Acquired childhood aphasia : historical and theoretical perspectives
The traditional concept of Acquired Childhood Aphasia (AeA) has been derived from
a limited number of late 19th century cases. The concept can be summarised as:
a) Language comprehension is preserved relative to expression.
b) Recovery is swift and complete.
c) ACA is found after right as well as left cerebral lesions.
This traditional concept has been contested by late 20th century reports of sensory
aphasia, auditory comprehension deficits and poor prognosis in childhood. It now
seems less certain that the clinical description of ACA is as homogeneous as first
Reconsideration of the early modern period of neuroscientific research typically
considers work carried out on the Continent. This study critically examines clinical
research carried out in England to determine whether the traditional concept of ACA
is accurately reflected in 19th century British medical opinion.
The study reviews cases of AeA drawn from the archives of Great Ormond Street
Hospital (GOSH) covering the period 1860-1900. These cases illustrate the
characterisation of language difficulties in various modalities and reflect assumptions
regarding development and organisation of mental faculties. They also reveal
information about which variables were considered significant. The etiology and
prognosis of these ACA cases together with possible variables such as the child's age
and gender are discussed in the light of contemporaneous medical opinion.
Comparison of archived casenotes with cases published in English medical journals
reveals biases in the evidence selected to serve as the basis for the standard view of
presentation, recovery and pathology of ACA.
The study concludes that, from the English language literature, there is little evidence
to support the traditional concept of AeA. Cases of aphasic children presenting with
adult-like long term language impairment (including comprehension deficits) appear
both in the archived and published papers from this period, while few cases of ACA
following right cerebral lesions are to be found.