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This article examines in detail the relationship between language and learning disorders in children of school age and the behavioral characteristics of children with language and learning disabilities. Guidelines are offered for screening for identification of language disorders and for differential diagnosis.
We report the evaluation of a new automated protocol for the treatment of asyntactic comprehension. This is a follow-up study to the "Microworld for Aphasia" work of Crerer, Ellis, and Dean (1996). An efficacy study involving three patients is reported. All three patients achieved statistically significant improvements in written sentence comprehension as a result of eight hours of treatment focusing on active, passive, and object cleft sentence structures. Treatment effects generalized both to untreated Microworld sentences and to the more naturalistic sentences of the Philadelphia Comprehension Battery (Saffran, Schwartz, Linebarger, Martin, & Bochetto, 1988), with some further evidence of generalization to spoken sentence comprehension. Treatment effects were obtained with minimal input from a clinician.
A 6-year-old boy lost his normally-developed language ability within 2 months after bilateral sudden peripheral deafness. The boy became non-communicative with others, restless with frequent meaningless bursts of shouts (communication skills equivalent to 9-11 months of language development: a rapid breakdown of language). Since conservative methods were ineffective, cochlear implantation was performed. A surprising success was observed: he regained the language retracing the normal developmental stages and caught up with his contemporaries in 2 years. Behavioral improvement paralleled his language development. This case (1) provides insights into the brain function with respect to language acquisition, in relation to the plasticity during the 'critical period' of language learning, (2) reveals the close relationship between language development and behavior, and (3) suggests the predominance of auditory stimulation in learning language.
The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.
Speech perception, speech production, and spoken language skills of 13 age-matched groups of prelingually deaf children, all enrolled in the same educational setting, were compared. Each group consisted of three children, two with hearing aids but different degrees of hearing loss (pure-tone average > 100 dB HL and pure-tone average between 90 and 100 dB HL) and one who had used a Nucleus multichannel implant (Cochlear Corp., Englewood, Colo.) for 3 years. The implanted group exhibited significantly better performance in all areas than aided children with greater than 100 dB losses. However, children with hearing losses in the 90 to 100 dB range who received hearing aids and auditory oral instruction at an early age performed just as well as children who had used implants for 3 years.
Of all the factors under consideration during the evaluation for a cochlear implant, perhaps the most critical is the speech perception ability of the candidate when using appropriate amplification. For children, this issue is often complicated by inadequate training or limited use of the sensory aid. Guidelines for implantation suggest that there be a "lack of benefit from hearing aids" to qualify as a candidate. This "lack of benefit" must be explored when using the most appropriate aid coupled with the proper rehabilitation. In determining candidacy for children, it becomes extremely important to assess benefit using a variety of sensory aids while having access to well-directed auditory intervention. The types of amplification that can be used during the preimplant evaluation stage include conventional behind-the-ear devices, FM units, vibrotactile aids, and frequency transposition aids. Although some of these devices are used more often than others, centers implanting children should be aware of the role that each plays in the evaluation process. To determine the frequency with which these devices are used as well as the types of strategies that are emphasized in the preimplant training interval, a questionnaire was developed to gather information from the cochlear implant facilities in the United States. The results of this survey will be presented to demonstrate training and device trends that are incorporated during the preimplant process. Additionally, the use of frequency transposition hearing aids as part of the preimplant training procedure will be explored. The facility at Manhattan Eye, Ear and Throat Hospital has studied these devices in a small group of adults and children. Data pertaining to the speech perceptual abilities obtained with both the TranSonic and the Emily will be presented and compared to results with the Nucleus cochlear implant system.
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This paper argues that higher priority should be given to the development of services which support people with communication disabilities in low income countries and that these services should be different from those in other countries. Present services for this population group have poor coverage levels, tend to be centrally located and are orientated to specialist services. WHO (Health Programme Evaluation, Geneva, WHO, 1981) argue that health services should be based on meeting people's needs. This paper describes an analysis of 'needs related' qualitative data concerning people with communication disabilities and their families in two low income countries and examines the results in relation to service development. The data was collected as part of five different studies concerning people with communication disabilities carried out in Uganda and Nigeria. Using the principles of established theory, these data helped develop, a theoretical model. This model is compared with WHO's classification of Impairment Disability and Handicap ICIDH-2 WHO (International Classification of Impairments Disabilities and Handicaps (ICIDH-2), A manual of classification relating to the consequences of diseases, Geneva, WHO. 1997a; 1999). Suggestions are made as to how this model might inform planning and practice from the perspective of the five major stakeholder groups; government and non-government organizations, people with communication disabilities, their families and professionals. Consideration is also given as to how this theory can be used to strengthen existing services, or encourage a complete paradigm shift, with the creation of different services in new and innovative ways.
Three patients with a typical syndrome of nonfluent primary progressive aphasia (Mesulam's syndrome) were trained daily with a remediation protocol including auditory exercises specifically designed to involve several aspects of phonological processing, a domain known to be specifically affected in the condition. The speech content of the exercises was based on the temporal theory of phonological processes according to which increasing the duration of formant transition should facilitate phoneme discrimination and phoneomic awareness. Significantly improved performance on the trained tasks was demonstrated in the three patients. Improvement further generalized to other tasks such as nonword repetition and reading. We conclude that such results (1) argue for using intensive focused therapy of language impairment in neurodegenerative disorders, (2) may constitute a good model of brain plasticity in neurodegenerative disorders in general, and (3) support theories of phonological processing emphasizing temporal features of the auditory signal.
The effect of the use of written language (WL) for the training of children with severely impaired hearing was compared with that of oral language (OL). WL training was given by means of a WL card method from the age of 1 (group 1; 6 cases) of 2 (group 2; 2 cases). The children in group 1 acquired 3.8 words in OL and 50.5 words in WL as an average number of receptive vocabulary, while 4.5 words in OL and 50.5 words in WL as that of expressive vocabulary by the age of 1 year and 11 months. In group 2, one case acquired 641 words and six-word sentences in OL and 1,066 words and nine-word sentences in WL for reception, while 401 words and five-word sentences in OL and 1,066 words and six-word sentences in WL for expression by the age of 3 years and 6 months. The other case acquired no word in OL but 676 words and nine-word sentences in WL for reception, while 131 words and four-word sentences in OL and 676 words and six-word sentences in WL for expression by the age of 4. The results would indicate that the training of children with poor hearing using WL from an early period of life is effective for the promotion of the language development.
Recent modeling of language development and intervention for children with disabilities has increasingly focused on the interactions between adults and children. These models have resulted in a number of recent advances in the behavioral treatment of language abilities in children with disabilities. Because these interventions are associated with substantial growth in a number of skills including speech, grammar and vocabulary, these paradigms may provide a useful model for studying neurological development of these aspects of language. The purpose of this paper is to discuss the potential neurodevelopmental ramifications of this type of theoretical model for facilitating language growth in children with and without disabilities. Indeed, because intervention can sometimes trigger rapid advances in language skills and presumably, associated neurological organization, this may prove to be a very useful paradigm for understanding the neurological correlates of language growth.
This study investigated the transfer and maintenance of question-answering skills in five children diagnosed with autism. A multiple baseline design across classes of questions (i.e., what, where, who and why) was applied for each child. Question-answer exemplars were selected within each class, and each class was trained separately in consecutive order. The dependent variable was the proportion of appropriate answers (i.e., complete sentences) to novel questions within each class, on first trial. The results showed that all children became able to answer novel questions with complete sentences within each of the classes that were trained, and they showed transfer of these skills across persons, settings and time. The findings support the use of analogous question-answer exemplars in order to facilitate response-transfer to novel questions. It is also suggested that this type of transfer is more likely to occur if the answers trained are in full sentence and there is a structural correspondence between the question and the answer in each single exemplar and across exemplars within a class of questions.
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The phonemic inventories of 30 children (aged 3;4-5;7) with phonological delays were examined in terms of featural distinctions in order to address universal vs. individual accounts of acquisition. Phonetic inventories of these same children were also identified for comparison purposes. Across children, four hierarchical and implicationally related types of phonemic inventory were identified. The typology uniquely captured common distinctions maintained by all children, and at the same time, allowed for individual differences in the specific phonemic composition of each system. These cross-sectional results have theoretical implications for the longitudinal course of phonemic acquisition. In particular, children appear to have a number of linguistic choices that relate to the course, the specifics, and the mechanism of change in acquisition.
Comparison of patterns of cluster realization from 47 children ranging in age from 3;4 to 6;8 with functional (non-organic) speech disorders with those reported in the literature for normal acquisition reveals that these patterns are essentially the same for both groups. Using a two-level generative phonology for children's independent systems, further analysis of cluster realizations by means of feature geometry and underspecification theory reveals that there are systematic and principled relationships between adult representations of clusters and children's underlying representations and between children's underlying representations and their phonetic representations. With special emphasis on coalescence phenomena, it is suggested that the apparent diversity in children's cluster realizations can be reduced to four constraints on the form of underlying and phonetic representations.
Naming of two semantically impaired aphasic patients was treated with the contextual repetition priming technique, which involves repeated repetition of names of pictures that are related semantically, phonologically, or are unrelated. Our previous studies using this technique have suggested that patients with impaired access to lexical-semantic representations benefit in the short-term from this treatment technique, but show no long-term improvement in naming. In contrast, patients with good access to semantics show short- and long-term benefits from this treatment. Here we report two studies of treatment for two individuals with aphasia affecting access to lexical semantics and anomia but spared access to input and output phonology and spared conceptual semantics. We predicted that they would show short-term facilitation from the contextual priming, but no long-term improvements in naming. The results confirmed the prediction. An account of this pattern is offered within the framework of an interactive activation model of word retrieval. Additionally, we discuss alternative techniques for addressing naming deficits when access to semantics is impaired.
Links between verbs and gesture knowledge suggest that verb retrieval may be particularly amenable to gesture+verbal training (GVT) in aphasia compared to noun retrieval. This study examines effects of GVT for noun and verb retrieval in nine individuals with aphasia subsequent to left hemisphere stroke. Participants presented an array of noun and verb retrieval deficits, including impairments of semantic and/or phonologic processing. In a single-participant experimental design, we investigated effects of GVT for noun and verb retrieval in two counterbalanced treatment phases. Effects were evaluated in spoken naming and gesture production to pictured objects and actions. Spoken naming improvements associated with large effect sizes were noted for trained nouns (5/9) and verbs (5/9); no improvements were evident for untrained words. Gesture production improved for trained nouns (8/9) and verbs (6/9), and for untrained nouns (2/9) and verbs (2/9). No significant differences were evident between nouns and verbs in spoken naming or gesture production. Improvements were evident across individuals with varied sources of word retrieval impairments. GVT has the potential to improve communication by increasing spoken word retrieval of trained nouns and verbs and by promoting use of gesture as a means to communicate when word retrieval fails.
The purpose of this article is to discuss research opportunities arising from the current literature in the area of communication. Six general themes are discussed, including (a) increasing spontaneity, initiations, and the variety of functions of language verbal and nonverbal children with autism exhibit; (b) assessing and teaching precursors relating to positive outcome; (c) the importance of family involvement in intervention programs; (d) best practices for implementation of communicative interventions; (e) the interrelationship between language and other behavioral symptoms of autism; and (f) the social and pragmatic use of language. These areas are discussed in terms of improving assessment and intervention practices to produce greater long-term communicative outcomes for individuals with autism.