Reliability of the Group for Advancement of Psychiatry Diagnostic Categories in Child Psychiatry.

A total of 403 multiple diagnoses were independently assigned to 41 patient protocols by 73 psychiatrists, psychologists, and social workers to determine the levels of interrater reliability of the Group for the Advancement of Psychiatry (GAP) diagnostic categories. With the exception of the psychotic disorders category, these diagnostic categories were found to have low levels of interdiagnostician reliability. Differences in the reliabilities across disciplines and levels of training were found. It is noted, however, that neither years of experience, kind of training, nor direct contact with the patient can be regarded as a substitute for improvements in the classification system itself. The importance of a reliable classification system for child psychiatry is emphasized and suggestions for improvements in the present GAP system are made.

Learning disorders with a special emphasis on reading disorders: a review of the past 10 years.

OBJECTIVE: To review the past 10 years of clinical and research reports on learning disorders. METHOD: The most common and best-researched type of learning disorder is reading disability, which is the focus of this review. A selective review of the literature from Psychological Abstracts and Index Medicus from 1985 to the present was conducted. This review focused on conceptual and methodological issues, current assessment practices, epidemiology, correlates of brain function, biological factors, predictors of reading achievement, core deficits, comorbidity reading development and instructional approaches, treatment, and outcome. RESULTS: Definitional issues, still unresolved, bedevil the field with the debate between those for and those against discrepancy definitions of reading disabilities. Nevertheless considerable progress has been made. Phonological processing problems are now considered the main core deficit responsible for reading disabilities. Correlates of brain function and possible genetic factors are noted. Comorbidity with externalizing and internalizing disorders is described, and some theories for the overlap are identified. Studies on the comorbidity with internalizing disorders are lacking. Good assessment practice and promising approaches to remediation are identified. Unless a concurrent disorder is present, the use of medication for the treatment of reading disabilities should be considered experimental. Favorable outcomes are dependent on initial severity and a supportive home and school environment. CONCLUSIONS: Much progress has been made in our understanding of learning disabilities, especially in reading disabilities. Resolution of definitional and conceptual issues will greatly assist research into assessment, treatment, and long-term outcome of learning disabilities with and without concurrent psychiatric disorders. Further research into the nature, extent, and correlates of comorbid learning disabilities and their treatment is much needed.

The children's self-report questionnaire: factor score age trends and gender differences.

Age trends and gender differences in a normative sample of 1,676 children (6- to 13-years) were explored with the use of scores obtained from the Children's Self-Report Questionnaire (SRQ). Several interesting trends emerged. Boys scored higher than girls on Conduct Problems, and girls scored higher than boys on dimensions labeled Worry and Sensitive-Emotional. Scores on other SRQ factors exhibited orderly increases or decreases across age groups. These trends are discussed in an attempt to clarify behavioral cognitive and affective age appropriate norms and are cautiously interpreted within a developmental framework. The identification of age and gender trends are a necessary step in the development of a diagnostic instrument intended for use with children. The age and gender trends observed lend additional support to the validity of the SRQ.

Empirical classification of speech/language impairment in children. II. Behavioral characteristics.

Behavioral symptomatology in 188 children, 5 years of age, classified according to four different speech/language profiles, is described. Information was collected from the teacher, parent, child self-report, and psychiatric interview. The results indicated that risk for psychiatric disorder, particularly ADHD, is greatest among children with general linguistic impairment. Specific deficits such as poor auditory comprehension or articulation problems were not consistently associated with behavioral disturbance. It is postulated that neurodevelopmental immaturity may be the common underlying antecedent of both linguistic impairment and psychiatric disorder.

Empirical classification of speech/language impairment in children. I. Identification of speech/language categories.

Cluster analysis was employed to classify speech/language impairment in a sample of 347 children 5 years of age. Based on scores on a variety of speech and language tests, four groups of children with similar linguistic profiles were identified. These groups were labeled high overall, low overall, poor auditory comprehension, and poor articulation. Differences among these groups according to cognitive, developmental, demographic, and audiometry variables were examined. The low overall group was most disadvantaged on all measures, the high overall group was most advantaged, and the poor articulation and poor auditory comprehension groups were intermediate. The implications of these findings for the development of a theory of the relationship between speech/language and psychiatric disorders are discussed.

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.

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

OBJECTIVE: This study examined the 7-year outcome of speech/language (S/L) impaired and control children selected from a community sample at age 5 years. METHOD: Two hundred fifteen children completed a variety of speech and language tests at age 12 years. Children with S/L impairment were further classified as "speech only," "language only," or "speech and language impaired." RESULTS: More than 72% of children who had S/L impairment at age 5 remained impaired at age 12. Children with both speech and language problems were most likely to remain S/L impaired; 81% had some kind of S/L impairment at follow-up. Similarly, children with both expressive and receptive language impairment were more likely to show expressive or receptive impairment at follow-up than children with expressive impairment alone. One third of time 1 controls had S/L problems at follow-up, and of these 82% had speech impairment only. CONCLUSIONS: S/L impairment identified at age 5 has long-lasting effects. More pervasive problems were associated with poorer outcomes. Screening at age 5 may be useful, as most serious S/L problems that emerged by middle childhood could be identified at age 5. The effects of S/L treatment require further study.

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

OBJECTIVE: To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. METHOD: In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. RESULTS: Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. CONCLUSIONS: Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.

Speech and language impairment and psychiatric risk. Toward a model of neurodevelopmental immaturity.

This article examines the relationship between speech and language impairment and psychiatric disorders in children. Recent research on the prevalence and correlates of speech and language impairment is reviewed. The natural history and classification of speech and language impairment is explored and the implications for clinical practice, theory, and research are discussed.

Childhood schizophrenia. A review and comparison with adult-onset schizophrenia.

Childhood schizophrenia versus childhood autism and the phenomenology, epidemiology, and premorbid characteristics of childhood schizophrenia are reviewed, as well as pregnancy and birth complications, electroencephalographic studies, biochemistry, and genetic factors of this disorder. Treatment considerations and follow-up studies are outlined.

The continuum of linguistic dysfunction from pervasive developmental disorders to dyslexia.

This article examines speech and language impairment in relation to several common childhood psychiatric disorders. Similarities among disorders can be found in the associated language impairments, family histories, and certain language outcomes. The article describes prevalence surveys of speech and language disorders and the correlates of language impairment, such as IQ, socioeconomic status, and birth order. The association between language impairment and childhood psychiatric disorders (i.e., hyperactivity, autism) is investigated, and the outcomes of language impairment are discussed. Finally, the hypothesis that a common underlying neurolinguistic diathesis may be present for certain subgroups of psychiatrically disordered children is presented. In some groups, psychiatric disorder (i.e., hyperactivity) and linguistic impairment may develop in parallel as a function of an underlying neurodevelopmental immaturity. The relation between the linguistic impairment and neurodevelopmental immaturity requires clarification so as to disentangle their specific associations with the various disorders discussed.

Disorders of language, communication, and behavior in mentally retarded children. Some ideas on their co-occurrence.

The thesis of this article is that deficits in language and communication contribute to behavior problems in childhood. Mentally retarded children show a range of deficits in language and communication compared with normals; they are also at increased risk for behavior problems. The evidence suggests that these deficits are quantitative rather than qualitative. In addition, these linguistic deficits may contribute independently to the development of behavior disorders insofar as the linguistic deficit interferes with the child's ability to make himself understood or to understand others.

Psychiatric risk in children with speech and language disorders.

Based on an initial community sample of 1,655 5-year-old children, this report utilized the risk statistic to estimate a child's risk for developing a psychiatric disturbance depending on his or her status as speech/language-impaired. Results showed that risk estimates varied as a function of gender and source of information (teacher, parent, psychiatric reports). Overall, speech- and language-impaired children had a higher risk for developing a psychiatric disturbance compared with normal language controls, with speech/language-impaired girls being at greater risk than boys.

Child psychiatry, public health policy, and the aggregate burden of suffering.

We review the parameters for calculating the costs of illness and suggest a framework for understanding how these may apply to various psychiatric disorders of childhood. The costs of childhood psychiatric disorders can best be understood by looking at the prevalence of a given disorder, its duration and severity, whether it be episodic or stable, and how it impacts on the individual, family and community at large. These factors contribute to the "aggregate burden of suffering" associated with any given disorder.

A review of the short-term effects of child sexual abuse.

This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.

A review of the long-term effects of child sexual abuse.

The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.

Local norming of the test of adolescent/adult language-3 in the Ottawa Speech and Language Study.

The young adult norms for the Test of Adolescent/Adult Language-3 (TOAL-3; D. Hammill et al., 1994) are based only on individuals who pursued postsecondary education, a restriction that renders the norms inappropriate for many clinical and research purposes. This research note details the rationale, methods, and results of a local norming of the TOAL-3 spoken language subtests, based on participants from the Ottawa Speech and Language Study (C. J. Johnson et al., 1999). The resulting Ottawa norms represent the full range of young adult language abilities and, therefore, can be used with caution for some clinical and research purposes.

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.

Substance use disorders in young adults with and without LD: predictive and concurrent relationships.

This article reports on young people with and without learning disabilities (LD) and substance use disorders (SUD). Participants were assessed for LD at ages 12 and 19 and for SUD and psychiatric disorders at age 19. Participants with LD at ages 12 and 19 were more likely to develop an SUD or a psychiatric disorder compared to participants without consistent LD. Participants with LD at age 19 were more likely to have a concurrent SUD or psychiatric disorder compared to those without LD at age 19, while participants with LD at age 12 showed only a trend toward increased rates of SUD at age 19 when compared to participants without LD at age 12. Participants with and without LD did not differ in substance use, consumption levels, or onset history. In a multivariate model, adolescent LD was associated with a three-fold increased risk for SUD after behavioral problems and family structure had entered the model. Although these results provide some support for the notion that adolescents with LD are at increased risk for SUD, LD also appears to confer a general risk for adverse outcomes.