Relationships between language impairment, temperament, behavioural adjustment and maternal factors in a community sample of preschool children.

BACKGROUND: Relationships between child language development and temperament have been little studied in young children, although it is known that children with language impairment are at risk in a number of domains of psychosocial development involving temperamental influences. AIMS: To investigate the relationships between temperament and language development, along with child behavioural adjustment and maternal psychosocial factors. METHODS & PROCEDURES: A sample of 4-year-old children with language impairment was compared with typically developing children, from a large community cohort in a longitudinal study, on three temperament dimensions, behavioural and emotional problems, and maternal factors. Participants were part of a large community cohort involved in a longitudinal study. OUTCOMES & RESULTS: While the groups did not differ significantly on temperamental shyness/sociability, children with language impairment showed more negative dispositions on the persistence/self-regulation factor, and on overall temperamental difficultness. Behavioural problems were elevated in the language impairment group and were associated with temperament in both groups. Maternal measures of education level, reading and vocabulary skills were significantly lower in the language impairment group. CONCLUSIONS & IMPLICATIONS: Generally the language impairment group showed a constellation of developmental disadvantages which add to the existing developmental vulnerability conferred by the presence of language impairment. Poorer child temperament self-regulation and behavioural adjustment are strong risk factors for school learning, while lower mother education and literacy contribute further disadvantage. Clinicians managing language impairment in children need to be aware of the whole package of risk factors which are common in this population.

Changing cultures: enhancing mental health and wellbeing of refugee young people through education and training.

Many refugee people and others entering Australia under the Humanitarian Program, have experienced extremely stressful and disrupted lives prior to arrival. A major difficulty experienced by a significant number of refugee young people is their lack of formal education before arrival. It directly affects their ability to start connecting to their new society and constructing a new life. The level of ease with which young people can move into the education and training system and begin to establish a meaningful career pathway has a huge impact on their successful settlement and stable mental health. This paper describes the Changing Cultures Project, a three-year project, which explored models of appropriate and accessible education and training for refugee and newly arrived young people that would enhance their mental health. The Changing Cultures Project was a partnership between the education, health and settlement sectors. This paper describes the program and system response to the health, settlement, education and vocational issues facing refugee young people using a mental health promotion framework and reflective practice. We discuss how the refugee youth programs met a broad range of needs as well as providing language, literacy and basic education to newly arrived young people. While working in an environment of changing policy and public opinion regarding refugee issues, the Project delivered successful outcomes at the program and organisational levels for refugee young people by addressing issues of program development and delivery, organisational development and capacity building and community development and evaluation.

Language Outcomes at 7 Years: Early Predictors and Co-Occurring Difficulties.

OBJECTIVE: To examine at 7 years the language abilities of children, the salience of early life factors and language scores as predictors of language outcome, and co-occurring difficulties METHODS: A longitudinal cohort study of 1910 infants recruited at age 8 to 10 months. Exposures included early life factors (sex, prematurity, birth weight/order, twin birth, socioeconomic status, non-English speaking background,family history of speech/language difficulties); maternal factors (mental health, vocabulary, education, and age); and child language ability at 2 and 4 years. Outcomes were 7-year standardized receptive or expressive language scores (low language: ≥1.25 SD below the mean), and co-occurring difficulties (autism, literacy, social, emotional, and behavioral adjustment, and health-related quality of life). RESULTS: Almost 19% of children (22/1204;18.9%) met criteria for low language at 7 years. Early life factors explained 9-13% of variation in language scores, increasing to 39-58% when child language scores at ages 2 and 4 were included. Early life factors moderately discriminated between children with and without low language (area under the curve: 0.68-0.72), strengthening to good discrimination with language scores at ages 2 and 4 (area under the curve: 0.85-0.94). Low language at age 7 was associated with concurrent difficulties in literacy, social-emotional and behavioral difficulties, and limitations in school and psychosocial functioning. CONCLUSIONS: Child language ability at 4 years more accurately predicted low language at 7 than a range of early child, family, and environmental factors. Low language at 7 years was associated with a higher prevalence of co-occurring difficulties.

Levers for Language Growth: Characteristics and Predictors of Language Trajectories between 4 and 7 Years.

BACKGROUND: Evidence is required as to when and where to focus resources to achieve the greatest gains for children's language development. Key to these decisions is the understanding of individual differences in children's language trajectories and the predictors of those differences. To determine optimal timing we must understand if and when children's relative language abilities become fixed. To determine where to focus effort we must identify mutable factors, that is those with the potential to be changed through interventions, which are associated with significant differences in children's language scores and rate of progress. METHODS: Uniquely this study examined individual differences in language growth trajectories in a population sample of children between 4 and 7 years using the multilevel model for change. The influence of predictors, grouped with respect to their mutability and their proximity to the child (least-mutable, mutable-distal, mutable-proximal), were estimated. RESULTS: A significant degree of variability in rate of progress between 4 and 7 years was evident, much of which was systematically associated with mutable-proximal factors, that is, those factors with evidence that they are modifiable through interventions with the child or family, such as shared book reading, TV viewing and number of books in the home. Mutable-distal factors, such as family income, family literacy and neighbourhood disadvantage, hypothesised to be modifiable through social policy, were important predictors of language abilities at 4 years. CONCLUSIONS: Potential levers for language interventions lie in the child's home learning environment from birth to age 4. However, the role of a family's material and cultural capital must not be ignored, nor should the potential for growth into the school years. Early Years services should acknowledge the effects of multiple, cascading and cumulative risks and seek to promote child language development through the aggregation of marginal gains in the pre-school years and beyond.

Natural history of stuttering to 4 years of age: a prospective community-based study.

OBJECTIVES: To document the natural history of stuttering by age 4 years, including (1) cumulative incidence of onset, (2) 12-month recovery status, (3) predictors of stuttering onset and recovery, and (4) potential comorbidities. The study cohort was a prospective community-ascertained cohort (the Early Language in Victoria Study) from Melbourne, Australia, of 4-year-old children (n = 1619; recruited at age 8 months) and their mothers. METHODS: Outcome was stuttering onset by age 4 years and recovery within 12 months of onset, defined using concurrent monthly parent and speech pathologist ratings. Potential predictors: child gender, birth weight, birth order, prematurity, and twinning; maternal mental health and education; socioeconomic status; and family history of stuttering. Potential comorbidities: preonset and concurrent temperament, language, nonverbal cognition, and health-related quality of life. RESULTS: By age 4 years, the cumulative incidence of stuttering onset was 11.2% (95% confidence interval [CI]: 9.7% to 12.8%). Higher maternal education (P = .004), male gender (P = .02), and twinning (P = .005) predicted stuttering onset. At outcome, stuttering children had stronger language (mean [SD]: 105.0 [13.0] vs 99.6 [14.6]; mean difference 5.5, 95% CI: 3.1 to 7.8; P < .001) and nonverbal cognition (mean [SD]: 106.5 [11.4] vs 103.9 [13.7], mean difference 2.6, 95% CI: 0.4 to 4.8; P = .02) and better health-related quality of life but were otherwise similar to their nonstuttering peers. Only 9 of 142 children (6.3%; 95% CI: 2.9% to 11.7%) recovered within 12 months of onset. CONCLUSIONS: Although stuttering onset is common in preschoolers, adverse affects are not the norm in the first year after onset.

Early indicators of autism spectrum disorders at 12 and 24 months of age: a prospective, longitudinal comparative study.

Prospective questionnaire data from a longitudinal population sample on children with autism spectrum disorders (ASD), developmental delay, specific language impairment, or typical development (TD), were collected at ages eight, 12 and 24 months, via the Communication and Symbolic Behavior Scale Developmental Profile (CSBS) - Infant Toddler Checklist, and the Actions and Gesture section of the MacArthur-Bates Communicative Development Inventory (CDI):Words and Gestures. The four groups were compared at four years of age to identify whether any early behaviours differentiated the groups. While children with ASD differed from TD children on most social communicative measures by 12 months of age, the only social communication characteristic which could differentiate the children with ASD from the other groups were gesture scores on the CDI at 12 months and the CSBS at 24 months. Significant markers of ASD were identifiable in this community sample at an early age, although discrimination between clinical groups was rarely evident.

Predicting language outcomes at 4 years of age: findings from Early Language in Victoria Study.

OBJECTIVE: To quantify the contributions of child, family, and environmental predictors to language ability at 4 years. METHODS: A longitudinal study was performed with a sample of 1910 infants recruited at 8 months in Melbourne, Australia. Predictors were child gender, prematurity, birth weight and order, multiple birth, socioeconomic status, maternal mental health, vocabulary, education, and age at child's birth, non-English-speaking background, and family history of speech/language difficulties. Outcomes were Clinical Evaluation of Language Fundamentals-Preschool, language scores, low language status (scores >1.25 SDs below the mean), and specific language impairment (SLI) (scores >1.25 SDs below the mean for children with normal nonverbal performance). RESULTS: A total of 1596 children provided outcome data. Twelve baseline predictors explained 18.9% and 20.9% of the variation in receptive and expressive scores, respectively, increasing to 23.6% and 30.4% with the addition of late talking status at age 2. A total of 20.6% of children (324 of 1573 children) met the criteria for low language status and 17.2% (251 of 1462 children) for SLI. Family history of speech/language problems and low maternal education levels and socioeconomic status predicted adverse language outcomes. The combined predictors discriminated only moderately between children with and without low language levels or SLIs (area under the curve: 0.72-0.76); this improved with the addition of late talking status (area under the curve: 0.78-0.84). CONCLUSIONS: Measures of social disadvantage helped explain more variation in outcomes at 4 years than at 2 years, but ability to predict low language status and SLI status remained limited.

Predicting stuttering onset by the age of 3 years: a prospective, community cohort study.

OBJECTIVES: Our goals were to document (1) the onset of stuttering and (2) whether specific child, family, or environmental factors predict stuttering onset in children aged up to 3 years. METHODS: Participants included a community-ascertained cohort of 1619 2-year-old Australian children recruited at 8 months of age to study the longitudinal development of early language. The main outcome measure was parental telephone report of stuttering onset, verified by face-to-face expert diagnosis. Preonset continuous measures of the child's temperament (approach/withdrawal) and language development were available. Information on a range of predictor measures hypothesized to be associated with stuttering onset was obtained (maternal mental health and education levels, gender, premature birth status, birth weight, birth order, twinning, socioeconomic status, family history of stuttering). RESULTS: By 3 years of age, the cumulative incidence of stuttering onset was 8.5%. Onset often occurred suddenly over 1 to 3 days (49.6%) and involved the use of word combinations (97.1%). Children who stuttered were not more shy or withdrawn. Male gender, twin birth status, higher vocabulary scores at 2 years of age, and high maternal education were associated with stuttering onset. The multivariable model, however, had low predictive strength; just 3.7% of the total variation in stuttering onset was accounted for. CONCLUSIONS: The cumulative incidence of stuttering onset was much higher than reported previously. The hypothesized risk factors for stuttering onset together explained little of the variation in stuttering onset up to 3 years of age. Early onset was not associated with language delay, social and environmental factors, or preonset shyness/withdrawal. Health professionals can reassure parents that onset is not unusual up to 3 years of age and seems to be associated with rapid growth in language development.

Influences on communicative development at 24 months of age: child temperament, behaviour problems, and maternal factors.

Within a longitudinal study using a large representative, community sample of infants recruited at mean age 8 months, we examined influences on infant communication development at 24 months, including child gender, shy temperament, behavioural and emotional problems, and several variables relating to maternal psychosocial health. On most developmental measures girls were in advance of boys and they also showed shyer temperament. Child gender, shy temperament and maternal psychosocial indices were associated with both vocabulary development as measured by the MacArthur-Bates Communicative Development Inventory (CDI), and communication and symbolic development assessed via the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS) at 24 months. No prediction was found using scores at 8 or 12 months, although moderate stability between measures between 12 and 24 months was evident. Predictors of 24 month outcomes were all concurrently measured variables, and included temperamental shyness, but very little variance in communication outcomes was explained. Children whose mothers were experiencing clinical levels of depression and life difficulties reported more child behavioural problems.

Mortality in young offenders: retrospective cohort study.

OBJECTIVES: To estimate overall and cause specific standardised mortality ratios in young offenders. DESIGN: Comparison of mortality data in cohort of young offenders. SETTINGS: State of Victoria, Australia. SUBJECTS: Cohort of young offenders aged 10-20 years with a first custodial sentence from 1 January 1988 to 31 December 1999. MAIN OUTCOME MEASURES: Deaths ascertained by matching with the national death index, a database containing records of all deaths in Australia since 1980. Death rates in the reference Victorian population used to calculate standardised mortality ratios. RESULTS: The offender cohort comprised 2621 men and 228 women with 11 333 person years of observation. The median age of first detention was 17.9 years for men and 18.4 years for women. Median follow up was 3.3 years for men and 1.4 years for women. Overall standardised mortality ratio adjusted for age (expressed as a ratio) was 9.4 (95% confidence interval 7.4 to 11.9) for men and 41.3 (20.2 to 84.7) for women. Cause specific standardised mortality ratios for men were 25.7 (17.9 to 36.9) for drug related causes, 9.2 (5.8 to 15) for suicide, and 5.7 (3.6 to 9.2) for non-intentional injury. A quarter of drug related deaths in men aged 15-19 years were in offenders. CONCLUSIONS: Social policies for young offenders should address both the prevalent drug and mental health problems as well the high levels of social disadvantage.

Predicting death in young offenders: a retrospective cohort study.

OBJECTIVE: To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services. DESIGN: A retrospective cohort of 2849 (2625 male) 11-20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified. MAIN OUTCOME MEASURES: Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records. RESULTS: The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0-1.9), repeat admissions (HR, 1.8; 95% CI, 1.1-2.9) and drug offences (HR, 1.5; 95% CI, 1.0-2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1-5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5-20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3-68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15-0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0-2.4). CONCLUSIONS: Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to reduce the mortality rate in this group.