Hr. Van Dongen et al., Clinical evaluation of conversational speech fluency in the acute phase ofacquired childhood aphasia: Does a fluency/nonfluency dichotomy exist?, J CHILD NEU, 16(5), 2001, pp. 345-351
Traditional neurologic tenets claim that the clinical picture of acquired c
hildhood aphasia is nonfluent irrespective of lesion location. In the past
20 years, however, several case studies have shown that fluent aphasic patt
erns can be observed in children with acquired childhood aphasia. But the q
uestion remains open as to whether the pattern of their speech characterist
ics is similar to the one described in adult aphasics as studies addressing
spontaneous speech fluency characteristics in larger series of children wi
th acquired childhood aphasia are scarce. The objective of this study was t
o investigate whether an analysis of spontaneous speech fluency as has prev
iously been performed in adult aphasics by other investigators would also y
ield two distinct groups of aphasic children and, if so, whether the distri
bution of the different speech characteristics in both groups would reflect
the rank order found in adults, that is, whether nonfluent verbal output c
haracteristics would predominate in one group and fluent features in the ot
her. Audiotaped and videotaped recordings of 24 cooperative children with a
cute acquired childhood aphasia unselected for age, gender, etiology, and a
phasia severity ratings were analyzed according to 10 different speech char
acteristics. A cluster analysis (two-means clustering) was performed to see
k the existence of two distinct groups of aphasic children. Results were co
nfirmed, and exact P values were computed with Mann-Whitney U-tests. A two-
means clustering created two distinct classes. Mann-Whitney U-tests ranked
the speech characteristics according to their discriminating power between
clusters. Comparing this rank order with the one previously found in adults
revealed a high correlation (Spearman's rank correlation: r(s) = .915, P m
uch less than .005), thus indicating that the clusters we found were highly
similar to the adult clusters. Thus, the use of the speech variables propo
sed to evaluate adult aphasic spontaneous speech enabled us to demonstrate
a fluent/nonfluent dichotomy in a childhood aphasic population as well. Thi
s study shows that the traditional views on the uniformity of the clinical
picture of acquired childhood aphasia are obsolete. Our findings corroborat
e data issued from several case reports of fluent acquired childhood aphasi
a and from the few studies focusing on speech fluency in acquired childhood
aphasia, which all point to the existence of an adultlike heterogeneity of
childhood aphasic syndromes. Current clinical evidence no longer supports
the hypotheses of equipotentiality and progressive lateralization but favor
s the notion that the anatomic substrate for language representation in the
child is similar to that in adults, even in young subjects.