The development of lexical processing: Real-time phonological competition and semantic activation in school age children.

Prior research suggests that the development of speech perception and word recognition stabilises in early childhood. However, recent work suggests that development of these processes continues throughout adolescence. This study aimed to investigate whether these developmental changes are based solely within the lexical system or are due to domain general changes, and to extend this investigation to lexical-semantic processing. We used two Visual World Paradigm tasks: one to examine phonological and semantic processing, one to capture non-linguistic domain-general skills. We tested 43 seven- to nine-year-olds, 42 ten- to thirteen-year-olds, and 30 sixteen- to seventeen-year-olds. Older children were quicker to fixate the target word and exhibited earlier onset and offset of fixations to both semantic and phonological competitors. Visual/cognitive skills explained significant, but not all, variance in the development of these effects. Developmental changes in semantic activation were largely attributable to changes in upstream phonological processing. These results suggest that the concurrent development of linguistic processes and broader visual/cognitive skills lead to developmental changes in real-time phonological competition, while semantic activation is more stable across these ages.

Specific language impairment: a convenient label for whom?

BACKGROUND: The term 'specific language impairment' (SLI), in use since the 1980s, describes children with language impairment whose cognitive skills are within normal limits where there is no identifiable reason for the language impairment. SLI is determined by applying exclusionary criteria, so that it is defined by what it is not rather than by what it is. The recent decision to not include SLI in DSM-5 provoked much debate and concern from researchers and clinicians. AIMS: To explore how the term 'specific language impairment' emerged, to consider how disorders, including SLI, are generally defined and to explore how societal changes might impact on use the term. METHODS & PROCEDURES: We reviewed the literature to explore the origins of the term 'specific language impairment' and present published evidence, as well as new analyses of population data, to explore the validity of continuing to use the term. OUTCOMES & RESULTS AND CONCLUSIONS & IMPLICATIONS: We support the decision to exclude the term 'specific language impairment' from DSM-5 and conclude that the term has been a convenient label for researchers, but that the current classification is unacceptably arbitrary. Furthermore, we argue there is no empirical evidence to support the continued use of the term SLI and limited evidence that it has provided any real benefits for children and their families. In fact, the term may be disadvantageous to some due to the use of exclusionary criteria to determine eligibility for and access to speech pathology services. We propose the following recommendations. First, that the word 'specific' be removed and the label 'language impairment' be used. Second, that the exclusionary criteria be relaxed and in their place inclusionary criteria be adopted that take into account the fluid nature of language development particularly in the preschool period. Building on the goodwill and collaborations between the clinical and research communities we propose the establishment of an international consensus panel to develop an agreed definition and set of criteria for language impairment. Given the rich data now available in population studies it is possible to test the validity of these definitions and criteria. Consultation with service users and policy-makers should be incorporated into the decision-making process.

Terminological debate over language impairment in children: forward movement and sticking points.

BACKGROUND: There is no agreed terminology for describing childhood language problems. In this special issue Reilly et al. and Bishop review the history of the most widely used label, 'specific language impairment' (SLI), and discuss the pros and cons of various terms. Commentators from a range of backgrounds, in terms of both discipline and geographical background, were then invited to respond to each lead article. AIMS: To summarize the main points made by the commentators and identify (1) points of consensus and disagreement, (2) issues for debate including the drivers for change and diagnostic criteria, and (3) the way forward. CONCLUSIONS & IMPLICATIONS: There was some common ground, namely that the current situation is not tenable because it impedes clinical and research progress and impacts on access to services. There were also wide-ranging disagreements about which term should be adopted. However, before debating the broad diagnostic label it is essential to consider the diagnostic criteria and the systems used to classify childhood language problems. This is critical in order to facilitate communication between and among clinicians and researchers, across sectors (in particular health and education), with the media and policy-makers and with families and individuals who have language problems. We suggest four criteria be taken into account when establishing diagnostic criteria, including: (1) the features of language, (2) the impact on functioning and participation, (3) the presence/absence of other impairments, and (4) the language trajectory or pathway and age of onset. In future, these criteria may expand to include the genetic and neural markers for language problems. Finally, there was overarching agreement about the need for an international and multidisciplinary forum to move this debate forward. The purpose would be to develop consensus regarding the diagnostic criteria and diagnostic label for children with language problems. This process should include canvassing the views of families and people with language problems as well as the views of policy-makers.

Co-morbidity of autism and SLI: kinds, kin and complexity.

There has been a long-standing interest in the relationship between specific language impairment (SLI) and autism spectrum disorder (ASD). In the last decade Tager-Flusberg and colleagues have proposed that this relationship consists of a partial overlap between the two. Therefore, among children with ASD there exists a subgroup who have SLI and ASD which has been called 'ALI'. Tager-Flusberg's laboratory has presented several papers showing similar language profiles and brain structure abnormalities in both SLI and ALI. Others (Bishop, Whitehouse, Botting, Williams) have been less convinced that these ALI children have both ASD and SLI. Although they generally agree that the two groups are grossly similar, careful inspection of the data shows that there are differences. I will argue that many of the problems in this debate stem from a view of SLI that represents a particular kind of language learner and therefore a particular and unique profile can be assumed. I argue for recognizing that SLI is not likely to be a unique kind of language learner. Many of the features reported to be characteristic of SLI are also found in other forms of neurodevelopmental disorders. Other features are the outgrowth of studying clinically identified children with SLI and thus the profile appears to reflect biases and practices in the clinical service system. As a result it may be more reasonable to conclude that there is a large group of children with ASD who have poor language skills. The question then remains why are there so many children with ASD who also have poor language? There are several factors that collectively are strong candidates for answers to this question.

Bilateral cochlear implants in infants: a new approach--Nucleus Hybrid S12 project.

OBJECTIVE: The purpose of this feasibility study was to evaluate whether the use of a shorter-length cochlear implant (10 mm) on one ear and a standard electrode (24 mm) on the contralateral ear is a viable bilateral option for children with profound bilateral sensorineural hearing loss. A secondary purpose of this study was to determine whether the ear with the shorter-length electrode performs similarly to the standard-length electrode. Our goal was to provide an option of electrical stimulation that theoretically might preserve the structures of the scala media and organ of Corti. STUDY DESIGN: The study is being conducted as a repeated-measure, single-subject experiment. SETTING: University of Iowa-Department of Otolaryngology. PATIENTS: Eight pediatric patients with profound bilateral sensorineural hearing loss between the ages of 12 and 24 months. INTERVENTIONS: Nucleus Hybrid S12 10-mm electrode and a Nucleus Freedom implant in the contralateral ear. MAIN OUTCOME MEASURES: The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) parent questionnaire, Early Speech Perception, Glendonald Auditory Screening Procedure word test, and Children's Vowel tests will be used to evaluate speech perception and the Minnesota Child Development Inventory and Preschool Language Scales 3 test will be used to evaluate language growth. RESULTS: Preliminary results for 8 children have been collected before and after the operation using the IT-MAIS. All 3 children showed incremental improvements in their IT-MAIS scores overtime. Early Speech Perception, Glendonald Auditory Screening Procedure word test, and Children's Vowel word perception results indicated no difference between the individual ears for the 2 children tested. Performance compared with age-matched children implanted with standard bilateral cochlear implants showed similar results to the children implanted with Nucleus Hybrid S12 10-mm electrode and a Nucleus Freedom implant in contralateral ears. CONCLUSION: The use of a shorter-length cochlear implant on one ear and a standard-length electrode on the contralateral ear might provide a viable option for bilateral cochlear implantation in children with bilateral profound sensorineural hearing loss. Further study of this patient population will be continued.

Current state of knowledge: outcomes research in children with mild to severe hearing impairment--approaches and methodological considerations.

This paper will provide a backdrop to the others in this section on outcomes of children with mild to moderate sensorineural hearing loss. Our objective here is to provide an overview of the research approaches used to study the outcomes of these children to provide guidance for future studies of children with mild to severe sensorineural hearing impairment (HI). During the past 20 yr there has been a gradual coalescence of research practices concerned with examining outcomes. Those who have done this work have come from different disciplines and in many cases were motivated by different circumstances. As a result, terminology and perspectives on outcomes research often still bears the features of these different disciplines and objectives of this research. This paper is an effort to provide the reader with an overview of this research endeavor that will highlight the diversity of the work being conducted on outcomes but also emphasizes the common properties. This overview will emphasize the kinds of research questions that are asked in this area of research and the associated evidence obtained to address these research questions. After this initial section there will be a consideration of the methodological issues that need to be considered, particularly for outcome research in children with HI.

Children with a cochlear implant: characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production.

The objectives of the study were to describe the characteristics of the first 79 prelingually deaf cochlear implant users in Norway and to investigate to what degree the variation in speech recognition, speech- recognition growth rate, and speech production could be explained by the characteristics of the child, the cochlear implant, the family, and the educational setting. Data gathered longitudinally were analysed using descriptive statistics, multiple regression, and growth-curve analysis. The results show that more than 50% of the variation could be explained by these characteristics. Daily user-time, non-verbal intelligence, mode of communication, length of CI experience, and educational placement had the highest effect on the outcome. The results also indicate that children educated in a bilingual approach to education have better speech perception and faster speech perception growth rate with increased focus on spoken language.

Communicative competence in parents of children with autism and parents of children with specific language impairment.

While the primary language deficit in autism has been thought to be pragmatic, and in specific language impairment (SLI) structural, recent research suggests phenomenological and possibly genetic overlap between the two syndromes. To compare communicative competence in parents of children with autism, SLI, and down syndrome (DS), we used a modified pragmatic rating scale (PRS-M). Videotapes of conversational interviews with 47 autism, 47 SLI, and 21 DS parents were scored blind to group membership. Autism and SLI parents had significantly lower communication abilities than DS parents. Fifteen percent of the autism and SLI parents showed severe deficits. Our results suggest that impaired communication is part of the broader autism phenotype and a broader SLI phenotype, especially among male family members.

Familiar melody recognition by children and adults using cochlear implants and normal hearing children.

This study investigated the effects of age at time of testing, hearing history (age at hearing loss) and hearing status on melody recognition. Four groups were compared: children with normal hearing thresholds, and three groups of cochlear implant recipients (children with prelingual deafness, children with postlingual deafness, adults with postlingual deafness). Participants were tested for recognition of familiar melodies (no lyrics) in a closed-set task. Groups differed in accuracy in the following rank order (most to least accurate): children with normal hearing thresholds, adult cochlear implant recipients, children with postlingual deafness, children with prelingual deafness. Melody recognition scores were correlated with age, variables regarding hearing history, musical background/experience and speech perception scores.

Performance of cochlear implant recipients with GJB2-related deafness.

Congenital profound hearing loss affects 0.05-0.1% of children and has many causes, some of which are associated with cognitive delay. For prelingually-deafened cochlear implant recipients, the etiology of deafness is usually unknown. Mutations in GJB2 have been established as the most common cause of heritable deafness in the United States. In this report, we identify cochlear implant recipients with GJB2-related deafness and examine the performance of these individuals. Cochlear implant recipients received a battery of perceptive, cognitive, and reading tests. Neither subjects nor examiners knew the etiology of deafness in these individuals. The implant recipients were then examined for mutations in GJB2 using an allele-specific polymerase chain reaction assay, single-strand conformation polymorphism analysis, and direct sequencing. GJB2 mutations were the leading cause of congenital deafness among the cochlear implant recipients screened. Cochlear implant recipients with GJB2-related deafness read within one standard deviation of hearing controls better than other congenitally deaf cochlear implant recipients and non-cochlear implant recipients. Individuals with congenital deafness should be offered GJB2 screening. Positive results establish an etiologic diagnosis and provide prognostic, genetic, and therapeutic information. Effective rehabilitation for profoundly deaf individuals with GJB2-related deafness is possible through cochlear implantation.