What influences literacy outcome in children with speech sound disorder?

PURPOSE

In this study, the authors evaluated literacy outcome in children with histories of speech sound disorder (SSD) who were characterized along 2 dimensions: broader language function and persistence of SSD. In previous studies, authors have demonstrated that each dimension relates to literacy but have not disentangled their effects. Methods Two groups of children (86 SSD and 37 controls) were recruited at ages 5-6 and were followed longitudinally. The authors report the literacy of children with SSD at ages 7-9, compared with controls and national norms, and relative to language skill and SSD persistence (both measured at age 5-6).

RESULTS

The SSD group demonstrated elevated rates of reading disability. Language skill but not SSD persistence predicted later literacy. However, SSD persistence was associated with phonological awareness impairments. Phonological awareness alone predicted literacy outcome less well than a model that also included syntax and nonverbal IQ.

CONCLUSIONS

Results support previous literature findings that SSD history predicts literacy difficulties and that the association is strongest for SSD + language impairment (LI). Magnitude of phonological impairment alone did not determine literacy outcome, as predicted by the core phonological deficit hypothesis. Instead, consistent with a multiple deficit approach, phonological deficits appeared to interact with other cognitive factors in literacy development.

Sequelae due to bacterial meningitis among African children: a systematic literature review

BACKGROUND

African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent.

METHODS

We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures) and mortality, by pathogen.

RESULTS

A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequelae (median = 18%, interquartile range (IQR) = 13% to 27%). About a quarter of children surviving pneumococcal meningitis and Haemophilus influenzae type b (Hib) meningitis had neuropsychological sequelae by the time of hospital discharge, a risk higher than in meningococcal meningitis cases (median = 7%). The highest in-hospital case fatality ratios observed were for pneumococcal meningitis (median = 35%) and Hib meningitis (median = 25%) compared to meningococcal meningitis (median = 4%). The 10 post-discharge studies of children surviving bacterial meningitis were of varying quality. In these studies, 10% of children followed-up post discharge died (range = 0% to 18%) and a quarter of survivors had neuropsychological sequelae (range = 3% to 47%) during an average follow-up period of 3 to 60 months.

CONCLUSION

Bacterial meningitis in Africa is associated with high mortality and risk of neuropsychological sequelae. Pneumococcal and Hib meningitis kill approximately one third of affected children and cause clinically evident sequelae in a quarter of survivors prior to hospital discharge. The three leading causes of bacterial meningitis are vaccine preventable, and routine use of conjugate vaccines could provide substantial health and economic benefits through the prevention of childhood meningitis cases, deaths and disability.

Quality of life in mothers of speech impaired children

Today, health-related quality of life (HRQOL) is an important outcome parameter in medicine. As a mother's well-being is important for the development of her child it is assumed that her HRQOL influences her child. In children with developmental disorders mothers may experience a reduction of their HRQOL. This study focused on HRQOL in mothers of speech impaired children. In 91 mothers the SF-36 questionnaire revealed lower scores of all subscales except for 'bodily pain' and 'mental health'. Although the data allow for no conclusion on whether the speech impairment is the reason or the consequence of a reduced HRQOL, the results indicate the necessity to take into account the mothers' well-being when dealing with speech impaired children.

Perceptual analysis of speech and the activity in the lateral pharyngeal walls before and after velopharyngeal flap surgery

The purpose of this study was to investigate the effects of velopharyngeal flap surgery on speech and its relation with the activity in the lateral pharyngeal walls. Videofluoroscopic recordings made before and after operation were used in this retrospective study, which comprised 28 patients who had pharyngeal flap surgery between 5:5 and 14:3 (mean 8:6) years:months of age at the Sahlgrenska University Hospital, Göteborg, Sweden. Twenty-four patients had different types of clefts and four had velopharyngeal impairment (VPI) without a cleft palate. Eleven had additional malformations. Speech and activity in the lateral pharyngeal walls were perceptually preoperatively and postoperatively. The study confirmed that patients with VPI can be helped by a velopharyngeal flap operation. There seemed to be a relation with the activity in the lateral pharyngeal wall and speech. The later the postoperative assessment, the better the speech, but the age at operation did not affect the result. The impact of additional anomalies and syndromes should be investigated further.

Communicative abilities in toddlers and in early school age children with cleft palate

OBJECTIVES

Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate.

METHODS

Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed.

RESULTS

Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%.

CONCLUSIONS

At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.

Cochlear implantation in children with cerebral palsy. A preliminary report

OBJECTIVES

The aim of this study is to assess the post-implantation speech perception and intelligibility of speech produced by five profoundly deaf children with cerebral palsy.

METHODS

This study is derived by a review of a prospectively maintained data collection on all patients entering the cochlear implant program. Five children with cerebral palsy who underwent cochlear implantation participated in this study. Functional outcome was assessed using the Speech Perception Categories and the Speech Intelligibility Rating scale. The follow-up of the series ranged from 12 to 45 months.

RESULTS

At the last follow-up, two children who were placed into speech perception category 1 (detection of a speech signal) preoperatively progressed to category 6 (open-set word recognition with familiar words) postoperatively. Two children moved from preoperative category 2 (pattern perception) to postoperative category 6. One child placed into category 0 (no detection of speech) preoperatively progressed to category 4 (word identification) postoperatively. Before implantation, three children had connected speech unintelligible, and two subjects had connected speech intelligible to a listener who concentrates and lip-reads. At the last follow-up, one child had connected speech unintelligible, two children had connected speech intelligible to a listener who concentrate and lip-reads, one child had connected speech intelligible to a listener who has little experience of a deaf person's speech, and one child had connected speech intelligible to all listeners.

CONCLUSIONS

Cochlear implantation allowed these patients to dramatically improve their quality of life, increasing their self-confidence, independence and social integration.

Brief report: Inner speech impairment in children with autism is associated with greater nonverbal than verbal skills

We present a new analysis of Whitehouse, Maybery, and Durkin's (2006, Experiment 3) data on inner speech in children with autism (CWA). Because inner speech development is thought to depend on linguistically mediated social interaction, we hypothesized that children with both autism and a nonverbal > verbal (NV > V) skills profile would show the greatest inner speech impairment. CWA and typically developing controls (n = 23 in each group) undertook a timed mathematical task-switching test, known to benefit from inner speech use. Participants completed the task with and without articulatory suppression (AS), which disrupts inner speech. The hypothesis was supported: AS interference varied with cognitive profile among CWA but not among controls. Only the NV > V autism group showed no AS interference, indicating an inner speech impairment.

Tongue piercing and speech

OBJECTIVE

The purpose of the present study was to document the possible impact of tongue piercing on speech.

STUDY DESIGN

A questionnaire study and a listener experiment were conducted.

METHODS

Eight participants with a barbell-type piercing placed dorsoventral in the midline of the tongue completed a questionnaire inquiring about possible pre-existing speech-language problems and about the participants' history and experience with the piercing. Three graduate speech-language pathologists evaluated the articulation of the participants. They scored speech samples of the participants reading a text on a 9-point interval scale with "seriously disturbed articulation" (score 1) and "normal articulation" (score 9) as left and right extremes, respectively, once with the piercing in place and once with the piercing removed.

RESULTS

All participants reported having experienced articulation problems immediately after placement of the tongue piercing. These problems lasted from a few days to 1(1/2) months and affected most frequently alveolar and postalveolar consonants. In the listener experiment, articulation was generally judged to be quite normal. Scores assigned to reading with the piercing in place compared with reading with the piercing removed were not significantly different.

CONCLUSION

Individuals considering obtaining a tongue piercing should expect some impact on speech, which is not permanent, however.

[Neuropsychological profiles associated with the children's oral language disorders]

INTRODUCTION

Oral language disorders constitute a group of syndromes with a high prevalence among the childhood population. They form a heterogeneous group that ranges from simple problems in articulating a phoneme (dyslalias) to severe disorders affecting communication, such as children's dysarthrias and aphasias. In this paper our objective is to review the neuropsychological profiles of children who manifest different oral language disorders.

DEVELOPMENT

Due to the wide range of clinical pictures and causations covered by children's oral language disorders, very few systematic reviews have been conducted to obtain an overall view of the neuropsychological profiles of these children. Although the linguistic signs and symptoms of these disorders are well understood, the associated neuropsychological signs and symptoms have not been studied. In some cases, these neuropsychological signs cause greater learning problems in children than the actual language problems themselves.

CONCLUSIONS

Childhood language disorders are associated with different neuropsychological problems. The most commonly associated neuropsychological deficits are problems involving memory, attention, executive functions, motor dysfunctions, temporal perception, tactile recognition, body scheme, spatial orientation and difficulties in visual discrimination. Mnemonic disorders (essentially in short-term and working auditory memory) are usually a common denominator in the different clinical pictures that make up language disorders. The mnemonic impairment associated to dyslalias deserves special attention as this disorder is sometimes similar to that seen in language problems deriving from clinical pictures with important neurological alterations.

Effect of bilateral stimulation of the subthalamic nucleus on different speech subsystems in patients with Parkinson's disease

The effect of deep brain stimulation on the two speech-production subsystems, articulation and phonation, of nine Parkinsonian patients is examined. Production parameters (stop closure voicing; stop closure, VOT, vowel) in fast syllable-repetitions were defined and measured and quantitative, objective metrics of vocal fold function were obtained during vowel production. Speech material was recorded for patients (with and without stimulation) and for a reference group of healthy control speakers. With stimulation, precision of the glottal and supraglottal articulation as well as the phonatory function is reduced for some individuals, whereas for other individuals an improvement is observed. Importantly, the improvement or deterioration is determined not only on the basis of the direction of parameter change but also on the individuals' position relative to the healthy control data. This study also notes differences within an individual in the effects of stimulation on the two speech subsystems. These findings qualify the value of global statements about the effect of neurostimulatory operations on Parkinsonian patients. They also underline the importance of careful consideration of individual differences in the effect of deep brain stimulation on different speech subsystems.

Fundamental frequency development in typically developing infants and infants with severe-to-profound hearing loss

Little research has been conducted on the development of suprasegmental characteristics of vocalizations in typically developing infants (TDI) and the role of audition in the development of these characteristics. The purpose of the present study was to examine the longitudinal development of fundamental frequency (F(0)) in eight TDI and eight infants with severe-to-profound hearing loss matched for level of vocal development. Results revealed no significant changes in F(0) with advances in pre-language vocal development for TDI. Infants with hearing loss, however, showed a statistically reliable higher variability of F(0) than TDI, when age was accounted for as a covariate. The results suggest development of F(0) may be strongly influenced by audition.

Development of oral reading fluency in children with speech or language impairments: a growth curve analysis

This longitudinal study used piece-wise growth curve analyses to examine growth patterns in oral reading fluency for 1,991 students with speech impairments (SI) or language impairments (LI) from first through third grade. The main finding of this study was that a diagnosis of SI or LI can have a detrimental and persistent effect on early reading skills. Results indicated differences between subgroups in growth trajectories that were evident in first grade. A large proportion of students with SI or LI did not meet grade-level reading fluency benchmarks. Overall students with SI showed better performance than students with LI. Reading fluency performance was negatively related to the persistence of the SI or LI; the lowest performing students were those originally identified with SI or LI whose diagnosis changed to a learning disability. The results underscore the need to identify, monitor, and address reading fluency difficulties early among students with SI or LI.

Speech production in 12-month-old children with and without hearing loss

PURPOSE

The purpose of this study was to compare speech production at 12 months of age for children with hearing loss (HL) who were identified and received intervention before 6 months of age with those of children with normal hearing (NH).

METHOD

The speech production of 10 children with NH was compared with that of 10 children with HL whose losses were identified (better ear pure-tone average at 0.5, 1, and 2 kHz poorer than 50 dB HL) and whose intervention started before 6 months of age. These children were recorded at 12 months of age interacting with a parent. Three properties of speech production were analyzed: (a) syllable shape, (b) consonant type, and (c) vowel formant frequencies.

RESULTS

Children with HL had (a) fewer multisyllable utterances with consonants, (b) fewer fricatives and fewer stops with alveolar-velar stop place, and (c) more restricted front-back tongue positions for vowels than did the children with NH.

CONCLUSION

Even when hearing loss is identified shortly after birth, children with HL do not develop speech production skills as their peers with NH do at 12 months of age. This suggests that researchers need to consider their approaches to early intervention carefully.

Executive dysfunction and its association with personality and behaviour changes in the development of Alzheimer's disease in adults with Down syndrome and mild to moderate learning disabilities

BACKGROUND

Recent research suggests that preclinical Alzheimer's disease (AD) in people with Down syndrome (DS) is characterized by changes in personality/behaviour and executive dysfunction that are more prominent than deterioration in episodic memory. This study examines the relationship between executive dysfunction and the clinical and preclinical features of AD in DS. To determine the specificity of this relationship, performance on executive function (EF) measures is contrasted with performance on memory measures.

METHODS

One hundred and three people with DS (mean age 49 years, range 36-72) with mild to moderate learning disabilities (LD) took part. Dementia diagnosis was based on the CAMDEX informant interview conducted with each participant's main carer. Reported changes in personality/behaviour and memory were recorded. Participants completed six EF and six memory measures (two of which also had a strong executive component) and the BPVS (as a measure of general intellectual ability). First, performance was compared between those with and without established dementia of Alzheimer's type (DAT), controlling for age and LD severity using ANCOVA. Next, the degree to which informant-reported changes predicted cognitive test performance was examined within the non-DAT group using multiple regression analyses.

RESULTS

The DAT group (N=25) showed a consistent pattern of impaired performance relative to the non-DAT group (N=78), across all measures. Within the non-DAT group, number of informant-reported personality/behaviour changes was a significant predictor of performance on two EF and two 'executive memory' tests (but not on episodic memory tests). Informant-reported memory changes, however, were associated with impaired performance on a delayed recall task only.

CONCLUSIONS

These findings provide further evidence for a specific impairment in frontal-lobe functioning in the preclinical stages of AD in DS. Implications for the assessment, diagnosis, and management of dementia in DS are discussed.

Speech disruptions in the narratives of English-speaking children with specific language impairment

PURPOSE

This study examined the types, frequencies, and distribution of speech disruptions in the spoken narratives of children with specific language impairment (SLI) and their age-matched (CA) and language-matched (LA) peers.

METHOD

Twenty 4th-grade children with SLI, 20 typically developing CA children, and 20 younger typically developing LA children were included in this study. Speech disruptions (i.e., silent pauses and vocal hesitations) occurring in the narratives of these children were analyzed.

RESULTS

Children with SLI exhibited speech disruption rates that were higher than those of their age-matched peers but not higher than those of their language-matched peers. The difference in disruption rates between the SLI and CA groups was restricted to silent pauses of 500-1000 ms. Moreover, children with SLI produced more speech disruptions than their peers before phrases but not before sentences, clauses, or words.

CONCLUSIONS

These findings suggest that there is a relationship between language ability and speech disruptions. Higher disruption rates at phrase boundaries in children with SLI than in their age-matched peers reflect lexical and syntactic deficits in children with SLI.

Characterizing the growth trajectories of language-impaired children between 7 and 11 years of age

BACKGROUND

A number of different systems have been suggested for classifying language impairment in children but, to date, no one system has been widely accepted.

METHOD

This paper outlines an alternative system looking for distinct patterns of change in receptive language skills across time, involving a secondary analysis of children identified as having specific language impairment. Participants The participants were 184 children age-assessed at 3 time points--7, 8, and 11 years of age.

RESULTS

The pattern of receptive language development is highly predictable. The dominant pattern of growth is consistent with declining rates of growth over time for all children. The primary way in which the children differ is with respect to their initial severity. The testing of the 2 classification systems revealed some statistically significant differences among the subtypes with regard to the shape of the growth rates, but the effect sizes associated with these differences were very small. Thus, it is possible to conclude that beyond the dominant pattern of growth, some subtypes of language impairment at 7 years of age showed only subtle differences in receptive language change across time. The results are discussed in terms of the sample selection and the age of the children who were studied.

Verbal fluency dysfunction in euthymic bipolar patients: a controlled study

OBJECTIVE

To study the executive functioning in euthymic bipolar patients in comparison to healthy controls and to examine the relationship between neuropsychological deficits and clinical variables.

METHODS

Twenty-five euthymic bipolar patients and 31 controls underwent a battery of executive tasks including mental flexibility, inhibitory control and verbal fluency tests.

RESULTS

There were no significant differences between bipolar patients and controls in relation to mental flexibility and inhibitory control. However, patients performed worse than controls on verbal fluency tests. Poor performances on the Stroop Test and the Hayling and Brixton Tests--part A were associated to lifetime occurrence of psychotic symptoms, prior number of episodes, and previous hospitalizations.

CONCLUSIONS

In our study, only verbal fluency tests differentiated bipolar euthymic patients from healthy controls. Patients who showed deficits in information processing speed and inhibitory control had more episodes and hospitalizations and lifetime occurrence of psychotic symptoms.

Unilateral and mild bilateral hearing loss in children: past and current perspectives

Since the early 1980s, audiologists have become increasingly aware of the potential effect of even mild degrees of hearing loss on the psychoeducational and psychosocial outcomes of children. This review describes some of the key research findings during the past several decades that have led us to our current thinking about unilateral and mild bilateral hearing loss in children. The first section addresses unilateral hearing loss. This is followed by a review of the literature on mild bilateral hearing loss. Specifically, the issues addressed include the significance of permanent mild degrees of hearing loss on children's psychoeducational and psychosocial development and the speech, language, and auditory characteristics of children with mild degrees of hearing loss. Finally, some recommendations regarding the direction of future research are offered. This review is followed by 2 articles summarizing the proceedings of a 2005 workshop convened by the Centers for Disease Control and Prevention (CDC), Early Hearing Detection and Intervention (EHDI) program, and the Marion Downs Hearing Center to address concerns about the underidentification of-- and professionals' apparent lack of awareness of-- permanent unilateral and minimal to mild hearing loss in children.

Listeners' perceptions of speech and language disorders

Using semantic differential scales with nine trait pairs, 445 adults rated five audio-taped speech samples, one depicting an individual without a disorder and four portraying communication disorders. Statistical analyses indicated that the no disorder sample was rated higher with respect to the trait of employability than were the articulation, voice, and language disorder conditions; and higher in self-esteem than the fluency, voice, and language disorders. In addition, there were differences among the disorders. Most notably, the language disordered condition was rated significantly lower in decisiveness and reliability and higher in stress level than all other conditions. Within-subject analyses indicated that the variables of age, gender, exposure to individuals with communication disorders, and urban versus rural residency did not affect ratings. These results support previous research indicating the existence of negative stereotypes toward individuals with communication disorders. In addition, they reveal differences in how various disorders were perceived.

LEARNING OUTCOMES

Participants will be able to: (1) identify the different methods investigators have used to examine perceptions toward individuals with communicative disorder, (2) recognize that there are differences in how the various communicative disorders are perceived, and (3) discuss the need for public education in order to dispel stereotypes associated with communicative disorders.

Speech fluency in fragile X syndrome

The present study investigated the dysfluencies in the speech of nine French speaking individuals with fragile X syndrome. Type, number, and loci of dysfluencies were analysed. The study confirms that dysfluencies are a common feature of the speech of individuals with fragile X syndrome but also indicates that the dysfluency pattern displayed is not identical to developmental stuttering. To what extent the pattern of dysfluency in individuals with fragile X syndrome is syndrome specific is not yet clear.

Voice Parameters in Children With Down Syndrome

Down syndrome (DS) is the most frequent chromosomal disorder. Commonly, individuals with DS have difficulties with speech and show an unusual quality in the voice. Their phenotypic characteristics include general hypotonia and maxillary hypoplasia with relative macroglossia, and these contribute to particular acoustic alterations. Subjective perceptual and acoustic assessments of the voice (Praat-4.1 software) were performed in 66 children with DS, 36 boys and 30 girls, aged 3 to 8 years. These data were compared with those of an age-matched group of children from the general population. Perceptual evaluations showed significant differences in the group of children with DS. The voice of children with DS presented a lower fundamental frequency (F(0)) with elevated dispersion. The conjunction of frequencies for formants (F(1) and F(2)) revealed a decreased distinction between the vowels, reflecting the loss of articulatory processing. The DS vocalic anatomical functional ratio represents the main distinctive parameter between the two groups studied, and it may be useful in conducting assessments.

Children with comorbid speech sound disorder and specific language impairment are at increased risk for attention-deficit/hyperactivity disorder

This study focuses on the comorbidity between attention-deficit/hyperactivity disorder (ADHD) symptoms and speech sound disorder (SSD). SSD is a developmental disorder characterized by speech production errors that impact intelligibility. Previous research addressing this comorbidity has typically used heterogeneous groups of speech-language disordered children. This study employed more precise speech-language diagnostic criteria and examined ADHD symptomatology in 108 SSD children between the ages of 4 and 7 years old with specific language impairment (SLI) (n = 23, 14 males, 9 females) and without SLI (n = 85, 49 males, 36 females). We also examined whether a subcategory of SSD, persistent (n = 39, 25 males, 14 females) versus normalized SSD (n = 67, 38 males, 29 females), was associated with ADHD and/or interacted with SLI to predict ADHD symptomatology. Results indicated that participants in the SSD + SLI group had higher rates of inattentive ADHD symptoms than those in the SSD-only and control groups. In addition, an unexpected interaction emerged such that children with SLI and normalized-SSD had significantly higher ADHD inattentive ratings than the other subgroups. A proposed explanation for this interaction is discussed.