Defining a developmental subtype of bipolar disorder in a sample of nonreferred adults by age at onset

Objective To test the hypothesis that the age at onset of bipolar disorder would identify a developmental subtype of bipolar disorder in adults characterized by increased levels of irritability, chronic course, rapid cycling, and comorbidity with attention deficit hyperactivity disorder. Methods Forty-four adult subjects diagnosed with bipolar disorder were selected from large family studies of youth with and without attention deficit hyperactivity disorder. These subjects were stratified by the age at onset in childhood (younger than 13 years; n = 8, 18%), adolescence (13–18 years; n = 12, 27%, or adulthood (older than 19 years; n = 24, 55%). All subjects were administered structure diagnostic interviews and a brief cognitive battery. Results In contrast with adult-onset bipolar disorder, child-onset bipolar disorder was associated with a longer duration of illness, more irritability than euphoria, a mixed presentation, a more chronic or rapid-cycling course, and increased comorbidity with childhood disruptive behavior disorders and anxiety disorders. Conclusion Stratification by age at onset of bipolar disorder identified subgroups of adult subjects with differing clinical correlates. This pattern of correlates is consistent with findings documented in children with pediatric bipolar disorder and supports the hypothesis that child-onset bipolar disorder may represent a developmental subtype of the disorder.

Determination of the effect of JO146, a CtHtrA inhibitor, on the chlamydial developmental cycle and persistence

The role of Chlamydia trachomatis HtrA (CtHtrA) for the growth and pathogenesis of this organism is presented. Inhibition of CtHtrA led to loss of infectious progeny in Chlamydia, particularly during heat stress or recovery from penicillin persistence. Isolation of CtHtrA inhibitor resistant mutants identified positive selection for mutants in fatty acid related pathways. Importantly, HtrA inhibition was effective against clinical isolates of C. trachomatis. Thus the findings combined indicate that CtHtrA is an important chlamydial growth factor that has the potential to be targeted for the development of anti-chlamydial drugs in the future.

Prevalence and developmental course of 'secret language'.

The prevalence and developmental course of supposed ‘secret language’ was examined in a cohort of twins and closely spaced singletons pairs, with systematic assessments at 20 months and again at 36 months. Two forms of apparent ‘secret language’ were examined: (1) shared understanding—speech directed generally but unintelligible to the parent, although apparently clearly understood within the child pair, and (2) private language directed exclusively to the other twin/sibling—not intelligible to the parent, but apparently clearly understood and used only within the child pair. Both occurred in singleton pairs, but the rate was much higher in twins. In most cases it seemed to be a developmental phenomenon occurring in the second year of life with the emergence of immature speech, and decreasing considerably over the next 16 months. A small group of children, primarily male twins, was reported to use a private language at 36 months. This group had poorer cognitive and language functioning, and was characterized by highly dependent relationships. Some aspects of the twins’ home environment were less stimulating and less responsive, most probably reflecting the abilities and relationships of the children. A follow-up of these children when they were ~6 years of age showed that language outcome was poor for the subgroup (n = 4) who did not develop normal language alongside the use of a private language.

A journey access tool to facilitate better health outcomes for people with disabilities

- Background One of the three objectives of the WHO Global Disability Action Plan 2014–2021 is removal of barriers and improved access to health services and programmes. Access to transport contributes to positive health outcomes; however, people with disabilities leaving their dwellings are confronted with barriers to their mobility. Mobility restrictions, sensory or other disabilities increase their vulnerability as road users, exposing them to higher risks of injury. PHSW and CARRS-Q have been collaborating with Handicap International Cambodia (HIC) on a Journey Access Tool (JAT). - Aims Use of the JAT is to (1) Identify transport and journey safety and barriers for people with disability and (2) Evaluation and modification of the tool after trailing to for use by NGOs and government agencies in prioritising actions around barriers. - Methodology The tool has undergone initial proof-of-concept testing in India and Viet Nam, and was trialled in Cambodia in February and May, 2015. Five teams were formed comprising a person with disability (physical, sensory or intellectual), researchers from QUT, staff from HIC, and local university students. The JAT was completed by each team and then discussed and evaluated. Two further Cambodian trials are scheduled for 2015. - Results The JAT is responsive to rural and urban contexts, and has utility for people with different disabilities. Two tools have been developed: a short version for people with a disability to complete independently, or with assistance; and a version for NGOs, DPOs and government. The tool has efficacy for advocacy.   - Conclusion The JAT has potential to assist the Mekong region with: (1) evaluating access for people with disability and other vulnerable members of the community including older people; (2) developing plans for changes to the routes in consultation with local authorities; (3) evaluating the effectiveness of implemented changes in terms of access and health; (4) inputting into policy; (5) The tool can be used for advocacy for change.

Developmental and physiological traits associated with high yield and stay-green phenotype in wheat

Water availability is a key limiting factor in wheat production in the northern grain belt of Australia. Varieties with improved adaptation to such conditions are actively sought. The CIMMYT wheat line SeriM82 has shown a significant yield advantage in multi-environment screening trials in this region. The objective of this study was to identify the physiological basis of the adaptive traits underpinning this advantage. Six detailed experiments were conducted to compare the growth, development, and yield of SeriM82 with that of the adapted cultivar, Hartog. The experiments were undertaken in field environments that represented the range of moisture availability conditions commonly encountered by winter crops grown on the deep Vertosol soils of this region. The yield of SeriM82 was 6-28% greater than that of Hartog, and SeriM82 exhibited a stay-green phenotype by maintaining green leaf area longer during the grain-filling period in all environments where yield was significantly greater than Hartog. However, where the availability of deep soil moisture was limited, SeriM82 failed to exhibit significantly greater yield or to express the stay-green phenotype. Thus, the stay-green phenotype was closely associated with the yield advantage of SeriM82. SeriM82 also exhibited higher mean grain mass than Hartog in all environments. It is suggested that small differences in water use before anthesis, or greater water extraction from depth after anthesis, could underlie the stay-green phenotype. The inability of SeriM82 to exhibit stay-green and higher yield where deep soil moisture was depleted indicates that extraction of deep soil moisture is important.

Temporal acuity in developmental dyslexia across the life span : Tactile, auditory, visual, and crossmodal estimations

Taustaa Kehityksellinen dysleksia (lukivaikeus) on erityinen lukemaan oppimisen vaikeus, johon liittyy usein myös vaikeuksia kirjoittamaan oppimisessa. Lukivaikeuden oletetaan useissa tapauksissa johtuvan vaikeudesta käsitellä kielen äännerakenteita (fonologinen prosessointi). Tämä poikkeavuus voi olla joko lukivaikeuden perimmäinen syy tai vaihtoehtoisesti ongelmat äänteiden käsittelyssä voivat heijastaa jotain vielä perustavamman tason vaikeutta. Eräs tällainen ehdotettu perustavan tasoin syy on poikkeavuus aistien toiminnoissa, erityisesti aistien aikatarkkuudessa. Aikatarkkuudella tarkoitetaan kykyä ja rajoja siinä, kuinka nopeasti esitettyä aistitiedon virtaa henkilö kykenee vastaanottamaan ja käsittelemään. Monet arjen toiminnot lukemisen rinnalla edellyttävät aistien erittäin tarkkaa ajallista erottelukykyä (esimerkiksi kuulo puheen ymmärtämisessä, tunto pintamateriaalin tunnistamisessa). Aikatarkkuusvaikeuksien esiintyvyyttä lukivaikeudessa on tutkittu aiemminkin, mutta yksimielisyyteen ei ole päästy siitä, onko kaikilla lukivaikeuksisilla näitä ongelmia tai mihin aisteihin vaikeudet mahdollisesti rajoittuvat. Myöskään ei tiedetä, havaitaanko aikatarkkuuden ongelmia kaiken ikäisillä lukivaikeuksisilla vai vaihteleeko mahdollinen ongelmien kuva iän mukana. Lisäksi on epäselvää, kuinka aikatarkkuuden ongelmat itseasiassa ovat yhteydessä kielen käsittelyn ja varsinaisen lukemisen vaikeuksiin. Tutkimussarjan aihe Tässä tutkimussarjassa aikatarkkuutta tutkittiin kolmessa yksittäisessä aistissa, joita olivat tunto, näkö ja kuulo, sekä kolmessa aistien välisessä yhdistelmässä, joita olivat audiotaktiilinen (kuulo-tunto), visuotaktiilinen (näkö-tunto) ja audiovisuaalinen (näkö-kuulo). Aikatarkkuutta arvioitiin kahdella eri menetelmällä, jotta saataisiin lisää tietoa siitä, missä tietyssä aikatarkkuuden osa-alueessa lukivaikeuksisilla mahdollisesti on vaikeuksia. Ensimmäisessä tehtävässä tutkittavan tuli arvioida, ovatko esitetyt ei-kielelliset ärsykkeet samanaikaisia vai eriaikaisia. Toisessa tehtävässä koehenkilön tuli arvioida esitettyjen ei-kielellisten ärsykkeiden esitysjärjestys. Molemmissa tehtävissä määriteltiin millisekuntitasolla (sekunnin tuhannesosa) se esitysnopeus, jolla koehenkilö kykeni arvioimaan ärsykkeiden ajalliset suhteet oikein. Englanninkielinen demonstraatio aikatarkkuustehtävistä löytyy internetistä (http://www.helsinki.fi/hum/ylpsy/neuropsy). Itse aikatarkkuustehtävien lisäksi tutkimussarjassa arvioitiin tutkimushenkilöiden päättelykykyä, kielellisiä toimintoja ja lukemista. Tutkimushenkilöt Tutkimuksiin osallistui 53 lukivaikeuksista ja 66 sujuvaa lukijaa, jotka oli jaettu kolmeen pääikäryhmään: lapset (8-12 vuotta), nuoret aikuiset (20-36 vuotta) ja ikääntyneemmät aikuiset (20-59 vuotta). Ikääntyneempien aikuisten ryhmä oli edelleen jaettu ikävuosikymmenluokkiin, mikä mahdollisti sen tutkimisen, vaikuttaako lisääntyvä aikuisikä lukivaikeuksisten aikatarkkuuteen (20-29, 30-39, 40-49 ja 50-59 -vuotiaat). Tutkimussarjan tulokset Aikatarkkuuden ongelmat lukivaikeuksisilla olivat yleistyneitä yli iän, aistien ja tehtävien Lukivaikeuksiset kaikissa pääikäryhmissä (lapset, nuoret aikuiset, ikääntyneemmän aikuiset) tarvitsivat samanikäisiä sujuvia lukijoita hitaamman esitystahdin, jotta he kykenivät arvioimaan ei-kielellisten ärsykkeiden ajallisen esitystavan oikein. Tämä aikatarkkuuden ongelma havaittiin lukivaikeuksisilla kaikissa aisteissa (tunto, kuulo, näkö) ja niiden yhdistelmissä (audiotaktiilinen, visuotaktiilinen, audiovisuaalinen). Lukivaikeuksisten aikatarkkuusongelmat ilmenivät edelleen molemmissa tehtävätyypeissä (samanaikaisuuden ja järjestyksen arvioinnissa). Aikatarkkuus ja sen ongelmat olivat yhteydessä äänteiden käsittelyyn Aikatarkkuus oli yhteydessä äänteiden käsittelykykyyn (fonologiseen prosessointiin), niin lapsilla kuin aikuisillakin, kaikissa aisteissa, niiden yhdistelmissä ja tehtävätyypeissä. Yhteys ei-kielellisen aikatarkkuuden ja kielellisten toimintojen välillä oli kuitenkin selkeämpi lukivaikeuksisilla kuin sujuvilla lukijoilla. Tämä tarkoittaa, että etenkin lukivaikeuksisilla ryhmätason huono aikatarkkuus oli yhteydessä huonoon äänteiden käsittelyyn (fonologiseen prosessointiin) ja päinvastoin. Suoraa yhteyttä lukemisen ja aikatarkkuuden välillä ei kuitenkaan havaittu. Lisääntyvä aikuisikä heikensi lukivaikeuksisten aikatarkkuutta suhteettoman paljon Tiedonkäsittelyn nopeuden on toistuvasti osoitettu hidastuvan normaalissa ikääntymisessä. Lisääntyvä aikuisikä (20-59 -vuotiailla) heikensikin sekä sujuvien että lukivaikeuksisten aikatarkkuutta. Toisin sanoen, mitä iäkkäämmästä aikuisesta oli kysymys, sitä hitaammin hänelle tuli esittää ärsykkeet, jotta hän kykeni arvioimaan niiden ajalliset suhteet oikein. Tämä ikään liittyvä tavanomainen hidastuminen oli kuitenkin yllättäen suhteettoman nopeaa lukivaikeuksisilla. Toisin sanoen, jo nuorilla lukivaikeuksisilla havaittu aikatarkkuuden vaikeus (ryhmäero verrattuna sujuviin lukijoihin) ei pysynyt saman suuruisena, vaan ryhmien ero kasvoi aikuisiän lisääntyessä. Tulosten merkitys Lukivaikeuden osoitettiin tässä tutkimussarjassa olevan yhteydessä yleistyneeseen vaikeuteen käsitellä ajassa nopeasti muuttuvaa ei-kielellistä aistitietoa (yli aistien ja niiden yhdistelmien, tehtävätyyppien, tutkittavien iän). Tämä osoittaa, että lukivaikeus ei ole ongelma, joka rajoittuu vain kielellisen materiaalin käsittelyn vaikeuksiin (äänteiden käsittely, lukeminen, kirjoittaminen). Nyt havaitut vaikeudet eivät myöskään rajoittuneet vain niihin aisteihin, jotka selkeimmin liittyvät lukemiseen (näkö) ja puhuttuun kieleen (kuulo); Ongelmia esiintyi myös muissa aisteissa (tunto). Lukivaikeuksisten lukijoiden ryhmätasolla havaittu aikatarkkuuden ongelma ei kuitenkaan heijastunut yksilötasolle; Jokainen lukivaikeuksinen ei ollut huono aikatarkkuustehtävissä. Näin ollen ei siis voida väittää, että kaikkien lukivaikeuksisten äänteiden käsittelyn tai lukemaan oppimisen vaikeudet voisivat selittyä aistien toimintojen poikkeavuudella. Aikatarkkuuden ongelmat eivät olleet yhteydessä varsinaiseen lukemiseen. Sekä lukivaikeuksisilla lapsilla että aikuisilla todettiin kuitenkin selkeä yhteys aikatarkkuuden ongelmien ja lukemaan oppimisen keskeisen ennakkoehdon, fonologisen prosessoinnin, välillä. Saattaa siis olla, että synnynnäinen aistien toimintojen poikkeavuus vaikuttaa yksilön suoriutumiseen jo ennen varsinaista lukemaan oppimista, kun ne taidot kehittyvät (fonologinen prosessointi), joille myöhempi lukemaan oppiminen perustuu. Ikäännyttäessä havaittu lukivaikeuksisten suhteettoman nopea aikatarkkuuden heikkeneminen osoittaa, että lukivaikeus ei voi olla ongelma, joka koskee vain lapsuusikää, tai vaikeus, joka johtuu vain kehityksen viivästymästä joka kurottaisiin iän myötä umpeen. Tulosten ymmärtämiseksi onkin muistettava kaksi seikkaa. Lukivaikeus on ensinnäkin yhdistetty synnynnäisiin, pieniin, poikkeavuuksiin aivojen rakenteissa ja toiminnoissa. Toisaalta tavanomaiseen ikääntymiseen liittyy se, että aivot kykenevät yhä huonommin korjaamaan ja kiertämään (kompensoimaan) pieniä vaurioita. Tämän perusteella tutkimussarjan tuloksista voidaan päätellä, että lukivaikeuksisten jo synnynnäisesti heikentyneet aivojen kompensointimahdollisuudet eivät ole yhtä tehokkaita puskuroimaan ikääntymisen tavanomaisia vaikutuksia kuin sujuvilla lukijoilla. Yllättävää kuitenkin on, että tämä korostunut heikkeneminen havaittiin jo suhteellisen nuorilla, työikäisillä, lukivaikeuksisilla, ennen 60 ikävuotta. Samanlaista ikäännyttäessä korostuvaa vaikeutta ei lukivaikeuksilla kuitenkaan havaittu päättelyssä, kielellisissä toiminnoissa tai itse lukemisessa. Vaikuttaakin siis siltä, että ne toiminnot, joita on harjaannutettu aktiivisesti, eivät heikkene kasvavan aikuisiän myötä yhtä suhteettomasti. Alkuperäiset artikkelit Laasonen M, Tomma-Halme J, Lahti-Nuuttila P, Service E, and Virsu V (2000) Rate of information segregation in developmentally dyslexic children, Brain and Language, 75(1), 66-81. Laasonen M, Service E, and Virsu V (2001) Temporal order and processing acuity of visual, auditory, and tactile perception in developmentally dyslexic young adults, Cognitive, Affective, and Behavioral Neuroscience, 1(4), 394-410. Laasonen M, Service E, and Virsu V (2002) Crossmodal temporal order and processing acuity in developmentally dyslexic young adults, Brain and Language, 80(3), 340-354. Laasonen M, Lahti-Nuuttila P, and Virsu V (2002) Developmentally impaired processing speed decreases more than normally with age, NeuroReport, 13(9), 1111-1113.

The Eligibility Definition Used in the Social Security Administration’s Disability Programs Needs to be Changed

In its October 2003 report on the definition of disability used by the Social Security Administration’s (SSA’s) disability programs [i.e., Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for people with disabilities], the Social Security Advisory Board raises the issue of whether this definition is at odds with the concept of disability embodied in the Americans with Disabilities Act (ADA) and, more importantly, with the aspirations of people with disabilities to be full participants in mainstream social activities and lead fulfilling, productive lives. The Board declares that “the Nation must face up to the contradictions created by the existing definition of disability.” I wholeheartedly agree. Further, I have concluded that we have to make fundamental, conceptual changes to both how we define eligibility for economic security benefits, and how we provide those benefits, if we are ever to fulfill the promise of the ADA. To convince you of that proposition, I will begin by relating a number of facts that paint a very bleak picture – a picture of deterioration in the economic security of the population that the disability programs are intended to serve; a picture of programs that purport to provide economic security, but are themselves financially insecure and subject to cycles of expansion and cuts that undermine their purpose; a picture of programs that are facing their biggest expenditure crisis ever; and a picture of an eligibility determination process that is inefficient and inequitable -- one that rations benefits by imposing high application costs on applicants in an arbitrary fashion. I will then argue that the fundamental reason for this bleak picture is the conceptual definition of eligibility that these programs use – one rooted in a disability paradigm that social scientists, people with disabilities, and, to a substantial extent, the public have rejected as being flawed, most emphatically through the passage of the ADA. Current law requires eligibility rules to be based on the premise that disability is medically determinable. That’s wrong because, as the ADA recognizes, a person’s environment matters. I will further argue that programs relying on this eligibility definition must inevitably: reward people if they do not try to help themselves, but not if they do; push the people they serve out of society’s mainstream, fostering a culture of isolation and dependency; relegate many to a lifetime of poverty; and undermine their promise of economic security because of the periodic “reforms” that are necessary to maintain taxpayer support. I conclude by pointing out that to change the conceptual definition for program eligibility, we also must change our whole approach to providing for the economic security of people with disabilities. We need to replace our current “caretaker” approach with one that emphasizes helping people with disabilities help themselves. I will briefly describe features that such a program might require, and point out the most significant challenges we would face in making the transition.

Policy and Practice Brief: Representative Payment

This brief provides an overview of the Representative Payee program administered by Social Security. Discussed are the many provisions of the programs as well as practice tips and implications for BPA&O and PABSS personnel.

Universal Access-NY User’s Guide

What is Universal Access-NY? Universal Access-NY is a complete online planning toolkit, www.UniversalAccessNY.org, where a One-Stop Delivery System can assess its practices, and develop work plans to improve physical and programmatic accessibility for all One-Stop customers. This web site and manual was developed by Cornell University’s Employment and Disability Institute, through the support and guidance of the New York State Department of Labor, with funding from two U.S. Department of Labor Work Incentive Grants (WIG 1 and 2). This web site was designed for use in a collaborative manner, bringing together One-Stop personnel, agency partners, business leaders and customers with disabilities. Universal Access-NY supports continuous improvement, with features that encourage multiple uses and incremental systems change.

Developmental origins of psychological vulnerability factors for mental disorders

Premature birth and associated small body size are known to affect health over the life course. Moreover, compelling evidence suggests that birth size throughout its whole range of variation is inversely associated with risk for cardiovascular disease and type 2 diabetes in subsequent life. To explain these findings, the Developmental Origins of Health and Disease (DOHaD) model has been introduced. Within this framework, restricted physical growth is, to a large extent, considered either a product of harmful environmental influences, such as suboptimal nutrition and alterations in the foetal hormonal milieu, or an adaptive reaction to the environment. Whether inverse associations exist between body size at birth and psychological vulnerability factors for mental disorders is poorly known. Thus, the aim of this thesis was to study in three large prospective cohorts whether prenatal and postnatal physical growth, across the whole range of variation, is associated with subsequent temperament/personality traits and psychological symptoms that are considered vulnerability factors for mental disorders. Weight and length at birth in full term infants showed quadratic associations with the temperamental trait of harm avoidance (Study I). The highest scores were characteristic of the smallest individuals, followed by the heaviest/longest. Linear associations between birth size and psychological outcomes were found such that lower weight and thinness at birth predicted more pronounced trait anxiety in late adulthood (Study II); lower birth weight, placental size, and head circumference at 12 months predicted a more pronounced positive schitzotypal trait in women (Study III); and thinness and smaller head circumference at birth associated with symptoms of attention-deficit hyperactivity disorder (ADHD) in children who were born at term (Study IV). These associations occured across the whole variation in birth size and after adjusting for several confounders. With respect to growth after birth, individuals with high trait anxiety scores in late adulthood were lighter in weight and thinner in infancy, and gained weight more rapidly between 7 and 11 years of age, but weighed less and were shorter in late adulthood in relation to weight and height measured at 11 years of age (Study II). These results suggest that a suboptimal prenatal environment reflected in smaller birth size may affect a variety of psychological vulnerability factors for mental disorders, such as the temperamental trait of harm avoidance, trait anxiety, schizotypal traits, and symptoms of ADHD. The smaller the birth size across the whole range of variation, the more pronounced were these psychological vulnerability factors. Moreover, some of these outcomes, such as trait anxiety, were also predicted by patterns of growth after birth. The findings are concordant with the DOHaD model, and emphasise the importance of prenatal factors in the aetiology of not only mental disorders but also their psychological vulnerability factors.

When are SSDI/SSI Benefits Paid Pending Appeal?

This Just the Facts Series details when SSDI/SSI benefits are paid pending appeal.

Implications of the Information Technology Revolution for People with Disabilities

The paper focuses on opportunities for the integration of persons with different types of disabilities in the information technology (IT) labour market. Recent IT developments are identified and examined for their potentially harmful or beneficial effects on access to the IT labour market for persons with disabilities. The opportunities created by new job creation, new forms of training, teleworking, and the role of assistive technologies in facilitating workplace accommodations are briefly described. The focus is on new options for the design and implementation of computer-related assistive technologies in the workplace, and the impact of teleworking and the World Wide Web on employability and work-related training of persons with disabilities. The paper closes with a brief discussion of the roles that government agencies, business firms, labour unions, non-governmental organisations and education can play to help people with disabilities join the IT revolution and share its benefits.

Promising Practices: Ensuring Choice Under the Ticket to Work Program - The Indiana PABSS Approach

The Ticket to Work program offered disabled and blind social security beneficiaries the promise of greater choice when selecting a vocational rehabilitation provider. With the issuance of Transmittal #17, much of the opportunity to choose a provider was removed. The Protection and Advocacy agency in Indiana took steps to protect the rights of disabled and blind beneficiaries to choose providers in the face of this significant policy change. Learn what was done to protect the rights and ability of beneficiaries to seek and choose vocational rehabilitation providers.

The Benefits Planner: Improved Work Incentives in Social Security Disability Insurance Program - Changes Will Make Work More Attractive to SSDI Recipients

This newsletter will provide valuable information on how work for persons with disabilities effects government benefits, with an emphasis on the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) work incentives. Each newsletter will contribute to an ongoing dialogue on topics related to benefits and work.

Developing Strategic Marketing Plan

This publication is first in a series targeted for Coordinators and Managers within Benefits Planning, Assistance and Outreach Programs concerned with developing continuous quality improvement approaches. This early publication focuses on understanding strategies for market position, strategic planning and provides a tool for conducting an organizational self-assessment along with a stakeholder analysis