Judy Clegg

Inflexibility as an interactional phenomenon: Using conversation analysis to re-examine a symptom of autism.

Many accounts of autism spectrum disorder (ASD) imply that the conditions behavioural ‘symptoms’ are direct reflexes of underlying deficits. In doing so, however, they invariably overlook the social contexts in which symptomatic behaviours occur and are identified as pathological. This study addresses this issue, using conversation analysis (CA) to examine the emergence of inflexibility, a behavioural trait symptomatic of ASD, during play involving an adult and diagnosed child. We argue that ‘inflexibility’ is the product of the childs strategic attempts to retain control over the unfolding interaction, within a context where such attempts breach normative expectations about adult–child play. Furthermore, it demonstrates that the adult does not resist these attempts, on occasion even explicitly providing opportunity for subsequent inflexibility. This challenges the assumption that ASDs behavioural profile solely represents the endpoint of underlying deficit, and demonstrates how ‘non-impaired’ speakers can be implicated in the manifestation of symptomatic behaviours.

Language Abilities of Secondary Age Pupils at Risk of School Exclusion: A Preliminary Report.

In the UK, exclusions from school because of behaviour problems usually occur when other alternatives have proved unsuccessful. There is some evidence to suggest that behaviour problems and resulting school exclusions are associated with language impairment. In older children who are permanently excluded, expressive rather than receptive language impairment is more common and this is associated with increased rates of emotional problems (Ripley and Yuill, 2005). The language abilities of secondary age pupils at risk of permanent school exclusion who are still in mainstream educational provision have not yet been a focus of study. Fifteen pupils attending a mainstream secondary school located in an area of socio-economic deprivation were studied. All the pupils were at risk of permanent exclusion owing to significant behaviour problems. Measures of language and behaviour identified language difficulties in 10 of the 15 pupils, where five of these pupils had significant and severe language difficulties. In contrast, the remaining five pupils showed age-appropriate or typical language abilities. Although differences were identified in language abilities, severe behaviour problems were found in both the pupils with language difficulties and those with age-appropriate language. Mixed receptive-expressive language difficulties were more common than expressive only difficulties but these were not associated with a particular type of behaviour problem. For a high proportion of secondary age pupils at risk of permanent school exclusion, language difficulties are a factor in their behaviour problems and school exclusion. The preliminary findings are discussed with reference to the relationship between language impairment and behaviour problems, the criteria for defining language impairment in this population, the need for further research and potential implications for education and speech and language therapy.

The co-development of speech and gesture in children with autism.

Recent interest in gesture has led to an understanding of the development of gesture and speech in typically developing young children. Research suggests that initially gesture and speech form two independent systems which combine together temporally and semantically before children enter the two‐word period of language development. However, little is known about gesture development in childrens disordered speech. This paper presents two case studies of young children with autism. The children are under 3 years of age and attend an intervention programme to facilitate their social and communication development. Early indications suggest that whilst both gesture and speech development is delayed in children with Autistic Spectrum Disorders (ASD), the developmental trajectory is the same as for typically developing children.

The contribution of early language development to children's emotional and behavioural functioning at 6 years: an analysis of data from the Children in Focus sample from the ALSPAC birth cohort.

BACKGROUND An association between childrens early language development and their emotional and behavioural functioning is reported in the literature. The nature of the association remains unclear and it has not been established if such an association is found in a population-based cohort in addition to clinical populations. METHODS This study examines the reported association between language development and emotional and behavioural functioning in a population-based cohort. Data from 1,314 children in the Children in Focus (CiF) sample from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Regression models identified the extent to which early language ability at 2 years of age and later language ability at 4 years of age is associated with emotional and behavioural functioning at 6 years while accounting for biological and social risk and adjusting for age and performance intelligence (PIQ). RESULTS A series of univariable and multivariable analyses identified a strong influence of biological risk, social risk and early and later language ability to emotional and behavioural functioning. Interestingly, social risk dropped out of the multivariate analyses when age and PIQ were controlled for. Early expressive vocabulary at 2 years and receptive language at 4 years made a strong contribution to emotional and behavioural functioning at 6 years in addition to biological risk. The final model accounted for 11.6% of the variance in emotional and behavioural functioning at 6 years. CONCLUSIONS The study identified that early language ability at 2 years, specifically expressive vocabulary and later receptive language at 4 years both made a moderate, but important contribution to emotional and behavioural functioning at 6 years of age. Although childrens language development is important in understanding childrens emotional and behavioural functioning, the study shows that it is one of many developmental factors involved.

Speech and language therapy intervention in schizophrenia: a case study

BACKGROUND There is a significant body of evidence documenting the speech and language abnormalities found in adult psychiatric disorders. These speech and language impairments can create additional social barriers for the individual and may hinder effective communication in psychiatric treatment and management. However, the role of speech and language therapy in this patient population has not been extensively studied. AIMS Speech and language therapy is reported in a 53-year-old adult male patient who presented with severe poverty of speech as part of his diagnosis of schizophrenia. The aims of speech and language therapy focused on increasing the patients verbal communication using a combination of traditional and non-traditional speech and language therapy methods. METHODS & PROCEDURES Two phases of speech and language therapy were implemented. The first phase focused on desensitizing the patient to verbal communication. The second phase developed the patients language productivity and increased his awareness of his social communication skills. Five separate measures were taken as baselines which were repeated at the end of the intervention. OUTCOMES & RESULTS Post-intervention scores showed that the intervention was partly successful. The patients verbal communication increased and he developed more appropriate social communication skills. His negative attitude to communication remained unchanged even though his self-evaluative status improved. CONCLUSIONS The intervention is discussed in terms of the pre- and post-intervention measures and the role of speech and language therapy in schizophrenia. The study suggests that speech and language therapy can contribute to the understanding and management of schizophrenia and other adult psychiatric disorders.

Use of single case study research in child speech, language and communication interventions

Evidencing the effectiveness of speech, language and communication interventions continues to be a challenge for both researchers and practitioners who work with children and young people with speech, language and communication needs (SLCN). The use of case study design as a methodology for evaluating the effectiveness of these interventions, and the value of their contribution to the evidence base, is often not recognized. In this editorial, the merits of case study design as a robust and achievable methodology for practitioners to use to evidence the effectiveness of their interventions are discussed. Child Language Teaching and Therapy has published a number of case studies or case series reports over the years. Some case studies have been descriptive, with the aim of explicating aspects of a child’s difficulties. Carvey and Bernhardt (2009) used a framework for profiling intentional communication to describe the skills of a child with a rare genetic syndrome, thus adding to the literature on this particular disorder. Worth and Reynolds (2008) presented detailed assessment findings of a boy with Asperger’s syndrome and showed how these enabled a better understanding of the nature of his difficulties. The findings were explored in relation to the research literature and the implication for assessment practices and for intervention. Murphy and Dodd (2010) used assessment findings from the case of a child with a hearing impairment and a non-dominant language home background to discuss diagnostic criteria for specific language impairment. Whilst this type of case study is useful for illuminating our understanding of children with SLCN, it neither aims, nor is designed, to evaluate interventions. However, case study research that includes some element of experimental control can and does contribute to the evidence base for speech, language and communication interventions. Within a hierarchy of evidence composed of five levels, the highest is systematic reviews, and meta-analyses of randomized controlled trials, single case studies and case study series are ranked at level 2, above observation and expert opinion (Sackett et al., 2000). Logan et al. (2008) also present levels of evidence for single case research, from those that are designed to prove causal inference of the effects of intervention, to those that can hint at or suggest causal inference. These experimental case studies are known by a number of terms, such as single subject design, single subject research, single case design/research and n of 1. The design can include more than one individual receiving the same intervention reported as a case series or case study series. Each participant serves as his or her own control (Horner et al., 2005). Studies such as these have been and are published in Child Language Teaching and Therapy and can make an important contribution to the evidence base. 457766 CLT28310.1177/0265659012457766Child Language Teaching and TherapyEditorial 2012

Measuring quality of life in children with speech and language difficulties: a systematic review of existing approaches

BACKGROUND Childrens and adolescents speech and language difficulties (SaLD) can affect various domains of quality of life (QoL), and speech and language therapy interventions are critical to improving QoL. Systematically measuring QoL outcomes in this population is highly complex due to factors such as heterogeneity in impairments and differing targets during intervention. However, measurements of QoL are increasingly required by healthcare commissioners and policy-makers to inform resource allocation. AIMS To review the use of QoL measures in research involving children (age ≤ 18 years) with SaLD. METHODS & PROCEDURES A systematic review was undertaken. A systematic search across various databases was performed. Information on the methodological details of each relevant study, along with descriptions of the QoL measures employed, were extracted into standardized data extraction forms. Findings were discussed in a narrative synthesis. OUTCOMES & RESULTS Twenty-one relevant studies were identified that deal with a range of subpopulations of children with SaLD. For the most part, generic QoL measures were used, although there was little convergence on the type of QoL measures employed throughout the literature. Five studies utilized preference-based QoL measures, including the 16D/17D, HUI3, EQ-5D and QWB-SA. Of these measures, the HUI3 demonstrated the most promising discriminant validity, although the preference weights for this measure were generated with adults. CONCLUSIONS & IMPLICATIONS QoL among children with SaLD is not yet being captured in a systematic way. The HUI3 measure appears to show some promise for generating relevant preference-based QoL estimates, although further testing of the measure is required.

Education practitioner-led intervention to facilitate language learning in young children: An effectiveness study

In the UK there is much concern about the educational progress of children from areas of significant social disadvantage entering primary school with impoverished language skills. These children are not routinely referred to speech and language therapy services and therefore education practitioners in schools deliver intervention to facilitate their language learning. The evidence base to support these interventions is small and more needs to be known about their effectiveness. However, evaluating such interventions in an educational context can be challenging due to limited opportunities and resources. The study evaluated small-group language intervention for Key Stage 1 children with impoverished language delivered by trained education practitioners in schools. Children receiving the language intervention were compared to a matched comparison group not receiving the intervention. Baselines of receptive and expressive language ability were taken pre-intervention and post-intervention using standardized language assessments. The intervention consisted of eight sessions delivered over eight weeks by trained education practitioners. The children in the intervention group made significant gains in their expressive language compared to the comparison group in the length and complexity of their utterances. Neither the intervention group nor the comparison group made any gains in their receptive language. This effectiveness study showed that small-group language intervention for children with impoverished language delivered by trained education practitioners in schools is effective in facilitating children’s expressive language. It is proposed that education practitioners would benefit from more knowledge of children’s speech, language and communication development and training in how to assess and measure these skills in young children appropriately in a school context.

‘I don’t come out with big words like other people’: Interviewing adolescents as part of communication profiling

Assessing adolescent language skills poses significant challenges due to the subtle nature of language proficiency at this age, along with the high linguistic demands both academically and socially. As with young children, the current range of language assessments designed specifically for adolescents mostly includes standardized tests. This article explores how interviews can contribute to the assessment of adolescents’ language and communication skills. Two case studies of adolescents with previously undetected language difficulties are presented. The case studies show how the adolescents were able to reflect upon their language skills in an interview situation. Case studies also compare adolescents’ comments with the outcomes of standardized assessments. The interview allowed consideration of adolescent’s perceptions of strengths and difficulties, and identified possible barriers for these adolescents to both language intervention and education. Relationships between assessment and interview data are discussed and implications for assessment procedures are highlighted.

Language, social class and education: listening to adolescents’ perceptions

Young peoples perceptions may offer an insight into the complex associations between language, education and social class. However, little research has asked young people what they think of their own talking. Forty-two British adolescents aged between 14 and 15 years were interviewed: 21 attended a school in a working class area; 21 attended school in a middle class area. This paper examines and compares interview extracts from the two groups of adolescents. Results of a thematic analysis suggest that adolescents in both schools use language to signal their identity and to identify the group membership of others. Identity was linked by participants to social class. For example, adolescents attending school in a working class area described how they avoid talking ‘posh’ and those in a middle class area avoided talking like a ‘chav’. Adolescents attending school in a working class area described differences between the requirements of talking with teachers versus with their peers. Those in a middle class area discussed how their language skills were related to literacy and educational success. Implications for educational policy and practice are examined.