Persistent Difficulties Research Articles

Long-term neurocognitive follow-up in children with traumatic brain injury: A literature review and monocentric cohort study

Children with mild traumatic brain injury (mTBI) may experience long-term cognitive sequelae. However, previous study results have been controversial. It remains unclear whether clinical follow-up is useful, how long patients should be followed-up, and which psychological dimensions should be investigated. Herein, we described neurocognitive evolution in a small sample of Italian children who were hospitalized for mTBI and systematically reviewed the existing evidence in this setting. In total, 15 children aged 4 – 16 (median, 9) years who were evaluated for mTBI at our institution between March 2017 and September 2018 were retrospectively enrolled. All patients underwent computed tomography or magnetic resonance imaging for clinical reasons; moreover, they underwent neurocognitive evaluation within few days from the event (T0), after 3 – 6 months (T1), and after 18 – 24 months (T2). Neuropsychological assessment included the Child Behavior Checklist, Developmental Neuropsychology Assessment II Edition, and Wechsler Intelligence Scale for Children. An electronic search was conducted to identify studies published in the past 12 years. Neurocognitive assessments revealed low scores in memory, sensorimotor, and social perception tasks at T1 and T2. Univariate analysis of neuroradiological and clinical findings revealed no risk factors for cognitive deficits. Overall, 17 studies involving 1336 children were reviewed and analyzed. Following mTBI, psychiatric disorders were frequently newly diagnosed and were associated with significant deficits in adaptive functioning and other pre-injury psychosocial risk factors. Our study findings demonstrate that children with mTBI exhibit subtle persistent cognitive difficulties that may affect academic and social functioning. Thus, follow-up using extensive neuropsychological evaluation is essential.

Substantial morbidity and mortality due to cardiovascular diseases in hospitalized vaccinated and un-vaccinated patients with COVID-19 from 16 countries: the WHF COVID-19 Long-term study

Abstract Background Long-term adverse consequences of the COVID-19 affect many organ systems, and this requires the identification and appropriate care of diverse symptoms. Purpose The World Heart Federation (WHF) international study describes the burden of clinical sequelae of COVID-19 up to 1 year after hospitalization, including patients from low- middle-and high-income countries. Methods We prospectively recruited patients hospitalized due to COVID-19 from 16 countries between January 2022 and June 2023. Patients were followed up at 1, 3, 6, and 9-12 months after hospital discharge. A standardized questionnaire administered by telephone collected data on long COVID symptoms, quality of life using the EuroQol 5 Dimension scale (EQ-5D), and disease outcomes including new onset diabetes and hypertension, major adverse cardiovascular events (MACE), and mortality. We report a descriptive analysis including demographic characteristics and outcomes up to one year after initial hospitalization. Results Of 2504 patients, the majority were Asian (78%), and male (56%). Mean age was 59.2 years (SD 19.9). Low- and lower-middle-income country participants constituted 65% of the cohort, with upper middle-income and high-income representing 20% and 15%, respectively. Follow-up rate was complete for 86%. 55% had received at least two doses of COVID-19 vaccination. At 1 month, 63% reported at least one persistent symptom, which decreased to 28% at 9-12 months. Fatigue was reported by 45% at 1-month and 17% at final follow-up. Anxiety occurred in 20% and 9% at these respective timepoints, and breathlessness in 12% and 6%. At 9-12 months, moderate to severe impairment of usual activities as measured by EQ-5D occurred in 19%, anxiety/depression in 10%, and mobility problems in 10%. The most frequent post-discharge new-onset illnesses were pulmonary embolism (7%), kidney problems (4%), and hypertension (3%). In-hospital mortality was 4% (n=102), and a further 12% (265 patients) died by one-year. The most common cause was sudden cardiac death (59%), respiratory disease including pulmonary embolism (13%), and stroke (6%). Conclusions We observed a significant burden of post-COVID-19 complications with one fifth of patients with persistent difficulties in usual activities at one year. This underscores the urgent need to understand the underlying mechanisms for organ damage and death, and for targeted preventive strategies and proactive management approaches to reduce them.

Enhancing Employee Retention: The Impact of Training, Career Development and Remuneration Benefits in Selected Manufacturing Companies of Johor Bahru

The lack of employee retention programs is the most persistent difficulty in most organizations today. Employees are a crucial and precious asset for an organization for them to achieve their company goals and objectives. This has raised the demand for staff training programs, career development, and remuneration benefits in most organizations to ensure employee retention. The study aimed to identify the influence of employee training, career development, and remuneration benefits on employee retention in selected manufacturing companies in Johor Bahru, Malaysia. For data collection, a structured questionnaire was administered to 152 employees from seven departments of manufacturing companies in Johor Bahru. All the data was analyzed using SPSS statistics. The finding implies that career development appeared to be the most significant variable among all independent variables. Therefore, organizations should put more focus on the improvement of career development among their employees. Top management should emphasize career development and regularly offer training programs to gain employees’ interest in staying in the organizations. Top management should also highlight the importance and benefits of the career development programs and encourage them to join. This in turn enhances retention and increases productivity at selected manufacturing companies in Johor Bahru, Johor.

Translational Research in Oral Lichen Planus: From Laboratory Discoveries to Clinical Applications.

Oral lichen planus (OLP) is a chronic inflammatory condition that affects the oral mucous membrane, causing discomfort and pain for millions of people worldwide. Challenges in managing OLP include its chronic nature, varied clinical manifestations, poor patient compliance, and potential for malignant transformation. Recent breakthroughs in the therapy of OLP have opened up new paths for dental practitioners, yet persistent difficulties require attention. Topical calcineurin inhibitors, photodynamic treatment, and biologics have all demonstrated success in relieving symptoms and delaying disease progression. Furthermore, advances in understanding OLP's immunopathogenesis have revealed new targets for targeted treatments, raising hopes for more tailored therapy methods. However, obstacles remain, particularly in the area of long-term treatment and the danger of malignant transformation, needing close monitoring and interdisciplinary teamwork. This review will attempt to explore all of the therapeutic strategies for treating OLP that have been addressed in the literature.

Self-management support program delivered in the sub-acute phase after traumatic injury—study protocol for a pragmatic randomized controlled trial

BackgroundTraumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury.MethodsThis study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure.DiscussionThis RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers.Trial registrationThe study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

Predictive Measures in Child Language Development: The Role of Familial History and Early Expressive Vocabulary.

Prediction of developmental language disorder in children under 3 years of age is challenging. Among early risk factors, research has focused on having a positive familial history (FH+) for language or literacy problems and on late language emergence, that is, late-talker (LT) status. The interaction between these two risk factors and their cumulative effect is still debated. Here, we (a) investigate the effect of FH+ on 24-month language development, (b) test for cumulative effects of FH+ status and early language delay on 36-month language outcomes, and (c) disentangle the direct and indirect effects of familial history (FH) on the language outcome. One hundred eighty-five Italian children were followed up longitudinally between 24 and 36 months of age (64 FH+ and 121 FH-) through parental questionnaires and direct child assessment. At the age of 24 months, the FH+ group showed worse expressive vocabulary and higher prevalence of LT. At the age of 36 months, main effects of LT and FH were identified on lexical and phonological performances, respectively. Interestingly, significant interaction effects were identified on expressive vocabulary and phonological processing. Path analysis highlights that FH had a direct effect on later measures of phonology, whereas its effect on 36-month lexical abilities was indirect, via measures of expressive vocabulary at 24 months. The study suggests specific predictive roles of FH and LT status on language development. Interestingly, FH+ seems to represent an additive risk for LT children. The use of cumulative risk measures is confirmed as a powerful approach to identify those children with the highest probability of developing persistent language difficulties. https://doi.org/10.23641/asha.26790580.

Magnetic mesoporous silica nanoparticles loaded with peptides for the targeted repair of cavernous nerve injury underlying erectile dysfunction

Erectile dysfunction (ED) is a common male sexual disorder characterized by repeated or persistent difficulty in achieving or maintaining an erection. It can arise from various factors, with cavernous nerve injury (CNI) from radical prostatectomy being a predominant cause of iatrogenic ED, posing significant clinical concerns. The complexity of cavernous tissue damage in CNI-induced ED (CNIED) often results in poor efficacy and resistance to conventional vascular ED treatments. To address CNI-induced ED, this study developed a system of magnetic mesoporous silica nanoparticles (MSNs) loaded with peptides for targeted treatment. Core-shell Fe3O4-coated MSNs were used as drug carriers and loaded with RADA16-I/RAD-RGI peptides (PD) to create a neurotrophic microenvironment to treat peripheral nerve defects. Furthermore, the neuro-targeting peptide HLNILSTLWKYR (PT) was grafted onto MSNs. The in vivo therapeutic effect was evaluated using a rat bilateral cavernous nerve injury (BCNI) model. The results showed that the neuro-targeted Fe3O4@SiO2-PT-PD nanoparticles significantly promoted regeneration of the cavernous nerve and restored erectile function. This promising strategy offers significant clinical potential for treating CNI-induced ED. Nanomedicine technology has the potential to not only improve treatment outcomes but also reduce side effects in healthy cells, paving the way for more accurate targeted repair of cavernous nerve damage.

Error Analysis of Grammatical Features in Saudi Undergraduate EFL Writing

Mastery of English grammatical accuracy is paramount for developing proficiency as a foreign language. However, research examining tendencies among Saudi undergraduate writers remains limited. This study aimed to address such gaps through a comprehensive identification and categorization of errors present in student essays. A rigorous mixed-methods approach analyzed over 350 grammatical mistakes across 50 female students' writing samples. Errors were systematically coded and categorized to reveal frequency data through quantitative analysis. Findings demonstrated spelling, subject-verb agreement, and capitalization as the most prevalent issue areas, collectively accounting for over 75% of errors. Examples uncovered specific challenges involving verb tense, sentence fragments, and article usage. While outcomes aligned with previous literature, linguistic influences on persistent spelling difficulties were explored to broaden understandings. Recommendations for targeted exercises strengthening weaker domains like phonics rules and irregular verbs were provided. Continuing periodic error analyses can optimally inform evolving pedagogy tailored to emerging needs over time. Significantly, this novel diagnostic approach begins addressing critical literature gaps through data-driven insights that meaningfully inform curriculum development to better support the still under-researched Saudi EFL student population.

Impact on the nervous system of long COVID-19 infection in children.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound global impact, raising concerns about its long-term effects, particularly neurological complications. While studies have highlighted such complications in adults, there is a paucity of research focusing on children. To examine the medium- to long-term neurological and cognitive symptoms in 18 year old children and below with positive versus negative COVID-19 antigens and to identify the probable risk factors to promote specific health actions. An observational study was carried out to determine neurological symptoms in the medium and long terms after COVID 19. A random sample of 124 children, both symptomatic or asymptomatic, tested positive or negative for COVID-19 through swab tests. Neurological symptoms were assessed between 6 to 12 months and 2 years after the infection. Acute symptoms, including headache, anosmia, ageusia, and myalgia, were observed in more than 20% of the children, but they generally resolved within 6 to 12 months. Persistent functional difficulties, such as in studying, paying attention, and socializing, were reported in 3% of the cases. Behavioral symptoms at baseline were noted in 7.8% of children, but they were remitted in most cases, except for those with prior involvement. These findings underscore the need for continued monitoring of children following COVID-19 infection and the importance of tailored health interventions.

"Characterization Of Acinetobacter Baumannii Resistance And Prevalence In Icu Settings: Insights From A Retrospective Study."

Purpose: This study aimed to determine the prevalence and antibiotic resistance patterns of Acinetobacter baumannii isolated from ICU patients at a tertiary care hospital. Understanding these patterns is crucial for informing infection control strategies and treatment protocols. Material and methods: A retrospective cross-sectional study was conducted at the Department of Microbiology, Government Medical College & New Civil Hospital, Surat. Clinical samples from ICUs were analyzed from January 2023 to December 2023. A total of 4,432 samples were processed for culture and sensitivity testing. Identification of A. baumannii was performed using Gram staining, motility tests, and biochemical tests. Antimicrobial susceptibility was assessed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar, with results interpreted according to CLSI guidelines. Results: Out of 4,432 samples, 650 showed significant bacterial growth. Acinetobacter baumannii was identified in 144 samples, accounting for 22% of all ICU culture-positive cases. The highest number of isolates was from the Medical ICU (MICU), representing 44% of total isolates. Over 95% of A. baumannii isolates were multidrugresistant (MDR). Resistance rates were highest for Ceftriaxone and Imipenem (92%), followed by Cefepime (90.2%). Colistin susceptibility was observed in all pan-drug-resistant isolates. Discussion: The high prevalence of A. baumannii in ICU-acquired infections and the observed multidrug resistance highlight a significant challenge in managing these infections. The resistance patterns are consistent with recent studies, confirming the persistent difficulty in treating A. baumannii infections with conventional antibiotics. The effectiveness of Colistin for pan-drug-resistant isolates underscores its continued relevance, despite concerns about potential side effects. Conclusion: The study reveals a high prevalence of multidrug-resistant A. baumannii in ICU settings, emphasizing the urgent need for effective infection control measures and antimicrobial stewardship. Continuous monitoring and stringent infection prevention practices are essential to combat the growing threat of A. baumannii in ICU environments

Brief historical account of autism in Peru.

We present a historical account of autism in Peru. Currently, the term "autism spectrum conditions", from the neurodiversity paradigm, is used to describe neurodevelopmental disorders characterized by persistent difficulties in communication, social interaction, and restricted and repetitive behaviors and interests. In Peru, the scientific study of nervous and mental diseases began around 1920 and although the diagnosis of "childhood autism" was proposed in 1959, it only began to spread in the 1980s. Although significant advances were made in the 21st century, Peru still faces many challenges in addressing autism.

Возможности консервативной тактики ведения пациентов с гипертрофией и воспалением глоточной миндалины

Patients who suffer from pharyngeal tonsil hypertrophy or inflammation are very common visitors in outpatient physicians’ practice. Hypertrophy of the pharyngeal tonsil may be accompanied by persistent difficulty in nasal breathing and complications whilst adenoditis in the absence of a significant impact on the child’s quality of life and associated complications had not been regarded as a ‘pathology’ in pediatric physicians’ practice until the patient is reached the age of 7 to 9 years old. The purpose of this research was to compare the regimens of the use of the homeopathic medications in patients with pharyngeal tonsil hypertrophy or inflammation. Materials and methods used: a single-center controlled randomized observation of the use of homeopathic medications of a single active substance had been conducted in pediatric patients aged 1 to 18 y/o with pharyngeal tonsil hypertrophy or inflammation. The study included patients with pharyngeal tonsil hypertrophy or inflammation who had previously taken homeopathic single-substance medications, including in combination with standard treatment. Depending on the choice of patients (repetition of the homeopathic single-substance medications intake or prophylactic regimen) the patients were then divided into comparison groups. All of the patients had undergone both the routine examination and the ENT endoscopy, the parents’/caregivers’ satisfaction with the treatment results was then assessed using the 5-point Likert scale as well as the incidence of acute respiratory infections (ARI) in children while taking homeopathic medicines (compared to the period without taking them) and the willingness to use homeopathic medicines in the future. Results: after the ENT endoscopy (reduction in the size of the pharyngeal tonsil in 38% of cases, p≤0.001) and the parents’/caregivers’ survey (reduction in the ARI frequency in 62% of cases and high satisfaction with the treatment results), the majority of parents/caregivers have assessed the repetition of the repetition of the homeopathic single-substance medications intake as rather more effective in treatment of patients with inflammation of the pharyngeal tonsil of varying degrees of hypertrophy. Conclusion: the use of homeopathic medicines in patients with pharyngeal tonsil hypertrophy or inflammation has showed good effectiveness. According to the ENT endoscopy results before v. after the treatment and the parents’/caregivers’ survey it is preferable to repeat the homeopathic single-substance medications intake in the next adenoiditis episode. The parents’/caregivers’ readiness to go on with the homeopathic medicines’ intake ranges from 50% to 78%.

Performance on curriculum-based mathematics assessments in developmental dyscalculia: the effect of content domain and question format

Developmental Dyscalculia (DD) is characterised by persistent difficulties in learning mathematical skills, which usually becomes apparent in the early years of schooling. Traditionally, DD is known to affect children’s arithmetic processing, whilst other domains of mathematics receive much less research attention. Nevertheless, contemporary diagnostic guidelines suggest that DD is linked to widespread and diverse difficulties, both within and outside of the domain of numbers. This study examined the performance (i.e., accuracy and number of questions attempted) of children on a curriculum-based mathematics assessment, considering the effect of content domains, question format (i.e., multiple-choice questions vs. constructed response questions) and test half. Participants were forty children aged 8 to 11 years old with DD (n = 20) and a carefully matched control group of typically developing children (n = 20) from primary schools in Northern Ireland. Results revealed that the DD group achieved significantly lower scores than the control group across all areas of the curriculum, and the magnitude of group differences was similar across all content domains. These findings indicate that performance in content domains other than in arithmetic may be equally informative in supporting the identification of children with DD. In addition, we found that using multiple-choice questions may support learners with DD in achieving the best outcome, and, thus, could be useful for assessing mathematics skills in dyscalculic children in classroom contexts. Nevertheless, constructed response questions may show the greatest sensitivity to identifying learners at risk, and could be the most useful in diagnostic settings.

Exploring adults’ recollections of growing up with childhood motor difficulties: a qualitative study using systematic text condensation

ObjectiveTo explore the ramifications of childhood motor difficulties, providing insights into their impact and consequences over time.DesignA qualitative study using semistructured individual interviews. Data were analysed using systematic text condensation.SettingNeonatal...

Guessing errors made by children with dyslexia in word and text reading.

Children with dyslexia face persistent difficulties in reading acquisition, which results in poor reading accuracy. In addition to the commonly studied reading errors such as omissions, additions, substitutions, and letter reversals, they also make guessing errors characterized by replacing a word with an orthographic neighbor. These errors, which occur in the context of isolated words and sentence or text reading, might be linked to the inhibition issues that have already been demonstrated in connection to dyslexia. However, to the best of our knowledge, there is no experimental evidence that children with dyslexia make more guessing errors than typically developing children, as is the case for sequential errors. The current study aimed to evaluate whether children with dyslexia made more guessing errors than typically developing children and whether these errors were more frequent in an isolated word or sentence context. Twenty-eight children with dyslexia from Grade 4 were matched with typically developing children by either chronological age or reading level. Reading was assessed through word and text reading tasks. Error types were classified into seven categories and analyzed. A repeated-measure ANOVA showed that children with dyslexia made more guessing errors, particularly visual and morphemic errors, than typically developing children. Moreover, these errors were found at both the single word and sentence levels. These findings suggest that children with dyslexia tend to use a global treatment of words, relying on incomplete information to compensate for their difficulties. The findings have practical implications for pedagogical and therapeutic approaches.

Link between Wi-Fi, cordless devices, mobile phone usage patterns, and behavioral problems among Japanese children: A prospective cohort study

BackgroundWith the recent advent of technology, it is important to confirm the health and safety of the youth. This study aimed to prospectively evaluate the relationship between Wi-Fi, cordless phones, and mobile phone usage patterns and behavioral problems. MethodsThis study involved 2465 children aged 8–17 years from the Hokkaido Study on Environment and Children’s Health from October 2020 to January 2021, with a follow-up from September 2021 to March 2022. The mother–child dyad provided information on the presence of residential Wi-Fi and cordless phones, cordless phone call duration, and mobile phone usage pattern (duration of calls using mobile network and internet, online audio streaming, online video streaming, and playing online games) via a baseline questionnaire. Based on the scores on Strength and Difficulties Questionnaire at baseline and follow-up, the children were categorized into four groups: normal, persistent, improved, and concurrent. ResultsNo significant association was found between Wi-Fi, mobile phone calls via mobile networks, and behavioral problems. Cordless phone at home had higher odds for improvement in total difficulty scores, and cordless phone for calling more than 4 min per week had lower odds of persistent problematic prosocial behavior. Longer duration of mobile phone calling via the internet (>40 min/week) had higher odds of concurrent total difficulties. Mobile phone calling via mobile network for <5 min per week had higher odds for improved total difficulty scores. Audio streaming via mobile phones for 60–120 min had lower odds of persistent total difficulties. ConclusionOur results showed sporadic findings between residential RF-EMF indoor sources and mobile phone usage pattern. These observed findings could be affected by residual confounding and chance findings. Ongoing follow-up studies are necessary to further explore this association through detailed exposure assessment and addressing the potential limitations of our study.

Supporting the mental health needs of children with language and literacy difficulties

Supporting the mental health needs of children with language and literacy difficulties Professor Mark Boyes, Curtin enAble Institute, spotlights mental health in the context of language and literacy difficulties, including the urgent need for accessible mental health interventions. Both oral (spoken) and written (reading, writing) language are crucial for success in educational and social contexts. Up to 15% of children experience significant and persistent difficulties with oral and written language, representing approximately four children in a typical Australian classroom. These children are at substantially elevated risk of mental health problems, are overrepresented in our justice systems, and are more likely to develop suicidal thoughts and behaviours than children who do not experience language difficulties.

Kebijakan Sekolah Dalam Mengatasi Kesulitan Belajar Pada Siswa Di SDI Bimoku Kota Kupang

This research aims to understand the school's policies in addressing learning difficulties of students at SDI Bimoku. This qualitative research uses a case study approach, with subjects being students experiencing learning difficulties and the object of study being the school's policies in addressing these difficulties. The principal and class teachers, who handle the students directly, are the primary sources of data obtained through interviews and observations at SDI Bimoku in Kupang City. Secondary data sources are gathered from books, the internet, and other documents. Data analysis in this study follows the Miles &amp; Huberman method, which includes data reduction, data presentation, and conclusion drawing. The validity of the data is tested using the triangulation technique. The results show that learning difficulties at SDI Bimoku include both academic and non-academic challenges. The causes of these difficulties are internal and external factors. The school's policies to address student learning difficulties include initial tests, teacher observation during the learning process, remedial programs, and curriculum adjustments. These policies, implemented through various school programs, largely meet the school's expected outcomes, though some students require special and longer-term attention due to persistent learning difficulties. However, based on the obtained information, the school's programs have improved the grades of several students who previously had learning difficulties. Overall, it can be concluded that the school's policies through these programs are considered successful.

Identifying early language predictors: A replication of Gasparini etal. (2023) confirming applicability in a general population cohort.

Identifying language disorders earlier can help children receive the support needed to improve developmental outcomes and quality of life. Despite the prevalence and impacts of persistent language disorder, there are surprisingly no robust predictor tools available. This makes it difficult for researchers to recruit young children into early intervention trials, which in turn impedes advances in providing effective early interventions to children who need it. To validate externally a predictor set of six variables previously identified to be predictive of language at 11 years of age, using data from the Longitudinal Study of Australian Children (LSAC) birth cohort. Also, to examine whether additional LSAC variables arose as predictive of language outcome. A total of 5107 children were recruited to LSAC with developmental measures collected from 0 to 3 years. At 11-12 years, children completed the Clinical Evaluation of Language Fundamentals, 4th Edition, Recalling Sentences subtest. We used SuperLearner to estimate the accuracy of six previously identified parent-reported variables from ages 2-3 years in predicting low language (sentence recall score ≥ 1.5 SD below the mean) at 11-12 years. Random forests were used to identify any additional variables predictive of language outcome. Complete data were available for 523 participants (52.20% girls), 27 (5.16%) of whom had a low language score. The six predictors yielded fair accuracy: 78% sensitivity (95% confidence interval (CI) = [58, 91]) and 71% specificity (95% CI = [67, 75]). These predictors relate to sentence complexity, vocabulary and behaviour. The random forests analysis identified similar predictors. We identified an ultra-short set of variables that predicts 11-12-year language outcome with 'fair' accuracy. In one of few replication studies of this scale in the field, these methods have now been conducted across two population-based cohorts, with consistent results. An imminent practical implication of these findings is using these predictors to aid recruitment into early language intervention studies. Future research can continue to refine the accuracy of early predictors to work towards earlier identification in a clinical context. What is already known on the subject There are no robust predictor sets of child language disorder despite its prevalence and far-reaching impacts. A previous study identified six variables collected at age 2-3 years that predicted 11-12-year language with 75% sensitivity and 81% specificity, which warranted replication in a separate cohort. What this study adds to the existing knowledge We used machine learning methods to identify a set of six questions asked at age 2-3 years with ≥ 71% sensitivity and specificity for predicting low language outcome at 11-12 years, now showing consistent results across two large-scale population-based cohort studies. What are the potential or clinical implications of this work? This predictor set is more accurate than existing feasible methods and can be translated into a low-resource and time-efficient recruitment tool for early language intervention studies, leading to improved clinical service provision for young children likely to have persisting language difficulties.

A retrospective analysis of factors affecting speech production in school-aged children with cleft palate (+- cleft lip)

ObjectiveThe present investigation examined how factors such as cleft type, age of primary palatal surgery, diagnosed syndromes, hearing problems, and malocclusions could predict persistent speech difficulties and the need for speech services in school-aged children with cleft palate. MethodsParticipants included 100 school-aged children with cleft palate. Americleft speech protocol was used to assess the perceptual aspects of speech production. The logistic regression was performed to evaluate the impact of independent variables (IV) on the dependent variables (DV): intelligibility, posterior oral CSCs, audible nasal emission, hypernasality, anterior oral CSCs, and speech therapy required. ResultsSixty-five percent of the children were enrolled in (or had received) speech therapy. The logistic regression model shows a good fit to the data for the need for speech therapy (Hosmer and Lemeshow's χ2(8)=9.647,p=.291). No IVs were found to have a significant impact on the need for speech therapy. A diagnosed syndrome was associated with poorer intelligibility (Pulkstenis-Robinson's χ2(11)=7.120,p=.789). Children with diagnosed syndromes have about six times the odds of a higher hypernasality rating (Odds Ratio = 5.703) than others. The cleft type was significantly associated with audible nasal emission (Fisher’sexactp=.006). At the same time, malocclusion had a significant association with anterior oral CSCs (Fisher’sexactp=.005). ConclusionsAccording to the latest data in the Cleft Registry and Audit Network Annual Report for the UK, the majority of children with cleft palate attain typical speech by age five. However, it is crucial to delve into the factors that may influence the continuation of speech disorders beyond this age. This understanding is vital for formulating intervention strategies aimed at mitigating the long-term effects of speech disorders as individuals grow older.