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PubMed2003

The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization.

This article focuses on the schizophrenic disorganization syndrome, which was initially described by Bleuler (who used the term "dissociation") as lying at the heart of schizophrenia. While adopting a neo-Bleulerian approach, we describe schizophrenic disorganization using a pathogenetic hypothesis and a three-part structure. First, we discuss previous approaches to characterizing and defining schizophrenic disorganization, providing arguments in favor of a complementary approach to describing schizophrenic disorganization that relies on a pathogenetic analysis of the disorganization syndrome, and especially thought and language disorders. Second, we present two possible cognitive pathophysiological mechanisms that may explain schizophrenic disorganization: (1) a deficit in the integration of contextual information, based on the results of semantic priming studies; and (2) a theory of mind deficit, based on the results of studies of the attribution of mental states to others. We propose a cognitive model of schizophrenic dysfunctioning on the basis of these two anomalies. Third, we summarize our published findings to examine the implications of these two cognitive pathophysiological mechanisms for schizophrenic disorganization. On the basis of the same two anomalies, we then propose and illustrate a neo-Bleulerian approach to the assessment of communication disorders that is critical to the improvement of schizophrenic disorganization's clinical description.

Cognition Disorders↗

PubMed1997

Functional and anatomical aspects of prefrontal pathology in schizophrenia.

Neuropathology is a field that correlates autopsy findings to clinical symptomatology. Since the brain has an inordinate number of parceled regions, each having a different function, it makes more sense to work in an inverse fashion and use clinical findings to establish pathological correlations. In this regard, a lesion in the prefrontal lobes can explain some of the salient findings in schizophrenia, for example, scrambled language, disordered thinking, and abnormal behavior. Recent quantitative cytoarchitectural observations by Goldman-Rakic and Selemon sustain such a correlation. By using a computerized image analysis system, these authors have described an abnormally high neuronal density and reduced cortical thickness in many of their patients with schizophrenia. The importance of these findings is discussed in terms of the recent schizophrenia literature.

Brain Mapping↗

PubMed1998

Use of elaborative encoding to facilitate verbal learning after adolescent traumatic brain injury.

OBJECTIVE: To investigate the effectiveness of elaborative encoding in learning and remembering word definitions after traumatic brain injury (TBI). DESIGN: Two case studies. SETTING: University outpatient clinic. PARTICIPANTS: Two adolescents with severe memory impairments after TBI who needed specific vocabulary for school. INTERVENTIONS: A series of individual speech-language therapy sessions incorporating clinician- and subject-generated strategies to facilitate elaborative encoding. Target words were based on school requirements and pretreatment test results and were assigned randomly to treatment or control groups. MAIN OUTCOME MEASURE: Accuracy of free-recalled definitions at the conclusion of therapy and after 1 month with no therapy. RESULTS: Significant improvement in expressed word knowledge at the conclusion of therapy, with improvement on treated words maintained at 1 month for both subjects. CONCLUSIONS: Elaborative encoding was an effective tool for teaching specific information required for school. Patterns of response differed substantially from those of normally developing children. Generalization to classroom use was planned for and should be measured in future research.

Accidents, Traffic↗

PubMed2001

Longitudinal outcome of verbal discourse in children with traumatic brain injury: three-year follow-up.

PURPOSE: This study compared changes in discourse ability between two groups of children age 5 to 10 years after brain injury: those with severe traumatic brain injury (TBI) and those with mild/moderate injury over 3-year follow-up testing. MATERIALS AND METHODS: Forty-three children with TBI were recruited from a larger research project examining cognitive and linguistic recovery after injury. Twenty-two of these patients had severe injuries and 21 sustained mild/moderate injuries. All children were presented an ordered sequence of pictures and asked to verbally produce a story/narrative discourse. Each child was then asked to produce a lesson relating to the story. RESULTS: The severe group performed significantly worse than the mild/moderate group when performance across all four discourse domains was considered. Both groups improved across time on selected discourse measures. Qualitative analysis suggested that the severe group showed differential rates of improvement across the individual discourse variables over the 3-year interval. CONCLUSIONS: Severe TBI can have a pernicious effect on discourse abilities in children years after injury compared with children with mild/moderate injuries. The major caveat is that the discourse measures must be sufficiently challenging when used to assess older children and children with milder forms of TBI.

Analysis of Variance↗

PubMed2001

Comparison of literal, inferential, and intentional text comprehension in children with mild or severe closed head injury.

BACKGROUND: Children with head injury have impairments in pragmatic language at the level of both single words and texts. Text comprehension deficits are likely to be the more consequential for everyday and academic function, yet the relative magnitudes of literal and nonliteral text comprehension deficits have not been measured. DESIGN: We compared the magnitude of the impairment in three forms of text comprehension for children with mild or severe head injury relative with controls: literal language (understanding literal text information), inferential language (making pragmatic inferences, textual coherence inferences, or enriching inferences), and the language of mental states and intentions (eg, producing speech acts, appreciating irony, and understanding deception). MEASURES: Effect sizes were used to measure the magnitude of the difference between children with head injury and age-matched controls. RESULTS: Children with severe closed-head injury were significantly impaired on tasks of literal text understanding, inferencing, and intentionality. Children with mild head injury were impaired on some inferencing and all intentionality tasks, although they had no literal text comprehension deficits. CONCLUSIONS: For both groups, the greatest deficits (ie, the largest effect sizes) were on tasks requiring understanding of the language of mental states and intentions. The data bear on the long-term effects of childhood closed-head injury on text- and discourse-level language and also on the nature and timing of language rehabilitation in children with head injury.

Adolescent↗

PubMed2001

Pictures to print: a software scaffold to written literacy.

BACKGROUND: Successful school placements require effective written literacy skills. When a student has traumatic brain injury (TBI), written literacy instruction may need to be individualized and intense to facilitate optimal reintegration into the school program. Software products can provide a method that assists in creating the needed individualized, intense experiences. Written literacy-learning experiences span a continuum from preconventional messages expressed through pictures, to conventional printed expressions designed to convey meaning, to the literate writing needed to create stories and reports. DESIGN: This article is designed to familiarize rehabilitation and research professionals in TBI with the range of written literacy software and to stimulate clinical applications and research related to their use with students who have sustained a TBI.

Adolescent↗

PubMed1990

Language and Parkinson disease.

Previously published reports of deficits in linguistically oriented tasks were reviewed for both demented and nondemented Parkinson disease (PD) patients in a discussion of the question of whether PD affects language. Additionally, to illustrate the methodological problems inherent in evaluating linguistic competence, the performance on four linguistically oriented tasks of 12 PD patients who scored 8 or better on the Mental Status Questionnaire was compared to that of 32 age- and education-matched control subjects. These tasks, from which a composite variable representing performance was formed, were oral object description, story retelling, the Peabody Picture Vocabulary Test, and the Similarities subtest of the Wechsler Adult Intelligence Scale (WAIS), a test of verbal associative reasoning. After controlling for the effects of disease severity, a significant effect was observed for the presence of PD. However, when the additional effects of performance on the Block Design subtest of the WAIS were controlled, the PD effect was of borderline significance. These results typify those in the literature, that is, whereas nondemented PD patients can be demonstrated to perform significantly more poorly on linguistically oriented tasks, the performance deficit cannot be conclusively demonstrated to result from a language deficit per se.

Aged↗

PubMed1995

Anosognosia in Alzheimer disease.

This study evaluated Alzheimer disease (AD) patients' awareness of impairment in several domains, including cognitive, psychiatric, and behavioral functioning. Ratings made by 13 patients with moderate to moderately severe probable AD were compared with ratings made by their relatives using the Cognitive Behavior Rating Scales (Williams et al., 1985; Williams, 1987). Unawareness was defined as the discrepancy between informant and patient ratings. Informants consistently rated patients' impairment as more severe than the patients rated themselves. However, the discrepancy between the ratings was statistically significant only for Language Disorder, Higher Cognitive Deficits, Memory Disorder, Dementia, and Apraxia, and not for Agitation, Need for Routine, Depression, and Disorientation scales. Unawareness was not related to severity of memory impairment, as measured by the Rivermead Behavioural Memory Test (Wilson et al., 1985). The results of this small, preliminary study of relatively severely impaired AD patients suggest that awareness of psychiatric and behavioral problems may be relatively preserved compared to awareness of cognitive problems. These findings should be replicated with a larger sample with a broader range of severity.

Activities of Daily Living↗

PubMedDate not supplied

Relationship between two dichotic listening tests and the Token test for children.

The relationship between two dichotic listening tasks was studied. The two dichotic tests used were the Staggered Spondaic Word (SSW) test and the directed Dichotic Consonant-Vowel (CV) test. These measures were administered to 104 children between the ages of 6.0 and 8.0 yrs. The subjects were divided into two groups according to their Token test scores with group I having normal Token test scores and group II having below average scores on the Token test. When the performances of the two groups on the SSW test were compared, a significant difference was found between them on the right and left competing conditions of the test. There was no difference between the groups on any response bias. On the directed Dichotic CV test the two groups were significantly different on the right ear scores but not on the left ear scores under both directed conditions. The groups were also significantly different on the directed right task when the difference between the two ear scores was compared but not on the directed left task. It was concluded that there is a relationship between these two dichotic measures and the Token Test for Children.

Auditory Pathways↗

PubMed1996

Longitudinal study of FM system use in nonacademic settings: effects on language development.

OBJECTIVE: The overall objective of the present study was to assess the efficacy of FM system use in the home setting for a group of preschool children with mild-to-severe sensorineural hearing loss. Changes in language acquisition were monitored and compared with similar measures from a group of children who used hearing aids. Secondarily, the perceived benefits and practical problems associated with FM system use across a variety of nonacademic situations were documented. DESIGN: Ten children with mild-to-severe sensorineural hearing loss participated in a 2-yr longitudinal study investigating the efficacy of FM system use in the home setting. The subjects were divided into two groups: one group was instructed to use FM systems at home as often as possible while the other used only their personal hearing aids. Changes in language acquisition were monitored in both groups. Subjective benefit and the practical problems associated with use of FM systems outside of traditional academic environments were monitored via daily use logs, a weekly observation inventory, and a situational listening profile. RESULTS: The majority of children in both groups improved in all measures of language development over the study interval. Although there were relatively large individual differences in performance for some measures, no statistically significant differences between the FM and hearing aid users were found. However, some children in the FM group made unusually large gains in some aspects of language development over the study interval. In addition, both parents and children reported benefits of FM system use in specific listening situations. Throughout the 2-yr study, a number of practical problems associated with FM system use outside the classroom were identified. CONCLUSIONS: Formal language measures did not yield significant differences between the FM and HA groups, but some subjects had rates of language acquisition which suggested that FM system use may be beneficial in selected cases. In addition, subjective reports of FM system benefit suggest that appropriate use of the device may facilitate effective communication in a variety of listening situations. Although recent advances in FM system design may minimize some of the factors that reportedly restricted consistent FM use in this study, the complexities associated with the modes of operation and problems with FM interference remain issues that require consistent audiologic monitoring of FM system use in nonacademic environments.

Audiometry, Pure-Tone↗

PubMed2004

Otitis media, hearing loss, and language learning: controversies and current research.

This article reviews research on the possible linkage of otitis media with effusion (OME) to children's hearing and development, identifies gaps, and directions for research, and discusses implications for healthcare practices. About half of children with an episode of OME experience a mild hearing loss while about 5-10% of children have moderate hearing loss. Recent prospective and randomized clinical trials suggest none to very small negative associations of OME to children's later language development. Based on both retrospective and prospective longitudinal studies, associations between OME and perceiving speech in noise and tasks that require equal binaural hearing have been reported but have not been adequately studied with regard to functional outcomes. Thus, on average, for typically developing children, OME may not be a substantial risk factor for later speech and language development or academic achievement. However, these conclusions should be interpreted cautiously, since most of these studies used OME rather than hearing loss as the independent variable (although hearing loss rather than OME is hypothesized to affect language development) and many studies did not control for important confounding variables such as socioeconomic status (SES).

Attention↗

PubMed1996

Cerebral blood flow imaging in paediatrics: a review.

The ability to study regional cerebral blood flow (rCBF) is available in many institutions, especially with the spread of multi-headed gamma cameras. The use of this technique in paediatrics requires special attention to detail in the manner of data acquisition and handling the child. The interpretation of the rCBF study in a child requires knowledge of normal brain maturation. The major clinical use in paediatrics is epilepsy because of the advances in surgery and the frequency of complex partial seizures. Other indications in paediatric neurology include brain death, acute neurological loss including stroke, language disorders, cerebral palsy, hypertension due to renovascular disease, traumatic brain injury and migraine. There are paediatric psychological conditions in which rCBF assessment has been undertaken, including anorexia nervosa, autism, Gilles de la Tourette Syndrome (GTS) and attention deficit disorder-hyperactivity (ADHD). This article attempts to review all aspects of rCBF studies in paediatrics.

Adolescent↗

PubMed2006

Working memory and sentence comprehension of Hong Kong Chinese children with specific language impairment.

Children with Specific Language Impairment present with delayed language development, but do not have a history of hearing impairment, mental deficiency, or associated social or behavioral problems. Non-word repetition was suggested as an index to reflect the capacity of phonological working memory. There is a paucity of such studies among Hong Kong Chinese children. This preliminary study aimed to examine the relationship between phonological working memory and Specific Language Impairment, through the processes of non-word repetition and sentence comprehension, of children with Specific Language Impairment and pre-school children with normal language development. Both groups of children were screened by a standardized language test. A list of Cantonese (the commonest dialect used in Hong Kong) multisyllabic nonsense utterances and a set of 18 sentences were developed for this study. t-tests and Pearson correlation were used to study the relationship between non-word repetition, working memory and specific language impairment. Twenty-three pre-school children with Specific Language Impairment (mean age = 68.30 months; SD = 6.90) and another 23 pre-school children (mean age = 67.30 months; SD = 6.16) participated in the study. Significant difference performance was found between the Specific Language Impairment group and normal language group in the multisyllabic nonsense utterances repetition task and the sentence comprehension task. Length effect was noted in Specific Language Impairment group children, which is consistent with the findings of other literature. In addition, correlations were also observed between the number of nonsense utterances repeated and the number of elements comprehended. Cantonese multisyllabic nonsense utterances might be worth further developing as a screening tool for the early detection of children with Specific Language Impairment.

Child↗

PubMed2006

Verbal fluency predicts mortality in Alzheimer disease.

OBJECTIVES: To assess the predictive value of neuropsychologic profiles, at diagnosis, for mortality in incident Alzheimer disease (AD). BACKGROUND: Rate of AD progression varies significantly across individuals for reasons that are not well understood. Several studies have linked rapid decline with disproportionately impaired executive functioning, presumably reflecting greater impairment of frontal networks. To the extent that differential neuropsychologic profiles reflect various neuropathologic presentations of AD, such profiles may inform survival estimates early in the disease. METHODS: Five neuropsychologic indices were used to characterize performance in 161 individuals at diagnosis of AD during a 15-year, longitudinal, primarily community-based study. RESULTS: Fifty-two percent of participants reached the mortality end point with a median survival of 5.52 years (95% confidence interval, 4.41-6.63). Cox proportional hazards analyses indicated that older age at diagnosis was associated with higher risk of mortality (risk ratios, 1.08; 95% confidence interval, 1.04-1.12) whereas Hispanic ethnicity predicted lower mortality [0.22 (0.09-0.55)]. Controlling for these 2 demographic variables, higher verbal fluency scores at diagnosis predicted lower mortality [0.69 (0.49-0.96)]. CONCLUSIONS: Disproportionate impairment of both category and letter fluency at the earliest stages of AD predicts mortality. The prognostic value of these tests may derive from their general psychometric properties, or may reflect the measures' sensitivity to an early or critical level of compromise to frontal networks.

Aged↗

PubMed1998

Speech modifications algorithms used for training language learning-impaired children.

In this paper, the details of processing algorithms used in a training program with language learning-impaired children (LLI's) are described. The training program utilized computer games, speech/language training exercises, books-on-tape and educational CD-ROM's. Speech tracks in these materials were processed using these algorithms. During a four week training period, recognition of both processed and normal speech in these children continually increased to near age-appropriate levels. We conclude that this form of processed speech is subject to profound perceptual learning effects and exhibits widespread generalization to normal speech. This form of learning and generalization contributes to the rehabilitation of temporal processing deficits and language comprehension in this subject population.

Algorithms↗

PubMed2001

Psycholinguistic markers for specific language impairment (SLI).

In this study 160 children, aged 11 years with a definite history of specific language impairment (SLI), completed four tasks that could be potential positive psycholinguistic markers for this impairment: a third person singular task, a past tense task, a nonword repetition task, and a sentence repetition task. This allowed examination of more than one type of marker simultaneously, facilitating both comparisons between markers and also evaluation of combinations of markers in relation to identifying SLI. The study also provided data regarding the markers in relation to nonverbal IQ, made use of new normative data on all tasks, and examined marker accuracy in relation to current language status. The results show that markers vary in accuracy, with sentence repetition (a previously unused marker) proving to be the most useful. This psycholinguistic marker shows high levels of sensitivity (90%), specificity (85%), and overall accuracy (88%), as well as being able to identify the majority of children whose current language status falls in the normal range despite a history of SLI.

Child↗

PubMed2001

Predicting pathways of specific language impairment: what differentiates good and poor outcome?

A group of 117 children who met criteria for Specific Language Impairment (SLI) at 7 years of age were reassessed at 11 years of age. The data gathered from both stages were used to identify predictors of good and poor outcome from earlier test assessments. Results of logistic regressions indicated that measures of narrative retelling skills and expressive syntax were the strongest predictors of overall prognosis. This finding persisted when a nonverbal measure was included as a predictor alongside language measures in the regression model. There was found to be a lack of independent predictive contribution of early measures of articulation to later overall prognosis. Demographic factors (maternal education and family income) were not differently distributed across outcome groups. The theoretical and practical implications of the findings are discussed.

Adolescent↗

PubMedDate not supplied

Language enhancement in the developmentally delayed child through a cognitive/receptive mode.

An approach to enhancing the language comprehension of young developmentally delayed children utilizing receptive language tasks presented in a cognitive, 'problem-solving' context is described. Over a 2 year period 16 language impaired and developmentally delayed children were provided with 8 weeks of concentrated instruction in five language areas: nouns, verbs, adjectives, prepositions and syntax. Instruction consisted of systematic verbal stimulation without overt attempts to elicit expressive language. Responses by the subjects were in the form of motor behaviours of picture/object identifications. Results indicated a marked increase in the number of stimuli to which these children could provide appropriate responses at the end of the 8 week instructional period. The gains were also maintained 3 months after termination of instruction and the learned material was considered to have become part of these children's verbal repertoire.

Child Development↗