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www.speechpathologyaustralia.org.au
ACQ
Volume 11, Number 3 2009
157
Mental health
Laura Caire
•
understanding questions posed by police and solicitors;
•
understanding the court process;
•
dealing with complex information and understanding
lengthy explanations (such as those regarding diagnoses,
medication and treatment options);
•
understanding ulterior motives, such as recognising when
they are being scapegoated or set up by peers, being
taken advantage of, or knowing when another person is
joking or serious;
•
practising appropriate social behaviour including empathy
and using language in a way that takes account of a
social hierarchy (e.g., peer vs. teaching assistant vs.
principal);
•
appropriately problem-solving and resolving conflict
through offering of verbal solutions (vs. aggressive/
physical/impulsive ones) and negotiating outcomes;
•
taking responsibility for their actions (when they may not
even understand what they did wrong);
•
proposing ways to make amends;
•
telling a clear narrative of events using adequate detail
and sequencing;
•
making positive peer and community connections;
•
giving reasons for their behaviour and actions;
•
organising themselves, planning ahead and formulating
goals;
•
making sound judgments and thinking through decisions;
and
•
regulating affect, behaviour, and emotional arousal and
controlling their responses and participating in talking-
based therapies.
(Cohen et al., 1998; Conti-Ramsden & Durkin, 2008;
Gilmour, Hill, Place, & Skuse, 2004; Hart, Fujiki, Brinton, &
Hart, 2004; Sanger, Moore-Brown, Magnuson, & Svoboda,
2001; Snow & Powell, 2008; Fujiki, Spackman, Brinton, &
Hall, 2004; Speech Pathology Association of Australia, 2001;
Zadeh et al., 2007).
It could be argued that because of these adolescents’
inability to request assistance or participate in
communicative discourse with mental health and legal
professionals they could easily be taken advantage of or
not treated fairly as a result. In the Charter of Human Rights
and Responsibilities document “Protection of freedoms and
rights for everyone in Victoria”(2009), Victoria’s Attorney-
General, The Hon. Rob Hulls MP, writes “At the heart of
Victoria’s Charter of Human Rights and Responsibilities is
respect: the belief that everyone is entitled, as we say, to
‘a fair go’” (p. 2). On their website under “The Victorian
Charter of Human Rights and Responsibilities explained” the
This article provides a brief overview of
findings in the literature concerning
comorbidity of communication impairment
and social, emotional, and psychiatric
difficulties including those associated with
juvenile offending. The need for and role of
speech pathologists in mental health and
forensic settings is discussed.
L
anguage is an essential tool for communication
(Speech Pathology Association of Australia, 2001).
It is through language that humans learn to express
emotions and thoughts, develop self-image and influence
the behaviour and attitude of others. It is not surprising,
therefore, that the comorbidity of communication disorders
and mental health problems has been estimated as
ranging from 50% to 80% (Baltaxe & Simmons, 1988;
Benner, Nelson, & Epstein, 2002; Cantwell & Baker, 1991;
Cohen, Barwisk, Horodezky, Vallance, & Im, 1998; Cohen,
Davine, Horodezky, Lipsett, & Isaacson, 1993; Eichmann,
2008; Giddan, Milling, & Campbell, 1996; Gualtieri,
Koriath, Bourgondien, & Saleeby, 1983; Kotsopoulos &
Boodoosingh, 1987; Zadeh, Im-Bolter, Cohen, 2007).
Many of these language impairments are unsuspected.
Among children who have a language impairment, the most
common types of psychopathology are externalising ones,
e.g., ADHD, CD, ODD (Zadeh et al., 2007). Many juvenile
offenders also present with language impairment. For
example, in a study conducted by Snow and Powell (2008),
more than 50% of a community sample of male youth
offenders had unidentified language impairment which could
not be accounted for by low IQ. The participants presented
with particular difficulties in narrative (storytelling) skills and
figurative/abstract language.
It is ironic that although so many juvenile offenders
present with language impairment, the justice system
expects them to perform many tasks that require higher level
metalinguistics, executive functioning and language skills,
without appropriate communicational support. The tasks
include:
•
understanding rules, linking actions to and predicting
consequences;
•
learning from their “mistakes” and responding to
punishment;
•
comprehending commonly used signs such as “no
trespassing” and words like “penalty, caution” and
“flammable”;
Exploring the need for the
speech pathologist in forensic
and mental health settings
Laura Caire
Keywords
adolescent
language
juvenile
offenders
psychiatric
disorder
mental health
communication
impairment