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[Clinical forms of infantile dysphasias].

INTRODUCTION: By 'Dysphasias' we mean disorders of language development in children, as opposed to Aphasias which is the term used for loss of previously acquired language as a consequence of focal cerebral lesions. The definition of Dysphasia refers to alteration in the expression or comprehension of language which cannot be explained by deafness, motor deficit, mental retardation, brain damage, emotional disorders or insufficient exposure to language (DSM IV). Even within this definition there is room for different criteria for inclusion. This is shown by the lack of homogeneity in the populations studied by different authors, depending to some degree on the age of the children studied (the symptoms and signs of dysphagia are not the same in a 3 year old child as in one of school age) and the intellectual level required to rule out mental deficiency. Once the differential diagnosis with other conditions has been established, we should try to situate the dysphasia as being due to faulty reception, emission or both. Allen and Rapin have defined 4 categories of Dysphasia with subtypes which permit more specific classification within the two spheres mentioned above (reception and emission). In the sphere of emission, with characteristics of lack of fluency of speech and better comprehension than elocution are: syntactic phonological deficit syndrome, phonological programming deficit syndrome, verbal dyspraxia and lexical syntactic deficit syndrome. In the sphere of reception, with comprehension more affected than elocution are: verbal auditory agnosia and pragmatic semantic syndrome. Although the work of Allen and Rafin was done on a population of English-speaking children, this classification has also been shown to be useful in the Spanish language. We give a detailed description of these syndromes, illustrating them with video recordings of clinical cases.

Aphasia↗

Age of symptom onset in young children with pervasive developmental disorders.

Data from 39 young children with autism or other pervasive developmental disorders were examined to determine the relevance of the age of social symptom onset and language symptom onset to other developmental variables. Contrary to the authors' hypotheses, earlier onset of social symptoms was not indicative of a greater severity of autistic symptoms, retardation, or incidence of insecure attachments. Early speech loss was associated with lower IQ, greater social deficits, and poorer language development, while the presence of useful speech at age 2 was related to better functioning in multiple domains. Thus, language functions, rather than the social behaviors examined, carried the greatest predictive power regarding short-term outcomes.

Age Factors↗

Third person pronoun errors by children with and without language impairment.

UNLABELLED: Research findings have been mixed about pronoun case problems in the language-learning profile of children with specific language impairment (SLI). This study (N= 36) extended previous findings and located a number of error patterns using detailed error analyses. Results indicated that the children with expressive SLI produced more errors with third person singular (3Psg) pronouns than did their age-level peers, but they did not make more errors than their MLU-matched peers. Error patterns were similar in the children with SLI and their language-level peers. The most frequent type of error was the substitution of the objective case for the nominative case. More errors were made on the feminine pronoun, she, than on the masculine pronoun, he. Implications for theories and clinical practice were explored. EDUCATIONAL OBJECTIVES: As a result of this activity, the reader will (1) learn how children with SLI compare to their peers in producing third person pronouns, (2) learn the most common types of pronoun errors made by the children matched for mean length of utterance (MLU), and (3) evaluate how the findings relate to two current theories: one from typical language development and one from the area of SLI.

Child Language↗

Correlations of language abnormalities with localization of mutations in the beta-thyroid hormone receptor in 13 kindreds with generalized resistance to thyroid hormone: identification of four new mutations.

Generalized resistance to thyroid hormone is an inherited disease characterized by unresponsiveness of pituitary and peripheral tissues to thyroid hormone. Genetic analysis of several kindreds linked this syndrome to the gene for the beta-form of the thyroid hormone receptor, and this led to the subsequent identification of various mutations in the ligand-binding domain of this receptor. In this region we now have found 4 new point mutations with reduced T3-binding affinities from separate kindreds by direct sequencing of polymerase chain reaction products. Similar to previously studied kindreds, the reduction in T3 binding of these four kindreds ranged from 2.5- to 5-fold, indicating that these are not neutral polymorphisms. Furthermore, the pattern of inheritance of these 4 kindreds is familial in 2, sporadic in 1, and unknown in 1. To date, 20 distinct mutations have been identified, of which 18 are clustered in 2 distinct topographical regions: 11 are within the tau i/dimerization subdomains of exon 9, and 7 are within the L2 subdomain of exon 10. The 4 newly identified mutations coupled to the 9 mutations our laboratory has previously identified provide new insights into the clinical aspects of generalized resistance to thyroid hormone. Kindreds with mutations in exon 9 compared with those in exon 10 have significantly more problems in language development, as manifested by articulation problems and/or wide discrepancies in verbal and performance IQs. Interestingly, marked variability in language deficiency as well as other clinical patterns were seen not only between kindreds but also within a kindred. Further identification and clinical correlations of new mutations will continue to enhance our understanding of the structure/function relationships and physiological role of the human thyroid hormone receptor.

Adolescent↗

Spanish diminutives in mother-child conversations.

The present study examined gender and age patterns of diminutive use in conversations between 32 Spanish-speaking Peruvian mothers and their three- and five-year-old children. Results confirm previous findings concerning both parents' greater use of diminutives with younger children and children's early acquisition of this complex aspect of morphology. However, findings do not support previous studies on gender differences in parental use of diminutives with young children. Results also revealed that mothers' and children's imitations of their interlocutors' diminutized words promoted their interlocutors' overall diminutive use. This finding highlights the acute sensitivity of both speakers to each others' language and the potential role of imitation in older children's language development.

Adult↗

Comparison between the development of Malaysian and Denver children.

126 Malay children from higher income families were followed-up regularly from birth to six years of age in the University Hospital, Kuala Lumpur. Their developmental performance was compared to that of Denver children. Generally, Malaysian and Denver children appear to be similar in their development during the first six years of life except for some minor differences in the personal-social, language and gross motor sectors. Malaysians appear to be slower in self-care but more advanced in "helping around the house", "playing interactive games" and in "separating from mother". They were slightly slower in gross motor function during the first year of life but more advanced during the second year of life. However, they were slightly more advanced in language development. The differences in development between the two groups of children are discussed and it is concluded that the differences can partly be explained by differences in socio-economic or cultural differences between the two groups of children. However, the influence of genetic factors cannot be dismissed.

Child↗

Organization of language networks in children: functional magnetic resonance imaging studies.

Functional magnetic resonance imaging (fMRI) is a relatively new neuroimaging procedure that has been used to study a wide variety of cognitive phenomena in adults, including attention, language, and memory. More recently, this technique has been successfully applied to pediatric populations as well. In particular, many investigators have employed fMRI as a tool to study language development in normal children. This paper reviews the current imaging research on the identification of cortex subserving components of language processing in young children. The literature suggests that fMRI can successfully identify regions of language cortex in children in much the same capacity as it can with adults, and that generally, adults and children show fundamental similarities in the patterns of activation. However, special considerations with pediatric imaging, paradigm design, and image analysis are also discussed.

Brain↗

Why we should consider pragmatics when planning treatment for children who stutter.

Pragmatics, the use of language in context, has been investigated only recently in the language used by children who stutter (CWS). Historically researchers compared the length and complexity of the syntactic constructions produced by these children with those of children who do not stutter (CWNS) and generally found the CWS to be relatively deficient. More recently, some investigators have begun to address how the language and fluency of CWS are influenced in different communicative settings. This article describes several findings concerning the pragmatic competencies of CWS set against the traditional famework of pragmatic language development. Most studies have shown no significant differences between the CWS and CWNS groups, although some aspects of pagmatic language use have yielded an exacerbation of stuttering for CWS. These findings have suggested specific ways of incorporating a pragmatic focus in the treatment programming for CWS where the degree of difficulty of language use is increased gradually.

Child↗

Revision of the Belgian Nursing Minimum Dataset: From data to information.

The Ministry of Public Health commissioned a research project to the Catholic University of Leuven and the University Hospital of Liège to revise the Belgian Nursing Minimum Dataset (B-NMDS). The study started in 2000 and will end with the implementation of the revised B-NMDS in January 2007. The study entailed four major phases. The first phase involved the development of a conceptual framework based on a literature review and secondary data analysis. The second phase focused on language development and development of a data collection tool. The third phase focused on data collection and validation of the new tool. In the fourth phase the validity and reliability of the dataset was tested. The new dataset is without avail if it is not leading to new information. Four applications of the dataset has been defined from the beginning: evaluation of the appropriateness of stay (AEP) in the hospital, nurse staffing, hospital financing and quality management. The aim of this paper is to describe how the B-NMDS can contribute to each of these applications.

Belgium↗

Belief term development in children with autism, Asperger syndrome, specific language impairment, and normal development: links to theory of mind development.

This study examined the relationship between the development of theory of mind and the development of the belief terms think, know, and guess. Children with autism and Asperger syndrome, matched to children with specific language impairment and normal development, completed false belief, belief term comprehension, and belief term expression tasks. The autistic group's performance on the false belief, belief term comprehension, and belief term expression tasks was significantly poorer than that of the Asperger, language impaired, and normal groups. Across groups an association was found between false belief and belief term performance. Results support a growing body of literature demonstrating links between the development of theory of mind and communicative competence.

Autistic Disorder↗

Breaking the language barrier: an emergentist coalition model for the origins of word learning.

How do children learn their first words? The field of language development has been polarized by responses to this question. Explanations range from constraints/principles accounts that emphasize the importance of cognitive heuristics in language acquisition, to social-pragmatic accounts that highlight the role of parent-child interaction, to associationistic accounts that highlight the role of "dumb attentional mechanisms" in word learning. In this Monograph, an alternative to these accounts is presented: the emergentist coalition theory. A hybrid view of word learning, this theory characterizes lexical acquisition as the emergent product of multiple factors, including cognitive constraints, social-pragmatic factors, and global attentional mechanisms. The model makes three assumptions: (a) that children cull from multiple inputs available for word learning at any given time, (b) that these inputs are differentially weighted over development, and (c) that children develop emergent principles of word learning, which guide subsequent word acquisition. With few exceptions, competing accounts of the word learning process have examined children who are already veteran word learners. By focusing on the very beginnings of word learning at around 12 months of age, however, it is possible to see how social and cognitive factors are coordinated in the process of vocabulary development. After presenting a new method for investigating word learning, the development of reference is used as a test case of the theory. In 12 experiments, with children ranging in age from 12 to 25 months of age, data are described that support the emergentist coalition model. This fundamentally developmental theory posits that children construct principles of word learning. As children's word learning principles emerge and develop, the character of word learning changes over the course of the 2nd year of life.

Child, Preschool↗

Vocabulary growth in late talkers: lexical development from 2;0 to 3;0.

Vocabulary growth from 2;0 to 3;0 was studied in 28 late talkers using expressive vocabulary inventories reported bimonthly on the Language Development Survey (LDS). Group milestones were 18 words at 2;0, 89 words at 2;6, and 195 words at 3;0. A sub-group of 11 children (Group 1) showed a rapid vocabulary spurt between 2;2 and 2;8, reached the 150-180 word mark by 2;6, and attained the LDS ceiling of about 300 words by 2;10. In contrast, the 17 children in Group 2 still had a mean vocabulary of fewer than 30 words at 2;6, had less of a vocabulary spurt when they did start acquiring words, and attained the 150-180 vocabulary mark at 3;0. All 3;0 language outcome measures were significantly predicted by LDS vocabulary size from 2;2 to 2;4.

Age Factors↗

Early speech- and language-impaired children: linguistic, literacy, and social outcomes.

The aim of this study was to follow-up prospectively a cohort of preschool children originally recruited from successive referrals to speech and language therapy community clinics and to investigate their linguistic, literacy, and social outcomes at 7 to 10 years of age. Three hundred and fifty children aged 84 to 113 months (mean age 99.9mo [SD 5.4mo]) were singletons from monolingual backgrounds where there was concern about their speech and language development. Children who had severe learning difficulties, autism, oromotor deficits, dysfluency, or dysphonia were excluded. Altogether 196 (56%), 134 males and 62 females, were seen at follow-up. A control group of children who had never been referred for speech and language therapy, 57% of whom were males, was also recruited (n=94; mean age 104.4mo [SD 6.8mo]). All children were assessed on standardized measures of speech, language, and literacy. Teachers and parents completed questionnaires on educational and social outcomes. In total, 139 children in the cohort were within the normal range on standardized language assessments. About 30% of the original cohort of children continue to struggle with language, literacy, and social difficulties. The study demonstrates the long-term nature of language impairment and reinforces the need for awareness among professionals in child development and education of the ongoing needs of this population of children.

Age Factors↗

Mild Brachmann-de Lange syndrome. Phenotypic and developmental characteristics of mildly affected individuals.

Since 1981, we have identified 3 patients with mild Brachmann-de Lange syndrome (BDLS) who have had subtle but definite manifestations of the syndrome and mild effects on growth and development. J.G. (B.D. 12/9/72) was first examined at 20 months. He had rather typical craniofacial findings and hirsutism, limitation of full supination of his arms, and brachyclinodactyly of the 5th fingers. IQ was estimated at 65. K.H. (B.D. 10/10/83) was first examined by us at age 9 months and was diagnosed as having "mild" BDLS. At age 5, K.H. has demonstrated relatively normal cognitive development (low average-average IQ of 74) with specific learning problems: weakness of visual-motor skills, delayed expressive language development, and articulation difficulties. At age 7, he was attending a regular 1st grade classroom, with some special education assistance. M.E. (B.D. 4/19/78) was diagnosed at age 10 years as having "mild" BDLS. His physical changes were more subtle than those of the 2 patients above. At age 10, M.E. was in the regular 4th grade classroom receiving special education support. His IQ was in the borderline-low-average range. He had strengths in rote verbal skills, with weaknesses in reading and writing. These 3 patients demonstrate mild BDLS in which characteristic manifestations of the syndrome, particularly craniofacial anomalies, are present and recognizable, but quite subtle, thus making the clinical diagnosis difficult. In addition, the milder physical phenotype is associated with milder cognitive and behavioral consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Developmental training by parents of the very young child with potential handicap.

Fifteen children aged 9 to 15 months, who were on the observation register of a city, and considered to be showing signs of delayed development, were studied over a 3-month period. Following assessment, the parents were shown ways in which they could train their children appropriate to their development levels, in separate fields of locomotion, social development, language, and hand-eye coordination. Eight out of 13 children with delay showed significant improvement in general quotients of development over the 3 months. This occurred in 5 out of 7 children with no signs of neurological abnormality at the time of the study, and in 3 out of 6 children with signs of neurological disorder. Two children without delay showed no significant improvement. Parents' reactions are discussed, and a description is given of the way in which this project was designed, suggesting implications for future implications for future Community Health services.

Child Development↗

Gender differences in response to auditory-verbal intervention in children who are deaf or hard of hearing.

Recent research has questioned the role of gender in language development and in special education outcomes, yet neither issue has been addressed in literature on students who are deaf or hard of hearing. To determine if language and placement outcomes differ by gender, the present study considered the behavior of children who attended a clinical program subscribing to an auditory-verbal philosophy. Parents of 28 boys and 42 girls with hearing losses evaluated their children using the Parent Rating Scale of the Leiter International Performance Scale--Revised (Roid & Miller, 1997) and the Parental View of Therapy Scale (developed for the present study). Also, clinical file data were surveyed. The boys were found to be more likely than the girls to be rated by their parents as having basic features of temperament nonconducive to traditional clinical language intervention. The girls' language and placement outcomes surpassed the boys', although both groups' outcomes were positive. A possible limitation of the study was that the population was atypical of students with hearing losses in general.

Child↗

Neurocognitive impairments in schizophrenia: a piece of the epigenetic puzzle.

This paper is a review of studies examining the neurobehavioral antecedents of schizophrenia which flesh out neurodevelopmental models of schizophrenia by detailing the time course of the ontogeney of neurobehavioral impairments in schizophrenia. A follow back design was used to identify precursors of psychotic symptoms in children with a schizophrenic disorder. The vast majority of children with a schizophrenic disorder had significant developmental delays beginning early in life. For example, gross deficits in early language development were found in almost 80% of the schizophrenic children. Somewhat later in development impairments in fine motor and bi-manual coordination are noted. Some of these early developmental delays are transitory. For example, basic language skills are among the best preserved neurocognitive functions in children and adults with schizophrenia. The results of our cross-sectional neurocognitive studies suggest that children with schizophrenia suffer from limitations in the ability to engage in effortful cognitive processing or impairments in working memory. The links between these elementary neurocognitive impairments and the development of formal thought disorder as well as discourse deficits in children with a schizophrenic disorder will be discussed.

Adult↗

From language to reading and dyslexia.

This paper reviews evidence in support of the phonological deficit hypothesis of dyslexia. Findings from two experimental studies suggest that the phonological deficits of dyslexic children and adults cannot be explained in terms of impairments in low-level auditory mechanisms, but reflect higher-level language weaknesses. A study of individual differences in the pattern of reading skills in dyslexic children rejects the notion of 'sub-types'. Instead, the findings suggest that the variation seen in reading processes can be accounted for by differences in the severity of individual children's phonological deficits, modified by compensatory factors including visual memory, perceptual speed and print exposure. Children at genetic risk who go on to be dyslexic come to the task of reading with poorly specified phonological representations in the context of a more general delay in oral language development. Their prognosis (and that of their unaffected siblings) depends upon the balance of strengths and difficulties they show, with better language skills being a protective factor. Taken together, these findings suggest that current challenges to the phonological deficit theory can be met.

Child↗