Evaluating atypical language in autism using automated language measures

Measurement of language atypicalities in Autism Spectrum Disorder (ASD) is cumbersome and costly. Better language outcome measures are needed. Using language transcripts, we generated Automated Language Measures (ALMs) and tested their validity. 169 participants (96 ASD, 28 TD, 45 ADHD) ages 7 to 17 were evaluated with the Autism Diagnostic Observation Schedule. Transcripts of one task were analyzed to generate seven ALMs: mean length of utterance in morphemes, number of different word roots (NDWR), um proportion, content maze proportion, unintelligible proportion, c-units per minute, and repetition proportion. With the exception of repetition proportion (p $$= .07$$ = . 07 ), nonparametric ANOVAs showed significant group differences (p$$< 0.01$$ < 0.01 ). The TD and ADHD groups did not differ from each other in post-hoc analyses. With the exception of NDWR, the ASD group showed significantly (p$$< 0.01$$ < 0.01 ) lower scores than both comparison groups. The ALMs were correlated with standardized clinical and language evaluations of ASD. In age- and IQ-adjusted logistic regression analyses, four ALMs significantly predicted ASD status with satisfactory accuracy (67.9–75.5%). When ALMs were combined together, accuracy improved to 82.4%. These ALMs offer a promising approach for generating novel outcome measures.

Communication Limitations in Patients With Progressive Apraxia of Speech and Aphasia

Purpose Individuals with primary progressive apraxia of speech (AOS) have AOS in which disruptions in articulation and prosody predominate the speech pattern. Many develop aphasia and/or dysarthria later in the disease course. The aim of this study was to describe the communication limitations in these patients, as measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating. Method Speech and language evaluations were completed for 24 patients with progressive AOS ( n = 7 with isolated AOS; n = 17 with a combination of AOS and aphasia). Descriptive comparisons were utilized to evaluate differences in communication measures among patients with various combinations of MSDs and aphasia. Differences associated with phonetic predominant or prosodic predominant AOS were also examined. Across the entire cohort, correlations were calculated between the participation ratings and other clinical assessment measures. Results The CPIB reflected greater limitations for those with aphasia and AOS compared to isolated AOS, but was not notably different when dysarthria occurred with AOS ( n = 9/24). Across the cohort, there were statistically significant correlations between the CPIB and ASHA FCM–Motor Speech and Language Expression ratings and the MSD severity rating. The CPIB did not correlate with the ASHA FCM–Language Comprehension or other speech-language measures. Conclusions Patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits. The study suggests measures of severity cannot be assumed to correlate with measures of participation restrictions and offers a foundation for further research examining the day-to-day sequela of progressive speech and language disorders. Supplemental Material https://doi.org/10.23641/asha.12743252

SURG-40. SURGICAL RESECTIONS IN BROCA’S AREA DO NOT LEAD TO BROCA’S APHASIA

Brodmann’s areas 44/45 of the inferior frontal gyrus (IFG), are the seat of Broca’s area. The Western Aphasia Battery is a commonly used language battery that diagnoses aphasias based on fluency, comprehension, naming and repetition. Broca’s aphasia is defined as low fluency (0-4/10), retained comprehension (4-10/10), and variable deficits in repetition (0-7.9/10) and naming (0-8/10). The purpose of this study was to find anatomic areas associated with Broca’s aphasia. Patients who underwent resective brain surgery in the dominant hemisphere were evaluated with standardized language batteries pre-op, POD 2, and 1-month post-op. The resection cavities were outlined to construct 3D-volumes of interest. These were aligned using an affine transformation to MNI brain space. A voxel-based lesion-symptom mapping (VLSM) algorithm determined areas associated with Broca’s aphasia when incorporated into a resection. Post-op MRIs were reviewed blindly and percent involvement of pars orbitalis, triangularis and opercularis was recorded. 287 patients had pre-op and POD 2 language evaluations and 178 had 1 month post-op language evaluation. 82/287 patients had IFG involvement in resections. Only 5/82 IFG resections led to Broca’s aphasia. 11/16 patients with Broca’s aphasia at POD 2 had no involvement of IFG in resection. 35% of IFG resections were associated with non-specific dysnomia and 36% were normal. By one-month, 76% of patients had normal speech. 80% of patients with Broca’s aphasia at POD 2 improved to normal speech at 1-month, with 20% improved to non-specific dysnomia. The most highly correlated (P&lt; 0.005) anatomic areas with Broca’s aphasia were juxta-sylvian pre- and post-central gyrus extending to supramarginal gyrus. While Broca’s area resections were rarely associated with Broca’s aphasia, juxta-sylvian pre- and post-central gyri extending to the supramarginal gyrus were statistically associated with Broca’s type aphasia when resected. These results have implications for planning resective brain surgery in these presumed eloquent brain areas.

THE APPRAISAL ANALYSIS OF CHARACTER IN RESOLUTION PART OF THE OLD MAN AND THE SEA BY ERNEST HEMINGWAY

This research aimed to analyze the character of Santiago in resolution part of the novel “The Old Man and The Sea” by Ernest Hemingway using SFL Appraisal Theory. From the data analysis, it was found that attitude (affect) and graduation (force) dominated the appraisal items in the resolution part of “The Old Man and The Sea”. In total there were 34 appraisal items found. There were 11 appraisal items on affect found (29.72%), 3 items on judgment (8.1%), 1 item on appreciation (2.7%), 5 items on engagement (13.5%) and 17 items on graduation (45.94%). Those expressions developed from character revelation through dialogue and narration on setting, and those difference marks significant importance of character’s development in the resolution part. The character revelations found in the resolution part are: reflective, affectionate (caring and loving), humble, wise, realistic, and optimistic. This research showed the contribution of appraisal theory, especially attitude and graduation to develop a character in fiction, to be more exact, vivid, and naturally convincing. In the context of language teaching, the awareness of linguistics expression, language evaluations on meanings and values are relevant to be introduced from early to get better understanding of the language.

Clinical Profiling of a Bilingual Client with Anomic Aphasia

Background: Aphasia is an acquired condition affecting auditory comprehension, verbal expression, reading, writing and word-finding abilities along with sensory-motor impairments. Anomia refers to difficulty in word retrieval or naming which is seen irrespective of the type of aphasia. However, if a patient shows word-finding difficulty, in specific, a diagnosis of Anomic aphasia is made. There are variations within anomic aphasia on which the management and recovery depend. The article provides one such case report. Purpose: Speech and language profiling in anomic aphasia, specific treatment strategies, the effect of bilingualism on recovery. Methods: Mr S, a 38-year-old bilingual male reported 5 months post-stroke with difficulty in expressing, difficulty in writing and weakness in the right side of the body. Medical history was checked and speech and language evaluations including both formal and informal assessments were performed. After this, a diagnosis of Anomic aphasia with mild dysarthria was made. An appropriate speech–language therapeutic plan and specific activities were formulated for Mr S in his first language (L1) and he was given a therapy for a span of 3 months. A follow-up evaluation in both first and second language of the patient yielded differential recovery patterns. Results: The diagnosis was affected by different variants of anomic aphasia; treatment was specific to the clinical profiling and followed life-participation approach of aphasia. The recovery was affected by differential recovery patterns between the languages. Discussion: Factors pertaining to diagnosis, recovery, bilingualism and treatment of the client with anomic aphasia are discussed.

Attention, Speech-Language Dissociations, and Stuttering Chronicity

Summary The purpose of this study was to investigate the singular and joint contributions of speech-language dissociations and attention (i.e., distractibility and attention span) to stuttering chronicity. Method Participants, aged 3;0–4;11 (years;months) at an initial visit, were classified as persisting ( n = 10; 9 boys), recovered ( n = 32; 23 boys), and nonstuttering ( n = 28; 19 boys) based on multiple speech and language evaluations spread across 2 years. The evaluations included assessments of articulation, receptive and expressive vocabulary, and omnibus receptive and expressive language. These measures were used to identify speech-language dissociations using a correlation-based statistical approach. Attentional characteristics, which included measures of distractibility and attention span, were based on parent report. Analyses investigated between-group differences related to dissociations and attentional characteristics as well as the relation between these indices. Results There were no significant between-group differences for the persisting and recovered groups on measures of speech-language dissociations; however, the recovered group was found to exhibit less optimal attention span than the persisting group. In addition, children with dissociations exhibited less optimal distractibility and attention spans at the final time point than children without dissociations. Conclusions Present results indicate that attention is related to both stuttering chronicity and the presence of speech-language dissociations; however, they do not support the notion that dissociations are associated with stuttering persistence. These results provide novel insights into the complex nature of the association between developmental stuttering, speech-language dissociations, and attention.

Navajo Speech and Language Evaluation

The case study highlights the importance of culturally and linguistically appropriate assessment of young Navajo/American Indian children and the importance of alternative assessment procedures to support appropriate diagnoses and recommendations. The case also illustrates systemic issues that result in lack of coordinated care, appropriate diagnosis, and lack of American Indian speech-language pathologists who understand linguistic and cultural differences. The case is based on a typical experience when clinicians who are not familiar with the Navajo language perform speech-language evaluations in Navajo-speaking communities.

Continuous Quality Improvement Processes in Child Protection: A Systematic Literature Review

Purpose: Protecting children from mistreatment is a global concern, and further research and evaluation in child protection services is required. Continuous Quality Improvement (CQI) has demonstrated potential, but to date, there is no systematic review of studies that evaluate the application of CQI in child protection. Method: This systematic literature review examined the application of CQI in child protection services. The review identified published, English-language evaluations of CQI in child protection from 2000 to 2016 and critiqued the characteristics, methodological quality, and reported benefits of the included studies. Results: A search of social science electronic databases identified eight peer-reviewed studies, including six quantitative studies, one mixed-methods study, and one qualitative study. Discussion: The review highlighted that many studies on this topic lack specific validating data, but there is evidence that CQI models have some potential to improve processes for working with children and families by promoting implementation fidelity.