Insights gained over 60 years on factors shaping post-stroke aphasia recovery: A commentary on Vignolo (1964).

Aphasia is an acquired language disorder resulting from brain injury, including strokes which is the most common etiology, neurodegenerative diseases, tumors, traumatic brain injury, and resective surgery. Aphasia affects a significant portion of stroke survivors, with approximately one third experiencing its debilitating effects in the long term. Despite its challenges, there is growing evidence that recovery from aphasia is possible, even in the chronic phase of stroke. Sixty years ago, Vignolo (1964) outlined the primary challenges confronted by researchers in this field. These challenges encompassed the absence of an objective evaluation of language difficulties, the scarcity of evidence regarding spontaneous aphasia recovery, and the presence of numerous variables that could potentially influence the process of aphasia recovery. In this paper, we discuss the remarkable progress that has been made in the assessment of language and communication in aphasia as well as in understanding the factors influencing post-stroke aphasia recovery.

Sketch and Speak Expository Intervention for Adolescents: A Single-Case Experiment via Telepractice.

PURPOSE: This study investigated the effects of Sketch and Speak strategy intervention on expressive and receptive expository discourse for adolescents with language-related learning disabilities (LLD). METHOD: Three participants completed baseline and twelve 45- to 60-min individual treatment sessions in a multiple-baseline across participants design. In treatment, participants learned to take notes using pictography and conventional bulleted notes, orally generate sentences from their notes, and orally practice full sentences and oral reports. Session tests with varied levels of instructional support were used to collect outcome data on free-recall oral reports, short-answer question responses, and participant notes. A distal, age- referenced expository task and social validity questionnaires were administered pre-/postintervention. RESULTS: Visual and statistical analyses revealed significant effects of treatment on the primary outcome measure of Oral Report Quality and on secondary outcomes of Note Quantity and Quality. There was no significant effect of treatment on Short-Answer Recall questions. Two participants generalized strategies during the treatment phase to independent performance on Oral Reports and one improved on Note Quality. All three participants improved on the distal expository measure. Social validity questionnaires showed participant awareness and buy-in of taught strategies, with potential for generalization at the high school level. CONCLUSIONS: These adolescent students benefited from explicit instruction in note-taking strategies and systematic oral practice of expository discourse even within the challenging delivery setting of telepractice. This study provides evidence for the use of Sketch and Speak expository intervention with adolescents with LLD to improve comprehension and expression of grade-level material. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23681505.

The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke.

Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.

'Moderate global aphasia': A generalized decline of language processing caused by glioma surgery but not stroke.

Unlike stroke, neurosurgical removal of left-hemisphere gliomas acts upon a reorganized language network and involves brain areas rarely damaged by stroke. We addressed whether this causes the profiles of neurosurgery- and stroke-induced language impairments to be distinct. K-means clustering of language assessment data (neurosurgery cohort: N = 88, stroke cohort: N = 95) identified similar profiles in both cohorts. But critically, a cluster of individuals with specific phonological deficits was only evident in the stroke but not in the neurosurgery cohort. Thus, phonological deficits are less clearly distinguished from other language deficits after glioma surgery compared to stroke. Furthermore, the correlations between language production and comprehension scores at different linguistic levels were more extensive in the neurosurgery than in the stroke cohort. Our findings suggest that neurosurgery-induced language impairments do not correspond to those caused by stroke, but rather manifest as a 'moderate global aphasia' - a generalized decline of language processing abilities.

Language disorder as a marker for schizophrenia.

A language disorder is a significant symptom of schizophrenia. A psychiatrist can find this disorder when interviews with a patient. Screening and diagnosis in patients with schizophrenia alone rely heavily on interviews conducted on patients and any instructions captured from patients both verbally and nonverbally. A psychiatrist can also analyze the language aspects in schizophrenia from a language level perspective ranging from phonetic to pragmatic. This analysis paves the way for the process of interference detection since the prodromal phase. Language disorder in schizophrenia is often associated with impaired thinking processes. However, with the development of science and technology today, there is an objective and quantitative method of computational analysis of language through the Natural Language Processing process with a semantic space model that allows a psychiatrist to learn aspects of the human language process, especially in semantic and pragmatic aspects. The review provides a groundbreaking proposal for biomarkers for schizophrenia that have not been available so far through the assessment of language disorders in patients with schizophrenia. Objective and accurate detection of language disorders in schizophrenia can be a modality for psychiatrists to screen, make diagnoses, determine prognosis, evaluate therapies, and monitor recurrence using existing technology media.

Handedness in bipolar disorders is associated with specific neurodevelopmental features: results of the BD-FACE cohort.

OBJECTIVES: High rates of non-right-handedness (NRH) and mixed-handedness exist in neurodevelopmental disorders. Dysfunctional neurodevelopmental pathways may be implicated in the underlying pathophysiology of bipolar disorders (BD), at least in some subgroups. Yet little is known about correlates of NRH and mixed-handedness in BD. The objectives of this national study are to determine (i) the prevalence of NRH and mixed-handedness in a well-stabilized sample of BD individuals; (ii) if NRH/mixed-handedness in BD is associated with a different clinical, biological and neurocognitive profile. METHODS: We included 2174 stabilized individuals. Participants were tested with a comprehensive battery of neuropsychological tests. Handedness was assessed using a single oral question. Learning and/or language disorders and obstetrical complications were recorded using childhood records. Common environmental, clinical and biological parameters were assessed. RESULTS: The prevalence of NRH and mixed-handedness were, respectively, 11.6 and 2.4%. Learning/language disorders were found in 9.7% out of the total sample and were associated with atypical handedness (only dyslexia for mixed-handedness (p < 0.01), and dyslexia and dysphasia for NRH (p = 0.01 and p = 0.04, respectively). In multivariate analyses, NRH was associated with a younger age of BD onset (aOR 0.98 (95% CI 0.96-0.99) and lifetime substance use disorder (aOR 1.40 (95% CI 1.03-1.82) but not with any of the cognitive subtasks. Mixed-handedness was associated in univariate analyses with lifetime substance use disorder, lifetime cannabis use disorder (all p < 0.01) and less mood stabilizer prescription (p = 0.028). No association was found between NRH or mixed-handedness and the following parameters: trauma history, obstetrical complications, prior psychotic symptoms, bipolar subtype, attention deficit/hyperactivity disorder, peripheral inflammation or body mass index. CONCLUSIONS: Handedness may be associated with specific features in BD, possibly reflecting a specific subgroup with a neurodevelopmental load.

[Non-aphasic misnaming: a case report and literature review].

A 71-year-old, right-handed woman was admitted to our hospital due to a sudden difficulty with conversation. On admission, she was alert, but had a euphoric mood, disorientation, and a disturbance of recent memory. Her speech was fluent. Her repetition and auditory word cognition were excellent, but she had a slight difficulty with naming visual objects. She frequently showed word-finding difficulty and irrelevant paraphasia during free conversation and a word fluency task. Her irrelevant paraphasia was observed more frequently when she was asked to explain her outbreak of anger at the hospital, i.e., it was situation-dependent. She also had anosognosia. MRI showed an infarct in the territory of the left tuberothalamic artery. Single-photon emission computed tomography revealed low-uptake lesions in the left thalamus and orbital frontal, medial frontal, and medial temporal lobes. The patient was diagnosed with non-aphasic misnaming. The clinical characteristics of patients with non-aphasic misnaming in the literature were reviewed. All of the patients with non-aphasic misnaming had word-finding difficulty and irrelevant paraphasia. Additionally, they had either emotional disturbance or anosognosia.

[Linguistic impairments in patients with mild cognitive impairment: a systematic review]. / Alteraciones lingüísticas en pacientes con deterioro cognitivo leve. Revisión sistemática.

INTRODUCTION: The neuropsychological profile of patients with mild cognitive impairment (MCI) has been the target of several investigations. However, few works have been published about the language profile in these patients. AIM: To analyse and integrate the published scientific literature about this topic after the systematic review carried out by Johnson and Lin in 2014. SUBJECTS AND METHODS: A systematic review was carried out in which three databases (Web of Science, PubMed and PsycInfo) were consulted. Seventeen studies have been analysed, with adult participants diagnosed with MCI, that included at least one control group, and studies that evaluated language parameters. A self-made registration protocol has been applied to encode the characteristics and results of the studies; and the quality of the studies and articles has been evaluated through a self-elaboration scale based on previously validated instruments. RESULTS: Patients with MCI can present deficits in naming, speech production, oral comprehension, and written comprehension. CONCLUSIONS: It is important to evaluate language in patients with MCI, although this exploration does not allow establishing a diagnosis on by itself. However, the pathology variability associated with the diagnosis, the age, the language, and the educational level of the participants, as well as the sample size, and the instruments and measures used to evaluate the language in the studies reviewed, make impossible to obtain a conclusive statement, so further research about this topic is needed.

TITLE: Alteraciones lingüísticas en pacientes con deterioro cognitivo leve. Revisión sistemática.Introducción. El perfil neuropsicológico de los pacientes con deterioro cognitivo leve ha sido objeto de estudio de diversas investigaciones. Sin embargo, se han publicado relativamente pocos trabajos sobre las características del lenguaje en estos pacientes. Objetivo. Analizar e integrar la bibliografía publicada sobre el tema tras la revisión sistemática realizada por Johnson y Lin en 2014. Sujetos y métodos. Se ha realizado una revisión sistemática en la que se han consultado tres bases de datos (Web of Science, PubMed y PsycInfo). Se han analizado 17 estudios empíricos revisados por pares, con participantes adultos con deterioro cognitivo leve, que incluyen al menos un grupo control y que evalúan parámetros de lenguaje. Se ha aplicado un protocolo de registro de elaboración propia para codificar las características y los resultados de los estudios, y se ha evaluado la calidad de los estudios y los artículos en los que se han publicado a través de una escala de elaboración propia basada en instrumentos validados previamente. Resultados. Los pacientes con deterioro cognitivo leve pueden presentar déficits en denominación, producción del discurso, comprensión oral y comprensión escrita. Conclusiones. Es importante evaluar el lenguaje en pacientes con deterioro cognitivo leve, aunque dicha exploración no permita establecer por sí sola un diagnóstico. No obstante, la variabilidad en la patología asociada al diagnóstico, la edad, el idioma y el nivel educativo de los participantes, así como al tamaño muestral, y los instrumentos utilizados para evaluar el lenguaje en los estudios revisados impiden que se puedan realizar afirmaciones concluyentes y hacen que sea necesario realizar más investigación sobre el tema.

Generalized Effects of Naturalistic Social Communication Intervention for Minimally Verbal Children with Autism.

JASP-EMT, the combined Enhanced Milieu Teaching (EMT) and Joint Attention, Structured Play, and Emotion Regulation (JASPER) interventions, has been found to be effective for promoting social communication in young children with autism (Kasari et al. in J Am Acad Child Adolesc Psychiatry 53(6):635-646, https://doi.org/10.1016/j.jaac.2014.01.019 , 2014). The current study examined the effects of this naturalistic intervention on social language use in three children with autism who were in the early stages of language acquisition. Generalization to communication partners who did not utilize the intervention strategies was systematically examined using a multiple-baseline design. The results from this study indicate that this blended intervention is effective in increasing target social language for young children with autism, however, generalization to communication partners does not readily occur. Implications for practice and future research are discussed.

Tailoring Effective Behavior Management Strategies for Speech-Language Pathologists.

Purpose Many speech-language pathologists (SLPs) experience challenging behaviors during service delivery and also report minimal training in effective behavior management strategies. The purpose of this tutorial is to present low-effort behavior management strategies that SLPs can adopt, adapt, and implement. Method After providing an overall rationale for effective behavior management strategies, we present two evidence-based behavior management strategies aimed at improving positive behavior and engagement. We provide descriptions, steps, and applied examples for implementing visual activity schedules and behavior-specific praise. We include three implementation scenarios and resources for SLPs to access specifically tailored to speech-language pathology practice. Conclusions Visual activity schedules and behavior-specific praise are two flexible behavior management strategies that can be collaboratively created by SLPs and educators and implemented during a variety of instructional arrangements during speech and language therapy. Implementing evidence-based behavior management strategies may improve students' engagement and achievement in speech and language-focused outcomes.

Network Analysis of Language Disorganization in Patients with Schizophrenia.

Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptom of schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structure of language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluate the network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17 of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosure failure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within the network structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorder in schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning of language disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., duration of illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.

A Systematic Review of Academic Discourse Interventions for School-Aged Children With Language-Related Learning Disabilities.

Purpose This systematic review synthesized a set of peer-reviewed studies published between 1985 and 2019 and addressed the effectiveness of existing narrative and expository discourse interventions for late elementary- and middle school-aged students with language-related learning disabilities. Method A methodical search of the literature for interventions targeting expository or narrative discourse structure for students aged 9-14 years with group experimental designs identified 33 studies, seven of which met specific criteria to be included in this review. Results An 8-point critical appraisal scale was applied to analyze the quality of the study design, and effect sizes were calculated for six of the seven studies; equivocal to small effects of far-transfer outcomes (i.e., generalizability to other settings) and equivocal to moderate near-transfer outcomes (i.e., within the treatment setting) were identified. The most effective intervention studies provided explicit instruction of expository texts with visual supports and student-generated learning materials (e.g., notes or graphic organizers) with moderate dosage (i.e., 180-300 min across 6-8 weeks) in a one-on-one or paired group setting. Greater intervention effects were also seen in children with reading and/or language disorders, compared to children with overall academic performance difficulties. Conclusions A number of expository discourse interventions showed promise for student use of learned skills within the treatment setting (i.e., near-transfer outcomes) but had limited generalization of skills (i.e., far-transfer outcomes). Supplemental Material https://doi.org/10.23641/asha.12449258.

Executive, language and fluency dysfunction are markers of localised TDP-43 cerebral pathology in non-demented ALS.

OBJECTIVE: Approximately 35% of patients with amyotrophic lateral sclerosis (ALS) exhibit mild cognitive deficits in executive functions, language and fluency, without dementia. The precise pathology of these extramotor symptoms has remained unknown. This study aimed to determine the pathological correlate of cognitive impairment in patients with non-demented ALS. METHODS: In-depth neuropathological analysis of 27 patients with non-demented ALS who had undergone cognitive testing (Edinburgh Cognitive and Behaviour ALS Screen (ECAS)) during life. Analysis involved assessing 43 kDa Tar-DNA binding protein (TDP-43) accumulation in brain regions specifically involved in executive functions, language functions and verbal fluency to ascertain whether functional deficits would relate to a specific regional distribution of pathology. RESULTS: All patients with cognitive impairment had TDP-43 pathology in extramotor brain regions (positive predictive value of 100%). The ECAS also predicted TDP-43 pathology with 100% specificity in brain regions associated with executive, language and fluency domains. We also detected a subgroup with no cognitive dysfunction, despite having substantial TDP-43 pathology, so called mismatch cases. CONCLUSIONS: Cognitive impairment as detected by the ECAS is a valid predictor of TDP-43 pathology in non-demented ALS. The profile of mild cognitive deficits specifically predicts regional cerebral involvement. These findings highlight the utility of the ECAS in accurately assessing the pathological burden of disease.

Mapping eloquent cortex: A voxel-based lesion-symptom mapping study of core speech production capacities in brain tumour patients.

This study used voxel-based lesion-symptom mapping to examine the cortical and white matter regions associated with language production impairments in a sample of 63 preoperative tumour patients. We identified four cognitive functions considered crucial for spoken language production: semantic-to-lexical mapping (selecting the appropriate lexical label for the intended concept); phonological encoding (retrieving the word's phonological form); articulatory-motor planning (programming the articulatory motor movements); and goal-driven language selection (exerting top-down control over the words selected for production). Each participant received a score estimating their competence on each function. We then mapped the region(s) where pathology was significantly associated with low scores. For semantic-to-lexical mapping, the critical map encompassed portions of the left posterior middle and inferior temporal gyri, extending into posterior fusiform gyrus, overlapping substantially with the territory of the inferior longitudinal fasciculus. For phonological encoding, the map encompassed the left inferior parietal lobe and posterior middle temporal gyrus, overlapping with the territory of the inferior longitudinal and posterior arcuate fasciculi. For articulatory-motor planning, the map encompassed parts of the left frontal pole, frontal operculum, and inferior frontal gyrus, and overlapped with the territory of the frontal aslant tract. Finally, the map for goal-driven language selection encompassed the left frontal pole and the anterior cingulate cortex. We compare our findings with those from other neuropsychological samples, and conclude that the study of tumour patients offers evidence that complements that available from other populations.

Psicopatología asociada al complejo Dandy Walker: descripción de un caso / Psychopathology Associated with Dandy Walker Complex: A Case Description

La malformación de Dandy Walker (DW) es una malformación cerebelosa asociada a múltiples déficits cognitivos, alteraciones psicopatológicas y alteraciones motoras. Presentamos el caso de un paciente afectado de esta malformación y derivado a la unidad de salud mental infantil por presentar psicopatología asociada. Realizamos una revisión sobre la epidemiología, la clínica, el pronóstico y la comorbilidad propia de esta malformación así como sobre la psicopatología asociada a la patología cerebelosa en su conjunto, incluyendo el síndrome cerebeloso cognitivo-afectivo de Shamahmann y Sherman. Por último, incluimos la descripción del caso y establecemos el diagnóstico diferencial a partir de la historia del paciente, la exploración del estado mental y el análisis de las exploraciones complementarias (radiológicas y neuropsicológicas)

Dandy Walker (DW) malformation is a cerebelar malformation associated with multiple cognitive deficits, psychopathological alterations and motor disturbances. We present the case of a patient affected by this malformation who was referred to the child mental health unit. We conducted a review on the anatomy, epidemiology, clinical presentation, prognosis and comorbidity of this malformation as well as on the psychopathology associated with cerebelar pathology as a whole, including Shamahmann and Sherman's cognitive-affective cerebellar syndrome. Finally, we present the case description and establish the differential diagnosis from the patient's history, the mental state examination and complementary examinations (neuroimaging and neuropsychological tests)

Neural correlates of association strength and categorical relatedness in youths with autism spectrum disorder.

Impaired language and communication are commonly observed in youths with autism spectrum disorders (ASDs). However, the organization of semantic knowledge in youths with ASD remains unclear compared to typically developing (TD) youths. The present study addresses this issue by using functional magnetic resonance imaging (fMRI) to examine the distinction between association strength and categorical relatedness of semantic knowledge. A sample of 31 male youths with ASD (mean age = 12.1 years, SD = 1.2) and 38 TD youths (mean age = 11.9 years, SD = 1.0) was recruited with matched age, gender, and handedness. Participants decided if two visually presented Chinese characters were semantically related during fMRI scanning. For weaker association strength, the ASD group showed greater left cuneus activation, which was positively correlated with the picture completion for visual perception, whereas the TD group showed greater middle temporal gyrus and inferior frontal gyrus activation. For higher categorical relatedness, the TD group showed greater activation than the ASD group in the occipitotemporal cortex and left precuneus, which was positively correlated with the similarities for concept formulation. Findings imply that the ASD group may use lower-level visual information for both association strength and categorical relatedness. The TD group showed higher-level controlled processes of more elaborate semantic representations for association strength and more elaborate features of categorical knowledge for semantic selection and integration. Autism Res 2019, 12: 1484-1494. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) often present language/communication impairments. Exploring the difference of semantic processing between youths with ASD and typically developing (TD) youths is crucial for understanding the organization of semantic knowledge. We found different neural substrates of semantic knowledge between these two groups. ASD youths may rely more on lower-level visual information during semantic judgments, whereas TD youths showed higher-level controlled processes of more elaborate semantic representations for selection and integration of words, phrases, and sentences.

Evidence-Based Interventions for Learners Who Are Deaf and/or Multilingual: A Systematic Quality Review.

Purpose Many educators and speech-language pathologists have difficulty providing effective interventions to the growing population of d/Deaf and hard-of-hearing (DHH) learners who use more than 1 language. The purpose of this review article was to identify evidence-based interventions for speech, language, and literacy used with DHH multilingual learners (DMLs), monolingual DHH learners, and hearing bilingual learners without hearing loss. Interventions used with these groups can inform the practice of professionals providing services to DMLs. Method This review article considered speech, language, and literacy interventions used with DHH and hearing bilingual learners from birth to 21 years of age. The following electronic databases were searched: Academic Search Complete/EBSCO (CINAHL, Education, ERIC), Linguistics & Language Behavior Abstracts, PsycINFO, and PubMed. Data describing article, participant, methodological, and intervention variables were extracted from studies. The methodological quality of studies was examined using the Council for Exceptional Children's (2014) standards for evidence-based practice in special education. Results A total of 144 studies were reviewed, describing over 9,370 learners aged 1.8-22.0 years. Two studies investigated DMLs, 76 investigated DHH learners, and 67 investigated hearing bilingual learners. A total of 146 different interventions were examined. Most studies reported positive effects. Only 17 studies met all quality indicators specified by the Council for Exceptional Children (2014): 7 examined DHH learners, and 10 examined hearing bilingual learners. There was insufficient evidence for any intervention to be considered an evidence-based intervention, although 6 could potentially contribute to evidence-based practice. Conclusions No evidence-based interventions for DMLs were identified. A small number of interventions examined in high-quality studies of DHH and hearing bilingual learners were identified, which may be appropriate for use with DMLs following further investigation. Supplemental Material https://doi.org/10.23641/asha.9108386.

Speech-Language Disorders in 22q11.2 Deletion Syndrome: Best Practices for Diagnosis and Management.

Purpose Speech and language disorders are hallmark features of 22q11.2 deletion syndrome (22qDS). Learning disabilities, cognitive deficits, palate abnormalities, velopharyngeal dysfunction, behavioral differences, and various medical and psychiatric conditions are also major features of this syndrome. The goal of this document is to summarize the state of the art of current clinical and scientific knowledge regarding 22qDS for speech-language pathologists (SLPs) and provide recommendations for clinical management. Method Best practices for management of individuals with 22qDS were developed by consensus of an expert international group of SLPs and researchers with expertise in 22qDS. These care recommendations are based on the authors' research, clinical experience, and literature review. Results This document describes the features of 22qDS as well as evaluation procedures, treatment protocols, and associated management recommendations for SLPs for the often complex communication disorders present in this population. Conclusion Early diagnosis and appropriate management of speech-language disorders in 22qDS is essential to optimize outcomes and to minimize the long-term effects of communication impairments. Knowledge of this diagnosis also allows anticipatory care and guidance regarding associated features for families, health care, and educational professionals.

Management of Dysphagia in Acquired and Progressive Neurologic Conditions.

As the act of deglutition involves much of the central and peripheral nervous systems, neurologic disease can affect swallowing behaviors ranging from mild to profound in severity. The key in working with neurogenic dysphagia is to have a solid foundation in normal swallowing processes, including neural control. Within this framework, then, understanding how the neurologic condition affects neural control will guide hypothesis-based assessment and evidence-based treatment. The purpose of this article is to provide an overview of evaluation and treatment of neurogenic dysphagia in adult populations as well to propose assessment of co-occurring speech, language, and airway compromise. Furthermore, it is vital to be familiar with ethical decision making and end-of-life issues. Continuing education in the form of research articles, conferences, and professional discussion boards is useful in maintaining a high level of service delivery. Whenever possible, an inter- or transdisciplinary approach is recommended.

Differences in profiles of emotional behavioral problems across instruments in verbal versus minimally verbal children with autism spectrum disorder.

There has been increasing attention to the assessment of minimally verbal (MV) children with autism spectrum disorder (ASD). Previous research has begun to examine the relationship between verbal abilities and emotional and behavioral problems (EBP). The current study compared parent-reported EBP in children of differing language levels on two instruments commonly used in ASD research and clinical practice, the Child Behavior Checklist (CBCL) and Aberrant Behavior Checklist (ABC). The study consisted of 1,937 6-18 years old children with ASD from the Simons Simplex Collection. Children were divided into three language groups, by ADOS module (Module 1 = MV, 2 = phrase speech (PS), and 3 = verbally fluent (VF)) and then compared on CBCL and ABC subscales. The ABC and CBCL showed different patterns of elevations across the language groups. MV children were reported to have more impairment than VF children on the ABC irritability, lethargy, and hyperactivity scales. Children with less language (MV and PS) exhibited less impairment on the CBCL internalizing domain than VF children, but did not differ on the externalizing domain. Post hoc comparisons showed that internalizing differences were driven by fewer children with less language exhibiting clinically elevated anxious/depressed scores compared to VF children. The present study underscores the significance of considering language when assessing EBP. Results have implications for the psychiatric screening of children with ASD, particularly those with language impairments. Researchers should exercise caution when applying EBP instruments designed for use with different populations and purposes to broad samples of children. Autism Res 2019, 12: 1367-1375. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Some emotional and behavioral problem (EBP) scales include items that may be inappropriate for children with ASD and limited language. The present study found that there was a tendency for children with language impairment to have lower internalizing scores on the Child Behavior Checklist, but higher scores lethargy and irritability scores on the Aberrant Behavior Checklist, relative to verbally fluent children. This suggests that each of these instruments may underestimate EBPs in certain subsets of children.