OUTCOME OF ACQUIRED APHASIA IN CHILDHOOD: PROGNOSIS FACTORS

A. VAN HOUT
Department of Neuropediatrics
U.C.L. 10/1303
st. Luc University Clinic
10, Avenue Hippocrate
1200 Brussels
Belgium

ABSTRACT: Among the prognostic factors in acquired aphasia in

children, age used to be said to play the major role. However, the
literature is confused on the subject because of the small number of
cases and the lack of homogeneity for etiologies, age at the lesion,
follow-up duration, and even the recovery criteria themselves. A
critical review of the literature indicates that younger children do
not always have a favourable outcome and that other prognosis factors
may intervene. The importance of follow-up duration is stressed since
recovery processes can extend over many years and also since lin-
guistic and non-linguistic deficits may develop later.

Introduction

The factors of a prognosis for acquired aphasia in childhood are often

confounded because of the small number of cases in series and also
because of their lack of homogeneity.
In addition to the constraints imposed by the nature of the lesion
itself such as its etiology, extension, and localization, the age at
the lesion was said to playa major rcle in recovery, which was often
assumed to be more rapid and complete than in adults. Moreover, while
recovery in adults may be defined as a restitution of the prelesional
language status, in children, the whole sequence of developing lan-
guage is abruptly disrupted, so recovery also implies the continuation
of this interrupted sequence with the development of new skills at the
expected times. In this respect, the prognosis in acquired childhood
aphasia has to project into the future and to do this not just for
what concerns language.
One of the supposed neural aphasia recovery mechanisms from aphasia
in children is a taking over of language by uncommitted brain areas
(Goldman, 1974). Those non-functional immature zones are often those
initially intended to support later non-linguistic cognitive func-
tions. When these areas are engaged in their suppletive language
functions, they may fail to develop the functions for which they were
originally intended, and thus secondary disorders also appear for non-
language functions. Those late-occurring disorders, either linguistic
163
l. P. Martins et al. (eds.), Acquired Aphasia in Children, 163-169.
© 1991 Kluwer Academic Publishers.
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or visuo-spatial may entail learning disorders (Van Hout and Seron,

1983) .
We will briefly examine these different clinical aspects of recov-
ery in acquired childhood aphasia.

1. The Effect of Age

The qualification "more rapid" to designate recovery in children

relative to that in adults is overused and is usually attributed to
Lenneberg in his book, "The Biological Foundations of Language"
(1967). However, while Lenneberg does use "better" and "more com-
plete" in reference to child aphasia, his data do not permit one to
conclude that recovery is more "rapid" in children than in adults, on
the contrary. The comparison of recovery from aphasia in children and
in adults was conducted by Lenneberg on the basis of two large series
from the literature: the childhood series was that of Basser (1962) to
which Lenneberg added a few cases from his own practice, and the adult
series was the traumatic series presented by Russel and Espir (quoted
by Lenneberg, 1967). Three different recovery rhythms were observed
in the adults, with a steady, long lasting one being the less fre-
quent. In children, this mode of evolution dominated the picture,
extending over years. This opposition thus contradicts the frequent
misquotation of Lenneberg's findings. What Lenneberg did consider as
more rapid, was in fact, some aspect of symptom recovery within the
childhood series themselves, in favour of very young children. Lenne-
berg supposed that recovery was achieved sometimes around puberty or
even before (he himself does not appear quite clear about this and
speaks of the age of eight or ten or of "puberty" without further
precision). This end of recovery potential marked the end of the
"critical" period for language acquisition.
However, this last notion is contradicted by other reports that
describe continuation of the aphasic resolution processes well beyond
of puberty. For instance, Woods and Teuber (1978) described a retro-
spective case of jargonaphasia in a five-year-old boy. When the boy
was re-examined in his early teens, he was still aphasic (now with
anomia), but, when seen again in his twenties, his language problem
had subsided. The extension of this evolution over many years is
evocative of some descriptions of hemispherectomies for early lesions.
Hemispherectomy can be regarded as an extreme form of unilateral
cerebral lesion, and long evolution durations have been described in
this condition (Smith and Sugar, 1975). It may be that similar
recovery processes could occur in cases of aphasia acquired at an
early age, which is why there should be long-term follow up in the
evaluation of recovery.
Consequently, a comparison of recovery variables across series is
difficult, as most of them have different durations of follow-up, with
long-term follow up being rare. Thus, outcome evaluation is difficult
to establish, and the moment of recovery for a given function is also
difficult to ascertain, as the intervals separating evaluations are
uneven. Observed recovery may correspond to the interval between two