Differences in Child Language Assessment Practices Between School-Based and Non-School-Based Speech-Language Pathologists: Results From a Nationwide Survey.

PURPOSE: The purpose of this study was to compare child language assessment practices of speech-language pathologists (SLPs) working in school and nonschool settings to determine if their place of employment impacts the diagnostic decision-making process. METHOD: School-based SLPs (e.g., direct service providers employed in preschool and/or K-12 schools; n = 382) and non-school-based SLPs (e.g., direct service providers employed in private practices, university clinics, and/or medical settings; n = 147) completed a web-based questionnaire. The questionnaire examined the types, frequency, and perceived importance of specific assessment tools and potential workplace factors that may impact their diagnostic decision-making process. RESULTS: Both school-based and non-school-based SLPs reported using a combination of assessment tools when evaluating children with potential language disorders. School-based SLPs tended to rank the frequency of use and importance of most assessment tools similarly, while non-school-based SLPs ranked interviews as the most frequently used and most important assessment tool. Statistically significant group differences indicated that school-based SLPs ranked the frequency of use and importance of standardized testing higher compared to their non-school-based counterparts. Also, school-based SLPs rated employment-based factors impacting diagnostic decision making higher compared to non-school-based SLPs. CONCLUSIONS: SLPs practicing in school-based settings seem to handle more employment-based factors that impact independent diagnostic decision making than SLPs working in different employment settings when assessing children for potential language disorders. Clinical recommendations are provided, and implications for implementation-based assessment research in child language are discussed.

Speech and Language Disorders in Friedreich Ataxia: Highlights on Phenomenology, Assessment, and Therapy.

Speech and language disorders are prominent signs in Friedreich ataxia (FRDA), which significantly impact on patients' quality of life. Despite such relevance, several issues regarding phenomenology, assessment, and treatment are still unmet. In this short review, we thus analyzed the existing literature to summarize what is known about the features of speech and language disorders in FRDA, which methods are used for evaluation and rating, and what are the available therapeutic strategies and future direction of scientific research in this field, in order to highlight critical aspects for a better clinical approach to the problem. FRDA patients often present dysarthria, resulting from central and peripheral causes and additional primary language disorders. Speech disturbances have peculiar characteristics, although variable among patients, and progress along the disease course. Assessment relies on multiple but not specific clinical scales, some of which can also reflect the general severity of ataxia; classical instrumental investigations and novel technologies allow more accurate measurements of several speech parameters, which could found application as potential disease's biomarkers. No successful treatments exist for communication disorders of FRDA patients; however, the tailored speech training or the non-invasive neuromodulation appear as the most reliable therapeutic options to be validate in future trials.

Access to speech-language pathology therapy and continuity of assistance in Primary Health Care for victims of motorcycle accidents. / Acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária em Saúde para vítimas de acidente de motocicleta.

PURPOSE: To verify the access to speech-language pathology (SLP) therapy and continuity of assistance in Primary Health Care (PHC) for victims of motorcycle accidents. METHODS: A quantitative and qualitative study was conducted at a large hospital in the city of Recife, Pernanbuco state, Brazil. Among the 99 victims recruited between June and July 2014, 30 had SLP complaints as a result of the accidents. After hospital discharge, all victims were contacted for investigation of the SLP rehabilitation process. Absolute and relative frequencies were used for the analysis in PHC, and data were displayed in tables for the therapy cases. RESULTS: Among the 30 individuals who reported having alterations of the stomatognathic system, eight were undergoing rehabilitation and 18 reported residing in an area covered by the Family Health Strategy (primary care modality). Seeking and obtaining continuity of treatment (medication and bandaging) in primary care were frequent; in contrast, home visits were less frequent. The main obstacles to access SLP therapy were distance to the service and waiting time to begin treatment. CONCLUSION: This study identified obstacles that hamper access to SLP therapy in PHC, such as the low frequency of home visits, contributing to the fragmentation of continuous and complete care for victims.

OBJETIVO: Verificar o acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária à Saúde (APS) em vítimas de acidente de motocicleta. MÉTODO: Trata-se de estudo realizado em um hospital de grande porte localizado em Recife-Pernambuco, recrutado entre o período de junho e julho de 2014. Após a alta hospitalar todos foram contatados para investigação do processo de reabilitação fonoaudiológica. Para o estudo na Atenção Primária à Saúde, foram utilizadas medidas de frequência absoluta e relativa. Já os casos em reabilitação foram descritos através de quadros. RESULTADOS: Foi verificado que 99 indivíduos foram vítimas de acidentes por motocicletas no período estudado. Desses, 30 entrevistados referiram ter essas queixas de alteração no sistema estomatognático, dos quais 8 estavam em reabilitação e 18 referiram residir em área adstrita a Unidade de Saúde da Família. Os principais obstáculos para o acesso à fonoterapia apontados foram a distância aos serviços de Fonoaudiologia e o tempo de espera para início do tratamento. Um dos aspectos relacionados à continuidade do cuidado pela Atenção Primária à Saúde, como a busca e obtenção de insumos, foi visto como frequente. Ao contrário da visita domiciliar, menos frequente. CONCLUSÃO: Foram identificados obstáculos que dificultaram o acesso à fonoterapia, assim como fragilidades nos cuidados dispensados pela Atenção Primária, como a visita domiciliar, contribuindo para a fragmentação do cuidado contínuo e integral às vítimas.

Acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária em Saúde para vítimas de acidente de motocicleta / Access to speech-language pathology therapy and continuity of assistance in Primary Health Care for victims of motorcycle accidents

RESUMO Objetivo Verificar o acesso à reabilitação fonoaudiológica e a continuidade do cuidado pela Atenção Primária à Saúde (APS) em vítimas de acidente de motocicleta. Método Trata-se de estudo realizado em um hospital de grande porte localizado em Recife-Pernambuco, recrutado entre o período de junho e julho de 2014. Após a alta hospitalar todos foram contatados para investigação do processo de reabilitação fonoaudiológica. Para o estudo na Atenção Primária à Saúde, foram utilizadas medidas de frequência absoluta e relativa. Já os casos em reabilitação foram descritos através de quadros. Resultados Foi verificado que 99 indivíduos foram vítimas de acidentes por motocicletas no período estudado. Desses, 30 entrevistados referiram ter essas queixas de alteração no sistema estomatognático, dos quais 8 estavam em reabilitação e 18 referiram residir em área adstrita a Unidade de Saúde da Família. Os principais obstáculos para o acesso à fonoterapia apontados foram a distância aos serviços de Fonoaudiologia e o tempo de espera para início do tratamento. Um dos aspectos relacionados à continuidade do cuidado pela Atenção Primária à Saúde, como a busca e obtenção de insumos, foi visto como frequente. Ao contrário da visita domiciliar, menos frequente. Conclusão Foram identificados obstáculos que dificultaram o acesso à fonoterapia, assim como fragilidades nos cuidados dispensados pela Atenção Primária, como a visita domiciliar, contribuindo para a fragmentação do cuidado contínuo e integral às vítimas.

ABSTRACT Purpose To verify the access to speech-language pathology (SLP) therapy and continuity of assistance in Primary Health Care (PHC) for victims of motorcycle accidents. Methods A quantitative and qualitative study was conducted at a large hospital in the city of Recife, Pernanbuco state, Brazil. Among the 99 victims recruited between June and July 2014, 30 had SLP complaints as a result of the accidents. After hospital discharge, all victims were contacted for investigation of the SLP rehabilitation process. Absolute and relative frequencies were used for the analysis in PHC, and data were displayed in tables for the therapy cases. Results Among the 30 individuals who reported having alterations of the stomatognathic system, eight were undergoing rehabilitation and 18 reported residing in an area covered by the Family Health Strategy (primary care modality). Seeking and obtaining continuity of treatment (medication and bandaging) in primary care were frequent; in contrast, home visits were less frequent. The main obstacles to access SLP therapy were distance to the service and waiting time to begin treatment. Conclusion This study identified obstacles that hamper access to SLP therapy in PHC, such as the low frequency of home visits, contributing to the fragmentation of continuous and complete care for victims.

Poverty and Trends in Three Common Chronic Disorders.

OBJECTIVES: For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions. METHODS: Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics. RESULTS: Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities. CONCLUSIONS: Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact.

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study.

PURPOSE: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. METHOD: Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. RESULT: It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. CONCLUSION: Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Speech sound disorders in a community study of preschool children.

PURPOSE: To undertake a community (nonclinical) study to describe the speech of preschool children who had been identified by parents/teachers as having difficulties "talking and making speech sounds" and compare the speech characteristics of those who had and had not accessed the services of a speech-language pathologist (SLP). METHOD: Stage 1: Parent/teacher concern regarding the speech skills of 1,097 4- to 5-year-old children attending early childhood centers was documented. Stage 2a: One hundred forty-three children who had been identified with concerns were assessed. Stage 2b: Parents returned questionnaires about service access for 109 children. RESULTS: The majority of the 143 children (86.7%) achieved a standard score below the normal range for the percentage of consonants correct (PCC) on the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002). Consonants produced incorrectly were consistent with the late-8 phonemes ( Shriberg, 1993). Common phonological patterns were fricative simplification (82.5%), cluster simplification (49.0%)/reduction (19.6%), gliding (41.3%), and palatal fronting (15.4%). Interdental lisps on /s/ and /z/ were produced by 39.9% of the children, dentalization of other sibilants by 17.5%, and lateral lisps by 13.3%. Despite parent/teacher concern, only 41/109 children had contact with an SLP. These children were more likely to be unintelligible to strangers, to express distress about their speech, and to have a lower PCC and a smaller consonant inventory compared to the children who had no contact with an SLP. CONCLUSION: A significant number of preschool-age children with speech sound disorders (SSD) have not had contact with an SLP. These children have mild-severe SSD and would benefit from SLP intervention. Integrated SLP services within early childhood communities would enable earlier identification of SSD and access to intervention to reduce potential educational and social impacts affiliated with SSD.

What makes a caseload (un)manageable? School-based speech-language pathologists speak.

PURPOSE: Large caseload sizes and a shortage of speech-language pathologists (SLPs) are ongoing concerns in the field of speech and language. This study was conducted to identify current mean caseload size for school-based SLPs, a threshold at which caseload size begins to be perceived as unmanageable, and variables contributing to school-based SLPs' feelings of caseload manageability. METHOD: Approximately 2,000 public-school-based SLPs from across the country were solicited to participate in an online, Web-based survey between April and May of 2007. Of those SLPs who were contacted, 634 full-time SLPs from 49 states completed the survey. The data were evaluated using descriptive statistics and logistic regression. RESULTS: The mean caseload size for SLPs in this study was 49 students. At the caseload range of 41-50 students, approximately 60% of the SLPs perceived their caseload size as unmanageable. Logistic regression revealed caseload size, years of experience, and extent of collaboration as significant predictors of an SLP's likelihood of feeling that his or her caseload size is manageable. CONCLUSIONS: Caseload size continues to be an area of concern for school-based SLPs, and efforts to address this problem must continue in order to prevent long-term struggles with SLPs' dissatisfaction, shortages, and turnover. Policy, research, and clinical implications are discussed.

Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).

BACKGROUND AND AIMS: Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting. METHODS: Sixty severely demented patients (MMSE /=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected. RESULTS: Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients. CONCLUSIONS: The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.

[Qualifying language disorders of schizophrenia through the speech therapists' assessment]. / Caractérisation des troubles du langage dans la schizophrénie grâce au bilan orthophonique.

This study investigates a comprehensive assessment of language disorders in order to identify impaired and unaffected language abilities of individuals with schizophrenia. Furthermore, the purpose of this study was to demonstrate the importance of the role of speech therapists in the treatment of schizophrenia. Speech therapy is especially thought to treat language disorders. However, to date, speech therapists have not been solicited in the treatment of schizophrenia, despite growing evidence supporting that schizophrenia is characterized by cognitive disorders such as impairments in memory, attention, executive functioning and language. In this article, we discuss the fact that elements of language and cognition are interactively affected and that cognition influences language. We then demonstrate that language impairments can be treated in the same way as neurological language impairments (cerebrovascular disease, brain injury), in order to reduce their functional outcome. Schizophrenia affects the pragmatic component of language with a major negative outcome in daily living skills [Champagne M, Stip E, Joanette Y. Social cognition deficit in schizophrenia: accounting for pragmatic deficits in communication abilities? Curr Psychiatry Rev:2006;(2):309-315]. The results of our comprehensive assessment also provide a basis for the design of a care plan. For this, subjects with schizophrenia were examined for language comprehension and language production with a focus on pragmatic abilities. In neurology, standardized tests are available that have been designed specifically to assess language functions. However, no such tests are available in psychiatry, so we gathered assessments widely used in neurology and examined the more relevant skills. In this article, each test we chose is described and particular attention is paid to the information they provided on impaired language abilities in schizophrenia. In this manner, we provide an accurate characterization of schizophrenia-associated language impairments and offer a solid foundation for rehabilitation. Current research makes connections between schizophrenia and other neurological disorders concerning language. Nevertheless, further studies are needed to explore these connections to complete our investigations. The strategies we designed are aimed at enabling a subject with schizophrenia to improve his/her language skills. We support the idea that such improvement could be reached by speech therapy. We conclude that speech therapists can play an important role in the non pharmacological treatment of schizophrenia, by selecting appropriate interventions that capitalize on spared abilities to compensate for impaired abilities.

Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation.

When mental health clinicians perform mental status examinations, they examine the language patterns of patients because abnormal language patterns, sometimes referred to as language dysfluency, may indicate a thought disorder. Performing such examinations with deaf patients is a far more complex task, especially with traditionally underserved deaf people who have severe language deficits in their best language or communication modality. Many deaf patients suffer language deprivation due to late and inadequate exposure to ASL. They are also language dysfluent, but the language dysfluency is usually not due to mental illness. Others are language dysfluent due to brain disorders such as aphasia. This paper examines difficulties in performing a mental status examination with deaf patients. Issues involved in evaluating for hallucinations, delusions, and disorganized thinking are reviewed. Guidelines are drawn for differential diagnosis of language dysfluency related to thought disorder vs. language dysfluency related to language deprivation.

Translational research on early language development: current challenges and future directions.

There is a pressing need for the early and accurate identification of young children at risk for language and other developmental disabilities and the provision of timely, age-appropriate intervention, as mandated by Part C of the Individuals with Disabilities Education Act. Research has shown that early intervention is effective for many language impaired children in different etiological groups, and can reduce the functional impact of persistent disorders on children and their families. Yet, the accurate identification of infants and toddlers at risk for language impairment remains elusive, especially for late-talking children without obvious genetic or neurological conditions. In this paper, the need for translational research on basic processes in early language development in typical and atypical populations and the contextual factors that affect them are discussed, along with current challenges and future directions for its successful implementation. Implications of this research for clinical evidence-based practice are also considered.

Children enrolled in public pre-K: the relation of family life, neighborhood quality, and socioeconomic resources to early competence.

This article presents data on the family and social environments of 501 children enrolled in public sponsored pre-K in 5 states and tests the relation of these resources to child competence. Structured interviews and questionnaires provide information from parents about the family's social and economic status. Direct assessments and teacher reports provide data on children's literacy, numeracy, and behavioral problems. A majority of the children served in public pre-K lived in poverty and showed decrements in language but not in other domains. A socioeconomic resource factor consisting of parental education, household income, and material need predicted all domains of children's functioning. Children from households high in socioeconomic resources entered pre-K with more well developed language and math skill but fewer behavioral problems than their disadvantaged peers. Neighborhood quality status was related to language competence and mother's marital status to math competence. Neighborhood quality and income level may have their impact on child competence through their relation to dyadic quality and the health and the psychological well-being of the parents.

Efficacy of language assessment in Alzheimer's disease: comparing in-person examination and telemedicine.

BACKGROUND: With the large number of aging individuals requiring screening of cognitive functions for dementing illnesses, there is a necessity for innovative evaluation approaches. One domain that should allow for online, at a distance, examination is speech and language dysfunction, if the auditory and visual transmission is of sufficient quality to allow adequate patient participation and reliable, valid interpretation of signs and symptoms (Duffy et al 1997). OBJECTIVE: Examine the effectiveness of language assessment in mild Alzheimer's patients using telemedicine (TM) compared with traditional in-person (IP) assessment. DESIGN: Ten patients with mild Alzheimer's disease, enrolled at a Geriatric Memory Clinic received a battery of standard language tests under two conditions: face-to-face and via satellite TM. RESULTS: Comparison of TM and IP testing conditions were assessed within each for scores on each test in the two conditions. On each of the five language tasks, the Wilcoxon signed ranks test indicated no significant difference on performance between the TM and IP conditions for each participant. Overall acceptance of the TM evaluation in an elderly population was rated at a high level except for one individual. CONCLUSION: Telemedicine can improve access to speech and language evaluation services which is relevant to both dementia and other neurological diseases of the elderly. In particular, this specific assessment tool can be used to provide evaluations in under-served rural areas.

[Speech therapy assessment: field study on psychometric properties, practicability, acceptance and process quality]. / Das logopädische Assessment: Feldversuch zu psychometrischen Eigenschaften, Praktikabilität, Akzeptanz und Prozessqualität.

OBJECTIVE: to investigate the internal consistency, responsiveness, discriminative validity, practicability, acceptance and process quality of a recently developed Speech Therapy Assessment (STA) under routine work conditions of speech and language therapists in German speaking countries. Since standardised, generic and ICF-oriented assessment tools for documentation and evaluation of speech therapy interventions for adult clients are missing in German speaking countries and existing tests cover only sub-areas, the STA has been developed in the years 1995 to 2002. By means of different domains, speech and language therapists assess client (1) communication, (2) aphasia, (3) speech apraxia, (4) dysarthria and (5) dysphagia as well as (6) her or his dealing with corresponding disabilities. METHODS: 17 therapists from 14 institutions applied the STA to 260 adult clients with language, speaking or swallowing disorders. The clients were included in the study consecutively over a period of 7 month. After this period, the therapists completed a questionnaire regarding the benefit and practicability of the STA. Cronbach alpha was calculated as indicator for internal consistency, effect sizes (standardised response means) for responsiveness and ROC values for discriminative validity. The answers of the questionnaire about the benefit of the STA were evaluated both, quantitatively and qualitatively. RESULTS: The internal consistency and discriminative validity were high (Cronbach alpha: 0.79 to 0.95; ROC-values: 0.84 to 0.98). Effect sizes regarding responsiveness were moderate (standardised response means: 0.46 to 0.78). On a 5-step Likert scale (1 = very good, 5 = inadequate), the therapists rated the average (standard deviation) benefit of the STA with: practicability 2.6 (1.2), acceptance 2.8 (1.3), impact on diagnostics 2.8 (1.3), impact on finding therapeutic goals 3.5 (1.2), impact on communication with other rehabilitation partners 2.7 (1.5) and overall judgement 2.6 (0.9). CONCLUSION: The STA fulfils essential quality criteria of the classical test theory. The involved therapists assessed the benefit of the STA as satisfactory. In addition, they pointed out concrete improvement potential for the implementation in practice. It is planed to investigate a refined version of the STA in a multi centre validation study.

Evidence-based assessment of autism spectrum disorders in children and adolescents.

This article reviews evidence-based criteria that can guide practitioners in the selection, use, and interpretation of assessment tools for autism spectrum disorders (ASD). As Mash and Hunsley (2005) discuss in this special section, evidence-based assessment tools not only demonstrate adequate psychometric qualities, but also have relevance to the delivery of services to individuals with the disorder (see also Hayes, Nelson, & Jarrett, 1987). Thus, we use what is known about the symptoms, etiologies, developmental course, and outcome of ASD to evaluate the utility of particular assessment strategies and instruments for diagnosis, treatment planning and monitoring, and evaluation of outcome. The article begins with a review of relevant research on ASD. Next we provide an overview of the assessment process and some important issues that must be considered. We then describe the components of a core (minimum) assessment battery, followed by additional domains that might be considered in a more comprehensive assessment. Domains covered include core autism symptomatology, intelligence, language, adaptive behavior, neuropsychological functions, comorbid psychiatric illnesses, and contextual factors (e.g., parent well-being, family functioning, quality of life). We end with a discussion of how well the extant literature meets criteria for evidence-based assessments.

Quantitative assessment of the frequency of normal associations in the utterances of schizophrenia patients and healthy controls.

BACKGROUND: The intrusion of associations into the utterances of schizophrenic individuals typically disrupts the coherence of the patient's utterances. Recent theoretical formulations of these phenomena have emphasized the hyperactivity) of associational networks in such language disturbance (e.g., Maher, B.A. 2003 Schizophrenia, aberrant utterance and delusions of control: the disconnection of speech and thought, and the connection of experience and belief. Mind and Language, 18, 1-22). There has been only limited effort to quantify such features in patient populations. METHODS: We hypothesized that (1) coherent utterances elicited from a sample of schizophrenia patients will present a higher mean frequency of normative associations than in normal controls; and (2) there is a positive association between total associations in utterances and hyperassociative activity (positive facilitation) as assessed by a semantic priming task. Participants included 43 schizophrenic patients and 25 healthy controls. Three measures were employed, a new computer program, Computed Associations in Sequential Text (CAST), to quantify normative associations; a picture description technique for eliciting speech samples; and a semantic priming task to measure associative facilitation. RESULTS: In coherent utterances, schizophrenia patients produced higher mean totals of associations compared to controls. Patients with positive facilitation scores in the controlled processing interval (1250 ms) of the semantic priming procedure, there was a correlation between facilitation scores and total frequency of associations. This effect was absent in controls. CONCLUSIONS: These results are consistent with models of language disturbance in schizophrenia that posit hyperactivity of associational networks.

The Carter Neurocognitive Assessment for children with severely compromised expressive language and motor skills.

In this paper, different means of assessing cognitive development in children with severe impairments in both their expressive language and their motor skills are reviewed. A range of techniques are considered, including traditional cognitive tests and behavioral and physiological measures, but these techniques are generally impractical and minimally informative when it comes to assessing children with both motor and speech impairments. Electrophysiological measures show some promise for the future, but are currently inadequate for wide-ranging cognitive assessment. Development of the Carter Neurocognitive Assessment (CNA) is described. The CNA is appropriate for use in clinical and research settings and was designed to minimalize the impact of severely impaired motor skills and expressive language on performance. The CNA is intended to itemize and quantify a range of skills reflecting a cognitive level up to approximately 18 to 24 months in four areas: Social Awareness, Visual Attention, Auditory Comprehension and Vocal Communication. The use of the CNA to assess the performance and developmental growth of eight children with Holoprosencephaly (HPE), a midline developmental brain malformation, is described. The CNA is a useful tool for the assessment of children with severely compromised motor and verbal skills and has provided a more positive view of the cognitive potential of children with severe handicaps, such as the sample of children with HPE, than that presented in the past.

Validation of a Developmental Neuropsychological Assessment (NEPSY) through comparison of neurological, scholastic concerns, and control groups.

Validity of the standard, 13 subtest A Developmental Neuropsychological Assessment (NEPSY) was investigated by comparing scores for 30 children with neurological conditions, 35 children with scholastic concerns, and 39 controls. Overall differences were found among the groups with and without controlling for IQ (Lambda = .60, Lambda = .001; Lambda = .70, P < .001). Four of five NEPSY domain scores differed among the three groups. Language and Sensorimotor domain score differences were found even when IQ was controlled, and group status accounted for substantial variance in these domain scores. Regarding specific tasks, Phonological Processing and Fingertip Tapping were among the subtests that varied the most between groups, especially when children with scholastic concerns were compared with controls. Findings offer preliminary support for the validity of several NEPSY indexes.