[Early diagnosis and early therapy in language development disorders].
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Deafness↗
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[What is the role of large muscle performance in children with severe specific language development disorder?].
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Auditory Perceptual Disorders↗
Thought disorder, pragmatic language impairment, and generalized cognitive decline in schizophrenia.
BACKGROUND: Schizophrenia is associated with pragmatic language impairment (PLI), a reduced ability to communicate intention in a rule-governed fashion. Two explanations for PLI include that PLI is equivalent to thought disorder and that PLI is secondary to generalized cognitive decline. OBJECTIVES: The aims of this study were to demonstrate PLI in schizophrenia and to test which of these explanations best accounts for the relationships among thought disorder, PLI, and generalized cognitive decline. METHOD: Schizophrenia (n=20) and control (n=26) participants provided speech samples that were scored for thought disorder (type-token ratio and Cloze procedure) and PLI [Profile of Pragmatic Impairment in Communication (PPIC)]. Generalized cognitive decline was determined from discrepancies between current and premorbid verbal IQ. RESULTS: Patients with schizophrenia exhibited significant PLI and generalized cognitive decline. There was no evidence of an association between thought disorder and PLI. Moreover, generalized cognitive decline predicted PLI (r(2)=0.33 to 0.59) but not thought disorder (r(2)=0.02 to 0.06). CONCLUSIONS: The results conformed to a predicted pattern of associations based on the notion that PLI in schizophrenia is secondary to generalized cognitive decline.
Adult↗
The GBG model: is there more to consider than handedness?
It is peculiar that Bryden and his colleagues admit to the inadequacy of handedness as an index for cerebral anomalous dominance and then attack a model of anomalous dominance using primarily handedness data. In reality, the GBG model (which was intended to be "a hypothesis and program for research," to quote the exact titles of the 1985 articles) is not nearly as narrow as Bryden's worldview. We present here the rest of the literature on the link between immune disorders and language disorders which Bryden et al. neglected and argue that the data are sufficient to have warranted a +2 in their evaluation. The strength of this link is worthy of further investigation, even though the hormonal mechanism proposed in the GBG model may be erroneous.
Animals↗
Developmental dyscalculia.
Developmental dyscalculia is a specific learning disability affecting the acquisition of arithmetic skills in an otherwise-normal child. Although poor teaching, environmental deprivation, and low intelligence have been implicated in the etiology of developmental dyscalculia, current data indicate that this learning disability is a brain-based disorder with a familial-genetic predisposition. The neurologic substrate of developmental dyscalculia is thought to involve both hemispheres, particularly the left parietotemporal areas. Developmental dyscalculia is a common cognitive handicap; its prevalence in the school population is about 5-6%, a frequency similar to those of developmental dyslexia and attention-deficit-hyperactivity disorder. Unlike these, however, it is as common in females as in males. Developmental dyscalculia frequently is encountered in neurologic disorders, examples of which include attention-deficit-hyperactivity disorder, developmental language disorder, epilepsy, and fragile X syndrome. The long-term prognosis of developmental dyscalculia is unknown; it appears, however, to persist, at least for the short-term, in about half of affected preteen children. The consequences of developmental dyscalculia and its impact on education, employment, and psychologic well-being of affected individuals are unknown.
Brain Damage, Chronic↗
Government-Binding Theory and some of its applications: a tutorial.
Government-Binding Theory is the dominant theory of grammar in present-day linguistics, and is receiving increasing attention from investigators of normal and disordered language behavior. This paper serves as a general introduction to the theory and provides a number of examples of its application.
Aphasia↗
Assessment of brain function in clinical pediatric research: behavioral and biological strategies.
Psychobiological research in child psychiatry requires rigorous assessment of behavior and multiple perspectives on brain function through neurochemical, neuroendocrine, psychophysiological, and other advanced methods. The serious neuropsychiatric disorders of childhood, such as autism, attention deficit disorder, and language disorders, can be studied in complementary clinical protocols aimed at explicating patterns of behavioral and metabolic dysfunction which characterize various clinical syndromes. Clinical research with children raises sensitive ethical issues; the ethical problems can be addressed when children and families are active collaborators with the investigators and a long-term relationship is established. In this setting, participation in research can facilitate better treatment for a child. The use of novel biological strategies, such as pharmacological challenge tests, permits evaluation of the relation of specific neuronal systems to behavioral dimensions in clinical disorders. The development of a new treatment for Tourette's syndrome illustrates the integration of basic and clinical research methods.
Catecholamines↗
Topiramate: new indication. Migraine prevention: best avoided.
(1) The first-line drug for prevention of migraines is propranolol: it is the most thoroughly evaluated treatment, and thus far no other drug has been found to be more effective. (2) Topiramate, an antiepileptic drug, is now also approved for migraine prevention. Only 3 out of 4 double-blind placebo-controlled trials showed that topiramate 100 mg/day was effective: on average, 46% of patients had a reduction of at least 50% in the frequency of migraines, compared to 23% of patients on placebo. Increasing the dose to 200 mg did not lead to better efficacy. (3) A double-blind trial versus propranolol failed to show that topiramate was as effective or better than propranolol. (4) Topiramate has numerous, frequent and sometimes serious adverse effects, mainly including neurosensory disorders (paraesthesias, language disorders, confusion) and gastrointestinal disturbances. (5) Topiramate treatment costs nearly 5 times more than propranolol. (6) In practice, the adverse effects of topiramate outweigh its efficacy in the prevention of migraine attacks.
Cost-Benefit Analysis↗
[Long-term prognosis for premature infants].
Recent advances in perinatology have been associated with a decrease in perinatal mortality among very low birth weight (VLBW) infants. However, only comprehensive follow-up programmes allow obstetricians and neonatologists to measure short-term and long-term effects of neonatal intensive care. In our experience, sequential brain ultrasonography together with serial neurological assessments during the neonatal period play an important role in the prediction of later neurodevelopmental outcome. Major sequelae are closely related to periventricular leukomalacia and extensive parenchymal haemorrhage. With improving knowledge of the physiopathology of cerebral damage, more effective preventive measures are now being taken. Nowadays, the incidence of major handicaps (5%) is steadily decreasing among VLBW survivors. Only a few comprehensive studies have regularly followed up preterm infants until school age. Our results showed that 17% of VLBW infants had minor neurodevelopmental abnormalities (visuomotor or motor disorders and language disorders) at 8 years of age. School failure was frequently found among children who presented the association of several neurodevelopmental abnormalities. Most of these developmental problems can be detected in preschool age, and early recognition may allow better counselling of parents and appropriate intervention. An optimistic attitude regarding the outcome in VLBW infants without cerebral lesions or associated neurodevelopmental abnormalities is certainly justified at the present time. These results emphasize the importance of optimal perinatal intensive care for VLBW infants.
Brain Damage, Chronic↗
Familial Alzheimer Dementia: a prevalent disorder with specific clinical features.
The early literature on Alzheimer Dementia (AD) describes the clinical features aphasia, apraxia and agraphia as characteristic. We investigated the hypothesis that these features would specifically identify the familial form of AD (FAD). Since pedigree studies had suggested that FAD is an autosomal dominant genetic disorder, we hypothesized that the first-degree relatives of language-disordered or apractic AD probands would show at least 50% lifetime risks of dementia. Using standardized methods, we screened 3500 nursing home beds for stringently defined AD cases and controls, tested for agraphia, and obtained probands' clinical and family histories from multiple informants. Language disorder and apraxia were found in 78% of AD cases. They strongly predicted familial aggregation of dementia, with a 90-year lifetime incidence among relatives exceeding 50%, or 7 times the control values. The results suggest that language disorder and apraxia specifically identify a distinct clinical entity, Familial Alzheimer Dementia, that is among the commonest forms of senile dementia.
Aged↗
Handedness is related to formal thought disorder and language dysfunction in schizophrenia.
The handedness of 29 schizophrenics, 42 manic-depressives, and 25 normal controls was examined in relation to formal thought disorder and language dysfunction. Subjects demonstrated hand preference (Preference Index) and also performed four tasks of manual proficiency. On each of the four proficiency tasks a lateral proficiency score was computed to quantify direction and degree of manual superiority and their mean constituted the Lateral Proficiency Index. A Variability Index, consisting of their standard deviation, was also computed. Sinistrality, as measured by the Preference Index, was related to severity of formal thought disorder in male schizophrenics. The Variability Index was significantly related to severity of formal thought disorder and to language dysfunction in the schizophrenic group as a whole. These relations were not demonstrated in the control groups. These findings support the hypothesis that, in schizophrenia, atypical handedness is a marker of left-hemisphere dysfunction that also disrupts language processes, including those implicated in the manifestation of formal thought disorder.
Adult↗
A correlated fluctuation of language and EEG abnormalities in a case of the Landau-Kleffner syndrome.
Despite growing interest in the Landau-Kleffner syndrome there have been few reports dealing with language disorders in recent years. The authors present a clinical case of a child with Landau-Kleffner syndrome focusing particularly on the relationship between language disorders and electroencephalographic abnormalities. The authors emphasize that the language disorders primarily affect the receptive sphere and that there seems to be a relationship between abnormalities during sleep with a deterioration in verbal comprehension.
Child, Preschool↗
Outcomes of severe disorders of language acquisition.
Data on speech, language, performance IQ, school placement, and behavior are presented on 18 subjects diagnosed in childhood as "aphasic" and followed through adolescence. Results reveal that slow but steady growth in language is made, with expressive skills showing somewhat more rapid progress than comprehension. Performance IQ is highly correlated with language skills in later childhood and, along with receptive skill, is a good predictor of school placement. The diagnostic and prognostic implications of this information are discussed.
Adolescent↗
Mothers' estimates of their children with disorders of language development.
The authors' objective in this article was to explore the accuracy of mothers' estimates concerning their children's developmental functioning, especially with respect to vocabulary and gross motor development, by comparing the results of diagnostic tests administered to both the children and their mothers. The authors studied 55 children with disorders of language development (LD) between the ages of 3 and 6 years using several diagnostic scales concerning child development. The authors assessed the mothers' estimates regarding vocabulary and gross motor development by the same scales as those used for their children. These scales were presented as questionnaires and scored like the tests used for the children. There was a significant tendency toward a general overestimation of a child's developmental functioning regarding vocabulary and gross motor skills. Moreover, the accuracy of the mothers' estimates did not seem to be associated with several selected variables. The results did not correspond to those of other studies that have shown that mothers' estimates provide a good indication for the developmental status of a child--at least for the child's developmental status considering vocabulary and gross motor skills in children with LD. The results support the objection regarding the use of maternal estimates as the only source of information concerning the development of a child among scientific studies, especially if they deal with research on the development of vocabulary or gross motor skills.
Attitude to Health↗
Delay in maturation of the auditory pathway and its relationship to language acquisition disorders.
We studied 81 children, mostly boys, who experienced language acquisition delay but whose audiometric thresholds were normal. We assessed the evolution of children with delayed maturation of auditory pathways by brainstem evoked response audiometry (BERA). We also used a questionnaire administered during diagnostic procedures to determine if there was a probable etiology in each patient. In addition, we further studied language evolution in 29 patients by means of a second questionnaire that was administered approximately 2 years later. Finally, we studied the evolution of the I-V interwave interval and the I/V amplitude ratio in 16 patients by performing a second BERA after a mean interval of 3 years. We observed improvement in both brainstem transmission time and language acquisition in all 81 patients. However, only a few patients achieved normal range results. Morphologic alterations, which were most common in patients who had had perinatal jaundice, remained unchanged. The most common possible risk factors for the delayed maturation pattern observed on BERA were parental consanguinity, prematurity, perinatal anoxia and jaundice, and postnatal seizure and infection. Some patients had more than one of these possible risk factors. We conclude that high-risk newborns and 2-year-old children who have no primitive verbal language skills should undergo BERA as well as investigation of hearing thresholds, interwave intervals, and I/V amplitude ratios. The alteration of the parameters points out the need for early intervention if there is no favorable prognosis.
Age Factors↗
[Exclusion of receptive speech disorders with the ADOS (Autism Diagnostic Observation Schedule)].
OBJECTIVE: The purpose of our pilot study was to assess the reliability and diagnostic validity of the Autism Diagnostic Observation Schedule (ADOS). The usefulness of the schedule in the differentiation between children with autism and children with a severe specific receptive language disorder is examined. METHOD: Eight boys with early infantile autism and eight age- and IQ-matched boys with a specific receptive language disorder were examined with the ADOS. The reliability of the instrument was assessed using the ratings of eight pairs of raters. The agreement between diagnostic classification based on the ADOS ICD-10 algorithm and the independent clinical psychiatric diagnosis of two experts was used as the measure of validity. RESULTS: The reliability of the different ADOS items proved to be good among experienced raters. Various ADOS items clearly discriminate both groups. Using the ADOS ICD-10 algorithm, the clinical diagnosis of infantile autism could be confirmed for five of the eight children in this group. None of the children with the clinical diagnosis of a receptive language disorder was identified as autistic according to the algorithm. CONCLUSIONS: In the hands of experienced raters the ADOS is a reliable diagnostic instrument. It can support the differentiation between autism and specific receptive language disorder, but additional parent information is needed to confirm the diagnosis.
Auditory Perceptual Disorders↗
[Concerning specific language impairment: intelligibility in expressive language].
BACKGROUND: Even in the age of two years toddlers with Expressive Language Impairment (SLI-E) differ regarding their phonetic inventories compared with an age-matched group developing normally. METHOD AND PATIENTS: PCC-R scores of 19 children with expressive language disorder, aged between four and six years, are compared with age and sex matched controls with normal language acquisition. RESULTS: There are significant differences between PCC-R scores, children with expressive language disorder show lower scores than children with normal language acquisition. Age, sex and nonverbal intelligence do not influence performance measured with PCC-R. Analysis regarding early, middle and late consonants shows, that expressive language disordered children show bigger problems in aquiring late than early and middle consonants.
Age Factors↗
Learning disability, attention-deficit disorder, and language impairment as outcomes of prematurity: a longitudinal descriptive study.
A longitudinal study of mildly preterm children and full-term comparison children found a higher-than-expected percentage among preterm children of learning disabilities, attention-deficit disorder (ADD), language impairment, mild neurologic impairment, and general school concerns by Grade 5. Seventy-five percent of the preterms fell into the above outcome diagnostic categories. Examination of early developmental patterns reflected differences in attention deployment at ages 13 months and 15 months, manifesting as increased engaged time on the part of the children with ADD, with a greater number of attentional shifts, and as decreased engaged time for the other outcome diagnostic categories. At 20, 24, and 30 months, mothers' perceptions of their children's competence revealed generally strong assessment of competence among children later identified as ADD, and weak competence in the other outcome diagnostic categories. Variability distinguished the identified groups at all ages and is evident in the Stanford-Binet subscale scores at age 3.
Attention Deficit Disorder with Hyperactivity↗