Pediatric human immunodeficiency virus and acquired immunodeficiency syndrome: an overview.

This article covers the epidemiological manifestations of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) in children, demographic statistics, and information on the three modes of virus transmission. The various opportunistic diseases and neurological dysfunction that characterize pediatric HIV are described. The Center for Disease Control pediatric HIV classification system is presented, and the developmental disorders often found in children with HIV are discussed. The Universal Disease Precautions of the American Speech and Hearing Association (ASHA) for clinicians is also presented.

Language development and assessment in children with human immunodeficiency virus: 3 to 6 years.

Young children infected or exposed, or both to the human immunodeficiency virus (HIV) present with a variety of speech, language, and communication problems. The purpose of this article is to provide an overview of the impact that HIV has on young children from 3 to 6 years of age. Issues concerning medically related problems are discussed, along with assessment criteria and descriptions of communication disorders among HIV-infected and -exposed children.

Epidemiologic principles in studies of infectious disease outcomes: pediatric HIV as a model.

Epidemiologic principles have been employed in the investigation of AIDS since the early 1980s. Although such principles have demonstrated the difficulties in reporting the everchanging rates of incidence and prevalence, in addition to distributions of children with HIV, they have also established specific pieces of a multifaceted puzzle. Professionals interested in examining only a piece of the puzzle, such as a particular communication disorder, often are unable to see how it fits into the complete puzzle. This article presents several epidemiologic findings of pediatric HIV, including population distributions, a summary of modes of transmission, occurrence of opportunistic infections, and manifestations of the disease in child populations. It also discusses HIV-related speech, language, swallowing, and voice disorders, examining the complexities of quantification of risk for each piece within the pediatric HIV puzzle. The purpose is to broaden the perspective of professionals concerned with how these disorders fit within the overall puzzle of immunocompromised populations of children.

The Fluharty Preschool Speech and Language Screening Test: a population-based validation study using sample-independent decision rules.

Two cohorts of 4- and 5-year-old children (N = 700) were screened with the Fluharty Preschool Speech and Language Screening Test. Two stratified samples (n = 51 cohort 1; n = 147 cohort 2), based on speech/language screening results, were administered criterion tests for articulation (AAPS-R or Templin-Darley) and language (TOLD or TALC-R). Clinical validation indices for combined speech or language outcome in the two cohorts were as follows: sensitivity, .43 and .31 respectively; specificity, .82 and .93; predictive value, .43 and .54; overreferral, 14% and 5%; underreferral, 14% in both cohorts, and percent agreement, 72% and 80%. The measure of sensitivities for language outcomes was lower than the above, whereas sensitivities for articulation was higher. These results suggest that the Fluharty is too insensitive to be relied on for screening programs aimed at identifying preschool children with language disorders, although it appears to have promise for the identification of children with articulation impairments.

Relation of cognitive operational performance to comprehension and production of dimensional adjectives.

This study compared normal developing children, aged 34 to 51 mo., on comprehension and production of relative dimensional adjectives using object manipulations in a close elicitation procedure and on Piagetian operational tests of conservation of continuous quantity, length, reversibility and seriation. Analysis indicated a significant difference on the expressive language performance of the transitional and the concrete operational children over the preoperational children, but no significant differences occurred between the first two groups. Children who performed better on seriation were significantly better on expressive language performance. Children classified as operational for length performed better on all language measures than those classified as nonoperational. Reversibility and conservation of a continuous quantity did not differentiate children.

Language training with autistic children using four different modes of presentation.

The purpose of this study was to determine (1) whether comprehension, production, and spontaneous use of language are greater following language training by sign-alone, speech-alone, simultaneous communication, or alternating between speech and sign; (2) whether high- and low-verbal imitators benefit from the same mode of treatment; and (3) whether retention of the language skills differs among the four training conditions. Subjects were 60 moderate to severe autistic children randomly assigned to one of four treatment conditions. Subjects were divided into high- and low-verbal imitators based on verbal imitation performances. The results indicated that the high-verbal imitators did equally well in all four treatment conditions, while the low-verbal imitators did poorest in the speech-alone condition. The high-verbal imitators performed better than did the low-verbal imitators in all of the treatment conditions. Words or signs learned were retained for three months after treatment regardless of the treatment condition or level of imitative ability. The results were discussed in terms of the efficacy of using sign language with autistic children.

Speech following sign language training in autistic children with minimal verbal language.

This study was carried out to test the main and interaction effects of training condition and pretreatment-elicited verbal imitation ability when predicting spoken language use during language training of 60 minimally verbal autistic children. Subjects were randomly assigned to Speech Alone, Sign Alone, Simultaneous Presentation of Sign and Speech, and Alternating Presentation of Sign and Speech training conditions. Speech Alone, Simultaneous Presentation, and Alternating Presentation condition facilitated more child-initiated speech during treatment than did the Sign Alone condition. Regardless of training condition, pretreatment verbal imitation ability positively predicted the size of child-initiated spoken vocabulary observed during training. Exploratory analyses indicated that, in addition to verbal imitation, pretreatment age and IQ may also predict spoken language developed during training.

Description of semantic--syntactic relations in an autistic child.

This longitudinal study investigated the language acquisition strategies employed by an autistic child learning sign language. The child's core vocabulary and developing semantic-syntactic relationships were compared with language acquisition in normal children. There were specific deviations in language development noted, in spite of providing the child with appropriate sign language training.

Use of mean morphological units to assess language development.

The intent of this study was to determine what size language sample was needed in order to obtain a reliable index of mean morphological units. Shriner (1967) suggested that 50 sentences were necessary for obtaining a mean length of response and a length complexity index. Brown (1973) recommended using 100 sentences when determining mean morphological units. However, other investigators (Schneiderman, 1955; Griffith and Miner, 1969) said that as few as 15 sentences could serve to provide enough data for reliable estimates of mean length of response and a length complexity index. For a practitioner, knowing that the first 15 sentences produced would be a reliable estimate of overall language ability would be of substantial benefit. Obtaining, transcribing, and analyzing 15 sentences takes about 20 min. The results of this study show that as few as 15 sentences are adequate for determining a reliable index of mean morphological units.