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					  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-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
• 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 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
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:

þLow education
þLow expressiveness
þPoverty
þHigh levels of parents stress
þParents 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 Emotional-
                Behavioral Disorders had not
                been evaluated for speech-
                language 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
•Publicschool settings:
  expressive language deficits-
  externalizing 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
•   é 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, self-
  calming 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 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)
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
    and Variations [Relevant Paper]. Available from www.asha.org/policy.
•   Armstrong, J. (2011, August 30). Serving Children with Emotional-Behavioral and Language
    Disorders: Collaborative Approach. The ASHA Leader. Electronically retrieved February 20, 2012.
•   Benner, G., Nelson, J.R., & Epstein, M. (2002). Language skills of children with EBD: A literature
    review. Journal of Emotional and Behavioral Disorders, 10 (1), 43-59.
•   Cantwell, D.P., Baker, L., & Mattison, R. (1981). Prevalence, type and correlates of psychiatric
    diagnoses in 200 children with communication disorders. Journal of Developmental and Behavioral
    Pediatrics,2, 131-136.
•   Cohen, N., Davine, D., &Meloche-Kelly, M. (1989). Prevalence of unsuspected language
    disordersin a child psychiatric population. Journal of American Academy of Child and Adolescent
    Psychiatry, 28 (1), 107-111.
•   Horwitz, S.M. Irwin, J.R., Briggs-Gowan, M.J. et al:Language Delay in community cohort of young
    children.Journal of American Academy Child Adolescent Psychiatry, 42, 932-940
•   Michelson, L., Manarino,A.P., Marchione, K.E, Stren, M., Figueroa, J. &Beck, S. (1983). A
    comparative outcome study of behavioral social skills training, interpersonal problem-solving, and
    nondirective control treatments with child psychiatric patients. Behavior Research Therapy, 21, 545-
    556.
•   Marzano, R.J. (2004). Building background knowledge for academic achievement: Research on
    what works in schools.Alexandria, VA: Association for Supervision and Curriculum Development.
References
• Miniutti, A (1991). Language deficiencies in inner-city children with learning and behavioral
    problems. Language, Speech and Hearing Services in the Schools,22, 31-38.
•   Montana Office of Public Instruction. Montana Common Core Standards and Asessment.for
    English Language Arts and Literacy: http://opi.mt.gov/Curriculum/MontCAS/GetReady.php#gpm1_2
•   Myles, B., Trautman, M., & Shelvan, R. (2004). The Hidden Curriculum: Practical Solutions for
    Understanding Unstated Rules in Social Situations. AAPC Publishing, Shawnee Mission, KS.
•   Nelson, J.R., Benner, G.J., Cheney, D. (2005). An investigation of the language skills of students
    with emotional disturbance served in the public school settings. The Journal of Special Education,
    39 (2),97-105
•   Prizant, B., & Meyer, E. (1993). Socioemotional Aspects of Language and Social-Communication
    Disorders in Young Children and Their Families. American Journal of Speech Language
    Pathology,2, 56-71.
•   Prizant, B., Audet, L., Burke, G., Hummel, L., Maher, S., Theadore, G. (1990). Communication
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•   Sundheim, S. & Voeller, K. (2004) Psychiatric Implications of Language Disorders and Learning
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•   Warr-Leeper, G., Wright, N., & Mack, A. (1994) Language Disabilities of Antisocial boys in
    Residential Treatment. Behavioral Disorders, 19 (3), 159-169.

				
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