248 Chapter 30
impairments. When a language disorder is associated with low IQ, the
prognosis is generally worse. Within the phonologic-syntactic disorders,
the chances of a complete recovery are highest for children with pure
articulation problems and lowest for children with a receptive language
disorder. A child with a receptive language disorder and a normal IQ is
likely to make enough progress by adult life to communicate fairly well,
but some noticeable language deficits usually persist. Studies of autistic
spectrum disorders suggest that pragmatic deficits in language use and
content can be very persistent. The prognosis in Landau-Kleffner syn-
drome is very variable, with severe persisting problems in some instances,
particularly when the onset occurred before the age of 5 or 6.
Associated scholastic difficulties
Severe and persistent language disorders are associated with a substantial
risk of academic difficulties, even if the child is of normal intelligence (as
judged by non-verbal IQ). This risk is mainly for reading and spelling prob-
lems, though maths problems may also occur. Children whose language
catches up completely do not seem to be at increased risk. Expressive and
receptive language disorders carry a higher risk than articulation problems.
Indeed, pure articulation problems may not result in any increased risk of
academic problems.
Associated psychiatric and personality problems
Many studies have shown that children with language problems are at
increased psychiatric risk. In some instances, the psychiatric risk may stem
directly from the language disorder itself, for example, as a result of the
teasing, frustration and social isolation engendered by communication
difficulties. In other instances, however, the language and psychiatric
problems may both stem from a single underlying cognitive or neurobi-
ological disorder.
Children with language disorder are primarily at risk for anxiety disor-
ders, ADHD and difficulties with social relationships. These problems are
often more obvious in older children and adolescents than in younger
children. There is little or no excess of disruptive behavioural problems.
The rate of psychopathology is particularly high in individuals of low IQ,
but the rate is also substantially increased in those of normal IQ. Psychi-
atric risk is primarily associated with expressive and receptive language
problems, although children with pure articulation problems may be more
liable to emotional problems.
Children with receptive language problems often show some degree of
pragmatic language impairment. This may become more evident as the
individual grows older. One follow-up study of children with receptive
language problems and normal IQ found that over half had major prob-
lems with social relationships in adult life. In many instances, the failure