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ACQ
Volume 11, Number 3 2009
ACQ
uiring knowledge in speech, language and hearing
Mental health
Dean Sutherland
This article
has been
peer-
reviewed
Keywords
COMMUNICATION
LANGUAGE
BEHAVIOUR
CHILDREN
ADOLESCENTS
Communication impairments
and behaviour problems in
children and adolescents
A review of the literature
Dean Sutherland, Brigid McNeill, and Gail Gillon
Communication impairments and
behaviour problems
Preschool children
The association between communication impairment and
problems with behaviour and social skills is evident from a
young age (McCabe, 2005; Qi & Kaiser, 2004). Qi and Kaiser
investigated the behaviour and social skills of 3- and
4-year-old children (n = 60) from low socioeconomic
backgrounds who were attending a head start program. The
behaviour characteristics of 32 children with receptive and/or
expressive language delays were compared with 28 children
with typical language development. A combination of
classroom observations and teacher reports were used to
determine that children with language delay demonstrated
significantly higher levels of behaviour problems (e.g., hitting
other children and disrupting class). McCabe (2005)
examined behaviour and social skills of 170 preschool
children with and without speech and/or language
impairments using teacher and parent ratings. McCabe
found children with language impairment were rated as less
social and exhibited more errant behaviour (e.g., physical
aggression) compared to children with speech impairment
only or to children without communication impairment. In
contrast, McCabe and Meller (2004) found no difference in
problem behaviours reported by teachers and parents for
4–5-year-old children with and without speech-language
impairment. However, in comparison to children with typical
language development, children with speech-language
impairment were rated lower on a measure of self-control by
parents and lower on assertiveness by teachers. These
studies contribute to a growing evidence base supporting
the early emergence of a relationship between
communication impairments and behaviour problems. Early
language and behaviour difficulties are in turn likely to hinder
children’s readiness for school entry (Justice, Bowles, Pence
Turnbull, & Skibbe, 2009) which also increases the risk of
poor academic outcomes (Duncan et al., 2007).
School-aged children and adolescents
School-aged children with specific language impairment (SLI)
often experience social and behaviour problems in
classroom contexts (Conti-Ramsden & Botting, 2004). For
example, school-aged children may experience difficulty
following multi-step classroom instructions which a teacher
may interpret as non-compliant behaviour (Redmond & Rice,
1998). Conti-Ramsden and Botting (2004) used a range of
behavioural questionnaires and checklists (e.g., Strengths
Young children experiencing communication
impairments may also display behaviour
problems that persist into adolescence and
adulthood, contributing to a range of negative
long term outcomes such as low academic
achievement and anti-social behaviour.
Additionally, children and adolescents
identified with behaviour problems often
present with undiagnosed communication
impairments. This paper provides a narrative
review of research that has investigated the
relationship between communication
impairments and behaviour problems in
children and adolescents over the past 30
years and examines the potential role of
speech pathologists working in this area of
practice.
C
hildren with communication impairments are at
increased risk of experiencing social, emotional, and
behaviour disorders (e.g., Gallagher, 1999; McCabe,
2005). Similarly, children with emotional and behaviour
disorders often present with coexisting communication
impairments (Camarata, Hughes, & Ruhl, 1988; Ruhl,
Hughes, & Camarata, 1992). Comorbidity estimates of
communication disorders and behaviour disorders range
from 12% to 71% (e.g., Benner, Nelson, & Epstein, 2002;
Pinborough-Zimmerman, Satterfield, Miller, Hossain, &
McMahon, 2007) with methodological differences across
studies contributing to the variation in reported rates.
The prevalence of communication impairments and
frequent co-occurrence with behaviour problems suggest
that speech pathologists have a role to play in assessing
and supporting children and adolescents diagnosed with
language and/or behaviour problems. This is particularly
important considering the risk of poor long-term social and
employment outcomes for adolescents and adults who
experience significant childhood speech-language difficulties
(e.g., Clegg, Hollis, Mawhood, & Rutter, 2005; Snow &
Powell, 2008). We conclude this paper with suggested
strategies to support speech pathologists in working
with children and adolescents presenting with complex
communication and behavioural needs.