Digit span in individuals with Down syndrome and in typically developing children: temporal aspects

This study explored factors influencing digit span performance in individuals with Down syndrome. The following questions were asked: Is there a deficit in the phonological loop, either in articulatory rehearsal (measured in speaking rate and recall latency) or in the passive store (measured in recall duration)? Is reduced auditory short-term memory associated with a language production deficit? Thirty five adolescents with trisomy 21 Down syndrome were compared to 35 mental-age-matched and 35 language-production-matched controls. There was no group difference in speaking rate. The DS group had shorter digit spans than the MA controls. Language production level accounted for substantial variance in digit span in individuals with Down syndrome.

Writing impairment in schizophasia: two case studies

Two case studies were conducted of patients suffering from paranoid schizophrenia with glossomanic schizophasia. Their dictation-taking performance was assessed via a comprehensive standardized neuropsychological test battery following a protocol specifically designed for the purpose (Lecours, 1996.). The patients' performance was compared with normative data from the general population. The results show that the patients committed graphemic paragraphias, that is, they replaced target graphemes with others representative of the corresponding phoneme (ph and f for/f/, in French) or with graphemes representative of a similar phoneme (v for/f/). These errors suggest that components of a cognitive model of writing are dysfunctional.

The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours

We present data on the intellectual, language and executive functions of 26 children who had undergone surgery for the removal of cerebellar hemisphere or vermal tumours. The children with right cerebellar tumours presented with disturbances of auditory sequential memory and language processing, whereas those with left cerebellar tumours showed deficits on tests of spatial and visual sequential memory. The vermal lesions led to two profiles: (i) post-surgical mutism, which evolved into speech disorders or language disturbances similar to agrammatism; and (ii) behavioural disturbances ranging from irritability to behaviours reminiscent of autism. These data are consistent with the recently acknowledged role of the cerebellum as a modulator of mental and social functions, and suggest that this role is operative early in childhood.

Common pattern of language impairment in vascular dementia and in Alzheimer disease

The authors studied language performance patterns in early stages of vascular dementia and Alzheimer disease. The objective was to clarify to what extent dissolution of language in vascular dementia is similar to that in Alzheimer disease. Both structured language tests (comprehension, repetition, reading, and naming tasks) and nonstructured language tests (object and picture description) were employed. The structured tasks evidenced impairment on complex auditory comprehension and on picture naming for both dementia groups, whereas oral reading and single word repetition did not differentiate the patients from matched control subjects. On the unstructured narrative tasks, both patient groups showed normal fluency, but content analysis revealed that the patients with dementia produced fewer semantic units (themes) than the control subjects. In summary, both patient groups showed impairment, specifically on semantically mediated language tasks. According to the present results, language impairment in vascular dementia resembles that observed in Alzheimer disease. Semantically mediated functions are among the most sensitive language measures in differentiating early stages of both vascular dementia and Alzheimer disease from normal aging.

Syntactic comprehension deficits in Alzheimer's disease

Syntactic comprehension of German patients with dementia of the Alzheimer type was investigated and compared to healthy controls matched with respect to age, sex, and education. Special attention was directed at syntactic structures, which, in contrast to a language like English, are feasible in a grammatically rich language like German. In a sentence picture matching paradigm, only semantically reversible sentences were used. Syntactic complexity ranged from simple active voice sentences to more complex sentences like center-embedded object relative sentences. In comparison to their controls, patients showed a deficit in nearly all categories. Their performance was not influenced by age, but was heavily influenced by the degree of cognitive impairment. Patients with mild cognitive impairment, as defined by a MMSE score of 20 or higher, showed only slight difficulties in syntactic processing, whereas patients with moderate to severe impairment (MMSE < 20) did not perform above chance limits in most syntactic categories. It appears as though syntactic comprehension is only mildly affected in the early stages of Alzheimer's disease and is rather severely impaired in more advanced stages. In the present report, results are discussed in terms of working memory demands for syntactic processing.

Online measures of basic language skills in children with early focal brain lesions

Twenty children with early focal lesions were compared with 150 age-matched control subjects on 11 online measures of the basic skills underlying language processing, a digit span task, and 6 standardized measures. Although most of the children with brain injury scored within the normal range on the majority of the tasks, they also had a disproportionately high number of outlier scores on the reaction time tests. This evidence for a moderate impairment of the basic skills underlying language processing contrasts with other evidence suggesting that these children acquire normal control of the functional use of language. Furthermore, these children scored within the normal range on a measure of general cognitive ability, suggesting that there is no particular sparing of linguistic functions at the expense of general cognitive functions. Using the MPD procedure (Valdés-Pérez & Pericliev, 1997), we found that the controls and the five clinical groups could be best distinguished with two measures of online processing (word repetition and visual number naming) and one standardized test subcomponent (the CELF Oral Directions subtest). The 12 children with left hemisphere lesions scored significantly lower than the 8 other children on the CELF-RS measure. Within the group of children with cerebral infarct, the nature of the processing disability could be linked fairly well to site of lesion. Otherwise, there was little relation between site or size of lesion and the pattern of deficit. These results support a model in which damage to the complex functional circuits subserving language leads to only minor deficits in process efficiency, because of the plasticity of developmental processes.

Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary structural equation model

The goals of this study were to estimate the risk for lowered speech-language outcomes associated with early recurrent otitis media with effusion (OME) with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Three statistical approaches were used to assess associations among OME, hearing loss, and speech-language outcomes. Participants were a subsample of 70 children followed prospectively in the Dallas Cooperative Project on Early Hearing and Language Development (Friel-Patti & Finitzo, 1990). Findings indicated that hearing levels at 12-18 months were significantly associated with speech delay and low language outcomes at 3 years of age. The risk for subclinical or clinical speech delay at 3 years of age was 2% for children with less than 20 dB average hearing levels at 12-18 months and 33% for children with greater than 20 dB average hearing levels at 12-18 months. A structural equation model (Jöreskog & Sörbom, 1993) indicated that the significant and substantial effects of hearing levels at 12-18 months on speech status at 3 years were significantly mediated by language status at 3 years. Discussion includes implications of these findings for alternative speech perception models linking early OME and hearing loss to later speech-language disorder.

Otitis media: precursor of delayed reading

OBJECTIVE

To investigate the connection between otitis media in the language acquisition years and the occurrence of delayed reading between the ages of 8 and 10.

METHOD

Participants were 40 children, half of whom had a history of otitis media between the ages of birth and three years and half who were free of the disease. These children, now ages 8-10, were tested with the WISC-R and a variety of reading measures.

RESULTS

Children with a history of otitis media scored over a year below grade level in reading and significantly below controls on a variety of literacy measures as well as on the Verbal Comprehension factor on the WISC-R.

CONCLUSIONS

Children with early onset otitis media (birth to three years) tend to be at greater risk for delayed reading than age-matched controls.

Sentence processing in the face of semantic loss: a case study

The modularity of the sentence processor, or lack thereof, remains a much-debated issue in psycholinguistics. The authors present evidence from a semantically impaired patient (DM) that bears on this issue. As demonstrated elsewhere (S. D. Breedin, E. M. Saffran, & H. B. Coslett, 1994), DM suffered a significant loss of semantic knowledge. Here, the authors show that this impairment did not compromise DM's ability to process syntactic information. DM performed well on grammaticality judgment tasks and on sentence comprehension tasks that required the use of syntactic information for the assignment of thematic roles. The resistance of syntactic operations to semantic loss would seem to pose a challenge for models in which "the syntactic and conceptual aspects of processing are ... inextricably intertwined" (J. L. McClelland, M. St. John, & R. Taraban, 1989, p. 329).

Parental perceptions of grommet insertion in children with cleft palate

Otitis media with effusion is almost universal in children with cleft palate and can delay speech, language and educational development by causing hearing loss. Grommet insertion at the time of cleft palate repair is common. There is debate about whether the benefits of grommets outweigh the risk of complications. A postal questionnaire was used to investigate parental perceptions of middle-ear ventilation via grommet insertion in children attending the multidisciplinary cleft palate clinic. These children's case notes were reviewed. Many children had speech and language delay, but parents thought this improved after grommet insertion. Overall parents were pleased with the results. This confirms that grommets have an important part to play in the management of children with cleft palate.

'Speaking in tongues'. Paradoxical fixation on a non-native language following anaesthesia

An intriguing case of transient language disturbance following anaesthesia is described which may throw some light on the way languages are stored in the brain. A review of the existing literature and its relevance to this unique case is discussed.

[Neuropsychological implications of Crouzon syndrome: a case report]

INTRODUCTION

Crouzon syndrome (CS) has traditionally been associated with moderated mental retardation. However, very few studies have quantified in these patients the degree of this mental retardation, and even less research has been carried out to evidenciate the typical neuropsychological profile, including affective, cognitive and executive functions.

CLINICAL CASE

We present a single case-study of a 16 year-old, right-handed female affected of CS. Neuropsychological functions assessed included attention, concentration, memory, visual perception, language, arithmetic processes, praxis, executive functions, reasoning and general intelligence. Deficient results have been obtained in learning and memory, attention, language, graphic praxis, comprehension of social situations and executive functions (frontal lobes). Nevertheless, the patient kept within normal limits her spatial and temporal orientation, visual perception, visual-spatial and manipulative abilities and arithmetic processes.

CONCLUSIONS

Results suggest that the intellectual defect in CS is not general and uniform and that some intellectual abilities are preserved, while others are affected in different degrees. The importance of carrying out a thorough neuropsychological assessment in these cases is emphasized.

Short-term memory deficit after focal parietal damage

The neuropsychological symptomatology is reported for a 44-year-old patient of normal intelligence, EE, after removal of a circumscribed left hemispheric tumor the major part of which was located in the angular gyrus and in the subcortical white matter. EE had a distinct and persistent short-term memory impairment together with an equally severe impairment in transcoding numbers. On the other hand, his performance was flawless in calculation tasks and in all other tests involving number processing. Impairments in language tests could be attributed to his short-term memory deficit, which furthermore was characterized by a strong primacy effect in the absence of a recency effect. His graphomotoric output was temporarily inhibited. The patient, with a strong left-sided dominance, manifested a bi-hemispherical activation of the Broca and Wernicke regions in a positron-emission-tomographic investigation when required to produce verbs which he was to derive from nouns. The findings in EE suggest that unilateral and restricted lateral parietal damage can result in a profound short-term memory deficit together with a transcoding deficit for stimuli extending over only a few digits or syllables in the absence of any symptoms of the Gerstmann syndrome.

Brain tumors in children with neurofibromatosis: additional neuropsychological morbidity?

Neurofibromatosis type 1 is a common autosomal dominant genetic disorder associated with numerous physical anomalies and an increased incidence of neuropsychological impairment. Tumors of the CNS occur in approximately 15% of children with neurofibromatosis, presenting additional risk for cognitive impairment. This study examines the impact of an additional diagnosis of brain tumor on the cognitive profile of children with neurofibromatosis. A comprehensive battery of neuropsychological tests was administered to 149 children with neurofibromatosis. Thirty-six of these children had a codiagnosis of brain tumor. A subset of 36 children with neurofibromatosis alone was matched with the group of children diagnosed with neurofibromatosis and brain tumor. Although mean scores of the neurofibromatosis plus brain tumor group were, in general, lower than those of the neurofibromatosis alone group, these differences were not statistically significant. Children in the neurofibromatosis plus brain tumor group who received cranial irradiation (n = 9) demonstrated weaker academic abilities than did children with brain tumor who had not received that treatment. These results suggest that neurofibromatosis is associated with impairments in cognitive functioning, but the severity of the problems is not significantly exacerbated by the codiagnosis of a brain tumor unless treatment includes cranial irradiation.

The effect of elicitation task on discourse coherence and cohesion in adolescents with brain injury

Six adolescents with traumatic brain injury and six adolescents who had been hospitalized for an illness or injury not affecting the brain were administered two narrative tasks designed to vary in their demand for spontaneous organization of information and minimize the requirement for new learning. The discourse topics--a description of each subject's injury and hospitalization, and a re-telling of a current event--were chosen to be representative of discourse in adolescent daily living. Narratives produced by subjects in each group were compared between the two tasks on measures of coherence and cohesion. Subjects in both groups produced significantly more coherent and cohesive narratives in the personal event task than in the current event task, and there was no significant difference between groups. The results are discussed in relation to face validity of language tasks for adolescents, and the multiple factors contributing to adolescent social discourse.

Semantic processing deficits in patients with Parkinson's disease: degraded representation or defective retrieval?

OBJECTIVE

To determine whether degraded representations (characterized by small differences between word sense frequencies), or defective competitive processes (high levels of word sense lateral inhibition), individually or jointly, can give rise to parkinsonian semantic deficits.

DESIGN

Computer model of semantic processing.

OUTCOME MEASURES

Correct sense selection, defined by the activation of the word sense unit that first reaches the 0.5 activation threshold. If Parkinson disease (PD)-like errors are observed only at high levels of lateral inhibition, independently of low or high sense frequency deltas (SFDs), this would indicate that a defective competitive process alone could account for the errors. Alternatively, if PD-like errors were observed at any level of lateral inhibition, exclusively with low SFD words, this would indicate that degraded representations alone could account for the errors.

RESULTS

Neither degraded representations nor defective competitive processes alone can account for parkinsonian semantic errors. An interaction between the 2, however, correctly reproduces both increased errors and longer latency responses.

CONCLUSIONS

Competing explanations for semantic deficits in patients with Parkinson's disease need to be integrated in order to develop effective interventions (e.g., estimating the amount of context required to improve semantic processing performance).

Psychometric aspects of verbal pragmatic ratings

This study examined the psychometric aspects of a verbal pragmatic rating scale. The scale contained six pragmatic features (i.e., Conciseness, Lexical Selection, Quantity, Relevancy, Specificity, and Topic Maintenance) based on Grice's cooperative principles. Fifteen right brain-damaged (RBD), 15 left brain-damaged (LBD), and 16 healthy normal control (NC) right-handed adult participants produced narratives while recollecting emotional and nonemotional experiences. Naive raters evaluated each pragmatic feature for appropriateness on a 5-point Likert scale. When reliability was examined, the overall internal consistency of the pragmatic scale was extremely high (alpha =.96). Factor analysis was conducted to examine the theoretical relations among the six pragmatic features. Three meaningful factors involving discourse content, conceptual unity, and parsimony were identified. Findings are discussed in light of Grice's model and the construct validity of the scale.

Discourse studies in neurologically impaired populations: a quest for action

Organism and environment are in a state of constant interaction, and discourse is viewed as one form of manifestation of this interaction. Through the study of discourse insights can be gained into those components that bring about mental events. Verbal structure, communication of beliefs and action/interaction are highly interactive dimensions of discourse. Taking this perspective as a framework, the findings of discourse studies with a particular emphasis on right-hemisphere brain-damaged individuals are discussed. Neurolinguistic studies of discourse can be divided into four categories: (1) studies that focus primarily at providing a detailed description of the structural and interactional abilities of brain-damaged individuals, (2) studies that are mainly concerned with investigating the processing aspects of discourse, (3) studies that investigate the influence of cognitive systems such as attention or memory on discourse processing, and (4) studies that try to relate discourse processing mechanisms to underlying biological substrates or neurophysiological mechanisms. A quest is made for future research to base discourse studies on well-defined processing theories, to include different processing components and levels, and to systematically investigate the impact of facets of cognitive systems on such processing. Established methodological approaches should be complemented by electrophysiological procedures (such as the event related potentials technique) or functional imaging techniques (such as fMRI) to tackle relationships between discourse processing mechanisms, cognitive systems and underlying biological mechanisms. Consideration of the influence of biochemical processes (such as asymmetries of neurotransmitters, endocrine functions, or influence of pharmacological agents) on component processes may add to our insights.

[Cognition, emotion, and behavior. Neuropsychosomatisms and non-neurological paroxysms]

INTRODUCTION

We present neuropsychosomatic disorders diagnosed and treated during the period 1994-1997.

PATIENTS AND METHODS

A total of 83 cases, 24 boys and 59 girls, were selected according to suspected diagnosis. Their ages were in relationship with the psychosomatic disorder. This 83 cases is 10% of neuropediatric assistance in the period. A protocol was designed for disclosing any organic pathology. The psychopedagogic method is based on the PASS theory of intelligence and emotion processing theory of masquerade behavior. The success was defined after a period of, at least, two years of follow-up.

RESULTS

Cephalalgia was the most frequent diagnosis. Language and learning difficulties, attention deficit disorder and pseudo-epilepsy were also frequent. Other diagnoses were: amblyopia, paralysis, pseudo-autism, tic, sphincter disorder, vertigo, mutism and sleep disorder.

DISCUSSION

Concerning differential diagnosis, it must be emphasized that complex partial epilepsy of frontal lobe can mimic psychosomatics disorder as short, less than one minute, automatism. Partial epilepsy of temporal lobe may also mimic psychosomatic disorder but epilepsy does not respond to psychopedagogic remediation. Tumor and migraine must be also disclosed in case of cephalalgia but they do not respond to psychopedagogic remediation. Neurological scientific bases of emotion processing theory are widely explained.

CONCLUSION

Cognition and emotion are functions of the central nervous system so they are competency of neuropediatrician. On the other hand, it is convenient for neuropediatrician to know about behavioral analysis in order to improve diagnosis and economical cost.

Making requests: illustrations of how right-hemisphere brain damage can affect discourse production

This article examines several factors that influence the production of requests for behavior. Using a role-play methodology, we elicited request productions from well-recovered patients with right-hemisphere brain damage (RHD) and from non brain-damaged control participants. The stimulus items represented variation both on interpersonal factors based on characteristics of the people in the interaction and on situational factors based on what was being requested. A large corpus of responses was elicited from each patient. Responses were coded for request directness, amount of explanatory material over and above the request proper (a relatively demanding method for manipulating the tone of a request), and use of "please" (a relatively simple device for signaling a request). Case-by-case analysis of the patients' performances revealed some common areas of abnormality and also some idiosyncratic features. Some patients produced less explanatory supportive material than control participants, and they tended not to vary the amount of explanatory material as a function of the request scenario. Of interest is that some of the same patients overused "please," and varied their use of this simple device as a function of request scenarios. The discourse strategies observed were likely due to deficits both in pragmatic awareness and in planning utterances. One implication of these results concerns an apt description of the abnormal discourse of RHD patients. The relative lack of supportive explanatory material in their requests may result in patients' seeming rude or inappropriate.

Pragmatic assessment and therapy for persons with brain damage: what have clinicians gleaned in two decades?

Pragmatic competence comprises a number of interrelated skills which manifest in real-time in a range of adaptive behaviors and which are driven by underlying cognitive processes that appear to be variably compromised in brain damage. Differential neurological profiles reflect different pragmatic outcomes. The essence of pragmatic assessment and therapy for clinicians is therefore to capture accurately, measure, and, where possible, enhance the ability of the individual to adapt to a changing communicative environment. Assessment measures differ along a number of dimensions. A distinction is drawn between testing and assessment and the argument proposed that for clinical purposes, it is helpful to keep the notions of functional and pragmatic distinct.