02-. Promoting the Communication Skills of Primary School Children Excluded From School or at Risk...

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2003 19: 1Child Language Teaching and TherapyJames Law and Sonia Sivyer

excluded from school or at risk of exclusion: An intervention studyPromoting the communication skills of primary school children

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Promoting the communication skills ofprimary school children excluded fromschool or at risk of exclusion: Anintervention studyJames LawDepartment of Language and Communication Science, City University,London

and

Sonia SivyerEast Kent Hospitals NHS Trust (and City University, London)

Abstract

Previous research has focused on the close association between speech andlanguage dif� culties and emotional and behavioural dif� culties. However,little attempt has so far been made to examine this relationship in childrenwith emotional or behavioural dif� culties who are at risk of exclusion or whohave been excluded from school. In particular there are no data on the impactof speech and language interventions on this group of children. This studytests the hypothesis that children with emotional or behavioural dif� cultiescurrently excluded from school or at risk of exclusion, receiving interventionfor their language and communications skills, would make signi� cant progressboth in terms of language, self esteem and behaviour in relation to acomparison group. Children made signi� cant progress as a result of treatmentcompared to no-treatment, in the areas of language and social communicationskills, and self esteem. The data suggest that, in the short term at least, thetype of intervention carried out had bene� cial effects for the childrenconcerned. Implications for practice for speech and language therapistsand teachers working with this client group are also discussed.

Address for correspondence: James Law, Department of Language and Communication Science, CityUniversity, Northampton Square, London EC1V 0HB. Email: [email protected]

# Arnold 2003 10.1191=0265659003ct241oa



Introduction

The management of children with emotional and behavioural dif� culties is anissue of enormous concern for all working in education. At one level this istranslated into the � gures for school exclusions. Whilst there has been, as aresult of government policy in the UK, a fall and then a rise in permanentexclusions from mainstream schools over the past ten years, data on thenumber of temporary exclusions have not been available (DfES, 2002). This,in effect, means that mainstream teachers are having to deal with these issueson a routine basis in their classrooms. When asked to explain increasingconcerns about behaviour in the classroom, head teachers highlighted ‘disobe-dience in various forms – constantly refusing to comply with school rules,verbal abuse or insolence to teachers,’ rather than ‘physical aggression’ (DfE,1992). The Audit Commission report (1996) also refers to children’s poorliteracy skills. The relationship between early learning dif� culties, exclusionand crime has been described as a ‘downward spiral’ in which children whoperceive themselves to be ‘failing’ in primary school (that is lacking in basicskills), become disenchanted and drop out (Basic Skills Agency, 1997). It hasbeen suggested that children with special needs, in particular, may be margin-alised where ‘local � nancial management and market forces operate’ (Boewand Ball, 1992). The majority of children with emotional and behaviouraldif� culties in a study by Parsons (1994), were referred for assessment oftheir special educational needs. However, many were excluded before thisprocess was completed, meaning that needy children were in several caseswithout any educational placement and assessment details became out of date.

To some extent this is a poorly speci� ed population. The heavy social andpolitical emphasis placed upon school exclusion has served to mask the needto provide support in core areas that may underlie school performance. Therelationship between emotional and behavioural dif� culties and languageproblems is recognised in the literature (Benner et al., 2002) but this doesnot necessarily mean that this association is widely recognised in practice. Ofparticular interest to the present study are recent reports of the high level ofunderreporting of speech and language dif� culties in these children (Cross,1997; Cohen et al., 1998). Cohen and Lipsett (1991) found that children whohad a previously unrecognised language impairment were rated by theirmothers as more ‘delinquent’ and by their teachers as exhibiting more‘psychopathology’ and particularly more ‘externalizing (conduct) psycho-pathology’. They argue that ‘children with ‘‘invisible’’ handicaps are perceivedas more ‘‘dif� cult’’’. Lipsky (1985) describes ‘marginal handicaps’ related to‘language and learning’ problems, which can contribute to the perception of

2 Child Language Teaching and Therapy



the child as problematic: ‘normal’ in many ways but not in others. This view isalso supported by Paul and James (1990), who found that parents of childrenwith delayed language have been found to perceive their child as temper-amentally dif� cult and hard to manage relative to children who are developinglanguage normally. They argue that problems in producing or understandinglanguage may appear to adults as ‘non-compliance, inattentiveness or socialwithdrawal’. The lack of clarity in the relationship between early languagelearning dif� culties and emotional and behavioural dif� culties is re� ected inthe level of disagreement between parents and teachers and, indeed, betweenteachers from different schools (Rutter et al., 1970, 1976; Herbert, 1998;Botting and Conti-Ramsden, 2000). This problem is exacerbated by the lack ofexpertise in the assessment of children’s speech and language skills. A recentmajor study of the provision of services to children with speech and languageneeds in England and Wales has demonstrated that negligible levels ofresource are allocated to meet the children’s needs if they are classi� ed ashaving emotional and behavioural dif� culties (Law et al., 2000).

The exact nature of the relationship between behavioural disorders on theone hand and communication disorders on the other has been discussedextensively (Baker and Cantwell, 1985). In general the conclusion drawn hasbeen that, for most children, early communication dif� culties lead to beha-vioural dif� culties or at least are integrally linked in a common pathway ofdevelopment that may become stronger as the child develops. Some argue thatlanguage disorders are likely to interfere with cognitive development and to be‘instrumental in causing or exacerbating behavioural problems’ (Cohen et al.,1989). Others suggest that linguistic impairment is a risk factor for psycho-pathology in general (Baker and Cantwell, 1982; Beitchman et al., 1986). Thechildren at greatest risk for this were those initially diagnosed with receptiveand pervasive speech or language impairment. These may be a speci� c riskfactor for later aggressive and hyperactive symptoms.

However, it has been suggested that there may be as many as � ve differentpossible patterns in the relationship between the two (Rutter and Lord, 1987).The psychiatric disorder may lead to the language problem and vice versa: thetwo may be different facets of the same phenomenon; the two may co-occur,but with different causal mechanisms; there may be multiple interconnectedcausal processes. Baker and Cantwell (1985) also discuss several hypothesesregarding the possibility that communication disorders may lead to psychiatricdisturbances. Communication disorders could contribute to patterns of deviantparent–child interactions, leading to increased stress, and vulnerability todeveloping psychiatric disorders. Lack of intact language may affect socialbehaviour, interaction and ‘inner speech’, which is essential for the inter-

Promoting the Communication Skills of Primary School Children 3



nalisation of social codes for the self-regulation of behaviour (Luria, 1961;Vygotsky, 1993). Verbal language is the principal means of expressingemotions and feelings and a way of learning to in� uence the behaviour ofothers. Although such models are appealing in their simplicity it seems likelythat different models will operate for different individuals and that there isbound to be an interactive relationship between the two (Stevenson, 1996).Indeed it is hard to see how speech and language dif� culties would not beassociated with factors that clearly mediate behaviour such as self esteem,literacy and general academic performance.

There is very little published evidence of the impact of interventionstargeting the communication skills of children with emotional and behaviouraldif� culties. Accordingly the present study was set up to examine this issuewith particular reference to children excluded from school or at risk ofexclusion and, more speci� cally, to test directly the possibility that theimpact of communication intervention extends into important aspects of thechild’s self perceptions and could affect behaviour itself. The experimentalhypothesis was that, when compared to a group of children receiving nosupport, those receiving intervention for their language and communicationskills would make signi� cantly more progress in the following areas: languageskills, social communication skills, self esteem, and perceived emotional andbehavioural dif� culties. A particular focus of this study is the differences inparent and teacher perceptions of the children’s behaviour.

Method

ParticipantsThe 31 children referred to the project were all drawn from an inner city area.In order to minimise bias of sampling, referral requests were sent across thewhole borough. Referring agents were either specialist teachers of childrenwith emotional and behavioural dif� culties, educational psychologists, classteachers in conjunction with their head teacher and=or special educationalneeds coordinator (SENCO), or the head of the Primary Pupil Referral Unit(PRU) for children already excluded from mainstream school. In most casesthe referrals were made in conjunction with a speech and language therapistallocated to the school, but the children were not those with whom the thera-pist was already working.

The children were all in primary school year 5 or year 6 (ages 9 to 11 years,mean age 10 years and 8 months) that is, coming up to the age at which theywould transfer to secondary school. They were identi� ed through the relevant




agencies, assessed by the researcher (SS) and subsequently identi� ed as havinglanguage and communication dif� culties. Also, they all had emotional and=orbehavioural dif� culties and were already excluded from mainstream school orwere perceived by their head teacher as being at risk of exclusion. In addition allchildren had to have a primary language or communication dif� culty, that is,dif� culties that could not be directly attributed to another condition such ascerebral palsy, autism, or general developmental delay, but the participants hadnot previously received speech and language therapy intervention. No racial orethnic criteria were adopted. Children from the black community made up 73%of those referred to the project. Of the 20 who participated to the conclusion ofthe study, only one spoke a language other than English (Yoruba). Of thechildren referred to the project 92% were boys.

ProcedureAn independent groups design was adopted. Children were assigned to twogroups. Group I, the study group, comprised ten children who received weeklylanguage and communication therapy during the Summer term. Group II, thecomparison group, also comprised ten children. The comparison group was toreceive no intervention while those in the study group were treated, but wouldsubsequently receive an intensive block of speech and language therapy. Thechildren in Group I were further subdivided into two groups of � ve children.Children in Group IA were attending the PRU, having already been excludedfrom mainstream school, while the children in Group IB were perceived by thereferring agent to be ‘at risk’ of exclusion. Only 17 of these children’s resultscould be included in the � nal analysis. One child would not comply with anyreassessment, one was absent for all reassessment and one was found to havereceived speech and language therapy independently of the project.

For practical reasons it was not possible for children to be allocated to thegroups in a random manner, as the excluded children at the PRU had to be seen inone group. Whilst the two groups were not therefore matched, the baseline scoresfor each group were checked and no statistical differences were identi� ed betweenthe two groups in terms of age or baseline scores. The groups were matched forgender, with one girl in the treatment group and one in the control group.

The project was devised in three phases:

° Phase I: Baseline assessment phase, during which referrals were receivedand baseline assessments carried out.

° Phase II: First treatment phase. During this period children in Groups IA andIB received intervention weekly throughout one term, a total of 10 sessions




of 45 minutes each. Children in the comparison group did not receive anyintervention.

° Phase III: Reassessment phase at the end of the school term, in which theinitial assessments were repeated. It included the children in all the groups,that is, both treatment and comparison conditions.

InterventionThe package of therapeutic intervention was devised through consultation witha number of professionals. The aim was to take a holistic approach that treatedspeci� c language and social communication skills, and also dealt withbehaviour management, issues of self esteem and general emotional well-being. Guidance was provided by clinical psychologists on the setting up andstructuring of a group for children with emotional and behavioural dif� cultiesand also with assessments for self esteem and behaviour. Specialist behavioursupport teachers gave advice on the use of basic counselling skills and CircleTime techniques (Mosley, 1990).

Regular sessions were run at the same time on the same day each week bythe speech and language therapist, with the support of a speech and languagetherapy assistant. In the case of the PRU, support was also provided by theclass teacher plus one of the Unit’s learning support assistants, who helpedwith behaviour management and would later run similar groups. This highadult-to-child ratio was adopted to enable the facilitation of structured activitiesin a supportive and non-threatening environment. Sessions were designed tofollow a set structure (see Table 1) with speci� c activities allocated to certainadults who introduced and ran them from week to week. This familiar routine

Table 1 Structure of therapy sessions

Duration Activity

7 minutes Welcome: ‘Categories’ game (semantic organization=languagegame). Rules (established in � rst session and brie� y reviewedin all other sessions).

5 minutes Self esteem: colour-coded rating scale activity.10 minutes Social communication activity (listening skills).5 minutes Break (during which ‘Special Time’ was available on request).10 minutes Main language activity.5 minutes Feedback on the day’s activities with an emphasis on

complimenting each other and thus increasing self esteem.3 minutes ‘Guess who I am’ game (higher level language skills game)

A homework activity was given mid-way through the course ofsessions and a certi� cate was presented to each child on the� nal day.




was intended to provide a sense of consistency and security, and to help thechildren feel more con� dent and able to experience success.

Behaviour management. The approach to running the group was toestablish a positive, secure environment in which the children could grow incon� dence in order to have the opportunity to demonstrate their strengths andcapabilities; in order to achieve this, it was important to set relatively � rmlimits on children’s behaviour. Above all it was felt to be important to be fairand consistent, very much following the guidelines set down by the NewLearning Centre (Janis-Norton, 1995), which encourages the establishment of‘a positive, � rm and consistent environment’. It was also essential for adults toemphasise that it was certain behaviours that they did not like or accept, andnot the child him=herself. In order to achieve this, the children devised theirown ‘group rules’ to which they all agreed to adhere. They signed these rulesto indicate this, as did the adults. For children who were not abiding by theirown group rules, it was agreed between the children and therapist that theywould have one ‘warning’ and if this were not observed, then there would be‘time-out’ until that child was calm enough and felt ready to return to thegroup (that is the child would go with an adult to an allocated ‘time-out’ roomor area for a few minutes). In order to make this approach feel less ‘harsh’, thetherapist incorporated football warnings which were readily accessible andculturally relevant. Thus, a ‘warning’ was a yellow card and then a ‘time-out’or red card could be shown if necessary. The aim of this approach was to‘lighten’ the potentially punitive aspect of these measures. Red cards wereneeded on only two occasions in total.

Self esteem. Each session included an opportunity for the children to talkabout their feelings, using a visual rating scale based on the work of Pretzlik andHindley (1993) who gave advice on the use of a colour-coded response scale.The children were introduced to this concept during assessment, and during the� rst session they were encouraged to work together to devise their own ten-pointrating scale of self esteem. The children and adults then used this each day tomake a comment on how they were feeling, if they wished. Initially the adultsgave models and the children were encouraged to contribute too; for example,‘Today I’m feeling a two because my Mum shouted at me this morning.’Children were free to give a number but not explain their reason if they did notwish to do so, and ‘real life’ examples of both high and low scores were given sothat children did not feel pressure to select a high number.

Towards the end of each session, the therapist led a feedback activity to enablegroup members to share what they had done. There was also the opportunity for




everyone to say one thing that the person on their right had done well that day.This meant that everyone had the chance to pay another child a compliment andto hear others complimenting them. Any positive comments about others werepraised and could be reinforced by comments from the adults such as ‘X did wellin noticing and talking about good things that others did.’ The ethos of the groupwas to promote emotional well-being, hence all children were offered anopportunity for ‘special time’ at every session. This meant that any childcould choose to speak to any adult they wished in privacy and in con� dence.

Language activities. The assessment pro� les highlighted which aspects oflanguage skills would be best incorporated into such activities. Each sessionalways included the same two language activities (short, fun activities, whichwere adapted and developed in different ways each time) and one longeractivity which changed from session to session. Inherent within this approachwas the need to sustain the interest and attention levels of the childrenconcerned, whilst also providing a familiar structure.

These activities focused on developing the following skills:

° Lexical organisation skills (for storage and retrieval of vocabulary)° Description of objects by class, function, location and attribute° Classi� cation=semantic connections (Speake and Bigland-Lewis, 1995)° Categorisation=semantic links (Bigland and Speake, 1995)° Higher level language skills: asking and responding to questions; reasoning,

inference and problem solving skills (Locke and Beech, 1991; Heinzeand Johnson, 1987; Semel, 1982), narrative techniques (Shanks, 2000;Catherall, 1998).

Social communication activitiesSocial communication activities were based primarily on the principles of:

Social Use of Language Programme (Rinaldi, 1995a,b). One structuredsocial communication activity took place each session which focused on basiclistening skills. This activity incorporated speci� c features of good listening:eye contact, posture, � llers and comments, facial expression, and head move-ments. Extensive use was made of a video camera in order to motivate andprovide visual feedback.

Circle Time (Mosley, 1990). Adults reinforced and praised all positivecontributions of any kind, including ‘pro-social’ behaviour, spoken commu-nications and listening skills. Circle Time offered the children an opportunityto share experiences and to listen to others’ experiences, and was intended todevelop a strong sense of shared experience and empathy.




It was not possible on the basis of the assessments to specify differentpathways through the intervention and it was concluded that given the similarpredicament of many of the children in terms of their educational provisionthere was much to be gained from developing a group identity by including allthe children in all the activities listed above.

MeasuresThe following measures were used in assessments.

Language. A selection of tests and sub-tests from the SAOLA School AgeOral Language Assessment – were chosen – (Allen et al., 1993). The assessmentof semantics consists of practical tasks (for example, what you would see in a petshop), which translate easily into therapy activities, with the aim that the skills solearnt could be generalised to every-day life. Although the SAOLA is not anorm-referenced test, it is extremely useful in providing a ‘descriptive pro� le ofkey language competences related to the school setting’ (Allen et al., 1993, p. 1).In particular, this pro� le describes the dif� culties that children with languagedisorders have with the speci� c assessment tasks compared with age-matchedpeers without such dif� culties. An example can be seen in Table 2. Two areas ofthe SAOLA (Narrative Skills and Semantic Organisation) were selected.Outcomes were measured in terms of the changes in total scores on theSAOLA Narrative Assessment and Semantic Skills Assessment.

Social communication skills. Video was considered the least obtrusivemeans of assessing skills in this area. Children were � lmed in structuredlistening activities involving peers and the speech and language therapist. TheSocial Use of Language Programme: Primary and Pre-School AssessmentPack (Rinaldi, 1995) was chosen as the best existing measure of socialcommunication skills for this client group. As the children had had no relevantprevious training, the � rst rating chart was selected, which covers ‘ListeningSkills’ – the most basic of social communication skills (see Table 3 for anexample of scoring for one of the items).

All of the above assessments were videotaped and subsequently scored byan independent tester, a speech and language therapist, blind to the groupstatus of the children. The videos were presented in a random order.

Behaviour. ‘The Strengths and Dif� culties Questionnaire’ (Goodman,1997) was selected as the most appropriate tool to ascertain the views ofparents and teachers concerning emotional and behavioural issues relating tothe children. This is a behavioural screening questionnaire, developed from the




well established Rutter (1967) questionnaires, which is shorter in format andprovides one user-friendly form suitable for both parents and teachers. Inresponse to statements such as ‘Often has temper tantrums or hot tempers,’ abox is marked as ‘Not True,’ ‘Somewhat True’ or ‘Certainly True.’

Self esteem. A questionnaire ‘What I Think About Myself’ by Kosmoskiet al. (1994) was employed. This is not a norm-referenced test, but ratherprovides the child with the opportunity to produce self-worth ratings. Harter(1987) has demonstrated that children over the age of eight years candifferentially assess their abilities in various domains in order to produce

Table 2 Example from ‘Semantic Skills’ assessment (Comparison task: ability to compare=contrast (dogs) and explain concepts of same=different)

Score CriteriaMainstreamchildren (year 4)

Language disordered(year 4)

0 No evidence ofcontrasting,seems to choosefor personal=random reasons.

The majority canidentify anddescribedifferences butnot substantiateon the basis ofsimilarity.

The majority canselect on the basisof same=differentbut lack linguisticskills required foreffectivesubstantiation.

1 Chooses dogs thatare similar=different anddiscusses theirattributes butdoes notcompare=contrast, or anyattempts areambiguous.

2 Is able to select adog and explainwhy the otherdog is different(part a) but notsubstantiatechoice of asimilar dog fromsheet 2 (part b).

3 Contrasts dogsusing the sameattribute both indifference (part a)and similarity(part b).

Source: ‘School Age Oral Language Assessment’ (Allen et al., 1993).




such ratings. The questionnaire was modi� ed slightly to make it both easier todemonstrate a shift in opinion and to make it more accessible to children. Thus,children could rate themselves on a scale from 0 to 4, (rather than 0 to 2)depending on how strongly they agreed or disagreed with the statement, and acolour-coded response scale was introduced along the lines developed by Pretzlikand Hindley (1993) and Pretzlik and Sylva (1995). The greater the intensity ofcolour in a box, the more the agreement and strength of feeling. The colourschosen corresponded to those of the football team supported by the vast majorityof the children, and the therapist taught the children to use the rating scale bypractising with a range of statements related to their own interests, such as ‘I amgood at football.’ The questionnaire is written in language which the children inthe project could understand, and the sentences were read aloud to the children.Of the eighteen phrases, eight are ‘reversed’ as a protection against systematicreporting bias. Thus to agree with number 1 ‘I am good at my school work’would suggest high self esteem, whereas to agree with number 2 ‘I am picked onat home’ would suggest lower self esteem.

Results

AttritionApproximately one-sixth of the children referred to the project changedschool, due either to exclusion or parental choice, within one or twomonths of referral (that is during the baseline assessment phase, before theintervention began). In the case of children who changed to and attended adifferent school, it was possible to continue to work with them at the new site.However, for children excluded or withdrawn from school and not placedelsewhere, it was beyond the scope of this project to work with them.

Table 3 Example from ‘Listening Skills’ assessment (Listener feedback—facial expression)

Score Criteria

0 ˆ most desirable Gives appropriate facial expression to re� ect content ofspeaker’s talk, for example, smiles on hearing goodnews.

1 Facial expression a little lacking but not perceived asinappropriate.

2 Facial expression rarely used, or facial expressionsometimes inappropriate, for example, smiles onhearing bad news.

3 ˆ least desirable Facial expression not used - remains ‘blank’, or facialexpression frequently inappropriate.

Source: ‘Social Use of Language Programme: Primary and Pre-School Assess-ment Pack’ (Rinaldi, 1995).




Nevertheless, they represent perhaps the neediest of client groups. Out of atotal of 31 children referred to the project, only 20 remained to the end. It isdif� cult to say what the implications of such a high rate of attrition would beon the results of the study. It might be assumed that the more motivatedparents and children remained engaged with the services, but this is not clear.

Absences and non-complianceSeveral children referred to the project were frequently absent from school.This made initial assessment dif� cult, as it was often uncertain whether or nota child would be in school at the time when the assessment was planned.Similarly, during intervention, attendance was somewhat erratic, especially inthe case of excluded children, due largely to children arriving extremely late atthe unit. This tended to be disruptive, both for those already in the room andfor the latecomers themselves, as a result of missing part of the session.Repeated absences by certain children at the time of reassessment resulted insome variation in the numbers for the � nal analysis.

For two particular children who were already excluded, there was a speci� cdif� culty with non-compliance for reassessment. In spite of frequent attemptsby the therapist and colleagues, these two children were very unwilling torepeat measures that had been carried out before. This was especially the casefor self esteem and semantic skills, for which neither of them completed thereassessment. Although the assessments had been selected to be as motivatingas possible, these children had initially been dif� cult to focus and motivate forassessment. The incentive of being videotaped for the other two assessmentswas no longer enough for one of them, although one did comply, but only withthe two assessments that were videotaped.

Language and social communication skillsEach child’s social communication skills and language (narrative and semantic)skills were measured at the baseline assessment and again at the reassessment

Table 4 Comparison of changes in social communication skills

Number Mean rank

Treatment group 9 5.72Comparison group 7 12.07Total 16Mann–Whitney U 6.5Signi� cance (one-tailed) 0.005**

**p < 0.01.Note The scores for this assessment are inverted, hencea lower rank signi� es improvement.




that took place at the end of the � rst period of intervention. The changes thathad occurred in the children’s skills were analysed, using Mann–Whitney teststo compare the progress made by the treatment and comparison groups, andthe results are presented in Tables 4 and 5. These show signi� cant differencesacross all these areas, and demonstrate that relative to the comparison groupthe treatment group showed improvement in, speci� c social communicationskills, and speci� c language skills, both narrative skills and semantic skills.

Self esteemTable 6 gives the result of a Mann–Whitney test in which the changes in eachchild’s total score on the ‘What I think about myself’ questionnaire wereanalysed, in order to compare the progress of the treatment and comparisongroups. This represents a signi� cant difference, showing that children’s selfesteem appeared to be enhanced as a result of receiving therapy.

BehaviourBaseline assessment. Table 7 shows the Parents’ and Teachers’ percep-

tions of the children’s initial behaviour for a total of 15 children, being all thechildren for whom both parents’ and teachers’ perceptions were available atthe start of the project. This does not include any of the excluded children at

Table 5 Comparison of changes in language skills

Narrative skills Semantic skills

Number Mean rank Number Mean rank

Treatment group 9 11.06 8 12.25Comparison group 7 5.21 8 4.75Total 16 16Mann–Whitney U 8.5 2Signi� cance (one-tailed) 0.012* 0.001**

*p < 0.05; **p < 0.01.

Table 6 Comparison of changes in self esteem

Number Mean rank

Treatment group 8 11.13Comparison group 8 5.88Total 16Mann–Whitney U 11Signi� cance (one-tailed) 0.028*

*p < 0.05.




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the PRU, whose parents did not return questionnaires sent out. The table alsoincludes the results of a comparison of these perceptions and shows that forthe scales of ‘Pro-social’ (e.g., ‘Shares readily with other children such thingsas treats, toys, pencils etc.’) and ‘Conduct Problems’ (e.g., ‘Often � ghts withother children or bullies them’), there was a signi� cant difference betweenparents’ and teachers’ perceptions.

Goodman (1997) suggests bands by which the population can be dividedinto ‘normal’ (80%), ‘borderline’ (10%) and ‘abnormal’ (10%). Table 8summarises how many ‘border-line’ and ‘abnormal’ results were observed.The total (i.e., ‘abnormal’ plus ‘borderline’) � gures for both parents andteachers appear much higher than the expected proportion of 20% whichGoodman suggests as the cut-off. Given the target group this is not surprising.

Post-therapy assessment. Discussions with parents and teachers followingintervention indicated that they perceived an improvement in the children’semotional and behavioural status. However, analysis of their perceptions asmeasured by the Goodman ‘Strengths and Dif� culties Questionnaire’, usingMann–Whitney tests indicated that the differences were not statisticallysigni� cant.

Discussion and recommendations

Initial pro� le of the childrenBearing in mind that these children would not have been brought to theattention of the schools’speech and language therapists had it not been for thisstudy, that is, no language or communication dif� culties had previously beenidenti� ed, it is noteworthy that they were all found to have language skills nohigher than the level commonly found in children with language disorders inyear 4. As the children in the study were all in years 5 and 6, this gives anindication of the severity of their previously unidenti� ed dif� culties.

The measures usedThe majority of measures used in this study might best be described ascriterion referenced measures with relatively high face validity but withrelatively little in the way of standardisation to back them up. These havethe advantage that they purport to capture real change, which makes clinicalsense. Yet in the � nal analysis there is always the risk with measures that donot report reliability coef� cients in their standardisation that it may be dif� cult




to differentiate change from measurement error. Revising the design of thisstudy it might be recommended that standardised assessments should replacethose used. The risk is that such measures may not be sensitive to change inthis population, assuming that the children would cooperate with them at all.

The effects of interventionThe data suggest that the intervention carried out had bene� cial effects for thechildren concerned, particularly with regard to their language, their socialcommunication skills and their self esteem. Although there is some suggestionthat behaviour may have been modi� ed, the differences between the twogroups did not reach signi� cance and we could not conclude on the basis ofthese data that modi� ed language and communication skills necessarily leadsto modi� ed behaviour. Given that the main focus of the intervention groupswas the children’s communication skills and, given the relative brevity of theintervention, it is perhaps not surprising that there was not a substantial impacton behaviour. It would be interesting in the light of these results to monitor theimpact of a more extended intervention phase on behaviour. It would bereasonable to assume that behavioural changes would follow from improve-ments in language and communication skills. Similarly it would be interestingto look at the long-term effect of such intervention on the children’s capacity tointegrate back into school. Progress made by excluded children was comparedwith that made by mainstream children at risk of exclusion. Although thesample sizes were small, these analyses suggested that differences wereminimal, indicating that excluded children could bene� t from such interven-tion, just as much as those at risk of exclusion.

Teachers’ perspectivesIn addition to completing questionnaires, teachers working with the childreninvolved in the project held discussions with the therapist to provide moredetailed feedback. All teachers welcomed the opportunity for joint-working,which enabled much improved carry-over into the classroom. Many expressedthe view that they had not previously thought of their pupil as having speci� cdif� culties with language or communication, and that this gave them adifferent perspective on the child with whom they were working. Theimportant point here is that while the speech and language therapist has aspeci� c responsibility for assessing children’s communication, in practice theyare unlikely to be able to provide the coverage of mainstream schools withcurrent levels of staf� ng to support children with emotional, behavioural andcommunication needs. This means that the teacher is likely to be the lynchpin




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of support offered to these children and that the key to working effectivelywith them is the appropriate skill mix between the different professionals,learning support assistants, classroom teachers, educational psychologists andspeech and language therapists.

Whilst initial assessment highlighted the fact that teachers were extremelyconcerned about children’s emotional and behavioural status, on completion ofthe package of care, all teachers described some progress made by theirpupil(s). In addition to their increased language and communication skills,other skills were also observed in the classroom:

° the majority described their pupil as ‘more con� dent’.

For mainstream pupils, the teachers highlighted the bene� ts of:

° being selected for a group;° going out to another school;° meeting peers;° forming new relationships with others to whom they could relate.

For excluded children, the teachers highlighted:

° offering the pupils opportunities to show skills that would not be seenelsewhere;

° the children being able to develop improved attention and listening skills,week by week;

° for individual children, they identi� ed bene� ts in: ‘getting used to beinglistened to,’ ‘being able to see tasks through to the end,’ ‘opportunities to seemore of the child’s potential,’ ‘learning the need to listen to others thuskeeping in touch with his=her peer group.’

Intervention appeared to be bene� cial in changing some teachers’ perceptionsof certain children, previously at risk of exclusion. Of particular note is thecomment of one head teacher who said, ‘B is now a pleasure to have at school . . . Iam very happy as he was not at all a pleasure before . . . The joint approachbetween speech and language therapy, the class teacher and Child Guidance hasbeen very, very positive for B’. This suggests that this child, who prior to therapywas at signi� cant risk of exclusion, was perceived in a more positive lightsubsequently and was considerably less likely to be excluded from school.

Parents’ perspectivesThe response to the study by parents differed markedly. In total, 80% of parentsof mainstream children (at risk of exclusion) gave feedback and perceived some




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progress in most areas of their children’s emotional and behavioural status. Forexample, one parent said, ‘C loved the group and people and going on thebus . . . He is much more con� dent and talks about it all the time . . . It was a verypositive experience . . .’. However, the PRU requested that no direct face-to-faceor telephone contact be made with parents and unfortunately this group ofparents did not respond to any questionnaires sent. This seemed to correspondto the fact that the parents of children still attending their mainstream schoolwere extremely keen for their child to be given this constructive support, andschool staff reported that parents found this approach much less ‘threatening’compared to mental health or social service provision. It contrasted with theirexperience of a negative cycle of their child being ‘stigmatised’, frequentunproductive meetings and temporary exclusions. On the other hand, parents ofexcluded children appeared very disenchanted with ‘the system.’ Severalseemed to have lost con� dence in the professionals.

Differences between parents’ and teachers’ perspectivesThe data in Tables 7 and 8 clearly re� ect the types of discrepancy betweenparent and teacher in the perception of behaviour dif� culties already wellcharacterised in the literature. Consistently, parents had a more positive viewof their children’s behaviour than did the teachers. Given that these childrenhad been identi� ed for school exclusion, such a � nding is probably notsurprising. In the majority of cases teachers did seem to change theirperceptions of the participants, and parents also perceived a change in theirchildren’s behaviour. Although the latter was less marked this may beattributed to a lower level of concern in the � rst instance. Such � ndingssuggest that this type of intervention is likely to have had a positive effect asfar as the teachers are concerned and one might infer that this is likely to leadto raised expectations and a more positive performance in class. At this pointwe would maintain a positive but cautious position. On the basis of theseresults it is not possible to extrapolate from the intervention in question to areduction in school exclusion. It may well be that such behavioural progra-mmes primarily have behavioural outcomes and are not able to reach theemotional needs of the children concerned. Nevertheless these are importantsecondary � ndings, which could usefully be carried forward.

Children’s perspectivesThe change in attitude of some of the children was quite marked. For example,at � rst some children covered their ears when others were complimentingthem, but it gradually became easier for them to accept compliments. Also




some participants initially had extremely poor self or other awareness, forexample, they were unable or unwilling to listen to others, unable to take turnsor to regulate their own contributions.

At the end of the intervention period the children expressed positive viewson the intervention. They described bene� ts for themselves in terms of whatthey felt they had learnt, including:

° ‘It was fun. You could learn a lot about listening and quietness . . . andmaking new friends.’

° ‘It’s good to let other people talk when it’s their turn.’

Ethnicity. One issue that stands out as potentially important is thedifferences in ethnicity and cultural background of the children and thetherapists and teachers involved with this project. Compared with a nationalaverage ethnic community population of 6%, over 50% of children under 18years in the population in which the study was carried out are from black andother ethnic minorities (Lambeth Education, 1995). The size of the sample isinsuf� cient to test whether the proportion (74%) of the referrals who werefrom the black community is statistically signi� cantly higher than the baselineproportion. Given the preponderance of black children in the interventiongroups and given the apparently different perceptions of parents and profes-sionals at least as far as behaviour is concerned, it might be argued that thisstudy was in fact only picking up on very real differences in culture. To acertain extent this problem was overcome by the extensive use of speech andlanguage therapy staff from ethnic minorities. The local NHS Trust wasrunning a scheme in which applicants from ethnic minorities were employedas speech and language therapy assistants whilst undergoing training as speechand language therapists. Participants in the project appeared to relate extre-mely well to them and bene� ted from their presence.

Placebo effect. It is important to consider whether the results could be dueto a placebo effect (Crow et al., 1999). It might be argued that the observedchanges were due to the fact that the therapist had treatment-related outcomeexpectations of the children combined with a belief in the therapeutictechniques concerned. The critical issue here is the nature of the supportreceived by the comparison group. While it is true that they were not receivingspeech and language therapy during the period concerned it is not strictly truethat they received no help. Indeed they were receiving the level of supportconventionally offered in the area concerned. The only way of really control-ling for this, but which was not part of the present design, would be to have




two comparison groups, one being offered no intervention at all and a second anon-speci� c intervention of comparable duration and intensity. It is notaltogether clear what the latter would be, given the relatively untested natureof the interventions concerned with this client group. Nevertheless this issue isa justi� able concern and one that would need to be taken into considerationwhen considering the results. While these � ndings do not prove a causalrelationship between the intervention and the outcome it is important to pointout that it is commonly dif� cult to disentangle the relationship between inputsand outputs in complex interventions of this sort. At one level the fact that theintervention appears to be effective on such a small sample suggests that itwarrants further investigation.

Recommendations

° The � ndings of this study suggest that children’s language and communica-tion dif� culties are not always identi� ed when there is a strong behaviouralcomponent in their pro� le of needs.

° Based on the data reported in this study, the authors’ recommendation isthat intervention targeting language and communication skills should beavailable for all children with emotional and behavioural dif� culties at riskfor school exclusion. It would also suggest a strong case for specialistspeech and language therapy intervention for children with emotional andbehavioural dif� culties who have already been excluded.

° In addition, the study suggests that teachers should be mindful of a child’slanguage and communication dif� culties in particular, prior either to consider-ing exclusion or reviewing school placement. At this stage, resources should beavailable for these students to access a multi-agency team, including specialistbehavioural support teachers and speech and language therapists.

° This study also shows the bene� ts of class teachers, learning supportassistants, speech and language therapists, and speech and language therapyassistants working closely together, in order for speci� c skills being learnt intherapy sessions to be generalised into the classroom.

° This study also highlights the need to engage parents to work alongside theprofessionals.

Future developments

The project has highlighted a number of areas for consideration in future.




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For the Pupil Referral UnitOn the basis of these results a multi-disciplinary package of care involving an‘induction period’ for all children arriving at the PRU could be introduced.This would include detailed initial assessments of their skills by a range ofprofessionals, including speech and language therapists who would be lookingfor previously unidenti� ed speech and language dif� culties. If necessary theformal process of pro� ling and drawing up statements of educational needcould be instigated, or if a statement was no longer appropriate, it could bereviewed. This would enable children to be more quickly placed in anappropriate educational establishment that catered for their speci� c needs,and also enable them to access appropriate services including speech andlanguage therapy. Parents would be asked to attend the induction period.Ideally, home visits could take place as part of the package of care provided bythe speech and language therapist.

For children at risk of exclusionIn order to bene� t mainstream pupils, it is recommended that a longer-terminvestigation should be provided for this client group, in order to carry outfollow-up studies. This would also ensure continuity of provision for this needygroup through a structured programme of reviews and liaison with school staff.It would be vital that teachers, SENCOs, and learning support assistants werefully trained in the techniques in order to feel con� dent enough to continue theintervention in collaboration with a speech and language therapist.

AcknowledgementsWe thank the children who made this study possible and all the staff andparents who provided their support. In particular, we are grateful to Dr. UrsulaPretzlik, for help regarding the visual scale to measure rating, Dr. Suze Leitao,for agreeing to the use of the SAOLA with this client group; and Dr. WendyRinaldi, for agreeing to the use of the Primary SULP assessment in this study.

References

Allen, L., Leitao, S. and Donovan, M. 1993: School age oral languageassessment – Manual. South Fremantle, Australia: Language-LearningMaterials.

Audit Commission 1996: Report on Juvenile offenders. London: HMSO.




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Resaltado

Baker, L. and Cantwell, D. P. 1982: Psychiatric disorders in children withdifferent types of communication disorders. Journal of CommunicationDisorders 15, 113–26.

Baker, L. and Cantwell, D. P. 1985: Psychiatric and learning disorders inchildren with speech and language disorders: a critical review. InGadow, K. D., editors, Advances in learning and behavioural dif� culties(Vol 4). Greenwich, CT: JAI Press.

Basic Skills Agency Survey 1997: Truant pupils blamed for wave of streetcrime. Reported in The Guardian (2=1=98).

Beitchman, J. H., Nair, R., Clegg, M., Ferguson, B. and Patel, P. G. 1986:Prevalence of psychiatric disorders in children with speech and languagedisorders. Journal of the American Academy of Child Psychiatry 25,528–35.

Benner, G. J., Nelson, J. R. and Epstein, M. H. 2002: Language skills ofchildren with EBD. Journal of Emotional and Behavioural Disorders 10,43–59.

Bigland, S. and Speake, J. 1995: Semantic LINKS. Ponteland, Northumber-land: STASS Publications.

Boew, R. and Ball, S. 1992: Reforming education and changing schools: Casestudies in policy sociology. London: Routledge.

Botting, N. and Conti-Ramsden, G. 2000: Social and behavioural dif� cultiesin children with language impairment. Child Language Teaching andTherapy 16, 105–20.

Catherall, P. 1998: A narrative based approach to treating children withlanguage impairment. NAPLIC conference, London.

Cohen, N. J., Davine, M. and Meloche-Kelly, M. 1989: Prevalence ofunsuspected language disorders in a child psychiatric population. Journalof the American Academy of Child and Adolescent Psychiatry 28,107–11.

Cohen, N. J. and Lipsett, L. 1991: Recognised and unrecognised languageimpairment in psychologically disturbed children: child symptomology,maternal depression and family disfunction. Preliminary report.Canadian Journal of Behavioural Science 23, 376–89.

Cohen, N. J., Barwick, M. A., Horodsky, N. B., Vallance, D. D. and Im, N.1998: Language, achievement and cognitive processing in psychiatricallydisturbed children with previously identi� ed and unsuspectedlanguage impairments. Journal of Child Psychology and Psychiatry 39,865–77.

Cross, M. 1997: Challenging behaviour or challenged comprehension. Bulletinof the Royal College of Speech and Language Therapists 545, 11–12.




Crow, R., Gage, H., Hampson, S., Hart, J., Kimber, A. and Thomas, H. 1999:The role of expectancies in the placebo effect and their use in the delivery ofhealth care: a systematic review. Health Technology Assessment 3, 1–106.

Department for Education 1992: Exclusions: a discussion document.Nottingham: DfE.

Department for Education and Skills 2002: Permanent exclusions and exclu-sion appeals in school 2000–2001. First release. London: DfES

Goodman, R. 1997: The strengths and dif� culties questionnaire: a researchnote. Journal of Child Psychology and Psychiatry 38, 581–86.

Harter, S. 1987: The determinants and mediational role of global self-worth inchildren. In Eisenberg, N., editor, Contemporary issues in developmentalpsychology. New York: Wiley, 219–42.

Heinze, B. A. and Johnson, K. L. 1987: Easy does it. East Moline, IL: LinguiSystems.

Herbert, M. 1998: Clinical child psychology (2nd edition). Chichester: Wiley.Hutchings, S., Comins, J. and Of� ler, J. 1994: The social skills handbook.

Bicester: Winslow Press.Janis-Norton, N. 1995: Providing the support they need. London: New

London Learning Centre.Kosmoski, G. J., Pollak, D. R. and Estep, S. G. 1994: Reliability of children’s

self-esteem assessment: What I think about myself. PsychologicalReports 75, 83–8.

Lambeth Education 1995: An introduction to the London borough of Lambeth.London: Borough of Lambeth.

Law, J., Lindsay, G., Peacey, N., Gascoigne, M., Soloff, N., Radford, J. andBand, S. 2000: Provision for children with speech and language needs inEngland and Wales: Facilitating communication between education andhealth services. Nottingham: DfEE Publications.

Lipsky, D. K. 1985: A parental perspective on stress and coping. AmericanJournal of Orthopsychiatry 55, 614–17.

Locke, A. and Beech, M. 1991: Teaching talking: Teaching procedureshandbook=teaching resources. Slough: NFER-Nelson.

Luria, A. R. 1961: The role of speech in the regulation of normal andabnormal behaviour. New York: Leveright.

Mosley, J. 1990: Quality circle time. London: LDA.Parsons, C. 1994: Excluding primary school children London: Family Policy

Studies Centre.Paul, R. and James, D. F. 1990: Language delay and parental perceptions

(letter to the editor). Journal of the American Academy of Child andAdolescent Psychiatry 29, 669–70.




Pretzlik, U. and Hindley, P. 1993: Assessment of coping strategies in youngchildren. IVth European Conference on Developmental Psychology,Bonn, Germany.

Pretzlik, U. and Sylva, K. 1995: Children’s appraisal of distress and copingduring a blood test: A comparison between two measures. VIIthEuropean Conference on Developmental Psychology, Krakow, Poland.

Rinaldi, W. 1995: Social Use of Language Programme: Primary and pre-school teaching packs 1 and 2. Guildford: Child Communication andLearning.

———— 1995b: Social Use of Language Programme: Primary and pre-school assessment pack. Guildford: Child Communication and Learning.

Rutter, M. 1967: A children’s behaviour questionnaire for completionby teachers: preliminary � ndings. Journal of Child Psychology andPsychiatry 8, 1–11.

Rutter, M., Tizard, J. and Whitmore, K. 1970: Education, health andbehaviour. London: Longmans.

Rutter, M., Tizard, J., Yule, W. and Whitmore, K. 1976: Isle of Wight studies1964–1974. Psychological Medicine 6, 313–32.

Rutter, M. and Lord, C. 1987: Language disorders associated with psychiatricdisturbance. In Yule, W. and Rutter, M., editors, Language developmentand disorders. Oxford: MacKeith Press.

Semel, E. 1982: Language intervention activities. New York: The Psycholo-gical Corporation, Harcourt Brace Jovanovich.

Shanks, R. 2000: Telling tales. Bulletin of the Royal College of Speech andLanguage Therapists, Nov. 2000, 9, p. 10.

Speake, J. and Bigland-Lewis, S. 1995: Semantic connections. NewcastleUpon Tyne: STASS Publications.

Stevenson, J. 1996: Developmental changes in the mechanism linkinglanguage disabilities and behaviour disorders. In Beitchman, J. H.,Cohen, N. J., Konstantereas, M. M. and Tannock, R., editors, Languagelearning and behaviour disorders: Developmental, biological and clinicalperspectives. Cambridge: Cambridge University Press.

Vygotsky, L. S. 1993: The psychology and pedagogy of children’s handicaps.In Knox, J. E. and Stevens, C. B., editors, The collected works ofL.S. Vygotsky: Volume 2 The fundamentals of defectology (abnormalpsychology and learning disabilities). London: Plenum press.




02-. Promoting the Communication Skills of Primary School Children Excluded From School or at Risk...

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