Time to drop “specific” in “specific language impairment”
Time to drop “specific” in “specific language impairment”
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是时候放弃“特定语言障碍”中的“特定”了
作者：
Marianne Ors
与我们的朋友交谈并理解他们的语言或非语言反应的能力，对我们大多数人来说都是理所当然的，几乎到了我们期望我们的语言和语言功能像我们的感官一样顺畅有效的地步。大多数孩子在他们生命的前几年就获得了这种独特的人类能力，似乎毫不费力。然而，令人惊讶的是，大量原本健康的儿童没有这样做，在大多数情况下，原因不明。在一项针对7000多名说英语的5岁幼儿园儿童的大型流行病学研究中，据报道，语言发展迟缓或异常的患病率为7.4%(1)，与其他对同一年龄组的研究大体一致（2,3）。Fernell et al.发表在这期Acta Pædiatrica上的研究源于他们与孩子们的日常工作，这些孩子由于某种原因有异常的语言发展。这项研究的主要信息并不完全是新的，但仍然需要重复：患有语言障碍的儿童通常患有其他认知障碍，这些障碍需要在针对这些儿童的个人培训计划中加以考虑。实质上，Hayes和Naidoo(4)对在Dawn House学校就读的患有严重语言障碍的学生进行了令人印象深刻的回顾性研究，得出了同样的结论。此外，在对他们学生的随访总结中，作者指出，“语言障碍，其最严重的表现是一个终生的问题。”我们的前学生中没有一个人在口语或书面语言或社交方面没有一些困难，尽管有些问题现在相对较小。”在瑞典最近的另一项关于严重语言障碍儿童共病的研究中，得出的结论是，这种情况经常与其他神经发育障碍合并(5)。Fernell和合著者的第二个信息同样重要。对严重语言障碍儿童进行适当的评估需要多学科的团队合作。在评估的初期阶段，需要语言治疗师和心理学家的专业知识。一个小组还应包括一名具有这些儿童经验的儿科医生，如果可能的话，一名儿科神经科医生。自闭症谱系中与干扰的重叠促使与儿童精神病学家密切合作。语音专家的专业知识是无价的，特别是在检查患有口语-语言障碍的儿童时。此外，理疗师可能需要评估和处理神经和大肌肉运动发展方面的问题。Fernell等人几乎没有提到的一个问题是，在儿童语言发育障碍领域仍然存在术语混淆，尽管公平地说，这超出了他们文章的范围。多年来，人们使用了许多术语，如发展性语言障碍、发展性语言障碍、延迟语言和语言学习障碍。今天，术语“特殊语言障碍”及其缩写SLI是最广泛使用的术语，特别是在研究文献中(6)。这个词被用来描述语言障碍是主要和唯一障碍的儿童。这个术语的核心问题在于，它是一种基于排斥性的描述，描述的是那些有语言障碍但表现出正常认知能力的儿童，他们的困难没有明确的原因。许多研究者在识别特殊语言障碍时采用了某种差异标准；例如，在任何语言测试中，严重的语言缺陷被定义为低于平均值2个标准差或更多，同时表现智商不超过低于平均值1个标准差。这种标准的相关性受到了正确的质疑。患有特殊语言障碍的儿童是一个异质性的儿童群体。事实上，特殊语言障碍应该被视为一个总括性术语(6)，涵盖了广泛的不同的过程，甚至可能随着时间的推移而改变。在纳入标准的基础上找到适当定义的问题部分是由于缺乏一个普遍接受的和全面的儿童语言障碍分类教育系统。不同的研究者得出不同的类型学，这取决于他们关注语言的哪些方面以及他们使用的工具(7)。伦纳德（Leonard）提供了对该主题的快速概述。因此，从通常与语言能力受损相关的其他实体（例如ADHD（注意缺陷多动障碍））中描述特定语言障碍的诊断问题没有得到解决。费尔内尔和他的同事们所表达的临床印象是，患有孤立性语言问题的儿童是罕见的，这是我们许多在日常工作中遇到这些儿童的人所共有的。Fernell等人的发现得到了其他研究的支持，不仅证实了我们的临床印象，而且提供了新的理由
The ability to talk to our friends and understand their responses, verbal or non-verbal, is taken for granted by most of us, almost to the point where we expect our speech and language functions to run as smoothly and ef ciently as our ve senses. Most children acquire this uniquely human ability during their rst years of life, seemingly without effort. However, a surprisingly large number of otherwise healthy children fail to do so, in most cases for unknown reasons. In a large epidemiological study of more than 7000 English-speaking 5-yold kindergarten children, the prevalence of delayed or deviant language development was reported to be 7.4% (1), in general accordance with other studies of the same age group (2, 3). The study by Fernell et al. published in this issue of Acta Pædiatrica has its origin in their own everyday work with children who for some reason have a deviant language development. The main message brought home in the study is not entirely a new one but nevertheless needs to be repeated: children with language impairment usually suffer from other cognitive impairments that need to be considered in the individual training programmes for these children. In essence, the same conclusion was reached by Hayes and Naidoo (4) in their impressive retrospective study of pupils attending Dawn House School for children with severe language disorders. Moreover, in a summary of a follow-up of their pupils, the authors stated, “language impairment, in its severest manifestations is a life-long problem. None of our ex-pupils is free from some dif culty with spoken or written language or social consequence, even though some of the problems are now relatively minor” (4). In another recent Swedish study of comorbidity in children with severe language impairment, it was concluded that this condition is often combined with other neurodevelopmental disabilities (5). The second message from Fernell and co-authors is equally important. A multidisciplinary team approach is necessary for proper assessment of children with severe language impairments. The expertise of both speech and language therapists and psychologists is needed early in the initial phase of the assessment. A team should also include a paediatrician with experience of these children, if possible a paediatric neurologist. The overlap with disturbances within the autistic spectrum motivates close collaboration with a child psychiatrist. The expertise of a phoniatrician is invaluable, particularly in examining children with oral–verbal dyspraxia. In addition, a physiotherapist may be needed to evaluate and deal with problems in ne and gross motor development. A problem barely touched upon by Fernell et al., although in all fairness beyond the scope of their article, is the terminological confusion that still exists in the eld of impaired language development in children. Many terms have been used over the years, such as developmental language disorder, developmental dysphasia, delayed speech and language learning disability. Today, the term “speci c language impairment” along with its abbreviation SLI is the most widely adopted term, especially in the research literature (6). The term was introduced to describe children where the language impairment was the primary and only handicap. The core problem with the term is that it is an exclusionbased description of children who have language impairments yet display normal cognitive ability and no identi able cause of their dif culties. Many researchers have adopted some sort of discrepancy criterion in identifying subjects with SLI; for example a severe language de cit de ned as 2 SD or more below the mean on any language measurement in combination with a performance IQ of no more than 1 standard deviation below the mean. The relevance of such a criterion has rightly been questioned. Children with SLI constitute a heterogeneous group of children. In fact, SLI should be regarded as an umbrella term (6), covering a wide range of different pro les that may even change over time. The problem of nding an adequate de nition based on inclusion criteria is partly due to the lack of a generally accepted and comprehensive classi cation system for language impairments in childhood. Different researchers arrive at different typologies depending on what aspects of language they focus on and what instruments they use (7). A quick overview of the topic is provided by Leonard (6). Thus, the problem of delineating the diagnosis of speci c language impairment from other entities often associated with impaired language pro ciency, for example ADHD (attention de cit hyperactivity disorder), is not solved. The clinical impression expressed by Fernell and colleagues that children with isolated language problems are rare is shared by many of us who meet these children in our everyday work. The ndings by Fernell et al., supported by other studies, not only con rm our clinical impressions but provide new reasons for
影响因子：
2.6
作者：
Tomblin, JB;Records, NL;O'Brien, M
通讯作者：
O'Brien, M