Predicting long-term cognitive and neuropathological consequences of moderate to severe traumatic brain injury: Review and theoretical framework.

Prognostic modeling in moderate to severe traumatic brain injury (TBI) has historically focused primarily on the projection of crude outcomes such as the risk of mortality and disability. Initial work in this area has perpetuated the notion that prognosis after moderate to severe TBI can be measured as a single, static, and dichotomous outcome. However, more recent conceptualizations describe moderate to severe TBI as the initiation of a chronic disease state with high levels of inter-individual variability in terms of symptom manifestation and disease progression. Unfortunately, existing prognostic models provide limited insight into the extent of chronic cognitive and neurodegenerative changes experienced by moderate to severe TBI survivors. Though prior research has identified a variety of acute factors that appear to influence post-injury cognitive and neuropathological outcomes, an empirically supported framework for prognostic modeling of these injury-distal outcomes does not exist. The current review considers the literature on an expanded array of empirically supported predictors (both premorbid and injury-related) in association with long-term sequelae of moderate to severe TBI. We also provide a theoretical framework and statistical approach for prognostic modeling in moderate to severe TBI in order to unify efforts across research groups and facilitate important progress in this research area.

IQ-Achievement Discrepancy for Identification of Disabilities in Spanish-speaking English Learners.

This article examines the validity of IQ-achievement discrepancy and low achievement as criteria for the identification of disabilities in Spanish-speaking English-language learners (ELs) and the factors that moderate the validity of these approaches as bases for identification. While there has been a long history of examining the validity of different approaches to disability identification in monolinguals, there are no systematic approaches taken for ELs. Data from Grades 1 and 2 of a large longitudinal data set consisting of young Spanish-speaking students attending schools in the United States were used to empirically examine criteria for disability identification among language minority children-one of the first large-scale attempts. Findings indicated significant overidentification when the language of assessment was not matched to the language of the instruction, although the effects varied predictably over time and by language of instruction. Validation of classifications using measures external to the classification found that low achieving and discrepant children differ from typically developing children, and from one another in predictable ways based on differences in IQ. The study highlights the importance of taking into account the language of instruction and the severity of the cut-off to reduce misidentification of typically developing children.

Data-driven heterogeneity in mathematical learning disabilities based on the triple code model.

Many classifications of heterogeneity in mathematical learning disabilities (MLD) have been proposed over the past four decades, however no empirical research has been conducted until recently, and none of the classifications are derived from Triple Code Model (TCM) postulates. The TCM proposes MLD as a heterogeneous disorder, with two distinguishable profiles: a representational subtype and a verbal subtype. A sample of elementary school 3rd to 6th graders was divided into two age cohorts (3rd - 4th grades, and 5th - 6th grades). Using data-driven strategies, based on the cognitive classification variables predicted by the TCM, our sample of children with MLD clustered as expected: a group with representational deficits and a group with number-fact retrieval deficits. In the younger group, a spatial subtype also emerged, while in both cohorts a non-specific cluster was produced whose profile could not be explained by this theoretical approach.

Identifying classes of persons with mild intellectual disability or borderline intellectual functioning: a latent class analysis.

BACKGROUND: Persons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics. METHODS: Latent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3-70) years. RESULTS: Five distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability. CONCLUSIONS: The identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.

Borderline intellectual functioning: an update.

PURPOSE OF REVIEW: Borderline intellectual functioning (BIF) is a descriptive v-code that is often used, especially in forensic settings, as if it were a full-fledged disorder. Various historical and other aspects of this classification are reviewed, and commentary is made on the question of whether to upgrade BIF to a regular psychiatric category, or to eliminate it by folding it into an already recently expanded category of intellectual developmental disorder (IDD). RECENT FINDINGS: Full-scale intelligence quotient (IQ) is an outmoded concept that is decreasingly being used. For example, DSM-5 states that measures of 'executive functioning' (reasoning, planning, consequential thinking, attention, self-regulation, and so on) are often more meaningful that full-scale IQ as diagnostic indicators of IDD. Even the definition of BIF in DSM-5 no longer specifies an IQ score range. SUMMARY: BIF is a descriptive v-code (rather than a typical psychiatric category), which started out as a sub-type of IDD (formerly mental retardation or intellectual disability) but morphed into its current status when the IQ ceiling for IDD was changed from minus one standard deviation (85) to minus two standard deviations (70). It has been suggested that, as people with BIF often have adjustment problems, the BIF category be elevated to the status of a formal psychiatric disorder. In this article, a contrary opinion is expressed, namely that the BIF category be dropped.

Linguistic and Cognitive Profiles of 8- to 15-Year-Old Children With Specific Reading Comprehension Difficulties.

This article presents two studies investigating the role of executive functioning in written text comprehension in children and adolescents. In a first study, the involvement of executive functions in reading comprehension performance was examined in normally developing children in fifth grade. Two aspects of text comprehension were differentiated: literal and inferential processes. The results demonstrated that while three aspects of executive functioning (working memory, planning, and inhibition processes) were significantly predictive of the performance on the inferential questions of the comprehension test, these factors did not predict the scores on the literal tasks of the test. In a second experiment, the linguistic and cognitive profiles of children in third/fifth and seventh/ninth grades with a specific reading comprehension deficit were examined. This analysis revealed that the deficits experienced by the less skilled comprehenders in both the linguistic and the executive domains could evolve over time. As a result, linguistic factors do not make it possible to distinguish between good and poor comprehenders among the group of older children, whereas the difficulties relating to executive processing remain stable over development. These findings are discussed in the context of the need to take account of the executive difficulties that characterize less skilled comprehenders of any age, especially for remediation purposes.

From Disabled Students to Disabled Brains: The Medicalizing Power of Rhetorical Images in the Israeli Learning Disabilities Field.

The neurocentric worldview that identifies the essence of the human being with the material brain has become a central paradigm in current academic discourse. Israeli researchers also seek to understand educational principles and processes via neuroscientific models. On this background, the article uncovers the central role that visual brain images play in the learning-disabilities field in Israel. It examines the place brain images have in the professional imagination of didactic-diagnosticians as well as their influence on the diagnosticians' clinical attitudes. It relies on two theoretical fields: sociology and anthropology of the body and sociology of neuromedical knowledge. The research consists of three methodologies: ethnographic observations, in-depth interviews, and rhetorical analysis of visual and verbal texts. It uncovers the various rhetorical and ideological functions of brain images in the field. It also charts the repertoire of rhetorical devices which are utilized to strengthen the neuroreducionist messages contained in the images.

Subtypes and comorbidity in mathematical learning disabilities: Multidimensional study of verbal and visual memory processes is key to understanding.

A large body of research suggests that mathematical learning disability (MLD) is related to working memory impairment. Here, I organize part of this literature through a meta-analysis of 36 studies with 665 MLD and 1049 control participants. I demonstrate that one subtype of MLD is associated with reading problems and weak verbal short-term and working memory. Another subtype of MLD does not have associated reading problems and is linked to weak visuospatial short-term and working memory. In order to better understand MLD we need to precisely define potentially modality-specific memory subprocesses and supporting executive functions, relevant for mathematical learning. This can be achieved by taking a multidimensional parametric approach systematically probing an extended network of cognitive functions. Rather than creating arbitrary subgroups and/or focus on a single factor, highly powered studies need to position individuals in a multidimensional parametric space. This will allow us to understand the multidimensional structure of cognitive functions and their relationship to mathematical performance.

The DSM and learning difficulties: formulating a genealogy of the learning-disabled subject.

The article examines the manner in which the learning-disabled subject is created as an object within contemporary psychiatric discourse by means of a genealogical analysis of the learning-disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It investigates how this pathology was formed historically in the text, what metamorphoses it underwent, and their epistemic significance. First, the theoretical underpinnings of the sociological discourse on DSM are presented, giving a brief background of the DSM status in the Israeli context. Many problematic characteristics in the text are unveiled, by means of critiques from sociology, anthropology and discourse studies. Second, the changing definitions and conceptualizations of learning-disorders in the seven editions of the Manual and the accompanying case studies (1952-2013) are examined. It becomes apparent that the disorders have undergone changes that have enabled the biomedical paradigm to triumph. The implications of these transformations are addressed.

Psychosocial and Adaptive Deficits Associated With Learning Disability Subtypes.

Children with specific learning disabilities (SLD) have deficits in the basic psychological processes that interfere with learning and academic achievement, and for some SLD subtypes, these deficits can also lead to emotional and/or behavior problems. This study examined psychosocial functioning in 123 students, aged 6 to 11, who underwent comprehensive evaluations for learning and/or behavior problems in two Pacific Northwest school districts. Using concordance-discordance model (C-DM) processing strengths and weaknesses SLD identification criteria, results revealed working memory SLD (n = 20), processing speed SLD (n = 30), executive SLD (n = 32), and no disability groups (n = 41). Of the SLD subtypes, repeated measures MANOVA results revealed the processing speed SLD subtype exhibited the greatest psychosocial and adaptive impairment according to teacher behavior ratings. Findings suggest processing speed deficits may be behind the cognitive and psychosocial disturbances found in what has been termed "nonverbal" SLD. Limitations, implications, and future research needs are addressed.

'Learning disabilities' as a 'black box': on the different conceptions and constructions of a popular clinical entity in Israel.

This article aims to stimulate new thinking about learning disabilities than is customary in local literature. Previous educational and psychological studies concerning learning disabilities regarded them as if they were objective categories with formal definitions and criteria accepted in scholarly literature. Contrary to that, this article explores the various conceptions, constructions, and meanings of learning disabilities that comprise the narrative descriptions and explanations of didactic diagnosticians. For this purpose, 50 in-depth interviews were conducted. There are four sections. Part One lays out the theoretical and methodological background of the sociological and discursive debate about learning disabilities. Part Two explores the various main thematic aspects and narrative strategies that were used by the diagnosticians in their construction of their purportedly 'objective', 'a-historical', 'a-political' experts' narrative. The third part reveals the polyphonic multifaceted nature of the learning disabilities construct. The experts' narrative undermines the objective and homogeneous definitions in the literature by uncovering learning disabilities' heterogeneous meaning repertoire. This repertoire consists, among others, of conceptualizing disability as a 'disease', a 'symptom', a 'genetic defect', a 'disorder', an 'educational difficulty', a 'variance', and even a 'gift'. This part also reveals the experts' narrative reaction strategies to the aforementioned polyphonic spectacle. It is revealed that the interviewees' narrative deconstructs the 'scientific factual nature' of the clinical categories. The fourth part highlights a central paradox in the expert narrative: The tension between the narrative stigmatic-labeling aspects and the destigmatic-'liberating' aspects. The claim is made that this tension can partly explain the current popularity of the LD diagnosis. This article is the third in a series of papers that seeks to contribute to the creation of a more nuanced disability discourse by exposing its shaky scientific foundations.

[Specific learning disabilities - from DSM-IV to DSM-5]. / Spezifische lernstörungen.

The publication of the DSM-5 means changes in the classification and recommendations for diagnosis of specific learning disabilities. Dyslexia and dyscalculia have been reintroduced into the DSM. Three specific learning disorders - impairment in reading, impairment in the written expression, and impairment in mathematics, described by subskills - are now part of the DSM-5. Three subcomponents of the reading disorder are expressly differentiated: word reading accuracy, reading rate, and fluency and reading comprehension. Impaired subskills of the specific learning disorder with impairment in written expression are spelling accuracy, grammar and punctuation accuracy, and clarity and organization of written expression. Four subskills are found in the mathematics disorder: number sense, memorization of arithmetic facts, accurate or fluent calculation, and accurate math reasoning. Each impaired academic domain and subskill should be recorded. A description of the severity degree was also included. The diagnosis is based on a variety of methods, including medical history, clinical interview, school report, teacher evaluation, rating scales, and psychometric tests. The IQ discrepancy criterion was abandoned, though that of age or class discrepancy criterion was retained. The application of a discrepancy is recommended by 1 to 2.5 SD. All three specific developmental disorders are common (prevalence 5 %-15 %), occur early during the first years of formal schooling, and persist into adulthood.

Cognitive subtypes of mathematics learning difficulties in primary education.

It has been asserted that children with mathematics learning difficulties (MLD) constitute a heterogeneous group. To date, most researchers have investigated differences between predefined MLD subtypes. Specifically MLD children are frequently categorized a priori into groups based on the presence or absence of an additional disorder, such as a reading disorder, to examine cognitive differences between MLD subtypes. In the current study 226 third to six grade children (M age=131 months) with MLD completed a selection of number specific and general cognitive measures. The data driven approach was used to identify the extent to which performance of the MLD children on these measures could be clustered into distinct groups. In particular, after conducting a factor analysis, a 200 times repeated K-means clustering approach was used to classify the children's performance. Results revealed six distinguishable clusters of MLD children, specifically (a) a weak mental number line group, (b) weak ANS group, (c) spatial difficulties group, (d) access deficit group, (e) no numerical cognitive deficit group and (f) a garden-variety group. These findings imply that different cognitive subtypes of MLD exist and that these can be derived from data-driven approaches to classification. These findings strengthen the notion that MLD is a heterogeneous disorder, which has implications for the way in which intervention may be tailored for individuals within the different subtypes.

Community college students with learning disabilities: evidence of impairment, possible misclassification, and a documentation disconnect.

Recent research suggests that most 4-year college students diagnosed with specific learning disability (SLD) do not meet objective criteria for the disorder, show normative deficits in academic skills, or have childhood histories of SLD. The purpose of this study was to examine the functioning of students diagnosed with SLD attending community college. We reviewed SLD documentation for 359 community college students previously diagnosed with SLD and receiving academic accommodations. Most students met objective criteria (82.3%) and were first diagnosed in childhood (93.3%). Most students also showed average intellectual functioning and below-average to borderline academic achievement. However, 27.3% showed uniformly low ability and achievement scores, suggesting possible misclassification. Students who failed to meet objective criteria for SLD often submitted test data that lacked current, adult-normed standardized test scores; many were diagnosed based on response to intervention and submitted only an individualized education program or summary of performance. This finding provides initial evidence of a disconnect between the qualitative documentation that secondary schools provide and the quantitative documentation that postsecondary institutions require for SLD classification.

Borderline intellectual functioning: consensus and good practice guidelines.

INTRODUCTION: The Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits "normal" intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. OBJECTIVES: To elaborate a conceptual framework and to establish consensus guidelines. METHOD: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. RESULTS: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is "Borderline Intelligence". The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. CONCLUSIONS: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual.

Memory processes in learning disability subtypes of children born preterm.

The purpose of this study was to evaluate immediate auditory and visual memory processes in learning disability subtypes of 40 children born preterm. Three subgroups of children were examined: (a) primary language disability group (n = 13), (b) perceptual-motor disability group (n = 14), and (c) no learning disability diagnosis group without identified language or perceptual-motor learning disability (n = 13). Between-group comparisons indicate no significant differences in immediate auditory or visual memory performances between language and perceptual-motor learning disability groups. Within-group comparisons revealed that both learning disability groups performed significantly lower on a task of immediate memory when the mode of stimulus presentation and mode of response were visual.

A critical review of the literature on NLD as a developmental disorder.

The extant research on nonverbal learning disability (NLD) was analyzed in this review. Studies were defined for use in the review as those that appeared in a peer-reviewed journal and included participants characterized as having NLD. Each study also needed to provide a statistical analysis of dependent variables. An a priori system was used to evaluate the quality of the research. Of the 88 publications found, 32 met criteria for inclusion in the review, with 6 meeting full criteria as strong studies. The diagnostic criteria used and the research findings are briefly discussed, as are proposed guidelines for future research.