Written Language Impairment Research Articles

What Works in Collaboration? Identifying Key Ingredients to Improve Service Delivery in Schools.

This survey study examined factors that may influence interprofessional collaboration in schools to support children with oral and written language impairments, namely, knowledge, collaborative beliefs and practices, and resources. A survey was conducted across 319 school-based professionals, in a partnering public school district, to examine these constructs within the context of each individual participant's professional role. Between-groups comparisons were made between special educators, general educators, paraprofessionals, and indirect educators (i.e., those whose roles do not explicitly include language-based instruction). Special educators had significantly higher levels of learning experiences and knowledge about language disorders compared to other groups. Those who engaged in the most independent learning (i.e., learning outside of pre- or in-service learning) exhibited the highest levels of knowledge. Collaborative beliefs among professionals were best predicted by access to resources and overall professional learning experiences. More positive collaborative beliefs, in turn, predicted higher rates of collaborative behaviors. Resources were predicted by a small negative relationship with years of experience and by working in specific school buildings within the district. Those with less experience in specific buildings reported more resources. Individuals with higher levels of individual learning and positive attitudes toward collaboration may enhance the interprofessional collaborative practices of teams supporting children with language disorders. https://doi.org/10.23641/asha.24059178.

Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents.

Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.

Alexia and agraphia in Spanish.

Every language has certain specific idiosyncrasies in its writing system. Cross-linguistic analyses of alexias and agraphias are fundamental to understand commonalities and differences in the brain organization of written language. Few reports of alexias and agraphias in the Spanish language are currently available. To analyse the clinical manifestations of alexias and agraphias in Spanish, and the effect of demographic variables. Spanish versions of the Western Aphasia Battery (WAB) and Boston Diagnostic Aphasia Examination (BDAE) were used for language assessment. Lesion localization was obtained by using computed axial tomography and magnetic resonance imaging. The final sample included 200 patients: 195 (97.5%) right-handed and five (2.5%) left-handed; 119 men and 81 women with a mean age of 57.37 years (SD = 15.56), education of 13.52 years (SD = 4.08), and mean time post-onset of 6.58 months (SD = 12.94). Using the WAB, four quotients were calculated: aphasia quotient (AQ), reading-writing quotient (RWQ), language quotient (LQ) and cortical quotient (CQ). The types of aphasia were: global = 11 patients (5.5%), Broca = 31 (15.5%), Wernicke = 30 (15.0%), conduction = 22 (11.0%), transcortical sensory = 17 (8.5%), transcortical motor = 3 (1.5%), amnesic or anomic = 54 (27.0%) and mixed non-fluent = 32 (16.0%). The degree of oral and written language impairment differed across the various aphasia types. Most severe reading and writing difficulties were found in global, mixed non-fluent and transcortical motor aphasia; fewer difficulties were observed in amnesic, Broca and conduction aphasia. The severity of the written language impairments paralleled the severity of the oral language disturbances. Age negatively, while schooling positively, correlated with the scores in reading and writing tests. No effect of sex and time since onset was found. In Spanish-speaking aphasia patients, difficulties in reading and writing are similar to oral language difficulties. This similarity of performance is mostly based on severity rather than the participants' patterns of errors. What this paper adds What is already known on the subject There is limited information about alexia and agraphia in Spanish. What this paper adds to existing knowledge An extensive study with a large sample of patients. What are the potential or actual clinical implications of this work? The study contributes to the clinical management of patients with reading and writing disturbances.

Is cognitive impairment associated with reduced syntactic complexity in writing? Evidence from automated text analysis

ABSTRACT Background: Written language impairments are common in Alzheimer’s disease and reduced syntactic complexity in written discourse has been observed decades before the onset of dementia. The validity of average dependency distance (ADD), a measure of syntactic complexity, in cognitive decline needs to be studied further to evaluate its clinical relevance. Aims: The aim of the study was to determine whether ADD is associated with levels of cognitive impairment in memory clinic patients. Methods & procedures: We analyzed written texts collected in clinical practice from 114 participants with subjective cognitive impairment, mild cognitive impairment, and Alzheimer’s disease during routine assessment at a memory clinic. ADD was measured using automated analysis methods consisting of a syntactic parser and a part-of-speech tagger. Outcomes & results: Our results show a significant association between ADD and levels of cognitive impairment, using ordinal logistic regression models. Conclusion: These results suggest that ADD is clinically relevant with regard to levels of cognitive impairment and indicate a diagnostic potential for ADD in cognitive assessment.

Structured Literacy Intervention for Students With Dyslexia: Focus on Growing Morphological Skills

Purpose Structured literacy (SL) is an umbrella term used by the International Dyslexia Association that refers to evidence-based instructional approaches that incorporate all aspects of spoken language into the teaching of reading, spelling, and writing (International Dyslexia Association, 2016). SL has gained prominence in the field of reading but is less familiar to speech-language pathologists. This tutorial seeks to describe SL with specific attention to the morphological component. Using current research literature combined with descriptions of specific therapeutic practices, this tutorial offers research-informed, clinical strategies for facilitating the development of morphological skills in students with spoken and written language impairments including dyslexia. Method In this tutorial, the authors focus on the research literature and clinical applications related to the topics of (a) spoken and written language impairments, including dyslexia; (b) SL intervention; (c) intervention in the areas of morphological awareness and analysis; and (d) the promotion of academic success in students who struggle with language and literacy. Conclusions SL is a term used to unify and describe evidence-based principles and components that should be included in all effective reading and writing instructions. Among other linguistic skills, morphology holds a prominent place in SL. It is critical that speech-language pathologists become familiar with SL and the evidence-based practices for growing these students' morphological awareness skills in order to promote language and literacy success.

Re-learning to be different: Increased neural differentiation supports post-stroke language recovery

Identifying the neural changes that support recovery of cognitive functions after a brain lesion is important to advance our understanding of human neuroplasticity, which, in turn, forms the basis for the development of effective treatments. To date, the preponderance of neuroimaging studies has focused on localizing changes in average brain activity associated with functional recovery. Here, we took a novel approach by evaluating whether cognitive recovery in chronic stroke is related to increases in the differentiation of local neural response patterns. This approach is supported by research indicating that, in the intact brain, local neural representations become more differentiated (dissimilar) with learning (Glezer et al., 2015). We acquired fMRI data before and after 21 individuals received approximately 12 weeks of behavioral treatment for written language impairment due to a left-hemisphere stroke. We used Local-Heterogeneity Regression Analysis (Purcell and Rapp, 2018) to measure local neural response differentiation associated with written language processing, assuming that greater heterogeneity in the pattern of activity across adjacent neural areas indicates more well-differentiated neural representations. First, we observed pre to post-treatment increases in local neural differentiation (Local-Hreg) in the ventral occipital-temporal cortex of the left hemisphere. Second, we found that, in this region, higher local neural response differentiation prior to treatment was associated with less severe written language impairment, and that it also predicted greater future responsiveness to treatment. Third, we observed that changes in neural differentiation were systematically related to performance changes for trained and untrained items. Fourth, we did not observe these brain-behavior relationships for mean BOLD responses, only for Local-Hreg. Thus, this is the first investigation to quantify changes in local neural differentiation in the recovery of a cognitive function and the first to demonstrate the clear behavioral relevance of these changes. We conclude that the findings provide strong support for the novel hypothesis that the local re-differentiation of neural representations can play a significant role in functional recovery after brain lesion.

Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss.

The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL). Ninety children, aged 8-16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability. Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems. Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor.

Broca meets Wernicke in a single case

The aim of this follow-up study is to describe the clinical and neuroradiological findings in an exceptional case presenting a marked discrepancy between oral and written language impairment. In this 22-year-old right-handed patient in-depth neurolinguistic investigations were, conducted 5, 15 and 27 weeks after head trauma inducing a left frontotemporoparietal traumatic brain lesion. Oral as well as written communication is qualitatively analyzed. Initially, the aphasia profile was primarily characterized by a striking dissociation between oral and written output. In the acute phase, neurolinguistic findings were consistent with phonological jargon aphasia selectively affecting oral output. By contrast, no fluent aphasia symptoms were found in written output. The patient wrote slowly and intelligibly but written output was distorted by agrammatism. As such, typical fluent aphasia symptoms marked oral output, while nonfluent aphasia symptoms characterized written output. During longitudinal follow-up the dissociation between oral and written output resolved. Phonological errors and self-corrections in speech indicated an evolution to conduction aphasia. The exceptional aphasia profile of this patient at 5 weeks posttrauma consists of a unique typological combination of typical fluent, Wernicke-like symptoms confined to oral output and typical nonfluent, Broca-like symptoms in writing. This case study shows the existence of a layered semantic system and an autonomic orthographic lexicon. Follow-up results revealed the impact of a controller system, by means of which the patient could sidestep disturbed phonology at the expense of communicative content. • Follow-up study of a right-handed patient with aphasia after head trauma. • Striking dissociation in aphasia profile between oral and written output. • The profile shows the existence of a layered semantic system.

Levantamento da prevalência de distúrbios da comunicação em escolares do ensino público fundamental da cidade de Vila Velha/ES

OBJETIVO: levantar a prevalência de distúrbios da comunicação na comunidade escolar do município de Vila Velha - ES. MÉTODO: participaram da pesquisa 1.103 crianças de 15 escolas municipais de ensino fundamental avaliadas em cinco momentos: a) levantamento situacional; b) apresentação da proposta e orientações à comunidade escolar; c) triagens fonoaudiológicas; d) triagens auditivas, e) retorno dos resultados à comunidade escolar. Neste trabalho, serão descritas as etapas c) e d) RESULTADOS: na triagem auditiva, das 1.103 crianças avaliadas, 22,4% falharam demonstraram algum tipo da alteração auditiva. Na triagem fonoaudiológica, das 1.014 crianças avaliadas, 30,4% apresentaram algum tipo de alteração na comunicação: 25% alteração de fala, 32,5% alteração na motricidade oral, 17,8% alteração na voz, 8,8% alteração de linguagem (oral e/ou escrita) e 15,9% apresentaram associação de duas ou mais alterações. CONCLUSÃO: as alterações mais encontradas, em ordem de frequência, foram: de motricidade orofacial, de fala, de voz, de audição, de linguagem (oral e/ou escrita). Verificou-se, ainda, em muitas crianças, a presença de duas ou mais alterações.

Written Language Impairments in Primary Progressive Aphasia: A Reflection of Damage to Central Semantic and Phonological Processes

Connectionist theories of language propose that written language deficits arise as a result of damage to semantic and phonological systems that also support spoken language production and comprehension, a view referred to as the "primary systems" hypothesis. The objective of the current study was to evaluate the primary systems account in a mixed group of individuals with primary progressive aphasia (PPA) by investigating the relation between measures of nonorthographic semantic and phonological processing and written language performance and by examining whether common patterns of cortical atrophy underlie impairments in spoken versus written language domains. Individuals with PPA and healthy controls were administered a language battery, including assessments of semantics, phonology, reading, and spelling. Voxel-based morphometry was used to examine the relation between gray matter volumes and language measures within brain regions previously implicated in semantic and phonological processing. In accordance with the primary systems account, our findings indicate that spoken language performance is strongly predictive of reading/spelling profile in individuals with PPA and suggest that common networks of critical left hemisphere regions support central semantic and phonological processes recruited for spoken and written language.

Troubles du langage oral et écrit chez des jeunes pris en charge par l’aide sociale à l’enfance et bénéficiant de soins hospitaliers

Background Children and adolescents involved with foster care are a population at high risk of developing psychiatric disorders and poor language skills. Here, we aimed to assess in children and adolescents admitted in a university department of child and adolescent psychiatry whether being involved with foster care would change oral and written language impairments they face. Method We conducted a case-control study in a sample of 104 inpatients aged six to 18 years (50 supported by foster care; 54 not supported). Assessment included family and medical histories, axis 1 diagnoses and a systematic screening of written abilities using the French version of the 1-minute reading test, a spelling task and two tasks of sentence comprehension. For subjects showing at least one score below two standard deviations at one screening task, a full language assessment was performed including tasks for oral language, phonological skills, word identification, naming speed, syntax and comprehension. Results We found more language impairments in inpatients involved with foster care than controls. They had lower scores in complex language comprehension tasks, more impaired phonological skills, and more fragile word identification strategies (both the grapho-phonologic conversion and the assembling strategy). We found a significant association between language and gender (male), intellectual disability and pervasive developmental disorder. Although externalized disorders were significantly associated with written language impairment, this association was mediated by gender. Finally, children and adolescents involved with foster care were at higher risk not to be treated for a language impairment (odd ratio = 3.5 [95%CI : 1.03–12.05], P = 0.038). Conclusion The severity and prevalence of language impairments among youths involved with foster care and requiring psychiatric inpatient stay show the impact of learning disabilities in this population. In terms of prevention, assessment of language skills should be promoted in this population as they appear to be at risk of not receiving proper speech or reading remediation.

The benefits and protective effects of behavioural treatment for dysgraphia in a case of primary progressive aphasia

Background: Spoken and written language difficulties are the predominant symptoms in the progressive neurodegenerative disease referred to as primary progressive aphasia (PPA). There has been very little research on the effectiveness of intervention on spoken language impairments in this context and none directed specifically at progressive written language impairment. Aims: To examine the effectiveness of behavioural intervention for dysgraphia in a case of primary progressive aphasia. Methods & Procedures: We carried out a longitudinal single‐case study that allowed us to examine the effectiveness of a non‐intensive spell‐study‐spell intervention procedure. We did so by comparing performance on four sets of words: trained, repeated, homework, and control words at five evaluations: baseline, during intervention, after the intervention, and at 6‐ and 12‐month follow‐up. Outcomes & Results: We find that: (1) at the end of the intervention, Trained words show a small but statistically significant improvement relative to baseline and an advantage in accuracy over Control, Homework, and Repeated word sets. (2) All word sets exhibited a decline in accuracy from the end of treatment to the 6‐month follow‐up evaluation, consistent with the degenerative nature of the illness. Nonetheless, accuracy on Trained words continued to be superior to that of Control words and not statistically different from pre‐intervention baseline levels. (3) Repeated testing and practice at home yielded modest numerical advantages relative to Control words; but these differences were, for many comparisons, not statistically significant. (4) At 12 months post‐intervention, all words sets had significantly declined relative to pre‐intervention baselines and performance on the four sets was comparable. Conclusions: This investigation documents—for the first time—that behavioural intervention can provide both immediate and short‐term benefits for dysgraphia in the context of primary progressive aphasia. We are grateful for the support of NIH grant DC006740; to Alexis Kruczek and Joelle Urrutia for their hard work and dedication to this project; to Ranjan Maitra (University of Iowa, Department of Statistics) for his help with statistical analyses; and for CB's friendship and example of humour and humanity throughout difficult times.

Language Learning Disabilities

Developmental language learning impairments affect 10 to 20% of children and increase their risk of later literacy problems (dyslexia) and psychiatric disorders. Both oral- and written-language impairments have been linked to slow neural processing, which is hypothesized to interfere with the perception of speech sounds that are characterized by rapid acoustic changes. Research into the etiology of language learning impairments not only has led to improved diagnostic and intervention strategies, but also has raised fundamental questions about the neurobiological basis of speech, language, and reading, as well as hemispheric lateralization.

Developmental language learning impairments.

Developmental language learning impairments (LLI) are one of the most prevalent of all developmental disabilities, can occur in children for a wide variety of reasons, and have been shown to co-occur frequently with other developmental social, emotional and behavioral disorders, as well as with academic achievement problems. Research pertaining to developmental LLI of unknown origin, with an emphasis on the continuum between oral and written language impairment, is the focus of this review. Given the complexity of language learning, research has focused on multiple levels of analysis, including linguistic, neuropsychological, genetic, neurobiological, and remediation studies. To date, the vast majority of data on LLI derive from studies focused on a single level of analysis. Although attempts have been made to integrate data across studies and multiple levels of analysis, this has proven to be problematic, given the heterogeneity of the subject populations used to study LLI, as well as the differences in ages, degree of impairment, and types of impairment included in each study. Given that LLI is a complex developmental disability, it is suggested that future research would benefit from taking a multiple levels of analysis approach with the same individuals, incorporating mathematical models designed to analyze dynamically changing complex systems, and studying individual differences in language learning, prospectively and longitudinally, throughout the most dynamic stages of the process.

The impact of orthographic consistency on dyslexia: A German-English comparison

We examined reading and phonological processing abilities in English and German dyslexic children, each compared with two control groups matched for reading level (8 years) and age (10–12 years). We hypothesised that the same underlying phonological processing deficit would exist in both language groups, but that there would be differences in the severity of written language impairments, due to differences in orthographic consistency. We also hypothesized that systematic differences due to orthographic consistency should be found equally for normal and dyslexic readers. All cross-language comparisons were based on a set of stimuli matched for meaning, pronunciation and spelling. The results supported both hypotheses: On a task challenging phonological processing skills (spoonerisms) both English and German dyslexics were significantly impaired compared to their age and reading age controls. However, there were extremely large differences in reading performance when English and German dyslexic children were compared. The evidence for systematic differences in reading performance due to differences in orthographic consistency was similar for normal and for dyslexic children, with English showing marked adverse effect on acquisition of reading skills.

Occurrence and pattern of impaired reading and written language in children with attention deficit disorders

The purpose of this study was to investigate the occurrence and severity of reading, spelling, and written language impairment in children clinically referred for Attention Deficit Hyperactivity Disorder (ADHD). Specific questions involved 1) whether ADD subgroups with and without hyperactivity differ in reading, spelling, and written language achievement, 2) whether age and gender interact with ADD sub-group class to affect reading/written language achievement, and 3) whether prevalence of impaired reading/written language in these subgroups is consistent with previous reports in heterogeneous samples. Subjects were 115 ADD children aged 6-12 who were subclassified as ADD + H(72 percent) and ADD - H(28 percent) by objective teacher ratings. Dependent measures included tests of single word recognition and vocabulary, word attack, contextual comprehension, written spelling, written sentence construction, and writing fluency, in addition to a structured behavioral observation, during which aspects of inattention and motor activity were coded. A large fraction of this sample met public school LD criteria (54 percent), and achievement on most measures was globally poorer than the respective test normative groups. The ADD + H subgroup showed significantly poorer word attack skills, while the subgroups did not significantly differ from each other on other reading/written language measures. However, 17 percent of the total ADD sample were ≥ 1.5 SD below the mean in total reading achievement, and 29 percent were ≥ 1.5 SD below the mean on measures of written spelling/language. Gender X age interactions, indicating poorer performance in the middle age group of females, were likely related to lower IQ.