Factors affecting swallowing outcomes after total laryngectomy: Participant self-report using the swallowing outcomes after laryngectomy questionnaire.

BACKGROUND: Little is known about what factors affect patient-reported swallowing outcome after total laryngectomy. We explored whether patient demographics, surgical variables, use of adjuvant treatment, and time since surgery were associated with patient-reported swallowing outcome. METHODS: Cross-sectional study of laryngectomees in eight UK hospitals. Demographic, treatment, and surgical variables were drawn from medical notes. The swallowing outcomes after laryngectomy (SOAL) questionnaire captured perceived swallowing outcome. RESULTS: Two hundred and twenty one participants had complete data on treatment-related variables. In regression analysis, having a free jejunum flap repair and requiring chemoradiation were the only two variables that added significantly to the model of worse self-reported swallowing outcome (R2 adjusted = .23, P < .001). CONCLUSION: The SOAL is a sensitive measure of self-reported swallowing outcome after laryngectomy. Type of surgical closure and the type of additional treatment influenced the swallowing outcome reported by patients. Changes in perceived swallowing function need to be routinely evaluated to inform clinical decision-making and intervention.

The Early Sociocognitive Battery: a clinical tool for early identification of children at risk for social communication difficulties and ASD?

BACKGROUND: A substantial proportion of preschool children referred to speech and language therapy (SLT) services have social communication difficulties and/or autistic spectrum disorders (SC&/ASD) that are not identified until late childhood. These 'late' diagnosed children miss opportunities to benefit from earlier targeted interventions. Prior evidence from a follow-up clinical sample showed that preschool performance on the Early Sociocognitive Battery (ESB) was a good predictor of children with social communication difficulties 7-8 years later. AIMS: The aims were three-fold: (1) to determine the impact of child/demographic factors on ESB performance in a community sample of young children; (2) to assess the ESB's concurrent validity and test-retest reliability; and (3) to use cut-offs for 'low' ESB performance derived from the community sample data to evaluate in a clinical sample the predictiveness of the ESB at 2-4 years for outcomes at 9-11 years, including parent-reported SC&/ASD diagnosis. METHODS & PROCEDURES: A community sample of 205 children aged 2-4 years was assessed on the ESB and a receptive vocabulary test. A subsample (n = 20) was retested on the ESB within 2 weeks. Parents completed a questionnaire providing background child/demographic information. The clinical sample from our previous study comprised 93 children assessed on the ESB at 2;6 to < 4;0 whose parents completed the Social Responsiveness Scale (SRS), our measure of social communication, when the children were 9-11 years. Cut-offs for 'low' ESB performance derived from the community sample were used to determine the predictive validity of 'low' ESB scores for social communication outcomes and parent-reported SC&/ASD diagnosis according to age of ESB assessment. OUTCOME & RESULTS: Findings from the community sample confirmed the ESB as psychometrically robust, sensitive to age and language delay, and, in contrast to the receptive vocabulary measure, unaffected by bilingualism. While overall associations between ESB performance and later social communication difficulties in the clinical sample were particularly strong for the youngest age group (2;6 to < 3;0; r = .71, p < .001), 'low' ESB performance was equally predictive across age groups and overall identified 89% of children with 'late' SC&/ASD diagnoses (sensitivity), and 75% of those without (specificity). CONCLUSIONS & IMPLICATIONS: Results indicate that the ESB is a valid preschool assessment suitable for use with children from diverse language backgrounds. It identifies deficits in key sociocognitive skills and is predictive of social communication difficulties in school-age children that had not been identified in preschool clinical assessment, supporting earlier targeted interventions for these children.

Detecting Memory Impairment in Deaf People: A New Test of Verbal Learning and Memory in British Sign Language.

OBJECTIVE: Most existing tests of memory and verbal learning in adults were created for spoken languages, and are unsuitable for assessing deaf people who rely on signed languages. In response to this need for sign language measures, the British Sign Language Verbal Learning and Memory Test (BSL-VLMT) was developed. It follows the format of the English language Hopkins Verbal Learning Test Revised, using standardized video-presentation with novel stimuli and instructions wholly in British Sign Language, and no English language requirement. METHOD: Data were collected from 223 cognitively healthy deaf signers aged 50-89 and 12 deaf patients diagnosed with dementia. Normative data percentiles were derived for clinical use, and receiver-operating characteristic curves computed to explore the clinical potential and diagnostic sensitivity and specificity. RESULTS: The test showed good discrimination between the normative and clinical samples, providing preliminary evidence of clinical utility for identifying learning and memory impairment in older deaf signers with neurodegeneration. CONCLUSIONS: This innovative video testing approach transforms the ability to accurately detect memory impairments in deaf people and avoids the problems of using interpreters, with international potential for adapting similar tests into other signed languages.

Sentence repetition: what does the task measure?

BACKGROUND: Sentence repetition is gaining increasing attention as a source of information about children's sentence-level abilities in clinical assessment, and as a clinical marker of specific language impairment. However, it is widely debated what the task is testing and therefore how informative it is. AIMS: (1) To evaluate the effects of different types of long-term linguistic knowledge on immediate recall, (2) to assess age sensitivity of repetition tasks designed to evaluate these effects, and (3) to establish if the effects are similar across typologically different languages. The study also considers the implications of the findings for the use of sentence repetition as a research and clinical assessment tool. METHODS & PROCEDURES: Participants were 50 English-speaking and 50 Czech-speaking typically developing 4-5-year-olds. Children's ability to recall sequences of items was compared in seven linguistic conditions ranging from fully well-formed sentences to sequences of non-words. In each condition, children repeated blocks of successively longer stimuli to establish their span. OUTCOMES & RESULTS: Results showed significant but differential effects of all linguistic factors in both languages. While syntactic violations and presence of non-words dramatically reduced children's span, semantic implausibility and the removal of sentence prosody played a significant but much smaller role. Familiarity of function words was more important than familiarity of content words. The effects of different linguistic factors on spans were the same for both languages and did not change between 4 and 5 years, although average spans increased over this age range. CONCLUSIONS & IMPLICATIONS: Children's ability to repeat sentences is more dependent on their familiarity with morphosyntax and lexical phonology than semantics or prosody, with function words of particular importance. Findings have implications for the use of recall in clinical assessment and as a research tool.

Early predictors of language and social communication impairments at ages 9-11 years: a follow-up study of early-referred children.

PURPOSE: In this study, the authors aimed to evaluate hypotheses that early sociocognition will predict later social communication and early phonology will predict later morphosyntax in clinically referred preschoolers. METHOD: Participants were 108 children ages 9-11 years who had been referred to clinical services with concerns about language at age 2½-3½ years. Predictors at Time 1 (T1) were measures of sociocognition, word/nonword repetition, and receptive language. Outcome measures at Time 3 (T3) included a social communication questionnaire completed by parents and tests of nonword repetition, morphosyntax, and receptive language. RESULTS: Group- and case-level analyses revealed early sociocognition to be the strongest predictor of social communication problems, which by T3 affected almost one third of the sample. At the group level, early phonology, which was a significant problem for the majority of children at T1, was a weak predictor of morphosyntax at T3. However, at the case level the majority of children with poor morphosyntax and nonword repetition at outcome had had very low repetition scores at T1. CONCLUSIONS: In early language referrals, it is important to identify and address sociocognitive problems, a considerable risk for later social communication and autism spectrum disorders. The majority of early-referred children had phonological problems, often severe, but these require further investigation to determine their longer term significance for language.

Nonverbal imitation skills in children with specific language delay.

Research in children with language problems has focussed on verbal deficits, and we have less understanding of children's deficits with nonverbal sociocognitive skills which have been proposed to be important for language acquisition. This study was designed to investigate elicited nonverbal imitation in children with specific language delay (SLD). It is argued that difficulties in nonverbal imitation, which do not involve the processing of structural aspects of language, may be indicative of sociocognitive deficits. Participants were German-speaking typically developing children (n=60) and children with SLD (n=45) aged 2-3 ½ years. A novel battery of tasks measured their ability to imitate a range of nonverbal target acts that to a greater or lesser extent involve sociocognitive skills (body movements, instrumental acts on objects, pretend acts). Significant group differences were found for all body movement and pretend act tasks, but not for the instrumental act tasks. The poorer imitative performance of the SLD sample was not explained by motor or nonverbal cognitive skills. Thus, it appeared that the nature of the task affected children's imitation performance. It is argued that the ability to establish a sense of connectedness with the demonstrator was at the core of children's imitation difficulty in the SLD sample.

Psychological distress after stroke and aphasia: the first six months.

OBJECTIVE: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia. DESIGN: Prospective longitudinal observational study. SETTING AND SUBJECTS: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke. MAIN MEASURES: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months. RESULTS: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R(2) = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (chi(2) (1) = 8.61, P<0.01). CONCLUSIONS: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one's social network are particularly important and contribute to long-term psychological distress.

Early vocabulary development in deaf native signers: a British Sign Language adaptation of the communicative development inventories.

BACKGROUND: There is a dearth of assessments of sign language development in young deaf children. This study gathered age-related scores from a sample of deaf native signing children using an adapted version of the MacArthur-Bates CDI (Fenson et al., 1994). METHOD: Parental reports on children's receptive and expressive signing were collected longitudinally on 29 deaf native British Sign Language (BSL) users, aged 8-36 months, yielding 146 datasets. RESULTS: A smooth upward growth curve was obtained for early vocabulary development and percentile scores were derived. In the main, receptive scores were in advance of expressive scores. No gender bias was observed. Correlational analysis identified factors associated with vocabulary development, including parental education and mothers' training in BSL. Individual children's profiles showed a range of development and some evidence of a growth spurt. Clinical and research issues relating to the measure are discussed. CONCLUSIONS: The study has developed a valid, reliable measure of vocabulary development in BSL. Further research is needed to investigate the relationship between vocabulary acquisition in native and non-native signers.

Early phonological and sociocognitive skills as predictors of later language and social communication outcomes.

BACKGROUND: Previous studies of outcome for children with early language delay have focused on measures of early language as predictors of language outcome. This study investigates whether very early processing skills (VEPS) known to underpin language development will be better predictors of specific language and social communication outcomes than measures of language itself. METHOD: Participants were 163 children referred to clinical services with concerns about language at 2;6-3;6 years and followed up at 4-5 years. Novel assessments of phonological and sociocognitive processing were administered at Time 1 (T1), together with a standardised test of receptive and expressive language, and parental report of expressive vocabulary. The language test was re-administered at Time 2 (T2), together with assessments of morphosyntax and parental reports of social communication. RESULTS: Intercorrelations at and between T1 and T2 were high, and dissociations were rare. Ordinal regressions were run, entering predictors singly and simultaneously. With the exception of the phonological task, every early measure on its own was significantly predictive of most outcomes, and receptive language was the strongest all-round predictor. Results of simultaneous entry, controlling for the effect of other predictors, showed that early language was the strongest predictor of general language outcome, but early phonology was the strongest predictor of a measure of morphosyntax, and early sociocognition the strongest predictor of social communication. CONCLUSIONS: Language measures which draw on a wide range of skills were the strongest overall predictors of general language outcomes. However, our VEPS measures were stronger predictors of specific outcomes. The clinical and theoretical implications of these findings are discussed.

Parental Report of Infant Language Skills: A Review of the Development and Application of the Communicative Development Inventories.

The Communicative Development Inventories (CDIs) are parent report measures of vocabulary and other aspects of language development in very young children. They have evolved over the past 20 years to be one of the most well recognised assessments of infant language. Of particular significance is the fact that the CDIs are the first measures of their kind to be widely translated and adapted for use in many different languages. The inventories have served a variety of functions including measuring early language acquisition, deriving normative data on language acquisition, and both identifying and describing children whose early language is significantly delayed. This review describes the development of the CDIs, summarises the volume of research that has been generated in a range of applications of the measures, and evaluates their current standing both as a research tool and as a clinical measure. Issues around the sensitivity and predictive value of the CDIs are also considered.

Evaluation of the clinical decisions made for 2-year-olds referred for speech and language therapy: a follow-up study.

BACKGROUND: Clinicians in the UK rely mainly on informal observations and structured and semi-structured tasks rather than standardized testing in their assessments of pre-school children referred with speech and language difficulties. The informal nature of the clinical decision-making process at this age is unsurprising given the dearth of research on early clinical referrals. Evidence of outcome for young children referred with speech and language problems typically begins in the early school years. AIMS: To examine the clinical decision-making of an experienced individual therapist by evaluating the extent to which follow-up evidence supported initial prognosis. METHODS & PROCEDURES: Forty-three randomly selected pre-school children referred to speech and language therapy services were seen at an average age of 2;8, when a range of informal assessments were carried out. They were followed up 18 months later. Outcomes were compared with initial diagnosis and prognosis. OUTCOMES & RESULTS: Initial judgements showed high associations between the type of problem, the presence of complex difficulties, severity ratings and prognosis. In line with previous findings, prognosis was significantly associated with the type of problem and severity at outcome, although overall changes were more pronounced than had been predicted. A minority of children were rated substantially worse than predicted at follow-up. CONCLUSIONS: This study illustrates the potential of this kind of approach to inform the process of decision-making and reflective clinical practice with very young children. Limitations of the study and implications for future action research are discussed.

The preschool repetition test: an evaluation of performance in typically developing and clinically referred children.

PURPOSE: To determine the psychometric properties of the Preschool Repetition (PSRep) Test (Roy & Chiat, 2004), to establish the range of performance in typically developing children and variables affecting this performance, and to compare the performance of clinically referred children. METHOD: The PSRep Test comprises 18 words and 18 phonologically matched nonwords systematically varied for length and prosodic structure. This test was administered to a typical sample of children aged 2;0-4;0 (n = 315) and a clinic sample of children aged 2;6-4;0 (n = 168), together with language assessments. RESULTS: Performance in the typical sample was independent of gender and socioeconomic status but was affected by age, item length, and prosodic structure and was moderately correlated with receptive vocabulary. Performance in the clinic sample was significantly poorer but revealed similar effects of length and prosody and similar relations to language measures overall, with some notable exceptions. Test-retest reliability and interrater reliability were high. CONCLUSION: The PSRep Test is a viable and informative test. It differentiates within and between typical and clinic samples of children and reveals some unusual profiles within the clinic sample. These findings lay the foundations for a follow-up study of the clinic sample for investigation of the predictive value of the test.

Institutional care: associations between inattention and early reading performance.

BACKGROUND: Recent government papers have expressed concern about the poor educational attainment of 'looked after' children. Early reading development has been found to be significant in their subsequent academic achievement. The possibility that biosocial factors extraneous to their experiences in public care may underpin their low attainment has not been investigated to date. METHODS: The reading ability of 19 primary school children, who had been raised in institutional care from an early age, were compared with 19 children, matched for age and sex, who were comparable in biological background and who had experienced uninterrupted family foster care. Both groups were compared with classroom controls using teacher questionnaires, interviews, systematic observations and cognitive testing. RESULTS: Reading delay was more prevalent in the institutional group and as a group they had lower reading scores than the children reared in family foster care. Variation in IQ accounted for the lower reading scores of the family foster care group compared with their matched classroom controls. Inattention, found in a previous study to be much more evident in the institutional group, partially accounted for the group difference in reading scores, and was situationally specific to formal teacher-directed tasks. Differential effects of caregivers' interest in terms of help with homework were also found. CONCLUSIONS: Early reading performance was associated with the experience of being raised 'in care' but was not an inevitable outcome. It was concluded that the type of substitute caregiving experienced affected reading performance. Institutional upbringing affected reading performance both directly and indirectly through the heightened levels of inattention associated with institutional care.

Institutional care: associations between overactivity and lack of selectivity in social relationships.

BACKGROUND: The behaviour of children raised in institutional care in their early years is typified by heightened levels of inattention and overactivity irrespective of the quality of the care. There is some evidence that this behaviour may be specifically associated with forms of attachment disorder behaviours, but to date studies have been restricted to institutions characterised by high levels of malnutrition and lack of active experiences. METHODS: Nineteen primary school age children admitted to good quality residential group care before the age of 1 year were compared with 19 children of the same gender reared in a foster family from the same age. A combination of observational, questionnaire, interview and psychometric measures was employed. RESULTS: A fifth of the institutional children but none of the foster-family children showed a marked lack of selective attachment relationships with their caregivers. The same proportions were found for a lack of selectivity in friendships with their peers but the children showing these features were not identical. A lack of selectivity in relationships was strongly associated with inattention/overactivity, both as observed and reported. The pattern of a marked lack of selectivity and inattention/overactivity was evident only in the boys in the institution-reared group. CONCLUSIONS: It is concluded that the pattern represents a relatively specific response to some feature of an institutional rearing; nevertheless, it occurred in only just over a third of the institutional children, so that it is a far from universal consequence.

A prosodically controlled word and nonword repetition task for 2- to 4-year-olds: evidence from typically developing children.

An association has been found between nonword repetition and language skills in school-age children with both typical and atypical language development (C. Dollaghan and T. F. Campbell, 1998; S. Ellis Weismer et al., 2000; S. E. Gathercole and A. D. Baddeley, 1990; J. W. Montgomery, 2002). This raises the possibility that younger children's repetition performance may be predictive of later language deficits. In order to investigate this possibility, it is important to establish that elicited repetition with very young children is both feasible and informative. To this end, a repetition task was designed and carried out with 66 children between 2 and 4 years of age. The task consisted of 18 words and 18 matched nonwords that were systematically manipulated for length and prosodic structure. In addition, an assessment of receptive vocabulary was administered. The repetition task elicited high levels of response. Total scores as well as word and nonword scores were sensitive to age. Lexical status and item length affected performance regardless of age: Words were repeated more accurately than nonwords, and 1-syllable items were repeated more accurately than 2-syllable items, which were in turn repeated more accurately than 3-syllable items. The effect of prosodic structure was also significant. Whole syllable errors were almost exclusive to unstressed syllables, with those preceding stress being most vulnerable. Performance on the repetition task was significantly correlated with performance on the receptive vocabulary test. This repetition task effectively elicited responses from most of the 2- to 4-year-old participants, tapped developmental change in their repetition skills, and revealed patterns in their performance; and thus it has the potential to identify deficits in very early repetition skills that may be indicative of wider language difficulties.

Left cradling and left ear advantage for emotional speech: listen to the other side too.

In a recent issue of this journal, Turnbull and Bryson (2001) examined a possible relation between left ear (right hemisphere) advantage for perception of emotional speech and the universal preference of mothers to cradle infants on the left side, referring to a hypothesis that we had previously suggested (Sieratzki & Woll, 1996). Although they concluded that their data do not support our theory, reanalysis does suggest a connection between the hemispheric asymmetry for speech prosody and the leftward cradling bias.