Why might language and motor impairments occur together?

Developmental Language Disorder and Uninhibited Primitive Reflexes in Young Children

Purpose Developmental language disorder (DLD) is a developmental disorder where children fail to acquire language in the absence of a clear cause. Many studies have reported general motor deficits in children with DLD, but no studies have uncovered a cure. The purpose of our study is to better understand the underlying motor deficits in DLD, starting from uninhibited primary reflexes-which are the most basic stage of motor development. Knowledge of this motor-language relationship should lead to earlier and more targeted interventions in young children with DLD. Method Children with DLD (n = 75, age range: 4-10 years) and 99 age-matched typically developing (TD) children completed a nonword repetition test to assess DLD and six other tests to assess primitive reflexes. Results Children with DLD demonstrated higher levels of persistent primitive reflexes compared to TD children. As the scores for neuromotor immaturity increased, nonword repetition test scores decreased (r = -.44, p < .01). Results indicated that TD children exhibited lower neuromotor immaturity (M = 7.63, SD = 3.75) compared to children with DLD (M = 13.51, SD = 4.47). All primitive reflexes (the Moro reflex, the symmetrical tonic neck reflex in flexion and in extension, the asymmetrical tonic neck reflex, the tonic labyrinthine reflex, and the Galant reflex) turned out to be statistically significantly different for the TD and DLD groups (p < .001). We also observed some differences between sexes. Conclusions Children with impaired language development underwent slower neuromotor development. However, further research is needed to determine whether motor intervention programs that inhibit primitive reflexes are helpful for children with DLD.

Auditory Processing Disorder and Its Comorbidities: A Need for Consistency in Test Cutoff Scores

Purpose No gold standard criteria exist for diagnosing developmental auditory processing disorder (APD). This study aimed to identify APD criteria, which are consistent with that used for comorbidities, and how comorbidities predicted APD. Method A retrospective study of 167 participants (males = 105, females = 62; age: 6-16 years; nonverbal IQ > 80) with suspected APD is presented. Five SCAN-3 tests evaluated auditory processing (AP). Comorbidities included attention-deficit/hyperactivity disorder, language impairment, and impaired manual dexterity, which were identified using percentile ≤ 5 in the Swanson, Nolan and Pelham parental rating scale; Children's Communication Checklist-2; and Movement Assessment Battery for Children-2, respectively. Results Percentiles ≤ 9, ≤ 5, and < 2 in two or more AP tests had sensitivities (specificities) of 76% (70.6%), 59.3% (76.5%), and 26% (82.4%), respectively, in predicting comorbidities, which were present in 150 of the 167 participants. The criterion of "≤ 9 percentile in two or more AP tests" (Approach I) diagnosed APD in 119 participants, and criterion "≤ 5 percentile in two or more AP tests or ≤ 5 percentile in one AP plus one or more measures of comorbidities" (Approach II) diagnosed 123. The combination of approaches diagnosed 128 participants (76.6%) with APD, of which 114 were diagnosed by each approach (89%). Language impairment and impaired manual dexterity, but not attention-deficit/hyperactivity disorder, predicted APD. Conclusions "Percentile ≤ 9 in two or more AP tests" or "percentile ≤ 5 in one AP plus one or more measures of comorbidities" are evidence-based APD diagnostic criteria. Holistic and interprofessional practice evaluating comorbidities including motor skills is important for APD.

Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?

BACKGROUND

Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development.

OBJECTIVES

To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI).

METHOD

Ten children, aged 4-17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children's Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception.

RESULTS

A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05).

CONCLUSION

The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI.

Does early object exploration support gesture and language development in extremely preterm infants and full-term infants?

BACKGROUND

An increasing body of research on typically and atypically developing infants has shown that motor skills play an important role in language development. To date, however, the role of specific object exploration skills for early gesture and vocabulary development has not been investigated in extremely low gestational age infants (ELGA, GA < 28 weeks), who are at greater risk for motor and language delays than full-term (FT) infants.

PURPOSE

This longitudinal study examined relations between 6-month active exploratory behaviors and 12- month word comprehension, gestures and vocal production, controlling for cognitive performance and neonatal condition (ELGA vs FT).

METHODS

Forty infants, 20 ELGA and 20 FT, and their mothers participated in the study. Mother-infant play interaction was video-recorded at 6 and 12 months. Oral and manual object exploration at 6 months and spontaneous gestures and vocal production at 12 months were coded. Word comprehension was evaluated with the Italian version of the MacArthur-Bates CDI parent questionnaire at 12 months. Cognitive performance was examined with the Griffiths Mental Developmental Scales at 6 months and the Bayley-III Scales at 12 months.

RESULTS

Regression analyses showed that after accounting for cognitive performance and neonatal condition, oral exploration was related to word comprehension, and manual exploration to gestures and vocal production in the overall sample.

CONCLUSIONS

Cascading effects of specific object exploration skills on gestures and language comprehension and production in preterm infants and FT infants are discussed. Clinical implications for early assessment of and interventions involving object exploration skills, which may affect language development, are considered for the preterm population.

The interrelationships between motor, cognitive, and language development in children with and without intellectual and developmental disabilities

It is generally agreed that cognitive and language development are dependent on the emergence of motor skills. As the literature on this issue concerning children with developmental disabilities is scarce, we examined the interrelationships between motor, cognitive, and language development in children with intellectual and developmental disabilities (IDD) and compared them to those in children without IDD. In addition, we investigated whether these relationships differ between children with different levels of cognitive delay. Seventy-seven children with IDD (calendar age between 1;0 and 9;10 years; mean developmental age: 1;8 years) and 130 typically developing children (calendar age between 0;3 and 3;6 years; mean developmental age: 1;10 years) were tested with the Dutch Bayley Scales of Infant and Toddler Development, Third Edition, which assesses development across three domains using five subscales: fine motor development, gross motor development (motor), cognition (cognitive), receptive communication, and expressive communication (language). Results showed that correlations between the motor, cognitive, and language domains were strong, namely .61 to .94 in children with IDD and weak to strong, namely .24 to .56 in children without IDD. Furthermore, the correlations showed a tendency to increase with the severity of IDD. It can be concluded that both fine and gross motor development are more strongly associated with cognition, and consequently language, in children with IDD than in children without IDD. The findings of this study emphasize the importance of early interventions that boost both motor and cognitive development, and suggest that such interventions will also enhance language development.

Learning, forgetting, and relearning: skill learning in children with language impairment

PURPOSE

The current study tested whether the difficulties of children with specific language impairment (SLI) in skill acquisition are related to learning processes that occur while practicing a new skill or to the passage of time between practice and later performance.

METHOD

The acquisition and retention of a new complex grapho-motor symbol were studied in 5-year-old children with SLI and peers matched for age and nonverbal IQ. The children practiced the production of the symbol for 4 consecutive days. Retention testing took place 10 days later.

RESULTS

Children with SLI began each practice day slower than their peers but attained similar levels of performance by its end. Although they increased their performance speed within sessions more than their peers, they did not retain their learning as well between sessions. The loss in speed was largest in the 10-day retention interval. They were also less accurate, but accuracy differences decreased over time. Between-session group differences in speed could not fully be accounted for based on fine motor skills.

CONCLUSIONS

In spite of effective within-session learning, children with SLI did not retain the new skill well. The deficit may be attributed to task forgetting in the presence of delayed consolidation processes.

Sensorimotor function in preschool-aged children with expressive language disorder

AIM

The aim of the study was to evaluate functional motor performance and haptic object recognition in 5-year-old children with mild expressive language disorder (ELD) in comparison with age- and gender-matched healthy children.

METHODS

The subjects were classified by speech-language pathologist using The Reynell Developmental Language Scales III and Boehm Test of Basic Concepts: Preschool as children with mild ELD (n=29, incl. 23 boys and 6 girls) and children with typical language development as controls (n=29, incl. 23 boys and 6 girls). The children were examined for manual dexterity, ball skills, static and dynamic balance by Movement-ABC, haptic object recognition (HOR), hand-grip strength (HGS) and vertical jumping performance.

RESULTS

Children with mild ELD demonstrated significantly higher scores (i.e., inferior performance) in all subtests of M-ABC (all p values <0.05), in haptic object recognition (p<0.01) and vertical jumping height (p<0.05) compared to controls. However, no statistically significant differences (p>0.05) emerged from HGS. Boys with mild ELD demonstrated higher results in impairment score (p<0.001), ball skills (p<0.01) and balance (p<0.01) of M-ABC, as well as in HOR (p<0.05). Girls with mild ELD showed higher impairment score (p<0.05) with lower percentile (p<0.05) in M-ABC, indicating inferior motor performance, and lower HGS for the non-dominant hand (p<0.05). Seven out of 29 (24.1%) children with mild ELD had definite or borderline motor difficulties, while only one child in control group (3.4%) demonstrated borderline motor difficulties.

CONCLUSIONS

Children with mild expressive language disorder do not perform as well as controls in tests of functional motor skills, but their results in tests demanding maximal muscle force generation are in level with typically developing children. Boys and girls with mild ELD demonstrated higher impairment scores in M-ABC, indicating the need to follow their overall development more closely.

Delayed motor skill acquisition in kindergarten children with language impairment

The acquisition and consolidation of a new grapho-motor symbol into long-term memory was studied in 5-year-old children with language impairment (LI) and peers matched for age and visual-motor integration skills. The children practiced the production of a new symbol and were tested 24h and two weeks post-practice day. Differences in performance speed emerged between the groups: children with LI showed a later onset of rapid learning in the practice phase, and only the comparison group exhibited delayed, consolidation, gains 24h post-training. At two weeks post-training, children with LI improved, closing the gap in performance speed. Speed-accuracy trade-off was characteristic of speed improvements in LI. These results indicate atypical and delayed acquisition in children with LI, and support the view that deficient skill acquisition in LI goes beyond the language system.

Influence of balance on oral-motor control of speech: a pilot investigation

In this exploratory study, the interaction between motor coordination for balance and oral-motor control for speech was investigated in 31 typical college-aged women, ages 20 to 29 years (M = 22.3, SD = 2.1), recruited through the local university. Since speech is dependent on the control and coordination of the subsystems of the speech production mechanism, it was hypothesized that a difficult balance task would interfere with speech motor control. Oral-motor control was measured by diadochokinesis while participants were in a nonchallenging balance position (floor standing) and a challenging balance position (balance disk on one leg). Results indicated that individuals compensated for speech rate while having to maintain their balance for the syllable repetitions. However, the number of syllables repeated was significantly fewer while on the balance disk. In addition, a correlational analysis indicated that history of speech therapy services was related to poorer balance screening score. Directions for future research are discussed.

Kognitive Leistungsprofile motorisch- und sprachentwicklungsverzögerter Vorschulkinder

Unterschiedliche Studien belegen, dass Kinder mit umschriebenen motorischen Entwicklungsstörungen häufig auch komorbide Sprachentwicklungsstörungen aufweisen. Vermutlich liegt der Kombination beider Störungen eine gemeinsame Ursache zugrunde. Für die klinische Praxis ist es von Interesse zu untersuchen, ob Kinder mit motorischen und sprachlichen Entwicklungsstörungen ein spezifisches kognitives Leistungsprofil aufweisen, um frühzeitig umfassende Interventionen einleiten zu können. Dazu wurden die WPPSI-III-Resultate von insgesamt 53 Kindern im Alter von vier bis sechs Jahren mit isolierten motorischen Entwicklungsstörungen, isolierten expressiven Sprachstörungen und Kindern mit kombinierten motorischen und sprachlichen Entwicklungsstörungen untereinander, aber auch mit einer normativ entwickelten Referenzgruppe verglichen. Die Kinder mit isolierten expressiven Sprachstörungen weisen ausschließlich gravierende Defizite in den sprachlichen Subtests auf; Kinder mit motorischen Entwicklungsstörungen schneiden in allen Kerntests geringfügig schlechter als unauffällige Kinder ab, wobei signifikante Differenzen für die Untertests Mosaik-Test, Matrizen-Test, Allgemeines Wissen und Wortschatz-Test auffallen. Kinder mit motorischen und sprachlichen Entwicklungsstörungen zeigen im Vergleich zu ausschließlich sprachauffälligen Kindern identische Defizite in den verbalen Untertests der WPPSI-III. Der Vergleich mit den ausschließlich motorisch auffälligen Kindern lässt erkennen, dass sich die Testresultate in den handlungsbezogenen Subtests jedoch verschlechtern. Die erhobenen Befunde unterstützen die Argumente eines eigenen Störungskonzeptes; das kombinierte Auftreten motorischer und sprachlicher Entwicklungsstörungen unterstreicht die Notwendigkeit den kognitiven Leistungsstand umfassend zu überprüfen.

Comorbidity of motor and language impairments in preschool children of Taiwan

Comorbidity of motor and speech/language impairments was investigated in 363 preschool children between the ages of 5 and 6 years (boys: 205, age 6.04+/-0.48 years; girls: 158, age 5.98+/-0.53 years). The children were sampled from two municipals of Taiwan, and were determined to present no apparent neurological, musculoskeletal, cardiopulmonary system impairment or mental insufficiency. They were administered with three speech/language tests and a motor test (Movement Assessment Battery for Children, or M-ABC). The results showed a significant correlation between the total score of the motor test and the total score of each of the speech and language tests. Regression analysis that controlled for IQ (C-TONI) further showed that manual dexterity, but not ball skills or balance, of M-ABC was predictive of all scores on the speech and language tests. To determine a deficit on a test, a score at or below the 10th percentile of the norm or a score at or below 1.25SD from the group mean was established as the cutoff. For the speech/language impairment, a deficit on at least two out of the three tests also applied. Following these criteria, 22 children (6.1%) were identified to have Developmental Speech and Language Disorder (DSLD), and 45 (12.4%) to have Developmental Coordination Disorder (DCD). Comorbid DSLD and DCD were found in six children (1.65%). Chi-square analysis revealed a significant correlation between DSLD and DCD (p<.03). The odds of DSLD was higher (by about three-fold) among the children with DCD than among the children without (0.15 vs. 0.05). Comorbid motor and speech/language impairments in preschool children appear to be a significant clinical condition that requires the attention of the therapeutic community. Manual dexterity, in particular, seems to be an important clue for understanding the shared mechanism of motor and speech/language impairments.

Motor impairment in dyslexia: the influence of attention disorders

Developmental dyslexia is a heterogeneous syndrome with a phonological core deficit and frequent association with other developmental disorders. Controversies exist about the influence of motor difficulties frequently encountered in dyslexia. According to different theoretical approaches, these motor impairments would reflect either a frequent co-morbid entity or a cerebellar dysfunction that could constitute the causal factor of reading disabilities. The principal aim of this study was to determine the frequency of motor impairments in a population of children with phonological dyslexia and specify possible links with attention deficit. We analysed retrospectively motor and attention abilities of 58 children with phonological dyslexia. An important sub-group of children with dyslexia (40-57% depending on the severity of motor difficulties) presented a motor impairment affecting co-ordination, balance and manual dexterity suggesting a cerebellar dysfunction. There was a significant association between attention deficit and motor impairments, with a specific impact on balance and co-ordination deficits. The comparison of performance in four groups defined according to the presence versus absence of attention deficit and motor impairment, respectively, were not in favour of a unequivocal causal link between reading disabilities and motor or attention disorders.

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.

Early motor development and later language and reading skills in children at risk of familial dyslexia

Relationships between early motor development and language and reading skills were studied in 154 children, of whom 75 had familial risk of dyslexia (37 females, 38 males; at-risk group) and 79 constituted a control group (32 females, 47 males). Motor development was assessed by a structured parental questionnaire during the child's first year of life. Vocabulary and inflectional morphology skills were used as early indicators of language skills at 3 years 6 months and 5 years or 5 years 6 months of age, and reading speed was used as a later indicator of reading skills at 7 years of age. The same subgroups as in our earlier study (in which the cluster analysis was described) were used in this study. The three subgroups of the control group were 'fast motor development', 'slow fine motor development', and 'slow gross motor development', and the two subgroups of the at-risk group were 'slow motor development' and 'fast motor development'. A significant difference was found between the development of expressive language skills. Children with familial risk of dyslexia and slow motor development had a smaller vocabulary with poorer inflectional skills than the other children. They were also slower in their reading speed at the end of the first grade at the age of 7 years. Two different associations are discussed, namely the connection between early motor development and language development, and the connection between early motor development and reading speed.

Static balance in children with hand-eye co-ordination problems

OBJECTIVE

The aim of the present study was to examine static balance on one leg in 10-year-old children with and without hand-eye co-ordination problems (HECP) in an attempt to come closer to an understanding of developmental co-ordination disorder in children.

METHOD

The children were compared on three different balance tasks with the right and/or left leg together with a systematic manipulation of vision.

RESULTS

The results showed that when the scores for both legs were combined, the control group, in general, had superior performance in all conditions. Separate preferred and non-preferred leg analyses demonstrated that the differences between the HECP group and control group could be accounted for by lowered performances when the non-preferred leg was used in only one static balance task, stork stand with vision. In the two other balance tasks, balance on beam and one-board balance, the HECP group displayed significantly worse performance than the control group irrespective of the use of the preferred or non-preferred leg.

CONCLUSIONS

Explanation related to the development of the hemispheres controlling the preferred and non-preferred leg is invoked to account for the poor performance in the HECP group.