Fluency of conversational speech in children with unilateral brain lesions.

The spontaneous conversational speech of 20 children with unilateral left hemisphere lesions and 13 with right lesions was compared to normally developing peers matched by age, sex, race, and social class for instances of stuttering type nonfluencies, normal nonfluencies, and rate of speech. Both left and right lesioned children provided quantitatively more and qualitatively different patterns of nonfluencies than their neurologically normal peers. Left and right lesioned children produced more stuttering types of nonfluencies than their controls, but neither lesioned group produced a greater number of normal nonfluencies than controls. Left lesioned children also had a slower rate of speech as measured by number of syllables per second during either stuttered or fluent speech. Considerable variability was observed among lesioned children. Implications for neurogenic theories of developmental fluency disorders are discussed.

A familial study of severe phonological disorders.

The present study examined the familial basis for severe phonological disorders. Twenty children with severe phonological disorders and their siblings were compared to 20 normally developing children and their siblings on measures of phonology, language, reading, and motor ability. Results revealed that the siblings of the disordered children performed more poorly than control siblings on phonology and reading measures. Disordered subjects' phonological skills correlated significantly and positively with their siblings', whereas controls' scores did not. Families of disordered children reported significantly more members with speech and language disorders and dyslexia than did families of controls. Sex differences were reflected in the incidence but not the severity or type of disorder present. These findings suggest a familial basis for at least some forms of severe phonological disorders.

Effect of eyelid closure and vocalization upon the vestibulo-ocular reflex during rotational testing.

During rotational testing of the vestibulo-ocular reflex (VOR), eyelid closure is known to reduce both VOR gain and nystagmus frequency. We tested the effect of vocalization, such as counting aloud, on the VOR in ten healthy normal subjects. Velocity-step and sinusoidal stimuli were applied in complete darkness under three test conditions: 1) eyes open, performing mental arithmetic; 2) eyes closed, performing mental arithmetic; and 3) eyes closed and vocalizing. With velocity-step stimuli, eyelid closure significantly reduced VOR gain (peak eye velocity/head velocity) and nystagmus duration, but vocalization reversed these effects and resulted in the highest gain values. Similar results were obtained for VOR gain during sinusoidal stimulation. This study demonstrates that when eyelid closure is necessary or unavoidable during VOR testing, continuous vocalization ensures responses that are comparable to or better than those with eyes open in darkness.

Scholastic aptitude and achievement among children with unilateral brain lesions.

Cognitive abilities, scholastic aptitude and academic achievement were studied for 20 left hemisphere lesioned (LL) and 12 right hemisphere lesioned (RL) children in comparison with matched peers. On the Cognitive clusters, both LL and RL children performed significantly poorer than controls on the reasoning, perceptual speed and memory clusters. For the Scholastic Aptitude clusters, lesioned subjects performed significantly lower than controls on all clusters except for the knowledge cluster. On the Academic Achievement clusters, LL performed significantly poorer on the written language cluster while RL performed lower on the reading, math and written language clusters. Age of lesion onset, site of lesion and IQ differences are discussed in relationship to the ability clusters measured.

Auditory temporal perception of children with left or right brain lesions.

Twenty left and 12 right brain lesioned children were administered Tallal's Repetition Task in which they were required to discriminate, associate and sequence two nonverbal auditory stimuli. Unlike adults with left hemisphere injury or children with developmental language disorders previously described by Tallal, neither left nor right brain-lesioned children differ significantly from control subjects matched by age, sex, race and social class. These results contrast with earlier reports of impaired spoken syntax and delayed lexical retrieval among many of these same left lesioned children, suggesting that prelinguistic auditory processing and higher language deficits may be dissociable among young left hemisphere impaired children. The findings demonstrate that the higher level language deficits seen in the left brain lesioned children cannot be attributed to difficulty in more preliminary analyses of the acoustic stimuli.

Unilateral brain lesions in childhood: performance on the Revised Token Test.

Comprehension of connected language as assessed by the Revised Token Test (RTT) was studied in 17 children with left hemisphere lesions (LL) and 11 with right hemisphere lesions (RL). LL children's significantly lower performance on several subtests than left controls (LC) matched by age, sex, race, and social class appeared to be related to the memory demands of these subtests rather than the limited syntactic elements assessed by the RTT. LL subjects requested significantly more command repetitions than control or RL subjects and when a repetition was not requested LL subjects often responded with immediacy. Although RL children tended to perform lower than right matched controls (RC), these differences were not significant nor readily related to either the memory or specific linguistic structures assessed. RL subjects required fewer command repetitions than LL subjects and exhibited a significantly greater frequency of immediate responses than controls or LL subjects. While based on few children, a trend for LL children with retrorolandic lesions to perform more poorly than those with left prerolandic lesions was suggested. No systematic difference in performance was apparent for children with left cortical vs. left subcortical lesions or among discrete sites of lesions within the right hemisphere. Children with left lesions prior to 1 year of age performed no better and, in several instances, significantly poorer than LL patients sustaining lesions after 1 year of age. Among RL subjects, those sustaining lesions after 1 year of age had greater difficulty than those with lesion onset before 1 year of age, especially on linguistic elements which seemed to be dependent upon visual spatial properties. Further studies are needed to evaluate the comprehension of more complex linguistic structures among children with unilateral brain lesions as well as to study the role of more basic factors such as memory and attention in explaining the present findings.

Lexical retrieval in left and right brain lesioned children.

Performance on two measures of lexical retrieval for 19 left and 13 right brain lesioned children was compared to that of control subjects matched by age, sex, race, and social class. On the Word-Finding Test, left lesioned subjects were significantly slower in response time than left controls when given semantic and visual cues and made more errors when given rhyming cues. On the Rapid Automatized Naming Test, left lesioned subjects were significantly slower than left controls in naming all semantic categories, including colors, numbers, objects, and letters. In contrast, right lesioned subjects responded as quickly as or more quickly than did right controls in all access conditions and in naming semantic categories yet tended to produce more errors than their controls, suggesting a speed-accuracy tradeoff. Children sustaining left brain lesions before 1 year of age appeared to be as impaired as those whose lesions occurred after 1 year of age. Diverse lesion sites within the left hemisphere were associated with increased lexical retrieval latencies.

Trophic changes following early unilateral injury to the brain.

Measurements of the lengths of the feet and hands are reported for 15 neurologically normal children and for 17 children with left and 12 with right cerebral lesions. For those with left lesions the length of the left hand and foot significantly exceeded the right, while for those with right lesions the right hand and foot significantly exceeded the left. No significant foot or hand differences were found among the neurologically normal children. These findings demonstrate the association of atrophic limb-changes with unilateral brain lesions, and suggest that asymmetrical foot and hand growth may be a biological marker of early cerebral lesions.

Spoken syntax in children with acquired unilateral hemisphere lesions.

The spoken syntax of eight left hemisphere lesioned and eight right hemisphere lesioned children were compared to matched controls. The children's lesions were acquired between 0.08 and 6.17 years of age (mean = 1.33 years), and at the time of testing they were between 1.67 and 8.15 years of age (mean = 4.19). Based on analyses of spontaneous language samples, left hemisphere lesioned subjects performed more poorly than did their controls on most measures of simple and complex sentence structure. In contrast right lesioned subjects performed similarly to their controls on these measures, except for a tendency to make more errors in simple sentence structures. These findings provide further evidence that the left and right hemispheres are not comparable in supporting syntactic abilities.

Intelligence and hypoxemia in children with congenital heart disease: fact or artifact?

Previous studies have reported lower intelligence for cyanotic than for acyanotic children with congenital heart disorders, a finding attributed to the degree of hypoxemia present. Several important variables have not been examined consistently, however, including coexisting neurologic or genetic disorders, definitive surgery, degree of sickness, age at testing sex and social class. The present study examined the relation of these variables to obtained intelligence measures for 82 consecutively admitted children, excluding children with abnormal neurologic examinations and those having received definitive surgery. Consistent with earlier reports, intelligence quotients for the acyanotic children (112.81 +/- 14.52 mean +/- SD) were significantly higher (t = 2.60; p = 0.006) than for the cyanotic group (103.50 +/- 15.81). Although sex, race and social class were not significantly different between the 28 cyanotic and the 54 acyanotic children, the cyanotic children were significantly sicker (x2 = 9.12; p = 0.005) and younger (t = 4.10; p = 0.001). However, when young and old children and the degree of sickness within cyanotic and acyanotic groups were compared, no significant differences were found. These findings demonstrate that intelligence differences between cyanotic and acyanotic children persist when the effect of neurologic abnormalities and definitive surgery is removed and remain despite the severity of sickness or child's age at testing.

Verbal and cognitive sequelae following unilateral lesions acquired in early childhood.

Eight left-hemisphere lesioned children and eight right-hemisphere lesioned children between 18 months and 8 years of age were compared to control subjects on a battery of intelligence and language measures. Both left- and right-lesioned subjects had lower IQ scores than their controls, yet most functioned within the normal range or higher. Lexical comprehension and production were depressed in both subject groups and appeared to be depressed to a greater degree in right-lesioned subjects than in those with left lesions. In contrast, syntactic production in left-lesioned subjects was markedly deficient in comparison to controls as well as right-lesioned subjects. Although both subjects and controls included children with articulation errors, the number of misarticulating children and misarticulated sounds was greatest in the left-lesioned group. Finally, fluency disorders were observed in both right- and left-lesioned subjects but were not observed in controls. The study provides further evidence that the right and left hemispheres are not equipotential for language and that left-hemisphere lesions acquired early in childhood impair syntactic development to a greater degree than do right-hemisphere lesions.

Preschoolers with language disorders: 10 years later.

Language, intelligence, academic achievement, and behavioral adjustment were assessed in a group of 20 adolescents originally studied 10 years earlier as preschoolers with language disorders. At follow-up, 20% had WISC-R IQ scores in the mentally deficient range and were being educated in EMR classrooms. Of the remaining 16, 11 (69%) had required special tutoring, grade retention, or LD class placement. The majority of non-EMR subjects continued to evidence persistent deficits in language and academic achievement and were rated by their parents as being less socially competent and having more behavioral problems than their peers. Of the initial preschool measures available, the Leiter was found to be the best single predictor of intelligence, language, class placement, and reading achievement in adolescence, although the NSST: Expressive subtest also was a strong predictor of adolescent language.

Syntactic findings in developmental verbal apraxia.

Spontaneous language samples of eight children diagnosed as presenting developmental verbal apraxia were analyzed in terms of their mean length of utterance, Developmental Sentence Scores, use of 14 grammatical markers, and yes-no and wh-question forms. Although MLUs were greater than the range associated with stage V syntactic development, all children demonstrated difficulties with stage V and beyond grammatical markers and many omitted stage II markers. Developmental Sentence Scores were generally well below chronologic age expectations and revealed notable difficulties with personal pronoun and main verb selection. Omissions or noninversions of auxiliary and/or copulas in yes-no and wh-questions were apparent. Omissions of regular and irregular third-person singular markers, inconsistent use of regular and irregular past tense, and difficulty with question transformations provide evidence that at least some of the errors presented by this group of apraxic children cannot be attributed to motor speech and/or phonologic limitations but rather they evidence concomitant syntactic disorders.