Martines_Anna_FINALFINAL

Running Head: ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS
Acquired Childhood Aphasia: An Examination of Diagnosis
Annie Martines
Senior Inquiry, Winter Term 2016
Lynn Drazinski, Research Advisor
Augustana College, Rock Island, IL

ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 2
Acknowledgements
Ms. Martines acknowledges the unconditional support of her advisor Lynn Drazinski.
Her guidance and reassurance were essential to the development of this investigation.
Additionally, Ms. Martines is grateful for the outstanding faculty and staff at Augustana
College’s Center of Speech-Language and Hearing for their encouragement and support of Ms.
Martines’ endeavors as a student a professional.

Stroke and Aphasia
Within recent decades medicine has made substantial progress in order to ensure the
livelihood of children who have suffered from stroke. For example, between the years 1979 and
1998 the childhood mortality rate due to a stroke decreased by 58% as a result of advances in
medicine (American Stroke Association, 2015). Even though more children are surviving these
difficulties, many of them still suffer from the effects of stroke such as cognitive impairments,
physical disabilities, and language difficulties. Since more children are living due to these
medical milestones, recent research has been able to focus on the risk factors, possible etiologies,
and outcomes associated with children who suffered from stroke. The most recent research in
these topics will be discussed throughout this investigation.
A cerebrovascular accident (CVA), commonly referred to as a stroke, is a life threatening
condition in which the blood supply of the brain is either interrupted or severely reduced
(National Institute of Neurological Disorders and Stroke, 2015). According to the American
Stroke Association (ASA), anyone can be affected by a stroke, no matter his or her race, gender,
or age. In fact, strokes are the leading cause of adult disability, as well as the fifth most common
cause of death within the United States. The ASA differentiates two overarching types of stroke,
ischemic and hemorrhagic. For an ischemic stroke, the blood supply is either severely reduced or
blocked, and in a hemorrhagic stroke blood vessels erupt and cause bleeding in the brain. In
either type, the brain is deprived of oxygen and nutrients, which results in brain cell damage, or
even death.
Causes of Stroke
Although every stroke is unique, there are a wide variety of factors that influence the risk
of having a stroke. ASA classified the risk factors for stroke into two categories: risk factors that

can be modified, and risk factors that cannot be modified. The adult population can be affected
by both risk factor categories, such as unhealthy lifestyle choices or increase in age. Children
who have strokes, on the other hand, only suffer from the unchangeable risk factors of a stroke,
which will later be discussed.
Aphasia
While the impact or severity of the stroke varies greatly throughout the affected
population, the location of the damaged cells influences the symptoms and severity of each
stroke (American Speech-Language-Hearing Association, 2015). An individual who suffered
from a stroke may experience gross and fine motor difficulties, paralysis, or even communication
deficits. A specific communication disorder is aphasia, an acquired deficit that impairs the
expressive or receptive element of speech and language, including the ability to read or write
(National Aphasia Association, 2015). Aphasia occurs when there is neurological damage, which
results from traumatic brain injuries and tumors (Fogle, 2013); however, strokes are the most
common cause of aphasia (ASHA, 2014).
Aphasia Symptoms
The location of damaged neurons within the language-dominant hemisphere determines
the symptoms of the specific type of aphasia (NAA, 2015). ASHA describes these types of
aphasia along with the respective symptoms as occurring in a variety of categories. For example,
if the damage is located posterior to the central sulcus, also known as Wernicke’s area, it will
result in receptive or fluent aphasia. A person with receptive aphasia will exhibit impairments of
auditory comprehension and integration of information. If the lesion is located anterior to the
central sulcus, specifically Broca’s area, it will result in expressive or nonfluent aphasia. A
person with expressive aphasia will exhibit impairments in producing complete sentences,

correct syntax; and naming objects. When a person exhibits both receptive and expressive
deficits, it is generally considered to be the most severe form of aphasia called global aphasia.
This type of aphasia is associated with larger lesions, which affect both the posterior and anterior
portion of the brain in relation to the central sulcus.
Incidence and Prevalence
Currently, there are one million people in the United States who are diagnosed with
aphasia (NINDS, 2015). Each year, about 180,000 people in the United States acquire aphasia
(NAA, 2015). While strokes and aphasia are most commonly associated with adults, they can
affect children as well.
The ASA conducted the most current research on the incidence and prevalence of stroke
in children (2015). The organization found that strokes occur in 1 out of every 4,000 live births.
Also, the incidence of stroke from birth to 18 years old is 11 per 10,000 children. Strokes are one
of the top 10 causes of death for children, but out of the children who do survive, 50-80% will
suffer permanent neurological deficits.
The risk factors for stroke within the adult population consist of both modifiable and non-
modifiable aspects of an individual’s life. An adult can increase their chances of stroke through
modifiable aspects such as unhealthy life choices, and through non-modifiable aspects such as
age. Children on the contrary, are not pre-disposed to these modifiable factors. They are only at
risk through the non-modifiable, unpreventable aspects. With this in mind, there is need for an
examination of these factors in order for health professionals, especially speech-language
pathologists (SLP), working with this population to better understand the medical events
associated with the individual’s outcomes.

In addition, there are well-established protocols in assessing and treating adults with
aphasia within the speech-language pathology realm. In fact, the majority of the body of
literature about strokes and aphasia focuses on the adult population. For this population, speech
and language development have already been established for many years. However, what occurs
when there is an interruption in language function before or during speech and language
development? How would this impact assessment and intervention of a child for a speech-
language pathologist? Examination is needed to differentiate the treatment protocols of aphasia
between adults and children.
This research essay will address the following questions, specifically:
 What are the causes of stroke and aphasia in children?
 What are the known treatment options for children with aphasia?
Causes of Stroke and Aphasia in Children
There is a variety of definitions presented throughout the medical and rehabilitation
literature that describes the specific gestational and chronicle age of an infant. The literature
involving the risk factors or etiologies of stroke divides the terms into two categories, perinatal
and pediatric. The perinatal stage begins at 20 weeks gestation and continues until 28 days after
birth. From there the infant is considered to be within the pediatric stage until reaching 18 years
of age. Technically, the term neonatal is used to describe the lifespan from one month to one
year of age, however; many studies combine the neonatal stage with the pediatric stage
(Darmency-Stamboul, 2012). The causes of stroke within each stage of infancy and childhood
are differential from one another. Furthermore, the causes are further separated between ischemic
and hemorrhagic strokes for these age groups.

Sickle Cell Disease
Sickle Cell Disease (SCD) is the most common cause of childhood stroke (NINDS,
2015). The Internet Stroke Center (2015) is an online resource that focused on how SCD
influences stroke in children, and defined SCD as a group of inherited blood disorders that have
a diminished ability to carry oxygen throughout the body. The sickle-shaped blood cells clump
together throughout the arterial system and eventually block the blood flow, causing an arterial
ischemic stroke. SCD is inherited throughout an autosomal recessive gene, which means the
gene is received from both parents. In regards to treatment of SCD, the STOP 2 clinical trial
(2000) concluded that receiving red blood cell transfusions every month will reduce the
likelihood of stroke by 90%. With this clinical significance in mind, many researchers have
modified their personal research within childhood stroke to specifically exclude participants with
SCD, in order to find the underlying causes of stroke for the population without SCD. Therefore,
the research presented throughout this essay will only consist of participants without SCD.
Maternal Risk Factors of Stroke
The child’s risk of stroke can begin with the mother. Many studies have shown that there
are preventable environmental factors, such as smoking and other teratogens, that will increase
the likelihood of the child having a stroke (Darmency-Stamboul et al., 2012). However, more
recent studies have focused on the unpreventable genetic factors that influence the risk of
childhood stroke. In 2005, Lee et al. conducted a case-controlled study focusing on maternal risk
factors that are associated with perinatal ischemic stroke. The study discovered independent risk
factors that can be categorized by problems within a specific body system. For example, mothers
who had problems within the reproductive system, such as a history of infertility or structural
abnormalities in the placenta, were more prevalent in the perinatal arterial stroke population in

comparison to a control group. Also, specific maternal diseases within the gestational system,
such as gestational diabetes, may also increase the chance of the child having a stroke. Finally,
problems with the hematologic system, such as coagulation, hyperhomocysteinemia, and Factor
V Leiden can put the child at risk for ischemic stroke as well. Other circumstantial factors, such
as being pregnant for the first time, were also significantly associated with the child having a
stroke.
Perinatal Risk Factors of Stroke
When prepartum complications occur before the perinatal stage of fetal or embryonic
development, it usually results in fatality. Therefore, researchers only include participants of the
perinatal stage of the 20-week gestational mark, and not earlier in development, within the
studies. Also, the body of literature addressing perinatal stroke is relatively recent, so the
researchers have only discovered risk factors, as opposed to etiologies, within the population. In
continuation of the study, Lee et al. (2005) determined infant characteristics associated with
perinatal stroke. The study found that decreased fetal movement or oligohydramnios is a
predictor of perinatal arterial stroke. In addition, the study concluded that a stable fetal
environment is essential during the perinatal stage. A stressed fetus can experience heart-rate
abnormalities and meconium-stained amniotic fluids, which are both risk factors associated with
stroke. In addition, chorioamnionitis, or inflammation of the fetal membranes due to infection,
can put the infant at risk for having a stroke.
When compared to a control group, intrapartum complications were more common
within the infant population who has suffered from a perinatal stroke (Darmency-Stamboul,
2012). However, the specificity of the types of complications throughout the delivery process
was not significant enough to determine it as an independent risk factor for perinatal strokes (Lee

et al., 2005). The more risk factors associated with the infant, the higher chance of a stroke
occurring. These risk factors discussed are only linked with perinatal ischemic strokes, and do
not influence strokes in later infancy.
Pediatric Etiologies of Stroke
In comparison to perinatal strokes, there is a greater abundance of literature involving the
causes of pediatric strokes. While the literature for perinatal stroke only has examined risk
factors, the literature involving pediatric stroke has revealed specific etiologies, or definitive
causes of strokes. The latest research focusing on strokes in children is a systematic review by
Gumer, Del Veccio, and Aronoff (2014). The researchers examined 12 studies involving
pediatric strokes and divided the etiologies of ischemic stroke into 10 categories. Almost half of
the etiologies involved arterial damage or malfunction, such as steno-occlusive arteriopathies,
moyamoya syndrome, and arterial dissection. However, the single most common category of
ischemic stroke in children was undetermined, involving 26% of the population. Overall, the
study concluded that the etiology of pediatric stroke is diverse but also still undetermined, unlike
the adult population.
Another study conducted by Mackay et al. (2011) focused on risk factors and etiologies
of pediatric stroke across the world. The study contained a population of 676 children of any age
between one month and 18 years in order to determine differential risk factors between age
groups. The researchers divided the population into four age groups in order to determine the
prevalence of risk factors associated by age. One of the significant differences found was a
higher prevalence in acute systemic conditions, or problems associated with a specific body
system, within children one month to five years old. Chronic head and neck disorders were
significantly more prevalent among children who suffered from stroke who were 10 years or

older. Other than those significant differences, the risk factors associated with pediatric strokes
were similar among all ages within the population. The study found results similar to the Gumer
et al. systematic review with arterial problems, specifically arteriopathies, being the most
common risk factor associated with pediatric strokes across the globe. The second most common
etiology in both studies, however, was cardiac disorders, which includes congenital heart disease,
cardiac catheterization, cardiac surgery, and cardio embolism. This finding influenced other
international pediatric studies to continue research focusing on cardiac disorders.
Dowling et al. conducted the most recent study involving this topic in 2013. The
researchers focused on 667 children within various pediatric stages in order to differentiate
characteristics and clinical presentations between children who had strokes in addition to cardiac
disorders and children who had strokes without cardiac disorders. The study found that usually
children who have cardiac disorders are younger, and that congenital heart disease is the most
common type of cardiac disorder among the entire population. The study also included children
with bilateral and hemorrhagic strokes, and discovered a higher prevalence in children with
cardiac disorders involving those types of strokes.
As a general overview, the etiologies and risk factors of ischemic strokes are associated
with arterial problems as well as specific cardiac diseases. However, it is important to
differentiate these findings in regards to hemorrhagic strokes (Gunner et al., 2014).
Hemorrhagic Strokes
The incidence of hemorrhagic stroke, 2.9 out of 100,000 children, is much less than the
incidence of arterial ischemic strokes, which occur in 7.8 out of 100,000 children (Tran &
Heaton, 2015). Therefore, the research does not categorize the population between perinatal and
pediatric; it combines all children under 18 years old. While ischemic strokes are associated with

disease and specific symptoms, hemorrhagic strokes are caused by structural malformations or
severe head trauma (Tran & Heaton, 2015). Specifically, vascular malformations such as
arteriovenous malformations, venous malformations, and cavernous hemangioma make up the
majority of the structural malformations that cause a pediatric hemorrhagic stroke (Tran &
Heaton, 2015). Gumer et al. expanded these etiologies by also including aneurysms, brain
tumors, and trauma (2014). Similar to arterial ischemic strokes, there are undetermined etiologies
associated with hemorrhagic strokes.
Seizures as Related to Stroke
The adverse outcomes of childhood stroke have been well researched and examined
throughout the general body of literature. Persistent neurological deficits, stroke recurrence,
psychosocial implications, and others can result from any kind of stroke at any age of
development (Tran & Heaton, 2015). Rather than being classified as an etiology or risk factor
associated with stroke, seizures are associated with stroke in unique ways. Not only can seizures
be a result of a stroke in some cases, but also can be a manner of presentation of a stroke in some
cases. In other words, seizures can both be a result and a symptom in relation to childhood
stroke.
In regards to outcomes, nearly one third of child stroke survivors develop epilepsy
sometime throughout his or her lifetime (Tran & Heaton, 2015). Some researchers theorize that
the effects of cumulative seizures may interfere with the child’s continuous learning, and cause
secondary functional damage (Murias, K., Brooks, B., Kirton, A., & Iairia, G., 2014). In a
longitudinal study of children with perinatal ischemic stroke researchers did not find an overall
decrease in IQ in comparison to the control group. However, when the stroke-effected group was

divided between children with seizures and children without seizures, there was a significant
interaction between children with seizures and a depressed IQ (Ballantyne et al., 2008).
In relation to seizures being a result of childhood strokes, 31% of strokes are presented
through seizures (Mackey et al., 2011). A recent case report focused on a five-year-old female
with an existing seizure disorder who complained of a severe headache along with consistent
vomiting. Although the patient had consistent seizures in the past, the family indicated that the
most recent seizure was different and admitted her to the emergency room. After a computed
tomography (CT) scan of her head, the physician diagnosed her with a right-sided stroke due to
the loss of grey white matter differentiation with the CT scan (Ahmadzedeh, K., Bhardwaj, V., &
Johnson, S.A., 2014). The authors summarize that this case is significant for all emergency
physicians in order to recognize that a seizure may be the initial symptom of a pediatric stroke,
regardless of case history. Overall, seizures are 18 times more likely associated with children
than adults (Chadehumbe, M.A., Khatri, P., & Khoury, J.C., 2009). It is necessary to be aware of
the aftermath of seizures in relation to stroke causes, as well as the outcomes of strokes in
relation to reoccurring seizures.
Summary
Overall, both hemorrhagic and ischemic pediatric stroke have a low incidence of 2 to 8
per 100,00 children (Gumer, 2014). Substantial progress has been made in discovering risk
factors and etiologies, such as arteriopothies and vascular malformations, in childhood strokes.
However, there is still a wide range of unknown risk factors and etiologies for children, unlike
the adult population. In addition, the effects of childhood stroke are dangerous, especially the
language and cognitive deficits seen in acquired childhood aphasia. Speech-language

pathologists would benefit from knowledge of the known treatments for speech and language
development in association with acquired childhood aphasia.
Known Treatment Options for Children with Aphasia
Aphasia is an acquired language disorder caused by brain damage that results in partial or
complete impairment of language comprehension, formulation, and use for communication
(Anderson N.B., & Shames, G.H., 2006). When adults are diagnosed with aphasia, speech and
language has already been developed and well established for many years. Children, however,
are currently in the process, or have not begun the process of developing these communication
skills. Therefore when a stroke impacts the neurological system, especially in regards to speech
and language, adults and children will present language deficits in different ways.
Diagnosis of aphasia is relatively common among the adult population; however, based
on the differences of language deficits it is difficult to determine aphasia among the pediatric
population. Unfortunately, medical doctors and researchers have consistently misdiagnosed all
types of acquired language disorders in children as aphasia. It is necessary to differentiate how
language is affected after stroke between the adult and child populations, including a
consideration of how plasticity within a developing brain contributes to language function after
stroke. The differences of presentation of language deficits between adults and children inform
the speech-language pathologist (SLP) in how to assess and provide intervention for this younger
population.
How Language Is Affected After Stroke: Differences Between Adults and Children
Although both populations experience language deficits after a neurological trauma, there
is a significant difference between adults and children. Murias and peers (2014) conducted a
systematic review involving 27 studies focusing on the cognitive outcomes of children who

experienced perinatal stroke. This study analyzed the site of lesion of children’s strokes in
association to their speech and language deficits, and discovered significant differences
compared to the adult population. This is the most recent and comprehensive study regarding the
language outcomes of perinatal stroke, and will be cited throughout the research essay, unless
otherwise stated.
Adults present speech and language deficits immediately following a stroke, while
children with stroke will most likely exhibit deficits later on in life. Babies who have
experienced perinatal strokes, in particular, are typically born without presenting concerns, but
may present language deficits later in infancy. Speech and language deficits in adults who suffer
from stroke are associated with specific symptoms of receptive or expressive aphasia, while
children who suffer from stroke present overall language deficits, such as experience late
language development, or an overall delay in verbal skills.
In addition to overall presentation of deficits, the specific location of stroke will impact
the speech and language abilities differently between adults and children. Children do not usually
display hemispheric or location specific deficits, which significantly differs from the adult
symptoms of aphasia. For example, when the stroke occurred in the left hemisphere, there was a
decrease in only vocabulary expression in children, as opposed to multiple aspects of expressive
language in adults. In regards to the right hemisphere there was a decrease in vocabulary
comprehension as well as inappropriate gesture use. These language aspects in adults are
typically associated within the left hemisphere of the brain.
Improvement in aphasia for adults is a slow process, and unfortunately adults who still
experience aphasic symptoms for more than 3 months after stroke will probably not fully recover
(NAA, 2015). Children are different. Children who experience language deficits such as, but not

limited to, a decrease in vocabulary expression due to a perinatal stroke, will not display these
deficits by the time they are five to seven years old. Also, when children following perinatal
stroke exhibit initial language delays, they reach normal language ability and achievement by
preschool age.
Confirming these findings is a longitudinal study by Lauterbah, Gilde Costa, Leah,
Willmes, & Martins (2010), who focused on three young adults who all experienced a left frontal
subcortical ischemic stroke during infancy. Twenty years after the stroke, magnetic resonance
imaging (MRI) and functional magnetic resonance imaging (fMRI) were conducted in order to
analyze how each patient’s brain had developed. Each imaging technique focused on specific
Brodmann’s areas, regions within the cerebral cortex specifically associated with a function,
while patients were asked to complete a variety of linguistic tasks. The study discovered a full
and functional recovery of speech and language skills for each participant. There were deficits
within some subcomponents of language, such as semantic, phonological, or fluency difficulties;
however, none of these were adequately significant to determine the early stroke as their cause.
Although full recovery from stroke in children is the outcome of some research, there are
some conflicting studies. Murias and peers (2014) theorize that these conflicting studies of
language outcomes are due to various populations, as well as intervention options. Since each
stroke is highly individualized based on type, onset, or severity, it is difficult to analyze the
outcome of each situation with clinical significance. None of the studies in the review discussed
or defined intervention options and measures. This, which will later be discussed, can be an
impacting factor for language recovery.
Overall, children have a better chance of fully recovering from speech and language
deficits due to stroke than adults, which may be attributed to neuroplasticity (Chilosi, 2007).

Plasticity
Plasticity is defined as a general property of the brain and refers to the compensatory
mechanisms underlying lesion-induced neurofunctional reorganization (Chilosi, 2007). Children
who suffer from stroke are able to retain the ability to develop both verbal and non-verbal
functions of speech and language through the mechanisms of neuroplasticity (Murias et al.,
2014).
Imaging has played a crucial role in analyzing the neuroplasticity within a child’s
affected brain. Especially within the last decade, there have been multiple studies comparing
fMRI results between children who have had a stroke and a control group. Murias’ and peers’
(2014) review of these studies discovered an overall reorganization of cortical representation
within the brains of children affected from stroke. When children were asked to perform
cognitive-based tasks, the fMRI showed neural activity occurring in atypical locations. For
example in some language specific tasks, the control group showed neural activity in Broca’s
area, while children with strokes demonstrated a bilateral increase in neural activity.
There are a few studies that have focused on plasticity specifically within the left
hemisphere of children. Raja Beharelle and cohorts (2010) used imaging to study 25 children
with pediatric or perinatal stroke within the left hemisphere and compared the findings to a
control group that consisted of each participant’s siblings. The study assessed each participant in
measures such as cognitive and language abilities, including the Clinical Evaluation of Language
Fundamentals (CELF), along with an fMRI in order to develop a global language score. Overall,
the siblings had significantly higher global language scores in comparison to the stroke group;
however, the affected stroke group still regained functional language abilities, despite the deficit.
From there the researchers focused on specific language areas within the brain, and compared the

neural activity between the two groups. When asked to execute receptive language tasks, the
frontal lobe within both hemispheres showed activation in both groups. However, when asked to
perform other language tasks, language areas within the posterior and temporal language regions
of the brain were different between the sibling control group and the children who were affected
by strokes. Left hemisphere activation in these areas was typical, while children affected by
stroke showed a bilateral neural pattern during these tasks.
In addition, Lauterbah and cohorts (2010) found a relationship between hemispheric
activation and the size of lesion. For bigger lesions, lateralization occurred in both hemispheres,
while smaller lesions resulted in changes within the left hemisphere. From this, the researchers
concluded that the affected brain would try to maintain language functions within the left
hemisphere as much as possible, or until a sufficiently large lesion compromises it. In this case,
plasticity will enable right hemisphere function for language tasks that are typically considered
left hemisphere functions.
However, not all stroke cases produce the same recovery results. The onset of stroke is
very important in regards to plasticity. As the child gets older the brain becomes less plastic.
Plasticity can only play a significant role until puberty, until which time hemispheric
specialization for language is presumed to be incomplete until then (Chilosi 2007). For example,
children who experienced stroke later in childhood exhibited greater difficulties in narrative
retelling when they reached puberty as compared to the narrative abilities of a child with a
perinatal stroke (Murias et al., 2014). Age of onset of the stroke is essential in regards to
recovery, due to the amount of plasticity within the brain.
Murias and his counterparts (2014) discussed another theory associated with the
inconsistencies of plasticity, in regards to children’s recovery abilities. They theorize that

plasticity can only accommodate the functions within early development, and cannot handle the
complexity of new skills in later years. This may be the reason why some children may begin to
exhibit cognitive deficits at later ages, as opposed to presenting deficits immediately after stroke.
In conclusion, plasticity is the primary reason for cognitive-linguistic recovery for
children who suffer from strokes. The earlier the onset of stroke the more plastic the brain is, and
the greater likelihood of attaining typical speech and language development.
Summary
This evidence makes clear the significant differences in language outcomes between
adults and children who have strokes. Given the definition of aphasia, it is not appropriate to
provide intervention based on what we know about aphasia; however, based on the specific
language deficit that each child presents. There are well-established protocols in the speech-
language pathology realm regarding these deficits, and the children should be treated
accordingly.
Discussion
The current research of the causes of stroke, as well as speech and language outcomes
following a stroke, shows a significant difference between the adult and child populations.
However, children who have suffered any speech or language deficits due to a stroke were
possibly misdiagnosed with aphasia among the health professional field. There has been
substantial progress regarding these misdiagnoses; however, it is still a critical problem today.
A study involving aphasia in children by A.W.G. Ewing (1930) wrongfully used 10 child
participants with cases of “aphasia.” The diagnosis was based on “binaural lack of hearing”
deficiency that was associated with each participant’s speech and language development (p.
253). Ewing hypothesized that the speech and language deficits of the participants was due to his

or her hearing, which enables them to hear the high frequency speech sounds. Aphasia is not an
aural disorder like Ewing concluded, but an auditory processing disorder can be a symptom. This
is only one example of the common misdiagnoses in children within the medical field. Although
this article is relatively outdated, these incorrect findings are still discussed today.
The most recent study focusing on Landau Kleffner Syndrome (LKS), an epileptic
disorder associated with aphasia in children, by Gaworowski (2015) wrongfully describes
aphasic symptoms in children. While describing LKS the author defines aphasia as “a severe
disorder in auditory comprehension leading to complete muteness as the child can no longer hear
his/her own words.” Muteness is not associated with aphasia, nor does the child not being able to
hear ever cause muteness or aphasia. Differential diagnosis needs to occur in the body of
literature in relation to children with aphasia. Medical researchers must know the exact
symptoms that aphasia presents, especially when associating the disorder within the pediatric
population.
Unfortunately, these misconceptions diffuse into the speech-language pathology field. A
meta-analytic review regarding motor impairments in children in association with speech and
language development used the diagnoses of “developmental language disorder” and
“developmental aphasia” interchangeably (Rechetnikov & Maitra, 2000, p. 255). This is
inaccurate because aphasia is not developed, but acquired. In addition, a language disorder can
encompass aphasia; however, aphasia cannot encompass all language disorders as the study
implied.
Also, the body of literature lacks in measurement or assessment of the children’s exact
language deficits when defining participants referred to as having aphasia. For example, Martins
and Ferro gathered 11 cases of “acquired childhood aphasia” based on lesions shown by medical

scans (1993, p. 489). There was no further assessment or examination measures by a speech-
language pathologist in order to confirm the diagnosis of aphasia. Even recently, Lauterbach and
cohorts determined aphasia in a case study solely based on the location of the lesion in the left
frontal cerebral area in the individual (2010). Both cases are illogical assumptions of an aphasia
diagnosis, with the knowledge of the literature examining the differences between adults and
children regarding the location of language functions in the brain. Differentiation between the
disorders of aphasia and language impairments need to be distinguished, and assessment and
measurement should be conducted in order to determine true aphasia in children.
Bates and colleagues noticed this trend in literature, and conducted a study focusing on
the differences between adults and children in regards to how unilateral lesions affect language
production (2001). An adult with a lesion in the left temporal lobe would typically present with
Wernicke’s, or receptive aphasia; however, children show significantly greater delays in
expressive vocabulary and grammar when there is a lesion involving the same area. Bates and
colleagues concluded that these children did not manifest true aphasic symptoms because the
effects of the lesion sites are vastly different in comparison to adults (2001). Therefore, it is
wrong to diagnose a child with aphasia solely based on the location of the lesion.
The research in this investigation illustrates that children are still developing speech and
language. The brain, being plastic, is often able to adjust to the changes imposed by a lesion,
unlike an adult. The location of the lesion does not determine specific symptoms in regards to
language deficits, as it does in adults. Due to these drastic differences, health professionals
should not be diagnosing children with aphasia.
The majority of the studies reviewed in this investigation suggested speech and language
intervention; however, no studies stated current protocols or provided recommendations in how

to proceed with intervention. Speech-language pathologists need to be aware of the language
differences between adults and children following stroke, as well as determine the most
appropriate intervention for the child. This profession plays an important role in developing
future research regarding speech and language assessment and intervention for this population of
children who have suffered a stroke.

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