The Multilingual Naming Test (MINT) as a Measure of Picture Naming Ability in Alzheimer's Disease.

OBJECTIVE: The present study investigated the ability of the Multilingual Naming Test (MINT), a picture naming test recently added to the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set neuropsychological test battery, to detect naming impairment (i.e., dysnomia) across stages of Alzheimer's disease (AD). METHOD: Data from the initial administration of the MINT were obtained on NACC participants who were cognitively normal (N = 3,981) or diagnosed with mild cognitive impairment (N = 852) or dementia (N = 1,148) with presumed etiology of AD. Dementia severity was rated using the Clinical Dementia Rating (CDR) scale. RESULTS: Cross-sectional multiple regression analyses revealed significant effects of diagnostic group, sex, education, age, and race on naming scores. Planned comparisons collapsing across age and education groups revealed significant group differences in naming scores across levels of dementia severity. ROC curve analyses showed good diagnostic accuracy of MINT scores for distinguishing cognitively normal controls from AD dementia, but not from MCI. Within the cognitively normal group, there was a robust interaction between age and education such that naming scores exhibited the most precipitous drop across age groups for the least educated participants. Additionally, education effects were stronger in African-Americans than in Whites (a race-by-education interaction), and race effects were stronger in older than in younger age groups (a race-by-age interaction). CONCLUSIONS: The MINT successfully detects naming deficits at different levels of cognitive impairment in patients with MCI or AD dementia, but comparison to age, sex, race, and education-corrected norms to determine impairment is essential.

Schizophrenia, culture and neuropsychology: sensory deficits, language impairments and social functioning in Chinese-speaking schizophrenia patients.

BACKGROUND: While 20% of schizophrenia patients worldwide speak tonal languages (e.g. Mandarin), studies are limited to Western-language patients. Western-language patients show tonal deficits that are related to impaired emotional processing of speech. However, language processing is minimally affected. In contrast, in Mandarin, syllables are voiced in one of four tones, with word meaning varying accordingly. We hypothesized that Mandarin-speaking schizophrenia patients would show impairments in underlying basic auditory processing that, unlike in Western groups, would relate to deficits in word recognition and social outcomes. METHOD: Altogether, 22 Mandarin-speaking schizophrenia patients and 44 matched healthy participants were recruited from New York City. The auditory tasks were: (1) tone matching; (2) distorted tunes; (3) Chinese word discrimination; (4) Chinese word identification. Social outcomes were measured by marital status, employment and most recent employment status. RESULTS: Patients showed deficits in tone-matching, distorted tunes, word discrimination and word identification versus controls (all p<0.0001). Impairments in tone-matching across groups correlated with both word identification (p<0.0001) and discrimination (p<0.0001). On social outcomes, tonally impaired patients had 'lower-status' jobs overall when compared with tonally intact patients (p<0.005) and controls (p<0.0001). CONCLUSIONS: Our study is the first to investigate an interaction between neuropsychology and language among Mandarin-speaking schizophrenia patients. As predicted, patients were highly impaired in both tone and auditory word processing, with these two measures significantly correlated. Tonally impaired patients showed significantly worse employment-status function than tonally intact patients, suggesting a link between sensory impairment and employment status outcome. While neuropsychological deficits appear similar cross-culturally, their consequences may be language- and culture-dependent.

Phonological fluency is uniquely impaired in Japanese-speaking schizophrenia patients: confirmation study.

In alphabet-based language-speaking patients with schizophrenia, category fluency is disproportionately disturbed as compared with phonological fluency. Deficits in category and phonological fluency observed in Japanese patients, however, were similar. The aim of the present study was to replicate these findings by modifying the task to minimize the influence of lack of motivation and concentration in the patients. Similar deficits were found in both types of fluency in Japanese patients. Patients who speak Japanese have deficits in phonological fluency, compared with patients who speak alphabet-based languages, suggesting that the pattern of impairment in verbal fluency in schizophrenia is dependent on the specific language system.

Multicultural issues in test interpretation.

Designing the ideal test or series of tests to assess individuals who speak languages other than English is difficult. This article first describes some of the roadblocks-one of which is the lack of identification criteria for language and learning disabilities in monolingual and bilingual populations in most countries of the non-English-speaking world. This lag exists, in part, because access to general education is often limited. The second section describes tests that have been developed in the United States, primarily for Spanish-speaking individuals because they now represent the largest first-language majority in the United States (80% of English-language learners [ELLs] speak Spanish at home). We discuss tests developed for monolingual and bilingual English-Spanish speakers in the United States and divide this coverage into two parts: The first addresses assessment of students' first language (L1) and second language (L2), usually English, with different versions of the same test; the second describes assessment of L1 and L2 using the same version of the test, administered in the two languages. Examples of tests that fit a priori-determined criteria are briefly discussed throughout the article. Suggestions how to develop tests for speakers of languages other than English are also provided. In conclusion, we maintain that there will never be a perfect test or set of tests to adequately assess the communication skills of a bilingual individual. This is not surprising because we have yet to develop an ideal test or set of tests that fits monolingual Anglo speakers perfectly. Tests are tools, and the speech-language pathologist needs to know how to use those tools most effectively and equitably. The goal of this article is to provide such guidance.

Specific linguistic and pragmatic deficits in Italian patients with schizophrenia.

OBJECTIVE: Verbal communication impairments are prominent features of schizophrenia. The grammatical and pragmatic components of expressive and receptive verbal abilities were systematically examined, for the first time, in Italian patients with schizophrenia. Indeed, most of the language literature is composed of studies on English speaking people. METHOD: Elicited narrative production, and syntactic and pragmatic receptive abilities were analyzed in a cohort of 37 patients with schizophrenia and 37 healthy controls. Furthermore, a conversational speech production task was administered to an age- and gender-matched subset of this population. The level of significance was set at p

Flexibility and variability in lexicon usage among Yoruba-speaking Nigerian outpatients with schizophrenia: a controlled study.

BACKGROUND: The studies on language dysfunction in schizophrenia are few, inconclusive and have all been done in the western culture. There may be cross-cultural and cross-lingual differences in problems with speeches of patients with schizophrenia. This study aims to examine the flexibility or variability in the use of words among a group of Nigerian patients with schizophrenia compared with healthy controls. SAMPLING AND METHODS: The spoken samples of 48 outpatients with schizophrenia and 48 matched controls were assessed using the mean segmental type-token ratio (MSTTR). The sociodemographic and clinical variables of the patients with schizophrenia were also compared with their MSTTR scores. RESULTS: The MSTTR score for the patients with schizophrenia was significantly lower compared with that of healthy controls (p < 0.001). The factors independently associated with a lower MSTTR in patients with schizophrenia include younger age at onset of illness, presence of negative formal thought disorder and simple or hebephrenic subtype of schizophrenia. CONCLUSIONS: The problem with flexibility and variability in lexicon usage among patients with schizophrenia is a cross-cultural phenomenon. The MSTTR may have value in predicting clinical judgements of thought disorder or in identifying deviant language. These may have broad potentials for application in longitudinal and pathogenetic studies of schizophrenia.

Foreign language learning difficulties in Italian children: are they associated with other learning difficulties?

A group of seventh- and eighth-grade Italian students with low achievement (LA) in learning English as a foreign language (FL) was selected and compared to a group with high achievement (HA) in FL learning. The two groups were matched for age and nonverbal intelligence. Two experiments were conducted to examine the participants' verbal and nonverbal learning skills, such as native language reading accuracy, speed and comprehension, calculation, and attention and self-regulation. Both experiments showed that the LA group seemed at risk for reading comprehension difficulties, but its reading speed and accuracy were within the average range according to Italian norms. The results also excluded the possibility that FL learning difficulties of LA participants could be associated with a deficit in calculation. Furthermore, according to teachers' ratings, children with LA appeared at risk for attention-deficit disorder (ADD). The pattern of learning difficulties of seventh- and eighth-grade participants with LA appeared to be not completely comparable with that of high school students at risk of FL learning difficulties as described in the literature.

Sentence Recall by Children With SLI Across Two Nonmainstream Dialects of English.

PURPOSE: The inability to accurately recall sentences has proven to be a clinical marker of specific language impairment (SLI); this task yields moderate-to-high levels of sensitivity and specificity. However, it is not yet known if these results hold for speakers of dialects whose nonmainstream grammatical productions overlap with those that are produced at high rates by children with SLI. METHOD: Using matched groups of 70 African American English speakers and 36 Southern White English speakers and dialect-strategic scoring, we examined children's sentence recall abilities as a function of their dialect and clinical status (SLI vs. typically developing [TD]). RESULTS: For both dialects, the SLI group earned lower sentence recall scores than the TD group with sensitivity and specificity values ranging from .80 to .94, depending on the analysis. Children with SLI, as compared with TD controls, manifested lower levels of verbatim recall, more ungrammatical recalls when the recall was not exact, and higher levels of error on targeted functional categories, especially those marking tense. CONCLUSION: When matched groups are examined and dialect-strategic scoring is used, sentence recall yields moderate-to-high levels of diagnostic accuracy to identify SLI within speakers of nonmainstream dialects of English.

Disorganization of semantic memory underlies alogia in schizophrenia: an analysis of verbal fluency performance in Japanese subjects.

Patients with schizophrenia exhibit impaired semantic memory as well as deficits in a wide range of language-related functions, such as verbal fluency, comprehension and production of complex sentences. Since language and memory disturbances may underlie some of the psychotic symptoms of schizophrenia, the present study investigated the specific association between alogia (i.e. poverty of speech, poverty of content of speech, blocking, and increased latency of response) and semantic memory organization using the category fluency task (CFT) as a measure of verbal fluency. Thirty-eight patients with schizophrenia and an equal number of normal controls entered the study. Semantic structure was derived from multidimensional scaling analysis using sequential word outputs from the CFT. Patients with schizophrenia revealed disorganized semantic structure (e.g. irregular association of category members) compared with controls, consistent with previous reports. The patients were then divided into two groups, i.e. alogia- and non-alogia subjects, based on the Alogia scores from the Scale for the Assessment of Negative Symptoms (SANS). The symptom-based analysis showed that the semantic structure for the alogia group (Alogia score < or =2) was more disorganized than that for the non-alogia group (Alogia score <1) although the number of words produced did not differ between the two groups. The results of cluster analysis revealed the presence of bizarre coherence specifically in the alogia group. These results indicate that semantic memory disorganization may contribute to the symptom of alogia in schizophrenia. In addition, this is one of the few studies that examined verbal fluency in Japanese patients with schizophrenia and suggest that the language abnormalities in schizophrenia are universal.

Language development in preschool-age children adopted from China.

This study examined the language development of 55 preschool-age children adopted from China who had resided in their permanent homes for approximately 2 years or longer. Slightly over 5% of the children scored below average on 2 or more measures from a battery of standardized speech-language tests normed on monolingual English speakers. However, the vast majority scored within or well above the average range on 2 or more measures. Contrary to other reports on the language development of internationally adopted children, the results suggest that "second first language" acquisition proceeds rapidly in the majority of preschool-age children adopted as infants and toddlers. For the children in the sample who scored below average, results indicated that they were among the children who had been exposed to English for the least amount of time. The results of this study demonstrate both the robustness of the language system in the majority of adopted children from China as well as slower growth in a small subset of lower performers in the 1st years after adoption.

Vietnamese children and language-based processing tasks.

PURPOSE: Vietnamese children's performance on language-based processing tasks of fast-mapping (FM) word-learning and dynamic assessment (DA) word- and rule-learning tasks were investigated. METHOD: Twenty-one first- and second-generation Vietnamese preschool children participated in this study. All children were enrolled in 2 Head Start programs in a large city in the Midwest. All children had passed a developmental assessment and routine speech, language, and hearing screenings. All participants were taught 4 invented monosyllabic words in an FM word task, an invented monosyllabic suffix rule (-po) meaning "a part of" in a DA rule task, and 4 invented bisyllabic words in a DA word task. Potential relationships among task performances were investigated. Receptive task performances, expressive task performances, and task totals were added to create receptive total, expressive total, and accumulated performance total (APT) scores. Relationships among receptive total, expressive total, and APT scores were also investigated. RESULTS: Significant correlations were found between FM word, DA rule, and the receptive total. The expressive total correlated with all task total scores, APT, age, and modifiability scores. Modifiability scores correlated with the two DA tasks, expressive total, and the APT. Findings indicate that FM word and the expressive total were positively correlated with most of the other tasks, composite totals, and age. CLINICAL IMPLICATIONS: Performance on language-based processing tasks may provide valuable information for separating typically developing Vietnamese preschool children from their peers with language disorders. Practitioners should consider linguistic characteristics of target stimuli. Comparisons should include task, receptive, expressive, and APT.

Intervention with linguistically diverse preschool children: a focus on developing home language(s).

PURPOSE: This article addresses a series of questions that are critical to planning and implementing effective intervention programs for young linguistically diverse learners with primary language impairment (LI). Linguistically diverse learners in the United States include children whose families speak languages such as Spanish, Korean, Cantonese, Hmong, Vietnamese, or any language other than, or in addition to, English. METHOD: A narrative review of the relevant literature addresses clinical questions including (a) Why support the home language when it is not the language used in school or the majority community? (b) Does continued support for the home language undermine attainment in a second language? (c) Should we support the home language when it includes the code switching or mixing of two traditionally separate languages? and (d) What are some strategies that can be used to support the home language when it is a language that the speech-language pathologist (SLP) does not speak? CONCLUSION: SLPs should provide services to linguistically diverse preschool-age children with LI in a manner that effectively supports the development of the home language. Parent and paraprofessional training along with peer-mediated models of intervention are presented as two possible methods for facilitating the home language in children with LI.

Comorbidity and WISC-III profiles of Greek children with attention deficit hyperactivity disorder, learning disabilities, and language disorders.

The aim of the present study was to (a) examine the prevalence of ADHD and the comorbid difficulties in a sample of 114 children, 3.6 to 17.6 yr. of age (89 boys, 25 girls) referred to our Unit and (b) evaluate the discriminative ability of the WISC-III scores for children with Attention Deficit Hyperactivity Disorder (n = 22), Learning Disability (n = 50), and Language Disorder (n = 42). Analysis showed only 18% of 114 children had an Attention Deficit Hyperactivity Disorder diagnosis. Multivariate analysis of variance and stepwise discriminant function analysis were applied. Vocabulary and similarities were the best predictors for distinguishing between language disorders and the other two groups. Moreover, the Language Disorder group scored significantly lower on all the subtests while the Attention Deficit Hyperactivity Disorder and Learning Disability groups scored lower on coding and information, respectively. Children with Attention Deficit Hyperactivity Disorder and Learning Disability could not be accurately identified from the WISC-III test or their ACID profile.

The Effects of Visual Stimuli on the Spoken Narrative Performance of School-Age African American Children.

PURPOSE: This study investigated the fictional narrative performance of school-age African American children across 3 elicitation contexts that differed in the type of visual stimulus presented. METHOD: A total of 54 children in Grades 2 through 5 produced narratives across 3 different visual conditions: no visual, picture sequence, and single picture. Narratives were examined for visual condition differences in expressive elaboration rate, number of different word roots (NDW) rate, mean length of utterance in words, and dialect density. The relationship between diagnostic risk for language impairment and narrative variables was explored. RESULTS: Expressive elaboration rate and mean length of utterance in words were higher in the no-visual condition than in either the picture-sequence or the single-picture conditions. NDW rate was higher in the no-visual and picture-sequence conditions than in the single-picture condition. Dialect density performance across visual context depended on the child's grade, so that younger children produced a higher rate of African American English in the no-visual condition than did older children. Diagnostic risk was related to NDW rate and dialect density measure. CONCLUSION: The results suggest the need for narrative elicitation contexts that include verbal as well as visual tasks to fully describe the narrative performance of school-age African American children with typical development.

Neuropsychological Language Tests in Dementia Diagnosis in English-Speaking Hispanic and Non-Hispanic White Outpatients.

Neuropsychological language tests have limitations (e.g., unrepresentative norms) when applied to "Hispanics" and clinicians are likely aware that these tests may lead to inaccurate dementia diagnoses. Therefore, it was hypothesized that language tests would be weaker diagnostic predictors in Hispanics versus "Non-Hispanic Whites." Participants included 436 English-speaking Hispanic and 436 Non-Hispanic White (randomly selected from 10,937) outpatients classified as having dementia or normal cognition at initial evaluation. When covarying for age, sex, education, and functional abilities, vegetable fluency significantly predicted diagnosis among Non-Hispanic Whites (odds ratio = 0.80, 95% confidence interval [0.69, 0.94], p < .01). Animal fluency and an abbreviated (30-item) Boston Naming Test (BNT) comparably predicted diagnosis across groups. Results remained similar when covarying for primary language among Hispanics. Findings suggest that vegetable fluency, but not animal fluency, was relatively unimportant in diagnosis for the English-speaking Hispanics in this study possibly because of cultural influences on the familiarity, salience, and relevance of this category's items. Additionally, clinicians may have informally adjusted Hispanics' 30-item BNT and animal fluency scores and discounted vegetable fluency to account for their limitations. Animal fluency and BNT may be preferable language tests when assessing dementia in English across groups, as they comparably predicted diagnosis in both groups.

Normative data for the Boston naming test in native Dutch-speaking Belgian elderly.

A normative study of the 60-item version of the Boston Naming Test (BNT) was performed in a group of 200 native Dutch-speaking Flemish elderly. Analysis of test results revealed that BNT performance in Dutch is significantly affected by age, years of education, and gender. Error analysis disclosed verbal semantic paraphasias to occur as the most frequent error type (1/3 errors). "Don't know responses," verbal semantic paraphasias, and adequate circumlocutions were found on at least 30 different BNT items and constituted the most diffusely distributed error types. Following a careful review of other normative BNT studies, group characteristics rather than cultural differences were found to account for the difference in the overall mean scores. Our study surprisingly revealed that, as far as American-English, Australian-English and Dutch-speaking elderly are concerned, linguistics do not have an impact on the overall mean BNT score. A linguistic impact, however, clearly holds on the qualitative levels of performance, reflected by fundamental differences in the error distribution in different languages. Language-related BNT characteristics therefore stress the need for specific adaptations of norms.

Grammatical morphology and the role of weak syllables in the speech of Italian-speaking children with specific language impairment.

Italian-speaking children with specific language impairment (SLI) were compared to a group of younger control children in their use of auxiliary verbs, pronominal clitics, infinitives, present tense verb inflections, and articles. Differences favoring the control children were found for those morphemes that required the production of nonfinal weak syllables. On other grammatical morphemes, the two groups did not differ. A relationship was seen between the use of morphemes requiring nonfinal weak syllables and the use of nonfinal weak syllables that had no morpheme status. The findings are considered from the perspective of both prosodic production limitations and limitations in input processing.

Identifiers of predominantly Spanish-speaking children with language impairment.

The purpose of this study was to identify a set of measures that would discriminate 31 predominantly Spanish-speaking children with normal language (NL children) from 31 children with language impairment (LI children). The LI children were identified as such by experienced, bilingual (Spanish/English), ASHA-certified, speech-language pathologists who were currently seeing the children in their caseloads. Children ranged in age from 5 to 7 years and were matched for age, gender, and school. Additionally, nonverbal cognitive measures assured that they did not differ significantly intellectually. Measures of vocabulary, novel bound-morpheme learning skills, and language form were randomly administered to all children. Further, parents responded to questions about their perceptions of their children's speech and language skills and family history of speech and language problems. A stepwise discriminant analysis indicated that 4 measures discriminated the groups of children with a sensitivity of 91.3% and a specificity of 100% (p < .0001): parental report of the child's speech and language skills, number of errors per T-unit, mean length per T-unit, and family history of speech and language problems. A second discriminant analysis indicated that the sensitivity and specificity could be maintained when only the first 2 measures were included. Confirmatory discriminant analyses of the 2- and 4-measure models indicated that the discriminant accuracy was stable on an independent sample.

Negative concord in child African American English: implications for specific language impairment.

In this study, African American English (AAE)-speaking children's comprehension of 2 different types of double negative sentences was examined and contrasted with that of a comparison group of Standard American English (SAE)-speaking children. The first type of double negative, negative concord, involves 2 negative elements in a sentence that are interpreted together as single negation. The second type of double negative, called true double negation, involves 2 negatives that are interpreted as independent negatives. A cross-sectional cohort of 61 (35 AAE, 26 SAE) typically developing children ranging in age from 5;2 (years;months) to 7;11 participated. The children responded to story-based grammatical judgment tasks that required them to differentiate between negative concord and true double negation. Results revealed no statistically significant differences between AAE- and SAE-speaking children in the way they interpreted negative concord and true double negation. However, there were significantly more correct responses to negative concord sentences across combined groups. In particular, the older children (i.e., 7-year-olds) produced more correct responses to negative concord than did the younger group (i.e., 5-year-olds). Explanations for these findings are framed in terms of children's knowledge about sentences with 2 negatives, the constraints affecting the interpretation of 2 negatives that include negative concord, and the clinical importance of negative concord for assessing specific language impairment in child AAE speakers.

An assessment battery for identifying language impairment in African American children.

This investigation compares the performances of 24 African American children, diagnosed as language impaired (LI) and receiving school-based language therapy, to 2 groups of typically developing peers (N = 48) on 5 traditional types of language assessment measures. Three of the measures were derived from child-centered free play language sample analyses and included average length of communication units (MLCU), frequencies of complex syntax, and numbers of different words. Two of the measures examined language comprehension and included responses to requests for information in the form of Wh-questions and responses to probes of active and passive sentence constructions. The performances of the group of children with language impairments were significantly lower on each measure than that of chronological age matched African American children who were typically developing. Sensitivity and specificity of the battery appeared excellent. The findings are discussed in terms of the potential of these informal language measures to contribute to a culturally fair assessment protocol for young African American children.