Aided communication, mind understanding and co-construction of meaning.

Mind understanding allows for the adaptation of expressive language to a listener and is a core element when communicating new information to a communication partner. There is limited knowledge about the relationship between aided language and mind understanding. This study investigates this relationship using a communication task. The participants were 71 aided communicators using graphic symbols or spelling for expression (38/33 girls/boys) and a reference group of 40 speaking children (21/19 girls/boys), aged 5;0-15;11 years. The task was to describe, but not name, drawings to a communication partner. The partner could not see the drawing and had to infer what was depicted from the child's explanation. Dyads with aided communicators solved fewer items than reference dyads (64% vs 93%). The aided spellers presented more precise details than the symbol users (46% vs 38%). In the aided group, number of correct items correlated with verbal comprehension and age.

Constructing narratives to describe video events using aided communication.

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication.

Assessment of aided language comprehension and use in children and adolescents with severe speech and motor impairments.

There is limited knowledge about aided language comprehension and use in children who use aided communication and who are considered to have a relatively good comprehension of spoken language. This study's purpose was to assess their aided language skills. The participants were 96 children and adolescents who used communication aids (aided group) and 73 children and adolescents with natural speech (reference group), aged 5 to 15 years. All of the participants who used aided communication were regarded by their teachers or professionals as having age-appropriate language comprehension. All of the participants completed (a) standardized tests of visual perception, non-verbal reasoning, and comprehension of spoken language, and (b) tasks designed for this study that measured comprehension and production of graphic utterances through communicative problem solving. Using their own communication systems, the participants achieved an average of 72% correct on the graphic symbol comprehension task items, and 63% on the expressive tasks. The participants with natural speech achieved an average of 88% correct on comprehension items, and 93-96% accuracy on production items. The differences between groups were significant on all the tasks and standardized tests. There was considerable variation within the group of participants who used aided communication, and the results reveal a need to develop instruments with norms for aided language competence that can inform the implementation of interventions to support aided language development.

Communicating the unknown: descriptions of pictured scenes and events presented on video by children and adolescents using aided communication and their peers using natural speech.

The facility to describe scenes and events is important in everyday communication, but little is known about the description skills and strategies of young people using aided communication. This article explores how 81 children and adolescents using aided communication and 56 peers using natural speech, aged 5-15 years, described pictured scenes and events presented on video to a partner who had no prior knowledge of the content. The group who used aided communication took longer and included fewer elements in their descriptions than the reference group; however, the groups did not differ in their use of irrelevant or incorrect elements, suggesting that both groups stayed on topic. Measures related to aided message efficiency correlated significantly with measures of spoken language comprehension. There were no significant differences between groups for their descriptions of pictured scenes and video events. Analyses showed both unpredicted group similarities and predictable differences, suggesting key components for future research consideration.

Childhood placement in out-of-home care in relation to psychosocial outcomes in adults with fetal alcohol syndrome.

BACKGROUND: Even in adulthood, the disabilities associated with fetal alcohol spectrum disorders (FASD) may have a major impact on life, but different environmental circumstances during childhood may also be influential. This study aimed to investigate placements in out-of-home care, and number of early separations from caregivers, related to psychosocial outcomes in adults with fetal alcohol syndrome (FAS). Additional analyses were then done on a subgroup's cognitive development and mental health. METHODS: Data on education and living with biological parents or in out-of-home care were obtained from childhood medical records on 51 adults (43% women), mean age 32, all diagnosed with FAS. Adult psychosocial outcomes (e.g. highest completed education, economic status, care due to alcohol or illicit drug abuse, mental health and conviction for crime) were obtained from national registers. RESULTS: No significant within-group differences related to the adult psychosocial outcomes were found. Psychiatric disorders, psychotropic drug prescriptions and crime convictions were equally common, regardless of whether placement in care was early or late, or whether the participants had experienced few or many early separations. CONCLUSIONS: We suggest that the findings illustrate the heterogeneity among individuals with FASD. Welfare authorities' decisions concerning special education and placement in out-of-home care should be tailored to each individual. Interventions from society are still needed for individuals with FAS over 22 years old.

Cognitive and executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrome.

BACKGROUND: Primary disabilities in children with fetal alcohol syndrome (FAS) are the results of alcohol's teratogen effect on the fetal brain. Reduced cognitive and executive functions and social cognition are examples of such disabilities. Little is known about primary disabilities in adults with FAS as well as their sense of coherence (SoC). There is thus a need for knowledge about FAS in adulthood. AIMS: To investigate cognitive and executive functions, social cognition and SoC in adults with FAS. METHODS: Twenty adults with FAS (mean age: 30 years) were compared with 20 individuals matched on gender and age. Berg's Card-sorting Test-64, the Tower of Hanoi, Raven's Coloured Progressive Matrices, Digit Span, Faux Pas and the Swedish version of Antonovsky's Sense of Coherence Scale (SoC-29) were used. RESULTS: The FAS group had a weak SoC and displayed deficits in the neuropsychological tests sensitive to cognitive and executive functions and social cognition. The FAS group's median SoC score was 112, lower than the comparison group's median of 133 (P < 0.001). The FAS group had median scores of 29.0 on Raven's Matrices. The median for Digit Span was 5 forwards and 3 backwards, lower than in the comparison group (P < 0.001). CONCLUSIONS: Reduced cognitive and executive functions and impaired social cognition are assumed to have a major impact on life for adults with FAS. We suggest that the findings showing that adults with FAS had a weak SoC, with particularly low scores on the manageability scale, reflect their experiences of living with those primary disabilities. CLINICAL IMPLICATIONS: This study may enhance healthcare for individuals prenatally exposed to alcohol. In general, it contributes with knowledge about this group of individuals who need to be more visible in healthcare, and particularly, it demonstrates some of the neuropsychological disabilities they might have.

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective.

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.

Inferential ability in children with cerebral palsy, spina bifida and pragmatic language impairment.

The aim of the study was to investigate and compare the ability to make inferences in three groups of children ranging from 5.2 to 10.9 years: 10 children with cerebral palsy (CP), 10 children with spina bifida and hydrocephalus (SBH) and 10 children with pragmatic language impairment (PLI). The relationship between inferential and literal comprehension was investigated by analysing atypical responses. For this analysis an analytic framework was developed. The PLI group performed significantly worse on inferential questions than the CP group. It was only in the PLI group that problems with inferential questions exceeded the problems with literal questions, and the CP group even performed significantly better in this condition. Inferential comprehension was found to be related to language comprehension in the CP group, but was more related to the ability to predict future developments in the SBH- and PLI-groups. The PLI group relied more on world knowledge and associations than on text-related factors when delivering an atypical response compared to the CP group. The analysis of atypical responses proved to be a promising tool for the planning of an adequate intervention.

Interaction during intervention: conversations between professionals and children with cerebral palsy.

To develop interactional ability, conversation with both peers and adults is vital. However, for children with physical impairments, like cerebral palsy, interactions with adults often dominate. In this study, interaction between eight Swedish children with cerebral palsy, mean age 8.6 years, and their physiotherapists (PTs) and speech-language therapists (SLTs) was analysed during intervention across 16 dyads. The analysis of data focused on how quantitative, interactional and topical dominance was manifested by the PTs and the SLTs. In addition, mitigating strategies and use of feedback was investigated. Surprisingly, the only significant finding was in topic maintenance, where the PTs' conversations were more directed towards topics unrelated to the intervention context when compared to the conversations of the SLTs. Although not significant, the PTs tended to dominate by having a greater amount of talk, and the SLTs by asking many questions. It is discussed how the two professions may contribute to the development of interactional skills and pragmatic ability among children with cerebral palsy, given their professional training and focus of intervention.

Children with cerebral palsy, spina bifida and pragmatic language impairment: differences and similarities in pragmatic ability.

Pragmatically related abilities were studied in three clinical groups of children from 5 to 11 years of age; children with cerebral palsy (CP; n=10), children with spina bifida and hydrocephalus (SBH; n=10) and children with pragmatic language impairment (PLI; n=10), in order to explore pragmatic abilities within each group. A range of pragmatic, linguistic and cognitive assessments were performed, and comparisons between the groups were made. In addition, connections between variables were studied. The most salient result was the many similarities and the lack of clear boundaries between the groups. The only significant differences found concerned short-term memory and inference ability, where all three groups experienced problems but to varying extent. Different patterns of variance were found in the groups, indicating that different underlying abilities such as reception of grammar, inferential comprehension and lexical comprehension seem to affect pragmatic ability in somewhat different ways. The results suggest that the children with CP and SBH in this study shared a number of pragmatically related traits, being more similar than would be expected according to earlier research. Finally, it is suggested that pragmatic assessment is further subdivided into a socially versus a linguistically related assessment.

Reading and spelling in children with severe speech and physical impairments: a comparative study.

BACKGROUND: Effective literacy skills are crucial in supporting communication for children with severe speech and physical impairments (SSPI). Reading and spelling difficulties are reported to be over-represented in this group, even where language and cognitive skills are age appropriate. AIMS: To compare the performance of children with SSPI on a range of language, reading and spelling tasks with that of their typically developing peers matched for receptive vocabulary and mental age. METHODS & PROCEDURES: A wide range of tasks was developed as part of a larger study exploring phonological awareness, reading and spelling skills. All tasks were accessible to children with severe physical impairments. Two groups of primary school-aged children were recruited, children with SSPI of average intelligence, and naturally speaking peers, matched for receptive vocabulary. Children were assessed individually on language, non-verbal cognition, phonological awareness, reading and spelling tasks. OUTCOMES & RESULTS: Sixteen children with SSPI were recruited. Their performance was compared with that of 15 naturally speaking peers, matched for receptive vocabulary scores. The children with SSPI achieved significantly lower scores on reading and spelling measures relative to their naturally speaking peers. However, at least one participant with SSPI scored at ceiling on each task, indicating that SSPI do not preclude the development of reading and spelling, at least in the early stages of literacy development. CONCLUSIONS & IMPLICATIONS: This study indicates that some children with severe speech impairments can develop phonological awareness, reading and spelling skills. However, the data suggest that phonological awareness may not be as good a predictor of reading and spelling abilities in this group of children as in typically developing children. Further research is needed to track development of reading and spelling, as well as the instructional support needed to scaffold more effective skills in these areas.

Early reading and spelling abilities in children with severe speech and physical impairment: a cross-linguistic comparison.

Early reading and spelling abilities in children from Ireland and Sweden with severe speech and physical impairment (SSPI) were studied and compared. The aim was to look for similarities as well as for differences that could be related to the different linguistic environments. Both group consisted of 15 children, and were matched on linguistic age. Reading and spelling as well as phonological awareness and memory were tested. Both groups performed fairly well on the phonological awareness tasks, but the Swedish children did not seem to manage to use this ability successfully for reading and spelling. Overall the Irish children showed a slightly stronger performance, and were significantly better at the reading tasks. There were some signs that children were affected by the structure of their individual languages. The Irish children revealed the greatest problems with pseudoword spelling which is in line with results from speaking children with English as their mother tongue and could be a result of using a strategy based on larger linguistic units. The Swedish children had particular problems with tasks presented without oral support, which may be an effect of memory problems due to their lack of articulatory ability.

Referential communication in children with autism spectrum disorder.

Referential communication was studied in children with autism spectrum disorder (ASD) including children with autism and Asperger syndrome. The aim was to study alternative explanations for the children's communicative problems in such situations. Factors studied were theory of mind, IQ, verbal ability and memory. The main results demonstrated diminished performance in children with autism spectrum disorder, mirroring performance in everyday life, in comparison to verbal IQ and mental age matched typically developing children. Among children with autism spectrum disorders, there was a positive relationship between performance in referential communication and theory of mind. Memory capacity also proved to play a role in success in the task.

Memory ability of children with complex communication needs.

Phonological memory is central to language and reading and writing skills. Many children with complex communication needs (CCN) experience problems with reading and writing acquisition. The reason could be because of the absence of articulatory ability, which might have a negative affect on phonological memory. Phonological and visuo-spatial short-term memory and working memory were tested in 15 children with CCN, aged 5 - 12 years, and compared to children with natural speech matched for gender, and mental and linguistic age. Results indicated weaker phonological STM and visuo-spatial STM and WM in children with CCN. The lack of articulatory ability could be assumed to affect subvocal rehearsal and, therefore, phonological memory which, in turn, may affect reading and writing acquisition. Weak visuo-spatial memory could also complicate the use of Bliss symbols and other types of augmentative and alternative communication.

Phonological awareness in Swedish-speaking children with complex communication needs.

BACKGROUND: Children with complex communication needs (CCN) often experience problems achieving literacy. The aim of this project was to study phonological awareness, a central predictor for literacy achievement, in children with CCN, and to compare their performance to a group of children with natural speech. METHOD: One group of 15 Swedish children with CCN and cerebral palsy (CP), and one group of 15 children with natural speech, matched for gender, linguistic age and mental age, were administered nine phonological awareness tasks, testing onset/rime and phonemic awareness. RESULTS: Overall, children with CCN showed good levels of phonological awareness. However, on the one task that did not include any verbal support from the experimenter, the children with CCN performed at a significantly lower level. CONCLUSION: Phonological awareness does not seem to depend on overt articulation, although the lack of speech might affect the children's ability to manipulate linguistic material that is not verbally presented.

Children with autistic spectrum disorders and speech-generating devices: communication in different activities at home.

The communication of four children with autistic spectrum disorder was investigated when they were supplied with a speech-generating device (SGD) in three different activities in their home environment: mealtime, story reading and "sharing experiences of the preschool day". An activity based communication analysis, in which collective and individual background factors for the activities were outlined, was used as a basis for the discussion of linguistic coding data derived from video-recordings made before and during SGD intervention. The coded communicative behaviours were engagement in activity, role in turn-taking, communicative form, function and effectiveness. An increase in communicative effectiveness was more noticeable when the SGDs could be used to fulfil goals and roles within the activity. The instruction to the parents to use the SGDs in their communication with the child had an important influence on the activities.

Preferred communication modes: prelinguistic and linguistic communication in non-speaking preschool children with cerebral palsy.

Seven non-speaking preschool children with severe cerebral palsy, 5-7 years of age, were studied with respect to the amount of prelinguistic versus linguistic modes of communication used in communicative interaction with a previously unknown adult. An attempt was also made to analyse this in relation to the childrens' physical, cognitive and linguistic capacities. No significant correlations were found, however. Given that all participants had reached preschool age and were of normal intelligence, the amount of linguistic communication used (12%) was much less than could be expected. Explanations for the results were suggested, including limited interaction possibilities with the environment due to motor dysfunction, which in turn might prevent development of linguistic skills necessary to take part in more complex communicative interaction later in life.