title: Family and Community Predictors of Comorbid Language, Socioemotional and Behavior Problems at School Entry.
abstract: OBJECTIVE
  To identify the prevalence and family and community-level predictors of comorbid speech-language difficulties and socioemotional and behavioral (SEB) difficulties across a population of children at school entry.
  
  
  METHODS
  The School Entry Health Questionnaire is a parent survey of children's health and wellbeing, completed by all children starting school in Victoria, Australia (N = 53256). It includes parental report of speech-language difficulties, the Strengths and Difficulties Questionnaire (behavior), and numerous family and community variables. Following univariate analysis, family and community risk characteristics were entered into a multinomial logistic regression model to identify the associated relative risk of comorbid speech/language and SEB needs. The influence of experiencing multiple risk factors was also examined.
  
  
  RESULTS
  20.4% (n = 10,868) began school with either speech-language or SEB difficulties, with 3.1% (n = 1670) experiencing comorbid needs. Five factors predicted comorbidity: the child having witnessed violence; a history of parent mental illness; living in more deprived communities; and the educational attainment of each parent (independently). The relative risk of comorbidity was 6.1 (95% Confidence Interval: 3.9, 9.7) when a child experienced four or more risk factors, compared to those with no risk factors.
  
  
  CONCLUSIONS
  The risk of comorbidity in early childhood is associated with a range of family and community factors, and elevated by the presence of multiple factors. Children growing up in families experiencing multiple, complex needs are therefore at heightened risk of the early development of difficulties likely to impact upon schooling. Early identification of these children offers opportunities for appropriate and timely health and education intervention.
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Melbourne, Australia.|University of Birmingham, Edgbaston, Birmingham, United Kingdom.|The University of Melbourne, Parkville, Melbourne, Australia.
authors.forename: Nathan
authors.identifier: http://orcid.org/0000-0002-5859-808X
authors.initials: N
authors.lastname: Hughes
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Melbourne, Australia.|Deakin University, Burwood, Melbourne, Australia.|The Royal Children's Hospital, Parkville, Melbourne, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Sciberras
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Melbourne, Australia.|The University of Melbourne, Parkville, Melbourne, Australia.|The Royal Children's Hospital, Parkville, Melbourne, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Goldfeld
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D003147:Communication Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005190:Family; D005192:Family Health; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012574:Schools; D013064:Speech Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014739:Victoria / Q000453:epidemiology