A Guide to Expressive Language Difficulties

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1 Speech and Language Therapy A Guide to Expressive Language Difficulties Looking after you locally

2 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 2 The Communication Pyramid... Communication is more than just talking; early development of social interaction, play, listening and attention skills form the foundations of language. Children usually develop these skills from the bottom to the top of the Communication Pyramid, though all of them continue to develop over many years. Talking (or expressive language) includes all the words we use, the way we put them together in sentences and the grammar which helps it all make sense. If children struggle with talking, it may be that they have difficulties with some of the other skills in the pyramid, such as their attention and listening or their understanding. If this is the case then they will need some support to develop these other skills, as well as giving them opportunities to build their expressive language skills. Speech sounds Talking Understanding Play Attention, looking, listening Social interaction

3 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 3 How does expressive language develop? The first year Starts communicating by crying, cooing, gurgling 3 6 months: laughs 8 months: babbles 1 year: single words mummum dada months single words (unclear) Pointing Copies words from adults Children may go through a phase of using jargon this is where the child uses all the right sounds, pitch, intonation and rhythm of their language, but with very few or no real words. It sounds a bit like gobbledygook! 18 months 24 months 50 single words (at least) Linking 2 or more words together Copies words from adults 2 years 3 years Starting to use prepositions in, on, under Starting to use pronouns me, him, she Linking 3 or more words together 300 words 3 years 4 years Tells stories Uses 4 6 word sentences, eg, I want to play with cars Past and future tense emerging: I jumped and I will find Difficulty with irregular verbs: I runned he swimmed 4 years 5 years Now using well formed sentences: I played with Ben at lunchtime and he kicked the ball over the fence. Mrs Smith got angry May continue to make occasional errors with irregular plurals or verbs, eg, mouses, broked

4 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 4 Expressive language diff iculties... Why do some children have difficulties with expressive language? Expressive language difficulties may arise for a number of reasons. They may occur in association with other developmental difficulties, or for no obvious reason. Some of the things that may give rise to an expressive language difficulty are: Hearing loss, including glue ear Global developmental delay where many aspects of development are delayed, including language Delay or difficulties in other early communication skills, such as, reduced attention and listening skills Lack of exposure to language and stimulation Specific language impairment, when a child has no other difficulties, only their language development is affected Lack of communicative intent, where children have not learnt the importance of language and that it can be used for lots of different reasons (to make requests, to find out information, to show like/dislike, to make and maintain relationships, to get attention and to share our feelings). Delay or disorder? Children may have a range of difficulties. An important part of identifying the difficulty is to establish whether it is a delay or a disorder. Delay: the child is following the normal developmental pattern, but with slower progress than expected. They may be 36 months, but only using single words. Knowing your developmental norms will help in identifying these children. Disorder: the child is not following the normal developmental pattern which we would expect. The child may be doing something which is unusual for any child at any age. For example, repeating language that they have heard in a favourite story or TV programme, but are less able to use language to interact socially. Or they may put words in the wrong order in sentences.

5 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 5 Recognising expressive language diff iculties... A child with an expressive language difficulty may find using and learning vocabulary hard, use limited language, or language that seems more appropriate to a younger child. Children with expressive language difficulties will benefit from a language rich environment where language is used in a simple and repetitive way. You may observe one or more of these typical features: Limited expressive language compared to other children of the same age Limited vocabulary, eg, saying thingy or wotsit rather than the object s name, or put it there rather than the specific place word Using the incorrect tense beyond the age expected, eg, I runned away, he buyed it Using very limited language, perhaps only making their immediate needs known, rather than commenting or enquiring Difficulty finding the correct word. They may use a similar word such as apple instead of orange, make up a word, or choose a word which sounds similar

6 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 6 How you can help... There are lots of strategies you can use. Some of our top tips are: Set a good example Children learn to talk by watching, listening and copying. Set a good example by using clear and simple language; add gestures or signs to communicate more information. Add a little more Show children how they can extend their language. Repeat back what they have said, but add a bit to it. For example if the child says biscuit, you can say chocolate biscuit, biscuit gone, more biscuit or Lucy s biscuit. Follow their lead Be responsive to children s interests and join in with their play and what they are focused on. They are far more likely to pick up language if it relates to what they are doing, rather than when the adult tries to take the lead. Repetition Children learn new words by hearing them repeated in different places and at different times. For example, if you are teaching the word bucket, show the child a real bucket, a toy and a picture in a book and say its name each time. You can go on to talk about what it is made of and used for, when the child is ready to learn more. Commenting Throughout the day, talk with the child about what you can see, what you are doing and what you can see they are interested in. Asking questions is less helpful for learning language as it doesn t teach them any new words. A useful rule is to aim to make four comments for every one question you ask. Practice makes perfect Talking, like any other skill, takes practice. Create as many opportunities as you can for conversations between children and adults by giving children new experiences and things worth talking about.

7 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 7 How you can help... Some children have specific difficulties with their vocabulary, and all children need help to make good links between the words they already know and the new words that you are introducing them to. Supporting children to categorise words can be helpful and can be done in a number of ways: Categorising by group This looks at the function of the items and how they all group together. Some good ones to start with are food, clothes, animals, transport, shapes. Try and refer to the categories by name (eg, food) and by function (eg, things we can eat, things we can wear). Categorising by feature This is categorising by describing word. Collect objects or pictures together so that they can be split into different characteristics. Some good ones to start with are colours, size, texture, number of legs, where they belong. Words and word links Learning about the relationship between words is important to develop links in vocabulary. This helps with retaining new vocabulary and learning about synonyms, opposites and word relationships. These games can be used with all children to help them develop strong vocabulary: Things that go together Find pictures of things that go together such as knife and fork, hat and gloves and play a pairs game with them. At the end of the game, see if the child can think of other items that might go with the pair. Find items around the classroom or from memory that go together. Odd one out Use a selection of 4 or 5 object pictures or real objects. The child must find the object or picture that does not fit with the others (eg, cow, cheese, pig, horse) and say why. You can gradually make this more difficult by making the categories closer together (eg, bike, car, lorry, bus). Same or Different? Think about the ways in which two objects are the same and how they are different. In the early stages help to make the comparisons, eg, dog/cat, pen/pencil. Gradually move onto more difficult pairs, eg, cup/bucket. Similarity Snap Spread out a selection of pictures or say several words. The child must shout, SNAP if they think that two of the words connect in some way. Can they explain HOW they can be connected? If the reason is logical they can have a point/tick/stamp, or win the pair. Younger children might need lots of support to explain why they go together, and you might need to start off by telling them, rather than asking them.

8 Norfolk Community Health and Care NHS Trust A Guide to Expressive Language Difficulties 8 Resources... I CAN: Afasic: The Communication Trust: Toddler Talk, Chatting with Children from I CAN: For further information or advice For further information, such as how to refer a child to our Speech and Language Therapy Service, contact your local office on You can receive help with queries about NHS services from NCH&C Patient Advice and Liaison Service (PALS) Tel: pals@nchc.nhs.uk If you would like this publication in large print, Braille, alternative format or in a different language, please contact us on and we will do our best to help. Produced by Norfolk Community Health and Care NHS Trust, September Review date, September Looking after you locally