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Why is understanding language disorders essential to improving the criminal justice system?

At any given time, nearly 60,000 youth are incarcerated in the United States. From a lack of investment in poor neighborhoods and schools to draconian drug laws, bail policies that criminalize poverty, and lack of adequate rehabilitation and reentry services, there is a myriad of reasons that the United States has the highest rate of both youth and adult incarceration in the world.

But one factor that rarely gets talked about is the known correlation between language disorders and offending behaviors. It is estimated that between fifty and sixty percent of youth offenders have a Developmental Language Disorder, compared to just seven to twelve percent of the general population. So, why are language disorders so overrepresented within the justice system, and could providing services to treat language disorders in juvenile detention centers reduce recidivism rates?

What are language disorders?

Often referred to as DLD, Developmental Language Disorder refers to persistent difficulties understanding and using spoken language despite adequate exposure to language during childhood. Developmental Language Disorder must occur in the absence of any other biomedical condition known to affect language capabilities, such as Autism Spectrum Disorder or Intellectual Disability. Rather than a single cause, DLD can generally be attributed to multiple risk factors working together, including genetic factors and environmental factors, such as poor early childhood nutrition or low birth weight.

A child with DLD may use simple or ungrammatical sentences, similar to children of a younger age. Adults with DLD may struggle to organize their thoughts in a way that makes sense to their listeners. Both children and adults may have difficulty understanding what others say to them or following verbal instructions. They will generally also struggle with reading and writing and are subsequently at risk for academic failure.

Despite limited public awareness, DLD affects one in fourteen children, making it the most common developmental disorder and the largest treatment group for pediatric speech-language pathologists. That said, where the right support and intervention are provided, DLD is a treatable disorder. Without intervention, however, it is unlikely to resolve and may follow a child into adolescence and adulthood.

The correlation between DLD and behavioral disorders in children

Lack of public awareness about language disorders means that children with DLD often go undiagnosed or misdiagnosed. Children struggling with language frequently engage in masking behaviors to try to hide their difficulties, such as being quiet in the classroom and at home in an effort to slip by unperceived. Alternatively, they may act out and be labeled as lazy, disruptive, or the class clown by teachers who have a limited understanding of DLD.

Difficulty with language also puts children at increased risk of social rejection and bullying. They may struggle to join in conversations with their peers or say things that appear immature or irrelevant. This can lead to difficulty making and maintaining friendships, and thus reduce opportunities to develop good social skills, putting them at risk for emotional difficulties and poor self-esteem. This becomes a vicious circle in which children with language disorders exhibit worsening behavior patterns in reaction to the cascade of difficulties they are experiencing, both academically and socially.

The level of correlation between emotional and behavioral difficulties and DLD is rather astounding. A 2014 meta-analysis of 22 studies showed that 81% of children accessing help for an emotional-behavioral disorder have below-average language skills, while 47% have moderate to severe language impairment. Despite this known correlation, teachers and other educational professionals often fail to make the connection between a child who is acting out and a potential underlying language disorder. In fact, one study showed that even in a special school for children with emotional and behavioral difficulties in which 74% were eventually identified as having a language disorder, less than half of these children were identified for language evaluation by school staff.

The school-to-prison pipeline

As children with untreated language disorders move into their teenage years, lifelong difficulty engaging academically, along with poor self-esteem and the experience of being labeled by themselves and others as ‘dumb,’ ‘disruptive,’ ‘lazy,’ or ‘unmotivated,’ often leads children to leave the educational system entirely. Behavioral difficulties may at this point escalate to engaging in criminal activities, and this is often exacerbated by a lack of vocational opportunities available to people with low educational attainment.

All too often, we see this cycle repeated particularly amongst children from disadvantaged backgrounds who are less likely to be identified with language disorders at an early age. As these children begin to make contact with the justice system, a lack of professional awareness of the prevalence of DLD amongst youth offenders again plays a punishing role. Professionals within the legal system may perceive children with DLD as rude, insolent, or incoherent in their retelling of events during forensic interviewing. In one account told by a young person in prison, a judge asked him if he was remorseful of his crime, and he answered “no.” He went on to explain that he had never heard the word “remorseful” before, and had no idea what it meant.

Many anecdotes can be found of children with undiagnosed language disorders inadvertently incriminating themselves as they move through the justice system. This is a tragedy in and of itself. But what happens to these children during their subsequent period of incarceration?

Failure to rehabilitate

Counseling, social skills training, and educational/vocational programs have been shown to be the most effective for reducing recidivism and helping to rehabilitate young offenders. And yet, all of these programs rely on children having adequate language skills to understand and benefit from them. Considering again that an estimated fifty to sixty percent of youth offenders have DLD, the fact that language-dense programs should be the primary offerings in rehabilitative services seems about as absurd as pushing calculus classes on a person that failed Algebra.

This absurdity is reflected in the numbers. Unidentified DLD is a significant predictor of reoffending post-release in youth offenders, and indeed, the severity of the offense has been correlated with the severity of the language disorder. In other words, the more severe the disorder, the more serious the crime committed.

Though there are no national figures on juvenile recidivism rates, states have reported up to 76% of youth offenders re-offend within three years, and up to 84% within five years. One study of over 30,000 youth offenders in Illinois found that 40% were incarcerated in an adult prison for reoffending by the time they were twenty-five.

These numbers are incredibly bleak. And yet they are illuminating. What they tell us loud and clear is that the youth justice system is utterly failing in its one and only job: to rehabilitate young people.

Glimpses of a better world

Children with Developmental Language Disorder are not failing within the educational system, and they are not failing within the justice system. Rather, with no universal policies in place to identify and treat DLD, and with limited public or professional knowledge of the way DLD often presents itself in young people, it is the educational and justice systems that are failing these children.

What might a world look like in which the relationship between Developmental Language Disorder and academic failure, behavioral and emotional difficulties, and offending behaviors is widely known and recognized? My guess is that it would be a kinder, more understanding world.

But we don’t have to use our imaginations to get a sense of how things might be different. Developmental Language Disorder is treatable. Children who receive targeted speech pathology intervention almost universally show gains in their receptive language (understanding) and expressive language (speaking) skills, with many improving into the average range of language functioning. In other words, a child who is treated for a language disorder has the potential to overcome the disorder entirely.

Moreover, adults with a history of DLD who received targeted intervention during their school years have been shown to have less contact with their local police service compared with age-matched peers at age 24. Thus, not only does treatment for DLD improve language capacities, it decreases negatively associated difficulties such as emotional and behavioral disturbances.

Using knowledge to implement change

If we know that language disorders are treatable and that treatment improves educational and vocational outcomes and reduces contact with the justice system, there’s really only one question that remains: how can we begin to tackle this issue?

Many speech pathologists advocate for the implementation of universal screening for DLD in schools, with subsequent treatment offered to identified children. This can be seen as a preventative measure that will work to keep young children from going down the route of academic failure and social isolation, to begin with.

But what about offering treatment to kids that are already beyond this point? Though there have been limited studies of the effects of speech pathology intervention in youth justice centers, preliminary research is highly promising. In a number of pilot speech therapy programs, youth offenders have been shown to make meaningful communication gains, improve their self-perception of communication ability, and show strong therapeutic engagement in response to relatively short-term, medium-intensity interventions.

Additionally, youth justice staff have reported positive perceptions of speech-language pathology intervention. They have described such interventions as beneficial for the management of youth offenders, whose confidence, communication, and behavior were perceived to have improved as a result of an intervention. They have also reported benefits to the staff working in this sector, and possibly to the life outcomes of youth offenders following their release from detention.

Given the high prevalence of language disorders within the justice system, the institution of universal language screening for youth offenders just makes sense. The subsequent provision of speech pathology services to those identified for DLD is the way that we then help these children improve their language skills so that they can properly engage in rehabilitation programs and return to their communities with better prospects for academic re-engagement or vocational attainment. In other words, just as a foundational knowledge of Algebra is needed to succeed in calculus, a foundation of strong language skills is essential to succeed in almost every other area of life.

The role of the justice intermediary

Other additional innovations are already being trialed to help make the justice system a more safe and more equitable system for young people with language disorders. In recent years, the UK, Australia, Canada, South Africa and a number of other countries have introduced justice intermediary programs. A justice intermediary is a communication specialist such as a speech-language pathologist whose job is to work out what level of questioning a person with a communication disorder can understand and help them to provide the most accurate and coherent account they can.

While the role of justice intermediary has not yet been introduced in the United States, it is clear that this is another method that could be used to ensure equitable treatment of individuals with DLD that come into contact with the justice system.

Building awareness

Left untreated, Developmental Language Disorder may spiral outward into a myriad of poor life outcomes, from social and educational difficulties to poor vocational attainment, and increased contact with the justice system. There are many ways we can begin to attack this problem, but it all starts with public awareness.

Despite affecting approximately ten times as many people as Autism Spectrum Disorder, DLD is virtually unheard of outside the world of speech-language pathology. With approximately two kids in every classroom affected, we need parents and teachers to be our first line of defense to keep kids from falling through the cracks. And if we want to start fixing a criminal justice system that has been broken since its inception, professionals working within the system, from lawyers and judges to counselors and wardens, need to begin to recognize DLD as a significant piece of the puzzle.

Janet Barrow holds a B.A. in Written Arts from Bard College, and a Master of Speech-Language Pathology from the University of Sydney. She works as a pediatric speech pathologist and freelance writer, and is currently finishing her first novel.

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