RESUMO
OBJECTIVE: To characterize the organization of speech- and language-related white matter tracts in children with developmental speech and/or language disorders. STUDY DESIGN: We collected magnetic resonance diffusion-weighted imaging data from 41 children, ages 9-11 years, with developmental speech and/or language disorders, and compared them with 45 typically developing controls with the same age range. We used probabilistic tractography of diffusion-weighted imaging to map language (3 segments of arcuate fasciculus, extreme capsule system) and speech motor (corticobulbar) tracts bilaterally. The corticospinal and callosal tracts were used as control regions. We compared the mean fractional anisotropy and diffusivity values between atypical and control groups, covarying for nonverbal IQ. We then examined differences between atypical subgroups: developmental speech disorder (DSD), developmental language disorder, and co-occurring developmental speech and language disorder. RESULTS: Fractional anisotropy in the left corticobulbar tract was lower in the DSD than in the control group. Radial and mean diffusivity were higher in the DSD than the developmental language disorder, co-occurring developmental speech and language disorder, or control groups. There were no group differences for any metrics in the language or control tracts. CONCLUSIONS: Atypical development of the left corticobulbar tract may be a neural marker for DSD. This finding is in line with reports of speech disorder after left corticobulbar damage in children and adults with brain injury. By contrast, we found no association between diffusion metrics in language-related tracts in developmental language disorder, and changes for language disorders are likely more complex.
Assuntos
Transtornos do Desenvolvimento da Linguagem/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Distúrbios da Fala/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Anisotropia , Estudos de Casos e Controles , Criança , Imagem de Difusão por Ressonância Magnética , Imagem de Tensor de Difusão , Feminino , Humanos , MasculinoRESUMO
OBJECTIVE: To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years. STUDY DESIGN: Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N?=?1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder). RESULTS: At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P?=?.02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors. CONCLUSIONS: Children with speech delay at age 4 years seem more likely to resolve, and this might justify a "watch and wait" approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts.
Assuntos
Transtornos do Desenvolvimento da Linguagem/terapia , Encaminhamento e Consulta , Distúrbios da Fala/terapia , Fonoterapia , Conduta Expectante , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Inteligibilidade da FalaRESUMO
OBJECTIVES: To evaluate oromotor feeding at 12 months' corrected age in children born before 30 weeks' gestational age compared with term-born peers by the use of observational assessment and to examine predictors of oromotor feeding difficulties in children born before 30 weeks. STUDY DESIGN: Oromotor feeding was assessed at 12 months' corrected age with the Schedule for Oral Motor Assessment in 90 children born before 30 weeks and 137 term-born children. Feeding outcomes were compared between groups. Sex, gestational age at birth, birth weight, social risk, history of tube feeding, surgery, and respiratory support were analyzed as potential risk factors. RESULTS: At 12 months' corrected age, 38% of children born before 30 weeks had oromotor feeding difficulties-with greater odds of difficulties than term-born participants (OR 2.21; 95% CI 1.55-3.16). Difficulties were observed with specific food textures (purees, solids, crackers) and areas of oromotor skill (lip and jaw movement, food loss, swallowing). Neonatal surgery (n = 4/89) appeared to be the only predictor of oromotor feeding issues (OR 11.66; 95% CI 1.56-87.23; P = .02). CONCLUSIONS: Children born before 30 weeks presented with greater odds of oromotor feeding problems at 12 months' corrected age than their term-born peers. Neonatal surgery was associated with increased odds of feeding difficulties in children born before 30 weeks. Surveillance and support of oromotor feeding skills for very preterm children is indicated, particularly during their transition to solid foods.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Doenças do Prematuro/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Fatores de Risco , Nascimento a TermoRESUMO
OBJECTIVES: To investigate language abilities in children born very preterm (VPT; <32 weeks' gestational age) or very low birth weight (VLBW; <1500 g) at 7 years of age and compare their performances with children born at term, and to determine whether group differences could be explained by cerebral white matter abnormality on neonatal magnetic resonance imaging. STUDY DESIGN: A cohort of 198 children born <30 weeks' gestational age and/or <1250 g, and 70 term controls were examined. White matter abnormalities were rated quantitatively on brain magnetic resonance imaging at term-equivalent age. Language was assessed at age 7 years using standardized language tests. Differences between groups were tested in the 5 language subdomains of phonological awareness, semantics, grammar, discourse, and pragmatics. A mediation effect was tested between birth group, white matter abnormality, and language subdomains. RESULTS: The VPT/VLBW group performed significantly worse than controls on all language subdomains (all P < .001). White matter abnormality mediated the effect of group differences on phonological awareness, and partly mediated this effect for semantics, grammar, and discourse. White matter abnormality was not significantly associated with pragmatics (P = .13). CONCLUSIONS: Language is an important area of concern in children born VPT/VLBW. Neonatal white matter abnormality is an important predictor of outcome; however, different language abilities are differentially associated with neonatal white matter abnormality.
Assuntos
Encéfalo/anormalidades , Transtornos da Linguagem/etiologia , Encéfalo/patologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro , Recém-Nascido de muito Baixo Peso , Idioma , Transtornos da Linguagem/diagnóstico , Imageamento por Ressonância Magnética/métodos , Masculino , Testes Neuropsicológicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To assess speech abilities in adolescents born preterm and investigate whether there is an association between specific speech deficits and brain abnormalities. STUDY DESIGN: Fifty adolescents born prematurely (<33 weeks' gestation) with a spectrum of brain injuries were recruited (mean age, 16 years). Speech examination included tests of speech-sound processing and production and speech and oromotor control. Conventional magnetic resonance imaging and diffusion-weighted imaging was acquired in all adolescents born preterm and 30 term-born control subjects. Radiological ratings of brain injury were recorded and the integrity of the primary motor projections was measured (corticospinal tract and speech-motor corticobulbar tract [CST/CBT]). RESULTS: There were no clinical diagnoses of developmental dysarthria, dyspraxia, or a speech-sound disorder, but difficulties in speech and oromotor control were common. A regression analysis revealed that presence of a neurologic impairment, and diffusion-weighted imaging abnormalities in the left CST/CBT were significant independent predictors of poor speech and oromotor outcome. These left-lateralized abnormalities were most evident at the level of the posterior limb of the internal capsule. CONCLUSION: Difficulties in speech and oromotor control are common in adolescents born preterm, and adolescents with injury to the CST/CBT pathways in the left-hemisphere may be most at risk.
Assuntos
Lesão Encefálica Crônica/complicações , Nascimento Prematuro , Tratos Piramidais/patologia , Distúrbios da Fala/diagnóstico , Adolescente , Lesão Encefálica Crônica/patologia , Lesão Encefálica Crônica/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Seguimentos , Perda Auditiva/etiologia , Humanos , Imageamento por Ressonância Magnética , Desempenho Psicomotor , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Percepção da Fala , Medida da Produção da FalaRESUMO
OBJECTIVE: To conduct a meta-analysis to characterize differences in language ability between children born very preterm (VPT, <32 weeks' gestational age), with a very low birth weight (VLBW, <1500 g), or both and in term-born control children. STUDY DESIGN: Electronic databases were systematically searched, and 12 studies met the inclusion criteria. Effect sizes were calculated to compare VPT/VLBW children and control children. RESULTS: VPT/VLBW children performed between 0.38 and 0.77 SD below control subjects in the areas of expressive and receptive language overall and expressive and receptive semantics. Results for expressive and receptive grammar were equivocal. Subgroup analysis of school-aged children revealed similar results. No studies assessing phonological awareness, discourse, or pragmatics were identified. CONCLUSIONS: Language ability is reduced in VPT/VLBW children. When considering only school-aged children, this reduction is still present, suggesting that their difficulty appears to be ongoing. Rigorous studies examining a range of language subdomains are needed to fully understand the specific nature of language difficulties in this population.