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Language cortex activation in normal children

From the Brain Research Institute (Drs. Wood, Harvey, Wellard, Abbott, Saling, Jackson, and Mr. Kean), and Departments of Neurology (Drs. Harvey and Jackson), Psychology (Drs. Wood and Anderson), and Radiology (Mr. Kean and Dr. Jackson), Royal Children’s Hospital; Departments of Neurology (Dr. Harvey) and Neuropsychology (Dr. Saling), Austin and Repatriation Medical Centre; Departments of Pediatrics (Drs. Wood, Harvey, and Anderson), Psychology (Drs. Anderson and Saling), and Medicine (Drs. Wood and Jackson), The University of Melbourne; and Murdoch Children’s Research Institute (Drs. Harvey, Abbott, Anderson, and Jackson), Melbourne, Australia.

Address correspondence and reprint requests to Dr. Amanda Wood, Department of Medicine (Neurosciences), Monash Medical Centre, 5th floor, E block, 246 Clayton Road, Clayton, 3168, Victoria, Australia; e-mail: Amanda.Wood{at}med.monash.edu.au

Objective: To describe a protocol for use in young children and adolescents for determining language representation.

Methods: We performed 130 fMRI studies in 48 children and 17 adults. Verb generation (VG) and orthographic lexical retrieval (OLR) were used. The localization and lateralization of activation was rated visually. Regional voxel counts measured asymmetry and extent of activation.

Results: Activation was predominantly left-lateralized (children 85%, adults 94%), and there was no difference in the localization of activation for either paradigm. Children’s typical sites of activation included mesial (96%), inferior (94%) and middle frontal (92%) gyri, the inferior (85%) and superior (65%) temporal cortex, and the cerebellum (67%). Less frequently activated sites were insular (50%) and posterior parietal (48%) cortices. Quantitative asymmetry index scores and visual inspection of laterality were concordant. Greater quantitative asymmetry for VG than OLR occurred in children. Laterality was not related to age, sex, task proficiency, or handedness. Frontal region voxel counts lower in children than adults and left sided counts correlated with task proficiency.

Conclusions: Language fMRI can be performed in young children using resources available to clinical centers. The similarity in frequency of left language lateralization between children and adults suggests that language representation establishes early in development. The reduced amount of frontal region of interest activation in task-specific regions in children may reflect different levels of ability. However, the left-right distribution of activation does not appear to depend on task performance or age. These normative data provide a basis for decisions about language laterality in pediatric patients.

Received July 3, 2003. Accepted in final form May 24, 2004.

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