The Association Between Language Impairment And Behavior Problems In Preschool-aged Children

Part Ⅰ: Language impairment in preschool-aged children: at-risk population of developing hyperactivity/inattention and peer relation problems.Objective: Children with language impairment exhibited low language performance and potential risk for presenting hyperactivity/inattention and peer relation problems,this study is to investigate the relative risk of social behavioral problems in children with language impairment comparing to normal peers,and to what extend does perceptive language,expressive language,syntax and semantics have effects on social behavioral problems.Methods: Participants(36 to 72 months)were recruited from Shanghai Children’s Medical Center.114 preschool-aged children were evaluated by the Diagnostic Receptive and Expressive Assessment of Mandarin(DREAM)on perceptive language,expressive language,syntax,semantics and total score.The parent-reported Strengths and Difficulties Questionnaire(SDQ)assessed social-behavioral status.ANOVAs tested differences of social-behavioral status between language-impaired children and normal peers,following up with stepwise linear regression models discussing the effects of language profile and covariates on social behavioral problems.Results: Hyperactivity/inattention,peer relation problem,total difficulties scores on SDQ were significantly higher and prosocial behavior scores was evidently lower in language-impaired group comparing to normal control group;emotion and conduct scores showed no evident difference between groups.Language-impaired children were 2.15(χ2=11.61,P=.0007)times more likely to exhibit hyperactivity/inattention behaviors and 2.18(χ2=14.40,P=.0001)times more likely to exhibit peer relation problems.In stepwise regression models,language ability had significant influence on hyperactivity/inattention symptoms after controlling for covariates,linear coefficient of syntax(β=-.063)was remarkable when comparing to other three language patterns.Peer relation problems were influenced by language.Conclusion: In conclusion,preschool period holds the key to language and social cognition development.Preschool-aged children with language impairment were at higher risk for developing hyperactivity/inattention and peer relation problems.We not only concern about their language development trajectories but also monitor social skills and the occurrence of behavioral problems.Part Ⅱ: Mediation effect of executive function in the relationship between language impairment and hyperactivity/inattention symptomObjective: To investigate whether executive function can mediate language impairment’s effect for hyperactivity/inattention symptoms and provide evidence to diagnose and treat comorbidity of language impairment and attention deficit/hyperactivity disorder in children.Methods: The clinical data were retrospectively analyzed in 19 language impairment children(n=19 boys/girls=12/7,age 57.5±11.8 months)from September2014 to November2014,1:2 matching with age and sex to 41 language normal peers(n=41 boys/girls=29/12,age 63.0±15.9months)as candidates for no language impairment group.All data were collected for language,executive functions,the SDQ questionnaire and nonverbal IQ.Paired t-test was used to test the group differences on short-term memory,inhibitory control and the SDQ hyperactivity/inattention scores.We utilized bootstrapping to identify mediation effect executive functions on language impairment’s influence for hyperactivity/inattention symptoms.Results: In our findings,children with language impairment exhibited significantly poorer short-term memory(t=3.72,P<0.001,Cohen’s d 0.96),inhibitory control functions(t=3.30,P=0.002,Cohen’s d 0.82)and scored significantly higher on the hyperactivity/inattention(t=-2.24,P=0.029,Cohen’s d 0.65)than those who have no language impairment.Bootstrapping results showed that short-term memory and inhibitory control had no evident mutual impact on language impairment’s effect for hyperactivity/inattention,but mediating effect of short-term memory and inhibitory control separately remained significant when testing independent mediating effect.Nonverbal IQ did not moderate these results.Conclusion: Language impairment’s influence for hyperactivity/inattention symptoms can be independently mediated by short-term memory and inhibitory control respectively.Part Ⅲ: The factors influencing peer relation development among children with and without language impairment in preschool ageObjective: Discussing the potential risk factors influencing peer relation problems in preschool children with and without language impairment.Methods: 43 language impairment children(boy=34,girl=9,mean age± SD 50.86±9.680 months on average)and 71 normal control peers(n=71,boy=43,girl=28,mean age± SD 52.25±10.879 months on average)were retrospectively collected between September to November 2014.Using logistic regression model to analyze potential factors’ effect on abnormal peer relationship,including language,demographic factors,nonverbal IQ and screen exposure in both language impairment group and normal control group.Results: Language impairment(LI)group’s abnormal rate of peer relation(67.44%)was higher than total sample(44.74%)and normal control group(30.99%).They were 5.105 times(Adjusted OR=5.975,95%CI 2.027-17.608,P=0.0012)more likely to experience peer relation problems than peers without LI.Screen exposure was a significant risk factor for peer relation problem in children with LI.For children with typical language,expressive language can be a strength for peer relation development,and boys are more susceptible to peer relation problem than girls.Conclusion: Lone time exposure to screen was harm to peer relation development for language-impaired children.It is more important to control media use and increase opportunities to parent-children interaction.thereby diminishing the rate of peer relation problems in preschool children with language impairment.