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.
Georgina White
