When a child is noticeably behind their peers in acquiring speech and/or language skills, communication is considered delayed. This is referred to as Speech and Language Difficulties (Sp&LD) or Speech, Language and Communication Needs (SLCN).
A child naturally acquires language from a very early age and goes through a recognised pattern of learning vocabulary, sentences and concepts to be able to communicate verbally. Add to this speech sound processes, attention and social development and you realise how complex communication is.
When this natural process diverges from the normal pattern eg when a child has difficulty with grammar or speech sounds, poor listening or stammering, it is called a speech, language and communication difficulty. It is estimated that one in 10 children have some sort of speech and language difficulty, many more boys than girls.
- Educational implications
- How parents can help
- Professional help
- Useful strategies
- Types of difficulties
Causes are very often unknown. We do know that some are passed on within families; others are delayed in line with cognitive development; and some are an acquired or environmental problem, eg speech sounds distorted by a dummy.
Hearing loss, physical difficulties and a host of other associated conditions like dyslexia have an impact on language learning. Speech, language and communication needs are also a known element of some behavioural conditions, eg autism, and neurological conditions eg brain damage, as well as physical impairments such as cleft palate.
Speech, language and communication involves a long interconnected chain of cognitive, physiological and neurological processes: from hearing, listening and memory to articulation and speech sounds, with complex functions of language and social understanding between. In order to communicate, a child develops skills in attention and listening, social-interaction, non-verbal communication eg gesture, understanding, expression and speech sounds and has to co-ordinate them all. Any one of these areas can be delayed or develop a difficulty.
Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.
It is estimated that communication disorders (including speech, language and hearing disorders) affect between five and 10 per cent of children in the UK. This estimate does not include children who have speech and language problems secondary to other conditions such as hearing impairment, autism, or cerebral palsy.
Language is vital for learning. Whether it is show and tell at nursery, discussing ideas in a primary class, or understanding a maths question at A level, communication is a pre-requisite. In addition it has been shown that children with poor speech and language skills have confidence issues that last long after the language issue has cleared up, even into secondary and higher education. Learning is done mainly through language, so it is critical that children develop a language for learning, through intensive and specialised help.
Children who develop language skills are able to make friends and build confidence. There are many studies to show that poor language skills restrict a child’s psycho-social development and can lead to mental health and behavioural problems.
Often a parent only knows that their child is not talking like their peers and this is impacting on their learning, behaviour and confidence. What they don’t realise is a parent’s talk is music to a child’s ears. Parents are the ones best equipped to teach children how to talk, having been hot-wired by nature with the skills. Mothers naturally use a form of simple language, in a musical tone of voice and sing to their children, all of which, research has shown, stimulates a child’s language development. In addition, they naturally extend their child’s understanding of spoken language to just the right degree, as the child learns to speak, to continue the learning process. The problems happen when this natural relationship breaks down, either because the child has an innate difficulty with communication or when the parent ceases to stimulate the child’s language effectively.
When a child is showing signs of a language delay, relative to their peers, or has difficulties listening or responding, it is time to seek help from a speech and language therapist. 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.
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. And because of the way the brain develops, it is easier to acquire language and communication skills before the age of five.
A speech and language therapist is the first stop for a child with language difficulty. They can identify the difficulty and treat the child’s communication themselves or refer on to a further clinician or specialist. The therapist will liaise with the child’s teacher or special educational needs co-ordinator (SENCo) to provide support either in class or individually. If necessary, a specialist in hearing Impairment, stammering, phonology or another expert may be involved. In some cases, a paediatrician or medical professional will want to assess the child.
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 communication difficulties.
Some children with speech and language difficulties may require alternative means of communication, such as sign language, symbols, or voice output devices. 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.
Children may be referred for speech and language therapy for a variety of reasons, including:
- language delay
- language disorder
- specific language impairment
- specific difficulties in speech and producing sounds
- hearing impairment
- cleft palate
- autism/social interaction difficulties.
What do speech and language therapists do?
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 child’s communication potential. 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.
The therapist will have access to medical information from doctors and health visitors and at the first session you will be asked for information about your child’s talking, which the clinician will collate in a case history. The therapist will carry out a screening assessment of all aspects of your child’s communication skills, which may include informal observation, a physical examination of their mouth or formal tests. The results will be discussed with you, and the proposed therapy explained, including when it will be offered and for how long.
Therapy varies, but may involve an individual session, group work or a programme to be used within a classroom situation. In some instances, written or verbal advice alone will be effective. Speech and language therapists are also involved in staff and parent training, writing Education, Health and Care Plans (EHCPs) and tribunals.
You will be expected to support 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. Children will need to carry over their new skills in talking to new situations eg school, home and with friends; having an involved carer can ensure this happens.
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, a child’s communication difficulty will be part of a larger condition eg autism. In these instances, it is useful for the therapists to work collaboratively with experts in managing the impact on the child’s social world and wellbeing. 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 can refer your child?
Parents, GPs, health visitors, school or early years staff can make a referral to a therapist.
Who provides the therapy?
Therapy is provided by a qualified speech and language therapist, who will be a registered member of the Health Care Professionals Council. NHS therapy teams work in collaboration with Education, either within a community setting, such as a clinic, or within a school setting. Often a special school will have a resident SLT. Alternatively, a private therapist can be arranged by the parent.
The NHS provides speech and language therapy in collaboration with 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.
- Present good model of speech and language for your child to copy.
- Simplify instructions and be prepared to repeat them.
- Support speech with visual prompts, signs or gestures.
- Use pictures/symbols to aid understanding in the form of visual timetables or signing.
- Encourage good listening.
- Encourage regular, constant reinforcement of skills introduced at speech and language sessions.
- Make use of books, role play, drama, singing, social stories to support understanding of language.
Speech, language and communication work as interconnected skills but a difficulty may occur with speech or language or more generalised communication. Therapy may target any one of these or a combination:
Language is both give and take, it is understanding what others are saying, their questions and instructions (receptive language) and the message we impart in talking (expression). It can be used for a variety of social interactions eg greeting, commenting, questioning, requesting, conversation. When a child learns language, they learn meanings of individual words and how to string them together to form a sentence. This will necessitate syntax, grammar and comprehension of higher concepts like inference. They learn how to manipulate different linguistic elements to make questions or narratives and how to combine these with other speakers to make conversation. A child starts developing language at birth, with first words occurring from 12 months; word combinations tend to occur a year later. A child may start developing normally in every other way, apart from their language skills, this is known as a Developmental Language Difficulty (DLD).
Speech is the name for the sounds we use to get our message across. It varies from language to language, and even within one language different people will speak with different vowels and consonants, using different intonation patterns. Phonology is the name we give to the arrangement of speech sounds in a language. A child with a speech difficulty will have problems with the sounds they use. This is not necessarily a physical articulation problem but may be a difficulty with discrimination of sounds, auditory memory, production of sounds or co-ordinating the processes eg oral dyspraxia. Good hearing is necessary for good speech.
Stammering can also be called stuttering or dysfluency. It is not uncommon for young children to stammer while learning language and many will outgrow it without any intervention. The stammering may take the form of repetitions of parts of words, prolongations or stopping altogether before certain sounds. A speech and language therapist can help lessen the impact of stammering on a child’s intelligibility and confidence.
This is an area of communication which deals with the unspoken rules of conversation and interaction. Social communication means knowing how to use the skills of speech and language effectively with others. It can involve body language, reciprocity, recognising verbal and non-verbal cues and humour. It is the area of language that typically an autistic person will find most difficult.
Attention and listening
Talking is all very good but only effective if a child can listen too. Listening is a vital tool in learning. Attention and listening develop in young children in a recognised pattern, from single-channelled fixation to flexible and voluntary listening skills (integrated attention). When a child has difficulty sustaining and maintaining focus, their learning will suffer. A speech and language therapist can work on attention skills and listening tasks.
Perhaps your child has a hoarse voice, or has had a physical difficulty like vocal nodules which has affected their voice? Childhood voice problems occur in 3-6 per cent of the school age population, more often in boys. They are a complex mix of psychological, social, environmental and pathological difficulties.
A difficulty in any of these areas will necessitate a referral to a Speech and Language Therapist, and possibly a specialist school. The Good Schools Guide consultants can advise you how.