[Language Delay: What is the Prognosis of Late Bloomers?]. / Sprachentwicklungsverzögerung: Was wird aus Late Bloomern?

BACKGROUND: 30-50% of late talkers catch-up their language delay during the third year of life. So far it is unclear whether this is a permanent or an illusionary recovery. The aim of the study was to examine the further language development of late bloomers. METHOD: Language skills of 83 three-year-old children (16 late bloomers [LB], 29 late talkers [LT] with persistent language problems, 38 Non-LT) were assessed with a standardized language test. Before school entry formal language skills, expressive and receptive vocabulary and precursors of written language (verbal memory, phonological awareness, verbal information-processing speed) were assessed. RESULTS: At follow-up before school entry LB scored below Non-LT on phonological memory test. 31% of the LB in contrast to 3% of the Non-LT had slight language problems. 38% had received speech-language therapy. Nevertheless, no LB met the criteria of developmental language disorder. The language skills of LT with persistent language problems remained significantly below the level of LB and Non-LT. Every fourth of these children was language impaired. CONCLUSION: LB as a group are not at risk for later clinically relevant language disorders. However, their language abilities are often within the lower range of normal variation. Therefore, it is recommended to facilitate their language acquisition either by kindergarten training programs or by parent-directed intervention programs to provide a more stimulating environment.

[Language comprehension in late talkers]. / Sprachverständnis bei Late Talkers.

BACKGROUND: Late talkers (LTs) show very different courses of language development. The aim of this study was to examine whether subgrouping LTs in terms of language comprehension could allow the identification of specific subtypes with different prognoses. PATIENTS AND METHODS: Amongst other assessment strategies, standardized language (SETK-2, SETK 3-5), general nonverbal development (MFED, SON-R 2½-7) and hearing tests (TOAE) were used to examine 48 LTs at the ages of 25 and 37 months. RESULTS: Deficits in language comprehension were recorded for 38 % of the LTs. LTs with and without impaired language comprehension differed only slightly in terms of their further language and nonverbal development, as well as in terms of anamnestic data. Comprehension of words but not of sentences proved to be a predictor of later speech impairments. CONCLUSION: Classification of LTs based on the comprehension of single words, but not of sentences or general language comprehension, at the age of 25 months can define subgroups of children with different prognoses. However, this only leads to marginal improvements in the predicted development of LTs, since substantial impairment of word comprehension is rarely observed.

[Language development between the german preventive paediatric examinations at the age of 2 and 3 in children with and without language delay]. / Sprachentwicklung von der U7 bis zur U7a bei Kindern mit und ohne Sprachentwicklungsverzögerungen.

At the beginning the course of language acquisition has a high degree of variability and it is unclear so far, at what age language delay is of clinical relevance. The present study addresses the question whether language skills at the age of 2 years allow prognostic statements and whether children with language delay at this age, are to be considered as children of risk.Starting from birth announcements children of average (n=42), borderline (n=28) and below-average stage of language development (n=50) were recruited. The language skills were assessed at the age of 2 (25+0.6 months) and 3 years (37+0.6 months) using standardized language tests.The correlation between the global stage of language development at the age of 2 and 3 years was strong (rsp=0.78, p<0.001). At 3 years of age one third of the former late talkers reached language abilities within the normal range (late bloomers), one third showed language difficulties and the last third met the criteria of specific language impairment. The risk for language difficulties was increased in these children to the 13-fold. Even the late bloomers scored significantly lower in the language test compared to the control children.From the third year of live language development is relatively stable, and language skills at the age of 2 allow a prediction of the stage of language development one year later. Late talkers are at high risk for persistent language difficulties. A general language screening at the age of 2 years would enable an early identification of children at risk and an early parent-based intervention.

[Diagnostic accuracy of language tests and parent rating for identifying language disorders]. / Diagnostische Zuverlässigkeit von Sprachtests und Elternrating bei Sprachentwicklungsstörungen.

BACKGROUND: Until now German language tests have been rarely evaluated for their diagnostic accuracy. The goal of the study was to determine whether frequently used German language instruments are valid measures for identifying developmental language disorders in 3-year-old children. MATERIAL AND METHODS: The language test SETK 3-5 (including the short version SSV) and the parent questionnaire SBE-3-KT were administered to 88 children with and without language impairment. The procedure of the selection of children enabled an extrapolation to general population. A language sample rating was used as a gold standard. RESULTS: Depending on case definition 6-22% of children were classified as language impaired by SETK 3-5, 9% by SSV and 15% by SBE-3-KT. Sensitivity, specificity and positive predictive values of SETK 3-5 for specified cut-offs were 35-93%, 86-97% and 41-58%, respectively. The corresponding values of SSV were 49%, 96%, 56% and of SBE-3-KT 92%, 93%, 59%. CONCLUSIONS: 3-year-old children with developmental language disorders can been identified with sufficient accuracy by means of SETK 3-5, an individual language test, as well as by SBE-3-KT, a parent questionnaire. However, the number of false positive classifications is relatively high. The hit rate of SSV, an individual short test, was too low for clinical use.

[Possibilities and limitations of the early identification of developmental language disorders]. / Möglichkeiten und Grenzen der Früherkennung von Sprachentwicklungsstörungen.

BACKGROUND: It is not been proven to date that children with developmental language disorders can be identified by general language screening in 2-year-old children. The goal of the present study was to determine the predictive diagnostic power of the parent questionnaire SBE-2-KT. METHODS: The language abilities of 562 children were assessed using the SBE-2-KT at the age of 2 and reassessed 1 year later using the parent questionnaire SBE-3-KT. RESULTS: The correlation between language scores at age 2 and 3 were moderate and highly significant (rSp=0.59-0.68, p<0.001). Sensitivity, specificity, as well as positive and negative predictive values against language impairment at age 3 as a reference were 43%, 93%, 57% and 88%, respectively. CONCLUSIONS: The possibility to identify children with language disorders at the age of 2 is limited. Almost half of the children with delayed language development at age 2 had results on language screening within the normal range at 3 years. Furthermore, nearly every second child with subnormal language scores at age 3 is not classified as a late talker at age 2. Therefore, for early identification of language disorders a general reassessment of language skills is necessary at the age of 3.

[Validity of a parent questionnaire for identification of children with developmental language disorders at the age of 3 years (SBE-3-KT)]. / Diagnostische Zuverlässigkeit eines Elternfragebogens (SBE-3-KT) zur Erfassung von Kindern mit Sprachentwicklungsstörungen bei der U7a.

BACKGROUND: Up to now, no German language test for children has been controlled for diagnostic accuracy. Therefore the application of language tests in clinical diagnostics is limited. The aim of the study was to determine the diagnostic validity of the SBE-3-KT, a parent questionnaire for identification of children with developmental language disorders at the age of 3 years. SUBJECTS AND METHODS: Language skills of 91 children (aged from 33 to 38 months) were assessed by clinical examination and language tests (SETK 3-5, SSV) blinded against SBE-3-KT results. To calculate validity scores SBE-3-KT results were referenced to expert rating and results on language tests. RESULTS: All children who were sorted in the language disorders group according to the expert rating were also classified as having language impairment on SBE-3-KT (high sensitivity) and all children with normal results on SBE-3-KT were sorted by experts in the unimpaired group (high negative predictive value). On the other hand, 8% of the unimpaired children according to experts were false positive classified by SBE-3-KT (specificity 92%, positive predictive value 50%). The correlations between subtest measures of SBE-3-KT and SETK 3-5 varied between rSp=0.42 and 0.63 (p<0.001). CONCLUSIONS: The parent questionnaire SBE-3-KT can be recommended for routine use in pediatric praxis. Three year old children with developmental language disorders are identified with high accuracy. In cases of subnormal results on parent report a further assessment is necessary to clarify the subtype and the etiology of the language abnormalities.

[Early identification of developmental language disorders--predictive value of the German version of the CDI--infant form (ELFRA-1)]. / Prognostische Validität des ELFRA-1 bei der Früherkennung von Sprachentwicklungsstörungen.

BACKGROUND: Early identification of developmental language disorders is a precondition for early intervention and therefore of high clinical relevance. The ELFRA-1 was constructed to identify children at risk for language disorders in the context of the routine examination of children at the age of 12 months. The aim of the study was to determine the predictive validity of this screening tool. SUBJECTS AND METHOD: 121 parents completed the questionnaire for their 12 months old children. One year later the language development was assessed by means of the ELFRA-2, the German version of the CDI for two year old children. RESULTS: 63% of the children were correctly classified. The sensitivity amounted to 52% and the specificity to 65%. The RATZ-index (relative improvement of the hit rate in comparison to the random hit rate) was 23%, which has to be considered as unsatisfying. Improvement of language abilities were less likely in boys compared to girls and in cases of low educational background of the mother. CONCLUSIONS: The prognostic validity of the ELFRA-1 is insufficient and too low to identify children at risk for later language impairment. The screening overlooked too many late talkers and classified too many normally developed children as language impaired. The ELFRA-1 can not be recommended as a useful method for the early identification of language impaired children at the age of 12 months.

[Validity of a short form of the ELFRA-2 (German Version of the CDI-Toddler Form) for early identification of late talkers]. / Diagnostische Zuverlässigkeit einer Kurzversion des Elternfragebogens ELFRA-2 zur Früherkennung von Sprachentwicklungsverzögerungen.

BACKGROUND: Parents' questionnaires are assumed to be reliable instruments for early identification of language retardation. The general use of the ELFRA-2 in practice, however, is limited by its length. The goal of the study was to construct and to evaluate a short version. SUBJECTS AND METHOD: The ELFRA-2 was sent to 1397 parents shortly before their child's second birthday. The return rate of the questionnaire was 71%. Questionnaires of monolingual German speaking children were included in the study (n=866) and randomly divided into two samples. From the first sample the most informative word categories were extracted by means of regression analysis and were used to compose a short form. With the second independent sample the validity of the short version was determined. RESULTS: By means of stepwise regression analysis within the first sample a short version consisting of 42 items was developed. The correlation between scores of the short and the long version was high (r=0.95) and the classification (no language retardation vs. late talker) was congruent for most children. The sensitivity and the specifity of the short form were 83% and 97%, respectively. For the prediction of language impairment at the age of three years the short and the long version reached similar detection rates. CONCLUSIONS: The results show that the validity of the short and the long form are comparable with respect to detection of late talkers. The time necessary to complete the short version allows its application during standard check-up examinations of children at the age of two years, and also to immediately discuss its result with the parents. Before the short form can be applied in pediatric practice, however, a standardization is necessary.

[Television in a child's bedroom--a possible risk factor for expressive language impairment in 5- and 6-year-old children]. / Fernseher im Kinderzimmer--ein möglicher Risikofaktor für expressive Sprachstörungen bei 5- und 6-jährigen Kindern.

OBJECTIVE: There are a number of established risk factors for expressive language-impairment. Does reading aloud with children reduce the risk? Are extensive TV viewing and a TV set in the child's bedroom associated with an increased risk in preschool kids? PATIENTS AND METHODS: Testing for expressive language impairment was carried out as part of the school entrance health examinations in four Bavarian districts. Testing included: correct use of the plural, comparative/superlative forms, syntax, verb flexion and use of articles (a maximum of 5 mistakes could be made). Parents were asked to answer a questionnaire on a number of biographic, sociodemographic and lifestyle factors potentially related to expressive language impairment. RESULTS: The participation rate in the 4 districts was 88.3 % on average. Complete data were acquired for 3234 children. The prevalence for expressive language impairment (more than one mistake) was 12.2 (95 % CI: 11.3-13.2 %). Children who did not speak German predominantly at home were more often affected than children of German nationality: 44.4 % (95 % CI: 32.3-54.6 %) versus 9.9 % (95 % CI: 8.9 %-10.8 %). Logistic regression analyses identified only a TV set in the child's bedroom as an independent risk factor for expressive language impairment: OR 1.82 (95 % CI: 1.15-2.88). CONCLUSIONS: Possession of an own TV in a child's bedroom appears to be an important, independent risk factor for expressive language impairment in preschool children.

Auditory language comprehension in children with developmental dyslexia: evidence from event-related brain potentials.

In the present study, event-related brain potentials (ERPs) were used to compare auditory sentence comprehension in 16 children with developmental dyslexia (age 9-12 years) and unimpaired controls matched on age, sex, and nonverbal intelligence. Passive sentences were presented, which were either correct or contained a syntactic violation (phrase structure) or a semantic violation (selectional restriction). In an overall sentence correctness judgment task, both control and dyslexic children performed well. In the ERPs, control children and dyslexic children demonstrated a similar N400 component for the semantic violation. For the syntactic violation, control children demonstrated a combined pattern, consisting of an early starting bilaterally distributed anterior negativity and a late centro-parietal positivity (P600). Dyslexic children showed a different pattern that is characterized by a delayed left lateralized anterior negativity, followed by a P600. These data indicate that dyslexic children do not differ from unimpaired controls with respect to semantic integration processes (N400) or controlled processes of syntactic reanalyses (P600) during auditory sentence comprehension. However, early and presumably highly automatic processes of phrase structure building reflected in the anterior negativity are delayed in dyslexic children. Moreover, the differences in hemispheric distribution of the syntactic negativity indicate different underlying processes in dyslexic children and controls. The bilateral distribution in controls suggests an involvement of right hemispherically established prosodic processes in addition to the left hemispherically localized syntactic processes, supporting the view that prosodic information may be used to facilitate syntactic processing during normal comprehension. The left hemispheric distribution observed for dyslexic children, in contrast, suggests that these children do not rely on information about the prosodic contour during auditory sentence comprehension as much as controls do. This finding points toward a phonological impairment in dyslexic children that might hamper the development of syntactic processes.

[Trial of time processing training in children with reading and spelling disorders]. / Erprobung eines Zeitverarbeitungstrainings bei Kindern mit Lese-Rechtschreibschwierigkeiten.

OBJECTIVE: It has been suggested that training in temporal processing may significantly improve language processing and reading skills. However, improvement effects of training on language impairment or dyslexia have not been proven so far. In the present study a temporal processing training was evaluated. METHOD: The participants of the present study were 42 children (5th graders) of a special school for children with reading and spelling problems. Children of one class (n = 21) were assigned to a training group (n = 21), the other class to a control group. Children in the training group took part in a training program consisting of auditory and visual order threshold and sound localisation tasks, over a period of eight weeks. We determined the order thresholds, sound localisation ability and reading and spelling performance of all children before and after the training period. Six months later all subjects were re-tested. RESULTS: Auditory and visual order thresholds decreased significantly more in the training group than in the control group. However, these changes were not accompanied by improvements in reading or spelling skills. CONCLUSIONS: In the present study no training effects on reading and writing performance were observed by using a program including temporal processing tasks. It is questionable whether training programs of temporal processing are useful methods in therapy of dyslexic children.

[Are specific developmental language disorders caused by deficits in auditory perception?]. / Sind umschriebene Sprachentwicklungsstörungen Folge von Defiziten in der auditiven Wahrnehmung?

BACKGROUND: Specific language impairment is assumed to be caused by deficits in auditory perception and therefore the training of auditory abilities is recommended as a treatment. Our study focussed on the question of whether a correlation between language disorders and auditory perception abilities can be proven empirically. PATIENTS: 23 language impaired children and 52 controls aged 7 to 11 years were examined. METHOD: Auditory abilities were measured by means of a battery of nonverbal and verbal tests. The children had to identify tones of different frequencies, loudness, duration or patterns as well as every day sounds and mixtures of such sounds. Noise-overlaid, time-compressed and frequency-limited speech tasks, and binaural summation tasks were also used. In addition, phoneme discrimination ability and auditory memory were assessed. RESULTS: Language impaired children scored low on phoneme discrimination and auditory memory tests but not on nonverbal or verbal auditory perception tasks. There are significant correlations between their expressive language ability and their scores on phoneme discrimination, auditory memory and sound duration identification tests. CONCLUSIONS: The results do not support the assumption that developmental language disorders are associated with auditory perception deficits. However, there are indications that auditory memory and time processing are deficient. Thus, training of auditory perception does not appear to be a suitable treatment for language impaired children.

[Significance of auditory processing deficits for the pathogenesis of reading and spelling disorders]. / Die Bedeutung auditiver Wahrnehmungsschwächen für die Pathogenese der Lese-Rechtschreibstörung.

OBJECTIVE: It has been claimed that children with dyslexia show auditory processing deficits and a training of auditory perception is recommended as a therapy. this study addresses the question whether a causal connection between auditory perception and dyslexia can be proven empirically. METHOD: 27 dyslexic children with average intelligence and normal hearing and 31 controls were examined. The auditory perception ability was judged with non-linguistic (pitch, tone duration, sound discrimination tasks) and verbal (speech in noise, compressed speech) tasks. In addition auditory short-term memory, nonverbal IQ, spelling and language ability were assessed. RESULTS: Group differences were found in tone processing tasks, but not in sound discrimination or auditory verbal tasks. Despite significant main effects in tone processing tasks the individual values of the dyslexic children lay predominantly in the range of the controls. In addition, there was no correlation between tone processing and spelling ability. CONCLUSION: Dyslexic children do not show remarkable deficits in verbal auditory processing. Auditory low level deficits can only be observed within a small subgroup. There is no evidence for central auditory dysfunction as a cause of dyslexia. The relevance of auditory processing training for treatment programmes for dyslexia should be questioned.

[Speech and language development disorders in children]. / Kinder mit Sprech- und Sprachentwicklungsstörungen. Frühzeitig zum Logopäden!

Despite their frequency and clinical relevance, disturbances in the acquirement of language skills are not infrequently overlooked or are recognized too late, in particular when the problem is speech understanding, or when behavioral disturbances predominate. Diagnostic guidelines differentiate between circumscribed articulation disorders and expressive and receptive speech problems. The diagnostic work-up must take account of the changes in symptoms occurring during the course of the child's development. Mental comorbidity may be observed in every second speech-disordered child. For the operationalized establishment of speech performance--also during the course of treatment--greater use should be made of standardized test procedures. In order to early recognize speech acquisition disorders, the regular use of pediatric routine diagnostic should be practiced. With regard to management, direct treatment of the child--especially when very young--should taken second place to training of the parents on language-furthering behavior.

Automatic processing of tones and speech stimuli in children with specific language impairment.

It is well known from behavioural experiments that children with specific language impairment (SLI) have difficulties discriminating consonant-vowel (CV) syllables such as /ba/, /da/, and /ga/. Mismatch negativity (MMN) is an auditory event-related potential component that represents the outcome of an automatic comparison process. It could, therefore, be a promising tool for assessing central auditory processing deficits for speech and non-speech stimuli in children with SLI. MMN is typically evoked by occasionally occurring 'deviant' stimuli in a sequence of identical 'standard' sounds. In this study MMN was elicited using simple tone stimuli, which differed in frequency (1000 versus 1200 Hz) and duration (175 versus 100 ms) and to digitized CV syllables which differed in place of articulation (/ba/, /da/, and /ga/) in children with expressive and receptive SLI and healthy control children (n=21 in each group, 46 males and 17 females; age range 5 to 10 years). Mean MMN amplitudes between groups were compared. Additionally, the behavioural discrimination performance was assessed. Children with SLI had attenuated MMN amplitudes to speech stimuli, but there was no significant difference between the two diagnostic subgroups. MMN to tone stimuli did not differ between the groups. Children with SLI made more errors in the discrimination task, but discrimination scores did not correlate with MMN amplitudes. The present data suggest that children with SLI show a specific deficit in automatic discrimination of CV syllables differing in place of articulation, whereas the processing of simple tone differences seems to be unimpaired.

Stability of mismatch negativities in children.

OBJECTIVES AND METHODS: Mismatch negativities (MMN) to frequency and duration changes in a series of repetitive tones and to two different consonant-vowel syllables (ba and ga, standard da) were recorded in a test and retest session in 15 children aged 7-11 years. Reliability within one session and stability between the sessions of MMN amplitudes and the ERP-components P1 and N1 were determined by correlation coefficients. RESULTS: Mean amplitudes of the grand averages showed a decrease of MMN during the second test session in a late latency window (400-500 ms) for the frequency MMN and of the MMN elicited by speech stimuli. The individual stability reached significance only for the duration deviant and one of the syllables. Compared to results found in adults with similar stimulus conditions the stability of the MMN in children seems to be somewhat lower. The components P1 and N1 to both stimulus types (tone and speech), however, showed a high reliability and individual stability. CONCLUSION: While MMN is a useful tool to study processing deficits in groups of children, as e.g. in language-impaired children, MMN as a individual diagnostic measure should be interpreted very cautiously.

[Perception of stress by mothers of children with language development disorders]. / Belastungserleben von Müttern sprachentwicklungsgestörter Kinder.

Subject of this study is the maternal stress as a result of the disabilities of language impaired children. The report concentrates on the influence of the children disabilities and the maternal coping strategies on the stress in the families. The study is based on an inquiry of 98 mothers with speech and language impaired children. Nearly 50% of the mothers suffer from stress because of their children' disabilities. Special caregiving demands, family conflicts, anxiety about the child future, depressive mood, aggressive feeling or deception were often experienced by the mothers as a direct consequence of their child's problems. The correlation of this specific maternal stress with general stress factors was insignificant. The maternal stress was more due to the attention deficits and the behavioural problems of the children than to the language delay. An increased level of stress was hardly related to the severity of the impairment, but to the maternal coping strategies. Mothers applying emotion focused coping strategies experienced more stress than those who predominantly used problem focused strategies. The results prove that mothers of children with even minor disabilities feel overstrained by their children' disorders. During counseling experts should attach more importance to deal with the needs and wishes of mothers and families of language impaired children. Reduction of family stress can be achieved by intervention programs helping the mothers to improve their psychological resources.

[Reliability of parameters of cognitive evoked P3 potentials]. / Gütekriterien von Parametern der kognitiven evozierten Welle P3.

Reliability of event-related P3 parameters. Various parameters of the P3 wave were tested for reliability and test-retest stability. To this end, event-related P3 waves were evoked in 21 subjects during visual and auditory oddball tasks. The protocol was repeated one to two weeks later. Amplitude, latency and area between P3 and baseline were estimated by different procedures. The stability within and between sessions was assessed with the split-half method and a measure of test-retest reliability, respectively. A literature review revealed that latency estimation is most commonly done by computer-aided peak measurement, but determining peak parameters visually after interpellating superimposed artifacts turned out to be significantly more reliable. Interrater reliability for this visual inspection was very high if preestablished rules were employed. Amplitude and area were measured reliably by both computer-aided procedures and visual inspection. The area was quite stable both within and between sessions. Area can serve as a measure of cerebral activation and should therefore be determined. Based on the results recommendations are made about analyzing components of event-related potentials. The need to control for error variance is emphasized. This is the only way to improve methods enough that they will be suitable for use in single case diagnosis.