Language skills are related to child psychopathology (Beitchman et al., 1996a; Cantwell and Baker, 1991; Toppelberg and Shapiro, 2000). On the one hand, lan- guage problems often co-occur with poor adaptations and psychopathology, according to both epidemiologi- cal and clinical studies (Beitchman et al., 1996b; Cantwell and Baker, 1991; Giddan et al., 1996). On the other, strong language skills are substrate to many protective factors, such as IQ, communicative and social compe- tence, and academic success (Hinshaw, 1992). These rela- tions, mostly found in research with monolingual children, may have particular relevance to bilingual children. As we witness the largest wave of child immigration in American history (Suarez-Orozco and Suarez-Orozco, 2001), we must consider that bilingualism is common and becoming more prevalent. It is estimated that 6 mil- lion American children (14% of the U.S. child popula- tion, mostly U.S.-born children of immigrant parents) have English as a second language and a different lan- guage (most commonly Spanish) as the home language (U.S. Census Bureau, 1990). Focusing on the relation- ship between language and psychopathology in bilingual children is critical for clinical, educational, and policy purposes. For instance, language delays in bilingual chil- Accepted December 18, 2001. Dr. Toppelberg is Director, Project on Language and Child Psychiatry, Judge Baker Children’s Center and Harvard Medical School Department of Psychiatry, Boston. Ms. Medrano and Mr. Nieto-Castañon are with the Judge Baker Children’s Center and Harvard Medical School Department of Psychiatry. Dr. Peña Morgens is with McLean Hospital and the Harvard Medical School Department of Psychiatry. Supported in part by NIMH grants MH19126/MH16259, an American Academy of Child and Adolescent Psychiatry Eli Lilly Award, a Harvard Department of Psychiatry Livingston Award, and a Children’s Studies at Harvard Research Award to Dr. Toppelberg, and by the Judge Baker Children’s Center and the Cambridge Hospital. The authors thank Drs. Catherine Snow, Stuart Hauser, Ted Shapiro, and Martin Laroche for their support and input. Correspondence to Dr. Toppelberg, Judge Baker Children’s Center, Harvard Medical School, 3 Blackfan Circle, Boston, MA 02115; e-mail: topi@hms.har- vard.edu. 0890-8567/02/4106–07122002 by the American Academy of Child and Adolescent Psychiatry. Bilingual Children Referred for Psychiatric Services: Associations of Language Disorders, Language Skills, and Psychopathology CLAUDIO O. TOPPELBERG, M.D., LAURA MEDRANO, M.A., LIANA PEÑA MORGENS, PH.D., AND ALFONSO NIETO-CASTAÑON, M.S. ABSTRACT Objective: To investigate (1) the prevalence of language deficits and disorders and (2) the relationship of bilingual lan- guage skills and psychopathology, in Spanish-English bilingual children referred for child and adolescent psychiatry ser- vices. Method: Bilingual language skills, emotional/behavioral problems, sociodemographics, immigration variables, and nonverbal IQ were studied in 50 consecutively referred children. Results: Estimated prevalence was high for language deficits (48%) and disorders (41%), with most cases (>79%) being of the mixed receptive-expressive type. In children with clinically significant emotional/behavioral problems, bilingual language skills were strongly and inversely correlated with problem scores, particularly global problems (r = –0.67, p < .001); social, thought, and attention problems (r ≥ –0.54; p < .004); delinquency (r = –0.66, p < .001); and aggression (r = –0.52, p < .01). These correlations remained significant after IQ adjustment. Conclusions: Prior findings from monolingual children were confirmed in this bilingual sample, namely (1) the high prevalence of mixed receptive-expressive and other language disorders and delays and (2) the close tie between poor language skills and emotional/behavioral problems. The data strongly suggest the clinical importance and feasibility of language assessment and the significance of receptive problems in bilingual children referred for psy- chiatric services. A safe approach is to fully assess language skills, rather than misattributing these children’s language delays to normal bilingual acquisition processes. J. Am. Acad. Child Adolesc. Psychiatry, 2002, 41(6):712–722. Key Words: bilingualism, psychopathology, language disorders/delays. 712 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 41:6, JUNE 2002