Language and oral-motor development and disorders in infants and young toddlers with human immunodeficiency virus

There are only a few studies on the preverbal and language development of infants and toddlers with human immunodeficiency virus (HIV). However, the available literature indicates that HIV infection appears to compromise language development. No studies could be found on the oral-motor development of such children. This article reviews current research on the preverbal and language development of children with HIV from birth to 3 years of age and provides recommendations for future research. Information on several virus-related pathologies that can interfere with oral-motor integrity and development is also presented. Proper intervention to remediate language disorders and support oral-motor development of these children requires their comprehensive assessment, and a dynamic assessment strategy is recommended.

Auditory neuropathy: case study with hyperbilirubinemia

Auditory neuropathy (AN) has been described in the literature as presenting with a combination of audiometric findings that include elevated behavioral audiometric thresholds, auditory brainstem response findings that are not consistent with audiometric findings, poor speech recognition, and present otoacoustic emissions (OAEs) and/or cochlear microphonics. Since the availability of clinical OAE testing, AN has come to be identified with increasing frequency; however, incidence and prevalence figures are unavailable. There is a great deal of discussion about the accurate diagnosis of AN, its characteristics, and its treatment. Some of this discussion is occurring on the Internet and over the telephones. The need to continue to provide information in accessible peer-reviewed journals is paramount. Following a review of the literature, a case study is presented of a boy who was diagnosed with AN as a newborn. He experienced hyperbilirubinemia and other neonatal health complications. His educational intervention was managed elsewhere until recently. Information is presented about the progression of the case over a 5-year period that includes audiologic data and communication development results.

Language repair via metalinguistic means

Children with specific language impairment (SLI) have been shown to be deficient in the use of complex sentences. In an attempt to remediate this area of weakness, two groups of such children (mean ages 9;4 and 10;6) received about 55 half-hour sessions of metalinguistic training spread over 12 months. Results showed that the use of complex sentences increased to at least normal levels in the experimental groups, and were significantly improved, at both the written and oral levels, as compared with SLI control groups, which evidenced little change over the same period. Further analysis of the data revealed the striking finding that those children who had the poorest complex sentence usage tended to benefit the most from metalinguistic training. These results are interpreted as support for the hypothesis that metalinguistic training helps to overcome the presumed neurological deficit of the language disordered child by making linguistic rules conscious, and thereby providing a 'metalinguistic bridge' via which information can bypass the damaged area.

Reliability of speech and language therapists using therapy outcome measures

The Therapy Outcome Measure (TOM) aims to provide Speech and Language Therapists (SLT) with a practical tool to measure outcomes of care by providing a quick and simple measure which can be used over time with patients and clients in a routine clinical setting. The TOM allows therapists to reflect their clinical judgement on the dimensions of impairment, disability/activity, handicap/participation and well-being on an 11-point ordinal scale. The purpose of this paper is to examine the reliability and the influences on reliability of SLT using this measure. Three studies are presented and give information on 73 SLT using the measure with different client groups. Study one assesses the degree of reliability of six SLT using the TOM following training and practice. Reliability was studied on three occasions and the results demonstrate the influence of training and practice. Study two included 56 SLT to examine reliability over a broader range of client groups and to investigate the effect of the SLT specializing on rating patients from within or -out that specialism. Eleven therapists were included in the study, which examined the influence of a specific training approach. The participating SLT achieved a substantial-moderate level of reliability; this was established in all domains. The degree of reliability achieved on the TOM was affected by some, but not extensive, training and experience.

Characteristics of children attending language units in England: a national study of 7-year-olds

The present investigation examined the characteristics of 7-year-old children attending language units in England. The study involved 242 participants who represented a randomized sample of all 7-year-old children spending 50% of more of the school week in a language unit. Results are discussed in terms of the following questions: what is the non-verbal ability of children attending language units?; do children attending language units fit the discrepancy criteria between verbal and non-verbal ability diagnostic of specific language impairment (SLI)?; and what types of language difficulties do children with SLI attending language units have?

Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes

This report concerns the speech and language outcomes of young adults (N = 242) who participated in a 14-year, prospective, longitudinal study of a community sample of children with (n = 114) and without (n = 128) speech and/or language impairments. Participants were initially identified at age 5 and subsequently followed at ages 12 and 19. Direct assessments were conducted in multiple domains (communicative, cognitive, academic, behavioral, and psychiatric) at all three time periods. Major findings included (a) high rates of continued communication difficulties in those with a history of impairment; (b) considerable stability in language performance over time; (c) better long-term outcomes for those with initial speech impairments than for those with language impairments; and (d) more favorable prognoses for those with specific language impairments than for those with impairments secondary to sensory, structural, neurological, or cognitive deficits. These general conclusions held when either a liberal or a more stringent criterion for language impairment was employed. Some of these findings are consistent with those from earlier follow-up studies, which used less optimal methods. Thus, the present replication and extension of these findings with a sound methodology enables greater confidence in their use for prognostic, planning, and research purposes.

Speechreading: advances in understanding its cortical bases and implications for deafness and speech rehabilitation

Some cortical correlates of (silent) speechreading in normal people are described and contextualized with respect both to seeing faces and to hearing speech. Some preliminary work with two people with abnormal language is described, as are some findings concerning evoked responses to seen speech. Superior temporal cortical areas (classical 'speech association' areas) are strongly and specifically implicated in seeing silent speech. In addition, primary auditory cortex can be activated by silent speechreading in hearing people. The implications of these findings for deafness and for issues of compensation and plasticity are outlined.

Tutorial: survival analysis--a statistic for clinical, efficacy, and theoretical applications

Current demands for increased research attention to therapeutic efficacy, efficiency, and also for improved developmental models call for analysis of longitudinal outcome data. Statistical treatment of longitudinal speech and language data is difficult, but there is a family of statistical techniques in common use in medicine, actuarial science, manufacturing, and sociology that has not been used in speech or language research. Survival analysis is introduced as a method that avoids many of the statistical problems of other techniques because it treats time as the outcome. In survival analysis, probabilities are calculated not just for groups but also for individuals in a group. This is a major advantage for clinical work. This paper provides a basic introduction to nonparametric and semiparametric survival analysis using speech outcomes as examples. A brief discussion of potential conflicts between actuarial analysis and clinical intuition is also provided.

Issues to consider in the evaluation of speech and language therapy for preschool children

This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a 'watching-waiting' control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.

[Behavior problems in language-impaired children: therapy evaluation using child behavior checklist]

Speech and language impaired children often show accompanying behavioral and emotional problems, putting an additional burden on their developmental course. In a sample of 57 children with a specific speech and language disorder we evaluated the behavioral changes after therapeutic intervention. The children got intensive treatment for about 15 months. Before the beginning of the treatment, all children were assessed using clinical psychiatric interviews and observations and were diagnosed according to the multiaxial classification scheme. The CBCL was filled in by the same parent before and after the treatment program. The Total Behavior Problem Score was used to assess changes in behavioral problems. The school type as well as the still necessary therapeutic interventions after the completion of the treatment program were used as global measures of psychosocial adaptation. 45 of 57 children had a psychiatric diagnosis on axis 1 of the multiaxial classification scheme. Hyperkinetic disorder, with or without conduct disorders were the most commonly given diagnoses, in addition to emotional disorders and adjustment problems. Before treatment, the children with a psychiatric diagnosis had higher scores on the Total Behavior Problem Score than the children without a psychiatric diagnosis. The children with psychiatric problems showed a significant decrease in the Total Behavior Problem Score of the CBCL. Although the children with a conduct disorder also showed improvement after treatment, their CBCL scores remained high. The stability of their problems was associated with a worse school prognosis and with further institutional care after the end of the treatment.

Peer-mediated social intervention for young children with autism

In this paper, we trace the history of peer-mediated intervention for young children with autism. Special attention is paid to outcomes achieved, implementation strategies, practicality, combining peer-mediation and naturalistic teaching, and overall conclusions from 20 years of study.

Pivotal responses and the natural language teaching paradigm

This article discusses the identification of pivotal behaviors for maximizing the impact of intervention for children with autism. Language deficits are not likely to make sufficient improvement unless pivotal variables, such as motivation, are addressed in the design of intervention programs. Pivotal target behaviors related to such children's motivation to engage in social communication are discussed, and their integration into a Natural Language Teaching Paradigm is described. Of particular interest are variables related to child choice, the use of natural reinforcers, the interspersal of maintenance trials to build behavioral momentum, and reinforcing communicative attempts. When used in combination to motivate the children to engage in and initiate communicative interactions, the impact on development can be considerable in terms of rate of acquisition, generalization of gains, and normalization of language development.

Environmental supports to enhance social-communication

"Environmental support" is a general term used to define the systematic use of explicit visual and/or social cues to clarify meaning for children with autism. Environmental supports can serve as a compensatory means to structure and enhance language understanding, social engagement, and social-communicative interactions. The unique and atypical developmental patterns associated with autism provide the rationale for the use of two environmental supports: visually cued instruction and modified sociolinguistic input. Using empirical research, multiple examples of environmental supports to enhance social-communication are provided.

The picture exchange communication system

The Picture Exchange Communication System (PECS) was developed as a means to teach children with autism and related developmental disabilities a rapidly acquired, self-initiating, functional communication system. Its theoretical roots combine principles from applied behavior analysis and guidelines established within the field of alternative and augmentative communication. This approach has several potential advantages relative to imitation-based strategies (both vocal and gestural) and symbol selection strategies. The system begins with the exchange of simple icons but rapidly builds "sentence" structure. The system also emphasizes developing the request function prior to developing responding to simple questions and commenting. The development of requesting with a sentence structure also permits the rapid development of attributes more traditionally taught within a receptive mode. The relationship between the introduction of PECS and various other behavioral issues (i.e., social approach and behavior management) as well as its relationship to the codevelopment of speech are reviewed.

[Diagnostic value of ERTL4: a screening test of language disorders in 4-year-old children]

BACKGROUND

Language disorders in children are frequent and may sometimes severely affect their development. ERTL4 (screening test for language disorders of children aged 4) is the first test for screening language disorders to be used by doctors. It has not yet been evaluated.

AIM

The objective of this study is to assess and optimize the diagnostic value of the ERTL4 test and to evaluate its potential interest as a screening test.

MATERIAL AND METHODS

A sample of 370 children was randomly constituted among children aged between 3 years 9 months and 4 years 6 months from schools in Nancy, France and surrounding areas. These children undertook both the ERTL4 test and a standardized examination of language and speech as a reference.

RESULTS

Among the 325 children included in the analysis, 34.1% presented with disorders requiring speech and language therapy. ERTL4 sensitivity and specificity were 88.6% and 66.8%, respectively. Varying thresholds for disorder diagnoses and proposals for a modified test led to a sensitivity of 72.9% and a specificity of 91.0%. The proportion of well-classified subjects improved from 73.8% to 85.3% (P < 10(-3)). The positive predictive value was 78.7% and the negative predictive value was 88.1% (with the observed frequency in the sample).

CONCLUSION

ERTL4 is a good test for doctors to screening of children's language disorders and their management.

Use of elaborative encoding to facilitate verbal learning after adolescent traumatic brain injury

OBJECTIVE

To investigate the effectiveness of elaborative encoding in learning and remembering word definitions after traumatic brain injury (TBI).

DESIGN

Two case studies.

SETTING

University outpatient clinic.

PARTICIPANTS

Two adolescents with severe memory impairments after TBI who needed specific vocabulary for school.

INTERVENTIONS

A series of individual speech-language therapy sessions incorporating clinician- and subject-generated strategies to facilitate elaborative encoding. Target words were based on school requirements and pretreatment test results and were assigned randomly to treatment or control groups.

MAIN OUTCOME MEASURE

Accuracy of free-recalled definitions at the conclusion of therapy and after 1 month with no therapy.

RESULTS

Significant improvement in expressed word knowledge at the conclusion of therapy, with improvement on treated words maintained at 1 month for both subjects.

CONCLUSIONS

Elaborative encoding was an effective tool for teaching specific information required for school. Patterns of response differed substantially from those of normally developing children. Generalization to classroom use was planned for and should be measured in future research.

Evaluation of a mechanical hand-support for facilitated communication

A specially designed hand-support device was evaluated to determine its effectiveness in assisting nonspeaking mentally handicapped children transition from facilitated communication (FC) to independent typing. Six autistic individuals (age range: 5 to 31) participated in the main experiment. All six had been reported to be moderately to highly proficient in the use of FC prior to the study. Pre- and posttraining tasks included pointing to pictures, numbers, and letters as well as copying single words by typing on a keyboard or letterboard. After 8 weeks of training, subjects' ability to point or type on all four tasks was assessed in three different conditions: (a) with an experienced facilitator, (b) independently, and (c) with the mechanical hand-support system. Postassessment measures did not reveal any evidence of independent communication with or without the device. An informal extension of the study, in which four of the original six subjects and three additional subjects were included for 4 additional months, also failed to provide evidence of significant communication.

The use of graphic language intervention among young children in Norway

Knowledge about graphic communication intervention and use among young disabled children has been sparse. The present study is based on a thorough search, and provides reliable information about children who are 10 years old or younger who have graphic communication (for example, photographs, drawings, Blissymbols, PIC, traditional orthography) as their main form of communication. The study covers all such children in three Norwegian counties, comprising a population of 1.1 million people. Detailed descriptions of the children, the systems they use, and their educational settings are presented, and implications for the organisation of habilitation services are discussed.