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J Commun Disord. 2018 Jan - Feb;71:85-96. doi: 10.1016/j.jcomdis.2018.01.001. Epub 2018 Jan 10.

Blood lead levels and longitudinal language outcomes in children from 4 to 12 years.

Author information

Department of Psychological Sciences, Case Western Reserve University, United States. Electronic address:
Mandel School of Applied Social Sciences, Case Western Reserve University, United States.
Department of Psychological Sciences, Case Western Reserve University, United States.
Departments of Pediatrics and Environmental Health Sciences, Case Western Reserve University, United States.



In this study, the authors aimed to examine the association of a range of blood lead levels on language skills assessed at 4, 6, 10 and 12 years of age using a prospective longitudinal design controlling for potential confounding variables including maternal vocabulary, caregiver's psychological distress and symptomatology, child's race and prenatal drug exposure.


The participants (N = 278) were a subsample of a large longitudinal study that examined the association of prenatal drug exposure on children who were followed prospectively from birth and assessed for receptive and expressive language skills at 4, 6, 10 and 12 years of age. Blood lead levels were determined at 4-years of age by atomic absorption spectrometry. A mixed model approach with restricted maximum likelihood procedures was used to assess the association of lead on language outcomes.


Longitudinal mixed model analyses suggested a negative effect of lead exposure on both receptive and expressive language, with the adverse outcomes of lead exposure appearing to become more prominent at 10 and 12 years. Higher caregiver vocabulary was positively associated with child's language scores whereas caregiver psychological distress appeared to negatively affect language scores. Prenatal drug exposure was not related to the effects of lead on language skills.


These findings suggest that elevated blood lead levels occurring early in life may be associated with poorer language skills at older ages. A language rich environment may minimize the negative influence of early lead exposure on language skills, with psychological distress seemingly exacerbating the negative outcome.


BLL; EBL; FIML; Language; Lead exposure; Longitudinal outcomes; NCE; PCE; blood lead levels; elevated blood lead levels; full-information maximum likelihood; no cocaine exposure; prenatal cocaine exposure

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