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PubMed2004

A cluster-randomised trial of screening for language disorders in toddlers.

OBJECTIVE: To assess the screening performance of a specific language-screening instrument at 18 and 24 months of age and to assess its effect on the early detection and prognosis of language delay. DESIGN: Child health care physicians were randomised to the intervention group, in which specific language screening was conducted twice (at age 18 months and 24 months), or to the control group (usual care). The specific screening instrument consisted of a uniform set of questions for the parents and test elements for the child, with scaled scores to assess responses. SETTING: Child health care in the Netherlands and referral of screen-positive children. SUBJECTS: 5734 children in the intervention group and 4621 in the control group. MAIN OUTCOME MEASURES: Test characteristics and disorders at 24 months, and confirmed diagnoses of a language disorder before 36 months in both groups. Gold standard based on reports of parents, specialists and expert panel. Prognosis estimated from two diagnostic language development performance scores at 36 months (in questionnaire). RESULTS: In the intervention group, 3147 of the 5734 children (55%) were screened with the specific screening instrument and 73 of the screened children (2.3%) were screen-positive. Of the screen-positive children, 41 (55%) had confirmed language delay (diagnostic assessment and/or reported treatment). The estimated sensitivity of the test ranged between 24-52% depending on the severity of language disorders. The prevalence of language disorders in three-year olds was estimated to be 2.4-5.3%. In the intervention group, 1.25-2 times more children with language delay had been diagnosed before 36 months. The assessment of language development at 36 months showed no statistically significant differences between the intervention and the control groups. CONCLUSIONS: The inclusion of a specific language-screening instrument in child health centre activities resulted in the earlier detection of children with language delay. Short-term health benefits could not be demonstrated. Large-scale introduction cannot be recommended on the basis of this information alone.

Case-Control Studies↗

PubMed2004

Otitis media and speech and language: a meta-analysis of prospective studies.

OBJECTIVE: Considerable controversy surrounds whether a history of otitis media with effusion (OME) in early childhood causes later speech and language problems. We conducted a meta-analysis of prospective studies to determine: 1) whether a history of OME in early childhood is related to receptive language, expressive language, vocabulary, syntax, or speech development in children 1 to 5 years old and 2) whether hearing loss caused by otitis media in early childhood is related to children's receptive language or expressive language through 2 years of age. METHODS: We searched online databases and bibliographies of OME studies and reviews for prospective or randomized clinical trials published between January 1966 and October 2002 that examined the relationship of OME or OME-associated hearing loss in early childhood to children's later speech and language development. The original search identified 38 studies, of which 14 had data suitable for calculating a pooled correlation coefficient (correlational studies) or standard difference between parallel groups (group studies). Random-effects meta-analysis was used to pool data when at least 3 studies had usable data for a particular outcome. RESULTS: We performed 11 meta-analyses. There were no significant findings for the analyses of OME during early childhood versus receptive or expressive language during the preschool years in the correlation studies. Similarly, there were no significant findings for OME versus vocabulary, syntax, or speech during the preschool years. Conversely, there was a significant negative association between OME and preschoolers' receptive and expressive language (lower language) (0.24 and 0.25 standard difference, respectively) in the group studies. Additionally, hearing was also related to receptive and expressive language in infancy (3%-9% of variance). CONCLUSIONS: Our results indicate no to very small negative associations of OME and associated hearing loss to children's later speech and language development. These findings may overestimate the impact of OME on outcomes, because most studies did not adjust for known confounding variables (such as socioeconomic status) and excluded data not suitable for statistical pooling, especially from methodologically sound studies. Although some OME language differences were detectable by meta-analysis due to increased statistical power, the clinical relevance for otherwise healthy children is uncertain.

Child, Preschool↗

PubMed1988

Language development: a sensory development and signal processing perspective.

The relationship between the development of sensory mechanisms and the maturation of language behavior is poorly understood. From the outset it is important to distinguish between what is necessary for the development of any language system versus what is involved in the development of the verbal language system in the unimpaired child. The presence of highly sophisticated language systems among persons who communicate manually reminds us that no single source of sensory information is absolutely required for the development of at least some form of language system. Nevertheless, there persists a general belief that the availability of an accurate representation of the acoustic environment will facilitate at least the normal process of language acquisition. A more tenable question is whether the completeness or accuracy of the sensory representation places limitations on the emergence of language comprehension and production. I think this is unlikely, unless the relatively untested area of the maturation of "nonlinear processing mechanisms" provides information different than that obtained from more traditional linear systems analysis approaches. The relative integrity of the language systems of the hearing impaired, despite very dramatic differences in auditory sensitivity and frequency-resolving power, argues strongly that whatever mechanisms account for language organization are relatively immune to significant alterations in sensory input. Caution must be exercised here, however, since these comments generally refer to the outcome of studies performed on persons with acquired hearing loss. Naturalistic or descriptive studies of patients with congenital hearing loss are always susceptible to the criticism that whatever agent or agents produced the sensory impairment may also have produced concomitant impairment of nonsensory mechanisms. Nevertheless, comparisons of young infants and hearing-impaired adults, with respect to behavioral studies, suggest that there is a sufficiently rich sensory representation of the acoustic environment to permit the development of language skills much earlier than they naturally emerge. Electrophysiologic comparisons of human newborns and adults also suggest that the diminished auditory sensitivity and alterations in the frequency contour of sensitivity are insufficient to explain age differences in language comprehension and production performance. It may well be that the brain mechanisms responsible for the establishment of language behavior are sufficiently flexible to accommodate even a greatly impoverished sensory representation.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain↗

PubMed1994

[Language performance of deaf children and adolescents in verbal and written retelling of a picture story].

Evaluation of the spoken and written language skills of prelingually deaf pupils is necessary to improve existing language curricula. Research on written language shows notable delays and substantial differences in the development of written language in comparison to hearing peers. It is difficult to investigate the spontaneous speech because of methodological problems (no control of speech parameters, language becomes a confounding variable). The written language is therefore a good indicator of language development. Nevertheless, oral communication ability can only be studied through spoken utterances. The present study deals with oral and writing performance of 23 prelingually deaf pupils from 9 to 15 years of age whose hearing losses range from 85 to 117 dB. Tape-recorded short picture sequences described by the children and adolescents were examined by experienced listeners. Furthermore, the written narratives of these picture sequences were also analyzed. Parameters included frequency of occurrence of content and function words, type-token ratio, mean length of sentence, and speech fluency. Speech intelligibility was rated by a panel of naive listeners. The results demonstrate the enormous retardation of oral and written language development and specific qualitative differences compared to hearing children. Language skills improve with age, especially in writing. However, oral and written narrative abilities are positively correlated. The loss of sound requires substitutional media for the acquisition of a formal language system. This should be taken into account in the teaching of language to the deaf in order to build up a language competence which is adequate for their age.

Adolescent↗

PubMed1997

Location of language in the cortex: a comparison between functional MR imaging and electrocortical stimulation.

PURPOSE: To determine the accuracy of functional MR imaging in locating language areas for planning surgical resection. METHODS: Intraoperative photographs were digitized and overlaid on functional MR language maps. The sensitivity and specificity of functional MR imaging for identifying language areas were determined for five different language tasks by comparing functional MR areas of language activation with results of electrocortical stimulation. A match was considered to occur if an activated area contacted overlapped, or surrounded a language tag. The borders of the activation areas were extended by 1 and 2 cm to determine whether the number of matches changed. Language and nonlanguage tag matches were tabulated separately. RESULTS: Sensitivity/specificity for all patients and all language tasks ranged from 81%/53% for areas that touched to 92%/0% for areas separated by 2 cm. Individual language tasks were not as sensitive as a battery of language tasks combined. Location of language areas varied among subjects for a given task and among tasks for a given subject. CONCLUSION: Functional MR imaging should be considered a useful presurgical planning tool for mapping cortical language areas, because it is sensitive, it provides increased time for planning before surgery, and it is noninvasive.

Brain Diseases↗

PubMed2003

Genetic and environmental mediation of the relationship between language and nonverbal impairment in 4-year-old twins.

This study of 4-year-old twins investigated the genetic and environmental origins of comorbidity between language impairment and nonverbal ability by testing the extent to which language impairment in one twin predicted nonverbal ability in the co-twin. Impairment of language ability was defined as scores below the 15th percentile on a general language scale derived from a battery of diverse language tests. Four hundred thirty-six children, members of 160 monozygotic (MZ) and 131 same-sex dizygotic (DZ) twin pairs, were identified as language impaired. Language-impaired probands also suffered significant impairments in nonverbal ability. DeFries-Fulker extremes analysis showed evidence for substantial genetic mediation of the phenotypic relationship between language impairment and poor nonverbal ability in that language problems in one twin predicted poor nonverbal ability in the co-twin, much more so for MZ twins than for DZ twins. This finding held even when we excluded those children with language impairment whose nonverbal score indicated general cognitive delay. These results point to a general genetic factor that includes both language and nonverbal problems.

Case-Control Studies↗

PubMedDate not supplied

Developmental perspectives on bilingual Swedish-Arabic children with and without language impairment: a longitudinal study.

BACKGROUND: There is a need for studies on bilingual language acquisition in combination with language impairment (LI). The speech and language clinician must have tools to differentiate between problems depending on inadequate exposure to a language and problems depending on a LI. Another important issue is the pace of bilingual language acquisition relative to the severity of LI. AIMS: To investigate grammatical development over 12 months in both languages in 10 Swedish-Arabic pre-school children with severe LI and 10 Swedish-Arabic pre-school children without LI. METHODS & PROCEDURES: The children were matched for age, gender, exposure to Swedish dialect, and exposure to Arabic dialect. The developmental hierarchy predicted by Processability Theory was used in tests in both Swedish and Arabic. Processability Theory was used as a yardstick to measure grammatical development in both languages. OUTCOME & RESULTS: Bilingual children, both with and without LI, developed grammatical structures in Swedish and Arabic in the same implicational way. Children with severe LI could develop two languages, although the pace of development was much slower in both languages. Bilingual children with severe LI were also more vulnerable to limited exposure of both their languages. CONCLUSIONS: A developmental perspective is important to understand the nature of LI in bilingual children. The results also have implications for the assessment of language development in bilingual children with severe LI, since a hardly perceptible development over time is observed.

Child↗

PubMed1997

Receptive and expressive language function of children with symptomatic HIV infection and relationship with disease parameters: a longitudinal 24-month follow-up study.

OBJECTIVES: To longitudinally assess the receptive and expressive language functioning of children with symptomatic HIV disease and to explore the relationship between immune status, computed tomography (CT) brain scan abnormalities, and language dysfunction over time. METHODS: Children with symptomatic HIV infection were administered an age-appropriate standardized comprehensive language test and general cognitive measure prior to starting antiretroviral therapy (n = 44) and again after 6 months (n = 29) and 24 months (n = 17). CD4 percentage and CT brain scans were also obtained at each evaluation. RESULTS: Expressive language was significantly more impaired than receptive language at the baseline, 6- and 24-month evaluations. No significant changes over time were found in receptive or expressive language from baseline to after 6 months of antiretroviral therapy, but despite treatment, language scores declined significantly between 6 and 24 months. Overall cognitive function, however, remained stable from baseline to 24 months. Age-adjusted CD4 percentage increased significantly over the initial 6 months, then remained stable. Overall CT brain scan severity ratings did not change significantly over 24 months. CONCLUSION: Expressive language was consistently more impaired than receptive language over 24 months, further supporting an earlier finding that expressive language was differentially affected by HIV in children with symptomatic disease. Both receptive and expressive language declined significantly after 24 months despite antiretroviral therapy, although overall cognitive function remained stable. Thus, functioning in some domains may be more vulnerable to the effects of HIV and global measures of cognitive ability may mask such differential changes in specific brain functions.

Adolescent↗

PubMed1999

Cerebral lateralization: relationship of language and ideomotor praxis.

OBJECTIVE: To determine the relationship of language lateralization and hand preference to praxis performance following left and right hemispheric amobarbital-induced inactivations. BACKGROUND: Patients who are aphasic from left cerebral dysfunction also frequently exhibit ideomotor apraxia in which they make temporal, spatial, and postural errors of learned skilled movements. However, hemispheric lateralization of the systems mediating ideomotor praxis in patients with atypical cerebral language dominance (i.e., bilateral or right hemispheric language function) remains uncertain. METHODS: Subjects included 90 patients with intractable seizures who were undergoing the intracarotid amobarbital procedure (IAP) as part of their preoperative evaluation for epilepsy surgery. Hand preference was determined by the Benton Handedness Questionnaire. Praxis was assessed by the subject's performance when pantomiming the use of four pictured tools. RESULTS: During left IAP, patients with typical language dominance made more ideomotor apraxic errors than did patients with atypical language dominance. During right IAP, patients with atypical language dominance made more ideomotor apraxic errors than did patients with typical language dominance. Overall, patients with atypical language dominance made fewer ideomotor apraxic errors than did patients with typical language dominance. These relationships were present irrespective of hand preference. CONCLUSIONS: Language dominance is more closely associated with the laterality of temporal and spatial movement representations (i.e., ideomotor praxis dominance) than is hand preference. Patients with atypical language dominance exhibit more bilateral cerebral distribution of both language and praxis function.

Adult↗

PubMed2001

Mapping of receptive language cortex in bilingual volunteers by using magnetic source imaging.

OBJECT: There are conflicting claims in the functional imaging literature concerning whether different languages are represented by distinct brain mechanisms in individuals who are proficient in more than one language. This interesting theoretical issue has practical implications when functional imaging methods are used for presurgical language mapping. To address this issue the authors compared the location and extent of receptive language cortex specific to English and Spanish in neurologically intact bilingual volunteers by using magnetic source imaging. METHODS: Areas of the cortex that were specialized for receptive language functions were identified separately for each language in 11 healthy adults who were bilingual in English and Spanish. The authors performed exactly the same procedures used routinely for presurgical receptive language mapping. In each bilingual individual, the receptive language-specific map always encompassed the posterior portion of the superior temporal gyrus. In every case, however, substantial differences in the receptive language maps were also observed for the two languages, regardless of whether each participant's first language was English or Spanish. CONCLUSIONS: Although the reasons for such differences and their ultimate significance in identifying the cerebral mechanisms of language are subject to continuing investigation, their presence is noteworthy and has practical implications for the surgical management of patients with lesions in the temporal and parietal regions of the dominant hemisphere.

Adult↗

PubMed2001

Theoretical perspectives on language and communication problems in mental retardation and developmental disabilities.

We argue that researchers interested in language and communication problems in mental retardation or any other developmental disorder should view such problems as emerging within the broader context of the behavioral profile, or phenotype, associated with a particular genetic condition. This will require understanding the direct and indirect effects of genes on the development of language and communication and thereby an understanding of the complex relations that exist between language and other dimensions of psychological and behavioral functioning as well as an understanding of the environments in which the developing person acts and is acted upon. We believe that the dominant model for understanding language and communication problems--the nativist approach, which emphasizes the child's innate capacity for acquiring language and characterizes language as consisting of a set of context-free deterministic rules that operate on abstract representations--is inconsistent with an emphasis on indirect genetic effects. We review recent evidence that undermines the nativist approach--evidence concerning the initial state of the language-learning child, the role of environmental input, the competence-performance distinction, and modularity. In place of nativism, we argue for Emergentism, which is a model in which language is seen to emerge from the interaction between the child's biological abilities to map statistical properties of the language input into a distributed representation and the characteristics of the language learning environment and for the purpose of engaging in real-time, meaningful language use.

Child↗

PubMed2005

Multimodal protocol for awake craniotomy in language cortex tumour surgery.

BACKGROUND: Intra-operative neurophysiological language mapping has become an established procedure in patients operated on for tumours in the area of the language cortex. Awake cranial surgery has specific risks and patients are exposed to an increased physical and mental stress. The aim of the study was to establish an algorithm that enables tailoring the neurosurgical and anaesthetic techniques to the individual patient. METHOD: A total of 25 patients underwent awake craniotomy for intra-operative language mapping between 1999 and 2004. Following craniotomy under analgesia and sedation without rigid pin fixation of the head, cortical language mapping was performed in the fully co-operative patient. The results of functional magnetic resonance imaging and of cortical language mapping were incorporated into the 3D dataset for neuronavigation. Depending on the functional data and the individual operative risk tumour resection then proceeded either under conscious sedation with the option of subcortical language monitoring or under general anaesthesia. FINDINGS: After cortical language mapping patients are assigned to one of four groups: BACC (Berlin awake craniotomy criteria) I-IV. BACC I (9 patients): adequate functional data+operative risk not increased-->tumour resection in the awake patient; BACC II (4 patients): limited functional data+operative risk not increased-->tumour resection in the awake patient with the option of language monitoring as needed; BACC III (9 patients): adequate functional data+increased operative risk-->tumour resection under general anaesthesia using functional navigation; BACC IV (3 patients): limited functional data+increased operative risk-->tumour resection in the awake patient with the option of language monitoring as needed. We observed less adverse events in group BACC III. No permanent deterioration of language function occurred in this series. CONCLUSIONS: The multimodal protocol for awake craniotomy provides for tumour resection under general anaesthesia in selected patients using functional neuronavigation. Our experience with the algorithm suggests that it is a useful tool for preserving function in patients undergoing surgery of the language cortex while reducing the operative risk on an individual basis.

Adult↗

PubMed2004

Expressive and receptive language functioning in preschool children with prenatal cocaine exposure.

OBJECTIVE: To estimate the relationship between severity of prenatal cocaine exposure and expressive and receptive language skills in full-term, African American children at age 3 years. METHODS: Language was assessed at age 3 using the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P). The sample included 424 children (226 cocaine exposed, 198 non-cocaine exposed) who received preschool language assessments at age 3, drawn from a cohort of 476 children enrolled prospectively at birth. RESULTS: Structural equation modeling was used to regress expressive and receptive language as intercorrelated response variables on level of prenatal cocaine exposure, measured by a latent construct including maternal self-report of cocaine use and maternal/infant urine toxicology assays and infant meconium. Results indicated a.168 SD decrease in expressive language functioning for every unit increase in exposure level (95% CI = -.320, -.015; p =.031) after consideration for fetal growth and gestational age as correlated response variables. Receptive language was more modestly related to prenatal cocaine exposure and was not statistically significant. Results for expressive language remained stable with inclusion of the McCarthy general cognitive index as a response variable (expressive language beta = -.173, 95% CI = -.330, -.016; p =.031), and with adjustment for maternal age and prenatal exposures to alcohol, tobacco, and marijuana (expressive language beta = -.175, 95% CI = -.347, -.003; p =.046). Additional child and caregiver environmental variables assessed at age 3 were also evaluated in varying statistical models with similar results. CONCLUSION: The evidence from this study supports a gradient relationship between increased level of prenatal cocaine exposure and decreased expressive language functioning in preschool-aged cocaine-exposed children.

Child↗

PubMed1990

[Test method for pre-speech language: I. Outline of test].

The purpose of this study is to determine infants' preliminary linguistic ability. For this a pre-speech language test method has been developed. The test method is as follows. First, a definition of language is given. Then the development process in infancy is explained according to the definition. Subsequently, the test items are decided according to the above process. (1) Definition of language: It is difficult to define language because of its many aspects. Here, for the language definition, the aspects are restricted to the following based on the properties of natural language. Section-1 Situation of language i) Formation of communication ii) Understanding and grasping of situation circumstance Section-2 Development of symbolizing function Section-3 Representing the function of language (generally, articulation of babbling and functional change) (2) Development of language: the above three aspects develop and change from preterm infancy to late infancy. The development process is as follows. Section-1 i) The formation of communication is confirmed by action situations between baby and mother. The actions include a steady gaze in the early stage and talking baby talk later. Requests for instruction assistance and emotional communication appear with gradual differentiation of communication. Section-1 ii) Understanding and grasping of the situation circumstance is confirmed with response to action from mother to baby in the early stage. These are then confirmed with the ability to understand the action and situation of surroundings as time and space extensity, and to give appropriate appeal to the surroundings. Subsequently, understanding with language only is acquired by daily experience, including language and understanding of the surrounding.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1993

Language matches: illuminating or confounding? Research note.

The practice of matching younger, language-matched controls, in addition to age-matched controls, is often used in studies of language-disordered children to examine the role of "language level" on performance. However, the interpretation of the relative performance of subjects in studies using such dual control groups is problematic. Conceptual concerns arise with the use of language matches because language is a multidimensional skill that is not reflected equivalently for the language-disordered children and their language-matched controls. Furthermore, matching by language level inevitably introduces an extraneous age effect that confounds interpretation. In addition, erroneous interpretations of null findings can occur when no differences are found between language-disordered and language-matched groups.

Age Factors↗

PubMed2000

Speech and language therapy for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched: March 1999), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. We searched The International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. Date of most recent searches: January 1999. SELECTION CRITERIA: Randomised controlled trials comparing: 1. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus no treatment. 2. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus any type of informal support for aphasia, given by speech and language therapists or volunteers, whether these were trained or untrained. 3. One type of speech and language therapy versus another type. Outcome measures included measures of any type of communication, other measures of functioning, numbers of drop-outs, and other non-clinical outcomes. DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. MAIN RESULTS: We considered sixty studies in detail, from which we identified twelve trials suitable for the review. Most of these trials were relatively old with poor or unassessable methodological quality. None of the trials was detailed enough for us to complete description and analysis. We could not determine whether formal speech and language therapy is more effective than informal support. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that speech and language therapy treatment for people with aphasia after a stroke has not been shown either to be clearly effective or clearly ineffective within a RCT. Decisions about the management of patients must therefore be based on other forms of evidence. Further research is required to find out if effectiveness of speech and language therapy for aphasic patients is effective. If researchers choose to do a trial, this must be large enough to have adequate statistical power, and be clearly reported.

Aphasia↗

PubMed2003

The role of age of acquisition and language usage in early, high-proficient bilinguals: an fMRI study during verbal fluency.

We assessed the effects of age of acquisition and language exposure on the cerebral correlates of lexical retrieval in high-proficient, early-acquisition bilinguals. Functional MRI was used to study Spanish-Catalan bilinguals who acquired either Spanish or Catalan as a first language in the first years of life. Subjects were exposed to the second language at 3 years of age, and have used both languages in daily life since then. Subjects had a comparable level of proficiency in the comprehension of both languages. Lexical retrieval with the verbal fluency task resulted in the well-established pattern of left hemispheric activation centered on the inferior frontal region. The effect of age of acquisition was assessed by dividing the subjects into two groups, on the basis of the language acquired first (Catalan-born or Spanish-born bilinguals). Functional comparisons indicated that less extensive brain activation was associated with lexical retrieval in the language acquired earlier in life. The two groups were also different in language usage/exposure, as assessed with a specific questionnaire; in particular, the exposure to the second language (Spanish) was less intensive in the case of Catalans. This was reflected in a significant interaction, indicating a more extensive activation in Catalans during production in Spanish. Overall, these results indicate that, during a production task, both age of acquisition and language exposure affect the pattern of brain activation in bilinguals, even if both languages are acquired early and with a comparable level of proficiency.

Adult↗

PubMed2000

In search of the language switch: An fMRI study of picture naming in Spanish-English bilinguals.

For many years, researchers investigating the brain bases of bilingualism have concentrated on two basic questions. The first concerns the nature of language representation. That is, are a bilinguals' two languages represented in distinct or overlapping areas of the brain. The second basic question in the neuropsychology of bilingualism concerns the neural correlates of language switching, that is, the areas that are active when bilinguals switch from one language to the other. Performance between single-language and dual-language picture naming was compared in a group of six Spanish-English bilinguals using behavioral measures and functional magnetic resonance imaging. Participants showed slower reaction times and increased activation in the dorsolateral prefrontal cortex in the mixed language condition relative to single language condition. There was no evidence that each language was represented in different areas of the brain. Results are consistent with the view that language switching is a part of a general executive attentional system and that languages are represented in overlapping areas of the brain in early bilinguals.

Adult↗