Communication in the High School Classroom

Supporting students with a

communication impairment in the

classroom

Christine Porter, Speech Pathologist

June 2016

Christine’s background

• is a Certified Practising Speech Pathologist, works for EnhanceABILITY with children with complex needs, completes contract work for other organisations and also has private clients

• has worked in Western Sydney, the Blue Mountains and Central Western NSW in early intervention, school-aged children and young adults since 1991

• Her caseload has included children with speech, language and/or learning difficulties and students with complex needs

• has a special interest in supporting students with assistive technology, and prides herself on knowing more about iDevices than her teenage children

• organised an assistive technology expo and workshops in Bathurst in conjunction with DET in 2009

• headed a team researching the use of a personalised story application to increase social interaction for students with severe expressive communication disability in 2012 - 2015

• completed an 18 month communication project in June 2016 in local DET schools. The focus of this project was increasing communicative participation of students with communication impairments.

© Christine Porter 2016. May be reproduced without alteration.

What is communication impairment?

• Speech: saying the sounds in words so that people can understand what is being said

• Language: exchanging ideas using words, usually in spoken or written form.

• Literacy: reading, understanding what is read and communicating in written form.

• Social Communication: how we communicate - interpreting the context of a conversation,

understanding non-verbal information and the social rules of communication that are

needed to develop a relationship with another person.

• Voice: using the vocal cords or voice box to produce speech.

• Fluency: commonly known as stuttering. This problem is usually first noticed when a child starts

putting sentences together but can continue into adulthood.(Source: Speech Pathology Australia, 2016)

A person with a communication impairment may have difficulties with:


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

A study of students in primary and secondary Catholic schools in

one Sydney diocese suggested that 12 -13% of students had

communication disorders, and the ratio of boys to girls in this statistic

averaged 1.88:1. (McLeod and McKinnon, 2007)

The prevalence of middle ear disease for indigenous children in remote

communities is around 70%. Additionally, 21% of the indigenous population

do not use Australian English. (Speech Pathology Australia, 2016)

Australian studies indicate that students with communication impairment represent around 14% of the population, with some recent studies suggesting this figure could be as high as 25%, or approximately 7 students in the average classroom. (McLeod, Harrison, McAllister and McCormack, 2007).


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)© Christine Porter 2016. May be reproduced without alteration.

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)


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.


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: Case Example

SAM:• 9 year old male, Year 4

• Long term learning difficulties, 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

• Challenging behaviours in class(eg disruptive) and unstructured settings eg

playground, verbally and physically aggressive, appears reactive rather than

instigator ie triggered by another student • Included in small group literacy support but minimal progress

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

clinical psychologist© Christine Porter 2016. May be reproduced without alteration.

Focus shift of assessment and intervention

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, face to face focus


Focus shift of assessment and intervention

Initial meeting with teacher, case worker, support teacher 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 class - identified embarrassment about literacy difficulties, becomes highly anxious and acts out to cover. Strategies discussed with student.

Liaison with team re results and recommendations. Discussion re strengths, interests, self-esteem. Anxiety flagged with team for monitoring. Verbal aggression and repetitive behaviours noted to occur during transitions eg moving from classroom to music. Library flagged as a voluntary “safe space” for when Sam is escalating in playground, positive verbal reinforcement of independent withdrawal to safe space. 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 aide to work on /L/ sound for 10 minutes daily in withdrawal. SP to monitor progress at school on fortnightly basis for 4 sessions. Individual sessions with Sam and carer externally for assertiveness and conversational skills following OT assessment. Literacy support AT trial monitored by key worker in school context.

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, consultative


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, because supports enable

participation, and participation enables learning.


Indicators for speech and language

screening/referral


There is lots to know about speech and language, and these quality, evidence-based links are specific to education and will be useful if you are concerned about a child in your class and want to know more.

o Speech sounds: red flags, a screener and talking to parents about speech sound difficulties are beautifully presented here, includes live links to further quality information about speech sound disorders:

o Identifying and supporting students with language impairment is well-summarised in this NSW resource in stages relevant to the curriculum:

http://www.cer.education.nsw.gov.au/documents/249903/250184/NSWCER_WPdoc_1a_Language.pdf

The earlier the identification of and intervention with communication impairment, the better the life outcomes for the child.

http://www.speech-language-therapy.com/pdf/QS5t-notes.pdf

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© Christine Porter 2016. May be reproduced without alteration.

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_Indigenous_Children.pdf

http://speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_Speech_Pathology_in_Mental_Health_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 20 July 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].

• 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.

• 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:

[email protected]

Twitter: @CP_eABILITY


Documents

Communication in the High School Classroom