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    Contribution of speech/language difficulties to health-related quality-of-life in Australian children: a longitudinal analysis

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    Speech and/or language difficulties (SaLD) are among the most frequently observed developmental problems affecting children. Research points to the impact of childhood SaLD on literacy/educational achievement, behaviour and self-esteem; however, there has been limited attention paid to the impact of SaLD, directly or indirectly, on health-related quality-of-life (HRQoL). HRQoL is the impact a particular health condition (or intervention) has on an individual. HRQoL comprises numerous distinct dimensions (ā€˜domainsā€™, commonly physical, psychological and social). Very few studies have examined associations between HRQoL, SaLD, and other child and family factors and none have been undertaken in Australia. This research will explore these associations using data from a sample of children aged 4 to 9 years, extracted from the Longitudinal Study of Australian Children (LSAC), a nationally representative longitudinal study of childhood development. The rich data available in the LSAC afforded an opportunity to investigate various child and family factors that may be related to childrenā€™s HRQoL and hence was well suited to exploratory research. Use of LSAC data also enabled tracking of childrenā€™s outcomes over six years. The Disability-Stress-Coping (DSC) model (which examines physical health, mental health and social functioning in children with chronic illness) formed the basis for variable selection. This thesis comprises two studies, the first cross-sectional, and the second longitudinal. The cross-sectional study provided an exploration of the LSAC data and elicited variables which were appropriate for further analysis in the subsequent longitudinal investigation. Further, this study component enabled examination of relationships between HRQoL and SaLD while accounting for fine and gross motor skills which could not be examined in the longitudinal study component as there were no appropriate motor skills measures at Waves 4 and 5. The cross-sectional study involved analysis of data from the baby cohort (children aged 4-5 years) of the LSAC (n=4, 386). For this study, three domains of HRQoL were examined, assessed by the physical, emotional and social functioning subscales of the Pediatric Quality of Life Inventory (PedsQLTM). SaLD was assessed in two ways: (1) parent concern about speech/language (Parentsā€™ Evaluation of Developmental Status) and (2) receptive vocabulary ability (adapted Peabody Picture Vocabulary Test-III). Multiple regression analyses were used to examine relationships at the cross-sectional level between HRQoL, SaLD, and various other explanatory variables including child specific factors (e.g., gender, ethnicity, temperament) and family characteristics (social-ecological considerations and psychosocial stressors). The longitudinal study examined the trajectory of HRQoL for children aged from 4 to 9 years and its relationship with SaLD. Generalised linear latent and mixed modelling (GLLAMM) was used to analyse data from Waves 3, 4 and 5 of the LSAC to understand HRQoL trajectories, assessed in the longitudinal study across four domains of HRQoL (physical, emotional, social and school functioning). Domains of HRQoL were examined to find the contribution of SaLD while accounting for child specific factors and family characteristics considered in the cross-sectional study. In the cross-sectional study, children with SaLD, as defined by parent concern about speech/language, exhibited relatively lower functioning across all HRQoL domains. In contrast, children with SaLD, as determined by poor receptive vocabulary ability, demonstrated reduced social functioning only. In regression analyses various child and family factors representing all constructs from the DSC model were significantly associated with HRQoL. Specifically, HRQoL was positively associated with parental warmth and childā€™s general health and negatively associated with parent speech/language concerns and maternal depression across all domains. Children who were at least as competent as their peers at gross motor tasks demonstrated better social functioning. In the longitudinal study, HRQoL from 4 to 9 years was negatively associated with parent concerns about receptive language across all HRQoL domains. Parent concerns about expressive speech/language were also negatively associated with HRQoL trajectories. Covariates positively associated with all HRQoL domains from 4 to 9 years included childā€™s general health and primary caregiver labour force engagement. Parents who had concerns about their childā€™s speech and language (particularly receptive language), rated the quality of their childā€™s HRQoL significantly more poorly across physical, emotional, social and school functioning domains. Results indicate that overall, the impact of SaLD, particularly receptive language, on HRQoL increases over time. School and social functioning were the domains of HRQoL most strongly associated with SaLD, consistent with earlier research. Associations were notable for being apparent in a (non-clinical) population sample and for persisting, independent of factors such as maternal depression, parenting style and the childā€™s general health. Findings suggest that there are reductions in HRQoL even where SaLD are transient, as few children with SaLD displayed difficulties across multiple data collection waves. For most LSAC study children, having typical speech/language skills was a protective factor promoting HRQoL. Findings highlight the public health importance of early speech and language competence and the need for early intervention as well as further research on optimal methods for early identification of SaLD
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