Merely misunderstood? Receptive, expressive, and pragmatic language in young children with disruptive behavior disorders

The Association Between Persistence and Change in Behavioral Difficulties During Early to Middle Childhood and Cognitive Abilities at Age 8

We investigated the association between persistence and change in behavioral difficulties during early to middle childhood and several cognitive outcomes. We observed 3904 8-year-olds enrolled in the longitudinal study Growing Up in New Zealand (50% male/female; 23% Māori, 9% Pacific Peoples, 13% Asian, 2% Middle Eastern/Latin American/African, 9% Other, 43% European). The NIH Toolbox Cognition Battery was used to assess cognitive functioning at 8 years and the Strengths and Difficulties Questionnaire for behavioral difficulties at 4.5 and 8 years. Multivariate logistic regression analyses were conducted, controlling for well-known sociodemographic confounders. Children with persistent or later onset of behavioral difficulties were at higher risk for poorer vocabulary, reading, inhibitory control/attention, episodic memory, working memory and processing speed at age 8 compared to children with no or improved difficulties. Our study supports the importance of addressing both cognitive and behavioral aspects when planning educational programmes and interventions in early and middle childhood.

What does metaphoric language say about aggression? The relationships between metaphoric language, impulsivity, and aggression

Aggressive behavior among adolescents has been identified as a serious worldwide problem, especially when combined with trait impulsivity. This study investigates the impact of an overlooked aspect of language, namely, metaphor comprehension, on impulsivity and aggression in adolescents. A total of 204 adolescents completed self-reported questionnaires assessing impulsivity and aggression and underwent tests assessing familiar and less familiar metaphor comprehension. The findings reveal inverse relationships between metaphor comprehension and both impulsivity and aggression. Regarding aggression, notable distinctions were observed in the correlations between familiar and less familiar metaphors with specific aggression types. Additionally, impulsivity was found to mediate the relationship between the comprehension of familiar metaphors and aggression. These results are elucidated in the context of cognitive and executive functions, emphasizing the significance of considering metaphor comprehension as a cognitive process capable of modulating aggressive behavior.

Language abilities in children and adolescents with DLD and ADHD: A scoping review

PURPOSE

There is an emerging view that attention-deficit/hyperactivity disorder (ADHD) is marked by problems with language difficulties, an idea reinforced by the fact that ADHD is highly comorbid with developmental language disorder (DLD). This scoping review provides an overview of literature on language abilities in children with DLD and ADHD while highlighting similarities and differences.

METHOD

A comprehensive search was performed to examine the literature on language abilities in the two disorders, yielding a total of 18 articles that met the inclusion criteria for the present review. Qualitative summaries are provided based on the language domain assessed.

RESULTS

The current literature suggests children and adolescents with ADHD have better morphosyntax/grammar, general/core language abilities, receptive, and expressive abilities than those with DLD. Further, that performance is comparable on assessments of semantic and figurative language but varies by sample on assessments of phonological processing, syntax, narrative language, and vocabulary.

CONCLUSION

Evidence presented points to children and adolescents with DLD as having greater language difficulties compared to those with ADHD, but with some important caveats. Despite limitations related to the paucity of studies and inconsistencies in how the two types of disorders are identified, our review provides a necessary and vital step in better understanding the language profiles of these two highly prevalent childhood disorders. These findings are useful in optimizing language outcomes and treatment efficacy for children and adolescents with ADHD and DLD.

Pragmatic language and associations with externalizing behaviors in autistic individuals and those who have lost the autism diagnosis

Background

Pragmatic language weaknesses, a core feature of autism spectrum disorder (ASD), are implicated in externalizing behavior disorders (Gremillion & Martel, 2014). Particularly in a clinical setting, these co-occurring externalizing disorders are very common in autism; rates of Attentional Deficit-Hyperactive Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are as high as 83% (ADHD) and 73% (ODD; Joshi et al., 2010). It is possible that pragmatic language weaknesses impact the ability to effectively communicate one's needs, which may lead autistic children to utilize externalizing behaviors in order to achieve a desired outcome (Ketelaars et al., 2010; Rodas et al., 2017).

Methods

The aim of the current study is to investigate the relationship between pragmatic language, assessed via multiple modalities, and externalizing behaviors, assessed by parent interview, in youth with autistic (n=33) or neurotypical (NT; n=34) developmental histories, along with youth diagnosed with autism, who lost the diagnosis (LAD) by adolescence (n=31).

Results

The autism group had significantly more pragmatic language difficulties, and more externalizing behaviors and disorders; ADHD symptoms were particularly more prevalent, while LAD and NT groups did not differ. Challenges in pragmatic language abilities were associated with more externalizing symptoms when controlling for other facts that typically influence such symptoms, including nonverbal cognition, structural language, executive functioning, and autistic characteristics, but did not remain when age was included in the model.

Conclusions

We discuss the mechanisms underlying difficult-to-manage externalizing behaviors and implications for interventions and long-term outcomes for youth with and without a history of autism.

Language Problems and ADHD Behaviors: Unique and Interactive Associations with School Readiness in a Socioeconomically Disadvantaged Preschool Sample

This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (M_age = 3.98, SD_age = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children's receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.

Structural and pragmatic language in young children with sex chromosome trisomy (XXX, XXY, XYY): Predictive value for neurobehavioral problems one year later

Objective: To investigate pragmatic language abilities in young children with an increased risk for adverse neurobehavioral and neurocognitive outcomes due to an extra X or Y chromosome (sex chromosome trisomy; SCT) and to investigate to what degree early structural and pragmatic language abilities are predictive of neurobehavioral problems one year later. Method: In total, 72 children with SCT and 71 controls aged 3-7 years were included. Language assessments included parent-reported pragmatic language skills and direct assessment of structural language abilities. Parent-reported behavioral outcomes were measured one year after the initial language assessment. Results: Children with SCT demonstrated weaker pragmatic language skills compared to controls. These differences were not driven by karyotype, time of diagnosis, or ascertainment bias and irrespective of the presence of structural language impairment. Odds of having pragmatic difficulties was 23 times higher in the SCT group, with 25% of the children not meeting age-expectations. In addition, language, in particular pragmatic language, was an important predictor for later affective, oppositional defiant, pervasive developmental, attention deficit, and social-emotional problems in young children with SCT. Conclusions: This study is one of the first studies that directly illustrates the relationship between language and behavioral outcomes in children with SCT. Our results stress the importance to closely monitor pragmatic language in addition to structural language in clinical care of children with SCT, as pragmatic language abilities could serve as an early marker for children at risk for developing behavioral problems.

Prevalence and functional impact of social (pragmatic) communication disorders

BACKGROUND

The aim of this study was to evaluate the Children's Communication Checklist-2 (CCC-2) for measuring social-pragmatic communication deficits and to ascertain their prevalence and functional impact in a community sample.

METHODS

We used parent and teacher responses to the CCC-2 to approximate inclusion (poor social-pragmatic skills) and exclusion (poor structural language skills or autistic symptomatology) criteria for social (pragmatic) communication disorder (SPCD). We tested the prevalence of social-pragmatic deficits in a population-based sample of children (n = 386) aged 5-6 years old using CCC-2 algorithms. We also investigated the academic and behavioural profiles of children with broadly defined limitations in social-pragmatic competence on the CCC-2.

RESULTS

Regardless of the diagnostic algorithm used, the resulting prevalence rates for social-pragmatic deficits indicated that very few children had isolated social-communication difficulties (0-1.3%). However, a larger proportion of children (range: 6.1-10.5%) had social-pragmatic skills outside the expected range alongside structural language difficulties and/or autism spectrum symptoms, and this profile was associated with a range of adverse academic and behavioural outcomes.

CONCLUSIONS

A considerable proportion of children in the early years of primary school has social-pragmatic deficits that interfere with behaviour and scholastic activity; however, these rarely occur in isolation. Exclusionary criteria that include structural language may lead to underidentification of individuals with social-pragmatic deficits that may benefit from tailored support and intervention.

Children's vocabulary and friendships: A comparative study between children with and without Specific Learning Disorder and Attention Deficit Hyperactivity Disorder

Language skills are important in the formation and maintenance of friendships. Children with specific learning disorder (SLD) or attention-deficit/hyperactivity disorder (ADHD) experience difficulties with their relationships and have language-related problems. This study aims to examine how expressive and receptive vocabulary may relate to friendships of children with and without SLD or ADHD. Participants were 64 children with SLD, 64 children with ADHD, and 64 typically developing (TD) children, aged 8-12 years (M_age  = 9.77 years, SD = 1.22), attending Grades 3 to 6 in inclusive primary schools of Attica, Greece. The Greek versions of the Peabody Picture Vocabulary Test and the expressive vocabulary subscale of the WISC-III were administered along with the sociometric nominations of friends and the self-reports of best friendship duration. Results showed that children with SLD and ADHD reported best friendships of shorter duration and had significantly poorer receptive and expressive vocabulary. Children with ADHD had significantly fewer close and best friends than children with SLD, who in turn had significantly fewer close and best friends than the TD children. Children's vocabulary in all three groups was positively correlated with the duration of their best friendships and was found to moderately predict children's close friendships.

Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents

Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.

Investigating the Role of Inattention and/or Hyperactivity/impulsivity in Language and Social Functioning Using a Dimensional Approach

The current study parsed out the distinct components of attention-deficit/hyperactivity disorder (ADHD) symptomatology to examine differential relations with language and social ability. Using a research domain criteria (RDoC) framework, we administered standardized tests and previously developed and validated questionnaires to assess levels of inattention and/or hyperactivity/impulsivity symptomatology, language, social responsivity and social competency in 98 young adults. Those with higher inattention and/or hyperactivity/impulsivity symptomatology had reduced language comprehension, social responsivity, and social competency. Inattention and hyperactivity/impulsivity both predicted language comprehension, but not language production. Interestingly, inattention uniquely contributed to social responsiveness and social competency, but hyperactivity/impulsivity did not. Findings suggest that inattention and/or hyperactivity/impulsivity symptoms, inattention in particular, may be especially important for social skills programs geared towards individuals with attention limitations.

Elaborative Reminiscing and Child Receptive Language in the Context of Maltreatment: The Moderating Role of Maternal Sensitivity

This study investigated whether the effect of maternal elaborative reminiscing on child language is moderated by maternal sensitivity and whether this association depends on children's experience of maltreatment. A total of 236 mothers and their 3- to 7-year-old children (mean age = 5 years) were observed interacting with experimenter-provided toys in the lab and at home, and maternal sensitivity was coded from these interactions. Of that, 155 of the children had a history of maltreatment with the mother being named a perpetrator, and the remaining dyads were demographically matched with no history of maltreatment. Dyads were also asked to discuss four past emotional events, and these conversations were coded for maternal elaborative reminiscing. Children and mothers participated in an assessment of receptive language. Findings revealed an unqualified positive main effect of elaborative reminiscing on children's receptive language in the nonmaltreating families. However, for maltreated children, elaborative reminiscing was only associated with higher child receptive language when mothers were also more sensitive. These findings indicate that, in the context of maltreatment, both elaborative reminiscing and more general aspects of the quality of the parent-child relationship are important for facilitating child receptive language.

What you say, and how you say it: Preschoolers' growth in vocabulary and communication skills differentially predict kindergarten academic achievement and self-regulation

The idea that language skills support school readiness, predicting later self-regulation and academic success, is widely accepted. Although vocabulary is often emphasized in the developmental literature, the ability to use language appropriately in the classroom, or social communication skills, may also be critical. This paper examined longitudinal contributions of children's vocabulary and social communication skills, from preschool to kindergarten, to kindergarten academic achievement (reading and math) and self-regulation (executive functions and learning behaviors). Participants were 164 children (14% Latinx, 30% Black, 56% White; 57% girls) enrolled in Head Start programs. Results revealed that initial levels and growth in vocabulary and communication skills predicted better academic achievement. Social communication skills uniquely predicted self-regulation, after accounting for vocabulary. We discuss potential mechanisms for these links and recommend that strategies to build social communication skills be incorporated in preschool interventions promoting school readiness.

The Association Between Persistence and Change in Early Childhood Behavioural Problems and Preschool Cognitive Outcomes

The link between behavioural and cognitive difficulties is well established. However, research is limited on whether persistence and change in behavioural difficulties relates to cognitive outcomes, particularly during preschool. We used a large New Zealand birth cohort to investigate how persistence and change in serious behavioural problems from ages 2 to 4.5 years related to measures of cognitive delay at 4.5 years (n = 5885). Using the Strengths and Difficulties total problems score at each time point, children were categorised as showing no difficulties, improved behaviour, concurrent difficulties, and persistent difficulties. Cognitive measures assessed included receptive language, early literacy ability, and executive control. Our results showed that children with concurrent and persistent behavioural difficulties were at a greater risk of showing delays within specific cognitive domains relative to children with no difficulties and were also more likely to show comorbid delays across multiple cognitive domains.

Executive Dysfunction and Language Deficits in a Pediatric Patient with OCD and MDD with Suicidality

The role of neuropsychiatric testing in psychiatric disorders is becoming more prominent. Neuropsychological measures that are similar across symptom domains and phenomena such as suicidality may help clinicians guide treatment and tailor therapies to the patient in the most effective way possible. We report the case of a 16-year-old girl who presented with bizarre, intrusive suicidal thoughts in the setting of OCD and MDD. This case is unusual in that we have accurate neuropsychological determination of our patient's language and executive function deficits, and we propose a link between them and her expression of suicidality in the context of OCD and MDD.

Infant Language Production and Parenting Skills: A Randomized Controlled Trial

The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the child-directed interaction phase of parent-child interaction therapy, on infant language production. Participants were 60 infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers, who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the infant behavior program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers' use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.

Relationship between early language skills and the development of inattention/hyperactivity symptoms during the preschool period: Results of the EDEN mother-child cohort

BACKGROUND

This study aims to examine bidirectional relationships between children's language skills and Inattention/Hyperactivity (IH) symptoms during preschool.

METHOD

Children (N = 1459) from the EDEN mother-child cohort were assessed at ages 3 and 5.5 years. Language skills were evaluated using the WPPSI-III, NEPSY and ELOLA batteries. Children's behavior, including IH symptoms, was assessed using the parent-rated Strengths & Difficulties Questionnaire (SDQ). Using a Structural Equation Modeling (SEM) approach, we examined the relationship between language skills and IH symptoms, as well as potential mediating processes.

RESULTS

SEM analyses indicated a small negative effect of language skills at 3 years on ADHD symptoms at 5.5 years after adjusting for IH symptoms at 3 years (β =-0.12, SE = 0.04, p-value = 0.002). Interpersonal difficulties did not mediate the relationship between early language skills and later IH symptoms, nor was this association reduced after adjusting for a broad range of pre- and postnatal environmental factors and performance IQ. Among different language skills, receptive syntax at 3 years was most strongly related to IH symptoms at 5.5 years.

CONCLUSIONS

Poor language skills at age 3 may predict IH symptoms when a child enters primary school. Implications for the understanding and the prevention of the co-occurrence of language disorders and ADHD are discussed.

Social (pragmatic) communication disorders and autism spectrum disorder

Changes have been made to the diagnostic criteria for autism spectrum disorder (ASD) in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and similar changes are likely in the WHO International Classification of Diseases (ICD-11) due in 2017. In light of these changes, a new clinical disorder, social (pragmatic) communication disorder (SPCD), was added to the neurodevelopmental disorders section of DSM-5. This article describes the key features of ASD, SPCD and the draft ICD-11 approach to pragmatic language impairment, highlighting points of overlap between the disorders and criteria for differential diagnosis.

Early pragmatic language difficulties in siblings of children with autism: implications for DSM-5 social communication disorder?

BACKGROUND

We evaluated early pragmatic language skills in preschool-age siblings of children with autism spectrum disorder (ASD), and examined correspondence between pragmatic language impairments and general language difficulties, autism symptomatology, and clinical outcomes.

METHODS

Participants were younger siblings of children with ASD (high-risk, n = 188) or typical development (low-risk, n = 119) who were part of a prospective study of infants at risk for ASD; siblings without ASD outcomes were included in analyses. Pragmatic language skills were measured via the Language Use Inventory (LUI).

RESULTS

At 36 months, the high-risk group had significantly lower parent-rated pragmatic language scores than the low-risk group. When defining pragmatic language impairment (PLI) as scores below the 10(th) percentile on the LUI, 35% of the high-risk group was identified with PLI versus 10% of the low-risk group. Children with PLI had higher rates of general language impairment (16%), defined as scores below the 10(th) percentile on the Receptive or Expressive Language subscales of the Mullen Scales of Early Learning, relative to those without PLI (3%), but most did not evidence general language impairments. Children with PLI had significantly higher ADOS scores than those without PLI and had higher rates of clinician-rated atypical clinical best estimate outcomes (49%) relative to those without PLI (15%).

CONCLUSIONS

Pragmatic language problems are present in some siblings of children with ASD as early as 36 months of age. As the new DSM-5 diagnosis of Social (Pragmatic) Communication Disorder (SCD) is thought to occur more frequently in family members of individuals with ASD, it is possible that some of these siblings will meet criteria for SCD as they get older. Close monitoring of early pragmatic language development in young children at familial risk for ASD is warranted.