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Promoting the communication skills of primary school children

excluded from school or at risk of exclusion: An intervention study
James Law and Sonia Sivyer
Child Language Teaching and Therapy 2003 19: 1
DOI: 10.1191/0265659003ct241oa
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Promoting the communication skills of
primary school children excluded from
school or at risk of exclusion: An
intervention study
James Law
Department of Language and Communication Science, City University,
London
and
Sonia Sivyer
East Kent Hospitals NHS Trust (and City University, London)
Abstract
Previous research has focused on the close association between speech and
language dif culties and emotional and behavioural dif culties. However,
little attempt has so far been made to examine this relationship in children
with emotional or behavioural dif culties who are at risk of exclusion or who
have been excluded from school. In particular there are no data on the impact
of speech and language interventions on this group of children. This study
tests the hypothesis that children with emotional or behavioural dif culties
currently excluded from school or at risk of exclusion, receiving intervention
for their language and communications skills, would make signi cant progress
both in terms of language, self esteem and behaviour in relation to a
comparison group. Children made signi cant progress as a result of treatment
compared to no-treatment, in the areas of language and social communication
skills, and self esteem. The data suggest that, in the short term at least, the
type of intervention carried out had bene cial effects for the children
concerned. Implications for practice for speech and language therapists
and teachers working with this client group are also discussed.
Address for correspondence: James Law, Department of Language and Communication Science, City
University, Northampton Square, London EC1V 0HB. Email: J.C.Law@city.ac.uk
# Arnold 2003 10.1191=0265659003ct241oa

2 Child Language Teaching and Therapy
Introduction
The management of children with emotional and behavioural dif culties is an

issue of enormous concern for all working in education. At one level this is
translated into the gures for school exclusions. Whilst there has been, as a
result of government policy in the UK, a fall and then a rise in permanent
exclusions from mainstream schools over the past ten years, data on the
number of temporary exclusions have not been available (DfES, 2002). This,
in effect, means that mainstream teachers are having to deal with these issues
on a routine basis in their classrooms. When asked to explain increasing
concerns about behaviour in the classroom, head teachers highlighted ‘disobe-
dience in various forms – constantly refusing to comply with school rules,
verbal abuse or insolence to teachers,’ rather than ‘physical aggression’ (DfE,
1992). The Audit Commission report (1996) also refers to children’s poor
literacy skills. The relationship between early learning dif culties, exclusion
and crime has been described as a ‘downward spiral’ in which children who
perceive themselves to be ‘failing’ in primary school (that is lacking in basic
skills), become disenchanted and drop out (Basic Skills Agency, 1997). It has
been suggested that children with special needs, in particular, may be margin-
alised where ‘local nancial management and market forces operate’ (Boew
and Ball, 1992). The majority of children with emotional and behavioural
dif culties in a study by Parsons (1994), were referred for assessment of
their special educational needs. However, many were excluded before this
process was completed, meaning that needy children were in several cases
without any educational placement and assessment details became out of date.
To some extent this is a poorly speci ed population. The heavy social and
political emphasis placed upon school exclusion has served to mask the need
to provide support in core areas that may underlie school performance. The
relationship between emotional and behavioural dif culties and language
problems is recognised in the literature (Benner et al., 2002) but this does
not necessarily mean that this association is widely recognised in practice. Of
particular interest to the present study are recent reports of the high level of
underreporting of speech and language dif culties in these children (Cross,
1997; Cohen et al., 1998). Cohen and Lipsett (1991) found that children who
had a previously unrecognised language impairment were rated by their
mothers as more ‘delinquent’ and by their teachers as exhibiting more
‘psychopathology’ and particularly more ‘externalizing (conduct) psycho-
pathology’. They argue that ‘children with ‘‘invisible’’ handicaps are perceived
as more ‘‘dif cult’’’. Lipsky (1985) describes ‘marginal handicaps’ related to
‘language and learning’ problems, which can contribute to the perception of
Promoting the Communication Skills of Primary School Children 3
the child as problematic: ‘normal’ in many ways but not in others. This view is
also supported by Paul and James (1990), who found that parents of children
with delayed language have been found to perceive their child as temper-
amentally dif cult and hard to manage relative to children who are developing
language normally. They argue that problems in producing or understanding
language may appear to adults as ‘non-compliance, inattentiveness or social
withdrawal’. The lack of clarity in the relationship between early language
learning dif culties and emotional and behavioural dif culties is re ected in
the level of disagreement between parents and teachers and, indeed, between
teachers from different schools (Rutter et al., 1970, 1976; Herbert, 1998;
Botting and Conti-Ramsden, 2000). This problem is exacerbated by the lack of
expertise in the assessment of children’s speech and language skills. A recent
major study of the provision of services to children with speech and language
needs in England and Wales has demonstrated that negligible levels of
resource are allocated to meet the children’s needs if they are classi ed as
having emotional and behavioural dif culties (Law et al., 2000).
The exact nature of the relationship between behavioural disorders on the
one hand and communication disorders on the other has been discussed
extensively (Baker and Cantwell, 1985). In general the conclusion drawn has
been that, for most children, early communication dif culties lead to beha-
vioural dif culties or at least are integrally linked in a common pathway of
development that may become stronger as the child develops. Some argue that
language disorders are likely to interfere with cognitive development and to be
‘instrumental in causing or exacerbating behavioural problems’ (Cohen et al.,
1989). Others suggest that linguistic impairment is a risk factor for psycho-
pathology in general (Baker and Cantwell, 1982; Beitchman et al., 1986). The
children at greatest risk for this were those initially diagnosed with receptive
and pervasive speech or language impairment. These may be a speci c risk
factor for later aggressive and hyperactive symptoms.
However, it has been suggested that there may be as many as ve different
possible patterns in the relationship between the two (Rutter and Lord, 1987).
The psychiatric disorder may lead to the language problem and vice versa: the
two may be different facets of the same phenomenon; the two may co-occur,
but with different causal mechanisms; there may be multiple interconnected
causal processes. Baker and Cantwell (1985) also discuss several hypotheses
regarding the possibility that communication disorders may lead to psychiatric
disturbances. Communication disorders could contribute to patterns of deviant
parent–child interactions, leading to increased stress, and vulnerability to
developing psychiatric disorders. Lack of intact language may affect social
behaviour, interaction and ‘inner speech’, which is essential for the inter-

nalisation of social codes for the self-regulation of behaviour (Luria, 1961;

Vygotsky, 1993). Verbal language is the principal means of expressing
emotions and feelings and a way of learning to in uence the behaviour of
others. Although such models are appealing in their simplicity it seems likely
that different models will operate for different individuals and that there is
bound to be an interactive relationship between the two (Stevenson, 1996).
Indeed it is hard to see how speech and language dif culties would not be
associated with factors that clearly mediate behaviour such as self esteem,
literacy and general academic performance.
There is very little published evidence of the impact of interventions
targeting the communication skills of children with emotional and behavioural
dif culties. Accordingly the present study was set up to examine this issue
with particular reference to children excluded from school or at risk of
exclusion and, more speci cally, to test directly the possibility that the
impact of communication intervention extends into important aspects of the
child’s self perceptions and could affect behaviour itself. The experimental
hypothesis was that, when compared to a group of children receiving no
support, those receiving intervention for their language and communication
skills would make signi cantly more progress in the following areas: language
skills, social communication skills, self esteem, and perceived emotional and
behavioural dif culties. A particular focus of this study is the differences in
parent and teacher perceptions of the children’s behaviour.
Method
Participants
The 31 children referred to the project were all drawn from an inner city area.
In order to minimise bias of sampling, referral requests were sent across the
whole borough. Referring agents were either specialist teachers of children
with emotional and behavioural dif culties, educational psychologists, class
teachers in conjunction with their head teacher and=or special educational
needs coordinator (SENCO), or the head of the Primary Pupil Referral Unit
(PRU) for children already excluded from mainstream school. In most cases
the referrals were made in conjunction with a speech and language therapist
allocated to the school, but the children were not those with whom the thera-
pist was already working.
The children were all in primary school year 5 or year 6 (ages 9 to 11 years,
mean age 10 years and 8 months) that is, coming up to the age at which they
would transfer to secondary school. They were identi ed through the relevant
agencies, assessed by the researcher (SS) and subsequently identi ed as having

language and communication dif culties. Also, they all had emotional and=or
behavioural dif culties and were already excluded from mainstream school or
were perceived by their head teacher as being at risk of exclusion. In addition all
children had to have a primary language or communication dif culty, that is,
dif culties that could not be directly attributed to another condition such as
cerebral palsy, autism, or general developmental delay, but the participants had
not previously received speech and language therapy intervention. No racial or
ethnic criteria were adopted. Children from the black community made up 73%
of those referred to the project. Of the 20 who participated to the conclusion of
the study, only one spoke a language other than English (Yoruba). Of the
children referred to the project 92% were boys.
Procedure
An independent groups design was adopted. Children were assigned to two
groups. Group I, the study group, comprised ten children who received weekly
language and communication therapy during the Summer term. Group II, the
comparison group, also comprised ten children. The comparison group was to
receive no intervention while those in the study group were treated, but would
subsequently receive an intensive block of speech and language therapy. The
children in Group I were further subdivided into two groups of ve children.
Children in Group IA were attending the PRU, having already been excluded
from mainstream school, while the children in Group IB were perceived by the
referring agent to be ‘at risk’ of exclusion. Only 17 of these children’s results
could be included in the nal analysis. One child would not comply with any
reassessment, one was absent for all reassessment and one was found to have
received speech and language therapy independently of the project.
For practical reasons it was not possible for children to be allocated to the
groups in a random manner, as the excluded children at the PRU had to be seen in
one group. Whilst the two groups were not therefore matched, the baseline scores
for each group were checked and no statistical differences were identi ed between
the two groups in terms of age or baseline scores. The groups were matched for
gender, with one girl in the treatment group and one in the control group.
The project was devised in three phases:
° Phase I: Baseline assessment phase, during which referrals were received

and baseline assessments carried out.
° Phase II: First treatment phase. During this period children in Groups IA and
IB received intervention weekly throughout one term, a total of 10 sessions

of 45 minutes each. Children in the comparison group did not receive any
intervention.
° Phase III: Reassessment phase at the end of the school term, in which the
initial assessments were repeated. It included the children in all the groups,
that is, both treatment and comparison conditions.
Intervention
The package of therapeutic intervention was devised through consultation with
a number of professionals. The aim was to take a holistic approach that treated
speci c language and social communication skills, and also dealt with
behaviour management, issues of self esteem and general emotional well-
being. Guidance was provided by clinical psychologists on the setting up and
structuring of a group for children with emotional and behavioural dif culties
and also with assessments for self esteem and behaviour. Specialist behaviour
support teachers gave advice on the use of basic counselling skills and Circle
Time techniques (Mosley, 1990).
Regular sessions were run at the same time on the same day each week by
the speech and language therapist, with the support of a speech and language
therapy assistant. In the case of the PRU, support was also provided by the
class teacher plus one of the Unit’s learning support assistants, who helped
with behaviour management and would later run similar groups. This high
adult-to-child ratio was adopted to enable the facilitation of structured activities
in a supportive and non-threatening environment. Sessions were designed to
follow a set structure (see Table 1) with speci c activities allocated to certain
adults who introduced and ran them from week to week. This familiar routine
Table 1 Structure of therapy sessions
Duration Activity
7 minutes Welcome: ‘Categories’ game (semantic organization=language
game). Rules (established in rst session and brie y reviewed
in all other sessions).
5 minutes Self esteem: colour-coded rating scale activity.
10 minutes Social communication activity (listening skills).
5 minutes Break (during which ‘Special Time’ was available on request).
10 minutes Main language activity.
5 minutes Feedback on the day’s activities with an emphasis on
complimenting each other and thus increasing self esteem.
3 minutes ‘Guess who I am’ game (higher level language skills game)
A homework activity was given mid-way through the course of
sessions and a certi cate was presented to each child on the
nal day.

was intended to provide a sense of consistency and security, and to help the
children feel more con dent and able to experience success.
Behaviour management. The approach to running the group was to

establish a positive, secure environment in which the children could grow in
con dence in order to have the opportunity to demonstrate their strengths and
capabilities; in order to achieve this, it was important to set relatively rm
limits on children’s behaviour. Above all it was felt to be important to be fair
and consistent, very much following the guidelines set down by the New
Learning Centre (Janis-Norton, 1995), which encourages the establishment of
‘a positive, rm and consistent environment’. It was also essential for adults to
emphasise that it was certain behaviours that they did not like or accept, and
not the child him=herself. In order to achieve this, the children devised their
own ‘group rules’ to which they all agreed to adhere. They signed these rules
to indicate this, as did the adults. For children who were not abiding by their
own group rules, it was agreed between the children and therapist that they
would have one ‘warning’ and if this were not observed, then there would be
‘time-out’ until that child was calm enough and felt ready to return to the
group (that is the child would go with an adult to an allocated ‘time-out’ room
or area for a few minutes). In order to make this approach feel less ‘harsh’, the
therapist incorporated football warnings which were readily accessible and
culturally relevant. Thus, a ‘warning’ was a yellow card and then a ‘time-out’
or red card could be shown if necessary. The aim of this approach was to
‘lighten’ the potentially punitive aspect of these measures. Red cards were
needed on only two occasions in total.
Self esteem. Each session included an opportunity for the children to talk
about their feelings, using a visual rating scale based on the work of Pretzlik and
Hindley (1993) who gave advice on the use of a colour-coded response scale.
The children were introduced to this concept during assessment, and during the
rst session they were encouraged to work together to devise their own ten-point
rating scale of self esteem. The children and adults then used this each day to
make a comment on how they were feeling, if they wished. Initially the adults
gave models and the children were encouraged to contribute too; for example,
‘Today I’m feeling a two because my Mum shouted at me this morning.’
Children were free to give a number but not explain their reason if they did not
wish to do so, and ‘real life’ examples of both high and low scores were given so
that children did not feel pressure to select a high number.
Towards the end of each session, the therapist led a feedback activity to enable
group members to share what they had done. There was also the opportunity for

everyone to say one thing that the person on their right had done well that day.
This meant that everyone had the chance to pay another child a compliment and
to hear others complimenting them. Any positive comments about others were
praised and could be reinforced by comments from the adults such as ‘X did well
in noticing and talking about good things that others did.’ The ethos of the group
was to promote emotional well-being, hence all children were offered an
opportunity for ‘special time’ at every session. This meant that any child
could choose to speak to any adult they wished in privacy and in con dence.
Language activities. The assessment pro les highlighted which aspects of

language skills would be best incorporated into such activities. Each session
always included the same two language activities (short, fun activities, which
were adapted and developed in different ways each time) and one longer
activity which changed from session to session. Inherent within this approach
was the need to sustain the interest and attention levels of the children
concerned, whilst also providing a familiar structure.
These activities focused on developing the following skills:
° Lexical organisation skills (for storage and retrieval of vocabulary)
° Description of objects by class, function, location and attribute
° Classi cation=semantic connections (Speake and Bigland-Lewis, 1995)
° Categorisation =semantic links (Bigland and Speake, 1995)
° Higher level language skills: asking and responding to questions; reasoning,
inference and problem solving skills (Locke and Beech, 1991; Heinze
and Johnson, 1987; Semel, 1982), narrative techniques (Shanks, 2000;
Catherall, 1998).
Social communication activities

Social communication activities were based primarily on the principles of:
Social Use of Language Programme (Rinaldi, 1995a,b). One structured
social communication activity took place each session which focused on basic
listening skills. This activity incorporated speci c features of good listening:
eye contact, posture, llers and comments, facial expression, and head move-
ments. Extensive use was made of a video camera in order to motivate and
provide visual feedback.
Circle Time (Mosley, 1990). Adults reinforced and praised all positive
contributions of any kind, including ‘pro-social’ behaviour, spoken commu-
nications and listening skills. Circle Time offered the children an opportunity
to share experiences and to listen to others’ experiences, and was intended to
develop a strong sense of shared experience and empathy.
It was not possible on the basis of the assessments to specify different

pathways through the intervention and it was concluded that given the similar
predicament of many of the children in terms of their educational provision
there was much to be gained from developing a group identity by including all
the children in all the activities listed above.
Measures
The following measures were used in assessments.
Language. A selection of tests and sub-tests from the SAOLA School Age
Oral Language Assessment – were chosen – (Allen et al., 1993). The assessment
of semantics consists of practical tasks (for example, what you would see in a pet
shop), which translate easily into therapy activities, with the aim that the skills so
learnt could be generalised to every-day life. Although the SAOLA is not a
norm-referenced test, it is extremely useful in providing a ‘descriptive pro le of
key language competences related to the school setting’ (Allen et al., 1993, p. 1).
In particular, this pro le describes the dif culties that children with language
disorders have with the speci c assessment tasks compared with age-matched
peers without such dif culties. An example can be seen in Table 2. Two areas of
the SAOLA (Narrative Skills and Semantic Organisation) were selected.
Outcomes were measured in terms of the changes in total scores on the
SAOLA Narrative Assessment and Semantic Skills Assessment.
Social communication skills. Video was considered the least obtrusive

means of assessing skills in this area. Children were lmed in structured
listening activities involving peers and the speech and language therapist. The
Social Use of Language Programme: Primary and Pre-School Assessment
Pack (Rinaldi, 1995) was chosen as the best existing measure of social
communication skills for this client group. As the children had had no relevant
previous training, the rst rating chart was selected, which covers ‘Listening
Skills’ – the most basic of social communication skills (see Table 3 for an
example of scoring for one of the items).
All of the above assessments were videotaped and subsequently scored by
an independent tester, a speech and language therapist, blind to the group
status of the children. The videos were presented in a random order.
Behaviour. ‘The Strengths and Dif culties Questionnaire’ (Goodman,

1997) was selected as the most appropriate tool to ascertain the views of
parents and teachers concerning emotional and behavioural issues relating to
the children. This is a behavioural screening questionnaire, developed from the

Table 2 Example from ‘Semantic Skills’ assessment (Comparison task: ability to compare=
contrast (dogs) and explain concepts of same=different)
Mainstream Language disordered

Score Criteria children (year 4) (year 4)
0 No evidence of The majority can The majority can
contrasting, identify and select on the basis
seems to choose describe of same=different
for personal= differences but but lack linguistic
random reasons. not substantiate skills required for
on the basis of effective
similarity. substantiation.
1 Chooses dogs that
are similar=
different and
discusses their
attributes but
does not
compare=
contrast, or any
attempts are
ambiguous.
2 Is able to select a
dog and explain
why the other
dog is different
(part a) but not
substantiate
choice of a
similar dog from
sheet 2 (part b).
3 Contrasts dogs
using the same
attribute both in
difference (part a)
and similarity
(part b).
Source: ‘School Age Oral Language Assessment’ (Allen et al., 1993).
well established Rutter (1967) questionnaires, which is shorter in format and

provides one user-friendly form suitable for both parents and teachers. In
response to statements such as ‘Often has temper tantrums or hot tempers,’ a
box is marked as ‘Not True,’ ‘Somewhat True’ or ‘Certainly True.’
Self esteem. A questionnaire ‘What I Think About Myself ’ by Kosmoski

et al. (1994) was employed. This is not a norm-referenced test, but rather
provides the child with the opportunity to produce self-worth ratings. Harter
(1987) has demonstrated that children over the age of eight years can
differentially assess their abilities in various domains in order to produce
Table 3 Example from ‘Listening Skills’ assessment (Listener feedback—facial expression)
Score Criteria
0 ˆ most desirable Gives appropriate facial expression to re ect content of
speaker’s talk, for example, smiles on hearing good
news.
1 Facial expression a little lacking but not perceived as
inappropriate.
2 Facial expression rarely used, or facial expression
sometimes inappropriate, for example, smiles on
hearing bad news.
3 ˆ least desirable Facial expression not used - remains ‘blank’, or facial
expression frequently inappropriate.
Source: ‘Social Use of Language Programme: Primary and Pre-School Assess-

ment Pack’ (Rinaldi, 1995).
such ratings. The questionnaire was modi ed slightly to make it both easier to
demonstrate a shift in opinion and to make it more accessible to children. Thus,
children could rate themselves on a scale from 0 to 4, (rather than 0 to 2)
depending on how strongly they agreed or disagreed with the statement, and a
colour-coded response scale was introduced along the lines developed by Pretzlik
and Hindley (1993) and Pretzlik and Sylva (1995). The greater the intensity of
colour in a box, the more the agreement and strength of feeling. The colours
chosen corresponded to those of the football team supported by the vast majority
of the children, and the therapist taught the children to use the rating scale by
practising with a range of statements related to their own interests, such as ‘I am
good at football.’ The questionnaire is written in language which the children in
the project could understand, and the sentences were read aloud to the children.
Of the eighteen phrases, eight are ‘reversed’ as a protection against systematic
reporting bias. Thus to agree with number 1 ‘I am good at my school work’
would suggest high self esteem, whereas to agree with number 2 ‘I am picked on
at home’ would suggest lower self esteem.
Results
Attrition
Approximately one-sixth of the children referred to the project changed
school, due either to exclusion or parental choice, within one or two
months of referral (that is during the baseline assessment phase, before the
intervention began). In the case of children who changed to and attended a
different school, it was possible to continue to work with them at the new site.
However, for children excluded or withdrawn from school and not placed
elsewhere, it was beyond the scope of this project to work with them.

Nevertheless, they represent perhaps the neediest of client groups. Out of a

total of 31 children referred to the project, only 20 remained to the end. It is
dif cult to say what the implications of such a high rate of attrition would be
on the results of the study. It might be assumed that the more motivated
parents and children remained engaged with the services, but this is not clear.
Absences and non-compliance

Several children referred to the project were frequently absent from school.
This made initial assessment dif cult, as it was often uncertain whether or not
a child would be in school at the time when the assessment was planned.
Similarly, during intervention, attendance was somewhat erratic, especially in
the case of excluded children, due largely to children arriving extremely late at
the unit. This tended to be disruptive, both for those already in the room and
for the latecomers themselves, as a result of missing part of the session.
Repeated absences by certain children at the time of reassessment resulted in
some variation in the numbers for the nal analysis.
For two particular children who were already excluded, there was a speci c
dif culty with non-compliance for reassessment. In spite of frequent attempts
by the therapist and colleagues, these two children were very unwilling to
repeat measures that had been carried out before. This was especially the case
for self esteem and semantic skills, for which neither of them completed the
reassessment. Although the assessments had been selected to be as motivating
as possible, these children had initially been dif cult to focus and motivate for
assessment. The incentive of being videotaped for the other two assessments
was no longer enough for one of them, although one did comply, but only with
the two assessments that were videotaped.
Language and social communication skills

Each child’s social communication skills and language (narrative and semantic)
skills were measured at the baseline assessment and again at the reassessment
Table 4 Comparison of changes in social communication skills
Number Mean rank

Treatment group 9 5.72
Comparison group 7 12.07
Total 16
Mann–Whitney U 6.5
Signi cance (one-tailed) 0.005**
**p < 0.01.

Note The scores for this assessment are inverted, hence
a lower rank signi es improvement.
Table 5 Comparison of changes in language skills
Narrative skills Semantic skills
Number Mean rank Number Mean rank

Treatment group 9 11.06 8 12.25
Comparison group 7 5.21 8 4.75
Total 16 16
Mann–Whitney U 8.5 2
Signi cance (one-tailed) 0.012* 0.001**
*p < 0.05; **p < 0.01.
that took place at the end of the rst period of intervention. The changes that
had occurred in the children’s skills were analysed, using Mann–Whitney tests
to compare the progress made by the treatment and comparison groups, and
the results are presented in Tables 4 and 5. These show signi cant differences
across all these areas, and demonstrate that relative to the comparison group
the treatment group showed improvement in, speci c social communication
skills, and speci c language skills, both narrative skills and semantic skills.
Self esteem
Table 6 gives the result of a Mann–Whitney test in which the changes in each
child’s total score on the ‘What I think about myself’ questionnaire were
analysed, in order to compare the progress of the treatment and comparison
groups. This represents a signi cant difference, showing that children’s self
esteem appeared to be enhanced as a result of receiving therapy.
Behaviour
Baseline assessment. Table 7 shows the Parents’ and Teachers’ percep-
tions of the children’s initial behaviour for a total of 15 children, being all the
children for whom both parents’ and teachers’ perceptions were available at
the start of the project. This does not include any of the excluded children at
Table 6 Comparison of changes in self esteem
Number Mean rank

Treatment group 8 11.13
Comparison group 8 5.88
Total 16
Mann–Whitney U 11
Signi cance (one-tailed) 0.028*
*p < 0.05.

Table 7 Initial pro le of children’s emotional and behavioural dif culties from the strengths and dif culties questionnaire (Goodman, 1997) 14
Parents’ Teachers’ Comparison of perceptions using
perceptions perceptions Wilcoxon signed ranks test
Area of perception T C T C No. Sum p (2-tailed)

Emotional symptoms Mean 2.4 3.1 3.3 4.4 Negative ranks 9 63.5 0.205
SD 1.5 2 1.6 2.6 Positive ranks 4 27.5
Max 5 7 5 9 Ties 2
Min 1 0 0 0
Conduct problems Mean 2 2.3 4.4 6.5 Negative ranks 10 77.5 0.024*
SD 1.1 1.7 3.3 3 Positive ranks 3 13.5
Max 4 5 9 9 Ties 2
Min 1 0 0 1
Hyperactivity Mean 6 6.4 6.3 7.9 Negative ranks 7 52.5 0.62
SD 2.2 2 3.2 2.2 Positive ranks 6 38.5
Max 9 9 10 10 Ties 2
Min 3 3 1 3
Child Language Teaching and Therapy
Peer problems Mean 3.6 3.3 3.9 3.3 Negative ranks 8 51 0.698
SD 2.1 1 2.5 2.4 Positive ranks 5 40
Max 7 4 7 7 Ties 2
Min 1 1 0 0
Pro-social behaviour Mean 1.8 3 4.5 5.4 Negative ranks 3 9 0.018*
SD 1.2 1.9 2.8 2.3 Positive ranks 9 69
Max 3 7 10 10 Ties 3

Min 0 0 0 2
Overall dif culties Mean 9 9 11 11 Negative ranks 7 40 0.253
SD 4 4 3 3 Positive ranks 8 80
Max 16 14 15 15 Ties 0
Min 3 2 5 5
T represents the treated group, C the comparison or untreated group.

*p < 0.05
Table 8 Summary of parents’ and teachers’ perceptions of children’s emotional and behavioural dif culties from the strengths and
dif culties questionnaire (Goodman, 1997)
Overall dif culties Emotional Conduct Hyperactivity Peers Pro-social

(%) (%) (%) (%) (%) (%)
Teachers ‘Abnormal’ 70 10 60 65 55 50
Teachers ‘Borderline’ 15 25 10 10 5 5
Teachers Totala 85 35 70 75 60 55
Parents ‘Abnormal’ 40 20 20 40 60 7
Parents ‘Borderline’ 13 7 27 13 20 0
Parents Totala 53 27 47 53 80 7
a
Total percentage of children perceived as falling outside the ‘normal’ cut-off. This has an expected value of 20%.

Promoting the Communication Skills of Primary School Children
15
the PRU, whose parents did not return questionnaires sent out. The table also
includes the results of a comparison of these perceptions and shows that for
the scales of ‘Pro-social’ (e.g., ‘Shares readily with other children such things
as treats, toys, pencils etc.’) and ‘Conduct Problems’ (e.g., ‘Often ghts with
other children or bullies them’), there was a signi cant difference between
parents’ and teachers’ perceptions.
Goodman (1997) suggests bands by which the population can be divided
into ‘normal’ (80%), ‘borderline’ (10%) and ‘abnormal’ (10%). Table 8
summarises how many ‘border-line’ and ‘abnormal’ results were observed.
The total (i.e., ‘abnormal’ plus ‘borderline’) gures for both parents and
teachers appear much higher than the expected proportion of 20% which
Goodman suggests as the cut-off. Given the target group this is not surprising.
Post-therapy assessment. Discussions with parents and teachers following

intervention indicated that they perceived an improvement in the children’s
emotional and behavioural status. However, analysis of their perceptions as
measured by the Goodman ‘Strengths and Dif culties Questionnaire’, using
Mann–Whitney tests indicated that the differences were not statistically
signi cant.
Discussion and recommendations
Initial pro le of the children

Bearing in mind that these children would not have been brought to the
attention of the schools’ speech and language therapists had it not been for this
study, that is, no language or communication dif culties had previously been
identi ed, it is noteworthy that they were all found to have language skills no
higher than the level commonly found in children with language disorders in
year 4. As the children in the study were all in years 5 and 6, this gives an
indication of the severity of their previously unidenti ed dif culties.
The measures used

The majority of measures used in this study might best be described as
criterion referenced measures with relatively high face validity but with
relatively little in the way of standardisation to back them up. These have
the advantage that they purport to capture real change, which makes clinical
sense. Yet in the nal analysis there is always the risk with measures that do
not report reliability coef cients in their standardisation that it may be dif cult
to differentiate change from measurement error. Revising the design of this

study it might be recommended that standardised assessments should replace
those used. The risk is that such measures may not be sensitive to change in
this population, assuming that the children would cooperate with them at all.
The effects of intervention

The data suggest that the intervention carried out had bene cial effects for the
children concerned, particularly with regard to their language, their social
communication skills and their self esteem. Although there is some suggestion
that behaviour may have been modi ed, the differences between the two
groups did not reach signi cance and we could not conclude on the basis of
these data that modi ed language and communication skills necessarily leads
to modi ed behaviour. Given that the main focus of the intervention groups
was the children’s communication skills and, given the relative brevity of the
intervention, it is perhaps not surprising that there was not a substantial impact
on behaviour. It would be interesting in the light of these results to monitor the
impact of a more extended intervention phase on behaviour. It would be
reasonable to assume that behavioural changes would follow from improve-
ments in language and communication skills. Similarly it would be interesting
to look at the long-term effect of such intervention on the children’s capacity to
integrate back into school. Progress made by excluded children was compared
with that made by mainstream children at risk of exclusion. Although the
sample sizes were small, these analyses suggested that differences were
minimal, indicating that excluded children could bene t from such interven-
tion, just as much as those at risk of exclusion.
Teachers’ perspectives
In addition to completing questionnaires, teachers working with the children
involved in the project held discussions with the therapist to provide more
detailed feedback. All teachers welcomed the opportunity for joint-working,
which enabled much improved carry-over into the classroom. Many expressed
the view that they had not previously thought of their pupil as having speci c
dif culties with language or communication, and that this gave them a
different perspective on the child with whom they were working. The
important point here is that while the speech and language therapist has a
speci c responsibility for assessing children’s communication, in practice they
are unlikely to be able to provide the coverage of mainstream schools with
current levels of staf ng to support children with emotional, behavioural and
communication needs. This means that the teacher is likely to be the lynchpin

of support offered to these children and that the key to working effectively
with them is the appropriate skill mix between the different professionals,
learning support assistants, classroom teachers, educational psychologists and
speech and language therapists.
Whilst initial assessment highlighted the fact that teachers were extremely
concerned about children’s emotional and behavioural status, on completion of
the package of care, all teachers described some progress made by their
pupil(s). In addition to their increased language and communication skills,
other skills were also observed in the classroom:
° the majority described their pupil as ‘more con dent’.
For mainstream pupils, the teachers highlighted the bene ts of:

° being selected for a group;
° going out to another school;
° meeting peers;
° forming new relationships with others to whom they could relate.
For excluded children, the teachers highlighted:

° offering the pupils opportunities to show skills that would not be seen
elsewhere;
° the children being able to develop improved attention and listening skills,
week by week;
° for individual children, they identi ed bene ts in: ‘getting used to being
listened to,’ ‘being able to see tasks through to the end,’ ‘opportunities to see
more of the child’s potential,’ ‘learning the need to listen to others thus
keeping in touch with his=her peer group.’
Intervention appeared to be bene cial in changing some teachers’ perceptions

of certain children, previously at risk of exclusion. Of particular note is the
comment of one head teacher who said, ‘B is now a pleasure to have at school . . . I
am very happy as he was not at all a pleasure before . . . The joint approach
between speech and language therapy, the class teacher and Child Guidance has
been very, very positive for B’. This suggests that this child, who prior to therapy
was at signi cant risk of exclusion, was perceived in a more positive light
subsequently and was considerably less likely to be excluded from school.
Parents’ perspectives
The response to the study by parents differed markedly. In total, 80% of parents
of mainstream children (at risk of exclusion) gave feedback and perceived some
progress in most areas of their children’s emotional and behavioural status. For
example, one parent said, ‘C loved the group and people and going on the
bus . . . He is much more con dent and talks about it all the time . . . It was a very
positive experience . . .’. However, the PRU requested that no direct face-to-face
or telephone contact be made with parents and unfortunately this group of
parents did not respond to any questionnaires sent. This seemed to correspond
to the fact that the parents of children still attending their mainstream school
were extremely keen for their child to be given this constructive support, and
school staff reported that parents found this approach much less ‘threatening’
compared to mental health or social service provision. It contrasted with their
experience of a negative cycle of their child being ‘stigmatised’, frequent
unproductive meetings and temporary exclusions. On the other hand, parents of
excluded children appeared very disenchanted with ‘the system.’ Several
seemed to have lost con dence in the professionals.
Differences between parents’ and teachers’ perspectives

The data in Tables 7 and 8 clearly re ect the types of discrepancy between
parent and teacher in the perception of behaviour dif culties already well
characterised in the literature. Consistently, parents had a more positive view
of their children’s behaviour than did the teachers. Given that these children
had been identi ed for school exclusion, such a nding is probably not
surprising. In the majority of cases teachers did seem to change their
perceptions of the participants, and parents also perceived a change in their
children’s behaviour. Although the latter was less marked this may be
attributed to a lower level of concern in the rst instance. Such ndings
suggest that this type of intervention is likely to have had a positive effect as
far as the teachers are concerned and one might infer that this is likely to lead
to raised expectations and a more positive performance in class. At this point
we would maintain a positive but cautious position. On the basis of these
results it is not possible to extrapolate from the intervention in question to a
reduction in school exclusion. It may well be that such behavioural progra-
mmes primarily have behavioural outcomes and are not able to reach the
emotional needs of the children concerned. Nevertheless these are important
secondary ndings, which could usefully be carried forward.
Children’s perspectives
The change in attitude of some of the children was quite marked. For example,
at rst some children covered their ears when others were complimenting
them, but it gradually became easier for them to accept compliments. Also

some participants initially had extremely poor self or other awareness, for
example, they were unable or unwilling to listen to others, unable to take turns
or to regulate their own contributions.
At the end of the intervention period the children expressed positive views
on the intervention. They described bene ts for themselves in terms of what
they felt they had learnt, including:
° ‘It was fun. You could learn a lot about listening and quietness . . . and
making new friends.’
° ‘It’s good to let other people talk when it’s their turn.’
Ethnicity. One issue that stands out as potentially important is the

differences in ethnicity and cultural background of the children and the
therapists and teachers involved with this project. Compared with a national
average ethnic community population of 6%, over 50% of children under 18
years in the population in which the study was carried out are from black and
other ethnic minorities (Lambeth Education, 1995). The size of the sample is
insuf cient to test whether the proportion (74%) of the referrals who were
from the black community is statistically signi cantly higher than the baseline
proportion. Given the preponderance of black children in the intervention
groups and given the apparently different perceptions of parents and profes-
sionals at least as far as behaviour is concerned, it might be argued that this
study was in fact only picking up on very real differences in culture. To a
certain extent this problem was overcome by the extensive use of speech and
language therapy staff from ethnic minorities. The local NHS Trust was
running a scheme in which applicants from ethnic minorities were employed
as speech and language therapy assistants whilst undergoing training as speech
and language therapists. Participants in the project appeared to relate extre-
mely well to them and bene ted from their presence.
Placebo effect. It is important to consider whether the results could be due

to a placebo effect (Crow et al., 1999). It might be argued that the observed
changes were due to the fact that the therapist had treatment-related outcome
expectations of the children combined with a belief in the therapeutic
techniques concerned. The critical issue here is the nature of the support
received by the comparison group. While it is true that they were not receiving
speech and language therapy during the period concerned it is not strictly true
that they received no help. Indeed they were receiving the level of support
conventionally offered in the area concerned. The only way of really control-
ling for this, but which was not part of the present design, would be to have
two comparison groups, one being offered no intervention at all and a second a
non-speci c intervention of comparable duration and intensity. It is not
altogether clear what the latter would be, given the relatively untested nature
of the interventions concerned with this client group. Nevertheless this issue is
a justi able concern and one that would need to be taken into consideration
when considering the results. While these ndings do not prove a causal
relationship between the intervention and the outcome it is important to point
out that it is commonly dif cult to disentangle the relationship between inputs
and outputs in complex interventions of this sort. At one level the fact that the
intervention appears to be effective on such a small sample suggests that it
warrants further investigation.
Recommendations
° The ndings of this study suggest that children’s language and communica-
tion dif culties are not always identi ed when there is a strong behavioural
component in their pro le of needs.
° Based on the data reported in this study, the authors’ recommendation is
that intervention targeting language and communication skills should be
available for all children with emotional and behavioural dif culties at risk
for school exclusion. It would also suggest a strong case for specialist
speech and language therapy intervention for children with emotional and
behavioural dif culties who have already been excluded.
° In addition, the study suggests that teachers should be mindful of a child’s
language and communication dif culties in particular, prior either to consider-
ing exclusion or reviewing school placement. At this stage, resources should be
available for these students to access a multi-agency team, including specialist
behavioural support teachers and speech and language therapists.
° This study also shows the bene ts of class teachers, learning support
assistants, speech and language therapists, and speech and language therapy
assistants working closely together, in order for speci c skills being learnt in
therapy sessions to be generalised into the classroom.
° This study also highlights the need to engage parents to work alongside the
professionals.
Future developments
The project has highlighted a number of areas for consideration in future.

For the Pupil Referral Unit

On the basis of these results a multi-disciplinary package of care involving an
‘induction period’ for all children arriving at the PRU could be introduced.
This would include detailed initial assessments of their skills by a range of
professionals, including speech and language therapists who would be looking
for previously unidenti ed speech and language dif culties. If necessary the
formal process of pro ling and drawing up statements of educational need
could be instigated, or if a statement was no longer appropriate, it could be
reviewed. This would enable children to be more quickly placed in an
appropriate educational establishment that catered for their speci c needs,
and also enable them to access appropriate services including speech and
language therapy. Parents would be asked to attend the induction period.
Ideally, home visits could take place as part of the package of care provided by
the speech and language therapist.
For children at risk of exclusion

In order to bene t mainstream pupils, it is recommended that a longer-term
investigation should be provided for this client group, in order to carry out
follow-up studies. This would also ensure continuity of provision for this needy
group through a structured programme of reviews and liaison with school staff.
It would be vital that teachers, SENCOs, and learning support assistants were
fully trained in the techniques in order to feel con dent enough to continue the
intervention in collaboration with a speech and language therapist.
Acknowledgements
We thank the children who made this study possible and all the staff and
parents who provided their support. In particular, we are grateful to Dr. Ursula
Pretzlik, for help regarding the visual scale to measure rating, Dr. Suze Leitão,
for agreeing to the use of the SAOLA with this client group; and Dr. Wendy
Rinaldi, for agreeing to the use of the Primary SULP assessment in this study.
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Child Language Teaching and

Promoting the communication skills of primary school children

The online version of this article can be found at:

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>> Version of Record - Feb 1, 2003

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# Arnold 2003 10.1191=0265659003ct241oa

The management of children with emotional and behavioural dif culties is an

Downloaded from clt.sagepub.com at UNIVERSIDAD DE CHILE on August 26, 2013

nalisation of social codes for the self-regulation of behaviour (Luria, 1961;

agencies, assessed by the researcher (SS) and subsequently identi ed as having

° Phase I: Baseline assessment phase, during which referrals were received

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Table 1 Structure of therapy sessions

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Behaviour management. The approach to running the group was to

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Language activities. The assessment pro les highlighted which aspects of

Social communication activities

It was not possible on the basis of the assessments to specify different

Social communication skills. Video was considered the least obtrusive

Behaviour. ‘The Strengths and Dif culties Questionnaire’ (Goodman,

Downloaded from clt.sagepub.com at UNIVERSIDAD DE CHILE on August 26, 2013

Mainstream Language disordered

Source: ‘School Age Oral Language Assessment’ (Allen et al., 1993).

well established Rutter (1967) questionnaires, which is shorter in format and

Self esteem. A questionnaire ‘What I Think About Myself ’ by Kosmoski

Table 3 Example from ‘Listening Skills’ assessment (Listener feedback—facial expression)

Source: ‘Social Use of Language Programme: Primary and Pre-School Assess-

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Nevertheless, they represent perhaps the neediest of client groups. Out of a

Absences and non-compliance

Language and social communication skills

Table 4 Comparison of changes in social communication skills

Number Mean rank

**p < 0.01.

Table 5 Comparison of changes in language skills

Narrative skills Semantic skills

Number Mean rank Number Mean rank

*p < 0.05; **p < 0.01.

Table 6 Comparison of changes in self esteem

Number Mean rank

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Area of perception T C T C No. Sum p (2-tailed)

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T represents the treated group, C the comparison or untreated group.

Overall dif culties Emotional Conduct Hyperactivity Peers Pro-social

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Post-therapy assessment. Discussions with parents and teachers following

Discussion and recommendations

Initial pro le of the children

The measures used

to differentiate change from measurement error. Revising the design of this

The effects of intervention

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For mainstream pupils, the teachers highlighted the bene ts of:

For excluded children, the teachers highlighted:

Intervention appeared to be bene cial in changing some teachers’ perceptions

Differences between parents’ and teachers’ perspectives

Downloaded from clt.sagepub.com at UNIVERSIDAD DE CHILE on August 26, 2013

Ethnicity. One issue that stands out as potentially important is the

Placebo effect. It is important to consider whether the results could be due

The management of children with emotional and behavioural dif culties is an

agencies, assessed by the researcher (SS) and subsequently identi ed as having

Language activities. The assessment pro les highlighted which aspects of

Behaviour. ‘The Strengths and Dif culties Questionnaire’ (Goodman,

Overall dif culties Emotional Conduct Hyperactivity Peers Pro-social

Initial pro le of the children

For mainstream pupils, the teachers highlighted the bene ts of:

Intervention appeared to be bene cial in changing some teachers’ perceptions