Mean Length Of Utterance Research Articles

Measure What You Treat: Using Language Sample Analysis for Grammatical Outcome Measures in Children With Developmental Language Disorder

Purpose Language sample analysis (LSA) is commonly used to monitor progress for children with language disorders (Pavelko et al., 2016). For children with grammar goals, pediatric speech-language pathologists report mean length of utterance (MLU) and type–token ratio (TTR) as the two LSA measures most commonly used (Finestack & Satterlund, 2018). For focused grammatical intervention, these measures may be ineffective in capturing treatment growth. In this clinical focus article, we provide a preliminary comparison of four measures that could be considered as progress monitoring tools following intervention for one finiteness marker. Method Pre- and posttreatment spontaneous language samples from six children with developmental language disorder who underwent treatment for the third-person singular –s ( –3s ) morpheme were analyzed qualitatively. Four measures are reported: MLU, TTR, percent accuracy of –3s , and Tense and Agreement Productivity score of –3s (cf. Hadley & Short, 2005). Results Increases were most common across participants in measures that examined use of the treatment target (i.e., percent accuracy and Tense and Agreement Productivity score of –3s ). Changes in MLU were not always congruent with measures of the treatment target. Change was mostly not appreciable for TTR. Conclusions For preschool-aged children with developmental language disorder, MLU and TTR may not be effective as the sole outcome measures following treatment of –3s. Our six case studies highlight the benefit of measuring the treated skill as discretely as possible and with multiple measures. More research is needed into the use of LSA for outcome measures in children with language disorders.

Language in schizophrenia: relation with diagnosis, symptomatology and white matter tracts

Language deviations are a core symptom of schizophrenia. With the advances in computational linguistics, language can be easily assessed in exact and reproducible measures. This study investigated how language characteristics relate to schizophrenia diagnosis, symptom, severity and integrity of the white matter language tracts in patients with schizophrenia and healthy controls. Spontaneous speech was recorded and diffusion tensor imaging was performed in 26 schizophrenia patients and 22 controls. We were able to classify both groups with a sensitivity of 89% and a specificity of 82%, based on mean length of utterance and clauses per utterance. Language disturbances were associated with negative symptom severity. Computational language measures predicted language tract integrity in patients (adjusted R2 = 0.467) and controls (adjusted R2 = 0.483). Quantitative language analyses have both clinical and biological validity, offer a simple, helpful marker of both severity and underlying pathology, and provide a promising tool for schizophrenia research and clinical practice.

Spontaneous productions of infinitive clauses by English-speaking children with and without specific language impairment

ABSTRACT As a group, children with specific language impairment (SLI) have presented with lower levels of proficiency with infinitive clauses relative to comparison groups with typical language (TL). The presence of considerable individual variability within those affected by SLI, however, remains unexplained. Furthermore, the status of infinitive clause productions in children with language impairments that do not meet criteria for SLI, because of either low nonverbal abilities or other concomitant conditions, is unknown. Previous studies focused on children with SLI and have not included children who would fit into a broader developmental language disorder (DLD) designation. In this study, spontaneous language samples were collected on 30 children with DLD and 30 children with typical language skills, including those with low nonverbal abilities or other neurodevelopmental disorders (age range: 5;1–7;7). Samples were analyzed to examine potential predictors of children’s infinitive clause use and their infinitive TO omission rates. Significant group differences were found for the number and accuracy of infinitive clauses produced. Consistent with previous reports examining children with SLI, considerable variability was found across cases of DLD. Maternal education and mean length of utterance (MLU) were significant predictors for children’s infinitive clause use. Finite verb morphology composite scores and MLU were significant predictors of children’s infinitive TO omission rates.

Comparing Tense and Agreement Productivity in Boys With Fragile X Syndrome, Children With Developmental Language Disorder, and Children With Typical Development.

Purpose This study compared and characterized the tense and agreement productivity of boys with fragile X syndrome (FXS), children with developmental language disorder (DLD), and children with typical development (TD) matched on mean length of utterance. Method Twenty-two boys with FXS (M age = 12.22 years), 19 children with DLD (M age = 4.81 years), and 20 children with TD (M age = 3.23 years) produced language samples that were coded for their productive use of five tense markers (i.e., third-person singular, past tense -ed, copula BE, auxiliary BE, and auxiliary DO) using the tense and agreement productivity score. Children also completed norm-referenced cognitive and linguistic assessments. Results Children with DLD generally used tense and agreement markers less productively than children with TD, particularly third-person singular and auxiliary BE. However, boys with FXS demonstrated a more complicated pattern of productivity, where they were similar to children with DLD and TD, depending on the tense marker examined. Results revealed that children with DLD and TD showed a specific developmental sequence of the individual tense markers that aligns with patterns documented by previous studies, whereas boys with FXS demonstrated a more even profile of productivity. Conclusions These findings help to further clarify areas of overlap and discrepancy in tense and agreement productivity among boys with FXS and children with DLD. Additional clinical implications of these results are discussed.

Tracking Early Sentence-Building Progress in Graphic Symbol Communication.

Purpose As is the case with children who rely on spoken language, speech-language pathologists must support and track the expressive language development of children with complex communication needs who use graphic symbols to communicate. This research note presents a framework of the progression of expressive English sentence development using graphic symbols and introduces possible approaches for measuring and analyzing graphic symbol use. Method Current issues in measuring graphic symbol utterances are explored, and a range of measures designed to analyze individual graphic symbol utterances as well as larger samples of utterances are presented. Results Both the Graphic Symbol Utterance and Sentence Development Framework and suggested measures are based on years of graphic symbol intervention research, including two large ongoing research studies of preschoolers with severe speech impairments. Our framework adapts the work of Hadley (2014) to depict expressive language progression from early symbol combinations to childlike and adultlike sentences and highlights developmental patterns unique to graphic symbol productions. Adaptations of existing measures (such as mean length of utterance) as well as measures unique to graphic symbol analyses are presented and discussed. Conclusion To accurately track changes in early graphic symbol utterance growth and complexity, a multidimensional approach, which includes analyses such as symbol relevance, word class diversity, and lexical diversity, is recommended.

The Effects of Frequency and Predictability on Repetition in Children With Developmental Language Disorder.

Purpose Studies have shown that children with typical development (TD) respond to frequency and predictability when repeating nonidiomatic multiword sequences (e.g., go wash your hands). We extended these findings by explicitly examining the interaction between frequency and predictability in a repetition task for children with developmental language disorder (DLD) and children with TD. Method We created 48 four-word phrases, manipulating two factors: the frequency of occurrence of the entire four-word phrase (e.g., look in the mirror vs. look in the basket) and the predictability of the fourth word in the phrase given the preceding three words (e.g., corn on the ___ vs. look in the ___). These phrases were presented in a repetition task to 17 children with DLD (M age = 58.89 months), 19 same-age children with TD (M age = 59.79 months), and 17 younger children with TD matched to the DLD group on nonword repetition and mean length of utterance (M age = 38.94 months). Children's repetitions were judged for the presence or absence of word and morphological errors. Only the first three words of the sequence were scored (e.g., look in the). Results We found a main effect of sequence frequency, with high-frequency sequences being repeated more accurately than low-frequency sequences, modulated by a significant interaction with predictability, where the effect of sequence frequency was larger for sequences with high-predictability contexts than for sequences with low-predictability contexts. We also found a significant effect of group, with children with DLD demonstrating poorer overall performance, particularly when compared to the same-age group with TD. Conclusions Frequency and predictability are strong predictors of language production in children with TD. These factors also have effects for children with DLD, raising important clinical questions about the design of facilitative contexts for the teaching of difficult linguistic forms.

Language therapy outcomes in deaf children with cochlear implant using a new developed program: A pilot study

BackgroundCochlear implanted (CI) children have problems in most aspects of language and in particular with regards to grammar. Considering the lack of studies in the field of grammar treatment in CI children and bearing in the mind that CI children have the potential to develop language, the aim of the present study was to investigate the effect of treating grammar in CI children using a treatment grammar program. Methodologyfirst, the literature related to grammar were reviewed so as to extract different grammatical components for developing grammar treatment program and to make sentences for each element as well as to compile a manual for its implementation. Second, the validity of the sentences was examined using the Delphi method. Third, grammar treatment was performed on five CI children. Persian Developmental Sentence Scoring(PDSS) and Mean Length of Utterance(MLU) were used to evaluate them before and after treatment. ResultsFive grammatical classes were extracted, and the grammatical elements were classified in each category according to age. For all of the grammatical items, 2076 sentences were constructed. After applying the Delphi method, a total of 1936 sentences with Kendall's coefficient of concordance (W) of 71%, remained. Using this program, grammar treatment was effective in all five children. The PDSS and MLU increased in all five children during the treatment phase, which was confirmed by Percentage of Non-overlapping Data (PND), Improvement Rate Difference (IRD). During the follow-up period, the children showed that they were able to maintain the trained components. ConclusionCochlear implants have the potential to learn language skills, and the present study confirms their ability to learn grammar, using a comprehensive grammar treatment program.

The Narrative Competence Task

Abstract. The oral narratives of 240 Italian children aged 3–8 years were analyzed using a new instrument, the Narrative Competence Task (NCT). The data showed a gradual increase in the children’s narrative competence in both the macrostructure and the microstructure. Statistically significant differences between preschool-age and school-age children were found on all the variables considered. In addition to increased chronological age, a significant role of cognitive abilities (general non-verbal intelligence and sequential reasoning) and linguistic skills (mean length of utterance and lexical diversity) emerged in explaining the variance in children’s narrative macrostructure. Children with superior cognitive and linguistic abilities produced richer narratives characterized by a greater quantity of information, a better structure, and a wider use of mental state lexicon.

An Introductory Examination of Speech Disfluencies in Spanish–English Bilingual Children Who Do and Do Not Stutter During Narratives

Purpose The purpose of this study is to examine the frequency and type of speech disfluencies (stuttering-like and nonstuttering-like) in bilingual Spanish–English (SE) children who stutter (CWS) to SE children who do not stutter (CWNS) during narrative samples elicited in Spanish and English to provide further diagnostic information for this population and preliminary data toward an expansion of this study. Method Participants included six bilingual SE children (three CWS, three CWNS) ranging in age from 5 years to 7;5 (years;months) and recruited from the surrounding Houston, Texas area. Participants provided a narrative sample in English and Spanish. The frequency of speech disfluencies was tabulated, and mean length of utterance was measured for each sample. Results Results indicate that both talker groups exceed the diagnostic criteria typically used for developmental stuttering. Regardless of the language being spoken, CWS participants had a frequency of stuttering-like speech disfluencies that met or exceeded the diagnostic criteria for developmental stuttering that is based on monolingual English speakers. The CWNS participants varied in meeting the criteria depending on the language being spoken, with one of the three CWNS exceeding the criteria in both languages and one exceeding the criteria for percentage of stuttering-like speech disfluencies in one language. Conclusion Findings from this study contribute to the development of more appropriate diagnostic criteria for bilingual SE-speaking children to aid in the reduction of misdiagnoses of stuttering in this population.

Classifying Disfluencies in Preschool- and School-Age Spanish–English Bilinguals Who Do Not Stutter: An Exploratory Study

Purpose This exploratory study examined the language skills and the type and frequency of disfluencies in the spoken narrative production of Spanish–English bilingual children who do not stutter. Method A cross-sectional sample of 29 bilingual students (16 boys and 13 girls) enrolled in grades prekindergarten through Grade 4 produced a total of 58 narrative retell language samples in English and Spanish. Key outcome measures in each language included the percentage of normal (%ND) and stuttering-like (%SLD) disfluencies, percentage of words in mazes (%MzWds), number of total words, number of different words, and mean length of utterance in words. Results Cross-linguistic, pairwise comparisons revealed significant differences with medium effect sizes for %ND and %MzWds (both lower for English) as well as for number of different words (lower for Spanish). On average, the total percentage of mazed words was higher than 10% in both languages, a pattern driven primarily by %ND; %SLDs were below 1% in both languages. Multiple linear regression models for %ND and %SLD in each language indicated that %MzWds was the primary predictor across languages beyond other language measures and demographic variables. Conclusions The findings extend the evidence base with regard to the frequency and type of disfluencies that can be expected in bilingual children who do not stutter in grades prekindergarten to Grade 4. The data indicate that %MzWds and %ND can similarly index the normal disfluencies of bilingual children during narrative production. The potential clinical implications of the findings from this study are discussed.

Production of noun suffixes by Turkish-speaking children with developmental language disorder and their typically developing peers.

Turkish has a rich system of noun suffixes, and although its complex suffixation system may seem daunting, it can actually present a learning opportunity for children. Despite its unique features, Turkish has not been studied extensively, especially in the case of children with language deficits, such as developmental language disorder (DLD). Most of the extant studies are focused on bilingual children, and the results are somewhat mixed. To focus on the noun morphology system of Turkish-speaking preschoolers with DLD and compare their use with that of two groups of typically developing (TD) children. Moreover, to investigate the nature of their noun suffix errors in detail. We report data from a total of 80 monolingual children, 40 children with DLD (age range = 4;0-7;10), 20 TD age-matched children (4;0-7;3) and 20 younger mean length of utterance (MLU)-matched children (2;0-4;3). The data for this study came from language samples obtained from children in individual clinical assessment sessions. The children with DLD made less use of noun suffixes than both the younger and the age-matched TD children. The use of the unmarked (nominative case) form in place of an overt suffix was the most likely error by all groups. Suffix-change alternations required beyond vowel harmony seemed to pose real problems for these children. These results suggest that even when a language appears to provide significant advantages for the learning of noun morphology, children with DLD do not succeed in closing the gap. Certain factors such as morphophonological changes beyond vowel harmony, multiple allomorphs for the same suffix type and accusative suffixes that are not uniformly applied in the adult input were found to be significant predictors of the DLD group's difficulty with noun suffixes. Because these same factors can serve as characteristics of other languages, a child's difficulties might seem to be language specific (e.g., a particular allomorph in the language), but may actually be based on a broader difficulty (e.g., dealing with multiple allomorphs for the same suffix). Accordingly, factors that transcend a single language should be considered during clinical assessment and therapy. What this paper adds? What is already known on this subject? The current literature on the use of noun suffixes by Turkish-speaking children with DLD is very limited. Although Turkish is often described as a learner-friendly language, the degree to which children with DLD enjoy these learning benefits is unknown. What does this paper add to existing knowledge? Turkish children with DLD are less accurate in noun suffixes than both age-matched and younger control groups. For this group, the central problem seems to be increased complexity in morphophonology rather than difficulty with suffixation more generally. What are some of the clinical applications of this study? For clinicians who work with Turkish-speaking children with DLD, priority should be given to morphophonology. These children would benefit from treatment that focuses on how to attach different allomorphs to different open-class words. Because factors such as morphophonological complexity operate in other languages, the findings have broader clinical implications. In particular, regardless of the target language, clinicians should consider the possibility that these broader factors, rather than language-specific details, are the basis for a child's difficulty.

The Role of Behavioral Inhibition for Conversational Speech and Language Characteristics of Preschool-Age Children Who Stutter.

Purpose The purpose of this study was to investigate whether preschool-age children who stutter (CWS) were more likely to exhibit a temperamental trait of behavioral inhibition (BI), a correlate of shyness, than children who do not stutter (CWNS) and whether this temperamental trait affected preschool-age children's speech fluency and language complexity during a conversation with an unfamiliar adult. Method Sixty-eight preschool-age children (31 CWS, 37 CWNS) participated. The degree of BI was assessed by measuring the latency to their sixth spontaneous comment and the number of all spontaneous comments during a conversation with an unfamiliar examiner (following Kagan et al.'s [1987] methodology). Parent report of shyness from the Children's Behavior Questionnaire served as an indirect measure of BI. Children's language complexity was assessed by measuring their mean length of utterance and the number of words spoken. For CWS, the frequency of stuttering and the negative impact of stuttering were also assessed. Results First, we found no between-group differences in the degree of BI across the behavioral observation measures. However, CWS were rated shyer by parents than CWNS. Second, for CWS only, higher BI was associated with less complex utterances and fewer words spoken. Third, for CWS, higher BI was associated with fewer stuttered disfluencies produced. Conclusions This study provides empirical evidence that BI to the unfamiliar may have salience for childhood stuttering as it affected the quantity and quality of language spoken with an unfamiliar adult. Clinical implications of high BI for the assessment and treatment of preschool-age stuttering are discussed.

Reciprocal Influences Between Parent Input and Child Language Skills in Dyads Involving High- and Low-Risk Infants for Autism Spectrum Disorder.

We examined the language input of parents of infants at high and low familial risk for autism spectrum disorder (ASD) and investigated reciprocal associations between parent input and child language skills in the first 2 years of life. Parent-infant dyads (high-risk: n = 53; low-risk: n = 33), 19 of whom included an infant later diagnosed with ASD, were videotaped during free play interactions at 12, 18, and 24 months. Measures of parent input were derived from parent-child interactions. Children's language skills were assessed using the Mullen Scales of Early Learning at 12, 18, and 24 months. Results suggested that (a) parents of high- and low-risk infants produced similar word tokens, word types, and proportions of contingent verbal responses, but parents of high-risk infants used shorter mean length of utterances (MLU) than parents of low-risk infants at 18 and 24 months; (b) parents' MLU at 18 months was positively associated with their infants' language at the subsequent visit after 6 months, regardless of group; and (c) infants' language at 18 months was positively associated with parents' MLU at the subsequent visit after 6 months in the high-risk group only. These findings contribute to our understanding of the mechanisms underlying early language learning of high-risk infants who have an increased risk for language delays and deficits. Autism Res 2020, 13: 1168-1183. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Parents provide an important source of language input to their children. In this study, we looked at parent input to infants at high- and low-risk for autism spectrum disorder and relations between parent input and child language in the first 2 years of life. We found that parents of high- and low-risk infants provided similar quantity and quality of input, except shorter average length of utterances at 18 and 24 months in the high-risk group. Also, there were bidirectional relations between parent input and child language at 18 and 24 months in high-risk pairs, suggesting that parents and children collectively shape the early language environment.

Investigating Gray and White Matter Structural Substrates of Sex Differences in the Narrative Abilities of Healthy Adults.

Linguistic aspects of narration have been investigated in healthy populations, in a wide variety of languages and speech genres with very different results. There is some evidence indicating that linguistic elements, such as speech rate (i.e., the measure indicating the amount of speech produced in a certain time period), mean length of utterance (MLU) (i.e., the index reflecting sentence grammatical structure), frequency of nouns and verbs, might be affected by non-linguistic factors such as sex. On the other hand, despite the existence of neuroimaging evidence of structural differences between males and females, it is yet unknown how such differences could explain between-sex disparities in linguistic abilities in natural speech contexts. To date, no study has evaluated discourse production elements in relation to sex differences and their neural correlates in terms of brain structure, a topic that could provide unique insights on the relationship between language and the brain. The aim of the present study was to determine sex differences in narrative skills in healthy adults and to investigate white and gray matter structural correlates of linguistic skills in each group. Twenty-seven male and 30 female (N = 57) right-handed, neurologically intact, monolingual Greek speakers, matched for age and years of education, participated. Narrations of a personal medical event were elicited. Linguistic elements of speech rate (words per minute), MLUs, frequency of nouns and verbs were calculated for each speech sample, by two independent raters. Structural 3D T1 images were segmented and parcellated using FreeSurfer and whole-brain between-sex differences in cortical thickness, cortical volume and surface area, were obtained. Between-group differences in white matter diffusion tensor scalars were examined via Tract-Based Spatial-Statistics and whole-brain tractography and automated tract delineation using Automated Fiber Quantification. Speech rate and noun frequency were significantly lower for men, while verb frequency was significantly higher for women, but no differences were identified for MLU. Regarding cortical measures, males demonstrated increased volume, surface area and cortical thickness in several bilateral regions, while no voxel-wise or tractography-based between-group differences in white matter metrics were observed. Regarding the relationship between sex and speech variables, hierarchical regression analyses showed that the superior/middle frontal cluster in surface area may serve as a significant predictor of speech rate variance, but only in females. We discuss several possible interpretations of how sex-related speech abilities could be represented differently in men and women in gray matter structures within the broad language network.

Linguistic Maze Production by Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Purpose Previous investigations reveal that children with attention-deficit/hyperactivity disorder (ADHD) produce elevated rates of linguistic mazes (i.e., filled pauses, repetitions, revisions, and/or abandoned utterances) in expressive language samples (Redmond, 2004). The current study aimed to better understand maze use of children and adolescents with ADHD with a focus on the specific maze types produced in different language sampling contexts based on the Autism Diagnostic Observation Schedule (ADOS-2; Lord et al., 2012). Method Participants included twenty-five 4- to 13-year-olds with a confirmed diagnosis of ADHD. Each participant completed the ADOS to provide narrative and conversational language samples. Research assistants transcribed at least 100 utterances from the ADOS using Systematic Analysis of Language Transcripts (Miller & Chapman, 2000) conventions. Dependent variables included the rates of repetitions, revisions, filled pauses, content mazes (Thordardottir & Ellis Weismer, 2002), and stalls (Rispoli, 2003; Rispoli, Hadley, & Holt, 2008) produced in narrative and conversational portions of the ADOS. Results In the full sample, participants produced a significantly greater rate of revisions than filled pauses (p = .01) and repetitions (p < .01). Participants also produced a significantly lower rate of filled pauses than content mazes (p < .01). Across contexts, participants produced a higher rate of filled pauses in conversational versus narrative contexts. Age was positively correlated with revisions and content mazes. Mean length of utterance was positively correlated with revisions, repetitions, and context mazes. Expressive language ability was positively correlated with filled pauses and stalls. Conclusion The children and adolescents in our sample demonstrated a unique profile of maze use. Sampling context had a limited influence on maze use, whereas maze use was impacted by age, mean length of utterance, and expressive language ability. Study findings highlight the importance of analyzing maze types separately rather than as a single category.

Social responsiveness and language use associated with an enhanced PRT approach for young children with ASD: Results from a pilot RCT of the PRISM model

BackgroundVulnerabilities in social motivation among children with ASD constrain attention and responsiveness to parents and other social partners. When this limited social responsiveness remains uncorrected, it is hypothesized to restrict the quality and quantity of social learning opportunities and ultimately yield negative long-term effects on development. Early intervention efforts that target social motivation may hold promise for correcting this detrimental chain of events. MethodThe current pilot RCT examined changes in participant social responsiveness and language use in a trial of 21 young children with ASD who were randomly assigned to treatment or waitlist control groups. Treatment participants received a mean of 6.81 h/week of an enhanced Pivotal Response Intervention for Social Motivation (PRISM) treatment model for six months. Data on social responsiveness to parent bids and expressive language (number of total words, number of different words, mean length of utterance in words) were obtained from behaviorally coding and analyzing video-recorded parent-child play sessions. ResultsResults indicated that young children who participated in the PRISM treatment model demonstrated significant pre-post improvements in social responsiveness and mean length of utterances. Participants in the waitlist condition experienced negligible improvements. Participants who are minimally verbal appear to experience greater gains as a result of the PRISM model. Additionally, initial levels of social responsiveness with parents appear to be predictive of subsequent language use at post-intervention among minimally verbal participants. ConclusionThis study provides preliminary evidence for the importance of using early intervention paradigms that explicitly target social motivation and responsiveness in young children with ASD. Results also suggest that initial social responsiveness to parents may serve as an important predictor of treatment response.

Expressive language abilities of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder: Cross-context comparisons.

Understanding the unique expressive language profiles of children with phenotypically similar, but distinct neurodevelopmental disorders, such as idiopathic autism spectrum disorder and fragile X syndrome with a co-diagnosis of autism spectrum disorder (fragile X syndrome + autism spectrum disorder), has both clinical and theoretical implications. However, comparative studies of these two clinical groups have been limited, and results have been inconsistent, partially as a result of different assessment methods being utilized. Thus, the current study compared the expressive language profiles of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder and examined whether a similar linguistic profile emerged across different language sampling contexts: a semi-structured conversation and the Autism Diagnostic Observation Schedule. Eighteen boys with autism spectrum disorder (Mage = 13.25 years) and 19 boys with fragile X syndrome + autism spectrum disorder (Mage = 12.19 years), matched on autism spectrum disorder symptom severity and similar in terms of chronological age and mean length of utterance, participated in this study. Boys produced two language samples: one semi-structured conversation and one taken from the Autism Diagnostic Observation Schedule. Language samples were coded for talkativeness, lexical diversity, mean length of utterance, intelligibility, and repetitive or perseverative language. Analyses revealed that boys with autism spectrum disorder produced language samples that were more lexically diverse and intelligible, and that included less topic perseveration compared to boys with fragile X syndrome + autism spectrum disorder. With regards to sampling context, boys in both groups were more talkative and produced longer and more intelligible utterances in their conversation sample compared to their Autism Diagnostic Observation Schedule sample. However, boys with autism spectrum disorder and fragile X syndrome + autism spectrum disorder used a higher proportion of topic perseveration during the conversation sample. Overall, we found similarities as well as distinctions in the expressive language profiles of boys with fragile X syndrome + autism spectrum disorder and boys with idiopathic autism spectrum disorder. Moreover, the Autism Diagnostic Observation Schedule sample elicited a relatively different language profile than the conversation sample for boys in both groups. These findings help to further elucidate the unique language phenotypes of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder. Moreover, our findings indicate that multiple language samples may be needed to obtain a comprehensive account of a child's expressive language ability.

Rates and Predictors of Co-occurring Autism Spectrum Disorder in Boys with Fragile X Syndrome.

Background and aims Males with fragile X syndrome display many behavioral features of autism spectrum disorder. Despite this overlap, our understanding of autism spectrum disorder symptoms and severity in fragile X syndrome is limited due to variation in assessment methods in the literature. Furthermore, the relationship between autism spectrum disorder symptoms and child characteristics, like age, language, and cognitive abilities, are not well understood in individuals with fragile X syndrome. Therefore, the first research aim was to compare the rates of autism spectrum disorder classifications from three commonly reported autism spectrum disorder assessments in the literature. Our second research aim was to examine the relationship between autism spectrum disorder characteristics and other child characteristics. Methods The present study compared autism spectrum disorder classifications and symptoms using the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, second edition in a sample of 33 school-age and adolescent boys with fragile X syndrome. In addition, the participants completed nonverbal IQ testing, expressive vocabulary and grammar tests, and a conversation language sample. Results The majority of the participants met criteria for autism spectrum disorder on the Autism Diagnostic Observation Schedule (96.97%) and Autism Diagnostic Interview, Revised (90.91%), while only half met criteria for autism spectrum disorder on the Childhood Autism Rating Scale, second edition. Sixteen boys (48.48%) met criteria for autism spectrum disorder on all three measures, and all participants met criteria for autism spectrum disorder on at least one measure. Expressive vocabulary accounted for a unique amount of variance in Childhood Autism Rating Scale, second edition and Autism Diagnostic Observation Schedule scores. Additionally, grammatical complexity accounted for a unique amount of variance in Childhood Autism Rating Scale, second edition scores. None of the child variables accounted for the variance found in Autism Diagnostic Interview, Revised scores. Although nonverbal IQ scores did not account for a significant amount of variance on the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, Second Edition, boys who met criteria for autism spectrum disorder on all three measures had lower nonverbal IQ compared to the boys who did not. Additionally, mean length of utterance and expressive vocabulary scores were lower in the boys who met criteria for autism spectrum disorder on all three measures than those who did not. Conclusions Our findings identify areas of overlap and difference in the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, second edition when used with males with fragile X syndrome. Variation in assessments may differentially identify the phenotypic behaviors of boys with fragile X syndrome that lead to a co-diagnosis of autism spectrum disorder, which contributes to the variation in reported co-morbidity of fragile X syndrome and autism spectrum disorder. Also, expressive language abilities, especially expressive vocabulary, are associated with autism spectrum disorder symptomatology. Implications: When interpreting comorbid fragile X syndrome and autism spectrum disorder rates in the literature, it is important to consider the assessment tool that was used. Although the assessments that we used in the present study yielded scores that were highly correlated (i.e. Autism Diagnostic Observation Schedule and Childhood Autism Rating Scale, second edition), their categorical classifications did not align perfectly. Our findings also highlight the importance of considering language skills when assessing autism spectrum disorder severity in fragile X syndrome.

Effects of Lamotrigine on Problem-Solving Abilities in Newly Diagnosed Pediatric Patients with Epilepsy.

Background and PurposeThis study aimed to determine the effects of lamotrigine (LTG) on language unction, including problem-solving abilities, in newly diagnosed pediatric epileptic patients.MethodsThis study included 112 newly diagnosed epileptic patients treated with LTG [69 males and 43 females aged 9.6±2.7 years (mean±SD)]. Repeated neurologic examinations, electroencephalography, neuroimaging studies, and standard language tests including the Test of Problem Solving (TOPS), mean length of utterance in words (MLU-w), Receptive and Expressive Vocabulary Test (REVT), and Urimal Test of Articulation and Phonology were performed before and after initiating LTG treatment. The starting LTG dosage was 1 mg/kg/day (maximum: 25 mg/day) for the first 14 days, which was increased to 2 mg/kg/day for the subsequent 14 days and then up to 7 mg/kg/day (or 200 mg/day) for maintenance.ResultsProblem-solving skills as assessed by TOPS scores significantly improved after initiating LTG treatment (33.5±14.5 vs. 35.7±14.25, p<0.01). Scores in the “determining causes” category (11.9±4.7 vs. 12.9±4.8, p<0.01), “making inferences” category (12.9±6.2 vs. 13.6±6.0, p<0.05), and “predicting” category (8.9±5.4 vs. 9.7±5.6, p<0.01) significantly improved after LTG treatment. The MLU-w score did not decrease after LTG treatment (4.7±1.9 vs. 5.0±2.1). There was a significant improvement in receptive language function as assessed using the REVT score (9.4±3.4 years vs. 9.9±3.3 years, p<0.01). Precise articulation also improved after initiating LTG treatment (97.8% vs. 98.5%).ConclusionsLanguage function including problem-solving skills improved after LTG treatment, suggesting that LTG can be administered without causing significant negative effects on language function in pediatric patients.

Impact of Auditory Verbal Therapy in Children with Cochlear Implant

Introduction&#x0D; Auditory Verbal Therapy (AVT) is considered as most successful therapeutic approach for cochlear implant children. The impact of auditory verbal therapy has been studied vividly in Indian context. The number of cochlear implantees receiving AVT has been increased nationwide but there is no structured protocol that is used to assess the efficacy of AVT on children with cochlear implant. Hence, it is important to develop a structured protocol consisting of established tools to study the effectiveness of AVT.&#x0D; Materials and Methods &#x0D; The study was conducted on 62 (male-38, female-24) bilaterally profound sensorineural hearing impaired children with cochlear implant done under ADIP (Assistance to Disabled Persons for Purchase/ Fitting of Aids and Appliances) scheme. Pre-therapy assessments were done before 2 weeks of cochlear implantation using Functional Auditory Performance Indicator (FAPI), Assessment of language development, Speech intelligibility rating scales, Brown’s (1973) stages of mean length of utterance (MLU) assessment, and Overall rating of parental satisfaction on a visual analog scale of 0 to 10. Auditory verbal therapy (AVT) was given for 6-8 months, twice per week under video-monitoring of the sessions. Post therapeutic scores were obtained by assessing with the same tools through observation and interaction with the children and interviewing the caregivers.&#x0D; Results&#x0D; Independent Sample’s T-test in SPSS -16 software were used and significant differences between pre and post therapy scores were obtained (p&lt;0.005).&#x0D; Conclusion&#x0D; These tools can be used further as a protocol for assessment of baseline skills before AVT, then develop an individualized management program and finally to assess the improvement after AVT.