Relationship among Connectivity of the Frontal Aslant Tract, Executive Functions, and Speech and Language Impairment in Children with Childhood Apraxia of Speech

Round 1

Reviewer 1 Report

The work is interesting and examines executive functions, motor speech and the role of FAT tract in children with CAS. However, in this current form, the manuscript is hard to read due to style, the referencing in the text (mixed and non-consistent), and the terminology used (speech, language, linguistic terms intermixing). The Introduction needs proper revising entirely with updating with references.

 

Title of the work – suggested to slightly modify it, for example as “Relationship of connectivity of frontal aslant tract, executive functions and speech and language impairment in children with childhood apraxia" or similarly , “instead of “Executive functions in children with childhood apraxia of speech and language impairment: a missing link with neuroanatomical correlates.” The submitted title suggests or implies that the authors are testing children with CAS that have speech and language impairments as two broad constructs, while the CAS definition in the Introduction gives the impression as CAS is a speech and language impairment. Why than stressing in the aim that CAS has comorbidity with LI?

-Referencing in the whole manuscript text should be verified (i.e. - raw 53 (is it [3-5], or [3,5]?..raw 83, is ti [9],[25], or is simply [9,25]?...raw 85, [22]-[24],[26], or is it simply [22-24, 26]….?

 

-Abstract, raw 23, “the same MRI”, please rewrite to be more understandable

-The introduction, raw 35, CAS  - the full term should be given for acronyms at their first appearance

-raw 50, “possible ability” please rewrite this sentence to be more understandable.

-raw 57, “linguistic manifestation of the disorder”, please rewrite. It is suggested to use the phrases such as “language deficits, language disorder..not the term “linguistic” (in the whole manuscript, please check).

-raw 65, the “T” should be capitalized for “through”

-raw 67, the sentence misses the full stop after the episodic buffer.

-please check the quotation marks for episodic buffer and phonological loop to see if they are appropriate to use versus quotation marks used in raw 75 for executive functions.

 

-Paragraph 1.1. needs rewriting since the first paragraph relates to the phonological loop and working memory and the second paragraph is somehow focused on executive functions terms which again encompasses the working memory and bit confuses a reader.  Maybe simply rewrite both paragraphs and join it without too much theoretisizing and making definitions (this 1.1. part sounds like a chapter book).

 

-The Introduction 1.2. needs updating to the neurosurgical references on FAT mapping and making some distinctions on the left and right FAT comparing executive functions versus speech. The recent findings propose that left FAT has implicated in speech and right FAT in executive functions. The language areas tested intraop (such as Broca’s area and eliciting speech arrest, but also implying that left hemisphere is producing more language errors) (Please consult the refrences: DOI: 10.3171/2013.11.JNS13952, DOI: 10.1016/j.clinph.2014.01.023). Please revise the whole 1.2 paragraph by clearly updating with the references and separting left and righ hemisphere functional roles of FAT, SMA, Broca. Currently the paragraph is not clearly written to follow.

 

-135-136 sentence, please write it more clearly. The reader gets confused with terminology speech /language, somehow, it looks this is the same construct. The whole manuscript needs rewriting for this terminology but using terms expressive or receptive language versus speech. Speech is an expressive language component, similar to reading as a receptive language component or auditory understanding.

 

-rows 134-147, please rewrite it to be more understandable and grammatically correct. The three paragraphs under 1.2. need proper joining to be fluent and easy to read.

 Please look at publication : doi: 10.1007/s11682-021-00581-x and references in these paper Corrivetti et al., 2019; Rutten, 2015; Szelényi et al., 2010; Vassal et al., 2014.

 Look at: doi: 10.1016/j.ridd.2021.104170.

 

-The part that is redundant in 1.2 are also definitions of the methods DWI, FA (part of method section)..and defocusing the reader since in 1.2. the reader needs to be updated with recent findings on FAT, from the neurosurgical point of view (mappings), and neuroimaging point of view.

 

-the term oral language and speech (raw 116), should be replaced with “expressive language and motor speech”. Please consider adding the term “motor speech “ to be clear if the author thinks of this.

 

-it is suggested to change paragraph 1.1. and 1.2. title without the term “profile” since it is a bit confusing, maybe 1.1. simple as Executive functions, and 1.2.  Neuroanatomical correlates in childhood apraxia.

 

-1.2. “Neurofunctional Profile” and “1.2. Aim of the study” are the same paragraphs, or the Aim should be 1.3?

 

-2.2.2. paragraph, please stress clearly if the tests were mainly assessing motor speech or is there was any specific language test. The “Speech tasks” should be rewritten accordingly since the reader relay gets confused with speech vs language terminology, and somehow speech term is also used for language here. Make a clear distinction when referencing motor speech assessment tools versus language assessment tools.

-raw 102-106, please rewrite the sentence to be more understandable. The part “ “some consideration in a body of study” is redundant

-raw 124, …”in the linguistic [53]…to use term “language”.

 

-raw 165-166 “confirming the highest prevalence of CAS in males (ASHA, 2007)” – This sentence is not a part of the methodology and should be placed in the introduction.

 

-Was the gender controlled in the control sample?

 

-raw 215 check proper referencing in the whole manuscript text, for example Bombeto 2022, and raw 199 raw for Wechsler, check also referencing for raw 320, Hayes, 2022, 327 raw McLeod 2022, raw 417 Hayes 2013, Fiori et al 2021..

 

-raw 351 “Response Inhibition.”? Is this sentence?

 

-It is suggested to add the table with the results for speech, language, and EF scores, including referent scores (references) for CAS and control sample.

 

-Fig 1 needs adding for “CAS sample”

 

-Fig 2 , is the MRI left on is left side or vice versa?

-Fig 3, keep the same terms, instead of presma, it should be “preSMA”..

 

-For all Figures, the title and legend should be placed below the figure

 

-The sentence relating to the aim in the Discussion (raw 435-438) should be placed or written in the aim of the study in the methodology (Aim of the study currently marked as 1.2 paragraph -raw 148), with no need for repeating. In this sentence, only speech impairment as a term is written, and no language impairment.  Also, raw 452-456 again explains the aim and hypothesis, this also should go to Aims of the study in methodology. Also, raw 494-496 is not properly the discussion on the results but more as the impact and possible contribution and should be placed at the end of the Discussion.

 

-raw 41-42  This sentence is a bit too stressed. “To our knowledge, this is the first study that has tested these hypotheses in children with CAS.”

 

-raw 523, please explain better vocal and non vocal domains to be more understandable in the context of the used terminology in the submitted paper.

 

-raw 538 “ heterogeneous linguistic characteristic” please explain more clearly

 

 

-Conclusion should focus more on the concrete study results; please add.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

Comments to the Author

In this study, Clara and colleagues investigated the effect of executive function on FAT and language performance in childhood apraxia of speech and language impairment. The results first revealed differences in speech severity in different executive functions and found a FA defect in the left FAT in the CAS. The subsequent moderation analyses showed that visuo-spatial working memory significantly moderated the predictive role of speech severity on the FA value of the left FAT SMA component. However, some questions should be considered, and it is recommended that the data be reanalyzed in the revision.

 

1.      It is a wonder why all the cognitive and behavioral variables in the text do not use continuous variables. The conversion of continuous variables into grouping variables will probably lose more information.

 

2.      Considering the number of behavioral and cognitive variables in this study, it is recommended to do a factor analysis before the analysis to reduce the dimensionality of the variables and better focus on the key variables.

 

3.      After doing factor analysis on the variables, correlation analysis was performed in the subsequent analysis, and it was necessary to include age, gender and handedness as covariates in the correlation analysis.

 

4.      The subjects in the control group were not traditional healthy subjects, and they scanned brain MRI for various reasons (including headache, seizures during fever, strabismus, cataract, paroxysmal vertigo, and diplopia). It is necessary to clarify that these problems will not affect dMRI. Otherwise, it is difficult to determine whether the difference between the CAS and control groups comes from language performance or other factors.

 

5.      Data from 40 TD Italian children were used for reference, but the speech and language assessment criteria in the results differ from that described in the method. For example, in the method, “Each measure was assigned 0 when normal (> 25th percentile or z-scores >1), 0.5 when delayed (percentile scores between 10th and 25th or z scores between -1 and -2), and 1 when deficient (<10th percentile or z scores <-2)”, but this standard is changed in the results “80% of the children with CAS had normal (> 25th percentile) or borderline (between 25th and 6th percentile) scores, whereas 20% of the children showed a deficit (scores <5th percentile)”, and the grouping standards in language performance and executive function are not consistent, too. The inconsistent grouping in this article makes the interpretation of the results of this article more confusing. It is necessary to explain the basis of grouping. Another point to be clarified is the basis for the classification of langue severity and speech severity.

 

6.      The ANCOVA analysis performed for FAT was not corrected for multiple comparisons, and given the p values provided in Table 1, this result may be difficult to survive the correction.

 

7.      Whether the moderating effects in Table 2 and all the correlation results in this paper have been corrected by Bonferroni or FDR? Reporting p values is necessary. Besides, this moderating effect is too weak in Table 2.

 

8.      The analysis of moderating effects performed by the authors at the end does not have strong theoretical assumptions. There is no sufficient justification for the analysis of moderating effects.

 

 

Minor points:

1.      The descriptive statistics are suggested to be provided in the results with the table.

 

2.      The format should be proofread in text (e.g., statistic values should be italicized), tables (e.g., the format of the confidence interval is “95%CI” not “IC95%” in Table 2 ) and figures carefully.

 

3.      The authors did not mention in the study how the control group was matched, whether they matched for age, gender, or IQ. Since the study analyzed the left and right brains separately, handedness was also considered a variable.

 

 

 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors responded to the Reviewer's comments.