Auditory training for children with auditory processing disorder and language impairment: a response to Bellis, Chermak, Weihing, and Musiek

PURPOSE: We respond to Bellis, Chermak, Weihing, and Musiek's (2012) criticisms of the evidence-based systematic review of Fey et al. (2011) on the effects of auditory training on auditory, spoken, and written language performance of children with auditory processing disorder or language impairment. In general, we argue that the conceptualizations and methods on which our review was based were well motivated, and that our original conclusions are valid given the limited evidence that is currently available from clinical studies of auditory training with school-age children with auditory processing disorder or language impairment.     

Dimensions of early speech sound disorders: A factor analytic study

The goal of this study was to classify children with speech sound disorders (SSD) empirically, using factor analytic techniques. Participants were 3-7-year olds enrolled in speech/language therapy (N = 185). Factor analysis of an extensive battery of speech and language measures provided support for two distinct factors, representing the skill dimensions of articulation/phonology and semantic/syntactic skills. To validate these factors, 38 of the children were followed to school age to re-evaluate speech and language skills and assess reading/spelling achievement. The validity of the two factors was supported by their differential associations with school-age reading and spelling achievement, persistence of SSD, and affection status in family members. A closer relationship of the family member to the proband and male gender predicted higher odds of a disorder. The findings suggest that articulation/phonology and language abilities are at least partially independent in children with SSD and that these constructs have distinct clinical and biological correlates. LEARNING OUTCOMES: The reader will develop knowledge about subtypes of speech sound disorders, understand the relationship between early speech sound disorders and later reading and spelling difficulties, and obtain information concerning familial transmission of speech sound disorders.     

Fast mapping semantic features: Performance of adults with normal language,history of disorders of spoken and written language,and attention deficit hyperactivity disorder on a word-learning task

PurposeThis study was designed to test the word learning abilities of adults with typical language abilities, those with a history of disorders of spoken or written language (hDSWL), and hDSWL plus attention deficit hyperactivity disorder (+ADHD).MethodsSixty-eight adults were required to associate a novel object with a novel label, and then recognize semantic features of the object and phonological features of the label. Participants were tested for overt ability (accuracy) and covert processing (reaction time).ResultsThe +ADHD group was less accurate at mapping semantic features and slower to respond to lexical labels than both other groups. Different factors correlated with word learning performance for each group.ConclusionsAdults with language and attention deficits are more impaired at word learning than adults with language deficits only. Despite behavioral profiles like typical peers, adults with hDSWL may use different processing strategies than their peers.Learning Outcomes: Readers will be able to: (1) recognize the influence of a dual disability (hDSWL and ADHD) on word learning outcomes; (2) identify factors that may contribute to word learning in adults in terms of (a) the nature of the words to be learned and (b) the language processing of the learner.     

日本听障儿童“9岁界限”现象对我国听障儿童随班就读教育的启示

本文介绍了日本听障儿童“9岁界限”现象的历史背景、理论基础、成因及其对我国听障儿童随班就读教育的启示。针对口语和书面语的差异问题，笔者建议帮助听障儿童掌握丰富且正确的口语，为书面语打好基础；提高听障儿童的认知能力，有针对性地加强逻辑思维训练，从而胜任以书面语为主的学校教育。     

Spoken and written language relationships in language/learning-impaired and normally achieving school-age children.

Students with language/learning impairment (LLI) and three groups of normally achieving children matched for chronological age, spoken language, and reading abilities wrote and told stories that were analyzed according to a three-dimensional language analysis system. Spoken narratives were linguistically superior to written narratives in many respects. The content of written narratives, however, was organized differently than the content of spoken narratives. Spoken narratives contained more local interconnections than global interconnections; the opposite was true for written narratives. LLI and reading-matched children evidenced speaking-writing relationships that differed from those of the age- and language-matched children in the way language form was organized. Further, LLI children produced more grammatically unacceptable complex T-units in their spoken and written stories than students from any of the three matched groups. The discussion focuses on mechanisms underlying the development of speaking-writing differences and ramifications of spoken-language impairment for spoken and written-language relationships.     

Verb and noun morphology in the spoken and written language of children with language learning disabilities.

The purpose of this study was to investigate the use of verb and noun morphology in school-age children's spoken and written language. Sixty children, with and without language learning disabilities (LLD), each produced 2 spoken and 2 written language samples. The children's accuracy in using morphemes that mark verb finiteness (regular past tense, 3rd person singular present tense, copula, and auxiliary BE) was compared with their accuracy in using noun morphology (regular plural, possessive, articles). As would be expected, the typically achieving children, who were aged 7 to 12 years, had mastered the verb and noun morphology in spoken and written samples. The children with LLD, aged 10 to 12 years, also showed high accuracy in the spoken samples. On the other hand, they showed substantial difficulty in the written samples with the regular past tense, with errors in 26% of obligatory contexts. However, the children with LLD also had difficulty with the regular plural, with errors in 12% of obligatory contexts. For both the regular past tense and plural, all errors were errors of omission. These results indicate that finiteness marking remains an area of relative difficulty, but perhaps not the only grammatical difficulty, for children with language impairments in the school years.     

NON-SYNDROMIC HEARING LOSS AND HIGH-THROUGHPUT STRATEGIES TO DECIPHER ITS GENETIC HETEROGENEITY

Hearing loss (HL) is the most common sensory disorder, affecting all age groups, ethnicities, and gen-ders. According to World Health Organization (WHO) estimates in 2005, 278 million people worldwide have moderate to profound HL in both ears. Results of the 2002 National Health Interview Survey indicate that nearly 31 million of all non-institutionalized adults (aged 18 and over) in the United States have trouble hearing. Epidemiological studies have estimated that approximately 50%of profound HL can be attributed to genetic causes. With over 60 genes implicated in nonsyndromic hearing loss, it is also an extremely het-erogeneous trait. Recent progress in identifying genes responsible for hearing loss enables otolaryngologists and other clinicians to apply molecular diagnosis by genetic testing. The advent of the $1000 genome has the potential to revolutionize the identification of genes and their mutations underlying genetic disorders. This is especially true for extremely heterogeneous Mendelian conditions such as deafness, where the muta-tion, and indeed the gene, may be private. The recent technological advances in target-enrichment methods and next generation sequencing offer a unique opportunity to break through the barriers of limitations im-posed by gene arrays. These approaches now allow for the complete analysis of all known deafness-causing genes and will result in a new wave of discoveries of the remaining genes for Mendelian disorders. This re-view focuses on describing genotype-phenotype correlations of the most frequent genes including GJB2, which is responsible for more than half of cases, followed by other common genes and on discussing the im-pact of genomic advances for comprehensive genetic testing and gene discovery in hereditary hearing loss.     

Toward diagnostic and phenotype markers for genetically transmitted speech delay.

Converging evidence supports the hypothesis that the most common subtype of childhood speech sound disorder (SSD) of currently unknown origin is genetically transmitted. We report the first findings toward a set of diagnostic markers to differentiate this proposed etiological subtype (provisionally termed speech delay-genetic) from other proposed subtypes of SSD of unknown origin. Conversational speech samples from 72 preschool children with speech delay of unknown origin from 3 research centers were selected from an audio archive. Participants differed on the number of biological, nuclear family members (0 or 2+) classified as positive for current and/or prior speech-language disorder. Although participants in the 2 groups were found to have similar speech competence, as indexed by their Percentage of Consonants Correct scores, their speech error patterns differed significantly in 3 ways. Compared with children who may have reduced genetic load for speech delay (no affected nuclear family members), children with possibly higher genetic load (2+ affected members) had (a) a significantly higher proportion of relative omission errors on the Late-8 consonants; (b) a significantly lower proportion of relative distortion errors on these consonants, particularly on the sibilant fricatives /s/, /z/, and //; and (c) a significantly lower proportion of backed /s/ distortions, as assessed by both perceptual and acoustic methods. Machine learning routines identified a 3-part classification rule that included differential weightings of these variables. The classification rule had diagnostic accuracy value of 0.83 (95% confidence limits = 0.74-0.92), with positive and negative likelihood ratios of 9.6 (95% confidence limits = 3.1-29.9) and 0.40 (95% confidence limits = 0.24-0.68), respectively. The diagnostic accuracy findings are viewed as promising. The error pattern for this proposed subtype of SSD is viewed as consistent with the cognitive-linguistic processing deficits that have been reported for genetically transmitted verbal disorders.     

Sensitivity to structure in the speech signal by children with speech sound disorder and reading disability

PurposeChildren with speech sound disorder (SSD) and reading disability (RD) have poor phonological awareness, a problem believed to arise largely from deficits in processing the sensory information in speech, specifically individual acoustic cues. However, such cues are details of acoustic structure. Recent theories suggest that listeners also need to be able to integrate those details to perceive linguistically relevant form. This study examined abilities of children with SSD, RD, and SSD + RD not only to process acoustic cues but also to recover linguistically relevant form from the speech signal.MethodTen- to 11-year-olds with SSD (n = 17), RD (n = 16), SSD + RD (n = 17), and Controls (n = 16) were tested to examine their sensitivity to (1) voice onset times (VOT); (2) spectral structure in fricative-vowel syllables; and (3) vocoded sentences.ResultsChildren in all groups performed similarly with VOT stimuli, but children with disorders showed delays on other tasks, although the specifics of their performance varied.ConclusionChildren with poor phonemic awareness not only lack sensitivity to acoustic details, but are also less able to recover linguistically relevant forms. This is contrary to one of the main current theories of the relation between spoken and written language development.Learning outcomes: Readers will be able to (1) understand the role speech perception plays in phonological awareness, (2) distinguish between segmental and global structure analysis of speech perception, (3) describe differences and similarities in speech perception among children with speech sound disorder and/or reading disability, and (4) recognize the importance of broadening clinical interventions to focus on recognizing structure at all levels of speech analysis.     

The human lexinome: genes of language and reading

Within the human genome, genetic mapping studies have identified 10 regions of different chromosomes, known as DYX loci, in genetic linkage with dyslexia, and two, known as SLI loci, in genetic linkage with Specific Language Impairment (SLI). Further genetic studies have identified four dyslexia genes within the DYX loci: DYX1C1 on 15q, KIAA0319 and DCDC2 on 6p22, and ROBO1 on 13q. FOXP2 on 7q has been implicated in the development of Speech-Language Disorder. No genes for Specific Language Impairment have yet been identified within the two SLI loci. Functional studies have shown that all four dyslexia genes play roles in brain development, and ongoing molecular studies are attempting to elucidate how these genes exert their effects at a subcellular level. Taken together, these genes and loci likely represent only a fraction of the human lexinome, a term we introduce here to refer to the collection of all the genetic and protein elements involved in the development of human language, expression, and reading. LEARNING OUTCOMES: The reader will become familiar with (i) methods for identifying genes for complex diseases, (ii) the application of these methods in the elucidation of genes underlying disorders of language and reading, and (iii) the cellular pathways through which polymorphisms in these genes may contribute to the development of the disorders.     

Diagnostik und Differenzierung sprachentwicklungsgestörter Kinder?

BACKGROUND: Specific language impairment (SLI) is defined as a developmental disorder in which language comprehension and the child's ability to use expressive spoken language is markedly below the appropriate level for his or her mental age. The intelligence of SLI children is in the normal range, while their language abilities are impaired. "Normal intelligence", the defining feature of SLI is questioned in this study. PATIENTS AND METHODS: Using IDIS (an inventory of diagnostic information in language impairment), we examined 138 children aged 5 and 6 years with severe language impairment; 108 SLI and 30 LI children. Various indicators of speech and language such as articulation, the ability to discriminate sounds, lexicon, grammar and pragmatic abilities but also auditory and visual perception, auditory and visual memory, fine and gross motor function were assessed. RESULTS: The performance of the SLI children was significantly higher in most of the tests than that of the LI children. Factor analysis showed that the two groups also differed in the structure of performance. Auditory short-term memory was reduced in most children irrespective of intelligence. CONCLUSIONS: We propose the retention of the differentiation of subgroups of developmental speech and language disorders depending on the level of intelligence.     

Speech perception and spoken word recognition: past and present

OBJECTIVE: The scientific study of the perception of spoken language has been an exciting, prolific, and productive area of research for more than 50 yr. We have learned much about infants' and adults' remarkable capacities for perceiving and understanding the sounds of their language, as evidenced by our increasingly sophisticated theories of acquisition, process, and representation. We present a selective, but we hope, representative review of the past half century of research on speech perception, paying particular attention to the historical and theoretical contexts within which this research was conducted. Our foci in this review fall on three principle topics: early work on the discrimination and categorization of speech sounds, more recent efforts to understand the processes and representations that subserve spoken word recognition, and research on how infants acquire the capacity to perceive their native language. Our intent is to provide the reader a sense of the progress our field has experienced over the last half century in understanding the human's extraordinary capacity for the perception of spoken language.     

Hearing speech sounds: top-down influences on the interface between audition and speech perception

This paper focuses on the cognitive and neural mechanisms of speech perception: the rapid, and highly automatic processes by which complex time-varying speech signals are perceived as sequences of meaningful linguistic units. We will review four processes that contribute to the perception of speech: perceptual grouping, lexical segmentation, perceptual learning and categorical perception, in each case presenting perceptual evidence to support highly interactive processes with top-down information flow driving and constraining interpretations of spoken input. The cognitive and neural underpinnings of these interactive processes appear to depend on two distinct representations of heard speech: an auditory, echoic representation of incoming speech, and a motoric/somatotopic representation of speech as it would be produced. We review the neuroanatomical system supporting these two key properties of speech perception and discuss how this system incorporates interactive processes and two parallel echoic and somato-motoric representations, drawing on evidence from functional neuroimaging studies in humans and from comparative anatomical studies. We propose that top-down interactive mechanisms within auditory networks play an important role in explaining the perception of spoken language.     

Advances in the changing patterns of aetiology of head and neck cancers

PURPOSE OF REVIEW: Recent cumulated evidence suggests that factors other than those conventionally known may contribute to the development of head and neck cancer. In fact, a review of the most recent literature shows interesting advances in molecular epidemiology. RECENT FINDINGS: Recent studies have pointed out the role both of exposure to carcinogens and of an inherited or acquired genetic susceptibility. A very broad mechanism by which gene families can be responsible for the disease has been depicted. This mechanism ranges from behaviour genes, which can regulate lifestyle habits, to metabolizing genes, DNA repair genes and cell cycle control genes. SUMMARY: This review tries to summarize the most recent advances in the field of cancerogenesis in head and neck cancer.     

Overall intelligibility, language, articulation, voice and resonance characteristics in a child with Shprintzen-Goldberg syndrome

OBJECTIVE: Recognition of the phenotypic spectrum and prognosis of a genetic disorder is critical to proper patient care. A 7-year-old boy with Sphrintzen-Goldberg syndrome (SGS) was studied to investigate speech, language and voice patterns associated with this syndrome. METHODS: The child's language (expressive and receptive) and speech was characterized with regard to overall intelligibility, articulation (phonetic and phonological errors), voice (flexible videolaryngostroboscopy, quality, pitch and loudness) and resonance (type of disorders). RESULTS: Based on this detailed study the most striking communication characteristics in this child with SGS appear to be a delayed speech and language onset, an expressive and receptive language disorder, a moderately impaired speech intelligbility, relatively good phonetic but poorer phonological abilities, an oral hypotonia, a high-pitched soft voice and a slight hypernasality. CONCLUSIONS: The explanation for this communication disorder is not completely straightforward. It is not clear either to what extent the present case can be considered as typical for SGS. Only more data will allow to determine whether or not SGS is associated with a typical syndrome specific pattern of communication disorders. Not only detailed speech and language analyses of additional cases of SGS are necessary, but also studies that compare the speech and language of individuals with SGS with that of individuals with other genetic syndrome.     

Childhood autism: deficits of communication and symbolic development. I. Distinctions from language disorders

The present paper reviews, outlines, and explores the literature concerned with the speech-language disorder of childhood autism. The problems of communication of the autistic child are compared and contrasted with those of children with a variety of other language disorders (e.g. receptive developmental dysphasia). Based upon the review of normal preverbal communicatory and symbolic development, it is concluded that childhood autism involves a pervasive language disorder encompassing communication in general, as well as certain symbolic-representational abilities necessary for language. An overview of the attempts to teach speech to autistic children in then undertaken with special emphasis on the possible implications of developmental knowledge for these training pursuits. Finally, the role of neurologic substrates in the language and communication disorder of autism is presented.     

Spoken and written English errors of postsecondary students with severe hearing impairment

This investigation compared the spoken and written English errors of 20 hearing-impaired postsecondary students with intelligible speech and poor English language. Error categories used to assess the language samples were function, content, and structure. Spoken and written performances were distinguished only by a greater number of function word errors in writing samples. A trend toward greater complexity in writing was also found. Implications for instruction are discussed.     

Narrative production by children with and without specific language impairment: oral narratives and emergent readings.

The research reported in this paper was based on the premise that oral and written language development are intertwined. Further, the research was motivated by research demonstrating that narrative ability is an important predictor of school success for older children with language impairment. The authors extended the inquiry to preschool children by analyzing oral narratives and "emergent storybook reading" (retelling of a familiar storybook) by two groups of 20 children (half with, half without language impairment) age 2;4 (years;months) to 4;2. Comparative analyses of the two narrative genres using a variety of language and storybook structure parameters revealed that both groups of children used more characteristics of written language in the emergent storybook readings than in the oral narratives, demonstrating that they were sensitive to genre difference. The children with language impairment were less able than children developing typically to produce language features associated with written language. For both groups, middles and ends of stories were marked significantly more often within the oral narratives than the emergent readings. The children with language impairment also had difficulty with other linguistic features: less frequent use of past-tense verbs in both contexts and the use of personal pronouns in the oral narratives. Emergent storybook reading may be a useful addition to language sampling protocols because it can reveal higher order language skills and contribute to understanding the relationship between language impairment and later reading disability.     

A method to break the cognitive barrier between a deaf child and a hearing parent

A deaf child actively uses about 1000 concepts in common with the hearing world. The rest of his up to 10,000 concepts belong to sign language and cannot be accurately translated into written language. This makes it difficult for the deaf to understand a normal written text, especially its abstractions. We have developed a new communication system in order to break the barrier between the hearing and the deaf. In this system a deaf child speaks with a writing hand-piece terminal through an FM route to a small unlimited text-to-speech synthesizer carried by the parent. The parent answers similarly to a 48-grapheme alphanumerical display carried by the child on a rack in front of him. The parent's unit with a speech synthesizer weighs about 2 kg and its size is about 7 X 20 X 25 cm; the size of the child's unit is one half of that and it weighs, with the display, 2 kg. Even a 4-year-old child carries the apparatus easily; nevertheless a still lighter unit is under construction. The system takes the learning process to everyday situations and makes it possible for a deaf child to converse in the normal written and spoken language. Thus, his concept capacity in the spoken language can be increased.     

Divergence of fine and gross motor skills in prelingually deaf children: implications for cochlear implantation

OBJECTIVE: The objective of this study was to assess relations between fine and gross motor development and spoken language processing skills in pediatric cochlear implant users. STUDY DESIGN: The authors conducted a retrospective analysis of longitudinal data. METHODS: Prelingually deaf children who received a cochlear implant before age 5 and had no known developmental delay or cognitive impairment were included in the study. Fine and gross motor development were assessed before implantation using the Vineland Adaptive Behavioral Scales, a standardized parental report of adaptive behavior. Fine and gross motor scores reflected a given child's motor functioning with respect to a normative sample of typically developing, normal-hearing children. Relations between these preimplant scores and postimplant spoken language outcomes were assessed. RESULTS: In general, gross motor scores were found to be positively related to chronologic age, whereas the opposite trend was observed for fine motor scores. Fine motor scores were more strongly correlated with postimplant expressive and receptive language scores than gross motor scores. CONCLUSIONS: Our findings suggest a disassociation between fine and gross motor development in prelingually deaf children: fine motor skills, in contrast to gross motor skills, tend to be delayed as the prelingually deaf children get older. These findings provide new knowledge about the links between motor and spoken language development and suggest that auditory deprivation may lead to atypical development of certain motor and language skills that share common cortical processing resources.