D.8 Diseño industrial

The SEN Code of Practice (2001) discussed above is underspecified in comparison with mental classifications. Mental classification systems of language and communication deficits go beyond educational classification and further specify the nature of a child’s problem. The DSM-IV categorises language deficits under communication disorders. This category includes expressive language disorder, missed expressive/receptive language disorder, phonological disorder, stuttering, and communication disorder not otherwise specified. The greater specificity of mental health classifications is reflected in the DSM-IV guidance of when a diagnosis should be made. Diagnosis is made when there is a substantial difference between the child’s language abilities and non-verbal performance, and difficulties do not meet the diagnostic criteria for other disorders. The ICD-10 classification of mental and behavioural disorders classifies speech and language deficits under two separate categories of receptive and expressive difficulties, as well as including a separate category for specific speech articulation disorders. The categorisation of receptive difficulties as a separate deficit differentiates the ICD-10 from the DSM-IV, as the DSM-IV does not categorise receptive language disorder on its own. Furthermore, ICD-10 diagnostic criteria are based more on disparity between language scores than the DSM-IV. Diagnostic criteria include: that children’s language skills are two standard deviations below the norm on standardised tests and at least one standard deviation below the norm on tests of non-verbal IQ; and that there are no neurological, sensory or physical impairments that directly affect the use of language.

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Unlike the DSM-IV, the ICD-10 does not state that for diagnosis difficulties must interfere with academic, occupational achievement or social communication (Bishop, 1997b). Therefore, the DSM-IV addresses the everyday impact of language deficits for diagnosis, whereas the ICD-10 mainly considers statistical indications of impairment.

Receptive language difficulties include problems with listening and understanding others; expressive language difficulties include problems with speech formation and conveying thoughts and ideas. While the distinction between these in the ICD-10 may be helpful in conceptualising whether a child’s problem lies within incoming (receptive) or outgoing (expressive) language and communication ability, this categorisation is still simplistic. It does not reflect the heterogeneous nature of language and communication deficits; it reveals nothing about structural or pragmatic impairment or severity of impairment. It is important to consider that language and communication disorders in children may not be of one specific nature only, and a child may possess difficulty with more than one aspect of language and communication. Clinically, diagnostic ‘boxes’ have been created to classify developmental disorders including language disorders (Rapin, 2011). In reality, one child may fit into more than one diagnostic category, whether this be different language categories or across different types of disorders. As the ICD-10 states, and in spite of distinction between the two, a child with receptive difficulties will almost always possess expressive difficulties also. This

combination of expressive and receptive difficulties is reflected in the DSM-IV categorisation. An alternative way of conceptualising language and communication is to categorise deficits according to several factors: the aspect of language that is impaired (phonology, morphology, semantics, syntax or pragmatics); the severity of impairment; and its effect, whether it impairs expressive or receptive abilities (Bishop, 1997b). Persistence of impairment alongside

severity is also important to consider in differentiating between what may be typical delayed language development and what may manifest as atypical disordered language. As Rapin (2011) describes, the observable phenotype may be considered a disorder only to the extent to which it interferes with everyday life. Clinical frameworks of language and communication reflect this; however, Rapin (2011) argues that there is no clear distinction between what constitutes a disorder and what represents a trait. Differentiation between characteristics of disorder and those of a trait is subjective and ultimately the decision of clinicians.

2.2 Summary

The educational and clinical conceptual framework represents definitional variability in what constitutes BESD and language and communication difficulties. Clinical frameworks provide

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the most detailed definitions and are most widely used to guide research and for diagnostic purposes. However, their clinical nature makes them less appropriate for the identification of BESD and language and communication difficulties in a non-clinical population where impairment is less severe. Educational frameworks, on the other hand, are less descriptive. Perhaps this is because there is resistance within these frameworks to providing children with a diagnostic label as mental health frameworks do (Bishop, 2014). They do not aim to identify clinically significant deficits, but are tailored towards remediation by educationalists and towards the characteristics observed in children in school contexts.

By definition and diagnostically, and under educational and clinical frameworks, difficulties are considered to be mutually exclusive of each other. Existing frameworks do not account for co-occurring ‘comorbid’ difficulties across domains, and so do not appropriately represent clinical reality (Bishop, 2010). The adoption of an appropriate conceptual framework when investigating co-occurring problems is further confounded by difficulty in identifying the type of impairment in children. Overlapping impairments may make it difficult to determine and separate primary and secondary difficulties. In the case of behaviour and language, one may ask, in mainstream schools, are we frequently seeing children with primary behaviour problems struggling with language, or primary language and communication problems causing them to struggle with behaviour? This question remains unanswered. Neither

educational nor mental health definitional criteria identify a ‘behaviour/language’ difficulties group; they are consistently defined as separate constructs.

As the current project is not targeting clinical samples or exploring diagnosis of disorder, but rather, focuses on the identification of characteristics in a non-clinical population within an educational context, an educational framework is adopted. In line with the target population the term ‘difficulties’, rather than ‘deficits’ or ‘disorder’, will be used to refer to behaviour and language problems. This is important, since there is a distinction between mental health frameworks, which discuss ‘deficits’ or ‘disorder’ in clinical populations, and educational frameworks, which discuss ‘difficulties’ or ‘problems’ in non-clinical populations. A further advantage of adopting an educational framework is that it addresses the social characteristics of children’s behaviour and language, which is important in considering the impacts of characteristics on children’s social interactions.

The following chapter will review the existing literature surrounding the association between behaviour, language and communication difficulties. This will help inform the current

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behaviour, language and communication difficulties, as well as identifying gaps in existing research for the current study to address.

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