The stability of AQT processing speed, ADAS-Cog and MMSE during acetylcholinesterase inhibitor treatment in Alzheimer's disease.

OBJECTIVES: To explore the longitudinal stability of measures of cognition during treatment with acetylcholinesterase inhibitors (AchEI) in patients with Alzheimer's disease (AD). MATERIALS AND METHODS: Cognitive status was measured in a cohort of 60 patients at 6 months after initiation of treatment with AchEI (baseline) and after an additional 6 months of treatment (endpoint). A Quick Test of Cognitive Speed (AQT), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and MMSE were administered concurrently. RESULTS: Correlations (rho) between age and AQT processing speed were non-significant, but were significant for ADAS-Cog and Mini Mental State Examination (MMSE). AQT and ADAS-Cog means did not differ significantly between baseline and endpoint. There was a small, significant reduction in MMSE point scores. Measures of stability (Spearman's rho) were moderate-to-high for all tests. Means for subgroups did not differ as a function of medication type. CONCLUSIONS: AQT processing speed, ADAS-Cog, and MMSE measures proved stable during the second 6 months of treatment with AChEI.

Developing a language screening test for Arabic-speaking children.

This report gives an account of general and specific issues associated with developing an Arabic-language screening test for children aged between 3 and 12 years. Challenges, dilemmas and stages in the developmental process are discussed. The development of the Arabic Language Screening Test: Preschool and School Age illustrates the process. Issues and stages included: (1) arriving at a consensus about scope and purpose; (2) conceptualizing tasks and items; (3) specifying item content and structure; (4) field-testing the screening tool in a circumscribed environment; (5) developing a robust scoring and interpretation system for determining Pass or Fail, and (6) establishing the degree of accuracy in differentiating children with and without language disorders. The product is a screening test of verbal and related nonverbal abilities with parallel components for children of preschool (3-5 years) and elementary school age (6-12 years). Normative data were collected for 750 Arabic-speaking children in Jordan and Palestine, distributed fairly equally between the ages of 3 and 12 years. Normative means increased with age and standard deviations decreased. Interscorer agreement (99%), internal consistency (Cronbach alpha = 0.98) and diagnostic sensitivity (over 90% accuracy) were high. Constraints and limitations in the development of the test are described and discussed from both objective and personal perspectives.

A clinical rationale for assessing rapid automatized naming in children with language disorders.

Three continuous rapid naming tasks (Semel, Wiig, & Secord, 1995) were administered to 2,450 American, English-speaking, academically achieving individuals with typical language development and intellectual ability (ages 6 to 21 years) and 136 individuals with primary language disorders (LD; ages 6, 7, 9, 11, 12, 15-16). Naming time in seconds differed significantly (p < .01) between the groups for color naming (Task 1) at age 12, shape naming (Task 2) at age 6, and color-shape naming (Task 3) at ages 6, 7, 9, and 12. Naming accuracy did not differ significantly (p > .01) between groups at the majority of the age levels compared. In the normative group, naming speed increased with age in a monotonic progression. The developmental trajectory in the LD group was essentially parallel, but elevated. The percentages of individuals who failed the naming-time criteria for Task 3 (color-shape naming) differed significantly in the two groups at all ages compared (p < .05). These findings indicate that the requirements for two-dimensional, continuous naming (Task 3 color-shape naming) resulted in reduced naming speed (longer total times) and interference with fluency in language production in about half of the clinical sample.

Assessments of adolescent language.

I have stressed that language and learning disabilities that are exhibited in the preschool or elementary school years often persist into adolescence but that the characteristics and implications of these disabilities change with the preadolescent and adolescent transitions to metalinguistic maturity. As the student with language disabilities matures and as educational demands increase in complexity and in level of abstractness, the interactions between language and cognition become more apparent. Language disabilities of adolescents are often described in relation to observed deficits in the acquisition of content (semantics), form (morphology and syntax), and use (pragmatics). I have broadened this perspective to consider identification of metalinguistic strengths and/or deficits, deficits in the integration and organization of communication, reasoning and problem solving, and in conceptualization and creativity. Several assessment options were discussed, among them, norm-and criterion- referenced testing, language sample analysis, portfolio assessments of integrated communication, observational checklists and interviews, classroom language probes, and self-assessments. The perspectives taken for assessment have been that no single assessment option can satisfy all assessment objectives and/or constraints. I have also stressed that all tests are subject to measurement error and how to account for this error. Last, but not least, I have shared some of the voices of adolescents which express their perspectives and priorities.

Interpreting figurative language expressions.

Interpretations of figurative language expressions were compared in matched samples of 28 language/learning-disabled (LLD) and 28 academically achieving (non-LLD) adolescents. LLD adolescents performed significantly poorer than their non-LLD age peers. All but 1 of 12 figurative language expressions contributed to the significant group difference. Stepwise discriminant analysis identified 3 figurative expressions as the best single predictors of an LLD group placement. Qualitative analysis indicated that the LLD group produced predominantly literal error interpretations while the non-LLD controls produced predominantly partial and/or incomplete error interpretations. The results indicate that interpretation and matching of figurative language expressions can assess levels of acquisition of metaphoric ability by adolescents and provide suggestions for intervention.

Language-learning disabilities: Paradigms for the nineties.

We are beginning a decade, during which many traditional paradigms in education, special education, and speech-language pathology will undergo change. Among paradigms considered promising for speech-language pathology in the schools are collaborative language intervention and strategy training for language and communication. This presentation introduces management models for developing a collaborative language intervention process, among them the Deming Management Method for Total Quality (TQ) (Deming 1986). Implementation models for language assessment and IEP planning and multicultural issues are also introduced (Damico and Nye 1990; Secord and Wiig in press). While attention to processes involved in developing and implementing collaborative language intervention is paramount, content should not be neglected. To this end, strategy training for language and communication is introduced as a viable paradigm. Macro- and micro-level process models for strategy training are featured and general issues are discussed (Ellis, Deshler, and Schumaker 1989; Swanson 1989; Wiig 1989).

Language disorders in childhood and adolescence: implications for learning and socialization.

Children and adolescents with language disorders encounter disruption in the fluency of social interaction. Because of the chronic nature of language disabilities, problems in academic achievement and success become the hallmark of the disorders during the school years. Since adolescence represents a time of experimentation and definition of the self, individuals with language disorders are at high risk for the development of fragmented and inappropriate perspectives about themselves. Treatment must address, in a functionally coordinated manner, the acquisition of essential linguistic and basic academic skills, the learning of curriculum content, and the development of appropriate perspectives of the self and the environment.

Psycholinguistic aspects of learning disorders: identification and assessment.

This article examines in detail the relationship between language and learning disorders in children of school age and the behavioral characteristics of children with language and learning disabilities. Guidelines are offered for screening for identification of language disorders and for differential diagnosis.

Perception and interpretation of explicit negations by learning-disabled children and adolescents.

The present study evaluated and compared the preception and interpretation of 21 explicit negative sentences by 15 learning disabled third graders and 15 controls, 20 learning disabled adolescents and 20 controls, and 16 randomly selected adults. The proportions of correct interpretations of the experimental sentences did not differ significantly among subject groups. In a similar vein the proportions of correct responses to individual test items did not differ significantly. The findings suggest that the learning-disabled third graders and adolescents adequately perceived the stressed negated elements and interpreted the meanings of the explicit negative sentences appropriately. These findings conflict with previous observations that dyslexic children experienced problems in processing prosodic suprasegmental features (Vogel, 1974).

Immediate recall fo semantically varied "sentences" by learning-disabled adolescents.

The immediate recall of 20 semantically and syntactically varied sentences was assessed and compared for 30 learning-disabled and 30 academically achieving adolescents. Learning-disabled adolescents repeated significantly fewer of the sentences verbatim than their achieving age peers. They exhibited significant reductions in the recall of sentences which violated semantic (selectional) rules, contained correctly and incorrectly sequenced modifier-strings, contained a random word-setting, or were syntactically complex. Perseveration errors occured more frequently among the learning-disabled adolescents than among the achievers and inter-sentence perseverative errors were exhibited only by those who were learning disabled. The rank order of difficulty for the sentences agreed for the two groups, suggesting primarily quantitative reductions in the immediate recall by the learning-disabled adolescents. The findings suggest that learning-disabled adolescents depend heavily upon semantic aspects for language processing, experience immediate memory and sequencing problems for modifier-strings, and exhibit a prevalence of interfering perseverative responses.