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Developmental language and speech disability.

Speech disabilities (articulation deficits) and language disorders--expressive (vocabulary) receptive (language comprehension) are not uncommon in children. An overview of these along with a global description of the impairment of communication as well as clinical characteristics of language developmental disorders are presented in this article. The diagnostic tables, which are applied in the European and Anglo-American speech areas, ICD-10 and DSM-IV, have been explained and compared. Because of their strengths and weaknesses an alternative classification of language and speech developmental disorders is proposed, which allows a differentiation between expressive and receptive language capabilities with regard to the semantic and the morphological/syntax domains. Prevalence and comorbidity rates, psychosocial influences, biological factors and the biological social interaction have been discussed. The necessity of the use of standardized examinations is emphasised. General logopaedic treatment paradigms, specific therapy concepts and an overview of prognosis have been described.

Child Language↗

A study of idiom comprehension in children with semantic-pragmatic difficulties. Part I: Task effects on the assessment of idiom comprehension in children.

In the apparent absence of suitable measures of idiom comprehension in normally developing and clinical populations, this study examined the relationship between a newly developed play task and a more conventional definition task. On the play task, children listened to a 1.5-minute, tape-recorded story into which were embedded 12 common idioms drawn from recordings of classroom teaching and children's television. As the story was then played again, sentence by sentence, the children were required to act it out using a play set and props. For each idiom, it was possible to act out either the idiomatic or literal meaning, but only the idiomatic meaning made sense in the context. The children's actions were video-taped and then played back to the child during the definition task. For this task, the video was stopped after each idiom occurred and the children were asked what they thought each idiom meant. Four groups of children were included. Twenty-six children (aged between 6-11 years), considered to have semantic-pragmatic difficulties, were compared with two groups of mainstream children (aged 6;6-7;6 and 10;6-11;6, respectively) and with a group of children (aged between 8-11 years) diagnosed with (other) language disorders not primarily of a semantic or pragmatic nature. The results indicate that the definition task underestimated common-idiom comprehension in normally developing children and, in particular, in children diagnosed with semantic-pragmatic difficulties or (other) language disorders. Furthermore, a significant difference in idiom comprehension between the two clinical groups evidenced on the play task was entirely masked on the definition task. It appeared that the expressive and metalinguistic demands of the definition task had a greater negative effect on the group of children with language disorders than on the children with semantic-pragmatic difficulties. Possible mechanisms through which the play task might have overestimated or underestimated idiom comprehension in these groups are examined and discussed. Although the nature of the play task probably facilitated idiom comprehension in these children, analysis supports the results of the play task being a reflection of true ability rather than an overestimation of idiom comprehension. A considerable incidence of false positive results on the definition task, coupled with its masking of significant differences in idiom comprehension across clinical groups militates against the use of definition tasks to assess idiom comprehension in research and clinical settings. In comparison with definition and multiple choice methodologies, the play task emerged as a more valid measure of common- and concrete-idiom comprehension in normally developing and clinical child populations.

Autistic Disorder↗

Symbolic play of children with language impairment: a critical review.

There have been a number of studies that have reported on the symbolic play abilities of children assessed as demonstrating developmental language disorders or specific language impairment. In general, this research has reported significant differences in the symbolic play abilities of children with language impairment and those developing language normally. In most, though interestingly, not all cases, the differences reflected less developed symbolic play of the children with language impairments. It will be argued here that these reported differences should not be interpreted as demonstrative of marked deficits in the general representational or specific symbolic play competence of children with language impairments. It will be argued further that part of the research conducted to date on the symbolic play abilities of children with language impairment has been confounded by the encroachment of language into the research procedures, that the level of play often investigated has not been unquestionably symbolic in nature, and that the actual differences in symbolic play have not been substantial.

Child, Preschool↗

Aphasia owing to subcortical brain infarcts in childhood.

The aim of this study was to further define the clinical features of subcortical aphasia in children with deep brain infarcts and to define the sequelae associated with childhood strokes. We retrospectively studied nine children with left subcortical brain infarcts who presented with acquired language disorder and underwent language investigations based on standardized tests. Stroke in these patients involved the left internal capsule, lenticular or thalamic nuclei, or a combination of these. Early aphasic manifestations following the deep cerebral infarcts affected language expression. These included mutism, nonfluent speech, word finding difficulties, and phonemic and semantic paraphasia. Speech comprehension was generally more preserved. All patients subsequently improved, although variably; sequelae such as dysfluency, word finding difficulties, and written language learning impairment could be detected through standardized tests in six of them (all younger than 6 years at the time of the infarct). Two of the three remaining patients (both older than 6 years at the time of the infarct) had a full recovery. Our study confirms the concept of childhood subcortical aphasia, depicts the linguistic profile in these patients, and sustains the indication of systematic formal language assessment during the follow-up of all children with subcortical infarct involving the dominant hemisphere.

Adolescent↗

A comparison of empirically derived groups of aphasic patients on the Neurosensory Center Comprehensive Examination for Aphasia.

Rating scales were used to identify characteristic aphasic phenomena in a sample of natural language from aphasic patients. These variables were used to derive empirically four groups of aphasic patients. These groups showed significant multivariate differences on the basis of their performance on the Neurosensory Center Comprehensive Examination for Aphasia. Seven subtests showed significant univariate differences among the four groups: Visual Naming, Description of Use, Sentence Repetition, Repetition of Digits, Reversal of Digits, Identification by Sentence, and Oral Reading Sentences. Two of the groups reflected Howes dichotomy of articulate-nonarticulate language disorders. Another group was thought to reflect Schuell's single dimension of language disorders that could be differentiated only in terms of severity. Afourth group was characterized by a major impairment of memory. These results indicated that aphasic phenomena could be identified reliably on the basis of rating of verbal output on scales that reflect language disorders. These scales were used in a statistical fashion to derive empirically oriented groups that were identified on the basis of psychometric measures of language skills.

Adolescent↗

The implications of different approaches to evaluating intervention: evidence from the study of language delay/disorder.

There is a pressure to both identify and expand the evidence base with regard to the treatment of speech and language disorders in children, as there is in other areas of speech and language therapy. This paper addresses two sources of evidence, a systematic review and meta-analysis of early language interventions and the monitoring of an early language target for socially disadvantaged children in Sure Start programmes in England. There is a growing number of efficacy studies in the field of speech and language disorders in children. For example, in a recent review for the Cochrane Collaboration in the UK 36 articles reporting a total of 33 different trials. Twenty-five of these articles provided sufficient information for use in a series of meta-analyses. The results indicate that speech and language therapy may be effective for children with phonological or expressive vocabulary difficulties. There is mixed evidence concerning the effectiveness of intervention for children with expressive syntax difficulties and little evidence available considering the effectiveness of intervention for children with receptive language difficulties. No significant differences were found between interventions administered by trained parents and clinicians. A number of gaps in the evidence base are identified. But such reviews are essentially retrospective and, while the results may be interesting for practitioners, they do not provide the whole picture. The paper then turns to a very different data set and the role of population monitoring, an approach to assessing the value of interventions which has not hitherto been used in any area of speech and language therapy. The data are derived from a year-on-year monitoring of the language output of 2-year-olds in Sure Start programmes in England. This is a programme funded by central government in the UK to reduce the impact of social disadvantage on children, parents and their communities. The practice and policy implications of these two different sources of information are considered. Who is the consumer of such information and what can they do with it once they have it?

Child↗

SRPX2 mutations in disorders of language cortex and cognition.

The rolandic and sylvian fissures divide the human cerebral hemispheres and the adjacent areas participate in speech processing. The relationship of rolandic (sylvian) seizure disorders with speech and cognitive impairments is well known, albeit poorly understood. We have identified the Xq22 gene SRPX2 as being responsible for rolandic seizures (RSs) associated with oral and speech dyspraxia and mental retardation (MR). SRPX2 is a secreted sushi-repeat containing protein expressed in neurons of the human adult brain, including the rolandic area. The disease-causing mutation (N327S) resulted in gain-of-glycosylation of the secreted mutant protein. A second mutation (Y72S) was identified within the first sushi domain of SRPX2 in a male with RSs and bilateral perisylvian polymicrogyria and his female relatives with mild MR or unaffected carrier status. In cultured cells, both mutations were associated with altered patterns of intracellular processing, suggesting protein misfolding. In the murine brain, Srpx2 protein expression appeared in neurons at birth. The involvement of SRPX2 in these disorders suggests an important role for SRPX2 in the perisylvian region critical for language and cognitive development.

Adult↗

[Haptic form discrimination. Group comparison of children with normal speech development and former speech development disordered patients].

The importance of the neurobiological basis of developmental language disorders includes somatosensory modalities. Twenty-five children were diagnosed as having specific language-impairment at preschool age. All were examined with regard to their manual haptic form discrimination without visual control at a mean age of 8.7 years +/- 7.1 months. This study group was compared to age- and gender-matched normal children of equal non-verbal intelligence (control group). Haptic discrimination was measured with the Seguin formboard on which the children were required to place ten geometrical forms in appropriate holes. Both groups differed significantly in their mean quantitative performances in favor of the control group (P < 0.05). The difference in their mean performance and their mean discrimination times did not reach statistical significance. All results were not age-dependent. The control group on average performed significantly better with their left hands than the study group (P < 0.05). Qualitative analysis revealed a significant difference in haptic discrimination of the pointed forms and was probably caused by inadequate exploration procedures and/or cognitive representation deficits. The results of the children with previous developmental language disorders were interpreted as an expression of an impaired cerebral maturation.

Child↗

Evaluation of speech and language in neuropsychiatric disorders.

Changes of language and speech in neuropsychiatric patients are described by use of a quantifying procedure. In the transcript of a standardized interview the following variables are evaluated (by estimation of indices): rate of speech, pauses, indistinct and incomprehensible articulations, aphasic disturbances, subordinate: principal clause ratio, stuttering, neologisms, grammatical mistakes, thought disconnections, perseverations/verbigerations, vague utterances, disturbances of orientation, utterances with unusual though content, euphoric utterances, dysphoric utterances, and change of the affective state. Reliability of these indices is tested by inter-rater comparison. The course of speech-language reorganization during therapy is followed. The present method does not intend to give a detailed psycholinguistic analysis, but it yields an objective measure of clinical impressions on abnormalities of language and speech in neuropsychiatric disorders.

Aphasia↗

An examination of youth with attention-deficit/hyperactivity disorder and language learning disabilities: a clinical study.

This study examined the performance of 96 youth hospitalized at an acute-care psychiatric hospital on a battery of language measures. The participants were separated into four groups: (a) participants with language learning disabilities (LLD; n = 14), (b) participants with attention-deficit/hyperactivity disorder (ADHD; n = 26), (c) participants with both ADHD and LLD (ADHD/LLD; n = 18), (d) participants with neither ADHD nor LLD (Neither; n = 38). Participants with ADHD/LLD performed significantly more poorly than did the ADHD group or the Neither group on measures of phonology and syntax, but not semantics. However, participants with ADHD/LLD did not significantly differ from participants with LLD on a majority of language-based measures. This finding suggests that participants with ADHD/LLD have profiles more similar to those of participants with LLD than participants with ADHD. Educational implications for instruction for students with ADHD/LLD are presented.

Adolescent↗

Language disturbances from paramedian thalamic infarcts: a CT method for lesion location.

The authors describe the case of three patients suffering from language disorder secondary to mesencephalo-thalamic infarcts. One of them showed the clinical features of transcortical motor aphasia, while the other two presented the typical pattern of the so-called "thalamic aphasia". The CT-stereotaxic method for lesion localization disclosed that the dorso-medial was the mostly involved thalamic nucleus in each case. Since this nucleus is connected both with Broca's and Wernike's areas, the authors suggest that the more or less extensive involvement of the fibres connecting these structures may be responsible for the different aphasic features presented in these cases.

Aged↗

Prevalence of disabilities in a national sample of 3-year-old Israeli children.

The prevalence of chronic conditions and illnesses causing disability in Israeli Jewish children aged 2 to 3 years, born in 1980, was studied on the basis of a national sample (n = 9,854). Seventy-six principle medical conditions causing disability were defined. The study showed a total disability rate of 8.9%. Very low birth weight and family problems were considered risk factors for developmental delay or for disability. The prevalence of the children at risk was 2.4%. The disability rate among this group was 6 to 7.5 times greater than in the total population. Data were analyzed by selected demographic characteristics. Speech and language disorders and undefined developmental delay were more prevalent among children of mothers with a low educational level. Speech and language disorders were also more prevalent among children born to mothers of Asian origin. Speech and language disorders, asthma and spastic bronchitis, hearing impairment and undefined developmental delay were more prevalent among male children. This is the first comprehensive nation-wide prevalence study of children with disabilities in Israel.

Birth Order↗

The association of reading disability, behavioral disorders, and language impairment among second-grade children.

Children with language impairment (LI) have been shown to be at risk for reading disability (RD) and behavior disorder (BD). Previous research has not determined the specific pattern of these conditions associated with LI. This study sought to determine if the behavior disorder and reading problems represented different outcomes or if these conditions occurred together when found with LI. A group of 581 second-grade children, including 164 children with LI, were examined for spoken language, reading, and behavior disorder. The data for each of these areas were examined as dimensional traits and as clinical categorical traits. Reading and spoken language were found to be strongly correlated (r = .68); RD was found in 52 % of the children with LI and in only 9 % of the controls. Scores of parent ratings for BD were also significantly correlated with spoken language scores (r = .29). Clinical levels of BD were found in 29% of the children with LI and 19% of the controls. An examination of the co-occurrence of clinical levels of BD, RD, and LI showed BD in children with LI to be conditioned by the child's reading status. The data indicated that whereas RD was directly associated with BD, the association of LI with BD required the mediation of RD.

Child↗

Chronic aphasia subsequent to striato-capsular and thalamic lesions in the left hemisphere.

The language abilities of a group of seven chronic aphasics with vascular lesions centered on the striato-capsular region and thalamus of the left hemisphere were described. A range of severity and types of chronic language disorder were documented through assessment using a battery of standardized language tests. The most common language disorder documented was a naming impairment of varying degrees of severity, exhibited by six of the seven cases. The majority of subjects made predominantly semantic errors in the naming task; however, each subject produced a variety of error types and there was no pattern of errors characteristic of the group. The language data obtained were used to evaluate previously developed models of the role of the subcortical structures in naming functions.

Adult↗

Urinary organic acid screening in children with developmental language delay.

The prevalence of 3-methylglutaconic aciduria was evaluated among children with developmental language disorders. A urine specimen was obtained from 40 children referred for developmental language delay to the Tel-Aviv Child Development Center during 12/96-6/97 and from 50 age-matched controls. Urine organic acids were analysed by gas chromatography-mass spectrometry. Urinary 3-methylglutaconic acid was quantified. A mildly increased excretion of 3-methylglutaconic acid was found in 8 children with developmental language delay. The combined excretion of 3-methylglutaconic and 3-methylglutaric acid was increased in 9 patients. There were no differences in the excretion of other organic acids. The patients with elevated 3-methylglutaconic acid did not differ from the other patients with developmental language disorders in any of the parameters evaluated. Mildly elevated urinary levels of 3-methylglutaconic acid may be a marker of a still undefined metabolic disorder presenting with developmental language delay. A further study in large groups of children with different developmental disorders is mandatory.

Child↗