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Remediation of children with developmental language disorders.

There is no single approach to intervention in children with developmental language disorders. Remedial approaches differ in that they are based on differing theoretical perspectives. Four theoretical frames are reviewed. Neuropsychologically driven remediation, which tailors intervention to a child's profile of cognitive and linguistic strengths and weakness, is emphasized. Concrete examples of compensatory techniques suited to specific profiles are presented.

Child

Prevalence of speech and language disorders in 5-year-old kindergarten children in the Ottawa-Carleton region.

A representative sample of 5-year-old kindergarten children was assessed for speech and/or language disorder. Of the 1,655 children tested, 180 were identified as having speech or language impairment. It is estimated that within the total reference population, between 16.2% and 21.8% would show some impairment; for the boys, the rate would be 15.5% to 20.7% and for the girls, between 19.1% and 25.1%. Most of these children would show some language impairment as opposed to speech problems only. Approximately 36% of the identified boys and 30% of the girls would have speech problems only, the remainder having speech and language problems or language problems only. Followup studies of these children are needed to ascertain their outcome and language status in middle childhood.

Articulation Disorders

Acquisition of semantic role by language-disordered children: differences between production and comprehension.

Six 3-year-old language-disordered children were taught the relationship between semantic role and word order through either production or comprehension training. All 6 subjects successfully learned the relationship through production training as indicated by their responses to a production probe and by their use of word order to express semantic role distinctions in their conversational speech. These subjects never used word order cues to decode semantically reversible sentences on comprehension tests even after they were using word order appropriately in their conversational speech. Also, none of the subjects were able to learn word order through comprehension training. The results were interpreted to mean the subjects could learn a word-order rule by teaching them to say sentences that contrast word order and meaning but that they could not learn by being taught to respond to sentences. The problem with this latter procedure may be that it requires a mental operation that is beyond the level of cognitive development of children under the age of 4.

Child, Preschool

[Symptomatology of language disorders in cerebral palsy with mutism].

Language disturbances in cerebral palsy with mutism. The analysis of the afferent side of language in 18 cerebral palsy children with no oral expression shows that they form a very heterogeneous population. The semiological analysis concerning comprehension leads to their classification into four main groups akin to the classical dysphasia syndromes. Major agrammatism occurring in phonologico-syntactic dysphasia. Sensory dysphasias (or verbal deafness). Mixed (or global) dysphasias. Motor dysphasias: phonological programmation disturbances (anarthria) and motor production disturbances (dysarthria). The disclosure of these various dysphasias allows for specific rehabilitation and for education procedures suitable for each individual patient.

Adolescent

Language disorder in a right-hander after occlusion of the right anterior cerebral artery.

A right-handed woman developed left hemiparesis and a language disturbance. At autopsy, there was infarction in the territory of the right anterior cerebral artery, involving, among other structures, the supplementary motor area. This brain region has been considered to play a role in speech, but whether the language disorder that follows its destruction is truly aphasic is controversial. Our patient does not answer that question, but if her disturbed language is viewed as aphasic, she represents the fourth autopsy case of "crossed aphasia in a dextral" and the first, with or without autopsy, after right anterior cerebral artery occlusion.

Aged

Auditory brainstem responses of children with developmental language disorders.

Brainstem auditory evoked potentials (BAEPs) were recorded from 48 children with language disorders (aged four to nine years old, IQs normal to borderline, normal audiometric thresholds and attending special school) and 20 healthy children (four to eight years old, with normal IQs, audiometry and school-level). The language-disabled group showed significantly lower absolute latency values of the BAEPs than controls. There were no significant differences in the central conduction time of the auditory pathway (I-V interval). Therefore, the only significant difference corresponded to a minor value for the first wave (auditory nerve discharge) of the BAEP. A reduction in the control mechanisms of the sensory inputs at the peripheral level, or a disturbance in the inhibitory mechanisms of cortico-subcortical modulation, might explain these findings.

Aphasia

Comprehension monitoring in language-disordered children: a preliminary investigation of cognitive and linguistic factors.

This study provided a preliminary investigation of the relative influence of cognitive and communicative factors in comprehension monitoring. This question was approached by studying language-disordered (LD) children for whom these abilities are presumably dissociated. Their performance on an ambiguity detection task was compared to that of two groups of control children, one matched for comprehension level and the other for cognitive level. Results revealed that LD children performed similarly to the control children who were matched for level of comprehension. The LD children's performance was examined along a continuum of the relative influence of cognitive and communicative factors, given that neither type of factor alone could sufficiently account for effective comprehension monitoring. It was concluded that communicative factors, both active primary comprehension and social communicative knowledge, had a stronger influence than the cognitive factors in our particular comprehension monitoring task.

Child

Sensory modulation of auditory stimuli in children with autism and receptive developmental language disorder: event-related brain potential evidence.

Three groups of age- and PIQ-matched children (Autism, Receptive Developmental Language Disorder, and normal controls) participated in two event-related brain potential (ERP) experiments. Each of these experiments was aimed at evaluating whether either of the two clinical groups of children demonstrated abnormalities in two auditory ERP components, N1 and P2, which are known to be dependent on stimulus characteristics (frequency, intensity, and probability), and believed to be generated within primary and secondary cortex. Results of Experiment 1 provide partial support for the idea that both clinical groups failed to fully process changes in stimulus intensity as indexed by the N1 component. Results are discussed in reference to potential abnormalities in serotonergic regulation of auditory cortex.

Adolescent

[Short term memory and severe language disorders in the child].

Memory, and particularly short-term memory or "working memory" (Baddeley), is involved in language acquisition in children. We have studied short-term memory, with verbal-and non verbal tests, of 8 children suffering from developmental dysphasia compared with other ones, matched in terms of age and performance I.Q. (W.I.S.C.-R.). The digit span did not significantly differ in the two groups, while the visuo-spatial span was lower in the dysphasic group. The memorization of a list of monosyllabic words by dysphasic children was poor in the absence of visual presentation and improved by it. Differences between dysphasic and control-children are unlikely to be due to speech rate which does not significantly differ from one group to the other one. The results suggest the existence, in language disordered children, of cognitive functions disorders much more important than those directly involved in the speech production.

Case-Control Studies

A longitudinal study of a hyperlexic child: hyperlexia as a language disorder.

The longitudinal study of a hyperlexic girl, A.E., is described. Although her WISC-R IQ was 58, her reading was significantly advanced for age and level of intellectual functioning. She was socially withdrawn and displayed repetitive and self-stimulation behaviors. At birth she weighed 1000 g and was 32 weeks gestational age. She had severe respiratory distress, seizures and apnea in the perinatal period. She had a history of significantly delayed development, although the delays were more pronounced in language than in perceptual motor skills. She demonstrated difficulties with semantic and syntactic processing of language and could read words and sentences of which she had little or no comprehension. The existence of reading in spite of severely disordered language suggests that reading may occur by visual and/or phonological routes but that semantic and syntactical processing of words is not essential.

Child