Language, learning, and behavioral disturbances in childhood: a longitudinal perspective

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.

Exposure to Spoken Communication During the COVID-19 Pandemic Among Children With Cochlear Implants

Importance

School closures and other COVID-19-related restrictions could decrease children's exposure to speech during important stages of development.

Objective

To assess whether significant decreases in exposure to spoken communication found during the initial phase of the COVID-19 pandemic among children using cochlear implants are confirmed for a larger cohort of children and were sustained over the first years of the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study used datalogs collected from children with cochlear implants during clinical visits to a tertiary pediatric hospital in Toronto, Ontario, Canada, from January 1, 2018, to November 11, 2021. Children with severe to profound hearing loss using cochlear implants were studied because their devices monitored and cataloged levels and types of sounds during hourly use per day (datalogs) and because their hearing and spoken language development was particularly vulnerable to reduced sound exposure. Statistical analyses were conducted between January 2022 and August 2023.

Main Outcomes and Measures

Daily hours of sound were captured by the cochlear implant datalogging system and categorized into 6 auditory scene categories, including speech and speech-in-noise. Time exposed to speech was calculated as the sum of daily hours in speech and daily hours in speech-in-noise. Residual hearing in the ear without an implant of children with unilateral cochlear implants was measured by pure tone audiometry. Mixed-model regression analyses revealed main effects with post hoc adjustment of 95% CIs using the Satterthwaite method.

Results

Datalogs (n = 2746) from 262 children (137 with simultaneous bilateral cochlear implants [74 boys (54.0%); mean (SD) age, 5.8 (3.5 years)], 38 with sequential bilateral cochlear implants [24 boys (63.2%); mean (SD) age, 9.1 (4.2) years], and 87 with unilateral cochlear implants [40 boys (46.0%); mean (SD) age, 7.9 (4.6) years]) who were preschool aged (n = 103) and school aged (n = 159) before the COVID-19 pandemic were included in analyses. There was a slight increase in use among preschool-aged bilateral cochlear implant users through the pandemic (early pandemic, 1.4 h/d [95% CI, 0.3-2.5 h/d]; late pandemic, 2.3 h/d [95% CI, 0.6-4.0 h/d]) and little change in use among school-aged bilateral cochlear implant users (early pandemic, -0.6 h/d [95% CI, -1.1 to -0.05 h/d]; late pandemic, -0.3 h/d [95% CI, -0.9 to 0.4 h/d]). However, use decreased during the late pandemic period among school-aged children with unilateral cochlear implants (-1.8 h/d [95% CI,-3.0 to -0.6 h/d]), particularly among children with good residual hearing in the ear without an implant. Prior to the pandemic, children were exposed to speech for approximately 50% of the time they used their cochlear implants (preschool-aged children: bilateral cochlear implants, 46.6% [95% CI, 46.5%-47.2%] and unilateral cochlear implants, 52.1% [95% CI, 50.7%-53.5%]; school-aged children: bilateral cochlear implants, 47.6% [95% CI, 46.8%-48.4%] and unilateral cochlear implants, 51.0% [95% CI, 49.4%-52.6%]). School-aged children in both groups experienced significantly decreased speech exposure in the early pandemic period (bilateral cochlear implants, -12.1% [-14.6% to -9.4%]; unilateral cochlear implants, -15.5% [-20.4% to -10.7%]) and late pandemic periods (bilateral cochlear implants, -5.3% [-8.0% to -2.6%]; unilateral cochlear implants, -11.2% [-15.3% to -7.1%]) compared with the prepandemic baseline.

Conclusions and Relevance

This cohort study using datalogs from children using cochlear implants suggests that a sustained reduction in children's access to spoken communication was found during more than 2 years of COVID-19 pandemic-related lockdowns and school closures.

Pathways From Preschool Language Difficulties to School-Age Internalizing Problems

PURPOSE

Early language difficulties are associated with later internalizing problems across different ages and for different aspects of language. The mechanisms behind this association are, however, less understood. In the current study, we investigated longitudinal associations between language difficulties at 5 years and internalizing problems at 6 years. We also examined emotion regulation, empathy, assertiveness, and social engagement at 6 years as possible pathways for this association.

METHOD

A subsample from the Norwegian Mother, Father and Child Cohort Study (MoBa) was used (N = 928). Structural equation models were developed to test the longitudinal associations and indirect pathways between language and internalizing problems.

RESULTS

The results showed high stability for internalizing problems from 5 to 6 years (β = .59, p < .001). Furthermore, semantic language difficulties predicted change in internalizing problems (β = .12, p < .001). Finally, the path between semantic language and internalizing problems was partially mediated by social engagement and emotion regulation, with the indirect pathways accounting for 55% of the initial association. For girls, there was a significantly stronger correlation (p < .05) between semantic language difficulties and internalizing problems at baseline (r = .30, p < .001) than for boys (r = .16, p < .001). Otherwise, there were no sex differences.

CONCLUSIONS

Indirect pathways from language difficulties to internalizing problems were identified through social engagement and emotion regulation. The results may guide targets for intervention in groups of children with language difficulties at risk for developing internalizing problems.

The complexity of early diagnostic decision making: A follow-up study of young children with language difficulties

BACKGROUND & AIMS

Due to the complexity of early diagnostic decision making, we examined the predictive value of an early diagnostic classification and early abilities on later best estimate diagnosis for 22 clinically referred children with language difficulties.

METHODS AND PROCEDURES

Four years after initial evaluation (Time 1), the clinical files of these children were reviewed. A best-estimate (BE) diagnosis of language disorder (LD), intellectual disability (ID), or autism spectrum disorder (ASD) was established, with ASD being most common.

OUTCOMES AND RESULTS

Early clinical classifications were relatively unstable or difficult to establish at a young age. The magnitude of children's cognitive and receptive language delay was a significant predictor of a later BE diagnosis of ID and LD respectively. A BE diagnosis of ASD, by contrast, could not be predicted from children's early social communication problems nor the presence of restricted and repetitive behaviors and interests.

CONCLUSIONS

Taken together, the results of this study suggest that language difficulties can be an early marker of a neurodevelopmental disorder which is often not identified at the age of first referral.

IMPLICATIONS

Eligibility for treatment should, therefore, be based on biopsychosocial case formulation rather than DSM or ICD diagnostic classification.

WHAT THIS PAPER ADDS?

In this study a dimensional approach was used to characterize the abilities of young children referred with mild to profound receptive and/or expressive language difficulties. Later on, a categorical approach was adopted to establish best estimate diagnoses. Our clinical, broadly defined sample reflects the heterogeneous intake of young children referred for diagnostic assessment. Other studies on diagnostic stability often only focus on one diagnostic category (and are explicitly excluding children with specific other diagnoses), not taking into account the difficulties of early differential diagnostic decision making and stability across different categories over time. Investigations of differential diagnosis within a clinical group, instead of only differentiating children with a specific diagnosis from typically developing children, may be more informative for clinicians.

Children With Persistent Versus Transient Early Language Delay: Language, Academic, and Psychosocial Outcomes in Elementary School

Purpose The objective of this study was to compare children with persistent versus transient preschool language delay on language, academic, and psychosocial outcomes in elementary school. Method Children with persistent language delay (n = 30), transient language delay (n = 29), and no language delay (controls; n = 163) were identified from a population-based sample of twins. They were compared on language skills, academic achievement, and psychosocial adjustment in kindergarten and Grades 1, 3, 4, and 6. Results Children with persistent language delay continued to show language difficulties throughout elementary school. Furthermore, they had academic difficulties, in numeracy, and psychosocial difficulties (attention-deficit/hyperactivity disorder behaviors, externalizing behaviors, peer difficulties) from Grade 1 to Grade 6. Children with transient language delay did not differ from controls on language and academic performance. However, they showed more externalizing behaviors in kindergarten and peer difficulties in Grade 1 than controls. Conclusion Difficulties at school age are widespread and enduring in those with persistent early language delay but appear specific to psychosocial adjustment in those with transient language delay.

Problem behavior in young children referred with language difficulties: Relations to language and intentional communication

BACKGROUND AND AIMS

This exploratory study aims to examine the relative contribution of language and intentional communication to internalizing and externalizing problem behavior.

METHODS

Twenty-nine Dutch-speaking children (age range 24-46 months) referred with language difficulties participated in this study. For the majority of children, these early language difficulties appeared to be part of a broader neurodevelopmental disorder, mainly autism spectrum disorder. Parent ratings on the Achenbach Child Behavior Checklist 1½-5 were predicted from children's language level and intentional communicative abilities, the latter being assessed by both parent report and direct observation. In all series of hierarchical regression analyses, chronological age and nonverbal mental age were included as covariates.

RESULTS

Parents commonly reported withdrawal, emotionally reactive behavior, attention problems, and aggressive behavior. Parent-rated intentional communication was the most important predictor of internalizing problem behavior and played an important role in the prediction of aggressive behavior as well. However, chronological age and/or nonverbal mental age also predicted parent-rated levels of externalizing problem behavior, especially attention problems.

CONCLUSIONS

The relation between language difficulties and problem behavior may be influenced by maturation and children's ability to communicate intentionally.Implications: Language proficiency should, therefore, be independently assessed from children's intentional communicative abilities which, in turn, may differ across contexts.

Neonatal White Matter Maturation Is Associated With Infant Language Development

BACKGROUND

While neonates have no sophisticated language skills, the neural basis for acquiring this function is assumed to already be present at birth. Receptive language is measurable by 6 months of age and meaningful speech production by 10-18 months of age. Fiber tracts supporting language processing include the corpus callosum (CC), which plays a key role in the hemispheric lateralization of language; the left arcuate fasciculus (AF), which is associated with syntactic processing; and the right AF, which plays a role in prosody and semantics. We examined if neonatal maturation of these fiber tracts is associated with receptive language development at 12 months of age.

METHODS

Diffusion-weighted imaging (DWI) was performed in 86 infants at 26.6 ± 12.2 days post-birth. Receptive language was assessed via the MacArthur-Bates Communicative Development Inventory at 12 months of age. Tract-based fractional anisotropy (FA) was determined using the NA-MIC atlas-based fiber analysis toolkit. Associations between neonatal regional FA, adjusted for gestational age at birth and age at scan, and language development at 12 months of age were tested using ANOVA models.

RESULTS

After multiple comparisons correction, higher neonatal FA was positively associated with receptive language at 12 months of age within the genu (p < 0.001), rostrum (p < 0.001), and tapetum (p < 0.001) of the CC and the left fronto-parietal AF (p = 0.008). No significant clusters were found in the right AF.

CONCLUSION

Microstructural development of the CC and the AF in the newborn is associated with receptive language at 12 months of age, demonstrating that interindividual variation in white matter microstructure is relevant for later language development, and indicating that the neural foundation for language processing is laid well ahead of the majority of language acquisition. This suggests that some origins of impaired language development may lie in the intrauterine and potentially neonatal period of life. Understanding how interindividual differences in neonatal brain maturity relate to the acquisition of function, particularly during early development when the brain is in an unparalleled window of plasticity, is key to identifying opportunities for harnessing neuroplasticity in health and disease.

Relations Between Toddler Expressive Language and Temper Tantrums in a Community Sample

This study examined the frequent clinical observation that toddlers with less expressive language have more severe temper tantrums. A representative sample of 2,001 mothers reported on their toddler's expressive vocabulary and frequency of different temper tantrum behaviors, a prominent feature of irritability and an emergent marker of mental health risk. Results revealed that 12- to 38-month-olds with fewer spoken words demonstrated more severe (frequent and dysregulated) temper tantrums. Toddlers who were late talkers at 24-30 months also had more severe tantrums; their relative risk of having severe tantrums was 1.96 times greater than peers with typical language. These results are the first to show that language and temper tantrums are related, and that this relation is present in the second year of life. These findings point to the importance of assessing both language and mental health risk in order to promote earlier identification and intervention for early childhood disorders.

Pragmatic language impairment general and specific associations to mental health symptom dimensions in a child psychiatric sample

Background

The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment.

Aims

The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC).

Methods

Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included.

Results

The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores).

Conclusion

There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor.

Comparison of aural rehabilitation outcomes in presence and absence of back ground noise in hearing impaired children with and without attention deficit hyperactivity disorder (ADHD)

OBJECTIVE

We sought to understand the extend of improvement in seven major skills to determine the best rehabilitation approach in hearing impaired young children with and without attention deficit and hyperactivity disorder (ADHD).

METHODS

Newsha developmental scale was assessed in 40 hearing impaired children with and without ADHD in two conditions, in which seven major skills (hearing, speech, receptive language, expressive language, cognition, social communication, and motor skills) were evaluated. Two separate analyses were conducted, each after six months of rehabilitation. The first six months rehabilitation was done by controlling background noise level, while the other six months rehabilitation was performed with background multi talker babble noise, and ADHD and non ADHD children performance were compared.

RESULTS

After the first six months of rehabilitation there were no significant difference in improvement in any of the major skills except for motor and cognition skills between hearing impaired ADHD and non ADHD children. After the second six months of rehabilitation the extend of improvement was equal in both groups.

CONCLUSION

The equal improvement of hearing impaired ADHD and non- Children with ADHD support the benefits of rehabilitation program in both groups. In addition, it seems background multi talker babble noise can facilitate the process of rehabilitation in ADHD group. As a result, it is important to understand the specific needs of hearing impaired children with ADHD in rehabilitation program to provide the best services and increase the chance for success.

SOCIOEMOTIONAL AND BEHAVIORAL PROBLEMS IN TODDLERS WITH LANGUAGE DELAY

Toddlers with language delay are at risk for persistent developmental and behavioral difficulties; however, the association between socioemotional/behavior problems and language in young children is not well understood. This study explored socioemotional/behavior problems in a unique sample of toddlers with language delays using a measure developed explicitly for this age group. Toddlers identified by 18 months with receptive and expressive language delay (LD; n = 30) or typical development (TD; n = 61) were evaluated at 18 and 24 months of age using the Infant-Toddler Social and Emotional Assessment (ITSEA) and the Mullen Scales of Early Learning. Compared to toddlers who had TD, toddlers with LD had significantly more concerning scores at 18 and 24 months on all ITSEA domains. The rate of "clinical concern" on most domains was not high in either group, except that >60% of LD toddlers were in the clinical concern range on the Competence domain. Socioemotional/behavioral problems were dimensionally related to receptive and expressive language, with greater language delay associated with more concerning ITSEA scores. Socioemotional and behavioral problems are related to receptive and expressive language abilities in 18- and 24-month-olds, indicating the need for screening of both types of concerns in toddlers identified with potential language delays.

Language difficulties and internalizing problems: Bidirectional associations from 18 months to 8 years among boys and girls

Studies have shown that early language difficulties are associated with later internalizing problems. Less is known about the nature of the association: the bidirectional relationship over time, the role of different types of language difficulties, and gender differences. The present study examined bidirectional longitudinal associations between parent-rated language difficulties and internalizing problems in a four-wave cross-lagged model from 18 months to 8 years. Data from the Norwegian Mother and Child Cohort Study were used (N = 114,000). Gender-specific dichotomized language variables were created, and associations were investigated uniquely for boys and girls. Logistic regression analyses showed that all cross-lagged associations from 18 months to 5 years were significant for girls (odds ratios [ORs] = 1.48-1.94). For boys, only internalizing problems at 3 years predicted change in language difficulties (OR = 2.33). From 5 to 8 years, the cross-lagged associations between semantic language difficulties and internalizing problems were significant and strong for girls (ORs = 1.92-2.97) and nonsignificant for boys. The results suggest that the associations between language difficulties and internalizing problems are bidirectional from an early age, and that girls are especially vulnerable for developing co-occurring language difficulties and internalizing problems during the years of transition to school.

Trajectories of internalizing problems during the transition to adolescence in children with and without conduct problems

Children with conduct problems are at greater risk for internalizing problems. The objectives of this study were to (1) examine trajectories of internalizing problems among children with and without clinically significant conduct problems during the transition to adolescence; and (2) identify how academic achievement, peer rejection, parent socioeconomic status, maternal distress, parental warmth, child temperament, and receptive verbal functioning explained differences between the two groups. Children with conduct problems ( N = 388, 45% girls) and a comparison sample without conduct problems ( N = 299, 52% girls) were recruited from Quebec, Canada, when they were between the ages of 7 and 10 years, and were followed across 4 years. Mothers and teachers provided information on internalizing problems each year. Having clinically significant conduct problems was associated with higher initial levels of internalizing problems according to mothers and teachers, but not with changes in internalizing problems over time. With regards to teacher ratings, academic achievement, peer rejection, and negative emotionality partially explained differences in internalizing problems for youth with and without conduct problems. For mother ratings, maternal distress, negative emotionality, and peer rejection completely explained the association for girls, and partially explained the association for boys. Findings supported a multi-rater approach for understanding risk for internalizing problems among children with and without conduct problems. In particular, they highlight the importance of differences across context for understanding factors associated with vulnerability to internalizing problems.

The Longitudinal Effects of Early Language Intervention on Children's Problem Behaviors

Researchers examined whether a parent-implemented language intervention improved problem behaviors 1 year after intervention. Ninety-seven children with language delays (mean age at 12-month follow-up = 48.22 months) were randomized to receive Enhanced Milieu Teaching (EMT) language intervention or business as usual treatment. Twelve months after the intervention ended, children in the EMT intervention condition displayed lower rates of parent-reported externalizing, internalizing, and total problem behaviors. A mediation analysis revealed that the relation between EMT and problem behaviors was partially mediated by child rate of communication for both internalizing and total problem behaviors. A developmental framework is proposed to explain the impact of EMT on problem behaviors, and future lines of research are discussed.

Children's Language Proficiency at Ages 2 and 3 as Predictors of Behavior Problems, Social and Cognitive Development at Age 3

This study examined the relationship between language proficiency, behavior problems, and other areas of development in a sample of 36 children ranging from 36–40 months (M = 37.3; SD = 1.1). Although none of the children were in the clinical range of behavioral disturbance, the findings indicated a strong general association between deficiencies in both expressive and receptive language and children's behavioral difficulties. Specifically, deficits in expressive language at age 2 (M = 25.5 mo.; SD = 0.6 mo.) were more predictive of internalizing rather than externalizing behavior problems at age 3, including symptoms associated with anxiety and depression, withdrawal, sleep and somatic problems. However, deficits in receptive language at age 3 were more predictive of these same types of symptoms at age 3, along with more destructive kinds of behaviors. Scores on measures of receptive language abilities at age 2 were positively predictive of social and cognitive development at age 3. These findings indicate a need for early identification of language delays in young children to help prevent deficits in language that might be linked to behavior problems or delays in other areas of development. Further, our results suggest the need for early intervention, especially for children who display both language delays and behavioral difficulties.

Neural Mechanisms of Language-Based Learning Impairments: Insights from Human Populations and Animal Models

The acquisition of speech perception and consequent expression of language represent fundamental aspects of human functioning. Yet roughly 7% to 8% of children who are otherwise healthy and of normal intelligence exhibit unexplained delays and impairments in acquiring these skills. Ongoing research has revealed several key features of language disability that may pro-vide more direct insight into underlying anomalous neural functioning. For example, evidence supports a strong association between basic defects in processing rapidly changing acoustic information and emergent disruptions in speech perception, as well as cascading effects on other forms of language development (including reading). Considerable neurobiological research has thus focused on developmental factors that might deleteriously influence rapid sensory processing. Additional research focuses on mechanisms of neural plasticity, including how such brains might be “retrained” for improved processing of language. These and related findings from human clinical studies, electrophysiological studies, neuroimaging studies, and animal models are reviewed.

Temporal Attention as a Scaffold for Language Development

Language is one of the most fascinating abilities that humans possess. Infants demonstrate an amazing repertoire of linguistic abilities from very early on and reach an adult-like form incredibly fast. However, language is not acquired all at once but in an incremental fashion. In this article we propose that the attentional system may be one of the sources for this developmental trajectory in language acquisition. At birth, infants are endowed with an attentional system fully driven by salient stimuli in their environment, such as prosodic information (e.g., rhythm or pitch). Early stages of language acquisition could benefit from this readily available, stimulus-driven attention to simplify the complex speech input and allow word segmentation. At later stages of development, infants are progressively able to selectively attend to specific elements while disregarding others. This attentional ability could allow them to learn distant non-adjacent rules needed for morphosyntactic acquisition. Because non-adjacent dependencies occur at distant moments in time, learning these dependencies may require correctly orienting attention in the temporal domain. Here, we gather evidence uncovering the intimate relationship between the development of attention and language. We aim to provide a novel approach to human development, bridging together temporal attention and language acquisition.

The role of social cognition and prosocial behaviour in relation to the socio-emotional functioning of primary aged children with specific language impairment

BACKGROUND AND AIMS

Children with language impairments often experience difficulties with their socio-emotional functioning and poorly developed prosocial behaviour. However, the nature of the association between language impairment and difficulties with socio-emotional functioning remains unclear. The social cognition skills of a group of primary-aged children (6-11 years old) with Specific Language Impairment (SLI) were examined in relation to their teachers' ratings of socio-emotional functioning.

SAMPLE

Forty-two children with SLI were individually matched with 42 children for chronological age and non-verbal cognitive ability, and 42 children for receptive language ability. The children all attended mainstream primary schools or one Language Unit.

METHODS

Four aspects of social cognition were directly assessed: emotion identification, emotion labelling, inferring the causes of emotions, and knowledge of conflict resolution strategies. The children's socio-emotional functioning was assessed using the Strengths and Difficulties questionnaire (SDQ), a standardised measure, completed by their teachers. Associations between children's performance on tasks of social cognition and children's socio-emotional functioning were explored.

RESULTS

Significant group differences were found for all social cognition tasks. The SLI group was rated to experience significantly more problems with socio-emotional functioning by their teachers than both control groups, indicating problems with all aspects of socio-emotional functioning. Social cognition and prosocial behaviour, but not language ability, predicted teacher-rated behavioural, emotional and social difficulties for the SLI group.

CONCLUSION

The results challenge current understanding of socio-emotional functioning in children with SLI by pointing to the crucial role of social cognition and prosocial behaviour. Factors other than expressive and receptive language play a role in the socio-emotional functioning of children with SLI.

Preterm delivery and risk for early language delays: a sibling-control cohort study

BACKGROUND

Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design.

METHODS

The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses.

RESULTS

The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this.

CONCLUSIONS

Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Consequences of co-occurring attention-deficit/hyperactivity disorder on children's language impairments

PURPOSE

Co-occurring attention-deficit/hyperactivity disorder (ADHD) and communication disorders represent a frequently encountered challenge for school-based practitioners. The purpose of the present study was to examine in more detail the clinical phenomenology of co-occurring ADHD and language impairments (LIs).

METHOD

Measures of nonword repetition, sentence recall, and tense marking were collected from 57 seven- to nine-year-old children. The performances of children with ADHD+LI status were compared with those of children with specific language impairment (SLI) and children with typical development (TD).

RESULTS

ADHD status had no independent detrimental impact on the affected children's LIs (SLI = ADHD+LI < TD). A modest positive correlation was found between the severity of children's ADHD symptoms and their sentence recall performance, suggesting a tendency for affected children who had higher levels of ADHD symptoms to perform better than those children with lower levels.

CONCLUSION

These outcomes are difficult to reconcile with attention-deficit/information-processing accounts of the core deficits associated with SLI. Potential protective mechanisms associated with ADHD status are discussed.

24-Month-Old Children With Larger Oral Vocabularies Display Greater Academic and Behavioral Functioning at Kindergarten Entry

Data were analyzed from a population-based, longitudinal sample of 8,650 U.S. children to (a) identify factors associated with or predictive of oral vocabulary size at 24 months of age and (b) evaluate whether oral vocabulary size is uniquely predictive of academic and behavioral functioning at kindergarten entry. Children from higher socioeconomic status households, females, and those experiencing higher quality parenting had larger oral vocabularies. Children born with very low birth weight or from households where the mother had health problems had smaller oral vocabularies. Even after extensive covariate adjustment, 24-month-old children with larger oral vocabularies displayed greater reading and mathematics achievement, increased behavioral self-regulation, and fewer externalizing and internalizing problem behaviors at kindergarten entry.

A cross-etiology comparison of the socio-emotional behavioral profiles associated with attention-deficit/hyperactivity disorder and specific language impairment

Cross-etiology comparisons provide important information that can help practitioners establish criteria for differential diagnosis and tailor interventions towards the source of children's difficulties. This study examined the extent to which parent rating scales of socioemotional behavioral difficulties differentiate cases of attention-deficit/hyperactivity disorder (ADHD) from cases of specific language impairment (SLI), and typical development (TD). Parents of 60 children (7-8 years) completed the Child Behavior Checklist (Achenbach & Rescorla, 2001) and the Conners Parent Rating Scale-Revised (Conners, 2004). Significant differences were observed between ratings provided for the children with ADHD and the children with SLI and TD across several scales which assessed behavioral and emotional difficulties. Most of the observed differences between ratings provided for the SLI and TD groups were not significant when nonverbal IQ was treated as a covariate or when syndrome scales were adjusted for the presence of language and academic items. In contrast, these adjustments had little impact on observed differences between the children with ADHD and the other groups. These results highlight important and clinically useful differences between the scope and the scale of socioemotional behavior difficulties associated with ADHD and SLI.

Parent Training Outcomes among Young Children with Callous-Unemotional Conduct Problems with or At-Risk for Developmental Delay

School-aged children with conduct problems and high levels of callous-unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP+CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to CP outcomes. To date, little is known about treatment response among young children with CP+CU, particularly those with or at risk for developmental delay. Components of Parent-Child Interaction Therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP+CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at-risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at-risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP+CU are discussed.

Behavior problems in children with specific language impairment

We studied behavior in a group of children with specific language impairment in its 2 subtypes (expressive and mixed receptive/expressive). After exclusion of other psychiatric conditions, we evaluated 114 children of ages 2 to 7 years using language developmental tests and behavioral screening scales. Behavior problems appeared in 54% of the children. Withdrawn was the most frequently found syndrome in preschool children, whereas anxious/depressed and social problems were the most frequent in older children. The high frequency of behavioral syndromes in children with specific language impairment is remarkable and requires the awareness of primary attendants and specialists. Anxiety, depression, social isolation, and aggressive and rule-breaking behavior can obscure identification of the language impairment. Taking into account this relationship would improve the chances of a timely and appropriate intervention.

A comparative study of pathways to care for children with specific learning disability and mental retardation

CONTEXT

Early intervention in specific learning disability (SpLD) results in better outcome and prevents comorbidity. Understanding the pathways is therefore important.

AIMS

To study and compare the pathways to care for children with SpLD and mental retardation (MR) before reaching a tertiary care center.

SETTINGS AND DESIGN MATERIAL AND METHODS

A cross-sectional study was conducted for pathways to care of two groups: SpLD and MR with 50 children in each group from 8 to 16 years. MINI-KID for comorbidity and Goldberg's pathway to care instrument was used. The groups were divided into early contact (up to three carers) and late contact (more than three carers) and compared.

STATISTICAL ANALYSIS

Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 10.0 software.

RESULTS

Majority (n = 24 or 48%) of SpLD children visited "others" (teachers, neighbors, relatives, and guardians of fellow classmates) as first carer. Allopathic practitioners were the first choice for MR children (n = 31 or 62%). Six children (12%) in SpLD group and 10 of MR (20%) group have seen either traditional practitioner or healer as first carer. Maximum referral to the tertiary center in both groups was done by others (62% in SpLD and 56% in MR group). Early contacts in SpLD group belonged to younger age group (P = 0.01). While comparing both groups on the basis of early and late contact, mother's education was found to be significant in early contact group (P = 0.036) and having comorbidity was significant among late contacts (P = 0.038).

CONCLUSIONS

The pathways to care for SpLD children are more or less similar to MR children whose parents recognize MR late. Both the groups visit multiple carers including traditional healers substantiating the strong belief for supernatural causation of developmental disorders in India.

Language and internalizing and externalizing behavioral adjustment: developmental pathways from childhood to adolescence

Two independent prospective longitudinal studies that cumulatively spanned the age interval from 4 years to 14 years used multiwave designs to investigate developmental associations between language and behavioral adjustment (internalizing and externalizing behavior problems). Altogether 224 children, their mothers, and teachers provided data. Series of nested path analysis models were used to determine the most parsimonious and plausible paths among the three constructs over and above stability in each across age and their covariation at each age. In both studies, children with poorer language skills in early childhood had more internalizing behavior problems in later childhood and in early adolescence. These developmental paths between language and behavioral adjustment held after taking into consideration children's nonverbal intellectual functioning, maternal verbal intelligence, education, parenting knowledge, and social desirability bias, as well as family socioeconomic status, and they applied equally to girls and boys.

Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies

BACKGROUND

Prospective evidence on psychological outcomes for children with specific language impairments (SLI) is accumulating. To date, there has been no attempt to summarise what this evidence says about the strength of link between SLI and later child and adolescent emotional and behavioural (EB) outcomes.

METHODS

We undertook a systematic review and meta-analysis (following PRISMA guidelines and involving a literature search to June 2012 of seven databases, including MEDLINE and PsychAPA) of prospective, cohort studies of children with SLI and typical language development (TLD) reporting on the incidence and severity of EB problems later in childhood or adolescence.

RESULTS

Nineteen follow-up reports of eight cohorts with 553 SLI children and 1533 TLD controls were identified. Initial assessment was at 3-8.8 years of age and follow-up duration from 2 to 12 years. Pooled across comparable studies, SLI children were about two times more likely to show disorder levels of overall internalising problems, overall externalising and ADHD problems than TLD children. Compared with the average TLD child (50 percentile), at follow-up, the symptom severity of the average SLI child was at the 72 percentile (95% CI 65-79 percentile) on internalising symptoms, the 69 percentile (95% CI 63-74 percentile) on externalising symptoms and the 60 percentile (95% CI 52-68 percentile) on AHDH severity. The findings about risk to specific mental disorders and the severity of specific problems were inconclusive.

CONCLUSIONS

Relative to typical children, SLI children experience clinically important increases in the severity of diverse emotional, behavioural and ADHD symptoms and more frequently show a clinical level of these problems. The small number of studies included in pooled analysis and methodological heterogeneity reduce the precision and generalisability of the findings. Most studies do not account for initial levels of EB problems.

Longitudinal Patterns of Behavioral, Emotional, and Social Difficulties and Self-Concepts in Adolescents With a History of Specific Language Impairment

Purpose

This study explored the prevalence and stability of behavioral difficulties and self-concepts between the ages of 8 and 17 years in a sample of children with a history of specific language impairment (SLI). We investigated whether earlier behavioral, emotional, and social difficulties (BESD); self-concepts; and language and literacy abilities predicted behavioral difficulties and self-concepts at 16/17 years.

Method

In this prospective longitudinal study, 65 students were followed up with teacher behavior ratings and individual assessments of language, literacy, and self-concepts at 8, 10, 12, 16, and 17 years.

Results

The students had consistently higher levels than norms of 5 domains of BESD, which had different trajectories over time, and poorer scholastic competence, whose trajectory also varied over time. Earlier language ability did not predict later behavioral difficulties or self-concepts, but the prediction of academic self-concept at 16 by literacy at 10 years approached significance.

Conclusions

The importance of distinguishing domains of behavioral difficulties and self-concept is demonstrated. Language, when measured at 8 or 10 years of age, was not a predictor of behavior or self-concepts at 16 years, or of self-concepts at 17 years. The study stresses the importance of practitioners addressing academic abilities and different social–behavioral domains in delivering support for adolescents with SLI.

How Can the Comorbidity with ADHD Aid Understanding of Language and Speech Disorders?

This paper serves to provide a background for the topic of comorbidity than extends through this issue. Comorbidity is common within developmental disorders. It is shown that there are many possible reasons for comorbidity. Some of these can be viewed as artifacts as simple as chance occurrence or because of the way that the research participants were sampled. If these artifacts are eliminated, then comorbidity can be informative with respect to possible causes of the disorders that are comorbid. Several possible etiologic models are presented along with a general framework for considering levels of causality in developmental disorders.

Examining the comorbidity of language disorders and ADHD

In the companion papers this issue we presented the value of research on comorbidity, particularly in complex developmental disorders where the identification of etiology is challenging. As we will document below, Language Impairment (SLI) and Attention Deficit Hyperactivity Disorder (ADHD) have been shown to co-occur in a number of studies, and this phenomenon is commonplace in the experience of many clinicians. Given this, we must ask whether the overlap between SLI and ADHD can aid our understanding of these disorders, particularly with regard to the basis for comorbidity. As we review the literature, we will consider the models of comorbidity that were outlined in the Introduction to this issue. Finally, we present original data on SLI and ADHD from a population-based sample of children that have studied over the last two decades in the State of Iowa.

Violence Exposure and the Development of School-Related Functioning: Mental Health, Neurocognition, and Learning

The relation between history of violence exposure and the development of academic and mental health problems is explored. Violence exposed children have an increased risk of developing school-related problems including: mental health problems, learning disabilities, language impairments, and other neurocognitive problems. These problems interact to create a complex web of deficits and disabilities where intervention access points are difficult to assess. Often mental health problems and academic problems develop in parallel. Timing of violence exposure and the developmental stage of the child during exposure complicate our understanding of the underlying mechanism. A model is presented that explores pathways linking violence exposure to aspects of school-related functioning, both academically and behaviorally. Early life stress, in the form of violence exposure, is related to neurocognitive deficits, including executive functioning and problems in self-regulation. Deficits in self-regulation at the level of behavior, and cognitive control and executive functioning, at the level of brain processing, are related to both academic and mental health problems, suggesting a possible psychological mechanism. Biological mechanisms are also included in the model to illustrate the contribution of the stress response, neuroendocrine system response, and neuroanatomical structural and functional impairments associated with violence exposure.

Sensory over-responsivity, psychopathology, and family impairment in school-aged children

OBJECTIVE

To establish the diagnostic validity of sensory overresponsivity (SOR), there is a need to document rates of SOR and the co-occurrence of SOR with other psychiatric disorders. Although this was not a diagnostic study of SOR, this study was designed to investigate rates of elevated SOR symptoms and associations between elevated SOR symptoms, psychiatric disorder status, and family impairment.

METHOD

From a larger birth cohort followed from infancy to school age, 338 children aged 7 to 10 years (51% boys, 49% girls) and their parents participated in an intensive assessment. Parents were interviewed with the Diagnostic Interview Schedule for Children (DISC) and completed the SensOR inventory and the Family Life Impairment Scale.

RESULTS

Approximately one-fifth (21.2%) of children had elevated SOR symptoms. One-fourth (24.3%) of those with an elevated SOR score met criteria for a DSM-IV diagnosis, and 25.4% of children with a DSM-IV diagnosis had an elevated SOR score. Parents of children with elevated SOR alone reported a similar number of restrictions in family life as parents of those with an internalizing and/or externalizing diagnosis. SOR predicted concurrent family impairment above and beyond DSM diagnostic status and socio-demographic risk.

CONCLUSIONS

Elevated SOR occurs in the absence of other psychiatric conditions and is associated with impairment in family life. Services for children with comorbid elevated SOR and an externalizing disorder are needed to address the extremely high level of family impairment reported.

Late talking and the risk for psychosocial problems during childhood and adolescence

OBJECTIVE

Although many toddlers with expressive vocabulary delay ("late talkers") present with age-appropriate language skills by the time they are of school age, little is known about their broader behavioral and emotional profile. The aim of this study was to determine whether late talkers are at increased risk for behavioral and emotional problems during childhood and adolescence.

PATIENTS AND METHODS

Participants were from the Western Australian Pregnancy Cohort Study. Early expressive vocabulary was measured by parent report at age 2 years using the Language Development Survey. Late talkers were defined as toddlers who scored at or below the 15th percentile on the Language Development Survey for their gender but were screened not to have any other developmental delays. The Child Behavior Checklist was used to measure problem child behavior with continuous z scores and clinical thresholds at ages 2, 5, 8, 10, 14, and 17 years. Potential confounders included maternal and family sociodemographic characteristics as well as prenatal smoking and alcohol exposure.

RESULTS

At age 2 years, late talkers (n = 142) had higher Child Behavior Checklist scores (representing poorer behavior) than control toddlers (n = 1245) in total, internalizing, and externalizing scales and higher risk for clinically significant internalizing and externalizing problems. Regression models, incorporating the confounding variables, revealed no association between late-talking status at age 2 years and behavioral and emotional problems at the 5-, 8-, 10-, 14-, and 17-year follow-ups.

CONCLUSIONS

Expressive vocabulary delay at the age of 2 years is not in itself a risk factor for later behavioral and emotional disturbances.

A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI)

Children with specific language impairment (SLI) have often been reported to have associated behavioral, emotional and social difficulties. Most previous studies involve observations at a single time point, or cross sectional designs, and longitudinal evidence of the developmental trajectories of particular difficulties is limited. The Strengths and Difficulties Questionnaire was used to measure behavioral (hyperactivity and conduct), emotional and social (peer) problems in a sample of individuals with a history of SLI at four time points from childhood (age 7) to adolescence (age 16). A decrease in behavioral and emotional problems was observed from childhood to adolescence, although emotional problems were still evident in adolescence. In contrast, there was an increase in social problems. Reading skills and expressive language were related only to behavioral problems. Pragmatic abilities were related to behavioral, emotional and social difficulties. As a group, those with a history of SLI have poorer long term social and, to a lesser extent, emotional outcomes. In contrast, behavioral difficulties appear to decrease to normative levels by adolescence. Different aspects of early language abilities and reading skills exert different types and degrees of influence on behavioral, emotional and social difficulties.

LEARNING OUTCOMES

Readers will be able to: (1) understand the types of behavioral, emotional and social difficulties present in individuals with a history of SLI; (2) be familiar with the developmental trajectory of these difficulties from childhood to adolescence; and (3) understand the relationships between behavioral, emotional and social difficulties and early language and literacy ability.

Longitudinal patterns of behaviour problems in children with specific speech and language difficulties: Child and contextual factors

BACKGROUND

The purpose of this study was to examine the stability of behavioural, emotional and social difficulties (BESD) in children with specific speech and language difficulties (SSLD), and the relationship between BESD and the language ability.

METHODS

A sample of children with SSLD were assessed for BESD at ages 8, 10 and 12 years by both teachers and parents. Language abilities were assessed at 8 and 10 years.

RESULTS

High levels of BESD were found at all three ages but with different patterns of trajectories for parents' and teachers' ratings. Language ability predicted teacher- but not parent-rated BESD.

CONCLUSIONS

The study confirms the persistence of high levels of BESD over the period 8-12 years and the continuing comorbidity of BESD and language difficulties but also indicates a complex interaction of within-child and contextual factors over time.

Social competence, externalizing, and internalizing behavioral adjustment from early childhood through early adolescence: developmental cascades

This study used a three-wave longitudinal design to investigate developmental cascades among social competence and externalizing and internalizing behavioral adjustment in a normative sample of 117 children seen at 4, 10, and 14 years. Children, mothers, and teachers provided data. A series of nested path analysis models was used to determine the most parsimonious and plausible cascades across the three constructs over and above their covariation at each age and stability across age. Children with lower social competence at age 4 years exhibited more externalizing and internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. Children with lower social competence at age 4 years also exhibited more internalizing behaviors at age 10 years and more internalizing behaviors at age 14 years. Children who exhibited more internalizing behaviors at age 4 years exhibited more internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. These cascades among social competence and behavioral adjustment obtained independent of child intelligence and maternal education and social desirability of responding.

Behavioural problems in young children with language problems

OBJECTIVE

Analysis of behavioural problems in young children with language problems.

MATERIALS AND METHODS

From 38 children diagnosed with a language problem, the opinion of the parents about the behaviour of their child, scored by the Child Behaviour Checklist 1.5-5 was compared with the behavioural problems in the Dutch population with the Chi-square test. T-tests and Mc Nemar tests were used to compare the opinion of the fathers about the behavioural problems with the opinion of the mothers and to compare the scores on internalizing problems with scores on externalizing problems. Plots display the measurement of the mean behavioural problems of the parents against the discrepancy between the parents and of the total behavioural problems against the discrepancy between internalizing and externalizing problems. The relation between the behavioural problems, the language score and the non-verbal intelligence score was also compared and is presented in a bar chart.

RESULTS

All children had an inadequate language production (GDS). Twenty-seven children had an adequate and 11 children had an inadequate Language Comprehension Quotient (LCQ). Twenty-eight children had an adequate and 10 children had an inadequate non-verbal IQ (SON-IQ). In the clinical population mothers report more internalizing behavioural problems than in Dutch peers. The fathers also experience differences, but these are not significant. There is agreement between the parents in how they experience problems on the internalizing, externalizing and total problem scale. And there are no significant differences between the internalizing and externalizing problem scales, between boys and girls, and in behavioural problems in children with both adequate LCQ and SON-IQ and with inadequate LCQ and/or SON-IQ.

CONCLUSION

Compared to their peers in the Dutch population, young children with language problems show more internalizing problems according to their mothers. The fathers also experience differences, but these are not significant. Fathers and mothers agree on the behaviour analysis of their child and there are no differences between the occurrences of internalizing or externalizing problems and between boys and girls. There is also no relation between the behavioural problems and the severity of the language problem or the level of non-verbal functioning.

Predicting behavior problems in deaf and hearing children: the influences of language, attention, and parent-child communication

The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years. Secondary analyses were performed on data collected as part of the Childhood Development After Cochlear Implantation Study, funded by the National Institutes of Health. Hearing-impaired children showed more language, attention, and behavioral difficulties, and spent less time communicating with their parents than normally hearing children. Structural equation modeling indicated there were significant relationships between language, attention, and child behavior problems. Language was associated with behavior problems both directly and indirectly through effects on attention. Amount of parent-child communication was not related to behavior problems.

Prevalence of speech and/or language impairment in preparatory students in northern Tasmania

The purpose of this paper is to report the prevalence of speech and/or language impairment in a sample of preparatory students in northern Tasmania, Australia. A total of 308 preparatory students attending 30 public schools in northern Tasmania were administered assessments by a speech-language pathologist, and subsequently diagnosed with either typical or impaired speech and/or language skills. Overall, 41.2% of assessed preparatory students were identified as having either speech and/or language impairment. Specifically, 8.7% of students were found to have isolated speech impairment, 18.2% were diagnosed with isolated language impairment, and 14.3% were identified as having comorbid speech and language impairment. Compared to prior Australian and international research, the present data reflect one of the highest prevalence estimates for speech and/or language impairment reported to date. Given the relative paucity of Australian prevalence data, further epidemiological research specifically of Australian children is needed to validate the current findings.

Language delay and behavioral/emotional problems in toddlers: findings from two developmental clinics

PURPOSE

The association between language delay and behavior problems in toddlers was examined in 2 studies, 1 conducted in a developmental clinic in New Jersey (Study 1; N = 83) and the other conducted in a developmental clinic in New York (Study 2; N = 103).

METHOD

In both clinics, parents of 18- to 35-month-olds completed the Language Development Survey (LDS) and the Child Behavior Checklist/1.5-5 (CBCL). In Study 2, the Preschool Language Scale-Fourth Edition (PLS-4) was also administered. Neurodevelopmental delay (ND) and pervasive developmental disorder (PDD) symptoms were also assessed in both studies but were done so using different measures.

RESULTS

In Study 1, LDS Vocabulary score and CBCL Total Problems, Internalizing, and Withdrawn scores were significantly correlated. However, when children with ND and/or suspected PDD were excluded, only the correlation between LDS Vocabulary and Withdrawn remained significant. In Study 2, only the correlation between LDS Vocabulary and Withdrawn approached significance. Children delayed in language on the PLS-4 had higher CBCL scores than typically developing toddlers only on the CBCL Withdrawn syndrome.

CONCLUSION

Significant associations between language delays and behavior problems were not found in 2 samples of 18- to 35-month-olds when children with ND and PDD were excluded, except that toddlers with language delays appeared to show elevated social withdrawal relative to typically developing toddlers.

Language proficiency, development, and behavioral difficulties in toddlers

The aim of this cross-sectional descriptive study was to explore the relation of language proficiency, behavioral difficulties, and development in infants and toddlers. Surveyed were 118 parents/caregivers of preschool children (76 boys, 42 girls). The children were a mean age of 27 months (range, 18-35 months), and 32 (27.1%) had no language delay, 8 (6.8%) had expressive delay, 14 (11.9%) had receptive delay, and 64 (54.2%) had mixed receptive-expressive delay. Children with expressive delay were more likely to have social-emotional problems. Those with receptive delay were more likely to have pervasive developmental problems. Children with receptive-expressive delay were more substantially delayed in all developmental domains; they were more withdrawn and more likely to have pervasive developmental problems. When parents of toddlers report problems, especially behavior problems, a search for delayed language is warranted as these children may be at risk for future social and emotional problems.

Enhancing early communication through infant sign training

Existing research suggests that there may be benefits to teaching signing to hearing infants who have not yet developed vocal communication. In the current study, each of 4 infants ranging in age from 6 to 10 months was taught a simple sign using delayed prompting and reinforcement. In addition, Experiment 1 showed that 2 children independently signed in a variety of novel stimulus conditions (e.g., in a classroom, with father) after participating in sign training under controlled experimental conditions. In Experiment 2, crying and whining were replaced with signing when sign training was implemented in combination with extinction.

Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment

BACKGROUND

Evidence suggests there is a heightened risk of psychiatric disorder in children with speech-language impairments. However, not all forms of language impairment are strongly associated with psychosocial difficulty, and some psychiatric disorders (e.g., attention deficit/hyperactivity disorder (ADHD)) are more prevalent than others in language-impaired populations. The present study assessed the psychosocial adjustment in adolescence of young people with history of speech-language impairment, and investigated specific relationships between language deficits and psychiatric disorders.

METHODS

Seventy-one young people (aged 15-16 years) with a preschool history of speech-language impairment were assessed using a psychiatric interview (K-SADS) supplemented by questionnaires probing social encounters and parental reports of behaviour and attention. Their psycho-social adjustment was compared with that of a cross-sectional control group of age-matched controls.

RESULTS

Overall the rate of psychiatric disorder was low in the clinical sample and children whose language delay had resolved by 5.5 years had a good outcome. For those whose language difficulties persisted through the school years, there was a raised incidence of attention and social difficulties. These difficulties were partially independent and associated with different language profiles. The group with attention problems showed a profile of specific expressive language difficulties; the group with social difficulties had receptive and expressive language difficulties; and the group with both attention and social difficulties was of low IQ with global language difficulties.

CONCLUSIONS

Amongst children with speech-language delays at 5.5 years, those with more severe and persistent language difficulties and low nonverbal IQ are at higher risk of psychiatric morbidity in adolescence.

Stability, change, and correlates of the peer relationships of young children with mild developmental delays

The peer relationships of young children with mild developmental (cognitive) delays recruited at 4-6 years of age were examined in a longitudinal study across a 2-year period. Results revealed only modest increases in children's peer interactions, a high degree of intraindividual stability, and the existence of a poorly organized and conflict-prone pattern of peer interactions. Child cognitive and language levels as well as family stress and support were associated with children's peer interactions. A subgroup was identified of initially low interactors who were at especially high risk for future peer interaction problems. These findings further underscore the importance of designing and implementing early intervention programs in the area of peer relationships for children with mild developmental delays.

A subtype of speech delay associated with developmental psychosocial involvement

This report presents findings supporting the hypothesis of a clinically relevant subtype of childhood speech sound disorder, provisionally titled speech delay-developmental psychosocial involvement (SD-DPI). Conversational speech samples from 29 children who met inclusionary criteria for SD-DPI were selected from a case record archive at a university speech clinic for children. Participants with SD-DPI had been characterized by speech clinicians and caregivers as having speech delay with psychosocial issues that required attention in the course of at least 1 semester of speech treatment. The 29 participants were divided into 2 subgroups, based on clinicians' and parents' records indicating either approach-related negative affect (n = 23) or withdrawal-related negative affect (n = 6). Each participant with SD-DPI was matched by age, gender, and type of speech involvement to 3 comparison speakers with speech delay of unknown origin (n = 87). Analyses of the conversational speech samples indicated that in comparison with participants in the control group, those with SD-DPI had significantly more severe speech delay, averaging approximately 7% to 10% lowered speech competence in conversation. The clinical prevalence of SD-DPI was estimated at approximately 12% of children referred to the university speech clinic in the present study. The authors interpret the present findings to indicate that approach-related or withdrawal-related negative affect, negative emotionality or mood, and decreased task persistence or attention are risk factors for increased severity of expression of speech delay.

Auditory perceptual consolidation in early-onset blindness

Early-onset blindness (EB) produces measurable advantages in auditory perception, attention, memory and language. Neville and Bavelier [Neville, H. J., & Bavelier, D. (2001) Variability of developmental plasticity. In J. L. McClelland, R. S. Siegler (Eds.) Mechanisms of cognitive development: Behavioral andellon symposia on cognition (pp. 271-301)] hypothesized that faster temporal processing underlies many auditory compensatory effects in the blind. We tested this hypothesis by comparing early-onset blind individuals and sighted counterparts (SC) by assessing their rates of perceptual consolidation, the accurate perceptual representation of auditory stimuli. Firstly, we first tested both groups on a temporal-order judgment task (TOJ). EB subjects had significantly lower TOJ thresholds than the SC subjects. Secondly, we assessed perceptual consolidation speed using auditory backward masking tasks, taking into account individual TOJ thresholds. Discrimination performance was unaffected at all mask delays in the EB group while the SC subjects needed a mask delay of 160 ms to perform comparably. A backward masking task using single tone stimuli found no differences between the EB and SC groups any mask delay. A simultaneous masking task demonstrated that the mask effectively impaired discrimination in EB subjects at sensory stages. These results suggest that advantages in perceptual consolidation may reflect a mechanism responsible for the short response times and better performance reported in early blind individuals across a number of complex auditory tasks.