CHILDREN WITH COMMUNICATION DISORDERS
SUPPORT FOR SPEECH AND LANGUAGE SERVICES IN EDUCATIONAL SETTINGS
Of those individuals in our society who are between 0-21 years of age, 88% are in elementary, secondary or postsecondary education. Clearly, schools shape the future of North America and as such, bear an enormous burden of responsibility for the evolution of our society. Speech and language services administered by Speech-Language Pathologists provide crucial services which advance the mission of education, to prepare children for life.
To further the mission of education for the majority of children with communications disorders, speech and language services must be integrated into the overall curriculum at school. Only school-based management can provide the continuous services that ensure the progress of children throughout their school careers. As the child moves through the educational system and the demands for communication change, speech and language services support the child, as well as the parents and teachers, who will help the child meet these changing demands.
There is clear evidence that language intervention is effective (Nye, Foster, and Seaman, 1987) and that the earlier treatment is initiated, the better the outcome (Schery, 85). For school children with weak language skills, language services which are integrated into the education setting by school Speech-Language Pathologists have resulted in important educational outcomes, including significant gains in reading skills for elementary school children (Hoffman & Norris, 1994), meaningful improvements in adaptive behaviour in the classroom (Schery & O'Connor, 1992), and substantial reductions in the drop-out rate for students in secondary school (Larson & McKinley, 1995), and finally for at risk children, lasting benefits representing a significant savings to the social support system and society (Schweinhart, Berrueta-Clement, Barnett, Epstein & Weikart, 1985).
When considering services for communication disorders in Ontario, it can be said without doubt that "too many, wait too long, for too little" (Fox, 1980). Many school boards provide premier services that are a model of efficiency and effectiveness. Services in Ontario Boards are deployed by Speech-Language Pathologists and supervised supportive personnel utilizing the most educationally current and innovative techniques and service delivery models.
Language is not just another subject. It is the means by which all other subjects are pursued (Boyer, 1985). The only sensible and practical solution to educating those with communications disorders is integrated, not fragmented, educational services administered by educational Speech-Language Pathologists in educational settings.
In consideration of the mission
of education and the needs of students, ideally speech and language services
should be expanded and practically should be sustained. If budgetary considerations
necessitate changes, every effort should be made to preserve integrity
of speech and language services in consultation with the parents and teachers
of the children affected as well as speech and language personnel.
[Please see Appendices A and B for further details]
Boyer, J. (1985). The Communicator. Position Paper on Language in the Schools, Center for Advancement of Teaching and Learning. Pennsylvania: Carnegie-Mellon.
Hoffman, P. & Norris, J. (1994). Whole language and collaborative work: Evidence from at-risk kindergartners, Journal of Childhood Communication Disorders, 16(1), 41-48.
Larson, V. & McKinley, N. (1995). Language Disorders in Older Students. Eau Claire, WI: Thinking Publications.
Nye, C., Foster, S. & Seaman, D. (1987). Effectiveness of language intervention with the language/learning disabled. Journal of Speech and Hearing Disorders, 52(4), 348-357.
Schery, R.K. (1985). Correlates of language development in language disordered children. Journal of Speech and Hearing Disorders, 50. 73-83.
Schery, T. & O'Connor, L. (1992). The effectiveness of school-based computer language intervention with severely handicapped children. Language, Speech and Hearing Services in Schools, 23, 43-47.
Schweinhart, L., Berrueta-Clement, J., Barnett, W., Epstein, A. & Weikart, D.
(1985). Effects of the Perry
Preschool Program on youths through age 19: A summary. Topics in Early
Childhood Special Education, 5(2), 26-35.
THE CASE FOR MANAGEMENT OF LANGUAGE DISORDERS IN THE SCHOOLS
"Language is not just another subject. Language is the means by which all other subjects are pursued." (The Communicator, J. Boyer from the Center for Advancement of Teaching and Learning)
Communication Disorders are the largest handicapping condition in society affecting 5-10% of the general population and ranging from hearing impairments to language disorders which can be developmental in nature or acquired (Canadian Association of Speech Pathologists and Audiologists). Second to being alive, communication is the most critical human function allowing for full participation in society. Since the primary function of the educational system is to allow all children, regardless of their particular circumstances, to acquire the skills needed to live, work and contribute to society then surely management of communication disorders is a necessary responsibility of the schools.
The most common communication disorder is language impairment. You may ask what is language. Language is simply the invisible information we all carry in our heads that allows us to understand the thoughts of others and express our own thoughts. This may be accomplished through a variety of mediums, including speaking, listening, reading, writing, or hand signals as in sign language. The child with language impairment will have poorly developed language information. This disability often is not superficially evident, indeed some children may appear normal in conversational language since they can "talk a blue streak." The devastating evidence of their disability, however, becomes apparent in inability to adapt to and learn in the classroom where they must listen, read, speak and write and in failed social interactions so critically dependent on language skills.
We can expect language disorders to comprise the largest handicapping condition in the schools. Of the total school population JK-OAC, we can expect:
1. 4.73% will be labelled Learning Disabled with 40%-100% of these children showing language disorders
2. 1.68% will be labelled Developmentally Disabled with 85% of these children showing language disorders
3. 1% will be labelled Emotionally Handicapped with 70% of these children showing language disorders
The most conservative estimate of the extent of the language problems would be 6% of the total school population JK-OAC. (Casby, 89).
One may ask why we should be concerned about language disorders. There are at least 4 reasons which are well documented:
1. Language provides the main method of establishing and maintaining social relationships. Psychiatric disorders are more common in language disordered than normal language learning children (Cantwell and Baker, 1991; Waller, Sollad, Sander and Kunicki, 1983, Warr-Leeper, 1994). It is clear that poorly developed language skills are strongly associated with life-long difficulties in psycho-social development (Weiner, 1985).
2. Language constitutes a principal means of organizing behaviour and is central to the normal acquisition of many cognitive and academic skills, particularly literacy. Language is the medium of instruction in the classroom (Berlin, Blank and Rose, 1980). Problems in comprehension and production of oral and written language result in academic failure which are not alleviated over time (Weiner, 1985).
3. As the language-delayed child ages, the gap between himself/herself and his/her peers widens (Wiig and Semel, 1984). Thus, the longer the child remains unmanaged, the more pronounced the delay becomes and the more pervasive the impact.
4. There is evidence that an "optimal" period for language learning may exist (Berko-Gleason, 1989 and Flavell, 1985). Although the precise timing of this critical period is unclear, a great deal of research suggests that the preschool and school years are an optimal period for the acquisition of many language skills (Funk & Ruppert, 1984 and Owens, 1988). Thus, the older the child is when initially diagnosed, the greater the risk of failure in remediation attempts (Dumtschin, 1988; Goldberg, 1984; Huntley, Butterfill & Latham, 1988; Janko & Bricker, 1987; Sande & Billingsley, 1985 and Schery, 1985).
It is clear that language acquisition is an integral component in the development of an individual (Allen & Rapin, 1980) and failure of the language system will have life-long negative impact on social, academic and vocational success (Weiner, 1985). There are systematic ways in which the language skills of an individual and the level of language used by other individuals in the world interact to place the person with poorly developed language at a disadvantage. Developing a relationship with your primary care givers can be a major challenge when a child is language impaired. Learning the curriculum, which is necessarily presented through the language mode, is hindered by weak language skills. Speech in the classroom is coming at you at 10-12 sounds per second and 120 to 150 words per minute. Imagine trying to learn Calculus with a weak language system, such as what we all experience when trying to manage in a second language.
In the practical world you may be asked, "Won't these children outgrow their problems?" After all, you do not hear adults saying "Me go bathroom" so these children who are slow must develop the skill but at a slower pace. It is true that persons with slow development do get better as they get older so that superficial evidence of poor language knowledge may not be readily apparent. The evidence is overwhelmingly clear, however, that problems remain and manifest in every aspect of their lives (Wiener,1985 and Blalock, 1982). The child with an unresolved language problem as he enters school has problems in learning to read and write is isolated due to difficulties in socializing and will eventually have great difficulty in getting and holding a job. This is a verbal world and a literate world that one can not manage without competence in language.
In the practical world one may also ask if treatment is effective with children who do not develop language well. There is overwhelming evidence that it is effective (Nye, Foster, and Seaman, 1987) and that the earlier treatment is initiated, the better the outcome (Schery, 85). Further, the SLP is guided in case load selection by information regarding which children are most likely to spontaneously improve without intervention and which children will show persistent language dysfunction (Bishop and Edmondson, 87) and therefore only those children who are genuinely in need of service will be treated.
The Speech-Language Pathologist (SLP) is the uniquely qualified professional to provide service. S/he has a wide variety of educational training in the structure of language and its acquisition, has a minimum of 300 classroom hours in the assessment and treatment of language disorders and 320 hours of supervised experience in clinical management of communication disorders. The fact the profession is regulated by the government in most of Canada and the most of the Western world would suggest that the communicatively handicapped can be harmed by persons who do not have appropriate training in the field.
The Speech-Language Pathologist (SLP) not only intervenes to improve the communication skills but also to facilitate access to others in their world, sometimes enhancing access to training and education and sometimes providing the social link so necessary to the psychological well-being of humans. One could argue that what the SLP provides is access to the quality of life we all enjoy.
The current trend to compress the services of SLP to school-age children and increase the demand on existing personnel is a short-term solution that will leave a legacy of harmful effects. How can teachers be expected to do their job well without support for the primary means of educating, language? How will teachers have time for the average child if the teacher is given no support for the integrated special needs child? The SLP provides not only direct work with children but also indirect work with significant others and the environment of the child to increase the potential for learning language all of the time and access to the verbal world. If the SLP is not a member of the school and can not concentrate efforts on the school curriculum and personnel, then the child is not being properly serviced.
Given the shrinking services in every sector of public service, the need for SLP is even greater than before. We serve the sometimes invisible and voiceless minority who can not always understand or speak for themselves yet they deserve to be treated as equitably as those with more obvious disabilities. One would not consider denying access to buildings via wheel-chair ramps so why would one consider denying access to the entire world due to an untreated communication disorder? Individuals with communication disorders should not be denied sheltered passage into the world the rest of us control. Better outcomes in education for children mean that these children become contributing and independent members of society thus saving our limited resources. We can provide what is needed now or we can provide support through the social system for lifetimes wasted.
Genese Warr-Leeper, Ph.D.
"If all my possessions were taken from me with one exception, I would choose to keep the power of communication, for by it I would soon regain all the rest." Daniel Webster.
**Warr-Leeper, G. (1993) The case for management of language disorders in the schools:Indispensable or incidental? Communication Exchange,4(4), 1-5.
Allen, D.A. & Rapin, I. (1980). Language disorders in preschool children: Predictors of outcome. Brain and Development, 2, 73-80.
Berko-Gleason, J. (1989). The development of language (2nd Ed.) Toronto: Charles E. Merrill.
Berlin, L.J., Blank, M., & Rose, S.A. (1980). The language of instruction: The hidden complexities. Topics in Language Disorders, 1(1), 47-58.
Bishop, D. & Edmundson,
A. (1987). Language-impaired 4 year olds: Distinguishing transient from
persistent impairment. Journal of Speech and Hearing Disorders,
Blalock, J. (1982). Persistent auditory language deficits in adults with LD. Journal of Learning Disabilities, 15, 604-609.
Cantwell, D. & Baker, L. (1991). Psychiatric and developmental disorders in children with communication disorder. Washington, D.C.: American Psychiatric Press, Inc.
Casby, M.W. (1989). National data concerning communication disorders and special education. Language, Speech and Hearing in the Schools, 20, 22-30.
Dumtschin, J.U. (1988). Recognize language development and delay in early childhood. Young Children, 43, 16-24.
Flavell, J. (1985). Cognitive development (2nd. Ed.) Englewood Cliffs, N.J.: Prentice Hall.
Funk, J.B. & Ruppert, E.S. (1984). Language disorders and behavioral problems in preschool children. Journal of Developmental and Behaviourial Pediatrics, 5, 357-360.
Goldberg, R. (1984). Identifying speech and language delays in children. Pediatric Nursing, 10, 252-259.
Huntley, R.M.C., Holt, K.S., Butterfill, A., & Latham, C. (l988). A follow-up study of a language intervention program. British Journal of Disorders of Communication, 23, 127-140.
Janko, S. & Bricker, D. (1987). Language intervention with young children: Current practice and future goals. Australia and New Zealand Journal of Developmental Disabilities, 13, 65-72.
Nye, C., Foster, S. & Seaman, D. (1987). Effectiveness of language intervention with the language/learning disabled. JSHD, 52(4), 348-357.
Owens, R., (1988). Language Development: An Introduction. Toronto: Merrill Publishing Co.
Schery, R.K. (1985). Correlates of language development in language disordered children. Journal of Speech and Hearing Disorders, 50. 73-83.
Sande, D.R. & Billingsley, D.S. (1985). Language development in infants and toddlers. Nurse Practitioner, 10, 39-47.
Warr-Leeper, G., Wright, N. and Mack, A. (1994) Language disabilities of antisocial boys in residential treatment Behavioral Disorders, 19(3),159-170.
Waller, M., Sollod, R., Sander, E., & Kunkicki E. (1983). Psychological assessment of speech and language-disordered children. Language, Speech, and Hearing Services in the Schools, 14(2), 92-98.
Weiner, P. (1985). The value of follow-up studies. Language impaired youths: The years between 10 and 18. Topics in Language Disorders, 5(3), 78-92.
Wiig, E.H. & Semel, E.M.
(1984). Language Assessment and Intervention for the Learning Disabled.
Columbus: Charles E. Merrill.
THE SOCIAL CONSEQUENCES OF FAILURE IN COMMUNICATION
Communicative competency is strongly linked to social acceptability and popularity in preschool and school-age children (Hazen & Black, 89; Black & Hazen, 90; Place & Becker, 91). Studies have found that "liked" children were more skilled at initiating, contingent responding, acknowledging and speaking to more than one partner simultaneously (Hazen & Black, 89). In contrast, "disliked" children were less skilled at requesting using polite forms (Place & Becker, 91), less responsive in interactions, and more likely to produce irrelevant remarks (Black & Hazen, 1990). Further, research examining social interaction/social status of children with language impairments in preschool classrooms has shown that children with communication impairments were more frequently ignored by peers (Rice, Sell, & Hadley, 91) and were not as popular as their normally developing classmates (Gertner, Rice, & Hadley, 94). Finally, it appears that biases about children with communication impairments are also shared by adults, including teachers and speech language pathologists. Results of a study by Rice and colleagues have shown that adults consistently rate children with communication impairments as less intelligent and less socially competent (Rice, Hadley, & Alexander, 93). People form quick and negative impressions of individuals who evidence even minor articulation disorders such that those who have distorted speech are considered to be intellectually slow and handicapped (Clase, 1969; Mowren, Wahl, & Doolan, 1978; Perrin, 1954). The findings of studies such as these have important implications for the development and maintenance of friendships and judgements of academic potential for children with communication deficits (Rice, 93; Gertner et al., 94).
Friendship is one of the most basic human needs and the one thing that all parents want for their children. If all of our children, including those with communication disorders, are to have the opportunity to 'belong', their communication needs must be met.
Black, B. & Hazen, N.L. (1990). Social status and patterns of communication in acquainted and unacquainted preschool children. Developmental Psychology, 26, 379-387.
Clase, J. (1969). A comparison of responses of speech clinicians and laymen to the effects of conspicuous articulation deviations on certain aspects of communication. Ph.D. Dissertation. State University of New York at Buffalo.
Gertner, B.L., Rice, M.L., & Hadley, P.A. (1994). Influence of communicative competence on peer preferences in a preschool classroom. Journal of Speech and Hearing Research, 37, 913-923.
Hazen, N.L. and Black, G. (1989). Preschool peer communication skills: The role of social status and interaction context. Child Development, 60, 867-876.
Perrin, E. (1954). The social position of the speech defective child. Journal of Speech and Hearing Disorders, 19, 250-262.
Place, K.S. & Becker, J.A. (1991). The influence of pragmatic competence on the likability of grade-school children. Discourse Processes, 14, 227-241.
Mowren, D., Wahl, P. & Doolan, S. (1978). The effects of lisping on audience evaluation of male speakers. Journal of Speech and Hearing disorders, 42(2), 140-148.
Rice, M.L. (1993). Don't talk to him; he's weird: A social consequences account of language and social interactions. In Kaiser, A.P. & Gray, D.B. (eds) Enhancing children's communication: Research foundations for intervention. Baltimore, MD: Brookes Publishing Co.
Rice, M.L., Hadley, P.P., Alexander, A.L. (1993). Social biases toward children with specific language impairment: A correlative causal model of language limitations. Applied Psycholinguistics, 14 (443-472).
Rice, M. Sell, M. Hadley, P. (1991). Social interactions of speech-and language-impaired children. Journal of Speech and Hearing Research, 34, 1299-1308.
Return to Parent Resources Index