JCPSLP November 2017

Supporting social, emotional and mental health and well-being: Roles of speech-language pathologists

The role of the speech-language pathologist in supporting primary school students with social, emotional and behavioural difficulties Clinical insights Hannah Stark

While the adage “behaviour is communication” is frequently used in speech- language pathology practice, the interactions between communication and behaviour are often poorly understood in practice in Australian primary schools. This article will provide an overview of how classroom behaviour is conceptualised including existing literature about the communication profiles and needs of primary school students with social, emotional and behavioural difficulties (SEBD). Current education provisions for these students will also be discussed. Clinical insights from a pilot trial of a speech-language pathology program in a specialist unit for primary school age children with SEBD will be offered, along with recommendations for speech-language pathologists (SLPs) who assess, support and advocate for this population. P rimary school age students with social, emotional and behavioural difficulties (SEBD) are a cause of great concern to teachers and school administrators (Armstrong, Elliott, Hallett, & Hallett, 2016; Graham, Sweller, & Van Bergen, 2010; Stringer & Lozano, 2007; Tommerdahl & Semingson, 2013; Van Bergen, Graham, Sweller, & Dodd, 2015). Even though most speech-language pathologists (SLPs) who work in primary school settings will have students in their caseload who present with behavioural difficulties, it is suggested that, for a number of reasons, speech-language pathology services are not sufficiently accessible to vulnerable students, including those with SEBD (Cross, 2011; Hollo, Wehby, & Oliver, 2014; Snow, Powell, & Sanger, 2012; Stringer & Lozano, 2007). The Speech Pathology Australia Speech Pathology Services in Schools Clinical Guidelines (2011) recommend “that SLPs working in schools continue to advocate for involvement in less well recognised fields such as behaviour management, mental health” (p. 21). Six years on, involvement of SLPs in the support of students with SEBD in schools continues to be an emerging area of practice in Australia. This article first provides an overview of the literature, including the conceptualisation of problematic classroom behaviour, the prevalence and communication profiles of

primary school-aged students with SEBD (including an overview of current provisions), and the issues associated with the identification and remediation of language and literacy difficulties in this population. Second, clinical insights, including a description of current educational provisions, and a rationale behind the delivery of a speech pathology service for this student population is offered. This is followed by the author’s reflections upon the early implementation of a service within a specialist school for students with SEBD. Review of the literature Conceptualising classroom behaviour The affective states of students, such as increased anger, anxiety, emotional lability, depressed mood, signs of trauma, a lack of empathy or an inability to cope, and their associated behavioural manifestations, can present challenges to teachers and SLPs within classroom or clinical settings (Cross, 2011; Todis, Severson, & Walker, 1990). These associated behavioural manifestations may be externalising (for example, aggression towards peers) and/ or internalising (for example, the avoidance of peers) (see Table 1), and it is important to note that these behaviour types are not mutually exclusive (Todis et al., 1990). Disruptive or unproductive behaviours in the classroom are limited only by a student’s imagination, but commonly Table 1. Examples of externalising and internalising classroom behaviours Internalising classroom behaviours

KEYWORDS BEHAVIOUR LANGUAGE LITERACY

PROFESSIONAL COLLABORATION SEBD THIS ARTICLE HAS BEEN PEER- REVIEWED

Hannah Stark

Externalising classroom behaviours Aggressive behaviour towards objects or persons Arguing Forcing the submission of others Defying the teacher Being out of the seat Not complying with teacher instructions or directives Having tantrums Being hyperactive Disturbing others Stealing Refusing to follow teacher or school imposed rules

Low or restricted activity levels Not talking with other children Shyness Timidity or unassertiveness Avoidance or withdrawal from social situations Preference to play or spend time along Fearful behaviour Avoidance of games and activities Unresponsiveness to social initiations by others Not standing up for oneself

Source: Todis et al., 1990

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JCPSLP Volume 19, Number 3 2017

www.speechpathologyaustralia.org.au