Transitioning to independence: challenges for young people with disabilities and their caregivers

For all teens, the process of moving from childhood to adulthood is challenging. For young people with disabilities, transitioning to independence presents even more challenges. Barriers to successful transition for young people with disabilities include low expectations by parents and other significant people in the community, lack of knowledge of existing career and vocational education services, and lack of self-advocacy skills. This article provides an overview of issues related to transitioning to adult independence and offers suggestions for assessment, planning, and intervention that can help nurses be effective partners with families and other caregivers in transition efforts. Nurses caring for children with disabilities can help families see strengths in their children and develop realistic, developmentally-appropriate expectations for skill development, attitudes, and behaviors that will promote self-sufficiency in adulthood. Nurses can help families think about possibilities for independence and refer families to community resources that can help young people with disabilities pursue postsecondary education, obtain and maintain jobs, and live independently.     

Right hemisphere dysfunction in nonverbal learning disabilities: Social, academic, and adaptive functioning in adults and children.

Addresses recent research on social and nonverbal learning disabilities. Involvement of right hemispheric dysfunction in these disabilities has been hypothesized, as studies with adults have suggested that documented right hemisphere damage may lead to deficits in social skills, prosody, spatial orientation, problem solving, and recognition of nonverbal cues. Studies of children purported to evidence nonverbal learning disabilities are reviewed and compared with the results from studies of adults with right hemisphere damage. Specific subtypes of nonverbal learning disabilities are reviewed, including the nonverbal perceptual-organization-output subtype, Asperger's syndrome, Developmental Gerstmann syndrome, left hemisyndrome, right hemisphere syndrome, and right parietal lobe syndrome. Finally, implications and future research needs are addressed. The need for a diagnostic nosology and improved and validated intervention techniques is stressed as is early identification of these types of specific nonverbal learning disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching phonological awareness to young children with learning disabilities

This study examined the feasibility of teaching phonological manipulation skills to preschool children with disabilities. Forty-seven children, 4-6 years old, enrolled in a special education preschool, were randomly assigned to receive training in one of three categories of phonological tasks (rhyming, blending, and segmenting) or a control group. Results indicated that children were able to make significant progress in each experimental category, but that they demonstrated little or no generalization either within a category (e.g., from one type of blending task to another type of blending task) or between categories (e.g., from blending to segmenting). Although the children's level of cognitive development significantly predicted some learning outcomes, it did not appear to limit the learning of phonological tasks.     

Disabilities of arithmetic and mathematical reasoning: perspectives from neurology and neuropsychology

Current research on brain-behavior relationships in disabilities of arithmetic and mathematical reasoning is reviewed from both a neurological and a neuropsychological perspective. Although no entirely satisfactory statement of the relationship between arithmetic skills and brain functions has yet emerged, investigators in this area have provided evidence regarding the involvement of some brain systems in processes of calculation. Also, the developmental importance of right- versus left-hemisphere integrity for the mediation of arithmetic learning and performance has been suggested. We propose that an account of brain-behavior relationships in children intended to explain and predict developmental disabilities of arithmetic learning needs to address several important content and processing distinctions in order to (a) encompass empirically derived subtypes of children with learning disabilities who exhibit difficulties with arithmetic and (b) provide adequate direction for future subtyping and intervention research.     

Transfer among phonological manipulation skills.

Skills that require the manipulations of sounds that make up words are closely associated with the process of learning to read. This study involved an experimental analysis of the relations among phonological manipulation skills. Several skills were taught to 35 Head Start preschool children (mean age 5.2 yrs), and the degree to which learning 1 of these skills resulted in improved skill performance and accelerated learning of a 2nd skill was investigated. Instruction produced robust gains in skill performance and generalization of skills to novel instances. Posttest scores and data on students' efficiency of learning, however, offered no evidence of transfer across phonological manipulation skills. These results imply that the class of phonological manipulation skills does not have a simple structure and suggest that task and subject characteristics must be considered in predicting transfer among such skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer problems of children with hemiplegia in mainstream primary schools

A representative sample of 55 mainstreamed 9-10-year-olds with hemiplegia were compared with all classmates on sociometric measures of popularity and friendship, and with 55 matched controls on measures of victimization. Children with hemiplegia were more rejected and less popular, had fewer friends, and were more often victimized; they were not more likely to be bullies themselves. These differences were not fully accounted for by group differences in teacher-estimated IQ and behaviour. Possible explanations range from neurologically determined deficits in mentalizing skills to peer prejudices about children with disabilities. The development of appropriate intervention strategies should be a high priority, particularly since peer problems not only result in current distress but also predict psychosocial problems in the future.     

Child development and emergent literacy

Emergent literacy consists of the skills, knowledge, and attitudes that are developmental precursors to reading and writing. This article offers a preliminary typology of children's emergent literacy skills, a review of the evidence that relates emergent literacy to reading, and a review of the evidence for linkage between children's emergent literacy environments and the development of emergent literacy skills. We propose that emergent literacy consists of at least two distinct domains: inside-out skills (e.g., phonological awareness, letter knowledge) and outside-in skills (e.g., language, conceptual knowledge). These different domains are not the product of the same experiences and appear to be influential at different points in time during reading acquisition. Whereas outside-in skills are associated with those aspects of children's literacy environments typically measured, little is known about the origins of inside-out skills. Evidence from interventions to enhance emergent literacy suggests that relatively intensive and multifaceted interventions are needed to improve reading achievement maximally. A number of successful preschool interventions for outside-in skills exist, and computer-based tasks designed to teach children inside-out skills seem promising. Future research directions include more sophisticated multidimensional examination of emergent literacy skills and environments, better integration with reading research, and longer-term evaluation of preschool interventions. Policy implications for emergent literacy intervention and reading education are discussed.     

The role of TGFbeta1 in initiating hepatic stellate cell activation in vivo

This article provided an introduction to AAC systems for children and adolescents with severe spoken-language disorders. Over the last decade, significant advances have been made in assessment and intervention approaches. For children with severe spoken communication disabilities, the AAC assessment is an ongoing process that includes information about the child's communication development, the child's environments, and the child's physical abilities. Children with severe disabilities who use AAC systems can demonstrate communication achievements far beyond traditional expectations. Recommended assessment and intervention practices are continuing to develop and the future is certainly optimistic for children with severe spoken-language disorders who may use AAC to communicate.     

An early intervention model for pediatric settings.

Four groups of preschool children are likely to present to pediatricians in private or hospital practice: those with (a) developmental disabilities identifiable at a young age, (b) illnesses or handicaps, (c) temperamental traits predisposing to parent–child interaction problems, and (d) behavior problems. Parents view pediatricians as experts in child development and thus seek their guidance. Yet, many of these children will require treatment beyond the pediatrician's office. The Early Intervention Program (EIP) for Preschoolers and Parents is intended for such children. Organized into modules that focus on specific needs of the child and/or the parent–child interaction, EIP emphasizes parent training and skills development through applying behavioral–social learning principles. The modules include individual tutoring in speech and self-help skills, toddler management for behavioral compliance, and classrooms for developing school readiness skills and cooperative peer relationships. EIP is consistent with the treatment orientation of pediatricians and can serve as a useful training resource for pediatric residents. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of an organization skills intervention to improve the academic functioning of students with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder (ADHD) exhibit significant academic impairments, as evidenced by poor academic achievement, grade retention, and school dropout. Deficits in organization skills may contribute to these academic impairments, as children with ADHD frequently lose assignments, misplace their completed work, and have difficulty planning for tests. The present study examined the pilot efficacy of an 8-week organization skills intervention for children with ADHD. Thirty-seven children were randomly assigned to receive the intervention immediately or to a wait-list control. Participants made significant improvements in organization and homework management skills during the intervention and these gains were maintained at 8-week follow-up. Parents of children in the intervention group reported decreased homework problems. Children in the intervention group also demonstrated pre-post gains on teacher ratings of academic impairment and GPA. This study suggests that targeted academic skills interventions have the potential to improve overall academic performance among children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A stimulus control technique for improving the efficacy of an established toilet training program

Standard toilet training regimens used with children with developmental disabilities have demonstrated effectiveness at achieving bladder and bowel continence. However, in some clinical applications in everyday practice, success has not been achieved, necessitating research into possible modifications of the current approaches. A widely used toilet training program was modified to reduce toileting accidents of a referred child. The modification involved the assessment of the discriminative stimulus for eliminating, namely, his undergarments. By removing the undergarments when an elimination became imminent, an "errorless" learning paradigm was established that allowed for more rapid and enduring acquisition of toileting skills than seen in previous training attempts. The results indicate the present procedure could expedite training for individuals who are difficult to teach appropriate toileting skills through an analysis of the controlling antecedent stimulus for accidents and subsequent manipulation of such stimuli.     

The cognitive and linguistic foundations of early reading development: A Norwegian latent variable longitudinal study.

The authors present the results of a 2-year longitudinal study of 228 Norwegian children beginning some 12 months before formal reading instruction began. The relationships between a range of cognitive and linguistic skills (letter knowledge, phoneme manipulation, visual–verbal paired-associate learning, rapid automatized naming (RAN), short-term memory, and verbal and nonverbal ability) were investigated and related to later measures of word recognition in reading. Letter knowledge, phoneme manipulation, and RAN were independent longitudinal predictors of early reading (word recognition) skills in the regular Norwegian orthography. Early reading skills initially appeared well described as a unitary construct that then showed rapid differentiation into correlated subskills (word decoding, orthographic choice, text reading, and nonword reading) that showed very high levels of longitudinal stability. The results are related to current ideas about the cognitive foundations of early reading skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social acceptance and rejection of preschool children with disabilities: A mixed-method analysis.

Eighty children with disabilities enrolled in a nationally distributed set of inclusive preschool programs participated in this study. The average age of the participants was 3.9 years, and 60% were male. The children exhibited a range of disabilities and developmental levels. Using a mixed-method approach, the authors established quantitative criteria for identifying children with disabilities who were socially accepted and socially rejected by their peer group, and qualitative methods revealed themes associated with social participation of each group. Cluster analyses of themes identified 3 clusters associated with social acceptance (e.g., awareness-interest, communication-play, friendship-social skills) and 2 clusters associated with social rejection (e.g., social withdrawal, conflict-aggression). Subsequent cluster analyses of children and matrix analyses illustrated how child social participation was related to superordinate theme clusters and constructs of acceptance and rejection. Socially accepted children tended to have disabilities that were less likely to affect social problem solving and emotional regulation, whereas children who were socially rejected had disabilities that were more likely to affect such skills and developmental capacities. Implications of this research for theory and practice are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early intervention and early experience.

For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing substance abuse with children and adolescents.

Reviews research, from 1977 to 1984, on the prevention of tobacco, alcohol, and drug abuse with children and adolescents. The review is organized according to an intervention focus on the agent, environment, and host. A study, involving 193 6th graders and skills and attention-placebo interventions, examined methods and results of host-oriented skills intervention to prevent cigarette smoking. Results suggest that attention-placebo interventions (e.g., oral quizzes, games, debates) were insufficient to prevent smoking. Based on the review, conceptual and methodological progress in substance abuse prevention research is noted. Suggestions for future research include technological improvements necessary to implement preventive interventions on a wide scale. Highlighted are the importance of careful designs: manipulation checks on independent variables; process data collection; multimodal measures of self-report, behavioral, and physiological variables; and multivariate statistical analyses in studies on interventions to prevent tobacco, alcohol, and drug abuse with children and adolescents. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of learning disorders

INTRODUCTION: The child neurologist, developmental pediatrician or child psychiatrist involved in the care of children with learning disabilities has a crucial role that extends beyond diagnosis. DEVELOPING: Despite the lack of sound scientific studies on treatment interventions for children with learning disabilities there are specific interventions that are helpful in the remediation of children with learning disabilities. CONCLUSIONS: The role of the health professional in the treatment of learning disabilities includes: 1. Making specific recommendations regarding early intervention strategies; 2. Putting into a neurological perspective the types of educational interventions that will maximize a child's potential; 3. Discussing the role of medications in the management of learning disorders, as well as using medications in appropriate situations, and 4. Coordinating the multimodal approach which is essential to the long term treatment of all children with learning disabilities.     

Neuroimaging and Psychopharmacology.

This review presents the most recent research concerning neuroimaging in developmental disabilities. Changes in structure and activation have been found in children with ADHD and learning disabilities, following intervention. For the children with learning disabilities changes in activation have been found following intensive behavioral and academic intervention. Structural and activation differences in the auditory processing regions of the brain were found prior to academic intervention, with activation differences found for those children responding to the reading programs. Children with ADHD have been found to show differences in brain structures with few studies evaluating the differences in activation following medication. Emerging evidence indicates differences in the frontal regions of the brain for children who respond successfully to medication. Finally, a discussion of the variables that can impact the results in neuroimaging studies is presented. Further study is needed in this area, and additional variables of concern are also discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Phonological processing skills and the Reading Recovery Program.

Sought to determine whether the Reading Recovery Program would be more effective if systematic instruction in phonological recoding skills were incorporated into the program. First-grade at-risk readers were divided into 3 matched groups of 32 children each; a modified Reading Recovery group, a standard Reading Recovery group, and a standard intervention group. The children in the modified Reading Recovery group received explicit code instruction involving phonograms. Results indicated that, although both Reading Recovery groups achieved levels of reading performance required for discontinuation of the program, the modified Reading Recovery group reached these levels of performance much more quickly. Results further indicated that the children selected for Reading Recovery were particularly deficient in phonological processing skills and that their progress in the program was strongly related to the development of these skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research-based language intervention strategies adapted for deaf and hard of hearing children

Strategies found to facilitate the language development of young, hearing children are reviewed in this paper, and adaptations and examples for use with deaf and hard-of-hearing children are provided as alternatives to simply advising professionals and parents to increase the quantity of conversation with these children. It is suggested that adults accelerate the language acquisition of deaf and hard-of-hearing students by capitalizing on the linguistic opportunities provided in particular environments, rearranging environments, being responsive to indications that children have comprehended messages and are open to risk communication, and specifically by intervening on form, content, and use skills. The author challenges professionals to document empirically the usefulness of each language intervention technique presented here.     

Crisis intervention workers in New South Wales: knowledge, skills, qualities and preparation

Ninety-five mental health workers employed by 13 randomly selected crisis intervention and extended hours teams in NSW responded to a questionnaire designed to elicit information concerning the perceived competencies required for crisis intervention. The findings reported and underscore the need for specialized knowledge and skills to address the problems presented by mentally ill clients in crisis. Assessment of suicide risk, being able to work as part of a team, and knowledge of crisis intervention strategies were perceived as the most important competencies required. It is suggested that these competencies are gained through initial induction programmes, 'on-the-job' experience, and clinical supervision rather than previous experience in the mental health field. The lists of competencies provided will be of interest to those involved in the development of induction and continuing education programmes for crisis intervention workers and in the selection of staff for positions in crisis intervention.