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PubMed1991

A minority perspective in the diagnosis of child language disorders.

The effective diagnosis and treatment of persons from diverse minority language backgrounds has become an important issue in the field of speech and language pathology. Yet, many SLPs have had little or no formal training in minority language, there is a paucity of normative data on language acquisition in minority groups, and there are few standardized speech and language tests appropriate for these groups. We described a diagnostic process that addresses these problems. The diagnostic protocol we have proposed for a child from a Black English-speaking background characterizes many of the major issues in treating minority children. In summary, we proposed four assessment strategies: gathering referral source data; making direct observations; using standardized tests of non-speech and language behavior (cognition, perception, motor, etc.); and eliciting language samples and probes.

Black or African American↗

PubMed1995

Differential receptive and expressive language functioning of children with symptomatic HIV disease and relation to CT scan brain abnormalities.

OBJECTIVES: To investigate the effect of HIV disease on the receptive and expressive language of children and the relationship between CT scan brain abnormalities and language functioning. METHODS: Thirty-six children (mean age, 5.5 years; range, 1 through 10 years; 75% vertical transmission; 58% classified as encephalopathic) with symptomatic HIV infection and 20 uninfected siblings (mean age, 7.8 years; range, 3 through 15 years) were administered an age-appropriate comprehensive language test assessing both receptive and expressive language (Reynell Developmental Language Scales or Clinical Evaluation of Language Fundamentals--Revised). Each HIV-infected child had a CT scan of the brain as part of the baseline evaluation, which was rated independently and blindly by two neurologists, for presence and severity of brain abnormalities using a semiquantitative rating system. RESULTS: Expressive language was significantly more impaired than receptive language in the overall sample of HIV-infected children. The encephalopathic children scored significantly lower than the non-encephalopathic children, however, the degree of discrepancy between mean receptive and expressive language scores was not significantly different between these two groups. The uninfected sibling control group did not have a significant discrepancy between receptive and expressive language, and they scored significantly higher than the infected patient group. Greater severity of CT scan abnormalities was significantly correlated with poorer receptive and expressive language functioning in the overall HIV-infected sample and a higher discrepancy between receptive and expressive language in the encephalopathic group. CONCLUSION: Pediatric HIV disease is associated with differential receptive and expressive language functioning in which expressive language is significantly more impaired than receptive language. The sibling data and CT scan correlations suggest that the observed language impairments are associated with the direct effects of HIV-related central nervous system disease.

AIDS Dementia Complex↗

PubMed1990

Cerebral language lateralization: evidence from intracarotid amobarbital testing.

Cerebral language lateralization was investigated in 103 patients undergoing intracarotid amobarbital testing as part of their diagnostic work-up for epilepsy surgery. Inclusion criteria included adequate bilateral intracarotid amobarbital studies and no radiologic lesion in areas other than the temporal lobe. Language was evaluated with respect to strict presence or absence of language representation, in which a patient was considered to have bilateral language despite potentially having asymmetric language representation, and with respect to forced relative hemispheric dominance, in which a single side could be considered dominant despite bilateral language representation. Seventy-nine patients displayed exclusive left hemisphere language representation, two patients showed exclusive right hemisphere language representation, and 22 patients had language represented in each hemisphere. In the 22 patients with bilateral language, an asymmetry was present in 17 cases (13 L greater than R, 4 R greater than L). These data indicate that language restricted only to the right hemisphere is rare, and that in the absence of purely left hemisphere language, most patients exhibit bilateral representation. Previously reported incidence of exclusive right hemisphere language may be an artifact of dichotomizing a continuous variable.

Amobarbital↗

PubMed2000

Language abilities of 8-year-old preterm children among the northern Finland 1-year birth cohort for 1985-1986.

The language abilities of 42 8-year-old preterm children with birth weight < 1,750 g from a 1-year birth cohort in northern Finland was studied with four different language tests. Control children from the same birth cohort matched individually with their preterm pairs for age, sex, twinship, mother's education, place of residence, birth order and family type were also studied. In psycholinguistic test, auditory skills did not differ between the preterm and the full-term groups. Nor did any other linguistic subtest differentiate between the groups. Instead, the preterm children scored significantly poorer than their controls in visual subtests. The study also showed that the poor performance in visual tests was associated with neonatal morbidity, namely neonatal infections, need for continuous positive airway pressure (CPAP) treatment and patent ductus arteriosus (PDA). When studying the language abilities of preterm children, we suggest that qualitative methods should be used to analyse linguistic skills. We recommend versatile follow-up of preterm children until school age.

Catchment Area, Health↗

PubMed1993

Unsuspected language impairment in psychiatrically disturbed children: prevalence and language and behavioral characteristics.

OBJECTIVE: This study examined the prevalence of unsuspected language impairments in 4-12-year-old psychiatric outpatients. METHOD: Children (N = 399) were routinely screened with standardized language tests, and parents and teachers completed behavioral checklists. RESULTS: Results indicated that of 288 children referred solely for a psychiatric disorder, 99 (34.4%) had a language impairment that had not been suspected previously. These children had more subtle language impairments than did the 111 children referred with previously identified language impairments. Both children with unsuspected and previously identified language impairments had symptoms associated with attention-deficit hyperactivity disorder. Children with unsuspected language impairments had the most serious externalizing behavioral problems. CONCLUSIONS: Attention needs to be paid to screening children for language impairments and to helping adults understand how language disabilities impact on communication and behavior.

Attention Deficit Disorder with Hyperactivity↗

PubMed1977

A new method for the examination of language in aphasics: internal and external reliability coefficients.

A new method is presented to test language, worked out by one of the authors (R.R.L.). Briefly, it consists of the systematic and ordered exploration of the functions from the cortical sensory and motor areas, the interchange of the sensorial information from the sensory to the motor areas. Nine patients with different aphasic syndromes were examined independently from each other. The test was divided in two ranks; the sensory interchange and the motor-oral-manual. The Spearman Correlation Coefficient and its statistical meaning was calculated for each rank. For the internal reliability tests, the results achieved by two successive examination on the same patient were compared by the same explorer. For the external reliability, the results from two sucessive tests on the same patient were compared by two different explorers. The Spearman Correlation Coefficient rate in all the cases varied between 1 and 0.88 with a probability of more than 0.0005 and high statistical significance, with exception of the motor rank of case 4, where it was 0.87 with a probability of more than 0.005 and less than 0.0005 with still some statistical meaning.

Aphasia↗

PubMed2005

Childhood stuttering and dissociations across linguistic domains.

UNLABELLED: The purpose of this investigation was to evaluate the possible presence of dissociations in the speech and language skills of young children who do (CWS) and do not stutter (CWNS) using a correlation-based statistical procedure [Bates, E., Appelbaum, M., Salcedo, J., Saygin, A. P., & Pizzamiglio, L. (2003). Quantifying dissociations in neuropsychological research. Journal of Clinical and Experimental Neuropsychology, 25, 1128-1153]. Participants were 45 preschool CWS and 45 CWNS between the ages of 3;0 and 5;11 (years;months), with the two groups matched by age, gender, race, and parental socioeconomic status. Children participated in a parent-child interaction for the purpose of disfluency analysis and responded to four standardized speech-language tests for subsequent analyses as main dependent variables. Findings indicated that CWS were over three times more likely than CWNS to exhibit dissociations across speech-language domains, with 44 cases of dissociation for CWS and 14 for CWNS across 10 possible comparisons. Results suggest that there may be a subgroup of CWS who exhibit dissociations across speech-language domains, which may result in a greater susceptibility to breakdowns in speech fluency. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize findings from previous studies examining differences in speech and language performance between children who do and do not stutter; (2) describe what is meant by "dissociations" in the speech and language skills of young children who do and do not stutter; and (3) discuss three hypotheses that could account for the present findings that suggest CWS, more often than CWNS, exhibit dissociations in their speech-language system.

Child↗

PubMed2006

Dynamics of language reorganization after stroke.

Previous functional imaging studies of chronic stroke patients with aphasia suggest that recovery of language occurs in a pre-existing, bilateral network with an upregulation of undamaged areas and a recruitment of perilesional tissue and homologue right language areas. The present study aimed at identifying the dynamics of reorganization in the language system by repeated functional MRI (fMRI) examinations with parallel language testing from the acute to the chronic stage. We examined 14 patients with aphasia due to an infarction of the left middle cerebral artery territory and an age-matched control group with an auditory comprehension task in an event-related design. Control subjects were scanned once, whereas patients were scanned repeatedly at three consecutive dates. All patients recovered clinically as shown by a set of aphasia tests. In the acute phase [mean: 1.8 days post-stroke (dps)], patients' group analysis showed little early activation of non-infarcted left-hemispheric language structures, while in the subacute phase (mean: 12.1 dps) a large increase of activation in the bilateral language network with peak activation in the right Broca-homologue (BHo) was observed. A direct comparison of both examinations revealed the strongest increase of activation in the right BHo and supplementary motor area (SMA). These upregulated areas also showed the strongest correlation between improved language function and increased activation (r(BHo) = 0.88, r(SMA) = 0.92). In the chronic phase (mean: 321 dps), a normalization of activation with a re-shift of peak activation to left-hemispheric language areas was observed, associated with further language improvement. The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement. Thereafter, a normalization of activation is observed, possibly reflecting consolidation in the language system.

Acute Disease↗

PubMed2001

Selective mutism: how a successful speech and language assessment really is possible.

A speech and language assessment of children with selective mutism is often difficult because these children are silent in most situations. In Australia, a study was designed to assess the children in their homes, the place where they usually speak. Five children who met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria for selective mutism participated in the study. Assessment included audio-taping extracts of the children's conversations with members of their family and the administration of a number of standardised speech and language tests. The study found that four of the five children had a communication disorder. This paper outlines these communication disorders and describes how a successful speech and language assessment of children with selective mutism is possible.

Child↗

PubMed1994

Fifty years of language maintenance and language dominance in bilingual Hispanic immigrants.

Spanish language tests of 801 Cuban and Mexican immigrants showed no evidence of language loss during 50 years of U.S. residence; a few years after immigration, their English vocabulary approximated that of English monolinguals. The critical-age hypothesis was not supported for the acquisition of English vocabulary when English schooling and language usage were controlled by multiple regression. Most Ss continued to speak about as much Spanish as English; but read, wrote, and heard (on television and radio) far more English than Spanish. Under these conditions, Ss maintained Spanish dominance on tests of vocabulary recognition, lexical decision, and oral comprehension. Dominance was task specific and shifted to English on a category generation task about 12 years after immigration. No evidence of bilingual language interference was found; this is attributed to the strong Spanish foundation of the participants.

Adult↗

PubMed1994

Word skills of children normal and impaired in communication skills and measures of language and speech development.

Results from two related investigations are reported, one using 60 normal language learners, ages 3-5 and one using 34 children with communication disorders, ages 5.4-8.5. Tasks involving the sequential recall of words from five categories (nouns, verbs, adjectives, adverbs, and prepositions) were given to the subjects in each investigation, thus providing an opportunity to compare group performances. A hierarchy of recall strengths of words from different categories and the organizational pattern of scores was determined for each group. Each group's word category scores were used as independent variables in regression analyses to predict scores from a battery of language tests and a test of phonology. The results were anticipated to be capable of contributing to descriptions of children's mental dictionaries, have implications for word category differences in normal and impaired language learners, and clinical relevance. Comparisons of the word recall accuracy of skills of children from each group revealed that the younger normal Ss had word scores equal to the older language and speech impaired children. However, the hierarchy of word category strengths and the patterns of organization within each group's mental dictionary were essentially the same in both groups. Word category scores predicted language and speech scores in both investigations, but the prediction was stronger in the children having impaired language or speech.

Child↗

PubMed2005

Language development in preschool-age children adopted from China.

This study examined the language development of 55 preschool-age children adopted from China who had resided in their permanent homes for approximately 2 years or longer. Slightly over 5% of the children scored below average on 2 or more measures from a battery of standardized speech-language tests normed on monolingual English speakers. However, the vast majority scored within or well above the average range on 2 or more measures. Contrary to other reports on the language development of internationally adopted children, the results suggest that "second first language" acquisition proceeds rapidly in the majority of preschool-age children adopted as infants and toddlers. For the children in the sample who scored below average, results indicated that they were among the children who had been exposed to English for the least amount of time. The results of this study demonstrate both the robustness of the language system in the majority of adopted children from China as well as slower growth in a small subset of lower performers in the 1st years after adoption.

Adoption↗

PubMed1997

Reducing bias in language assessment: processing-dependent measures.

One potential solution to the problem of eliminating bias in language assessment is to identify valid measures that are not affected by subjects' prior knowledge or experience. In this study, 156 randomly selected school-age boys (31% majority; 69% minority) participated in three "processing-dependent" language measures, designed to minimize the contributions of prior knowledge on performance; and one traditional "knowledge-dependent" language test. As expected, minority subjects obtained significantly lower scores than majority participants on the knowledge-dependent test, but the groups did not differ on any of the processing- dependent measures. These results suggest that processing-dependent measures hold considerable promise for distinguishing between children with language disorders, whose poor language performance reflects fundamental psycholinguistic deficits, and children with language differences attributable to differing experiential backgrounds.

Achievement↗

PubMed1993

The effects of early bilateral otitis media with effusion on language ability: a prospective cohort study.

The current study, which is a follow-up on the epidemiological Nijmegen Otitis Media study, examines the relationship between early otitis media with effusion (OME) and later language ability in a group of children with systematically documented bilateral OME. In the Nijmegen Otitis Media study, children were screened using tympanometry at regular intervals of 3 months, between their second and fourth birthdays. At age 7, three groups of children participated in language testing: 82 OME-free children, 151 children with early bilateral OME, and 37 children treated with ventilation tubes at preschool age. A history of OME, even up to nine instances, did not have negative consequences for language performance at age 7. Intermittent, as opposed to more continuous, OME was not found to affect language ability negatively. The suggested benefit of treatment with ventilation tubes was not found.

Child↗

PubMed1997

Receptive and expressive language function of children with symptomatic HIV infection and relationship with disease parameters: a longitudinal 24-month follow-up study.

OBJECTIVES: To longitudinally assess the receptive and expressive language functioning of children with symptomatic HIV disease and to explore the relationship between immune status, computed tomography (CT) brain scan abnormalities, and language dysfunction over time. METHODS: Children with symptomatic HIV infection were administered an age-appropriate standardized comprehensive language test and general cognitive measure prior to starting antiretroviral therapy (n = 44) and again after 6 months (n = 29) and 24 months (n = 17). CD4 percentage and CT brain scans were also obtained at each evaluation. RESULTS: Expressive language was significantly more impaired than receptive language at the baseline, 6- and 24-month evaluations. No significant changes over time were found in receptive or expressive language from baseline to after 6 months of antiretroviral therapy, but despite treatment, language scores declined significantly between 6 and 24 months. Overall cognitive function, however, remained stable from baseline to 24 months. Age-adjusted CD4 percentage increased significantly over the initial 6 months, then remained stable. Overall CT brain scan severity ratings did not change significantly over 24 months. CONCLUSION: Expressive language was consistently more impaired than receptive language over 24 months, further supporting an earlier finding that expressive language was differentially affected by HIV in children with symptomatic disease. Both receptive and expressive language declined significantly after 24 months despite antiretroviral therapy, although overall cognitive function remained stable. Thus, functioning in some domains may be more vulnerable to the effects of HIV and global measures of cognitive ability may mask such differential changes in specific brain functions.

Adolescent↗

PubMed1993

The challenge of interpreting test scores.

In summary, it is clear that the practicing speech-language pathologist needs to demonstrate a working knowledge of some of the basic principles of psychometric measurement in order to effectively interpret the results of commonly employed speech and language tests. It is important that the SLP is familiar with the process used for standardization of tests, as well as the difference between norm-referenced and criterion-referenced tests. It is also critical that the SLP be aware of issues related to validity and reliability, as well as various types of scores associated with tests. While a background in statistics is helpful, it should be noted that the manual that accompanies each standardized test generally includes definitions, explanations, and conversion tables designed to assist the SLP in administering and interpreting the results. Careful study of the manual and a review of any questionable items via an appropriate textbook should assist the SLP in the literal interpretation of test results. In addition to the information obtained from standardized testing, it is also important to consider results of observation of the client and informal testing in order to accurately characterize speech and language behavior.

Data Interpretation, Statistical↗

PubMed2005

Prognostic value of brain perfusion single-photon emission computed tomography (SPECT) for language recovery in patients with aphasia.

AIM: To determine the prognostic value of brain perfusion single-photon emission computed tomography (SPECT) in patients with aphasia after a stroke. METHODS: Brain perfusion SPECT with 99mTc-ethyl cysteinate dimer (99mTc-ECD) was used in 16 right-handed patients with aphasia after a left-sided cerebrovascular accident (CVA) in the early chronic period after the onset of CVA. The region of interest (ROI) method was used to calculate the relative regional cerebral blood flow (rCBF) in each cerebral lobe, the thalamus, the putamen and the cerebellum as ratios to the count in the left cerebellar hemisphere. The Standard Language Test of Aphasia (SLTA) was performed twice, once at the same time as SPECT, a mean of 2.3 months after CVA onset (early SLTA), and again a mean of 17.0 months after CVA onset (late SLTA). In addition to the overall language function score, scores for taking dictation (Dictation), oral reading (Speaking) and comprehension (Comprehension) were calculated, and the correlations with each of the rCBF values were evaluated. RESULTS: Left temporal CBF correlated with the late Dictation score; bilateral frontal, bilateral temporal and right parietal CBF correlated with the late Speaking score; and right frontal, left temporal and left occipital CBF correlated with the late Comprehension score. CONCLUSION: Brain perfusion SPECT in the early chronic stage was shown to be useful for predicting recovery from aphasia, recovery of oral reading, ability to take dictation and comprehension.

Aged↗

PubMed2002

Speech in same- and different-sex twins 4 and 5 years old.

The purpose of this study was to examine the impact of the sex makeup of pairs of twins on language acquisition. Past research indicated that this variable plays a role in speech problems of twin children. The questions raised were whether being a boy or a girl and having a boy or girl co-twin affected linguistic performance. A language test was given to 30 pairs of boy-girl twins, 16 pairs of boy twins, and 16 pairs of girl twins whose average age was 4 years 8 months. Their test scores confirmed our hypotheses. The poorest performance was obtained by the boy twin pairs and the best performance, by either the girl twin pairs or the different-sex pairs. The results were interpreted in the light of findings on language learning differences between girls and boys, and also in terms of Vygotsky's zone of proximal development.

Child, Preschool↗