SP in Schools project 2017 Low Res V2

Speech Pathology in Schools

A resource to support engagement and participation of students with speech , language and communication needs in schools.


Speech Pathology Australia: Speech Pathology in Schools Project


Acknowledgment is given to the members of the profession who contributed their knowledge and current literature to this project.

Speech Pathology Australia Reference Group

Gaenor Dixon, National President, Speech Pathology Australia/ Principal Advisor, Therapies Tim Kittel, Director, Speech Pathology Australia Alison Smith, Queensland Branch Chair/ Director Strategy and Performance, Metropolitan Region, Department of Education and Training (Queensland) Gail Mulcair, Chief Executive Officer, Speech Pathology Australia Candice Brady, Speech Pathologist at Children’s Hospital at Westmead (SCHN), Leader for Advocacy and Influence – Speech Pathology Australia (NSW Branch) Felicity Burke, Practice Leader Speech Pathology, Clinical Innovation and Governance, Ageing Disability and Home Care, Department of Family and Community Services Associate Professor Patricia Eadie, Melbourne Graduate School of Education Dr Charlotte Forwood, Leader of Advanced Learning – Strathcona Girls Grammar School Associate Professor Suze Leitao, Life Member SPA, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University Professor Sharynne McLeod, Life Member SPA, ASHA Fellow, Professor of Speech and Language Acquisition, School of Teacher Education, Charles Sturt University

Eleanor McMillan, Speech Pathologist in Private Practice/ School Leader in the ACT Education Direcorate Dr Natalie Munro, Course Director BAppSc(SpPath) and Senior Lecturer Speech Pathology, Faculty of Health Sciences, The University of Sydney, and University Associate, Curtin University Dr Tanya Serry, Senior Lecturer, Discipline of Speech Pathology; Chair, Human Research Ethics Sub-Committee; Honorary Research Fellow, Murdoch Childrens Research Institute, Policy Equity and Transition Group Dr Julia Starling, Certified Practicing Speech-Language Pathologist Adjunct Lecturer, The University of Sydney; President, Learning Difficulties Coalition of NSW Kathryn Thorburn, Speech Pathologist/Teacher Language and Learning: K-12 Speech Pathology and Learning Support Pamela Thuan, Speech Pathologist and Speech and Language Specialist Consultant Sue Wilks, Speech Pathologists/Managing Director One Stop: Allied Health & Medical Centre Christine Lyons, Senior Advisor – Professional Practice, Speech Pathology Australia Cathy Olsson, National Advisor – Disability, Speech Pathology Australia.

The reference group was supported by Mary Gornik, SPA National Advisor - Education, Early Childhood and Projects. A special thanks to Hayley Tancredi for her contribution to the section on inclusive education. www.speechpathologyaustralia.org.au >What’s On > Schools Project Resource

For more information on the Speech Pathology in Schools Project contact Speech Pathology Australia Senior Advisor, Early Childhood and Education, Jane Delaney at jdelaney@speechpathologyaustralia.org.au

Copyright: © (2017) The Speech Pathology Association of Australia Limited. All rights reserved. Disclaimer: To the best of The Speech Pathology of Australia Limited’s (‘the Association’) knowledge, this information is valid at the time of publication. The Association makes no warranty or representation in relation to the content or accuracy of the material in this publication. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of information provided. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this publication.

Speech Pathology Australia Level 1 / 114 William Street Melbourne Victoria 3000 Australia

1300 368 835 P: +61 3 9642 4899 office@speechpathologyaustralia.org.au


Speech Pathology Australia: Speech Pathology in Schools Project


Speech Pathology Australia has produced this resource to promote a whole school approach to support engagement and participation of students with speech, language and communication needs in schools. We acknowledge collaboration with the NSW Department of Education and its stakeholders to produce the components for principals, teachers and families which are available on their website. Sections of this resource may be useful to you when you are presenting professional development forums and advocating for your role in schools, and to educate school staff on the benefits of a whole school approach and what speech pathologists can offer schools.

NSW DoE website: Disability, learning and support


Speech Pathology Australia: Speech Pathology in Schools Project




The United Nations Convention on the Rights of Persons with Disabilities The Salamanca Statement and Framework for Action on Special Needs Education Disability Discrimination Act Disability Standards for Education, 2005 Overview of the National Disability Strategy 2010–2020 Melbourne Declaration on Educational Goals for Young Australians (December 2008) Prevalence of speech, language and communication needs


Aboriginal and Torres Strait Islanders References Typical speech, language and communication development

12 13

Common speech, language and communication needs (SLCN)

Markers of potential concern Other speech, language and communication markers of needs Complex communication needs and augmentative and alternative communication


References The impact of speech, language and communication needs

18 19 20

Identifying students with speech, language and communication needs

Best practice models and support for students with speech, language and communication needs

Why we are promoting inclusive education? The features of inclusive education References Response to intervention The RtI approach Response to intervention and literacy difficulties



Useful references The positive impact of providing best practice support to students with speech, language and communication needs Ensuring communication is embedded at a universal level Skilled and confident staff can make a positive impact Links with the curriculum A functional approach A strategy-focused approach Support at transition times Involving young people Opportunities for specialist intervention where difficulties are severe and complex



Speech Pathology Australia: Speech Pathology in Schools Project



Role of teachers and speech pathologists in the educational setting

Collaborative partnerships Reference What you need to consider when working in schools


Workload management Service delivery options Employment arrangements

Employee vs. independent contractor Clinical supervision and mentoring Resource requirements

Ownership of files and student information Administrative and program delivery support Children from culturally and linguistically diverse backgrounds


Free resources for speech pathologists References The different needs of rural and regional schools Telepractice considerations Working with other speech pathologists (dual servicing) Terminology


39 40 42

Resources References

Prevalence and background information Whole school approach/ response to intervention Speech pathology evidence-based practice Speech Pathology Australia documents Appendix



Speech Pathology Australia: Speech Pathology in Schools Project


There are several international and national imperatives that provide context to this resource. The most relevant ones are: The United Nations Convention on the Rights of Persons with Disabilities, The Salamanca Statement and Framework for Action on Special Needs Education, the Disability Discrimination Act , Disability Standards for Education, 2005, National Disability Strategy 2010–2020, Melbourne Declaration on Educational Goals for Young Australians (December 2008). The United Nations Convention on the Rights of Persons with Disabilities Declaration: “Australia recognizes that persons with disability enjoy legal capacity on an equal basis with others in all aspects of life. Australia declares its understanding that the Convention allows for fully supported or substituted decision-making arrangements, which provide for decisions to be made on behalf of a person, only where such arrangements are necessary, as a last resort and subject to safeguards; Australia recognizes that every person with disability has a right to respect for his or her physical and mental integrity on an equal basis with others. Australia further declares its understanding that the Convention allows for compulsory assistance or treatment of persons, including measures taken for the treatment of mental disability, where such treatment is necessary, as a last resort and subject to safeguards; Australia recognizes the rights of persons with disability to liberty of movement, to freedom to choose their residence and to a nationality, on an equal basis with others. Australia further declares its understanding that the Convention does not create a right for a person to enter or remain in a country of which he or she is not a national, nor impact on Australia’s health requirements for non-nationals seeking to enter or remain in Australia, where these requirements are based on legitimate, objective and reasonable criteria.”

The convention is international legislation and Australia reports on its actions towards meeting the requirements regularly to the UN. For you as a speech pathologist working in schools, this legislation frames your work around ensuring equal access to education for students with disability to support schools to use appropriate materials, techniques and forms of communication for the students you support, and to provide support measures for students with speech, language and communication needs. The Salamanca Statement and Framework for Action on Special Needs Education These documents are informed by the principle of inclusion, by recognition of the need to work towards “schools for all” – institutions which include everybody, celebrate differences, support learning, and respond to individual needs. As such, they constitute an important contribution to the agenda for achieving education for all and for making schools educationally more effective. The guiding principle that informs this framework is that schools should accommodate all children regardless of their physical, intellectual, social, emotional, linguistic or other conditions. These conditions create a range of different challenges to school systems. Schools have to find ways of successfully educating all children, including those who have serious disadvantages and disabilities. There is an emerging consensus that children and youth with special educational needs should be included in the educational arrangements made for the majority of children. This has led to the concept of the inclusive school. The challenge confronting the inclusive school is that of developing a child-centred pedagogy capable of successfully educating all children, including those who have serious disadvantages and disabilities. The merit of such schools is not only that they are capable of providing quality education to all children; their establishment is a crucial step in helping to change discriminatory attitudes, in creating welcoming communities and in developing an inclusive society.

Salamanca Statement 1994

The United Nations Convention on the Rights of Persons with Disabilities

This statement calls on schools to ensure that they respond to the needs of all students through the use of adjusted curriculum, organisational


Speech Pathology Australia: Speech Pathology in Schools Project


strategies, good teaching and partnerships. The statement calls for schools to provide a continuum of support to meet the needs of students. This provides the context in which we describe the Response to Intervention Strategy – the provision of a continuum of increasing frequency and intensity of support to meet the needs of students. Disability Discrimination Act Disability is broadly defined within the Disability Discrimination Act (DDA) to include physical, intellectual, sensory, neurological and psychiatric disabilities as well as including people who may have a disease and people with an imputed disability, (i.e. being treated as if you have a disability). People like relatives, friends, and carers are also protected if they are discriminated against because of their association with a person with disability. The definition of disability in the DDA is very broad and covers a wide range of cognitive, physical, sensory and social/emotional disabilities. This includes speech language and communication needs. Disability Standards for Education, 2005 The Disability Standards for Education are subordinate legislation to the Disability Discrimination Act. In effect, it sets out the standards that schools and education facilities must adhere to in order to meet their obligations under the Disability Discrimination Act , 1996. Children and young people in Australian education settings have differing needs, abilities and interests. Learning happens when teaching responds to these individual qualities. As there is no single method of Overview Disability Discrimination Act

teaching that supports the learning of all students, education providers make adjustments to enable every student to participate in learning.

Many students, including students with disability, need adjustments to support their learning.

Under the Disability Standards for Education 2005, students with disability are entitled to reasonable adjustments to enable them to participate in education on the same basis as other students.

The Education Institute > disability our rights

Overview of the National Disability Strategy 2010–2020 The National Disability Strategy 2010-2020 is Australia’s whole of government plan for the progressive implementation of the United Nations Convention on the Rights of Persons with Disabilities . The Australian Government undertook significant consultation with people with disability, their families and carers to inform the strategy. This process reflected the fact that people with disability are their own experts and are best-placed to provide input on issues that affect them. Most importantly, it ensured that the strategy was truly reflective of the priorities of people with disability across Australia. The final strategy includes six core outcome areas. Each of these outcome areas then includes a number of policy directives to help guide the work of governments in meeting that particular outcome. Outcome area 5 focuses on learning and skills. Outcome area 5 – learning and skills • Strengthen the capability of all education providers to deliver inclusive high quality educational programs for people with all abilities from early childhood through adulthood.


Speech Pathology Australia: Speech Pathology in Schools Project


Educational goals Goal 1 Australian schooling promotes equity and excellence Goal 2 All young Australians become: • successful learners; • confident and creative individuals; and • active and informed citizens.

• Focus on reducing the disparity in educational outcomes for people with a disability and others. • Ensure that government reforms and initiatives for early childhood, education, training and skill development are responsive to the needs of people with disability. • Improve pathways for students with disability from school to further education, employment and lifelong learning. Each state or territory will have its own disability plan that guides the work that each government agency needs to complete to meet the strategy goals. Education departments will have contributed to the development of the state or territory disability plan, and will have their own actions arising out of that plan. Being aware of the priorities for the department and schools can assist you in discussing how your work contributes to the bigger picture. Melbourne Declaration on Educational Goals for Young Australians (December 2008) As signatories to the Melbourne Declaration, Australian education ministers seek to achieve the highest possible level of collaboration with the government, Catholic and independent school sectors and across and between all levels of government. Australian education ministers also seek to achieve new levels of engagement with all stakeholders in the education of young Australians. The Melbourne Declaration acknowledges major changes in the world that are placing new demands on Australian education: • global integration and international mobility • globalisation and technological change • complex environmental, social and economic pressures • rapid and continuing advances in information and communication technologies. Human Rights National Disability Strategy

Melbourne Declaration on Educational Goals for Young Australians

The Melbourne Declaration provided the basis for the development of the Australian Curriculum. The Australian Curriculum, Assessment and Reporting Authority (ACARA) was set up to be responsible for the development of a high-quality curriculum for all Australian students, one that promotes excellence and equity in education. All students are entitled to rigorous, relevant and engaging learning programs drawn from a challenging curriculum that addresses their individual learning needs. The F-10 Australian Curriculum sets out the core knowledge, understanding, skills and general capabilities important for all Australian students. It describes the learning entitlement of students as a foundation for successful, lifelong learning and participation in the Australian community. It acknowledges that the needs and interests of students will vary, and that schools and teachers will plan from the curriculum in ways that respond to those needs and interests.


Speech Pathology Australia: Speech Pathology in Schools Project

Prevalence of speech, language and communication needs 1

The following evidence will be valuable to speech pathologists when performing an advocacy role in schools to highlight the need for speech pathology in the education sector. • Australian estimates (from the Longitudinal Study of Australian Children) indicate that between 22.3 and 24.5 per cent of children have a speech, language or communication disorder at school entry McLeod & Harrison, 2009). • One large study based on NSW students estimated that 11 per cent of students in secondary school have a communication disorder (McLeod & McKinnon, 2010). There is no evidence to indicate that the prevalence of communication disorders in secondary • Forty six percent of young offenders have a language impairment (Snow, 2014). • There is very good evidence to indicate a negative trajectory for these young people with increased incidence of disengagement from school, poor educational outcomes, mental ill-health, problematic behaviour, anti-social problems and interaction with the juvenile justice system (Conti- Ramsden,Durking, Simkin, & Knox, 2009). with scores of “developmentally at risk” or “vulnerable” in the language and cognitive domain (which includes pre-literacy skills), and over 25 per cent are at risk or vulnerable in relation to their communication skills and • Over 17 per cent of children start school school students would be significantly different from this in other states and territories.

general knowledge as measured by the Australian Early Development Census at school entry.

• Children living in the most socioeconomically disadvantaged locations were four times as likely to be developmentally vulnerable (falling below the 10th percentile) than those from the least disadvantaged areas in the language and cognitive skills domain (AEDC, 2015). • Children living in very remote Australia were nearly five times more likely to be developmentally vulnerable in the language and cognitive skills domain than children living in major cities (AEDC, 2015). • Speech, language and communication difficulties are closely linked to behaviour (Lindsay & Dockrell, 2012), social skills, self- esteem, health and well-being, family and social relationships. • Adolescents with speech, language and communication difficulties have been shown to be at a greater risk of developing emotional, social and behavioural difficulties, mental health issues (anxiety and depression), emotional difficulties 2, early school leaving and poor school engagement. • There is strong evidence that many students with language and learning difficulties struggle enormously with the transition to secondary school and may develop mental health problems. 3 • Boys were 1.7 times more likely to be developmentally vulnerable than girls in the language and cognitive skills domain (AEDC, 2015).

1 Speech, language and communication needs (SLCN) is the umbrella term most commonly used to describe these difficulties. 2 There is now substantial research evidence that children and young people with speech, language and communication needs (SLCN) are more likely to develop behavioural, emotional and social difficulties (BESD) than typically developing young people (Beitchman et al., 1996 Fujiki, Brinton, & Clarke, 2003; Tomblin et al., 2000. Studies have shown prevalence rates as high as 35–50 per cent. 3 Communication disorders frequently co-occur with mental health issues. Bryan and Roach (2001) reported the incidence of speech and language problems in individuals receiving mental health services to be higher than that in the general population. Longitudinal studies have indicated an increased likelihood of mental health problems in those who initially presented with significant speech/language impairments as a child. Developmental Language Disorders have been found to contribute to the development pf personality disorders in adulthood.


Speech Pathology Australia: Speech Pathology in Schools Project

Prevalence of speech, language and communication needs

• Students with communication problems are at greater risk of bullying 4 and report less school enjoyment than their peers. • Young people with communication needs are overrepresented in juvenile justice 5 settings. Aboriginal and Torres Strait Islanders • Among Aboriginal and Torres Strait Islander children (Williams & Jacobs, 2009), rates of otitis media are high, the disease manifests early in life, and it may continue to occur in adolescence and beyond. Australian data indicates that Indigenous Australian children experience otitis media for a cumulative total of 32 months between the ages of 2

and 20 years compared to non-indigenous children who experience 3 months of otitis media within the same period. • Indigenous children in 2015 were nearly four times more likely to be developmentally vulnerable than non-indigenous children in the language and cognitive skills domain (AEDC, 2015). times more likely to be developmentally vulnerable than non-Indigenous children on the communication skills and general knowledge domain (19.3 and 7.9 per cent respectively) (AEDC, 2015). • Indigenous children in 2015 were 2.4

4 A general pattern seen in the literature is that children with SLCN are reported to be particularly vulnerable to bullying ( McLaughlin et al., 2012). Given the negative links between bullying and children’s mental health (Gini and Pozzoli, 2009), there is clearly a particular need to establish mechanisms for children with SLCN to voice their perspectives and concerns. 5 In a 2011 study in Victoria (Snow & Powell, 2014), approximately 50 per cent of young offenders were found to have an oral language impairment. Those with more severe types of offences performed more poorly on language assessments. References Beitchman, J. H., Wilson, B., Brownlie, E. B., Walters, H., Inglis, A., Lancee, W. (1996) Long-term consistency in speech/language profiles: 11. Behavioral, emotional and social outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 35 (6), 815-825. Bryan K, & Roach J. (2001) Assessment of speech and language in mental health. In: J. France & S.Kramer (eds). Communication and mental illness. Jessica Kingsley Publishers: London. pp 110- 122. Conti-Ramsden, G., Durkin, K., Simkin, Z. & Knoz, E., (2009). Specific language impairment and school outcomes. 1. Identifying and explaining variability at the end of compulsory education. International Journal of Language and Communication Disorders , 44, 15–35. Fujiki, M., Brinton, B., and Clarke, D. (2002) Emotional regulation in children with specific language impairment. Language, Speech, and Hearing Services in Schools. (33) 102-111. Gini, G. and Pozzoli, T. (2009). Association between bullying and psychosomatic problems: a meta- analysis. American Academy of Pediatrics. 123 (3). Law, J., Rush, R., Schoon, I., & and Parsons, S. (2009). Modeling developmental language difficulties from school entry into adulthood: literacy, mental health and employment outcomes. Journal of Speech, Language and Hearing Research , 52, 1401–-1416.


Speech Pathology Australia: Speech Pathology in Schools Project

Lindsay, Geoff, and Julie E. Dockrell. (2012).The relationship between speech, language and communication needs and behavioural, emotional and social difficulties. London, UK: Department for Education. (Better Communication Research Programme). McLaughlin, C., Byers, R., Oliver, C. (Eds.) (2012). Perspectives on bullying and difference: supporting young people with special educational needs and/or disabilities in schools. (1st Ed.) London, National Children’s Bureau. McLeod, S., & Harrison, L. J. (2009). Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research , 52(5), 1213–1229. McLeod, S., and & McKinnon (2010) Support required for primary and secondary students with communication disorders and/or other learning needs. Child Language Teacher and Therapy , 26(2), 123–143. Snow, P. (2014). Submission to the Senate Committee Report, Community Affairs References Committee: Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia . September, 24–25. Snowling, M., Adams, J., Bishop, D., and & Stothard, S., (2001). Educational attainments of school leavers with a preschool history of speech-language impairments. International Journal of Language and Communication Disorders , 36, 173-–183. Tomblin, J. B., Zhang, X., Buckwalter, P. and Catts, H. (2000). The association of reading disability, behavioural disorders, and language impairment among second-grade children. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 41 (4), 473-482. Williams, C. J. & Jacobs, M. A. (2009). The impact of otitis media on cognitive and educational outcomes. Medical Journal of Australia , 2 Nov, 191(9 Suppl), S69–72. Retrieved October 2017, from mja.com.au


Speech Pathology Australia: Speech Pathology in Schools Project

Typical speech, language and communication development

This section is provided as a resource for speech pathologists to use when you are required to present information to principals, teachers and parents. Links to websites outlining developmental milestones are included below. Level of educational attainment is one of the strongest single determinants of health on a population basis and is heavily reliant on language and literacy skills. All children and young people need to have acquired well-developed speech, language and communication skills to reach their full potential; academically, socially, vocationally, and economically. As well as being vital for learning, speech, language and communication skills are essential across the school day – for students to make friends, sort out problems and share experiences. Speech, language and communication underpin literacy and numeracy – skills which are necessary for students to understand and achieve in all key learning areas. In turn, having adequate literacy skills also contributes to children’s language skills. Speech, language and communication are closely linked to behaviour, educational outcomes, social skills and self-esteem. Language skills are innate and do not directly need to be taught when children are developing typically. However, literacy skills, in particular reading, must be explicitly taught. Children must master the basics of decoding and comprehension in the first three years of school in order to progress from “learning to read”, to “reading to learn”. Speech, language and communication needs that are evident in a child during early to mid- primary school do not resolve on transition to secondary school without appropriate intervention. Many young people with speech, language and communication needs struggle enormously with the transition to secondary school and it has been shown that many develop mental health problems such as anxiety and depression as a result. More sophisticated aspects of language develop during secondary school years: complex verbal reasoning, understanding and using figurative language, telling more involved stories, and using

increasingly sophisticated social communication skills. All of these skills are needed to access both the academic and social curriculum of school, to cope with the demands of adolescence and to ensure a successful onward transition to the workplace. As learning becomes more reliant on independent study, language enables students to make contact with others; to organise, manage and evaluate experiences; and to influence and inform. Adolescents spend more time than younger children talking to others, so becoming adept at switching between styles of language. Socially, interactions become more complex and sophisticated and interaction becomes increasingly reliant on competent communication skills; being able to hold a conversation and to put together sentences into a story or report (narrative) is integral to creating and maintaining social relationships. A focus on speech, language, and communication is seen by some as the key for young people to fit into society, and language difficulties are identified as a significant risk factor in adult outcomes (e.g., participation in education and training, and employment). Many employers place communication skills above qualifications and value young people with good communication, literacy and interaction skills, which is why we need to support those with SLCN. Some schools have an increasing emphasis on the development of functional skills for life and work and on personal learning and thinking skills. None of these can be achieved without effective communication skills. For information on milestones of primary and secondary school-aged students, see:

www.raisingchildren.net.au > language development www.talkingpoint.org.uk > ages and stages I CAN, the children’s communication charity (UK Registered charity 21003) www.icancharity.org.uk


Speech Pathology Australia: Speech Pathology in Schools Project

Common speech, language and communication needs (SLCN)

The following information is included to provide speech pathologists with the latest advice regarding “red flags”. A useful resource: Visser-Bochane, Margot I., Gerrits, E., Van der Schans, C. P., Reijneveld, S. A. and Luinge, M. R. (2016). Atypical speech and language development: a consensus study on clinical signs in the Netherlands. International Journal of Language & Communication Disorders , 52 (1), 10–20. Markers of potential concern The following features are markers of potential concern (red flags) for language development of children. 4–5 years of age: • At most, three-word sentences • No simple sentences • Not intelligible for strangers • Not 50–75% intelligible for parents • Disturbed interaction • Does not understand spoken language/cannot process spoken language quickly enough 5–6 years of age: • Poorly intelligible for teacher/grandparents • No adequate reaction to questions or commands • Does not understand composite commands • At most, simple sentences • Poor intelligibility • Does not ask questions 6–7 years of age: • Does not understand composite commands • Disturbed communication • Incomplete sentences • No adequate reaction to questions or commands • Poor understanding of language • Poor intelligibility • Poor vocabulary • Does not produce compound sentences

Children who start school with oral language difficulties are at risk of experiencing challenges when learning to read and spell. Some children have problems with language development that creates significant barriers within everyday life or educational progress. Developmental language disorder (DLD) has recently emerged in the literature as the preferred term for language problems that are severe enough to interfere with daily life. Speech, language and communication needs can also include the following: • limited eye contact; • poor turn taking and difficulty with starting and ending conversations; • problems getting the conversation back on track after two people have talked at once, or if there has been a misunderstanding between them; • difficulty understanding or responding to feedback from the listener, (e.g., not noticing when someone is bored or doesn’t understand something); • difficulty staying on topic in conversation; • difficulty using language to negotiate in discussions or arguments; • word finding difficulties and basic use of vocabulary; • difficulty understanding and/or using meta linguistic skills such as interpreting abstract information, inferring meaning from non-literal language, understanding and using linguistic devices such as cohesive devices, ellipsis and humour.

• Poor story telling • Cluster reduction


Speech Pathology Australia: Speech Pathology in Schools Project

Complex communication needs and augmentative and alternative communication

Complex communication needs (CCN) is the term used to describe SLCN in association with cognitive, physical, perceptual, or sensory impairments. Students with CCN may have difficulties with understanding or using speech and language for communication, and may use different modes to add to, or as an alternative to their speech. Examples include using signs and gestures, a communication book or board with symbols, or a speech output device. These are called augmentative and alternative communication (AAC). CCN may lead to communication partners, including teachers, having reduced expectations, and providing reduced opportunities for communication participation and learning for students with CCN (Pennington & McConchie, 1999). Attempts to communicate may not be recognised or acknowledged. They may have fewer interactions and these may be shorter. Their needs may be anticipated and they may not be asked or expected to take their turn in interactions or within learning activities (Harris, 1982; Light, Collier, & Parnes, 1985). These reduced expectations and opportunities impact on opportunities for learning and using language. There is a broad scope of the desired outcomes of AAC interventions. The focus is not on teaching students to use symbols or devices, but to support them to share meaning and involvement in everyday life activities. Teachers may have trouble understanding how to integrate use of AAC - Augmentative and Alternative Communication into the learning environment. As well as working directly with the student to develop their communication skills, the speech pathologist plays an important role in supporting communication partners, both educators and other students, to understand how the student communicates, and the strategies to ensure that the student can participate in all activities at school, in the same way as other students. The Participation Model (Beukelman & Mirenda, 2014) provides a great framework to help identify goals for classroom participation, as well as the opportunity and skills based barriers which may need to be addressed to achieve these. Speech pathologists typically play an important role in

“The focus is not on teaching students

Definition of AAC An area of clinical and educational practice that provides communication strategies, techniques, and interventions for people with a range of communication limitations. The term “augmentative” in this context means supplemental or additional to speech. Augmentative techniques (e.g., gestures, facial expressions, and items of reference) are commonly used when communicating and interacting with others. The use of the term “alternative” acknowledges that there are some individuals whose speech is sufficiently impaired that they must rely completely on strategies, systems, and techniques which do not augment speech but are alternatives to speech (SPA, 2013). Purpose of AAC To enable the person to meet all of his/ her varied communication requirements as intelligibly, specifically, efficiently, independently and in as socially valued a manner as possible; and to understand others and to be understood (Porter, 2004). to use symbols or devices, but to support them to share meaning and involvement in everyday life activities.”


Speech Pathology Australia: Speech Pathology in Schools Project

supporting those who are in the educational as well as care environment of children to understand and use AAC modelling, including using aided AAC as they are speaking with the student, as part of naturalistic communication interactions (ASHA). Along with all the skills that typically developing children are acquiring, students with CCN need to learn different and additional skills. For example, they may need to learn to recognise symbols and understand what they represent, or how to “repair” interactions when the person they are talking with misinterprets their meaning, or how and when to increase and decrease the volume of their communication device, or when to use gesture to greet someone, rather than taking the time to generate speech output on a device. Light’s Communication competencies provide a useful framework to identify goals for intervention to support children to participate using AAC in the educational context. (Light & McNaughton, 2014.) If there is a language disorder, it is likely that the development of literacy will also be affected. Language and literacy skills do not develop in isolation but over time and are dependent on students’ skills as well as environmental exposure and demands. Students with CCN will often need or benefit from the same interventions as children with speech sound disorders or developmental language disorder, as well as requiring specific and additional supports due to the specific and additional barriers they face to developing literacy. For example, children who have limited or no speech do not have the same ability to “sound out” words, or even to match a letter with the motor pattern associated with that sound. (Hetzroni, 2004: Millar, Light, & McNaughton, 2004). Children with CCN may also have changed and reduced experiences of shared book reading, which can impact on their opportunities to develop literacy. For example, it may be difficult for them to request that a favourite book is read repeatedly. They may not have been able to ask questions, or make comments, or “pretend” to read a book that they have memorised, have limited opportunities to ask questions or practice with books (Light & Kelford-Smith, 1993).

Research focusing on students with CCN who use AAC has highlighted the discrepancy between their cognitive abilities and predicted literacy skills (Sandberg, 2006). Therefore, it is critical that professionals who work with students with CCN identify appropriate AAC to promote literacy and to develop effective strategies that foster acquisition of skills necessary for literacy development. As professionals with expertise in communication and AAC, you as speech pathologists can play an important and unique role in working with teachers and other educational staff (as well as the student and their family) to help embed the use of AAC to support a student’s literacy development (Sturm & Clendon, 2004; Hetzroni, 2004; Erickson, Koppenhaver, & Cunningham, 2006; Porter, 1997). AAC users, who may not have the ability to produce speech, face unique challenges in the development of phonological awareness skills. The development of literacy skills for students who are AAC users can be even more important, not only because it supports their ability to generate novel and spontaneous utterances using text, but also because it can provide for access to new experiences, and may be a critical skill to enable them to enter the job market (Smith & Blischak, 1997).


Speech Pathology Australia: Speech Pathology in Schools Project

Complex communication needs and augmentative and alternative communication

References Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs . Baltimore, MD: Brookes Erickson, K. A., Koppenhaver, D. A., & Cunningham, J. W. (2006). Balanced reading intervention and assessment in augmentative communication. In R. J. McCauley, M. E. Fey, & R. Gillam (Eds.), Treatment of language disorders in children (pp. 309–346). Baltimore, MD: Brookes). Harris, D. (1982). Communicative interaction processes involving non-vocal physically handicapped children, Topics in Language Disorders , 2 (2), 21-38. Hetzroni, O. E. (2004). AAC and literacy. Disability and Rehabilitation , 26, 1305–1312. Lund, S. K., & Light, J. (2007). Long-term outcomes for individuals who use augmentative and alternative communication: Part III – Contributing factors. Augmentative and Alternative Communication , 23, 323–335. Light, J., Collier, B., & Parnes, P. (1985). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part I: Discourse patterns. Augmentative and Alternative Communication , 1(3),98-107 Light, J., & Kelford Smith, A. (1993). Home literacy experiences of pre-schoolers who use AAC systems and of their nondisabled peers. Augmentative and Alternative Communication , 9(1), 10–25. doi:10.1080/07434619312331276371 Light, J. C., &, McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication , 30, 1–18. Millar, D. C., Light, J. C., & McNaughton, D. B. (2004). The effect of direct instruction and writer’s workshop on the early writing skills of children who use augmentative and alternative communication. Augmentative and Alternative Communication , 20, 164–178. Pennington, L. & McConachie, H. (1999). Mother–child interaction revisited: Communication with non-speaking physically disabled children. International Journal of Language and Communication Disorders , 34(4), 391–416. Porter, G. (1997). Integrating AAC into programmes applying the principles of conductive education. Conductive Education News , 12(3), 2–8. Porter, G. (2004). AGOSCI National Tour , Adelaide. Sandberg, A. (2006). Reading and spelling abilities in children with severe speech impairments and cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: A longitudinal study. Developmental Medicine & Child Neurology , 48(8), 629-634. doi:10.1017/S0012162206001344 Sennott, S.C., Light, J.C. and McNaughton, D. 2016) Research and practice for persons with severe disabilities. Sage Journals, AAC Modeling Inervention Research Review 41, (2), 101-115. Smith, M. M., & Blischak, D. M. (1997). Literacy. In L. L. Lloyd, D. R., Fuller, & H. H. Arvedson (Eds.), Augmentative and alternative communication: Handbook of principles and practices (pp. 414–444). Needham Heights, MA: Allyn and Bacon. Speech Pathology Australia (SPA). (2012). Augmentative and alternative clinical guideline. 2012 Sturm, J. M., & Clendon, S. A. (2004). Augmentative and alternative communication, language, and literacy: Fostering the relationship. Topics in Language Disorders , 24(1), 76–91.


Speech Pathology Australia: Speech Pathology in Schools Project

AAC resources ADHC Augmentative and Alternative Communication (AAC): Guidelines for speech pathologists who support people with disability http://www.adhc.nsw.gov.au/__data/assets/file/0011/302402/ Augmentative_and_Alternative_Communication_Practice_Guide.pdf American Speech and Hearing Association AAC Resources https://www.asha.org/PRPSpecificTopic. aspx?folderid=8589942773§ion=Resources Augmentative and Alternative Communication Newsletter: Archived copies are available at http:// www.augcominc.com/newsletters/?fuseaction=newsletters&C=ACN The focus on outcomes of communication under six (FOCUS) is a freely available resource developed by the Bloorview McMillan Center, which can be used to measure changes in communicative participation of pre-school children. http://www.research.hollandbloorview.ca/ outcomemeasures/focus PrAACtical AAC School and Education related posts http://www.praacticalaac.org The WA Independent Living Centre has a number of resources focused on supporting students using AAC in education settings. http://www.ilc.com.au/ilc-tech-resources-communication Commercially available AAC assessment tools AAC Evaluation Genie App https://www.itunes.apple.com/au/app/aac-evaluation-genie/ id541418407 Augmentative and Alternative Communication Profile http://www.linguisystems.com/products/ product/display-itemid=10547 Communication Matrix http://www.communicationmatrix.org The Pragmatics Profile of Everyday Communication Skills (Adults/Children) http://www.edit.wmin. ac.uk/psychology/pp/children.htm Social Networks Tool http://www.spectronicsinoz.com/product/social?networks The Source for Augmentative Alternative Communication http://www.linguisystems.com/products/ product/display-itemid=10184 Triple C Checklist of Communication Competencies http://www.spectronicsinoz.com/product/ thetriple-c-checklist-of-communication-competencies AAC and literacy resources Centre for Literacy and Disability Studies https://www.med.unc.edu/ahs/clds Caroline Musselwhite: Literacy for All http://www.engagingalllearners.ca/ip/conversation-with- caroline-musselwhite/index.php David Koppenhaver’s Literacy and Disability site http://www.litdis.com Everyone Communicates - Literacy and AAC http://www.everyonecommunicates.org/resources/ literacy.html Literacy Instruction for individuals with Autism, Cerebral Palsy, Down Syndrome and other disabilities http://www.aacliteracy.psu.edu PrAACtical AAC Literacy related posts http://www.praacticalaac.org Tar Heel Reader – provides access to a wide range of books at different levels and on a range of topics https://www.tarheelreader.org


Speech Pathology Australia: Speech Pathology in Schools Project

The impact of speech, language and communication needs (SLCN)

Speech, language and communication skills such as knowledge of the sounds of language, phonological awareness, vocabulary, and the ability to understand sentence and story structure underpin learning. Communication is the means by which learning is facilitated and assessed. The curriculum is heavily reliant on oral language skills; without strong foundational communication skills children are at risk of falling behind in many areas. When children have ongoing difficulties in language-learning the gap is compounded between typical language learners and those with speech language and communication needs. Children’s communication abilities strongly predict their later reading skills, with a sixfold increased chance of reading problems for children with poor language skills. Children with developmental language disorders have demonstrably weaker skills in areas (such as their ability to remember, discriminate and identify sounds in words, or to understand the structure of stories) that are crucial for reading development. In addition, their speech, language and communication needs may impact on their vocabulary, verbal reasoning skills, and their ability to analyse the structure or meaning of words and sentences, so that even if they can decode words while reading, they may not understand.

Children’s social communication skills may also be compromised, so that they have difficulty interacting appropriately to make friends, participate in conversations, and to negotiate and make choices, all of which are an important part of school life. Their problems include use of inappropriate strategies for negotiation and conflict resolution and difficulty in understanding non-verbal social cues such as facial expressions and gestures. These problems impact on their ability to interact socially and communication needs are at greater risk of bullying and report less school enjoyment than peers. Over half of children with poor speech, language and communication skills also have a behavioural disorder, further reducing learning opportunities, options and effectiveness, and leading to disengagement from school. Research into the outcomes for children with language impairment in early childhood identified that these children were twice as likely to show internalising and externalising behavioural problems in later childhood and adolescence. Further, children with a history of language impairment were over 1.5 times more likely to meet the criteria for ADHD in later childhood or adolescence than their typically developing peers. problems increase as children grow. Children with speech, language and


Speech Pathology Australia: Speech Pathology in Schools Project

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