Early Language Impairment Research Articles

Transcranial Magnetic Stimulation improves language and language network functional connectivity in a patient with logopenic Primary Progressive Aphasia

AbstractBackgroundPrimary progressive aphasia (PPA) refers to a group of neurodegenerative disorders characterized by early language impairments. Neuroimaging evidence suggests that language networks anchored in prefrontal, temporal and parietal cortices are selectively affected in these syndromes. Focal neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), are able to change resting‐state functional connectivity in a network‐specific manner.MethodHere, we characterized the language network of a patient with logopenic PPA and targeted this network in an individualized manner with high frequency (20Hz) rTMS and with sham rTMS. We used detailed language testing and resting‐state functional connectivity MRI as outcome measures.ResultThe patient’s language performance improved following active but not sham rTMS. This was accompanied by increased functional connectivity in the patient’s individually characterized language network after active but not sham rTMS.ConclusionThis case report supports further controlled clinical trials of individually‐targeted rTMS in PPA.

Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome.

Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD). 44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning. Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD. Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later. Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments.

BackgroundChildren with language impairment (LI) show heterogeneity in development. We tracked children from pre‐school to middle childhood to characterize three developmental trajectories: resolving, persisting and emerging LI.MethodsWe analyzed data from children identified as having preschool LI, or being at family risk of dyslexia, together with typically developing controls at three time points: t1 (age 3;09), t3 (5;08) and t5 (8;01). Language measures are reported at t1, t3 and t5, and literacy abilities at t3 and t5. A research diagnosis of LI (irrespective of recruitment group) was validated at t1 by a composite language score derived from measures of receptive and expressive grammar and vocabulary; a score falling 1SD below the mean of the typical language group on comparable measures at t3 and t5 was used to determine whether a child had LI at later time points and then to classify LIs as resolving, persisting or emerging.ResultsPersisting preschool LIs were more severe and pervasive than resolving LIs. Language and literacy outcomes were relatively poor for those with persisting LI, and relatively good for those with resolving LI. A significant proportion of children with average language abilities in preschool had LIs that emerged in middle childhood – a high proportion of these children were at family risk of dyslexia. There were more boys in the persisting and resolving LI groups. Children with early LIs which resolved by the start of formal literacy instruction tended to have good literacy outcomes; children with late‐emerging difficulties that persisted developed reading difficulties.ConclusionsChildren with late‐emerging LI are relatively common and are hard to detect in the preschool years. Our findings show that children whose LIs persist to the point of formal literacy instruction frequently experience reading difficulties.

Early language impairments and developmental pathways of emotional problems across childhood.

Language impairments are associated with an increased likelihood of emotional difficulties later in childhood or adolescence, but little is known about the impact of LI on the growth of emotional problems. To examine the link between early language status (language impaired (LI), typical language (TL)) and the pattern and predictors of growth in emotional difficulties from school entry to the start of high school in a large cohort of Australian children. Unconditional latent growth curves of emotional difficulties were modelled across four waves (ages 4-5, 6-7, 8-9 and 10-11) using data from 1627 boys (280 LI, 1347 TL) and 1609 girls (159 LI, 1450 TL). Conditional latent growth curves estimated the main effects of LI on the severity and slope of growth in emotional problems. Simultaneous multiple regression tested the interaction between language status and the other predictors of the development of emotional symptoms. LI predicted a significant persistent elevation in severity of emotional difficulties across childhood among boys (d = 0.33-0.57) and girls (d = 0.25-0.39) but was not associated with their growth. LI moderated the association between hostile parenting and the severity of emotional symptoms for boys and the effect of socioeconomic status (SES) and temperamental sociability on the linear and quadratic growth of emotional problems for girls but had no impact on the influence of other predictors. There is no effect of LI on the characteristic rate and shape of growth in emotional symptoms across childhood although LI children maintain elevated severities of emotional difficulties. The associations between child reactivity, peer problems, prosocial behaviours, maternal distress and parental warmth and the development of emotional difficulties were the same for LI and TL children. LI enhanced the influence of hostile parenting on a higher severity of emotional symptoms for boys and of lower SES on a faster rate of development of emotional symptoms for girls. LI offset the usual protective effect of higher sociability and the usual vulnerability of higher social avoidance to a faster increase in emotional symptoms with age.

Building words on actions: Verb enactment and verb recognition in children with specific language impairment

Recent studies have shown that language processing is grounded in actions. Multiple independent research findings indicate that children with specific language impairment (SLI) show subtle difficulties beyond the language domain. Uncertainties remain on possible association between body-mediated, non-linguistic expression of verbs and early manifestation of SLI during verb acquisition. The present study was conducted to determine whether verb production through non-linguistic modalities is impaired in children with SLI. Children with SLI (mean age 41 months) and typically developing children (mean age 40 months) were asked to recognize target verbs while viewing video clips showing the action associated with the verb (verb-recognition task) and to enact the action corresponding to the verb (verb-enacting task). Children with SLI performed more poorly than control children in both tasks. The present study demonstrates that early language impairment emerges at the bodily level. These findings are consistent with the embodied theories of cognition and underscore the role of action-based representations during language development.

Clinical-Genetic Correlations in Familial Alzheimer's Disease Caused by Presenilin 1 Mutations

We describe the clinical phenotype of nine kindred with presenile Alzheimer's disease (AD) caused by different presenilin 1 (PS1) point mutations, and compare them with reported families with mutations in the same codons. Mutations were in exon 4 (Phe105Val), exon 5 (Pro117Arg, Glu120Gly), exon 6 (His163Arg), exon 7 (Leu226Phe), exon 8 (Val261Leu, Val272Ala, Leu282Arg), and exon 12 (Ile439Ser). Three of these amino acid changes (Phe105Val, Glu120Gly, and Ile439Ser) had not been previously reported. Distinct clinical features, including age of onset, symptoms and signs associated with the cortical-type dementia and aggressiveness of the disease, characterized the different mutations and were quite homogeneous across family members. Age of onset fell within a consistent range: some mutations caused the disease in the thirties (P117R, L226F, V272A), other in the forties (E120G, H163R, V261L, L282R), and other in the fifties (F105V, I439S). Associated features also segregated with specific mutations: early epileptic activity (E120G), spastic paraparesis (V261L), subcortical dementia and parkinsonism (V272A), early language impairment, frontal signs, and myoclonus (L226F), and late myoclonus and seizures (H163R, L282R). Neurological deterioration was particularly aggressive in PS1 mutations with earlier age of onset such as P117R, L226F, and E120G. With few exceptions, a similar clinical phenotype was found in families reported to have either the same mutation or different amino acid changes in the same codons. This series points to a strong influence of the specific genetic defect in the development of the clinical phenotype.

Directional effects between rapid auditory processing and phonological awareness in children

Deficient rapid auditory processing (RAP) has been associated with early language impairment and dyslexia. Using an auditory masking paradigm, children with language disabilities perform selectively worse than controls at detecting a tone in a backward masking (BM) condition (tone followed by white noise) compared to a forward masking (FM) condition (tone preceded by white noise). Tallal's (1980) auditory processing hypothesis posits that abnormal RAP leads to reduced (or impaired) phonological awareness (PA), resulting in reading and language difficulties. Alternative theories suggest that impaired PA may have more of a top-down effect on auditory processing. The current study examines RAP in children tested at two time points, average age 5.6 and average age 8.3, in order to test causal relations between RAP and PA in a path analysis. Additional hierarchical regressions examine how well RAP predicts reading ability when accounting for PA and vocabulary. The path analysis indicates a top-down effect, such that PA has a larger impact on BM over time than the reverse. Regressions indicate no direct impact of RAP on reading ability. The path analysis provides evidence against the auditory processing hypothesis and instead suggests that between the ages of 5 and 8 it is variability in early phonological representations that predicts subsequent lower-level rapid auditory processing.

The Persistence of language Disorders in a Group of Disadvantaged Grade 3 Learners

A strong correlation between early language impairment and academic failure has been suggested by past research. This followup cohort study of 25 monolingual, disadvantaged grade 3 learners investigated whether the language impairments diagnosed in their preschool year were still evident after 3 years of school attendance, maturation and speech-language therapy. The results verified the persistence of preschool language impairments, which have been associated with poor reading and academic failure.

Handedness, eyedness and nasal cycle in children with autism

ObjectiveAutism is referred to as cerebral lateralization abnormality. In this study, the possible relationships among handedness, eyedness and nasal cycle in autism have been investigated. Materials and methodsThirty-seven children with autism and 20 controls were included in the study. The patient group included 27 boys and 10 girls who ranged in age from 5 to 20 years. For hand preference, hand used to write and throw a ball was accepted as dominant hand. For eye preference or dominance, eye used to look through keyhole of a door was accepted as dominant eye. Nasal dominance was assessed by a method of measuring the nasal airflow. ResultsThe rates of left-handedness and left-eyedness were higher in children with autism compared to normal populations. A majority of children with autism had left nasal dominance. ConclusionAutism and early language impairment may be associated with left handedness, eyedness and nasal dominance.

Social anxiety in late adolescence: The importance of early childhood language impairment

Social phobia is a common, highly comorbid, poorly understood and relatively understudied condition. The origins of social phobia share familial and biological features common with those of other anxiety disorders, but seldom have precursors of the fear of social communication been examined as a possible pathway to social phobia. Here we examine the role of early childhood language impairment as an antecedent to social phobia in late adolescence. Participants in a prospective longitudinal community study identified as having language impairment at age 5 and matched controls were followed up at age 19. Compared to normal language controls, individuals with a history of early language impairment had 2.7 times the odds of having a social phobia by age 19. Results suggest that early language impairment represents a distinct pathway to late adolescent social phobia.

Early language impairment and young adult delinquent and aggressive behavior.

Clinic and forensic studies have reported high rates of language impairments in conduct disordered and incarcerated youth. In community samples followed to early adolescence, speech and language impairments have been linked to attention deficits and internalizing problems, rather than conduct problems, delinquency, or aggression. This study examines the young adult antisocial outcomes of speech or language impaired children. Language impaired boys had higher levels of parent-rated delinquency symptoms by age 19 than boys without language impairment, controlled for verbal IQ and for demographic and family variables. Language impaired boys did not differ from controls in self-reported delinquency or aggression symptoms on a standardized checklist; however, language impaired boys reported higher rates of arrests and convictions than controls. Language impairment was not related to aggression or delinquency in girls. We examine alternate models of the interrelationships between language, academics, and behavior, at ages 5, 12, and 19.

Language Impairment at School Entry and Later Reading Disability: Connections at Lexical Versus Supralexical Levels of Reading

This study employed the distinction between lexical and supralexical processes in reading in order to gain a more fine-grained picture of the relationships between early language impairment and later reading disabilities. We hypothesized that early semantic-syntactic deficits would be only weakly related, if at all, to the characteristically modular word recognition processes involved in reading isolated words and pseudowords. On the other hand, early language deficiencies were expected to be significantly associated with processes operating beyond the level of individual words when children are required to read and understand connected text. These predictions were tested using data from a longitudinal study of over 500 unselected children followed from kindergarten to the end of Grade 1. Both traditional categorical analyses of specific subgroups with early language impairment or later reading disability as well as dimensional (regression) analyses were carried out. As predicted, higher order language was found to be related to supralexical aspects of reading after controlling IQ, age, gender and socioeconomic status, with only a weak and statistically marginal association with lexical processing. With biosocial variables and phonological awareness partialled out, higher order language was unrelated to lexical aspects of reading. These data highlight the multicomponential nature of reading and suggest that different measures of reading cannot simply be regarded as interchangeable measures of a single undifferentiated reading construct.

Fourteen-Year Follow-up of Speech/Language-Impaired and Control Children: Psychiatric Outcome

To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.

Early onset Alzheimer's disease in a South American pedigree from Argentina

We report the clinical, SPET, immunohistochemical and DNA features of an early-onset familial Alzheimer's disease (FAD) in an Argentine pedigree of South American indian ethnic background. Pedigree spans 5 generations comprising more than 110 biological relatives. Clinical data supported the diagnosis of early onset FAD (mean age at onset 38.9 years) in 10 family members, including 3 with pathological confirmation (mean age at death 48.5). The pattern of transmission suggested autosomal dominant inheritance. Prominent features were mood changes, early language impairment, myoclonus, seizures and cerebellar signs. SPET displayed bilateral frontal, temporo-parietal and cerebellar hypoperfusion in early stages and in an asymptomatic member at risk, suggesting that SPET may have predictive value in this family. Immunohistochemistry showed β amyloid deposits within neuritic plaques and vessel walls and no anti-PrP immunoreactivity. DNA analysis showed no abnormalities in the β amyloid precursor protein gene. The identification of additional genetic defects in well characterized independent FAD pedigrees will contribute to the understanding of the pathogenesis of Alzheimer's disease.

Early onset Alzheimer's disease in a South American pedigree from Argentina.

We report the clinical, SPET, immunohistochemical and DNA features of an early-onset familial Alzheimer's disease (FAD) in an Argentine pedigree of South American indian ethnic background. Pedigree spans 5 generations comprising more than 110 biological relatives. Clinical data supported the diagnosis of early onset FAD (mean age at onset 38.9 years) in 10 family members, including 3 with pathological confirmation (mean age at death 48.5). The pattern of transmission suggested autosomal dominant inheritance. Prominent features were mood changes, early language impairment, myoclonus, seizures and cerebellar signs. SPET displayed bilateral frontal, temporo-parietal and cerebellar hypoperfusion in early stages and in an asymptomatic member at risk, suggesting that SPET may have predictive value in this family. Immunohistochemistry showed beta amyloid deposits within neuritic plaques and vessel walls and no anti-PrP immunoreactivity. DNA analysis showed no abnormalities in the beta amyloid precursor protein gene. The identification of additional genetic defects in well characterized independent FAD pedigrees will contribute to the understanding of the pathogenesis of Alzheimer's disease.

Language, Learning, and Behavioral Disturbances in Childhood: A Longitudinal Perspective

Objective Investigate longitudinally the course of development of preschool learning impaired (LI) children to better understand the interaction between neurodevelopmental delay, behavioral/emotional disorders, and language development and disorders. Method Relationships between developmental language disorders and emotional problems were investigated in 99 8-year-old specifically language impaired and control children originally assessed at age 4 years using the Achenbach Child Behavior Checklist and the Conners' Parents Questionnaire. Results LI children received higher behavior problem scores and were more likely to score in the clinical range than were control children. Neither degree of early language impairment nor amount of language improvement predicted 8-year behavioral/emotional status. LI children with the largest drop in IQ between ages 4 and 8 received the highest behavior problem scores. No significant comorbid relationship was seen between LI and attention-deficit hyperactivity disorder. Conclusions The enhanced incidence of behavior problems reported heretofore may be related more to lower IQ than to linguistic deficit per se. Care must be taken to differentiate the symptoms of neurodevelopmental delay and emotional disturbance, however, preschool children with scores in the clinical range on such measures should be referred for additional evaluation. J. Am. Acad. Child Adolesc. Psychiatry, 1993, 32, 3:585–594.