Language Regression in Children: An Ominous Sign

Abstract & Commentary

Source: Shinnar S, et al. Language regression in childhood. Pediatr Neurol. 2001;24:185-191.

Regression of previously acquired language skills in childhood is commonly considered to be a sign of autistic regression or a neurodegenrative disease. Little information is available regarding associated clinical features in these patients. Shinnar and colleagues examined the clinical features of 177 children from 4 medical centers who exhibited language regression. Median age at regression was 18 months. One hundred ten of the 177 patients identified had electroencephalograms (EEG), with abnormal results in approximately one third by routine study and in 50% by overnight EEG.

Commentary

Several interesting points emerged from this study. First, almost 90% of children with language regression in early childhood met criteria for autistic spectrum disorders. An outcome of autism was considerably more likely if language regression occurred before age 3, and was more common in males than females whatever the age of regression. Among children who displayed language regression after age 3, there was a significantly higher incidence of seizures and, if seizures were present, a lower incidence of an outcome of autism.

Thus, this study suggests that language regression in childhood can occur in 2 contexts: younger (< 3 years) children in whom language regression is more typically associated with autistic features but not seizures, and older (> 3 years) children in which language regression is associated with seizures but not autism. Many of these older children may be subsumed under the term "Landau-Kleffner syndrome." The study suggests that the finding of language regression in children of any age should prompt an EEG. Of considerable interest—and still unsettled—is whether anticonvulsants afford any benefit to children with language regression and/or autistic features without clinical seizures. —Rosario Trifiletti