What to expect from speech and language therapy
Speech, language and communication difficulties are on the increase amongst children in the UK. According to the Royal College of Speech and Language Therapists, 7% of five-year-olds have a specific speech and language impairment, and another 1.8% have speech, language or communication difficulties linked to another condition, like autism or cerebral palsy.
That means that in every Reception class, two to three children are likely to have problems communicating.
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Many of these children will be referred for speech and language therapy (SLT).
Why might your child need SLT?
‘There’s a huge range of reasons that a child might be referred for an SLT assessment,’ says Jon Gilmartin, a speech and language adviser with I CAN, the children’s communication charity (www.ican.org.uk).
- Language delays/disorders: a difficulty with language, such as a delay in starting to talk, problems understanding or retaining vocabulary, or problems using the correct word order. A child may be developing normally in other areas, but behind with their language skills. Language difficulties may go alongside conditions such as dyspraxia, or caused by glue ear: a condition where the ear canals are blocked by mucus.
- Speech delays/disorders: problems with producing speech sounds. Children might have difficulty with specific sounds (such as saying ‘t’ instead of ‘c’ – so ‘car’ becomes ‘tar’) or a range of sounds.
- Social communication delays/disorders: also known as pragmatic communication disorders. In this case, children struggle with the social side of communication, like holding conversations. Many children with autism spectrum disorders have problems in this area.
- Medical or genetic needs: this includes conditions such as cleft palate, cerebral palsy and hearing impairment. Some children need SLT due to overuse of a dummy, and some because they have problems chewing, swallowing or drinking.
How do children get referred?
There are various different ways in which a child can be referred to NHS SLT services. ‘Many areas have open referral services, so parents can contact the SLT team directly and ask about how they can have their child assessed,’ Jon explains.
You can find out whether open referrals operate in your area by asking your child’s GP or health visitor. There may be a specific protocol to follow, like completing a detailed form.
‘Children might also be referred for SLT by their school, GP or health visitor,’ Jon says. Many parents prefer to go down this route, finding it beneficial to have the backing of a professional. If your child’s school wants to make a referral, they must talk to you about it first.
You can also bypass NHS waiting lists and ask an independent SLT to assess your child.
What happens at the initial assessment?
Being referred for SLT doesn’t necessarily mean that your child will receive therapy. All children must first go through an assessment to establish their needs.
‘A key element of the assessment is taking a case history, where the therapist finds out as much as they can about the child’s life, from pregnancy to the present day,’ Jon says. ‘This might feel quite intrusive, but it’s essential to gather any information that may explain their difficulties.’
At the same time, the therapist will be observing your child, looking at things such as how they speak and use language, how they interact, and what their behaviour is like. They might use developmental profiles, such as the Early Years Foundation Stage (EYFS) profile, to establish whether they are on track for their age.
If your child is over three, the therapist may conduct a formal assessment. There are several different types of formal assessment, but they might involve asking your child questions (‘Point to the picture of the dog’), looking at their social skills and profiling the speech sounds they are using.
Following the assessment, you’ll be told what will happen next. Some children need no intervention; some don’t need SLT but are given activities to do at home to help with their difficulties; some will be referred for ongoing therapy.
It’s also possible that your child will be referred to a different specialist, like the hearing impairment service or a paediatrician specialising in autism.
What happens if your child needs therapy?
Exactly what happens during SLT sessions depends on factors including the area you live in and the nature and extent of your child’s difficulties.
They might see their therapist at school, at a community health centre or children’s centre, in a hospital outpatients clinic, or at home. SLT might be one-to-one or in a small group, and they may be seen weekly or at set intervals.
SLT aims to help children progress by making learning fun and engaging. Some of the strategies that your child might encounter are:
- Language intervention activities: playing, talking, using pictures, books, toys or other objects to stimulate language development. This includes modelling correct vocabulary.
- Articulation activities: practising specific speech sounds. The therapist will show your child how to move their mouth to make the sounds, and might demonstrate for them to copy.
- Oral exercises: tongue, lip and jaw exercises and facial massage aimed at strengthening the muscles of the mouth.
‘Everything is play-based and designed to be rewarding for the child,’ Jon explains. ‘The focus is on getting them as involved and motivated as possible.’
How important is ‘homework’?
Your child’s therapist will give you tasks to do at home in between sessions. ‘It’s vital that you get on board with this, and make time to practise at least daily,’ Jon says. ‘The activities you do at home are as important as the therapy sessions themselves, if not more so.’
When will a child be discharged?
‘Speech and language therapists should set accurate and achievable targets, and review them regularly,’ says Jon. ‘If a child has made sufficient progress over a six- to 12-month period, they will be reassessed to see whether they have made enough improvements to be discharged.’
Sometimes, children are discharged but their progress then slows down, but don’t panic if your child isn’t doing so well – they might be re-referred in the future if they need more intervention.
Where can you get more help?
I CAN runs an enquiry service run by speech and language therapists. Call 020 7843 2544.
Talking Point is a comprehensive website covering all aspects of children’s communication. There is also a useful Progress Checker to see if your child is on track with their development.
The Association of Speech and Language Therapists in Independent Practice (ASLTIP) has a database of private speech and language therapy practitioners.
'Be prepared to fight for your child'
Clare is mum to James, four, who has speech and language delays.
'When James was two and a half, I could tell he wasn’t picking up speech in the same way that my elder two children had.
'I went to a drop-in session run by the health visitors, where I had to fight to have him referred. After a long wait, we had an assessment over two sessions and the speech and language therapist agreed that he would benefit from SLT.
'James’s key therapist was a mum, and she really engaged him. She could see when he was getting bored and would change tack, but the tasks were really repetitive and the materials were really outdated.
'At home, we looked at pictures together and my older two liked to get involved. I also found a private therapist who came to the house weekly. He was brilliant with James: he got down on the floor and played with him, and created bright, colourful books which included the words he wanted him to practise.
'Earlier this year we moved to a new area. James started a new nursery, and they were brilliant at doing one-to-one activities with him. He started school in September; he’s still very difficult to understand, and I suspect he’ll need a lot more help, but his Reception teachers are great and he is getting clearer.
'My advice to other parents would be to start early and hold your ground if you think your child has a problem. Do consider going private if you can afford it: you'll be seen quicker and more often.'