Bisaya News: Communication disorders can have lifelong health impacts – where is the commensurate response?

According to Tricia McCabe, professor of speech pathology at Sydney University, communication disorders have far-reaching health implications and greater efforts are required to help children, families and others.

“Imagine paying for more and better services for children and young people with communication disabilities,” said McCabe when he recently ran Croakey’s rotating Twitter account @WePublicHealth. Below is a summary of their tweets, including links to many helpful resources.

Tricia McCabe writes:

I’m going to cover the interface between communication disorder and public health using the hashtag #CommSDoH, starting with sharing some information about what we mean by a communication disorder and jumping from there.

Communication disorders (impairments, limitations) occur when people have difficulty receiving a message from others. This may be due to a sensory impairment (hearing loss, deafness, visual impairment) as they have difficulty interpreting the message.

The difficulty in interpreting someone else’s message can arise for a number of reasons including illness, injury, development, or the environment. Understanding what you are being told depends on understanding the content, structure, and purpose of the message.

To understand content, you need to know the vocabulary and sounds of the language. We also need to understand the order of words and the structure (grammar) of what is being said.

Finally, we need to understand the tone, pitch, tempo, and volume of speech that give us the emotion and purpose of what is being said (or written). This is a simple explanation of the understanding as we shall see.

Human communication involves not only understanding, but also the ability to construct a message that others can easily interpret. This may require an effective use of voice, language, language (vocabulary, grammar, etc.), facial expressions, gestures, signs or writing.

To be an effective communicator, we also need to understand how others interpret our message. These skills of understanding and expression develop over the course of our lives and are an integral part of our social and economic success (more on this later).

After all, a person’s environment must enable them to communicate and interpret their communication as meaningful and important.

Thought experiment

So let’s do a thought experiment: what happens in your life when you cannot communicate effectively?

Children with speech and language delay (for whatever reason) hear fewer words spoken to them; hear more instructions and have fewer opportunities to start conversations. The words and phrases they hear are simpler, often “dumbfounded”.

If you start out in life with a communication delay or disorder, you are often at a higher risk of lower literacy and are therefore more likely to drop out of school.

The combination of not understanding instructions in the classroom or being teased or bullied for not understanding them or not communicating in the same way as their classmates can cause it to have an impact in class and lead to exclusion from school.

Children and adolescents with communication disabilities are more often involved in juvenile justice than their peers.

Children and adolescents with communication disabilities are also at higher risk for mental health problems than their peers.

In recent years, health economists like Dr. Paula Cronin from UTS showed that mothers of children with speech delay earn less than parents of children with typical development. I should note that this is the case when all other variables are taken into account.

Back to our thought experiment: what happens in your life when you have a communication disability?

In my own work with people with severe language disabilities, they report as adults:

Earn less than their friends
They are less educated and less literate than their siblings
Adults with a history of lifelong language disorder are more likely to have clinical anxiety, and the worse their language is than adults, the worse the anxiety they report.

Injustices

Above I described a communication disability that has many faces. One of these is the difficulty of understanding the intent of a person’s communication and drawing conclusions from their choice of words, tone of voice, and facial expressions. This is a kind of pragmatic obstruction to communication.

And pragmatic communication disabilities do not interact well with the legal system.

For people with communication disabilities, there are a number of additional factors that make their ability to participate in society even more difficult.

Self-advocacy can be a challenge. If you have difficulty communicating, understanding how to present your case can be problematic.
People with communication disabilities find it difficult to interpret forms, bureaucratic language, or the language of the legal system.
If you are a parent with a communication disability, you may find it difficult to stand up for your children. This can be a double blow when dealing with organizations like the NDIS.
Unfortunately, services for people with communication disabilities, such as speech pathology, are unevenly distributed with a well-known “zip code lottery”.
This is where the Matthew effect comes into play. Families in more affluent areas have better access to services and there the effects of communication disabilities can be mitigated compared to families in poorer areas who share fewer resources and benefit less from limited services.
Speech pathologists use service rationing as a strategy to handle large numbers of cases. The effect in richer communities is a migration to private services, the effect in poorer communities is a long delay before aid is provided.
The cumulative effect is delayed access to services in the early years, resulting in lower academic success and a lifelong increased risk of socio-economic precariousness.
Hearing health is affected by overcrowded or unstable housing, access to clean water and sanitation. Poverty causes ear diseases. Ear diseases cause poor understanding, attention, and participation in school.
And like a language disorder, poor ear health leads to decreased literacy, early school leaving, and greater interaction with the justice system. #CommSDoH not understand = disadvantage.

It is estimated that one in three people in the justice system has a communication disability (see: https://aic.gov.au/publications/tandi/tandi435)
Imagine paying for more and better services for children and young people with communication disabilities.