[Language development disorders - delay of language development. Attempted definition].
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In the process of early detection of developmental language disorders, the option of the parents can be reckoned with. Especially the parental opinion about the language production of their child is reliable and based on a realistic norm, while their opinion about language comprehension and pragmatics is unreliable.
OBJECTIVE: The objective of the study was to explore the univariate and multivariate differences in behavioural problems among children with disorders in expressive or mixed receptive-expressive language development and children with unimpaired language development. METHOD: Ninety-four children with language development disorders (LDD) between the ages of 4 and 6 years and 94 children (matched by age and sex) without disorders of language development were compared concerning behavioural problems, as measured by the German version of the Child Behavior Checklist/4-18. RESULTS: Thirty-two children (34%) with LDD showed behavioural problems in the clinical range, whereas only 6 control subjects (6%) had scores in this range. Univariate group comparisons between patients and control subjects showed significant differences in all 8 syndromes and the scale "other problems," with patients having higher scores. Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales "other problems," "social problems," "anxious-depressed," "thought problems," "attention problems," and "delinquent problems." CONCLUSIONS: In general, our results agree with several studies that report that children with speech and language disorders are at special risk for developing behavioural problems. Neurodevelopmental immaturity may be one factor underlying both the disorder in language development and the behavioural problems.
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Difficulties in language acquisition seem to be serious, if there are additional problems like intellectual and/or emotional/social impairment, which are often reported [10]. These additional problems and the definition of specific language impairment as a developmental disorder, restricted to language acquisition seem to be contradictory [17]. Aim of that study is to look for specific language impaired children with similar cognitive abilities and though to investigate, if there are children without additional cognitive problems considering the definition of specific language impairment. 93 children, between 4;0 and 6;6 years old, were diagnostized as specific language impaired (ICD-10) and were assessed by the "Hannover Wechsler Intelligenztest für das Vorschulalter (HAWIVA)" [6] (german version of WPPSI). Cluster analysis showed, that 1/3 of the specific language impaired children presented no additional cognitive problems and 2/3 of them showed cognitive problems regarding nonverbal and verbal intelligence indeed. These additional cognitive problems indicate that there may be a more basic cognitive defect underlying specific language impairment [15]--at least for a group of specific language impaired children. Furthermore the nonverbal and verbal intellectual difficulties emphasize to general developmental support of specific language impaired children for optimal improvement in language acquisition.
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Children with severe speech disorders were examined to determine the causes of their abnormal speech development. Thirty-seven preschool and school-age children were followed up and results compared. All children had low intelligence quotients, with most of the children coming from low social backgrounds. However, both of these factors (intelligence and low social background) had no influence on the improvement of speech levels after therapy. Two-thirds of the children with moderate conductive hearing losses showed improvement after therapy, so that the effect of this hearing loss was believed to be a significant cause for the development of speech disorders. An early evaluation must be performed by a qualified phoniatrican or pediatric audiologist when children are 1.5 years old and are not able to construct words.
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Diagnostics of developmental speech- and language disorders is based primarily on the criteria severity of involvement and pattern. Regarding phonological disorders single word articulation tests are widely used because of efficiency considerations. However they are insufficient for ICD-10 diagnostics, because severity of involvement and pattern are influenced from the fact that children are spontaneously talking or giving single word responses. "Percentage of Consonants Correct (PCC)" and "Percentage of Consonants Correct for early, middle and late consonants" are described as an articulation competence metric, whereas "Natural Process Analysis" is proposed to describe the pattern of the disorder. Three case studies are used to outline the methods. Data show that "Percentage of Consonants Correct" is a good metric to index severity of involvement and "Natural Process Analysis" is a prerequisite to describe the pattern of the disorder.
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One of the prerequisites for normal language development is a highly sensitive auditory perception. An auditory perception deficit is therefore likely to affect the normal course of language acquisition. To test this hypothesis, we studied the BAEPs in 25 preschool boys with an expressive developmental language disorder and 12 boys with a history of stuttering. These children had no hearing disorders. Comparisons with the control group (49 neurologically healthy male subjects with normal hearing) revealed a statistically significant delay of waves III, IV and V in the language impaired subjects, whereas no significant differences were detected in the group of stutterers. Our findings suggest that a delayed or altered conduction of acoustic stimuli is important to the pathogenesis of developmental language disorders.
Problems of terminology, differential diagnosis, etiology and therapy of language development disorders are demonstrated by a casuistic example. Besides the importance of clinical date special attention was laid on neuropsychological diagnostic procedures and their therapeutic implications. Therapeutic interventions concerning language deficits should be developed individually and in accordance to the diagnostic findings. An early and reliable objectivation of etiology as well as of the degree of the language development disorder is necessary in order to avoid detours of the children through different intitutions.
33 children with Specific Language Impairment (F 80, ICD 10) were randomly selected and their results regarding nonverbal intelligence, passive vocabulary and sentence comprehension were compared with data of 33 control children matched by age and sex. Although cognitive performance is average in both groups, significant differences regarding nonverbal intelligence are found. Whereas nonverbal intelligence is predictable from sentence comprehension to a high degree in den SLI-group, it is not predictable in the control group.
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Diagnosis of developmental speech and language disorders in accordance with the ICD-10 is to be based on the psychometric assessment of speech and language performance. In the present study the clinical validity of the Heidelberger Sprachentwicklungstest (HSET) for diagnosing expressive language disorders was assessed by comparing HSET subtest results for 92 children aged 4 to 10 years who had various speech and language disorders with the children's scores on another language test, a cognitive test and clinical findings. The HSET scores differed considerably from the clinical ratings of the severity of the language disturbance. The correlations between the HSET scores and the score on the other language test was also low. Although the correlations of the HSET scores with the performance IQ was low, the correlations with the verbal IQ were high. The implications of these findings for the use of the HSET in diagnosing children with language impairments are discussed.
Prosody is complex and hierarchically organized but is realized as rhythmic movement sequences. Thus, observations of the development of rhythmic aspects of movement can provide insight into links between motor and language processes, specifically whether prosodic distinctions (e.g., feet and prosodic words) are instantiated in rhythmic movement output. This experiment examined 4-7-year-old children's (both normally developing and specifically language impaired) and adults' productions of prosodic sequences that were controlled for phonetic content but differed in morphosyntactic structure (i.e., content vs. function words). Primary analyses included kinematic measures of rhythmic structure (i.e., amplitude and duration of movements in weak vs. strong syllables) across content and function contexts. Findings showed that at the level of articulatory movement, adults produced distinct rhythmic categories across content and function word contexts, whereas children did not. Children with specific language impairment differed from normally developing peers only in their ability to produce well-organized and stable rhythmic movements, not in the differentiation of prosodic categories.
Four-and-one-half- to eight-and-one-half-year-old children with normal language development, normal adults, and dysphasic children were tested for their ability to perceive binary sequences of nonverbal auditory stimuli. Performance was studied in relation to the rate of presentation of stimulus sequence, as measured by the time interval between stimulus elements. Of the normal children studied, only the eight-and-one-half-year-old group responded as well as the adult group to auditory patterns composed of complex tones presented in rapid succession (8-305 msec intervals). Normal children six-and-one-half years and older were able to respond to these same auditory patterns when they were presented more slowly (947-4026 msec intervals). The overall pattern of performance of the dysphasic children was not similar to that of any age group of children with normal language development. The dysphasics' performance was significantly poorer than that of even the four-and-one-half-year-old normal group on rapidly presented auditory sequences, but not significantly different from normal children their own age or adults on the same patterns which were presented more slowly. The interrelation of normal development of rapid auditory processing and normal language development is discussed.
In a prospective study, we examined whether it is possible to diagnose language disorders in children in their second and third years. Twenty patients aged 17-35 months (average 26 months) were examined from August 2002 to June 2004. Language development was tested on the basis of a questionnaire for parents (ELFRA-1 or ELFRA-2) and on a detailed language assessment. After 3-8 months, the children's language was examined again by the same speech pathologist. In 12 children, in whom we had suspected a language disorder, the diagnosis was confirmed. Eight patients showed age-appropriate language development, which was confirmed in six patients at follow-up. In two cases, the follow-up revealed a language disorder. On the basis of a parent questionnaire and examination by a speech therapist, language disorders can be diagnosed in the second and third years of life. However, control assessments are necessary in order to reveal language development disturbances beginning at later ages.