COMMUNICATION DISORDERS

1. 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

2. 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

3. 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

4. “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)

5. 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)

7. 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)

8. 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)

9. 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

10. Research Trends • Attention Deficit/Hyperactivity Disorder and Antisocial behaviors • Learning Disabilities and Antisocial Behaviors • Communication Deficits and Antisocial Behaviors?

11. What is the percentage of students with SEB issues who have Communication Disorders?

12. 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)

13. 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)

14. What about in a clinical setting?

15. 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

16. 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)

17. The co-morbidity rates of communication and socio-emotional-behavioral disorders must be entirely different in a school setting. Perhaps less?

18. EDUCATIONAL SETTING: Communication & Social-Emotional-Behavioral 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

19. 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

20. 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)

21. INTERVENTION MUST START EARLY

22. “ A language or communication disorder may have a significant impact on the development of self-regulatory 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

23. 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)

24. 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

25. “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

26. 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)

27. Identification and prevention are also important issues for older children and adolescents 88% of children with Emotional- Behavioral Disorders had not been evaluated for speech- language problems (Nelson et al, 2005)

28. Implications to Therapy Treatment interventions (rely on verbal communication) may be hindered by language deficits.

29. EDUCATIONAL RELEVANCE of COMMUNCATION DISORDERS • Public school settings: expressive language deficits- externalizing behaviors were likely to exhibit form- and content-related language deficits • Clinical settings: Receptive language deficits

30. 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)

31. 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)

32. 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)

33. 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)

34. Complex Syntax and Morphology

36. 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)

37. 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)

38. “Speech and language assessments should become routine portion of the management program for behaviorally disordered children.” Camarata et al, 1988

39. 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

40. 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

41. 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

42. 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)

43. COLLABORATIVE Learning EnvironmentsInclusive Groups SLP+ LCSW SLP + Recreational Therapist

44. 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, self-calming activity, and discussion • Practicing good sportsmanship • Making amends when appropriate (Armstrong, 2011)

45. 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

46. 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

47. CASE STUDY X Significant Language deficits: PLAY (Westby symbolic play scale)- no pretend play, no action on familiar objects, no sequences- DISORGANIZED 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)

48. 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

49. 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

50. 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