THE PROBLEM POSED BY LANGUAGE REGRESSION
Rapin I
Albert Einstein College of Medicine, Bronx
NY 10461, USA
Objective: to address a vexing diagnostic and
management problem
Methods: review of the literature and of my own
cases of children who underwent early language regression
Results: loss of language is unlikely to go
unnoticed in children who spoke in full sentences, but when it occurs in an
infant or toddler who had few single words or communicative gestures their
loss is often passed off as trivial.
In children over age 3 years language deterioration is likely to be
associated with clinical or subclinical epilepsy (acquired epileptic
aphasia or Landau-Kleffner syndrome [LKS]) and less often with an autistic
spectrum disorder. In toddlers
and preschoolers under age 3 years language regression generally heralds an
autistic spectrum disorder, but children are rarely referred at
immediately. There are
overlaps, in particular in previously normal children with disintegrative
disorder who spoke in sentences and undergo a massive autistic regression
which often leaves them mute, and severely and permanently demented with or
without epilepsy. Language
regression is rarely the harbinger of a degenerative disease of the brain;
its usual course is a plateau that lasts weeks or months, sometimes with
fluctuations, then improvement, but rarely complete recovery, except for
some with LKS and some young children diagnosed promptly who receive
intensive early intervention.
The dilemma is how to treat language regression besides special
education: antiepileptic drugs, steroids, fluoxetine, no medication?
Conclusion:
early loss of language is ominous and must not be ignored. To understand this devastating
disorder, prevent or treat it rationally, children need to be studied with
EEGs, immunologic inventories, and other biologic tests as they are regress
rather than months to years later, as all too often happens today.