Accommodations Knowledge and Practice for Students With Visual Impairments

Introduction Classroom accommodations are a primary means of supporting the appropriate education for students with disabilities. Student involvement in the accommodation process is valuable. Therefore, we need to teach students to be knowledgeable and strategic regarding their accommodations. Methods Four high school students with visual impairments were taught the Student Self-Accommodation Strategy (SSA). A comparative case studies approach within a sequential explanatory design was used to investigate their accommodations knowledge and practices. Results Participants improved or maintained accommodations knowledge. Their most-used types of accommodations were access accommodations and accommodations for content support. Three of the participants increased advocacy after strategy instruction. The participants’ accommodation practices were influenced by emotional-behavioral regulation, independence, and teacher involvement. Discussion Findings from this study relate to existing literature on accommodations support, teacher involvement in the accommodations process, instruction in accommodations advocacy, and the relationship between accommodations and emotional-behavioral dysregulation. Implications Findings emphasize the need to be explicit about the accommodations available to students with visual impairments and the need for strategy instruction in the SSA to address emotional-behavioral dysregulation.

Changes in cognitive and behavioral control after lamotrigine and intensive dialectical behavioral therapy for severe, multi-impulsive bulimia nervosa: an fMRI case study

Purpose Adults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine. Methods Go/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment. Results After lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use. Conclusion Improved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment. Level of Evidence IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Valproate Induced Behavioral Dysregulation in an Adolescent with Intellectual Disability: A Case Report

A 14-year-old with mild intellectual disability and autism spectrum disorder was admitted to a long-term psychiatric hospital with complaints of treatment resistant aggressive behavior. Her psychopharmacologic regime was Depakote 1500mg, Intuniv XR 2mg twice daily, and Inderal 10 mg thrice daily, for her mood and behavior symptoms, and prn Ativan and Benadryl for acute episodes of agitation. Despite multiple medication trials, she was continued on Depakote for seven months prior to her admission to long term care. During the first month in long term care, she had over 20 emergency interventions due to physical aggression. She was also witnessed to exhibit abnormal behavior and self-harm during this time. There were concerns that Depakote may be contributing to her dysregulated behavior, thus the medication was slowly down-titrated while her other scheduled medications and dosages remained the same. The patient started to require fewer emergency interventions with noted improvement in her behavior. After the complete termination of Depakote, clinical observations were remarkable for mitigation of aggressive and abnormal behavior as evidenced by the patient going six weeks without any emergency intervention. Behavioral dysregulation is a possible adverse effect of valproate. Individuals with intellectual disabilities are most vulnerable to polypharmacy for management of aggression, behavioral problems, and other psychiatric comorbidities. There is a need for pharmacovigilance on the negative behavioral effects in patients receiving valproate.

Traumatic brain injury and mood disorders

Traumatic brain injury is an increasing cause of morbidity worldwide. Neuropsychiatric impairments, such as behavioral dysregulation and depression, have significant impacts on recovery, functional outcomes, and quality of life of patients with traumatic brain injuries. Three patient cases, existing literature, and expert opinion are used to select pharmacotherapy for the treatment of target symptoms while balancing safety and tolerability.