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PubMed1993

Consultation and collaboration programs for individuals with autism.

Students with autism present a challenge to the SLP not only because of the severity of their communication disorders, but also because of the great variety of learning styles and social skills. Collaboration- and consultation-based service delivery systems offer an alternative to traditional therapy for these students. This model uses the strength of a team approach and permits strategies for improving communication that are not possible in other environments.

Adolescent↗
PubMedDate not supplied

Language, articulation, voice and resonance characteristics in 4 children with Goldenhar syndrome: a pilot study.

The purpose of this study was to describe the language, articulation, voice and resonance characteristics in children with Goldenhar syndrome. The 4 Dutch-speaking subjects were 2 boys (age 4.5 and 10.2 years) and 2 girls (aged 5.0 and 5.4 years) with normal cognitive functioning. Language testing showed a delay in the development of morphosyntactic abilities. Speech analysis showed that these four children were capable of producing all the sounds of their mother tongue. One type of distortion error, namely dentalization, was found in 2 children. Phonological process analysis revealed the persistence of processes such as final consonant deletion, unstressed syllable deletion and cluster reduction, which are normal in young children but are suppressed with maturation. Also the substitution process of devoicing was observed in these 4 children. It is not clear how the speech and language problems demonstrated in these 4 children are to be explained. It must be taken into consideration that the Goldenhar syndrome has a variable expression. It is possible that the presence of a mandibular defect, hearing impairment, the type and severity of palatal abnormality and decreased linguistic processing skills influence articulation in an individual child. The voices of 2 children were characterized by the presence of slight roughness, corresponding with a higher jitter percentage. How the occurrence of the hoarse voices is to be explained is not quite clear. Laryngoscopic evaluation of the vocal folds showed no organic or functional voice disorder. Regarding resonance, only the child with a cleft palate showed hypernasality and nasal emission. The ENT specialist and the speech-language pathologist must be aware of these communication disorders in order to start preventive and early 'tailor-made' speech and language intervention as soon as possible.

Articulation Disorders↗
PubMed1996

Use of the family to facilitate communicative changes in adults with neurological impairments.

Systemic concepts may be used to expand upon the traditional notion that family members influence the outcome of treatment services to adults with neurological communicative disorders. Several systemic concepts are discussed and illustrated as they are used with different clients having (1) aphasia, (2) right cerebral hemisphere dysfunction, and (3) progressive dementia. Discussion focuses on determining the unit of treatment with which to work, promoting and measuring positive communicative changes, and selecting effective intervention techniques.

Adult↗
PubMed2006

Suffering in silence: why a developmental psychopathology perspective on selective mutism is needed.

A developmental psychopathology perspective is offered in an effort to organize the existing literature regarding the etiology of selective mutism (SM), a relatively rare disorder in which a child consistently fails to speak in 1 or more social settings (e.g., school) despite speaking normally in other settings (e.g., home). Following a brief description of the history, prevalence, and course of the disorder, multiple pathways to the development of SM are discussed, with a focus on the various genetic, temperamental, psychological, and social/environmental systems that may be important in conceptualizing this unusual childhood disorder. The authors propose that SM develops due to a series of complex interactions among the various systems reviewed (e.g., a strong genetic loading for anxiety interacts with an existing communication disorder, resulting in heightened sensitivity to verbal interactions and mutism in some settings). Suggestions are provided for future longitudinal, twin/adoption, molecular genetic, and neuroimaging studies that would be particularly helpful in testing the pathways perspective on SM.

Child↗
PubMed2000

Anaesthesia and pain management in cerebral palsy.

Cerebral palsy is the result of an injury to the developing brain during the antenatal, perinatal or postnatal period. Clinical manifestations relate to the area affected. Some of the conditions associated with cerebral palsy require surgical intervention. Problems during the peri-operative period may include hypothermia, nausea and vomiting and muscle spasm. Peri-operative seizure control, respiratory function and gastro-oesophageal reflux also require consideration. Intellectual disability is common and, in those affected, may range from mild to severe. These children should be handled with sensitivity as communication disorders and sensory deficits may mask mild or normal intellect. They should be accompanied by their carers at induction and in the recovery room as they usually know how best to communicate with them. Postoperative pain management and the prevention of muscle spasm is important and some of the drugs used in the management of spasm such as baclofen and botulinum toxin are discussed. Epidural analgesia is particularly valuable when major orthopaedic procedures are performed.

Analgesia↗
PubMed1995

Marital communication in eating disorder patients: a controlled observational study.

In order to investigate the communication between 21 eating disorder (ED) patients and their husbands, an observational study was carried out using two matched control groups of 21 maritally distressed (MD) and 21 nondistressed (ND) couples. During some discussion tasks the interaction was videotaped and the (verbal and nonverbal) communication skills were rated afterwards according to the Kategoriensystem für Partnerschaftliche Interaktion (KPI) coding system. Unexpectedly, compared with the control groups ED couples do not show a greater disequilibrium (between patient and husband) in the emission rate of positive and negative messages. Also striking is the generally higher degree of self-disclosure in ED couples than in ND couples, but this may reflect their experience of distress. Overall and most importantly, ED couples appear to lack some of the ND couples' skills of constructive communication, but manage to avoid the destructive communication style of MD couples.

Adult↗
PubMed1975

Prognostic factors in rehabilitation after severe head injury. Assessment six months after trauma.

After initial neurosurgical treatment, 40 patients who regained consciousness 1 to 90 days after major cerebral trauma, were admitted for rehabilitation. Six months after their injury they were assessed in terms of: 1) Locomotor function, 2) Intellectual performance, 3) Communication disorder, and 4) behaviour disturbances. The usefulness of these parameters as prognostic factors in rehabilitation is discussed. Eight patients without significant disabilities in all 4 parameters returned to normal life. Patients who showed locomotor, communicative and behaviour impairment but no gross intellectual deficits, were considered capable of being retrained. The poorest prospects for social and vocational rehabilitation were found in 15 patients with cognitive defects.

Adult↗
PubMed1998

Describing the consequences of disorders: stuttering and the International Classification of Impairments, Disabilities, and Handicaps.

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) proposed by the World Health Organization (WHO, 1980) can be a useful method for describing the experiences of individuals exhibiting speech and language disorders such as stuttering. Unfortunately, the definitions for the terms impairment, disability, and handicap that were previously presented in the stuttering literature have not accurately represented the true purpose of the ICIDH as a tool for describing the consequences of disorders. This paper reviews the history of these terms in the stuttering literature and proposes alternate definitions that are more consistent with the use of the ICIDH elsewhere in the field of communication disorders, as well as within the health-related professions in general. Based on the ICIDH framework, a model is proposed for discussing the outcomes of various types of stuttering treatments in the context of an individual's experience of the stuttering disorder, and the implications for treatment outcomes research using this framework are discussed.

Persons with Disabilities↗
PubMed1989

Metabolic correlates of learning disability.

To summarize, the neuropsychologic findings in MSUD and MMA children in both groups demonstrated deficits in cognitive/language areas, but interesting individual differences existed. For example, a marked contrast in abilities existed between NT and GV, even taking into account the age difference between these children with MSUD. While NT's general intellectual functioning was within the low-average range, GV was severely impaired. In more specific areas of cognitive functioning, NT had an uneven performance profile with areas of strengths and weaknesses, while GV evidenced a flat profile with significant impairment in all areas. NT demonstrated mild delay in visual-spatial processing, articulation development, motor-speech abilities, and selective attention and concentration; however, his language and psychosocial development were within the broad range of normality. In contrast, GV exhibited severe dysfunction in speech, language, and perceptual/conceptual development. The three children with MMA also exhibited a range of disabilities in cognitive functioning. TJ and SH contrasted in the degree of developmental delay across language and cognitive domains. Both were distractible and exhibited very short attention spans but there was a measurable difference in the extent of their speech, language, visual-spatial development. CH was markedly delayed in all areas of cognitive development, which is consistent with global retardation. The severity of her disease and its probable impact on brain development were undoubtedly related to her intellectual impairment. These datasets illustrate the challenges we face, because within each group we see a range of impairment. Nevertheless, we are optimistic that our efforts to relate metabolic, anatomic and neuropsychologic findings for such children will lead to a better understanding of these disorders. We are hopeful that this will result in new advances in diagnosis and intervention, which will ultimately improve the prognosis for cognitive development. In summary, a multidisciplinary center has been established at UCSD to study the neurologic basis of disorders of language, learning and behavior in infants and children. The center draws together a group of researchers from many fields including neurology, biochemistry, pediatrics, cognitive and developmental neuropsychology, psycholinguistics, neurophysiology and communicative disorders. Because of the diverse interests and expertise of our group, it is hoped to forge a synthesis of the behavioral and neurosciences to study populations of children with a variety of neurologic, metabolic, and language/learning disorders. Disorders currently under study include Lesch-Nyhan disease, oculocutaneous tyrosinemia, propionic acidemia, carnitine palmityl transferase deficiency, Schwachman-Diamond syndrome, histidinemia, Hartnup disease, citrullinemia, galactosemia, maple syrup urine disease, and methylmalonic acidemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMedDate not supplied

Combination therapy of donepezil and vitamin E in Alzheimer disease.

A retrospective chart review was performed on 130 patients from the Ohio State University Memory Disorders Clinic to examine the long-term effects of combination therapy with donepezil and vitamin E on patients with Alzheimer disease. Subjects were included if they met National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer disease, had taken at least 5 mg donepezil and at least 1000 U vitamin E daily, had at least a 1-year follow-up while continuing these medications, and had a Mini-Mental State Examination score of 10-24. The Mini-Mental State Examination was then recorded annually thereafter. These data were compared with the Consortium to Establish a Registry for Alzheimer's Disease database for patients collected prior to the availability of these treatment options. Patients declined at a significantly lower rate as compared with the Consortium to Establish a Registry for Alzheimer's Disease data. The long-term combination therapy of donepezil and vitamin E appears beneficial for patients with Alzheimer disease. Future prospective studies would be needed to compare combination treatment to vitamin E and donepezil alone.

Aged↗
PubMedDate not supplied

When novel sentences spoken or heard for the first time in the history of the universe are not enough: toward a dual-process model of language.

Although interest in the language sciences was previously focused on newly created sentences, more recently much attention has turned to the importance of formulaic expressions in normal and disordered communication. Also referred to as formulaic expressions and made up of speech formulas, idioms, expletives, serial and memorized speech, slang, sayings, clichés, and conventional expressions, non-propositional language forms a large proportion of every speaker's competence, and may be differentially disturbed in neurological disorders. This review aims to examine non-propositional speech with respect to linguistic descriptions, psycholinguistic experiments, sociolinguistic studies, child language development, clinical language disorders, and neurological studies. Evidence from numerous sources reveals differentiated and specialized roles for novel and formulaic verbal functions, and suggests that generation of novel sentences and management of prefabricated expressions represent two legitimate and separable processes in language behaviour. A preliminary model of language behaviour that encompasses unitary and compositional properties and their integration in everyday language use is proposed. Integration and synchronizing of two disparate processes in language behaviour, formulaic and novel, characterizes normal communicative function and contributes to creativity in language. This dichotomy is supported by studies arising from other disciplines in neurology and psychology. Further studies are necessary to determine in what ways the various categories of formulaic expressions are related, and how these categories are processed by the brain. Better understanding of how non-propositional categories of speech are stored and processed in the brain can lead to better informed treatment strategies in language disorders.

Aphasia↗
PubMed2006

Mutations in the gene encoding the synaptic scaffolding protein SHANK3 are associated with autism spectrum disorders.

SHANK3 (also known as ProSAP2) regulates the structural organization of dendritic spines and is a binding partner of neuroligins; genes encoding neuroligins are mutated in autism and Asperger syndrome. Here, we report that a mutation of a single copy of SHANK3 on chromosome 22q13 can result in language and/or social communication disorders. These mutations concern only a small number of individuals, but they shed light on one gene dosage-sensitive synaptic pathway that is involved in autism spectrum disorders.

Autistic Disorder↗
PubMedDate not supplied

Tracheoesophageal puncture for alaryngeal voice restoration.

Thirty-two tracheoesophageal punctures (TEP) were performed on 30 patients by The Cleveland Clinic Foundation Department of Otolaryngology and Communicative Disorders. In all cases, the Blom-Singer duckbill prosthesis was utilized for alaryngeal voice restoration. Ninety-three percent were able to produce significantly better voice following TEP when compared to their preoperative mode of communication, The preoperative orientation/evaluation format, surgical technique, success-failure ratios, and possible factors affecting successful TEP voice restoration are examined.

Adult↗
PubMed1990

[Autism in infants and young children. The value of early diagnosis].

Clinical studies of early symptoms are among the most significant advances achieved during recent years in the field of autism. The first descriptions of early symptoms were retrospective and lacked precision. Autistic children are now being seen increasingly early and new insight is being gained into the initial manifestations and differences in clinical patterns. Similarly, differential diagnosis problems (borderline forms) are changing as clinicians evaluate children at younger ages. Although a definitive diagnosis is neither possible nor even desirable before the age of 18 to 24 months, detailed clinical data should be collected early. This data forms the basis for differential diagnosis and will be needed later for differentiating various clinical patterns of developmental disorders, establishing a prognosis, and monitoring therapeutic effects. In prospective longitudinal studies of autistic children, comparison of recent observations with detailed early data is essential. Early initial evaluation includes videotape recordings, assessment of cognitive functions and communication skills, and use of a scale for autistic symptoms. Using the results of evaluations of very young children, a specific semiology (communication disorders) can be developed. Several symptoms probably denote neurophysiologic and/or perceptive disorders. Primary symptoms are now being better distinguished from secondary anomalies (behavior disorders) that may be avoidable or treatable.

Age Factors↗
PubMed1986

Disorders of language, communication, and behavior in mentally retarded children. Some ideas on their co-occurrence.

The thesis of this article is that deficits in language and communication contribute to behavior problems in childhood. Mentally retarded children show a range of deficits in language and communication compared with normals; they are also at increased risk for behavior problems. The evidence suggests that these deficits are quantitative rather than qualitative. In addition, these linguistic deficits may contribute independently to the development of behavior disorders insofar as the linguistic deficit interferes with the child's ability to make himself understood or to understand others.

Child↗
PubMed1999

Bipolar disorder and family communication: effects of a psychoeducational treatment program.

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.

Adolescent↗
PubMed2007

Autism in the Faroe Islands: an epidemiological study.

The Faroe Islands are considered to be a genetic isolate. This population study of the prevalence of autism sought to identify a representative cohort for future genetic studies. In 2002 all schools were screened for autism spectrum disorders. The target population were all children born in 1985 through 1994 and living in the Faroe Islands on December 31, 2002. Children who screened positive for autism characteristics were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). Of the children aged 8 through 17 years, 0.56% had childhood autism, Asperger syndrome or atypical autism. The male:female ratio was just under 6:1. The prevalence of autism in the Faroe Islands was very similar to that reported from many western countries.

Adolescent↗
PubMed2006

Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting.

OBJECTIVES: To elucidate the importance of clinically diagnosed cerebral comorbidity in idiopathic normal-pressure hydrocephalus (INPH) and its effect on improvement after shunt surgery as well as concordance with parenchymal pathological changes described in frontal cerebral biopsy specimens. METHODS: In 28 consecutive patients diagnosed with INPH and shunted according to clinical, radiological and cerebrospinal fluid dynamic criteria, concomitant disorders were carefully registered, with special emphasis on cerebrovascular disease (CVD) and possible Alzheimer's disease. During shunt surgery, a frontal cerebral biopsy specimen was obtained and subsequently analysed for pathological changes. RESULTS: One or several concurrent disorders were present in 89% of the patients, most often CVD (n = 17) and possible Alzheimer's disease (n = 12), of which eight patients presented both, diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. The shunt success rate was 33%. A clear tendency towards increasing prevalence of CVD or Alzheimer's disease was found in the subgroups with no improvement or clinical deterioration compared with the patients improving after shunt surgery. The presence of CVD tended towards an unfavourable shunt outcome. The pathological parenchymal changes reflected the clinical diagnoses of comorbidity, and were described in about half of the biopsy specimens, with Alzheimer's disease (n = 7) and vascular changes (n = 7) being the most common findings. However, no significant correlation was found with the clinical diagnoses of Alzheimer's disease and CVD. The presence of cerebral comorbidity, whether diagnosed clinically or by brain biopsy, did not preclude clinical improvement after shunt operation. CONCLUSIONS: A high prevalence of CVD and Alzheimer's disease was found in patients shunted for INPH, which was reflected, although less commonly, by similar neuropathological biopsy findings. No significant correlation was found between the presence of comorbidity and shunt outcome. The findings support the perception of INPH as a multiaetiological clinical entity, possibly overlapping pathophysiologically with CVD and Alzheimer's disease.

Aged↗