Behind the Scenes of Developmental Language Disorder: Time to Call Neuropsychology Back on Stage

Interactive virtual reality training to improve socio-emotional functioning in adolescents with developmental language disorders: A feasibility study

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: 'InterAction'. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents' appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants' sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13-16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that 'InterAction' was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

Disentangling the relationship between sensory processing, alexithymia and broad autism spectrum: A study in parents' of children with autism spectrum disorders and sensory processing disorders

BACKGROUND

Autistic features and sensory processing difficulties and their phenotypic co-expression with alexithymia share a transdiagnostic vulnerability. In this work, we explored whether the current concept of broad autism phenotype rather translates altered sensory processing (non-specific to autism), meaning that the characteristics of altered sensory processing should be overexpressed among individuals with heightened vulnerability to sensory processing atypicalities (parents of children with sensorial processing disorder, or SPD parents) and individuals with heightened vulnerability to autistic traits (parents of children with autism spectrum disorders, or ASD parents). In addition, the association between altered sensory processing and alexithymia was inspected.

METHOD

The Adolescent/Adult Sensory Profile, Autism Spectrum Quotient, and Toronto Alexithymia Scale were completed by 31 parents of children with ASD, 32 parents of children with SPD, and 52 parents of typically developed (TD) children.

RESULTS

Extreme sensory patterns were overexpressed both in parents of children with SPD and parents of children with ASD when compared to parents of TD children. In addition, extreme sensory patterns were significantly associated with alexithymia scores. Specifically, sensory avoidance, low registration, and sensory sensitivity were positively correlated with alexithymia. No significant differences were found regarding the proportion of autistic traits and alexithymia between ASD and SPD groups of parents.

CONCLUSIONS

These results challenge the specificity of broad autism phenotype and suggest a neurodevelopmental atypicity with roots in altered sensory and emotional processing.

A Role for Visual Memory in Vocabulary Development: A Systematic Review and Meta-Analysis

Although attention and early associative learning in preverbal children is predominantly driven by rapid eye-movements in response to moving visual stimuli and sounds/words (e.g., associating the word "bottle" with the object), the literature examining the role of visual attention and memory in ongoing vocabulary development across childhood is limited. Thus, this systematic review and meta-analysis examined the association between visual memory and vocabulary development, including moderators such as age and task selection, in neurotypical children aged 2-to-12 years, from the brain-based perspective of cognitive neuroscience. Visual memory tasks were classified according to the visual characteristics of the stimuli and the neural networks known to preferentially process such information, including consideration of the distinction between the ventral visual stream (processing more static visuo-perceptual details, such as form or colour) and the more dynamic dorsal visual stream (processing spatial temporal action-driven information). Final classifications included spatio-temporal span tasks, visuo-perceptual or spatial concurrent array tasks, and executive judgment tasks. Visuo-perceptual concurrent array tasks, reliant on ventral stream processing, were moderately associated with vocabulary, while tasks measuring spatio-temporal spans, associated with dorsal stream processing, and executive judgment tasks (central executive), showed only weak correlations with vocabulary. These findings have important implications for health professionals and researchers interested in language, as they advocate for the development of more targeted language learning interventions that include specific and relevant aspects of visual processing and memory, such as ventral stream visuo-perceptual details (i.e., shape or colour).

Definition and terminology of developmental language disorders-Interdisciplinary consensus across German-speaking countries

In recent years, there have been intense international discussions about the definition and terminology of language disorders in childhood, such as those sparked by the publications of the CATALISE consortium. To address this ongoing debate, a Delphi study was conducted in German-speaking countries. This study consisted of three survey waves and involved over 400 experts from relevant disciplines. As a result, a far-reaching consensus was achieved on essential definition criteria and terminology, presented in 23 statements. The German term 'Sprachentwicklungsstörung' was endorsed to refer to children with significant deviations from typical language development that can negatively impact social interactions, educational progress, and/or social participation and do not occur together with a potentially contributing impairment. A significant deviation from typical language development was defined as a child's scores in standardized test procedures being ≥ 1.5 SD below the mean for children of the same age. The results of this Delphi study provide a proposal for a uniform use of terminology for language disorders in childhood in German-speaking countries.

A Scoping Review of Diagnosis of Autism Spectrum Disorder in Primary Care

INTRODUCTION

This scoping review was performed to collect, examine, and present literature on interventions promoting the diagnosis of Autism Spectrum Disorder (ASD) in U.S. primary health care settings.

METHOD

The literature searched was from 2011-2022, in the English language, in PubMed, CINAHL, Psych INFO, Cochrane, and Web of Science, for persons with autism or ASD aged ≤ 18 years.

RESULTS

Six studies met the search criteria, including a quality improvement project, a feasibility study, a pilot study, and three primary care provider (PCP) intervention trials. Measured outcomes included: accuracy of diagnosis (n = 4), practice change maintenance (n = 3), time to diagnosis (n = 2), specialty clinic appointment wait time (n = 1), PCP comfort making ASD diagnosis (n = 1), and increased ASD diagnosis (n = 1).

DISCUSSION

Results inform future implementation of PCP ASD diagnosis for the most obvious cases of ASD and research evaluating PCP training, using longitudinal measures of PCP knowledge of ASD and intention to diagnose.

Functional near-infrared spectroscopy measures of neural activity in children with and without developmental language disorder during a working memory task

INTRODUCTION

Children with developmental language disorder (DLD) exhibit cognitive deficits that interfere with their ability to learn language. Little is known about the functional neuroanatomical differences between children developing typically (TD) and children with DLD.

METHODS

Using functional near-infrared spectroscopy, we recorded oxygenated hemoglobin (O₂ hb) concentration values associated with neural activity in children with and without DLD during an auditory N-back task that included 0-back, 1-back, and 2-back conditions. Analyses focused on the left dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL). Multilevel models were constructed with accuracy, response time, and O₂ hb as outcome measures, with 0-back outcomes as fixed effects to control for sustained attention.

RESULTS

Children with DLD were significantly less accurate than their TD peers at both the 1-back and 2-back tasks, and they demonstrated slower response times during 2-back. In addition, children in the TD group demonstrated significantly greater sensitivity to increased task difficulty, showing increased O₂ hb to the IPL during 1-back and to the DLPFC during the 2-back, whereas the DLD group did not. A secondary analysis revealed that higher O₂ hb in the DLPFC predicted better task accuracy across groups.

CONCLUSION

When task difficulty increased, children with DLD failed to recruit the DLPFC for monitoring information and the IPL for processing information. Reduced memory capacity and reduced engagement likely contribute to the language learning difficulties of children with DLD.

Association of Developmental Language Disorder With Comorbid Developmental Conditions Using Algorithmic Phenotyping

IMPORTANCE

Developmental language disorder (DLD) is a common (with up to 7% prevalence) yet underdiagnosed childhood disorder whose underlying biological profile and comorbidities are not fully understood, especially at the population level.

OBJECTIVE

To identify clinically relevant conditions that co-occur with DLD at the population level.

DESIGN, SETTING, AND PARTICIPANTS

This case-control study used an electronic health record (EHR)-based population-level approach to compare the prevalence of comorbid health phenotypes between DLD cases and matched controls. These cases were identified using the Automated Phenotyping Tool for Identifying Developmental Language Disorder algorithm of the Vanderbilt University Medical Center EHR, and a phenome enrichment analysis was used to identify comorbidities. An independent sample was selected from the Geisinger Health System EHR to test the replication of the phenome enrichment using the same phenotyping and analysis pipeline. Data from the Vanderbilt EHR were accessed between March 2019 and October 2020, while data from the Geisinger EHR were accessed between January and March 2022.

MAIN OUTCOMES AND MEASURES

Common and rare comorbidities of DLD at the population level were identified using EHRs and a phecode-based enrichment analysis.

RESULTS

Comorbidity analysis was conducted for 5273 DLD cases (mean [SD] age, 16.8 [7.2] years; 3748 males [71.1%]) and 26 353 matched controls (mean [SD] age, 14.6 [5.5] years; 18 729 males [71.1%]). Relevant phenotypes associated with DLD were found, including learning disorder, delayed milestones, disorders of the acoustic nerve, conduct disorders, attention-deficit/hyperactivity disorder, lack of coordination, and other motor deficits. Several other health phenotypes not previously associated with DLD were identified, such as dermatitis, conjunctivitis, and weight and nutrition, representing a new window into the clinical complexity of DLD.

CONCLUSIONS AND RELEVANCE

This study found both rare and common comorbidities of DLD. Comorbidity profiles may be leveraged to identify risk of additional health challenges, beyond language impairment, among children with DLD.

Parental sociodemographic characteristics and mental health referrals by nurses in Swedish child health centres

AIM

To explore the influence of parents' socio-economic characteristics on child healthcare nurses' mental health referrals of 3- to 5-year-olds and also to test the association between mental health problems and referrals.

METHODS

Repeated cross-sectional data including parents' Strengths and Difficulties Questionnaire (SDQ) assessments and referral data (psychologist and speech and language pathologist). Hierarchical regression was used to analyse whether parents' country of birth, education level, marital status and mental health problem scores (SDQ; total difficulties and impact scores) were associated with nurses' referrals.

RESULTS

About 9% of mothers and 12% of fathers rated high SDQ scores (total difficulties) in their children. Approximately, 1% of the children were referred. The influence of parents' socio-economic characteristics on referral rates was not observed. However, for children with Swedish-born mothers, referral rates were significantly lower. Scores for SDQ total difficulties and impact were associated with the child's referral to specialists.

CONCLUSION

In general, parental sociodemographic characteristics do not influence Swedish child healthcare nurses' mental health referrals. Although there was a significant association between problem behaviour and referral, a disproportion between children rated with high SDQ scores (9% and 12%) and children referred to specialists (1%) should be addressed.

What does the Sentence Structure component of the CELF-IV index, in monolinguals and bilinguals?

The Sentence Structure sub-test (SST) of the Clinical Evaluation of Language Fundamentals (CELF) aims to "measure the acquisition of grammatical (structural) rules at the sentence level". Although originally designed for clinical practice with monolingual children, components of the CELF, such as the SST, are often used to inform psycholinguistic research. Raw scores are also commonly used to estimate the English proficiency of bilingual children. This study queries the reliability of the SST as an index of children's ability to deal with structural complexity in sentence comprehension, and demonstrates that cognitive complexity induces a considerable confound in the task, affecting 5- to 7-year-old monolinguals (n = 87) and bilinguals (n = 87) alike.

Early Attachment and the Development of Social Communication: A Neuropsychological Approach

Social communication forms the foundation of human relationships. Social communication, i.e., the appropriate understanding and use of verbal and non-verbal communication within a social context, profoundly impacts mental health across the lifespan and is also highly vulnerable to neurodevelopmental threats and social adversities. There exists a strong interconnection between the development of language and other higher cognitive skills, mediated, in part, through the early attachment relationship. Consideration of how attachment links to brain development can help us understand individuals with social communication difficulties across the lifespan. The early attachment relationship supports the development of the foundational constructs of social communication. In this paper, a neuropsychological perspective was applied to social communication, which integrated evidence from early attachment theory, examining the underpinnings of social communication components identified by the SoCom model, namely socio-cognitive, socio-emotional, and socio-linguistic constructs. A neuropsychological perspective underscores the importance of interdisciplinary collaboration. This should also inform approaches to prevention, policy, intervention, and advocacy for individuals with or at risk for social communication impairments, as well as their families.

Improving social emotional functioning in adolescents with Developmental Language Disorders: A mini review and recommendations

Adolescents with Developmental Language Disorders (DLD) have more difficulties in social emotional functioning than their typically developing peers (TD), such as shyness and anxiety in social situations, fewer peer relations, greater risk of victimization, social isolation and depression. In addition, they are more likely to report higher levels of hyperactivity and conduct problems. These problems derive from a complex interplay between difficulties in language, social communication, underlying cognitive deficits in Theory of Mind (ToM), Executive Functioning (EF) and self-directed speech (SDS). The aim of this mini review is to provide an overview of studies examining the effectiveness of interventions targeting the factors underlying social emotional functioning of school-aged children and adolescents with DLD. We found that studies dedicated to social emotional functioning in school-aged children and adolescents with DLD were relatively scarce. Based on this overview, we give suggestions to improve social emotional functioning in adolescents with DLD. We propose that intervention programs should target the social, linguistic and cognitive functions underlying social emotional functioning and create opportunities to practice these skills in daily, real-life situations with peers.

Association of epileptiform brain activity and specific language impairment (SLI) in preschool children

Background

Epileptiform activities can cause transient or permanent deficits that affect the children during development and may be accompanied by neurodevelopmental disorders like specific language impairment.

Objectives

The objective of this study was to find if there is a possible association and the impact of epilepsy and epileptiform activity in children with specific language impairment.

Patients and methods

The study was conducted on 80 children suffering from specific language impairment and 80 age and sex match healthy control children. Computed tomography brain was performed and electroencephalography was recorded for children. Intelligence quotient level, cognitive age, social, and phoniatric assessment were done for all patients.

Results

Eighty children with specific language impairment (51 males and 29 females) with a mean age of 4.11 ± 1.93. Patients with specific language impairment showed significantly higher rates of abnormal electroencephalography (P = 0.006) and epilepsy (P < 0.001) compared to the control group. Spearman correlation demonstrated a highly negative significant relationship linking the language, intelligence quotient with abnormal electroencephalography and epilepsy (r = − 0.91, P < 0.01 and r = − 0.91, P < 0.01 respectively). Also, there was a moderately inverse significant relationship linking the cognitive age, social with abnormal electroencephalography, and epilepsy (r = − 0.70, P < 0.05 and r = − 0.65, P < 0.05 respectively).

Conclusion

Epileptiform activities even without epilepsy in preschool children may alter normal language function. Specific language impairment was associated with lower intelligence quotient levels, social, and cognitive age.

Trial registration

ClinicalTrials.gov ID: NCT04141332

Reduced brain activation during spoken language processing in children with developmental language disorder and children with 22q11.2 deletion syndrome

Language difficulties of children with Developmental Language Disorder (DLD) have been associated with multiple underlying factors and are still poorly understood. One way of investigating the mechanisms of DLD language problems is to compare language-related brain activation patterns of children with DLD to those of a population with similar language difficulties and a uniform etiology. Children with 22q11.2 deletion syndrome (22q11DS) constitute such a population. Here, we conducted an fMRI study, in which children (6-10yo) with DLD and 22q11DS listened to speech alternated with reversed speech. We compared language laterality and language-related brain activation levels with those of typically developing (TD) children who performed the same task. The data revealed no significant differences between groups in language lateralization, but task-related activation levels were lower in children with language impairment than in TD children in several nodes of the language network. We conclude that language impairment in children with DLD and in children with 22q11DS may involve (partially) overlapping cortical areas.

Executive Function, Working Memory, and Verbal Fluency in Relation to Non-Verbal Intelligence in Greek-Speaking School-Age Children with Developmental Language Disorder

Developmental Language Disorder (DLD) is often associated with impairments in working memory (WM), executive functions (EF), and verbal fluency. Moreover, increasing evidence shows poorer performance of children with DLD on non-verbal intelligence tests relative to their typically developing (TD) peers. Yet, the degree and generality of relevant difficulties remain unclear. The present study aimed at investigating WM capacity, key EFs and verbal fluency in relation to non-verbal intelligence in Greek-speaking school-age children with DLD, compared to TD peers (8–9 years). To our knowledge, the present study is the first to attempt a systematic relevant assessment with Greek-speaking school-age children, complementing previous studies mostly involving English-speaking participants. The results showed that children with DLD scored lower than TD peers on the non-verbal intelligence measure. Groups did not differ in the inhibition measures obtained (tapping resistance to either distractor or proactive interference), but children with DLD were outperformed by TD peers in the WM capacity, updating, monitoring (mixing cost), and verbal fluency (phonological and semantic) measures. The effects showed limited (in the case of backward digit recall) or no dependence on non-verbal intelligence. Findings are discussed in terms of their theoretical and practical implications as well as in relation to future lines of research.

Beyond the Senses: How Self-Directed Speech and Word Meaning Structure Impact Executive Functioning and Theory of Mind in Individuals With Hearing and Language Problems

Many individuals with developmental language disorder (DLD) and individuals who are deaf or hard of hearing (D/HH) have social–emotional problems, such as social difficulties, and show signs of aggression, depression, and anxiety. These problems can be partly associated with their executive functions (EFs) and theory of mind (ToM). The difficulties of both groups in EF and ToM may in turn be related to self-directed speech (i.e., overt or covert speech that is directed at the self). Self-directed speech is thought to allow for the construction of non-sensory representations (i.e., representations that do not coincide with direct observation). Such non-sensory representations allow individuals to overcome the limits set upon them by the senses. This ability is constrained by the development of word meaning structure (i.e., the way words are understood). We argue that the greater ability to construct non-sensory representations may result in more enhanced forms of EF and ToM. We conclude that difficulties in EF, ToM, and social–emotional functioning in those with hearing and language problems may be accounted for in terms of word meaning impairments. We propose that word meaning structure and self-directed speech should be considered in assigning EF and ToM treatments to individuals with DLD and those who are D/HH.

Toddlers' Ability to Leverage Statistical Information to Support Word Learning

PURPOSE

This study investigated whether the ability to utilize statistical regularities from fluent speech and map potential words to meaning at 18-months predicts vocabulary at 18- and again at 24-months.

METHOD

Eighteen-month-olds (N = 47) were exposed to an artificial language with statistical regularities within the speech stream, then participated in an object-label learning task. Learning was measured using a modified looking-while-listening eye-tracking design. Parents completed vocabulary questionnaires when their child was 18-and 24-months old.

RESULTS

Ability to learn the object-label pairing for words after exposure to the artificial language predicted productive vocabulary at 24-months and amount of vocabulary change from 18- to 24 months, independent of non-verbal cognitive ability, socio-economic status (SES) and/or object-label association performance.

CONCLUSION

Eighteen-month-olds' ability to use statistical information derived from fluent speech to identify words within the stream of speech and then to map the "words" to meaning directly predicts vocabulary size at 24-months and vocabulary change from 18 to 24 months. The findings support the hypothesis that statistical word segmentation is one of the important aspects of word learning and vocabulary acquisition in toddlers.

A Multimodal Comparison of Emotion Categorization Abilities in Children With Developmental Language Disorder

Purpose Current research has demonstrated that behavioral, emotional, and/or social difficulties often accompany developmental language disorder (DLD). It is an open question to what degrees such difficulties arise as consequence of impaired language and communicative skills, or whether they might also be driven by deficits in verbal and nonverbal emotion processing (e.g., the reduced ability to infer and verbalize emotional states from facial expressions). Regarding the existence of nonverbal deficits, previous research has yielded inconsistent findings. This study was aimed at gaining deeper knowledge of the basic aspects of emotion understanding in children with DLD by comparing their performance on nonverbal and verbal emotion categorization tasks to that of typically developing children. Method Two verbal tasks (Lexical Decision and Valence Decision With Emotion Terms) and two nonverbal tasks (Face Decision and Valence Decision With Facial Expressions) were designed to parallel each other as much as possible, and conducted with twenty-six 6- to 10-year-old children diagnosed with DLD. The same number of typically developed children, carefully matched by age and gender, served as a control group. Results The children with DLD showed lower performance in both verbal tasks and exhibited noticeable problems in the nonverbal emotion processing task. In particular, they achieved lower accuracy scores when they categorized faces by their valence (positive or negative), but did not differ in their ability to distinguish these faces from pictures displaying animals. Conclusions This study provides evidence for the hypothesis that problems in emotion processing in children with DLD might be multimodal. Therefore, the results support the idea of mutual influences in the development of language and emotion skills and contribute to the current debate about the domain specificity of DLD (formerly referred to as specific language impairment).

Behavioral problems of Mandarin-speaking late-talking toddlers and preschool aged children: A prospective case-control study in Taiwan

This study aimed to examine whether Mandarin-speaking late-talking (LT) toddlers have a higher incidence of behavioral problems than typical language developing (TLD) children in toddlerhood and at preschool age from a community sample in Taiwan.This prospective case-control study comprised 32 LT and 32 TLD toddlers. Participants' parents provided reports about their children at 2 and 4 years using the Child Behaviors Checklist, a component of the Achenbach System of Empirically Based Assessment.The results indicated that compared to the TLD group, a higher percentage of the LT group was at risk of behavioral problems at both two and four years. Similarly, the chance of internalizing problems was higher in the LT group than the TLD group at both ages.The findings indicated that LT toddlers are at risk for behavioral problems not only in toddlerhood, but also at preschool age. Thus, it is crucial to identify LT toddlers with behavioral problems and enroll them in early developmental evaluation programs in their communities and also include them in early intervention programs if necessary. In addition, the underlying mechanism of the association between language delay and behavioral problems in children needs to be longitudinally explored from a young age.

Conversations With Health Care Providers and Parents Before Autism Diagnosis: A Qualitative Study

INTRODUCTION

The purpose of this study was to explore communication with health care providers from the perceptions of parents before their child's diagnosis of autism spectrum disorder and provide some examples of how communication may contribute to the autism diagnosis.

METHOD

This study used a qualitative descriptive design with multiple individual structured in-person interviews.

RESULTS

Three themes captured parents' (n = 8) descriptions of the phases of communication during their children's diagnoses including, (1) anguished questioning, (2) urgently seeking help, and (3) expecting a diagnosis. In addition, three themes characterized the communication style that parents needed, although not always received, in each of the periods of diagnosis including (1) compassionate curiosity, (2) acknowledgment and affirmation, and (3) engagement with parents.

DISCUSSION

Results point to opportunities for pediatric providers to use a more empathic and engaging communication style during the diagnostic process with better identification of education and support needed by parents and families.