Supporting high school-aged

students with a communication

impairment

Christine Porter, Speech Pathologist, eCOST Resource Project

March 2016

An “Every Student Every School” Initiative

Difficulty vs Disability

Student

Hearing lossSpecific

language impairment

Student

Home environment

Limited opportunity

Non-English speaking parents

…arise from a wide range of extrinsic factors,

such as limited opportunity to communicate,

or a mismatch between the language,

dialect, and/or communication styles used

at home and at school.”

…may result from speech, language,

physical, intellectual, hearing, vision or

multiple impairments [ie intrinsic factors]…

…Communication disabilities can be

transient or permanent and range from mild

to severe.”

(Source: Clinical Guideline: Speech Pathology Services in Schools, The Speech Pathology Association of Australia, 2011)

Prevalence of communication

impairment

• 1 in 7 people have a communication impairment (McLeod, Harrison,

McAllister and McCormack, 2007).

• 1 in 500 people in Australia have complex communication needs (little or no speech)(Iacono, 2004).

• 12 -13% of students had communication disorders in a study of primary

and secondary students in a Sydney Catholic Diocese and

• The ratio of boys to girls in this study averaged 1.88:1(McLeod and McKinnon,

2007).

• 70% of indigenous children in remote communities have middle ear

disease

• 84% of the indigenous population in remote areas do not speak

Australian English at home (Speech Pathology Australia, 2016).

Social implications of communication

impairment

Students with communication impairment frequently struggle in all aspects of the curriculum. Their difficulties with receptive and expressive language in the classroom frequently translate to the playground. In late primary (for girls) and middle secondary (for boys), social communication becomes more subtle and peer groups have more rigid rules for acceptance.

Cantwell and Baker (1987): Longitudinal study of 202 children with communication impairment. 57% presented with comorbid psychiatric disorders at follow up;

Cohen and Lipsett (1991): 38% children referred for psychiatric services had previously undiagnosed language impairments;

Speech Pathology Australia (2013): 46% of young Australian offenders have a language impairment.

Academic implications of

communication impairment

Overwhelmingly, research has found that communication impairment is likely to impact on:

o Literacy (including spelling, phonological awareness and writing)

o Numeracy (storage and retrieval of rote material, calculations)

o Approach to learning (attention, information processing)

(In Harrison, McLeod, Berthelsen and Walker, 2009)

Reading disability and speech and

language impairment

Longitudinal followup of 71 adolescents with preschool speech‐ language impairment

At age 15–16:

• Those with resolved speech and language impairment (SLI) had good vocabulary and language comprehension skills, but significantly poor performance for

phonological processing and reading.

• Those with persisting SLI had significant impairments in all aspects of spoken and

written language.

• These children fell further and further behind their peer group in vocabulary growth

over time.

Stothard, Snowling, Bishop, Chipchase, and Kaplan (1998).

Speech impairment alone may affect

“learning to read… (and) write…

focusing attention… calculating,

communication, mobility, self-care,

relating to persons in authority, informal

relationships with friends/peers, parent-

child relationships, sibling relationships,

school education and acquiring,

keeping and terminating a job.”

(McCormack, McLeod, McAllister and Harrison, 2009)

Functioning, disability and health

The World Health Organisation’s International Classification of Functioning,

Disability and Health (ICF)f

o is the conceptual basis for the

definition, measurement and policy

formulations for health and disability;

o stresses health and functioning rather than disability;

o mainstreams disability by recognising it

as a universal human experience:

Everyone at some point experiences

health issues and therefore some

disability;

o shifts the focus from cause to impact. World Health Organization, 2002.

“Previously, disability began where health

ended; once you were disabled, you were

in a separate category. We want to get

away from this kind of thinking. We want to

make ICF a tool for measuring functioning in

society, no matter what the reason for one's

impairments. So it becomes a much more

versatile tool with a much broader area of

use than a traditional classification of health

and disability”.

Focus shift of assessment and intervention:

Case Example

SAM:• 13 year old male, Year 8

• Long term learning difficulties, mild hearing loss recently diagnosed,

psychometric testing indicated borderline IQ and severe language scores

• Case management recently transferred to Veritas House

• Out of home care, new foster placement with younger sibling

• History of domestic violence and neglect

• Suspension in Term 4, Year 7, following physical aggression with another student

• Challenging behaviours in mainstream classes (eg disruptive) and unstructured

settings eg playground, verbally and physically aggressive, appears reactive ie triggered by another student

• Speech and language assessment allocated as a result of recommendations by

clinical psychologist

Focus shift of assessment and intervention:

Case example

Standardised speech and

language assessment (1.5

hours)

Reporting on standardised assessment only, without reference to variations to

speech and language ability in different environments or with different audiences. (2

hours)

Impairment-focused goals: eg“Sam will use irregular past tense in spoken and written sentences

during structured activities to 80% accuracy; Sam will achieve 90% accuracy with /L/ and /r/ sounds

at sentence level”. (1.5 hours)

6 x weekly clinic-based intervention working on goals

identified in standardised

assessment. Home program supplied.

(6 hours)

Review and discharge.

(1 hour)

Traditional speech pathology assessment and

intervention: 12 hour allocation

Focus shift of assessment and intervention:

Case example

Initial meeting with teacher,

casemanager, school counsellor, itinerant support teacher -hearing and carer to identify holistic priorities and location for intervention.

Qualitative data collected (questionnaires) at home and school; classroom and playground observation completed. Screening of speech and language skills. Self-assessment of social communication skills completed – demonstrated insight into strengths and weaknesses. Discussion about issues in mainstream – identified embarrassment about literacy difficulties, becomes highly anxious. Literacy support software options demonstrated in assessment context.

Liaison with team re results and recommendations. Discussion re strengths – enjoys woodwork. Support worker to accompany him to “The Woodies” hobby woodworking group on Wednesday afternoons. Anxiety flagged with team for monitoring. Verbal aggression and repetitive behaviours noted to occur during transitions eg moving from support unit to mainstream subjects. Referral to OT identified for self-regulation during transitions. Trial of literacy support software recommended. /L/ sound targeted at request of student. Assertiveness and conversational skills targeted.

Collaborative plan compiled, speech pathologist (SP) to provide training to SLSO to work on /L/ sound for 10 minutes daily in withdrawal. SP to monitor progress fortnightly. Sam to be included in assertiveness and conversational skills group conducted by staff member and supported by SP in Term 2. Literacy support trial – monitored by key worker in school context, checked by SP.

SP to review Sam’s progress with self-assessment of social skills prior to IEP review in meeting in Term 3; to be available for troubleshooting as required by team. If goals met, Sam closed and re-referred as required.

ICF-based speech pathology assessment and

intervention: 12 hour allocation

Service delivery: Classroom-based

service vs withdrawal

vs

o The responsibility of a student’s school is education, not

therapy

o Withdrawal removes a child from his or her learning

environment

o Research evidence suggests that isolated activities do

not promote generalisation of skill, particularly with

respect to communication disability

o Collaboratively designed therapy goals that are

embedded in daily routine are promoted as best

practice by Speech Pathology Australia.

vs

Remediation vs Compensation:

Christine’s Soapbox

o Communication disability and learning disability are likely to exist in some

form post-treatment. Beyond approximately seven years of age

complete remediation is unlikely.

o Students who require vision, hearing or walking aids are provided with

equipment early on in order for them to keep up with their peers. Should

we deny children with communication and/or literacy impairment

access to compensatory aids and classroom modifications and therefore

prevent them from doing the same? And can anyone convince the

Board of Studies that their Disability Provisions are unfair and inconsistent?

o A frequent response to augmentative communication (eg the use of

pictures, sign or speech generating devices to communicate) is that it

will stop a student talking. Similarly, there is a widespread belief that

provision of assistive technology to support literacy will stop a student

learning to read and “make them lazy”. In both instances, the reverse

has been consistently proven in research.

Take home messages…

o Communication difficulty/disability can have a significant negative affect on a student’s ability to participate and achieve in the classroom, and a life-long impact on participation in social relationships.

o Around 15 – 20% of students have a communication difficulty/disability. Of these students, boys are nearly twice as likely to be affected.

o Children with communication disability are less likely to respond to treatment and more than half are likely to develop psychiatric disorders.

o Collaboration between teachers, speech pathologists and families to identify goals, and design curriculum and classroom modification for a student is an effective means of programming for communication difficulty/disability at school.

o Multisensory methods of teaching and communication (auditory, visual, tactile/kinesthetic/ technological) have been proven highly effective, particularly for students with reading and writing difficulties.

Fabulous Fact Sheets

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Communication_Impairment_in_

Australia.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Stuttering.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_AAC.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Speech_Pathology_and_Indigeno

us_Children.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Speech_Pathology_in_Mental_He

alth_Services.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Voice.pdf

References

• Cantwell, DP and Baker, L (1987). Prevalence and type of psychiatric disorder and developmental disorders in three speech and language groups. Journal of

Communication Disorders. Apr;20(2):151-60.

• Cohen, N., & Lipsett, L. (1991). Recognized and unrecognized language impairment in psychologically disturbed children: Child symptomatology, maternal depression, and

family dysfunction: Preliminary report. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, Vol 23(3), Jul 1991, 376-389

• Harrison LJ, McLeod S, Berthelsen D, Walker S (2009). Literacy, numeracy and learning in school-aged children identified as having speech and language impairment in

early childhood. International Journal of Speech-Language Pathology. 2009;11(5)

• http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Communication_Impairment_in_Australia.pdf. 2013. Speech Pathology Australia. [ONLINE]

Available at: http://speechpathologyaustralia.org.au. [Accessed 09 March 16].

• http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Speech_Pathology_and_Indigenous_Children.pdf. 2013. Speech Pathology Australia. [ONLINE]

Available at: http://speechpathologyaustralia.org.au. [Accessed 09 March 16].

• http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_AAC.pdf. 2013. Speech Pathology Australia. [ONLINE] Available

at: http://speechpathologyaustralia.org.au. [Accessed 09 March 16].

• Iacono, T. (2004) Patients with disabilities and complex communication needs: The GP consultation. Australian Family Physician Vol. 33, No. 8, August 2004

• McCormack, J., McLeod, S., McAllister, L. & Harrison, L.J. (2009). A systematic review of the association between childhood speech impairment and participation across the

lifespan. International Journal of Speech Language Pathology, 11(2), 155-170.

• McLeod, S, Harrison, L, McAllister, L and McCormack, J (2007). Prevalence of speech and language impairment in 4,983 four-five-year-old Australian children. Poster

presented at American Speech-Language-Hearing Association Convention, Boston.

• Speech Pathology Australia (2011). Clinical Guideline: Speech Pathology Services in Schools. Modified December, 2011. Melbourne, VIC.

• S. E. Stothard, M.J. Snowling, D. V. M. Bishop, B.B. Chipchase, and C. A. Kaplan (1998). Language‐Impaired Preschoolers: A Follow‐Up Into Adolescence. Journal of Speech,

Language, and Hearing Research, April 1998, Vol. 41,407‐418. doi:10.1044/jslhr.4102.407

• World Health Organization. 2002. WHO International Classification of Functioning, Disability and Health. [ONLINE] Available at:

http://www.who.int/classifications/icf/icfbeginnersguide.pdf?ua=1. [Accessed 09 March 16].

Christine’s contact details:

cporter@enhanceability.com.au

Twitter: @CP_eABILITY

www.enhanceability.com.au