J Child Psychol Psychiatry. 2004 Jul;45(5):967-78.
Social communication deficits in conduct disorder: a clinical and community survey.
Gilmour J, Hill B, Place M, Skuse DH.
Sub-Department of Clinical Health Psychology, University College London, UK.
Background: Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour.
Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Methods: Using the Children’s Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. Results: On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits.
Conclusions: These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
PMID: 15225339 [PubMed - in process]
well duh?
As a speech pathologist I have seen kids behavior improve as their communication abilities improve. It makes a lot of sense to me just as it does to Sue…
Re: Social communication deficits in conduct disorder
Anecdote: teaching a college algebra class. I gave a test at the testing center and students could choose their own time and work without a time limit (wouldn’t you know, they complained bitterly about being given this setup. They were upset they had to use time outside class. You can’t win.)
Anyhow one girl had missed the regular test time and was going to write it during an extension I gave (bent over backwards).
So she asked in class if she should take her calculator to the test. I said yes, in fact a calculator is required for the class. She asked again, but should I take it to the test? I answered again, yes, that’s what I just said, that’s what required means. She became angry and yelled, Tell me if I’m supposed to take the calculator. I said yes, I repeat, you’re supposed to use the calculator at all times in this class, yes. She stormed out of class.
It occurred to me that in some way she could not process the answer — either could not believe it was a yes, or could not process a sentence more than three words, I’m not sure. A frustrating and weird experience and of course the poor kid got nowhere in algebra since she could’t process things. I’m sure this is very common (and this one was a girl.)
Re: Social communication deficits in conduct disorder
I think language barriers or difficulties complicate a lot of pictures. I have noticed over the years that as my boys communications difficulties have become less severe so have some of their other problem areas although they have not completely disappeard. When my son who falls on the autism spectrum was young he had very severe speech/language issues, he did not talk meaningfully until about age six, his behaviors were almost unbearable. At about age 2 we started to use sign language with him, after he learned enough signs to get his needs met he became more relaxed and slowly learned to speak more words. By age 6 he had enough words to not need sign any more. It took another few years of half decent language for his academics to start to improve, as these have slowly improved we have again noticed changes in his behavior for the better. All this improvement started once they addressed something so basic as being able to communicate effectively with ones peers and others in society. I would not consider him completely cured but he is ssssooooo much different now, it gives you hope for what the future will bring—and all because they worked on speech/language skills.
Lisa
Makes sense that frustration/inability to understand...
or express yourself would result in inappropriate behaviour!
In the latest book from Ron Davis, he presents a scenario that theorizes an explanation of the inappropriate behaviour of a child by illustrating what the child thinks and visualizes due to receiving an incomplete message when his teacher explains WHY he should not push ahead of the line to the top of the slide and go down — this really made sense to me.
Davis believes that the ‘connecting’ and ‘not concrete’ words (eg if, why, when, and, first, last, etc,) are hard for a visual thinker to ‘picture’, and therefore hard or impossible for him to process. The intended message is often missed since he has no basis for understanding many of the words — he hasn’t picked them up ‘naturally’ as most of us do. His scenario shows how, due to his language difficulties, the child completely misses the message, and only ends up with a visual of ‘me going down the slide AGAIN’, while missing the ‘IT’s WRONG to push ahead, and WHY and HOW to take turns’ part of the teacher’s message.
He therefore seems to ‘ignore’ his teacher’s admonishment and, when she releases him to ‘try again’, he…rushes right over to the slide, pushes in front of all the others, and goes down AGAIN…it really made me think.
Re: Social communication deficits in conduct disorder
It occurs to me that disorders of conduct are addressed much sooner than disorders of learning due in no small part (IMHO) to the gatekeeper called “2 year discrepancy formula”, and while treating a symptom of an underlying problem may mask the situation, just like in other forms of medical practice it often does little outside of placebo effect to improve the overall condition as the source of the behaviors addressed is left untouched.
UNFORTUNATELY...
YOU ARE SO RIGHT, DAD…YET…over and over again, we hear that when COMMUNICATION problems are addressed — behaviour changes MUCH for the better…why don’t we start looking at this from a learning point of view? Why do we assume that, because we have spoken, we have communicated effectively?
I’m starting to feel that ALL problems in behaviour stem from essential failures in some facet of receptive/expressive communication…think about it!
And the whole SPED ‘funding’ model is WRONG WRONG WRONG…above and below the border, though we don’t have the 2 year rule — but we don’t got no FAPE up here, either, so we get what we’re given and due process is NO THREAT to anyone.
WHAT IF…we started teaching children, ALL THE CHILDREN, according to their needs, regardless of the cost…? Imagine! FAPE for everyone…anyone else agree this would have a hugely beneficial effect on our society?
Sorry, veered off into dreamland…but if nobody has a dream, nothing will change…guess that’s part of why I hang around here…feeds my dreams!
It’s about time …
It didn’t take me too long to figure out that some of my kiddos’ behavior issues were really psychological, but other kiddos’ behavior problems shrank incredibly when communication was addressed. (Sigh, and for a whole lot more, it was a combination of the communication, and the psychological stuff as a result of the patterns built up by the communication probelms…)P