Language Disorder in Preschoolers

Well-designed large population-based studies of the prevalence and correlates of learning disabilities in preschool children are rare.

A research group working out of University College London has address that issues with a large study of language disorder in a group of over 7000 4 and 5 year olds in England.

A stratified group of 529 children received a comprehensive assessment of language along with assessment of IQ, social, emotional and behavior function.

The study found the following important points.

• The prevalence of language disorders in the sample was 9.9%
• This group consisted of 7.6% with language disorder of unknown origin and 2.3% with language disorder associated with intellectual disability or known medical condition
• Language disorder diagnosis was linked to a wide array of other problems including failure to make academic progress
• A significant number of children with normal non-verbal IQ demonstrated language disorder

The authors of the study not their findings suggest that out of every classroom with 30 students, two will have significant language problems. This supports comprehensive screening early to identify these children at high-risk for academic failure.

You can read more about this study in MedicalXpress HERE.

The free full-text manuscript can be accessed HERE.

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Photo of children at play during sunset is from my personal collection. 

Norbury, C., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., Vamvakas, G., & Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study Journal of Child Psychology and Psychiatry DOI: 10.1111/jcpp.12573

One Parent,Two Parents and Child Well-Being

The structure of the family in the United States and other countries is changing. 

This change has occurred over a relatively brief period of time. Data noted in the study I am reviewing today shows that between 1970 and 2013 in the U.S.:

• Percentage of children living with two parents dropped 24%
• Percentage of children living with a single mother increased to 23.7%
• Percentage of children living with a single father quadrupled to 4.1%
• Percentage of children living with a grandparent doubled to 6.2%

It is important to understand how these changes in the structure of family effects children across a variety of domains.

This topic is the focus of an important manuscript published in Population Health Metrics. Patrick Krueger along with four colleagues summarized data related to parental structure and child well-being using the National Health Interview Survey.

They grouped parental structure into nine parental groups. Using married couples (comprising 67% of the sample) as a reference parental unit other structural units in the study included: cohabiting non-married couples, single mother, single father, extended married couple, extended cohabiting couple, extended single mother, extended single mother and skipped generation (care by grandparent). Extended modifiers were added to parental structure when at least one grandparent was available and provided direct care activity to the child.

Children with the various parental structures were compared across multiple variables. The findings that stood out to me included the following:

• Children of married couples generally show higher markers of well-being. However, this effect is reduced but not eliminated when controlling for socioeconomic status
• Children living with a single father fared better than children living with a single mother--fewer ER visits, fewer missed school days, better global health status
• The presence of an extended grandparent did not appear to significantly buffer the effect of single parent on health well-being and other well-being measures
• Learning disabilities and child ADHD rates were highest in children of single mothers and children being raised by grandparents
• Children of single mothers were more likely to be reported as having several medical problems including headaches, ear infections, asthma and anemia 

The findings from this study are important. The most important implication from my perspective is the need to identify at-risk children across all family structure groups. Targeting assessment and intervention assistance in children of single mother and grandparents may produce the highest improvement in well-being and outcome.

The additional services required to address changes in parental structure are evident. Improving access to child medical and mental health care seems to be a key first step. Providing additional financial assistance, assistance with transportation and regular day care support is needed. Expanding early childhood education programs and integrating medical and mental health services with school services may also benefit those most at risk.

There is a load of data in this important paper that readers may want to review in more detail. The free full-text manuscript can be accessed by clicking on the PMID link in the citation below.

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Krueger PM, Jutte DP, Franzini L, Elo I, & Hayward MD (2015). Family structure and multiple domains of child well-being in the United States: a cross-sectional study. Population health metrics, 13 PMID: 25729332

Autism Spectrum: Why Boys Are At Higher Risk

It is no secret gender plays a key role in the risk for a variety of childhood developmental disorders. Discussion of this issue is often difficult as biases in how boys and girls are raised and evaluated can contribute to confusion. Nevertheless, research progresses in explaining why boys are more likely to develop autism spectrum condition (ASC) and other neurodevelopmental abnormalities.

Baron-Cohen and colleagues from the UK and US recently summarized some of the potential mechanisms for male predominance in autism spectrum. They note a significant male predominance in a group of childhood neurodevelopmental disorders in addition to ASC:

• ADHD
• Conduct disorder
• Developmental reading disorders (dyslexia)
• Specific language impairment
• Tourette Syndrome

They note rates for ASC in boys is 4:1 compared to girls and for full autism is estimated as high as 11:1.

The authors note that predominance of ASC and other neurodevelopmental disorders in boys may be an “extreme expression of the male brain”. This concept states that boys and girls brains begin to differ early in the uterus. These differences result in different strengths and weaknesses. ASC may be an example of the male brain development gone too far.

Females appear to have a stronger drive to empathize (identify and respond to the feelings of others) while the male brain appears to have a stronger drive to systemize (analyze and construct rule based systems). The ASC as extreme male brain theory would propose the ASC brain is just the prototypical male brain gone to far in masculinization.

Males typically have three surges of the male hormone or androgen testosterone. The first surge occurs between 2 and 6 months in the uterus. This surge if felt to be responsible for brain masculization. The second surge occurs in the first six months of life and the third and final surge occurs in adolescence around puberty. If ASC is an example of the extreme male brain, then the fetal testosterone surge might be expected to be higher in those with ASC.

Progress in this front has evolved by comparing fetal testosterone levels with a variety of cognitive, behavioral and and emotional traits. Among normal children the following relationships have be discovered:

Positive associations with fetal testosterone levels (high levels with higher evidence of trait)

• Autistic traits
• Restricted or reduced interests
• Tendency to systemize
• Rightward asymmetry of brain corpus callosum (isthmus)

Negative associations with fetal testosterone (high levels with lower evidence of trait)

• Amount of eye contact
• Quality of social relationships
• Vocabulary size
• Empathy

Studies in those with ASC also appear to support the extreme brain hypothesis. Ten genes related to sex steroid synthesis, transport or metabolism have been linked to ASC or empathy traits. Testosterone levels tend to be higher in males with ASC than those without. Research in progress is likely to provide additional information on the merit of the extreme male brain hypothesis

The authors note there are other theories that might be supported in future research on the gender ratio in ASC. Two of these theories stem from differences in the X and Y chromosome.

A better understanding of why boys are at higher risk of ASC and autism is important. Such understanding might provide insight into avenues for early diagnosis and treatment.

Molecular model of the chemical structure of testosterone from Wikipedia Creative Commons file by Ben Mills. 


Baron-Cohen S, Lombardo MV, Auyeung B, Ashwin E, Chakrabarti B, & Knickmeyer R (2011). Why are autism spectrum conditions more prevalent in males? PLoS biology, 9 (6) PMID: 21695109