ABSTRACT
BACKGROUND: Although the standard procedure to treat adult patients with lesions in eloquent brain areas is awake craniotomy with direct electrical stimulation, this procedure is not often used in children because of feasibility concerns. Some studies have shown that the procedure is feasible in children. They reported the postoperative language ability, which was not based on standardized language tests for children. To give an objective overview of preoperative assessment of the language ability of a child before and after this procedure, the authors described the perioperative course, including standardized language tests for children and the awake surgery setting, of a 12-year-old child undergoing awake craniotomy with brain mapping for the indication of cavernoma in the left somatosensory cortex close to the motor cortex. OBSERVATIONS: The patient performed better on language tests after surgery, showing that his language ability improved. He also cooperated well during the entire perioperative period. His mother was present during the awake surgery, and the patient tolerated the surgery well. LESSONS: The authors conclude that awake craniotomy is indeed feasible in a child and that it can even result in an improved postoperative language outcome. It is, however, crucial to carefully assess, inform, and monitor the child and their proxies.
ABSTRACT
BACKGROUND: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. AIMS: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. METHODS & PROCEDURES: A database of 11,450 children was analysed consisting of data on children, aged 2-7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono- and bilingualism, nature of the language delay, and language profile of the children. OUTCOMES & RESULTS: Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. CONCLUSIONS & IMPLICATIONS: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children. What this paper adds What is already known on the subject Identifying language disorders before children enter school can foster the initiation of early interventions before these problems interfere with formal education and behavioural adjustment. Information on caseload characteristics is important to plan speech and language therapy service provision. There are only a few studies on the caseload characteristics of children at first referral for language assessment. What this paper adds to existing knowledge This study provides a detailed description of the caseload characteristics of children referred to Dutch speech and hearing centres. The results reveal an age bias in referral: boys were referred earlier than girls, and monolingual children were revealed earlier than bilingual children. On top of that, bilingual children seemed to have more complex problems at referral. What are the potential or actual clinical implications of this work? This study indicates that it is important to be aware of bias in the age of referral of subgroups of children with language disorders. Solutions might be to implement a language screening instrument designed for use by non-speech-language therapists, and training in early recognition of girls and multilingual children with (less complex) language disorders for health professionals in key positions in child healthcare. In addition, it might be worthwhile to assign speech and language therapists with diverse ethnic and language backgrounds and/or with experience with bilingual/cultural children in a regional mentoring function to support referral agents and parents.
