Serving Children With Emotional-Behavioral and Language Disorders: A Collaborative Approach Getting 8-year-old Roberto’s attention and keeping it is a perennial challenge, in class and at home. The fact that he’s usually angry and aggressive doesn’t help, either. Roberto started demonstrating aggression, unresponsiveness to direction, and difficulty maintaining attention to tasks around age 4, according to his mother. Today, he doesn’t ... Features
Free
Features  |   August 01, 2011
Serving Children With Emotional-Behavioral and Language Disorders: A Collaborative Approach
Author Notes
  • Jennifer Armstrong, PhD, CCC-SLP, is an assistant professor at Governors State University (University Park, Ill.). Her interests include language and literacy development in early childhood, prevention of speech and language disorders, and language development in special populations. Contact her at jarmstrong@govst.edu.
    Jennifer Armstrong, PhD, CCC-SLP, is an assistant professor at Governors State University (University Park, Ill.). Her interests include language and literacy development in early childhood, prevention of speech and language disorders, and language development in special populations. Contact her at jarmstrong@govst.edu.×
Article Information
Language Disorders / Social Communication & Pragmatics Disorders / Attention, Memory & Executive Functions / Features
Features   |   August 01, 2011
Serving Children With Emotional-Behavioral and Language Disorders: A Collaborative Approach
The ASHA Leader, August 2011, Vol. 16, 32-34. doi:10.1044/leader.FTR6.16102011.32
The ASHA Leader, August 2011, Vol. 16, 32-34. doi:10.1044/leader.FTR6.16102011.32
Getting 8-year-old Roberto’s attention and keeping it is a perennial challenge, in class and at home. The fact that he’s usually angry and aggressive doesn’t help, either.
Roberto started demonstrating aggression, unresponsiveness to direction, and difficulty maintaining attention to tasks around age 4, according to his mother. Today, he doesn’t get along with peers. He disrupts classroom activities, doesn’t care about or follow rules, has difficulty working in groups, and blames others for his negative behaviors. He cannot apply social rules related to others’ personal space and belongings, and demonstrates poor conflict-resolution and problem-solving skills. Roberto also exhibits learning difficulties, limited communication skills, and poor self-esteem.
Roberto lives in a neighborhood plagued by gang violence. Both parents receive disability payments (his father for bipolar disorder); the family is transient and has trouble making ends meet. Roberto’s parents, however, want to do what is best for their son. Realizing that his behaviors are atypical and that he was showing no signs of improvement, they asked about an evaluation. After physical, psychological, educational, and speech and hearing testing, Roberto was diagnosed with attention deficit disorder, emotional/behavioral disorder, and speech and language disorder.
Children and youths like Roberto, who have been identified with emotional/behavioral disorder (EBD), face myriad challenges that affect development of academic and communication skills. Students with this disorder—characterized by an array of emotional, behavioral, and social disabilities; poor communication and language skills; and low academic achievement—present a complex issue for academic professionals and related personnel. In fact, learning how best to address these issues in growing numbers of children and youth has become a national concern (Chesapeake Institute, 1994).
The National Association of School Psychologists (2005) indicates that children with EBD are under-identified within the educational system, and only a small number receive the mental health services they need. What we do know, however, is that almost 450,000 children and youth suffer from emotional disorders, according to the U.S. Department of Education (2002). Among these children, co-occurrence of emotional and behavioral disorders is common, as are attention-deficit hyperactivity disorder, anxiety disorders, and mood and language disorders that may intensify behavior problems and affect academic performance.
According to Hyter, Rogers-Adkinson, Self, Simmons, and Jantz (2001), EBD and language research indicate 50% to 80% of children with language disorders may have co-occurring emotional/behavioral disorders, and findings of school-based population studies indicate that as many as 88% of children identified with EBD had not been evaluated for speech-language problems. Several studies have identified receptive and expressive delays/disorders for these children; primary area of difficulty, however, is in pragmatics with specific concerns for poor social functioning (Elksnin & Elksnin, 1998; Hill & Coufal, 2005; Hummel & Prizant, 1993; Hyter et al., 2001; Nelson, Benner, & Cheney, 2005).
Left unidentified and untreated, problematic patterns of social behavior characterized by poor nonverbal and verbal communication skills may become ingrained, increasing the risk for substance abuse and negative encounters with the juvenile justice and prison systems (Center for Effective Collaboration and Practice, Office of Special Education Programs, 1994; Hummel & Prizant, 1993). Although literature discussing the relationship between communication disorders and delinquency, violence, and incarceration is limited, a significant number of individuals with speech, language, and hearing impairments in juvenile detention and state prison populations may not be receiving appropriate speech and language services (ASHA, 2004).
Factors such as belonging to a racial/ethnic minority group, genetic predisposition, and living in poverty place children at greater risk for poor health, education, and social outcomes and an increased likelihood of having a mental health disorder than children without those factors (Centre for Social Justice, 2011). A psychologist or behavior specialist, as part of a multidisciplinary team, is most likely to be able to provide an appropriate diagnosis.
Social Skills Development
Although a clear solution to this multifaceted dilemma has yet to be identified, the academic setting (public, private, therapeutic, and residential) plays a role in fostering the emotional development and adjustment of youngsters identified with or at risk for developing EBD. Interventions such as social skills groups provide students the tools to exercise strategies for positive conflict resolution and problem-solving. Students are better able to identify their emotions and articulate feelings as they occur, a skill that reduces anxiety and unwarranted aggression (Hummel & Prizant, 1993). Participating in a social skills group provides students tools for communicative success and the time to use these tools in real-life situations. Students learn to equate this time with caring and begin to reciprocate in other contexts such as home life (Elksnin & Elksnin, 1998; Hummel & Prizant, 1993).
Collaboration
The role of speech-language pathologists in the management of students with EBD is of particular importance because the students often have speech and language disorders that may go untreated. Conversely, a number of children with language disorders also exhibit characteristics of EBD that may be unaddressed.
Wagner, Kutash, Duchnowski, Epstein, and Sumi (2005) suggest that school programs must be strengthened by identifying the needs for diverse groups of individuals, adopting programs that provide the least restrictive environment for learning, and creating opportunities for collaboration within the school community. Collaborative learning environments have the potential to respond to the needs of all students by teaching academic, language, and social skills while building on student strengths and interests. In identifying roles and responsibilities for the school-based SLP, ASHA also supports the recommendation for collaboration, specifically between teachers, parents, and other professionals during the pre-referral and intervention phases of service delivery (ASHA, 1991). Elksnin and Elksnin (1998) offer multiple strategies for emphasis in parent and teacher training: identify potential times throughout the day when skills developed in social skill groups can be taught; show parents and teachers how to prompt students to use skills and praise them when they do; and teach parents and teachers to reinforce use of target skills. The overall goal is to help students generalize goals across settings and situations.
Collaboration between an SLP and a licensed clinical social worker (LCSW) or school counselor through the development and facilitation of a social skills group helps address behavior and communication concerns and represents a model of successful intervention for children with EBD and language disorder (LD).
Collaborative learning environments respond to the needs of all students, but they particularly benefit those with deficits in receptive and expressive language skills, pragmatic skills, and behavior concerns, because collaboration can provide greater opportunity to practice target behaviors and develop knowledge, skill, and attitudes essential for educational, social, and workplace achievement (Center for Effective Collaboration and Practice, 1994; Elksnin & Elksnin, 1998). The development of related goals and ways to address them among disciplines is integral to facilitating increased communication for the child and promoting better communication among professionals. A marriage of skill sets of the SLP and an LCSW, in particular, is an example of collaboration specifically designed to meet the multifaceted needs of this population.
SLPs have knowledge of the language skills necessary for academic success during adolescence for disordered and typically developing children, particularly as they pertain to semantic and pragmatic skills. With their specialized training, LCSWs can help individuals cope with high levels of anxiety and frustration. Both professionals offer expertise in the use of varied strategies and appropriate standards for planning and facilitating intervention with children who have difficulty expressing wants, feelings and needs, and in communication with family members, teachers, and peers.
Social skills groups for children with EBD, co-facilitated by an SLP and LCSW, offer a number of benefits to participating students.
Cross-Disciplinary Goals
Children with EBD may have fewer opportunities to interact with other children, due to frequent alienating and antisocial behaviors (Centre for Social Justice, 2011; Hill & Coufal, 2005; Hummel & Prizant, 1993; Hyter et al., 2001), and—like children with LD—fewer communicative tools to participate appropriately in interactions with peers and adults (Hyter et al., 2001). Therefore, it is essential to establish speech-language and social-emotional/behavioral goals that emphasize communication of feelings, intent, and needs. Establishing relevant goals across disciplines will help students communicate their feelings, interpret the feelings of others, exercise self-control, and deal with unwanted stressors. Specific examples of goals include:
  • Recognize and use feeling words to describe personal feelings.

  • Recognize and label feelings of others by making an inference about a person’s nonverbal cues.

  • Control and appropriately express anger with peers and adults through the use of positive affirmations, self-calming activity, discussion.

  • Practice good sportsmanship.

  • Say positive things to self and others.

  • Consider the perspective of another person.

  • Ask permission before using others’ belongings.

  • Admit to and accept consequences for mistakes.

  • Make amends when appropriate.

  • Use strategies to avoid conflict such as walking away, expressing anger with nonaggressive words, telling an authority figure about the difficulty.

Autonomy and Independence
Although these goals can be the focus of individual treatment, a group setting gives the student greater opportunities to use strategies that reduce conflict and improve overall communication skills.
In the context of a social skills group constructed by the SLP and the LCSW, students can develop tools for successful participation in the routines of school, work, and community in a familiar environment. Students with EBD and LD have difficulty developing skills of autonomy necessary to be successful in interpersonal arenas, but the group rules for interaction and related consequences can encourage self- and mutual regulation of behaviors and increase use of designated language skills. The rules often are simplified versions of classroom and individual treatment rules: take turns, follow directions, be respectful, don’t yell, and don’t leave the room without permission. Consequences may be carried out gradually (Level 1, peer warning; Level 2, SLP or LCSW warning; Level 3, removal from group), providing students an opportunity to use strategies for positive redirection.
Develop and Practice Skills
Once rules and consequences are established, students put them into practice through the introduction of new and familiar activities within the context of socially recognized themes, such as finding a job and managing household responsibilities. Examples of activities for each theme may include:
  • Job-finding: identify interests, research wages/salaries, discuss job-related responsibilities, and participate in mock interview.

  • Home maintenance: shop for groceries, budget, launder clothes, and perform other chores (wash dishes, set table, sweep floor).

Throughout each of the activities, students receive guidance in the appropriate use of language and in behavioral goals. The SLP and the LCSW promote the use of communication and problem-solving to reduce conflict and potentially aggressive behavior.
Outcomes
Students participating in behavior- and communication-enhancing activities such as those provided in a social skills group have a greater opportunity to participate in peer-to-peer interactions, use appropriate words to express feelings and emotions (Hummel & Prizant, 1993), and solve problems (Elksnin & Elksnin, 1998). Applying effective strategies to improve deficits in behavior and language in multiple environments may also increase student independence, self-regulation, and use of strategies to handle disappointment, frustration, and anger. In addition, providing experiences that include career, vocational, and transitional planning is imperative for improving future outcomes (National Association of School Psychologists, 2005).
Addressing the EBD population is crucial in the face of growing expulsion and dropout rates and poor life outcomes for older children, especially boys. These students are also at risk for substance abuse and involvement with the criminal justice system (Center for Social Justice, 2011; Chesapeake Institute for the U.S. Department of Education, 1994). By implementing a collaborative social skills group model, SLPs and LCSWs can engage in focused and frequent exchanges about methods used to improve overall communication skills, share strategies to increase opportunities for social and academic success (in accordance with goals established in the Individualized Education Plan), step outside their typical roles in providing intervention, and establish working models of collaboration for other professionals to emulate.
Sources
American Speech-Language-Hearing Association (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. [Relevant paper]. Retrieved June 1, 2011, from www.asha.org/policy/RP1991-00123/.
American Speech-Language-Hearing Association (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. [Relevant paper]. Retrieved June 1, 2011, from www.asha.org/policy/RP1991-00123/.×
American Speech-Language-Hearing Association (2004). Special populations: Prison Populations—2004 Edition. Rockville, MD.
American Speech-Language-Hearing Association (2004). Special populations: Prison Populations—2004 Edition. Rockville, MD.×
Center for Effective Collaboration and Practice (1994). National agenda for achieving better results for children and youth with serious emotional disturbance. Retrieved March 3, 2011, from http://cecp.air.org/resources/ntlagend.asp.
Center for Effective Collaboration and Practice (1994). National agenda for achieving better results for children and youth with serious emotional disturbance. Retrieved March 3, 2011, from http://cecp.air.org/resources/ntlagend.asp.×
Centre for Social Justice (2011, February). Mental health: Poverty, ethnicity, and family breakdown. Interim Policy Briefing. Artillery Row, London: The Centre for Social Justice.
Centre for Social Justice (2011, February). Mental health: Poverty, ethnicity, and family breakdown. Interim Policy Briefing. Artillery Row, London: The Centre for Social Justice.×
Chesapeake Institute (1994, September). National agenda for achieving better results for children and youth with serious emotional disturbance. Washington, DC: Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs.
Chesapeake Institute (1994, September). National agenda for achieving better results for children and youth with serious emotional disturbance. Washington, DC: Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs.×
Elksnin, L. K., & Elksnin, N. (1998). Teaching social skills to students with learning and behavior problems. Intervention in School and Clinic, 33(3), 131–140. [Article]
Elksnin, L. K., & Elksnin, N. (1998). Teaching social skills to students with learning and behavior problems. Intervention in School and Clinic, 33(3), 131–140. [Article] ×
Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly, 27(1), 33–46. [Article]
Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly, 27(1), 33–46. [Article] ×
Hummel, L. J., & Prizant, B. M. (1993). Clinicial forum: Language skills in the school-age population—A socioemotional perspective for understanding social difficulties of school-age children with language disorders. Language, Speech, and Hearing Services in Schools, 24, 216–224. [Article]
Hummel, L. J., & Prizant, B. M. (1993). Clinicial forum: Language skills in the school-age population—A socioemotional perspective for understanding social difficulties of school-age children with language disorders. Language, Speech, and Hearing Services in Schools, 24, 216–224. [Article] ×
Hyter, Y. D., Rogers-Adkinson, D. L., Self, T. L., Simmons, B. F., & Jantz, J. (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16. [Article]
Hyter, Y. D., Rogers-Adkinson, D. L., Self, T. L., Simmons, B. F., & Jantz, J. (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16. [Article] ×
National Association of School Psychologists (2005). Position statement on students with emotional and behavioral disorders. Available at http://naspsonline.org.
National Association of School Psychologists (2005). Position statement on students with emotional and behavioral disorders. Available at http://naspsonline.org.×
Nelson, J. R., Benner, G. J., & Cheney, D. (2005). An investigation of the language skills of students with emotional disturbance served in public school settings. Journal of Special Education, 39, 97–105. [Article]
Nelson, J. R., Benner, G. J., & Cheney, D. (2005). An investigation of the language skills of students with emotional disturbance served in public school settings. Journal of Special Education, 39, 97–105. [Article] ×
Sanger, D., Maag, J. W., & Shapera, N. R. (1994). Language problems among students with emotional and behavioral disorders. Intervention in School and Clinic, 30(2), 103–108. [Article]
Sanger, D., Maag, J. W., & Shapera, N. R. (1994). Language problems among students with emotional and behavioral disorders. Intervention in School and Clinic, 30(2), 103–108. [Article] ×
U.S. Department of Education (2002). 24th annual report to congress on implementation of the Individuals with Disabilities Education Act. Washington, DC: Author.
U.S. Department of Education (2002). 24th annual report to congress on implementation of the Individuals with Disabilities Education Act. Washington, DC: Author.×
Wagner, M., Kutash, K., Duchnowski, A. J., Epstein, M. H., & Sumi, C. (2005). The children and youth we serve: A national picture of the characteristics of students with emotional disturbances receiving special education. Journal of Emotional and Behavioral Disorders, 13(2), 79–96. [Article]
Wagner, M., Kutash, K., Duchnowski, A. J., Epstein, M. H., & Sumi, C. (2005). The children and youth we serve: A national picture of the characteristics of students with emotional disturbances receiving special education. Journal of Emotional and Behavioral Disorders, 13(2), 79–96. [Article] ×
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
August 2011
Volume 16, Issue 10