**About the Editors**

#### **Jes ´us-Mar´ıa Garc´ıa-Mart´ınez**

Jesus-Mar ´ ´ıa Garc´ıa-Mart´ınez holds a Ph.D. in Chemistry (Chemical Engineering) from Universidad Complutense de Madrid (1995), two M.Sc. level degrees, and has received more than 70 highly specialized courses. He is a Tenured Scientist at the Institute of Polymer Science and Technology (ICTP) of the Spanish National Research Council (CSIC). Since 1992, within the Polymer Engineering Group (GIP), he has co-authored more than 180 scientific and/or technical works in topics related to polymer engineering, chemical modification of polymers, heterogeneous materials based on polymers, interphases, and interfaces, polymer composites, polyblends and alloys, organic–inorganic hybrids materials, polymer recycling, quality, and so on. Furthermore, he has participated in more than 32 research and industrial projects (national and international programs) and is co-author of one currently active industrial patent on polymer recycling. From 2000 to 2005, he also assumed the position of Quality Director for the ICTP (CSIC) ISO 17025 Accreditation Project of the ICTP Laboratories. Additionally, Dr. Garc´ıa-Mart´ınez is actively reviewing tasks for WOS, and SCOPUS-indexed journals, with more than 370 reports in the last years, being awarded twice with the Publons Reviewer Awards (2018 2019) and once with the POLYMERS Outstanding Reviewer Award (2019). Editor of more than 60 papers, he has been a guest Editor for many special issues in Q1 journals. Since 2016, he has served as Head of the Department of Chemistry and Properties of Polymer Materials within the ICTP (CSIC).

#### **Emilia P. Collar**

Ph.D. in Industrial Chemistry (U. Complutense, 1986). Since 1990 she has been permanent member of staff (Tenured Scientist) at the Consejo Superior de Investigaciones Cient´ıficas (CSIC), after two years (1986–1988) as CSIC's postdoc fellow and one (1989) as Chemical Engineering Assistant Teacher at the Universidad Complutense de Madrid. In the Polymer Science and Technology Institute (ICTP/CSIC), she works at the Polymer Engineering Group (GIP), founded in 1982 by Prof. O. Laguna, being the GIP's Head since 1999. Between 1990 and 2005, she supervised 6 doctoral theses and 5 post-graduate ones, under 14 research public funds projects, jointly to 18 research private funded contracts issuing 53 technical reports for different companies. Furthermore, from 2001 to 2005, she performed the positions of Technical Director of the Physical and Mechanical Properties Laboratory and Deputy-Technical Director of the Thermal Properties Laboratory under the successful ISO 17025 Accreditation Project for the CSIC/ICTP's Laboratories, ACiTP, commanded by the ICTP's Head. Author and co-author of more than 20 chapters on books, two currently active industrial patents on polymer recycling, and more than 150 papers mainly on SCI Journals, her research work lines deal with polymers and environment under the general frame of heterogeneous materials based on polymers. From 2006 to date, she has participated in three public Spanish-funded research projects and one EU project under its 7th Framework Program.


**13. Results**

Exercises 1–4, in their individual and combined applications, yielded the following results for the four conditions underlined by Torrance [35] and developed in contexts of schoolchildren in Mexico by Ramirez and colleagues [45], and also for investigative paradigm among primary school children in Chile by Lubart [38]; Lopéz and Navarro [23] indicate a *p*-value < 0.01 for general creativity for a comparative analysis of experiment and control groups in these categories.

Through Tables 1 and 2 we can observe the evolution of results before and after the program of nine activities for creative development. Through the evolution of means and standard deviations, the impact of the imaginative strategies in the narrative and the reflected drawing is observed in the context of a significant increase in the score in the experimental group.

**Table 1.** Mean and standard deviation calculated on EXCEL for pre-test variables of creativity for the individual components suggested in the literature following Torrance (1966).

**Table 2.** Standard deviation in post-test variables for individual Torrance components of narrative and graphic creativity for individually tested experimental and control groups.

Table 3 shows results of inferential analysis obtained from the differences following interventions related to each one of the variables, namely of verbal and figurative creativity. In the first column, the mean change score is presented; in the second, standard deviation; while in the third column, the significance of this difference is presented. In the follow-up test, the test scores of the TCTT and the PIC-J are not comparable to each other at intra-group level because they are measured on different scales of measurement. For this reason, only the differences observed at the intergroup level are analyzed (Table 3).

**Table 3.** Mean, standard deviation, and ANOVA results of intergroup differences in the creativity of the follow-up test (*PIC-N*).

Note: \*\*\* *p* < 0.001. \*\* *p* < 0.01 \* *p* < 0.05.

The results obtained from the narrative and graphic creativity in the monitoring test at the nomothetic level show significant differences between the EG and the GC in most of the creativity variables (Table 3). Specifically, the development of GE creativity is significantly greater than that of CG in narrative flexibility, special details and graphic creativity (*p* < 0.001); in the elaboration, the narrative creativity, the graphic creativity and in the general creativity (*p* < 0.01) and; in graphic originality (*p* < 0.05). The development of narrative fluency and the title of the GE is greater than that of the CG, but the difference between one and the other is not significant (*p* > 0.05).

A comparison of means was carried out using the Student's *t*-statistic, in order to evaluate the level of significance achieved after applying the strategies to the control group. Similarly, Pearson correlation and linear regression between each indicator were established, and the overall result for creative imagination of the experimental group was determined to verify the degree of association between them. For this analysis, we used the statistical program SPSS for Windows. The following graphs show the results according to the following criteria. In the X axis, there are six ranges that contain the direct scores distributed in intervals: Where the range of the number of is greater, the greater the score. The Y-axis represents the relative frequencies, which indicate the percentages of the absolute frequencies of subjects grouped in each interval. Subsequently, the level of significance of the totals in both groups are analyzed with the Student's T, which is established from the midpoint of the six intervals, in which the direct scores obtained by the subjects are distributed. Finally, we establish the Pearson correlation in the experimental group between the indicators of the narrative and graphic creativity in front of the general creativity as evidence of influence. The following is a summary of the results of the open research.

In Figure 1, the narrative creativity dimension, results were obtained in the first four ranks for the control group, with a higher percentage in the third. In the experimental group, however, no results appear in the first column, and show an increase in the fourth column, reaching maximum representation in the last one. This points to an increase in scores for the experimental group as opposed to the control.

**Figure 1.** Narrative Creativity.

As shown in Figure 2, in the context of graphic or image-based creativity, the experimental group achieved its highest performance in the third range, followed by in the fourth one where its highest percentages are noted. This, as well as what we see is the fact that it obtained high percentages in the last two columns, unlike as in the control group, shows its highest percentages in the first three columns, standing out in the second, and without showing results in the last two.

**Figure 2.** Graphic creativity (post-test).

As for general creativity (Figure 3), the control group scored in the first three ranges with their highest score in the third, unlike the experimental group that showed results from the second to the sixth range, but with the exception of the fifth.

**Figure 3.** General creativity post-test.

As observed, the correlation is significant at the 0.01 level between the narrative dimension of the test and that of overall or general creative imagination. This result is explained by the fact that the strategies designed have a high component of activities related to narrative representation: Seven activities out of nine focus on narrative creativity. This means that the component that had the highest incidence in relation to the PIC test was narrative creativity. It seems that narrative creativity has a high correlation with fluidity, flexibility, and narrative originality (see Table 4).

 *p* <

 *p* <

 *p* <

**Table 4.** Correlation Creativity Narrative to General Creativity.

Unlike the previous result, the graphic dimension does not have a high correlation with a general creative imagination scale (Table 5). The results suggest that graphic originality and graphic design do not correlate more closely with total overall creativity (Appendix A). This means that the items of the PIC test, as well as the strategies employed, support the changes of creativity in terms of narrative rather than graphic creativity activity. However, as suggested in the discussion, the experiment demonstrates evidence of the importance of writing and narrative in general creative imagination.

**Table 5.** Correlation of graphic creativity to general creativity.

### **14. Post Test Qualitative Assessment**

It is important to note that a complete evaluation of children's creative capacities requires attending to other environmental, academic, familial, and social factors that may influence the overall development of the child. This implies including qualitative information from observation scales performed by teachers or from interviews with children, parents, and teachers, or taking quantitative measures of attitudes and interests, peer nominations, teacher nominations, supervisor evaluations, product judgments, self-reports of activities, or creative achievements [50]. Taking as reference the Renzulli–Smith student characteristics rating scale and the Monterde primary school pupil observation scale, we followed up on open interviews and discussion groups with tutors and teachers that attended the performance of the sample of students. The objectives were several: To have a closer look, although approximately, at their habits outside the school; inserting reflections on creativity in a wider framework of knowledge of the people who contribute to the children's formation and on the places that host them. We met and listened to the people who lived with the sample of children, as a way to establish a relationship of mutual trust and respect and to approach the peculiar reality of schools. Interviews

were conducted on the same school day, in which tests were applied to children, during recess or at a teacher-free time.

Tutors described boys and girls as generally restless and cheerful, and healthy in the broadest sense of the word. They defined them also as very autonomous in their daily chores. Most children come and go by themselves to school, are accustomed to go shopping from the age of seven, have their gang of friends with whom they go out, and know to organize their games.

In the opinion of the tutors, the areas in which children showed more creativity are organization of games using resources o ffered by the environment, the resolution of conflicts between themselves, and their crafts. The tutors agree that the environment in which they live o ffers endless resources for the promotion of their creativity. This, in addition to the freedom granted by their parents, helps them to become more aware of their skills and interests. Tutors considered autonomy as a fundamental aspect of the development of creativity. In their environment, children moved with confidence and responsibility; outside of it, during cultural visits for example, they seemed to lose their safety and sometimes appeared disoriented. In this case, the di fference between those who are accustomed to going out with the family and moving in di fferent contexts and those who are not, were noted. In general, they do not show special fears but are cautious and respectful of the unknown. There are no evident problems of discipline. Children manifest in general self-control and respect towards the school environment and the tutors.

The group of teachers who either attended or took care of the children reported positive attitude and motivation after the experience generated by this research project. Regardless of the disciplinary field in which they are found, the after-e ffects of artistic education can be adjusted to all educational processes. A majority of the teachers agreed that transdisciplinary performances were generally conducive to civic and ethical education, English, mathematics, and Spanish. A second group endorsed transdisciplinary plastic arts education for better development of precepts in civic formation and ethics, mathematics, and natural sciences. Likewise, this group of teachers expressed that they observed creative thinking skills in their fourth-grade students, which are similar to those that formed part of the conceptual framework of our research, especially to fluidity of thinking, originality, and elaboration. The rest of the qualities stated by the teachers have little relation to the qualities that reflect creative thinking abilities addressed in the conceptual framework of this research.

Most teachers agree that creativity does not consist of the perfect use of a technique to perform an artistic work, because they recognize the need of creativity to solve problems of daily life as well. Creative attitudes are often observed in students, in formats such as socializing and acquainting with new and unpublished objects or creations, followed by indications that they relate to knowledge from di fferent fields to express their opinion on a topic. It includes production of novel hypotheses and questions on introductory topics, in the same way they express gracious analogies about everyday situations. It is logical to assume that many teachers find it very di fficult to drive and follow up on experiences generating creative thinking skills in their educational plans if they themselves had no chance to experience them during their training processes in their respective training faculties, i.e., it is not enough to learn from the concept of memory or copy the characteristics of such thinking. It is necessary to make the activity existential [44].

Only two teachers were trained in concrete subjects of education and artistic appreciation, and a great majority are unaware that children could be educated through the creative imagination. Moreover, those who know him do not know how to do it. This awareness should lead to teachers using innovative strategies in the classroom, and to believe in education, because children can be educated in other ways.


*3.3. FTIR of Paulownia Wood and Residual Solid*

δ

FTIR spectroscopy is a fast and simple technique that allows extracting valuable information about the existence of functional groups and their changes during chemical treatments. Figure 2 shows the fingerprint region of the FTIR spectra of Paulowia wood (P), and the solid residue after the formosolv treatment (PFP). The assignment of the bands was made based on data published elsewhere [9,28]. −

**Figure 2.** FTIR spectra of Paulowia wood (P) and Paulownia formosolv pulp (PFP).

Several typical bands of lignin can be clearly seen in the spectra, which involve aromatic skeleton vibrations, which disappeared or were greatly diminished in the residual solid of the formosolv treatment due to extensive delignification. For example: 1594, 1504, 1420 cm−1 , and the broad

band around 1230 cm−1 that contains the contributions of vibration modes from G and S units. In addition, the band located around 1650 cm−1 reflects some loss of C=O conjugate aryl ketones in lignin. The absorption band in the Paulownia wood spectrum at 1730 cm−1 , attributable to the presence of acetyl groups of the hemicellulose, disappeared after organosolv treatment, indicating the solubilization of the majority of the hemicellulose. In addition, a new absorption band appeared in the spectrum of formosolv pulp, at lower wavelength (1710 cm−1 ) that is assigned to the incorporation of formate groups to the propyl chain of lignin [11]. Finally, the bands located at 1325 and 1265 cm−1 , originated by the stretching of C–O bonds in S and G-units, respectively, modified their relative intensity in an evident way. Although it is not possible to confirm the exclusive contribution of G-units in the band at 1265 cm−1 , its great decrease in intensity seems to indicate an important loss of guaiacyl structures [30].


*Edited by Basel I. Ismail*

Geothermal energy for electricity generation is an appealing solution to reducing greenhouse gas emissions produced by fossil fuels. As such, this book presents a comprehensive overview of the research related to and the potential applications of geothermal energy. Chapters cover such topics as power technology using lowtemperature geothermal energy resources, current world status of geothermal resource utilization, low-temperature district heating systems, and much more.

Published in London, UK © 2022 IntechOpen © kimberrywood / iStock

Geothermal Energy

Geothermal Energy

*Edited by Basel I. Ismail*


**Oxidation Resistance of Nanocrystalline Alloys**

Rajeev Kumar Gupta1, Nick Birbilis1 and Jianqiang Zhang2

*1Department of Materials Engineering, Monash University, 2School of Materials Science & Engineering, The University of New South Wales, Australia*


**3. Bone marrow anatomical structure**

The bone is an organ composed of cortical and trabecular bone, cartilage, and hematopoietic and connective tissues. The bone tissue has an essential role in the structure and protection of the human body. Spongy, or trabecular bone, is composed of a lattice of fine bone plates filled with hematopoietic marrow, fatcontaining marrow, and arterial-venous sinusoidal blood vessels. Furthermore, it consists of bone cells at different developmental stages (including pre-osteoblasts, osteoblasts, and osteocytes), collagen fibrils, and calcium and phosphate deposits [8]. Arterial vessels enter the marrow through foramina nutricia and then divide into several arterioles. Small arterioles and capillaries from these vessels span throughout the bone marrow and supply sinusoids, which are interconnected by inter-sinusoidal capillaries [9]. The BM tissue is soft, similar to the peripheral blood, flexible connective tissue comprising the center and the epiphysis of bones, referred to as the BM cavity. In this place a variety of new blood cells are produced and ultimately released to the peripheral circulation.

### **3.1 Red and yellow bone marrow**

We recognize two categories of bone marrow tissue: the red and yellow marrow. Depending on age, teh red marrow is replaced by the yellow marrow. In adults, the

red bone marrow is a rich source of bone marrow-derived cells and present in most skeletal system bones of the iliac crest, tibia, spine vertebrae, humerus, calcaneus, ribs, and near point of attachment of long bones of legs and arms. In this wellshielded environment, an estimate of 500 billion cells per day can be produced, in particular erythrocytes, granulocytes, and platelets [10]. Regenerative medicine applications have a focus on the use of the red bone marrow as it contains myeloid and lymphoid stem cells and MSCs. In contrast the yellow marrow consists primarily of fat cells with poor vascularity and is deprived of the multipotential MSCs [11].


**1. Introduction**

This paper (The views expressed are purely those of the authors and may not in any circumstances be regarded as stating an official position of the European Commission) focuses on the relationship between energy efficiency policies and macroeconomic performance. A better understanding of this relationship is of key importance due to the increasing volume of regulated energy related products, as well as the number of countries implementing energy efficiency standards. In particular, the aim of the analysis is to add new empirical evidence regarding the macroeconomic impact of specific energy efficiency regulations on three household appliances: dishwashers, washing machines, and washer dryers in the European Union (EU). These appliances contribute approximately 2.8% to the residential energy consumption of the EU [1].

Nowadays, energy efficiency policies are one of the key measures to reduce the impact of human activities on the environment and the climate. Looking at the EU current growth strategy, climate change and energy sustainability priorities establish, for instance, the need of a 32.5% energy efficiency improvement for 2030. The improvement of energy efficiency has key impacts on the efforts that the EU undertakes to reduce energy consumption and greenhouse gas (GHG) emissions [2].

Theoretically speaking, energy efficiency policies are expected to have impacts not only on the environmental footprint of human activities, but also on the economic system through different channels [3]. In a first instance, these policies create incentives for certain economic sectors to introduce

new production technologies, with possible consequent changes in the costs and product prices. On the other hand, energy e fficiency technologies imply a reduction in energy consumption and, therefore, a consequent reduction in energy expenditure. These two direct e ffects will then have repercussions in the entire economy, through changes in the distribution of productive resources or changes in the composition of end-user spending.

The growing attention and use of energy e fficiency policies has given rise to a growing body of literature that seeks to provide scientific evidence on the economic impact of these policies. These studies propose di fferent methodologies, and can be classified into two main approaches: analyses that use partial models, and analyses that instead use general equilibrium models.

When considering the first approach, in recent years a growing number of analyses [4–7] focus on the e ffects of the implementation of energy e fficiency measures on household appliances by using engineering approaches and bottom-up stock models. For example, there are some scientific studies analyzing and projecting the electricity use, water use, pollutant emissions, and consumer welfare implications for household appliances in Europe [8,9]. McNeil et al. (2013) [10] use a bottom-up stock accounting model that predicts the energy consumption of di fferent equipment in 11 EU countries according to engineering-based estimates of the annual unit energy consumption. The authors model a high-e fficiency policy scenario and conclude that significant energy savings can be achieved by adopting the current best practices of appliance energy e fficiency policies. Braungardt et al. (2016) [11] investigate the impact of eco-innovations on the EU residential electricity demand (excluding heating) while using a detailed bottom-up modelling approach and find out that energy savings are achieved through the development of technologies with e fficiencies beyond the status quo. Studies on the market penetration of high energy e fficiency appliances in the residential sector are carried out by Radpout et al. (2017) [12]. These authors develop a model based on econometrics and time series analysis combined with the cost models. They find that government incentives to encourage people to buy higher energy e fficient appliances are more e ffective than electricity price policies. Yilmaz et al. (2019) [6] publish a study that describes the development and application of a stock model that allows for quantifying the changes in the number of household appliances in stock, the related evolution of energy e fficiency, as well as the changes/projections of electricity consumption between 2000 and 2035 in Switzerland. From the methodological point of view, this bottom-up stock model addresses the limitations of other previous models [13,14] that o ffer insight into demand dynamics but provide scarce information regarding the evolution of key parameters, such as new technologies, systems, or practices or the forecasting of the sales and stock. Specifically, for washing machines, washer-dryers, and dishwashers, Boyano et al. (2017) [15,16] analyze the environmental, employment, and economic impacts in the EU of stricter energy e fficiency requirements for these appliances. The authors built-up a bottom-up stock model that projects stock sales, lifespans, and related evolution of energy e fficiency classes. They estimate the electricity consumption, water consumption, and consumer welfare between 2015 and 2030. The authors find a decrease in the employment, but they were unable to quantify indirect, supply-chain, or cross-sectorial impacts.

While using a general equilibrium framework, other studies focus instead on the economic and environmental impact of energy e fficiency policy while considering all interlinkages and dependences of the economic system. Hanson and Laitner (2004) [17] use the All Modular Industry Growth Assessment (AMIGA) system to analyse the policies that increase investment in energy-e fficient technologies in the United States (U.S.) economy. They find that the policies would lead to substantial domestic reduction of carbon emissions and a net positive impact on the economy. Rose and Wei (2012) [18] analyse the impacts of the Florida Energy and Climate Change Action Plan that was introduced in 2001. Using the econometric general equilibrium REMI model, they find that most of the recommended options individually—as well as the combined recommendations—have positive impacts on the state's economy. Barker et al. (2016) [19] analyse four di fferent policies that the International Energy Agency suggests in order to close the 2020 emissions gap. They estimate the GDP and employment e ffect while using the econometric general equilibrium model Global Energy-Environment-Economy Model

(E3MG), finding that the policies are not enough to reach the required emissions reduction, although presenting positive impacts on GDP and employment.

There is finally a third group of studies that combine the two approaches using hybrid models. These analyses integrate detailed bottom-up technical descriptions of specific industries a ffected by the policies with a broader economic perspective provided by the macroeconomic framework. Barker et al. (2007) [20] analyze the UK Climate Change Agreements and related energy e fficiency policies for energy-intensive industrial sectors. They combine bottom-up estimates of the e ffects of these policies and the dynamic econometric model of the UK economy Multisectoral Dynamic Model-Energy-Environment-Economy (MDM-E3). They find final energy reduction and a slight increase in economic growth through improved international competitiveness. Ringel et al. (2016) [21] use a hybrid approach—bottom-up model together with the Assessment of Transport Strategies (ASTRA) model—to analyze the environmental and socio-economic impacts of Germany's latest energy e fficiency and climate strategies for the year 2020. They find that enhanced green energy policies bring about economic benefits in terms of GDP and employment, even in the short term. Additionally, the European Commission uses a hybrid approach in the impact assessment of the proposal for the revision of the energy e fficiency directive [22]. The analysis uses bottom-up models— Price-Induced Market Equilibrium System (PRIMES), Greenhouse gas - Air pollution Interactions and Synergies (GAINS), Global Biosphere Management Model - Global Forest Model (GLOBIOM-G4M), Prometheus, Common Agricultural Policy Regional Impact (CAPRI)—together with two di fferent general equilibrium macroeconomic models: the computational general equilibrium model GEM-E3 and the dynamic econometric global model E3ME. While the E3ME model presents positive impacts GDP and employment in all analyzed scenarios, the results for the GEM-E3 models are mixed. Finally, Hartwig et al. (2017) [3] present a case study for Germany, where a scenario including ambitious energy e fficiency measures for building, household appliances, industry, and the service sector is compared to a reference scenario with respect to the macroeconomic impacts. Connecting the energy demand models Forecast and invert/EE-lab with the macroeconomic model ASTRA-D is undertaken to analyze the e ffects of the policy scenarios. The authors conclude that the macroeconomic e ffects of ambitious energy e fficiency policies in Germany have considerable positive impacts on employment (particularly in those that produce energy e fficiency technologies and construction and manufacturing sector, as well as in real-state and consulting) and GDP.

In this paper, we follow the third approach to use the technical information that is o ffered by bottom-up models, while going beyond the direct impacts on employment and value added of the energy e fficiency regulations to analyze their impacts across industries and countries. In particular, we use a hybrid framework combining the detailed bottom-up energy demand stock based model that Boyano et al. developed [15,16], together with the macro-econometric dynamic general equilibrium model FIDELIO [23]. The resulting hybrid model is used to provide new empirical evidence on a specific energy e fficiency policy, which is the revision of the energy e fficiency regulatory framework for dishwashers, washing machines, and washer dryers. In particular, the overarching regulatory framework for energy e fficiency products is the combination of two policies: The Energy Labelling Regulation (EU) 2017/1369 [24], which defines the process of determination of energy label to be displayed in new appliances, and the Eco-design Directive 2009/125/EC [25], which specifies the process of defining minimum energy performance levels. Acting in combination as a pull-push e ffect, these regulatory measures have improved the average energy e fficiency of the household appliance stock over the years in the EU [26]. Regarding the analyzed appliances, their specific regulations are: (1) for washing machines, Regulation EU No 1061/2010 on energy label and Regulation EU No 1015/2010 on Eco-design requirements, (2) for washer dryers Regulation EU No 96/60/EC on energy label, and (3) for dishwashers, Regulation EU No 1060/2010 on energy label and Regulation EU No 1016/2010 on Eco-design requirements. These regulations have been revised in 2014–2018, and adopted in 2019. The revision introduces stricter energy e fficiency requirements of the products that enter the EU market from March 2021, and a rescaling of the energy e fficiency classes. Additionally, some changes in the

testing programs are introduced to bring the energy e fficiency developments of the products closer to the end-user behavior. This paper quantifies the EU-wide economic (in terms of value added) and employment impacts between 2020 and 2030 of such proposed changes to the EU energy e fficiency regulations on the aforementioned household's appliances. The analysis provides results by countries and for most of the economic sectors in the EU.

The paper is organized as follows. Section 2 provides an overview of the methods and materials that were used in the study. Section 3 presents the impacts from changes in the EU regulations estimated using FIDELIO. Section 4 discusses a range of implications of the empirical results, while Section 5 draws some concluding remarks.


**Author details**

Bilge Doran1 \*, Hasan Orhun Köksal2 , Selen Aktan2 , Oktay Jafarov3 and Cengiz Karakoç4 [10] Shing PB, Lofti HR, Barzegarmehrabi A, Brunner J. Finite-element analysis of shear resistance of masonry wall panels with and without confining frames. Proceedings of

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[15] Dhanasekar M, Page AW, Kleeman PW. A finite element model for the in-plane behavior of brick masonry. Proceedings of the 9th Australasian Conference on Mechanisms of

[16] Ganz HR, Thurlimann B. Strength of brick walls under normal force and shear. Proceedings of the 8th International Symposium on Load Bearing Brickwork. London,

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**3. ADHD**

Kleinpeter, Maccubbin, & Taga, 2005). It has also been shown that parents of autistic chil‐ dren are twice as likely themselves to have suffered from psychiatric illness than parents of

Most of these problems are distinct from those examined in this chapter: the common devel‐ opmental disorders of childhood which are also found to co-occur with autism, particularly

Before reviewing the evidence that suggests many children share difficulties symptomatic of these conditions, and the theories of why this may be, I will briefly describe how dyslexia

Dyslexia is conceptualized by both educational bodies and the psychiatric classification sys‐ tems as a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristic features of dyslexia are difficulties in phonological awareness, verbal memory and verbal processing speed. Dyslexia is developmental delay in literacy and generally slow and inaccurate reading and spelling. The definition of dyslexia has changed over time, and such changes have often been based on the research identifying a range of associated difficulties that occur with dyslexia. Estimates of the prevalence of dyslexia have been complicated because dyslexia cut-offs are contested (Coltheart & Jackson, 1998) and dys‐ lexia manifests itself differently in various languages according to levels of phonic regularity (Miles, 2004). Research over the last 40 years has focused on phonological skills. These are the reading and de-coding skills used when breaking down language into its component sounds

Like autism, dyslexic difficulties are considered to exist in a continuum throughout the general population (Fawcett, 2012). There is much interest in the association of cognitive ability with changing symptom profiles and diagnosis. The definition of dyslexia is in flux, and has been re‐ cently redefined by many national bodies, for example in the UK, the British Psychological So‐

Dyslexia is evident when accurate and fluent word reading and/or spelling develops very incompletely or with great

This definition implies that the problem is severe and persistent despite appropriate learn‐ ing opportunities. This UK definition differs from the ICD-10 diagnosis of developmental dyslexia or 'Specific Reading Disorder', which requires a discrepancy between actual read‐ ing ability and the reading ability predicted by a child's IQ. So an intellectual disability, (generally considered IQ below 70) can co-occur with the British Psychological Society defi‐ nition of dyslexia. This new definition includes the so called 'garden variety' dyslexic chil‐

ciety, focusing on literacy learning at the 'word level' without attainment discrepancy:

non-autistic children (Daniels et al., 2008).

362 Recent Advances in Autism Spectrum Disorders - Volume I

and reassembling the parts in order to read or to spell a word.

ADHD and dyslexia.

**2. Dyslexia**

and ADHD manifest themselves.

difficulty (British Psychological Society, 1999)

ADHD is known as 'Hyperkinetic Disorder' in ICD-10; there are three subtypes of ADHD according the DSM. In the first, a child will primarily have problems with attention which may manifest as an inability to remain 'on task' for long periods, lack of response to instruc‐ tion or distractibility. In the second sub-type, symptoms of hyperactivity and impulsivity dominate, which is characterized by wriggling, squirming, being unable to sit still, inter‐ rupting and finding it difficult to wait. Children may also be climbing in inappropriate sit‐ uations and always on the move when free to do so. The third sub-type is simply the coexistence of both attention problems and hyperactivity, with each behavior occurring infrequently alone and symptoms starting before seven years of age.

According to ICD-10, eventually, assessment instruments should develop to the point where it is possible to take a quantitative cut-off score to assess ADHD. Like dyslexia and autism, the symptoms are behavioural in nature, and are part of a continuously distributed pattern that extends into the population at large.

The persistence of ADHD symptoms is not so marked as for autism. Around 70 to 50 per‐ cent of those individuals diagnosed in childhood do not continue to have symptoms into adulthood (Elia, Ambrosini, & Rapoport, 1999). There is evidence suggesting to some extent symptoms of ADHD are expressed in reaction to home (Mulligan et al. 2011) and other envi‐ ronmental contexts. Individuals with ADHD also tend to develop coping mechanisms to compensate for some or all of their impairments. ADHD is diagnosed more often in boys with the reported ratio varying from 2:1 to 4:1 (Dulcan, 1997; Kessler et al., 2005) though some studies suggest this may be partially due to referral bias where teachers are more like‐ ly to refer boys than girls (Sciutto, Nolfi, & Bluhm, 2004). Treatments for ADHD involve a combination of medication, usually methyphenidates which are well established in improv‐ ing symptoms of inattention, and behavioral intervention in education and at home. The is‐ sue of girls being overlooked on identification is a common thread for research in dyslexia, ADHD and autism. Our own results suggest there is some evidence to back up the claim that boys with ASD symptoms are given the diagnosis more frequently than girls with equivalent ASD symptoms (Russell, Steer, & Golding, 2011). This may be because the disor‐ ders tend to be conceptualized as 'male' leading to referral bias.

The imposition of a cut off between normality and abnormality is therefore 'an arbitrary but convenient way of converting a dimension into a category' as Goodman and Scott (1997, p.

Co-Occurrence of Developmental Disorders: Children Who Share Symptoms of Autism, Dyslexia and Attention Deficit

Hyperactivity Disorder

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http://dx.doi.org/10.5772/54159

Various studies have looked for ADHD or ADHD symptoms in samples of children with autism or ASD. Rates of ADHD have ranged from 28% to 78% of these samples (Ronald, Edelson, Asherson, & Saudino, 2010). Studies that look at ADHD symptoms have reported even higher numbers: for example, Sturm, Fernell, & Gillberg, (2004) looked at a sample of around 100 high functioning children with ASD and found 95% had attention problems, 75% had motor difficulties, 86% had problems with regulation of activity level, and 50% had impulsiveness. About three-quarters had symptoms compatible with mild or severe ADHD, or had deficits in attention, motor control, and perception, indicating a considerable overlap

In an large analysis of nine hundred forty-six twins, Reierson and colleagues (2008) assigned DSM-IV ADHD diagnoses, and measured autistic traits using the Social Responsiveness Scale. The study showed that there are clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These findings confirm results in earlier studies (Clark, Feehan, Tinline, & Vostanis, 1999). Santosh and Mijoovic (2004) which found children with ADHD had elevated levels of impairment in all three autistic symptom do‐ mains, namely social deficits, communication and stereotyped behaviors. Clark *et al* found 65-80% of parents of children with ADHD reported difficulties in social interaction (particu‐ larly in empathy and peer relationships) and in communication (particularly in imagination, and maintaining conversation). So the presence of autistic traits in children with ADHD ap‐

In an analysis conducted with Lauren Rodgers at the Peninsula Medical School in the UK using data from the Millennium Cohort Study, a cohort of around 19,000 children who were all born between 2000 and 2002, we noted 44 children had a dual diagnosis of both ASD and ADHD (proportion of total population 0.3%) by age seven. The prevalence of children with identified ADHD in the ASD sample was 17%. Conversely, the prevalence of children with ASD in the ADHD sample was higher at 27%. Both figures indicate substantial overlap be‐

Various European research groups have examined co-morbid disorders in adults with diag‐ nosed ASD. An international team lead by Hofvander studied a group of 122 adults with normal IQ from specialist clinics in three European cities: Gothenburg, Paris and Malmö (Hofvander et al., 2009). Here the overwhelming majority had symptoms of ASD. Nonverbal communication problems were also very common, described in 89% of all their subjects. In this study over half the participants, (52%) were diagnosed with co-morbid ADHD. Interest‐ ingly, participants diagnosed with pervasive developmental disorder. 'Not Otherwise Speci‐ fied' (PDD-NOS) diagnosis had significantly more symptoms of inattention and

**4. Evidence of symptom overlap – ASD and ADHD**

between these disorders and high-functioning ASD in children.

pears common (Ronald et al., 2010).

tween these conditions.

23) point out.

Because ASD, Dyslexia and ADHD are all behaviorally defined, so 'symptoms' are behaviours. All three conditions are conceived as particular behaviours along a spectrum, where traits have a continuous distribution and extend into the general (non-disordered) population. An arbitra‐ ry cut off point determines who is considered to be within the various categories and who is not. The clinician giving a diagnosis will be responsible for judging where this cut off may come, guided by diagnostic criteria and standards within disciplines as well as perceived im‐ plications: the benfits versus any possible risks of assigning a diagnosis. This is perhaps best es‐ tablished for autism: Constantino and Todd (2003) measured autistic traits in a large community sample, and found no jump in the threshold of autistic behaviours between 'nor‐ mal' individuals and those with an autism spectrum diagnosis, rather they found a continuous distribution. These findings concurred with those in a Scandinavian study (Posserud, Lunder‐ vold, & Gillberg, 2006). One of our own studies has likewise shown that autistic traits do ex‐ tend into the 'subclinical' population (Figure 1). As with dyslexia and ADHD, there is not a sharp line separating severity in those with a diagnosis from less severe traits in those without (London, 2007). In both dyslexia, ADHD and the autism spectrum, some children have more severe difficulties than others, and the symptoms extend into the population of children (and adults) as a whole. For dyslexia, there are many people who may have mild dyslexic difficul‐ ties but perhaps might not qualify as 'dyslexic'. For autism spectrum disorders, many people without an autism diagnosis do have autistic-type behaviours but the severity and frequency of those behavioural symptoms is less severe than in those deemed to qualify for a diagnosis.

**Figure 1.** The distribution of an ASD composite trait in the general population from Russell et al.(2012)

The imposition of a cut off between normality and abnormality is therefore 'an arbitrary but convenient way of converting a dimension into a category' as Goodman and Scott (1997, p. 23) point out.