DIFFERENTIAL DIAGNOSIS AND CO-MORBIDITY OF CHILDHOOD LANGUAGE DISORDERS

DIFFERENTIAL DIAGNOSIS AND CO-MORBIDITY OF CHILDHOOD LANGUAGE DISORDERS

v  The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin (February 15, 1856-October 7, 1926), a German Psychiatrist.

v  Abbreviated as DDx, ddx, or ΔΔ in medicine

Definition of Differential Diagnosis

The diagnosis can be considered   DIFFERENTIAL   –

ü  when it takes into consideration all significant variables

ü  that might contribute to the disorder, and

ü  seek to differentiate the patients problem from similar related or dissimilar problems

Why Differential Diagnosis of Language Disorder….

ü  establish a baseline

ü   setting up an appropriate treatment/management plan

ü   help the child, family and others to come to terms with the history and implications of the condition

ü   help these people recognize if it recurs

ü   allow cross-child comparisons which would be helpful in clinically based research

Establishing a baseline of the child’s language disorder

ü  The Case History

ü  Other Investigations

o   Hearing test

o   Examination of fine and gross motor skills

o   Physical examination including

  neurological examination

o   Medical investigations and tests

o   Assessment of general cognitive function

ü  Language Assessment

o   Auditory-verbal comprehension

o    word-finding and lexical organisation

o    auditory-verbal memory and discrimination

o    Expressive language

Research Implications of Differential Diagnosis

            Comprehensive diagnostic procedures through the use of computer technology, help in development of ‘expert systems’ to describe logically and clearly the features of language disorder. To devise an expert system a large no. of variables need to be considered. An experimental version of ‘expert system’ considered to diagnose language disorders has recently been described and provisionally tested by Dalton (1989); further work is in progress which uses the Rapin and Allen (1987) 6 categories as the basis for the diagnostic criteria and presents these via a computer screen in a range of user friendly choices.

Reference:

Lees, J. & Urwin, S. (1995). Children with language Disorders. New Delhi: A.I.T.B.S. Publishers and Distributors

DISORDERS COVERED IN THE FOLLOWING PRESENTATION ARE-

• Mental Retardation
• Hearing Impairment
• Autism Spectrum Disorders
• Learning Disability
• Childhood Aphasia
• SLI
• ADHD
• Childhood Syndromes

 

MENTAL RETARDATION

Associated conditions:

• Hearing loss is more common in children who are retarded than in general population. These child are prone to have middle ear diseases (such as otitis media) and accompanying conductive hearing impairment
• Many diseases that are associated with MR (such as rubella) also can damage the inner ear and the neural mechanisms involved in hearing. Therefore, Sensorineural hearing loss also is frequently observed in persons with retardation.
• Physical Diabilities are likely to be associated with children with MR. they are also prone to frequent illness. Neurological impairment may be frequently observed.

Reference

Hegde M. N. (1996). A Cousebook on Language Disorders in Children. London: Singular publishing group 

Comorbidity of ADHD and MR

• The rates of ADHD and MR are estimated to be 9 and 18  percent.
• Usually the diagnosis of ADHD specifically excludes children with cognitive disability
• Also the diagnosis of ADHD is based on developmental ,namely significantly greater motoric  hyperactivity ,impulsivity and inattention than is expected for a given developmental age. Thus the threshold for diagnosis in persons with severe to profound MR should be elevated
• In case of profound MR, attention span, distractibility or on- task behaviour predictability is quite variable.
• Individuals given the diagnosis of ADHD in this context should exhibit shorter attention span, greater psychomotor activity and more remarkable impulsivity than their peers with similar level of retardation.
• Often clinicians encounter situations in which an individual does not evidence hyperactivity or attentional difficulties but may be unusually impulsive. In these situations one should entertain the diagnosis of an impulse control disorder not otherwise specified(ICD-NOS)

Co morbidity of impulse-controlled disorders (self injury and aggression) and MR

• Aggression and self injurious behaviors are common in MR and increase as cognitive disability becomes more severe.
• Self injurious behavior occur in context of specific syndromes but are more common in unknown or non-specific causes of MR

MR	AUTISM
History
Developmental delays in areas other than language are often noted	Usually they show language deviancy
Communication
Even though retarded children may not understand, he can gesture or mimic something and he appears to want to communicate	Usually doesn’t want to communicate with others in the environment
Inter-personal relationships
Overall not grossly impaired, social smile present and maintains eyecontact	Most of these behaviours are absent
Motor development
Show some of the same unusual motor movements seen in autistic children	Unusual motor movements like stereotyped movements like rocking ,flapping hand etc, tantrums and unresponsiveness to pain and self stimulation

MR	LD
flat profile on given tasks and on each subtasks	have adequate intelligence as measured with traditional intelligence tests
perform very poorly, below average and do not have adequate intelligence as measured by IQ test	show an erratic or scatter pattern in the subtest performance ie,they do poorly in some items and do much better in others. So, on profiling, troughs and peaks will be present

•        One more important criteria which can be used for differentiating is “adaptive skills". This refers to an individuals capacity to cope up with her environment .

•        According to the definition of MR, they have limitations in 2 or more adaptive skills

Reference

Wong, B. Y. L. (1996). The ABCs of Learning Disabilities. Toronto: Academic Press

Differentiating children with mental retardation associated with Down syndrome, fragile X Syndrome, Fetal Alchol Syndrome, and Williams Syndrome on the basis of the strengths and weaknesses among them

(check Appendix- Table- 1)

Reference:

Ms Cauley R. J. (2001). Assessment of language disorders in children. New Jersey: Lawrence Erlbaum associates

The effects of fetal exposure to substance abuse on child development-differential characteristics

(check Appendix Table-2)

Reference:

Fahey K. R. & Reid D. K. (2000). Language development, Differences and Disorders. Texas: Pro-ed

Related Articles :

I. Syntactic Complexity During Conversation of Boys With Fragile X Syndrome and Down Syndrome

Johanna R. Price, Joanne E. Roberts, Elizabeth A. Hennon, Mary C. Berni, Kathleen L. Anderson and John Sideris, Journal of Speech, Language, and Hearing Research, Vol. 15, 3-15, Feb 2008

Purpose- This study compares the syntax of boys who have fragile X syndrome (FXS) with and without autism spectrum disorder (ASD) with that of (a) boys who have Down Syndrome (DS) and (b) typically developing (TD) boys.

Method-

            Thirty-five boys with FXS only,

            36 boys with FXS with ASD,

            31 boys with DS, and

            46 TD boys participated.

            Conversational Language Samples were evaluated for utterance length and syntactic complexity (i.e., Index of Productive Syntax; H.S. Scarborough, 1990).

Results – After controlling for nonverbal mental age and maternal education levels, the 2 FXS groups did not differ in utterance length or syntactic complexity.

The FXS groups and the DS group produced shorter, less complex utterances overall and less complex noun phrases, and sentence structures than did the TD boys.

The FXS with ASD group and the DS group, but not the FXS-only group, produced less complex questions/negations than did the TD group.

Compared with the DS group, both FXS groups produced longer, more complex utterances overall, but on the specific complexity measures, they scored higher only on questions/negations.

Conclusions- Boys with FXS and DS have distinctive language profiles. Although both groups demonstrated syntactic delays, boys with DS showed greater delays.

 

AUTISM

Differentiating Autistic disorder from other disorders within the autism spectrum disorder (Check Appendix table-3)

Differentiating children with Autistic Disorder- High-functioning, Autistic Disorder-Low functioning, and Asperger’s Disorder (check Appendix table-4)

Reference:

Ms Cauley R. J. (2001). Assessment of language disorders in children. New Jersey: Lawrence Erlbaum associates

Differentiating pervasive Developmental Disorders of Childhood

(check Appendix Table-5)

Reference:

Smith M. D. & Damico, J, S. (1995). Childhood Language Disorders. New York: Thieme Medical Publishers

AUTISM	ADHD
Onset in infancy or early development but always before 3 years of age	Onset in childhood before 3 years of age
Not overactive	Behaviorally seem to be overactive
Have difficulty monitoring attention	have deficits in shifting attention
Prevalence- 2 to 5 in 10,000 children	Prevalence- 2 to 3 % in children and 3 to 5% in school aged children

Reference:

Farber, E. T. & Radziewicz C. (2008). Language Disorders in Children- Real Families, real issues, and Real interventions. New Jersey: Merill Prentice Hall

AUTISM  vs  MUTISM
DSM-IV, Selective Mutism- persistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations. Disntinction from autism- The marked social disturbances observed in autism are not present and Exhibits a wide range of social communication for functioning than would be expected in communication
AUTISM	SCHIZOPHRENIA
Has failure or delay in the development	Has loss of reality after development is better established
Have deficiency in fantasy	Retreats from reality into fantasy
Symptoms like poor eye movements etc are present	Symptoms like hallucinations and delusions frequently occur
Ratio—3:1	Ratio-1:1
Show relatively steady course	Marked by remissions and relapses
AUTISM  vs  APHASIA
Language disturbances of autistic children and aphasic children or children with developmental language disorders differ in – Autistic children have more severe and extensive communication problems than aphasic children. Aphasic children showed immature language whereas autistic children showed deviant features such as echolalia, pronoun reversals,etc. Autistic have more difficulty in comprehending language than aphasics In aphasics, language impairment is more extensive and it extends beyond spoken language to include gestures,abstraction,sequencing,written language Autistics have family history of speech delay. They do not engage in imaginative play and meaningful relationship with others unlike aphasic children

Reference;

Hamaguchi, P. M. A. (2001). Childhood Speech, Language, and Listening Problems- What Every Parent Should Know, 2^nd edn. Toronto: John Wiley & Sons, Inc.

Hegde M. N. (1996). A Cousebook on Language Disorders in Children. London: Singular publishing group

Related Articles:

I. Pragmatic Language Profiles of School- Age Children With Autism Spectrum Disorders And Williams Syndrome

Amy Philofsky and Deborah J. Fidler, American Journal of Speech Language Pathology, Vol.16, Nov 2007, 368-380

Purpose- The article was aimed at describing and comparing the pragmatic language profiles of school-age children with autism-spectrum disorders (ASD) and Williams Syndrome (WS) on a standardized measure to determine whether a standard pragmatics tool can differentiate between 2 groups of children with opposing social presentations and pragmatic language difficulties.

Method- twenty-two parents of School-age children with ASD, 21 parents of school-age children with WS, and 19 parents of school-age typically developing children rated their child on the Children’s Communication Checklist- Second Edition (CCC-2; D. Bishop, 2003), a standardized pragmatic language assessment tool.

Results- Both clinical groups demonstrated impairment in overall communication and pragmatic language functioning, but children with WS performed significantly better on overall pragmatic language functioning, and the magnitude of the effect was medium.

   Profile examination revealed equivalent performances between ASD and WS on most CCC-2 subscales; however, significantly better performances on the Coherence, Stereotyped Language, Nonverbal Communication, and Social Relations subscales were obtained in WS.

Conclusions- The CCC-2 appears to provide an effective means to identify and characterize pragmatic language difficulties using a standardized approach in children with ASD and WS.                  

PRAGMATIC BEHAVIOR

ASD

WS

ü 

+                      - +                      - +                      - +                      + +                      +/- -                       - +                      - +                      +/- -/+                    + +                      - +                      + +                      + +                      + +                      + +                      + +                      - +                      + +                      +

Unusual use of eye contact

ü  Difficulty reading emotion in facial expressions

ü  Difficulty expressing emotions in facial expressions

ü  Difficulty understanding communicative, nonverbal gestures

ü  A lack of use of communicative, nonverbal gestures

ü  Difficulties with conversational repair

ü  Lacking prosody

ü  Difficulties with topic maintenance

ü  over talkativeness

ü  Lack of social initiations with others

ü  Difficulties with conversational reciprocity

ü  Perseveration with language

ü  Difficulties with topic coherence

ü  Use of tangential language

ü  Difficulties interpreting abstract language

ü  Difficulties demonstrating interest in others

ü  Difficulties with friendships

ü  Restricted and repetitive interests

 

(Distinguishing characteristics as discussed by the authors in the above article)

 

ADHD

Related Articles:

I. Differentiating Attention-Deficit/Hyperactivity Disorder From Pervasive Developmental Disorder Not Otherwise Specified

Herbert Roeyers, Heidi Keymeulen, and Ann Buysse, Journal of Learning Disabilities

Volume 31, no.6, November /December 1999,565-571

Investigation- This study investigated early clinical differences between children with a diagnosis of pervasive developmental disorder not otherwise specified (PDD-NOS) and children with attention-deficit /hyperactivity disorder (ADHD). Differential diagnoses between the two disorders is often difficult in infancy or early childhood.

Method- Twenty-seven children with PDD-NOS were matched with 27 children with ADHD as to IQ and chronological age. Their parents were retrospectively questioned on pre-, peri-, and postnatal complications and on atypical or delayed development of the children between 0 and 4 years of age.

Results- This exploratory study revealed almost no differences between both groups with respect to pregnancy or birth complications.

The results suggest that differences between the two groups become more pronounced and specific with growing age.

The exception to this was the extremely loud crying behavior of children with ADHD immediately after birth.

Social impairments, anxieties, social-information-processing difficulties, and stereotypic motor behaviors became more and more evident in children with PDD-NOS, whereas recklessness was increasingly observed in children with ADHD.

Consequently, this investigation offers sufficient guidelines for more specific research with larger samples.

II. . Information Processing Deficits in Children with Attention-Deficit / Hyperactivity Disorder, Inattentive type, and Children with Reading Disability

Michael David Weiler, Jane Holmes Bernstein, David Bellinger, and Deborah P. Waber

Journal of Learning Disabilities, Vol. 35, No. 5, Sept/Oct 2002, 448-461

Aim- Examined the information processing capabilities of children diagnosed with the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD) who had been characterized as having a sluggish cognitive tempo.

Method- Children  referred for school-related problems (n=81) and nonreferred community controls (n=149) participated. Of the referred children, 24 met  criteria for ADHD, 42 met criteria for reading disability (RD), and 9 of these were comorbid for RD and ADHD.

Results- Children with ADHD differed from those without ADHD on a visual search task but not on auditory processing task; the reverse was true for children with RD.

Decomposition of the visual search task into component operations demonstrated that children in the ADHD group had a slow processing rate that was not attributable to inattention.

The children with ADHD were not globally poor at information processing or inattentive, but demonstrated diminished speed of visual processing.

 

SPECIFIC LANGUAGE IMPAIRMENT

Comorbidity with other differential disorders

Children with SLI have high rates of ADHD ( Wilson, 1996), developmental coordination disorder (Powell & Bishop, 1992), literacy problems ( Bishp & Adams, 1990), and imapirments of social interaction ( Brinton & Fujiki, 1993).

The same child might receive a label of SLI from a SLP, dyslexia from a school-psychologist, ADHD from a pediatrician, PDDNOS from a child psychiatrist, right hemisphere LD from a neuropsychologist, and developmetal coordination disorder from a physical therapist.

A multidimensonal model appears to do a better job in capturing clinical reality than a diagnostic system with sharp divisions between discrete disorders.

Reference:

Verhoeven, L. & Balkom, H. V. (2004). Classification of Developmental Language disorders- theoretical issues and Clinical implications. London: Lawrence Erlbaum associates

SLI	LATE-TALKERS
Phonology
Not all children have impaired phonology	More limited phonetic repertoire and use fewer consonants than age matched peers
Semantics
Greater impairment in production	Vocabulary delay seen which resolves by 3 to 4 yrs of age
Syntax
Slow in developing  word combination	Produce ungrammatical utterances at higher rates
Pragmatics
Roughly normal pragmatic development	Poor pragmatic development
Cognitive abilities
Perform below mental aged matched groups	Less higher level play engagements
READING DISABILITY	SLI
Diagnosed at school age	Diagnosed at younger age
Can discriminate and note temporal order	Auditory processing disorders present
No H/o lg impairment, may have spoken language deficits	Lg impairment present from younger age
Perform better on tasks of repetition of multisyllabic non-sense words	Poor performance

Reference:

Verhoeven, L. & Balkom, H. V. (2004). Classification of Developmental Language disorders- theoretical issues and Clinical implications. London: Lawrence Erlbaum associates

Related Articles:

I. Acquisition of Verb Meaning Through syntactic cues: A comparison of children with autism, children with specific language impairment (SLI) and children with typical language development (TLD)

Cory Shulman and Ainat Guberman, Journal of Child Language, 34 (2007), 411-423

Objective- The ability to extract meaning through the use of syntactic cues, adapted from Naigles’ (1990) paradigm, was investigated in Hebrew-speaking Children with autism, SLI and those with TLD, in an attempt to shed light on the similarities and differences between the two diagnostic criterias.

Method- 13 children with autism, 13 children with SLI and 13 children with TLD. Language level measured by the CELF-P

Results- Children with Autism and TLD learned Novel words using the Syntactical cues in the sentences in which they were presented, whereas children with SLI experience more difficulty. Only 4 of the 13 children with SLI (31%) learned the new words, whereas 11 children with autism and 10 children with TLD learned the novel verb using syntactical cues from the sentence frame.

Conclusions- Children with autism seem to rely on relatively intact syntactic abilities, while children with SLI seem to have marked impairment in using this mechanism in acquiring word meaning.

 

LEARNING DISABILITY

LD vs. EMOTIONAL DISTURBANCES

Individuals with LD have emotional problems that are associated with their histories of academic failure. But these are ameliorated and appear to subside as they achieve academic success or improvement.

Whereas emotional and behavioral disordered have impaired learning performance.

One can predict progress in academic learning in students with LDs but not with those with emotionally disturbed	……
……	Extremeness of their behavioral problems and their persistent inability to make or sustain satisfactory relationship with others

LD	LOW-ACHIEVERS
Continual failure	Less interest
Discrepancy between ability and performance	No discrepancy
Processing problems (eg; memory problems)	Do not have
SUBTYPES OF LD

Siegel’s classification:

READING DISABILITY- consistently have much difficulty with phonological tasks as nonword reading and grammar; also have working memory problems that interfere with their reading and reading comprehension. On the other hand, until they get older, they are relatively adequate in arithmetic.

ARITHMETIC DISABILITY- have adequate word recognition and decoding skills but have problems with arithmetic and working memory

READING AND ARITHMETIC DISABILITY- most disbled because they have both reading and arithmetic disability.

Reference:

Wong, B. Y. L. (1996). The ABCs of Learning Disabilities. Toronto: Academic Press

Related Articles:

I. Speech and Language Skills in Children with Learning Disability and Normal Children

Swapna Sebastian and Shyamala K.C., Journal of the Indian Speech and Hearing Association, 2005, Vol. 19

Objective- The objective of this study was to compare the speech and language skills of children with learning disability with that of normal children and to find out whether the children with specific developmental disorders of speech and language are prospective candidates for learning disability.

Method- 4 group of subjects- two experimental groups and two control groups.

First EG- 16 children (3-5 yrs) diagnosed as specific developmental disorders of speech and language (developmental learning disability)

Second EG- 34 children (5-9 yrs) diagnosed as learning disability (academically)

The speech and language proficiency of both the control and experimental groups were tested using (1) Malayalam diagnostic Articulation test (Maya, 1990) (2) Malayalam language test (Rukimini, 1994) (3) Test for Reading and metaphonological skills in Malayalam (Roopa, 2000).

Results- The scores obtained by the academic learning-disabled children were in par with the scores obtained by the normally achieving children of the same age range.

   The children with learning disability performed significantly poorer than normally achieving children on measure of semantic reception, semantic expression, syntactic reception and syntactic expression.

   There was a difference noticed across the different tasks in terms of their discriminating ability between academic learning disabled and their normally achieving peers

Conclusions- Children with preschool language impairments should be followed carefully into elementary school as they are at risk for school age language impairment and learning disability. It also suggests the need for developing screening devices for identifying children at risk for early reading disabilities.

NONVERBAL LD	ADHD
Difficluty with spatial relationships and perceptions; frequently bumps into objects; may have difficluty with maintaining balance in seat	Often fidgets or squirms; difficulty remaining still or seated when sustained visual attention is required
Slow motoric performance on nonverbal tasks withhypervigilance to details vs. big picture	Easiley distarcted and impulsive; poor planning and follow-thorough with details
Talkative; reliant on verbal meditation; may not be aware of manipulation or deception	Talks excessively; imaptient and often lose things; may be manipulative and deceptive
Poor social judgement; frequent avoidance of novel situations	Seeks out novelty with enthusiasm; risk-taking behaviors
Comorbidity with depressive or anxious symptoms	Comorbidity with oppositional and defiant behaviors

Reference:

Lees, J. & Urwin, S. (1995). Children with language Disorders. New Delhi: A.I.T.B.S. Publishers and Distributors

Vinson B. P. (1999). Language Disorders across the Life Span- An Introduction. London: Singular publishing group

Comorbidity: ADHD & LD

•      7 to 92%

•      Liberal definitions- 38%

•      Stringent definitions-23%; 15%

•      Comorbids have more severe attentional and cognitive problems

•      ADHD characteristics- distractibility, impulsivity, restlessness

•      LD charateristics- academic problems in reading, mathematics etc.

•      Faraone et al. (1993)- family genetic data- relatives of children with ADHD with and without LDs to have substantially higher risks of ADHD than the relatives of normally achieving, non-ADHd children.

•      However the risk of LDs was found to be higher only among relatives of children who have both ADHD and LD.

Reference:

Wong, B. Y. L. (1996). The ABCs of Learning Disabilities. Toronto: Academic Press

 

HEARING IMPAIRMENT

PERIPHERAL DEAFNESS	APHASIA	PSYCHIC DEAFNESS	MENTAL DEFICIENCY
Good inner lg.	Poor inner lg.	Good inner language but used only for phantasy	Lg is deficient bt not seriously discrepant with mental age Retarded in all phases of lg dvpt.
good gesture	Little or no use of gesture.	No use of gesture
Use voice projectively.	Not use voice projectively	Do not use voice projectively
Behave symbolically	May be echolalic	May be mute

A differential diagnosis on the characteristic performance of each type on the areas evaluated in making

(check Appendix Table-6)

Reference:

Aram D. M. & Nation J. E. (1982). Child language disorders. London: C V Mosby

Related Articles:

I. A Comparative study of Pragmatic aspects of Language  in Normal Hearing and Hearing-impaired Individuals

Vaishnavi, V. Bhalinge and M. N. Nagaraja, Journal of the Indian Speech and Hearing Association, 2002, Vol. 16

Purpose- Not much of research has focused in pragmatic skills of hearing impaired. Most of the studies are done on children considering the normal hearing subjects have achieved linguistic language by age 16 years. No studies are conducted to assess pragmatic skills of hearing impaired beyond this age level. In the absence of assessment protocol in Indian context pragmatic protocol was found to be a useful tool to assess pragmatic skills of hearing impaired and compare it with normals of the same age group.

Method- sixty subjects, 30 normal hearing and 30 hearing impaired in the age range of 16 to 23 years were selected. The HI subjects had prelingual hearing impairment, hearing loss more than 70dBHL in the better ear, no major illness and all were of average intelligence.

Data collection was carried out by recording unstructured spontaneous conversation/ communication taking place between two subjects of the same group and sex.

For judging the pragmatic features as being appropriate/inappropriate three judges were selected.

Results – The Results indicate that there exists significant difference in pragmatic skills of normal hearing and hearing impaired subjects; and normal hearing subjects have better pragmatic skills than hearing impaired subjects.

Within normal-hearing subjects there exists difference between males and females

There was no significant difference in the pragmatic skills of hearing impaired males and females.

In the profile of normal hearing, most of the parameters were assessed as appropriate. The few parameters marked inappropriate were pause time, interruption/overlap, and repair/revision.

In the profile of hearing impaired subjects only the nonverbal aspects were marked appropriate (except in one subject). All the paralinguistic aspects intelligibility, vocal intensity, vocal quality, prosody and fluency were marked inappropriate in all subjects.

In lexical selection specificity of words used and cohesion were affected. In turn taking behavior repair/revision was the most affected which is also indicated by earlier research studies. Topic change is also affected.

 

LANGUAGE DISORDER SUBTYPES

Comparison of language disorder subtypes

ü  Verbal auditory agnosia

ü  Semantic-pragmatic disorder

ü  Verbal dyspraxia

ü  Phonological syntactic deficit

ü  Lexical syntactic deficit

(check Appendix Table-7)

Reference:

Adams, C. Betty B. B. & Edwards, M. (1997). Developmental Disorders of Language, 2nd edn. California: Singular Publishing Group 

ACQUIRED COGNITIVE COMMUNICATIVE DIORDERS

	DEMENTIA	TBI	RHD	APHASIA
Onset	Gradual	Sudden	Sudden	sudden
Progression	Worsens	Improve/stabilizes	Improve/stabilizes	Improve/stabilizes
Damage	Diffuse	Diffuse	Focal	focal
Characteristic deficits (representative, not all inclusive)	Memory, all cognitive adaptive, and communicative functions as disease progresses	Memory, cognitive-based aspects of communication, pragmatics or social use of language	pragmatics or social use of language including discourse comprehension, prosodic interpretation	Language content and form for speaking, listening, reading , writing

LANGUAGE LEARNING DISBILITY	ACQUIRED LANGUAGE DISORDER
mild memory problems	Severe, recent memory problems
Early onset	Later onset
Central damage can only be assumed from soft neurological signs	Direct evidence for neurological impairment
Skills and knowledge show uneven development	Some old skills and knowledge remain, but there are inconsistencies of performance
Mild motor coordination	Paresis or spasticity is seen
Basic cognitive skills may be intact	Basic cognition is commonly disrupted
Acquisition of new skills is slow	What is learned may not be retained
Status changes slowly	Status may change rapidly during recovery
Visual perceptual problems	Visual problems often include double vision
Normal or high activity level	Recovery from coma may include slowness or lethargy
Usually aware of own learning problems	Injury may cause lack of learning problems
Emotional reactions connected with present situation	Emotions can be unpredictable and may not be linked to immediate situation

Reference:

Kohnert K. (2008). Language Disorders in Bilingual Children and Adults. San Diego: Plural Publishing Inc.

REFERENCES

1.      Aram D. M. & Nation J. E. (1982). Child language disorders. London: C V Mosby

2.      Fahey K. R. & Reid D. K. (2000). Language development, Differences and Disorders. Texas: Pro-ed

3.      Ms Cauley R. J. (2001). Assessment of language disorders in children. New Jersey: Lawrence Erlbaum associates

4.      Adams, C. Betty B. B. & Edwards, M. (1997). Developmental Disorders of Language, 2nd edn. California: Singular Publishing Group 

5.      Verhoeven, L. & Balkom, H. V. (2004). Classification of Developmental Language disorders- theoretical issues and Clinical implications. London: Lawrence Erlbaum associates

6.      Hegde M. N. (1996). A Cousebook on Language Disorders in Children. London: Singular publishing group

7.      Farber, E. T. & Radziewicz C. (2008). Language Disorders in Children- Real Families, real issues, and Real interventions. New Jersey: Merill Prentice Hall

8.      Kohnert K. (2008). Language Disorders in Bilingual Children and Adults. San Diego: Plural Publishing Inc.

9.      Vinson B. P. (1999). Language Disorders across the Life Span- An Introduction. London: Singular publishing group

10.  Lees, J. & Urwin, S. (1995). Children with language Disorders. New Delhi: A.I.T.B.S. Publishers and Distributors

11.  Hamaguchi, P. M. A. (2001). Childhood Speech, Language, and Listening Problems- What Every Parent Should Know, 2nd edn. Toronto: John Wiley & Sons, Inc. 

12.  Wong, B. Y. L. (1996). The ABCs of Learning Disabilities. Toronto: Academic Press

13.  Smith M. D. & Damico, J, S. (1995). Childhood Language Disorders. New York: Thieme Medical Publishers

14.  Dodd, B. (2006). Differential Diagnosis and Treatment of Children with Speech Disorder, 2nd edn. London: Whurr publishers. 

15.  http://www. google.com