Unsuspected language impairment in psychiatrically disturbed children: prevalence and language and behavioral characteristics.

OBJECTIVE: This study examined the prevalence of unsuspected language impairments in 4-12-year-old psychiatric outpatients. METHOD: Children (N = 399) were routinely screened with standardized language tests, and parents and teachers completed behavioral checklists. RESULTS: Results indicated that of 288 children referred solely for a psychiatric disorder, 99 (34.4%) had a language impairment that had not been suspected previously. These children had more subtle language impairments than did the 111 children referred with previously identified language impairments. Both children with unsuspected and previously identified language impairments had symptoms associated with attention-deficit hyperactivity disorder. Children with unsuspected language impairments had the most serious externalizing behavioral problems. CONCLUSIONS: Attention needs to be paid to screening children for language impairments and to helping adults understand how language disabilities impact on communication and behavior.

Language, achievement, and cognitive processing in psychiatrically disturbed children with previously identified and unsuspected language impairments.

This study examined the language, achievement, and cognitive characteristics of 380 children, aged 7 to 14 years, consecutively referred to child psychiatric services. Among those children referred solely for psychiatric problems, 40% had a language impairment that had never been suspected. Children with previously identified and unsuspected language impairments were similar with respect to receptive and expressive language and on measures of cognitive processing. Although both groups of children with language impairments exhibited poorer academic achievement than children with normal language, children with previously identified language impairments had the lowest achievement. The milder achievement problems of children with unsuspected language impairment may explain why their problems had not been suspected. Both the clinical and theoretical implications of the findings are discussed. Heightened awareness concerning the high frequency of language impairment and other cognitive processing problems in children referred for psychiatric assessment and treatment should lead to more systematic examination of language functioning and evaluation of the impact of language and communication functioning on therapeutic outcomes.

The interface between ADHD and language impairment: an examination of language, achievement, and cognitive processing.

Language impairments are commonly observed among children referred for psychiatric services. The most frequent psychiatric diagnosis of children with language impairment (LI) is Attention Deficit Hyperactivity Disorder (ADHD). It is not clear whether there are differences between children with ADHD and comorbid LI and children with other psychiatric disorders who are also comorbid for LI. In the present study the language, achievement, and cognitive processing characteristics of 166 psychiatrically referred 7-14-year-old children were examined using a 2 x 2 (ADHD, LI) design to examine four groups: children with ADHD + LI, children with ADHD who have normally developing language, children with psychiatric diagnoses other than ADHD with a language impairment (OPD + LI) or without a LI (OPD). Results indicated that children with LI were at the most disadvantage regardless of the nature of the psychiatric diagnosis. Contrary to prediction, working memory measures, used to tap the core cognitive deficit of ADHD in executive functions, were more closely associated with LI than with ADHD. It was concluded that caution must be exercised in attributing to children with ADHD what might be a reflection of problems for children with language impairment generally. As most therapies are verbally based it is notable that language competence is rarely evaluated systematically before such therapies are undertaken.

Language, social cognitive processing, and behavioral characteristics of psychiatrically disturbed children with previously identified and unsuspected language impairments.

This study examined characteristics of social cognitive processing, psychiatric disorder, and behavioral ratings of 380 children aged 7 to 14 years who had been referred consecutively for child psychiatric services with identified and unsuspected language impairments and with normally developing language. The results indicated that children with language impairments generally exhibited greater deficits in social cognitive processing, and particularly emotion decoding and social problem solving, than children who have language that is developing normally. Differences in psychiatric diagnosis and behavior problems were observed only between children with previously identified language impairments and children with normally developing language; children with previously identified language impairments were more likely to be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) and to be rated by both parents and teachers as having more severe attentional problems. In addition, teachers rated them as more socially withdrawn. The results suggest that it is important to incorporate measures of both social cognition and language functioning routinely into clinical assessment, something that currently is rarely done.