Mind and brain in Rett disorder

Development and retention of speech is reported in 265 people with Rett syndrome: 30% (80) never gained real words, 55% (145) gained real words and lost them, 15%(40) retained some words and 6% of the total (16/265) continued to use phrases appropriately. Morphological studies of the cytoarchitecture of the speech areas in 14 cases indicate the existence of interhemispheric differences which form part of the infrastructure for speech processing. Ten adults with Rett syndrome and with meaningful speech are compared to age matched adults without speech. The profile of mind and strategies for coping with its problems are described by a family. Although the range in severity is wide the mental profile is remarkably consistent across the severity range with regard to both positive and negative aspects.

Speech errors in Alzheimer's disease: reevaluating morphosyntactic preservation

Researchers studying the speech of individuals with probable Alzheimer's disease (PAD) report that morphosyntax is preserved relative to lexical aspects of speech. The current study questions whether dividing all errors into only two categories, morphosyntactic and lexical, is warranted, given the theoretical controversies concerning the production and representation of pronouns and closed-class words in particular. Two experiments compare the speech output of 10 individuals with Alzheimer's disease to that of 15 healthy age- and education-matched speakers. Results of the first experiment indicate that the pattern of errors in the speech of participants with mild PAD reflects an across-the-board increase in the same types of errors made by healthy older speakers, including closed-class and morphosyntactic errors. In the second task, participants produced a grammatical sentence from written stimuli consisting of a transitive verb and two nouns. Only adults with Alzheimer's disease had difficulties with this task, producing many more closed-class word errors than did healthy older adults. Three of the participants with PAD produced nearly agrammatic speech in this task. These 3 people did not differ from the rest of the PAD group in age, education, working memory, or degree of semantic impairment. Further, error rates on the two tasks were highly correlated. We conclude that morphosyntax is not preserved in the speech output of individuals with PAD, but is vulnerable to errors along with all aspects of language that must be generated by the speaker. We suggest that these results best support a model of speech production in which all words are represented by semantic and grammatical features, both of which are vulnerable to failures of activation when there is damage or noise in the system as a result of pathology, trauma, or even divided attention.

Childhood speech disorders: reported prevalence, comorbidity and socioeconomic profile

OBJECTIVE

To describe the reported prevalence, comorbidity and socioeconomic status (SES) of children with speech disorders.

METHODOLOGY

Data from the 1995 Australian Health Survey were used. Information relating to the health of 12 388 children aged 0-14 years was collected via face-to-face interviews with a responsible adult. Speech disorders were recorded if children had reported difficulty talking, producing speech sounds, or who stuttered.

RESULTS

The prevalence of childhood speech disorders (CSD) was 1.7% (n = 209). Of this group, 25.8% (n = 54) had a developmental delay or intellectual impairment; when these were excluded, the prevalence of CSD was reduced to 1.3% (n = 155). Among males, the peak prevalence occurred at age 5 (6.5%), for females the highest rates were for 3-4-year-olds (1.8%). Children with a speech disorder had a greater number of additional health problems. No relationship was found between SES and CSD.

CONCLUSIONS

Children with speech disorders often have complex health and developmental needs. Developing effective prevention programs with a view to improving the long-term health and social outcomes of these children will require a mix of individual (clinical) and population-based (public-health) strategies.

Early identification of at-risk infants and toddlers: a transdisciplinary model of service delivery

Traditional models of service delivery prevent speech-language therapists and audiologists from identifying and implementing early communication intervention (ECI) in South Africa. This study utilized the framework of the transdisciplinary team approach to develop a collaborative partnership between community nurses and speech-language therapists and audiologists. An interdisciplinary in-service training programme was implemented with 24 community nurses employed at family health clinics in Kwa-Zulu Natal; with the aim of enhancing their knowledge and attitudes toward the early identification and referral of at-risk children to speech-language therapists and audiologists. Three questionnaires were used to evaluate the nurses' knowledge and attitudes. Results indicated that the training programme significantly improved the nurses' knowledge regarding ECI but not their attitudes. Implications of these findings are discussed in terms of service delivery for ECI, and the education and training of early interventionists in the South African context.

Incidence of hearing loss among children presented with speech-language delay

Infants' first attempts to communicate with their environment begin shortly after birth. However, real words appear by age of 12-15 months. Any delay in expressing their needs verbally beyond this age is defined as speech delay and may be associated with a variety of pathological conditions. The aim of this study is to investigate the incidence of hearing impairment in those children presented with speech delay. Ninety-one speech-delayed children were audiologically assessed between March 1993 and March 1995. In 25 out of 91 children (27.4%) a moderate to severe hearing loss was detected, either sensorineural or conductive. The increased incidence of hearing impairment found in this group mandates a thorough hearing evaluation for any case of speech-language delay.

Developmental language and speech disability

Speech disabilities (articulation deficits) and language disorders--expressive (vocabulary) receptive (language comprehension) are not uncommon in children. An overview of these along with a global description of the impairment of communication as well as clinical characteristics of language developmental disorders are presented in this article. The diagnostic tables, which are applied in the European and Anglo-American speech areas, ICD-10 and DSM-IV, have been explained and compared. Because of their strengths and weaknesses an alternative classification of language and speech developmental disorders is proposed, which allows a differentiation between expressive and receptive language capabilities with regard to the semantic and the morphological/syntax domains. Prevalence and comorbidity rates, psychosocial influences, biological factors and the biological social interaction have been discussed. The necessity of the use of standardized examinations is emphasised. General logopaedic treatment paradigms, specific therapy concepts and an overview of prognosis have been described.

Bilateral posterior parietal polymicrogyria: a mild form of congenital bilateral perisylvian syndrome?

PURPOSE

The main features of congenital bilateral perisylvian syndrome (CBPS) are pseudobulbar palsy, cognitive deficits, epilepsy, and perisylvian abnormalities on imaging studies, however, the clinical spectrum of this syndrome is much wider than previously believed and may vary from minor speech difficulties to severely disabled patients. The objective of this study was to present the different imaging and clinical findings of 17 patients with CBPS, their genetic background, and the occurrence of prenatal injury during their pregnancies.

METHODS

We evaluated 17 consecutive patients with CBPS and divided them into two groups according to the imaging findings: (a) diffuse polymicrogyria around the sylvian fissure and (b) posterior polymicrogyria at the posterior parietal regions. They were systematically interviewed regarding history of prenatal events during their pregnancies, family history of speech difficulties, epilepsy, or other neurologic abnormality.

RESULTS

There were seven women, ages ranging from 3 to 41 years (mean, 11.5; median, 7 years). Seven patients had bilateral posterior parietal polymicrogyria (BPPP), and 10 had diffuse bilateral perisylvian polymicrogyria. All seven patients with BPPP had only minor speech difficulties, none had epilepsy, and all but one had a family history of epilepsy or cortical dysgenesis. In contrast, 10 patients with diffuse bilateral perisylvian polymicrogyria had pseudobulbar palsy, four had epilepsy, eight had a history of a major prenatal event, and only four had a family history of epilepsy or developmental delay.

CONCLUSIONS

These findings suggest that diffuse bilateral perisylvian polymicrogyria appears to be more related to injuries caused by environmental factors, whereas BPPP has a stronger genetic predisposition. In addition, BPPP appears to have a wider clinical spectrum than previously believed, and may represent a milder extreme within the spectrum of CBPS.

Verbal and nonverbal fluency in children with heavy prenatal alcohol exposure

OBJECTIVE

Executive function deficits, including verbal fluency, have been documented in children with histories of prenatal alcohol exposure. Whereas nonverbal fluency impairments have been reported in adults with such exposure, these abilities have not been tested in children. Deficits in both verbal and nonverbal fluency were predicted and assessed in children and adolescents with histories of heavy prenatal alcohol exposure.

METHOD

There was a total of 28 (54% female) subjects; children with heavy prenatal alcohol exposure with (n = 10) and without (n = 8) fetal alcohol syndrome (FAS) were compared to nonexposed controls (n = 10) on the design and verbal fluency measures from the Delis-Kaplan Executive Function System. Both fluency measures consist of three conditions, including a new set-shifting task. All tests require the generation of multiple responses within both rule and time constraints.

RESULTS

Data were analyzed using repeated measures analyses of variance and hierarchical regression analyses. Compared to controls, children with heavy prenatal alcohol exposure with and without FAS displayed deficits in both fluency domains, but did not differ from each other. In addition, prenatal alcohol exposure was a significant predictor of performance on the set-shifting design fluency task above and beyond performance on more traditional fluency tasks. IQ was not a significant predictor for the traditional or set-shifting fluency measures, whereas diagnostic group remained a significant predictor when IQ was included in the model.

CONCLUSIONS

This study adds to the literature on the integrity of executive functions in children with heavy prenatal alcohol exposure, documenting fluency impairment in both verbal and nonverbal domains. It is important to note that these impairments were demonstrated in higher functioning alcohol-exposed children, both with and without FAS, and that diagnostic group explained such deficiencies above and beyond general intellectual ability.

Speech and language therapy for adults in Hackney: an assessment of need

With the development of separate community and the hospital trusts in the London borough of Hackney, at a time of increasing numbers and range of referrals, a number of gaps in service became apparent. The need for community adult speech and language therapy (SLT) in Hackney was identified, based on previous studies and other relevant literature. Comparison with services locally and nationally shows clearly that Hackney, in having virtually no community SLT for adults, is significantly disadvantaged. It was intended that this work would result in the widest consultation and discussion by the relevant agencies to explore ways of meeting this need.

Factors determining the efficiency of logopaedic care of children in Poland

The purpose of this article is to establish factors which determine the efficiency of the system of care provided to children with speech disorders attending regular schools and kindergartens. The analysis was made using Poland as an example, which, similar to other countries, has made some achievements in this matter. Although Poland has had an institutionalised care system for children with speech development anomalies for 30 years, the problem of speech disorders is still very difficult to solve. Due to the large scale of the phenomenon among Polish children, this problem can be defined as a social problem in this country. The above-described situation makes it necessary to search for methods of fighting this adverse phenomenon. One of the means of solving this problem is following examples and learning from the experience of countries in which efficient systems of disabled children's care have already been worked out. By giving examples from other countries the author attempts to establish factors determining the efficiency of logopaedic care.

Cleft lip and/or palate in the west of Ireland, 1980-1996

The aim of this study was to identify and investigate care for children born, over a 17-year period (1980-1996), with cleft lip and/or palate (CL/P) in the Western Health Board region of Ireland. One hundred and six cleft-affected children were identified. The incidence was 1.14 per thousand (1:871) live births. Epidemiological findings in relation to cleft type, gender, family history, and location followed international trends. The establishment of a national Register with mandatory reporting of children with CL/P in Ireland would ensure greater consistency in data collection and may help improve co-ordination of care.

Premorbid speech and language impairments in childhood-onset schizophrenia: association with risk factors

OBJECTIVE

As both premorbid neurodevelopmental impairments and familial risk factors for schizophrenia are prominent in childhood-onset cases (with onset of psychosis by age 12), their relationship was examined.

METHOD

Premorbid language, motor, and social impairments were assessed in a cohort of 49 patients with childhood-onset schizophrenia. Familial loading for schizophrenia spectrum disorders, familial eye-tracking dysfunction, and obstetrical complications were assessed without knowledge of premorbid abnormalities and were compared in the patients with and without developmental impairments.

RESULTS

Over one-half of the patients in this group had developmental dysfunction in each domain assessed. The patients with premorbid speech and language impairments had higher familial loading scores for schizophrenia spectrum disorders and more obstetrical complications, and their relatives had worse smooth-pursuit eye movements. The boys had more premorbid motor abnormalities, but early language and social impairments did not differ significantly between genders. There were no other significant relationships between premorbid social or motor abnormalities and the risk factors assessed here.

CONCLUSIONS

Premorbid developmental impairments are common in childhood-onset schizophrenia. The rates of three risk factors for schizophrenia (familial loading for schizophrenia spectrum disorders, familial eye-tracking dysfunction, and obstetrical complications) were increased for the probands with premorbid speech and language impairments, suggesting that the pathophysiology of schizophrenia involves the abnormal development of language-related brain regions.

Redefining the survival of the fittest: communication disorders in the 21st century

OBJECTIVES

To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language.

STUDY DESIGN

Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language.

METHOD

Analysis of epidemiological and economic data for industrialized countries, North America, and the United States.

RESULTS

Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product.

CONCLUSIONS

Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.

[Approaches to formation of a territorial logopedic service]

The incidence of speech disorders in children and adolescents of the Ryazan region in 1993-1998 is analyzed. Speech abnormalities became highly prevalent among children in recent years, particularly among preschool children, and hence specialized service for subjects with speech disorders is to be formed, which should pay the priority attention to children. Approaches to creation of logopedic service of a territory are outlined.

Prevalence of speech delay in 6-year-old children and comorbidity with language impairment

We estimate the prevalence of speech delay (L.D. Shriberg, D. Austin, B. A. Lewis, J. L. McSweeny, & D. L. Wilson, 1997b) in the United States on the basis of findings from a demographically representative population subsample of 1,328 monolingual English-speaking 6-year-old children. All children's speech and language had been previously assessed in the "Epidemiology of Specific Language Impairment" project (see J. B. Tomblin et al., 1997), which screened 7,218 children in stratified cluster samples within 3 population centers in the upper Midwest. To assess articulation, the Word Articulation subtest of the Test of Language Development-2: Primary (Newcomer & Hammill, 1988) was administered to each of the 1,328 children, and conversational speech samples were obtained for a subsample of 303 (23%) children. The 6 primary findings are as follows: (a) The prevalence of speech delay in 6-year-old children was 3.8%; (b) speech delay was approximately 1.5 times more prevalent in boys (4.5%) than girls (3.1%); (c) cross-tabulations by sex, residential strata, and racial/cultural backgrounds yielded prevalence rates for speech delay ranging from 0% to approximately 9%; (d) comorbidity of speech delay and language impairment was 1.3%, 0.51% with Specific Language Impairment (SLI); (e) approximately 11-15% of children with persisting speech delay had SLI; and (f) approximately 5-8% of children with persisting SLI had speech delay. Discussion includes implications of findings for speech-language phenotyping in genetics studies.

Health effects of environmental contaminant exposure: an intrafile comparison of the Trichloroethylene Subregistry

The establishment of the National Exposure Registry represents the first major effort toward longitudinal surveillance of general populations exposed long-term to low levels of specific substances in the environment. The authors investigated the National Exposure Registry's Trichloroethylene Subregistry intrasubregistry differences with respect to health outcomes and the possible relationships with types and levels of chemical exposure. Investigators divided the 4041 living members of the Trichloroethylene Subregistry into 4 subgroups, by type(s) of exposures (chemicals) and duration and level of exposures. The authors compared the reporting rates for 25 health outcomes across subgroups. The authors used logistic regression, in which age, sex, education, smoking history, and occupational history were the covariates. Statistically significant increases in reporting rates were seen with (a) increased maximum trichloroethylene exposures for the outcome stroke, (b) increased cumulative chemical exposure for respiratory allergies, and (c) duration of exposure for hearing impairment. Consistently elevated reporting rates across the exposure subgroups were seen for hearing impairment, speech impairment, asthma and emphysema, respiratory allergies, and stroke. Reporting rates for urinary tract disorders were related only to cumulative chemical levels. The authors noted that there appeared to be a relationship between trichloroethylene and reporting rates for speech impairment, hearing impairment, and stroke and between volatile organic compounds and asthma and emphysema, respiratory allergies, and urinary tract disorders.

Evaluation and management of the child with speech delay

A delay in speech development may be a symptom of many disorders, including mental retardation, hearing loss, an expressive language disorder, psychosocial deprivation, autism, elective mutism, receptive aphasia and cerebral palsy. Speech delay may be secondary to maturation delay or bilingualism. Being familiar with the factors to look for when taking the history and performing the physical examination allows physicians to make a prompt diagnosis. Timely detection and early intervention may mitigate the emotional, social and cognitive deficits of this disability and improve the outcome.

Communication disturbances and family psychiatric history in parents of schizophrenic patients

Parents of schizophrenic patients have demonstrated subtle disturbances of thought, language, and communication. The etiologic relevance of these disturbances is not clear. This study assessed levels of referential communication disturbance in the "natural speech" of schizophrenic patients, nonschizophrenic parents of patients, and control subjects matched to the patients' parents and tested for associations of communication disturbances in parents with family history of psychosis and with schizotypy scale scores. The speech of the patients' parents as a group contained high frequencies of referential failures. Those parents with first-degree family histories of psychosis and/or high schizotypy scale scores made more frequent referential failures than the rest of the parents. Family history was particularly highly associated with failures involving language structural breakdown. The results of this study suggest that referential disturbances in parents of patients may be related to genetic liability in the parents. However, such an effect does not appear to account fully for the sizable differences between parents and controls in levels of communication disturbance.