Joint Attention in the Context of Hearing Loss: A Meta-Analysis and Narrative Synthesis.

Joint attention is important for children's language development. We report two meta-analyses that demonstrate that the congruency in hearing status between parent and child affects the establishment and maintenance of joint attention. Dyads consisting of hearing parents and children with hearing loss, achieve fewer and briefer moments of joint attention in comparison to dyads of hearing parents and hearing children and dyads of deaf parents and deaf children. The theoretical and practical implications of these differences are discussed and placed in the context of two narrative syntheses. The first one focusing on parental strategies used to achieve and maintain moments of joint attention and the second one on the relation between joint attention and spoken language proficiency. We also expect that this review may serve as the start of quest towards a more detailed description (taxonomy) and operationalization of joint attention in the context of hearing loss.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study.

Background and aims: Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD. Methods: Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories. Results: For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions. Conclusions: By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD. Implications: The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Interactive virtual reality training to improve socio-emotional functioning in adolescents with developmental language disorders: A feasibility study.

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: 'InterAction'. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents' appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants' sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13-16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that 'InterAction' was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

Individual variation in bilingual vocabulary in preschoolers with developmental language disorder.

BACKGROUND: It is unclear how speech production, selective attention, and phonological working memory are related to first- (L1) and second-language (L2) vocabularies in bilingual preschoolers with Developmental Language Disorder (DLD). AIMS: To study individual variation in vocabularies in DLD bilingual preschoolers by (1) comparing them to typically developing (TD) bilingual, and TD and DLD monolingual peers; (2) differentially predicting L2 vocabulary; and (3) identifying and characterizing bilinguals' L1/L2 vocabulary profiles. METHODS: We measured the selective attention, working memory, and L1 Turkish/Polish (where applicable) and L1/L2 Dutch speech and vocabulary abilities of 31 DLD bilingual, 37 TD bilingual, and 61 DLD and 54 TD Dutch monolingual three-to-five year-olds. RESULTS: DLD bilinguals scored lower than TD bilinguals and TD/DLD monolinguals on all measures, except L2 vocabulary, where all bilinguals underperformed all monolinguals. Selective attention predicted Dutch vocabulary across groups. Three bilingual vocabulary profiles emerged: DLD bilinguals were less likely to be L1 dominant, TD/DLD bilinguals with better attention more often had a Balanced high L1/L2 profile, while those with poorer selective attention and L1 speech tended to be L2 dominant. CONCLUSIONS: These findings highlight the roles of L1 speech and selective attention, rather than L2 speech and working memory, in understanding bilingual vocabulary variation among DLD preschoolers.

Development of the Musi-CI Training, A Musical Listening Training for Cochlear Implant Users: A Participatory Action Research Approach.

A cochlear implant (CI) is a prosthesis that allows people with severe to profound hearing loss to understand speech in quiet settings. However, listening to music presents a challenge to most CI users; they often do not enjoy music or avoid it altogether. The Musi-CI training course was developed for CI users with the goal of reducing music aversion and improving music enjoyment. A consortium was established consisting of a professional musician with CI, CI rehabilitation professionals and researchers. Participatory action research (PAR) was applied to develop and evaluate the training experiences, collaborating with 37 CI users during three cycles of eight training sessions, each held over a period of 3 months. Input and feedback were collected after each training session using questionnaires, observations and focus group interviews. Almost all participants (86%) completed the training. After completing the training a large majority of participants reported increased music appreciation, increased social participation in musical settings and a positive impact on general auditory perception. The resulting Musi-CI training programme focuses on music listening skills, self-efficacy, and self-motivation. It consists of exercises intended to strengthen attention and working memory, to improve beat and rhythm perception (with online rhythm exercises) and exercises to distinguish timbre of instruments and emotion in music. A Melody Game was developed to improve pitch and melodic contour discrimination.

Cross-Language Transfer and Attentional Control in Early Bilingual Speech.

PURPOSE: This study investigated the roles of cross-language transfer of first language (L1) and attentional control in second-language (L2) speech perception and production of sequential bilinguals, taking phonological overlap into account. METHOD: Twenty-five monolingual Dutch-speaking and 25 sequential bilingual Turkish-Dutch-speaking 3- and 4-year-olds were tested using picture identification tasks for speech perception in L1 Turkish and L2 Dutch, single-word tasks for speech production in L1 and L2, and a visual search task for attentional control. Phonological overlap was manipulated by dividing the speech tasks into subsets of phonemes that were either shared or unshared between languages. RESULTS: In Dutch speech perception and production, monolingual children obtained higher accuracies than bilingual peers. Bilinguals showed equal performance in L1 and L2 perception but scored higher on L1 than on L2 production. For speech perception of shared phonemes, linear regression analyses revealed no direct effects of attention and L1 on L2. For speech production of shared phonemes, attention and L1 directly affected L2. When exploring unshared phonemes, direct effects of attentional control on L2 were demonstrated not only for speech production but also for speech perception. CONCLUSIONS: The roles of attentional control and cross-language transfer on L2 speech are different for shared and unshared phonemes. Whereas L2 speech production of shared phonemes is also supported by cross-language transfer of L1, L2 speech perception and production of unshared phonemes benefit from attentional control only. This underscores the clinical importance of considering phonological overlap and supporting attentional control when assisting young sequential bilinguals' L2 development.

Measuring Theory of Mind in Adolescents With Language and Communication Problems: An Ecological Perspective.

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

The relation between working memory, number sense, and mathematics throughout primary education in children with and without mathematical difficulties.

Number sense and working memory contribute to mathematical development throughout primary school. However, it is still unclear how the contributions of each of these predictors may change across development and whether the cognitive contribution is the same for children with and without mathematical difficulties. The aim of the two studies in this paper was to shed light on these topics. In a cross-sectional design, a typically developing group of children (study 1; N = 459, Grades 1-4) and a group with mathematical difficulties (study 2; N = 61, Grades 4-6) completed a battery of number sense and working memory tests, as well as a measure of arithmetic competence. Results of study 1 indicated that number sense was important in first grade, while working memory gained importance in second grade, before predictive value of both predictors waned. Number sense and working memory supported mathematics development independently from one another from Grade 1. Analysis of task demands showed that typically developing children rely on comprehension and visualization of quantity-to-number associations in early development. Later in development, pupils rely on comparing larger numerals and working memory until automatization. Children with mathematical difficulties were less able to employ number sense during mathematical operations, and thus might remain dependent on their working memory resources during arithmetic tasks. This suggests that children with mathematical difficulties need aid to employ working memory for mathematics from an early age to be able to automatize mathematical abilities later in development.

Improving social emotional functioning in adolescents with Developmental Language Disorders: A mini review and recommendations.

Adolescents with Developmental Language Disorders (DLD) have more difficulties in social emotional functioning than their typically developing peers (TD), such as shyness and anxiety in social situations, fewer peer relations, greater risk of victimization, social isolation and depression. In addition, they are more likely to report higher levels of hyperactivity and conduct problems. These problems derive from a complex interplay between difficulties in language, social communication, underlying cognitive deficits in Theory of Mind (ToM), Executive Functioning (EF) and self-directed speech (SDS). The aim of this mini review is to provide an overview of studies examining the effectiveness of interventions targeting the factors underlying social emotional functioning of school-aged children and adolescents with DLD. We found that studies dedicated to social emotional functioning in school-aged children and adolescents with DLD were relatively scarce. Based on this overview, we give suggestions to improve social emotional functioning in adolescents with DLD. We propose that intervention programs should target the social, linguistic and cognitive functions underlying social emotional functioning and create opportunities to practice these skills in daily, real-life situations with peers.

Drama Therapy for Children and Adolescents with Psychosocial Problems: A Systemic Review on Effects, Means, Therapeutic Attitude, and Supposed Mechanisms of Change.

Drama therapy is applied to children and adolescents with psychosocial problems. Drama therapy is an experimental form of treatment which methodologically uses drama and theatre processes to achieve psychological growth. Although in clinical practice, drama therapy has been applied successfully, little is known about how and why drama therapy contributes to a decrease in psychosocial problems. A systematic narrative review was performed to obtain more insight into this issue. Eight databases were systematically searched. Ten out of 3742 studies were included, of which there were four random controlled trails, three non-controlled trials, and three pre-and post-test design studies. We identified the results, drama therapeutic means, attitude, and mechanism of change. Positive effects were found on overall psychosocial problems, internalizing and externalizing problems, social functioning, coping and regulation processes, social identity, and cognitive development. An adaptive approach was mentioned as the therapeutic attitude. The means established contribute to a dramatic reality, which triggers the mechanisms of change. These are processes that arise during treatment and which facilitate therapeutic change. We found ten supposed mechanisms of change to be frequently used in all studies. No direct relations were found between the results, drama therapeutic attitude, means, and mechanisms of change.

The relationship of language and emotion: N400 support for an embodied view of language comprehension.

According to embodied theories, the symbols used by language are meaningful because they are grounded in perception, action, and emotion. In contrast, according to abstract symbol theories, meaning arises from the syntactic combination of abstract, amodal symbols. If language is grounded in internal bodily states, then one would predict that emotion affects language. Consistent with this, advocates of embodied theories propose a strong link between emotion and language [Havas, D., Glenberg, A. M., & Rinck, M. Emotion simulation during language comprehension. Psychonomic Bulletin & Review, 14, 436-441, 2007; Niedenthal, P. M. Embodying emotion. Science, 316, 1002-1005, 2007]. The goal of this study was to test abstract symbol vs. embodied views of language by investigating whether mood affects semantic processing. To this aim, we induced different emotional states (happy vs. sad) by presenting film clips that displayed fragments from a happy movie or a sad movie. The clips were presented before and during blocks of sentences in which the cloze probability of mid-sentence critical words varied (high vs. low). Participants read sentences while ERPs were recorded. The mood induction procedure was successful: Participants watching the happy film clips scored higher on a mood scale than those watching the sad clips. For N400, mood by cloze probability interactions were obtained. The N400 cloze effect was strongly reduced in the sad mood compared with the happy mood condition. Furthermore, a difference in late positivity was only present for the sad mood condition. The mood by semantic processing interaction observed for N400 supports embodied theories of meaning and challenges abstract symbol theories that assume that processing of word meaning reflects a modular process.

Diagnosing autism spectrum disorders in elderly people.

BACKGROUND: As autism spectrum disorders (ASD) have largely been neglected in old-age psychiatry, the objective of the present paper is to describe the diagnostic process in elderly patients. METHODS: A systematic review of the literature on ASD in older age was undertaken and illustrated by a case series of three elderly patients first diagnosed with ASD in later life by a tertiary mental health clinic. RESULTS: The search of the literature only yielded three papers on late-life ASD, while the review of the available diagnostic procedures among adults suggests some relevance for screening instruments (Autism Questionnaire), diagnostic instruments (Module 4, Autism Diagnostic Observation Schedule), and neuropsychological examination to profile impairments. Nonetheless, the case reports clearly showed that taking a thorough history with the patient, corroborated and supplemented by a close relative or caregiver who has known the patient for at least ten years, still remains the most important diagnostic tool. CONCLUSION: The three case studies show that in clinical practice ASD can easily be missed in elderly individuals presenting with comorbid psychiatric disorders, potentially causing iatrogenic damage. Although further research on phenotyping and diagnosing ASD in older people is warranted, the most important step at this point is to create a greater awareness of the possibility of ASD in old age among health-care professionals working with people in this age group.

Beyond the Senses: How Self-Directed Speech and Word Meaning Structure Impact Executive Functioning and Theory of Mind in Individuals With Hearing and Language Problems.

Many individuals with developmental language disorder (DLD) and individuals who are deaf or hard of hearing (D/HH) have social-emotional problems, such as social difficulties, and show signs of aggression, depression, and anxiety. These problems can be partly associated with their executive functions (EFs) and theory of mind (ToM). The difficulties of both groups in EF and ToM may in turn be related to self-directed speech (i.e., overt or covert speech that is directed at the self). Self-directed speech is thought to allow for the construction of non-sensory representations (i.e., representations that do not coincide with direct observation). Such non-sensory representations allow individuals to overcome the limits set upon them by the senses. This ability is constrained by the development of word meaning structure (i.e., the way words are understood). We argue that the greater ability to construct non-sensory representations may result in more enhanced forms of EF and ToM. We conclude that difficulties in EF, ToM, and social-emotional functioning in those with hearing and language problems may be accounted for in terms of word meaning impairments. We propose that word meaning structure and self-directed speech should be considered in assigning EF and ToM treatments to individuals with DLD and those who are D/HH.

Inhibitory Control and Craving in Dual Disorders and Recurrent Substance Use. Preliminary Findings.

Objective: In Dual Disorders (DD), which involves the co-occurrence of a disorder in substance use and a mental disorder, recurrent struggles with addictive behavior are frequent. Neuropsychological knowledge concerning the profile of inhibitory control and the irresistible urge to use substances (craving) within the DD patient group may contribute to the prevention of this recurrent addictive behavior. Methods: Inhibitory control and craving were assessed in 25 patients with DD and 25 healthy controls (HC). Inhibitory control tasks (Go/No-go task and Stop Signal Task) were performed combined with brain measurements (Event Related Potentials) mapping inhibitory control. Moreover, implicit and explicit measures concerning craving were administered. Statistical DD and HC comparisons, correlational and regression analyses on exploratory base were conducted. Results: DD patients committed more inhibitory control errors than HC when confronted with (alcohol) consumption-related picture stimuli. Furthermore, patients with DD showed higher levels of implicit and explicit craving. The number of inhibitory control errors was positively related to levels of implicit and explicit craving. Moreover, explicit craving and impulsivity (as a dimension of inhibitory control) predicted the severity of addictive behavior. Event Related Potential analyses did not show differences in inhibitory control-associated brain activity between DD patients and HC; both groups showed reduction of P300 amplitudes in response to alcohol pictures. Conclusions: Impulsivity and craving are elevated in DD patients and show predictive value for the severity of addictive behavior. One's level of impulsive action tendency may trigger less effort to control (recurrent) substance use. The findings may contribute to existing DD treatment indications by the promotion of impulse control training via "stop-think-act" methods for DD patients.

Is a Negative Attentional Bias in Individuals with Autism Spectrum Disorder Explained by Comorbid Depression? An Eye-Tracking Study.

Heightened attention towards negative information is characteristic of depression. Evidence is emerging for a negative attentional bias in Autism spectrum disorder (ASD), perhaps driven by the high comorbidity between ASD and depression. We investigated whether ASD is characterised by a negative attentional bias and whether this can be explained by comorbid (sub) clinical depression. Participants (n = 116) with current (CD) or remitted depression (RD) and/or ASD, and 64 controls viewed positively and negatively valenced (non-)social pictures. Groups were compared on three components of visual attention using linear mixed models. Both CD individuals with and without ASD, but not remitted depressed and never-depressed ASD individuals showed a negative bias, suggesting that negative attentional bias might be a depressive state-specific marker for depression in ASD.

Monitoring in language perception: mild and strong conflicts elicit different ERP patterns.

In the language domain, most studies of error monitoring have been devoted to language production. However, in language perception, errors are made as well and we are able to detect them. According to the monitoring theory of language perception, a strong conflict between what is expected and what is observed triggers reanalysis to check for possible perceptual errors, a process reflected by the P600. This is at variance with the dominant view that the P600 reflects syntactic reanalysis or repair, after syntactic violations or ambiguity. In the present study, the prediction of the monitoring theory of language perception was tested, that only a strong conflict between expectancies triggers reanalysis to check for possible perceptual errors, reflected by the P600. Therefore, we manipulated plausibility, and hypothesized that when a critical noun is mildly implausible in the given sentence (e.g., "The eye consisting of among other things a pupil, iris, and eyebrow ..."), a mild conflict arises between the expected and unexpected event; integration difficulties arise due to the unexpectedness but they are resolved successfully, thereby eliciting an N400 effect. When the noun is deeply implausible however (e.g., "The eye consisting of among other things a pupil, iris, and sticker ..."), a strong conflict arises; integration fails and reanalysis is triggered, eliciting a P600 effect. Our hypothesis was confirmed; only when the conflict between the expected and unexpected event is strong enough, reanalysis is triggered.

The Emergence of Inner Speech and Its Measurement in Atypically Developing Children.

Inner speech (IS), or the act of silently talking to yourself, occurs in humans regardless of their cultural and linguistic background, suggesting its key role in human cognition. The absence of overt articulation leads to methodological challenges to studying IS and its effects on cognitive processing. Investigating IS in children is particularly problematic due to cognitive demands of the behavioral tasks and age restrictions for collecting neurophysiological data [e.g., functional magnetic resonance imaging (fMRI) or electromyography (EMG)]; thus, the developmental aspects of IS remain poorly understood despite the long history of adult research. Studying developmental aspects of IS could shed light on the variability in types and amount of IS in adults. In addition, problems in mastering IS might account for neuropsychological deficits observed in children with neurodevelopmental conditions. For example, deviance in IS development might influence these children's general cognitive processing, including social cognition, executive functioning, and related social-emotional functioning. The aim of the present paper is to look at IS from a developmental perspective, exploring its theory and identifying experimental paradigms appropriate for preschool and early school-aged children in Anglophone and Russian literature. We choose these two languages because the original work carried out by Vygotsky on IS was published in Russian, and Russian scientists have continued to publish on this topic since his death. Since the 1960s, much of the experimental work in this area has been published in Anglophone journals. We discuss different measurements of IS phenomena, their informativeness about subtypes of IS, and their potential for studying atypical language development. Implications for assessing and stimulating IS in clinical populations are discussed.

The Effect of Alexithymia on Attentional Bias Toward Emotional Stimuli in Depression: An Eye-Tracking Study.

Alexithymia-reflecting deficits in cognitive emotion processing-is highly prevalent in individuals with depressive disorders. Subsequently, mixed evidence for attentional bias is found in these individuals. Alexithymia may be a potential influencing factor for attentional bias in depression. In the current study, 83 currently depressed (CD) and 76 never-depressed (ND) controls completed an eye-tracker task consisting of valenced (non)-social pictures. Alexithymia scores were also included as a moderator as both a continuous and categorical measure (so high vs. low alexithymia). No group difference or moderating effect of alexithymia was found on attentional bias. Thus, alexithymic symptoms, included both dimensionally and categorically, may not influence biased attentional processing in depression compared to ND individuals. Thus, it is important to explore other potential explaining factors for the equivocal results found on biased attentional processing of emotional information in depression.

The Interplay Between Theory of Mind and Social Emotional Functioning in Adolescents With Communication and Language Problems.

Adolescents with developmental language disorders (DLDs) and adolescents who are deaf or hard of hearing (D/HH) are at greater risk of social emotional problems. These problems may not only be attributed to communication and language problems but, at least in part, to Theory of Mind (ToM) deficits as well. In this mini review, an overview is provided of studies on social emotional functioning and ToM performance in adolescents with DLD and D/HH adolescents. A possible interplay between social emotional functioning and Theory of Mind is discussed. There is empirical evidence for social emotional problems and ToM problems in both adolescents with DLD and D/HH. We hypothesized that language deficits as seen in adolescents with DLD and impoverished exposure to language and communication, as seen in adolescents who are D/HH can explain differences in social emotional functioning and ToM performance. The present mini review provides a possible framework for the relation between ToM and social emotional functioning in adolescents with communication and language problems, which is mediated by their limited linguistic ability or restricted language exposure and gives suggestions for future research.