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Background: fMRI is becoming a standard tool for the presurgical lateralization and mapping of brain areas involved in language processing. However, its within-subject reproducibility has yet to be fully explored., Objective: To evaluate within-test and test-retest reliability of language fMRI in consecutive patients undergoing evaluation for epilepsy surgery., Methods: Thirty-four unselected patients were investigated once (within-test reliability) and 12 patients twice (test-retest reliability). The imaging series consisted of an alternating 25-second synonym judgment condition with a 25-second letter-matching condition repeated 15 times. Reproducibility of activation maps of the first and second half of session 1 or activation maps of sessions 1 and 2 was evaluated by comparing one global and three regional lateralization indexes (Broca's area, remaining prefrontal cortex, temporoparietal area) and on a voxel-by-voxel basis (intraclass correlation coefficient, percentage overlap, correlation of t-values)., Results: Global and regional language lateralization was achieved with high reliability within and across sessions. Reproducibility was evenly distributed across both hemispheres but not within each hemisphere. Frontal activations were more reliable than temporoparietal ones. Depending on the statistical threshold chosen, the voxel-by-voxel analysis revealed a mean overlap of activations derived from the first and second investigation of up to 48.9%., Conclusion: Language fMRI proved sufficiently reliable for the determination of global and regional lateralization of language representation in individual unselected patients with epilepsy.

The objective of this study was to compare the efficacy of corticotropin (ACTH) versus vigabatrin in treating infantile spasms and to determine which medication has a more favorable long-term outcome in terms of cognitive function, evolution of epilepsy, and incidence of autism. Patients with infantile spasms were included in the study if they were 3 to 16 months old, had hypsarrhythmia, and had no previous treatment with vigabatrin or corticosteroids. Patient evaluation included electroencephalographic and psychometric measures before and after treatment. Patients were stratified based on etiology (idiopathic or symptomatic) and sex and then randomized between the ACTH and vigabatrin treatment groups. Each of the treatment groups received either ACTH or vigabatrin for 2 weeks. At the end of 2 weeks of treatment, patients were considered responders if spasms and hypsarrhythmia resolved. Nonresponders were crossed over and treated with the alternate drug. Nine patients were included in the study. Three patients received ACTH, one of whom was a responder. Six patients received vigabatrin, three of whom were responders. The five nonresponders received both therapies. All patients had some degree of developmental plateau or regression before the initiation of treatment. Four patients with idiopathic infantile spasms showed improved cognitive function following treatment. The remaining five patients remained significantly delayed. Five patients with symptomatic infantile spasms had epilepsy following treatment; three of them were in the autistic spectrum. The small number of infants in this pilot study is insufficient to determine which of the two drugs is more effective. However, the following trends were identified: vigabatrin may be more effective for patients with symptomatic infantile spasms; patients with idiopathic infantile spasms tend to have a better cognitive outcome; and patients with symptomatic infantile spasms tend to develop both epilepsy and autism.

Objectives: The aim of this study is to demonstrate the accuracy of direct cortical stimulation of language areas preparatory to the removal of infiltrating tumors of dominant hemisphere., Material and Methods: From June 1998 to March 2000 we included in our study 15 patients, aged from 30 to 75 years, harboring gliomas (14 high grades and 1 low grade) close to language-specific cortex. All patients had slight inaugural phasic troubles. They underwent craniotomy under local anesthesia for cortical stimulation language mapping, in conjunction with electrocorticography to identify the after-discharge threshold. Stimulation mapping covered the entire macroscopically tumor involved area, extending up to 3 cm away from the margins of the lesion, without searching to identify systematically the language areas. Therefore, the lesion was removed as completely as possible, respecting a security margin of at least 1 cm from the recognized language sites., Results: We identified from 1 to 6 language sites for 14 of our patients, in different locations. A radical removal was achieved for all high grade gliomas, while the low grade was only partially removed. A patient died on the 16th postoperative day from pulmonary embolism; 2 patients deteriorated from peri- or immediate postoperative complications; 9 showed a transient neurological worsening that receded by the 2nd postoperative month, while 3 did not present any postoperative aggravation. At a follow-up of 1 month to 2 years (mean 8 months), 6 patients died and the 9 survivors maintain a good life quality., Conclusions: Cortical stimulation for language mapping is an accurate technique that allows the surgical morbidity of lesions in proximity to language areas to decrease and become comparable to the surgical morbidity for lesions in non eloquent areas.

Early identification of disorders of oral and written language development is essential for effective action before the vicious circle of educational failure and established psychosocial consequences. There has been growing awareness among health and education professionals that the means of recognizing, treating and teaching children with specific oral and written language disorders are inadequate. There is still a limited number of diagnostic tools that have not been fully evaluated. Nevertheless, considerable effort has been made in recent years to develop instruments for early detection and precise diagnostic evaluation. Developments in cognitive neuropsychology provide new approaches for the management of these disorders.

Otitis media is the most frequent reason that children go to the doctor for illness. In developing countries, where children have limited access to medical care, suppurative complications of otitis media (OM) are frequent and permanent hearing loss results. In developed countries, the most common morbidity of OM is conductive hearing loss due to middle ear effusion. Infants with severe and recurrent OM and persistent middle ear effusion are at risk for problems in behavior and development of speech, language and cognitive abilities. Parent stress is frequent. The cost of otitis media is large (>$5 billion in the United States). Selection and spread of multi-drug resistant bacterial pathogens arising from extensive use of antimicrobial agents for OM is a problem for management of all diseases due to the pathogens. The incidence and severity of OM may diminish with introduction of new bacterial and viral vaccines.

During the canonical stage of infant babbling, infants produce well-formed syllables, often in reduplicated sequences such as "bababa." Although nearly all infants with normal hearing begin the canonical stage by 10 months of age, a few are delayed, and these infants may be of special interest. Recent studies indicate that late onset of canonical babbling may be a predictor of disorders. A simple screening procedure that focuses on canonical babbling was used to evaluate over 3400 infants at risk who were about 10 months of age. Among infants who showed late onset of canonical babbling, fewer than half had been previously diagnosed as having a significant medical problem that might have accounted for the delay. A follow-up study indicated that infants with delayed canonical babbling had smaller production vocabularies at 18, 24, and 30 months than did infants in the control group. The results suggest that late onset of canonical babbling, a factor that can be monitored effectively through an interview with a parent, can predict delay in the onset of speech production.

The purpose of this investigation was to compare the ability of nurses and parents to detect speech and language disability. The methodology included development and validation of a parent questionnaire to detect speech and language disability in 398 3-year-old English-speaking children. The parent questionnaire and a standard developmental screen administered by child health nurses were compared with a gold standard (a speech and language assessment). International criteria for screening tools were applied. The tools were comparable in performance. A simple parent questionnaire, completed without professional assistance, was a viable alternative to professional screening. Parents' education and parity had no influence on their ability to detect language disorders. Although size of sibship had no association with the occurrence of speech and language disability, third-born children were more likely to have a speech and language disability than any other birth order.

An intensive early intervention program was evaluated through determining child gains made by 44 children with special needs in cognition, gross-motor, fine-motor, receptive language, and expressive language domains. Gains were examined for the total group and two subgroups based upon their delays at pretesting. Analyses comparing actual to predicted posttest scores for the total group did not reveal statistically significant gains in any domains. Findings by subgroup revealed that in cognition, gross-motor, and fine-motor domains, the group with less severe impairments made more progress. Results were interpreted in light of constraints imposed by the measurement tools and discussed in terms of policy implications and the limitations involved in conducting quality program evaluation in early intervention.

This study investigated the efficacy of a parent questionnaire as a component for screening early language development of children 16 to 30 months of age with cleft lip and palate. Thirty nonsyndromic children with cleft lip and palate and 30 children without clefts received the MacArthur Communicative Development Inventory: Toddler (CDI: Toddler), administered by a pediatrician. In addition, a speech-language screening was performed by a speech-language pathologist. Results of the two assessments indicated that the CDI:Toddler was a valid screener of language development when compared with a comprehensive speech-language screening. Language and speech characteristics of the subject populations are discussed. In particular, differences between the cleft and noncleft groups demonstrated evidence of delays in expressive language development in the children with cleft lip and palate.

It has been well-established that children with Down syndrome experience a high incidence of persistent conductive hearing loss because of their predisposition to stenosis of the external auditory canal (EAC), cerumen impaction, serous otitis media (SOM), and cholesteatoma. Because this hearing problem may be a primary cause of the spoken communication skills in these children being far below their cognitive ability, assertive management is required. The authors present an aggressive multi-discipline treatment model that is instituted during the first year of life in an infant with Down syndrome. Reconstruction of the EAC, amplification technology, and speech/language intervention that emphasizes auditory-verbal (A/V) therapy are discussed. In a pilot study, we compared the language development of six infants with Down syndrome who received aggressive treatment during their first year of life (group A) to six infants who did not (group B). The results showed age-appropriate oral language development for the infants in group A.

Acute otitis media and middle ear effusion are among the most common illnesses of childhood. Accuracy in identification and diagnoses, and awareness of the epidemiologic risk factors, the resultant hearing loss and possible language impairment are of paramount importance to the pediatrician and otolaryngologist alike. The goals of management are prompt and effective treatment and follow up to restore hearing and avoid speech and language impairment and other long term sequelae.

Between five and 20% of preschool age children have language problems. These can be related to the child's hearing, socioeconomic status, intellectual development, or a psychiatric disorder. Even when it is difficult to recommend a formal screening program, family physicians can interpret delays in speech and language as "indicators" of underlying disorders.

Children with recurrent physical illnesses such as infections of the ears and chest are more likely than average to have developmental and behavioural disorders as well. Specialist skills are needed for the assessment and management of these disorders; the belief that "the child will grow out of it" is rarely correct. Any reorganisation of the child health services should take account of the need for children with developmental and behavioural disorders to be treated within the community by doctors and other health workers with the appropriate skills.

After observing the lack of generalization of language trained in highly structured training sessions using established behavior modification techniques, "incidental teaching" procedures were developed to change the use of specified language behaviors in the natural environment. This paper reports an analysis of the general changes in the language, other than that specifically targeted by the incidental teaching procedures, used by disadvantaged preschool children. The daily language samples of disadvantaged children involved in a previously reported experiment to increase compound sentence usage were reexamined and compared to comparable records of other disadvantaged children and of middle-class children of college parents in order to assess possible general effects of the intervention program. Whereas the language that both groups of comparison children used changed little across the preschool year, the amount of talking by the children in the experimental program increased markedly. Their use of more elaborate vocabulary and more elaborate sentences also increased in direct proportion to the increases in overall language use, such that both language use and language elaboration in the experimental group of children changed from a pattern simlar to the comparison group of disadvantaged children to a pattern similar to the comparison group of middleclass children. It is argued that some general features of the incidental teaching procedure--differentially attending to child overtures and responding relative to the child's selected topic (reinforcer)--contributed to the increase in overall language use beyond the specific language behavior targeted, and that this increase in the probability of children's talking itself resulted in the substantial increases in elaboration seen in the children's spontaneous language. Because, at least in children with fairly well-developed language repertoires, language use is contextually controlled, talking more involves talking in more varied and complex contexts, which inevitably produces the use of more elaborate language.

The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.