I have worked as a speech, language and hearing (SLH) scientist for 37 years, a discipline traditionally referred to speech-language pathology, but “pathology” implies an ableist perspective (Nielsen, 2021), prompting my use of a different nomenclature. Over these years, I have worked with children who have histories of maltreatment and suffered from complex trauma. Complex trauma is the exposure to, encounters with and long-term impacts of experiences in the caregiving system that leave the child feeling helpless, a loss of safety, and overwhelmed (National Child Traumatic Stress Network, 2014). In the 1980s, I worked in a transdisciplinary classroom with preschoolers diagnosed as “severely emotionally disturbed” (the common term used at the time) and in a residential center with “juvenile delinquents.” Transdisciplinary, in general, refers to an interdisciplinary team working together engaged in collective learning, role sharing and role release (Suarez, 2017; Hyter, 2014). Team members integrate knowledge and practice to understand the child and their family holistically (Straub et al., 2021). In retrospect, I believe these children were suffering from complex trauma because of adverse childhood experiences, such as maltreatment and significant loss in the family and/or caregiving system. In 2000, I was one of the founding members of a transdisciplinary trauma clinic providing comprehensive assessments for children with maltreatment histories and prenatal alcohol exposure. This team, engaged in transdisciplinary processes, included social workers; occupational therapists; a pediatrician; speech, language and hearing clinicians; and counselors. We learned the value of a transdisciplinary team for understanding and meeting the complicated needs of children and adolescents with complex trauma. Unfortunately, the structure of our team is not as common as it should be. The purpose of this article is to remind practitioners of the important role that SLH clinicians can play in the assessment and support of a child and/or adolescent with a trauma history. Young children and children with disabilities, including communication disabilities, are more at risk for maltreatment in the home (Centers for Disease Control, 2021). The national report on child maltreatment indicates that most children who experienced maltreatment in 2019 were less than one year of age (U. S. Department of Health and Human Services, 2021). Language, communication and some of the social cognitive skills that support social pragmatic communication begin to develop in infancy (e.g., understanding that others can be intentional) (Tomasello, 2005), therefore social pragmatic communication is particularly vulnerable to the effects of complex trauma. Additionally, this article serves as a clarion call for SLH clinicians to increase our knowledge of and ability to engage in practice while employing a trauma-informed lens.
The number of children experiencing maltreatment resulting in complex trauma is a significant public health threat in the U. S. (Centers for Disease Control, 2019; Chatterjee, 2019; Magruder et al., 2017) as well as a worldwide concern (Cyr et al., 2013; Westby, 2007). These numbers might have multiplied during the time of the COVID-19 pandemic due to increased familial stress and uncertainty and parental burnout as well as housing and job instability experienced by many families (Griffith, 2020; Hyter, in press). It’s more important now, than ever before, for SLPs to collaborate with psychologists, psychiatrists, social workers, counselors and other mental health professionals in providing trauma-informed care to children and adolescents with trauma histories. Complex trauma impacts every aspect of development including language and communication – “the most important” skills, “essential for interacting with peers,” representing knowledge, and developing and expressing complex thought (Moreno Manso et al., 2016, p. 241). Language is the systematic, rule-governed process used for oral, written or manual communication. Language is often described as including three interdependent systems: language structure, meaning and function. It is language function, how language is used in context, also called social pragmatic communication, that is the focus of this article. Children with trauma histories are more at risk for social pragmatic communication difficulties than their peers (Ciolino et al., 2020; Di Sante et al., 2019; Lum et al., 2015; Snow, 2020; Sylvestre, 2016; Moreno-Manso et al., 2012; Yehuda, 2016).
Social pragmatic communication is the ability to use language and communication in social situations across multiple contexts and with a variety of interlocutors. Social pragmatic communication is influenced by culture and is supported by social cognitive skills, cognition, emotion regulation and sensory modulation (Brinton & Fujiki, 2019; Hyter, 2017, 2020). Social pragmatic communication is composed of interdependent skills that facilitate one engaging in perspective taking (taking another’s point of view), intention reading (determining others’ goals), use of cognitive flexibility and inhibition to adapt to communicative contexts and partners, and participate in communication goals during a range of interactions while processing additional information (Hyter, 2020, 2021).
Children with social pragmatic communication disorders exhibit difficulties in both verbal and nonverbal communication and they struggle to develop social skills in the same way and at the same rate as their peers. Children with social pragmatic communication disabilities often have difficulties such as (1) developing and maintaining social relationships; (2) interpreting the intentions of others; (3) comprehending motivations of characters represented in literature; (4) carrying out communication goals; (5) changing their communication style based on the needs of the context and of their communication partners; (6) seeing events from others’ perspectives; (7) problem solving; (8) planning a response and carrying it out in real time; (9) understanding and producing discourse (conversations, narratives and explanations); (10) autobiographical memory; and (11) engaging in self-advocacy (Brien et al.. 2020; Timler & Moss, 2021). All these skills are crucial for academic success, as well as for success in daily life beyond school. Current literature in speech, language and hearing sciences has shown that children with histories of maltreatment use fewer words that refer to cognitive and emotional states (e.g., think, believe, angry, sad) (Hyter, 2021; Yehuda, 2016). Toxic stress interferes with the child’s ability to engage with others, recall and sequence events, and attend to the events happening around them (Ciolino et al., 2020).
Speech, language and hearing clinicians have extensive knowledge about language and communication as well as the ability to support the social pragmatic communication development and progress of children and adolescents. SLH clinicians can complement the somatic, mindfulness and psychosocial work of other disciplines to help children heal from their trauma histories and thrive throughout their lives.
About the Author
Yvette D. Hyter, PhD, CCC-SLP, is an ASHA fellow, professor emerita at Western Michigan University and a founding member of the Children’s Trauma Assessment Center. Her research and clinical work focus on culturally/linguistically responsive services for children and families, globally sustainable practice, social pragmatic communication of children with histories of maltreatment and prenatal alcohol exposure, and children who speak language variations such as African American English. She developed a pragmatic language and social communication assessment battery; served in leadership positions regarding diversity, inclusion and global issues in national and international organizations; and co-teaches a study abroad course in West Africa about the consequences of globalization. Dr. Hyter is also owner of Language & Literacy Practices, LLC, providing culturally and linguistically responsive, trauma-informed and globally sustainable supports for schools.
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