Measuring the complex syntax of school-aged children in language sample analysis: A known-groups validation study.

BACKGROUND: Complex syntax is affected by developmental language disorder (DLD) during the school years. Targeting areas of syntactic difficulty for children with DLD may yield useful assessment techniques. AIMS: To determine whether wh-movement can be measured in language samples from typically developing mono- and bilingual school-aged children, and, if so, to provide preliminary evidence of validity by comparison with traditional measures of syntax in a cross-sectional, known-groups design. METHODS & PROCEDURES: Participants were 48 typically developing children recruited from the Canadian province of Nova Scotia in four groups: monolingual English and bilingual French-English children in early (7-8 years of age) and late (11-12 years of age) elementary school. Language samples were collected and analysed with mean use of wh-movement, mean length of utterance and clausal density. These measures were compared for effects of age, bilingual development and elicitation task. OUTCOMES & RESULTS: The results from all measures closely paralleled each other, providing preliminary evidence of validity. Wh-movement-based and traditional measures demonstrated similar age-related and discourse genre effects. Neither demonstrated an effect of mono- versus bilingual development. CONCLUSIONS & IMPLICATIONS: The results confirm research interest in syntactic movement as an area of language assessment. Further research is required to understand its application to clinical populations. What this paper adds What is already known on the subject Complex syntax is known to be an area of difficulty for children with DLD. Certain syntactic constructions appear to be particularly difficult for these children. Assessments targeting these areas of difficulty are emerging. What this paper adds to existing knowledge The paper compares traditional measures of syntax with measures based on wh-movement. It shows similar results for both types of measures, suggesting construct and convergent validity. Results suggest that syntactic movement is an age-appropriate area of assessment for elementary school-aged children's language. What are the potential or actual clinical implications of this work? Language sample assessment measures based on wh-movement appear promising. The impact of task effects of the discourse genre on assessing syntax must be carefully considered in research and clinical practice.

When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure.

Children's distress during painful medical procedures is strongly influenced by adult behavior. Adult reassurance (e.g., "it's okay") is associated with increased child distress whereas distraction is associated with increased child coping. It is unknown why reassurance shows this counterintuitive relationship with child distress. The present research investigated whether children perceive their parents as fearful when they reassure using complementary observational and experimental methodologies. One hundred children (40 boys, 60 girls) 5-10years old (M=8.02, SD=1.69) and their parents (86 mothers, 14 fathers) participated. First, spontaneous parent-child interactions during pediatric venipuncture were captured and used for a video-mediated recall task in which the children viewed instances of parental reassurance and distraction and rated their parents' fear and happiness. Second, the children were asked to rate the intensity of parental fear and happiness for 12 video vignettes showing an actor posing as a parent during venipuncture. To determine whether the children's perceptions varied with the qualities of the behavior, the vignettes manipulated: facial expression (happy vs. fearful), vocal tone (rising vs. falling), and content (informative reassurance vs. uninformative reassurance vs. distraction). For both tasks, the children provided higher ratings of fear during reassurance than distraction. In response to the vignettes, the children gave higher ratings of parental fear for a fearful facial expression, but the influence of vocal tone differed with the verbal content of the utterance. The results provide insight into the complexity of adult reassurance and highlight the important role of parental facial expression, tone, and verbal content during painful medical procedures.

Effect of galantamine on verbal repetition in AD: a secondary analysis of the VISTA trial.

OBJECTIVES: To understand how commonly diminution of verbal repetition was a goal of treatment in patients with Alzheimer disease (AD), how commonly that goal was achieved, whether goal attainment might be attributable to galantamine treatment, and whether change in verbal repetition is a marker of the overall treatment response. METHODS: This is a secondary analysis of the Video-Imaging Synthesis of Treating Alzheimer's Disease study, a 4-month, double-blind, randomized, placebo-controlled trial of galantamine in 130 community-dwelling patients with mild to moderate AD. The primary outcome was Goal Attainment Scaling, in which individualized problems identified by patients/caregivers and treating physicians were assessed bimonthly. RESULTS: Reduction of verbal repetition was set as a treatment goal in 44% (n = 57) of randomized patients. More patients/caregivers (32%) set repetition goals than did physicians (18%). After 4 months, more galantamine-treated patients showed diminution of verbal repetition (58%) than did placebo-treated patients (24%; p < 0.01). Reduction of verbal repetition correlated with improvement in clinical measures, but not in standardized ones. CONCLUSIONS: Reduction of verbal repetition is a common goal of Alzheimer disease treatment. After 4 months, patients treated with galantamine were more likely to experience a reduction of verbal repetition than those treated with placebo. Diminution of verbal repetition was associated with other improvements, suggesting it might be a clinical marker of a positive treatment response.

Parental reassurance and pediatric procedural pain: a linguistic description.

UNLABELLED: Certain parental behaviors are associated with child coping and others with child distress when children undergo painful medical procedures. The finding that parental reassurance is linked with increases in child distress is perplexing and counterintuitive. The objective of the present study was to provide a detailed linguistic description of the speech functions and tones parents use when reassuring during painful medical procedures. Videotapes of 28 5-year-old children (12 boys, 16 girls) receiving immunizations who were accompanied by their parents were examined. The majority of reassuring verbalizations were statements; minor clauses (eg, "okay") were the next most frequent type of utterance. Half of the reassuring verbalizations were spoken with a falling tone, which is indicative of speaker certainty and protectiveness. This detailed linguistic approach offers new insights into the qualities of parental reassurance during painful medical procedures. Further research is needed to elucidate the complex interactions of tone, speech function, and reassurance and their effects on child distress. PERSPECTIVE: This article presents a detailed description of parental reassurance during pediatric immunizations. The description of the linguistic qualities of reassurance can help inform future research examining which characteristics of reassurance are associated with child distress and can help guide parental behavior during immunizations.

Verbal repetition in patients with Alzheimer's disease who receive donepezil.

BACKGROUND: Current outcome measures for Alzheimer's disease (AD) drugs have been criticized as insufficiently patient-centred. One commonly unmeasured goal of patients and caregivers is verbal repetition. OBJECTIVES: We examined how often reducing repetition (of questions, statements or stories) was set as treatment goal, whether and when it responded, and how change in repetition correlated with change in other domains. METHODS: This is a secondary analysis of the open-label Atlantic Canada Alzheimer's Disease Investigation of Expectations study of donepezil for mild-moderate AD in 100 community-dwelling people. Goal Attainment Scaling, an individualized account of the goals of treatment, was the primary outcome measure. RESULTS: Reducing repetition was a treatment goal in 46%, who were not systematically different from others. Of 18 patients in whom repetition improved for 9 months, 83% (15) showed a response at 3 months. Early (3-month) response correlated best with the overall level of goal attainment (r = 0.74) and changes in leisure activities (r = 0.69) and social interactions (r = 0.68) compared with changes in cognition (r = 0.44) or behaviour (r = 0.11). Correlations with the ADAS-Cog and MMSE change scores remained only modest (at 12 months = -0.25 and 0.19, respectively). Correlations with the CIBIC-Plus were higher (-0.47 at 3 months and -0.43 at 12 months). CONCLUSION: Diminution of repetition is common, and appears to mark response to cholinesterase inhibition in some patients. Responders generally also show improved cognition and function, perhaps as an aspect of improved executive function.

Self-referential tags in the discourse of people with Alzheimer's disease.

In a study of the discourse of 100 people with Alzheimer's disease treated for 12 months with donepezil, we observed that, as a group, they used a form of tag, described here as a self-referential tag (SRT), 14 times more frequently than did caregivers. Patients use SRTs to check propositions dependent on episodic memory as in I haven't seen the doctor recently, have I? and to monitor information flow as in I told you that already, didn't I? Based on criteria developed for distinguishing checking from monitoring tags, we document the type and frequency of patients' SRT use in the ACADIE corpus and analyze these in relation to standard measures of cognitive function (Mini Mental State Exam and Alzheimer's Disease Assessment Scale-cognitive sub-scale) at baseline and 12 months. Patients using monitoring SRTs (N=31), with or without checking SRTs, show significantly better cognitive test scores at 12 months, than are seen in patients who never use tags (N=29), or who only use checking tags (N=40). SRT use may be an independent measure of potential treatment responsiveness.