Speech and Language Therapy

SEN1

What is a Speech and Language Therapist (SLT)?

A Speech and Language Therapist is a trained professional who specialises in Speech, Language and Communication needs (SLCN). They also specialise in swallowing and feeding difficulties. They are frequently called SLT’s or SALT’s.

SLT’s are often confused with Speech and Drama teachers who focus on articulation and diction – more like elocution. However, the role of a SLT is much greater than this.

SLT’s assess and diagnose children with SLCN.  A therapist identifies the child’s difficulties and creates a management plan to help the child develop their skills.

Speech, Language and Communication Needs (SLCN)
According to ICAN [i] it is estimated that “around 10% of all children have long term, persistent SLCN.”

These needs are often a “hidden disability” as they can be difficult to identify without the help of a SLT.  Children with SLCN look and act like other children, and many have intellectual strengths. However, some children with SLCN struggle to communicate and they may be seen as ‘difficult’ or ‘naughty’ because their needs are not apparent. Others may be seen as ‘shy’ or ‘awkward’ when they are withdrawn; these children often feel isolated and lonely.

What does a SLT do?
A SLT will assess children to find out if they have any underlying SLCN.  SLT’s are concerned with 4 key areas;

  • Language
  • Communication
  • Speech
  • Swallowing

Uncovering Language and Communication difficulties:

There are 3 main aspects of language that SLT’s are concerned with:

Receptive Language
This is one’s ability to understand the language used by others. This includes the words people use (vocabulary) and how sentences are constructed (grammar). The length of a sentence can also determine whether language will be understood (working memory).

Children who have receptive language difficulties may

  • Have poor behaviour
  • Be frequently upset or withdrawn
  • Struggle have limited attention/concentration
  • Be very good at ‘covering up’ their limited understanding
  • Take longer to process language (information processing delay)
  • Prefer activities which do not rely on language e.g. tag or hide and seek
  • Misinterpret an instruction
  • Miss part of an instruction
  • Copy children around them
  • Seem confused or may seem like they are ‘day dreaming’
  • Pick up on non-verbal cues such as gestures, pointing
  • Rely heavily on context

Expressive Language
Talking – This includes your ability to find words, use vocabulary, construct grammatical sentences and ask questions.

Children who have expressive language difficulties may:

  • Mix up words e.g. name a table as a chair
  • Mix up the structure of a sentence e.g. jumping boy instead of boy jumping
  • Miss out grammatical information such as ‘it, and, his.’
  • Overuse ‘fillers’ such as ‘thing, it, stuff.’
  • Avoid games which rely on talking to others
  • Avoid speaking in class
  • Misbehave when asked a question
  • Act immature for their age
  • Feel embarrassed
  • Feel frustrated or angry
  • Stop talking to others and become withdrawn
  • Have less sophisticated language than their peers
  • Struggle to find the words they want to use 

Pragmatic Language
The vital skills we use to communicate with people. This is how we use language to interact with others. Skills associated with pragmatic language are initiating a conversation, maintain a conversation, turn taking and topic maintenance. It also involves non verbal communication such as eye contact and facial expressions particularly to show you are an ‘active listener.’

Children with pragmatic language difficulties may:

  • Find it difficult to start a conversation with someone
  • Say things which are inappropriate
  • Talk too much and give details which are not necessary
  • Provide too little information or respond with one word answers
  • Avoid eye contact
  • Struggle to understand facial expressions and tone of voice
  • May find non-literal phrases confusing (You better pull your socks up!)
  • Misunderstand sarcasm and become upset or agitated
  • Fidget and find it difficult to remain seated
  • Struggle to stay on topic and will ‘go off tangent’ and talk about their interests
  • Seem socially awkward
  • Find it difficult to meet friends or sustain relationships
  • Seem inconsiderate of others thoughts or feelings
  • Want to make friends but struggle to do so
  • Have no awareness of their difficulties
  • Become lonely, upset, withdrawn or isolated
  • Seek attention or misbehave 
  • Struggle to wait their turn
  • Always want to be at the front of the line

Speech
Speech difficulties are seen as the easiest of SLCN to identify as it is something you can hear.  Many parents and teachers know there is a problem when they cannot understand the words a child says. However, the ability to use speech sounds is more complex than many may think.  Here are some common reasons why children find it difficult to speak properly.

An important part of being able to speak properly is actually being able to hear the sounds and words others make.

Some children have a history of hearing problems or ear infections. When children suffer from these problems at a young age they struggle to hear the sounds people make and often confuse very similar sounds such as ‘p’ and ‘b.’

Auditory Processing Disorder is a specific language impairment which affects one’s ability to hear and segment sounds properly. They may struggle when learning phonics and often have difficulties with literacy. This is because they may not process sounds properly.

Structural abnormalities can also cause speech difficulties. For example, if a child has an overbite, under bite or tongue tie they may struggle to get their mouth or tongue in the right position to make certain sounds.

Prolonged use of a ‘dummy’ – Whilst it is widely debated about how much the use of a dummy impacts speech it is accepted that using a dummy for too long can cause some speech difficulties. This is particularly true for children who talk with a dummy in their mouth. Frequent problems include a ‘lisp’ because the air needs to move around the dummy.  Children also use ‘k’ and ‘g’ sounds more because these sounds are made at the back of the mouth.

Motor movement planning – also known as Dyspraxia. This is when the brain struggles to sequence sounds together. A child may be able to say sounds individually e.g. ‘d’ ‘o’ ‘g’ but may struggle to put the sounds together to make ‘dog.’ Children with severe dyspraxia may struggle to produce lots of sounds and may have little control of their lip and tongue movement (this may cause them to drool).

Swallowing
Some children experience difficulties with feeding and swallowing. They may only be able to eat ‘runny’ or ‘mashed’ food and struggle with chewy food. This can be linked to dyspraxia due to poor motor movements or there can be some physiological reason for these difficulties.

Children who have feeding or swallowing difficulties need to be carefully monitored. Choking is a common problem with children who have swallowing difficulties. A SLT will be able to assess a child’s swallow and recommend foods they should eat and highlight foods which should be avoided. They will also be able to manage the child in order to help them develop a better ‘swallow.’

What types of children do SLT work with?

‘Over 1 million children throughout the UK suffer from communication difficulties ‘ (I CAN).

SLT’s work with these children who may have:

  • Attention and Listening difficulties
  • Speech Sound difficulties
  • Dyspraxia
  • Learning difficulties such as Attention deficit hyperactivity disorder (ADHD)
  • Literacy difficulties (due to underlying SLCN)
  • Autism Down Syndrome and other syndromes
  • Cerebral Palsy
  • Acquired Brain Injury (ABI)
  • Pragmatic Language Impairment
  • Emotional and behavioural issues (due to underlying SLCN)
  • English as an additional language (Bilingualism)
  • Language Delay
  • Specific language impairment e.g. Auditory processing disorder
  • Poor working memory
  • Receptive Language
  • Expressive Language Delay

Who else do SLT’s work with?
SLT’s work with a range of professionals in order to meet the holistic needs of a child; these include:

  • Parents
  • Carers
  • SENCO’s
  • Teachers
  • Teachins Assistante
  • Occupational Therapists
  • Arts Therapists (Drama, Play, Music, Movement, Art)
  • Physiotherapists
  • Educational Psychologists
  • Nurses
  •  Interpreters

SLT’s work in a range of settings including;

  • Nurseries and Playschools
  • Child’s home
  • Community Clinics
  • Schools
  • Foster Homes
  • Community centres
  • Day centres
  • Care homes
  • Summer camps
  • Young Offender Institutes

For further information visit: www.integratedtreatments.co.uk

Integrated Treatment Services are able to help schools identify Speech, Language and Communication difficulties without delay.  It is important that student’s are identified as young as possible so that these difficulties do not Impact on the student’s access to learning.  Access to early therapy can support many students to resolve their difficulties. By training teaching staff, SALTs are able to help early identification and provide preventative strategies to provide every student with their best possible chance.

If you are concerned that your school needs to access consistent therapy, delivered by one named therapist, Integrated Treatment Services could help support your setting.

Please refer to our website for further helpful resources to share with teaching staff and parents: www.integratedtreatments.co.uk

Phone us on 0845 038 2921 for a free telephone consultation about your settings needs.

Lisa Franklin Speech and Language Therapist

May 2013
Written on behalf of Integrated Treatment Services

I.T.S is a private Speech and Language Therapy service based in Leicestershire, East Midlands and Southern England. It specialises in providing highly-skilled Speech and Language Therapists, but also associates with other therapeutic professionals, including Occupational Therapists, Physiotherapists, Psychologists and Arts Psychotherapists  

http://twitter.com/ITSTherapy/


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  1. Speech and language impairments may occur separately in a person, or the individual may demonstrate both types of impairments; to further complicate matters, this distinction is usually not easy to make. A speech impairment affects spoken language. Examples of this include stuttering (repeating syllables or words, prolonging sounds, or “blocking” on a word or sound), phonological or articulation disorders (inability to say sounds properly), speech in the hearing impaired (speech may be difficult to understand, nasal-sounding, unusual in pitch or rhythm), apraxia (facial grimaces or unusual movements may accompany speech, such as groping to produce sounds, syllables, and words; difficulty planning and sequencing movements for speech within the brain; speech may be unintelligible, or not understandable), etc. Voice disorders affect the sound of the voice itself (i.e. hoarseness, breathy voice, strained/tense voice). Such disorders are often caused by changes in the shape of the vocal cords (e.g., swelling of the vocal cords, growths on the vocal cords such as vocal nodules). A language impairment affects the understanding of language (receptive language disorder), the formulation of an utterance (saying what one intends to say–expressive language disorder), or both. Receptive and expressive abilities may be impaired together such as in a disorder called developmental language delay in toddlers and preschoolers or language learning disability in school-aged children. A child who is unable to talk (called a nonverbal child) may have good receptive language abilities. In contrast, a child who is able to express his/her thoughts well may have difficulty following directions. Reading/writing disabilities (e.g., dyslexia) are also types of language disorders. Persons with learning disabilities may also exhibit difficulties comprehending language or expressing themselves with language.

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