Deficits in auditory temporal and spectral resolution in language-impaired children

Between 3 and 6 per cent of children who are otherwise unimpaired have extreme difficulties producing and understanding spoken language. This disorder is typically labelled specific language impairment. Children diagnosed with specific language impairment often have accompanying reading difficulties (dyslexia), but not all children with reading difficulties have specific language impairment. Some researchers claim that language impairment arises from failures specific to language or cognitive processing. Others hold that language impairment results from a more elemental problem that makes affected children unable to hear the acoustic distinctions among successive brief sounds in speech. Here we report the results of psychophysical tests employing simple tones and noises showing that children with specific language impairment have severe auditory perceptual deficits for brief but not long tones in particular sound contexts. Our data support the view that language difficulties result from problems in auditory perception, and provide further information about the nature of these perceptual problems that should contribute to improving the diagnosis and treatment of language impairment and related disorders.     

Heterogeneity of auditory verbal working memory in schizophrenia.

The heterogeneity of schizophrenia remains an obstacle for understanding its pathophysiology. Studies using a tone discrimination screening test to classify patients have found evidence for 2 subgroups having either a specific deficit in verbal working memory (WM) or deficits in both verbal and nonverbal memory. This study aimed to (a) replicate in larger samples differences between these subgroups in auditory verbal WM; (b) evaluate their performance on tests of explicit memory and sustained attention; (c) determine the relation of verbal WM deficits to auditory hallucinations and other symptoms; and (d) examine medication effects. The verbal WM and tone discrimination performance did not differ between medicated (n = 45) and unmedicated (n = 38) patients. Patients with schizophrenia who passed the tone screening test (discriminators; n = 60) were compared with those who did not (nondiscriminators; n = 23) and healthy controls (n = 47). The discriminator subgroup showed poorer verbal WM than did controls and a deficit in verbal but not visual memory on the Wechsler Memory Scale–Revised (Wechsler, 1987), whereas the nondiscriminator subgroup showed overall poorer performance on both verbal and nonverbal tests and a marked deficit in sustained attention. Verbal WM deficits in discriminators were correlated with auditory hallucinations but not with negative symptoms. The results are consistent with a verbal memory deficit in a subgroup of schizophrenia having intact auditory perception, which may stem from dysfunction of language-related cortical regions, and a more generalized cognitive deficit in a subgroup having auditory perceptual and attentional dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epilepsy in the school aged child: Cognitive-behavioral characteristics and effects on academic performance.

Discusses the cognitive-behavioral and academic functioning of children with epilepsy, the effects of anticonvulsant medications and other peri-ictal phenomena, and their relative impact on cognitive functioning and school achievement. Learning problems often occur in children with epilepsy, with the greatest difficulties in arithmetic, spelling, reading comprehension, and word recognition. Epileptic children also tend to experience more problems in overall achievement, concentration, and mental processing than nonepileptic children. While epileptic children tend to fall within the normal range of IQ, the distribution of their scores is skewed toward the lower level of functioning. Peri-ictal phenomena can effect brain discharges, which can thereby effect concentration, attention, and learning ability. Anticonvulsant medications have potentially negative side effects on neuropsychological functioning as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychologie de l'épilepsie infantile.

From a neuropsychological standpoint, epilepsy is a very heterogeneous condition. Epilepsies are divided into two categories (focal and generalized) that are differentiated by the neuropsychological symptoms that are present. Cognitive difficulties present in children suffering from focal epilepsy are usually specific to the cerebral area involved, while generalized epilepsies are linked to a diffuse neuropsychological deficit profile as well as to a more limited intellectual functioning. The aim of this article was to establish a neuropsychological profile of the various syndromes of focal and generalized epilepsy, and to outline the psychological and social effects of epilepsy among children with this condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological comparison of alcohol-exposed children with or without physical features of fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is associated with behavioral and cognitive deficits. However, the majority of children born to alcohol-abusing women do not meet the formal criteria for FAS and it is not known if the cognitive abilities of these children differ from those of children with FAS. Using a set of neuropsychological tests, 3 groups were compared: (a) children with FAS, (b) children without FAS who were born to alcohol-abusing women (the PEA group), and (c) normal controls. The results indicated that, relative to controls, both the FAS and the PEA groups were impaired on tests of language, verbal learning and memory, academic skills, fine-motor speed, and visual-motor integration. These data suggest that heavy prenatal alcohol exposure is related to a consistent pattern of neuropsychological deficits and the degree of these deficits may be independent of the presence of physical features associated with FAS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complexities of primary generalized epilepsy

Abnormal arousal responses paired with paroxysmal discharges and photosensitivity are the principal mechanisms in the precipitation of seizures in primary generalized epilepsy. The abnormal arousal responses show a consistent maximum over the frontal midline region. An exception from this rule was found in two children with primary generalized epilepsy (petit mal absences, one also with grand mal) with a strongly positive family history. In these patients, the generalized-synchronous bursts showed a maximum over the vertex (Cz electrode). Both of these children also had single spikes over the Rolandic region. A relationship between primary generalized and benign Rolandic epilepsy is demonstrated. Both forms of seizure disorder are based on dysfunction (hyperexcitability) rather than on a structural epileptogenic lesion. A dichotomy of dysfunctional and structural epilepsies is presented but gray zones of overlap indubitably exist. The limitations of the dichotomy concept are pointed out.     

Mismatch negativity in the neurophysiologic/behavioral evaluation of auditory processing deficits: a case study

The subject of this case report is an 18-year-old woman with grossly abnormal auditory brain stem response (ABR), normal peripheral hearing, and specific behavioral auditory processing deficits. Auditory middle latency responses (MLRs) and cortical potentials N1, P2, and P300 were intact. The mismatch negativity (MMN) was normal in response to certain synthesized speech stimuli and impaired to others--consistent with her behavioral discrimination of these stimuli. Behavioral tests of auditory processing were consistent with auditory brain stem dysfunction. A neuropsychological evaluation revealed normal intellectual and academic performance. The subject was in her first year of college at the time of the evaluation. This case study is important because: (1) Although there have been several reports of absent/abnormal ABR with preserved peripheral hearing and deficits in auditory processing, little is known about the specific nature of the auditory deficits experienced by these individuals. Such information may be valuable to the clinical management of patients with this constellation of findings. (2) Of interest is the information that the mismatch negativity (MMN) cortical event-related potential can bring to the evaluation of patients with auditory processing deficits. The MMN reflects central auditory processing of small acoustic differences and may provide an objective measure of auditory discrimination. (3) From a theorectical standpoint, a patient with neural deficits affecting specific components of the auditory pathway provides insight into the relationship between evoked potentials and physiological mechanisms of auditory processing. How do various components of the auditory pathway contribute to speech discrimination? How might evoked potentials reflect the processes underlying the neural coding of specific features of speech stimuli such as timing and spectral cues?     

Attention and verbal learning in patients with chronic fatigue syndrome

Former neuropsychological studies with Chronic Fatigue Syndrome (CFS) patients evaluated a broad range of cognitive functions. Several, but not all, reported subtle attentional and memory impairments suggesting possible mild cerebral involvement. In this study, a battery of attentional tests and a verbal memory task were administered to 20 CFS patients and 22 healthy controls (HC) in order to clarify the specific nature of attention and memory impairment in these patients. The results provide evidence for attentional dysfunction in patients with CFS as compared to HC. CFS patients performed more poorly on a span test measuring attentional capacity and working memory. Speeded attentional tasks with a more complex element of memory scanning and divided attention seem to be a sensitive measure of reduced attentional capacity in these patients. Focused attention, defined as the ability to attend to a single stimulus while ignoring irrelevant stimuli, appears not to be impaired. CFS patients were poorer on recall of verbal information across learning trials, and poor performance on delayed recall may be due to poor initial learning and not only to a retrieval failure.     

Predicting reading and mathematics achievement in fourth-grade children from kindergarten readiness scores.

This study examined age and gender differences in verbal skills and visuomotor skills at kindergarten, in achievement in reading and mathematics at Grade 4, and in the link between skills at kindergarten and later achievement (n?=?281). Older children had higher verbal skills and visuomotor skills than younger children, and girls had higher visuomotor skills and reading achievement than boys. With controls for age, verbal skills uniquely predicted later reading achievement, whereas both verbal skills and visuomotor skills uniquely predicted later mathematics achievement. Readiness in the specific areas of auditory memory and verbal associations predicted later reading achievement, whereas readiness in the specific areas of auditory memory, number skills, and visual discrimination predicted later mathematics achievement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlation of auditory 'oddball' P300 with verbal memory deficits in schizophrenia

BACKGROUND: The study attempts to recruit well known 'cognitive' event related potential measures as an objective estimate of cognitive and specific memory impairment in schizophrenia. METHODS: We examined 19 schizophrenic patients and 28 healthy controls using an auditory discrimination task to elicit event related potentials, and a number of neuropsychological tests, including tests of general intellectual ability, putative frontal lobe function and verbal memory. RESULTS: The late positive deflection presumed to be associated with stimulus evaluation (P300) was of lower amplitude and had a longer latency in the patients compared with controls of similar age and sex. We found correlations between P300 amplitude and latency, and neuropsychological performance scores in patients. There were correlations between decreased P300 amplitude and lower IQ and poorer memory performance, in particular, abnormal semantic clustering, discriminability and intrusion errors. Increased P300 latency was correlated with lower pre-morbid IQ, poorer total memory scores and serial clustering, but paradoxically less relative retrieval deficit and fewer intrusion errors. CONCLUSIONS: These findings suggest that abnormal P300 is generally more likely to occur in patients with memory impairment.     

Neuropsychological functioning among the nonpsychotic relatives of schizophrenic patients: A 4-year follow-up study.

In a prior study of 54 relatives of patients with schizophrenia and 72 control participants, 3 neuropsychological functions met the criteria for risk indicators of the schizophrenia genotype: executive functioning, memory, and auditory attention. In an assessment of the stability of these findings, the sample was reexamined 4 years after the initial assessment. Three test scores were found to differ between groups (Immediate Verbal Memory, Delayed Verbal Memory, and Dichotic Listening Digits Detected) or to show a significant Group?×?Gender interaction (immediate and delayed verbal and visual memories). None of the test scores showed Group?×?Time interactions, suggesting that the discriminating power of the tests was stable over time. Evidence for deficits in working memory and rule learning on the object alternation test was also found. These results support the idea that neuropsychological dysfunction among relatives of patients with schizophrenia is a stable trait caused by the familial predisposition to schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fluency and memory differences between ischemic vascular dementia and Alzheimer's disease.

This study compared 32 patients with ischemic vascular dementia (IVD) to 32 patients with probable Alzheimer's disease (AD) on select language and verbal memory tests. The IVD and AD patients were individually matched on the basis of age, dementia severity, years of education, and gender. The IVD patients had poorer verbal fluency, but better free recall, fewer recall intrusions, and better recognition memory than the AD patients. Relationships between the neuropsychological measures and radiological indexes of cortical and subcortical pathology were also examined. Number of infarcts, white-matter lucency, and ventricular enlargement correlated with some of the neuropsychological measures; cortical atrophy correlated with most of the measures. The findings suggest that neuropsychological deficits in IVD may be related to dysfunction of frontal-subcortical circuits, although an associated degenerative cortical process may also be involved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal and nonverbal memory processing in patients with obsessive-compulsive disorder: Its relationship to clinical variables.

Memory deficits have been reported in several neuropsychological studies of obsessive-compulsive disorder (OCD). Dysfunction in nonverbal memory has been consistently reported, whereas findings on verbal memory are more heterogeneous. The authors studied 50 patients with OCD who were matched for sex, age, educational level, and hand dominance with 50 healthy controls (HC). Cognitive performance in both groups was assessed on verbal and nonverbal memory tasks, and several clinical variables were also assessed in the patient group. Patients with OCD showed a pattern of cognitive dysfunction with alterations in areas of nonverbal memory (recall and recognition), and verbal memory (learning and recall). Older age at onset of OCD was associated with poorer performance on verbal memory tasks. Low scores on some verbal memory tasks were associated with severity of OCD, and nonverbal memory was influenced by depressive symptoms. The study suggests the existence of dysfunction in the execution of verbal and nonverbal memory tasks in OCD; the influence of clinical variables depends on the specific neuropsychological function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Language comprehension in learning disabled children who perform poorly on memory span tests.

Conducted three studies of language comprehension skills in 9- and 10-year-old learning disabled (LD) children who have extreme difficulties retaining brief sequences of verbal information. The performance of this subgroup of LD children is contrasted with other LD subjects who perform normally on memory span tests and with normally achieving subjects. In Experiment 1 we showed that although children in the target subgroup had difficulties remembering the specific words and word order used in expository passages, they were not different from the two control groups in their comprehension of the passages. In Experiment 2 we showed that the gist recall of idea units from two folk tales was equally influenced in all groups by the thematic importance of the idea units being recalled. The primary inference was that the groups comprehended the stories equally well. Experiment 3 showed that children in the subgroup with memory limitations had more difficulty than children in the other two groups in following simple directions involving the manipulation of blocks. They were impaired in their ability to follow sequences of directions whether order of execution was important or not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hemispheric function in developmental language disorders and high-level autism

Two groups of children with contrasting types of developmental language disorder (phonologic-syntactic and semantic-pragmatic) were compared with a group of children with high-level autism and with a control group of normal children on a broad battery of neuropsychological tests, known to be sensitive to left-right hemisphere damage. Significant differences found between the groups suggest contrasting forms of hemispheric dysfunction.     

Verbal and visuospatial performance in male alcoholics: A test of the premature-aging hypothesis.

Tested the premature-aging hypothesis of generalized dysfunction, using a paired-associate learning test that has separate verbal and visuospatial subtests of the same structure and method. Ss were 36 hospitalized White male chronic alcoholics (mean age 42.4 yrs), 36 control Ss (mean age 42.5 yrs), and 24 elderly Ss (mean age 71.4 yrs). Ss were also administered the Shipley Institute of Living Scale for Measuring Intellectual Impairment and Memory-for-Designs test. Results show that elderly control Ss performed significantly worse than middle-aged control Ss on both learning subtests. For Ss between 30 and 80 yrs of age, increasing age resulted in increasing errors. According to the generalized dysfunction hypothesis, the performance of alcoholics should be similar to that of the elderly, showing impairment compared to control Ss on both learning tests. However, alcoholics performed at the same level as the middle-aged control Ss on verbal learning and were significantly poorer on visuospatial learning. The generalized dysfunction version of the premature-aging hypothesis for performance of alcoholics on neuropsychological tests was not supported. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual memory change after anterior temporal lobectomy: a base rate analysis using regression-based outcome methodology

PURPOSE: To characterize patterns of base rate change on measures of verbal and visual memory after anterior temporal lobectomy (ATL) using a newly developed regression-based outcome methodology that accounts for effects of practice and regression towards the mean, and to comment on the predictive utility of baseline memory measures on postoperative memory outcome. METHODS: Memory change was operationalized using regression-based change norms in a group of left (n = 53) and right (n = 48) ATL patients. All patients were administered tests of episodic verbal (prose recall, list learning) and visual (figure reproduction) memory, and semantic memory before and after ATL. RESULTS: ATL patients displayed a wide range of memory outcome across verbal and visual memory domains. Significant performance declines were noted for 25-50% of left ATL patients on verbal semantic and episodic memory tasks, while one-third of right ATL patients displayed significant declines in immediate and delayed episodic prose recall. Significant performance improvement was noted in an additional one-third of right ATL patients on delayed prose recall. Base rate change was similar between the two ATL groups across immediate and delayed visual memory. Approximately one-fourth of all patients displayed clinically meaningful losses on the visual memory task following surgery. Robust relationships between preoperative memory measures and nonstandardized change scores were attenuated or reversed using standardized memory outcome techniques. CONCLUSIONS: Our results demonstrated substantial group variability in memory outcome for ATL patients. These results extend previous research by incorporating known effects of practice and regression to the mean when addressing meaningful neuropsychological change following epilepsy surgery. Our findings also suggest that future neuropsychological outcome studies should take steps towards controlling for regression-to-the-mean before drawing predictive conclusions.     

Can bipolar disorder-specific neuropsychological impairments in children be identified?

This study examined neuropsychological deficits among children with bipolar disorder while attending to its comorbidity with attention-deficit/hyperactivity disorder (ADHD). Seventy-three unmedicated children (ages 6-17 years) with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) bipolar disorder plus ADHD (BPD + ADHD) were compared with 102 unmedicated children with ADHD without bipolar disorder, and 120 children without bipolar disorder or ADHD. Ninety-four percent of participants were Caucasian, 58% were male, and 42% were female. On average participants were of middle to upper socioeconomic status. Participants were assessed with a comprehensive neuropsychological battery and measures of academic achievement, school failure, and special education placement. Participants with BPD + ADHD and with ADHD were impaired in interference control, verbal learning, and arithmetic achievement and had higher rates of special school services. Across all of the measures of neuropsychological functioning, the only difference observed between youths with BPD + ADHD and youths with ADHD was that youths with BPD + ADHD performed more poorly on one measure of processing speed. Thus, comorbidity with ADHD may account for many of the neuropsychological deficits observed in children with bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention problems in epilepsy: possible significance of the epileptogenic focus

Investigation of the relation between epilepsy and cognition presents serious methodologic problems because several factors may contribute to impair neuropsychological performances in epileptic persons. Benign epilepsy of childhood with rolandic paroxysmal discharges (EPR) may be a very useful model of investigation in relation to opportunity to examine subjects without brain damage, therapy, and negative environmental influences. Thus, neuropsychological dysfunction in patients with EPR may support the hypothesis that epilepsy itself plays a specific role in the genesis of cognitive disturbances. We assessed the impact of the laterality of the epileptogenic focus on cognition of children with EPR. All subjects performed a figure cancellation task, a test used to evaluate mainly attention mechanisms and abilities in processing visuospatial information. Results showed that children with right-sided (or bilateral) focus scored worse, whereas children with left-sided focus performed as well as the control subjects. Our data agree with those of studies suggesting that focal discharges may be related to poor cognitive performance. Evidence of a concordance between neurophysiologic and neuropsychologic findings may have great practical and theoretical implications in management of epileptic patients.