Speech and language profiles in 4- to 6-year-old children with early diagnosis of autism spectrum disorder without intellectual disability

Purpose: This study aimed to present speech and language data from a community-representative group of 4- to 6-year-old children with early-diagnosed autism spectrum disorder (ASD) without intellectual disability (ID). Methods: The study group comprised 83 children 4–6 years of age with ASD without ID. They had been diagnosed with ASD before age 4.5 years and had received intervention at a specialized habilitation center. At 2-year follow-up, their language abilities were evaluated comprehensively by two speech–language pathologists using a battery of assessments. Receptive and expressive language and phonology were examined. The phonology evaluation included measures of phonological speech production and of phonological processing. Results: Results revealed that almost 60% had moderate–severe language problems. Nearly half exhibited combined expressive and receptive language problems, of which a majority also had phonology problems. Phonological speech problems were found in 21% of the total group. Conclusion: The findings underscore the importance of considering speech/language disorders in children with ASD without ID, since they usually attend mainstream classes but need specific educational adaptations

Coexisting Disorders and Problems in Preschool Children with Autism Spectrum Disorders

Objectives. To analyze cooccurring disorders and problems in a representative group of 198 preschool children with autism spectrum disorders (ASD) who had had interventions at a specialized habilitation center. Methods. Parents and children were seen by a research team. Data were based on parental interviews, pediatric assessments, and tests of the child. Information on autistic symptoms, general cognitive function, speech and language, motor function, epilepsy, vision, hearing, activity level, behavior, and sleep was collected. Results. Three ASD categories were used: (1) autistic disorder (AD), (2) autistic-like condition (ALC) or Asperger syndrome, and (3) one group with autistic symptoms/traits but not entirely all its criteria met for ASD. Children with autism had a mean of 3.2 coexisting disorders or problems, the ALC/Asperger group had a mean of 1.6, and children with autistic traits had a mean of 1.6. The most common disorder/problems in the total group pertained to language problems (78%), intellectual disability (ID) (49%), below average motor function (37%), and severe hyperactivity/ADHD (33%). Conclusions. The results accord with the concept of early symptomatic syndromes eliciting neurodevelopmental clinical examination (ESSENCE), and highlight the need of considering ASD in a broad perspective taking also other cooccurring developmental disorders into account

Teenage outcomes after speech and language impairment at preschool age

Ulla Ek1, Fritjof Norrelgen3,4, Joakim Westerlund2, Andrea Dahlman5, Elizabeth Hultby5, Elisabeth Fernell61Department of Special Education, 2Department of Psychology, Stockholm University, Stockholm, Sweden; 3Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; 4Department of Clinical Neuroscience, 5CLINTEC/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; 6The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg and the Research and Development Centre, Skaraborg Hospital, Skövde, SwedenAim: Ten years ago, we published developmental data on a representative group of children (n = 25) with moderate or severe speech and language impairment, who were attending special preschools for children. The aim of this study was to perform a follow-up of these children as teenagers.Methods: Parents of 23 teenagers participated in a clinical interview that requested information on the child's current academic achievement, type of school, previous clinical assessments, and developmental diagnoses. Fifteen children participated in a speech and language evaluation, and 13 participated in a psychological evaluation.Results: Seven of the 23 teenagers had a mild intellectual disability, and another three had borderline intellectual functioning. Nine had symptoms of disorders on the autism spectrum; five of these had an autism spectrum disorder, and four had clear autistic traits. Six met criteria for attention-deficit hyperactivity disorder (ADHD)/subthreshold ADHD. Thirteen of 15 teenagers had a moderate or severe language impairment, and 13 of 15 had a moderate or severe reading impairment. Overlapping disorders were frequent. None of the individuals who underwent the clinical evaluation were free from developmental problems.Conclusion: A large number of children with speech and language impairment at preschool age had persistent language problems and/or met the criteria for developmental diagnoses other than speech and language impairment at their follow-up as teenagers. Language impairment in young children is a marker for several developmental disorders, particularly intellectual disability and autism spectrum disorder.Keywords: language impairment, dyslexia, developmental disorders, autism spectrum disorder, ADHD, follow-u

Early intervention in 208 Swedish preschoolers with autism spectrum disorder

A B S T R A C T Early intervention has been reported to improve outcome in children with autism spectrum disorders (ASDs). Several studies in the field have been randomized controlled trials (RCTs). The aim of this study was to assess ASD outcome in a large naturalistic study. Two hundred and eight children, aged 20-54 months, with a clinical diagnosis of ASD were given intervention and monitored prospectively in a naturalistic fashion over a period of 2 years. The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county. They fell into three cognitive subgroups: one with learning disability, one with developmental delay, and one with normal intellectual functioning. Data on intervention type and intensity were gathered prospectively in a systematic fashion. Intervention was classified into intensive applied behaviour analysis (ABA) and non-intensive, targeted interventions, also based on ABA principles. Children were comprehensively assessed by a research team before the onset of intervention, and then, again, 2 years later. Change in Vineland adaptive behaviour scales composite scores from intake (T1) to leaving the study (T2) was set as the primary outcome variable. The research team remained blind to the type and intensity of interventions provided. One hundred and ninety-eight (95%) of the original samples stayed in the study throughout the whole 2-year period and 192 children had a complete Vineland composite score results both at T1 and T2. Vineland composite scores increased over the 2-year period. This increase was accounted for by the subgroup with normal cognitive functioning. There was no significant difference between the intensive and nonintensive groups. Individual variation was considerable, but no child in the study was ''problem-free'' at follow-up. Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA.

Development of working memory, speech perception and auditory temporal resolution in children with allention deficit hyperactivity disorder and language impairment

Speech perception (SP), verbal working memory (WM) and auditory temporal resolution (ATR) have been studied in children with attention deficit hyperactivity disorder (ADHD) and language impairment (LI), as well as in reference groups of typically developed children. A computerised method was developed, in which discrimination of same or different pairs of stimuli was tested. In a functional Magnetic Resonance Imaging (fMRI) study a similar test was used to explore the neural correlate of the verbal WM. In addition the neurodevelopmental profiles of language impaired children have been investigated. (i) Speech perception is deeply intertwined with language learning. If SP is not functioning, language learning will be impaired. SP has previously not been studied in children with neurodevelopmental disorders. To test SP, stimulus pairs with nine different consonant contrasts were used. Examination of LI children showed that they had reduced speech perception for three of the contrasts. However, it is uncertain whether this has negative consequences for language functions. Children with ADHD and children with ADHD + developmental coordination disorder (DCD) performed equally well as a control group. There was no apparent change of SP in typically developed children between five and eight years of age. (ii) Verbal WM is important for the development of lexicon, language comprehension and expression both in typical children and in those with Ll. To test verbal WM with different memory loads, pairs of two to five syllable long non-words were used. A study of verbal WM in children with ADHD and ADHD+DCD, revealed that the latter group performed worse at higher memory loads than both the control group and the children with ADHD. The result was interpreted as a genuine WM problem since it could not be explained by group differences in IQ, hyperactivity or attention. An examination of LI children showed that their performance was worse than that of the controls for all memory loads. Yet, the LI group's performance was better than that reported in previous studies probably caused by differences in the methods. In typically developed children we found an improvement in verbal WM capacity between six and seven years of age. (iii) A controversial hypothesis has suggested that poor ATR underlies specific Ll. To test ATR, stimulus pairs with two 20 ms long tones, 878Hz and 1350Hz, presented with five different inter stimulus intervals between 256 and 16 ms were used. In typically developed children we found weak associations between ATR and verbal WM and speech perception. In a second experiment, a weak association was found between ATR and gender and phonological awareness. The results did thus not indicate that ATR plays an important role for language functions in children. A possible developmental effect was found between five and six years of age. In Ll children we found no impairment in ATR, supporting that language problems are not related to ATR. In all experimental groups a high variability in ATR was observed. (iv) The temporal sequence of cortical activations in a verbal working memory task was investigated with fMRI. Increased activation was found in the right pre-motor area when the subject was listening to the first stimulus of a pair. During rehearsal the right temporal cortex was activated in addition to the right pre-motor area. When the second stimulus in the pair was presented and a response decision was made, there were bilateral activations in the temporal cortex, ventro- and dorso-lateral prefrontal cortex and in the supplementary motor area. The findings indicate that the prefrontal cortex, and possibly the posterior parietal cortex, is more involved in response selection than in rehearsal in WM tasks. The lack of prefrontal activity during rehearsal is controversial and the experiment needs to be replicated before any definite conclusions can be drawn from the findings. (v) We examined a broad spectrum of neurodevelopmental symptoms in a group of language impaired preschool children. Among children with moderate or severe LI, 90 % had additional functional deficits. In the motor assessment, deficits were found in 42% of the children and an additional 13% had isolated fine motor problems. The cognitive assessment showed that 12% of the LI group had an IQ < 71 and that 16% had an IQ of 72 to 85. Diagnostic levels in one or more of four standardised behaviour scales were found in 44% and when a milder degree of symptoms were measured 80% in the LI group were affected. The findings show that LI usually is accompanied by other dysfunctions, thereby demonstrating the need for multidisciplinary assessments of children with Ll

Presurgical language lateralization assessment by fMRI and dichotic listening of pediatric patients with intractable epilepsy

Objective: The aim of this study was to evaluate the clinical use of a method to assess hemispheric language dominance in pediatric candidates for epilepsy surgery. The method is designed for patients but has previously been evaluated with healthy children. Methods: Nineteen patients, 8–18 years old, with intractable epilepsy and candidates for epilepsy surgery were assessed. The assessment consisted of two functional MRI protocols (fMRI) intended to target frontal and posterior language networks respectively, and a behavioral dichotic listening task (DL). Regional left/right indices for each fMRI task from the frontal, temporal and parietal lobe were calculated, and left/right indices of the DL task were calculated from responses of consonants and vowels, separately. A quantitative analysis of each patient's data set was done in two steps based on clearly specified criteria. First, fMRI data and DL data were analyzed separately to determine whether the result from each of these assessments were conclusive or not. Thereafter, the results from the individual assessments were combined to reach a final conclusion regarding hemispheric language dominance. Results: For 14 of the 19 subjects (74%) a conclusion was reached about their hemispheric language dominance. Nine subjects had a left-sided and five subjects had a right-sided hemispheric dominance. In three cases (16%) DL provided critical data to reach a conclusive result. Conclusions: The success rate of conclusive language lateralization assessments in this study is comparable to reported rates on similar challenged pediatric populations. The results are promising but data from more patients than in the present study will be required to conclude on the clinical applicability of the method

Language lateralization in children aged 10 to 11 years: a combined fMRI and dichotic listening study.

OBJECTIVE: The aims of this study were to develop and assess a method to map language networks in children with two auditory fMRI protocols in combination with a dichotic listening task (DL). The method is intended for pediatric patients prior to epilepsy surgery. To evaluate the potential clinical usefulness of the method we first wanted to assess data from a group of healthy children. METHODS: In a first step language test materials were developed, intended for subsequent implementation in fMRI protocols. An evaluation of this material was done in 30 children with typical development, 10 from the 1(st), 4(th) and the 7(th) grade, respectively. The language test material was then adapted and implemented in two fMRI protocols intended to target frontal and posterior language networks. In a second step language lateralization was assessed in 17 typical 10-11 year olds with fMRI and DL. To reach a conclusion about language lateralization, firstly, quantitative analyses of the index data from the two fMRI tasks and the index data from the DL task were done separately. In a second step a set of criteria were applied to these results to reach a conclusion about language lateralization. The steps of these analyses are described in detail. RESULTS: The behavioral assessment of the language test material showed that it was well suited for typical children. The results of the language lateralization assessments, based on fMRI data and DL data, showed that for 15 of the 17 subjects (88%) a conclusion could be reached about hemispheric language dominance. In 2 cases (12%) DL provided critical data. CONCLUSIONS: The employment of DL combined with language mapping using fMRI for assessing hemispheric language dominance is novel and it was deemed valuable since it provided additional information compared to the results gained from each method individually

Maximum Intensity Projections (MIP) of fMRI data for subject 1 to 17 in the listening paradigm at p<0.001 uncorrected.

<p>Spatial orientation of all projections is shown on the top row (P = posterior, A = anterior, L = left, R = right).</p

The criteria applied in the analysis of the fMRI data (1.), and of the dichotic listening data (2.), and the criteria used to combine these two analyses to reach a final conclusion about hemispheric language dominance (3.).

<p>The criteria applied in the analysis of the fMRI data (1.), and of the dichotic listening data (2.), and the criteria used to combine these two analyses to reach a final conclusion about hemispheric language dominance (3.).</p

Children with autism spectrum disorders who do not develop phrase speech in the preschool years

There is uncertainty about the proportion of children with autism spectrum disorders who do not develop phrase speech during the preschool years. The main purpose of this study was to examine this ratio in a population-based community sample of children. The cohort consisted of 165 children (141 boys, 24 girls) with autism spectrum disorders aged 4–6 years followed longitudinally over 2 years during which time they had received intervention at a specialized autism center. In this study, data collected at the 2-year follow-up were used. Three categories of expressive language were defined: nonverbal, minimally verbal, and phrase speech. Data from the Vineland Adaptive Behavior Scales-II were used to classify expressive language. A secondary objective of the study was to analyze factors that might be linked to verbal ability, namely, child age, cognitive level, autism subtype and severity of core autism symptoms, developmental regression, epilepsy or other medical conditions, and intensity of intervention. The proportion of children who met the criteria for nonverbal, minimally verbal, and phrase speech were 15%, 10%, and 75%, respectively. The single most important factor linked to expressive language was the child’s cognitive level, and all children classified as being nonverbal or minimally verbal had intellectual disability