Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study

  • Yi-Chen Lee
  • Vincent Chin-Hung Chen
  • Yao-Hsu Yang
  • Ting-Yu Kuo
  • Tai-Hsin Hung
  • Yu-Fang Cheng
  • Kuo-You HuangEmail author
Original Article


Anxiety and depression are common emotional problems in children and adolescents. This study used a long-term tracking large database to investigate whether the proportion of children who were diagnosed with speech and language impairments were later diagnosed with anxiety or depression were significantly greater than that of matched group of the same age and gender without speech and language impairments. More than 4300 eligible children with speech and language impairments and matched controls were identified and assessed for anxiety and depression. The risk of anxiety and depressive disorders in children with speech and language impairments were examined with Cox regression analyses and adjusting for covariables (gender, age, and comorbidities). The results showed that speech and language impairments were positively associated with anxiety disorders (adjusted hazard ratio [AHR] 2.87, 95% confidence interval [CI] 2.20–3.76) and depressive disorders (AHR 2.51, 95% CI 1.52–4.13). The number of boys with speech and language impairments was more than twofold that of girls, but boys did not different from girls in the risk of anxiety disorders (AHR 0.95, 95% CI 0.75–1.20) and depressive disorders (AHR 0.72, 95% CI 0.47–1.11). Infantile autism and intellectual disabilities were positively associated with anxiety (AHR 1.54, 95% CI 1.07–2.21; AHR 1.47, 95% CI 1.09–1.98), and the latter was positively associated with depression (AHR 1.83, 95% CI 1.06–3.17). In addition to speech and language impairments interventions, our findings supported the necessity of identification and interventions in anxiety and depressive disorders among children with speech and language impairments from elementary school until youth.


Speech and language impairments Emotional disorders Anxiety Depression 



The authors would like to thank the Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital (CMRPG6F0281) for funding, and the Health Information and Epidemiology Laboratory (CLRPG6G0042) for comments and assistance in data analysis.

Author Contributions

Y-CL contributed to the study design and revised the manuscript; VC-HC contributed to the study design, statistical analysis, interpreted the data, and contributed equally to the first author; Y-HY and T-YK carried out the statistical analysis and made tables and figures; T-HH and Y-FC critically reviewed the manuscript; K-YH conceptualized the study, drafted the initial manuscript, finalized the manuscript, and took responsibility for the accuracy of the data analysis. All authors approved the final manuscript as submitted.


The present study was supported in part by Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital (CMRPG6F0281) and the Health Information and Epidemiology Laboratory (CLRPG6G0042). The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

All authors have no conflicts of interest to disclose.


  1. 1.
    Simms MD (2007) Language disorders in children: classification and clinical syndromes. Pediatr Clin N Am 54:437–467CrossRefGoogle Scholar
  2. 2.
    Tseng YC, Lai DC, Guo HR (2015) Gender and geographic differences in the prevalence of reportable childhood speech and language disability in Taiwan. Res Dev Disabil 40:11–18PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    ICD-9Data (2015) 2015 ICD-9-CM Diagnosis codes.
  4. 4.
    Beitchman JH, Nair R, Clegg M, Patel PG, Ferguson B, Pressman E, Smith A (1986) Prevalence of speech and language disorders in 5-year-old kindergarten children in the Ottawa-Carleton region. J Speech Hear Disord 51(2):98–110CrossRefGoogle Scholar
  5. 5.
    Blum-Harasty JA, Rosenthal JBM (1992) The prevalence of communication disorders in children: a summary and critical review. Aust J Hum Commun Disord 20(1):63–80CrossRefGoogle Scholar
  6. 6.
    Boyle CA, Decoufle P, Yeargin-Allsopp M (1994) Prevalence and health impact of developmental disabilities in US children. Pediatrics 93(3):399–403PubMedPubMedCentralGoogle Scholar
  7. 7.
    Harasty J, Reed VA (1994) The prevalence of speech and language impairment in two Sydney metropolitan schools. Aust J Hum Commun Disord 22(1):1–23CrossRefGoogle Scholar
  8. 8.
    Keating D, Turrell G, Ozanne A (2001) Childhood speech disorders: reported prevalence, comorbidity and socioeconomic profile. J Paediatr Child Health 37(5):431–436PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Law J, Boyle J, Harris F, Harkness A, Nye C (2000) Prevalence and natural history of primary speech and language delay: findings from a systematic review of the literature. Int J Lang Commun Disord 35(2):165–188CrossRefGoogle Scholar
  10. 10.
    Leske MC (1981) Prevalence estimates of communicative disorders in the US speech disorders. ASHA 23:217–225PubMedPubMedCentralGoogle Scholar
  11. 11.
    McKinnon DH, McLeod S, Reilly S (2007) The prevalence of stuttering, voice, and speech-sound disorders in primary school students in Australia. Lang Speech Hear Serv Sch 38(1):5–15PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Nelson HD, Nygren P, Walker M, Panoscha R (2006) Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force. Pediatrics 117(2):e298–e319CrossRefGoogle Scholar
  13. 13.
    Pennington L, Goldbart J, Marshall J (2005) Direct speech and language therapy for children with cerebral palsy: findings from a systematic review. Dev Med Child Neurol 47(1):57–63PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Rescorla L (1989) The language development survey: a screening tool for delayed language in toddlers. J Speech Hear Disord 54(4):587–599CrossRefGoogle Scholar
  15. 15.
    Shriberg LD, Tomblin JB, McSweeny JL (1999) Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. J Speech Lang Hear Res 42:1461–1481CrossRefGoogle Scholar
  16. 16.
    Tomblin JB, Records NL, Buckwalter P, Zhang X, Smith E, O’Brien M (1997) Prevalence of specific language impairment in kindergarten children. J Speech Lang Hear Res 40(6):1245–1260PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Prizant BM, Audet LR, Burke GM, Hummel LJ, Maher SR, Theadore G (1990) Communication disorders and emotional/behavioral disorders in children. J Speech Hear Disord 55:179–192PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Voci SC, Beitchman JH, Brownlie EB, Wilson B (2006) Social anxiety in late adolescence: the importance of early childhood language impairment. J Anxiety Disord 20(7):915–930PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Baker L, Cantwell DP (1987) Factors associated with the development of psychiatric illness in children with early speech/language problems. J Autism Dev Disord 17(4):499–510PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Beitchman JH, Brownlie EB, Inglis A, Wild J, Ferguson B, Schachter D, Lancee W, Wilson B, Mathews R (1996) Seven-year follow-up of speech/language impaired and control children: psychiatric outcome. J Child Psychol Psychiatry 37(8):961–970PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Beitchman JH, Wilson B, Johnson CJ, Atkinson L, Young A, Adlaf E, Escobar M, Douglas L (2001) Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome. J Am Acad Child Adolesc Psychiatry 40(1):75–82PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Conti-Ramsden G, Botting N (2008) Emotional health in adolescents with and without a history of specific language impairment (SLI). J Child Psychol Psychiatry 49(5):516–525PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Pinborough-Zimmerman J, Satterfield R, Miller J, Bilder D, Hossain S, McMahon W (2007) Communication disorders: prevalence and comorbid intellectual disability, autism, and emotional/behavioral disorders. Am J Speech Lang Pathol 16(4):359–367PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Yew SG, O’Kearney R (2013) Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies. J Child Psychol Psychiatry 54(5):516–524PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Mirza N, Ruiz C, Baum ED, Staab JP (2003) The prevalence of major psychiatric pathologies in patients with voice disorders. Ear Nose Throat J 82(10):808–814PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Willinger U, Völkl-Kernstock S, Aschauer HN (2005) Marked depression and anxiety in patients with functional dysphonia. Psychiatry Res 134(1):85–91PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Bray MA, Kehle TJ, Lawless KA, Theodore LA (2003) The relationship of self-efficacy and depression to stuttering. Am J Speech Lang Pathol 12(4):425–431PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Kefalianos E, Onslow M, Block S, Menzies R, Reilly S (2012) Early stuttering, temperament and anxiety: two hypotheses. J Fluen Disord 37(3):151–163CrossRefGoogle Scholar
  29. 29.
    Gunn A, Menzies RG, O’Brian S, Onslow M, Packman A, Lowe R, Iverach L, Heard R, Block S (2014) Axis I anxiety and mental health disorders among stuttering adolescents. J Fluen Disord 40:58–68CrossRefGoogle Scholar
  30. 30.
    Iverach L, Jones M, McLellan LF, Lyneam HJ, Mnzies RG, Onslow M, Rapee RM (2016) Prevalence of anxiety disorders among children who stutter. J Fluen Disord 49:13–28CrossRefGoogle Scholar
  31. 31.
    Clegg J, Hollis C, Mawhood L, Rutter M (2005) Developmental language disorders: a follow-up in later adult life. Cognitive, language and psychosocial outcomes. J Child Psychol Psychiatry 46(2):128–149PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Snowling MJ, Bishop DV, Stothard SE, Chipchase B, Kaplan C (2006) Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment. J Child Psychol Psychiatry 47(8):759–765PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Tomblin JB, Zhang X, Buckwalter P, Catts H (2000) The association of reading disability, behavioral disorders, and language impairment among second-grade children. J Child Psychol Psychiatry 41(4):473–482PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Clark TG, Bradburn MJ, Love SB, Altman DG (2003) Survival analysis part I: basic concepts and first analyses. Br J Cancer 89(2):232–238PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Durkin K, Conti-Ramsden G (2007) Language, social behavior, and the quality of friendships in adolescents with and without a history of specific language impairment. Child Dev 78(5):1441–1457PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    St Clair MC, 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). J Commun Disord 44(2):186–199PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Durkin K, Conti-Ramsden G (2010) Young people with specific language impairment: a review of social and emotional functioning in adolescence. Child Lang Teach Ther 26:105–121CrossRefGoogle Scholar
  38. 38.
    Mok PL, Pickles A, Durkin K, Conti-Ramsden G (2014) Longitudinal trajectories of peer relations in children with specific language impairment. J Child Psychol Psychiatry 55(5):516–527PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Yliherva A, Olsen P, Maki-Torkko E, Koiranen M, Jarvelin MR (2001) Linguistic and motor abilities of low-birthweight children as assessed by parents and teachers at 8 years of age. Acta Paediatr 90(12):1440–1449PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL (1998) Language of early- and later-identified children with hearing loss. Pediatrics 102(5):1161–1171CrossRefGoogle Scholar
  41. 41.
    Pennington L, Miller N, Robson S, Steen N (2010) Intensive speech and language therapy for older children with cerebral palsy: a systems approach. Dev Med Child Neurol 52(4):337–344PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Kim SK (2015) Recent update of autism spectrum disorders. Korean J Pediatr 58(1):8–14PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Mukherjee SB (2017) Autism spectrum disorders-diagnosis and management. Indian J Pediatr 84(4):307–314PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Abbeduto L, Short-Meyerson K, Benson G, Dolish J (2004) Relationship between theory of mind and language ability in children and adolescents with intellectual disability. J Intellect Disabil Res 48(Pt 2):150–159PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Meuris K, Maes B, Zink I (2014) Evaluation of language and communication skills in adult key word signing users with intellectual disability: advantages of a narrative task. Res Dev Disabil 35(10):2585–2601PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryChiayi Chang Gung Memorial HospitalChiayiTaiwan
  2. 2.School of MedicineChang Gung UniversityTaoyuanTaiwan
  3. 3.Health Information and Epidemiology LaboratoryChiayi Chang Gung Memorial HospitalChiayiTaiwan
  4. 4.Department of Traditional Chinese MedicineChiayi Chang Gung Memorial HospitalChiayiTaiwan
  5. 5.Chang Gung Institute of TechnologyTaoyuanTaiwan
  6. 6.Department of Applied Science (Occupational Therapy)University of Western SydneySydneyAustralia
  7. 7.Department of Speech Language Pathology and AudiologyChung Shan Medical University and HospitalTaichungTaiwan
  8. 8.Speech and Language Therapy RoomChung Shan Medical University HospitalTaichungTaiwan

Personalised recommendations