Atypical Language Research Articles

Atypical cerebral language dominance in a right-handed patient: An anatomoclinical study

ObjectiveApproximately 97% of the right-handers has left hemisphere language dominance. Within the language dominant hemisphere Broca's area is of crucial importance for a variety of linguistic functions. As a result, tumour resection in and around Broca's area is controversial. However, studies showed that by means of Direct Electrical Stimulation (DES) tumour resection in this region can be safely performed. We report unexpected anatomoclinical findings in a right-handed patient who underwent tumour resection in the left prefrontal lobe. MethodsLanguage functions in this right-handed patient were extensively examined in the pre-, intra-, and postoperative phase by means of a standardised battery of neurolinguistic and neurocognitive tests. Results obtained in the pre- and postoperative phase are compared. In addition, intraoperative DES findings and postoperative functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) results are reported. ResultsTumour resection near Broca's area was safely performed since no positive language sites were found during intraoperative DES. Since no linguistic deficits occurred in the pre-, intra-, or postoperative phase, atypical language dominance was suspected. Neuropsychological investigations, however, disclosed permanent executive dysfunction. Postoperative fMRI and DTI confirmed right cerebral language dominance as well as a crossed cerebro-cerebellar functional link with the left cerebellar hemisphere. DiscussionAtypical right hemisphere language dominance in this right-handed patient is reflected by: (1) the total absence of language problems in the pre-, intra- and postoperative phase, (2) absence of positive stimulation sites during DES, (3) a clearly more pronounced arcuate fasciculus in the right cerebral hemisphere (DTI), (4) a crossed functional connection between the right cerebrum and the left cerebellum (fMRI). Two hypothetical explanations for the pattern of crossed cerebral language dominance are put forward: (1) preoperative brain plasticity mechanisms inducing a shift of language functions to the right hemisphere or (2) right hemisphere language dominance as a maturational variant. This case with atypical cerebral language dominance shows that although DES is the ‘gold standard’ to identify eloquent language regions and their pathways, fMRI and DTI are important adjuncts to guide surgery, to identify language lateralisation and to study anatomoclinical correlations.

Real-Time Functional Mapping With Electrocorticography in Pediatric Epilepsy

SIGFRIED (SIGnal modeling For Real-time Identification and Event Detection) software provides real-time functional mapping (RTFM) of eloquent cortex for epilepsy patients preparing to undergo resective surgery. This study presents the first application of paradigms used in functional magnetic resonance (fMRI) and electrical cortical stimulation mapping (ESM) studies for shared functional cortical mapping in the context of RTFM. Results from the 3 modalities are compared. A left-handed 13-year-old male with intractable epilepsy participated in functional mapping for localization of eloquent language cortex with fMRI, ESM, and RTFM. For RTFM, data were acquired over the frontal and temporal cortex. Several paradigms were sequentially presented: passive (listening to stories) and active (picture naming and verb generation). For verb generation and story processing, fMRI showed atypical right lateralizing language activation within temporal lobe regions of interest and bilateral frontal activation with slight right lateralization. Left hemisphere ESM demonstrated no eloquent language areas. RTFM procedures using story processing and picture naming elicited activity in the right lateral and basal temporal regions. Verb generation elicited strong right lateral temporal lobe activation, as well as left frontal lobe activation. RTFM results confirmed atypical language lateralization evident from fMRI and ESM. We demonstrated the feasibility and usefulness of a new RTFM stimulation paradigm during presurgical evaluation. Block design paradigms used in fMRI may be optimal for this purpose. Further development is needed to create age-appropriate RTFM test batteries.

Impact of the NICU environment on language deprivation in preterm infants

It is unclear whether the atypical language development commonly seen in preterm infants is a consequence of language deficiency experienced during their prolonged NICU stay. This review provides a novel viewpoint, which highlights the potential impact of the NICU design on the developmental origin of language disabilities in preterm infants. Further research is needed to identify evidence-based design solutions for providing preterm infants with a healthier linguistic hospital environment that aids growth and development.

Processing of non-canonical word-order: A case-series on lesion-induced reorganized language and age-effects in typical development

Complex grammatical structures are mastered late in language acquisition. We studied age-effects on performance in object topicalization in 48 typically developing German-speaking participants (aged 8–30years) and in five patients (children and adolescents) with lesion-induced atypical language representation. Production was tested by a sentence repetition task, comprehension by an acting out task. Three topicalized conditions with differing disambiguation (agreement, case, and case plus agreement) were contrasted with canonical control sentences.Children’s (aged 8–13years) performance was significantly below that of adolescents and adults in all topicalized conditions. All participants made most mistakes in the agreement condition. Patients showed remarkable difficulties as compared with age-appropriate control groups in all topicalization conditions and across age-groups. Despite the small sample size, the consistency of these difficulties might hint to the importance of an intact typical neural language substrate for processing complex grammatical structures even in very early brain lesions.

Assessing language acquisition from parent-child interaction: An event-related potential study on perception of intonation contours in infancy

The aim of this paper is to present our multidisciplinary project to study parent-child interaction. The goal of the project is to identify, test, and simulate components of child and adult speech and gestures and the consequences they might have on child language acquisition. Since typical parent-child interaction is built upon both interlocutors’ intention-reading, responsiveness to joint-attention, and imitation of speech/gestures, we make video recordings along with recordings of speech data to grasp the integration of semantic and pragmatic aspects of language acquisition. The understanding of parent-child interaction benefits further from information on brain activation involved in speech processing. As a first step to achieve the project goals, an electroencephalography/event-related potential (EEG/ERP) study exploring children’s early perception of intonation contours involved in human interactions was performed. This paper discusses the characteristics of integration of multimodal social-emotional (speech, prosody, faces, posture) signals as part of the dynamics of communication in typically developing children. Possible application fields are social signal processing (SSP; an emerging research domain that aims to provide computers ability to understand human social signals), and improvement of diagnosis of late or atypical language development in pathologies that affect the dynamics of social interaction (such as autism spectrum disorders).

Asymmetry of planum temporale constrains interhemispheric language plasticity in children with focal epilepsy

Reorganization of eloquent cortex enables rescue of language functions in patients who sustain brain injury. Individuals with left-sided, early-onset focal epilepsy often show atypical (i.e. bilateral or right-sided) language dominance. Surprisingly, many patients fail to show such interhemispheric shift of language despite having major epileptogenic lesions in close proximity to eloquent cortex. Although a number of epilepsy-related factors may promote interhemispheric plasticity, it has remained unexplored if neuroanatomical asymmetries linked to human language dominance modify the likelihood of atypical lateralization. Here we examined the asymmetry of the planum temporale, one of the most striking asymmetries in the human brain, in relation to language lateralization in children with left-sided focal epilepsy. Language functional magnetic resonance imaging was performed in 51 children with focal epilepsy and left-sided lesions and 36 healthy control subjects. We examined the association of language laterality with a range of potential clinical predictors and the asymmetry of the length of the planum temporale. Using voxel-based methods, we sought to determine the effect of lesion location (in the affected left hemisphere) and grey matter density (in the unaffected right hemisphere) on language laterality. Atypical language lateralization was observed in 19 patients (38%) and in four controls (11%). Language laterality was increasingly right-sided in patients who showed atypical handedness, a left perisylvian ictal electroencephalographic focus, and a lesion in left anterior superior temporal or inferior frontal regions. Most striking was the relationship between rightward asymmetry of the planum temporale and atypical language (R = 0.70, P < 0.0001); patients with a longer planum temporale in the right (unaffected) hemisphere were more likely to have atypical language dominance. Voxel-based regression analysis confirmed that increased grey matter density in the right temporo-parietal junction was correlated with right hemisphere lateralization of language. The length of the planum temporale in the right hemisphere was the main predictor of language lateralization in the epilepsy group, accounting for 48% of variance, with handedness accounting for only a further 5%. There was no correlation between language lateralization and planum temporale asymmetry in the control group. We conclude that asymmetry of the planum temporale may be unrelated to language lateralization in healthy individuals, but the size of the right, contra-lesional planum temporale region may reflect a ‘reserve capacity’ for interhemispheric language reorganization in the presence of a seizure focus and lesions within left perisylvian regions.

Lexical Diversity and Omission Errors as Predictors of Language Ability in the Narratives of Sequential Spanish–English Bilinguals: A Cross-Language Comparison

This study explored the utility of language sample analysis for evaluating language ability in school-age Spanish-English sequential bilingual children. Specifically, the relative potential of lexical diversity and word/morpheme omission as predictors of typical or atypical language status was evaluated. Narrative samples were obtained from 48 bilingual children in both of their languages using the suggested narrative retell protocol and coding conventions as per Systematic Analysis of Language Transcripts (SALT; Miller & Iglesias, 2008) software. An additional lexical diversity measure, VocD, was also calculated. A series of logistical hierarchical regressions explored the utility of the number of different words, VocD statistic, and word and morpheme omissions in each language for predicting language status. Omission errors turned out to be the best predictors of bilingual language impairment at all ages, and this held true across languages. Although lexical diversity measures did not predict typical or atypical language status, the measures were significantly related to oral language proficiency in English and Spanish. The results underscore the significance of omission errors in bilingual language impairment while simultaneously revealing the limitations of lexical diversity measures as indicators of impairment. The relationship between lexical diversity and oral language proficiency highlights the importance of considering relative language proficiency in bilingual assessment.

White-matter microstructure and language lateralization in left-handers: A whole-brain MRI analysis

Most people are left-hemisphere dominant for language. However the neuroanatomy of language lateralization is not fully understood. By combining functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we studied whether language lateralization is associated with cerebral white-matter (WM) microstructure. Sixteen healthy, left-handed women aged 20–25 were included in the study. Left-handers were targeted in order to increase the chances of involving subjects with atypical language lateralization. Language lateralization was determined by fMRI using a verbal fluency paradigm. Tract-based spatial statistics analysis of DTI data was applied to test for WM microstructural correlates of language lateralization across the whole brain. Fractional anisotropy and mean diffusivity were used as indicators of WM microstructural organization. Right-hemispheric language dominance was associated with reduced microstructural integrity of the left superior longitudinal fasciculus and left-sided parietal lobe WM. In left-handed women, reduced integrity of the left-sided language related tracts may be closely linked to the development of right hemispheric language dominance. Our results may offer new insights into language lateralization and structure–function relationships in human language system.

Cerebral Asymmetry and Language Development: Cause, Correlate, or Consequence?

In most people, language is processed predominantly by the left hemisphere of the brain, but we do not know how or why. A popular view is that developmental language disorders result from a poorly lateralized brain, but until recently, evidence has been weak and indirect. Modern neuroimaging methods have made it possible to study normal and abnormal development of lateralized function in the developing brain and have confirmed links with language and literacy impairments. However, there is little evidence that weak cerebral lateralization has common genetic origins with language and literacy impairments. Our understanding of the association between atypical language lateralization and developmental disorders may benefit if we reconceptualize the nature of cerebral asymmetry to recognize its multidimensionality and consider variation in lateralization over developmental time. Contrary to popular belief, cerebral lateralization may not be a highly heritable, stable characteristic of individuals; rather, weak lateralization may be a consequence of impaired language learning.

Atypicalities in Cortical Structure, Handedness, and Functional Lateralization for Language in Autism Spectrum Disorders

Language is typically a highly lateralized function, with atypically reduced or reversed lateralization linked to language impairments. Given the diagnostic and prognostic role of impaired language for autism spectrum disorders (ASDs), this paper reviews the growing body of literature that examines patterns of lateralization in individuals with ASDs. Including research from structural and functional imaging paradigms, and behavioral evidence from investigations of handedness, the review confirms that atypical lateralization is common in people with ASDs. The evidence indicates reduced structural asymmetry in fronto-temporal language regions, attenuated functional activation in response to language and pre-linguistic stimuli, and more ambiguous (mixed) hand preferences, in individuals with ASDs. Critically, the evidence emphasizes an intimate relationship between atypical lateralization and language impairment, with more atypical asymmetries linked to more substantive language impairment. Such evidence highlights opportunities for the identification of structural and functional biomarkers of ASDs, affording the potential for earlier diagnosis and intervention implementation.

Rethinking echolalia: repetition as interactional resource in the communication of a child with autism

Echolalia is a pervasive phenomenon in verbal children with autism, traditionally conceived of as an automatic behavior with no communicative function. However, recently it has been shown that echoes may serve interactional goals. This article, which presents a case study of a six-year-old child with autism, examines how social interaction organizes autism echolalia and how repetitive speech responds to discernible interactional trajectories. Using linguistic, discourse, and acoustic analyses, we demonstrate that the child is able to mobilize echolalia to mark different stances, through the segmental and suprasegmental modulation of echoes. We offer an interpretive framework that deepens our understanding of the complex interactions that children with autism can engage in by using echoes, and discuss the implications of this perspective for current views of atypical language development in autism.

Comparing multilingual children with SLI to their bilectal peers: evidence from object and action picture naming

Against the background of the increasing number of multilingual children with atypical language development around the world, this study reports research results on grammatical word class processing involving children with specific language impairment (SLI). The study investigates lexical retrieval of verbs (through picture-naming actions) and compares performances for the same children with noun retrieval (through picture-naming objects). It was found that nouns (object names) were better retrieved than verbs (action names) in the multilingual group with SLI, a finding similar to bilectal peers with SLI and typically developing language-matched controls. The results suggest that grammatical class is an organising principle shared across languages. Moreover, when tested in first and third language, multilingual children with SLI revealed a comparable verb–noun dissociation both in terms of the direction of the effect (V < N) and major error type. These findings are discussed in relation to the delayed acquisition hypothesis for SLI and psycholinguistic models of multilingualism.

Cholecystokinin A Receptor (CCKAR) Gene Variation Is Associated with Language Lateralization

Schizophrenia is a psychiatric disorder associated with atypical handedness and language lateralization. However, the molecular mechanisms underlying these functional changes are still poorly understood. Therefore, the present study was aimed at investigating whether variation in schizophrenia-related genes modulates individual lateralization patterns. To this end, we genotyped 16 single nucleotide polymorphisms that have previously been linked to schizophrenia on a meta-analysis level in a sample of 444 genetically unrelated healthy participants and examined the association of these polymorphisms with handedness, footedness and language lateralization. We found a significant association of the cholecystokinin-A receptor (CCKAR) gene variation rs1800857 and language lateralization assessed using the dichotic listening task. Individuals carrying the schizophrenia risk allele C of this polymorphism showed a marked reduction of the typical left-hemispheric dominance for language processing. Since the cholecystokinin A receptor is involved in dopamine release in the central nervous system, these findings suggest that genetic variation in this receptor may modulate language lateralization due to its impact on dopaminergic pathways.

Language lateralization by fMRIand Wada testing in 229 patients with epilepsy: Rates and predictors of discordance

To more definitively characterize Wada/functional magnetic resonance imaging (fMRI) language dominance discordance rates with the largest sample of patients with epilepsy to date, and to examine demographic, clinical, and methodologic predictors of discordance. Two hundred twenty-nine patients with epilepsy underwent both a standardized Wada test and a semantic decision fMRI language protocol in a prospective research study. Language laterality indices were computed for each test using automated and double-blind methods, and Wada/fMRI discordance rates were calculated using objective criteria for discordance. Regression analyses were used to explore a range of variables that might predict discordance, including subject variables, Wada quality indices, and fMRI quality indices. Discordant results were observed in 14% of patients. Discordance was highest among those categorized by either test as having bilateral language. In a multivariate model, the only factor that predicted discordance was the degree of atypical language dominance on fMRI. fMRI language lateralization is generally concordant with Wada testing. The degree of rightward shift of language dominance on fMRI testing is strongly correlated with Wada/fMRI discordance, suggesting that fMRI may be more sensitive than Wada to right hemisphere language processing, although the clinical significance of this increased sensitivity is unknown. The relative accuracy of fMRI versus Wada testing for predicting postsurgical language outcome in discordant cases remains a topic for future research.

Early neural disruption and auditory processing outcomes in rodent models: implications for developmental language disability

Most researchers in the field of neural plasticity are familiar with the “Kennard Principle,” which purports a positive relationship between age at brain injury and severity of subsequent deficits (plateauing in adulthood). As an example, a child with left hemispherectomy can recover seemingly normal language, while an adult with focal injury to sub-regions of left temporal and/or frontal cortex can suffer dramatic and permanent language loss. Here we present data regarding the impact of early brain injury in rat models as a function of type and timing, measuring long-term behavioral outcomes via auditory discrimination tasks varying in temporal demand. These tasks were created to model (in rodents) aspects of human sensory processing that may correlate—both developmentally and functionally—with typical and atypical language. We found that bilateral focal lesions to the cortical plate in rats during active neuronal migration led to worse auditory outcomes than comparable lesions induced after cortical migration was complete. Conversely, unilateral hypoxic-ischemic (HI) injuries (similar to those seen in premature infants and term infants with birth complications) led to permanent auditory processing deficits when induced at a neurodevelopmental point comparable to human “term,” but only transient deficits (undetectable in adulthood) when induced in a “preterm” window. Convergent evidence suggests that regardless of when or how disruption of early neural development occurs, the consequences may be particularly deleterious to rapid auditory processing (RAP) outcomes when they trigger developmental alterations that extend into subcortical structures (i.e., lower sensory processing stations). Collective findings hold implications for the study of behavioral outcomes following early brain injury as well as genetic/environmental disruption, and are relevant to our understanding of the neurologic risk factors underlying developmental language disability in human populations.

Abnormalities in fronto-striatal connectivity within language networks relate to differences in grey-matter heterogeneity in Asperger syndrome

Asperger syndrome (AS) is an Autism Spectrum Disorder (ASD) characterised by qualitative impairment in the development of emotional and social skills with relative preservation of general intellectual abilities, including verbal language. People with AS may nevertheless show atypical language, including rate and frequency of speech production. We previously observed that abnormalities in grey matter homogeneity (measured with texture analysis of structural MR images) in AS individuals when compared with controls are also correlated with the volume of caudate nucleus. Here, we tested a prediction that these distributed abnormalities in grey matter compromise the functional integrity of brain networks supporting verbal communication skills. We therefore measured the functional connectivity between caudate nucleus and cortex during a functional neuroimaging study of language generation (verbal fluency), applying psycho-physiological interaction (PPI) methods to test specifically for differences attributable to grey matter heterogeneity in AS participants. Furthermore, we used dynamic causal modelling (DCM) to characterise the causal directionality of these differences in interregional connectivity during word production. Our results revealed a diagnosis-dependent influence of grey matter heterogeneity on the functional connectivity of the caudate nuclei with right insula/inferior frontal gyrus and anterior cingulate, respectively with the left superior frontal gyrus and right precuneus. Moreover, causal modelling of interactions between inferior frontal gyri, caudate and precuneus, revealed a reliance on bottom-up (stimulus-driven) connections in AS participants that contrasted with a dominance of top-down (cognitive control) connections from prefrontal cortex observed in control participants. These results provide detailed support for previously hypothesised central disconnectivity in ASD and specify discrete brain network targets for diagnosis and therapy in ASD.

Investigating the Relationship Between Nonword Repetition Performance and Syllabic Structure in Typical and Atypical Language Development

In this study, the authors examined the role of syllabic structure in nonword repetition performance in typically developing (TD) children and children with specific language impairment (SLI). Eighteen children with SLI (5;7-6;7 [years;months]) and 18 TD children matched for chronological age were tested on their ability to repeat phonemes in different positions within syllable structure (onset, nucleus, coda). The test involved 2 separate nonword repetition tasks differing in lexicality (high vs. low). High-lexicality nonwords contained subparts that are morphemes of the language (i.e., subparts were "lexical"), whereas nonlexical nonwords did not. Repetition performance across the 3 syllabic positions showed a significant effect for both populations and on both tasks. However, although on the high-lexicality task the direction of the effect revealed the onset as the most error-prone constituent (onset > coda > nucleus), on the low-lexicality task, it was the coda that attracted most errors (coda > onset > nucleus). Results suggest that the procedures involved in computing syllabic structure are qualitatively similar in the 2 populations. We take these results to support the view that different syllabic positions involve different levels of phonological complexity and that tests that control for lexicality are crucial in illuminating these differences.

Verb inflection in German-learning children with typical and atypical language acquisition: the impact of subsyllabic frequencies

Previous research has shown that high phonotactic frequencies facilitate the production of regularly inflected verbs in English-learning children with specific language impairment (SLI) but not with typical development (TD). We asked whether this finding can be replicated for German, a language with a much more complex inflectional verb paradigm than English. Using an elicitation task, the production of inflected nonce verb forms (3(rd) person singular with -t suffix) with either high- or low-frequency subsyllables was tested in sixteen German-learning children with SLI (ages 4;1-5;1), sixteen TD-children matched for chronological age (CA) and fourteen TD-children matched for verbal age (VA) (ages 3;0-3;11). The findings revealed that children with SLI, but not CA- or VA-children, showed differential performance between the two types of verbs, producing more inflectional errors when the verb forms resulted in low-frequency subsyllables than when they resulted in high-frequency subsyllables, replicating the results from English-learning children.

Plural noun inflection in Kuwaiti Arabic-speaking children with and without Specific Language Impairment

This study examined the production of three types of noun plural inflections, feminine sound plural (FSP), masculine sound plural (MSP), and broken plural (BP) in Kuwaiti Arabic-speaking children with and without language impairment. A total of thirty-six Kuwaiti participants - twelve adults, twelve children with specific language impairment (SLI), and twelve typically developing age-matched controls (TD) were presented with twenty-seven pictured stimuli of real and nonsense words. The results showed that the TD children were significantly more accurate in using the required noun plural inflections than the SLI group. The TD children's preferred overgeneralization strategy was to substitute FSP for the regular MSP and irregular BP contexts much more than their peers with SLI. The performance of the SLI group also differed from that of their age-matched counterparts in the number of errors and their distribution across categories. The results are discussed in the light of relevant theories of atypical language development.

Pitch discrimination and melodic memory in children with autism spectrum disorders

Pitch perception is enhanced among persons with autism. We extended this finding to memory for pitch and melody among school-aged children. The purpose of this study was to investigate pitch memory in musically untrained children with autism spectrum disorders, aged 7-13 years, and to compare it to that of age- and IQ-matched typically developing children. The children were required to discriminate isolated tones in two differing contexts as well to remember melodies after a period of 1 week. The tasks were designed to employ both short- and long-term memory for music. For the pitch discrimination task, the children first had to indicate whether two isolated tones were the same or different when the second was the same or had been altered to be 25, 35, or 45 cents sharp or flat. Second, the children discriminated the tones within the context of melody. They were asked whether two melodies were the same or different when the leading tone of the second melody was the same or had been altered to be 25, 35, or 45 cents sharp or flat. Long-term memory for melody was also investigated, as the children attempted to recall four different two-bar melodies after 1 week. The children with autism spectrum disorders demonstrated elevated pitch discrimination ability in the single-tone and melodic context as well as superior long-term memory for melody. Pitch memory correlated positively with scores on measures of nonverbal fluid reasoning ability. Superior short- and long-term pitch memory was found among children with autism spectrum disorders. The results indicate an aspect to cognitive functioning that may predict both enhanced nonverbal reasoning ability and atypical language development.