Introduction and Overview
Thank you for having me back for Part Two of a three-part series on pragmatics and social communication. When we talk about educational impact, I want to first clarify to any SLPs in any setting the importance and relevance of how a pragmatic language disorder can impact educational success. I am a tremendous proponent of working together, so even if you see a child in an outpatient setting, it is so important and beneficial to the student to work together with the school-based service providers. We are going to talk about how social communication impacts the goal of education, how tricky eligibility can be in the school setting and why it is so tricky. We will also talk about the difference between two important terms in the school setting that both relate to educational success: academic performance and functional performance. We will also consider several factors when it comes to service provision. We will review a few ideas about how to get started in therapy and what you may want to start on when you first start therapy.
In Part One I introduced myself, so to save time, I am not going to go into very much of that. But I do want to make sure you know that this is a three-part workshop: one part on assessment (Course 8528), one on educational impact, and one on strategies (Course 8409). There is no way I will ever be able to touch on everything about social communication in three hours.
I also really want everyone to know that I did not get into social communication or pragmatics until I was in the school setting. That is when I became very interested in social communication; the reason being that social communication in school is constant. There is not a single time of day, class or happening within a school that is not social. Social communication in school is not only more important, but the impact of poor social communication is also more obvious.
Here are a few examples. I had a student in first grade that was having meltdowns. Come to find out, he was not sure how to ask how to go to the bathroom. I had another little girl in second grade who everyone thought was a bully. They reported to me that she was hitting everyone at recess one day. It turns out they were all playing tag, and she just didn’t understand the rules of the game. I have also had a fourth grader who was an absolute angel in kindergarten through third grade. But in fourth grade, he started to threaten his teacher's life on multiple occasions. Why? Well, the work had gotten exponentially harder, and the language requirements were infinitely more complex, and the emotional regulation needed was much greater. I can also recall a first grader who could read at a third-grade level, but he could not answer a single comprehension question. All of this is just at the elementary level.
Let's take the long view and see what this might look like over time. I am not sure if you are familiar with Tim Kowalski, but he is a private SLP in Florida who specializes in working with higher functioning individuals – those who were previously referred to as Asperger's. He once shared what the social communication impact can look like once older individuals get to college. For example, an individual who has tried to relate to others without understanding how might look like this: “He only talks to that one person who was kind enough to give him directions the first day. He attaches himself to that person, peppers her with questions, and gets in her personal space. He seeks out that person, and only that one person, constantly. It ends up looking a little bit like stalking.
Here is another example. Let's say an individual's social communication skills are more like that of a 14- or 15-year-old, but chronologically he is a 21- or 25-year-old. That is going to be a problem if he seeks out that younger age group for romantic relationships because that is not okay under the law. This is why it is important to address these skills in school to help individuals learn to deal with these bumps in the road before they graduate, while they are surrounded by people who know them and are there to support them. In school, when there is an issue that pops up, there is a plan for that. But in the real world, some of these behaviors can get them in really big trouble with the law, especially on social media where there is hardly any filter whatsoever. We can make a difference, and it needs to happen well before students get into high school. With all things related to language, there is a developmental continuum; and we don’t want the gap to get exponentially bigger year after year. So, let's keep that in mind.
What Does it Mean to Become College and Career Ready?
By the End of High School
The goal of education is for students to become college and career ready. That is the purpose behind the standards and how they are written. But what does this mean? By the end of high school, there are a few basic social skills that students need to have. They should be able to introduce themselves, start and maintain a conversation, interact with a variety of people, and make small talk. They should demonstrate active, engaged listening, have some basic manners, overcome a fear of public speaking, and know how to ask for what they need.
In a Work Setting
Many of these same skills actually overlap with what is needed in the career or work setting. We need to be able to communicate knowledge clearly and effectively. Think about how much we do this when we communicate individualized education program (IEP) goals or evaluation results. What about “responding to and developing on what other people have said”? We do this when problem-solving with other members of a team. We need to be capable of articulating our opinion; again, as we work and collaborate within a team. It is necessary to be able to give and follow instructions to volunteers, teachers, students, etc., and to have interpersonal and collaborative skills, not just acknowledging the hundreds of people and students we pass in the hall each day.
In the work setting, we have to be able to interact with a variety of people; not just the ones that we like, and not just the ones who are nice to us. We must know how to be likable, and how to manage relationships, including repairing those relationships when needed. We have to make small talk in a work setting; we do that all the time in elevators, hallways, or before a meeting starts. “Basic manners” is on this list as well which I will review shortly.
Actually, the top four most important skills in the workplace, as identified by the American Management Association in 2012, are critical thinking, creativity, collaboration, and communication. Those last two are the most important.
But, what is needed to even get a job? Let's imagine this scenario: There are three students who are graduating from college - let's say they are graduating from Stanford, Cornell, and Clemson - and applying for the same job. All of them graduate with a degree in engineering, and they have similar extracurricular activities, similar grade point average (GPA) and class rank. When those three students walk out of an interview, who is going to get the job? It is going to go to the one who was most likable in the interview.
It is one thing to get a job, but what about keeping that job? People are usually hired for their hard skills - the knowledge they show up with - but they are most often fired because they lack many of the soft skills that we just talked about.
Now, let's forget all that and imagine no one is ever going to get a job and they are never going to get to college. What social communication skills might they need, for example, for jury duty? What social communication skills are be needed in order to vote in an election? Skills like impartial decision-making, point of view, fact versus assumption, analyzing details, and managing and resolving conflicting opinions are absolutely necessary. I say that to demonstrate how social communication is much, much more than just making conversation, eye contact, and good manners.
Three Prongs of Eligibility in the School Setting
Let's go back to the beginning. How do we start? We start with student eligibility for support and the three prongs of eligibility in the school setting. For anyone not in the school setting, or for anyone who has had an outpatient provider ask, “Why in the world do these students not qualify for services?” it is important to know that in the school setting, eligibility is based on three prongs, not just one. It is not just the presence of a disability. I have had plenty of students who have a disability, but at one point in time or another, they did not meet prong two or three.
Let's start with prong one, the question being, “Is there a disability”? In other words, is the child eligible for a speech-language impairment under the Individuals with Disabilities Education Act (IDEA)? As discussed in Part One (Course 8528) of this series, we need a good assessment that takes into account academic and functional performance, as well as their language knowledge, in order to make this determination. We have also talked about the issues with using a standardized assessment as the sole means for determining a deficit in the area of pragmatics -- the use of language across contexts. For a review, refer to Part One for more on that.
In schools, we also have to determine which disability is the most applicable under IDEA's 13 categories of disability. This is equally important. We did touch on this in Part One, when we discussed differentiating a real lack of pragmatic knowledge from other deficits that may impact the ability to consistently demonstrate pragmatic knowledge, or other syndromes or conditions that have similar characteristics. This was discussed in relation to the dramatic increase in incidence and prevalence we are seeing in both the medical diagnoses and school classifications of autism.
In terms of eligibility, there is some variation from state to state, and to a certain degree, from district to district. Therefore, I can’t talk too specifically about eligibility criteria. For some it may be one and a half, 1.75, or two standard deviations below the mean; or the seventh percentile; or a certain standard score -- 80, 78, 75; or some kind of worksheet where there are several factors to consider which can raise or lower the “score.” But generally, the findings must fall within the moderate range.
Many of our students with pragmatic language concerns are not meeting eligibility for a few reasons, one of which is the problem with the standardized test of pragmatics. I am not going to address that now. But there is also the problem with which language test would show the deficits in a related area of language. For my students, I can usually find deficits in semantics, comprehension, and expression. When I say semantics, I do not mean, “point to the word” or “tell me the word.” I mean figurative language, multiple meaning words, comparing two words, and so on. When I say comprehension, I mean paragraph comprehension, looking at point of view, inferencing, prediction, and main idea. When I talk about expression, I really mean narratives -- the ability to tell a coherent story that makes sense. There are some language tests that do not assess this. So how would we know if there is a deficit in semantics, comprehension or expression if we did not look at it through an assessment lens?
SLPs may also have a restricted number of appropriate tests due to budget constraints. We may not even have the options that we would love to have in terms of the number or variety of assessment tools, so that is something we need to advocate for.
All of that is related to answering the question in the first prong, “Is there a disability under IDEA,” which could be a really complicated question to answer.
Prong 2 asks, “Is there an adverse effect on educational performance?” This is why the assessment data needs to include information related to academic and functional performance. Again, this may seem like an odd question to anyone who is not in the school setting, but it is possible to have a social impairment that is not affecting the student academically or functionally yet, especially in younger grades. Some students can carry along pretty well for now.
Also, the IEP goals in the school setting have to relate to educational performance in some way. I hear questions all the time from parents asking the IEP team about helping their child develop friendships. It is important to talk about the development of skills that are necessary for having friends as well as being a friend. In other words, it is difficult to have friends if the child cannot jointly attend to an activity with them, or if they struggle to have conversations about things other than manhole covers! So we address those needs through the IEP by working on joint attention, perspective taking, improving the ability to ask questions, etc.
What is educational performance? What does that term really mean? IDEA does not use the word “academics” to define educational performance, nor is it defined by the Office of Special Education Programs. As a matter of fact, both of these federal entities have chosen consistently not to define it. They did not forget to define it, they chose not to define it, because the Office of Special Education Programs wants schools to consider progress with both academic and non-academic skills when determining whether a child's impairment adversely affects his or her educational performance. We will explore this further.
To round out the three prongs of eligibility, the third prong is determining if specially designed instruction or services are needed in order to help the student make progress in the general education curriculum. This is where we begin considering services: which services; who is going to provide the service; the amount of service; where the service will be provided; and so on.
Really, when thinking about the three prongs of eligibility, these are three very complex questions.
Prong 2: Adverse Effect on Educational Performance
What is educational performance? How do we know what constitutes an “adverse effect on academic and functional performance”? One of the handouts is an adverse effects checklist. This is something simple that can be used as part of our screening or evaluation or used to support goal writing in an annual review. If used as an evaluation, it can be part of the two informal assessments, along with a pragmatics checklist. But the whole goal of it is to gather relevant data regarding educational and functional performance from the teacher. There is a functional performance section for all grades and a more specific set of academic questions for students in grades two and above.