Standardized Language Tests Research Articles

Exploring Narrative Ability in Greek-Speaking Children with High-Functioning ASD: Associations with Memory and Attention

Background/Objectives: Narration is a sensitive tool for the assessment of language in children with high-functioning autism spectrum disorder (HF-ASD) since mild language deficits beyond the sentential level are not always noticeable through the administration of standardized language tests targeting the lexical or sentential level. This study investigated the narrative ability of monolingual Greek-speaking HF-ASD children in comparison to that of their typically developing (TD) peers and explored the associations between narrative variables, ADHD symptomatology, and memory skills in the participants on the autistic spectrum. Methods: The participants were 39 children aged 7 to 12 years, 19 with HF-ASD and 20 age-matched, vocabulary-matched, and cognitively matched TD peers. Results: The two groups were similar in most microstructural and macrostructural variables but differed significantly in syntactic complexity (p = 0.024; d = 0.754) and subordination (p < 0.001; d = −1.576) indices, implying that the HF-ASD group presented syntactic delay in comparison to their TD peers. The HF-ASD participants showed significantly higher heterogeneity in the amount of information generated for the story’s main character (p = 0.004; d = −0.093) in comparison to their TD peers. Significant associations were observed between verbal and visual memory, complex syntactic structures, and Theory of Mind-related internal state terms. ADHD symptomatology was negatively correlated with the generation of simple and coordinated clauses. Finally, complex syntax and delayed vSTM were correlated with retelling total scores, indicating that language ability and verbal memory compensate for narrative competence in HF-ASD children. Conclusions: The findings highlight the impact that language skills, memory ability, and ADHD symptomatology have on narrative competence in children with HF-ASD, as well as the importance of narrative use for assessing the language skills in populations with mild language impairment.

Language Profiles of School-Age Children With 16p11.2 Copy Number Variants in a Clinically Ascertained Cohort.

Individuals with proximal 16p11.2 copy number variants (CNVs), either deletions (16p11.2DS) or duplications (16p11.2Dup), are predisposed to neurodevelopmental difficulties and disorders, such as language disorders, intellectual disability, and autism spectrum disorder. The purpose of the current study was to characterize language profiles of school-age children with proximal 16p11.2 CNVs, in relation to the normative sample and unaffected siblings of children with 16p11.2DS. Standardized language tests were conducted in 33 school-age children with BP4-BP5 16p11.2 CNVs and eight unaffected siblings of children with 16p11.2DS to evaluate language production and comprehension skills across various language domains. A standardized intelligence test was also administered, and parents completed a standardized questionnaire to assess autistic traits. Language profiles were compared across 16p11.2 CNVs and intrafamilial pairs. The influence of nonverbal intelligence and autistic traits on language outcomes was investigated. No significant differences were found between children with 16p11.2DS and those with 16p11.2Dup, although both groups exhibited significantly poorer language skills compared to the normative sample and unaffected siblings of children with 16p11.2DS. Severe language deficits were identified in 70% of individuals with 16p11.2 CNVs across all language subdomains, with significantly better receptive vocabulary skills than overall receptive language abilities. In children with 16p11.2DS, expressive language deficits were more pronounced than receptive deficits. In contrast, only in children with 16p11.2Dup did nonverbal intelligence influence their language outcomes. The current study contributes to the deeper understanding of language profiles in 16p11.2 CNVs in a clinically ascertained cohort, indicating generalized deficits across multiple language domains, rather than a syndrome-specific pattern targeting specific subdomains. The findings underscore the importance of early diagnosis, targeted therapy, and monitoring of language skills in children with 16p11.2 CNVs. https://doi.org/10.23641/asha.27228702.

Spontaneous speech: a robust measurement before, during and after awake brain surgery in patients with glioma

Background Patients with glioma often report language complaints with devastating effect on daily life. Analysing spontaneous speech can help to understand underlying language problems. Spontaneous speech monitoring is also of importance during awake brain surgery: it can guide tumour resection and contributes to maintaining language function. We aimed to investigate the spontaneous speech of patients with glioma in the perioperative period and the additional value of spontaneous speech analyses compared to standardised language testing. Methods We elicited and transcribed spontaneous speech of eight patients with glioma elected for awake brain surgery preoperatively, intraoperatively and 2.0–3.5 months postoperatively. Linguistic errors were coded. Type Token Ratio, Mean Length of Utterance of words, minimal utterances, and errors were extracted from the transcriptions. Patients were categorised based on total error patterns: stable, decrease or increase during surgery. Reliable Change Index scores were calculated for all spontaneous speech variables to objectify changes between time points. Language performance on language tests was compared to spontaneous speech variables. Results Most errors occurred in lexico-syntax, followed by phonology/articulation, syntax, and semantics. The predominant errors were Repetitions, Self-corrections, and Incomplete sentences. Most patients remained stable over time in almost all spontaneous speech variables, except in Incomplete sentences, which deteriorated in most patients postoperatively compared to intraoperatively. Some spontaneous speech variables (total errors, MLUw, TTR) gave more information on language change than a standard language test. Conclusions While the course of spontaneous speech over time remained relatively stable in most patients, Incomplete sentences seems to be a robust marker of language difficulties patients with glioma. These errors can be prioritised in spontaneous speech analysis to save time, especially to determine intra- to postoperative deterioration. Importantly, spontaneous speech analyses can give more information on language change than standardised language testing and should therefore be used in addition to standardised language tests.

MED13L-related disorder characterized by severe motor speech impairment.

MED13L-related disorder is associated with intellectual disability, motor delay, and speech deficits. Previous studies have focused on broad clinical descriptions of individuals, but limited information regarding specific speech diagnoses and results of direct testing has been published to date. We conducted deep phenotyping to characterize the speech, language, motor, cognitive, and adaptive phenotypes of individuals with MED13L-related disorder. In this cross-sectional study, we administered standardized articulation, language, motor, and cognitive testing to 17 children and adolescents (mean age 9y 9m; SD 4y 5m; range 4y 2m to 19y 7m). In-person testing was supplemented with broad developmental, medical, and behavioral information collected virtually from a cohort of 67 individuals. All individuals who completed in-person articulation testing met diagnostic criteria for speech apraxia, dysarthria, or both. Language impairment was present in all of the in-person cohort and almost all (97%) of the virtual cohort. Those who were able to complete motor testing demonstrated significant deficits in visual motor integration (mean 57.08, SD 9.26). Full scale IQs fell in the borderline to intellectual disability range, consistent with reported cognitive impairment in 97% of the virtual cohort. Notable medical features included hypotonia (83%), vision problems (72%), recurrent otitis media (58%), gastrointestinal problems (57%), and seizures (31%). MED13L-related disorder is characterized by a high rate of motor speech disorders that occur in the context of globally impaired motor, language, and cognitive skills. Children would benefit from intensive, individualized speech therapy and the early adoption of augmentative communication strategies.

A novel approach to assessing the joint effects of mercury and fish consumption on neurodevelopment in the New Bedford Cohort.

Understanding health risks from methylmercury (MeHg) exposure is complicated by its link to fish consumption, which may confound or modify toxicities. One solution is to include fish intake and a biomarker of MeHg exposure in the same analytical model, but resulting estimates do not reflect the independent impact of accumulated MeHg or fish exposure. In fish-eating populations, this can be addressed by separating MeHg exposure into fish intake and average mercury content of the consumed fish. We assessed the joint association of prenatal MeHg exposure (maternal hair mercury level) and fish intake (among fish-eating mothers) with neurodevelopment in 361 children aged 8 years from the New Bedford Cohort (New Bedford, Massachusetts; born in 1993-1998). Neurodevelopmental assessments used standardized tests of IQ, language, memory, and attention. Covariate-adjusted regression assessed the association of maternal fish consumption, stratified by tertile of estimated average fish mercury level, with neurodevelopment. Associations between maternal fish intake and child outcomes were generally beneficial for those in the lowest average fish mercury tertile but detrimental in the highest average fish mercury tertile, where, for example, each serving of fish was associated with 1.3 fewer correct responses (95% CI, -2.2 to -0.4) on the Boston Naming Test. Standard analyses showed no outcome associations with hair mercury level or fish intake. This article is part of a Special Collection on Environmental Epidemiology.

Comparative analysis of microstructures of narrative abilities in language-age-matched Tamil-speaking children with cochlear implants and typical hearing

In a unique exploration of narrative development among Tamil-speaking children, this study delves into the intricacies of linguistic expression, explicitly comparing the microstructure of narratives in two distinct groups: those with hearing differences (HD) and those with normal hearing. A total of 30 children were included in the study, with 15 children in each group, matched for language age between 3-5 years on standard language tests. The children were asked to retell a story they had listened to, and the obtained samples were transcribed verbatim and analyzed for various microstructural elements, including the mean length of utterances, total number of words, number of utterances, and number of different word types. The results revealed that children with hearing loss used fewer words and simpler sentences during retelling despite having the same language age as their peers. This highlights the importance of incorporating narrative assessment in standard language evaluations. Furthermore, the findings emphasise integrating narrative intervention into language intervention programs to enhance language productivity. Overall, this study provides valuable insights into the narrative abilities of Tamil-speaking children with cochlear implants and underscores the significance of addressing narrative skills in language intervention approaches.

Montessori primary schools’ effectiveness: a quasi-experimental study on schooling outcomes

ABSTRACT Montessori is a highly individualized pedagogy that prioritizes following each child’s individual interests over standardized test scores. This quasi-experimental study compares groups of Montessori students (treatment groups, N = 535–710) with control groups of non-Montessori students, matched through the simple matching method, which controls for the effect of background variables on schooling outcomes. The tested hypothesis is that the treatment groups achieve mean scores that are not significantly lower and have a significantly higher standard deviation on standardized tests of mathematics and language. The study encompassed students in Grade 2, 5, 8, and 10 across two separate cohorts. Results indicate that Montessori students attain either comparable or significantly higher scores than non-Montessori students, depending on grade and cohort, with greater score variability observed, particularly at Grade 8 and in mathematics. This finding implies the necessity for future investigations into the effect of Montessori teachers’ instructional practices.

Narrative Discourse in Youth Offenders: Examining Individual Differences.

This study examined narrative discourse in youth offenders, focusing on quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. The participants were 15 incarcerated adolescents, ages 13-18 years (Mage = 16 years). Each was evaluated at their detention center via Zoom, using a standardized language test and language samples that elicited narrative speaking with fables. After retelling a fable, the participant answered questions that examined story comprehension and critical thinking. Most participants performed below average on the standardized language test and had difficulty on one or more of the language sampling measures. Areas of concern included quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. Had language sampling not been employed, those weaknesses might have been overlooked. When evaluating youth offenders, it is important to elicit language samples that can provide detailed information about an adolescent's ability to communicate for genuine purposes. In this regard, the tasks employed in the current study could be helpful to speech-language pathologists in working with youth offenders, enabling them to pinpoint deficits and offer targeted intervention.

Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping

ObjectivesBuild the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data.DesignMixed methodology study including two...

Mental state verb use in play by preschool-age children who stutter and their mothers

IntroductionPreschool-age children use mental state verbs (MSVs; e.g., think, know) to reference thoughts and other cognitive states. In play-based language, MSV use requires conversational flexibility, as speakers shift from discussion of actions happening in the here-and-now to more abstract discussion of mental states. Some evidence suggests that children who stutter (CWS) demonstrate subtle differences in shifting on experimental tasks of cognitive flexibility, differences which may extend to conversational flexibility. This study explored MSV use in conversational language between CWS and their mothers. MethodsThirty-five preschool-age CWS and 35 age- and gender-matched children who do not stutter (CWNS), all performing within the typical range on standardized language testing, conversed with their mothers during play. Samples were transcribed and coded for MSV use. ResultsNo between-group differences were observed in MSV use, either between the CWS and CWNS or between the groups of mothers. Age and language skills were positively associated with MSV use in the CWNS group only. For both groups of dyads, mothers’ MSV use corresponded at least to some extent to their children’s language skills. Finally, correspondence between CWNS and their mothers was observed for two conversational language measures, representing lexical diversity and morphosyntax; this overall pattern was not observed in the CWS dyad group. ConclusionsAlthough these findings point to similar use of MSVs among the groups of children and their mothers, for the CWS group, the patterns of use in relation to age and language skills are somewhat different from developmental expectations.

Predictors of self-reported word-finding difficulties in glioma patients – a longitudinal study

ABSTRACT Background Word-finding difficulties are a common self-reported concern in glioma patients known to negatively affect social participation and life satisfaction. Discrepancies between self-reported difficulties and performance on objective tests have been reported, but studies are seldom conducted longitudinally. Aims The aim of the present study was to examine the occurrence of self-reported word-finding difficulties before and during the first year after glioma surgery. In addition, we investigated whether self-reported word-finding difficulties were predicted by standardized language tests and psychological distress. Methods and procedures Twenty-three patients with gliomas (grade 1–3) were assessed pre-surgery, at six and twelve months follow-up. Self-reported word-finding difficulties were addressed with the item I am able to find the right word(s) to say what I mean, from the Functional Assessment of Cancer Therapy – Brain (FACT-Br). Confrontation naming was tested with the Boston Naming Test (BNT), word production with a semantic fluency test and word knowledge with a vocabulary test. Self-reported measures of psychological distress were assessed with the Hospital Anxiety and Depression Scale (HADS). Ordinal regression models were used to examine predictors of self-reported word-finding difficulties. Outcomes and results Word-finding difficulties were reported by 68% of the patients pre-surgery, increasing to 90% and 85% at the following assessments. Significant changes were observed in the magnitude of reported concerns between pre-surgery assessment and six months follow-up. Regression analyses demonstated that self-reported word-finding difficulties were predicted by psychological distress and vocabulary pre-surgery and vocabulary at six months follow-up, whereas confrontation naming and semantic fluency did not become significant in any of the assessments. Conclusion Our results indicate that self-reported word-finding difficulties occurred in a high percentage of glioma patients throughout the first year of illness. Patients reported increased difficulties after surgery that were not predicted by confrontation naming or semantic fluency but by vocabulary performance. The results imply further that psychological distress is a factor that should be taken into account. Self-reported function is an important supplement to objective testing and can provide indications about mental health status and the patients` perspective on language related challenges in everyday life.

Translation, cultural adaptation, and validation of an Arabic version of the test of narrative language—second edition

BackgroundThe significance of narrative skills is evident due to their role in the development of language and their connection to significant social and academic skills. This study aimed to translate, adapt, and validate the Test of Narrative Language-Second Edition (TNL-2) for its use as a tool for the assessment of narrative language in Arabic-speaking Egyptian children. In a cross-sectional study design, the Arabic-translated version of the TNL-2 was administered to 200 typically developing Arabic-speaking Egyptian children ranging in age from 4 years to 15 years and 11 months for validation. The participants were categorized according to their age into ten groups and their scores were analyzed. Face validity was assessed by asking five expert phoniatricians to review the Arabic version of the TNL-2 and complete a questionnaire that assessed the test’s effectiveness in measuring different narrative skills.ResultsA statistically significant difference was found when comparing the TNL-2 scores among the age groups under study. In addition, there was a significant correlation between standardized Arabic language test scores and the total comprehension and total production subtests’ raw scores of the TNL-2. The test-retest reliability and inter-rater agreement demonstrated a high level of reliability and inter-rater agreement. Experts have reached a consensus that the Arabic version of the TNL-2 is capable of evaluating the primary microstructural and macrostructural components of Arabic narratives. Furthermore, it can provide insights into the overall narrative skills of Egyptian Arabic-speaking children.ConclusionThe Arabic-translated version of the TNL-2 demonstrated validity and reliability as an instrument for assessing narrative language comprehension and production skills in Arabic-speaking Egyptian children.

Effects of word length and frequency on word identification in second- and fifth-grade children as a function of language skills

The purpose of the current study was to examine the combined effect of word length and lexical frequency in a lexical decision task in second- and fifth-grade children with varying language skills. The participants, 47 second graders and 55 fifth graders, performed a lexical decision task in which word length and lexical frequency were manipulated orthogonally so that 32 words were short and frequent (e.g., fleur [flower]), 32 words were short and rare (e.g., navet [turnip]), 32 words were long and frequent (e.g., escalier [staircase]), and 32 words were long and rare (e.g., boussole [compass]). Language skills (phonological awareness, reading, vocabulary, and rapid automatized naming skills) were measured using standard language tests. The results showed that word length and, to a lesser extent, lexical frequency influence the speed and accuracy of word identification in different ways, depending on the children’s educational level. Furthermore, language skills were found to influence the effects of word length and frequency, differently in second- and fifth-grade children. The results are interpreted within the dual-route model of visual word recognition. The role of language skills in the implementation of these processes is also discussed.

Comparing Spoken Versus iPad-Administered Versions of a Narrative Retell Assessment Tool in a Practice-Based Research Partnership.

In the current age of greater digital delivery of services, it is important to examine the validity and differences between spoken and digital delivery of materials. The current study is a practice-based research partnership between school-based speech-language pathologists (SLPs) and researchers, evaluating presentation effects and validity of a narrative retell assessment tool created by SLPs. Fifty-one children across kindergarten, Grade 1, and Grade 2 completed the narrative retell task, retelling One Frog Too Many and Frog Goes to Dinner in three in-person story presentation conditions administered 1 week apart: spoken, iPad with audio-recorded natural rate of speech, and iPad with slow rate of speech. This was followed by 10 comprehension questions related to story events. Children also completed the Story Retelling subtests from the Test of Integrated Language and Literacy Skills (TILLS). Children recalled significantly fewer events in the spoken condition compared to audio-recorded iPad conditions. No significant effect of speaking rate was found. Presentation condition and rate did not affect performance on comprehension questions. Correlations among retell measures and corresponding subtests on a standardized language test ranged from weak to strong, providing some evidence of concurrent validity. This practice-based research partnership provided valuable insight into differences in delivery modality as well as the validity of a school-based SLP created narrative retell assessment tool. This study found that rate did not impact recall of events or performance on comprehension questions. Additionally, children performed better on narrative retell measures when stories were told using an iPad. This highlights the potential for iPad delivery as an option in narrative retell tasks. Finally, this study provided an initial examination of the Narrative Evaluation Tool's validity, finding the tool captures ability to recall narrative events; however, future studies are needed to examine the tool's validity as a measure of narrative comprehension. https://doi.org/10.23641/asha.25260910.

The Effects of Teacher-Centered and Student-Centered Approaches in TOEIC Reading Instruction

Teacher-centered instruction is prevalent in preparation courses for large-scale standardized language tests. Student-centered instruction, while known to be effective in enhancing communicative competence, has been considered ineffective and time-consuming to implement in preparation courses for large-scale standardized language tests. To investigate this assumption, a quasi-experimental study was conducted to investigate the effectiveness of two teaching approaches— teacher-centered and Jigsaw—on students’ Test of English for International Communication (TOEIC) Reading Comprehension Part Seven scores. The results showed that both groups experienced significant improvements from the pre-test to the post-test in their overall performance; however, there was no statistically significant difference between them. Furthermore, students in the Jigsaw group showed statistically significant improvements in all three passage types (single, double, and triple), while students in the teacher-centered group showed insignificant improvement in one of the three passage types (single passages). These findings suggest that both teaching approaches can effectively improve students’ TOEIC Reading Comprehension scores. The study adds to the body of research on teaching approaches in EFL TOEIC Reading Comprehension university classrooms. The findings suggest that teacher-centered and student-centered approaches can effectively improve students’ TOEIC Reading Comprehension scores.

The Relationship between Physical Activity and Academic Achievement among Elementary School Children in Japan

Purpose: The aim of the study was to investigate the relationship between physical activity and academic achievement among elementary school children in Japan
 Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.
 Findings: This study examined the relationship between physical activity and academic achievement among elementary school children in Japan. The participants were 1,024 fifth-grade students from 29 public schools in Tokyo. Physical activity was assessed by a questionnaire and a pedometer, and academic achievement was measured by standardized tests of Japanese language, mathematics, and science. The results showed that physical activity was positively associated with academic achievement, after controlling for gender, socioeconomic status, and school-level factors.
 Unique Contribution to Theory, Practice and Policy: Cognitive enhancement theory, self-determination theory & bioecological systems theory may be used to anchor future studies on the relationship between physical activity and academic achievement among elementary school children. Schools should prioritize high-quality physical education programs that include both structured and unstructured physical activities. Educational policymakers should consider including physical activity guidelines within the broader educational policy framework.

Normal but Different: Autistic Adolescents Who Score Within Normal Ranges on Standardized Language Tests Produce Frequent Linguistic Irregularities in Spontaneous Discourse.

A substantial minority of autistic individuals score within typical ranges on standard language tests, suggesting that autism does not necessarily affect language acquisition. This idea is reflected in current diagnostic criteria for autism, wherein language impairment is no longer included. However, some work has suggested that probing autistic speakers' language carefully may reveal subtle differences between autistic and nonautistic people's language that cannot be captured by standardized language testing. The current study aims to test this idea, by determining whether a group of autistic and nonautistic individuals who score similarly on a standardized test show differences in the number of unconventional and erroneous language features they produce in a spontaneous language sample. Thirty-eight older children and adolescents (19 autistic; 19 nonautistic), between the ages of 10 and 18, were recruited. Both participant groups scored within normal ranges on standardized language and IQ tests. Participants engaged in a "double interview" with an experimenter, during which they were first asked questions by the experimenter about themselves, and then they switched roles, so that it was the participant's turn to ask the experimenter questions. Participants' language during the interview was transcribed and analyzed for linguistic irregularities, including both semantic anomalies and morphosyntactic errors. Group membership accounted for significant variance in irregularity frequency; autistic participants produced more linguistic irregularities than nonautistic participants. Scores on a standardized language test did not improve model fit. Secondary analyses involving irregularity type (semantic vs. morphosyntactic) showed that group differences were primarily driven by relatively high numbers of semantic unconventionalities produced by the autistic group. While the autistic group made more morphosyntactic errors than the nonautistic group, differences in these numbers were only marginally significant. These findings suggest that a commonly used standardized language test does not adequately predict the number and perhaps type of language irregularities produced by some older autistic children and adolescents during spontaneous discourse. Results also suggest that differences in language use, especially semantic differences, may characterize autistic language, even the language produced by people who score within normal ranges on standardized language tests. It is debatable whether differences reflect underlying language impairments and/or a linguistic style adopted/preferred by autistic speakers. In this paper, we discuss both possibilities and offer suggestions to future research for teasing these possibilities apart.

Memorizing and fabricating? Uncovering online writing test preparation

With high-stakes decisions relying on standardized language tests (Chapelle, 2021a), many test takers seek test preparation from commercial ‘cram schools’, including TOEFL iBT writing (E.-Y. J. Kim, 2017; S. Kim, 2021). Despite a $1.2 billion market for online test preparation courses in Korea, previous studies have primarily focused on in-person classes through interviews and surveys, neglecting online courses. This study analyzed ten prerecorded online lectures from two popular cram schools, applying Messick’s (1982) taxonomy of test preparation to code instructional content. The analysis revealed that three types of instructional activities: three Type 1 (enhancing construct-relevant factors), four Type 2 (reducing construct-irrelevant factors), and four Type 3 (enhancing construct-irrelevant factors) test preparation activities were identified. Type 1 activities primarily covered vocabulary, grammar, and organizational patterns. Type 2 focused on teaching test formats, TOEFL trends, time management, and topic choice. Type 3 addressed templates, fabricating examples, gaming the scoring system, and cramming tips. Notably, students were encouraged to utilize memorized templates and fabricate examples. However, these practices may undermine support for the explanation and consequence implication inferences of the validity argument of TOEFL iBT. This study provides valuable insights into language testing preparation, applicable to various contexts with different tests.

P211: Quality of Life and participation in society of elderly people with aphasia

Objective:Aphasia is a communication disorder associated with impairments in spoken language, understanding, reading and writing that impacts upon daily activities, participation in society and the quality of life (QoL), and it is common in elderly patients in the context of vascular diseases. We aimed to investigate participation in society and the environmental factors and health-related QoL of elderly people with aphasia.Methods:People with aphasia whose age was above 65 were included in this study. QoL was assessed by the Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) and Life stage Aphasia Quality Of Life scale-11 (LAQOL-11), and the participation in society and the environmental factors as barriers was assessed by the Japanese version of the Community Integration Questionnaire (CIQ) and the Japanese version 2 of the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. We explored predictors such as aphasia severity, communication impairment, cognitive functions, motor paralysis, activities of daily living (ADL).Results:We included 58 individuals (43 men; mean age 73.2 [SD 5.7] years) with aphasia after the mean 48 (SD 64.9) months of onset (of stroke, cerebral hemorrhage, subarachnoid hemorrhage, brain tumor, traumatic brain injury). The median of the total score of SAQOL-39 and LAQOL-11 was 3.91 (Quartile Deviation 0.47) out of 5 and 85.0 (QD 12.5) out of 110. The QoL was not associated with aphasia severity assessed by the Standard Language Test of Aphasia (SLTA) which is the most frequently used comprehensive aphasia rating scale in Japan, but poor QoL was significantly associated (Spearman correlations) with increased severity of communication impairment assessed by Communication ADL Test (P = 0.01). Moreover, increased QoL was significantly associated with increased participation in society (P = 0.03) and decreased environmental factors (P = 0.01).Conclusion:Poor communication ADL may have a negative effect on QoL in elderly people with aphasia. Also, we show that QoL is associated with participation in society. For patients with aphasia after retirement, specific rehabilitation of communication ADL might be beneficial and should be explored in future studies.

Vascular Burden Moderates the Relationship Between ADHD and Cognition in Older Adults

ObjectivesRecent evidence suggests attention-deficit/hyperactivity disorder (ADHD) is a risk factor for cognitive impairment in later life. Here, we investigated cerebrovascular burden, quantified using white matter hyperintensity (WMH) volumes, as a potential mediator of this relationship. DesignThis was a cross-sectional observational study. SettingParticipants were recruited from a cognitive neurology clinic where they had been referred for cognitive assessment, or from the community. ParticipantsThirty-nine older adults with clinical ADHD and 50 age- and gender-matched older adults without ADHD. MeasurementsA semiautomated structural MRI pipeline was used to quantify periventricular (pWMH) and deep WMH (dWMH) volumes. Cognition was measured using standardized tests of memory, processing speed, visuo-construction, language, and executive functioning. Mediation models, adjusted for sex, were built to test the hypothesis that ADHD status exerts a deleterious impact on cognitive performance via WMH burden. ResultsResults did not support a mediated effect of ADHD on cognition. Post hoc inspection of the data rather suggested a moderated effect, which was investigated as an a posteriori hypothesis. These results revealed a significant moderating effect of WMH on the relationship between ADHD memory, speed, and executive functioning, wherein ADHD was negatively associated with cognition at high and medium levels of WMH, but not when WMH volumes were low. ConclusionsADHD increases older adults’ susceptibility to the deleterious cognitive effects of WMH in the brain. Older adults with ADHD may be at risk for cognitive impairment if they have deep WMH volumes above 61 mm3 and periventricular WMH above 260 mm3.