ACQ_Vol_11_no_3_2009

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ACQ Volume 11, Number 3 2009 151
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders (4th ed. text rev.).
Washington, DC: American Psychiatric Association.
Bishop, D. V. M. (1998). Development of the Children’s
Communication Checklist (CCC): A method for assessing
qualitative aspects of communicative impairment in children.
Journal of Child Psychology and Psychiatry and Allied
Disciplines, 39, 879–891.
Bishop, D. V. M. (2003). Children’s communication
checklist – 2. London: Harcourt Assessment.
Bishop, D. V. M., & Norbury, C. F. (2002). Exploring the
borderlands of autistic disorder and specific language
impairment: a study using standardised diagnostic
instruments. Journal of Child Psychology and Psychiatry and
Allied Disciplines, 43, 917–929.
Bishop, D. V. M., Whitehouse, A. J. O., Watt, H. J., & Line,
E. A. (2008). Autism and diagnostic substitution: evidence
from a study of adults with a history of developmental
language disorder. Developmental Medicine and Child
Neurology, 50 , 341–345.
Whitehouse, A. J. O., & Bishop, D. V. M. (2009).
Communication checklist – Adult. Pearson: London.
Whitehouse, A. J. O., Durkin, K., Jaquet, E., & Ziatas, K.
(2009). Friendship, loneliness and depression in adolescents
with Asperger’s Syndrome. Journal of Adolescence, 32 ,
309–322.
Whitehouse, A. J. O., Line, E. A., Watt, H. J, & Bishop,
D. V. M. (2009). Qualitative aspects of developmental
language impairment relate to language and literacy
outcome in adulthood. International Journal of Language and
Communication Disorders, 44, 489–510.
Whitehouse, A. J. O., Watt, H. J., Line, E. A., & Bishop,
D. V. M. (2009). Adult psychosocial outcomes of children
with specific language impairment, pragmatic language
impairment and autism. International Journal of Language
and Communication Disorders, 44 , 511–528.
Whitehouse, A. J. O., Spector, T. D., Cherkas, L. F. (in
press). No clear genetic influences on the association
between dyslexia and anxiety in a population-based sample
of female twins. Dyslexia.
also experienced a period of psychosis in which he saw
religious figures in his bedroom.
Clinical implications
The findings of this longitudinal investigation highlight a
number of clinical implications. First, childhood language
profiles (i.e., SLI vs PLI vs ASC) were found to predict
language and psychosocial outcomes in adulthood. The
broad differences in the outcome of the groups suggest that
PLI may represent a meaningful diagnostic category.
Importantly, however, it was communicative profile (i.e.,
structural language difficulties only vs pragmatic language
difficulties only vs structural and pragmatic difficulties), and
not diagnosis that was the best indicator of later outcome.
Childhood language difficulties are likely to persist to
adulthood, and have wide-ranging implications on other
aspects of development. The association between early
abilities and adult outcome highlights the importance of a
wide-ranging assessment in childhood. Pragmatic difficulties
have traditionally been difficult to assess, and we have made
a concerted attempt to develop a range of assessments that
reliably measure these abilities in children ( Children’s
Communication Checklist – 2; Bishop, 2003) and adults
( Communication Checklist – Adult; Whitehouse & Bishop,
2009). Obtaining an understanding of communicative ability
across the entire language profile will afford greater insight
into the possible outcomes of different children, and assist in
the identification of areas likely to be in need of current or
future intervention.
Second, the findings demonstrate that mental health
problems are of serious concern among those with
developmental language disorders. It not yet clear whether
the increased rate of psychiatric problems among those with
communication problems reflects a genetic predisposition
for disorder (Whitehouse, Spector & Cherkas, in press)
or the result of accumulated experience. For example, in
a recent study we found that affective disorders among
adolescents with ASC were more common for those who
expressed a desire to develop friendships (Whitehouse,
Durkin, Jaquet & Ziatas, 2009). A mismatch between the
desire of adolescents with ASC to develop friendships and
their reduced ability to do so may lead to a clinical level of
low mood. While this is a question to be answered by future
research, the findings of the longitudinal study were clear:
mental health problems are common among adolescents
and adults with a history of communication disorder. It is
thus important for speech pathologists to have a good
working knowledge of psychiatric conditions, and be vigilant
to disorder onset in their clients.
Summary
In sum, there is considerable variability in symptomatology
among children diagnosed with a communication disorder.
Obtaining an appreciation of an individual’s strengths and
difficulties across the full communicative profile will not only
enable a better understanding of potential avenues for
intervention in childhood, but also provide important insights
into possible adult outcomes. Severe mental health problems
are common among adults with a history of developmental
language disorder, and therefore an understanding of these
conditions should form an important part of a speech
pathologist’s intervention arsenal.
References
American Psychiatric Association. (1980). Diagnostic and
statistical manual of mental disorders (3rd ed.). Washington,
DC: American Psychiatric Association.
Andrew Whitehouse completed his undergraduate degree
in speech pathology at Curtin University, followed by a PhD in
psychology at UWA. He then moved to Oxford University on
a postdoctoral fellowship under the guidance of Prof Dorothy
Bishop. For the last three years he has been the Scott Family
Fellow at University College, University of Oxford. Andrew has
recently returned to Australia to take up a position as a senior
research fellow at the Telethon Institute for Child Health Research.
His main research interests are in the neurological, genetic and
epidemiological characteristics of developmental disorders such
as autism and specific language impairment. Andrew has also
developed a parallel research program investigating the neurological
and genetic aspects of mental health disorders, in particular anxiety
disorders and schizophrenia.
Correspondence to:
Dr Andrew Whitehouse
Telethon Institute for Child Health Research
Centre for Child Health Research
University of Western Australia
100 Roberts Road, Subiaco, WA 6008
email: