The Talk Behind The Tantrums

Sometimes behavioural issues may mask a deeper language problem in children, writes speech pathologist Karen James.

I love being a speech pathologist. Twelve years of working with people of different ages in health, disability, school and community settings has taught me the importance of communication in every stage of our lives. As an eager new graduate, I was ready to ‘save the world’ and imagined it would be obvious when someone couldn’t speak or had language difficulties. And, of course, all the kids would be compliant and want to see me because I would fix them and make it fun.

Older and wiser, I now laugh to think of my naivety. One of the most important lessons I’ve learned is that speech and language difficulties are not always obvious and can be masked by other more noticeable problems. Everyone knows of a child who is hyperactive and behaves inappropriately, or a quiet child who hardly says ‘boo’. However, their communication problems go unnoticed as either they don’t draw attention to themselves or we’re too busy stopping them from crawling up the wall to look for the reason behind the behaviour.

Have you ever heard a teacher speak of a student they ‘just didn’t know what to do with’ or whom they wished would ‘stop talking and do their work’? One seven-year-old student (I’ll call her Joan) with whom I worked was an active girl who excelled at sport and maths, but when it came to reading, writing or any subject that required her to sit and listen, she struggled. Joan always managed to get herself into trouble by chatting to her neighbour and regularly forgot whatever it was she had been asked to do.

After controversially suggesting that perhaps Joan played up because she didn’t understand what she was required to do (the mindset of the staff was that she talked, answered questions and followed instructions when she wanted to, so how could she not be understanding?), I discovered an underlying receptive language disorder that had gone unnoticed since she was a toddler. In particular, she had auditory processing problems, or difficulty processing and making sense of information she heard. Short and simple instructions related to what she was doing were fine; however, as soon as other distractions or more-complicated instructions were thrown in, she was in trouble.

Simply explained, two things commonly occurred when Joan listened to instructions: by the time her brain processed the first part of an instruction, Joan had missed the second part; or by the time she managed to process the second part of an instruction, she’d forgotten the first part. This also explained Joan’s mathematical ability – by seeing the figures, she didn’t have to rely on understanding the words spoken.

Once the difficulty was uncovered, things started to change and Joan learned to use a number of strategies that gave her control of the situation and that met her needs. As well as encouraging other people to speak in short, simple sentences and to write things down, Joan wrote down key words as they were heard and made a note of the number of things she needed to do. This meant that even if she forgot what to do, she knew there was more and could ask for it to be repeated.

Working with Joan, I found it incredible that she had managed to make it all the way to the age of seven without anyone picking up on her language disorder. She managed by bluffing her way through lessons or copying her classmates. She was also able to effectively use the numerous visual supports that are commonly employed by teachers in the early years of school. By the time she reached a level where these tactics weren’t possible, her inattention and behaviours were put down to hyperactivity. There had been no consideration given to the idea that the reason she had trouble concentrating was because she was being given more information than she could cope with.

A sentiment I have heard echoed in various forms by many parents I’ve seen over the years is: ‘The terrible twos seem to be turning into the terrible threes – and at this rate it’ll be the terrible fours!’

This rang particularly true for one mother who came to see me on the recommendation of an early-childhood nurse she’d spoken to about her three-and-a-half-year-old son’s (I’ll call him Damian) frequent tantrums. Having another child, she was used to the normal temper tantrums, but the frequency of Damian’s tantrums didn’t seem to be decreasing with age. By all accounts, Damian was developing typically: he crawled, walked and said his first words at the expected ages and was very sociable, but his mother was concerned about his limited speech. Friends and other professionals reassured her that it was ‘quite normal for boys not to say much at this age’ as well as for ‘a second child to choose to point or grunt rather than speak, because the older sibling would do everything for them’.

From my observations and assessment, it didn’t surprise me to discover that Damian had an expressive language delay. His receptive language skills (the ability to understand) were normal, but his mum was right to be concerned about his expressive language skills. His mum was relieved when I explained that in this instance his tantrums were most likely the result of his frustration at not being able to communicate. Pointing and grunting had worked when Damian was younger, as his needs and wants were more obvious. As he got older, his needs and wants became more complex and were no longer able to be expressed by his limited vocabulary or pointing – hence the frustration. This was something that could be addressed.

Initially, the most important thing was to find a way for Damian to communicate while his vocabulary developed. A combination of strategies proved successful, including key word signing with natural gestures and getting Damian to take someone to the thing he wanted. It was also important to educate his family about the techniques, encouraging them to be patient and consistent in using them so their benefits were learned and reinforced in place of a tantrum.

It was great to see how early intervention had a positive effect on Damian, especially as speech and language issues if left unaddressed are known to have an impact on a child’s ability to read and write later at school. Eventually, the efforts of Damian’s family were rewarded as his expressive language skills developed to an age-appropriate level and the tantrums stopped.

It’s been my most recent experience working in a transitional school setting with children between the ages of 12 and 16 with extreme behavioural issues that has given me the greatest appreciation of how much behaviour is influenced by a person’s language and communication skills. Behaviour such as swearing, lack of concentration, ignoring the teacher, storming out of class, anger, refusal to work, yelling at teachers and fighting was commonplace and the main reason these kids were often put in the ‘too-hard basket’.

In many cases, language wasn’t the only issue for these children, but it played a significant role in their ability to learn and attend in class. Once a language disorder was detected, strategies were put in place and the student often then succeeded. This led to increased attention and the desire to learn.

By removing the pressure in the learning situation, the children achieved – breaking the pattern of failure they associated with learning.

By giving them the tools to find the answers, they could contribute without the worry of possibly being wrong. In teaching, I think we tend to forget that positive reinforcement is just as important as the correct answer. It doesn’t always matter how the answer is reached, as long as it results in the child gaining the confidence to answer in the future without fear.

For parents and teachers, half the battle is recognising that there may be a problem in the first place. So if you notice your child struggling to express their wants, follow instructions, understand a story, answer questions or even maintain attention, stop and ask yourself, ‘Could there be a language problem?’

Karen James is a clinical educator and speech pathologist.

Illustrations by Gregory Baldwin