While the awareness of mental health has been growing continuously, it is essential for us to recognize that children with speech, language and communication needs (SLCN) have a higher risk of having difficulties with their mental health and well-being (Hancock et al., 2023; Conti-Ramsden & Botting, 2008; Botting et al., 2016). The relationship between mental health and SLCN is highly complex and thus poses challenges for teachers and caregivers to understand the development of children and adolescents with co-occurring SLCN and mental health needs, a population which is often labelled as being “naughty”. In this article, we will explore the connections between speech, language and communication difficulties and mental health and how we can help those children who might be struggling.
How do speech, language and communication difficulties affect mental health
Behavioral issue
Language and communication competence are the fundamental tools for learning and engaging in social interaction. We rely heavily on our language skills for communicating our needs and wants, talking about thoughts and feelings, negotiating and resolving conflicts. Imagine if, just for a day, every conversation you had was a hurdle, how would you feel? Struggling to communicate can lead to frustration and such frustration likely brings about negative behavioural outcomes. Some children may present aggressive behaviour as a response to frustration or the inability to express their needs.
A 2014 systematic review reported that 81% of children who were referred solely for emotional behavioural problems had language difficulties which had not been previously identified, with 34% and 47% of them were later diagnosed to have mild and moderate/ severe language disorder respectively (Hollo et al., 2014).
These figures inform us that while we are addressing mental health issues, it is important to take a child’s language and communication competency into account as there might be communication problems at the roots of the mental health concerns. Incorporating speech therapy into mental health interventions can provide essential support for children, helping them improve their communication skills and, in turn, better manage their emotional and behavioural challenges.
Psychological well-being
Children with SLCN are more prone to having anxiety and depressive symptoms (Moree & Davis, 2010; Cohen et al., 2013; Wadman et al., 2011; Conti-Ramsden & Botting, 2008). The anxiety might originate from the fear of miscommunication and negative judgements. Some children and adolescents may withdraw from situations that require high-level language skills, such as group discussion and class presentations, and where their speech and language difficulties are likely to be highlighted.
In a more extreme case, communication difficulties can lead to social withdrawal or isolation, which is a known risk factor of depressive symptoms. Moreover, the struggle to express can lead to the feeling of inadequacy which exacerbates self-esteem. Integrating speech therapy with mental health support can be vital in addressing both communication challenges and emotional well-being.
What can we do to help a child who might be struggling?
Since mental health struggles and communication disorders interweave, it is critical for professionals and caregivers to have a holistic view of a child’s or an adolescent’s developmental concerns and provide the right support in place early. First and foremost, we should keep an eye on the potential communication challenges in children and adolescents with mental health issues. When a child or an adolescent is observed to display difficulties with learning, building social relationships or emotion regulation, we should take a close look into his/her speech, language and communication ability.
If communication problems are one of the contributing factors of mental health issues, speech therapy will be the first step of the intervention journey. Second, “Talking therapies” are common psychotherapies for mental health problems. Deficits in language are likely to affect the accessibility and efficacy of traditional talking therapies as communicating abstract thoughts and narrating personal experiences are usually challenging for children with SLCN.
For example, a child might not be able to describe his/her feelings with precise words because of his/her limited vocabulary inventory. Psychotherapists can provide visual support, such as emoji cards and drawings, to help children to talk about their feelings and experiences. We can also support their participation in talking therapies by using simple language, talking slowly, and checking understanding from time to time.
- Monitor Communication Challenges:
Keep an eye on potential communication difficulties in children and adolescents experiencing mental health issues. Observe for signs of struggles in learning, social relationships, or emotion regulation alongside speech, language, and communication abilities.
- Speech Therapy:
If communication problems are one of the contributing factors of mental health issues, initiating speech therapy is very likely to be an essential first step in the intervention process
- Psychotherapy:
“Talking therapies” are common psychotherapies for mental health problems. Children with SLCN may struggle to express abstract thoughts and narrate personal experiences effectively when having talking therapies.
- Language support:
Use visual aids like emoji cards and drawings to help children articulate their feelings and experiences. Employ simple language and speak slowly during therapy sessions. Regularly check for understanding to ensure that the child is engaging and comprehending the discussion”?
Photo Credits:
First image: Oksana Donets
Second image: KatarzynaBialasiewicz
References
Botting, N., Toseeb, U., Pickles, A., Durkin, K., Conti-Ramsden, G., & Ebmeier, K. (2016). Depression and Anxiety Change from Adolescence to Adulthood in Individuals with and without Language Impairment. PloS One, 11(7), e0156678–e0156678. https://doi.org/10.1371/journal.pone.0156678
Cohen, N. J., Farnia, F., & Im-Bolter, N. (2013). Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry, 54(7), 733–744. https://doi.org/10.1111/jcpp.12060
Conti-Ramsden, G., & Botting, N. (2008). Emotional health in adolescents with and without a history of specific language impairment (SLI). Journal of Child Psychology and Psychiatry, 49(5), 516–525. https://doi.org/10.1111/j.1469-7610.2007.01858.x
Hancock, A., Northcott, S., Hobson, H., & Clarke, M. (2023). Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals. International Journal of Language & Communication Disorders, 58(1), 52–66. https://doi.org/10.1111/1460-6984.12767
Hollo, A., Wehby, J. H., & Oliver, R. M. (2014). Unidentified Language Deficits in Children with Emotional
and Behavioral Disorders: A Meta-Analysis. Exceptional Children, 80(2), 169–186. https://doi.org/10.1177/001440291408000203
Moree, B. N., & Davis, T. E. (2010). Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: Modification trends. Research in Autism Spectrum Disorders, 4(3), 346–354. https://doi.org/10.1016/j.rasd.2009.10.015
Wadman, R., Botting, N., Durkin, K., & Conti-Ramsden, G. (2011). Changes in emotional health symptoms in adolescents with specific language impairment. International Journal of Language & Communication Disorders, 46(6), 641–656. https://doi.org/10.1111/j.1460-6984.2011.00033.x
Yoyo Lee
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