IntroductionIn this assignment, I amwriting the related controversial issues from different arguments and findingssurrounding inclusion of children diagnosed with Social (Pragmatic)Communication Disorder (SPCD). Increasing demand of service for children withcommunication disorders needs to be address. According to SpecialEducational Needs and Disability (SEND) Code of Practice (2015), that school have duties to cater the children with disabilitieswith appropriate educational service. Thus, should provide practical adjustmentof aids and service that suitable in their needs.
Currently, researchers,health and education professionals are working together to provide effectiveintervention that help children with speech language and communication needs ineducational setting. There is a significant change of educational policy thatcreate an effort to deliver inclusion education setting for all children withspecial educational needs (Lipsky & Gartner 1989; Peck, Odom, & Bricker1993; Sailor 1991; Will 1986; Wolery & Wilbers 1994 cited American Speech-Language-Hearing Association (ASHA) 1996). This assignment comprisesof different section that tackles issues related to inclusion of children with SPCD.The background section will give us an idea on how SPCD got itsterm and what terminologies that are used by other researchers and researchbodies. In this paper, I am also going share insights in the rationale sectionon why SPCD is one of subjects of debates and on-goingresearches related to ASD. I also included the latest description in the ‘Definition’section by ‘American PsychiatricAssociation’ 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 diagnosissection where researchers provide the most suitable tools to provideappropriate service to children with social communication deficiencies.
Furthermore,in the intervention section it covers the issues inclusive practices and one ofthe most common treatment that is being used to provide at least the mosteffective intervention. Background• n 1983, Rapin and Allen proposed a classic?cation of children with developmental• language disorders, which included children with autism as well as thosewith• special?c language impairments (SLI).• n 1983, Rapin and Allen proposed a classic?cation of children with developmental• language disorders, which included children with autism as well as thosewith• special?c language impairments (SLI).• n 1983, Rapin and Allen proposed a classic?cation of children with developmental• language disorders, which included children with autism as well as thosewith• special?c language impairments (SLI).
• n 1983, Rapin and Allen proposed a classic?cation of children with developmental• language disorders, which included children with autism as well as thosewith• special?c language impairments (SLI).During the 1950s and 1960s, segregated programs were opened to servechildren with disabilities. Then, in the late 1960s and 1970s, children withspecial educational needs were included in the mainstream programs. The term inclusionwas defined by McCarthy (1994 cited by 1994 cited ASHA 1996) “…a state-of-the-art term that refers to placing children withdisabilities in integrated sites, which … means bringing support services tothe child rather than moving the child to a segregated setting to receivespecial services” This section will also discuss the background the SPCD basedon the literature. Before the SPCD was used todiagnose children with difficulties in using pragmatic and social context itwas known to be ‘Semantic-Pragmatic Deficit Syndrome’ (Rapin and Allen 1983 citedAdams 2001a).
There are different labels that had been used, but the commonlyused until now is the term ‘Semantic-Pragmatic Language Disorder (SPLD) (Bishopand Resebloom 1987 cited Adams 2001b). There are debates regarding thelabelling that draw attention to children with SLPD that links to those on theautistic spectrum (Lister Brook and Bowler 1982, Boucher 1998 cited Adams 2001c).Moreover, more research results show that children diagnosed at SPLD do notnecessarily have additional grammatical or semantic problem (Bishop et al.
2000 cited Adams 2001d). Accordingto Bishop (2000a), the label ‘Pragmatic Language Impairment’ (PLI) ‘seemspreferable’. He further explains that it is not required that semantic andpragmatic problem will coincide rather ‘it is easier to accommodate a more dimensionalview of language impairment’, this will help to find a treatment in pragmaticsas one domain in which communication may be impaired. This issue is gettingmore controversial (Adams 2001a) with the increaserelated evidence that children diagnosedwith PLI are not necessarily to be included in autisticspectrum. (Bishop 2000b) argues that children with autistic-like pragmaticdifficulties should be regarded as autistic? She emphasizes that there are crucial evidenceto be considered before jumping to that conclusion. First, she stated that ‘thestudies concerned with differential diagnosisof autism and Specific Language Impairment (SLI), and reveal cases that arehard to categorize as one or the other’.
Second,she added that ‘children who are identified as having semantic-pragmaticdisorder reveal that only a subset of them appear to have significant autisticfeatures in non-linguistic domains.ore recent research (Bishopet al.2000) hasindicated that children diagnosed at SPLD do notnecessarily have additionalgrammatical or semantic problems.
This has ledBishop (In 2013, the American Psychiatric Association labelled ‘SPCD as a new diagnosis in the fifthedition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).It gives better understanding and recognitionof individuals ‘who have significant problems using verbal and nonverbal communicationfor social purposes, leading to impairments in their ability to effectivelycommunicate, participates socially, maintains social relationships, or otherwiseperform academically or occupationally’. Studies related to SPCD is continually developing and updatesof DSM-5 was recently released (Supplement to Diagnostic and Statistical Manualof Mental Disorders 2016). There might be arguments and debates from theprevious findings and resulted in various challenges to medical practitioners,clinics and treatment centres.
But themost important issue is how these individuals who have SPCD be given propertreatment and services that they need (American Psychiatric Association 2017). RationaleThe understanding that inclusiveservice provides a wide-ranging goal, it should not compromise to recognize the individual service needs most especiallyspecific children and families. Hence, with the services given in schools, theterm ‘inclusive practices’ rather than ‘inclusion’ is the appropriatedescription of services that are offered. Inclusive practices serve as anintervention that is present in the educational setting that is leastrestrictive. It may use ‘natural environment’ to serve as an ‘interventioncontext’, it also creates services that combine ‘classroom content andcurriculum activities, and collaborating with families, educators and otherpersonnel’. Thus, it is argued that ‘inclusive practices’ are suitable toimplement to the needs of children with communication disorders (ASHA 1996). Children with socialcommunication deficits have hard times befriending others.
Lack of interaction hindersthem to socially cooperate with peers. It very important to let them feel thatthey are part of the group. They need to understand that they might havesimilarities or differences to one another (Deiner 2009). Children’s communication development requires seriousattention. Having good communication skills could help them to be independentand achieve greater expectation in life. According to (Norbury 2014b), to beeffective in communicating we should possess a deeperunderstanding of the precise words we uttered and construct meaningfulideas in relation to our knowledge andexperiences.
In addition. Childrenwith SPCD is considered to have social andlearning difficulties which mean they areentitled to a special educationalprovision (Bristol City Council). As mandated in SEND Code of Practice (2015), Chapter6 Schools, Section 6.8 Equality, andInclusion highlights the necessity of services to students with SpecialEducational Needs (SEN) in every school. Schools are obliged to work togetherwith the local authority in any provision and development for the benefit ofthe children.
It is also the duty of schools to collaborate with other localeducation providers and find different ways to effectively meet the needs ofthe students (GOV.UK). Even though that SPCD has become a new term of diagnosis, there has been a lot of debates when itcomes toterminologies and diagnostic criteria. In addition, there are inconsistenciesof reliable assessment tools and inadequate assessment of profiles acrossdifferent neurodevelopmental disorders (Norbury 2014c). Moreover, it has beencriticised due to a lack of experimental evidence showing that the disorder isdifferent from Autism Spectrum Disorder (ASD) (Ozonoff, 2012; Skuse, 2012;Tanguay, 2011 cited by Taylor and Whitehouse 2016).
With the issues of various terminologies, Norbury (2014d) pointedout that there are disadvantages attached the new diagnosis plus the ‘differentperspectives of the clinical practitioners’ who will give influence on theoutcome. There is an argument related to the diagnostic criteria of SPCD and ASD. It overlaps with each other making it complicated to diagnose.
Sheeven highlighted that when the children will receive the diagnosis it might notreceive the ‘clinical or educational services’ that are appropriate to them. Itis also being supported by Skuse (2012 cited by Norbury 2014a) that how thesediagnostic criteria are effectively utilized without overlapping the diagnosticcriteria for Autism Spectrum Disorder. DefinitionGrohol (2017) stated that children with SPCD face challenges in followingthe social rules in conversation it might be verbal or non-verbalcommunication. With these sorts of hurdles in social communication, theeffectiveness of communicating and their involvement in a social manner withothers will lead the children to struggle, and ‘can even affect academicperformance’. Norbury (2014a) mentionedthat to have successful communication this requires the use of linguisticcontext (pragmatic) which (Rhalmi 2013) refers to the language setting in whicha word is used within a text and, the use of language in social contexts(social communication) which (Nugent 2013) defined as ‘the general environmentor circumstances that are the social framework for interpersonal and individualbehaviour’. Communication skills are a significantfactor in life’s experience of the individual,especially for developing language critical to cognitive growth and learningamong children. To provide ideas effectively, we learn to read, write, make a gesture, listen, and speak. It will not offerinstant outcome but instead, it takesplace the process of communication.
Having the skills to take part in a dynamicand interactive communication with peers and adults in the educational settingis very important for a child to succeedin school (American Speech-Language-Hearing Association (ASHA) 2005a). Accordingto the DSM-5 (American Psychiatric Association 2013a), children with SPCD is described mainly as with a difficulty with pragmatics, and thesocial use of language and communication. The lack of understanding andfollowing social rules of verbal and nonverbal communication in a realistic setting.It would be challenging to children with social communication deficits toconverse effectively, participate in any social interaction, develop socialrelationships, and have academic achievement.
In addition, the mentionedsymptoms must be present in the early developmental period of a child. The SPCD may exist inother communication disorders in the DSM-5, but cannot be identified in thepresence of Autism Spectrum Disorder (ASD) (Swineford et al. 2014a). Even though SPCD and AutismSpectrum Disorder have the identical requirements of the deficit in social communication needs, butchildren with SPCD have differentspecific diagnostic features compared to ASD with restricted repetitivepatterns of behaviour (Swineford et al.2014b).
Additional description is that SPCD shared a similarcharacteristic with Language Impairment. Children with difficulties with usingsocial communication tend to interactsocially with their family and peers. Studies also show that children with thisdiagnostic criterion can acquire similar characteristics from AttentionDeficit/Hyperactivity Disorder, behaviouralproblems, and even Specific Language Disorder (DSM-5 American PsychiatricAssociation 2013).
IdentificationBased on DSM-5 (AmericanPsychiatric Association 2013b) diagnosis of SPCD is not common among childrenyounger than 4 years old it is because social (pragmatic) communication relieson the satisfactory developmental progress in speech and language. When childrenreached 4 or 5 years old that would be the appropriate level to identify anyspecific deficits in social communication. There are even ‘milder forms of thedisorder’ that may not become obvious until they reach early adolescence. The outcome may vary depending on the child’sdevelopment there are some children who extensively improve in a certain amountof time and others may continue to have difficulties into adulthood. Eventhough with the considerable improvement, difficulties in ‘social relationshipsand behavioural problems and acquisitionof other related skills’ may still be present when a child has an early pragmatic deficiency. Furthermore, ifa family has hereditary issues with AutismSpectrum Disorder, Communication Disorder, or even Specific Learning disorderit may increase the possibility for a child to have SPCD. Norbury (2014e)justifies that findings showed most of the children with SPCD were beingevaluated having’ speech abnormalities associated with autism and usedstereotyped language’.
Adams et. al (2012a) also provide clearer identificationthat most of the children with this disorder possess ‘higher level languageimpairments such as difficulty with interference generation, narrativeorganization and comprehension of discourse and mild difficulties’. Assessmentand DiagnosisLooking at the broad picture of DSM-5 where SPCD is a new diagnostic category (American Psychiatric Association2013c) researchers are finding and developing the most suitable assessment to providethe service to the children and to use in further studies. It is emphasized by Norbury (2014f) that measuringsocial communication and pragmatic language abilities are excessively difficultin ‘standardized ways because they are a set of contextually dependent human behaviours that occur in dyadic exchanges’. Tosupport the argument, (Adams 2002, Volden etal., 2009 cited by Norbury 2014b) accordingto ‘the structure provided by a standardized testing situation makes it difficultto capture social communication problems that may arise in everyday situationswhere the rules of engagement are less explicit and highly dynamic’. When establishinga standardized assessment, Carter et al.(2005) point that large sample of respondentsfrom the ‘target population’ and if at all possible children with’ the sameethnic, cultural and linguistic background, age, sex and educational level andtype’.
Social communication assessment ‘should involve some examination of achild’s comprehension of the social signals sent to him/her by others’. It isvery significant to learn and use the language in proper possibilities with asocial context. However, if a child has challenges in understanding ‘socialcues’ given in his/her communication experiences, the child is likely to’violate pragmatic rules’ and even face difficulties to language learning (Landa2005). The use of standardized checklists for social communication andpragmatic disorder has become a ‘popularmethod of assessment’ (Norbury 2014g). Perhaps the most well-recognized assessment material in both clinical practice andresearch development is the Children’s Communication Checklist-2 (CCC-2) (Bishop2003 cited by Norbury 2014c). In spite of the result being used for thediagnosis, there are still issues and clarifications that surround thereliability of the assessment. On the other hand, (Bishop & Adams 1989cited by Norbury 2014d) by using ‘quantitative approaches’, the result of the assessmentin ‘analysing conversation in detail has been developed with acceptable levels ofinterrater reliability’.
It is supported by the research findings that by usingconversational analysis it provides a higherpercentage of reliability (Adams et al., 2006). We can see that it givesadvantages related to the efficiency of the assessment, however, Norbury (2014h)stresses out that it is ‘a time-consuming assessment method, which may limitits clinical and research utility’.Assessment of social community-tion should involve some examination ofa child’s comprehension of the social sig-nals sent to him/her by others. This isbecause language is learned and usedwithin a social context.
If a child does notunderstand the social cues given by oth-ers, he/she is likely to violate basic prag-matic rules as well asencounter chal-lenges to languagelearning.Assessment of social community-tion should involve some examination ofa child’s comprehension of the social sig-nals sent to him/her by others. This isbecause language is learned and usedwithin a social context.
If a child does notunderstand the social cues given by oth-ers, he/she is likely to violate basic prag-matic rules as well asencounter chal-lenges to languagelearning. InterventionThroughout the year, there was adevelopment of intervention for children with communication disorders. There isa selection of services that may be suitable to meet chidlren’s individualneeds (Cirrin & Penner, 1995; Holzhauser-Peters & Husemann,1988; Nelson, 1993; Silliman & Wilkinson, 1991 cited ASHA 1996).In consideration with inclusive setting, it is very important to include fullcollaboration with parents, teachers and health professionals, as well as, theeducational 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 providesvariation of intervention in classroom setting approaches. This will also helpother children within the entire class as they also involve in interaction (Elksnin & Capilouto, 1994; Norri, 1989; Prelock, 1993; Rice& Wilcox 1995; Secord1990; Watson,Layton, Pierce, & Abraham 1994 cited ASHA 1996). In addition,’community-based’ service may help children with pragmatic problems and thosechildren with special educational needs whose using ‘community-based curriculum.
This intervention process sets in either home and community setting, theybenefit with the help of other people around them (Sailor,Anderson, Halvorsen, Doering, Filler, & Goetz 1989; Snell & Janney 1993 cited ASHA 1996). Moreover, Prizant (1995cited ASHA 1996) emphasised that critical planning is a must to providevariation of inclusive experiences that includes ‘modification to theenvironment, activities, and child interaction’. On the other hand, I am alsodiscussing specific intervention that is available for children with SPCD. There arestill ongoing debates on the findings of the effectiveness of speech-language interventionsthat mainly will benefit the children with language pragmatic or socialcommunication needs. Therefore, Adams et. al.
(2012b) give emphasis to theneed for suitable communication interventions as preventative measures. Adams et al. (2012 cited by Norbury 2014e) releasedthe first randomized controlled trial of a social communication intervention withan objective to provide appropriate intervention specifically at children with SPCD.
The SocialCommunication Intervention Project (SCIP)(http://www.psych-sci.manchester.ac.
uk/scip/) ‘is an individualizedintervention approach that targets development in three areas: socialunderstanding and social interaction; verbal and nonverbal pragmatic skills,including conversation; and language processing, including narrative,inferencing, and developing word knowledge’. Moreover, Norbury (2014i) clarifiedthat despite the positive outcomes of the study through the period of intensiveintervention there are still challenges to overcome. According to Adams andGaile (2012 cited by Adams et al. 2012), they described that the experimental treatmentwas an ‘intensive manualized social communication intervention’ that willcorrect any deficits in ‘semantics and high-level language skills, pragmaticdifficulties, and social interaction and social cue interpretation’. Based on the result and findings ofthe research, Adams et al (2012c) determinedthat by the used of ‘manualized experimental SCIP intervention’ there is asuccess in giving thorough treatment procedure in order to provide consistentintervention that will give way to an accurate support to children with socialcommunication difficulties. We can look at fromthis perspective that it has provided a clearer picture that the effectivenessof research findings could better intervention.
In some way, Norbury (2014j) yieldeda very significant viewpoint that the most aims of intervention are to improve language and communicativefunction rather the ‘cure’ disorder. Furthermore, she gave emphasis to thewhole efficacy of the diagnostic materials to provide clear intervention.Nevertheless, it is still necessary to utilize ‘standardisedassessment tools’ for it will be very advantageous for future studies. ConclusionThe implementation of services to children with SPCD comes with a wide range of inclusiveservice models. There should be flexible selections to consider as any changesdepending on the children’s’ needs.
Thus, the inclusivesetting provides opportunities to develop their social and interactive skilland other specific competencies that would benefit them by using the variousservice models. In the other (Guralnick & Groom, 1988; Jenkins, Odom, , 1989; Lamorey & Bricker, 1993; Notari & Cole, 1993; Wolery& Wilburs, 1994 cited by AmericanSpeech-Language-Hearing Association 1996). On the other hand, there is asubstantial advantage in early integration, but it would not guarantee to havepositive results all the time rather the success of the intervention depends onorganised plan and implementation (Lamorey & Bricker 1993; Notari & Cole 1993; Wolery & Wilbers 1994 cited by ASHA 1996). It also an issueto consider the funding that may cause an approval or rejection of inclusiveservice plus the administrative perceptions towards inclusion efficacy (Salisbury& Chambers 1994 cited by ASHA 1996).
There is a need for educational preparation for professionalswho will be given responsibilities that are essential in an inclusive setting. In addition, inclusion isvery challenging to achieve without the presence of qualified personnel whocollaboratively work and share roles among speech-language pathologists, teachers,and family members. It should also consider the effects of the children withininclusion. It was stressed by Sharpe, York, & Knight (1994 cited by ASHA 1996) that there are possibilities that childrenwith special needs may affect the ability of regular students to benefit fromthe general education. Presently, there arepositive research findings about the effectiveness of inclusive practices.Thus far, further studies should be conducted to provide more concrete findingsand assessment to inclusive practices for children with communication disorders.
In relation, the need to expand the range research to finding suitable interventionand the effectiveness of inclusion in mainstream educational setting. Consideringthe long-term effect of inclusive practises that will track their academic andsocial development (ASHA 1996).