“Speech, language and communication are crucial to all children ... if a child does not benefit from early intervention, there are multiple risks which may become evident over a period of years – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects, of challenges to mental health and in some cases, of a descent into criminality.”
The Bercow Report: A review of services for children and young people with speech, language and communication needs (Department for Children, Schools and Families, 2008).
The links between underdeveloped speech, language and communication needs (SLCN) and negative life outcomes are well-documented and indeed provided the impetus for the governmental review of services for children and young people with SLCN that led to the Bercow Report.
Historically, the concern related to outcomes for children with identified SLCN, but more recently the focus has been on the link between unwanted behaviour in various settings and previously unidentified communication needs.
The evidence base for this link is large and robust, repeatedly demonstrating significant levels of SLCN (between 50 and 80 per cent) within many groups who are a focus for behavioural change. This includes children and young people with psychiatric externalising disorders – e.g. ADHD, Oppositional Defiance Disorder (ODD) or Conduct Disorder (CD) – children in care, children at risk of exclusion or already excluded from school, and the young offender population. See Owen 2014 for a review of the evidence (1).
In short, for many children the focus is on behaviour management, when a more effective response may be intervention aimed at supporting language and communication ability.
When you also consider that unwanted behaviour is usually addressed through verbal communication, the persistent disruptiveness of many children can be viewed rather differently – did the student fully understand the instruction or reprimand?
The large evidence-base referred to has been concerned with structural language abilities; predominantly verbal skills often formally assessed by measures of expressive (speaking) or receptive (listening comprehension) language. However, our ability to communicate effectively relies on a much broader skill-set than being able to use and understand verbal communication.
Figure 1 presents an influential and well-accepted model of language that identifies three dimensions of language development. Form and content in this model are structural language skills. The third dimension concerns the social use of language – or pragmatic language skills. This includes using and reading non-verbal communication, understanding communication conventions, adapting to the needs of the listener, and taking cues from the social context.
A competent communicator’s skills would be plotted in the central intersection. In infancy, these areas are thought to develop separately, beginning to integrate as a child develops verbal language (2), therefore it is possible for children to have notable difficulties in one area with strengths in another – e.g. consider the child with a diagnosis of Aspergers who has clear and coherent speech (form) an advanced vocabulary with accompanying understanding (content) but struggles to initiate or maintain a conversation with another child (use or pragmatics).
Indeed it is with children with autistic spectrum conditions that most research relating to this area of need has been undertaken with debate centring on whether a differentiating diagnosis (e.g. “semantic-pragmatic disorder” or “pragmatic language impairment”) is required to clearly delineate the needs of a sub-set of children.
More recently, however, the link between unwanted behaviour and less well-developed pragmatic language skills has been identified in various groups, such as young people with CD (3), non-diagnosed attention/hyperactivity difficulties (4), peer problems (5), and in children at-risk of school exclusion in the secondary-aged population (6).
Poor pragmatic language abilities
In essence, a child (or adult) who has not yet become competent in this area is likely to miscommunicate and misconstrue, therefore they may be less aware of the signals they are giving out through non-verbal language and more likely to “take things the wrong way”. Children with less well-developed pragmatic language abilities may:
- Not make appropriate eye contact.
- Not know how to initiate, turn-take and end conversations and social interactions.
- Understand most of the words, but not get the meaning as they haven’t “read” the context.
- Communicate unintended messages, especially non-verbally.
- Misconstrue others’ communications to them.
- Misread social situations.
- Have little awareness of status relationships.
- Have little awareness of unwritten social rules.
Or as summarised in one publication, such children “may appear rude, distracted or self-involved” (7), particularly if areas of form and content are strengths they are likely to mask less well-developed pragmatic abilities resulting in a child appearing to be a competent communicator who is being wilfully disobedient or awkward.
What can be done?
One outcome of the Bercow Report was the creation of the Better Communication Research Programme, commissioned to enhance the evidence base in relation to SLCN.
One outcome of the programme was a thorough consideration of the interventions, and their evidence bases, available to support language and communication development in children and young people.
In partnership with the Communication Trust a “What Works” web-based database has been set up (8) allowing schools to search for appropriate interventions, fitting well with the current drive for adopting evidence-based practice in education.
Unfortunately, the evidence base is not robust for many approaches – because research has not been undertaken rather than concerns regarding the efficacy of the approach. However, inclusion in the database suggests that approaches have met standards identified by the programme.
As with other areas of school improvement and development the issue should be considered at different levels to ensure an effective response: whole-school, targeted and specialist. What follows are some general considerations for each level.
Whole-school
The cornerstone of a whole-school approach is knowledge and understanding among all staff in relation to SLCN. Each member of staff does not need to be a specialist, but knowing how to recognise signs of potential SLCN and which groups are more at risk of experiencing SLCN will support early identification.
Staff understanding how to modify their own communication and teaching methods will support language development and curricular access while removing unnecessary barriers that can prevent academic attainment or even promote unwanted behaviour.
Staff can ensure that their communications are clear, brief and to the point, avoiding idioms, sarcasm, irony, ambiguity and rhetorical questions. Understanding such communication puts a heavy load on pragmatic language skills. Verbal teaching content can be supported visually, and partner and group work can be considered carefully to ensure children work with more able others and engage fully.
Schools may also want to consider their policies to ensure that if SLCN are suspected robust procedures are in place to ensure needs are met. It is worth considering how language and communication skills are learnt (through reciprocal interactions, with plenty of opportunity to practise the range of skills (form, content, use) with more able others).
Unfortunately, due to curriculum requirements and perhaps teaching methods, these opportunities tend to reduce as a child advances through their school career, although many children still need them and all will benefit from more opportunities to develop. Incorporating more talking, supported group activities and time for staff to talk with students individually could all be of benefit.
Do not presume that the child understands the social expectations in all areas of the school environment. When I deliver training on unwanted behaviour and pragmatic language competence I refer to arriving in a new social setting (such as a school) with less well-developed pragmatic language abilities as “orienteering without a compass”. You can help all children by ensuring the social terrain is mapped – explicitly.
Finally, a useful tool for auditing practice in the classroom in relation to supporting language and communication development is the Communication Supporting Classroom Observation Tool (9). Available online, this observation schedule allows staff to evaluate current arrangements and identify areas for development.
Targeted
At this level, the focus is on early identification and intervention. Ideally children who may have less well-developed pragmatic language abilities should be identified before they start getting into trouble at school, to prevent them associating the setting and the adults in it with uncomfortable and negative feelings.
Therefore it is important to identify vulnerable groups and provide targeted intervention. Such groups are likely to involve children who struggle with attention and concentration (specific work may also be required to develop attention skills), those who have a medical diagnosis of ADHD, ODD or CD, and where inconsistent early care experiences are suspected.
Language and communication needs should always be considered for children viewed as persistently disruptive or at risk of being permanently excluded. Targeted interventions as recorded in the What Works database can then be selected to support need. Some programmes include checklists to ensure appropriate selection of children, although consideration of their behavioural presentation against descriptors above may suffice.
It is vital that small group or individual interventions are not delivered in isolation, with the onus on the child to independently transfer the skills to real-life situations.
Session-based interventions can be likened to learning to drive; the theory is essential, but you also need to be supported to put the theory into practice on the road. Outcomes from programmes will be better if opportunities are provided where children can be supported to apply skills in the real social environments of the classroom and playground and if the wider staff group have knowledge of the intervention to ensure they are able to reinforce and reward learning.
Individual/specialist
Individual level intervention may overlap with targeted and is only usually required where whole-school approaches and targeted intervention are not producing results, suggesting more significant or complex needs. The child may require more intensive support to develop pragmatic skills on a one-to-one basis, although it will still be important to provide group work to practise skills and support to apply skills in the real world environment.
At this level, referral to specialist support, such as a speech and language therapist or educational psychologist, may be required, although not necessarily.
Many schools have supported members of staff to allow them to develop a specialism in SLCN, often in conjunction with commissioned support from psychology or speech and language services, to provide a robust package of intervention that can efficiently and effectively respond to the varying levels of need found within a school community.
- Dr Zoe Owen is an educational psychologist with Creative Psychologists in Action. Visit www.cpa-ltd.co.uk
Further information and references
- The relationship between pragmatic language competence and school exclusion: an interactionist perspective (Owen, 2014, App Ed and Child Psy D. Thesis, University of Birmingham).
- Language Development and Language Disorders (Bloom & Lahey, 1978, Collier Macmillan).
- Social communication deficits in conduct disorder: a clinical and community survey (Gilmour, Hill, Place & Skuse, 2004, Journal of Child Psychology and Psychiatry 45:5: 967–978).
- The role of pragmatic language use in mediating the relation between hyperactivity and inattention and social skills problems (Leonard, Milich & Lorch, 2011, Journal of Speech, Language and Hearing Research, 54: 567–579).
- Pragmatic language impairment and associated behavioural problems (Ketelaars, Cuperus, Jansonius & Verhoeven, 2010, International Journal of Communication Disorders, 45 (2): 204–214).
- Incidence of pragmatic language difficulties in children at risk of exclusion from mainstream secondary schools (Owen, 2010, unpublished).
- Pragmatic Language Assessment Guidelines (Early Childhood Intervention Council of Monroe County 2004): http://bit.ly/1T3exoU
- The Communication Trust’s What Works database: www.thecommunicationtrust.org.uk/whatworks
- Communication Supporting Classroom Observation Tool (Dockrell et al, 2012): http://bit.ly/1S5TUHU