By Kate Ripley, East Sussex Educational Psychology Service and Nicola Yuill,
Cognitive and Computing Sciences, University of Sussex

Our thanks to the authors and the British Psychological Society for their permission to reproduce part
of this fascinating study. To read the complete version, please click on the link at the bottom of the report

Background.

High levels of behaviour problems are found in children with language impairments, but less is known about the level and nature of language impairment in children with severe behavioural problems. In particular, previous data suggest that at primary age, receptive impairments are more closely related to behaviour problems, whereas expressive language has a closer link at a later age.

Aims.

The study assessed expressive and receptive language problems in boys
excluded from primary and secondary schools, to investigate the extent of impairment, the pattern of relations between age, receptive and expressive language, and relations with different aspects of behaviour.

Sample.

Nineteen boys (8–16 years of age) who had been excluded from school and 19 non-excluded controls matched for age and school participated.

Method.

The sample group was given assessments of: receptive language from the British Picture Vocabulary Scale (BPVS), and Wechsler Objective Language Dimensions (WOLD); expressive-language evaluations from the Wechsler Intelligence Scale for Children (WISC); auditory working memory evaluations from the Clinical Evaluation of Language Fundamentals (CELF); and verbal reasoning and non-verbal IQ assessments derived from Raven’s matrices. Teachers completed behaviour ratings using the Strengths and Difficulties Questionnaire (SDQ).

Results.

Excluded boys were significantly poorer than controls on expressive measures but similar on receptive language and non-verbal IQ. Boys excluded from primary school were poorer than controls on auditory working memory. Expressive problems were linked with high levels of emotional symptoms.

Conclusion.

Many of the excluded boys had previously unidentified language problems, supporting the need for early recognition and assessment of language in boys with behaviour problems. Expressive problems in particular may be a risk factor.

The incidence of speech and language impairment (SLI) among children has been difficult to establish. Lindsay and Dockrell (2000) estimated that speech and language impairment affects 7% of children, while Law et al. 2000) arrived at a 10% estimate. The evidence suggests therefore that SLI is a significant category of educational need and is not confined to the early years of learning.

A recent study of children in National Curriculum Year 2 carried out by Botting and Conti-Ramsden (2000) indicated that of the 5% of the children they expected to experience SLI, only 1% appeared on registers of special educational need with SLI as their primary need. The children who are most likely to be identified as having SLI are those who experience phonological problems which affect speech intelligibility and who go on to struggle with the acquisition of literacy (Bishop & Adams, 1990). Children who have less obvious difficulties with receptive or expressive language may not be identified as having language problems (Beitchman, 1985), but may be referred to support services for other reasons such as slow educational progress, poor reading comprehension, or behavioural issues.

Some children may not be identified as having SLI until they are in the secondary phase of their education (Ripley, Barrett, & Fleming, 2001). If teachers are not aware that a child in their class has SLI, the student’s behavioural response may give rise to perceptions of primary problems such as emotional and behavioural disorders (Gordon,1991), stubbornness, and non-compliance (Freeman & Willig, 1995).

Baker and Cantwell (1987) attempted to explain how abnormal language development might disrupt the development of behavioural control. They asserted that children with SLI were frequently put under pressure to conform when they were unable to understand or respond as other children of their age did. The outcome was, all too often, tantrums, attention problems, and non-compliant behaviour that were then interpreted simply as bad behaviour. Significantly, they reported that the behaviours rather than the underlying SLI then became the focus for intervention.

For Vygotsky (1962), the key tool for the self-regulation of behaviour is language. In their second year, children are capable of some impulse control with the aid of emerging language, but it is not until between three and four years of age that true self-control develops (Kopp, 1982). At this stage most children are able to understand and obey external rules and restrictions and hold themselves back from prohibited acts. It is during these preschool years that a child’s own language starts to become a vehicle for the self-regulation of behaviour (Luria, 1961), a technique for controlling action and thought (Berk, 1992; Berk & Winsler, 1995).

As children get older, they become able to use ‘self-speech’ to understand situations, focus on problems, and overcome difficulties (Harris, 1990). Language can be used as verbal trial-and-error by making it possible to talk through possibilities instead of acting them out, and to plan ahead (Dollard & Miller, 1950). According to Vygotsky (1962), this self-talk or private speech is internalized as thought between the ages of six and seven years.

The behaviour problems of children with identified SLI have been investigated in many studies (Aram, Ekelman, & National, 1984; Beadle, 1979; Beitchman, 1985; Knoll, 1999; Silva, Justin, McGee, & Williams, 1984; Tallal, Dukette, & Curtiss, 1989). In their study of children with SLI in Year 2, Botting and Conti-Ramsden (2000) identified 40% of children as having antisocial or emotional problems in addition to their SLI. The majority of the studies that have established that children with SLI are at risk of developing behavioural problems, have tracked children who have SLI identified in the early years.

Stevenson, Richman, and Graham (1985) demonstrated that children who had language problems at three years of age were at risk of showing behaviour problems at eight years of age. However, Stevenson et al. (1985) and Funk and Ruppert (1984), found that as language skills improved, so the attendant behaviours were ameliorated. Paul (1991) hypothesized that the early maladaptive behaviour of toddlers was caused by frustration at being unable to communicate effectively.

Evidence from population studies indicates that the incidence of SLI is significantly underestimated in the school-age population, while studies of children who have been identified with SLI suggest that unresolved problems may precipitate challenging behaviour. Despite the evidence of a coincidence between SLI and behaviour problems, there have been relatively few studies that have focused on the language profiles of children who experience behaviour problems.

Camarata, Hughes, and Ruhl (1988) studied mild-to-moderately behaviourally disordered students and found that 71% had language scores which were more than two standard deviations below the mean. Warr-Leeper, Wright, and Mack (1994) investigated a population of antisocial boys in a residential treatment centre and found that 80% of the children had undetected language impairments. Burgess and Bransby (1990) undertook a detailed study of the language profiles of children in a unit for moderate emotional and behavioural problems, and recommended intervention by a speech and language therapist for 16 of the 17 students.

Other investigations have focused upon children who had been referred to psychiatric services (Beitchman, 1995; Vallance, Im, & Cohen, 1999). Cohen (1998) reported that 40% of 7–14-year-olds referred to psychiatric services had undetected SLI.

The incidence was 6% higher in an older age group of 7–14-year-olds than in the younger population of 4–12-year-olds who were investigated in the 1996 study. The children with undetected SLI were more likely to demonstrate ‘aggressive, delinquent’ behaviours, and receive a diagnosis of oppositional defiant or conduct disorder. Aram et al. (1984) used parent ratings of adolescent boys with SLI, and found that the boys were rated as significantly more aggressive and hyperactive than matched peers.

Studies of prison populations and residents of youth offender institutions have, likewise, been shown to have a higher than expected incidence of inmates with SLI. Bryan (2004) found high levels of speech and language problems in a UK young offenders’ institution. A similar need for speech and language therapy services in prisons was identified by Pryor (1998) in a study of young offenders.

The first aim of the present study was to investigate the incidence of language impairment in a group of children identified as having behaviour problems, but with no reported language problems. We recruited children who had been excluded from mainstream schools because of behaviour problems. A detailed language profile was obtained for each child. Assessments of auditory working memory were also carried out because working memory has been implicated in executive function and the self regulation of behaviour (Cohen, 1998).

The discussion thus far has addressed the broad issues of the links between SLI and challenging behaviour. However, in the literature there is some debate about whether receptive or expressive language difficulties are more closely linked to behaviour problems. Evidence from studies of preschool populations suggests that the type of behaviour problems experienced by children with receptive and expressive language problems may be different. Beadle (1979) found that preschool children with expressive language problems were at risk for poor attention, emotional liability, impulsivity, and high levels of arousal.

Beitchman (1985) found similar behavioural characteristics for a group with expressive language problems but a different pattern for children with receptive problems. Mild receptive language difficulties were linked to temper tantrums and negativism, while children with severe receptive problems were likely to show problems similar to those of children on the autistic spectrum. Among a population of three-year-olds, Silva et al. (1984) found a higher incidence of behaviour problems for children with receptive language impairment. However, Silva et al. and Botting and Conti-Ramsden (2000) agree in their claim that children with combined receptive and expressive language problems are most likely to experience behaviour problems, particularly in relationships with peers. Botting and Conti-Ramsden reported that these difficulties increased with age.

There is some evidence for a shift in the significance between receptive and expressive language difficulties over time. Thus, Silva et al. identified a group of children with expressive language problems at 11 years of age that had not been apparent in that cohort at nine years of age. Similarly, Ripley (1984) reported that 71% of a population of adolescents with SLI who were referred to a psychologist for aggressive behaviour towards peers, adults, and the physical environment, had expressive language problems. Pryor (1998) found that among young offenders, 64% had significantly lower scores for expressive language than for receptive language.

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