Speech and language difficulties 

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.

Causes

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.

Types of difficulty

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Understanding what others say (receptive language). This could be due to
  • Not hearing the words (hearing loss).
  • Not understanding the meaning of the words.
     
• Communicating thoughts using language (expressive language). This could be due to
  • Not knowing the words to use.
  • Not knowing how to put words together.
  • Knowing the words to use but not being able to express them.
     

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Speech disorders
  • Difficulty with forming specific words or sounds correctly.
  • Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Language disorders
  • Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
  • Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

  • Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

     

    Language development has different parts, and children might have problems with one or more of the following:

     

  • Understanding what others say (receptive language). This could be due to
    • Not hearing the words (hearing loss).
    • Not understanding the meaning of the words.
       
  • Communicating thoughts using language (expressive language). This could be due to
    • Not knowing the words to use.
    • Not knowing how to put words together.
    • Knowing the words to use but not being able to express them.
       

  • Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

  • Speech disorders
    • Difficulty with forming specific words or sounds correctly.
    • Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
  • Language delay – the ability to understand and speak develops more slowly than is typical
  • Language disorders
    • Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
    • Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

• Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

   

  Language development has different parts, and children might have problems with one or more of the following:

   

• Understanding what others say (receptive language). This could be due to
  • Not hearing the words (hearing loss).
  • Not understanding the meaning of the words.
     
• Communicating thoughts using language (expressive language). This could be due to
  • Not knowing the words to use.
  • Not knowing how to put words together.
  • Knowing the words to use but not being able to express them.
     

• Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Speech disorders
  • Difficulty with forming specific words or sounds correctly.
  • Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Language disorders
  • Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
  • Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)
  • If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others.

Social Implications

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.

How parents can help

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as :

• Responding to the first sounds, gurgles, and gestures a baby makes.
• Repeating what the child says and adding to it.
• Talking about the things that a child sees.
• Asking questions and listening to the answers.
• Looking at or reading books.
• Telling stories.
• Singing songs and sharing rhymes.

Professional help

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 Additional needs coordinator (ALNCo) 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.

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
• stammering/dysfluency
• 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.

Useful strategies

Try to:

• 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.

What is Developmental Language Disorder?

Developmental Language Disorder (DLD) means that you have significant, on-going difficulties understanding and/or using spoken language, in all the languages you use. DLD was previously known as Specific Language Impairment (SLI).

There is no known cause of DLD and that can make it hard to explain. DLD is not caused by emotional difficulties or limited exposure to language.

DLD is not caused by other medical conditions such as hearing loss, physical impairment, Autism, severe learning difficulties, or brain injuries. However, children and young people with these difficulties may also have a language disorder.

What signs may a child/young person with DLD show?

• They may not talk as much and find it difficult to express themselves verbally.
• Their language may sound immature for their age.
• They may struggle to find words or to use varied vocabulary.
• They may not understand, or remember, what has been said.
• Older children may have difficulties reading and using written language

Remember: Language difficulties may also underlie behaviour issues such as anxiety or misbehaving in class

DLD looks different in each individual child. The child’s specific difficulties can also change as they get older and need to develop more complex skills.

DLD is a long term condition that can have a big impact on a child/young person’s learning and achievement at school.

Children with DLD are at risk of reading difficulties when they reach school age. Sometimes DLD can affect children’s social interaction skills and their ability to make and keep friends. Children with DLD often learn and understand better through visual and /or practical methods, rather than verbal methods. For example they would understand a story better if they watched it being acted out and drew it rather than being told verbally.