The auditory performance in children using cochlear implants: effects of mental function

OBJECTIVE

Mental function is considered to affect the post-operative outcomes of deaf children with cochlear implants. The purpose of this study is to evaluate the effect of mental function on the auditory performance in children with cochlear implants.

METHODS

In a retrospective review of data, 26 pre-lingual deafened children received pre-operative evaluation of mental function and were divided into normal and retarded groups. Categories of auditory performance scale (CAP) was conducted at 1-year intervals after implantation. ANCOVA was used for statistic analysis.

RESULTS

The average scores of auditory performance in normal group (n=14) were 3.93 (S.D. 1.07) and 5.86 (S.D. 0.95) at 1- and 2-year post-implantation. While the average scores in the retarded group were 2.5 (S.D. 1.51) and 4.17 (S.D. 1.85), both groups demonstrated obvious improvement in speech perception (F 103.12, P<0.001) during the first 2 post-operative years. The auditory performance in the normal group was significantly superior to the retarded group (F 8.67, P<0.01). However, the interaction between the duration of the device use and mental status showed no significant difference in the auditory perception performance (F 1.575, P=0.222).

CONCLUSIONS

The results revealed the mental function plays as one of the predictive parameters of auditory performance in profoundly hearing impaired children after cochlear implantation.

Validity of childhood disintegrative disorder apart from autistic disorder with speech loss

In order to test clinical validity of DSM-IV childhood disintegrative disorder (CDD), 10 CDD children (mean age = 8.2 years, SD = 3.8; 7 male and 3 female) and 30 age- and gender-matched children with DSM-IV autistic disorder (AD) with speech loss (SL) (ADSL) were compared on 24 variables not directly related to CDD criteria. Compared with the ADSL children, the CDD children showed fearfulness significantly more frequently during the period of SL; displayed epilepsy significantly more frequently and stereotypy significantly more prominently at first visit on average about 6 years after SL; and had significantly less uneven intellectual profile at first visit to support the validity of CDD to a certain extent. No significant difference in the retardation level at first visit between the two groups suggested no worse short-term outcome in CDD than ADSL, although a long-term prospective study to compare them from infancy is needed.

[Speech impaired children. Anxiety, depression and quality of life of the mothers]

BACKGROUND

It is widely held that the well being of a mother significantly influences the way she brings up her child: Mothers with depression speak less to their child than healthy mothers do and so their emotional disorder has to be regarded an important cofactor for their child's speech development. On the other hand it is suspected that a mother's well being and quality of life may be influenced by her child especially in cases when the child suffers from impairment or developmental disturbance. As literature provides only little information on this topic the purpose of this study was to estimate both health related quality of life HRQOL and distinctive emotional reactions i.e. depression and anxiety in mothers of children with a speech developmental disorder.

MATERIALS AND METHODS

100 mothers (age 33.4+/-5.3 years, range: 22 to 47 years) of 100 preschool children (32 girls, 68 boys; age 4.2+/-1.5 years, range 1;3 to 7;7 years) with a speech impairment were investigated. Mothers of children with cochlear hearing loss, syndromes or other developmental disorders were excluded from the study. To estimate the prevalence of anxiety disorders and depression in the mothers the German version of the Hospital Anxiety and Depression Scale (HADS) was used. Data from 157 healthy women from the German test manual served as controls. HRQOL was assessed by the SF-36 questionnaire with age matched normal controls taken from the German test manual. Microsoft((R)) Excel and Matlab((R)) software packages were used for description, analysis, and evaluation. The differences in prevalence rates were tested by chi(2)-test and Wilcoxon's rank sum test.

RESULTS

Assessed by the HADS-depression subscale 11% of the mothers of speech impaired children met criteria for depression compared to 2.5% in the control group. The prevalence in the study group was significantly higher ( p<0.01). The prevalence of anxiety disorders did not differ from normative data on a significant level ( p>5%). The SF-36 questionnaire revealed lower scores of most SF-36 subscales on different significance levels. The results of both tests correlated on a statistically significant level.

CONCLUSIONS

Screening mothers of speech impaired children for a "soft" parameter like HRQOL and for epidemiologically relevant emotional disorders like depression and anxiety is of significant clinical interest. The SF-36 and the HADS are suitable tests. As the results of both tests are highly correlated for clinical purposes it seems reasonable to focus on depression and anxiety only. Up to now no data exist about how fathers of speech impaired children react emotionally, so this question has to be focused on in future. Although data allow no conclusion on whether the speech impairment is the reason or the consequence of a reduced HRQOL or an emotional disorder the results clearly indicate the necessity to take into account the mothers' well being when dealing with speech impaired children.

Co-occurrence of developmental delays in a screening study of 4-year-old Finnish children

The aim of this population study was to examine the severity and prevalence of co-occurring developmental delays in 4-year-old children, the rate of overlapping problems, and sex differences. A sample of 434 children (196 males, 238 females; mean age 4 years 3 months, SD 1 month) were administered the 'Lene' test: a comprehensive neurodevelopmental screening test. Results suggest that co-occurrence of attention-behavioural, motor-perceptual, and language delays occurring in school-aged children could already be detected at the age of 4 years. Isolated delays were usually mild, but co-occurring difficulties were mostly moderate or severe. Overlap between developmental delays depended on the severity of the problems. It emerged that males had more severe and more often co-occurring problems than females. Co-occurrence of developmental delays as a risk factor at the early stage of development is discussed.

Children with speech and language disability: caseload characteristics

BACKGROUND

There has been no previous incidence survey of children referred to a speech and language therapy service in the UK. Previous studies of prevalence of specific communication difficulties provide contradictory data from which it is difficult to plan speech and language therapy service provision. Reliable data are needed concerning the nature and severity of impairments as well as the age and source of referral and the effects of cultural and socio-economic profiles of the population served.

AIMS

To describe referrals received between January 1999 and April 2000 by the paediatric speech and language therapy service of Middlesborough Primary Care Trust, an area of social deprivation.

METHODS & PROCEDURES

All referrals were offered an initial assessment appointment within 8 weeks of referral. Standardized tests and quantitative measures of communication difficulties, determined by age, were undertaken. Population and case history information was also gathered.

OUTCOMES & RESULTS

The incidence rate of referrals who attended for assessment in a single year was calculated as 16.3% for primary communication disability and 14.6% for speech/language disability. Of the 1100 referrals, 14.9% failed to attend and 9.8% had normal functioning. The distribution of disorder type was dysfluency 5.3%, voice or nasality disruption 2.0%; receptive language difficulties 20.4%, expressive language difficulties 16.9% and speech difficulties 29.1%. A further 0.7% had special educational needs and 0.9% had speech and language impairment but refused consent. The majority of referrals were between 2 and 6 years old, more boys than girls were referred, and socio-economic status matched that of the local population. Both gender and socio-economic status affected diagnosis.

CONCLUSIONS

Based on the Middlesborough data, the estimated national incidence rate of referrals who attend for assessment and who have speech and language disability is 85 000-90 000 children per year (14.6% of births). While findings from only one Primary Care Trust must be treated cautiously, they provide paediatric speech and language therapy services managers with information that might guide service planning.

Preliminary study of the prevalence of speech and language difficulties in young offenders

BACKGROUND

There are no systematic surveys of the UK prison population, but data from several sources suggest that a significant number of prisoners might have limitations in their speech, language and communication abilities.

AIM

To examine the hypothesis that compared with the general population, a significantly larger number of the prison population has speech, language and communication difficulties.

METHODS & PROCEDURES

A survey of 10% of the young offenders within one young offender's institution was conducted. Tests of naming, picture description, grammatical competency and comprehension were used.

OUTCOMES & RESULTS

Forty-three per cent of participants scored at a level significantly lower than the limits acceptable for their age on the Boston Naming Test; 73% scored significantly below the acceptable limits for their age on grammatical competency; 23% scored significantly below the acceptable limits for their age on language comprehension; 47% of participants received more than one rating of moderate impairment on picture description.

CONCLUSION

It was confirmed that high levels of speech, language and communication difficulties are found among the young offender population. The implications for the management of young offenders, the limitations of the study and indications for further research are discussed.

Outcome in patients with profound biotinidase deficiency: relevance of newborn screening

Profound biotinidase deficiency (PBD) is an autosomal recessively inherited disorder of biotin metabolism, which can be detected by newborn screening and treated with biotin supplementation. Children were investigated in whom PBD was detected by newborn screening and who were treated presymptomatically, or who were not screened but were diagnosed and treated after experiencing initial clinical symptoms (symptomatic children). In a follow-up of our study group, differences in development, social and behavioural adaptation, and signs of residual impairment were examined. Parents and physicians of children with PBD completed questionnaires which included the Child Behavior Checklist and Vineland Adaptive Behavior Scales. Information was obtained for 37 children (24 males, 13 females; median age at recruitment 6 years 8 months, range to 6 months-20 years; median length of follow-up 6 years 6 months, range 5 months to 18 years 3 months). All 11 symptomatic children had residual enzyme activity of <1%, or variants of the Michaelis-Menten constant which were not detected by newborn screening. Some symptomatic children showed residual impairments: hearing impairment (n=2), optic atrophy (n=2), both hearing impairment and optic atrophy (n=2). In addition, symptomatic children had a higher risk of delayed motor and speech development. No child with PBD detected by newborn screening (n=25) had auditory or visual loss; and milestones of speech development and motor skills were reached at an appropriate age. There was no significant difference in social adaptation or behavioural problems between symptomatic and asymptomatic children. Symptomatic children often have developmental delay and are at risk of irreversible damage to auditory, visual, or central nervous functions; whereas children with PBD (established presymptomatically following newborn screening) treated with biotin supplementation, do not experience these effects.

Pediatricians' opinions about otitis media and speech-language-hearing development

Twenty-five pediatricians responded to a confidential survey about their opinions on the relationship between otitis media and children's speech-language-hearing status. Results found that pediatricians did not necessarily agree that otitis media has an impact on speech-language-hearing development. Pediatricians reported that an early otitis media onset (birth to age 2) affects speech-language development, but they also reported that parents and daycare environments could mitigate any otitis media effect. Pediatricians reported a possible otitis media impact on hearing status, but they did not necessarily agree that an otitis media history required referral for audiological testing. Clinical implications are discussed for collaboration among pediatricians, speech-language pathologists, and audiologists.

LEARNING OUTCOMES

(1) The reader will become familiar with pediatricians' opinions about the impact of otitis media on speech-language development. (2) The reader will become familiar with strategies to support interdisciplinary collaboration between pediatricians, speech-language pathologists, and audiologists.

Chronic physical health conditions and disability among Canadian school-aged children: a national profile

OBJECTIVE

The objective of this study was to provide a national health and disability profile of Canadian school-aged children based on the World Health Organization's definitions of health condition and disability that would facilitate international comparisons of child health data.

METHODS

Data were used from the National Longitudinal Survey of Children and Youth, a 1994 - 95 population-based sample of 22 831 children.

FINDINGS

An estimated total of 30.3% of Canadian children aged 6 to 11 had one or more chronic physical health conditions/impairments, while 3.6% had activity-limiting conditions/impairments. Children living with one parent were significantly more likely to have activity-limiting conditions/impairments than those living with two parents. Children with conditions/impairments, particularly those with activity limitations, were significantly more likely than children without health problems to have experienced mental health conditions and learning disabilities, missed school days, received special education, visited health professionals, been hospitalized, and used prescription medication.

CONCLUSION

Important differences were found among children in a number of areas as a function of overall physical health status. The findings emphasize the importance of measuring activity limitations distinctly from chronic conditions and impairments, and, perhaps, of measuring impairments distinctly from chronic conditions, and of comparing children with such health problems to children without health problems in order to obtain a more accurate picture of the impact of health on children's lives. The World Health Organization's distinct definitions of health condition and disability facilitate a dimensional approach for describing child health that can serve to clarify this field of study and improve comparability of data across countries.

Catastrophic injuries in high school and college baseball players

BACKGROUND

There are few epidemiologic studies of catastrophic baseball injuries.

PURPOSE

To develop a profile of catastrophic injuries in baseball players and to describe relevant risk factors.

STUDY DESIGN

Retrospective cohort study.

METHODS

The authors reviewed 41 incidents of baseball injuries reported to the National Center for Catastrophic Sports Injury Research from 1982 until 2002.

RESULTS

There were an estimated 1.95 direct catastrophic injuries per year, or 0.43 injuries per 100,000 participants. The most common mechanisms of injury were a collision of fielders (9) or of a base runner and a fielder (8), a pitcher hit by a batted ball (14), and an athlete hit by a thrown ball (4). Catastrophic injuries included 23 severe head injuries, 8 cervical injuries, 3 cases of commotio cordis, and 2 cases each of a collapsed trachea and facial fractures. Three athletes sustained a severe head injury and facial fractures. Ten of the 41 injuries were fatalities.

CONCLUSIONS

Suggestions for reducing catastrophic injuries in baseball include teaching proper techniques to avoid fielding and baserunning collisions, protecting the pitcher via a combination of screens and/or helmets with faceguards, continued surveillance and modifications of the bat and ball, eliminating headfirst slides, and continued analysis of chest protectors and automatic external defibrillators for commotio cordis.

Complications of otitis media before placement of tympanostomy tubes in children

OBJECTIVES

To report the incidence of short-term complications from otitis media in children before placement of tympanostomy tubes (TTs) and to compare children treated according to the Agency for Health Care Policy and Research guidelines with those who were treated earlier or later than recommended.

DESIGN

Retrospective outcomes review.

PATIENTS

Subjects were children aged 10 or younger who had TTs inserted at a tertiary care county hospital from January 1, 1999, to December 31, 2000. Exclusion criteria included prior TT placement, any concurrent head and neck procedure, and craniofacial defects.

INTERVENTION

Tympanostomy tube placement.

MAIN OUTCOME MEASURES

Any occurrences of otorrhea, tympanic membrane perforation, tinnitus, antibiotic reactions, speech or language delay, febrile seizures, or meningitis before placement of TTs documented in the county hospital records were recorded as complications. Hearing loss was considered separately.

RESULTS

Of 147 children who met our criteria, 81 (55.1%) had 1 or more complications from otitis media before placement of TTs. Fifty-five (37.4%) had 2 to 6 complications documented. Adverse reactions to antibiotics were the most common complication, reported in 34 (23.1%).

CONCLUSIONS

Most children in this county hospital experienced short-term complications of otitis media before receiving TTs. Even the children treated "on time" according to the guidelines from the Agency for Health Care Policy and Research experienced complications; however, adherence to the guidelines had no significant effect on complications.

Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS)

We aimed to develop and validate a novel rating scale for multiple system atrophy (Unified Multiple System Atrophy Rating Scale-UMSARS). The scale comprises the following components: Part I, historical, 12 items; Part II, motor examination, 14 items; Part III, autonomic examination; and Part IV, global disability scale. For validation purposes, 40 MSA patients were assessed in four centers by 4 raters per center (2 senior and 2 junior raters). The raters applied the UMSARS, as well as a range of other scales, including the Unified Parkinson's Disease Rating Scale (UPDRS) and the International Cooperative Ataxia Rating Scale (ICARS). Internal consistency was high for both UMSARS-I (Crohnbach's alpha = 0.84) and UMSARS-II (Crohnbach's alpha = 0.90) sections. The interrater reliability of most of the UMSARS-I and -II items as well as of total UMSARS-I and -II subscores was substantial (k(w) = 0.6-0.8) to excellent (k(w) > 0.8). UMSARS-II correlated well with UPDRS-III and ICARS (rs > 0.8). Depending on the degree of the patient's disability, completion of the entire UMSARS took 30 to 45 minutes. Based on our findings, the UMSARS appears to be a multidimensional, reliable, and valid scale for semiquantitative clinical assessments of MSA patients.

Verbal Deficits and Disruptive Behavior Disorders among Children of Opiate-Dependent Parents

In order to explore the association between verbal deficits and disruptive behavior disorders among children of addicted parents, 283 6-17-year-old children and their opiate-dependent parents completed diagnostic interviews and standardized measures of vocabulary. Unexpectedly, racial differences in the scores confounded the exploration of the relationship between cognitive scores and disruptive behavior disorders. An interaction between disruptive behavior disorder and race is explored; among Caucasian youths, low verbal scores are associated with disruptive behavior disorders, but this association was not found among African- and Hispanic-American youths. Further analysis and research are needed to understand the clinical significance of relationships between verbal deficits and disruptive behavior disorders within racially diverse groups.

Outcomes for Children with Submucous Cleft Palate and Velopharyngeal Insufficiency

OBJECTIVE

To review the outcomes of children with submucous cleft palate who also have velopharyngeal insufficiency (VPI).

METHODS

A retrospective chart review was carried out at a tertiary care academic centre of all patients who had VPI with a submucous cleft palate. The University of Iowa Cleft Palate registry parameters encompassing nasality (hyper- and hyponasality) were compared pre- and postoperatively.

RESULTS

Preliminary results demonstrate a significant, stable improvement in children who underwent palatal surgery for VPI.

CONCLUSION

Positive outcomes in the treatment of VPI in the submucous cleft palate population were demonstrated with a combined approach of speech therapy and palatal surgery.

The influence of long-term tracheostomy on speech and language development in children

BACKGROUND

Individuals diagnosed as having primary neurological disorders have a high incidence of abnormal speech and language development. However, results in cohorts where this group are excluded are controversial. With no coexisting neurological impairment, some suggested that tracheostomy has little influence on speech development, whilst others showed a clear pattern of language disability. The aim of this study is to evaluate the influence of tracheostomy on speech and language development.

METHOD

Retrospective study using standardised outcome measures.

RESULTS

A series of 39 paediatric tracheostomies was studied. In the group where children had neurological disorders, 94% showed no language or delayed language development. In contrast, of the group of children without a neurological impairment, 60.9% had normal speech and language development. The median age at the decannulation in those children with delayed speech was 23 months, whilst in those children with normal speech it was 14.5 months.

CONCLUSION

Tracheostomy affects speech and language development in those with and without neurological disorders. Crucial factors affecting speech and language development within the neurologically normal group are age at the tracheostomy, and the duration of the tracheostomy until decannulation. Achieving earliest decannulation improves the chance of a normal speech and language development.

Co-occurring disorders in children who stutter

This study used a mail survey to determine the (a) percentage of children who stutter with co-occurring non-speech disorders, speech disorders, and language disorders, and (b) frequency, length of sessions, and type of treatment services provided for children who stutter with co-occurring disorders. Respondents from a nationwide sample included 1184 speech-language pathologists (SLPs). Of the 2628 children who stuttered, 62.8% had other co-occurring speech disorders, language disorders, or non-speech-language disorders. Articulation disorders (33.5%) and phonology disorders (12.7%) were the most frequently reported co-occurring speech disorders. Only 34.3% of the children who stuttered had co-occurring non-speech-language disorders. Of those children with co-occurring non-speech-language disorders, learning disabilities (15.2%), literacy disorders (8.2%), and attention deficit disorders (ADD) (5.9%) were the most frequently reported. Chi-square analyses revealed that males were more likely to exhibit co-occurring speech disorders than females, especially articulation and phonology. Co-occurring non-speech-language disorders were also significantly higher in males than females. Treatment decisions by SLPs are also discussed.

LEARNING OUTCOMES

As a result of this activity, the participant should: (1) have a better understanding of the co-occurring speech disorders, language disorders, and non-speech disorders in children who stutter; (2) identify the speech disorders, language disorders, and non-speech disorders with the highest frequency of occurrence in children who stutter; and (3) be aware of the subgroups of children with co-occurring disorders and their potential impact on assessment and treatment.

A chart review study of the inattentive and combined types of ADHD

Studies of the clinical correlates of the subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD) have identified differences in the representation of age, gender, prevalence, comorbidity, and treatment. We report retrospective chart review data detailing the clinical characteristics of the Inattentive (IA) and Combined (C) subtypes of ADHD in 143 cases of ADHD-IA and 133 cases of ADHD-C. The children with ADHD-IA were older, more likely to be female, and had more comorbid internalizing disorders and learning disabilities. Individuals in the ADHD-IA group were two to five times as likely to have a referral for speech and language problems. The children with ADHD-IA were rated as having less overall functional impairment, but did have difficulty with academic achievement. Children with ADHD-IA were less likely to be treated with stimulants. One eighth of the children with ADHD-IA still had significant symptoms of hyperactivity/impulsivity, but did not meet the DSM-IV threshold for diagnosis of ADHD-Combined Type. The ADHD-IA subtype includes children with no hyperactivity and children who still manifest clinically significant hyperactive symptomatology but do not meet DSM-IV criteria for Combined Type. ADHD-IA children are often seen as having speech and language problems, and are less likely to receive medication treatment, but respond to medical treatment with improvement both in attention and residual hyperactive/impulsive symptoms.

Response-shift bias and parent-reported quality of life in children with otitis media

OBJECTIVES

To validate the 6-item quality-of-life survey (OM-6) and to investigate response-shift bias regarding children with otitis media.

SETTING

Otorhinolaryngology department of a university hospital that serves the southernmost part of the Netherlands.

PATIENTS

Seventy-seven children (age range, 12-38 months) experiencing persistent otitis media with effusion and scheduled for placement of tympanostomy tubes.

SURVEY

The OM-6 measures health-related quality of life in 6 domains: physical suffering, hearing loss, speech impairment, emotional distress, activity limitations, and caregiver concerns.

INTERVENTION

Parents completed the OM-6 before surgery (pretest) and 6 weeks after surgery (posttest). At the posttest, parents also completed a retrospective version of the pretest (retrospective pretest).

RESULTS

For most items, the test-retest reliability was good (R>0.8). The internal consistency of the OM-6 was satisfactory (alpha =.79). The construct validity, determined by correlating the ear-related global quality-of-life measure and the OM-6 summary score, was fair (R = -0.77, P<.01). Prospective change in quality of life on the OM-6 ranged from moderate (standardized response mean >/=0.5) to large (standardized response mean >/=0.8). Response-shift bias was present at the group level (t = -3.3, P<.01). Retrospective change was significant for hearing loss (z = -3.3, P<.05) and ear-related global quality of life (z = -3.6, P<.05).

CONCLUSIONS

The validity of the OM-6 has been proved in a Dutch population. The data suggest that parents underestimate the seriousness of hearing loss and overestimate the quality of life of their child before surgery, indicating a response shift. Treatment results could lead parents to realize that the situation before surgery had been worse than they thought.

Comparability of perceptual analysis of speech characteristics in Australian and Swedish speakers with multiple sclerosis

The aims of the present study were to compare the perceptual assessments of deviant speech signs (dysarthria) exhibited by Australian and Swedish speakers with multiple sclerosis (MS) and to explore whether judgements of dysarthria differed depending on whether the speakers and the judges spoke the same or different languages. Ten Australian and 10 Swedish individuals with MS (matched as closely as possible for age, gender, progression type and severity of dysarthria) were assessed by 2 Australian and 2 Swedish clinically experienced judges using a protocol including 33 speech parameters. Results show that the following perceptual dimensions were identified by both pairs of judges in both groups of speakers to a just noticeable or moderate degree: imprecise consonants, inappropriate pitch level, reduced general rate, and glottal fry. The reliability (Spearman rank-order correlation) of the consensus ratings from the Australian and the Swedish judges was high, with a mean rho of 85.7 for the Australian speakers and mean rho of 84.3 for the Swedish speakers. The most difficult perceptual parameters to assess (i.e. to agree on) included harshness, level of pitch and loudness, precision of consonants and general stress pattern. The study indicated that perceptual assessments of speech characteristics in individuals with MS are informative and can be achieved with high inter-judge reliability irrespective of the judge's knowledge of the speaker's language.

The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the "prodromal" sample

The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome. This identifies them as being at high risk for developing psychosis in the near future. The study aims include prevention of psychosis onset and disability, as well as palliation of ongoing symptomatology. The purpose of this report is to describe the study's "prodromally symptomatic" sample at baseline, i.e., at intake immediately prior to randomization and prior to receiving study medication. Sixty treatment-seeking patients meeting prodromal inclusion criteria were recruited across four sites: New Haven, CT (n=39), Toronto, Ontario (n=9), Calgary, Alberta (n=6), and Chapel Hill, NC (n=6). The sample was young (median age 16), largely male (65%), and came from families with high titers of serious mental illness (44%). Most patients (93%) met criteria for the Attenuated Positive Symptom (APS) prodromal syndrome and presented with significant but nonpsychotic suspiciousness, perceptual aberrations, unusual thought content, and conceptual disorganization. They presented with minimal to mild affective symptoms and substance use/abuse, but they were quite functionally compromised (mean Global Assessment of Functioning (GAF) score=42). The prodromal sample was compared with other clinical-trial samples of adolescent depression, adolescent mania, and first episode schizophrenia. Prodromal patients proved not to be depressed or manic. They were less severely ill than untreated first episode schizophrenia but more severely ill than treated first episode schizophrenia. While not psychotically disabled, these patients nevertheless present with a clinical syndrome. Subsequent reports will detail the effects of drug versus placebo on prodromal symptoms, neuropsychological profile, and the rate of conversion to psychosis.

Ability to speak at the age of 1 year and alexithymia 30 years later

OBJECTIVE

We studied the association between speech development in the first year of life and alexithymia in young adulthood.

METHODS

The study forms a part of the Northern Finland 1966 Birth Cohort. The original material consisted of all liveborn children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The comprehensive data collection began during the antenatal phase. In 1997, a 31-year follow-up study was made on a part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5983 subjects. Of them, 84% returned the questionnaire properly filled in. The ability to talk was classified according to whether the child spoke no words, one or two words, or three or more words at the age of 1 year. Statistical analyses on the association between the ability to speak at the age of 1 year and alexithymia at the age of 31 years were performed, adjusted for birth weight, mother's parity, place of residence and wantedness of pregnancy.

RESULTS

The mean of the total TAS score was lowest among early speakers and for both genders separately. The differences were statistically significant. A parallel significant difference was found among males on TAS Factors 2 and 3 and in case of females on TAS Factors 1 and 3.

CONCLUSIONS

We found evidence for an association between speaking development in early childhood and later alexithymia. Our results support the theory that alexithymia may be a developmental process starting in early childhood and reinforcing itself in a social context.

Speech and language sequelae of severe malaria in Kenyan children

PRIMARY OBJECTIVE

To conduct a preliminary investigation into the occurrence of speech and language impairments following severe malaria in Kenyan children.

RESEARCH DESIGN

Cohort study comparing the prevalence of impairments in children exposed or unexposed to severe malaria.

METHODS AND PROCEDURES

The study recruited 25 children who had previously been admitted to hospital with severe falciparum malaria and 27 unexposed to the disease. Assessments of comprehension, syntax, lexical semantics, higher level language abilities, pragmatics and phonology were administered to each child at 8-9 years of age, at least 2 years after admission to hospital in children exposed to severe malaria.

MAIN OUTCOMES AND RESULTS

Exposed children were found to have lower scores on each assessment and significantly lower scores on four aspects of language ability: comprehension (p = 0.02); syntax (p = 0.02); content words (p = 0.02) and function words (p = 0.004) components of lexical semantics.

CONCLUSIONS

These data suggest that speech and language deficits may be an important and under-recognized sequela of severe falciparum malaria.

Longitudinal changes in children's speech and voice physiology after cochlear implantation

OBJECTIVES

The purposes of this investigation were 1) to describe speech/voice physiological characteristics of prelingually deafened children before and after cochlear implantation and determine whether they fall into a range that would be considered deviant, 2) to determine whether selected deviant articulatory and phonatory behaviors of children with cochlear implants persist despite long-term cochlear implant use and continued participation in aural rehabilitation services, and 3) to determine whether further development of deviant articulatory and phonatory behaviors occurs postimplantation.

DESIGN

Seven prelingually deafened children who received cochlear implants after 5 yr of age were followed from shortly before implantation until 5 to 6 yr postimplantation. These children received their early education in a Total Communication environment and used the Nucleus 22-electrode cochlear implant. All of them initially used the MPEAK speech processing strategy, and five of them eventually upgraded to the SPEAK speech processing strategy. Speech/voice physiological measurements that were obtained periodically from the children included intraoral air pressure (P(o)), nasal and phonatory air flow, voice onset time (VOT), and fundamental frequency (F(o)). Data from the deaf children were compared with a database from 56 children with normal hearing to determine when the deaf children exhibited "deviant" speech/voice behaviors. Speech/voice behaviors were considered "deviant" if they never occurred for children with normal hearing or were associated with z-scores that were outside the range of +/-2.0.

RESULTS

The deaf children showed a wide range of deviant speech and voice behaviors both pre- and post-cochlear implant. The most frequently occurring atypical behaviors were use of negative P(o), high P(o) for [b, m], long and short VOT for [p], and high F(o). Some deviant behaviors improved post-cochlear implant. However, deviant behaviors often persisted for several years post-cochlear implant. There was considerable evidence of further development of deviant behaviors post-cochlear implant. All of the deaf children demonstrated deviancy on at least two of our measures at the last data collection interval (5 to 6 yr post-cochlear implant).

CONCLUSIONS

Children who received cochlear implants after 5 yr of age and who were educated in a Total Communication setting showed persistence and further development of deviant speech/voice behaviors for several years post-cochlear implant. Although our findings cannot be generalized to other populations of children with cochlear implants (i.e., those who were implanted earlier, those educated in auditory-oral programs), it seems wisest at the present time not to assume that children's deviant speech/voice behaviors will remit spontaneously with continued cochlear implant use. Our data provide an important comparative database for future investigations of pediatric cochlear implant users who have had shorter periods of auditory deprivation and who have received cochlear implants with more current technological features. Longitudinal Changes in Children's Speech and Voice Physiology after Cochlear Implantation

The influence of listener experience and academic training on ratings of nasality

This study assessed listener agreement levels for nasality ratings, and the strength of relationship between nasality ratings and nasalance scores on one hand, and listener clinical experience and formal academic training in cleft palate speech on the other. The listeners were 12 adults who represented four levels of clinical experience and academic training in cleft palate speech. Three listeners were teachers with no clinical experience and no academic training (TR), three were graduate students in speech-language pathology (GS) with academic training but no clinical experience, three were craniofacial surgeons (MD) with extensive experience listening to cleft palate speech but with no academic training in speech disorders, and three were certified speech-language pathologists (SLP) with both extensive academic training and clinical experience. The speech samples were audio recordings from 20 persons representing a range of nasality from normal to severely hypernasal. Nasalance scores were obtained simultaneously with the audio recordings. Results revealed that agreement levels for nasality ratings were highest for the SLPs, followed by the MDs. Thus, the more experienced groups tended to be more reliable. Mean nasality ratings obtained for each of the rater groups revealed an inverse relationship with experience. That is, the two groups with clinical experience (SLP and MD) tended to rate nasality lower than the two groups without experience (GS and TR). Correlation coefficients between nasalance scores and nasality judgments were low to moderate for all groups and did not follow a pattern. EDUCATIONAL OUTCOMES: As a result of this activity, the reader will be able to (1) describe the influence of listener experience and academic training in cleft palate speech on perceptual ratings of nasality. (2) describe the influence of experience and training on the nasality/nasalance relationship and, (3) compare the present findings to previous findings reported in the literature.