Diagnóstico diferencial ante la sospecha de TEA / Differential diagnosis of suspected ASD

Ateneo de la Residencia de Psicopedagogía del Hospital General de Agudos Ramos Mejía, de la Ciudad de Buenos Aires, que describe las acciones realizadas por el Equipo del hospital, que forma parte de la red de centros públicos de salud que participan del Programa de Orientación Temprana y Concientización en Trastornos del Neurodesarrollo y en el Espectro Autista (PROTECTEA). Se detallan la conceptualización y características del Trastorno del Espectro Autista, su diagnóstico específico, y su diferenciación del diagnóstico de Trastorno del Lenguaje, y de la Comunicación Social.

Similarities and differences in psycho-educational assessments of adolescents with specific language impairments and specific learning disabilities: A challenging differential diagnosis.

Specific Language Impairment (SLI) and Specific Learning Disabilities (SLD) have been the subject of extensive research especially with respect to the connection between them. However, the manifestation of these disorders in adolescence has not been thoroughly investigated. The objective of the present study was to compare the intelligence scores and the reading, oral and written language skills of Greek adolescents with SLI and Greek adolescents with SLD, as assessed during their psycho-educational evaluation, in order to clear the path for diagnosis and intervention. 124 Greek adolescents diagnosed with Specific Learning Disabilities and 76 Greek adolescents diagnosed with Specific Language Impairment aged from 11 to 16 years took part in the study. All participants were assessed in reading, oral language and written language skills and took part in IQ testing. Independent samples t-test, chi-square test, odds ratios and their 95 percent confidence intervals were implemented to determine statistically significant differences. Analyses revealed differences in IQ scores and some differences in the skills assessed, thus indicating that SLI adolescents exhibited more difficulties across most of the basic academic skills, whereas SLD adolescents' difficulties confined to the affected written language skills. Specifically, the observed difference was statistically significant for the total and verbal IQ score, and WISC-III scores also disclosed a significant difference for the similarities and information defisub- tests. Regarding reading skills, SLI adolescents were 4.9 times more likely to exhibit line skipping, 5.8 times more likely to exhibit hesitations, 3.2 times more likely to exhibit repetitions of syllables/words/ phrases, and 8.5 times more likely to exhibit non-acknowledgement of punctuation. Regarding reading comprehension, adolescents with SLI were more likely to have difficulty in retrieving simple information questions, making inferences, and giving titles. Adolescents with SLI were also more likely to have difficulties in story reproduction, giving synonyms/opposites, oral sentence reproduction and auditory oral word reproduction. In the area of written language skills, SLI adolescents were more likely to have poor handwriting, poor content, poor structure, and poor use of punctuation. In adolescence, Specific Language Impairment can be a different manifestation of an ongoing language disorder, which finally appears as a different type of Specific Learning Disability, but with a more generalized nature of learning difficulties. This finding should be interpreted in terms of the importance of differential diagnosis, especially during the challenging period of adolescence.

Contextual influences on sentence repetition as a tool for the identification of language impairment in Grade 3 Sepedi-English bilinguals: A case against bilingual norms.

BACKGROUND: Specific language impairment (SLI) is difficult to identify because it is a subtle linguistic difficulty, and there are a few measures available to differentiate between typical and atypical language development in bilinguals. Sentence repetition (SR) has strong theoretical foundations and research evidence as a valid tool for the identification of SLI in bilinguals. OBJECTIVE: This study assessed the value of SR using peer group comparisons to identify Sepedi-English bilingual children at the risk of SLI. METHOD: One hundred and two Grade 3 learners in three different contexts of education were assessed on equivalent English and Sepedi SR measures. RESULTS: Eleven participants who scored between 1 and 2 standard deviations (SD) below the peer group means on both the English and Sepedi SR tests were identified with possible SLI. Learners in the English language of learning and teaching (LoLT) - Sepedi additional language (SAL) context obtained similar scores in both languages, a higher score in English than the English LoLT group and a higher score in Sepedi than the Sepedi LoLT - EAL group. The English LoLT group obtained a significantly higher score in English than in Sepedi and a significantly lower score than the other two groups in Sepedi. The Sepedi LoLT group obtained a significantly higher score in Sepedi than in English, their additional language, in which they obtained a significantly lower score than the other two groups. CONCLUSION: Sentence repetition tasks are valid screening tools to identify bilingual children with SLI by comparing them to peer groups. The SR tests were sensitive to language practices in different educational contexts. It was observed that a bilingual approach that uses both English and the home language as academic languages leads to better language outcomes.

Individualized Narrative Intervention for School-Age Children With Specific Language Impairment.

Purpose This study extends the research on narrative intervention by evaluating the effect of a standard treatment protocol, Story Champs (Petersen & Spencer, 2012), on personal narrative generations of school-age children with specific language impairment (SLI). Method Four second-grade, 8- to 9-year-old boys with SLI participated in this multiple baseline across behaviors, single-case design study that was repeated across participants. Each one-on-one intervention session involved eight steps across two intervention segments: story retell and personal story generation. The interventionist provided systematic scaffolding (visual and verbal supports) that was faded within each session. Three individualized story grammar elements per participant were targeted sequentially across the weeks of intervention based on each participant's needs identified in baseline. The dependent variable probe (personal narrative generation) was administered at the beginning of each twice-weekly session, and individualized story grammar elements were scored on a 4-point rubric (dependent variable). Results In this single-case research design study, a functional relation was evaluated for each participant (i.e., replication of an effect across three story grammar elements). A functional relation between Story Champs intervention and the dependent variable was observed for two participants. Conclusion Results provide preliminary evidence for the efficacy of individually administered Story Champs intervention for children with SLI.

Morphosyntactic weaknesses in Developmental Language Disorder: the role of structure and agreement configurations.

Agreement is a morphosyntactic dependency which is sensitive to the hierarchical structure of the clause and is constrained by the structural distance that separates the elements involved in this relation. In this paper we present two experiments, providing new evidence that Italian-speaking children with Developmental Language Disorder (DLD), as well as Typically Developing (TD) children, are sensitive to the same hierarchical and locality factors that characterise agreement in adult grammars. This sensitivity holds even though DLD children show accrued difficulties in more complex agreement configurations. In the first experiment, a forced-choice task was used to establish whether children are more affected in the computation of S-V agreement when an element intervenes hierarchically or linearly in the agreement relation: DLD children are more subject to attraction errors when the attractor intervenes hierarchically, indicating that DLD children discriminate between hierarchical and linear configurations. The second experiment, also conducted through a forced-choice task, shows that the computation of agreement in DLD children is more 'fragile' than in TD children (and also in children with a primary impairment in the phonological domain), in that it is more sensitive to the factors of complexity identified in Moscati and Rizzi's (2014) typology of agreement configurations. To capture the agreement pattern found in DLD children, we put forth a novel hypothesis: the Fragile Computation of Agreement Hypothesis. Its main tenet is that DLD children make use of the same grammatical operations employed by their peers, as demonstrated in Experiment 1, but difficulties increase as a function of the complexity of the agreement configuration.

Similarities and differences in the lexical-grammatical relation of young dual language learners with and without specific language impairment.

This study examines the lexical-grammatical relation within and across in preschool Latino dual language learners (DLLs) with and without specific language impairment (SLI) using language-specific vocabulary and conceptual lexical-semantic skills. The participants were sixty-one typically developing (TD) Spanish-English speaking DLLs and seventy-four DLLs with SLI from low-income households. Standardized and researcher developed assessment tools were used to measure vocabulary, semantics, and grammar in both Spanish and English. Cross-sectional data were analyzed using hierarchical linear regressions to determine the nature of the lexical-grammatical association within and across languages. The study found significant within-language relations between measures of vocabulary and grammar for both groups. Conceptual vocabulary was a significant predictor for English grammar in both groups. For the SLI group only, both English and Spanish vocabulary scores significantly predicted English grammar and bilingual semantics scores predicted Spanish grammar. These findings underscore the role of language-specific vocabulary on grammatical development and suggest the presence of bilingual bootstrapping in DLLs. However, the degree and nature of cross-linguistic associations vary by language ability and language proficiency. The role of age and nonverbal cognition and clinical implications are also discussed.

A comparative study of language phenotypes in Autism Spectrum Disorder and Specific Language Impairment.

BACKGROUND: Problems with communication and language are among the main characteristics of both Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). The main objective of the present study was to analyze whether the two disorders have similar formal language profiles. METHOD: The study involved three groups of 20 students each, divided into ASD, SLI, and Control, of similar ages and IQ. The CELF-4 standardized test was administered to assess their language skills. RESULTS: No significant differences in language were found between the SLI and ASD groups, with no effect sizes. Differences were observed between the SLI and ASD groups when they were compared separately with the Control group, with a large effect size. CONCLUSIONS: There is an overlap in the linguistic profiles of children with SLI and children with ASD. Similarity is thus confirmed in comprehensive and expressive language, as well as in morphosyntactic and lexical-semantic production.

Linguistic Contributions to Word-Level Spelling Accuracy in Elementary School Children With and Without Specific Language Impairment.

Purpose Children with specific language impairment (SLI) are more likely than children with typical language (TL) to exhibit difficulties in word-level spelling accuracy. More research is needed to elucidate the contribution of linguistic knowledge to word-level spelling accuracy in this population. The purpose of this study was to explore the contributions of linguistic knowledge to spelling accuracy in a group of 2nd- to 4th-grade children with SLI and a group of 2nd- to 4th-grade children with TL. Method Participants were 32 children with SLI and 32 children with TL in Grades 2 through 4. Five areas of linguistic knowledge were assessed: phonological awareness, morphological knowledge, orthographic pattern knowledge, mental grapheme representation knowledge, and vocabulary knowledge. Mixed-effects logistic regression models were utilized to address the research aim. Results Mental grapheme representation knowledge was selected as a significant predictor in both models; however, phonological awareness was the only additional significant predictor in the model for children with SLI, whereas morphological knowledge was the only other significant predictor in the model for children with TL. Orthographic pattern knowledge and vocabulary knowledge were not significant for either group. Conclusions The results suggest that spelling instruction and intervention for children with SLI should take linguistic knowledge into account and explicitly relate linguistic knowledge to spelling. Additionally, future research should consider if instructional targets for children with SLI should differ from targets for children with TL and if these findings represent a delay or a disorder in spelling acquisition for children with SLI.

Nonword Repetition Across Two Dialects of English: Effects of Specific Language Impairment and Nonmainstream Form Density.

Purpose Nonword repetition (NWR) has been proposed as a culturally and linguistically fair measure of children's language abilities that is useful for the identification of specific language impairment (SLI). However, Moyle, Heilmann, and Finneran (2014) suggested that the density of a child's nonmainstream forms also influences NWR in ways that could complicate its use. Using speakers of either African American English (AAE) or Southern White English (SWE), we asked if NWR performance differed in children with SLI and same dialect-speaking typically developing (TD) children and if nonmainstream form density impacted their scores. Method The participants were 106 kindergartners (AAE: SLI n = 35; TD n = 35; SWE: SLI n = 18; TD n = 18; groups matched for age and IQ) who performed the NWR task of Dollaghan and Campbell (1998) . Nonmainstream form density measures were gathered from listener judgments of conversational samples. Results NWR performance differed between those with and without SLI, but the difference was smaller in AAE than in SWE, especially at the longest syllable length. Nonmainstream form density was found to further explain NWR performance beyond the children's SLI status for AAE speakers; density and SLI status were confounded for the SWE speakers, making it harder to disentangle the effects of each in that dialect. Conclusions Results indicate the NWR may differ in diagnostic utility between speakers of different dialects. Results also support Moyle et al.'s (2014) finding that density affects NWR. Thus, NWR is more sensitive to dialectal differences than originally assumed.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment.

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.