Introduction and Overview
First are my disclosures. I am the author of “The Pirate Who could not Say Arrr,” “Simply Social At School,” “Spelling That Makes Sense,” and I have a couple of items listed on Teachers Pay Teachers. I am receiving an honorarium for this course. There are no non-financial disclosures that I need to disclose.
In this course, we are going to take a thoughtful look at standardized measures of pragmatic language knowledge, the impact of screen time on the development of social communication abilities, and differentiation of pragmatic difficulties from related areas of disability. We are also going to talk about the components of social communication as outlined by ASHA. In addition, we are going to identify a few early foundational skills in the area of social communication.
I am a school-based SLP and have been for about 15 years. I do the same thing you guys do every day, and deal with the same stresses -- the same paperwork, the Medicaid craziness, and all of that other good stuff. I hope that you will keep this in mind as I talk, because the recommendations and strategies I will discuss have been and are being used in the schools; meaning, this is doable. This is not someone in a different setting saying, "You should do this, or you should do that," without any understanding of the complexities and the dynamics that are part of working in the school setting. Also, I spent seven years working in outpatient pediatrics. Working with physical therapists (PTs), occupational therapists (OTs), developmental pediatricians, neurologists, behavioral specialists, etc. in that setting gave me a great understanding and appreciation for the expertise that comes from other related areas. It is this knowledge from the related fields that adds depth to our skill set, and it helps to take an interdisciplinary view in order to provide the best services possible to our students.
I mention having worked in both of these settings because I want you to know that I do have an appreciation for working on pragmatics in both settings. There is a difference between the two when working on pragmatics. It does not seem like there should be, but it is. That difference relates very much to the impact of social language on educational performance.
But, no matter which setting you are in, I hope that you will leave this three-part series with a better understanding of the factors to consider when addressing pragmatic language in the school setting, whether you are sending or reading reports to or from a school-based SLP, or you are a school-based SLP. Again, this is a three-part series: one hour on assessment, one hour on educational impact, and one hour on strategies. However, there is no way I will ever be able to touch on everything within three hours.
Let's begin at the beginning with assessment. First and foremost, when looking at an assessment of social communication, the assessment question is different from our typical assessment question (“Is there evidence of an undeveloped language skill?”). That is because this is pragmatics, the use of language. So the question should not be, “Is this behavior there or not?” For example, “Do they initiate greetings or not?”; “Do they make eye contact or not?” or “Do they acknowledge the speaker or not?” Rather, we should look at when the behavior is appropriate and when it is inappropriate. This is a very different way of looking at assessment, because how we use language is different across different contexts, settings, people, time, and so on.
Consider this example. The way you speak to your children is likely a little bit different than how you speak to your students, right? And the way you speak to your principal, or your special education director, or your boss, is likely different than how you would speak to your students, right? That all has to do with context.
To further explain this, I am going to ask you a few questions. “What is a nice birthday gift for a friend?” “Is it okay to touch someone else's hair?” “What do you do when the bell rings?” “What should you do when someone raises his or her hand?” Is there only one right answer to these? No, because it depends. What does it depend on? It depends on context.
You may ask, is context part of our assessments? When you use a standardized assessment, the answer is, “absolutely not.” Standardized assessments, by definition, necessitate that there is only one right answer, and real life is just not this way. Moreover, the most complex task we ask of a student in an assessment is still less complex than what is asked of them in the real world in real time. Remember, too, that the definition of pragmatics is the use of language. The worst possible way to measure that is one-on-one in a room with no other people, in the most quiet, perfect setting possible, where you are asking them to respond a certain way to a certain prompt. Most pragmatic assessments ask the students, “What would you do if…?” But pragmatics is not just the initiation and response to a social stimulus; it is the ability to adapt our social language in response to whatever the stimulus is at that time, or in that context.
I am sure many of you have already experienced working with students who have obvious pragmatic deficits. These children often pass standardized measures of pragmatics, with standard scores in the high-average or even above-average range. In these situations, I really want you to consider this: absence of evidence is not evidence of absence. The quality and quantity of data collected is only as good as the tools you use.
Again I ask, do standardized assessments include the use of appropriate social language across different contexts? No. Students with social language deficits who do well on these standardized language measurements for pragmatics typically perform well because they have good rote memory for what they are supposed to do. The problem is that this does not always translate well within the complexity of the real world, especially when there is disinhibition or reduced impulse control that makes them unable to stop themselves even if they wanted to. This is often related to comorbid challenges, which we will discuss later, but also because of emotionality. What do I mean by emotionality? Well, think about this. Day One of school, this is me: "Hey, I am so glad to see you! How was your summer? I love that dress, you look so cute." Day 89 of school, this is me: "Hey, yeah, we have speech today." To a certain extent, we are all emotional. That does not constitute a pragmatic language impairment. The difference is recognizing when you are emotional and inhibiting what you know is inappropriate behavior, language or response, and changing it to what you know is appropriate behavior, language or response. This knowledge piece is what we are going to discuss at length in this workshop.
Here are a few more things to know about standardized measures. They do not provide educators in the school setting with an adequate picture of the difficulties in an academic setting. They do not take into account interactions with peers, and/or non-predictable routines and environments such as fire drills and assemblies. They do not take into account inconsistent structure; for example substitute teachers, or that one teacher who has a whole different discipline plan than anybody else in the building. Standardized measures also do not take into account sensory stressors, like the lights and the intercom. They do not take into account new and novel situations, such as field trips, changing classes, and changing teachers.
So, how should we assess social communication? My recommendation is that we use informal measures, such as a checklist or portfolio assessment. These tools, especially when completed by the SLP, the teacher, and - if you can get it - from the parent, these things yield a more accurate picture of the student's strengths and weaknesses in real time, in real world applications. They also address the consistency of a skill, and when it is used appropriately versus inappropriately. It is very helpful to use a checklist that is designed with a school setting in mind, when trying to write individualized education program (IEP) goals that will be measured in the school setting.
Code of Federal Regulation 300.304
The Individuals with Disabilities Education Act (IDEA) is very clear on the fact that assessment in the school setting should include more than just standardized test scores, state scores and reading levels. The Code of Federal Regulation 300.304 states that there should be the use of a variety of assessment tools and strategies to gather relevant functional, developmental, and academic information. This is what is referred to as the “three prongs of eligibility” that we will be discussing shortly. This code says that any single measure or assessment should not be the sole criterion for determining whether or not a child has a disability, and for determining an appropriate educational program for that child. It also states that assessment tools and strategies that provide relevant information should be used. These should directly assist persons in determining the educational needs of the child. IDEA does not say that you have to use a standardized measure. It does say that one measure should not be the sole criterion for eligibility. It also says the information from testing needs to be useful for both diagnostic and programmatic decision-making.
Assessments in a school should include classroom observations, as well as samples of student work. I typically like to get the student's writing journal, especially if she is in third grade or above, and I like to look at her responses to questions on social studies tests. Why is that? Because that is where you start to see the higher order thinking skills, like inferencing, prediction, comparing and contrasting, and stating the main idea. These skills tend to be very hard for younger students, due to underlying deficits like difficulty with Theory of Mind. When you look specifically at these areas in reading comprehension and writing, you start to see the direct connection between social language and the curriculum that is not evident with a standardized test.
The IEP program that we use in our eligibility criteria worksheet specifically says that the following is required evidence of the disability: It must demonstrate language skills that are significantly below average; it must note a history of academic and functional difficulty (we are going to talk more about that in Part Two); multiple sources of data must be used; and if standardized measures cannot be administered, a criterion-referenced measure or two informal measures may be used.
Components of Social Communication
What are we looking for when we look at pragmatics? This has been a really vague area to pin down for a long time. But ASHA has published a document called Components of Social Communication that you can easily find on this webpage: http://www.asha.org/uploadedfiles/asha/practice_portal/clinical_topics/social_communication_disorders_in_ school-age_children/components-of-social-communication.pdf.
They also published a companion document with benchmarks to help SLPs have a better idea of what social communication skills should be developed by a certain age. I highly encourage you to look at that document on the ASHA website. It is also wonderful at clarifying something as broad as social communication and breaking it down into manageable, well-organized pieces.
What are the components of social communication, according to ASHA? Social communication includes social interaction, which is made up of basic social rules, politeness, greetings, farewells, introductions, obtaining attention, interrupting, apologizing, giving compliments, showing respect to adults, and so on. This is what we must commonly think of when we think about pragmatics.
Social cognition includes meta-cognition; the ability to think about your own thinking. It also encompasses self-evaluation, the ability to reflect upon, “How did that interaction go? Or what could I do to make it better?” It might also include recognizing when things do not make sense.
This includes narrative language, conversational language skills, and the basic verbal communication of needs and wants through labeling, requesting, protesting and commenting.
Then we have non-verbal language. This is comprised of body language, eye contact, gestures, tone of voice, and so on.
Finally, we have language processing -- comprehension and expression of both spoken and written language. This includes processing of language for syntax, semantics, morphology, and pragmatics, whether it is through the verbal or written modality, and is the one that most relates to our English Language Arts (ELA) standards in schools. A great example of this is when a student with a pragmatic language deficit struggles to understand figurative language in the second grade poetry unit, or when he struggles with comprehension of what he reads because he misinterprets the multiple meaning words, or does not understand the idioms within the text.
The ASHA document provides an awesome framework for SLPs to work from. But what we do in the school setting has to relate back to the impact of a disability on the educational standards. So, let me tell you what is not part of this document. What is not in this document is any mention of sensory processing, and/or restricted or repetitive interests. That is because we are talking about the components of social communication disorder, or language disorder. We are not talking about a classification of autism spectrum disorder (ASD). This will become clearer as we go through this course. You will gain an understanding of why it is important to tease out the social communication features thoroughly, especially when you are part of an interdisciplinary team evaluation that is considering an autism classification. What sets a language disorder in the area of pragmatics apart from a diagnosis or classification of autism is that a student with autism would have to have the sensory processing deficits and the restricted, repetitive interests. That being said, children can have sensory processing disorders without social communication deficits, and children can have restricted interests without having sensory or language impairments, and children can have pragmatic deficits and not have autism. Only if all three were present would there be a consideration of autism. I point this out because I have had teachers see a child with obvious sensory challenges - hand flapping, sound sensitivities, etc. - and they want to immediately jump to autism. I cannot stress enough how important it is to inform staff how difficult this diagnosis is to make, and how difficult it is to hear. It is not a diagnosis or classification to be made lightly.
As it relates to the restricted interests, I will point this out as well. Interest in MineCraft does not make a child autistic. Seriously, how many little fellows do you know that are so totally into MineCraft, especially in first, second or third grade? Interest in detailed knowledge of dinosaurs and animals also does not make a child autistic. What would typically signal a restricted interest is when the child cannot talk about anything else, or when he comes up to you and instead of saying hello, he leads in with, "SpongeBob is a sponge who lives in a pineapple under the sea." I once had a student whose restricted interest had to do with the size of things. So instead of leading in with hello, it was, "You are shorter than Miss Harrison," or, "Miss Smith is shorter than you." Now that is atypical.