Exploring the link between language problems and behaviour

 A summary of the link between language problems and emotional and behavioural difficulties (EBD) reported on by the Centre for Integrated Healthcare Research, has shown:

• Approximately three quarters of children with identified emotional and behavioural difficulties have significant language deficits.
• Approximately half of those with language disorders have identifiable emotional and behavioural difficulties.
• The prevalence of language deficits in children who exhibit anti-social behaviours is ten times higher than in the general population.
• Pure language deficits, especially those associated with comprehension difficulties, are at greatest risk.
• Thus EBD children with unsuspected receptive disorders were rated the most delinquent, the most depressed (by parents) and aggressive (by teachers) and had more severe challenging behaviour.
• Children with expressive language disorders were rated as more socially withdrawn and anxious.
• The strength of the association between language difficulties and antisocial behaviour increases with age.
• Difficulties in initiating and maintaining interpersonal relationships is a key mediating variable between language disorders and antisocial behaviours.
• "Language disorders appear to have a devastating effect on interpersonal relationships (ie peer, family, companion) throughout the lifespan." (Benner, 2002)

I carried out a study in 2005 which showed a definite link between auditory memory difficulties and behaviour problems. It's not just a case of 'not understanding', a language problem affects all aspects of a child's life.

Just recently I was asked to see a 15year old boy with a terrible history of violence. He was in residential care but had committed a string of offences. When I assessed him it became apparent that he had such poor language skills that he didn't really understand most of what was being said to him. He was constantly seeking a familiar response and had worked out that if you punch someone the response is always consistent! He understood the outcome of that exchange! He was bright and chatty on the surface which disguised his difficulties. He had a set of well rehearsed stories to impress the listener on a superficial level (some of which I recognised as scenes from films). Yet his auditory memory was just 2 items which means that he can follow only sentences with 2 pieces of information (like a typical 2 year old!).

There's definitely a proven link which is why all children with behaviour difficulties could do with a speech, language and communication assessment by a suitably experienced Therapist. There will be more about the role of SLT in young offenders in a later blog post.

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August up-date Podcast

The RCSLT 'Giving Voice' Campaign Key messages

Giving Voice Key Messages

With the financial climate hitting all areas of the economy the RCSLT realised the profession would be heading for a difficult period. As a result, we set in motion our Giving Voice campaign. 

Giving Voice will help us and speech and language therapy services demonstrate SLTs’ unique value to national and local decision makers, while showing evidence of their efficiency and value for money.

The RCSLT has defined four Giving Voice campaign messages, please click on each message to find out more.

Key Message 1:

Speech and Language Therapists are specialists who enable people to develop or regain vital communication and swallowing skills.

Key Message 2:

Problems with speech and language imprison the individual and severely limit their participation in family life, the community, education and the world of work.

Key Message 3:

Tackling communication and swallowing problems reduces avoidable costs and waste in the NHS, local authorities, the criminal justice system and the wider economy.

Key Message 4:

Urgent changes are needed to support timely access to speech and language therapy for those who need it.

• Giving Voice will provide a strong platform to support national and local influencing as we move into more severe funding constraints across the public sector.

We need your help to make it a success. Remember, speech and language therapy transforms lives:pass it on.

Is it always autism?

NO!!! We're too quick to jump to conclusions when a child doesn't tick all the boxes for 'normal'! (Can you tell this is another of my personal bug bears?!)
Everyone has heard of autism but few know anything about receptive language difficulties or other language disorders which can mean that the child has trouble making sense of the world, fitting in with his peers and communicating his needs and thoughts. These are all symptoms of autism but do not necessarily mean the child has ASD. My own clinical case-load has several children who have been referred for ASD assessments by their school but actually have language based disorders. As they've already been referred when I pick them up it's too late to stop the parent needlessly worrying.

This is why  proper assessment for a differential diagnosis of ASD needs to be very thorough and requires Paediatrician, highly specialist speech & language therapist and expert Clinical Psychologist. At Small Talk our assesments follow the NAS guidelines. A one-off assessment in clinic is not sufficient to label a child for a life-time.
We used to have a term called semantic-pragmatic disorder: Semantic refers to the meanings of words and phrases while Pragmatic refers to the use of language in a social context (knowing what to say and when and how to say it to other people). We now try to separate the two so that we can work on the exact needs of the child. 
The Charity AFASIC have lots more information and they describe it in a way I can't improve upon. The following is from their website www.afasic.org.uk © Afasic 
"Children with semantic difficulties:

• Struggle to understand the meaning of sentences or words. 
• Words which refer to abstract concepts such as feelings (sad, puzzled, jealous) or status (important, official) can be especially hard for these children to understand. 
• They misinterpret and take literally phrases such as "Cut it out!", "Stop it" or "He's a push-over". 
• Often it can be difficult for children with a semantic disorder to work out the topic or key information in a sentence. 

Children with pragmatic difficulties struggle:

• To use language socially. 
• They do not understand how we take turns when we talk. 
• They interrupt more than is acceptable. 
• Their conversation often seems inappropriate or irrelevant. 
• They can seem to be unaware of what their conversational partner needs to know - and can therefore say too much or too little about a subject. 

Some children have both semantic and pragmatic difficulties" other children might have significant receptive language impairment which lead to problems understanding spoken language. I met a 15 year old earlier this year with severe behaviour problems... he had an auditory memory of just 2 items, no wonder he punched first, he knows what outcome is expected from that type of interchange! Imagine how frightening it would be to live in a world when you 'just don't get it' all the time (to use his words).
One of the only benefits of the long wait for ASD diagnosis in Staffordshire (up to 90 weeks for some) has been that it's now clearer when the child's problems are more language based than autistic spectrum based. The difference lies mainly in the rigidity of thinking.
I can highly recommend the AFASIC web site for any parent or professional who wants to know more.
We know more about autism as society now so its time to spread the word about other disorders and problems that affect our chidren's ability to communicate. Problems of any kind, however mild, will certainly lead to isolation, frustration and an inability to fully integrate into society. Children will have a harder time making friends and fitting into nursery or school.

Who are Small Talk?

Small Talk Paediatric Speech & Language Therapy team work independently and treat children privately. We see children who have:

• mild, moderate or severe learning difficulties
• physical disabilities
• language delay
• specific language impairment
• specific difficulties in producing sounds
• hearing impairment
• cleft lip and or palate
• stammers
• autism / social interaction difficulties
• voice disorders

We are based in Hednesford at the Keys Business Park but cover most of Staffordshire by seeing children in nurseries, schools and their own homes.


We can offer one-off assessments or regular therapy.


We can also offer many in-set opportunities for parents and teaching staff: half-Day or full-day courses on any aspect of speech, language or communication issue. We can tailor-make these for individual need.


For more information www.private-speech-therapy.co.uk  or 0844 704 5888

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Word finding frustration

I went to a great party at the weekend, it started early and went on til late. I'm not sure how much I had to drink but this morning I didn't feel too bad. Not really so much as a headache. What I did experience, through the combination of alcohol and lack of sleep probably, was a temporary word finding difficulty. I was trying to tell some-one how funny I'd found Chris Evans' stand-in on the radio 2 breakfast show last week. Try as I might I couldn't think of his name: I could picture his face, his suits, I knew he was small, Irish and proudly gay but for hours his name eluded me. I had to google 'breakfast show stand-in' to get it...... Graham Norton of course! Then I wanted to say the name of a place: I could recall the letter it began with, the number of syllables etc. but not the actual name. I was angry, frustrated and bewildered. The more I tried the harder it was!

We all get this tip-of the tongue experience from time to time and people have probably heard about stroke patients suffering this difficulty. There are however, so many children who have this problem most of the time. I have 4 regular clients with this difficulty on my current caseload, they use a lot of 'thingy', 'whatsit' or words similar to the one they want e.g. one child said, 'I'm going swimming and I don't need my armpits now!' They might talk around the word e.g. elephant, 'You know it's grey and got a long thingy'. They look normal, are bright and chatty but have a problem which gets in the way of them being able to express themselves fully. Sometimes they have other language based issues which compound things. They are probably aware of their problem and have associated anxiety. The problem is the more stressed they are, the harder it will be. As with the tip-of-the-tongue experiences we all have, when we're relaxed the elusive words are recalled. It's definitely a problem that's getting worse. One of the NHS Therapists has 2 in one school and she does a course specifically to share our approach.

I've always sympathised with them and done my best to teach them strategies to help but today I could really empathise. I'll be OK tomorrow but they have to live with this all day everyday and people just don't understand.

Sadie Lewis' work is widely respected in this area.

Brief mention..........

Although the Smart Talker groups were designed for everyone, not just children with identified difficulties, we have several children with very significant problems who come along. I write the programmes so they can be tailored to each child. The others who run the groups are either Speech and Language Therapists or experienced, capable individuals with early years backgrounds. It's more important for prospective franchisees to be the right type of person than the qualifications they have. All the children make progress but some are worthy of a special mention:

Louis began to attend the Small Talker group in September 2009 with some of his nursery peers and others. He had no speech but was known to have a small repertoire of signs that he understood. However, he was so withdrawn that he did not appear to have the confidence to look at a person when they spoke to him, let alone reply. Communication was extremely difficult with foster parents and nursery staff having to guess what he wanted. Even pointing was a problem. He was reported to be a single word level for understanding but this was not evident in his performance. Mainstream schooling appeared to be ‘out of the question’. He was almost 4.

He has been attending the group weekly since and his nursery teacher has worked very hard with him. He is not recognisable as the same child: he appears, happy, confident and relaxed in the group. He takes turns and gives responses both vocally and by sign. He spontaneously points things outs and names items. Comprehension is now 2-3-word level. He initiates interaction with children and adults. He does everything I expect of the others.

It gives me a lump in my throat to see how much he enjoys the group and how he has come on…… and he’s going to mainstream school!!!' YESSSSSS! It will be tough and he'll need a great deal of support but how fantastic!