Tomas Ekaterina, Vissers Constance
National Research University Higher School of Economics, Moscow, Russia.
Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.
Front Hum Neurosci. 2019 Jan 9;12:517. doi: 10.3389/fnhum.2018.00517. eCollection 2018.
Although the Developmental Language Disorder (DLD), also known as Specific Language Impairment in children has been the focus of unceasing scientific attention for decades, the nature and mechanisms of this disorder remain unclear. Most importantly, we still cannot reliably identify children requiring urgent intervention among other 'late talkers' at an early age and understand the high prevalence of comorbidity with psychiatric phenomena such as Autism Spectrum Disorder. One of the main reasons for this is the traditional 'diagnosis-by-exclusion,' resulting in heterogeneity of the DLD population. This paper proposes an alternative approach to the diagnosis, treatment and research of DLD, claiming that it is these children's multiple deficits in neuropsychological development, which impede the spontaneous acquisition of their first language. Specifically, this review of the state-of-the-art in DLD research demonstrates deep and systematic interconnections between the speech and other higher cognitive functions developing in early childhood, including perception, attention and executive functions. In the proposed framework, speech is, therefore, considered as one of neuropsychological abilities, and the delay in its development is explained by other neuropsychological deficits, resulting in highly individual clinical profiles. By considering DLD as a complex neuropsychological syndrome, whose successful treatment depends on a holistic approach to diagnosis and intervention, we may significantly increase the efficacy of speech therapy, and also better understand the flexibility of the developing brain, its compensatory mechanisms and hence the comorbidity of DLD with psychiatric symptoms. Implications for using this paradigm in future scientific research are discussed.
尽管几十年来发育性语言障碍（DLD），即儿童特定语言障碍，一直是持续科学关注的焦点，但这种障碍的本质和机制仍不清楚。最重要的是，我们仍然无法在早期可靠地识别出那些需要紧急干预的儿童，而不是其他“说话晚的孩子”，也无法理解其与自闭症谱系障碍等精神现象共病的高发生率。造成这种情况的主要原因之一是传统的“排除法诊断”，这导致了DLD人群的异质性。本文提出了一种诊断、治疗和研究DLD的替代方法，认为正是这些儿童在神经心理发展方面的多重缺陷阻碍了他们对第一语言的自然习得。具体而言，这篇对DLD研究现状的综述表明，幼儿期发展的言语与其他高级认知功能之间存在深刻而系统的联系，包括感知、注意力和执行功能。因此，在所提出的框架中，言语被视为一种神经心理能力，其发展延迟是由其他神经心理缺陷所解释的，从而导致了高度个体化的临床特征。将DLD视为一种复杂的神经心理综合征，其成功治疗取决于诊断和干预的整体方法，我们可能会显著提高言语治疗的效果，同时也能更好地理解发育中大脑的灵活性、其代偿机制以及DLD与精神症状的共病情况。文中还讨论了在未来科学研究中使用这种范式的意义。
