A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy

© 2017 The British Psychological Society Objective: Nearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID. Method: Narrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words ‘intellectual disability’, ‘learning disability’, ‘neuropsychology’, ‘attention’, ‘learning’, ‘memory’, ‘executive function’, ‘language’, and ‘reading’. Results: Children with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed. Conclusions: There are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population. Practitioner points: Clinical implications. Effective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practice As rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the recommendations provided in this study will encourage more mental health practitioners to provide CBT to children with ID. Limitations. These recommendations are based only upon neuropsychological literature. Trialling the effectiveness of an adapted form of CBT for children and adolescents with ID is required. There are varying causes of intellectual disability, with differences in cognitive profiles. The utility of the recommendations made here may vary according to specific aetiologies

Regulating the Business of Insurance: Federalism in an Age of Difficult Risk

Natural disasters and terrorism events of a massive scale are difficult risks. They are difficult (or, if large enough, impossible) to insure, and they present enormous risk-management challenges. Indeed, we are now in an era when difficult risks are the dominant feature of the risk-management landscape. These kinds of risks are inevitably multi-jurisdictional in nature, and managing them effectively requires a cohesive, comprehensive national catastrophe policy involving ex ante prevention and mitigation measures, effective risk allocation through insurance mechanisms, and ex post victim-compensation strategies. Although our nation is not yet close to establishing a much-needed and increasingly discussed national catastrophe policy, most significant points in current risk management strategies involve significant federal coordination and control. In our judgment, it would be peculiar - and less effective - if ex ante risk-reduction and loss-mitigation strategies and ex post victim compensation programs were the province of the federal government, but risk allocation and distribution decisions that are made in insurance markets were left primarily to the regulatory authority of the states. In other words, we suggest that a regulatory model that defers to the states with respect to the regulation of the insurance aspects of difficult risks is no longer viable, and an enhanced federal role in insurance regulation specifically - and in risk management more generally - is both necessary and appropriate with respect to difficult risks

Regulating the Business of Insurance: Federalism in an Age of Difficult Risk

Although the United States has not established a much-needed and increasingly discussed national catastrophe policy, most significant points in current risk management strategies involve significant federal coordination and control. The authors suggest that a regulatory model that defers to the states with respect to the regulation of the insurance aspects of difficult risks is no longer viable, and an enhanced federal role in insurance regulation specifically -- and in risk management more generally -- is both necessary and appropriate with respect to difficult risks

Regulating the Business of Insurance: Federalism in an Age of Difficult Risk

Although the United States has not established a much-needed and increasingly discussed national catastrophe policy, most significant points in current risk management strategies involve significant federal coordination and control. The authors suggest that a regulatory model that defers to the states with respect to the regulation of the insurance aspects of difficult risks is no longer viable, and an enhanced federal role in insurance regulation specifically -- and in risk management more generally -- is both necessary and appropriate with respect to difficult risks

Daily Increment Formation in Otoliths of the Redspotted Sunfish

To generate reliable age information for fishes, we must assess the robustness of techniques to environmental variation. We quantified daily ring deposition within the sagittal otoliths of known-age larval and juvenile redspotted sunfish Lepomis miniatus reared in ponds. We also determined how daily light : dark cycles mimicking natural conditions, reduced daylight, or constant daylight affected ring deposition in fish housed in aquaria. Additionally, we quantified how constant temperature (26°C), low daily variability in temperature (26 ± 1°C), and high daily variability (26 ± 2°C) affected production of daily rings. In pond-reared fish, the first increment was produced by the evening of hatch, and increment deposition occurred with 24-h periodicity through 119 d. Independent age estimates from two readers closely agreed. Photocycle and temperature variation did not affect periodicity of increment formation or the precision and accuracy of age estimates. Age and growth data can be reliably determined in this species to assess recruitment dynamics and develop management and conservation strategies