What the resource is: This is a systematic review of the research literature, using the EPPI protocols. The literature was searched in a thorough, explicit and replicable way, thereby reducing any bias which might occur in a more ‘narrative' review. Full technical details are available. The research context shows that there is considerable overlap between children with speech language and communication difficulties (SLCD) and emotional and behavioural difficulties (EBD).
The review included studies about the relationship between communication difficulties and behaviour. In particular interventions for children with communicative difficulties and related behavioural problems or children with behavioural problems and related communication difficulties
The aims of the resource:
The aim was to identify research which investigated the links between SLCD and EBD in children aged 5-12 years. The authors also wanted to find any research which investigated whether intervening in either area; behaviour or communication skills, could affect outcomes in the other.
The intended audience includes researchers and all practitioners who work with primary aged children with SLCD or EBD. These include teachers, speech and language therapists, and workers in child and adolescent mental health services. It is also relevant to policy-makers, parents and carers.
Key findings or focus:
- There were only 21 intervention studies for children with either SLCD or EBD which included both communication and behavioural outcomes.
- They identified three types of studies
- Didactic interventions (8 studies) used behavioural modification alone (e.g. modelling and reinforcing) to improve communication skills or behavioural skills. These studies tend to teach very specific skills and tend not to focus on their generalisation. These approaches were mostly used with children who had severe impairments
- Hybrid interventions (11 studies) teach communication or behavioural skills in a range of contexts. They do focus on the generalisation of skills.
- Pharmacological interventions (2 studies) refer to interventions that use drug therapy to improve communication and behaviour.
- All of these studies reported evidence of positive effects of intervention on both communication and behaviour. However they were all very small scale and they provided a low weight of evidence, so the results cannot easily be generalised to other groups of children with SLCD and EBD
- Nonetheless promising interventions are;
- Didactic interventions were found to have beneficial impact on speech, language and behaviour in children with autism. For example, The Picture Exchange Communication System (PECS) was found to be successful in improving, expressive language in autistic children. Improvements in social communication and a reduction in problem behaviour were also reported. (Charlop-Christy et al. 2002)
- Two didactic intervention studies (Sigafoos and Meikle, 1996 Keen et al. 2001) reported peer interventions (group work) to be effective for autistic children in teaching functional communication and improving language. This type of intervention also improved social interactions peer acceptance and joint attention.
- Within the hybrid approaches to intervention, speech and language therapy was found to improve classroom behaviour, and expressive and receptive language in children with language and behavioural difficulties. Speech and language therapy also improved language, vocabulary, behaviour and social skills in children with EBD (Law and Sivyer 2003, Henneker 2005, Stringer 2006).
The quality, authority and credibility of the resource from your subject perspective in relation to ITE. (If not subject based then a generic perspective in relation to ITE):
- This review was produced by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) which is part of the Social Science Research Unit at the Institute of Education, University of London.
- Its key strength is in its rigorous and explicit methodology
The width of the review group increased the likelihood of finding relevant studies. The review group included researchers, lecturers and practitioners from speech and language, educational psychology, communication sciences, communicative disorders and health care research. The review group also included policy makers involved in inclusion, public health researchers, and parent group representation.
- Members were also recruited from Higher Education Institutions in Australia and the United States to provide an international perspective.
- Studies were included in the review if they met high methodological standards and were relevant to the research questions.
- There was an extensive initial search of the literature.
- The limitations of the review are the small number of studies it is based upon and their low methodological quality. Therefore the generalisation of the results of this review is limited.
The implications for ITE tutors/mentors - when and how it could have best impact:
- The overlap between SLCD and EBD should be considered in educational practise, so this research is important in terms of awareness raising. Although this link between SLCD and EBD is well known in the literature it is not necessarily reflected in practise and the allocation of appropriately trained specialist staff.
- All teaching and interventions aimed at developing behaviour and communication are delivered verbally and therefore rely on the communication skills of the child. So if a child has difficulty understanding language, using it to reflect, or to express themselves this could limit the effectiveness of any interventions. Many children with EBD have undetected SLCD (Gilmour et al 2004), so this is relevant to all educationalists working with pupils who have EBD in any setting.
- There are implications for research; children with SLCD and EBD are in every class and yet we have little research to guide teaching and intervention. Most of the research available addresses the needs of children with severe needs and is clinical in nature. There is a need for more education based intervention research for these children.
- It is worth noting that EPPI reviews of class based interventions for EBD
- Did not find multi-session social skills interventions implemented by class teachers to be effective in reducing the incidence of emotional problems (Evans et al. 2003).
- There is a limited evidence base for effective strategies for supporting pupils with EBD and trainee primary school teachers in the use of these strategies (Harden et al. 2003).
The relevance to ITE students - how and why it has importance:
- The research literature shows us that these two groups (SLCD and EBD) overlap to a considerable extent. Children who have SLCD often have EBD and vice versa and emotional and communication problems may go undetected.
- It is therefore important to see a pupil holistically and not to consider terms such as EBD and SLCD as mutually exclusive. It is also important to consider the possibility of undetected SLCD in children with EBD.
- Understanding the importance of inner speech for behaviour control is important in understanding the links between EBD and SLCD
- Other possible links are;
- that communication and behaviour difficulties are part of the same condition e.g. in autism
- Another factor, for example learning difficulties could lead to both language and behavioural issues
- there may be two separate causes of EBD and SLCD
- psychiatric difficulties could lead to SLCD, the authors quote ADHD as an example of this
- or psychiatric difficulties could arise as a result of language difficulties. This could be partly through frustration and though a lack of inner speech
However not all pupils with SLCD go on to have EBD.
Gilmour J, Hill B, Place M, Skuse DH (2004) Social Communication Defcits in Conduct Disorder: a Clinical and Community Survey. Journal of Child Psychology and Psychiatry and Allied Disciplines 45 (5): 967-978