Nancy J. Cohen

The Interface between ADHD and Language Impairment: An Examination of Language, Achievement, and Cognitive Processing

Language impairments are commonly observed among children referred for psychiatric services. The most frequent psychiatric diagnosis of children with language impairment (LI) is Attention Deficit Hyperactivity Disorder (ADHD). It is not clear whether there are differences between children with ADHD and comorbid LI and children with other psychiatric disorders who are also comorbid for LI. In the present study the language, achievement, and cognitive processing characteristics of 166 psychiatrically referred 7-14-year-old children were examined using a 2 x 2 (ADHD, LI) design to examine four groups: children with ADHD + LI, children with ADHD who have normally developing language, children with psychiatric diagnoses other than ADHD with a language impairment (OPD + LI) or without a LI (OPD). Results indicated that children with LI were at the most disadvantage regardless of the nature of the psychiatric diagnosis. Contrary to prediction, working memory measures, used to tap the core cognitive deficit of ADHD in executive functions, were more closely associated with LI than with ADHD. It was concluded that caution must be exercised in attributing to children with ADHD what might be a reflection of problems for children with language impairment generally. As most therapies are verbally based it is notable that language competence is rarely evaluated systematically before such therapies are undertaken.

WATCH, WAIT, AND WONDER: TESTING THE EFFECTIVENESS OF A NEW APPROACH TO MOTHER-INFANT PSYCHOTHERAPY

This research compared two forms of psychodynamic psychotherapeutic interventions for 67 clinically referred infants and their mothers. One was an infant-led psychotherapy delivered through a program called Watch, Wait, and Wonder (WWW). The other was a mother- infant psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately 5 months. A broad range of measures of attachment, qualities of the mother- infant relationship, maternal perception of parenting stress, parenting competence and satisfaction, depression, and infant cognition and emotion regulation were used. The WWW group showed a greater shift toward a more organized or secure attachment relationship and a greater improvement in cognitive development and emotion regulation than infants in the PPT group. Moreover, mothers in the WWW group reported

Language, Social Cognitive Processing, and Behavioral Characteristics of Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined characteristics of social cognitive processing, psychiatric disorder, and behavioral ratings of 380 children aged 7 to 14 years who had been referred consecutively for child psychiatric services with identified and unsuspected language impairments and with normally developing language. The results indicated that children with language impairments generally exhibited greater deficits in social cognitive processing, and particularly emotion decoding and social problem solving, than children who have language that is developing normally. Differences in psychiatric diagnosis and behavior problems were observed only between children with previously identified language impairments and children with normally developing language; children with previously identified language impairments were more likely to be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) and to be rated by both parents and teachers as having more severe attentional problems. In addition, teachers rated them as more socially withdrawn. The results suggest that it is important to incorporate measures of both social cognition and language functioning routinely into clinical assessment, something that currently is rarely done.

Language, Achievement, and Cognitive Processing in Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined the language, achievement, and cognitive characteristics of 380 children, aged 7 to 14 years, consecutively referred to child psychiatric services. Among those children referred solely for psychiatric problems, 40% had a language impairment that had never been suspected. Children with previously identified and unsuspected language impairments were similar with respect to receptive and expressive language and on measures of cognitive processing. Although both groups of children with language impairments exhibited poorer academic achievement than children with normal language, children with previously identified language impairments had the lowest achievement. The milder achievement problems of children with unsuspected language impairment may explain why their problems had not been suspected. Both the clinical and theoretical implications of the findings are discussed. Heightened awareness concerning the high frequency of language impairment and other cognitive processing problems in children referred for psychiatric assessment and treatment should lead to more systematic examination of language functioning and evaluation of the impact of language and communication functioning on therapeutic outcomes.

Evaluation of the Relative Effectiveness of Methylphenidate and Cognitive Behavior Modification in the Treatment of Kindergarten-Aged Hyperactive Children.

This study of kindergarten-aged hyperactive children evaluated the effects of three modes of treatment in relation to an untreated control group. The treatments were administered over a 3-month period and included cognitive behavior modification, methylphenidate, and the two treatments combined. A follow-up assessment was done approximately 1 year later at the end of the first grade. Analyses of psychological, rating scale observational, and interview data showed that hyperactive children became less symptomatic over time;the data did not provide evidence indicating that any of the treatments studied was more effective than any other or than no treatment at all.

Children adopted from China: a prospective study of their growth and development

BACKGROUND China has become a lead country for international adoption because of the relatively young age of the children and reported positive conditions of the orphanages. This study examined the process and outcome of growth and development of children adopted from China over their first two years with their adoptive families. METHOD Seventy infant girls adopted from China at 8 to 21 months of age (Mean age = 13 months) were examined on arrival in Canada and 6, 12, and 24 months later. Comparisons were made with non-adopted Canadian girls of similar age and from a similar family background as adoptive parents on indices of growth and standardized measures of mental, psychomotor, and language development. RESULTS At arrival, children adopted from China were smaller physically and exhibited developmental delays compared to current peers. Children adopted from China were functioning in the average range on physical and developmental measures within the first 6 months following adoption. However, they were not performing as well as current peers until the end of their second year after adoption. Even then, there was developmental variation in relation to comparison children and continuation of relatively smaller size with respect to height, weight, and head circumference. Physical measurement was related to outcomes at various points on all developmental measures. CONCLUSIONS Deprivation in experience in the first year of life has more long-lasting effects on physical growth than on mental development. The variable most consistently related to development was height-to-age ratio. As a measure of nutritional status, the findings reinforce the critical importance of early nutrition.

Expressed emotion in families of clinically referred and nonreferred children: Toward a further understanding of the expressed emotion index.

As assessed from a 5-min speech sample, level of expressed emotion (EE) in parents significantly discriminated between families of 7- to 16-year-old children who were referred for mental health treatment and a nonclinical comparison group ; however, both groups contained a relatively high proportion of high-EE families. Furthermore, EE independently predicted clinical-nonclinical group status when considered in conjunction with overall family functioning and level of psychological distress in mothers. Findings support the relevance of EE, although the measure showed poor specificity and an analysis of the components that comprise the EE index indicated that only certain components were pertinent. The need to reassess the meaning of the EE construct and strengthen its applicability for the general clinical population of children and families is discussed.

Discourse deficits associated with psychiatric disorders and with language impairments in children

The purpose of the current study was to examine whether types of discourse deficits were associated differentially with psychiatric disorders (PD) and with language impairments (LI) in children. Discourse analyses examining the occurrence of different types of discourse deficits in language structure, information structure, and flow of information were performed on the spoken narratives of 111 children aged 7 to 12 years who comprised 4 groups: (1) psychiatrically referred children with LI (PD + LI), (2) psychiatrically referred children with normally developing language (PD), (3) nonreferred children with language impairments (LI), and (4) nonreferred children with normally developing language (controls). Discourse deficits in language and information structure characterized children with LI, whereas disruptions in the flow of discourse characterized children with PD. Children with the comorbid condition exhibited deficits associated with both LI and PD; in addition, they displayed distinct deficits related to pronominal reference and causal cohesion. The findings provide a preliminary understanding of the associations among language, discourse, and psychopathology in children.

Outcome Evaluation of a Therapeutic Day Treatment Program for Delayed and Disturbed Preschoolers

This report describes some findings of an outcome evaluation of a multifocused day treatment program for delayed and disturbed preschoolers. The sample consisted of 55 children, 3 to 6 years of age, attending a therapeutic preschool, and 45 nonclinical comparison children. A battery of objective developmental, behavioral, and clinical measures was administered at an initial test point, 8 to 9 months later, and for children in teh therapeutic preschool, at discharge. The results indicated that children with developmental delays and associated emotional and behavioral problems made the most gains, particularly those who initially had nonverbal IQ scores within the normal range. Gains were not observed among children who presented primarily with behavior problems. The results also suggest that intervention for delayed children needs to be prolonged and that the time required for gains to be observed depends on the area of functioning being considered and the childs initial developmental level.

Perceptions and Attitudes of Hyperactive Children and their Mothers regarding Treatment with Methylphenidate

Fifteen hyperactive children and their mothers were interviewed regarding their knowledge, perception, and attitudes toward treatment with methylphenidate 6 months after commencing a stimulant regime with the child. Measures of locus of control and self-esteem were also administered to the child. The results indicated that mothers and children agreed on the effects of medication and knowledge about the cause of hyperactivity. Both mothers and children had mixed feelings about medication. Most of the children felt that continuing with this treatment was important and seemed to be more concerned than their mothers over negative consequences if medication was stopped. Although it has been suggested that impaired self-esteem may be a consequence of children seeing improved behaviour as a result of medication rather than self-control, the results indicated an increase in both self-esteem and internal, locus of control during the 6-month period of the study.