The Biology of Language – PediaCast 272
Dr Christopher Bartlett and Dr Stephen Petrill join Dr Mike in the PediaCast Studio to talk about the biology of language. Topics include genetic research involving specific language disorder, the relationship between language and autism, and the emerging field of mathematical medicine.
The Biology of Language Study
Specific Language Disorder
Language & Autism
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Announce 1: This is PediaCast.
Announce 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from the campus of Nationwide Children's here is your host Dr. Mike.
Dr. Mike Patrick: Hello everyone and welcome once again to PediaCast, it is a pediatric podcast for moms and dads this is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio, it is November 13, 2013 episode 272 we're calling this one the Biology of Language, I want to welcome everyone to the program. I have a bit of a different show lined up for you today and it's regarding a topic that I will admit to knowing very little about.
It's one that affects lots of kids and families out there, language impairment which may or may not be associated with disorders on the autism spectrum but it's often associated with reading and school performance difficulties. To get to the root of this problem we're going to talk about the biology of language. What is the acquisition in day-to-day use of language look like inside the brain? In what ways are genetics involved? Is there a way to screen babies for these problems, and if so can early intervention be provided as language develops? We'll also explore a particular language disorder, it's called specific language impairment and it affects more children than autism, childhood cancer, and Down syndrome. We'll talk about the symptoms of specific language impairment as well as how it's diagnosed, and treated, and prevented. We'll also cover language impairment as it relates to autism.
Lots coming your way and as I mentioned today's topic is not exactly my strong suit and I've lined up a couple of great studio guest to help me out with the discussion. Dr. Christopher Bartlett is a principal investigator with the Battelle Center for Mathematical Medicine and the Research Institute at Nationwide Children's. Dr. Stephen Petrill is professor of psychology who specializes in reading disabilities, math impairment, and language problems at the Ohio State University. We'll get to them in a moment, but first it is November, the holidays are just around the corner and as you know every gift matters during the holidays. Here at Nationwide Children's Hospital we rely on your gifts and our effort to advance ground breaking pediatric research and to provide the best pediatric care on the face of the planet. Please consider helping us as we help kids from across the United States and around the world. Many of you gave to Nationwide Children's last year, thank you for that, we do appreciate your trust and your support. This year as the gift giving season approaches I would simply ask that you consider including Nationwide Children's in your tax deductible charitable giving.
It's an easy thing to do, just head over to the show notes for this episode 272 at pediacast.org and click on the Every Gift Matters link, you can also call us toll free at 1855-885-5437 and I'll include that phone number in the show notes as well. Another reminder, PediaCast is on iHeart Radio Talk, it's easy to find us there too, just head over to iheart.com or you can download the iHeart radio app for iPhone or android and search for PediaCast. You'll find our latest full length shows as well as the new way to consumer material, it's called PediaBytes and these are short single topic segments and you can incorporate these into your daily polls and iHeart radio will knit them together with other talk show programs one's of your choosing. You can even infuse your local news, traffic, and weather, iHeart radio also has a couple of pre-fabricated talk show stations geared toward moms and dads which include PediaCast content, they're called Mom's Sippy Cup and The Parent Hood, look for those as well on iHeart Radio Talk over iheart.com and to the iHeart radio app for iPhone and android.
Dr. Mike Patrick: We are back, Dr. Christopher Bartlett is a principal investigator with the Battelle Center for Mathematical Medicine and the Research Institute at Nationwide Children's Hospital. He's also an assistant professor of pediatrics at the Ohio State University, College of Medicine. Dr. Bartlett's laboratory seeks to identify genetic factors for language impairments by examining DNA, running it through a wide range of molecular and mathematical methods and calling upon the disciplines of statistics in computer science. Dr. Bartlett is a first time guest on PediaCast and it's with a warm welcome that we say hello. Thank you for stopping by the studio today.
Dr. Bartlett: Thank you so much for having me.
Dr. Mike Patrick: Dr. Stephen Petrill is a professor of psychology at the Ohio State University, his interest include the study of genetic and environmental contributions to developmental delays including reading disability, math impairment, and language problems. He's a principal investigator on the Western Reserved Reading and Math Projects, a longitudinal study tracking the cognitive social and academic skills of a thousand children from kindergarten through adolescents. Dr. Petrill is an associate editor of the Journal of Child Psychology and Psychiatry and former chair of the Behavioral Genetic and Epidemiology review panel at the National Institutes of Health. This is Dr. Petrill's first visit to the PediaCast studio, a warm welcome to you as well.
Dr. Petrill: Thank you, and thank you for having me.
Dr. Mike Patrick: We appreciate you both stopping by. Let's start with you Dr. Bartlett, what is exactly meant by the biology of language?
Dr. Bartlett: The biology of language is this notion that if you take a child, and they're born, and they're dropped into one of the hundreds of local, cultural, or language environment throughout the entire world, yet without any explicit instruction, within a few years' time, they will learn the local language and achieve near adult like mastery. Yet this is occurring at a time when there's many other thing that kids can't do in terms of their motor abilities, their ability to reason out problems, and learn other tasks, there's something special about language and about the ability of children to learn language. This endowment that everyone is born with is a biological imperative to learn language, there's something unique about that in a sense. The biology of language is trying to define what is it about a child's endowment in terms of their genes, in terms of their brain, in terms of how these changes go about that they can learn language so rapidly, and that's the biology of language.
Dr. Mike Patrick: What biological components are we talking about inside the brain? What biological components specifically are involved in language?
Dr. Bartlett: We believe most of what's happening in language is going on in the brain for obvious reasons, but there's an inter play between your genetic endowment, the DNA that you're born, with and the natural changes in genes from person to person that influences how the brain develops. And the current thinking is one of the biggest differences between language learners is the rate at which they learn language, the rate at which the brain is making this necessary changes in order to adopt the local language environment that is in fact what drives a lot of what we see in language development and we're trying to explore that.
Dr. Mike Patrick: You mentioned most of it is in the brain but there's also hearing, and vision, and motor pathways to pronounce words and to speak. It's all very complicated and when you think about this is all happening on a cellular level and with chemicals, neuro-transmitters and in cells, it's mind boggling that this all works.
Dr. Bartlett: When we talk about language we're talking about grammar, and vocabulary, and the ability to manipulate these thoughts. The aspect of speaking which we will call speech, not language, that involves a lot of motor components and other things; that's a rich area of development as well, but we focus mostly on the stuff that goes on inside your head. It's more like the ability to parse sentences and understand the meaning, the ability to attach significance to vocabulary words, to the environment, this is the kind of stuff we're dealing with.
Dr. Mike Patrick: In your studies, do you look at bi-lingual environments as well? Do kids learn two languages at the same rate but depend on which one is being spoken primarily? Which one comes along faster? Or have you even looked at bi-lingual environments when thinking about these things?
Dr. Bartlett: That's a whole area of specialization that adds a layer of complication to these studies. We typically shy away from that because there are experts in dual language learning as well as second language learning in adulthood, and even those are separate topics. The way the adult tries to learn a second language is very different from a kid who's exposed to two languages from birth. These are complications that we're very interested in but we're still trying to work on a slightly simpler problem, which is what happens when there's one language in the home.
Dr. Mike Patrick: Dr. Petrill what is meant by the term specific language impairment? During the introduction of the program I mentioned that that's one specific language disorder, what is that?
Dr. Petrill: How we can think about this is in two ways, one is that it's all language, by language what we're talking about as Dr. Bartlett mentioned was being able to understand what's being said to you, which is receptive language. Also being able to produce language which means you can make this more complicated but two things being able to speak it so that speech again. Then there's also the process called expressive language, which is being able to formulate your thoughts and come up with the ideas that you want to express. Language impairment can involve one or both of those receptive language or expressive language and what makes specific language specifically more complicated is that it's a specific type of language impairment. There're many reasons why you could have problems expressing yourself or understanding what's being said to you, but the term specific language impairment is a clinical diagnosis that basically is a diagnosis by exclusion.
It requires a few things, for one the language difficulties have to interfere with daily life for academic progress. Children vary in how quickly or slowly they learn language and what becomes an issue where you're having problems being understood, or being able to understand, or having problems in your environment then that raises a two level where maybe a diagnosable condition. Second thing is that other causes are excluded, it's a diagnosis of exclusion, these are things like hearing, general developmental delay, autism, or physical difficulty in producing language. Then the third thing which is somewhat complicated and controversial especially in language is it's performed on its standardized language test and what that test is can vary.
Certain clinicians prefer certain test to others, certain braches of the field prefer certain test than others but they basically tapped in on those receptive language. Understanding language may all produce language, grammar, being able to synthesize sounds quickly those kinds of things.
Dr. Mike Patrick: Are there specific difficulties associated with specific language impairment that you use to diagnose it? Specific problems that you would see or something that parents maybe noticing at home that would clue them in, that this is a possibility?
Dr. Petrill: Some things for example would be vocabulary, how many words does a child able to understand or to use? One that's little harder to diagnose without a test is grammar. There can be very profound but also very subtle grammatical things that children with language impairment do than children without language impairment tend not to do.
Another thing that you can see too, especially children with expressive languages use, you'll hear them using words like "thing" and very non-specific words. Not every child who does that necessarily has a specific language impairment, but if you're noticing that your child is having difficulty expressing themselves then it's not about speech but it's about formulating their thoughts and speaking them to you in a way that you can understand the words that they're saying but you're not understanding what ideas they're trying to express to you.
Dr. Mike Patrick: I mentioned this is something that I don't have innate knowledge about. It's just as general pediatrician we're not come across the specifics of this. I had to do a little bit more digging and research for this show and I came across this idea that verbs are a hallmark of this specific language impairment, is that true or is that more of a generalization?
Dr. Petrill: When we get to the work that Dr. Bartlett and I are doing together that's one of the major questions about specific language impairment is it's a very specific diagnosis but it's a very heterogeneous condition. You exclude all these things but yet even within language there's many different ways you can conceptualize language. It's difficult to hone in on one specific thing but the constellation of those things results in problems with being understood or understanding what's being said around you.
Dr. Mike Patrick: What causes specific language impairment?
Dr. Petrill: There are number of things, and the easy answer is that it's due to genetic and environmental influences that work together at particular times in the development of the child, and their particular brain development to yield differences on how quickly or slowly children learn language.
There's been lots of twin research and there've been a number of twin studies and it suggested that identical twins are more likely to be more similarly diagnosed with language impairment than fraternal twins. Biological siblings are more likely to be concordant for these things than children who are adoptive siblings. There's a pretty clear indications that there's genetic influences involved but on the other hand identical twins aren't completely concordant for language impairments. That suggests that there're also some environmental differences. Narrowing those down to specific kinds of genetic risks and specific kinds of environmental risk is a whole other matter. On the environmental side of language impairment, some of the things that are associated with language impairment would be home environments where there's an impoverishment of the language environment.
When we get to the work that we do together one of the complications of that is that people who lived together tend to be genetically related to one another, if there's genetic risk that can get tied in with the environmental risk all wrapped into one. Genetics can be directly affecting your brain but they also can influence probabilistically or they can influence the likelihood of being in contact with environments that may help or hurt a child's development.
Dr. Mike Patrick: Before we get to the specifics of the study itself, you'd mentioned that specific language impairment one of the ways that it's diagnosed is first you make sure that there's not something else is going on like autism or hearing disorder. Then you'd mentioned language test, let's say they have a kid who has some language impairment that they feel that the child's expressive language is not quite the same as other kids their age and it is interfering with their school work.
We've established that it's not a developmental issue and that it's not hearing. How does a parent go from that point then to getting this diagnosis?
Dr. Petrill: It depends on how old the child is when they first suspect there's an issue. The first place to start is with your child's' pediatrician and to express to them your concerns about their language development. Second place where parents typically can go to get help, or may hear from people that there may be an issue is in the child's pre-school, or in their child's school. In that case there're services that are available to parents that are related to getting children ready to go to school, there's a whole place where parents can get services that comes from the school environment.
But then there's also clinics, Nationwide Children's has a speech and hearing clinic where parents can come with or without the referral of their pediatrician depending on how all those things go and get a specific assessment. Specific language impairment doesn't always occur in isolation and can occur with some speech problems, it can occur with some autism sometimes. This diagnosis are not pigeonholes there what clinicians do to try to best understand what is going out with your particular child and what's the best course of treatment as an act and sometimes overlap so getting a good comprehensive assessment is very important.
Dr. Mike Patrick: Once they have that assessment and it has been determined that specific language impairment is at least a component of the issues that they're having, is that something then that kids just have to live with, or is there treatment that can help?
Dr. Petrill: There're a number of treatments and as a parent who's coming in to the process of gaining treatment for their children, there's some questions that you could ask your clinician. There's a couple of schools of thought, one school of thought is a more global kind of intervention that is trying to have the child, the intervention is based on the global environment where the children are interacting and increase in the child's level of social communication looking globally at how language is used in school, or in the home, or at play, or wherever the child is and try to getting the big picture. There's another school of thought that really tries to dial in on the underlying mechanisms that may produce this complex differences in complex social use of language.
Quickly processing auditory information has been one example that researchers have looked at. The therapist can be very global, ecological interventions like in a school, or with peers but then it can also be very reductionist looking at this sort of underlying process so when you're engaging in your search for the right therapist or the right clinicians for your child that's one question you can be aware of is so what is their approach and what kind of things that they interest in looking at in. If this particular intervention doesn't work well what's the next thing that can happen down the line? They have that person not just give you diagnosis but to help you understand what the different courses of treatment might be for your child.
Dr. Mike Patrick: How these actually look? Let's say you're going the global route, this is a role playing with other kids, and sharing so that they're exposed to normal language with other kids their age is that a good description?
Dr. Petrill: And I have to admit too I'm not a speech language pathologist and I don't do speech language interventions, I'm glossing over very complicated field. Speech language pathologists out there understand the field is very complicated. In general what you would do, for example, is if you have a child who's having a receptive language problem, having trouble understanding language, you would structure that environment, you would scaffold that environment, you'd scaffold those interventions so that when the child is interacting you're pointing out not just the word that they might use but the different word that they can use, a more complex word that they can use. And again it's much more complicated but those are the kinds of things that someone might do.
Dr. Mike Patrick: Dr. Bartlett let's talk about the work the two of you are doing together. Give us a brief overview first just what is the biology of language study?
Dr. Bartlett: The biology of language study is designed to try to figure out what are the genetic components to language impairment. The way we do this is in contacting families that have multiple individuals with language problems and then we want to examine the DNA that those individuals have and see how it relates to the pattern of language ability in all the family members. Our studies are family studies rather than looking at an individual patient which I know is a little bit more than normal and a lot is heard about pediatricians who take kids with the disease and kids without a disease and they look for the differences between them, but we're actually looking at the family units.
So within the family some people will have language problems and some people will not and we're looking at the differences within the family, that helps us get at the genetic aspect of what's going on.
Dr. Mike Patrick: What specific question is before the researcher, what's your hypothesis in this study?
Dr. Bartlett: The hypothesis for the biology of language study is that there are genetic factors for language impairment and that they are of large enough effects sizes as in there's a DNA changes that have big enough effects on language that we can discover them using this family based methods and that is the emphasis of the research. Where we sort of break a little bit from traditional hypothesis testing research is we don't know the exact location in all the chromosomes as far as the genome of the language risk factors so we have to try to figure out the position of them, you know, where in the genome are these things? And that's not a hypothesis testing question that's more of a estimating a location problem and it's statistically it winds up being a slightly different thing.
So the hypothesis is that we can find these risk factors but the day to day is really in finding this specific location.
Dr. Mike Patrick: Tell us about your study population, you're talking about families, how do we identify folks to actually participate?
Dr. Bartlett: Currently we have 355 people who are involved with the study, these individuals are living within families it's called the pedigree study. What we're doing is we're trying to find children beginning around age five and then going into early childhood and early adolescence and even adults in some cases with specific language impairment with at least one other family member with either language or a reading problem in their family. Then we look to find as many other family members, siblings, brothers and sisters, parents, aunts and uncles, cousins, we have some grandparents, we have some families with average of 10 and 12 family members in them, and so those 355 people are within about 20 or 30 families.
Dr. Mike Patrick: And then I would assume that the folks or the kids who have specific language impairment you wouldn't want them to have other developmental problems that could complicate things.
Dr. Bartlett: Well yes and no, there are some exclusion, we do look for families where the child is called the "proband" child the child that we're basing the family around has language problem but doesn't have speech issues that are the primary diagnosis, primarily language not autism as the primary diagnosis, no other hearing problem is not a part of the diagnosis. But then beyond that it's fairly broad about this specific kind of language impairment that a child has.
It's not speech, it's not speaking and understanding what a child is saying. It's if a child is speaking and you can understand what they're saying but you don't understand what they're trying to say. Or they're having trouble understanding you but it doesn't have to do with them having hearing problem, those are the kinds of children that we're looking for.
Dr. Petrill: As Dr. Bartlett mentioned earlier, language impairments don't occur in a vacuum they can be highly come morbid with other things. The design for this study is you find out one child that has a very clean diagnosis they're definitely have specific language impairment and nothing else. Then we look for another family member that has a very clean prominent language impairment and nothing else going on that affects language. The rest of the family all bets are off we're interested in families that have potentially people with multiple diagnosis including autism come morbid with language impairment.
That's important to us because I don't know where the genetics of language impairment end and another disorder begins and they could overlap completely for all I know between language impairment say dyslexia, difficulty reading. We want to do is we want to start with families that have this language issues and then whatever else is going on in that family that's what it is and we're going to let the genetics to that family tell us how does language impairment relate to this other disorders.
Dr. Bartlett: Another part of that is that, because we were looking in our generationally, treatments and diagnosis have changed over the last few decades and so when we're working with a grandparent what we may be seeing maybe the result of a different treatment course for that particular person with the same underlying genetic risk compared to their grandchild who maybe has been to identified early in treatment and so that's another reason why we look more broadly not just specifically at language but the kinds of things that are associated with language impairment like reading for example.
Dr. Mike Patrick: I would suspect it's hard to get back to that grandparent who may have been treated and really doesn't demonstrate an issue anymore but they did have a problem in trying to get that history out in the way that they describe what life was like that many years ago is a difficult thing to do.
Dr. Bartlett: It's a very challenging area for us to go to. There's definitely individuals who are from an older generation may never have been told in school that they have dyslexia or language impairment. They may never even heard these words so you have to ask indirectly; Do you like to read books? Have you ever read a newspaper on a regular basis? Do you prefer TV or the radio? And these are weak indicators that someone had a problem with reading and had a problem with language and so you have to take a very detailed family history across the generatiosn to be sure.
Dr. Mike Patrick: Not being a geneticist I'm going to over simplify this, but at the base level are we trying to find a family with two people who have a specific language impairment, look at their DNA and try to see what might be similar in the two who have language impairment compared to others in the family who may not have an issue to see if what points on the DNA or different between those who have a problem and those who don't have a problem?
Dr. Bartlett: We're interested in what regions of the human genome are similar across the individuals who have similar issues so language reading and dissimilar from people who don't have problems. That's going to be our internal contrast within the family that tells us this piece of DNA across generation is consistently associated with language deficits. That's a region we want to spend more time investigating molecularly to see what are the actual changes that could be causing such a change in the brain.
Dr. Mike Patrick: How do you design a study to do that?
Dr. Bartlett: We've actually been doing this work for a long time now the original biology of language study the first incarnation of it was when I was at Rutgers University in collaborating with some of the folks there and we've continued it ever since. This has been going on for good 14-15 years and the design was simple in the beginning and it work so well first we've kept it the same. We're interested in bigger families we want as many cousins, and aunts, and uncles, and anybody else who will agree to give us DNA and to be tested with all the language reading task to participate in the study That's the trick, the bigger the better, the more family members who are interested in participating the more information we have genetically to help us figure things out.
Dr. Mike Patrick: How do you get the DNA?
Dr. Petrill: So what we do we have the family members provide a saliva samples, basically we have a tube.
Dr. Mike Patrick: No blood?
Dr. Petrill: No blood.
Dr. Mike Patrick: No needles?
Dr. Petrill: No needles, nothing like that.
Dr. Mike Patrick: Dr. Bartlett what preliminary observations have you made? Have you found some locations in the DNA that are suspicious for this?
Dr. Bartlett: We have one pretty interesting finding on chromosome 13 that we believe is a significant risk factor for language impairments at least a subset of families with specific language impairment. We're very excited about that we've been working on that for several years now to try to figure out exactly what's going on but i don't have a smoking gun to hand you, I can't say this is the one thing that makes these families so interesting or different just yet, but we're working on that.
But along the way we have learned some very interesting names, for example we've been looking at the genetics of memory and seeing how that intersects with the genetics of language and it turns out that individuals who have several risk factors for language impairments, if they also have issues with working memory from their genetic endowment they lose the ability to compensate. Basically we were saying that the kids with less ability in working memory, the ability to keep things in mind over short periods of time, they're at a deficit in terms of overcoming their language problems, but if you're really good at working memory then this is going to be a benefit to you because you might have some language issues but because you have good working memory you have a route to compensate. It's an interesting area we weren't the first to discover this, a lot of people been hypothesizing that it involved memory in language but we're the first group to show that genetically there seems to be a link between the two.
We're learning a lot of interesting things about what are the routes we could use for potential treatments because we find clever ways that people naturally learned how to compensate for the language deficits so we can learn more about that, we learn more about what we could use in the clinic. Even without knowing the cause of specific language impairment we may actually be moving towards better treatments.
Dr. Mike Patrick: Once you have identified a location, you have more kids, let's say a few years down the road do you envision a screening tool genetically to be able to identify kids who may have a higher risk for specific language impairment based on their DNA?
Dr. Bartlett: It's a complicated pipe-line to go from a genetic finding to an actual screening test. Say years down the road; I want to preface that it might be decades down the road.
Screening is one area where there could be some utility because ultimately what we want to do is in a sense over treat a little bit. Some kids have slightly slower language growth and they don't need a lot of attention but you don't know who are those kids versus the ones that you really need to be aggressive with the interventions. You want to have some good idea as to where you should be putting your resources and I think genetics might help in that equation but ultimately the clinical picture and a good family history is going to be necessary to do the job. I don't think there's going to be a blood test that you send it out and you get the results back and you know with some certainty whether or not you have this is a realistic goal but it'll be part of the clinical equation. Another place where I think we might get some real traction is an understanding the different types of language impairments. If we had a genetic test that says all right we believe this child has language impairment based on various clinical factors are there strategies for treatment, which have a higher probability working than others? And so genetics might help feedback to the clinicians more information to help them make that determination.
Dr. Petrill: In another way of thinking about this is that specific language impairment is diagnosed completely behaviorally. If you have specific language impairment, if your child is being assess for specific language impairment there's no clinical probation, there's no biological testing that's done. Unlike other things in medicine for example high blood pressure, for example you may have physical test done. What this research and others like it are trying to do is to fill that gap so we have these genes that we think have some influence on language and then we think we know that language itself is genetically influenced at a broader level but bridging that gap in the middle like getting from the genes to the outline behavior, the diagnosis of language impairment is the idea that is the kind of do what other disciplines have done in other fields of medicine.
Dr. Mike Patrick: Are you still recruiting families actively? I assume that you are since bigger is better and we want more test subjects. How can families get in touch with the program if they believe that they could be good candidates?
Dr. Petrill: If they want to talk to us, the person to contact is Maggie Beard and she's the program director of our study. Her phone number is 614-292-1022 or you can email her at firstname.lastname@example.org and she's really the main contact person. The first thing she'll do is to have a short conversation with you to do an interview to get a better understanding of what your child's language is like, or what other language is going on in your family
and at that point if there's some suggestion that there's language disability in the family, and that there's family members who might be interested, then Maggie schedules a screening interview and then she'll come out and do a short screening interview for about 45 minutes with the child that the parents are bringing into the study. If that child meets criteria then we schedule a larger set of visits with the other family members who are interested.
Dr. Mike Patrick: I'll put that contact information in the show notes for this episode, again its 272 over at pediacast.org and we'll put a link to the biology of language study website as well which has all of these information that we're kind of going through in the contact information, we'll make it really easy for parents and families to get in touch with you.
What can participating families expect? They're going to have the initial interview and then I would suspect that if they qualify then you're going to get the larger family together as many folks as you can. Do you do the language test on everyone or just the immediate family? How extensive do you do the whole battery of language test and I suspect you get saliva from everyone then too correct?
Dr. Petrill: I'm a parent, Dr. Bartlett's a parent, we know what it's like to be a parent. We try to be as flexible as we can for families do it when it's convenient for them doing in ways as convenient for families because we understand. What happens is that the first thing we do is this interview is about a half an hour and it's just to understand if there's a possibility of a family qualifying.
And then we come to families, we'll schedule times convenient for us to come to them. Sometimes families come to us but most of the time we go to their home, or go to a library, or someplace like that and do a relatively short like a half hour 45 minutes screen of the child that we think would be the main child that from which the family is based on. Then if that child meets criteria then we will schedule times to visit the families. Sometimes we've gone over with and the whole family will come over, it's over the holidays and we'll come and we'll be there for a long period of time, other times we'll go over a number of visits, basically whatever works for the family.
Dr. Mike Patrick: So you just want to make it easy and convenient because folks are taking time out of their day to give you valuable information.
Dr. Bartlett: We'll go to you and we'll even do weekends.
Dr. Mike Patrick: No cost to families who would want to be involved in this?
Dr. Petrill: No in fact when we do the phone interview we give a gift card for families to do the short visit for the child that where we build the family around. But then if we do the larger visits we give each family member a $100 as a thank you for their time and their allowing us to learn more about their family.
Dr. Mike Patrick: We'll put a links to all that in the show notes so folks can find you. Let's talk a little bit about the relationship between language impairment and autism this was a study that was recently published in the American Journal of Psychiatry, Dr. Bartlett can you tell us a little bit about that study.
Dr. Bartlett: We have another program of research going on in the lab where we're interested in the relationship between specific language impairment and autism. It's been of a lot of interest in the clinical community as to whether or not there's some genetic relationship between the two disorders or if there in fact completely separate from one another.
Our line of research was designed to ask the question if there are shared genetic risk factors between the two where are those in the human genome. Can we find them so that we could do something with them? The program of research is interesting because it led us to a path which was not what we were expecting. We thought going in that there's probably very simple relationship between the two disorders but what's probably happening is subtle, and interesting, and potentially useful to clinicians. It turns out that the genetics to specific language impairment can have a profound effect on the communication abilities of a child with autism. Under normal circumstances specific language impairment genes might reduce someone's language a little bit here, a little bit there and if you got enough of them then you'd be diagnosed with specific language impairment.
But those same things that don't have a huge effect in the general population can have a profound effect if you also have autism. Despite the fact that language impairment is not required for the diagnosis of autism, somewhere between the half and two-thirds of the children with autism have some kind of communication deficits which could be tied back to language impairments. There's that relationship and it turns out that it's not because the two disorders we think are in fat sharing risk factors per say we believe what's happening is language impairment genes have a huge effect if you also have autism. It's modulating if you will communication ability of individuals of autism so it's important for us to understand those risk factors so we can learn a little bit more about how to help out in autism.
Dr. Mike Patrick: Is this something that you set out to find or was this a by-product of the biology of language study that you started to see this association?
Dr. Bartlett: Early on in the biology of language study we noticed that families with specific language impairment were more likely to have children with autism than the general population so that we didn't start out thinking the two disorders were necessarily related it does turn out that there's some kind of relationship between the two and we're still trying to figure out exactly what that is. The bigger player here is the idea that the reason you see pervasive communication issues in autism might be linked back to a more common or general forms of language impairment.
Dr. Mike Patrick: Let's talk a little bit about the Battelle Center for Mathematical Medicine, what exactly is that?
Dr. Bartlett: The Battelle Center for Mathematical Medicine is a research group at Nationwide Children's that's trying to address the centrality of computational and quantitative methods that's becoming much more important in all of biological research. We all know that a lot more is being done in the computer that's not to say the level ever go away it's going to be huge but the use of computers in biological research is getting more and more prominent. The leaders at Nationwide Children's Hospital wanted to create a unit that would be leaders in that area. The Battelle Center for Mathematical Medicine includes statisticians, physicist , bio-physicist, computer scientist, computational nurse scientist and puts them all in one place with the idea that they can interact with one another and do new things because we've broken down the silos. Statisticians are normally in the Stat department, nurse scientist normally in the nurse science department, but if you put them on the same hallway and allow them to interact with each other, what kinds of new math, and what kinds of new biology can come out of that?
I can give you two quick examples of some synergies that have been developing for the Battelle Center for Mathematical Medicine. A statistician and a physicist got together to ask the question how do you find out what's the best equation to understand in example that was just published in the Proceedings of the National Academy of Sciences, a very prestigious journal form and function of e. coli growth which is a bacteria that has some public health implication and can make people sick. So they got together and they started doing what is essentially new mathematics, this is a brand new stuff that would probably not have occurred very easily in just a physics department or just in a statistics department and this is being applied to not just E. coli but to specific language impairment, diabetes, juvenile myoclonic epilepsy a wide range of diseases.
Dr. Mike Patrick: I think this is a really new area which medicine is heading and I suspected it's not only you that's coming up with ideas but then principal researchers like Dr. Petrill can come to you and say I need your help with the specific component.
Dr. Bartlett: We would like the Battelle Center for Mathematical medicine to be one stop shopping for all things computational quantitative that could be used in the service of medical research.
Dr. Mike Patrick: We really appreciate both of you stopping by and talking today, anything that we didn't cover that you wanted to make sure folks know about this study or about specific language impairment?
Dr. Petrill: I think we got everything covered.
Dr. Bartlett: I think we've got everything covered and just to reiterate to family members if what we described sounded like your family then we would like to talk to you and you could probably get up with us and maybe help us understand a little bit more about language impairment.
Dr. Mike Patrick: And again we'll have all the contact information on the website pediacast.org and it'll be episode 272 in the show notes so folks can find that so that they can get in touch with you easily. Alright well we thank both of you for stopping by, we really do appreciate it, I want to remind everyone we have lots of links for you at the show notes for 272 over at pediacast.org every gift matters we have a link there to help you support the hospital and also the phone number. Wait there's something we didn't cover, Dr. Petrill you wanted to talk briefly about the National Institutes Child Health and Development Hub, what exactly is that?
Dr. Petrill: It's called the Learning Disabilities Innovation Hub in Ohio State and it's one of four in the country and the goal of ours is really to pick up on some of the things that Dr. Bartlett was talking about in the biology of language. What we're trying to do is trying to understand how genetic and environmental differences in reading, and language, and math are reflected in brain structure and function. We're trying to do is to bridge the links between how the differences and how the brain is structured, differences in how the brain functions and how that relates to differences in reading math and language and projecting out the language disability.
Dr. Mike Patrick: I'll put a link in the show notes for that as well so folks can check out exactly what the Learning Disabilities Innovation Hub is with the National Institutes of Health. We also have links to the biology of language study, the Battelle Center for Mathematical Medicine and the Bartlett Research Group at the Battelle Center, so all this things also the autism study that we talked about we do have a link to an article about the identification of a genetic link between language impairment and autism. You can find all of those links again in the show notes over at pediacast.org for episode 272. Let's take a quick break and then I'll be back to wrap up the show right after this.
Dr. Mike Patrick: Once again thanks to our guests Dr. Christopher Bartlett and Dr. Steven Petrill with the biology of language study lots of great information there. Don't forget PediaCast and our single topic short format programs PediaBytes are both available on iHeart Radio Talk which you'll find on the web at iheart.com and inside the iHeart radio app for mobile devices. Reviews and comments on iHeart radio and in iTunes are most helpful as our links, mentions, shares, re-tweets, re-pens all those things. We're on all the major social media sites PediaCast is on Facebook, Twitter, Google Plus and Pinterest and be sure to tell your family, friends, neighbors, and co-workers about the show. There's going be a lot of family gatherings this holiday season and you're going to be maybe talking to some aunts and uncles or cousins, second cousins once removed and what not over the holidays and so talk about language in your family and if you're finding a recurring theme make sure that you head over to the show notes at pediacast.org for episode 272 and get in touch with the biology of language folks.
And tell them about PediaCast too while you're at it. Also be sure to tell your child's doctor about the program next time you're in for well check-up or a sick office visit just let them know there's an evidenced based pediatric podcast aimed for moms and dads with lots of great information and at that way they can point their other patients in our direction as well, and we do have posters available under the resources tab at pediacast.org. Once again if you have a topic you like us to talk about, or question, or a news article, or journal article that you'd like to point me toward, just head over to pediacast.org and look for the contact link. Until next time this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids so long everybody.
Announce 2: This program is a production of Nationwide Children's, thank you for listening. We'll see you next time on PediaCast.