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Specificity and characteristics of learning disabilities.

BACKGROUND: The specificity of impairments in specific reading disabilities (SRD) and specific language impairments (SLI) has recently been questioned, with many children recruited for studies of SRD and SLI demonstrating impairments in both reading and oral language development. This has implications for the results of SRD and SLI studies where both reading and oral language skills are not assessed. Thus there is a need to compare the profiles of children with both oral language and reading impairments to groups of children with SRD and SLI. METHODS: The reading, oral language, short-term auditory memory, phonological processing, spelling, and maths abilities of 151 children (aged between 7 and 12 years) drawn from a Learning Disabilities Clinic were assessed. RESULTS: Five groups were identified, including children who demonstrated either a specific reading disability or a specific language impairment and children who showed evidence of both reading and oral language impairments. Differences were found between the groups on maths, phonological processing, short-term auditory memory, and spelling measures, with the children displaying both language and reading deficits generally performing at a lower level than the children with specific reading or language deficits. CONCLUSIONS: It was concluded that more careful screening needs to be conducted in both clinical and research settings to accurately identify the nature of deficits in children with reading and oral language difficulties. Furthermore, a third and separate category of children with a mixed pattern of impairments needs to be considered.

Analysis of Variance↗

[The effect of cochlear implantation on voice development].

OBJECTIVES: The effect of cochlear implantation on voice development in prelingually deaf children was investigated. PATIENTS AND METHODS: The study included 60 prelingually deaf children (28 girls, 32 boys; mean age 68 months; range 37 to 128 months) who underwent cochlear implantation. Voice analyses were made between 6 to 21 months after the first fitting and six months after the baseline. The patients were divided into two groups (i) according to age (younger or older than 48 months) and (ii) to the duration of implant use (more or less than 18 months) to observe the changes in fundamental frequency (F(0)), and two formant frequencies (F(1) and F(2)). Forty-seven children (22 girls, 25 boys; mean age 62 months; range 38 to 118 months) with normal speech and language development comprised the control group. In all the cases, F(0), F(1), and F(2) values of the vowel /a/ were studied. RESULTS: In the patient group, F(0) and F(2) values significantly differed between the first and second voice analyses, whereas the change in F(1) values was insignificant. No significant differences were found in terms of F(0), F(1) and F(2) values between the patients younger than 48 months and age-matched controls; however, F(0) and F(1) values significantly differed in those older than 48 months while F(2) values remained insignificant. Albeit statistically insignificant, F(0), F(1), and F(2) values approximated normal levels in children in whom the duration of implant use exceeded 18 months. CONCLUSION: Our study confirms that early cochlear implantation and longer implant use result in improved development of voice, speech, and language.

Case-Control Studies↗

Short-term longitudinal study of a child with Williams syndrome.

BACKGROUND: The superiority of language and communication skills in children and adults with Williams syndrome (WS) is currently being debated. Whilst there have been a number of reports of precursors of language in WS in children who have already developed language, there have not been many studies that have prospectively investigated precursors of language in pre-verbal children with WS. AIMS: To investigate the development of early social communication skills before the onset of language in WS. METHODS & PROCEDURES: A short-term longitudinal single case study was carried out spanning 10 months. The child was assessed five times using parent report, observation of mother-child interactions and by administering the Pre-verbal Communication Schedule, the Pragmatics Profile of Early Communication Skills and the Pre-School Language Scale - 3. OUTCOMES & RESULTS: Longitudinal comparisons showed that the level of verbal communication in the child with WS always lagged behind the level of motor and cognitive development. CONCLUSIONS: The results indicate that rather than being a strength, social communication was an area of weakness relative to other aspects of development in this case. This case raises the potential desirability for early speech and language assessment and intervention in infants with WS.

Cognition↗

Results of psychological testing of patients aged 3-6 years.

Cognitive development of early treated PKU children (132) was investigated by intelligence tests, tests for visual perception, motor and language development. Deviations from test norms occurred at 5 years of age concerning performance IQ, mathematical thinking, and visual perception. With the exception of mathematical thinking, "normal" results were obtained at the age of 6 years. Correlation with levels of plasma Phe revealed a relation between quality of dietary control and performance IQ. Results are discussed in light of methodological aspects and with respect to treatment consequence.

Child, Preschool↗

Patterns of perceptual and academic deficits related to early chronic otitis media.

The effects of chronic otitis media during the first three years of life on developing auditory processing skills were examined. Two groups of children with auditory processing deficits were compared in areas of language development, intellectual factors, auditory processing skills, and academic capabilities. One group of children with auditory processing deficits had a history of severe chronic otitis media during the first three years of life, whereas a second group had auditory processing deficits but no history of early middle ear infections. The results indicate that subjects who had a history of chronic otitis media were slower in developing word combinations, had depressed verbal intelligence scores, manifested pervasive auditory processing deficits, and were significantly poorer in reading. A profile has been constructed that permits early detection of the child at risk.

Achievement↗

Using augmentative communication with infants and young children with Down syndrome.

This paper reports the use of two forms of augmentative and alternative communication (AAC) with young children with Down syndrome: a program using signing (Makaton), and the COMPIC system of computerised pictographs. Children with Down syndrome are frequently reported to have difficulties in the area of language and communication, with relative strengths in visual and perceptual areas. This suggests possible benefits from the use of AAC systems to enhance language development. The paper discusses the use of AAC systems to assist young children with Down syndrome, and reports an experimental study of the use of such systems with an object naming task.

Child, Preschool↗

Vowel duration in mothers' speech to young children.

The purpose of this investigation was to determine whether content words are selectively highlighted through increased vowel duration in mothers' speech to young children. Fifteen mother-child dyads served as subjects. All children (ages 1:6-2:4) were female and had a mean length of utterance between 1.00 and 1.40 morphemes. Each mother was asked to read five experimental stories aloud to her child and to an adult. The vowel durations of both content words and function words in these stories were examined. Vowels in content words--but not function words--were significantly longer in child-directed than in adult-directed speech. It is suggested that this characteristic of child-directed speech might heighten young children's attention to content words and contribute to the exclusion of function words during the early stages of English language development.

Female↗

Benefits to Down's syndrome children through training their mothers.

This study investigated the hypothesis that training of mothers with Down's syndrome children would be beneficial both to the child and parents. The mothers were taught behaviour modification techniques based on learning theory and were given group discussions on dealing with their family or personal problems. The subjects were 16 mothers with a Down's syndrome child, divided into two groups on the basis of their child's sex and chronological and mental ages. The Griffiths Scale was used for assessment. The mothers in the treatment group received 12 sessions of training and group counseling over a 6-month period, whereas the control mothers received no additional attention except the usual routine from the general practitioner and health visitor. The result show clear gains to both the child and mother in the treatment group. The child improved, especially in language development as well as in the other areas, and the mother-gained more confidence and competence in her daily management of the child.

Behavior Therapy↗

Unfavourable left-right asymmetries of the brain and autism: a question of methodology.

Thirty-six patients with infantile autism and various neurological disorders underwent computerized tomographic (CT) scanning of the brain. All CT scans were assessed blindly and independently by a diagnostic radiologist. Two techniques modified from two previous studies were used for measuring parieto-occipital asymmetry. The frequency of reversed asymmetry in autistic patients was the same as that in patients with various neurological disorders, and there was no significant association between reversed asymmetry and delayed language development. The study does not support the concept that unfavourable morphological asymmetries of the brain near the posterior language zone may contribute to the difficulties autistic children experience in acquiring language. Methodological difficulties and the design of new studies are discussed.

Adolescent↗

How parents can help young visually-impaired children to communicate.

A study of parents' strategies to communicate with their young visually-impaired children has implications for all health visitors working with young children, write Vanessa Moore and Helen McConachie. The study highlights the important role of naturally-occurring communicative exchanges between parent and young child in promoting language development.

Blindness↗

The growth and development of twins compared with singletons at ages 9 and 11.

The growth and development of 9 and 11-year old twins who have been studied at birth, and at ages 3, 5, and 7 years was compared with that of a large group of singletons. The twins were not significantly different to the singletons in language development, reading, spelling or Performance IQ. They remained significantly shorter, lighter and had smaller head circumferences. This difference was shown to have been fairly consistent from age 3. The twins had significantly lower Verbal and Full Scale IQ, but in view of a lack of disadvantage in educational progress this was not considered to be of any practical importance.

Anthropometry↗

Late plasticity for language in a child's non-dominant hemisphere: a pre- and post-surgery fMRI study.

The ability of the right hemisphere to sustain the acquisition or the recovery of language after extensive damage to the left hemisphere has been essentially related to the age at the time of injury. Better language abilities are acquired when the insult occurs in early childhood (perinatal insults) compared with later occurrence. However, while previous studies have described the neuropsychological pattern of language development in typical cases, the neural bases of such plasticity remain unexplored. Non-invasive functional MRI (fMRI) is a unique tool to assess the neural correlates of brain plasticity through repeated studies, but the technique has not been widely used in children because of methodological limitations. Plasticity of language was studied in a boy who developed intractable epilepsy related to Rasmussen's syndrome of the left hemisphere at age 5 years 6 months, after normal language acquisition. The first fMRI study at age 6 years 10 months showed left lateralization of language networks during a word fluency task. After left hemispherotomy at age 9 years, the child experienced profound aphasia and alexia, with rapid recovery of receptive language but slower and incomplete recovery of expressive language and reading. Postoperative fMRI at age 10 years 6 months showed a shift of language-related networks to the right during expressive and receptive tasks. Right activation was seen mainly in regions that could not be detected preoperatively, but mirrored those previously found in the left hemisphere (inferior frontal, temporal and parietal cortex), suggesting reorganization in a pre-existing bilateral network. In addition, neuropsychological data of this case support the hypothesis of innately more bilateral distribution of receptive than expressive language. This first serial fMRI study illustrates the great plasticity of the child's brain and the ability of the right hemisphere to take over some expressive language functions, even at a relatively late age. It also suggests a limit for removal of the dominant hemisphere beyond the age of 6 years, a classical limit for the critical period of language acquisition.

Brain↗

The use of nonword repetition as a test of phonological memory in children with Down syndrome.

Recent research suggests a significant relationship between verbal short-term memory and normal language development. Although poor short-term memory and impaired language are features of Down syndrome there has been little investigation of the relationship between these functions in this population, and no studies have included the nonword repetition test devised by Gathercole and Baddeley on which much of the evidence from normal development is based. This study reports the use of nonword repetition with 33 children and teenagers with Down syndrome aged from 5 to 18 years, and investigates the relationship between this test and other memory and language measures. Word repetition was included as an indirect control for the perceptual and speech impairments often associated with this group. Words were repeated significantly more successfully than nonwords and both these tasks were sensitive to word length. Nonword repetition was significantly correlated with age, and when age and nonverbal cognitive ability were controlled, nonword repetition was significantly correlated with all other language-based memory measures, i.e. auditory digit span, word span, sentence repetition, and fluency, and also with memory for a sequence of hand movements, but not with memory for faces or a visual digit span task. There was also a significant relationship between nonword repetition and receptive vocabulary, language comprehension, and reading. When performance on the word repetition task was controlled in addition to age and nonverbal ability, significant correlations between nonword repetition and word span, sentence memory, hand movements, language comprehension, and reading remained. Fewer relationships between auditory digit span and these other measures were established; in particular, there was no association between digit span and the language and reading measures. Results suggest that nonword repetition is a reliable measure of phonological memory in Down syndrome and can predict language comprehension and reading ability.

Adolescent↗

Infants with a thumb-in-fist posture.

OBJECTIVE: In early infancy the infant's thumb is not infrequently enclosed within the palm, ie, thumb-in-fist (TIF). This posture has received scant attention in the neurodevelopmental literature. Its prevalence, resolution, and clinical associations were investigated in this study. METHODOLOGY: Two hundred sequentially born, apparently healthy full-term newborn infants comprised the cohort. The whole study group was followed up until the disappearance of the TIF occurred. In the first 150 of the cohort, additional data on development and the neurological status were obtained at 12 months of life. RESULTS: In 125 infants (62.5%) of the total cohort, a TIF was noted. The mean age of disappearance was 1.5 months, and no TIF persisted after 7 months old. No relationship was noted between the TIF resolution and abnormal neurological signs or gross or fine motor development. The only association noted between age of resolution of the TIF and the neurodevelopmental status was a delay in language attainment at the 12-month screening. CONCLUSIONS: The TIF posture in infancy was noted in 65% of our cohort, and it had resolved in all infants by 7 months old. Therefore, a TIF posture after this age should alert the clinician to the possibility of possible neurological dysfunction. An unanticipated association of a delay in the 12-month language milestone attainment was noted in those infants with later resolution of the TIF posture. No data on language development in this group were obtained after 12 months old; therefore, the clinical significance of this finding is not yet elucidated.

Cohort Studies↗

Echolalic and spontaneous phrase speech in autistic children.

The study investigated the syntactical level of spontaneous and echolalic utterances of 26 autistic children at different stages of phrase-speech development. In children using very brief utterances, echolalic phrases were significantly longer than their spontaneous speech. At higher levels of language development there were no significant differences between the lengths of echoed and spontaneous utterances. The frequency of echolalic phrases in children's speech was also found to be significantly less than the frequency of their spontaneous remarks, and the frequency of echolalic utterances declined as children advanced in linguistic competence.

Autistic Disorder↗

Developmental language impairments with complex origins: learning from twins and multiple birth children.

Various factors that make language development vulnerable in twins and multiple birth children are discussed. Researchers have investigated single explanations for language impairment in twins. However, this paper argues that in individual cases the language impairment is more often the outcome of a complex interaction of factors. Some factors play a greater part than others in some cases. It is suggested that clinicians can develop a dynamic model of language acquisition from understanding the effect of multiple birth and other exceptional circumstances on language acquisition. This model is needed to underpin investigations into individual cases of language impairment. An approach to assessment is described that identifies factors operating in individual cases of multiple birth, providing an essential precursor to implementing appropriate case-based intervention.

Birth Intervals↗

Developmental and behavioural disturbances in 13 boys with fragile X syndrome.

Developmental and behavioural aspects were studied in 13 boys aged 2.6-12.5 years from three families with the fragile X syndrome. The following observations were made. Moderate to severe retardation was present in all boys; non-verbal IQs ranged between 25 and 67 (mean 46 +/- 14); IQ and age were negatively correlated (P less than 0.01). Language development was grossly delayed in all boys; most had severe articulation problems. Imitative and symbolic play (e.g. doll play) were strikingly retarded as compared to abstract play (e.g. block design). Autistic features such as no use of eye contact, stereotyped movements and echolalia were found in 9/13 boys; the same number showed aggressive behaviour. General activity was reduced during the 1st year of life; most boys became very hyperactive during the second year; and short attention span and increased distractability were observed in all. Motor development was mildly delayed; all boys were clumsy and moderately hypotonic. The fragile X syndrome ought to be considered in retarded boys with a dissociated developmental pattern, in particular a striking delay in language and play development, and autistic features.

Child↗

Conversational replies of children with specific language impairment.

Conversational replies were examined in two groups of children with comparable vocabularies and speech limited to single-word utterances: children with specific language impairment, ages 2:10 to 3:6 (years:months); and children, ages 1:5 to 1:11, who were developing language normally. In interactions with adults the language-impaired children produced a greater number and variety of replies to both questions and statements than the normal-language children. The findings suggest that language-impaired children can serve as responsive conversationalists when syntactic skill is not a factor and that comprehension, world knowledge, and/or experience with conversations permit considerable variability in conversational skill even within the same level of expressive language ability.

Child, Preschool↗