Emotional/behavioral disorders: a retrospective examination of social skills, linguistics, and student outcomes.

A language-based social skills instruction intervention used to prepare middle and high school students with emotional/behavioral disorders for return to less restrictive public school placements was evaluated. The daily 50-minute intervention focused on repetitive readings, recitations, and role-playing of skill step procedures until students achieved mastery on each required task in five broad dimensions: peer relations, self-management, academic, compliance, and assertion. The students were divided into three groups according to the length of intervention (under 2 years, 2 to 3 years, and more than 3 years). Dependent t tests were used to test the effects of prolonged intervention on past year and final year disruptive behavior totals and response to a self-control question for students in each group. In addition, a chi-square was used to evaluate the frequency of students with four or fewer disruptive behaviors across groups to determine progress toward unsupervised transition. Implications for social skills intervention and communication disorders practice are discussed.

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Social competence is defined as "the ability to interact successfully with peers and significant adults" (Gresham, Sugai, & Horner, 2001, p. 331). Children not exhibiting appropriate social competence in the context of school, home, or other cultural contexts are often included in programs designed to improve their social skills. Social skills training, however, has not been shown to produce the desired changes in social competence that the programs intend. Gresham et al. report that interpretation of meta-analyses has led to the conclusion that "social skills training has not produced particularly large, socially important, long-term, or generalizable changes in social competence" (p. 332). The weak effects of the training may be a function of the taxonomy used to classify behavior and behavior problems.

As detailed by Gresham and his colleagues (2001), "social skills are behaviors that must be taught, learned, and performed, whereas social competence represents judgments or evaluations of these behaviors within and across situations" (p. 333). Social skills are those behaviors used by an individual to function in social tasks, such as in starting and maintaining conversations, giving and receiving compliments, engaging in play with peers, requesting actions or information, and taking part in other socially relevant activities for the individual's age group. Social competence, in contrast, is defined by significant others within the contexts in which the individual has opportunities for interaction. As such, teachers, parents, siblings, and peers judge whether an individual's behaviors are socially relevant and desirable; that is, that the behaviors are acceptable and functional for the individual to gain peer and adult acceptance, form friendships, and participate successfully in social tasks.

To be socially valid outcomes of social skills instruction (SSI), behaviors need to exist not only in the presence of the teachers or interventionists, but also in the generalized contexts of everyday functioning and in the opinion of those significant others with whom the child interacts. If the SSI program produces only weak effects in the children participating, we must question why this occurred and how it can be modified.

RELATIONSHIPS BETWEEN LANGUAGE ABILITY AND BEHAVIOR PROBLEMS

It has been widely established that poor language ability and emotional/behavioral problems, including psychopathology, psychosocial impairments, and psychiatric disorders, have a close association (Asher & Gazelle, 1999; Baltaxe & Simmons, 1990; Beitchman, Cohen, Konstantareas, & Tannock, 1996; Brinton & Fujiki, 1993, 1999; Brown, 1994; Cantwell & Baker, 1987, 1991; Fujiki, Brinton, Hart, & Fitzgerald, 1999; Gallagher, 1999; Hyter, Rogers-Adkinson, Self, Simmons, & Jantz, 2001). Furthermore, it is generally acknowledged that concomitant behavior/emotional problems are present and persistent for many children and adolescents with language disorders. The co-morbidity rate has been reported to be as high as 88% in children identified with language deficits and psychiatric problems (Beitchman, 1985; Cantwell & Baker, 1987; Hyter et al., 2001). Baltaxe and Simmons described the communication behaviors of children diagnosed with oppositional--defiant disorders as violating the expected interpersonal and social communication norms. The transactional effect of language and emotional disorders are associated with poor development of mutual regulation and self-regulatory behaviors. Such problems occur in significantly higher incidence in children with language disorders than they do in the general population. As summarized by Brinton and Fujiki (1999), longitudinal studies of children initially identified as exhibiting communication disorders at ages 3 and 5 years, without concomitant symptoms of emotional/behavioral disorders (EBD), later (ages 8 and 12 years) had emotional/ behavioral or psychiatric disorders at a higher than typical prevalence rate. According to Baltaxe and Simmons (1990),

   The pervasiveness of disordered communication
   in psychiatric populations is no longer in doubt.
   The need for greater awareness in both professions
   regarding the degree, kind, and significance of the
   relationship between psychiatric disorders and communication
   handicaps is obvious, as is the need
   for and central place of the speech-language specialist
   in child psychiatric inpatient and outpatient
   settings. (p. 29)

One component of emotional/behavioral well-being and the complex factors contributing to healthy psychosocial development is the child's ability to form and maintain friendships. A related aspect is the child's acceptance in the culture of his or her peers. Acceptance and friendships have a direct effect on children's self-concept, school performance, and cognitive development (Asher & Gazelle, 1999). Friendships provide opportunities for children to use, refine, and enhance skills that allow them to interact, negotiate, resolve conflicts, exchange ideas, collaborate, and solve problems. Fujiki et al. (1999) examined eight elementary-age children with specific language impairment (SLI) to determine the profiles of peer acceptance and friendships. They hypothesized that children with SLI, as represented by these eight students, would exhibit poor peer acceptance and few friendships. Although the researchers found surprising variability in the profiles, in general they confirmed that children with SLI had greater difficulty interacting with their peers in school in ways that earned social acceptance and were rarely named as one of three persons other children regarded as friends. According to Fujiki et al., "Of the eight children with SLI, 5 (63%) were not named by any child as a best friend.... Across the four classes observed in this study, 15% of the children were not named by anyone as a friend, and almost half of those (5/12) were children with SLI" (p. 44).

In describing the behaviors of the children, Fujiki et al. (1999) reported that children with SLI were observed during recess to play alone, play with younger children, shadow the activities of others without joining the group, or disrupt group play when they attempted to enter into the group. In general, they were described as being on the outskirts of social activity. Because friendships are formed and maintained through interpersonal interactions, largely dependent on language proficiency, children with SLI may find it outside of their ability to engage in self-disclosure, expression of concern or affection, negotiation, and conflict resolution, as well as the conversational mechanisms of using humor, taking turns, interpreting sarcasm, and using other social-exchange tools. As concluded by Fujiki and his colleagues,

   social functioning is an important part of educational
   programming. Children with SLI struggle with communication
   and academics, and they need good peer
   relationships to provide support in school settings.
   Friendships provide an essential context for scaffolding
   language and interactional skills. (p. 46)

The challenge in promoting the development of social skills is not only in teaching the behavior, but also in creating natural contexts in which the skills can be developed, used, and refined. As discussed by Gresham et al., (2001), the failure of SSI to produce social competence (reflected in acceptance and friendships) may be related to the historical focus on skill acquisition rather than development and internalization of skills that are useful and appropriate across varying contexts. If children fail to develop friendships, which may in part be due to their poor linguistic abilities, they are further compromised in their social-emotional development and school performance. This is further evidence that the communicative abilities of all children need to be considered holistically, and with "an ear to the future" to be alert to potential problems with the social, emotional, and behavioral development of every child.

Brinton and Fujiki (1999), in their study of six children with SLI (ages 8 years 10 months to 12 years 5 months), concluded,

   Many children with SLI ... will show internalizing behaviors
   and operate on the edge of social groups.
   Some, however, ... may also show externalizing behaviors
   and appear disruptive in classroom and social settings....
   As with all aspects of language intervention,
   specific treatment targets, and procedures must be tailored
   to fit individual profiles. (pp. 67-68)

The difficulty in selecting targets for intervention is that the problems are not easily identified; therefore, isolating specific service needs is difficult. The linguistic profiles of individual children must be examined in comparison with their behavior profiles to determine the ramifications of the linguistic deficits, targets for intervention, and intervention techniques and contexts. Furthermore, the efficacy of any intervention must be considered in the contexts of social competence as well as specific skill development. The implication of these studies is that it is not enough to conclude a child does or does not exhibit language impairment or an emotional/behavioral problem and assume such diagnosis leads to prescriptive intervention. This implies a morbidity model associated with a medical--diagnostic taxonomy. Rather, the specific aspects of a child's communication and behavior must be examined to determine the interrelationships among particular abilities across developmental domains and the reciprocity/transactional effect when one domain is not fully developed or is deviant from the typical pattern.

THE DECALAGE OF LANGUAGE, COGNITION, AND BEHAVIOR

The term decalage is used by Siegel (1996) in the Piagetian sense to refer to a

   coming together of heterogeneously staged abilities
   from different domains of development that together
   represents developmental functions that cannot
   be wholly characterized as fitting one stage of
   development or …