ACQUIRED

CHILDHOOD
APHASIA
INTRO
 The terms developmental or congenital aphasia have sometimes
been used to describe children who show language impairment
without sensory dysfunction, intellectual disability, or other
neurological damage, these terms have been replaced by
developmental language disorder or specific language impairment.
 In contrast, the term childhood aphasia or, preferably, acquired
aphasia refers to children who have a language disorder secondary
to an accident or a disease that alters neurological functioning.
Children with acquired aphasia will have begun to develop
language normally but then lose all or part of their communicative
abilities as a result of neurological damage they sustain.
DEFINITION OF ACA
 Definition (Lees, 1993): ACA is a language disorder secondary to
cerebral dysfunction in childhood, but appearing after a period of
normal development.

 The cerebral dysfunction may be the result of:

 A focal lesion of one of the cerebral hemispheres or other area
primary to language processing

 A diffuse lesion of the central nervous system above the level of

the brain-stem, secondary to head injury or cerebral infection

 A diffuse lesion as in 2, but related to convulsive activity

 Unknown etiology
 ACA, unlike aphasia in adults, was traditionally
described as a homogeneous syndrome, characterized
by:
 the relative preservation of auditory comprehension;
 non-fluent, markedly reduced speech, ranging from
mutism to problems with articulation;
 a telegraphic style of speech;
 the absence of features that typically accompany
fluent adult aphasia, such as neologisms; and
 a rapid recovery unlike in acquired aphasia in adults
AETIOLOGIES
OF ACA
1. TBI:

 an insult to the brain, not of a degenerative or congenital nature but caused by an

external physical force, that may produce a diminished or altered state of
consciousness, which results in impairment of cognitive abilities or physical
functioning. It can also result in the disturbance of behavioral or emotional
functioning.
 TBI results from several causes, and these etiologies vary somewhat by age
groupings. Infants and toddlers are generally hurt through falls or abuse. Older
preschoolers suffer falls, while young school-age children suffer injuries through
sports and accidents involvng them as pedestrians, bike or skateboard riders, or
passengers.
 Beginning in the preschool years, boys become 2 to 4 times more likely than girls to
suffer a TBI. In fact, TBI rates are higher for males compared to females across
almost every age group (Faul et al., 2010).
 Automobile accidents causing head injury in children are more likely to be at low
speeds. The rotational acceleration to which their brains are subjected is, therefore,
likely to be less than that of adolescents and adults whose accidents are more likely to
be high-speed crashes. Damage to children may, therefore, be confined to the cortex
of the brain, whereas in adolescents and adults it can extend into the deeper white
matter. In addition, children are less likely to develop contusions, hematomas, and
white matter damage (because their brains have little myelination).
2.Strokes and Tumors. Strokes, the most common cause of aphasia in adults,
are relatively uncommon in children. In 2000, the death rate for cerebrovascular
disease in the United States was 0.5 per 100,000 (for children under 15 years of
age)
 when Strokes or tumors produce unilateral damage to the left hemisphere,
they result in aphasia-like symptoms that are comparable to those seen in
adults.
 More than a third of childhood strokes occur during the first 2 years of life.
The usual causes are vascular malformation, cardiac disease, vascular
occlusion, sickle cell disease, or hemorrhage. Blockage of a cerebral artery
may result from trauma, infection, or cellular changes or for no discernible
reason. In sickle cell anemia, deformed red cells cause vascular obstruction,
leading to a crisis in which coma and seizures occur. Cerebral hemorrhage is
often produced by the rupture of malformed blood vessels.
Other Acquired cause of
Childhood Aphasia
Vascular
Head trauma Tumours
disorders

Convulsive
Infection
disorders
 Aetiology Impairments seen

• Receptive and expressive language deficits.

• Reading and Writing difficulties
• Mutism
Vascular disorders • Articulatory disorders
(complications of systemic disorders eg cardiac • Naming disorders
conditions) • Auditory comprehension deficits
• Paraphasias

• Long term language deficits

Head trauma (chief cause of ACA)
Mild anomic aphasia or severe sensory (receptive)
aphasia.)
• Deficit in naming
• reading and writing disorders
• mutism
• articulation disorders
• auditory comprehension deficits
 • Muteness (in some cases)
Tumours • deficits in articulation.
(post. Fossa tumors in young • deficits in reading and writing.
children most common)

• Severe comprehension deficit.

Infection • Neologistic jargon.
• Logorrhoea
• Anosognosia
 • Initial deterioration of language
comprehension followed by disruption
of the child’s expessive abilities.
• Due to reduced comprehension ability
the presence of a hearing loss is
suspected.
Convulsive disorder • Mutism
(epilepsy) • Jargon speech
• Production of odd sounds
• Misarticulations
• Inappropriate substitution of words
• Anomia
• Resort to gestures and grunts.
 Clinical features of acquired childhood aphasia

Symptoms most reported in the classical studies to be characteristic

of acquired childhood aphasia include:
1. Deficits in receptive and expressive language.
2. Initial mutism ( suppression of spontaneous speech ).
3. (Followed by) a period of reduced speech initiative.
4. Non-fluent speech output.
5. Simplified syntax (telegraphic expression).
6. Impaired auditory comprehension abilities.
7. Impairment in naming.
8. Dysarthria
9. Disturbances in reading and writing.
10. Echolalia (compulsive immediate or delayed repetition of heard word or sentences)
11. Jargon (production of unintelligible speech because of a large no. of neologism)
Alajouanine and Lhermitte (1965) found that the predominant
features of the acquired aphasia demonstrated by children at < 10
years of age included:

decreased auditory
comprehension

severe writing deficit

Children > 10 years of age is a more fluent form of aphasia,
with :

Paraphasia(substitutuins of words (verbal

paraphasia) or of phoneme (phonemic paraphaisa)

Less frequent articulatory and phonetic disintegration

disturbed written language

 Most cases of acquired aphasia in children have been traditionally described as
presenting as nonfluent regardless of the location of the brain injury (Satz & Bullard-
Bates, 1981).
 As more studies have been conducted, however, it appears that, as with adults,
children with aphasia demonstrate either nonfluent or fluent types (van Dongen,
Paquier, Creten, van Borsel, & Catsman-Berrevoets, 2001), although descriptions of
the nonfluent form still predominate in the literature. In other respects, children also
appear to show disturbances across language modalities. These disordered areas
include, like adults, auditory comprehension, writing, reading, naming, and working
memory (Aram, 1988; Jordan & Ashton, 1996; Levin et al., 2004; Mandalis, Kinsella,
Ong, & Anderson, 2007).
 Although the symptoms of children with aphasia are similar to those of adults, the
prognosis for the two groups is considerably different. When all cases of acquired
aphasia are taken together, the great majority of children—estimated at about 75
percent—shows a dramatic recovery of language that is unrelated to their recovery of
motor function (Aram, 1988; Eisele & Aram, 1995; Satz & Bullard-Bates, 1981).
 The rate of recovery is considerably lower for children who suffer from seizures
(Bates & Roe, 2001). Seizures negatively impact brain plasticity as evidenced by
lower performance scores on intellectual and language measures (i.e., two longitudinal
studies of children with unilateral ischemic perinatal stroke) (Ballantyne, Spilkin,
Hesselink, & Trauner, 2008).
 ASSESSMENT OF ACA
Areas of Assessment
 Auditory-verbal comprehension
 Expressive language
 Word-finding ability
 Monitor presence of jargon aphasia, phonemic
and semantic paraphasias, perseverations
 Non-verbal communication
 Repetition
 Reading and writing
 Cognitive skills
CHILDREN’S ACQUIRED APHASIA
SCREENING TEST
 The CAAST (Whurr and Evans, 1986) was
designed to evaluate acquired language
disturbances in brain-damaged children aged
between 3 and 7 years.

 The CAAST has been standardized on 108

UK children with normal speech and
language between the ages of 3 and 7 years.
 The test battery comprises 25 sub-tests
organized as follows: A.Visual, B.Auditory,
C.Pre-speech and speech, D.Expressive
language, E.Drawing and F.Gesture subtests.

 The sub-tests are divided into two main

divisions: those testing language
comprehension (Subtests A & B) and those
testing language production deficits (Subtests
C, D, E, & F).
 The CAAST (Whurr & Evans, 1986) was
adapted and standardized on a sample
comprising of 80 normal Kannada-speaking
children by Chengappa and Treasa (2007).

 It was administered on 6 children with

language disorder/deviancy (acquired causes).
The pattern of language impairments were
described with reference to the established
norms and discussed with respect to the review
of literature.
Test for Reception of Grammar (TROG)
 Author/s:
Dorothy Bishop, 2003
 Age Range:
4 years to adult
 Administration:
Individual - 10 to 20 minutes

 The TROG-2 is a fully revised and nationally

re-standardised version of the widely used
TROG. TROG-2 tests understanding of 20
constructs four times each using different test
stimuli.
 Each test stimuli is presented in a four picture
multiple-choice format with lexical and
grammatical foils. The difficulty range has been
increased to effectively tap into the receptive
grammar of secondary aged school children and
young adults.
 Standardizationsample: 792 children aged 4 to
16 years and 70 adults
 The TROG-2 is suitable for use by SLP’s,
Psychologists and Teachers of the Deaf. It is
also useful for Neuropsychologists assessing
adults with acquired language disorder.
 TROG-E is the electronic version of the Test for
Reception of Grammar - Version 2 (TROG-2).
TROG-E is a receptive language test which
assesses understanding of English grammatical
contrasts marked by inflections, function words
and word order.
 It was standardised nationally on 4 to 16 year
olds and a small sample of adults. It enables the
tester to discover not only how a person's
comprehension compares to that of other people
of the same age, but also to pinpoint specific
areas of difficulty.
 The TROG-E is faster, more flexible and user
friendly.
 TESTS AUTHOR & YEAR PURPOSE AGE RANGE

Clinical evaluation of Wiig, Semel, & It evaluates aspects of 3- 6.11 years
Language Secord, 2004 language neccesary for
Fundamentals- preschool children to make
Preschool (CELF-P2) transition to the classroom

 Its subtests includes

indepth language
assessment, preliteracy
scale ,Phonological
awareness & Pragmatic
profile

Preschool Language Zimmerman, Steiner •Assess a child's ability to Birth – 6.11

Scales (PLS) & Pond, 2002 meet the demands of years
classroom discourse.
 TESTS AUTHOR & YEAR PURPOSE AGE RANGE

Expressive One word Gardner, 2000 To test a child’s verbal 2- 18.11 years
Picture vocabulary expressive
Test , Revised vocabulary in a quick
(EOWPVT-R) and efficient manner.
The test can be used
as a screening tool or
to monitor progress.

Peabody Picture Dunn and Dunn, 1997 Measures verbal 2.6- 90+ years
Vocabulary Test ability in standard
(PPVT) American English
vocabulary.
 TESTS AUTHOR & YEAR PURPOSE AGE- RANGE
Test of Language Newcomer, Assesses spoken 4- 8.11 years
Development &Hammill, 1997 language in young
Primary ( TOLD-P) children. It is used
to (1) identify
children who are
significantly below
their peers in oral
language
proficiency,
(2) determine their
specific strengths
and weaknesses in
oral language
skills,
(3) document their
progress in
remedial programs,
(4) measure oral
language in
research studies.
It has 9 subtests.
 TESTS AUTHOR & YEAR PURPOSE AGE RANGE
Sequenced Hedrick, Prather, & •Assesses 4- 48 years
Inventory of Tobin, 1984 communication
Communication skills of delayed
Development and normally
(SICD) developing
children.
•Receptive section
tests sound and
speech
discrimination,
awareness, and
understanding.
Expressive section
includes tests of
− three behaviors
(imitations,
initiation, and
response); and
 TESTS AUTHOR & YEAR PURPOSE AGE- RANGE

Test of Auditory Carrow, Wool, & Individually 3- 9.11 years

Comprehension Folk, 1999 administered
of Language measure of
(TACL) receptive spoken
vocabulary,
grammar, and
syntax. The test
consists of 142
items divided into
three subtests :-
•Vocabulary
•Grammatical
Morphemes
•Elaborated
Phrases and
Sentences
 TESTS AUTHOR & YEAR PURPOSE AGE RANGE

Preschool Blank, Rose, & Assesses how 3- 6 years

language Berlin, 1978 effectively a child
Assessment integrates
Instrument cognitive,
(PLAI) linguistic and
pragmatic
components to
deal with
student-to-
teacher verbal
exchanges.
 TESTS AUTHOR & YEAR AREAS ASSESSED
32
AGE RANGE

Bankson Language Bankson, 1990 Receptive and 3-7 years

Screening Test expressive;
semantics,
morphology, syntax;
auditory and visual
perception

Coston- Reindenbach Coston & Expressive- receptive, ------

Articulation/ Reidenbach, 1978 vocabulary syntax,
Language Quick auditory
Screen comprehension

Joliet 3 Minute Kinzler, 1992 Identifies children in 2.5- 4.5 years

Speech and need of services-
Language Screen- phonology, grammar
Preschool and semantics

Northwestern Syntax Lee, 1971 Receptive and 3- 7.11 years

Screening Test expressive syntax,
morphology,
semantics
Grammar and McClelland, A. GAPS test is a 3.4 to 6.8 years
Phonology (2007). quick and simple
Screening screening test
(GAPS) test used to assess
the grammatical
abilities and key
pre reading skills
of children
Children’s D.V.M. Bishop, 2006 70 items divided into 4:0 to 16:11
Communication 10 scales
Checklist (CCC–2) Each scale has 7
items (5 address
difficulties, 2 focus on
strengths) Scales A,
B, C, & D assess
articulation and
 ho need specialist help vs phonology, language
non-impaired children.
structure, vocabulary
and discourse
Scales E, F, G & H
address pragmatic
aspects of
communication
Scales I & J assess
behaviors commonly
impaired in children
with ASD
Indian studies for assessment
 Screening Test of Syntax Acquisition in Kannada
(STASK )-Vijayalakshmi, 1981.
 Syntax Screening Test In Tamil-Sudha. K.Murthy,Thirumalai,1981
 3DLAT-Geetha Herlekar,1986
 A Screening Picture Vocabulary Test in Kannada( Sreedevi.N, 1988)
 Linguistic Profile Test(Kannada-Prathiba karanth, 1980, Hindi - Monika
Sharma,1995., Malayalam – Asha.M.M ,1997 ., Telugu- Suhasini ,1997)
 Reading Acquisition Profile in Kannada – (Prema, K.S, 1997)
 Malayalam Language Test(Rukmini.A.P, 1994)
 Kannada Language Test (UNICEF funded project , 1990)
 Computerized Linguistic Protocol for Screening (CLIPS)-Anitha & Prema, 2004
 Cognitive Linguistic Assessment Protocol for Children (CLAP-C )-Anuroopa, 2006
 Tests of articulation (as per language)
 DAPIC – Dsylexia assesment profile for Indian children (Kuppuraj and
Jayashree ,2012 ) etc.....