Newborn Auditory Brainstem Responses in Children with Developmental Disabilities

We integrated data from a newborn hearing screening database and a preschool disability database to examine the relationship between newborn click evoked auditory brainstem responses (ABRs) and developmental disabilities. This sample included children with developmental delay (n = 2992), speech impairment (SI, n = 905), language impairment (n = 566), autism spectrum disorder (ASD, n = 370), and comparison children (n = 128,181). We compared the phase of the ABR waveform, a measure of sound processing latency, across groups. Children with SI and children with ASD had greater newborn ABR phase values than both the comparison group and the developmental delay group. Newborns later diagnosed with SI or ASD have slower neurological responses to auditory stimuli, suggesting sensory differences at birth.

Anxiety Rating Scale for Speech and Hearing-impaired Children

Background

It has been observed that children with special healthcare needs exhibit higher dental anxiety levels because of various barriers. In the literature, there is no anxiety assessment scale for speech and hearing-impaired children. A new concept of pictorial representation of common emotions observed during dental treatment was used to design an innovative scale, thereby helping to improve communication and in bringing out positive behavior among the children. This study aimed to assess and validate the efficacy of an anxiety rating scale for speech and hearing-impaired children.

Materials and methods

A total of 36-12-year-old children with speech and hearing impairments from a special school were selected for this study. The pretreatment anxiety score among the children was assessed using the pictorial anxiety rating scale.

Results

The anxiety rating scale was well accepted by speech and hearing-impaired children. It was well-supported by expert opinions and equal distribution of anxiety scores.

Conclusion

The pictorial scale is a valid anxiety assessment scale for measuring dental anxiety among speech and hearing-impaired children. It can be used independently to assess dental anxiety in clinical settings and epidemiological studies as well.

How to cite this article

Shivashankarappa PG, Kaur J, Adimoulame S. Anxiety Rating Scale for Speech and Hearing-impaired Children. Int J Clin Pediatr Dent 2022;15(6):704-706.

[Diagnostic Value of Speech Acoustic Analysis in Parkinson's Disease]

Screening for and identifying patients with Parkinson's disease (PD) at an early stage and forming accurate diagnosis of PD during the course of the progression of the disease are of essential importance but still remain challenging for the clinical diagnosis and treatment of PD. One of the common clinical manifestations of PD is speech impairment, or voice impairment. Thanks to the recent advances in the field of acoustic analysis, a large number of acoustic parameters have been proposed for evaluating speech impairment quantitatively. Early identification and accurate diagnosis of PD was henceforth made possible through the application of speech acoustic analysis. Herein, we summarized the latest research findings on the application of acoustic analysis in PD diagnosis. We reported some acoustic parameters commonly used in the evaluation of voice impairment in PD patients. Then, we presented the diagnostic value of acoustic analysis in developing accurate diagnosis, early screening and differential diagnosis. Furthermore, we discussed the drawbacks and prospects of current studies, intending to enhance understanding of acoustic analysis of PD patients and its potential diagnostic values.

An algorithm for Parkinson's disease speech classification based on isolated words analysis

INTRODUCTION

Automatic assessment of speech impairment is a cutting edge topic in Parkinson's disease (PD). Language disorders are known to occur several years earlier than typical motor symptoms, thus speech analysis may contribute to the early diagnosis of the disease. Moreover, the remote monitoring of dysphonia could allow achieving an effective follow-up of PD clinical condition, possibly performed in the home environment.

METHODS

In this work, we performed a multi-level analysis, progressively combining features extracted from the entire signal, the voiced segments, and the on-set/off-set regions, leading to a total number of 126 features. Furthermore, we compared the performance of early and late feature fusion schemes, aiming to identify the best model configuration and taking advantage of having 25 isolated words pronounced by each subject. We employed data from the PC-GITA database (50 healthy controls and 50 PD patients) for validation and testing.

RESULTS

We implemented an optimized k-Nearest Neighbours model for the binary classification of PD patients versus healthy controls. We achieved an accuracy of 99.4% in 10-fold cross-validation and 94.3% in testing on the PC-GITA database (average value of male and female subjects).

CONCLUSION

The promising performance yielded by our model confirms the feasibility of automatic assessment of PD using voice recordings. Moreover, a post-hoc analysis of the most relevant features discloses the option of voice processing using a simple smartphone application.

Hyperkinetic stereotyped movements in a boy with biallelic CNTNAP2 variants

Background

Heterozygous variants in CNTNAP2 have been implicated in a wide range of neurological phenotypes, including intellectual disability (ID), epilepsy, autistic spectrum disorder (ASD), and impaired language. However, heterozygous variants can also be found in unaffected individuals. Biallelic CNTNAP2 variants are rarer and cause a well-defined genetic syndrome known as CASPR2 deficiency disorder, a condition characterised by ID, early-onset refractory epilepsy, language impairment, and autistic features.

Case-report

A 7-year-old boy presented with hyperkinetic stereotyped movements that started during early infancy and persisted over childhood. Abnormal movements consisted of rhythmic and repetitive shaking of the four limbs, with evident stereotypic features. Additional clinical features included ID, attention deficit-hyperactivity disorder (ADHD), ASD, and speech impairment, consistent with CASPR2 deficiency disorder. Whole-genome array comparative genomic hybridization detected a maternally inherited 0.402 Mb duplication, which involved intron 1, exon 2, and intron 2 of CNTNAP2 (c.97 +?_209-?dup). The affected region in intron 1 contains a binding site for the transcription factor FOXP2, potentially leading to abnormal CNTNAP2 expression regulation. Sanger sequencing of the coding region of CNTNAP2 also identified a paternally-inherited missense variant c.2752C > T, p.(Leu918Phe).

Conclusion

This case expands the molecular and phenotypic spectrum of CASPR2 deficiency disorder, suggesting that Hyperkinetic stereotyped movements may be a rare, yet significant, clinical feature of this complex neurological disorder. Furthermore, the identification of an in-frame, largely non-coding duplication in CNTNAP2 points to a sophisticated underlying molecular mechanism, likely involving impaired FOXP2 binding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-021-01162-w.

Loss of cGMP-dependent protein kinase II alters ultrasonic vocalizations in mice, a model for speech impairment in human microdeletion 4q21 syndrome

Chromosome 4q21 microdeletion leads to a human syndrome that exhibits restricted growth, facial dysmorphisms, mental retardation, and absent or delayed speech. One of the key genes in the affected region of the chromosome is PRKG2, which encodes cGMP-dependent protein kinase II (cGKII). Mice lacking cGKII exhibit restricted growth and deficits in learning and memory, as seen in the human syndrome. However, vocalization impairments in these mice have not been determined. The molecular pathway underlying vocalization impairment in humans is not fully understood. Here, we employed cGKII knockout (KO) mice as a model for the human microdeletion syndrome to test whether vocalizations are affected by loss of the PRKG2 gene. Mice emit ultrasonic vocalizations (USVs) to communicate in social situations, stress, and isolation. We thus recorded ultrasonic vocalizations as a model for human speech. We isolated postnatal day 5-7 pups from the nest to record and analyze USVs and found significant differences in vocalizations of KO mice relative to wild-type and heterozygous mutant mice. KO mice produced fewer calls that were shorter duration and higher frequency. Because neuronal activation in the arcuate nucleus in the hypothalamus is important for the production of animal USVs following isolation from the nest, we assessed neuronal activity in the arcuate nucleus of KO pups following isolation. We found significant reduction of neuronal activation in cGKII KO pups after isolation. Taken together, our studies indicate that cGKII is important for neuronal activation in the arcuate nucleus, which significantly contributes to the production of USVs in neonatal mice. We further suggest cGKII KO mice can be a valuable animal model to investigate pathophysiology of human microdeletion 4q21 syndrome.

Report of a de novo c.2605C > T (p.Pro869Ser) change in the MED13L gene and review of the literature for MED13L-related intellectual disability

Background

MED13L-related intellectual disability is a new syndrome that is characterized by intellectual disability (ID), motor developmental delay, speech impairment, hypotonia and facial dysmorphism. Both the MED13L haploinsufficiency mutation and missense mutation were reported to be causative. It has also been reported that patients carrying missense mutations have more frequent epilepsy and show a more severe phenotype.

Case presentation

We report a child with ID, speech impairment, severe motor developmental delay, facial deformity, hypotonia, muscular atrophy, scoliosis, odontoprisis, abnormal electroencephalogram (EEG), and congenital ureteropelvic junction obstruction (UPJO) combined with high ureter attachment. We used whole-exome sequencing (WES) to detect the genetic aberration of the child and found a de novo mutation, c.2605C > T (p.Pro869Ser), in the MED13L gene. Neither of her parents carried the mutation. Additionally, we review the literature and summarize the phenotypes and features of reported missense mutations. After reviewing the literature, approximately 17 missense mutations in 20 patients have been reported thus far. For 18 patients (including our case) whose clinical manifestations were provided, 100% of the patients had ID or developmental delay (DD). A total of 88.9, 83.3 and 66.7% of the patients had speech impairment, delayed milestones and hypotonia, respectively. A total of 83.3% of the patients exhibited craniofacial deformity or other dysmorphic features. Behavioral difficulties and autistic features were observed in 55.6% of the patients. Cardiac anomalies were seen in only 27.8% of the patients. Of these patients, 44.4% had epileptic seizures. Of the 17 mutations, 2 were located in the N-terminal domain, 8 were located in the C-terminal domain, and 1 was located in an α-helical sequence stretch. One of them was located in the MID domain of the MedPIWI module.

Conclusions

We report a new patient with a reported missense mutation, c.2605C > T (p.Pro869Ser), who exhibited some infrequent manifestations except common phenotypes, which may broaden the known clinical spectrum. Additionally, by reviewing the literature, we also found that patients with missense mutations have a higher incidence of seizures, MRI abnormalities, autistic features and cardiac anomalies. They also have more severe ID and hypotonia. Our case further demonstrates that Pro869Ser is a hotspot mutation of the MED13L gene.

Dysarthria enhancement mechanism under external clear speech instruction in Parkinson's disease, progressive supranuclear palsy and multiple system atrophy

Clear speech refers to intentionally modifying conversational speech to maximise intelligibility. This study aimed to compare the speech behaviour of patients with progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and Parkinson's disease (PD) under conversational and clear speech conditions to gain greater pathophysiological insight. A total of 68 participants including 17 PD, 17 MSA, 17 PSP and 17 healthy controls (HC) performed two readings of the same standardized passage. During the first reading, participants were instructed to read the text in an ordinary way, while during the second reading to read the text as clearly as possible. Acoustic analyses were based upon measurements of mean loudness, loudness variability, pitch variability, vowel articulation, articulation rate and speech severity. During clear speech production, PD patients were able to achieve improvements mainly in loudness (p < 0.05) and pitch variability (p < 0.001), leading to a reduction in overall speech severity (p < 0.001), whereas PSP and MSA patients were able to modulate only articulation rate (p < 0.05). Contrary to HC and PD groups, which slowed or maintained articulation rate, PSP and MSA groups employed a markedly faster articulation rate under the clear speech condition indicating an opposing approach to speech adaptation. Patients with atypical Parkinsonism showed a different strategy to intentionally improve their speech performance following a simple request to produce speech more clearly compared to PD, suggesting important therapeutic implications for speech rehabilitation management.

A new missense mutation in DPF2 gene related to Coffin Siris syndrome 7: Description of a mild phenotype expanding DPF2-related clinical spectrum and differential diagnosis among similar syndromes epigenetically determined

BACKGROUND

Coffin-Siris syndrome (CSS) is a neurodevelopmental disorder characterized by somatic dysmorphic features, developmental and speech delay. It is due to mutations in many different genes, belonging to BAF chromatin-remodelling complex. The last gene involved in this complex, recently individuated and related to CSS, was DPF2, although only nine patients have been reported until now.

METHOD

Here we report on a boy with a history of developmental delay, especially regarding speech and language, and dysmorphic features resembling a syndromic condition. Array-Comparative Genomic Hybridization (CGH) and a custom Next Generation Sequencing (NGS) panel including developmental delay related genes were executed.

RESULTS

Array-CGH was negative while NGS panel revealed a novel mutation in DPF2 gene.

CONCLUSIONS

We add the clinical description of another patient with a novel mutation in DPF2, with a mild phenotype, thus trying to contribute to enlarge CSS phenotypic variability. Moreover, we briefly discuss about cohesinopathies and major differential diagnosis among syndromes with phenotypes overlapping to CSS.

Phonological working memory and FOXP2

The discovery and description of the affected members of the KE family (aKE) initiated research on how genes enable the unique human trait of speech and language. Many aspects of this genetic influence on speech-related cognitive mechanisms are still elusive, e.g. if and how cognitive processes not directly involved in speech production are affected. In the current study we investigated the effect of the FOXP2 mutation on Working Memory (WM). Half the members of the multigenerational KE family have an inherited speech-language disorder, characterised as a verbal and orofacial dyspraxia caused by a mutation of the FOXP2 gene. The core phenotype of the affected KE members (aKE) is a deficiency in repeating words, especially complex non-words, and in coordinating oromotor sequences generally. Execution of oromotor sequences and repetition of phonological sequences both require WM, but to date the aKE's memory ability in this domain has not been examined in detail. To do so we used a test series based on the Baddeley and Hitch WM model, which posits that the central executive (CE), important for planning and manipulating information, works in conjunction with two modality-specific components: The phonological loop (PL), specialized for processing speech-based information; and the visuospatial sketchpad (VSSP), dedicated to processing visual and spatial information. We compared WM performance related to CE, PL, and VSSP function in five aKE and 15 healthy controls (including three unaffected members of the KE family who do not have the FOXP2 mutation). The aKE scored significantly below this control group on the PL component, but not on the VSSP or CE components. Further, the aKE were impaired relative to the controls not only in motor (i.e. articulatory) output but also on the recognition-based PL subtest (word-list matching), which does not require speech production. These results suggest that the aKE's impaired phonological WM may be due to a defect in subvocal rehearsal of speech-based material, and that this defect may be due in turn to compromised speech-based representations.

First de novo ANK3 nonsense mutation in a boy with intellectual disability, speech impairment and autistic features

Ankyrin-G, encoded by ANK3, plays an important role in neurodevelopment and neuronal function. There are multiple isoforms of Ankyrin-G resulting in differential tissue expression and function. Heterozygous missense mutations in ANK3 have been associated with autism spectrum disorder. Further, in three siblings a homozygous frameshift mutation affecting only the longest isoform and a patient with a balanced translocation disrupting all isoforms were documented. The latter four patients were affected by a variable degree of intellectual disability, attention deficit hyperactivity disorder and autism. Here, we report on a boy with speech impairment, intellectual disability, autistic features, macrocephaly, macrosomia, chronic hunger and an altered sleeping pattern. By trio-whole-exome sequencing, we identified the first de novo nonsense mutation affecting all ANK3 transcripts. Thus, our data expand the phenotype of ANK3-associated diseases and suggest an isoform-based, phenotypic continuum between dominant and recessive ANK3-associated pathologies.

A speech pronunciation practice system for speech-impaired children: A study to measure its success

BACKGROUND

The speech pronunciation practice (SPP) system enables children with speech impairments to practise and improve their speech pronunciation. However, little is known about the surrogate measures of the SPP system.

AIMS

This research aims to measure the success and effectiveness of the SPP system using three surrogate measures: usage (frequency of use), performance (recognition accuracy) and satisfaction (children's subjective reactions), and how these measures are aligned with the success of the SPP system, as well as to each other.

METHODS AND PROCEDURES

We have measured the absolute change in the word error rate (WER) between the pre- and post-training, using the ANOVA test. Correlation co-efficiency (CC) analysis was conducted to test the relation between the surrogate measures, while a Structural Equation Model (SEM) was used to investigate the causal relations between the measures.

OUTCOMES AND RESULTS

The CC test results indicate a positive correlation between the surrogate measures. The SEM supports all the proposed gtheses. The ANOVA results indicate that SPP is effective in reducing the WER of impaired speech.

CONCLUSIONS AND IMPLICATIONS

The SPP system is an effective assistive tool, especially for high levels of severity. We found that performance is a mediator of the relation between "usage" and "satisfaction".

Characterization of ultrasonic vocalizations of Fragile X mice

Fragile X Syndrome (FXS) is the leading form of inherited intellectual disability. It is caused by the transcriptional silencing of FMR1, the gene which codes for the Fragile X Mental Retardation Protein (FMRP). Patients who have FXS exhibit numerous behavioral and cognitive impairments, such as attention-deficit/hyperactivity disorder, obsessive compulsive disorder, and autistic-like behaviors. In addition to these behavioral abnormalities, FXS patients have also been shown to exhibit various deficits in communication such as abnormal sentence structures, increased utterances, repetition of sounds and words, and reduced articulation. These deficits can dramatically hinder communication for FXS patients, exacerbating learning and cognition impairments while decreasing their quality of life. To examine the biological underpinnings of these communication abnormalities, studies have used a mouse model of the Fragile X Syndrome; however, these vocalization studies have resulted in inconsistent findings that often do not correlate with abnormalities observed in FXS patients. Interestingly, a detailed examination of frequency modulated vocalizations that are believed to be a better assessment of rodent communication has never been conducted. The following study used courtship separation to conduct a detailed examination of frequency modulated ultrasonic vocalizations (USV) in FXS mice. Our analyses of frequency modulated USVs demonstrated that adult FXS mice exhibited longer phrases and more motifs. Phrases are vocalizations consisting of multiple frequency modulated ultrasonic vocalizations, while motifs are repeated frequency modulated USV patterns. Fragile X mice had a higher proportion of "u" syllables in all USVs and phrases while their wildtype counterparts preferred isolated "h" syllables. Although the specific importance of these syllables towards communication deficits still needs to be evaluated, these findings in production of USVs are consistent with the repetitive and perseverative speech patterns observed in FXS patients. This study demonstrates that FXS mice can be used to study the underlying biological mechanism(s) mediating FXS vocalization abnormalities.

Developmental trajectories of writing skills in first grade: Examining the effects of SES and language and/or speech impairments

We examined growth trajectories of writing and the relation of children's socio-economic status, and language and/or speech impairment to the growth trajectories. First grade children (N = 304) were assessed on their written composition in the fall, winter, and spring, and their vocabulary and literacy skills in the fall. Children's SES had a negative effect on writing quality and productivity. Children with language and/or speech impairment had lower scores than typically developing children in the quality and productivity of writing. Even after accounting for their vocabulary and literacy skills, students with language and/or speech impairment had lower scores in the quality and organization of writing. Growth rates in writing were not different as a function of children's SES and language/speech impairment status. Theoretical and practical implications are discussed.

Ultrasonic vocalizations during male-female interaction in the mouse model of Down syndrome Ts65Dn

Down syndrome (DS) is the leading cause of genetically defined intellectual disability. Although speech and language impairments are salient features of this disorder, the nature of these phenotypes and the degree to which they are exacerbated by concomitant oromotor dysfunction and/or hearing deficit are poorly understood. Mouse models like Ts65Dn, the most extensively used DS animal model, have been critical to understanding the genetic and developmental mechanisms that contribute to intellectual disability. In the present study, we characterized the properties of the ultrasonic vocalizations (USVs) emitted by Ts65Dn males during courtship episodes with female partners. USVs emitted by mice in this setting have been proposed to have some basic correlation to human speech. Data were collected and analyzed from 22 Ts65Dn mice and 22 of their euploid littermates. We found that both the minimum and maximum peak frequencies of Ts65Dn calls were lower than those produced by euploid mice, whereas the mean individual duration of "down" and "complex" syllable types was significantly longer. Peak, minimal and maximal, and the fundamental frequencies of short syllables generated by Ts65Dn mice were lower compared to those by euploid mice. Finally, Ts65Dn males made fewer multiple jumps calls during courtship and the mean total duration of their "arc", "u", and "complex" syllables was longer. We discuss the human correlates to these findings, their translational potential, and the limitations of this approach. To our knowledge, this is the first characterization of differences between adult Ts65Dn and euploid control mice with respect to USVs.

Health related quality of life in parents of children with speech and hearing impairment

OBJECTIVES

Hearing impairment and specific language disorder are two entities that seriously affect language acquisition in children and reduce their communication skills. These children require specific treatment and higher levels of care than healthy children. Their language abilities also strongly influence parent-child interactions. The purpose of our study was to evaluate the health-related quality of life (HRQOL) of the parents of hearing-impaired children and the parents of children with speech difficulties (specific language disorder).

METHODS

Our study subjects included 349 parents (182 mothers and 167 fathers) of preschool-aged children with receptive expressive language disorder and 131 parents (71 mothers and 60 fathers) of children with severe hearing impairment. A control group was composed of 146 parents (82 mothers and 64 fathers) of healthy children of the same age. HRQOL was assessed using the SF-36 questionnaire.

RESULTS

For all groups of parents, the mothers had poorer scores compared with the fathers, but large differences were apparent depending on the child's impairment. In the control group, the scores of the mothers were significantly lower than the fathers' scores in only two (of eight) health domains. In contrast, the scores were lower in three domains for the mothers of speech-impaired children and in six domains for the mothers of hearing-impaired children, representing the greatest difference between the parents. When compared with the control group, both the mothers and fathers of speech-impaired children scored significantly worse in five health domains. Fathers of hearing-impaired children scored significantly worse than controls in three health domains. The lowest scores, indicating the poorest HRQOL, were observed for mothers of hearing-impaired children, who obtained significantly lower scores than the control mothers in all health domains except the emotional role.

CONCLUSIONS

The parents of preschool-aged speech-and hearing-impaired children experience poorer HRQOL than parents of healthy children of the same age. Mothers of hearing-impaired children are especially affected, demonstrating a negative impact in almost all health domains.