gms | German Medical Science

100 Jahre Phoniatrie in Deutschland
22. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie
24. Kongress der Union Europäischer Phoniater

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.

16. bis 18.09.2005, Berlin

A longitudinal study of children with specific language impairment (SLI)

Eine Studie bei Kindern mit spezifischer Sprachentwicklungstörung

Vortrag

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  • corresponding author presenting/speaker Olga Dlouha - Phoniatric department 1st Faculty of Medicine, Charles University, Prague, Prague 2, Czech Republic

100 Jahre Phoniatrie in Deutschland. 22. Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie, 24. Kongress der Union der Europäischen Phoniater. Berlin, 16.-18.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05dgppV13

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgpp2005/05dgpp095.shtml

Veröffentlicht: 15. September 2005

© 2005 Dlouha.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Abstract

This study reports longitudinal follow-up of 300 children with SLI (specific language impairment). In our children with more typical SLI language comprehension is impaired, but the most obvious problems are with expressive syntax and phonology. Their expressive disturbances are a manifestation of their decoding impairment. At the heart of SLI there is an impairment of auditory perception. Auditory-phonological processing presents the heterogenity of specific language impairment. Identification of speech sounds appears to be a problem for all groups of children with SLI.

These children were investigated on battery of tests of spoken language, of phonological processing, of different audiometric procedures - in order to register all information necessary to judge the speech development.


Text

Introduction

The literature on auditory-phonological processing presents the heterogenity of SLI (specific language impairment). Some studies have focused on children with severe comprehension problems, asking how far their difficulties are auditory or linguistic. Others have concentrated on looking for a link between defective speech production and abnormal speech perception. Identification of speech sounds appears to be a problem for all groups. Several reviewers have documented the number and variety of cognitive tasks that are difficult for children with SLI.

SLI (developmental dysphasia, SES - Sprachentwicklungstoerungen) denotes the inability to acquire normal expression and/or comprehension of language in the absence of peripheral hearing impairment, neurological disorder, and mental retardation. For more typical SLI - where language comprehension is impaired, but the most obvious problems are with expressive syntax and phonology. Auditory. At the heart of SLI there is an disorder of auditory perception. Central auditory deficit may result in or coexist with difficulties in other CNS-based skills, such as speech-language impairment, attention deficit, learning and developmental disabilities. The term SLI is sometimes used, but exactly how specific such a condition is remains a debatable issue given the reported co-morbidity.

Developmental dysphasia (SLI) - the typical clinical picture is retarded speech development with a specific disorders in all speech structures: the individual phonological system and the other linguistic levels-lexical, syntactic, grammatical and semantic. The children have typical speech comprehension problem varying in intensity, they have typical auditory decoding deficits, integration deficit, associative deficit and out-put organisation deficit of speech. Many of the children are not able to recognize acoustic contours and to identify the keywords from a spoken message. The children with SLI often behave as if peripheral hearing loss is present, despite normal hearing. Disorders of speech comprehension are typical for all patients with central auditory processing disorders (CAPD). In speech perception temporal processing is one of the functions necessary for the discrimination of phonemes and for the discrimination of similar words. The existence of cognitive functions disorders is much more important then those directly involved in the speech production.

Central auditory tests go beyond standard tests of hearing to examine how well the auditory system uses or interprets the information that the ear sends it. The term "auditory processing" refers to "what we do with what we hear". Dichotic speech tests - dichotic listening involves the presentation of stimuli to both ears simultaneously with the information presented to one ear being different from that presented to the other. The information presented to each ear is composed of a portion of the entire message, necessitating integration of the information order for the listener to perceive the whole message.

Material and methods

The group of 300 children (212 boys and 88 girls) was being monitored, of age 4-8 years. The relationship of handedness: 247 right-handed and 53 left-handed. The mean age of children suffering from SLI (dysphasia) was 6 years 2 months, follow-up period 1-5 years. Children within this age (6 to 7 years old) were best diagnosed in view of the fact of possibility to accomplish the widest spectrum of examinational methods. Majority of children underwent detailed phoniatric examination (analysis of language and speech functions, audiometric tests, discriminative auditory tests of phonemes, tests of word repetition, study of auditory evoked potentials, dichotic central tests).

Results

Family history - a positive family history was comfirmed in 185 children. Sex of risk relatives - overbalancing representation of male relatives as it is with majority of speech disorders. Perinatal history - a positive perinatal risks were found in 145 children (risk pregnancy in 59, immaturity in 26 children, patological delivery - 19, respiratory di-stress syndrome in 41 cases.

Phoniatric examination - disorders of phonemic discrimination and of verbal comprehension were found in majority of cases. Auditory decoding deficits, phonological, lexical and syntactic deficits, associative deficit were diagnosed. Pure tone audiometry was normal in all cases. Long latency auditory evoked potentials (LAEPs) were observed-the responses to verbal stimuli were not recorded or were found with decreased amplitudes and with prolonged latency (wave P3), almost in the left dominant hemisphere.

The findings of 70 preschool-aged (6-7 y. old) SLI children confirmed disability to synthesize 2 two-syllabic words during dichotic listening: 45 children (64%) repeated only 1 word (Figure 1 [Fig. 1], Figure 2 [Fig. 2]) from a two-word sentence. 16 children (23%) with SLI repeated ½ word stimuli within dichotic presentation. Only 9 children (13%) out of 70 managed to repeat all 2 two-syllabic words like children from a control group, and they recognized whole sentence. Statistical analysis (Table 1 [Tab. 1]) confirmed significant differences between results in test 1-3 (p=0.001).

These results confirmed integration deficit and problems with temporal processing and with quality of short-time memory.

Conclusions

A longitudinal (follow-up) study was conducted to document and compare the evolution of children with linguistic acquisition impairment.

Our results indicate the relationship between specific language impairment and central auditory processing disorder: Our dysphasic children have auditory processing deficit - not only integration, but also associative deficit. Deficiency in the ability to perform tasks that require interhemispheric communication and inefficient intrahemispheric cooperation. At the heart of SLI there is an disorder of auditory perception. Their expressive disturbances are a manifestation of their decoding impairment.

We suppose that this initiate evaluation corresponds to the approach to developmental language disorders at our workplace. With an auditory training producing improved language abilities in everyday context, this would be the strongest support yet for the view that linguistic difficulties in these children are secondary to more fundamental auditory limitations.


References

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Dlouha, O.: Auditory evoked potentials in children with developmental speech disorders. Electroenceph. Clin. Neurophysiol. 1996, 4: 351-2.
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