9/25/2015

1

Talking Trouble: Language, learning and behaviour

Sally Kedge, Linda Hand, Clare McCann and Alayne McKeeTalking Trouble Aotearoa NZ

Workshop for RTLB Conference25 September 2015

talkingtroublenz@gmail.com

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?

9/25/2015

2

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

9/25/2015

3

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

9/25/2015

4

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.

9/25/2015

5

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

9/25/2015

6

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”

9/25/2015

7

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

9/25/2015

8

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

9/25/2015

9

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’.

9/25/2015

10

“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’.

9/25/2015

11

‘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

9/25/2015

12

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?

9/25/2015

13

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

talkingtroublenz@gmail.com

• 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