Language: Spanish
References: 60
Page: 315-322
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ABSTRACT
Introduction: Expressive language problems are common amongst preschoolers both in the general population (15-20%) and in clinical settings (50-75%); furthermore, these problems are often not detected. Language problems require attention since they are associated with severe developmental disorders such as autism (Au), Asperger’s syndrome (AS), attention-deficit hyperactivity disorder (ADHD) and mental retardation. In theory, language development, specifically expressive vocabulary, associated to psychiatric disorders could be identified with a scale that measures expressive language.
Objectives: 1. To determine the frequency of language delay in a sample of Mexican children with typical development in the community. 2. To determine the vocabulary level for autism, Asperger’s syndrome, ADHD and other psychiatric disorders through the use of the Language Development Survey (LDS). 3. To analyze if differences in vocabulary ratings among the clinical subgroups can be detected with this instrument.
Materials and methods: The sample consisted of: A community group with typical development (TDG) (n=302) and a clinical group (CG) (n=55); both groups had an age range of 2-5 years. The clinical group was subdivided into 4 clinical subgroups based on DSM-IV criteria for: autism, Asperger’s syndrome, ADHD and other psychiatric disorders (OPD) (enuresis, encopresis, separation anxiety). Exclusion criteria were: deafness, hypoacusia and other sensorial disorders and mental retardation.
A semi-structured interview based on DSM-IV criteria was designed
ad hoc to diagnose: autism, Asperger’s syndrome, ADHD (inattentive, combined or hyperactive impulsive varieties), specific phobia disorder, tics (transitory, chronic and Tourette’s syndrome), dysthymic disorder, depression, enuresis, separation anxiety disorder based on parent information. The clinical evaluation included a semistructured play session with age-appropriate didactic material. Discrepancies in diagnosis were resolved by consensus. All interviews were conducted by an experienced clinician. The number of bulbs in the household was used to measure socioeconomic status (SES).
The LDS is a list of words that explores children’s vocabulary based upon parental report. The original survey has a Cronbach’s alpha coefficient of 0.99, test-retest coefficient of 0.97-0.99, and a sensitivity and specificity of 86-90%. Language delay (LD) was defined as ≤50 words, as recommended by several researchers. All parents signed an informed consent form and answered the LDS.
Statistical analysis. Categorical data was analyzed using a χ
2 analysis; continuous data such as age, socioeconomic status, and LDS score, were analyzed using t-tests. To analytically compare the LDS group medians, a Kruskal-Wallis test was used, since the variable distribution violated the normality distribution requirements for parametric tests. For the post hoc tests, a Tamhane analysis was used for groups of different sizes. Differences were considered statistically significant if they had a
p‹0.05.
Results: The groups were similar for variables such as child’s age, parents’ age and the LDS median between the normal development group and the clinical group t(355)=1.12, p=.26. The pro portion of male children was greater in the clinical group (CG) than in the TDG, 76.4% vs. 53%, χ
2(1,N=357)=10.63, p‹.001. SES was higher for the TDG (M=7.2, SD=4.2) than for the CG (M=5.8, SD=3), p‹.005. The father’s age (r=.15,
p‹.009), the mother’s age (r=.16, p‹.003) and the SES (r=.13, p‹.01) were correlated to the LDS score. Additionally, father’s and mother’s age were strongly correlated (r=.72, p‹.0001) and the mother’s age showed small correlations with the socioeconomic status (r=.15, p‹.004). The mother’s age was correlated with the child’s vocabulary for both sexes (males: r=.16, p‹.04, females: r=.16, p‹.02), and vocabulary was significantly correlated with the SES, only for the males.
Language delay frequency in the TDG was 21.2%, and 23.6% for the CG, χ
2(1,N=352)=1.03, p‹0.59. By sex, males in both groups exhibited a greater frequency of LD [TDG: 21.6% males vs. 20.7% females, χ
22(1,N=55)=.642, p‹0.423].
The autism subgroup had the lowest vocabulary rating (M=85, SD=78.68), followed by the OPD subgroup (M=149,
SD=121), whose rating was very similar to the typically development group (M=179, SD=105). The Asperger group (M=259, SD=27) had a similar score to the ADHD group (M=286,
SD=100.2), which had the highest vocabulary score of all. The Kruskal-Wallis test for median differences was significant [H(4)=17.47, p‹.002]. Multiple contrast comparisons and Tamhane’s
post hoc analysis showed that only the contrast between the autism and the ADHD subgroups (means: 85 vs. 286, respectively) was significant (ANOVA Tamhane
post hoc, p‹.01).
Discussion: Language delay (LD) measured through LDS in the TDG (21.6%) was very similar to other studies (15-20%). Nevertheless, LD in the clinical sample was inferior (23.6%) to what has been reported elsewhere (35-75%). It is possible that exclusion of mental retardation, in the clinical sample, could explain these differences. The greater proportion of males suffering from language delay in the clinical group is due to the fact that children with developmental problems occur more frequently among males. Some studies have found a marked and significant female superiority in vocabulary at an early age, but our results found that the girls’ vocabularies in both groups were very similar to the boys’. This result is not explained by differences in the instruments used, since other studies carried out with the LDS also report greater scores for girls in both community and clinical samples. Therefore, it is possible that these results are due to cultural differences in the quantity and quality of the verbal stimulus towards Mexican girls and boys. Our scores were also inferior to the Caucasian American population scores.
The LDS was sensitive to detection of vocabulary level between groups and the results were congruent with the expected observations, with a few exceptions: Mainly, the community group had a nonsignificant lower score than the clinical group.
The subgroups analysis showed that, generally, the vocabulary level corresponded with the expected levels; nevertheless, we found great variability in the scores for the different subgroups. The ADHD had the highest score of all, which determined that the LDS mean for the CG was higher than TDG’s. Children with ADHD generally express a greater number of words compared to children in the general population at younger ages. Different studies show that this vocabulary advantage is lost between 8-12 years of age. The group with the next highest score was the Asperger subgroup, which also had the greatest variability, along with the OPD subgroup. This makes identification of Asperger’s syndrome through the LDS impossible, due to confounding with other groups. This is unfortunate because differential diagnosis between ADHD and the autism spectrum disorders is very important. Vocabulary was better in the Asperger than the autism subgroup, although these differences were not significant in the post hoc tests. The only significant comparison was between ADHD and autism groups, which is consistent with other studies through other measures.
Conclusions: The Mexican version of the LDS is a useful tool for screening language delays in preschoolers. It may aid in the identification of autism and other common causes of language delays such as: transitory delay, late language emergence, specific language impairment and selective mutism. The LDS is a quantitative screening instrument and does not measure other complex alterations in other language domains such as: narrative, expository and conversational discourse; and other pragmatic language abilities individually or in any combination. Language impairment should be diagnosed based on multiple sources of information, including naturalistic observation and standardized, culturally appropriate psychometric measures.
REFERENCES
Broomfield J, Dodd B. Children with speech and language disability: caseload characteristics. Int J Lang Commun Disord 2004;39:303-324.
Reilly S, Wake M, Bavin E et al. Predicting language at 2 years of age: A prospective community Study. Pediatrics 2007;120:e1441-1449.
Cohen NJ. Unsuspected language impairments in psychiatrically disturbed children: Developmental issues and associated conditions. En: Beitchman JH, Cohen NJ, Konstantareas M, Tannock R (eds.). Language, learning and behavior disorders: Cambridge: Cambridge University Press; 1996; p. 105-121.
Miniscalco C, Nygren G, Hagberg B, Kadesjö B et al. Neuropsychiatric and neurodevelopmental outcome of children at the age 6 and 7 years who screened positive for language problems at 30 months. Dev Med Child Neurol 2006;48:361-366.
Van Daal J, Verhoeven L, van Balkom H. Behaviour problems in children with language Impairment. J Child Psychol Psychiatry 2007;48: 1139-1147.
Bennett T, Szatmari P, Bryson S, Volden J et al. Differentiating autism and Asperger syndrome on the basis of language delay or impairment. J Autism Dev Disord 2007;38:616-25.
Cohen N, Vallance D, Barwick M, Im N et al. The interface between ADHD and Language Impairment: An examination on language, achievement and cognitive processing. J Child Psychol Psychiatry 2000;41:353-362.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Cuarta edición. Washington, DC; 1994.
De Giacomo A, Fombonne E. Parental recognition of developmental abnormalities in autism. Eur Child Adolesc Psychiatry 1998;7:131-136.
Idiazábal-Aletxa MA, Boque-Hermida E. Procesamiento cognitivo en los trastornos del espectro autista. Rev Neurol 2007;44:S49-S51.
Cantwell D, Baker L. Attention deficit disorder with and without hyperactivity: a review and comparison of matched groups J Am Acad Child Adolesc Psychiatry 1992;31:432-438.
Tannock R, Schachar R. Executive dysfunction as an underlying mechanism of behavior and language problems in attention deficit hyperactivity disorder. En: Beitchman JH, Cohen NJ, Konstantareas MM, Tannock R (ed.). Language, learning, and behaviour disorders: Developmental, biological, and clinical perspectives Cambridge: Cambridge University Press; 1996; p. 128-155.
Beitchman JH, Nair R, Clegg M, Ferguson B e al. Prevalence of psychiatric disorders in children with speech and language disorders. J Am Acad Child Adolesc Psychiatry 1986;25:528-535.
Beitchman JH, Nair R, Clegg M, Patel PG. Prevalence of speech and language disorders in 5-year-old kindergarten children in the Ottawa-Carleton region. J Speech Hear Disord 1986;51:98-110.
McGrath L, Hutaff-Lee C, Scott A, Boada R et al. Children with comorbid speech Sound Disorder and specific language impairment are at increased risk for attention-deficit/hyperactivity disorder. J Abnormal Child Psychol 2008;36:151-163.
Albores-Gallo L. ¿Puede el CBCL /1.5-5 distinguir entre el autismo y el déficit de la atención? México D.F.: Universidad Nacional Autónoma de México UNAM; 2008.
Achenbach TM, Rescorla LA. Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont. Department of Psychiatry; 2000.
Rescorla L. The language development survey: A screening tool for delayed language in toddlers. J Speech Hear Disord 1989;54:587-599.
Rescorla L, Hadicke-Wiley M, Escarce E. Epidemiological investigation of expressive language delay at age two. First Language 1993;13:5-22.
Klee T, Carson DK, Gavin WJ, Hall L et al. Concurrent and predictive validity of an early language screening program. J Speech Hear Disord 1998;41:627-641.
Rescorla L, Alley A. Validation of the Language Development Survey (LDS): A parent report tool for identifying language delay in toddlers. J Speech Hear Disord 2001;44:434-445.
Stelzer SC. Adaptación, normalización, y estudios de validez del «sondeo del desarrollo de lenguaje» (SDL) para la detección de retraso de lenguaje expresivo en niños Mexicanos de 15 a 31 meses de edad. México: Universidad de las Américas; 1995.
Patterson JL. Expressive vocabulary development and word combinations of Spanish-English bilingual toddlers. J Speech Lang Pathol 1998;746-756.
Rescorla L, Achenbach TM. Use of the language development survey (LDS) in a national probability sample of children 18 to 35 months old. J Speech Lang Hear Res 2002;45:733-743.
Beitchman JH, Wilson B, Johnson CJ, Atkinson L et al. Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome. J Am Acad Child Adolesc Psychiatry 2001;40:75-82.
Love AJ, Thompson MG. Language disorders and attention deficit disorders in young children referred for psychiatric services: analysis of prevalence and a conceptual synthesis. Am J Orthopsychiatry 1988;58:52-64.
Buschmann A, Jooss B, Rupp A, Dockter S et al. Children with developmental language delay at 24 months old of age: results of a diagnostic workup. Dev Med Child Neurol 2008;50:223-229.
Bishop DVM, Edmundson A. Language impaired 4-years olds: distinguishing transient from persistent impairment J Speech Hear Disord 1987;52:156-173.
Silva PA. The prevalence, stability, and significance of developmental language delay in preschool children. Dev Med Child Neurol 1980;22:768-777.
Stevenson J, Richman N. The prevalence of language delay in a population of three-year-old children and its association with general retardation. Dev Med Child Neurol 1976;18:431-441.
Rescorla L, Ross G, Mc Clure S. Language delay and behavioral/emotional problems in toddlers: Findings from two developmental clinics. J Speech Lang Hear Res 2007;50:1063-1078.
Hurks PP, Vles JS, Hendriksen JG, Kalff AC et al. Semantic category fluency versus initial letter fluency over 60 seconds as a measure of automatic and controlled processing in healthy schoolaged children. J Clin Exp Neuropsychol 2006;28:684-695.
Lynn R. Sex differences on the differential aptitude test. British American Adolescents Educ Psychol 1992;12:101-106.
Mann VA, Sasanuma S, Sakuma N, Masaki S. Sex differences in cognitive abilities: a cross-cultural perspective. Neuropsychologia 1990;28:1063-1077.
Martin DJ, Hoover HD. Sex differences in educational achievement: a longitudinal study. J Early Adolesc 1987;7:65-83.
Undheim JO, Nordvik H. Socio-economic factors and sex differences in an egalitarian educational system: academic achievement in 16-yearold Norwegian students. Scand J Educ Res 1992;36:87-98.
Roulstone S, Loader S, Northstone K. Descriptive data from the Avon longitudinal study of parents and children. Early Child Dev Care 2002;22:259-268.
Voyer D, Voyer S, Bryden M. Magnitude of sex differences in spatial abilities: a meta-analysis and consideration of critical variables. Psychol Bull 1995;117:250-270.
Patterson JL. Expressive vocabulary development and word combinations of Spanish-English bilingual toddlers. Am J Speech Lang Pathol 1998;7:46-56.
Lutchmaya S, Baron-Cohen S, Raggattá P. Foetal testosterone and vocabulary size in 18- and 24-month-old infants. Infant Behav Dev 2002;24:418-424.
Sonnander K. Parental developmental assessment of 18-month-old children: Reliability and predictive value. Dev Med Child Neurol 1987;29:351-362.
Jacobs E, Miller LC, Tirella LG. Developmental and behavioral performance of internationally adopted preschoolers: A pilot study. Child Psychiatry Hum Dev 2009.
Redmond SM. Conversational profiles of children with ADHD, SLI and typical development. Clin Linguist Phon 2004;18:107-125.
Mathers ME. Aspects of Language in Children with ADHD: Applying Functional Analyses to Explore Language Use. J Atten Disord 2006; 9:523-533.
Zentall SS. Production deficiencies in elicited language but not in the spontaneous verbalizations of hyperactive children. J Abnorm Child Psychol 1988;16:657-673.
Barkley RA, Cunningham CE, Karlsson J. The speech of hyperactive children and their mothers: comparison with normal children and stimulant drug effects. J Learn Disabil 1983;16:105-110.
Camarata S, Gibson T. Pragmatic language deficits in attention-deficit hyperactivity disorder. Ment Retard Dev Disabil Res Rev 1999;5:207-214.
Oram J, Fine J, Okamoto C, Tannock R. Assessing the language of children with attention deficit hyperactivity disorder. J Speech Lang Pathol 1999;8:72-80.
Kim OH, Kaiser AP. Language characteristics of children with ADHD. Communic Disord Quart 2000;21:154-165.
Whalen C, Henker B, Collins B, McAuliffe S et al. Peer interaction in a structured communication task: Comparisons of hyperactive boys and of methylphenidate (Ritalin) and placebo effects Child Dev 1979;50:388-401.
Mandell D, Ittenbach R, Levy S, Pinto-Martin JA. Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder. J Autism Developmental Disorders 2007;37(9):1795-1802.
Siklos S, Kerns KA. Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Research in Developmental Disabilities 2007;28(1):9-22.
Ghaziuddin M, Mountain-Kimchi K. Defining the intellectual profile of Asperger Syndrome: Comparison with high-functioning autism. J Autism Dev Disord 2004;34:279-284.
Koyama T, Inada N, Tsujii H, Kurita H. Predicting children with pervasive developmental disorders using the Wechsler Intelligence Scale for Children-Third Edition. Psychiatry Clin Neurosci 2008;62476-62478.
Eisenmajer R, Prior M, Leekam S, Wing L et al. Delayed language onset as a predictor of clinical symptoms in pervasive developmental disorders. J Autism Dev Disord 1998;28(6):527-533.
Glascoe FP. Early detection of developmental and behavioral problems. Pediatri Rev 2000;21:272-279.
Pan BA, Rowe ML, Spier E et al. Measuring productive vocabulary of toddlers in low-income families: concurrent and predictive validity of three sources of data. J Child Lang 2004;31:587–608.
Feldman HM, Dale PS, Campbell TF et al. Concurrent and predictive validity of parent reports of child language at ages 2 and 3 years. Child Dev 2005;76:856–868.
Sachse S, Von Suchodoletz W. Early identification of language delay by direct language assessment or parent report? J Dev Behav Pediatr. 2008;29(1):34-41.
Sachse S, Anke B, von Suchodoletz W. [Early identification of language delay among two-year-olds-a comparison of methods]. Z Kinder Jugendpsychiatr Psychother 2007;35(5):323-331.
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