Toward a Definition of the Linguistic Profile of Children With Autism Spectrum Disorder

The current investigation assessed linguistic and narrative abilities in a cohort of children with Autism Spectrum Disorder (ASD). The linguistic assessment was performed with both traditional tests and a multilevel procedure for discourse analysis. The results showed difficulties at different stages of message planning, organization, and microlinguistic processing (i.e., lexical selection and grammatical processing). Their macrolinguistic impairments were likely related to more general difficulties in the prelinguistic conceptual phase of message planning and mental model generation. Such weaknesses included a difficulty in the non-verbal conceptualization of the story and the generation of an internal representation of the addressee\u2019s mental model

The complex relation between executive functions and language in preschoolers with developmental language disorders

Backgrounds: The relationship between linguistic difficulties and cognitive impairments in children with developmental language disorders (DLDs) is receiving growing interest in international research. Executive functions (EF) appear to be weak in these children. The current investigation aims at exploring the relationship between difficulties in two components of EF (i.e., updating and inhibition) and the linguistic and narrative skills of 16 DLD preschoolers matched with 24 typically developing peers. Methods: Updating skills were tested by administering the forward and backward digit recall subtests of the Wechsler Scales, while children\u2019s inhibition abilities were assessed by completion of Developmental Neuropsychological Assessment (NEPSY-II) inhibition tasks. Information on the linguistic skills of the participants was collected through a set of subtests included in the Batteria per la Valutazione del Linguaggio in bambini dai 4 ai 12 anni (Batteria per la Valutazione del Linguaggio; BVL_4-12), assessing articulatory and phonological discrimination skills, lexical production/comprehension, grammatical production/comprehension, and narrative production skills. Results: Findings revealed that DLD children performed significantly lower than their peers on both updating and inhibitory tasks. Linguistic difficulties were found in the DLD group on articulatory/phonological skills, grammatical production/comprehension, and lexical informativeness on narrative production. Measures of EF correlated with linguistic and narrative measures. Conclusion: The current study confirms a significant association between DLD\u2019s performances on EF and displayed linguistic skills, suggesting the need to include the assessment of executive functions to target early intervention rehabilitation programs for children with DLDs

Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial

Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed

Trained facilitators’ experiences with structured advance care planning conversations in oncology : an international focus group study within the ACTION trial

Background In oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation. Methods A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes. Results Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script. Conclusions Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients’ preferences while staying attuned to patients’ needs

A characterization of language development in heritage speakers

This study focuses on the assessment of working memory and linguistic skills in 21 Italian\u2013Russian speaking bilingual children who were born in Italy and inherited Russian from their parents. Their performance was compared to that of 21 monolingual Russian-speaking and 21 monolingual Italian-speaking peers. For the assessment of the two languages (Russian and Italian) in bilinguals and the respective languages (Russian OR Italian) in monolinguals, the equivalent forms of the same battery of tests were used. Overall, the bilinguals showed enhanced verbal working memory with respect to Italian monolinguals but not Russian ones. The lexical skills of the participants in the bilingual group, as measured via semantic fluency, naming and lexical comprehension, appeared to be rather limited in Russian when compared to those of the monolingual group. Their vocabulary was mainly made of words with medium-to-high frequency. Passive, reversible and negative sentences appeared to be the most difficult for the participants who inherited Russian from their parents. The findings are discussed in the light of current theories of heritage languages acquisition

Hearing impairment and vowel production. A comparison between normally hearing, hearing-aided and cochlear implanted Dutch children

This study investigated the acoustic characteristics of the Belgian Standard Dutch vowels in children with hearing impairment and in children with normal hearing. In a balanced experimental design, the 12 vowels of Belgian Standard Dutch were recorded in three groups of children: a group of children with normal hearing, a group with a conventional hearing aid and a group with a cochlear implant. The formants, the surface area of the vowel space and the acoustic differentiation between the vowels were determined. The analyses revealed that many of the vowels in hearing-impaired children showed a reduction of the formant values. This reduction was particularly significant with respect to F2. The size of the vowel space was significantly smaller in the hearing-impaired children. Finally, a smaller acoustic differentiation between the vowels was observed in children with hearing impairment. The results show that even after 5 years of device use, the acoustic characteristics of the vowels in hearing-assisted children remain significantly different as compared to their NH peers

Evaluation of formant frequencies in Persian speaking children with different degrees of hearing loss

Background: This study compared formant frequencies in vowel productionamongchildren with different degrees of hearing loss (HL) and normal hearing. Methods: This study was carried out on 40 children with different degrees of HL (moderate, moderate to severe, severe, and profound). Forty age (7 to 9 years old) and gender (22 males and 18 females) matched children with normal hearing were included. After collecting acoustic data during vowel production (/a/i/,/u/) for 3 seconds, the mean of the F1 and F2 were selected using the Praat software. The data were analyzed using analysis of variance (ANOVA) and Dunnett’s Post Hoc test. Results: Several differences in formant frequencies were confirmed with ANOVA tests. The results from Dunnett’s post hoc test showed that the F2 value of /a/ and /i/ in the control group were significantly different from all groups with HL (P < 0.05). However, the F1’s of the control group in all 3 vowels were significantly different only from the profound group. Conclusions: There was little distinction between vowels of HL children, and their vowel space had become centralized presumably due to limited auditory feedback, relative invisibility of the articulatory gestures needed for vowel production, and similar tongue position for all vowels. The second formant tended to be affected more than the first formant because less audibility and the difficulty of its learning through vision