Comprehension, expression of speech may be impaired: communication disorders.
Receptive problems involve the ability to interpret language. These patients often speak well but don't always understand what is said to them, said Dr. Levine, professor of pediatrics at the University of North Carolina at Chapel Hill.
Pediatricians and others who have only intermittent contact with these children may not notice anything untoward; these patients do very well in casual conversation, but their problems are apparent in school. They can't express themselves when asked to write an essay or to analyze a story or poem out loud. Other signs include tuning out verbal explanations, following directions with difficulty, and struggling with mathematical word problems despite demonstrating good basic math skills.
Children with receptive communication problems may also display attention deficits, but attention-deficit hyperactivity disorder (ADHD) is a separate entity. Academic problems and ADHD may coexist, but ADHD by itself is not enough to cause major academic delays. 'Any time there is a delay in spelling or writing or reading, you have to ask what else is there besides the attention deficit," said Dr. Levine, who also directs the center for development and learning at the university.
In early adolescence, the language centers in the brain normally expand, and children's language skills become more sophisticated. Their speech becomes more densely packed with information and increasingly abstract ideas.
But not everyone makes this transition. One test of a 13- or 14-year-old's higher language skills is to ask her to give two different meanings to an ambiguous sentence, such as: "It is too hot to eat." Patients with higher language deficits will think of only one meaning, or may not understand the question at all and wonder how one sentence can have two different interpretations.
Another test is to ask the patient to draw a conclusion from a hypothetical situation. For example, suppose Suzy and Judy like to play with each other every day after school, but each night before they go to bed they argue and fight. How do Suzy and Judy know each other? An adolescent with a higher language problem might reply that the information isn't given or that Suzy and Judy know each other "because they play together." This patient would not infer that the girls in the story are sisters.
Expressive disorders involve language production and output. These disorders may affect a child's academic performance, because one component of understanding concepts is the ability to explain them in one's own words. Pediatricians are in a good position to detect expressive disorders and should develop a sensitivity for possible red flags, Dr. Levine said. (See box.)
Management depends on the child's age and the nature of the communication disorder. Children may be able to overcome some of these deficits if parents encourage them to avoid monosyllabic responses, to elaborate on and summarize their statements, and to speak in complete sentences, Dr. Levine said. The child might be asked to talk about an area of interest, such as sports, horses, or cars. Parents can also offer little rewards--such as staying up an extra half-hour to watch a television program--when the child summarizes how the day went or what happened in soccer practice.
Teachers should he asked not to call on the child in class or to do so only for questions with short answers. Speech therapy may help, but it is expensive and not readily available in every community.
Children who are more visually than verbally oriented may respond well to special computer programs--available from Inspiration Software Inc. at www.inspiration.com--that present verbal information in graphs and diagrams.
Telltale signs of expressive language dysfunction
* Lack of cohesive ties among sentences. A child might say, "I went to school. I came home. I watched television. I ate dinner," and not, 'Alter school I went home and watched television for a while, and then I ate dinner." This is one of the most telling signs of an expressive disorder.
* Problems with word retrieval. This may lead to circumlocution or referring to something by its definition rather than its name. For example, the child may call an umbrella a "rain stopper."
* Verbal hesitancy. The child works too hard to find the right words.
* Oversimplifying ideas.
* Failure to elaborate. The child answers questions with monosyllabic or one-word responses.
Source: Dr. Mel Levine
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|Title Annotation:||Behavioral Pediatrics|
|Date:||Jun 1, 2004|
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