Language comprehension in language-learning impaired children improved with acoustically modified speech

A speech processing algorithm was developed to create more salient versions of the rapidly changing elements in the acoustic waveform of speech that have been shown to be deficiently processed by language-learning impaired (LLI) children. LLI children received extensive daily training, over a 4-week period, with listening exercises in which all speech was translated into this synthetic form. They also received daily training with computer "games" designed to adaptively drive improvements in temporal processing thresholds. Significant improvements in speech discrimination and language comprehension abilities were demonstrated in two independent groups of LLI children.

The persisting communicative difficulties of 'remediated' language-impaired children

This study addresses the effiacy of dismissal criteria used by speech and language pathologists by investigating communicative functioning in children declared 'remediated'. A battery of measures comprising the Language Assessment and Remediation Procedure (LARSP); the Behavioural inventory of Speech Act Performances (BISAP); the BISAP Addendum and the Devereux School Behaviour Rating Scale (DESB) was conducted on five children with language impairment who had been declared 'remediated'. Findings for certain 'remediated' subjects revealed persisting problems. The results suggest that decisions about dismissal from therapy may, in some cases, be premature and point to the need for a broad-based perspective concerning remediation dismissal decisions. An additional study on larger populations and the use of designs which investigate long term outcomes would further inform clinical decision-making concerning dismissal from therapy.

Management of speech and language disorders in a mental illness unit

Few speech and language therapists work with psychiatric patients. This study investigates how the specific communication problems of this population are addressed by care staff. Following a survey to determine the prevalence of speech and language problems in a psychiatric population, subjects assessed as having moderate or severe difficulties were selected for further study in order to investigate how they were currently being managed by the people responsible for their care. Key workers or charge nurses were interviewed, and ward and department nursing care plans were examined for mentions of speech and language problems, for aims in connection with these problems and for strategies to achieve these aims. Speech and language problems were not mentioned in 40% of the nursing care plans inspected. Where speech and language problems were mentioned there were aims in connection with half of these and strategies to achieve the aims in only 10% of the sample. The reasons for failure to mention speech and language in nursing care plans and for discrepancies between the results of speech and language therapy assessment and assessments of ward and department staff are discussed.

Differential recovery from impairment to the phonological lexicon

Word production was examined in four aphasics diagnosed acutely with neologistic jargon and who displayed impairment to the lexical stage of phonological production (Kohn & Smith, 1993, 1994a). To investigate the major source of their nonword errors (i.e., neologisms, phonemic paraphasias), single word production was tested at three different times over the first 6 months postonset, with one subject receiving additional testing at 14 months postonset. Two subjects showed signs of recovery to the phonological output system with respect to: (1) improved word production scores, (2) increased frequency of phonemic paraphasias versus neologisms, and (3) increased production of target phonemes. These subjects also displayed above-chance production of target phonemes and no significant tendency to perseverate phonemes across picture-naming trials. It was argued that this pattern reflects a resolving disturbance in retrieving entries from the phonological lexicon. The other two subjects showed no improvement in word production. They also consistently produced target phonemes at chance levels and had a tendency to perseverate phonemes across picture-naming trials. This static pattern of performance was considered to reflect loss of information from the phonological lexicon. The neuroanatomical damage sustained by each case was consistent with these two recovery patterns.

Redirects: a strategy to increase peer initiations

Preschoolers' verbal abilities influence their verbal interactions with play partners. Previous research has suggested that preschoolers with specific language impairment (SLI) are more likely to initiate conversations with adults than with peers, as compared to their typically developing peers. This study investigated a teacher-implemented procedure, redirects, as a means to facilitate initiations to peers. A redirect occurs when a child initiates to the teacher, and the teacher then suggests the child initiate to a peer, thereby redirecting the child from an adult to a peer. Four preschool boys with SLI participated in the study. The teacher training was successful in increasing the teacher's ability to redirect the children's initiations. The children consistently responded to redirects by initiating to peers, and most redirected initiations received conversational responses from peers. Generalization effects to spontaneous peer initiations following the intervention period were demonstrated for 2 of the boys.

The responsibilities of speech-language pathologists toward children with ADHD

The speech-language pathologist has the skills needed to be an active participant in both the diagnostic and intervention phases of the treatment of children with ADHD. Many of the behaviors that define ADHD are directly linked to communication. Westby and Cutler (1994) assert that "the strong association between language disorders and ADHD suggests the possibility of a common antecedent to both disorders, perhaps a temperamental or neurological characteristic linked to deficits in behavioral regulation" (p. 61). Although the speech-language pathologist may not have the security of standardized test scores to support his or her diagnosis, behaviors that cannot be tested (e.g., pragmatics and social interactions) may be keys to a child's classroom difficulties. As discussed, many of the criteria found in the DSM-IV diagnostic criteria for ADHD are characteristics of pragmatic skills. Supported by Barkley's (1993) new theory of ADHD which is based on poor response inhibition or inability to delay responses, the speech-language pathologist can be an important resource to both the teacher and parents by helping them understand the behaviors exhibited by an ADHD child. The impulsivity that is so disruptive in the classroom is directly linked to the inability to delay responses. It is agreed that continued research into the behavioral characteristics associated with ADHD as well as their long-term implications for learning is needed. ADHD is a multifaceted developmental disorder. There is no known cure for ADHD, and we are dependent on early diagnosis and ongoing intervention to reduce its lifelong effects. Effective treatment must be multi-modal and involve the coordination of a professional team as well as the child's family. It is vital that we help children with ADHD develop positive self-esteem, effective social skills, and good pragmatic language skills that will eventually have a positive impact on their functioning in all aspects of their interactions with their environment. If this is accomplished, the effects of ADHD will be minimized. The speech-language pathologist needs to take a leadership role in this process.

The Landau-Kleffner Syndrome: a review

The Landau-Kleffner syndrome or the syndrome of acquired epileptic aphasia was first described in 1957. The disorder is characterised by gradual or rapid loss of language in a previously normal child. All children have abnormal EEG compatible with the diagnosis of epilepsy, however, only 70% have clinical seizures. The present article presents a review of the current knowledge concerning this disorder. Information is provided related to the clinical picture, etiology, pathogenesis, treatment and outcome.

Adult partner-augmented communication input to youth with mental retardation using the System for Augmenting Language (SAL)

The primary purpose of this study was to characterize the frequency and nature of augmented input that adult partners provided to 13 youth with mental retardation as they began to use the System for Augmenting Language (SAL). Analyses of youth-partner interactions revealed differences in the frequency with which home and school partners provided augmented input and in the manner and style of home and school partners' augmented input, particularly in directiveness and position of lexigram symbols within Utterances. Overall, partners naturally provided augmented input in a manner likely to promote youth's learning of the SAL.

Successful use of facilitated communication with an oral child

A 6 1/2-year-old child's oral and spelled utterances were compared over a 3-month period as he was trained to use Facilitated Communication (FC), a method of augmentative and alternative communication. The child's language with FC was significantly better than his oral language in length of utterances, novelty of utterances, and syntactic complexity. His language with FC also contained more function words and over time was more intelligible and required less verbal scaffolding than his oral communication. Evidence that he was authoring his own messages during his facilitated spelling was found in his idiosyncratic use of language and his ability to convey verifiable information that was unknown to the facilitator. The strongest evidence came later with his ability to type messages without physical support. The results suggest the potential for using FC with children who have some functional oral skills but cannot express themselves fully in the oral modality. The method can serve as a means of investigating language potential and as a transition to literacy and independent typed communication.

The efficacy of kinesthetic reading treatment for pure alexia

This paper presents an effective treatment for pure alexia by a type of single-case design, which we termed a "material-control single-case design" [Sugishita et al., Neuropsychologia, Vol. 31, 559-569, 1993]. Two patients with pure alexia were treated using kinesthetic reading (reading by tracing or copying the outline of each letter with the patient's finger). The results clearly demonstrated that both patients significantly improved their reading and copying performances. Their recovery of reading performance arose from improvement in copying. The results of tachistoscopic reading tests suggested that the patient obtained the ability to read without kinesthetic movements.

FM amplification for enhancement of conversational discourse skills: case study

The purpose of this single-subject pilot study was to examine the efficacy of FM amplification for enhancing the discourse skills of a 4-year-old girl with a history of speech-language impairments, otitis media with effusion (OME), and motoric delays. Over a period of several weeks, language treatment sessions were conducted with and without FM amplification, in a classroom setting. Sessions were videotaped and analyzed for the appropriateness and effectiveness of the subject's conversational turns during sessions with amplification and with no amplification. Although the number of sessions was small, more appropriate and effective conversational turns occurred during sessions with amplification.

Augmentative and alternative communication: treatment principles and strategies

This article has attempted to clarify the principles of AAC evaluation and intervention, in part by dispelling myths that have persisted for too long. To the list of general guidelines for deciding when to consider AAC and how to begin breaking down the barriers to full participation by children with severe impairments, we need to add some warning signs that we have learned to heed in our work with these children. These signs are listed in Table 6 and are indicators that aspects of an approach to AAC must be altered or the child may fail to benefit from an intervention. Each sign conflicts in one way or another with current principles of augmentative and alternative communication. We give you these signs along with some possible ways to eliminate or prevent these errors in the future. Providing the best possible set of strategies for communication for a child with severe communication impairments is an enormously complex task. Whether a child can or cannot be assessed with standard procedures or whether he or she has unitary or multiple disabilities, the barriers to communication are many and intricately constructed. Sorting out strategies and how to apply them ordinarily requires input from the consumers of AAC (i.e., the family, child, and primary communication partners), the core team of professionals, as well as a team of specialists in AAC. Conducting evaluations and intervention is challenging because of institutional, bureaucratic, and professional barriers that each member of the team faces. Few, if any, teams can provide services that meet all of the established principles of best practice for every child that it serves. Yet, attempts to identify weaknesses within AAC programs and work to strengthen them must be given high priority in order to provide the best possible AAC services for such children. Only then will it be possible for children with severe communication impairments to overcome their own barriers and begin to participate in their choice of life's activities. That is, after all, the ultimate goal.

[Language disorders]

Language is the basis for acquisition and execution of communicative skills. The neurological structures underlying language can be localized through clinical-pathological studies and neuroimaging studies. The classical language areas (Broca and Wernicke areas) are involved in lesions causing aphasia, and the main types of aphasia are motor (Broca), sensory (Wernicke), global and anomic aphasia. In stable lesions a negatively accelerated recovery curve is observed. Age and severity of aphasia are important prognostic factors. Treatment consists of broadly targeted language stimulation, but specialists services are important for assessment, education, and selection of patients for special forms of therapy.

Speech and language therapy: is it effective?

As part of a needs assessment of local speech and language therapy services, a review of the literature was carried out to examine the evidence for effectiveness of speech and language therapy. Purchasing authorities and general practice fundholders need to know whether what they are buying for their local population is effective, and whether the service is being provided in the most cost-effective way. This paper considers the published evidence and some of the limitations of the studies, and gives suggestions for purchasing speech and language therapy services based on current evidence. More evaluative work needs to be done to provide purchasers with the information necessary to decide which speech and language therapy services will result in real benefits for their population.

Developing study, organization, and management strategies for adolescents with language disabilities

Developing strategies for learning is important for all individuals, but even more so for students who have difficulty learning and processing information. Because many students with language disabilities have not developed a repertoire of such strategies or do not actively apply the strategies they know, direct instruction in this area is imperative. It is also important that any strategy taught is functional, easily and directly applied to present learning situations, and easy to generalize. Determining the variables in a learning situation (the script) should provide appropriate choices and direction for strategic teaching and learning. The acquisition of strategies involves direct, explicit teaching and requires time for modeling, practice, and discussion. Using a cognitive strategy model is critical because it supports the later use and generalization of strategies, but it is important to explore various models for strategy instruction and to work collaboratively with students and teachers. The SLP can provide direct instruction, consultation, or training, or can facilitate a collaborative model among professionals. In so doing, her impact may reach throughout a life, because learning strategies are life strategies, and if learned they are tools forever.

Down syndrome: a multidisciplinary perspective

Trisomy 21, a genetic disorder resulting from a chromosomal abnormality, is one of the most common forms of mental disability in the United States. Individuals with Down syndrome frequently present with a constellation of medical problems including conductive hearing loss and, to a lesser degree, sensorineural hearing loss. As part of a health care team, audiologists must be sensitive to and aware of medical conditions prior to establishing intervention strategies. Medical conditions, by necessity, precede audiologic interventions and, therefore, a close working relationship among team members is critical. Yet, audiologic and communication interventions should be established at the earliest possible time for maximizing an individual's development potential. This article stresses the importance of a multidisciplinary team in the provision of services so that prevention of further disabilities, improved outcomes of medical interventions, and appropriate habilitative and educational planning may ensue.

Parents and families of children with communication disorders

The role of parents in the development of the communicative competence of their children has been of growing interest to researchers and practitioners in the field of speech and language therapy. Researchers have attempted to define and test specific hypotheses regarding the nature and degree of the influence of parental interaction styles upon the developing child's pragmatic skills. The literature includes studies regarding normal children and those with speech and language impairments. Practitioners have endeavoured to move towards a firmer framework of partnership with parents which will ultimately be of benefit to children with speech and language impairments and their families.

Comparison of conversational-recasting and imitative procedures for training grammatical structures in children with specific language impairment

The recent literature on language intervention has become increasingly focused upon developing treatments that more closely parallel normal language acquisition. However, there have been relatively few reports that directly compare imitative procedures to conversational-interactive interventions. The purpose of the present study was to compare the relative effectiveness of imitative intervention and conversational recast language intervention applied to a wide range of grammatical morpheme and complex sentence targets in 21 children with specific language impairment. The results indicated that although both kinds of treatments were effective in triggering acquisition of most targets, consistently fewer presentations to first spontaneous use were required in the conversational procedure. In addition, the transition from elicited production to generalized spontaneous production was more rapid under conversation-interactive treatment. Finally, although imitation treatment was more effective in generating elicited production, a significantly greater number of spontaneous productions occurred under the conversational training procedures. The theoretical and applied ramifications of these findings are discussed.

Use of phonological information in a word-finding treatment for children

Two children with word-finding deficits characterized largely by semantic substitutions participated in a treatment involving phonological information about target words. The treatment was motivated by models of naming where semantic information and phonological information are stored in independent ordered components. Given such models, it is possible to characterize some semantic word-finding substitutions as well as phonological word-finding substitutions as the result of breakdown at the level of the phonological output representation. The treatment was organized according to a single-subject multiple baseline design across behaviors and subjects. As hypothesized, the phonologically based treatment resulted in reduction not only of occasional phonological word-finding substitutions but also of the large number of semantic word-finding substitutions displayed during baseline and control measures of confrontation naming. In light of these data, the possible source of word-finding breakdowns in these children is explored.

Seven-year follow-up of speech/language-impaired and control children: speech/language stability and outcome

OBJECTIVE

This study examined the 7-year outcome of speech/language (S/L) impaired and control children selected from a community sample at age 5 years.

METHOD

Two hundred fifteen children completed a variety of speech and language tests at age 12 years. Children with S/L impairment were further classified as "speech only," "language only," or "speech and language impaired."

RESULTS

More than 72% of children who had S/L impairment at age 5 remained impaired at age 12. Children with both speech and language problems were most likely to remain S/L impaired; 81% had some kind of S/L impairment at follow-up. Similarly, children with both expressive and receptive language impairment were more likely to show expressive or receptive impairment at follow-up than children with expressive impairment alone. One third of time 1 controls had S/L problems at follow-up, and of these 82% had speech impairment only.

CONCLUSIONS

S/L impairment identified at age 5 has long-lasting effects. More pervasive problems were associated with poorer outcomes. Screening at age 5 may be useful, as most serious S/L problems that emerged by middle childhood could be identified at age 5. The effects of S/L treatment require further study.