Another 2 year old not talking

This morning,  I went to the home of Fred, a lovely two year old who isn't talking. He did say some words but now doesn't. Understandably his parents are worried. When I first qualified, parents would have been a little concerned BUT there was no internet so they couldn't google their problem. (Let's face it we all do and  we could all convince ourselves that we have a terminal disease if we check our symptoms in this way!)

The same happens for parents: there's so much on the internet about Autism that parents are drawn to this as the only reason a child might not talk. However, there are several reasons why a 2 year old isn't talking, not just because they have ASD. They might just have a delay in the area of speech, language and communication (there might be a family history), it might reflect overall ability, they might not need to talk as everything is done for them or a combination of some of the above. We have had an influx of referrals for younger children who aren't developing language as they should be. We like to have referrals as young as possible so we can put plans into place to help. Early intervention is vital.

We're interested in:

• Interaction skills, do they want to interact?
• What is their eye contact and non-verbal ability like?
• What is their attention and listening like?
• What is the level of the child's play? This gives us a good idea of overall developmental levels
• Do they understand what is said to them? We need to see if they understand word and phrases. There is a difference between situational understanding so of you have your car keys in your hand and you say 'Shall we go in the car?', they don't need to understand the words to be able to work out what's going on?
• What are they communicating without words? 
• How do they get their message across?

In Fred's case, his interaction and non-verbal ability is really good. His verbal understanding is age-appropriate. Play is developing well. He gets everything without needing to talk but is sensing the pressure to talk. There is also a family member who had language difficulties as a child. His functional communication is great!

We decided to do the following for 1 month:

1. To take the pressure off making him say things, so don't ask to repeat or ask too many questions in a story (handy rule 1 question to 4 comments). He is a very strong personality and knows whether the adult knows the answer so is unlikely to 'play the game'

2. Step up the opportunity for him to as make as many choices (non-verbal at the moment) see http://www.smarttalkersblog.com/2014/02/reasons-means-and-opportunities-choice.html

3. Encourage non-speech noises e.g. animals, vehicles etc  

4. Keep adding language to his grunts/noises adding what you think he'd be saying if he could talk, children learn by echoing to start with so need a model to echo

5. Use repetitive rhymes to hesitate on words to give him chance to add the approximation of the word (don't care how he says it just that he has an opportunity).Work out which songs and words so  both parents do the same.  

6. Make a word book of Fred's things and people using photographs

I'm going into nursery to discuss Fred's communication skills with them and to see what help they might need. We'll review him at home in 4 weeks and I'll keep you posted on how he gets on!

What to expect from your first speech therapy visit

The other day I was approached by a parent whose daughter had been referred by their Health Visitor to Speech and Language Therapy. This parent came across very anxious as she did not know what to expect, or exactly why her daughter had been referred. It then occurred to me that health professionals i.e.  a  SLT, Health Visitor, Audiologist, GP etc; need to bear in mind what it must be like for parents coming to our appointments.

With this in mind I would like to take the opportunity to let you know what to typically expect from your SLT appointment. However, it must be noted that SLT services vary across the UK, and between independent and NHS services. For instance, we at Small Talk SLT Ltd; prefer to see children in their homes as this is where they are most comfortable and relaxed.

A referral may have been made by your Health Visitor, GP or Teacher; or in some instances parents themselves may request a referral through their GP or Health Visitor due to concerns regarding their child’s speech, language and communication. You may have to wait some time for your initial appointment; however if seen by an Independent Therapist children are typically seen very quickly.

So what happens at this initial appointment?

Case History: typically a SLT will take a thorough case history of your child’s development e.g. when they first sat upright, crawled, walked etc; the ages they were when they first said their first word. They may enquire about any eating or swallowing difficulties, hearing tests or any difficulties encountered during pregnancy or birth etc. All of which provides an SLT with a holistic view of your child’s development.

Listen to parents concerns: a SLT will typically allow you time to explain any concerns you may have about your child. Or, explain why your child has received this referral e.g. his teacher is concerned about the production of his speech sounds; ‘k’ and ‘g’. Etc.

Assessment: the SLT will then carry out a range of assessments. Some of which may be informal, and can appear as though they are playing games with your child; or they may be more formal e.g. sitting at a table with a book and score sheet. The approach taken all depends on what your concerns are, what the child’s difficulty is, and their age and level of attention. Often, the SLT may need to further observe your child in another setting e.g. school, or home.

So for example, at Small Talk SLT Ltd, if we receive a referral for a child under the age of Five Years. We will make an appointment to see them at home, take a case history from the parents then spend time with your child to build a rapport and observe them in their home setting. We will then carry out any necessary assessments. The areas we are typically looking at are illustrated in the diagram; building blocks to language....

Attention & listening skills are the foundation blocks to your child’s language development. The ability to ‘listen’ and ‘look’ appropriately, and learn to focus their attention will form the basis of all learning. A child’s development of attention is sequential, a SLT will typically use a framework developed by Reynell (1977) to describe a child’s stage of development of attention control.

Play is a good indicator of a child’s general development e.g. physically, cognitively and sensory. It also provides an SLT with an indication of what symbolic level the child is at. Play is also an excellent way to assess and build a rapport with a child; then play can be used during therapy especially with under fives. How else would you motivate them?

Understanding (receptive language) is the ability to understand what someone communicates, either through sound (auditory), or visually (reading and interpretation of sign). A child’s receptive language skills can be affected by poor attention and listening skills. A child with difficulties in this area may have poor auditory memory, poor concept development, poor vocabulary, poor reasoning skills, difficulties with auditory discrimination, difficulty with interpreting complex grammar communicated by others, poor sequencing skills; and so on.

Talking (expressive language) is the ability to formulate a message into words and sentences; which can be spoken, written or signed. A child’s expressive language skills can be affected by their level of understanding e.g. poor vocabulary and concept development can affect how a child expresses what they did at school today. Speech production difficulties, a limited opportunity to communicate, lack of confidence, and motivation can also effect a child’s expressive language.

Speech Sounds, the physical production of sounds e.g. p, t k, d etc. are the ‘cherry on the cake’. The child’s ability to produce speech sounds are affected by the previous language levels; and, or physical difficulties e.g. cleft palate.

An assessment at each level will determine where a child’s therapy needs to target. For example, a child may be refereed due to poor intelligibility. However, assessment reveals that he has a very poor level of understanding. Therefore this area would be targeted first.

If you are worried about your child please see www.private-speech-therapy.co.uk

Georgina White

Specific language impairment: new series of AFASIC videos

AFASIC are working on a series of videos to look at speech, language and communication impairments. I look forwards to a day when everyone understands these issues!

Thank you to Damien and AFASIC for sharing this:

Help! my child is not talking

Are you concerned that your child's speech, language or communication is not developing as it should? Sometimes, if you don't see other children of the same age, you just don't know what is expected. Other times you may see others of the same age chatting away while your child isn't. How are you supposed to know whats OK and when you need to worry? When should you seek help? 

We strongly recommend that you seek help from a speech-language professional if your child:

By 12 months

• doesn’t babble with changes in tone – e.g. dadadadadadadadada
• doesn’t use gestures like waving “bye bye” or shaking head for “no”
• doesn’t respond to her/his name
• doesn’t communicate in some way when s/he needs help with something

By 15 months

• doesn't understand and respond to words like "no" and "up"
• says no words
• doesn't point to objects or pictures when asked “Where’s the...?
• doesn’t point to things of interest as if to say “Look at that!”  and then look right at you

By 18 months

• doesn’t understand simple commands like "Don't touch"
• isn’t using at least 20 single words like "Mommy" or "up"
• doesn’t respond with a word or gesture to a question such as “What’s that? or “Where’s your shoe?”
• can’t point to two or three major body parts such as head, nose, eyes, feet

By 24 months

• says fewer than 100 words
• isn’t consistently joining two words together like "Daddy go" or “ shoes on”
• doesn’t imitate actions or words
• doesn’t pretend with toys, such as feeding doll or making toy man drive toy car

By 30 months 

• says fewer than 300 words
• isn’t using action words like “run”, “eat”, “fall”
• isn’t using some adult grammar, such as “two babies” and “doggie sleeping”

3-4 years 

• doesn’t ask questions by 3 years
• isn’t using sentences (e.g., "I don't want that" or "My truck is broken")  by three years
• isn’t able to tell a simple story by four or five years 

If you’ve noticed one or more of these warning signs in your child, it’s important that you take action right away to ensure that he receives the help he needs.

Taken from the Hanen website which has useful info for parents as well as professionals. We are Hanen accredited SLTs www.private-speech-therapy.co.uk

My child isn't talking, why is this?

Written by the Admin team at YGOY

Most parents eagerly wait for their children’s first words. Hence, it can be worrisome and disappointing if they are slow and don’t utter those precious words. There are several reasons behind speech delays. However, the good news is that many children who seem to talk “late” catch up on their speech without any problems by the time they turn two years old. About one in four children is usually a late talker. Also, most of them don’t need any special help to get them back on the right track. Read on to know about the reasons behind speech delays.

Reasons Behind Speech Delays
Temperament and heredity can hinder in speech delivery, as can a eager parent’s anticipation of their child’s every single need rather than letting them speak for themselves. Here are a few reasons for speech delays in children:

• Boys – They mostly develop speech later than girls, even though there is generally 1-2 month lag. By 16 months, boys use only 30 words on an average whereas girls use around 50 words.
• Premature babies – Babies who are born early usually take longer to reach speech development milestones than others. However, by the time they turn two years-old, they catch up with other children’s speech development. According to pediatricians, parents should start counting from the child’s due date rather than his or her birth date, when they are analysing a preemie’sdevelopment. A premature baby born 3 months early than his or her due date might seem like a late talker but in reality it might be progressing fine.
• Multiples – According to speech-language pathologists, it is estimated that nearly 50% of all multiples have some form of speech delays. Medical intervention during delivery, low birth weight and prematurity can occur more frequently among multiples. This can lead to speech and language delays.
• Kids with chronic ear infections – If a child has fluid in the ear for months – more importantly in the first year when he or she is beginning to process language – it can lead to poor hearing. Thus, this may lead to delayed speech.

Of course there are other reasons why, such as they don't need to talk, an overall developmental delay, specific language impairment or even ASD. A Speech & Language Therapist would be able to assess and give advice. If you are worried contact your local NHS therapist or www.private-speech-therapy.co.uk


Our Teeny Talkers classes help 2 - 3 year olds who might need a little help www.smarttalkers.org.uk

There are some great articles at http://speechtherapy.ygoy.com

Tweet