Longitudinal Emergence of Concurrent Mental Health and Substance Use Concerns in an Ontario School-Based Sample: The Research and Action for Teens Study.

OBJECTIVES: This study characterizes patterns of mental health, substance use and their co-occurrence, and identifies developmental trajectories associated with progression from single to concurrent mental health and substance use concerns in an Ontario school-based population. It is a longitudinal extension of the Ontario Student Drug Use and Mental Health Survey, as part of the RAFT collaborative project. METHODS: In this study, an Ontario-wide survey was administered to students across three biennial waves starting in grades 7-8 (ages 12-14). We explored how developmental patterns of externalizing, internalizing and co-occurring symptoms were differentially associated with late-adolescent (ages 17-19) problematic substance use. RESULTS: On average, students exhibited early (ages 12-14) moderate risk of an internalizing and/or externalizing disorder and approached the low threshold for a diagnostic concern for substance use disorder at age 17-19. The pattern confirmed a potential pathway from early mental health concerns to later adolescent problematic substance use, with rates of co-occurrence increasing with age. Youth with early moderate-to high externalizing and co-occurring internalizing and externalizing symptomology had the highest levels of problematic substance use, with scores indicating high likelihood of a substance use disorder diagnosis. CONCLUSIONS: Given the overall pattern of progression, early identification and referral of at-risk youth, especially youth with co-occurring mental health concerns, is of critical importance. Findings support the importance of integrated and co-located mental health and substance use services for youth to more effectively serve a diverse population of youth with varying levels of need.

OBJECTIFS: La présente étude caractérise les modèles de santé mentale, l'utilisation de substances et leur cooccurrence, et identifie les trajectoires développementales associées à la progression des problèmes isolés à concurrents de santé mentale et d'utilisation de substances dans une population scolaire de l'Ontario. Il s'agit d'une extension longitudinale du Sondage sur la consommation de drogues et la santé des élèves de l'Ontario, dans le cadre d'un projet RAFT de collaboration. MÉTHODES: Dans la présente étude, un sondage a été administré à l'échelle de l'Ontario à des élèves de trois vagues biennales commençant en 7e et 8e année (de 12 à 14 ans). Nous avons exploré comment les modèles développementaux d'externalisation, d'internalisation et les symptômes co-occurrents étaient différemment associés au début tardif (de 17 à 19 ans) d'une utilisation de substances problématique. RÉSULTATS: En moyenne, les élèves montraient un risque modéré précoce (de 12 à 14 ans) d'un trouble d'internalisation et/ou d'externalisation et s'approchaient du seuil bas d'un problème diagnostique d'utilisation de substances entre 17 et 19 ans. Le modèle confirmait une trajectoire potentielle allant de problèmes précoces de santé mentale à l'apparition ultérieure d'une utilisation de substances problématique, avec des taux de cooccurrence augmentant avec l'âge. Les jeunes ayant une externalisation modérée à élevée et une symptomatologie d'internalisation et d'externalisation co-occurrentes avaient les taux les plus élevés d'utilisation de substances problématique, leurs scores indiquant une probabilité élevée d'un diagnostic de trouble d'utilisation de substances. CONCLUSIONS: Étant donné le modèle de progression général, l'identification précoce et l'aiguillage d'un jeune à risque, surtout les jeunes présentant des problèmes de santé mentale co-occurrents, sont d'une importance vitale. Les résultats appuient l'importance des services intégrés et en colocation de santé mentale et d'utilisation de substances pour les jeunes afin de servir plus efficacement une population de jeunes diversifiée dont les besoins sont de niveaux variés.

Enhancing prevention and intervention for youth concurrent mental health and substance use disorders: The Research and Action for Teens study.

BACKGROUND: Concurrent mental health and substance use disorders among youth are associated with functional impairment in developmentally salient domains, yet research on prevention and intervention for this vulnerable population is sparse. This paper describes the rationale and design of the Research and Action for Teens study, an initiative designed to strengthen the evidence base for prevention, screening, treatment and service delivery for youth concurrent mental health and substance use concerns. METHODS: Four sub-studies were developed: (1) a cohort study examining the emergence of mental health and substance use concerns from early to mid-adolescence; (2) a screening and diagnosis study validating screening tools with a diagnostic interview; (3) a treatment study examining the feasibility and effectiveness of dialectical behaviour therapy skills training interventions for youth and family members; and (4) a systems study implementing cross-sectoral collaborative networks of youth-serving agencies using a common screening tool. RESULTS: Multiple stakeholders, including service providers from youth-serving agencies across sectors, consumer groups and family members participated in an initial consultation, and in the implementation of 4 sub-studies. CONCLUSIONS: Collaboration with community stakeholders across sectors and disciplines throughout the research process is challenging but feasible, and is important for the production of applicable knowledge across the continuum of care.

Collaborating with community-based services to promote evidence-based practice: Process description of a national initiative to improve services for youth with mental health and substance use problems.

Many youth with significant mental health (MH) and/or substance use (SU) difficulties do not receive specialized services. Collaboration between service providers, researchers, and other stakeholders is essential to improve youth service system capacity to provide evidence-based services to meet the complex array of needs of youth. Facilitators and barriers of implementing evidence-based practice have been identified, but few studies provide examples of the processes of collaboration and implementation for youth MH services. This study explicates the design features and implementation processes of a project to improve screening activities in youth services. These processes supported the building of 16 collaborative networks of service providers from diverse youth-serving sectors (e.g., MH, youth justice, child welfare) in urban, rural, suburban, and remote Canadian communities. These cross-sectoral networks implemented an evidence-based practice (screening youth aged 12-24 years for MH and SU problems using the Global Assessment of Individual Needs-Short Screener [GAIN-SS]) across their services. Materials and resources were provided by a centralized research team. Core project components were standardized and adherence to these components was monitored. Over 800 service providers participated in cross-sectoral networks, capacity-building events, joint data analysis, or interpretation and recommendation sessions. Across the 89 participating agencies, service providers for 84% of participating youth implemented the evidence-based practice accurately in accordance with project protocols, with 98% of positive screens reviewed and addressed according to organizational protocols. Service provider feedback is reported. Facilitators, barriers, and implications of promoting implementation of evidence-based practices across sites and sectors are discussed. (PsycINFO Database Record

Language disorder and retrospectively reported sexual abuse of girls: severity and disclosure.

BACKGROUND: Despite emerging evidence for an association between communication disorders and maltreatment, little research has examined sexual abuse characteristics or disclosure experiences among individuals with language disorder (LD). Given that communication difficulties may constitute a barrier to disclosure, the disclosure experiences among individuals with and without communication difficulties may also differ. METHODS: Five-year-old children identified with a language and/or speech disorder from a nonclinical community sample and a control group were followed to adulthood in a prospective longitudinal study. At age 31, participants completed a behaviorally specific questionnaire on experiences of sexual abuse and questionnaires on disclosure experiences and social reactions to disclosure. Due to low endorsement of sexual victimization among male participants and low sample size, results are reported for women only and exclude nine participants with speech disorder without LD. Participation rates were 28 of 40 in the LD cohort and 45 of 51 controls. Sexual victimization severity was defined using an index combining five indicators (duration, invasiveness, relationship to perpetrator, coercive tactics used, and number of perpetrators). Subthreshold sexual victimization was defined as a single, noncontact incident with a perpetrator unknown to the child; experiences with greater severity were classified as child sexual abuse. RESULTS: Among women who reported sexual victimization by age 18, invasiveness and overall severity were greater in the LD cohort than in the control cohort. Women in the LD cohort (43%) were more likely than controls (16%) to report child sexual abuse, excluding subthreshold experiences. There were no differences between cohorts in probability of disclosure, latency to disclosure, or social reactions. CONCLUSIONS: Women with a history of child LD in a nonclinical sample reported substantial child sexual abuse experiences. Implications for understanding associations between LD and mental health and for prevention and early intervention are discussed.

Characteristics of Youth Presenting to a Canadian Youth Concurrent Disorders Program: Clinical Complexity, Trauma, Adaptive Functioning and Treatment Priorities.

OBJECTIVE: This study describes clinical characteristics of youth presenting for service at a Canadian youth concurrent mental health and substance use disorders (SUD) program. METHOD: Participants were 100 adolescents and emerging adults (aged 14-25) who attended a Canadian concurrent mental health and substance use disorders outpatient program. SUDs were assigned using the Structured Clinical Interview for DSM-IV. Self-reported mental health symptoms, trauma exposure and adaptive functioning were also assessed. RESULTS: Eighty-three percent of participants scored over the clinical cut-off on at least one mental health scale and 33% reported at least one suicide attempt. Sixty-six percent met criteria for a current SUD; 96% met lifetime criteria. Exposure to adverse events was nearly universal (94%). Almost half of female (46%) and almost a third of male (31%) participants endorsed symptoms consistent with posttraumatic stress disorder (PTSD). Youth reported impairment and need for support in multiple domains of functioning, including school, peer, family and mental health. Substance use was least likely to be identified as a treatment priority. CONCLUSIONS: High rates of adverse events and PTSD highlight the need for trauma-informed care when providing services to this vulnerable population. Functional impairment in domains related to developmental transitions and tasks underscores the need for a developmental lens and integrated treatment that goes beyond mental health and SUD symptoms and addresses developmentally relevant domains during this transitional age.

OBJECTIF: Cette étude décrit les caractéristiques cliniques des adolescents qui se présentent pour obtenir un service à un programme canadien de troubles co-occurrents de santé mentale et d'utilisation de substances (TUS) pour adolescents. MÉTHODE: Les participants étaient 100 adolescents et jeunes adultes (âgés de 14 à 25 ans) qui étaient inscrits à un programme canadien ambulatoire de troubles co-occurrents de santé mentale et d'utilisation de substances. Les TUS ont été attribués à l'aide de l'entrevue clinique structurée du DSM-IV. Les symptômes de santé mentale auto-déclarés, l'exposition à un traumatisme et le fonctionnement psychosocial ont aussi été évalués. RÉSULTATS: Quatre-vingt-trois pour cent des participants ont eu des scores supérieurs au seuil d'inclusion clinique à au moins une échelle de santé mentale et 33 % ont déclaré au moins une tentative de suicide. Soixante-six pour cent satisfaisaient aux critères d'un TUS actuel, et 96 % satisfaisaient aux critères de durée de vie. L'exposition à des événements indésirables était presque universelle (94 %). Près de la moitié des participantes (46 %) et presque le tiers des participants (31 %) présentaient des symptômes liés au trouble de stress post-traumatique (TSPT). Les adolescents déclaraient des incapacités et un besoin de soutien dans de nombreux domaines de fonctionnement, dont l'école, les pairs, la famille, et la santé mentale. L'utilisation de substances était la moins susceptible d'être identifiée comme une priorité de traitement. CONCLUSIONS: Les taux élevés d'événements indésirables et de TSPT font ressortir le besoin de soins qui tiennent compte des traumatismes lorsqu'on fournit des services à cette population vulnérable. L'incapacité fonctionnelle dans des domaines liés aux transitions et aux tâches développementales souligne le besoin d'une optique développementale et d'un traitement intégré qui vont au-delà des symptômes de santé mentale et de TUS et qui abordent les domaines qui relèvent du développement durant cet âge transitionnel.

Childhood Language Disorder and Social Anxiety in Early Adulthood.

Language disorder is associated with anxiety and with social problems in childhood and adolescence. However, the relation between language disorder and adult social anxiety is not well known. This study examines social anxiety in early adulthood in a 26-year prospective longitudinal study following individuals identified with a communication disorder at age 5 and a control group. Social anxiety diagnoses and subthreshold symptoms were examined at ages 19, 25, and 31 using a structured diagnostic interview; social anxiety symptoms related to social interaction and social performance were also assessed dimensionally at age 31. Multiple imputation was used to address attrition. Compared to controls, participants with childhood language disorder had higher rates of subthreshold social phobia at ages 19 and 25 and endorsed higher levels of social interaction anxiety symptoms at age 31, with particular difficulty talking to others and asserting their perspectives. Childhood language disorder is a specific risk factor for a circumscribed set of social anxiety symptoms in adulthood, which are likely associated with communication challenges.

Mental health trajectories from adolescence to adulthood: Language disorder and other childhood and adolescent risk factors.

Longitudinal research on mental health development beyond adolescence among nonclinical populations is lacking. This study reports on psychiatric disorder trajectories from late adolescence to young adulthood in relation to childhood and adolescent risk factors. Participants were recruited for a prospective longitudinal study tracing a community sample of 5-year-old children with communication disorders and a matched control cohort to age 31. Psychiatric disorders were measured at ages 19, 25, and 31. Known predictors of psychopathology and two school-related factors specifically associated with language disorder (LD) were measured by self-reports and semistructured interviews. The LD cohort was uniquely characterized by a significantly decreasing disorder trajectory in early adulthood. Special education was associated with differential disorder trajectories between LD and control cohorts, whereas maltreatment history, specific learning disorder, family structure, and maternal psychological distress were associated with consistent trajectories between cohorts. From late adolescence to young adulthood, childhood LD was characterized by a developmentally limited course of psychiatric disorder; maltreatment was consistently characterized by an elevated risk of psychiatric disorder regardless of LD history, whereas special education was associated with significantly decreasing risk of psychiatric disorder only in the presence of LD.

Program manager perspectives on the service system to meet the needs of youth with concurrent disorders: findings from a Canadian national survey.

BACKGROUND: Concurrent mental health and substance use issues are a serious problem for adolescents and transition-aged youth. Service providers across sectors must be involved in informing system change to meet youth needs. This study examines stakeholder perspectives on services for youth with concurrent disorders including 1) clinical issues in youth services; 2) priority system issues; and 3) optimal knowledge translation strategies to enhance researcher-stakeholder communication. METHODS: A database of youth clinical services across Canada was developed. Program managers (n = 481) at cross-sectoral (mental health, addictions, justice, child welfare, advocacy, and outreach) youth-serving (aged 12-24) programs were invited to complete an online survey; 232 responded. Survey questions concerned youth needs, program characteristics, priorities for service system enhancement; and usual and preferred knowledge translation methods. RESULTS: Across service sectors, the mean estimated proportion of youth using services with concurrent mental health and substance use problems was 55%. Program managers reported routine screening for mental health and substance use concerns (66%), referring to other agencies to meet the concurrent disorder needs of youth (54%), offering specific programming for concurrent disorders (42%), and program evaluation (48%). Notably, mental health programs were significantly less likely to offer concurrent disorders services than addictions programs. Where services do exist, most are targeted at youth aged 12-18 years, with fewer services available for transition-aged youth. Endorsement of various system change goals exceeded 80%, with a particular emphasis on improving access to services (49%), ensuring a continuum of services for varying levels of severity (37%), and improved integration across sectors (36%). Preferred knowledge exchange methods were workshops and websites for receiving information; and focus groups or surveys, rather than intensive participation on research teams, to inform research. CONCLUSIONS: There is a high need to build capacity across most sectors for meeting the needs of youth with co-occurring mental health and substance use problems, especially for transition-aged youth. In addition, limits in program evaluation should be addressed. Innovative knowledge exchange strategies are needed to better meet the needs of youth with concurrent disorders. Although service providers expressed readiness to participate in service enhancement and knowledge translation activities, effective, feasible approaches must integrate strategies likely to result in desired clinical outcomes, given clinical workload challenges.

Age 31 mental health outcomes of childhood language and speech disorders.

OBJECTIVE: Language disorders are associated with emotional and behavioral problems in childhood and adolescence. Although clinical studies with small samples suggest that psychosocial difficulties continue into adulthood, adult mental health outcomes of childhood language disorders are not well known. The objective of this prospective longitudinal study is to determine whether the age 31 mental health outcomes of individuals who had childhood language disorders differ from the outcomes of typically developing controls. METHOD: A 26-year cohort study followed up children with language or speech disorders from age 5 to age 31. The children were selected from a 1-in-3 random sample of 5-year-olds using a 3-stage screening and assessment process. A control group matched by sex, age, and classroom or school was also selected. Diagnoses were assigned with the Composite International Diagnostic Interview with the additional criterion that Global Assessment of Functioning scores indicated at least mild impairment. Dimensional psychosocial self-report measures were also administered. RESULTS: Rates of diagnosis at age 31 years were equivalent between participants who had childhood language disorders and controls, with and without multiple imputation to estimate missing outcomes. Differences in rates of affective and substance use disorders could not be ruled out because of attrition in the cohort with language disorders, who were less likely to participate at age 31. Psychosocial scores for both cohorts were in the normal range. The cohort with language disorders had poorer self-rated physical health than controls. CONCLUSION: Mild/moderate language disorders may not have significant long-term mental health consequences in early adulthood.

Validating a self-report screen for ADHD in early adulthood using childhood parent and teacher ratings.

OBJECTIVE: This article evaluates the diagnostic utility of a self-report screening tool for adults based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD criteria. METHOD: Children with speech/language (S/L) impairment and typically developing controls had ADHD symptoms rated by parents and teachers at ages 5 and 12. At age 19, participants completed the Adult Attention Problems Scale (AAPS), an 18-item screen. Receiver operative characteristic curve analyses were used to assess the efficiency of this instrument in screening for ADHD. RESULTS: The AAPS had moderate sensitivity and high specificity, but only for adults without a history of communication disorders. CONCLUSION: The AAPS provides clinicians with the only self-report scales for ADHD in adulthood, validated with childhood ADHD symptoms assessed by multiple raters. However, scale characteristics were poor for the S/L-impaired cohort. Given the overlap between language impairment and ADHD, adult ADHD measures validated in S/L-impaired samples are needed.

Twenty-year follow-up of children with and without speech-language impairments: family, educational, occupational, and quality of life outcomes.

PURPOSE: Parents, professionals, and policy makers need information on the long-term prognosis for children with communication disorders. Our primary purpose in this report was to help fill this gap by profiling the family, educational, occupational, and quality of life outcomes of young adults at 25 years of age (N = 244) from the Ottawa Language Study, a 20-year, prospective, longitudinal study of a community sample of individuals with (n = 112) and without (n = 132) a history of early speech and/or language impairments. A secondary purpose of this report was to use data from earlier phases of the study to predict important, real-life outcomes at age 25. METHOD: Participants were initially identified at age 5 and subsequently followed at 12, 19, and 25 years of age. Direct assessments were conducted at all 4 time periods in multiple domains (demographic, communicative, cognitive, academic, behavioral, and psychosocial). RESULTS: At age 25, young adults with a history of language impairments showed poorer outcomes in multiple objective domains (communication, cognitive/academic, educational attainment, and occupational status) than their peers without early communication impairments and those with early speech-only impairments. However, those with language impairments did not differ in subjective perceptions of their quality of life from those in the other 2 groups. Objective outcomes at age 25 were predicted differentially by various combinations of multiple, interrelated risk factors, including poor language and reading skills, low family socioeconomic status, low performance IQ, and child behavior problems. Subjective well-being, however, was primarily associated with strong social networks of family, friends, and others. CONCLUSION: This information on the natural history of communication disorders may be useful in answering parents' questions, anticipating challenges that children with language disorders might encounter, and planning services to address those issues.

Emerging adult outcomes of adolescent psychiatric and substance use disorders.

This study investigates the age 25 outcomes of late adolescent mental health and substance use disorders. A hierarchical cluster analysis of age 19 DSM-III-R mental health and substance diagnoses placed participants into one of 9 clusters: Anxious, Depressed, Antisocial, Drug Abuser, Problem Drinker, Anxious Drinker, Depressed Drug Abuser and Antisocial Drinker, and No Diagnosis. Diagnoses were generated from the University of Michigan Composite International Diagnostic Interview. Repeated measures multivariate analyses of variance revealed distinct trajectories of improvement and decline among the 9 clusters. Clusters with co-occurring substance and mental health disorders improved over adolescent levels, but continued to have higher levels of depression symptoms, poorer global functioning, and higher levels of substance use than the No Diagnosis cluster. Members of the The Problem Drinkers cluster, who tended to have alcohol use disorders only at age 19, did not differ from their peers with no diagnoses. Drug use disorders in adolescence, with or without a co-occurring mental health disorders, were associated with a poor prognosis in emerging adulthood. Clinical interventions should distinguish among these diverse clinical presentations.

Models and determinants of vocabulary growth from kindergarten to adulthood.

BACKGROUND: Increasing evidence suggests that childhood language problems persist into early adulthood. Nevertheless, little is known about how individual and environmental characteristics influence the language growth of individuals identified with speech/language problems. METHOD: Individual growth curve models were utilised to examine how speech/language impairment and environmental variables (socioeconomic status, family separation, and maternal factors) influence vocabulary development from age 5 to 25. Participants were taken from a community sample of children initially diagnosed with speech/language problems at age 5 and their sex- and age-matched controls. RESULTS: The language impaired group had significantly poorer receptive vocabulary than the speech impaired and control groups throughout the 20-year period. Family income was a significant predictor of vocabulary growth when considered separately, but ceased to be a predictor when language impairment status was taken into account. Maternal education and family separation were determinants of vocabulary at age 5, over and above language impairment status. CONCLUSION: Language impairment is a significant risk factor for vocabulary development from childhood to adulthood. Individuals with speech impairment were less impaired on receptive vocabulary than individuals with language impairment. Further investigation into maternal and familial risk factors may provide targets for early intervention with children at risk for language impairment.

Language impairment and sexual assault of girls and women: findings from a community sample.

Both children and adults with disabilities face increased prevalence of abuse and assault, including sexual assault. Women and girls are disproportionately the victims of sexual assault in both disabled and nondisabled populations. Communication difficulties have been identified as a factor that may increase the vulnerability of individuals with disabilities to sexual assault. However, few studies have examined whether language impairment increases risk for sexual assault. This study reports on a community sample of children with speech or language impairment, followed to age 25. Sexual assault history was assessed based on two questions from the Composite International Diagnostic Interview Posttraumatic Stress Disorder module. Women with language impairment (n = 33) were more likely than women with unimpaired language (n = 59) to report sexual abuse/assault, controlled for socioeconomic status. Sexual assault was associated with higher rates of psychiatric disorders and poorer functioning. Women with neither language impairment nor a history of sexual assault had fewer psychiatric disorders and higher functioning than women with language impairment and/or a history of sexual assault.

Social anxiety in late adolescence: the importance of early childhood language impairment.

Social phobia is a common, highly comorbid, poorly understood and relatively understudied condition. The origins of social phobia share familial and biological features common with those of other anxiety disorders, but seldom have precursors of the fear of social communication been examined as a possible pathway to social phobia. Here we examine the role of early childhood language impairment as an antecedent to social phobia in late adolescence. Participants in a prospective longitudinal community study identified as having language impairment at age 5 and matched controls were followed up at age 19. Compared to normal language controls, individuals with a history of early language impairment had 2.7 times the odds of having a social phobia by age 19. Results suggest that early language impairment represents a distinct pathway to late adolescent social phobia.

Early language impairment and young adult delinquent and aggressive behavior.

Clinic and forensic studies have reported high rates of language impairments in conduct disordered and incarcerated youth. In community samples followed to early adolescence, speech and language impairments have been linked to attention deficits and internalizing problems, rather than conduct problems, delinquency, or aggression. This study examines the young adult antisocial outcomes of speech or language impaired children. Language impaired boys had higher levels of parent-rated delinquency symptoms by age 19 than boys without language impairment, controlled for verbal IQ and for demographic and family variables. Language impaired boys did not differ from controls in self-reported delinquency or aggression symptoms on a standardized checklist; however, language impaired boys reported higher rates of arrests and convictions than controls. Language impairment was not related to aggression or delinquency in girls. We examine alternate models of the interrelationships between language, academics, and behavior, at ages 5, 12, and 19.

Fourteen-year follow-up of children with and without speech/language impairments: speech/language stability and outcomes.

This report concerns the speech and language outcomes of young adults (N = 242) who participated in a 14-year, prospective, longitudinal study of a community sample of children with (n = 114) and without (n = 128) speech and/or language impairments. Participants were initially identified at age 5 and subsequently followed at ages 12 and 19. Direct assessments were conducted in multiple domains (communicative, cognitive, academic, behavioral, and psychiatric) at all three time periods. Major findings included (a) high rates of continued communication difficulties in those with a history of impairment; (b) considerable stability in language performance over time; (c) better long-term outcomes for those with initial speech impairments than for those with language impairments; and (d) more favorable prognoses for those with specific language impairments than for those with impairments secondary to sensory, structural, neurological, or cognitive deficits. These general conclusions held when either a liberal or a more stringent criterion for language impairment was employed. Some of these findings are consistent with those from earlier follow-up studies, which used less optimal methods. Thus, the present replication and extension of these findings with a sound methodology enables greater confidence in their use for prognostic, planning, and research purposes.

Seven-year follow-up of speech/language impaired and control children: psychiatric outcome.

This study examined the 7-year psychiatric outcome of 202 speech/language (S/L) impaired and control children selected from a community sample at age 5 years. Children with S/L at age 5 years were more likely to be psychiatric cases at age 12.5 years than were normal controls, even if their S/L improved. Controlling for concurrent psychiatric disorder, S/L impairment at age 5 years was still associated with an increased rate of psychiatric disorder at 12.5 years. Psychiatric disorder at age 12.5 years was more likely to co-occur with language disorder than with speech disorder.

Long-term consistency in speech/language profiles: I. Developmental and academic outcomes.

OBJECTIVE: This study examined the 7-year developmental and academic outcome of speech/language-impaired and control children selected from a community sample. METHOD: Speech/language and psychiatric measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The long-term consistency of these subgroups was explored. The association between time 1 speech/language clusters and linguistic, cognitive and academic measures at time 2 were examined. RESULTS: Four groups were identified in the cluster analysis: high overall, poor articulation, poor comprehension, and low overall. Children with pervasive language problems continued to perform poorly on linguistic, cognitive, and academic measures, while those with comprehension problems fared slightly better but still had more difficulties than those with normal language. The poor articulation cluster had few articulation errors at follow-up. CONCLUSIONS: Empirically supported speech/language classifications identified as early as age 5 continued to be relevant into late childhood. Pervasive speech/language impairment in early childhood was associated with increased risk of poor linguistic and academic outcome at follow-up, while isolated articulatory problems improved over time. These findings reveal the urgent need for early intervention among children with pervasive speech/language impairment.

Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes.

OBJECTIVE: This study examined the 7-year behavioral, emotional, and social outcome of speech/language-impaired and control children selected from a community sample. METHOD: Speech/language and psychosocial measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The association between speech/language cluster at age 5 and psychosocial functioning at age 12.5 was examined. RESULTS: Children with receptive and pervasive speech/language problems at age 5 demonstrated greater behavioral disturbance than children without such impairment. Controlling for initial behavioral status, early childhood language profile was still associated with behavioral and social competence ratings, 7 years later. Children without receptive language problems showed superior social adjustment. CONCLUSIONS: Empirically supported speech/language classifications identified as early as age 5 were associated with behavioral disturbance in late childhood. Receptive and pervasive speech/language impairment in early childhood was associated with the greatest risk at follow-up. Early auditory comprehension problems may be a specific risk factor for later aggressive and hyperactive symptoms. These findings identify the need for effective intervention with speech/language-impaired children.