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[Applicability of the Child Behavior Checklist in developmentally delayed children].

OBJECTIVES: The Child Behavior Checklist is used to assess behavioral problems in a large unselected sample of children. In the present study we assess the usefulness of the CBCL in the evaluation of the typical behavioral problems usually reported in children with developmental disorders. METHODS: We examined two groups of children which both had language or communication problems. The first group consisted of 34 children with infantile autism, the second group consisted of 34 age-, sex- and IQ-matched children with a specific developmental speech and language disorder. The CBCL was filled out by the parents in both groups as part of the routine diagnostic procedures. RESULTS: Half of the language-impaired children have Total Behavioral Problem scores within the clinical range. Problems are mainly reported on the scales: "Attention Problems", "Social Problems" and "Withdrawn". Two-thirds of the autistic children have deviant scores on the syndrome scales mentioned above. 32 out of 34 autistic children score within the clinical range on the scale "Thought Problems", whereas only one language-impaired child does so. Single item analysis shows a high prevalence of developmental problems (speech problems, enuresis ...) in both groups. CONCLUSION: The CBCL records characteristic behavioral problems in children with developmental disorders. The problematic behaviors are shown on the syndrome scale level as well as on the single item level. Children with developmental disorders and high scores on the "Thought Problems" scale of the CBCL should be evaluated for the presence of a possible pervasive developmental disorder.

Adolescent↗

[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↗

A multimethod approach to the evaluation of community preschool speech and language therapy provision.

OBJECTIVES: The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/language delays. As a 'worked example', it demonstrates the value of a multimethod approach to evaluation. METHODS: The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in-depth interviews, which were the methods used in the evaluation, overlap and complement each other. RESULTS: There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or 'watchful waiting', the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable. CONCLUSIONS: Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.

Child Welfare↗

Pattern-based approaches to phonological therapy.

Pattern-based approaches to phonological disorders emerged in the 1970s and 1980s after researchers realized that phonological "rules" used to describe speech patterns of adults could be used in the analysis of children's speech. In this article, a pattern-based approach to assessment and treatment of phonological disorders is described, based on identification and treatment of phonological processes. Means of identifying and quantifying phonological processes are provided and assessment tests are described. Principles underlying the use of phonological processes in intervention programs are presented and decisions regarding target selection are discussed. A case study of the treatment program for one child illustrates the application of phonological processes within a cycles approach.

Adult↗

Do actions speak louder than words? The case of the disappearance of social communication oddities.

Within the last decade, researchers and clinicians have reported an increase in the incidence and diagnosis of Autism Spectrum Disorder (ASD). Various factors have been proposed for this apparent change including broader diagnostic criteria, greater public awareness, biological and environmental interactions, and earlier detection. However, it has been observed in a certain percentage of children, during the toddler and preschool years and before intervention is introduced, that severe language deficits distort social and self-regulatory behavior to such a degree that they mimic the characteristics of ASD. Professional caution is vital in this regard to describe early functioning and to defer diagnosis until the effects of intervention and treatment can be monitored over time. The case of Nicole, a preschooler with developmental delays and social communication oddities, illustrates what I believe is the most professionally responsible, cautious, family-centered, and data-based diagnostic process that links assessment, intervention, and evaluation for young children with early developmental difficulties.

Autistic Disorder↗

Language skills of adolescents with Tourette Syndrome.

A multiple single-case study investigated language characteristics of adolescents with Tourette Syndrome (TS). Ten adolescent subjects with diagnosed TS were evaluated on a test battery sensitive to high level language and discourse impairment. Results were compared to established norms or, where no norms have been established, with results obtained by 15 non-neurologically impaired adolescent subjects. Five subjects were differentiated from normal communicative performance by their test results. Although language profiles were variable, disorganized output, concreteness of language and poor language formulation abilities were apparent in these subjects. This symptomatology may reflect prefrontal disturbance and can possibly be explained by the pathogenesis of the disorder. This finding adds to literature regarding subcortical and frontal cortex language involvement and indicates further research.

Adolescent↗

Word-learning skills of deaf preschoolers: the development of novel mapping and rapid word-learning strategies.

Word-learning skills of 19 deaf/hard-of-hearing preschoolers were assessed by observing their ability to learn new words in two contexts. The first context required the use of a novel mapping strategy (i.e., making the inference that a novel word refers to a novel object) to learn the new words. The second context assessed the ability to learn new words after minimal exposure when reference was explicitly established. The children displayed three levels of word-learning skills. Eleven children learned words in both contexts. Five were able to learn new words rapidly only when reference was explicitly established. Two children did not learn new words rapidly in either context. The latter seven children were followed longitudinally. All children eventually acquired the ability to learn new words in both contexts. The deaf children's word-learning abilities were related to the size of their vocabularies. The present study suggests that word-learning strategies are acquired even when children are severely delayed in their language development and they learn language in an atypical environment.

Association Learning↗

Behaviour problems and language abilities at three years and behavioural deviance at eight years.

A representative sample of 535 children were followed up from their third to their eighth birthday using measures of language ability and behaviour. At age 8 yr it was found that there were significantly more boys with behavioural deviance than girls, and that children from manual social class backgrounds also showed more behavioural deviance. The only difference between the immigrant and non-immigrant children was a less frequent occurrence of neurotic deviance in the immigrant group. It was found that behaviour problems at age 3 yr were strongly related to behavioural deviance at school at age 8 yr, particularly for boys. This medium-term stability in behaviour problems had not been found in previous studies looking at younger children. A low score on a measure of language structure at age 3 yr was found to be related to a high rate of neurotic deviance at age 8 yr even when behaviour at age 3 yr was controlled. The implications of these findings for the early identification and intervention with children at risk for later behaviour deviance are discussed.

Antisocial Personality Disorder↗

Cognitive and behavioural characteristics of children with idiopathic epilepsy in a low-income area of Ankara, Turkey.

Fifteen school-age children with idiopathic epilepsy but with no other neurological symptoms were compared with non-epileptic children, matched for age, on four cognitive tests selected to measure specific cognitive skills at two levels of functioning, and a behaviour rating scale. All children were from a low-income district of Ankara, Turkey. Epileptic children did as well as controls on the recognition of a geometric designs test but were significantly inferior at drawing these designs, suggesting some deficit at a cognitive level involving coordination of perception and motor activity. In language functioning, they were significantly poorer on the receptive test but not on the expressive test. They had significantly more behavioural problems than either the control group or their own siblings, those related to fears and anxiety being most prominent. However, in comparison with their siblings, they also had significantly more problems related to conduct- disobedience and inattention. These findings provide further evidence for the importance of some form of counselling for school-age epileptic children and their families.

Adolescent↗

Williams syndrome and related disorders.

Three clinical conditions displaying phenotypic overlap have been linked to mutation or deletion of the elastin gene at 7q11.23. Supravalvar aortic stenosis, an autosomal dominant disorder characterized by elastin arteriopathy, is caused by mutation or intragenic deletions of ELN resulting in loss of function. Autosomal dominant cutis laxa, a primarily cutaneous condition, is the result of frameshift mutations at ELN that cause a dominant-negative effect on elastic fiber structure. Williams syndrome, a neurodevelopmental disorder is due to a 1.5 Mb deletion that includes ELN and at least 15 contiguous genes. The disorder is characterized by dysmorphic facies, mental retardation or learning difficulties, elastin arteriopathy, a unique cognitive profile of relative strength in auditory rote memory and language and extreme weakness in visuospatial constructive cognition, and a typical personality that includes overfriendliness, anxiety, and attention problems. The understanding of these disorders has progressed from phenotypic description to identification of causative mutations and insight into pathogenetic mechanisms for some aspects of the phenotype.

Aortic Stenosis, Supravalvular↗

Childhood schizophrenia: present but not accounted for.

The subjects of this study were 19 children and 11 adolescents who had been psychotic since childhood and who satisfied DSM-III criteria for schizophrenia except for the stipulation that a "deterioration from a previous level of functioning" must have occurred. Seven subjects had had documented signs of psychosis before the age of 30 months. The presence of thought disorder precluded giving these 7 subjects the diagnosis of early infantile autism. The authors argue that only symptoms and signs, not age at onset, can define a disorder. They also emphasize that in children and adolescents, developmental issues influence the clinical presentation.

Adolescent↗

Comparison of three methods for eliciting phonological processes.

Eight articulatory disordered children were studied to compare the occurrence of phonological processes using three elicitation methods, including single-word productions, imitated sentences, and continuous speech sampling. A total of 11 phonological processes were shown by the subjects, with only the process of gliding indicative of significantly different rates of occurrence among the three procedures. These subjects were relatively consistent in their use of phonological processes under different speaking conditions.

Articulation Disorders↗