Associations between expressive and receptive language and internalizing and externalizing behaviours in a community-based prospective study of slow-to-talk toddlers

摘要

Background: Evidence suggests that language and social, emotional and behavioural (SEB) difficulties are associatedin children and adolescents. When these associations emerge and whether they differ by language or SEB difficultyprofile is unclear. This knowledge is crucial to guide prevention and intervention programmes for children withlanguage and SEB difficulties.Aims: To determine whether receptive and expressive language skills are associated with internalizing and externalizingbehaviours in slow-to-talk toddlers.Methods & Procedures:In a community-based prospective study of 200 slow-to-talk children, language was measuredat 24 and 36 months using Preschool Language Scale 4th Edition and at 48 months using Clinical Evaluation ofLanguage Fundamentals—Preschool 2nd Edition. Internalizing and externalizing behaviours were measured byparent report at each age. Longitudinal data were analysed using repeated-measures regression, with up to threeobservations per child. Robust standard errors were used to account for non-independence of measures withinparticipants. The shape of the associations were examined by fitting quadratic and cubic terms. The effects ofconfounders on the associations were examined.Outcomes & Results: Receptive language had a negative linear association with internalizing behaviours afteradjusting for confounders (β = –0.16, 95% [CI = –0.26, –0.07], p = .001); and a negative curved associationwith externalizing behaviours after adjusting for biological confounders (βquadratic = 0.08 [0.01, 0.15], p = .03,βcubic = –0.04 [–0.07, –0.02], p = .001), attenuating after adjusting for environmental confounders (βquadratic =0.06 [–0.01, 0.13], p = .09, βcubic = –0.03 [–0.06, –0.003], p = .03). The curvature suggests that the negativeassociation with externalizing behaviours only existed for children with either very low or very high receptivelanguage scores. After controlling for confounders, there was no evidence that expressive language scores wereassociated with internalizing (β = –0.08, 95% [CI = –0.17, 0.01], p = .10) or externalizing behaviours (β =0.03, 95% [CI = –0.09, 0.18], p = .61). Tests of interaction revealed no evidence of a differential association by age.Conclusions & Implications: In 24–48-month-old slow-to-talk children, lower receptive language scores wereassociated with higher internalizing behaviours. The magnitude of the association was small. For children withvery poor receptive language scores, lower receptive language skills were associated with higher externalizingbehaviours. Young children with low receptive language abilities may be at risk of internalizing difficulties; thosewith very low receptive language skills may be at particular risk of externalizing difficulties. This has clinicalimplications for interventions for young children with receptive language difficulties.