His name is "Jeff"; he is age 25 and a likeable fellow. The
problem is that he has a speech impediment, so it's hard to understand what he
says. It is possibly because of this problem that he has never asked a girl
for a date.
Jeff is not alone. A new longitudinal study out of Canada, and in press
with the Journal of Anxiety Disorders, has found that youngsters with
speech and language problems are three times more likely to suffer from social
anxiety (social phobia) at age 19 than are youngsters without such
This finding is valuable because little has been known about the origins of
social anxiety, even though it is one of the most common mental health
problems (Psychiatric News, December 17, 2004).
Studies have already revealed that children with speech/language problems
often have trouble interacting with peers, are often viewed as undesirable
playmates, and are frequently rated by teachers as having poor social skills.
But no one appeared to have examined whether early speech/language
difficulties might lead to social phobia later in life. So Joseph Beitchman,
M.D., clinical director of the Child, Youth, and Family Program at the Centre
for Addiction and Mental Health in Toronto, and his coworkers decided to
conduct a prospective study to find out.
In 1982, some 1,700 5-year-olds in the Ottawa-Carleton region of Ontario
were screened for speech/language competency. Of those, 142 who were found to
be speech and/or language impaired agreed to take part in the study. Another
142 children without speech/language difficulties served as controls. The
controls were the same age and gender as the impaired children and from the
When the 284 subjects were 19 years old, 258 (90.8 percent) agreed to take
part in the second follow-up study. Data about the social fears of 240 of the
258 were obtained. Due to the small number of speech-impaired-only subjects
with social phobia, Beitchman and his coworkers decided to compare social fear
results for just two groups—76 who were language or language/speech
impaired and 126 controls.
Sixteen percent of the impaired subjects were found to have social phobia
at follow-up, while only 7 percent of the control subjects did, and the
difference was statistically significant. This 16 percent one-year prevalence
rate is "one of the highest rates of social phobia" ever reported,
the investigators indicated.
Further, 23 percent of the impaired subjects met criteria for a lifetime
prevalence of social phobia, compared with only 11 percent of the
controls—also a significant difference.
And compared with controls, individuals who had been impaired at age 5 were
also three times more likely to experience social anxiety at age 19.
Moreover, the mothers of both impaired subjects and control subjects had
been assessed for social anxiety when the subjects were 5 years old. A
significant link was later found in control subjects, but not in impaired
subjects, between having a socially anxious mother and having social anxiety
Beitchman was not surprised that speech/language impairment and social
anxiety were strongly linked, he told Psychiatric News. But what did
surprise him, he said, "was that there appear to be two routes to social
phobia—one through a family history of anxiety and a second through a
history of language impairments."
The findings have implications for preventing mental illness, the
researchers suggested. For instance, if early speech/language difficulties are
a risk factor for later social phobia, then perhaps children with such
problems should receive help in developing social skills.
The results also have implications for clinical psychiatrists, Beitchman
added. "They need to be aware of this [speech/language impairment] route
to social phobia and engage [patients who have developed social phobia via
this route] in appropriate strategies to address their concerns."
"This is one of the strongest longitudinal studies of its kind, in
that 90 percent of subjects initially studied were retained for
reassessment," Claudio Toppelberg, M.D., told Psychiatric News.
Toppelberg is a child psychiatrist at Children's Hospital Boston and Harvard
Medical School and director of child language and developmental psychiatry at
Judge Baker Children's Center.
"While this research cannot directly address issues of causality and
etiology—a limitation shared by other naturalistic developmental
epidemiology research," Toppelberg continued, "the results are
consistent with a well-supported account indicating that early language
impairment leads to maladaptation and to clinical and subclinical
psychopathology down the road. One issue that the study does not address is
the potential link with selective mutism, which is known to be associated with
language impairment in children and predictive of social phobia in adults.
"The presence of language impairment or its sequelae needs to be
considered when working clinically with socially phobic and other adult
patients, as language impairment can greatly affect the effectiveness of
therapy and perpetuate the functional impairment, thus magnifying the burden
of these disorders."
The study was funded by Health Canada, National Health and Research
An abstract of "Social Anxiety in Late Adolescence: The
Importance of Early Childhood Language Impairment" can be accessed at<www.sciencedirect.com>
by clicking on "Browse A-Z of Journals," "J,""
Journal of Anxiety Disorders," and "Articles in