Evaluation of a bilingual questionnaire-based assessment on hearing in children with speech delay

@#Introduction: To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, Medical Centre (UMMC), Kuala Lumpur, Malaysia over a 9 month period. Methods: This is a prospective instrument correlation study done on 93 children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14-point questionnaire final scores and is statistically correlated. Results: There were 26 patients, 15 males (58%) and 11(42%) females who were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtained through our patients was 3.83±1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss. Conclusion: Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.

Comparison of anxiety and child-care education characteristics of mothers who have children with or without speech delays / Comparação da ansiedade e características da educação infantil em mães com filhos com ou sem atrasos na fala

Abstract Introduction: Speech delay in a child could be the cause and/or result of the emotional disorder. The child rearing attitude that the parents have accepted could have both positive and negative effects on the personality of the child. Objective: The current study aimed to investigate the sociodemographic features and the mothers' anxiety of children with speech delay. Methods: One hundred five mothers with children aged between 3 and 6 years with speech delays were included in the patient group, and 105 mothers who have children aged between 3 and 6 years with normal speech and language development were included in the control group. An information form questionnaire including demographic characteristics, the Family Life and Childrearing Attitude Scale (PARI - Parental Attitude Research Instrument) and Beck anxiety scale were requested from all mothers in the patient and the control groups. Results: In the current study, there was a significant difference between the groups in terms of gender (p = 0.001). According to Parental Attitude Research Instrument, the mean of mothers of the children with speech delays was higher than the mean of mothers of normal children in terms of the answers to overprotective mother aspect (p < 0.01). The mothers of children with speech delays had more overprotective motherhood attitudes; however, the difference in terms of the answers to the aspects of democratic attitude and provision of equality, refusal to be a housewife, husband-wife conflict, and suppression and discipline were not statistically significant. The Beck anxiety scale, a significant difference was detected between the two groups (p < 0.01). It was found that the mothers of children with speech delays had more severe levels of anxiety. Conclusion: The social structure of the family, the attitudes and the behaviors of the mother, and the anxiety levels of the mothers have important effects on child development. Thus, it is necessary to perform further studies related to speech delays, in which many factors play a role in the etiology.

Resumo Introdução: O atraso da fala em uma criança pode ser a causa e/ou o resultado de distúrbio emocional. As atitudes tomadas pelos pais na educação da criança podem ter efeitos positivos e negativos sobre a personalidade infantil. Objetivo: Investigar as características sociodemográficas e a ansiedade das mães de crianças com atraso na fala. Método: Foram incluídas no grupo de pacientes 105 mães com crianças entre 3 e 6 anos de idade e atrasos na fala e no grupo controle 105 mães com crianças na mesma faixa etária e desenvolvimento normal da fala e da linguagem. Foi solicitado às mães de ambos os grupos o preenchimento de informações em um formulário, incluindo características demográficas, o instrumento Family Life and Child Rearing Attitude Scale (PARI - Parental Attitude Research Instrument) e o inventário de ansiedade Beck. Resultados: No estudo atual, houve diferença significativa entre os grupos em relação ao gênero (p = 0,001). De acordo com o instrumento Parental Attitude Research Instrument, a média das mães das crianças com atrasos na fala foi maior do que a média das mães de crianças normais em relação às respostas sobre superproteção materna (p < 0,01). As mães de crianças com atrasos na fala apresentaram mais atitudes de proteção materna excessiva; no entanto, a diferença das respostas sobre atitudes democráticas e igualitarismo, recusa do papel de dona de casa, conflito marital e disciplina rígida não foram estatisticamente significantes. No inventário de ansiedade de Beck foi encontrada uma diferença significativa entre os dois grupos (p < 0,01). Verificou-se que as mães de crianças com atrasos na fala apresentavam níveis mais graves de ansiedade. Conclusão: A estrutura social da família, as atitudes, o comportamento e os níveis de ansiedade das mães têm efeitos importantes no desenvolvimento da criança. Conclui-se, portanto, a necessidade de realizar estudos adicionais relacionados aos atrasos na fala, nos quais diversos fatores desempenham um papel etiológico.

Toxoplasmose congênita: evolução da função auditiva e da linguagem emcrianças diagnosticadas e tratadas precocemente / Congenital toxoplasmosis: auditory and language outcomes inearly diagnosed and treated children

A cross-sectional study included all children diagnosed with congenital toxoplasmosis, through the Minas Gerais State Neonatal Screening Program, from September 2006 to March 2007. All children received early treatment, initiated before the age of 2.5 months, and were periodically assisted by a team of specialists including pediatricians, ophthalmologists and speech-language therapists and audiologists. Hearing function was evaluated with the following procedures: tympanometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, behavioral observation audiometry, and brainstem auditory evoked potentials. Hearing function and sensitivity was estimated and audiological results were classified as normal, conductive hearing loss, sensory-neural hearing loss and central dysfunction. Language performance was assessed and classified as normal or abnormal, according to test results. The following variables were studied: audiological results, neurological and ophthalmological conditions, language performance and presence of risk indicator for hearing loss other than congenital toxoplasmosis. Univariate analysis was conducted using the chi-square or Fisher?s Exact test. Results: From September 2006 to March 2007, 106 children were diagnosed with congenital toxoplasmosis through the neonatal screening program, and were included in the study. Data analysis showed normal hearing in 60 children (56.6%), while 13 children (12.3%) had conductive hearing loss, four children (3.8%) had sensory-neural hearing loss and 29 children (27.4%) presented central hearing dysfunction. There was association between hearing problems and language deficits. The comparison between children with additional risks for hearing loss other than toxoplasmosis and children who only presented toxoplasmosis as a risk factor showed no differences. This finding suggests that audiological problems were due to congenital toxoplasmosis alone.

Um estudo transversal descritivo incluiu todas as crianças diagnosticadas com toxoplasmose congênita (TC) pelo Prog. Est. de Tria. Neonatal de MG entre set. 2006 e mar. de 2007. Todas as crianças foram submetidas ao protocolo de tratamento com pirimetamina e sulfadiazina iniciado antes dos 2,5 meses de idade e com duração de 12 meses, tendo realizado acompanhamento pediátrico, oftalmológico e fonoaudiológico periódico. Para avaliar a audição foram usados, como instrumentos diagnósticos, medidas de imitância acústica, emissões otoacústicas evocadas por estímulo transiente e produto de distorção, potencial evocado auditivo de tronco encefálico e observação do comportamento auditivo. Foi avaliada a acuidade auditiva e as alterações auditivas foram classificadas em condutivas, neurossensoriais e retrococleares. O desempenho de ling. foi avaliado usando-se um instrumento de aval. do desenvolvimento da ling., e os resultados foram classificados como normais ou alterados. As seguintes variáveis foram estudadas: resultados audiológicos, condições neurológicas e oftalmológicas, linguagem e presença de fator de risco para perda auditiva além da TC. Foi realizada análise univariada pelo qui-quadrado ou teste exato de Fisher. Resultados: entre set. 2006 e mar. 2007, 106 crianças foram diagnos. com TC pelo programa de triagem neonatal, sendo incluídas no estudo. A análise dos dados mostrou que 60 crianças apresentavam audição normal (56,6%) e 46 crianças apresentavam audição alterada, sendo 13 crianças (12,3%) com alteração condutiva, 4 (3,8%) com perda auditiva neurossensorial e 29 (27,4%) com comprometimento retrococlear. Houve associação entre presença de alteração auditiva e déficit de linguagem. A comparação entre crianças que apresentavam outro fator de risco além da TC e crianças que apresentavam somente a toxoplasmose como fator de risco para alteração auditiva não mostrou diferenças.

Landau-Kleffner syndrome without seizures: would speech delay justify the treatment with antiepileptic drugs?: [review] / Síndrome de Landau-Kleffner sem crises: atraso na aquisição da fala justifica o tratamento com drogas epilépticas?: [revisão]

INTRODUCTION: Landau-Kleffner Syndrome is a rare epileptic syndrome characterized by the association of receptive aphasia, epileptic seizures, behavioral disorders and electroencephalographic changes with discharges at the temporal lobe unilaterally or bilaterally. Seizures are not essential for diagnosis. CASE REPORT: J. V. S. S., 3 y/o male, with delay in acquirement of speech, psychomotor agitation and sleep disorder (sleeplessness). Attempt to communicate was established by gestures and pointing at things. His behavior characterized by agitation, restlessness, aggressiveness and difficulty to establish social contact with other children by the same age. MRI was normal and the EEG showed sharp-wave discharges in the left medial and posterior temporal regions. After three months of treatment with carbamazepine the child returned to an evaluation, presenting substantial improvement at speech, speaking simple words and with meaningful improvement on both behavioral and sleep patterns, as well as, social interaction. DISCUSSION: Expression and reception speech disorders are relatively common in children with different epileptic syndromes, particularly in Landau-Kleffner syndrome. Epileptiform discharges can occur in people without epilepsy and use to be called subclinical discharges. What would be the impact of subclinical discharges on this population remains uncertain at the present time. We reviewed these interactions in the light of a representative case, showing favorable outcome following introduction of an antiepileptic drug.

INTRODUÇÃO: Síndrome de Landau-Kleffner é uma síndrome epiléptica rara caracterizada pela associação de afasia de recepção, crises epilépticas, distúrbios do comportamento e alterações eletrencefalográficas com descargas nos lobos temporais unilaterais ou bilaterais. Crises convulsivas não são essenciais para o diagnóstico. RELATO DO CASO: J.V.S.S., masculino, três anos de idade, com atraso na aquisição da fala, agitação psicomotora e distúrbio do sono. Ele usava gestos e apontava para os objetos tentando se comunicar. Seu comportamento era muito agitado, impaciente, períodos de agressividade e muita dificuldade em estabelecer contato social com outras crianças da mesma idade. RNM foi normal e o EEG mostrou descargas de ondas agudas nas regiões temporais média e posterior esquerda. Após três meses de tratamento com carbamazepina a criança retornou para reavaliação, apresentando importante melhora da fala, falando palavras simples, melhora do comportamento e do padrão de sono e da interação social. DISCUSSÃO: Alterações na linguagem de recepção e de expressão são relativamente comuns em crianças com diferentes síndromes epilépticas, particularmente na síndrome de Landau-Kleffner. Descargas epileptiformes podem ocorrer em pessoas sem epilepsia sendo denominadas descargas subclínicas. Qual o impacto das descargas subclínicas para estas pessoas é incerto até o momento. Relatamos o caso de um menino com descargas epileptiformes no EEG, sem história de crises convulsivas e excelente evolução clínica após tratamento com droga antiepiléptica.

Clinical Aspects of Functional Articulation Disorder

PURPOSE: Speech and language development is an useful indicator of the overall development of children. Since speech and language delay can lead to emotional, social, and learning problems, the early intervention is very important. We examined 137 children with speech or language problems including 22 children of functional articulation disorders of their clinical features. METHODS: 137 children with speech or language problems in the Department of Pediatrics, Uijeongbu St. Mary's Hospital from January 2004 to December 2007 were reviewed for sex, age, developmental and language test findings retrospectively. Especially, in 22 children diagnosed with functional articulation disorders, articulation test findings were analyzed. RESULTS: 1) The mean age of 137 children was 46.8 months, the ratio of male to female was 2.5:1, and the most frequent age group was 24-35 months. The chief complaints included language delay(67.2%), mispronouncing speech sound(27%), stuttering(3.6%), learning disability(2.2%). The diagnoses of them were developmental language disorder(70.8%), functional articulation disorders(16.1%), mental retardation(5.8%), stuttering(2.9%), tongue tie(0.7%), normal language pattern(3.6%). 2) The mean age of 22 patients with functional articulation disorders was 63 months, the ratio of male to female was 1.4:1, and the most frequent age group was 60-71 months. The mean percentage of consonant correct of Picture Consonant Articulation Test was higher in older age group. In the types of phonetic errors substitutions were most common. Distortions, omissions, and additions were followed in the order of frequency. Substitutions and distortions were common in word initial and medial but omissions in word final. It is appeared that the patients had the difficulties in pronouncing alveolar fricative, palatal affricate, liquid, and velar plosive which mature lately in older children. Mainly palatal affricate, alveolar fricative, and velar plosive were substituted for alveolar plosive and the liquid and alveolar fricative were distorted as gliding. CONCLUSION: Categorizing the cause of language and speech delay is essential to make an adequate treatment plans and decrease the late complications. The future studies for the early screening, more suitable tests in Korean, treatment guidelines or prognosis are needed.