ACQ Vol 10 No 1 2008

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ACQuiring knowledge in speech , language and hearing, Volume 10, Number 1 2008 25
barium, curd-type yoghurt and boiled rice. At the same time,
a physiatrist who is a specialist in physical medicine and
rehabilitation completed the VDS, a checklist that measures
swallowing performance along 14 parameters of ability (e.g.,
lip closure, mastication, laryngeal elevation).
The swallowing ability of the participants was reassessed
with videofluoroscopy 6-months later (on average, 183 days
post-stroke). The researchers examined the relation between
the 14 parameters of swallowing ability observed at initial
assessment and the presence of subglottic aspiration at the
6-month follow-up assessment. Based on the predictive power
of the different parameters, a scoring system for the VDS was
formulated (total score = 100). The parameters that best
predicted aspiration at follow-up (i.e., poor tongue-to-palate,
laryngeal elevation, coating of the pharyngeal wall, pharyngeal
transit time, aspiration) were given greater weighting towards
the total score, while those parameters that showed relatively
weak predictive power (lip closure, apraxia) had a reduced
contribution. The scoring system is outlined below:
1. Lip closure (intact = 0; inadequate = 2; none = 4)
2. Bolus formation (intact = 0; inadequate = 3; none = 6)
3. Mastication (intact = 0; inadequate = 4; none = 8)
4. Apraxia (none = 0; mild = 1.5; moderate = 3; severe = 4.5)
5. Tongue-to-palate contact (intact = 0; inadequate = 5; none
= 10)
6. Premature bolus loss (none = 0; <10% = 1.5; 10-50% = 3;
>50% = 4.5)
7. Oral transit time (≤ 1.5 seconds = 0; >1.5 seconds = 3)
8. Triggering of pharyngeal swallow (normal = 0; delayed =
4.5)
9. Vallecular residue (none = 0; <10% = 2; 10–50% = 4; >50%
= 6)
10. Laryngeal elevation (normal = 0; delayed = 9)
11. Pyriform sinus residue (none = 0; <10% = 4.5; 10–50% = 9;
>50% = 13.5)
12. Coating of pharyngeal wall (no = 0; yes = 9)
13. Pharyngeal transit time (≤ 1 second = 0; >1 second = 6)
14. Aspiration (none = 0; supraglottic penetration = 6;
subglottic aspiration = 12)
Further analysis indicated that a cut-off score of 47 or above
shows optimal sensitivity and specificity for long-term
dysphagia prediction, i.e., those who score 47 or above at
initial assessment are most at risk for long-term dysphagia.
Genetic overlap between SLI and autism?
Whitehouse, A. J. O., Barry, J. G., & Bishop, D. V. M. (2007).
The broader language phenotype of autism: A comparison
with Specific Language Impairment. Journal of Child Psychology
and Psychiatry , 48 , 822–830.
In the recent years, evidence that autism and specific language
impairment may share a common underlying genetic cause
has been accumulating. One of the strongest pieces of
evidence is that relatives of individuals with autism often
show language impairments similar to that experienced by
individuals with SLI. This study investigated the idea of a
common genetic cause for autism and SLI, by comparing the
language functioning of parents of children with SLI and
parents of children with autism. If there is a shared genetic
liability for the two disorders, then it was expected that the
Behaviour problems in children with language
impairment
Van Daal, J., Verhoeven, L. & van Balkom, H. (2007). Behaviour
problems in children with language impairment. Journal of
Child Psychology and Psychiatry, 48, 1139–1147.
There is a well-established association between language
impairment and childhood behavioural problems. Behavioural
difficulties fall into two broad categories. Externalising
problems relate to a child’s outward behaviour and reflect a
child negatively acting on the external environment (e.g.,
aggression, delinquency), while internalising problems relate
to behaviours that are directed inward (e.g., withdrawal,
anxiety, low self-esteem). The current study sought to
investigate the presence of internalising and externalising
behaviours in children with language impairment, and to
determine whether these behaviours are related to any
specific pattern of speech/language deficit.
The sample was 71 five-year-old children recruited from
schools around the Netherlands that specialise in the
education of children with language impairment. Children
were given a battery of standardised psychometric tests
assessing various aspects of language ability. Parents of the
children completed the Child Behaviour Checklist (CBCL) – a
questionnaire assessing various non-adaptive behaviours.
As expected, the bulk of the children performed poorly on
the language tasks. Similarly, there was a high level of
reported behavioural disturbances, with around 40% of
children scoring in the “clinical” (impaired) or “borderline”
(near-impaired) range on the CBCL. The most frequently
reported internalising problems were somatic complaints and
withdrawn behaviours, while externalising problems were
most commonly exhibited in the form of aggression. Intern­
alising and externalising behaviours tended to occur to the
same extent in this sample of children.
Further analyses found that internalising problems (anxiety/
depression and withdrawn behaviours) were most commonly
seen in those children with phonological or semantic deficits.
Externalising problems, on the other hand, were related to
phonological problems only. Speech problems appeared to
carry the least risk for any form of behavioural problem.
These findings highlight the importance of gauging both
language and behavioural abilities at initial assessment.
Development of a scale that predicts long-term
dysphagia progress
Han, T. R., Paik, N-J, Park, J-W., & Kwon, B. S., (2008). The
prediction of persistent dysphagia beyond 6 months after
stroke. Dysphagia, 23(1), 59–64.
This paper reports the development of the Videofluoroscopic
Dysphagia Scale (VDS), an instrument designed to provide an
objective prediction of long-term persistent dysphagia after
stroke.
Eighty-three participants with dysphagia underwent a
videofluoroscopic swallowing examination upon their admission
to a rehabilitation unit (on average, 40 days post-stroke).
Participants received a standard swallowing assessment,
where they were asked to ingest 2ml and 5ml of diluted
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Andrew Whitehouse