Ennenaikaisina ja pienipainoisina syntyneiden lasten puheen- ja kielenkehityksen taso kahdeksan vuoden iässä:pohjoissuomalainen syntymäkohortti 1985-86

Abstract The speech and language abilities of preterm and low birthweight children were studied at the age of 8 in the northern Finland 1-year birth cohort for 1985 - 86. The language abilities of 42 8-year-old preterm children with birthweight < 1750 g were studied with four different language tests: the Illinois Test of Psycholinguistic Abilities (ITPA), the Token Test for Children (TTC), the Morphological Test for Finnish speaking children (MT) and the Peabody Picture Vocabulary Test (PPVT). Full-term control children with birthweight ≥ 2500 g (n = 42) from the same birth cohort matched individually with their preterm pairs for age, sex, twinship, mother's education, place of residence, birth order and family type were also studied. In addition, linguistic and motor abilities of low birthweight (LBW, < 2500 g) 8-year-old children (n = 279) were studied using parental (n = 8370, 90 %) and teacher (n = 8525, 92 %) evaluations by mailed questionnaire. The results showed that the 8-year-old preterm (< 1750 g) children scored significantly poorer than their controls in visual subtests measured by ITPA and that the poor performance in visual tests was associated with neonatal infections, continuous positive airway pressure (CPAP) and patent ductus arteriosus (PDA). In addition, the preterm children with minor neurodevelopmental dysfunction (MND) scored worst and differed significantly from their matched controls in verbal comprehension measured by TTC. They also differed significantly from other preterm groups, namely healthy preterm and preterm children with cerebral palsy (CP) in TTC. Periventricular leukomalasia (PVL) findings in magnetic resonance imaging (MRI) were not associated with the performance in the language ability tests. The parents evaluated the LBW (< 2500 g) children to have more problems in speech and language than the normal birth-weight (NBW, ≥ 2500 g) children. The LBW boys were the poorest in linguistic and motor skills compared with the NBW boys or any of the groups of girls. There was also a clear relationship between speech/linguistic and motor disabilities. Multivariate logistic regression analyses showed that the lower birthweight and some sociodemographic factors, for example mother's younger age (20 - 24y), having more than four children in the family, a reconstructed family, as well as hearing impairment and male gender were the most important determinants of poor speech and language abilities at 8 years of age, with and without adjustment for neonatal risk factor. Smallness for gestational age was also a risk factor for poor speech and language skills. Preterm birth was associated with poor skills only after removal of the neonatal risk factor from the model. Brain auditory evoked potential (BAEP) findings did not associate to poor language abilities of preterm children. To conclude, the preterm (< 1750 g) and the LBW children experienced speech and language disabilities at 8 years of age more than their full-term mates with NBW. Problems in speech production and especially in speech perception were more frequent among them both in clinical studies and parental evaluations.The visual problems were typical for preterm children (< 1750 g), which should be taken into account also in speech therapy. A closer and regular follow-up of language development in the preterm children with MND is important. Parental and teachers evaluations are useful in studying children's speech and language abilities.Tiivistelmä Pohjoissuomalaisen vuoden 1985 - 86 syntymäkohortin ennenaikaisina ja pienipainoisina syntyneiden lasten puheen- ja kielenkehitystä tutkittiin heidän ollessaan 8-vuotiaita. Aluksi testattiin 42 ennenaikaisena ja alle 1750 g syntyessään painanutta 8-vuotiasta lasta sekä heidän 42 täysiaikaisina syntynyttä ja ≥ 2500 g painanutta kontrollipariaan neljällä kielellisellä testillä, nimittäin Illinois Test of Psycholinguistic Abilities -testillä (ITPA), Lasten Token testillä, Morfologiatestillä ja Peabody Picture Vocabulary Test nimisellä sanavarastotestillä (PPVT). Kontrollilapset valittiin samasta kohortista ja kaltaistettiin ennenaikaisina syntyneiden lasten kanssa iän, sukupuolen, kaksosuuden, äidin koulutuksen, asuinpaikan, syntymäjärjestyksen ja perhetyypin perusteella. Koko syntymäkohortin kaikkien pienipainoisina (LBW, < 2500 g) syntyneiden 8-vuotiaiden lasten (n=279) kielellisiä ja motorisia taitoja tutkittiin lisäksi vanhemmille (n = 8370, 90 %) ja opettajille (n = 8525, 92 %) osoitetun kyselyn perusteella. Tulokset osoittivat, että ennenaikaisina (< 1750 g) syntyneet lapset saivat merkitsevästi heikommat pisteet kuin heidän kontrollinsa ITPA:n visuaalisissa tehtävissä. Heikko visuaalinen suoriutuminen oli yhteydessä neonataalikauden infektioihin, ylipainehoitoon (CPAP) ja avoimeen valtimotiehyeen (PDA). Lisäksi ne ennenaikaisina syntyneet lapset, joilla oli lievää neurologista toiminnan häiriötä (MND) saivat puheen ymmärtämistä mittaavasta Token testistä heikommat pisteet kuin kontrollinsa. MND-lapset erosivat myös merkitsevästi muista ennenaikaisina syntyneistä lapsista, terveistä ja CP-vammaisista, Token testillä mitattuna. Periventrikulaarisen leukomalasian (PVL) löydökset aivojen magneettikuvauksessa (MRI) eivät olleet yhteydessä suoriutumiseen kielellisissä testeissä. Vanhempien arvioiden perusteella LBW lapsilla oli enemmän ongelmia puheessa ja kielessä kuin normaalipainoisina (NBW, ≥ 2500 g) syntyneillä kahdeksan vuoden iässä. LBW-pojat olivat heikompia kielellisissä ja motorisissa taidoissa kuin NBW-pojat tai kummatkaan tyttöjen ryhmät. Tutkimuksen perusteella puheen ja kielellisten taitojen sekä motoriikan välillä oli selvä yhteys. Monimuuttujaisen logistisen regressioanalyysin perusteella matala syntymäpaino sekä tietyt sosiodemografiset tekijät, kuten äidin nuori ikä (20 - 24 v.), perheen yli neljän menevä lapsimäärä, uusperhe sekä kuulovika ja poikasukupuoli olivat lasten keskeisimpiä heikkoon puheen- ja kielenkehitykseen liittyviä riskitekijöitä 8 vuoden iässä riippumatta siitä, oliko analyysissa mukana neonataalikauden riskitekijä vai ei. Pienipainoisuus raskauden kestoon nähden oli myös riski heikolle puheen ja kielen kehitykselle. Ennenaikaisuus oli yhteydessä heikkoon puheen ja kielen kehitykseen, kun neonataalikauden riskitekijä poissuljettiin analyysista. Aivorunkoaudiometrian (BAEP) löydökset puolestaan eivät olleet yhteydessä kielenkehityksen ongelmiin. Tutkimuksen johtopäätöksenä voidaan esittää, että ennenaikaisina (< 1750 g) syntyneillä ja LBW-lapsilla oli enemmän ongelmia kuin täysiaikaisina syntyneillä NBW-lapsilla puheen- ja kielenkehityksessään 8 vuoden iässä. Ongelmat puheen tuotossa ja erityisesti vastaanotossa olivat heillä yleisempiä sekä kliinisen tutkimuksen että vanhempien arvion perusteella. Visuaalisen hahmottamisen vaikeudet olivat tyypillisiä ennenaikaisina (< 1750 g) syntyneille lapsille, mikä olisi hyvä huomioida myös puheterapiassa. Tutkimuksen perusteella ennenaikaisina syntyneiden MND-lasten kielenkehityksen tarkka ja säännöllinen seuranta on tärkeää. Vanhempien ja opettajien arviot ovat hyödyllinen lisä lasten puheen- ja kielenkehityksen tutkimuksessa.Čoahkkáigeassu Davvisuopmelaš jagi 1985-86 riegadankohortta ovdaláigge ja menddo geahpasin riegádan mánáid hupman- ja giellaovdaneapmi dutkojuvvui go mánát ledje 8-jahkáččat. Álggos testejuvvojedje 42 riegádettiin vuollái 1750 g deaddán 8-jahkásaš máná ja sin 42 dievasáigge šaddan ja ≥2500g deaddán kontrollapára njeljiin giellateasttain, namalassii ITP:ain (Illinois Test of Psycolinguistic Abilities), Mánáid Toke-teasttain, Morfologiijateasttain ja Peabody Picture Vocabulary Test-sátnerádjoteasttain (= PPTV). Kontrollapárat válljejuvvojedje seamma kohorttas ja dahkkojuvvojedje seammaláganin čuovvovaš áššiid ektui: ahki, sohkabealli,jumešvuohta,eatni skuvlejupmi,orrunbáiki,riegádanortnet ja bearaštiipa. Riegádankohortta menddo geahpasin (< 2500) riegádan 8-jahkásaš mánáid (n = 279) gielalaš ja motora dáiddut dutkojuvvojedje dasa lassin váhnemiid ja oahpaheaddjiid árvvoštallamiid vuođul. Mánáid váhnemiin 8370 (90%) ja oahpaheaddjiin 8525 (92%) vástidedje jearahallamii. Bohtosat čájehedje, ahte ovdaláigge riedágan mánát ožžo statistihkalaččat mearkkašahtti heajut čuoggaid go sin kontrollapárat ITPA visuála bargguin. Heajos visuála návccain lei oktavuohta neonatála-áiggi infekšuvnnaide, alladeaddodikšui (CPAP) ja rabas váibmosutnii (PDA). Dasa lassin ovdaláigge riegádan mánát, geain ledje muhtun veardde neurologalaš doaibmanváttut(MND) ožžo Toke-teasttas, mainna mihtidit hupmama ipmirdeapmi,heajut čuoggáid go sin kontrollapárat. MND-mánát sierranedje maiddái mearkkašahtti veardde Toke-teasttas eará ovdaláigge riegádan mánáin, sihke dearvasiin ja CP-váttogiin. Periventikuláralaš leukomasiija (PVL) gávdnosiin ii lean oktavuohta gielalaš teasttain birgemii. Periventikuláralaš leukomasiija (PVL) gávdnosiin magnehtagovvideamis(MRI) ii lean oktavuohta gielalaš teasttain birgemii. Váhnemiid árvvoštallama mielde menddo geahpasin riegádan mánáin ledje eambbo váttisvuođat hupmamis go normáladeattogin riegádan mánáin. Menddo geahpasin riegádan bártnit ledje heajubut gielalaš ja ja motora dáidduid ektui go normáladeattogin riegádan bártnit dahje goabbáge nieddaid joavkkuin. Dutkamuša vuođul hupmama ja gielalaš dáidduid ja motoriikka gaskkas lea čielga oktavuohta. Logistihkalas regreššuvdna-analiissa,mas ledje máŋga rievdi, vuođul menddo geahppa riegádandeaddu ja dihto sosiodemográfalaš dahkkit, dego eatni ahki (20-24 j.), mánáid lohku > 4 bearrašis, ođđabearaš ja lossa gullu ja bárdnesohkabealli ledje mánáid deaháleamos heajos hupmama ja giela ovdaneami einnosteaddjit 8 jagi agis, fuolakeahttá das, leigo analiissas mielde neonatála-áiggi várradahkki vai ii. Menddo geahppa riegádandeaddu ohkeagi ektui lasihii maiddái vára ahte mánná hupmagoahtá heajut ja su giella ovdana funet. Ovdaláigge riegádeamis lei oktavuohta heajos hupmama ja giela ovdaneapmái, go neonatála-áigge várradahkki ii váldojuvvon vuhtii analiissas. BAEP-gávdnosiin ii lean fas lean oktavuohta giela heajos ovdaneapmái. Dutkamuša jurddaboađusin sáhttá buktit ovdan,ahte ovdaláigge ja menddo geahpasin riegádan mánáin ledje 8- jahkásažžan eambbo váttisvuođat hupmama ja giela ovdaneamis go ollesáigge ja normáladeattogin riegádan mánáin. Maiddái hupmama ipmirdeamis ledje eambbo váttisvuođat. Heajos visuála návccat ledje sidjiide mihtilmaččat ja dan galggašii váldit vuhtii maid hupmanterapiijas.Dutkamuša vuođul MND-mánáid giellaovdaneami dárkilit ja regulára čuovvun lea deahálaš. Váhnemiid ja oahpaheaddjiid árvvoštallamat sáhttet leat ávkkalaččat mánáid hupmama ja giela ovdameami dutkamis

Teachers’ and children’s experiences after an acoustic intervention and a noise-controlling workshop in two elementary classrooms

Abstract Introduction: Treating sources of noise is a novel aspect of voice ergonomics intended to enhance the preconditions for good voice production and easy listening. Objective: To improve experiences of listening and voice ergonomics in classrooms. Methods: Participants were two female elementary school teachers with voice symptoms and their pupils (n = 50). Two interventions were performed: the acoustic intervention and then the workshop intervention where the teachers and pupils were active. Teachers’ voice symptoms and pupils’ and teachers’ experiences of the interventions were elicited by questionnaire. Results: The teacher with many voice symptoms experienced more annoyance from sounds and benefitted more from the interventions. After the interventions both teachers suffered fewer voice breaks and voice symptoms such as lump and mucus in the throat. The pupils reported improvement in the teachers’ voice clarity and audibility (p = 0.001). Pupils aged 12–13 years were more annoyed by sounds than those aged 8–9 years (p = 0.003). The older pupils experienced less sound annoyance after both interventions and the younger ones after the workshop intervention. Conclusions: The importance of good acoustics and individuals’ ability to improve voice ergonomics and listening conditions was demonstrated

Foetal growth restriction has negative influence on narrative skills in 8–10‐year‐old children

Abstract Aim: The risk for neurocognitive difficulties is increased in children born with foetal growth restriction (FGR), but no data exist yet on their narrative skills. The narrative skills of 8‐ to 10‐year‐old children born with FGR between 24 and 40 weeks were compared with those of children born with appropriate growth for gestational age (AGA). Methods: A prospectively collected cohort of 36 children with FGR was recruited prenatally at a Finnish tertiary hospital from 1998‐2001, and 31 children with AGA served as controls. Narrative skills were assessed using a standardised test, and correlations between narrative, communication, reading and spelling skills were studied. Results: Children born with FGR produced significantly less information and shorter utterances in their narratives than the AGA group. Children born preterm with FGR performed significantly more poorly in their narratives than the preterm AGA group. Poor narrative skills correlated with poor communication, reading and spelling skills. Conclusions: Children born with FGR had poorer narrative skills compared with their AGA peers at the age of 8‐10 years, and narrative skills were linked to other language‐based skills, which underlines the importance of early detection and preventive measures to optimise the educational outcome of children born with FGR

A randomized controlled trial with female teachers:are there differences between and within the outcomes in voice therapy groups with and without carryover strategies?

Abstract Purpose: We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). Method: A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f₀, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). Results: No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f₀ increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f₀ decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls’ eight-week non-therapy period (P = 0.003). Conclusions: The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group’s voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life

Children born before 32 weeks of gestation displayed impaired reading fluency, comprehension and spelling skills at 9 years of age

Abstract Aim: Our aim was to study whether prematurity, associated with prenatal and neonatal risk factors, affects specific literacy skills among school children born at a very low gestational age (VLGA) of <32 weeks. Methods: The study group comprised 76 prospectively followed VLGA children born between November 1998 and November 2002 at Oulu University Hospital, Finland, and 51 term controls. The median gestational age of the VLGA children was 29.0 (24.1‐31.9) weeks. All children were examined at a median age of 8.9 (8.0‐9.9) years in Oulu between November 2007 and November 2011. Reading fluency, comprehension and spelling skills were evaluated using standardised tests for Finnish‐speaking children. Results: Very low gestational age children had significantly poorer test results in reading comprehension (median 6.9 vs 8.3, P = .014) and spelling (median 35.7 vs 38.0, P = .013) than term children. Furthermore, VLGA children more often performed below the 10th percentile normal values in spelling (P = .012) compared with term controls. Foetal growth restriction was associated with lower scoring in reading fluency (P = .023) and spelling (P = .004) among VLGA children. Conclusion: Very low gestational age school children performed poorer in reading comprehension and spelling than term children. In addition, poor foetal growth in VLGA children was associated with literacy problems

Autism and the right to education in the EU:policy mapping and scoping review of Nordic countries Denmark, Finland, and Sweden

Abstract Introduction: The universal right to education for people with disabilities has been highlighted by the Universal Declaration on Human Rights and the Convention on the Rights of Persons with Disabilities. In this paper, we mapped policies addressing the right to education and special education needs of autistic children in Denmark, Sweden, and Finland. Methods: A policy path analysis was carried out using a scoping review as an underlying framework for data gathering. Policy mapping was performed independently by both lead authors to increase reliability. Results and discussion: The values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities have been closely translated into the respective education systems of the countries under study, offering special education needs services and support in mainstream education with the aim of including as many children into mainstream education as possible. Even though the education systems are comparable, the approaches between the countries under study are slightly different. Denmark and Sweden have passed several policies specifically geared towards special education needs, while Finland incorporates this more in general education policy. Conclusion: All countries under study have incorporated the values of the Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities in their respective education systems while emphasising the need to include as many children in the mainstream system as possible

Autistic adult health and professional perceptions of it:evidence from the ASDEU project

Abstract The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults—especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services

Real-world experiences in autistic adult diagnostic services and post-diagnostic support and alignment with services guidelines:results from the ASDEU study

Abstract Research providing an evidence-base for autistic adult services is sparse. The Autism Spectrum Disorders in the European Union (ASDEU) network implemented an on-line survey to determine gaps in autistic adult diagnostic evaluation and post-diagnostic support services. More than 55% in all groups experienced most of the recommended features for diagnostic evaluation for autistic adults. In contrast, < 2% of adults or carers, and < 21% of professionals experienced each of the recommended features for post-diagnostic support. In contrast to 61% of professionals, only about 30% of autistic adults and carers had knowledge of good local services models for autism diagnosis in adulthood. There are major differences between good practice guidelines for diagnostic and post-diagnostic care for autistic adults, and what is actually experienced by services users and professionals