Perceptual and linguistic factors in the language impairment of developmental dysphasics: an experimental investigation with the token test.

Twelve developmental dysphasics and twelve control children were tested on De Renzi and Vignolo's Token Test. The performance of the dysphasics, though significantly poorer than that of the controls on Parts 2-5 of the test, seemed to follow a similar pattern. Both groups were errorless on the initial parts of the test. As the demand on auditory retention increased on subsequent parts of the test, the performance of both groups progressively deteriorated. However, the addition of grammatical complexity on Part 5, rather than causing even further deterioration in performance, actually served to improve the performance of both groups, though not significantly. Although the pattern of errors made by the two groups was similar, the quantity of errors made by the dysphasics, as compared to the normal control children, demonstrated the magnitude of the dysphasic children's receptive language impairment. Analysis of errors indicated that dysphasic children have greater difficulty with auditory retention and verbal memory than they do with the grammatical or structural complexity of language. It is suggested that the observed gross language impairment of developmentally dysphasic children does not result, at least primarily, from a specific inability to analyze the linguistic components of language. Rather, the language impairment of these children appears to reflect their primary inability to analyze the rapid stream of acoustic information which characterizes speech and is essential to normal speech perception and language development.     

The relationship between auditory temporal analysis and receptive language development: evidence from studies of developmental language disorder

The relationship between sensory, perceptual and motor abilities and receptive language abilities was studied in developmental dysphasic children. The tests administered included experimental auditory, visual and cross-modal perceptual tests. In addition, a battery of neurodevelopmental "soft sign" sensory, perceptual and motor tests were also given. Demographic and case history data were collected. Receptive language was derived based upon a battery of standardized language tests. Multivariate analyses were employed to examine the relationship between receptive language and sensory, perceptual and motor abilities. Results demonstrated that auditory perceptual variables, specifically those requiring rapid temporal analysis, were most highly correlated with the degree of receptive language deficit of the dysphasic children.     

Verbal and nonverbal semantic processing in children with developmental language impairment

In an effort to clarify whether semantic integration is impaired in verbal and nonverbal auditory domains in children with developmental language impairment (a.k.a., LI and SLI), the present study obtained behavioral and neural responses to words and environmental sounds in children with language impairment and their typically developing age-matched controls (ages 7-15 years). Event-related brain potentials (ERPs) were recorded while children performed a forced-choice matching task on semantically matching and mismatching visual-auditory, picture-word and picture-environmental sound pairs. Behavioral accuracy and reaction time measures were similar for both groups of children, with environmental sounds eliciting more accurate responses than words. In picture-environmental sound trials, behavioral performance and the brain's response to semantic incongruency (i.e., the N400 effect) of the children with language impairment were comparable to those of their typically developing peers. However, in picture-word trials, children with LI tended to be less accurate than their controls and their N400 effect was significantly delayed in latency. Thus, the children with LI demonstrated a semantic integration deficit that was somewhat specific to the verbal domain. The particular finding of a delayed N400 effect is consistent with the storage deficit hypothesis of language impairment (Kail & Leonard, 1986) suggesting weakened and/or less efficient connections within the language networks of children with LI.     

Treatment of Childhood Idiopathic Language Deterioration with Valproate

Childhood idiopathic language deterioration is a rare condition in which children lose previously gained language skills. In some children this language deterioration occurs in association with behavioral seizures or EEG epileptiform activity. The effectiveness of antiepileptic drugs in this patient population is not known. Here we retrospectively reviewed records of 57 children with childhood idiopathic language deterioration associated with seizures or epileptiform activity on their EEG who received valproate for the purpose of treating their language impairment. In 22 of the children improvement in language skills was observed. In two children language returned to normal while in the other 20 the improvement was modest. Children who responded to valproate had an earlier age of onset of the aphasia than children who were nonresponders. Seizure type, EEG findings, developmental status, and presence or absence of a frequency-modulated auditory evoked potential were not related to response. This study demonstrates that valproate can be helpful in improving language function in some children with idiopathic language deterioration associated with seizures or epileptiform activity on the EEG.     

Pathophysiologic findings in nonretarded autism and receptive developmental language disorder

In nonretarded autistic, receptive developmental language disordered, and normal subject groups, we recorded in auditory and visual target detection tasks two neurophysiological components of the event-related brain potential, Nc and P3b. Existent research shows that, in normals, Nc and P3b appear early in development, are associated with attention and memory processes, and are endogenous which means that they are triggered by internal, consciously initiated attentional and cognitive mechanisms and that they can be triggered even by the omission of sensory stimulation so long as it has meaning or importance for the subject. In this report, Nc and P3b were recorded in response to auditory and visual stimulation and to the omission of auditory and visual stimulation. Consistent with the hypothesis that non-retarded autism involves abnormal attentional and cognitive responses to important information, P3b was found to be smaller than normal and Nc was small and often absent in the nonretarded autistic group even under the condition when no auditory language or sensory processing was required. Receptive developmental language disorder has been linked with difficulties in processing sequences of auditory stimuli, and in this study P3b was found to be somewhat enlarged in this group even under the conditions when P3b was elicited by stimuli separated by 1 sec and also when P3b was elicited by the omission of stimulation.     

Therapeutic considerations with the language impaired preschool child

This paper examines the relevance of language impairment to the development of psychiatric disorders of childhood. The literature showing a relationship between language impairment and psychiatric disorders is briefly reviewed. Although deficiencies of both expressive and receptive language have been associated with psychiatric disorder, this discussion focuses on disturbances of "receptive language". Some cases are described which illustrate the connections between deficient receptive language and disturbances of development. These disturbances of development range from excessive temper tantrums, with defiant and oppositional behavior, to mannerisms, the insistence on sameness and frank autistic symptoms. These disorders are understood in a developmental context in which deficiencies of receptive language are seen to interfere with the normal unfolding of the child's developing individuation, autonomy and independence. Depending on the severity of the language disorder and the responsivity of the environment, this results in a continuum of behavioral problems with oppositional and defiant behaviour at one end, and mannerisms and autistic symptoms on the other end. The implications for therapy and long term development are discussed.     

Intellectual and language functions in children of mothers with epilepsy

PURPOSE: To compare the intellectual and language functions of children of mothers with epilepsy (CME) with that of controls matched for age and socioeconomic status. METHODS: Cases were CME, aged six years or more (n = 71), drawn from a prospective cohort in the Kerala Registry of Epilepsy and Pregnancy. Controls were 201 children of parents without epilepsy, matched for age and socioeconomic status. The outcome measures included Indian adaptation of Wechsler Intelligence Scale for children and MLT-a locally developed proficiency test for regional language. All relevant data were abstracted from the registry records. RESULTS: The Full Scale IQ and MLT scores were significantly lower for the cases (87.7 +/- 22.6 and 73.4 +/- 17.3) compared to controls (93.0 +/- 14.4 and 83.2 +/- 11.8). Compared to controls, CME scored poor on all subtests of MLT but their impairment was confined to only some of the subtests of IQ. Maternal education and maternal IQ significantly correlated with low IQ and MLT scores for CME whereas type of epilepsy, seizures during pregnancy or low birth weight did not have any significant association with these outcome measures. Polytherapy and higher dosage of antiepileptic drugs (AEDs) were associated with significant impairment in outcome measures. Infants with low developmental quotient at one year of age continued to have low scores on outcome measures at six years. CONCLUSIONS: Low maternal IQ, maternal education, and antenatal AED exposure were associated with significant impairment of intellectual and language functions for CME at six years.     

Meta-analysis of receptive and expressive language skills in autism spectrum disorder

Clinical anecdotes suggest that children with autism spectrum disorder (ASD) often show an atypical language profile in which expressive language exceeds receptive language competency. However, the few studies to directly explore this language profile have yielded inconsistent findings. This meta-analysis examined 74 studies that reported the receptive and expressive language performances of children and youth with ASD. Four potential predictors (age, language domain, source of language data, method of ASD diagnosis) were separately analyzed for their contribution to the relative receptive and expressive language impairment in ASD. Contrary to popular belief, the current meta-analyses found no evidence that an expressive advantage is common in ASD. Overall, children and youth with ASD showed equally impaired receptive and expressive language skills, both falling roughly 1.5 SD below peers with typical development. No discrepancies were found in receptive and expressive language across developmental stages, cognitive abilities, vocabulary, global language skills, caregiver report measures, clinician-administered measures, mixed method measures, or method of ASD diagnosis. Although some individual children with ASD may have an expressive-better-than-receptive language profile, this profile is not common enough to be a useful marker of ASD.     

Neurological and magnetic resonance imaging findings in children with developmental language impairment

Neurologic and radiologic findings in children with well-defined developmental language impairment have rarely been systematically assessed. Children aged 7 to 13 years with developmental language impairment or normal language (controls) underwent language, nonverbal cognitive, motor and neurological assessments, standardized assessment for subtle neurological signs, and magnetic resonance imaging. Nine children with developmental language impairment and 12 controls participated. No focal abnormalities were identified on standard neurological examination. Age and developmental language impairment were independent predictors of neurological subtle signs scores (r(2) = 0.52). Imaging abnormalities were identified in two boys with developmental language impairment and no controls (P = .17). Lesions identified were predicted neither by history nor by neurological examination. Previously unsuspected lesions were identified in almost 25% of children with developmental language impairment. Constraints regarding cooperation and sedation requirements may limit the clinical application of imaging modalities in this population.     

脑干听觉诱发电位在听阈正常的语言发育迟缓患儿中的意义

目的 探讨脑干听觉诱发电位（BAEP）在听阈正常而语言发育迟缓患儿中的变化规律及应用价值.方法 分析100例听阈正常而语言发育迟缓患儿BAEP的变化规律;按年龄分组比较两个年龄段之间各波的延长时间.结果 （1）BAEP正常10例,异常90例,BAEP表现为Ⅰ、Ⅴ波潜伏期（PL）延长,Ⅲ~Ⅴ、Ⅰ~Ⅴ波峰间期（IPL）延长;（2）随着年龄增长,Ⅴ波PL与Ⅲ~Ⅴ波IPL延长时间越长.结论 Ⅰ波、Ⅴ波延长对早期诊断听阈正常而语言发育迟缓患儿具有一定的意义,说明即使听阈正常也可能存在听觉传导通路异常,且随着年龄增加,脑干上段受损越严重.     

Outcomes at school age of preschool children with developmental language impairment

In a prospective study, preschool children diagnosed with developmental language impairment were systematically reassessed during the early school years with standardized developmental (Battelle Developmental Inventory) and functional measures (Vineland Adaptive Behavior Scale). Of an original cohort of 70 children assessed and diagnosed at a mean age of 3.6 +/- 0.7 years, 43 were reassessed at a mean age of 7.4 +/- 0.7 years. Group performance on the Battelle overall was 71.9 +/- 8.2 with the lowest sub-domain score in communication at 69.5 +/- 8.9. On the Battelle, 67% of children fell below the 1.5 standard deviation (S.D.) cutoff signifying significant developmental concerns. Between 36% (gross motor) and 83% (communication) of the cohort performed at least 1.5 S.D. below the normative mean on the individual domains of the Battelle. Seventy-four percent were impaired in two or more domains of the Battelle. The group mean on the Vineland overall was 81.1 +/- 16.9 with between 19% (socialization) to 48% (communication) of the cohort scoring more than 1.5 S.D. below the mean on each of the sub-domains. Almost half of the cohort (20/42, 48%) manifested functional impairment in at least two domains of the Vineland. Univariate and multivariate analysis of potential predictor variables identified only female sex as being predictive of significantly poorer performance on the Vineland communication sub-domain and the Vineland total score. Children with early developmental language impairment demonstrate persistent impairments in developmental and functional skills at school entry not limited to language. Deficits remain especially evident in the communication sub-domain. These results have implications with respect to later prognostication, family counseling, and devising a programmatic approach to this group of children.     

Contextual probability evaluation in autistic,receptive developmental language disorder,and control children: Event-related brain potential evidence

Compared 8- to 14-year-old children with either autism or receptive developmental language disorder (RDLD) to age- and IQ-matched normal controls in their ability to detect both frequent (p=.70) and infrequent (p=.30) randomly presented auditory stimuli under task and no-task conditions. Event-related brain potentials (ERPs), behavioral reaction times, and target detection accuracy rates were measured. Although the three groups of children performed in a similar manner on behavioral measures, only the children with autism demonstrated an abnormally small amplitude of the P3b, a component of the ERP. This result is interpreted in terms of (a) the consistency of this finding with other ERP studies involving older individuals with autism; and (b) its significance with respect to the difficulty children with autism have in modifying their expectancies to contextually relevant sequences of auditory information.Supported by NINCDS grant R01-NS26814-01 awarded to Alan Lincoln. The senior author thanks the San Diego Regional Center and the San Diego Unified School District for their continued assistance and support.     

Delayed Language Onset as a Predictor of Clinical Symptoms in Pervasive Developmental Disorders

DSM-IV states that Asperger Disorder may be distinguished from Autistic Disorder by a lack of a delay in early language development. The aim of this study was to establish whether the presence or absence of early language delay would predict autistic symptomatology in children diagnosed with a PDD/autism spectrum disorder. Forty-six language-delayed and 62 normal language onset individuals (M age 11 years) were compared on ICD-10 research criteria and DSM-IV criteria, receptive language, and developmental history variables. Retrospective data were also obtained to determine whether language onset predicted autism symptomatology when young (<6 years). We found that early language delay predicts more autistic symptomatology when young, but not at an older age. Early language delay is also associated with developmental motor milestone delays and lower receptive language abilities. The results question the use of early language delay as a valid discriminating variable between PDD subgroups.     

The influence of premorbid language skills and behavior on language recovery in children with verbal auditory agnosia

Previous studies of children with Landau-Kleffner syndrome and related language-epilepsy syndromes have focused on the relationship of seizure control to language recovery. We examined the effect of premorbid language skills and behavior, as well as some characteristics of clinical seizures and electroencephalograms, on language recovery in a retrospective study of 67 children with the severe receptive and expressive language disorder, verbal auditory agnosia. Fifty-eight percent of these children had seizures, 76% were autistic, and 24% had a history of language regression after showing previously normal language skills. The duration of language loss was not influenced by the persistence of clinical seizures. Premorbid language and behavior were more predictive of language recovery in these children. Most children with normal early language (acquired verbal auditory agnosia) had onset of language loss after age 3 years, in contrast to those with abnormal early language. Children with acquired verbal auditory agnosia were more likely to show fluctuations in language skills than those in other groups. Autistic children were more likely to begin having seizures before age 3 years, and had a longer duration of language loss and lower educational placement at time of last follow-up than those with normal behavior. This study emphasizes the importance of assessing premorbid language and behavior in predicting recovery of language skills in children with language-epilepsy syndromes.     

Relationships amongst age,language and related skills in adults with Down syndrome

Studies into the effects of ageing on language in adults with Down syndrome (DS) have tended to rely on measures that lack sensitivity to change because they fail to explore across linguistic domains or rely on proxy reports. The study aim was to use measures of receptive and expressive language from studies of younger individuals with DS in exploring relationships across linguistic and associated skills, and age in young to older adults. Fifty-five adults (aged 19–58 years), 10 with a diagnosis of or signs of early stage Alzheimer's Disease (AD), provided data on measures of functioning associated with AD, non-verbal cognition, receptive language (which provided a measure of mental age), receptive and expressive language, and short term auditory and visual memory. The first order correlation between the measure of AD and CA was significant; but not when the 10 participants with AD were removed from the analysis. Significant negative correlations were obtained between CA and all other measures; small to large significant positive correlations were found amongst the other measures. Partial correlations were conducted to remove the potential effects of AD and IQ (the latter measured by a test of non-verbal cognition). Remaining significant correlations were between auditory short term memory and all other included measures, expressive language and all other included measures, and CA and auditory short term memory and expressive language. The results indicate that deterioration with age in this cross-sectional study was accounted for largely by the presence of AD. The exceptions were for auditory short term memory and expressive language. The findings may reflect an underlying deficit in auditory short term memory for adults with DS, as has been found in previous research of children and adolescents. The implications are discussed in terms of the importance of including comprehensive measures of receptive and expressive language and the need to account for the presence of AD in studies of cognitive decline associated with ageing in DS.     

Developmental learning impairments in a rodent model of nodular heterotopia

Developmental malformations of neocortex—including microgyria, ectopias, and periventricular nodular heterotopia (PNH)—have been associated with language learning impairments in humans. Studies also show that developmental language impairments are frequently associated with deficits in processing rapid acoustic stimuli, and rodent models have linked cortical developmental disruption (microgyria, ectopia) with rapid auditory processing deficits. We sought to extend this neurodevelopmental model to evaluate the effects of embryonic (E) day 15 exposure to the anti-mitotic teratogen methylazoxymethanol acetate (MAM) on auditory processing and maze learning in rats. Extensive cortical anomalies were confirmed in MAM-treated rats post mortem. These included evidence of laminar disruption, PNH, and hippocampal dysplasia. Juvenile auditory testing (P21–42) revealed comparable silent gap detection performance for MAM-treated and control subjects, indicating normal hearing and basic auditory temporal processing in MAM subjects. Juvenile testing on a more complex two-tone oddball task, however, revealed a significant impairment in MAM-treated as compared to control subjects. Post hoc analysis also revealed a significant effect of PNH severity for MAM subjects, with more severe disruption associated with greater processing impairments. In adulthood (P60–100), only MAM subjects with the most severe PNH condition showed deficits in oddball two-tone processing as compared to controls. However, when presented with a more complex and novel FM sweep detection task, all MAM subjects showed significant processing deficits as compared to controls. Moreover, post hoc analysis revealed a significant effect of PNH severity on FM sweep processing. Water Maze testing results also showed a significant impairment for spatial but not non-spatial learning in MAM rats as compared to controls. Results lend further support to the notions that: (1) generalized cortical developmental disruption (stemming from injury, genetic or teratogenic insults) leads to auditory processing deficits, which in turn have been suggested to play a causal role in language impairment; (2) severity of cortical disruption is related to the severity of processing impairments; (3) juvenile auditory processing deficits appear to ameliorate with maturation, but can still be elicited in adulthood using increasingly complex acoustic stimuli; and (4) malformations induced with MAM are also associated with generalized spatial learning deficits. These cumulative findings contribute to our understanding of the behavioral consequences of cortical developmental pathology, which may in turn elucidate mechanisms contributing to developmental language learning impairment in humans.     

Categorization skills and receptive language development in autistic children

The category knowledge and receptive language skills of 16 autistic, mentally retarded, and normal children were assessed. The autistic children's knowledge of function, form, and color categories was comparable to that of the mental-age-matched mentally retarded and normal comparison groups. Category knowledge and receptive language were more closely associated for mentally retarded and normal children than for autistic children. The findings indicate that category knowledge is not sufficient for the development of receptive language in autistic children.     

Delayed magnetic mismatch negativity field, but not auditory M100 response, in specific language impairment

Recent studies show that electrophysiological markers of auditory processing such as the cortical 100 ms response (M100) and the mismatch field, derived from magnetoencephalography, might be used to identify children with autism spectrum disorders--M100 peak latency--and to stratify children with autism according to the degree of language impairment--mismatch field peak latency. The present study examined the latency of right superior temporal gyrus M100 and mismatch field in a cohort of children and young adolescents with specific language impairment (n=17), in comparison with age-matched and nonverbal intelligence quotient-matched typically developing controls (n=21). Neither group showed symptoms associated with autism. Although M100 latency (reflecting early auditory processing) did not distinguish controls from children with specific language impairment, the later 'change detection' mismatch field response was significantly delayed (by >50 ms) in the specific language impairment group. Linear discriminant analysis confirmed the role of mismatch field latency (92%) but not M100 latency (8%) in distinguishing groups. The present results lend support to the claim that a delayed M100 is specific to autism spectrum disorders (with relative independence of degree of language impairment) and that a delayed mismatch field reflects an abnormality more generally associated with language impairment, suggesting that mismatch field delay in the present specific language impairment group and previously reported in autistic children with language impairment may be indicative of a common neural system dysfunction.     

Binaural interaction in specific language impairment: an auditory evoked potential study

The aim of the study was to examine whether auditory binaural interaction, defined as any difference between binaurally evoked responses and the sum of monaurally evoked responses, which is thought to index functions involved in the localization and detection of signals in background noise, is atypical in a group of children with specific language impairment (SLI). Binaural interaction components (BICs) in the brainstem were compared in 19 children with SLI (13 males, six females; age range 7y 4mo-11y 10mo; mean age 9y 7mo [SD 1y 2mo]), and 31 comparison children with typical language development (16 males, 15 females; age range 7y 1mo-11y 4mo; mean age 9y 7mo [SD 1y 5mo]). Children with SLI had a significantly smaller BIC amplitude than the comparison group. However, no clear relationship was found between BIC measures and severity of language impairment. We conclude that, for some children, SLI may be associated with reduced binaural interaction which may hinder the detection or localization of speech sounds from noisy contexts during critical periods of language acquisition.     

Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting

This prospective, longitudinal, study charted the developmental profiles of young children with Autism Spectrum Disorders (ASD) identified through routine developmental surveillance. 109 children with Autistic Disorder (AD), 'broader' ASD, and developmental and/or language delays (DD/LD) were assessed using the Mullen Scales of Early Learning (MSEL) at 12-months (n?=?10 assessments), 18-months (n?=?45 assessments), and 24-months (n?=?99 assessments). The children with AD performed most poorly, overall, than the ASD and DD/LD groups on the MSEL. Furthermore, the children with AD/ASD displayed an uneven cognitive profile, with poorer performance on verbal (particularly receptive language) relative to nonverbal skills. There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum, especially those with AD. Given that the poor receptive, relative to expressive, language profile emerges very early in life for children with AD/ASD, this cognitive profile may serve as an additional red flag to social attention and communication deficits. Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life.