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Evaluation for suspected language disorders in preschool children.

Pediatricians can identify a child with a developmental language disorder by expanding a traditional developmental assessment with special screening tests of language skills. They can direct parents to specialists who can define the nature of the language disturbance in more detail and predict its natural history. They must then support the parents as they learn to use the community resources available for remediation of their child. As more is learned about the biologic bases of normal and abnormal language development in children, pediatricians will undoubtedly have an even more central role in identification of patients with language disorders and education of their families.

Child Language

The relationship between perceptual dysfunction and language disorders: a case report.

The acquisition of language is discussed in relation to two specific perceptual processes: first, identification and discrimination of recurring aspects of an experience, and second, integration of the language form with the specific aspect of the event being represented. The analysis of the language of a child with perceptual and integrative deficits revealed expressive use of language without comprehension and limited knowledge of concepts. Explanations of these behaviors are presented in light of the child's perceptual and integrative dysfunctions. Implications for clinical management of a perceptually based language disorder are discussed.

Child

Prevalence of unsuspected language disorders in a child psychiatric population.

Nonretarded 5- to 12-year-old consecutive referrals to a child psychiatric outpatient clinic underwent a routine systematic language assessment. The assessment battery comprised standardized measures of the receptive and expressive components of syntax, semantics, and phonology. Standardized behavior rating scales also were completed by parents. Of the children referred solely for a psychiatric problem, 28% had a moderate or severe language disorder that previously had not been suspected or diagnosed. These children differed from a comparison group of children with both psychiatric and language disorders in that they were younger and more likely to have an externalizing behavioral problem. The findings indicate that there is a sizeable proportion of children whose language disorders are overlooked possibly because of their disruptive behavior. This suggests the need for routine screening of language in child psychiatric populations.

Child

Cohesion repairs in the narratives of normal-language and language-disordered school-age children.

The self-initiated repairs produced by 14 normal-language and 14 language-disordered children during a story retelling task are described. When grammatical repairs and repairs to text meaning were analysed, no group differences were found for either repair type. Both groups initiated significantly more repairs to text meaning. When repairs to text meaning were probed for the cohesive aspects of the repair activity, there were no group differences for the frequency or the types of cohesive repairs that were initiated. However, differences were significant for the success of the cohesive repair attempts and for the location of the repairs. Normal-language and language-disordered children appear to share similar strategies for monitoring narrative discourse, but they differ in their abilities to actualize their monitoring attention.

Child

The validity of discrepancy criteria for identifying children with developmental language disorders.

Empirical data from two studies address the clinical validity of discrepancy criteria for identification of children with developmental language disorders (DLD). Study 1 involved 256 preschoolers clinically defined as DLD and meeting inclusionary criteria for normal hearing, intellectual, neurological, and psychiatric status. Application of alternative psychometrically derived discrepancy criteria identified only 40% to 60% of the clinically defined group as language disordered. Study 2 applied nonverbal IQ-language performance discrepancy criteria to 368 eight-year-old, randomly selected control subjects, resulting in over 45% of the controls being identified as DLD. Factors contributing to underidentification in Study 1 and over-identification in Study 2 are discussed, raising questions regarding the validity of discrepancy criteria for identification of DLD children.

Achievement

Rapid auditory processing in normal and disordered language development.

Four-and-one-half- to eight-and-one-half-year-old children with normal language development, normal adults, and dysphasic children were tested for their ability to perceive binary sequences of nonverbal auditory stimuli. Performance was studied in relation to the rate of presentation of stimulus sequence, as measured by the time interval between stimulus elements. Of the normal children studied, only the eight-and-one-half-year-old group responded as well as the adult group to auditory patterns composed of complex tones presented in rapid succession (8-305 msec intervals). Normal children six-and-one-half years and older were able to respond to these same auditory patterns when they were presented more slowly (947-4026 msec intervals). The overall pattern of performance of the dysphasic children was not similar to that of any age group of children with normal language development. The dysphasics' performance was significantly poorer than that of even the four-and-one-half-year-old normal group on rapidly presented auditory sequences, but not significantly different from normal children their own age or adults on the same patterns which were presented more slowly. The interrelation of normal development of rapid auditory processing and normal language development is discussed.

Adult

Children with language disorders: natural history and academic success.

Children with developmental language disorders pose specific and unique problems for educators. This article addresses the continuing academic vulnerability of these children during the school years. We advance the position that their academic vulnerability results from the lifelong need to acquire language, to learn with language, and to apply language knowledge for academic learning and social development. Issues are addressed that relate to persistence of language deficits and learning in school.

Achievement

Who shall be called language disordered? Some reflections and one perspective.

This paper discusses some issues involved in identifying children who have language problems. The perspective taken is that (a) the goal of identification must be clearly distinguished from other goals of assessment; (b) identification of children with language disorders is better based on language performance than on inferences about the language knowledge that underlies this performance; (c) language performance must be sampled in more than one context, including, for purposes of identification, contexts that stress the language system; (d) the standards of expectations for comparing performance and determining differences must be explicit; (e) standards used to determine differences are better based on the performance of chronological-age peers than on the performance of children with similar mental abilities; and (f) children who do not evidence poor language performance but are considered at risk for language-related problems should be distinguished from children who demonstrate poor language skills.

Child

[Early management of language disorders].

The audio-language consultations of the Centre d'Audiophonologie of Lyon, France, allow the diagnosis of language delay to be documented in very young children. Based on a five-year clinical study, the authors propose a method of regular follow-up for the child and the parents.

Age Factors

Toe walking. A marker for language disorders in the developmentally disabled.

Toe walking unassociated with an autistic disorder or cerebral palsy generally has been considered a normal infant gait. The incidence of toe walking in various diagnostic subgroups of 799 developmentally disabled children presenting to a tertiary-level multidisciplinary assessment clinic was reviewed to investigate the authors' clinical impression that toe walking may be a marker for language dysfunction. Toe walking was found to be more frequent in those diagnostic subgroups with more severe language disorders. Toe walking also correlated with lower IQ scores (p less than 0.0001). The sensitivities, specificities, predictive validities and odds ratios all supported the hypothesized association between toe walking and language disorders. Further prospective studies of the neurodevelopmental outcome of children with toe walking are needed to determine whether this behavior can identify children at risk for language disorders.

Autistic Disorder

Brainstem auditory evoked potentials in receptive developmental language disorder.

It has been hypothesized that receptive developmental language disorder (RDLD) may be explained by an auditory processing deficit. The neuroanatomical locus of this deficit is unknown. Brainstem auditory evoked potentials (BAEPs) reflect the functioning of the auditory nerve and auditory brainstem pathways to high-frequency acoustical stimulation in humans and reflect the first stages of auditory processing. These were studied in 12 subjects with RDLD (four females and eight males, ages 12 to 19) and twelve control subjects (three females and nine males, ages 14 to 24). Click intensity and rate of stimulation were varied. The BAEPs for the RDLD group were comparable to the control group as well as to hospital norms across intensity levels and stimulation rates. The evidence obtained suggests that a disorder in the neurophysiological systems underlying the BAEPs and reflecting initial stages of auditory processing is not essential for RDLD.

Adolescent

Nonverbal indicants of comprehension monitoring in language-disordered children.

This study investigated normal and language-disordered (LD) children's patterns of nonverbal behavior in response to messages varying in degree of ambiguity. Each LD child was matched to two normally developing children: one for comprehension level (LM) and the other for chronological age (CM). All children participated in a videotaped ambiguity detection task. Nonverbal behaviors that were produced between the time the message was completed and the examiner's acknowledgment of the response were scored for type of behavior exhibited including eye contact, hand behavior, body movement, and smile. Results demonstrated that all subjects increased their nonverbal behavior (e.g. eye contact) from unambiguous to ambiguous message conditions, suggesting awareness of the differences in these message types at a rudimentary level. Most often nonverbal indication was the only signal of ambiguity detection exhibited by the LD children and their LM peers. Only the CM children concurrently indicated awareness through more direct means (i.e., verbalization and pointing to all possible referents) in a consistent and accurate manner. The finding that LD children did differentiate inadequate from adequate messages in a rudimentary manner suggests that clinicians might promote the intentionality of these preintentional nonverbal behaviors as a possible intervention strategy.

Child

A syntax program designed to present base linguistic structures to language-disordered children.

An intervention strategy for teaching syntax to language-disordered children is described, and the results of its use in a controlled study with 11 children are reported. The therapy program attempts to move the child from single words through a series of successive approximations to use of the construct noun + "is" + verbing + noun, incorporating auditory directions and visual stimuli in the form of cards and boards upon which the cards are sequentially ordered. The results of the experimental group who participated in this therapeutic sequence were compared to those of 11 control subjects and suggested significant gains as measured by the pre- to postprogram performance (t = 2.31, p 0.05). Advantages and limitations of this type of intervention strategy are also discussed.

Audiovisual Aids

Conversational aspects of the speech of language-disordered children: revision behaviors.

Revision behaviors in the speech of language-disordered children were investigated. Subjects were 12 children, four at each of Brown's language States I, II, and III. During the taping of a one-hour spontaneous language sample from each child, one of the experimenters pretended 20 times not to understand and asked "What?". The relationship between the child's original utterance and his response to "What?" was analyzed. The results indicated a significantly greater use of revisions than repetitions or no responses at each stage and a pattern of revision behavior that was uniform across stages and qualitatively different from the previously reported patterns of normal children. The results are discussed in terms of the nature of languare disorder and its implications for pragmatic theories of language.

Child

[Language disorders in schizophrenia].

Psychiatrists, psycholinguists and linguists have been interested in the language disorders of schizophrenia. Physicians have described their semiology. Psycholinguists have tried to show their structural alterations, using standardized tests in the fields of syntax, semantics and more recently, prosody. We try to present Benveniste's and Culioli's Enunciation Theory and Irigaray's works. Only a theory which studies the dynamic aspects of language would be of some use for the analysis of schizophrenic language.

Humans

Language disorders in dementia of the Alzheimer type.

The language profile of a group of 18 Alzheimer patients is documented and their performance on a standard aphasia test battery compared to a group of institutionalized, nonneurologically impaired control subjects matched for age, sex, and educational level. The Alzheimer patients scored significantly lower than the controls in the areas of verbal expression, auditory comprehension, repetition, reading, and writing. Articulation abilities were the same in each group. A language deficit was evident in all Alzheimer patients. The language disorder exhibited resembled a transcortical sensory aphasia. Syntax and phonology remained relatively intact but semantic abilities were impaired. The results support the inclusion of a language deficit as a diagnostic criterion of Alzheimer's disease.

Aged

Brainstem and middle latency auditory evoked potentials in autism and developmental language disorder.

Brainstem auditory evoked potentials (BAEP) and middle latency responses (MLR) were studied in 8 nonretarded subjects with infantile autism (mean age = 23.3, SD = 2.8), 8 subjects with receptive developmental language disorder (mean age = 16.3, SD = 1.4), and normal control subjects matched to each group for age, gender, and Performance IQ. Click stimuli were delivered monaurally to the left and the right ear and binaurally for both the BAEPs (70-dB HL, 7/sec) and the MLRs (60-dB HL, 13/sec). Amplitudes and latencies (Waves I to VI), interwave latencies (III-V, I-V, and I-III), and Wave I/V amplitude ratio of the BAEPs were determined for each group. For the MLR study, Wave Na, Pa, and Nb latencies, and Wave Na-Pa and Pa-Nb amplitudes were calculated. There were no consistent differences in the BAEP and MLR characteristics of the control and the experimental groups. These results suggest that the abnormal cognitive processes indexed by the cognitive and attention-related event-related potential components in infantile autism and receptive developmental language disorder are not due to abnormal sensory processing in the brainstem and in areas central to the brainstem whose activity generates the BAEPs and MLRs.

Adolescent