Medication-related osteonecrosis of the jaw after long-term bisphosphonate treatment in a cat.

A 12-year-old, neutered female, domestic medium hair cat was evaluated for a nonhealing, oral mucosal ulceration. The cat had a history of idiopathic hypercalcemia that had been treated with a bisphosphonate for 41 months. Oral examination identified exposed maxillary bone adjacent to a previous extraction site. Histopathology of the exposed bone and associated mucosa was most consistent with medication-related osteonecrosis of the jaw. Treatment involved both medical and surgical interventions. Oral mucosal healing occurred after 6 months of treatment.

Alignment of classification paradigms for communication abilities in children with cerebral palsy.

AIM: We examined three communication ability classification paradigms for children with cerebral palsy (CP): the Communication Function Classification System (CFCS), the Viking Speech Scale (VSS), and the Speech Language Profile Groups (SLPG). Questions addressed interjudge reliability, whether the VSS and the CFCS captured impairments in speech and language, and whether there were differences in speech intelligibility among levels within each classification paradigm. METHOD: Eighty children (42 males, 38 females) with a range of types and severity levels of CP participated (mean age 60mo, range 50-72mo [SD 5mo]). Two speech-language pathologists classified each child via parent-child interaction samples and previous experience with the children for the CFCS and VSS, and using quantitative speech and language assessment data for the SLPG. Intelligibility scores were obtained using standard clinical intelligibility measurement. RESULTS: Kappa values were 0.67 (95% confidence interval [CI] 0.55-0.79) for the CFCS, 0.82 (95% CI 0.72-0.92) for the VSS, and 0.95 (95% CI 0.72-0.92) for the SLPG. Descriptively, reliability within levels of each paradigm varied, with the lowest agreement occurring within the CFCS at levels II (42%), III (40%), and IV (61%). Neither the CFCS nor the VSS were sensitive to language impairments captured by the SLPG. Significant differences in speech intelligibility were found among levels for all classification paradigms. INTERPRETATION: Multiple tools are necessary to understand speech, language, and communication profiles in children with CP. Characterization of abilities at all levels of the International Classification of Functioning, Disability and Health will advance our understanding of the ways that speech, language, and communication abilities present in children with CP.

Early Language Intervention Using Distance Video-Teleconferencing: A Pilot Study of Young Boys With Fragile X Syndrome and Their Mothers.

PURPOSE: This study examined the effects of a naturalistic parent-implemented language intervention on the use of verbally responsive language by mothers of 6 young boys with fragile X syndrome. The intervention included parent education sessions and clinician coaching delivered onsite and by distance video-teleconferencing. METHOD: A single-case multiple baseline across participants was used to examine intervention effects on maternal use of language support strategies. A nonparametric analysis was used to evaluate the relative effectiveness of onsite compared with distance coaching sessions. RESULTS: Mothers increased their use of utterances that followed into their child's focus of attention and prompted child communication acts. Intervention effects were not observed for maternal contingent responses to child communication, possibly due to the limited number of spontaneous communication acts children produced. Children showed moderate increases in the use of prompted communication acts, whereas intervention effects on spontaneous communication acts were more modest and variable. Comparable increases in maternal strategy use were observed during onsite and distance sessions. CONCLUSIONS: No previous study has examined a distance-delivered parent-implemented language intervention for young boys with fragile X syndrome. Mothers were able to increase their use of verbally responsive language. Intervention efficacy might be enhanced by incorporating an augmentative and alternative communication device for some children and a more concerted focus on increasing the frequency of child communication acts. Findings provide preliminary support for the efficacy of the distance delivery format.

Variability and Diagnostic Accuracy of Speech Intelligibility Scores in Children.

PURPOSE: We examined variability of speech intelligibility scores and how well intelligibility scores predicted group membership among 5-year-old children with speech motor impairment (SMI) secondary to cerebral palsy and an age-matched group of typically developing (TD) children. METHOD: Speech samples varying in length from 1-4 words were elicited from 24 children with cerebral palsy (mean age 60.50 months) and 20 TD children (mean age 60.33 months). Two hundred twenty adult listeners made orthographic transcriptions of speech samples (n = 5 per child). RESULTS: Variability associated with listeners made a significant contribution to explaining the variance in intelligibility scores for TD and SMI children, but the magnitude was greater for TD children. Intelligibility scores differentiated very well between children who have SMI and TD children when intelligibility was at or below approximately 75% and above approximately 85%. CONCLUSIONS: Intelligibility seems to be a useful clinical tool for differentiating between TD children and children with SMI at 5 years of age; however, there is considerable variability within and between listeners, highlighting the need for more than one listener per child to ensure validity of an intelligibility measure.

Play with objects in young males with fragile X syndrome: a preliminary study.

UNLABELLED: Using the Developmental Play Assessment, this preliminary study described the categories and levels of play with objects produced by 10 young boys with diagnoses of full mutation fragile X syndrome, the leading inherited cause of intellectual disability. Additionally, the study examined concurrent associations between child characteristics and three different summary level variables representing object play skills. Presentation Combinations (i.e., recreating structured configurations of objects) was the highest play level emerging or mastered for all participants. The number of toys touched during the play sample, an index of object interest, was positively related to standardized measures of receptive and expressive language while the number of different actions produced, an index of play diversity, was negatively related to autism symptom severity. Both variables were significantly related to the number of nonverbal communication acts children produced while interacting with their mothers in play. Clinical implications and future directions are discussed. LEARNING OUTCOMES: Readers will be able to: (1) define a framework for categorizing developmental levels of play; (2) discuss the constructs represented by three different summary level metrics of play with objects; (3) describe the relationship between object-play skills and child characteristics for young males with FXS.

Providing a parent-implemented language intervention to a young male with fragile X syndrome: brief report.

PURPOSE: Although fragile X syndrome (FXS) is the leading inherited cause of intellectual disability, there are no published intervention studies focused on improving communication and language outcomes for affected children. The current study utilized a collaborative coaching approach incorporating strategies from speech-language pathology and applied behavior analysis to examine the efficacy of a naturalistic parent-implemented language intervention for a young boy with FXS. METHODS: The mother was taught the language and behavioral support strategies and submitted weekly video recordings of a caregiving routine. Written feedback was provided. RESULTS: Results indicated moderate increases in maternal use of targeted language support strategies and variable performance in maternal use of behavior support strategies. Child use of appropriate requests increased while challenging behaviors decreased. CONCLUSIONS: This collaborative approach model should be used to guide future larger scale replications and develop new intervention models.

Examining the operant function of challenging behavior in young males with fragile X syndrome: a summary of 12 cases.

This study used experimental functional analyses to examine the operant function of challenging behaviors exhibited by 12 males (ages 27-51 months) with fragile X syndrome (FXS). Eight children met criteria for negatively reinforced challenging behavior in the form of escape from demands and/or escape from social interactions. Nine children met criteria for positively reinforced challenging behavior in the form of obtaining access to highly preferred items. Attention was identified as a maintaining consequence for three children. The functional analysis was inconclusive for one child. Results suggest that, for young males with FXS, challenging behaviors may more likely be tangibly and escape maintained than attention maintained. Our findings affirm past research suggesting a unique behavioral phenotype for this population.

Sentence comprehension in boys with autism spectrum disorder.

PURPOSE: Previous research has suggested that language comprehension might be particularly impaired in children with autism spectrum disorder (ASD), but this profile has been only broadly characterized. In the current study, the authors examined sentence comprehension in school-age boys with ASD, including a subgroup with intellectual disability (ID), with particular attention paid to errors that might differentiate between lexically and syntactically based difficulties. METHOD: Participants were boys with ASD (n = 45, ages 4-11 years) and younger typically developing boys (n = 45, ages 2-6 years). Comprehension was assessed with the Test for Reception of Grammar-Version 2 (TROG-2; Bishop, 2003). Error types were analyzed for a subset of items. RESULTS: Boys with ASD did not differ from younger typically developing boys matched on receptive vocabulary in overall sentence comprehension on the TROG-2 or the number of lexical errors committed. In contrast, the subgroup of boys with ASD and ID (n = 16) had poorer overall performance and committed more lexical errors than younger typically developing boys matched on nonverbal cognition. CONCLUSIONS: On average, comprehension was delayed in school-age boys with ASD but not beyond receptive vocabulary expectations. Boys with ASD and ID, however, had a weakness in sentence comprehension beyond nonverbal cognitive expectations.

Language comprehension profiles of young adolescents with fragile X syndrome.

PURPOSE: In this study, the authors sought to characterize the language phenotype of fragile X syndrome (FXS), focusing on the extent of impairment in receptive syntax, within-syndrome variability in those impairments in relation to gender, and the syndrome specificity of those impairments. METHOD: The Test for Reception of Grammar, Version 2 ( Bishop, 2003), was used to examine the overall receptive syntactic skills of adolescents with FXS ( n = 35; 30 males, 5 females), adolescents with Down syndrome (DS; n = 28; 18 males, 10 females), and younger typically developing (TD) children ( n = 23; 14 males, 9 females) matched on nonverbal cognition. Performance on specific grammatical constructions and error types was examined for a subset of matched participants. RESULTS: Participants with FXS had overall receptive syntax scores that were lower than those of the TD participants but higher than those of the participants with DS; however, there was no difference in performance between the FXS and DS groups when females were excluded. Grammatical constructions that were especially difficult for participants with FXS and those with DS were identified, especially relative clause constructions and reversible constructions requiring attention to word order encoded by syntactic features. CONCLUSION: The current findings have implications for understanding the nature of the language learning difficulties of individuals with FXS and for language interventions.