Functional near-infrared spectroscopy and language development: An integrative review.

Functional near-infrared spectroscopy (fNIRS) stands poised to revolutionize our understanding of auditory detection, speech perception, and language development in infants. In this study, we conducted a meticulous integrative review across Medline, Scopus, and LILACS databases, targeting investigations utilizing fNIRS to explore language-related features and cortical activation during auditory stimuli in typical infants. We included studies that used the NIRS technique to study language and cortical activation in response to auditory stimuli in typical infants between 0 and 3 years old. We used the ROBINS-I tool to assess the quality and the risk of bias in the studies. Our analysis, encompassing 66 manuscripts, is presented in standardized tables for streamlined data extraction. We meticulously correlated findings with children's developmental stages, delineating crucial insights into brain development and its intricate interplay with language outcomes. Although most studies have a high risk for overall bias, especially due to the high loss of data in NIRS studies, the low risk in the other domains is predominant and homogeneous among the studies. Highlighted are the unique advantages of fNIRS for pediatric studies, underscored by its innate suitability for use in children. This review accentuates fNIRS' capacity to elucidate the neural correlates of language processing and the sequential steps of language acquisition. From birth, infants exhibit abilities that lay the foundation for language development. The progression from diffuse to specific neural activation patterns is extremely influenced by exposure to languages, social interaction, and prosodic features and, reflects the maturation of brain networks involved in language processing. In conclusion, fNIRS emerges as an indispensable functional imaging modality, providing insights into the temporal dynamics of language acquisition and associated developmental milestones. This synthesis presents the pivotal role of fNIRS in advancing our comprehension of early language development and paves the way for future research endeavors in this domain.

Características Fonoaudiológicas de Pacientes Atendidos por um Serviço de Genética Clínica / Speech-language Pathology Characteristics of Patients Assisted by a Clinical Genetics Service / Características de patología del habla y lenguaje de Pacientes Atendidos por un Servicio de Genética Clínica

Introdução: O trabalho conjunto da genética médica e da fonoaudiologia é essencial, contribuindo para o desenvolvimento de procedimentos que auxiliam no tratamento de pacientes com distúrbios da comunicação. Objetivo: Analisar as características fonoaudiológicas de pacientes pediátricos atendidos por um serviço de genética clínica. Método: Estudo transversal observacional, realizado com pacientes atendidos pelo serviço de genética de um hospital em Porto Alegre. Para a coleta de dados, aplicou-se um questionário relacionado as áreas de audição, deglutição, motricidade orofacial, voz e linguagem. Resultados: A amostra foi constituída por 54 participantes com idades entre 8 meses e 17 anos (média de idade 6 anos e 5 meses). 24,07% (n=13) dos pacientes apresentaram diagnóstico de síndrome, e 59,26% (n=32) tinham atraso no desenvolvimento neuropsicomotor. Com relação ao perfil fonoaudiológico, 81,48% (n=44) apresentaram algum hábito oral deletério durante a infância. 16,67% (n=9) percebiam alguma dificuldade para ouvir e 29,62% (n=16) para deglutir. 85,19% (n=46) dos participantes manifestaram a linguagem oral desenvolvida e, destes, 71,74% (n=33) apresentavam trocas na fala. 33,33% (n=18) já estavam em atendimento fonoaudiológico, e outros 24,07% (n=13) estavam na fila de espera para este atendimento. Conclusões: Uma parte significativa dos pacientes apresentou queixas e/ou manifestações nas áreas da comunicação humana, principalmente em relação à linguagem, à fala e aos hábitos orais deletérios. Esses dados destacam a importância do encaminhamento para a equipe de fonoaudiologia. (AU)

Introduction: The collaborative efforts of medical genetics and speech therapy are essential, contributing to the development of procedures that assist in treating patients with communication disorders. Objective: To analyze the speech therapy characteristics of pediatric patients seen by a clinical genetics service. Methods: Observational cross-sectional study conducted with patients seen at the genetics service of a hospital in Porto Alegre. A questionnaire related to hearing, swallowing, orofacial motricity, voice, and language areas was used for data collection. Results: The sample consisted of 54 participants aged between 8 months and 17 years, with an average age of 6 years and 5 months. 24.07% (n=13) of the patients had a diagnosis of syndrome, and 59.26% (n=32) had delayed neuropsychomotor development. Regarding the speech therapy profile, 81.48% (n=44) had some harmful oral habit during childhood. 16.67% (n=9) reported some difficulty in hearing, and 29.62% (n=16) in swallowing. 85.19% (n=46) of the participants showed developed oral language, and of these, 71.74% (n=33) made speech substitutions. 33.33% (n=18) of the patients were already undergoing speech therapy, and another 24.07% (n=13) were on the waiting list for this treatment. Conclusions: A significant portion of the patients presented complaints and/or manifestations in the areas of human communication, especially regarding language, speech, and harmful oral habits. These data highlight the importance of referral to the speech therapy team. (AU)

Introducción: La colaboración entre genética médica y foniatría es esencial para desarrollar procedimientos que ayuden en el tratamiento de pacientes con trastornos de la comunicación. Objetivo:Analizar las características de patología del habla y lenguaje de pacientes pediátricos atendidos por un servicio de genética clínica. Método: Estudio transversal observacional con pacientes atendidos por el servicio de genética de un hospital en Porto Alegre. Se aplicó un cuestionario sobre audición, deglución, motricidad orofacial, voz y lenguaje. Resultados: La muestra consistió en 54 participantes con edades comprendidas entre 8 meses y 17 años (media: 6 años y 5 meses). El 24,07% (n=13) de los pacientes tenían un diagnóstico de síndrome, y el 59,26% (n=32) presentaron retraso en el desarrollo neuropsicomotor. En cuanto al perfil foniatra, el 81,48% (n=44) presentaron algún hábito oral perjudicial durante la infancia. El 16,67% (n=9) reportaron dificultades para oír, y el 29,62% (n=16) para tragar. El 85,19% (n=46) manifestaron lenguaje oral desarrollado y, de ellos, el 71,74% (n=33) realizaban intercambios en el habla. El 33,33% (n=18) de los pacientes ya estaban en tratamiento foniatra y el 24,07% (n=13) estaban en lista de espera para este tratamiento. Conclusiones: Una parte significativa de los pacientes presentó quejas y/o manifestaciones en las áreas de la comunicación humana, especialmente en relación con el lenguaje, el habla y los hábitos orales perjudiciales, enfatizando la importancia de la derivación al equipo de foniatría. (AU)

Functional Language in Children from a Public Cochlear Implant Program in a Developing Country.

Introduction The World Health Organization (WHO) estimates that ∼ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study).

Language development in children from a public cochlear implant program.

OBJECTIVE: To evaluate the rate of loss to follow-up in a cochlear implant program from the public health system in Southern Brazil as well as the characteristics of hearing loss, sociodemographic, sociocultural and the development of oral language in children with prelingual deafness. METHODS: Retrospective cohort study with children who underwent CI surgery between 2010 and 2020. Data was collected through of interviews and review of medical records. The language development assessment was performed using the MUSS, MAIS and IT-MAIS scales. For the classification of language development, we used as parameters the values (mean ±â€¯SD) found in a previous national study. From those values, the Z-score for each patient at each hearing age (time of experience with the cochlear implant) was calculated. RESULTS: Of the 225 children implanted between 2010-2020, 129 were included in this study. The rate of loss to follow-up in the program was 42.6%. The mean age at first surgery was 40.5 (±16.9) months, with 77.5% of patients having received a unilateral implant. Language results below the expected for hearing age (

Psychometric Validation of a Hearing Screening Questionnaire for Preschoolers Based on Language Development Evaluation by Caregivers.

INTRODUCTION: This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents' perception of their children's hearing and oral language. METHODS: Psychometric validation was conducted on three questionnaires, each comprising nine items with yes/no responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended daycare centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12-18 months, 19-35 months, and 36-48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TEOAE), and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out. RESULTS: Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%. CONCLUSION: Language-development-oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy. The validated questionnaire affords an easy-to-apply, low-cost, and effective instrument for preschool hearing screening.

Utilização de dispositivos digitais, funcionamento familiar e desenvolvimento da linguagem em crianças de idade pré-escolar: um estudo transversal / Use of digital devices, family functioning, and language development in preschool children: a cross-sectional study

RESUMO Objetivo Este estudo teve como objetivo analisar a relação entre a utilização de dispositivos digitais, o funcionamento familiar e o desenvolvimento da linguagem em crianças de idade pré-escolar. Método Estudo transversal, descritivo-correlacional com uma amostra de 93 díades pais-crianças. As crianças tinham uma média etária de 57,01 ± 9,95 meses, sendo a maioria do gênero feminino. Os instrumentos de recolha de dados incluíram um questionário sobre o uso de dispositivos digitais, a versão portuguesa da Escala de Avaliação da Flexibilidade e Coesão Familiar - Versão IV (FACES-IV) e o Teste de Linguagem - Avaliação de Linguagem Pré-Escolar (TL-ALPE). Resultados As respostas demonstram uma maior tendência para a utilização do smartphone, tablet e televisão entre 0 e 3 horas por dia nas crianças. Com a aplicação da FACES-IV e do TL-ALPE, verificou-se que a maioria das famílias participantes eram do tipo equilibrado e que a maioria das crianças apresenta um normal desenvolvimento da linguagem. Observaram-se relações estatisticamente significativas entre a FACES-IV e o TL-ALPE; a FACES-IV e a utilização de dispositivos digitais; a utilização de dispositivos digitais e o TL-ALPE. Verificou-se que crianças com um funcionamento familiar mais equilibrado pontuam mais alto nas provas do TL-ALPE e que o tempo de uso de dispositivos digitais pode comprometer o desenvolvimento da linguagem. Conclusão Destaca-se o impacto da utilização dos dispositivos digitais e o papel do funcionamento familiar no desenvolvimento da linguagem da criança, sugerindo que uma utilização moderada de dispositivos digitais e um funcionamento familiar equilibrado são fatores facilitadores de um bom desenvolvimento da linguagem.

ABSTRACT Purpose This study aimed to analyse the relationship between the use of digital devices, family function, and language development in preschool children. Methods This cross-sectional, descriptive-correlational study included a sample of 93 parent-child dyads. The children were of an average age of 57.01 ± 9.95 months, and the majority were female. The data collection instruments included a questionnaire on the use of digital devices, the Portuguese version of the Family Flexibility and Cohesion Evaluation Scale - Version IV (FACES-IV), and a Preschool Language Test (TL-ALPE). Results The findings showed a greater tendency of children to use smartphones, tablets, and television for 0-3 hours daily. The analysis of the responses on the FACES-IV and TL-ALPE instruments showed that most of the participating families were of the balanced type and that most children had normal language development. Statistically significant relationships were found between the FACES-IV subscales and TL-ALPE subtests, FACES-IV subscales and the use of digital devices, and the use of digital devices and TL-ALPE subtests. Notably, children in more balanced family functioning scored higher on TL-ALPE tests, and the time spent using digital devices may compromise language development. Conclusion This study highlights the impact of digital device use and the role of family functioning on children's language development, suggesting that moderate digital device use and balanced family functioning are facilitating factors for good language development.

Repertório lexical de crianças de 24 e 30 meses falantes do português brasileiro: resultados preliminares / Lexical repertoire of 24 and 30-month-old children speaking Brazilian portuguese: preliminary results

RESUMO Objetivo Verificar o repertório lexical de crianças falantes do português brasileiro aos 24 e 30 meses e a associação entre a quantidade de palavras faladas e as variáveis: nível socioeconômico, escolaridade dos pais, presença de irmãos no convívio familiar, frequentar ou não escola e uso exacerbado de tablets e celulares pelas crianças. Método 30 pais de crianças com 24 meses, residentes no estado de São Paulo participaram do estudo. Por meio de plataformas de videoconferência eles foram submetidos à anamnese fonoaudiológica, entrevista com o serviço social e preencheram o "Inventário MacArthur de Desenvolvimento Comunicativo - Primeiras Palavras e Gestos", quando seus filhos tinham 24 e 30 meses. Foi aplicada estatística indutiva inferencial, quantitativa e qualitativa. Resultados A mediana das palavras emitidas foi de 283 aos 24 meses e 401 aos 30 meses, indicando aumento em torno de 118 palavras após seis meses. A criança estar frequentando ambiente escolar apresentou relação significativa com o aumento do vocabulário. Conclusão O estudo reforça o crescimento do vocabulário conforme o avanço da idade e corrobora o fato de as crianças com 24 meses já possuírem um repertório maior que 50 palavras. Aqueles que frequentam escola diariamente produzem pelo menos 70 palavras a mais dos que não frequentam.

ABSTRACT Purpose To check the lexical repertoire of Brazilian Portuguese-speaking children at 24 and 30 months of age and the association between the number of words spoken and the following variables: socioeconomic status, parents' education, presence of siblings in the family, whether or not they attend school, and excessive use of tablets and cell phones. Methods 30 parents of children aged 24 months living in the state of São Paulo participated in the study. Using videoconferencing platforms, they underwent a speech-language pathology anamnesis, an interview with social services, and then they completed the "MacArthur Communicative Development Inventory - First Words and Gestures" as soon as their children were 24 and 30 months old. Quantitative and qualitative inferential inductive statistics were applied. Results the median number of words produced was 283 at 24 months and 401 at 30 months, indicating an increase of around 118 words after six months. The child attending a school environment had a significant relationship with increased vocabulary. Conclusion The study reinforces the fact that vocabulary grows with age and corroborates the fact that children aged 24 months already have a repertoire greater than 50 words. Those who attend school every day produce at least 70 more words than those who do not.

Um curso de capacitação sobre comunicação na primeira infância impacta no conhecimento de profissionais da educação infantil? / Does a training course on early childhood communication have an impact on the knowledge of early childhood education professionals?

Resumo Objetivo Analisar se um curso de capacitação sobre o desenvolvimento da comunicação na primeira infância tem impacto positivo no conhecimento de profissionais da educação infantil e verificar a percepção dos participantes sobre o curso. Método Estudo longitudinal conduzido em ambiente virtual entre setembro de 2021 e dezembro de 2022. No total, participaram 91 profissionais da educação infantil que concluíram um curso de capacitação. O curso consistiu em três módulos sobre desenvolvimento da comunicação na primeira infância, ofertados por meio da plataforma Google Classroom, com uma carga horária total de 50 horas distribuídas ao longo de quatro meses. Os participantes responderam um questionário composto por 20 itens relacionados aos temas abordados antes de iniciar o curso, imediatamente após a conclusão e seis meses após o término. Para cada questão respondida corretamente foi atribuído 1 ponto. A análise dos dados foi conduzida por meio de uma abordagem descritiva e inferencial, sendo a comparação do total de acertos nos três momentos realizada por meio da ANOVA de Friedman, com nível de significância de 5%. Resultados Tanto a análise dos acertos de cada item do questionário, quanto a pontuação geral revelou aumento gradual entre os três momentos. A percepção dos participantes sobre o curso teve alto índice de satisfação. Conclusão Os participantes demonstraram aumento no número de acertos no questionário nos momentos pré e pós curso de capacitação, o que sugere maior conhecimento sobre o desenvolvimento da comunicação na primeira infância tanto imediatamente após sua conclusão, quanto após seis meses.

Abstract Purpose To analyze whether a training course on communication development in early childhood has a positive impact on the knowledge of early childhood education professionals and to verify the participants' perception of the course. Methods A longitudinal study conducted in a virtual environment between September 2021 and December 2022. A total of 91 early childhood education professionals took part and completed a training course. The course consisted of three modules on communication development in early childhood, offered through the Google Classroom platform, with a total workload of 50 hours spread over four months. Participants answered a questionnaire made up of 20 items related to the topics covered before starting the course, immediately after completing it and six months after finishing. For each question answered correctly, 1 point was awarded. The data was analyzed using a descriptive and inferential approach, and the total number of correct answers at the three moments was compared using Friedman's ANOVA, with a significance level of 5%. Results Both the analysis of the correct answers to each item in the questionnaire and the overall score showed a gradual increase between the three moments. The participants' perception of the course was highly satisfied. Conclusion The participants showed an increase in the number of correct answers to the questionnaire before and after the training course, which suggests greater knowledge about the development of communication in early childhood both immediately after the course and after six months.

A systematic review of assessment instruments for linguistic precursors during child development, ages 6 to 18 months.

Linguistic precursors (gaze, joint attention, gestures, social interaction, etc.) have a predictive value over the course of child development. The aim of the present review is to analyze the content structure, and the theoretical perspective, of assessment instruments that focus on linguistic precursors for the 6-18-month age group. The search was achieved through the following citation databases: BVS, MEDLINE/PubMed, Web of Science, SciELO, Redalyc, Web of Science, Google Scholar, as well as the American Speech-Language-Hearing Association (ASHA). Elegible articles were obtained using the following terms: "neuropsychological tests," "nonverbal communication," "child language" and "infant" as well as their equivalents in Spanish and Portuguese. Twenty-six assessment instruments were found to be compatible with the eligibility criteria. From the results, 19 instruments explore various domains of linguistic precursors, while 7 are task-specific proposals. Five instruments are aimed at early detection of signs of Autistic Spectrum Disorder. The implementation of Bruner's model of communicative functions was found on 15% of the instruments. This article provides timely information for clinicians who work with children during early stages of development, in relation to the methodical monitoring, assessment and accompaniment of infants and toddlers during the prelinguistic stage.

A relação entre a oralidade e escrita e sua implicação na clínica fonoaudiológica sob diferentes perspectivas teóricas: revisão integrativa / The relationship between orality and writing and its implication in the speech therapy from different theoretical perspectives: integrative review / La relación entre oralidad y escritura y su implicación en la clínica logopédica desde diferentes perspectivas teóricas: revisión integradora

Introdução: Este trabalho diferencia três abordagens teóricas que, comumente, sustentam a prática fonoaudiológica na área da linguagem. O foco é a relação entre oralidade e escrita e sua implicação nos procedimentos clínicos nos distúrbios ou dificuldades de leitura e escrita. Objetivo: apresentar e analisar a relação entre a oralidade e a escrita e discutir como a clínica fonoaudiológica conduz o tratamento ou o acompanhamento de crianças com distúrbios na linguagem escrita em diferentes perspectivas teóricas. Método: Trata-se de uma revisão integrativa da literatura. Foram selecionados dezesseis artigos que respondem às questões de pesquisa nas seguintes abordagens: Cognitivo-Linguística, Enunciativo-Discursiva e Clínica de Linguagem (Linguístico-Discursiva). Resultados: Nota-se diferentes interpretações clínicas para a prevenção, os critérios diagnósticos, nomenclatura e método de tratamento. Conclusão: As diferentes posições teóricas definem modelos de clínicas distintos, considerando como a oralidade pode afetar a escrita. (AU)

Introduction: This work differentiates three theoretical approaches about language that are used by Brazilian speech therapists. The focus is the relationship between orality and writing and its implication in clinical procedures in disorders or difficulties in reading and writing. Objective: to produce and analyze the relationship between orality and writing and to discuss how the speech therapy clinic conducts the treatment or follow-up of children with written language disorders in different theoretical perspectives. Method: This is an integrative literature review. Sixteen articles were selected that answer the research questions in the following approaches: Cognitive-Linguistic, Enunciative-Discursive and Language Clinic (Linguistic-Discursive). Results: There are different clinical interpretations for prevention, nomenclature, diagnosis, and treatment method. Conclusion: The different theoretical positions define different clinical models, considering how orality can affect writing. (AU)

Introducción: Este trabajo diferencia tres enfoques teóricos que comúnmente sustentan la práctica de la patología del habla y el lenguaje en el área del lenguaje. El enfoque es la relación entre la oralidad y la escritura y su implicación en los procedimientos clínicos en los trastornos o dificultades en la lectura y la escritura. Objetivo: presentar y analizar la relación entre la oralidad y la escritura y discutir cómo la clínica de logopedia realiza el tratamiento o seguimiento de niños con trastornos del lenguaje escrito en diferentes perspectivas teóricas. Método: Esta es una revisión integradora de la literatura. Se seleccionaron dieciséis artículos que responden a las preguntas de investigación en los siguientes enfoques: Cognitivo-Lingüístico, Enunciativo-Discursivo y Clínica del Lenguaje (Lingüístico-Discursivo). Resultados:Existen diferentes interpretaciones clínicas para la prevención, criterios diagnósticos, nomenclatura y método de tratamiento. Conclusión: Las diferentes posiciones teóricas definen diferentes modelos clínicos, considerando cómo la oralidad puede afectar la escritura. (AU)

Comportamento Auditivo e Validação no Diagnóstico Audiológico e Intervenção em Bebês e Crianças com Deficiência Auditiva / Auditory Behavior and Validation in Audiological Diagnosis and Intervention in Infants and Children with Hearing Impairment / Comportamiento auditivo y validación en el diagnóstico e intervención audiológicos en bebés y niños con deficiencia auditiva

Introdução: A atuação profissional com bebês e crianças pequenas com deficiência auditiva exige conhecimento e técnica específica no que diz respeito à prescrição e adaptação do aparelho de amplificação sonora individual (AASI) e ao processo de desenvolvimento de linguagem. Limitações e imprecisões ao longo do processo diagnóstico poderão comprometer todos os procedimentos subsequentes do processo de intervenção. Objetivo: Analisar a validação do processo de diagnóstico audiológico e intervenção em bebês e crianças com deficiência auditiva a partir da análise comparativa de exames audiológicos, comportamento auditivo e aplicação do princípio de verificação cruzada após adaptação de AASI. Método: Foram sujeitos da pesquisa 12 crianças de até 36 meses de idade, com diagnóstico de perda auditiva neurossensorial bilateral, selecionados a partir da disponibilidade de acesso ao serviço para a avaliação e agrupados em G1 (sujeitos com Índice de Inteligibilidade de Fala - SII 65 dB até 35%) e G2 (sujeitos com Índice de Inteligibilidade de Fala - SII 65 dB acima de 54%). Resultados: A média de idade do diagnóstico audiológico foi de 4,33 meses. Os resultados audiológicos de todas as crianças tiveram correspondência entre si, com exceção de dois sujeitos do G2. Conclusão: O comportamento auditivo não só permitiu a validação dos processos de diagnóstico e intervenção auditiva dos sujeitos da pesquisa, como também permitiu a identificação de comportamentos não compatíveis com a audibilidade devido ao uso inconsistente dos AASI. A aplicação dos instrumentos de acompanhamento de desenvolvimento mostrou-se adequada para o monitoramento do desenvolvimento de habilidades de audição e linguagem em crianças pequenas. (AU)

Introduction: Professional work with infants and young children with hearing impairment requires specific knowledge and technique regarding the prescription and adaptation of the individual sound amplification device (PSAD) and the language development process. Limitations and inaccuracies throughout the diagnostic process may compromise all subsequent procedures of the intervention process. Purpose: To analyze the validation of the process of audiological diagnosis and intervention in infants and children with hearing impairment based on the comparative analysis of audiological tests, auditory behavior and application of the cross-checking principle after adaptation of hearing aids. Method: The research subjects were 12 children aged up to 36 months, with a diagnosis of bilateral sensorineural hearing loss, selected from the availability of access to the service for the evaluation and grouped into G1 (subjects with Speech Intelligibility Index - SII 65 dB up to 35%) and G2 (subjects with Speech Intelligibility Index - SII 65 dB above 54%). Results: The average age of the audiological diagnosis was 4.33 months. The audiological results of all children corresponded to each other, except for two subjects from G2. Conclusion: The auditory behavior not only allowed the validation of the processes of diagnosis and auditory intervention of the research subjects, but also allowed the identification of behaviors that are not compatible with audibility due to the inconsistent use of hearing aids. The application of developmental monitoring instruments proved to be adequate for monitoring the development of hearing and language skills in young children. (AU)

Introducción: El trabajo profesional con lactantes y niños pequeños con discapacidad auditiva requiere conocimientos y técnica específicos respecto a la prescripción y adaptación del dispositivo individual de amplificación del sonido (PSAD) y el proceso de desarrollo del lenguaje. Las limitaciones e imprecisiones a lo largo del proceso de diagnóstico pueden comprometer todos los procedimientos posteriores del proceso de intervención. Propósito: Analizar la validación del proceso de diagnóstico e intervención audiológica en lactantes y niños con discapacidad auditiva a partir del análisis comparativo de pruebas audiológicas, conducta auditiva y aplicación del principio de cruce tras adaptación de audífonos. Método: Los sujetos de investigación fueron 12 niños de hasta 36 meses, con diagnóstico de hipoacusia neurosensorial bilateral, seleccionados de la disponibilidad de acceso al servicio para la evaluación y agrupados en G1 (sujetos con Índice de inteligibilidade del Habla - SII 65 dB hasta 35%) y G2 (sujetos com Índice de inteligibilidade del Habla - SII 65 dB por encima del 54%). Resultados:La edad promedio del diagnóstico audiológico fue de 4,33 meses. Los resultados audiológicos de todos los niños se correspondieron entre sí, a excepción de dos sujetos del G2. Conclusión: La conducta auditiva no sólo permitió validar los procesos de diagnóstico e intervención auditiva de los sujetos de investigación, sino que también permitió identificar conductas no compatibles con la audibilidad debido al uso inconsistente de audífonos. La aplicación de instrumentos de seguimiento del desarrollo demostró ser adecuada para controlar el desarrollo de las habilidades auditivas y lingüísticas en niños pequeños. (AU)

Language skills development in children with congenital Zika virus syndrome.

BACKGROUND: The characterization of the phenotype of children with congenital Zika virus syndrome (CZS) is an ongoing process, since many characteristics can only be described with the advancing age of children providing some insights into the long-term sequelae. AIMS: To describe emerging findings on the impact of CZS on language development in children with CZS in a 4-year longitudinal study. METHODS AND PROCEDURES: 39 boys and 44 girls with CZS were allocated into four groups according to age ranging from 12 to 36 months. Language development was assessed using the Early Language Milestone Scale. OUTCOMES AND RESULTS: Visual, expressive, and receptive auditory skills of patients were lower than expected for their age. Despite producing vowel sounds, they did not babble; despite present hearing, the majority of the children did not understand simple commands. In over 4 years of follow-up, there was no evolution in language parameters, with the children stagnating at the language skills corresponding to 3 months of age. CONCLUSIONS AND IMPLICATIONS: Most children with CZS are not able to produce vocalic sounds, but some may be able to communicate basic needs through alternative communication. WHAT THIS PAPER ADDS?: Some babies with CZS died prenatally, at birth, or in the first year of life due to associated complications such as respiratory infection, dysphagia, and epilepsy. However, the functionality of the future remains uncertain for surviving babies. This study adds information about the impact of Zika Virus on the central nervous system and, consequently, the severity and complexity of the CZS language. Over 4 years of follow-up, no evolution in language parameters was observed in children with CSZ. Children with CZS demonstrate severe neurodevelopmental impairment, stagnating in language skills at the age of 3 months. In the future, some of them may be able to communicate their basic needs through alternative communication.

[Impact of electronic devices used at an early age on language]. / Impacto del uso de dispositivos electrónicos a edad temprana en el lenguaje.

Background: The acquisition of language in infants is largely the result of the process of brain maturation, as well as environmental stimulation. Currently, society is in an era of technology and use of electronic devices from an early age. Objective: The aim of this study was to demonstrate if the amount of time of use of electronic devices in children under 5 years of age affects language development. Methods: An observational, comparative, survey-type study was carried out in 269 infants of both sexes, with an age range of 6 to <60 months. The language development section of the Child Development Scale (EDI) was used. A logistic regression was performed to determine the strength of association between the factors to be studied. Results: 269 participants were included, of which 224 (83.2%) presented their level of neurological maturation, 44 infants (16.4%) presented laged development and one (0.4%) was classified as having developmental delay. It was found that the number of daily hours that an electronic device is used behaved as a risk factor by increasing the risk of delayed language development by 1.37 times for each hour of exposure (OR: 1.37, CI95%: 1.15-1.62). Conclusions: It was shown that a greater number of hours of use of electronic devices is a risk factor for delayed language development in children under 5 years of age. Therefore, it is vital to limit its use in this population.

Introducción: la adquisición del lenguaje en los infantes es, en gran medida, resultado del proceso de maduración cerebral, así como de la estimulación ambiental. En la actualidad, la sociedad se encuentra en una era de tecnología y uso de dispositivos electrónicos desde temprana edad. Objetivo: evaluar el efecto del tiempo de uso de dispositivos electrónicos en los menores de 5 años en el área del lenguaje. Métodos: se realizó un estudio observacional, comparativo, tipo encuesta, en infantes con rango de edad de 6 a < 60 meses de ambos sexos. Se utilizó la sección para medir desarrollo del lenguaje de la Escala de Desarrollo Infantil (EDI). Adicionalmente, se llevó a cabo una regresión logística con el objetivo de determinar la fuerza de asociación entre los factores a estudiar. Resultados: se incluyeron 269 participantes, de los cuales 224 de ellos (83.2%) correspondían a su nivel de maduración neurológica, 44 infantes (16.4%) presentaron rezago en su desarrollo y uno (0.4%) se clasificó con retraso en el desarrollo. Encontramos que el número de horas diarias utilizando algún dispositivo electrónico se comportó como factor de riesgo, aumentando 1.37 veces el riesgo de retraso en el desarrollo del lenguaje por cada hora de exposición (OR: 1.37, IC95%: 1.15-1.62). Conclusiones: un mayor número de horas de uso de los dispositivos electrónicos es factor de riesgo para presentar retraso en el desarrollo del lenguaje en menores de 5 años.

Comunicação social no transtorno do espectro autista: adolescentes no contexto teatral / Social communication in autistic spectrum disorder: teenagers in a theater context / Comunicación social en el trastorno del espectro autista: los adolescentes en el contexto teatral

Introdução: O transtorno do espectro autista (TEA) é caracterizado por prejuízos persistentes na comunicação e interação social e por padrões restritos de interesses e de atividades. As manifestações do quadro são presentes em níveis variáveis entre indivíduos e podem ser evidenciadas à medida que as demandas sociais excedem o limite de suas habilidades. A hipótese é de que a exposição à atividade teatral geraria impactos na comunicação social. Objetivo: Comparar o desempenho em aspectos sociais e de linguagem antes e após realização de atividade teatral em um grupo de adolescentes com TEA. Método: Participaram do estudo12 indivíduos com diagnóstico multidisciplinar de TEA com média de 16,1 anos de idade, todos com comunicação predominantemente verbal, inseridos em atividade pedagógicas e/ou ocupacionais com frequência de participação na atividade teatral de pelo menos 75%. Foram avaliados pré e pós-atividade teatral os aspectos de compreensão verbal, realização de inferência e memória a partir do reconto de uma história e as respostas diante de um texto curto em formato de piada. Esses dados foram relacionados a variáveis de nível de inteligência e de habilidades adaptativas. Resultados: Houve relação entre desempenho em habilidades de linguagem e aspectos cognitivos e de habilidades adaptativas e essas relações mantiveram-se positivas pré e pós-atividade proposta. Conclusão: A hipótese inicial foi parcialmente confirmada e os resultados sugerem tendência de melhora da comunicação social nesse contexto. (AU)

Introduction: Autism spectrum disorder (ASD) is characterized by persistent impairments in communication and social interaction and by restricted patterns of interests and activities. The condition ́smanifestations are present at different levels between individuals and can be evidenced as social demands exceed the limits of their abilities. The hypothesis is that exposure to theatrical activity would generate social communication impacts. Objective: To compare performance in social and language aspects before and after performing a theatrical activity in a group of adolescents with ASD. Method: Twelve individuals with a multidisciplinary diagnosis of ASD with an average age of 16.1 years participated in the study, all with predominantly verbal communication, engaged in educational and/or occupational activities and with at least 75% of frequency in theatrical activities. The aspects of verbal comprehension, inference and memory from the retelling of a story and the answers to a short text in a joke format were evaluated before and after the theatrical activity. These data were related to variables of level of intelligence and adaptive abilities. Results: There was a relationship between performance in language skills and cognitive aspects and adaptive skills and those relationships remained positive before and after the proposed activity. Conclusion: The initial hypothesis was partially confirmed and the results suggest a trend towards improvement in social communication in this context. (AU)

Introducción: El trastorno del espectro autista (TEA) se caracteriza por deficiencias persistentes en la comunicación y la interacción social y por patrones restringidos de intereses y actividades. Las manifestaciones de la condición están presentes en distintos niveles entre individuos y pueden evidenciarse a medida que las demandas sociales superan los límites de sus capacidades. La hipótesis es que la exposición a la actividad teatral generaría impactos en la comunicación social. Objetivo:Comparar el desempeño en aspectos sociales y lingüísticos antes y después de realizar una actividad teatral en un grupo de adolescentes con TEA. Método: Participaron del estudio doce personas con diagnóstico multidisciplinario de TEAcon una edad promedio de 16,1 años, todas con comunicación predominantemente verbal, dedicadas a actividades educativas y / u ocupacionales con una frecuencia de participación en la actividad teatral de al menos 75%. Se evaluaron los aspectos de comprensión verbal, inferencia y memoria a partir del recuento de una historia y las respuestas a un texto breve en formato de broma antes y después de la actividad teatral. Estos datos se relacionaron con variables de nivel de inteligencia y habilidades adaptativas. Resultados: Hubo una relación entre el desempeño en las habilidades del lenguaje y los aspectos cognitivos y las habilidades adaptativas y estas relaciones se mantuvieron positivas antes y después de la actividad propuesta. Conclusión: La hipótesis inicial fue parcialmente confirmada y los resultados sugieren una tendencia hacia la mejora de la comunicación social en este contexto. (AU)

Impactos do isolamento social no desenvolvimento de pré-escolares / Impacts of social isolation on the development of preschoolers

Uma das principais estratégias utilizadas para conter a progressão da pandemia da COVID-19 foi o isolamento social. As escolas precisaram se adequar a um novo formato de funcionamento, buscando ofertar ensino remoto por meio de atividades e ferramentas novas. Professores e familiares precisaram se adaptar a essas novas condições, mesmo sem uma preparação prévia e com muitas dificuldades. Destaca-se que a Educação Infantil foi particularmente afetada pelas mudanças, por ser um período em que as vivências lúdicas e interações sociais são muito importantes. O objetivo desta pesquisa foi investigar a percepção de pais e professores sobre o impacto do isolamento social no desenvolvimento de pré-escolares. Foram realizadas entrevistas com 5 pais e 5 professores, de forma remota; as informações foram transcritas, categorizadas e interpretadas, seguindo a técnica da análise de conteúdo na modalidade temática. Do discurso das entrevistadas foi possível extrair as seguintes categorias: 1. Dificuldades de adaptação ao ensino remoto; 2. Atrasos no desenvolvimento da linguagem e aprendizagem das crianças; 3. Importância da relação entre a família e a escola. Conclui-se que pais e professores enfrentaram grandes dificuldades e perceberam atrasos importantes em habilidades como atenção, concentração, reconhecimento de letras e números, em função das medidas de isolamento social. Destaca-se que, de acordo com os relatos, a parceria entre a família e a escola foi imprescindível neste momento.

One of the main strategies used to contain the progression of the COVID-19 pandemic was social isolation. Schools had to adapt to a new operating format, seeking to offer remote teaching through new activities and tools. Teachers and family members had to adapt to these new conditions, even without prior preparation and with many difficulties. It is noteworthy that Early Childhood Education was particularly affected by the changes, as it is a period in which playful experiences and social interactions are very important. The objective of this research was to investigate the perception of parents and teachers about the impact of social isolation on the development of preschoolers. Interviews were carried out with 5 parents and 5 teachers, remotely, the information was transcribed, categorized and interpreted, following the technique of content analysis in the thematic modality. From the interviewees' discourse, it was possible to extract the following categories: 1. Difficulties in adapting to remote teaching; 2. Delays in children's language development and learning; 3. Importance of the relationship between family and school. It is concluded that parents and teachers faced great difficulties and noticed important delays in skills such as attention, concentration, recognition of letters and numbers, due to social isolation measures. It is noteworthy that, according to the reports, the partnership between the family and the school was essential at this time.

Clinical management and diagnosis of CLN2 disease: consensus of the Brazilian experts group / Manejo clínico e diagnóstico da doença CLN2: consenso do grupo de especialistas brasileiros

Abstract Neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare neurodegenerative genetic disease that affects children in early life. Its classic form is rapidly progressive, leading to death within the first 10 years. The urge for earlier diagnosis increases with the availability of enzyme replacement therapy. A panel of nine Brazilian child neurologists combined their expertise in CLN2 with evidence from the medical literature to establish a consensus to manage this disease in Brazil. They voted 92 questions including diagnosis, clinical manifestations, and treatment of the disease, considering the access to healthcare in this country. Clinicians should suspect CLN2 disease in any child, from 2 to 4 years old, with language delay and epilepsy. Even though the classic form is the most prevalent, atypical cases with different phenotypes can be found. Electroencephalogram, magnetic resonance imaging, molecular and biochemical testing are the main tools to investigateand confirm the diagnosis. However, we have limited access to molecular testing in Brazil, and rely on the support from the pharmaceutical industry. The management of CLN2 should involve a multidisciplinary team and focus on the quality of life of patients and on family support. Enzyme replacement therapy with Cerliponase α is an innovative treatment approved in Brazil since 2018; it delays functional decline and provides quality of life. Given the difficulties for the diagnosis and treatment of rare diseases in our public health system, the early diagnosis of CLN2 needs improvement as enzyme replacement therapy is available and modifies the prognosis of patients.

Resumo Lipofuscinose ceróide neuronal (CLN2) é uma doença genética neurodegenerativa rara que afeta crianças nos primeiros anos de vida. A sua forma clássica é rapidamente progressiva, levando à morte nos primeiros 10 anos. A necessidade de um diagnóstico precoce aumenta com a disponibilidade do tratamento de terapia enzimática. Um painel de nove neurologistas infantis brasileiros combinou sua experiência em CLN2 com evidências da literatura médica para estabelecer um consenso no manejo desta doença no Brasil. Eles votaram 92 questões abordando diagnóstico, manifestações clínicas e tratamento, considerando o acesso à saúde no Brasil. Deve-se suspeitar de CLN2 em qualquer criança de 2 a 4 anos de idade que apresente atraso de linguagem e epilepsia. Apesar da forma clássica ser a mais prevalente, podem ser encontrados casos atípicos com diferentes fenótipos. Eletroencefalograma, ressonância magnética, testes moleculares e bioquímicos são as principais ferramentas para investigar e confirmar o diagnóstico. No entanto, o acesso aos testes moleculares é limitado no Brasil, necessitando contar com o apoio da indústria farmacêutica. O manejo da CLN2 deve envolver uma equipe multidisciplinar e focar na qualidade de vida dos pacientes e no apoio familiar. A terapia de reposição enzimática com Cerliponase alfa é um tratamento inovador aprovado no Brasil desde 2018; ele retarda o declínio funcional e proporciona qualidade de vida. Diante das dificuldades para o diagnóstico e tratamento de doenças raras em nosso sistema público de saúde, o diagnóstico precoce de CLN2 precisa de melhorias pois a terapia de reposição enzimática está disponível e modifica o prognóstico dos pacientes.

School and language performance in children born with low birth weight.

OBJECTIVES: To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. METHODS: The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). RESULTS: The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p = 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. CONCLUSIONS: Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

Babies With Pierre Robin Sequence: Neuropsychomotor Development.

BACKGROUND: The Pierre Robin Sequence presents heterogeneous symptoms, and each newborn can manifest from mild breathing and feeding difficulties to severe complications, as well as a predisposition to present changes in growth and neuropsychomotor development in the first years of life. OBJECTIVE: The aims were to evaluate and associate the neuropsychomotor development of zero- to 12-month-old children with Pierre Robin sequence (PRS) in the personal-social, fine motor-adaptive, language, and gross motor aspects. METHODS: The subjects of the study were 17 infants of both sexes with PRS admitted to the special care unit (SCU) of a reference hospital in the interior of the state of São Paulo, Brazil, in the age range of 20 days to 263 days. Developmental assessments were performed using the Denver Development Screening Test II. The evaluations were carried out in the SCU, with duration of 30 minutes each. Statistical analysis was descriptive using the Mann-Whitney test, two-proportion equality test, and Spearman correlation. The level of significance was set at 0.05. RESULTS: According to Denver Development Screening Test II, median 78.5 of the babies were at risk for developmental delay identified by the Denver II Test (n = 14, 82.4%). For the developmental areas analyzed by the test there was statistically significant difference in language area. CONCLUSION: The babies aged up to 12 months with PRS in this study presented risks for delay in neuropsychomotor development in language, gross motor, fine motor-adaptive, and personal-social aspects, and this finding should be considered to set goals in family orientation and intervention.

Thematic Analysis of Coping Strategies Used by Parents of Children with Cleft Lip and Palate in El Salvador.

OBJECTIVE: The aim of this study was to describe coping strategies used by parents of children with cleft palate with or without a cleft (CP ± L) during the early development of their children in El Salvador. DESIGN: Qualitative interviews were completed with 16 parents of children born with CP ± L who were 6 months to 6 years old. Parents were questioned about their emotions and coping during eight time periods: prenatal, birth, social interaction before the first surgery, the beginning of surgeries, social interaction after the first surgery, early childhood education (ECE), speech-language therapy, and formal education. Thematic analysis (TA) was used to identify coping strategies as conceptualized by Lazarus and Folkman (1984). RESULTS: Four major themes emerged: (a) experienced emotions related to diagnosis, (b) interpretations related to the birth of a child with a cleft, (c) seeking and experiencing cleft treatment, and (d) social interaction of the children. During prenatal and birth stages, parents used emotion-focused strategies. A few hours to a week after birth, they used problem-focused strategies, which led them in search of treatment. Some parents used avoidance strategies during periods of social interaction before surgery, ECE, and formal education. Socioeconomic challenges impacted access to speech-language therapy. Sociocultural factors, such as discrimination, religion, and folk beliefs, appeared to influence some of the coping strategies used by parents. CONCLUSIONS: Problem-focused strategies appear to be helpful in seeking surgical treatments. The emotion-focused strategy of avoidance seemed to have adverse effects in minimizing opportunities for social interaction prior to surgery and early education.

Análise da relação entre eixos estruturantes na constituição do psiquismo e emergência de um lugar de enunciação de bebês com e sem atraso na aquisição da linguagem / Analysis of the relationship between structural pillars in the constitution of the psychism and the emergence of a place of enunciation in babies with and without delays in language acquisition

RESUMO Objetivo Analisar a correlação entre os eixos estruturantes do psiquismo no roteiro IRDI (Indicadores de Referência ao Desenvolvimento Infantil) e na aquisição da linguagem por meio dos Sinais Enunciativos de Aquisição da Linguagem (SEAL) quanto ao papel do bebê e da mãe nas protoconversações iniciais. Método A amostra contou com 77 bebês, que concluíram todas as avaliações no IRDI e no SEAL. Os resultados obtidos por meio desses dois instrumentos foram analisados por meio do coeficiente de Spearman e do teste de U de Mann-Whitney, considerando valor de p<= 0,05. Resultados Identificou-se correlação significativa entre as alterações nos indicadores relacionados à função materna (suposição de sujeito, estabelecimento da demanda e alternância presença/ausência) e as alterações nos sinais enunciativos dos bebês e das mães. Não houve correlação significativa na relação isolada do eixo função paterna e a presença de atraso na aquisição da linguagem. Conclusão Houve correlação significativa entre os eixos de função materna do roteiro IRDI e risco à linguagem pelo SEAL.

ABSTRACT Purpose To analyze the correlation between the psychism structuring pillar in the RIID (Reference Indicators of Infant Development) script and language acquisition through Enunciative Signs of Language Acquisition (ESLA) as to the role of the baby and the mother in early protoconversations. Methods The sample included 77 infants, who completed all the RIID and ESLA assessments. The results obtained from these two instruments were analyzed using Spearman's coefficient and the Mann-Whitney U test, considering a p-value < 0.05. Results A significant correlation was identified between changes in the indicators related to the maternal function (assumption of subject, establishment of demand and presence/absence alternation) and changes in the enunciative signals of babies and mothers. There was no significant correlation in the isolated relation of the paternal function pillar and the presence of delayed language acquisition. Conclusion There was a significant correlation between the pillars of maternal function of the RIID script and language risk by ESLA.