Risk For Language Problems Research Articles

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca

BackgroundFew studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning.MethodsThe Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children’s version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects.ResultsThe overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample.ConclusionsThe prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

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There is circumstantial but insufficient high-level evidence that immunising schoolchildren against influenza protects their contacts, that is confers herd immunity. A Canadian study tested this hypothesis using a cluster randomised study design. Schoolchildren aged 3–15 years in Hutterite colonies (Anabaptist rural communities) were randomised to receive the standard inactivated trivalent influenza vaccine (intervention) or hepatitis A vaccine (control). Each colony consists of 60–120 people in a tight-knit community with its own school. Overall, inactivated influenza vaccine was 59% effective in protecting all study participants, both those immunised and those not, against laboratory-confirmed influenza (PCR positive). It also reduced the incidence of proven influenza in non-recipients of influenza vaccine from 7.6% in control colonies to 3.1% in intervention colonies, giving a protective efficacy of 61% (95% confidence interval (CI) 8–83%) for contacts. This important study provides the best proof to date that immunising schoolchildren against influenza confers significant herd immunity which protects their community contacts. Reviewer: David Isaacs, davidi@chw.edu.au There is some evidence that alterations in the right hemisphere of the brain are associated with both attention-deficit/hyperactivity disorder (ADHD) and dyslexia. The authors believe that non-right-handedness may be a risk factor for neurobehavioural difficulties and mixed-handedness may be more important than left-handedness. A Northern Finland birth cohort study collected questionnaire data on handedness of over 8000 children at 8 years of age. Parents were asked if their child was right-handed, left-handed or mixed-handed. The proportions were 90.9%, 8% and 1.1%, respectively. A follow-up questionnaire at age 15–16 years enquired about ADHD symptoms using the Strengths and Weakness of ADHD symptoms and Normal behaviour scale and was completed by almost 80% of adolescents. At 8 years old, 16.6% of children had problems with speech and language, and mixed-handedness but not left-handedness was associated with about twice the risk of language problems and a trend towards more behaviour problems. At 16 years of age, 4.4% of right-handed children had inattention and/or hyperactivity–impulsivity, while in comparison 14% of mixed-handed children had inattention (odds ratio 2.96, 95% CI 1.38, 6.35), although they were not more hyperactive. This study suggests that it might be possible to target the 1% of children with mixed-handedness for early intervention. Link: http://pediatrics.aappublications.org/cgi/content/full/125/2/e340 Reviewer: David Isaacs, davidi@chw.edu.au A meta-analysis of 11 randomised controlled trials of probiotics in over 2000 preterm (<34 weeks), very low birthweight (<1500g) neonates showed a 65% reduction in necrotising enterocolitis (NEC) (relative risk (RR) 0.35, 95% CI 0.23, 0.55) and a 58% reduction in all-cause mortality (RR 0.42, 95% CI 0.29, 0.62). Thus, only 20 babies need to be treated with probiotics to prevent one death. This effect was not merely reducing deaths from NEC, and since probiotics had no effect on blood-culture positive sepsis, the mechanism for the reduction in mortality remains speculative. The meta-analysis stimulated conflicting editorial comments. One by Soll argued caution, pointing out that the trials studied many different probiotic preparations and feeding regimes in relatively mature babies. The other by Tarnow-Mordi et al. argued that it was reasonable to combine studies if you were looking for a class effect of probiotics and urged a change in practice to routine use of probiotics, although access to quality-controlled, licensed products is problematic. Tarnow-Mordi et al. also discussed the ethics of continuing enrolment of babies in trials and the need for fully informed consent. A flurry of letters followed, mostly cautious about overinterpreting the meta-analysis and urging further studies. Link: http://pediatrics.aappublications.org/cgi/content/full/125/5/921 Reviewer: David Isaacs, davidi@chw.edu.au Fig. 1 In 1998, a New England Journal of Medicine paper reported that authors with financial ties to drug manufacturers were more likely than those without ties to publish recommending use of calcium channel antagonists. Worryingly, only 2 of the 70 authors with financial ties declared them. There is current controversy over whether or not the diabetes drug rosiglitazone increases the risk of myocardial infarction. Researchers from the Mayo Clinic performed a systematic review of authors' affiliations with industry (declared in the published papers and found elsewhere, e.g. online) and their written position on the controversy. Only 53% of published papers included a conflict of interest statement. Unsurprisingly, the 90 authors with financial conflicts of interest were three to seven times more likely to recommend use of rosiglitazone. Disclosure had improved since 1998, but still 21 (23%) of the 90 articles did not disclose financial links and 3 of the 21 articles published statements that there was no conflict of interest. Link: http://www.bmj.com/cgi/content/full/340/mar18-1/c1344 Reviewer: David Isaacs, davidi@chw.edu.au

Communicative and linguistic development in preterm children: a longitudinal study from 12 to 24 months

Research conducted on preterm children's linguistic skills has provided varying pictures, and the question of whether and to what extent preterm children are delayed in early language acquisition remains largely unresolved. To examine communicative and linguistic development during the second year in a group of Italian children born prematurely using the 'Primo Vocabolario del Bambino' (PVB), the Italian version of the MacArthur-Bates Communicative Development Inventory. The primary goal was to compare action/gesture production, word comprehension, and word production, and the relationship between these three domains in preterm children and to normative data obtained from a large sample of Italian children born at term. A second aim was to address the longstanding debate regarding the use of chronological versus corrected gestational age in the assessment of preterm children's abilities. Parents of twelve preterm children completed the PVB questionnaire at five age points during the children's second year, and scores were compared with those from a normative sample of full-term children and those of 59 full-term children selected as a control group from the normative sample for the PVB. Preterm children exhibited a delay in all three aspects of communication and language. In particular, communicative-linguistic age tended to lag approximately 3 months behind chronological age when children were between the ages of 12 and 24 months. When chronological age was used, preterm children's percentile scores for all three components of communication and language fell within the lower limits of the normal range, while scores calculated using corrected age either fell at or above the 50th percentile. Findings suggest that despite the significant biological risk engendered by premature birth, early communicative and linguistic development appears to proceed in a relatively robust fashion among preterm children, with tight relations across communicative domains as in full-term children. Employing both chronological and corrected gestational age criteria in the evaluation of preterm children's abilities may provide important information about their progress in language acquisition. This may be especially important during the initial stages of communicative and linguistic development, inasmuch as comparisons of the two sets of scores may provide clinicians with a way to distinguish children who may be at risk for language problems from those who may be expected to progress normally.

Early communicative intents expressed by 12-month- old children with and without chronic otitis media

The current study compares the early communication of 12- month-old children with and without chronic otitis media during interactions with their parents. Results indicated that children with chronic otitis media used significantly fewer nonverbal strategies to help parents interpret their otherwise unintelligible vocaliz ations than their healthy peers did. The two groups were similar in early lexical development and some aspects of pragmatic development; however, there was much individual variation within groups in frequency and diversity of communicative intents. These findings suggest that children with chronic otitis media may be at risk for subsequent language problems, and that low frequency of nonverbal gestures may serve as an early marker of later language difficulties within this population. In addition to providing information about the earliest stages of communicative development in this group of children at mild to moderate risk of language problems, this finding confirms the results of other studies suggesting that nonverbal and verbal communicative attempts form a single system in the young child.

Promoting Toddlers' Language Development Through Community-Based Intervention

This study evaluated an adaptation of a developmentally based, 6-week parent–child reading program (“dialogic reading”) demonstrated to facilitate vocabulary and syntactic skills of toddlers, including those at risk for language problems. In this study, dialogic reading was modified for broad dissemination through four branches of a city library system. Children's librarians taught parents the reading techniques in two 1-hour sessions. The study design was an efficacy trial with two thirds of families randomly assigned to the dialogic reading condition n = 88 and one third to a comparison condition. The comparison condition was comprised of existing library services for parents and children n = 41 . Analysis of baseline to post-test change showed a significant intervention-group effect on parent–child reading style and children's expressive language. In addition, at a 3-month follow-up assessment, parents in the dialogic reading group reported less parenting stress, specifically stress resulting from characteristics of their child.

Follow-up of children at risk for language problems

Nineteen students (ages 10–14) who were previously identified as at risk for language problems were examined after a period of five to seven years. Information concerning cognitive, academic, and linguistic skills was collected using standardized and informal measures. Results were analyzed for the total group and also for two subgroups. At the time of follow-up, seven subjects (37%) who had not been served by a speech-language pathologist (SLP) were unidentified with language impairments (LI); two subjects (11%) were being seen by a SLP; one subject (5%) was identified as mentally handicapped, and nine subjects (47%) did not exhibit language problems. Subgroup comparisons between the seven unidentified language impaired subjects (LI) and the nine without language impairments (contrast = CG) revealed lower language scores, especially for receptive and composite language as measured by the CELF-R and TLC-E. Teachers rated these two groups (LI and CG) differently in the areas of following/giving directions, initiating/maintaining conversation, and taking turns. Parents also reported greater concerns for the LI group in the areas of listening, communication, and social skills. Issues concerning identification of at-risk groups and future studies using at-risk populations are discussed.

Patterns of language comprehension deficit in abused and neglected children.

The similarity between factors associated with child abuse/neglect and those associated with language disability suggests that maltreated children are a population at risk for language problems. This study investigated the performance of three groups of abused/neglected children and a matched group of nonmaltreated subjects on three tests of language comprehension. Results revealed significant differences among groups for all measures. Severely neglected children obtained the lowest scores on all tests; the abused children consistently obtained lower scores than the controls; and generally neglected children showed the smallest difference in performance from the control group. These findings suggest a model for understanding relationships between abuse/neglect and language disability.