BACKGROUND:People with intellectual disabilities often have undetected hearing loss. METHODS:In this prospective observational study featuring 110 adults with intellectual disabilities, hearing evaluations based on objective hearing threshold estimation using distortion-product otoacoustic emission growth functions (DPOAEgfs) were performed in a sheltered workshop. Results were compared with thresholds obtained by conventional subjective pure-tone audiometry (cPTA) and the adaptive self-test PTA Multiple-Choice-Auditory-Graphical-Interactive-Check (MAGIC). RESULTS:The differences between the lowest thresholds obtained by cPTA and MAGIC for the frequencies 1, 2, 4 and 6 kHz (LPTATs) and the estimated distortion-product thresholds (EDPTs) were calculated. Four hundred twenty-seven of 880 (48.5%) pairs of measurements did not differ by any more than 5 dB. With LPTATs as reference criterion, for a favourable four-frequency average over 1.0, 2.0, 4.0 and 6.0 kHz with a cutoff of 20 dB HL, the sensitivity of the EDPTs was 92% and the specificity 62%; a cutoff of 30 dB HL increased the respective values to 98% and 77%. CONCLUSIONS:DPOAEgfs are acceptable for estimating hearing thresholds in individuals with intellectual disability who may have limitations in performing conventional audiometry.

Introduction About 9.9% of children have developmental language disorders (DLD), about 7.6% "circumscribed" (formerly "specific") DLD, i.e., without additional impairments, and another 2.3% with language-related comorbidities, e.g., autism-spectrum disorder or hearing loss. DLD are among the most commonly treated childhood disorders and, if persistent, often reduce educational success and later social status. A risk stage for "circumscribed" DLD is a developmental language delay between the 2nd and 3rd birthday.

Einleitung Circa 9,9% aller Kinder haben Sprachentwicklungsstörungen (SES), davon ca. 7,6% in einer umschriebenen Form – (U)SES – ohne gravierende Zusatzbeeinträchtigungen, weitere 2,3% mit sprachrelevanten Komorbiditäten. SES gehören zu den meist behandelten Störungen im Kindesalter. Ein wichtiges Risikostadium für (U)SES sind Sprachentwicklungsverzögerungen (SEV).

Phonological developmental speech sound disorders (pDSSD) in childhood are often associated with later difficulties in literacy acquisition. The present study is a follow-up of the randomized controlled trial (RCT) on the effectiveness of PhonoSens, a treatment for pDSSD that focuses on improving auditory self-monitoring skills and categorial perception of phoneme contrasts, which could have a positive impact on later spelling development. Our study examines the spelling abilities of 26 German-speaking children (15 girls, 11 boys; mean age 10.1 years, range 9.3-11.2 years) 3-6 years after their successful completion of the PhonoSens treatment. Spelling assessment revealed that only 3 out of 26 participants developed a spelling disorder. In the overall population of fourth-graders, one in five children showed a spelling deficit; in another study of elementary school children, with resolved pDSSD, 18 of 32 children had a spelling deficit. Thus, the applied pDSSD treatment method appears to be associated with positive spelling development. Multiple regression analysis revealed that among the potentially predictive factors for German-speaking children with resolved pDSSD to develop later spelling difficulties, parental educational level and family risk for developmental language disorder (DLD) had an impact on children's spelling abilities; gender and the child's phonological memory had not.

There is substantial evidence that newborn hearing screening (NHS) reduces the negative sequelae of permanent childhood hearing loss (PCHL) if performed in programs that aim to screen all newborns in a region or nation (often referred to as Universal Newborn Hearing Screening or UNHS). The World Health Organization (WHO) has called in two resolutions for the implementation of such programs and for the collection of large-scale data. To assess the global status of NHS programs we surveyed individuals potentially involved with newborn and infant hearing screening (NIHS) in 196 countries/territories (in the following text referred to as countries). Replies were returned from 158 countries. The results indicated that 38% of the world's newborns and infants had no or minimal hearing screening and 33% screened at least 85% of the babies (hereafter referred to as UNHS). Hearing screening programs varied considerably in quality, data acquisition, and accessibility of services for children with PCHL. In this article, we summarize the main results of the survey in the context of several recent WHO publications, particularly the World Report on Hearing, which defined advances in the implementation of NHS programs in the Member States as one of three key indicators of worldwide progress in ear and hearing care (EHC).

Zusammenfassung Hintergrund Sprachtherapeutisch-linguistische Fachkreise empfehlen die Anpassung einer von einem internationalen Konsortium empfohlenen Änderung der Nomenklatur für Sprachstörungen im Kindesalter, insbesondere für Sprachentwicklungsstörungen (SES), auch für den deutschsprachigen Raum. Fragestellung Ist eine solche Änderung in der Terminologie aus ärztlicher und psychologischer Sicht sinnvoll? Material und Methode Kritische Abwägung der Argumente für und gegen eine Nomenklaturänderung aus medizinischer und psychologischer Sicht eines Fachgesellschaften- und Leitliniengremiums. Ergebnisse Die ICD-10-GM (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification) und eine S2k-Leitlinie unterteilen SES in umschriebene SES (USES) und SES assoziiert mit anderen Erkrankungen (Komorbiditäten). Die USES- wie auch die künftige SES-Definition der ICD-11 (International Classification of Diseases 11th Revision) fordern den Ausschluss von Sinnesbehinderungen, neurologischen Erkrankungen und einer bedeutsamen intellektuellen Einschränkung. Diese Definition erscheint weit genug, um leichtere nonverbale Einschränkungen einzuschließen, birgt nicht die Gefahr, Kindern Sprach- und weitere Therapien vorzuenthalten und erkennt das ICD(International Classification of Disease)-Kriterium, nach dem der Sprachentwicklungsstand eines Kindes bedeutsam unter der Altersnorm und unterhalb des seinem Intelligenzalter angemessenen Niveaus liegen soll, an. Die intendierte Ersetzung des Komorbiditäten-Begriffs durch verursachende Faktoren, Risikofaktoren und Begleiterscheinungen könnte die Unterlassung einer dezidierten medizinischen Differenzialdiagnostik bedeuten. Schlussfolgerungen Die vorgeschlagene Terminologie birgt die Gefahr, ätiologisch bedeutsame Klassifikationen und differenzialdiagnostische Grenzen zu verwischen und auf wertvolles ärztliches und psychologisches Fachwissen in Diagnostik und Therapie sprachlicher Störungen im Kindesalter zu verzichten.

BACKGROUND:The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP). METHODS:Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment. RESULTS:The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen's d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months. CONCLUSION:IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.

Background German speech-language professionals and linguists recommend the adoption of a nomenclature change for language-associated disorders in childhood, especially for developmental language disorders (DLD) for German-speaking countries. Objective Does the recommended terminology make sense from a medical and psychological perspective? Methods Evaluation of the arguments for and against a terminology change. Results The ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th revision) and a German guideline divide DLD into circumscribed (specific) DLD (CDLD) and DLD with other disorders (comorbidities). The CDLD as well as the future DLD definition of the ICD-11 require the exclusion of sensory impairments, neurological disorders, and intellectual limitations. This definition appears to be broad enough to include milder nonverbal impairments, does not risk depriving children of speech and other therapies, and recognizes the ICD criterion that a child's level of language development should be markedly below what would be expected given age and level of intellectual functioning. The proposed replacement of the term comorbidities by differentiating conditions, risk factors, and co-occurring conditions prefigures the omission of a decided medical differential diagnosis. Conclusion The proposed terminology risks blurring etiologically meaningful classifications and differential diagnostic boundaries and circumventing valuable medical and psychological expertise in the diagnosis and treatment of language disorders in children.

For children who stutter (CWS), there is good evidence of the benefits of treatment for pre-school age, but an evidence gap for elementary school age. Here we report on the effectiveness of a fluency shaping treatment for 6- to 9-year-old children. The main treatment component is the reinforcement of soft voice onsets. An intensive in-patient group treatment phase lasts 6 days, followed by a 6-month maintenance phase with 3 in-patient weekend group refresher courses. Child and a parent participate together in various treatment activities. In this controlled intervention study (waitlist control, intention-to-treat design) assessments were performed before treatment (T1), 4 weeks after the intensive phase (T2), at the end of the maintenance phase (T3), and 1 year later (T4). Participants were 119 children (108 boys, 11 girls, age 5.5‑10.4 years). Control conditions included a subgroup with delayed treatment (N=25) as well as the assessment of complexity of utterances, inter-rater reliability, and speech naturalness. From before treatment to 1-year follow-up, percent stuttered syllables and OASES-S (Overall Assessment of the Speaker's Experience with Stuttering - School-age) scores decreased with large effect size. Speech naturalness improved during this period but did not reach the level of non-stuttering children. Complexity of utterances increased during the intensive phase, but only temporarily. Twenty children (16.8 %, including dropouts) showed no demonstrable treatment benefit. Fluency shaping treatment can be effectively applied to young school children. It is assumed that parental support, group therapy, intensive treatment, and regular exercises at home are essential.

PURPOSE:(1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components.METHODS:124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions.RESULTS:A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained).DISCUSSION:Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions.CONCLUSION:The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies.

Human gender differences tend to be largest in behaviors of high reproductive relevance, that is, sexual and parenting behavior. Such differences show up best in biologically meaningful configurations of specific behaviors rather than in coarse categories. Paternal involvement is thus expressed in aspects and optima which differ from those of maternal involvement. A case in point is sensitivity in its effect on secure attachment, with paternal behavior to be measured by a yardstick different from maternal behavior. Secure father-child attachment may be fostered by optimal levels of paternal activation/stimulation which are different from maternal optima. Paternal action preferences lead to preferences for rough play, which may be especially relevant to the socialization of male offspring. Moreover, fathers-unlike mothers-may perceive their paternal effort as mating effort. The study of father-child attachment-and especially its differences from mother-child attachment-can benefit from considering evolved sex differences in parental behavior.

BACKGROUNDApproximately 1% of children and adolescents, 0.2% of women, and 0.8% of men suffer from stuttering, and lesser numbers from cluttering. Persistent speech fluency disorders often cause lifelong problems in communication and social participation.METHODSIn an interdisciplinary, evidence and consensus based clinical practice guideline, the current understanding of the nature, identification, diagnosis, and treatment of stuttering and cluttering was summarized. A systematic review of the literature was carried out to assess the efficacy and effectiveness of treatments for stuttering. Evidence is lacking on the etiology, pathogenesis, evaluation, and treatment of cluttering.RESULTSIn view of the fact that common (developmental, idiopathic) stuttering is associated with structural and functional changes of the brain, the guideline recommends that it should be called "originary neurogenic non-syndromic stuttering." Heritability estimates for this disorder range from 70% to over 80%. For preschool children, the Lidcombe therapy has the best evidence of efficacy (Cohen's d = 0.72-1.00). There is also strong evidence for an indirect treatment approach. For children aged 6 to 12, there is no solid evidence for the efficacy of any treatment. For adolescents and adults, there is good evidence with high effect sizes (Cohen's d = 0.75-1.63) for speech restructuring methods such as fluency shaping; weak evidence with intermediate effect sizes for stuttering modification (Cohen's d = 0.56-0.65); and weak evidence for combined speech restructuring and stuttering modification. The evidence does not support the efficacy of pharmacotherapy, rhythmic speaking, or breathing regulation as the sole or main form of treatment, or that of hypnosis or eclectic, unspecified stuttering therapies.CONCLUSIONStuttering is often treated in Germany with therapies for which there is inadequate evidence, and the initiation of treatment is often unnecessarily delayed. The guideline presents treatment methods whose efficacy is supported by the current evidence.

PURPOSE:Brain imaging and brain stimulation procedures have now been used for more than two decades to investigate the neural systems that contribute to the occurrence of stuttering in adults, and to identify processes that might enhance recovery from stuttering. The purpose of this paper is to review the extent to which these dual lines of research with adults who stutter have intersected and whether they are contributing towards the alleviation of this impairment. METHOD:Several areas of research are reviewed in order to determine whether research on the neurology of stuttering is showing any potential for advancing the treatment of this communication disorder: (a) attempts to discover the neurology of stuttering, (b) neural changes associated with treated recovery, and (c) direct neural intervention. RESULTS AND CONCLUSIONS:Although much has been learned about the neural underpinnings of stuttering, little research in any of the reviewed areas has thus far contributed to the advancement of stuttering treatment. Much of the research on the neurology of stuttering that does have therapy potential has been largely driven by a speech-motor model that is designed to account for the efficacy of fluency-inducing strategies and strategies that have been shown to yield therapy benefits. Investigations on methods that will induce neuroplasticity are overdue. Strategies profitable with other disorders have only occasionally been employed. However, there are signs that investigations on the neurology of adults who have recovered from stuttering are slowly being recognized for their potential in this regard.

Purpose: The study aimed at the examination of a link between stuttering and verbal skills (speech comprehension, articulation, grammar, vocabulary, and phonological short-term memory) in three- to five-year-old children.Method: Two samples with a total of 7,217 unselected German children were tested with the validated speech and language test Marburger Sprachscreening – revised version (MSSrev). Linguistic domains were compared for pre-school children who stuttered (CWS; n=110) and those who did not (CWNS; n=7,107) by means of Mann-Whitney U tests, general linear models, Spearman correlations, and cross-tables. Results: In both samples, CWS scored lower in grammar, articulation, and overall performance on the MSSrev. Statistically significant associations between stuttering and (a) sex of the child, and (b) language disorders in the family were identified.Conclusions: Taking into account the effect sizes, there appears to be a weak, but statistically significant link between stuttering and verbal skills.

Purpose: Speech in persons who stutter (PWS) is associated with disturbed prosody (speech melody and intonation), which may impact communication. The neural correlates of PWS' altered prosody during speaking are not known, neither is how a speech-restructuring therapy affects prosody at both a behavioral and a cerebral level. Methods: In this fMRI study, we explored group differences in brain activation associated with the production of different kinds of prosody in 13 male adults who stutter (AWS) before, directly after, and at least 1 year after an effective intensive fluency-shaping treatment, in 13 typically fluent-speaking control participants (CP), and in 13 males who had spontaneously recovered from stuttering during adulthood (RAWS), while sentences were read aloud with 'neutral', instructed emotional (happy), and linguistically driven (questioning) prosody. These activations were related to speech production acoustics. Results: During pre-treatment prosody generation, the pars orbitalis of the left inferior frontal gyrus and the left anterior insula were activated less in AWS than in CP. The degree of hypo activation correlated with acoustic measures of dysprosody. Paralleling the near-normalization of free speech melody following fluency-shaping therapy, AWS normalized the inferior frontal hypo-activation, sooner after treatment for generating emotional than linguistic prosody. Unassisted recovery was associated with an additional recruitment of cerebellar resources. Conclusions: Fluency shaping therapy may restructure prosody, which approaches that of typically fluent-speaking people. Such a process may benefit from additional training of instructed emotional and linguistic prosody by inducing plasticity in the inferior frontal region which has developed abnormally during childhood in PWS.