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between child and adolescent behaviour problems, and underlying deficits in language comprehension and/or expression. This evidence has highlighted that children who experience communication impairments are at increased risk of behaviour problems and that some young people with behaviour problems are likely to present with unidentified communication impairments. The following section outlines the role of speech pathologists in this area of practice. The role of speech pathology in managing clients Historically, children with behaviour problems and adolescents generally have received minimal input from speech pathologists (Larson & McKinley, 2003). For example, Ruhl et al. (1992) identified 30 school-aged students (8 females and 22 males aged 9;4 – 16;2) from a Pennsylvania school district with mild/moderate social skill disorders and IQs within the typical range. Although all participants performed at least one standard deviation below the mean on both receptive and expressive language measures, the researchers reported that no speech pathology services had been provided for these students. Similarly, Camarata et al.’s (1988) study summarised above identified only 2 out of 38 school-aged children with behaviour disorders as receiving services from speech pathologists. This was despite 97% of the participants demonstrating significant difficulties on one or more subtests of a standardised language test. More recently, Snow and Powell (2008) noted a subgroup of young offenders (n = 16) with language impairment experiencing early intervention such as reading recovery; however, no speech pathology input was reported. Considering the evidence of the relationship between communication impairments and behaviour problems, speech pathologists have a role to play in identifying and supporting children with behaviour problems (Snow & Powell, 2004). However, speech pathologists are generally not qualified to diagnose behaviour or social problems. Therefore speech pathologists should work together with developmental and educational psychologists and behaviour specialists, parents, families, and children during the evaluation and intervention process. Speech pathologists also have significant capacity to increase professional understanding of social and behaviour disorders by providing insight and advice on children’s linguistic strengths and weaknesses (Ruhl et al., 1992). Input from speech pathologists will contribute to the development of appropriate communication, social, academic, and psychological profiles, which can then be used to determine functional intervention goals across domains and environments (Hummel & Prizant, 1993). Speech pathologists will also be able to provide insight into the appropriateness of assessment tools. For example, many psychological assessment tools require competent language skills in order to formulate appropriate responses to questions. Therefore children and adolescents with underlying language impairments are at risk of poor performance on these assessments. When called upon to evaluate a child or adolescent with behaviour problems a number of assessment considerations are recommended (see Brinton & Fujiki, 1993; Larson & McKinley, 2003): • What is the status of this child’s higher level language skills (e.g., ability to draw inferences)? • What is the impact of this child’s language abilities on their social interactions and relationships with peers and adults?

• What is the role of emotions, motivation, and self-esteem in this child’s daily life? • How does this child think and learn best? Each of these considerations is designed to provide information in order to develop intervention goals that aim to equip children and adolescents with the skills and confidence to participate effectively in classroom contexts. These include goals that target meta-linguistic development and discourse skills that are commonly used during academic problem-solving activities and social interactions. Investigating this area of development is particularly important considering the lack of information on these higher level language skills provided by traditional norm-referenced assessments (e.g., Clinical Evaluation of Language Fundamentals (4th ed.): CELF-4; Semel, Wiig, & Secord, 2003). Developing intervention goals based on a profile of children’s higher level language skills may reduce the risk of negative outcomes reported in the literature for children and adolescents experiencing communication impairments and behaviour problems. These negative outcomes include social withdrawal, academic failure, anti-social, and criminal behaviour. Specifically, these intervention goals should aim to (Prizant, Audet, Burke, & Hummel, 1990): • enhance basic and higher level language skills and communicative competence; • promote positive social relationships with peers, family, and adults; and • develop cognitive and academic skills. There is also a clear need for research into the role of speech pathology in improving behaviour, social, and academic outcomes for children and adolescents with communication impairments. This research must determine effective ways to: • identify children with communication impairments who are at risk of behaviour problems; • identify children and adolescents with behaviour problems and unidentified communication impairments; and • provide support for developing communication, social and academic skills and reducing behaviour problems. Summary This review has summarised a large body of evidence for the relationship between communication impairments and behaviour problems in children and adolescents. This relationship is not surprising considering the critical role of speech and language skills during social interactions and academic experiences. The potential for positive long-term outcomes for children with behaviour and communication difficulties may be increased if speech pathologists work closely with the child, their family, professionals and researchers, towards intervention goals based on accurate communication and behaviour evaluations. However, further research is needed to identify specifically how speech pathologists can best contribute to this area of practice. References Arkkila, E., Räsänen, P., Roine, R. P., & Vilkman, E. (2008). Specific language impairment in childhood is associated with impaired mental and social well-being in adulthood. Logopedics Phoniatrics Vocology , 33 , 179–189. Benner, G. J., Nelson, J. R., & Epstein, M. H. (2002). Language skills of children with EBD: A literature review. Journal of Emotional and Behavioral Disorders , 10 , 43–56. Beitchman, J. H., Wilson, B., Johnson, C. J., Atkinson, L., Young, A., Adlaf, E., et al. (2001). Fourteen-year follow-up of speech/language-impaired and control children: Psychiatric

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing