BIRMINGHAM COMMUNITY CHILDREN S SPEECH AND LANGUAGE THERAPY SERVICE. DEVELOPMENTAL SPEECH AND LANGUAGE DELAY or DISORDER INFORMATION FOR PARENTS

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1 BIRMINGHAM COMMUNITY CHILDREN S SPEECH AND LANGUAGE THERAPY SERVICE DEVELOPMENTAL SPEECH AND LANGUAGE DELAY or DISORDER INFORMATION FOR PARENTS What is speech? What is language? What happens when they go wrong? What is speech? Speech is the process of moving the different parts of the mouth (articulators) to add a variety of sounds to the air stream when we breathe out. A few children have structural differences (cleft palate or very small lower jaw) that make it difficult to say speech sounds. Sometimes children have weak or imprecise movements of their articulators resulting in speech that is slurred or unclear (dysarthria). Other children have difficulty controlling and coordinating patterns of movement (dyspraxia). Most children who are said to have speech difficulties have no difficulty moving the parts of their mouth or coordinating those movements. These children have a phonological delay or disorder. They have not learned the speech sound system that other children learn to use without being taught. Although they do not use the speech patterns of normal speech, their speech sounds usually do follows rules. These rules (or phonological processes) affect the pronunciation of groups of similar sounds. For instance: Fronting when sounds which should be produced at the back of the mouth are produced at the front of the mouth (e.g. cat becomes tat) Backing when sounds are produced further back in the mouth than they should be (e.g. ten becomes ken) Developmental speech and language disorder final parents version Nov O7 1

2 Stopping when long sounds such as (f, v, s, z, sh, th) are produced as short sounds (p, b, t, d, k) What can go wrong with speech? It is normal for some children to use one or more of these phonological processes for a while when they are learning to speak. If they carry on using them for too long we say they have a phonological delay. If the child uses phonological processes which are inconsistent or do not occur as a stage in normal speech development we say they have a phonological disorder. What is language? Language is a code people use to communicate. In order to use language you must understand many different sets of rules about aspects of language such as: the use of sounds described above - phonology the meanings of words - semantics How to make new words (e.g. drink, drinking, drank) - morphology How to combine words together ("James walked to the new shop." Not "James walk shop new") - syntax What word combinations are best in different situations ("I don t think you should do that. might become "Stop right now!" if the first request got no results.) - pragmatics What can go wrong with language? We continue to learn the code of language throughout our lives. Most people pick up the rules of the language code without really thinking about it when they hear other people talk. When a person has difficulty Developmental speech and language disorder final parents version Nov O7 2

3 understanding the language code, we say they have a receptive language difficulty. They may have trouble understanding because: They don t know the meaning of the words (poor vocabulary) They don t understand the way the words have been put together They don t understand how the language has been used. (For instance, when the speaker s words say one thing and their body language and tone of voice say something different). If a person does not know enough language rules to share their thoughts, ideas, and feelings effectively with others, then we say they have an expressive language difficulty. Expressive language difficulties may include one or more of the following: Other people can t understand them because they are using delayed or disordered phonological processes (see above). They know words that could be used to convey their ideas but they have trouble thinking of them; they have word-finding difficulties They don t know how to put words together to express complex meaning. They are unable to judge the appropriate way to talk in different social situation. One problem (receptive language difficulty or expressive language difficulty) can exist without the other, but often they occur together. Specific language impairment is another term used to describe these children who have difficulties learning the language code but who do not have other cognitive, physical or sensory (hearing and sight) disabilities Developmental speech and language disorder final parents version Nov O7 3

4 or interference with their language development due to emotional problems or environmental deprivation. What is higher level language disorder? Children do not stop learning about language when they can use and understand sentences about their every day lives. As they get older they learn how to express and understand more complex language including idiomatic language ( Pull your socks up ), inference ( She looked outside and went to get her umbrella it s raining), humour based on language, multiple meanings of words and speculation about what might happen or ought to be. When older children or adults have good cognitive ability (ability to learn) but difficulties with these more abstract aspects of language we say that they have a higher level language disorder. What are specific learning difficulties /dyslexia? Specific learning difficulties is a term used to describe children who do well in most areas of learning but have particular difficulties in one or two areas. It does not refer to spoken language difficulties but may be used for difficulties with mathematics, for instance. Usually it is used for children who are having unexpected difficulty learning to read and write. This unexpected failure to acquire written language cannot be attributed to identifiable physical, emotional or cognitive problems. The term dyslexia is also used to describe specific written language difficulties but the use of this term has been problematic due to a lack of agreement on diagnostic and intervention criteria. Often a child with specific written language difficulties/dyslexia has a history of developmental speech and language delay or disorder. Aims and Principles of Service Delivery Developmental speech and language disorder final parents version Nov O7 4

5 The aim of the Birmingham Children s Speech and Language Therapy Service (SLT) is to promote the child s communications skills in order to maximise his/her ability to: satisfy his/her needs and desires exchange information use language creatively initiate and maintain social interaction learn and participate in education Therapists adhere to the following principles: To use the child s strengths in communication in order to minimise his/her weaknesses; to work with the child from a baseline of success and to reinforce positively as skills develop. To provide the child with strategies for communication including augmentative communication skills and problem-solving skills for use in situations where he/she is unable to understand or is not understood. To recognise the effects of speech and language difficulties on other areas of development and vice versa. In particular, to acknowledge the effects of speech and language difficulties on communication and on the formation and maintenance of social relationships. To work through the child s carer/nursery staff/education staff in order that a functional approach to intervention may be achieved, ensuring carry over and generalisation into the child s meaningful communication environment. To ensure that, as far as is possible and appropriate, intervention is part of a total programme for the child. To ensure that any intervention programme is seen as the joint responsibility of all parties involved in the child s speech and language development. Developmental speech and language disorder final parents version Nov O7 5

6 To access further referral as appropriate, either for specific investigation, e.g. audiology, or for an additional opinion regarding speech and language skills. To acknowledge that, where intervention is indicated, it should be offered so that it is both minimal in duration and optimally effective. To contribute to the achievement of educational placement/needs, where appropriate. To facilitate access to the National Curriculum for the school-age child. Referral The Birmingham Community Children s SLT Service maintains an open referral system. Referrals can originate with the child him/herself, the parent/carer, education staff or other health professionals. Agreement of carer/child must be gained before a referral is made with due regard to consent to treat as outlined in the Children Act. Referral requests for school-aged children must include a completed school questionnaire/observation schedule except in exceptional circumstances. Referral details should include an up-to-date audiological assessment. All paediatric referrals for speech and language assessment will be offered a first appointment within 13 weeks of referral with a speech and language therapist based in a community Health or Children s Centre. It is essential that referrals for SLT assessment indicate the child and parent/carer s predominant language and any additional languages he/she uses so an interpreter can be organised to attend the initial appointment if necessary. Developmental speech and language disorder final parents version Nov O7 6

7 The SLT service does not accept referrals requesting diagnosis of autism or assessment of purely written language difficulties (e.g. dyslexia). Initial Assessment Initial assessment will aim to obtain an overview of the child s communicative ability including speech, oral and written language abilities and pragmatics. At the end of the initial assessment (typically one appointment but may be extended) the therapist, in consultation with the parent/carer, will have formulated a hypothesis about the nature of the child s speech and language and about the most appropriate plan for his/her future management. A bilingual assessment will be carried out as appropriate using a bilingual co-worker or an interpreter from the BILC service. At the end of the initial assessment: The therapist may decide to arrange additional opportunities to assess the child in either the Health/Children s Centre, the nursery /educational setting or the home, for further information to inform the differential diagnosis and plans for future management. The child may be referred to another speech and language therapist for a second opinion or a specialist assessment. The parent/carer may be given advice and/or a programme to follow with a follow up contact at a future time (either face to face or by telephone). The child may be placed on the waiting list for direct intervention by the speech and language therapist (and the parent/carer is usually also given advice and/or a programme to follow until they are offered a block of therapy). The child may be referred on to another agency for further investigation (e.g. audiology). Models of Intervention Developmental speech and language disorder final parents version Nov O7 7

8 Decisions about intervention will be made in the context of the Aims and Principles of Service Delivery described above. Intervention will be based on assessment findings and be planned in conjunction with the child/carer and other professionals as appropriate. Timing of intervention will be determined by an evaluation of the individual s readiness and ability to change (or the potential to change the environment). Timing will also take into account the individual s motivation to change and the level of support available. Work towards identified speech, language and communication targets may be carried out by the therapist directly in one to one or small group sessions. Alternatively, intervention may be facilitated by the therapist but carried out by the carer and/or other professionals. Intervention is the joint responsibility of therapist, child, carer and/or other professionals and can be based in the home, the Health/Children s Centre or the school. Direct intervention for pre-school children, for school-aged children with articulation difficulties or speech and language difficulties at the phonological level and for voice and fluency difficulties is normally Health/Children s Centre based. See Clinical Guidelines for Fluency for further information concerning therapy for stammering/stuttering. For other school-aged children, whenever possible, the service will be school-based and will consider the needs of the child within the context of the curriculum. See Clinical Guidelines for Working in Mainstream Schools, Language Unit Models of Care and Clinical Guidelines for Working in Special Schools (not yet available) for more information on models of care used in different educational settings. When the speech and language therapist, in consultation with the parents/carers and other health and education professionals, feels that the most appropriate setting to meet child s educational needs would be a Speech and Language Resource Base (Unit) or Special School the child may be referred to the Preschool Liaison Group for further investigation or the Special Educational Needs Assessment Service (SENAS) for Developmental speech and language disorder final parents version Nov O7 8

9 initiation of a statement of SEN. SLT advice, to be included as part of a Statement of Special Educational Needs, will be provided on request. Each period of intervention will be accompanied by a Birmingham Outcome System (BOS) greensheet (developed from the East Kent Outcome System, EKOS) that will include a description of the overall long term aim(s) for the child, the current level of performance, goals for the current episode of care ( outcomes ) and an intervention plan. At the end of a period of intervention outcomes will be evaluated and if intervention is still indicated a new BOS greensheet will be written for the new intervention plan. Discharge The child will be discharged from a Health/Children s Centre: If the child and parent/carer do not attend their first appointment and do not respond to the DNA letter within four weeks. After initial assessment if the speech and language therapist concludes, in consultation with the parent/carer, that the child does not need speech and language therapy or that the child would not benefit from therapy at that time (not timely ). After one or more blocks of therapy in the Health/Children s centre if further intervention is not necessary or not timely. When a child is discharged parents/carers and referees will be informed that the child may be re-referred at any time if the child s circumstances change without being placed on the waiting list for initial assessment. See Clinical Guidelines for Working in Mainstream Schools and Clinical Guidelines for Working in Special Schools for more information on discharge of school-aged children. Developmental speech and language disorder final parents version Nov O7 9

10 Parental Component Parents/carers are present at initial assessments in all but exceptional circumstances to provide information for case history and in order to be involved in decision making and planning for future management. Parents are involved in intervention whenever possible/appropriate. Parents will receive verbal or written feedback at designated intervals as appropriate. Parents will be told how to contact the speech and language therapist and encouraged to do so for further information or advice. Joint Working Collaborative working between the speech and language therapist, the parent/carers and other health and education professions is essential for effective assessment, planning and intervention. Skill Mix Children with speech and language delay/disorder will usually be seen initially as part of a general clinical population and will be assessed initially by a generalist speech and language therapist. Where necessary the generalist speech and language therapist may consult a specialist (e.g. the Clinical Lead for Mainstream Schools or for Higher Level Language and Literacy) or more experienced therapist (e.g. the Lead for Working in Secondary Schools or a Team Leader) for joint assessment and intervention planning or for more informal advice. For pre-school children the Health/Children s Centre generalist therapist will usually undertake ongoing management and intervention. Children with severe or complex difficulties may be referred on to a Developmental speech and language disorder final parents version Nov O7 10

11 Child Development Centre for multidisciplinary assessment and intervention. For school-aged children therapists working in mainstream schools will usually undertake ongoing case management. Speech and language therapy assistants have an important contribution in all settings. They may assist speech and language therapists or education staff with individuals or in group intervention, carry out programmes under the direction of a qualified speech and language therapist and help to prepare equipment and materials for intervention. Bilingual assistants/co-workers are essential in the assessment and intervention of bilingual children. References and Sources of Further Information AFASIC (Association for All Speech Impaired Children) American Speech-Language-Hearing Association (ASHA) CaF (Contact a Family) Council for Disabled Children Dyspraxia Foundation ICAN (Invalid Children s Aid Nationwide) NAPLIC (National Association of Professional concerned with Language Impairment in Children) NASEN (National Association for Special Educational Needs) National Parent Partnership Network Network for Education and Training in Phonetics: OAASIS Speech & Language Therapy in Practice Royal College of Speech and Language Therapist (RCSLT) Clinical Guidelines, RCSLT. Communicating Quality 2, RCSLT. Communicating Quality 3, These guidelines will be reviewed in Oct 2008 Developmental speech and language disorder final parents version Nov O7 11

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