- Email: [email protected]
15.0 Advances in Understanding and Assessing Communication and Language Disorders in Clinical Populations
SYMPOSIA 15.0 – 15.2
significant improvement in PTSD (p ¼ 0.001) and depressive (p ¼ 0.018) symptoms. Conclusions: W+L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.
PTSD Supported by NIMH Grant R01MH095208 http://dx.doi.org/10.1016/j.jaac.2016.07.203
SYMPOSIUM 15 ADVANCES IN UNDERSTANDING AND ASSESSING COMMUNICATION AND LANGUAGE DISORDERS IN CLINICAL POPULATIONS Theodore A. Petti, MD, MPH, Robert Wood Johnson School of Medicine, UBHC, 671 Hoes Ln W, Piscataway, NJ 08854-8021; Theodore Shapiro, MD; Claudio O. Toppelberg, MD Objectives: This Symposium describes maturation, development, and importance of communication skills and higher-order language (HOL, social/ pragmatic) throughout childhood; tool development to assess HOL from preschool through adulthood; and the prevalence of HOL impairment (HOLI) in psychiatrically ill youth. It considers preventive aspects of special education in children with communication disorders and demonstrates that a youth in clinical settings can report them. Methods: The role of communication in normal and abnormal development is presented. The emphasis is on HOL, illustrated by a tool to assess for deficits, and its development across the lifespan. Results: from the study of 144 mental health youth and 186 comparison youth (ages 12–18 years), assessed from standardized tests, indicate a much higher incidence of HOLI in the clinic group, with significantly lower scores on related deficits. Further analyses in a longitudinal study on psychiatric disorder trajectories in a community sample group of children (aged 5 years), with communication disorders, and a matched control cohort (age 31 years) indicate that the language disorder cohort has a significantly decreasing disorder trajectory in early adulthood associated only with special education, whereas other risk factors had no differential impact. Prevalence of self-reported communication deficits in two adolescent clinical populations and the implications for diagnosis, formulation, and treatment planning based on an anonymous forced-choice questionnaire are detailed. A large proportion showed frequent deficits with communication, anger at being ineffective, and a need for help. Few adolescents had been diagnosed with a communication disorder using standard psychiatric interviews. Results: Communication disorders cause serious impairment, are highly associated with comorbid psychiatric illness, and are underdiagnosed. HOLI is present at a high degree in youth receiving treatment in mental health programs. Adolescents can report communication disorders. Early intervention may improve functioning and decrease associated psychiatric symptoms. Conclusions: Communication disorders, highly prevalent in mental health settings, cause significant impairment and distress, may negatively affect the therapeutic relationship through miscommunication, and are infrequently diagnosed without formal assessment.
COMD CM LD Sponsored by AACAP's Health Promotion and Prevention Committee http://dx.doi.org/10.1016/j.jaac.2016.07.205
15.1 DEVELOPMENT OF A TEST OF HIGHER-ORDER LANGUAGE SKILLS Fataneh Farnia, PhD, Psychiatry, University of Toronto, M4Y 1E1, Toronto, ON M4Y 1E1, Canada; Nancy Cohen, PhD Objectives: Adolescents with higher-order language (HOL) impairment are at risk for being a school dropout and experience more problems in their adulthood (e.g., choice of lower standing career and subsequent lower earning) than their typically developing counterparts. Research suggests that HOL abilities are related to different types of psychopathology. Thus, timely identification
S280
www.jaacap.org
and treatment of HOL impairment is of essence. However, there is a lack of standardized measures that reflect present-day language usage, provide current norms, and represent today’s multicultural societies and technologically modern population. The objectives of the presentation are as follows: 1) to review maturation and development of HOL throughout childhood, and 2) to describe development and properties of a tool that can measure HOL from preschool through adulthood. Methods: The presentation lays the groundwork for designing the Test of Higher Order Language (TOHOL) and compilation of items for three age ranges: early childhood (ages 2–5 years), middle childhood (ages 6–11 years), and adolescence (ages 12–18 years). The framework of the TOHOL that includes aspects of higher-order language (idioms, similes, metaphors, proverbs, sarcasm, semantic, and syntactic ambiguity) is described. Use of a Rasch method to inform final item selection is detailed. Results: The TOHOL items were created to assess the developmental progression of receptive and expressive figurative language from preschool through adulthood. The test will allow a culturally sensitive and reliable assessment of early markers of higher-order language applicable to individuals with different cognitive, psychiatric, and functional abilities. Relevance of results to family background and developmental information is discussed. Conclusions: HOL develops from early childhood and has an impact on cognitive and emotional growth. It is important to assess progression of HOL language abilities to identify problems as early in development as possible and thus to develop the most appropriate treatment plans. Implications for informing psychiatric and psychoeducational services for children from preschool onward are discussed.
DEV http://dx.doi.org/10.1016/j.jaac.2016.07.206
15.2 IMPLICATIONS OF HIGHER-ORDER LANGUAGE PROBLEMS FOR ADOLESCENT MENTAL HEALTH AND PSYCHIATRIC TREATMENT Nancy Cohen, PhD, Psychology, Hincks-Dellcrest Centre and University of Toronto, 114 Maitland Street, Toronto, ON M4Y 1E1, Canada; Fataneh Farnia, PhD Objectives: The goals of this session are to describe the association between difficulties in higher-order language skills, academic performance, and socialemotional adjustment in adolescents and to demonstrate the prevalence of communication deficits in adolescents presenting for mental healthcare and implications for assessment and treatment. Methods: This study is based on research that children and youth presenting for mental health care have unidentified language impairment without formal testing. The study goes beyond prior structural language-focused research (e.g., vocabulary size, grammar, and phonological awareness). Upon transition to adolescence, language demands grow in complexity (higher-order language, HOL) (e.g., to understand abstract concepts, make inferences, and integrate verbal/nonverbal cues). HOL deficits are known to contribute to difficulties in social relationships and therapeutic interchanges. Thus, standardized tests of intelligence, working memory, structural and HOL, reading achievement, and related factors were administered to 144 clinic-referred and 186 comparison youth (aged 12–18 years). Parent ratings on the Child Behavior Checklist provided a measure of severity of social-emotional problems. Results: Adolescents (45 percent) presenting for mental health service had an HOL impairment not identified previously compared to 15 percent of comparison youth. Clinic and comparison youth did not differ significantly in nonverbal IQ; however, clinic-referred youth scored significantly lower on measures of structural language and HOL, working memory, word reading and reading comprehension, and interpersonal negotiating skills. HOL impairments were associated with parent ratings of the severity of externalizing psychopathology in the clinic sample group. Conclusions: Many youth presenting for mental health services have undiagnosed language impairments. Study findings are important because of the following: 1) HOL deficits have an impact on case formulation and treatment; and 2) therapeutic techniques rely on skills where HOL is at
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
significant improvement in PTSD (p ¼ 0.001) and depressive (p ¼ 0.018) symptoms. Conclusions: W+L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.
PTSD Supported by NIMH Grant R01MH095208 http://dx.doi.org/10.1016/j.jaac.2016.07.203
SYMPOSIUM 15 ADVANCES IN UNDERSTANDING AND ASSESSING COMMUNICATION AND LANGUAGE DISORDERS IN CLINICAL POPULATIONS Theodore A. Petti, MD, MPH, Robert Wood Johnson School of Medicine, UBHC, 671 Hoes Ln W, Piscataway, NJ 08854-8021; Theodore Shapiro, MD; Claudio O. Toppelberg, MD Objectives: This Symposium describes maturation, development, and importance of communication skills and higher-order language (HOL, social/ pragmatic) throughout childhood; tool development to assess HOL from preschool through adulthood; and the prevalence of HOL impairment (HOLI) in psychiatrically ill youth. It considers preventive aspects of special education in children with communication disorders and demonstrates that a youth in clinical settings can report them. Methods: The role of communication in normal and abnormal development is presented. The emphasis is on HOL, illustrated by a tool to assess for deficits, and its development across the lifespan. Results: from the study of 144 mental health youth and 186 comparison youth (ages 12–18 years), assessed from standardized tests, indicate a much higher incidence of HOLI in the clinic group, with significantly lower scores on related deficits. Further analyses in a longitudinal study on psychiatric disorder trajectories in a community sample group of children (aged 5 years), with communication disorders, and a matched control cohort (age 31 years) indicate that the language disorder cohort has a significantly decreasing disorder trajectory in early adulthood associated only with special education, whereas other risk factors had no differential impact. Prevalence of self-reported communication deficits in two adolescent clinical populations and the implications for diagnosis, formulation, and treatment planning based on an anonymous forced-choice questionnaire are detailed. A large proportion showed frequent deficits with communication, anger at being ineffective, and a need for help. Few adolescents had been diagnosed with a communication disorder using standard psychiatric interviews. Results: Communication disorders cause serious impairment, are highly associated with comorbid psychiatric illness, and are underdiagnosed. HOLI is present at a high degree in youth receiving treatment in mental health programs. Adolescents can report communication disorders. Early intervention may improve functioning and decrease associated psychiatric symptoms. Conclusions: Communication disorders, highly prevalent in mental health settings, cause significant impairment and distress, may negatively affect the therapeutic relationship through miscommunication, and are infrequently diagnosed without formal assessment.
COMD CM LD Sponsored by AACAP's Health Promotion and Prevention Committee http://dx.doi.org/10.1016/j.jaac.2016.07.205
15.1 DEVELOPMENT OF A TEST OF HIGHER-ORDER LANGUAGE SKILLS Fataneh Farnia, PhD, Psychiatry, University of Toronto, M4Y 1E1, Toronto, ON M4Y 1E1, Canada; Nancy Cohen, PhD Objectives: Adolescents with higher-order language (HOL) impairment are at risk for being a school dropout and experience more problems in their adulthood (e.g., choice of lower standing career and subsequent lower earning) than their typically developing counterparts. Research suggests that HOL abilities are related to different types of psychopathology. Thus, timely identification
S280
www.jaacap.org
and treatment of HOL impairment is of essence. However, there is a lack of standardized measures that reflect present-day language usage, provide current norms, and represent today’s multicultural societies and technologically modern population. The objectives of the presentation are as follows: 1) to review maturation and development of HOL throughout childhood, and 2) to describe development and properties of a tool that can measure HOL from preschool through adulthood. Methods: The presentation lays the groundwork for designing the Test of Higher Order Language (TOHOL) and compilation of items for three age ranges: early childhood (ages 2–5 years), middle childhood (ages 6–11 years), and adolescence (ages 12–18 years). The framework of the TOHOL that includes aspects of higher-order language (idioms, similes, metaphors, proverbs, sarcasm, semantic, and syntactic ambiguity) is described. Use of a Rasch method to inform final item selection is detailed. Results: The TOHOL items were created to assess the developmental progression of receptive and expressive figurative language from preschool through adulthood. The test will allow a culturally sensitive and reliable assessment of early markers of higher-order language applicable to individuals with different cognitive, psychiatric, and functional abilities. Relevance of results to family background and developmental information is discussed. Conclusions: HOL develops from early childhood and has an impact on cognitive and emotional growth. It is important to assess progression of HOL language abilities to identify problems as early in development as possible and thus to develop the most appropriate treatment plans. Implications for informing psychiatric and psychoeducational services for children from preschool onward are discussed.
DEV http://dx.doi.org/10.1016/j.jaac.2016.07.206
15.2 IMPLICATIONS OF HIGHER-ORDER LANGUAGE PROBLEMS FOR ADOLESCENT MENTAL HEALTH AND PSYCHIATRIC TREATMENT Nancy Cohen, PhD, Psychology, Hincks-Dellcrest Centre and University of Toronto, 114 Maitland Street, Toronto, ON M4Y 1E1, Canada; Fataneh Farnia, PhD Objectives: The goals of this session are to describe the association between difficulties in higher-order language skills, academic performance, and socialemotional adjustment in adolescents and to demonstrate the prevalence of communication deficits in adolescents presenting for mental healthcare and implications for assessment and treatment. Methods: This study is based on research that children and youth presenting for mental health care have unidentified language impairment without formal testing. The study goes beyond prior structural language-focused research (e.g., vocabulary size, grammar, and phonological awareness). Upon transition to adolescence, language demands grow in complexity (higher-order language, HOL) (e.g., to understand abstract concepts, make inferences, and integrate verbal/nonverbal cues). HOL deficits are known to contribute to difficulties in social relationships and therapeutic interchanges. Thus, standardized tests of intelligence, working memory, structural and HOL, reading achievement, and related factors were administered to 144 clinic-referred and 186 comparison youth (aged 12–18 years). Parent ratings on the Child Behavior Checklist provided a measure of severity of social-emotional problems. Results: Adolescents (45 percent) presenting for mental health service had an HOL impairment not identified previously compared to 15 percent of comparison youth. Clinic and comparison youth did not differ significantly in nonverbal IQ; however, clinic-referred youth scored significantly lower on measures of structural language and HOL, working memory, word reading and reading comprehension, and interpersonal negotiating skills. HOL impairments were associated with parent ratings of the severity of externalizing psychopathology in the clinic sample group. Conclusions: Many youth presenting for mental health services have undiagnosed language impairments. Study findings are important because of the following: 1) HOL deficits have an impact on case formulation and treatment; and 2) therapeutic techniques rely on skills where HOL is at
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016