Validating the Use of Percent Grammatical Utterances for Assessing Mandarin-Speaking Children's Grammatical Skill: Evidence From 3-Year-Olds.

PURPOSE: The study examined the use of percent grammatical utterances (PGUs) for assessing grammatical skills in Mandarin-speaking 3-year-old children. METHOD: Participants were 30 Mandarin-speaking 3-year-olds with typical development. Language samples were collected in two visits for each child using a picture description task. Children were asked to talk about 16 pictures in response to questions and prompts at each visit. Pictures for the language sample collection were identical across the visits. PGUs were computed, and the grammatical errors that children produced in the task were coded and tallied for error types at each visit. Test-retest reliability, split-half reliability, and concurrent criterion validity of PGUs were evaluated. RESULTS: The mean PGU level was approximately 78% at Visit 1 and 81% at Visit 2, both of which were significantly below the mastery level (i.e., 90%). The correlation coefficient for test-retest reliability of PGU was large (r = .70, p < .01); the correlation coefficient for split-half reliability was medium at Visit 1 (r = .47, p < .01) and large (r = .65, p < .01) at Visit 2. In addition, the correlation coefficient for concurrent criterion validity of PGU was medium for both visits (rs ≥ .35, ps ≤ .03). The ranking and proportion of each error type were similar between the visits. CONCLUSION: The initial evidence from psychometric properties suggests that PGU computed from the picture description task is a reliable and valid measure for evaluating grammatical skills in Mandarin-speaking 3-year-old children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25395499.

Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial.

Background: Racial inequities in maternal health outcomes, the result of systemic racism and social determinants of health, require maternity care systems to implement interventions that reduce disparities. One such approach may be support from a community doula, a health worker who provides emotional support, peer education, navigation, and advocacy for pregnant, birthing, and postpartum people who share similar racial identities, cultural backgrounds, and/or lived experiences. While community support during birth has a long tradition within communities of Black Indigenous and People of Color (BIPOC), the reframing of community doula support as a social intervention that reduces disparities in clinical outcomes is recent. Methods: We conducted a pragmatic randomized trial at an urban safety net hospital, comparing standard maternity care with standard care plus enhanced community doula support. We tested the effectiveness of a community doula program embedded in a safety net hospital in improving birth outcomes and explored the association between community doula support and health equity. Participants were nulliparous, insured by publicly funded health plans, and had lower risk pregnancies. The primary outcome was cesarean birth. Secondary outcomes included preterm birth and breastfeeding outcomes. Exploratory subgroup analysis was conducted by race-ethnicity. Results: Three hundred sixty-seven participants were included in the primary analysis. In the intent-to-treat analysis, outcomes were similar between groups. There was a trend toward increased breastfeeding initiation (p=0.08). There was a statistically nonsignificant 12% absolute reduction in cesarean birth and 11.5% increase in exclusive breastfeeding during delivery hospitalization among Black non-Hispanic participants. Discussion: While outcomes for the study sample were similar between randomization groups, health outcomes were improved for Black birthing people in cesarean and breastfeeding rates. Conclusion: This study demonstrates the need for larger studies of community doula support for Black birthing people. Clinicaltrials.gov ID: NCT02550730.

Characteristics of Early Expressive Vocabulary in Mandarin-Speaking Children With Cochlear Implants.

PURPOSE: The aim of this study is to evaluate whether Mandarin-speaking children with cochlear implants (CIs) demonstrated early lexical composition similar to their hearing peers who were at the same vocabulary level and the extent to which children with CIs were sensitive to linguistic and conceptual properties when developing early lexicon. METHOD: Participants were 77 Mandarin-speaking children with CIs who received CIs before 30 months of age. Their expressive vocabulary was documented using the Infant Checklist of the Early Vocabulary Inventory for Mandarin Chinese 9 or 12 months after CI activation. Percent social words, common nouns, predicates (verbs, adjectives), and closed-class words in total vocabulary were computed for children at different vocabulary levels. Common nouns and verbs were further coded for their word class (noun, verb), word frequency, word length, and imageability to predict how likely a given noun or verb would be produced by children with CIs. RESULTS: Like children with typical hearing, social words were the most dominant category when vocabulary size in children with CIs was smaller than 20 words; common nouns became the most dominant category when the vocabulary size reached 21 words. The difference in percent common nouns and percent predicates (i.e., noun bias) was similar in children with CIs and their hearing peers. In addition, verbs, common words, monosyllabic words, and more imageable words were more likely to be produced by children with CIs than their counterparts. CONCLUSIONS: Mandarin children with CIs showed language-specific patterns in early lexical composition like their hearing peers. They were able to use multiple linguistic and conceptual cues when approaching early expressive vocabulary despite perceptual and processing constraints. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21357723.

Dorsal bed nucleus of stria terminalis in depressed and nondepressed temporal lobe epilepsy patients.

OBJECTIVE: Temporal lobe epilepsy (TLE) and depression are common comorbid disorders whose underlying shared neural network has yet to be determined. Although animal studies demonstrate a role for the dorsal bed nucleus of the stria terminalis (dBNST) in both seizures and depression, and human clinical studies demonstrate a therapeutic effect of stimulating this region on treatment-resistant depression, the role of the dBNST in depressed and nondepressed TLE patients is still unclear. Here, we tested the hypothesis that this structure is morphologically abnormal in these epilepsy patients, with an increased abnormality in TLE patients with comorbid depression. METHODS: In this case-controlled study, 3-T structural magnetic resonance imaging scans were obtained from TLE patients with no depression (TLEonly), TLE patients with depression (TLEdep), and healthy control (HC) subjects. TLE subjects were recruited from the Yale University Comprehensive Epilepsy Center, diagnosed with the International League Against Epilepsy 2014 Diagnostic Guidelines, and confirmed by video-electroencephalography. Diagnosis of major depressive disorder was confirmed by a trained neuropsychologist through a Mini International Neuropsychiatric Interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The dBNST was delineated manually by reliable raters using Bioimage Suite software. RESULTS: The number of patients and subjects included 35 TLEonly patients, 20 TLEdep patients, and 102 HC subjects. Both TLEonly and TLEdep patients had higher dBNST volumes compared to HC subjects, unilaterally in the left hemisphere in the TLEonly patients (p = .003) and bilaterally in the TLEdep patients (p < .0001). Furthermore, the TLEdep patients had a higher dBNST volume than the TLEonly patients in the right hemisphere (p = .02). SIGNIFICANCE: Here, we demonstrate an abnormality of the dBNST in TLE patients, both without depression (left enlargement) and with depression (bilateral enlargement). Our results demonstrate this region to underlie TLE both with and without depression, implicating it as a target in treating the comorbidity between these two disorders.

Vocabulary Growth in Mandarin-Speaking Children With Bilateral Cochlear Implants, Bimodal Stimulation, or Unilateral Cochlear Implants During the First Year After Activation.

PURPOSE: The purpose of this study was to evaluate vocabulary development in Mandarin-speaking children with bilateral cochlear implants (CIs), bimodal stimulation (CI plus hearing aids [HAs]), or unilateral CIs during the first year after CI activation. METHOD: Participants included 23 children with simultaneous bilateral CIs, 23 children with bimodal stimulation, and 15 children with unilateral CIs. They all received CIs before 30 months of age. Parents were asked to endorse words that their child could understand only or understand and say using the Early Vocabulary Inventory for Mandarin Chinese at the day of CI activation and 1, 3, 6, 9, and 12 months after CI activation. Receptive and expressive vocabulary sizes were computed. RESULTS: Growth curve analysis revealed that children with simultaneous bilateral CIs demonstrated faster growth of receptive vocabulary than those with bimodal stimulation, followed by those with unilateral CIs. Moreover, children with simultaneous bilateral CIs reached the 100-word mark for receptive vocabulary earlier than children with bimodal stimulation, followed by those with unilateral CIs. There were no significant differences among the three groups in expressive vocabulary. CONCLUSIONS: Bilateral CIs have an advantage over bimodal stimulation in early receptive vocabulary development in Mandarin, a tone language. HA usage is still recommended for those who receive one CI.

Rethinking "aggression" and impulsivity in bipolar disorder: Risk, clinical and brain circuitry features.

BACKGROUND: Elevated aggression and impulsivity are implicated in Bipolar Disorder (BD); however, relationships between these behavioral constructs have not been clarified, which can lead to misconceptions with negative consequences including stigma and adverse outcomes including suicide. The study aimed to clarify brain-based distinctions between the two constructs and their associations to risk factors, symptoms and suicide thoughts and behaviors. METHODS: Self-rated Brown-Goodwin Aggression (BGA) and Barratt Impulsiveness Scale (BIS) scores were compared between adults with BD (n = 38, 74% female) and healthy controls (HC, n = 29, 64% female). Relationships were examined between BGA and BIS with childhood trauma questionnaire (CTQ), mood, comorbidities, and magnetic resonance imaging gray matter volume (GMV) assessments. RESULTS: In BD, BGA and BIS total scores were both elevated and associated with childhood maltreatment (CM), particularly emotional CM, depression, substance use disorders (SUDs) and suicide attempts (SAs). BGA scores were increased by items corresponding to dysregulation of emotional and social behavior and associated with elevated mood states and suicide ideation and GMV decreases in bilateral orbitofrontal cortex and left posterior insula brain regions, previously associated with these behaviors and clinical features. BIS motor impulsiveness scores were associated with GMV decreases in anterior cingulate cortex implicated in mood and behavioral dyscontrol. LIMITATIONS: modest sample size, self-reports CONCLUSIONS: The findings suggest separable brain-based domains of dysfunction in BD of motor impulsiveness versus emotionally dysregulated feelings that are primarily self-directed. Both domains are associated with suicide behavior and modifiable risk factors of CM, depression and SUDs that could be targeted for prevention.

Taking the strain: An examination of upper back musculoskeletal tissue sensitivity in relation to upper back pain and breast size. A cross-sectional study.

BACKGROUND: The physiological basis for upper back pain experienced by women with large breasts is unclear but could relate to sensitivity of musculoskeletal tissues strained from the postural adaptations to large breasts. The aim of this cross-sectional study was to examine if upper back pain and breast size were associated with greater localised sensitivity of upper back musculoskeletal tissues. METHODS: 119 healthy postmenopausal women (mean age 61 years) had their upper back pain (numerical rating scale), breast size (breast size score), and upper back tissue sensitivity (pressure pain thresholds (digital algometry, kPa)) assessed. The pressure pain thresholds of six skeletal sites (T2, T4, T6, T8, T10 and T12) and six muscular sites (pectoralis major, levator scapulae, sternocleidomastoid, and upper, middle, and lower trapezius muscles) were examined. Linear mixed models with random subject effects were used to evaluate differences in sensitivity at each anatomical site between participants grouped by upper back pain (nil-mild, moderate-severe) and breast size (small, large). FINDINGS: For most sites, the differences in sensitivity between upper back pain groups were highly significant (P < 0.002) with significantly lower pressure pain thresholds (Mean difference (MD): 74.6 to 151.1 kPa) recorded for participants with moderate-severe upper back pain. There were no differences in sensitivity between breast size groups. INTERPRETATION: Increased upper back musculoskeletal sensitivity is related to perceived upper back pain but not to breast size. It remains unclear if and how structural or mechanical factors related to breast size contribute to upper back pain in women with large breasts.

Brain grey and white matter structural associations with future suicidal ideation and behaviors in adolescent and young adult females with mood disorders.

Background: To reduce suicide in females with mood disorders, it is critical to understand brain substrates underlying their vulnerability to future suicidal ideation and behaviors (SIBs) in adolescence and young adulthood. In an international collaboration, grey and white matter structure was investigated in adolescent and young adult females with future suicidal behaviors (fSB) and ideation (fSI), and without SIBs (fnonSIB). Methods: Structural (n = 91) and diffusion-weighted (n = 88) magnetic resonance imaging scans at baseline and SIB measures at follow-up on average two years later (standard deviation, SD = 1 year) were assessed in 92 females [age(SD) = 16.1(2.6) years] with bipolar disorder (BD, 28.3%) or major depressive disorder (MDD, 71.7%). One-way analyses of covariance comparing baseline regional grey matter cortical surface area, thickness, subcortical grey volumes, or white matter tensor-based fractional anisotropy across fSB (n = 40, 43.5%), fSI (n = 33, 35.9%) and fnonSIB (n = 19, 20.6%) groups were followed by pairwise comparisons in significant regions (p < 0.05). Results: Compared to fnonSIBs, fSIs and fSBs showed significant decreases in cortical thickness of right inferior frontal gyrus pars orbitalis and middle temporal gyrus, fSIs of left inferior frontal gyrus, pars orbitalis. FSIs and fSBs showed lower fractional anisotropy in left uncinate fasciculus and corona radiata, and fSBs in right uncinate and superior fronto-occipital fasciculi. Conclusions: The study provides preliminary evidence of grey and white matter alterations in brain regions subserving emotional and behavioral regulation and perceptual processing in adolescent and young adult females with mood disorders with, versus without, future SIBs. Findings suggest potential targets to prevent SIBs in female adolescents and young adults.

Altered frontal cortex functioning in emotion regulation and hopelessness in bipolar disorder.

OBJECTIVES: Emotion regulation difficulties precipitate and exacerbate acute mood symptoms in individuals with bipolar disorder (BD), and contribute to suicidal behavior. However, few studies have examined regional brain responses in explicit emotion regulation during acute BD mood states, or hopelessness, a major suicide risk factor. We assessed brain responses during explicit emotion regulation, and their relationship with hopelessness, in acutely symptomatic and euthymic individuals with BD. METHODS: Functional MRI data were obtained from individuals with BD who were either in acute negative (BD-A; n = 24) or euthymic (BD-E; n = 24) mood states, and from healthy volunteers (HV; n = 55), while participants performed a paradigm that instructed them to downregulate their responses to fearful (EmReg-Fear) and happy (EmReg-Happy) facial stimuli. Emotion regulation-related differences in brain responses during negative and euthymic BD states, as well as their associations with negative affective symptoms (hopelessness and depression), were examined. RESULTS: Decreased responses were observed in ventral and dorsal frontal regions, including medial orbitofrontal (mOFC) and dorsal anterior cingulate cortices, during EmReg-Fear across symptomatic and euthymic states in participants with BD relative to HVs. The lowest responses were observed in the BD-A group. Across BD participants, negative associations were observed between mOFC responses and hopelessness, particularly due to loss of motivation. Differences were not significant during EmReg-Happy. CONCLUSIONS: Lesser emotion regulation-related ventral and dorsal frontal engagement in BD could represent a trait abnormality that worsens during acute negative states. The reduced mOFC engagement in BD during explicit regulation of negative emotions may contribute to hopelessness particularly in the context of diminished motivation.

Incorporation of Second-Tier Biomarker Testing Improves the Specificity of Newborn Screening for Mucopolysaccharidosis Type I.

Enzyme-based newborn screening for Mucopolysaccharidosis type I (MPS I) has a high false-positive rate due to the prevalence of pseudodeficiency alleles, often resulting in unnecessary and costly follow up. The glycosaminoglycans (GAGs), dermatan sulfate (DS) and heparan sulfate (HS) are both substrates for α-l-iduronidase (IDUA). These GAGs are elevated in patients with MPS I and have been shown to be promising biomarkers for both primary and second-tier testing. Since February 2016, we have measured DS and HS in 1213 specimens submitted on infants at risk for MPS I based on newborn screening. Molecular correlation was available for 157 of the tested cases. Samples from infants with MPS I confirmed by IDUA molecular analysis all had significantly elevated levels of DS and HS compared to those with confirmed pseudodeficiency and/or heterozygosity. Analysis of our testing population and correlation with molecular results identified few discrepant outcomes and uncovered no evidence of false-negative cases. We have demonstrated that blood spot GAGs analysis accurately discriminates between patients with confirmed MPS I and false-positive cases due to pseudodeficiency or heterozygosity and increases the specificity of newborn screening for MPS I.

Is Breast Size Related to Prevalent Thoracic Vertebral Fracture? A Cross-Sectional Study.

Large breasts may increase the likelihood of thoracic vertebral fractures by increasing the mechanical loading of the spine. We examined breast size as a factor associated with prevalent thoracic vertebral fractures, also considering its relationship with thoracic kyphosis and upper back extensor muscle endurance. Using a cross-sectional study, the design measurements collected were thoracic vertebral fractures (≥20% loss in vertebral body height on lateral radiograph), breast size (bra size converted to an ordinal breast size score), BMD (g/cm2 averaged femoral neck, DXA), upper back extensor muscle endurance (isometric chest raise test), body composition (DXA), thoracic kyphosis (radiograph), and upper back pain (numerical rating scale). Correlations and multivariable logistic regression examined relationships between characteristics and their association with vertebral fracture. Participants were 117 healthy postmenopausal women. The 17 (15%) women with ≥1 thoracic vertebral fracture had larger breast size (mean difference [MD]: 2.2 sizes; 95% CI, 0.6 to 3.8 sizes), less upper back extensor muscle endurance (MD: -38.6 s; 95% CI, -62.9 to -14.3 s), and greater thoracic kyphosis (MD: 7.3°; 95% CI, 1.7° to 12.8°) than those without vertebral fracture. There were no between group differences in age, height, weight, and BMD. Breast size (r = -0.233, p = 0.012) and thoracic kyphosis (r = -0.241, p = 0.009) correlated negatively with upper back extensor muscle endurance. Breast size was unrelated to thoracic kyphosis (r = 0.057, p = 0.542). A (final) multivariable model containing breast size (OR 1.85; 95% CI, 1.10 to 3.10) and thoracic kyphosis (OR 2.04; 95%CI, 1.12 to 3.70) explained 18% of the variance in vertebral fracture. Breast size had a significant, but weak relationship with vertebral fracture (R 2 = 0.10), which was independent of BMD and unrelated to thoracic kyphosis. Further work is needed to confirm larger breast size as a risk factor for vertebral fracture. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

The relationship between breast size and aspects of health and psychological wellbeing in mature-aged women.

OBJECTIVES: Increases in breast size with age are common but have not been widely examined as a factor that could affect the health and psychological wellbeing of mature-aged women. The purpose of this study was to examine the relationships between breast size and aspects of health and psychological wellbeing in mature-aged women. METHODS: This was a cross-sectional study of mature-aged women (⩾40 years). Breast size (breast size score) was determined from self-reported bra size and was examined against health-related quality of life (Medical Outcomes Study Short-Form 36 and BREAST-Q), body satisfaction (numerical rating scale), breast satisfaction (BREAST-Q), physical activity levels (Human Activity Profile), the presence of upper back pain and breast and bra fit perceptions. RESULTS: Two hundred sixty-nine women (40-85 years) with bra band sizes ranging from 8 to 26 and bra cup sizes from A to HH participated. The mean (standard deviation) breast size score of 7.7 (2.7) was equivalent to a bra size of 14DD. Increasing breast size was associated with significantly lower breast-related physical wellbeing (p < 0.001, R2 = 0.043) and lower ratings of body (p = 0.002, R2 = 0.024) and breast satisfaction (p < 0.001, R2 = 0.065). Women with larger breasts were more likely to be embarrassed by their breasts (odds ratio: 1.49, 95% confidence interval: 1.31 to 1.70); more likely to desire a change in their breasts (odds ratio: 1.55, 95% confidence interval: 1.37 to 1.75) and less likely to be satisfied with their bra fit (odds ratio: 0.84, 95% confidence interval: 0.76 to 0.92). Breast size in addition to age contributed to explaining upper back pain. For each one-size increase in breast size score, women were 13% more likely to report the presence of upper back pain. CONCLUSION: Larger breast sizes have a small but significant negative relationship with breast-related physical wellbeing, body and breast satisfaction. Larger breasts are associated with a greater likelihood of upper back pain. Clinicians considering ways to improve the health and psychological wellbeing of mature-aged women should be aware of these relationships.

Finite Verb Morphology Composite Between Age 4 and Age 9 for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties.

Purpose The purpose of this study was to provide reference data and evaluate the psychometric properties for the finite verb morphology composite (FVMC) measure in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method Participants included 377 children between age 4 and age 9, including 300 children with typical language and 77 children with language impairment (LI). Narrative samples were collected using a story generation task. FVMC scores were computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for FVMC were further evaluated. Results Children's performance on FVMC increased significantly between age 4 and age 9 in the typical language and LI groups. Moreover, the correlation coefficients for the split-half reliability and concurrent criterion validity of FVMC were medium to large (rs ≥ .429, ps < .001) at each age level. The diagnostic accuracy of FVMC was good or acceptable from age 4 to age 7, but it dropped to a poor level at age 8 and age 9. Conclusion With the empirical evidence, FVMC is appropriate for identifying children with LI between age 4 and age 7. The reference data of FVMC could also be used for monitoring treatment progress. Supplemental Material https://doi.org/10.23641/asha.10073183.

Percent Grammatical Utterances Between 4 and 9 Years of Age for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties.

Purpose The purpose of this article was to provide the reference data and evaluate psychometric properties for the percent grammatical utterances (PGU; Eisenberg & Guo, 2013) in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method Participants were 377 children who were between 4 and 9 years of age, including 300 children with typical language (TL) and 77 children with language impairment (LI). Narrative samples were collected using the ENNI protocol (i.e., a story generation task). PGU was computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for PGU were further evaluated. Results PGU increased significantly in children between 4 and 9 years of age in both the TL and LI groups. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of PGU were all large (rs ≥ .557, ps < .001). The diagnostic accuracy of PGU was also good or acceptable from ages 4 to 9 years. Conclusions With the attested psychometric properties, PGU computed from the ENNI could be used as an assessment tool for identifying children with LI between 4 and 9 years of age. The reference data of PGU could also be used for monitoring treatment progress. Supplemental Material https://doi.org/10.23641/asha.9630590.

Upper back pain in postmenopausal women and associated physical characteristics.

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31-0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28-0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

The Production of Question Intonation by Young Adult Cochlear Implant Users: Does Age at Implantation Matter?

Purpose The purpose of this observational study was to investigate the properties of sentence-final prosody in yes/no questions produced by cochlear implant (CI) users in order to determine whether and how the age at CI implantation impacts CI users' production of question intonation later in life. Method We acoustically analyzed recordings from 46 young adult CI users and 10 young adults with normal hearing who read yes/no questions. Of the 46 CI users, 20 had received their CI before the age of 4.0 years (early implantation group), 15 between ages 4.0 and 8.11 years (midimplantation group), and 11 at the age of 9.0 years or later (late implantation group). We assessed the prosodic properties of the produced questions for each implantation group and the normal hearing comparison group (a) by measuring the sentence-final rise in fundamental frequency, (b) by labeling the question-final intonation contour using the Tones and Breaks Index ( Beckman & Ayers, 1994 ; Silverman, Beckman, et al., 1992 ; Veilleux, Shattuck-Hufnagel, & Brugos, 2006 ), and (c) by assessing phrase-final lengthening. Results The fundamental frequency rises produced by all CI users exhibited a smaller magnitude than those produced by the normal hearing comparison group, although the difference between early implanted CI users and the normal hearing group did not reach statistical significance. Early implanted CI users were more comparable in their use of question-final intonation contours to the individuals with typical hearing than to those users with CI implanted later in life. All CI users exhibited significantly less phrase-final lengthening than the normal hearing comparison group, regardless of age at CI implantation. Conclusion The results of this investigation of question intonation produced by CI users suggest that those CI users who were implanted with CI earlier in life produce yes/no question intonation in a manner that is more similar to, albeit not the same as, individuals with normal hearing when compared to the productions of those users with CI implanted after 4.0 years of age.

Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders.

BACKGROUND: Findings regarding brain circuitry abnormalities in suicide attempters (SAs) converge across bipolar disorder (BD) and major depressive disorder (MDD), the most common disorders observed in suicides. These abnormalities appear to be present during adolescence/young adulthood when suicide rates increase steeply, and suicide is a leading cause of death in this age group. Identification of brain circuitry common to adolescent/young adult SAs with BD and MDD is important for generating widely effective early prevention strategies. We examined brain circuitry in SAs in adolescents/young adults across these two disorders. METHODS: Eighty-three participants (ages 14-25 years), 46 with BD (21 SAs) and 37 with MDD (19 SAs), underwent structural and diffusion-weighted magnetic resonance scanning. Whole-brain analyses compared gray matter (GM) volume and white matter (WM) fractional anisotropy (FA) between SAs and non-suicide attempters (NSAs) across and within BD and MDD (p < 0.005). RESULTS: Across and within BD and MDD, SAs showed differences compared to NSAs in ventral prefrontal cortex (PFC) GM volume and fronto-limbic (including uncinate fasciculus (UF)) WM FA. Exploratory analyses showed additional within-disorder differences for BD SAs in dorsolateral PFC (dlPFC) and hippocampus GM volume and UF FA, and for MDD SAs dorsomedial and dlPFC GM and dorsal frontal WM. However, there was no significant interaction between suicide attempt status and diagnosis. LIMITATIONS: Modest sample size. CONCLUSIONS: Common fronto-limbic gray and white matter alterations in adolescent/young adult SAs are potential targets for suicide prevention strategies across mood disorders. Preliminary findings of disorder-specific regional findings could suggest diagnostic-specific optimal targets may exist.

Preliminary examination of gray and white matter structure and longitudinal structural changes in frontal systems associated with future suicide attempts in adolescents and young adults with mood disorders.

BACKGROUND: Mood disorders are major risk factors for suicidal behavior. While cross-sectional studies implicate frontal systems, data to aid prediction of suicide-related behavior in mood disorders are limited. Longitudinal research on neuroanatomical mechanisms underlying suicide risk may assist in developing targeted interventions. Therefore, we conducted a preliminary study investigating baseline gray and white matter structure and longitudinal structural changes associated with future suicide attempts. METHODS: High-resolution structural magnetic resonance imaging, diffusion tensor imaging, and suicide-related behavioral assessment data for 46 adolescents and young adults with mood disorders [baseline agemean = 18 years; 61% female] were collected at baseline and at follow-up (intervalmean = 3 years). Differences in baseline and longitudinal changes in gray matter volume and white matter fractional anisotropy in frontal systems that distinguished the participants who made future attempts from those who did not were investigated. RESULTS: Seventeen (37%) of participants attempted suicide within the follow-up period. Future attempters (those attempting suicide between their baseline and follow-up assessment), compared to those who did not, showed lower baseline ventral and rostral prefrontal gray matter volume and dorsomedial frontal, anterior limb of the internal capsule, and dorsal cingulum fractional anisotropy, as well as greater decreases over time in ventral and dorsal frontal fractional anisotropy (p < 0.005, uncorrected). LIMITATIONS: Sample size was modest. CONCLUSIONS: Results suggest abnormalities of gray and white matter in frontal systems and differences in developmental changes of frontal white matter may increase risk of suicide-related behavior in youths with mood disorders. Findings provide potential new leads for early intervention and prevention strategies.

Communication skills of deaf and hard-of-hearing college students: Objective measures and self-assessment.

Objectively measured speech reception, speech production and expressive and receptive sign skills were compared with the self-assessment ratings of those skills in 96 college students with hearing loss. Participants with no aidable hearing used cochlear implants (CIs) or nothing. Participants with aidable hearing used either hearing aids (HAs) or nothing. Results revealed that individuals using CIs had speech reception and production skills that were as good as or better than students with more hearing who used HAs. Students using CIs or HAs had better speech reception and production skills than those without sensory aids. There was no difference in measured receptive sign skills across groups, despite differences in age of sign acquisition. Students typically provided accurate self-assessments of their communication skills with two notable exceptions: CI users overestimated their speech skills and nonusers overestimated their receptive sign skills. This study extends our knowledge regarding speech reception, production, sign skills and the ability to self-assess those skills in college students with hearing loss. Students who do not use sensory aids may be at academic risk with regard to receiving input via speech or sign.