Predicting language and behavioural outcomes for high-risk children at eight years of age

Seventy high-risk children, who were born prematurely and/or had experienced medical complications during the neonatal period, were evaluated at 8 years to determine the prevalence of language and behaviour problems and to investigate whether a relationship exists between language functioning and behaviour outcome. This study assessed the accuracy of a system that consisted of a risk index scale and preschool language and behaviour measures in predicting subsequent language and behaviour development, and identifying children at risk for language and behaviour problems. The children were administered a variety of standardized language measures (e.g., Reynell Language Scales; Peabody-Picture Vocabulary Test-Revised) at 3, 4 and 8 years. The Child Behavior Checklist/4-18 (CBCL) was administered at 4 and 8 years to evaluate behaviour. Although most of the children's receptive and expressive language skills fell in the average range at 3, 4, and 8 years, they performed significantly lower on the Expressive Language Scale of the Reynell at 3 years, and the Grammatical Morphemes subtest of the TACL-R at 8 years compared to the normative samples of these language measures. Boys at 4 and 8 years did not differ significantly from the normative sample of the CBCL on the Internalizing or Externalizing scales, but girls were rated as having significantly fewer behaviour problems compared to the normative sample of the CBCL. Both boys and girls did not differ significantly from the normative sample of the CBCL on the Total Competence, Activities, Social, or School competence scales of the CBCL at 8 years of age. In this sample of generally normal functioning children, expressive vocabulary at 3 years of age was found to predict language and Total Competence at 8 years, whereas as Externalizing behaviour at 4 years predicted behaviour outcome on the Internalizing and Externalizing scales of the CBCL at 8 years. Because of the small sample size and low prevalence rate of language and behaviour problems found in this sample of children, it was not possible to determine how useful the system consisting of a risk index scale and preschool measures was at predicting or identifying delays/problems in language and behaviour outcome at 8 years. The present findings are very encouraging for the developmental outcome of high-risk children with normal intelligence who were found to have average language skills and normal behaviour. However, the development for these children must continue to be monitored given that they performed significantly lower on the Expressive Language Scale of the Reynell Language at 3 years, and the Grammatical Morphemes subtest of the TACL-R at 8 years compared to the normative samples. It was also found that preschool expressive language functioning was related to outcome on the Total Competence scale of the CBCL at 8 years, primarily for the boys, rather than early behaviour problems (i.e., internalizing and externalizing problems) being related to language outcome at 8 years. Although aspects of language and competence involved in this relationship were not indicative of problems in the present sample, this relationship should be monitored. Given this relationship, it is possible that other features of early language and/or later school and social competence are problematic for some high-risk children, and that early language delays do predict later competence difficulties.