Cases reported "Learning Disorders"

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1/8. The assessment of cognitive procedural learning in amnesia: why the tower of Hanoi has fallen down.

    The Tower of Hanoi has been widely accepted as an evaluation of cognitive procedural learning in amnesia but inconsistent findings have raised questions about the nature of the learning process involved in this task. This article presents the performance of a hippocampal amnesic, MS, who, showing poor learning across daily sessions of a formal evaluation, subsequently solved the puzzle through spontaneous use of a declarative-level strategy (the odd-even rule), suggesting that his primary approach to the task was the deployment of declarative solution-searching strategies. The presented data suggest normal learning within daily sessions, but subnormal learning across daily sessions due to the forgetting of acquired declarative information. It is suggested that tasks that are potentially solvable by an algorithm or rule, as is the Tower of Hanoi, be regarded as inappropriate for use in cognitive procedural assessments.
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2/8. The meaning of respite care to mothers of children with learning disabilities: two Irish case studies.

    There is a growing interest in ireland in the nature and significance of respite care for carers and those for whom they care. The relationship of individual stress with caring full time for a child who is learning disabled is well documented. Provision of respite care is seen as an important means of alleviating individual carer stress. Yet, the apparent benefits of respite care have been called into question. The present study looks at this issue within the context of respite service provision in ireland for young people with learning disabilities. A phenomenological approach was used to explore the views of two mothers on respite care and, in particular, its personal significance for them within the context of their caring relationship for their children. The authors found that for these two mothers, whilst some of the predicted benefits of respite care were present, for example improved social activity, their use of respite care and the experience of separation initiated feelings of guilt and appeared to engender a degree of emotional stress. It is argued that providers of respite services in ireland need to consider how they can support parents who use respite care so that they see its use as a mark of caring for their child and thereby alleviate such feelings of guilt.
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3/8. The language of dissociation.

    Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.
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4/8. Clinical use of dreams with latency-age children.

    Although various authors have discussed the technical modification required for dream interpretation with children, the basic conceptualization of the psychotherapeutic use of the dream with children has remained virtually identical to that with adult analysands. Examining various sources including formal studies on the nature of children's dreams, clinical case reports and series, and cognitive theories, the authors conclude that a dream arising in the course of a child's therapy must be conceptualized theoretically as a posttraumatic phenomenon. This holds whether or not there has been overt trauma to the child. The reasons for the conceptualization include both the heightened degree of anxiety contained in a dream reported in the course of psychotherapy as well as the specific cognitive abilities of children to contain anxiety and abstract and generalize symbolic meanings. A specific technique based on this conceptualization is then detailed that calls for translation of the dream into more tangible expression (drawing, play, etc.) and a noninterpretative approach. The authors also discuss the more general problem of the nature of insight in children.
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5/8. The second individuation process in handicapped adolescents.

    Blos has conceptualized adolescence as the stage when a second process of separation individuation takes place. It is assumed that maturational processes like physical and sexual development combined with higher levels of thinking play a dominant role in this process enabling the disengagement of the adolescent from the family. Various handicapping conditions may force the adolescent to stay closer to his/her family and hence interfere with the adolescent's separation-individuation. It is suggested that the nature of the interference will vary depending on whether the handicap is physical or cognitive. Both conditions appear to have differential effects on the separation individuation process. The influences of various parental attitudes are also discussed.
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6/8. The other side of the coin: growing up with a learning disability.

    This study is a narrative analysis of the life history of Dale, a 25-year-old man with a learning disability who received sensory integrative treatment in early childhood. The analysis revealed that Dale's self likely developed through occupational engagement with three interconnected themes: "my mother said" and "parental tricks"; "adrenaline surges" and "hell-raising"; and work, "deal making," and self-construction. These themes depict Dale's self-construction, character development, occupation selection, and adaptation. In addition, these themes revealed how his parents used principles based on his sensory needs and learning problems to organize his childhood occupations and assist with his adaptation. The concept of occupational metamorphosis is also proposed to describe a person's search for and selection of occupations that satisfy biological and sensory needs. This study supports the idea that the complex nature of adaptation can be revealed through an occupational history, and that adaptation is multifaceted and not absolute.
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7/8. Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies.

    Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem-focused or emotion-focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand; ways in which to communicate effectively; and strategies for coping with the long-term implications of serious parental illness.
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8/8. midazolam via the intranasal route: an effective rescue medication for severe epilepsy in adults with learning disability.

    People with a learning disability are often disadvantaged due to the nature of their disability. Up to a third are likely to have concomitant epilepsy which adds to the health loss experienced by this group. It is important to manage their epilepsy in such a way as to limit the debilitating effects of both the illness and the medication. Rectal diazepam remains the gold standard rescue medication for prolonged, recurrent seizures or seizures associated with hypoxia. Some of the drawbacks are highlighted in this paper and we go on to explore a novel means of treating these seizures. midazolam, via the intranasal route, has been used extensively in children, mostly as a sedative but also in the treatment of epilepsy. We present two cases, both are adults with a learning disability, who have benefited significantly from the use of intranasal midazolam. Ongoing research into the safe use of this form of treatment, training of staff and carers and the impact on the individual is being conducted.
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