ACQ_Vol_11_no_3_2009

Mental health

Communication impairments and behaviour problems in children and adolescents

A review of the literature Dean Sutherland, Brigid McNeill, and Gail Gillon

Communication impairments and behaviour problems Preschool children The association between communication impairment and problems with behaviour and social skills is evident from a young age (McCabe, 2005; Qi & Kaiser, 2004). Qi and Kaiser investigated the behaviour and social skills of 3- and 4-year-old children (n = 60) from low socioeconomic backgrounds who were attending a head start program. The behaviour characteristics of 32 children with receptive and/or expressive language delays were compared with 28 children with typical language development. A combination of classroom observations and teacher reports were used to determine that children with language delay demonstrated significantly higher levels of behaviour problems (e.g., hitting other children and disrupting class). McCabe (2005) examined behaviour and social skills of 170 preschool children with and without speech and/or language impairments using teacher and parent ratings. McCabe found children with language impairment were rated as less social and exhibited more errant behaviour (e.g., physical aggression) compared to children with speech impairment only or to children without communication impairment. In contrast, McCabe and Meller (2004) found no difference in problem behaviours reported by teachers and parents for 4–5-year-old children with and without speech-language impairment. However, in comparison to children with typical language development, children with speech-language impairment were rated lower on a measure of self-control by parents and lower on assertiveness by teachers. These studies contribute to a growing evidence base supporting the early emergence of a relationship between communication impairments and behaviour problems. Early language and behaviour difficulties are in turn likely to hinder children’s readiness for school entry (Justice, Bowles, Pence Turnbull, & Skibbe, 2009) which also increases the risk of poor academic outcomes (Duncan et al., 2007). School-aged children and adolescents School-aged children with specific language impairment (SLI) often experience social and behaviour problems in classroom contexts (Conti-Ramsden & Botting, 2004). For example, school-aged children may experience difficulty following multi-step classroom instructions which a teacher may interpret as non-compliant behaviour (Redmond & Rice, 1998). Conti-Ramsden and Botting (2004) used a range of behavioural questionnaires and checklists (e.g., Strengths

Young children experiencing communication impairments may also display behaviour problems that persist into adolescence and adulthood, contributing to a range of negative long term outcomes such as low academic achievement and anti-social behaviour. Additionally, children and adolescents identified with behaviour problems often present with undiagnosed communication impairments. This paper provides a narrative review of research that has investigated the relationship between communication impairments and behaviour problems in children and adolescents over the past 30 years and examines the potential role of speech pathologists working in this area of practice. C hildren with communication impairments are at increased risk of experiencing social, emotional, and behaviour disorders (e.g., Gallagher, 1999; McCabe, 2005). Similarly, children with emotional and behaviour disorders often present with coexisting communication impairments (Camarata, Hughes, & Ruhl, 1988; Ruhl, Hughes, & Camarata, 1992). Comorbidity estimates of communication disorders and behaviour disorders range from 12% to 71% (e.g., Benner, Nelson, & Epstein, 2002; Pinborough-Zimmerman, Satterfield, Miller, Hossain, & McMahon, 2007) with methodological differences across studies contributing to the variation in reported rates. The prevalence of communication impairments and frequent co-occurrence with behaviour problems suggest that speech pathologists have a role to play in assessing and supporting children and adolescents diagnosed with language and/or behaviour problems. This is particularly important considering the risk of poor long-term social and employment outcomes for adolescents and adults who experience significant childhood speech-language difficulties (e.g., Clegg, Hollis, Mawhood, & Rutter, 2005; Snow & Powell, 2008). We conclude this paper with suggested strategies to support speech pathologists in working with children and adolescents presenting with complex communication and behavioural needs.

This article has been peer- reviewed LANGUAGE BEHAVIOUR CHILDREN ADOLESCENTS Keywords COMMUNICATION

Dean Sutherland

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing