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Microtia and significant auricular malformation. Ninety-two pediatric patients.

OBJECTIVE: To study congenital auricular malformation, an uncommon but serious condition. The literature about auricular malformation separates the medical, otologic, and auricular reconstructive elements; this study addresses all elements in a single report. DESIGN: A retrospective chart analysis of patients with microtia and severe auricular malformation from initial presentation through surgical reconstruction for those of appropriate age. SETTING: A single author's experience in a practice at a referral institution. PATIENTS: Ninety-two patients (108 ears). RESULTS: Early presentation at less than 1 year of age was noted for 40 patients. Coexisting medical conditions were noted in 16 patients. Seven patients demonstrated facial paralysis. Unexpected sensorineural hearing loss was discovered in six patients. Twenty-four patients had undergone auricular reconstruction at the time of this report. Additional patients had undergone skin tag removal, ventilation tube placement, and atresia repair. CONCLUSIONS: Children with microtia and significant auricular malformation require global attention to early family guidance, to expected and unexpected hearing loss, to language development, to associated medical conditions, and to both auricular and otologic reconstruction issues.

Adolescent↗

Neural patterns to speech and vocabulary growth in American infants.

We report infant auditory event-related potentials to native and foreign contrasts. Foreign contrasts are discriminated at 11 months of age, showing significant differences between the standard and deviant over the positive (P150-250), or over the negative (N250-550) part of the waveform. The amplitudes of these deflections have different amplitude scalp distributions. Infants were followed up longitudinally at 18, 22, 25, 27 and 30 months for word production. The infant speech discriminatory P150-250 and N250-550 are different components with different implications for later language development.

Acoustic Stimulation↗

Emotional disturbance in mental retardation: an investigation of differential diagnosis.

The study sought to determine whether 100 emotionally disturbed mentally retarded subjects assigned four distinct diagnostic labels could be differentiated from each other on the basis of sex, age, degree of mental impairment, and adaptive behavior. Univariate and multivariate analyses indicated that the autism classification was distinguishable from psychosis, schizophrenia, and severe emotional disturbance in terms of degree of retardation and adaptive behavior. The primary distinguishing feature was the autistic group's low level of language development. The schizophrenics, psychotics, and severely emotionally disturbed subjects were indistinguishable from each other on the variables examined.

Adolescent↗

Improving the social-conversational skills of developmentally delayed children: an intervention study.

Twenty mothers and their preschool-aged, developmentally delayed children participated in this parent-focused intervention study. Nine mother-child dyads received an 11-week training program that espoused a social-conversational approach, while 11 dyads served as controls. Pre- and posttest videotapes were transcribed and coded to yield measures of turn taking, as well as indexes of responsiveness, topic control, and uninvolvement. Following treatment, the mothers in the experimental group were more responsive to and less controlling of their children's behavior than the mothers in the comparison group. The children initiated more topics, were more responsive to their mother's preceding turns, and used more verbal turns and a more diverse vocabulary than the control group children. No differences in language development, as measured by a standardized test, were found. Individual maternal responses to intervention as well as implications for modifying parent training programs are discussed.

Child, Preschool↗

Clinical characteristics of children with mental retardation of unknown etiology in Korea.

The purpose of this study was to investigate the clinical characteristics of children with mental retardation (MR) of unknown etiology for early recognition and intervention. In this study, we defined children with MR of unknown etiology as those without clear etiologies for MR despite extensive evaluation and were not associated with pathological behavioral problems such as pervasive developmental disorders and attention-deficit/hyperactivity disorder. The clinical characteristics of children with MR of unknown etiology were as follows. 1) MR of unknown etiology was 48.8% of all MR. 2) MR of unknown etiology was more common in males. 3) Delayed language development was a leading factor that made the parents of children with MR of unknown etiology seek help from physicians. However, most of the children with MR of unknown etiology showed a relatively uniform delay in several areas of development. 4) Most children with MR of unknown etiology were delayed walkers. 5) Most children with MR of unknown etiology were mild cases.

Child↗

Language abilities in children who stutter: toward improved research and clinical applications.

The nature of the association between language and stuttering in young children has been the focus of debate for many years. One aspect of this ongoing discussion is the status of language abilities in children who stutter (CWS). Available research findings and associated interpretations of these findings are equivocal. This article asserts that an important contributor to the ambiguous nature of this literature may be differences in research traditions and methods that typically have been employed n the study of language development and in the study of stuttering. Cross-disciplinary investigations are inherently complex and, in designing and intterpreting research of this nature, a larger set of issues must be considered and more diverse variables must be aressed and/or controlled. This article presents five prinples that can be used to guide future research in the area language and stuttering. These principles also assist in interpreting and applyng the current research literature to clinical concerns.

Child↗

Evaluation of a language program for young autistic children.

This report presents retrospective data comparing an individualized language development program for preschool autistic children receiving language remediation (experimental subjects) with a group receiving the basic school curriculum only (control subjects). All findings favored the language remediation group, as indicated: (1) experimental subjects made significant gains in one year while the control group required two years; (2) after one year, experimental subjects surpassed controls on four measures; (3) only experimental subjects made significant gains in communicative speech, noteworthy because interpersonal interaction is so difficult for the autistic child; and (4) after two years, 58% of the experimental subjects, but only 14% of the controls, had mastered all seven skills. These results support the hypothesis that an individualized language remediation program facilitates the acquisition of prelinguistic and linguistic skills.

Autistic Disorder↗

The language of dissociation.

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.

Child↗

The association between language and symbolic play at two years: evidence from deaf toddlers.

The association between expressive language and symbolic play was investigated in 3 groups of 2-year-olds: deaf children with hearing parents (dH), deaf children with deaf parents (dD), and hearing children with hearing parents (hH). (Each group included 6 girls and 4 boys.) 3 language-level groups were defined. The highest group was well into the vocabulary "explosion" and frequently produced multiword/sign utterances; a middle group was beginning the period of vocabulary expansion and occasionally produced utterances of more than 1 word/sign; a third group produced single word/sign utterances only, and had a limited vocabulary. Hearing status was associated with duration of symbolic play (deaf > hearing). Higher language levels were associated with more canonically sequenced and preplanned play, even when language delays were due to exogenous factors.

Child, Preschool↗

Variation in vocal-motor development in infant siblings of children with autism.

In this study we examined early motor, vocal, and communicative development in a group of younger siblings of children diagnosed with autism (Infant Siblings). Infant Siblings and no-risk comparison later-born infants were videotaped at home with a primary caregiver each month from 5 to 14 months, with follow-up at 18 months. As a group, Infant Siblings were delayed in the onset of early developmental milestones and spent significantly less time in a greater number of postures, suggestive of relative postural instability. In addition, they demonstrated attenuated patterns of change in rhythmic arm activity around the time of reduplicated babble onset; and they were highly likely to exhibit delayed language development at 18 months.

Autistic Disorder↗

Hearing assessment in pre-school children with speech delay.

OBJECTIVE: The purpose of this study was to detect any underlying hearing loss among the healthy pre-school children with speech delay. METHODS: 76 children, aged from 1 to 5 years, underwent a thorough audiological examination consisting of tympanometry, free field testing, otoacoustic emission recordings and auditory brainstem responses (ABRs). If hearing was normal, then they were evaluated by a child neurologist-psychiatrist. RESULTS: According to our findings, the children were classified into 3 groups; those with normal hearing levels (group I, 52 children, 68.4%), sensorineural hearing loss (group II, 22 children, 28.9%) and conductive hearing loss (group III, 2 children, 2.6%). In group I, speech delay was attributed to pervasive developmental disorder (PDD), which represents high-functioning autistic children (37 cases). Other causes were specific language impairment (SLI)-expressive (3 cases), bilingualism (2 cases), and unknown etiology (10 cases). More than half (59%) of the children diagnosed with PDD evidenced significant language impairment limited to more than two words. Children with SLI-expressive and bilingualism used a maximum of two words. In group II, 13 children suffered from profound hearing loss in both ears, 3 from severe, 3 had profound hearing loss in one ear and severe in the other, 2 from moderate, and 1 had moderate in one ear and severe in the other. No child had mild sensorineural hearing loss. The children with profound hearing loss in at least one ear had total language impairment using no word at all (10 cases), or a maximum of two words (6 cases). When hearing loss was moderate to severe, then the speech vocabulary was confined to several words (more than two words-6 cases). Only two children suffering from conductive hearing loss both presented with complete lack of speech. CONCLUSION: A great number of healthy pre-school children with speech delay were found to have normal hearing. In this case, the otolaryngologist should be aware of the possible underlying clinical entities, especially of psychiatric nature. The children with profound sensorineural hearing loss exhibited more severe speech delay than those with moderate to severe. Regardless of etiology, the early identification and intervention contribute to positive outcome in this critical period of childhood for language development.

Acoustic Impedance Tests↗

[Diagnosis of speech retardation and early intervention].

In the diagnosis of speech retardation, not only speech production and comprehension, but the assessment of interpersonal relationships is important as an indicator of non-language development. The newly revised K method developmental examination ("Shinban K-shiki Kensahou") is widely used as an assessment for preschool children. I think the Enjouji method analytical developmental examination for infant and preschool children ("Enjouji-shiki Bunsekiteki Kensahou") is a simple and useful examination scale of developmental delay because it includes the category of interpersonal relationship. Developmental language disorder (DLD) is the most frequently noted (4.3%) in the general population as seen in our research of speech retardation of 1 year-6 month examination in Ota-ku district. Some academic societies of children warn that TV watching for a long time causes speech retardation or psychiatric disorders, but it seems to me that this influence is of limited significance. To assess autism adequately we made a checklist that includes concrete behavioral abnormalities based on the criteria of DSM-IV. The criteria of DLD are diverse and are not currently standardized now. I proposed, therefore, a criterion by unifying them.

Child, Preschool↗

Clinical use of AEVP- and AERP-measures in childhood speech disorders.

It has long been recognized that from the first months of life auditory perception plays a crucial role in speech and language development. Only in recent years, however, is the precise mechanism of auditory development and its interaction with the acquisition of speech and language beginning to be systematically revealed. This paper presents the results of a series of studies exploring the relevance of electrophysiological measurements for the objective diagnosis of children with language and speech disorders. In the first, retrospective, study, an inventory was made of clinical neurological, neuropsychological, logopedic and neurophysiological findings obtained from 43 children referred to the Paediatric Neurology Centre for the diagnosis of their speech and language deficits. Neurophysiological abnormalities were found in 95% of these children, among these deviant auditory evoked potentials (AEVPs). The second study demonstrated developmental trends in the waveform of the cortical AEVPs up to age 6 years; the implications for longitudinal studies are discussed. Preliminary results from the third study show emerging differences in auditory event-related potentials (AERPs) for young children who are at risk for developmental dyslexia based on their family history. These findings underscore the clinical usefulness of neurophysiological measures for the diagnosis of speech-language disorders. Clinical protocols are further developed and tested.

Child↗

Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay.

BACKGROUND: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness. AIMS: To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis. METHODS & PROCEDURES: Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group (n=10) received standard individual general care. The comparison group (n=12) received PBI. OUTCOMES & RESULTS: After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care. CONCLUSIONS: Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach.

Adult↗

International adoption: a health and developmental prospective.

Adoptions from international countries have become an option for many US families, with over 150,000 children adopted in the past 14 years. Typically, internationally adopted children present with a host of medical and developmental concerns. Issues such as growth stunting, abnormal behaviors, and significant delays in motor, speech, and language development are likely directly related to the prenatal and early postnatal environment experienced prior to adoption. The new family and its health-care team must quickly work to identify and address these issues to aid the child's integration into his or her new family. This article will examine potential issues seen in children who are being adopted, including the impact of early environment on subsequent development. We will summarize early and long-term medical issues and review the extent of developmental delays seen in children adopted internationally. Finally, we will discuss possible mechanisms leading to the observed delays, including the impact of stress on subsequent development. By understanding the extent of expected delays and the mechanisms likely causing the issues, the health-care team will be in a good position to quickly identify and develop intervention protocols that will foster the child's assimilation into his or her new family.

Acculturation↗

Maternal fish oil supplementation in lactation: effect on developmental outcome in breast-fed infants.

Docosahexaenoic acid (DHA) accumulates in the brain during the 1st and 2nd years of life. The objective of this study was to see if an increased content of DHA in breast-milk via maternal fish oil (FO)-supplementation affects mental development in term infants. one hundred twenty-two Danish mothers with a habitual fish intake below the population median were randomized to 4.5 g.d(-1) of FO or olive oil (OO) for the first four months of lactation. Fifty-three mothers with habitual fish intake in the highest quartile were included as reference group. The effect of the resulting increase in infant DHA-intake and RBC-DHA level was assessed on problem solving ability at nine months and language at one and two years of age. Infants in the three groups performed equally well on the problem test and no association was observed between problem solving and erythrocyte-DHA at four months. Passive vocabulary at one year was lower in the children of the FO- compared with the OO-group (P < 0.05), but no differences were found at two years of age. Word comprehension at one year was inversely associated with erythrocyte-DHA at four months. The trial indicate a small effect of DHA levels in breast-milk on early language development of breast-fed infants.

Adult↗

[Pragmatic language impairment in children].

When a child's language development does not follow the normal developmental course for no known reasons specific language impairment (SLI) is diagnosed. In contrast, pragmatic language impairment (PLI) refers to children who experience significant difficulties with the use of language. Clinical accounts of PLI have suggested that unlike children with more typical SLI, children with PLI have adequate syntax and phonology and are often verbally fluent. However, they may exhibit a range of linguistic and communicative deficits such as comprehension deficits for connected speech, conversational inadequacies, poor turn-taking, atypical word choices, literal interpretation of figurative language, and poor topic maintenance. There also may be fundamental deficits in social cognition, such as appreciating the thoughts and feelings of others. PLI may be found in SLI children, children with learning disabilities, autism and traumatic brain injuries. Here we review aspects of pragmatic communication skills, the development of emotion recognition, and diagnostic and therapeutic procedures. Otolaryngologists have to be aware of PLI in case children with communication problems are referred to them. This may enable a timely diagnosis and early intervention.

Child↗

Socio-perceptual bases for the emergence of language: an alternative to innatist approaches.

Recent challenges from a variety of fields suggest a re-examination of the nativist position and its implications for child language and communication research and theory. Basic assumptions crucial to the innatist position influence researchers to ignore the source of input, its characteristics, and its impact on language development. In contrast, from a socio-perceptual/ecological position, the linchpin of the emergence of language is the dynamic structure of the social-interactive environment in which the child develops. Evidence from a series of studies investigating the social and perceptual bases of the emergence of the lexicon is marshaled to support and illustrate this perspective. Parallel arguments can and ought to be constructed to explain other aspects of language learning.

Child Language↗