Evidence of behaviour difficulties in children with language problems

The literature presented above suggests the existence of pragmatic, structural, expressive and receptive language problems as being present in children with behaviour as their primary difficulty. Table 3 displays the key descriptive elements of three studies that address behaviour difficulties in samples of children with primary language and communication difficulties or disorders.

32

Study Sample (n) Age, gender (M/F)

Assessment Key outcomes

van Daal, Verhoeven and van Balkom (2007) Language Impaired (speech, syntax, semantics and phonology) 71 5 years (51M, 20 F) CCC-2 40% scored in the borderline/clinical range for behaviour

difficulties. Phonology associated

with social behaviour, attention, withdrawal, anxiety, depression, delinquency and aggression CBCL (Dutch version)* St Clair, Pickles, Durkin and Conti- Ramsden (2010) SLI 234 7, 8, 11 and 16 years (179 M, 55 F) CCC-2 15-49% scored over the behaviour impairment threshold. Expressive language related to hyperactivity and conduct problems, pragmatic related to emotional and social (peer) difficulties. SDQ Ketelaars, Cuperus, Jansonius and Verhoeven (2010) Non-clinical pragmatic language difficulties 1364 4 years (678 M, 673 F) CCC-2 56% of boys in the PLI group showed hyperactivity. Pragmatic ability correlated with hyperactivity, peer problems and pro- social behaviour SDQ

Table 3: Key descriptive elements of three studies exploring behaviour difficulties in children with primary language/communication disorders or difficulties.

33

The studies displayed in Table 3 report upon samples of children from clinical and non- clinical populations. Two of these focus on young children aged 4 and 5 years, while one looks more longitudinally at children over primary school age. Unlike the studies reporting upon children with behaviour difficulties or disorders, none report upon children in

adolescence. Perhaps this indicates behaviour difficulties as being more problematic during adolescence or more persistent than language and communication difficulties.

The reported behaviour difficulties in children with language/communication impairments are broad, including social behaviour, thought and attention, withdrawn behaviour, anxiety, depression, delinquency and aggression, hyperactivity, peer problems, pro-social behaviour, and emotional problems. Although some emotional (and therefore internalised) problems were found to be associated with language impairment, these behaviour characteristics are mostly representative of externalising and social behaviour difficulties. An important distinction may be made here between rates of comorbidity in children with language problems, and rates of comorbidity in children with behaviour problems as previously presented in Table 2. As observed in literature reviews of the relationship between behaviour and language, formerly displayed in Table 1, reported degree of association displayed in Table 3 seem to be lower in samples of children with language difficulties.

Two studies report social behaviour problems as related to pragmatic language difficulties, detected by the CCC-2 (Ketelaars et al., 2010; St Clair et al., 2010). This supports evidence of pragmatic language difficulties in children with primary behaviour problems discussed above (Gilmour et al., 2004; Mackie and Law, 2010). St Clair et al. (2010) also report externalising behaviour as related to expressive language difficulties as well as pragmatic language

difficulties, which supports evidence reported in Nelson, Benner and Cheney (2005) discussed above. This study further indicates that the relationship between behaviour and language remains consistent over time; it is evident at each of the four time-points measured. St Clair et al. (2010) conclude that children with a history of language impairment are at increased risk of social problems in adolescence. Since pragmatic and expressive impairments showed the most global relationship to problem behaviour in this study, it is likely that social impairments in adolescence may be the result of pragmatic and expressive problems impacting on peer interactions, reducing the frequency and quality of interaction experiences with others. Ketelaars et al. (2010) report association between pragmatic language and hyperactivity and peer behaviour problems. They conclude that pragmatic language difficulties may be

34

difficulties. The strong evidence for pragmatic difficulties in the studies reviewed in this chapter would support this. Furthermore, this study reports a direct correlational relationship between certain behaviour and language characteristics. The heterogeneous nature of

behaviour and language association means that it may be expected that severity of difficulty would not be correlated; however, if behaviour and language characteristics share similar natures and perhaps reciprocally influence each other, correlations between subscales may be expected. This is also one of a few studies which sample children as young as 4 years. It is therefore significant, in that it provides indication of early developmental association, points to a need for early intervention, and provides support for children aged 4 years to be included in the current study.

One study did not report pragmatic difficulties associated with behaviour, but did report some structural language difficulties associated with behaviour. Van Daal, Verhoeven and van Balkom (2007) found that the sample of children in their study had language impairment in the areas of speech, syntax, semantics and phonology, and each of these apart from speech showed medium to large correlations with problem behaviour. Phonology was found to have the strongest associations with problem behaviour. The authors suggest that these findings are representative of language operating within the context of communication, influenced by cognitive processes such as thought and attention, and also indicative of shared neurological processes. No pragmatic difficulties were reported in this study despite the inclusion of the Children’s Communication Checklist-2. This leads to the question, if language is operating within the context of communication in a sample of children who are language and

cognitively impaired, why is there no reported evidence of pragmatic impairment? A limitation of the van Daal, Verhoeven and van Balkom (2007) study is that phonology was shown to be most broadly associated with behaviour problems, which creates the potential for a misinterpreted association. It is indicated that the majority of the included sample of

children probably had phonological impairments; therefore, the chances that phonological impairments were related to behaviour presentations will surely be increased. However, the reverse may also be true: if the whole sample had phonological impairments, variability among the sample will be lower, and so associations between behaviour and language would be more difficult to determine. The addition of a control group for comparison would improve this research, as observed in Ketelaars et al. (2010).

The characteristics of behaviour that are reported in these studies are dependent upon the measurement of behaviour that was used. Mainly, they reflect target characteristics of the

35

CBCL and SDQ techniques that were employed. Across studies measurement includes the assessment of both language and communication and behaviour, which is in comparison and contrast to the above studies sampling children with primary behaviour problems, as only Mackie and Law (2010) measured both of these constructs. Behaviour and language outcomes are, however, based on report data, thus increasing the risk of reported bias and contextual influences, as also discussed above. One study, however, correlates behaviour and language subscales of the CBCL and CCC-2 (van Daal, Verhoeven and van Balkom, 2007).

Correlations provide an advantage over proportional statistics as they indicate the nature and extent of the behaviour and language/communication association, that is, which

characteristics across these domains may be related to each other. Despite this, it may be questioned whether what is being correlated is merely the opinions of reporters, rather than the actual competencies of the child.