COVID-19: IMPLICATIONS FOR CHILDREN WITH SPECIAL NEEDS

The struggles faced by children with special needs during the COVID-19 pandemic are diverse, including higher risk of SARS-CoV-2 infection, restricted access to health-care facilities, limited capability to practice preventive measures along with increased rehabilitation needs due to interruption of schooling and education programmes. The concerns of these children and their caregivers should be resolved with appropriate solutions in order to accomplish an inclusive healthcare response to the global pandemic

EXPERIENCES OF FAMILY CAREGIVERS OF INDIVIDUALS WITH ID AND DEMENTIA

Introduction: Dementia poses a number of impairments in cognitive functioning impacting everyday operational tasks and functions. Individuals with intellectual disability (ID) may experience dementia earlier and at a greater rate than the general population. Dementia can pose complex challenges for individuals with ID and their caregivers. Aim: A qualitative phenomenological study was used to examine the lived experiences of caregivers of individuals diagnosed with both ID and dementia. Method: Individual interviews were conducted among six participants, who were all family caregivers of individuals diagnosed with both ID and dementia. Results: Based on the results from the content analysis of interview responses, four themes emerged: (a) difficulty getting a dementia diagnosis, (b) barriers to obtaining services, (c) caregiving realities and challenges, and (d) rewards of caregiving. Implications for Practice: To support caregivers, practitioners should be adequately trained on this dual diagnosis to assess the support needs in helping caregivers obtain adequate services. Conclusion: As individuals with ID continue to live longer and age, many will experience dementia. Caregivers of individuals with ID and dementia are often an overlooked, vulnerable population. Practitioners should be aware of their needs in order to provide adequate support to this caregiving population and individuals with ID and dementia

Predictors of Aggressive Behaviour in Children with Autism Spectrum Disorder

Introduction: Aggressive behaviour is not the main symptom of autism spectrum disorders, and if it occurs in this population, it is a consequence of some other factors. Objectives: With regard to that, the aim of this paper is to determine to what extent certain aspects of executive functions, severity of autism, sleep habits, and parenting actions contribute to the manifestation of different forms of aggressive behaviour in children with an autism spectrum disorder. Methods: The sample included 40 children with autism spectrum disorders, 5-7 years of age (M=6.18, SD= .55). The following instruments were used in the assessment: The Children’s Scale of Hostility and Aggression – Reactive/Proactive, Gilliam Autism Rating Scale – Third Edition, The Children’s Sleep Habits Questionnaire and Behavior Rating Inventory of Executive Function. Results: The obtained results showed that sleep problems were the most significant predictor of verbal, physical and covert aggression. From the domain of behavioural aspects of executive functions, only task monitor was a significant predictor of bullying, and inhibit and shift were significant predictors of hostility. From the field of autistic disorders, significant predictors of aggressive behaviour were emotional responses (as predictors of bullying, covert aggression and hostility), and maladaptive speech (as a predictor of verbal aggression, covert aggression and hostility). Punitive discipline was a significant factor only in explaining verbal aggression. Conclusion: Practical implications of this research indicate that, in treating aggressive behaviour in children with ASD, more attention should be paid to sleep habits, practising task monitor, inhibit and shift skills, and avoiding rigorous punitive measures

Overview of Evidence-Based Treatment of Stuttering in Bulgaria and in the USA and Canada

Introduction: The move towards evidence-based practice (EBP) requires speech-language pathologists (logopedists) to understand the types of studies that build an evidence base for the field as well as the standards for assessing the quality of evidence. Objectives: This article discusses the conceptual and methodological issues associated with EBP in Bulgaria, the USA, and Canada related to clinical stuttering intervention. This article discusses how the movement towards the current high-level standards of practice established in North America may challenge some of the traditional Bulgarian beliefs regarding stuttering treatment. Method: Theoretical overview and analysis of the existing literature data sources including systematic meta-analysis articles on EBP on stuttering. Results: The study outlines the steps of EBP accepted in SLP. Thirteen systematic reviews and meta-analyses are discussed concerning the application of research evidence to clinical decision making. These issues remain problematic for Bulgarian logopedists who received their training before or during the recent professional shift from a special education subspecialty to a health profession specialty as represented by speech-language pathology (SLP). Conclusions: The professional bodies that govern clinical practice in the Bulgarian health fields are not currently guided by EBP concepts. In Bulgaria, there is no evidence-based framework for the prevention, diagnosis, and treatment of stuttering as there is in the USA and Canada. In Bulgaria EBP stands as a fundamental way to promote changes appropriate for SLP as a health profession

PSYCHOLOGICAL ASPECTS OF AUTISM SPECTRUM DISORDER

Introduction: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that occurs within the first 3 years of life, which is characterised by poor social skills, communication problems and stereotyped patterns of behaviour. Autism is a life-long disorder that has a substantial effect on the individual, their family, and society. The purpose of this paper is to provide an overview about the psychosocial aspects of autism spectrum disorders. Methods: An analysis of relevant literature, sources from the internet and published literature, personal experience and observations of the author. Findings: Despite widespread research and greater public awareness, ASD has an unclear etiology and no known cure, making it difficult to acquire an accurate and timely diagnosis. Psychologic functions such as attention, executive function, academic functioning, memory, emotions, and sensory processing are described. There is a need for continuous psycho-social support for people with ASD and their relatives during the diagnostics and early intervention period, as well as resources that better represent the diversity of experiences and symptoms associated with ASD across the lifespan. Conclusion: It is clear that more special education services are needed, together with timely and ongoing psychosocial support to parents of children with ASD

Positive Psychology Couple Schema Therapy: A new model of couple therapy focusing on reigniting couple attraction via schema therapy and positive psychology

Introduction: There is growing evidence indicating schema modes influences emotional and behavioural response in couple interaction which affects relationship satisfaction. Thus, identifying dominant schema modes is important for effective couple therapy. Objective: A two-stage positive psychology couple schema therapy, which takes into account the influences of schema and schema modes on couple attraction and dysfunctional conflict resolution style in couples, is proposed. Method: This article describes a case study applying positive psychology couple schema therapy. The first stage of this couple therapy involves identifying the schema mode of each partner, rescript significant childhood experiences, helping each partner to meet the unmet childhood needs and strengthening healthy adult mode. The second stage of the therapy incorporates positive psychology and collaborative therapy to help couples identify and support each other’s positive interests, values and dreams, thus enhancing couple attraction and relationship. Conclusion: Positive psychology couple schema therapy was able to help couples heal childhood unmet needs and reinforce couple attraction

Treatment of insomnia in elderly patients

Introduction: Insomnia is one of the most common health conditions amongst the elderly population. It causes suffering and numerous health problems for those affected. Objectives: To review published results of common non-pharmacological and pharmacological interventions of insomnia and to discuss their application in older patient groups. Methods: We conducted a systematic literature review for the topic non-pharmacological treatment of Insomnia in Elderly and non-systematic review on the topic of pharmacological treatment using the electronic databases PubMed, PsycInfo, Google Scholar and Web of Knowledge. Only published articles and reviews were included. Results: Sleep education can support the onset of sleep. As a simple and side-effect-free measure, sleep education should be offered to all elderly individuals with sleep-onset insomnia including those living in retirement homes. Stimulus control means that the bed or the bedroom should only be visited, if there is sufficient tiredness, or left, when tiredness is not sufficient, which is very challenging and sometimes impossible due to the decreasing mobility of the elderly, especially under treatment with hypnotics. Sleep restriction can be conducted in a moderate way, reducing the time spent in bed every week for 30 minutes. Light therapy supports the regulation of the circadian body rhythm by exposing the patients to bright artificial light during the day. As a simple measure with only a few side effects, it is suitable when treating elderly individuals in institutions. Digital therapies are an emerging trend in the treatment of sleep disorders and require further empirical investigation of their effectiveness in the treatment of insomnia in the elderly. Non-pharmacological therapy should be the first-line therapy according to guidelines. Prescribing of sleep medication should take into account the period of time until the maximum effective level is reached, the half-life of the preparation, the binding behaviour to receptors and the metabolism of the preparation, which is especially relevant for elderly populations due to polypharmacy. Conclusion and implications: A modified, short cognitive behavioural therapy for insomnia combined with light therapy is the treatment of choice for elderly patients. However, a short-term pharmacological therapy is recommended as a temporary solution to immediately reduce high levels of distress. It is suggested to integrate both therapeutic approaches into a comprehensive therapeutic concept for insomnia in elderly people. Key words: Insomnia, cognitive behavioural therapy for insomnia, CBT-I, Hypnotics, light therapy, elderl

Immune, Autonomic, and Endocrine Dysregulation in Autism and Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorders Versus Unaffected Controls

Background: A growing body of literature suggests etiological overlap between Ehlers-Danlos syndrome (EDS)/hypermobility spectrum disorders (HSD) and some cases of autism, although this relationship is poorly delineated. In addition, immune, autonomic, and endocrine dysregulation are reported in both conditions and may be relevant to their respective etiologies. Aims: To study symptom overlap in these two comorbid spectrum conditions. Methods and Procedures: We surveyed 702 adults aged 25+ years on a variety of EDS/HSD-related health topics, comparing individuals with EDS/HSD, autism, and unaffected controls. Outcomes and Results: The autism group reported similar though less severe symptomology as the EDS/HSD group, especially in areas of immune/autonomic/endocrine dysregulation, connective tissue abnormalities (i.e., skin, bruising/bleeding), and chronic pain. EDS/HSD mothers with autistic children reported more immune symptoms than EDS/HSD mothers without, suggesting the maternal immune system could play a heritable role in these conditions (p = 0.0119). Conclusions and Implications: These data suggest that EDS/HSD and autism share aspects of immune/autonomic/endocrine dysregulation, pain, and some tissue fragility, which is typically more severe in the former. This overlap, as well as documented comorbidity, suggests some forms of autism may be hereditary connective tissue disorders (HCTD)

Advances in the understanding of cellular pathogenesis associated with Autism Spectrum Disorder

Autism Spectrum Disorders (ASD) are a group of heterogeneous neurodevelopmental disorders with an estimated worldwide prevalence of 1-2%. Although it is highly heritable, the contribution of environmental factors and risk associated genes on the aberrant brain development is not well understood.In this review, we summarise some of the key risk factors and explore ASD associated cellular pathology from the perspective of the four predominant cells in the brain; neurons, oligodendrocytes, microglia and astrocytes. Further, we discuss the contributions of the associated cellular pathology to the three common hypotheses of ASD.We highlight the major neuro-pathologies underlying ASD, however more research is needed to ensure appropriate and efficient therapies can be directed towards ASD

DISSOCIATIVE PHENOMENOLOGY AND GENERAL HEALTH IN NORMAL POPULATION

Background: Dissociative symptoms are most commonly found in females and adolescents, and when discussing their background, they can be from lower socio-economic backgrounds and rural areas. They are always preceded by psychosocial stressors. Dissociative disorders previously known as “hysteria” have been described since antiquity and Hippocrates even hypothesised “wandering uterus” to be the cause for dissociation in females. With the advances in science, there has been shift from these religious and spiritual concepts to a scientific basis for dissociation. Aim: To assess the dissociative phenomenology in normal population and to assess the subjective health in normal population. Methods: A group of 100 (50 females & 50 males) were selected from the community using a snowball sampling technique. Tools: Socio-demographic data sheet, General Health Questionnaire-12 and Dissociative Experience Scale-II were used. Results: The study found that females differ from males in the reporting of subjective health rating (X2=5.76, p=0.01) and similar results shown in terms of dissociative phenomenology (X2=67.76, p=0.001). Discussion: It has been found that only 4% from the female group and 2% from the male group rated their health under the “normal” category. 52% of females and 64% of males were categorised under “mild ill health” and 24% to 26% were in “moderate ill health”, whereas 20% of female participants and 8% of male participants rated their health as “severely ill”. In another domain of the study, dissociative phenomenology, 32% of female participants reported severe dissociative symptoms and 38% of male participants also showed similar results. Conclusion: Dissociative disorder significantly affects the population but it is hard to diagnose due to factors such as; cultural factors, socio-economic factors etc. The study shows clearly that dissociative symptoms are found in the general population also