The Speech and Language Therapist (SaLT)

Why speech and language therapy?

Katherine Tweedie, specialist in specific language impairment explains.

Communication is central to the learning process - it is the main tool for teaching, learning and building relationships. So a child who is experiencing any sort of difficulty in this area, perhaps having trouble in making themselves understood, embarrassment over a speech impediment, or difficulty understanding the meaning of what people are saying to them, is likely to find not only lessons, but social interaction a struggle.

Who can benefit from seeing a SaLT?

An estimated 1 in 10 children experience a communication difficulty. The type of difficulty can be very different, for example:

• Difficulty with speech sounds. It might be hard to work out what a child is trying to say if they have problems with specific sounds - for example, a 4-year-old who says 'tat' instead of 'cat'.
• Problems with spoken language. Some children use less vocabulary than their peers or their utterances are jumbled and immature. They may also have problems understanding spoken language.
• Social communication difficulties. For some children the problem lies with the pragmatic aspects of communication, for example using and interpreting facial expression and eye contact. They may tend to take things too literally.
• Stammering: children who get 'stuck' when talking. They might repeat part of a word or a whole word or struggle to start off a sentence.
• Some children have a specific communication difficulty in just one area and generally good development otherwise, therapists also see children whose speech and language difficulties are part of additional learning, physical or medical difficulties.
• Specialist knowledge of speech and oral anatomy enables therapists to work with babies and children who have difficulty in eating, drinking or swallowing. A child who is inclined to choke easily on lumpy food, for example, may be referred to an SaLT, whose role will be to assess and provide advice. This may involve liaison with other professionals such as a dietitian.

What will happen on my child's first session?

The therapist will want to gather as much information as possible about your child's skills and difficulties.

They need to know about their general development and hearing skills as well as, for instance, when your child said their first words. It helps the therapist to know about your child's strengths as well as the things they find hard - what sort of toys and games they enjoy, what they quickly tire of. Sessions can then be geared to the most effective way of reaching and helping your child in a way that they enjoy and respond to.

The therapist may ask to talk to other professionals involved with your child, such as teaching staff. This is important as it helps them gain a better understanding of your child and how they communicate in different situations.

Throughout the session the therapist will be assessing your child's communication skills. With a young child this may be through play and observation, while older children may complete a more formal assessment. Some tests provide standardised scores, which help the therapist decide whether a child's skills are appropriate for their age. You and the therapist will then discuss together whether your child will benefit from therapy and what form this should take.

How will the therapist work with my child?

Speech therapists work with children in a variety of ways. This may mean one-to-one sessions or group sessions. Parents sometimes worry that a group will amount to 'watered down' therapy. In fact, group sessions can be very effective, provided the group meets your child's specific needs.

As well as working directly with a child, therapists work indirectly. This might take the form of home or school activities and advice to parents and teachers - therapists also provide formal training and workshops for parents and professionals. It makes sense for all the key adults in your child's life to know how best to support your child's skills.

Some schools have regular visits from therapists, or even resident therapists. Work with your child in the classroom can be of considerable benefit, because it is desirable to establish good communication everywhere.

Case studies

The names and specific personal details of these children are fictional, but they closely reflect the experiences of children who are frequently seen by SaLTs.

Sarah

Sarah first saw a SaLT shortly after her fourth birthday. Her parents were able to understand her, but knew that unfamiliar listeners often found it hard to work out what she was saying.

One of the specific difficulties she had was in pronouncing the /f/ sound. Sarah's parents and the therapist decided that it would be a good idea to refer Sarah for a second hearing check. The therapist also showed Sarah's parents how to help her make an /f/ sound, while playing a game.

Sarah began going to the speech and language clinic for a weekly session with five other children. They played games that helped them listen and use particular speech sounds. Sarah's mum watched and joined in with some of the sessions so that she knew how to help Sarah practise the activities at home.

With Sarah soon to start school, her parents were worried that her teachers would not be able to understand her, and whether learning to read would be difficult. They talked this through with the therapist, and it was agreed that information and advice would be sent to her new teachers. Sarah attended a review appointment shortly after starting school; she was now using the /f/ sound, which made her easier to understand, and with the understanding teachers had of her difficulties she had also settled into school well, to her parents' relief.

Peter

Peter moved to a new school when he was 13 years old; he had just received a diagnosis of Asperger's syndrome. The SaLT who worked in his new school came to see Peter a few weeks after he started. They talked about the things he was interested in, what he liked and didn't like about school, and who his friends were.

Peter's whole class had a session once a week with the therapist and their teacher, each week practising a different social communication skill.

One week, for example, they practised 'making a compromise'. They talked about why this was important, and role-played situations in which the children had to agree a compromise. Peter found that specifically thinking and practising difficult social situations helped him get on with his peers.

Ben

Ben's parents first took him to see a SaLT when he was 2 years old. They were worried because he had not yet started using any words. The therapist suggested encouraging his first spoken words by using signs. To start with, his parents decided to use 10 signs, which related to things Ben often wanted to talk about. They continued to learn more signs together, and gradually they found that Ben started to use the signs as well. Later, when he was able, Ben said the word and dropped the sign.

Before Ben started school it was agreed that a teaching assistant (TA) would be able to support him in his first year. Ben's parents and his TA attended a course on signing and using visual symbols, run by the SaLT, and Ben's therapist came to visit him at school in his first term. The therapist, his TA and teacher planned how to adapt the teaching environment for Ben, as a result of which Ben enjoyed his first year in school and his teachers were confident that he was participating and learning.

Katherine Tweedie works for Bexhill and Rother NHS Primary Care Trust, working in community clinics in Bexhill and Hastings and in a language unit attached to a mainstream school.

Further reading

The Occupational Therapist

The Educational Psychologist 

The Music Therapist

Nurture Groups

Dyspraxia Introduction - More than just a clumsy child?

Dysgraphia - Difficulty Writing

Neuro Diversity - Thinking Differently

Getting an Educational Psychology Assessment

The Orthoptist

The Physiotherapist

The Special Educational Needs Coordinator (SENCo)

Teaching Assistants

SEN In The Classroom

The Good Schools Guide - Special Educational Needs (2008)