Intelligence Scale, third edition (WAIS-III; verbal IQ, performance [nonverbal] IQ, verbal comprehension, perceptual organization, and processing speed). FXTAS subjects scored significantly lower on three of four measures of ECF and on two tests of information processing speed. The results provide evidence that FXTAS involves impairment of general intellectual functioning, with marked impairment of executive cognitive abilities. The pattern of cognitive performance is somewhat similar to that observed in the frontal variant of frontotemporal dementia and several of the spinocerebellar ataxias, but differs from the deficits observed in dementia of the Alzheimer type. © 2007 Movement Disorder Society

Abstract: Purpose of review A high proportion of people with intellectual disability have behaviour problems and psychotropic medication is a commonly used management strategy for these behaviours, despite lack of good-quality evidence to support this practice. Recent findings In recent years, one randomized controlled trial among adults and four on children with intellectual disability have been published showing effectiveness of low-dose risperidone in the management of behaviour problems as compared with placebo. Most of these randomized controlled trials are of good quality and included a reasonable number of participants. Most of these studies showed adverse effects, however, somnolence and weight gain particularly being associated with risperidone treatment. Most of the evidence on other psychotropic medications such as antidepressants, mood stabilizers, antianxiety drugs and opioid antagonists is difficult to interpret because it is based primarily on small case studies. Summary There is growing evidence in support of some antipsychotic medication, particularly the atypical antipsychotic, risperidone. Many of the studies of effectiveness included in this review have methodological flaws however. Therefore, the results need to be interpreted with caution. Furthermore, the paucity of evidence for some groups of medication does not necessarily mean that these medications are ineffective, but rather that their use is not currently supported by good-quality research.

Abstract: The engagement hypothesis suggests that social and intellectual engagement may buffer age-related declines in intellectual functioning. At the same time, some have argued that social structures that afford opportunities for intellectual engagement throughout the life span have lagged behind the demographic shift toward an expanding older population. Against this backdrop, we developed the Senior Odyssey, an existing team-based program of creative problem solving. We tested the engagement hypothesis in a field experiment. Relative to controls, Senior Odyssey participants showed improved speed of processing, marginally improved divergent thinking, and higher levels of mindfulness and need for cognition after the program. This pilot translational project suggests that the Senior Odyssey program may serve as one effective model of engagement with good scaling-up potential.

Abstract: The relation between level of intellectual functioning and risk for associated symptoms in children with autism spectrum disorder (ASD) was investigated. Cognitive ability and associated s...

Abstract: Background It was predicted that offenders with intellectual disability (ID) categorised according to Ward & Hudson's (1998b) self‐regulation theory as having an Approach goal would have higher levels of distorted cognitions, less victim empathy, and a history of more prolific offending compared to those with an Avoidant goal. Offenders categorised as having a Passive strategy were hypothesised to have lower levels of general intellectual functioning, and more known offences and convictions compared to those with an Active strategy.Method Using a cross‐sectional independent groups design, the offence pathways of 34 men with ID who were taking part in group cognitive behavioural therapy were rated by therapists. Participants assigned to each pathway were then compared using measures of sexual knowledge, distorted cognitions, and victim empathy. Cronbach's alpha for the measures was found to be acceptable.Results Offenders with an Approach goal were found to have higher levels of distorted cognition...

Abstract: Although individuals with Asperger Syndrome (AS) usually possess average or above average intellectual functioning they often exhibit significant non-academic disabilities. These can interfere with their academic performance. Consequently college students with AS often fail. Typical college level special student supports usually do not address these types of problems. This article describes a collaborative arrangement to provide needed supports and services to college students with AS. ********** Asperger Syndrome was first identified by Hans Asperger in 1944, yet his work was not known in the United States until after 1981, when Lorna Wing's article publicized his work (Safran, 2002). Asperger Syndrome as a separate disability label has only been in use in the United States since the early 1990s. Before then, people with AS too often went undiagnosed. The American Psychiatric Association included AS to its diagnostic and statistical manual in 1994, as a pervasive developmental disorder (American Psychiatric Association, 2000). Considered to be on the mildest end of the Autistic Spectrum, it is characterized by disabilities in three developmental areas, communication, socialization and emotional/behavioral difficulties (Fine, 2004). Asperger Syndrome is today one of the most common developmental disabilities. Its prevalence is estimated to be 4 in 1,000 students (Nordesjo, 2002). Communication While Asperger Syndrome does not include the delay in speech that is common in other forms of Autism, the language of one with AS is frequently quite idiosyncratic. It may include archaic word forms or unusual and rarely used words or grammar. Such language can become a social barrier, separating a person with these characteristics from others. (Barnhill, 2004) Emotional/behavioral characteristics: a person diagnosed with AS may possess adequate adaptive skills but such skills may take unique and unusual forms. For example, although completely capable of dressing independently, a person with AS might insist on a very particular or unusual arrangement of clothing. Or, while bathing can be done independently, it might be done in a proscribed or ritualized pattern. Hand washing may be an elaborate, flamboyant and lengthy ritual. These patterns may become sources of rejection and derision. They may interfere with other important daily activities such as getting to class on time. (LaMarine, 2001) Socialization: Poor social skills and difficulty establishing and maintaining relationships are common characteristics of AS. These might prevent a person from successfully using one's intellectual skills to excel in studies. Even where this does not interfere with academic achievement, it can result in rejection and isolation outside of class. The concept of Theory of Mind has been proposed to explain the often divergent or socially unacceptable actions or thoughts of persons with AS. It is believed by some that people with AS can only see their own point of view, not able to understand that another person might have a differing perspective. Some use this theory of mind concept to explain the antisocial behaviors or just plain inexplicable social behaviors exhibited by some people with AS (Sally, 2004). Despite demonstrated abilities and gifts, impairment in communication, socialization, and behavior often lead to significant problems and failure (Smith, 2001). For every student with this syndrome who experiences success, there are countless others who fail and are rejected. Even for many who succeed, the experience can be torturous. College Participation: Many students with AS are successful in college. They do not necessarily have intellectual or academic disabilities and may demonstrate exceptional abilities. In fact, preoccupation with specific interests has often led to gaining great expertise in a particular area. For many individuals with disabilities, the college experience provides a sense of personal growth and self-esteem (Page, 1998). …

Abstract: Health-related quality of life and intellectual functioning in children in remission from acute lymphoblastic leukaemia

Abstract: Background Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or l...

Abstract: Purpose of review To critically review recent publications on the relationship between challenging behaviour and psychiatric disorder in people with intellectual disabilities. Recent findings Although a number of recent studies have highlighted possible similarities in the aetiology of challenging behaviour and psychiatric disorder, these findings need to be viewed with caution as they do not constitute evidence that the two phenomena are equivalent. While research into their possible interrelationship has produced equivocal findings, there are a number of theoretical perspectives that have been tested to some degree by empirical studies. Intervention studies that attempt to explore these perspectives are rare, however, and there is some evidence that people with complex mental health and behavioural needs are receiving far from optimal treatment. Summary The relationship between challenging behaviour and psychiatric disorder has yet to be adequately explored in the research literature. While both undoubtedly coexist in some people with intellectual disability, available research suggests that it is unlikely that disturbances in psychiatric functioning will underpin the majority of challenging behaviours. Evidence to link specific patterns of behaviour with particular disorders also remains elusive. Recommendations for future research are discussed.

Abstract: This study investigated the frequency and latency of naturally occurring social interaction with typically developing children and those with autism in inclusive kindergarten settings. The children with autism were also subdivided into two groups according to intellectual functioning in order to analyze frequency and latency of social interaction in relation to degree of disability. The results showed a significant difference in frequency of social interaction between the typical children and those with autism. There was no difference between the groups on latency to initiate interaction. However, shorter latency was associated with higher frequency in the typical group but not in the group of children with autism. Significant differences in IQ and adaptive functioning were found between the children with autism who showed interaction and those who did not. The results for the typical children may be used as benchmark values for the assessment of treatment outcome for children with autism.

Abstract: 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.

Abstract: Research indicates that persons with learning disorders often suffer from psychopathology. We assessed current and future psychopathology in male adolescents with discrete impairments in reading comprehension (IRC) or arithmetic abilities (IAA) but with average or above-average general intellectual abilities. Subjects were a population-based cohort of 174,994 male adolescents screened by the Israeli Draft Board with average or above-average intellectual abilities but with low scores (8.6th and 10th lowest percentile respectively) on reading or arithmetic tests. They were compared with adolescents who scored in the 10th percentile and above on these tests (comparison group). Relative to the comparison group, male adolescents with IRC, IAA, or IRC and IAA (0.69%), had poorer scores on most behavioral assessments and higher prevalence of current psychopathology: 4.2% (comparison group), 8.0% (IRC), 7.0% (IAA), and 9.8% (IRC and IAA). Adolescents with IRC were also at increased risk for later hospitalization for schizophrenia (hazard ratios = 1.8, 95% confidence interval: 1.3-2.6). Male adolescents with average and above-average general intellectual abilities but with IRC or IAA are more likely to have current and future psychopathology. Impairments in intellectual functioning and abnormal behaviors leading to mental illnesses may share common neurobiological substrates. The results support screening male adolescents with learning disorders for psychopathology.

Abstract: Background There is evidence to suggest that among young people with mild intellectual disability there are those whose cognitive difficulties may predict the subsequent manifestation of a schizophrenic phenotype. It is suggested that they may be detectable by simple means. Aims To gain adequate cooperation from educational services, parents and students so as to recruit a sufficiently large sample to test the above hypothesis, and to examine the hypothesis in the light of the findings. Method The sample was screened with appropriate instruments, and groups hypothesised as being likely or not likely to have the phenotype were compared in terms of psychopathology and neuropsychology. Results Simple screening methods detect a sample whose psychopathological and neuropsychological profile is consistent with an extended phenotype of schizophrenia. Conclusions Difficulties experienced by some young people with mild and borderline intellectual disability are associated with enhanced liability to schizophrenia. Clinical methods can both identify those with this extended phenotype and predict those in whom psychosis will occur.

Abstract: The result of investigations of child abuse and neglect allegations may include the State's taking action to terminate parental rights (TPR). Though unification is ostensibly the goal in the early stages of the proceedings, the defendants with the most difficulty complying with the demands of the child-protection agency—those with mental illness, developmental disabilities, learning disabilities, and other cognitive deficits—often find themselves on an inexorable course toward termination. The authors have drawn upon a sample of 300 cases from New Jersey to explore the diagnostic types among defendants in these cases. The results include a significant proportion of individuals with readily treatable conditions, such as mood and anxiety disorders, as well as those with varying degrees of cognitive deficits, whose needs often go unmet. The authors identified a high percentage of defendants with learning disorders and borderline intellectual functioning. The article concludes by discussing ways in which defe...

Abstract: There have been inconsistent findings regarding the significance of family history of schizophrenia spectrum disorders in relation to presentation and course of illness. There has been little research relevant to this issue from first-episode patients. We examined the differences in premorbid adjustment, symptoms, and intellectual functioning between 28 first-episode schizophrenia spectrum patients with a history of such illness in first degree relatives and 28 matched patients without such a family history. The results indicate that whereas the 2 groups did not differ in presenting symptoms, those with a positive family history showed poorer intellectual functioning and less reduction in symptoms at 2 and 3 year follow-up and greater likelihood of abnormal electroencephalogram findings. The findings provide evidence that presence of a positive family history in first-episode patients is associated with a more pernicious form of illness.

Abstract: The quality of life of 127 Israeli young adults diagnosed as having borderline intelligence quotient and attention-deficit/hyperactivity disorder, and living in community residences, was studied with respect to personal, disability and social ecology data. Overall, quality of life was associated with studying in inclusive education, total attention-deficit disorder symptomatology score, monthly income, participation in leisure activities and having a personal friend. Two significant predictors of quality of life were attention-deficit disorder symptomatology score and monthly income. Additional analysis indicates that among younger residents the two significant predictors were inclusive education and high monthly income, whereas the predictors for older residents were low level of medical disability and low attention-deficit disorder symptomatology score.

Abstract: The relationship between attention, intelligence, memory, achievement, and behavior in a large population (N = 939) of children without neuropsychologic problems was investigated in children with mild and moderate asthma. It was hypothesized that different levels of children's attentional capabilities would be associated with different levels of intellectual, memory, and academic abilities. Children ages 6–12 at the eight clinical centers of the Childhood Asthma Management Program (CAMP) were enrolled in this study. Standardized measures of child neuropsychological and behavioral performance were administered to all participants, with analyses examining both the developmental trajectory of child attentional capabilities and the associations between Continuous Performance Test (CPT) scores and intellectual functioning, and measures of memory, academic achievement, and behavioral functioning. Findings demonstrated that correct responses on the CPT increase significantly with age, while commission errors dec...

Abstract: Evaluations of competency to stand trial (CST) in defendants with mental retardation or borderline intellectual functioning can be difficult when deficits are masked by the type of adaptations seen in many with developmental disabilities. Accordingly, many evaluators have used validated test instruments, such as the CAST*MR (Competence Assessment to Stand Trial for Defendants with Mental Retardation) and tests measuring receptive and expressive language, to augment the clinical interview. The authors present a New Jersey case illustrating the need for clinicians to have adequate experience and training in some of the less known psychometric tests before presenting evidence in court. At the CST hearing, the judge disregarded the testimony of several psychologists while accepting that of a less experienced state's expert, we believe, to find the defendant competent. The finding was reversed on appeal. We encourage forensic professionals to be aware of the various instruments and minimum standards when employing specialized testing.

Abstract: Objectives: Examine the prevalence and outcome of autism in child and adult population cohorts using the Diagnostic Interview for Social and COmmunication disorders (DISCO). Method: The Faroe Islands school population aged 7-18 years (n=7689) was screened for autism and cases raising suspicion were examined and tested. Parents were interviewed using the DISCO. Clinical diagnoses were established on the basis of all available information. Prevalence rates for autistic disorder, atypical autism and Asperger syndrome were calculated. The autism outcome was looked at in 3 partly overlapping population cohorts of individuals (n=120) diagnosed in childhood as suffering from autism or atypical autism from the region of Goteborg, Sweden. They were re-examined at ages 17-40 years, 13-22 years after diagnosis. Parents and carers were interviewed using the DISCO. Strict operationalised criteria for outcome were used. Diagnostic stability over time was analysed. Symptom profiles on the basis of the DISCO were reviewed and background factors contributing to outcome in adult age were assessed. Aspects of Quality of Life were examined. Results: The prevalence of autism, atypical autism and Asperger syndrome in the Faroe Islands child population was 0.56%. The boy:girl ratio was 4.8:1. The DISCO was very useful in eliciting the information needed for a correct clinical diagnosis. The overall outcome of autism in the Goteborg population was psychosocially poor with few adults leading independent lives. Mortality was high (5%) and seemed to be associated with medical disorders including epilepsy. All but one of the individuals included in the follow-up study (n=108) still met criteria for autism or atypical autism. A small subgroup showed better psychosocial outcomes. They had all had some spoken language at age 3 years. Those with a childhood diagnosis of atypical autism tended to be diagnosed with autism at follow-up. The correspondence between clinical diagnoses and DISCO algorithm diagnoses was very good. The level of intellectual functioning showed a significant shift downwards. A subgroup deteriorated in adolescence. According to DISCO results, social, communication, and sensory impairment problems typical of the childhood period were still present at very high rates in late adolescence and adult life. Quality of Life seemed to be relatively good in some cases in spite of the poor overall psychosocial outcome. Early communication skills and IQ predicted aspects of outcome. Discussion: The DISCO is a useful instrument for diagnosis and follow-up of individuals with autism spectrum conditions. Combined with clinical examination of the individuals themselves, the DISCO yields important diagnostic and symptom information needed for appropriate diagnosis in childhood and for clinical review of diagnosis and symptom load in adolescence and adult life. The prevalence of autism in the Faroe Islands was very similar to that reported for autism in other parts of the world. The outcome of autism in the Goteborg cohort was psychosocially very poor, but life quality did not generally appear to be at a correspondingly low level. However, an important minority had very poor quality of life. The Faroe Islands cohort included relatively much higher functioning individuals than did the Goteborg group, which included cases diagnosed 15-30 years ago. The Faroe Islands cohort may have a very different prognosis, and the outcome findings from the Goteborg study can only be generalized, if at all, to other populations with autism diagnosed before the 1990s, when diagnostic concepts and criteria were more narrow than they are today. Conclusions: Autism is not a very rare disorder. Outcome in severe cases with intellectual impairment is psychosocially poor (with little or no independence in adult life), but life quality can be good even in such cases. The DISCO is a very helpful instrument for diagnosis in childhood and in adult life and can be used for follow-up of symptom profiles and problem assessment before and after adolescence.

Abstract: The purpose of this study was to examine the impact of treatment modality on the cognitive functioning of pediatric brain tumor survivors. Cognitive and behavioral testing batteries were administered to 20 brain tumor survivors (12 receiving surgical intervention only and 8 receiving chemotherapy, radiation therapy, or both). Findings revealed significant declines in intellectual functioning and moderately elevated levels of behavioral problems among patients in both treatment groups. These results have important clinical implications including the need for adjunctive treatments for all brain tumor survivors, regardless of treatment type.

Abstract: The aim of this study is to collect information from the counsellors on the assessment issues of children with cognitive disability, giving special attention to the methodology used to distinguish between those showing a borderline intelligence from those showing slight mental retardation. Data collected, via a questionnaire, “Assignment methods used to group special education needs” from active counsellors, regarding slight mental retardation, borderline intelligence and the instruments used in the fore mentioned assessment are now presented.