THERAPY FOR SCHOOL AGED CHILDREN

Learning to speak clearly is a vital part of a child’s development and will help them develop and master the rules of language required for success at school and within the community. Although the development of speech and language skills vary among children, there are certain milestones that provide a guide for tracking normal development. Generally speaking, for a child to develop more complex skills, these milestones will need to be reached by a certain age. At Care2Communicate these milestones help our speech pathologists determine the areas of communication your child requires help with. The following outlines how we can help.

Assessment

In order to understand a child’s speech and language needs a comprehensive assessment must be undertaken. This allows our therapists to tailor therapy to the specific areas your child is experiencing difficulties in. Assessment sessions are used to identify strengths and weaknesses across the following areas: articulation, phonological awareness, expressive and receptive language, pragmatics (social communication), voice and stuttering. These assessment sessions will be tailored to the child’s level of understanding, motivation and ability. A combination of informal and standardised assessment may be used to obtain a holistic picture of the child’s communication skills. 

Articulation and Phonological Disorders/Delays

Articulation and Phonological Delays/Disorders are very common in young children and can be overcome through implementing therapy programs focusing on building awareness of speech sound errors and utilising new techniques for correct production. Articulation is the way we shape sounds, syllables and words using structures such as the teeth, lips, tongue, palate and jaw to manipulate the air flow coming from the vocal chords. Articulation Delays/Disorders can be described by the child having errors for individual speech sounds. For example, the child may substitute, omit, add or distort sounds. There is not always a known cause of an articulation disorder, however, referrals to the appropriate professionals such as an ear nose throat (ENT) specialist or audiologist may be necessary to ensure there are no underlying structural causes that need to be addressed.

The following benchmarks are when your child should have acquired the following sounds:

0-3 years - t, d, m, n, h, y, w, b, p, g, k

3 1/2 years - f

4 years - l, sh, ch

4 1/2 years - j, s, z

5 years + - r, v, th

We also commonly deal two main types of lisps that we deal with: frontal lisps and lateral lisps.  A frontal lisp, also known as an interdental lisp, occurs when a child says the /s/ and /z/ sounds with the tongue coming between the teeth as it is pushed too far forward. This results in the /s/ and /z/ to sound more like “th”.  A lateral lisp occurs when the air air is forced over the sides of the tongue for sounds like /s/, /z/, and “sh” instead of out the front.  This will sound as though the child’s speech sounds slushy. Lisps can have a significant impact on the child’s ability to be understood, impacing on their confidence and relationships. The research also shows that lisps may also have a significant impact on a child’s literacy skills if it is not dealt with appropriately. 

A Phonological Disorder is seen in children who make a consistent pattern of errors with sounds that are not usually present in typical speech development. If there is a pattern identified for the incorrect production of a sound, then we know the child is presenting with a phonological process. This can have a significant impact on the child’s intelligibility and ability to learn and apply speech sound rules. Some examples are listed below:

· Final consonant deletion (omitting the ends of words): E.g. ‘cat’ pronounced as ‘ca’

Resolved by 3;3 years

· Fronting (bringing the sounds at the back of the mouth forward): E.g. ‘go’ pronounced as ‘to’ and ‘car’ pronounced as ‘tar’

Resolved by 3;6 years

· Weak syllable deletion (simplifying multisyllabic words): E.g. ‘elephant’ pronounced as ‘ephelent’

Resolved by 4 years

· Stopping sounds (difficulty discriminating and producing long versus short sounds): E.g. ‘soap’ pronounced as ‘doap’.

Resolved by 3 years

· Cluster reduction: E.g. ‘stop’ pronounced as ‘sop’ OR ‘top’

Resolved by 4 years

· Gliding of liquids: E.g. ‘rain’ pronounced as ‘wain’’ and ‘lolly’ pronounced as ‘wowy’

Resolved by 5 years

Receptive Language Difficulties (Understanding of Language)

Receptive Language is the ability to understand words and language including:

· Comprehension skills

· Ability to follow verbal and written instructions that increase in length and complexity

· Understanding of vocabulary and language concepts

· Ability to answer questions from others (Wh questions – where, what, when, how, why, who)

· Developing auditory memory

SIGNS OF A RECEPTIVE LANGUAGE DISORDER

· Child is appearing to not listen when they are spoken to

· Child is lacking interest when storybooks are read to them

· Child has difficulty understanding the meaning of words and sentences

· Child has difficulty remembering all the words in a sentence in order to comprehend what has been said

· Child has an Inability to follow verbal instructions; particularly if the instruction is long or complicated.

· Child lacks understanding of complicated sentences

Expressive Language Difficulties (Use of Language)

Expressive Language is the ability to convey or express information in speech, writing, sign language or gesture. It looks at:

· Expressive language in conversation – story recount, asking questions, exchanging information. 

· Sequencing – Tell and retell stories and events in a logical order

· Sentence structure – sentence complexity

· Grammar – Use most parts of speech (grammar) correctly (e.g. pronouns, plurals and tense)

· Narrative skills – Developing and structuring stories, creating plots, providing significant pieces of information, using metaphoric and figurative language to add to the complexity of the stories

· Expressive language in verbal and written work at school – Providing word definitions, explaining thoughts, reasoning and critical thinking skills through verbal expression, debating topics and writing essays, narratives etc. 

SIGNS OF AN EXPRESSIVE LANGUAGE DISORDER

· Child has difficulty combining words to form accurate phrases and sentences. 

· Child is using noticeably fewer words and sentences than children of a similar age

· Child is using shorter, simpler sentence construction than children of a similar age

· Child has a limited and more basic vocabulary than children of a similar age

· Child has difficulty putting words and sentences together to express thoughts and ideas

· Child has difficulty recalling words

· Child has difficulty using language appropriately in a variety of settings with different people (for example, at home, in school, with parents and teachers).

· Child is making grammatical errors, leaving out words and using poor/ incomplete sentence structure 

· Child has word finding difficulties 

· Child is using non-specific vocabulary such as ‘this’ or ‘thing’

· Child is using the wrong words in sentences or confusing meaning in sentences

· Child is relying on learned/rehearsed phrases and limited content in speech

· Child is sounding hesitant when attempting to converse

· Child is repeating (or ‘echoing’) a speaker’s words

· Child finds it difficult to get to the point, or talking ‘in circles’ (Paraphasia)

· Child is having problems with retelling a story or relaying information in an organised or cohesive way

· Child is unable to start or hold a conversation 

· Child is not observing general rules of communicating with others

· Child is having difficulty with oral and written work, and school assignments.

Pragmatic SKILLS (Social Communication)

Pragmatics refers to the way we use language to communicate with different people in various contexts. When children struggle with social skills, this can have a significant impact on their schooling, social and future work life. We can help with the following difficulties your child may experience in their use of language for social interactions, including:

· Turn taking

· Requesting (e.g. more information, permission, repetition)

· Commenting

· Limited verbal fluency

· Brief verbal contributions

· Conversation disruptions 

· Language may be less assertive, less persuasive, less polite, less tactful and less clear and complete than that of their peers

· Poor topic maintenance

· Identifying and repairing communication breakdown e.g. Asking for clarification

· Non-verbal communication (eye contact, facial expressions, body language

· Understanding social norms and adjusting interaction styles

· Drawing conclusions, making predictions and inferring

· Appropriateness of interactions for context.