On the clinical relevance of early deficits in critical linguistic functions

3
children and adolescents, has to be considered. The perspective of everyday pleasure has to take precedence over the perspective of disciplined perfection. References [1] Batch JA, Baur LA. Management and prevention of obesity and its complications in children and adolescents. Med J Aust 2005;182:130–5. [2] Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360: 473–82. [3] Robinson TN. Reducing children’s television viewing to pre- vent obesity: a randomized controlled trial. JAMA 1999;282: 1561–7. [4] Francis LA, Lee Y, Birch LL. Parental weight status and girls’ television viewing, snacking, and body mass indexes. Obes Res 2003;11:143–51. [5] Socialstyrelsen [Swedish National Board of Health and Welfare]. Ma ¨tning av barns och ungdomars psykiska ha ¨lsa – fo ¨rslag till nationella och a ˚terkommande underso ¨kningar. [Measurement of the mental health of children and adoles- cents – proposals of national and recurrent investigations.] Author: Curt Hagquist. Stockholm: Socialstyrelsen; 2005. [6] Prosser J, McArdle P. The changing mental health of children and adolescents: evidence for a deterioration? Psychol Med 1996;26:715–25. [7] Solantaus T, Leinonen J, Punamaki RL. Children’s mental health in times of economic recession: replication and exten- sion of the family economic stress model in Finland. Dev Psychol 2004;40:412–29. [8] Lewis O, Sargent J, Friedrich W, Chaffin M, Cunningham N, Cantor PS. The impact of social change on child mental health in Eastern Europe. Child Adolesc Psychiatr Clin N Am 2001;10:815–24. [9] Cassidy K, Kotynia-English R, Acres J, Flicker L, Lautenschlager NT, Almeida OP. Association between lifestyle factors and mental health measures among commu- nity-dwelling older women. Aust N Z J Psychiatry 2004;38: 940–7. [10] Rohrer JE, Pierce JR Jr, Blackburn C. Lifestyle and mental health. Prev Med 2005;40:438–43. [11] Parfitt G, Eston RG. The relationship between children’s habitual activity level and psychological well-being. Acta Pae- diatr 2005;94:1790–6. [12] Samha ¨llsmedicin, Stockholms la ¨ns landsting och Statens folkha ¨lsoinstitut. [Unit of Community Medicine, Stockholm County Council, and Swedish National Institute of Public Health.] Rasmussen F, Eriksson M, Bokedal C, Scha ¨fer Elinder L. Fysisk aktivitet, matvanor, o ¨vervikt och sja ¨lvka ¨nsla bland ungdomar. COMPASS – en studie i sydva ¨stra Stor- stockholm. [Physical activity, eating habits, overweight and self-esteem in adolescents. COMPASS – a study in the south west parts of larger Stockholm.] Rapport. Stockholm: Samha ¨llsmedicin, Stockholms la ¨ns landsting och Statens folk- ha ¨lsoinstitut; 2004. Rapport 2004 : 1. On the clinical relevance of early deficits in critical linguistic functions FRANCISCO LACERDA Department of Linguistics, Stockholm University, Stockholm, Sweden Abstract The clinical significance of patterns of deficits in semantic and phonological representations observed by Miniscalco et al. is discussed in light of an ecological approach to language development. Conclusion: Deficits in semantic representations reflect problems in capturing the core linguistic referential function and should be taken as serious early warning signals for language delay. Key Words: Early childhood, infants, language acquisition This issue’s article by Miniscalco et al. [1] addresses the important issue of detecting early signs of language delay problems. Language acquisition is a life-long process but, because its most dramatic phases unfold in infancy and early childhood, the consensus is that children who run the risk of language delay should be treated as early as possible. Early intervention is not really expected to cure language delay but is known to significantly improve the child’s chances to adjust to the demands of the linguistic environment, both as a direct consequence of the child’s individual training and as an indirect effect of educating the caregivers in how to take into consideration the child’s handicap [2]. The problem, however, is early identification of the Correspondence: Francisco Lacerda, Department of Linguistics, Stockholm University, SE-106 91 Stockholm, Sweden. Tel: +46 (0)8 162341. Fax: +46 (0)8 155389. E-mail: [email protected] (Received 10 October 2005; accepted 12 October 2005) Commentaries 1701 ISSN 0803-5253 print/ISSN 1651-2227 online # 2005 Taylor & Francis DOI: 10.1080/08035250500409522

Transcript of On the clinical relevance of early deficits in critical linguistic functions

children and adolescents, has to be considered. The

perspective of everyday pleasure has to take precedence

over the perspective of disciplined perfection.

References

[1] Batch JA, Baur LA. Management and prevention of obesity

and its complications in children and adolescents. Med J Aust

2005;182:130–5.

[2] Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity:

public-health crisis, common sense cure. Lancet 2002;360:

473–82.

[3] Robinson TN. Reducing children’s television viewing to pre-

vent obesity: a randomized controlled trial. JAMA 1999;282:

1561–7.

[4] Francis LA, Lee Y, Birch LL. Parental weight status and girls’

television viewing, snacking, and body mass indexes. Obes Res

2003;11:143–51.

[5] Socialstyrelsen [Swedish National Board of Health and

Welfare]. Matning av barns och ungdomars psykiska halsa –

forslag till nationella och aterkommande undersokningar.

[Measurement of the mental health of children and adoles-

cents – proposals of national and recurrent investigations.]

Author: Curt Hagquist. Stockholm: Socialstyrelsen; 2005.

[6] Prosser J, McArdle P. The changing mental health of children

and adolescents: evidence for a deterioration? Psychol Med

1996;26:715–25.

[7] Solantaus T, Leinonen J, Punamaki RL. Children’s mental

health in times of economic recession: replication and exten-

sion of the family economic stress model in Finland. Dev

Psychol 2004;40:412–29.

[8] Lewis O, Sargent J, Friedrich W, Chaffin M, Cunningham N,

Cantor PS. The impact of social change on child mental health

in Eastern Europe. Child Adolesc Psychiatr Clin N Am

2001;10:815–24.

[9] Cassidy K, Kotynia-English R, Acres J, Flicker L,

Lautenschlager NT, Almeida OP. Association between

lifestyle factors and mental health measures among commu-

nity-dwelling older women. Aust N Z J Psychiatry 2004;38:

940–7.

[10] Rohrer JE, Pierce JR Jr, Blackburn C. Lifestyle and mental

health. Prev Med 2005;40:438–43.

[11] Parfitt G, Eston RG. The relationship between children’s

habitual activity level and psychological well-being. Acta Pae-

diatr 2005;94:1790–6.

[12] Samhallsmedicin, Stockholms lans landsting och Statens

folkhalsoinstitut. [Unit of Community Medicine, Stockholm

County Council, and Swedish National Institute of Public

Health.] Rasmussen F, Eriksson M, Bokedal C, Schafer

Elinder L. Fysisk aktivitet, matvanor, overvikt och sjalvkansla

bland ungdomar. COMPASS – en studie i sydvastra Stor-

stockholm. [Physical activity, eating habits, overweight and

self-esteem in adolescents. COMPASS – a study in the

south west parts of larger Stockholm.] Rapport. Stockholm:

Samhallsmedicin, Stockholms lans landsting och Statens folk-

halsoinstitut; 2004. Rapport 2004 : 1.

On the clinical relevance of early deficits in critical linguistic functions

FRANCISCO LACERDA

Department of Linguistics, Stockholm University, Stockholm, Sweden

Abstract

The clinical significance of patterns of deficits in semantic and phonological representations observedby Miniscalco et al. is discussed in light of an ecological approach to language development.

Conclusion: Deficits in semantic representations reflect problems in capturing the core linguisticreferential function and should be taken as serious early warning signals for language delay.

Key Words: Early childhood, infants, language acquisition

This issue’s article by Miniscalco et al. [1] addresses

the important issue of detecting early signs of language

delay problems. Language acquisition is a life-long

process but, because its most dramatic phases unfold in

infancy and early childhood, the consensus is that

children who run the risk of language delay should be

treated as early as possible. Early intervention is not

really expected to cure language delay but is known

to significantly improve the child’s chances to adjust to

the demands of the linguistic environment, both as a

direct consequence of the child’s individual training

and as an indirect effect of educating the caregivers in

how to take into consideration the child’s handicap [2].

The problem, however, is early identification of the

Correspondence: Francisco Lacerda, Department of Linguistics, Stockholm University, SE-106 91 Stockholm, Sweden. Tel: +46 (0)8 162341. Fax:

+46 (0)8 155389. E-mail: [email protected]

(Received 10 October 2005; accepted 12 October 2005)

Commentaries 1701

ISSN 0803-5253 print/ISSN 1651-2227 online # 2005 Taylor & Francis

DOI: 10.1080/08035250500409522

children at risk for language delay. Extreme cases are

easy to spot, but more common ones may lack clear

indicators and therefore put high demands on clini-

cians who must recognize them with high enough

specificity and sensitivity. At the core of this problem

is the difficulty to capture and quantify the complex

dynamic process of language acquisition. From this

perspective Miniscalco et al.’s [1] retrospective study

points to some relevant early warning signals that

clinicians should be aware of. By relating children’s

language development status at 6 y of age with different

measures performed on the same children when they

were 212 y old, the authors contribute a general pattern

of relevant “early warnings” that make good sense

from a general theoretical perspective on language

development.

Humans have evolved a flexible and efficient speech

communication system (as well as non-speech

communication, like sign language) based on the

recursive use of sound strings and hierarchical struc-

tures of meaning by exploring combinatorial principles

that are fundamentally different from those used in

other intelligent species’ communication systems [3].

This combinatorial power allows humans to create

an unlimited number of utterances departing from a

rather small finite set of elements. But when adults

address language from the young language learner’s

perspective, coming to grips with the ambient language

often appears as a nearly impossible task. Since the

utterances that the learner has access to are only a

limited amount of particular exemplars of all

the utterances that might have been drawn from the

infinite set of possible utterances according to

the ambient language, inferring from these exemplars

the underlying linguistic structure of the ambient

language appears to be an insurmountable problem.

Yet, the overwhelming majority of young humans

discovers most of the basic linguistic principles of their

ambient language within the first couple of years of life

and typically engages in speech interaction with people

around them. How can infants solve this problem?

While avoiding debating directly on the relative

importance of genetic and ambient components for

the language-learning process, it is apparent that the

actual linguistic input available to the young language

learner is much more structured than the principled

theoretical approach sketched above would suggest.

Under typical circumstances, human infants are richly

exposed to the sounds of their ambient languages.

From the very beginning of postnatal life1, speech

is available in the infant’s immediate environment,

both as part of the acoustic background that the infant

may or may not attend to, and as infant-directed

speech.

Some key aspects of typical infant-directed speech

are that it is highly context bound, very repetitive and,

unsurprisingly, not very rich in terms of linguistic

content [5,6]. An adult addressing a 2- or 3-mo-old

infant tends, for instance, not use elaborate sentences.

The adult’s primary goal appears to be to maintain the

infant’s interest in the general speech communication

situation rather than attempting a peer-to-peer

conversation with the young infant [7,8]. Adding to

this the fact that the adult is often biased to speak

about objects or events that are available in the

infant’s visual field or directly linked to the infant’s

emotional state, it is compelling to recognize that

the potentially unlimited scope of possible utterances

within the ambient language is only barely explored

in actual speech directed to young infants. Yet,

experience with such a rather limited sample of

highly structured utterances is probably a very im-

portant factor to bootstrap the language acquisition

process because the utterances available to the infant

refer to salient objects in its immediate vicinity and

therefore richly demonstrate the core principle of

linguistic referential function [5]. In this way, the

initial small-scale discovery of linguistic relations

between utterances and objects, or events that go

along with them, quickly becomes the true trigger of

the language acquisition process that will unfold from

then on [9].

From the infant’s point of view, it is almost trivial to

point out that the young language learner’s interaction

with speakers of the ambient language rather

soon leaves language-specific traces in the child’s

speech perception and production [10,11], but this

convergence towards the ambient language clearly

exposes the underlying implication that the particu-

larities of a language learner’s linguistic environment

will impact on his/her individual linguistic strategies, at

least during the early stages of the language acquisition

process. Of course, the patterns of interaction between

language learners and their linguistic environments are

extremely complex and strongly influenced by learners’

biologically determined skills as well as by the linguistic

affordances of the ambient language. Adding to this

complexity, the language learner’s speech perception

and production skills are also developed as a con-

sequence of the very adaptation to the ambient

language, suggesting that the individual learning paths

during the language acquisition process may be

expected to be contingent on the learner’s personal

preferences and focus of interest as well as on the

particular characteristics of his/her immediate language

environment. With this language acquisition scenario

in mind, the amazingly large number of successful

1 Actually, the sounds of speech, presumably low-pass filtered by thewomb, can be heard by the fetus from about the 5th gestationalmonth, when the fetus’s auditory system has reached maturation.Indeed, the infant’s prenatal exposure to the rhythmic characteristicsof, mainly, its mother’s speech has been demonstratedexperimentally [4].

1702 Commentaries

language acquisition paths available to the normally

developing child becomes apparent. From the clinical

perspective, however, the problem is to distinguish

successful developmental paths that may be charac-

terized by individual preferences from deviant language

development that may be mistakenly interpreted as a

manifestation of the learner’s personal preference.

Miniscalco et al.’s article brings up aspects of early

language development that may be relevant for the

clinical assessment of potential language delays. One of

its clear messages is that low performance in semantic

aspects by 212 y of age should be taken as a serious

warning for language delay. Admittedly, a low score

on a semantics test is not, by itself, a definitive flag

for language delay problems, but it builds up to a

very strong warning signal if, in line with the reasoning

on the language development process sketched above,

it is associated with other problems such as grammat-

ical deficits or difficulties in non-word repetitions.

Indeed, low performance in semantic measures reflects

difficulties in grasping the language’s referential func-

tion, which is a fundamental component of the very

symbolic representation underlying speech communi-

cation, while difficulties in repetitions of non-words are

likely to be linked to the child’s immature phonological

representations [12,13]. But both semantics and

phonological representations are in a sense two aspects

of the same linguistic process that can be equated in

terms of current theories on the emergence of linguistic

structure during the language acquisition process. These

theoretical approaches propose phoneme- or syllable-

like representations as emergent consequences of

the increasing lexical pressure that is associated with

the child’s general cognitive maturation process and

augmenting representation needs [14,15]. The data

reported in Miniscalco et al.’s paper are well in line

with such an approach: their data strongly suggest

that a pattern of deficits in the establishment of critical

semantic and phonological representations by 212 y of

age is a strong early warning that has to be taken seriously

and engage carefully designed early intervention to

minimize the impact of very likely upcoming language

delay problems.

References

[1] Miniscalco, C, Westerlind M, Lohmander A. Language skills at

6 years in Swedish children screened for language delay at 212

years of age. Acta Paediatr 2005;94:1797–1805.

[2] Coplan J, Gleason JR. Quantifying language development from

birth to 3 years using the early language milestone scale.

Pediatrics 1990;86:963–71.

[3] Hauser MD, Chomsky N, Fitch WT. The faculty of language:

what is it, who has it, and how did it evolve? Science

2002;298:1569–79.

[4] De Casper A, Fifer W. Of human bonding: newborns prefer

their mothers’ voices. Science 1980;208:1174–6.

[5] Lacerda F,Klintfors E,GustavssonL,LagerkvistL,MarklundE,

Sundberg U. Ecological theory of language acquisition. Genova:

Epirob; 2004.

[6] Lacerda F,MarklundE,LagerkvistL,GustavssonL,Klintfors E,

Sundberg U. On the linguistic implications of context-bound

adult-infant interactions. Genova: Epirob; 2004.

[7] Fernald A. Intonation and communicative intent in mothers’

speech to infants: is the melody the message? Child Dev

1989;60:1497–510.

[8] Sundberg U, Lacerda F. Voice onset time in speech to infants

and adults. Phonetica 1999;56:186–99.

[9] Elman JL. Learning and development in neural networks: the

importance of starting small. Cognition 1993;48:71–99.

[10] Kuhl PK, Williams KA, Lacerda F, Stevens KN, Lindblom B.

Linguistic experience alters phonetic perception in infants by 6

months of age. Science 1992;255:606–8.

[11] Engstrand O, Williams KA, Lacerda F. Does babbling sound

native? Listener responses to vocalizations produced by

Swedish and American 12- and 18-month-olds. Phonetica

2003;60:17–44.

[12] Bishop DV, North T, Donlan C. Nonword repetition as a

behavioural marker for inherited language impairment:

evidence from a twin study. J Child Psychol Psychiatry

1996;37:391–403.

[13] Bishop DV, Adams CV, Norbury CF. Using nonword repeti-

tion to distinguish genetic and environmental influences

on early literacy development: a study of 6-year-old twins.

Am J Med Genet 2004;129B:94–6.

[14] Davis BL, Lindblom B. Phonetic variability in baby talk and

development of vowel categories. In: Lacerda F, von Hofsten

C, Heimann M, editors. Emerging cognitive abilities in early

infancy. Mahwah, New Jersey: Lawrence Erlbaum Associates;

2001. p 135–71.

[15] Lacerda F, Lindblom B. Some remarks on Tallal’s transform in

the light of emergent phonology. In: C. von Euler, editor. Basic

neural mechanisms in cognition and language – with special

reference to phonological problems in dyslexia. Oxford:

Wenner-Gren Foundations and Rodin Remediation Academy,

Elsevier Science; 1998. p 197–222.

Commentaries 1703