Atuação fonoaudiológica em projeto social: estudo preliminar / Speech-language hearing performance in social project: preliminary study / Actuación fonoaudiológica en proyecto social: estudio preliminar

Introdução: Pesquisas vêm demonstrando a importância dos primeiros anos de vida no desenvolvimento do cérebro. Quando a criança não apresenta o desenvolvimento de linguagem esperado, poderá ter prejuízo em aquisições. Desta forma, a identificação precoce de alterações evita consequências educacionais e sociais desfavoráveis. Objetivo: propor projeto de intervenção fonoaudiológica em instituição de acolhimento de crianças; levantar dados acerca da linguagem das crianças antes e depois da intervenção fonoaudiológica; possibilitar a superação de alterações da linguagem. Métodos: Observação das crianças, em sala de atividades coletivas, por meio do formulário de observação. Em seguida, foram selecionadas crianças com risco para alteração de linguagem e estas foram submetidas a avaliação por meio da Avaliação do Desenvolvimento da Linguagem (ADL) e Avaliação Fonológica da Criança (AFC). As crianças foram estimuladas durante 12 encontros semanais, em grupos, e depois foram reavaliadas. Os dados foram tabulados e analisados comparando-se as avaliações antes e depois da estimulação e relatando-se os dados obtidos pelos questionários respondidos pelas cuidadoras. Resultados: As quatro crianças - 3 meninos e 1 menina - que participaram do estudo tiveram melhora nas avaliações da linguagem após o período de estimulação, 3 modificaram o grau de gravidade do distúrbio de linguagem, e uma superou as alterações de linguagem - "desenvolvimento normal da linguagem" - após a reavaliação. Conclusão: Os relatos das cuidadoras e resultados das reavaliações demonstraram que as intervenções surtiram efeitos positivos e foram relevantes para as crianças, caracterizando uma boa proposta de intervenção coletiva fonoaudiológica.

Introduction: Research has shown the importance of early life in brain development. When the child does not have the expected language development, may have impairment in acquisitions. Thus, early identification of changes avoids unfavorable educational and social consequences. Objective: to propose a speech-language intervention project in a childcare institution; collect data about children's language before and after speech therapy intervention; enable overcoming language changes. Methods: Observation of children, in the collective activity room, through the observation form. Then, children at risk for language impairment were selected and were submitted to assessment through the Language Development Assessment (ADL) and the Child Phonological Assessment (CFA). The children were stimulated during 12 weekly group meetings and then reevaluated. Data were tabulated and analyzed by comparing the evaluations before and after stimulation and reporting the data obtained from the questionnaires answered by the caregivers. Results: The four children - 3 boys and 1 girl - who participated in the study had improved language assessments after the stimulation period, 3 modified the severity of the language disorder, and one outperformed the language disorders - "normal development of language "- after reevaluation. Conclusion: The caregivers' reports and reassessment results showed that the interventions had positive effects and were relevant for the children, characterizing a good proposal for collective speech therapy intervention.

Introducción: la investigación ha demostrado la importancia de la vida temprana en el desarrollo del cerebro. Cuando el niño no tiene el desarrollo del lenguaje esperado, puede tener un impedimento en las adquisiciones. Por lo tanto, la identificación temprana de los cambios evita consecuencias educativas y sociales desfavorables. Objetivo: proponer un proyecto de intervención de habla y lenguaje en una institución de cuidado infantil; recopilar datos sobre el lenguaje de los niños antes y después de la intervención de terapia del habla; permitir la superación de los cambios de idioma. Métodos: Observación de niños, en la sala de actividades colectivas, a través del formulario de observación. Luego, se seleccionaron los niños con riesgo de discapacidad del lenguaje y se los sometió a evaluación a través de la Evaluación del desarrollo del lenguaje (ADL) y la Evaluación fonológica del niño (AFC). Los niños fueron estimulados durante 12 reuniones grupales semanales y luego reevaluados. Los datos se tabularon y analizaron comparando las evaluaciones antes y después de la estimulación e informando los datos obtenidos de los cuestionarios respondidos por los cuidadores. Resultados: Los cuatro niños (3 niños y 1 niña) que participaron en el estudio mejoraron las evaluaciones del lenguaje después del período de estimulación, 3 modificaron la gravedad del trastorno del lenguaje y uno superó los trastornos del lenguaje: "desarrollo normal de lenguaje "- después de la reevaluación. Conclusión: Los informes de los cuidadores y los resultados de la reevaluación mostraron que las intervenciones tuvieron efectos positivos y fueron relevantes para los niños, caracterizando una buena propuesta para la intervención colectiva de terapia del habla.

Long-term developmental follow-up in children with nonsyndromic craniosynostosis.

OBJECT: The aim of this study was to determine the distribution of Full Scale IQ (FSIQ) by type of craniosynostosis and to verify the finding that at long-term follow-up, verbal IQ (VIQ) is significantly higher than performance IQ (PIQ) in patients with single-suture sagittal synostosis (SS) despite falling within the "average" range for intelligence. Whether this also occurs in other types of craniosynostosis and whether surgery and sex are relevant were also determined. The relationship between age at time of surgery and later IQ was ascertained. METHODS: The data for 91 children with craniosynostosis (47 sagittal, 15 unicoronal, 13 metopic, 9 multisuture, and 7 bicoronal) were collected at their routine, 10 years of age IQ assessment (mean age 123.8 months). The patients included 61 males and 30 females; 62 patients had undergone surgery and 29 had not. RESULTS: The mean FSIQ for all types of craniosynostosis combined (96.2) fell within the average range for the general population. Some variation was evident across the different types of craniosynostosis: the SS group showed the highest FSIQs and a "normal" distribution of bandings; the other types had a higher proportion of FSIQs in the lower bandings. The data confirmed the finding that VIQ is greater than PIQ despite falling within the average range for intelligence, with a difference of 5.0 for all types of craniosynostosis combined (p = 0.001), 7.6 for the SS group (p = 0.001), and 6.9 for the unicoronal group (p = 0.029). This VIQ > PIQ effect was not found with multisuture craniosynostosis. The VIQ > PIQ discrepancy occurred regardless of whether the patient had undergone surgery and occurred more often in males than females. In the SS group and the bicoronal group, FSIQ (p = 0.036 and p = 0.046, respectively) and PIQ (p = 0.012 and p = 0.017, respectively), though not VIQ, were higher when surgery had been performed early. CONCLUSIONS: The study confirms that at long-term follow-up, although children with nonsyndromic craniosynostosis fall within the normal range for intelligence, there is a VIQ > PIQ discrepancy above what would be expected in the normal population, which may be indicative of more subtle difficulties in achievement. This discrepancy is affected by type of craniosynostosis, sex, and age at time of surgery.

Exposición a televisión y retardo primario del lenguaje en menores de 5 años / Exposure to television viewing and delayed primary language development in children younger than 5 years

Introducción: además del impacto en los hallazgos genéticos planteados en la actualidad, en estudios recientes se enfatiza en 2 factores de impacto ambiental: la interacción verbal padre-hijo y la exposición del niño a medios electrónicos (televisión, videos, computadoras) con interesantes implicaciones en el desarrollo del lenguaje. Objetivo: evaluar la exposición a la televisión como factor de riesgo en el desarrollo del lenguaje, en niños entre 18 meses y 5 años de edad. Métodos: estudio analítico caso-control, en niños entre 18 meses y 5 años, atendidos en la consulta de Neuropediatría del Hospital Pediátrico Juan Manuel Márquez por retardo del lenguaje, entre enero de 2010 y julio de 2011, en relación con un grupo control de niños sanos. Resultados: el retardo primario del lenguaje es más frecuente en niños procedentes de familias de nivel universitario en más del 80 por ciento, que presentan una exposición más prolongada (p= 0,0001) y precoz (p= 0,001) a la televisión. Conclusiones: se consideran factores de riesgo para el retardo primario del lenguaje, la exposición a la televisión antes de los 2 años de edad y por más de 2 horas al día

Introduction: in addition to the impact of the genetic findings at present, recent studies emphasize two factors of environmental impact such as verbal interaction between father and child, and the child exposure to the electronic media (television, video, and computers) with interesting implications on the language development. Objective: to evaluate the child exposure to television viewing as a risk factor in the development of language in children aged 18 months to 5 years. Methods: analytical case-control study of children aged 18 months to 5 years, who were attended to in the neuropediatric service of Juan Manuel Marquez pediatric hospital because of language impairment, from January 2010 to July 2011, and a control group of healthy children. Results: the primary language impairment is more common in children from university education families in over 80 percent , who presented with longer (p= 0.0001) and earlier (p= 0.001) exposure to television viewing. Conclusions: risk factors for primary language impairment were considered to be exposure to television viewing before the 2 years of age for more than two hours a day

[Language development between the german preventive paediatric examinations at the age of 2 and 3 in children with and without language delay]. / Sprachentwicklung von der U7 bis zur U7a bei Kindern mit und ohne Sprachentwicklungsverzögerungen.

At the beginning the course of language acquisition has a high degree of variability and it is unclear so far, at what age language delay is of clinical relevance. The present study addresses the question whether language skills at the age of 2 years allow prognostic statements and whether children with language delay at this age, are to be considered as children of risk.Starting from birth announcements children of average (n=42), borderline (n=28) and below-average stage of language development (n=50) were recruited. The language skills were assessed at the age of 2 (25+0.6 months) and 3 years (37+0.6 months) using standardized language tests.The correlation between the global stage of language development at the age of 2 and 3 years was strong (rsp=0.78, p<0.001). At 3 years of age one third of the former late talkers reached language abilities within the normal range (late bloomers), one third showed language difficulties and the last third met the criteria of specific language impairment. The risk for language difficulties was increased in these children to the 13-fold. Even the late bloomers scored significantly lower in the language test compared to the control children.From the third year of live language development is relatively stable, and language skills at the age of 2 allow a prediction of the stage of language development one year later. Late talkers are at high risk for persistent language difficulties. A general language screening at the age of 2 years would enable an early identification of children at risk and an early parent-based intervention.

[Evaluation of current assessment tools in early detection of developmental deviations in speech and language in the German preventive paediatric examination (Kindervorsorgeuntersuchung U8)]. / Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8.

OBJECTIVE: The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. METHODS: A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. RESULTS: 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. CONCLUSION: These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

Measuring word complexity in speech screening: single-word sampling to identify phonological delay/disorder in preschool children.

BACKGROUND: Children's speech sound development is assessed by comparing speech production with the typical development of speech sounds based on a child's age and developmental profile. One widely used method of sampling is to elicit a single-word sample along with connected speech. Words produced spontaneously rather than imitated may give a more accurate indication of a child's speech development. A published word complexity measure can be used to score later-developing speech sounds and more complex word patterns. There is a need for a screening word list that is quick to administer and reliably differentiates children with typically developing speech from children with patterns of delayed/disordered speech. AIMS: To identify a short word list based on word complexity that could be spontaneously named by most typically developing children aged 3;00-5;05 years. METHODS & PROCEDURES: One hundred and five children aged between 3;00 and 5;05 years from three local authority nursery schools took part in the study. Items from a published speech assessment were modified and extended to include a range of phonemic targets in different word positions in 78 monosyllabic and polysyllabic words. The 78 words were ranked both by phonemic/phonetic complexity as measured by word complexity and by ease of spontaneous production. OUTCOME & RESULTS: The ten most complex words (hereafter Triage 10) were named spontaneously by more than 90% of the children. There was no significant difference between the complexity measures for five identified age groups when the data were examined in 6-month groups. A qualitative analysis revealed eight children with profiles of phonological delay or disorder. When these children were considered separately, there was a statistically significant difference (p < 0.005) between the mean word complexity measure of the group compared with the mean for the remaining children in all other age groups. The Triage 10 words reliably differentiated children with typically developing speech from those with delayed or disordered speech patterns. CONCLUSIONS & IMPLICATIONS: The Triage 10 words can be used as a screening tool for triage and general assessment and have the potential to monitor progress during intervention. Further testing is being undertaken to establish reliability with children referred to speech and language therapy services.

Folic acid supplements in pregnancy and severe language delay in children.

CONTEXT: Prenatal folic acid supplements reduce the risk of neural tube defects and may have beneficial effects on other aspects of neurodevelopment. OBJECTIVE: To examine associations between mothers' use of prenatal folic acid supplements and risk of severe language delay in their children at age 3 years. DESIGN, SETTING, AND PATIENTS: The prospective observational Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and December 2008. Data on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 16, 2010, were used. Maternal use of folic acid supplements within the interval from 4 weeks before to 8 weeks after conception was the exposure. Relative risks were approximated by estimating odds ratios (ORs) with 95% CIs in a logistic regression analysis. MAIN OUTCOME MEASURE: Children's language competency at age 3 years measured by maternal report on a 6-point ordinal language grammar scale. Children with minimal expressive language (only 1-word or unintelligible utterances) were rated as having severe language delay. RESULTS: Among 38,954 children, 204 (0.5%) had severe language delay. Children whose mothers took no dietary supplements in the specified exposure interval were the reference group (n = 9052 [24.0%], with severe language delay in 81 children [0.9%]). Adjusted ORs for 3 patterns of exposure to maternal dietary supplements were (1) other supplements, but no folic acid (n = 2480 [6.6%], with severe language delay in 22 children [0.9%]; OR, 1.04; 95% CI, 0.62-1.74); (2) folic acid only (n = 7127 [18.9%], with severe language delay in 28 children [0.4%]; OR, 0.55; 95% CI, 0.35-0.86); and (3) folic acid in combination with other supplements (n = 19,005 [50.5%], with severe language delay in 73 children [0.4%]; OR, 0.55; 95% CI, 0.39-0.78). CONCLUSION: Among this Norwegian cohort of mothers and children, maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years.

[Evolution of competence in reading, spelling and comprehension levels in low socioeconomic environments and impact of cognitive and behavioral factors on outcome in two years]. / Evolution des compétences en lecture, compréhension et orthographe en environnement socioéconomique défavorisé et impact des facteurs cognitifs et comportementaux sur le devenir à deux ans.

BACKGROUND: The prevalence of poor reading skills is particularly high among children from low socioeconomic backgrounds, but no longitudinal studies have been conducted so far in France to determine whether poor reading in a socioeconomically challenged population is persistent and warrants preventive action. DESIGN: One hundred and fifty-four children were divided into three groups according to their reading skills: poor, intermediate and typical readers. They were followed over a period of 2 years. Reading levels, spelling and comprehension were assessed by standardized measurement scales in order to determine reading outcome and predictive variables. RESULTS: The reading skills in each group progressed at similar rates, but the differences between the three groups remained relatively constant over the 2 years. The gap between good and poor readers actually increased for the poorest readers. Spelling scores followed a similar pattern and remained weak. Comprehension scores followed a different pattern. Most of the initially poor readers with low comprehension scores almost caught up and reached the level of the typical readers. The best predictive variables of reading and spelling outcome were phonological awareness, rapid naming and attention deficit. The strongest predictive variables for comprehension were IQ, lexical level and attention. CONCLUSIONS: Our results confirm the relative stability of reading measurement across time in poor readers from low socioeconomic backgrounds. Their behavior are similar to the classic dyslexic population. The predictive variables are different depending on whether reading or spelling or comprehension is considered. These results provide a clear agenda for preventive literacy action in children with low socioeconomic levels (SES): phonological decoding and oral language skills in early grades, and screening and treatment of attention disorders.

Assessing early communication behaviours: structure and validity of the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP) in 12-month-old infants.

BACKGROUND: Parent report instruments are frequently used for the identification of both 'at-risk' children and to support the diagnosis of communication delay. Whilst the evidence is strong for the accuracy of parent report of vocabulary between 2 and 3 years, there are fewer studies that have considered the ability of parents to report on early communication behaviours in 12-month-old infants. AIMS: To investigate the validity of the underlying structure of the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP) for each of the direct observation and parent reports of communication behaviour in infants at 12 months of age. METHODS & PROCEDURES: Participants were 1725 infants, already participating in a longitudinal study of language development, whose parents completed the Infant-Toddler Checklist from the CSBS-DP. Seven hundred and twenty-eight (728) of these infants also completed the Behaviour Sample from the CSBS-DP. The structure of the CSBS-DP was examined using confirmatory factor analyses (CFA) of the Behaviour Sample and the Infant-Toddler Checklist. Correlations between the Infant-Toddler Checklist and the Behaviour Sample on the total, composite, and subscale scores were also calculated. OUTCOMES & RESULTS: Confirmatory factor analysis of the CSBS-DP Behaviour Sample replicated previous work conducted during the development of the instrument, but on a larger and younger cohort of Australian infants. The data provided support for at least three factors, broadly representing Social, Speech, and Symbolic communication skills, with some evidence that the speech factor could be further split into sub-factors representing Sounds and Words. There was support for a three-factor structure for the Infant-Toddler Checklist. Moderate correlations were found between results from the Behaviour Sample and the Infant-Toddler Checklist. CONCLUSIONS & IMPLICATIONS: As measures of early communication skill for young infants, the CSBS-DP Behaviour Sample and the Infant-Toddler Checklist are valid clinical tools for measuring constructs broadly representing Social, Speech, and Symbolic communication skills. The Speech composite in particular emerged as a strong factor under the Behaviour Sample.

Development of a screening instrument for early language delay in Hong Kong Chinese: a preliminary study.

Having language delay--one of the common neurodevelopmental difficulties during childhood--does not only imply an impairment in communication in the 1st few years of life. Previous studies have suggested that language problems have long-term implications for social, emotional, and intellectual development. Researchers have found that early identification and intervention of speech and language delay yields better treatment effects. However, unlike most of the motor developmental assessment tools, language assessment tools are not readily transferred across cultures because of the different linguistic features and the developmental stages of such features in a particular language or dialect. The present study presents an empirical example of the initial development of a culturally sensitive screening protocol, using vocabulary size as the indicator to minimize the effect of linguistic differences.

Predictive validity of the get ready to read! Screener: concurrent and long-term relations with reading-related skills.

This study examined concurrent and longitudinal relations for the Get Ready to Read! (GRTR) emergent literacy screener. This measure, within a battery of oral language, letter knowledge, decoding, and phonological awareness tests, was administered to 204 preschool children (mean age = 53.6, SD = 5.78; 55% male) from diverse socioeconomic backgrounds. Subgroups were reassessed at 6 months and 16 and 37 months later. Results indicate strong relations between the GRTR and the literacy and language assessments. Long-term follow-up indicated that the screener was significantly related to some reading-related measures, including decoding skills. These results support the utility of the GRTR as a brief, valid measure of children's emergent literacy skills. The GRTR holds promise as a tool useful for educators, parents, and others in regular contact with preschool children to help determine those who may be at risk for later reading difficulties and could benefit from intervention and focused instruction in emergent literacy.

Collateral benefits of the Family Check-Up on early childhood school readiness: indirect effects of parents' positive behavior support.

The authors examined the longitudinal effects of the Family Check-Up (FCU) on parents' positive behavior support and children's school readiness competencies in early childhood. It was hypothesized that the FCU would promote language skills and inhibitory control in children at risk for behavior problems as an indirect outcome associated with targeted improvements in parents' positive behavior support. High-risk families in the Women, Infants, and Children Nutrition Program participated in a multisite preventive intervention study (N = 731) with 3 yearly assessments beginning at child age 2 years. Positive behavior support was measured using 4 indicators derived from at-home observations of parent-child interaction during semistructured tasks. Longitudinal structural equation models revealed that parents in families randomly assigned to the FCU showed improvements in positive behavior support from child age 2 to 3, which in turn promoted children's inhibitory control and language development from age 3 to 4, accounting for child gender, ethnicity, and parental education. Findings suggest that a brief, ecological preventive intervention supporting positive parenting practices can indirectly foster key facets of school readiness in children at risk.

Will they catch up? The role of age at cochlear implantation in the spoken language development of children with severe to profound hearing loss.

PURPOSE: The authors examined the benefits of younger cochlear implantation, longer cochlear implant use, and greater pre-implant aided hearing to spoken language at 3.5 and 4.5 years of age. METHOD: Language samples were obtained at ages 3.5 and 4.5 years from 76 children who received an implant by their 3rd birthday. Hierarchical linear modeling was used to identify characteristics associated with spoken language outcomes at the 2 test ages. The Preschool Language Scale (I. L. Zimmerman, V. G. Steiner, & R. E. Pond, 1992) was used to compare the participants' skills with those of hearing age-mates at age 4.5 years. RESULTS: Expected language scores increased with younger age at implant and lower pre-implant thresholds, even when compared at the same duration of implant use. Expected Preschool Language Scale scores of the children who received the implant at the youngest ages reached those of hearing age-mates by 4.5 years, but those children implanted after 24 months of age did not catch up with hearing peers. CONCLUSION: Children who received a cochlear implant before a substantial delay in spoken language developed (i.e., between 12 and 16 months) were more likely to achieve age-appropriate spoken language. These results favor cochlear implantation before 24 months of age, especially for children with aided pure-tone average thresholds greater than 65 dB prior to surgery.

Dificultades de lenguaje en preescolares: concordancia entre el test TEPSI y la evaluación fonoaudiológica / Language difficulties in pre-scholars: concordance between TEPSI test and speech therapist evaluation

Background: Language deficits cause difficulties in the family, school and social settings, so early detection and intervention are crucial. In Primary Care, children undergo developmental screening using the TEPSI test, which includes language at 4 years-old. Objective: Establish the frequency of language delay in children at pre-school, determined by specific language tests, in order to establish their concordance with TEPSI test. Method: Children between 3 and 5 years-old, attending 2 low-income pre-school facilities from the North Metropolitan Area, were evaluated during 2006. The information was obtained in a blind and simultaneous mode through TEPSI test performed by nurses and 3 specific language tests performed by speech therapists. A performance < p10 or < 2SD in one or was more language tests was considered a deficit. The concordance and discordance between both evaluations were established. Results: From a total of 219 children, 194 (89 percent) completed the evaluation. 48 percent had a language deficit by speech evaluation and 13,9 percent by TEPSI test. The concordance between both evaluations was poor (Kappa 0,2), with a significant discordance (p < 0,0000) by Mc NemarÆs X². Conclusion: The frequency of language problems in this population is high; a poor concordance between the tests used in Primary Care and language evaluations performed by speech therapists was found. The differences could be caused by the different aspects of language being evaluated. The findings lead to reconsider the screening strategies used in Primary Care and to implement language stimulation programs directed to low-income populations at high risk for language deficits.

Introducción: Los déficit del lenguaje conllevan dificultades en el contexto familiar, escolar y social, siendo fundamental la pesquisa e intervención precoz. En la atención primaria (APS) el lenguaje se evalúa en el marco del desarrollo psicomotor (DSM), a los 4 años mediante el test de TEPSI. Objetivo: Describir la frecuencia de déficit de lenguaje en preescolares asistentes a jardín infantil según pruebas de lenguaje específicas y establecer la concordancia entre estas pruebas y el TEPSI. Metodología: Se evaluó a todos los niños entre 3 y 5 años, asistentes a dos jardines infantiles de nivel socioeconómico bajo, del área Norte de la Región Metropolitana. La información se obtuvo en forma simultánea y ciega mediante la aplicación del TEPSI por enfermeras y la evaluación del lenguaje con dos pruebas específicas aplicadas por fonoaudiólogos. Se consideró un desempeño deficitario cuando el rendimiento en una o más pruebas de lenguaje fue < p10 ó < 2DS para la edad. Se estableció la concordancia y discordancia entre ambas evaluaciones. Resultados: De un total de 219 niños, 194 (89 por ciento) completaron la evaluación con los instrumentos señalados. 48,8 por ciento presentó dificultades del lenguaje según la evaluación fonoaudiológica y 13,9 por ciento según TEPSI. La concordancia entre ambas evaluaciones fue pobre (Kappa 0,2), con una discordancia altamente significativa p < 0,0000 según X² de Mc Nemar. Conclusión: Destaca la alta frecuencia de problemas de lenguaje en la población estudiada y la pobre concordancia entre las pruebas aplicadas en APS y la evaluación fonoaudiológica. Las diferencias podrían deberse a los distintos aspectos del lenguaje considerados en las evaluaciones. Los hallazgos invitan a replantear las estrategias de pesquisa utilizadas en APS y a la implementación de programas integrales de estimulación en poblaciones desfavorecidas, consideradas de riesgo para problemas de lenguaje.

A short-term follow-up of children with poor word production at the age of 18 months.

AIM: (a) To study the stability of poor language development assessed by a new screening instrument based on parents' recognition of words their 18-mo-old children use; (b) to evaluate the predictability of the less-than-eight-words cut-off used by Child Health Centres (CHCs) in Sweden at the present 18-mo check-up--an assessment based on parents' recall of their children's vocabulary. METHODS: All failures of the less-than-eight-words criterion, corresponding to about 10% of 1000 children from a community-based study, were followed up within half a year after the first assessment. The follow-up instrument was an extensive, internationally well-known and structured parent questionnaire, standardized for Swedish children. RESULTS: Almost half of the followed-ups performed below the 10th percentile and more than two-thirds were found below the 20th percentile. Thus, after a few months about one-third of the children had caught up to a fairly normal level of performance. Two of the children who had recovered performed above median. More relaxed cut-off criteria were applied ad hoc, reducing the proportion of children with a fast recovery. CONCLUSION: Age of language assessment and/or the level of cut-off criterion presently used at Swedish CHCs should be reconsidered.

Cochlear implants in young children.

The cochlear implant is best characterized as a device that provides access to the sound environment. The device enables the hearing pathway to respond to environmental and speech sounds, providing informational cues from the surroundings and from others that may escape visual detection. As the developmental effects of a profound hearing loss are multiple, cochlear implants have been applied to ever younger children in an attempt to promote a more normal level of developmental learning through audition. In deafness, transducer elements of the inner ear fail to trigger auditory nerve afferent nerves in the presence of sound input. However, large reserves of afferent fibers exist even in the auditory nerve of a profoundly deaf patient. Furthermore, these nerve fibers retain the ability to respond to prosthetic activation. Through developmental learning in the early, formative years, auditory centers of the brain appear capable of processing information from the implant to provide speech comprehension and oral language development. Multichannel implants have replaced original single channel designs. multichannel devices enable larger percentages of recipients to recognize the spoken word without visual cues because they provide spectral information in addition to temporal and intensity cues. Testing under conditions of auditory (implant)-only input reveals significant open-set speech understanding capabilities in more than 75% of children after three years of device use. The benefit provided by implants may vary with a number of conditions including: hearing history, age of deafness onset, age at implantation, etiology of deafness, linguistic abilities, and the presence of a motivated system of support of oral language development. Patient variables should be given individual consideration in judging candidacy for a cochlear implant and in planning rehabilitative and education services after surgery and activation of the device.

Early intervention critical to autism treatment.

It is still not universally accepted within the scientific community that the habilitation of autistic children is possible, or that their ability to function without supports in regular education by third, fourth, or fifth grade happens as a direct result of EIBI. However, using the outcome studies that have been reported, the rate of children reaching a best-outcome status appears to be between about 10% and 47%. There is a more global way to look at the effects of EIBI or behavioral intervention. Even if the child retains many characteristics of autism, the usual outcome of treatment is that the child learns useful skills. Behavioral intervention results in effective and efficient learning, which is precisely what it aims to accomplish and what behavioral techniques have been developed to do. Children and families have been able to achieve much more than many would ever have believed before EIBI became a realistic possibility.

Early childhood hearing loss: a frequently overlooked cause of speech and language delay.

The explosion of information regarding the genetics of hearing loss, the extraordinary effectiveness of early intervention, and the widespread practice of universal newborn hearing screening make for exciting times for those who serve young children who are deaf or hard-of-hearing and their families. These rapid changes in the knowledge base and practice standards also require the cooperation and help of pediatricians to enable children to take full advantage of available opportunities to optimize development of early communication.