Language Profiles Associated With Pediatric ADHD With & Without Co- Occurring LI

Transcription

1 Language Profiles Associated With Pediatric ADHD With & Without Co- Occurring LI Sean M. Redmond, Ph.D., CCC-SLP University of Utah Funding Source: National Institute on Deafness and Other Communication Disorders Geralyn R. Timler, Ph.D., CCC-SLP Miami Unversity Funding Source: American Speech, Language, and Hearing Foundation

2 General Game Plan Redmond: Introduction, Children s Verbal Memory and Morphosyntactic Profiles Timler: Children s Social Communication (Pragmatic) Profiles, Conclusion We have no relevant financial or nonfinancial relationships to disclose

3 ADHD a common, and commonly co- occurring, disorder Attention-deficit/hyperactivity disorder (ADHD) refers to the presence of pronounced difficulties in the areas of inattention, distractibility, and hyperactivity that lead to significant impairments in academic and social functioning (American Psychiatric Association, 2013). ADHD is one of the most commonly diagnosed clinical conditions affecting approximately 5-7% of the student population (Willcutt, 2012). Co-occurring ADHD and communication disorders represent a frequently encountered challenge for school-based practitioners (American Speech Language Hearing Association, 2008). Determining the source of children s academic and social difficulties as either language-based, attention-based, or a combination of both can be a daunting task for assessment teams.

4 ADHD and LI ADHD has also been one of the most frequently reported co-occurring neurodevelopmental disorders in study samples of children with language impairments (LI) (e.g. Beitchman, Hood, & Inglis, 1990; Benasich, Curtiss, & Tallal, 1993; Lindsay, Dockrell, & Strand, 2007; St. Clair, Pickles, Durkin, & Conti-Ramsden, 2011; Willinger et al., 2003). although the literature provides some discrepant findings with the extent to which co-occurrence rates have exceeded expectations based on general population estimates (cf. Lindsay & Dockrell, 2008; Redmond & Rice, 2002; Rescorla, Ross, & McClure, 2007; Whitehouse, Robinson, & Zubrick, 2011).

5 ADHD prevalence rate: APA (2013); Willcutt, (2012)

6 ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD diagnosis rate: both sexes CDC (2013)

7 ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD dx rate also varies as a function of locale: western states below 6%; southern/eastern states above 10% ADHD dx rate: both sexes CDC (2013) ADHD dx rate: males CDC (2013)

8 LI/SLI prevalence rate: Johnson et al., 1999; Tomblin et al., 1997 ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD dx rate: both sexes CDC (2013) ADHD dx rate: males CDC (2013)

9 LI/SLI prevalence rate: Johnson et al., 1999; Tomblin et al., 1997 LI/SLI dx rate:? ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD dx rate: both sexes CDC (2013) ADHD dx rate: males CDC (2013) Ironically, ASHA has tracked service provision for cases of ADHD but has never collected a census on the cases of primary LI/SLI served by SLPs

10 LI/SLI prevalence rate: Johnson et al., 1999; Tomblin et al., 1997 ADHD+LI Co-occurrence Lindsay & Dockrell (2008) Snowling et al (2006) Gualtieri et al 1983 ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD dx rate: both sexes CDC (2013) ADHD dx rate: males CDC (2013)

11 ADHD+LI Co-occurrence LI/SLI prevalence rate: Johnson et al., 1999; Tomblin et al., 1997 ADHD prevalence rate: APA (2013); Willcutt, (2012) ADHD dx rate: both sexes CDC (2013) Lindsay & Dockrell (2008); Snowling et al (2006) Redmond & Rice (2002); Willinger et al. (2003) Tomblin et al. (2000) Baker & Cantwell (1987); St Clair et al (2011) Beitchman et al (1989) Gualtieri et al (1983) Warr-Leeper et al (1994) Trautman et al. (1990) ADHD dx rate: males CDC (2013) Tirosh & Cohen (1998); Love & Thompson (1988); Cohen et al. (1998)

12 Informant as source of instability in ADHD+LI co-occurrence rates Children with specific learning disability may appear inattentive because of frustration, lack of interest, or limited ability. However, inattention in individuals with a specific learning disorder who do not have ADHD is not impairing outside of academic work (DSM 5 pg. 64) Teacher ratings vulnerable to negative halo effects when used with children who have LI or RD (Charach, Chen, Hogg- Johnson, & Schachar, 2009)

13 Co-occurrence rates are not very useful if measures cannot be trusted to differentiate cases of known SLI from cases of known ADHD Are language tests administered to children with ADHD valid? o Psychometric integrity of language measures for differential diagnosis

14 Do LI and ADHD interact with each other? o If language proficiency in ADHD+LI < LI then: 2 kinds of LI representing different developmental pathways Different prognoses Different interventions o If ADHD+LI = LI then: Models of LI that implicate attention deficits, executive dysfunction, or related weaknesses in information processing as causal contributors (e.g. Gilliam et al., 2009; Hedenius et al., 2011; Windsor & Kohnert, 2009) would be called into question

15 Psychometric Integrity: Redmond, Thompson & Goldstein (2011) Results: ADHD = TD > SLI: nonword repetition, sentence recall, tense-marking on lexical verbs (see also Parigger, 2012; Redmond 2004; 2005). Parigger (2012) reported no significant association between executive function measures and Dutch language versions of these measures in ADHD, SLI, or TD groups

16

17

18

19 Do LI and ADHD Interact with Each Other? Redmond, Ash & Hogan (in prep) ADHD+LI = SLI <TD: nonword repetition, sentence recall, tensemarking ADHD status had little noticeable impact on the affected children s performances. In fact, ADHD+LI group means were consistently higher than SLI means Correlational analyses detected a weak but significant association (r ~.30) between sentence recall and ADHD symptoms. i.e. Children with LI who had higher levels of behavioral difficulties tended to perform better than children whose parents had reported fewer ADHD symptoms.

20 ADHD as protective factor?! ADHD status might have functioned as a small protective factor for children with LI in our study sample because the presence of behavioral difficulties had increased the likelihood of referral and earlier identification. Maybe the presence of co-occurring behavioral difficulties was encouraging the provision of more intensive interventions. Stated differently: The presence of language impairments in the absence of additional behavioral difficulties may have needed to be relatively more severe in cases of SLI in order to trigger the same level of concern among teachers and other referral sources or the same kind of therapeutic response from clinicians (see Zhang & Tomblin, 2000).

21

22

23

24 DSM-ADHD * Nonword Rep *.545***.532**.487**.427** 3. Sentence Recall **.433**.507**.388* 4. 3 rd person pres ***.743***.536** 5. Regular Past ***.494** 6. Irregular finite 7. Irregular correct ** -- N = 38 p =.055 * p <.05, ** p <.01, *** p <.001

25 Diagnostic Conversions Nonword Repetition o SLI: z score = ; standard score = 76.5 o ADHD+LI: z score = -1.27; standard score = Sentence Recall o SLI: z score = -3.10; standard score = 53.5 o ADHD+LI: z score =-2.37; standard score = TEGI Screening (-3s, -ed, ptirr) o SLI: z score = -8.9 ; standard score = < 1 o ADHD+LI: z score = ; standard score = 19.45

26 Free Measures! NWR: Dollaghan & Campbell (1998) JSLHR, 41, SR: Redmond (2005), Clinical Linguistics and Phonetics, 19, Scoring procedures and norms available from Archibald & Joanisse (2009) JSLHR, TEGI:

27 ADHD +/- L.I.: Social Communication (Pragmatic) Profiles Geralyn R. Timler, Ph.D., CCC-SLP Miami Unversity Funding Source: American Speech, Language, and Hearing Foundation

28 Agenda Definitions Literature review o Conversation samples o Narrative samples o Parent report Clinical implications: Redmond & Timler

29 Definitions Broad view: language use in social interactions o Social cognition, executive functions, social problemsolving, social knowledge, pragmatic language Slightly narrower view: linguistic behaviors related to language use o Figurative language (e.g., metaphor, irony, and idioms) inferencing skills, referential communication Related to structural language abilities (see Norbury, 2013 for review)

30 Definitions: DSM-5 (APA, 2013) Social (Pragmatic) Communication Disorder Persistent (significant) difficulties in pragmatics or the social uses of verbal and nonverbal communication in naturalistic contexts, which affects social reciprocity and social relationships o Cannot be explained by low abilities in word structure, grammar, or general cognitive ability Persistent difficulties in the acquisition and use of language.. for narrative, expository, and conversational discourse Functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination

31 ADHD and Social (Pragmatic) Communication Conversation samples: o More inappropriate pragmatic language behaviors (Cohen et al., 2000) including more mazes (Redmond, 2004), more interruptions, and less feedback to communication partners (Kim & Kaiser, 2000) Narrative samples: o Conflicting evidence for criterion-referenced measures Shorter samples (Cohen et al., 2000), more cohesion errors (Purvis & Tannock, 1995), fewer story grammar elements (see review by Tannock & Schachar, 1996) However, when language performance is considered (i.e., +/-LI), ADHD+LI < ADHD=TD (Luo & Timler, 2008; Parigger, 2012) o Norm-referenced: Test of Narrative Language (Gillam & Pearson, 2004) ADHD+LI < ADHD=TD (Redmond, Thompson, & Goldstein, 2011).

32 TNL: Story Sample #1: Male with ADHD (age 7;5) TNL Narrative Language Ability Index: 97, Oral Narration Subtest: 10 C (um) Some alien/s from space want/ed to move in onto earth. C And everybody got scared cause of the alien/s. C Their alien dog, their alien daughter, their alien mother and father, their alien sister, and their alien brother. C And everybody ran away. C That/'s that. A And that's it? C Can I name them? A Sure. C This one/'s Frank Junior. C This one/'s Debbie. C This one/'s Diana. C This one/'s Cindy.

33 TNL: Story Sample #2: Male with ADHD+LI (age 7;6) TNL Narrative Language Ability Index: 79, Oral Narration Subtest: 7 C Alien/s were fly/ing in space. C *they [Ep:they] drop/ed off to earth to see (all) all the forest and tree/s. C And they brung [EW:brought] the dog with them (because they) because the dog was/n't even go/ing to be left down in the basement. C You know because it was being bad. C And it want/ed to see all the animal/s of it/z friend/s [EU]. C and two kid/s just found them. C and they start/ed to go chase/ing after them. C And that bad alien over there just said "bye" and let/ed [EO:let] them stay on earth forever. C And that/'s her evil plan. C And now she walk/ed back into the spaceship to get more on earth. C And they both found the alien/s and start/ed chase/ing after them some more but they just did nothing. C All the alien/s did is just take one blink at them and put their suitcase down and ask/ed them some question/s on the bench. C That/'s it.

34 ADHD and Social (Pragmatic) Communication Parent report measures for identification of psychopathology: o DSM-5 and multiple social-emotional measures reflect overlap among items for psych diagnosis and pragmatic language (Redmond, 2002) Excessive talking, little attention to detail, frequent interruptions Parent report measures for the identification of pragmatic language deficits o In community samples of children without a diagnosis of ADHD, higher levels of inattention and hyperactivity/impulsivity are associated with pragmatic language weaknesses (Bignell & Cain, 2007; Ketelaars, et al., 2010; Leonard, Milich, & Lorch, 2011) o In children with a confirmed diagnosis of ADHD, pragmatic language skills are reportedly poorer than typical children and not dissimilar to children with autism spectrum disorder (Bishop & Baird; 2001; Bruce, Thernlund, & Nettelbladt, 2006; Geurts & Embrechts, 2008; Guerts et al., 2004; Helland, Biringer, Helland, & Heimann, 2012; Helland & Heimann, 2007)

35 Parent Report: Children s Communication Checklist-2 (CCC-2) CCC-2 (Bishop, 2006) pragmatic language scales: E) Initiation: it is difficult to stop him or her from talking F) Scripted Language: provides over-precise information in his or her talk G) Context: misses the point of jokes and puns H) Nonverbal Communication: does not look at the person he or she is talking to I) Social Relations: appears anxious in the company of other children J) Interests: shows interest in things or activities that most people would find unusual

36 CCC-2 Pragmatic Language Scales: Group Comparisons (Typ, ADHD, ASD) E) Initiation: Typical > ADHD = ASD G) Context: Typical > ADHD > ASD Typical > ADHD = ASD F) Scripted Language: Typical > ADHD > ASD Typical = ADHD > ASD H) Nonverbal Communication: Typical > ADHD > ASD I) Social Relations: Typical > ADHD = ASD Typical > ADHD > ASD J) Interests: Typical = ADHD > ASD Typical > ADHD > ASD

37 CCC-2 Pragmatic Language Scales: Group Comparisons (ADHD +/- LI) Typical ADHD (-LI) ADHD+LI F η 2 Post Hoc (n =12) (n = 22) (n = 10) Contrasts M (SD) M (SD) M (SD) General Com. Comp (12.85) (11.64) 76.2 (8.01) 16.17***.441 1, 2 > 3 Pragmatic Composite (9.91) (11.6) 35.0 (8.33) 16.72*** > 2 > 3 Initiation 9.67 (2.5) 7.36 (2.34) 4.2 (2.01) 14.99*** > 2 > 3 Scripted Language (1.95) 9.59 (2.23) 6.8 (2.15) 7.89***.278 1, 2 > 3 Context (2.15) 9.41 (1.89) 6.3 (2.41) 14.66***.417 1, 2 > 3 Nonverbal Comm (2.19) 8.09 (2.37) 6.1 (1.85) 8.84*** > 2, 3 Social Relations 9.67 (2.06) 8.32 (2.9) 4.5 (2.07) 12.26***.374 1, 2 > 3 Interests (2.13) 8.5 (3.3) 7.1 (2.77) , 2, 3

38

39

40 CCC-2 Pragmatic Language Scales: Group Comparisons (ADHD +/- LI) Item analysis reveals further group differences among children with ADHD and children with ADHD +LI o Initiation Scale: Item 45: Asks a question even though he/she has been given the answer Reported as a more frequent behavior in children with ADHD+LI than in other two groups

41 Results & Clinical Implications Nonword repetition, sentence recall, and tense-marking tasks: ADHD+LI = SLI <TD o Clinical implications: Use these psycholinguistic measures to identify LI in young children with ADHD Parent report of pragmatic skills: ADHD+LI < ADHD < TD but further comparison with a SLI group is needed o When LI and ADHD in a young child is identified, complete comprehensive assessment of linguistic skills related to pragmatic language (e.g., figurative language, inferencing, cohesion in narratives and conversation, etc.) Some evidence that even mild differences in figurative language knowledge contributes to social problem solving deficits in adolescents with psychopathologies (Im-bolter, Cohen, & Farnia, 2013)

42 References American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders-5 th Edition (DSM-5). Washington, DC, American Psychiatric Association, American Speech-Language-Hearing Association. (2008) Schools Survey report: Caseload characteristics. Rockville, MD: Author. Beitchman, J., Hood, J., Inglis, A. (1990). Psychiatric risk in children with speech and language disorders. Journal of Abnormal Child Psychology, 18(3), Bignell, S., & Cain, K. (2007). Pragmatic aspects of communication and language comprehension in groups of children differentiated by teacher ratings of hyperactivity and inattention. British Journal of Developmental Psychology, 25, doi: / x Benasich, A., Curtiss, S., & Tallal, P. (1993). Language, learning, and behavioral disturbance in childhood: A longitudinal perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 32, Bishop, D. (2006). Children s Communication Checklist-2 (United States Edition). San Antonio, TX: Harcourt Assessment, Inc. Bishop, D. & Baird, G. (2001). Parent and teacher report of pragmatic aspects of communication: Use of the Children s Communication Checklist in a clinical setting. Developmental Medicine & Child Neurology, 43, Bruce, B., Thernlund, G., & Nettelbladt, U. (2006). ADHD and language impairment: A study of the parent questionnaire FTF (Five to Fifteen). European Child and Adolescent Psychiatry, 15,

43 References Cont. Cohen, N., Barwick, M., Horodezky, M., Vallance, D., & Im, N. (1998). Language, achievement, and cognitive processing of psychiatrically disturbed children with previously unidentified and unsuspected language impairments. Journal of Child Psychology and Psychiatry, 39(6), Cohen, N., Vallance, D., Barwick, M., Im, N., Menna, R., Horodezky, N., & Isaacson, L. (2000). The interface between ADHD and language impairment: An examination of language, achievement, and cognitive processing. Journal of Child Psychology and Psychiatry, 41(3), Conti-Ramsden, G., Botting, N., & Faragher, B. (2001). Psycholinguistic markers for specific language (SLI). Journal of Child Psychology and Psychiatry, 42, Dollaghan, C., & Campbell, T. (1998). Nonword repetition and child language impairment. Journal of Speech, Language, and Hearing Research, 41, Gillam, R. & Pearson, N. (2004). Test of Narrative Language (TNL). Austin, TX: PRO-ED. Geurts, H. & Embrechts, M. (2008). Language Profiles in ASD, SLI, and ADHD. Journal of Autism and Developmental Disorders, 38, Geurts, H., Verte, S., Oosterlaan, J., Roeyers, H., Hartman, C., Mulder, E., Sergeant, J. (2004). Can the Children s Communication Checklist differentiate between children with autism, children with ADHD, and normal controls? Journal of Child Psychology and Psychiatry, 45, Gillam, R. B., Montgomery, J. W., Gillam, S. L. (2009). Attention and memory in child language disorders. In R. G. Schwartz (Ed.), Handbook of child language disorders (pp ). New York: Psychology Press.

44 References Cont. Gualtieri, C.T., Koriath, U., Van Bourgondien, M.E., & Saleeby, N. (1983). Language disorders in children referred for psychiatric services. Journal of the American Academy of Child Psychiatry, 22, Hedenius, M., Persson, J., Tremblay, A., Adi-Japha, E., Veríssimo, J., Dye, C., Alm, P., Jennische, M., Tomblin, J. B., Ullman, M.T. (2011). Grammar predicts procedural learning and consolidation deficits in children with specific language impairment. Research in Developmental Disabilities, 32(6), Helland, W., Biringer, E., Helland, T., & Heimann, M. (2012). Exploring language profiles for children with ADHD and children with Asperger Syndrome. Journal of Attention Disorders, 16, Helland, W. & Heimann, M. (2007). Assessment of pragmatic language impairment in children referred to psychiatric services: A pilot study of the Children s Communication Checklist in a Norwegian sample. Logopedics Phoniatrics Vocology, 32, Im-bolter, N., Cohen, N., & Farnia, F. (2013). I thought we were good: Social cognition, figurative language, and psychopathology. Journal of Child Psychology and Psychiatry, doi: /jcpp Johnson, C., Beitchman, J. H., Escobar, M., Atkinson, L., Wilson, B., Brownlie, E. B., Douglas, L., Taback, N., Lam, I., & Wang, M. (1999). Fourteen-year follow-up of children with and without speech/language impairments: Speech/language stability and outcomes. Journal of Speech, Language, and Hearing Research, 42,

45 References Cont. Ketelaars, M., Cuperus, J., Jansonius, K., & Verhoeven, L. (2010). Pragmatic language impairment and associated behavioural problems. International Journal of Language and Communication Disorders, 45, Leonard, M. Milich, R. & Lorch, P. (2011). The role of pragmatic language use in mediating the relation between hyperactivity and inattention and social skills problems. Journal of Speech, Language, and Hearing Research, 54, DOI: / (2010/ ) Lindsay, G., & Dockrell, J.E. (2008). Outcomes for young people with a history of specific language impairment at years: A more positive picture? In V. Joffe, M., Cruice, & S. Chiat (Eds.), Language disorder in children and adults: New issues in research and practice (pp ). Lindsay, G., Dockrell, J., Strand, S., (2007). Longitudinal patterns of behaviour problems in children with specific speech and language difficulties: Child and contextual factors. British Journal of Educational Psychology, 77(4), Love, A.J., & Thompson, M.G.G. (1988). Language disorders and attention disorders in young children referred for psychiatric services: Analysis of prevalence and a conceptual synthesis. American Journal of Orthopsychiatry, 58, Luo, F., & Timler, G. (2008). Narrative organization skills in children with attention deficit hyperactivity disorder and language impairment: Application of the causal network model. Clinical Linguistics and Phonetics, 22,

46 References Cont. Milch-Reich, S., Campbell, S., Pelham, W., Connelly, L., & Geva, D. (1999). Developmental and individual differences in children's on-line representations of dynamic social events. Child Development, 70(2), Norbury, C. (2013). Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications. Journal of Child Psychology and Psychiatry, doi: /jcpp Parigger, E. (2012). Language and executive functioning in children with ADHD. University of Amsterdam Press. Redmond, S.M. (2002). The use of rating scales with children who have language impairments: A tutorial. American Journal of Speech Language Pathology, 11, Redmond, S.M. (2004). Conversational profiles of children with ADHD, SLI and typical development. Clinical Linguistics and Phonetics, 18, Redmond, S.M., (2005). Differentiating SLI from ADHD using children s sentence recall and production of past tense morphology. Clinical Linguistics & Phonetics, 19, Redmond, S. M. & Rice, M.L. (2002). Stability of behavioral ratings of children with specific language impairment. Journal of Speech, Language, and Hearing Research, 45, Redmond, S.M., Thompson, H.L., & Goldstein, S. (2011). Psycholinguistic profiling differentiates specific language impairment from typical development and from attention deficit/hyperactivity disorder. Journal of Speech, Language, and Hearing Research, 41,

47 References Cont. Redmond, S.M., Ash, A., Hogan, T. (2013). Consequences of ADHD comorbidity on the severity of children s LI symptoms. Poster presentation: Symposium for Research on Child Language Disorders, Madison: WI. Rescorla, L., Ross, G.S., & McClure, S. (2007). Language delay and behavioral/emotional problems in toddlers: Findings from two developmental clinics. Journal of Speech, Language, and Hearing Research, 50, Rice, M.L., & Wexler, K. (2001). Rice/Wexler Test of Early Grammatical Impairment. San Antonio, TX: The Psychological Corporation. Rice, M.L., Tomblin, J.B., Hoffman, L., Richman, W.A., & Marquis, J. (2004). Grammatical tense deficits in children with SLI and nonspecific language impairment: Relationships with nonverbal IQ over time. Journal of Speech, Language, Hearing Research, 47, Snowling, M.J., Bishop, D.V.M., Sothard, S.E., Chipchase, B., & Caplan, C. (2006). Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment. Journal of Child Psychology and Psychiatry, 47, St Clair, C. Pickles, A., Durkin, K., Conti-Ramsden, G. (2011). A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI), Journal of Communication Disorders, 44(2), Stanton-Chapman, T.L., Justice, L.M., Skibbe, L.E., & Grant, S.L. (2007). Social and behavioral characteristics of preschoolers with specific language impairment. Topics in Early Childhood Special Education, 27, (2),

48 References Cont. Tannock, R., Purvis, K., & Schachar, R. (1993). Narrative abilities in children with attention deficit hyperactivity disorder and normal peers. Journal of Abnormal Child Psychology, 21(1), Tannock, R., & Schachar, R. (1996). Executive dysfunction as an underlying mechanism of behaviour and language problems in attention deficit hyperactivity disorder. In J. H. Beitchman, N. J. Cohen, M. M. Konstantareas, & R. Tannock (Eds.), Language, Learning, and Behaviour Disorders: Developmental, Biological, and Clinical Perspectives (pp ). Cambridge: Cambridge University Press. Timler, G. (in press). Use of the Children s Communication Checklist-2 for Classification of Language Impairment Risk in Young School-Age Children with Attention- Deficit/Hyperactivity Disorder. American Journal of Speech-Language Pathology. doi: / (2013/ ) Tirosh, E., & Cohen, A. (1998). Language deficit with attention-deficit disorder: A prevalent comorbidity. Journal of Child Neurology, 13, Tomblin, J. B., Records, N., Buckwalter, P., Zhang, X., Smith, E., & O Brien, M. (1997). Prevalence of Specific Language Impairment in Kindergarten Children. Journal of Speech, Language, and Hearing Research, 40, Trautman, R. C., Giddan, J. J., & Jurs, S. G. (1990). Language risk factor in emotionally disturbed children within a school and day treatment program. Journal of Childhood Communication Disorders, 13,

49 References Cont. Warr-Leeper, G., Wright, N., Mack, A. (1994). Language disabilities of antisocial boys in residential treatment. Behavioral Disorders, 19(3), Whitehouse, A.J.O., Robinson, M., & Zubrick, S.R. (2011). Late talking and the risk for psychosocial problems during childhood and adolescence. Pediatrics, 128 (2), Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9, Willinger, U., Brunner, E., Diendorfer-Radner, G., Mag, J.S., Sirsch, U., & Eisenwort, B. (2003). Behavior in children with language development disorders. Canadian Journal of Psychiatry, 48, Windsor, J. & Kohnert, K. (2009). Processing speed, attention, and perception in child language disorders. In R. Schwartz (Ed.,), Handbook of child language disorders (pp ). New York: Psychology Press. Zhang, X. and Tomblin, J.B., ( 2000). The Association of intervention receipt with speechlanguage profiles and social demographic variables. American Journal of Speech- Language Pathology, 9,