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PubMed2006

Elaboration of a rehabilitation method based on a pathogenetic hypothesis of "theory of mind" impairment in schizophrenia.

"Theory of mind" skills have repeatedly been shown to be impaired in schizophrenic patients. The purpose of this paper is to develop a therapeutic intervention targeting schizophrenic patients' abilities to attribute mental states to others. This preliminary study tried to test the hypothesis that this kind of intervention should improve patients' communication abilities; we also wondered if this would have a positive impact on their more general psychopathology. Eight chronic schizophrenic patients were asked to analyse video scenes (showing interactions between two or more persons), with particular attention being paid to the characters' mental states. Their clinical assessments (general clinical symptoms, communication, and the ability to attribute intentions to others, rated before and after two training sessions, over a one-week period) were compared with those of a control group of six chronic schizophrenic patients. The results support our hypothesis of a possible improvement of patients' communication disorders and an improvement of their abilities to attribute intentions to others. The more general psychopathology ratings, however, remained unchanged. Although these results need further development and confirmation, they suggest a possible promising approach for psychosocial rehabilitation therapies based on "theory of mind" skills.

Adult↗
PubMedDate not supplied

[Basic disorders in human communication].

This paper specifies the areas and disorders that concern human communication medicine. The frequency of the diverse disorders is analyzed in relation to age and sex, and the distribution in group ages of several disabling diseases is also discussed.

Adult↗
PubMed2001

Teacher/therapist collaboration: a Scottish higher education institution development.

The collaborative work is described of a principal speech and language therapist (SLT) and a lecturer in a college of education in Scotland in writing and evaluating a Post Graduate Award Scheme (PGAS) module. This was in response to Her Majesty's Inspectorate's (HMI) (1996) recommendation that teacher education institutions should 'consider the in-service and post-graduate training needs of those working with pupils with language and communication disorders and autism'. Official Scottish Executive Education Department (SEED) statements were examined by analysing HMI (1996) and subsequent official documents. Higher educational (HE) institution statements were read in the PGAS handbook and in the module descriptor (Northern College 1998). Accounts of change are described in the thinking and practice of course members as a result of the module and the implications for future module development are considered.

Child↗
PubMed1998

Themes in diagnostic decision making.

The diagnosis of communication disorders is a complex clinical task that can have significant clinical, social, and economic consequences for the patient. This issue is about the conceptual process by which clinicians perform this important clinical task. Through the presentation of ten clinical cases, experienced clinicians illustrate a variety of diagnostic decision-making approaches that can be used to answer important clinical questions. In this initial article, the diagnostic themes that have emerged from these cases are summarized and four diagnostic strategies that can be used in making clinical diagnoses are discussed.

Communication Disorders↗
PubMed1997

Peer social networks of young boys with developmental delays.

Community-based peer social networks of young boys with developmental delays and parental arranging and monitoring of their child's peer contacts were examined. Comparisons were made to matched groups of children who were developing typically and to children with communication disorders. Results showed more limited peer social networks for both groups of children with disabilities based primarily on the frequency of contacts with peers and linkages established across school and community settings. All three groups were indistinguishable from one another on numerous measures of peer social networks, including duration and quality of individual relationships and participation in organized group activities with peers. Groups also differed on parental arranging and monitoring, which appeared to be related to children's developmental level.

Analysis of Variance↗
PubMed2000

Cleft palate: modern technology and neuroscience merge.

This is a report of a cleft palate-craniofacial team's experience with 768 patients that have had clefting over 22 years, with a primary focus on function and prevention of communication disorders associated traditionally with cleft palate. The treatment philosophy is based on tenets of child development and the dependency of neuropsychobiological development on the child's inherent competency, and early environmental stimulation and support. The applied treatments include ensuring early and adequate hearing, psychosocial adaptation of the parent and child through training for applications of indirect therapies, and early fistula-free surgical closure of the cleft that produces minimal scarring and a mobile velum. Team members have extensive backgrounds in child development that seem to have helped the majority of families in their complex efforts of daily care and sensory stimulation, and their children have developed early the ability to adapt modified structures to normal functions. Only one of these patients has needed or received secondary palatal surgery for correction of velopalatal insufficiency. Fifty-six children who did not achieve acceptable 2 to 3-year old communication criteria were referred for speech and language evaluation and therapy. These patients were reported to exhibit oral motor deficits described as developmental verbal dyspraxia.

Apraxias↗
PubMed1987

Prevalence and type of psychiatric disorder and developmental disorders in three speech and language groups.

Six hundred children with communication disorders presenting to a community clinic were evaluated for psychiatric and developmental disorders. The 600 children fell into three subgroups: those with "pure speech disorders," those with "speech and language disorders," and those with "pure language disorders." The two subgroups with language involvement had higher rates of both psychiatric and developmental disorders than the children with pure speech involvement. Those children with language involvement also had a different pattern of psychiatric diagnoses than the children with pure speech disorders. Possible etiological factors and clinical significance of these findings are discussed.

Child↗
PubMed2006

Conductive hearing loss and otopathology in cleft palate patients.

OBJECTIVES: Assess incidence of conductive hearing loss, ear pathology, and associated communicative disorders in cleft palate patients. STUDY DESIGN: Retrospective chart review of 101 patients all treated at a tertiary facility since birth. RESULTS: The median patient age was 19 years old (range 8-25) at last follow-up, 35% female. Median age of cleft palate repair was 16 months (range 12-60). Median number of myringotomy tubes was 3 (range 1-7). Conductive hearing loss (CHL) greater than 20 db PTA was found in 25% of patients at last follow-up. Severity of CHL was mild in 75%, moderate in 21%, and severe in 4%. Cholesteatoma was identified in 5.9%. The mean age at resolution of CHL was 5 years (range 3-19). Risk factors associated with CHL at last follow-up included middle ear surgery (P = 0.016), cholesteatoma (P = 0.003), and 4 or more myringotomy tube insertions (P = 0.030). Associations between CHL and age at cleft repair, speech impairment, or learning disabilities were not found. CONCLUSIONS: Children requiring increased number of myringotomy tubes and middle ear surgery and found to have cholesteatoma are at increased risk for long-standing CHL. EBM RATING: C-4 SIGNIFICANCE: Cleft palate children requiring multiple tube insertions should be monitored closely for CHL.

Adolescent↗
PubMedDate not supplied

Communication problems in Turner syndrome: a sample survey.

Turner syndrome is a condition first recognized in 1938 with an incidence estimated at 1/2500 female births. It is known to result from a missing X chromosome and has as its main features a short stature, ovarian dysgenesis, neck webbing, congenital peripheral lymphedema, coarctation of the aorta, cubitus valgus, dysplastic nails, and pigmented nevi. In addition, psychosocial difficulties including communication disorders may occur. While the physical characteristics of Turner syndrome have been well documented, information on the communication problems in Turner syndrome is scarce. This study reports the results of a sample survey in 128 girls with Turner syndrome ranging in age from 2.4 to 58.8 years. Results are presented on the occurrence and nature of speech and language problems (voice disorders, articulation problems, stuttering, and delayed language development), on the presence of learning disabilities, and on educational history.

Adolescent↗
PubMedDate not supplied

Partner effects in adolescent conversations.

UNLABELLED: Twenty-four adolescents participated in social conversations with a same-sex peer, an opposite-sex peer, or a speech-language pathologist (SLP) or graduate student. The conversations were compared in regard to specific verbal and nonverbal behaviors, with the goal of identifying conversational behaviors that may be assessed with validity in a clinical setting. Significant differences were found in speaker and listener linguistic behaviors between conversations with peers and those with clinicians. A trend towards the increase in speaker nonverbal behaviors was also noted with clinician partners. Conversations with opposite-sex peers tended to be characterized by fewer direct questions, reduced listener eye contact, and increased listener nonverbal behaviors than those with same-sex peers. Several behaviors occurred rarely in any group, including physical contact between partners and requests for clarification; others occurred with high frequency in all groups, including eye contact and emotional expression. The implications of these patterns for persons with communication disorders are considered. EDUCATIONAL OBJECTIVES: (1) To describe communication behaviors that may be measured in adolescent conversations. (2) To identify those communication behaviors that may be influenced by factors related to the conversation partner.

Adolescent↗
PubMed2003

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.

Adolescent↗
PubMed1999

Detecting Attention Deficit Hyperactivity Disorder in a communications clinic: diagnostic utility of the Gordon Diagnostic System.

This study examines the sensitivity, specificity, predictive values, and likelihood ratios of laboratory measures of attention and impulsivity (the Gordon Diagnostic System; GDS) in 99 school-aged boys with a history of suspected language disorders. Classification analyses comparing scores from these tests with parent and teacher ratings of attention deficit hyperactivity disorder (ADHD) symptoms revealed low positive predictive values (20.0% to 36.8%) and high negative predictive values (71.9% to 87.9%). Likelihood ratios for abnormal test scores were low to moderate (0.74 to 1.73), suggesting that these tests may not accurately identify children with ADHD. Likelihood ratios for normal scores were also low to moderate (0.41 to 1.16). These findings suggest that GDS scores have clinical utility in ruling out a diagnosis of ADHD, but not in confirming the diagnosis in a clinic population of boys with communicative disorders who are at risk for developing ADHD.

Attention↗
PubMedDate not supplied

Rehabilitation of the communicatively impaired stroke patient.

The stroke patient who has lost the ability to communicate has lost more than the ability to talk. To one degree or another, he has lost the ability to understand his environment, the ability to structure his thought process internally in a logical and meaningful order, and the ability to formulate language in a logical and meaningful order. The ability to structure one's thoughts and ideas internally, as well as the ability to communicate them to others, are intrinsic factors in an individual's ability to motivate himself to establish a goal and to pursue the acquisition of that goal. Therefore, the successful physical rehabilitation of the stroke patient with a communication disorder rests heavily upon an understanding and a resolution of his communication problem.

Aphasia↗
PubMedDate not supplied

[Communication interventions: windows of opportunity].

OBJECTIVE: An understanding of how verbal and non verbal language develops and how it is related to social behavior is essential in order to devise effective interventions for children with disorders of communication. We review the literature on interventions for children with communication disorders from the perspective of the clinical neurologist emphasizing both therapeutic and pharmacological interventions. FINDINGS: Our knowledge on effective interventions in children with disorders of communications is limited due to the heterogeneity of the population and the lack of well controlled studies. There is some limited data suggesting that therapeutic interventions for children with language impairments are most effective if all forms of communication are emphasized. Interventions should be adapted to the age of presentation and associated clinical findings of the child. CONCLUSIONS: A multimodal intervention approach is essential to maximize the potential of children with communication disorders. The role of medication in interventions for children with disorders of communication is limited to the treatment of associated symptoms that may interfere with the ability of a child to receive non pharmacological therapeutic interventions.

Brain↗
PubMed1990

The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education.

We report the prevalence rates for dementia and Alzheimer's disease (AD) obtained from a probability sample survey of 5,055 noninstitutionalized older persons in Shanghai, China. A two-stage procedure was used for case finding and case identification. A Chinese version of the Mini-Mental State Examination was used to determine cases of possible dementia. Three different cutoff points on this mental status test were used depending on the respondent's level of education. Clinical evaluations, based on functional assessments and psychiatric interview, medical and neurological examinations, three standardized mental status tests, and a selected group of psychometric tests, were made in the second stage of the study to ascertain the clinical diagnosis of dementia and AD utilizing the Diagnostic and Statistical Manual for Mental Disorders, edition 3 and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, respectively. The prevalence rate of dementia in persons 65 years and older was 4.6%. Clinically diagnosed AD accounted for 65% of the subjects with dementia. These findings indicate that the prevalence of dementia in Shanghai is very much higher than figures published earlier for China and Japan, and at the lower part of the range of values reported for community residents in the United States and other Western countries, but less than half of that reported in the recently published survey of the elderly in East Boston. Increasing age, gender (female), and low education are each highly significant and independent risk factors for dementia. One hypothesis to explain the increased prevalence in elderly women who had received no formal education invokes the possibility of an effect of early deprivation, perhaps lowering brain "reserve," allowing the symptoms of dementia to appear at an earlier date during disease progression.

Age Factors↗
PubMed2005

Clinical diagnosis and management of Alzheimer's disease.

The diagnosis of dementia of the Alzheimer's type is defined by criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the National Institute of Neurologic, Communicative Disorders and Stroke-AD and Related Disorders Association. The latter divides diagnosis into definite, probable, and possible Alzheimer's disease (AD), with definitive diagnosis requiring pathologic confirmation. Both criteria require that other causes of dementia are excluded. A diagnosis of AD can be made with reasonably high accuracy using a combination of clinical criteria, neuropsychologic testing, and conventional CT and MR imaging. There is increasing emphasis on early recognition. Although current therapies produce a mild improvement in symptoms, there are several disease-modifying therapies on the horizon. This article reviews current standards in clinical diagnosis and management.

Aged↗
PubMed2005

Dementia and Alzheimer's disease in community-dwelling elders taking vitamin C and/or vitamin E.

BACKGROUND: Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events. OBJECTIVE: To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American and white individuals delayed incident dementia or Alzheimer's disease (AD). METHODS: We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-representative persons aged 65-105 years living in 5 adjacent counties in North Carolina, and followed them for dementia (1986-1987 through June 2000). Information gathered during in-home interviews included sociodemographic characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimer's Disease, with final determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision, and National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders criteria. RESULTS: Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of subjects at baseline) nor high-dose use reduced the time to dementia or AD. CONCLUSIONS: In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not delay the incidence of dementia or AD.

Aged↗