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Outcome in high-functioning adults with autism with and without early language delays: implications for the differentiation between autism and Asperger syndrome.

The question of whether Asperger syndrome and high-functioning autism should be considered as the same or different conditions has been a source of debate and controversy over recent years. In the present study, 34 adults with autism who had shown early delays in language were compared with 42 individuals who were reported to have had no such delays, either in their use of words or phrases. All participants were at least 18 years of age, had a nonverbal IQ of 70 or above and met ADI-R criteria for age of onset, communication and social impairments, and stereotyped behaviors. Those in the language delay group were diagnosed as having high-functioning autism. The remainder were designated as having Asperger syndrome. The groups were matched for age, nonverbal IQ and gender. No significant differences were found between the groups either in their total ADI-R algorithm scores, or in their algorithm scores on individual domains. Social outcome ratings and ADI-R scores based on current functioning also failed to differentiate between the groups. Scores on tests of language comprehension and expression were also similar, but in both groups language abilities were well below chronological age level. The implications of these results with respect to the differences between Asperger syndrome and high-functioning autism are discussed. The poor performance on language tests also challenges the assumption that early language development in Asperger syndrome is essentially normal.

Adolescent↗

Late diagnosis of congenital hearing impairment in children: the parents' experiences and opinions.

The purpose of the present investigation is to describe how parents experience a delayed identification of their child's hearing impairment. Ten parents of 8 children were interviewed. The impairment was confirmed when the children were between 2 years, and 5 years and 8 months. The results show that the parents and their child pass through a series of distinct phases: Unawareness, Suspicion, Confirmation and Habilitation. After the birth of the child there was first a calm period, which lasted until the possibility of a hearing impairment was suspected. Once the suspicion was raised, a time of much anxiety and frustration ensued. The parents described how defective communication and misunderstanding lead to frequent conflicts with their child. The differing behaviour of the child, in combination with poor language development, initiated referral to audiological assessment and confirmation of the hearing impairment. After confirmation, the parents felt relief but at the same time a sorrow. When hearing aids had been fitted and education in sign language was under way, the child's language and social behaviour improved. Supposedly, the late detection is explained by the combination of an insufficient test method that cannot detect all children with a hearing impairment and, in cases of uncertainty, a tendency to let the child pass rather than "bringing bad news". All parents in the present study would have wished to participate in a hearing screening program for new-borns, had the opportunity been present.

Adult↗

A nation-wide project for the revision of the Belgian nursing minimum dataset: from concept to implementation.

This paper describes the process of revising the Belgian Nursing Minimum Data Set (NMDS). The study started in 2000. Implementation is planned from 2006. The project is divided in 4 major phases. The first phase (June-October 2002) implied the development of the conceptual framework based on literature review and secondary data-analysis. The Nursing Interventions Classification (NIC) was selected as framework for the revision of the NMDS. The second phase focused on the language development (November 2002 - September 2003) with panels of clinical experts (N=75) for six care programs. They indicated hospital financing, nurse staffing allocation and assessment of the appropriateness of hospitalization as priorities of a revised B-NMDS. A draft instrument with 84 variables, using NIC, was developed during this period. This leads to an alpha version of a revised NMDS. The third phase (October 2003 - December 2004) focused on the data collection and validation of the new tool. The new NMDS was tested on 158 nursing wards in 66 Belgian hospitals from December 2003 until March 2004. This test generated data for some 95.000 inpatient days. The interrater-reliability of the revised NMDS is tested. The criterion-related validity of the revised NMDS is compared with the actual NMDS. The discriminative power of the revised NMDS is tested to select the most relevant items for data collection. This will result in a beta version of revised NMDS in December 2004. The records of the revised NMDS are linked with the hospital discharge dataset and other mandatory datasets to integrate the revised NMDS in the broader health care management. The fourth phase (January-December 2005) will focus on information management.

Belgium↗

[Early diagnosis important in hearing loss in children].

Owing to the identification of pre-, peri- and post-natal risk factors for the development of hearing loss or impairment, diagnosis is now possible at 10-14 months of age and rehabilitative measures can be implemented. It is vital that hearing impairment is discovered at an early stage, as language development occurs predominantly before the age of three. Several methods have been evolved for testing hearing in infants.

Age Factors↗

Nonword repetition abilities of children who stutter: an exploratory study.

UNLABELLED: Past research has suggested that children who stutter (CWS) may have less well-developed language skills than fluent children, and that such relative linguistic deficiencies may play a role in precipitating their disfluencies. However, data to support this position are primarily derived from results of standardized diagnostic inventories, which are originally designed to identify frank language impairment. Nonword repetition has emerged as a more sensitive measure of children's linguistic abilities. In this exploratory study, eight CWS (mean age 5:10, range 4:3-8:4) were compared to eight normally developing children (ND) (mean age 5:9, range 4:1-8:4) in their ability to repeat the nonwords of the Children's Test of Nonword Repetition. CWS performed more poorly than NS on measures of Number of Words Correct and Number of Phoneme Errors at all nonword lengths, although statistical differences were observed only for 3-syllable nonwords. When lexical stress of the nonwords was varied to a non-English stress pattern, all participants repeated the stimuli with less accuracy, and the CWS again exhibited more errors than NS. Fluency for the CWS group did not change systematically with increasing nonword length. These preliminary findings are interpreted in light of a number of extant theories of the underlying deficit in childhood stuttering. We conclude that children who stutter may have diminished ability to remember and/or reproduce novel phonological sequences, and that further investigation into this possibility may shed light on the emergence and characteristics of childhood stuttering. EDUCATIONAL OBJECTIVES: After completing this activity, the learner will: (1) be able to evaluate the research support for a linguistic component to stuttering; (2) describe the use of nonword repetition as an experimental and assessment device with children with SLI and children who stutter; (3) suggest future directions for research to further refine the potential role that linguistic encoding plays in the etiology and persistence of stuttering.

Case-Control Studies↗

The role of stress on the language-independence and code-switching phenomena.

This investigation studies the extent to which stress affects the assumed functional separation of coordinate bilingual's linguistic organization. Spanish/English bilinguals were subjects in a GSR linguistic conditioning experiment using two intensities of buzzer sounds (stressful conditions) and two lists of words. One word for each list functioned as the conditioned stimulus. Generalization to semantically, phonemically, and unrelated words occurred in both languages and buzzer conditions. We found a differential impact of the buzzer on the functional separation of the languages, although not in the direction predicted. We concluded that stress produced code-switching, and hence, a primitivization of the subject's cognitive and linguistic functioning is assumed to have occurred. These findings are important in understanding the way stress affects the bilingual's languages at the linguistic and cognitive levels. They are also important in understanding the role of stress in language development and in the transfer of linguistic information.

Adolescent↗

Auditory neuropathy: a potentially under-recognized neonatal intensive care unit sequela.

Auditory neuropathy (AN) is a hearing disorder that affects newborns. Those with high-risk neonatal histories, family history of childhood hearing loss, and hyperbilirubinemia are at greatest risk. Current neonatal intensive care unit (NICU) hearing screening methods that rely only on otoacoustic emissions will fail to detect this disorder. Auditory neuropathy differs from conductive hearing loss and sensorineural hearing loss; a specific constellation of findings on audiologic evaluation are diagnostic of this disorder. The pathophysiology of AN is unclear; however, it may be caused by demyelinization or degeneration at points along the auditory pathway. The actual incidence of AN is unknown; it is more prevalent in high-risk infants. The course of AN varies widely among patients. Current management ranges from close monitoring of the child's development to cochlear implantation. Neonatal intensive care unit nurses need to be aware of this disorder to help support and educate at-risk families and to alert them of the need to monitor hearing and language development in their infants.

Auditory Diseases, Central↗

Comprehension and production of relative clauses: a comparison between Swedish impaired and unimpaired children.

The aim of the present study is to investigate the relationship between language comprehension and language production in Swedish children. This was done longitudinally with 10 children with specific language impairment (SLI), aged 4;0 to 6;3 at Time I, and 10 children with unimpaired language development, aged 3;1 to 3;7 at Time I. The target structure was subordination, more precisely relative clauses. The children's comprehension was tested with picture pointing, act-out and oral response tests. Their production was tested with elicited imitation and sentence completion tests. Data were collected twice, with an interval of six months. The results from the unimpaired children at Time I showed a difference between comprehension and production. At Time II these children scored higher on production than on comprehension. The children with SLI scored significantly higher on comprehension than on production at Time I. In half of the SLI group there was a clear development between the two data collection sessions, diminishing the dissociation. On neither testing did the children with SLI differ significantly from the unimpaired children in comprehension. At both testings, however, the children with SLI had significantly more responses where they did not insert the complementizer in relative clauses. The results indicate that the relationship between comprehension and production is different at different stages in development. They also show that structures involving dependency relations are particularly difficult to produce for children with SLI.

Child↗

Living conditions and receptive vocabulary of children aged two to five years.

OBJECTIVE: To assess the receptive vocabulary of children aged between two years and six months and five years and eleven months who were attending childcare centers and kindergarten schools. METHODS: An analytical cross-sectional study was carried out in the municipality of Embu, Southeastern Brazil. The Peabody Picture Vocabulary Test and analysis of factors associated with children's performance were applied. The sample consisted of 201 children of both genders, aged between two and six years. Statistical analysis was performed using multivariate analysis and logistic regression model. The dependent variable analyzed was test performance and the independent variables were child's age, mother's level of education and family socio-demographic characteristics. RESULTS: It was observed that 44.3% of the children had performances in the test that were below what would be expected for their age. The factors associated with the best performances in the test were child's age (OR=2.4; 95% CI: 1.6-3.5) and mother's education level (OR= 3.2; 95% CI: 1.3-7.4). CONCLUSIONS: Mother's education level is important for child's language development. Settings such as childcare and kindergarten schools are protective factors for child development in families of low income and education.

Child Language↗

Lexical-semantic processes in children with specific language impairment.

The current study used event-related brain potentials to investigate lexical-semantic processing of words in sentences spoken by children with specific language impairment and children with normal language development. Children heard correct sentences and sentences with a violation of the selectional restriction of the verb. Control children showed an N400 effect followed by a late positivity for the incorrect sentences. In contrast, children with specific language impairment showed no N400 effect but did show a late, broadly distributed positivity. This absence of the N400 effect is due to a relatively large negativity for correct sentences, suggesting weaker lexical-semantic representations of the verbs and their selectional restrictions in children with specific language impairment.

Acoustic Stimulation↗

[Secretory otitis. Treatment in the light of current knowledge].

Secretory otitis media refers to the presence of middle ear effusion behind an intact tympanic membrane without acute signs or symptoms. 10-20% of all children with acute otitis media subsequently develop secretory otitis media of at least eight weeks duration, but the disease can also be seen without previous existence of acute otitis media. Although spontaneous recovery is common, long-lasting secretory otitis may cause delayed language development. In the light of current knowledge about risk factors and treatment strategies for secretory otitis media, this paper discusses guidelines for the treatment of this condition.

Child↗

Smaller left hemisphere planum temporale in adults with autistic disorder.

The structure of the planum temporale is often disturbed in disorders with associated communication problems, particularly in auditory and language processing areas in the brain. We hypothesized that people with autism would have reduced left hemisphere volumes in the planum temporale, a language related brain structure. We performed magnetic resonance imaging scans of 15 adults with autistic disorder and 15 comparison subjects, and measured the volume of gray matter in the planum temporale and Heschl's gyrus (HG) in both hemispheres. Planum temporale volume reduced in the left hemisphere of the autism group (P<0.003). No differences in HG volumes were observed between the two groups. The volume reduction seen in the left hemisphere of the autism group may suggest an early neurodevelopmental disturbance in autism that impacts language development.

Adolescent↗

Diagnostic assessment and treatment goals in logopedics: impairments, disabilities and handicaps.

This study was aimed to investigate to what extent impairments, disabilities and handicaps are used as diagnostic assessments and treatment goals in logopedics. Traditionally, logopedists are mainly concerned with impairments. These days, increasing attention is demanded for disabilities and handicaps as well. A survey study was carried out on 1,567 patients in logopedic practices in the Netherlands to provide an empirical quantitative description of diagnostic assessments and treatment goals, formulated in terms of impairments, disabilities and handicaps. Results show that logopedists indeed often indicate impairments as diagnostic assessments and as treatment goals, particularly language development impairments and phonetic/phonological articulation impairments. Interestingly, also large numbers of diagnostic assessments and treatment goals were indicated at the level of disabilities and handicaps; the most important being disability in expressing communication and occupational handicap. These results demonstrate that disabilities and handicaps may serve an important function in logopedics, in that they may guide assessment as well as therapy. It is concluded that disabilities and handicaps should be considered in the future development of the profession of logopedics.

Adolescent↗

[Word list for evaluating oral language perception in children with total and partial hearing impairment].

This article presents twelve lists of 25 words each that are counterbalanced for use in audiology. The lists are equivalent in phonetic and semantic complexity and difficulty for lipreading. The twelve TAV lists consist of a basic child's vocabulary known by profoundly deaf prolocutive children of school age. These lists allow the evaluation of lipreading, hearing, and language perception. They also make it possible to compare improvements made in technical aids. Four lists of 20 words are added for use with younger deaf children (preschool lists). These lists are useful for people with scant language development. Three training lists are included as well.

Child, Preschool↗

Giant posterior fossa cystic craniopharyngiomas presenting with hearing loss. Report of three cases and review of the literature.

BACKGROUND: Autopsy studies and recent reviews report that 4% of craniopharyngiomas have posterior fossa extension at initial operation, and 12% subsequently develop this extension during their course. However, only two patients in the literature have been shown to present with deafness, which preceded the more typical suprasellar signs and symptoms of increased intracranial pressure, endocrine disturbance, altered mentation, and visual deterioration. METHODS: The authors report three cases of giant cystic posterior fossa craniopharyngioma initially presenting in childhood with either unilateral or bilateral deafness. These cases are presented, the literature on posterior fossa craniopharyngioma is reviewed, and staged operative management is discussed. RESULTS: Despite being rarely reported, 10% to 20% of giant cystic craniopharyngiomas with posterior fossa extension at presentation may have unilateral or bilateral deafness as their first symptom. Deafness as a presenting symptom is much less common in patients presenting with recurrent tumors in this location than with primary tumors. Pterional or bifrontal craniotomy is appropriate for management of the parasellar component and should be undertaken first when visual symptoms are present. Suboccipital craniectomy is appropriate for management of the posterior fossa component and should be undertaken first when brain stem compressive symptoms make it necessary. Skull-base techniques may have value in certain settings, but patient's morbidity when using these techniques must be carefully considered. CONCLUSIONS: Our results indicate that staged operations with the goal of achieving gross total resection can yield excellent results. Adjuvant radiation is indicated for those with residual tumor seen on magnetic resonance imaging (MRI), but in young children without residual tumors by MRI, we prefer to follow carefully with serial scans. Since the loss of hearing in children can compromise language development, we suggest referral of these children to a specialist in language rehabilitation.

Child↗

Residual developmental disabilities in children with transient hypertonicity in infancy.

Developmental disabilities occurred in children who manifested transient neurologic abnormalities in early infancy. In an attempt to identify associated problems at an earlier age, the neuromotor and developmental progress of 33 children who had transient hypertonicity during early infancy was analyzed. At 2-3 years of age, various developmental abnormalities were identified in more than two-thirds of these children. Delays in speech and language development and also in fine motor/adaptive and behavioral difficulties were most frequently present. Over time, these problems persisted and other disorders also became apparent. At 5 years of age or older, learning disabilities were frequent and associated with language and perceptual problems. None of the patients had epilepsy; mental retardation was present in only 2 children. Our study demonstrates that children with transient hypertonicity in early infancy are at risk for various developmental problems which can be identified as early as 2 years of age. It also indicates that although their severity lessens over time, these developmental abnormalities tend to persist.

Adolescent↗

Sensitivity to grammatical morphemes in children with specific language impairment.

Grammatical morphemes, such as articles and auxiliary verbs, provide potentially useful information to language learners. However, children with specific language impairment (SLI) frequently fail to produce grammatical morphemes, raising questions about their sensitivity to them. To address this issue, two experiments were conducted in which 3- to 5-year-old children with SLI and with normally developing language (NL) heard sentences asking them to identify a picture corresponding to a named target word. The target occurred in either a grammatical sentence or one with an incorrectly used grammatical morpheme. In Experiment 1, the picture representing the target occurred with three unrelated distractor pictures. In Experiment 2, distractor sets included pictures that were semantically related to the target. In both studies, the SLI group chose fewer correct pictures when the target followed an incorrectly used morpheme. In Experiment 2, the SLI group chose more semantically related than unrelated distractors. These results suggest that children with SLI are sensitive to grammatical morphemes and that their incorrect picture choices may reflect a failure to maintain the target in memory.

Child↗

An expert system for simulation of coronary heart disease risk factor interventions.

The feasibility of using an expert system to support intervention studies within CRISPERS was investigated. A prototype expert system named CRISPERT was designed to accept user inputs, adjust the values to CRISPERS requirements, start a sequence of simulations, and analyze and interpret the results. The rule-based system was implemented using the expert system development language OPS5 combined with FORTRAN, as well as SAS procedures and DEC VMS system service routines. Results of initial tests suggest that using an expert system as an interface between users and CRISPERS is a viable approach. The development of CRISPERT facilitates the usability of CRISPERS for intervention studies of coronary heart disease.

Computer Simulation↗