CHAPTER ELEVEN

Acquired aphasia in
childhood

Childhood speech-language disorders can be divided into develop-

mental disorders and acquired disorders (Ludlow, 1980). Developmental
disorders of speech and language are those which onset prior to the
emergence of language (Le. between birth and one year of age).
Consequently children with developmental language disorders have
never developed language normally. Although it is usually presumed
that primary developmental speech-language disorders are caused by
dysfuflctioning of the central nervous system, in most cases they have
an idiopathic origin (Le. the cause is unknown). Developmental
speech-language disorders can, however, occur secondary to con-
ditions such as peripheral hearing loss, mental retardation, cerebral
palsy, child autism, birth trauma and environmental deprivation.
Acquired speech-language disorders, on the other hand, are
disturbances in speech-language function that result from some form
of cerebral insult after language acquisition has already commenced
(Hecaen, 1976). The cerebral insult, in turn, can result from a variety
of aetiologies, including head trauma, brain tumours, cerebrovascular
accidents, infections, convulsive disorders (intractable epilepsy) and
electroencephalographic abnormalities (Miller et at., 1984). Typically
these children have commenced learning language normally and were
acquiring developmental milestones at an appropriate rate prior to
injury.
Of the two types of childhood language disorder, the acquired
variety most closely resembles the acquired adult communicative
disorders discussed in earlier chapters. Unfortunately, many texts on
the language disorders in the past have paid this important group of
neurologically based speech-language disorders only scant attention.
This chapter will review acquired childhood speech-language dis-
orders in terms of their aetiology and clinical features.

B. E. Murdoch, Acquired Speech and Language Disorders

© B.E. Murdoch 1990
 Acquired childhood aphasia 283

11.1 ACQUIRED CHILDHOOD APHASIA

11.1.1 Clinical features of acquired childhood aphasia

Children with acquired language disorders are referred to as having
acquired aphasia. The clinical features of acquired childhood aphasia
are manifestly different in a number of ways to those of adult aphasia.
In particular, there appear to be two major differences between
acquired aphasia in children and aphasia in adu~ts. First, the
recovery process is described as being more rapid and complete in
children (Lenneberg, 1967). Secondly, in the majority of cases,
acquired childhood aphasia is predominantly non-fluent, its major
features being mutism and lack of spontaneity of speech (Alajouanine
and Lhermitte, 1965; Hecaen, 1976; Fletcher and Taylor, 1984).
Further, with some rare exceptions, the acquired aphasia in children
does not appear to fall into clear-cut syndromes evocative of the well-
known aphasia sub-types described in adults (see Chapter 2).
Although there is some variation between reports in the literature,
the symptoms most reported in the classical studies to be character-
istic of acquired childhood aphasia include initial mutism (suppression
of spontaneous speech) followed by: a period of reduced speech
initiative; a non-fluent speech output; simplified syntax (telegraphic
expression); impaired auditory comprehension abilities (particularly in
the early stages post-onset); an impairment in naming; dysarthria; and
disturbances in reading and writing (primarily in the acute stage post-
onset). Most authors suggest that fluent aphasia and receptive dis-
orders of oral speech such as literal and verbal paraphasic errors,
logorrhoea, and perseverations are only rarely found in children with
acquired aphasia. There is, however, evidence to suggest that the age
of the child has a role to play in determining whether or not these
symptoms occur in a particular case. Some authors are of the opinion
that the primarily non-fluent pattern of aphasia is only prevalent in
children who are less than ten years of age at the onset of the aphasia
(Poetzl, 1926; Guttmann, 1942; Alajouanine and Lhermitte, 1965). For
example, Alajouanine and Lhermitte (1965) found that the pre-
dominant features of the acquired aphasia demonstrated by children
at < 10 years of age included decreased auditory comprehension,
severe writing deficit, and no logorrhoea, paraphasias or persever-
ation. These same authors, however, reported that the acquired
aphasia demonstrated by children > 10 years of age is a more fluent
form of aphasia, with paraphasia present, less frequent articulatory
and phonetic disintegration and disturbed written language. Other
authors, however, are of the opinion that the non-fluent type of