Language impairments affect 3–7% of the population (Norbury & Paul, 2013), yet receive very little public attention, research interest or research funding (Bishop, 2010). This is quite surprising given that language is central to our everyday lives; we use language to learn and to work, to communicate with our friends and loved ones and to access leisure activities such as reading and television. Additionally, language is a fantastic resource for problem solving, negotiating and managing our thoughts, feelings and behaviour. Thus, language impairment places a child at greatly increased risk of negative social, emotional and behavioural outcomes.1 Two papers in the current issue provide empirical evidence for the strong association between language competence and adolescent mental health.
Cohen et al.2 assessed 144 adolescents referred to mental health services and 186 non-referred peers. Overall, the referred group had significantly lower scores on standardised tests of structural and pragmatic language abilities, with 45% of the group meeting criteria for language impairment. Lower non-verbal IQ, poorer working memory, and lower levels of maternal education increased risk for language impairment in this group.
These findings resonate with earlier seminal work by the same research group, demonstrating high proportions of children referred to child and mental health services for emotional and behavioural problems experienced concomitant language impairments, many of which were previously unsuspected (Cohen et al. 1998). The findings are also in accord with longitudinal studies of children with identified language and communication impairments, who are at elevated risk for social, emotional and behavioural difficulties in adolescence and adulthood (Snowling, Bishop, Stothard, Chipchase, & Kaplan, 2006; St Clair, Pickles, Durkin, & Conti-Ramsden, 2011).
Im-Bolter et al. investigated the role of language impairment in social cognitive reasoning in the same group of children. The referred adolescents were rated by themselves and by their parents to have more severe internalising and externalising symptoms, more severe symptoms overall, and less social competence than the comparison group.
The adolescents were asked to complete the Interpersonal Negotiation Strategies interview (INS: Schultz et al. 1989), which presents two hypothetical vignettes depicting a social conflict with a familiar peer and a social conflict with an adult of higher social status (an employer). Eight questions are used to elicit the individual's ability to identify the problem, identify emotions of those involved in the conflict, provide a strategy for solving the conflict, identify potential obstacles to conflict resolution, identify solutions to overcoming obstacles, and determine when the problem had been satisfactorily resolved. Referred adolescents achieved lower scores overall, and had particular challenges identifying potential obstacles to conflict resolution and how to overcome them, as well as recognising when a conflict had been resolved. Within the referred group, scores on measures of figurative language comprehension made significant contribution to scores on the INS, even when age, working memory and structural language abilities had been taken into account. This study highlights how important language is for managing relationships and social problem solving.
Together, both studies draw our attention to two additional factors of great importance. First, language impairments, like psychiatric disturbance more generally (cf. Copeland et al.), persist into adolescence and have a remarkably stable trajectory (Conti-Ramsden, St. Clair, Pickles, & Durkin, 2012). Indeed, difficulties using language to negotiate with peers have been reported in children as young as six (Brinton, Fujiki, & McKee, 1998). Thus children presenting in clinic should be evaluated for language learning difficulties. Those with language impairment are likely to require support and monitoring over the longer term.
Second, these papers highlight the need to consider language ability in planning and delivering intervention, and predicting response to treatment. Numerous psychological interventions rely heavily on the individual's ability to use language to identify treatment goals, articulate the difficulties they are experiencing and exceptions to problems, reflect on their behavioural strengths and resources and regulate their own behaviour and interactions. This is illustrated nicely Bond et al.'s review of solution focused brief therapy (SFBT), and it is notable that many of the populations in which SFBT was applied are groups in which language impairments co-occur at higher than expected rates.
It therefore seems prudent for clinicians and researchers to routinely collect information about a child's language abilities and consider how variation in language ability may influence response to treatment. Grant et al. discuss developing CONSORT extensions for educational and psychological interventions, and identify a need for research reports to provide more information about external validity of trials: how interventions work, for whom and under what conditions. Language status may be an important moderator of intervention effects and long term mental health outcomes.