The relationship between language difficulties, psychosocial difficulties, and speech-language pathology service access in the community

Background: A range of factors may impact on whether children access speech-language pathology services, beyond their communication difficulties. For instance, co-occurring psychosocial difficulties may amplify children’s observable difficulties, leading to greater access. It is important to examine such associations, because they may reflect inherent differences between children with language difficulties who access services and those who do not, indicating under-servicing for sub-groups in the community. Aims: The first aim of this study was to examine possible differences in psychosocial difficulties between children with language difficulties who did versus did not access speech-language pathology (SLP) services in the past 12 months. The second aim was to examine the unique contribution of psychosocial difficulties to service access, over and above language difficulties, common predictors of service access. Methods & Procedures: Analyses were carried out on data gathered from 808 11-year-old children who took part in the Early Language in Victoria Study (ELVS). Children were categorised as having language difficulties based on their CELF-4 Core Language Score with a cut-point of >1.25 SD below the mean. The primary outcome measure was access to speech-language pathology services in the past 12 months. Comparison and predictor variables included children’s psychosocial difficulties, language skills, relevant demographic variables (gender, caregiver education), and prior SLP access. Outcomes & Results: 42 children with language difficulties who had accessed speech-language pathology services had significantly greater psychosocial difficulties than those who had not (SDQ Total Difficulties, U = 53.00, z = -4.080, p < .001). Using binary logistic regression, a model examining child gender, caregiver education, psychosocial difficulties (internalising and externalising behaviours), language difficulties, and prior SLP access (in earlier years) was significant χ2 (8) = 137.285, p < .001, with increased externalising difficulties (OR = 1.213, p < .001), increased communication difficulties (OR = .949, p <.001), and prior SLP access (OR = 7.430, p <.001) identified as unique predictors of service access. Conclusions & Implications: The results indicate that children with language difficulties who have comorbid psychosocial difficulties are more likely to access services than those who do not. Accordingly, children with language difficulties who access clinical services may require interdisciplinary support, while children without co-morbid psychosocial difficulties may be under-referred for SLP services.