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Childhood autism: deficits of communication and symbolic development. I. Distinctions from language disorders.

The present paper reviews, outlines, and explores the literature concerned with the speech-language disorder of childhood autism. The problems of communication of the autistic child are compared and contrasted with those of children with a variety of other language disorders (e.g. receptive developmental dysphasia). Based upon the review of normal preverbal communicatory and symbolic development, it is concluded that childhood autism involves a pervasive language disorder encompassing communication in general, as well as certain symbolic-representational abilities necessary for language. An overview of the attempts to teach speech to autistic children in then undertaken with special emphasis on the possible implications of developmental knowledge for these training pursuits. Finally, the role of neurologic substrates in the language and communication disorder of autism is presented.

Aphasia↗

Development of speechreading supplements based on automatic speech recognition.

In manual-cued speech (MCS) a speaker produces hand gestures to resolve ambiguities among speech elements that are often confused by speechreaders. The shape of the hand distinguishes among consonants; the position of the hand relative to the face distinguishes among vowels. Experienced receivers of MCS achieve nearly perfect reception of everyday connected speech. MCS has been taught to very young deaf children and greatly facilitates language learning, communication, and general education. This manuscript describes a system that can produce a form of cued speech automatically in real time and reports on its evaluation by trained receivers of MCS. Cues are derived by a hidden markov models (HMM)-based speaker-dependent phonetic speech recognizer that uses context-dependent phone models and are presented visually by superimposing animated handshapes on the face of the talker. The benefit provided by these cues strongly depends on articulation of hand movements and on precise synchronization of the actions of the hands and the face. Using the system reported here, experienced cue receivers can recognize roughly two-thirds of the keywords in cued low-context sentences correctly, compared to roughly one-third by speechreading alone (SA). The practical significance of these improvements is to support fairly normal rates of reception of conversational speech, a task that is often difficult via SA.

Adult↗

Communication problems in hearing children of deaf parents.

Fifty-two children who had deaf parents and were thought to have normal hearing were evaluated for speech, hearing, and language problems. Standardized tests, audiological evaluations, and informal conversation and play techniques were used. Of the 52 children of deaf parents, less than half were considered to be developing speech and language normally and 12% had previously undiagnosed hearing loss. The prevalence of speech and language problems and hearing losses is higher in this population than in the population at large. The children appeared to be using two systems to communicate, one with hearing people and one with the deaf. Of the children having some speech and language difficulty, approximately half had problems that were not associated with other known physiological or environmental factors that might affect speech and language. Although there were no children of intelligible mothers who had speech and language problems, there were children developing normally who had parents whose speech intelligibility was poor. Contrary to indications in the literature, speech and language problems did not disappear after the children entered school. A large number of school-age children as well as preschoolers appeared to be having speech and language problems. The amount of time spent with hearing adults during the preschool years or the presence of older normal-hearing and -speaking siblings did not seem related to speech and language difficulty. However, when an elder sibling had speech and language difficulty, the younger siblings tended to have similar problems. The relationship between sign and oral language development is ambiguous, but there is no indication that the use of sign language deters oral language development. In view of the high incidence of communication problems in this population, annual audiological evaluations and counseling of deaf parents concerning aspects of hearing loss and normal language development are recommended. The problems encountered in providing therapy are discussed.

Age Factors↗

Wernicke and Alzheimer on the language disturbances of dementia and aphasia.

Signs of language dysfunction in dementia of the Alzheimer's type (DAT) and in the aphasic syndromes of transcortical sensory aphasia and Wernicke's aphasia are superficially similar. The unresolved question concerning the extent to which the language disturbances of DAT are "aphasic" is linked to a more fundamental question concerning the relation of language to thought, given that aphasia is often defined as language disturbance without disturbance of intellect, and dementia as dissolution of intellectual function, of which language forms an integral part. In this paper we explore the historical roots of today's debate by analyzing the original case studies of Wernicke (1874) and Alzheimer (1907, 1911). Although each of these neurologists described similar patterns of language disturbance, they drew different conclusions. Wernicke argued for a distinction between language and thought and between the language disturbances of aphasia and those of dementia. Alzheimer continued the then dominant paradigm of aphasia in describing the language disturbances of his demented patients as aphasic. Paradoxically his conclusion makes him appear, in contrast to Wernicke, to argue for the identity of the language disturbances of aphasia and dementia. Yet he himself acknowledged that the presence of focal language symptoms arising from diffuse degenerative pathology was indeed problematic. We conclude that today's discussion could profitably be refocused on the question which emerges from the original works of Wernicke and Alzheimer, which Alzheimer himself asked, and which remains unanswered: How can diffuse cerebral pathology give rise to a pattern of language deficit virtually identical to that of a focal lesion?

Aged↗

Speech, vocabulary, and the education of children using cochlear implants: oral or total communication?

This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program and that other considerations, such as the age at which children receive implants, are more important. Implications and future research needs are discussed.

Child Language↗

Language-impaired children: No sign of the FOXP2 mutation.

A mutation in the FOXP2 gene has been found to be responsible for the autosomal dominant inheritance of a severe form of speech and language impairment in a family known as KE. We genotyped the FOXP2 mutation for 270 4-year-old children selected for low general language scores from a representative community sample of more than 18,000 children. No language-impaired child had the FOXP2 mutation. Although rare severe disorders such as those of the KE family are often caused by a single gene, common disorders such as language impairment are more likely to be the quantitative extreme of the same multiple genetic factors responsible for heritability throughout the distribution.

Child, Preschool↗

Brief report: comparative ABA and DIR trials in twin brothers with autism.

Trial interventions in DIR and ABA with twin brothers with autism were offered to help the parents choose one of the programs for their sons. Pre- and post-test scores on the Communication and Symbolic Behavior Scales (CSBS) revealed a slight gain in the composite score of the ABA child and a slight loss in the score of the DIR child. Contrasted gains and losses occurred in six of the seven CSBS clusters. Results from this pilot research are discussed with additional communication and behavior data from the intervention period. Careful interpretation of CSBS outcomes in counseling parents and graduate students is strongly advised. Continued research in comparative outcomes for intervention programs is strongly encouraged.

Autistic Disorder↗