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General introduction
participate in lessons. Therefore, it is possible that children at certain ages do not seem to have 1
much difficulties because of their DLD, but fall short of expectations when the communicative
demands of the environment increase (Dockrell et al., 2014).
Heightened risk for psychosocial problems in children with DLD
The communication problems of children with DLD may impede their development in
different developmental areas. Especially when the communicative demands of the
environment are too high, or when language problems are not recognized, miscommunication
is likely to occur (Redmond & Rice, 1998). These communication problems will impede the
ability of children to learn from the social environment. Not only the educational progress of
children will be hampered, but also their social-emotional development (Dockrell, Lindsay, &
Palikara, 2011; Snowling et al., 2016). Indeed, a growing body of research shows that children
with DLD are at risk for the development of psychosocial problems (Durkin & Conti-Ramsden,
2010; Yew & O'Kearney, 2013). Vice versa, the majority of children with severe psychosocial
problems also have language difficulties, problems which often are not recognized. It is likely
that these language problems play a role in the development and maintenance of their problems
(Cohen et al., 1998; Gallagher, 1999; Hollo, Wehby, Oliver, 2014).
Children with DLD seem particularly at risk of social problems. From an early age on,
they are less popular with their peers, are more often rejected or bullied and have less
friendships than their peers without DLD (Andrés-Roqueta, Adrian, Clemente, & Villanueva,
2016; Botting & Conti-Ramsden, 2004; 2008; Durkin & Conti-Ramsden, 2007; Knox & Conti-
Ramsden, 2003; Redmond, 2011; Wadman, Durkin, & Conti-Ramsden, 2011a). Additionally,
internalizing problems are reported in children and adolescents with DLD such as depressive
symptoms, social anxiety, and psychosomatic complaints (Beitchman et al., 1996; Botting,
Toseeb, Pickels, Durkin, & Conti-Ramsden, 2016; Conti-Ramsden & Botting, 2008; Gregl et
al., 2014; Maggio et al., 2014; Van Daal, Verhoeven, & Van Balkom, 2007; Wadman, Durkin,
& Conti-Ramsden, 2011b). Finally, higher levels of externalizing problems are reported in
children with DLD such as anger outbursts, or aggression (Conti-Ramsden, Mok, Pickels, &
Durkin, 2013; Lindsay, Dockrell, & Strand, 2007; Maggio et al., 2014; St. Clair et al., 2011;
Timler, 2008; Van Daal et al., 2007; Winstanley, Webb, & Conti-Ramsden, 2018).
Overall, longitudinal studies indicated that internalizing problems of children with DLD
were higher during the primary school years, but decreased during adolescence (St Clair,
Pickles, Durkin, & Conti-Ramsden, 2011). Externalizing problems showed more diverse
developmental trajectories in different longitudinal studies, with some studies reporting higher
but decreasing levels (St Clair et al., 2011), whereas another study found higher and increasing
levels of externalizing problems in the same age range (Lindsay & Dockrell, 2012). Conversely,
social problems of children with DLD tended to increase during the primary and secondary
school years (Lindsay & Dockrell, 2012; St Clair et al., 2011). However, recent reanalyses of
the social and internalizing problems of one of these studies indicated different developmental
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