ACQUIRED CmLDHOOD APHASIA: OUTCOME ONE YEAR AFTER ONSET

M.Christa B. Loonen and Hugo R. van Dongen

The Department of Neurology
University Hospital Rotterdam-Dijkzigt
The Netherlands.

ABSTRACT. The effects of the variables age at onset, cause, severity and bilaterality of lesion,
and type of aphasia on course and outcome were investigated in a group of 28 aphasic children.
Analysis of spontaneous speech and tests of auditory verbal comprehension were used to deter-
mine the presence of aphasia. The severity of the cerebral lesion was assessed using a rating scale
for CT-scans. Most of the children had not recovered completely one year after-onset. Recovery
was significantly different according to etiological categories. Complete recovery was seen in the
majority of traumatic cases.

Introduction.

The standard doctrine about childhood aphasia claims that recovery of language functions is rapid
and complete (1). However, this claim rests largely on quotations from the earlier literature (2,3)
and is increasingly contradicted by more recent reports (4,5,6,7,8).
The main factors considered to be associated with language recovery are : age at onset, cause,
severity and bilaterality of lesion, and type of aphasia.

This paper has been published in "Archives of Neurology",vol 47,

1324-1328,1990 (Copyright 1990,American Nedical Association).
Perm~ssion for its reproduction here was kindly granted by the
Amer1can Nedical Association.

185
I. P. Martins et al. (eds.), Acquired Aphasia in Children, 185-200.
© 1990 American Medical Association.
186

AGE AT ONSET.

Alajouanine and Lhermitte (9) found no difference in "the speed of recovery in children less than
10 years old versus children of 10 or more years old". According to Lenneberg (3) the prognosis
of acquired aphasia in children is directly related to the age at onset of the aphasia. Aphasias that
develop before puberty would clear up completely. In the series of Woods and Teuber (10) all
children who became aphasic before the age of eight years regained speech but recovery time
ranged from one month to more than two years. In the syndrome of acquired aphasia with
convulsive disorder (Landau-Kleffner syndrome = LKS) an opposite relationship is found, ie, the
older the child at onset the better the outcome (11,12,13).

CAUSE.

Children with a head trauma have been reported to improve more than those with vascular disease
(6,14). However, Byers and McLean (15) reported a complete restitution of speech function in 10
aphasic children with persistent hemiplegia due to a cerebrovascular lesion at follow-up from 1 -
4 years. Longitudinal follow-up studies present evidence that the prognosis in children with the
syndrome of acquired aphasia with convulsive disorder is poor (16,17 ,18).

SEVERITY AND BILATERALITY OF THE LESION.

Persistent aphasic symptoms have been linked with the severity of the lesion (14,19,20). Exten-
sive CT-scan data are limited to the first reports of children with a subcortical aphasia (21,22), a
fluent aphasia (23), a crossed aphasia (24), and a conduction aphasia (25). StUdying the incidence
of paraphasias, VanHout et aI. (7) mention CT scan abnormalities, but do not assess the severity
of the lesion in 11 children who demonstrated an aphasia arising from a range of causes.
However, in children with acquired aphasia with convulsive disorder, normal CT-scans are
consistently reported despite severe aphasic disturbances (for refs. see 26).
It is claimed that if in childhood the left hemisphere is damaged, language can develop in the
corresponding area of-the right hemisphere. Consequently bilateral cerebral damage is considered
a bad prognostic sign (20,27,28).

TYPE OF APHASIA.

Guttmann (14) emphasized the good prognosis of purely motor (nonfluent) aphasia in young
children: combined motor and sensory aphasia had a more serious prognosis. Assai and Campiche
(28) confirmed, but Collignon et al. (27) contradicted this finding. Fluent aphasia in children has
been considered rare: no firm statements concerning prognosis are available (23).

The aim of this study was to investigate the association of age at onset, cause of the lesion,
severity and bilaterality of the lesion, and type of aphasia with recovery of acquired childhood
aphasia.
Assuming a rapid initial recovery, language functions of the children were assessed at one year
after onset.