A Case History of Acquired Auditory Vebral Agnos Ia

A young girl had been developing speech and language normally until abou t the age of three and a half Over a period of weeks, her communicative ability deterior ated to the point where she was simply pointing and using gestures. She was diagnosed as having suffered bilateral temporal lobe seizures. The seizure activity has been und er control since December, 1977. For the last three years, this girl has been attending a scho ol which uses the Aphasic Method. This approach had helped her in terms of communication to some extent, but she was auditorily and orally virtually nonfunctional. It was decided to teach her sign language. Interestingly, although the prognosis was guarded, she h as developed a significant degree of auditory-oral language. Sign language appeared to h elp her close the verbal system. Her auditory-oral repertoire has continued to grow, both with and independently of continued sign language exposure. Acquired auditory verbal agnosia in children is an impairment in r eception and/or expression of previously acquired language without loss of hearing. C hildren with this disorder respond to nonverbal, environmental stimuli to varying deg rees. There have been a number of reports in the literature in recent years concerning acq uired childhood aphasia (Campbell and Heaton, 1978; Cooper and Ferry, 1978; Gas con et aI., 1973; Landau and Kleffner, 1957; Rapin et aI., 1973; Shoumaker et aI., 1974; WorsterDrought, 1971). The syndrome is characterized by seizures preceding or following the loss of previously acquired language. Loss of varying degrees of comm unication skills occurred as much as six months (Shoumaker et aI., 1974) to three year s (Gascon et aI., 1973) before the presence of seizures. In fact, while EEG's were abnorm al, in three cases (McKinney and McGreaL 1974; Rapin et aI., 1973) clinical seizures wer e never observed. The most comprehensive article concerning this disorder is Cooper et ai, (1978), which provides a summary and insights into 45 cases of acquired childhoo d aphasia. They reported that language abilities improved in some children with med ication alone, in others with medication plus speech and language therapy, and in some with no particular intervention. Most studies reported that poor comprehension oflanguage was followed by expressive difficulties. Cooper and Ferry (1978) state d that "children become mute, use jargon or produce odd sounds, exhibit misarticulation s, inappropriate su bstitutions of words, and anomia, or resort to gestures and grunts" (p. 177). Landau and Kleffner (1957) noted that some children acquire a vocal quality a nd pitch which is similar to that of the deaf child. Recovery from the disorder is variable. Of the 45 cases which Cooper and Ferry (1978) reviewed, "42CJ; were left with severe residual deficits, 24 cfr· had mild-to-moderate residual deficits, and 3JC./r, made complete recovery" (p. 182). Complete recov ery can require from several weeks to years. However, most children suffer some degree of aphasia ranging from auditory verbal agnosia with no functional verba l skills to varying degrees of learning disabilities (Gascon et al.. 1973). Speculation as to the cause of the disorder ranges from some type of subacute viral encephalitis (Hare\, Walsh, and Men kes, 1973) to vascular anomali es (Rapin et aI., 1973).