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also experienced a period of psychosis in which he saw religious figures in his bedroom. Clinical implications The findings of this longitudinal investigation highlight a number of clinical implications. First, childhood language profiles (i.e., SLI vs PLI vs ASC) were found to predict language and psychosocial outcomes in adulthood. The broad differences in the outcome of the groups suggest that PLI may represent a meaningful diagnostic category. Importantly, however, it was communicative profile (i.e., structural language difficulties only vs pragmatic language difficulties only vs structural and pragmatic difficulties), and not diagnosis that was the best indicator of later outcome. Childhood language difficulties are likely to persist to adulthood, and have wide-ranging implications on other aspects of development. The association between early abilities and adult outcome highlights the importance of a wide-ranging assessment in childhood. Pragmatic difficulties have traditionally been difficult to assess, and we have made a concerted attempt to develop a range of assessments that reliably measure these abilities in children ( Children’s Communication Checklist – 2; Bishop, 2003) and adults ( Communication Checklist – Adult ; Whitehouse & Bishop, 2009). Obtaining an understanding of communicative ability across the entire language profile will afford greater insight into the possible outcomes of different children, and assist in the identification of areas likely to be in need of current or future intervention. Second, the findings demonstrate that mental health problems are of serious concern among those with developmental language disorders. It not yet clear whether the increased rate of psychiatric problems among those with communication problems reflects a genetic predisposition for disorder (Whitehouse, Spector & Cherkas, in press) or the result of accumulated experience. For example, in a recent study we found that affective disorders among adolescents with ASC were more common for those who expressed a desire to develop friendships (Whitehouse, Durkin, Jaquet & Ziatas, 2009). A mismatch between the desire of adolescents with ASC to develop friendships and their reduced ability to do so may lead to a clinical level of low mood. While this is a question to be answered by future research, the findings of the longitudinal study were clear: mental health problems are common among adolescents and adults with a history of communication disorder. It is thus important for speech pathologists to have a good working knowledge of psychiatric conditions, and be vigilant to disorder onset in their clients. Summary In sum, there is considerable variability in symptomatology among children diagnosed with a communication disorder. Obtaining an appreciation of an individual’s strengths and difficulties across the full communicative profile will not only enable a better understanding of potential avenues for intervention in childhood, but also provide important insights into possible adult outcomes. Severe mental health problems are common among adults with a history of developmental language disorder, and therefore an understanding of these conditions should form an important part of a speech pathologist’s intervention arsenal. References American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text rev.). Washington, DC: American Psychiatric Association. Bishop, D. V. M. (1998). Development of the Children’s Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry and Allied Disciplines , 39 , 879–891. Bishop, D. V. M. (2003). Children’s communication checklist – 2. London: Harcourt Assessment. Bishop, D. V. M., & Norbury, C. F. (2002). Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments. Journal of Child Psychology and Psychiatry and Allied Disciplines , 43 , 917–929. Bishop, D. V. M., Whitehouse, A. J. O., Watt, H. J., & Line, E. A. (2008). Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder. Developmental Medicine and Child Neurology , 50 , 341–345. Whitehouse, A. J. O., & Bishop, D. V. M. (2009). Communication checklist – Adult . Pearson: London. Whitehouse, A. J. O., Durkin, K., Jaquet, E., & Ziatas, K. (2009). Friendship, loneliness and depression in adolescents with Asperger’s Syndrome. Journal of Adolescence , 32 , 309–322. Whitehouse, A. J. O., Line, E. A., Watt, H. J, & Bishop, D. V. M. (2009). Qualitative aspects of developmental language impairment relate to language and literacy outcome in adulthood. International Journal of Language and Communication Disorders , 44 , 489–510. Whitehouse, A. J. O., Watt, H. J., Line, E. A., & Bishop, D. V. M. (2009). Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism. International Journal of Language and Communication Disorders , 44 , 511–528. Whitehouse, A. J. O., Spector, T. D., Cherkas, L. F. (in press). No clear genetic influences on the association between dyslexia and anxiety in a population-based sample of female twins. Dyslexia . Andrew Whitehouse completed his undergraduate degree in speech pathology at Curtin University, followed by a PhD in psychology at UWA. He then moved to Oxford University on a postdoctoral fellowship under the guidance of Prof Dorothy Bishop. For the last three years he has been the Scott Family Fellow at University College, University of Oxford. Andrew has recently returned to Australia to take up a position as a senior research fellow at the Telethon Institute for Child Health Research. His main research interests are in the neurological, genetic and epidemiological characteristics of developmental disorders such as autism and specific language impairment. Andrew has also developed a parallel research program investigating the neurological and genetic aspects of mental health disorders, in particular anxiety disorders and schizophrenia.

Correspondence to: Dr Andrew Whitehouse Telethon Institute for Child Health Research Centre for Child Health Research University of Western Australia 100 Roberts Road, Subiaco, WA 6008 email: awhitehouse@ichr.uwa.edu.au

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