Michelle C. St Clair

A Longitudinal Study of Behavioral, Emotional and Social Difficulties in Individuals with a History of Specific Language Impairment (SLI).

UNLABELLED Children with specific language impairment (SLI) have often been reported to have associated behavioral, emotional and social difficulties. Most previous studies involve observations at a single time point, or cross sectional designs, and longitudinal evidence of the developmental trajectories of particular difficulties is limited. The Strengths and Difficulties Questionnaire was used to measure behavioral (hyperactivity and conduct), emotional and social (peer) problems in a sample of individuals with a history of SLI at four time points from childhood (age 7) to adolescence (age 16). A decrease in behavioral and emotional problems was observed from childhood to adolescence, although emotional problems were still evident in adolescence. In contrast, there was an increase in social problems. Reading skills and expressive language were related only to behavioral problems. Pragmatic abilities were related to behavioral, emotional and social difficulties. As a group, those with a history of SLI have poorer long term social and, to a lesser extent, emotional outcomes. In contrast, behavioral difficulties appear to decrease to normative levels by adolescence. Different aspects of early language abilities and reading skills exert different types and degrees of influence on behavioral, emotional and social difficulties. LEARNING OUTCOMES Readers will be able to: (1) understand the types of behavioral, emotional and social difficulties present in individuals with a history of SLI; (2) be familiar with the developmental trajectory of these difficulties from childhood to adolescence; and (3) understand the relationships between behavioral, emotional and social difficulties and early language and literacy ability.

Relationships Between Language Structure and Language Learning: The Suffixing Preference and Grammatical Categorization

It is a reasonable assumption that universal properties of natural languages are not accidental. They occur either because they are underwritten by genetic code, because they assist in language processing or language learning, or due to some combination of the two. In this paper we investigate one such language universal: the suffixing preference across the worlds languages, whereby inflections tend to be added to the end of words. A corpus analysis of child-directed speech in English found that suffixes were more accurate at cuing the grammatical category of the root word than were prefixes. An artificial language experiment found that there was a learning advantage for suffixes over prefixes in terms of grammatical categorization within an artificial language. The results are consistent with an account of language universals that originate in general purpose learning mechanisms.

Learning grammatical categories from distributional cues:Flexible frames for language acquisition

Numerous distributional cues in the childs environment may potentially assist in language learning, but what cues are useful to the child and when are these cues utilised? We propose that the most useful source of distributional cue is a flexible frame surrounding the word, where the language learner integrates information from the preceding and the succeeding word for grammatical categorisation. In corpus analyses of child-directed speech together with computational models of category acquisition, we show that these flexible frames are computationally advantageous for language learning, as they benefit from the coverage of bigram information across a large proportion of the language environment as well as exploiting the enhanced accuracy of trigram information. Flexible frames are also consistent with the developmental trajectory of childrens sensitivity to different sources of distributional information, and they are therefore a useful and usable information source for supporting the acquisition of grammatical categories.

Growth of reading skills in children with a history of specific language impairment: The role of autistic symptomatology and language-related abilities

Individuals with a history of specific language impairment (SLI) often have subsequent problems with reading skills, but there have been some discrepant findings as to the developmental time course of these skills. This study investigates the developmental trajectories of reading skills over a 9-year time-span (from 7 to 16 years of age) in a large sample of individuals with a history of SLI. Relationships among reading skills, autistic symptomatology, and language-related abilities were also investigated. The results indicate that both reading accuracy and comprehension are deficient but that the development of these skills progresses in a consistently parallel fashion to what would be expected from a normative sample of same age peers. Language-related abilities were strongly associated with reading skills. Unlike individuals with SLI only, those with SLI and additional autistic symptomatology had adequate reading accuracy but did not differ from the individuals with SLI only in reading comprehension. They exhibited a significant gap between what they could read and what they could understand when reading. These findings provide strong evidence that individuals with SLI experience continued, long-term deficits in reading skills from childhood to adolescence.

Exercise and depressive symptoms in adolescents: a longitudinal cohort study

IMPORTANCE Physical activity (PA) may have a positive effect on depressed mood. However, whether it can act as a protective factor against developing depressive symptoms in adolescence is largely unknown. OBJECTIVE To investigate the association between objectively measured PA and depressive symptoms during 3 years of adolescence. DESIGN, SETTING, AND PARTICIPANTS We performed a longitudinal study between November 1, 2005, and January 31, 2010, of a community-based sample from Cambridgeshire and Suffolk, United Kingdom, that included 736 participants (mean [SD] age, 14.5 years [6 months]). The follow-up period was approximately 3 years after baseline (the ROOTS study). Linear regression models were fitted using physical activity energy expenditure (PAEE) and moderate and vigorous physical activity (MVPA) as the predictors and depressive symptoms as the outcome variable. Binomial logistic regression models were also fitted using PAEE and MVPA as the predictors and clinical depression as the outcome measure. EXPOSURES Exercise. MAIN OUTCOMES AND MEASURES Individually calibrated heart rate and movement sensing were used to measure PA at baseline only. Physical activity summary measures included total PAEE and time spent in MVPA. These measures were divided into weekend and weekday activity. All participants also completed the Mood and Feelings Questionnaire, a self-report measure of current depressive symptoms, and took part in a Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview at baseline and 3 years later. RESULTS Depressive symptoms at 3-year follow-up were not significantly predicted by any of the 4 PA measures at baseline: weekend MVPA (unstandardized β = 0.02; 95% CI, -0.15 to 0.20; P = .79), weekday MVPA (β = 0.00; 95% CI, -0.17 to 0.17; P = .99), weekend PAEE (β = 0.03; 95% CI, -0.14 to 0.20; P = .75), and weekday PAEE (β = -0.03; 95% CI, -0.20 to 0.14; P = .71). This was also true for major depressive disorder diagnoses at follow-up: weekend MVPA (odds ratio [OR], 1.37; 95% CI, 0.76-2.48; P = .30), weekday MVPA (OR, 1.33; 95% CI, 0.74-2.37; P = .34), weekend PAEE (OR, 1.19; 95% CI, 0.67-2.10; P = .56), and weekday PAEE (OR, 0.92; 95% CI, 0.52-1.63; P = .78). CONCLUSIONS AND RELEVANCE No longitudinal association between objectively measured PA and the development of depressive symptoms was observed in this large population-based sample. These results do not support the hypothesis that PA protects against developing depressive symptoms in adolescence.

Childhood adversity subtypes and depressive symptoms in early and late adolescence

Within a longitudinal study of 1,005 adolescents, we investigated how exposure to childhood psychosocial adversities was associated with the emergence of depressive symptoms between 14 and 17 years of age. The cohort was classified into four empirically determined adversity subtypes for two age periods in childhood (0–5 and 6–11 years). One subtype reflects normative/optimal family environments (n = 692, 69%), while the other three subtypes reflect differential suboptimal family environments (aberrant parenting: n = 71, 7%; discordant: n = 185, 18%; and hazardous: n = 57, 6%). Parent-rated child temperament at 14 years and adolescent self-reported recent negative life events in early and late adolescence were included in models implementing path analysis. There were gender-differentiated associations between childhood adversity subtypes and adolescent depressive symptoms. The discordant and hazardous subtypes were associated with elevated depressive symptoms in both genders but the aberrant parenting subtype only so in girls. Across adolescence the associations between early childhood adversity and depressive symptoms diminished for boys but remained for girls. Emotional temperament was also associated with depressive symptoms in both genders, while proximal negative life events related to depressive symptoms in girls only. There may be neurodevelopmental factors that emerge in adolescence that reduce depressogenic symptoms in boys but increase such formation in girls.

5-HTTLPR-environment interplay and its effects on neural reactivity in adolescents.

It is not known how 5-HTTLPR genotype × childhood adversity (CA) interactions that are associated with an increased risk for affective disorders in population studies operate at the neural systems level. We hypothesized that healthy adolescents at increased genetic and environmental risk for developing mood disorders (depression and anxiety) would demonstrate increased amygdala reactivity to emotional stimuli compared to those with only one such risk factor or those with none. Participants (n = 67) were classified into one of 4 groups dependent on being homozygous for the long or short alleles within the serotonin-transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene and exposure to CA in the first 11 years of life (present or absent). A functional magnetic resonance imaging investigation was undertaken which involved viewing emotionally-salient face stimuli. In addition, we assessed the role of other variables hypothesized to influence amygdala reactivity, namely recent negative life-events (RNLE) assessed at ages 14 and 17, current anxiety symptoms and psychiatric history. We replicated prior findings demonstrating moderation by gene variants in 5-HTTLPR, but found no support for an effect of CA on amygdala reactivity. We also found a significant effect of RNLE aged 17 with amygdala reactivity demonstrating additive, but not interactive effects with 5-HTTLPR. A whole-brain analysis found a 5-HTTLPR × CA interaction in the lingual gyrus whereby CA appears to differentially modify neural reactivity depending on genotype. These results demonstrate that two different forms of environmental adversities interplay with 5-HTTLPR and thereby differentially impact amygdala and cortical reactivity.

Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents

Background Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications. Methods We used structural equation modelling and examined the impact of adolescent friendships and/or family support at age 14 on depressive symptoms at age 17 in adolescents exposed to ELS before age 11. To this end, we used structural equation modelling in a community sample of 771 adolescents (322 boys and 477 girls) from a 3 year longitudinal study. Significant paths in the model were followed-up to test whether social support mediated or moderated the association between ELS and depressive symptoms at age 17. Results We found that adolescent social support in adolescence is negatively associated with subsequent depressive symptoms in boys and girls exposed to ELS. Specifically, we found evidence for two mediational pathways: In the first pathway family support mediated the link between CFA and depressive symptoms at age 17. Specifically, CFA was negatively associated with adolescent family support at age 14, which in turn was negatively associated with depressive symptoms at age 17. In the second pathway we found that adolescent friendships mediated the path between peer bullying and depressive symptoms. Specifically, relational bullying was negatively associated with adolescent friendships at age 14, which in turn were negatively associated with depressive symptoms at age 17. In contrast, we did not find a moderating effect of friendships and family support on the association between CFA and depressive symptoms. Conclusions Friendships and/or family support in adolescence mediate the relationship between ELS and late adolescent depressive symptoms in boys and girls. Therefore, enhancing affiliate relationships and positive family environments may benefit the mental health of vulnerable youth that have experienced CFA and/or primary school bullying.

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later

BackgroundUK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services.MethodsA cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074).ResultsAt discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes.ConclusionsThe findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person’s readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.

Characterising the latent structure and organisation of self-reported thoughts, feelings and behaviours in adolescents and young adults

Little is known about the underlying relationships between self-reported mental health items measuring both positive and negative emotional and behavioural symptoms at the population level in young people. Improved measurement of the full range of mental well-being and mental illness may aid in understanding the aetiological substrates underlying the development of both mental wellness as well as specific psychiatric diagnoses. A general population sample aged 14 to 24 years completed self-report questionnaires on anxiety, depression, psychotic-like symptoms, obsessionality and well-being. Exploratory and confirmatory factor models for categorical data and latent profile analyses were used to evaluate the structure of both mental wellness and illness items. First order, second order and bifactor structures were evaluated on 118 self-reported items obtained from 2228 participants. A bifactor solution was the best fitting latent variable model with one general latent factor termed ‘distress’ and five ‘distress independent’ specific factors defined as self-confidence, antisocial behaviour, worry, aberrant thinking, and mood. Next, six distinct subgroups were derived from a person-centred latent profile analysis of the factor scores. Finally, concurrent validity was assessed using information on hazardous behaviours (alcohol use, substance misuse, self-harm) and treatment for mental ill health: both discriminated between the latent traits and latent profile subgroups. The findings suggest a complex, multidimensional mental health structure in the youth population rather than the previously assumed first or second order factor structure. Additionally, the analysis revealed a low hazardous behaviour/low mental illness risk subgroup not previously described. Population sub-groups show greater validity over single variable factors in revealing mental illness risks. In conclusion, our findings indicate that the structure of self reported mental health is multidimensional in nature and uniquely finds improved prediction to mental illness risk within person-centred subgroups derived from the multidimensional latent traits.