Title: Examining the Association Between Language Delay and BehavioralEmotional Problems in Children Under
1Examining the Association Between Language Delay
and Behavioral/Emotional Problems in Children
Under Age 3
- Leslie Rescorla
- Professor of PsychologyBryn Mawr College
- ASHA, 2007
- rescorl_at_brynmawr.edu
2Association Between Language Delay and Behavior
Problems in Children gt Age 5
- For children gt age 5
- Language problems are often comorbid with other
problems (Cohen, 2001) - About 50 of children in mental health clinics
have a language impairment - About 50 of children in speech/language clinics
have a behavioral or emotional disorder
3Association Between Language Delay and Behavior
Problems in Children Age 3
- For children age 3
- A link between language delay and behavior
problems was found in the Dunedin (Silva, 1980)
and London (Stevenson Richman, 1978) general
population samples - However, these associations were reduced when
children with low IQ and/or neurodevelopmental
delays were excluded
4Association Between Language Delay and Behavior
Problems in Children lt Age 3
- Results with children lt 3 years are mixed
- Seven studies have used the Language Development
Survey (LDS) and the Child Behavior Checklist
(CBCL/1.5-5) - 4 from general population samples
- 3 from clinic samples
- Will present these 7 studies in some depth, after
summarizing findings from six other studies that
used various other measures
5Recruited Late Talker Sample (1)
- Caulfield, Fischel, DeBaryshe, Whitehurst
(1989) recruited 34 late talkers (LTs) - LTs were compared with typically developing (TD)
peers matched on age, gender, SES, and receptive
language - On Eyberg Behavior Inventory and an interview,
mothers of LTs reported more shyness and more
bedtime problems than mothers of peers - LTs were more resistant and difficult than peers
in lab clean up situation
6Recruited Late Talker Sample (2)
- Paul, Spangle-Looney Dahm (1991) recruited 21
LTs - 29 of the LTs had receptive language delay as
well as expressive language delay - LTs were compared with peers matched on age,
gender, and SES - 62 of LTs had socialization delays on the
Vineland Adaptive Behavior Scale - At follow-up 12 to 18 months later, about 50 of
the LTs still had socialization delays on the
Vineland
7Urban General Population Sample (3)
- Horwitz et al. (2003) identified LTs with the CDI
- 15, 18, and 28 scored lt 10th percentile on
the CDI in 24-29, 30-35, 36-39 month groups (N
639) - LTs scored lower than TDs on Infant-Toddler
Social-Emotional Assessment (ITSEA) Competence
but not higher on Internalizing or Dysregulation - 30-39 group had higher Externalizing scores (OR
4.2) - ITSEA problem scores did not predict language
delay in logistic regression analysis - Low ITSEA Competence ( attention, compliance,
imitation/play, mastery motivation, empathy,
prosocial peer relations) significantly predicted
language delay in logistic regression (OR 3.2)
8Early Intervention Sample (4)
- Irwin, Carter, Briggs-Gowan (2002) recruited a
sample of 14 LTs from an Early Intervention
program - LTs were matched with 14 TD children from a
general population sample on age, sex, and
ethnicity - LTs had higher scores than TDs on ITSEA
Depression/Withdrawal and Social Relatedness - LTs also scored higher than TD children on CBCL
Withdrawn - Fitzgerald (2003) suggests LTs included some
children with PDD, although procedures to exclude
children with PDD were described by Irwin et al.
9General Population Twin Sample (5)
- Plomin et al. (2002) study with 4,000 twin pairs
- Correlations between CDI score and Rutter Total
Problems at 2 -.05 for both genders, at 3
-.13 (B) -.09 (G) - Correlations with nonverbal ability and Total
Problems at 2 -15 (B) -.10 (G), at 3 -25
(B) -.22 (G) - rs also low between CDI and TP for those scoring
lt10th percentile on CDI (.10 at 2, .20 at 3) - At 2, those scoring lt10th percentile on CDI
scored lt .20 SDs above the mean on Total Problems - At 3, those scoring lt10th percentile on CDI
scored about .30 above the mean on Total Problems
10Early Intervention Clinic Sample (6)
- Ross Weinberg (2006) studied 109 children age
18 to 36 months evaluated in an Early
Intervention clinic - Children with both receptive and expressive
language delays on PLS-3 had lower scores on
Bayley Rating Scale Orientation/Engagement and
Emotional/Regulation factors than children with
expressive delay only or with normal language - Children with mixed language delays also had
significantly more neurodevelopmental delays - Both mixed and expressive language delayed groups
scored lower than TD children on the Vineland
Socialization scale
11Summary of the Six Studies
- Associations between language delay and
behavioral/emotional problems in children lt 3 are
generally modest, if significant at all - Both internalizing and externalizing problems
have shown some association with language delay - Associations between language delay and behavior
problems increase as children approach age 3 - Associations may be stronger between language
delay and measures of socialization and adaptive
behavior than measures of behavior problems - Selection factors may increase association
between language delay and behavior problems in
recruited LT samples, due to Berksons bias. - Next, review seven LDS/CBCL studies
12Language Development Survey
- Language Development Survey (LDS)
- checklist completed by parents of children 18-35
months - 310 vocabulary words arranged by semantic
category - vocabulary score sum of words reported to be
used by child spontaneously (not imitated or
comprehended only). - Does child combine words into phrases?
- If yes, parent writes in childs five longest
best phrases - mean number of words calculated for the five
phrases - LDS norms
- Vocabulary score norms - separately by gender for
18-23, 24-29, and 30-35 months age groups - Mean length of phrases norms - for 24-29 30-35
months age groups with genders combined
13(No Transcript)
14(No Transcript)
15Psychometric Properties of LDS
- Reliability
- Test-retest reliability .97-.99
- Cronbachs alpha .99
- Validity
- Correlations with expressive language tests
.66-.87 - Sensitivity generally gt80, specificity gt 85
- Predictive validity from age 2 (Rescorla, 2002)
(N59) - age 7 vocabulary .63
- age 8 grammar .41
- age 8 age 9 reading .39 .34
16Assessment of Behavioral and Emotional Problems
- CBCL/1.5 - 5 and C-TRF
- 99 problem items (0, 1, 2 scale) (not true,
somewhat or sometimes true, very true or often
true) - write in concerns and best things about the child
- normed in general population sample
- forms yield scores on empirically based
syndromes, DSM-oriented scales, and
Internalizing, Externalizing, and Total Problems
17(No Transcript)
18Syndromes for Preschool Forms
- Emotionally Reactive
- Anxious/Depressed
- Somatic Complaints
- Withdrawn
- Attention Problems
- Aggressive Behavior
- Sleep Problems (CBCL only)
19DSM-Oriented Scales for Preschool Forms
- Affective Problems
- Anxiety Problems
- Pervasive Developmental Problems
- Attention Deficit/Hyperactivity Problems
- Oppositional Defiant Problems
20(No Transcript)
21(No Transcript)
22Psychometric Properties of the CBCL/1.5-5
- Reliability
- test-retest mean r .85 (.68 to .90 across
scales) - internal consistency alphas .89 to .95 for INT,
EXT, TP range from .63 to .92 for syndromes and
DSM-oriented scales - Validity
- Demographically-matched referred and nonreferred
samples (N 563, per group) differed
significantly on all CBCL scales and items - ES 22 for Total Problems, 20 for INT, 8 for
EXT
23(No Transcript)
24(No Transcript)
25LDS/CBCL Studies in General Population Samples (1)
- Carson et al. (1998)
- LTs (N 17) and TD peers (N 47) who were
identified using the LDS in a mail-based
screening in Wyoming were seen for assessment - LTs had higher CBCL Total Problems, Sleep
Problems, and Other Problems scores than TD peers - But only 38 of possible LTs invited to
participate came in for the evaluation which
suggests a selection bias favoring children with
more problems
26LDS/CBCL Studies in General Population Samples (2)
- Rescorla Alley (2001)
- Assessed 33 LTs identified with the LDS in a
household screening (80 yield rate), plus 33
matched TD toddlers with normal language - LT and TD groups differed greatly on LDS
Vocabulary (29 vs. 196 words) at screening and at
assessment about 1 month later (43 vs. 230 words) - Large group differences on Bayley, Reynell, and
Vineland Adaptive Behavior score (93 vs. 110) - No group differences on CBCL Total Problems
27LDS/CBCL Studies in General Population Samples (3)
- Rescorla Achenbach (2002)
- Used LDS and CBCL data for 278 children in
national survey (18-23, 24-29, 30-35 months) - Vocabulary and Mean Phrase Length scores not
correlated with any CBCL scores (22 tests, p lt
.001) - For ages 24 to 35 months, 15 had fewer than 50
words or no combinations and 19 had CBCL TP
scores gt 60 (borderline clinical range) - No significant association between LDS delay and
CBCL deviance (only 6/172 deviant on both - 3) - None of 9 referred kids were deviant on both
28LDS/CBCL Studies in General Population Samples (4)
- Zubrick Western Australia household survey
- 900 children 24 to 25 months screened with LDS
and CBCL/1-5-5 - 11 had fewer than 50 words VOC Delay
- 10 had no combinations COMB Delay
- 20 had fewer than 50 words OR no combinations
LDS delay (lack of overlap between vocabulary and
combinations unusual) - deviant on TP, INT, and Ext gt 84th ile
- deviant on Withdrawn gt 93rd ile
29Zubrick Results
- LDS Vocabulary score not significantly correlated
with any CBCL/1/5-5 scores - Children with VOC Delay did not have higher
scores on any CBCL problem scale - Children with COMB Delay and LDS Delay had higher
scores on Withdrawn (only CBCL scale with a
significant difference) - LDS Delay not significantly associated with
deviance on TP, INT, or EXT - Association with deviance on Withdrawn was modest
(r .09) but significant (p lt .01)
30LDS/CBCL Studies in Clinics New Jersey Sample
(5)
- Sample of 83 children age 18 to 35 months
- Study 1 in Rescorla, Ross, McClure (2007)
- Children being assessed for developmental
problems or as part of NICU follow-up - 64 of the sample were delayed on the LDS (lt15th
percentile on Vocabulary or lt 20th percentile on
Mean Phrase Length) - Mean Total Problems score 54.44 17 scored
gt 84th percentile on TP ( deviant) - 31 scored gt 93rd percentile on DSM-Pervasive
Developmental Problems (PDP) scale
31New Jersey Sample Results
- Correlational results with Vocabulary SS
- Significant rs with CBCL Total Problems (-.38),
Internalizing (-.44), Emotionally Reactive
(-.24), and Withdrawn (-.56) - BUT with children deviant on PDP excluded, only
Withdrawn still significant (r - .42) - Cross-tabulation of deviance on LDS/CBCL
- Only 21 of children with language delay on LDS
were deviant on TP not significant - But 79 of those deviant on TP had delayed
language on LDS
32LDS/CBCL Studies in Clinics New York Sample (6)
- Sample of 103 children age 18 to 35 months
- Study 2 in Rescorla, Ross, McClure (2007)
- Essentially the same sample as Ross Weinberg
(2006) Early Intervention clinic study - 7 were diagnosed with PDD, 47 had Bayley MDI
scores lt75, and 30 were born premature - 56 were delayed in vocabulary on the LDS
- 66 were language-delayed based on delay in
either vocabulary or mean phrase length - Mean CBCL Total problems scores 48.53, 16 to
17 scored in deviant range (gt 84th percentile)
33New York Sample Results
- Correlational results with Vocabulary SS
- The only significant LDS/CBCL association was
with Withdrawn (r - .20, p lt .05) - The other 9 correlations ranged from -.09 to .08
- Cross-tabulation of deviance on LDS/CBCL
- No significant associations between delay on LDS
and deviance on Total Problems, INT, or EXT (phi
coefficients .07 to .11) - Only 17 of children with language delay on LDS
were deviant on INT
34LDS/CBCL Studies in Clinics Referred Manual
Sample (7)
- Sample of 102 children age 18 to 35 months
- Children assessed in various developmental and
mental health clinics - Referred children lt 3 years of age from referred
sample in CBCL/1.5-5 manual - Significant rs between LDS Vocabulary and
Withdrawn, Attention Problems, Other,
Internalizing, Total Problems, DSM-Affective, and
DSM-PDP scales (p lt .01, rs .25 to .35)
35Referred Manual Sample (II)
- Cross-tabulation of delay on LDS with deviance on
CBCL problem scores - Significant ?2 associations (p lt .01) for
Withdrawn (OR 4.8), Internalizing (OR 3.9),
and Total Problems (OR 3.7) - Comorbid percentages
- delayed on LDS also deviant on CBCL
- TP 52 and INT 58 (T 60)
- WITH 27 (T 65)
- deviant on CBCL also delayed on LDS
- TP 47 and INT 44 (T 60)
- WITH 36 (T 65)
36Conclusions Association Between Language Delay
and BehaviorProblems in Children lt Age 3
- General population samples
- Language delay on the LDS and deviance on the
CBCL are not generally associated - Clinical samples
- More association between language delay on the
LDS and deviance on the CBCL - Most consistent association is for Withdrawn
- Degree of association varies with type of clinic
and composition of sample
37Conclusions and Implications
- Main conclusions
- Many children lt3 with language delays have normal
behavioral/emotional adjustment - Many children lt3 with behavioral/emotional
maladjustment have normal language development - Children with both language delay and
maladjustment are likely to have low IQs, high
family risk, low SES, or PDD spectrum problems - Most common problem associated with language
delay is social withdrawal - Children under age 3 with language delay tend to
have delays in adaptive behavior/socialization
38Explanatory Speculations
- Insofar as behavioral/emotional problems are a
consequence of language delay - it may take time for the negative effects of
language delay to produce behavior problems - the negative effects of language delay may
increase when children move into group settings
where they have to interact more with peers - Insofar as language delay and behavior problems
arise from shared genetic or environmental
factors - the emergence of language delay may precede the
emergence of behavioral/emotional problems
39Questions for Further Research
- Longitudinal studies are needed to examine the
association between language delay and
behavioral/emotional problems - Do LT toddlers develop more behavioral or
emotional maladjustment as they get older? - Do LTs in day care settings develop behavioral
problems earlier than LTs cared for at home? - Do LTs with normal receptive language have less
maladjustment than LTs with mixed delays? - Do IQ and/or SES moderate the link between
language delay and behavior problems? - What interventions can forestall development of
behavior problems in children with language
delay?