Abstract
BackgroundCommunication, behavioural, and executive function problems often co-occur in childhood. Previous attempts to identify the origins of these comorbidities have typically relied on comparisons of different deficit groups and/or latent variable models. Here we apply a network approach to a heterogeneous sample of struggling learners to conceptualise these comorbidities as a dynamic system of interacting difficulties.Methods714 children struggling with attention, learning, and/or memory were included. The sample consisted of children with both diagnosed (41%) and undiagnosed difficulties. The conditional independence network of parent ratings of everyday behaviour, cognition, and communication was estimated.ResultsA clustering coefficient identified four interconnected areas of difficulty: (1) structural language and learning; (2) pragmatics and peer relationships; (3) behavioural and emotional problems; and (4) cognitive skills. Emotional and behavioural symptoms shared multiple direct connections with pragmatic abilities and cognitive problems, but not with structural language skills or learning problems. Poor structural language and cognitive skills were associated with learning problems. Centrality indices highlighted working memory and language coherence as symptoms bridging different problem areas.ConclusionThe network model identified four areas of difficulty and potential bridging symptoms. Although the current analytic framework does not provide causal evidence, it is possible that bridging symptoms may be the origins of comorbidities observed on a dimensional level; problems in these areas may cascade and activate problems in other areas of the network. The potential value of applying a dynamic systems network approach to symptoms of developmental disorders is discussed.
Highlights
Communication, behavioural, and executive function problems often co-occur in childhood
Hyperactivity disorder (ADHD), while communication difficulties such as poor speech are often studied in children with developmental language disorder (DLD)
The co-occurrence of pragmatic communication and behavioural problems was observed in a large heterogeneous sample of children with a broad range of difficulties
Summary
Communication, behavioural, and executive function problems often co-occur in childhood. Behavioural problems such as hyperactivity are typically studied in children with attention deficit hyperactivity disorder (ADHD), while communication difficulties such as poor speech are often studied in children with developmental language disorder (DLD). There are practical advantages to this categorical approach It defines clear symptom-based criteria to inform practitioner decision-making about diagnoses and interventions. It fails to accommodate high rates of comorbidity across developmental disorders [6,7,8,9,10] and substantial heterogeneity within disorders [7, 11,12,13]. Symptom associations are Mareva and Holmes BMC Pediatrics (2019) 19:452 explored in a large heterogeneous sample of children with clinical and subclinical levels of difficulties
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