The white matter connectome as an individualized biomarker of language impairment in temporal lobe epilepsy.

ObjectiveThe distributed white matter network underlying language leads to difficulties in extracting clinically meaningful summaries of neural alterations leading to language impairment. Here we determine the predictive ability of the structural connectome (SC), compared with global measures of white matter tract microstructure and clinical data, to discriminate language impaired patients with temporal lobe epilepsy (TLE) from TLE patients without language impairment.MethodsT1- and diffusion-MRI, clinical variables (CVs), and neuropsychological measures of naming and verbal fluency were available for 82 TLE patients. Prediction of language impairment was performed using a robust tree-based classifier (XGBoost) for three models: (1) a CV-model which included demographic and epilepsy-related clinical features, (2) an atlas-based tract-model, including four frontotemporal white matter association tracts implicated in language (i.e., the bilateral arcuate fasciculus, inferior frontal occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus), and (3) a SC-model based on diffusion MRI. For the association tracts, mean fractional anisotropy was calculated as a measure of white matter microstructure for each tract using a diffusion tensor atlas (i.e., AtlasTrack). The SC-model used measurement of cortical-cortical connections arising from a temporal lobe subnetwork derived using probabilistic tractography. Dimensionality reduction of the SC was performed with principal components analysis (PCA). Each model was trained on 49 patients from one epilepsy center and tested on 33 patients from a different center (i.e., an independent dataset). Randomization was performed to test the stability of the results.ResultsThe SC-model yielded a greater area under the curve (AUC; .73) and accuracy (79%) compared to both the tract-model (AUC: .54, p < .001; accuracy: 70%, p < .001) and the CV-model (AUC: .59, p < .001; accuracy: 64%, p < .001). Within the SC-model, lateral temporal connections had the highest importance to model performance, including connections similar to language association tracts such as links between the superior temporal gyrus to pars opercularis. However, in addition to these connections many additional connections that were widely distributed, bilateral and interhemispheric in nature were identified as contributing to SC-model performance.ConclusionThe SC revealed a white matter network contributing to language impairment that was widely distributed, bilateral, and lateral temporal in nature. The distributed network underlying language may be why the SC-model has an advantage in identifying sub-components of the complex fiber networks most relevant for aspects of language performance

PREDICTING THE LANGUAGE ABILITIES OF CHILDREN

The ability to learn language is influenced both by children\u27s biological abilities and the environment in which they find themselves. Rather than low test scores alone, it may be that children who exhibit disproportionately low language abilities relative to what would be predicted from their biological abilities and expectations based on their environmental situations may be considered to exhibit a specific language impairment. The present study explores this hypothesis by taking measures aimed at estimating 45 children’s biological potential through direct measures o f parental abilities and environmental situations and examining the ability of these measures to predict children’s language abilities. Predictors were based on parental measures of nonword repetition, nonverbal intelligence, working memory, sentence recall, grammaticality judgment, reading, and family environment. The findings of this study show a myriad of variables affect language development from both biological and environmental factors, implying that learning language involves the interplay between children’s innate makeup and their environmental conditions

English morpheme accuracy, diversity, and productivity measures in school-aged bilingual children

The identification of meaningful language measures for bilingual children has important clinical implications in the diagnosis of impairment. Given the shortage of bilingual speech-language pathologists, informative English measures are invaluable. This study extends current research to examine the utility of widely accepted English grammatical measures in bilingual school-aged children with differing levels of English exposure. The language sample analyses implemented have shown repeatedly to discriminate between typical and language impaired monolinguals, and more recently were considered in the assessment of developing bilinguals. Measures were taken from the language samples of thirteen school-aged bilingual Spanish-English speaking children who told a story using a wordless picture book. These thirteen participants were split into groups of high and low proficiency based on English preschool Language Assessment Scales (pre-LAS) scores and age of first exposure to English. There was no significant evidence found to support that these measures correlate with the broad measures of language (mean length of utterance and number of different words) or can differentiate between the two groups of varying proficiency

Evaluation of speech and language therapy interventions for pre-school children with specific language impairment: a comparison of outcomes following specialist intensive, nursery-based and no intervention

Background: Clinical services in the UK are increasingly delivering ‘consultative’ methods of intervention rather than ‘direct’ intensive input for children with receptive and expressive language difficulties, yet there has been little systematic evaluation of these different intervention models. Aims: To investigate the effectiveness of different models of therapy provision for children with specific language impairment between the ages of 4;00 and 4;06 years. Methods & Procedures: Twenty-four children were selected from a specialist waiting list in the London Borough of Lambeth. They were assessed on a range of verbal and non-verbal skills, and randomly assigned to three different intervention groups. Group 1 received direct intensive speech and language therapy weekly over an 8-month period at a child development centre; Group 2 received a nursery-based model of intervention; and Group 3 received review sessions at their local clinic. Outcome & Results: Statistical analysis before the intervention phase revealed no significant differences in scores between the three groups on a range of clinical and parental measures of language, non-verbal skills, play and behaviour. At the end of the intervention period the Intensive group showed significantly greater improvement than the No Intervention group on all clinical and parental measures, and significantly greater improvement than the Nursery-based group on all clinical and parental measures except for expressive grammar. Conclusions & Implications: The results of this small-scale study demonstrate that intensive direct speech and language therapy delivered by speech and language therapists was a more effective model of intervention for this clinical group with severe speech and language impairment

Linguistic and Cognitive Measures in Arabic-Speaking English Language Learners (ELLs) and monolingual children with and without Developmental Language Disorder (DLD)

Understanding the current level of language knowledge in English Language Learners (ELLs) can present a challenge. The standardized language tests that are commonly used to assess language tap prior knowledge and experience. ELLs may score poorly on such ‘knowledge-based’ measures because of the low levels of exposure to each of their languages. Considerable overlap has been found on several knowledge-based measures (Paradis, 2010) between ELLs and monolingual children with an unexpected delay in language development known as Developmental Language Disorder (DLD). Measures of cognitive processing, on the other hand, are less dependent on ELLs’ linguistic knowledge because they employ nonlinguistic or novel stimuli to tap skills considered to underlie language learning. It has been suggested that processing-dependent tasks such as measures of verbal short-term memory may differentiate ELLs from children with DLD (Kohnert, Windsor, & Yim, 2006; Paradis, Schneider, & Duncan, 2013). This thesis presents three studies that investigated the performance of Arabic-speaking ELLs and monolingual children with and without DLD on linguistic and cognitive measures. Study 1 provided a description of the performance of monolingual Arabic-speaking children on a battery of Arabic language tests. The results of study 1 revealed that the majority of language measures were sensitive to developmental change in younger children between the ages of 6 and 7. Study 2 demonstrated lower standardized scores by ELLs on the Arabic and English knowledge-based language tasks. However, ELLs scored above or at age-level expectations on the cognitive measures, with the exception of an Arabic-nonword repetition task. Study 3 found a significant overlap between ELLs and monolingual Arabic-speaking children with DLD on first language (L1) knowledge-based measures. With the exception of the Arabic nonword repetition task, verbal short-term and working memory tasks distinguished ELLs from children with underlying language impairment. The results indicated that there is a need to develop language assessment measures that evaluate a broad range of language abilities for Arabic-speaking children. The findings also suggested that unlike knowledge-based measures, cognitive measures may be valid assessment tools that minimize the role of linguistic knowledge and experiences and help distinguish between ELLs and children with DLD

Inferencing Abilities of Children With Specific Language Impairment

Inferencing is the ability to make judgments based upon limited information. It is necessary for basic problem solving, negation social interaction, and comprehension of oral and written language. Despite the importance of inferencing in daily life, there are currently no commercially available tests dedicated entirely to the assessment of inferencing. Previous research has demonstrated a developmental progression of inferencing abilities in neurotypical children. However, no clinical norms exist. Additionally, little research has been conducted regarding the inferencing abilities of children with language impairments. The purpose of this project was to compare inferencing abilities of children with language impairment to typically developing children and to examine the validity of the recently developed, Test of Inferencing (DePew & Veale, 2010). Ten children with language impairment and twelve typically developing children participated in this study. All subjects were between the ages of six and eight. Utilizing a group comparative design, performance on an inferencing battery was evaluated. The following measures were included: the Test of Inferencing (DePew & Veale, 2010), the Test of Problem Solving 3-Elementary (TOPS-3; Huisingh, Bowers, & LoGiudice, 2005), the Listening Comprehension: Making Inferences subtest of the Test of Language Competence-Expanded Edition (TLC-E; Wiig & Secord, 1989), and the Inference subtest of the Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk, 1999). Results indicated that subjects with language impairment demonstrated significantly worse inferencing skills than neurotypical subjects. Significant differences were found between the groups on all inferencing measures. Additionally, results demonstrated that the Test of Inferencing is an effective measure of inferencing skills

An In Depth Analyses of Specific Language Impairment as Compared to Other Developmental Disorders

Specific language impairment (SLI), defined as a disproportionate difficulty in learning language despite having normal hearing, intelligence, and no known neurological or emotional impairment, has been shown to share similar cognitive characteristics with individuals with attention deficit hyperactive disorder (ADHD). However, little research has investigated the dissimilarities in these two different developmental disorders. Children with SLI also show many similar symptoms with individuals diagnosed with dyslexia. The aim of these studies is to get a better understanding of cognitive differences between SLI and ADHD, and the cognitive similarities between SLI and dyslexia. Tests of both verbal and non-verbal measures of working memory, IQ, and academic performance were administered to all groups. It was hypothesized that children with SLI would perform worse on verbal measures due to their language deficits but perform better on non-verbal measures than children with ADHD. It was also predicted that children with SLI will perform similarly, but worse than children with dyslexia. Results from the SLI/ADHD experiment confirm this pattern: children with SLI performed poorer than children with ADHD on all verbal cognitive measures. When looking at the non-verbal measures of abilities, the SLI group outperformed the ADHD group on working memory and IQ scores but not academic performance scores. Results from the SLI/Dyslexia experiment also confirmed what was predicted. Children with dyslexia outperformed their SLI counterparts on all cognitive measures. A possible explanation for these finding is that there are fewer classroom-based programs designed specifically to support children with SLI

CMIP and ATP2C2 Modulate Phonological Short-Term Memory in Language Impairment

Specific language impairment (SLI) is a common developmental disorder characterized by difficulties in language acquisition despite otherwise normal development and in the absence of any obvious explanatory factors. We performed a high-density screen of SLI1, a region of chromosome 16q that shows highly significant and consistent linkage to nonword repetition, a measure of phonological short-term memory that is commonly impaired in SLI. Using two independent language-impaired samples, one family-based (211 families) and another selected from a population cohort on the basis of extreme language measures (490 cases), we detected association to two genes in the SLI1 region: that encoding c-maf-inducing protein (CMIP, minP = 5.5 × 10−7 at rs6564903) and that encoding calcium-transporting ATPase, type2C, member2 (ATP2C2, minP = 2.0 × 10−5 at rs11860694). Regression modeling indicated that each of these loci exerts an independent effect upon nonword repetition ability. Despite the consistent findings in language-impaired samples, investigation in a large unselected cohort (n = 3612) did not detect association. We therefore propose that variants in CMIP and ATP2C2 act to modulate phonological short-term memory primarily in the context of language impairment. As such, this investigation supports the hypothesis that some causes of language impairment are distinct from factors that influence normal language variation. This work therefore implicates CMIP and ATP2C2 in the etiology of SLI and provides molecular evidence for the importance of phonological short-term memory in language acquisition

Clinical Effectiveness of the Queen Square Intensive Comprehensive Aphasia Service for Patients With Poststroke Aphasia

BACKGROUND AND PURPOSE: Poststroke aphasia has a major impact on peoples' quality of life. Speech and language therapy interventions work, especially in high doses, but these doses are rarely achieved outside of research studies. Intensive Comprehensive Aphasia Programs (ICAPs) are an option to deliver high doses of therapy to people with aphasia over a short period of time. METHODS: Forty-six people with aphasia in the chronic stage poststroke completed the ICAP over a 3-week period, attending for 15 days and averaging 6 hours of therapy per day. Outcome measures included the Comprehensive Aphasia Test, an impairment-based test of the 4 main domains of language (speaking, writing, auditory comprehension, and reading) which was measured at 3 time points (baseline, immediately posttreatment at 3 weeks and follow-up at 12-week post-ICAP); and, the Communicative Effectiveness Index, a carer-reported measure of functional communication skills collected at baseline and 12 weeks. RESULTS: A 2-way repeated measures multivariate ANOVA was conducted. We found a significant domain-by-time interaction, F=12.7, P<0.0005, indicating that the ICAP improved people with aphasia's language scores across all 4 domains, with the largest gains in speaking (Cohen's d=1.3). All gains were maintained or significantly improved further at 12-week post-ICAP. Importantly, patients' functional communication, as indexed by changes on the Communicative Effectiveness Index, also significantly improved at 12-week post-ICAP, t=5.4, P<0.0005, also with a large effect size (Cohen's d=0.9). CONCLUSIONS: People with aphasia who participated in the Queen Square ICAP made large and clinically meaningful gains on both impairment-based and functional measures of language. Gains were sustained and in some cases improved further over the subsequent 12 weeks

COMPARISON OF LANGUAGE PERFORMANCE USING EXPOSURE AND NON-EXPOSURE NORMS IN ENGLISH LEARNERS IDENTIFIED WITH SPEECH LANGUAGE IMPAIRMENT

English Learners (ELs) in the U.S. have historically been misidentified as having a Speech Language Impairment (SLI). School psychologists and speech language pathologists must determine whether ELs present with language differences that are due to normal patterns of language acquisition or language impairment. Not only is the process complicated by the presence of two or more languages rather than just one, it often involves the use of standardized tests that do not control adequately for the differences in developmental language proficiency. Based on the results of this study, it was found that using tests that are developed with language exposure norms (e.g., the Ortiz PVAT) seem to produce scores that are substantially higher when used with ELs as compared to the scores that are derived from traditional tests using non-exposure norms. This study focused on an analysis and comparison between traditional measures of verbal ability (e.g., WISC-V Verbal Comprehension Index (VCI)), other language assessments (e.g., CELF-5 and PLS-5) and the Ortiz PVAT scores. It was found that both verbal ability VCI and language scores were consistently over one standard deviation lower than the Ortiz PVAT scores. Furthermore, when ELs were tested with the Ortiz PVAT their mean values were consistently within the average range. This suggests that current methods may be misidentifying English Learners as having a Speech Language Impairment where none exists, which negatively affects eligibility and intervention decisions and, ultimately, their academic trajectory. Overall, the results indicate that the Ortiz PVAT provides an alternative to current evaluation instruments because it targets receptive vocabulary while controlling for language exposure in ELs. This alternative method allows practitioners to use the Ortiz PVAT to assess English Learners in a manner that assists in determining if their performance is reflective of typical language acquisition or if it is suggestive of a language disorder