Don't rely on the test score alone

I read this interesting article today which mirrors my beliefs: https://www.smartspeechtherapy.com/what-does-research-say-about-the-functionality-of-language-standardized-tests/

We cannot rely on standard testing alone, we need a measure of what the child or young person is doing in 'real-life' everyday, functional ways. As a great example, I've got an annual review this week where the 14yo has scored age-equivalently on everything on the CELF-4 BUT that does not mean he needs to be discharged.

I see him on a one-one basis where he sees me as an equal. There's no anxiety so I can push him to his absolute best, he wants to both please me and beat me at tasks. His memory has wikapaedic qualities! However, in everyday situations he cannot put his skills into place as he has auditory processing issues, anxiety, difficulty reading people's cues and clues and he acts as a much younger child (as a safety devise?). His anxiety affects his processing and his language and communication difficulties remain a huge barrier to accessing the curriculum, making friends and 'fitting in' with his peer group. Fortunately, he has a parent who knows all this and will fight to the nth degree to make sure he receives the support he needs.

I've also seen numerous children who score well on tests but in context cannot use these skills demonstrated in the one-to-one, quiet situation with the very nice lady/man who is skilled at getting the best out of children for the short time they're there. We only get a snap-shot of the child in that situation, at that time.

Instead of relying on just a score, we also make use of checklists and interviews with people who know the child best, so parents and teachers; we use tools such as the CCC2 and the Dewart and Summers Pragmatic profile. We also use a dynamic approach so we're looking at everything from the initial 'Hello' to the sight of the back of their head on the way out!

Formal assessments have a place, of course (I'm not stupid!) but we need to listen well to the important people in the child's life and be more confident in our skills as clinicians! What do you think?

Our new Speech, Language and Communication Centre is now open!

We are happy to have a new centre, to which families can come to see us from further away. We already have  families from West Yorkshire, North Wales, Sussex, Surrey and Buckinghamshire booked in. I've just taken  call from someone in France who wants to come too!

We will have an official opening ceremony soon but meantime here's a preview:

 Can you spot Ralph, the therapy dog waiting at the door. He's happy to welcome anyone but especially enjoys working with children with ASD and Selective Mutism. There's a safe place for him if you don't like dogs though.

 This is the reception area where you can wait with a coffee. There's toys and books for the children and magazines for the adults.

From reception you go through into the  therapist's room. Its full of toys but these can be screened off if they're too distracting.

This is the training room below but it's also a multi-purpose room as the tables fold away. We might use this room for very distractible younger ones or for older ones who don't want to be in a play-type room.

We are happy to see people from all over so please get in touch if you think there's anything we can help with.

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

Help! Im worried about my child's school report

Many of our children will be receiving their school reports this week or next, so I have included this blog post from the great team at Talking Matters. As they report, there are many reasons why it might not be good including language and communication causes. Read the post and see if it rings any bells:

School reports are coming out at this time of year and sometimes the results are not what parents or children hoped they would be.  Here are some things that might help if you are concerned about your child’s results:

If your child is having difficulties with learning checking your child’s vision and hearing is a good place to start. Make sure your child is assessed by a professional experienced with testing children. Your GP or child health nurse may be able to recommend a good audiologist and optician in your area. For more information about hearing tests log into plus.talkingmatters.com.au and look under “hearing and listening”. Children with a history of ear infections are at a higher risk of learning difficulties. Even a slight hearing loss in one ear can have a significant effect on your child’s learning. Often these can be treated easily so it is important to have these checked.     

Whether your child has a problem with vision or sight or not the next step would be to look at the way your child learns. Even if your child has new glasses or their hearing problem treated they would benefit from further assessment.  There may be other difficulties effecting their learning, they may have developed gaps in their skills and knowledge because of the difficulties they have had and they may need help to catch up.  A child who is one year behind in their school work will have to learn twice as much as other children to catch up by the end of the next year. This is more likely to happen if a child has specialised help targeted directly at the skills they need to develop.

Reading, reading comprehension, spelling and written language are all language based tasks.  A language assessment from a speech pathologist will tell about your child’s ability to understand and use words, sentences, grammar and concepts to communicate; as well as their ability to understand how sounds and letters work when reading and writing.  They can let you know how your child compares to others of the same age; what areas your child needs help in; and how they can get this extra help. Speech pathologists can also help with social skillssuch as understanding and expressing feelings, making friends and communicating with others in social settings.    

If your child has difficulties with handwriting tasks such as forming letter shapes, writing on the lines, writing quickly or neatly without getting tired; an occupational therapy assessment may be useful. OT’s can also help children who have trouble sitting still, keeping on task and concentrating.

If your child is struggling across all areas of learning an intellectual assessment from an educational psychologist can be a good place to start to pin point areas of difficulty and recommend strategies for home and school. Educational psychologists usually do an assessment and make recommendations but don’t usually provide regular ongoing support for a child’s learning; so do ask them to recommend a suitable professional who can do some regular sessions with your child to develop their skills.

If your child is having difficulties with behaviour a child psychologist can be of help to work with you and your child to manage these difficulties and can also provide strategies for school. They will also let you know if further assessment is needed in relation to underlying causes for behavioural issues.  

For more information on learning, literacy and language check our website talkingmatters.com.au  You can also download articles, information and activities at plus.talkingmatters.com.au on a range of topics about children.

www.private-speech-therapy.co.uk