Who Needs SLPs Children in the Psych Unit

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Who Needs SLPs? Children in the Psych Unit

• Diane Geiger, Ph.D. CCC-SLP
• Leisa Lauck, M.A. CCC-SLP
• Kevin McElfresh, M.A. CCC-SLP

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Introduction

• CLOTHES
• PHYSICAL APPEARANCE
• SPEECH
• PERSONALITY

3
Overview

• Literature review
• Framework for pragmatic language
• Group guidelines
• Activities

4
LITERATURE REVIEWCo-Occuring Diagnoses

• Aram, Ekelman, Nation, 1984
• Pragmatic language disorders are associated with
  academic failure and can complicate co-occurring
  psychiatric disorders
• Beitchman, Brownie, Inglis, Wild, Ferguson,
  Schachter, Lancee, Wilson, Matthews, 1996
• Correlation between language impairment and
  anti-social personality disorder
• Benner, Nelson, and Epstein, 2002
• 3 of 4 children with Emotional/behavioral
  disorders have significant pragmatic language
  deficits

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LITERATURE REVIEWCo-Occuring Diagnoses

• Carson, Klee, Donaghy and Muskina, 1997
• Measures of pragmatic language abilities were
  strongly predictive of scores on measures of
  behavior problems
• Faraone, Biederman, Weber, Russell, 1998
• Correlation between language impairment and
  conduct disorder, ODD, bipolar, and ADHD
• Vallance, Im Cohen, 1999
• Found increased likelihood of language-processing
  impairments
• Cohen et al., 1998
• In children between 7 and 14 with both language
  and psychiatric disorders the most common delays
  were in emotion decoding and social problem
  solving

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LITERATURE REVIEWNeed for SLPs

• Prizant et al., 1990
• SLPs are key members of the team needed to
  adequately serve children with emotional or
  psychiatric disorders
• Condon, 2004
• Reported on a study language impairment in 84 of
  inpatient and outpatient psychiatric patients in
  Dublin (n62)
• McDonald, C., Patterson, R., Bauer, P.,
  McDermott, B. 1998
• Severe speech and/or language disorders in 32 of
  patients with psychiatric disorders
• Patterson, Bauer, McDonald McDermott, 1997
• significantly decreased measures of
  socialization, communication, daily living
  skills, self-esteem
• Mod-severe language handicap in 40 of patients

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GETTING IN TROUBLE WITH SOCIAL LANGUAGE SIMON

• Do not use it as a tool
• Do not change it to meet the environment
• Do not ask questions
• Dont initiate respond instead

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PIAGETS OBSERVATIONS

• Egocentric Speech Ignore the listener
• Socialized Speech Acknowledge the listener

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BERNSTEINS CODES

• Restricted Code
• Sequence of statements unplanned
• Speech is fast, sloppy
• Syntax and vocabulary is basic
• Common experience with listener is assumed
• Conceptual alternatives to ideas are not
  explored

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ELABORATED CODES

• Coherence of expression suggests mental planning
• Rate and articulation are clear
• Syntax and vocabulary have variety and are
  appropriately parallel to listeners
• Different experiences are presumed and welcomed
• A range of possible conceptual alternatives are
  explored

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Grices Four Expectations for Dialogue

• 1. QUANTITY Keep it as informative as needed,
  but not effusive
• 2. QUALITY Do not say what you do not believe
  and do not say that which you lack evidence
• 3. RELATION Stay on topic and signal when you
  change
• 4. MANNER Be clear, brief, and orderly

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VALUE OF GROUP SOCIAL LANGUAGE THERAPY

• Advantage over grouping by achievement
• Respect, value other members
• Mentors come forth
• Stretch our thinking

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Our Environments

• Main Campus
• 2 adolescent units, 23 beds
• Divided into 2 age groups 2-12, 13-21
• College Hill
• 1 inpatient unit (36 beds)
• 1 residential unit (33 beds)
• Divided into 2 age groups 2-12, 13-21

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Our Team

• Psychiatrist
• Mental Health Specialist
• Nurse care manager
• Occupational therapist
• Recreation therapist

• SLP
• 3 at Main Campus
• 3 at College Hill
• Social Worker
• Spiritual Leader
• Family

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Most Common Diagnoses

• Depression
• Suicidal Ideation
• Homicidal Ideation
• Schizophrenia
• PTSD
• Bipolar Disorder
• ODD

• Mood Disorder
• Drug Abuse
• Physical Abuse
• Sexual Abuse
• Anorexia Nervosa
• Bulimia
• Conduct Disorder

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Group Itinerary

• 1230-1240 De-briefing from charge nurse on
  difficult cases including chart review if
  necessary
• 1240-1245 Introductions
• 1245-1255 Ice-breaker
• 1255-120 Communication Activities
• 120-128 Self-reflection and discussion
• 128-130 Homework
• 130-140 Charting/progress notes

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Group Guidelines

• One person talks others listen
• G-rated Language
• Staff handles aggressive behaviors
• Apply goals developed in Goals Group.

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Specific Activities

• Eye contact
• Body language
• Intonation
• Self-esteem

• Conversation
• Problem Solving
• Agree to disagree
• Descriptive Vocab

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ICEBREAKERS

• Snowball fight
• Team puzzle
• Name alliteration
• Three names
• Two truths and a lie
• I like people who.

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Audience Demo
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SELF ESTEEM

• Five, ten, twenty years
• Envelope of compliments
• Social values and myths

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Video clipself-esteem
23
CONVERSATIONS

• Initiate two questions
• Maintain
• Asking/telling cards
• Empathy exercise
• Interview
• No Interruptionslistening for the last word

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Audience Demono interruptions
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EYE CONTACT

• Winker
• Eye-contact concentration?
• Whats different

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Video clip-eye contact
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AGREE TO DISAGREE

• Effective disagreeing
• Restate speakers opinion
• State own opinion
• Provide support
• Assertive, Aggressive, Passive worksheet

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Video clipagree/disagree
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DESCRIPTIVE VOCABULARY

• Taboo
• Cranium
• Telephonedrawing

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Video clipdescriptive vocab
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BODY LANGUAGE

• Body language cards
• Charades
• Non-verbal Worksheet
• Comic fill-in-the-blank
• Taxi Driver

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Video clip body language
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INTONATION AND PAUSE

• Tell a joke
• I am really angry about
• Whats my line ?
• Mark a script
• Blah Blah Blah

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Video clip intonation
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PROBLEM SOLVING

• Cicada worksheet
• Problem solving situations
• Problem solving workbooks
• Assertiveness rating scale
• Compromise win-win vs. win-lose

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Video clipproblem solving
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Response from StaffSurvey Results
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Challenges

• Different group dynamic each week
• Repeat offenders
• Length/time of groups

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Need for Future Research

• Efficacy of pragmatic language groups run by SLPs
  in Psych Units
• Early identifying factors for future psych
  disorders in children with speech/language
  difficulties

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References

• Antshel, K. Remer, R. (2003) Social Skills
  Training in Children With Attention Deficit
  Hyperactivity Disorder A Randomized-Controlled
  Clinical Trial. Journal of Child and Adolescent
  Psychology, 32, 153-165
• Aram, D.M., Ekelman, B.E., Nation, J.E.
  (1984). Preschoolers with language disorders 10
  years later. Journal of Speech and Hearing
  Research, 27, 232-244.
• Beichtman, J.H., Brownie,.B., Inglis, A., Wild,
  J., Ferguson, B., Schachter, D., Lancee, W.,
  Wilson, B., Matthews, R. (1996). Seven year
  follow-up of speech-language impaired and control
  children psychiatric outcomes. Child
  Psychology and Psychiatry Applied Disciplines,
  37, 961-970.
• Beichtman, J., Douglas, L., Wilson, B., Johnson,
  C., Young, A., Atkinson, L., Escobar, M.,
  Taback, N. (1998) Adolescent Substance Use
  Disorders Findings From a 14-year Follow-Up of
  Speech/Language Impaired and Control Children.
  Journal of Clinical Child Psychology, 28(3),
  312-321
• Benner, G.J., Nelson, R., Epstein, M.H.
  (2002). Language skills of children with EBD a
  literature review-emotional and behavioral
  disorders- statistical data included. Journal of
  Emotional and Behavioral Disorders, 10, 43-59.
• Bernstein, B. (1971. Class, Codes, and Control.
  London Paladin Press.

41
References

• Carson, D.K., Klee, T., Perry, C.K., Donaghy, T.,
  Muskina, J) (1997). Measures of language
  proficiency as predictors of behavioral
  difficulties, social and cognitive development in
  two-year-old children. Perceptual Motor Skills,
  84, 923-930.
• Cohen, N.J., Menna, R., Vallance, D.D., Barwick,
  M.A., Im, H., Horodezky, N.B. (1998).
  Language, social cognitive processing, and
  behavioral characteristics of psychiatrically
  disturbed children with previously identified and
  unsuspected language impairment. Journal of
  Child Psychology and Psychiatry, 39, 853-864.
• Cohen, N. Barwick, M. (1996) Comorbidity of
  Language and Social-Emotional Disorders
  Comparison of Psychiatric Outpatients and Their
  Siblings. Journal of Clinical Child Psychology,
  25(2), 192-200.
• Condon, D. (2006). Psychiatric link to
  language. Irish Health, 1-3.
• Faraone, S., Biederman, J., Weber, W., Russell,
  R.(1998) Psychiatric, neuropsychological, and
  psychosocial features of DSM-IV subtypes of
  attention-deficit/hyperactivity disorder
  results from a clinically referred sample.
  Journal of the American Academy of Child and
  Adolescent Psychiatry, 37(2) 185-89.
• Marquis, M., Addy-Trout, E. Social
  Communication Activities for Improving Peer
  Interactions and Self-Esteem. 1992. Eau Claire,
  Wisconsin. Thinking Publications.

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References

• McDonald, C., Patterson, R., Bauer, P.,
  McDermott, B. (1998) Paediatric assessment in a
  residential child and adolescent psychiatry unit.
  Journal of Paediatric Child Health, 34(4),
  276-272.
• Patterson, R., Bauer, P., McDonald, C.,
  McDermott, B. (1997) A profile of children and
  adolescents in a psychiatric unit multidomain
  impairment and research implications. Australia
  New Zealand Journal of Psychiatry 31(5), 682-690.
• Prizant, B.M., Audent, L.R., Burke, G.M., Hummel,
  L.J., Maher, S.R., Theodore, G. (1990).
  Communication disorders and emotional/behavioral
  disorders in children and adolescents. The
  Journal of Speech and Hearing Disorders, 55,
  179-192.
• Simon, C. (1985). The language-learning disabled
  student Description and therapy implications.
  In C. Simon (Ed.), Communication Skills and
  Classroom Success Therapy Methodologies for
  Language-Learning Disabled Students. San Diego
  College-Hill Press.
• Werner, E.E. (1993). Risk and resilience in
  individuals with learning disabilities. Learning
  Disabilities Research and Practice, 8(1), 28-34/
• Vallance, D., Im, N., Cohen, N. (1999).
  Discourse deficits associated with psychiatric
  disorders and with language impairments in
  children. Journal of Child Psychology and
  Psychiatry, 40(5), 693-704.