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Stübner C, Nielsen C, Jakobsson K, Gillberg C, Miniscalco C. Early-Life Exposure to Perfluoroalkyl Substances (PFAS) and Child Language and Communication Development: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7170. [PMID: 38131721 PMCID: PMC10742458 DOI: 10.3390/ijerph20247170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Language development starts during the fetal period when the brain is sensitive to endocrine disruptions from environmental contaminants. This systematic review aims to systematically summarize the existing literature on early-life exposure to PFAS and children's language and communication development, which is an indicator of neurocognitive development. A structured literature search was conducted using three databases, PubMed, Scopus, and CINAHL, last updated in April 2023. The population was defined as children and young adults. PFAS exposure was assessed pre- or postnatally. The outcome was defined as a language and communication ability assessed with validated instruments, parental self-reports, or clinical language disorder diagnoses. In total, 15 studies were identified for subsequent analyses. Thirteen were performed in background-exposed populations and two in highly exposed populations. There were some indications of potential adverse effects; however, these were not consistent across child sex, age of assessment, or PFAS exposure levels. No systematic effect of early-life PFAS exposure on language and communication development was found. These inconclusive findings may partly be explained by the use of general test instruments with limited validity as to children's language and communication development. Further studies over a wider exposure range using specific language test instruments are needed.
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Affiliation(s)
- Charlotte Stübner
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; (C.G.); (C.M.)
- Department of Pediatric Speech and Language Pathology, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden
| | - Christel Nielsen
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, 223 81 Lund, Sweden;
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden;
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, 413 90 Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; (C.G.); (C.M.)
- Department of Child and Adolescent Neuropsychiatry Unit, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; (C.G.); (C.M.)
- Department of Pediatric Speech and Language Pathology, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden
- Department of Child and Adolescent Neuropsychiatry Unit, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden
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Boerma T, Ter Haar S, Ganga R, Wijnen F, Blom E, Wierenga CJ. What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development. Neurosci Biobehav Rev 2023; 154:105398. [PMID: 37741516 DOI: 10.1016/j.neubiorev.2023.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.
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Affiliation(s)
- Tessel Boerma
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Sita Ter Haar
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands; Cognitive Neurobiology and Helmholtz Institute, Department of Psychology, Utrecht University/Translational Neuroscience, University Medical Center Utrecht, the Netherlands
| | - Rachida Ganga
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Frank Wijnen
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Elma Blom
- Department of Development and Education of youth in Diverse Societies (DEEDS), Utrecht University, Utrecht, the Netherlands; Department of Language and Culture, The Arctic University of Norway UiT, Tromsø, Norway.
| | - Corette J Wierenga
- Biology Department, Faculty of Science, Utrecht University, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
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Lindgren Fändriks A, Almqvist K, Hjärthag F, Pernebo K. Child health care nurses' experience of language screening for 2.5-year-old children: A qualitative study. Nurs Open 2023; 10:6583-6591. [PMID: 37317482 PMCID: PMC10416044 DOI: 10.1002/nop2.1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
AIM To investigate the experience of Child Health Care Nurses (CHCNs) using language screening for 2.5-year-old children. DESIGN An exploratory qualitative design with an inductive approach. METHOD Data were collected through semi-structured, interviews with Swedish CHCNs who regularly performed language screening for children. The interviews were analysed by thematic analysis. RESULTS Four themes were identified: 'The difficult visit', 'Explanations for language delay', 'Language screening across cultures' and 'Language screening with children exposed to adverse life events'. PATIENT OR PUBLIC CONTRIBUTION Our findings suggest that in routine care a modified procedure is used for the language screening of children aged 2.5 to secure the child's cooperation and to preserve an alliance with the parents. Consequently, the validity of the screening is called into question, particularly when it comes to children from families with origins outside the dominant culture and children exposed to adverse life events.
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Affiliation(s)
- Anna Lindgren Fändriks
- Department of Social and Psychological SciencesKarlstad UniversityKarlstadSweden
- Department of Research and DevelopmentRegion VärmlandKarlstadSweden
| | - Kjerstin Almqvist
- Department of Social and Psychological SciencesKarlstad UniversityKarlstadSweden
| | - Fredrik Hjärthag
- Department of Social and Psychological SciencesKarlstad UniversityKarlstadSweden
| | - Karin Pernebo
- Department of PsychologyLinnaeus UniversityVäxjöSweden
- Department of Research and DevelopmentRegion KronobergVäxjöSweden
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Cundari M, Vestberg S, Gustafsson P, Gorcenco S, Rasmussen A. Neurocognitive and cerebellar function in ADHD, autism and spinocerebellar ataxia. Front Syst Neurosci 2023; 17:1168666. [PMID: 37415926 PMCID: PMC10321758 DOI: 10.3389/fnsys.2023.1168666] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
The cerebellum plays a major role in balance, motor control and sensorimotor integration, but also in cognition, language, and emotional regulation. Several neuropsychiatric disorders such as attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as neurological diseases such as spinocerebellar ataxia type 3 (SCA3) are associated with differences in cerebellar function. Morphological abnormalities in different cerebellar subregions produce distinct behavioral symptoms related to the functional disruption of specific cerebro-cerebellar circuits. The specific contribution of the cerebellum to typical development may therefore involve the optimization of the structure and function of cerebro-cerebellar circuits underlying skill acquisition in multiple domains. Here, we review cerebellar structural and functional differences between healthy and patients with ADHD, ASD, and SCA3, and explore how disruption of cerebellar networks affects the neurocognitive functions in these conditions. We discuss how cerebellar computations contribute to performance on cognitive and motor tasks and how cerebellar signals are interfaced with signals from other brain regions during normal and dysfunctional behavior. We conclude that the cerebellum plays a role in many cognitive functions. Still, more clinical studies with the support of neuroimaging are needed to clarify the cerebellum's role in normal and dysfunctional behavior and cognitive functioning.
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Affiliation(s)
- Maurizio Cundari
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, Lund, Sweden
- Unit of Neuropsychiatry, Hospital of Helsingborg, Helsingborg, Sweden
- Unit of Neurology, Hospital of Helsingborg, Helsingborg, Sweden
| | - Susanna Vestberg
- Department of Psychology, Faculty of Social Science, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Medical Faculty, Lund University, Lund, Sweden
| | - Sorina Gorcenco
- Department for Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Rasmussen
- Department of Experimental Medical Science, Faculty of Medicine, Lund University, Lund, Sweden
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Moreno-Villagómez J, Yáñez-Téllez G, Prieto-Corona B, Seubert-Ravelo AN, García A, Hernández-Echeagaray E. Cognitive performance in preschoolers with non-syndromic craniosynostosis undergoing surgery: A comparison with typically developing children. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-7. [PMID: 36840597 DOI: 10.1080/21622965.2023.2183476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
This study aimed to determine the cognitive profile of preschool children undergoing surgery to correct non-syndromic craniosynostosis, compare them with typically developing children, and analyze possible cognitive deficits in the most prevalent subtypes: sagittal and unicoronal. Thirty-one children aged 3 years to 5 years and 11 months with non-syndromic craniosynostosis (11 sagittal, 9 unicoronal, 4 metopic, 3 lambdoid, 4 multisutural) who underwent surgery were compared with thirty-one typically developing children. The Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) was used to assess cognitive function. Children with non-syndromic craniosynostosis scored below the typically developing children in the Verbal Intelligence Quotient (VIQ) and Full-Scale Intelligence Quotient (FISQ). When specific subtypes were compared, children with sagittal synostosis scored similarly to the typically developing children; in contrast, children with unicoronal synostosis had lower performance in the Processing Speed Quotient and FISQ. The proportion of participants scoring below one standard deviation on the VIQ, General Language Composite, and FISQ was greater in the non-syndromic craniosynostosis group. This study supports the finding that children with non-syndromic craniosynostosis, particularly those with unicoronal synostosis, have more cognitive difficulties than those with normal development. Assessing cognition at preschool age in children with non-syndromic craniosynostosis is important in order to detect difficulties before they become more apparent at school age.
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Affiliation(s)
- Julieta Moreno-Villagómez
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Guillermina Yáñez-Téllez
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Belén Prieto-Corona
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Ana Natalia Seubert-Ravelo
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Antonio García
- Pediatric Neurosurgery Department, Unidad Médica de Alta Especialidad "La Raza" IMSS, México City, Mexico
| | - Elizabeth Hernández-Echeagaray
- Biomedical Unit, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
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Capelli E, Silibello G, Provera A, Dall'Ara F, Ajmone PF, Monti F, Scionti N, Zanchi P, Costantino MA, Vizziello PG, Zampini L. Speech Sound Development in 18-Month-Old Children With Sex Chromosome Trisomies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:287-297. [PMID: 36603546 DOI: 10.1044/2022_ajslp-22-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to describe speech sound development in a group of 18-month-old children with sex chromosome trisomies (SCTs), compared with a group of typically developing (TD) peers. Concurrent and longitudinal relationships between speech sound abilities and lexical development were examined. METHOD A group of 76 children aged 18 months, 38 children prenatally diagnosed with SCTs (12 with XXY, 12 with XYY, and 14 with XXX) and 38 TD children, participated in the study. From video recordings of semistructured naturalistic parent-child play sessions, quantitative and qualitative measures of speech sound development were collected (e.g., the number of consonants, type and place of articulation, and syllable structures used), and group differences were observed. The relationships between the number of consonants produced and vocabulary size at 18 and 24 months were assessed. RESULTS At 18 months, children with SCTs used a significantly lower number of consonants than TD children. Qualitatively, children with SCTs used significantly fewer articulatory complex consonants (fricative/affricates) and a more restricted inventory of syllable structures. The number of consonants used was significantly correlated with lexical development at 18 months. Moreover, in the SCTs group (but not in the TD group), the children with lower speech sound development at 18 months showed a significantly smaller vocabulary growth between 18 and 24 months than those with higher speech-sound development. CONCLUSIONS Toddlers with SCTs showed a significantly delayed speech sound development pattern rather than an atypical one. Children with SCTs with low speech sound development also showed lower vocabulary growth between 18 and 24 months of age. These results can be clinically relevant for follow-up and treatment planning for children with SCTs.
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Affiliation(s)
- Elena Capelli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gaia Silibello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesca Dall'Ara
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Francesca Ajmone
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Monti
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicoletta Scionti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Paola Zanchi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Maria Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Vizziello
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Zampini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Overbeck G, Kragstrup J, Gørtz M, Rasmussen IS, Graungaard AH, Siersma V, de Voss S, Ertmann RK, Shahrzad S, Appel CL, Wilson P. Family wellbeing in general practice: a study protocol for a cluster-randomised trial of the web-based resilience programme on early child development. Trials 2023; 24:7. [PMID: 36597136 PMCID: PMC9810520 DOI: 10.1186/s13063-022-07045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Social, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child's life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood. OBJECTIVE In the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire). METHODS The study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent-child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years. DISCUSSION We hypothesise that the intervention will increase mothers' ability to be sensitive to their child's mental state to an extent that improves the child's language and mental state at 30 months of age measured by parent-reported questionnaires. TRIAL REGISTRATION ClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.
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Affiliation(s)
- Gritt Overbeck
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Mette Gørtz
- grid.5254.60000 0001 0674 042XDepartment of Economics and Center for Economic Behavior and Inequality (CEBI), University of Copenhagen, Copenhagen, Denmark
| | - Ida Scheel Rasmussen
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anette Hauskov Graungaard
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Sarah de Voss
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Kirk Ertmann
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Sinead Shahrzad
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Clara Lundmark Appel
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark ,grid.7107.10000 0004 1936 7291Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Fernell E, Gillberg C. Autism under the umbrella of ESSENCE. Front Psychiatry 2023; 14:1002228. [PMID: 36756219 PMCID: PMC9901504 DOI: 10.3389/fpsyt.2023.1002228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
This brief article gives a short overview of "comorbidity" in autism. The most common co-occurring disorders will be presented and discussed within the context of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations), a concept that provides a holistic perspective for neurodevelopmental disorders. The ESSENCE concept also considers the heterogeneous and changing clinical panorama of developmental disorders over time, and also the multifactorial etiologies, including so called behavioral phenotype syndromes. Aspects on behavioral interventions in autism are presented-interventions that need to be adapted and take into account all non-autism associated ESSENCE, including intellectual disability and Attention-Deficit/Hyperactivity Disorder (ADHD). The article also focuses on current research on pharmacological intervention based on the hypothesis of imbalance in excitatory/inhibitory transmitter systems in autism and some other ESSENCE.
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Affiliation(s)
- Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Developmental language disorders in preschool children after high exposure to perfluoroalkyl substances from contaminated drinking water in Ronneby, Sweden. ENVIRONMENTAL EPIDEMIOLOGY (PHILADELPHIA, PA.) 2022; 7:e233. [PMID: 36777530 PMCID: PMC9916036 DOI: 10.1097/ee9.0000000000000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022]
Abstract
There are indications that early-life exposure to perfluoroalkyl substances (PFAS) can impact neurodevelopment, but results are inconclusive. The objective was to investigate if high early-life exposure to primarily perfluorohexanesulfonic acid (PFHxS) and perfluorooctanesulfonic acid (PFOS) increases the risk of developmental language disorder in children up to seven years of age. Methods A register-based cohort of all children born 1998-2013 in Blekinge county, Sweden, was studied. Maternal residential history, that is, with or without highly PFAS-contaminated drinking water, during the 5-year period before childbirth was used as a proxy for early-life exposure. Exposure was categorized as high (n = 646), intermediate (n = 1,650), or background (n = 9,599). We used Cox proportional hazards regression to estimate hazard ratios (HR) for (1) referral to a speech- and language pathologist after routine screening at Child Health Services, and (2) subsequent language disorder diagnosis after clinical assessment. Models were adjusted for parity, maternal age, education level, and smoking, and explored effect modification by sex. Results In children from the high-exposed area, the adjusted HR for referral was 1.23 (95% CI = 1.03, 1.47) and 1.13 (95% CI = 0.97, 1.56) for subsequent diagnosis. There was no increased risk in the intermediate exposure category. Conclusion Children, particularly girls, with high exposure had an increased risk of both referral and confirmed developmental language disorder. Further research is needed on PFAS in the context of general neurodevelopment, for which language development is a proxy.
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Capelli E, Silibello G, Ajmone PF, Altamore E, Lalatta F, Vizziello PG, Costantino MA, Zampini L. Language Development in Sex Chromosome Trisomies: Developmental Profiles at 2 and 4 Years of Age, and Predictive Measures. Dev Neurorehabil 2022; 25:337-348. [PMID: 34983283 DOI: 10.1080/17518423.2021.2020925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Describing language development in children with sex chromosome trisomies (SCT) and testing the predictive value of early language measures on later outcomes. METHOD Thirteen children with SCT were followed longitudinally. Their developmental profile was assessed, with particular attention to language, at 2 and 4 years. The predictive value of direct (spontaneous speech analysis) and indirect (communicative development inventory) language measures at 2 on performances at 4 was tested. RESULTS Language performances at both ages were lower than non-verbal development. At 2, more than 50% of the group produced less than 50 words. At 4, impaired performances were observed in speech sound development and expressive morpho-syntax. Direct measures of Pre-syntactic development predicted later global language outcomes and Sentence Repetition. The number of consonants used at 2 was significantly related to Nonword Repetition at 4. CONCLUSIONS The study highlights the importance of early detection and careful follow-up for children with SCT.
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Affiliation(s)
| | - Gaia Silibello
- Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Elena Altamore
- Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Faustina Lalatta
- Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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López I, Förster J. Trastornos del neurodesarrollo: dónde estamos hoy y hacia dónde nos dirigimos. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Levlin M, Wiklund-Hörnqvist C, Sandgren O, Karlsson S, Jonsson B. Evaluating the Effect of Rich Vocabulary Instruction and Retrieval Practice on the Classroom Vocabulary Skills of Children With (Developmental) Language Disorder. Lang Speech Hear Serv Sch 2022; 53:542-560. [PMID: 35320680 DOI: 10.1044/2021_lshss-21-00101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Learning new vocabulary has been identified as a challenge for students with (developmental) language disorder ((D)LD). In this study, we evaluate the effects of two active learning methods, (a) retrieval practice (RP) and (b) rich vocabulary instruction (RVI), in a group of students with (D)LD in secondary school. METHOD A quasi-experimental counterbalanced within-subject design was used to compare and evaluate the effect of RP and RVI on learning Tier 2 vocabulary, with target and control words as dependent measures. Eleven students with (D)LD (M age = 14.9 years) attending a language unit participated. RP and RVI were implemented in regular classroom activities during 16 lessons (eight lessons/instructional condition). Learning was assessed by comparing performance on a pretest session 1-2 weeks prior, with posttest performance 1 week after each instructional condition. RESULTS The learning gain for RP was superior to that for RVI, both with respect to the Bayesian probabilistic estimations for target words relative to control words and in direct comparison with RVI. Only weak evidence was found for RVI with respect to the Bayesian probabilistic estimations for target words relative to control words. CONCLUSIONS All participants showed positive learning gains following RP, whereas the outcome for RVI was more diverse. This initial work suggests that RP promotes larger learning gains relative to RVI and promotes learning across language profiles. This study extends previous studies by exploring the implementation of RP in regular classroom activities and by using more complex to-be-learned material (Tier 2 words).
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Affiliation(s)
- Maria Levlin
- Department of Language Studies, Umeå University, Sweden
| | | | - Olof Sandgren
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Sweden
| | - Sara Karlsson
- National Agency for Special Needs Education and Schools, Umeå, Sweden
| | - Bert Jonsson
- Department of Applied Educational Science, Umeå University, Sweden
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Yu Y, Zuo E, Doig S. The Differential Effects of Tai Chi vs. Brisk Walking on Cognitive Function Among Individuals Aged 60 and Greater. Front Hum Neurosci 2022; 16:821261. [PMID: 35370574 PMCID: PMC8968319 DOI: 10.3389/fnhum.2022.821261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to investigate the differential effects of Tai Chi vs. brisk walking on cognitive function among individuals aged 60 and greater. Patients and Methods For participant recruitment, a health talk was arranged at two communities in which two different exercise modalities (Tai Chi and brisk walking) were assigned to participants of each community free of charge. The intervention programs lasted 10 weeks, with three 60-min training sessions per week. General cognitive ability and specific cognitive outcomes were measured using the Chinese version of the Montreal Cognitive Assessment (MoCA). Results A significant interaction on total scores of the MoCA was observed (F = 11.15, p < 0.05). Post hoc analysis indicated significant improvements on general cognitive performance as measured in performance on the MoCA for both exercise groups at the end of 10 weeks. A significant interaction was only observed on the delayed recall sub-domain (F = 12.93, p < 0.001). Results from post hoc analysis indicate that the Tai Chi group had a significantly better memory performance relative to brisk walking group (p < 0.05). Specifically, significant improvement was observed in Tai Chi group (p < 0.05), but not in the brisk walking group. Both exercise groups demonstrated significant improvements from baseline to Week 10, which emerged in visualspatial ability (p < 0.05) and attention performance (p < 0.001). Lastly, animal naming and orientation significantly benefited from brisk walking (p < 0.05) and Tai Chi training (p < 0.05), respectively. Conclusion Tai Chi and brisk walking as the most commonly used, culture-specific mind-body exercise method have been proven to be effective in improving general cognitive performance and specific cognitive domains. Furthermore, differential effects of two different exercise modalities on cognitive domains were observed, which has provided insightful information for customized exercise programs. Finally, aging individuals who are experiencing cognitive decline should either take Tai Chi classes regularly or engage in brisk walking, which could contribute to brain health.
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Affiliation(s)
- Ye Yu
- School of Sports Science, Changsha Normal University, Changsha, China
| | - Erfei Zuo
- School of Physical Education, Xiangnan University, Chenzhou, China
- *Correspondence: Erfei Zuo,
| | - Scott Doig
- Department of Education and Kinesiology, Limestone University, Gaffney, SC, United States
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Ottosson S, Schachinger Lorentzon U, Kadesjö B, Gillberg C, Miniscalco C. Neurodevelopmental problems and quality of life in 6-year-olds with a history of developmental language disorder. Acta Paediatr 2022; 111:115-122. [PMID: 34516681 DOI: 10.1111/apa.16104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/18/2021] [Accepted: 09/10/2021] [Indexed: 12/01/2022]
Abstract
AIM To explore family-reported neurodevelopmental functioning and quality of life in 6-year-olds who had screened positive for developmental language disorder at age 2.5 years. METHODS Parents of 85 6-year-old children completed questionnaires about child neurodevelopmental difficulties and quality of life. The children were interviewed regarding quality of life, and their language was assessed by speech and language pathologists. Test results at 6 years identified three subgroups: children with developmental language disorder (n = 68) or speech sound disorder (n = 6) and children with no current language disorder (n = 11). RESULTS Out of the 68 children with developmental language disorder, 33 (48%) had significant parent-rated problems with language, executive functions 17 (25%), perception 15 (22%) and/or motor skills 15 (22%). Four (67%) of the children with speech sound disorder had significant problems with language. Significant problems were reported with language in five (45%) and with perception in four (36%) children with no current language disorder. The parents reported no impaired quality of life, whereas the children themselves reported impairment mainly with school functioning. CONCLUSIONS Overlap between language difficulties and other neurodevelopmental problems was higher in 6-year-olds who had screened positive for developmental language disorder about 3 years earlier, than in the general population. The parent and child reports of quality of life were not consistent.
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Affiliation(s)
- Simon Ottosson
- Department of Pediatrics Angered Hospital Gothenburg Angered Sweden
| | - Ulrika Schachinger Lorentzon
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatric Speech and Language Pathology Queen Silvia Children’s Hospital Gothenburg Gothenburg Sweden
| | - Björn Kadesjö
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Child Neuropsychiatry Queen Silvia Children’s Hospital Gothenburg Gothenburg Sweden
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatric Speech and Language Pathology Queen Silvia Children’s Hospital Gothenburg Gothenburg Sweden
- Department of Child Neuropsychiatry Queen Silvia Children’s Hospital Gothenburg Gothenburg Sweden
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Wilson P, Rush R, Charlton J, Gilroy V, McKean C, Law J. Universal language development screening: comparative performance of two questionnaires. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001324. [PMID: 36053598 PMCID: PMC8739429 DOI: 10.1136/bmjpo-2021-001324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Low language ability in early childhood is a strong predictor of later psychopathology as well as reduced school readiness, lower educational attainment, employment problems and involvement with the criminal justice system. Assessment of early language development is universally offered in many countries, but there has been little evaluation of assessment tools. We planned to compare the screening performance of two commonly used language assessment instruments. METHODS A pragmatic diagnostic accuracy study was carried out in five areas of England comparing the performance of two screening tools (Ages and Stages Questionnaire (ASQ) and Sure Start Language Measure (SSLM)) against a reference test (Preschool Language Scale, 5th edition). RESULTS Results were available for 357 children aged 23-30 months. The ASQ Communication Scale using optimal cut-off values had a sensitivity of 0.55, a specificity of 0.95 and positive and negative predictive values of 0.53 and 0.95, respectively. The SSLM had corresponding values of 0.83, 0.81, 0.33 and 0.98, respectively. Both screening tools performed relatively poorly in families not using English exclusively in the home. CONCLUSION The very widely used ASQ Communication Scale performs poorly as a language screening tool, missing over one-third of cases of low language ability. The SSLM performed better as a screening tool.
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Affiliation(s)
- Philip Wilson
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Inverness, UK
| | - Robert Rush
- Independent statistical consultant, Edinburgh, UK
| | - Jenna Charlton
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Cristina McKean
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
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Brimo K, Dinkler L, Gillberg C, Lichtenstein P, Lundström S, Åsberg Johnels J. The co-occurrence of neurodevelopmental problems in dyslexia. DYSLEXIA (CHICHESTER, ENGLAND) 2021; 27:277-293. [PMID: 33759268 DOI: 10.1002/dys.1681] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The primary aim of this study was to explore the overlaps between dyslexia and a range of neurodevelopmental disorders and problems (NDPs), specifically symptoms of attention-deficit/hyperactivity disorder, autism spectrum disorder, atypical sensory perception and developmental coordination disorder. Capitalizing on a population-based sample of twins, secondary aims included estimating the heritability of dyslexia and reporting on the measurement characteristics of the scale used to assess dyslexia. A telephone interview regarding symptoms of dyslexia and other NDPs was conducted with parents of 1,688 nine-year-old twins. The prevalence and the heritability of dyslexia were estimated at 8 and 52%, respectively. The boy: girl ratio was 1.5:1. Results revealed that there was more than an eight-fold increase in (diagnostic proxy) NDPs prevalence in the dyslexia group as compared to typical readers. Quantitatively measured symptoms of inattention, oral language problems and atypical sensory perception significantly predicted dyslexia status in a multivariate analysis. By contrast, ASD-related inflexibility was inversely associated with dyslexia in the multivariate model. In sum, dyslexia often overlaps with other NDPs. The current study provides new knowledge supporting the position to move beyond isolated diagnostic categories into behavioural profiles of co-occurring problems when trying to understand the pattern of strengths and needs in individuals with dyslexia.
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Affiliation(s)
- Katarzyna Brimo
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Speech and Language Pathology unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Wang Y, Hu C, Fang T, Jin Y, Wu R. Perspective on prenatal polychlorinated biphenyl exposure and the development of the progeny nervous system (Review). Int J Mol Med 2021; 48:150. [PMID: 34132363 PMCID: PMC8219518 DOI: 10.3892/ijmm.2021.4983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/26/2021] [Indexed: 02/05/2023] Open
Abstract
The developmental origins of health and disease concept illustrates that exposure in early life to various factors may affect the offspring's long-term susceptibility to disease. During development, the nervous system is sensitive and vulnerable to the environmental insults. Polychlorinated biphenyls (PCBs), which are divided into dioxin-like (DL-PCBs) and non-dioxin-like PCBs (NDL-PCBs), are synthetic persistent environmental endocrine-disrupting chemicals. The toxicological mechanisms of DL-PCBs have been associated with the activation of the aryl hydrocarbon receptor and NDL-PCBs have been associated with ryanodine receptor-mediated calcium ion channels, which affect neuronal migration, promote dendritic growth and alter neuronal connectivity. In addition, PCB accumulation in the placenta destroys the fetal placental unit and affects endocrine function, particularly thyroid hormones and the dopaminergic system, leading to neuroendocrine disorders. However, epidemiological investigations have not achieved a consistent result in different study cohorts. The present review summarizes the epidemiological differences and possible mechanisms of the effects of intrauterine PCB exposure on neurological development.
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Affiliation(s)
- Yinfeng Wang
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Changchang Hu
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Tao Fang
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yang Jin
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Ruijin Wu
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
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Jansen R, Maljaars J, Zink I, Steyaert J, Noens I. The complexity of early diagnostic decision making: A follow-up study of young children with language difficulties. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:2396941520984894. [PMID: 36381531 PMCID: PMC9620700 DOI: 10.1177/2396941520984894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Due to the complexity of early diagnostic decision making, we examined the predictive value of an early diagnostic classification and early abilities on later best estimate diagnosis for 22 clinically referred children with language difficulties. METHODS AND PROCEDURES Four years after initial evaluation (Time 1), the clinical files of these children were reviewed. A best-estimate (BE) diagnosis of language disorder (LD), intellectual disability (ID), or autism spectrum disorder (ASD) was established, with ASD being most common. OUTCOMES AND RESULTS Early clinical classifications were relatively unstable or difficult to establish at a young age. The magnitude of children's cognitive and receptive language delay was a significant predictor of a later BE diagnosis of ID and LD respectively. A BE diagnosis of ASD, by contrast, could not be predicted from children's early social communication problems nor the presence of restricted and repetitive behaviors and interests. CONCLUSIONS Taken together, the results of this study suggest that language difficulties can be an early marker of a neurodevelopmental disorder which is often not identified at the age of first referral. IMPLICATIONS Eligibility for treatment should, therefore, be based on biopsychosocial case formulation rather than DSM or ICD diagnostic classification. WHAT THIS PAPER ADDS? In this study a dimensional approach was used to characterize the abilities of young children referred with mild to profound receptive and/or expressive language difficulties. Later on, a categorical approach was adopted to establish best estimate diagnoses. Our clinical, broadly defined sample reflects the heterogeneous intake of young children referred for diagnostic assessment. Other studies on diagnostic stability often only focus on one diagnostic category (and are explicitly excluding children with specific other diagnoses), not taking into account the difficulties of early differential diagnostic decision making and stability across different categories over time. Investigations of differential diagnosis within a clinical group, instead of only differentiating children with a specific diagnosis from typically developing children, may be more informative for clinicians.
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Affiliation(s)
- Rianne Jansen
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Jarymke Maljaars
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Inge Zink
- Department of Neurosciences, ExpORL, KU Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Belgium
| | - Jean Steyaert
- Department of Neurosciences, Developmental Psychiatry, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Ilse Noens
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
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Andersson K, Klintö K. Does the narrative ability during retelling differ in 5-year-olds born with and without unilateral cleft lip and palate? LOGOP PHONIATR VOCO 2020; 47:18-24. [PMID: 33966584 DOI: 10.1080/14015439.2020.1822441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A previous study has indicated poorer narrative ability during retelling in 5-year-olds with unilateral cleft lip and palate (UCLP) as a group, compared to peers without UCLP. AIM To investigate if there are any differences between 5-year-olds with and without UCLP in narrative ability during retelling. METHODS A total of 83 children participated, 51 with UCLP and 32 without. They had no known additional malformations or syndromes. The children were audio recorded while performing the Bus Story Test (BST). The recordings were orthographically transcribed. From the transcriptions the BST information score was calculated. The macrostructure of the narratives was assessed with the Narrative Scoring Scheme (NSS), and the microstructure with mean length of utterance in words, grammaticality, grammatical complexity and lexical diversity. Results for children with and without UCLP were compared. RESULTS The group with UCLP performed better than the group without UCLP in the NSS sub-category Conclusion. No other significant differences were seen between the groups. The UCLP group had a larger standard deviation for the information score than the group without UCLP. CONCLUSIONS The group with UCLP displayed at least as good results as the group without UCLP, but the information score was more varied for the UCLP group than for the group without UCLP.
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Affiliation(s)
- Ketty Andersson
- Department of Clinical Sciences in Lund, Division of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Kristina Klintö
- Department of Otorhinolaryngology, Division of Speech and Language Pathology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences in Malmö, Division of Surgery, Lund University, Lund, Sweden
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20
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Mogren Å, Sjögreen L, Barr Agholme M, McAllister A. Orofacial function in children with Speech Sound Disorders persisting after the age of six years. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:526-536. [PMID: 32114835 DOI: 10.1080/17549507.2019.1701081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.
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Affiliation(s)
- Åsa Mogren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Orofacial Resource Centre for Rare Diseases, Public Dental Service, Mun-H-Center, Gothenburg, Sweden
| | - Lotta Sjögreen
- Orofacial Resource Centre for Rare Diseases, Public Dental Service, Mun-H-Center, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, Gothenburg, Sweden
| | - Monica Barr Agholme
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden, and
| | - Anita McAllister
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech & Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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Atypical communication characteristics among clinic-referred youth with and without autism spectrum disorder: Stability and associations with clinical correlates. Dev Psychopathol 2020; 32:1240-1253. [PMID: 32938518 DOI: 10.1017/s095457942000070x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atypical communication characteristics (ACCs), such as speech delay, odd pitch, and pragmatic difficulties, are common features of autism spectrum disorder (ASD) as are the symptoms of a wide range of psychiatric disorders. Using a simple retrospective method, this study aimed to better understand the relation and stability of ACCs with a broad range of psychiatric symptoms among large, well-characterized samples of clinic-referred children and adolescents with and without ASD. Youth with ASD had higher rates and a more variable pattern of developmental change in ACCs than the non-ASD diagnostic group. Latent class analysis yielded three ACC stability subgroups within ASD: Stable ACCs, Mostly Current-Only ACCs, and Little Professors. Subgroups exhibited differences in severity of ASD symptomatology, co-occurring psychiatric symptoms, and other correlates. Our findings provide support for the clinical utility of characterizing caregiver-perceived changes in ACCs in identifying children at risk for co-occurring psychopathology and other clinically relevant variables.
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Abstract
Borderline intellectual functioning (BIF), that is to say, tested IQ levels in the range of 70-84/85, is prevalent, affecting about 12%-14% of the population depending on the exact level for "diagnostic" cutoff. In the current Diagnostic and Statistical Manual of Mental Disorders, BIF does not have a separate diagnostic category but can be categorized with a V-code. Children and adolescents with BIF usually struggle both as regards school performance and in respect of social functioning. BIF is common in attention deficit hyperactivity disorder, but sometimes attention problems in schoolchildren with BIF may be a consequence of nonadapted academic demands. Autism and BIF may also coexist, and there are many cases of so-called high-functioning autism who are high functioning only in the sense that they do not meet criteria for intellectual disability, but function in the area of BIF. Currently, too little attention is given to the negative effects of BIF on child development and adaptation. Learning, academic, and behavioral problems and grade retention may be markers of BIF. Our diagnostic and classification manuals need to have specific categories that clarify the problems that BIF entails so that affected individuals can avail themselves of better educational support and understanding.
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Affiliation(s)
- Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Gothenburg University, Gothenburg, Sweden.
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Jansen R, Maljaars J, Verhappen A. Problem behavior in young children referred with language difficulties: Relations to language and intentional communication. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2020; 5:2396941519900076. [PMID: 36381553 PMCID: PMC9620458 DOI: 10.1177/2396941519900076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS This exploratory study aims to examine the relative contribution of language and intentional communication to internalizing and externalizing problem behavior. METHODS Twenty-nine Dutch-speaking children (age range 24-46 months) referred with language difficulties participated in this study. For the majority of children, these early language difficulties appeared to be part of a broader neurodevelopmental disorder, mainly autism spectrum disorder. Parent ratings on the Achenbach Child Behavior Checklist 1½-5 were predicted from children's language level and intentional communicative abilities, the latter being assessed by both parent report and direct observation. In all series of hierarchical regression analyses, chronological age and nonverbal mental age were included as covariates. RESULTS Parents commonly reported withdrawal, emotionally reactive behavior, attention problems, and aggressive behavior. Parent-rated intentional communication was the most important predictor of internalizing problem behavior and played an important role in the prediction of aggressive behavior as well. However, chronological age and/or nonverbal mental age also predicted parent-rated levels of externalizing problem behavior, especially attention problems. CONCLUSIONS The relation between language difficulties and problem behavior may be influenced by maturation and children's ability to communicate intentionally.Implications: Language proficiency should, therefore, be independently assessed from children's intentional communicative abilities which, in turn, may differ across contexts.
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Affiliation(s)
| | - Jarymke Maljaars
- Jarymke Maljaars, KU Leuven, Leopold
Vanderkelenstraat 32 box 3765, Leuven 3000, Belgium.
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Roy P, Chiat S. The Early Sociocognitive Battery: a clinical tool for early identification of children at risk for social communication difficulties and ASD? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:794-805. [PMID: 31132198 DOI: 10.1111/1460-6984.12477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/19/2019] [Accepted: 04/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND A substantial proportion of preschool children referred to speech and language therapy (SLT) services have social communication difficulties and/or autistic spectrum disorders (SC&/ASD) that are not identified until late childhood. These 'late' diagnosed children miss opportunities to benefit from earlier targeted interventions. Prior evidence from a follow-up clinical sample showed that preschool performance on the Early Sociocognitive Battery (ESB) was a good predictor of children with social communication difficulties 7-8 years later. AIMS The aims were three-fold: (1) to determine the impact of child/demographic factors on ESB performance in a community sample of young children; (2) to assess the ESB's concurrent validity and test-retest reliability; and (3) to use cut-offs for 'low' ESB performance derived from the community sample data to evaluate in a clinical sample the predictiveness of the ESB at 2-4 years for outcomes at 9-11 years, including parent-reported SC&/ASD diagnosis. METHODS & PROCEDURES A community sample of 205 children aged 2-4 years was assessed on the ESB and a receptive vocabulary test. A subsample (n = 20) was retested on the ESB within 2 weeks. Parents completed a questionnaire providing background child/demographic information. The clinical sample from our previous study comprised 93 children assessed on the ESB at 2;6 to < 4;0 whose parents completed the Social Responsiveness Scale (SRS), our measure of social communication, when the children were 9-11 years. Cut-offs for 'low' ESB performance derived from the community sample were used to determine the predictive validity of 'low' ESB scores for social communication outcomes and parent-reported SC&/ASD diagnosis according to age of ESB assessment. OUTCOME & RESULTS Findings from the community sample confirmed the ESB as psychometrically robust, sensitive to age and language delay, and, in contrast to the receptive vocabulary measure, unaffected by bilingualism. While overall associations between ESB performance and later social communication difficulties in the clinical sample were particularly strong for the youngest age group (2;6 to < 3;0; r = .71, p < .001), 'low' ESB performance was equally predictive across age groups and overall identified 89% of children with 'late' SC&/ASD diagnoses (sensitivity), and 75% of those without (specificity). CONCLUSIONS & IMPLICATIONS Results indicate that the ESB is a valid preschool assessment suitable for use with children from diverse language backgrounds. It identifies deficits in key sociocognitive skills and is predictive of social communication difficulties in school-age children that had not been identified in preschool clinical assessment, supporting earlier targeted interventions for these children.
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Affiliation(s)
- Penny Roy
- Language and Communication Science, City, University of London, London, UK
| | - Shula Chiat
- Language and Communication Science, City, University of London, London, UK
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Nayeb L, Lagerberg D, Westerlund M, Sarkadi A, Lucas S, Eriksson M. Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier. Acta Paediatr 2019; 108:1642-1648. [PMID: 30896050 DOI: 10.1111/apa.14790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022]
Abstract
AIM We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. METHODS This study observed 105 monolingual Swedish-speaking children (53% boys) aged 29-31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse-led screening. RESULTS The results for the three-word and two-word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three-word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two-word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse-led screening. CONCLUSION Changing the required word combinations from three to two words worked well. The three-word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.
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Affiliation(s)
- Laleh Nayeb
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Dagmar Lagerberg
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Monica Westerlund
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Steven Lucas
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Mårten Eriksson
- Department of Social work and Psychology Faculty of Health and Occupational Studies University of Gävle Gävle Sweden
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Kang E, Gadow KD, Lerner MD. Atypical Communication Characteristics, Differential Diagnosis, and the Autism Spectrum Disorder Phenotype in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:251-263. [DOI: 10.1080/15374416.2018.1539912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Erin Kang
- Department of Psychology, Stony Brook University
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Gillberg C, Pry R, Nadel J. Le concept d�essence et la comorbidit� dans les troubles neurod�veloppementaux. ENFANCE 2019. [DOI: 10.3917/enf2.191.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Miniscalco C, Fernell E, Thompson L, Sandberg E, Kadesjö B, Gillberg C. Development problems were common five years after positive screening for language disorders and, or, autism at 2.5 years of age. Acta Paediatr 2018; 107:1739-1749. [PMID: 29637606 DOI: 10.1111/apa.14358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/21/2018] [Accepted: 04/04/2018] [Indexed: 12/31/2022]
Abstract
AIM This study identified whether children who had screened positive for either developmental language disorder (DLD) or autism spectrum disorder (ASD) at the age of 2.5 years had neurodevelopmental assessments five years later. METHODS Our study cohort were 288 children born from 1 July 2008 to 20 June 2009 who screened positive for DLD and, or, ASD at 2.5 years. Of these, 237 children were referred to, and assessed, at the Paediatric Speech and Language Pathology clinic (n = 176) or the Child Neuropsychiatry Clinic (n = 61) at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Clinical registers covering all relevant outpatient clinics were reviewed five years later with regard to established diagnoses. RESULTS When the 237 were followed up five years later, 96 (40%) had established neurodevelopmental disorders or problems, often beyond DLD and ASD. Co-existing problems were common in this cohort and multidisciplinary assessments were indicated. The other 60% did not appear in subsequent clinic records. It is likely that this 40% was a minimum rate and that more children will be referred for developmental problems later. CONCLUSION Five years after they had been screened positive for DLD and, or autism at 2.5 years, 40% of our cohort had remaining or other developmental problems.
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Affiliation(s)
- Carmela Miniscalco
- Gillberg Neuropsychiatry Centre; Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Department of Paediatric Speech and Language Pathology; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre; Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
| | - Lucy Thompson
- Gillberg Neuropsychiatry Centre; Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
| | - Eva Sandberg
- Department of Paediatric Speech and Language Pathology; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Björn Kadesjö
- Gillberg Neuropsychiatry Centre; Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre; Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
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Henry L, Farmer C, Manwaring SS, Swineford L, Thurm A. Trajectories of cognitive development in toddlers with language delays. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 81:65-72. [PMID: 29699725 PMCID: PMC6325633 DOI: 10.1016/j.ridd.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Toddlers with early language delays (LD) are at risk for developmental difficulties, including autism spectrum disorder (ASD). However, little is known about early cognitive skill acquisition in this population. AIMS To explore heterogeneity in cognitive development in toddlers with significant LD (n = 30) or typical development (n = 61), and how this relates to 36-month outcomes (ASD, non-ASD delays, or no delays). METHODS Growth mixture modeling of nonverbal and verbal mental age (NVMA, VMA) scores from the Mullen Scales of Early Learning was conducted with data from 18, 24 and 36 months. RESULTS A two-class NVMA solution was selected (Age Appropriate, 82%, Delayed, 18%); class membership was related to the no delay outcome, and although the proportion of toddlers with ASD in the Age-Expected class was 17% compared to 50% of toddlers with non-ASD delays, this difference was not statistically significant. The best-fitting model for VMA included three classes: Age Appropriate (66%), Delay Catch-Up (23%), Delayed (11%); class assignment differed by outcome. Children in the Delay Catch-Up class were more likely to have non-ASD delays compared to ASD, while the reverse was true in the Delayed class. CONCLUSIONS Cognitive development in toddlers with LD is heterogeneous, and delayed verbal trajectories relate to later ASD diagnosis.
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Affiliation(s)
- Laura Henry
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, United States.
| | - Cristan Farmer
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, United States.
| | - Stacy S Manwaring
- University of Utah, Department of Communication Sciences and Disorders, Salt Lake City, UT, United States.
| | - Lauren Swineford
- Washington State University, Department of Speech & Hearing Sciences, Spokane, WA, United States.
| | - Audrey Thurm
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, United States.
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Wilson P, Wood R, Lykke K, Hauskov Graungaard A, Ertmann RK, Andersen MK, Haavet OR, Lagerløv P, Abildsnes E, Dahli MP, Mäkelä M, Varinen A, Hietanen M. International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function. Scand J Public Health 2018; 46:805-816. [PMID: 29726749 DOI: 10.1177/1403494818772211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. FINDINGS Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. CONCLUSIONS Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.
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Affiliation(s)
- Philip Wilson
- 1 Centre for Rural Health, University of Aberdeen, Scotland.,2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Rachael Wood
- 3 Women and Children's Health, NHS National Services Scotland, Information Services Division, Edinburgh, Scotland
| | - Kirsten Lykke
- 2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anette Hauskov Graungaard
- 2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Kirk Ertmann
- 2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Per Lagerløv
- 5 Department of general practice, University of Oslo, Norway
| | - Eirik Abildsnes
- 6 Department of global public health and primary care, University of Bergen, Norway
| | - Mina P Dahli
- 5 Department of general practice, University of Oslo, Norway
| | - Marjukka Mäkelä
- 2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,7 THL (National Institute for Health and Welfare), Helsinki, Finland
| | - Aleksi Varinen
- 8 Department of General Practice, Faculty of Medicine and Life Sciences, University of Tampere, Finland
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Marklund U, Lacerda F, Persson A, Lohmander A. The development of a vocabulary for PEEPS-SE-profiles of early expressive phonological skills for Swedish. CLINICAL LINGUISTICS & PHONETICS 2018; 32:844-859. [PMID: 29634359 DOI: 10.1080/02699206.2018.1445780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper describes the development of a vocabulary for Profiles of Early Expressive Phonological Skills for Swedish (PEEPS-SE), a tool for assessment of expressive phonology in Swedish-learning children in the age range of 18-36 months. PEEPS-SE is the Swedish version of the original PEEPS, Profiles of Early Expressive Phonological Skills, which uses two age-adequate word lists-a basic word list (BWL) for the assessment of 18-24-month-old children, to which an expanded word list (EWL) is added for assessment of 24-36-month-old children, or children with more than 250 words in their expressive vocabulary. The selection of words in PEEPS-SE is based on two types of criteria: age of acquisition and phonological complexity. The words also need to be easy to elicit in a natural way in test situations. Vocabulary data previously collected with the Swedish Early Communicative Development Inventory are used for selection of age-adequate words, where the BWL contains words acquired earlier compared to the additional words in the EWL. The latter also contains words that are more phonologically complex compared to those in the BWL. Word complexity was determined by the Swedish version of word complexity measure. PEEPS-SE has made an attempt to match the original version of PEEPS in terms of both assessment method and word selection.
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Affiliation(s)
- Ulrika Marklund
- a Department of Linguistics , Stockholm University , Stockholm , Sweden
- b Functional Area SLP, Speech Clinic , Danderyds Hospital , Stockholm , Sweden
| | - Francisco Lacerda
- a Department of Linguistics , Stockholm University , Stockholm , Sweden
| | - Anna Persson
- c Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology , Karolinska Institutet , Stockholm , Sweden
- d Functional area Special Education, Hearing and Balance Clinic, Habilitation Children and Youth , Karolinska University Hospital , Stockholm , Sweden
| | - Anette Lohmander
- c Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology , Karolinska Institutet , Stockholm , Sweden
- e Functional Area SLP , Karolinska University Hospital , Stockholm , Sweden
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Ikeno T, Miyashita C, Nakajima S, Kobayashi S, Yamazaki K, Saijo Y, Kita T, Sasaki S, Konishi K, Kajiwara J, Hori T, Kishi R. Effects of low-level prenatal exposure to dioxins on cognitive development in Japanese children at 42months. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 618:1423-1430. [PMID: 29017727 DOI: 10.1016/j.scitotenv.2017.09.267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/23/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prenatal exposure to polychlorinated dibenzo-p-dioxins (PCDDs) or polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dioxin-like compounds [DLCs]) through environmental chemicals may affect the neurodevelopment of children. In our previous study, an inverse association was observed between prenatal DLCs and neurodevelopment of infants aged 6months in both sexes. However, studies are yet to determine how long these adverse effects last. OBJECTIVE To examine whether the effects of DLCs on cognitive development remains at 42months. METHODS In this prospective cohort study conducted in Sapporo, Japan, pregnant mothers' blood was analyzed for the congener level of DLCs. The Kaufman Assessment of Battery for Children (K-ABC) was used to test their children's cognitive development at 42months. A total of 141 mother-child pairs were included in the final analysis. The multiple linear regression analysis was used to examine the association between the K-ABC scores and DLC levels in the maternal blood. RESULTS Seven isomers (1,2,3,6,7,8-HxCDD, 2,3,4,7,8-PeCDF, 33'44'55'-HxCB(#169), 2344'5- PenCB(#114), 233'44'5-HexCB(#156), 233'44'5'-HexCB(#157), 23'44'55'-HexCB(#167), total PCDF, and TEQ-PCDD, PCDF, PCDD/DFs levels were positively associated with the achievement score (AS) of K-ABC. However, total non-ortho PCBs were negatively associated with the Mental Processing Composite Score (MPCS) of K-ABC in males. In females, increased TEQ-dl PCB and TEQ-PCDD/F/dl-PCB were also associated with increasing AS score. CONCLUSIONS This study suggests that the negative effects of prenatal DLC exposure on children's cognitive development at 6months were not observed in children aged 42months. Regarding the sex-specific effects, AS and DLCs were positively correlated in females, whereas those of MPCS and DLCs were significantly negative in males.
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Affiliation(s)
- Tamiko Ikeno
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan
| | - Chihiro Miyashita
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan
| | - Sonomi Nakajima
- Sapporo Medical University, School of Health Science, Sapporo, Japan
| | - Sumitaka Kobayashi
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan
| | - Keiko Yamazaki
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan
| | - Yasuaki Saijo
- Asahikawa Medical University, Department of Health Science, Asahikawa, Japan
| | - Toshiko Kita
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan; Sapporo City University, School of Nursing, Sapporo, Japan
| | - Seiko Sasaki
- Hokkaido University Graduate School of Medicine, Department of Public Health, Sapporo, Japan
| | - Kanae Konishi
- Showa Women's University, Faculty of Life and Environmental Sciences, Tokyo, Japan
| | - Junboku Kajiwara
- Fukuoka Institute of Health and Environmental Sciences, Dazaifu, Japan
| | - Tsuguhide Hori
- Fukuoka Institute of Health and Environmental Sciences, Dazaifu, Japan
| | - Reiko Kishi
- Hokkaido University, Center for Environmental and Health Sciences, Sapporo, Japan.
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Bornehag CG, Reichenberg A, Hallerback MU, Wikstrom S, Koch HM, Jonsson BA, Swan SH. Prenatal exposure to acetaminophen and children's language development at 30 months. Eur Psychiatry 2018; 51:98-103. [PMID: 29331486 DOI: 10.1016/j.eurpsy.2017.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age. METHOD A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8-13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (<25, 25-50 and >50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD). RESULTS 59.2% of women enrolled in weeks 8-13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P<0.01). Language delay was more prevalent in boys (12.6%) than girls (4.1%) (8.5% in total). Both the number of APAP tablets and urinary APAP concentration were associated with greater LD in girls but not in boys. The adjusted odds ratio (OR) for LD among girls whose mothers reported >6 vs. 0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10-31.94). The OR for LD in girls whose mothers' urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37-77.86). While it cannot be ruled out, our available data do not support confounding by indication. CONCLUSIONS Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.
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Affiliation(s)
- C-G Bornehag
- Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, NY, USA.
| | | | | | | | - H M Koch
- Institute of the Ruhr-University, Bochum, Germany
| | | | - S H Swan
- Icahn School of Medicine at Mount Sinai, NY, USA
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Kantzer AK, Fernell E, Westerlund J, Hagberg B, Gillberg C, Miniscalco C. Young children who screen positive for autism: Stability, change and "comorbidity" over two years. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:297-307. [PMID: 27818061 DOI: 10.1016/j.ridd.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a developmental disorder with a wide variety of clinical phenotypes and co-occurrences with other neurodevelopmental conditions. Symptoms may change over time. AIMS The aim of the present study was to prospectively follow 96 children, initially assessed for suspected ASD at an average age of 2.9 years. METHODS AND PROCEDURES All children had been identified with autistic symptoms in a general population child health screening program, and had been referred to the Child Neuropsychiatry Clinic in Gothenburg, Sweden for further assessment by a multi-professional team at Time 1 (T1). This assessment included a broad neurodevelopmental examination, structured interviews, a cognitive test and evaluations of the child́s adaptive and global functioning. Two years later, at Time 2 (T2), the children and their parents were invited for a follow-up assessment by the same team using the same methods. OUTCOMES AND RESULTS Of the 96 children, 76 had met and 20 had not met full criteria for ASD at T1. Of the same 96 children, 79 met full ASD criteria at T2. The vast majority of children with ASD also had other neurodevelopmental symptoms or diagnoses. Hyperactivity was observed in 42% of children with ASD at T2, and Intellectual Developmental Disorder in 30%. Borderline Intellectual Functioning was found in 25%, and severe speech and language disorder in 20%. The children who did not meet criteria for ASD at T2 had symptoms of or met criteria for other neurodevelopmental/neuropsychiatric disorders in combination with marked autistic traits. Changes in developmental profiles between T1 and T2 were common in this group of young children with ASD. The main effect of Cognitive level at T1 explained more than twice as much of the variance in Vineland scores as did the ASD subtype; children with IDD had significantly lower scores than children in the BIF and AIF group. Co-existence with other conditions was the rule. CONCLUSIONS AND IMPLICATIONS Reassessments covering the whole range of these conditions are necessary for an optimized intervention-adapted to the individual child's needs.
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Affiliation(s)
- Anne-Katrin Kantzer
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Child and Adolescent Psychiatry, NU Hospital Organization, Uddevalla, Sweden.
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Joakim Westerlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Institute of Psychology, Stockholm University, Stockholm, Sweden
| | - Bibbi Hagberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Child Neuropsychiatry Clinic, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Schachinger-Lorentzon U, Kadesjö B, Gillberg C, Miniscalco C. Children screening positive for language delay at 2.5 years: language disorder and developmental profiles. Neuropsychiatr Dis Treat 2018; 14:3267-3277. [PMID: 30568449 PMCID: PMC6276636 DOI: 10.2147/ndt.s179055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To characterize language disorder and developmental profiles in children who screened positive for language delay but negative for autism at 2.5 years of age. PATIENTS AND METHODS The first 100 children who screened positive for language delay - but negative for autism - in 2016 were assessed in detail by speech language pathologists. Parents completed a newly developed questionnaire covering eight domains - Motor, Executive functions, Perception, Memory, Language, Learning, Social skills and Child's behaviour - with impairment scored for each domain. RESULTS ICD-10 language disorder diagnoses were made in 87/100 children (29 girls, 58 boys). Of 52 children with mixed receptive-expressive language disorder, 32% had problems in other developmental areas according to the "global rating" in the impairment questions of the questionnaire. Of the 35 with expressive language disorder, 21% had problems in other areas according to the impairment questions. Thirteen children had isolated language delay with no other diagnoses according to the speech and language pathologists' assessment; however, 23% of them had problems according to the parental rating on the impairment questions. CONCLUSION Most children screening positive for language delay but negative for autism at age 2.5 years were diagnosed with ICD-10 language disorder diagnoses. Parents in about one in four cases reported impairing problems within other developmental areas. Possible explanations for the findings are discussed.
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Affiliation(s)
| | - Björn Kadesjö
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Carmela Miniscalco
- Department of Pediatric Speech and Language Pathology, Queen Silvia Children's Hospital, Gothenburg, Sweden, .,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Helland WA, Helland T. Emotional and behavioural needs in children with specific language impairment and in children with autism spectrum disorder: The importance of pragmatic language impairment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 70:33-39. [PMID: 28886424 DOI: 10.1016/j.ridd.2017.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Language problems may negatively affect children's behaviour and have detrimental effects on the development of peer-relations. AIMS We investigated and compared emotional and behavioural profiles in children with SLI and in children with ASD aged 6-15 years and explored to what extent pragmatic language problems contributed to the emotional and behavioural needs (EBN) in these clinical groups. METHODS AND PROCEDURES The ASD group consisted of 23 children (19 boys; 4 girls) and the SLI group consisted of 20 children (18 boys; 2 girls). In order to assess EBN and language abilities, the Strength and Difficulties Questionnaire (SDQ) and the Children's Communication Checklist -2 (CCC-2) were filled out by parents. OUTCOMES AND RESULTS Our main findings were that although EBN was common in both groups; the children in the ASD group were significantly impaired relative to the children in the SLI group. However, in both groups pragmatic language problems were found to be significantly associated with EBN. IMPLICATIONS A comprehensive assessment of EBN as well as pragmatic language abilities should be an integral part of the assessment procedure. Considering the substantial influence of pragmatic language abilities on social function and in resolving interpersonal conflicts with peers further development of therapy plans and interventions targeting pragmatics is strongly needed.
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Affiliation(s)
- Wenche Andersen Helland
- Section of Research and Innovation, Helse Fonna Health Authority, Norway; Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Turid Helland
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway
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Zavadenko NN. [Speech disorders in children: early diagnosis and treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:119-125. [PMID: 28139638 DOI: 10.17116/jnevro2016116121119-125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The author considers causes, clinical variants and diagnostic principles of speech development in children. A role of neurobiological factors in the genesis of speech disorders and developmental dysphasia including early organic CNS lesions due to perinatal pathology and hereditary predisposition is described. Outcomes of dysphasia in children reached school-age are discussed. A screening method of the identification of speech delay in early childhood is presented. Early diagnosis and treatment of speech disorders in children are of great importance. Timely treatment with nootropics facilitates the correction of speech disorders.
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Affiliation(s)
- N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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Hatakenaka Y, Ninomiya H, Billstedt E, Fernell E, Gillberg C. ESSENCE-Q - used as a screening tool for neurodevelopmental problems in public health checkups for young children in south Japan. Neuropsychiatr Dis Treat 2017; 13:1271-1280. [PMID: 28546752 PMCID: PMC5436770 DOI: 10.2147/ndt.s132546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan. METHODS The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored. RESULTS At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV. CONCLUSION The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses.
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Affiliation(s)
- Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Center, Kochi, Japan.,Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Westman Andersson G, Miniscalco C, Gillberg N. A 6-year follow-up of children assessed for suspected autism spectrum disorder: parents' experiences of society's support. Neuropsychiatr Dis Treat 2017; 13:1783-1796. [PMID: 28744128 PMCID: PMC5511026 DOI: 10.2147/ndt.s134165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Early support and interventions are suggested to be important for children with autism spectrum disorder (ASD) and other developmental problems and their families. Parents are described to have a burdensome life situation where the child's problems have a great impact on the family's well-being. AIM To obtain increased knowledge of parents' experiences of support and interventions 6 years after their child was assessed for ASD. METHODS AND PROCEDURES A semi-structured questionnaire was sent to all parents (n=101) whose preschool children (<4 years of age) had been assessed for ASD about 6 years prior in Gothenburg, Sweden. The open-ended questions were analyzed thematically using a hermeneutic phenomenological approach. OUTCOMES AND RESULTS Parents of 56 children answered 30 questions about their experiences concerning support from society after the neuropsychiatric assessment. From the eight open-ended questions, three themes were identified: parental responsibility, resources and competence among actors in society, and inequality. The parents experienced that they had to take responsibility for meeting the needs of and securing support for their child. They found that the support given was unequal, uncoordinated, and with great variations between both geographical areas and professionals. Parents' own resources were described as impacting the possibility to secure adequate interventions, resulting in unequal treatment of families depending on socioeconomic status. Several parents also expressed experiencing a lack of individualization of services and interventions. All children had received some kind of action from society, but not to the degree they had wished for when the children got their ASD diagnosis. CONCLUSION AND IMPLICATIONS The essence of parents' comments was the experience of authorities and societal actors trying to push the responsibility onto someone else. The study indicates a need for continuous longitudinal support for children identified with neurodevelopmental problems before the age of 3 years. This requires collaboration and coordination between different societal bodies.
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Affiliation(s)
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nanna Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Peyre H, Galera C, van der Waerden J, Hoertel N, Bernard JY, Melchior M, Ramus F. Relationship between early language skills and the development of inattention/hyperactivity symptoms during the preschool period: Results of the EDEN mother-child cohort. BMC Psychiatry 2016; 16:380. [PMID: 27821161 PMCID: PMC5100106 DOI: 10.1186/s12888-016-1091-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/25/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aims to examine bidirectional relationships between children's language skills and Inattention/Hyperactivity (IH) symptoms during preschool. METHOD Children (N = 1459) from the EDEN mother-child cohort were assessed at ages 3 and 5.5 years. Language skills were evaluated using the WPPSI-III, NEPSY and ELOLA batteries. Children's behavior, including IH symptoms, was assessed using the parent-rated Strengths & Difficulties Questionnaire (SDQ). Using a Structural Equation Modeling (SEM) approach, we examined the relationship between language skills and IH symptoms, as well as potential mediating processes. RESULTS SEM analyses indicated a small negative effect of language skills at 3 years on ADHD symptoms at 5.5 years after adjusting for IH symptoms at 3 years (β =-0.12, SE = 0.04, p-value = 0.002). Interpersonal difficulties did not mediate the relationship between early language skills and later IH symptoms, nor was this association reduced after adjusting for a broad range of pre- and postnatal environmental factors and performance IQ. Among different language skills, receptive syntax at 3 years was most strongly related to IH symptoms at 5.5 years. CONCLUSIONS Poor language skills at age 3 may predict IH symptoms when a child enters primary school. Implications for the understanding and the prevention of the co-occurrence of language disorders and ADHD are discussed.
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Affiliation(s)
- Hugo Peyre
- Laboratoire de Sciences Cognitives et Psycholinguistique (ENS, EHESS, CNRS), Ecole Normale Supérieure, PSL Research University, 29 rue d'Ulm, 75005, Paris, France. .,Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France.
| | - Cedric Galera
- Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France ,The Bordeaux School of Public Health (Institut de Santé Publique, d’Epidémiologie et de Développement), Centre INSERM U897, Epidemiology-Biostatistics, Bordeaux, France
| | - Judith van der Waerden
- INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, 75012 France
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, APHP, Issy-les-Moulineaux, France ,Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France ,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Jonathan Y. Bernard
- Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France ,Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and Disease (ORCHAD) Team, INSERM UMR 1153, F-94807 Villejuif, France
| | - Maria Melchior
- INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, 75012 France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique (ENS, EHESS, CNRS), Ecole Normale Supérieure, PSL Research University, 29 rue d’Ulm, 75005 Paris, France
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Carlsson E, Miniscalco C, Kadesjö B, Laakso K. Negotiating knowledge: parents' experience of the neuropsychiatric diagnostic process for children with autism. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2016; 51:328-338. [PMID: 26833425 DOI: 10.1111/1460-6984.12210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Parents often recognize problems in their child's development earlier than health professionals do and there is new emphasis on the importance of involving parents in the diagnostic process. In Gothenburg, Sweden, over 100 children were identified as having an autism spectrum disorder (ASD) in 2009-11 through a general population language and autism screening of 2.5 year olds at the city's child healthcare centres. AIMS To increase understanding of parents' lived experience of the neuropsychiatric diagnostic process, i.e. the period from the initial screening at age 2.5 years to the 2-year follow-up of the ASD diagnosis. METHODS & PROCEDURES A qualitative design, a phenomenological hermeneutic method, was used. Interviews were conducted with parents of 11 children who were diagnosed with ASD 2 years prior. The parents were interviewed about their experiences of the neuropsychiatric diagnostic process, i.e. the time before the screening, the time during the neuropsychiatric multidisciplinary evaluation and the time after diagnosis. The interviews lasted for 45-130 min, and an interview guide with set questions was used. Most of the interviews were conducted at the parents' homes. OUTCOMES & RESULTS The essence that emerged from the data was negotiating knowledge, and the three themes capturing the parents' experiences of going through the process of having their child diagnosed with ASD were seeking knowledge, trusting and challenging experts, and empowered but alone. CONCLUSIONS & IMPLICATIONS The parents expected intervention to start directly after diagnosis but felt they had to fight to obtain the resources their child needed. After the process, they described that they felt empowered but still alone, i.e. although they received useful and important information about their child, they were left to manage the situation by themselves. As for clinical implications, the study points to the necessity of developing routines to support the parents during and after the diagnostic process. Recommended measures include developing a checklist outlining relevant contacts and agencies, establishing a coordinator responsible for each child, dividing the summary meeting at the clinic into two parts, making more than one visit to the preschool, and providing a parental training programme.
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Affiliation(s)
- Emilia Carlsson
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Carmela Miniscalco
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Björn Kadesjö
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katja Laakso
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Caspersen IH, Haugen M, Schjølberg S, Vejrup K, Knutsen HK, Brantsæter AL, Meltzer HM, Alexander J, Magnus P, Kvalem HE. Maternal dietary exposure to dioxins and polychlorinated biphenyls (PCBs) is associated with language delay in 3year old Norwegian children. ENVIRONMENT INTERNATIONAL 2016; 91:180-7. [PMID: 26970589 DOI: 10.1016/j.envint.2016.02.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Prenatal exposure to dioxins and PCBs is potentially harmful to the developing fetus and may increase the risk of delayed or impaired neurodevelopment. Several studies have reported negative associations between prenatal exposure to these compounds and aspects of cognition related to language in early childhood. OBJECTIVES The aim was to examine the association between maternal low level dietary exposure to dioxins and PCB during pregnancy and language development in 3year old children in a large group of mother-child pairs participating in the Norwegian Mother and Child Cohort Study (MoBa). METHODS This study includes 44,092 children of women who were recruited to the Norwegian Mother and Child Cohort Study (MoBa) during the years 2002-2009. Maternal dietary exposure to dioxins and PCBs was estimated based on a validated food frequency questionnaire (FFQ) answered mid-pregnancy and a database of dioxin and PCB concentrations in Norwegian foods. Exposure to dioxins and dioxin-like PCBs (dl-compounds) was expressed in total toxic equivalents (TEQ), and PCB-153 was used as marker for non-dioxin-like PCBs (ndlPCBs). Children's language skills at age 3 were assessed by parental report including a Dale and Bishop grammar rating and questions about communication skills from the Ages and Stages Questionnaire (ASQ). Logistic regression models adjusted for confounders were used to examine the association between maternal dietary exposure to dl-compounds or PCB-153 and language development in children. RESULTS The maternal dietary exposure to dl-compounds and PCB-153 was generally low, and 98% of women had intakes of dl-compounds ≤14pg TEQ/kg bw/week, which is the tolerable weekly intake set by EU's Scientific Committee for Food (SCF). High maternal exposure (>14pg TEQ/kg bw/week of dl-compounds (median 2.6pg/kg bw/day, range 2-16) or >97.5-percentile intake of PCB-153 (median 11ng/kg bw/day, range 5-28) was associated with higher odds of incomplete grammar (in boys and girls, adjusted ORs 1.1 to 1.3) and severe language delay in girls, adjusted ORs 2.8 [95% CI 1.1, 7.1] for PCB-153 and 2.9 [95% CI 1.4, 5.9] for dl-compounds. Furthermore, high exposure to dl-compounds was associated with moderate language delay 1.4 [95% CI 1.0, 2.0] and lower communication score (ASQ), adjusted OR 1.4 [95% CI 1.1, 1.9] in girls. CONCLUSIONS The main findings of this study were: 1) Girls born to mothers who exceeded the tolerable weekly intake for dl-compounds or had a PCB-153 intake above the 97.5 percentile in early pregnancy may have increased risk of language delay at age 3years. 2) Negative associations with maternal exposure to dl-compounds or PCB-153 were observed for both boys and girls having incomplete grammar, which is a subtle reduction in language skills. This interesting finding should not be considered as deviant at this age.
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Affiliation(s)
- I H Caspersen
- Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway.
| | - M Haugen
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - S Schjølberg
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - K Vejrup
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - H K Knutsen
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - A L Brantsæter
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - H M Meltzer
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - J Alexander
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - P Magnus
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway
| | - H E Kvalem
- Norwegian Institute of Public Health (NIPH), P.O. Box 4404, Nydalen, NO-0403 Oslo, Norway; Bjørknes College, Lovisenberggata 13, NO-0456 Oslo, Norway
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Potijk MR, de Winter AF, Bos AF, Kerstjens JM, Reijneveld SA. Co-occurrence of developmental and behavioural problems in moderate to late preterm-born children. Arch Dis Child 2016; 101:217-22. [PMID: 26471109 DOI: 10.1136/archdischild-2015-308958] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the occurrence of emotional and behavioural problems (EBP) in moderate to late preterm (MLP) and full-term children with developmental delay. DESIGN Participants were recruited from 13 randomly selected preventive child healthcare (PCH) centres in the Netherlands. We included 903 MLP children of 32-36 weeks' gestation and 538 full-term controls, born between January 2002 and June 2003. Parents completed the Ages and Stages Questionnaire (ASQ) and Child Behaviour Checklist (CBCL) shortly before the scheduled PCH visit at 4 years of age. Co-occurrence was defined as: ASQ total or domain score >2 SDs below the mean and a CBCL score >84th percentile on total problems, internalising (emotional) or externalising (behavioural) problems. RESULTS EBP were more prevalent among MLP children with abnormal ASQ total problems scores than among full-term children, particularly regarding externalising problems (33.8% vs 23.8%). In MLP children, rates of EBP differed per developmental domain and were highest for the domains problem-solving (36.0% had externalising problems, 95% CI 24.1% to 49.9%) and personal-social skills (38.7% had internalising problems, 95% CI 26.4% to 52.8%). The risk of any type of co-occurrence was higher for MLP than for full-term children (OR 1.86; 95% CI 1.14 to 3.03). Independent risk factors for co-occurrence were male gender, low socioeconomic status and young maternal age. CONCLUSIONS Up to 39% of 4-year-old MLP children with developmental delay also have EBP, indicating that increased awareness of EBP is warranted in MLP children with developmental delay. Further research is needed to determine whether early detection of co-occurring problems results in better long-term health.
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Affiliation(s)
- Marieke R Potijk
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Department of Pediatrics, Division of Neonatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorien M Kerstjens
- Department of Pediatrics, Division of Neonatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hatakenaka Y, Kotani H, Yasumitsu-Lovell K, Suzuki K, Fernell E, Gillberg C. Infant Motor Delay and Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations in Japan. Pediatr Neurol 2016; 54:55-63. [PMID: 26706480 DOI: 10.1016/j.pediatrneurol.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/08/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities of early motor development have been reported in autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual developmental disorder, developmental coordination disorder, and other Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE). However, few studies have been conducted with a view to following up a clinically representative cohort of children coming for assessment of motor delay before age two years. We performed a prospective clinical cohort study to examine whether or not early motor delay is often an indication of ESSENCE. METHODS The sample comprised a one-year cohort of all children who came to a Japanese neurodevelopmental center before their second birthday because of delayed or abnormal gross motor development. The children were followed up from the ESSENCE viewpoint. RESULTS Of the 30 children, 28 (18 boys and 10 girls) (93%) were given diagnoses subsumed under the ESSENCE umbrella. Of the 15 children with an identified or strongly suspected etiology, 13 (8 boys and 5 girls) (87%) had ESSENCE disorders or symptoms. Of the 15 children without a known etiology, all had ESSENCE disorders or symptoms. CONCLUSION This study indicated that the vast majority of children with motor delay or abnormality in the first two years of life meet criteria for a disorder within the group of ESSENCE at follow-up; this means that young children, presenting with motor problems always need a broad clinical assessment, not just related to motor function, and systematic follow-up.
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Affiliation(s)
- Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi Prefectural Medical and Welfare Centre, Kochi, Japan.
| | - Haruko Kotani
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi Prefectural Medical and Welfare Centre, Kochi, Japan
| | - Kahoko Yasumitsu-Lovell
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Department of Environmental Medicine, Kochi Medical School, Kochi, Japan
| | - Keita Suzuki
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan; Kochi University Faculty of Education, Kochi, Japan
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McKean C, Mensah FK, Eadie P, Bavin EL, Bretherton L, Cini E, Reilly S. Levers for Language Growth: Characteristics and Predictors of Language Trajectories between 4 and 7 Years. PLoS One 2015; 10:e0134251. [PMID: 26241892 PMCID: PMC4524638 DOI: 10.1371/journal.pone.0134251] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022] Open
Abstract
Background Evidence is required as to when and where to focus resources to achieve the greatest gains for children’s language development. Key to these decisions is the understanding of individual differences in children’s language trajectories and the predictors of those differences. To determine optimal timing we must understand if and when children’s relative language abilities become fixed. To determine where to focus effort we must identify mutable factors, that is those with the potential to be changed through interventions, which are associated with significant differences in children’s language scores and rate of progress. Methods Uniquely this study examined individual differences in language growth trajectories in a population sample of children between 4 and 7 years using the multilevel model for change. The influence of predictors, grouped with respect to their mutability and their proximity to the child (least-mutable, mutable-distal, mutable-proximal), were estimated. Results A significant degree of variability in rate of progress between 4 and 7 years was evident, much of which was systematically associated with mutable-proximal factors, that is, those factors with evidence that they are modifiable through interventions with the child or family, such as shared book reading, TV viewing and number of books in the home. Mutable-distal factors, such as family income, family literacy and neighbourhood disadvantage, hypothesised to be modifiable through social policy, were important predictors of language abilities at 4 years. Conclusions Potential levers for language interventions lie in the child’s home learning environment from birth to age 4. However, the role of a family’s material and cultural capital must not be ignored, nor should the potential for growth into the school years. Early Years services should acknowledge the effects of multiple, cascading and cumulative risks and seek to promote child language development through the aggregation of marginal gains in the pre-school years and beyond.
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Affiliation(s)
- Cristina McKean
- Newcastle University, Newcastle upon Tyne, United Kingdom
- Murdoch Children’s Research Institute, Melbourne, Australia
- * E-mail:
| | - Fiona K. Mensah
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
| | | | | | - Lesley Bretherton
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
| | - Eileen Cini
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sheena Reilly
- Murdoch Children’s Research Institute, Melbourne, Australia
- Menzies Health Institute Queensland, Queensland, Australia
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Nayeb L, Wallby T, Westerlund M, Salameh EK, Sarkadi A. Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals. Acta Paediatr 2015; 104:198-205. [PMID: 25327143 DOI: 10.1111/apa.12834] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/22/2014] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Abstract
AIM A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices. METHODS An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children. RESULTS The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77). CONCLUSION Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.
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Affiliation(s)
- Laleh Nayeb
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Thomas Wallby
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Monica Westerlund
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | - Anna Sarkadi
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Roy P, Chiat S. Developmental pathways of language and social communication problems in 9-11 year olds: unpicking the heterogeneity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2534-2546. [PMID: 25005063 DOI: 10.1016/j.ridd.2014.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
This paper addressed relations between language, social communication and behaviour, and their trajectories, in a sample of 9-11-year-olds (n=91) who had been referred to clinical services with concerns about language as pre-schoolers. Children were first assessed at 2½-4 years, and again 18 months later. Results revealed increasing differentiation of profiles across time. By 9-11 years, 11% of the sample had social communication deficits, 27% language impairment, 20% both, and 42% neither. The size of group differences on key language and social communication measures was striking (2-3 standard deviations). Social communication deficits included autistic mannerisms and were associated with social, emotional and behavioural difficulties (SEBDs); in contrast, language impairment was associated with hyperactivity only. Children with both language and social communication problems had the most severe difficulties on all measures. These distinct school-age profiles emerged gradually. Investigation of developmental trajectories revealed that the three impaired groups did not differ significantly on language or SEBD measures when the children were first seen. Only low performance on the Early Sociocognitive Battery, a new measure of social responsiveness, joint attention and symbolic understanding, differentiated the children with and without social communication problems at 9-11 years. These findings suggest that some children who first present with language delay or difficulties have undetected Autism Spectrum Disorders which may or may not be accompanied by language impairment in the longer term. This new evidence of developmental trajectories starting in the preschool years throws further light on the nature of social communication and language problems in school-age children, relations between language impairment and SEBDs, and on the nature of early language development.
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Affiliation(s)
- P Roy
- Language and Communication Science, City University, Northampton Square, London EC1V 0HB, UK.
| | - S Chiat
- Language and Communication Science, City University, Northampton Square, London EC1V 0HB, UK
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Eun JJ, Lee HJ, Kim JK. Developmental profiles of preschool children with delayed language development. KOREAN JOURNAL OF PEDIATRICS 2014; 57:363-9. [PMID: 25210524 PMCID: PMC4155181 DOI: 10.3345/kjp.2014.57.8.363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/27/2022]
Abstract
Purpose This study examines changes in developmental profiles of children with language delay over time and the clinical significance of assessment conducted at age 2-3 years. Methods We retrospectively reviewed the medical records of 70 children (62 male, 8 female), who had visited the hospital because of delayed language development at 2-3 years, and were reassessed at ages 5-6. Language and cognitive abilities were assessed using multiple scales at the initial and follow-up visits. Results At the initial test, 62 of the 70 children had mental development index (MDI) below 70 of Bayley Scales of Infant Development Test II. Of the 62 children in the follow-up assessment, 30 children (48.4%) remained within the same cognitive range (full-scale intelligence quotient, FSIQ<70 of Wechsler preschool and primary scale of intelligence), 12 had borderline intellectual functioning (FSIQ, 70-85), 6 improved to average intellectual functioning (FSIQ>85), and 5 had specific language impairment, 9 had autism spectrum disorders. At the initial test, 38 of the 70 children had cognitive developmental quotients (C-DQ) below 70. Of the 38 children in the follow-up assessment, 23 children (60.5%) remained within the same cognitive range (FSIQ<70). The correlation coefficient for MDI and FSIQ was 0.530 (P<0.0001) and that for C-DQ and FSIQ was 0.727 (P<0.0001). There was a strong correlation between C-DQ and FSIQ, and a moderate correlation between MDI and FSIQ. Conclusion Low MDI scores reflect a specific delay in cognitive abilities, communication skills, or both. The C-DQ, receptive language development quotient, and social maturity quotient also help to distinguish between children with isolated language delay and children with cooccurring cognitive impairment. Moreover, changes in the developmental profile during preschool years are not unusual in children with language delay. Follow-up reassessments prior to the start of school are required for a more accurate diagnosis and intervention.
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Affiliation(s)
- Jeong Ji Eun
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyung Jik Lee
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Kyung Kim
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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Martín Ruiz ML, Valero Duboy MÁ, Torcal Loriente C, Pau de la Cruz I. Evaluating a web-based clinical decision support system for language disorders screening in a nursery school. J Med Internet Res 2014; 16:e139. [PMID: 24870413 PMCID: PMC4060144 DOI: 10.2196/jmir.3263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/11/2014] [Accepted: 05/19/2014] [Indexed: 11/22/2022] Open
Abstract
Background Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods This paper details the evaluation results of the “Gades” CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child’s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions This research demonstrated the benefit of a Web-based CDSS to monitor children’s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.
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Affiliation(s)
- María Luisa Martín Ruiz
- Technical University of Madrid, Department of Telematic and Electronic Engineering, Madrid, Spain.
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Helland WA, Helland T, Heimann M. Language profiles and mental health problems in children with specific language impairment and children with ADHD. J Atten Disord 2014; 18:226-35. [PMID: 22544386 DOI: 10.1177/1087054712441705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to explore whether children with specific language impairment (SLI) and children with ADHD can be differentiated from each other in terms of their language profiles, and also to investigate whether these two clinical groups differ regarding mental health problems. METHOD A total of 59 children in the age range 6 to 12 years participated in the study. The parents completed the Children's Communication Checklist-Second Edition and the Strengths and Difficulties Questionnaire. RESULTS Communication impairments were as prominent in the ADHD group as in the SLI group; however, the groups were separable from each other in terms of their language profiles. Furthermore, the ADHD group experienced significantly more mental health problems compared with the SLI group. CONCLUSION Language should be assessed in children with ADHD and instruments sensitive to ADHD should be included when assessing children with SLI. Mental health should be an area of concern to be addressed in both groups.
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