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].