Brain and Language Associations in Autism Spectrum Disorder: A Scoping Review.

Examining brain and behaviour associations for language in autism spectrum disorder (ASD) may bring us closer to identifying neural profiles that are unique to a subgroup of individuals with ASD identified as language impaired (e.g. ASD LI+). We conducted a scoping review to examine brain regions that are associated with language performance in ASD. Further, we examined methodological differences across studies in how language ability was characterized and what neuroimaging methods were used to explore brain regions. Seventeen studies met inclusion criteria. Brain regions specific to ASD LI+ groups were found, however inconsistencies in brain and language associations were evident across study findings. Participant age, age-appropriate language scores, and neuroimaging methods likely contributed to differences in associations found.

Non-linguistic cognitive measures as predictors of functionally defined developmental language disorder in monolingual and bilingual children.

BACKGROUND & AIMS: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non-linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. METHODS & PROCEDURES: We examined non-linguistic cognitive abilities in mono- and bilingual school-aged children (ages 8-12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non-verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. OUTCOMES & RESULTS: A combination of linguistic and non-linguistic measures provided the best distinction between fDLD and TD for both mono- and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. CONCLUSIONS & IMPLICATIONS: A combination of non-linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono- and bilingual groups. This study supports the possibility of using non-linguistic cognitive measures to identify fDLD in linguistically diverse settings. WHAT THIS PAPER ADDS: What is already known on the subject Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non-linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non-linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non-linguistic cognitive deficits. What this paper adds to existing knowledge The results indicated that a combination of linguistic and non-linguistic cognitive abilities increased the prediction of functional language disorder in both mono- and bilingual children. What are the potential or actual clinical implications of this work? This study supports the possibility of using non-linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings.

Exploring the Neural Structures Underlying the Procedural Memory Network as Predictors of Language Ability in Children and Adolescents With Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

Introduction: There is significant overlap in the type of structural language impairments exhibited by children with autism spectrum disorder (ASD) and children with attention deficit hyperactivity disorder (ADHD). This similarity suggests that the cognitive impairment(s) contributing to the structural language deficits in ASD and ADHD may be shared. Previous studies have speculated that procedural memory deficits may be the shared cognitive impairment. The procedural deficit hypothesis (PDH) argues that language deficits can be explained by differences in the neural structures underlying the procedural memory network. This hypothesis is based on the premise that the neural structures comprising the procedural network support language learning. In this study, we aimed to test the PDH in children with ASD, ADHD, and typical development (TD). Methods: One hundred and sixty-three participants (ages 10-21): 91 with ASD, 26 with ADHD, and 46 with TD, completed standardized measures of cognitive and language ability as well as structural magnetic resonance imaging. We compared the structural language abilities, the neural structures underlying the procedural memory network, and the relationship between structural language and neural structure across diagnostic groups. Results: Our analyses revealed that while the structural language abilities differed across ASD, ADHD, and TD groups, the thickness, area, and volume of the structures supporting the procedural memory network were not significantly different between diagnostic groups. Also, several neural structures were associated with structural language abilities across diagnostic groups. Only two of these structures, the inferior frontal gyrus, and the left superior parietal gyrus, are known to be linked to the procedural memory network. Conclusions: The inferior frontal gyrus and the left superior parietal gyrus, have well-established roles in language learning independent of their role as part of the procedural memory system. Other structures such as the caudate and cerebellum, with critical roles in the procedural memory network, were not associated with structural language abilities across diagnostic groups. It is unclear whether the procedural memory network plays a fundamental role in language learning in ASD, ADHD, and TD.

Procedural Sequence Learning in Attention Deficit Hyperactivity Disorder: A Meta-Analysis.

Previous literature proposes that the motor deficits in Attention Deficit Hyperactivity Disorder (ADHD) may be attributed to impairments of the procedural memory network, a long-term memory system involved in sensorimotor and cognitive skill development. A handful of studies have explored procedural sequence learning in ADHD, but findings have been inconsistent. A meta-analysis was conducted to begin to establish whether procedural sequence learning deficits exist in ADHD. The results of seven studies comprising 213 participants with ADHD and 257 participants with typical development (TD) generated an average standardized mean difference of 0.02 (CI95 -0.35, 0.39) that was not significant. Heterogeneity was significant across studies and could be partially attributed to the age of participants. We argue that procedural sequence learning appears to be preserved in ADHD and discuss potential explanations for and against this finding.

Bilingualism and Processing Speed in Typically Developing Children and Children With Developmental Language Disorder.

Purpose The aim of the current study was to investigate whether dual language experience modulates processing speed in typically developing (TD) children and in children with developmental language disorder (DLD). We also examined whether processing speed predicted vocabulary and sentence-level abilities in receptive and expressive modalities. Method We examined processing speed in monolingual and bilingual school-age children (ages 8-12 years) with and without DLD. TD children (35 monolinguals, 24 bilinguals) and children with DLD (17 monolinguals, 10 bilinguals) completed a visual choice reaction time task. The Clinical Evaluation of Language Fundamentals, the Peabody Picture Vocabulary Test, and the Expressive Vocabulary Test were used as language measures. Results The children with DLD exhibited slower response times relative to TD children. Response time was not modified by bilingual experience, neither in children with typical development nor children with DLD. Also, we found that faster processing speed was related to higher language abilities, but this relationship was not significant when socioeconomic status was controlled for. The magnitude of the association did not differ between the monolingual and bilingual groups across the language measures. Conclusions Slower processing speed is related to lower language abilities in children. Processing speed is minimally influenced by dual language experience, at least within this age range. Supplemental Material https://doi.org/10.23641/asha.12210311.

Bilingualism and Attention in Typically Developing Children and Children With Developmental Language Disorder.

Purpose The aim of the current study was to investigate whether dual language experience modulates the efficiency of the 3 attentional networks (alerting, orienting, and executive control) in typically developing (TD) children and in children with developmental language disorder (DLD). Method We examined the attentional networks in monolingual and bilingual school-aged children (ages 8-12 years) with and without DLD. TD children (35 monolinguals, 23 bilinguals) and children with DLD (17 monolinguals, 9 bilinguals) completed the Attention Network Test (Fan et al., 2002; Fan, McCandliss, Fossella, Flombaum, & Posner, 2005). Results Children with DLD exhibited poorer executive control than TD children, but executive control was not modified by bilingual experience. The bilingual group with DLD and both TD groups exhibited an orienting effect, but the monolingual group with DLD did not. No group differences were found for alerting. Conclusions Children with DLD have weak executive control skills. These skills are minimally influenced by dual language experience, at least in this age range. A potential bilingual advantage in orienting may be present in the DLD group.

Characterizing the Motor Skills in Children with Specific Language Impairment.

BACKGROUND/AIMS: Specific language impairment (SLI) is characterized by deficits in language ability. However, studies have also reported motor impairments in SLI. It has been proposed that the language and motor impairments in SLI share common origins. This exploratory study compared the gross, fine, oral, and speech motor skills of children with SLI and children with typical development (TD) to determine whether children with SLI would exhibit difficulties on particular motor tasks and to inform us about the underlying cognitive deficits in SLI. METHODS: A total of 13 children with SLI (aged 8-12 years) and 14 age-matched children with TD were administered the Movement Assessment Battery for Children - Second Edition and the Verbal Motor Production Assessment for Children to examine gross and fine motor skills and oral and speech motor skills, respectively. RESULTS: Children with SLI scored significantly lower on gross, fine, and speech motor tasks relative to children with TD. In particular, children with SLI found movements organized into sequences and movement modifications challenging. On oral motor tasks, however, children with SLI were comparable to children with TD. CONCLUSION: Impairment of the motor sequencing and adaptation processes may explain the performance of children with SLI on these tasks, which may be suggestive of a procedural memory deficit in SLI.

Planning Deficits in Children With Specific Language Impairment Are Reflected in Unnecessarily Awkward Grasps.

Purpose: Specific language impairment (SLI) affects many children, but its symptomatology is still being characterized. An emerging view, which challenges the notion that SLI is specific to language, is that SLI may actually reflect a domain-general deficit in procedural learning. We explored an extension of this hypothesis that a core deficit in SLI involves a domain-general problem in planning. Method: We used a dowel-transport task to study the extent to which 13 children with SLI and 14 typically developing (TD) controls (ages over both groups between 8;10 [years;months] and 12;11) would adopt initially awkward grasps that ensured comfortable final grasps when reaching out to move a dowel from 1 position to another (the end-state comfort effect). We predicted that children with SLI would be less likely to use end-state comfort grasps than would TD children. Results: Contrary to our prediction, when awkward grasps were needed to ensure comfortable final grasps, participants with SLI showed the end-state comfort effect as often as the TD children did. Unexpectedly, however, in trials where awkward grasps were not needed for comfortable final grasps, the participants with SLI used more awkward grasps than did the TD participants after trials in which initial awkward grasps were needed. Conclusion: We suggest that this perseverative behavior is indicative of a domain-general problem in planning in SLI.

Bilingualism and Procedural Learning in Typically Developing Children and Children With Language Impairment.

Purpose: The aim of this study was to investigate whether dual language experience affects procedural learning ability in typically developing children and in children with specific language impairment (SLI). Method: We examined procedural learning in monolingual and bilingual school-aged children (ages 8-12 years) with and without SLI. The typically developing children (35 monolinguals, 24 bilinguals) and the children with SLI (17 monolinguals, 10 bilinguals) completed a serial reaction time task. Results: The typically developing monolinguals and bilinguals exhibited equivalent sequential learning effects, but neither group with SLI exhibited learning of sequential patterns on the serial reaction time task. Conclusion: Procedural learning does not appear to be modified by language experience, supporting the notion that it is a child-intrinsic language learning mechanism that is minimally malleable to experience.

Procedural Motor Learning in Children With Specific Language Impairment.

Purpose: Specific language impairment (SLI) is a developmental disorder that affects language and motor development in the absence of a clear cause. An explanation for these impairments is offered by the procedural deficit hypothesis (PDH), which argues that motor difficulties in SLI are due to deficits in procedural memory. The aim of this study was to test the PDH by examining the procedural motor learning abilities of children with and without SLI. Method: Thirteen children with SLI and 14 age-matched typically developing children completed the following procedural measures: (a) a knot-tying task as a measure of motor sequencing and (2) a mirror-drawing task as a measure of visual-motor adaptation. Results: Although children with SLI produced significantly more errors on certain knot-tying tasks, they performed comparably on others. Also, children with SLI performed comparably with typically developing children on the mirror-drawing task. Conclusions: The PDH requires reframing. The sequence learning deficits in SLI are modest and specific to more difficult tasks. Visual-motor adaptation, on the other hand, appears to be unaffected in SLI.

Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the Pain Management Index.

CONTEXT: The Pain Management Index (PMI) is a simple index linking the usual severity of cancer pain with the category of medication prescribed to treat it. Medication categories are derived from the World Health Organization's "analgesic ladder" approach to cancer pain, and the PMI is an indicator of the extent to which the medication prescribed corresponds to the recommended categories for mild, moderate, and severe pain. OBJECTIVES: The aim of this study was to assess prevalence of inadequate pain management in an outpatient palliative radiotherapy clinic using the PMI. METHODS: All patients with bone metastases referred for palliative radiotherapy from 1999 to 2006 were retrospectively analyzed for patient-rated pain scores (0-10 scale) and analgesic consumption. Pain scores were assigned 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively. Analgesic scores of 0, 1, 2, and 3 were assigned when patients were prescribed no pain medication, nonopioids, "weak" opioids, and "strong" opioids, respectively. The PMI score was calculated by subtracting the pain score from the analgesic score. A negative PMI score was considered an indicator of potentially inadequate pain management by the prescriber. Descriptive statistics, Pearson's r correlation, and univariate and multivariate logistic regression analysis were used to determine the relationship of PMI over time, and the relationship with predictive factors. RESULTS: One thousand patients were included from January 1999 to December 2006. A negative PMI was calculated for 25.8% of patients at initial consultation. Prevalence of negative PMI significantly increased over years (P<0.0001). Higher Karnofsky Performance Status (P<0.0001) and breast primary cancer site (P<0.0001) were significantly associated with negative PMI after adjusting for year variable. CONCLUSION: Despite publication of numerous cancer pain management guidelines, undermedication appears to be a persistent problem for patients with painful bone metastases referred for radiotherapy.