Temporal processing deficits of language-learning impaired children ameliorated by training

Science

Volumn 271, Issue 5245, 1996, Pages 77-81

  Merzenich, Michael M ^a   Jenkins, William M ^a   Johnston, Paul ^a   Schreiner, Christoph ^a   Miller, Steven L ^b   Tallal, Paula ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b RUTGERS UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AUDITORY DISCRIMINATION; AUDITORY STIMULATION; CHILD; CLINICAL ARTICLE; COMPUTER PROGRAM; CONTROLLED STUDY; HUMAN; LANGUAGE DISABILITY; LEARNING DISORDER; PHONETICS; PRESCHOOL CHILD; PRIORITY JOURNAL; RECOGNITION; SCHOOL CHILD; TRAINING;

EID: 0030022626     PISSN: 00368075     EISSN: None     Source Type: Journal    
DOI: 10.1126/science.271.5245.77     Document Type: Article

References (50)

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8. M M Merzenich, C. S. Schreiner, W. M Jenkins, X. Wang, in Temporal Information Processing in the Nervous System: Special Reference to Dyslexia and Dysphasia, P Tallal, A M Galaburda, R R. Llinás, C. von Euler, Eds. (New York Academy of Sciences, New York, 1993). pp 1-22
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11. For reviews of this complex subject, see M M. Merzenich and W M Jenkins. in Memory Concepts, P. Anderson O Hvalbv, O Paulsen, B. Hokfelt, Eds (Elsevier Amsterdam. 1994) pp 437-451, M M Merzenich 3nd C DeCharms. in The Mind Brain Contjnuum R Llinas and P Churchland, Eds (MIT Press Cambridge in pressl
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13. M M Merzerich G M Recanzone, W M Jenkins, K A Grajsol Cod Sprna Harbor Symp Quant Biol 55, 873 (1990); N. N. Byl, M. M Merzenich, W. M. Jenkins, J. Neurol., in press.
14. P. Tallal et al , Science 271, 81 (1996).
15. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
16. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
17. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
18. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
19. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
20. P. Tallal and M. Piercy, Nature 241, 468 (1973), Neuropsychologia 13, 69 (1975); P. Tallal, Brain Lang. 9, 182 (1980), _ and R. E Stark, Ann Dyslexia 32, 163 (1982); _, E. D. Mellits, Brain Lang 25, 314 (1985); P, Tallal, S. Miller, R. H. Fitch, in (3), pp. 27-47. It has been argued that the fast-element (usually consonant) phonetic recognition difficulty arises because of an inappropriate "integration" with or "masking" by following or preceding speech elements (usually vowels) Although parametric psychophysical studies are lacking, this may apply only within frequency channels as these children apparently have less difficulty identifying consonant-vowel pairs with brief consonants in which consonant transitions and vowel formants are within largely non-overlapping channels
21. Cortical plasticity and learning studies conducted in primate and human models had shown that such training (i) had to be applied with a heavy schedule of practice trials, (ii) would be ideally conducted on a senes of successive training days, (iii) would require relatively intense practice schedules designed to dnve continuous performance improvements, and (iv) would have to be conducted under conditions of high motivational drive. We chose to accomplish these training objectives in LLI children by using entertaining and highly rewarding CD-ROM-mounted exercises disguised as games The Circus Sequence game was developed with Authorware Professional and Director (Macromedia) software. The FM stimuli were generated with a 22.05-kHz sampling rate and 16-bit processor in Audio Interchange File Format (AIFF) with Matlab (Mathworks) software. Stimuli were ramped on and off to reduce spectral spatter The compact disks were produced with Sony Hybrid software and a Sony 900 CDR. Games were played on Macintosh computers with CD-ROM drives or with these exercises copied and played off of Macintosh hard disks for convenience. Children received sound stimuli through Sony model MDR-V600 headsets. Four stimulus sets were mounted in this game in version 1 60-ms-duration FM sweeps with starting or ending frequencies at 0 5, 1.0, 2 0, or 4.0 kHz. Three successive correct responses resulted in a shortening of either the |S| or the stimulus duration An error resulted in a one-step lengthening of the |S| or stimulus duration This learning schedule assured that at least 79.3% of the child's responses were correct. When the child achieved a predetermined number of positive and negative task difficulty reversals in any single training session, he or she was advanced to a new FM stimulus set. Training was initiated at a new stimulus set at a performance level established by a prior session's performance achievements.
22. f]. In the initially tested version of this game, children performed trials under given parametric conditions in training blocks of 10. When performance criteria were met, consonant durations were shortened or differential amplification of fast consonant elements was reduced (or both) for another set of CVs through the next trial block In study 2, an adaptive staircase training procedure identical to that used in the Circus Sequence game (9) was used.
23. Seven children (four females, three males) ranging in age from 5.8 to 9.1 years (mean age - 7 3 years, standard deviation = 1 5 years) who had a mean nonverbal intelligence score of 106 (standard deviation = 1825) participated in the study. The group comprised four whites, two Hispanics, and one African American The children were from lower and middle socioeconomic status (SES) families All children demonstrated a severe delay in receptive and expressive language development (mean language age = 4.8 years) as well as marked temporal processing deficits These school-age children also had reading deficits All were without other primary deficits.
24. The Tallal Repetition Test determines the threshold |S| at which sequences of two tonal stimuli (in this case, of 1000 and 1400 or 800 and 1200 Hz) that are 150, 75, 40, or 17 ms in duration are perceived with their delivery sequence reproduced with a 75% accuracy |S|s vary in the test from 500 to 0 ms See P. Tallal, in Non-Speech Language and Communication, R. Schiefelbusch, Ed. (University Park Press, Baltimore, MD, 1980), pp. 449-467.
25. The Goldman-Fistoe-Woodcock Diagnostic Auditory Discrimination Test (American Guidance Service, Circle Pines, MN) was used as a standard benchmark It was designed to define an individual's ability to identify phonic elements within words.
26. In study 2, 22 children (8 females, 14 males) ranging in age from 5 2 to 10 0 years (mean age = 7.4 years, standard deviation = 1.4 years) who had a mean nonverbal intelligence score of 96.4 (standard deviation = 9.7) participated. The group included 18 whites, two Hispanics, one Asian, and one African American. All children were from middle SES families. All children demonstrated a severe delay in receptive and expressive language development (mean language age = 4.9 years; standard deviation = 14 years) as well as marked temporal processing deficits. These school-age children also had reading deficits All were without other primary deficits.
27. After initial testing with these training exercises in these seven children, both games were revised, then retested in study 2 in 11 LLI children (14). In the second version of the Circus Sequence game, the number of stimulus variations in each set was extended to 135 by including FM stimuli with durations of 60, 40, and 20 ms. An animated performance barometer was added to the game to further signal performance progress in yet another compelling visual manner, and points were subtracted for response "misses." To further ensure that children were kept on task in these games, five misses in a row resulted in a suspension of a change in difficulty level; task difficulty was then maintained constant until the child again recorded four "hits" in a row For the Phoneme Identification game, an animated per formance barometer was also added to the AV displays, and points were subtracted for incorrect responses Most importantly, the game was reconstructed as a progressively adaptive exercise in which task difficulty was (i) increased progressively when any three-trial block was completed without error, (ii) decreased by one step in difficulty for any error, and with the drop in game difficulty, (iii) halted whenever a child made five errors in succession Task difficulty was increased by first reducing the duration of the consonant stimulus elements, then a differential amplification of fast consonant elements progressively faded, then interstimulus |S|s for successive CVs were progressively reduced.
28. For the main effect of stimulus category, F(1,18) = 1-7, not significant (n.s.); for the interaction of time and stimulus category, F(1,18) = 2.5, n s.
29. Group B children, who received equivalent language training but with natural speech materials and who played video games rather than these adaptive auditory-speech training games (7), did not improve significantly with respect to either |S| or duration thresholds measured by the Tallal Repetition Test For |S|, ANOVA (repeated measures, two-tail) F(1,7) = 2 8, n s ; for duration, F(1,7) = 3 9, n.s In contrast to the experimental treatment group A, in which every child improved at this benchmark, the majority of group B children had equal or poorer performances on this test after their 1-month-long training period Although the mean performance of group B LLI children was modestly better than was that for group A children, children in these groups did not differ in their pretreatment Tallal Repetition Test measures of threshold |S|s or durations.
30. Children in study 2 were also trained at two additional games, both designed to facilitate the generalization of training gains from these first two described games to the wider range of temporal sequence events and phonetic element contexts and contrasts that occur in natural running speech The third game (Old McDonald's Flying Farm), produced with Director (Macromedia) software, was a limited hold reaction time task in which the child maintained a touchscreen "button" press while repeated stimuli were delivered in regular sequence The child's task was to release the button when there was a change in phonetic element identity The durations of a wider array of synthetic consonant elements and the interstimulus times between repeated stimuli were the main exercise variables. The fourth game (Phonic Match), also developed with Director (Macromedia) software, was a sound-matching exercise in which button presses resulted in soundings that the child had to locate a match for, on a 2-by-2 to 5-by-5 touch-screen button array The button array size and the temporal structure of elements and of element sequences in individual consonant-vowel-consonant stimuli were game variables. Stimuli applied in this exercise were synthetically processed to prolong and differentially amplify brief phonetic elements [see (1)]. Children also played both of these games for approximately 20 min/day throughout the 20-day training period In general, children's performances at these two games paralleled their progressive achievements at the time order judgment and phonetic element recognition tasks described in this report All LLI children who were trained at these games also underwent training with acoustically modified speech stimuli, as described by Tallal et al. (7).
31. Children were still improving at their game performances when these exercises were arbitrarily terminated at the end of the 4-week training period. Their ultimately achievable performance limits are unknown
32. The Token Test for Children (Teaching Resources Corporation, Boston, MA, copynghted 1978) is designed to test the ability to follow auditory commands of increasing length and grammatical complexity.
33. The intensity of practice at three FM stimulus categories were all significantly correlated with Token Test (language outcome) results. For the 1 + kHz category, trial numbers versus language outcome, r = 0.75, P ≤ 0.01; for 2+ kHz FM stimulus, trial numbers versus language outcome, r = 0.73, P ≤ 0.01; for 4+ kHz FM stimulus, trial numbers versus language outcome, r = 0 84, P ≤ 0 01 The 0.5+ kHz category practice trial numbers were not significantly correlated with language outcomes (r = 0.48).
34. A. A Benescish and P. Tallal, in (3), pp 312-314; Infant Behav Dev , in press
35. A. A Benescish and P. Tallal, in (3), pp 312-314; Infant Behav Dev , in press
36. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
37. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
38. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
39. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
40. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
41. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
42. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
43. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
44. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
45. A M Galaburda, G F Sherman, G D. Rosen, F. Aboitiz, N Geschwind, Ann. Neurol. 18, 222 (1985); J. P Larson, T. Hoien, I Lundberg, H Odegaard, Brain Lang. 39, 289 (1990); T. L Jemigan, J. R Hesselink, E. Soweli, P. A. Tallal, Arch. Neurol. 48, 539 (1991), J.M Flynn, W Deering, M. Goldstein, M. H. Rahbar, J Learn Disabil 25, 133 (1992), R. Duara et al., Arch Neurol 48, 410 (1991); J. O. Hagman, F. Wood, M. S. Buchsbaum, L. Flowers, W. Katz, ibid. 49, 734 (1992); A Kusch et al , Neuropsychologia 31, 811 (1993), A. M. Galaburda, Neurol. Clin 11, 161 (1993), _ and M. Livingstone, Ann. N Y Acad. Sci 682, 70 (1993), R. Naas, Curr. Opin. Neurol 7, 179 (1994).
46. P Tallal, J. Townsend, S. Curtiss, B Wulfeck, Brain Lang 41, 81 (1991); B A Lewis, J. Learn Disabil. 25, 486 (1992); _, N J Cox, P. J. Bayard, Behav Genet. 23, 291 (1993), B. F. Pennington, J. Child Neurol. 10, S69 (1995)
47. P Tallal, J. Townsend, S. Curtiss, B Wulfeck, Brain Lang 41, 81 (1991); B A Lewis, J. Learn Disabil. 25, 486 (1992); _, N J Cox, P. J. Bayard, Behav Genet. 23, 291 (1993), B. F. Pennington, J. Child Neurol. 10, S69 (1995)
48. P Tallal, J. Townsend, S. Curtiss, B Wulfeck, Brain Lang 41, 81 (1991); B A Lewis, J. Learn Disabil. 25, 486 (1992); _, N J Cox, P. J. Bayard, Behav Genet. 23, 291 (1993), B. F. Pennington, J. Child Neurol. 10, S69 (1995)
49. P Tallal, J. Townsend, S. Curtiss, B Wulfeck, Brain Lang 41, 81 (1991); B A Lewis, J. Learn Disabil. 25, 486 (1992); _, N J Cox, P. J. Bayard, Behav Genet. 23, 291 (1993), B. F. Pennington, J. Child Neurol. 10, S69 (1995)
50. We thank T. Jacobson, B. Wright, X Wang, G. Bedi, and G. Byma for their technical assistance, and C. Checko, N. Reid, and A Lipski for assistance in programming the animation reward sequences for these AV exercises T Realpe, I Shell, C. Kapelyn, A Katz-Nelson, L. Brzustowicz, C. Brown, A Khoury, J Reitzel, K. Masters, B. Glazewski, A Rubenstein, and S Shapeck assisted in the training of these children at Rutgers University This research was funded by the Charles A. Dana Foundation with supportive assistance by Hearing Research, Incorporated. For further information about this and related subjects, contact http.//wwwlducsfedu/