consequences of communication difficulties WK6

week 6 content

What is spoken communication?

Spoken communication is interaction with others, relationships, friendships, education, literacy, qualifications, employment and quality of life.

Parent reactions

Grief at different levels

acute initially for some- immediately obvious

less acute as a slow realisation of a problem is revealed

chronic and on going

not the life I had imagined

Parent self talk

Guilt

Sense of failure

Inadequacy

what are the implications for child and family

Interactions with other toddlers are delayed

less vocal interaction- less social interaction

less social interaction- less opportunity for language development'

less language- reduced social interaction Cyclical pattern

Frustration emerges and distressed behaviours emerge.

commence SLT using developmental sequence to interventions

Implications for family

Increased stress because of child’s frustration and distressed behaviours

Parents can become anxious

What is the role of professionals

• Listen and support

• provide realistic hope

• refrain from judgement

• provide honest comments

• seek out the positives

• never under estimate the challenges

• empathise and imagine how it would be to walk in their shoes

• provide useful strategies and activities

• show families how to perceive and celebrate small gains

• ensure families know that you value and respect their child

consequences of communication difficulties in children

• increasing evidence that communication difficulties in children are a life-long disability

• often a additional diagnostic label is used (ASD, ADHD, FASD, behavioural problems) many of these conditions have a communication difficulty at their core or as a associated factor

Evidence for consequences

Clegg et al (2005)

assessed long term outcomes of adults with a history of severe receptive developmental language disorder (DLD) diagnosed in childhood.

participants: 17 adult men mid 30s diagnosed with severe receptive DLD in childhood

comparative groups:

non language disordered siblings

adults matched on age and non verbal IQ

and a broad national cohort matched on IQ and social class.

findings of Clegg et al (2005)

• Individuals with childhood DLD showed significantly worse social adaptation in adulthood.

• Specific issues included:

  • History of unemployment

  • Limited close friendships

  • Few or failed romantic relationships

  • Frequent relationship breakdowns

  • Conclusion:

    Severe receptive DLD in childhood is linked to long-term social and occupational difficulties in adulthood, even when controlling for IQ, social class, and family background.

What did their childhood receptive language impairment (still in adulthood) involve significant deficits in?

• theory of mind

• verbal short term memory

• phonological processing

• substantial social adaptation difficulties

• increased risk of psychiatric disorder in adult life

what was the aim of the Johnson et al (2010) study

This study was a community sample of adults with 112 and without 113 early speech and or language impairments

What did the Johnson et al study find

at age 25, those with a history of language impairments showed- poorer outcomes in multiple domains (communication, cognition, educational attainment, and occupational status) than their peers without early communication impairments

They did not differ in: subjective perceptions of their quality of life from the other groups

subjective well being was primarily associated with strong networks of family, friends, others.

What was the aim of Elbro et al (2011)

A 30 year follow up of 198 participants who had been diagnosed with language impairments at 3-9 years of age.

what did the Elbro et al study find

most of the participants reported literacy difficulties, unemployment, and low socio economic status (at rates significantly higher than in the general population)

Participants diagnosed with specific language impairment (SLI) as a child had significantly better outcomes than those with additional diagnoses. (e.g. ASD, ADHD) irrespective of their non-verbal IQ

Trembath et al (2021)

the relationship between language difficulties, psychosocial difficulties and speech language pathology service access in the community.

Secondary analysis of previous collected data. Total of 808 children who completed a language assessment

The findings point to the possible under identification of children with language difficulties in the community and the need for clinical service provision that accounts for the multi faced needs that these children are likely to have

Cohen et al (1998) on behavioural problems

This study examined 7-14 year olds with specific language impairment

• children previously identified as having language impairments were more likely to be diagnosed as having ADHD.

• were rated by both parents and teachers as more socially withdrawn.

Lindsay and Dockrell (2000) on behavioural problems

studied 7-8 year old children with specific language impairment

• more likely to have behavioural problems than their non-language impaired peers, and boys were rated more severe than girls; especially with hyperactivity and conduct disorders

• parent ratings of behaviour was more severe than teacher’s ratings

• self esteem scores were not different to peers

Kedge (2007)

assessed 34 children referred to a behaviour service (NZ schools) at ages 8-14 years.

33 had never had a referral for language difficulties

19 scored below the normal range for age on a test oof oral language (56%)

all but 2 scored within normal limits on a test of non-verbal intelligence.

What is the relationship with the criminal justice system

Research over 10-15 years in the UK, US, Australia, and NZ

it has been long known that levels of literacy in the incarcerated population are well below average.

“screening of 120 people in NZ prisons by literacy expert found that nearly half had significant dyslexia. (52% men, 43% women), previously undiagnosed. More than 80% had been at secondary school for 2 years or less, with many having been excluded in their first year.” (Lambie 2020)

Summary of Lambie (2022) report ‘A breakdown across the whole system’

This follow up report is based on “how we fail children who offend'“ and what to do and the need for speech language therapy in children as a preventative factor for children who are at risk for becoming young offenders because of their language delay.

Bryan et al (2007) UK study

• assessed the language and communication skills 15-17 year olds in a juvenile offenders institution (N=58)

• 90% had ceased to attend school before age 16

• 66-90% had below average language skills with 46-67% poor or very poor

Snow and Powell (2008) AUS study

50 juvenile offenders and 50 controls (mean age 15.8 yrs)

measured on language processing and production, social skill.

and IQ (K-bit)

– Young offenders performed significantly worse on all language

and social skill measures, but not on non-verbal IQ

– 50% self-reported reading and writing difficulties in the early

school years cf. 20% of controls

– 61.5% had received some form of early intervention (e.g.

Reading Recovery), cf. 29% of the controls

– Just over half of the young offenders were identified as

language impaired

Lount et al 2017 NZ study

33 young people, 36 matched controls, 14-18 years

– Significantly different on all language measures

– Both groups were within normal limits on the Test of

Nonverbal Intelligence

– 11% of the control participants and 64% of youth

offenders met criteria for language impairment

– Similar to the UK and Australian studies. No reason

to think it is better here, but there are cultural

differences. We need local research and local

solutions

What is the Aotearoa context

• >50% of young people in youth courts in NZ are Māori

• None of the language assessments available here were normed or designed for Māori

 

Kedge and McCann study

Small scale unpublished report

– 21 young people in a youth justice residence in NZ (mean

age 16.2 yrs) measured on receptive and expressive

language (CELF-4), “time concepts”, understanding legal

vocabulary. Also asked for their own views about talking,

listening and understanding

– 19% scored within the average range

– 33% scored below the normal range (mild language

impairment)

– 47% scored well below normal range (moderate or severe

language impairment)

factors associated with communication disorders

Neurodevelopmental issues are likely (e.g., communication

disorders and ADHD and hearing loss)

– More likely to have acquired issues than their peers; head

injury, addictions (drug & alcohol abuse), poor nutrition

– Very likely to have grown up with social or socio-economic

issues; poverty, struggling parenting, domestic abuse &

trauma, unemployment, intergenerational post-colonial

trauma, racism, frequent moves/transitions, little stability

physically or emotionally

– Poor educational achievement, gang involvement

– Lambie (2020) “Higher rates [of all of these] in justice-

involved people

Impact on social relationships and friends

Friendships and social relationships are facilitated through

communication (in many different forms)

• Studies have become very interested in the impact of

communication difficulties on friendships

Durkin & Conti-Ramsden (2007) in UK

– compared friendship quality in 16-year-old adolescents with

(120) and without (118) specific language impairment

– language measures were associated with friendship quality

– typically developing adolescents enjoyed normal

friendships, whereas those with language impairment were

more likely to exhibit poorer quality friendships

• McCormack et al (2010) in Australia

– 7-9 year olds reported more bullying, poorer peer

relationships and less enjoyment of school than their peers

Impact on cognition and language

Many cognitive measures are confounded by language

– ‘verbal IQ’ is part of the total measure of IQ and depends on

verbal questions and responses

– Can measure IQ nonverbally (‘performance IQ’, TONI etc)

– As children with communication difficulties grow older, their

non-verbal IQ measures appear to decrease

• Probably reflects the increase in verbal input to non-verbal

skill performance that occurs over time

strong and weak cognitive hypotheses

Language depends on cognition, or is related but

not dependent

– Thought precedes language (Piaget)

– Cognition is needed for some language skills, but

not all

– Partial mismatch of language and cognition (Rice;

2000)

– Some go as far as seeing language and cognition as

having separate bases, with some interconnections

(Langacker, 1968, Vygotsky, 1962)

cognitive processes required for higher level language of reasoning and inferencing

 Figurative language

• Ambiguity, multiple meanings, jokes

• Imagination – ‘inner language’

• Information processing – including selection and

attention and memory processes

• Executive function “regulating feelings and behaviours to

select and guide behaviours to follow rules and attain

goals”

• These are all sites of difficulty in language disorders in

children (and adults), especially from school-age onwards