Characterization of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY). / Caracterização de aspectos fonoaudiológicos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ).

PURPOSE: Characterize the performance of outpatients regarding aspects of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY). METHODS: This is a descriptive, observational study based on a retrospective analysis of secondary data collected at a Speech-language Pathology outpatient clinic of the public health network, from records of patients aged 5-16 years, evaluated between 2010 and 2014. Elements of anamnesis and assessment reports were analyzed with identification of ICF-CY categories related to the following components: Body Functions, Activities and Participation, and Environmental Factors. These categories were defined as the study variables, stored as categorical variables, and had their frequency distribution investigated by descriptive statistical analysis. RESULTS: One hundred eighty medical records were included in the study, and 65 of the 168 pre-selected categories were identified. As for the component Body Functions, 13 items were verified, with the category related to impairment in Mental functions of language as the most frequently mentioned. Of the 34 categories identified in the component Activities and Participation, Learning to read - Performance and Doing housework - Performance were the ones that most frequently presented difficulties. Of the 18 categories of the component Environmental Factors, the one described in most reports as Barrier was Individual attitudes of acquaintances, peers, colleagues, neighbors, and community members. CONCLUSION: Changes were found in categories of the three components of the ICF-CY analyzed, indicating the existence of issues that affected the functional performance regarding aspects of communication disorders of children and adolescents assisted at an outpatient environment.

OBJETIVO: Caracterizar o desempenho em aspectos fonoaudiológicos de pacientes ambulatoriais segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ). MÉTODO: Trata-se de estudo observacional descritivo, baseado em análise retrospectiva de dados secundários coletados em serviço fonoaudiológico ambulatorial da rede pública, com prontuários de pacientes com idades entre 5 e 16 anos avaliados entre 2010 e 2014. Foram analisados elementos dos relatórios de anamnese e avaliação, sendo identificadas categorias da CIF-CJ referentes aos componentes Funções do Corpo, Atividades e Participação e Fatores Ambientais. As categorias presentes foram definidas como as variáveis do estudo. Todas foram armazenadas como variáveis categóricas, sendo realizada análise descritiva por meio da distribuição de frequências. RESULTADOS: Foram incluídos 180 prontuários e das 168 categorias pré-selecionadas, 65 foram identificadas. Para as Funções do Corpo, 13 itens foram verificados, sendo a categoria com mais frequência referida em que se observa deficiência a funções mentais da linguagem. Para as 34 categorias identificadas pertencentes às Atividades e Participação, as mais frequentemente apontadas como dificuldade foram: aprender a ler ­ desempenho e realização das tarefas domésticas ­ desempenho. Das 18 categorias dos Fatores Ambientais, a descrita na maior parte dos relatórios como Barreira foi a atitudes individuais de conhecidos, pares, colegas, vizinhos e membros da comunidade. CONCLUSÃO: Foram verificadas alterações em categorias dos três componentes da CIF-CJ analisados, indicando a existência de questões que afetaram o desempenho funcional em aspectos fonoaudiológicos de crianças e jovens atendidos em ambiente ambulatorial.

Functional Communication Profiles in Children with Cerebral Palsy in Relation to Gross Motor Function and Manual and Intellectual Ability.

PURPOSE: The aim of the present study was to investigate communication function using classification systems and its association with other functional profiles, including gross motor function, manual ability, intellectual functioning, and brain magnetic resonance imaging (MRI) characteristics in children with cerebral palsy (CP). MATERIALS AND METHODS: This study recruited 117 individuals with CP aged from 4 to 16 years. The Communication Function Classification System (CFCS), Viking Speech Scale (VSS), Speech Language Profile Groups (SLPG), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and intellectual functioning were assessed in the children along with brain MRI categorization. RESULTS: Very strong relationships were noted among the VSS, CFCS, and SLPG, although these three communication systems provide complementary information, especially for children with mid-range communication impairment. These three communication classification systems were strongly related with the MACS, but moderately related with the GMFCS. Multiple logistic regression analysis indicated that manual ability and intellectual functioning were significantly related with VSS and CFCS function, whereas only intellectual functioning was significantly related with SLPG functioning in children with CP. Communication function in children with a periventricular white matter lesion (PVWL) varied widely. In the cases with a PVWL, poor functioning was more common on the SLPG, compared to the VSS and CFCS. CONCLUSION: Very strong relationships were noted among three communication classification systems that are closely related with intellectual ability. Compared to gross motor function, manual ability seemed more closely related with communication function in these children.

Using the International Classification of Functioning, Disability and Health Framework to Achieve Interprofessional Functional Outcomes for Young Children: A Speech-Language Pathology Perspective.

The International Classification of Functioning, Disability and Health (ICF) framework is an excellent tool to facilitate the writing of functional goals for children who exhibit communication disorders and other developmental problems that require services from professionals in multiple therapeutic areas. The holistic view of children provides each professional with an approach that integrates how one's specific health conditions and contextual factors influence a child's functioning and participation in daily activities. This allows the interprofessional team to view the child as a person, recognizing how one need influences another within his or her environment.

Caracterização de aspectos fonoaudiológicos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ) / Characterization of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY)

RESUMO Objetivo Caracterizar o desempenho em aspectos fonoaudiológicos de pacientes ambulatoriais segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ). Método Trata-se de estudo observacional descritivo, baseado em análise retrospectiva de dados secundários coletados em serviço fonoaudiológico ambulatorial da rede pública, com prontuários de pacientes com idades entre 5 e 16 anos avaliados entre 2010 e 2014. Foram analisados elementos dos relatórios de anamnese e avaliação, sendo identificadas categorias da CIF-CJ referentes aos componentes Funções do Corpo, Atividades e Participação e Fatores Ambientais. As categorias presentes foram definidas como as variáveis do estudo. Todas foram armazenadas como variáveis categóricas, sendo realizada análise descritiva por meio da distribuição de frequências. Resultados Foram incluídos 180 prontuários e das 168 categorias pré-selecionadas, 65 foram identificadas. Para as Funções do Corpo, 13 itens foram verificados, sendo a categoria com mais frequência referida em que se observa deficiência a funções mentais da linguagem. Para as 34 categorias identificadas pertencentes às Atividades e Participação, as mais frequentemente apontadas como dificuldade foram: aprender a ler - desempenho e realização das tarefas domésticas - desempenho. Das 18 categorias dos Fatores Ambientais, a descrita na maior parte dos relatórios como Barreira foi a atitudes individuais de conhecidos, pares, colegas, vizinhos e membros da comunidade. Conclusão Foram verificadas alterações em categorias dos três componentes da CIF-CJ analisados, indicando a existência de questões que afetaram o desempenho funcional em aspectos fonoaudiológicos de crianças e jovens atendidos em ambiente ambulatorial.

ABSTRACT Purpose Characterize the performance of outpatients regarding aspects of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY). Methods This is a descriptive, observational study based on a retrospective analysis of secondary data collected at a Speech-language Pathology outpatient clinic of the public health network, from records of patients aged 5-16 years, evaluated between 2010 and 2014. Elements of anamnesis and assessment reports were analyzed with identification of ICF-CY categories related to the following components: Body Functions, Activities and Participation, and Environmental Factors. These categories were defined as the study variables, stored as categorical variables, and had their frequency distribution investigated by descriptive statistical analysis. Results One hundred eighty medical records were included in the study, and 65 of the 168 pre-selected categories were identified. As for the component Body Functions, 13 items were verified, with the category related to impairment in Mental functions of language as the most frequently mentioned. Of the 34 categories identified in the component Activities and Participation, Learning to read - Performance and Doing housework - Performance were the ones that most frequently presented difficulties. Of the 18 categories of the component Environmental Factors, the one described in most reports as Barrier was Individual attitudes of acquaintances, peers, colleagues, neighbors, and community members. Conclusion Changes were found in categories of the three components of the ICF-CY analyzed, indicating the existence of issues that affected the functional performance regarding aspects of communication disorders of children and adolescents assisted at an outpatient environment.

Addressing the Communication and Other Needs of Persons With Severe Disabilities Through Engaged Interprofessional Teams: Introduction to a Clinical Forum.

PURPOSE: Interprofessional collaborative practice (IPCP) is introduced as a viable and preferred clinical methodology for speech-language pathologists and others serving persons with severe disabilities. Contributions to this clinical forum dedicated to IPCP and severe disabilities are described. METHOD: This clinical focus article introduces IPCP and reviews literature specific to its origins and effectiveness, defines severe disabilities, and proposes IPCP as a vital tenet in effective communication-related and other service delivery for this population. CONCLUSION: IPCP is supported as a recommended practice methodology for speech-language pathologists and other team members providing services to persons with severe disabilities.

The Trifocus Framework and Interprofessional Collaborative Practice in Severe Disabilities.

PURPOSE: Individuals with severe disabilities are a diverse group of learners with complex communication needs. This article presents a synthesis of the literature addressing the five strategies of the trifocus framework, with its triadic structure of learner with disability, communication partner, and environment. The application of interprofessional collaborative practice (IPCP) to the implementation of trifocus framework communication strategies is emphasized. METHOD: A literature search was conducted using Google Scholar and EBSCO to identify literature and research studies on IPCP and communication intervention for learners with severe disabilities, published 1994-2015, and then organized within the trifocus framework. The trifocus strategies are enhancing sensitivity, utilizing routines, increasing communication opportunities, modifying the communication environment, and augmenting input. Studies that included at least one participant with severe disabilities and their communication partners were considered. A secondary search was then conducted by reviewing the articles referenced in the original articles. CONCLUSION: Effective IPCP in communication intervention considers the learner's characteristics, the knowledge and skills required of communication partners, and effective environmental arrangements to support communication. Future research should include clear participant descriptions, documentation of fidelity measures, and evidence of generalization to support professionals to know when findings are relevant to the individuals they serve.

The influence of scale structure and sex on parental reports of children's social (pragmatic) communication symptoms.

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children's Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children's sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties.

Development and reliability of the Functional Communication Classification System for children with cerebral palsy.

AIM: This paper describes the development, validation, and reliability of the Functional Communication Classification System (FCCS), designed to classify expressive communication skills of children with cerebral palsy (CP) aged 4 years and 5 years (between their fourth and sixth birthdays). METHOD: The Functional Communication Classification System (FCCS) was developed in 2006 using a literature review, client file audit, and expert consultative committee process in order to devise scale content, structure, and check clinical validity and utility. Interrater reliability was examined between speech-language pathologists (SLPs), other allied health professionals (AHPs), and parents of 48 children with CP. The scale was revised and a clinical reasoning prompt sheet added, then trialled again for 42 children. The result was a five-level system with descriptors and decision-making guides for classification of functional expressive communication for children with CP. RESULTS: Overall interrater reliability was excellent for the final FCCS, intraclass correlation coefficient=0.97 (95% confidence interval 0.95 to 0.98). Kappa values were 0.94 between SLPs and AHPs, 0.59 between SLPs and parents, and 0.60 between AHPs and parents. INTERPRETATION: The FCCS is a reliable tool for describing functional communication in young children with CP, appropriate for use by SLPs, other AHPs, and parents of children with CP.

Alignment of classification paradigms for communication abilities in children with cerebral palsy.

AIM: We examined three communication ability classification paradigms for children with cerebral palsy (CP): the Communication Function Classification System (CFCS), the Viking Speech Scale (VSS), and the Speech Language Profile Groups (SLPG). Questions addressed interjudge reliability, whether the VSS and the CFCS captured impairments in speech and language, and whether there were differences in speech intelligibility among levels within each classification paradigm. METHOD: Eighty children (42 males, 38 females) with a range of types and severity levels of CP participated (mean age 60mo, range 50-72mo [SD 5mo]). Two speech-language pathologists classified each child via parent-child interaction samples and previous experience with the children for the CFCS and VSS, and using quantitative speech and language assessment data for the SLPG. Intelligibility scores were obtained using standard clinical intelligibility measurement. RESULTS: Kappa values were 0.67 (95% confidence interval [CI] 0.55-0.79) for the CFCS, 0.82 (95% CI 0.72-0.92) for the VSS, and 0.95 (95% CI 0.72-0.92) for the SLPG. Descriptively, reliability within levels of each paradigm varied, with the lowest agreement occurring within the CFCS at levels II (42%), III (40%), and IV (61%). Neither the CFCS nor the VSS were sensitive to language impairments captured by the SLPG. Significant differences in speech intelligibility were found among levels for all classification paradigms. INTERPRETATION: Multiple tools are necessary to understand speech, language, and communication profiles in children with CP. Characterization of abilities at all levels of the International Classification of Functioning, Disability and Health will advance our understanding of the ways that speech, language, and communication abilities present in children with CP.

Classification systems of communication for use in epidemiological surveillance of children with cerebral palsy.

AIM: Children with cerebral palsy (CP) often experience communication difficulties. We aimed to identify a classification system for communication of children with CP suitable for epidemiological surveillance. METHOD: Systems to classify the communication of children with CP were identified. The Communication Function Classification System (CFCS), Functional Communication Classification System (FCCS), and Viking Speech Scale (VSS) were chosen for further investigation and translated. They were administered to 155 children aged 4 to 13 years with CP (across all motor severity levels) from eight European countries. Children's parents/carers, speech therapists, and other health professionals applied the systems through direct observation. Other professionals applied them from case notes only. The systems were assessed for agreement, stability, ease, and feasibility of application. RESULTS: Test-retest stability was moderate-to-high for VSS (k=0.66-0.88), CFCS (k=uncomputed-0.91), and FCCS (k=0.52-0.91). Overall interrater agreement was fair to very good for every classification system. VSS achieved the best agreement between parents/carers and speech therapists. VSS was considered the easiest instrument to apply. INTERPRETATION: Because of its ease of use by a range of healthcare professionals, the VSS should be considered for CP registers which intend to survey speech intelligibility. For a wider assessment of communication, the CFCS or FCC should be considered.

[Autism Spectrum Disorder and DSM-5: Spectrum or Cluster?]. / Autistische Störungen nach DSM-5: Spektrum oder Cluster?

Within the new DSM-5, the currently differentiated subgroups of "Autistic Disorder" (299.0), "Asperger's Disorder" (299.80) and "Pervasive Developmental Disorder" (299.80) are replaced by the more general "Autism Spectrum Disorder". With regard to a patient-oriented and expedient advising therapy planning, however, the issue of an empirically reproducible and clinically feasible differentiation into subgroups must still be raised. Based on two Autism-rating-scales (ASDS and FSK), an exploratory two-step cluster analysis was conducted with N=103 children (age: 5-18) seen in our social-pediatric health care centre to examine potentially autistic symptoms. In the two-cluster solution of both rating scales, mainly the problems in social communication grouped the children into a cluster "with communication problems" (51 % and 41 %), and a cluster "without communication problems". Within the three-cluster solution of the ASDS, sensory hypersensitivity, cleaving to routines and social-communicative problems generated an "autistic" subgroup (22%). The children of the second cluster ("communication problems", 35%) were only described by social-communicative problems, and the third group did not show any problems (38%). In the three-cluster solution of the FSK, the "autistic cluster" of the two-cluster solution differentiated in a subgroup with mainly social-communicative problems (cluster 1) and a second subgroup described by restrictive, repetitive behavior. The different cluster solutions will be discussed with a view to the new DSM-5 diagnostic criteria, for following studies a further specification of some of the ASDS and FSK items could be helpful.

Thin Versus Thick Description: Analyzing Representations of People and Their Life Worlds in the Literature of Communication Sciences and Disorders.

PURPOSE: Evidence-based practice relies on clinicians to translate research evidence for individual clients. This study, the initial phase of a broader research project, examines the textual resources of such translations by analyzing how people with acquired cognitive-communication disorders (ACCD) and their life worlds have been represented in Communication Sciences and Disorders (CSD) research articles. METHOD: Using textual analysis, we completed a categorical analysis of 6,059 articles published between 1936 and 2012, coding for genre, population, and any evidence of thick representations of people and their life worlds, and a discourse analysis of representations used in 56 ACCD research articles, identifying thin and thick representations in 4 domains (derived from the International Classification of Functioning, Disability, and Health) and across article sections. RESULTS: The categorical analysis identified a higher percentage of ACCD articles with some evidence of thick representation (30%) compared with all CSD articles (12%) sampled. However, discourse analysis of ACCD research articles found that thick representations were quite limited; 34/56 articles had thin representational profiles, 19/56 had mixed profiles, and 3/56 had thick profiles. CONCLUSIONS: These findings document the dominance of thin representations in the CSD literature, which we suggest makes translational work more difficult. How clinicians translate such evidence will be addressed in the next research phase, an interview study of speech-language pathologists.

The Communication Function Classification System: cultural adaptation, validity, and reliability of the Farsi version for patients with cerebral palsy.

BACKGROUND: This study developed a Farsi language Communication Function Classification System and then tested its reliability and validity. METHODS: Communication Function Classification System is designed to classify the communication functions of individuals with cerebral palsy. Up until now, there has been no instrument for assessment of this communication function in Iran. The English Communication Function Classification System was translated into Farsi and cross-culturally modified by a panel of experts. Professionals and parents then assessed the content validity of the modified version. A backtranslation of the Farsi version was confirmed by the developer of the English Communication Function Classification System. Face validity was assessed by therapists and parents of 10 patients. The Farsi Communication Function Classification System was administered to 152 individuals with cerebral palsy (age, 2 to 18 years; median age, 10 years; mean age, 9.9 years; standard deviation, 4.3 years). Inter-rater reliability was analyzed between parents, occupational therapists, and speech and language pathologists. The test-retest reliability was assessed for 75 patients with a 14 day interval between tests. RESULTS: The inter-rater reliability of the Communication Function Classification System was 0.81 between speech and language pathologists and occupational therapists, 0.74 between parents and occupational therapists, and 0.88 between parents and speech and language pathologists. The test-retest reliability was 0.96 for occupational therapists, 0.98 for speech and language pathologists, and 0.94 for parents. CONCLUSIONS: The findings suggest that the Farsi version of Communication Function Classification System is a reliable and valid measure that can be used in clinical settings to assess communication function in patients with cerebral palsy.

A population-based study of communication impairment in cerebral palsy.

To explore factors associated with communication impairments in children with cerebral palsy. Data were obtained on children born between 1999 and 2008 from the Quebec Cerebral Palsy Registry (REPACQ). Out of 535 children with cerebral palsy, 297 were identified to have communication impairments (55.5%). Of these, 96 were unable to communicate verbally (32.3%), 195 had some verbal communication (65.7%), and 6 were unspecified (2.0%). These children were significantly more likely to have a more severe motor deficit (Gross Motor Function Classification System levels IV and V and Manual Ability Classification System levels IV and V), to have spastic quadriplegia or dyskinetic subtypes of cerebral palsy, and gray matter injury on neuroimaging. Communication impairment is a common comorbidity in cerebral palsy and is associated with a more severe motor deficit, spastic quadriplegic or dyskinetic subtype of cerebral palsy, and gray matter injury on neuroimaging. This information allows clinicians to better predict and manage communication impairment in children with cerebral palsy.

Content validity of the Comprehensive ICF Core Set for multiple sclerosis from the perspective of speech and language therapists.

BACKGROUND: The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) is a comprehensive framework to structure the information obtained in multidisciplinary clinical settings according to the biopsychosocial perspective of the International Classification of Functioning, Disability and Health (ICF) and to guide the treatment and rehabilitation process accordingly. It is now undergoing validation from the user perspective for which it has been developed in the first place. AIMS: To validate the content of the Comprehensive ICF Core Set for MS from the perspective of speech and language therapists (SLTs) involved in the treatment of persons with MS (PwMS). METHODS & PROCEDURES: Within a three-round e-mail-based Delphi Study 34 SLTs were asked about PwMS' problems, resources and aspects of the environment treated by SLTs. Responses were linked to ICF categories. Identified ICF categories were compared with those included in the Comprehensive ICF Core Set for MS to examine its content validity. OUTCOMES & RESULTS: Thirty-four SLTs named 524 problems and resources, as well as aspects of environment. Statements were linked to 129 ICF categories (60 Body-functions categories, two Body-structures categories, 42 Activities-&-participation categories, and 25 Environmental-factors categories). SLTs confirmed 46 categories in the Comprehensive ICF Core Set. Twenty-one ICF categories were identified as not-yet-included categories. CONCLUSIONS & IMPLICATIONS: This study contributes to the content validity of the Comprehensive ICF Core Set for MS from the perspective of SLTs. Study participants agreed on a few not-yet-included categories that should be further discussed for inclusion in a revised version of the Comprehensive ICF Core Set to strengthen SLTs' perspective in PwMS' neurorehabilitation.

[Autism Spectrum Disorder in DSM-5 - concept, validity, and reliability, impact on clinical care and future research]. / Autismus-Spektrum Störung nach DSM-5. Konzeptualisierung validität und reliabilität, bedeutung für klinik, Versorgung und forschung.

Autism Spectrum Disorder (ASD) in DSM-5 comprises the former DSM-IV-TR diagnoses of Autistic Disorder, Asperger's Disorder and PDD-nos. The criteria for ASD in DSM-5 were considerably revised from those of ICD-10 and DSM-IV-TR. The present article compares the diagnostic criteria, presents studies on the validity and reliability of ASD, and discusses open questions. It ends with a clinical and research perspective.

Nonverbal and verbal cognitive discrepancy profiles in autism spectrum disorders: influence of age and gender.

Research suggests that discrepant cognitive abilities are more common in children with autism spectrum disorder (ASD) and may indicate an important ASD endophenotype. The current study examined the frequency of IQ discrepancy profiles (nonverbal IQ > verbal IQ [NVIQ > VIQ], verbal IQ > nonverbal IQ [VIQ > NVIQ], and no split) and the relationship of gender, age, and ASD symptomatology to IQ discrepancy profile in a large sample of children with ASD. The NVIQ > VIQ profile occurred at a higher frequency than expected, had more young males, and showed more autism symptoms than the other groups. Results suggest that the NVIQ > VIQ profile may be less likely to represent a subtype of ASD, but rather a common developmental pathway for children with ASD and other disorders.

Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications.

BACKGROUND: DSM-5 sees the introduction of Social (Pragmatic) Communication Disorder (SPCD), characterized by persistent difficulties using verbal and nonverbal communication for social purposes, in the absence of restricted and repetitive interests and behaviours. There is currently much confusion about the precise diagnostic criteria for SPCD and how this disorder relates to autism spectrum disorders (ASD), previous descriptions of pragmatic language impairment (PLI) and more specific language disorders (LD). METHOD: Proposed criteria for SPCD are outlined. A selective review of the evidence considers whether these criteria form a cohesive and distinct diagnostic entity. Approaches to assessment and intervention are discussed. RESULTS: Implementing the new diagnosis is currently challenged by a lack of well-validated and reliable assessment measures, and observed continuities between SPCD and other neurodevelopmental disorders. High rates of comorbidity between SPCD and other seemingly disparate disorders (including conduct disorder, ADHD and disorders of known genetic origin) raise questions about the utility of this diagnostic category. CONCLUSIONS: SPCD is probably best conceptualized as a dimensional symptom profile that may be present across a range of neurodevelopmental disorders, although there is an urgent need to investigate the latent structure of SPCD using consistent diagnostic criteria. In addition, social communication and aspects of pragmatic language may be dissociated, with the latter heavily influenced by structural language attainments. Finally, there is a dearth of reliable and culturally valid assessment measures with which to make a differential diagnosis, and few rigorously tested intervention programmes. The implications for research and clinical practice are outlined.

Communication ability in cerebral palsy: a study from the CP register of western Sweden.

BACKGROUND: Communication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support. AIM: To study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden. METHODS: Sixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded. RESULTS: Half the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I-II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p = 0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p < 0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p < 0.01). CONCLUSION: Communication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester.