Over the past few weeks we have been developing an understanding of the components of a mental state exam. So far we have discussed how a young persons appearance and behaviour can provide indicators as to their mental state. Today we look at how a young persons speech can provide insight into their current mental health.
A young persons speech is assessed by observing their spontaneous speech, and also by using structured tests of specific language functions. during this time we are focussed on the production of speech rather than the content of speech, which we will address under thought form and thought content in weeks to come. When observing the young persons spontaneous speech, a youth worker should note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech.
A structured assessment by a qualified speech pathologist is a great tool for diagnosing serious difficulties in speech however a basic screening can be performed by an aware youth worker. An assessment of speech includes an assessment of expressive language by asking the young persons to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under cognition which we will discuss in a coming cast.
Language assessment will allow you to recognise young people presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism or Asperger syndrome may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person’s words) and palilalia (repetition of the subject’s own words) can be heard by young people with autism, schizophrenia or Alzheimer’s disease. A young person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them.
Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.
If you know a speech pathologist or have the opportunity to do some training with one, do it! Aside from appearance speech is one of the most observable ways to notice a persons mental state.
Stay tuned next week for part four: Mood and Affect.
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Aaron Garth
Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.
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[…] Behaviour is difficult to observe objectively. Not Impossible, but difficult. Most of us observe others behaviour subjectively. We watch through the lens of what we find appropriate. In some cases this is not an issue. We see someone hit their child with a lump of wood, or a person overdosing or a young person in a relationship with a 40 year old and our observation is that this is abnormal. For the most part this is right. When we start to look at others behaviour we must think about what they are thinking when they do this. Most of us do not behave inappropriately on purpose… too often anyway. There is also a number of theories from a number of very noted behavioural theorists that can help us determine whether a person is normal or abnormal. Aside from the clear observable issues like shakes, poor eye contact or hyperactivity some peoples behaviour can just be different to us. One of the best way we know of to observe and relate to a person on a behavioural level is DISC. Disc is a quadrant based behavioural analysis tool which can help you to determine if another person is nuts or just in a different quadrant than you. Since doing some training in DISC and using this to view peoples behaviour I have found that my mental state exams (as well as my general observations) have become more clear. PS. If you observe something that seems out of the ordinary, try to explain what it is. For example, ‘John seemed depressed’, will not get you much help from a clinician. However, if you say, ‘John seemed depressed as he was making poor eye contact, was mumbling and wouldn’t finish sentences’, then you are more likely to elicit a response from clinicians. We hope this helps. See you next week for part three, Speech. […]
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