Prelinguistic communication development in children with childhood apraxia of speech: a retrospective analysis

In a retrospective study of prelinguistic communication development, clinically referred preschool children (n = 9) aged 3-4 years, who as infants had failed a community-based screening program, were evaluated for features of childhood apraxia of speech (CAS). Four children showed no features and either delayed or normal language, five had from three-to-seven CAS features and all exhibited delayed language. These children were matched by age with 21 children with typically-developing (TD) speech and language skills. Case-control comparisons of retrospective data from 9 months of age for two participants with more severe features of CAS at preschool age showed a dissociated pattern with low expressive quotients on the Receptive-Expressive Emergent Language Assessment-Second Edition (REEL-2) and records of infrequent babbling, but normal receptive quotients. However, other profiles were observed. Two children with milder CAS features showed poor receptive and expressive development similar to other clinically referred children with no CAS features, and one child with severe CAS features showed poor receptive but normal expressive developmental milestones at 9 months and records of frequent babbling. Results suggest some but not all children with features of suspected CAS have a selective deficit originating within speech motor development.     

Do Object and Gesture Imitation Skills Represent Independent Dimensions in Autism?

Children with autism exhibit significant deficits in imitation. Previous research has suggested that object and gesture imitation are independent in autism, and that object imitation may be related to play skills, while gesture imitation may be related to expressive language. However, this finding has not been replicated in the literature. This study examined the concurrent relationship between imitation and language and play in 27 young children with autism. After controlling for developmental age, total imitation was related to child expressive vocabulary. Object imitation had a unique relationship with symbolic play; however, gesture imitation was not uniquely correlated with language. Object and gesture imitation skills were highly correlated, questioning the true independence of these skills in children with autism. Different types of imitation skills in children with autism may be better described as involving a general imitative capacity along with other more specific skills.     

Speech and language delay in children

Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to parental concerns and to whether children are meeting expected developmental milestones, there currently is insufficient evidence to recommend for or against routine use of formal screening instruments in primary care to detect speech and language delay. In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of primary speech and language delay include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and language delays are attributable to another condition such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems, or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. There is good evidence that speech-language therapy is helpful, particularly for children with expressive language disorder.     

Comparing Selective Eaters with and Without Developmental Disabilities

Food selectivity has been a problem identified in children with and without disabilities. This study examined 178 children referred to a feeding program for the evaluation and treatment of food selectivity. This sample was divided into three groups; children with autism spectrum disorders, children with special needs without autism, and children without special needs. Children with autism spectrum disorders insisted on using the same utensil or dish and insisted on having food prepared in a certain way significantly more often than other children. Children with special needs had significantly more problems with spitting out food as well as oral motor delays than other children. Children without special needs had significantly more problems with anxiety or obsessive-compulsive behaviors than other children. Most caregivers reported their child’s feeding problems started prior to 18 months of age and persisted longer than 24 months, which is inconsistent with the hypothesis that food selectivity, at least for some children, is not a transient phase.     

Influence of IQ and Age in Childhood Autism: Lack of Support for DSM-IV Asperger's Disorder

Children with clinical diagnoses of autism or Asperger's disorder who had normal (n = 47) versus below normal (n = 110) intelligence were compared on several variables, including frequency and types of autistic symptoms, discrepancy between nonverbal and verbal IQs, and degree of incoordination, anxiety, and depression. Children with low versus high IQs had more autistic symptoms overall and a greater percentage of social problems. However, when the effects of IQ and age (and, therefore, mental age) were statistically removed, these differences were no longer significant. This finding does not support the DSM-IV's use of normal cognition as one criterion for creating two distinct diagnostic subgroups (Asperger's disorder and autistic disorder) because differences between children with normal versus below normal cognition can be explained simply by differences in IQ and age (as opposed to some intrinsic differenence related to autism).     

Preschool children’s communication,motor and social development: Parents’ and educators’ concerns

Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing.

Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n?=?275), receptive vocabulary (n?=?131) and language (n?=?274).

Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.     

Diagnostic,Demographic, and Neurocognitive Correlates of Dysgraphia in Students with ADHD,Autism, Learning Disabilities,and Neurotypical Development

The importance of diagnostic, demographic, and neurocognitive correlates of dysgraphia in 1006 students 6–16 years was determined. Children with ADHD or autism (n?=?831) and neurotypical children (n?=?175) were administered the Developmental Test of Visual-Motor Integration (VMI), Wechsler subscales, and reading and math tests. IQ was the strongest correlate of dysgraphia (VMI scores), followed by diagnosis (ADHD/autism vs. neurotypical). Visual-fine motor ability was the only other significant correlate. Verbal and visual reasoning ability, processing speed, working memory, attention, reading, and math did not contribute significantly more to concurrently predicting dysgraphia, nor did age, sex, race, and parent occupation. Dysgraphia was common in children with ADHD (56%) and autism (56%), especially those with a learning disability in reading (71%) or math (72%). The study demonstrates the importance of controlling for both IQ and diagnosis when examining factors related to dysgraphia, which previous studies have not done. Students with ADHD, autism, learning disability, or fine motor problems should be evaluated for dysgraphia because the majority of students with any one of these problems will have impaired handwriting, which needs to be identified and addressed in school. Effective accommodations to compensate for dysgraphia are available to help avoid its negative repercussions.     

Retrospective video analysis of the early speech sound development of infants and toddlers later diagnosed with lateralisation errors

Abstract

Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to compare the early (birth–24 months) speech sound development between children later diagnosed with LEs and typically developing children.

Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants’ parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.

Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which [s] or [z] emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including [s, z]), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7–12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.

Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.     

The impact of art therapy on the intelligibility of speech in children with cerebral palsy

Background. Children with cerebral palsy (CP) frequently have dysarthria, which reduces the intelligibility of their speech and can seriously impede their psycho-social adjustment. Traditional "bottom-up" rehabilitation oriented directly on the articulatory apparatus is not always successful in helping these children to speak intelligibly. The authors have developed a program of art therapy with elements of logopedic therapy to model and stimulate perception and expression, including linguistic performance, which has proven in clinical to be a helpful "top-down" approach to helping these children to speak more early.
Material and methods. Out of the population of CP children treated in the Cracow Rehabilitation Center's Art Therapy Workshop in the period 1994-2001, we identified 14 children, 9 boys and 5 girls, average age 15,3, who showed severe dysarthria at admission without other language or cognitive disturbances. Our retrospective study was based on recorder results from the Auditory Dysarthria Scale and standard neuropsychological tests for fluency of speech, administered routinely once each month during the 4-month art therapy program.
Results. All the children in the study group showed some degree of improvement after art therapy in all tested parameters. On the Auditory Dysarthria Scale, the largest improvements were noted in overall intelligibility (p < 0,0001); less improvement, though still statistically significant (p < 0,001) took place in respect to volume, tempo, and control of pauses. The least improvement was noted in the pronunciation of vowels and consonants (the most purely motor of the measured parameters). All the children also exhibited significant improvement in fluency of speech.
Conclusions. Art therapy with elements of logopedic therapy improves the ability of children with cerebral palsy to engage in purposeful behavior, including speech and language functions, especially intelligibility.     

The Relationship Between Symptoms and Abilities in Autism

We assessed if autism symptoms relate to ability deficits and achievement discrepancies in 29 children aged 4–13 years with a diagnosis of Autistic Disorder. Symptoms, intelligence, language, motor coordination and social cognition were assessed. Children with autism underachieve on all ability measures. There were significant achievement discrepancies between Performance IQ and theory of mind, fine and gross motor coordination. The most common discrepancy was between Performance IQ scores and motor coordination scores, which was observed in 86% of children. Early developmental abnormalities related to most abilities, social interaction symptoms related to motor coordination and receptive language, and symptoms related to discrepancies between PIQ and social cognitive abilities.     

Consonant and syllable complexity of toddlers with Down syndrome and mixed-aetiology developmental delays

Abstract

This study examines whether speech sound production of toddlers with Down syndrome (DS) is on par with or more severely impaired than that of mental age (MA) peers with developmental delay due to aetiologies other than Down syndrome at two points within an 18-month period near the onset of spoken word production. The utterances of 26 children with DS, aged 24–33 months, with a mean MA of 14.3 months, originally studied by Fey et al. and Warren et al. were compared to those of a group of 22 children with similar intellectual and communication delay but no DS (NDS). Phonological measures included the size of the consonant inventory, syllable shape complexity, and number of communication acts with canonical vocalizations. At Time 1, the DS group performed as well as or better than the NDS group on these measures of speech production. At Time 2, 18 months later, the DS group was behind the NDS group on the same measures. Results extended the pattern of more severe impairment in children with DS than NDS peers commonly noted in expressive language to measures of phonological development.     

ICF-CY based assessment tool for children with autism

Purpose: The objectives of this study was to develop an International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) based questionnaire for children with autism, investigate the inter-rater reliability of the questionnaire and assess functional performance in children with autism. Method: The ICF-CY based questionnaire for children with autism comprised 118 items was designed with reference the ICF-CY structure. The study protocol was divided into two parts. In the first part, the inter-rater reliability of the questionnaire was investigated using information from 26 children (aged 3–6 years) with autism and using the intra-class correlation coefficients to estimate reliability. The second part of the study aimed to assess functional performance of another independent sample (136 children, aged 3–6 years) utilizing the questionnaire. Mean scores were compared by nonparametric statistic. Results: The inter-rater reliability for each domains of the questionnaire was found to be moderate to high (intra-class correlation coefficients ranged from 0.72 to 0.97). Children with autism had major problems in voice and speech functions. They had high dependency when executing individual activities of learning and applied knowledge. They also required maximal assistance while engaging in social activities related to conversation and major life categories. Conclusions: This preliminary study shows that ICF-CY based questionnaire has good reliability and can reflect the functional profile of preschool children with autism. However, further study is needed to confirm other psychometric characteristics.

Implications for Rehabilitation

• The ICF-CY provides a comprehensive overview of functioning and constitutes a universal language for interdisciplinary work with children.

• Children with autism had major problems in voice and speech functions.

• The questionnaire is suitable for use in evaluating a heterogeneous group of children with autism.

     

Assessing children referred to speech and language therapy: Static and dynamic assessment of receptive vocabulary

Dynamic assessment (DA) has been proposed as an alternative or complementary means for assessing children's language development. This study investigates the use of a DA methodology alongside a static assessment in order to obtain information on the receptive vocabulary skills of young children with suspected language impairments. A DA procedure was piloted with a group of 14 children for whom there were no concerns about speech and language development and 40 children who had been referred to speech and language therapy (age 3;05 to 5 years). Twelve of the referred children had English as an additional language (EAL) and 28 were monolingual English. The static assessment from which the DA was developed was the British Picture Vocabulary Scales. The DA incorporated measures of children's ability to match a word to a referent and to retain the words for expressive and receptive purposes. Results indicated that monolingual children and those with EAL had comparable DA scores even though their static vocabulary scores were significantly different. Children with normally developing language and children referred to speech and language therapy performed significantly differently on these dynamic measures. In addition, there was greater variability in performance on the dynamic measures within the delayed language group than in the language normal group. The DA appears to capture additional information above and beyond that captured by the BPVS especially in the group of children with the lowest language skills.     

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.     

多导人工耳蜗植入术及听觉语言康复效果分析43例

目的总结43例多导人工耳蜗植入术围手术期的处理经验和听觉语言康复效果。方法介绍在多导人工耳蜗植入术围手术期的处理方法,分析比较语前聋与语后聋;学龄前聋儿与学龄聋儿人工耳蜗植入后的听觉语言康复效果。结果43例人工耳蜗植入术后通过1个月以上的调试和听觉训练,声场测听全部达到正常范围。语前聋儿童中,测定13例学龄前的可合作儿童的限定词表言语测听,言语识别率平均达到90%,非限定词表识别率平均达87%。测定9例7岁以上合作儿童的限定词表言语识别率平均达到82%,非限定词表言语识别率平均达78%,与学龄前组比较差异有显著意义。语后聋者经过一两个月的适应,全部能正常方式对话和打电话。结论人工耳蜗植入是治疗全聋患者的最佳选择。对语前聋患者而言,植入年龄最好在7岁前。人工耳蜗植入后,听觉语言康复工作将是一项长期的工作,需要家庭、社会、医生和聋康老师的共同努力。     

Variables Associated with Anxiety and Depression in Children with Autism

Mothers of 627 children with autism (ages 1–17, IQs 16–146) completed the Pediatric Behavior Scale. Maternal ratings of anxiety and depression increased with age and IQ, but were unrelated to gender, parent occupation, and race. Anxiety and depression were highly correlated with each other and with autism severity, somatic complaints, mood disturbance, and social problems. Remaining correlations with behavior problems, attention deficit, hyperactivity, and sleep problems were small. The strongest combined predictors of anxiety and depression were autism severity, verbal IQ, and age, explaining 25% and 23% of the variance. Findings suggest that anxiety and depression have a direct link with autism (increasing with autism severity) and a developmental component (increasing with age and IQ). Anxiety is present in most children with autism and depression is present in about half. Therefore, all children with autism should be screened for anxiety and depression and treated if indicated. Controlled studies are needed to determine what interventions are effective in reducing anxiety and depression in autism.     

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。     

Development of handwriting skill in children with unilateral cerebral palsy (CP)

Aim.?To investigate the development of handwriting, fine motor skills and school marks in children with unilateral cerebral palsy (CP) and relate the performance in handwriting skill to age and IQ at a 16-month follow-up.

Method.?Data from 16 children (5 females, 11 males; mean age 11 years 4 months, SD 1 year 6 months, range 8–13 years) with left-sided hemiplegia were collected. The Minnesota Handwriting Assessment (MHA) for handwriting skill, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) for fine motor skills, the Wechsler Intelligence Scale for Children Revised (WISC-R) for IQ, the Manual Ability Classification System (MACS) and school marks of children were used.

Results.?Handwriting quality, handwriting speed and fine motor skills improved over 16 months but the children with unilateral CP still performed below their peers. School marks did not change. The regression model (Adj. R² == 0.76) revealed that age and IQ were negatively correlated and good predictors for the improvement in handwriting quality. No relationship was found between handwriting speed and age or IQ.

Conclusion.?Children with unilateral CP continued to develop handwriting skill over a longer time period than expected. Age and IQ predicted the rate of development in handwriting quality. Children kept up school marks despite the increasing demands of the succeeding grade.     

Scalp acupuncture effect on language development in children with autism: a pilot study

BACKGROUND AND OBJECTIVES: Autism is a neurodevelopmental disorder that manifests in delays in social interaction, language used in social communication, and symbolic or imaginative play, with an onset prior to age 3 years. Language therapy (LT) for children with autism is the main form of rehabilitation, because it emphasizes its major presenting symptom (i.e., language impairment). Scalp acupuncture (scalp AP) is a modality based on the physiologic function of different brain areas, where different scalp zones are stimulated with needles so as to stimulate the reflexively related nervous tissue. This study aimed to evaluate the role of scalp AP as a complementary modality to LT in rehabilitation of children with autism. SUBJECTS AND DESIGN: The study involved 20 children (divided into 2 equal groups: A and B), diagnosed as autistic according to DSM IV classification. Their ages ranged between 4 and 7 years old. All subjects underwent LT twice weekly, aiming at stimulation of cognitive and verbal abilities. Group B only was subjected to scalp AP sessions--twice weekly--as a rehabilitation complementary tool during the 9-month period of the study. The acupoints used were: Du 20, 26, GV17; three temple needles; and Yamamoto's New Scalp Acupuncture cerebrum and aphasia points (acupuncture needles 0.3 x 30 mm). A language test was performed before and after therapy to monitor cognition and expression (an Arabic test was included). RESULTS: Both groups, whose mean age range was 5.5 years+/-1.22 years, showed a significant improvement in cognitive and expressive language skills pre- and post-therapy, which was highly significant among group B children treated with scalp AP (attention 2.8+/-0.8 in group A versus 3.5+/-0.8 in group B; receptive semantics were 7+/-3.8 in group A versus 9.4+/-3.1 in group B). Expressive semantics significantly improved in both groups. CONCLUSIONS: Scalp AP is a safe complementary modality when combined with LT and has a significantly positive effect on language development in children with autism.     

Expressive and receptive language skills in preschool children from a socially disadvantaged area

Purpose: Evidence suggests that children present with receptive language skills that are equivalent to or more advanced than expressive language skills. This profile holds true for typical and delayed language development. This study aimed to determine if such a profile existed for preschool children from an area of social deprivation and to investigate if particular language skills influence any differences found between expressive and receptive skills.

Method: Data from 187 CELF P2 UK assessments conducted on preschool children from two socially disadvantaged areas in a city in southern Ireland.

Result: A significant difference was found between Receptive Language Index (RLI) and Expressive Language Index (ELI) scores with Receptive scores found to be lower than Expressive scores. The majority (78.6%) of participants had a lower Receptive Language than Expressive score (RLI < ELI), 18.2% of participants had a higher Receptive score than score (RLI > ELI), with very few (3.2%) having the same Receptive and Expressive scores (RLI = ELI). Scores for the Concepts and Following Directions (receptive) sub-test were significantly lower than for the other receptive sub tests, while scores for the Expressive Vocabulary sub-test were significantly higher than for the other expressive sub tests.

Conclusion: The finding of more advanced expressive than receptive language skills in socially deprived preschool children is previously unreported and clinically relevant for speech-language pathologists in identifying the needs of this population.