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PubMed1999

Duration of breastfeeding and developmental milestones during the latter half of infancy.

Several studies have suggested that breastfeeding has a long-term influence on brain development. However, interpretation of these findings is complicated by the presence of many potential confounding factors. Only a few studies have examined infants before 1 y of age, although very early assessment might reduce the role of environmental influence. We investigated the association between exclusive breastfeeding and three developmental milestones related to general and fine motor skills and early language development at the age of 8 mo. We followed 1656 healthy, singleton, term infants, with a birthweight of at least 2500 g, born between May 1991 and February 1992 in Aarhus, Denmark. Information was collected at 16 wk gestation, at delivery and when the infant was 8 mo old. Motor skills were evaluated by measurement of crawling and pincer grip. Early language development was defined as the ability to babble in polysyllables. The proportion of infants who mastered the specific milestones increased consistently with increasing duration of breastfeeding. The relative risk for the highest versus the lowest breastfeeding category was 1.3 (95% CI: 1.0-1.6) for crawling, 1.2 (95% CI: 1.1-1.3) for pincer grip and 1.5 (95% Cl: 1.3-1.8) for polysyllable babbling. Little change was found after adjustment for confounding. In conclusion, our data support the hypothesis that breastfeeding benefits neurodevelopment.

Breast Feeding↗
PubMed1993

Intellectual development at 3 years of age of children who underwent major neonatal surgery.

Thirty full-term infants born with surgically correctable life-threatening abnormalities who underwent emergency neonatal surgery were followed up from birth to 3 years of age. Comparable data were obtained on a matched group of healthy newborn babies. At 3 years the cognitive functioning of children whose condition had been resolved in the early months of life was similar to the controls. Those children who required further medical or surgical treatment were functioning at lower levels than the controls, with language development being most affected. Number of operations, defined as all procedures under general anesthetic, was the medical factor most strongly associated with poorer outcome at 3 years. Family factors--higher maternal IQ and nonmanual social class--were also positively correlated with language development.

Child, Preschool↗
PubMed2002

Infant discrimination of rapid auditory cues predicts later language impairment.

The etiology and mechanisms of specific language impairment (SLI) in children are unknown. Differences in basic auditory processing abilities have been suggested to underlie their language deficits. Studies suggest that the neuropathology, such as atypical patterns of cerebral lateralization and cortical cellular anomalies, implicated in such impairments likely occur early in life. Such anomalies may play a part in the rapid processing deficits seen in this disorder. However, prospective, longitudinal studies in infant populations that are critical to examining these hypotheses have not been done. In the study described, performance on brief, rapidly-presented, successive auditory processing and perceptual-cognitive tasks were assessed in two groups of infants: normal control infants with no family history of language disorders and infants from families with a positive family history for language impairment. Initial assessments were obtained when infants were 6-9 months of age (M=7.5 months) and the sample was then followed through age 36 months. At the first visit, infants' processing of rapid auditory cues as well as global processing speed and memory were assessed. Significant differences in mean thresholds were seen in infants born into families with a history of SLI as compared with controls. Examination of relations between infant processing abilities and emerging language through 24 months-of-age revealed that threshold for rapid auditory processing at 7.5 months was the single best predictor of language outcome. At age 3, rapid auditory processing threshold and being male, together predicted 39-41% of the variance in language outcome. Thus, early deficits in rapid auditory processing abilities both precede and predict subsequent language delays. These findings support an essential role for basic nonlinguistic, central auditory processes, particularly rapid spectrotemporal processing, in early language development. Further, these findings provide a temporal diagnostic window during which future language impairments may be addressed.

Apgar Score↗
PubMed1988

Symbolic gesturing in normal infants.

2 studies are presented that document the spontaneous development by normal infants of nonverbal gestures to symbolically represent objects, needs, states, and qualities. These symbolic gestures are shown to be a typical rather than rare phenomenon of early development and to function in ways similar to early verbal symbols. Indeed, the case is made that these gestures and early words are both representative of common underlying mechanisms, in particular, the recognition that things have names. In the first study, mothers of 38 17-month-old infants were interviewed in regard to their infants' verbal and nonverbal development. The second study, designed to document with greater precision the findings of the interview study, is a longitudinal study of 16 infants who were followed from 11 to 24 months. Both studies provide evidence that symbolic gestures tend to develop in tandem with the child's early words, that girls tend to rely more heavily than boys on such gestures, that structured parent-child interactions are important to the development of these gestures, that the gestures tend to depict the function rather than the form of objects, and that the use of gestural labels is positively related to verbal vocabulary development. Implications of these findings for theories of language development and for speech pathology are discussed.

Child Development↗
PubMed2000

[Klinefelter syndrome in young children: possibility of diagnosis].

In one boy aged 7 years with a micropenis, and in 3 boys aged 6, 4 and 5 years with delayed speech and language development and behavioural problems, Klinefelter's syndrome was diagnosed. In the first case the diagnosis was immediately suspected because of the micropenis. The other three boys were diagnosed after long observation. One of them was suspected of having a chromosomal abnormality because of behavioural problems together with a typical, female fat distribution pattern. If a delayed speech and language development and behaviour problems are present, Klinefelter's syndrome should be considered, especially if tallness and (or) small genitals are present.

Body Constitution↗
PubMed2005

Incidence and diagnosis of unilateral arterial cerebral infarction in newborn infants.

AIMS: Magnetic resonance imaging (MRI) is accepted as the gold standard for the diagnosis of arterial cerebral infarction (ACI), but few studies have reported the incidence of neonatal ACI based on MRI findings. We provide new population-based epidemiologic and diagnostic data on all infants diagnosed between 1997 and 2002 in our center with an MRI-confirmed diagnosis of unilateral neonatal ACI. RESULTS: Nine patients were identified, giving an incidence of 1:2300 unilateral ACIs in our inborn population. In all patients the middle cerebral artery was affected. Seven patients showed epileptic seizures, usually starting within the first 3 days of life. EEG was pathologic in all patients. Only three infarctions were diagnosed by ultrasound. Initial MRI established diagnosis of ACI in eight out of nine patients and subsequent MRI described the exact location of infarctions in all patients. Six out of nine patients developed hemiparesis and five had deficits in language development. There is a substantial need for special care facilities and long-term therapeutic interventions. CONCLUSIONS: The incidence of neonatal ACI is higher than previously reported. The sensitivity of early cerebral ultrasound for diagnosis of ACI is low. Seizures in the first 3 days of life combined with pathologic EEG findings should lead to MRI, regardless of normal cerebral ultrasound.

Cerebral Infarction↗
PubMed2005

The role of a language scale for infant and preschool assessment.

The PLS-4 (Preschool Language Scale, 4th edition) is a psychometrically sound instrument constructed to assess language skills in children from birth to 6 years 11 months. It is a useful diagnostic and research tool that can be used to identify current comprehension and expressive language skills and can measure changes in language skills over time. The test is individually administered and includes tasks that assess skills in the areas of preverbal behaviors, as well as linguistic skills in the areas of semantics, morphology, syntax, integrative language skills, and preliteracy skills. Extensive reliability and validity evidence are presented. The test has been used extensively in research examining language development of young children from different home environments, children with identified medical conditions, and children participating in a variety of habilitation and intervention programs. Both the previous edition (PLS-3) and the new PLS-4 English and Spanish editions are used extensively in clinical, medical, and research settings to examine developmental language patterns of infants, toddlers, and preschoolers.

Child↗
PubMed2000

Occurrence of tics in Asperger's syndrome and autistic disorder.

Asperger's syndrome is a condition in the autistic spectrum in which language development is normal. Patients with Asperger's syndrome frequently exhibit repetitive movements (stereotypies), and can have motor and phonic tics in addition to other behavioral abnormalities. We present 12 patients with autistic spectrum disorders who were referred to our Movement Disorders Clinic for evaluation of tics. Eight of the 12 had normal language development and therefore met criteria for Asperger's syndrome. All patients exhibited stereotypic movements; in addition, seven had tics and six of these met diagnostic criteria for Tourette syndrome. Of the six patients with clinical features of both Asperger's syndrome and Tourette syndrome, three had severe congenital sensory deficits. The autistic patients in our series were clinically heterogeneous and though tics were clearly present, other aberrant movements demonstrated by them were harder to classify. Our series confirms the wide range of clinical manifestations in Asperger's syndrome and autism, including tics and other features of Tourette syndrome. Furthermore, it suggests that sensory deprivation contributes to the development of adventitious movements in this population.

Adolescent↗
PubMed1997

Ideal timing of pediatric laryngotracheal reconstruction.

OBJECTIVE: To determine whether there is an ideal age at which to perform a laryngotracheal reconstruction (LTR) in the pediatric population. DESIGN: Prospective observational study. SETTING: Tertiary care children's hospital. PATIENTS: Forty-eight patients aged 48 months or younger with laryngotracheal stenosis who underwent 50 LTRs from October 1, 1986, to June 30, 1995. Patients were divided into 2 groups: group 1, aged 8 through 24 months (22 patients); group 2, aged 25 through 48 months (26 patients). INTERVENTION: Endoscopy and LTR. MAIN OUTCOME MEASURES: Successful decannulation. RESULTS: Statistical analysis showed that (1) patients in group 2 had more severe degree of laryngotracheal stenosis as determined by duration of stenting with no difference in multiple sites of stenosis or type of repair required to correct laryngotracheal stenosis and (2) patients in group 2 were more likely to have successful decannulation. CONCLUSION: Laryngotracheal reconstruction at a younger age (< 25 months) is important for a child's speech and language development as well as for eliminating the morbidity and mortality associated with a tracheotomy. However, LTR at a younger age is associated with a higher risk of failure despite lesser degree of pathology. Therefore, although we still recommend LTR at a younger age since it may be beneficial for a child's speech and language development and avoidance of tracheotomy complications, this recommendation may be at the price of LTR failure and requirement for revision procedures.

Age Factors↗
PubMed2002

A major susceptibility locus for specific language impairment is located on 13q21.

Children who fail to develop language normally-in the absence of explanatory factors such as neurological disorders, hearing impairment, or lack of adequate opportunity-are clinically described as having specific language impairment (SLI). SLI has a prevalence of approximately 7% in children entering school and is associated with later difficulties in learning to read. Research indicates that genetic factors are important in the etiology of SLI. Studies have consistently demonstrated that SLI aggregates in families. Increased monozygotic versus dizygotic twin concordance rates indicate that heredity, not just shared environment, is the cause of the familial clustering. We have collected five pedigrees of Celtic ancestry that segregate SLI, and we have conducted genomewide categorical linkage analysis, using model-based LOD score techniques. Analysis was conducted under both dominant and recessive models by use of three phenotypic classifications: clinical diagnosis, language impairment (spoken language quotient <85) and reading discrepancy (nonverbal IQ minus non-word reading >15). Chromosome 13 yielded a maximum multipoint LOD score of 3.92 under the recessive reading discrepancy model. Simulation to correct for multiple models and multiple phenotypes indicated that the genomewide empirical P value is <.01. As an alternative measure, we also computed the posterior probability of linkage (PPL), obtaining a PPL of 53% in the same region. One other genomic region yielded suggestive results on chromosome 2 (multipoint LOD score 2.86, genomic P value <.06 under the recessive language impairment model). Our findings underscore the utility of traditional LOD-score-based methods in finding genes for complex diseases, specifically, SLI.

Autistic Disorder↗
PubMed1997

Phonological processing skills in speech and language impaired children.

Phonological processing has been shown by many researchers to be strongly related to the acquisition of reading and spelling skills. Children with speech and language impairment appear to be at increased risk for phonological processing problems and hence literary difficulties. However, not all children with speech and language impairment experience difficulties: the literature is not clear as to which groups of speech and language impaired children are most severely affected nor which aspects of phonological processing are most likely to be impaired. Rigorous subject selection was employed to compare the performance of four groups of 20 children, aged approximately 6 years: speech-impaired (Speech); language-impaired (Language); speech and language impaired (Mixed); and children with normally developing language (Normal), by use of a battery of phonological processing tasks. The results supported the research that has shown speech and language impaired children to have weaker phonological processing skills than the general population. All the subjects in this sample appeared to be at risk: the Mixed children demonstrated the most difficulty, followed by the Language group, with the Normal group performing the best. Whilst the Speech group as a whole performed significantly more poorly than the Normal group, it consisted of two levels of performance which, on post hoc analysis were shown to relate to the pattern of speech impairment exhibited by the child.

Child↗
PubMed2005

Stability and prediction of schizophrenia from adolescence to adulthood.

Stability of schizophrenia diagnosis from adolescence to adulthood, antecedents of schizophrenia, and differences in developmental and behavioural histories between subjects with early onset schizophrenia (EOS) and with adult onset schizophrenia (AOS) were investigated in 145 adult subjects diagnosed with mental disorders in adolescence and re-diagnosed on the basis of medical records according to DSM-IV.A very high diagnostic stability schizophrenia was demonstrated at the 28-year follow-up. Several factors, including neurological adversities, delayed language development, low IQ, and congenital functional disability, differentiated significantly between schizophrenic subjects and non-schizophrenic subjects. Histories of concussion, physical abuse, parental divorce, and unstable familial context differentiated significantly between EOS and AOS subjects. Our findings support earlier evidence of schizophrenia being a chronic disorder with high diagnostic stability, and confirm the importance of neurological adversities, delayed language development, and low IQ as factors predictive of schizophrenia. Exploration of four case histories of AOS subjects delineates "pre-schizophrenic warning cluster" where combination of neurological adversities, temperamental problems, antisocial behaviour, preference for solitary play, and unstable family system constitute main factors.

Adolescent↗
PubMed2004

[The cochlear implant--evolution of hearing and language with an artificial inner ear].

One of the most spectacular progresses in modern medicine is the possibility to replace a deaf ear, a sensory organ in total by an implantable electronic prosthesis, a so-called cochlear implant (CI). The CI stimulates the auditory nerve by electrical pulses and thus generates the sensation of hearing along the auditory pathway. One of the most impressive aspects of cochlear implantation is the fact that small children with profound deafness who were able a few years ago to learn spoken language only to very limited extent may achieve nowadays an almost normal language development. Duration and intensity of the training of listening and spoken language vary considerably as a function of etiology and time of deafness. Most important for the development of language is sufficient stimulation of the auditory pathway during early childhood. Early diagnosis of a severe to profound deafness is most important in order to fit hearing aids or a cochlear implant without a time delay. Affected children need intensive training by professionals specialized in education and speech therapy. Adults and adolescents who lost their hearing when language acquisition was established may understand spoken language only a few weeks after receiving a cochlear implant. Several individuals are able to use the telephone. Preliminary results after bilateral cochlear implantation of children and adults show advantages. Not only do these subjects report "better hearing with two CI as compared to hearing with one CI," but some of them developed directional hearing in a rather short time lag after fitting the second implant. And in addition they achieve better speech discrimination in environmental noise.

Adolescent↗
PubMed1998

Comprehension of language in congenitally deaf children with and without cochlear implants.

The consequences of profound early deafness on oral language in children are drastic. The modern cochlear implant (CI) has been shown to enhance speech production skills in prelingually deaf children. Many factors may contribute to a poor or an excellent outcome, making it difficult to compare groups of children wearing or not wearing cochlear implants. The present study compared receptive language levels in matched pairs of children from CI group and non-CI groups. The pre-op receptive language development curve suggest a possible growth over time with the maturation and the speech therapy. Comparison showed that the slope for post-op CI children to be greater than for non-CI children, and that this difference is statistically significant, and that the slope for CI children to be greater post- than pre-operatively. The main conclusion is that receptive language scores grow significantly higher over time after surgery in CI than in pair-matched non-CI children, despite better initial pure tone audiometric thresholds of the latter.

Age Factors↗
PubMed2004

Magnetoencephalography (MEG) and magnetic source imaging (MSI).

BACKGROUND: Real-time, direct assessment of brain electrophysiology is critical for noninvasive functional mapping and for the identification of paroxysmal epileptiform abnormalities in the evaluation of patients for epilepsy surgery. Historically, electroencephalography (EEG) and evoked potentials (EPs) have performed these functions. However, both often required direct intracranial recording for precise localization. Magnetoencephalography (MEG) takes advantage of the fact that neuromagnetic signals penetrate the skull and scalp without distortion. The magnetic source image (MSI) is created when the MEG data is superimposed on a magnetic resonance image (MRI). REVIEW SUMMARY: MEG performs noninvasive functional imaging by recording the magnetic flux on the head surface associated with electrical currents in activated sets of neurons. MEG has rapidly evolved in the last 2 decades because of the introduction of whole head systems and advances in computer technology. MEG is now the imaging modality of choice where a precise and high degree of localization is required. MEG can be used to localize the primary sensory cortices (visual, auditory, or somatosensory), areas involved with receptive language function, the irritative zone in epilepsy patients, and identify children with anomalous language development. This article reviews the basis of MEG, the instrumentation used, the clinical applications and current limits of the technology. CONCLUSION: MEG studies can now be performed on a routine basis as a clinical tool. MEG is now indicated for: 1) localization of the irritative zone in lesional and nonlesional epilepsy surgery patients, 2) functional mapping of eloquent cortex, and 3) assessment of normal and abnormal language development. In the future MEG may help the understanding of normal development and reorganization after brain injury. The neurologist can use MEG data to complement structural and metabolic imaging techniques.

Brain Mapping↗
PubMed2001

Management of the hearing impaired infant.

With the advent of new testing methods for screening and confirmation of hearing loss in the newborn and setting up neonatal screening programs across the country, significant number of children with hearing loss are being diagnosed very early. Although still considered as one of the best behavioural tests in the competent hands, distraction testing is becoming superseded by more refined and controlled techniques such as visual reinforcement audiometry which is capable of determining a more complete audiometric profile of an infant from about the age of 6 months. A combination of these methods has allowed audiologists to bring down the average age of diagnosis of permanent congenital hearing impairment (PCHI) from over 2 years to well below 12 months. At the same time, increasingly complex and sophisticated hearing instruments are being developed to address traditional problems and also to deliver better amplified speech. Habilitating a neonate with a hearing loss is often challenging and requires a significant amount of resources, expertise and experience. Determining the infant's amplification needs could be difficult, as often the audiometric information is not complete. Further, selecting a suitable hearing instrument for an infant from a vast range is not easy and measuring the outcome after fitting hearing aids, especially in a few months old infant, can be extremely hard. With professionals becoming more confident in implanting younger children and realizing the benefits of early implantation, especially for speech & language development, there is a growing demand for referring infants as early as possible to the implant teams. Providing amplification is only the beginning of the process of habilitation. A multidisciplinary team approach is extremely important in this process and inclusion of the parents in the multidisciplinary team managing the infant often leads to a much improved outcome. There is growing evidence that early diagnosis and habilitation of PCHI leads to better speech and language development and more children being educated in the mainstream setting.

Acoustic Impedance Tests↗
PubMed1992

Individual differences in early vocabulary development: redefining the referential-expressive distinction.

The existence of stylistic variation between children in the early stages of language acquisition has been most frequently studied using Nelson's (1973) referential-expressive distinction. While the use of this distinction has generated a great deal of interesting research, there are a number of major problems associated with it. The present study presents a simple scheme, based on formal categories, for coding stylistic variation in the early lexicon. When applied to the first 50 and 100 words of 12 children collected between 0;11 and 2;3, the major dimensions of difference are found to be the relative proportion of common nouns and the relative proportion of frozen phrases. Moreover, the proportion of frozen phrases is also found to be significantly positively related to children's early productivity, suggesting that, rather than being a 'dead-end' in early language development, the acquisition of frozen phrases may provide an alternative route into multiword speech.

Child Development↗
PubMedDate not supplied

Language stimulation group. Habilitation model.

Bloom's model of normal language development is reviewed in relation to clinical practice and is then expanded to account for disordered development. Four primary and four secondary assessment areas are then considered: language, cognition, motor, and affective development and nonverbal symbolic skills, attentional skills, social development, and physical-medical integrity. Finally, a way of integrating this evaluative information into the model of normal development is discussed and a sample curriculum is outlined.

Child↗