Psychosocial functioning of children with learning disabilities: The relations between psychosocial subtypes and neuropsychological functioning at three age levels.

The aims of this study were threefold: (1) develop a psychosocial typology of children with LD; (2) assess the external validity of the resulting typology; (3) explore the relations between age and psychosocial functioning. To this end, a sample of 728 children with LD between the ages of 7 and 13 years was constructed. All children met a commonly used set of criteria for LD (including normal intelligence, evidence of underachievement on a standardized test of academic skills, and no evidence of primary psychopathology) that has demonstrated good performance in previous research. For some analyses, children were subdivided into three age levels: Young (7-8 years old; 201 subjects), Middle (9-10 years; 258 subjects), and Old (11-13 years; 269 subjects). Psychosocial functioning was defined by scores on the Personality Inventory for Children (PIC). Two methods were used for derivation of psychosocial subtypes. The first method employed k-means cluster analysis, applied separately to each of the Young, Middle and Old samples, using Euclidean distance as the dissimilarity measure calculated on 10 PIC scales transformed in such a manner as to emphasize profile shape over the elements of elevation and dispersion. The second method of classification involved assigning subjects to the subtypes of a prototypical typology derived in previous research on the basis of similarity of PIC profile shape. Overall, the results suggested that the patterns and level of psychosocial adaptation of children with LD are remarkably stable across the age range addressed in this study. It appears that as children with LD grow older they show no greater incidence of pathological patterns of psychosocial functioning. Although some children in this study showed evidence of relatively severe psychopathology, there was no evidence that, with increased age, level of psychosocial adaptation deteriorates. These results contradict the commonly held notion that children with LD are likely to develop psychopathology from the cumulative effects of negative academic and interpersonal experiences. Rather, they suggest that, when significant changes in the psychosocial functioning of children with LD are observed, other factors must be considered. (Abstract shortened by UMI.)Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1991 .F847. Source: Dissertation Abstracts International, Volume: 53-01, Section: A, page: 0104. Thesis (Ph.D.)--University of Windsor (Canada), 1991

Variability in Carotid Endarterectomy Practice Patterns Within a Metropolitan Area

Background and Purpose— Previous clinical studies have suggested that patients with carotid stenosis with high surgical risk features may fare better with carotid artery stenting or aggressive medical therapy. The extent to which carotid endarterectomy is still being performed in this group of patients is unclear. Methods— A retrospective audit was performed among 4 hospitals over a 2-year period. The proportion of high surgical risk patients was compared and the in-hospital stroke, myocardial infarction, and death rates were compared among conventional and high surgical risk patients. Results— Three hundred thirty-five carotid endarterectomy operations were performed (63% asymptomatic) with 37.9% being high surgical risk subjects. The stroke, myocardial infarction, and death rate was 4.6% in conventional risk subjects and 10.2% in high surgical risk patients ( P <0.05). The only hospital with multidisciplinary carotid conferences had the lowest proportion of carotid endarterectomy operations in asymptomatic patients. Conclusions— A substantial proportion of carotid endarterectomy operations are performed in patients with high surgical risk features. These patients experienced a 2-fold increase in major in-hospital complications, raising doubts about whether they benefit from carotid surgery. The use of preintervention multidisciplinary conferences may improve patient safety