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In summer 2010 we asked primary school SENCOs about the services their pupils with SLCN are able to access, and how they are changing in the face of financial pressures. The picture that respondents painted was disheartening, with horror stories telling of strict limits on the number of referrals that could be made, 18-month waiting lists for assessment in several areas, and no replacements made available for therapists leaving their roles. If a school is told it can only refer 2 children to the local SLT department in an academic year, what should they tell the parents of a third child with needs?

We need to change the way we think about SLCN. Communication is such a crucial aspect of all our lives, and yet it’s not given the importance it merits. SLCN are the most prevalent documented SEN in primary school-aged children in this country. We need to stop thinking that savings can be made with cuts now, and start thinking about the bigger picture and how savings can be made in the future.

Not enough thought is being given to the alternative to short-term cuts. Despite clear and growing evidence about the benefits of early intervention and addressing SLCN effectively, we still focus our efforts on immediate savings without sufficient regard for the consequences of such actions in the future. This is particularly disappointing given that we have a Prime Minister with direct experience of the difficulty in accessing, and positive benefits of, speech and language therapy. On the other side of the bench in Westminster, Ed Balls MP, Shadow Chancellor, has forged a very successful public career despite his own communication difficulties as a child. Many other MPs have familial or personal experience of how crucial speech and language therapy can be to the life of a child.

The Speech Bubble is in contact with several MPs and a member of the House of Lords; the political will to enact change is there, and what we need is to turn that will into more substantial action from those in power. There is so much evidence detailing the irrefutable importance of better meeting the SLCN of our children, but particularly in the current economic climate there are few signs of anything changing. Perhaps when the Government’s Green Paper on SEN is published, we will have more idea about how the coalition plans to tackle such issues. Yet cases such as Southwark’s show that we are still not thinking correctly about this issue.

It’s clear to us that addressing rather than marginalising this issue would actually save resources, if only the Secretaries of State for Education, Health, and Mr Cameron himself would consider the wider picture. Effective SLT services would realise a plethora of financial savings. Some of them include:

• Substantial reductions in youth offending and associated costs, which are estimated to be over £4 billion annually
• The Audit Commission estimates that over £110,000 can be saved by appropriate early intervention for a 16 year old that turns to crime as a consequence of unaddressed needs
• A York University study showed that the real cost to society over the lifetime of an individual without appropriate early intervention, including benefits paid as opposed to tax revenue accrued after such intervention, could run to hundreds of thousands of pounds
• A reduction in Local Authority tribunal cases, 10% of which relate to SLCN
• A reduction in bureaucracy and administration time of support workers and teaching staff
• Keeping children off the SEN register who do not need to be on it

There are campaigns being run by the Royal College of Speech and Language Therapists and the Communications Trust, but we need to do more – not only to raise awareness of SLCN issues, but also to enact the necessary changes that will provide our children with equitable services regardless of socio-economic factors, save resources in the future, and ensure no child is unable to fulfil their potential because of a communication difficulty.

Since the coalition government took office we’ve heard about difficult decisions, the need to achieve ‘more for less’, and focusing on outcomes for children even during financially challenging times. We feel we have the strategies that speak to all these policies, and what we need now is for those in power to put aside short-sighted thinking of immediate savings only, and listen to plans that will make a real and lasting impact both now and for many years to come –  to our children, our society, and our economy as a whole.

We’ve helped thousands of children this academic year alone in all kinds of schools and nurseries that would otherwise not have been able to access essential services. But there’s still so much further to go.

If you or someone you know is as passionate as we are about changing the way we think about and address SLCN, and making real changes in this area, then please get in touch with any ideas or things you’d like to see us doing, and help us bang the drum as loudly as possible until those in power can ignore it no longer.

It stands to reason then that the consequences of unaddressed speech, language and communication needs (SLCN) can be disastrous for a child, and are often lifelong. Learning gaps between children with SLCN and their peers open up early in their academic lives, and continue to grow wider the longer that needs are left unchecked. As a child if you can’t fully understand what is being taught, and can’t effectively explain to teaching staff that you are struggling, then you have no chance to ever fulfil your potential in school.

It’s easy to see the impact that could have on your grades, your employment prospects, your self-confidence, your self-esteem, and your ability to interact socially – and there’s so many more ramifications too. Here are a few facts that need to be much more widely known:

• Communication needs are the most prevalent type of all SEN among children of primary school age, affecting over 24% of children with statements (Office for National Statistics)
• At least 60% of youth offenders have speech and language difficulties, with many unable to comprehend rehabilitation programmes, increasing recidivism
• Young people with a learning difficulty are twice as likely to be NEET (not in education, employment or training) as those without
• Approximately 10% of school children have speech and language difficulties; this figure can rise to over 50% in deprived areas

The pattern is all to familiar to those working in SLT and those in youth offending teams: there is clear evidence of the correlation between SLCN and poor behaviour in class. Frustrations at not being able to understand what is being taught often leads to misbehaviour, which can then lead to truancy, followed by exclusion from school, and then appearing in the youth offending system.

We work with lots of children who have simply needed the right support at the right time; we’ve been able to help several children come off the special needs register altogether, because their underlying issue was an undiagnosed problem with speech and language. When a communication difficulty manifests itself as a behavioural issue, it takes specialist skills, training and experience to identify it.

Many children in mainstream schools are not receiving this support when they need it, and some are subsequently unnecessarily placed in special schools, affecting the rest of their lives. Many children in special schools, despite a mandated requirement for the state to provide it, also cannot access the vital support they need.

That’s one of many reasons why we are so passionate about what we do, and why we feel so strongly that therapy should be delivered from within schools themselves. And of course, why we’re trying to help make sure as a country we do more.

There is a similar effect for children with autistic spectrum disorder (ASD). In fact it is so unsettling for them to not know what to expect that it can affect their behaviour and use of language. They see the world as jumbled and confusing – so having a system to help them organise their life, show what will happen next, and predict the expectations others have of them is reassuring and calming.

Introducing a visual timetable

So what is a visual timetable? Well, it’s a great way for a child with ASD, and also some children with SEBD, to know what is happening next. Using objects, photographs, symbols or words, we can show them what is coming up, and how long it might last for.

In its simplest form a visual timetable can show the activity now, followed by the activity due to be completed next. It can be used to breakdown complex tasks, such as cooking or dressing, into individual steps. The ultimate aim is to promote independence from care givers, who may not always be there to help.

Often schools introduce visual timetables to help pupils to move from task to task and lesson to lesson. A great example could be a strip of paper with pictures/symbols being placed somewhere accessible to pupils. They would be encouraged to go to the timetable upon entering the classroom to see what the next few activities are. An adult should help the pupil to point to each picture/symbol and name it for them. The pupil is then taken to the first task. Once that task is completed they are encouraged to go to the timetable again, take off the first symbol as it is finished and look at what the next task is. This can have a dramatic effect on behaviour and structure.

The system can be introduced at home in the same way. Break the day into short chunks and find pictures or objects that represent the tasks/activities that you would like your child to do. Ultimately the child should learn to visit the timetable independently at the change of each activity, remove the previous symbol and look at the next activity. Just like we might read a list of tasks and cross off the ones we have completed before looking at the next one.

A skill to be learnt just like any other.

Roll a ball: Take it in turns to roll a ball or car to each other. Each time you roll it count to three and say “go”. Encourage your child to join in with counting and saying “go” by leaving a pause after “ready, steady…”.

Building Blocks: Build a tower or house with bricks. Take it in turns to add a brick. When you are finished let your child knock it down, but encourage him to say “go”.

Grab Bag: Put a collection of toys or objects in a bag. Sing a song like “What’s in the bag?” and then let your child look in the bag. Leave a space for him to name the object. For example, (to the tune of ‘The farmers in his dell’), “What’s in the bag? What’s in the bag? Oh oh ______, What’s in the bag?” (spoken) Its a …..

Postal Play: Cut a hole in the side of a large cardboard box and turn it upside-down to make it into a post box. Try decorating it too! Take turns to post objects and toys and make a comment about each one (repetition is a good learning method) e.g. “Bye bye Teddy” or “Keys gone”. On your child’s turn encourage him/her to say or copy the name of the object before he posts it.

Lotto: Have pictures of 6 objects. Hold up an object and the child can find the correct picture. A similar activity can be done by simply matching pictures with pictures.

Ready Steady Go: This can be played with balls, cars, bubbles, a slide, anything at all really. Say “ready, steady, go” before each turn and begin to leave longer gaps before you say “go” to allow your child to fill in the gap.

Song Box/Bag: Collect objects that match songs that your child knows. Encourage them to select the object for the song they want to sing, e.g. a bobbin for ‘Wind the Bobbin’; a bus for ‘Wheels on the Bus’; a star for ‘Twinkle Twinkle’; a sheep for ‘Baa Baa Black Sheep’ etc. During the singing leave gaps at the end of some lines to let your child supply the word.

Most importantly of all during all the games, have fun and relax with your child, as this is how they learn best.

However for some children this process does not happen smoothly or naturally. They have difficulties understanding spoken language and this can affect their ability to follow instructions, join in conversations, and learn new skills. It can also lead to longer-lasting problems with attention and listening skills, poor behaviour, and difficulties reading and writing at school.

Below is a quick guide to the language a child should understand at each stage of development:

12 Months

• Can tell the difference between different sounds
• Responds to ‘no’
• Understands some single words e.g. Daddy, car, eyes, phone, key
• Begins to respond to requests e.g. “Give it to Mummy”
• Begins to respond to questions e.g. “More juice?”

18 Months

• Can identify a range of common objects
• Understands simple directions with or without cues e.g. “Push the bus!”

2 Years

• Understands several pronouns, e.g. me, my, your
• Understands concepts of quantity, e.g. one, some, all
• Understands action words, e.g. eat, sleep, etc.

2 Years 6 Months

• Begins to understand basic prepositions, e.g. in, on
• Can identify objects by function
• Understands some attributes, e.g. big, broken

3 Years

• Understands harder descriptive concepts, e.g. empty, same
• Begins to understand the names of some colours
• Understands simple ‘who, what, where’ questions

4 Years

• Understands more complex directions, e.g. two-part instructions
• Understands harder prepositions e.g. between, next to
• Begins to understand ‘why’ questions and how to make inferences
• Understands most of what is said, including stories and simple questions about themselves

5 Years

• Understands concepts of timing, e.g. first, last, next
• Understands more complex concepts of quantity and size, e.g. heavier than, bigger than

There are some general tips that can help children to understand what is being said:

• Keep sentences short and simple
• Say your child’s name before giving them an instruction to help them focus on what you are saying
• Use pointing and gestures alongside your words
• Talk about what your child is playing with and things that are happening around them
• When playing with them be face-to-face and down on their level, to encourage eye contact and to see what they are looking at
• Encourage your child to listen to everyday sounds, such as the doorbell or a lorry outside, or use instruments to encourage them to listen
• Allow time for your child to think about what you have said before saying it again if they haven’t fully understood you
• Rephrase and shorten an instruction using gesture if they didn’t understand you the first time

At times a child may appear to understand when they really don’t. They may use a lot of language, repeat nursery rhymes and imitate adults. This does not necessarily mean that they understand what is being said – that needs to be checked separately.

At a higher level some children struggle to learn the grammar that adults use in sentences, which means they are unable to construct stories and retell events that they have experienced in a clear way. Any difficulties in using spoken language will affect the child’s ability to use written language in school. It can lead to frustration at not being able to express themselves clearly and therefore go on to affect behaviour and relationships, even with their peer group.

Some children are slower to talk than others simply because they have difficulties understanding words and sentences, and this needs to be ruled out before working directly on spoken language alone.

Some tips to help young children include:

• Give your child alternatives e.g. “Would you like milk or juice?”
• Play with your child at their eye level (on the floor if necessary) and follow their lead, commenting in short phrases about what they are doing, e.g. “Teddy is falling over”
• When your child has shown an interest in something new, name it for them
• Nursery rhymes are an excellent way of encouraging your child to talk. Leave a pause before the last word to see if they fill in the word
• If your child says one word, repeat what they have said and add another word e.g. your child says “dog”, reply by saying “Yes, big dog” or “dog walking”
• Encourage your child to play with children of their own age, such as at nursery/playgroup
• Give your child the opportunity to talk – leave pauses for them to name objects, comment, ask questions etc.
• Try to avoid yes/no questions, instead ask open ended questions e.g. “What are you doing?” instead of “Are you playing with the cars?”

For older children with difficulties learning grammar simply say to them the sentence they said to you and ask them if it sounded right. Talk about different words and how they change when the sentence is about the past, present or future.

Without play a child has limited use of language and few skills in making and maintaining friendships. Rules and negotiation play a large part in children’s play. As with all development there are stages that children go through with their play and it becomes more complex with age. Here are some broad outlines of typical behaviour at certain ages:

6 months
Children explore objects with a limited number of movements – pushing, grasping and tasting them – to see the effect that this has.

1 Year
Children now enjoy sound-making toys like rattles, and hiding/finding objects. They have a greater understanding of how to make objects work. They don’t put as many objects in their mouth at this stage. Peek-a-boo games are tremendous fun and develop their turn-taking skills.

1 year 6 Months
At this stage throwing toys down from the high chair or push chair (casting) is highly entertaining, at least for the little one! It is used as a game or to reject objects. Children begin to relate objects together and pretend with them, e.g. putting a cup on a saucer and stirring an empty cup with a spoon. Experimenting with movements continue and push and pull toys are frequently enjoyed at this age.

2 Years
Pretend play develops further at this age with children copying household activities, such as cleaning, cooking etc.. Although they are fascinated with each other, often at 2 years old children enjoy playing near, rather than directly with, each other. Construction toys and building bricks become a greater part of play as do toys such as model cars and bikes.

3 Years
By 3 years old children join in active make-believe play with other children, acting out a variety of roles and stories. These may involve repeating things seen on television or read in books, or even real-life situations. Toys are more easily shared at this stage as children begin to play with one another rather than alongside others. Objects can easily fulfil a variety of roles in the play now, e.g. a brick can be a cup, car, bag, etc.

4 Years
Complicated make-believe play involving clearly defined roles and dressing up are typically a large part of play at this age. Rules and roles are signalled both explicitly and by the words/dialogue used during playing, e.g. “I am Daddy and you must eat all your food up before you go and play.” Children understand the need for turn-taking and begin to play games with rules, such as board games. Construction play has developed too – now children plan and build objects rather than just putting random pieces together.

12 – 18 Months

All sounds are present but not consistent. Babbling and repeating syllables e.g. “dada”.

2 Years

Final sounds are missed off words e.g. dog → “do”.  One consonant is used throughout word e.g. cat → “tat”.

2 Years & 6 Months

Final sounds are missed off words e.g. dog → “do”.

3 Years

These sounds are often ‘stopped’ into shorter sounds, such as d, t, b or p.  The sounds k/c and g are often replaced with t or d.

4 – 5 Years

Children are beginning to use clusters of consonants e.g. spoon.  “th” is replaced with “f” and “r” is replaced with “w” until 6 years.

Unfortunately some children continue to have difficulties with speech sounds and do not learn how to say the words correctly themselves. This can make them difficult to understand by people who are not close family. It may also affect your child’s behaviour and their ability to make friends.

There are some general tips that may help:

• When your child makes a mistake, say the word back to him using the correct production. Avoid correcting him

• Encourage your child to use natural gestures and pointing to help you understand what they have said

• If you are unable to understand them, be honest and ask them to show you in another way if they can

• Accept other ways your child may be communicating with you, such as sounds, facial expressions and gestures

• Remember if your child cannot say certain sounds they are not being lazy. To change how they say sounds takes a lot of practice, thought and effort. Try it yourself – talk about a subject of your choice (e.g. television, holidays, football, etc) for 5 minutes and miss out all the “s” sounds

Speech and Language Therapists usually follow small steps to change how a child produces a sound in their speech. Below is a quick idea of the stages that are used.

• Producing the sound on its own e.g. “s, s, s, s”

• Producing the sound within a word e.g. for “s” - sand (beginning of the word), kiss (end of the word), or basin (middle of the word)

• Practicing using the sound correctly in short sentences e.g. “I found a sock”

• Saying rhymes and tongue twisters that include words with the sound in them to practice

• Finally, using the sound in conversations

At all stages the Therapist will make deliberate errors of their own to check that the child can hear the difference between the sound and the one they are replacing it with. Games are a vital element of the practice to ensure it is fun and less pressured.

Also the effort rather than perfection is often rewarded especially at the beginning as a child is learning where their tongue should go.

Each child will obviously progress at different rates and it is not uncommon for a child to get stuck at one stage for a number of weeks. Helping children to say sounds correctly is never as straight forward as it seems.

It is now beginning to be recognised that children with emotional and behavioural difficulties often have underlying speech and language difficulties. Research has shown that between 60% and 90% of children with social, emotional and behavioural difficulties have underlying speech and language needs that have never been diagnosed or addressed. In addition to this, many children from an unsettled family and educational background also miss out on developing the language skills they require to negotiate and interact appropriately with both peers and adults. They have no appropriate role models to follow.

However there is still limited information in the sector detailing the impact that speech and language difficulties can have on a child’s ability to learn and their potential to achieve, especially after leaving education.

It has been reported by John Bercow (MP):

“Nearly two-thirds of young offenders have speech and language impairment or communication needs…”

This is a generalised figure. Until a full assessment is done who knows how accurate this is? One thing is clear –  communication difficulties can greatly affect the course of a person’s life.

Students presenting with social, emotional and behavioural difficulties would benefit from the following support in their school placement:

• An assessment of their speech and language skills, leading to the development of appropriate Speech and Language Therapy targets and programmes
• Teaching of basic vocabulary and particularly those words needed to describe emotions and feelings
• Discussion on problem solving and social skills in both group sessions and to individual students
• Staff training to enable teachers to recognize and understand the educational implications of speech and language difficulties, and equip them with the skills to maintain a programme of therapy

Improving communication skills cannot erase the difficult background, or horrific life changing events in students, but it can reduce the difficulties they have in learning and enable them to communicate their needs and feelings in a more effective manner.

Parent Child Interaction

This style of treating young children with a stammer was developed by the Michael Palin Centre. It works from the idea that parents can have a huge influence on their child’s talking (although they are in no way responsible for their child beginning to stammer). This maybe the first approach a Therapist will use to help a young child who is stammering. It focuses mainly on trying to alter the parent’s style of interaction with their child in order to help the child to use smooth speech again.

Lidcombe Programme

This was developed by professor Mark Onslow in Australia. It focuses on training a child to speak fluently by praising smooth speech and gently correcting “bumpy” talking by acknowledging it and at times asking a child to say it again smoothly. The parents are taught to carry out practice daily with their child to ensure smooth speech.

Older children

With children over 8 years old who are aware of their stammering/stuttering often therapy focuses on two main areas: Techniques to practice smooth speech and discussion on their feelings about talking and communication in general. Techniques to create smooth speech include slow speech, breathing, talking gently through stammers (easy onset) and catching stammers before they happen (block modification). Often group work can help older children as they can meet other people in the same situation as themselves and practice techniques in a ’safe’ environment. There is a lot of information on the internet about stammering; it is a controversial subject, as opinions about how to look at stammering varies from person to person.

Here are some tips for helping any child who is getting stuck when they are talking:

• Take time to listen to all that they are saying. It’s easy to try and finish off their sentences, particularly when you are in a rush and they have started the word or sentence for the 5th time. It will mean they feel pressure to finish what they have to say.

• Give them eye contact and get down to their level so that they know you are giving them your full attention.

• Slow your speed of speech. This will encourage your child to feel that there is no need to rush to tell you their thoughts, needs, or stories. Adding longer pauses also gives this impression. It sounds easy, but needs practice – trust me!

• Set aside time just for them. As little as 5 or 10 minutes each day for your child to talk about their day and what’s on their mind will reduce the interruptions and mean they don’t have to fight to tell you what is important. The time can also be spent playing a game or doing a puzzle.

• Encourage turn-taking. If your child is trying to say something over someone else it is an extra process added to get your attention. Making sure all the family takes their turn in conversation and games will make it fair and easier on you and your family.

• Ignore the stammer and focus on what is said. This may be hard at times, but if your child does not seem to notice it then drawing their attention to it by asking them to slow down, say it again or breathe before talking may affect the way they view their talking and make their speech look and sound more unusual.

• If your child comments on their talking or is distressed, talk about it openly. Try to make it as easy as possible by saying something like “That was a bit bumpy wasn’t it?” and go on to explain that everyone can be bumpy at times. Even pointing out when you stammer will help reduce anxiety and stop the subject becoming “taboo”.

As with all stammering contact your local Speech & Language Therapy service for specific direct advice as soon as you can, as early help is very important.

Then at night just as you are dropping off – Ping! the name appears like magic, there all along.  It happens to all of us occasionally. Can you imagine that happening over the simplest of words in every sentence you wish to say? Frustrating is the word. Also imagine that you have no strategies to help someone guess the word you wish to say – you end up in silence or give up and move on. Some children live with this every day. For some it is part of a greater language difficulty; for others a result of lacking in vocabulary or learning a large amount of vocabulary suddenly.

These problems can make children difficult to understand as they use different strategies to overcome their difficulties. They might:

• Say a word that means a similar thing but is incorrect
• Say a word that sounds similar e.g. “telephone” instead of “television”
• Say a made up ‘jargon’ word e.g. “bubet” instead of “bubble”

These children are often referred to the Speech and Language Therapist because they cannot say the sounds in words correctly, but the cause is much more complex and the treatment very different. Children with word-finding difficulties often have lots of vocabulary, but it is like a messy desk with each word represented by a piece of paper on the desk. There is no order, or system in place to help locate the one piece of paper (word) they need. What Speech and Language Therapy aims to do is turn the messy desk into a well-ordered filing cabinet with cross referencing to help a child to locate a word or describe it easily when they are really struggling.

Therapy focuses on organising words into categories, syllables in words and the length of words, knowledge of first sounds in words, and rhyming words, and linking all this knowledge together. So if you think a child is hard to understand, please don’t just assume they cannot say their sounds. They could be searching for the right words to say.

Practice Principal Katie Khan was invited onto Tony Livesey’s breakfast show on BBC Radio Lancashire to discuss various aspects of Speech & Language Therapy.

In August 2009 Katie was asked back onto the show to offer advice and information on a range of topics including lisps, speech sound difficulties, comprehension and understanding, and the ways in which a therapist works to alleviate these problems. She’s still waiting for the call from Chris Eubank!

You can hear her first appearance, discussing stammering, here.

Practice Principal Katie Khan was invited onto Tony Livesey’s breakfast show on BBC Radio Lancashire to discuss various aspects of Speech & Language Therapy.

During her first visit she was asked about stammering, why it occurs and some of the techniques that are typically used to help people with this condition. Click the play symbol below to listen to this segment of the show:

You can hear her second interview about speech & language difficulties here.