How to support children with specific language impairment
The term speech, language and communication needs (SLCN) covers children and young people with a wide range of different needs. One condition that is often overlooked and misunderstood is specific language impairment (SLI).
- a fundamental difficulty solely or primarily with language
- a difficulty with expressive language, meaning that children struggle to formulate thoughts into words and sentences
- and/or a difficulty with receptive language, meaning that children find it hard to understand language.
SLI is not:
- a language impairment associated with another condition, such as hearing impairment, autism or learning disability
- a speech sound disorder
- a social communication disorder
- a problem with learning or using English.
As with other developmental disorders, it is not known for certain what causes SLI, but the evidence from research points strongly to a genetic link.
Children with SLI start talking much later than other children. Thereafter, their language continues to develop more slowly and is likely to contain noticeable inaccuracies well into their school years. For example, children with SLI often miss out words like “in” or “to” or endings such as “-ed” in “walked”. In time, their language usually improves to become adequate for everyday use but is rarely robust enough to cope with the complex sentence structures and abstract concepts that characterise the language used in later stages of education and many aspects of adult life. So it is important not to make the assumption that their difficulties have gone away, even if, as sometimes happens, the speech and language therapist discharges them at this point. Children with SLI continue to struggle with literacy, numeracy, higher level thinking and learning, organising and managing their lives and social interaction. They are also particularly vulnerable to emotional and mental health problems. As a result, it is important that the support needs of children with SLI should be continually re-evaluated in an ongoing cycle of assessment/re-assessment, intervention and review.
The impact of SLI on children’s ability to access the curriculum and learn effectively is often poorly understood. To get a better idea of the interplay between language and learning, it may be helpful to think about a toddler who is just starting to talk. His/her first words are usually names of people or things, but quite soon s/he learns to say “more”, if s/he wants another drink, for example. Gradually, through hearing and saying “more” in different contexts, s/he realises that the word has a general meaning of “a larger quantity” and has an opposite: “less” (or “fewer”). By now, s/he is probably learning some numbers and beginning to realise that five is less (or fewer) than six but more than four. By the time s/he starts school, s/he is ready to start learning the various ways that combining numbers result in a larger or smaller total. Learning this enhances his/her language skills by introducing the names and concepts of arithmetical functions into his/her vocabulary, and this, in turn, prepares him/her for the next stage of the curriculum. This cycle, in which language and cognitive learning reinforce each other, continues throughout the school years and beyond. However, this process works imperfectly in children with SLI, whose language skills are insecure and below the standard required at every stage of the curriculum.
Identifying children with SLI
Many, perhaps most, children with SLI will start school or nursery with some record of involvement with speech and language therapy, even if they do not have a formal diagnosis. However, some do fall through the net, and their needs may not always be immediately obvious.
Although children with SLI are generally aware from quite a young age that other children seem to have no trouble doing things that they find hard, they do not really know why this is, so are unlikely to tell you directly if they do not always understand you or cannot remember how to say something. Nevertheless, if a child consistently takes longer than other children to answer a question, is much slower at writing, or seeks help from other children, it is worth considering whether SLI might be the cause, especially if there is a positive family history and/or the child has had some speech and language therapy in the past. If so, it is worth talking to the child concerned. Children with SLI can indicate where they are having difficulties, but will need skilled support to do so.
These children are often very quiet in class, and are careful not to draw attention to themselves. They tend not to raise their hands to answer questions or ask for help, but instead take their lead from the other children in the class, They learn coping strategies to deflect attention, for example answering “yes” if their teacher asks if they understand what they’ve got to do, regardless of whether this is true or not, or even whether they know if it is true. It is simply easier than trying to explain what the problem is, and making the effort to really concentrate while the teacher goes through it all again. They might also be afraid of showing themselves up in front of the other children.
Some children with SLI will present with other difficulties with learning, for example, with reading. Some might avoid having to work by fidgeting constantly with their pencil case or schoolbag, or even by using attention seeking behaviour.
A number of professionals with different skills should be involved in supporting children with SLI. It is most helpful if they work together as a team to agree what support the child needs and how this will be delivered, ensuring that there is agreement on who will do what, when, and that there are no gaps.
As well as the parents and child, the professional members of the team are likely to include: the child’s teacher (at secondary school, it can be helpful to designate a lead teacher to oversee the child’s wellbeing and act as a first point of contact for the child and parents), SENCO, teaching assistant, speech and language therapist, educational psychologist and specialist/advisory teacher. In some cases, it may include others such as an occupational therapist.
In some areas, access to specialist support is readily available. In others it may be rationed or not available at all under some circumstances. With more SEN funding being devolved to schools, this is an excellent opportunity for schools to commission the support they need for their children. This might mean groups of schools or even individual schools drawing up contracts with providers of speech and language therapy. Schools working individually or together might wish to train a member of staff to specialist teacher standard.
The child will, of course, need support to participate in the team and will not necessarily attend full meetings, but his or her feedback about the sort of thing s/he finds hard at school, and what has helped him or her most, is invaluable and should be at the centre of any discussions.
Parents, too, have a vital role to play. As they spend more time with their child than anyone else and see him or her in a range of different situations, they are best placed to feed back on how s/he copes with them all. Their child’s behaviour at home can also reveal quite a lot about how things are going at school. If the child takes hours to complete their homework, and cannot do it without help, or is always utterly exhausted after a day at school, or very difficult for parents to manage in the evening, this would probably suggest that changes need to be made.
It is important, though, to bear in mind that parents may need substantial support to participate fully in meetings. Understandably, they are likely to be more anxious than the professionals, and may feel outnumbered by them. Perhaps it would be helpful to start the discussion with a chance for everyone to mention one area of progress they have seen recently and their main area of concern at the moment.
Working with parents
Learning that their child has SLI is likely to come as a shock to most parents and it can signal the start of an emotional rollercoaster ride. Parents may well feel as though they are being pulled in two directions, between the mainstream world and the special needs world, sometimes feeling closer to one, and at other times to the other, but not quite belonging in either.
Supportive professionals can, and should, do a lot to help parents feel strong enough to play their full part as members of their child’s team. The “structured conversations” offered by the Achievement for All programme, for example, can be particularly useful in making sure everyone is working towards a common goal. Do remember that there are other organisations that can help as well. Your local parent partnership service, local parents’ support groups, parent/carer forums and relevant charities can provide information and support and it is good practice to signpost them for parents.
Models of support
Children with SLI need to be taught the language content of lessons alongside the subject matter. This is, of course, true of all children but children with SLI need much more structured and systematic teaching than most, though actually what works well for them can be very effective with a wide range of children with a range of barriers to learning, whose language skills are often underdeveloped. This might include, for example, children with reading or behaviour difficulties.
It is good practice to pre-teach important new vocabulary ahead of lessons, especially any subject-specific terms which can have very precise meanings that may differ from general usage. Colour coding techniques can help children learn how to formulate sentences, and templates can be used to help them write stories and project work. Using a multisensory approach is particularly important, as this helps children to understand and internalise new information. Many children with SLI have a poor short-term and working memory, so frequent repetition and reinforcement is essential and needs to be built into the school day.
In addition, children with SLI need to be taught the social and organisational skills which will enable them to participate fully at school and make a smooth transition to the next stage of their lives. For children moving from primary to secondary school, this means being able to recognise when they need help and know how to ask for it, find their way around school and make sure they have the right books and other equipment with them. Young people leaving secondary school for college or work need to be able to travel independently, manage their own money, and negotiate their way through any difficult situations they may encounter. Children with SLI find it harder than most to use language effectively in a range of contexts, both formal and informal, and should be given regular training and practice in social skills groups.
Linda Lascelles is CEO of Afasic, a charity supporting children and young people with SLCN and their parents: