Speech and Language Difficulties Following Encephalitis in Childhood

Information sheet for speech and language therapists, parents, etc.

This document has been prepared by Janet Lees MPhil DipCST RegMRCSLT Cert Theol (Oxon)Senior Specialist Speech and Language Therapist Wolfson Child Development Centre, Great Ormond Street Hospital, London.

Speech and Language Difficulties.

A wide range of speech and language difficulties have been described in children who survive encephalitis.  Some may recover completely without speech and language problems.  Others will have severe long term difficulties of communication associated with other cognitive, motor and sensory problems.  For a few the problems will be specific to language, either receptive language (comprehension, auditory processing), expressive language (word finding, grammar, discourse), and/or motor speech problems (swallowing, speech sound production).

Some children may have such severe motor speech problems that they require alternative or augmentative communication (signing, symbol system, electronic communication aid).  Because the damage caused by encephalitis is usually muitifocal or diffuse a combination of difficulties is more likely than a specific deficit.

Assessment of Speech and Language Skills.

A comprehensive assessment of speech and language skills should be carried out by a registered speech and language therapist.  Both formal and informal assessments have a place, and long-term assessment may be particularly important to document the, possibly, changing nature of the disorder.  The disorder may change in nature because of recovery or because of further brain dysfunction, like epilepsy.  Where possible test material should be suitable for the child's chronological age and results should provide reference to peer group performance.

As children are likely to tire easily, especially in the early stages of recovery, short carefully planned assessment sessions are recommended.  A developmental perspective is important in providing information about the child's pre-illness skills.  However encephalitis after speech and language acquisition can result in an acquired speech/language disorder (also called acquired childhood aphasia).  Language breakdown in childhood does not necessarily mirror language acquisition.  The therapist should be alert to the possibility of unusual speech/language patterns as a result of the acquired nature of the disorder.

Severe receptive problems may be both acute or long term, and expressive difficulties may include all language levels (phonology, morphology, syntax, semantics, pragmatics).  These complexities need to be reflected in the assessment process, and where necessary advice from a more experienced colleague should be sought.  Furthermore, in some children it is the development of future skills which are affected, like written language (reading and writing) or more complex grammatical or pragmatic skills, as if their future acquisition is compromised by damage to the developing brain.  This is why longitudinal assessment is important.

Management of Speech and Language Difficulties.

It is likely that the complexities of the child's needs will mean that multidisciplinary team working is essential to treatment.  For full access to education a statement of educational needs may be required.  The speech and language therapist might contribute to this.

When working with a child a skills orientated approach is to be recommended.  This should seek to maximise the child's strengths whilst being aware of the child's deficits.  It is more motivating for all concerned to work in an atmosphere of success.  Long and ineffective programmes which concentrate on the child's deficits, and reinforce failure, are to be avoided.

The aim should be to maximise functional communication skills.  To this end both direct treatment, aimed at improving speech and language, and alternative or augmentative communication should be used together, as appropriate.  The programme offered by a speech and language therapist can be delivered in a number of ways:

• one to one, by the professional or by an assistant or other co­worker
• by parent/s or carer/s
• in groups of different sizes
• in clinical or educational settings or at home

In all cases the programme should be tailored to the child's needs, which may change and will therefore need appropriate review.  There have been no studies of speech and language therapy with children who have had encephalitis.  Other studies suggest that a goal specific approach has more positive effects than a general programme.  The programme should be delivered intensively and monitored or modified over time.

Further Reading:

B E Murdoch (ed.) Acquired Speech/Language Disorders in Childhood.
Taylor and Francis (1990).

J A Lees Children with Acquired Aphasias. 
Whurr Publishers (1993).