The discrepancy hypothesis in children with language disorders: does it work?

OBJECTIVES: Analysis of the relationship between verbal and nonverbal development in children with language problems. METHODS: From 134 children enrolled in a multidisciplinary diagnostic procedure in a speech and hearing clinic and diagnosed as having a language disorder, the language comprehension score (LCQ) and the nonverbal IQ score (SON-IQ) were compared. t-Tests were used to test whether the children's mean LCQ differs from their mean SON-IQ and to test whether the children with an inadequate LCQ differ from children with an adequate LCQ with respect to discrepancy. Plots inspired by Bland and Altman [18] display the measurement of mean value of verbal and nonverbal development against the discrepancy between these scores. RESULTS: All children had a language production problem (inadequate GDS). Out of the 57 children with an adequate language comprehension (LCQ>80), 16 children (28%) show a discrepancy of 10 quotient points or more between their LCQ and SON-IQ. Out of the 77 children with an inadequate language comprehension (LCQ80 the discrepancy is not significant (p=0.084). CONCLUSIONS: The discrepancy hypothesis, in our opinion, must be modified. There is not only verbal and nonverbal functioning but there is language production, language comprehension and nonverbal learning abilities. Between these three aspects discrepancies can be found. In 43% of the children there is a discrepancy between language production and language comprehension. When children also show language comprehension problems, 58% of these children show a discrepancy with nonverbal functioning.

Communicative abilities in toddlers and in early school age children with cleft palate.

OBJECTIVES: Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate. METHODS: Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed. RESULTS: Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%. CONCLUSIONS: At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.

Global developmental delay in guanidionacetate methyltransferase deficiency: differences in formal testing and clinical observation.

Guanidinoacetate N-methyltransferase (GAMT) deficiency is a defect in the biosynthesis of creatine (Cr). So far, reports have not focused on the description of developmental abilities in this disorder. Here, we present the result of formal testing of developmental abilities in a GAMT-deficient patient. Our patient, a 3-year-old boy with GAMT deficiency, presented clinically with a severe language production delay and nearly normal nonverbal development. Treatment with oral Cr supplementation led to partial restoration of the cerebral Cr concentration and a clinically remarkable acceleration of language production development. In contrast to clinical observation, formal testing showed a rather harmonic developmental delay before therapy and a general improvement, but no specific acceleration of language development after therapy. From our case, we conclude that in GAMT deficiency language delay is not always more prominent than delays in other developmental areas. The discrepancy between the clinical impression and formal testing underscores the importance of applying standardized tests in children with developmental delays. Screening for Cr deficiency by metabolite analysis of body fluids or proton magnetic resonance spectroscopy of the brain deficiency should be considered in any child with global developmental delay/mental retardation lacking clues for an alternative etiology.

Language disorders in young children: when is speech therapy recommended?

OBJECTIVE: Analysis of treatment recommendation given by speech therapists. Evaluation of the language abilities in the examined children and re-examination of those abilities after 12 months. MATERIALS AND METHODS: Thirty-four children, aged between 2.0 and 5.3 years, referred to speech therapists by their General Practitioners because of possible language problems were included in a prospective study. The number of children receiving speech therapy and the number of speech therapy sessions received during 1 year, and the therapy effect on three quantitative language measures were compiled. RESULTS: In 97% of the children referred to a speech therapist, speech therapy was recommended. Most of these children showed average to above-average language scores on standardised tests for sentence development (61%) and language comprehension (79%). In addition, for most children spontaneous speech, as screened by the Groningen Diagnostic Speech Norms, was age-adequate (76%). The children's problems consisted of pronunciation difficulties or periods of stammering. After 12 months for 50% of these children speech therapy was still continued which means that the articulation problems still were present. The mean number of speech therapy sessions was 26.7. The language scores on the three language tests remained relatively stable over the 12-month interval. CONCLUSIONS: In young children pronunciation difficulties often lead to the recommendation for speech therapy. For a large number of children therapy takes more than a year, indicating that speech therapy cannot influence these problems to a great extent. In addition language scores remained relatively stable. Therefore, language problems and especially articulation problems in young children should be reconsidered regarding maturation and normal variations in speech motor development. A 'watchful waiting' approach should be taken more often.

Specific language impairment in children with velocardiofacial syndrome: four case studies.

OBJECTIVE: To describe specific language impairment in four children with velocardiofacial syndrome (VCFS). DESIGN: A descriptive, retrospective study of four cases. SETTING: University Hospital Groningen, tertiary clinical care. PATIENTS: Of 350 patients with cleft plate, 18 children were diagnosed with VCFS. Four children are described. INTERVENTIONS: In all children, cardiac and plastic surgery was carried out in the first year of life. Afterward, interventions consisted of hearing improvement, pharyngoplasty, and speech therapy. MAIN OUTCOME: Inadequate and uncharacteristic development of articulation and expressive language in four children with VCFS were observed. They differed from the majority in two ways: their nonverbal IQ was in the normal range, and their language skills were below expectations for their IQ. RESULTS: Four of 18 patients with VCFS (22%) showed poor response to therapy and did not develop language in accordance with their normal learning abilities (nonverbal learning capacities and language comprehension). Persistent hypernasal resonance and severe articulation problems remained in all four children. In two children the expressive language profile was also not in agreement with the nonverbal profile: they produced only two- and three-word utterances at the age of 6.0 and 5.3 years. The other two children at the age of 6.8 and 6.4 years produced very long sentences, but they were unintelligible. CONCLUSIONS: The speech and language impairment of the four children may be characterized as a phonological or verbal programming deficit syndrome and as such can be described as a specific language impairment in conjunction with VCFS.

Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay.

OBJECTIVE: this article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders. DESIGN: retrospective study-a follow-up after a mean of 2 years. MATERIALS AND METHODS: verbal and non-verbal functioning before and after therapy were examined in 31 language-impaired children with normal hearing and good health. In 16 children the language functioning was substantial behind their non-verbal functioning. They were categorised as children with specific language impairment (SLI). In 15 children the language problem was in comorbidity with cognitive delay, and these were categorised as children with non-SLI. At the first examination the children were at the age of 1;5-5;4 years and at the second examination they were at the age of 3;4-6;11 years. The children were examined for language comprehension (Standardised Dutch version of the Reynell Developmental Comprehension Scale), spontaneous language production (Groningen Diagnostic Speech norms) and non-verbal functioning (Snijders-Oomen non-verbal intelligence scale for children between 2 1/2 and 7 years). RESULTS: in both groups, a significant improvement was found in language functioning as well as in non-verbal functioning. Language comprehension and non-verbal IQ-scores in both groups improved by about the same amount. Language production made significantly more progress in the SLI group than in the non-SLI group. The improvements in the SLI group were mainly reached by speech therapy, whereas in the non-SLI group this was less the case. CONCLUSIONS: verbal and non-verbal development can improve in young children with developmental language delay. This underlines the idea that language and cognitive development are interacting and influencing each other in a positive way. Children with SLI seem to benefit more from speech therapy, whereas children with cognitive delay seem to benefit more from special education.