CASE EXAMPLESTHREE CASES REFERRED
TO SPEECH AND LANGUAGE THERAPIST WITHIN A JUVENILE YOI
The first is a relatively well educated young
man who has difficulty in using language in social situations.
His difficulties were sufficient to affect his ability to cope
within the regime.
M was 18 years old and prior to his custodial
sentence had lived with his family. He was serving a 10 month
Detention and Training Order and had a history of violence and
aggressive behaviour. He was referred to SLT for poor language
and social skills. M had attended mainstream school and had achieved
four GCSEs. He had then attended college, and gained further vocational
qualifications. In prison, he attended education part time and
had a part time job in the "paving" workshop. M was
frequently involved in confrontation or fighting with other young
people and staff. He had no history of substance misuse and an
IQ test showed that he was "within the average range".
SLT assessment showed that M did have poor descriptive
language skills (expressive language), limited social skills with
particular difficulties in non-verbal aspects of communication,
rigidity in his thoughts, difficulty using language to expand
his explanations and limited verbal reasoning skills, some memory
and comprehension (understanding) difficulties and also low self
esteem regarding his academic abilities. Formal assessments showed
that his understanding was equivalent to age 11 years and his
speaking and listening skills were considerably below the average
range for his age group.
M was motivated to attend SLT and jointly agreed
to the following goals:
to understand about non verbal communication
eg eye contact, facial expression;
to understand people's body language;
to understand how communication changes
in different situations; and
to be more aware of his own non-verbal
M accessed the following SLT care pathways:
receptive language, expressive language, and social skills to
address his difficulties over 12 sessions. M successfully met
all of his SLT goals, and the gains were evident in his day to
day conduct. The number of incidents relating to aggressive, confrontational
behaviour decreased and staff commented on his ability to deal
with difficult situations more effectively ie he was able to recognise
when someone was "joking" with him and was able to stop
and think about a situation before reacting. As a result of the
decrease in his aggressive behaviour he was perceived by others
more positively, which also helped to develop his self esteem.
The next case illustrates the problem of managing
a young person with a pre-existing problem that includes language
and communication difficulty within the context of residential
provision for young people.
L was 16 and looked after by Social Services
under a full care order with diagnoses of attention deficit hyperactivity
disorder (ADHD), Asperger's Syndrome and marked conduct disorder.
He was sentenced to a 10 month Detention Training Order, as a
second time in custody. In prison, L was attending education for
basic skills, and was also working towards a qualification in
L presented with literal understanding of language,
lack of empathy and tactlessness, impaired non-verbal communication,
difficulty focusing on relevant stimuli and difficulty in understanding
large amounts of information. He also had difficulty differentiating
between different types of objects. For example, in woodwork he
could never work out why there were different types of saws. Information
on L's language and communication difficulties was given to all
staff involved with him. An SLT intervention programme was devised
to support L in his woodwork course. This involved categorising
objects by their features and functions, in order to aid his understanding
of the difference in tools and to support him in using the correct
tools for specific jobs. The learning support assistant who worked
in the woodwork area conducted this programme.
The SLT was also asked to advise on L's behaviour
in his residential area. L frequently misused the cell bell, shouted
abusive comments from his cell and repetitively kicked his door.
This behaviour reflected L's incomplete understanding and his
use of inappropriate strategies to attract attention. The SLT
worked with L to increase his understanding of the routine within
the residential unit, and to develop more appropriate strategies
for him to attract the attention of staff. Following SLT intervention,
staff reported that L's behaviour had improved and he was coping
well with the woodwork programme. Information from SLT was also
used to plan appropriate service provision following L's release
The third case is a young person with schooling
problems pre-dating his offending problems. However, neither his
school nor the college catering for excluded children had identified
his language difficulties. N was 16 and a half years old and serving
an 18 month Detention and Training Order as his second custodial
sentence, and he was identified as a persistent offender in his
local area. He lived with his family prior to custody and had
a history of substance misuse.
N had attended mainstream school but was excluded
for the first time at age 11 years and following this his attendance
was sporadic due to further exclusions. He eventually attended
a course at a local college for excluded children, which he attended
until age 16 years. N had never received a statement of special
educational needs, despite difficulties with reading and writing,
but was diagnosed with dyslexia while in prison. N was accessing
education part time and had a part time job in the paints workshop.
Induction staff reported that N was having difficulty engaging
in conversation and in understanding what was said to him.
N presented with a restricted vocabulary, equivalent
to that expected of a child aged 10 years and word finding difficulties.
N's speaking and listening skills were within the "low average"
range. He also had noticeable difficulty understanding what was
said to him particularly if two or three pieces of information
were presented at the same time, and he showed some awareness
of these difficulties. He had little confidence in communicating
and low self-esteem, which was reflected in his limited eye contact
and his tendency to give up when tasks became more difficult.
The outcome of assessment was that N agreed
to address his vocabulary, his ability to retrieve words, and
his ability to express himself and talk about himself. Developing
these skills would then help develop his confidence in communicating
and promote his self-esteem. He received regular SLT input, which
later fed into a pre-release preparation programme aimed at coping
with interviews and coping with workplace communication.
These three cases illustrate the complexity
of the cases referred to SLT and the impact of speech, language
and communication difficulties on many aspects of the young people's
care, education and life experience. These cases were not unusual
as the population screening described in the next section demonstrates.