Language

LKS encompasses a broad spectrum of children with varying degrees of language difficulties. During the course of the disorder, it is not uncommon for language skills to fluctuate especially when the EEG abnormality is not controlled.

Language problems are usually first characterised by difficulties in understanding spoken language. As mentioned earlier, hearing loss may initially be suspected but formal testing (pure tone audiometry) invariably confirms a normal hearing system. The difficulty lies in the interpretation of the sounds. The difficulties with comprehension vary from problems understanding complex and longer instructions to complete inability to understand spoken language, including loss of understanding of previously known, simple vocabulary. In some children, the problems may become so severe that even environmental sounds (such as a dog barking, a telephone ringing, traffic noise) lose meaning for the child.

Difficulties with spoken or expressive language typically follow and show themselves in many different ways. For those who are still able to speak, sentences may be simplified and reduced in length. Some children experience problems retrieving known words from their memory (a “tip of the tongue” experience). Their spoken language may consequently contain many pauses as they try to find the word or they may substitute alternative words (for example, ice house for igloo). Some children slot the incorrect sounds into words so that the word produced resembles the target but is not a real word (for example, gilat for giraffe). Speech may also be affected with changes to intonation or voice quality. Some children sound slurred or speak in a jerky, hesitant manner. The spoken The Effects of LKS and Therapeutic Stratgies language difficulty can become so severe that the child does not have any speech at all. In such cases, the child may resort to using gesture or mime to communicate. Reading may or may not be preserved in children who had previously acquired this skill. More than half of children with LKS also have difficulty using gesture.

In some children, social functioning may also be affected, with problems resembling those of children with autistic spectrum disorders (ASD). This may or may not amount to an additional diagnosis of autism or ASD, which is made on the basis of a pattern of difficulties observed in the areas of social interaction, social communication and imagination. Individuals vary in how it affects them but features can include loss of desire to interact, selfdirectedness and problems with eye contact and facial expression. In addition, children may have difficulty using natural gestures or signs to communicate or they may use their communication skills only when highly motivated to get something (that is, needs driven, such as wanting a drink when they are thirsty) rather than just for social reasons (for example, to draw attention to an object of interest or share pleasure). At the milder end of the spectrum, problems may be noted with conversational skills and more subtle aspects of interaction (for example, understanding and producing sophisticated facial expressions such as guilt, embarrassment).