of speech, language and communication needs … · communication needs (slcn) and swallowing...

Seven signsof speech, language and communication needs (SLCN) and swallowing difficulties

Childrenand teenagers

How a speech and language therapist can help

ROYAL COLLEGE OF

SPEECH LANGUAGE

THERAPISTS

RCSLT_Children_NI seven signs A6 2012.indd 1 18/10/2012 11:52

Referring to a speech and language therapist:

Consult your local speech and language therapy provider website for arrangements on referral to speech and language therapy services.

Or simply enter ‘speech and language therapy’ + your region into your internet search engine.

Problems with communicating and swallowingThis booklet is a brief introduction to some of the signs of speech, language and communication needs (SLCN) and swallowing difficulties, the conditions these signs might indicate and the value a referral to a speech and language therapist can provide.

In all these cases, referral to a speech and language therapist provides:

•Specialistobjectiveassessmenttoidentify: – communicationdifficultiesand/orestablishadiagnosis. – swallowingdifficultiesand/orestablishadiagnosis.

•Appropriateinterventionandmanagement.

Speech and language therapists commonly work alongside, and provide education and training to doctors, health visitors, nursing staff, teachers and teaching assistants, occupational therapists, psychology and psychiatry services, social services and professionals working in the justice system.

They also support families, health staff, educators and employers to help people live with communication difficulties.

Bilingual childrenIn the case of bilingual* children, it is important to note that bilingualism does not cause or contribute to SLCN. Bilingual children are no more likely to present with SLCN than monolingual children. If a child has problems learning their home language(s) and English then they will need a referral to a speech and language therapist. If they have good home language skills then they may simply need more time to learn English.* The term ‘bilingual’ includes children who hear and/or speak two or more languages.



Seven signsof speech, language and

communication needs (SLCN) and swallowing difficulties

RoyalCollegeofSpeechandLanguageTherapists2 White Hart YardLondonSE11NX

Tel:02073781200Email:[email protected]

Website:www.rcslt.org3rd edition

ROYAL COLLEGE OFSPEECH LANGUAGE

THERAPISTS


1

“My child finds it difficult to understand people and can’t put

sentences together.”

Find out more about the evidence base for language impairment.


1

“My child finds it difficult to understand people and can’t put

sentences together.”

Possible causes?This could indicate a language impairment, sometimes called a language disorder.

A language impairment can affect a child’s ability to understand (receptive language); to put spoken sentences together (expressive language); to develop vocabulary (word recognition and naming skills); and to recall what has been said (auditory memory). Some children recognise words but can’t recall them for use in spoken sentences (word fi nding diffi culties).

Children often present with speech impairment in addition to their language impairment. Language impairment may occur in isolation (a primary condition) or secondary to other conditions (including neurological, cognitive, social-communication, hearing, behavioural and emotional impairments). It is important for the team around the child to profi le the child’s verbal and non-verbal skills to inform the best interventions for the child.

Referral to a speech and language therapist can add value by:

Developing a programme of therapy.

Integrating therapy targets into the educational curriculum.

Training and supporting other professionals working with the child.

Supporting parents to make communication easier.

Visit: http://tinyurl.com/3lc94sc


2

“People find it difficult to understand

what my child is saying.”

Find out more about the evidence base for speech and language impairment.

eople find it difficult to understand

what my

saying.”


2

“People find it difficult to understand

what my child is saying.”

Possible causes?Children begin to add a wide range of speech sounds into their speech system between the ages of two and six years of age. Children who are unclear, especially if their parents cannot understand them, may have a speech impairment. Speech impairment, sometimes called speech disorder, may affect the child’s ability to say single sounds (articulation), or use sounds in words and sentences (phonological disorder). Some children may have diffi culty hearing the difference between different sounds, and have diffi culty splitting a word into different smaller chunks (syllables and sounds).

Less commonly, children may present with slurred or slow speech patterns (dysarthria, see also adult section of this booklet). These may be associated with cerebral palsy, neurological conditions or traumatic brain injury.

Tongue tie is often thought to cause speech errors, but this is very rare. You should request a full speech examination prior to recommending surgery in these cases.


Developing an individual communication programme for the child. This may include the use of augmentative and alternative communication aids.

Supporting families and professionals to understand and develop the child’s communication needs.



3

“My child seems to get

stuck on some words.”

Find out more about the evidence base for speech and language therapy and stammering.


3

“My child seems to get

stuck on some words.”

http://tinyurl.com/3lc94sc

Possible causes?This could indicate developmental or acquired stammering.

Developmental stammering occurs initially during childhood. Overt speech symptoms may include whole word and part-word repetitions, prolongations, and/or blocking on some sounds. Acquired stammering usually has a later onset but can also include children and may be associated with a signifi cant event.

Coping strategies (substituting diffi cult words, situation avoidance) or changes in non-verbal behaviour may occur early or develop over time. In addition, fear of stammering may cause psychological or emotional distress.

Although many children may grow out of stammering, early intervention for all children who stammer is effective in reducing the risk of future stammering. It can also reduce future emotional diffi culties for those that go on to have a long-term stammer.


Identifying children at risk of developing persistent stammering.

Facilitating easier and more controlled communication.

Improving the child’s confi dence and reducing negative emotional responses.

Supporting families and education staff to manage stammering.


4

“My child’s voice sounds

strange.”

Find out more about the evidence base for speech and language therapy and vocal disorders.


4

“My child’s voice sounds

strange.”


Possible causes?This could indicate an organic or hyperfunctional voice disorder.

Children may present with a hoarse or ‘creaky’ voice, a whisper or no voice at all.

Hyperfunctional voice disorders fall into two categories. Muscle tension voice disorders cover vocal strain and vocal misuse (from, for example, shouting and screaming). Psychogenic voice disorders range from complete voice absence to varying degrees of vocal impairment.

It will be important to refer to an ear, nose and throat specialist who will be able to identify any upper airway pathology and any related medical issues (for example, hearing diffi culties, allergy, refl ux).


Improving vocal health.

Setting goals to improve vocal performance.

Reducing the child’s vocal tract discomfort.

Reducing or eliminating damaging vocal habits.

Helping the child participate more effectively if their voice cannot be fully restored.


5

“My child finds it difficult to talk to otherchildren and

make friends.”

Find out more about the evidence base for speech and language therapy and autism.


5

“My child finds it difficult to talk to otherchildren and

make friends.”


Possible causes?These kinds of problems could indicate that the child has social communication diffi culties.

Social communication includes sharing a mutual interest by pointing, looking and sharing verbal as well as non-verbal communication (such as facial expressions and gestures). Some children have diffi culty interpreting and using these social skills and this affects their ability to play imaginatively, make friends and learn and interact with others.

Social communication diffi culties fall along a spectrum or range. Children may have social communication diffi culties as a result of another condition, such as a congenital condition, or as a secondary effect of speech and language impairment. Other children may present with more severe diffi culties. Children with autism often have communication diffi culties that fall within this spectrum.


Developing individual programmes to help the child develop their communication skills.

Providing strategies to help the child make free choices, express their feelings and to learn.

Supporting parents and teachers to understand the source of the diffi culties and make communication easier.


6

“My child gets lots of colds,

and often doesn’t hear what I say.”

Find out more about the evidence base for speech and language therapy and deafness.


6

“My child gets lots of colds,

and often doesn’t hear what I say.”


Possible causes?Communication diffi culties can be caused by glue ear/otitis media. There is also a possibility that the child may have permanent childhood deafness. Although the majority of deaf children are identifi ed through the newborn screening programme, some children with progressive or sudden onset hearing loss may be missed and should be referred to audiology. Children under the age of fi ve are the largest group affected by glue ear, though for some it can persist into adolescence. Glue ear can cause temporary and fl uctuating deafness, delayed speech development in young children and affect children’s behaviour and their educational progress.

Children with cleft lip and palate (see over page), or with genetic conditions, such as Down syndrome, may be more likely to get glue ear because they may have smaller Eustachian tubes. As well as referral to a speech and language therapist, referral to an ear, nose and throat clinic may be considered.


Working with an audiology team to assess current levels of speech and language functioning.

Determining which speech, language and communication needs relate solely to hearing problems and identifying, by differential diagnosis, if the child has any other SLCN.


7

“My child was born with a cleft lip

and palate.”

“My child gets teased about

the way they talk.”

Find out more about the evidence base for speech and language therapy and cleft palate/lip.


7

“My child was born with a cleft lip

and palate.”

“My child gets teased about

the way they talk.”


Possible causes?Cleft lip and/or palate are congenital abnormalities. The type and severity of the cleft can vary, involving only the lip (cleft lip) or palate (cleft palate) or both together (unilateral or bilateral cleft lip and palate). Submucous cleft palate may first present because of speech concerns, usually around the age of three years. Indicators may be nasal speech, poor articulation development, history of nasal regurgitation of liquids/solids, ear infections and conductive hearing loss.

A cleft lip is usually surgically repaired at around the age of three months. A cleft palate is usually repaired between six and 12 months.

This condition can result in poor articulation development, reduced intelligibility, nasal sounding speech, language delay and psychosocial difficulties.


Assessing the child’s difficulties and contributing aetiological factors.

Advising if surgery or therapy is needed.

Monitoring ongoing communication difficulties.

Developing individual therapy programmes for the child.



Communicating Communicating Communicating Communicating Communicating

SwallowingSwallowingSwallowingSwallowingSwallowing

AutismAutismAutismAutismAutism

StammeringStammeringStammeringStammeringStammering

Cleft palateCleft palateCleft palateCleft palateCleft palate

Quality of lifeQuality of lifeQuality of lifeQuality of lifeQuality of lifeGlue earGlue earGlue earGlue earGlue ear

VoiceVoiceVoiceVoiceVoice

Speech Speech Speech Speech Speech

UnderstandingUnderstandingUnderstandingUnderstandingUnderstandingLanguageLanguageLanguageLanguageLanguage

LanguageLanguageLanguageLanguageLanguage Social communicationSocial communicationSocial communicationSocial communicationSocial communication


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