As a Speech and Language Therapist who specialises in working with young people with Social, Emotional and Mental Health issues, I often find my role is intrinsically linked to that of the Counsellors we work with here at Mable – especially with teenagers and those struggling with social communication difficulties and anxiety around communicating.
So, why is it that 81% of young people with Social, Emotional and Mental Health difficulties also have Speech, Language and Communication difficulties? I’ve talked previously about Adverse Childhood Experiences and their link with language development, but now I want to explore the reasons behind the direct relationship between limited communication skills and the difficulty in accessing support for our mental health.
The Links between Speech, Language and Communication and Mental Health
We need good language skills to be able to effectively communicate how we’re feeling. Children and young people need to have strong language and communication skills to be able to understand and label emotions, as well as to help them deal with different situations. This is because:
If young people struggle to express their thoughts, they are likely to become frustrated. Frustration can cause the young person to act out with challenging behaviours or to become socially isolated
Young children who have difficulties communicating are three times more likely to have behaviour that concerns parents and early years practitioners
Many young people may be able to mask their communication difficulties, or sometimes they become hidden behind the child’s other diagnoses; one study found that 40% of 7 to 14 year olds referred to child psychiatric services had a language difficulty that had never been suspected
Many treatments for mental health issues rely on language and communication to be successful, so for children and young people with SLCN, this may block them from accessing support
Are young people with SLCN vulnerable to mental health difficulties?
Young children might experience anxiety around communicating, caused by not understanding what people are saying or people not understanding what they’re saying. Other areas may cause mental health difficulties too, including:
Forming friendships and social relationships at nursery and school may be difficult as they have a limited vocabulary (the amount of words they are able to understand and use)
Low self-esteem could be caused by feelings of social isolation or being unable to communicate as effectively as peers
Children may have difficulty with thinking things through, sequencing events and working out what might happen, causing them to not really understand the implications of their actions
Any difficulties with language and communication might not have been picked up and therefore the child may not be getting the support they need
So, for example, a child in nursery who knows less words, does not always understand what they are being asked to do and cannot effectively start a conversation or initiate play with another child, may then miss some key opportunities to develop social skills. Over time, the gap may widen as peers develop more words and use increasingly complex play and social interaction, leaving the child frustrated but lacking the communication skills to express this.
Supporting children’s mental health and emotional wellbeing
One of the reasons it is so important to get children with speech, language and communication issues the support they need is because one third of children with SLCN need support for mental health difficulties in adult life. With this in mind, the following can support a child’s mental health and emotional wellbeing:
Secure attachment experiences – developing good relationships and bonding with key people in the child’s life
Improved communication skills – if the child is better able to understand what is being said, express themselves effectively and explain how they are feeling, they will be better at being able to ask for help and explain specifically what they are struggling with
Having a feeling of being in control – children who feel that they have a say in things and can make their own choices may have better self-esteem and feel more independent
A positive attitude and experience of success and achievement – even if it is a small achievement, constant reminders of things the child has achieved develops a sense of self and self esteem
Reflection skills – if the child is able to look back on things, consider their own actions and work out why something happened and then consider if they might do or say something differently in the future, this will support them to adapt their behaviour and learn from mistakes
Speech and language therapy is therefore vital to support each young person and their environment so they can engage in mental health services. Early intervention is very important, but speech and language therapists can support those with mental health difficulties throughout life.
Research has shown that speech and language therapy is effective in treating some of the conditions people who access mental health services have. These include ASC, Learning Disabilities and stammering (Bothe, A.K. et al (2006). Stuttering Treatment Research 1970–2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioural, Cognitive, and Related Approaches), but it has also been demonstrated to add value for people with schizophrenia, for example, one study found speech and language therapy input increased a patient’s verbal communication and they developed more appropriate social communication skills.
A similar study demonstrated how conversational skills could be revealed among people with schizophrenia (Bryan, K. (2013). op cit. 27 Clegg, J. et al. (2007). ‘Speech and language therapy intervention in schizophrenia: a case study’, International Journal of Language and Communication Disorders).
Recognition of communication as a major factor in accessing support allows speech and language therapists to maximise the success of intervention (Walsh, I. P. (2008). ‘Whose voice is it anyway? Hushing and hearing “voices” in speech and language therapy interactions with people with chronic schizophrenia’, International Journal of Language and Communication Disorders). There is also a large evidence base for vocabulary and language intervention being effective in school age children excluded from school due to social, emotional and mental health difficulties.
Mental health difficulties and speech, language and communication needs go hand-in-hand, and therefore, if there are difficulties in both, you cannot treat one without the other. Some of the areas that speech and language therapists can support children with, in order to get them ready for counselling or talking therapy include recognising emotions, sequencing events, creating sentence structures, understanding non-literal language and developing social communication skills.