When a child is noticeably behind their peers in acquiring speech and/or language skills, communication is considered delayed. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.
The causes of speech and language disorders may range from hearing loss, neurological disorders or brain damage to drug abuse, physical impairments such as cleft palate, or psychological trauma. Often, however, the cause is unknown.
Incidence of communication disorders
It is estimated that communication disorders (including speech, language, and hearing disorders) affect between 5 and 10 per cent of children in the UK. This estimate does not include children who have speech/language problems secondary to other conditions such as hearing impairment or language disorders related to other disabilities such as autism, or cerebral palsy.
What parents can do
Early intervention makes a difference. Communication disorders carry the potential to isolate individuals from their social and educational surroundings so appropriate timely intervention is essential.
Because of the way the brain develops, it is easier to acquire language and communication skills before the age of five. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected.
While many speech and language patterns can be called ‘baby talk’ and are part of a young child’s normal development, they can become a problem if they are not outgrown as expected. In this way an initial delay in speech and language, or an initial speech pattern, can become a disorder which can cause difficulties in learning.
Learning is done mainly through language, so it is critical that children develop a language for learning, through intensive and specialised help.
Some children may require specialist assistance from a resourced school such as a language unit with speech therapy. Others may need a special school environment with a curriculum geared to children with severe communication difficulties.
Some children with speech and language difficulties may require alternative means of communication, such as sign language, symbols, or voice boxes.
Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allows those with no speech and people with severe physical disabilities to express themselves.
Speech and language therapy
Children may be referred for speech and language therapy for a variety of reasons, including:
- mild, moderate or severe learning difficulties
- physical disability
- language delay
- language deprivation
- specific language impairment
- specific difficulties in producing sounds
- hearing impairment
- cleft palate
- autism/social interaction difficulties
Who can refer a child for therapy?
Parents, GPs, health visitors, school or early years staff can make a referral to a therapist.
If you have concerns, you may refer your child to a speech and language specialist without a referral from the GP or educational psychologist.
How does therapy help?
Speech and language therapists assist children who have communication disorders in various ways.
They work to assess, diagnose and develop a programme of care to maximise the communication potential of those referred to them; they may consult the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and they work closely with the family to develop goals and techniques for effective therapy in class and at home.
At the first session you will be asked for information about your child and the therapist will carry out a screening assessment of all aspects of your child’s communication skills. The results will be discussed with you, and the proposed therapy explained, including when it will be offered and the timescale.
Therapy varies, but usually involves individual sessions with the parent and child.
You will be expected to be involved in helping your child to practise and learn new skills so it is important to be clear about the aims and the results of each phase of therapy.
Sometimes a child will be placed on review – formal therapy sessions will be discontinued during this time; however, you should be told the reason for the review and what your child should be doing during the review period.
In some cases, perhaps where a child has a learning difficulty or where a severe and specific speech and language problem makes following the curriculum difficult, their education may be adversely affected. If this is the case for your child, ask the therapist who else needs to be involved, the expected procedures, timescales and what you can do to help.
Who is responsible for providing therapy?
Although the NHS provides speech and language therapy, it is often considered as an educational provision and may be provided or funded by the local education authority. There are many specialist areas within speech and language therapy, so if you feel your child’s needs aren't being met by the therapist assigned, ask to be referred to the specialist therapist for your child’s problem. If there is no specialist available or you want a second opinion, ask the therapist or GP to arrange this or contact one of the organisations listed below for help.
- speak in clear, short, simple sentences
- support speech with visual prompts, signs or gestures
- use pictures/symbols to aid understanding
- ensure prompt referral to a speech and language therapist, or the provision of specialist speech and language intervention within the educational setting
- encourage regular, constant reinforcement of skills introduced at speech and language sessions.
Strategies for or those with language impairment/delay
It helps to:
- ask a child to tell you in their own words what they have been asked to do
- reinforce learning by repeating answers (from the child or others)
- encourage ‘good listening’
- encouraging the child to (learn to) read
- use visual timetables/prompts gestures, signing eg Makaton or written instructions to reinforce the spoken word
- provide visual clues, don’t just talk about a cylinder, let them see it, feel it, play with it, find different cylinders
- teach word association skills
- teach the nuances of language, meanings of jokes, idioms, body language, facial expressions etc
- make use of books, role play, drama, singing, social stories to explain social situations and develop social skills and understanding
- play games that encourage listening and/or social skills
- plan the careful use of computers and ICT to facilitate learning.
Types of disorders
Speech disorders involve difficulties producing speech sounds or problems with voice quality. They might be characterised by an interruption in the flow or rhythm of speech, such as stuttering (which is called dysfluency). Speech disorders include problems with articulation (the way sounds are formed), or phonological disorders, or difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. Experiencing difficulty with some speech sounds may be a symptom of a delay, or of a hearing impairment. It can be difficult to understand what someone with a speech disorder is trying to say.
Language disorder is an impairment in the ability to understand and/or use words in context, both verbally and non-verbally. Characteristics of language disorders include improper use of words and their meanings, problems with sentence structure, inappropriate grammatical patterns, reduced vocabulary and inability to express ideas, or follow directions. One or a combination of these may occur in children who are affected by language-learning disabilities (such as dyslexia) or developmental language delay. Children may hear or see a word, but not be able to understand its meaning. Often, being unable to communicate frustrates them. The effects of language difficulties vary from mild and transient, perhaps requiring some short-term specialist intervention, to severe and long-term, requiring continual specialist input. Some children have specific language problems others have additional difficulties such as hearing impairments.