Child Language Difficulties and Internalizing and Externalizing Symptoms: A Meta-Analysis

Correlates of Impairment and Growth in Families of Young Autistic Children

The purpose of this project was to investigate potential correlates of family life impairment in families of young autistic children. This project incorporated measures of specific child and parent challenges in addition to a commonly used unidimensional measure of autism characteristics. In this way, we could assess whether such challenges explain variance in family life impairment, and whether their inclusion diminish associations between autism characteristics and family life impairment. Cross-sectional data were collected from 564 parents of autistic children aged 2 to 5 years who participated in a larger online study. Participants completed measures on child characteristics (autism characteristics, emotion dysregulation, speaking ability, flexibility, and sleep problems), parent depression, and family life impairment, using the Family Life Impairment Scale (FLIS). Multiple linear regression models were generated to examine whether any of the independent variables were associated with the four domains of the FLIS. Models controlled for child age and sex, parent education, and single-parent homes. All independent variables were associated with impairment in one or more FLIS domains. None of the primary independent variables were significantly associated with positive growth. More overt characteristics and behaviors (e.g., autism characteristics, reactivity, speaking ability, and flexibility) were associated with impairment in domains that reflected a family's ability to navigate the community. However, sleep challenges and parent and child emotional difficulties were most strongly associated with parent impairment. Findings suggests that families may have different needs across contexts and provide new avenues through which they might be better supported.

Emotional suffering in school-aged children and adolescents with and without developmental language disorder

BACKGROUND

Research on emotional suffering symptoms in individuals with Developmental Language Disorder (DLD) is still limited.

AIMS

To describe the emotional suffering experienced by school-aged children and adolescents with DLD.

METHODS AND PROCEDURES

Psychological symptoms were measured using the Spanish version of the Child Behavior Checklist (CBCL) in a sample of 109 (67 boys) children and adolescents with DLD and 101 (62 boys) TD participants reported by their parents.

OUTCOMES AND RESULTS

Participants with DLD experienced more emotional problems than TD children according to their parents. Those with DLD displayed significantly more symptoms related to anxiety, depression, social withdrawal, aggressive behavior, social, thought, and attention problems and also on the internalizing and externalizing composite indexes. A higher percentage of participants with DLD scored within the clinical range on almost all CBCL dimensions compared to TD participants. The severity of rule-breaking problems, aggressive behavior, and social problems decreased with age. Both boys and girls with DLD showed an internalizing and externalizing profile, but girls with DLD scored significantly higher on thought problems.

CONCLUSIONS AND IMPLICATIONS

Population with DLD experience heightened emotional suffering, with some experiencing severe symptoms. This underscores the need for preventive programs that address not only the language difficulties in DLD, but also their socio-emotional development.

English-Learning Infants' Developing Sound System Guides Their Early Word Learning

Children appear to acquire new words effortlessly from complex auditory input. However, this process is highly intricate, requiring the simultaneous integration of phonetic and phonemic details, prosodic cues, and grammatical structures. Furthermore, different components of a language's sound system-such as phonemes, syllables, and prosodic features-appear with different frequencies in the input and follow distinct patterns of distribution in speech. This article reviews research that illustrates how infants' growing understanding of their native language sound system facilitates their acquisition of new words.

Connecting Language Abilities and Social Competence in Children: A Meta-Analytic Review

Research examining relations between language skills and social competence has yielded mixed findings. Three meta-analyses investigated links between language skills (overall, receptive, and expressive) and social competence in 2- to 12-year-old children. Data from 130 studies representing 62,120 children (M age at language assessment = 4.70 years; 52% male), predominantly from North America and Europe, and identifying as White (33%), Black (17%), Hispanic (14%), Asian (2%), Mixed (4%), Indigenous (1%), and Other/Unspecified (29%) were analyzed. Analyses indicated significant medium-sized associations between social competence and: overall language (r = 0.27), receptive language (r = 0.23), and expressive language (r = 0.20). Exploratory analyses indicated significant moderating effects of study design, publication status, social type, and geographic region. Results and implications are discussed.

The Joint Development of Self-Regulation and Expressive Language in Preschool Classrooms: Preliminary Evidence from a Low-Income Sample

Self-regulation and expressive language are theorized to develop in tandem, shaped by children's social interactions in context, including interactions with teachers and peers in the preschool classroom. In the present study, we examined reciprocal associations between two components of self-regulation (behavior regulation and emotion regulation) and two components of expressive language skills (expressive vocabulary and narrative language) across two time points during the preschool year. We also explored whether individual children's interactions with teachers and peers moderate these associations. Participants were 767 preschool children (49% female; M = 53 months old; 49% Black, 22% White, 13% Hispanic, 14% multiracial/other) from low-income households. A multivariate latent change score model provided evidence that early self-regulation predicts increases in expressive language; fall emotion regulation predicted increases in narrative language and fall behavior regulation predicted increases in expressive vocabulary. Empirical support was also found for early expressive language predicting increases in self-regulation; fall expressive vocabulary predicted increases in behavior regulation. Moderation analysis indicated that some of these associations depended on individual children's interactions with peers, but not with teachers. Results provide preliminary evidence for the joint development of expressive language and self-regulation in early childhood classrooms.

Developmental Patterns in Autism and Other Neurodevelopmental Disorders in Preschool Children

BACKGROUND

Neurodevelopmental disorders (NDDs) encompass an inclusive group of conditions that appear during the developmental period but continue to persist in adulthood, ranging from particular difficulties to a global impairment of social, cognitive, and emotional functioning. The developmental trajectories associated with these conditions are highly heterogeneous. This study aimed to analyze and compare developmental and adaptive profiles of preschool-aged children with different NDDs to better characterize their developmental trajectories.

METHODS

We analyzed data from the initial global evaluation of 196 children with NDDs (aged 20 to 71 months), enrolled in three subgroups: 108 with autism spectrum disorder (ASD), 52 with language disorder (LD), and 36 with mixed specific developmental disorder (MSDD). A comprehensive neuropsychiatric evaluation was performed using standardized tools (Griffiths-III, ADOS-2, VABS-II, and ADI-R), and the parents completed the DP-3 and the CBCL 1½-5.

RESULTS

Our results showed that all NDDs exhibited poor psychomotor skills, with children with ASD being the most impaired, although their profiles were comparable to those of MSDD in communication and motor areas. CBCL's pervasive developmental problem scale has been shown to provide relevant information for distinguishing children with ASD. Furthermore, DP-3 and VABS-II measure highly differentiated developmental profiles of each diagnostic group.

CONCLUSIONS

Our results highlighted the importance of including parents'/caregivers' perspectives in defining children's functioning and the possibility of using DP-3 as a screening tool for different neurodevelopmental disorders.

Internalizing and externalizing symptoms in individuals with neurofibromatosis type 1: a systematic review and meta-analysis

BACKGROUND

Individuals with neurofibromatosis type 1 (NF1) frequently report psychosocial problems, among which internalizing and externalizing symptoms are the most poorly understood due to limited research and inconsistent evidence. This hinders the overall attendance of their psychosocial needs and has a major impact on their quality of life. Thus, this systematic review and meta-analysis was conducted to synthesize existing findings on the degree to which individuals with NF1 experience internalizing and externalizing symptoms, compared with the unaffected population, and explore moderators of the group disparities.

METHODS

Scopus, PsycINFO, Web of Science, PubMed, and ProQuest were searched from inception to March 26th, 2024, which identified 59 eligible studies (N of NF1 = 3182, mean ages 2.38 to 46.4 years). Hedges' g was calculated for differences in internalizing and externalizing symptoms between the NF1 group and the unaffected controls. Study effect sizes were pooled using robust variance estimation and random-effects models. Moderators of group differences were tested using meta-regression.

RESULTS

Random-effects meta-analyses indicated that compared with unaffected controls, individuals with NF1 showed more severe depressive (k = 21; g = 0.43; 95% CI [0.21, 0.65]), anxiety (k = 24; g = 0.27; 95% CI [0.01, 0.54]), somatic (k = 27; g = 0.56; 95% CI [0.30, 0.83]), total internalizing (k = 75; g = 0.50; 95% CI [0.33, 0.67]), aggression (k = 33; g = 0.33; 95% CI [0.08, 0.58]), delinquency, (k = 37; g = 0.43; 95% CI [0.26, 0.60]), and total externalizing symptoms (k = 47; g = 0.24; 95% CI [0.13, 0.35]). Studies that included more participants with NF1 who had ADHD or a lower verbal IQ reported greater group disparities in total internalizing symptoms or aggression.

CONCLUSIONS

Findings highlight the importance of promptly recognizing internalizing and externalizing symptoms in individuals with NF1 for timely interventions. Future research should identify predictors of internalizing and externalizing symptoms within the NF1 population to inform our knowledge and intervention development. Other implications for future research were also discussed.

SYSTEMATIC REVIEW REGISTRATION

The study protocol of this meta-analysis was registered at PROSPERO (CRD42023478258).

Association among internalizing problems, white matter integrity, and social difficulties in children with autism spectrum disorder

Autism spectrum disorder (ASD) is characterized by social difficulties and often accompanied by internalizing and externalizing problems, which are frequently overlooked. Here, we examined and compared fractional anisotropy (FA) between 79 children with ASD (aged 4-7.8 years) and 70 age-, gender-, and handedness- matched typically developing controls (TDCs, aged 3-7.2 years). We aimed to explore the relationship among social difficulties, internalizing and externalizing problems, and brain structural foundation (characterized by white matter integrity). Compared with the TDCs, the children with ASD exhibited more severe internalizing and externalizing problems, which were positively correlated with social difficulties. Reduced FA values were observed in specific white matter tracts that integrate a fronto-temporal-occipital circuit. In particular, the FA values within this circuit were negatively correlated with internalizing problems and SRS-TOTAL scores. Mediation analysis revealed that internalizing problems mediated the relationship between the FA values in the left middle longitudinal fasciculus (L-MdLF) and corpus callosum forceps major (CCM) and social difficulties in children with ASD. These findings contribute to our understanding of social difficulties, internalizing and externalizing problems, and white matter integrity in children with ASD and highlight internalizing problems as a mediator between social difficulties and white matter integrity.

Maternal underestimations and overestimations of their infants' word comprehension: effects on mothers' verbal input and infants' receptive vocabulary

Infants' language is often measured indirectly via parent reports, but mothers may underestimate or overestimate their infants' word comprehension. The current study examined estimations of mothers from diverse educational backgrounds regarding their infants' word comprehension and how these estimations are associated with their verbal input and infants' receptive vocabulary at 14 months. We compared 34 infants' looking-while-listening (LWL) performances with the mothers' Turkish Communicative Development Inventory (TCDI) reports to calculate the mothers' overestimation and underestimation. During free-play sessions, we assessed the mothers' number of words, number of clauses, lexical diversity, and linguistic complexity. We found that mothers have overestimations and underestimations regardless of their educational background. Crucially, mothers' only overestimations were positively associated with their number of words and lexical diversity. Mothers' verbal input was not related to infants' receptive vocabulary scores. The findings suggest that mothers' input might be aligned with their estimations of their infants' language capabilities, which might not reflect the infants' true performance.

Concurrent and longitudinal associations of developmental language disorder with peer victimization in adolescence: evidence from a co-twin study

BACKGROUND

Children with developmental language disorder (DLD) experience higher levels of peer victimization than their peers. However, it is not known if such associations reflect genetic and environmental confounding. We used a co-twin control design to investigate the association of language difficulties (DLD and separately poor pragmatic language) with peer victimization and compare the developmental trajectories of peer victimization across adolescence for those with and without language difficulties.

METHODS

Participants were 3,400 pairs of twins in the Twins Early Development Study (TEDS), a UK-based population birth cohort. Language abilities were assessed via online tests at age 11 and peer victimization was self-reported at ages 11, 14 and 16. Language difficulties were defined as language abilities at least -1.25 SD below the mean of the TEDS sample. We performed linear regressions and latent growth curve modeling at a population level and within monozygotic and same-sex dizygotic twin pairs.

RESULTS

At population level, youth with DLD experienced higher levels of peer victimization at ages 11 (β = 0.27, 95% Confidence Interval (CI) 0.20-0.35), 14 (β = 0.15, 95% CI 0.03-0.27) and 16 (β = 0.17, 95% CI 0.03-0.32) and a sharper decline in peer victimization between ages 11 and 16 compared to their peers without DLD. The associations between DLD and peer victimization were reduced in strength and not statistically significant in within-twin models. Moreover, there was no difference in the rate of change in peer victimization between twin pairs discordant for DLD. Results were similar for the association of poor pragmatic language with peer victimization.

CONCLUSIONS

Associations between language difficulties (DLD and separately, poor pragmatic language) and peer victimization were confounded by genetic and shared environmental factors. Identifying specific factors underlying these associations is important for guiding future work to reduce peer victimization among adolescents with language difficulties.

Language learning in the context of a global pandemic: proximal and distal factors matter

BACKGROUND

Public health measures implemented during the COVID-19 pandemic fundamentally altered the socioecological context in which children were developing.

METHODS

Using Bronfenbrenner's socioecological theory, we investigate language acquisition among 2-year-old children (n = 4037) born during the pandemic. We focus on "late talkers", defined as children below the 10th percentile on the MacArthur-Bates Communicative Development Inventories-III.

RESULTS

Overall, the proportion of late talkers declined as a function of pandemic wave, with 13.0% of those born during the first wave classified as late talkers compared to 10.4% born in wave two, and 8.0% born during wave three. In sex-based analysis, we observed a 15.9% prevalence of late talking among female toddlers, which was significantly different from the norming sample. In contrast, the prevalence of late talking among male toddlers was 9.1%. Using hierarchical logistic regression to identify both proximal and distal factors associated with being a late talker, we found that male sex, lower socioeconomic status, greater screen time, receiving childcare at home, disruptions to childcare, and experiencing greater exposure to public health restrictions were associated with increased odds for being a late talker.

CONCLUSION

We interpret the findings in relation to the need to consider the special needs of young children in disaster preparation and response.

IMPACT

Two-year-old children acquiring language in the context of the COVID-19 pandemic have vocabulary size similar to historical norms. A higher-than-expected prevalence of late talkers (below the 10th percentile) was observed among females and children born during the first wave of the pandemic. Motivated by Bronfenbrenner's socioecological theory, we show that both proximal and distal environmental factors are associated with vocabulary size. Infants exposed to stricter public measures had reduced vocabulary size. The findings suggest a need to recognize the developmental needs of children as part of the public health response to emergencies.

Evaluating the association between developmental language disorder and depressive symptoms in preschool children

This study aims to investigate the association between developmental language disorder (DLD) and depressive symptoms in preschool-aged children, building upon previous research that has demonstrated emotional difficulties in children with DLD. Forty-one children with DLD or children at risk for DLD (DLD group) and 41 children with typical language development (TLD) were included in this study. Language development was evaluated using the TEDIL test which is a Turkish adaptation of the Test of Early Language Development-3. Auto acoustic Emissions Testing and Immittance-Metric Assessment were used to exclude children with hearing impairment. Developmental delays were excluded by Denver Developmental Screening Test II. Mothers filled out the Sociodemographic Data Form and the Child Depressive Symptoms Assessment Scale. The results demonstrate that children in DLD group scored significantly higher on the Child Depressive Symptoms Assessment Scale, manifesting increased levels of aggression, separation anxiety, impulsivity, hyperactivity, and encountering greater social adaptation difficulties and deterioration in cognitive processes than TLD. Multivariate regression analysis suggests that increased impulsivity and hyperactivity, alongside social and cognitive challenges, are predictors of DLD. The study concludes that depressive symptoms are more prevalent in children in DLD group than in their typically developing counterparts. These findings underscore the necessity for targeted psychiatric and pedagogical interventions, as well as individualized educational programs that cater to the socio-emotional and cognitive needs of children with DLD.

A follow up investigation of placental pathology, responsive parenting, and preschool children's executive functioning and language development

Despite documented effects linking underlying placental diseases and neurological impairments in children, little is known about the long-term effects of placental pathology on children's neurocognitive outcomes. In addition, maternal responsivity, known to positively influence early postnatal cognitive development, may act to protect children from putative adverse effects of placental pathology. The current study is a follow up of medically healthy, term born, preschool age children, born with placental pathology. A sample of 118 children (45 comparison children with normal placental findings, 73 born with placental pathology) were followed when children were 3-4 years old. In comparison to children born to mothers with normal placentas, placental pathology was associated with poorer performance in the executive function involving cognitive flexibility, but not inhibitory control or receptive language. Maternal responsivity was observed to be marginally protective on the impact of placental pathology risk on cognitive flexibility, but this was not seen for either inhibitory control or receptive language.

Putting the child in the driver's seat: Insights into language development from children's interactions in preschool classrooms

Children's own language production has a role in structuring the language of their conversation partners and influences their own development. Children's active participation in their own language development is most apparent in the rich body of work investigating language in natural environments. The advent of automated measures of vocalizations and movement have made such in situ research increasingly feasible. In this chapter, we review recent research on children's language development in context with a particular focus on research employing automated methods in preschool classrooms for children between ages 2 and 5 years. These automated methods indicate that the speech directed to preschool children from specific peers predicts the child's speech to those peers on a subsequent observation occasion. Similar patterns are seen in the influence of peer and teacher phonemic diversity on the phonemic diversity of children's speech to those partners. In both cases, children's own speech to partners was the best predictor of their language abilities, suggesting their active role in their own development. Finally, new research suggests the potential of machine learning to predict children's speech in group contexts, and to transcribe classroom speech to better understand the content of children's conversations and how they change with development.

Identifying subgroups of attention-deficit/hyperactivity disorder from the psychopathological and neuropsychological profiles

The Research Domain Criteria (RDoC) advocates the dimensional approach in characterizing mental disorders. We followed RDoC to characterize children with ADHD using profiling based on the cognitive and psychopathological domains. We aimed to identify and validate ADHD subtypes with different clinical characteristics and functional impairments. We recruited 362 drug-naïve children with ADHD and 103 typically developing controls. The cluster analysis was used to identify subgroups based on the Child Behaviour Checklist (CBCL) and the Behaviour Rating Inventory of Executive Function (BRIEF). The subgroups' clinical characteristics and functional impairments were assessed using the WEISS Functional Impairment Rating Scale-Parent Report (WFIRS-P) and the Conners Parent Symptom Questionnaire (PSQ). The cluster analysis yielded four subgroups: (1) ADHD with severe impairment in psychopathology and executive functions (EF), (2) ADHD with mild executive dysfunctions and normal-level psychopathology, (3) ADHD with severe externalizing problems and (4) ADHD with severe executive dysfunctions. These subgroups showed different clinical characteristics and degrees of functional impairment. The EF impairment group displayed more serious learning problems and worse life skills than the externalizing group. The two groups with externalizing problems (i.e. the severe impairment group and the externalizing group) both exhibited higher rates of the combined subtype of ADHD and higher rates of comorbid ODD. Different subtypes of ADHD displayed different profiles of internalizing and externalizing problems and levels of executive dysfunctions. In particular, the subtype with severe impairment in EF exhibited more learning problems and worse life skills, suggesting EF is a critical target for intervention in children with ADHD.

Bidirectional associations between mental health problems and language ability across 8 years of childhood

Research examining the development of behavior, emotions and language, and their intertwining is limited as only few studies had a longitudinal design, mostly with a short follow-up period. Moreover, most studies did not evaluate whether internalizing symptoms and externalizing symptoms are independently associated with language ability. This study examines bidirectional associations between internalizing symptoms, externalizing symptoms and language ability in childhood in a large, population-based cohort. Longitudinal data from the Millennium Cohort Study, a cohort of children in the United Kingdom followed from birth to 11 years (n = 10,878; 50.7% boys), were analyzed. Internalizing and externalizing symptoms were based on parent reports. Language ability (higher scores reflecting poorer ability) was assessed by trained interviewers at ages 3, 5, 7 and 11 years. Structural Equation Models (SEM) were performed, including random-intercept cross-lagged panel models (RI-CLPM) and cross-lagged panel models (CLPM). Internalizing symptoms, externalizing symptoms and language ability were stable over time and co-occur with each other from early life onwards. Over time, externalizing symptoms in early childhood were associated with less growth in language skills and with increases in internalizing symptoms. In late childhood, language ability was negatively associated with later internalizing and externalizing symptoms. The early start, co-occurrence and persistent nature of internalizing symptoms, externalizing symptoms and (poorer) language ability highlights the importance of comprehensive assessments in young children who present problems in one of these domains. Specifically, among children in the early grades of elementary school, those with language difficulties may benefit from careful monitoring as they are more likely to develop difficulties in behavior and emotions.

Linking Language Skills and Social Competence in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis

PURPOSE

This systematic review and meta-analysis aimed to examine the association between language skills and social competence in children with developmental language disorder (DLD) and to assess the potential moderators of these associations.

METHOD

The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified according to a search strategy carried out in PsycINFO, MEDLINE, Scopus, Linguistics and Language Behavior Abstracts, and ProQuest Dissertations and Theses Global databases. A total of 15,069 articles were independently double screened in the title and abstract phases, with 250 articles proceeding to a full-text review. Inclusion criteria comprised (a) a sample of children with DLD between the ages of 2 and 12 years, (b) a language measure, (c) a social competence measure, and (d) an appropriate statistic. Exclusion criteria were (a) intervention studies with no baseline data, (b) language measures based on preverbal abilities, (c) samples of children with DLD and other clinical conditions, and (d) studies without useable statistics. Data were extracted from 21 studies that met the eligibility criteria for the meta-analysis.

RESULTS

Pooled estimates across 21 studies (Mage = 7.52 years; 64% male) and 6,830 children indicated a significant association between language skills and social competence in children with DLD (r = .18, 95% confidence interval [.12, .24], p < .001), which was small in magnitude. The effect sizes were stronger in studies that assessed overall language skills than in those that specifically measured receptive or expressive language skills.

CONCLUSIONS

Findings from this study support a subtle and reliable relationship between language and social competence in children with DLD. The implications and limitations of this study and its future directions are also discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24514564.

Configurations of mother-child and father-child attachment relationships as predictors of child language competence: An individual participant data meta-analysis

An individual participant data meta-analysis was conducted to test pre-registered hypotheses about how the configuration of attachment relationships to mothers and fathers predicts children's language competence. Data from seven studies (published between 1985 and 2014) including 719 children (Mage : 19.84 months; 51% female; 87% White) were included in the linear mixed effects analyses. Mean language competence scores exceeded the population average across children with different attachment configurations. Children with two secure attachment relationships had higher language competence scores compared to those with one or no secure attachment relationships (d = .26). Children with two organized attachment relationships had higher language competence scores compared to those with one organized attachment relationship (d = .23), and this difference was observed in older versus younger children in exploratory analyses. Mother-child and father-child attachment quality did not differentially predict language competence, supporting the comparable importance of attachment to both parents in predicting developmental outcomes.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study

Background and aims

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.

Methods

Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.

Results

For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.

Conclusions

By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.

Implications

The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

A Role for Visual Memory in Vocabulary Development: A Systematic Review and Meta-Analysis

Although attention and early associative learning in preverbal children is predominantly driven by rapid eye-movements in response to moving visual stimuli and sounds/words (e.g., associating the word "bottle" with the object), the literature examining the role of visual attention and memory in ongoing vocabulary development across childhood is limited. Thus, this systematic review and meta-analysis examined the association between visual memory and vocabulary development, including moderators such as age and task selection, in neurotypical children aged 2-to-12 years, from the brain-based perspective of cognitive neuroscience. Visual memory tasks were classified according to the visual characteristics of the stimuli and the neural networks known to preferentially process such information, including consideration of the distinction between the ventral visual stream (processing more static visuo-perceptual details, such as form or colour) and the more dynamic dorsal visual stream (processing spatial temporal action-driven information). Final classifications included spatio-temporal span tasks, visuo-perceptual or spatial concurrent array tasks, and executive judgment tasks. Visuo-perceptual concurrent array tasks, reliant on ventral stream processing, were moderately associated with vocabulary, while tasks measuring spatio-temporal spans, associated with dorsal stream processing, and executive judgment tasks (central executive), showed only weak correlations with vocabulary. These findings have important implications for health professionals and researchers interested in language, as they advocate for the development of more targeted language learning interventions that include specific and relevant aspects of visual processing and memory, such as ventral stream visuo-perceptual details (i.e., shape or colour).

Early childhood education language environments: considerations for research and practice

The importance of developing early language and literacy skills is acknowledged by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) as a global human rights issue. Indeed, research suggests that language abilities are foundational for a host of cognitive, behavioral, and social-emotional outcomes. Therefore, it is critical to provide experiences that foster language acquisition across early learning settings. Central to these efforts is incorporating assessments of language environments into research and practice to drive quality improvement. Yet, several barriers may be preventing language environment assessments from becoming widely integrated into early education. In this brief, we review evidence on the types of experiences that promote language development, describe characteristics of language environment assessments, and outline practical and philosophical considerations to assist with decision-making. Further, we offer recommendations for future research that may contribute knowledge regarding strategies to assess and support language development. In addressing both areas, we highlight the potential for early childhood language environments to advance equity.

Contributions of socioeconomic status and cognition to emotion processes and internalizing psychopathology in childhood and adolescence: A systematic review

This systematic review evaluated evidence from 25 manuscripts regarding three possible relationships of socioeconomic disadvantage (SESD) and cognition to emotion knowledge (EK), emotion regulation (ER), and internalizing psychopathology (IP) across development; a) independent contributions of disadvantage and cognition; b) cognition mediates relations of disadvantage; or c) cognition moderates' relations of disadvantage. Results support associations between SESD and cognition to emotion that differ by cognitive domain and developmental epoch. For EK, in early and middle childhood language and executive functions contribute to EK independent of SESD, and early childhood executive functions may interact with socioeconomic status (SES) to predict prospective EK. Regarding ER, language contributes to ER independent of SES across development and may mediate associations between SES and ER in adolescence. Regarding IP, SES, language, executive function, and general ability have independent contributions to IP across development; in adolescence executive function may mediate or moderate associations between SES and IP. Findings highlight the need for nuanced and developmentally sensitive research on the contributions of SESD and domains of cognition to emotion.

A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use

BACKGROUND

Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility.

METHOD

We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature.

RESULTS

Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration.

CONCLUSION

Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.

Guidance for Increasing Primary Study Inclusion and the Usability of Data in Meta-Analysis: A Reporting Tutorial

Meta-analyses can be used to comprehensively summarize the state of a given literature base, understand development and relations between constructs, and synthesize intervention effects to identify "what works for whom," all of which can directly inform research, practice, and policy. In this tutorial, we first argue that data reporting in primary studies can meaningfully affect the results of meta-analyses and, most importantly, the subsequent interpretations and use of the findings in research, practice, and policy in speech, language, and hearing sciences. Though reporting guidelines have been well established for the results of meta-analyses, there is limited focus on the essentials for primary study reporting that allow for inclusion in meta-analyses. To this end, we provide guidance for primary study authors to ensure their studies can maximize their contributions to research syntheses and, specifically, to meta-analyses. We discuss current and ongoing issues related to reporting, provide data-based examples of instances where lack of reporting or transparency has rendered a study ineligible from inclusion in a meta-analysis, encourage editorial teams and peer reviewers to be flexible in the inclusion of supplemental data reporting based on journal requirements and limits, and suggest being explicit and earnest about why these requests are important to advancing the field. Supplemental Material: https://doi.org/10.23641/asha.23117996.

The association of prenatal phthalates, organophosphorous pesticides, and organophosphate esters with early child language ability in Norway

BACKGROUND

Prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides have been associated with neurodevelopmental deficits including language ability, however, few studies consider the effect of exposure mixtures and the potential longitudinal detriments over time.

OBJECTIVE

This study examines the influence of prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides, on children's language ability from toddlerhood to the preschool period.

METHODS

This study includes 299 mother-child dyads from Norway in the Norwegian Mother, Father and Child Cohort Study (MoBa). Prenatal exposure to chemicals were assessed at 17 weeks' gestation, and child language skills were assessed at 18 months using the Ages and Stages Questionnaire communication subscale and at preschool age using the Child Development Inventory. We ran two structural equation models to examine the simultaneous influences of chemical exposures on parent-reported and teacher-reported child language ability.

RESULTS

Prenatal organophosphorous pesticides were negatively associated with preschool language ability through language ability at 18 months. Additionally, there was a negative association between low molecular weight phthalates and teacher-reported preschool language ability. There was no effect of prenatal organophosphate esters on child language ability at either 18 months or preschool age.

CONCLUSIONS

This study adds to the literature on prenatal exposure to chemicals and neurodevelopment and highlights the importance of developmental pathways in early childhood.

Routines as a Protective Factor for Emerging Mental Health and Behavioral Problems in Children with Neurodevelopmental Delays

Objectives

Children with neurodevelopmental delays show higher levels of externalizing behavioral problems, resulting in increased parental stress. This study aims to determine if the frequency of family routines moderates children's externalizing problems and associated parental stress based on children's cognitive ability longitudinally.

Methods

Children with neurodevelopmental delays and caregivers (N = 202) participated in assessments that included the Wechsler Preschool and Primary Scale of Intelligence-Forth Edition, Child Behavior Checklist, Parent Daily Report, and Family Routines Inventory. Child participants were 28 to 72 months old (M = 48.00, SD = 10.652) and predominantly male (69.3%).

Results

Frequency of family routines at baseline (b = - .375, SE = .112, p = .001) was associated with lower child externalizing behaviours at baseline (b = - .104, SE = .047, p = .031). Frequency of family routines moderated parental stress for children with average (i.e., at the mean; b = - .211, SE = .119, p = .08) and above average (i.e., 1SD above mean; b = - .436, SE = .177, p = .02) nonverbal skills. Longitudinally, increased frequency of family routines (b = - .193, SE = .092, p = .04) was associated with less child externalizing behaviors.

Conclusions

Findings demonstrate that routines may reduce parental stress, but the use of routines alone may be less practical for children with lower verbal skills. Additionally, the importance of routines for minimizing behavioral problems in children was significant for children with average or higher nonverbal skills at baseline, suggesting that nonverbal skills are protective for these children.

Is language ability associated with behaviors of concern in autism? A systematic review

This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self-injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty-five publications (n = 11,961) were included. Forty studies were cross-sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high-quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC.

The effect of anxiety on working memory and language abilities in elementary schoolchildren with and without Additional Health and Developmental Needs

Although excessive childhood anxiety is recognised as a significant public health, education and socioeconomic concern, the specific effects of such anxiety on language development and working memory, particularly visual working memory, are relatively unknown. Thus, this study aimed to examine parent-reported trait anxiety, parent-reported functional language (daily communication skills) and clinical measures of non-verbal intelligence, receptive and expressive vocabulary, phonological awareness, and visual and auditory-verbal short-term and working memory in elementary schoolchildren. The final sample included 41 children categorised as Additional Health and Developmental Needs (AHDN) due to medical, neurodevelopmental or educational concerns and 41 age- and IQ-matched neurotypical (NT) children, aged 5- to 9-years. Results showed that 26% of all children in our entire sample (AHDN and NT) experienced moderate, sub-clinical anxiety (as reported by parents), and that AHDN children were 10.5 times more likely to experience high anxiety than the NT group (odds ratio). Parents of AHDN children reported lower functional language in their children than parents of NT children. Cognitive testing indicated that the AHDN group also had poorer visual and auditory-verbal working memory than the NT group. Further, High Anxiety children (drawn from both AHDN and NT groups) showed poorer parent-reported functional language skills, and lower visual and auditory-verbal working memory capacities. Our findings are amongst the first to confirm that the presence of high parent-rated trait anxiety is associated with reduced visual working memory in children, which is consistent with biological and theoretical expectations of the impact of anxiety on visually driven, goal-directed attention and working memory. Our results regarding the high prevalence of sub-clinical anxiety in both ADHD and neurotypical children highlight the need for early assessment of anxiety in all schoolchildren, especially those classified as AHDN.

Language disorder and internalizing mental health problems in youth offenders: A systematic review

BACKGROUND

The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth.

AIMS

To explore the co-occurrence of language disorder and anxiety and depression in youth offenders.

METHODS & PROCEDURES

A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative.

MAIN CONTRIBUTION

Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation.

CONCLUSIONS & IMPLICATIONS

Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling).

WHAT THIS PAPER ADDS

What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

Indirect Relations between Language and Behavior Problems in Preschoolers: The Role of Executive Difficulties

The present study investigated the concurrent relations between language ability, executive difficulties, and behavior problems in a sample of 142 preschoolers ranging in age between 3 and 6 years of age. Language skills were assessed with a direct task, whereas ratings of executive difficulties and behavior problems were obtained from teachers. Regression analyses indicated that difficulties in flexibility and inhibitory self-control were positively associated with internalizing problems, and difficulties in inhibitory self-control were positively associated with externalizing problems. The associations between emergent metacognition and internalizing problems and between inhibitory self-control and externalizing problems were both moderated by sex, being stronger in boys than in girls. Lastly, language had indirect effects on internalizing problems by decreasing children's difficulties in flexibility, as well as on externalizing problems by decreasing children' difficulties in inhibitory self-control. Overall, these findings support the idea that low language skills may interfere with preschoolers' ability to exploit the executive functions of inner language to self-regulate their own behaviors, especially in boys.

Research Review: Language and specific learning disorders in children and their co-occurrence with internalizing and externalizing problems: a systematic review and meta-analysis

BACKGROUND

Some studies suggest that children with language and learning disorders (LLDs) show more internalizing and externalizing problems than their peers. However, the available evidence remains inconsistent, especially regarding the conditions under which these psychological problems occur.

METHODS

We performed a meta-analysis of studies comparing children with LLDs and controls on internalizing (53 independent samples, 135 effect sizes) and externalizing problems (37 independent samples, 61 effect sizes) separately.

RESULTS

Children with LLDs showed higher internalizing (Hedges' g = 0.36) and externalizing problems (Hedges' g = 0.42) than controls did. The group standardized difference in internalizing problems was moderated by the primary disorder, with children with language disorders showing more internalizing problems than those with reading disorders. The severity of the primary disorder, IQ, and age did not moderate Hedge's g between children with LLDs and controls in internalizing and externalizing outcomes. The same pattern was found for gender as a moderator of Hedge's g in internalizing problems, while findings for externalizing problems were inconclusive. The results were consistent when methodological variables were assessed, also for informant, sample size, and geographical area. Clinical samples with LLDs reported higher internalizing problems respect to those with difficulties, but findings on externalizing outcomes were limited. Similarly, results on the presence of additional symptoms in learning and language, self-concept, and socioeconomic status were inconclusive, as few studies reported this information. Results were robust when publication bias, publication year, and study quality were assessed.

CONCLUSIONS

There is evidence that children with LLDs report higher internalizing and externalizing problems than controls do. Children with language disorders seemed more vulnerable to report more internalizing problems, and clinical samples reported higher problems than those with difficulties. For clinical practice, assessment and interventions should target socioemotional skills to support the psychological well-being of children with LLDs.

Association of Screen Time With Internalizing and Externalizing Behavior Problems in Children 12 Years or Younger: A Systematic Review and Meta-analysis

Importance

Currently, there is a lack of consensus in the literature on the association between screen time (eg, television, video games) and children's behavior problems.

Objective

To assess the association between the duration of screen time and externalizing and internalizing behavior problems among children 12 years or younger.

Data Sources

For this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO databases were searched for articles published from January 1960 to May 2021. Reference lists were manually searched for additional studies.

Study Selection

Included studies measured screen time (ie, duration) and externalizing or internalizing behavior problems in children 12 years or younger, were observational or experimental (with baseline data), were available in English, and had data that could be transformed into an effect size. Studies conducted during the COVID-19 pandemic were excluded. Of 25 196 nonduplicate articles identified and screened for inclusion, 595 met the selection criteria.

Data Extraction and Synthesis

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Extracted variables were child age, sex, and socioeconomic status; informants and measurement type for screen time and behavior problems; study publication year; and study design and quality. Data were extracted by 2 independent coders and were pooled using a random-effects model.

Main Outcomes and Measures

The primary outcome was the association of screen time duration with externalizing (eg, aggression, attention deficit/hyperactivity disorder symptoms) and internalizing (eg, depression, anxiety) behaviors or diagnoses.

Results

Of the 595 full-text articles assessed for eligibility, 87 studies met all inclusion criteria, comprising 98 independent samples and 159 425 participants (mean [SD] age, 6.07 [2.89] years; 83 246 [51.30%] male). Increased duration of screen time had a small but significant correlation with more externalizing problems (90 samples; r, 0.11; 95% CI, 0.10-0.12) and internalizing problems (43 samples; r, 0.07; 95% CI, 0.05-0.08) in children. Several methodological moderators explained between-study heterogeneity. There was evidence of significant between study heterogeneity (I2 = 87.80).

Conclusions and Relevance

This systematic review and meta-analysis found small but significant correlations between screen time and children's behavior problems. Methodological differences across studies likely contributed to the mixed findings in the literature.

Pathways From Preschool Language Difficulties to School-Age Internalizing Problems

PURPOSE

Early language difficulties are associated with later internalizing problems across different ages and for different aspects of language. The mechanisms behind this association are, however, less understood. In the current study, we investigated longitudinal associations between language difficulties at 5 years and internalizing problems at 6 years. We also examined emotion regulation, empathy, assertiveness, and social engagement at 6 years as possible pathways for this association.

METHOD

A subsample from the Norwegian Mother, Father and Child Cohort Study (MoBa) was used (N = 928). Structural equation models were developed to test the longitudinal associations and indirect pathways between language and internalizing problems.

RESULTS

The results showed high stability for internalizing problems from 5 to 6 years (β = .59, p < .001). Furthermore, semantic language difficulties predicted change in internalizing problems (β = .12, p < .001). Finally, the path between semantic language and internalizing problems was partially mediated by social engagement and emotion regulation, with the indirect pathways accounting for 55% of the initial association. For girls, there was a significantly stronger correlation (p < .05) between semantic language difficulties and internalizing problems at baseline (r = .30, p < .001) than for boys (r = .16, p < .001). Otherwise, there were no sex differences.

CONCLUSIONS

Indirect pathways from language difficulties to internalizing problems were identified through social engagement and emotion regulation. The results may guide targets for intervention in groups of children with language difficulties at risk for developing internalizing problems.

Does Where You Live Predict What You Say? Associations between Neighborhood Factors, Child Sleep, and Language Development

Language ability is strongly related to important child developmental outcomes. Family-level socioeconomic status influences child language ability; it is unclear if, and through which mechanisms, neighborhood-level factors impact child language. The current study investigated the association between neighborhood factors (deprivation and disorder) assessed before birth and child language outcomes at age 5, with sleep duration as a potential underlying pathway. Secondary analysis was conducted on data collected between 2008 and 2018 on a subsample of 2444 participants from the All Our Families cohort study (Calgary, Canada) for whom neighborhood information from pregnancy could be geocoded. Neighborhood deprivation was determined using the Vancouver Area Neighborhood Deprivation Index (VANDIX), and disorder was assessed using crime reports. Mothers reported on their children’s sleep duration and language ability. Multilevel modeling indicated that greater neighborhood deprivation and disorder during pregnancy were predictive of lower scores on the Child Communication Checklist–2 (CCC–2) at 5 years. Path analyses revealed an indirect effect of neighborhood disorder on language through child sleep duration at 12 months. These results add to growing evidence that child development should be considered within the context of multiple systems. Sleep duration as an underlying link between environmental factors and child language ability warrants further study as a potential target for intervention.

Developmental Language Disorder (DLD) in Young People Leaving Care in England: A Study Profiling the Language, Literacy and Communication Abilities of Young People Transitioning from Care to Independence

Research indicates children and young people in care have a high prevalence of Developmental Language Disorder (DLD) as part of a complex set of vulnerabilities. This study describes the profile of language, literacy and communication abilities of a cohort of care leavers. The language, literacy and communication abilities of 44 young people leaving care between the ages of 16 and 26 years were assessed using standardized measures. Demographic data about the young people was collected along with a survey to key staff to capture their perceptions and experiences of the language and communication abilities of these young people. Ninety percent of the care leavers' language abilities were below average and over 60% met criteria for DLD in combination with literacy difficulties, developmental disorders and social, emotional and mental health difficulties (SEMH). The implications of unidentified DLD on the lives of young people leaving care is discussed. Earlier identification of DLD is advocated to enable services to intervene to facilitate more positive outcomes and life chances for this very vulnerable population.