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PubMed2005

7. Language disorders and autism.

Early diagnosis of language disorders and autism is important, and early intervention for autism and some language disorders makes a difference. Developmental surveillance of children to detect these disorders should be a routine part of medical practice. The persistence and pervasiveness of communication and socialising deficits differentiate children with autism from those with specific developmental language disorders. Hearing and vision assessment is essential in any communication disorder. Interventions, targeted to identified areas of need, should encompass communication enhancement, behavioural therapy, educational modification, parent education and family support. Pharmacological interventions have an important but discrete role in autism, but there are no magic bullets. It is important to remember that the normal childhood illnesses occur in children with developmental disorders. Parents should be directed to reliable websites on the Internet, and given information and books to read as well as phone numbers of relevant services (eg, autism associations). There is a need for increased government financial support for early intervention programs.

Autistic Disorder↗
PubMed2005

[Specific language disorders: their diagnosis, classification and study using magnetoencephalography].

INTRODUCTION: Specific language disorder (SLD) is defined as a disorder in which language is slow and retarded with respect to the patient's chronological age, and which is not related to a sensory-auditory or motor deficit or to a pervasive development disorder; in other words, structural and functional neurological developmental disorders must be excluded. After many studies and attempts to reach an agreement, specific language disorders have been broadly classified into two groups: specific expressive language disorder and specific receptive-expressive language disorder. AIMS: Our objective was to study SLD using magnetoencephalography (MEG) in order to look for epileptiform manifestations in precise language areas. PATIENTS AND METHODS: We studied a sample made up of 11 patients with SLD, one of whom had Landau-Kleffner syndrome and one with cryptogenic-type SLD. The criteria used were age-dependent autism exclusion tests and specific language tests for SLD. The MSI technique was carried out on all the patients, by magnetic resonance and MEG. RESULTS: A characteristic pattern is obtained for SLD in the form of irregular spike and polyspike-wave discharges in bilateral frontal channels. The dipoles were situated mainly in the left perisylvian areas. CONCLUSIONS: The study of specific language disorders using MEG enables us to identify the SLD included in a proposed classification as primary-type specific language disorder, cryptogenic-type specific language disorder and secondary-type type specific language disorder, like Landau-Kleffner syndrome.

Language Disorders↗
PubMed2005

Interdisciplinary and prospective studies necessary to increase insight into developmental language disorders.

UNLABELLED: The study of developmental language disorders is discussed from an interdisciplinary perspective. It is argued that retrospective studies have provided valuable information on developmental language disorders that needs to be integrated into a theoretical model capable of capturing the basic mechanisms of language development. CONCLUSION: It is concluded that interdisciplinary and prospective studies and theoretical work are necessary to increase insight into developmental language disorders.

Child↗
PubMed1985

Constructive comprehension abilities exhibited by language-disordered children.

Constructive comprehension abilities were compared in a group of 12 language-disordered children (second graders) and two groups of children acquiring language normally (12 second graders matched to the language-disordered subjects on nonverbal cognitive skills and 12 kindergartners matched on language comprehension). Differences were examined in proficiency of the children in constructing spatial and causal inferences associated with short stories presented in a Verbal Task and Picture Task. The language-disordered group scored significantly lower on inference items than the cognitively matched control group of second graders on both tasks. A conditional analysis indicated that even when the language-disordered subjects appropriately answered the relevant premise items, they were significantly less likely than the second-grade controls to correctly respond to inference items on both tasks. There was no significant difference between the language-disordered and kindergarten children for either the overall or conditional analysis. The finding that language-disordered children evidenced difficulty in inference construction for both verbal and pictorial material was interpreted as being indicative of a cognitive deficit.

Child↗
PubMed2002

High incidence of language disorder in children with focal epilepsies.

To investigate the relationship between the presence of language disorder, type of epilepsy, and epileptic seizures in childhood, language levels, types of language impairment, and aetiologies were examined in 109 children, aged between 5 and 17 years, attending a national children's epilepsy assessment unit over a 4-year period. There were 70 males and 39 females. Median age was 11 years 4 months (range 5 to 18 years 9 months). In addition to neurological assessment, simultaneous video and EEG monitoring and prolonged ambulatory EEG, each child underwent a comprehensive series of multidisciplinary tests, including intelligence, language, and communication assessments. Classification of seizures and epilepsy syndromes was agreed in conference by a physician specializing in childhood epilepsies, a paediatric neurologist, and a neuropsychiatrist. Other test procedures were administered by a speech and language pathologist with assistance from a neuropsychologist when relevant. Level of language disability in these children was associated with a range of aetiological factors. Evidence was found of a significant number of associations between focal epilepsies, certain seizure types, and language disorder. Of the 46 (42.2%) children with language disorders in the research sample, 30 had localization-related epilepsies and a further three had epilepsies which were undetermined as to whether focal or generalized. Children with focal epilepsies were 30% more likely to have language disorder than other language disability subtypes. The research demonstrated a clear though often subtle association between focal (localization-related) epilepsy and language disorder, indicating an increased risk in this patient group. Children with simple or complex partial seizures were more likely to have language disorder than other language disability subtypes; they also tended to have the lowest number of seizure types per case. This is of importance to clinicians managing children with epilepsy and has implications for their educational and social welfare.

Adolescent↗
PubMed1985

Use of abstracts, orientations, and codas in narration by language-disordered and nondisordered children.

In this study language-disordered and nondisordered children viewed a nonverbal film, wrote the story, and narrated it to language-disordered and nondisordered peers who were unfamiliar with the film. The narratives were analyzed for the use of abstracts, orientations (background information), and codas. Language-disordered children made fewer references to the orientation clauses of props and activities than nondisordered children. Neither group modified their language in the areas examined to take into account the communicative status of their listeners. Therapeutic implications for the language-disordered children are presented as are suggestions for future research.

Child↗
PubMed1998

[Diagnostic value of ERTL4: a screening test of language disorders in 4-year-old children].

BACKGROUND: Language disorders in children are frequent and may sometimes severely affect their development. ERTL4 (screening test for language disorders of children aged 4) is the first test for screening language disorders to be used by doctors. It has not yet been evaluated. AIM: The objective of this study is to assess and optimize the diagnostic value of the ERTL4 test and to evaluate its potential interest as a screening test. MATERIAL AND METHODS: A sample of 370 children was randomly constituted among children aged between 3 years 9 months and 4 years 6 months from schools in Nancy, France and surrounding areas. These children undertook both the ERTL4 test and a standardized examination of language and speech as a reference. RESULTS: Among the 325 children included in the analysis, 34.1% presented with disorders requiring speech and language therapy. ERTL4 sensitivity and specificity were 88.6% and 66.8%, respectively. Varying thresholds for disorder diagnoses and proposals for a modified test led to a sensitivity of 72.9% and a specificity of 91.0%. The proportion of well-classified subjects improved from 73.8% to 85.3% (P < 10(-3)). The positive predictive value was 78.7% and the negative predictive value was 88.1% (with the observed frequency in the sample). CONCLUSION: ERTL4 is a good test for doctors to screening of children's language disorders and their management.

Adolescent↗
PubMed1980

Behavior problems in children with pure speech disorders and in children with combined speech and language disorders.

Forty-six children with pure speech disorders and 53 children with disorders of both speech and language were rated by parents and teachers for behavioral problems. Both parents and teachers rated the speech- and language-disordered children as having more severe and more frequent behavioral abnormalities, particularly hyperactive behaviors and developmental problems. Somatic complaints were more pronounced in the pure speech group. Conduct disorders, emotional problems, and poor relationships did not distinguish between the two groups. The importance of these findings for speech therapists and individuals working with speech- or language-impaired children is discussed.

Anxiety↗
PubMedDate not supplied

Screening for speech and language disorders: the reliability, validity and accuracy of the General Language Screen.

This paper reports the reliability, validity and accuracy of the General Language Screen (GLS) as the first stage in its development as a potential screening instrument for the identification of speech and language disorder (SLD) in the primary care setting. Data reported were obtained during the Cambridge Language and Speech Project (CLASP) a longitudinal epidemiological study of primary SLD. The GLS was originally used in initial CLASP sample ascertainment when children were aged 36 months. This report utilises speech and language data collected at subsequent stages of this study (37-months, 45-months and 8-years) to determine the reliability, validity and accuracy of the GLS. The GLS demonstrated sufficient levels of reliability (internal consistency alpha = 0.74) and validity (criterion validity r = -0.55). Adequate construct validity was demonstrated by a factor analysis in which two language related factors were identified. These data therefore justified exploration of the accuracy of the GLS as a screening instrument. Analysis of accuracy in this context is complicated by lack of a generally accepted method of defining SLD case status. This report utilises data on language function at different stages of development to provide measures of GLS accuracy over time. Concurrent accuracy, measured against parental report of language function at 37-months, was good (ROC area under the curve = 0.93). Predictive accuracy measured against direct assessment of speech and language at 45-months and 8-years was, as expected, somewhat less (ROC = 0.77 and 0.68 respectively). The implications for the use of the GLS as a screening instrument are discussed. The data indicate that the GLS would function most usefully as the first stage of a two-stage screen for SLD in the primary care setting. Recommendations are made as to the nature of the second stage of such a screen and plans for future research are outlined.

Child↗
PubMed1981

Developmental language disorders: cognitive processes, semantics, pragmatics, phonology, and syntax.

Five areas of research concerned with language acquisition--cognitive processes, semantics, pragmatics, phonology, and syntax--are reviewed in terms of their contribution to understanding language disorders. Two views of cognitive processes are discussed. One of these, emphasizing cognitive mechanisms such as short-term memory, is seen as providing possible explanations for some types of language deficits. The other, a concern with conceptual knowledge, is subjected to a critical analysis questioning how complete an explanation it is able to offer for some aspects of language acquisition. Problems of definition are also discussed when semantic aspects of language are considered. Problems in the pragmatic component of language are seen as providing an explanation for particular aspects of language disorder in some autistic children. The importance of focusing on phonology as a central grammatical process is discussed and linked to dyslexia and to spelling disorders. Finally, it is argued that the acquisition of syntactic structure is not yet understood. Impairments such as a hierarchical planning order deficit may affect syntactic ability and lead to disordered language, as found in some types of developmentally aphasic children. It is concluded that it is important to study all five areas of the title, and their interrelationships, if various language disorders are to be adequately understood.

Child, Preschool↗
PubMed2003

The relationship between membrane pathology and language disorder in schizophrenia.

Receptive language disorder in schizophrenia has been hypothesized to involve a fundamental deficit in the temporal (time-based) dynamics of brain function that includes disruptions to patterns of activation and synchronization. In this paper, candidate mechanisms and pathways that could account for this basic deficit are discussed. Parallels are identified between the patterns of language dysfunction observed for schizophrenia and dyslexia, two separate clinical disorders that may share a common abnormality in cell membrane phospholipids. A heuristic is proposed which details a trajectory involving an interaction of brain fatty acids and second-messenger function that modulates synaptic efficacy, and, in turn, influences language processing in schizophrenia patients. It is additionally hypothesized that a primary deficit of functional excitation originating in the cerebellum, in combination with a compensatory decrease of functional inhibition in the prefrontal cortex, influences receptive language dysfunction in schizophrenia.

Brain↗
PubMed1985

Production and comprehension of narrative discourse in normal and language disordered children.

Children's use of cohesion in spoken narratives was compared across three groups: normal, language disordered with good story comprehension, and language disordered with poor story comprehension (CA: 7:6-10:6). Comprehension was defined by the children's responses to questions structured to assess both factual information and knowledge of episodic relationships. Results indicated that the good comprehending language disordered children and the normal children used similar linguistic cohesive structures, but both groups differed from the poor comprehending language disordered children. Both groups of language disordered children used less adequate cohesion than the normal children. Discussion and conclusions are presented on the various levels of language ability that contribute to narrative discourse.

Child↗
PubMed1993

Relationship between language and fluency in children with developmental language disorders.

The present investigation addresses two primary hypotheses: (a) that a subset of children with developmental language disorders exhibits significantly more disfluencies than other children with language disorders and (b) that differences between the disfluent and nondisfluent groups observed in fluency may be related to differences in language deficits. Spontaneous language samples from 60 preschool children with developmental language disorders were analyzed for frequency and type of disfluencies. Comparisons of the frequency of disfluencies across subjects revealed that a subset of 10 subjects exhibited significantly more disfluencies than the other subjects with language disorders. Demographic, intelligence, and language variables were compared across the two groups to determine whether such factors could account for the differences in fluency. The subjects with greater percentages of disfluencies were found to be significantly older and demonstrated significantly higher scores on two standard measures of vocabulary. These findings were interpreted in light of two models of disfluencies: the neuropsycholinguistic (Perkins, Kent, & Curlee, 1991) and Demands and Capacities (Adams, 1990; Starkweather, 1987). This suggests that some children with language disorders are at risk for fluency breakdown because of dysynchronies in the development of lexical and syntactic aspects of language or as a result of mismathces between speaking demands and capacities.

Age Factors↗
PubMed1984

Play assessment in the differential diagnosis of autism and other causes of severe language disorder.

The autistic child's problems with language may be an impairment in symbolic functioning that affects all forms of communication, including representational thought and the ability to play creatively. The hypothesis that autistic children specifically do not project symbolic meaning onto toys (which is not associated with other conditions causing severe language disorder) was tested in a group of 15 severely language-impaired children. Data were obtained from a parent interview/questionnaire and analysis of a video-taped play session. The findings suggest that language-disordered children who meet DSM III criteria for autism most consistently show absence of symbolic play, and those who do have symbolic play fall into a wide range of diagnostic categories excluding autism. The report presents valuable observational and interpretational clinical factors, useful in the assessment and differential diagnosis of a language-impaired child.

Adolescent↗
PubMed1982

A comparison of request-response sequences in the discourse of normal and language-disordered children.

This study compared several discourse characteristics of linguistically normal and language-disordered children. In order to examine interactive skills, several types of request-response sequences were considered. These included choice questions, product questions, request for clarification, and the responses elicited by these speech acts. While neither the linguistically normal nor the language-disordered groups had achieved an adult level of competence, normal children were much more aware of the interactive nature of discourse than language-disordered children. Normals most often responded within the boundaries of an acceptable adult response. Language-disordered children frequently ignored and responded inappropriately to requests. Their responses were occasionally contrary to fact or totally unrelated to the expected information. Some language-disordered subjects also demonstrated linguistic strategies that facilitated the flow of conversation, but showed no understanding of the content of the communicative interchange. The clinical implications of these findings and the need for further research are discussed.

Child↗
PubMed1985

Effects of presentation rate and divided attention on auditory comprehension in children with an acquired language disorder.

We examined why auditory comprehension in language-disordered children improves when the rate of presentation of speech is slowed. Seven children with an acquired language disorder associated with a convulsive disorder participated in two divided-attention tasks in which pairs of sentences were presented simultaneously. Subjects were instructed to respond first to the sentence produced by a male speaker (primary sentence) and then to the sentence produced by a female speaker (secondary sentence). In the first condition, both sentences were presented at a normal rate of speech. In the second condition, primary sentences were time expanded 75%, and secondary sentences were presented at a normal rate. We hypothesized that when the primary sentences were presented slowly, spare attention would be available for processing the secondary sentences. Results showed that slowing the presentation rate of the primary sentences significantly improved performance on the secondary sentences, even though secondary sentences were presented at a normal rate of speech. Hypotheses of generally slowed processing of auditory information in language-disordered individuals cannot account for these results. They are consistent, however, with a model of defective attention allocation.

Attention↗
PubMed1983

Mental rotation abilities in language-disordered children.

This study investigated the possibility that language-disordered children suffer a pervasive representational deficit. A mental rotation task was used to measure proficiency in visual imagery, one of the major nonlinguistic symbolic modes. Normal and language-disordered first and third graders (matched for sex and cognitive level) were asked to decide whether two geometric arrays were similarly ordered. Arrays were presented parallel or with the right hand array rotated about its center either 45 degrees, 90 degrees, or 135 degrees in the picture plane. A significant (p less than .001) linear relationship between degree of rotation and reaction time indicated that children in all groups were using imagistic processes. Language-disordered children did not differ from normal children in accuracy of judgment or require more training trials, but they did respond more slowly (p less than .02). These findings suggest an impairment of visual imagery and hence representational deficits which extend beyond language. Current evidence does not, however, indicate whether difficulties with nonverbal and verbal symbolic modes stem from a single source.

Child↗
PubMed1989

Pathophysiologic findings in nonretarded autism and receptive developmental language disorder.

In nonretarded autistic, receptive developmental language disordered, and normal subject groups, we recorded in auditory and visual target detection tasks two neurophysiological components of the event-related brain potential, Nc and P3b. Existent research shows that, in normals, Nc and P3b appear early in development, are associated with attention and memory processes, and are endogenous which means that they are triggered by internal, consciously initiated attentional and cognitive mechanisms and that they can be triggered even by the omission of sensory stimulation so long as it has meaning or importance for the subject. In this report, Nc and P3b were recorded in response to auditory and visual stimulation and to the omission of auditory and visual stimulation. Consistent with the hypothesis that non-retarded autism involves abnormal attentional and cognitive responses to important information, P3b was found to be smaller than normal and Nc was small and often absent in the nonretarded autistic group even under the condition when no auditory language or sensory processing was required. Receptive developmental language disorder has been linked with difficulties in processing sequences of auditory stimuli, and in this study P3b was found to be somewhat enlarged in this group even under the conditions when P3b was elicited by stimuli separated by 1 sec and also when P3b was elicited by the omission of stimulation.

Action Potentials↗