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Adult Dyslexia

Adult Dyslexia

This is a comprehensive guide covering the basics of dyslexia to a wide range of diagnostic procedures and tips to help you manage with your symptoms. These tips and tricks have been used on people with dyslexia of every varying degree and with great success. People just like yourself that suffer with adult dyslexia now feel more comfortable and relaxed in social and work situations.

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Dyslexia Facts You Should Know

Dyslexia, Facts You Should Know Is A Unique Fact Filled E-book That Gathers Easy To Read Information About Dyslexia In One Place For The Interested Reader. Learn How to Cope With A Diagnosis of Dyslexia and What To Do Next. Every bit of this eBook is packed with the latest cutting edge information on Dyslexia. It took months to research, edit, and compile it into this intriguing new eBook. Here's what you'll discover in Dyslexia: Facts You Should Know: What is Dyslexia? History of Dyslexia. Is it Dyslexia or Something Else? How You Can Diagnose Yourself. Benefits of Catching Dyslexia Early. What is the Dyslexia Test? How to Get Everything You Will Need for Help in Coping with Dyslexia. Exploring Your Options for Schools and Programs. What is the Individualized Education Program? Alternatives to the Iep. The Roll Your Childs Teacher Plays. Your Part in Your Childs Education. Why Practice, Patience and Practicality are Most Important. Teens with Dyslexia. Success in Life: Adults Overcoming Dyslexia.

Dyslexia Facts You Should Know Summary

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Author: Dee Henry
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I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

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Specific reading disorder

The ICD-10 classification system distinguishes between 'Specific reading disorder' and 'Specific spelling disorder'. In DSM-IV, 'Specific reading disorder' is distinguished from disorder of written expression. The latter is not identical with the ICD-10 category 'Specific spelling disorder', in so far as that disorder excludes children whose sole problem is one of handwriting. In many cases, spelling difficulties continue into adolescence and persist in adulthood, even when reading skills improve considerably. The history of children with specific reading disorder frequently reveals a specific developmental disorder of speech and language. Symptoms of these disorders may still be present at elementary school when the specific reading disorder is first diagnosed. Additional frequently associated problems include poor school attendance and problems with social adjustment. The DSM-IV criteria for reading disorder state that reading achievement as measured by standardized tests should be...

Generalized learning disability

The primary function affected by intellectual impairment is learning (encompassing basic development). Standard tests of learning function are poorly developed tests generally measure performance of outcomes of learning processes such as memorization and recall, reading, writing, and numeracy. It is not clear how to combine them to describe generalized learning disability. Categories of learning disability used for teaching and school system administration are of little value for epidemiological research unless selection criteria and measures are standardized and validated.

Dyslexia

Many children on the autistic spectrum also have dyslexia. Dyslexia comes from the Greek meaning 'difficulty with words' and is a difference in the brain area that deals with language. Again, like dyspraxia, there is no 'only' about dyslexia - it pervades many areas of life. Interestingly, dyslexia and dyspraxia often go hand in hand and many difficulties that are present in one are also present in the other. As with a dyspraxia child, a dyslexic child may be clumsy, often tripping, have problems with tying shoe laces and ties. Overlaps are evident in so many of these 'disorders' that it really is impossible to fit each child neatly into little boxes and although that is exactly how it should be, no two people being the same, this causes problems for professionals, parents and children alike. One thing we all need to learn is that although a label is needed as a signpost in order to gain help for our unique children, they often have threads of many different parts of the colourful...

Cell death and trophic factors during development

The co-ordinated expression, in space and time, of many genes underlies neurodevelopment. Mutations in these 'neurodevelopmental genes' are increasingly being recognized as causes of developmental neurological disorders(15) such as cortical dysplasia and epilepsy they may also be relevant to learning disability and schizophrenia. Different gene families are involved in the major component processes of neurodevelopment, such as organogenesis, neurogenesis, neuronal migration, synaptogenesis, and programmed cell death (apoptosis).(1, ,17> The details are beyond the scope of this book, but a few examples are given here.

Transplant Related Complications

Neurologic Dysfunction Neurologic dysfunction can be an unrecognized problem after HSCT. Potential issues include memory disturbance and learning disability secondary to irradiation, Guillain-Barre syndrome, limbic encephalitis, cyclosporine tacrolimus-associated hypertensive encephalopathy and seizures, and peripheral neuropathies.124

Differential diagnosis Other psychiatric disorders Other psychoses

This is critical to the diagnosis of schizophrenia, especially the DSM-IV criteria. Here the difficulty is in distinguishing 'premorbid deficits', an illness prodrome and the illness itself. Premorbid personality factors will obscure or set in relief discontinuities in an individual's social trajectory. Objective information and informant testimony is crucial as in most of the diagnostic process. Other individual differences such as intelligence will also shape the presentation of schizophrenia. At the extreme, people with mental retardation (learning disability) may manifest psychosis in less obvious ways (see ChapterJ0.5 1, C p e.L10. 5.2 and Chapteri10.5.3). The old diagnosis of 'simple schizophrenia', retained in the ICD-10 describes 'insidious and progressive development of oddities of conduct' and the 'inability to meet the demands of society' that is, social disturbance of long duration. The progressive element distinguishes it from personality disorder although problems...

Interpersonal relations

Antisocial personality disorder is frequently comorbid with depression, which usually has atypical features. Bipolar disorder (manic phase) and mental retardation (learning difficulties) should be excluded. Substance abuse may be comorbid from childhood, and antisocial behaviour may be secondary to premorbid alcoholism type 2. Atypical schizophrenic disorder (pseudopsychopathic schizophrenia), temporal-lobe epilepsy, or a limbic-lobe syndrome should also be excluded.

Spontaneous Eeg And Intelligence

The majority of studies investigating the relationship between spontaneous EEG and intelligence have focussed their attention on measures of the alpha rhythm (AR), and to a lesser extent the slower theta and delta rhythms. The alpha rhythm has a frequency range of approximately 8-13 Hz, and is the dominant frequency in the EEG recorded from the scalp of adult humans (Pilgreen, 1995 Anokhin & Vogel, 1996 Klimesch, 1999). It is maximal over the occipital lobe when relaxed, but awake and alert, with eyes closed (Steriade, Gloor, Llinas, Lopes da Silva, & Mesulam, 1990 Pilgreen, 1995). There is multiple evidence that AR recorded from the scalp represents neurophysiological mechanisms directly related to individual differences in information processing in the human brain (Klimesch, Schimke& Pfurtscheller, 1993 Lebedev, 1990). The delta (1.5-4.5 Hz) and theta (4.5-7.0 Hz) rhythms are sometimes referred to as 'slow wave' activity, and research has indicated that these slow wave...

Hypoxicischemic Brain Injury As A Major Cns Disorder

Stroke is one of the most common causes of death and severe disability in adults of developed countries,1 accounting for a large proportion of health care costs. About 200 per 100,000 adults per year will have their first stroke. Because the incidence of stroke increases with age, the absolute number of patients with stroke is likely to increase even further, given that the population of aged adults is also increasing.2,3 However, ischemic brain injury does not only affect the adult population, it is a major cause of mortality and severe neurodevelopmental disability (cerebral palsy, mental retardation, epilepsy, neurological handicap, and learning disability) in the pediatric, especially the newborn, population.4,5 Although the etiologies of hypoxic-ischemic (HI) brain injury in adults and children may differ, much of the pathophysiology

Personality disorder and social development

Notions of an epileptic personality arising out of a hereditary 'taint' persisted well into the present century. The person with epilepsy was said to be explosively aggressive, rigid, egocentric, and irritable. These beliefs were formed by observations of often oversedated inmates of epileptic institutions. The concept of a specific epileptic personality has now largely been abandoned, though it is acknowledged that some features associated with, but not specific to, epilepsy may exercise a powerful influence on personality development. Many of these are consequences of brain damage rather than epilepsy as such. Thus learning difficulties, leading to limited educational opportunity, adult unemployment, and socioeconomic disadvantage may be significant personality determinants. But even in the epileptic individual without brain damage the sedative actions of anticonvulsant medication, the continuing stigma of seizure activity, and the social and occupational constraints are not without...

Children and adolescents

Therapeutic communities for children and adolescents were first developed in the field of therapeutic education almost a century ago, and now exist for a variety of needs learning disability, delinquency, emotional disturbance. Little systematic evaluation has been carried out. A survey of 186 children in nine therapeutic communities for emotionally disturbed children found evidence of increased stability and hopeful outcomes for those who stayed. (30) A 20-year follow-up of 28 children in one community reported evidence of long-term improvement.'3 '

The normalizationsocial role valorization approach

This approach was initially developed by psychologists in the field of learning difficulties. It arrived in the United Kingdom from the United States in the early 1980s, and not from Scandinavia where it was first developed in the late 1950s and early 1960s (even though the Scandinavians spoke and published in English). (2 26

Genes And Organisms

It is clear that mutations of specific genes have an enormous impact on behavior. For example, in neurofibromatosis type I (NF1), the mutation of a GTPase activating protein (NF1-GAP) leads to learning disabilities in as many as 1 out of 5000 children worldwide (for review, see Gutmann & Collins, 1995). The loss of the a-calcium-calmodulin kinase II (aCaMKII) leads to profound behavioral changes in mice, which range from alterations in social responses to profound deficits in learning tasks (Silva, Paylor, Wehner, & Tonegawa, 1992 Chen, Rainnie, Greene, & Tonegawa, 1994). However, the extensive evidence that the mutation of genes can cause specific behavioral disruptions cannot be used to conclude that single genes have behavioral functions or that it is possible to predict behavioral performance from genotype. Nevertheless, the problem of lesion studies in general is that it is irresistible to assume that the functional loss caused by the lesion is directly and almost...

A tribute to Emma Jane

Soon both Sam and I embarked on the mission of finding the right school and we knew that the children would not manage at mainstream schools. We looked at the local special schools and Sam eventually decided that she was going to give the school for moderate learning difficulties a go. Ben however, also had the physical difficulties and still did his level best to escape from everywhere and so, with our helpful head teacher (thank you Sam) and the LEA in agreement, I decided to flexi school him - partly at the school for profound and multiple learning difficulties and partly at home. Both ofthem developed in their own little ways once they started school. Ben doesn't strip at all at school, and Emma-Jane became toilet trained in the first couple of weeks of attending school.

Axis I clinical psychiatric syndromes

These include speech and language, reading, spelling, and motor development. In DSM-IV they are included in Axis I. Having a separate axis helps to ensure that they are not overlooked. This can easily happen, for example, in children with conduct disorder, where the antisocial behaviour tends to command attention, while in fact one-third of the children also have specific reading retardation (dyslexia) which if untreated worsens the prognosis. ( 8> Standardized tests are almost essential in order to characterize specific disorders of development. The lack of such tests for motor development is reflected in the lower reliability of the category. (1J.>

The Parents Survival Guide

If anything at all is going to be remembered from this book, I would like it to be this chapter. It is not at the end ofthe book because it is ofleast importance - it is here because I wanted you to remember this above all else If we as parents don't survive both mentally and physically, then our children lose their source oflove, support, encouragement and advocacy. Our children need us to be strong and well. Whether you are parenting a young child or a teenager, whether you have a large multicoloured family like my own or one or two children, whether you have children without any 'added extras' or are parenting a child with autism, AD HD, dyspraxia, dyslexia, AS or any shade in between one thing that is absolutely certain is that mentally, emotionally and physically, it is often an exhausting task and any tips that can make life that bit easier are gems to be treasured.

Evolution in clinical practice

Clinical practice in North America and the United Kingdom diverged markedly in the 1940s. In North America, the presence of the behavioural manifestations of the syndrome alone was considered sufficient for the diagnosis of minimal brain damage or dysfunction.( 4) Coexisting disorders such as conduct disorder and mental retardation (learning disability) were thought to be manifestations of the syndrome. ( 5) In the United Kingdom, clinicians required evidence of documented neuropathology, such as a history of head injury or seizure disorder, ( 6) significant behavioural disturbance in multiple settings (pervasive hyperactivity), and the absence of significant comorbid psychopathology, including conduct disorder. In many European countries, clinicians emphasized the need for evidence of neurological dysfunction, along with deficits in attention and motor control. ( 7>

Neurobehavioural teratology

Neurobehavioural teratology investigates abnormal development of the nervous system and of cognition and complex behaviour that results from prenatal environmental insults. Neurobehavioural research addresses the prevalence of cognitive-behavioural disorders in exposed individuals and the consequences of the brain insult on other developing brain systems, to identify risks for functional or behavioural deficits. Investigators focus on cognitive-behavioural deficits and their underlying anatomy and embryology. Assessment emphasizes not only IQ but also neuropsychological profiles, because learning disability or difficulty in visuomotor integration may be evident in children who function in the low to average range of general mental ability.

Effects on parenting and the family

Mothers of children with mental retardation (learning disability) and severe sleep problems have been reported to be more irritable, concerned about their own health, and less affectionate towards their children, with less control and increased use of punishment than mothers of such children without sleep problems. (7) Similar associations have also been suggested between sleeplessness in toddlers in the general population and family problems, including marital discord and possibly physical abuse of the child.(8)

Chapter References

Factors affecting parental reports of the sleep patterns of children with severe learning disabilities. British Journal of Health Psychology, 3, 45-59. 7. Quine, L (1992). Severity of sleep problems in children with severe learning difficulties description and correlates. Journal of Community and Applied Social Psychology, 2, 247-68.

Impairments disabilities and handicaps

The associated disability is the effect of the impairment on a person's ability to learn and acquire new skills that come with development. Table., These in turn enable the acquisition of increasingly advanced skills necessary for an independent life. The exact nature and extent of the disability may not only include learning disabilities but also physical and sensory disabilities. The extent to which a given impairment results in a loss of function (disability) may well be influenced by the extent and nature of interventions such as special education, or the correction of hearing loss through the use of a hearing aid. The final level, that of 'handicap', is a result of an interaction between the disability and the extent to which support is available or environmental adjustments made. It is a measure of disadvantage that can be ameliorated through, for example, the presence of carers to enable individuals to go out, or environmental modifications (e.g. wheelchair ramps) that diminish...

Generalized dependency handicap

If an IQ below 50 is the sole criterion for categories of learning disability or dependency handicap, they are, in reality, severe intellectual impairment. In practice, categories of learning disability use legal and administrative criteria that do not approximate to categories of intellectual impairment. Children and adults with learning disabilities do not necessarily have especially low intelligence, and not all persons with the same level of IQ share the same degree of generalized learning disability. Current terms such as 'special needs' and 'learning difficulties', in a school context, are proxies for learning disabilities. In other contexts, they are usually proxies for dependency handicap. Socially acceptable terms used in different societies (mentally retarded, mentally handicapped, developmentally disabled, etc.) without standard measures of intelligence, are in reality describing generalized dependency handicap. Discriminating between global impairment, disability, and...

Administrative prevalence of mental retardation in adulthood versus childhood

Although there is now a trend towards mainstreaming children with special needs, and providing extra support, separate special schools for children with moderate and for severe learning difficulties are still provided in many places. At school-leaving age many young people with mild or moderate learning difficulties (roughly equivalent to IQ over 50) will not receive special services only people who have severe mental retardation, and those with additional disabilities, including epilepsy, autism, mental illness, and or behavioural problems will be referred to adult specialist services. The administrative prevalence of adults with mental retardation is thus much lower in adulthood as it is a measure of those in contact with services, that is typically 3 to 4 per 1000 of the population. (2) The administrative prevalence rates should not be confused with true prevalence rates, which are far more difficult to assess.

Models of dual diagnosis services

In the United Kingdom services have developed differently. One of the main reasons being that in the United Kingdom there has been a strong specialist group of psychiatrists (who form one of the Faculties of the Royal College of Psychiatrists) specializing in the psychiatric aspects of people with mental retardation (known as 'learning disability' in the United Kingdom). The publication of the Mansell Report on Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs in the United Kingdom in 1993 offered impetus for the development of specialist services for people with severe mental retardation and severe challenging behaviours. Emphasis was given to community-based and locally based services to support good mainstream practice. The Royal College of Psychiatrists Council Report Meeting the Mental Health Needs of People with Learning Disability in 1996 addressed the issues of people with mild mental retardation and dual diagnosis. It recommended...

Residential and vocational programmes for people with dual diagnosis

Flexible training materials, which can be used by staff groups in their own settings, are now available. It is often useful to design training around particular clients, for instance a morning spent considering various aspects of autistic spectrum disorders followed by an afternoon working with a staff team developing ways together as to how to work with a specific individual with this diagnosis. The Training Package in the Mental Health of Learning Disabilities ( Z.) has been developed along these lines, with materials provided to run a series of workshops with lots of active participation in individual and group activities, some based on information provided and some based on participants' experience. A handbook( 8) for reference and further reading accompanies the Package for use by the workshop facilitators, and others. A video, Making Links, 13 complements the Package.

The law relying on status

Another example of law, this time in a private area, that is dependent upon status is the ability of some people to enter into sexual relations. For most people, this is a matter that is dependent upon their own consent. So, it is rape for a man to have anal or vaginal sexual intercourse with a woman or a man who does not consent (which happens to be the current English definition). It is an offence for a man or a woman to assault indecently another person without their consent. A homosexual act by a man is not a crime provided the other consents (and the act is in private). This would suggest that the critical question is whether the victim is competent to make the decision. For example, does she or he understand what sexual intercourse is so that her or his apparent assent is indeed consent However, this is not the case in all instances. This is for two reasons. First, there is an age of consent. Below the relevant age, the consent of the victim is irrelevant, however competent she...

Electrophysiological Research

This characteristic EEG slowing in children with ADHD has led to the use of Neurometrics or Quantitative EEG (QEEG) techniques, which have been claimed to be useful in diagnosing ADHD and in distinguishing between subtypes of the disorder. There are reports of these techniques being able to correctly classify between 75 and 95 of subjects as either normal or ADHD (Chabot et al., 1996 Chabot & Serfontein, 1996 Lubar, 1991 Mannetal., 1992 Monastra et al., 1999). Lubar (1991) suggests that the ratio of theta to beta is the best measure to distinguish those with ADHD from controls, although this is based on studies of children with attention deficit disorder without hyperactivity (Mann et al., 1992) and with learning disabilities (LD) with attention deficits (Lubar et al., 1985). Chabot et al. (1996) suggest that discriminant functions using combinations of QEEG features best discriminate children with ADHD from those with LD and from normal controls. However, Neurometrics is not...

Organic mental syndromes

Examination of paraphilacs for organic disease varies from treatment centre to treatment centre. When organic disease is suspected, outlying centres refer cases to larger medical facilities for more extensive evaluation. Consequently there have been no random studies of the prevalence of organic disease in paraphiliacs. However, specific medical centres report a relatively high occurrence of organic disease in paraphiliacs. Abnormal hormonal levels are found in 74 per cent of paraphiliacs, soft neurological signs in 27 per cent, chromosomal abnormalities in 24 per cent, seizure disorders in 9 per cent, dyslexia in 9 per cent, abnormal electroencephalograms in 4 per cent, major psychiatric disorders in 4 per cent, and mental retardation in 4 per cent. ( 5) The paraphilic individual's history suggests attention-deficit disorder, dyslexia, or mental retardation.

ADHKD and anxiety disorder53 Diagnosis and differential diagnosis Assessment of children

An interview with or direct observation of the child is important to the assessment. However, the clinician may be unable to observe the child's symptoms first-hand in all cases. Children with AD-HKD are able to suppress their inattentiveness, restlessness, and impulsiveness to a great extent in novel and highly structured situations, such as those afforded by the typical visit to the physician's office. However, parents and teachers can provide a picture of the child's typical behavioural, developmental, and social history, and response to variations in the environment (e.g. family upset or changing teachers). Direct examination of the younger child may be limited by the child's apparent lack of insight into his or her behaviour or an inability to communicate as a result of language or learning difficulties. Nevertheless, the individual child assessment may be useful for identifying comorbidities (e.g. anxiety or depression), monitoring treatment, and establishing the rapport...

Holidays Coping with Change 183

DSM-IV 315.4 - Diagnostic criteria for Developmental Coordination Disorder (Dyspraxia) 239 DSM-IV 299.00 - Diagnostic criteria for Autistic Disorder 239 DSM-IV and DSM-IV 315.00 - Diagnostic criteria for Reading Disorder (Dyslexia) 241 DSM-IV 299.80 -Diagnostic criteria for Asperger's Disorder 241 Gillbergs criteria for Asperger's Disorder 242

Tourettes Syndrome Nicotine And Animal Models

Tourette's disorder (TD) is a neuropsychiatry disorder with childhood onset that is characterized largely by the expression of sudden, rapid and brief, recurrent, non-rhythmic, stereotyped motor movements (motor tics) and sounds (vocal tics) that are experienced as irresistible, but can be suppressed for varying lengths of time.1 These motoric symptoms range from relatively mild to very severe over the course of a patient's lifetime.23 Most patients with TD also exhibit comorbid neuropsychiatry features including obsessive compulsive symptoms,4 inattention, hyperactivity, impulsivity,56 emotional liability, anxiety,78 and associated visual-motor deficits.9 Problems with extreme temper or aggressive behavior are also frequent,10-12 as are school refusal and learning disabilities.1314 While the specific etiology of TD is currently unknown, some believe that the disorder is caused by pathophysiology of cortical-striato-thalamo-cortical circuits in the brain.15 Several lines of evidence...

The alert state required for the above

A variety of pathologies impair attention. Among these are parietal and frontal lesions (Shallice 1993), schizophrenia (Andreasen et al. 1994), and attention-deficit hyperactivity disorder, one manifestation of which is learning difficulties (Shaywitz et al. 1997). It has been suggested that attention and memory are also co-impaired in chronic fatigue syndrome, and the hypothetical 'central executive' was implicated (Joyce et al. 1996). In real-life, multiple methods could be used to enhance attention, and, good news, some of these methods are clearly devoid of any side effect a comparison of memory for humorous and non-humorous versions of sentences shows that the humorous ones are remembered better, probably because they are associated with increased attention (Schmidt 1994).

Mixed disorders of scholastic skills

In ICD-10, this is specified as an ill-defined and inadequately conceptualized, but necessary residual, category of disorders in which both arithmetical and reading or spelling skills can be significantly impaired, and in which the disorder cannot be explained in terms of general mental retardation or inadequate schooling. This category covers disorders that meet the criteria of 'Specific disorder of arithmetical skills' (F81.2) and either 'Specific reading disorder' (F81.0) or 'Specific spelling disorder' (F81.1). As has been explained earlier, in the case of a mixed disorder of scholastic skills, it is specific arithmetical disorder that seems to dominate both in severity and with respect to associated psychopathological features.

Specific spelling disorder

In ICD-10, the main characteristic of this disorder is a specific and significant impairment in the development of spelling skills in the absence of a history of specific reading disorder, which is not solely accounted for by low mental age, visual acuity problems, or inadequate schooling. The children have difficulties in spelling orally and writing words correctly. For this diagnosis, the following criteria are required (ICD-10). The reading skills should be within the normal range and there should be no history of preceding reading difficulties.

Macular Degeneration

Diseases that are grouped as macular degenerations affect central vision. Damage to the macular region is the primary cause for the loss of vision. Symptoms include blurred vision, distortion of lines and shapes, blind spots, reading difficulties, and an inability to recognize faces. Peripheral vision is not severely affected in these individuals. There are two groups of macular degeneration age-related macular degeneration (AMD) and juvenile inherited macular degeneration. AMD affects more than 700,000 Americans each year and approximately 30 million individuals worldwide. It is the leading cause of irreversible blindness in the Western world in individuals over the age of 50. The disease affects the center of the retina and is related to aging, light iris color, prolonged exposure to sunlight, smoking, and a family history. Aging mechanisms are the main factors associated with degeneration of the RPE and photoreceptor cells and the subsequent progression of AMD. Loss of RPE cell...

Delirium in psychiatric patients

It is important not to miss uncommon presentations of delirium in psychiatric patients, especially in the elderly. Prevalence is high amongst older psychiatric inpatients. occasionally, neurological causes of delirium, such as epilepsy and problems with anticonvulsant medication, may need to be dealt with, especially by child and learning disability psychiatrists management should be in collaboration with physicians.

Advantages and disadvantages of the local community level for planning

Second, the local level is usually the most relevant scale at which to formulate a service strategy or plan, which will also take into account interfaces with other types of local service (such as old age, forensic, learning disabilities, and substance misuse services, general health services, and a range of non-clinical services including social service and housing departments, patient representative groups, local politicians, local newspapers and radio stations, and family, carer, and voluntary groups).

Psychological factors Personality

Altered neuropsychological function can be seen as an additional risk factor in alcoholism minimal brain damage, attention deficit, learning disabilities, head injuries, fetal alcohol effects, or the actions of other drugs of abuse are examples of brain conditions likely to increase individual vulnerability. Moreover, a transketolase deficiency (possibly genetic), which affects carbohydrate metabolism in the brain, is believed to predispose towards the occurrence of alcoholic organic brain complications 43)

Reliability of evidence

In dealing with suspects who are psychologically vulnerable, and under the Police and Criminal Evidence Act 1984 police should ensure that juveniles and the mentally disordered should only be interviewed in the presence of an independent 'appropriate adult'. Nonetheless, it is clinically accepted that false confessions are sometimes made by suspects. This can arise from pressure of interrogation, or from psychological vulnerability, or a combination of both. Psychological vulnerability can arise from a range of factors including fear and anxiety, learning disability, drug withdrawal states, and psychiatric illness.

Multiaxial assessment

ICD-10 recommends that multiaxial assessment be carried out for children and adolescents, while DSM-IV suggests it for all ages. In both systems Axis 1 is used for psychiatric disorders which have been discussed above. The last three axes in both systems cover general medical conditions, psychosocial problems, and level of social functioning, respectively these topics will be alluded to below under aetiology. In the middle are two axes in ICD-10, which cover specific (Axis II) and general (Axis III) mental retardation (learning disability) respectively, and one in DSM-IV (Axis II), which covers personality disorders and general mental retardation.

Meet the Jackoons

I have seven children, all very special, all very much loved and all very different - seven different colours of the rainbow. There are four boys and three girls the boys all being various colours of the autistic spectrum. In our house we have dyslexia, dyspraxia, Asperger Syndrome (AS), Attention Deficit, Hyperactivity Disorder (AD HD), Sensory Integration Dysfunction (SID) and autism to add that extra 'oomph' to an already manic family. Matthew, at nineteen years old, is at the stage where he is trying to decide what to do with his life. He is a sergeant in charge of Marine Cadets, has achieved his bronze and silver Duke of Edinburgh Award and is well on the way to getting his gold. He holds first aid certificates, GCSEs, has completed a pre-uniform course which gives him the equivalent of three A levels, and is living proof that dyslexia and dyspraxia don't need to prevent someone from achieving, either physically or academically.

Epilepsy

There is no single cognitive profile of people with epilepsy. The relationship between epilepsy and the presence of mental retardation (learning disability) will mainly be mediated by the original brain damage causing both the epilepsy and the mental retardation. However, some patients do deteriorate intellectually if seizures are frequent or uncontrolled or if there are lapses into status epilepticus. In terms of partial seizures, the most common pattern is disturbance of verbal memory if there is a left temporal (dominant) focus and of non-verbal memory if there is a right focus.(58) Anticonvulsants themselves may mildly impair performance on a wide variety of intellectual, cognitive, and speeded tasks.

The story of Matthew

Matthew was put on the special educational needs register at school and given extra lessons in spelling and reading, I paid for private lessons in reading and writing, and still things didn't seem to get any better. Eventually dyslexia was suggested and after getting sick of waiting for assessments through the local authorities, I had him assessed privately by a specialist in dyslexia and he was officially diagnosed. I have to say that around this time I was probably Matthew's biggest hindrance. He was my first child so I had no yardstick by which to measure his development. I have never had any difficulties at all with reading and writing - in fact I was able to read perfectly at an extremely young age, even before I went to school. For this reason I found it impossible to understand why Matthew could be taught the same words over and over again and yet spell them a different way each time. Poor Matthew had lesson after lesson in reading and spelling and we paid thousands of pounds...

A few more colours

As I have illustrated, Joe seems to fit the criteria for many other 'conditions' though I prefer to think of Joe as having an autistic spectrum 'difference' with a predominant label of AD HD - Joe is simply (well maybe it's not so simple ) Joe. I have written briefly how added extras such as dyspraxia, dyslexia and sensory issues affect us as a household, just as I have written about autism, AD HD and Asperger Syndrome in later chapters. Other colours of the autistic spectrum and labels which our children often acquire, either separately or along with autism, are listed below

School

All parents with an autistic child at any place on the spectrum know far too well the difficulties that arise when trying to find appropriate education for our children. To be fair, most professionals working with children on the autistic spectrum know how hard these children are to place. The nature of autism is that the children have an uneven profile and so whilst a child may have limited communication they may not have learning difficulties at all or may indeed have problems in one area but be way above average in another. Autism is pervasive and school is one place that causes stress for the children, parents and teachers alike.

Inattention

The inability to concentrate or sustain attention for any length oftime is undoubtedly the most disabling part of AD HD or ADD. It often appears that children with AD HD or ADD have associated learning difficulties and whilst this is true in some cases, in many others it is the inability to concentrate long enough to learn that causes the difficulties. These difficulties have far reaching consequences and can spread into every area of life and indeed, throughout the whole of someone's life. More and more evidence suggests that AD HD is not merely a childhood disorder but a very real difference in the way someone thinks and learns - a lifelong condition. Children having such problems with concentrating, and thus learning, can often suffer from low self-esteem and consider themselves to be 'thick' as they frequently achieve less than their peers both socially and academically. It is imperative, therefore, to pick up these problems as early as possible and give the right support in order...

Optic Pathway Glioma

Radiation therapy is generally reserved for patients over age 5 years with progressive radiographic findings or worsening clinical signs and symptoms.32 The risks of radiation are considerable and include cerebrovascular disease, moya moya disease, cerebral atrophy, subnormal intelligence or learning disabilities, secondary malignancies (e.g., astrocy-tomas), cataracts, radiation retinopathy or optic neuropathy, endocrinopathy, and hypothalmic dysfunc-tion.39-41 These risks are generally higher the younger the age of the patient. Chemotherapy is emerging as a possibly safer alternative to radiation therapy particularly in younger children.32 Various agents and combinations of agents have been used with some anecdotal success including actinomycin D, vincristine, CCNV, 6-thioguanine, procarbazine, dibromodulatol, topotecan, carboplatin, and etoposide.32

Sleep and epilepsy

Sleep affects epilepsy and epilepsy affects sleep.(5) Certain types of clinical seizure (as well as interictal discharges) occur mainly, and sometimes exclusively, during sleep. Examples include mesial frontal seizures, benign centrotemporal (Rolandic) epilepsy of childhood, and tonic seizures in the Lennox-Gastaut syndrome in people with mental retardation (learning disability). Electrical status epilepticus during slow-wave sleep is associated with psychological deterioration. The short-lasting form of nocturnal paroxysmal dystonia is now increasingly recognized as a form of frontal-lobe epilepsy. The distinction between nocturnal seizures and other parasomnias (Chapter 4.14.4) is important because of their different significance and management requirements.

General Principles

Sleep disorders should be considered whenever a child is being evaluated for a behavioral problem. Insufficient quality or quantity of sleep may be associated with learning difficulties and attention problems (8,18-23). When a child does not sleep well it can disrupt the entire household and lead to significant stress for the family (24-26). Unrecognized and under-treated sleep disturbances may carry over into adulthood (27).

On the positive side

In my household, as you have seen, I have a combination ofrather unusual characters with very different personalities and so have to help Luke and Matthew as they negotiate their pathway to adulthood. Dyslexia is making it harder for Matthew to fill out application forms in his bid to find employment and his rigidity and difficulties with social situations all make the interview stage even harder for him ifhe does get that far. As I have already written, Luke is struggling through the worst time ofadolescence and this is being exacerbated (for all of us ) by the fact that he is being ruled totally and utterly by his obsessions at the moment. In general, teenagers with autism or related conditions have their own shade of difficulties in adolescence and sometimes the explosion of 'colour' is blinding Whilst focusing on parenting a 'multicoloured' combination ofchildren, this book would be sadly lacking ifI didn't write a full chapter on the whole minefield ofadolescence and its...

Parental influences

Conversely, parents may not be concerned about their child's sleep when they should be. They may be unaware of the problem, indifferent, or they may mistakenly believe that the child's sleep problem is inevitable and untreatable. This mistaken view is sometimes expressed by parents of children with a learning disability whose sleep problems can be particularly severe.(5)

Needs assessment

A full needs assessment brings together the identified social, emotional, and health needs of an individual, including an understanding of the wishes of the person and views of other people who are concerned for and involved in the support and care of that individual. This whole process has, over the last few years in both mental health and learning disability services, become more formalized through the process of 'needs-led assessments' and the 'care programme approach' and in some cases involving inclusion on the 'supervision register'.

Secondary prevention

Once children with mental retardation have been identified, accurate assessment of aetiology and associated conditions, therapy, and rehabilitation lessen the risk of so-called caused learning disability, that is leaving the person with mental retardation without the possibility of developing further because he or she is unable to share in the learning experiences of the peer group.(6728)

Methyl Effects

We also found that there were differences in methylphenidate effects on the SSVEP between boys with ADHD-Combined type and boys with ADHD-Predominantly Inattentive type (Farrow et al., 1999b, 2000b). The Combined type subjects demonstrated more right frontal and right parieto-occipital amplitude and latency reductions following methylphenidate, a pattern similar to the activity seen in controls subjects during the same task. The Inattentive type subjects demonstrated more central and left parieto-occipital activation and left temporal latency reductions, suggesting methylphenidate has quite different effects on brain activity in children with ADHD-Inattentive type, which may be related to different underlying deficits. The greater changes in left hemisphere activation may be related to the higher incidence of learning difficulties in children with ADHD-Predominantly Inattentive type.

Specialized services

Learning disability patients in Special Hospitals have been accommodated in Ashworth and Rampton Hospitals, but in recent years only individuals presenting a grave and immediate danger to others have been accepted and there is a continued need to take this group, since care for those with learning disabilities outside Special Hospitals is largely in the community. The large hospitals have been closed. Many, even with mild learning disabilities, who had been admitted in previous decades, have been moved out as strategies for their care have changed. Medium-secure units can manage many of these patients who often also have other psychiatric disorders.

Info

Symmetrical, spherical hypermetropic refractive errors of this magnitude should not represent a barrier to clear vision in childhood, as they can easily be overcome by a child's powerful accommodation, but it remains unclear if and when such errors should be corrected. Early correction has been reported to encourage the development of normal acuity 8 , prevent strabismus 2, 3 and reduce learning difficulties 29 . There are, however, concerns that early refractive correction may impede the process of emmetropisation

Autism

As I have just written about the cocktail of different kinds of autism both within my family and in each of my boys, I apologize for the fact that I am now going to write mainly about Ben. The main reason for this is because although Luke has Asperger Syndrome, a form of autism, although Joe has AD HD and a kaleidoscope of different autistic spectrum 'differences' and Matthew has many autistic ways, woven into the dyspraxia and dyslexia, autism is Ben's main diagnosis and his endearing (and not so endearing ) ways are more likely to be recognized by any parents and professionals reading this.

Alcohol

This child shows some of the physical abnormalities associated with fetal alcohol syndrome. Children born with fetal alcohol syndrome often have physical, mental, behavioral, and learning disabilities. This child shows some of the physical abnormalities associated with fetal alcohol syndrome. Children born with fetal alcohol syndrome often have physical, mental, behavioral, and learning disabilities.