Abstract
Objective:
To identify neurological and structural brain abnormalities in children with Developmental Language Impairment (DLI).
Methods:
Children aged seven to 13 years with DLI or normal language (controls) were recruited. Children underwent language, non-verbal cognitive, motor and neurological assessments and standardized assessment for neurological soft signs. Children with non-verbal IQ (Wechsler Intelligence Scale for Children – IV) below the 5th percentile, autistic spectrum disorder, hearing impairment or neurological disease were excluded. Volumetric MRI scans of the brain were reviewed by a pediatric radiologist blinded to diagnosis.
Results:
Nine children with DLI (mean age: 10.3±0.9 years, seven boys) and 12 controls (mean age: 9.7±1.6 years [p=0.36], six boys) were recruited. Children with DLI showed greater impairments in language (Clinical Evaluation of Language Fundamental 4 [CELF-4] mean: DLI 83.2±12.9, controls 109.5±10.2 p<0.001) and greater discrepancies between non-verbal cognitive and language scores (mean discrepancy DLI: 20.3±16.7, controls 4.3±12.2, p=0.02). No focal abnormalities were identified on standard neurological examination. On multiple linear regression analysis age and DLI were independent predictors of neurological soft signs scores (r2=0.54). Imaging abnormalities were identified in two boys with DLI (left temporo-parietal porencephaly with white-matter volume loss, large left fronto-temporal arachnoid cyst with mass effect) and no controls (p=0.18). Lesions were predicted neither by history nor neurological examination.
Conclusion:
Previously unsuspected potentially causative lesions were identified in almost 25% of children with DLI. Brain MRI should be considered in the standard diagnostic evaluation of older children with DLI.