School-age outcomes of late-talking toddlers: Long-term effects of an early lexical deficit.

BACKGROUND: Early intervention for children identified as late talkers (LTs) at the age of 24 months is still a controversial issue in research and clinical routine. Previous studies have shown inconsistent results regarding predictors of early lexical deficits on school-age outcomes of late-talking toddlers. METHODS: In a five-wave follow-up study, we investigated various aspects of language and literacy abilities in 39 German-speaking third-graders who had been identified as LTs at the age of 24 months, compared to 39 typically developing children (TDC) also attending the third grade. The duration of auditory sensory memory was examined at the age of 4 years using mismatch negativity (MMN) of tones - an event-related potential not confounded by any language skill. In addition, the predictive value of memory performance was examined in a longitudinal perspective. RESULTS: Overall, LTs scored within normal range in language and literacy assessments. However, LTs differed from TDC in vocabulary size, verbalization of semantic relations, non-word repetition, and spelling. The findings can be explained by phonological working memory. The duration of auditory sensory memory and spatial working memory did not account for any variance. CONCLUSIONS: LTs sustain persistent phonological processing limitations even though their native language and literacy performance lay within the normal range at school age. Further research on second language acquisition, academic achievements, and the efficacy of early intervention in late-talking toddlers is recommended.

[Early identification of children with developmental language disorders - when and how?]. / Früherkennung von umschriebenen Sprachentwicklungsstörungen.

Children with developmental language disorders have a high risk for their cognitive, social, and emotional development. Therefore, they should be identified and treated as early as possible. This paper reviews the possibilities and limits of methods for such early identification. Language screenings during the first 3 years of life are described and appraised with respect to their diagnostic accuracy. The overview indicates that the current stage of language development can be estimated with high reliability by means of parent questionnaires. The possibility of identifying children with developmental language disorders early on is limited. Precursors and first steps of language acquisition correlate with later language abilities, although the relationship is weak and predicting further language development in a individual child is not possible. At the end of the second year of life, however, late talkers can be identified; these children are at risk of language impairment. But not until the end of the third year can sufficient detection of language-impaired children succeed. Parent questionnaires are the most reliable screening instruments for evaluating language abilities during the first 3 years.

[Concepts of therapy for children with dyslexia]. / Konzepte in der LRS-Therapie.

Numerous methods based on very different concepts are available to treat children with dyslexia. Basically, symptomatic and causal principles can be distinguished. Among the symptomatic methods are systematic programmes based on learning theory, in which reading and spelling or precursors of these abilities are directly trained. Causal methods promise pronounced and persistent improvement of reading and spelling abilities through elimination of the postulated reason underlying the learning disabilities. Among the causal methods are treatment programmes that train low-level functions. Such training is based on the assumption that deficits of auditory, visual or kinesthetic perception, of motor skills or of the coordination of cerebral functional areas are at the bottom of specific learning disabilities. Concepts of other causal methods act on the assumption that learning processes are blocked or that abnormal medical conditions or psychiatric disorders constitute the background of dyslexia. Reviewed in the article are treatment concepts for children with dyslexia in the German-speaking countries and the methods of treatment derived from the different concepts. Results of evaluation studies are summarized and characteristics of effective treatment methods are listed. It is stressed that efficacy is proven only for symptomatic training programmes but not for causal methods.

Auditory sensory memory and language abilities in former late talkers: a mismatch negativity study.

The present study investigated whether (a) a reduced duration of auditory sensory memory is found in late talking children and (b) whether deficits of sensory memory are linked to persistent difficulties in language acquisition. Former late talkers and children without delayed language development were examined at the age of 4 years and 7 months using mismatch negativity (MMN) with interstimulus intervals (ISIs) of 500 ms and 2000 ms. Additionally, short-term memory, language skills, and nonverbal intelligence were assessed. MMN mean amplitude was reduced for the ISI of 2000 ms in former late talking children both with and without persistent language deficits. In summary, our findings suggest that late talkers are characterized by a reduced duration of auditory sensory memory. However, deficits in auditory sensory memory are not sufficient for persistent language difficulties and may be compensated for by some children.

[Significance of auditory perceptual disorders for pediatric and adolescent psychiatric disorders]. / Zur Bedeutung auditiver Wahrnehmungsstörungen für kinder- und jugendpsychiatrische Störungsbilder.

The clinical relevance of central auditory processing disorders (CAPD) is highly controversial. The paper explicates different concepts of CAPD and reviews empirical studies of the relationship between auditory deficits and learning or psychiatric disorders. The overview of the available literature reveals that numerous authors have described subnormal auditory abilities in groups of children with developmental language disorders, dyslexia or ADHD. However, little or no relationship between the severity of clinical impairment and auditory deficits has been found. Thus auditory deficits do not appear to be causally related to learning disorders or conduct disorders. With respect to the diagnostic process the review makes clear that the validity of the diagnosis CAPD is low. There is no agreement about diagnostic criteria, and the reliability of most auditory tests in insufficient. Moreover, while an auditory training can only improve the directly trained auditory functions, there is no transfer effect to learning ability of behavior. Altogether there is little evidence for a significant relevance of CAPD in Child and Adolescent Psychiatry.

Children with specific language impairment: the role of prosodic processes in explaining difficulties in processing syntactic information.

Children with specific language impairment (SLI) experience great difficulties in language comprehension and/or production whereby the majority of these children have particular problems in acquiring syntactic rules. In the speech stream boundaries of major syntactic constituents are reliably marked by prosodic cues. Therefore, prosodic information provides an important cue for discovering the syntactic structure of a language [Jusczyk, P.W., 2002. How infants adapt speech-processing capacities to native language structure. Curr. Dir. Psychol. Sci. 11, 15-18.]. Following this, the question is, whether children with SLI differ in the processing of syntactic information from normally developing children and to what extent this is related to the processing of the inherent prosodic information. Children heard either correct sentences or sentences with a word category violation (syntactic level) and a joined prosodic incongruity (prosodic level) while event-related brain potentials (ERPs) were recorded. Judging the sentence's correctness, control children performed better than children with SLI for all types of sentences. With respect to the ERPs, control children showed a bilateral early starting anterior negativity sustaining into a late anterior negativity and a P600 in posterior regions in response to incorrect sentences. Children with SLI showed a comparable P600 but unlike the control children there was only a late, clearly left lateralized anterior negativity. The complete absence of a right anterior negativity in children with SLI suggests that they may not access prosodic information in the same way normal children do. The differences in prosodic processing may in turn hamper the development of syntactic processing skills as indicated by the absence of the syntax-related early left anterior negativity.

Perceived stigmatization of children with speech-language impairment and their parents.

OBJECTIVE: Developmental disorders in childhood are generally assumed to have stigmatizing effects. The goal of the present study was to assess whether parents of children with speech-language impairment perceive stigmatization of their child or themselves and which variables influence the degree of negative labeling. SUBJECTS AND METHODS: The study was based on 362 questionnaires completed by parents of children with speech-language impairment. The questionnaires concerned perceived stigmatization by other children, other adults and family members as a result of the child's developmental problems. RESULTS: In our sample, about 50% of the parents reported negative labeling of their child and about 30% felt they were involved in the stigmatizing process. Parents whose children also had behavioral problems more often reported negative labeling than parents whose children did not. CONCLUSION: The findings suggest that parents of children with speech-language disorders often perceive stigmatization of their children or themselves. In counseling such families, professionals should therefore address stigmatization and its consequences as a separate and important issue.

Development of auditory sensory memory from 2 to 6 years: an MMN study.

Short-term storage of auditory information is thought to be a precondition for cognitive development, and deficits in short-term memory are believed to underlie learning disabilities and specific language disorders. We examined the development of the duration of auditory sensory memory in normally developing children between the ages of 2 and 6 years. To probe the lifetime of auditory sensory memory we elicited the mismatch negativity (MMN), a component of the late auditory evoked potential, with tone stimuli of two different frequencies presented with various interstimulus intervals between 500 and 5,000 ms. Our findings suggest that memory traces for tone characteristics have a duration of 1-2 s in 2- and 3-year-old children, more than 2 s in 4-year-olds and 3-5 s in 6-year-olds. The results provide insights into the maturational processes involved in auditory sensory memory during the sensitive period of cognitive development.

Auditory sensory memory in 2-year-old children: an event-related potential study.

Auditory sensory memory is assumed to play an important role in cognitive development, but little is known about it in young children. The aim of this study was to estimate the duration of auditory sensory memory in 2-year-old children. We recorded the mismatch negativity in response to tone stimuli presented with different interstimulus intervals. Our findings suggest that in 2-year-old children the memory representation of the standard tone remains in the sensory memory store for at least 1 s but for less than 2 s. Recording the mismatch negativity with stimuli presented at various interstimulus intervals seems to be a useful method for studying the relationship between auditory sensory memory and normal and disturbed cognitive development.

Early identification of language delay by direct language assessment or parent report?

OBJECTIVE: The goal of the study was to compare the accuracy and diagnostic power of a parent report measure and direct language assessment for early identification of children with language delay. METHOD: The parent language report and direct language measures were compared for 47 typically developing toddlers and 70 late-talking toddlers aged 24 to 26 months. One year later, language abilities of 102 of the 117 children were reassessed. RESULTS: The concurrent validity of the parent report was high both for judging language skills and for identifying language delay. No evidence was found of differences in the rating accuracy of mothers with different educational levels. Language abilities 1 year later were predicted better with direct language measurement than with the parent report. However, there were no differences between the accuracy of the parent report and individual language assessment concerning the prediction of language delay at age 3. CONCLUSION: The results suggest that the parent language report is a valid and efficient tool for assessing productive language abilities and judging expressive language delay in 2-year-old toddlers. The measurement characteristics of the parent report are comparable with those of direct language measures.

[Early identification of language delay among two-year-olds--a comparison of methods]. / Früherkennung von Sprachentwicklungsstörungen--ein Methodenvergleich.

OBJECTIVE: In recent years, several language tests and parent questionnaires targeting the early identification of language delay have been developed. The present study compares the results from two such language tests administered to two-year-old children and those from a parent report measure. METHOD: Thirty-one normally developing or late-talking toddlers (aged 24 to 28 months) were included in the study. Their language skills were assessed by means of a parent report (ELFRA-2, a German version of the MacArthur Communicative Development Inventories--CDI, Toddler Form) and two language tests (SETK-2, RDLS III). RESULTS: The concordance regarding the level of language skills was high for all three measures. The correlations between subtest measures that assess similar language dimensions varied between rSp = 0.7 and 0.9. Most children who were classified as late talkers based on the parent report measure were also classified as having a language delay on the basis of both language tests. However, the language delay on the part of the late-talking children usually was not recognized during the routine pediatric examination at the age of 24 months. CONCLUSIONS: Parent reports and language tests identify late talkers almost equally well. Hence, the parent questionnaire ELFRA-2 is recommended as the primary instrument for the early identification of late talkers at age two. If the results on the parent report are below normal, further assessment of the child's language abilities by means of the SETK-2 is advisable. In contrast to language assessment on the basis of the parent report, assessment based on the SETK-2 provides information on language comprehension and thus enables a more sophisticated assessment of the child's language skills. The SETK-2 consists mainly of pictures, however. For those children who show little interest in the pictures in a clinical setting, use of the RDLS III should be considered.

Maturation of the long-latency auditory ERP: step function changes at start and end of adolescence.

The auditory event-related potential (ERP) is obtained by averaging electrical impulses recorded from the scalp in response to repeated stimuli. Previous work has shown large differences between children, adolescents and adults in the late auditory ERP, raising the possibility that analysis of waveform shape might be useful as an index of brain maturity. We reanalysed auditory ERPs from samples previously described by Albrecht, von Suchodoletz and Uwer (2000) and Uwer, Albrecht and von Suchodoletz (2002), using the intraclass correlation (ICC) as a global measure of similarity of an individual's waveform to a grand average comparison waveform for each age band. Three developmental periods were clearly distinguished: 5 to 12 years, 13 to 16 years, and adulthood. However, within each of these periods, there was no evidence of any developmental progression with age.

Atypical long-latency auditory event-related potentials in a subset of children with specific language impairment.

It has been proposed that specific language impairment (SLI) is the consequence of low-level abnormalities in auditory perception. However, studies of long-latency auditory ERPs in children with SLI have generated inconsistent findings. A possible reason for this inconsistency is the heterogeneity of SLI. The intraclass correlation (ICC) has been proposed as a useful statistic for evaluating heterogeneity because it allows one to compare an individual's auditory ERP with the grand average waveform from a typically developing reference group. We used this method to reanalyse auditory ERPs from a sample previously described by Uwer, Albrecht and von Suchodoletz (2002). In a subset of children with receptive SLI, there was less correspondence (i.e. lower ICC) with the normative waveform (based on the control grand average) than for typically developing children. This poorer correspondence was seen in responses to both tone and speech stimuli for the period 100-228 ms post stimulus onset. The effect was lateralized and seen at right- but not left-sided electrodes.

Lexical-semantic processes in children with specific language impairment.

The current study used event-related brain potentials to investigate lexical-semantic processing of words in sentences spoken by children with specific language impairment and children with normal language development. Children heard correct sentences and sentences with a violation of the selectional restriction of the verb. Control children showed an N400 effect followed by a late positivity for the incorrect sentences. In contrast, children with specific language impairment showed no N400 effect but did show a late, broadly distributed positivity. This absence of the N400 effect is due to a relatively large negativity for correct sentences, suggesting weaker lexical-semantic representations of the verbs and their selectional restrictions in children with specific language impairment.

[Stigmatization of language impaired children from the parents' perspective]. / Stigmatisierung sprachgestörter Kinder aus Sicht der Eltern.

Stigmatization can strongly affect the social integration of children and adolescents with developmental and behavioral disorders. The goal of the study was to investigate negative and positive labeling of speech-language impaired children as perceived by their parents. We analyzed 386 parental questionnaires on stigmatization by and support from other children, family members and other adults. Half of the parents reported stigmatization of their child. They perceived negative labeling and exclusion most frequently in the child's peer group, but also among family members. Support was more common than negative labeling, however. There was a strong positive relationship between negative labeling and behavioral problems. Parents of children with developmental and behavioral disorders often perceive stigmatization of their child. Therefore, in counseling such families child and adolescent psychiatrists should address this issue adequately and recommend appropriate coping strategies.

Measurement of temporal-order judgment in children.

Abnormal auditory temporal processing might be an underlying deficit in language disabilities. The auditory temporal-order threshold, one measure for temporal processing abilities, is defined as the shortest time interval between two acoustic events necessary for a person to be able to identify the correct temporal order. In our study, we examined the reliability of the auditory temporal-order threshold during a one-week period and over a time interval of four months in normally developing children aged 5 to 11 years. The results of our method show that children younger than 7 years have difficulties performing the task successfully. The reliability of the assessment of the temporal-order threshold during a period of one week is only moderate, and its stability over a time interval of four months is low. The results show that auditory-order thresholds in children have to be treated with caution. A high temporal-order threshold does not necessarily predict disabilities in temporal processing.