Introduction their needs. Currently, researchers, health and education

Introduction

In this assignment, I am
writing the related controversial issues from different arguments and findings
surrounding inclusion of children diagnosed with Social (Pragmatic)
Communication Disorder (SPCD). Increasing demand of service for children with
communication disorders needs to be address. According to Special
Educational Needs and Disability (SEND) Code of Practice (2015), that school have duties to cater the children with disabilities
with appropriate educational service. Thus, should provide practical adjustment
of aids and service that suitable in their needs. Currently, researchers,
health and education professionals are working together to provide effective
intervention that help children with speech language and communication needs in
educational setting. There is a significant change of educational policy that
create an effort to deliver inclusion education setting for all children with
special educational needs (Lipsky & Gartner 1989; Peck, Odom, & Bricker
1993; Sailor 1991; Will 1986; Wolery & Wilbers 1994 cited American Speech-Language-Hearing Association (ASHA) 1996). 

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This assignment comprises
of different section that tackles issues related to inclusion of children with SPCD.
The background section will give us an idea on how SPCD got its
term and what terminologies that are used by other researchers and research
bodies. In this paper, I am also going share insights in the rationale section
on why SPCD is one of subjects of debates and on-going
researches related to ASD. I also included the latest description in the ‘Definition’
section by ‘American Psychiatric
Association’ despite the different terminologies referred by other prominent researchers.
In the identification section it comprises the diagnostic criteria of SPCD. It will be followed by assessment and diagnosis
section where researchers provide the most suitable tools to provide
appropriate service to children with social communication deficiencies. Furthermore,
in the intervention section it covers the issues inclusive practices and one of
the most common treatment that is being used to provide at least the most
effective intervention.

 

Background

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

•      
n 1983, Rapin and Allen proposed a classic?cation of children with developmental

•      
language disorders, which included children with autism as well as those
with

•      
special?c language impairments (SLI).

During the 1950s and 1960s, segregated programs were opened to serve
children with disabilities. Then, in the late 1960s and 1970s, children with
special educational needs were included in the mainstream programs. The term inclusion
was defined by McCarthy (1994 cited by 1994 cited ASHA 1996) “…a state-of-the-art term that refers to placing children with
disabilities in integrated sites, which … means bringing support services to
the child rather than moving the child to a segregated setting to receive
special services” This section will also discuss the background the SPCD based
on the literature. Before the SPCD was used to
diagnose children with difficulties in using pragmatic and social context it
was known to be ‘Semantic-Pragmatic Deficit Syndrome’ (Rapin and Allen 1983 cited
Adams 2001a). There are different labels that had been used, but the commonly
used until now is the term ‘Semantic-Pragmatic Language Disorder (SPLD) (Bishop
and Resebloom 1987 cited Adams 2001b). There are debates regarding the
labelling that draw attention to children with SLPD that links to those on the
autistic spectrum (Lister Brook and Bowler 1982, Boucher 1998 cited Adams 2001c).
Moreover, more research results show that children diagnosed at SPLD do not
necessarily have additional grammatical or semantic problem (Bishop et al. 2000 cited Adams 2001d). According
to Bishop (2000a), the label ‘Pragmatic Language Impairment’ (PLI) ‘seems
preferable’. He further explains that it is not required that semantic and
pragmatic problem will coincide rather ‘it is easier to accommodate a more dimensional
view of language impairment’, this will help to find a treatment in pragmatics
as one domain in which communication may be impaired. This issue is getting
more controversial (Adams 2001a) with the increase
related evidence that children diagnosed
with PLI are not necessarily to be included in autistic
spectrum. (Bishop 2000b) argues that children with autistic-like pragmatic
difficulties should be regarded as autistic? She emphasizes that there are crucial evidence
to be considered before jumping to that conclusion. First, she stated that ‘the
studies concerned with differential diagnosis
of autism and Specific Language Impairment (SLI), and reveal cases that are
hard to categorize as one or the other’. Second,
she added that ‘children who are identified as having semantic-pragmatic
disorder reveal that only a subset of them appear to have significant autistic
features in non-linguistic domains.

ore recent research (Bishop

et al.

2000) has

indicated that children diagnosed at SPLD do not
necessarily have additional

grammatical or semantic problems. This has led
Bishop (

In 2013, the American Psychiatric Association labelled ‘SPCD as a new diagnosis in the fifth
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
It gives better understanding and recognition
of individuals ‘who have significant problems using verbal and nonverbal communication
for social purposes, leading to impairments in their ability to effectively
communicate, participates socially, maintains social relationships, or otherwise
perform academically or occupationally’. Studies related to SPCD is continually developing and updates
of DSM-5 was recently released (Supplement to Diagnostic and Statistical Manual
of Mental Disorders 2016). There might be arguments and debates from the
previous findings and resulted in various challenges to medical practitioners,
clinics and treatment centres. But the
most important issue is how these individuals who have SPCD be given proper
treatment and services that they need (American Psychiatric Association 2017).

 

 

Rationale

The understanding that inclusive
service provides a wide-ranging goal, it should not compromise to recognize the individual service needs most especially
specific children and families. Hence, with the services given in schools, the
term ‘inclusive practices’ rather than ‘inclusion’ is the appropriate
description of services that are offered. Inclusive practices serve as an
intervention that is present in the educational setting that is least
restrictive. It may use ‘natural environment’ to serve as an ‘intervention
context’, it also creates services that combine ‘classroom content and
curriculum activities, and collaborating with families, educators and other
personnel’. Thus, it is argued that ‘inclusive practices’ are suitable to
implement to the needs of children with communication disorders (ASHA 1996).

 

Children with social
communication deficits have hard times befriending others. Lack of interaction hinders
them to socially cooperate with peers. It very important to let them feel that
they are part of the group. They need to understand that they might have
similarities or differences to one another (Deiner 2009). Children’s communication development requires serious
attention. Having good communication skills could help them to be independent
and achieve greater expectation in life. According to (Norbury 2014b), to be
effective in communicating we should possess a deeper
understanding of the precise words we uttered and construct meaningful
ideas in relation to our knowledge and
experiences.  In addition. Children
with SPCD is considered to have social and
learning difficulties which mean they are
entitled to a special educational
provision (Bristol City Council). As mandated in SEND Code of Practice (2015), Chapter
6 Schools, Section 6.8 Equality, and
Inclusion highlights the necessity of services to students with Special
Educational Needs (SEN) in every school. Schools are obliged to work together
with the local authority in any provision and development for the benefit of
the children. It is also the duty of schools to collaborate with other local
education providers and find different ways to effectively meet the needs of
the students (GOV.UK).

 

Even though that SPCD has become a new term of diagnosis, there has been a lot of debates when it
comes to
terminologies and diagnostic criteria. In addition, there are inconsistencies
of reliable assessment tools and inadequate assessment of profiles across
different neurodevelopmental disorders (Norbury 2014c). Moreover, it has been
criticised due to a lack of experimental evidence showing that the disorder is
different from Autism Spectrum Disorder (ASD) (Ozonoff, 2012; Skuse, 2012;
Tanguay, 2011 cited by Taylor and Whitehouse 2016). With the issues of various terminologies, Norbury (2014d) pointed
out that there are disadvantages attached the new diagnosis plus the ‘different
perspectives of the clinical practitioners’ who will give influence on the
outcome. There is an argument related to the diagnostic criteria of SPCD and ASD. It overlaps with each other making it complicated to diagnose. She
even highlighted that when the children will receive the diagnosis it might not
receive the ‘clinical or educational services’ that are appropriate to them. It
is also being supported by Skuse (2012 cited by Norbury 2014a) that how these
diagnostic criteria are effectively utilized without overlapping the diagnostic
criteria for Autism Spectrum Disorder.

 

Definition

Grohol (2017) stated that children with SPCD face challenges in following
the social rules in conversation it might be verbal or non-verbal
communication. With these sorts of hurdles in social communication, the
effectiveness of communicating and their involvement in a social manner with
others will lead the children to struggle, and ‘can even affect academic
performance’. Norbury (2014a) mentioned
that to have successful communication this requires the use of linguistic
context (pragmatic) which (Rhalmi 2013) refers to the language setting in which
a word is used within a text and, the use of language in social contexts
(social communication) which (Nugent 2013) defined as ‘the general environment
or circumstances that are the social framework for interpersonal and individual
behaviour’. Communication skills are a significant
factor in life’s experience of the individual,
especially for developing language critical to cognitive growth and learning
among children. To provide ideas effectively, we learn to read, write, make a gesture, listen, and speak. It will not offer
instant outcome but instead, it takes
place the process of communication. Having the skills to take part in a dynamic
and interactive communication with peers and adults in the educational setting
is very important for a child to succeed
in school (American Speech-Language-Hearing Association (ASHA) 2005a). According
to the DSM-5 (American Psychiatric Association 2013a), children with SPCD is described mainly as with a difficulty with pragmatics, and the
social use of language and communication. The lack of understanding and
following social rules of verbal and nonverbal communication in a realistic setting.
It would be challenging to children with social communication deficits to
converse effectively, participate in any social interaction, develop social
relationships, and have academic achievement. In addition, the mentioned
symptoms must be present in the early developmental period of a child. The SPCD may exist in
other communication disorders in the DSM-5, but cannot be identified in the
presence of Autism Spectrum Disorder (ASD) (Swineford et al. 2014a). Even though SPCD and Autism
Spectrum Disorder have the identical requirements of the deficit in social communication needs, but
children with SPCD have different
specific diagnostic features compared to ASD with restricted repetitive
patterns of behaviour (Swineford et al.
2014b). Additional description is that SPCD shared a similar
characteristic with Language Impairment. Children with difficulties with using
social communication tend to interact
socially with their family and peers. Studies also show that children with this
diagnostic criterion can acquire similar characteristics from Attention
Deficit/Hyperactivity Disorder, behavioural
problems, and even Specific Language Disorder (DSM-5 American Psychiatric
Association 2013).

 

Identification

Based on DSM-5 (American
Psychiatric Association 2013b) diagnosis of SPCD is not common among children
younger than 4 years old it is because social (pragmatic) communication relies
on the satisfactory developmental progress in speech and language. When children
reached 4 or 5 years old that would be the appropriate level to identify any
specific deficits in social communication. There are even ‘milder forms of the
disorder’ that may not become obvious until they reach early adolescence. The outcome may vary depending on the child’s
development there are some children who extensively improve in a certain amount
of time and others may continue to have difficulties into adulthood. Even
though with the considerable improvement, difficulties in ‘social relationships
and behavioural problems and acquisition
of other related skills’ may still be present when a child has an early pragmatic deficiency. Furthermore, if
a family has hereditary issues with Autism
Spectrum Disorder, Communication Disorder, or even Specific Learning disorder
it may increase the possibility for a child to have SPCD. Norbury (2014e)
justifies that findings showed most of the children with SPCD were being
evaluated having’ speech abnormalities associated with autism and used
stereotyped language’. Adams et. al (2012a) also provide clearer identification
that most of the children with this disorder possess ‘higher level language
impairments such as difficulty with interference generation, narrative
organization and comprehension of discourse and mild difficulties’.

 

Assessment
and Diagnosis

Looking at the broad picture of DSM-5 where SPCD is a new diagnostic category (American Psychiatric Association
2013c) researchers are finding and developing the most suitable assessment to provide
the service to the children and to use in further studies.  It is emphasized by Norbury (2014f) that measuring
social communication and pragmatic language abilities are excessively difficult
in ‘standardized ways because they are a set of contextually dependent human behaviours that occur in dyadic exchanges’. To
support the argument, (Adams 2002, Volden et
al., 2009 cited by Norbury 2014b) according
to ‘the structure provided by a standardized testing situation makes it difficult
to capture social communication problems that may arise in everyday situations
where the rules of engagement are less explicit and highly dynamic’. When establishing
a standardized assessment, Carter et al.
(2005) point that large sample of respondents
from the ‘target population’ and if at all possible children with’ the same
ethnic, cultural and linguistic background, age, sex and educational level and
type’. Social communication assessment ‘should involve some examination of a
child’s comprehension of the social signals sent to him/her by others’. It is
very significant to learn and use the language in proper possibilities with a
social context. However, if a child has challenges in understanding ‘social
cues’ given in his/her communication experiences, the child is likely to
‘violate pragmatic rules’ and even face difficulties to language learning (Landa
2005).

 

The use of standardized checklists for social communication and
pragmatic disorder has become a ‘popular
method of assessment’ (Norbury 2014g). Perhaps the most well-recognized assessment material in both clinical practice and
research development is the Children’s Communication Checklist-2 (CCC-2) (Bishop
2003 cited by Norbury 2014c). In spite of the result being used for the
diagnosis, there are still issues and clarifications that surround the
reliability of the assessment. On the other hand, (Bishop & Adams 1989
cited by Norbury 2014d) by using ‘quantitative approaches’, the result of the assessment
in ‘analysing conversation in detail has been developed with acceptable levels of
interrater reliability’. It is supported by the research findings that by using
conversational analysis it provides a higher
percentage of reliability (Adams et al., 2006). We can see that it gives
advantages related to the efficiency of the assessment, however, Norbury (2014h)
stresses out that it is ‘a time-consuming assessment method, which may limit
its clinical and research utility’.

Assessment of social community-

tion should involve some examination of

a child’s comprehension of the social sig-

nals sent to him/her by others. This is

because language is learned and used

within a social context. If a child does not

understand the social cues given by oth-

ers, he/she is likely to violate basic prag-

matic rules as well as
encounter chal-

lenges to language
learning.

Assessment of social community-

tion should involve some examination of

a child’s comprehension of the social sig-

nals sent to him/her by others. This is

because language is learned and used

within a social context. If a child does not

understand the social cues given by oth-

ers, he/she is likely to violate basic prag-

matic rules as well as
encounter chal-

lenges to language
learning.

 

Intervention

Throughout the year, there was a
development of intervention for children with communication disorders. There is
a selection of services that may be suitable to meet chidlren’s individual
needs (Cirrin & Penner, 1995; Holzhauser-Peters & Husemann,
1988; Nelson, 1993; Silliman & Wilkinson, 1991 cited ASHA 1996).
In consideration with inclusive setting, it is very important to include full
collaboration with parents, teachers and health professionals, as well as, the
educational environment setting. One of the intervention models suggested are
‘classroom based’ and community-based’ services. In classroom based service,
teachers with the collaboration of speech-language pathologist provides
variation of intervention in classroom setting approaches. This will also help
other children within the entire class as they also involve in interaction (Elksnin & Capilouto, 1994; Norri, 1989; Prelock, 1993; Rice
& Wilcox 1995; Secord
1990; Watson,
Layton, Pierce, & Abraham 1994 cited ASHA 1996). In addition,
‘community-based’ service may help children with pragmatic problems and those
children with special educational needs whose using ‘community-based curriculum.
This intervention process sets in either home and community setting, they
benefit with the help of other people around them (Sailor,
Anderson, Halvorsen, Doering, Filler, & Goetz 1989; Snell & Janney 1993 cited ASHA 1996). Moreover, Prizant (1995
cited ASHA 1996) emphasised that critical planning is a must to provide
variation of inclusive experiences that includes ‘modification to the
environment, activities, and child interaction’.

 

On the other hand, I am also
discussing specific intervention that is available for children with SPCD. There are
still ongoing debates on the findings of the effectiveness of speech-language interventions
that mainly will benefit the children with language pragmatic or social
communication needs.  Therefore, Adams et. al. (2012b) give emphasis to the
need for suitable communication interventions as preventative measures. Adams et al. (2012 cited by Norbury 2014e) released
the first randomized controlled trial of a social communication intervention with
an objective to provide appropriate intervention specifically at children with SPCD. The Social
Communication Intervention Project (SCIP)
(http://www.psych-sci.manchester.ac.uk/scip/) ‘is an individualized
intervention approach that targets development in three areas: social
understanding and social interaction; verbal and nonverbal pragmatic skills,
including conversation; and language processing, including narrative,
inferencing, and developing word knowledge’. Moreover, Norbury (2014i) clarified
that despite the positive outcomes of the study through the period of intensive
intervention there are still challenges to overcome. According to Adams and
Gaile (2012 cited by Adams et al. 2012), they described that the experimental treatment
was an ‘intensive manualized social communication intervention’ that will
correct any deficits in ‘semantics and high-level language skills, pragmatic
difficulties, and social interaction and social cue interpretation’.

 

Based on the result and findings of
the research, Adams et al (2012c) determined
that by the used of ‘manualized experimental SCIP intervention’ there is a
success in giving thorough treatment procedure in order to provide consistent
intervention that will give way to an accurate support to children with social
communication difficulties. We can look at from
this perspective that it has provided a clearer picture that the effectiveness
of research findings could better intervention. In some way, Norbury (2014j) yielded
a very significant viewpoint that the most aims of intervention are to improve language and communicative
function rather the ‘cure’ disorder. Furthermore, she gave emphasis to the
whole efficacy of the diagnostic materials to provide clear intervention.
Nevertheless, it is still necessary to utilize ‘standardised
assessment tools’ for it will be very advantageous for future studies.

 

Conclusion

The implementation of services to children with SPCD comes with a wide range of inclusive
service models. There should be flexible selections to consider as any changes
depending on the children’s’ needs. Thus, the inclusive
setting provides opportunities to develop their social and interactive skill
and other specific competencies that would benefit them by using the various
service models. In the other (Guralnick & Groom, 1988; Jenkins, Odom, &
Speltz, 1989; Lamorey & Bricker, 1993; Notari & Cole, 1993; Wolery
& Wilburs, 1994 cited by American
Speech-Language-Hearing Association 1996). On the other hand, there is a
substantial advantage in early integration, but it would not guarantee to have
positive results all the time rather the success of the intervention depends on
organised plan and implementation (Lamorey & Bricker 1993; Notari & Cole 1993; Wolery & Wilbers 
1994 cited by ASHA 1996). It also an issue
to consider the funding that may cause an approval or rejection of inclusive
service plus the administrative perceptions towards inclusion efficacy (Salisbury
& Chambers 1994 cited by ASHA 1996). There is a need for educational preparation for professionals
who will be given responsibilities that are essential in an inclusive setting. In addition, inclusion is
very challenging to achieve without the presence of qualified personnel who
collaboratively work and share roles among speech-language pathologists, teachers,
and family members. It should also consider the effects of the children within
inclusion. It was stressed by Sharpe, York, & Knight (1994 cited by ASHA 1996) that there are possibilities that children
with special needs may affect the ability of regular students to benefit from
the general education. Presently, there are
positive research findings about the effectiveness of inclusive practices.
Thus far, further studies should be conducted to provide more concrete findings
and assessment to inclusive practices for children with communication disorders.
In relation, the need to expand the range research to finding suitable intervention
and the effectiveness of inclusion in mainstream educational setting. Considering
the long-term effect of inclusive practises that will track their academic and
social development (ASHA 1996).