Effects of adenotonsillectomy on speech spectrum in children

OBJECTIVE

The vocal tract, which starts from the glottis and extends to the lips is considered to be a resonator for speech production. Enlarged palatine tonsils may cause hypernasal speech, oral breathing or muffled voice. Changes in the structure of this resonator are assumed to modify the speech characteristics. The aim of this study was to evaluate changes in acoustic feature of speech after adenotonsillectomy in children and to establish concepts of management and rational therapeutic approach.

METHODS

Before and after surgery, an acoustic analysis was made to 40 children, aged between 5 and 14 years old, with enlarged palatine tonsils and hypetrophic adenoids. Phonetically balanced sentences were carried out and digitalized with Multi Dimensional Voice Program (MDVP, Kay Elemetrics). As a control group, 40 healthy children were identified. These parameters were estimated: average of fundamental frequency (Fo), Jitt, Shim, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV) and degree of voice breaks (DVB).

RESULTS

After adenotonsillectomy, our data showed an improvement in all the parameters: the analysis of Fo, Jitt, Shim, NHR, VTI, SPI, DUV and DVB showed a postoperative decrease; comparison with healthy children highlighted a postoperative normalization of NHR, VTI and DVB.

CONCLUSIONS

The postoperative improvement of the parameters suggests a reduction of the nasal resonance and the improvement of voice quality. MDVP method may be useful for analyzing speech characteristics, evaluating the effects of surgical excision and therapeutic approach: in selected cases of patients with enlarged tonsils, the decision to perform tonsillectomy depends on its potential positive effect on speech too.

Child maltreatment: a global issue

PURPOSE

This article explains why children with speech and language impairments are at increased risk for having experienced abuse, neglect, and trauma and how maltreatment may vary across cultures.

METHOD

International literature on maltreatment is reviewed in order to provide frameworks for identifying what constitutes maltreatment across cultures; how cultural variations in discipline practices impact maltreatment; and professionals' roles in treatment when they encounter children who have experienced abuse, neglect, or trauma.

CONCLUSION

Speech-language pathologists and audiologists are required to document and report any instance of suspected child abuse. To intervene effectively with children and families from diverse cultures who experience maltreatment, professionals must understand when a practice causes harm and be able to modify childrearing practices in culturally acceptable ways.

Acoustic correlates of inflectional morphology in the speech of children with specific language impairment and their typically developing peers

The development of the use of the third-person singular -s in open syllable verbs in children with specific language impairment (SLI) and their typically developing peers was examined. Verbs that included overt productions of the third-person singular -s morpheme (e.g. Bobby plays ball everyday; Bear laughs when mommy buys popcorn) were contrasted with clearly bare stem contexts (e.g. Mommy, buy popcorn; I saw Bobby play ball) on both global and local measures of acoustic duration. A durational signature for verbs inflected with -s was identified separately from factors related to sentence length. These duration measures were also used to identify acoustic changes related to the omission of the -s morpheme. The omitted productions from the children with SLI were significantly longer than their correct third-person singular and bare stem productions. This result was unexpected given that the omitted productions have fewer phonemes than correctly inflected productions. Typically developing children did not show the same pattern, instead producing omitted productions that patterned most closely with bare stem forms. These results are discussed in relation to current theoretical approaches to SLI, with an emphasis on performance and speech-motor accounts.

Neuropsychology and genetics of speech, language, and literacy disorders

The authors review the neuropsychology, brain bases, and genetics of three related disorders of language development: reading disability, or developmental dyslexia (RD); language impairment (LI); and speech sound disorder (SSD). Over the past three decades, cognitive analysis has demonstrated that the reading difficulties of most children who have RD result from phonologic impairments (difficulties processing the sound structure of language). Although understanding of LI and SSD is somewhat less developed, both disorders are also associated with phonologic impairments, which may account for their comorbidity with RD. Research across levels of analysis is progressing rapidly to promote understanding not only of each disorder by itself but also of the relationships of the three disorders to each other.

The tone production performance of children receiving cochlear implants at different ages

Sixty prelingually deaf children were tested on Cantonese tone production ability at seven time intervals. Results of linear regression showed children in general improved in tone production performance over time. The magnitude of improvement, nevertheless, was different for children implanted at different ages. For children to acquire tone acquisition satisfactory, a critical age of four to receive implant is suggested. Optimally, children should receive their implant before two where they will be able to achieve around 80% accuracy in tone production within 1 yr of implant use. Children received their implant from two to just below 4 yr old achieved high tone production accuracy but needed a longer duration of implant experience. Children who received their implants at the age of 4 yr or older made little, if any, progress in producing tones correctly even after four to 5 yr of implant use.

Characteristics of speech errors produced by children with and without delayed phonological awareness skills

PURPOSE

The purpose of this study was to examine the relationship between the types of speech errors that are produced by children with speech-sound disorders and the children's phonological awareness skills during their prekindergarten and kindergarten years.

METHOD

Fifty-eight children with speech-sound disorders were assessed during the spring of their prekindergarten year and then again at the end of their kindergarten year. The children's responses on the Goldman-Fristoe Test of Articulation (R. Goldman & M. Fristoe, 2000) were described in terms of match ratios for the features of each target sound and the type of error produced. Match ratios and error type frequencies were then examined as a function of the child's performance on a test of phonological awareness.

RESULTS

Lower match ratios for +distributed and higher frequencies of typical syllable structure errors and atypical segment errors were associated with poorer phonological awareness test performance. However, no aspect of the children's error patterns proved to be a reliable indicator of which individual child would pass or fail the test. The best predictor of test performance at the end of the kindergarten year was test performance 1 year earlier. Children who achieved age-appropriate articulation skills by the end of kindergarten also achieved age-appropriate phonological awareness skills.

CONCLUSION

Children who enter kindergarten with delayed articulation skills should be monitored to ensure age-appropriate acquisition of phonological awareness and literacy skills.

Early identification: are speech/language-impaired toddlers at increased risk for Developmental Coordination Disorder?

BACKGROUND

Developmental Coordination Disorder (DCD) is a movement skill disorder which impacts upon a child's ability to perform age-appropriate self-care and academic tasks. DCD is commonly comorbid with speech/language learning disabilities.

AIM

The present study was conducted to determine whether children who had been identified with speech/language delays as toddlers demonstrated characteristics of DCD and/or speech/language problems at kindergarten age.

RESULTS

Speech/language and motor assessments who were followed up at 63-80 months of age. Of the 40 children, 18 showed evidence of significant motor impairment and two-thirds of these met diagnostic criteria for DCD at follow-up. Twelve children were identified as having persistent speech/language problems and, of these, nine presented with significant motor co-ordination difficulties. Parental report of gross motor and fine motor problems at follow-up correlated highly with actual motor impairment scores.

CONCLUSIONS

Young children who are in early intervention programmes for speech/language delays may have significant co-ordination difficulties that will become more evident at kindergarten age when motor deficits begin to impact self-care and academic tasks. Clinical implications for early recognition of motor issues by speech/language pathologists and the potential use of parental reporting tools are addressed.

Children with language problems in a speech and hearing clinic: background variables and extent of language problems

OBJECTIVE

Analysis of a clinical population referred for language analysis in terms of background variables and extent of language problems.

DESIGN

Descriptive study.

MATERIALS AND METHODS

Children referred to a speech and hearing clinic because of assumed language problems were analyzed with standardized tests for language comprehension (Dutch version of the Reynell Developmental Comprehension Scale) and language production (Schlichting test for sentence development). A language problem was defined when the language quotient score differed 1.3S.D. from the mean (quotient scores< or =80). Furthermore, potential risk factors for language problems were compiled (gender, prematurity, birth weight, family composition, familial aggregation, parental education and daycare/home care).

RESULTS

Two hundred forty children, aged between 2 and 5 years of age were included in the study. A reliable language comprehension quotient (LCQ) was obtained in 204 children (85%) and a reliable sentence development quotient (SDQ) in 206 children (85%). In 35% of the children who were assumed to have language problems, adequate language development was found. The children with language problems differed from the children without language problems with regard to language problems in the family (more family aggregation). Also the former more frequently had parents with a low level of education and more often did not attend daycare. The total referred group differed from the Dutch population with regard to gender (more boys), more instances of low birth weight, more parents with middle and high educational level, more two-parent households, fewer siblings, and more frequent attendance at daycare.

CONCLUSION

Parents with a low level of education more frequently have children with language problems. However, parents with a middle and high level of education are more often concerned about the language development of their child. As a consequence, the overestimation of language problems is a real issue in clinical practice. Normal variations in language development often are not considered. The analysis of compiled background variables indicates that language problems are genetically influenced (gender and family aggregation). Language input also is of importance (interactions with a language-competent parent or caregiver and peers): children with language problems less often attended daycare.

The preschool repetition test: an evaluation of performance in typically developing and clinically referred children

PURPOSE

To determine the psychometric properties of the Preschool Repetition (PSRep) Test (Roy & Chiat, 2004), to establish the range of performance in typically developing children and variables affecting this performance, and to compare the performance of clinically referred children.

METHOD

The PSRep Test comprises 18 words and 18 phonologically matched nonwords systematically varied for length and prosodic structure. This test was administered to a typical sample of children aged 2;0-4;0 (n = 315) and a clinic sample of children aged 2;6-4;0 (n = 168), together with language assessments.

RESULTS

Performance in the typical sample was independent of gender and socioeconomic status but was affected by age, item length, and prosodic structure and was moderately correlated with receptive vocabulary. Performance in the clinic sample was significantly poorer but revealed similar effects of length and prosody and similar relations to language measures overall, with some notable exceptions. Test-retest reliability and interrater reliability were high.

CONCLUSION

The PSRep Test is a viable and informative test. It differentiates within and between typical and clinic samples of children and reveals some unusual profiles within the clinic sample. These findings lay the foundations for a follow-up study of the clinic sample for investigation of the predictive value of the test.

Exploring the utility of narrative analysis in diagnostic decision making: picture-bound reference, elaboration, and fetal alcohol spectrum disorders

PURPOSE

To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD).

METHOD

Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance (n = 7) versus average performance (n = 9) on a standardized expressive language task and (b) FASD (n = 16) versus TD (n = 16).

RESULTS

Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736-.991).

CONCLUSION

Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.

Discourse skills of boys with fragile X syndrome in comparison to boys with Down syndrome

PURPOSE

This study compared the conversational discourse skills of boys who have fragile X syndrome with and without autism spectrum disorder (ASD) with those of boys with Down syndrome and boys who are typically developing.

METHOD

Participants were boys who have fragile X syndrome with (n = 26) and without (n = 28) ASD, boys with Down syndrome (n = 29), and boys who are typically developing (n = 22). Turns during an examiner-child interaction consisting of structured and semistructured activities were coded for the boys' ability to maintain a topic of conversation and the frequency of perseveration.

RESULTS

The results revealed that boys who had both fragile X and ASD produced significantly more noncontingent discourse than did boys who had only fragile X, boys with Down syndrome, or typically developing boys. This finding was observed regardless of whether the topic was maintained or changed and whether the turn type was a response or initiation. Regardless of autism status, boys with fragile X used more perseveration than did boys in the other groups.

CONCLUSION

These findings suggest that some aspects of the conversational discourse difficulties attributed to fragile X syndrome may be a function of the high rate of comorbidity between fragile X and autism, whereas some difficulties may be characteristic of fragile X syndrome.

A preliminary study of speech discrimination in youth with Down syndrome

Few studies have examined the ability of individuals with learning disabilities, in general, or with Down syndrome, specifically, to discriminate speech. The purpose of this study was compare the speech discrimination abilities of eight children with Down syndrome (aged 5.7 to 12.8 years) to seven nonverbal mental-age matched controls (aged 4.0 to 5.3 years). A computer program presented the speech discrimination task using a two-cued alternative forced choice procedure. On each trial, the participants heard four successive synthesized speech syllables, with the first and last stimuli being the same and serving as the cue. The results indicated children with Down syndrome differed from their nonverbal mental-age matched peers in their ability to discriminate two of the five pairs, but not in the manner predicted. The relationship between speech discrimination, phonological memory, and speech-language development is also discussed.

Language impairment and sexual assault of girls and women: findings from a community sample

Both children and adults with disabilities face increased prevalence of abuse and assault, including sexual assault. Women and girls are disproportionately the victims of sexual assault in both disabled and nondisabled populations. Communication difficulties have been identified as a factor that may increase the vulnerability of individuals with disabilities to sexual assault. However, few studies have examined whether language impairment increases risk for sexual assault. This study reports on a community sample of children with speech or language impairment, followed to age 25. Sexual assault history was assessed based on two questions from the Composite International Diagnostic Interview Posttraumatic Stress Disorder module. Women with language impairment (n = 33) were more likely than women with unimpaired language (n = 59) to report sexual abuse/assault, controlled for socioeconomic status. Sexual assault was associated with higher rates of psychiatric disorders and poorer functioning. Women with neither language impairment nor a history of sexual assault had fewer psychiatric disorders and higher functioning than women with language impairment and/or a history of sexual assault.

[Asperger syndrome: diagnosis and treatment]

INTRODUCTION AND DEVELOPMENT

Asperger syndrome is a pervasive developmental disorder characterized by social impairments, restricted interests, and repetitive behaviours. It is not associated with delay in language development as others pervasive developmental disorders. Diagnosis should be made based on a complete clinical history and psychological assessment; specific diagnostic instruments are useful.

CONCLUSION

Asperger syndrome has no cure, but clinical features and those secondary to comorbid conditions could improve with an early diagnosis and correct individualized interventions.

Language and motor speech skills in children with cerebral palsy

The aim of the study was to investigate associations between the severity of motor limitations, cognitive difficulties, language and motor speech problems in children with cerebral palsy. Also, the predictive power of neonatal cranial ultrasound findings on later outcome was investigated. For this purpose, 36 children (age range 1 year 10 months to 9 years 0 months) with cerebral palsy due to premature birth and white-matter damage (periventricular leukomalacia) participated in the study. Twenty-two children (62%) had an intelligence level above 70. One-half of this group exhibited motor speech problems. Children with an intelligence level below 70 (n=14, 38%) showed problems in motor speech skills as well as in verbal expressive and comprehensive skills. Neonatal cranial ultrasonography findings were moderately associated with the severity of functional motor limitations.

LEARNING OUTCOMES

Readers will be able to: (1) describe different hypotheses regarding the relationship between language, speech, intelligence level and severity of cerebral palsy, (2) discuss how intelligence and functional motor limitations impact language and speech performance for children with cerebral palsy and (3) discuss the predictability of the ultrasound methodology.

Reaction to background stimulation of preschool children who do and do not stutter

This study investigated the maintenance of attention and adaptation to background stimuli of preschool children who do (CWS) and do not stutter (CWNS). Participants were 13 monolingual, Standard American English speaking, 3-5-year-old CWS and 14 CWNS. Results indicated that CWS were significantly more apt than CWNS to attend to or look at changes in background stimuli, although there were no significant differences between groups in duration and latency of these looks. Findings suggest that preschool CWS are more reactive to, distracted by, and slower to adapt and habituate to environmental stimuli than their CWNS counterparts.

LEARNING OUTCOMES

The reader should be able to: (1) recognize the temperamental differences between CWS and CWNS, (2) define attention reactivity and regulation, (3) explain how attention reactivity and regulation are associated with preschool stuttering, and (4) understand recent empirical evidence relating reactivity and regulation to preschool stuttering.

Atypical behaviors in children with autism and children with a history of language impairment

The frequency, course, and inter-relationships of atypical eating, sleeping, self-injurious behavior, aggression and temper tantrums in children with autism and children with a history of language impairment (HLI), was investigated using a parent interview that was created to examine these problem behaviors. The relationships between these behaviors and language, IQ, severity of autistic symptoms and depression were also assessed. Atypical eating behavior, abnormal sleep patterns, temper tantrums, and self-injurious behavior were significantly more common in the children with autism than those with HLI. Within the autism group, children who exhibited more atypical behaviors tended to have a lower nonverbal IQ, lower levels of expressive language, more severe social deficits and more repetitive behaviors. No relationship between the number of atypical behaviors and measures of cognitive or language ability was noted in the HLI group. However, having more atypical behaviors was related to increased restricted, repetitive behaviors in children with HLI. The atypical behaviors could be divided into two groups: abnormal eating and sleeping, which were independent and tended to begin early in life; and self-injury, tantrums and aggression, which began later and were inter-related. Sleep abnormalities were more common in children (groups combined) diagnosed with major depression.

Nasal consonant production in Broca's and Wernicke's aphasics: speech deficits and neuroanatomical correlates

The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three acoustic measures were analyzed corresponding to different properties of articulatory implementation: murmur duration (a measure of timing), amplitude of the first harmonic at consonantal release (a measure of articulatory coordination), and murmur amplitude over time (a measure of laryngeal control). Results showed that Broca's aphasics displayed impairments in all of these parameters, whereas Wernicke's aphasics only exhibited greater variability in the production of two of the parameters. The lesion extent data showed that damage in either Broca's area or the insula cortex was not predictive of the severity of the speech output impairment. Instead, lesions in the upper and lower motor face areas and the supplementary motor area resulted in the most severe implementation impairments. For the Wernicke's aphasics, the posterior areas (superior marginal gyrus, parietal, and sensory) appear to be involved in the retrieval and encoding of lexical forms for speech production, resulting in increased variability in speech production.

Prosody and voice characteristics of children with cochlear implants

This descriptive, longitudinal study involved the analysis of the prosody and voice characteristics of conversational speech produced by six young children with severe to profound hearing impairments who had been fitted with cochlear implants. A total of 40 samples were analyzed using the Prosody-Voice Screening Profile (PVSP; Shriberg, L. D., Kwiatkowski, J., & Rasmussen, C. (1990). Prosody-Voice Screening Profile (PVSP). Tuscon, AZ: Communication Skill Builders). Overall, the children presented with noticeable problems with stress and resonance quality. There were some difficulties noted with rate, loudness, and laryngeal quality, but there were no consistent difficulties with phrasing or pitch. This suggested that prosody and voice characteristics in this population are different from those typically observed in children with severe to profound hearing impairments though some problem areas remain. Some developmental trends were also observed. These findings suggest that cochlear implants offer some significant benefits to children with hearing impairment in terms of prosody and voice outcomes.

Variation in vocal-motor development in infant siblings of children with autism

In this study we examined early motor, vocal, and communicative development in a group of younger siblings of children diagnosed with autism (Infant Siblings). Infant Siblings and no-risk comparison later-born infants were videotaped at home with a primary caregiver each month from 5 to 14 months, with follow-up at 18 months. As a group, Infant Siblings were delayed in the onset of early developmental milestones and spent significantly less time in a greater number of postures, suggestive of relative postural instability. In addition, they demonstrated attenuated patterns of change in rhythmic arm activity around the time of reduplicated babble onset; and they were highly likely to exhibit delayed language development at 18 months.

Language and communication development in down syndrome

Although there is considerable variability, most individuals with Down syndrome have mental retardation and speech and language deficits, particularly in language production and syntax and poor speech intelligibility. This article describes research findings in the language and communication development of individuals with Down syndrome, first briefly describing the physical and cognitive phenotype of Down syndrome, and two communication related domains-hearing and oral motor skills. Next, we describe language development in Down syndrome, focusing on communication behaviors in the prelinguistic period, then the development of language in children and adolescents, and finally language development in adults and the aging period. We describe language development in individuals with Down syndrome across four domains: phonology, semantics, syntax, and pragmatics. Wethen suggest strategies for intervention and directions for research relating to individuals with Down syndrome.

An acoustic and perceptual study of initial stops produced by profoundly hearing impaired adolescents

This study investigated the role of Voice Onset Time (VOT) as perceptual cue to the aspiration contrast of Cantonese initial stops produced by adolescent profoundly hearing impaired speakers. Speakers with normal hearing signalled the aspiration contrast through VOT differences. Hearing impaired speakers produced initial stops with no significant VOT differences between aspirated and unaspirated stops; the accuracy of perception were above chance level for unaspirated stops but were below chance level for aspirated stops. Discriminant analysis conducted on data from a perceptual task showed that listeners with normal hearing relied on VOT cue for aspiration contrast of initial stops produced by control speakers. By contrast, stops produced by the hearing impaired speakers were not distinguished by listeners on the basis of VOT in that listeners were able to rely on VOT as a perceptual cue only to unaspirated stops, but not to aspirated stops.

Finite verb morphology and phonological length in the speech of children with specific language impairment

Children with specific language impairment (SLI) usually differ from younger peers in their use of grammatical morphemes pertaining to tense and agreement. The word-final consonant status of many of these morphemes has prompted researchers to verify that the children under study are capable of producing these consonants in monomorphemic words (e.g. hand, box). However, such a measure does not ensure that the children with SLI are capable of producing words of sufficient length to support grammatical morpheme use. To examine the possible influence of this factor, we employed Ingram's phonological mean length of utterance (PMLU) as the basis for matching a group of preschoolers with SLI and younger typically developing peers. The children's use of tense/agreement morphemes was then determined. The findings indicated that despite the comparable PMLUs of the two groups, the children with SLI were more limited in their use of tense/agreement morphology than the younger peers.