Atypical language in lesional and nonlesional complex partial epilepsy.

OBJECTIVE: We investigated the relationship between partial epilepsy, MRI findings, and atypical language representation. METHODS: A total of 102 patients (4 to 55 years) with left hemisphere epileptogenic zones were evaluated using three fMRI language tasks obtained at 1.5 or 3T with EPI BOLD techniques: verbal fluency, reading comprehension, and auditory comprehension. fMRI maps were visually interpreted at a standard threshold and rated as left or atypical language. RESULTS: Atypical language dominance occurred in 30 patients (29%) and varied with MRI type (p < 0.01). Atypical language representation occurred in 36% (13/36) with normal MRI, 21% (6/29) with mesial temporal sclerosis, 14% (4/28) with focal cortical lesions (dysplasia, tumor, vascular malformation), and all (6/6) with a history of stroke. Multivariate logistic regression analysis found handedness, seizure onset, and MRI type accounted for much of the variance in language activation patterns (chi(2) = 24.09, p < 0.01). Atypical language was more prevalent in patients with early seizure onset (43.2%, p < 0.05) and atypical handedness (60%, p < 0.01). None of the three clinical factors were correlated with each other (p > 0.40). Patients with atypical language had lower verbal abilities (F = 6.96, p = 0.01) and a trend toward lower nonverbal abilities (F = 3.58, p = 0.06). There were no differences in rates of atypical language across time, age groups, or MRI scanner. CONCLUSION: Early seizure onset and atypical handedness, as well as the location and nature of pathologic substrate, are important factors in language reorganization.

Parental language input to children at stuttering onset.

Many programs for the indirect management of stuttering in early childhood counsel adjustment of parental language models, which are presumed to play an exacerbating influence on vulnerable children's fluency. We examined the relative levels of linguistic demand in maternal language to stuttering and nonstuttering children, adjusted for each child's current level of linguistic development. No significant or observable differences were detected in the relative level of linguistic demand posed by parents of stuttering children very close to onset of symptoms. Empirical support for current advisement and potential ramifications are discussed.

Parental perceptions of children's communicative development at stuttering onset.

There has been clinical speculation that parents of young stuttering children have expectations of their children's communication abilities that are not well-matched to the children's actual skills. We appraised the language abilities of 15 children close to the onset of stuttering symptoms and 15 age-, sex-, and SES-matched fluent children using an array of standardized tests and spontaneous language sample measures. Parents concurrently completed two parent-report measures of the children's communicative development. Results indicated generally depressed performance on all child speech and language measures by the children who stutter. Parent report was closely attuned to child performance for the stuttering children; parents of nonstuttering children were less accurate in their predictions of children's communicative performance. Implications for clinical advisement to parents of stuttering children are discussed.

Syntactic complexity, fluency, and accuracy of sentence imitation in adolescents.

The majority of work that suggests a relationship between syntactic complexity and the frequency of stuttering has been carried out with young children. In this paper, we investigate whether or not syntactic complexity exerts an influence on the frequency of stuttering in adolescent speech. Fourteen adolescents, 7 of whom stuttered, and 7 of whom were normally fluent, ages 10-18 years, participated in a sentence imitation task in which stimuli were divided into three classes of grammatical complexity. Results indicated that for both groups of speakers, normal disfluencies and errors in repetition accuracy increased as syntactic complexity increased. However, stuttering frequency did not appear to be affected by changes in the syntactic complexity of the target stimuli. Such findings suggest either a diminution of the effects of syntactic complexity on stuttering over the course of language acquisition or changes in the mix of chronic and nonchronic stuttering speakers from those used in earlier studies of the effects of linguistic structure on stuttering in children.

Phonetic profiles of toddlers with specific expressive language impairment (SLI-E).

Spontaneous language samples of 30 24-month-old toddlers diagnosed with Specific Expressive Language Impairment (SLI-E) were compared with samples produced by an age-matched group of 30 typically developing toddlers. Vocalization patterns, phonetic inventories, and syllable formation patterns were compared. Toddlers with SLI-E vocalized significantly less often than their typically developing peers, had proportionately smaller consonantal and vowel inventories, and used a more restricted and less mature array of syllable shapes. Although the mean incidence of phoneme usage varied significantly in all comparisons, profiles of consonant usage were similar between the two groups for initial phoneme usage, but considerably different for final consonant closure. Such patterns of vocal and phonetic behavior confirm earlier reports of phonetic delay in SLI-E, and suggest that nongrammatical factors contribute to the development of expressive language deficits in toddlers. We further propose a bidirectional model for the expressive deficits in SLI-E, in which the child's limited phonetic capacity interacts with propensities in caretaker interaction to further reduce opportunities for expressive language learning and practice.

Communicative development in twins with discordant histories of recurrent otitis media.

The communicative abilities of six sets of same-sex, dizygotic twins (CAs 2;1-4;1) were examined. In each dyad, one sibling had a strong positive history of recurrent otitis media (ROM), while the other twin had a negative or minimal history of ROM. Standardized test performance and spontaneous speech and language abilities were examined. Results suggest that although a history of ROM is associated with lowered receptive vocabulary scores in these dyads, no consistent effects of ROM could be detected in expressive speech and language tasks. In two dyads, the ROM-positive twin did score lower on articulation and language measures; however, in two dyads, children with equivalent histories of ROM outscored their ROM-negative siblings. In the remaining dyads, little difference was observed between the siblings on the measures we used. We suggest that the effects of ROM on communicative development are complex and subtle, and that control of home and day care environment may minimize some of the previously documented associations between ROM and speech-language development.

Effects of gradual increases in sentence length and complexity on children's dysfluency.

To systematically evaluate the task demands of changes in utterance length and complexity, 8 normal and 8 stuttering children, ages 3:11-6:4, were administered an elicited imitation task in which the variables of syntactic complexity (as determined by normative age of acquisition) and length were manipulated to appraise their effects upon fluency and accuracy of sentence reproduction. Our findings suggest that fluency breakdown is significantly well correlated with gradual increases in syntactic complexity for both stuttering and normal children, as is sentence replication ability. Length does not appear to be as strong a predictor of fluency characteristics of elicited output. Additionally, we were unable to support a growing clinical impression of subtle language differences between normal and stuttering children; our stuttering subjects did not differ significantly from the normal children in their ability to accurately reproduce a variety of sentence types. The data suggest ways in which task complexity in stuttering therapy for young children might be ordered.