COMMUNICATION
DISORDERS
Serving the communication needs of
students with socio-emotional-behavioral
challenges
Daylinda Radley, MA, CCC-SLP
School Mental Health Conference, Helena, MT
March 2, 2012
Quick Test: True or False
1) Students with socio-emotional-behavioral (SEB) needs
are easy to work with
True or False
2) Students with socio-emotional-behavioral (SEB) needs
really don’t need a lot of help to get better
True or False
3) Students with socio-emotional-behavioral (SEB) needs
often have simple co-occurring disabilities or disorders
True or False
4) Students with socio-emotional-behavioral (SEB) require
therapy, counseling and other supports but never speech
True or False
FOCUS:
• Communication disorder and types of disorders
• Communication disorders and its occurrence with children
with socio-emotional-behavioral problems
• Communication Disorders & its relevance to social and
academic functioning
• Supporting the communication disorders of students with
social-emotional-behavioral needs
• Case Studies
“If psychological, educational, and social
skill programming are to be effective,
LANGUAGE PROBLEMS must be
understood and contravened. ”
(Warr-Leeper, et al., 1994, p. 167)
Prevalence
Communication Disorder prevalence
63.4 per 1,000 (6.3%)
gender ratio is 1.8 males to 1 female
(Pinborough-Zimmerman, et al, 2007)
Emotional Disorders
450,000 children and youth
(U.S. Department of Education, 2002)
What is a COMMUNICATION
DISORDER?
“A communication disorder is an
impairment in the ability to receive, send,
process, and comprehend concepts or verbal,
nonverbal and graphic symbol systems.”
Ad Hoc Committee on Service Delivery in the Schools
American Speech-Language-Hearing Association (ASHA)
Types of Communication Disorders
• Speech Disorders-impairment of the articulation of
speech sounds, fluency and/or voice.
• Language Disorders- impairment of comprehension
and/or use of spoken, written and/or other symbol
systems.
• Hearing Disorders
• Central Auditory Processing Disorders (CAPD)
LANGUAGE DISORDERS
• Language Disorder refers to impairment of
comprehension and/or use of spoken, written and/or other
symbol systems.
(1) the form of language (phonology, morphology,
syntax)
(2) the content of language (semantics), and/or
(3) the function of language in communication
(pragmatics) in any combination; SOCIAL SKILLS
Research Trends
• Attention Deficit/Hyperactivity Disorder and
Antisocial behaviors
• Learning Disabilities and Antisocial
Behaviors
• Communication Deficits and
Antisocial Behaviors?
What is the percentage
of students with SEB
issues who have
Communication
Disorders?
EARLY CHILDHOOD: Communication &
Social-Emotional-Behavioral Disorders
14 toddlers with delays in expressive language = higher in
depression or withdrawal, lower in social relatedness,
pretend play, compliance (Irwin, et al, 2002)
• Epidemiologic study of 3 year olds in London suburb, 59%
had delayed language and behavioral problems
(Stevenson & Richman,1978)
• Girls: expressive language impairment at 4 predicted
social withdrawn behavior at 8
Boys: expressive language impairment predicted significant
hyperactivity levels than controls (Benasich, et al, 1993)
What about in a clinical setting?
CLINICAL SETTING: Communication &
Social-Emotional-Behavioral Disorders
Warr-Leeper, et al (1994)
20 monolingual boys: 10 to 13 ½ years old
Primary Diagnoses: Oppositional Defiant Disorder, Conduct
Disorder, adjustment disorder with conduct disturbance
80% additional dx of AD/HD
85% separated or divorced families
50% foster care
abusive or chaotic backgrounds
lengthy histories of problematic behaviors
+ full scale IQ 95.6, mean verbal and performance IQ
95.6 and 101.1
• RESULT:
80% (16 out of 20) evidenced significant
language disorders that have not been identified prior to
their residential treatment
CONSISTENT other studies:
71-89% children with behavior disorders (Camarata et al,
1988; Cohen et al, 1989; Miniutti, 1991)
50-66% Specialty health clinics- psychiatric facilities and
speech-language clinics (Cantwell, Baker, & Mattison,
1981; Emerson & Enderby, 1996; Prizant et al, 1990)
The co-morbidity rates of communication
and socio-emotional-behavioral disorders
must be entirely different in a school
setting. Perhaps less?
EDUCATIONAL SETTING:
Communication & Social-EmotionalBehavioral Disorders
• Nelson, Benner & Chenney (2005)
166 students: 136 boys and 30 girls
K-12 grades
high achieving Midwest urban school district
random selection from ED population
Emotional Disturbance as classified by federal and
state special education criteria
+ Full Scale IQ Scores 93.79 to 100.50
Child Behavior Checklist: Teacher Report Form
• RESULT:
68% of the students with ED evidenced
with moderate to serious language deficits
Students with ED were likely to exhibit expressive language
deficits than receptive language deficits
Students with ED exhibiting externalizing behaviors were
more likely to exhibit language deficits
Boys and girls exhibit similar language deficits
OVERVIEW OF RESEARCH
3 out of 4 children formally identified with emotional and
behavioral disorders have significant language deficits
1 out 2 children with diagnosed language deficits were
identified with emotional and behavioral disorders
Language deficits are broad based- receptive, expressive
and pragmatic areas
(Benner, Nelson and Epstein, 2002)
INTERVENTION MUST START
EARLY
“ A language or communication disorder may have
a significant impact on the development of selfregulatory capacities. With the limitations in
developing and using internalized language,
children may be less able to represent and use
prior experiences to guide behavior, to solve
problems, and to anticipate events. Thus,
reactions may be more impulsive than reflective.”
Prizant & Meyer, 2003
Recognizing at-risk children
• Parents with at-risk children need to be provide during
appropriate information and social supports
(Prizant et al, 1990)
Other risk factors:
cognitive impairment
sensory impairments
central nervous system dysfunction
parent mental illness, perinatal complications
premature birth
(Cantwell, 1987)
When control group was compared with group of toddlers
with psychiatric illness + language impairment:
Low education
Low expressiveness
Poverty
High levels of parents stress
Parents who worried about their children’s language
problems
“Thus, although speculative, it may be that many
children with conduct disorders have learned the
behaviors associated with the disorder because
of language deficits which have not allowed them
to be effective in communicating with others.”
Warr-Leeper et al, 1994
Goals for Early Intervention
• Specific intervention goals and strategies should address
•
•
•
•
social motivation and developing relationships
Development of self-regulatory skills and mutual
regulatory strategies
Teaching socially acceptable means to express
dissatisfaction or protest
Development of vocabulary to share emotional states and
experiences with others
Promoting the development of empathy and ability to
respond empathically
(Prizant & Meyer, 1993)
Identification and prevention are
also important issues for older
children and adolescents
88% of children with EmotionalBehavioral Disorders had not
been evaluated for speechlanguage problems
(Nelson et al, 2005)
Implications to Therapy
Treatment interventions (rely on verbal
communication) may be hindered by language
deficits.
EDUCATIONAL RELEVANCE of
COMMUNCATION DISORDERS
• Public school settings:
expressive language deficitsexternalizing behaviors were likely to exhibit form- and
content-related language deficits
•
Clinical settings:
Receptive language deficits
Language Characteristics
Problems with:
abstract language concepts
language without contextual support
language requiring rapid processing
multiple meaning words
understanding cause and effects
producing complex linguistic structures (time,
reason, condition)
(Warr-Lepper et al, 1994)
PRAGMATIC Issues
Primary area of difficulty: PRAGMATICS/Social language
poor verbal and nonverbal communication skills
INCREASES the risk for substance abuse and negative
encounters with the juvenile justice and prison systems
(Center for Effective Collaboration and Practice, Office of Special Education
Programs, 1994)
Communication Expectations of the
General Curriculum
For students to have a mastery of the Subject Matter:
rich vocabulary
complex syntax and morphology
social language (pragmatics)
(Power-de Fur, 2011)
VOCABULARY
• Grade 1: 2,703- 26,000 words
• Grade 12: 17,000-45,000 words
*50% may have multiple meanings
GROWTH of at least 1,000 words per year
(Marzano, 2004)
Complex Syntax and Morphology
Speaking and Listening Standards
Common Core Standards-Montana
Grade 6
Speaking and Listening
Engage effectively in a range of collaborative discussions (one-on-one, in
groups, and teacher-led) with diverse partners on grade 6 topics, texts, and
issues, building on others’ ideas and expressing their own clearly.
Language Standards
Demonstrate command of the conventions of standard English grammar and
usage when writing or speaking.
Determine or clarify the meaning of unknown and multiple-meaning words and
phrases based on grade 6 reading and content, choosing flexibly from a range
of strategies.
READING and WRITING
Common Core Standards-Montana
Grades 11-12
Reading Standards for Literature
Determine the meaning of words and phrases as they are used in the text,
including figurative and connotative meanings; analyze the impact of specific
word choices on meaning and tone, including words with multiple meanings or
language that is particularly fresh, engaging, or beautiful.
Writing Standard
Use words, phrases, and clauses as well as varied syntax to link the major
sections of the text, create cohesion, and clarify the relationships between
claim(s) and reasons, between reasons and evidence, and between claim(s)
and counterclaims.
Speaking and Listening
Work with peers to promote civil, democratic discussions and decision-making,
set clear goals and deadlines, and establish individual roles as needed.
Academic Impact of Pragmatic
Language Impairment
Difficulty understanding the perspective of the teacher and
other student in group activities
Poor organization, time management and transition from
one activity to the next (executive functioning skills)
Difficulty interpreting and responding appropriately to a
lesson or question
(Myles, Trautman, & Shelvan, 2004)
Academic Impact of Pragmatic
Language Impairment
Problems understanding the hidden or unwritten social
rules of school environments (classroom, hallway, recess,
cafeteria, assembly, school dances)
Challenges with reading, writing, or history because of
attention, organization, literal thinking, sequencing, or
perspective-taking difficulties
Hesitancy or inability to ask for help when needed
(Myles, Trautman, & Shelvan, 2004)
“Speech and language assessments should become
routine portion of the management program for
behaviorally disordered children.”
Camarata et al, 1988
EDUCATING TEAM MEMBERS
•
Communication cases with complicated mental health
conditions such intellectual disability, autism, and
behavioral/emotional disorders
Highly trained SLPs
who are knowledgeable
in working with this population
Special Education Teachers should receive professional
development programs to improve competency for
language assessment & intervention
ASSESSMENT PROCEDURES
Systematic assessment to identify language disorders
Consider screening to determine young children at-risk for
language and ED
ASSESSMENTS of communication skills should be
pro-active
EFFECTIVE LANGUAGE
INSTRUCTION
• Incorporation of effective instruction
principles
• Involvement of speech-language
pathologists in the design, planning &
delivery language interventions
• Language Interventions should be
prevention-oriented
Social Skills Intervention
Social skills training to increase availability of social
behaviors and understanding of social cues= long term
positive changes in social skills competency, classroom
behavior, and expressive language skills (Michelson et al.,
1983)
-reduces anxiety and unwarranted aggression (Hummel &
Prizant, 1993)
COLLABORATIVE Learning Environments
Inclusive Groups
SLP+ LCSW
SLP + Recreational Therapist
Cross-disciplinary goals
• Recognizing and using feeling words
• Recognizing and labeling feelings of others by making an
inference about a person’s nonverbal cues
• Control and appropriately express anger with peers and
adults through the use of positive affirmations, selfcalming activity, and discussion
• Practicing good sportsmanship
• Making amends when appropriate
(Armstrong, 2011)
Social Skills: Autonomy & Independence
• JOB-FINDING: identifying interests, research wages and
salaries, discuss job-related responsibilities, and
participate in mock interview
• HOUSE MAINTENANCE: shop for groceries, budget,
launder clothes, and perform other chores
CASE STUDY X
• Young child, internationally adopted
no history of formal schooling
reports of language delay in primary language
abuse, neglect at the orphanage
executive functioning deficits: attentional problems,
impulsivity, hyperactivity, sensory-processing deficits, and
developmental delays
CASE STUDY X
Significant Language deficits:
PLAY (Westby symbolic play scale)- no pretend play,
no action on familiar objects, no sequencesDISORGANIZED
Social Skills- eye contact very poor; limited joint
attention; no boundaries, poor conversational skills
Authentic Measure/Dynamic assessment: language
disorder; lack of proficiency in any language and having to
learn a second primary language English (not a language
difference)
CASE STUDY X
• Intervention:
Intensive individual speech therapy sessions
increase knowledge of basic vocabulary including
feeling words
work on play skills and basic precursory behaviors
(i.e. eye contact, joint attention, following clinician’s gaze)
teaching functional scripts (ex. asking for help,
rejecting, expressing wants)
increase attention to tasks
CASE STUDY Y
Young adolescent
chaotic family background
family history of mental illness and learning disabilities
problematic social behavior at school
probable abuse
Academics: low average range, some areas average
“chooses not to do work”
+discrepancy between verbal/nonverbal
CASE STUDY Y
• Overall Language score: 85, 15% (low average)
Expressive Language: 91, 27%
Language Content: 98, 45%
Language Memory: 84, 14%
RECEPTIVE LANGUAGE: 58, 0.3%
SOCIAL SKILLS: unable to read body language, social
situations; rigid/limited ability to interpret situations
Interventions: IEP development
Intervention/Modifications to support comprehension
Parent education/support
CASE STUDY Z
Young teenager, female
11th grade
Long standing issues with academics
Chemical dependency, legal troubles
Hates school
Cognitive functioning: borderline intellectual functioning,
depression, social discomfort
Academics: 3rd grade- 8th grade level (Writing-Reading)
No IEP or history of special education supports
CASE STUDY Z
Language:
overall language functioning 78, 7% (1-1.5 to-2 SD)
Syntax construction 74, 4%
Pragmatic Judgment 76, 5%
Non-literal Language 74, 4%
Intervention: Counseling & education (patient and family)
Options for intervention
Strategies to circumvent issues
QUESTIONS?
Email: dradley@shodair.org
(406)444-1088
Shodair Children’s Hospital
2755 Colonial Drive, Helena, MT 59601
daylindaquiroz@yahoo.com
References
• American Speech-Language-Hearing Association. (1993). Definitions of Communication Disorders
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