Is EEG-biofeedback an effective treatment in autism spectrum disorders? A randomized controlled trial.

EEG-biofeedback has been reported to reduce symptoms of autism spectrum disorders (ASD) in several studies. However, these studies did not control for nonspecific effects of EEG-biofeedback and did not distinguish between participants who succeeded in influencing their own EEG activity and participants who did not. To overcome these methodological shortcomings, this study evaluated the effects of EEG-biofeedback in ASD in a randomized pretest-posttest control group design with blinded active comparator and six months follow-up. Thirty-eight participants were randomly allocated to the EEG-biofeedback, skin conductance (SC)-biofeedback or waiting list group. EEG- and SC-biofeedback sessions were similar and participants were blinded to the type of feedback they received. Assessments pre-treatment, post-treatment, and after 6 months included parent ratings of symptoms of ASD, executive function tasks, and 19-channel EEG recordings. Fifty-four percent of the participants significantly reduced delta and/or theta power during EEG-biofeedback sessions and were identified as EEG-regulators. In these EEG-regulators, no statistically significant reductions of symptoms of ASD were observed, but they showed significant improvement in cognitive flexibility as compared to participants who managed to regulate SC. EEG-biofeedback seems to be an applicable tool to regulate EEG activity and has specific effects on cognitive flexibility, but it did not result in significant reductions in symptoms of ASD. An important finding was that no nonspecific effects of EEG-biofeedback were demonstrated.

Cognitive correlates of mathematical achievement in children with cerebral palsy and typically developing children.

BACKGROUND: Remarkably few studies have investigated the nature and origin of learning difficulties in children with cerebral palsy (CP). AIMS: To investigate math achievement in terms of word-problem solving ability in children with CP and controls. Because of the potential importance of reading for word-problem solving, we investigated reading as well. SAMPLE: Children with CP attending either special (n= 41) or mainstream schools (n= 16) and a control group of typically developing children in mainstream schools (n= 16). METHOD: Group differences in third grade math and reading, controlled for IQ, were tested with analyses of co-variance (ANCOVAs). Hierarchical regression was used to investigate cognitive correlates of third grade math and reading. Predictors included verbal and non-verbal IQ measured in first grade, components of working memory (WM) and executive function (EF) measured in second grade, and arithmetic fact fluency and reading measured in third grade. RESULTS: Children with CP in special schools performed significantly worse than their peers on word-problem solving and reading. There was a trend towards worse performance in children with CP in mainstream schools compared to typically developing children. CONCLUSIONS: Impairments of non-verbal IQ and WM updating predicted future difficulties in both word-problem solving and reading. Impairments of visuospatial sketchpad and inhibition predicted future word-problem, but not reading difficulty. Conversely, deficits of phonological loop predicted reading but not word-problem difficulty. Concurrent arithmetic fact fluency and reading ability were both important for word-problem solving ability. These results could potentially help to predict which children are likely to develop specific learning difficulties, facilitating early intervention.

Food preferences in young Dutch children and recommendations for feeding intervention in developmental disabilities.

Total and chronic food refusal (i.e., the refusal of all types of food during a prolonged period) in young children with developmental disabilities can be treated effectively using a combination of environmental interventions. However, no guidelines for the selection of food items to offer the child in these interventions are available. The aim of the present study was to assess the preferences for specific food items of young Dutch nondisabled children (N=254) in order to enable trainers to select food items that maximize success of feeding interventions. Results indicate that 54 out of 107 food items were found to be preferred. The mean appreciation scores of boys and girls did not differ significantly for these preferred food items, except for raisins and brown bread. Also, there were no differences between the distinguished age-groups, except for peach. Recommendations for the selection of food items within feeding intervention for total and chronic food refusal in young children with developmental disabilities are given.

Emergent literacy activities, instructional adaptations and school absence of children with cerebral palsy in special education.

The goal of the present study was to get an overview of the emergent literacy activities, instructional adaptations and school absence of children with cerebral palsy (CP) compared to normally developing peers. The results showed that there were differences between the groups regarding the amount of emergent literacy instruction. While time dedicated to storybook reading and independent picture-book reading was comparable, the children with CP received fewer opportunities to work with educational software and more time was dedicated to rhyming games and singing. For the children with CP, the level of speech, intellectual, and physical impairments were all related to the amount of time in emergent literacy instruction. Additionally, the amount of time reading precursors is trained and the number of specific reading precursors that is trained is all related to skills of emergent literacy.

[Toilet training in mental retardation; approach to diurnal enuresis in a 12-year-old boy with hemiparesis]. / Zindelijkheidstraining bij verstandelijk beperkten; aanpak van broekplassen bij een 12-jarige hemiparetische jongen.

A 12-year-old boy with hemiparesis, severe mental retardation, reduced mobility and behavioural problems was not yet toilet trained. He was successfully trained using a behavioural treatment. The training program was based on gradual prolongation of urine retention, the introduction of behaviour restrictions, rewards for using the toilet and overcorrection using repeated exercises if diurnal enuresis occurred. A third of 4- to 18-year-olds with a cerebral palsy do not have diurnal bladder control at the age of 6, in contrast to 1-3% in the general population. An important cause of this difference is the believe that bladder control is dependent on the time of development of bladder control muscles and that it cannot be affected by external methods. This case study shows that even in a relatively older and severely and multiply disabled boy diurnal enuresis can be solved.

Quality of arithmetic education for children with cerebral palsy.

The aim of this exploratory study was to investigate the quality of arithmetic education for children with cerebral palsy. The use of individual educational plans, amount of arithmetic instruction time, arithmetic instructional grouping, and type of arithmetic teaching method were explored in three groups: children with cerebral palsy (CP) in special (CP-special; n = 41) and mainstream schools (CP-mainstream; n = 16) and a control group in mainstream schools (n = 16). The majority of individual educational plans did not include well-formulated arithmetic goals and many were not based on optimal assessment. Special schools scheduled much less arithmetic instruction time. Many CP-mainstream children received individualized instruction, which may help to explain why their arithmetic performance did not differ from controls. Remedial arithmetic teaching methods used in special schools did not seem to be optimal, but more research is required. Suggestions to improve arithmetic education to children with CP were discussed.

Predictors of verbal working memory in children with cerebral palsy.

The goal of the present study was to examine the precursors of verbal working memory in 52 children with cerebral palsy with varying degrees of speech impairments in the first grade of special education. Following Baddeley's model of working memory, children's verbal working memory was measured by means of a forced-recognition task. As precursors of verbal working memory, measures of intelligence, speech rate, speech intelligibility, auditory perception, and phonological awareness were also administered. Correlations were computed between all measures followed by Structural Equation Modeling analyses with speech rate and speech intelligibility being identified as a single factor 'speech'. The results revealed that verbal working memory was mostly predicted by intelligence, auditory perception and speech ability. It was also found that children with cerebral palsy with additional intellectual and speech impairments were at risk for limited verbal working memory spans.

Sleepiness, on-task behavior and attention in children with epilepsy who visited a school for special education: a comparative study.

Children with epilepsy are at risk for problems in daytime functioning. We assessed daytime sleepiness, on-task behavior and attention in 17 children (aged between 7 and 11 years) with epilepsy who visited a school for special education and compared these to 17 children from a control group who visited a regular school. Within the group of children with epilepsy, we explored whether behavioral and cognitive functioning varied across days of the week and times of the day. Data were collected during four consecutive school days. Children with epilepsy had more daytime sleepiness, less on-task behavior and less attention than controls. Furthermore, sleepiness and on-task behavior varied cross days of the week and times of the day, an effect that was not found in controls. Implications for educational practice are discussed.

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory.

BACKGROUND: Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. METHODS: Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n = 41) and mainstream education (n = 16) and controls in mainstream education (n = 16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time. RESULTS: Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic. CONCLUSIONS: Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.

Cyberbullying among students with intellectual and developmental disability in special education settings.

OBJECTIVE: To explore the types, prevalence and associated variables of cyberbullying among students with intellectual and developmental disability attending special education settings. METHODS: Students (n = 114) with intellectual and developmental disability who were between 12-19 years of age completed a questionnaire containing questions related to bullying and victimization via the internet and cellphones. Other questions concerned sociodemographic characteristics (IQ, age, gender, diagnosis), self-esteem and depressive feelings. RESULTS: Between 4-9% of students reported bullying or victimization of bullying at least once a week. Significant associations were found between cyberbullying and IQ, frequency of computer usage and self-esteem and depressive feelings. No associations were found between cyberbullying and age and gender. CONCLUSIONS: Cyberbullying is prevalent among students with intellectual and developmental disability in special education settings. Programmes should be developed to deal with this issue in which students, teachers and parents work together.

The relationship between medical impairments and arithmetic development in children with cerebral palsy.

Arithmetic ability was tested in children with cerebral palsy without severe intellectual impairment (verbal IQ >or= 70) attending special (n = 41) or mainstream education (n = 16) as well as control children in mainstream education (n = 16) throughout first and second grade. Children with cerebral palsy in special education did not appear to have fully automatized arithmetic facts by the end of second grade. Their lower accuracy and consistently slower (verbal) response times raise important concerns for their future arithmetic development. Differences in arithmetic performance between children with cerebral palsy in special or mainstream education were not related to localization of cerebral palsy or to gross motor impairment. Rather, lower accuracy and slower verbal responses were related to differences in nonverbal intelligence and the presence of epilepsy. Left-hand impairment was related to slower verbal responses but not to lower accuracy.

Teacher literacy expectations for kindergarten children with cerebral palsy in special education.

Teacher expectations are important for the literacy development of children. The goal of this study was to investigate to what extent teacher expectations for future literacy success at the end of elementary school differed for children with cerebral palsy (CP) as compared with peers without disabilities in kindergarten. In addition, we investigated to what extent teacher literacy expectations of children with CP were related to additional impairments such as speech, intellectual and physical impairments, and to the current level of emergent literacy skills. Forty-nine teachers of children with CP and 71 teachers of non-disabled children responded to the questionnaire. The results showed that teacher expectations for future reading and writing success of children with CP were lower (all P values are <0.001) but also of a different nature, as eight teachers had no idea what to expect for the future reading development, and 12 teachers did not know what to expect for the future writing development of the child with CP. Multiple regression analysis showed that teacher reading expectations could best be predicted by both intelligence and emergent literacy skills (P<0.001), whereas teacher writing skills could best be predicted by intelligence (P<0.001).

Home literacy environment: characteristics of children with cerebral palsy.

BACKGROUND: Various aspects of the home literacy environment are considered to stimulate the emergent literacy development in children without disabilities. It is important to gain insight into the home literacy environment of children with cerebral palsy given that they have been shown to have difficulty acquiring literacy skills. AIMS: The aims of the present study were to investigate whether the home literacy environment of children with cerebral palsy was comparable with that of peers without disabilities and to investigate to what extent speech, fine motor, and intellectual impairments limit their home literacy experiences. METHODS & PROCEDURES: Questionnaires addressed to the parents of the children were devised to investigate differences in the home literacy environment in 40 children with cerebral palsy and in 62 peers without disabilities who were comparable on chronological age, i.e., 6 years old, socio-economic status (SES) and sex. The relative influence of speech intelligibility, fine motor skills, and intelligence skills for the home literacy environment factors of children with cerebral palsy was investigated. OUTCOMES & RESULTS: Only a few group differences were significant: children with cerebral palsy were less interested in participating in writing activities, and less involved in word-orientation activities during shared storybook reading. On the other hand, parents of children with cerebral palsy were doing more leisure activities with their child. The speech intelligibility scores of the children with cerebral palsy predicted the amount of emergent literacy activities they were doing with their parents, as wells as their active participation in word-related activities during storybook reading. In addition, the active participation of the child in story-related activities could be predicted by his or her fine motor skills. Furthermore, parents of the children in the comparison group often had high expectations, while parents of the children with cerebral palsy often did not know what expectations to have for their child's literacy level at the end of elementary school. CONCLUSIONS & IMPLICATIONS: Although both groups have stimulating home literacy environments, children with cerebral palsy with speech or fine motor impairments are disadvantaged in a small number of literacy activities. Teachers and speech and language therapists can work with parents to give them suggestions on how to conduct emergent literacy activities with their child with speech impairments as well as how on to involve their child with speech and fine motor dysfunctions more actively in storybook reading activities. Furthermore, parents should be given more information about their child's language development in order the better to understand what goals are achievable so they may begin to form realistic expectations.

Access to and use of Internet by adolescents who have a physical disability: a comparative study.

The purpose of this study was to examine access to and use of Internet by 97 physically disabled adolescents. Four main objectives were to: (1) explore frequency and nature of Internet use and the role of care givers, (2) compare these results with non-disabled adolescents, (3) explore associations between access to and use of Internet and adolescents variables, and (4) examine differences between care givers in the guidance of adolescents concerning their Internet use. Outcomes on a questionnaire were compared to those from a control group consisting of 1566 non-disabled adolescents. No differences in access to Internet between physically disabled and non-disabled adolescents were found. In addition, the most common online activities were similar for both groups. Physically disabled adolescents were more often warned by their parents about the risks of Internet and more often had rules at home than their non-disabled peers. Among the group of physically disabled adolescents, gender and environmental setting were found to be related to online activities. In addition, age was found to be related to the amount of rules at home. No associations were found between IQ and the access to and use of Internet. Finally, parents of physically disabled more often warn adolescents and more often check their use of Internet than care staff.

Importance of speech production for phonological awareness and word decoding: the case of children with cerebral palsy.

The goal of this longitudinal study was to investigate the precursors of early reading development in 52 children with cerebral palsy at kindergarten level in comparison to 65 children without disabilities. Word Decoding was measured to investigate early reading skills, while Phonological Awareness, Phonological Short-term Memory (STM), Speech Perception, Speech Production and Nonverbal Reasoning were considered reading precursors. Children with cerebral palsy lag behind on all reading precursors at the beginning of the second year of kindergarten. For the children without disabilities, early reading skills in Grade 1 were best predicted by Phonological Awareness and Phonological STM while Speech Production was the most important predictor of early reading success for the children with cerebral palsy, followed by Phonological Awareness and Speech Perception. Furthermore, for children with cerebral palsy, Speech Production appears to dominate reading development, as Speech Production measured at the beginning of the second year of kindergarten was strongly predictive of all other reading precursors measured at the end of the second year of kindergarten. The results of this study reveal that children with cerebral palsy with additional speech impairments are at risk for limited literacy development. Clinical implications are discussed.

Home literacy predictors of early reading development in children with cerebral palsy.

The goal of the present 1-year long longitudinal study was to determine which home literacy variables were effective in stimulating early reading skills of children with cerebral palsy (CP) directly or indirectly via the reading precursors. Parents of 35 children with CP completed questionnaires regarding aspects of the home literacy environment (HLE). The reading precursors: Vocabulary, Syntactic skills and phonological awareness, i.e., Rhyme and Phonemic awareness, were assessed at the end of Kindergarten and the end of Grade 1, while the early reading skills Letter knowledge and Word recognition were assessed only at the end of Grade 1. Three HLE variables were found to be related to reading precursors and early reading skills: Parent literacy mediation, Word orientation and Story orientation activities during shared book reading. Path analyses showed that these three HLE variables were not directly related to early reading skills in Grade 1, but indirectly via the reading precursors, in particular phonological awareness.

The effect of cerebral palsy on arithmetic accuracy is mediated by working memory, intelligence, early numeracy, and instruction time.

The development of addition and subtraction accuracy was assessed in first graders with cerebral palsy (CP) in both mainstream (16) and special education (41) and a control group of first graders in mainstream education (16). The control group out-performed the CP groups in addition and subtraction accuracy and this difference could not be fully explained by differences in intelligence. Both CP groups showed evidence of working memory deficits. The three groups exhibited different developmental patterns in the area of early numeracy skills. Children with CP in special education were found to receive less arithmetic instruction and instruction time was positively related to arithmetic accuracy. Structural equation modeling revealed that the effect of CP on arithmetic accuracy is mediated by intelligence, working memory, early numeracy, and instruction time.

Computer vocabulary training in kindergarten children with special needs.

The aim of the present study was to determine whether vocabulary training on a computer can enhance vocabulary learning of young children with special needs and whether the task-on-behaviour of these children differed when story reading was carried out by the teacher or by the computer. An experimental group (n=9) listened to a story read to them by the computer and played additional computer vocabulary games during three 20-min sessions. The control group (n=9) had the same story read to them by a teacher and then followed the normal school curriculum. The results showed that children with special needs were equally able to keep their attention on the story when it was read to them by the computer as when it was read to them by the teacher. For vocabulary growth, the intervention showed positive effects. The children from the experimental group learned more experimental words between the pre-test and retention test than the children in the control group. The study shows that a group of kindergarten children with special needs can enhance their vocabulary by working with a computer program without human intervention.

Sleep problems in children and young adults with developmental disabilities: home-based functional assessment and treatment.

Sleep problems such as settling problems, frequent night waking, and early waking are prevalent as well as persistent with children and young adults with developmental disabilities who live at home. In this study, results of pretreatment functional assessment suggested that parental attention may have shaped and maintained the sleep problems with four participants. Effectiveness of extinction of parental attention, that is planned ignoring, was assessed on number of minutes of nighttime disruptive behaviors. Treatment resulted in a normalized sleep pattern in all cases and effects were maintained across time.

Parents' reasons for enrolment of their motor-disabled child in a Dutch therapeutic toddler class.

This article describes and categorizes the reasons why parents enrol their motor-disabled children in the therapeutic toddler class, a special centre-based service in early intervention. The results among a representative Dutch sample of 84 mothers showed that child-related reasons were considered more important than family- and parent-related reasons. Family- and parent-related reasons were influenced by the presence and severity of the child's behaviour problems. The results of this study are discussed within the context of parental expectations in early intervention, and the concept of family centredness.