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PubMed1988

Linguistic status subsequent to childhood immersion injury.

The linguistic abilities of two groups of children who had been involved in immersion incidents are reported--one group at 12 months after the immersion incident (n = 25), and the second group at five years after the immersion incident (n = 9). The performances of the two experimental groups on standardized language tests were compared with the performances of appropriate control groups that were matched for age, sex and socioeconomic status. The speech and language skills of the 12-months post-immersion group and the matched control group were assessed by means of the sequenced inventory of communication development. Subjects who were assessed 12 months after the immersion injury scored significantly lower results than did control subjects on receptive and expressive language ages that were calculated as percentages of the chronological age. No differences in language scores were evident between the subjects who were at five years after the immersion incident and their control subjects as assessed by the test of language development--primary. The language abilities of the victims of an immersion incident were correlated with their neurological status at presentation to hospital. The results suggest a need to monitor the linguistic development of all children who present initially in a coma after an immersion incident. The need for a longitudinal study of the linguistic abilities of these children is indicated.

Child, Preschool↗
PubMed1992

Interhemispheric dissociation of expressive and receptive language functions in patients with complex-partial seizures: an amobarbital study.

Bilateral intracarotid amobarbital procedures (IAP) were performed in 144 patients with medically intractable complex-partial seizures. As a result of language testing, 29 patients (20.1%) were found to have bilateral language representation to different degrees. In four (2.8%) of these patients--all right-handers with early onset of epilepsy and/or evidence of early brain damage--there was strong evidence of an interhemispheric dissociation of expressive and receptive language functions. Two of these patients had circumscribed temporal foci (one left, one right), and receptive language functions were represented in the hemisphere contralateral to the focus. One patient with a right frontal focus showed left-hemisphere dominance for expressive functions, while the fourth patient exhibited left-hemisphere dominance for receptive functions associated with a right temporo-parietal focus. It is argued that in these four cases the circumscribed functional and/or structural impairments have led to a shift of the anatomically associated language functions to the opposite hemisphere (rather than to neighboring regions of the same hemisphere). These findings substantiate the hypothesis that in special circumstances the anterior (expressive) language area can be located in one hemisphere and the posterior (receptive) area in the other.

Adolescent↗
PubMedDate not supplied

Early effects of traumatic brain injury on young children's language performance: a preliminary linguistic analysis.

Language skills undergo rapid development during the early childhood years, so that by the time children start school they are competent communicators with well established syntactic, semantic and pragmatic abilities for their age. Little is known about the effects of traumatic brain injury (TBI) on the acquisition of these language skills during the early childhood years. This study used a prospective, cross-sectional design to compare the language abilities of young children following their head injury. Fifteen brain injured children, aged between 4-6 years, were divided into three injury groups depending on severity of injury, i.e. mild, moderate and severe, and compared with a matched community control group. They were assessed within 3 months of sustaining their injury on a range of expressive and receptive language tests, and free speech conversation samples, which were analysed pragmatically and syntactically. Results indicated that the severe group performed most poorly on language tasks. It is suggested that linguistic evaluation is an important component of follow up at least for the severe head injured population.

Analysis of Variance↗
PubMed2001

Linguistic skills in relation to neurological findings at 8 years of age in children born preterm.

The linguistic skills of 8-year-old children born preterm (n = 42) with birthweight < 1750 grams from a 1-year birth cohort for 1985-86 in northern Finland were studied with three different language tests, namely the Illinois Test of Psycholinguistic Abilities (ITPA), the Token Test for Children (TTC) and the Morphological Test (MT) for Finnish children. Full-term control children (n = 42) with birthweight > or = 2500 grams from the same birth cohort were matched individually with their preterm pairs for age, sex, twinship, mother's education, place of residence, birth order and family type. The preterm children's language abilities were studied in relation to their neurological status and to the periventricular leukomalacia (PVL) findings of magnetic resonance imaging (MRI). The preterm children with minor neurodevelopmental dysfunctions (MND) scored worst and differed significantly from their matched controls in TTC. They also differed significantly from other preterm subgroups, namely healthy preterm and preterm children with cerebral palsy (CP), in verbal comprehension measured by TTC. PVL findings were not associated with performance in the language ability tests. A closer and regular follow-up of language development in the MND-disabled group among the low-birthweight preterm children is recommended.

Child↗
PubMed2001

Functional imaging in the work-up of childhood epilepsy.

In children with medically intractable lesional epilepsy, surgery is deemed successful if the epileptogenic focus can be removed while major neurological functions are spared. Current techniques rely on invasive intracranial recordings. The new developments in functional imaging offer the possibility of localizing the epileptogenic focus noninvasively (PET/SPECT) and mapping cognitive functions (fMRI). Ictal SPECT shows hyperperfusion in the focus and has proved to have better localizing value than interictal PET or SPECT, which show focal hypometabolism or hypoperfusion. Ictal SPECT is useful for deciding on the placement of intracranial electrodes in extratemporal epilepsies, particularly in young children. Functional MRI has proved highly accurate for localizing motor and language networks, thus offering the possibilities of replacing the Wada test (language hemispheric lateralization) and studying postlesional brain plasticity. Despite the difficulties of functional imaging in children owing to the limited cooperation that can be expected, ethical constraints, and poor normative data, SPECT/PET and fMRI provide clinically useful information for presurgical work-up of childhood epilepsies.

Adolescent↗
PubMed1999

Local norming of the test of adolescent/adult language-3 in the Ottawa Speech and Language Study.

The young adult norms for the Test of Adolescent/Adult Language-3 (TOAL-3; D. Hammill et al., 1994) are based only on individuals who pursued postsecondary education, a restriction that renders the norms inappropriate for many clinical and research purposes. This research note details the rationale, methods, and results of a local norming of the TOAL-3 spoken language subtests, based on participants from the Ottawa Speech and Language Study (C. J. Johnson et al., 1999). The resulting Ottawa norms represent the full range of young adult language abilities and, therefore, can be used with caution for some clinical and research purposes.

Adolescent↗
PubMed1986

Brain lesions associated with nonfluent aphasia fifteen years following penetrating head injury.

Men who sustained penetrating head injuries resulting in nonfluent aphasia within six months following injury, were examined fifteen years later and classified into two groups, 13 with persistent nonfluent aphasia, and 26 without symptoms of aphasia. Relative to a normal control group on a comprehensive battery of speech and language tests, the chronic nonfluent aphasics demonstrated syntactic processing deficits in all language modalities, with only mild or no impairment in other language faculties. The recovered group demonstrated deficits only in written expressive syntax. The CT lesions of the two groups differed in the extent of left hemisphere lesion volume and the degree of posterior and deep lesion extension within the left hemisphere. The nonrecovered group did not have greater right hemisphere damage. Broca's area was equally involved in 77 per cent of patients in both groups. All patients in the nonrecovered group had posterior extension of their lesions in Wernicke's area with some involvement of the underlying white matter and basal ganglia in the left hemisphere.

Adolescent↗
PubMed1995

[Speech perception test in Italian language for profoundly deaf children].

Speech perception tests are an important part of procedures for diagnosing pre-verbal hearing loss. Merely establishing a child's hearing threshold with and without a hearing aid is not sufficient to ensure an adequate evaluation with a view to selecting cases suitable for cochlear implants because it fails to indicate the real benefit obtained from using a conventional hearing aid reliably. Speech perception tests have proved useful not only for patient selection, but also for subsequent evaluation of the efficacy of new hearing aids, such as tactile devices and cochlear implants. In clinical practice, the tests most commonly adopted with small children are: The Auditory Comprehension Test (ACT), Discrimination after Training (DAT), Monosyllable, Trochee, Spondee tests (MTS), Glendonald Auditory Screening Priocedure (GASP), Early Speech Perception Test (ESP), Rather than considering specific results achieved in individual cases, reference is generally made to the four speech perception classes proposed by Moog and Geers of the CID of St. Louis. The purpose of this classification, made on the results obtained with suitably differentiated tests according to the child's age and language ability, is to detect differences in perception of a spoken message in ideal listening conditions. To date, no italian language speech perception test has been designed to establish the assessment of speech perception level in children with profound hearing impairment. We attempted, therefore, to adapt the existing English tests to the Italian language taking into consideration the differences between the two languages. Our attention focused on the ESP test since it can be applied to even very small children (2 years old). The ESP is proposed in a standard version for hearing-impaired children over the age of 6 years and in a simplified version for younger children. The rationale we used for selecting Italian words reflect the rationale established for the original version, but the choice of single words follows different criteria from the original version. In fact, the two languages differ in important linguistic features so that the test can not be not adapted to the Italian language by simply translating the words involved. As currently there is no children's language dictionary in Italian arranged according to age bracket, we chose words used in children and in pre-school reading material.

Child↗
PubMed2006

The composition of normative groups and diagnostic decision making: shooting ourselves in the foot.

PURPOSE: The normative group of a norm-referenced test is intended to provide a basis for interpreting test scores. However, the composition of the normative group may facilitate or impede different types of diagnostic interpretations. This article considers who should be included in a normative sample and how this decision must be made relative to the purpose for which a test is intended. METHOD: The way in which the composition of the normative sample affects classification accuracy is demonstrated through a test review followed by a simulation study. The test review examined the descriptions of the normative group in a sample of 32 child language tests. The mean performance reported in the test manual for the sample of language impaired children was compared with the sample's norms, which either included or excluded children with language impairment. For the simulation, 2 contrasting normative procedures were modeled. The first procedure included a mixed group of representative cases (language impaired and normal cases). The second procedure excluded the language impaired cases from the norm. RESULTS: Both the data obtained from test manuals and the data simulation based on population characteristics supported our claim that use of mixed normative groups decreases the ability to accurately identify language impairment. Tests that used mixed norms had smaller differences between the normative and language impaired groups in comparison with tests that excluded children with impairment within the normative sample. The simulation demonstrated mixed norms that lowered the group mean and increased the standard deviation, resulting in decreased classification accuracy. CONCLUSIONS: When the purpose of testing is to identify children with impaired language skills, including children with language impairment in the normative sample can reduce identification accuracy.

Child↗
PubMed1979

Effects of localised cerebral lesions and dysphasia on verbal memory.

Twenty-nine patients with unilateral left hemisphere lesions, 22 patients with unilateral right hemisphere lesions, and 19 neurological control patients with extracerebral lesions were assessed on verbal memory recall and recognition tests and on a battery of language tests. The left hemisphere group was significantly impaired in memory and language skills. Significant verbal memory impairment was found both in the subgroup of left hemisphere lesion patients whose lesions involved the temporal lobe and in the subgroup whose lesions did not. However, no significant differences between these left hemisphere subgroups' levels of performance on memory tasks emerged, even when dysphasia was taken into account. This study, therefore, fails to support the notion of a specific anatomical correlate of verbal memory impairment within the left hemisphere. Dysphasic subjects were significantly impaired on verbal memory tasks but displayed the same pattern of sensitivity to the effects of word frequency and word concreteness on verbal memory as control subjects, suggesting that the verbal memory of the dysphasic subjects was quantitatively rather than qualitatively impaired. This impairment could not be attributed to deficits in the comprehension or expression of the memory test items, and it is, therefore, proposed that language disturbances may hinder the efficient use of such language based procedures as may subserve verbal memory.

Adult↗
PubMed1996

The Cambridge Language and Speech Project (CLASP). I . Detection of language difficulties at 36 to 39 months.

A community-based investigation of the nature, characteristics and evolution of speech and language delay in a sample of 3-year-olds is being carried out in Cambridgeshire. 1936 parents completed a preschool language checklist (PLC) to identify children at risk of language difficulties. Two hundred and seventy-seven children at risk together with 148 controls completed a series of preliminary face-to-face standard language tests to determine expressive, receptive and phonological skills. Concordance between the Cambridge Language and Speech Project (CLASP) identification and speech therapy involvement suggests that the overall (CLASP) screening procedure identified a number of children that current surveillance had missed and support the conclusion that the PLC may be a useful adjunct for child health care services as an aid in prioritising children for referral to speech therapy services. Children with scores of 1 to 3 at 36 months should be reviewed at 39 months, and those with 4 or more should be a high priority for referral. Preliminary examination of the impairment profile suggests that children with language impairments rather than pure speech impairments at 36 and 39 months are more likely to have a broader range of overall language-related deficit.

Age Factors↗
PubMed1999

Determination of language dominance: Wada test confirms functional transcranial Doppler sonography.

OBJECTIVE: To determine the efficacy of the invasive Wada test in determining language dominance, and to validate the functional transcranial Doppler sonography (fTCD) examination in patients. BACKGROUND: Previous work shows that simultaneous bilateral fTDC may identify cognitive hemispheric dominance in healthy individuals. METHOD: fTDC and the Wada test were performed prospectively in 14 patients with various diseases (tumors, cerebrovascular events, head injury, intractable epilepsy). fTDC hemispheric dominance was determined based on the hemispheric blood flow velocity shift for language and visuospatial tasks. RESULTS: fTDC was performed easily in patients. One patient could not be examined by fTDC because of absent temporal bone window for ultrasonic transmission. Two Wada tests were inconclusive due to patient somnolence. One of these patients suffered from right frontal tumor and had aphasia remitted under steroids when examined. fTDC indicated a bilateral language dominance. In the remaining 11 patients the correlation between fTDC and Wada language lateralization indices was 0.75 (p = 0.008). If a post hoc cutoff score was taken for the fTDC language lateralization index, in eight patients, both fTDC and Wada testing determined the left hemisphere to be dominant for language; in the other three patients, language function was bilateral in both examinations. CONCLUSION: Although the current results are preliminary and require replication in a larger sample, fTDC seems to be able to assess hemispheric language dominance not only in healthy individuals, but also in patients. It might become an alternative noninvasive or complementary tool to the Wada test, particularly in patients in whom the Wada test is impractical or gives inconclusive results.

Adolescent↗
PubMed2000

Volumetric study of lobar atrophy in Pick complex and Alzheimer's disease.

BACKGROUND: Lobar atrophy is an important neuroimaging feature of Pick complex (PiC). However, differences in patterns of focal brain atrophy between PiC and Alzheimer's disease (AD), and among PiC subgroups, have not been studied quantitatively. OBJECTIVE: To compare volumetric measures among primary progressive aphasia (PPA), frontotemporal dementia (FTD) and AD; to assess association between brain atrophy and cognition. PATIENTS: Seventeen patients with PPA, 11 with FTD and 24 with probable AD were studied. METHODS: We measured total and regional volume quantitatively using MRI and computerized volumetry. Contributing factors were controlled statistically or by adopting brain volume ratios. We investigated the classifying power of volumetry and correlated regional brain volume with cognitive and language test scores. RESULTS: The ratio for fronto-temporo-central region was smaller on the left in PPA and on the right in FTD. AD and some PPA patients had smaller parietal lobes. The frontal ratios correctly classified 93% of PPA and FTD patients, but only 50% of the entire PiC and AD patients. Language-dependent examinations correlated with the left fronto-temporal volume. CONCLUSIONS: Brain atrophy differs in PPA, FTD and AD, but there is some morphological overlap between PiC and AD in parietal volumes. Focal brain atrophy is most consistently associated with language impairments.

Aged↗
PubMed1991

Hypochloremic metabolic alkalosis from ingestion of a chloride-deficient infant formula: outcome 9 and 10 years later.

In 1978 and 1979 two infant formulas, Neo-Mull-Soy and Cho-Free, were found to be deficient in chloride. The Centers for Disease Control received reports that hypochloremic metabolic alkalosis (HMA) had developed in 141 children as a result of exposure to these formulas. Thirty-five of these children were examined at 9 and 10 years of age and compared with a group of 32 children who were exposed to the chloride-deficient formulas but were not reported to experience HMA and a group of 61 children who received chloride-sufficient soy formulas in infancy. The control children were matched to the HMA children on sex, race, age, and maternal education. Growth characteristics, performance on the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Boston Naming Test, the Rey-Osterrieth Test, the Clinical Evaluation of Language Fundamentals-Revised (CELF-R), and subtests from several other speech and language tests were compared across the groups. After adjustment for family income and the level of the father's education, significantly lower scores were observed in the HMA children on the WISC-R Arithmetic subtest (mean = 10.5) compared with the soy control children (mean = 12.0, P less than .05) and on the WISC-R Coding subtest (mean = 9.0) compared with the soy control children (mean = 10.8, P less than .01). All the WISC-R subtest scores were, however, within the normal range. Although no significant differences occurred on the CELF-R between groups, the risk of an HMA child falling below the range expected for a standard population was increased on the CELF-R Composite Total, Receptive, and Expressive Language scores: risk ratios = 2.14, 2.14, and 3.03 respectively. Significant differences were observed between the children exposed, both HMA and non-HMA children, and the soy control children for behavioral problems as determined by the Achenbach Childhood Behavioral Checklist. It is concluded that as a group, children with documented HMA appear to have recovered from their growth failure and have normal cognitive development. They may, however, be at risk for deficits in language skills that require expressive language abilities.

Alkalosis↗
PubMed1997

Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism.

OBJECTIVE: To describe the outcome for 92 fetuses treated between May 1987 and January of 1993 with intrauterine (intravascular) transfusions for severe hemolytic disease in comparison with a high-risk and a healthy control group. STUDY DESIGN: Information on the perinatal period was obtained from the patient records. The children regularly attended the outpatient clinic, and a general pediatric examination was performed on each visit. The psychometer development of the child until age 4 1/2 years was assessed according to Gesell. At the age of 5 years, the adaptation part of the Denver Developmental Screening Test and a Dutch-language test were used. A neurologic examination was performed according to Touwen. RESULTS: In our study, 77 (83.7%) of 92 fetuses were born alive after intravascular transfusions. The overall survival rate was 79.3%. The follow-up group included 69 infants, with an age range of 6 months to 6 years. Correlation between antenatal and perinatal features showed a significant negative relationship between the number of intrauterine transfusions and the duration of phototherapy (p = 0.002). The probability that neurologic abnormalities would occur was significantly greater when perinatal asphyxia had been present (p < 0.05) and with a lower cord hemoglobin level at birth (p = 0.03). The total number of children with disabilities was 10.1% (7/69). CONCLUSIONS: The neurodevelopmental outcome for the group of survivors compared favorably with a group of high-risk, very low birth weight infants (10.1% to 18%), and less favorably with a healthy control group (10.1% to 6%).

Blood Transfusion, Intrauterine↗
PubMed1987

Specific language impairment as a maturational lag: evidence from longitudinal data on language and motor development.

Longitudinal language-test data on 87 language-impaired children assessed at the ages of four, 4 1/2 and 5 1/2 years were converted to age-equivalent scores to compare the rates of development of children who recover from early language delay with those who have more persisting problems. On most measures, over the 18-month period all the children progressed by about 18 months. Thus although children with good and poor outcomes were distinguished in terms of initial level of performance, they did not differ in rate of progress. Speed on a peg-moving task was closely related to language performance. Children who had a good outcome after early language delay had significantly impaired scores at four years, but subsequently were indistinguishable from a control group. Quantitative but not qualitative differences in peg-moving performance were found for children with good and poor outcomes. No association was found between presumptive aetiological factors and language or pegboard performance. These findings are interpreted in terms of a theory which attributes specific language impairment to a maturational lag in neurological development.

Child, Preschool↗
PubMed2000

Executive functions in dyslexia.

This study focused on executive functions in dyslexia. A group of 43 heavily-affected young dyslexics, divided into two groups based on the results of a receptive language test, and 20 non-dyslexic controls, were tested with a Dichotic Listening Test, the Stroop Color Word Test and the Wisconsin Card Sorting Test. The dyslexic subjects demonstrated significant impairment on all tasks, but with different patterns of impairment according to the subgrouping. The subgroups were equally impaired on the Dichotic Listening Test, but differed on the Stroop and the Wisconsin Tests. The data support a hypothesis suggesting executive problems in dyslexia, depending on receptive language skills.

Adolescent↗
PubMed2004

Psychopathology and pediatric complex partial seizures: seizure-related, cognitive, and linguistic variables.

PURPOSE: This study examined the role of cognition, language, seizure-related, and demographic variables in the psychopathology of children with complex partial seizure disorder (CPS) of average intelligence. METHODS: One-hundred one CPS and 102 normal children, aged 5.1 to 16.9 years, had a structured psychiatric interview and cognitive and language testing. Parents provided demographic, perinatal, and seizure-related information, as well as behavioral information through the Child Behavior Checklist (CBCL) and a structured psychiatric interview about the child. RESULTS: Significantly more CPS patients had psychopathology, cognitive deficits, and linguistic deficits than did those in the normal group. Among the patients, Verbal IQ predicted the presence of a psychiatric diagnosis, as well as CBCL scores in the borderline/clinical range. Seizure, linguistic, and demographic variables were unrelated to psychopathology. The cognitive and linguistic deficits of the CPS group, however, were predicted by seizure factors (e.g., prolonged seizures/febrile convulsions; seizure frequency/number of antiepileptic drugs) and demographic factors (e.g., minority status). CONCLUSIONS: Because subtle verbal cognitive deficits predict behavioral disturbances in pediatric CPSs, the study's findings highlight the importance of assessing behavior, cognition, and language in these children. They also underscore the negative impact of prolonged seizures, febrile convulsions, seizure frequency, and antiepileptic drug polytherapy on cognition and language in pediatric CPSs.

Adolescent↗