Language Characteristics of a Child With Noonan Syndrome: A Case Report

Dilek Eroğlu Uzun
Abstract

Introduction: Noonan Syndrome (NS) is a multiple congenital anomaly syndrome. NS is a single-gene disorder, it results from a missense mutation in of one of several different Ras/mitogen-activated protein kinase pathway genes. Mutations in PTPN11 gene, SOS1 gene, RAF1 gene, BRAF gene can cause NS phenotype. The aim of this study was to investigate language characteristics of a very rare syndrome and especially RAF1 gene mutation and its relation to language in NS. Method: The subject for this study was a 38-month-old male. Language data was gathered using spontaneous language sample obtained by the researcher at the clinic and by parents at home, and a standardized language tests for Turkish, TEDİL (Topbaş and Güven, 2007).  In addition, the subject’s general development was assessed by administering The Bayley Test of Development (1935) at the age of 20 months (Table 1) and AGTE (Ankara Developmental Screening Inventory) (Erol, Sezgin and Savaşır, 1993) at the age of 38 months. The AGTE showed that he had a development level of 20 months, and delay in all areas of development. Results and discussion: The results indicate that RAF1 gene mutation in NS can be accompanied by a language disorder. The TEDIL results showed that the subject was delayed in both receptive and expressive language, the latter being more delayed than the former (Table 2). According to the spontaneous language sample, the subject’s language consisted of single words, mostly names, used inconsistently.  The subject had not developed any suffixes. The transcripts were further analyzed using TR-LARSP (Topbaş, Cangökçe-Yaşar, and Ball, 2012) which showed that the subject was at level 1 (0;9-1,6 months). The results of the study share similarities with other studies on language characteristics of NS.


Keywords

Noonan Syndrome, language disorder, RAF1 mutation, development


References

Allanson, J. E., Bohring, A., Dorr, H. G., Dufke, A., Gillessen-Kaesbach, G., Horn, D., Zenker, M. (2010). The face of Noonan Syndrome: Does phenotype predict genotype. American Journal of Medical Genetics Part A, 152A (8), 1960–1966.

Bayley N. (1935). The development of the abilities during the first three years. Monographs of the Society  Research Child Devevopment; 1: 1-26

Erol N, Sezgin N, Savaşır I. (1993). Ankara Gelişim Tarama Envanteri ile ilgili geçerlik çalışmaları. Türk Psikoloji Dergisi, 29(8):16-22

Geurts, H., Embrechts, M. (2008). Language profiles in ASD, SLI, and ADHD. Journal of Autism and Developmental Disorders, 38(10), 1931–1943.

Hara, T., Sasaki, T., Miyauchi, H., Takakura, K., (1993). Noonan phenotype associated with intracerebral hemorrhage and cerebral vascular anomalies: Case report, Surgical Neurology, 39, 31-36

Hresko, W. P., Reid, D. K.,Hammill, D. D., (1999). Test of early language development (3rd ed.). Austin, TX: Pro-Ed

Noonan, J. A. (1994). Noonan Syndrome: An update and review for the primary pediatrician. Clinical Pediatrics, 33, 548-555

Nora, J. J., Nora, A. H., Sinha, A. K., Spangler, R. D., Lubs, H. A. (1974). Ullrich–Noonan syndrome (Turner-phenotype). American Journal of Diseases of Children, 127(1), 48–55

Pierpont, E. I., Weismer, S. E., Roberts, A. E., Tworog-Dube, E., Pierpont, M. E., Mendelsohn, N. J., Seidenberg, M. S. (2010). The language phenotype of children and adolescents with Noonan Syndrome. Journal of Speech, Language and Hearing Research, 53(4), 917-932

Pierpont, E. I., Tworog-Dube, E., Roberts, A. E. (2015). Attention skills and executive functioning in children with Noonan syndrome and their unaffected siblings. Developmental Medicine & Child Neurology, 57(4), 385–392.

Topbaş, S., Cangökçe-Yaşar, Ö., Ball, M. (2012). LARSP: Turkish. In. M.J. Ball, D. Crystal, ve P. Fletcher (Eds), Assessing Grammar: The Languages of LARSP (pp. 282 – 305). Bristol, UK: Multilingual Matters

Wingbermühle, E., Egger, J., van der Burgt, I., Verhoeven, W. (2009). Neuropsychological and Behavioral Aspects of Noonan Syndrome. Hormone Research, 2, 15-23.