Asking parents about babbling at 10 months produced valid answers but did not predict language screening result 2 years later.

AIM: We evaluated the concurrent and predictive validity of questions to parents of 10-month-old children about babbling. METHODS: Children with at least one native Swedish-speaking parent were eligible for inclusion in this prospective longitudinal study. The parents were asked three questions about babbling at a routine healthcare visit. If parents reported a lack of canonical babbling (CB), children were assessed by a speech and language pathologist to evaluate the questions' concurrent validity. We then examined whether the babbling questions predicted which children would fail the routine language screening at 2.5/3 years. RESULTS: Fifteen of the 1126 children lacked CB according to the parent responses and the expert assessment confirmed 12 of these cases, providing a concurrent validity of 80%. The sensitivity to predict routine language screening was 8% (95% confidence interval 3-17), and the positive predictive value was 40% (95% confidence interval 20%-65%). However, only six of the children lacking CB at 10 months were among the 71 children who failed later language screening. CONCLUSION: This study suggests that the babbling questions could be included in the 10-month surveillance at the child health services as valid measures of babbling development, but they cannot predict language screening result at 2.5/3 years.

Neurodevelopmental problems and quality of life in 6-year-olds with a history of developmental language disorder.

AIM: To explore family-reported neurodevelopmental functioning and quality of life in 6-year-olds who had screened positive for developmental language disorder at age 2.5 years. METHODS: Parents of 85 6-year-old children completed questionnaires about child neurodevelopmental difficulties and quality of life. The children were interviewed regarding quality of life, and their language was assessed by speech and language pathologists. Test results at 6 years identified three subgroups: children with developmental language disorder (n = 68) or speech sound disorder (n = 6) and children with no current language disorder (n = 11). RESULTS: Out of the 68 children with developmental language disorder, 33 (48%) had significant parent-rated problems with language, executive functions 17 (25%), perception 15 (22%) and/or motor skills 15 (22%). Four (67%) of the children with speech sound disorder had significant problems with language. Significant problems were reported with language in five (45%) and with perception in four (36%) children with no current language disorder. The parents reported no impaired quality of life, whereas the children themselves reported impairment mainly with school functioning. CONCLUSIONS: Overlap between language difficulties and other neurodevelopmental problems was higher in 6-year-olds who had screened positive for developmental language disorder about 3 years earlier, than in the general population. The parent and child reports of quality of life were not consistent.

A longitudinal case study of six children with autism and specified language and non-verbal profiles.

Language skills as well as general cognitive skills show a considerable variation in children with autism spectrum disorder (ASD). In previous studies, at least three profiles based on these skills have been suggested; autism with language and non-verbal cognitive skills within the average/normal range (ALN), autism with language disorder (ALD) without concurrent non-verbal cognitive disability, and autism with language disorder and cognitive disability, i.e. autism with a more general delay (AGD). The aim of the present longitudinal case study is to illustrate these three groups more thoroughly by presenting the developmental trajectories of children belonging to each profile. Six children were chosen based on their language and cognitive profiles from the first age 3-year assessment. They came from a larger group of children with ASD identified by autism screening at child health-care centres at age 2.5 years. These six children represent one boy and one girl from each of the three subgroups ALN, ALD and AGD, and were assessed a second time at age 5 and a third time at age 8 years, regarding expressive and receptive language skills, autistic severity and non-verbal cognitive skills. Although preliminary, our results indicate a rather stable developmental trajectory from age 3 to 8 years characterising children with autism based on language and non-verbal cognitive functioning. Thus, in order to help intervention planning and increase predictions of outcome, it seems important to specify both linguistic and cognitive level already at the first assessment in children with ASD.

Impact of auditory variables on consonant production in babbling and early speech in children with moderate hearing loss - a longitudinal study.

This longitudinal study aimed to investigate early consonant production and the impact of hearing aid (HA) use, and aided audibility in Swedish children with moderate hearing loss (CHL) who received amplification before 6 months of age. CHL (n = 11) and children with normal hearing (CNH) (n = 11) were followed-up at 10, 18, and 36 months of age. At 10 months of age, the CHL used significantly fewer oral stops (p < 0.01), dental/alveolar stops (p < 0.05) and had a significantly fewer number of different true consonants (p < 0.01). At 18 months, there were no significant differences between the groups regarding presence of oral stops, and dental/alveolar stops, but the significant difference in the number of different true consonants remained (p < 0.00). At 36 months of age, consonant proficiency did not differ between the groups. A higher number of hours of HA use was associated with the presence of consonant variables at 10 months. Aided audibility showed weak to moderate correlations with number of consonants produced and proficiency. This group of children presented with initial delays in their early consonant production but seemed to catch up as they aged. Consistency of HA use from initial fitting is an important factor that may decrease the possible delays in the development of early consonant production and proficiency in CHL by 36 months of age.

Internationally adopted children with and without a cleft lip and palate showed no differences in language ability at school-age.

AIM: The aim of this study was to investigate language ability in internationally adopted children aged 7-8 years with and without a unilateral cleft lip and palate. METHODS: We compared 27 internationally adopted children with a unilateral cleft lip and palate, adopted from China, with a group of 29 children without a cleft lip and palate, adopted from different countries. Participants were recruited from two cleft lip and palate teams in Sweden and through adoption organisations. Assessments were performed using standardised tests of speech and of receptive and expressive language ability. In addition, a parental questionnaire in which speech, language and communication aspects were rated was used. RESULTS: There were no significant differences in language ability between the groups. The only difference was related to speech ability, where the internationally adopted children with unilateral cleft lip and palate scored significantly lower. However, a high proportion of children in both groups scored low on measures of expressive language compared with test norms. CONCLUSION: The results suggested that having a cleft lip and palate did not increase the risk of language difficulties. Instead, being internationally adopted may be associated with a risk of delayed language development lasting for several years post-adoption.

Schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should be screened for neurodevelopmental problems.

AIM: The aim was to assess the rate and overlap of language and other neurodevelopmental problems in children aged 9-12 years with unilateral or mild to moderate bilateral sensorineural hearing loss. METHODS: Caregivers of 24 of the 58 eligible children, born 2004-2007, registered at the regional audiology department in Gothenburg, Sweden, with these types of hearing loss completed the Five-to-Fifteen questionnaire, a comprehensive screening instrument for neurodevelopmental problems. Of these 24 children, 21 were assessed with the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Children with scores indicating definite problem on the Five-to-Fifteen questionnaire and their parents were invited to a clinical neuropaediatric assessment. RESULTS: Of the 24 children, 13 (54%) screened positive for definite neurodevelopmental problems. Clinical assessments confirmed the presence of at least one neurodevelopmental disorder in eight of these 24, corresponding to 33%. Seven (33%) of the 21 children participating in the CELF-4 had scores indicating a language disorder, of whom four children had a neurodevelopmental disorder according to the neuropaediatric assessment. CONCLUSION: The results support that schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should undergo neurodevelopmental screening to identify possible coexisting neurodevelopmental problems or disorders.

Internationally Adopted Children With Unilateral Cleft Lip and Palate-Consonant Proficiency and Perceived Velopharyngeal Competence at the Age of 5.

OBJECTIVE: To compare consonant proficiency, consonant errors, and the perceived velopharyngeal (VP) competence in internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) and nonadopted (NA) children with the same cleft-palate type at age 5. DESIGN: Case-control study based on phonetic transcriptions of standardized speech recordings of 5-year-olds at a tertiary hospital. PARTICIPANTS: Twenty-five IA children were compared to 20 NA children. All consecutive patients at a cleft lip and palate center participated. MAIN OUTCOME MEASURE(S): Consonant proficiency was measured using percentage consonants correct, percentage consonants correct-adjusted for age, percentage correct place, percentage correct manner, and consonant inventory. Cleft speech characteristics (CSCs), developmental speech characteristics (DSCs), and the perceived VP competence were also measured. RESULTS: The IA children had significantly lower values for all consonant proficiency variables (p < .05) and a smaller consonant inventory (p = .001) compared to the NA children. The IA children had a higher frequency of CSCs (IA = 84%, NA = 50%, p < .05) and DSCs (IA = 92%, NA = 65%, p = .057), and twice as many IA children as NA children had perceived VP incompetence (IA = 52%, NA = 25%, p = .17). CONCLUSIONS: Severe speech disorder was more common in IA children than in NA children at age 5. Most importantly, the speech disorders seem to be not only cleft-related. More detailed speech assessments with a broader focus are needed for IA children with UCLP. Longitudinal studies are recommended to further investigate the impact of speech difficulties in IA children's daily lives.

Narrative Skills in Primary School Children with Autism in Relation to Language and Nonverbal Temporal Sequencing.

Recent research has suggested that temporal sequencing of narrative events might be a domain-general ability that underlies oral narrative capacities. The current study investigated this issue in a group of children with known pragmatic and narrative difficulties, namely Autism Spectrum Disorder (ASD). We hypothesized (1) that children with ASD (n = 45) would retell narratives of poorer quality than both chronological age-matched (CAM) children and younger children matched on sentence-level language skills (LM), and (2) that nonverbal temporal sequencing skills would uniquely predict individual differences in oral narrative performance in children with ASD. The results show that children with ASD performed poorer on all measures of oral narrative quality compared with the CAM group, and on eight of ten measures compared with the LM group. Thus, our first hypothesis was confirmed, suggesting that narrative difficulties in ASD cannot be fully explained by impaired language. The second hypothesis was only partly confirmed: nonverbal temporal sequencing explained significant or marginally significant variance in some, but not all, aspects of oral narrative performance of children with ASD. These results are discussed from theoretical and clinical/educational perspectives, in relation to the heterogeneity of language skills in ASD and to domain-general features of narrative processing.

Neurodevelopmental problems should be considered in children with febrile seizures.

AIM: Clinical developmental phenotyping of four- to five-year-old children with febrile seizures (FSs). METHODS: Children with FS (n = 157, corresponding to 3.7% of the targeted general population of four-five-year-olds) had been identified at child healthcare centres in Gothenburg. Parents of 73 children (41 boys, 32 girls) accepted participation in the present study. The assessments included a neuropaediatric assessment, Movement ABC, Wechsler Preschool and Primary Scale of Intelligence-III and parent questionnaires (Five-to-Fifteen (FTF) and Strengths and Difficulties Questionnaire (SDQ)). Hospital records were reviewed, when applicable. RESULTS: One-third of the children had at least one DSM-5 neurodevelopmental disorder diagnosis or marked developmental problems within areas of attention, activity regulation, behaviour, speech and language, general cognition or motor functioning. No differences were found between children with single vs recurrent or simple vs complex FS. CONCLUSION: Febrile seizure are relatively often associated with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCEs). We found no indications that ESSENCE might be caused by FS per se. However, the results suggest that child healthcare professionals should consider the possibility of ESSENCE in children with a history of FS.

Validation of the Swedish version of the LittlEARS® Auditory Questionnaire in children with normal hearing - a longitudinal study.

Objective: To externally validate the Swedish version of the LittlEARS® Auditory Questionnaire (LEAQ) in children with normal hearing followed longitudinally, and to examine to what extent the LEAQ correlates to other measures of auditory and language development. Design: The Swedish version of the LEAQ was completed every other month over a 2-year period and correlated with the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) and McArthur-Bates Communicative Development Inventory (CDI) to examine overlapping areas of development. Normative curve was derived through linear mixed models and the effect of time investigated with repeated measures ANOVA. Study sample: Parents of 25 typically developing children with normal hearing (13 girls, 12 boys). Results: The norm curve of the Swedish LEAQ showed a similar equation as the original German version and the effect of time was significant. Correlations between LEAQ and CDI were moderate to high, and between LEAQ and PEACH weak or non-existing. Conclusion: The Swedish version of the LEAQ is a reliable tool in accordance with the original version. However, results indicate that this questionnaire to a large extent measures language skill rather than audition specifically.

Development problems were common five years after positive screening for language disorders and, or, autism at 2.5 years of age.

AIM: This study identified whether children who had screened positive for either developmental language disorder (DLD) or autism spectrum disorder (ASD) at the age of 2.5 years had neurodevelopmental assessments five years later. METHODS: Our study cohort were 288 children born from 1 July 2008 to 20 June 2009 who screened positive for DLD and, or, ASD at 2.5 years. Of these, 237 children were referred to, and assessed, at the Paediatric Speech and Language Pathology clinic (n = 176) or the Child Neuropsychiatry Clinic (n = 61) at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Clinical registers covering all relevant outpatient clinics were reviewed five years later with regard to established diagnoses. RESULTS: When the 237 were followed up five years later, 96 (40%) had established neurodevelopmental disorders or problems, often beyond DLD and ASD. Co-existing problems were common in this cohort and multidisciplinary assessments were indicated. The other 60% did not appear in subsequent clinic records. It is likely that this 40% was a minimum rate and that more children will be referred for developmental problems later. CONCLUSION: Five years after they had been screened positive for DLD and, or autism at 2.5 years, 40% of our cohort had remaining or other developmental problems.

Assessing False-Belief Understanding in Children with Autism Using a Computer Application: A Pilot Study.

We have developed a False-Belief (FB) understanding task for use on a computer tablet, trying to assess FB understanding in a less social way. It is based on classical FB protocols, and additionally includes a manipulation of language in an attempt to explore the facilitating effect of linguistic support during FB processing. Specifically, the FB task was presented in three auditory conditions: narrative, silent, and interference. The task was assumed to shed new light on the FB difficulties often observed in Autism Spectrum Disorder (ASD). Sixty-eight children with ASD (M = 7.5 years) and an age matched comparison group with 98 typically developing (TD) children were assessed with the FB task. The children with ASD did not perform above chance level in any condition, and significant differences in success rates were found between the groups in two conditions (silent and narrative), with TD children performing better. We discuss implications, limitations, and further developments.

Negotiating knowledge: parents' experience of the neuropsychiatric diagnostic process for children with autism.

BACKGROUND: Parents often recognize problems in their child's development earlier than health professionals do and there is new emphasis on the importance of involving parents in the diagnostic process. In Gothenburg, Sweden, over 100 children were identified as having an autism spectrum disorder (ASD) in 2009-11 through a general population language and autism screening of 2.5 year olds at the city's child healthcare centres. AIMS: To increase understanding of parents' lived experience of the neuropsychiatric diagnostic process, i.e. the period from the initial screening at age 2.5 years to the 2-year follow-up of the ASD diagnosis. METHODS & PROCEDURES: A qualitative design, a phenomenological hermeneutic method, was used. Interviews were conducted with parents of 11 children who were diagnosed with ASD 2 years prior. The parents were interviewed about their experiences of the neuropsychiatric diagnostic process, i.e. the time before the screening, the time during the neuropsychiatric multidisciplinary evaluation and the time after diagnosis. The interviews lasted for 45-130 min, and an interview guide with set questions was used. Most of the interviews were conducted at the parents' homes. OUTCOMES & RESULTS: The essence that emerged from the data was negotiating knowledge, and the three themes capturing the parents' experiences of going through the process of having their child diagnosed with ASD were seeking knowledge, trusting and challenging experts, and empowered but alone. CONCLUSIONS & IMPLICATIONS: The parents expected intervention to start directly after diagnosis but felt they had to fight to obtain the resources their child needed. After the process, they described that they felt empowered but still alone, i.e. although they received useful and important information about their child, they were left to manage the situation by themselves. As for clinical implications, the study points to the necessity of developing routines to support the parents during and after the diagnostic process. Recommended measures include developing a checklist outlining relevant contacts and agencies, establishing a coordinator responsible for each child, dividing the summary meeting at the clinic into two parts, making more than one visit to the preschool, and providing a parental training programme.

Prenatal acquired cytomegalovirus infection should be considered in children with autism.

AIM: The aim of the study was to evaluate the prevalence of congenital cytomegalovirus infection (CMV) in a representative sample of children with autism spectrum disorder. METHODS: In a representative group of 115 preschool children with autism spectrum disorder, of whom 33 also had intellectual disability, the dried blood spots from the newborn metabolic screening were analysed for CMV DNA using TaqMan polymerase chain reaction. RESULTS: One of the 33 children with autism spectrum disorder and intellectual disability - 3% of that group - had congenital CMV infection. The corresponding prevalence in newborn infants in Sweden is 0.2%. None of the 82 children without intellectual disability had congenital CMV. CONCLUSION: The finding lends some further support for congenital CMV being one of the many aetiologies underlying autism spectrum disorder with intellectual disability. The rate of 3% of congenital CMV in children with autism spectrum disorder with intellectual disability has implications for the medical work-up. The finding of congenital CMV also indicates the need for repeated hearing assessments in the child. There is a need for similar studies with much larger samples.

Story retelling and language ability in school-aged children with cerebral palsy and speech impairment.

BACKGROUND: Research on retelling ability and cognition is limited in children with cerebral palsy (CP) and speech impairment. AIMS: To explore the impact of expressive and receptive language, narrative discourse dimensions (Narrative Assessment Profile measures), auditory and visual memory, theory of mind (ToM) and non-verbal cognition on the retelling ability of children with CP and speech impairment. METHODS & PROCEDURES: Fifteen speaking children with speech impairment (seven girls, eight boys) (mean age = 11 years, SD = 1;4 years), and different types of CP and different levels of gross motor and cognitive function participated in the present study. Story retelling skills were tested and analysed with the Bus Story Test (BST) and the Narrative Assessment Profile (NAP). Receptive language ability was tested with the Test for Reception of Grammar-2 (TROG-2) and the Peabody Picture Vocabulary Test - IV (PPVT-IV). Non-verbal cognitive level was tested with the Raven's coloured progressive matrices (RCPM), memory functions assessed with the Corsi block-tapping task (CB) and the Digit Span from the Wechsler Intelligence Scale for Children-III. ToM was assessed with the false belief items of the two story tests "Kiki and the Cat" and "Birthday Puppy". OUTCOMES & RESULTS: The children had severe problems with retelling ability corresponding to an age-equivalent of 5;2-6;9 years. Receptive and expressive language, visuo-spatial and auditory memory, non-verbal cognitive level and ToM varied widely within and among the children. Both expressive and receptive language correlated significantly with narrative ability in terms of NAP total scores, so did auditory memory. CONCLUSION & IMPLICATIONS: The results suggest that retelling ability in the children with CP in the present study is dependent on language comprehension and production, and memory functions. Consequently, it is important to examine retelling ability together with language and cognitive abilities in these children in order to provide appropriate support.

Imitation (rather than core language) predicts pragmatic development in young children with ASD: a preliminary longitudinal study using CDI parental reports.

BACKGROUND: Research in the last decades has clearly pointed to the important role of language and communicative level when trying to understand developmental trajectories in children with autism spectrum disorders (ASD). AIMS: The purpose of this longitudinal study was to investigate whether (1) core language skills, measured as expressive vocabulary and grammar, and/or (2) pre-linguistic social-communicative skills, including gestures and imitation abilities, drive pragmatic language development in young children with ASD. METHODS & PROCEDURES: We examined correlates and longitudinal predictors of pragmatic growth in a sample of 34 children with Autism spectrum disorder (ASD), whose parents were given parts of two MacArthur Communicative Developmental Inventories (CDI: Words & Gestures and CDI: Words & Sentences) for completion at two time points (at time 1 the mean child age was 41 months, and at time 2 it was 54 months). A novel feature in this study is that the relevant parts from both CDI forms were included at both time points, allowing us to examine whether pre-linguistic social-communication skills (e.g. imitation and gesturing) and/or core language skills (i.e. grammar and vocabulary) predict pragmatic language growth. OUTCOMES & RESULTS: The results show that basically all pre-linguistic, linguistic and pragmatic skills were associated concurrently. When controlling for possible confounders and for the autoregressive effect, imitation skills predicted pragmatic growth over time, whereas core language did not. This could only have been shown by the use of both CDI forms. CONCLUSIONS & IMPLICATIONS: This preliminary study may be of both conceptual and methodological importance for research in the field of language and communication development in ASD. Imitation may play a pivotal role in the development of subsequent conversational pragmatic abilities in young children with ASD. Future research should be directed at unravelling the mechanisms underlying this association.

Developmental language disorder: similarities and differences between 6-year-old mono- and multilingual children.

This study investigated language ability in 6-year-old mono- and multilingual children who, at age 2;6 years, had screened positive for developmental language disorder (DLD). One hundred children (32 girls, 68 boys) were assessed at an average age of 2;9 years (T1) and 85 of them (30 girls, 55 boys) were reassessed at age 6;0 years (T2) using a standardised test battery. Of these, 68 (23 girls, 45 boys) met the criteria for DLD diagnosis; 28 of them were monolingual and 40 multilingual. Language profiles at T2 were analysed, as were the associations between DLD and a mono- or multilingual background as well as other measures collected at T1, including mean length of utterance (MLU), heredity and parental education. As expected, the results showed that the total group (including both mono- and multilingual children) scored below test norms for 6-year-olds on all language tests, except for receptive vocabulary, where the monolingual children scored in line with those norms. The multilingual group performed significantly less well than the monolingual one on language comprehension, receptive vocabulary, recalling sentences, word finding and story retelling; disparities regarding MLU and language comprehension were already evident at T1. Interestingly, MLU at T1 showed a moderate association with language comprehension at T2 in the total group. The monolingual children were more likely than the multilinguals to have heredity for DLD or reading and writing disorders. In conclusion, language difficulties identified through screening and assessment before age 3 years often persist at age 6 years.

Autism in toddlers: can observation in preschool yield the same information as autism assessment in a specialised clinic?

We wanted to know whether preschool observation of children suspected of suffering from autism can provide the same information about core autism symptoms as the Autism Diagnostic Observation Schedule (ADOS) performed in a clinic. Forty 2-4-year-old children (9 girls, 31 boys), referred for assessment of suspected autism spectrum disorder participated in the study. The symptom areas covered by the ADOS algorithm were scored by an education specialist after free-field observation of each child in the preschool without using the prescribed ADOS materials. The ADOS was then completed in a clinic setting by examiners blind to the preschool results. Excellent agreement across results obtained at the two different types/settings of observations was found. The only significant difference found was with regard to spontaneous initiation of joint attention. The present study does not address the issue of whether or not one of the methods used is superior to the other when it comes to determining the "true" level of "autism problems" in these children. However, it is of interest that free-field preschool observation of children with suspected autism using a structured checklist yields very similar information as that obtained at ADOS assessment performed in a clinic setting.

Autism in preschoolers: does individual clinician's first visit diagnosis agree with final comprehensive diagnosis?

Comprehensive clinical diagnosis based on all available information is considered the "gold standard" in autism spectrum disorders (ASD). We examined agreement across independent assessments (clinical judgment) of 34 young children (age 24-46 months) with suspected ASD, assessed by a multidisciplinary team, and final comprehensive clinical diagnosis. Agreement across settings and between each clinician's assessment and final diagnosis was moderate. The poorest fit was found at assessment in connection with psychological evaluation and the best with preschool observation and parent interview. Some individual clinicians had good and others had poor fit with final diagnosis. Disagreement across assessments was pronounced for girls. The findings suggest that multidisciplinary assessments remain important and that comprehensive clinical diagnosis should still be regarded as the gold standard in ASD.

Narrative retelling in children with neurodevelopmental disorders: is there a role for nonverbal temporal-sequencing skills?

Oral narrative retelling is often problematic for children with communicative and neurodevelopmental disorders. However, beyond a suggested role of language level, little is known about the basis of narrative performance. In this study we examine whether oral narrative retelling might be associated not just with language level but also with skills related to nonverbal narrative temporal sequencing. A diagnostically heterogeneous sample of Swedish-speaking children with a full scale IQ >70 was included in the study (N = 55; age 6-9 years). Narrative retelling skills were measured using the three subscores from the bus story test (BST). Independent predictors included (1) temporal sequencing skills according to a picture arrangement test and (2) a language skills factor consisting of definitional vocabulary and receptive grammar. Regression analyses show that language skills predicted BST Sentence Length and Subordinate Clauses subscores, while both temporal sequencing and language were independently linked with the BST Information subscore. When subdividing the sample based on nonverbal temporal sequencing level, a significant subgroup difference was found only for BST Information. Finally, a principal component analysis shows that temporal sequencing and BST Information loaded on a common factor, separately from the language measures. It is concluded that language level is an important correlate of narrative performance more generally in this diagnostically heterogeneous sample, and that nonverbal temporal sequencing functions are important especially for conveying story information. Theoretical and clinical implications are discussed.