Assessing deaf and hearing children's communication in Brazil

In Brazil there are no specific tests for either signed or spoken language for deaf children. A protocol evaluating communicative abilities independent of modality of communication (sign language or spoken language), and comprising assessments of (a) pragmatic profile; (b) modality of communication and linguistic level; (c) complexity of communication; and (d) style and efficacy of communication between parent and child was administered to 127 deaf and hearing children. The children, aged 3-6 years old, were distributed in three groups: 20 with severe hearing loss, 40 with profound hearing loss and 67 normally hearing. Deaf children were found to be delayed, independent of their linguistic level and preferred modality of communication. The protocol in this study proved to be an useful instrument for gathering relevant information about the three groups of preschool children's communicative abilities, and particularly suitable for use in countries where standardized assessments are not available. Learning outcomes: The reader will be introduced to the use of an assessment protocol comprising its development, application and data analysis. The reader will be informed about assessment of deaf children's preferred modality of communication, by the participation of a bilingual (sign language user) professional. Communication abilities can be assessed independently of the linguistic modality. In developing countries in general, where simple and easy to administer assessments tools are scarce, such a protocol is of specific value.     

Motor–auditory–visual integration: The role of the human mirror neuron system in communication and communication disorders

The mirror neuron system (MNS) is a trimodal system composed of neuronal populations that respond to motor, visual, and auditory stimulation, such as when an action is performed, observed, heard or read about. In humans, the MNS has been identified using neuroimaging techniques (such as fMRI and mu suppression in the EEG). It reflects an integration of motor–auditory–visual information processing related to aspects of language learning including action understanding and recognition. Such integration may also form the basis for language-related constructs such as theory of mind. In this article, we review the MNS system as it relates to the cognitive development of language in typically developing children and in children at-risk for communication disorders, such as children with autism spectrum disorder (ASD) or hearing impairment. Studying MNS development in these children may help illuminate an important role of the MNS in children with communication disorders. Studies with deaf children are especially important because they offer potential insights into how the MNS is reorganized when one modality, such as audition, is deprived during early cognitive development, and this may have long-term consequences on language maturation and theory of mind abilities.Learning outcomes: Readers will be able to (1) understand the concept of mirror neurons, (2) identify cortical areas associated with the MNS in animal and human studies, (3) discuss the use of mu suppression in the EEG for measuring the MNS in humans, and (4) discuss MNS dysfunction in children with (ASD).     

Ecological aspects of auditory rehabilitation

Speech and language communication represents an important aspect of interaction between humans and their social environment. In this respect, communication can be analysed in analogy with ecological systems. A conceptual framework based on this analogy has been presented recently and is further developed in this paper. In particular, the consequences for design and accomplishment of auditory rehabilitation are discussed in relation to our own studies. The ecological model contains three levels of interpersonal interaction: signal, message and behaviour, as well as an interaction with the social and physical background. Sensory information is treated in afferent neural systems, processed in language centres and expressed via the vocal system. The communication situation is evaluated and compared with the internal reference "preferendum". The discrepancy between this internal template, a self-image and the perceived reality gives rise to a feedback signal that acts on the components of the communication process within the individual and in the environment, on the one hand, and on the preferendum, on the other. The role of language training, speaking behaviour, meta-communication, e.g. reporting lack of understanding or acknowledging understood messages, are made apparent through an application of the model to rehabilitation.     

Erkennen von Sprach- und Sprechst?rungen als Lerninhalt des Medizinstudiums

Background

Like hearing loss, language and speech disorders can also lead to impaired communication. Speech and language disorders can occur at any age, for example as a specific language impairment, stuttering, dysarthria, and aphasia. Hence, irrespective of their speciality, there is a high probability that physicians will at some point encounter communication-impaired patients, be required to classify their disorder and refer them for appropriate therapy.

Methods

A new module entitled ??communication disorders?? consisting of two teaching units was integrated in the practical course ??ENT??phoniatrics??pedaudiology?? for undergraduate clinical students in 2008. The learning objective of the first unit was to identify and classify communication disorders, presented using sound and video data, by means of simple criteria. The module was evaluated on the basis of questionnaires completed by 164?students.

Results

On a scale of 1?C7, the evaluation showed overall positive results with 6.54 (highest score) for professional competence and 5.32 (lowest score) for discussion. The overall score was 12.28 out of a possible maximum of 15?points.

Conclusion

The ability to identify communication impairments is an important medical skill. Since communication disorders are common diseases we suggest that this skill be incorporated in the medical curriculum. Thus we have introduced a module for communication disorders; its evaluation by students shows a high level of satisfaction in each category. After developing specific diagnostic indicators students were able to independently describe and identify communication disorders.     

Redefining the Survival of the Fittest: Communication Disorders in the 21st Century

Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication‐based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.     

Ethical and social implications of genetic testing for communication disorders

Advances in genetics and genomics have quickly led to clinical applications to human health which have far-reaching consequences at the individual and societal levels. These new technologies have allowed a better understanding of the genetic factors involved in a wide range of disorders. During the past decade, incredible progress has been made in the identification of genes involved in the normal process of hearing. The resulting clinical applications have presented consumers with new information and choices. Many of the same gene identification techniques are increasingly being applied to the investigation of complex disorders of speech and language. In parallel with gene identification, studies of the legal, ethical and psychosocial impacts of the clinical application of these advances and their influence on specific behaviors of individuals with communication disorders are paramount, but often lag behind. These studies will help to ensure that new technologies are introduced into clinical practice in a responsible manner. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) explain the differences between Mendelian and complex forms of inheritance and why these differences complicate the ethical impact of genetic testing, (2) explain how publicly funded genome research through the Human Genome Project, the International HapMap Project and others have examined the ethical, legal and social implications of genome research, (3) list some of the ethical complexities of prenatal, newborn and predictive testing for various genetic disorders and (4) discuss the importance of evidence-based practice to the development of public policy for the introduction and clinical use of genetic tests.     

Communication disorders in Nigerian children

BACKGROUND/AIM: Communication disorders have been acknowledged as a major public health issue because they compromise early childhood development, restrict vocational attainment and undermine the economic well being of the society. The aim of this study is to determine the pattern of communication disorders among children in a developing country and the requisite intervention services. MATERIALS AND METHODS: This prospective study was conducted in Lagos University Teaching Hospital, Lagos between January 2002 and June 2003 among children aged 6 months to 15 years that presented in the audiology clinic of the hospital with communication disorders. All the patients had neurological, otolaryngological, audiological and speech evaluations. RESULTS: A total of 184 patients were seen during the period out of whom 136 (74%) were between the ages of 6-47 months. Hearing impairment was documented in 120 (65.2%) children, speech disorders in 56 (30.4%), rhinolalia 2.2% and stuttering 2.2%. Of those with hearing impairment, 70% had delayed speech and language. Among children with speech disorders 78.6% had specific language impairment (SLI). Aetiological factors recorded for the communication disorders were seizures 10.9%, measles 8.7% meningitis 8.7%, birth asphyxia 6.5%, otitis media with effusion (OME) 4.3%, kernicterus 4.3%, congenital deformity 4.3%, ototoxicity 2.2%, cerebral palsy 2.2%, and undetermined causes 47.9%. CONCLUSION: Hearing impairment is the commonest communication disorder. Early detection and appropriate follow up is recommended for all children in their first year of life. The role of parents and caregivers in seeking early help should be strengthened while capacity building for the training of more audiologists and speech therapists should be pursued rapidly.     

Predicting language outcomes for young prelinguistic children with developmental delay.

The purpose of this study was to examine potential relationships between children's prelinguistic communication behaviors and subsequent (12 months later) expressive and receptive language outcomes. Participants included 25 toddlers with developmental delay and their mothers. The dyads were observed during natural interactions at 6-month intervals over a 12-month period for a total of 3 observation points (O1, O2, O3). Children's rate of nonverbal behavior that is often perceived as communication by adults was identified at O1 and O2. In the investigation, the children's intentional nonverbal communication acts all included coordinated attention between the communication referent and the adult. The other types of prelinguistic communication behavior, termed gestural indicating behavior and social interaction signals, were produced without coordinated attention to the adult. Receptive and expressive language test scores and spontaneous word productions were analyzed at O3 and served as outcome measures in regression analyses. Results indicated that rate of intentional nonverbal communication at O1 was a predictor of spontaneous word productions at O3. At O2, rate of intentional communication and rate of gestural indicating behavior predicted subsequent language outcomes as measured by the Sequenced Inventory of Communication Development-Revised. The results are consistent with previous findings for intentional nonverbal communication that includes coordinated attention, but additionally demonstrate that prelinguistic behavior lacking coordinated attention also bears a relationship to subsequent language outcome. Discussion of observed patterns focuses on child and adult factors that may motivate the transition from prelinguistic to early symbolic communication.     

Social cognition and language in children with specific language impairment (SLI)

This investigation examined the relationship between social pragmatics, social self-esteem, and language in children with specific language impairment (SLI) and in their age-matched peers (7-10 years). The children with SLI indicated significantly poorer social cognitive knowledge than their typically developing peers. They showed low social, but not academic self-esteem. They often used inappropriate negotiation and conflict resolution strategies. Their errors reflect some qualitative differences from those of the typically developing children (e.g., children with SLI use more nonverbal strategies, demonstrate passive/withdrawn behavior, etc.). Our data show that these children's social pragmatic deficit is not causally related to their language impairment; the two problems are co-occurring. Further, the parents and teachers of the children with SLI indicated different views regarding these children's social relations. Although the parents expressed major concerns about their children's social competence, the teachers did not notice this problem. LEARNING OUTCOMES: The reader will be able to summarize, critically analyze, and interpret the findings from existing research on social cognition and its relationship with language abilities in children with specific language impairment. Further, the reader will gain an understanding of the importance of applying intervention procedures that facilitate the use of language in different social situations, and the necessity of increasing parent-teacher communication in schools.     

What colour are the alligators? A critical look at methods used to assess communication skills in adults with learning difficulties

This paper describes the assessment of communication skills in 120 adults with severe to moderate learning difficulties. Each subject was assessed on the Communication Assessment Profile (CASP), a new communication assessment procedure for use with this client group. Qualitative and quantitative comparisons were made between three different methods of assessment used in CASP. These included observational assessment, elicited conversation and a structured language task. The relative usefulness of each method was evaluated, and the implications for communication assessment outlined.     

Communication disorders and emotional/behavioral disorders in children and adolescents

Recent research in child psychiatry has demonstrated a high prevalence of speech, language, and communication disorders in children referred to psychiatric and mental health settings for emotional and behavioral problems. Conversely, children referred to speech and language clinics for communication disorders have been found to have a high rate of diagnosable psychiatric disorders. Most of the emerging knowledge regarding relationships between communication disorders and psychiatric disorders has been presented in the child psychiatric literature. Speech-language pathologists and audiologists also need to be familiar with this information; an understanding of the complex interrelationship between communication disorders and emotional and behavioral disorders is important for diagnosis, assessment, and treatment. The purpose of this article is to review recent research and discuss clinical implications for professionals in speech-language pathology and audiology working with children and adolescents who have, or who are at risk for, developing emotional and behavioral disorders. Issues to be addressed include differential diagnosis, prevention, intervention, and the role of speech-language pathologists serving these children and adolescents.     

Chronic pediatric tracheotomy: assessment and implications for habilitation of voice, speech and language in young children

The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.     

Using case study methods to investigate the effects of interactive intervention for children with autism spectrum disorders

PURPOSE: The purpose of this multiple case study was to describe outcomes for three parents and their children following participation in a social interactive model of language intervention. More specifically, this study sought to clarify if changes in children's participation, engagement, and initiation of social interaction could be observed following an 11-week intervention. METHOD: Three preschool children with autism spectrum disorders and their mothers participated in an 11-week intervention program. The intervention taught parents to follow the children's lead, promote children's participation in routines, and model language at the children's level. Outcome measures included estimates of parents' responsive language input, and measures of children's rate of communication, number of engagements in social interaction, and initiations. RESULTS: The results indicated that all three mothers increased their responsive comments during play interactions and were rated as being more responsive on a rating scale. All three children evidenced positive outcomes in vocabulary and the number of engagements in social interaction. In addition, improvement was observed in social initiation skills for all three children. CONCLUSIONS: Increases in mothers' responsiveness and children's engagement in social interactions are consistent with the theoretical mechanisms of the social interaction model of language intervention. The results suggest that further randomized control trials of this intervention approach are warranted.     

Pediatric cochlear implantation — II: postoperative follow-up

A child with a cochlear implant is expected to achieve the successful outcome of facilitated perception of sound and more oral communication. To achieve this goal, ongoing intervention from a variety of professionals is required. These professionals may represent the disciplines of medicine, audiology, social work, education, and speech / language pathology. In India, cochlear implantation is available in only a few large cities. Here, the otolaryngologist will direct the cochlear implant program. Besides determination of medical candidacy, device implantation and medical management, the otolaryngologist is responsible to ensure that other aspects of cochlear implant management are implemented. This paper, the second of two that describe the multidisciplinary, team approach of the Pediatric Cochlear Implant Program of The Children’s Hospital of Philadelphia (CHOP), in Pennsylvania, USA, discusses the non-medical aspects of cochlear implant post-implantation follow-up. The first article, previously published, discussed cochlear implant candidacy. The various speech tests used at CHOP for assessment are based on the English language. They may be translated into the regional Indian languages where the assessment and training can be carried out accordingly.     

Spouses' understanding of the communication disabilities of aphasic patients.

The language skills of 11 aphasic patients were assessed through the use of the PICA. Spuses's understanding of the aphasic partner's language deficits was measured by rating the aphasic spouse on the Functional Communication Profile. Results indicate that spouses of aphasic patients view the patient's communication to be less impaired than it actually is. Implications for the counseling role of the speech pathologist in language therapy are discussed.     

Listeners' perceptions of speech and language disorders

Using semantic differential scales with nine trait pairs, 445 adults rated five audio-taped speech samples, one depicting an individual without a disorder and four portraying communication disorders. Statistical analyses indicated that the no disorder sample was rated higher with respect to the trait of employability than were the articulation, voice, and language disorder conditions; and higher in self-esteem than the fluency, voice, and language disorders. In addition, there were differences among the disorders. Most notably, the language disordered condition was rated significantly lower in decisiveness and reliability and higher in stress level than all other conditions. Within-subject analyses indicated that the variables of age, gender, exposure to individuals with communication disorders, and urban versus rural residency did not affect ratings. These results support previous research indicating the existence of negative stereotypes toward individuals with communication disorders. In addition, they reveal differences in how various disorders were perceived. LEARNING OUTCOMES: Participants will be able to: (1) identify the different methods investigators have used to examine perceptions toward individuals with communicative disorder, (2) recognize that there are differences in how the various communicative disorders are perceived, and (3) discuss the need for public education in order to dispel stereotypes associated with communicative disorders.     

Communication systems for the nonvocal based on frequent phoneme sequences

A new type of nonvocal communication system has been developed for people unable to produce speech because of neuromotor impairment. It is designed to be as flexible as the alphabet, while requiring significantly fewer acts of selection on the part of the user. The items in this type of system are phoneme sequences which have a high frequency of occurrence in the phoneme sequences included, the fewer the selection gestures required. A system of this type--Par le si la b-- is available for French, and one for English--SPEEC (Sequences of Phonemes for Efficient English Communication)--is being field-tested. Both systems are implemented in lapboard form and on encoded eye-gaze selection (Etran) charts (Eichler, 1975) and are potentially compatible with a variety of electronic communication devices. To the nonvocal individual with good comprehension and the ability to begin learning regular sound-letter correspondences, this approach offers an unrestricted and potentially more rapid communication mode that may allow greater opportunity to develop and exercise language than is currently afforded by the alphabet or by preselected-vocabulary systems.     

The relationship between communication problems and psychological difficulties in persons with profound acquired hearing loss

Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.     

Autism spectrum disorders in 24 children who are deaf or hard of hearing

Objectives

Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss.

Methods

Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected.

Results

The median age of diagnosis was 14 months (range 1–71) for hearing loss and 66.5 months (range 33–106) for ASD. Only 25% (n = 6) children were diagnosed with ASD ≤48 months of age and 46% by ≤6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators).

Conclusions

Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.