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The examiner may shake the forearm to antibiotics for acne how long cheap erythromycin 500 mg overnight delivery and fro and note the excursions of the patient’s hand antimicrobial yahoo buy cheap erythromycin 500mg, brace a limb and then suddenly remove the support infection game cheats 500 mg erythromycin sale, or note the range of movement of a part in response to bacteria cheap erythromycin online a slight blow. Bilateral examination of homologous parts helps compare for differences in tone on the two sides of the body. Tone should be assessed by both slow and rapid motion and through partial and full range of motion, documenting the distribution, type, and severity of any abnormality. The Babinski Tonus Test the arms are abducted at the shoulders, and the forearms are passively flexed at the elbows. With hypotonicity, there is increased flexibility and mobility, and the elbows can be bent to an angle more acute than normal. With hypertonicity, there is reduced flexibility, and passive flexion cannot be carried out beyond an obtuse angle. The Head-Dropping Test the patient lies supine without a pillow, completely relaxed, eyes closed, and attention diverted. The examiner places one hand under the patient’s occiput and with the other hand briskly raises the head, and then allows it to drop. Normally the head drops rapidly into the examiner’s protecting hand, but in patients with extrapyramidal rigidity there is delayed, slow, gentle dropping of the head because of rigidity affecting the flexor muscles of the neck. When meningismus is present, there is resistance to and pain on flexion of the neck. Pendulousness of the Legs the patient sits on the edge of a table, relaxed with legs hanging freely. The examiner either extends both legs to the same horizontal level and then releases them (Wartenberg pendulum test) or gives both legs a brisk, equal backward push. If the patient is completely relaxed and cooperative, there will normally be a swinging of the legs that progressively diminishes in range and usually disappears after six or seven oscillations. In extrapyramidal rigidity, there is a decrease in swing time but usually no qualitative change in the response. In spasticity, there may be little or no decrease in swing time, but the movements are jerky and irregular, the forward movement may be greater and more brisk than the backward, and the movement may assume a zigzag pattern. Pthomegroup the Shoulder-Shaking Test the examiner places her hands on the patient’s shoulders and shakes them briskly back and forth, observing the reciprocal motion of the arms. With extrapyramidal disease, there will be a decreased range of arm swing on the affected side. With hypotonia, especially that associated with cerebellar disease, the excursions of the arm swing will be greater than normal. The Arm-Dropping Test the patient’s arms are briskly raised to shoulder level and then dropped. In spasticity, there is a delay in the downward movement of the affected arm, causing it to hang up briefly on the affected side (Bechterew’s or Bekhterew’s sign); with hypotonicity, the dropping is more abrupt than normal. A similar maneuver may be carried out by lifting and then dropping the extended legs of the recumbent patient. Hand Position Hypotonicity, especially that associated with cerebellar disease or Sydenham’s chorea, may cause the hands to assume a characteristic posture. With the arms and hands outstretched, there is flexion at the wrists and hyperextension of the fingers (“spooning”) accompanied by moderate overpronation. With the arms raised overhead, the overpronation is exaggerated with the palms turned outward. This overpronation phenomenon differs from the pronator drift sign, in which the overpronation is due to weakness of corticospinal innervated muscles or increased tone in the pronator muscles. Myotatic irritability has been defined as both the response to direct percussion as well as the ability of a muscle to contract in response to sudden stretch. The response to direct muscle percussion in normal muscle is very slight and, in most muscles, is seen or felt with difficulty. The reaction may be more pronounced in wasting diseases, such as cachexia and emaciation, and in some diseases of the lower motor neuron. Hyperexcitability to such stimulation occurs in tetanus, tetany, and certain electrolyte disturbances. Occasionally, after a muscle is percussed with a reflex hammer, a wave of contraction radiates along the muscle away from the point of percussion. A small ridge or temporary swelling may persist for several seconds at the point of stimulation. The mechanism of myoedema is poorly understood, but it is probably a normal physiologic phenomenon. Its presence alone does not indicate a neuromuscular disorder, but the response may be exaggerated in some circumstances, most notably hypothyroid myopathy and cachexia. Hypothyroidism may also cause an electrically active muscle mounding and spreading contraction, manifest by a burst of normal motor unit action potentials upon percussion (for video, see Loomis et al. Myotonia is a persisting contraction following mechanical stimulation of muscle that is quite different from myoedema (see below). In rippling muscle disease, there are wave-like muscle contractions evokedPthomegroup by muscle stretch that move laterally along muscle over 5 to 20 seconds. Muscle tenderness on squeezing the muscle belly, or even with very slight pressure, may cause exquisite pain. Widespread muscle tenderness to palpation may occur with inflammatory myopathy, especially polymyositis and dermatomyositis, in some neuropathies, and in acute poliomyelitis. Hypotonicity may develop from disease of the motor unit, the proprioceptive pathways, cerebellar lesions, and in the choreas. The excursion of the joint may be increased with an absence of the normal “checking” action on extreme passive motion. Hypotonia When hypotonia is due to disease of the motor unit, there is invariably some degree of accompanying weakness. Infantile hypotonia (floppy baby syndrome) is a common clinical condition in which there is a generalized decrease in muscle tone, typically affecting a neonate (for video, see. Tone may also be decreased when disease affects the muscle spindle afferent system. Tabes dorsalis affects proprioceptive fibers in the posterior root and may cause muscle hypotonia with joint hyperextensibility. Hypotonia may occur with some lesions of the parietal lobe, probably due to disturbances of sensation. Hypotonicity may occur with various types of cerebellar disease but is never as severe as that which occurs with diseases of the lower motor neuron. Cerebellar hypotonia is not associated with weakness and the reflexes are not lost, although they may be pendular; there are no pathologic reflexes. Muscle tone is, of course, decreased in deep sleep, coma, and other states of impaired consciousness. Sudden attacks of impaired muscle tone in an awake patient occur in akinetic epilepsy and in cataplexy. With atonic (akinetic) seizures, the attacks of sudden loss of muscle tone occur spontaneously, and the patient may fall to the ground (drop attack or drop seizure). In cataplexy, the attacks are typically precipitated by sudden strong emotions, such as laughing. In cataplexy, there are attacks of decreased tone after strong emotion, such as laughter or anger. With severe attacks, the patient falls to the ground, but without loss of consciousness. With incomplete attacks, there may be slackening of facial muscles, jaw drop, head drop, slumping of the shoulders, or knee buckling without a fall. A state of continuous cataplexy has rarely been reported with midbrain tumors (the limp man syndrome). Sleep paralysis is a state common in narcolepsy, in which a patient has diffusely decreased tone and is unable to move immediately after awakening from sleep. The hemiparesis that is present acutely following hemispheric stroke may be associated with hypotonia (cerebral or neuralPthomegroup “shock”), which gradually evolves into hypertonia with the passage of time. Some conditions may cause abnormal joint laxity, which may be confused with muscle hypotonia. It is a routine feature of lesions that involve the corticospinal tract after the acute stage.

An extended and annotated review of what we know about variability in each ele- ment can be found in Appendix A virus 10 2009 order erythromycin 500 mg fast delivery. Reader differences in such capabilities as fluency in word recogni- 19 20 Reading for Understanding tion antibiotic kill curve protocol cheap 500mg erythromycin with mastercard, oral language ability antimicrobial resistance ppt generic erythromycin 500 mg mastercard, and domain knowledge infection rate cheap 500mg erythromycin, along with differences in such dispositions as the reader’s motivation, goals, and purposes, are important sources of variability in reading comprehension. Such variables interact with one another and with the text to which the reader is exposed (the text can be narrative, expository, etc. The capabilities and dispositions the reader brings to the task of reading, his or her engagement in and responses to given texts, and the quality of the out- comes produced by the act of reading for some purpose are, themselves, shaped by cultural and subcultural influences, socioeconomic status, home and family background, peer influences, classroom culture, and instructional his- tory. These multiple and interacting factors influence both the inter- and intra- individual differences in reading proficiency that we must consider in defining reading comprehension as a field of study. We summarize in this chapter what we know about the dimensions of reader differences or, perhaps more pre- cisely, what we know about the sources of variation in the functioning of the various comprehension processes in service of the various outcomes related to the act of reading for some purpose. Sociocultural Influences Reader variability is, to some extent, a product of the fact that children come from and learn to read in varying sociocultural contexts. We view learning and literacy as cultural and historical activities, not just because they are acquired through social interactions, but also because they represent how a specific cul- tural group or discourse community interprets the world and transmits this in- formation. According to Gee (1990), an awareness of how members of particular discourse communities construct their identities as readers (through their ways of behaving, interacting, valuing, thinking, believing, speaking, reading, and writing) is one important step in understanding variability in readers. However, the first discourse community into which children are socialized is their home and the surrounding community. When discourse communities differ in how they view the world and differ in what social practices guide their children’s instruction, conflicts are bound to occur. Schooling in the United States tends to reflect a European-American, middle-class, economically privileged view of what counts as the process and content of learning and literacy (Hernandez, 1989). A sociocultural perspective is often invoked to help explain the poorer literacy performance of students from groups not traditionally well served in U. In fact, though, sociocultural factors have to be considered in explain- ing any act of comprehension and in understanding how all students acquire reading comprehension. Read- ing research informed by a sociocultural perspective helps all parties who are interested in teaching and learning to identify and deal with the various ten- sions that affect the reading comprehension development, engagement, and performance of both younger and older students. Such research is crucial to designing instruction that will be effective for the full range of students in U. Group Differences We include group differences as a focus of our interest even though they are to some extent coterminous with sociocultural and linguistic sources of variability. For example, in research conducted with young children, Whitehurst and Lonigan (1998) reported that children from low-income homes had less experience with books, writing, rhymes, and other school-based liter- acy-promoting activities than did children from higher-income homes. As another example, second-language learning differentially affects literacy de- velopment depending on such factors as the age at which second-language learning is initiated, the language in which exposure to print and early literacy instruction is initiated, and the degree of support for first- and second-language 22 Reading for Understanding learning and literacy development in both the home and school environments (Snow, Burns, & Griffin, Eds. Thus, the relationship between reading comprehension and membership in social class and racial, ethnic, and second-language groups is a topic that merits further study. Effec- tive instruction for ethnic and racial groups who are traditionally ill served in U. Inter-Individual Differences Individual children vary in their reading comprehension abilities, and variabil- ity in reader characteristics may partially account for these differences. Thus, the differential development of a variety of capabilities and dispositions sup- porting reading comprehension may lead to patterns of relative strengths and weaknesses that are directly related to variations in reading comprehension outcomes. For example, we know from research done over the past two decades that accurate and fluent (automatic) word recognition is associated with ade- quate reading comprehension. We also know that language comprehension processes and higher-level processes affecting language comprehension (the application of world knowledge, reasoning, etc. However, we also know that fluent word recognition is not a suffi- cient condition for successful reading comprehension and that other variables that directly or indirectly influence language comprehension are also critically important determinants of variability in reading comprehension. These vari- ables include (1) vocabulary and linguistic knowledge, including oral language skills and an awareness of language structures; (2) non-linguistic abilities and processes (attention, visualization, inferencing, reasoning, critical analysis, working memory, etc. Still another important determinant of variability in reading comprehension is a reader’s perceptions of how competent she or he is as a reader. For both younger and older students, it is the belief in oneself (or the lack thereof) that makes a difference in how competent they feel (Pajares, 1996). Providing stu- dents who are experiencing reading difficulties with clear goals for a compre- hension task and then giving them feedback on the progress they are making can lead to increased self-efficacy and a greater use of comprehension strate- Variability in Reading Comprehension 23 gies (Dillon, 1989; Schunk & Rice, 1993). The degree to which these components develop in a younger or an older student may account, in part, for individual differences in the development of reading comprehension abilities. Thus, such inter-individual differences may be usefully targeted in research evaluating the relative contributions made by individual capabilities and dis- positions to variability in reading comprehension outcomes. Although these relationships between individual capacities and comprehension outcomes have been extensively studied, almost all of the work has been limited to monolin- gual learners; we have little idea whether the same pattern of relationships holds for second-language readers. Research that can inform better instruction in the various capacities and dispositions related to proficient reading, that can inform better assessments of these capacities and dispositions, and that can help us understand what teachers need to know about inter-individual varia- tion across the full array of students in their classrooms is sorely needed. Intra-Individual Differences Students differ from one another in how diverse their reading competencies and interests are. However, other students may be compe- tent in reading for information on the Internet but not in interpreting linear narrative texts. Moreover, intra-individual variability in the acquisition of reading competencies can be observed during each phase of reading develop- ment, and it is sometimes manifested in the uneven development of important skills and subskills that underlie proficient reading. For example, during the beginning phases of reading development, when children are acquiring basic word-recognition, phonological-decoding (letter-sound), and text-processing skills, it is not uncommon to find a significant imbalance in the acquisition of one or another of these skills in a given child, to the detriment of that child’s progress in becoming a proficient, motivated, and independent reader (Vellutino et al. Similarly, the child with limited vocabulary knowledge, limited world knowledge, or both, will have dif- ficulty comprehending texts that presuppose such knowledge, despite an ade- quate development of word-recognition and phonological-decoding skills. Further, the child who does little independent reading, and who is not moti- vated to read extensively and diversely, may have difficulty engaging and profit- ing from the broad array of expository and technical texts encountered in school learning, even if he or she has no basic intellectual deficits or basic deficits in reading or oral language development. At the same time, the child who has not acquired the cognitive and metacognitive strategies and study 24 Reading for Understanding skills necessary to use reading as an instrument of learning will undoubtedly profit less from reading in a given domain than the child who has acquired these skills, along with the disposition and tenacity to use them, even if the two children have comparable reading and oral language skills (Palincsar & Brown, 1984; Pearson & Fielding, 1991; Pressley, 2000; Tierney & Cunningham, 1984). And the child who is not motivated to acquire knowledge or to engage with the school curriculum and school learning at large risks falling behind age-mates in developing the reading comprehension capacities needed for progress in school or for employability. Thus, patterns of strength or weakness in the domains of word-reading accu- racy, fluency, comprehension strategies, vocabulary, domain knowledge, inter- est, and motivation can lead to performances that vary as a function of the characteristics of the text and of the task being engaged in. Little research di- rectly addresses the issue of intra-individual differences in young and older readers. Such research could help teachers use their students’ particular strengths and reading preferences to build wide-ranging reading proficiency and could inform the design of more sensitive assessments as well. Here we consider the characteristics of text that challenge various readers, recognizing of course that ultimately it is the match or mismatch between these characteristics and a reader’s capabili- ties that determines the likelihood of successful comprehension. The texts that children read in today’s schools are substantially more diverse than those in use several decades ago. Thirty years ago, children were assigned specific readings that were crafted for instructional purposes, or they were ex- posed to a select group of books in the narrative, descriptive, expository, and persuasive genres. The reading materials that made it into the “canon” did not come close to representing the array of cultures, socioeconomic classes, and perspectives of the wider society. We now live in a world that is experiencing an explosion of alternative texts that vary in content, readability levels, and genre. They incorporate multimedia and electronic options and pertain to a variety of cultures and groups. This variety makes it much more difficult for teachers to select appropriate texts for individual readers. One place to start in understanding variability in texts is to look at all the cate- gories of texts and the dimensions on which they vary. These categories and dimensions include the following: Variability in Reading Comprehension 25 • Discourse genre, such as narration, description, exposition, and persuasion. The assignment of texts to specific readers becomes more difficult as alternative texts grow in number and diversity. The assignment of texts should strategically balance a student’s interest in the subject matter, the student’s level of devel- opment, the particular challenges faced by the student, the pedagogical goals in the curriculum, and the availability of texts. Teachers will need an enhanced knowledge of the texts that are available and access to computer technologies to help them manage the complex task of text assignment that will be expected in schools of the future. One salient challenge is assigning texts to children at different grade levels when curricula are developed on a broad institutional scale and do not include detailed implementation instructions. We know that the assignments need to be diverse, but beyond that widespread consensus, we need an incisive plan that reflects scientific and pedagogical, rather than purely political, agendas. A large gap needs to be filled between the available electronic and multimedia materials and teachers’ understanding of how the materials should be inte- grated with the reading curriculum.

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Although the choice of one particular methodology antibiotics for acne long term effects purchase erythromycin 500 mg on-line, its underlying assumptions and the findings it produces can lead to antimicrobial activity of xanthium strumarium best 250mg erythromycin heated debates ntl generic erythromycin 250mg on-line, practitioners are wise to antibiotics you cannot take with methadone discount erythromycin american express examine the available research for converging evidence to develop sound practices. Key Research Questions A series of key questions continue to guide the research on reading that focuses on the transition from preschool to the early school years. What skills and knowledge do children bring with them that will facilitate the acquisition of readingfi What are the experiences that promote early literacy skills and knowledge as well as motivation to readfi How can we intervene early in the lives of at-risk children to prevent reading problemsfi What teaching methods are best suited to optimize the number of children who will learn to read successfullyfi An adequate presentation of recent findings on each of these questions is beyond the scope of the present chapter. Readers can obtain an excellent understanding of recent findings that address these issues by reading 6 4 the article by Rayner et al. Recent Research Findings the view herein is that early language skills play an important role in the acquisition of reading, and that learning language and learning to read are related but distinct domains. Recent research findings pertaining to two language skills, phonemic awareness and vocabulary, are discussed below. In addition to these topics, some findings on the role of reading on children’s developing self-concepts are discussed. Over the past 20 years, researchers have made important advances in understanding the role of children’s awareness of the spoken language. The term phonemic awareness refers to the ability to 7 identify, compare and manipulate the smallest units of spoken words — phonemes. Most spoken words contain more than one phoneme; for example, cat has three phonemes and spill has four phonemes. There is some evidence that children first become aware of larger units of spoken language such as words within sentences and syllables within words; however, awareness of phonemes themselves is the 2,7,8 best predictor of reading. Awareness of phonemes measured in kindergarten is one of the best single predictors of reading at the end of grade one. Phoneme awareness is thought to help children learn to read because it allows 7,8 children to understand that letters correspond to the sounds of spoken language. Intervention studies clearly show that teaching phonemic awareness to young children benefits word 7,8 reading as well as reading comprehension. Intervention studies that included alphabet letters in 7 activities on phonemic awareness were the most successful. The ultimate goal of reading instruction is to ensure that children understand the texts they read. Given this view of reading comprehension, children’s vocabulary is one component of oral language that is necessary to 9 reading comprehension. Children’s vocabulary, measured in kindergarten, is one of the best predictors of reading comprehension 10 in grades three and four. Intervention studies show that teaching words presented in a text improves children’s understanding of 11 the text. It remains to be demonstrated that improving young children’s vocabulary skills will have long-term consequences for their reading comprehension. There is limited longitudinal evidence on how children’s reading skills might affect their self- perceptions. The research is correlational in nature, but it is consistent with the view that children who read 12,13,14 poorly tend to perceive themselves as less able and to be less motivated to read. The longitudinal results 14, 15 suggest that early reading skills predict the development of self-perceptions and rather than the reverse. That is, all children tend to have positive self-perceptions as beginning readers, but these change over time. There is also some evidence showing that children who perceive themselves as less able tend to avoid reading 15 or read less frequently. In turn, reading less frequently further impedes the acquisition of efficient word reading 16 and comprehension skills. Although there is a need for converging evidence, these findings are in accord with the idea that it is crucial for young children to develop strong reading skills quickly. Children with stronger awareness of the structure of language will learn to read more easily than children who have weaker or no awareness of this structure. Children with stronger vocabulary skills tend to have better reading comprehension skills in grade three. Most importantly, vocabulary can be enhanced at home, in child-care centres and in kindergarten. Children with weaker reading skills tend to have less developed self-concepts and tend to read less. This highlights the importance of early interventions to ensure that children start grade one with the necessary skills and knowledge to learn to read. Implications Parents and educators can promote the development of phonemic awareness and vocabulary in young children. There is evidence that introducing the alphabet along with word games can help children understand that words are made of individual sounds. There is sound evidence that young children can learn new words introduced by an adult while looking at pictures in books, or when the adult reads the text in the book. Parents and educators can borrow 19, 20, 21,22 children’s books from their neighbourhood libraries. Phonemic awareness instruction helps children learn to read: Evidence from the National Reading Panel’s meta-analysis. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction. Department of Health and Human Services, National Institutes of Health, National Institute of Child Health and Human Development; 2000. Oral language and code-related precursors of reading: Evidence from a longitudinal structural model. Three methods for studying developmental change: A case of reading skills and self- concept. Cognitive-motivational characteristics of children varying in reading ability: Evidence for learned helplessness in poor readers. The relation of beginning readers’ reported word identification strategies to reading achievement, reading- related skills, and academic self-perceptions. Is there a bidirectional relationship between children’s reading skills and reading motivationfi Children’s motivation for reading: Domain specificity and instructional influences. Pathways to Literacy: A study of invented spelling and its role in learning to read. Book reading interventions with language-delayed preschool children: the benefits of regular reading and dialogic reading. Testing the home literacy model: Parent involvement in kindergarten is differentially related to grade 4 reading comprehension, fluency, spelling, and reading for pleasure. Introduction Language is central to social life; speech and language development is a cornerstone for successful outcomes later in life. Speech and language competency does not progress normally for a sizeable number of children, however, and research shows that these children are at greater risk for later psychosocial problems than children who do not have speech or language impairments. Studies have produced compelling evidence that the child and adolescent psychosocial outcomes of language impairment are disproportionately problematic; some disadvantages persist into adulthood. These outcomes include continued disadvantage in speech and language competence, intellectual functioning, and educational adjustment and achievement, psychosocial difficulties, and increased probability of psychiatric disorder. Key insights from the studies highlighted in this fact sheet imply a need for early identification of language problems and effective intervention addressing language problems and related cognitive, academic, behavioural and psychosocial concerns, and prevention of victimization in this population. Support for children and adolescents who have language impairment is particularly important in the school context. Subject There is strong evidence for the association between speech and language impairments and psychiatric 1,2,3 disorders.

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The development of early literacy skills among children with speech difficulties: a test of the “critical age hypothesis” infection pathophysiology order erythromycin 250 mg with amex. Educational consequences of developmental speech disorder: Key Stage I National Curriculum assessment results in English and mathematics antibiotics for sinus infection and ear infection buy 250 mg erythromycin with mastercard. Nonword repetition as a behavioural marker for inherited language impairment: Evidence from a twin study antimicrobial yarn erythromycin 500mg generic. Journal of Child Psychology and Psychiatry and Allied Disciplines 1996;37(4):391-403 virus vs virion cheap erythromycin online american express. American Journal of Medical Genetics Part B-Neuropsychiatric Genetics2004;129B(1):94-96. Non-specific nature of specific language impairment: a review of the literature with regard to concomitant motor impairments. Speech and language therapy interventions for children with primary speech and language delay or disorder. The feasibility of universal screening for primary speech and language delay: findings from a systematic review of the literature. Prevalence and natural history of primary speech and language delay: findings from a systematic review of the literature. Help-seeking for behavior problems by parents of preschool children: a community study. Journal of the American Academy of Child and Adolescent Psychiatry 1996;35(2):215-222. Introduction One of the most striking accomplishments of the preschool years is the child’s development of speech and language. As children enter school, they are expected to use these newly developed language skills as tools for learning and social negotiation. The important role of spoken and written communication in school-aged children’s lives suggests that individual differences in these skills may entail benefits and risks, in terms of broader academic and psychosocial competence. Children must master a system for representing meaning, and acquire a facility with the forms of language, ranging from the sound structure of words to the grammatical structure of sentences. Much of this learning is accomplished without formal instruction, and what is known is largely tacit in nature. Preschool children begin to develop some awareness of this knowledge by rhyming words, for example, or taking a word apart into syllables. Early reading development in alphabetic languages such as English depends on the integrity of phonological 1 awareness and other related phonological processing abilities. It is common to differentiate between two main aspects of reading: word recognition and comprehension. Early in reading development, children need to recognize letters, be aware of and able to manipulate sounds within words, and use conventions about the relationship between letters and their pronunciation. In addition, the child needs to be able to interpret the meaning of the printed text. The skills involved in this aspect of reading are very similar to those used in listening comprehension. Although word recognition and comprehension are often considered separately, they can influence one another over development, in a bidirectional way. For example, vocabulary knowledge contributes directly to growth in 2,3 4 word recognition, and later in the school years, skill in word recognition predicts the rate of vocabulary growth. Language impairments are commonly undiagnosed in these children, possibly because professionals are not sensitive to the manifestations of language impairments in this 30 group. Another concerning social outcome for individuals with language impairment is an elevated risk of 31,32 victimization, including sexual assault. Research Context the relationships between spoken language development, reading development and social development have been explored by several researchers in an effort to determine the extent to which these problems are associated with each other and the bases for these relationships. Key Research Questions the prominent research questions have been concerned with the extent to which aspects of early language status are predictive of later reading and behaviour problems and what the possible bases might be for these relationships. One hypothesis is that the associations between spoken language and later outcomes are causal. Alternatively, the association of language and reading problems with behaviour problems may rest on a common underlying condition such as a neuromaturational delay that results in poor achievement in both domains. The phonological-awareness deficits place them at risk for difficulties in learning decoding skills and the comprehension problems place them at risk for reading comprehension problems. There are several possible causal relationships between language and behavioural disorders: language difficulties might lead to reactive behaviour problems, behaviour problems could lead to fewer opportunities for 18 language learning, or the relationship between language and behavioural difficulties could be bidirectional. In support of this notion, behaviour problems are reported by the children’s teachers to a greater degree than their parents. Furthermore, teacher ratings of behaviour problems correspond more closely than parent ratings to child’s language test 17,33,42 scores. Another possibility is a bidirectional relationship between language and behavioural difficulties. This idea is supported by evidence that language 23 difficulties at age three increase the risk of conduct disorders at age five, and vice versa. In particular, children with language impairment are vulnerable to difficulties with self-regulation, which may in turn lead to observed 27,43,44 behavioural difficulties. Research Gaps Further research efforts are needed, focusing on the particular mechanisms that produce this complex of spoken, written and behaviour problems. Several recent studies have addressed the question of whether 24,25,31,45-49 certain profiles of language weaknesses are associated with different types of behavioural outcomes. This approach seems promising, as it could help focus interventions on the communication skills that are most likely to affect important outcomes. There is also a need for classroom-based studies of how children with language difficulties respond to communication demands and failure. Finally, given the risk of adverse outcomes such as incarceration or victimization, there is a need to continue to identify experiences and skills 48-50 that contribute to resilience in children with early language difficulties. Conclusions the existence of a strong relationship between spoken language skills and subsequent reading and behaviour development is generally supported in the literature. The basis of the relationship between early spoken language and later reading development is thought to be causal in nature, such that spoken language skills, especially phonological awareness and listening comprehension, are fundamental precursors to later successful reading. Children with limitations in phonological processing are at risk for early decoding problems, which can then lead to problems of reading comprehension. Children with problems of listening comprehension are at risk for reading comprehension problems even if they can decode words. The basis of the relationship between spoken language and later behaviour problems is less clear, although it seems possible that there are multiple mechanisms that could explain the relationship. Children with poor language skills are therefore at risk for reading and psychosocial problems. This identification process should be an especially high priority for children who already show signs of behavioural difficulties, given the high incidence and low identification of language difficulties in this group. Interventions are available for promoting language growth, and in particular, numerous programs exist to promote phonological awareness. Additionally, intervention efforts need to focus on approaches that provide supportive educational environments, to reduce the stressors that may result in maladaptive behaviours. Finally, early intervention efforts are warranted, to support the development of language skills prior to school entry. Where successful, such efforts could be expected to reduce a child’s risk of important academic and psychosocial difficulties throughout childhood, and into adulthood. A not-so-simple view of reading: how oral vocabulary and visual-word recognition complicate the story. Prevalence of speech and language disorders in 5-year-old kindergarten children in the Ottawa- Carleton region. The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. One million children: A national study of Canadian children with emotional and learning disorders. Journal of the American Academy of Child and Adolescent Psychiatry 1989;28(1):118-123. Language delay and hyperactivity in preschoolers: evidence for a distinct subgroup of hyperactives.

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