Outlines of some of the main issues affecting children with speech, language and communication needs
As a speech and language therapist, it is not unusual when having a conversation with a taxi driver or other new acquaintance to be met with a series of familiar responses when discussing my line of work. I’ll often get, “Oh, I’d better be careful that I speak properly then”, said in their best attempt at Queen’s English, or occasionally the comment, “Is that for people who stutter then?” After spending a few minutes explaining that speech and language therapists don’t teach elocution and that I haven’t worked with Gareth Gates, I am then allowed the opportunity to share my experience of some of the kinds of children and young people I might work with, such as those with Down syndrome or autism, or where learning language is simply really tricky for them.
Of course, the situation is different when talking to fellow professionals working with children and young people with SEN, but is it different enough? Usually, most professionals have heard of speech, language and communication needs (SLCN) but their knowledge of how to identify and support these needs differs enormously, quite often meaning they lack the confidence to successfully support the children and young people they work with. This lack of knowledge and confidence is nothing to do with overall professional competence or interest, but usually a simple lack of access to appropriate and practical training and resources in this area.
A recent Workforce Survey, with over 1200 responses across sectors and spanning the educational phases, found that almost 60 per cent of health visitors had little or no training in typical speech, language and communication (SLC) development or in supporting and identifying SLCN. It also found that only 25 per cent of respondents working in primary schools felt very confident in their ability to support the SLC development of those they work with.
This is particularly concerning when you consider that SLCN is the number one reported SEN in primary schools and the fourth most common in secondary schools, and these figures don’t include those with conditions such as autism or ADHD who will also have SLCN as a co-occurring need. Additionally there is strong evidence to suggest that SLCN is under reported in both the primary and secondary sector.
Understanding and identifying SLCN
So what is SLCN and what are the most common causes? When thinking about this it is useful to firstly consider all the things we actually do when we have a conversation. There are a huge number of complex processes taking place, including:
- following non-verbal rules in communication – such as turn taking and eye contact
- paying attention and listening for sustained periods
- comprehending language, understanding the vocabulary and grammar
- expressing language, formulating the appropriate vocabulary and grammar to respond
- articulating the right speech sounds to relay this response and speaking fluently.
Difficulties with speech, language and communication can happen at any individual part or at any combination of parts of this process.
Sometimes, SLCN is clearly associated with an underlying or co-occurring condition such as hearing loss, autism, cerebral palsy or cleft palate. On other occasions, there is no co-occurring condition and the cause of the SLCN is unidentified, as may be the case in developmental language disorder (DLD) which was previously known as specific language impairment (SLI). The main message here is that these difficulties are common, with up to 50 per cent of children in disadvantaged areas entering school without the communication skills expected for their age and on average two or three children in every classroom having DLD, a clinically significant language difficulty which would benefit from long-term, specialist support.
Impact of SLCN
Difficulties with SLC can have far reaching consequences across the whole spectrum of a child and young person’s development. For example:
Comprehension difficulties may mean that the young person doesn’t understand the instructions given in the classroom, copies other people or displays difficult behaviour to hide those difficulties, becomes passive and misses out on learning.
Expressive language difficulties may mean that a child can’t share their ideas or opinions and that their message doesn’t come across clearly and that they can become frustrated and isolated.
Communication difficulties may mean that the young person interrupts and doesn’t make eye contact in a way that encourages good turn taking, meaning that others get offended and the young person has difficulty forming and maintaining positive social relationships.
Speech difficulties may mean that it is time consuming for the child to get their message across, that people talk to them less to avoid misunderstanding and the child can’t contribute and is excluded.
We know that the impact of SLCN can be significant and long lasting; for example, good vocabulary at 16 to 24 months, predicts good reading accuracy and comprehension five years later. Children who struggle with language at five are six times less likely to reach the expected standard in English at age 11 than children who have had good language skills at five, and ten times less likely to achieve the expected level in maths.
But the good news is that with the right support and services children and young people with SLCN can make good progress.
Identifying and supporting SLCN
For staff working with children and young people the most important thing is that any SLCN is identified and understood, so that appropriate support and services can be put in place. It is incredibly easy to misinterpret disruptive behaviour as an attention or behaviour difficulty, when a comprehension problem may actually be at the heart of the issue. Equally, the child who doesn’t speak up in class, who is “shy” and fades into the background may actually be the child who struggles to find the right words or to speak clearly and fluently.
In order to identify children and young people with SLCN it is essential to:
- know how many children to expect to have SLCN – understand your local population
- know the key components of language
- know what is typical SLC development at what age
- know what to look out for, in terms of warning signs or red flags
- have a whole school system for identification and tracking
- look beneath the surface if a child is not participating or progressing or is presenting with challenging behaviour.
We know that SLCN is common, so it should always be considered when addressing a child’s SEN. It’s also really useful to have a sound understanding of what typical SLC development looks like, and this can be challenging particularly in older children and young people, when skills are more complex and harder to monitor. Training and professional development which gives a good overview of typical SLC development helps staff to have an understanding of approximate “ages and stages” and gives them a good basis for identifying when there is a cause for concern.
When looking out for SLCN it is always worth starting by considering all the children in a setting and seeing if any “red flags” for SLCN warrant further investigation.
Signs of potential problems could be:
- poor literacy
- poor behaviour
- poor self-esteem
- children watching or copying
If you see any of these signs, ask the question: “could this be poor language at work?” All the above are red flags for language that is not developing typically.
Once you have identified the children and young people where investigation is required, you may choose to observe more closely or monitor them or use a non-specialist screening tool or assessment to gain further information. The child or young person could be helped to catch up or have the impact of any difficulties minimised by the provision of targeted support which adapts and modifies the environment or delivers specific interventions focusing on the appropriate areas of speech, language or communication. For some children, specialist support via a referral to a specialist professional or service will also be needed to get more detailed assessment information and put intervention plans in place.
SLCN in your setting
Any setting will benefit if all staff have an awareness and understanding of typical SLC development and SLCN. Through effective staff training and development, early years settings, schools and colleges can create an environment which both supports SLC development and actively identifies and supports any difficulties. A clear process for monitoring and tracking SLC progress is really beneficial. You should consider key questions at each stage of the process, such as:
- what is the process for flagging concerns in your setting?
- what role does the SENCO and/or senior leadership team play?
- who refers externally if this is needed?
- is everyone aware what to do?
- would it help to have a diagram to illustrate the process?
Tackling common problems
And finally, how does my conversation with the taxi driver usually end? Well, when I’ve explained what SLCN actually is, I usually get a response along the lines of: “Oh that’s what you mean. Yes, my cousin/brother/daughter/neighbour had a difficulty like that”. Because SLCN is well known really – we’ve all come across it at some point in our lives – we just don’t always know what it is or how to help. As SEN professionals and as an inclusive society, we all have a responsibility to take some time to really understand SLCN and provide effective support where necessary, and together we can recognise this very common difficulty and help all involved to reach their full potential.
Theresa Redmond is a lead professional advisor at The Communication Trust, a consortium of over 50 not for profit organisations and charities which have an interest in supporting SLC development and children and young people with SLCN.
Information and a number of free resources which can assist you in understanding and supporting SLCN can be found on the Trust’s website: www.thecommunicationtrust.org.uk
The author would like to acknowledge that the title of this article borrows heavily from a quote by Professor Courtenay Norbury in an article in The Guardian (1/11/16): “Developmental language disorder is probably the most common childhood condition you have never heard of.”
1: Duff, F.J., Reen G., Plunkett K., Nation, K. (2015) Do infant vocabulary skills predict school-age language and literacy outcomes? J Child Psychol Psychiatry; 56(8):848-56. doi: 10.1111/jcpp.12378. Epub 2015 Jan 4.
2: Save the Children (2015) Early Language development and children’s primary school attainment in English and maths: new research findings. London: Save the Children.