Preschoolers with Developmental Disabilities: A Comparison of an ADHD and a NonADHD Group

Background To compare a group of preschoolers with developmental disabilities at-risk for ADHD (ADHD/DD) with a group of preschoolers with DD and no ADHD behaviors (nonADHD/DD). Materials and Methods Seventy-three preschoolers between 4 and 5 years of age with cognitive functioning between an IQ of 40 and 79 were recruited. All were enrolled in developmental preschool programs. The groups were compared using home and school questionnaires as well as laboratory measures of activity level, impulsivity, attention span, play, and compliance. Results Preschoolers with ADHD/DD had significantly greater conduct, language, adaptive and social deficits than controls. On laboratory measures, preschoolers with ADHD/DD were significantly more impulsive and out-of-seat than controls. Finally, families of ADHD/DD children experienced greater stress than controls. Conclusions DD preschoolers with symptoms suggestive of ADHD experience deficits in areas beyond that accounted for by DD alone. Similar to typically developing children with ADHD, this cohort has problems with learning, conduct, socialization, and adaptive skills. Consequently, these children remain at even greater risk of mental health and learning difficulties during their school years.     

A naturalistic study of school children's private speech in an academic problem-solving task

Private speech emitted by 25 first-grade children during an academic problem-solving task was investigated. Each child was videotaped twice while individually completing both a hard and an easy version of a fill-in-the-blank sentence reading and writing assignment and while wearing a wireless microphone. The coding system developed for this study coded speech by function, temporal order in relation to the motor act of writing, and to whose behavior the speech referred. Coded speech was correlated with standardized measures of cognitive ability. Although the pre-ponderance of speech occurred prior to the motor act associated with it, few self-instructional strategies were used. Lower IQ children, who were also less successful in the tasks, employed the same number of self-instructions as high IQ students. The only form of self-instruction used more frequently by high IQ children was phonetic reading, a directly trained strategy. These findings question the efficacy of self-instructional training for this type of task.An earlier version of this work was presented at the Association for Advancement of Behavior Therapy Annual Convention, Atlanta, 1977. We are indebted to the staff of the Kamehameha Early Education Project for their assistance in this project. We would also like to thank Doree Griffin, Mary dela Sierra, and Sandra Koval for the many patient hours they spent as research assistants. We appreciate the thoughtful and cogent comments on earlier drafts of this paper by Donald Meichenbaum and Rosemery Nelson.     

Speech-induced suppression of evoked auditory fields in children who stutter

Auditory responses to speech sounds that are self-initiated are suppressed compared to responses to the same speech sounds during passive listening. This phenomenon is referred to as speech-induced suppression, a potentially important feedback-mediated speech-motor control process. In an earlier study, we found that both adults who do and do not stutter demonstrated a reduced amplitude of the auditory M50 and M100 responses to speech during active production relative to passive listening. It is unknown if auditory responses to self-initiated speech-motor acts are suppressed in children or if the phenomenon differs between children who do and do not stutter. As stuttering is a developmental speech disorder, examining speech-induced suppression in children may identify possible neural differences underlying stuttering close to its time of onset. We used magnetoencephalography to determine the presence of speech-induced suppression in children and to characterize the properties of speech-induced suppression in children who stutter. We examined the auditory M50 as this was the earliest robust response reproducible across our child participants and the most likely to reflect a motor-to-auditory relation. Both children who do and do not stutter demonstrated speech-induced suppression of the auditory M50. However, children who stutter had a delayed auditory M50 peak latency to vowel sounds compared to children who do not stutter indicating a possible deficiency in their ability to efficiently integrate auditory speech information for the purpose of establishing neural representations of speech sounds.     

言语疗法对发育迟缓儿童智力的影响

目的观察言语治疗对发育迟缓儿童智力的影响。方法对20例言语发育迟缓儿童进行评估后,制订个别化言语训练计划,尤其是训练抽象思维和逻辑思维以及注意力认知能力的发育。将适合言语发育迟缓儿童的训练内容融合并演变为游戏方式进行训练,共训练1～3个疗程。训练前后分别进行言语发育水平和智力测验。结果治疗后,10例儿童(50%)言语智商达到正常水平,总有效率100%。结论综合言语康复训练可使言语发育迟缓儿童的智商、言语发育水平均明显提高。     

儿童肾病综合征患者血浆氧化低密度脂蛋白及其免疫复合物水平

目的分析儿童肾病综合征（NS）患儿血浆氧化低密度脂蛋白（ox-LDL）及其免疫复合物（LDL-IC）水平的变化。方法采用酶联免疫吸附试验（ELISA）分别测定106例活动期儿童NS患儿、42例恢复期儿童NS患儿和155名健康对照者ox-LDL和LDL-IC水平,同时对受检者血脂水平进行检测。结果恢复期及活动期NS患儿的ox-LDL水平均高于对照组（P〈0.05、P〈0.01）,且活动期高于恢复期（P〈0.01）;活动期NS患儿LDL-IC水平高于恢复期NS患儿和对照组（P〈0.01）。NS患儿ox-LDL、LDL-IC分别与总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）和尿素（Urea）呈正相关,与白蛋白（A lb）呈负相关。活动期NS患儿经类固醇治疗后,A lb水平升高,ox-LDL、LDL-IC、TC、TG和LDL-C水平下降。结论 NS患儿ox-LDL及LDL-IC水平明显升高,可能参与动脉粥样硬化的发生、发展过程。     

Tantrums are Not Associated with Speech or Language Deficits in Preschool Children with Autism

Communication problems and tantrums are common in children with autism. It has long been postulated that lack of speech is a cause of these tantrums. The goal of our study is to determine if impaired speech is associated with tantrums in preschool children with autism. The relationship between language and tantrum frequency in 240 children with autism, 15 to 71 months of age was investigated. Children were administered standardized IQ and language tests, and mothers rated tantrum frequency and speech intelligibility on a 4-point scale on the Pediatric Behavior Scale. Verbal and nonverbal IQ, expressive and receptive language quotients and age equivalents, and speech intelligibility explained less than 3% of the variance in tantrum frequency. Children whose mental age was sufficient for verbal communication but who lacked speech did not have more tantrums than children with adequate speech. In fact, children with an expressive language age at or above 24 months had more tantrums than children whose speech skills were below 24 months. Our findings and those of others do not support the belief that preschool children with autism have tantrums because they cannot speak or because their speech is difficult to understand.     

Pausing for thought: engagement of left temporal cortex during pauses in speech

Pauses during continuous speech, particularly those that occur within clauses, are thought to reflect the planning of forthcoming verbal output. We used functional Magnetic Resonance Imaging (fMRI) to examine their neural correlates. Six volunteers were scanned while describing seven Rorschach inkblots, producing 3 min of speech per inkblot. In an event-related design, the level of blood oxygenation level dependent (BOLD) contrast during brief speech pauses (mean duration 1.3 s, SD 0.3 s) during overt speech was contrasted with that during intervening periods of articulation. We then examined activity associated with pauses that occurred within clauses and pauses that occurred between grammatical junctions. Relative to articulation during speech, pauses were associated with activation in the banks of the left superior temporal sulcus (BA 39/22), at the temporoparietal junction. Continuous speech was associated with greater activation bilaterally in the inferior frontal (BA 44/45), middle frontal (BA 8) and anterior cingulate (BA 24) gyri, the middle temporal sulcus (BA 21/22), the occipital cortex and the cerebellum. Left temporal activation was evident during pauses that occurred within clauses but not during pauses at grammatical junctions. In summary, articulation during continuous speech involved frontal, temporal and cerebellar areas, while pausing was associated with activity in the left temporal cortex, especially when this occurred within a clause. The latter finding is consistent with evidence that within-clause pauses are a correlate of speech planning and in particular lexical retrieval.     

Communicating via expressive arts: the natural medium of self-expression for hospitalized children

The study was undertaken at a play therapy unit in a Swedish hospital. The purpose was directed toward investigating what takes place during play therapy when children were given the opportunity to use expressive arts such as clay, paint, and/or textile, and the meaning children input into their art objects. The study describes an approach to working with hospitalized children when they visited the play therapy unit. During a three-year period, hospitalized children (n=22) participated in the study. The assumption was that given the opportunity to express themselves freely by using a variety of expressive arts, children will tell what they express in their art works. It might mirror their thoughts and feelings of being hospitalized. The result of the qualitative analyzes generated the themes fear, longing, and powerlessness. The results also showed that expressive arts were a medium for communication. Expressive arts should be used as a tool to help the child express her/himself when being hospitalized.     

Motor speech impairment,activity, and participation in children with cerebral palsy

Abstract

The present study used a population-based sample of children with cerebral palsy (CP) to estimate the prevalence of motor speech impairment and its association with activity and participation. A sample of 79 Victorian children aged 4 years 11 months to 6 years 5 months was recruited through the Victorian CP Register. The presence of motor speech impairment was recorded using the Viking Speech Scale (VSS). Activity and participation outcomes included speech intelligibility (the National Technical Institute for the Deaf rating scale, NTID), the Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS). A parent completed rating scale was used to examine the association between motor speech impairment and participation. Ninety per cent (71/79) of children demonstrated a motor speech impairment. Strong associations were found between the VSS and NTID (< .001), CFCS (< .001), and FCCS levels (<.001). VSS levels III–IV were significantly associated with restrictions in home, school, and community-based participation as perceived by parents. Although some diversity in activity and participation outcomes was observed within specific VSS levels, the results of this study suggested that children with mild motor speech impairments are more likely to demonstrate superior activity and participation outcomes compared to children with moderate or severe deficits.     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: An ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

Course of the fatigue dimension "activity level" and the interference of fatigue with daily living activities for patients with breast cancer receiving adjuvant chemotherapy

The purpose of this study was to determine the course of the activity level, seen as a dimension of fatigue, as a function of chemotherapy within a breast cancer population receiving adjuvant chemotherapy. The second purpose of this study was to determine the course of the interference of fatigue, in general, with daily activities within a breast cancer population receiving adjuvant chemotherapy. In a prospective cohort study, a sample of 157 patients with breast cancer was interviewed, at the first, third, and fifth cycle of adjuvant chemotherapy as well as 4 and 12 weeks after the last cycle of adjuvant chemotherapy. The chemotherapy was administered with either a doxorubicin-containing schedule or cyclophosphamide, methotrexate, and 5-fluorouracil. These 2 groups were compared. The activity level was measured by the Multidimensional Fatigue Inventory. A linear multilevel model was used to analyze the course. The revised Piper Fatigue Scale was used to examine the behavioral changes in the interference of fatigue with activities of daily living. A logistic multilevel model was used to analyze the course of this interference over time. The activity level seems to be rather stable during the treatment with chemotherapy. After the completion of chemotherapy, an improvement is observed. The activity levels reported at the first and the last measurement do not significantly differ. The course of the activity level is not affected by the type of chemotherapy regimen. Age, having children, and the stage of breast cancer turn out to be important determinants of the course of activity level. At all measurement occasions, women with a mastectomy were significantly more hampered in their activity level than women that had undergone a lumpectomy. The longer the duration of radiotherapy, the less active, and the longer the time interval between the last radiotherapy session and the measurement point, the more active patients were at that measurement point. A phenomenon not easy to explain is that the activity level in women who had received, in total, more chemotherapy treatments was significantly less diminished than those who had received fewer treatments. During the study period, in approximately 15% to 35% of the sample, fatigue interferes considerably with their daily living activities. Furthermore, the interference of fatigue with activities in daily life first increases after the start of chemotherapy and decreases after the completion of chemotherapy. Fatigue definitely affects the daily living activities of patients with breast cancer receiving adjuvant chemotherapy. With this knowledge, healthcare providers can inform patients on what they can expect. Further research should include the trajectory preceding chemotherapy and a healthy control group.     

The Performance of Children with Language Impairment on Synthesized vs Digitized Speech Tests

Computer programs are being used increasingly in education and to assist in rehabilitation and treatment of people with special needs. Increasingly claims are being made which indicate that programs which “talk” can assist children with language impairments to learn. Traditionally talking computers used synthesized or “robotic” sounding speech whereas current practice is to utilise digitized or human sounding speech. The argument has been that the more human sounding speech would improve performance. Three groups of children were studied: 8 with language impairments (7 males, 1 female; aged 4;8-7;5); 8 aged and sex matched group of normal children; and 8 younger (aged 3;2–5;1) normal children. Each subject participated in a repeated measures experiment which involved the administration of a computerized version of the Test of Auditory Comprehension of Language, with digitized and synthesized speech. Analysis of variance for repeated measures were conducted. There was a significant effect for groups [F(2,140 = 9.95, p < .05] and speech type [F(1,7) = 14.58, p < .05] with no interaction. These findings indicate that children with language impairment benefit most from more human sounding speech. Speech-language pathologists and others need to consider the quality of speech output with the programs they use.     

Speech-language pathologists' assessment and intervention practices with multilingual children

Within predominantly English-speaking countries such as the US, UK, Canada, New Zealand, and Australia, there are a significant number of people who speak languages other than English. This study aimed to examine Australian speech-language pathologists' (SLPs) perspectives and experiences of multilingualism, including their assessment and intervention practices, and service delivery methods when working with children who speak languages other than English. A questionnaire was completed by 128 SLPs who attended an SLP seminar about cultural and linguistic diversity. Approximately one half of the SLPs (48.4%) reported that they had at least minimal competence in a language(s) other than English; but only 12 (9.4%) reported that they were proficient in another language. The SLPs spoke a total of 28 languages other than English, the most common being French, Italian, German, Spanish, Mandarin, and Auslan (Australian sign language). Participants reported that they had, in the past 12 months, worked with a mean of 59.2 (range 1-100) children from multilingual backgrounds. These children were reported to speak between two and five languages each; the most common being: Vietnamese, Arabic, Cantonese, Mandarin, Australian Indigenous languages, Tagalog, Greek, and other Chinese languages. There was limited overlap between the languages spoken by the SLPs and the children on the SLPs' caseloads. Many of the SLPs assessed children's speech (50.5%) and/or language (34.2%) without assistance from others (including interpreters). English was the primary language used during assessments and intervention. The majority of SLPs always used informal speech (76.7%) and language (78.2%) assessments and, if standardized tests were used, typically they were in English. The SLPs sought additional information about the children's languages and cultural backgrounds, but indicated that they had limited resources to discriminate between speech and language difference vs disorder.     

On the context-dependent nature of the contribution of the ventral premotor cortex to speech perception

What is the nature of the interface between speech perception and production, where auditory and motor representations converge? One set of explanations suggests that during perception, the motor circuits involved in producing a perceived action are in some way enacting the action without actually causing movement (covert simulation) or sending along the motor information to be used to predict its sensory consequences (i.e., efference copy). Other accounts either reject entirely the involvement of motor representations in perception, or explain their role as being more supportive than integral, and not employing the identical circuits used in production. Using fMRI, we investigated whether there are brain regions that are conjointly active for both speech perception and production, and whether these regions are sensitive to articulatory (syllabic) complexity during both processes, which is predicted by a covert simulation account. A group of healthy young adults (1) observed a female speaker produce a set of familiar words (perception), and (2) observed and then repeated the words (production). There were two types of words, varying in articulatory complexity, as measured by the presence or absence of consonant clusters. The simple words contained no consonant cluster (e.g. "palace"), while the complex words contained one to three consonant clusters (e.g. "planet"). Results indicate that the left ventral premotor cortex (PMv) was significantly active during speech perception and speech production but that activation in this region was scaled to articulatory complexity only during speech production, revealing an incompletely specified efferent motor signal during speech perception. The right planum temporal (PT) was also active during speech perception and speech production, and activation in this region was scaled to articulatory complexity during both production and perception. These findings are discussed in the context of current theories of speech perception, with particular attention to accounts that include an explanatory role for mirror neurons.     

听力言语发育异常儿童早期发现与干预的重要性分析

目的：探讨听力言语发育异常儿童的听力状况及听力言语异常对总体发育进程所产生的不同影响,以便及时发现听力言语轻微异常的早期迹象,积极医治与防御。方法选取6个月～8岁处于听力言语发育未达到正常小儿发育进程标准的56例儿童,详细了解小儿既往史、现病史、家族史、养育环境等成长过程的相关因素。对56例经临床听力学客观、主观听力测试均显示具有不同程度的听力损失特征的小儿进行听力言语评估,据不同的诱发因素指导相应的预防及医治护理措施。结果小儿听力损失左右耳各频率段听力损失程度不等同缺失的特征（听力在35～120 dB ）,时常掩盖实际真实的听力情况,难以引起重视。小儿生长发育进程中不显性的隐匿性听力、语言问题,特别是前语言阶段难以发现,致使其中16例4～8岁小儿平时对声音不能完全做出反应,语言简单、含糊不清,学习受限;20例小儿对声音无明显察知,时常以肢体语言表示所需,与同龄听力正常小儿语言发育不一致,直至2～4岁后就诊。新生儿听力筛查、复筛均未通过,且小儿听力损失程度为20～90 dB,小儿对声音时有反应,即使配助听器也时戴时不戴,虽已参与训练且无连贯性,家长认为以后还会自然发育,以致等待1．5～2岁后就诊,延迟及早形成条件化反射。结论酷似正常的听力语言问题在小儿动态发育过程中的早期阶段常是不显性的,随着年龄逐渐增长,轻微异常迹象会有所显现,对此了解并熟悉掌握小儿听力语言发育进程的时间规律,排除相关因素影响,可尽早发现听力语言偏离及时就医,缩短小儿生长发育的落差。     

Pre-linguistic children with cleft palate: Growth of gesture,vocalization, and word use

Abstract

Children with cleft lip and/or palate show early delays in speech and vocabulary development that may have an impact on later communication and social development. While delays in the complexity of babbling may put children at risk for later delays in speech and language development, there is considerable variability in development. This study focused on the rate of children's communication acts, canonical vocalizations, and word use as they made the transition from the pre-linguistic to linguistic development. The study included 15 children with non-syndromic cleft lip and/or palate who were seen at three time points between 17–34 months age. Communication rates were calculated from parent–child language samples collected during play activities. Assignment to linguistic stages was based on the children's expressive vocabulary, as reported on the MacArthur Communicative Development Inventory: Words and Sentences. From the pre-linguistic to linguistic level, the children's average rate per minute of: communicative acts overall increased significantly from 1.49 to 3.07 per minute; canonical vocalizations from 0.21 to 0.90 per minute; and word use from 0.16 to 3.61 per minute. Rates of communicative acts were associated with later word use. It appears that children with clefts rely on non-verbal communicative acts when verbal development is delayed.     

Mothers and Fathers at Play with their Children with Down Syndrome: Influence on Child Exploratory and Symbolic Activity

Background Through play children exercise their emerging mental abilities, and for their part, when in collaborative play, caregivers often adjust their behaviours to assist their children’s progress. In this study, we focused on comparisons between play of Down Syndrome (DS) children with their two parents as well as on comparisons between the two parents’ play behaviours. Method Altogether 40 parent–child dyads participated: 20 children with DS (M age = 36.14 months) with their mothers and separately with their fathers. We coded participants’ play behaviours during child solitary and mother–child and father–child collaborative sessions. Results Although children increased exploratory play from solitary to collaborative sessions with both parents, symbolic play increased only during joint play with fathers. Fathers displayed less symbolic and more exploratory activity compared to mothers. Mothers and fathers alike were attuned to their children, although fathers showed a higher degree of attunement. Conclusions This study shows that maternal and paternal contributions to DS child play skills are positive but different. During collaborative play children received specific and nonoverlapping scaffolding from their two parents, and fathers’ contributions were unique.     

Having your cake and eating it: The apparent paradox of long-term outcomes of SLI

The primary objective of this study was to determine the effectiveness of electropalatography (EPG) home training using a portable training unit (PTU) for clients with residual articulation disorders. The participants were five Japanese children with cleft lip and palate ranging in age from 8 to 13 years when they began EPG home training. These children had residual articulation disorders caused by abnormal tongue-palate contact, although four of them had received conventional speech therapy for 3 to 8 years before starting EPG training. The WinEPG system (Articulate Instruments, Edinburgh) was used to make recordings during the initial assessment and the monthly follow-up. The participants received EPG training sessions when they attended for their monthly recordings. A training programme was developed for each participant, and they were instructed to carry out their homework assignments using the PTU. After 7 to 9 months of home training, marked changes in the EPG patterns and “centre of gravity” values were observed in four of the five participants. The remaining one participant, who had not experienced speech therapy before, needed a longer period of EPG training to achieve good results. Our preliminary data suggested that EPG home training was effective in school-aged participants who had residual articulation disorders.     

Using a Mand-Model Procedure to Teach Preschool Children Initial Speech Sounds

There has not been any published research literature that focused on teaching preschool children speech sounds using the mand-model procedure. This study investigated teaching the initial /l/ speech sound within words through the natural context of a storybook. There were 4 children between the ages of 3- and 5- years. A multiple probe design was used during the research study. The mand-model procedure facilitated the acquisition and production of the targeted speech sound for 3 of the 4 children. Three of the children maintained and generalized the speech sound to an activity within the child’s inclusive preschool classroom. The first author completed this study as part of the requirement for a Master’s of Science degree in the Department of Special Education and Rehabilitation Counseling at the University of Kentucky