Bipolar Worksheet

							    Who Needs SLPs?
Children in the Psych Unit

  Diane Geiger, Ph.D. CCC-SLP
   Leisa Lauck, M.A. CCC-SLP
 Kevin McElfresh, M.A. CCC-SLP
          Introduction
•   CLOTHES
•   PHYSICAL APPEARANCE
•   SPEECH
•   PERSONALITY
                Overview
•   Literature review
•   Framework for pragmatic language
•   Group guidelines
•   Activities
          LITERATURE REVIEW:
                 Co-Occuring Diagnoses
• Aram, Ekelman, & Nation, 1984
   – Pragmatic language disorders are associated with academic
     failure and can complicate co-occurring psychiatric disorders
• Beitchman, Brownie, Inglis, Wild, Ferguson, Schachter,
  Lancee, Wilson, & Matthews, 1996
   – Correlation between language impairment and anti-social
     personality disorder
• Benner, Nelson, and Epstein, 2002
   – 3 of 4 children with Emotional/behavioral disorders have
     significant pragmatic language deficits
          LITERATURE REVIEW:
                 Co-Occuring Diagnoses
• Carson, Klee, Donaghy and Muskina, 1997
   – Measures of pragmatic language abilities were strongly
     predictive of scores on measures of behavior problems
• Faraone, Biederman, Weber, & Russell, 1998
   – Correlation between language impairment and conduct disorder,
     ODD, bipolar, and ADHD
• Vallance, Im & Cohen, 1999
   – Found increased likelihood of language-processing impairments
• Cohen et al., 1998
   – In children between 7 and 14 with both language and psychiatric
     disorders the most common delays were in emotion decoding
     and social problem solving
          LITERATURE REVIEW:
              Need for SLPs
• Prizant et al., 1990
   – SLPs are key members of the team needed to adequately serve
      children with emotional or psychiatric disorders
• Condon, 2004
   – Reported on a study language impairment in 84% of inpatient
      and outpatient psychiatric patients in Dublin (n=62)
• McDonald, C., Patterson, R., Bauer, P., & McDermott, B. 1998
   – Severe speech and/or language disorders in 32% of patients
      with psychiatric disorders
• Patterson, Bauer, McDonald & McDermott, 1997
   – ―significantly decreased measures of socialization,
      communication, daily living skills, self-esteem…‖
   – Mod-severe language handicap in 40% of patients
     GETTING IN TROUBLE WITH
     SOCIAL LANGUAGE: SIMON

•   Do not use it as a tool
•   Do not change it to meet the environment
•   Do not ask questions
•   Don’t initiate; respond instead
  PIAGET’S OBSERVATIONS
• Egocentric Speech: Ignore the listener

• Socialized Speech: Acknowledge the
  listener
     BERNSTEIN’S CODES
• Restricted Code
  – Sequence of statements unplanned
  – Speech is fast, sloppy
  – Syntax and vocabulary is basic
  – Common experience with listener is assumed
  – Conceptual alternatives to ideas are not
    explored
      ELABORATED CODES
• Coherence of expression suggests mental
  planning
• Rate and articulation are clear
• Syntax and vocabulary have variety and are
  appropriately parallel to listener’s
• Different experiences are presumed and
  welcomed
• A range of possible conceptual alternatives are
  explored
    Grice’s Four Expectations for
              Dialogue
• 1. QUANTITY: Keep it as informative as
  needed, but not effusive
• 2. QUALITY: Do not say what you do not
  believe and do not say that which you lack
  evidence
• 3. RELATION: Stay on topic and signal
  when you change
• 4. MANNER: Be clear, brief, and orderly
      VALUE OF GROUP SOCIAL
        LANGUAGE THERAPY
•   Advantage over grouping by achievement
•   Respect, value other members
•   Mentors come forth
•   Stretch our thinking
          Our Environments
• Main Campus
  – 2 adolescent units, 23 beds
  – Divided into 2 age groups: 2-12, 13-21
• College Hill
  – 1 inpatient unit (36 beds)
  – 1 residential unit (33 beds)
  – Divided into 2 age groups: 2-12, 13-21
                Our Team
• Psychiatrist           • SLP
• Mental Health            – 3 at Main Campus
  Specialist               – 3 at College Hill
• Nurse care manager     • Social Worker
• Occupational           • Spiritual Leader
  therapist              • Family
• Recreation therapist
      Most Common Diagnoses
•   Mood Disorder      •   Depression
•   Drug Abuse         •   Suicidal Ideation
•   Physical Abuse     •   Homicidal Ideation
•   Sexual Abuse       •   Schizophrenia
•   Anorexia Nervosa   •   PTSD
•   Bulimia            •   Bipolar Disorder
•   Conduct Disorder   •   ODD
                Group Itinerary
12:30-12:40: De-briefing from charge nurse on ―difficult
   cases‖ including chart review if necessary
12:40-12:45: Introductions
12:45-12:55: Ice-breaker
12:55-1:20: Communication Activities
1:20-1:28: Self-reflection and discussion
1:28-1:30: ―Homework‖
1:30-1:40: Charting/progress notes
          Group Guidelines
• One person talks; others listen

• G-rated Language

• Staff handles aggressive behaviors

• Apply goals developed in ―Goals Group.‖
            Specific Activities
•   Eye contact       •   Conversation
•   Body language     •   Problem Solving
•   Intonation        •   Agree to disagree
•   Self-esteem       •   Descriptive Vocab
             ICEBREAKERS
•   Snowball fight
•   Team puzzle
•   Name alliteration
•   Three names
•   Two truths and a lie
•   ―I like people who….‖
Audience Demo
          SELF ESTEEM
• Five, ten, twenty years
• Envelope of compliments
• Social values and myths
Video clip—self-esteem
         CONVERSATIONS
• Initiate: two questions
• Maintain
  – Asking/telling cards
  – Empathy exercise
• Interview
• No Interruptions—listening for the last
  word
Audience Demo—no interruptions
          EYE CONTACT
• ―Winker‖
• Eye-contact concentration?
• What’s different
Video clip-eye contact
     AGREE TO DISAGREE
• Effective disagreeing
  – Restate speakers opinion
  – State own opinion
  – Provide support
• Assertive, Aggressive, Passive worksheet
Video clip—agree/disagree
DESCRIPTIVE VOCABULARY
• Taboo
• Cranium
• Telephone—drawing
Video clip—descriptive vocab
           BODY LANGUAGE
•   Body language cards
•   Charades
•   Non-verbal Worksheet
•   Comic fill-in-the-blank
•   Taxi Driver
Video clip body language
     INTONATION AND PAUSE
•   Tell a joke
•   I am really angry about
•   What’s my line ?
•   Mark a script
•   ―Blah Blah Blah‖
Video clip intonation
           PROBLEM SOLVING
•   Cicada worksheet
•   Problem solving situations
•   Problem solving workbooks
•   Assertiveness rating scale
•   Compromise: win-win vs. win-lose
Video clip—problem solving
Response from Staff:
  Survey Results
             Challenges
• Different group dynamic each week
• ―Repeat‖ offenders
• Length/time of groups
    Need for Future Research
• Efficacy of pragmatic language groups run
  by SLPs in Psych Units
• Early identifying factors for future psych
  disorders in children with speech/language
  difficulties
                                       References
Antshel, K. & Remer, R. (2003) Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A
    Randomized-Controlled Clinical Trial. Journal of Child and Adolescent Psychology, 32, 153-165

Aram, D.M., Ekelman, B.E., & Nation, J.E. (1984). Preschoolers with language disorders: 10 years later. Journal of
    Speech and Hearing Research, 27, 232-244.

Beichtman, J.H., Brownie,.B., Inglis, A., Wild, J., Ferguson, B., Schachter, D., Lancee, W., Wilson, B., & Matthews, R.
     (1996). Seven year follow-up of speech-language impaired and control children: psychiatric outcomes. Child
     Psychology and Psychiatry Applied Disciplines, 37, 961-970.

Beichtman, J., Douglas, L., Wilson, B., Johnson, C., Young, A., Atkinson, L., Escobar, M., & Taback, N. (1998)
     Adolescent Substance Use Disorders: Findings From a 14-year Follow-Up of Speech/Language Impaired and
     Control Children. Journal of Clinical Child Psychology, 28(3), 312-321

Benner, G.J., Nelson, R., & Epstein, M.H. (2002). Language skills of children with EBD: a literature review-emotional
    and behavioral disorders- statistical data included. Journal of Emotional and Behavioral Disorders, 10, 43-59.

Bernstein, B. (1971. Class, Codes, and Control. London: Paladin Press.
                                       References
Carson, D.K., Klee, T., Perry, C.K., Donaghy, T., & Muskina, J) (1997). Measures of language proficiency as predictors
    of behavioral difficulties, social and cognitive development in two-year-old children. Perceptual Motor Skills, 84,
    923-930.

Cohen, N.J., Menna, R., Vallance, D.D., Barwick, M.A., Im, H., & Horodezky, N.B. (1998). Language, social cognitive
    processing, and behavioral characteristics of psychiatrically disturbed children with previously identified and
    unsuspected language impairment. Journal of Child Psychology and Psychiatry, 39, 853-864.

Cohen, N. & Barwick, M. (1996) Comorbidity of Language and Social-Emotional Disorders: Comparison of Psychiatric
    Outpatients and Their Siblings. Journal of Clinical Child Psychology, 25(2), 192-200.

Condon, D. (2006). Psychiatric link to language. Irish Health, 1-3.

Faraone, S., Biederman, J., Weber, W., & Russell, R.(1998) Psychiatric, neuropsychological, and psychosocial
    features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample.
    Journal of the American Academy of Child and Adolescent Psychiatry, 37(2) 185-89.

Marquis, M., Addy-Trout, E. Social Communication: Activities for Improving Peer Interactions and Self-Esteem. 1992.
    Eau Claire, Wisconsin. Thinking Publications.
                                       References
McDonald, C., Patterson, R., Bauer, P., & McDermott, B. (1998) Paediatric assessment in a residential child and
   adolescent psychiatry unit. Journal of Paediatric Child Health, 34(4), 276-272.

Patterson, R., Bauer, P., McDonald, C., & McDermott, B. (1997) A profile of children and adolescents in a psychiatric
     unit: multidomain impairment and research implications. Australia New Zealand Journal of Psychiatry 31(5), 682-
     690.

Prizant, B.M., Audent, L.R., Burke, G.M., Hummel, L.J., Maher, S.R., & Theodore, G. (1990). Communication
     disorders and emotional/behavioral disorders in children and adolescents. The Journal of Speech and Hearing
     Disorders, 55, 179-192.

Simon, C. (1985). The language-learning disabled student: Description and therapy implications. In C. Simon (Ed.),
    Communication Skills and Classroom Success: Therapy Methodologies for Language-Learning Disabled
    Students. San Diego: College-Hill Press.

Werner, E.E. (1993). Risk and resilience in individuals with learning disabilities. Learning Disabilities Research and
    Practice, 8(1), 28-34/

Vallance, D., Im, N., & Cohen, N. (1999). Discourse deficits associated with psychiatric disorders and with language
     impairments in children. Journal of Child Psychology and Psychiatry, 40(5), 693-704.