Controversial Issues In The Inclusion Of C Diagnosed With Social Pragmatic Communication Disorder
Introduction
In this assignment, I am writing the related controversial issues from different arguments and findings surrounding inclusion of children diagnosed with Social (Pragmatic) Communication Disorder (SPCD). With the increasing demand of service for children with communication disorders needs to be address. According to Special Educational Needs and Disability (SEND) Code of Practice (2015), that schools have duties to cater the children with disabilities with appropriate educational service. Thus, should provide practical adjustment of aids and service that suitable in their needs. Currently, researchers, health and education professionals are working together to provide effective intervention that help children with speech language and communication needs in educational setting. There is a significant change of educational policy that create an effort to deliver inclusion education setting for all children with special educational needs.
This assignment comprises of different section that tackles issues related to inclusion of children with SPCD. The background section will give us an idea on how SPCD got its term and what terminologies that are used by other researchers and research bodies. In this paper, I am also going share insights in the rationale section on why SPCD is one of subjects of debates and on-going researches related to ASD. I also included the latest description in the ‘Definition’ section by ‘American Psychiatric Association’ despite the different terminologies referred by other prominent researchers. In the identification section it comprises the diagnostic criteria of SPCD. It will be followed by assessment and diagnosis section where researchers provide the most suitable tools to provide appropriate service to children with social communication deficiencies. Furthermore, in the intervention section it covers the issues inclusive practices and one of the most common treatments that is being used to provide at least the most effective intervention.
Background
During the 1950s and 1960s, segregated programs were opened to serve children with disabilities. Then, in the late 1960s and 1970s, children with special educational needs were included in the mainstream programs. The term inclusion was defined by McCarthy “…a state-of-the-art term that refers to placing children with disabilities in integrated sites, [which] … means bringing support services to the child rather than moving the child to a segregated setting to receive special services” This section will also discuss the background the SPCD based on the literature. Before the SPCD was used to diagnose children with difficulties in using pragmatic and social context it was known to be ‘Semantic-Pragmatic Deficit Syndrome’. There are different labels that had been used, but the commonly used until now is the term ‘Semantic-Pragmatic Language Disorder (SPLD). There are debates regarding the labelling that draw attention to children with SLPD that links to those on the autistic spectrum. Moreover, additional research results show that children with a diagnosis of SPLD do not necessarily have additional problems with grammar and semantics. According to Bishop (2000a), the label ‘Pragmatic Language Impairment’ (PLI) ‘seems preferable’. She further explains that it is not required that semantic and pragmatic problem will coincide rather ‘it is easier to accommodate a more dimensional view of language impairment’, this will help to find a treatment in pragmatics as one domain in which communication may be impaired. This issue is getting more controversial with the increase related evidence that children diagnosed with PLI are not necessarily to be included in autistic spectrum. Bishop (2000) argues that children with autistic-like pragmatic difficulties should be regarded as autistic? She emphasizes that there are crucial evidence to be considered before jumping to that conclusion. First, she stated that ‘the studies concerned with differential diagnosis of autism and Specific Language Impairment (SLI), and reveal cases that are hard to categorize as one or the other’. Second, she added that ‘children who are identified as having semantic-pragmatic disorder reveal that only a subset of them appear to have significant autistic features in non-linguistic domains. In 1983, Rapin and Allen proposed a classicfication of children with developmental language disorders, which included children with autism as well as those with special language impairments (SLI).
More recent research has indicated that children diagnosed at SPLD do not necessarily have additional grammatical or semantic problems. In 2013, the American Psychiatric Association labelled SPCD as a new diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It gives better understanding and recognition of individuals with significant difficulties in using verbal and nonverbal communication for social purposes, that leads to deficiencies in their ability to effectively communicate, participates socially, maintains social relationships, or otherwise perform academically or occupationally. Studies related to SPCD is continually developing and updates of DSM-5 was recently released. There might be arguments and debates from the previous findings and resulted in various challenges to medical practitioners, clinics and treatment centres. But the most important issue is how these individuals who have SPCD be given proper treatment and services that they need.
Rationale
The understanding that inclusive service provides a wide-ranging goal, it should not compromise to recognize the individual service needs most especially specific children and families. Hence, with the services given in schools, the term ‘inclusive practices’ rather than ‘inclusion’ is the appropriate description of services that are offered. Inclusive practices serve as an intervention that is present in the educational setting that is least restrictive. It may use ‘natural environment’ to serve as an ‘intervention context’, it also creates services that combine ‘classroom content and curriculum activities, and collaborating with families, educators and other personnel’. Thus, it is argued that ‘inclusive practices’ are suitable to implement to the needs of children with communication disorders.
Children with social communication deficits have hard times befriending others. Lack of interaction hinders them to socially cooperate with peers. It very important to let them feel that they are part of the group. They need to understand that they might have similarities or differences to one another. Children’s communication development requires serious attention. Having good communication skills could help them to be independent and achieve greater expectation in life. According to Norbury (2014b), to be effective in communicating we should possess a deeper understanding of the precise words we uttered and construct meaningful ideas in relation to our knowledge and experiences. In addition children with SPCD is considered to have social and learning difficulties which mean they are entitled to a special educational provision (Bristol City Council). As mandated in SEND Code of Practice (2015), Chapter 6 Schools, Section 6. 8 Equality, and Inclusion highlights the necessity of services to students with Special Educational Needs (SEN) in every school. Schools are obliged to work together with the local authority in any provision and development for the benefit of the children. It is also the duty of schools to collaborate with other local education providers and find different ways to effectively meet the needs of the students.
Even though that SPCD has become a new term of diagnosis, there has been a lot of debates when it comes to terminologies and diagnostic criteria. In addition, there are inconsistencies of reliable assessment tools and inadequate assessment of profiles across different neurodevelopmental disorders. Moreover, it has been criticised due to a lack of experimental evidence showing that the disorder is different from Autism Spectrum Disorder (ASD). With the issues of various terminologies, Norbury (2014d) pointed out that there are disadvantages attached the new diagnosis plus the ‘different perspectives of the clinical practitioners’ who will give influence on the outcome. There is an argument related to the diagnostic criteria of SPCD and ASD. It overlaps with each other making it complicated to diagnose. She even highlighted that when the children will receive the diagnosis it might not receive the ‘clinical or educational services’ that are appropriate to them. It is also being supported by Skuse (2012) that how these diagnostic criteria are effectively utilized without overlapping the diagnostic criteria for Autism Spectrum Disorder.
Definition
Grohol (2017) stated that children with SPCD face challenges in following the social rules in conversation it might be verbal or non-verbal communication. With these sorts of hurdles in social communication, the effectiveness of communicating and their involvement in a social manner with others will lead the children to struggle, and ‘can even affect academic performance’. Norbury (2014a) mentioned that to have successful communication this requires the use of linguistic context (pragmatic) which Rhalmi (2013) refers to the language setting in which a word is used within a text and, the use of language in social contexts (social communication) which Nugent (2013) defined as ‘the general environment or circumstances that are the social framework for interpersonal and individual behaviour’. Communication skills are a significant factor in life’s experience of the individual, especially for developing language critical to cognitive growth and learning among children. To provide ideas effectively, we learn to read, write, make a gesture, listen, and speak. It will not offer instant outcome but instead, it takes place the process of communication. Having the skills to take part in a dynamic and interactive communication with peers and adults in the educational setting is very important for a child to succeed in school. According to the DSM-5 (American Psychiatric Association 2013a), children with SPCD is described mainly as with a difficulty with pragmatics, and the social use of language and communication. The lack of understanding and following social rules of verbal and nonverbal communication in a realistic setting. It would be challenging to children with social communication deficits to converse effectively, participate in any social interaction, develop social relationships, and have academic achievement. In addition, the mentioned symptoms must be present in the early developmental period of a child. The SPCD may exist in other communication disorders in the DSM-5, but cannot be identified in the presence of Autism Spectrum Disorder (ASD). Even though SPCD and Autism Spectrum Disorder have the identical requirements of the deficit in social communication needs, but children with SPCD have different specific diagnostic features compared to ASD with restricted repetitive patterns of behaviour. Additional description is that SPCD shared a similar characteristic with Language Impairment. Children with difficulties with using social communication tend to interact socially with their family and peers. Studies also show that children with this diagnostic criterion can acquire similar characteristics from Attention Deficit/Hyperactivity Disorder, behavioural problems, and even Specific Language Disorder.
Identification
Based on DSM-5 (American Psychiatric Association 2013b) diagnosis of SPCD is not common among children younger than 4 years old it is because social (pragmatic) communication relies on the satisfactory developmental progress in speech and language. When children reached 4 or 5 years old that would be the appropriate level to identify any specific deficits in social communication. There are even ‘milder forms of the disorder’ that may not become obvious until they reach early adolescence. The outcome may vary depending on the child’s development there are some children who extensively improve in a certain amount of time and others may continue to have difficulties into adulthood. Even though with the considerable improvement, difficulties in ‘social relationships and behavioural problems and acquisition of other related skills’ may still be present when a child has an early pragmatic deficiency. Furthermore, if a family has hereditary issues with Autism Spectrum Disorder, Communication Disorder, or even Specific Learning disorder it may increase the possibility for a child to have SPCD. Norbury (2014e) justifies that findings showed most of the children with SPCD were being evaluated having’ speech abnormalities associated with autism and used stereotyped language’. Adams et. al (2012a) also provide clearer identification that most of the children with this disorder possess ‘higher level language impairments such as difficulty with interference generation, narrative organization and comprehension of discourse and mild difficulties’.
Assessment and Diagnosis
Looking at the broad picture of DSM-5 where SPCD is a new diagnostic category (American Psychiatric Association 2013c) researchers are finding and developing the most suitable assessment to provide the service to the children and to use in further studies. It is emphasized by Norbury (2014f) that measuring social communication and pragmatic language abilities are excessively difficult by using standardised ways and she quoted, “they are a set of contextually dependent human behaviours that occur in dyadic exchanges”. To support the argument, that by using standardized testing process it is difficult to recognise social communication problems where the guidelines procedure is ‘less explicit and highly dynamic’. When establishing a standardized assessment, Carter et al. (2005) point that large sample of respondents from the ‘target population’ and if at all possible children with’ the same ethnic, cultural and linguistic background, age, sex and educational level and type’. Social communication assessment ‘should involve some examination of a child’s comprehension of the social signals sent to him/her by others’. It is very significant to learn and use the language in proper possibilities with a social context. However, if a child has challenges in understanding ‘social cues’ given in his/her communication experiences, the child is likely to ‘violate pragmatic rules’ and even face difficulties to language learning.
The use of standardized checklists for social communication and pragmatic disorder has become a ‘popular method of assessment’. Perhaps the most well-recognized assessment material in both clinical practice and research development is the Children’s Communication Checklist-2 (CCC-2). In spite of the result being used for the diagnosis, there are still issues and clarifications that surround the reliability of the assessment. On the other hand, (Bishop & Adams 1989 cited by Norbury 2014d) by using ‘quantitative approaches’, the result of the assessment in ‘analysing conversation in detail has been developed with acceptable levels of interrater reliability’. It is supported by the research findings that by using conversational analysis it provides a higher percentage of reliability. We can see that it gives advantages related to the efficiency of the assessment, however, Norbury (2014h) stresses out that ‘it is a time-consuming assessment method, which may limit its clinical and research utility’. Assessment of social community should involve some examination of a child’s comprehension of the social signals sent to him/her by others. This is because language is learned and used within a social context. If a child does not understand the social cues given by others, he/she is likely to violate basic pragmatic rules as well as encounter challenges to language learning.
Intervention
Throughout the year, there was a development of intervention for children with communication disorders. There is a selection of services that may be suitable to meet chidlren’s individual needs. In consideration with inclusive setting, it is very important to include full collaboration with parents, teachers and health professionals, as well as, the educational environment setting. One of the intervention models suggested are ‘classroom based’ and community-based’ services. In classroom based service, teachers with the collaboration of speech-language pathologist provides variation of intervention in classroom setting approaches. This will also help other children within the entire class as they also involve in interaction. In addition, ‘community-based’ service may help children with pragmatic problems and those children with special educational needs whose using ‘community-based curriculum. This intervention process sets in either home and community setting, they benefit with the help of other people around them. Moreover, Prizant (1995) emphasised that critical planning is a must to provide variation of inclusive experiences that includes ‘modification to the environment, activities, and child interaction’.
On the other hand, I am also discussing specific intervention that is available for children with SPCD. There are still ongoing debates on the findings of the effectiveness of speech-language interventions that mainly will benefit the children with language pragmatic or social communication needs. Therefore, Adams et. al. (2012b) gives emphasis to the need for suitable communication interventions as preventative measures. Adams et al. (2012) released the first randomized controlled trial of a social communication intervention with an objective to provide appropriate intervention specifically at children with SPCD. The Social Communication Intervention Project (SCIP) is an ‘individualized integration approach’, it focuses in communication development aspects such as ‘social understanding and social interaction, verbal and non-verbal pragmatic skills and language processing’. Moreover, Norbury (2014i) clarified that despite the positive outcomes of the study through the period of intensive intervention there are still challenges to overcome. According to Adams and Gaile (2012), they described that the experimental treatment was an ‘intensive manualized social communication intervention’, hence, will correct any deficits in ‘semantics and high-level language skills, pragmatic difficulties, and social interaction and social cue interpretation’.
Based on the result and findings of the research, Adams et al (2012c) determined that by the used of ‘manualized experimental SCIP intervention’ there is a success in giving thorough treatment procedure in order to provide consistent intervention that will give way to an accurate support to children with social communication difficulties. We can look at from this perspective that it has provided a clearer picture that the effectiveness of research findings could better intervention. In some way, Norbury (2014j) yielded a very significant viewpoint that the most aims of intervention are to improve language and communicative function rather the ‘cure’ disorder. Furthermore, she gave emphasis to the whole efficacy of the diagnostic materials to provide clear intervention. Nevertheless, it is still necessary to utilize ‘standardised assessment tools’ for it will be very advantageous for future studies.
Conclusion
To conclude the assignment, it will be focusing more in the intervention setting. The implementation of services to children with SPCD comes with a wide range of inclusive service models. There should be flexible selections to consider as any changes depending on the children’s’ needs. Thus, the inclusive setting provides opportunities to develop their social and interactive skill and other specific competencies that would benefit them by using the various service models. On the other hand, there is a substantial advantage in early integration, but it would not guarantee to have positive results all the time rather the success of the intervention depends on organised plan and implementation. It also an issue to consider the funding that may cause an approval or rejection of inclusive service plus the administrative perceptions towards inclusion efficacy. There is a need for educational preparation for professionals who will be given responsibilities that are essential in an inclusive setting. In addition, inclusion is very challenging to achieve without the presence of qualified personnel who collaboratively work and share roles among speech-language pathologists, teachers, and family members. It should also consider the effects of the children within inclusion. It was stressed by Sharpe, York, & Knight (1994) that there are possibilities that children with special needs may affect the ability of regular students to benefit from the general education.
Presently, there are positive research findings about the effectiveness of inclusive practices. Thus far, further studies should be conducted to provide more concrete findings and assessment to inclusive practices for children with communication disorders. In relation, the need to expand the range research to finding suitable intervention and the effectiveness of inclusion in mainstream educational setting. Considering the long-term effect of inclusive practises that will track their academic and social development.
