NEUROBIOLOGY OF DEPRESSION As oppos

NEUROBIOLOGY OF DEPRESSION
As opposed to anxiety, which focuses on complex circuits throughout the brain, the neurobiology of depression is characterized by dysfunction and abnormali-ties of neurotransmitter and neuroendocrine (hormonal) systems, The primary neurotransmitters studied for depression are norepinephrine, serotonin, and acetylcholine (Kowatch et al., 2006). Studies of medications such as selective-serotonin reuptake inhibitors (SSRI) indicate insufficient norepinephrine and serotonin are associated with depression. Abnormal functioning of the hypo-thalamic-pituitary-adrenal (HPA) axis has been associated with depression. Specifically, the HPA axis is activated in times of stress and results in instruc-tions to the hypothalamus to produce corticotrophin-releasing factor (CRT) that results in elevations of the hormone cortisol (Miller, 1998). Chronically elevated cortisol levels result in increased sensitivity to future stress, leading to an open feedback loop Of increasing cortisol levels. Recent studies have revealed that prolonged, intense maternal stress during pregnancy increases cortisol levels and can alter functioning of the [IPA axis in both the mother and fetus. Such alterations are associated with structural changes in the hippocampus, amyg-dala, and frontal cortex (Weinstock, 2008). Such changes can have systemic influence because the frontal lobe is the largest of the brain's lobes and performs diverse functions. Along with planning appropriate behavioral responses and working memory, it functions with other parts of the brain in regard to learning, memory, motivation, and attention. The frontal cortex integrates perceptual information from the parietal and temporal lobes, as well as the sensory and motor areas during learning (Buchsbaum, 2004). These findings correlate with the course of depression described above in which the time between depressive episodes and the stress needed to activate a depressive episode decrease over time. Soares and Mann (1997) conducted a review of existing morphological neuroimaging studies and found consistent evidence for decreased volume of the frontal lobe, cerebellum, caudate, and putamen in adults with depression. These findings have not been replicated in children due to difficulties with conducting MRI studies with children (Kowatch et al., 2006). However, the limited functional neuroimaging studies of cerebral blood flow have pointed to abnormalities in the limbic-thalamic-cortical network (Drevets et al., 1992; Soares & Mann, 1997).
NFUROCOGNJTIVE DEFICITS ASSOCIATED WITH INTERNALIZING DISORDERS
SENSORY-MOTOR DEFICITS
Baron (2004) pointed out that sensory-motor assessments have been minimized or marginalized in the typical child neuropsychological evaluation. This is evidenced by the very minimal information about sensory-motor functioning in the empirical literature base. Nevertheless, Baron concluded that sensory-motor assessment should be routine in child neuropsychological evaluations. For example, Hale and Fiorello (2004) report that right hemisphere dysfunction has been associated with internalizing disorders. Therefore, it would be important to assess hemispheric laterality through lateral dominance testing to assist in the interpretation of other assessment data. Depression has been associated with psychomotor retardation, which would likely impact sensory-motor tasks. In a study with adults, Zarrinpar, Deldin, and Kosslyn (2006) found that individuals with major depression evidence slower response times for visual-spatial tasks. They concluded that psychomotor retardation associated with depression may he a stimulus-encoding or motor-output deficit rather than a cognitive deficit. Replication studies are necessary to extend this finding to children, but the findings do suggest children may exhibit longer response times for visual-spatial tasks while in a depressive episode.
ATTENTIONAI, PROCESSING DEFICITS Inattention is often observed during the early childhood period of children who later become depressed. In fact, the DSM-IV-TR indicates that Major Depression in young children is often comorbid with attention-deficit dis-orders (American Psychiatric Association, 2000). Throughout the develop-mental period there is substantial evidence for the co-occurrence of Attention-Deficit/Hyperactivity Disorder (ADHD) and Major Depression (Ostrander, Crystal, & August, 2006). Despite the early appearance of inattention as a prodromal symptom in very young children, inattention may not be the primary attentional problem in school-aged children. Blackman, Ostrander, and Herman (2005) compared depressed and non-depressed school-age children to determine if the depressed children exhibited higher rates of ADHD inattentive type than combined type. They found no difference in rates of inattentive type and combined type compared to the control subjects suggesting that children with depression and ADHD may present either as inattentive or as overactive/impulsive. On the other hand, Hurtig and colleagues (2007) studied 457 adolescents with ADHD and found that those with primarily inattentive symptoms had increased probability of comorbid Major Depression. Blackman et al. (2005) further found that children with ADHD and depression exhibit great social impairment than normal controls.
VISUAL-SPATIAL PROCESSING DEFICITS
As with sensory-motor deficits, visual-spatial deficits in children with inter-nalizing disorders are not frequently reported in the literature. In a non-clinical sample of 66 children ages 6 to 13 years, Aronen, Vuontela, Steenari, Salmi, and Carlson (2005) found that children with internalizing symptoms performed poorly on visual working memory tasks. Additionally, there was a positive correlation between anxious/depressed symptoms and the number of incorrect, multiple, and missed responses on the visual working memory tasks. McClure, Rogeness, and Thompson (1997) found subtle differences between subclinically depressed adolescent females and nondepressed peers in terms of visuospatial perception and organization.


LANGUAGE DEFICITS
When examining the relatioilship between language deficits and internalizing disorders, if is difficult to determine if neuropsychological dysfunction accounts for the development of both language deficits and internalizing disorders or if the stigma from having difficulty speaking results in increased levels of anxiety or depression. It does appear, however that increased rates of both anxiety and depression as well as other internalizing disorders are strongly correlated with language disorders such as combined speech language disorder, stuttering, selective mutism, and Tourette syndrome. General SpeechlLangziage Disorders Vallance, Cummings, and Humphries (1998) studied school-aged students diagnosed with language learning dis-orders (LLD) who were found to have lower social discourse than the control students. The Test of Language Development (TOLD-2: Hammitt & Newcomer, 1988) was used to measure expressive and receptive language, while the Test of Language Competence—Expanded Edition (TLC-E: Wiig & Secord, 1989) was used to measure social discourse. The students with LLD were also found to be less social overall as well as demonstrating more problem behaviors. The researchers hypothesized that the language problems may interfere with a student's language, cognitive, and social processes, thus increasing in the display of behavior problems including internalizing disorders. Language disorders also appear to manifest in higher levels of anxiety as well. In a fourteen-year longitudinal study conducted by Beitchman and colleagues (2001), students who had both speech and language impairments (S/L) were found to have a higher prevalence of anxiety disorders (most of which were social phobic disorder) later in life than the control group or those with only a speech impairment or language impairment group. Early onset of S/L impairments was found to be associated with a higher likelihotxi of developing an anxiety disorder later in adolescence. These findings point to the accumulation of risk factors leading to poorer adaptive outcomes.
Specific Speech Disorders Specific speech disorders are also associated with internalizing behaviors. Selective mutism (SM), for example, is highly corre-lated with symptoms of anxiety. Ford, Sladeczek, Carlson, and Kratochwill (1998) found that individuals with SM showed similar symptoms on the parent and self-report behavior rating scales as individuals with only anxiety disorders. Manassis and colleagues (2007) found that children with SM performed poorer on tasks involving verbal comprehension or visual mem-ory than normal controls. The children with SM also had a higher prevalence of social anxiety Craig, Hancock, Tran, and Craig (2003) examined the link between stuttering and anxiety in a sample cat adolesc.sents and adults. Individuals who stuttered had higher scores for anxiety than those who did not stutter. The researchers also found that cal the people in the group who stuttered, the ones who sot'ght treatment In their stuttering were more anxious, It was interred that these

Hasil (Bahasa Indonesia) 1:

NEUROBIOLOGI DEPRESI As opposed to anxiety, which focuses on complex circuits throughout the brain, the neurobiology of depression is characterized by dysfunction and abnormali-ties of neurotransmitter and neuroendocrine (hormonal) systems, The primary neurotransmitters studied for depression are norepinephrine, serotonin, and acetylcholine (Kowatch et al., 2006). Studies of medications such as selective-serotonin reuptake inhibitors (SSRI) indicate insufficient norepinephrine and serotonin are associated with depression. Abnormal functioning of the hypo-thalamic-pituitary-adrenal (HPA) axis has been associated with depression. Specifically, the HPA axis is activated in times of stress and results in instruc-tions to the hypothalamus to produce corticotrophin-releasing factor (CRT) that results in elevations of the hormone cortisol (Miller, 1998). Chronically elevated cortisol levels result in increased sensitivity to future stress, leading to an open feedback loop Of increasing cortisol levels. Recent studies have revealed that prolonged, intense maternal stress during pregnancy increases cortisol levels and can alter functioning of the [IPA axis in both the mother and fetus. Such alterations are associated with structural changes in the hippocampus, amyg-dala, and frontal cortex (Weinstock, 2008). Such changes can have systemic influence because the frontal lobe is the largest of the brain's lobes and performs diverse functions. Along with planning appropriate behavioral responses and working memory, it functions with other parts of the brain in regard to learning, memory, motivation, and attention. The frontal cortex integrates perceptual information from the parietal and temporal lobes, as well as the sensory and motor areas during learning (Buchsbaum, 2004). These findings correlate with the course of depression described above in which the time between depressive episodes and the stress needed to activate a depressive episode decrease over time. Soares and Mann (1997) conducted a review of existing morphological neuroimaging studies and found consistent evidence for decreased volume of the frontal lobe, cerebellum, caudate, and putamen in adults with depression. These findings have not been replicated in children due to difficulties with conducting MRI studies with children (Kowatch et al., 2006). However, the limited functional neuroimaging studies of cerebral blood flow have pointed to abnormalities in the limbic-thalamic-cortical network (Drevets et al., 1992; Soares & Mann, 1997). NFUROCOGNJTIVE DEFISIT TERKAIT DENGAN GANGGUAN INTERNALISASI DEFISIT SENSORIK-MOTOR Baron (2004) menunjukkan bahwa penilaian sensorik-motor telah diminimalkan atau terpinggirkan dalam evaluasi neuropsychological khas anak. Hal ini dibuktikan oleh sangat minim informasi tentang sensorik-motor berfungsi di basis empiris sastra. Namun demikian, Baron menyimpulkan bahwa penilaian sensorik-motor harus rutin di evaluasi neuropsychological anak. Sebagai contoh, Hale dan Fiorello (2004) melaporkan bahwa kanan disfungsi belahan bumi telah dikaitkan dengan internalisasi gangguan. Oleh karena itu, ini akan menjadi penting untuk menilai melintang laterality melalui lateral dominasi pengujian untuk membantu dalam interpretasi dari data penilaian lain. Depresi telah dikaitkan dengan retardasi psikomotor, yang akan dampak kemungkinan sensorik-motor tugas. Dalam sebuah studi dengan orang dewasa, Zarrinpar, Deldin, dan Kosslyn (2006) ditemukan bahwa individu dengan depresi bukti respons yang lebih lambat kali untuk tugas-tugas yang visual-spasial. Mereka menyimpulkan bahwa retardasi psikomotor terkait dengan depresi mungkin ia stimulus-encoding atau motor-output defisit daripada defisit kognitif. Replikasi studi diperlukan untuk memperpanjang Temuan ini kepada anak-anak, tapi temuan menyarankan anak mungkin menunjukkan lebih lama respon kali untuk tugas-tugas yang visual-spasial sementara di episode depresi. ATTENTIONAI, kurangnya perhatian DEFISIT pengolahan sering diamati selama periode anak usia dini anak-anak yang kemudian menjadi tertekan. Pada kenyataannya, DSM-IV-TR menunjukkan bahwa depresi pada anak-anak sering komorbiditas dengan perhatian-defisit dis pesanan (American Psychiatric Association, 2000). Sepanjang periode mengembangkan-mental ada substansial bukti untuk Co-terjadinya perhatian-defisit/Hyperactivity Disorder (ADHD) dan depresi (Ostrander, kristal, & Agustus 2006). Meskipun tampilan awal kurangnya perhatian sebagai gejala prodromal pada anak-anak yang sangat muda, kurangnya perhatian mungkin tidak menjadi masalah attentional yang utama pada anak-anak usia sekolah. Blackman, Ostrander dan Herman (2005) dibandingkan anak usia sekolah tertekan dan depresi bebas untuk menentukan jika anak-anak tertekan dipamerkan tingkat lebih tinggi lalai jenis ADHD dibandingkan jenis gabungan. Mereka tidak menemukan perbedaan dalam tingkat jenis lalai dan gabungan jenis dibandingkan dengan kontrol mata pelajaran yang menyatakan bahwa anak-anak dengan depresi dan ADHD dapat hadir sebagai lalai atau sebagai terlalu aktif/impulsif. Di sisi lain, Hurtig dan rekan-rekan (2007) belajar 457 remaja dengan ADHD dan menemukan bahwa orang-orang dengan gejala terutama lalai telah meningkatkan probabilitas komorbiditas depresi. Blackman et al. (2005) lebih lanjut menemukan bahwa anak-anak dengan ADHD dan depresi menunjukkan gangguan sosial yang besar dari kontrol normal. VISUAL-SPASIAL PENGOLAHAN DEFISIT Sebagai dengan defisit sensorik-motor, visual-spasial defisit pada anak-anak dengan gangguan inter-nalizing tidak sering dilaporkan dalam literatur. Dalam non-klinis sampel 66 anak usia 6-13 tahun, Aronen, Vuontela, Steenari, Salmi sejarawan dan Carlson (2005) menemukan bahwa anak-anak dengan internalisasi gejala tampil buruk pada tugas-tugas memori kerja visual. Selain itu, ada suatu korelasi positif antara cemas/depresi gejala dan jumlah salah, beberapa, dan merindukan tanggapan pada tugas-tugas memori kerja visual. McClure, Rogeness, dan Thompson (1997) ditemukan perbedaan halus antara subclinically tertekan remaja perempuan dan rekan-rekan nondepressed visuospatial persepsi dan organisasi. DEFISIT BAHASAWhen examining the relatioilship between language deficits and internalizing disorders, if is difficult to determine if neuropsychological dysfunction accounts for the development of both language deficits and internalizing disorders or if the stigma from having difficulty speaking results in increased levels of anxiety or depression. It does appear, however that increased rates of both anxiety and depression as well as other internalizing disorders are strongly correlated with language disorders such as combined speech language disorder, stuttering, selective mutism, and Tourette syndrome. General SpeechlLangziage Disorders Vallance, Cummings, and Humphries (1998) studied school-aged students diagnosed with language learning dis-orders (LLD) who were found to have lower social discourse than the control students. The Test of Language Development (TOLD-2: Hammitt & Newcomer, 1988) was used to measure expressive and receptive language, while the Test of Language Competence—Expanded Edition (TLC-E: Wiig & Secord, 1989) was used to measure social discourse. The students with LLD were also found to be less social overall as well as demonstrating more problem behaviors. The researchers hypothesized that the language problems may interfere with a student's language, cognitive, and social processes, thus increasing in the display of behavior problems including internalizing disorders. Language disorders also appear to manifest in higher levels of anxiety as well. In a fourteen-year longitudinal study conducted by Beitchman and colleagues (2001), students who had both speech and language impairments (S/L) were found to have a higher prevalence of anxiety disorders (most of which were social phobic disorder) later in life than the control group or those with only a speech impairment or language impairment group. Early onset of S/L impairments was found to be associated with a higher likelihotxi of developing an anxiety disorder later in adolescence. These findings point to the accumulation of risk factors leading to poorer adaptive outcomes. Specific Speech Disorders Specific speech disorders are also associated with internalizing behaviors. Selective mutism (SM), for example, is highly corre-lated with symptoms of anxiety. Ford, Sladeczek, Carlson, and Kratochwill (1998) found that individuals with SM showed similar symptoms on the parent and self-report behavior rating scales as individuals with only anxiety disorders. Manassis and colleagues (2007) found that children with SM performed poorer on tasks involving verbal comprehension or visual mem-ory than normal controls. The children with SM also had a higher prevalence of social anxiety Craig, Hancock, Tran, and Craig (2003) examined the link between stuttering and anxiety in a sample cat adolesc.sents and adults. Individuals who stuttered had higher scores for anxiety than those who did not stutter. The researchers also found that cal the people in the group who stuttered, the ones who sot'ght treatment In their stuttering were more anxious, It was interred that these

Hasil (Bahasa Indonesia) 2:

Neurobiologi DEPRESI
Berbeda dengan kecemasan, yang berfokus pada sirkuit yang kompleks di seluruh otak, neurobiologi depresi ditandai dengan disfungsi dan-ikatan abnormali sistem neurotransmitter dan neuroendokrin (hormonal), The neurotransmitter utama dipelajari untuk depresi adalah norepinefrin, serotonin, dan asetilkolin (Kowatch et al., 2006). Studi dari obat-obatan seperti reuptake inhibitor selektif serotonin-(SSRI) menunjukkan norepinefrin dan serotonin tidak cukup berhubungan dengan depresi. Abnormal fungsi hipo-thalamic-hipofisis-adrenal (HPA) axis telah dikaitkan dengan depresi. Secara khusus, sumbu HPA diaktifkan pada saat stres dan hasil di diguna-tions ke hipotalamus untuk menghasilkan corticotrophin releasing factor (CRT) yang menghasilkan peningkatan hormon kortisol (Miller, 1998). Kronis peningkatan kadar kortisol menyebabkan peningkatan kepekaan terhadap stres masa depan, yang menyebabkan umpan balik loop terbuka Of meningkatkan kadar kortisol. Penelitian terbaru telah mengungkapkan bahwa berkepanjangan, stres ibu intens selama kehamilan meningkatkan kadar kortisol dan dapat mengubah fungsi [IPA sumbu di kedua ibu dan janin. Perubahan tersebut terkait dengan perubahan struktural dalam hippocampus, amyg-dala, dan frontal korteks (Weinstock, 2008). Perubahan tersebut dapat memiliki pengaruh sistemik karena lobus frontal adalah yang terbesar dari lobus otak dan melakukan fungsi yang beragam. Seiring dengan perencanaan respon perilaku yang tepat dan memori kerja, berfungsi dengan bagian lain dari otak dalam hal belajar, memori, motivasi, dan perhatian. Korteks frontal mengintegrasikan informasi persepsi dari parietal dan temporal lobes, serta daerah sensorik dan motorik selama belajar (Buchsbaum, 2004). Temuan ini berkorelasi dengan kursus depresi yang dijelaskan di atas di mana waktu antara episode depresi dan stres diperlukan untuk mengaktifkan penurunan episode depresi dari waktu ke waktu. Soares dan Mann (1997) melakukan tinjauan studi neuroimaging morfologi yang ada dan menemukan bukti yang konsisten untuk volume menurun dari lobus frontal, serebelum, berekor, dan putamen pada orang dewasa dengan depresi. Temuan ini belum direplikasi pada anak-anak karena kesulitan dengan melakukan studi MRI dengan anak-anak (Kowatch et al., 2006). Namun, studi neuroimaging fungsional terbatas aliran darah otak telah menunjukkan kelainan pada jaringan limbik-thalamic-kortikal (Drevets et al, 1992;. Soares & Mann, 1997).
Defisit NFUROCOGNJTIVE BERHUBUNGAN DENGAN internalisasi GANGGUAN
defisit sensorik-MOTOR
Baron ( 2004) menunjukkan bahwa penilaian sensorik-motorik telah diminimalkan atau terpinggirkan dalam evaluasi neuropsikologis anak khas. Hal ini dibuktikan dengan informasi yang sangat minim tentang sensorik-motor berfungsi di dasar literatur empiris. Namun demikian, Baron menyimpulkan bahwa penilaian sensorik-motor harus rutin dalam evaluasi neuropsikologis anak. Misalnya, Hale dan Fiorello (2004) melaporkan bahwa disfungsi belahan kanan telah dikaitkan dengan gangguan internalisasi. Oleh karena itu, akan menjadi penting untuk menilai lateralitas belahan otak melalui pengujian dominasi lateral membantu dalam interpretasi data penilaian lainnya. Depresi telah dikaitkan dengan retardasi psikomotor, yang kemungkinan akan berdampak tugas sensorik-motorik. Dalam sebuah penelitian dengan orang dewasa, Zarrinpar, Deldin, dan Kosslyn (2006) menemukan bahwa individu dengan bukti depresi respon lambat kali utama untuk tugas visual-spasial. Mereka menyimpulkan bahwa retardasi psikomotor berhubungan dengan depresi mungkin dia stimulus-encoding atau motor keluaran defisit daripada defisit kognitif. Studi replikasi diperlukan untuk memperpanjang temuan ini kepada anak-anak, tetapi temuan sarankan anak mungkin menunjukkan waktu respon lebih lama untuk tugas visual-spasial sementara dalam episode depresi.
ATTENTIONAI, defisit PENGOLAHAN kekurangan perhatian sering diamati selama periode anak usia dini anak-anak yang kemudian menjadi depresi. Bahkan, DSM-IV-TR menunjukkan bahwa Mayor Depresi pada anak-anak sering komorbiditas dengan perhatian-deficit dis-order (American Psychiatric Association, 2000). Sepanjang periode mengembangkan jiwa-ada bukti substansial untuk co-terjadinya Attention-Deficit / Hyperactivity Disorder (ADHD) dan Depresi Mayor (Ostrander, Crystal, & Agustus 2006). Meskipun penampilan awal kurangnya perhatian sebagai gejala prodromal pada anak-anak yang sangat muda, kurangnya perhatian mungkin tidak masalah attentional utama pada anak-anak usia sekolah. Blackman, Ostrander, dan Herman (2005) dibandingkan anak usia sekolah depresi dan non-depresi untuk menentukan apakah anak-anak depresi menunjukkan tingkat yang lebih tinggi dari jenis lalai ADHD dibandingkan jenis gabungan. Mereka tidak menemukan perbedaan dalam tingkat jenis lalai dan jenis gabungan dibandingkan dengan subyek kontrol menunjukkan bahwa anak-anak dengan depresi dan ADHD dapat hadir baik sebagai lalai atau terlalu aktif / impulsif. Di sisi lain, Hurtig dan rekan (2007) mempelajari 457 remaja dengan ADHD dan menemukan bahwa mereka dengan gejala terutama lalai meningkat probabilitas komorbiditas Depresi Mayor. Blackman dkk. (2005) lebih lanjut menemukan bahwa anak-anak dengan ADHD dan depresi menunjukkan penurunan sosial yang besar dari kontrol normal.
Defisit PENGOLAHAN VISUAL-TATA RUANG
Seperti defisit sensorik-motorik, defisit visual-spasial pada anak dengan gangguan antar-nalizing tidak sering dilaporkan dalam literatur. Dalam sampel non-klinis dari 66 anak-anak usia 6-13 tahun, Aronen, Vuontela, Steenari, Salmi, dan Carlson (2005) menemukan bahwa anak-anak dengan gejala internalisasi tampil buruk pada tugas-tugas memori kerja visual. Selain itu, ada korelasi positif antara cemas / depresi gejala dan jumlah yang salah, beberapa, dan tidak terjawab tanggapan pada tugas-tugas memori kerja visual. McClure, Rogeness, dan Thompson (1997) menemukan perbedaan halus antara remaja perempuan subclinically tertekan dan rekan-rekan depresi dalam hal persepsi visuospatial dan organisasi. Defisit BAHASA Ketika memeriksa relatioilship antara defisit bahasa dan gangguan internalisasi, jika sulit untuk menentukan apakah account disfungsi neuropsikologis untuk pengembangan kedua defisit bahasa dan gangguan internalisasi atau jika stigma dari memiliki kesulitan berbicara hasil peningkatan tingkat kecemasan atau depresi. Itu tidak muncul, namun yang meningkat tingkat kedua kecemasan dan depresi serta gangguan internalisasi lainnya sangat berkorelasi dengan gangguan bahasa seperti gangguan dikombinasikan bahasa pidato, gagap, sifat bisu selektif, dan sindrom Tourette. General SpeechlLangziage Gangguan Vallance, Cummings, dan Humphries (1998) mempelajari usia sekolah siswa didiagnosis dengan belajar bahasa dis-order (LLD) yang ditemukan memiliki wacana sosial yang lebih rendah daripada siswa kontrol. Uji Pembangunan Language (MEMBERITAHU-2: Hammitt & Newcomer, 1988) digunakan untuk mengukur bahasa ekspresif dan reseptif, sedangkan uji Edition Bahasa Kompetensi-Expanded (TLC-E: Wiig & Secord, 1989) digunakan untuk mengukur sosial wacana. Para siswa dengan LLD juga ditemukan kurang sosial secara keseluruhan serta menunjukkan masalah perilaku lebih. Para peneliti berhipotesis bahwa masalah bahasa dapat mengganggu bahasa siswa, kognitif, dan proses-proses sosial, sehingga meningkatkan dalam tampilan masalah perilaku termasuk gangguan internalisasi. Gangguan bahasa juga muncul untuk mewujudkan tingkat yang lebih tinggi dari kecemasan dalam juga. Dalam sebuah studi longitudinal empat belas tahun yang dilakukan oleh Beitchman dan rekan (2001), siswa yang memiliki keduanya bicara dan bahasa gangguan (S / L) ditemukan memiliki prevalensi lebih tinggi dari gangguan kecemasan (yang sebagian besar adalah gangguan fobia sosial) kemudian di hidup daripada kelompok kontrol atau mereka yang hanya gangguan berbicara atau bahasa kelompok gangguan. Onset awal S / L gangguan itu ditemukan terkait dengan likelihotxi lebih tinggi mengembangkan gangguan kecemasan kemudian pada masa remaja. Temuan ini menunjukkan akumulasi faktor risiko yang menyebabkan hasil adaptif miskin. Gangguan Pidato spesifik gangguan bicara khusus juga terkait dengan perilaku internalisasi. Sifat bisu selektif (SM), misalnya, sangat Corre-lated dengan gejala kecemasan. Ford, Sladeczek, Carlson, dan Kratochwill (1998) menemukan bahwa individu dengan SM menunjukkan gejala yang sama pada skala penilaian perilaku orang tua dan laporan diri sebagai individu dengan hanya gangguan kecemasan. Manassis dan rekan (2007) menemukan bahwa anak-anak dengan SM dilakukan miskin pada tugas-tugas yang melibatkan pemahaman verbal maupun visual mem-ory dari kontrol normal. Anak-anak dengan SM juga memiliki prevalensi lebih tinggi dari kecemasan sosial Craig, Hancock, Tran, dan Craig (2003) meneliti hubungan antara gagap dan kecemasan dalam adolesc.sents sampel kucing dan orang dewasa. Individu yang tergagap memiliki skor yang lebih tinggi untuk kegelisahan daripada mereka yang tidak gagap. Para peneliti juga menemukan bahwa kal-orang dalam kelompok yang tergagap, orang-orang yang sot'ght pengobatan Dalam gagap mereka lebih cemas, itu dikebumikan bahwa