Outcomes at school age of preschool children with developmental language impairment

doi:10.1016/j.pediatrneurol.2004.12.008

Pediatric Neurology

Volume 32, Issue 4, April 2005, Pages 264-269

https://doi.org/10.1016/j.pediatrneurol.2004.12.008 Get rights and content

In a prospective study, preschool children diagnosed with developmental language impairment were systematically reassessed during the early school years with standardized developmental (Battelle Developmental Inventory) and functional measures (Vineland Adaptive Behavior Scale). Of an original cohort of 70 children assessed and diagnosed at a mean age of 3.6 ± 0.7 years, 43 were reassessed at a mean age of 7.4 ± 0.7 years. Group performance on the Battelle overall was 71.9 ± 8.2 with the lowest sub-domain score in communication at 69.5 ± 8.9. On the Battelle, 67% of children fell below the 1.5 standard deviation (S.D.) cutoff signifying significant developmental concerns. Between 36% (gross motor) and 83% (communication) of the cohort performed at least 1.5 S.D. below the normative mean on the individual domains of the Battelle. Seventy-four percent were impaired in two or more domains of the Battelle. The group mean on the Vineland overall was 81.1 ± 16.9 with between 19% (socialization) to 48% (communication) of the cohort scoring more than 1.5 S.D. below the mean on each of the sub-domains. Almost half of the cohort (20/42, 48%) manifested functional impairment in at least two domains of the Vineland. Univariate and multivariate analysis of potential predictor variables identified only female sex as being predictive of significantly poorer performance on the Vineland communication sub-domain and the Vineland total score.

Children with early developmental language impairment demonstrate persistent impairments in developmental and functional skills at school entry not limited to language. Deficits remain especially evident in the communication sub-domain. These results have implications with respect to later prognostication, family counseling, and devising a programmatic approach to this group of children.

Introduction

Early childhood neurodevelopmental disabilities are chronic disorders featuring a significant and continued impact on the child’s developmental trajectory. These disorders share as an essential feature the predominant disturbance in the acquisition of motor, language, cognitive, or social skills [1]. Developmental language impairment, also known as developmental language disorders, specific language impairment, or developmental dysphasia, is one of the two most common subtypes of childhood developmental disability [2]. It is defined as an isolated significant delay in the proper use of communicative expressive or receptive language in the absence of observed cognitive impairment, hearing loss, or abnormal social interactions [3].

Typically children with a developmental language impairment are diagnosed by health professionals at preschool age. Little is known regarding the natural history of this diagnostic construct with reference to its nosologic stability, temporal evolution, and predictive validity with reference to eventual developmental and functional outcomes. Longitudinal outcome research in children with this disorder has focused largely on cognitive, language, and academic skills [2], [3], [4], [5], [6], [7], [8], [9], [10]. A better knowledge of developmental and functional outcomes would allow for improved counseling of parents at initial diagnosis regarding expectations and would also provide for the rational design of a programmatic approach to this patient group featuring intermittent assessments and needed interventions over the lifespan. Theoretically this approach would better optimize both service utilization and eventual individual and family outcome.

The primary objective of this study was to determine the developmental and functional outcomes at school entry (age 7–8 years) of young children (i.e., <5 years of age at initial diagnosis) with developmental language impairment. Efforts were also undertaken as a secondary objective to identify possible predictor variables at initial intake regarding eventual outcome.

Section snippets

Subjects

A prospective cohort study was undertaken using a previously defined cohort assembled over an 18-month interval at the Montreal Children’s Hospital of the McGill University Health Center. The initial study evaluated etiologic yield across developmental disability subtypes [11], [12], [13], [14]. Children were included in the original cohort if they met the following inclusion criteria: (a) less than 5 years of age, (b) initial medical evaluation of a suspected developmental delay, and (c)

Results

Of the original cohort’s 70 children with developmental language impairment, 43 (61%) were recruited for participation in the current study assessing outcome at school age. Of the 27 (39%) children not recruited, 14 (20%) were lost to follow-up and 13 (19%) refused follow-up. The age of initial parental concern about their child’s development was lower in the group who underwent follow-up (mean age 1.9 ± 0.7 years) than in the group who did not undergo follow-up (mean age 2.2 ± 0.6 years),

Discussion

Longitudinal studies of preschool children with developmental language impairment have focused on language, cognitive, and academic outcomes [2], [3], [4], [5], [6], [7], [8], [9], [10]. Persisting language, academic, and social difficulties have been highlighted in the most recent study reported [7]. Conflicting results with respect to language outcomes have been documented. Some authors have reported persistent delays in language development when both expressive and receptive elements were

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Cited by (31)

Not only motor skill performance but also haptic function is impaired in children with developmental language disorder
2023, Research in Developmental Disabilities
Previous studies have found an association between motor immaturity and developmental language impairment in children. However, systematic investigations of somatosensory dysfunctions that might be linked to motor deficits in children with developmental language disorder (DLD) are lacking.
Examined haptic perception and motor skills in school-age children with DLD and typically-developing (TD) children.
Sixteen children with DLD and sixteen age-matched TD children performed a curvature detection task measuring haptic sensitivity and a curvature discrimination task measuring haptic acuity. The Movement Assessment Battery for Children, 2nd edition (MABC-2) was also conducted to evaluate children’s motor ability.
The results revealed elevated thresholds of both haptic detection (67.5%) and haptic discrimination (67.9%) in the DLD group when compared to the TD group. In addition, the children with DLD performed significantly less well on the manual dexterity of MABC-2. Finally, a lower haptic acuity was associated with poorer manual dexterity scores of MABC-2.
This study demonstrates for the first time that not only motor skills, but also haptic function is altered in children with DLD. The observed association between manual dexterity and haptic acuity suggests a close relationship between haptic and motor skills in school-age children.
High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy
2014, Pediatric Neurology
Citation Excerpt :
Current literature regarding children 2-4.5 years old reports the prevalence of language delay as 5-8%; the incidence for children at age 36 months is 14-15.6%.2 Although earlier studies18 suggest that preschool children with normal cognitive function who suffer isolated delay in language development usually reach normal language skills later, a more recent study reveals that children with isolated language delay without observed cognitive impairments or hearing loss have higher risk of developmental difficulties by age 7-8 years.19 Previous studies have also reported an association between language and motor impairments in school-aged children.6-8
An association of language impairment with neonatal brachial plexus palsy has not been reported in the literature. The current treatment paradigm for neonatal brachial plexus palsy focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with neonatal brachial plexus palsy and potential neonatal brachial plexus palsy–related factors involved.
Twenty toddlers with neonatal brachial plexus palsy were consecutively recruited (12 males and eight females; mean age, 30 months). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. Neonatal brachial plexus palsy–related factors such as palsy side, treatment type, Narakas grade, muscle Medical Research Council score, and Raimondi hand score were reported. Student t test, chi-square test, or Fisher exact test were applied. Statistical significance level was established at P < 0.05.
Of study participants, 30% had language delay, whereas the prevalence of language delay in the population with normal development in this age range was approximately 5-15%.
We observed high language delay prevalence among toddlers with neonatal brachial plexus palsy. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population.
Motor skills, haptic perception and social abilities in children with mild speech disorders
2012, Brain and Development
Citation Excerpt :
AD do not usually have an identifiable cause, such as sensory (e.g., hearing), structural or neurological problems [3]. Despite an initial diagnosis of isolated SLI, children with significant speech/language problems that persist to age 5 years may show risk for additional developmental impairments [5,6]. The prevalence of motor dysfunctions in children with SLI varies from about 40% to 90%, thereat the fine-motor skills are reported to be more affected than gross-motor skills [2,6–9].
Aim: The aim of the study was to evaluate motor skills, haptic object recognition and social interaction in 5-year-old children with mild specific expressive language impairment (expressive-SLI) and articulation disorder (AD) in comparison of age- and gender matched healthy children. Methods: Twenty nine children (23 boys and 6 girls) with expressive-SLI, 27 children (20 boys and 7 girls) with AD and 30 children (23 boys and 7 girls) with typically developing language as controls participated in our study. The children were examined for manual dexterity, ball skills, static and dynamic balance by M-ABC test, haptic object recognition and for social interaction by questionnaire completed by teachers. Results: Children with mild expressive-SLI demonstrated significantly poorer results in all subtests of motor skills (p < 0.05), in haptic object recognition and social interaction (p < 0.01) compared to controls. There were no statistically significant differences (p > 0.05) in measured parameters between children with AD and controls. Children with expressive-SLI performed considerably poorer compared to AD group in balance subtest (p < 0.05), and in overall M-ABC test (p < 0.01). Conclusions: In children with mild expressive-SLI the functional motor performance, haptic perception and social interaction are considerably more affected than in children with AD. Although motor difficulties in speech production are prevalent in AD, it is localised and does not involve children’s general motor skills, haptic perception or social interaction.
Neurodevelopmental and neurofunctional outcomes in children with congenital diaphragmatic hernia
2011, Early Human Development
Citation Excerpt :
Psychomotor dysfunction interferes with the acquisition of every day skills and neurocognitive and social emotional development [35–37]. Because early language and psychomotor deficits have been associated with learning disorders and social difficulties [37–39], it is possible that subtle neurocognitive problems will become more evident with age. Taken together, CDH infants are at risk for neurocognitive and psychomotor performance problems.
The objective of this review was to provide a critical overview of our current understanding on the neurocognitive, neuromotor, and neurobehavioral development in congenital diaphragmatic hernia (CDH) patients, focusing on three interrelated clinical issues: (1) comprehensive outcome studies, (2) characterization of important predictors of adverse outcome, and (3) the pathophysiological mechanism contributing to neurodevelopmental disabilities in infants with CDH. Improved survival for CDH has led to an increasing focus on longer-term outcomes. Neurodevelopmental dysfunction has been recognized as the most common and potentially most disabling outcome of CDH and its treatment. While increased neuromotor dysfunction is a common problem during infancy, behavioral problems, hearing impairment and quality of life related issues are frequently found in older children and adolescence. Intelligence appears to be in the low normal range. Patient and disease specific predictors of adverse neurodevelopmental outcome have been defined. Imaging studies have revealed a high incidence of structural brain abnormalities. An improved understanding of the pathophysiological pathways and the neurodevelopmental consequences will allow earlier and possibly more targeted therapeutic interventions. Continuous assessment and follow-up as provided by an interdisciplinary team of medical, surgical and developmental specialists should become standard of care for all CDH children to identify and treat morbidities before additional disabilities evolve and to reduce adverse outcomes.
Neurodevelopmental outcome of infants with congenital diaphragmatic hernia prospectively enrolled in an interdisciplinary follow-up program
2010, Journal of Pediatric Surgery
Citation Excerpt :
Psychomotor dysfunction interferes with the acquisition of everyday skills and neurocognitive and social emotional development [28-30]. Furthermore, early language and psychomotor deficits have been associated with learning disorders and social difficulties during school years [30-32]. Whether the increased incidence of neurodevelopmental impairment among CDH survivors that underwent ECMO therapy reflects a more severe primary disease or a greater number of ECMO-associated complications continues to be debated, and probably both are true.
The purpose of the study was to evaluate the neurodevelopmental outcome in infants with congenital diaphragmatic hernia (CDH).
Between June 2004 and September 2007, 41 CDH survivors were prospectively enrolled in an interdisciplinary follow-up program. Neurodevelopmental status was evaluated using the Bayley Scales of Infant Development II (prior 2006, n = 9), the Bayley Scales of Infant Development III (after 2006, n = 27), or the Wechsler Preschool and Primary Scale of Intelligence III (children older than 4 years, n = 5). Scores were grouped as average, mildly delayed, and severely delayed by standard deviation intervals (115-85, 71-84, <70), and mixed if average and mildly delayed in either cognitive or language.
Median age at last assessment was 24 months (range, 6-62). Average, mixed, mildly delayed, and severely delayed scores for neurocognitive and language skills were found in 49%, 19%, 17%, and 15%, respectively. Psychomotor scores were normal, mildly delayed, and severely delayed in 46%, 23%, and 31%, respectively. Autism was present in 7%. Abnormal muscle tonicity was found in 51% (49% hypotonic, 2% hypertonic). Multivariate risk factors for borderline or delayed neurodevelopmental, neurocognitive, and/or psychomotor outcome were intrathoracic liver position (P = .02), presence of a right-sided CDH (P = .02), extracorporeal membrane oxygenation need (P < .001), Gore-Tex patch repair (P = .02), O₂ requirement at 30 days of life (P < .01), and hypotonicity (P < .01).
The prospective evaluation in an interdisciplinary follow-up program uncovered striking morbidities in neurodevelopmental status in approximately half of the CDH infants. The most common neurologic sequelae are neuromuscular hypotonicity and psychomotor dysfunction. Patient-specific factors are important determinants of adverse neurologic outcome.
Neurodevelopmental outcomes of congenital diaphragmatic hernia survivors followed in a multidisciplinary clinic at ages 1 and 3
2008, Journal of Pediatric Surgery
Citation Excerpt :
Webster et al [29] found that approximately half of children with developmental language disorders also had gross and fine motor delays. Both language and motor deficits have also been associated with learning disorders and social difficulties during the school years [27,30-32]. Developmental therapies have been found to be helpful in addressing areas of developmental deficit [29,33].
Infants who survive congenital diaphragmatic hernia (CDH) repair may have ongoing medical and neurodevelopmental morbidity after hospital discharge. We evaluated the relationship between medical and neurodevelopmental outcomes of CDH survivors seen in a multidisciplinary clinic at ages 1 and/or 3.
From January 1997 to December 2004, 69 (61%) of 112 CDH survivors were followed in our CDH clinic at ages 1 and/or 3. Medical issues (cardiac, pulmonary, gastrointestinal) were tabulated at hospital discharge and at follow-up. Neurodevelopmental data were obtained from clinic assessments by a neurodevelopmental pediatrician. Descriptive results were summarized for each cohort. Multivariate analyses were performed to identify predictors of motor problems at age 1.
Of the 69 study participants, 64% were male, 75% had left-sided CDH, 17% had cardiac anomalies, and 25% had other congenital malformations. Nearly all required ventilator management (99%) with a median ventilator time of 14 days (range, 1-54 days); 30% required extracorporeal membrane oxygenation. While 87% of patients had medical issues at hospital discharge, 61% and 67% had medical issues at ages 1 and 3, respectively. Pulmonary problems were noted in 34% and 33% of the ages 1 and 3 cohorts, respectively. Motor and language problems were detected in 60% and 18% of the age 1 cohort and 73% and 60% of the age 3 cohort, respectively. Multivariate analysis found ventilator time as the only independent predictor of motor problems at age 1 (odds ratio, 1.12 per day; 95% confidence interval, 1.05-1.20; P < .01).
Young CDH survivors continue to have ongoing medical problems and a high incidence of motor and language problems. Duration of neonatal ventilatory support was a significant predictor of motor problems at age 1. Prospective studies are needed to confirm these findings.

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Original articlesOutcomes at school age of preschool children with developmental language impairment

Introduction

Section snippets

Subjects

Results

Discussion

Sem Pediatr Neurol

J Pediatr

J Pediatr

Brain Devel

Sem Pediatr Neurol

A study of the prevalence, stability and significance of developmental language delays in preschool children

Dev Med Child Neurol

Disorders of higher cortical function in preschoolers

Preschoolers with language disorders10 years later

J Speech Lang Hear Res

Language-impaired preschoolersA follow-up into adolescence

J Speech Lang Hear Res

Developmental language delay from three to seven years and its significance for low intelligence and reading difficulties at age seven

Dev Med Child Neurol

A longitudinal study of children with developmental language delay at age threeLater intelligence, reading and behavior problems

Dev Med Child Neurol

Original articles
Outcomes at school age of preschool children with developmental language impairment