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.     

Developmental,social and behavioral characteristics of speech and language disordered children

This paper reports on an epidemiological study of psychiatric disorder in children with speech and language disorders. Earlier preliminary analyses of data on the children presenting to a speech clinic suggested that these children are at risk for the development of psychiatric disorder. Data on a larger number of children is analyzed in the present paper, and particular attention is given to the developmental, demographic and linguistic factors which may play a role in the etiology of psychiatric disorder or communication disorder. The data confirms that communication disordered children are at risk for the development of psychiatric disorder, and indicates that adverse environmental conditions do not seem to be responsible for this risk. A subgroup of children who are at greatest risk is identified and described.     

Prevalence of psychiatric disorder: with and without psychosocial impairment

OBJECTIVE : To identify rates of psychiatric disorder in a representative sample of primary school children in a North of England city. METHOD : The study obtained multi-criterion screen data on a representative one-in-three sample of 7- and 8-year-old children in Newcastle upon Tyne. It also obtained psychiatric interview data for screen-positive and a proportion of screen negative children. In addition the clinically trained interviewers rated psychiatric impairment. RESULTS : Estimated rates of disorder with impairment, calibrated to be equivalent to that of children attending local child psychiatric clinics, were 1.2% for emotional disorder, 5.6% for disruptive behaviour disorder and 6.7% for any disorder. CONCLUSION : These findings are consistent with other contemporary studies using similar impairment criteria.     

Psychosocial functioning in prepubertal major depressive disorders. I. Interpersonal relationships during the depressive episode

Psychosocial environment and relationships with parents, peers, and siblings of 115 prepubertal children were measured by interview with their parent(s) for the three-month period preceding the assessment. The children had a current diagnosis of major depression (52 children) or nondepressed neurotic disorder (23) or were assessed to be normal (40). Most aspects of psychosocial relationships were found to be significantly impaired in the psychiatric groups. This impairment was generally worse in the depressives and significantly worse for aspects of verbal and affective communication with parents and siblings. Prepubertal children with major depressive disorder regularly present social relation deficits in which two components can be distinguished: one general to childhood psychiatric disorder and another specific to major depression.     

Psychiatric disorder in children with speech and language retardation. A critical review.

This article critically reviews the literature concerning psychiatric disorder in children with speech and language retardation. The data indicate that speech- and language-disordered children are at risk for psychiatric disorder, that there is some correlation between the presence of psychiatric disorder and the type of speech and language disturbance, and that there is a likely correlation between certain types of speech and language problems and the type of psychiatric difficulty. Firm conclusions in this area are hampered by many methodological difficulties. Finally, a review of the nature of the association between psychiatric disorder and speech and language retardation reveals that except in rare instances psychiatric disorder does not cause speech and language retardation, and that in most cases psychiatric disorder is indirectly caused by speech and language retardation.     

Clinical significance of childhood communication disorders: perspectives from a longitudinal study

A group of 202 children who were referred for evaluation of communication disorders were also evaluated for psychiatric and learning disorders at two points in time. High rates of both psychiatric and learning disorders were found at initial evaluation, and even higher rates were found at follow-up 3 to 4 years later. Recovery from communication disorder occurred in approximately one fourth of the cases and varied widely depending on the type of disorder involved. Poor psychiatric outcome could be predicted by the presence and severity of initial disorders of language comprehension and expression, and by certain environmental factors (such as psychosocial stress). The high prevalence of linguistic, psychiatric, and development disorders at follow-up for the children in this study suggests the need for close monitoring of children with early communication impairments.     

Diagnosis and treatment of psychiatric disorders in children with a schizophrenic parent

Many children of a schizophrenic parent may inherit a portion of the genetic risk factors for schizophrenia. The frequency of DSM-IV psychopathology in children of a schizophrenic parent and the frequency and type of mental health treatment accessed by these youths is not well understood. Twenty-eight adults with schizophrenia were identified and 43 of their 6--15 year old children recruited. Clinical diagnoses, based on a structured DSM-IV interview; severity of impairment, based on the Child Global Assessment Scale; and treatment histories were obtained. Seventy-four per cent of children-with-a-schizophrenic-parent met diagnostic criteria for a current Axis I psychiatric disorder. The most common diagnostic categories included attention deficit/hyperactivity disorder (40%), any anxiety disorder (23%), and any depressive disorder (12%). Psychosis was present in 9% of this childhood sample. Of those children with a psychiatric diagnosis, 47% demonstrated current moderate or severe impairment. Approximately half of the children had received mental health evaluations and 26% had experienced at least one psychiatric medication trial. Children-with-a-schizophrenic-parent have frequent, often impairing, psychiatric problems. Despite this high prevalence, mental health evaluation and treatment is of similar frequency and type to other at-risk populations. The effectiveness and appropriateness of standard treatments remain unstudied in children-with-a-schizophrenic-parent.     

Language in pediatric epilepsy

Purpose:   This study examined the severity and range of linguistic impairments in young, intermediate, and adolescent youth with epilepsy and how these deficits were associated with illness effects, nonverbal intelligence, psychopathology, and reading.
Methods:   Tests of language, intelligence, achievement, and structured psychiatric interviews were administered to 182 epilepsy youth, aged 6.3–8.1, 9.1–11.7, and 13.0–15.2 years, as well as to 102 age- and gender-matched normal children. Parents provided demographic, seizure-related, and behavioral information on their children.
Results:   Significantly more epilepsy subjects had language scores 1 standard deviation (SD) below average than the age-matched control groups did. The intermediate and adolescent epilepsy groups also had significantly lower mean language scores compared to their matched controls. The older compared to the younger epilepsy groups had more language impairment and a wider range of linguistic deficits. Longer duration of illness, childhood absence epilepsy, psychiatric diagnosis, and socioeconomic status were associated with linguistic deficits in the young group. Prolonged seizures, lower Performance IQ, and minority status predicted low language scores in the intermediate epilepsy group. In the adolescent group, language impairment was associated with poor seizure control, decreased Performance IQ, and lower socioeconomic status. Linguistic and reading deficits were significantly related in each epilepsy group.
Conclusions:   The age-related increase in linguistic impairment, different profiles of predictors in each age group, and the relationship of linguistic deficits with poor reading skills have important clinical, developmental, theoretical, and academic implications.     

Child abuse, psychiatric disorder, and running away in a community sample of women.

OBJECTIVE: Studies involving clinical samples of adolescents indicate that running away is a common problem associated with substantial emotional impairment, yet little information is available from community-based samples. This study aimed to investigate runaway behaviour in female adolescents with and without a history of maltreatment in childhood. METHOD: We analyzed data from a province-wide community survey conducted in Ontario (n = 3760 girls and women, aged 15 to 64 years). Respondents returned a self-completed questionnaire regarding their history of maltreatment as children. Psychiatric disorder was assessed with a revised version of the Composite International Diagnostic Interview. RESULTS: Respondents who reported physical abuse only, sexual abuse only, and physical abuse with sexual abuse were 2 to 4 times more likely to report running away from home before age 16 years. Parental psychiatric disorder, respondent psychiatric disorder, respondent age, and income were also significant correlates of running away. CONCLUSIONS: Understanding the relation between exposure to maltreatment as a child, psychiatric disorder, and running away in women is important for determining ways to prevent a behaviour that puts youth at high risk for a wide range of difficulties.     

Psychiatric disorders and behavioral problems in children with velocardiofacial syndrome: usefulness as phenotypic indicators of schizophrenia risk.

BACKGROUND: Velocardiofacial syndrome (VCFS), a genetic deletion condition with numerous cognitive sequelae, is associated with a high rate of psychiatric disorders in childhood. More recently, VCFS has been identified as a high-risk factor for developing adult onset schizophrenia. However, it has never been demonstrated that the childhood psychiatric disorders found in children with VCFS differ from those found in children with a similar degree of cognitive impairment. Identification of a specific behavioral (psychiatric) phenotype in childhood VCFS offers the potential for elucidating the symptomatic precursors of adult onset schizophrenia. METHODS: Twenty-eight children with VCFS and 29 age- and cognitively matched control subjects received a standardized assessment of childhood psychiatric disorders and behaviors measured by the Child Behavior Checklist (CBCL). Findings from the two groups were compared. RESULTS: The rates and types of psychiatric disorder and behavior problems in VCFS and cognitively matched control subjects were very high, but showed no significant differences. CONCLUSIONS: Psychopathology in children with VCFS may not differ from that found in cognitively matched control subjects. Another explanation is that subtle phenotypic differences in behavior found in VCFS can not be observed using standard symptom inventories. The high rate of psychopathology in children with VCFS is not a useful phenotypic indicator of high risk for adult onset schizophrenia.     

Childhood absence epilepsy: behavioral, cognitive, and linguistic comorbidities

Purpose: Evidence for a poor psychiatric, social, and vocational adult outcome in childhood absence epilepsy (CAE) suggests long‐term unmet mental health, social, and vocational needs. This cross‐sectional study examined behavioral/emotional, cognitive, and linguistic comorbidities as well as their correlates in children with CAE. Methods: Sixty‐nine CAE children aged 9.6 (SD = 2.49) years and 103 age‐ and gender‐matched normal children had semistructured psychiatric interviews, as well as cognitive and linguistic testing. Parents provided demographic, seizure‐related, and behavioral information on their children through a semi‐structured psychiatric interview and the child behavior checklist (CBCL). Results: Compared to the normal group, 25% of the CAE children had subtle cognitive deficits, 43% linguistic difficulties, 61% a psychiatric diagnosis, particularly attention deficit hyperactivity disorder (ADHD) and anxiety disorders, and 30% clinically relevant CBCL broad band scores. The most frequent CBCL narrow band factor scores in the clinical/borderline range were attention and somatic complaints, followed by social and thought problems. Duration of illness, seizure frequency, and antiepileptic drug (AED) treatment were related to the severity of the cognitive, linguistic, and psychiatric comorbidities. Only 23% of the CAE subjects had intervention for these problems. Conclusions: The high rate of impaired behavior, emotions, cognition, and language and low intervention rate should alert clinicians to the need for early identification and treatment of children with CAE, particularly those with longer duration of illness, uncontrolled seizures, and AED treatment.     

Mental health problems in children and adolescents referred to a national epilepsy center

This study aimed to investigate the occurrence of psychiatric morbidity in children and adolescents referred to a tertiary national epilepsy center (inpatient unit) and the extent of the unmet need for psychiatric services in this group. Participants were 74 children and adolescents aged 9-15 referred from February 2001 to October 2002 (67% response rate). The multi-informant (parent, teacher, self-report) Strengths and Difficulties Questionnaires (SDQs) were answered before or at admission. Patients with severe mental retardation or pervasive developmental disorder were excluded. We found a large proportion (77%) with a possible or probable psychiatric disorder. The parents, teachers, and adolescents themselves had higher mean SDQ scores than a British community sample on total difficulties, emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and impairment, but not self-reported conduct problems. Nearly 80% of the children who probably had a psychiatric disorder had no contact with the psychiatric service.     

Applying impairment criteria to children's psychiatric diagnosis

This paper examines the effect of applying impairment criteria using the Children's Global Assessment Scale on rates, agreement between informants, and recall of diagnosis over 2 years in a sample of 220 offspring of depressed and nondepressed parents. The findings show that the offspring of depressed parents, compared with nondepressed parents, were more impaired overall. The rates of most psychiatric disorders in both groups of children were markedly reduced when impairment criteria were applied. The application of impairment criteria improved agreement between mother and child on many of the children's diagnoses and also improved stability of recall of child's diagnosis at 2-year follow-up. Long-term follow-up studies are needed to determine the clinical consequences for children who meet diagnostic criteria for psychiatric disorder but who have minimal functional impairment.     

Neuropsychological performance in children and adolescents with obsessive-compulsive disorder and influence of clinical variables.

BACKGROUND: Several studies have found impairment in visual memory and visual organization in adults with obsessive-compulsive disorder (OCD), but little is known about the neuropsychological profile of children and adolescents with this disorder. The influence of clinical variables such as age, severity of obsessive-compulsive symptomatology, depressive symptomatology, and pharmacological treatment on cognitive performance in these patients has not been thoroughly studied. METHODS: A neuropsychological battery designed for this study was administered to 35 patients with DSM-IV-TR diagnosis of OCD without psychiatric comorbidity aged between 7 and 18 years and 35 gender- and age-matched healthy subjects. RESULTS: Children and adolescents with OCD performed significantly worse on verbal and visual memory and velocity. When depressive symptomatology was controlled, impairment in visual memory, visual organization, and velocity again was found, but impairment in verbal memory was not. Neuropsychological impairment was not related to age, obsessive-compulsive severity, and pharmacological treatment. CONCLUSIONS: Children and adolescents with OCD without psychiatric comorbidity with acute illness show impairment in visual memory, visual organization, and velocity, similar to adults. The influence of depressive symptomatology is important in cognitive performance. No relation was found between neuropsychology and age, severity of obsessive-compulsive symptomatology, or pharmacological treatment in this study.     

Psychiatric issues of childhood seizure disorders

Children who suffer from childhood seizure disorders, especially epilepsy, have various potential psychiatric issues and concerns that the treating physician and psychiatric consultant should consider. These children are at increased risk of adjustment reactions, anxiety and mood disorders, ADHD, learning difficulties, and familial and social stress. Because of potential risks and vulnerabilities for the development of comorbid psychiatric conditions and the increased risk for individual, familial, and social impairment, a psychiatric consultation to children and families dealing with epilepsy may play an important role in the successful management of this complex disorder.     

The Role of Inhibitory Control in the Hospitalization of Children with Severe Psychiatric Disorders

Objective: Inhibitory control is a heterogeneous domain involving multiple inhibitory processes at levels of behavior, attention/cognition, and emotion/motivation. Prior studies have identified an underlying role of inhibitory control in the manifestation of childhood-onset psychiatric symptoms. This study investigated the inhibitory control abilities of children within a severe, childhood psychiatric sample. Method: A medical chart review was conducted for 100 children who received a neuropsychological evaluation during a children’s psychiatric inpatient program hospitalization from 2010 to 2014. Three measures neurocognitive of inhibitory control, Stroop Color–Word Score, CPT-II Commission Errors, and WCST Failure to Maintain Set were used in the present study. The presence of externalizing behaviors at hospital admission was classified as poor behavioral/self-control. Results: Forty-eight percent of the sample displayed evidence of inhibitory control impairment on neurocognitive measures, with 40% displaying response inhibition impairment and only 5–7% displaying interference control impairment. Similarly elevated rates of impairment were found in those children without attention deficit hyperactivity disorder (ADHD). Depressive disorders were associated with interference control, while ADHD was associated with interference control and response inhibition. Receiver Operating Characteristic analysis found that response inhibition predicted a prolonged hospitalization in an older males subgroup but not in the younger males or females subgroups. Conclusions: Current findings suggest that inhibitory control impairments are highly prevalent in the children’s psychiatric inpatient setting and associated with specific psychiatric disorders, although the influence of these impairments on subsequent outcome may be limited to a select portion of children. These findings highlight the importance of neuropsychological evaluation and management in childhood psychiatric disorders.     

Characterization of language and reading skills in familial polymicrogyria

Polymicrogyria (PMG) is a malformation of cortical development characterized by an excessive number of small gyri and abnormal cortical lamination, giving the cortical surface an irregular and gross appearance. The severity of clinical manifestations correlates with the extent of cortical involvement. The objective of the present study was to describe three families with linguistic features of developmental language disorder and reading impairment, and to establish a neuroanatomic correlation through neuroimaging. Subjects have been submitted to a comprehensive protocol including psychological assessment, language evaluation, neurological examination, and neuroimaging investigation. In our families, children usually had the diagnosis of developmental language disorder while adults had the diagnosis of reading impairment. MRI showed perisylvian polymicrogyria in several subjects of each family. Our data support the idea that there is a co-occurrence of developmental language disorder and reading impairment and both conditions may be associated with polymicrogyria.     

Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis

Childhood exposure to victimization is prevalent and has been shown to contribute to significant immediate and long-term psychological distress and functional impairment. Children exposed to interpersonal victimization often meet criteria for psychiatric disorders other than posttraumatic stress disorder (PTSD). Therefore, this article summarizes research that suggests directions for broadening current diagnostic conceptualizations for victimized children, focusing on findings regarding victimization, the prevalence of a variety of psychiatric symptoms related to affect and behavior dysregulation, disturbances of consciousness and cognition, alterations in attribution and schema, and interpersonal impairment. A wide range of symptoms is common in victimized children. As a result, in the current psychiatric nosology, multiple comorbid diagnoses are necessary-but not necessarily accurate-to describe many victimized children, potentially leading to both undertreatment and overtreatment. Related findings regarding biological correlates of childhood victimization and the treatment outcome literature are also reviewed. Recommendations for future research aimed at enhancing diagnosis and treatment of victimized children are provided.     

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.