Speech production accuracy in children with Down syndrome: relationships with hearing, language, and reading ability and change in speech production accuracy over time.

BACKGROUND: This study examines speech production accuracy in children with Down syndrome and concurrent relationships with hearing, language and reading ability. It also examines change in speech production accuracy over a 21-month period. METHODS: A group of 50 children with Down syndrome (aged 5-10 years) completed measures of speech accuracy, non-verbal IQ, reading (single-word reading, letter-sound knowledge and phoneme blending) and language (expressive and receptive vocabulary and receptive grammar). Hearing was assessed by parental report. Speech accuracy was reassessed 21 months later. RESULTS: Although there was considerable variability in the sample, speech was characterised by high levels of errors. There were no effects of gender, hearing status or non-verbal IQ on speech production accuracy. In contrast, speech production accuracy was significantly related to age and to measures of receptive vocabulary, phoneme blending and word reading. There was no significant improvement in speech production accuracy over time. CONCLUSIONS: Children with Down syndrome experience difficulties producing accurate sounds in speech. These difficulties are related to age and to vocabulary and reading skills and persist over time, highlighting the need for intensive targeted speech intervention in this group of children.

The development of comprehension and reading-related skills in children learning English as an additional language and their monolingual, English-speaking peers.

BACKGROUND: A significant number of pupils in UK schools learn English as an additional language (EAL). Relative differences between the educational attainment of this group and monolingual, English-speaking pupils call for an exploration of the literacy needs of EAL learners. AIMS: This study explores the developmental progression of reading and listening comprehension skills and a range of reading-related skills in EAL learners, whose first language is of South Asian origin, and their monolingual peers. SAMPLE: Participants were 39 children learning EAL and 39 monolingual, English-speaking children who were all in school Year 3 at the start of the study. METHOD: Children completed standardized measures of comprehension, vocabulary, reading accuracy, and reading fluency in school Year 3 and again in Year 4. RESULTS: The results suggest that, although children learning EAL often demonstrate fast and accurate reading accuracy skills, lower levels of vocabulary knowledge place significant constraints on EAL learners' comprehension of spoken and written texts. CONCLUSIONS: Reciprocal relationships between vocabulary and comprehension may lead to increasing gaps in reading comprehension between monolingual and EAL pupils over time. It is proposed that support for the development of vocabulary skills in children learning EAL is needed in early years' classrooms.

The comprehension skills of children learning English as an additional language.

BACKGROUND: Data from national test results suggests that children who are learning English as an additional language (EAL) experience relatively lower levels of educational attainment in comparison to their monolingual, English-speaking peers. AIMS: The relative underachievement of children who are learning EAL demands that the literacy needs of this group are identified. To this end, this study aimed to explore the reading- and comprehension-related skills of a group of EAL learners. SAMPLE: Data are reported from 92 Year 3 pupils, of whom 46 children are learning EAL. METHOD: Children completed standardized measures of reading accuracy and comprehension, listening comprehension, and receptive and expressive vocabulary. RESULTS: Results indicate that many EAL learners experience difficulties in understanding written and spoken text. These comprehension difficulties are not related to decoding problems but are related to significantly lower levels of vocabulary knowledge experienced by this group. CONCLUSIONS: Many EAL learners experience significantly lower levels of English vocabulary knowledge which has a significant impact on their ability to understand written and spoken text. Greater emphasis on language development is therefore needed in the school curriculum to attempt to address the limited language skills of children learning EAL.

How do the atypical antipsychotics work?

Understanding the action of atypical antipsychotics is useful in exploring the pathophysiology of schizophrenia and in synthesizing drugs that improve various domains of psychopathology without unwanted side effects. In animal models, atypical antipsychotic drugs appear to have a preferential action in the limbic dopaminergic system. Regionally specific action has been studied by measuring the amount of Fos protein produced in a particular brain region as a consequence of a drug's effects on the c-fos gene. Evidence suggests that the atypical and typical antipsychotic drug-induced increases in Fos levels in the nucleus accumbens are related to improvements in positive symptoms, whereas Fos increases in the prefrontal cortex, with the atypical antipsychotics only, correlate with negative symptom improvement. The extrapyramidal effects seen with typical antipsychotics are thought to be related to Fos increases in the striatonigral pathway. However, studies of Fos levels in specific brain regions reveal only the site of action, not the mode of action. The finding that atypicality is related to surmountable D2 dopamine receptor blocking provides another venue to define and explore atypical antipsychotic drug action.

Olanzapine treatment after clozapine-induced granulocytopenia in 3 patients.

BACKGROUND: How to best treat psychotic patients who have had past clozapine-induced agranulocytosis or granulocytopenia remains a problem. CASE REPORTS: We report 3 patients with chronic schizophrenia who had previously stopped clozapine due to hematologic side effects. The patients evidenced improvement with olanzapine that equated to 16- to 31-point decreases in rating scale scores during 1-year follow-up without any hematologic abnormalities. CONCLUSION: The results suggest that olanzapine may be useful in treating patients with clozapine-induced granulocytopenia without the risk of recurrence of hematologic side effects.

Tardive dyskinesia and ethnicity: review of the literature.

Tardive dyskinesia (TD) is a side effect of long-term neuroleptic administration. The wide variation of 2 to 51% in its reported prevalence can be attributed to the varied definitions of TD, the use of different methods of assessment, and the lack of control of independent variables. Why only certain patients develop this side effect is an intriguing question. The occurrence of TD in family members and in those persons with a family history of Parkinson's disease (PD) is suggestive of genetic vulnerability. Further support for a genetic predisposition comes from the fact that only certain strains of monkeys, such as the Cebus apella strain, have a higher propensity to develop TD than others, such as the Macaca sepciosa strain. If genetic factors play a significant role in the development of TD, then, genetically diverse ethnic groups may have a different propensity for the development of TD. One method of evaluating such a possibility is to compare its prevalence in different countries. The current literature on ethnic differences in the prevalence rates of TD is reviewed. This area of study needs further rigorous investigation.

Abuse of monoamine oxidase inhibitors.

Abuse of monoamine oxidase inhibitors is not common but there are a few cases of addiction in the literature. Most of these patients had an additional diagnosis, either history of past drug abuse or personality disorder and MAOI withdrawal symptoms have been reported. We encountered three patients who received MAOI under psychiatric care. They were all self medicated by increasing the doses on their own, experienced euphoria and visited various physicians to obtain MAOI prescriptions and manifested toxic states. One of our patients had a normal, another a schizoid and the third, an addictive personality. Two were addicted in the past to amphetamine. Therefore, it is important not to prescribe MAOI's to patients who have a history of amphetamine and other addictions.

Hepatic disease and psychiatric illness: relationships and treatment.

A relationship between hepatic diseases and psychiatric symptoms has long been speculated. While liver detoxication makes the exogenous substances harmless for the body, there are occasions where the liver may convert a harmless substance into a more toxic substance. With such an important role, the liver protects all the organs of the body. When liver is malfunctioning, toxic metabolites injurious to the brain may be produced. As the brain receives a high blood supply, a large amount of metabolites reach this organ. Hence, the metabolic function of the liver keeps a delicate reciprocal relationship between the two organs. In addition, a number of psychiatric medications affect liver functions. Another perplexing clinical problem is the difficulty in treating psychiatric symptoms in patients with liver disease. For example, benzodiazepines which do not affect the liver function in physically healthy psychiatric patients, may induce hepatic coma in patients with liver disease. Benzodiazepine antagonists produce dramatic and temporary improvement in patients with hepatic coma. Clinically, many psychoactive drugs produce hepatic complications. The very same drugs which produce hepatic side effects are required for the treatment of psychiatric symptoms in patients with hepatic disorders. To appropriately handle these situations, a thorough knowledge of the side effects of these drugs is necessary.

Low-birthweight children at early school-age: a longitudinal study.

Eighty-seven per cent of a cohort of 299 low-birthweight (LBW) infants (less than or equal to 2000 g) were examined at age 6 years 8 months, together with 111 control children. All the controls and 248 of the LBW children were individually assessed in school. Information about another 13 LBW children was obtained by questionnaire. Problems in primary school were related to social grade, evidence of early intra-uterine insult, sex, postnatal complications and neurological and developmental status in the first year of life. Multiple birth, gestation and intra-uterine growth were not clearly related to problems in school. The incidence of major handicap, as compared with LBW infants born between 1953 and 1955, showed little change when earlier-born infants who had been subjected to severe restriction of fluid and calorie intake were excluded. Ninety-two per cent of LBW children traced were attending normal schools. Those who showed no evidence of early intra-uterine insult and who were neurologically normal in the first year of life were largely indistinguishable from control children reared in similar homes.