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Talking Trouble: Language, learning and behaviour
Sally Kedge, Linda Hand, Clare McCann and Alayne McKeeTalking Trouble Aotearoa NZ
Workshop for RTLB Conference25 September 2015
Overview
• Who might have language and communication needs?
• What impact do language and communication difficulties have?
• What can be done to help?
Who we are
• All speech-language therapists
• Sally Kedge
• Clare McCann
• Linda Hand
• Alayne McKee
• Talking Trouble Aotearoa NZ
• Speech Science, Te Whare Wananga o Tamaki Makaurau (The University of Auckland).
How many young people have speech and language difficulties and are involved in the justice system?
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There are strong association between behavioural difficulties and oral language difficulties (Lindsay & Dockrell, 2000, Brownlie et al 2004)
What about the speech, language and communication of other vulnerable children and young people?
Those involved with• Behaviour services?• Mental health?• Care and Protection?• Truancy?
Similar levels of undetected needs,
probably not addressed
MASSIVE IMPACT
e.g. ASD (Autism Spectrum Disorders)
• TBI (Traumatic Brain Injury)
• ADHD (Attention Deficit Hyperactivity Disorder)
• Conduct Disorder
• FASD (Foetal Alcohol Spectrum Disorders)
• Learning difficulty
• Intellectual impairment
• Hearing impairment
Some diagnoses carry with them a high risk of oral communication difficulties
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Yet - these are not the most common communication problems in children
The most common ones are not so obvious –
they are when children have difficulties
comprehending and expressing oral language
in a wide range of communicative interactions
to the level expected of their peers – in the
absence of other problems.
How many children have oral communication difficulties?
Often multiple difficulties
• May occur together
• Have consequences for communication
• Mask communication disorder
Other diagnoses combinewith language difficulties
• behaviour disorders
• emotional disorders
• mental health problems
• Unclear from previous studies
(Stringer & Clegg, 2006; Griffith et al, 1997; Hart, Fujiki, Brinton & Hart, 2004)
EBD
LD
LD
EBD
???
• Possible to firmly establish direction of causation & patterns of
influence?
– Complexity of factors impacting on the relationship and the heterogeneity
of the language disorders and EBD.
Explanations of the relationship between language and emotional / behavioural difficulties
??? ??????
LD EBD EBDLD
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Learning, behaviour and language
• Implications of the ‘about 60%’
• Practitioners need to
• Recognise oral language and communication difficulties in children young people, as these can have a big impact on success of interventions
• Develop practical skills in adapting communication to help young people, and their families & whanau, to get the most out of interventions
Thinking about oral language
Who and why
Who did you talk to today?
• People at home?
• Friends?
• At work?
• People you don’t know?
• In the community?
• The cat? The computer? The car?
What was the reason?
• Greeting?
• Complaining?
• Finding out?
• Explaining?
• Persuading?
• Moaning?
• Organising?
Did you have to think about how you were communicating? Did it all go well? If not, why not?How did you feel?
Oral communication plays a part in almost everything we do
It is so taken for granted and subconscious that we don’t usually consciously consider
how we communicate.
We usually assume that whoever we are talking to will be understanding what we are
saying.
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At a very simple level we mean
Talking Understanding what was said
+
The words are important BUT so is everything else…
• Body language
• Facial expression
• Pausing
• Tone of voice
• Speed
• Eye gaze
• Clues in the environment
Communication Context
• Who it is?• Hierarchy / power / known / biases
• Where you are talking• Noisy / group / overheard /
conventions for the place
• What the topic is about• Sensitive / matters to you
• Emotions and feelings
• The language being used – shared?
• Do adults address children primarily with direct or indirect instructions?
• Do adults hold conversations with children? (babies?)
• Do children give opinions, tell stories, make comments etc, to adults?
• Do adults give explanations to children?
We cannot know all possible variations – but it pays to be aware that there are variations, and immediate judgements may not be correct.
There are many ways communication varies by culture
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Just English?
• NO
• We are interested in supporting people to have a voice and participate in whatever language is important to them and their community.
• We are not elocution teachers – we are not interested in people speaking ‘properly’ or with a particular accent or style.
A case study
Adam’s story
• Aged 13
• In school, but starting to truant occasionally
• No diagnosis
• History of learning and behavioural challenges
• Early history of glue ear
• Some care and protection issues over the years
• English speaking home
What others say about Adam
• “He talks OK”
• “He can talk in sentences”
• “Chooses not to participate”
• “Pretty quiet”
• “Gets what you’re saying”
• “Knows what’s going on”
• “Keeps himself to himself”
• “He swears fine”
• “He can’t be bothered most of the time”
• “He’s not very motivated”
• “You can talk to him just like any other kid”
• “He’s got an attitude problem”
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Adam’s understanding of spoken language
• Can he hear? Mild problems
• Can he listen and remember? Major problems
• Can he make sense of what others say? Major problems
• Knowledge of vocabulary and concepts like time / emotion words
• Complexity of grammar
• Read between the lines
• Deal with non-literal language – sarcasm, jokes
• Does he know when he hasn’t understood? Not always
Adam’s expressive language
What is the quality of his talking?
Highly compromised
• Grammar? Very basic
• Vocabulary? Major problems
• Speech sounds? No problems
• Fluency and voice? No problems
Adam’s expressive language
What can he do with talking?
• Explain his role in an event?
• Reason?
• Problem solve?
• Resolve conflict?
• Express his perspective or emotions?
Social interaction is difficult
Struggles with all these
Social Communication
How does he relate to other young people?
Adults?
Taking turns to talk?
Eye contact?
Body language?
Vary his style?
Gets into argumentsStruggles to keep friends
Seen as annoying and immature
Poor awareness of the listener - dominates
Challenging - often seen as rude
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What talking situations does he need to participate in?
• Home
• Friends
• School
• FGC
• Police
• Social Worker
• Mentor
• Counselling
• Other???
“It wasn’t easy to answer the questions... They would be talking to me and using these big words and I didn’t understand and I would say ‘yeah...yeah’”
Youth Justice Newsletter (UK) July 2012
“When I didn’t really understand I just looked at my Mum’s face. I knew it was bad ‘cause she was crying.”
“Remorse”? I don’t know what that means. I haven’t got a clue what you are talking about.”
“It would be helpful if they had, like, a person who could stand with you to help you understand.”
Attention and listening
Image from Pamela Snow,
Monash University (adapted)
Attachment and relationships
Experiences
Self and others’ emotions and intentions (empathy)
ADAM?
15 years
Single wordsPersuadeNegotiateReasonNarrate
SarcasmJokesExplain etc
5 yearsbaby
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How developed are Adam’s skills?
Gap between non-verbal and verbal skills
Great if he was 7 or 8
But he’s 13.
Core Language Scores and TONI scores
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
Children
Stan
dard s
cores
Series1
Series2
Sample size = 34 childrenMean CLS = 80
Typical Range for
age
Range CLS = 53 - 129Two or more SD below the mean = 29%
Core Language ScoreTONI (Non-verbal)mean
Related information needed
• What languages are used at home?
• Non-verbal skills?
• Reading and writing?
• Progress in education?
• Friendships?
• Behaviour?
• Early attachments?
• Mental health?
• Substance abuse?
• Head injury?
• Family history of communication difficulties?
• Who can support him to develop his language skills?
Had anyone been aware that language might be a problem
for Adam?
No
Other explanations to do with personality / behaviour were used to describe him.
Language difficulties were ‘hidden’ and ‘masked’.
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“Masked” difficulties
• His age and size
• He has a spiky profile of language
• Plus, a wide range of other developmental needs – attention, emotional regulation
• His behaviour has received a lot of attention
• He has developed strategies to cope
• Transient
• Poor oral skills are the norm?
Image from The Royal College of Speech and Language Therapists’ campaign
If someone has speech and language problems it will
never be this obvious
Not just the young person
• Language difficulties are problematic for the person, and for those who interact with them
• Success of interventions designed to help –most involve talking (+ literacy)
“He says a lot but it’s really hard for him to tell me things”
‘Masked’ problems
• On assessment, he misinterpreted the vocabulary (which often related to abstract concepts)
• He found it hard to remember all the parts of an instruction.
• He became very muddled when explaining information and telling a story
“When the teacher says something and then says another thing.”
“However putting the explosive in the other explosive so it won’t blow up more bigger. I know my chemicals”
e.g. pointed to the ‘last’ object instead of the ‘first’.
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‘Masked’ problems
• His word knowledge was very underdeveloped
• Relied heavily on ‘stuff’ ‘thing’ ‘dunno’
“We do different stuff” “A science thing” = microscope
• Distractible, fiddling with his hat. Noticeably more distractible if the topic became more abstract or longer.
Knew he had heard the word ‘coward’ but didn’t know what it meant.Really struggled to define words
Look out for ….
Agreeing, noddingTalking a lotStaying quiet
“Dunno” “All good”Humour
Watching othersChanging the subject
Consequences• Struggles with classroom instructions
• Can’t concentrate for long, disorganised
• Hard to understand lesson content
• Not progressing with literacy
• Often disruptive
• Naïve, irritates others
• Problems with friendships – fights
• Loses the plot when can’t explain / express emotions
VULNERABLE
Language problems = vulnerable
• Getting into trouble and becoming victims
• 80% of young offenders have come through care and protection
services
• Understanding and participating in the legal process
• Being misunderstood by professionals
• Participating and succeeding in rehabilitation
• Staying out of trouble
In the midst of all this, they are still CHILDREN first and foremost
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How does Adam’s language profile impact
on your work?
What could help?
Devise 1 goal relating to Adam’s language and communication needs that you want to address
Task (15 minsWork in small groups of 4 or 5
What could help Adam?
• Informing and training key adults (and Adam?)
• Strategies for breaking down curriculum content information and instructions
• Strategies for checking understanding
• Vocabulary
• Visuals for time lines/timetables
• Comic Strip Conversations
What he can be expected to understand (about at a 7 – 8 year old level) and what to look out for
Identifying and using his strengths and interests
Knowing when he might struggle to participate and how to support him• Giving an account or explanation• Understanding the curriculum• Following instructions• Expressing emotions• Participating in counselling• Making and keeping friends
Support his teachers (content and delivery)
Direct SLT therapy?
Your work
• What are the implications of all this for your work?
• Does it make you think of any particular child or young person?
• What changes are you going to make in your next session with a child or young person?
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If a young person you work with has a communication need, how talk and interact with them can make a big difference
• They will engage and want to participate
• They will understand more and are less likely to kick off and disengage
• You will spend less time managing behaviour
• Education, skills training, or any other interventions will be more successful
Talking Trouble Aotearoa NZ
www.talkingtroublenz.org
• Contact us to give any specific feedback, to request further information, a copy of the handout, reference lists or to discuss further professional development or collaboration in projects.
• Thank you for your time