JCPSLP November 2017

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

Top 10 resources Supporting individuals who have emotional behavioural disorders, attention deficit disorders and oppositional defiant disorders. Karen James

K aren James is a speech pathologist who works with clients (particularly teenagers) who have emotional behavioural disorders (EBD), attention deficit disorders (ADD/ADHD) and oppositional defiant disorders (ODD). Karen has compiled a list of her Top 10 ideas and resources for working with this population including useful assessment ideas, ideas to help focus clients who have problems attending to tasks, and strategies that have proven effective in overcoming defiant and resistant behaviours. Poor communication can be one of many contributions to disruptive behaviour as is seen in emotional behavioural disorders (EBD), attention deficit disorders (ADD/ADHD), and oppositional defiant disorders (ODD). Individuals may have difficulties with: (a) understanding what is being asked of them, (b) explaining themselves and the actions of others, (c) relaying the story around a single or series of events, and (d) understanding interpersonal relationships and social cues. Individuals may also have challenges with supplying sufficient or specific information, higher level executive functioning for problem-solving, planning and expressing ideas (particularly in writing), auditory processing difficulties, making inferences, and thinking about abstract ideas. Social communication difficulties are also prevalent. 1 A focus on oral language Narrative production can be difficult for individuals with EBD, ADHD and/or ODD. They may be literal in their interpretations and explanations, may omit important information, and may be unable to take alternate perspectives and adjust their message accordingly. Problems commonly occur in narrative microstructure (e.g., amount and variety of vocabulary; length of utterances; specificity; unnecessary repetition of information) and macrostructure (e.g., story introduction, event sequencing, identifying emotions, problems and possible solutions; providing a clear conclusion). Oral language skills are usually stronger than written language and therefore provide the strongest platform for learning. 2 A focus on social communication For those with EBD, ADHD and ODD, language and social communication problems are often masked by the presence of difficult behaviours. Receptive and expressive components involved in social communication may be impaired. Most individuals may be able to state social conventions, however are less successful at demonstrating them. Emotional vocabulary frequently requires development, with students often unable to distinguish the difference between feeling “bored” versus feeling “anxious” or “confused”. Ideally teaching needs to happen in the “here and now” to allow for maximum impact.

3 A focus on problem-solving/cause-and- effect reasoning It is common to find difficulties in higher level language skills especially problem-solving and reasoning (e.g., identifying consequences of actions). Impulsiveness, brain development or simply not knowing how to approach problems or unfamiliar situations can underpin some of these difficulties. Points 5 and 8 outline some ideas about how to target these areas. 4 A focus on literacy skills Literacy is a common difficulty seen in individuals with EBD, ADHD, and/or ODD. Poor spelling, reading fluency and comprehension means that students may try to avoid tasks involving these skills. It is not uncommon to observe a student reluctantly start a written task and suddenly stop and refuse to proceed because they come to a word they can’t spell. To help, have a pre-prepared vocabulary list with simple common words for them to refer to, including words such as there , because , they , which , etc. Read the words to them and point out that they can choose to use this to help if they want. Encourage them to ask you to add other words they need help with during written tasks. Emphasise the fact that the bigger the list the better it is, because it shows that they are recognising words that they need help with. With respect to generation of written texts, students can often recite the parts required in a written text but either an inability or lack of confidence in generating ideas prevents them from doing so. They need help drafting ideas and determining appropriate vocabulary to use. A basic Wh scaffold can help. Once the basic Wh elements are completed, you can ask the student to expand on each idea by providing scaffolds for specific information to include, for example: “What does the boy look like?” “Think about his size” (introduce list vocabulary related to size); “What is he wearing?” Oral texts may be easier to produce than written. For this reason, consider using a voice to text program (e.g., Dragon Naturally Speaking) to get the student started on a story. Once the student sees their story in writing, they are more likely to attempt editing or adding details. 5 Games! Games are powerful tools in both assessment and therapy, irrespective of a student’s age. Even the most “defiant” and “toughest” child/teenager will, more often than not, agree to “have a look” and then participate in a game. A game can be perceived as non-threatening and therefore non- stressful. Games are interactive which means students are more likely to attend for longer than during pen and paper

Karen James

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JCPSLP Volume 19, Number 3 2017

Journal of Clinical Practice in Speech-Language Pathology