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

Melissa Sweet
Tricia McCabe
Monday, September 27, 2021

Social determinants of health, Education, Justice and policing, Child health, Disabilities, Mental health, Health communications, Health inequalities, @WePublicHealth2021

Communications disorders have wide-ranging health impacts, and greater efforts are needed to help children, families and others who are affected, according to Tricia McCabe, Professor of Speech Pathology at the University of Sydney.

“Imagine if we paid for more and better services for children and young people with communication disabilities,” said McCabe, when recently at the helm of Croakey’s rotated Twitter account @WePublicHealth. Below is a summary of her tweets, including links to many helpful resources.

Tricia McCabe writes:

I’ll be covering the intersection between communication disorders and public health using the hashtag #CommSDoH, starting with sharing some information about what we mean by a communication disorder and jumping off from there.

Communication disorders (impairments, limitations) occur when humans have difficulty receiving a message from others. This may occur because of a sensory impairment (hearing loss, deafness, visual impairment) because they have difficulty interpreting the message.

Difficulty interpreting another’s message can occur for a range of reasons including disease, injury, development or environment. Understanding what is said to you relies on understanding the content, structure and purpose of the message.

Understanding content requires knowing the vocabulary and the sounds of the language. We also need to understand the order of the words and the structure (grammar) of what was said.

Finally we need to understand the tone of voice, the pitch, rate and volume of the speech, which give us the emotion and the purpose of what was said (or written). This is a simple explanation of comprehension as we will see.

As well as understanding, human communication involves being able to construct a message that others will easily interpret. This can require effective use of voice, speech, language (vocabulary, grammar etc), facial expression, gesture, sign or writing.

To be an effective communicator we need also to understand how others will interpret our message. These understanding and expression skills develop over our lifetimes and are integral to our social and economic success (more about this later).

Lastly, the environment surrounding a person needs to allow them to communicate and to interpret their communication as meaningful and important.

Thought experiment

So let’s do a thought experiment: What happens across your life if you cannot communicate effectively?

Children who have speech and language delay (for any reason) hear fewer words spoken to them; hear more instructions and have fewer opportunities to start conversations. The words and sentences they hear are simpler, often “dumbed down”.

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

The combination of not understanding instructions in the classroom, or being teased or bullied for not understanding or for not communicating the same way as your peers can lead to acting out in class, leading to school exclusion.

Children and young people with communication disabilities are more likely to be involved with the juvenile justice system than their peers.

Children and young people with communication disabilities are also at higher risk of mental health problems than their peers.

In recent years, health economists such as Dr Paula Cronin at UTS have shown that mothers of children with language delay earn less than parents of typically developing children. I should note this is when all other variables are accounted for.

So returning to our thought experiment, what happens across your life if you have a communication disability?

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

Earning less than their friends
Having less education and less literacy than their siblings
Adults with a life-time history of speech disorder are more likely to have clinical anxiety and the worse their speech as adults, the worse the anxiety that they report.

Injustices

Above I have described communication disability as having many faces. One is difficulty understanding the intent of someone’s communication, drawing inferences from word choice, tone of voice and facial expression. This is a type of pragmatic communication disability.

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

For people with communication disabilities there are a number of additional factors which further impede their capacity to participate in society.

Self-advocacy can be challenging. If you have difficulty communicating, then understanding how to put your case can be problematic.
People with communication disabilities may find forms, bureaucratic language or the language of the legal system difficult to interpret.
If you are a parent with a communication disability, you may find it difficult to advocate for your kids. This can be a double whammy when dealing with organisations such as the NDIS.
Unfortunately services for people with communication disability such as speech pathology tend to be unequally distributed with a well-known “postcode lottery”.
The Matthew effect applies here. Families in wealthier locations have better access to services and there the effect of the communication disability may be ameliorated versus those in poorer locations who share fewer resources and receive less benefit from the reduced service.
Speech pathologists use service rationing as a strategy to manage large caseloads. The effect in richer communities is a drift to private services, the effect in poorer communities is a long delay before assistance.
The cumulative effect is delayed access to services in the early years leading to decreased academic success and lifetime increased risk socio-economic precarity.
Hearing health is affected by crowded or unstable housing, access to clean water and sanitation. Poverty causes ear disease. Ear disease causes poor comprehension, attention and participation at school.
And as with developmental language disorder, poor ear health leads to lower literacy, early school leaving and more interaction with the justice system. #CommSDoH not understanding = disadvantage.

By some estimates, one in three people in the justice system have a communication disability (see: https://aic.gov.au/publications/tandi/tandi435)
So imagine if we paid for more and better services for children and young people with communication disabilities.