[Diagnostic value of ERTL4: a screening test of language disorders in 4-year-old children]

Child Development and Early Interaction: PERL Research Protocol, a Preventive Home Visiting Program, Randomized Controlled Trial in France

Background: Early childhood is a key period for reducing the social inequalities that affect health. Some parenting support and home visitation programs have proven to be effective in assisting parents during this period. France's Protection Maternelle et Infantile (maternal and child welfare) services (PMIs) are at the heart of this primary prevention and may adapt their intervention to improve parenting support. In this manuscript, we describe the protocol of the PERL study, an intervention based on a home visiting program. Method and design: The PERL study is a single-center, randomized, controlled interventional trial. The aim was to assess the impact of a preventive home visiting program on the development of young children and parent-baby interaction. Visits were made by PMI nurses to 64 randomly recruited families from the general population. All families who had a baby born after 37 weeks of pregnancy between September 2018 and December 2019, and who resided in the trial area were eligible. Participants were randomly allocated to the intervention group or the control group. The PMI nurses made 12 home visits in the first year, 6 in the second year, and 4 in the third and fourth years of the child's life. Primary and secondary outcomes were measured when the child was 4 and 24 months old. These measurements recorded (i) the child's developmental milestones, in particular, language and socio emotional skills, (ii) early interaction, maternal sensitivity, and attachment patterns, (iii) maternal psychopathology including depression. Discussion: This study aims to assess the impact of home visits, made by specifically-trained and supervised nurses, on the child's development and parent-child interactions. Such interventions are complementary to other preventive programs addressing the impact of social inequalities on perinatal health. Placing nurses' professional skills at the center of this project may prove an effective and cost-saving intervention compared to existing programs. The study proposes a prevention model that is in keeping with the principle of reducing social inequalities in health by providing support from the earliest age through public service. Clinical Trial Registration: The clinical trial number is NCT03506971, registered on April 24, 2018.

Relative contributions of prenatal complications, perinatal characteristics, neonatal morbidities and socio-economic conditions of preterm infants on the occurrence of developmental disorders up to 7 years of age

BACKGROUND

To investigate the relative contributions of prenatal complications, perinatal characteristics, neonatal morbidities and socio-economic conditions on the occurrence of motor, sensory, cognitive, language and psychological disorders in a large longitudinal preterm infant population during the first 7 years after birth.

METHODS

The study population comprised 4122 infants born at <35 weeks of gestation who were followed for an average of 74.0 months after birth. Developmental disorders, including motor, sensory, cognitive, language and psychological, were assessed at each follow-up visit from 18 months to 7 years of age. The investigated determinants included prenatal complications (prolonged rupture of membranes >24 hours, intrauterine growth restriction, preterm labour and maternal hypertension), perinatal characteristics (gender, multiple pregnancies, gestational age, birth weight, APGAR score and intubation or ventilation in the delivery room), neonatal complications (low weight gain during hospitalization, respiratory assistance, severe neurological anomalies, nosocomial infections) and socio-economic characteristics (socio-economic level, parental separation, urbanicity). Based on hazard ratios determined using a propensity score matching approach, population-attributable fractions (PAF) were calculated for each of the four types of determinants and for each developmental disorder.

RESULTS

The percentages of motor, sensory, cognitive, language and psychological disorders were 17.0, 13.4, 29.1, 25.9 and 26.1%, respectively. The PAF for the perinatal characteristics were the highest and they were similar for the different developmental disorders considered (around 60%). For the neonatal and socio-economic determinants, the PAF varied according to the disorder, with contributions of up to 17% for motor and 27% for language disorders, respectively. Finally, prenatal complications had the lowest contributions (between 6 and 13%).

CONCLUSIONS

This study illustrates the heterogeneity of risk factors on the risk of developmental disorder in preterm infants. These results suggest the importance of considering both medical and psycho-social follow-ups of preterm infants and their families.

Characterizing early detection of language difficulties in children born preterm

BACKGROUND

The optimal age for assessing language difficulties in premature children remains unclear.

AIMS

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

STUDY DESIGN

A prospective population-based study in the Loire Infant Follow-up Team LIFT SUBJECTS: All children born <35weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24months, the language items of Brunet Lezine test at 24months, and the "Epreuves de Repérage des Troubles du Langage" (ERTL) at 4years.

OUTCOME MEASURES

After 5years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

RESULTS

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n=116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18months was significantly lower (0.65±0.09) than that obtained at 24months (0.77±0.08) and the languages items of Brunet Lezine test at 24months (0.77±0.08), and the ERTL at 4years (0.76±0.09). The optimal cut-off value for ASQ communication at 24months is ≤45 [sensitivity of 0.79 (95%CI: 0.70-0.86); specificity of 0.63 (95%CI: 0.59-0.66)].

CONCLUSIONS

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.

[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.

12p13.33 microdeletion including ELKS/ERC1, a new locus associated with childhood apraxia of speech

Speech sound disorders are heterogeneous conditions, and sporadic and familial cases have been described. However, monogenic inheritance explains only a small proportion of such disorders, in particular in cases with childhood apraxia of speech (CAS). Deletions of <5 Mb involving the 12p13.33 locus is one of the least commonly deleted subtelomeric regions. Only four patients have been reported with such a deletion diagnosed with fluorescence in situ hybridisation telomere analysis or array CGH. To further delineate this rare microdeletional syndrome, a French collaboration together with a search in the Decipher database allowed us to gather nine new patients with a 12p13.33 subtelomeric or interstitial rearrangement identified by array CGH. Speech delay was found in all patients, which could be defined as CAS when patients had been evaluated by a speech therapist (5/9 patients). Intellectual deficiency was found in 5/9 patients only, and often associated with psychiatric manifestations of various severity. Two such deletions were inherited from an apparently healthy parent, but reevaluation revealed abnormal speech production at least in childhood, suggesting variable expressivity. The ELKS/ERC1 gene, which encodes for a synaptic factor, is found in the smallest region of overlap. These results reinforce the hypothesis that deletions of the 12p13.33 locus may be responsible for variable phenotypes including CAS associated with neurobehavioural troubles and that the presence of CAS justifies a genetic work-up.

BREV, une batterie d'évaluation des fonctions cognitives : validation dans les troubles des apprentissages

INTRODUCTION

The BREV battery (Battery for rapid evaluation of cognitive functions) is a tool which can be used for the rapid neuropsychological evaluation of children aged between 4 and 9 years.

OBJECTIVES

After standardization (700 unaffected children) and validation by comparison with a reference battery (202 children with epilepsy), the aim of this study was further validation in 173 children with learning disorders.

POPULATION AND METHODS

The study protocol included administration of the BREV, precise neuropsychological examination and evaluation of oral and written language. Statistical analysis was used to compare the findings of the BREV with those of the reference method, and the recommendations indicated by the BREV with the final diagnoses, and to define the sensitivity and the specificity of the BREV battery.

RESULTS

All the correlations between BREV tests and reference tests were significant. Recommendations after the BREV were in agreement with the conclusions of the reference evaluation in 168/172 children for language, 145/173 for the psychometric evaluation. For only 4 chidren, the results of the BREV were false negative. Diagnoses corresponded in 168/173 children for oral language, in 102/110 for written language, 166/173 for praxis disorders and 157/173 for intellectual deficit. The most predictive subtests of the BREV and sensitivity and specificity of verbal and non-verbal scores were calculated.

CONCLUSION

The BREV is a reliable examination, in learning disorders, to determine the most complementary investigations both in terms of language disorders and for non-verbal or global learning disabilities.

Repérage par les enseignants des difficultés de langage et de comportement chez 2 059 enfants de 3 ans et demi

BACKGROUND

Several tools have been proposed for screening for specific language impairment and behavioral problems in pre-school children. These disorders are risk factors for later poor school achievement and social life. However, presence of real disorders must be differentiated from environmental factors, such as low educational level of the parents or bilingual family.

METHODS

A 29-item teachers'questionnaire was used for screening for language and behavioral disorders in 2059 nursery-school children aged 3.5 years from 200 nursery-schools of different areas in France.

RESULTS

According to the teachers, difficulties were clearly more frequent in boys than girls, in children from low educational level families, and in children with not-french-speaking parents.

CONCLUSION

The gender of the child and the characteristics of the family play a very important role in the teachers'assessment of a young pre-school child's language and behavior. Longitudinal studies would be required to differentiate the presence of specific disorders, requiring individual intervention, from simple delays due to environmental factors.

Analyse d’une population de 100 enfants adressés pour troubles d’apprentissage scolaire

DESIGN

To determine the impact of a neuropediatrician view on diagnosis and management of learning disabilities.

METHOD

Retrospective review of the medical records of the last 100 children attending for learning disabilities from 1st June 2000 through 31st May 2001. Assessment concerned school curriculum, type of management before consultation, diagnosis procedure and type of management following consultation. Differential diagnosis was made in 100% of cases following evaluation.

RESULTS

The three main diagnoses were attentionnal deficit disorder with hyperactivity (39%), mental retardation (17%) and dyslexia (7%). Mental retardation and cerebral palsy diagnoses had not been made before consultation. Conversely, 70% of the diagnoses of dyslexia made before consultation were incorrect. Medical treatment was proposed in 38% of cases and modification in the management in 59% of cases.

CONCLUSION

This study highlights the interest of a rigorous diagnosis procedure for learning disabilities, based on a neuropediatrics examination, a cognitive evaluation and phonological and lexical evaluation. It only may lead to an appropriate management.

Pertinence du repérage par les parents des retards de langage chez l’enfant entre quatre et six ans

This study investigates the relevance of the information provided by parents when screening for language delays in pre-school children.

METHOD

Parents of 670 pupils of medium section of nursery school (4-5 years) and of 799 pupils of the high section of nursery school (5-6 years) answered questions about their child's language and behaviour. Some of these same children passed currently available ERTL4 and BREV tasks (in medium section) and BSEDS tasks (in high section). Items concerning language delay were selected from the parents' questionnaire by the principal component analysis method, and correlation between parental answers to these items and the task results were examined.

RESULTS

Parents' opinion was strongly and specifically correlated with tasks assessing the correct/incorrect aspects of speech and expressive language and less strongly with tasks assessing vocabulary or comprehension.

CONCLUSION

Parents' opinion is useful when screening for delays of speech and expressive language in pre-school children.

Accès aux soins orthophoniques précoces en Gironde : évaluation d’une campagne de dépistage des troubles du langage à 4 ans (1999–2001)

OBJECTIVE

The objective of this article was to evaluate the results of a prevention campaign on the access to early speech therapy for 4-year-old children.

POPULATION AND METHODS

A prevention campaign of speech disorders was conducted in Gironde area in 1999, offering a systematic screening by ERTL4 test and free speech therapy. The campaign results were evaluated by quality and efficiency indicators.

RESULTS

In 1999, 14037 children born in 1995 were included and 1363 children randomly selected from the schools benefited from the campaign. One child out of four failed in the screening test by ERTL4. The percentage of the assessment and speech therapy in the children of the campaign (16.0 and 8.2%) were significantly higher than the other children of the area (8.9 and 6.7%).

CONCLUSION

The campaign evaluation has demonstrated its capacity to access to speech therapy for children language disorders, allowing gains of frequency and earlier treatment.

[Health checkup for 3- to 4-year-old children: results of screening tests performed in 1999 by physicians in the Maternal and Infant Welfare program in the Gironde region]

BACKGROUND

In the Gironde region, the physicians of the Mother and Infant Welfare department in charge of the 3- to 4-year-old childrens' health checkup have set up a public health approach which led to new practical methods of screening tests in 1999. These have been used to evaluate the children's health problems of that age group in the region.

POPULATION AND METHODS

This study concerned 12,421 children born in 1995, attending the nursery schools of Gironde, who underwent a health checkup (visual and hearing screening test, language and behaviour exploration) in 1999.

RESULTS

Among them, 5,208 children failed screenings. One child out of six had language disorders, one child out of seven presented amblyopia, one out of eight suffered from behavioral problems and one child out of nine from a hearing defect. Furthermore, one out of three children who failed the test had several problems.

CONCLUSION

This study has enabled us to objectify the frequency of the troubles and their association, this information being particularly useful for evaluating these children's health needs and to help improve their healthcare management.

[Identification of language disorders in children. A contribution to the prevention of illiteracy]

Early identification of disorders of oral and written language development is essential for effective action before the vicious circle of educational failure and established psychosocial consequences. There has been growing awareness among health and education professionals that the means of recognizing, treating and teaching children with specific oral and written language disorders are inadequate. There is still a limited number of diagnostic tools that have not been fully evaluated. Nevertheless, considerable effort has been made in recent years to develop instruments for early detection and precise diagnostic evaluation. Developments in cognitive neuropsychology provide new approaches for the management of these disorders.

Detecting language disorders in 4-year-old French children. An application of the ERTL-4

This paper discusses the development of the ERTL-4 (Epreuve de repérage des troubles du langage lors du bilan medical de l'enfant de quatre ans), a measure developed in Nancy, France specifically for the purpose of identifying children with language difficulties in the 3.9-4.6 years age range. The test has been designed to identify 10-15% of the population and allows the assessing primary care doctor to ascertain whether difficulties occur in language, voice, fluency, hearing or perception on the basis of a 5-min assessment.

[A new look at dyslexia-dysorthography. Plea for an early recognition of that handicap]

Dyslexia is a primary development disorder characterized by reading and writing disability. Although frequent, it remains underdetected at school and badly known by practitioners. As a consequence, many children remain severely handicapped in their school life, and later on in their adult social life, although being fairly intelligent. Pediatricians must be involved in its early detection and management. ERTL4 test is a useful test of detection to be applied in 5-7-year-old children.