Original Research

Behaviour in Children With Language Development

Disorders
Ulrike Willinger, PhD1, Esther Brunner, PhD2, Gabriele Diendorfer-Radner, PhD3,
Judith Sams, Mag4, Ulrike Sirsch, PhD5, Brigitte Eisenwort, PhD6

Objective: The objective of the study was to explore the univariate and multivariate differences in behavioural
problems among children with disorders in expressive or mixed receptive–expressive language development and
children with unimpaired language development.
Method: Ninety-four children with language development disorders (LDD) between the ages of 4 and 6 years and
94 children (matched by age and sex) without disorders of language development were compared concerning
behavioural problems, as measured by the German version of the Child Behavior Checklist/4-18.
Results: Thirty-two children (34%) with LDD showed behavioural problems in the clinical range, whereas only 6
control subjects (6%) had scores in this range. Univariate group comparisons between patients and control subjects
showed significant differences in all 8 syndromes and the scale “other problems,” with patients having higher
scores. Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales “other
problems,” “social problems,” “anxious–depressed,” “thought problems,” “attention problems,” and “delinquent
problems.”
Conclusions: In general, our results agree with several studies that report that children with speech and language
disorders are at special risk for developing behavioural problems. Neurodevelopmental immaturity may be one
factor underlying both the disorder in language development and the behavioural problems.
(Can J Psychiatry 2003;48:607–614)
Information on author affiliations appears at the end of the article.

Clinical Implications

· One-third of the children with language developmental disorders showed behavioural problems in the clinical range.
· Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales “other problems,”
“social problems,” “anxious–depressed,” “thought problems,” “attention problems,” and “delinquent problems.”
· Neurodevelopmental immaturity may be one factor underlying both the disorder in language development and the
behavioural problems.

Limitations

· Child behaviour data are based on a checklist.

· The present study is cross-sectional.
· The generalizability of the findings might be limited by using a clinical sample.

Key Words: language development disorders, expressive language disorder, mixed receptive–expressive language
disorder, behavioural problems, Child Behavior Checklist/4-18, neurodevelopmental immaturity
anguage plays an important role in the cognitive, social, suggest a prevalence figure in the range of 6% to 8% among
L emotional, and behavioural development of children.
Therefore, impairment in language development may have a
children of this age (1).

According to DSM-IV (2), an LDD is signaled by impairment

serious impact on cognitive and psychosocial development.
of expressive and (or) receptive language development not
Language development disorders (LDD) are very often caused by sensory deficits, deficits in nonverbal intellectual
apparent in preschool children. Epidemiologic surveys capacity, a neurological condition, or environmental

Can J Psychiatry, Vol 48, No 9, October 2003 W 607

The Canadian Journal of Psychiatry—Original Research
deprivation. The linguistic features of expressive language
disorder include a limited amount of speech, a limited vocabu-
lary range, difficulty in acquiring new words, word finding or
vocabulary errors, shortened sentences, simplified grammati-
cal structures, limited varieties of grammatical structures (for
example, verb forms), limited varieties of sentence structures
(for example, imperatives and questions), the omission of crit-
ical parts of sentences, and the use of unusual word orders.
The most common feature associated with an expressive lan-
guage disorder in younger children is a phonological disorder.
The linguistic features of a mixed receptive–expressive lan-
guage disorder include difficulty understanding words, sen-
tences, or specific types of words in combination with
phonological and expressive language problems.
Problems in language development may be linked to other
basic disabilities, such as delays in reaching other develop-
mental milestones (3), impaired verbal and nonverbal intel-
lectual capacities (4), reading and spelling difficulties (5,6),
psychiatric diagnoses (7,8), and behavioural problems (9,10).
Evidence for associations between emotional and behavioural
problems and communication difficulties has been reported
by investigations into the prevalence rate of behavioural prob-
lems among children with speech and language disorders as
well as by evaluations of the prevalence rate of language prob-
lems among children with psychiatric disorders.
Beitchman and others (11) found that, based on parent and
teacher reports, 50% of children with speech and language
problems showed behavioural problems in comparison with
12% of children without speech and language problems.
Several studies suggest that children with psychiatric disor-
ders (12–14) have previously undiagnosed speech and lan-
guage difficulties. Cohen and others examined the prevalence
of unsuspected language impairments in 4- to 12-year-old
psychiatric outpatients (12). They reported that 34.4% of the
children had a language impairment that had not been previ-
ously suspected and that these children had the most serious
externalized behavioural problems. A longitudinal study
regarding the follow-up of 2 groups of young men, 1 with
autism and 1 with developmental receptive language disorder,
who were first assessed at the ages of 7 to 8 years and then at
the ages of 23 to 24 years, demonstrated that many of those
children with the receptive language disorder still had few
close friends and had moderate to severe social problems (15).
The association between behaviour problems and language
disorders has been documented extensively, although meth-
odological problems have been found in terms of inadequate
diagnostic classification and the heterogeneity of the groups
studied (16). Many studies deal with language disorders in a
broad sense. Diverse types of speech and language disorders,
such as articulation problems, stuttering, and expressive
608
and (or) receptive language disorders, are frequently grouped
together; speech and language problems are often associated
with intellectual impairment and autistic behaviour, but the
differentiation into subgroups of language-impaired children
is often neglected (17); and control groups are often omitted
from the experimental design.
The purpose of the present study was to investigate univariate
and multivariate differences in behavioural problems among
children with disorders in expressive and mixed receptive–
expressive language development, using children with unim-
paired language development as control subjects.
Methods
Subjects
Ninety-four children between the ages of 4 and 6 years with
LDD and without speech–motor, sensory, neurological, or
intellectual deficits were recruited at the Department of
Phoniatrics and Logopedics of the University of Vienna’s
Ear, Nose, and Throat Clinic and examined with respect to
their general development (that is, cognitive, language, and
emotional–social). The patient sample consisted of 70 (75%)
boys and 24 (25%) girls. Sex distribution showed a significant
majority of boys (c² = 22.51; df 1; P £ 0.0001), which is con-
sistent with current literature (2).
The mean age was 57 (SD 8.8) months, the mean position in
sibship was 1.7 (SD 0.8). Twenty-six (29%) children had no
siblings, 48 (53%) had 1 sibling, 12 (13%) had 2 siblings, 3
(3%) had 3 siblings, and 1 (1%) had 4 siblings in the family.
Ninety-two (98%) of the children had been in kindergarten
(corresponds to “preschool” in the US) for a mean duration of
19.9 (SD 12.5) months, 2 children (2%) were not in a daycare
program. The mean nonverbal IQ was 99.0 (SD 16.5).
Sixty-nine (76%) had not received any treatment before they
had been examined. Eighteen (32%) received speech therapy
for a mean duration of 6.9 (SD 9.0) months, 2 children (4%)
received occupational therapy for a mean duration of 2.5 (SD
0.7) months, and 1 child (2%) received physical therapy for a
period of 3 months.
The mean age of the patients’ mothers was 30.8 (SD 5.4)
years. Regarding educational level, 17 (18%) of the mothers
had left school after the compulsory 9-year school program,
50 (53%) had graduated from a 2- or 3-year high school pro-
gram, 21 (22%) had obtained a 4- or 5-year high school
diploma, and 6 (7%) mothers held a university degree.
Ninety-four children without LDD were recruited as control
subjects in Viennese kindergartens and were matched by age
and sex to the patient sample. They were also examined with
respect to their language development and their social–
emotional behaviour. The mean position in sibship was 1.5
(SD 0.7). Thirty-four (36%) children had no siblings,
W Can J Psychiatry, Vol 48, No 9, October 2003

47 (50%) had 1 sibling, 6 (6%) had 2 siblings, and 7 (8%) had
3 siblings. Control subjects had been in kindergarten for a
mean duration of 22.2 (SD 9.7) months. The mean nonverbal
IQ was 100 (SD 16.8). No child had received any treatment
before entering the study.
The mean age of the control subjects’ mothers was 34.2
(SD 5.9) years. Regarding educational level, 20 (21%) of the
mothers had left school after the compulsory 9-year school
program, 24 (26%) had graduated from a 2- or 3-year high
school program, 45 (48%) had a 4- or 5-year high school
diploma, and 5 (5%) held a university degree. There were no
significant differences between the patients’ mothers and the
control subjects’ mothers with respect to the maternal age
(t = –1.84; df 46; P = 0.072). A significant difference was
found between the patients’ mothers and the control subjects’
mothers with respect to the distribution of the maternal educa-
tion (c² = 18.2; df 3; P = 0.0004). It is not a systematic differ-
ence, because the distribution of the patients’ mothers showed
a higher percentage of graduation from a 2- or 3-year high
school program and an university degree but a lower percent-
age of the compulsory 9-year school program and a 4- or
5-year high school diploma than the distribution of the control
subjects’ mothers. Moreover, the explained variance between
maternal education and language development ranged from
1% to 10% in the children with LDD and from 1% to 9% in the
control subjects. Therefore, both maternal age and maternal
education were not used as covariates.
Materials
Information about actual language development regarding
phonology, vocabulary, and grammar (both expressive and
receptive) was assessed in both samples with the
Lautbildungstest für Vorschulkinder (Test of Articulation for
Preschool Children; 18), Aktiver Wortschatztest für
3–6jährige Kinder (Active Vocabulary Test for 3- to 6-Year-
Old Children; 19), Peabody Picture Vocabulary Test (20), and
Heidelberger Sprachentwicklungstest (Heidelberg Evalua-
tion of Language Development; 21). Information about non-
verbal intelligence was obtained through the Columbia
Mental Maturity Scale (22).
Child behaviour was measured by the German version (23) of
the Child Behavior Checklist/4-18 (CBCL) (24), which con-
sists of 2 sections: “child’s competence” and “child’s
social–emotional problems.” The present study only consid-
ered the scales of the child’s social–emotional problems sec-
tion. The 118 behaviour problem items, to be assessed by the
parents, refer to the 8 syndromes: “withdrawn,” “somatic
complaints,” “anxious–depressed,” “social problems,”
“thought problems,” “attention problems,” “delinquent prob-
lems,” “aggressive behaviour,” and “other problems.” A
t-score based on the normal population can be assigned to
Can J Psychiatry, Vol 48, No 9, October 2003 W
Behaviour in Children With Language Development Disorders
each syndrome. The t-scores of 67 and above have been desig-
nated by Achenbach (24) to define the clinically abnormal
range. These t-scores correspond to the 95th percentile of the
normal group.
Statistics
According to DSM-IV, the diagnosis expressive language
disorder is defined by the child’s actual and tested abilities
with respect to vocabulary (expressive), which is measured by
the Active Vocabulary Test for 3- to 6-Year-Old Children
(19), and grammar (expressive), which is measured by subtest
II and subtest XI of the Heidelberg Evaluation of Language
Development (21). The data values had to be at least 1 SD
below those of the normative sample of the tests used. The
receptive language abilities had to be at least average.
According to DSM-IV, a diagnosis of mixed receptive–
expressive language disorder is defined by the child’s actual
and tested abilities with respect to vocabulary (expressive and
receptive), which were measured by the Active Vocabulary
Test for 3- to 6-Year-Old Children (19) and the Peabody Pic-
ture Vocabulary Test (20) in this study, and grammar (expres-
sive and receptive), which was measured by the subtests I, II,
and XI of the Heidelberg Evaluation of Language Develop-
ment (21). The data values had to be at least 1 SD below those
of the normative sample of the tests used.
Univariate group differences within the patient sample and
between patients and control subjects were analyzed for sig-
nificance using t-tests (paired and unpaired), and chi-square
tests with Bonferroni correction for multiple testing. Stepwise
discriminant analysis was used for multivariate group differ-
ences between patients and control subjects regarding the
8 syndromes and the other problems scale of the CBCL (24).
Those children with at least 1 t-score within the clinical range
(67 or greater) were considered to be behaviourally disturbed.
The cut-off level for 2-tailed statistical significance was set at
P < 0.05. Data handling and analyses were carried out using
SPSS for Windows, version 10.0.
Results
Forty-five patients (48%) fulfilled the DSM-IV criteria for
expressive language disorder; 49 children (52%) met the cri-
teria for mixed receptive–expressive language disorder. None
of the patients and control subjects enrolled in the present
study had a pure speech disorder, and none of the control sub-
jects fulfilled the DSM-IV criteria for any language disorder.
Thirty-two children (34%) with LDD, 14 (31%) with an
expressive language disorder, and 18 (37%) with a mixed
receptive–expressive language disorder showed behaviour
problems within the clinical range, whereas only 6 control
subjects (6%) had scores within this range. Those syndromes
that most frequently occurred in the clinical range for the
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The Canadian Journal of Psychiatry—Original Research

Table 1 Distribution of the CBCL syndromes within the clinical range in children with expressive language
disorder (E-LD), mixed receptive–expressive language disorder (RE-LD), all children with language development
disorder (LDD), and control subjects

Syndromes Children with E-LD Children with RE-LD Children with LDD Control subjects
(n = 45) (n = 49) (n = 94) (n = 94)
n (%) n (%) n (%) n (%)

Withdrawn 4 (9) 8 (17) 12 (13) 0 (0)

Somatic complaints 4 (9) 2 (4) 6 (7) 0 (0)

Anxious–depressed 3 (7) 5 (10) 8 (9) 0 (0)

Social problems 4 (9) 3 (6) 7 (8) 0 (0)

Thought problems 5 (11) 6 (12) 11 (12) 4 (4)

Attention problems 5 (11) 8 (16) 13 (14) 0 (0)

Delinquent problems 1 (2) 3 (6) 4 (4) 0 (0)

Aggressive behaviour 5 (11) 4 (8) 9 (10) 2 (2)

comparisons between children with

Table 2 Group differences between patients and control subjects expressive language disorder and
mixed receptive–expressive language
Syndromes Patients Control subjects Statistical analyses
Mean (SD) Mean (SD) t-value disorder showed no significant differ-
ences in any of the 9 scales (Table 3).
Withdrawn 2.3 (2.8) 0.3 (0.8) –7.6a
Multivariate stepwise discriminant
Somatic complaints 0.7 (1.2) 0.1 (0.3) –5.8a
anal ys i s s how ed a s i g n i f i c a n t
Anxious–depressed 2.5 (3.2) 0.6 (0.8) –6.1a discriminant function (canonical cor-
Social problems 1.8 (1.7) 0.3 (0.7) –8.7a relation r = 0.8; Wilk’s Lambda = 0.4;
Thought problems 0.4 (0.8) 0.2 (0.6) –2.1a c² = 125.0; df 6; P £ 0.0001) for the
Attention problems 3.6 (2.8) 0.8 (1.0) –9.9a
scales other problems, social prob-
lems, anxious–depressed, thought
Delinquent problems 1.6 (1.8) 0.4 (0.9) –6.1a
problems, attention problems, and
Aggressive behaviour 8.2 (5.6) 2.1 (3.3) –9.5a delinquent problems. Ninety-two per-
Other problems 5.4 (4.0) 0.9 (1.5) –10.9a cent of control subjectss (sensitivity)
and 76% patients (specificity) were
P £ 0.0001 after Bonferroni correction
a

classified correctly in their respective

members of the entire combined LDD sample turned out to be
attention problems (14%), withdrawal (13%), thought prob-
lems (12%), and aggressive behaviour (10%), as reported by
their mothers. The syndromes most often specified (above
10%) by mothers of children with an expressive language dis-
order were thought problems (11%), attention problems
(11%), and aggressive behaviour (11%). For children with a
mixed expressive–receptive language disorder, withdrawal
(17%), attention problems (16%), thought problems (12%),
and social problems (10%) were most often noted. Details are
given in Table 1.
Group comparisons between patients and control subjects
showed significant differences in all 8 syndromes and the
other problems scale, with patients having higher scores.
Details are shown in Table 2. Within the patient sample, group
categories, with an overall correct
classification of 86.3% (Table 4).
Discussion
Thirty-two children (34%) with LDD, 14 (31%) with an
expressive language disorder, and 18 (37%) with a mixed
receptive–expressive language disorder were reported as hav-
ing behavioural problems by their mothers, whereas only 6
(6%) control subjects had CBCL scores within the clinical
range. Considering those syndromes that are most prevalent
(that is, with greater than 10% incidence within the clinical
range among the children with LDD), attention problems
(14%), withdrawal (13%), thought problems (12%), and
aggressive behaviour (10%) were reported. Nearly the same
most frequent CBCL syndromes (attention problems, 47%;
withdrawal, 39%; delinquent behaviour, 34%; and aggressive
behaviour, 33%) were reported by parents of children with

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 Behaviour in Children With Language Development Disorders

Table 3 Group differences within the patient sample between children with (26), as well as emotional–social func-
expressive language disorder (E-LD) and children with mixed tioning (27). Difficulties in several
receptive–expressive language disorder (RE-LD) areas may become more evident as
Syndromes E-LD RE-LD Statistical analyses children grow older. Children aged 3
Mean (SD) Mean (SD) t-value (P) to 6 years with specific language
Withdrawn 2.7 (2.8) 2.9 (3.0) –0.8 (0.417) impairment show fewer behavioural
Somatic complaints 0.8 (1.3) 0.6 (1.0) 0.8 (0.438) problems (28) than older children
(29). In follow-up studies, children
Anxious–depressed 2.8 (3.1) 2.8 (3.7) –0.1 (0.952)
with disorders in language develop-
Social problems 2.0 (1.8) 1.8 (1.7) 0.4 (0.693) ment in preschool had increased rates
Thought problems 0.4 (0.8) 0.4 (0.8) –0.1 (0.907) of behavioural problems when reas-
Attention problems 3.3 (2.3) 4.2 (3.3) –1.5 (0.132) sessed later in childhood (28). In the
study by Noterdaeme and Amorosa
Delinquent problems 1.8 (2.0) 1.7 (1.8) 0.0 (0.969)
(9), 41% of the patient sample were
Aggressive behaviour 9.3 (6.7) 7.8 (4.8) 1.2 (0.229) children with expressive language dis-
Other problems 5.5 (4.6) 5.8 (3.8) –0.3 (0.752) order and 59% were children with
receptive disorders, whereas in our
sample, 48% of the children had
Table 4 Stepwise discriminant analysis between patients and control expressive language disorder and 52%
subjects had a mixed receptive– expressive dis-
Steps Variables Wilk’s Lambda c 2 order. It seems to be rather unlikely
that the differences in the frequencies
1 Other problems 0.529 128.4a
of behavioural problems were caused
2 Social problems 0.491 74.1a by different patient sample composi-
3 Anxious–depressed 0.463 54.9 a tions. Children with mixed disorders
in receptive and expressive language
4 Thought problems 0.440 44.8a
development were indeed more likely
5 Attention problems 0.425 37.9a
to show scores within the clinical
6 Delinquent problems 0.412 33.1a range with respect to withdrawal and
attention problems, whereas children
a
P £ 0.0001
with disorders in expressive language
development more frequently reported
disorders in language development in a study by Noterdaeme “somatic complaints”; however, group comparisons within
and Amorosa (9), although they found higher frequencies for both the language disorder groups yielded no significant
behavioural problems. The higher frequencies may stem from differences.
different forms of patient recruitment, the difference in patient
age, or the different composition of the patient sample. Their The univariate group comparisons among all children with
patients were selected from a sample of children referred for disorders in language development and age- and sex-matched
diagnosis to the unit for developmental and behavioural disor- children without problems in their language development
ders at a child and adolescent psychiatry facility in Munich showed significantly higher CBCL scores among the children
after demonstrating a developmental language disorder. Our with LDD. The multivariate stepwise discriminant analysis
sample of children with LDDs was recruited from a university correctly classified 92% of control subjects as control subjects
ear, nose, and throat clinic and was examined for behavioural (sensitivity) and 76% of patients as patients (specificity); the
overall correct classification was 86.3% by the CBCL scales
problems through a routine psychological diagnostic process
other problems, social problems, anxious–depressed, thought
regarding general (that is, cognitive, language, and
problems, attention problems, and delinquent problems.
emotional–social) child development. The mean age of their
patients (8.2 years) was higher than the mean age of ours Coster and others reported that children with specific lan-
(4.8 years). This may explain the higher frequency of behav- guage impairment did not demonstrate more externalized
ioural problems, since the gap between children with disor- behaviour than children without language problems and sug-
ders in language development and their normally developing gested that the absence of aggressive behaviour might be a
peers tends to widen over time in several areas, such as lan- characteristic of children with specific language impairment
guage abilities (25), and cognitive and academic functioning (10). Our results could not confirm this hypothesis, because

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The Canadian Journal of Psychiatry—Original Research
the univariate results yielded significant differences between
the children with LDD and the control subjects with respect to
aggressive behaviour and delinquent problems, and the
multivariate stepwise discriminant analysis showed that
higher scores in delinquent problems, in addition to other
scales, contribute significantly to the classification of a child
as having LDD.
In general, our results agree with several studies that report
that children with speech and language disorders are at special
risk for developing behavioural problems (9,10). There are at
least 3 possible explanations for the association between dis-
orders in language development and behavioural problems.
· Disorders in language development may lead to behav-
ioural problems. Serious emotional problems flow from
the children’s inability to express themselves or to com-
prehend others appropriately (30). Having communica-
tion difficulties puts a child at risk not only educationally
but also emotionally (14). According to Goldstein and
Gallagher, children with language difficulties seemed to
be at particular risk for social failure because language
skills play a critical role in social interaction (31). The
ability to participate in social interactions with others is
essential to being integrated within our society (32).
Several studies strongly suggest that language disorders
may have a notable impact on patterns of social inter-
action (for example, 33,34). Children with language im-
pairment had much more difficulty accessing the ongoing
social interaction than language–age-matched or
chronological–age-matched peers (35). Children with
specific language impairment may have less social inter-
action with peers and may have difficulties entering
social interactions, or unresponsive conversational styles
may deflate the value of the child with language impair-
ment as a conversational, and therefore social, partner
(32). According to Rice (36), children with communica-
tion problems are at risk for “a negative social spiral.”
They may have difficulties interacting with their peers be-
cause of their language impairment and may be in danger
of social rejection. This social rejection may reduce expo-
sure to language and limit opportunities to exercise and
refine conversational skills. Thus, language impairment
and social difficulties may compound each other.
· Behavioural problems in children may lead to disorders in
language development by negatively influencing the com-
munication between child and parents. Further, mental
structures for acquiring language from their environment
also play an important part. Without exposure to lan-
guage, children cannot even begin to learn to speak. The
nature of the language environment seems to make a dif-
ference. The more parents interact linguistically with their
children when they are toddlers, the larger the children’s
vocabularies are by the time they start school (37).
Some researchers have argued that child-directed
speech—adults modifying their speech to toddlers to
612
make it easier for the children to acquire language (38)—
serves a primary attentional and affective function in
mother–child interaction. Mothers use it to capture their
babies´ attention and to communicate with them emotion-
ally, although it has little or no direct impact on chil-
dren’s syntactic development (39). Child-directed speech
alone does not explain children’s language acquisition. It
would simplify it, although the concrete, present-oriented
nature of adult–child conversations may help children to
make connections between words and the things they re-
fer to. Frequently asking questions and clearly taking
turns provide opportunities for linguistic practice and the
learning of conversational skills. Jerome Bruner has sug-
gested that the ways adults structure a child’s language
environment should be considered a language acquisition
support system—a complement to Chomsky’s language
acquisition device (40). Biology and environment interact
in children’s semantic and syntactic development just as
in their acquisition of the sound system of their language.
· Both the LDD and the behavioural problems may be
caused by a third factor, such as neurodevelopmental im-
maturity (7). A neurodevelopmental hypothesis of lan-
guage disorder suggests that an impairment of language
development appears to be the result of impaired brain
development. According to Beitchman and others,
neurodevelopmental immaturity may be evident in several
different ways (41).
Some of the early and more obvious effects of a neuro-
developmental immaturity could appear in the form of delays
in speech or language development and in a lower mental age.
Several studies reported verbal and nonverbal intellectual dis-
abilities in children with disorders in language development
(4).
Further, it may emerge in the form of neurological signs (42).
Slight structural and functional brain abnormalities, in
contrast to serious ones, have been reported (43).
Neuropathological studies of the brain of a 7-year-old girl
with developmental dysphasia revealed atypical symmetry of
the plana temporale and a dysplastic gyrus on the inferior sur-
face of the left frontal cortex along the inferior surface of the
sylvian fissure. According to Cohen and others, these abnor-
malities are likely related to midgestation, the period of
neuronal migration from the germinal matrix to the cerebral
cortex, and are consistent with a neurodevelopmental cause of
developmental dysphasia (44). EEG studies showed epileptic
abnormalities in 9 children (rare in 4 cases and frequent in
5 cases) with expressive developmental dysphasia, but
according to Duvelleroy-Hommet and others, it is unlikely
that EEG abnormalities could have produced dysphasia (45).
Single photon emission computed tomography (SPECT)
studies showed that functional specialization of both hemi-
spheres is impaired in developmental dysphasia (46).
High-resolution magnetic resonance imaging (MRI) revealed
W Can J Psychiatry, Vol 48, No 9, October 2003

bilateral parietotemporal gray matter heterotopias in
monozygotic male twins with a developmental language dis-
order, more frequently in the left hemisphere than in the right
and more pronounced in the more affected twin (47). They
suggested that neuronal migration defects and ensuing focal
heterotopias might be causally related to developmental lan-
guage disorder. Trauner and others reported neurological
abnormalities in 70% of children with developmental lan-
guage impairment; the most common abnormalities featured
obligatory synkinesis, fine motor impairments, and hyper-
reflexia (48). Further, about one-third of these children had
abnormal MRI scans, including ventricular enlargement, cen-
tral volume loss, and white matter abnormalities. They sug-
gested that language impairment is indicative of more
widespread nervous system dysfunction. Preis and others
found normal left–right asymmetry of the planum temporale
and planum parietale in 21 right-handed children with devel-
opmental language disorder when compared with 21 matched
control subjects (49). The planum temporale was bilaterally
smaller in the affected children, which seems to account for
their approximately 7% smaller forebrain sizes. They sug-
gested that their findings do not support a role of gross visible
unilateral abnormalities of posterior intrasylvian ontogenesis
in this disorder. In contrast to the results of Preis and others
(49), the neuroanatomical findings of Gauger and others (50)
demonstrate that the areas of the brain subserving language
function in the left hemisphere (the planum and pars
triangularis) are significantly different in size and shape in
children with LDD when compared with children without lan-
guage deficits. The typical leftward asymmetry for the
planum and pars triangularis was not found in most of the
LDD children. The pars triangularis was significantly smaller
in the left hemisphere, and children with LDD were more
likely to have right-side asymmetry of language structures,
which suggests a structure–function relation between the lan-
guage structures of the brain and language ability. They sug-
gested that atypical asymmetry of perisylvian structures may
indicate an absence of the necessary establishment of
neural networks required for specific functions, such as
language (51).
The limitations of this study are the collection of the cross-
sectional and checklist-based child behaviour data using a
clinical sample, which possibly limits the generalizability of
the findings. For future studies, it would be very interesting to
investigate child behaviour using an experimental design
between a clinical and a nonclinical sample. Moreover, longi-
tudinal studies exploring the association between LDD and
child behaviour would be also very informative.
To conclude, behavioural manifestations may be both direct
and indirect expressions of a neurodevelopmental immaturity
(41). The risk of psychiatric disorder among speech- or
Can J Psychiatry, Vol 48, No 9, October 2003 W
Behaviour in Children With Language Development Disorders
language-impaired children will increase as a function of the
underlying severity of the neurodevelopmental immaturity—
the more limited and specific the impairment, the milder the
neurodevelopmental delay and the better the prognosis (7).
Therefore, very early detection and appropriate develop-
mental diagnosis regarding language, cognitive, and
emotional–behavioural development are necessary to initiate
early-intervention programs.
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Manuscript received August 2002, revised, and accepted April 2003.
1
Associate Professor, Department of Phoniatrics and Logopedics, University
Ear, Nose, and Throat Clinic, Vienna, Austria.
2
Research Scientist, Department of Neuropsychiatry of Children, LKH
Klagenfurt, Austria.
3
University Assistant, Department of Phoniatrics and Logopedics, University
Ear, Nose, and Throat Clinic, Vienna, Austria.
4
Research Scientist, Department of Phoniatrics and Logopedics, University
Ear, Nose, and Throat Clinic, Vienna, Austria.
5
Assistant Professor, Department of Psychology, Vienna, Austria.
6
Associate Professor, Department of Medical Psychology, Vienna, Austria
Address for correspondence: Dr U Willinger, Department of Phoniatrics and
Logopedics, University Ear, Nose, and Throat Clinic, Waehringer Guertel
18-20, A-1090 Vienna, Austria
e-mail: ulrike.willinger@univie.ac.at

Résumé : Le comportement des enfants ayant des troubles de développement du langage

Objectif : L’objectif de cette étude consistait à examiner les différences univariées et multivariées des problèmes
de comportement chez les enfants ayant des troubles de développement du langage, soit de l’expression orale ou de
l’expression mixte orale-réceptive, et chez les enfants ayant un développement du langage normal.
Méthode : Quatre-vingt quatorze enfants ayant des troubles de développement du langage (TDL) et ayant entre 4
et 6 ans ainsi que 94 enfants jumelés selon l’âge et le sexe sans troubles de développement du langage ont été
comparés en ce qui concerne les problèmes de comportement, comme ils sont mesurés par la version allemande de
la Liste de comportement pour les enfants de 4 à 18 ans.
Résultats : Trente-deux enfants (34 %) ayant des TDL ont manifesté des problèmes de comportement dans
l’intervalle clinique, tandis que seulement 6 (6 %) des sujets témoins avaient des notes dans cet intervalle. Les
comparaisons du groupe univarié entre patients et témoins indiquaient des différences significatives pour tous les 8
syndromes et à l’échelle « autres problèmes » chez les patients ayant des notes élevées. L’analyse factorielle
discriminante pas à pas multivariée a révélé une fonction discriminante significative dans les échelles « autres
problèmes », « problèmes sociaux », « anxieux ou déprimé », « problèmes de pensée », « problèmes d’attention » et
« problèmes de délinquance ».
Conclusions : En général, nos résultats concordent avec plusieurs études qui concluent que les enfants ayant des
troubles de la parole et de langage sont spécialement à risque de développer des problèmes de comportement.
L’immaturité neurodéveloppementale peut être un facteur sous-jacent tant du trouble de développement du langage
que des problèmes de comportement.

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