This online course makes an important connection between language difficulties and emotional / behavioral disorders in older children and adolescents. Mental health professionals working with this population of young people will enhance their understanding of the relationship between difficulties of language and behavior. First, a framework is presented for understanding language, language disorders and the development of language skills from childhood to adolescence. Next, teacher instructional language is discussed as relates to student language skills necessary for learning. Specific connections between language problems and behavioral difficulties are explored, as relates to students with emotional and behavioral disorders. Recommendations are made for professionals working with such students, as regards identification and intervention. The author of this online course is Janet Harrison, Ph.D., CCC-SLP.

Learning Objectives
Upon completion of this course participants will be able to:

• Describe the framework for understanding language and language disorders offered by Bloom and Lahey (1978).



• Develop a basic understanding of the process of language development in late childhood and adolescence.



• Identify possible signs indicating the co-occurrence of learning disabilities, language difficulties and emotional or behavioral disorders.



• Explain the importance of multidisciplinary intervention with students who have both language difficulties and emotional or behavioral disorders.



• List steps that can be taken in the educational setting when working with students at-risk for language and behavioral difficulties.

Nearly three decades ago, Bloom and Lahey (1978) provided a framework for studying language in which three aspects were identified: language form (syntax, morphology, & phonology), language content (semantics) and language use (pragmatics). This was a seminal publication that provided a framework for teaching students in the fields of linguistics, psychology, and speech-language pathology. Application of this framework continues to serve as a foundation for discussion of language development, as well as language disorders. Although the scope of this course cannot adequately include the many approaches to explanation of language development, participants may wish to direct additional study to historical perspectives of language acquisition that include the behavioral approach described by B.F. Skinner, in the late 1950’s, and the psycholinguistic-syntactic model proposed by Noam Chomsky in the late ’50’s and early ‘60’s. The scope of this course does not include a descriptive historical review of linguistic paradigms. Rather, the focus is placed upon descriptions of language that support diagnostic and intervention models for students who have both emotional/behavior disorders and language difficulties. In the fields of speech-language pathology and developmental psychology, several models of language development emerged in the last three decades. In each of these models, a relationship between cognitive development and language development was defined. Cognition as an underpinning of early language development based on Piaget’s stages of sensorimotor development was widely described in the 1970’s and continued to be a primary foundation in the 1980’s (McLean & Snyder-McLean, 1978). In the 1990’s scholars of developmental psychology and artificial intelligence described cognitive developments such as the roles of event representations, schema and script theory (Nelson, 1985), and also related cognition as an underpinning of language.

In this course, a model of language described by Bloom & Lahey is used as a framework. In the Bloom & Lahey model, the following terms are used: language form which includes syntax, morphology, and phonology, language content or semantics, and language use or pragmatics. These parameters will be described to allow examination of how language development not only continues through adolescence, but also may interact with behavior and/or emotional disorders of children, adolescents and young adults.
         
This course begins with basic information that may serve as a review for speech-language pathologists (SLPs), and may introduce terminology used by SLPs to other professionals such as social workers, educators, psychologists, or counselors. Research-based descriptions of language development that occur in school-age-children and in adolescence, as well as information about language disorders manifested in adolescent years will be provided. Finally, implications are presented for all who work with adolescents who have may have communication disorders, along with emotional or behavioral disorders.


Communication has been defined in many ways and with a variety of different perspectives. For the purpose of this course, communication refers to the transmittal of messages, information, ideas, and feelings (Hulit & Howard, 2002), and must be both sent and received in order for communication to occur. Communication can be intentional, as when a human speaks or writes words for the purpose of sending a message to someone who will hear, read, comprehend, or “receive” the message. It may also be unintentional, as when an individual’s behavior is interpreted as an expression which may, or may not be an accurate reflection of what the individual is feeling or thinking. Communication may also be dichotomized as verbal—written or spoken words, or nonverbal. Examples of nonverbal communication includes body movements, positioning of a person in proximity to others, facial expressions, tone of voice, variation in intonation and/or the volume of an individual’s speech.
         
Language refers to a conventional code that is accepted and understood within a community of individuals. The code is a means of representing one thing, such as ideas or intents, with another. By using language, ideas or intents are encoded with words that may be spoken, manually signed, written, or typed (in modern cultures the “typing” occurs on computers or digital devices that support text communication). Each language has its own rules, or grammar, and with these rules an infinite number of word combinations can be expressed or generated. Some course participants may be familiar with this definition of “generative grammar.” Speech refers to the orally-produced signal that humans use to transmit auditory messages that someone (sometimes called the “receiver”) hears. Examples of speech disorders include articulation differences such as a lisp or a distortion of a consonant or vowel. Stuttering (e.g. hesitations, sound and/or word repetitions) or voice difficulties, such as a chronically hoarse voice, are other examples of speech disorders. The scope of this course does not include discussion of speech development or disorders.


Bloom and Lahey’s (1978) use of the terms “form, “ “content,” and “use” to describe language continues to serve as versatile and understandable nomenclature. Although this model was described nearly four decades ago, it is a simple framework that serves well for discussion of language development, as well as language disorders. Form is the explanation for how a person uses the language code to connect sounds or signs with meaning. More specifically, form, or syntax, refers to how a language user adheres to rules to combine words into sentences. For example, a speaker of English would know that “Bus here is now the,” is nonsensical and in order to be comprehended, the sentence must follow grammatical rules, resulting in “The bus is here now.” As young children begin to combine words to express themselves, they learn the grammar of the language that is spoken in their environment. Many years before they are presented with formal grammar instruction in a school setting, children learn syntax by listening to their ambient language, and by combining words in forms that are shaped by the feedback or responses of the adult users of the language in which they’re immersed. Parents and caregivers simplify their language to a young child’s level and provide support to the child’s language development by expanding word combinations that follow grammatical rules. For example, when a toddler says, “cookie,” as she/he reaches for another cookie, the parent might say, “want more cookies,” or “I want more cookies.” The ongoing modeling of language that adults give to young children helps them with the acquisition of new words, pronunciation of the sounds that make the words, and with the grammar that lets them know how words may be combined in their language.

Language Form
Language form includes syntax, morphology, and phonology. The rules which govern how words may be combined to form a sentence are syntax. Each language has its own syntax, which dictates how words are organized into sentences and also describes the classes of words, relationships between words, and sentence elements. Young children learn the basic syntax of their ambient language through their verbal interactions with parents, caregivers, and even other children with whom they interact. Semantic development precedes syntax since babies must have a core vocabulary of words that they are using before they begin to combine words into two-word utterances. An example of a typical early word-combination is the utterance, “More cookie!” that a child may use to express their request (or demand) for another cookie. As a result of many decades of study, language experts can reliably predict the types or classes, such as “object words,” or “function words,” that children first learn to combine, and can also gauge whether a child’s syntactic development is progressing as expected by looking at word types, as well as the average length of children’s utterances (Brown, 1973). When speech-language pathologists (SLPs) evaluate a young child’s language, they often compute the child’s Mean Length of Utterance (MLU) which is then compared to normative data to determine whether the child’s expressive syntax (form) is at expected levels for their age.

Early assessment of a child’s language development also includes evaluation of the developmental progression of their use of morphemes, which are the smallest units of meaning in a language. For example, the word “blocks” consists of two morphemes: the word block + s, which codes plurality. When an SLP evaluates Mean Length of Utterance, morphemes are included in the computation. Phonology, the 3rd aspect of “form” is evaluated by listening and recording the speech sounds that a young child uses. Developmental norms have been established for phonology, so it may be determined whether a young child is using the age-expected sounds of the phonological system. In English, most children develop intelligible speech and correctly articulate most speech sounds by the early grades of elementary school. For those children who have delayed or disordered development articulation or phonological therapy may be warranted.

Language Content
Semantics is the meaning, or “content” of a language, as described by Bloom and Lahey (1978). The words, or vocabulary, of each language must be learned by an individual in order to successfully communicate their wants, needs, or desires. Semantic development occurs at a rapid rate in the first years of life, and initially represents knowledge about 1) objects, 2) relations between objects, and 3) relations between events. Reed (2005) further describes semantic development to include spatial and temporal terms, for which primary development is seen between the ages of two to eleven years of age. Children typically understand words for spatial relationships (such as “on”) earlier than they understand temporal relationships. For example, a child who is three years in age would likely understand the preposition “on,” when it refers to the location of an object (example, “Put the block on the table.”). However, a child at that age would lack comprehension of the same preposition when used to express a temporal relationship such as in the phrase,”You are on time.”
         

Early expression of object knowledge is demonstrated by young children in what some have referred to as the “name game.” This occurs when toddlers point to objects around them and simply state a word with questioning intonation, or look to the caregiver as a prompt for the adult to tell them the word for the object at which the child is looking. For example, a young girl who is sitting in her car seat sees a truck go by, and says, “Truck!” Adults reinforce and teach semantic development by confirming the child’s use of new words and might, for example, say, “Yes, that is a truck,” or “a big RED truck!” Another example of how children spontaneously expand their vocabulary is when they point at things in their environment and look to their caregiver, perhaps uttering a questioning, “Dat?” The adult will typically label the object for them, and the child will approximate the word at their developmental level of articulation. For example, a toddler may point to the yellow object in the fruit bowl and look at their parent with their now habitual question of “Dat?” The parent would typically name the fruit, such as “banana,” and the child might say “nana.” Many times the caregiver or parent will confirm and expand the child’s utterance by repeating the word with emphasis on the number of syllables. In this example, the parent might say, yes, “ba-NA-na,” with emphasis or stress placed on the 2nd syllable of this three syllable word.
         
In addition to learning the names of objects (nouns) and the function, or action words (verbs), children quickly begin to encode the relationships of objects and events within their environment. Children’s early knowledge of relationships between events has been described as the development of event representations or “scripts” (Nelson, 1985). Creaghead (1992) and Reed (2005) describe these scripts as generalized representations of events in which the experiences within the script vary with an individual’s experiences. These event representations begin in childhood and we continue to use them throughout our lives. Every adult who is a parent (aunt, uncle, or even a babysitter) knows that toddlers quickly develop a personal “going to bed” script for what they experience each evening and subsequently expect to have the same events occur when they’re going to bed. For example, a child who has been consistently given a bath, then dressed in their pajamas, tucked into bed, had a story told or read to them, and then had a special song sung to them (that is known only by their parents) has this experiential knowledge organized in their minds as what we might call the “going to bed” script.

Although the young child could not explain the script events by telling a story (or narrative) about what happens when they go to bed, their knowledge of the bed-time script is seen when a baby sitter violates the order of events, or fails to sing the special song, and the child becomes upset. Interestingly, we continue to develop scripts for experiences that we experience throughout our lifetimes. By organizing our routine events into these “scripts,” we rely upon the familiar, routinized behavior to allow us to multi-task. For example, if we repeatedly follow the same driving route to our workplace, we can rely upon the “driving to work script” and think about other issues or even problem-solve as we drive. Similarly, it is thought that young children’s script-development serves as scaffolding for language development. In addition to learning how to order words to match the adult ambient language, children also gradually fill in, and expand, the events of a routine.

Rudimentary scripts serve as the basis for discourse development, which falls into the “use” category of language, as described by Bloom and Lahey. Children learn how to relay events (i.e. tell about their experiences) and eventually learn to create narratives to tell others about their world experiences. In early school years, this is seen in how a child learns to describe a field trip or events that happened throughout their day, after they return home from school and a caregiver asks, “What did you do today?” Creaghead (1990) has delineated at least 37 scripts that a student must learn in order to successfully navigate classrooms. Just a few of these examples include, Snack time, Following verbal directions, Taking tests, Making things, Negotiating rules for games, Going to the bathroom, or Giving directions.

Vocabulary development continues to grow at a steady rate throughout an individual’s school years, and continues throughout a person’s lifetime. According to Larson and McKinley (2003), semantic development during adolescent years is both quantitative and qualitative. They suggest that most adolescents will know the meaning of 80,000 different words by the time they graduate from high school. Qualitative change is seen in their ability to use multiple meaning words, and to understand and use words with more subtle variations of meaning. Vocabulary is influenced by the topics studied, as well as by the environment and interests of an individual. Figurative language is defined as non-literal language and includes forms such metaphors and similes. Figurative language is an important component of vocabulary development that will be further described in subsequent sections of this course that focus on school-age and adolescent language development.
         
The type of content, or vocabulary words, as well as the rate of acquisition varies with the life paths we choose. For example, an adult who chooses a vocation such as a hair stylist will learn a basic vocational vocabulary (or lexicon) during their training. Job-specific terminology exists for all careers. The growth of one’s professional vocabulary will be greatest during the initial years of training, but throughout the individual’s professional career new words are added, such as with a hair stylist, the vocabulary may expand to reflect new styles or products. A person who chooses a highly analytical or research-based career will experience a similar high rate of growth as they enter their chosen field of study, but will most likely add to their professional vocabulary at a more constant rate throughout their life time. For example, a professor who studies, teaches, and performs research work will continue to learn new terms in those areas of their life. The rate and types of semantic expansion that occur within a lifetime are largely influenced by the work, interests, hobbies, and avocations that we choose.

Language Use
In the Bloom and Lahey model of language, pragmatics refers to the use of language. Pragmatics involves how we use language to achieve objectives, how we consider context (physical, real-world surroundings -including our conversational partners) as we understand and form communication, and the ways we use language to interact with others. Geffner (2005), described communicative competence as, “knowing what to say; who says it; to whom, when and where it is said; and by what means it is said,” (p.48). In addition to learning words, and learning how to combine words to make sentences, children also learn the explicit and implicit rules of how to use language to effectively communicate. For example, an early pragmatics rule that young children learn is to say “thank you,” when they are given something, and “please” when they make a request.

Pragmatics includes the social conventions that result in polite use of language, as well as the skills to engage in conversation and other types of discourse. In addition to conversational discourse, expository discourse is language that is used to convey information. Children learn how they may change their style of speaking with others as they encounter different social situations, and also learn how to relay factual information and information about their own experiences. For example, when a child first goes to school they quickly learn that they must gain permission to ask a teacher a question, which is very different from how they spontaneously asked questions when at home with a caregiver or family member. Formal education demands that children orally report information that they’ve learned from experiences, experiments, school outings, and from books or other forms of text. As children grow they learn many different social rules of language uses, such as when it is acceptable to use slang, and how they must change their manner of speaking when they are speaking to an authority figure (such as a school principal) or to a classmate.

Pragmatics refers to the rules that govern how we use our language to communicate, and involves how we adapt or modify our language to fit with different conversational partners or situations. Children learn pragmatic skills that enable them to gracefully (and successfully) introduce, maintain, and/or change conversation topics. They also learn to use their language for a wide variety of purposes or intents. For example, functions of our utterances include, “to inform,” “to persuade,” to request,” or “to answer.” John Dore (1979) first described the variety of purposes or “Speech Acts” that young children use with their first words and utterances. A single word such as “Mama,” may be uttered as a request to be picked up, or as an expression of need (for food, or a dry diaper!). As language development continues, children expand the types of speech acts that they use, as well as add to the complexity and subtlety of how they express their intentions. Pragmatic development overlaps with semantics, syntax, morphology and phonology since effective communicators use intelligible complex sentences and an extensive vocabulary in both spoken and written language. Successful communication also includes finesse with the use and understanding of paralinguistic factors such as intonation, stress, facial expressions or body positioning.


Early language development, defined as that development which occurs between infancy and early school years, has been the topic of numerous texts in the fields of linguistics, speech-language pathology, developmental psychology and other related fields of study. In addition to the very brief overview in the previous section, course participants are referred to the “Supplemental Reading List” in Appendix A for further information about language development within that time span.
         
For the purposes of this course, the focus is upon language that develops in later elementary school years, at around 10-11 years of age, through the further developments that occur in adolescence. The following section on language development refers to the works of several widely known researchers. Supplemental readings that serve to expand this brief summary of information are listed in the references and in Appendix A. Larson & McKinley (1995; 2003) published and presented research-based information regarding theories of adolescent development, as well as language development that occurs in adolescence. Other expert resources for the following section on language development in adolescence include Nippold (1998), Nippold, Hesketh, Duthie, & Mansfield (2005), Reed, McLeod, & McAllister (1999), Simon (1985; 1998), Wallach & Miller (1988), and Ukrainetz (2006).

Critical and Analytical Thinking Skills
As we begin to discuss language developments that occur in the school age years, it is helpful to consider levels of cognition as have been described by developmental psychologists. It is widely accepted that language and cognition interact throughout development, but neither follow a strict linear progression. None the less, consideration of how a child or adolescent thinks about the world also helps us understand their language use and comprehension. Vygotsy (1962) suggested that one important interaction of cognitive and language development is seen in the way that language serves as a vehicle for acquiring new concepts.

Course participants may wish to embark upon further reading for discussions of the relationship between language and cognition, as well as results of research that have examined relationships between cognitive development and specific language developments in works by authors such as Fodor (1979), Paul (2001), or Rice & Kemper (1984).
         
Somewhere between ages 7 and 11, children typically become Concrete Learners (Piaget, 1964). Ellsworth & Sindt (1992) describe Concrete Learners as being able to think logically about what they have directly experienced, but lack the ability to think and reason abstractly. This is followed by the development of formal operational thinking that emerges between 12 and 15 years. Formal operational thought refers to the ability to reason systematically and logically about abstract ideas that may have no basis in reality. Larson & McKinley (2003) summarized studies that revealed that adolescents of average intelligence typically use formal operational thinking in some, but not all contexts. An individual who is able to fully use operational thinking applies logical reasoning to abstract concepts, relationships, theories, and/or properties. According to Larson & McKinley (2003) results of research have indicated that not all adults fully transition from concrete to operational thought, and may only engage in formal operational thought in their area of expertise. This observation may be considered a parallel, or at least similar, to semantic development in which adults may only continue to expand vocabulary and use of words to describe abstract thoughts within their field of study or chosen profession.
         
Marilyn Nippold (1998), in her extensive research of language skills of adolescents, discussed the relationship between deductive reasoning and syllogisms. She defined a syllogism as an argument with two premises and a conclusion that logically follows the arguments. Nippold (1998) cited results from several studies of the development of deductive reasoning and concluded that even older adolescents found syllogisms difficult to understand. She reviewed the results of others’ research, and conducted her own exploration of the interaction of semantics and the development of analogical reasoning. An example of verbal analogical reasoning is “A ruler is to length, as a calendar is to time.” Nippold (1998) concluded that analogical reasoning improves throughout adolescence and those who perform this type of reasoning best are those who have higher cognition and better academic performance, as well as increased knowledge of words. Hence, strong semantic development is an underpinning for analogical reasoning.
         
Larson & McKinley (2003) succinctly summarized that we expect adolescents to have the cognitive skills to organize and sequence information, to identify and solve problems, to think about events that are not in the “here and now,” and finally to navigate the many demands of studying and learning.

Development of Language Form in Adolescence
As described in the brief overview of normal language development in this course, we know that children learn to combine words that follow the rules of syntax, morphology and phonology of their native lan         guage in preschool and early school-age years. In the first five years of life, all aspects of language development occur rapidly and many sources provide developmental milestones for the progression of normal language development (see Appendix A for further reading). Although few adolescents continue to have phonological difficulties, during teenage years adolescents continue to refine their use of grammatical rules and structures, and they must be able to create and understand lengthy and complex sentences.

They must also learn to use and understand more sophisticated morphemes such as suffixes or prefixes that added nuances of meaning. However, as Larson & McKinley (2003) point out, “In adolescence, it is difficult to state in detail by age level the specific thinking, language, and communication developmental milestones because individuals become increasingly individualistic in their thinking and language abilities (p. 53).” This course provides some key communication developments that are expected to occur in adolescence, as described by the work of authors such as Adler & King (1994), Larson & McKinley (1995; 2003), Nippold (1998), Simon (1998), and Wallach & Miller (1988).
         
In regards to syntax, adolescents should be able to both understand and correctly form sentences that are of complex structure and use sophisticated morphological structure. Sentences increase in complexity as embedded clauses are used, which also increases the sentence length. Use of advanced syntactic structures adds to the complexity of sentences. An example of an advanced syntactic structure is the use of “passive voice.” The following sentence is a simple “active voice” structure: The elderly woman rides to the store.

In contrast, consider this sentence which contains clauses and is in the “passive voice”: The elderly woman, who lives in assisted living, was transported to the store by the facility’s bus. Even these examples are easier to understand than much of what is heard in an adolescent’s typical day—consider the ambiguity of conversational speech, and the complexity of directions given in formal education settings.

Adolescents are typically expected to be able to follow directions containing at least three steps (e.g. “Go to chapter three in your algebra book and do the even numbered questions at the end, then write a brief summary that explains why you chose the formulas that you used to solve the problems.”) and must be able to comply to the directions after hearing them only one time. They must also be able to give directions that are clear and concise. For example, when giving a friend the directions to their house, it is necessary for the adolescent to choose the salient information needed and to state it in the correct sequence with all of the details required for the friend to locate their home. An adolescent who has language form difficulties in the area of syntax may use sentence fragments that lack the organization and detail needed for effective communication. Larson and McKinley (2003) cite the results of a 13 year longitudinal study of the expressive language skills of students from kindergarten through grade 12 (this study was completed by W. Loban, in 1976, see Appendix A for complete reference) that measured the length of communication units used by the students. Loban (1976) defined a communication unit as an independent clause with its modifiers, using the term as a necessary metric for analyzing spoken language. That is, since speakers do not typically speak in sentences, this measurement facilitated analysis of syntax of spoken language. Loban also introduced the term “verbal maze,” in which a maze is defined as words or unattached fragments that are not necessary to a message. For example, consider the following utterance: “That girl, you know the girl who…well anyway, that girl in the second row is going to be the first one to give her report.”

The words, “you know the girl who…well anyway, that girl” are maze words that can be removed, and the words which remain are a communication unit that conveys the speaker’s meaning. Interestingly, the results of Loban’s work revealed that the number of maze words decreased according to grade level in normally developing adolescents. Subsequent clinical work (by speech-language pathologists, including the course author) with adolescents who have language disorders have shown that adolescents who have language disorders often have a higher number of maze words in sampled spoken language. The metrics for analyzing connected speech of mature language users today include either a “C-Unit” or terminal unit (T-unit), which is similar to the C-Unit and will be described in a later section of the course.
         
In addition to the discussion of verbal mazes, Larson & McKinley (2003) stated that, “the inclusion of longer and more complex dependent clauses, especially adjectival clauses, was a primary mark of increasing language development, both oral and written” (pg. 61). Adjective clauses are relative clauses that specify or expand information about a noun or pronoun in the subject or object positions of a sentence. For example, in the sentence “Mary’s hat was floppy with a large red ribbon,” floppy with a large red ribbon is an adjective clause. In summary, we expect adolescents to become more adept with their spoken and written language skills by decreasing the number of maze words, and by using longer sentences that are lengthened with clauses that add detail and complexity. Adolescents with language disorders may have difficulties with the language demands of classroom performance, and for those with behavior or emotional problems, complexity of language used in therapy sessions may also be a challenge.

Development of Language Content in Adolescence
Semantic development is seen in the expansion of the lexicon (vocabulary) and the addition of more abstract words. Adolescents also refine their word definitions and gradually decontextualize word meanings. That is, when a young child first learns a word, it has a direct referent (e.g. “ball” is first used to name a specific ball that the child plays with daily) but gradually the word is used to refer to all round, bouncy, toys. Similarly, as the adolescent progresses through formal education and experience adds to their world knowledge, many words attain multiple meanings. Words may also be so abstract that their meaning is learned through language explaining a concept, rather than a word that refers to a specific object. For example, the adolescent understands that the word “grade” may mean a level in formal education, a mark indicating a degree of accomplishment in school, a stage in a process, a military or naval rank, or even the degree of inclination of a road (of course, these are just some of the many meanings of this word!).
         
Adolescents must also be able to find the correct words to express their ideas and to give accurate information, descriptions and directions. Semantic development in early childhood was learned first-hand, through interactions with the world and people around the young child. However, as language acquisition progresses, language itself becomes another tool to augment language development. That is, as an individual learns to read (decode) and write (encode), they then use language to learn more about language. The term for this skill is metalinguistic and it includes tasks such as learning the names of word types (e.g., nouns, verbs, adverbs, adjectives, and participles), sentence types (e.g., active, passive) and the skill to diagram or parse sentences into their elemental components. These metalinguistic skills allow adolescents to learn more about language through formal education, in addition to their experiential world knowledge. Both semantic and syntactic developments are also stimulated through reading of literature, viewing of plays, and interacting with a wider, and often more diverse, range of conversational partners.

Figurative Language
Figurative language, or language that does not rely upon literal translation, is an extremely interesting aspect of semantic development that enriches many aspects of an individual’s communicative competence, as well as their social skills. As with other aspects of language development discussed in this course, we begin with consideration of the role of cognitive development in figurative language development. Gorman-Gard (1992) indicates that to begin to develop use of figurative language, a child must be entering into the cognitive stage of formal operational thought. As previously discussed, this cognitive level typically emerges at around ages 10 to 12, but continues to develop into adulthood, and total use of formal operational thinking may not ever be used in all areas by some adult individuals. In regards to figurative language, the cognitive level of thinking needed varies with the form of figurative language, and the level of figurative language may also progress as cognition develops.

To further explain the process, we begin with what Kathleen Gormand-Gard (1992) considers to be the simplest form of figurative language, which is a multiple-meaning word (MMW). Examples of multiple meaning words include walk (to ambulate vs. a place to stroll), or fork (eating utensil vs. split in a road). Before a child has learned to spell, as well as when a student is listening (but no printed word is provided) words such as “some” or “sum” may sound like the same word with two different meanings. Then, these words may continue to be confusing if they do not have a context to aid in accurate decoding. According to Gormand-Gard, children do not typically understand both the physical and psychological aspects of a MMW until the reach the ages of 10-12, when formal operational thinking emerges. The word “catch” is an example of a word in which the physical attribute would be to grasp and hold on to something in motion, while a psychological aspect might be to discover unexpectedly. Children at ages three or four will typically understand only the physical attributes of a MMW.

Rhea Paul (2001) describes understanding of multiple meaning words as a component of understanding and using word relations, a semantic development in the advanced language learning period of adolescence. While some consider MMW as a first step into figurative language, others may place it in the transition period that moves from understanding multiple meaning words, to understanding/using multiple meaning phrases that are idioms. Wallach & Miller (1988) described how older students must learn that a word can have different meanings which may result in ambiguity, and that two sentences with different forms can have the same meaning, which results in synonomy. They further described figurative interpretations as the various combinations of words and sounds which can serve to have different meanings. Whether multiple meaning words are classified as a feature of word relations, or as figurative language, language experts agree that understanding MMW is a metalinguistic skill that is necessary for mastery of advanced language, including forms of humor (ex. puns) involving language (Wallach & Miller, 1988).

Other forms of figurative language that require use of formal operational thought are metaphors and similes. These two forms differ only by a word, or grammatical marker. That is, “Mary is like the sun,” is a simile, while “Mary is the sun,” is a metaphor. Idioms, which are figures of speech such as “on the tip of one’s tongue,” are phrases that can have both a literal and figurative meaning. Since the exact phrase or words are preserved, they are often termed “frozen figures” of speech. Examples of American idioms include, “beg the question,” or “for the time being.” Although formal operational thought is necessary for an individual to explain an idiom, an individual who has not transitioned to formal operational thought may use idioms in normal conversational speech. That is, an adolescent may use an idiom that he/she has heard others use, and may even use it in the correct context without totally understanding its meaning. An idiom that is used excessively in a language is termed a cliché. In English, “boys will be boys,” or “join the crowd,” are clichés. Idioms and clichés are often used by a specific group—such as adolescents—as slang that is understood only by others within the group.

Each generation can likely recall slang that was popular from when they were teenagers, such as in the 1970’s when clichés such as “groovy,” or “far out” were often heard in the hallways of high schools. Recently, adolescents might have called a friend, “dog,” or used the phrase, “Peace out…” to say goodbye. Use of the word “sick” to mean that something is very good is a slang term that is currently creeping into mainstream adolescent conversation. As soon as the slang of a young generation begins to enter into everyday usage, new and different slang words are introduced by the adolescent/young adult groups that will continue to keep the group’s identity separate from mainstream English. Slang is a particularly significant form of figurative language that plays an important role for adolescents in their social interactions and peer-acceptance. Therefore, an adolescent who has language difficulties and fails to use or understand slang words correctly, often does not “fit in” with peers and self-esteem may be adversely affected.
         
Gorman-Gard (1992) described different types of metaphor and similes that vary in their structure. One example is a riddle that can take the form of an analogy when it uses a grammatical marker such as “like.” Gorman-Gard used the example of “What is like a scar but marks the sky?” (Answer: skywriting). A topic-less metaphor is one in which the topic is implied, but not stated, as in “The scar marked the sky,” with skywriting serving as the unstated topic (p.35). It is not necessary for an adolescent student to learn the names of the structural variations. However, if an adolescent has a language disorder that involves their semantic development, they may need support in understanding information that is presented in non-literal forms, such as metaphors, similes, or metaphors. Of particular importance are those figurative phrases that are used by peers with whom they interact. Social acceptance in the adolescent years may be a contributing factor to behavior and emotional disorders.

Gorman-Gard also described how metaphors may be perceptual, cross-sensory, or psychological. The psychological type of metaphor is especially relevant for those who work with adolescents with emotional or behavioral disorders, since many adults routinely use psychological metaphors to describe a personality characteristic, or express an emotion or mental state. For example, a counselor might say “you blew like a volcano” to an adolescent who has acted with aggression, but if the adolescent also has semantic language difficulties this phrase might not be understood. Kathleen Gorman-Gard’s text Figurative Language: A comprehensive program (1992) provides extensive descriptions and examples of figurative language, as well as suggestions for helping individuals who have difficulties in comprehending or using figurative language. While SLPs who identify language disorders in adolescents will be aware of their difficulties with figurative language, a teacher or counselor may discover an adolescent’s comprehension limits through their interactions with the adolescent. Being aware of how these subtle language developments affect social interaction is information that can be used to improve success in counseling and education settings.

Development of Language Use in Adolescence
The communication expectations that we have for adolescents are extensive. This includes abilities to carry on conversations, to give oral reports in school, and to express attitudes, opinions, feelings, and moods (Larson & McKinley, 1995). The styles of communication that we use are sometimes defined as “genres.” Two aspects of communication genres that change in our social use of language are termed rhetorical, which means who is being talked to, and referential, which means what is being talked about. Conversational speech of adolescents who have language disorders is often described as “empty speech.” Empty speech is characterized by use of filler words, (ex. “um, uh”) and non-specific words such as “thing.” That is, an adolescent who has difficulties with referential communication might say, “That thing, you know, that thing over there, is going to, uh, umm, go off, or something.” In this example, the referent (a timer) is described as a “thing” and the student experiences difficulty in specifying what is going to happen. A classic example of a problem with rhetorical discourse is when a student answers a peer’s, teacher’s, or counselor’s rhetorical question. For example, the adult might say, “Now who do you think is going to get in trouble for not being on time?” The adult may be speaking rhetorically in reference to the student being addressed. However, this student might innocently provide some other student’s name, because they have failed to understand the indirect rhetorical question. Students who experience this type of language difficulty are often labeled as “smarting off,” when it appears that they do not speak in an appropriate or polite manner. However, the underlying subtle language difficulty may be the reason that the student responds in a manner such as this.
         
Referential communication is one aspect of expository discourse, which was described by Nelson (1993) as that which conveys technical or factual information. Most textbooks are written in expository discourse structure, and teacher lectures are also typically of this style. Therefore, the older student who experiences difficulty with expository discourse is at risk for failing to understand complex language used in classrooms or therapy sessions. For example, a student who does not always comprehend expository discourse might be challenged to understand directions, specifications, predictions, or conclusions.

Nippold, Ward-Lonergan, & Fanning (2005) developed a study of adolescents’ skills in persuasive writing in order to identify information that could be used in collaboration of teachers and SLPs. This study included 180 participants- 60 children in grades 5 or 6, 60 adolescents in grades 11 or 12, and 60 adult university students. All participants were asked to write an essay that expressed their opinions regarding a topic that was established as one of interest and that would motivate the students’ persuasive writing.

Each of the successive age groups were found to use a greater number of words, utterances, and reasons (for persuasion of a point of view) than the younger age group. Developmental patterns were identified for use of abstract nouns, adverbial conjuncts and metaverbs. The authors of this study defined abstract nouns as those that refer to entities that cannot be seen (e.g., courage, freedom, or kindness).

Adverbial clauses are those words or phrases that introduce an independent clause and link it with a prior clause in an utterance. “Metaverbs” refers to metalinguistic or metacognitive verbs. That is, these are verbs that refer to thinking or speaking, such as, “realize,” or “argue.” Nippold, et al., outlined implications for areas of syntactic and semantic development that could be targeted collaboratively by teachers and SLPs who could engage adolescents in persuasive writing assignments. These areas included the development of syntactic structures and literate vocabulary. They also discussed the degree of flexibility that the students’ work demonstrated by identifying whether they acknowledged other viewpoints of the controversial topic of their essays, which they termed “increasing flexibility.” Results of this study suggested that older writers demonstrated more flexibility in their persuasive writing, and further discussed a relationship between flexibility and the emergence of formal operational thought (using Piaget’s model of cognitive development). They found that not all of the adolescents (and not all of the adults) in this study demonstrated clear evidence that they were using formal operational thought.

Paul (2001) has described how older students must cross the bridge from oral to “literate” language. In this context, literate language refers to language used in textbooks, as well as in classroom discourse. Interestingly, students must also learn event scripts (ex. Taking home and turning in homework), oral scripts (ex. Explaining or defending behavior), and written scripts (writing reports in specified subjects) (Creaghead, 1990). SLPs, psychologists, and counselors who work with these students will find it necessary to periodically check for comprehension and to offer simpler versions of information when a specific adolescent does not understand the verbal delivery style or content. A student who does understand expository text structures is able to organize study notes, use mnemonic strategies, follow outlines, and prepare their own verbal work efficiently. Evaluation of older students suspected of having difficulties in these higher-level aspects of language may include formal examinations administered by an SLP, observation of the student in classroom settings, as well as sampling of the student’s written work and homework assignments.


Classroom teachers are typically the best source for beginning to understand the impact of an older student’s language difficulties. Those students who are also referred for psycho-educational evaluation (typically performed by a school psychologist or psychometrician) are best served by a transdisciplinary team that includes a psychologist or counselor, classroom teacher(s), and a speech-language pathologist who has formally evaluated the student’s language expression and comprehension. The exact order of identification, evaluation, and intervention may vary with the situation. Within the last decade, “Response to Intervention” (RTI) and the Learning Disabilities (LD) Initiative have led to earlier identification of Specific Learning Disabilities. According to Bradley, Danielson, and Doolittle (2007), the LD Initiative was the result of a letter from the National Joint Committee on Learning Disabilities to the U.S. Office of Special Education Programs, which expressed concern about the accurate identification of learning disabilities.

The LD initiative influenced public policy and the reauthorization of the Individuals with Disabilities Education Act (IDEA) in 2004. This removed the federal requirement for an aptitude/achievement discrepancy to serve as the foundation for identification of a learning disability. With the removal of this requirement, school personnel are experiencing a variety of models for implementation of RTI. Although no one RTI model has been identified as a national standard, schools across the United States are using a variety of RTI models that are based on scientific research. These models promote intervention as soon as a student fails, or does not respond to traditional classroom instruction. The most common framework of RTI models consists of 1) research-based instruction in general education settings, 2) universal screening for identification of at-risk students, and 3) monitoring of progress to determine which students do not respond as expected to the primary intervention (Bradley, Danielson, Doolittle, 2007). As school personnel fully implement RTI, it is likely that adolescents with language disorders, as well as behavior/emotional disorders will be identified earlier. Further information regarding RTI and the federal regulations of IDEA may be found at the following sources: The U.S. Office of Special Education Programs’ website at http://idea.ed.gov and http://www.NRCLD.org which is the website of The National Research Center on Learning Disabilities.
         
Because of the increasing interest in language development in adolescence, as well as the need for improved resources for language programs for this population, the American Speech-Language-Hearing Association (ASHA) has compiled a packet of resources related to working with adolescents. For ASHA members, the complete packet is available on-line, through the website at www.asha.org. The packet includes information about assessment, service delivery, pragmatics, developmental milestones and suggestions for motivating adolescents who are challenged with communication difficulties. The ASHA website also includes the following information that is available to the public: “Communication Facts-Special Populations-Literacy” (2006 edition), and several publications about reading, writing, and literacy. In this course, key information and landmarks are provided for SLPs, teachers, counselors, or mental health professionals who work with this population. In addition to these course materials, a good resource for non-ASHA members is a certified speech-language pathologist (ASHA: CCC- SLP) who has experience in working with adolescents who have language disorders.

In the next section of this course, research evidence will be presented that describes language difficulties found in adolescence. Information from the previously mentioned ASHA packet, as well as summaries of recent research studies provide evidence for language difficulties based on the framework that has been used throughout this course. The dichotomy of language comprehension, or that which is understood, and language expression - that which is said or written, will be used in addition to the categories of language form, content and use.

Adolescents who have difficulties in language understanding and use are likely to demonstrate some, if not all, of the following characteristics.

Language Comprehension:
Form -
         Misunderstanding of complex sentences
         Misunderstanding of ambiguous sentences
         Difficulties understanding grammar rules of standard spoken English
         Restricted understanding of high level morphology

Use -
         Difficulty staying on a conversational topic, inappropriate responses, situational inappropriateness,
                     and inappropriate speech style
         Interpersonal negotiation strategies (Nippold, ASHA Clinical Forum)

Content -
         Difficulty understanding multiple meaning words
         Difficulty understanding language without contextual support
         Difficulty understanding that words may have multiple meanings that can change
                     the intent of the surface meaning of statements
         Difficulties understanding idioms

Language Production:
Form -
         Difficulty with creating, as well as imitating, complex sentences
         Morphology deficits (grammatical morphemes are the smallest units of language
                     which change meaning- they can be a single word, or word endings,
                     such as plural “s,” past-tense “ed,” or “ing” to indicate present progressive)

Use -
         Linguistic nonfluency and revisions
         Inappropriate use of vocal tone
         Violations of proximity; i.e., socially expected distance between conversational partners

Content -
         Deficient expressive vocabulary use

In addition to these verbal skills that are expected of adolescents for successful communication, there are also nonverbal aspects that must be developed. Nonverbal communication abilities include the skills to correctly interpret and use facial expressions and appropriate tones of voice. Additionally, individuals must understand and follow the rules of social distance as they apply to body movements or positioning, which is termed proximity, while speaking.

Nonverbal:
         Failure to understand and use facial expressions that match verbal meaning.
         Failure to understand sarcasm or subtle changes in meaning conveyed by tone of voice.
         Difficulty in respecting the listener’s comfortable space during conversation
                     (Note: In mainstream America, casual conversation is typically conducted at arm’s
                     length. That is, communication partners often stand/sit about 3 feet apart unless they
                     wish to convey intimacy or anger.)

What else may be a challenge for adolescents with language difficulties?


As a result of growing interest in understanding the impact of students' language disorders on their classroom performance, the role of teacher input in the communication interaction has been described. In early grades, verbal behavior of teachers is based on the events within the classroom and is related to the teachers' purpose in initiating communication (Nelson, 1985). The vocabulary that is selected also reflects the classroom context in regards to subject matter that is being addressed and to the content of the message. Nelson (1985) has described the ascending difficulty of the comprehension demands of school discourse which becomes less tied to the immediate environmental context as grade levels increase.

The role of language used in academic instruction shifts at around third grade. Experiential-based learning is gradually replaced with presentation of new information through formal language modalities. This shift in instructional style places greater demands on children's abilities to understand more complex verbal instruction in both written and spoken form. However, children's linguistic abilities continue to develop throughout middle grades and high school, with increasing refinement in syntax, morphology, semantics, and pragmatics. Phonological development is typically completed before adolescence. For those students who are experiencing difficulty with language development, the shift to language-based academic instruction adds to the difficulty of classroom performance. A student who has difficulties with referential language and/or expository discourse will likely experience difficulty with understanding instructional language used by teachers, as well as textbook discourse.

Paul (2001) recommends that SLPs observe students within their classrooms to identify the types of vocabulary the teachers use in direction. From these observations, the clinician can then create a criterion-referenced vocabulary evaluation to assess whether a student understand the terms used by a teacher.

Although methods for assessment of teachers' language were recommended 20 years ago (Larson & McKinley, 1987), only a few empirical studies have been described. One older, yet interesting observation of the relationship of child linguistic development to teacher language behavior was described by Lazar, Warr-Leeper, Nicholson, and Johnson (1989) who cited work published in 1985, from Riggin, Miller, Jadd, and Warr-Leeper which indicated there were no statistical differences across grades K through 8 in teachers' utterances in terms of length, complexity, and rate. Additionally, Richards (1978) indicated that teachers often use technical terminology in later grades without defining it. The findings of Lazar, et al. (1989) are of particular importance for understanding how semantic language deficits of students with EBD may impact classroom behavior. They reported that at least half of teachers' utterances in elementary grades could be considered as multiple meaning (figurative) expressions. As discussed in this course, use and comprehension of figurative language is a later developing skill in normal language development, and has been identified as particularly problematic for students with semantic language disorders. Therefore, this style of teacher instruction would appear to have greater potential for misunderstanding by many students, particularly those with language learning difficulties.
         
More recently, Paul (2001) discussed the need to teach some adolescents with language disorders how to comprehend whether they have understood teachers’ instructions. Intervention by a speech-language pathologist (SLP) may involve individual work with a student to increase their awareness of when they have not understood directions, as well as to learn how they may verbally request clarification.

An example of an individual therapy activity that might be used to develop these skills is the use of a “Barrier task,” to draw a designated route on a map of the student’s school. In barrier games or activities, a student sits at a table across from an SLP who provides a physical barrier that prevents the student from seeing the table space in front of the SLP. The SLP then may take the role of the “Sender,” and the student is the “Receiver.” In this example, the SLP might begin with an incomplete instruction, such as “Draw a line from the corner of your page up to the first classroom.” The student needs to know which corner (i.e., “left bottom,” or “top right”) and if they fail to ask for the unsupplied information, the SLP prompts to help the student realize what questions need to be asked to allow successful communication. This activity would proceed through the completion of a designated route, such as “How to get from the school cafeteria to the gymnasium.” In similar barrier activities, the roles may be reversed so that the SLP is the “Receiver,” and the student practices giving directions as the “Sender” of communication. The student’s skills for understanding and/or giving directions in isolated therapy tasks such as this must generalize to the classroom and other settings in the student’s environment. SLPs often work with teachers in either a consultative or collaborative manner to facilitate the transfer of skills.


For effective learning to occur, students must be able to attend to the information that is presented, as well as comprehend both spoken and written information. They must understand what a teacher says in lectures or directions, and they must also understand the textbooks that they read. Catts and Kamhi (2005) have discussed the use of schemata in students’ comprehension of written information in textbooks. Schemata is another term for script, which refers to the routinized, or generalized, hierarchical knowledge that we have for familiar events, objects, or classes of objects. According to Catts & Kamhi, schema play a variety of roles in text comprehension, such as providing scaffolding for understanding, facilitating select allocation of attention, and enabling a student to infer meaning from text. Some have described this type of inferencing as “reading between the lines.” In addition to those roles, they also describe how readers use schema to help them remember content of text and facilitate ability to recall information.
         
In an earlier study, Creaghead and Tattershall (1991) examined the interaction of communication skills and effective learning in school and identified three competencies that are required for effective learning: 1) Understanding of classroom routine and other school specific formats, 2) Ability to follow and give oral and written directions, and 3) Ability to comprehend and use nonliteral language. Teachers expect children to quickly learn the classroom routines soon after they enter kindergarten (Schultz, 1979). Related to the second competency, teachers' instructions include statements to supply information or provide direction, as well as verbal and nonverbal elicitations that involve exchanges of academic information. The amount of teacher instruction that includes figurative language is a compelling finding for students with emotional or behavior disorders (EBD). With at least half of teachers' utterances in elementary grades considered as multiple meaning expressions (Lazar, et al., 1989) and knowing that the ability to understand or explain nonliteral (figurative) language develops throughout adolescence and has been frequently identified as difficult for students with EBD (e.g., Warr-Leeper, et al., 1994), a major problem seems to lie here. Matching the complexity of teachers' instructions to students' language learning abilities is important for reducing the likelihood of evasiveness within the student/teacher dyad. The limited information regarding the sophistication of teacher instructional language suggests that teachers consistently use language that is above the level of their learners with disabilities (Bailey & deSouza, 1982). The particularly complicated pragmatic and semantic aspects of teacher instruction are a mismatch for the language difficulties of children with EBD. When a student with EBD fails to understand the language of instruction, they may be reinforced by the negative attention that is a consequence of communication failures (Harrison, Gunter, Lee, & Reed, 1996).         


Conversation Skills
Turkstra, Ciccia, and Seaton (2003) examined the interactive conversational behaviors of 24 female and 26 male typically developing African American and Caucasian adolescents from the Midwest United States with ages ranging from 13 years, to 21 years, 7 months. The purpose of their study was to gain data that would lead to a better understanding of adolescent’s typical interactive behaviors. The experimental method required observation of the adolescents as they engaged in extemporaneous, 3-minute conversations with a peer. The adolescents were allowed to choose their topics and typical topics were music, movies, the weekend, sports, friends, or events from work or school. Turkstra, et al, assessed effects of age, race, and sex on a variety of conversational behaviors. Discourse behaviors that they assessed are described in the following table.

Eye Gaze Patterns
While listening or talking, the Individual directs gaze at conversational partner; may be accompanied by other behaviors such as nodding. If the individual does not look at their conversational partner, it is called a non-directed gaze.

Facial Expression
Expressions may be positive, neutral, or negative during conversational interactions, and may co-occur with nodding or shrugging.

Verbal Behaviors
Asking or answering questions, commenting during conversation.

Back Channel Responses
A verbal response made by the listener which signals general agreement with the speaker and may let the speaker know that the listener does not wish to take a conversational turn.

Contingent Responses
Verbal response that is related to the previous utterance of the conversational partner.

Results of the analyses of the adolescent’s conversations showed few effects for race and sex, and high variability among speakers of the same sex or race. The nonverbal behaviors that occurred most frequently were nodding, use of neutral or positive facial expressions and use of backchannel responses while a conversational partner was talking.

The most frequent verbal behaviors were asking/answering questions, and giving contingent responses. The adolescents in this sample did not typically complete or repeat a conversational partner’s utterance, rarely asked for clarification of information, failed to answer questions, or responded with noncontingent information. Examination of nonverbal behaviors revealed that they rarely turned away from a conversation partner during conversation, and rarely showed negative emotions. Conversation turn-taking was an aspect of conversation that did show a difference, although it was not statistically significant. That is, males averaged 7 and ½ turns per minute and females averaged approximately six turns per minutes. The authors noted that total talking times between the male and female groups did not differ, and therefore males in this study had shorter talking turns.

In conclusion, the work of Turksta, et al, provided behavioral data from conversations of adolescents that may be used as comparison data for adolescents with communication disorders. This information can also be used as a reference and for comparison of communication behaviors expected of normally developing adolescents by professionals who are working with adolescents with emotional or behavior disorders.

Syntax
Nippold, Hesketh, Duthie, and Mansfield (2005) conducted a study of syntax development in expository and conversational discourse of children, adolescents, and adults. In this study, there were 120 participants divided into six groups (two groups of children- two groups of adolescents, and two groups of adults) and none of the study subjects were identified as having deficits in language or cognition. Subjects were asked to talk with an examiner about a common topic such as family, school, work, or friends, which resulted in a sample of conversational discourse. In order to attain expository discourse the subjects were asked to describe the rules or procedures of a favorite sport or game. Nippold, et al, indicated that although much research has been devoted to describing syntax of conversational discourse, much less is known about the syntactic structures used in expository discourse. They predicted that just as syntactic complexity increases in conversational discourse, developmental changes of increasingly complex syntax would be found in expository discourse. Indicators of sentence length and syntactic complexity that have been used in similar studies (Nippold, et al, 2005) were used as two measures of syntactic complexity: the terminal unit or “T-unit,” and the communication unit or “C-unit.” Each of these is used to analyze oral or written communication. Both the T-unit and the C-unit refer to constructs of an independent clause with any accompanying modifiers, including dependent, or subordinate clauses. An example of a “T-unit,” is And his brother has [independent clause] a car.

T-units are used to analyze connected speech of older adolescents and adults and are viewed as key markers of syntactic development, by measuring sentence length. C-units differ slightly from T-units in that they can include incomplete sentences in answer to questions. For example, in the following interchange, a C-Unit is underlined: Q- “What happened to the people who planned to accompany you on your trip?” A- “Oh, changed plans.” Examination of the use of T-units or C-units is an alternative to computing “mean length of utterance” or MLU. Computation of an MLU is the metric used for very young children who are using multiword utterances, but do not yet have sophisticated syntactic rules in place for their expressive language. Therefore, use of T-Units or C-Units is more helpful in the examination of adolescent language.

Results of the discourse study by Nippold, et al., revealed that syntactic development continued in both conversational and expository discourse through adolescence and into adulthood. As predicted, the complexity of syntax in expository discourse was greater than in conversational discourse. However, the authors also noted that there were individual variations at each of the age levels included in this study. This recent study of syntactic development provides important information regarding language developments that occur in adolescence. That is, anyone who is working with an older adolescent must realize that a “nearly adult” age does not equate to language skills of adulthood.

Possible problems that adolescents with language disorders may experience in the areas of “form,” “content,” or “use” are included in the following tables.

• Sentence length
  Examples
  Clarissa and her niece [expanded noun phrase] are planning a trip to the beach. They are going to take the scenic route that includes several hours of driving along the Atlantic coast. [prepositional phrase]
  Possible Problems
  Noun and verb phrases may remain simple; fewer clauses and prepositional phrases are used.


• Sentence clarity
  Examples
  John was so….well, I don’t know….he was, umm, he was not going to take a trip, or at least go with
  us to Florida, no, I mean, the Bahamas.
  Possible Problems
  Verbal mazes characterized by false starts, fillers, and hesitations and revisions.


• Sentence complexity-subordination clauses
  Examples
  The man that broke into our house [nominal subordinate clause] was caught when he stumbled over the cat [adverbial subordinate clause].
  Possible Problems
  Adolescent may use simple sentences that contain very few subordinate clauses—leading to
  restricted information expressed in oral or written language.


• Comprehension of linguistic features
  Examples
  Position of clauses within sentences; proximity of noun & verb within a sentence; ask/tell descriptions.
  Possible Problems
  These are later developing linguistic features that may not even be understood by all adults.


• Relative clauses in midsentence (Nippold, 1998; Larson & McKinley, 2003)
  Examples
  The runner who was wearing the red shirt won the race. vs. The runner who won the race was
  wearing the red shirt.
  Possible Problems
  Sentences with clauses at the end are easier to understand than sentences with relative clauses
  in the middle.


• Distance between noun and verb within a sentence (Nippold, 1998; Larson & McKinley, 2003)
  Examples
  My mother (noun) who is never home when I get back from school, and doesn’t seem to care
  what I do, wrecked (verb) her car.
  Possible Problems
  It is more difficult to understand a sentence in which the noun and verb are not in close proximity.


• Ask / Tell distinction (Larson & McKinley, 2003)
  Examples
  Errors in understanding sentences containing words such as ask, tell, promise, persuade, and
  threaten. Example: I don’t know why he threatens me every time I go near him.
  Possible Problems
  Distinction of ask/tell and related words are late-developing and may not be understood by all adults.

• Restricted Vocabulary
  Examples
  The stuff that goes into that thingy is really yucky.
  Possible Problems
  Lack of vocabulary words results in “empty” speech that is often vague or non-specific.


• Literate Lexicon
  Examples
  Words used in lectures, textbooks, or other educational settings.
  Possible Problems
  Academic difficulties are compounded when vocabulary words used in instruction are not understood.


• Figurative Language
  Examples
  Language that has both a concrete or literal meaning and an additional interpretation, or meaning of the stated words.
  Possible Problems
  Use of figurative language in conversational and social language results may affect social
  interactions, as well as confidence or self-esteem of an adolescent with difficulties
  with figurative language.


• Multiple meaning words MMW
  Examples
  down, keep, close, cut, fan,
  fresh, rank, pool, well
  Possible Problems
  To understand figurative language, one must be able to classify, define, and redefine MMW;
  comprehension precedes use.


• Metaphors & Similes
  Examples
  The sun is a fiery ball (metaphor). The sun is like a fiery ball (simile).
  Possible Problems
  Lack of both understanding and use leads to academic and social difficulties.


• Idioms
  Examples
  A linguistic unit also known as a ‘frozen figure of speech’ such as, “Beg the question.” Idioms may be
  formal, informal, or slang/clichés. For example: “pip squeak,” or “behind the eight ball.”
  Possible Problems
  Informal conversational speech contains a high proportion of idioms; adolescents who have
  comprehension difficulties have communication breakdowns and may also be the subject of ridicule
  when they have difficulties using or understanding slang used by their peers.

Informal conversational speech contains a high proportion of idioms; adolescents who have comprehension difficulties have communication breakdowns and may also be the subject of ridicule when they have difficulties using or understanding slang used by their peers.


Possible relationships between psychiatric, or emotional/behavioral disorders (EBD) and communication disorders have been suspected for nearly 40 years, with the Isle of Wright study (Rutter, Tizard, & Whitmore, 1970) serving as a frequently cited work that paved the way for subsequent decades (Benasich, Curtiss, & Tallal, 1993; McDonough, 1989; Prizant, et al, 1990; Warr-Leeper, Wright, & Mack, 1994). Although the nature of the relationship varies, children or adolescents with communication disorders are at risk for EBD, and many students with EBD appear to have language deficits (Baltaxe & Simmons, 1990; Cohen, Barwick, Horodezky, Vallance, & Im, 1998, Nelson, Benner & Cheney, 2005). Recently, researchers such as Blanton & Dagenais (2007), Conti-Ramsden & Botting (2004), Rescorla, Ross, & McClure (2007), and van Daal, Verhoeven, & van Balkom (2007) have explored concomitant language impairments and psychiatric or emotional/behavioral disorders. Benner, Nelson, & Epstein (2002) reviewed the results of 26 studies of students with emotional and behavioral disorders (EBD) and found that 71% of the students had clinically significant language deficits, which included difficulties with pragmatics, as well as expressive and receptive language skills.
         
In this course you have information that introduces some of the language deficits of children and adolescents with EBD, a brief review of literature that discusses the social development of children with language impairments, and discussion of language used by adults such as teachers or coaches, to instruct children. There may be a discrepancy between the language ability of students with EBD and the level or types of language used by educators, coaches, counselors or psychologists, and other professionals who work with these children or adolescents.

A basic knowledge of the skills that we expect adolescents to have and use allows us to consider possible relationships between communication problems and ED/BD. Just as an adolescent’s cognitive and language skills are individualistic, the relationship to their emotional or behavioral disorder is likely to be somewhat individualistic. It may appear that language difficulties interact, cause, or even result from emotional or behavioral disorders.

Nelson, Benner. & Cheney, (2005)
Nelson, Benner. & Cheney, (2005) examined 166 public school students who were identified as having emotional disorders (ED) to determine whether language disorders co-existed. They found that the majority of the students with ED did have significant language disorders. In addition, Nelson, et al, compared expressive and receptive language skills with types of behaviors.

Interpretation of the study’s results suggested that expressive language problems occurred more frequently in the students with ED, and that externalizing behaviors were related to both expressive and receptive language difficulties. In a more recent study by Nelson, Benner, Neill, & Stage (2006), the interrelationships among language, behavior, and academic performance were considered. Their exploration of these areas indicated that language skills did affect academic performance, but interestingly, externalizing behaviors did not appear to have a significant effect on academic or language skills. As Nelson, et al, indicated, these relationships need further study.

The Isle of Wright Study
The Isle of Wight study reported by Rutter, et al (1970) was one of the first examinations of a stable population of children that allowed consideration of possible relationships between psychiatric disorders and learning disabilities. The results of this study suggested that children who had overt behavior disorders (they included Attention Deficit Disorder, Oppositional Disorder, and Hyperactivity Disorder) were more likely to have a learning disorder (LD), and the LD was most frequently a reading disorder. In general, results of the Wight study and subsequent epidemiological studies support the observation that reading disabilities and overt behavior disorders do co-occur.

However, the causal relationship, if one exists, is a continued focus of study. Rutter, in this early study, identified possibly underlying mechanisms for the relationship between psychiatric and learning disabilities. Those hypothesized mechanisms included 1) temperamental characteristics, 2) effects of anxiety on learning, 3) psychosocial stressors that may have occurred at critical points in a child’s development, 4) lack of motivation or avoidance of learning, 5) impaired cognitive functioning, and 6) underlying factors (e.g., genetic or environmental) that may contribute to both a learning disorder and a psychiatric disorder. In the following section, results of more recent studies of social characteristics of children who have language disorders, and the converse situation in which language abilities of children that have emotional or behavioral disorders, are presented.
         
In the past three decades a number of researchers have examined the relationship of emotional disorders and language, or communication disorders. Some have focused on children who have a language disorder as the primary disability. Others have examined populations of children with emotional or behavioral disorders to see if concomitant communication disorders are present. For example, Cohen, Barwick, Horodezky, Vallance, & Im (1998) found that of 380 children (ages 7-14) who were referred for only psychiatric problems, evaluation of language and achievement revealed that 40% had previously undetected language problems. They recommended language and achievement evaluations for children who are referred for psychiatric assessment and practitioners should increase their awareness of the impact of communication disorders upon therapeutic outcome.

Rescorla, Ross, & McClure (2007)
Developmental psychology, special education, speech-language pathology and other research areas have produced an increasing number of studies that further our understanding of the interrelationship of language, communication, and behavior development. Rescorla, Ross, & McClure (2007) examined the relationship of behavior and communication disorders in a study in which they hypothesized that co-occurrence of behavioral/emotional problems and language delay would not be found in children younger than 3 years of age if they excluded children with PDD-spectrum disorders and/or low intelligence quotients. Rescorla, et al, reported results from two separate studies of children in developmental clinics in New York and New Jersey. The toddlers were between 18 and 35 months of age, with 83 children involved in the first study and 103 in the second research sample (seen at the 2nd clinic). Both clinics provided Early Intervention for infants and toddlers with a variety of at-risk factors, including premature birth. However, since the two settings involved different research teams, the populations varied in cultural diversity, and the evaluation protocols for cognitive development and language were not identical, Rescorla, et al, considered the studies to be replications, thereby strengthening the generalization of their findings.

Methodology for the studies included the use of several assessment tools such as the Language Development Survey (LDS), a 310 word vocabulary checklist developed by Rescorla in 1989. Parents completed the LDS, which yields information about words, word-combinations, and phrases or sentences that a child uses. To identify possible behavior/emotional problems that a child may exhibit, parents also completed the Child Behavior Checklist (CBCL). The authors used results from the CBCL to identify the presence of seven possible “syndromes”: Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn, Sleep Problems, Attention Problems, and Aggressive Behavior. Course participants are referred to the Manual for the Child Behavior Checklist/2–3 (Achenbach, 1992) for further information about the CBCL.

In addition to the LDS, the Preschool Language Scale-4 (PLS) was administered by a licensed speech-language pathologist to children seen at the 2nd clinic. The PLS-4 is a norm-referenced test of receptive and expressive language that yields Standard Scores for Auditory Comprehension, Expressive Language, and a Total Language Score (reflecting performance on the comprehensive test). At both clinics, additional developmental assessments were administered to facilitate identification of Pervasive Developmental Problems or other developmental problems that would fall in the PDD-Spectrum. Results from the two clinics were rigorously analyzed and Rescorla, Ross, & McClure concluded that neither study indicated a strong relationship between language delays and behavior/emotional disorders in toddlers. Their results were in agreement with a prior study by Rescorla and Achenbach (2002), of 278 toddlers in the same age range. In that earlier study, scores on the LDS and the CBCL were compared and low correlations were found, indicating that emotional and/or behavior problems and language delays were not closely associated in that sample population.

van Daal, Verhoeven, & van Balkom (2007)
More recently, van Daal, Verhoeven, & van Balkom (2007), published the results of their study of the behaviors of 71 five-year-old children who had been identified as having language impairment. This research is especially interesting because the authors not only looked at co-occurrence of language impairment and behavior disorders, but also drew conclusions between types of language difficulties that are associated with different behaviors. The stated goal of this study was to examine relations between different language components and specific behaviors. The 71 subjects were randomly selected from special education programs in the Netherlands. The children in these programs had nonverbal cognition at normal or below-average levels, had scored two standard deviations (SDs) below the mean on criterion-referenced language tests and did not have sensory-motor deficits or psychiatric disorders. The research group included 51 boys and 20 girls, but excluded all children with hearing impairments, all who were identified as having an IQ below 75, as well as those children who had an Autism Spectrum Disorder.

Dutch language tests were administered to assess morphosyntactic abilities, semantic development and pragmatic language skills. Course participants are referred to the published article of this study, in the Journal of Child Psychology and Psychiatry, for more detailed information about Taaltoets Alle Kinderen (TAK), which was described by van Daal, et al, as a “general Dutch language test” developed by Vanhoeven and Vemeer (2001). In addition, speech was assessed through administration of five experimental dyspraxia tasks. Auditory perception was measured through use of a Dutch experimental version of the Lindamood Conceptualization test (LAC), and with the sound discrimination subtest of the Dutch TAK.

Behavioral assessment was attained through administration of the Dutch version of the Child Behavior Checklist (Verhulst, Koot, Akkerhuis, & Veerman, 1990). The Dutch CBLC questionnaire was administered to the children’s parents, while speech and language tests were administered to the children at their schools. van Daal, et al, used the normative data from the standardized language tests (approximately 500 children ranging in age from four to eight years of age in the TAK and LAC norm groups) for comparison with the research group in order to find statistical evidence for differences in syntax, lexical-semantics, speech and phonology. They indicated that these language factors created a proficiency profile of children with language impairment. The results of the children’s behavior ratings (from the Dutch CBCL) allowed the researchers to determine the extent of the research subjects’ behavior problems.

By calculating correlations between four language factors and the CBCL scores, van Daal, et al, described relations between underlying language factors and observed behaviors. They found an overall negative correlation between language test scores and behavior disorders. That is, the lower the language score, the greater the number of identified problem behaviors. The semantics factor showed the greatest correlation with the CBCL subscales of social problems and attention problems. Further, lower scores in semantics also had a medium correlation with the CBCL areas of “withdrawn,” “anxious/depressed,” and “thought problems.” The speech factor (as measured with the dyspraxia tasks) was found to have a medium correlation with “social problems,” as identified with the CBCL. Scores in phonology showed large correlations with CBCL areas of “attention problems “and “social problems,” and medium correlations with “withdrawn,” “anxious/depressed,” “thought problems,” “delinquent behaviors,” and “aggressive behavior.” van Daal, et al, cautioned that behavior and language should be considered dynamic and constantly changing areas of development that are influenced by age, environmental effects, as well as intrinsic factors. However, they felt that the results of this study did demonstrate behavior problems in a group of children who had previously been identified as only having language impairment. They recognized that in some children there might be an underlying neurological problem affecting both language and behavior. While other children might have behaviors that were reactive to their language problems, and might also develop interactive problems. van Daal, et al, concluded that diagnostic evaluation of children with language impairment should include a behavior profile, that children with language impairment may need therapy to train social skills, and that failure to address such needs might result in psychiatric or social problems as the children grow to adulthood.

Fujiki, Brinton, Morgan, & Hart (1999)
Although research studies have not clearly demonstrated that emotional/ behavioral disorders can be identified in toddlers (younger than age 3) who have language delays, an emerging body of literature does support such evidence in preschool children and children of early elementary school-age. The possibilities of negative social consequences seen in children who have Language Impairment were explored by Fujiki, Brinton, Morgan, & Hart (1999). More specifically, they examined the relationship between language impairment and withdrawn social behavior. In their study classroom teachers were asked to rate withdrawn and social behavior of 82 children, using the Teacher Behavioral Rating Scale, an unpublished teacher questionnaire (Hart & Robinson, 1996) described in the published article of Fujiki, et al. The two groups of subjects in this study were 41 children with language impairment, matched with 41 peers (matched for age and gender) who did not have any disabilities. All of the children fell within two age ranges: 5-8 years and 10-13 years. In this study, three subtypes of withdrawal were identified and examined to attain further information regarding the possible relationships between language impairment and withdrawal.

Course participants are referred to the work of Fujiki, et al (1999), who cited numerous studies that support the delineation of 3 subtypes of withdrawal behavior, as outlined in the following table.

         Solitary-Active Withdrawal
         These children are rejected by their peers; engagement in solitary activities may be related to
         the action of the surrounding children, but there is no peer interaction.

         Solitary-Passive Withdrawal
         May also be called passive withdrawal or unsociable behavior. Child plays alone and seems to
         enjoy solitary play; peers in early and middle childhood may view these children negatively.

         Reticent Behavior
         May also be called passive-anxious. These children would like to interact with peers but are
         fearful and may watch others play without interacting.

Fujiki, et al (1999) provided extensive descriptions of the variability of withdrawal behaviors seen in children with language impairment. However, teachers reported the greatest differences between children with and without LI, in reticent behavior. Reportedly the teachers perceived that children with language disorders wanted to play with their peers but were too fearful, shy, or anxious.

They described reticence as off-task behavior or lack of activity, when a child was in a situation with many optional activities or interactions. Another finding of this research is of particular interest to those who are working with children who may have both LI and a behavioral or emotional disorder. The teachers reported that solitary-active behavior was a relatively rare behavior seen in all of the research subjects. However, the one group that displayed this the most was boys with LI. They emphasized the importance of this finding since this behavior can elicit negative attention and in other research (see Fujiki, et al references) it has been linked to impulsivity and aggression. Therefore, they concluded that boys with LI may be at greater risk for social difficulties. Fujiki, et al, suggested that the relationship between language impairment and social difficulties is complex, but language impairment is an important factor that may lead to social problems in children.

Ford & Milosky (2003)
Ford & Milosky (2003) examined kindergarten children’s abilities to label emotions when shown facial expressions. The subjects in this study included 24 children attending kindergarten, with two groups of 12. Twelve of the students had been identified as having language impairment with no concomitant disabilities present, and this group was matched with 12 kindergarten students who did not have any type of disability. The method used in this study employed the use of pictures of a cartoon character displaying four different emotions: happy, sad, surprised, or mad. The children were required to match the cartoon facial expression with a story that would consistently evoke one of the targeted emotions. To control individual comprehension differences, the stories were depicted in three different modalities: visually, verbally, or concurrent visual and verbal presentation. The authors further controlled the methodology by using three different stories so that each child would have only one story presented in each of the three modalities. This tightly controlled study revealed differences in how the children with language impairment inferred emotional reactions.

Although both groups of children were capable of identifying the emotions depicted in the character’s facial expressions, the two groups differed in their abilities to integrate the event knowledge (presented in the stories) with the emotional information depicted in facial expressions. The authors suggested that the children with language impairment (LI) were less proficient at making a correct social inference about the character’s feelings. Ford and Milosky also analyzed error response patterns and found interesting differences in the errors made by the two groups of children. The authors categorized emotional valence of “mad”/sad,” and “happy/surprised” as being similar (i.e., “mad” would be less similar in valance to “happy”). Error analysis revealed that when the children without LI mislabeled emotions, they tended to make a substitution error of an emotion that was closer in valence to the target emotion. Conversely, when children with LI erred they were likely to select emotions of a different valence (e.g., “mad” for “happy”).

The implications of this research are of particular interest to those who are exploring the possible relationship between communication disorders and emotional disorders. Inferencing errors such as these made by kindergarten children with LI may be a contributor to social difficulties, since these occur during early development of social processing (Ford & Milosky, 2003). Studies such as this 2003 work of Ford & Milosky, and earlier work of Horowitz, (1981), Rice, Sell, & Hadley (1991) and Gertner, Rice, & Hadley (1994) are of particular relevance to those who work with children who have Language Impairment (LI). Their research has revealed that children as young as 3 years old may tend to avoid conversing with peers who have language impairment and that children with LI are least liked by typical peers by age 4 years. This trend has also been shown to continue through school-age years, suggesting that children with language impairment are likely to be less popular than their peers without a language-based disability.

Qi and Kaiser (2004)
Qi and Kaiser (2004) examined the behavior of a group of 60 three- and four-year-old children who were from low income families and enrolled in a Head Start Program. Within this group, 28 of the children had typical language development while the other 32 demonstrated language delays. Unlike much of the research in this area, this study did not solely rely upon teacher or parent ratings of problem behaviors. Qi and Kaiser designed their methodology to include direct observations of the children in natural environment contexts. Highly trained research assistants observed the children during normal school and play activities, recording behavioral data on Palm Pilots that were programmed with the Multiple Option Observation System for Experimental Studies (MOOSES). MOOSES was developed by Tapp, Wehby, & Ellis (1995) as a tool that facilitates simultaneous recording of the frequency, duration, and/or intervals of target behaviors.

In this study, the frequencies of four types of aggression were recorded: verbal, nonverbal, physical, and aggression directed toward adults. Frequency of disruptive behavior (ex. running in the classroom without permission) and noncompliance, such as failure to respond to a teacher’s direction, was also recorded. Interactional behavior was analyzed to identify initiation (ex. child asks a peer for a toy, with a positive valence), and both positive and negative responses to peers. The duration of times in which a child was engaged (ex. playing a game in an appropriate manner) or involved in solitary activity (such as a paperwork assignment at their desk) was measured. How the target child behaved during teacher-directed activities was coded as “structured activity” and behaviors during any time that did not involve direct teacher instruction were considered to be “unstructured activities.”

Qi and Kaiser (2004) indicated that the results of this study revealed that children with language delays demonstrated higher levels of observed problem behaviors and lower social skills, when compared with their peers who had normal language development. The children with language delays also demonstrated more disruptive behaviors and engaged in fewer socially appropriate interactions than the children with typical language skills. In regards to interactions with peers, the children with language delays initiated fewer interactions than their typical-language peers. The authors of this study also noted that at the age of 3-years, problem behaviors seemed to be emerging in the children with language delays, however, the behaviors were not yet at a clinical level.

Although Qi and Kaiser pointed out that the observational and correlational results of this research do not reveal a cause and effect relationship between behavior disorders and language delays, the co-occurrence of these disorders is important for early intervention. They recommend that children at risk for behavior and language disorders should be identified prior to entering school, in order to implement effective intervention. Since the preschoolers with language delays demonstrated more disruptive behaviors during structured classroom activities, intervention within the classroom would be warranted to increase the likelihood of successful educational performance. Qi and Kaiser highlighted the need for teachers and clinicians to systematically observe children’s classroom behavior in order to make appropriate referrals and thereby reduce the under-identification of young children with behavior problems. Results of this study also support the need for all professionals who provide services to young children to consider and explore the possible co-occurrence of communication disorders and behavior disorders.

Conti-Ramsden & Botting (2004)
Conti-Ramsden & Botting (2004) conducted a longitudinal study of 242 children who were recruited at age 7 through randomized sampling of specialized language classes, termed “language units,” in British schools. In the United Kingdom language units were described as classes for children who have primary speech or language disorders and these classes have a high staff to student ratio (1:10). The staff members were described as either specialist teachers or classroom/speech therapy assistants. Although enrollment in the classes was initially dependent upon identification of some speech/language difficulties and all of the children had received speech-language therapy, the researchers reported that at the initiation of the study, not all subjects met strict criteria for Specific Language Impairment (SLI). However, the group was comprised of children with SLI or those who were thought to have either complex, or pragmatic, language deficits.

At the time of the follow-up, 200 children remained in the study and the average age at that time was 10 years, 11 months. Information about the children’s social skills was gathered through report from questionnaires administered to either the children or their teachers. The purpose of the study was to examine developmental patterns of social and behavioral difficulties in children with language impairment. The authors explored possible relationships between social difficulties and language abilities, as well as nonverbal cognition. An additional component of this study addressed whether the children had been targeted for victimization. Information about victimization was attained through administration of two of the questionnaires used in this study. The first was a subscale of the Harter Perceived Competence Scale, which was completed by teachers and used by these researchers to obtain an indication of the children’s peer acceptance or friendship with their classmates. The “My Life in School” (MLIS) questionnaire, which included 39 items about school experiences, was completed by the children in this study. Six of the items that are thought to be indicative of possible victimization were used by the researchers as a “victimization index.”
The MLIS is described as consisting of short, simple sentences which were read aloud to the participants so that reading abilities would not affect understanding. This longitudinal study included several stages during which cognition, nonverbal cognition, and specific speech and language performance was evaluated. The full scope of this study is of interest to all who are interested in understanding the complex interactions of cognition, language (both verbal and nonverbal), social skills and behavior problems. However, only the most salient aspects are reported here for the objectives of this course.

Results regarding victimization and friendship patterns of children with language impairment are of particular interest. Conti-Ramsden & Botting reported that the majority of the children with language impairment at age 11 also experienced problems in social and behavioral aspects of development. Interestingly a higher rate was indicated from self-report than from the responses obtained from teachers’ completion of the questionnaires. The authors reported that their results suggested that externalizing behaviors (e.g., aggression) tended to decrease across time, yet may be replaced with increased risk for victimization and social withdrawal. They recommended that further study is warranted to explore the presence of low self-esteem, depression, and social avoidance of children with long-term language disorders.


For practitioners working with those who have language disorders, the Bloom & Lahey area of language “use,” or pragmatics, most closely matches what others have termed a nonverbal language disorder (Volden, 2004). In 2000, when Asperger’s Disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), some felt that those individuals who fell within this diagnostic category had a primary nonverbal language disorder. Many individuals who were previously labeled as having “high functioning autism” were reclassified as having Asperger’s Syndrome. These individuals do have difficulties with language use, or pragmatics, and often fail to understand and use nonverbal communication in a typical manner, as well as have difficulty with figurative language and social interactions.

However, the areas of syntax and semantics are intact, and some individuals may have some areas of vocabulary that are highly developed. A quick overview of Asperger’s Syndrome is provided in the following table. Course participants are referred to DSM-IV for more complete information.

         Impairments in Social Interactions
         Problems with nonverbal behaviors, including eye gaze, facial expressions,
                     body positioning, and gestures.
         May not have peer relationships at expected level of development.
         Lack of spontaneous interactions with others, including emotional
                     give-and-take or shared enjoyment.

         Repetitive or Stereotyped Behaviors
         Interest patterns or preoccupations.
         Ritualistic behaviors or strict adherence to routines.
         Stereotypies- e.g. hand flapping, or repetitive motor movements.

         Language & Cognition are not significantly delayed
         Formal language evaluation does not indicate overall delays, although difference in pragmatics
                     (use of language) is present.
         Cognitive development, self-help and adaptive skills are typically not delayed,
                     yet social impairments affect occupational and adaptive functioning.


In this section of the course, evidence of communication skills of children or adolescents who have also been identified as having behavior disorders is provided.
         
McDonough (1989) reported that the expressive language skills of children identified with behavioral disorders were significantly below those of chronologically similar aged peers. The author wrote that "... emotionally handicapped subjects could not handle the conversational moves necessary to maintain coherent, fluent interactions" (p.137). In addition to conversational difficulties experienced by students with EBD, the research of Warr-Leeper, et al (1994) indicated that problems in understanding abstract language concepts, comprehending language without contextual support, and decoding language requiring rapid processing were also present almost ten times higher in children with EBD than in the general school population.
         
Varied language difficulties in the areas of syntax, grammar, and morphology rules, semantics (vocabulary), and pragmatics (social use of language), have been identified in children with disruptive behavior (Cohen, et al, 1998) and in incarcerated juvenile delinquents (Simmons & Glushenko, 1992). One study that actually compared the language skills of adolescents with, or without demonstrated behavior differences was completed in 1997, by Sanger, et al, who administered a standardized language assessment to 56 Caucasian females between the ages of 14 years and 18 years-old. Twenty eight of the subjects had been incarcerated at a juvenile correctional institution in the Midwest. The remaining twenty eight individuals, who served as the control subjects, were students in either junior or senior high schools in the Midwest. The formal evaluation of language skills was achieved through administration of The Test of Language Competence-Expanded (TLC-E), Level 2 (Wiig & Secord, 1989), which allows for assessment of semantic, syntactic, and pragmatic language performance. The researchers also examined the adolescents’ language by recording a 30 minute conversation between each adolescent and a female researcher, or research assistant. Each language sample was analyzed for discourse parameters using procedures based on those developed by Damico (1985), a widely accepted methodology that is used by both clinical and research speech-language pathologists.

Although the discourse error differences measured in the language samples were not significantly different between the two groups, the results of the TLC-E revealed lower scores for the incarcerated adolescents’ as compared to the nondelinquent students. The authors of this study reported that as a group, the female adolescents who were incarcerated and were not previously identified as having language or learning difficulties, had weaker language skills than their peers who were not previously identified as delinquent, or were incarcerated. Sanger and her colleagues also concluded that many juvenile delinquents may have learning and academic challenges in addition to language problems that have not been previously detected. They suggested that language and learning problems may have a negative impact on feelings of adequacy, self-esteem, motivation, and the acquisition of a broad general knowledge base, which impacts future academic success.
         
Although results of current studies of children with chronic behavior disorders reveal difficulties scattered across all language components, pragmatic deficits are a consistent finding. Pragmatic competence has been described as the ability to use language proficiently in social situations (Nippold, 1998). "Social use" of language applies to all environments in which an individual functions. Pragmatic language disorders are described according to the individuals involved, i.e., the dyad of speaker and listener, and by the contexts in which communication occurs. When pragmatic competence is assessed, an individual is observed in various communicative contexts in which the demands of the speakers, listeners, as well as the purposes of communication vary. The term "speech act" (Searle, 1986) has been used in descriptions of interactive communication, and refers to the ongoing communication between speaker and listener which involve comprehension of the words that are stated, as well as understanding of the speaker's intentions. It has been suggested that children with behavior disorders are often those who cannot respond to the speech acts used in their school or home environment (Norris, 1993).
         
Discourse difficulties, or language breakdowns identified within conversation, are a second major area of pragmatic language deficits that have been described in students with EBD. Discourse errors may include difficulty staying on a conversational topic, inappropriate responses, situational inappropriateness, and inappropriate speech style. Linguistic nonfluency and revisions were pragmatic deficits described by McDonough (1989) in her study of language skills of students with emotional handicaps within social interactions.
         
Wetherell, Botting, & Conti-Ramsden (2007)
Wetherell, Botting, & Conti-Ramsden (2007) examined the narrative skills of adolescents who had been previously identified with Specific Language Impairment (SLI), had scored at least one standard deviation below the norm on a standardized language test, and also had a nonverbal IQ of less than 85. Wetherell, et al, chose to look at this population because there has been some debate regarding the theoretical difference between children with SLI, and children with non-specific language impairment. The basis of this question asks whether there is a qualitative difference between children with SLI and children who have a primary language deficit and a nonverbal IQ (NVIQ) below the normal range.

The subjects of this study were adolescents with an average age of 14, who had been subjects of a larger study. Therefore, information about language and cognitive skills at earlier ages was available. At the time of this study, eight of the teenagers had NVIQ scores more than 1 standard deviation below the norm (i.e. below 85 with a Standard Score based on 100), and eleven had NVIQ scores within the normal range. All of the adolescents had a history of SLI, but did not have a primary pragmatic language disorder.

Two genres of narratives were sampled for this study: a story-telling task that used a wordless (pictures only) storybook, and a naturalistic narration in which the subject was asked to tell about a most annoying person. The narratives were analyzed for productivity, which was defined as the number of words and number of morphemes used by the adolescent in each of the two tasks. Syntax was measured by the following metrics:

         Syntactic units: simple sentences that contained a full main clause and any
         subordinate clauses belonging to it (ex. While the man was working, the dog ran away).
         Compound sentences (ex. That house is on fire and we need to call the police) were
         counted as two syntactic units.

         Complex sentences: those that contained complement or subordinate clauses, verbal
         complements, or passive construction.

          Syntactic errors of tense agreement, lexical errors, additions, or omissions.

For the story telling task, the researchers also considered how the teenagers described the story’s characters and established and maintained story-lines. These aspects of narration are indicators of cohesion and informativity (how much information is provided). Semantic measures involved measurements of the use of nouns vs. pronouns, as well as the degree of completeness that was reflected in propositions (ex., statements to introduce an idea). In the conversational task (in which subjects were asked to tell about an annoying person), the researchers noted how many “different annoying/naughty things” were reported. They chose that measurement as a gauge of quality or amount of information that was given in response to the question. The study also included the following “performance” measurements:

         Amount of investigator support needed by the student.
         Investigator prompts needed by the student.
         Fillers used by student (e.g., um, er, you know)
         Number of disfluencies (e.g., false starts, revisions).

The results of this study revealed that the students in the lower NVIQ group scored lower in productivity, using fewer syntactic units and fewer nouns. They also included fewer pieces of relevant semantic text in the story telling task than the group who had normal NVIQ scores. The lower NVIQ group produced longer narratives; however, further examination indicated that this was the result of a larger number of fillers or revisions.


The researchers described the NVIQ groups’ narratives as more effortful. Wetherell, et al, concluded that although the two groups in this study did not have significant differences on formal language tests, their everyday conversational language demonstrated differences revealed through analysis of the narratives. They interpreted these results as an important implication for identification of adolescents with subtle language disorders. These students may not be as easily identified by their performance on formal language tests, yet their difficulties with narrative language impacts classroom performance, as well as social interaction. Teachers, psychologists, SLPS, and counselors should consider these implications when they are working with adolescents who have low NVIQ.
         
Identification of the discourse difficulties of students with EBD suggests the possibility that pragmatic language deficits of these students may be perceived by teachers as aberrant behaviors. Teacher's perceptions of students with communication disorders frequently do not accurately reflect the academic abilities of the students (Ebert & Prelock, 1994).


Davis, Lane, Sutherland, Gunter, Denny, Pickens, & Wehby (2004) explained that implementation of federal legislation such as No Child Left Behind and the reauthorized Individuals with Disabilities Education Act (IDEA, 2004), is complicated by the varying definitions of curriculum. They differentiated three types of curricula. They described the adopted or official curriculum that is adopted by a school system as the intended curriculum. According to Davis and her colleagues, the materials that teachers use in a classroom and what the teachers do with those materials can be termed the enacted curriculum. The knowledge that students gain from these may be called the learned curriculum. Students who have language disorders, whether or not the difficulties co-occur with emotional/behavior disorders, are likely to respond differently to both the materials used in a curriculum, as well as the manner in which the information is presented.

In addition to the interactions that adolescents have within classroom settings, other aspects of a teenager’s life may be affected when they have a communication disorder. Masterson, Davies, and Masterson (2006) examined the linguistic demands that are placed upon students who are in extracurricular organized sports. They examined the language of five coaches of youth sports; two were coaching competitive basketball and the remaining three coached recreational basketball games. The youths included in this study were girls between the ages of nine and 14. The results of this study provided preliminary data that suggested that all of the coaches spoke more during group activities, as compared to individual interactions with the youths. Masterson, et al (2006) analyzed the coaches’ utterances for the following aspects of form: mean length of utterances (MLU), pauses, communicative repetitions and pauses. Although research has shown that a pause must last at least three second to be considered facilitative in a classroom, the pauses used by coaches in this study were shorter than 3 seconds. It was recognized that the stationary contexts of the coach-athlete interactions was not the same as in a classroom, but the authors suggested further study to examine whether shorter pauses results in the loss of teaching opportunities.

Of particular interest for this course, was the finding that the coaches’ utterances contained less than 10% mazes, which is a level that is conducive for comprehension. A prior section of this course presented research results that suggested a much higher percentage of verbal mazes used in classroom instruction. Masterson, et al (2006) also compared competitive coaches with recreational coaches and found that the utterances of competitive coaches contained fewer mazes that that of recreational coaches. Another area of particular interest for those who work with adolescents with LD/ED/BD was the coaches’ use of jargon. Jargon is the use of terms or phrases that are specific to a context, in this study, the sport being played. Jargon often included figurative language. Masterson, et al, found that competitive coaches used more jargon, (e.g., “stay in the paint on the defense”) than the recreational coaches. These researchers recommended further studies to measure player response and performance effects of jargon. However, the information in this course regarding the difficulty for LD/ED/BD students to understand figurative language suggests that those students would be at risk to not always comprehend the coaches’ instructions and their athletic performance might be impacted.


A common theme throughout much of the research reviewed in this course is that students with emotional and/or behavioral disorders are best served through the collaboration of a multidisciplinary team. In school settings, the Individual Education Program (IEP) may be the document that serves as the foundation for intervention and is developed by all the team members. Adolescents who are provided special education services in the U.S. will also have an Individual Transition Plan (ITP) that may involve other professions from the expected setting or program that the student will need in the future. In situations such as residential treatment centers, adolescents may have a treatment plan that is initiated under the direction of a psychiatrist or psychologist.

Treatment teams include all professions involved and may include professionals such as behavior analysts, counselors, social workers, educators, and speech-language pathologists. The literature regarding the co-occurrence of communication disorders and emotional/behavioral disorders highlights several possible roles for speech-language pathologists. SLPs may play a role in prevention through early identification of communication problems in young children who are at risk for development of behavior or emotional disorders. Treatment teams should consider referral of adolescents who have emotional/behavioral disorders to a certified speech-language pathologist for evaluation of communication skills. Collaboration of all team members is necessary when a student with EBD has been identified as in need of intervention. Although primary roles are typically defined by professional expertise, the manner and style of service delivery will vary with the severity of the student with EBD, as well as the treatment setting. Research in the past decade has been directed to developing a better understanding of possible precursors to EBD, with a goal of earlier intervention or prevention of the development of behavior disorders.

In 2000, Tomblin, Zhang, Buckwalter, & Catts published the results of a study developed to examine the relationships of language impairment (LI), behavior disorder (BD), and reading disability (RD). The subjects of their study were 581 children in the second grade, including 164 children who had language impairment. They found that children with LI were at a significantly greater risk for both BD and RD. From their examination of the associations of these three areas they concluded that children with LI had greater rates of BD because of their concomitant difficulties with reading. Tomblin, et al, suggested a causal relationship between the three areas, with LI serving as the precursor to the others. They found that behavior problems were more strongly related to reading than to spoken language, and suggested that effective reading intervention might reduce the occurrence of BD in children who have language impairment. Their findings provide us with additional information that highlights the importance of collaboration between educators (ie. classroom teachers and reading specialists) and SLPs, psychologists, and counselors.

Research by Bartlett, Flax, Logue, Vieland, Bassett, Tallal, & Brzustowicz (2002) compared phenotypic classifications for language impairment, reading discrepancy, and clinical diagnosis, revealing genetic factors for specific language impairment (SLI).

For the areas of reading and writing, the American Speech-Language-Hearing Association (ASHA, 2002) has identified the knowledge and skills needed by speech-language pathologists who are working with adolescents, and school age children. The areas and skills needed by SLPs, as identified by ASHA, was the result of work of an ad hoc committee on reading and writing.

The writers of the ASHA document first recognized that all certified speech-language pathologists (SLPs) have a basic foundation of knowledge and clinical skills related to language development and disorders. In this course, participants have reviewed very basic parameters of language development, with an emphasis placed on developments that occur in older children through adolescence, and into adulthood.

The ad hoc committee members also cautioned that the boundaries between “knowledge” and “skills” are not always clear — a point that can be equally applied to the various professionals who work with students with LD and behavior or emotional disorders.

The third assumption of the ad hoc committee was that typically there are collaborative responsibilities and roles shared by SLPs with other professionals who work with children or adolescents with reading and or writing difficulties.

Finally, the ad hoc committee recommended that the skills and knowledge needed for effective clinical practice require multiple learning experiences and cannot be attained by simply reading the guidelines.

In the following section of this course, a very brief sample of some of the knowledge and skills needed for working with adolescents who have reading and writing difficulties is provided with this same caution. That is, the following information is included in this course to increase participants’ awareness of the types of reading and writing deficits that may occur in adolescence, and participants should explore references or readings included in Appendix A for further descriptions.


The ASHA position regarding SLPs’ roles recognizes the nature of literacy as including “spoken-written language relationships, and reading and writing as acts of communication and tools of learning (p.456).” Adolescents who have language disorders may also have difficulties with the following skills: higher order thinking, abstract language, and/or metalinguistic abilities. These individuals may also experience difficulties with metacognitive skills that are necessary for successful reading or writing. Metacognition refers to the ability to think about thinking, while metalinguistic refers to the ability to use language to describe and regulate language.

The roles and skills that ASHA recommends for SLPs are extensive and for the purpose of this course, only a few will be described here. In addition to the prevention and identification roles that SLPs have (e.g., providing input for at-risk children, and evaluating those who are identified through screening or referral as individuals who may have a language disorder), the SLP treatment responsibilities extend further than the role of being a direct interventionist. For example, the SLP should be an advocate for an adolescent who has a language disorder and as a member of an interdisciplinary team, should “identify tools and strategies to be employed by each member of the team, in some cases sharing roles, as on transdisciplinary teams (p. 460).” In this author’s experience in working with adolescents with behavioral or emotional disorders, the SLPs advocacy role may include the following:

         Explaining the nature of the adolescent’s language disorder and
         the impact on educational performance.

         Explaining how language difficulties must be considered in behavioral intervention plans.

         Participate in the development of behavioral plans to assure that
         vocabulary and sentence structure matches the adolescent’s language comprehension.

         Participate in development of behavioral plans in which consequences may include a
         requirement for the adolescent to discuss their behavior:
                     Alternative methods may be necessary for an adolescent who cannot
                     write a description of why a targeted behavior was not acceptable.
                              Picture boards
                              Tape recorded explanations

In settings such as an alternative school or juvenile detention center, the SLP may be involved in the development of written material that is presented to adolescents to advise them of expected behaviors. For example, if a treatment unit has written rules or descriptions of acceptable/unacceptable behaviors and possible consequences, it is imperative that the written material be offered at language levels that the students can comprehend. In some settings, adolescents are asked to write out an explanation of events that led to an incident such as aggression or “acting out.” If an adolescent with EBD has even a mild language disorder, they may have significant limitations in their ability to write a narrative explanation of behavior.


Who & How
Many of the studies included in this course are directed toward identifying early signs of EBD, as well as co-occurrence of language disorders and emotional or behavioral problems. Application of this information suggests a need for prevention and early intervention for all disabilities that impact academic and social development. Only a small subset of students with EBD may ever become violent, yet as schools in the United States have experienced greater numbers of incidents of violence, practitioners in public education have recognized the need for prevention of violence, as well as for earlier identification of at-risk students.

Some of the research discussed in this course involved incarcerated youth, and there have been only a few very recent studies that considered intervention with students who have been violent. Course participants have reviewed information that explores relations between language/communication development and emotional/behavior disorders. The early development of problem behaviors seen in children with language impairment was detailed.

Since students with communication disorders are typically seen by speech-language pathologists, and some of these students may have been involved in violence, the role of SLPs in intervention may differ along the continuum of severity of students’ behavior or emotional disorders. Similarly, counselors and psychologists may be the first professionals to work with students who may also be at-risk for language disorders.

Sanger, Moore-Brown, Montgomery, and Hellerich (2004)
Several studies discussed in this course have highlighted the need for early identification of behavior or emotional problems in young children who have language impairment. Additional information is provided by Sanger, Moore-Brown, Montgomery, and Hellerich (2004), when they explored the role of SLPs who work with students who have communication disorders and have been violent. They distributed questionnaires to 578 SLPs working in eight states that represented regions of the United States. The questionnaire consisted of 26 items directed toward gathering information about many areas, including the amount of SLPs’ training in working with students who are violent, their training in behavior management, and their understanding of communication and violence. Basic information about each SLP’s professional training was collected, as well as information about their participation on multidisciplinary teams and in prevention programs. An additional section of their survey included open ended questions that asked the participants to express their opinions or concerns about providing services to students who had been involved in violence. The results of this study revealed that the training of SLPs to work with these students varied, yet both groups (those who had received training, and those who had not) recognized the importance and the challenges of addressing the students’ communication problems. Sanger, et al, identified the following five areas of concern:

         Do SLPs fully understand the role of communication in violence?

         Are educators aware of the role of communication in violence?

         SLPs need to have adequate training for provision of services to students who have been
         involved in violence.

         SLPs need to have training in behavior management.

         SLPs need sufficient understanding of multicultural issues to appropriately provide
         services to students with communication disorders who have been involved in violence.

The SLPs who participated in this study recognized that their role in providing services to students who have experienced violence is extremely important, but did not agree that all SLPs understand their role. Although participants recognized that SLPs are important in the multidisciplinary team model of service delivery, and that speech-language pathology services can positively impact behavior, social interaction, and academic performance, they did not report that they were sufficiently trained to provide these services. Sanger, et al, discussed the limited amount of research that has been directed toward understanding the interactions of communication and behavior in children who have emotional or behavioral disorders, particularly those students who have been involved in violence.

They recommended that more professional training opportunities should be developed for SLPs and suggested distance learning as a possible venue. In a similar study, Nungesser & Watkins (2005) identified preschool teachers’ reactions to challenging behavior in the classroom and discussed implications for SLPs who work with these children. Current findings in SLP research suggest that SLPs will most assuredly be members of the interdisciplinary teams who will work with children with emotional/behavioral disorders.
         
Ritzman & Sanger (2007) continued this area of research in a similar survey study that asked school principals their opinions of SLPs providing services to students who had been involved in violence. This study yielded 423 questionnaires completed by principals of elementary, middle, and high schools. As found in the study conducted by Sanger, et al, speech-language pathology services to students who had been involved in violent acts were considered to be of value. Although a wide array of feedback was attained through this survey study, one theme of particular importance to SLPs who are increasing their skills for working with these students was the service delivery model.

That is, a team approach was advocated, with some respondents highlighting the need for collaboration and communication. Ritzman and Sanger (2007) reported great diversity in the principals’ reports of SLPs involvement in serving students who are prone to violence. They cited comments indicating that some school multidisciplinary teams relied upon SLPs to be integral members, while others reported that their school-assigned SLPs were only marginally involved. One fourth of the principals expressed concern about education and training in behavior management and working with behavior disorders- not only for SLPs, but also for teachers. Ritzman and Sanger (2007) noted that the shortage of SLPs in schools was another area of concern for the principals who were surveyed. They concluded that the role of SLPs to special education students with behavioral/emotional problems is important and that a variety of service delivery models should be used. Collaboration/consultation with teachers, school counselors, and other team members would allow indirect intervention for those students who have communication problems but may not have been eligible for direct therapy services.


Public policy developments have impacted the service delivery models for students with ED/BD. Since 1975, when The Education for all Handicapped Children Act (Public Law 94-142) was legislated, services for all students in U.S. public schools have been mandated by U.S. federal law. The 1990 reauthorization of Public Law 94-142 expanded the number of disorder categories for children served in U.S. public schools and additional categories were included in subsequent reauthorizations.

According to Congressional Research Service Reports (Appling, 2002), the largest category of students served in 1998-1999 were children with specific learning disabilities. The other disabilities of students served were: mental retardation, hearing impairments, speech or language impairments, visual impairments, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, and other health impairments.

In 1997 The Education for all Handicapped Children Act was rewritten to express people first, so that children with disabilities were no longer referred to as “handicapped children,” rather children with disabilities. The law was renamed The Individuals with Disabilities Education Act (IDEA) at that time. Course participants may wish to review a more comprehensive review of special education legislation in Moore-Brown & Montgomery (2001), or on-line at http://www.ed.gov/offices/OSERS/Policy/IDEA/index.html .

As violence has increased in school settings, practitioners have turned to federal law for guidance for how to best provide a Free Appropriate Public Education (FAPE) to children who may be violent. An amendment to IDEA was made in 1994 that allowed states to remove a student with a disability from their education setting, if the student had brought a firearm to school.

The FAPE requirement was then met by placing the student in an alternative school setting. In the 1997 reauthorization, a change that was especially relevant to those who work with EBD adolescents was the definition of Free Appropriate Public Education (FAPE), which mandated that a FAPE must be made available to all children with disabilities, including children with disabilities who have been suspended or expelled from school. Potentially dangerous students who have disabilities are subject to any of the following three actions:

         They may be suspended for up to 10 days without any educational services.

         They may be reviewed in a manifestation determination
         to identify whether their behavior is related to a disability.

         If it is deemed that the student may be of harm to self, or others within the
         current education placement, then they be placed in an interim alternative education setting;
         this placement may last up to 45 days and is renewable.

Although other possible changes to the provisions of IDEA which pertain to discipline of students who are violent were discussed, no further modifications to FAPE have been mandated at this time. As the U.S. continues to experience school violence, it is likely that discipline of students, both with- and without disabilities, will be highly scrutinized.

The reality of service delivery for adolescents who have behavior disorders and live in the United States is that treatment is shaped by public education laws and the intervention models used in residential treatment centers, short-term acute care units, alternative schools, or juvenile detention centers. The roles of psychologists, counselors, social workers, educators, and speech-language pathologists may be somewhat different within these settings.
         
The use and application of the research based evidence presented in this course will vary with the purposes of each course participant who chooses to study this topic. Although researchers began to address the relationship of emotional or behavioral disorders with language-learning disabilities more than 30 years ago, the relationship has not yet been fully described. In the past decade more research has been undertaken which examines the language of adolescents, as well as the language difficulties of adolescents who have ED/BD. Contemporary studies are being developed to explore the emotional impact of language disorders, as well as the complexity of language used by adults who work with adolescents. Studies are also being undertaken to examine the impact of language impairment on emotional and social development. The convergence of these research areas will likely add to the body of scientific information necessary for evidence-based practice, and as response to intervention (RTI) models are studied, we can expect further information to guide us in our work with adolescents who have disabilities that involve language, behavior, and emotional development.



What are signs to watch for that may suggest previously undetected language difficulties?
         Student’s speech is characterized by frequent use of vague words such as, “stuff,” or “thing;”
         frequent pauses and fillers, such as “ummm,” “uh,” “you know.”

         A student uses language inappropriate to a situation (such as speaking
         too informally to an authority figure).

         A student may initially react inappropriately to what is said, yet change demeanor or
         behavior as the conversation continues and he/she has more information
         to facilitate understanding.

         A student has unexpected reactions to activities that involve language.

                     Dislikes games that require vocabulary use or understanding
                     (“Mad Libs,” Charades,” etc.).

                     Insists upon a map or drawing, rather than written directions.

                     Fails to complete written assignments, in contrast with consistent completion of work
                     that doesn’t involve writing. The tasks may be academic, but also might be journal type
                     assignments used in counseling.

         A student over-uses, or misuses a cliché or slang word, failing to realize
         that he/she is doing so.


What can I do if I work with students who are at-risk for language difficulties?
Periodically check for comprehension and restate information in more simple sentences if there is a possibility that your verbal delivery style is not understood.

Make sure that your instructions include statements to supply information or provide direction.

Avoid use of abstract analogies or metaphors to explain situations.

A student who does not understand expository text structures may have problems with:
                     Organization of study notes
                     Use of mnemonic strategies
                     Following outlines
                     Efficient preparation of spoken or written work

A student who has difficulty putting thoughts into words may appear to be reticent or uncooperative.

Refer students suspected of having difficulties in higher-level aspects of language.
                     This may include formal examinations administered by an SLP,
                     Observation of the student in classroom settings, or
                     Sampling of the student’s written work and homework assignments.

If the interdisciplinary team does not include a speech-language pathologist, check to see if consultative services may be available from a certified SLP.
                     Consultation may include a communication evaluation resulting in recommendations for
                              all who are working with the student.
                     Consultation may involve rewriting of behavior management plans in language that is at
                                          a level that supports effective communication with the student.

Consider whether I need further education or training in any of these areas:
                     Behavior management?
                     Understanding how language and behavior may interact?
                     Identifying warning signs that behavior problems may develop
                              secondary to language impairment?
                     Identifying whether language impairment is a component
                              of a student’s behavior disorder?
                     Understanding how behaviors/emotional problems are defined by the current
                              authorization of the Individuals with Disabilities Education Act (IDEA)?



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Appendix A: Supplemental Reading List
Ellsworth, P. & Sindt, V. (1992). What every teacher should know about how students think: A survival guide for adults. Eau Claire, WI: Thinking Publications.
Flasher, L.V. & Fogle, P.T. (2004). Counseling Skills for Speech-Language Pathologists and Audiologists. Clifton Park, NY: Delmar Learning.
Fodor, J.A. (1979). The language of thought. Cambridge, MA: Harvard University Press.
Haynes, W. O. & Shulman, B.B. (1994). Ti
New Jersey: Prentice-Hall.
Johnson, J. (2006). Thinking about child language. Eau Claire, WI: Thinking Publications.
Leonard, L. B. (1998). Children with Specific Language Impairment. Cambridge, MA: MIT Press.
Lindamood, C., & Lindamood, B. (1971). Lindamood Auditory Conceptualization test (LAC). Austin, TX: Pro-Ed.
Loban, W. (1976). Language development: Kindergarten through grade twelve. Urbana, IL: National Council of Teachers of English.
Piaget, J. (1964). Cognitive development in children: Development and learning. Journal of Research in Science Teaching, 2, 176-186.
Paul, R. (2001). Language disorders from infancy through adolescence: Assessment and intervention. St. Louis, MO: Mosby.
Reed, V.A., McLeod, K., & McAllister, L. (1999). Importance of social communication skills for talking with peers and teachers: Adolescent’s opinions. Language, Speech, and Hearing Services in Schools, 30, 32-49.
Simon, C.S. (1985). Communication skills and classroom success: Assessment of language- learning disabled students. CA: College Hill Press.
Simon, C. S. (1998). Assessment of classroom communication and study skills. Tempe, AZ: Communi-Cog Publications.
Ukrainetz, T.A. (2006). Contextualized language intervention: Scaffolding PreK-12 through literacy achievement. Eau Claire, WI: Thinking Publications.
Verhoeven, L, & Vemeer, A. (2001). Taaltest alle kinderen (TAK) (Language Test for Children). Arnhem, Netherlands: CITO.
Wallach, G.P. & Miller, L. (1988). Language intervention and academic success. Boston: Little, Brown, & Co.

Appendix B: Glossary
Behavioral Approach to Language Development - Also known as the “empiricist” approach. B.F.Skinner was one of the primary proponents of this explanation of communication development which was described in his text Verbal Behavior, published in 1957. Language is learned or conditioned through experiences; verbal behaviors are learned by operant conditioning. Therefore, language is learned through imitation, practice, and selective reinforcement.
C-Unit - Term used in analysis of connected speech in which the speaker uses complex sentences. The C-Unit is an independent clause and all of its modifiers. This method of assessment replaces the Mean Length of Utterance (MLU) that is used for speakers whose expressive language is just emerging into use of sentences.
Conventional Code (as used to describe language) - Speakers of any specified language use a finite number of symbols (ex. words) to encode meanings to communicate. The code is considered to be conventional because entities (such as ‘all speakers of English’) agree upon the meanings of words.
Discourse - How language is used; different purposes include conversation, expository (to inform), and narration (to tell a story). Classroom discourse includes the formal lecture format used by teachers, understanding of textbook formats, as well as skills for writing and speaking in informative or expressive styles such as essays, or speeches.
Genotype - Variations of a gene at any particular locus, which comprises the genetic make-up of an individual.
Genre - Style or type. In pragmatic language development, genre refers to types of discourse, such as expository, narrative, or conversational.
Grammar - Refers to the set of rules for any given language. Historically, theories of language development have included “Case Grammar” – which is a generative system that is based on meaning (semantics); words are categorized into broad concepts. “Transformational Grammar” is a theory that attempts to describe the underlying system that allows for all words and sentences of a specified language to be generated. “Transformational- Generative Grammar” defines knowledge that a speaker has that allows them to form sentences.
Metalinguistics - The ability to use language to talk about language; an awareness of the functions of language. Students learn to understand how language is used as a tool, and how to think about it as an entity separate from its function.
Morpheme - A minimal meaningful unit of language roughly thought of as root- words, prefixes, and suffixes. Morphemes are of two types: free morphemes can stand alone, as in the word “kiss.” Bound morphemes must be attached to a morpheme in order to be meaningful. An example of a bound morpheme is “ing” > kissing; kiss is the free morpheme and “ing” is the bound morpheme.
Narrative - A form of discourse; “Story telling,” or monologue. The speaker must stay focused on a topic, using a format that is culturally influenced. A complete narrative has a setting, initiating event, response(s) to the event, attempts to reach a goal & consequences of the attempts, ending with a resolution of the story.
Nonverbal Communication - Any communication that does not involve words or sentences. Some examples include: gestures, pointing to pictures (as some augmentative communication systems require), facial expressions, tone of voice, laughter, sighs, rate of speaking, proximity (distance between speaker & listener).
Pervasive Developmental Disorder - Spectrum, Pervasive Development Disorders- Neurologically based disorders that entail a wide range of variation, but all involve difficulties in socialization, behavior, and communication. PDDs include autism, Asperger’s Syndrome, Rett’s Disorder, Childhood Disintegrative Disorder, and “PDD-NOS (not otherwise specified) for those disorders that do not fall within any of the other PDD diagnostic categories as defined in the Diagnostic and statistical manual of mental disorders-4th Ed. (DSM-IV).
Phonology - The sound system of a language; it is rule-based, with each language having its own phonological system or rules. In the Bloom and Lahey model, phonology fall within the “form” aspect of language.
Pragmatics (Use) - Communication functions, or reasons for speaking/writing; Includes discourse skills, such as turn-taking and topic maintenance, as well as skills for modifying speech to meet the needs of different listeners or varying situations. In the Bloom-Lahey model, pragmatics refers to language use.
Psycholinguistic -Syntactic Model of Language Development- Acquisition of language is an innate, physiologically determined phenomenon. In the 1960’s, psycholinguist Noam Chomsky described the underlying mental representations thought to be necessary, with emphasis placed on syntax.
Schemata/Scripts - Cognitive representations of information about routine events, objects, or classes of objects. In the Piagetian approach to describing early cognitive development, actions of infants exploring their world are called “action or object schemes.” Event representations, or scripts, support early language development. Schema information is hierarchically organized and increases in detail with repeated exposure, adding to complexity or richness. A script is one type of schema. Comprehension of oral or written discourse (i.e., text) involves use of schema information that allows us to draw inferences that facilitate comprehension.
Semantic - Cognitive Model of Language Development- In late 1960’s and early ‘70’s, Lois Bloom described language acquisition with emphasis placed on meaning conveyed by children’s early utterances. From her work, more focus was then placed on the role of cognitive development in language learning and less emphasis placed on syntactic (structural) development.
Semantics (Content) - Using the Bloom-Lahey model, semantics is the content or meaning of language; vocabulary, word meanings, and/or lexicon.
Specific Language Impairment - A term that was first defined as a language impairment substantiated by a language age at least 6-12 months lower than mental age on a formal test; a discrepancy between language and cognition. Later, researchers have used the term to refer to children who have problems primarily confined to language, without concomitant cognitive deficits (i.e., mental retardation). L. Leonard, a major research contributor in the area of SLI, describes SLI as children who have significant limitations in language abilities, but do not have hearing impairment, low nonverbal IQ, or known neurological damage; prevalence is approximately 7% and it occurs more often in males than females.
Scripts - Cognitive representations that form from generalization of the experiences that occur within an event. We use internalized scripts to navigate through daily life; adolescents much learn a large number of school scripts. Examples include, “Going from homeroom to wait for a bus,” or “Following verbal directions within classes.”
Spatial Terms - Those words that refer to locations in space; an early developing spatial term is “in,” whereas later developing spatial terms include, “in front of,” or “beside.” Prepositions, such as, “in,” or “on” are often used to express spatial relationships.
Syntax (Form) - Grammatical rules for how words are combined to form sentences; structure of language. In the Bloom-Lahey model, syntax is considered to be the form of language.
T-Units - A measurement of syntactic complexity used for students at the elementary level and through adulthood; accommodates the long, run-on sentences typical of conversation. The T-unit is one main clause with all subordinate clauses and nonclausal phrases attached to or embedded in it. T-Units are the preferred metric to use in language analyses of older children. This replaces the “Mean Length of Utterance” (MLU) procedure used for analyses of syntax used by younger children. T-units were first developed for examining written language.
Temporal Terms - Those words that reference location in time; timing of events or actions; Examples include “after,” “before,” “while,” “as,” “later,” “during,” or “when.”
Verbal Communication - Any symbolic communication that uses words, whether spoken or written.

Copyright Janet Harrison, Ph.D., CCC-SLP



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