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ACQ Volume 11, Number 3 2009 133
of poor psychosocial outcome. Beitchman et al. (2001)
reported adolescents with communication impairments
being at increased risk of psychiatric problems. In a
prospective longitudinal design, the researchers tracked the
psychiatric profile of children from age 5 to 19 according to
three categories: 1) speech disorder only (n = 38); 2)
language impairment with and without speech impairment (n
= 77); or 3) typical development (n = 129). At age 19,
adolescents with childhood language impairments at age 5
were more likely to experience anxiety disorders, particularly
social phobia, compared to children with speech disorder
only, and children experiencing typical development.
Brownlie et al. (2004) investigated behaviour disorders within
the same group of children. They used parental reports to
identify higher levels of delinquent behaviour (e.g., lying,
cheating, stealing) among 19-year-old males with a language
impairment compared to males and females with speech
impairments or typically developing language. Clegg et al.
(2005) compared the psychosocial outcomes of 17 adults
with a history of severe developmental language disorder
with their siblings and a group matched on intelligence. The
adults with a language difficulty experienced higher levels of
social difficulties and emotional disturbance. Four adults with
language difficulty also reported clinically relevant mental
health disorders (e.g., anxiety related disorders). In a Finnish
study using a health-related quality of life questionnaire,
researchers reported higher levels of distress and lower
levels of cognitive functioning among 33 adults who
experienced childhood SLI compared to an age-and-gender
matched control group (Arkkila et al., 2008). All these studies
highlight a link between childhood communication
impairments and behaviour problems later in life.
Communication impairments
and juvenile offenders
The influence of poor language skills on adolescents’
behaviour and social experiences is also evident by the
language and literacy difficulties experienced by adolescents
in the juvenile justice system (Bryan, 2004; Putninš, 1999;
Snow & Powell, 2008). A study by Putninš reported young
offenders (aged 13–18 years) in secure care facilities in
South Australia as demonstrating poor literacy and
numeracy skills compared to age-matched controls.
However, uncontrolled group differences such as
socioeconomic background, gender, and cultural
background may have contributed to the group differences.
Similarly, linguistic profiles for 30 young offenders (aged
18–21 years) in a Scottish institution highlighted that 73% of
young offenders performed below the normative range on an
expressive syntactic task (Bryan, 2004). Half of the
participants also performed poorly on picture description and
naming tasks. In a recent Australian study, Snow and Powell
(2008) compared the language and social skills of 50 juvenile
offenders (mean age 15;8) with a control group matched on
age, IQ, gender, and socioeconomic background. The
performance of juvenile offenders was significantly poorer
than the control group on both social skills and language
assessments, and 26 of these offenders (52%) were noted
as having language impairment. These findings provide
further support for the link between language, literacy and
social communication skills and low academic achievement
(including learning and attention difficulties) and anti-social
behaviour for many young offenders.
In summary, a considerable body of evidence has
developed over the past 30 years to identify a relationship
and Difficulties Questionnaire; Goodman, 1997) during a
longitudinal study of behaviour and social skills among 242
children with SLI. At age 7, this group was overrepresented
in the areas of conduct difficulties (e.g., bullying other
children) and hyperactivity. However, by age 11, this
overrepresentation was not evident. Rather, at age 11 these
children presented with social difficulties such as withdrawn
social style and were the recipients of higher levels of bullying
compared to children without SLI.
School-aged children with written language impairments
can also demonstrate a range of behavioural and psychiatric
problems (Carroll, Maughan, Goodman, & Meltzer, 2005;
Willcutt & Pennington, 2000). High levels of Attention Deficit
Hyperactivity Disorder (ADHD), depression, aggression, and
conduct and anxiety disorders were reported among a cohort
of twins aged 8 to 18 years experiencing reading disability
(Willcutt & Pennington, 2000). Male participants were more
likely to display aggressive behaviour, and female participants
demonstrated higher levels of depression and anxiety.
Somatic complaints and depression correlated strongly with
reading disability after controlling for ADHD and additional
behaviour disorders (Willcutt & Pennington, 2000). Carroll et
al. (2005) reported a similar pattern of findings among a large
national sample of British children aged 9–15 years (n = 289)
with reading disorder. The presence of ADHD mediated the
link between reading disability and disruptive behaviour, and
conduct disorder; however, reading disability was directly
linked with anxiety. Given that children with histories of SLI
are at risk of reading problems (e.g., Catts & Hogan, 2003), it
could be that studies investigating school-aged children with
written language impairments have among them children
with histories of spoken language impairment. This would
suggest the importance of investigating both spoken and
written language skills in school-aged children suspected of
or diagnosed with behavioural problems.
Adolescents with behaviour or psychiatric problems often
present with undiagnosed communication impairments.
Sanger, Hux, and Belau (1997) investigated the oral language
skills of female juvenile delinquents (aged 14;1 to 17;11) who
had no history of language impairments. Comparison was
made with an age-matched control group with no history of
special education needs. The juvenile delinquent group
demonstrated difficulty in the domains of syntax, semantics,
and morphology. Similarly, Camarata, Hughes, and Ruhl
(1988) examined the language skills of 38 children aged 8 to
13 years with mild to moderate behaviour disorders enrolled
in special education programs within regular schools. Students
were identified with a behaviour disorder based on the authors’
criteria which included non-compliant behaviour and attention
problems. They reported 37 out of 38 subjects performing at
least one standard deviation below the mean on one or more
subtests of a broad-spectrum standardised language test.
Furthermore, 27 subjects scored 2 standard deviations or
greater below the mean on at least one subtest.
Older adolescents and adults
The psychosocial effects of childhood language impairment
often persist into adolescence and beyond (Arkkila,
Räsänen, Roine, Sinoten, & Vilkman, 2008; Brinton, Fujiki, &
Robinson, 2005; Clegg et al., 2005). Brinton et al. (2005)
presented a longitudinal case study of a child (Cody)
identified with SLI at age 4 through to age 19. Across his
development, Cody experienced persistently high levels of
anxiety and poor quality social relationships which the
authors linked to his significant and ongoing language
difficulties. Larger comparison studies also present evidence