Egyptian Journal of Psychiatry

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 39  |  Issue : 3  |  Page : 95--99

Biopsychosocial profile of children with speech and language impairment


Rania A Hamed1, Hala T Mohamed1, Omnia A Azazi1, Karima A Bahgat2,  
1 Department of Psychiatry, Faculty of Medicine for Girls, Cairo, Egypt
2 Department of Pediatric, Faculty of Medicine for Girls, Cairo, Egypt

Correspondence Address:
Rania A Hamed
Department of Psychiatry, Faculty of Medicine for Girls, Al-Azhar University, Cairo
Egypt

Abstract

Introduction Severe speech and language disorders in young children can negatively affect later educational achievement, even after intensive intervention unless early intervention is initiated. Aim The aim was to investigate speech and language impairment in a sample of children and its possible etiological factors and to assess electroencephalogram (EEG) and MRI findings in them. Participants and methods A total of 43 children with speech and language impairment referred to Psychiatry Department, Al Zahraa University hospital, during the period from April 2016 to January 2017 and 28 children with normal language development as control group, aged 3–6 years old, were subjected to clinical psychiatric assessment, Wechsler intelligence scale for children, EEG, and brain MRI. Results The total number of cases was 43 [30 male (69.8%) and 13 female (30.2%) patients]; there was a statistical significance regarding positive family history of illness, parental education, work of the mother, and delayed speech among siblings. The presence of antenatal medical problem, antenatal drug intake, and neonatal morbidity shows a statistical significance. Overall, 27.9% of cases had previous history of delayed milestones of growth and corporal punishment; verbal abuse is the method used to discipline them. Moreover, 25.6% of cases had separation trouble at early school experience and reported to be follower or isolated in their peer relationship. Intelligence quotient assessment showed that 34.9% of cases had borderline intellectual functioning. There was a statistically significant difference between cases and control regarding abnormal EEG findings. Overall, 9.4% of cases had abnormal MRI finding. Conclusion In the current study, we found that speech and language impairment is a multietiological disorder, and early recognition will permit early intervention.



How to cite this article:
Hamed RA, Mohamed HT, Azazi OA, Bahgat KA. Biopsychosocial profile of children with speech and language impairment.Egypt J Psychiatr 2018;39:95-99


How to cite this URL:
Hamed RA, Mohamed HT, Azazi OA, Bahgat KA. Biopsychosocial profile of children with speech and language impairment. Egypt J Psychiatr [serial online] 2018 [cited 2018 Oct 23 ];39:95-99
Available from: http://new.ejpsy.eg.net/text.asp?2018/39/3/95/243028


Full Text



 Introduction



Speech is the verbal production of language, whereas language is the conceptual processing of communication. Language includes receptive language (understanding) and expressive language (the ability to convey information, feelings, thoughts, and ideas).

The reported prevalence of language delay in children 3–6 years of age ranges from 2.3 to 19% (Burden et al., 1996). Severe speech and language disorders in young children can negatively affect later educational achievement, even after intensive intervention unless early intervention is done (Stern et al., 1995). Several studies have shown that children with speech and language problems at 3–6 years of age have increased difficulty in reading in the elementary school years (Catts et al., 2002). Children in whom speech and language impairments persist past 6 years of age have an increased incidence of attention and social difficulties (Snowling et al., 2006).

In one large study of children with speech and language disorders, the most common comorbid disorders were attention-deficit hyperactivity disorder (19%), anxiety disorders (10%), and oppositional defiant disorder and conduct disorder (7% combined) (Lattermann et al., 2008).

Researchers have always been interested by the variety of ways in which language can be afflicted by neurological disorders. Epilepsy may co-occur with speech and language disorders. Some studies have also demonstrated that abnormal electroencephalographic (EEG) recordings without clinical seizures can be observed.

Developmentally aphasic children show a higher incidence of abnormal EEG than expected (Echenne et al., 1992).

Neuroimaging studies of children with speech and language impairment are fast growing. In several studies of these children with MRI, there was evidence of gross structural abnormalities including a smaller volume of left posterior perisylvian region and atypical asymmetries in perisylvian volumes suggesting that the normal course of brain development may be altered in conditions associated with speech and language impairment (Traumer et al., 2010).

 Aim



The aim of the work was to investigate speech and language impairment in a sample of children and its possible etiological factors and to assess EEG and MRI findings in them.

 Participants and methods



The study was conducted on 43 children with speech and language impairment referred to Psychiatry Department, Al Zahraa University Hospital, from Phoniatric Department during the period from April 2016 to January 2017, with age ranging from 3 to 6 years old, after exclusion of those with gross organic disorders (severe medical or neurological disorders including epilepsy), hearing impairment, mental retardation, and uncooperative parents. The study also included 28 children with normal language development as a control group.

After obtaining informed consent from parents of both groups and ensuring confidentiality, all children were subjected to the following:Clinical psychiatric assessment: using a thorough history by a specifically designed sheet for children that include interview with the child and the parents. A detailed history was obtained including prenatal, perinatal, postnatal history, family history for any speech and language disorders, and seizures and neurodevelopmental history.Wechsler intelligence scale for children (Wechsler, 1949): the Arabic version of the tool was used. It yields verbal intelligence quotient (IQ) (performance IQ and total IQ).EEG: standard video EEG was performed, and activation procedures included hyperventilation (if feasible) and photic stimulation.Brain MRI.

Statistical analysis

Data were analyzed with SPSS for Windows (version 13.2) Software (SPSS Inc., Chicago, Illinois, USA). The χ2-test (Mantel–Haenszel) for linear association was used.

 Results



The total number of cases was 43 [30 male (69.8%) and 13 female (30.2%) patients]. The control group included 28 individuals [16 male (57.1%) and 12 female (42.9%) participants].

There was a statistical difference regarding positive family history of illness (scholastic failure, mental retardation, antisocial behavior, mood disorders, or epilepsy), parental education, work of the mother, and delayed speech among siblings.

The presence of antenatal medical problem (mostly preeclampsia, hypertension, and diabetes mellitus), antenatal drug intake, and neonatal morbidity (mostly jaundice, low birth weight, and seizures) shows a statistical significance.

From [Table 1],[Table 2],[Table 3],[Table 4], it could be observed that 27.9% of children with speech and language impairment had previous history of delayed milestones of growth, and the difference between cases and control was statistically significant.{Table 1}{Table 2}{Table 3}{Table 4}

When asked about type of punishment at home, there was a statistically significant difference between both groups regarding disciplinary methods.

It is evident that 25.6% of cases showed separation troubles at early school experience, and the difference between both groups was statistically significant. Moreover, there was a statistically significant difference between cases and controls regarding the issues of relationship with peers (control group exceeded cases in being leader among peers, whereas the reverse occurred in cases being follower or isolated, with the same percentage in quarrelsome behavior).

Most participants in both groups have average intelligence, but percentage was higher in control than in cases (71.4 and 51.1%, respectively). Moreover, the percentage of those with above average intelligence in the control group exceeded that of cases (28.6 and 16.2%, respectively), and the difference was statistically significant.

Overall, 34.9% of cases had borderline intellectual functioning compared with none in the control group (statistically significant).

There was a statistically significant difference between cases and control regarding abnormal EEG findings, either focal (unifocal, multifocal, two foci, or centrotemporal focus) or generalized type (polyspike, sharpwave, or bilateral epileptiform activity).

Overall, 9.4% of cases (four cases) had abnormal MRI finding compared with none of control group, with statistical significance.

 Discussion



One of the major challenges facing communities is to generate the knowledge needed to improve the children with speech and language impairment. Despite the importance of early diagnosis and intervention, unfortunately this disorder is actually either not detected or not referred for treatment and rehabilitation at early ages in many parts of the world (Vameghi et al., 2016).

It is also mandatory to investigate the possible etiological factors of speech and language impairment, and in our study, the presence of family history of illness in these children could clarify the importance of biological and psychological factors giving rise to a child with speech and language impairment.

Consanguinity is statistically nonsignificant, as the sample is a small sample not representative of the community regarding consanguinity.

Parental education indicated that better academic achievement of the child’s parents is a good predictor of language development of the child (Tamis-Le Monda and Rodriguez, 2009).

Being a child of a working mother was a favorable signal owing to better education and better economic level of the family providing more stimulation to the children (Blair and Scott, 2002).

Delayed speech was found to be significantly higher in siblings of cases owing to the fact that speech impairment may run in families (Muir, 2000).

Antenatal medical problems and drug intake may affect later development of language in children. Murase (1990) listed a number of prenatal variables that correlated with infant development outcome.

Chaudhari et al. (2004) added that low birth weight and neonatal morbidity is associated with lower intelligence, delayed language, and academic performance.

In the present study, delayed milestone of growth was significantly associated with later on speech and language impairment. This agrees with a study done by Sullivan and Marget (2003) who found that children with mild motor delay had delayed language and lower academic performance at age of eight.

Regarding disciplinary methods at home, corporal punishment followed by verbal abuse was the most frequent type used to discipline children with speech and language impairment ([Table 5]).{Table 5}

Many studies revealed that children raised in authoritarian families face severe restrictions in expressing their need and experience much physical punishment and verbal anger (Dornbusch et al., 1987).

Moreover, our study revealed that children with speech and language impairment face early separation troubles and difficulties in their relationship with peers ([Table 6],[Table 7],[Table 8],[Table 9]).{Table 6}{Table 7}{Table 8}{Table 9}

McCabe (2004) hypothesized that children with speech and language impairment are particularly susceptible to social interaction difficulties, resulting in separation troubles and diminished social competence.

Regarding IQ assessment, borderline intellectual functioning was 34.9% in cases compared with none in control group. A longitudinal study of children with developmental language delay at age three had significantly lower IQ and more behavior problems (Silva et al., 2007).

Regarding EEG study, we found that 44% of children with speech and language impairment have abnormal EEG findings; this was in agreement with the results found by Bhart et al. (2015) who reported abnormal EEG in 47.9% of their studied group. The findings of epileptiform activity in speech and language impairment children need further research to unravel the electrophysiologic basis of speech to provide insight into targeted and specific pharmacologic and nonpharmacologic treatment of speech and language impairment.

Abnormal MRI finding was found in 9.4% of cases and none of control; this was less than a study done by Traumer et al. (2010) who found abnormal MRI finding in 34% of the studied group, but they applied a higher investigation modality (multimodal MRI) to detect the defects of delayed speech in their class of patients.

 Conclusion



In the current study, we found that speech and language impairment is a multietiological disorder with a final common pathway resulting in speech and language impairment. Early recognition of language impairment will permit intervention when the developing nervous system has potential to reorganize.[19]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Bhart M, Chawla V, Anoop S (2015). EEG abnormalities in children with speech and language impairment. J Clin Diag Res 9:CC04–CC07.
2Blair C, Scott K (2002). Proportion of LD placements associated with low socioeconomic status: evidence for a gradient? (Learning disabled children). J Special Education 36:14–22.
3Burden V, Stott CM, Forge J, Goodyer I (1996). The Cambridge Language and Speech Project (CLASP). I. Detection of language difficulties at 36 to 39 months. Dev Med Child Neurol 38:613–631.
4Catts HW, Fey ME, Tomblin JB, Zhang X (2002). A longitudinal investigation of reading outcomes in children with language impairments. J Speech Lang Hear Res 45:1142–1157.
5Chaudhari S, Otiv M, Chitale A, Pandit A, Hoge M (2004). Low birth weight study, cognitive abilities and educational performance at twelve years. Indian Pediatr 41:121–128.
6Dornbusch SM, Ritter PL, Leiderman PH, Roberts DF, Fraleigh MJ (1987). The relation of parenting style to adolescent school performance. Child Dev 58:1244–1257.
7Echenne B, Cheminal R, Rivier F, Negre C, Touchon J, Billiard M (1992) Epileptic electroencephalographic abnormalities and developmental dysphasias: a study of 32 patients. Brain Dev 14:216–225.
8Lattermann C, Euler HA, Neumann K (2008). A randomized control trial to investigate the impact of the Lidcombe Program on early stuttering in German-speaking preschoolers. J Fluency Disord 33:52–65.
9McCabe PC (2004). The relationship between language and social competence: how language impairment affects social growth. Psychol Schs 41:313–321.
10Muir WJ (2000). Genetics advances and learning disability. Br J Psychiatry 176:12–19.
11Murase K (1990). School refusal and family pathology: a multi-factorial approach. In: Child C, Young J, editors. Why children reject school.views from seven countries. New Haven: Yale University press. pp. 73–87.
12Silva PA, Williams S, McGee R (2007). A longitudinal study of children with developmental language delay at age three: later intelligence, reading and behaviour problems. Dev Med Child Neurol 29:630–640.
13Snowling MJ, Bishop DV, Stothard SE, Chipchase B, Kaplan C (2006). Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment. J Child Psychol Psychiatry 47:759–765.
14Stern LM, Connell TM, Lee M, Greenwood G (1995). The Adelaide preschool language unit: results of follow-up. J Paediatr Child Health 31:207–212.
15Sullivan S, Marget A (2003). Psychiatric aspect of learning difficulties. Pediatr Clin North Am 31:490–497.
16Tamis-Le Monda CS, Rodriguez ET (2009). Parent’s Role in fostering young children’s learning and language development. Encyclopedia on Early childhood development.
17Traumer D, Wulfeck B, Tallal P (2010). Neurological and MRI profiles of children with language impairment. Devel Med Child Neur 42:470–475.
18Vameghi R, Amir Ali Akbari S, Sajjadi H, Sajedi F, Alavimajd H (2016). Correlation between mothers’ depression and developmental delay in infants aged 6-18 months. Glob J Health Sci 8:11–18.
19Wechsler D (1949). The measurement of children intelligence. Baltimore, MD: Williams & Witkins. 229.