2 - Language disorders and physical anomalies
The tests used for assessment of hearing and
language disorders by Church et al. (1997) could
possibly be employed to gain better insight into the
hearing and language impairments of children with
idiopathic autism [1]. The two children with fetal
alcohol syndrome and autistic tendencies in their
study could not be tested on the word and sentence
recognition tasks. However, higher functioning
children with autism might be expected to cooperate in
attempting these listening tasks. Two of the tests
employed by Church et al. involved word recognition
in quiet (WRIQ) or with competing noise, word
recognition in ipsilateral noise (WRIN).
The competing sentence test (CST) requires
reporting content of two different 6 to 7 word
sentences presented simultaneously to each ear [2].
As described by Church et al., the word recognition in
noise (WRIN) test is a figure-ground test that
assesses the subject's ability to identify words in the
presence of background noise. Signal extraction from
noise is believed to be one of the primary functions of
the inferior colliculus. Thus the WRIN test, or
modifications of it for non-verbal children, might be as
valuable as auditory evoked potentials in assessing
impairment of the auditory pathway at this level.
The children in Church et al.’s study were patients
at a craniofacial-anomalies and cleft palate clinic;
twelve of the 22 children studied had cleft palate,
including the two children who displayed autistic
behaviors. Fifteen of the children had serious dental
anomalies with misalignment of the jaws. Anomalies
of outer ears and eyes were apparent in many, as well
as skeletal and internal organ malformations.
Most children with autism do not have physical
anomalies. Kemper and Bauman (1998) made
special note of this as part of the clinical background
of their subjects [3]. As discussed in chapter XX3
above, Kemper and Bauman suggested some event
around 30 weeks of gestation might interfere with
brain development and cause the pattern of
pathology they observed. Rodier et al. (1997)
investigated malformations as part of a study of
children with autism in Nova Scotia, but they found
only minor deviations [4]. Autistic children with
physical deformities more likely represent those with
autistic behaviors accompanying disorders caused by
exposure to teratogenic substances during gestation,
including alcohol.
Well formed facial features indicates that
impairment of the brain in the core syndrome autism
occurs late in gestation, in the perinatal period, or
during the first few months of life, rather than at early
stages of tissue differentiation. This is far different
from fetal alcohol syndrome, where the developing
fetus may be repeatedly subjected to toxic injury
throughout pregnancy. The finding of children with
autistic behaviors among those with FAS is of interest
however because it means the brain area impaired in
autism is among those also affected by prenatal
alcohol exposure in some cases.
- Church MW et al. (1997)
Hearing, language, speech,
vestibular, and dentofacial
disorders in fetal alcohol
syndrome.
- Willeford JA (1985) Sentence
tests of central auditory
dysfunction.
- Kemper TL, Bauman M
(1998). Neuropathology of
infantile autism.
- Rodier PM et al. (1997) Minor
malformations and physical
measurements in autism:
data from Nova Scotia.
- Church MW, Eldis F, Blakley BW, Bawle EV (1997) Hearing, language, speech,
vestibular, and dentofacial disorders in fetal alcohol syndrome. Alcoholism, Clinical and
Experimental Research 21:227-237.
- Willeford JA (1985) Sentence tests of central auditory dysfunction, in Katz J, ed,
Handbook of Clinical Audiology. Baltimore: Williams & Wilkins.
- Kemper TL, Bauman M (1998). Neuropathology of infantile autism. Journal of
Neuropathology and Experimental Neurology 57:645-652 .
- Rodier PM, Bryson SE, Welch JP (1997) Minor malformations and physical
measurements in autism: data from Nova Scotia. Teratology 55:319-325.