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PubMed2003

Service delivery options for secondary students with language disorders.

Numerous adolescents are still undetected, unserved, and underserved by speech-language pathologists, resulting in astronomical financial and psychological costs to them and society. The purpose of this article is to provide an overview of past and present service delivery options for adolescents with language disorders. Before illustrating the authors' recommended model, the following background is provided: an overview of the three stages of adolescent development, characteristic expectations and problems for older students with language disorders, and a rationale for adolescent speech-language services. The comprehensive service delivery model for secondary-level speech-language students, designed and reported by the authors, consists of six components: information dissemination, identification, assessment, program planning, intervention, and follow-up. Some of the unique features of the comprehensive model are presenting services as a course for credit, providing grades, and using supportive course titles such as Individualized Communication Class.

Adolescent↗
PubMed2003

[Initial examination for school attendance in Mannheim: language development at initial school entry level].

INTRODUCTION: In autumn 2001 the initial examination for school attendance in Mannheim has been fundamentally reorganised. The individual examination elements had been widely standardized, the results can be evaluated by regions and a diagnosis for the early detection of legasthenia has been developed. METHODS: The testing involved repeating sentences, numbers and artificial words. This has been developed by the Pedagogical University Heidelberg. In pre-examinations in Heidelberg the results relate significantly to the subsequent results in reading and writing. PROBANDS: A total of 2,744 children (46.1% girls, 53.9% boys) aged of 5 to 7 years was seen. 71.5% of the children were German nationality. Most non-German nationalities were Turkish (15.4%) and Italian (3.6%) children. Besides the nationality the mother tongue has been also recorded. More than 96% of the children had been attending a kindergarten. For judgement of the social strata the frequency of social welfare receivers has been recorded. RESULTS: The testing results are significantly influenced by the native language and the social strata of the children. The results of children with German as native language are above those of non-Germans. Within the migrant children there are significant differences between the several nationalities. Children from a lower social strata achieved lower results. A positive effect to the language development is attributed to the attendance of a kindergarten. CONCLUSION: These results are the basis for language- and general health supporting projects in Mannheim. For the examination for school attendance in the current year the diagnostic for language development has been extended by some more aspects.

Child↗
PubMed2004

Speech and language therapy in hyperactivity: a United Kingdom perspective in complex cases.

In the United Kingdom, multidisciplinary teams within the National Health Service (NHS) usually manage children and adolescents with disorders of hyperactivity. These multidisciplinary teams do not routinely include speech and language therapists (SLTs), and therefore speech and language therapy services for children and adolescents with disorders of hyperactivity are limited. Consequently, research and service delivery for children and adolescents with disorders of hyperactivity in the United Kingdom is only starting to emerge. Two case studies are used to show how speech and language therapy in the United Kingdom can be involved in the treatment of hyperactivity through various types of service delivery. The cases are used to highlight the importance of detecting speech, language, and communication impairments in children with diagnoses of hyperactivity. The potential role of speech and language therapy in the assessment and management of these clients in the United Kingdom is discussed.

Adolescent↗
PubMed2005

Continued catch-up and language delay in children adopted from China.

Most internationally adopted children learn their new language rapidly after adoption. What is not known is whether these gains continue at the same developmental pace throughout the preschool years. To answer this question, the continued language development of the 10 lowest performers from a cohort of 55 preschool-aged children adopted from China was examined. All 55 children had originally been assessed approximately 2 years earlier as preschoolers. The purpose was to examine whether continued English language exposure resulted in greater gain scores on a battery of standardized speech-language tests normed on monolingual English speakers. The 10 lowest performers were retested on the same battery approximately 2 years later. Scores on the second testing were examined in two ways. First, the amount of gain made from first to second testing for each child was examined, and second, the low performers were compared with adopted children from the original cohort who were matched for age and duration of time in the United States. It was found that more than half of the low-scoring children made clinically significant gains on the second assessment, but that low performers as a group scored below the level of matched peers in the cohort, even after approximately 2 years of additional English language exposure.

Adoption↗
PubMed2006

Exploring visual-graphic symbol acquisition by pre-school age children with developmental and language delays.

The process of language acquisition requires an individual to organize the world through a system of symbols and referents. For children with severe intellectual disabilities and language delays, the ability to link a symbol to its referent may be a difficult task. In addition to the intervention strategy, issues such as the visual complexity and iconicity of a symbol arise when deciding what to select as a medium to teach language. This study explored the ability of four pre-school age children with developmental and language delays to acquire the meanings of Blissymbols and lexigrams using an observational experiential language intervention. In production, all four of the participants demonstrated symbol-referent relationships, while in comprehension, three of the four participants demonstrated at least emerging symbol-referent relationships. Although the number of symbols learned across participants varied, there were no differences between the learning of arbitrary and comparatively iconic symbols. The participants' comprehension skills appeared to influence their performance.

Child, Preschool↗
PubMed2002

Language impairment in Swedish bilingual children: a comparison between bilingual and monolingual children in Malmö.

UNLABELLED: In this study two groups of children were compared, 192 bilingual and 246 monolingual, referred over a 12-mo period to University Hospital in Malmö for suspected language impairment. Compared with monolingual children, bilingual children ran a significantly lower risk (RR = 0.76, p < 0.0001) of being referred by a child health centre, and a significantly higher risk (RR= 1.54, p < 0.0103) of being referred after 5 y of age. In the bilingual group there was also a significantly higher risk of parental refusal of assessment (RR = 2.35, p < 0.0016) and of the children being diagnosed with a severe language impairment (RR = 1.87, p < 0.0009). The risk for bilingual children with severe language impairment being discharged owing to non-attendance was high (RR = 6.20, p < 0.0002) compared to monolingual children. The risk increased with severity of language impairment. CONCLUSION: Bilingual children displayed a higher risk of a diagnosis of severe language impairment and of being discharged for non-attendance. The problem of low compliance among bilingual parents, despite strong indications of parental distress, must be addressed.

Adolescent↗
PubMed2004

Re-appraising contemporary theories of subcortical participation in language: proposing an interhemispheric regulatory function for the subthalamic nucleus (STN) in the mediation of high-level linguistic processes.

Apropos the basal ganglia, the dominant striatum and globus pallidus internus (GPi) have been hypothesized to represent integral components of subcortical language circuitry. Working subcortical language theories, however, have failed thus far to consider a role for the STN in the mediation of linguistic processes, a structure recently defined as the driving force of basal ganglia output. The aim of this research was to investigate the impact of surgically induced functional inhibition of the STN upon linguistic abilities, within the context of established models of basal ganglia participation in language. Two males with surgically induced'lesions'of the dominant and non-dominant dorsolateral STN, aimed at relieving Parkinsonian motor symptoms, served as experimental subjects. General and high-level language profiles were compiled for each subject up to 1 month prior to and 3 months following neurosurgery, within the drug-on state (i.e., when optimally medicated). Comparable post-operative alterations in linguistic performance were observed subsequent to surgically induced functional inhibition of the left and right STN. More specifically, higher proportions of reliable decline as opposed to improvement in post-operative performance were demonstrated by both subjects on complex language tasks, hypothesised to entail the interplay of cognitive-linguistic processes. The outcomes of the current research challenge unilateralised models of functional basal ganglia organisation with the proposal of a potential interhemispheric regulatory function for the STN in the mediation of high-level linguistic processes.

Aged↗
PubMed2004

Reappraising contemporary theories of subcortical participation in language: proposing an interhemispheric regulatory function for the subthalamic nucleus (STN) in the mediation of high-level linguistic processes.

Apropos the basal ganglia, the dominant striatum and globus pallidus internus (GPi) have been hypothesised to represent integral components of subcortical language circuitry. Working subcortical language theories, however, have failed thus far to consider a role for the STN in the mediation of linguistic processes, a structure recently defined as the driving force of basal ganglia output. The aim of this research was to investigate the impact of surgically induced functional inhibition of the STN upon linguistic abilities, within the context of established models of basal ganglia participation in language. Two males with surgically induced 'lesions' of the dominant and non-dominant dorsolateral STN, aimed at relieving Parkinsonian motor symptoms, served as experimental subjects. General and high-level language profiles were compiled for each subject up to 1 month prior to and 3 months following neurosurgery, within the drug-on state (i.e., when optimally medicated). Comparable post-operative alterations in linguistic performance were observed subsequent to surgically induced functional inhibition of the left and right STN. More specifically, higher proportions of reliable decline as opposed to improvement in post-operative performance were demonstrated by both subjects on complex language tasks, hypothesised to entail the interplay of cognitive-linguistic processes. The outcomes of the current research challenge unilateralised models of functional basal ganglia organisation with the proposal of a potential interhemispheric regulatory function for the STN in the mediation of high-level linguistic processes.

Aged↗
PubMed1991

Development of language in six hemispherectomized patients.

The development of language skills in the isolated right hemisphere was investigated by comparing the performance of 3 left hemispherectomized with that of the 3 right hemispherectomized patients and three groups of control subjects on baseline clinical measures of language and on production and judgement of morphological markers. The initial brain insult in the hemispherectomy patients of each group had occurred either during early, middle or late childhood. The left hemispherectomy patients were severely impaired in language processing across all three stages of language development. The consequences of a right hemisphere insult on language development were more restricted, with deleterious effects being apparent only in the case in which the lesion was acquired during early childhood.

Adolescent↗
PubMed1999

Specific temporoparietal gyral atrophy reflects the pattern of language dissolution in Alzheimer's disease.

The aim of this study was to determine the topography and degree of atrophy in speech and language-associated cortical gyri in Alzheimer's disease. The post-mortem brains of 10 patients with pathologically confirmed Alzheimer's disease and 21 neurological and neuropathological controls were sectioned in serial 3 mm coronal slices and grey and white matter volumes were determined for specific cortical gyri. All Alzheimer's disease patients had prospectively documented impairments in verbal and semantic memory with concomitant global decline. The cortical regions of interest included the planum temporale, Heschl's gyri, the anterior superior temporal gyri, the middle and inferior temporal gyri, area 37 at the inferior temporoparietal junction, areas 40 and 39 (supramarginal and angular gyri) and Broca's frontal regions. Although most patients had end-stage disease, the language-associated cortical regions were affected to different degrees, with some regions free of atrophy. These included Broca's regions in the frontal lobe and Heschl's gyri on the superior surface of the temporal lobe. In contrast, the inferior temporal and temporoparietal gyri (area 37) were severely reduced in volume. The phonological processing regions in the superior temporal gyri (the planum temporale) were also atrophic in all Alzheimer's disease patients while the anterior superior temporal gyri were only atrophic in female patients. Such atrophy may underlie the more severe language impairments previously described in females with Alzheimer's disease. The present study is the first to analyse the volumes of language-associated gyri in post-mortem patients with confirmed Alzheimer's disease. The results show that atrophy is not global but site-specific. Atrophied gyri appear to reflect a specific network of language and semantic memory dissolution seen in the clinical features of patients with Alzheimer's disease. Females showed greater atrophy than males in the anterior superior temporal gyri.

Aged↗
PubMed2002

Behavioural analysis of an inherited speech and language disorder: comparison with acquired aphasia.

Genetic speech and language disorders provide the opportunity to investigate the biological bases of language and its development. Critical to these investigations are the definition of behavioural phenotypes and an understanding of their interaction with epigenetic factors. Here, we report our investigations of the KE family, half the members of which are affected by a severe disorder of speech and language, which is transmitted as an autosomal-dominant monogenic trait. The cognitive manifestations of this disorder were investigated using a number of linguistic and non-linguistic tests. The aims of these investigations were to establish the existence of a 'core' deficit, or behavioural phenotype, and to explain how such a deficit during development might give rise to the range of other impairments demonstrated by affected family members. The affected family members were compared both with the unaffected members and with a group of adult patients with aphasia resulting from a stroke. The score on a test of repetition of non-words with complex articulation patterns successfully discriminated the affected and unaffected family members. The affected family members and the patients with aphasia had remarkably similar profiles of impairment on the tests administered. Pre-morbidly, however, the patients with aphasia had enjoyed a normal course of cognitive development and language experience. This benefit was reflected on a number of tests in which the patients with aphasia performed significantly better than the affected family members and, in the case of some tests, at normal levels. We suggest that, in the affected family members, the verbal and non-verbal deficits arise from a common impairment in the ability to sequence movement or in procedural learning. Alternatively, the articulation deficit, which itself might give rise to a host of other language deficits, is separate from a more general verbal and non-verbal developmental delay.

Adolescent↗
PubMed2000

Decline of language among women and men with Alzheimer's disease.

Previous research raises the possibility that gender differences occur in language function in Alzheimer's disease, but this hypothesis has not been evaluated systematically in longitudinal studies. The authors examined the association of gender with rate of decline in language and other cognitive functions among 410 persons with Alzheimer's disease. Participants were recruited from a dementia clinic and followed for up to 5 annual evaluations. Follow-up participation among survivors exceeded 90%. Decline in a composite score based on 8 language tests was evaluated in random effects models with age, education, and race controlled. Annual decline was 0.71 standard units (95% confidence interval [CI] = 0.62-0.79) for women and 0.74 units (95% CI = 0.61-0.86) for men, not a significant difference. Decline on the individual language tests and on composite measures of memory, perception, and global cognition also indicated no significant association with gender. These results suggest that Alzheimer's disease affects language and other cognitive functions similarly in women and men.

Aged↗
PubMed1999

Atypical temporal lobe language representation: MEG and intraoperative stimulation mapping correlation.

Functional brain imaging techniques hold many promises as the methods of choice for identifying areas involved in the execution of language functions. The success of any of these techniques in fulfilling this goal depends upon their ability to produce maps of activated areas that overlap with those obtained through standard invasive procedures such as electrocortical stimulation. This need is particularly acute in cases where active areas are found outside of traditionally defined language areas. In the present report we present two patients who underwent mapping of receptive language areas preoperatively through magnetoencephalography (MEG) and intraoperatively through electrocortical stimulation. Language areas identified by both methods were located in temporoparietal regions as well as in less traditional regions (anterior portion of the superior temporal gyrus and basal temporal cortex). Importantly there was a perfect overlap between the two sets of maps. This clearly demonstrates the validity of MEG-derived maps for identifying cortical areas critically involved in receptive language functions.

Adult↗
PubMed1993

Language, learning, and behavioral disturbances in childhood: a longitudinal perspective.

OBJECTIVE: Investigate longitudinally the course of development of preschool learning impaired (LI) children to better understand the interaction between neurodevelopmental delay, behavioral/emotional disorders, and language development and disorders. METHOD: Relationships between developmental language disorders and emotional problems were investigated in 99 8-year-old specifically language impaired and control children originally assessed at age 4 years using the Achenbach Child Behavior Checklist and the Conners' Parents Questionnaire. RESULTS: LI children received higher behavior problem scores and were more likely to score in the clinical range than were control children. Neither degree of early language impairment nor amount of language improvement predicted 8-year behavioral/emotional status. LI children with the largest drop in IQ between ages 4 and 8 received the highest behavior problem scores. No significant comorbid relationship was seen between LI and attention-deficit hyperactivity disorder. CONCLUSIONS: The enhanced incidence of behavior problems reported heretofore may be related more to lower IQ than to linguistic deficit per se. Care must be taken to differentiate the symptoms of neurodevelopmental delay and emotional disturbance, however, preschool children with scores in the clinical range on such measures should be referred for additional evaluation.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Preschool speech and language screening: further validation of the sentence repetition screening test.

A recent review indicated that only one speech and language screening test (the Sentence Repetition Screening Test; SRST) designed for preschoolers has been successfully validated in a representative population. This study sought to replicate the SRST validation study using a somewhat younger age group and to compare predictive indices to typical measures of parent concern and teacher judgment. A sample of (N = 343) prekindergarten children (ages 54 to 66 months) attending school registration in the spring before kindergarten entry was tested with the SRST. A stratified sample of 76 returned for criteria testing within 2 months. Teacher ratings were obtained 5 months later. Outcome measures were standard language (Bankson and Illinois Test of Psycholinguistic Abilities) and speech articulation (Arizona) tests. With a prevalence of 11%, SRST prediction of language outcomes resulted in the following indices: sensitivity, .62; specificity, .91; predictive validity, .44; overreferral, 8.4%; and underreferral, 4%. Prediction of the articulation outcome with a prevalence of 11% resulted in indices as follows: sensitivity, .57; specificity, .95; predictive validity, .75; overreferral, 3.7%; and underreferral, 8.3%. Teacher ratings and a parent questionnaire (Speech and Language Screening Questionnaire) approached the same rate of prediction of articulation but with a higher overreferral rate. The predictive indices from the SRST exceeded the comparison measures for language outcomes.

Articulation Disorders↗
PubMed2006

Early language and communication development of infants later diagnosed with autism spectrum disorder.

It is well recognized that delayed "first words" is among the most common presenting symptoms of autistic spectrum disorders (ASD). However, data on earlier language and communication development in children with ASD are limited to retrospective reports from parents and from home videos. In this study, we prospectively collected parent report data on early communication and language development in 97 infant siblings of children with ASD and 49 low-risk controls. Parents completed the MacArthur Communicative Development Inventory--Infant Form at 12 and 18 months. Analysis compared 3 groups defined on the basis of diagnostic assessment at 24 months: (1) siblings with ASD (n = 15), (2) siblings not meeting diagnostic criteria for ASD (n = 82), and (3) low-risk controls, none of whom had ASD (n = 49). Children with ASD showed delays in early language and communication compared with non-ASD siblings and controls. At 12 months, the ASD group was reported to understand significantly fewer phrases and to produce fewer gestures. At 18 months, they showed delays in their understanding of phrases, comprehension and production of single words, and use of gestures. Siblings not diagnosed with ASD also used fewer play-related gestures at 18 months than low-risk controls, even when children with identified language delays were excluded. Overall, this prospective study confirms that delays in communication and language development are apparent early in life in children with ASD, and emphasizes that developmental surveillance should include monitoring for delays in gesture, which may be among the earliest signs of ASD.

Autistic Disorder↗
PubMed2006

Language use in females with fragile X or Turner syndrome during brief initial social interactions.

Fragile X and Turner syndromes are associated with risk of atypical social function. We examined language use, including normal and atypical speech, during initial social interactions among participants engaged in a brief social role play with an unfamiliar adult. There were 27 participants with Turner syndrome, 20 with fragile X syndrome and 28 in an age-matched comparison group. Females with fragile X did not exhibit more abnormal language, but exhibited less of what is typical during initial interactions. Overall rates of dysfluencies did not differ, although females with fragile X made more phrase repetitions. Females with Turner syndrome had no language use abnormalities. Our findings suggest that language use may influence social function in females with fragile X syndrome and that such language characteristics may be observed in the context of brief encounters with an unfamiliar adult.

Adolescent↗
PubMed2005

Language and arithmetic--a study using the intracarotid amobarbital procedure.

The intracarotid amobarbital procedure is used as a standard procedure in presurgical evaluation to assess hemispheric lateralization of language and memory, but has not been applied to investigate numerical processing. Patients with medically intractable epilepsy (n=20) were consecutively recruited during a presurgical evaluation programme. All 14 patients with left-lateralized language showed better arithmetic performance with the left hemisphere (intracarotid amobarbital procedure right), while five out of six patients with bilateral or right-hemispheric language representation showed better performance with the right hemisphere (intracarotid amobarbital procedure left). Furthermore, in patients with left-lateralized language, an interaction between intracarotid amobarbital procedure and type of arithmetic operation was found. The study suggests a close association between language lateralization and hemispheric specialization for arithmetic processing.

Adult↗