Brainstem auditory evoked potentials in receptive developmental language disorder

It has been hypothesized that receptive developmental language disorder (RDLD) may be explained by an auditory processing deficit. The neuroanatomical locus of this deficit is unknown. Brainstem auditory evoked potentials (BAEPs) reflect the functioning of the auditory nerve and auditory brainstem pathways to high-frequency acoustical stimulation in humans and reflect the first stages of auditory processing. These were studied in 12 subjects with RDLD (four females and eight males, ages 12 to 19) and twelve control subjects (three females and nine males, ages 14 to 24). Click intensity and rate of stimulation were varied. The BAEPs for the RDLD group were comparable to the control group as well as to hospital norms across intensity levels and stimulation rates. The evidence obtained suggests that a disorder in the neurophysiological systems underlying the BAEPs and reflecting initial stages of auditory processing is not essential for RDLD.     

Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

Predicting cognitive recovery from closed head-injury in children and adolescents

Longitudinal data from 84 head-injured children and adolescents, who were tested at three points in the first year postinjury, were analyzed to determine the best combination of demographic, injury-related, and behavioral factors predicting cognitive performance. Dependent variables were language, memory, visuomotor, and speeded performance factor scores obtained through confirmatory factor analyses of an extensive test battery. Multiple regression analyses indicated that injury severity and the existence of previous psychological, physical, or cognitive disorders were primary for predicting acute (1 month post-hospital discharge) performance for older subjects. For younger subjects, however, parental marital status was the most important correlate of acute cognitive performance. Those residing in homes with both parents fared better than children in one-parent families. At 6 months and 1 year postinjury, the older subjects who performed most poorly initially remained the most impaired. For younger children, acute cognitive standing was also an important predictor of later performance, but parental marital status remained a crucial influence on their longer-term recovery of cognitive skills.     

Some effects of the Edinburgh Masker on stuttering during oral reading and spontaneous speech

This study assessed the effect of a voice-activated masking unit, known as the Edinburgh Masker, on the speech of four stutterers during oral reading and spontaneous speech. The results show that one stutterer reduced stuttering almost completely whenever the masker was activated. Two subjects showed either marginal or temporary reductions of stuttering during one speaking condition but showed no change in the other condition. The other subject reduced stuttering only during spontaneous speech. No reduction in stuttering was associated with reduced speech rate. A perceptual analysis procedure conducted to assess for altered speech quality during masking conditions found changes in speech quality were evident in two subjects. The clinical implications of these findings are discussed.     

An analysis of a token economy in stuttering therapy

A stuttering therapy program in which adult stutterers were hospitalized and treated in small groups (n = 4) under token economy conditions is described. The Token System reinforced reductions and penalized increases in stuttering during conversation. The therapy program was divided into three stages. Initially, subjects were treated by the token system, which was then integrated with a delayed auditory feedback schedule designed to instate and shape a prolonged speech pattern into normal fluent speech. Finally, subjects passed through a speech situation hierarchy while under token control conditions. Experiments conducted in the first two stages of treatment are described. The first-stage experiments examined the design of the token system; the second-stage experiment assessed the effect of a contingent punishment schedule integrated with the delayed auditory feedback procedure in order to shape rate of speaking as well as fluency.