Monday, March 24, 2014

Growing Up with a Speech Disorder: The Social Struggles Children with Speech Disorders Face



Growing Up with a Speech Disorder:

The Social Struggles Children with Speech Disorders Face

Rainie M. Wheeler

American Military University



Abstract

This paper focuses on the social impact caused by the unintelligible or difficult to understand speech produced by children with speech disorders.  A specific emphasis will be placed on children with speech sound disorders (SSD), or the speech that is unintelligible to people outside of the close family members due to problems producing proper articulatory phonetics.  Some attention will also be given to the impact of other common problems with speech such as stuttering. The multiple social issues speech disorders can cause range from behavioral troubles to poor self-esteem and may be correlated to the language barrier among children with speech disorders and their typically developing peers.  Research has indicated that children with language and speech difficulties are more likely to report problems with socio-emotional, attention, anxiety, and social relationships (Savage, 2005).  Intervention with a speech language pathologist (SLP) or a speech language therapist (SLT) have shown to be an effective means of overcoming speech disorders for children, thereby closing the language gap among peers.
The Social Struggles Children with Speech Disorders Face

          Picture yourself visiting a foreign country, whose primary language is one you may understand well, but you cannot seem to get the dialect down for the local nationals to understand you when you speak.  For the sake of this scenario, you do not have access to technology to assist you with finding a place to eat or directions to your destination for the day.  At first it may be exciting to communicate with the locals and be submerged in their language.  However, after a few days you may start to grow tired of repeating every question, every sentence, and trying to find different ways of posing your questions or phrasing your responses in order to get through basic communication with others.  Now imagine that this is how every single day of your life is for the indefinite future and it is not only the country that you are in, it is the entire population of the world that has extreme difficulty in understanding you.  Communication with others now has become a chore that you dread. This struggle is a reality for millions of children who suffer from various speech disorders.
          The 2008 edition of “Incidence and Prevalence of Communication Disorders and Hearing Loss in Children” reports that 24.1% of children attending public schools in the United States receive speech or language disorder services (Castrogiovanni).  This estimate includes only children whose primary condition is their speech disorder, not those who have an underlying condition that their difficulty with speech is a result of such as hearing loss or autism.
Etiology
          There is no one attributed cause of speech disorders, also commonly referred to as speech impediments; rather, there is a range of environmental, anatomical and even genetic origins of speech disorders.  An example of an environmental cause for a child to have delays in speech development is order of birth. Parents, typically, continuously communicate with their first-born; whereas, their second child may not get as many opportunities to communicate with their caregiver, because their needs are being predicted as the needs of the older sibling are being met (Crandell, Crandell, & Vander Zanden, 2009).  Another environmental cause that contributes to children with fluency speech disorders is anxiety; an intricate relation between increased anxiety and stuttering occurs in both children and adults (Blood, Blood, Tramontana, Sylvia, Boyle, & Motzko, 2011). 
          Anatomical characteristics that often cause articulation difficulties making speech unintelligible are craniofacial irregularities, tongue-tie, cleft lip, and/or soft palate (Bowen, 2012). 
         Lastly, speech disorders seem to cluster within families, indicating a strong genetic cause.  For example, in a family where a child has been identified as having a speech sound disorder there is a 28-60% chance that at least one other sibling, the mother, or the father had or has a speech sound disorder as well (Castrogiovanni, 2008).  Stuttering seems to have an even stronger familial link, with 20-74% of stutterers having a family history of the disorder.
Discussion
It is not uncommon for children at the beginning their primary education to have behavioral issues.  This is due the fact that it takes adjustment time for a child to learn the rules of the classroom, such as raising their hand to get the attention of the teacher rather than blurting out a question or statement, or taking issue with having to take turns or share.  Because of this, some behavioral issues can be expected from any child at certain times, triggered by various individual events.  However, a child with a speech disorder is unique, in that while they, too, have to learn to wait their turn and follow the rules of the classroom, they deal with the additional task of having to put forth a far greater effort in order to communicate in the classroom. The exhausting task of communicating with the class causes them to experience frustration more frequently in the classroom than his or her peers. Naturally, they have increased frequency in problems with anxiety, devoting attention, and forming social relationships (Savage, 2005), which can translate to less effective contribution to the classroom from these children. 
The increased anxiety that a child experiences because of their speech problem may make them more hesitant to raise their hand to answer a question for fear of being teased for their speech difficulties.  In addition, they may feel that the rest of the class does not want them to contribute their ideas because it will take them longer to get their point made than it would for one of the typically developed children.  If the child is not engaged in the classroom activity or discussion, they are more likely not to pay attention to what the lesson is and they may not be getting any benefit from the lesson at all for this reason.  Thus explains the issues with attention that children with speech disorders display.
Bullying is the repetitive, intentional, aggressive behavior that involves an abuser and a victim (Blood et al., 2011). It is, no doubt, a serious problem in the United States today.  Anything that makes a person an individual can also make them the target of bullying.  The list of negative impacts that result from bullying is a long one; a victim may experience mental distress, adjustment difficulties, negative changes in academic performance, poor self-esteem, depression, social isolation, exclusion, lonesomeness, and physical symptoms (Blood et al., 2011).  These negative impacts from being a victim of bullying are catastrophic for the sufferer; they cause wounds that no one can see.
Prevalence of being a victim of bullying among children with speech disorders is remarkably higher than it is for the population of typically developed children.  Blood et al. conducted a study of 108 students between the ages of 13-18, half of the students had a stutter and half of the students did not.  They used a self-report survey to get an estimate of the prevalence of victims of bullying among children who stutter versus the prevalence of victims of bullying among children who did not have a speech disorder.  In doing this, they found that out of 108 students, 44% of the children with a stutter fell into the classification of victim of bullying, while 9% of the children who did not have a stutter fell into the classification of victim of bullying (Blood et al., 2011).  This finding is significant because the 54 non-stuttering children were chosen specifically as matches to the children who did stutter, based upon grade, gender, ethnicity, and age, so it can be deduced that the stuttering played a significant role in their being the target of bullying.
A child who produces unintelligible speech is likely to be viewed as below average intelligence, despite actually being a bright child.  Some children, who are bright, will even describe themselves as not smart because they have internalized the social bias that they have experienced.  These kids are not making up this social prejudice; there is evidence that individuals who are ignorant to the reason behind the unintelligible speech describe children who produce speech that is unintelligible as having lower intelligence. 
Rice, Hadley, and Alexander conducted a study at the University of Kansas, in 1993.  In this study, children late in their pre-kindergarten school year from three different categories were selected: children who produced speech considered to be at the normal range for their age, children with speech sound disorders, and children with speech and language impairment.  The children were individually recorded for three minutes, as a sample of their speech, and then their sample was cut down to one and a half minutes.  These samples of speech were played for 283 adult raters comprised of four groups: speech language pathologists (SLPs), kindergarten teachers, non-educators matched to the teachers for gender and education levels, and undergraduate college students.  The adult raters rated the children in nine different areas: ability to get the message across, intelligence in comparison with peers, likelihood of ability to be a class leader, likability among peers, parental education level, social status of parents, social maturity, and ability to achieve academic success.
As expected, over all the raters rated the children without a speech disorder as better able to get the message across.  However, social bias was evident in the rest of the categories rated.  Results showed that over all, children without speech disorders were estimated to have been smarter, to have stronger leadership abilities, to be more likeable, to have parents with higher education, to have parents of higher social status, to be more socially mature, and to have the ability to achieve greater academic success than their peers that have speech disorders (Rice et al., 1993).   These results accurately portray the social biases children with speech difficulties face from adults they encounter in their daily lives. 
Findings such as these are paramount because it affects the daily lives of these children.  When a child is estimated to be less capable of achieving academic success due to lower intelligence, not only will they lose out on effort from their teacher, who will focus more on the children who clearly are capable of more academic success, but the other adults in the child’s life may have the same perception and spend less time encouraging the young student to push his or herself. 
Since children learn bias from their adult role models, an additional repercussion of adults holding the false belief that children with speech deficiencies are less intelligent than their typically developed peers is that the other students may hold these false beliefs as well. Unquestionably, this can lead to severe consequences for the kids with speech disorders on both an academic level and on a social development level.  For example, in a classroom setting where initially all of the children view themselves as equals, an educator who treats one child differently because of the difficulty he or she has in receiving the message the child is trying to convey may inadvertently be teaching the rest of the class, also, to treat that child differently. This can cause the child’s self-esteem to suffer. 
Self-esteem is detrimentally affected in a child who does not believe he or she is capable of academic achievement, or who has been the victim of bullying. Confidence in one’s abilities is necessary for one to attempt new things and to set forth goals for the future, without this children are not active participants in life but rather passive occupants questioning what their role in the world is. 
Adding to the individualized treatment of children with speech disorders, most children identified as having any kind of speech impairment attend regular speech therapy sessions during the traditional school day.  In order to attend the sessions, the children must be pulled from the classroom to receive personalized therapy in an attempt to gradually develop normal speech.  While these sessions are indisputably appropriate for the children, the act of segregating the children further identifies them as different from their typically developed peers.

Application

          Educators and parents certainly want to do whatever they can to help their children improve and should be optimistic that the children will overcome their speech disorder.  The first step in doing so is to identify that the child has a problem with their speech.  This is accomplished by contacting a speech language pathologist who, in their first session with the child, will conduct a test that will determine if the child is in need of therapy.  Once the need for treatment is determined, the child’s teacher, parents, and the SLP will meet to discuss the child’s individualized education plan (IEP).  In this meeting, both the frequency of the speech therapy sessions and the time of day in which the sessions will take place will be decided. This is usually a time that is agreed upon mostly between the teacher and the SLP, with the goal being for the child to miss the least necessary portion of the regular grade level lesson plan as possible. More than likely, the child will not be the only on from his or her class that is attending the lesson plan, due to the earlier discussed fact that speech difficulties are an issue that an estimated 24% of children receive speech or language services.
          Because it is likely that the child having to be pulled out of class on a frequent basis is unavoidable, parents can look for other kinds of opportunities for their child to participate in groups or activities with children.  For example, enrolling the child in an afterschool program such as the Boys and Girls Club may give the child more opportunities to socialize with other children.  Another option could be signing the child up for whatever sport they are interested in participating in.  Not only is being a member of a team an opportunity for more social inclusion, it also gives them the chance to show other children that, while they may have a speech difficulty, they may be talented in other areas, such as athletics.
As children are given multiple avenues of participation and more opportunities to figure out what interests them, they are more likely to build on their sense of who they are and their self-esteem and confidence will increase.
          It is inevitable for the child who speaks differently to be identified as different and to be treated different.  As long as intervention is necessary, they will have time spent away from their peers.  However, as a preventative measure, rather than a reactive measure, children can be taught methods of fighting back against being bullied as a part of their therapy sessions.  The “fogging” intervention is a perfect example of anti-bullying efforts. In this method, a child who is being bullied would respond to being insulted with rehearsed phrases that give the bully the impression that the victim is confident and their abuse has no effect.  This includes sayings such as “you might think so” or “I can see why you would think that way” (Savage, 2005).  SLP’s can be trained on the “fogging” method and incorporate this into their time with the children at the end of their sessions practicing these scenarios.  Even for the children who are not being teased for their speech disorder they may find that having this valuable tool presents a way of reaching out to other classmates who are being teased and find an opening to make a new friend.
          Parents and other family members of children with speech difficulties can help the child by remembering to exercise patience at all times when the child is trying to communicate.  The child is already experiencing frustrating circumstances trying to get the message across; the receiver of the message getting frustrated as well can only make matters worse.  Caregivers need to advocate for their child and stay informed with their academic progress as well as with their progress in speech therapy.  There is no reason for a parent not to have optimism when it comes to the improvement of their child’s speech.
          It is evident, due to the wide variety of causes for abnormal speech conditions, that there is no preventative measure that can be taken to thwart speech disorders from occurring.  The best course of action for parents and teachers to take is to educate themselves on the different speech disorders so that they can find the best route of treatment for the child.  Keeping a positive attitude is important for the success of the children who have these speech difficulties.



References

Blood, G. W., Blood, I. M., Tramontana, G., Sylvia, A. J., Boyle, M. P., & Motsko, G. R. (2011). Self-reported experience of bullying of students who stutter: relations with life satisfaction, life orientation, and self-esteem. Perceptual & Motor Skills, 113(2), 353-364.

Bowen, C. (2012). Questions from families about children’s speech sound disorders. Speech-language-therapy dot com. Retrieved March 17, 2014 from http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=16:ssd&catid=11:admin&Itemid=120

Castrogiovanni, A. (2008). Communication facts: incidence and prevalence of communication disorders and hearing loss in children.  American Speech-Language-Hearing Association. Retrieved March 17, 2014 from http://www.asha.org/research/reports/children.htm
Crandell, T. L., Crandall, C. H. & Vander Zanden, J. W. (2009). Human development (9th ed.). New York: McGraw-Hill.

Rice, Mabel L., Hadley, P. A., & Alexander, A. L. (1993). Social biases toward children with speech and language impairments: a correlative causal model of language limitations. Applied Psycholinguistics, 14, 445-471.

Savage, R. (2005). Friendship and bullying patterns in children attending a language base in a mainstream school. Educational Psychology In Practice, 21(1), 23-36.



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