Language disorders in children referred for psychiatric services.
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This symposium was focused on habilitation for children with visual and hearing impairment, speech-language disorder, and hyperkinetic disorder. New and variable approaches were reported in topics of habilitation for these handicapped children by an ophthalmologist, an otorhinolaryngologist, a child neurologist, a speech therapist and an educational psychologist. Many points of these approaches were then discussed.
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Language development is delayed in most children on the autistic spectrum. The children are dysphasic as well as autistic. Comprehension and pragmatics are invariably affected. Lower level mixed receptive/expressive disorders involve phonological and syntactical processing, whereas higher level processing disorders involve semantics and formulation of discourse. In some children, lower level disorders may be so severe as to preclude speech, whereas in others phonology may be deficient in spontaneous production but not in repetition. Abnormal features of autistic language include aberrant prosody, immediate and delayed echolalia (scripts), and perseveration. Electrophysiological studies indicate that brainstem-evoked potentials are normal. Even in fully verbal individuals with autism, early and late cortical components of auditory, but not visual, event-related potentials are abnormal. Appropriate intervention must address language and behavioral issues. In children with severely defective auditory language, provision of visual language to supplement speech is essential.
In this article we shall first attempt to show in a summary fashion how the concept of language has changed over the last 20 to 40 years. This will serve as a background and aid to understanding the current view that language disturbances are of such a complex nature that they can only be understood, analysed and treated by means of an interdisciplinary approach. A look at the recent developments in the sciences that touch upon the comprehension of language disturbances elucidates our current view of them. It can help to clarify the role of the psychologist, especially the school psychologist who works with children and adolescents in the diagnosis, counseling, in some cases in the treatment and often in cooperation with other professionals of lingual disturbances. Conclusions can also be drawn as to the specific professional qualifications required and as to the methodology of the psychological examination.
A model is presented for the integration of clinical-inferential and quantitative approaches to classification. In this, the first application of the proposed model, preschool children with developmental language disorders were classified on the basis of clinical interpretations of performance on psychometric subtests. Five hypothesized subgroups were validated on the basis of (a) consensus among five clinical neuropsychologists, (b) language pathologists' reports, (c) comparisons with subgroups defined by a cluster analytic approach, and (d) comparisons among subgroups on variables not used for classification. Results are discussed in terms of the feasibility of the integrated approach, commonalities with other typologies, and the implications of this work to issues of subtype stability, remediation, predictions of later reading achievement, brain-behavior relationships, and generalizability to other clinical groups.
The major purpose of this study is to determine whether children assigned to classes for severe oral language handicaps in California by a multidisciplinary diagnostic team exhibit a characteristic ITPA performance profile or a number of distinct profiles. A factor analysis and a cluster analysis was made on the scores of 237 children. It was found that on the factor analysis the results showed a clear auditory-vocal factor and a visual-motor factor. All five tests in the visual-motor channel were superior to the five tests in the auditory-vocal channel. Within the auditory-vocal channel the lowest scores were in auditory association and grammatic closure. Ninety-seven percent of the oral language handicapped children had the lowest scores on these two subtests. It appears from these results that the major deficit of children assigned to severe oral language classes is a deficit in the central organization process, formerly referred to as "central aphasia, or inner language".
Thirty-six subjects, 18 language-impaired and 18 articulation-impaired children, were followed up with respect to communication skills and educational performance 13 to 20 years after their initial contact with the Speech and Hearing Clinic. According to their parents, nine language-impaired subjects continued to exhibit communication problems as adults, compared to only one of the articulation-impaired subjects. Standardized educational testing conducted while the subjects were in elementary and secondary schools indicated that the language-impaired group consistently achieved at a lower level than the articulation-impaired group, particularly in reading. Differences between the groups were also exhibited in the types of postsecondary education attempted by the subjects. Clinical, educational, and research implications of these results are discussed.
When James was born he seemed the perfect baby. But gradually Venetia Young became concerned about his slow development. Despite repeated reassurance from health professionals, including her health visitor, she persisted in seeking medical opinion and finally learned that James had a language disorder. Here she describes his early years, the warning signs of his language problem and her battle against the experts' disbelief.
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Results of treatment of four patients are described. All of the patients had pervasive developmental disorder (PDD), a tic disorder, and a characteristic pattern of speech and language impairment. The patients were treated with haloperidol for their tic disorders, and concomitant with the reduction of the frequency and severity of tics was marked improvement in language. The patients averaged 3 months of language gain for each week of speech therapy directly after the initiation of haloperidol treatment for tics. Progress in speech and language therapy was extremely slow during the years prior to treatment with haloperidol. To the authors' knowledge, no language disorder has been described in the literature which shows such a predictable and marked response to pharmacological treatment. The authors hypothesize that tic disorders in individuals with PDD may be a marker for a more positive response to dopamine antagonists like haloperidol.
Three major types of treatment research methodologies are described. Studies on child language intervention are reviewed as examples of trends and methodological issues characterizing treatment research in speech, language, and swallowing within the last 2-3 decades. Principles are drawn from that literature and suggestions for future directions are discussed with particular attention to recent efforts to support clinical trials and treatment outcomes research.
The effective diagnosis and treatment of persons from diverse minority language backgrounds has become an important issue in the field of speech and language pathology. Yet, many SLPs have had little or no formal training in minority language, there is a paucity of normative data on language acquisition in minority groups, and there are few standardized speech and language tests appropriate for these groups. We described a diagnostic process that addresses these problems. The diagnostic protocol we have proposed for a child from a Black English-speaking background characterizes many of the major issues in treating minority children. In summary, we proposed four assessment strategies: gathering referral source data; making direct observations; using standardized tests of non-speech and language behavior (cognition, perception, motor, etc.); and eliciting language samples and probes.
Fifteen linguistically normal children and 15 linguistically deviant children were presented with three types of agrammatical sentences. The subjects were asked to judge the sentences as right or wrong and to change the sentences judged as wrong, rendering them correct. The three types of agrammatical sentences represented rule violations of syntactic agreement (Type A), lexical restrictions (Type B), and word order (Type C). The two groups of children were compared in terms of the number of sentences of each type that were agrammatical. Those productions which represented the child's correction of agrammatical sentences were subjected to descriptive analyses (percentages) with specific reference to the number of attempted changes and the number of those changes which demonstrated corrections of the specific deviation from well formedness. Results indicated that the two groups of subjects were significantly different in their ability to recognize grammatical errors in sentence Types A and C, but did not differ in their ability to recognize errors in sentence Type B. The descriptive comparison of the groups' verbal corrections reflected this trend, in that the language-disordered subjects made corrections specific to the error on more of the Type B sentences (for example, "The dog writes the food.") than on Types A (for example, "She will pick some flowers last week.") or C (for example, "Get and come your dinner."1.) Linguistically normal children accurately corrected 90.7% of the sentences judges as agrammatical; this percentage did not vary more than 1% across sentence types.
This article discusses findings using various imaging techniques regarding the neurological underpinnings of developmental language and learning disorders. Evidence from magnetic resonance imaging, functional magnetic resonance imaging, single photon emission spectroscopy, and positron emission tomography implicates the left perisylvian regions in the processing of phonemes and auditory information, as had been predicted from lesion data and from neurobiological theory. The areas of the planum temporale and angular gyrus have been found to be compromised in children and adults with dyslexia or language impairment. Emerging evidence suggests that these differences are also present in members of families with a history of developmental language disorders, which provides support for a transmittable, biological factor involved in such disorders. Dynamic imaging procedures are beginning to provide an understanding of the relationship between structure and function in normal and abnormal language acquisition.
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In this study we used the Kaufman-Assessment Battery for children (K-ABC), which assumes a dichotomy of sequential versus simultaneous processing of intelligence, in order to describe the typical pattern of processing in 25 children with normal nonverbal intelligence and developmental language disorder (DLD) of the phonologic-syntactic subtype, a mixed receptive-expressive DLD with grammatical and phonologic deficits. The results of the K-ABC showed a significant deficit in auditory sequential processing, whereas simultaneous processing was normally performed.