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Q&A with speech and language therapist Fiona Barry - ANSWERS BACK

(87 Posts)
RachelMumsnet (MNHQ) Wed 11-Sep-13 12:05:48

We're running a Q&A this week with Speech and Language therapist, Fiona Barry. Fiona will be answering any of your questions relating to children's speech, language and communication. If your child doesn't say much, mispronounces words, has a stammer, or you just want to boost their confidence and chatting skills, Fiona can provide practical advice on what to do at home. Post your questions to Fiona before midday on Wednesday 18th September and we'll post up her answers on 25th September.

Fiona has worked for the NHS with children who have speech language and communication needs. She also set up TalkingTipsForKids, a website and free app and Android app which helps parents boost their child's communication skills.

Fiona has developed a series of short films that give practical tips for parents worried about their child's communication skills, as well as for those who aren't but want to give their child the best start in life. The films are divided into age categories giving specifically geared advice for all stages of communication development. Starting with the baby in the womb and going right through to the 5 year old school child, Fiona shows how easy it is to fit language boosting tips into everyday routines. Each video also includes ideas for simple but fun games you can play with your child to help with their talking and listening skills. For more information see www.talkingtipsforkids.com

This Q&A is sponsored by talkingtipsforkids

mawbroon Mon 07-Oct-13 13:31:06

Thanks Rachel smile

RachelMumsnet (MNHQ) Mon 07-Oct-13 11:58:14

mawbroon

Hi Fiona, I have no idea if you will return to this or not. Thanks for your response to my query about tongue tie.

I need you to know that what you said about older children having to have revision under GA is not correct. There are a couple of dentists in the UK who have trained with Dr Kotlow who is a leading expert in this field.

They do laser revisions using only local anaesthetic. It is essential to have the patient awake during a revision, otherwise how can they assess tongue function? My son has had this done, so I have first hand experience of the procedure. He was fine, not at all traumatised and says he recommends that anybody needing revision should have it done because his tongue feels much better now.

I get the feeling that perhaps you are not up to date with developments in this field and are giving dated information to your clients which is a shame because as a SALT, you are in a prime position to spot tongue ties and help children who are struggling because of it.

You didn't answer my question about posterior tongue ties. Can you spot one? Often the tongue will look "normal" to the untrained eye and sadly many HCPs miss them.

I have had to dig and dig to find decent information for myself regarding DS1, basically the mainstream is woefully lacking in knowledge, sorry but it's true.

His ties went undiagnosed until he was 6yo and have caused no end of problems for him, including distortion of his orofacial structure and associated problems. There is a LOT more to this than speech and feeding.

If you are interested in further reading, I would recommend Carmen Fernando (she is a SALT), Dr Kotlow, Alison Hazelbaker, Dr Brian Palmer DDS, Catherine Genna Watson. For starters.

Yes, you say that tied kids can make the sounds required in English by positioning their tongues slightly differently. This is compensating. Compensating has knock on effects on the jaw/head/neck/shoulders in fact the whole body. Adults who have had revisions have talked about the instant relief of finally having the tension removed.

Imagine there was restriction in any other part of the body, I dunno, say your legs were tied together and only a doctor could free them. What would you think if a doctor said no, I'm not freeing the restriction,it's ok because you can shuffle along or maybe hop along with your feet together, OR WORSE STILL - no, the restriction in your legs is not the cause of your inability to walk properly. I don't know about you, but I'd be hopping and shuffling at top speed off to someone who could help me restore proper function in my legs!

It's no different with the tongue.

Hi Mawbroon, we'll forward your mail on to Fiona and let you know if she responds. Thanks

mawbroon Fri 04-Oct-13 21:56:23

Hi Fiona, I have no idea if you will return to this or not. Thanks for your response to my query about tongue tie.

I need you to know that what you said about older children having to have revision under GA is not correct. There are a couple of dentists in the UK who have trained with Dr Kotlow who is a leading expert in this field.

They do laser revisions using only local anaesthetic. It is essential to have the patient awake during a revision, otherwise how can they assess tongue function? My son has had this done, so I have first hand experience of the procedure. He was fine, not at all traumatised and says he recommends that anybody needing revision should have it done because his tongue feels much better now.

I get the feeling that perhaps you are not up to date with developments in this field and are giving dated information to your clients which is a shame because as a SALT, you are in a prime position to spot tongue ties and help children who are struggling because of it.

You didn't answer my question about posterior tongue ties. Can you spot one? Often the tongue will look "normal" to the untrained eye and sadly many HCPs miss them.

I have had to dig and dig to find decent information for myself regarding DS1, basically the mainstream is woefully lacking in knowledge, sorry but it's true.

His ties went undiagnosed until he was 6yo and have caused no end of problems for him, including distortion of his orofacial structure and associated problems. There is a LOT more to this than speech and feeding.

If you are interested in further reading, I would recommend Carmen Fernando (she is a SALT), Dr Kotlow, Alison Hazelbaker, Dr Brian Palmer DDS, Catherine Genna Watson. For starters.

Yes, you say that tied kids can make the sounds required in English by positioning their tongues slightly differently. This is compensating. Compensating has knock on effects on the jaw/head/neck/shoulders in fact the whole body. Adults who have had revisions have talked about the instant relief of finally having the tension removed.

Imagine there was restriction in any other part of the body, I dunno, say your legs were tied together and only a doctor could free them. What would you think if a doctor said no, I'm not freeing the restriction,it's ok because you can shuffle along or maybe hop along with your feet together, OR WORSE STILL - no, the restriction in your legs is not the cause of your inability to walk properly. I don't know about you, but I'd be hopping and shuffling at top speed off to someone who could help me restore proper function in my legs!

It's no different with the tongue.

StrawberryMojito Fri 27-Sep-13 19:18:48

Thanks Fiona, interesting articles.

HeatherMumsnet (MNHQ) Wed 25-Sep-13 16:33:59

Fiona's answers have now been uploaded. Thanks to everyone who posted questions.

FionaBarry Wed 25-Sep-13 16:28:22

Thank you to everyone who participated. There were similar questions, so I answered them together and have indicated this in my replies.

FionaBarry Wed 25-Sep-13 16:28:03

FutureMum

Please can you provide some tips to help encourage DD (nearly 3, ASD dx) to talk/babble in places other than at home. At the moment, the few words/ very occasional brief sentences she says are at home, which means during her nursery time or out and about she hardly says boo. Any tips to encourage her to say 'more' for requests?

To encourage her use of ’more’ try toys which have a definite end point (wind up or push and go). Play ‘ready steady go’ games where you say ‘ready, steady’ and wait for her to say ‘go’ before you start the toy. When it stops pick it up but do nothing. Just wait and watch – see what she does. She may look at you as if to ask for more (depending on her eye contact skills) or reach for the toy herself. When she does, you say ‘more?... you want more?’. If you know the Makaton sign for ’more’ then use that at the same time, shown here. Leave a pause for her and see if she attempts to copy your word or sign. If she doesn’t that’s fine.

Now model the phrase ‘I want more’ before you start the toy again.
Keep practising this and always leave a gap for her to copy you. Try the same in everyday routines like snack time
eg don’t give her a whole biscuit (unless this will be distressing for her), give it bit by bit
When she finishes one piece wait and see if she indicates she wants more. You can then model the ‘more’ and leave a gap for her to copy.

You may need to observe carefully if she doesn’t initiate communication much like many children with ASD. If so, start with something you know she finds highly motivating.

To encourage her to use verbal language outside the home you could start with nursery. Discuss this with staff, she may have a plan of targets already and this could be incorporated. Nurseries should have access to local health and education teams which would have all the advice needed to help her in their setting.

FionaBarry Wed 25-Sep-13 16:25:36

Beckyandboys

Hi, my son is nearly 7 and has been seen by a SALT for the last 2 years ( with much persuasion on my part for him to be seen). They have managed to get him to produce his 'K & G' sound but I've noticed him having trouble with his 'R' sound too, mainly sounding like a 'w', any advice on how to correct this without the constant battle and months of waiting for NHS SALT assessment would be greatly appreciated.

The tricky ‘r’ sound! A real uphill struggle for kids sometimes. It’s one of the later sounds to develop, usually mastered by about 5 years of age. Until this point most children use a speech process known as ‘gliding’, where ‘r’ is pronounced as ‘w’. This is a normal developmental speech sound process. It seems your son has not quite grown out of this stage yet, which makes sense if his speech sound system has been delayed.

You probably know the stages of speech sound therapy, he has to be able to say ‘r’ on its own before he can start practising it within words so bear this is mind.

My favourite tip is to ask him to roar like a lion ‘raaaa’, he may be inadvertently using a good ‘r’ sound. If so, then get him to practise shortening the roar to the first sound ’r’. If his ‘raa’ is more of a ‘waa’ then try getting him to say ‘errr’ then add a vowel sound to the end
eg ‘erraah’ or ‘erroo’
If his ‘r’ sounds good then you have a starting point. Get him to practise shortening the lead up to the ‘err’ so you get a neater ‘r’.

Practise in the mirror together so he sees how you do it and compares his attempts. Talk about how you make the sound, ‘my lips are round and my tongue lifts up to touch the roof of my mouth’. Keep it short and sweet. Stay with the ‘r’ plus vowel for a week or so then try words beginning with ‘r’. Don’t push this too much, he may need to see an SLT to get him to a point where you can carry on (make the referral now if you feel there’ll be a long wait?).

FionaBarry Wed 25-Sep-13 16:23:31

hazeyjane

My ds is 3.2, he has sn - gdd, hypotonia, severe reflux, swallowing problems (he aspirates causing frequent lung problems) etc. He is part of a study into a genetic condition called Kleefstra Syndrome - which he has a lot of genetic markers for.

He has a severe speech delay, which is consistent with kleefstra syndrome (where some children develop to be completely non verbal). He has no words, no babbling apart from a monotone 'unh' sound. His mouth is always open and his tongue protrudes, he has poor oro motor skills and drools (which is controlled by medication).

His understanding, whilst delayed, is much better than his expressive language. I have been signing makaton with him since he was 10 months old, and he now has quite a few signs. He was issued with a Go Talk communication device, as he is so good at using the ipad, that his SALT thought that AAC may be a good way forward if he remains non verbal.

I feel that ds has been sorely let down by the speech and language service. I don't feel he has ever had a thorough assessment, and apart from a videofluoroscopy, his oro motor skills have never really been dealt with.

He has now not seen a SALT since March when his GoTalk was issued, a lot of our provision has been to hand me a pile of signs and picture symbols and just get on with it.

After many phonecalls and letters, we are finally meeting a new SALT next week. So the questions I would like to ask you, are in light of this.

What should I be expecting in terms of support for ds?
How much SALT should be done by 1-1 at preschool?
Is there some sort of programme we should be following with the GoTalk (because frankly we are floundering!)
And finally - why do you think NHS SALT is letting down a child who has such severe needs in the area of speech and language?

Thankyou

It’s really sad to hear this. Of course, I’m unable to comment on your specific situation as I don’t know your child or the area you live in (re: SALT provision).

However, I can recommend this publication from The Royal College of Speech and Language Therapists (RCSLT) entitled Communicating Quality 3.

It sets out the professional standards that all SALT services should be adhering to. You may want to take a look at p229 re: Augmentative and Alternative Communication (AAC) regarding the GO Talk.
Look at p321 for standards on supporting with children with dysphagia (swallowing difficulties) and p351 which discusses working with pre-school children.

It’s not that reader-friendly but does set out the standards expected and you could use this in your discussion with the SALT service if you feel there is a mismatch between the guidelines and what you’re receiving. This RCSLT position paper on videofluoroscopy may also be useful.

With regard to the ‘Go talk’ it’s best to ask for more support with this as it’s not something that can just be switched on and off you go (as you’ve obviously discovered). The following places may be useful for you:
ACE Centre Advisory Trust
The CALL Centre

It’s good that you’ve got a meeting arranged with a new therapist – an opportunity to ask all these questions and find out exactly what your child should be receiving. If you’re still unsatisfied after this you could contact the NHS Patient Advice and Liaison Service (PALS). One of its functions is to represent patients who have a complaint or query about the care they’re receiving. This would be a good place to go if your discussions with the SALT service do not result in a solution you’re happy with.

FionaBarry Wed 25-Sep-13 16:18:50

StrawberryMojito

My DS, 2, has been slow to learn to talk, he is starting to pick it up but I think he is still behind his peers. I think he understands most things. Does being slow at learning to talk mean he will always be a slow learner? I am not bothered about him being brain of Britain but I would be sad for him if I felt he always struggled academically.

Basically, do late talkers tend to be less intelligent?

Good question! There’s been lots of research into this. Some research shows the size of a child’s vocabulary at age 2 is a strong predictor of later language and literacy skills.
Other research states that vocabulary at 5 years is a strong indicator of future qualifications and achievements.

Language is a fundamental skill that all children need to develop. Children with strong speaking and listening skills are more likely to make friends easily, do well at school, stay out of trouble and thrive in the workplace as adults. The whole of the school curriculum centres entirely on language. Teachers teach using words and sentences – (even Maths - think of all the different words for maths concepts like ‘subtraction’ - take away, minus, less). Academic achievement is linked to language skills because we pass knowledge on using language.

Your DS had been late to talk but now seems to be catching up, great news. By 2 children should be able to say at least 50 single words and combine these into 2 word phrases like ‘more juice’ or ‘bye-bye mummy’. Jot down all the words he can say so you have a rough idea. Listen out for any 2 word combinations. Also check to see if he can understand simple instructions eg ‘Show me your nose’ or ‘Find me your hat and shoes’. Our Ages & Stages video is also a useful checklist. If you’re concerned that he‘s not doing this then seek advice from your local speech and language therapy service.

The good news in all this is that parents are the key to unlocking children's communication skills. Evidence shows that how parents play and chat at home with their children is more important to language development than class, ethnicity, education or wealth.

FionaBarry Wed 25-Sep-13 16:15:40

goonIcantakeit

Why do you think there is so little information available to parents who want to help their child with receptive language delay?

I’m sorry to hear that you’ve found this a struggle, it shouldn’t be should it? Here are some resources - forgive me if I’m telling you things you already know, I’m not sure if you’re still looking or the age/specific needs of your child!

Leeds Speech and Language Therapy Service has a super-duper website with a whole section devoted to receptive language difficulties.
• [[http://www.amazon.co.uk/Receptive-Language-Difficulties-Liz-Baldwin/dp/1855034417/ref=sr_1_1?ie=UTF8&qid=1379693537&sr=8-1&keywords=receptive+language+difficulties Receptive Language Difficulties] by Liza Baldwin deals specifically with receptive language issues. It’s really aimed at teachers but is also useful for parents (although not for very young children).
The National Literacy Trust has a useful summary and set of strategies.
• A recent campaign called RALLI (Raise Awareness of Language Learning Impairments) – it’s been set up by leading academics in the field of Specific Language Impairment to support parents and professionals. There are a range of films dealing with language impairments including receptive language difficulties.
• Have you thought about using an app with your child? I use the Splingo App, it’s great for practising following instructions containing up to 4 or 5 key words including size concepts and positional concepts (not sure if this would apply for your child).

It may be that you’re not finding the information you want if you’re specifically looking for advice on ‘receptive language delay’. If you look at most sources of information for speech, language and communication needs (SLCN). Receptive language (understanding) and expressive language (talking) should both be included as well as phonology (speech), pragmatics (social skills) and fluency (stammering).

The recently formed Communication Trust has a great website containing information on all aspects of communication difficulties – receptive language delay being one area.

FionaBarry Wed 25-Sep-13 16:08:21

mawbroon

Hi Fiona, how much do you know about tongue tie?

Could you spot a posterior tie?

There’s a piece of skin called the lingual frenulum which attaches the underside of the tongue to the base of the mouth. Children are said to have a ‘tongue-tie’ if this piece of skin is very tight. About 3-10% of newborns have a ‘tongue-tie’ and it affects more boys than girls.

For some, the frenulum extends right to the tip of the tongue and restricts movement (can’t stick tongue out past lips or clean food from back teeth when older). The tongue can look heart shaped if very tight.

This topic is a bit controversial actually and advice can vary widely. Many say that the reduced tongue movement can affect latching on for breastfeeding in newborns. However there’s a whole range of reasons why feeding may be tricky in the early days such as positioning, restricted head movements or reduced muscle strength/co-ordination in the mouth. If a tongue tie is present many professionals automatically assume it’s the culprit.

Many also say it can cause a delay with speech production or affect how well a child can say certain sounds (like s,t,d,n – which all need the tongue tip to be able to elevate to just behind the top teeth). In reality even a tongue tied chid will be able to make all the sounds in English - their tongue positioning may be slightly different to an untied tongue, but the resulting sounds will be accurate enough. A speech and language therapist is the only professional who can assess your child and advise on this.

A tongue-tie snip or ‘frenotomy’ (a minor op) is often recommended –in newborns it can be done relatively pain-free and without general anaesthetic. With older children a general is used as it’s not possible to restrain an older child in a non-traumatic way.

FionaBarry Wed 25-Sep-13 16:06:20

NeoMaxiZoomDweebie

Hi Fiona....I am asking about my nephew who I sit for a lot. He is 3 and a half and is currently being assessed for High Functioning Autism. He's very bright and can count and recognise numbers to 30 and is starting to read but his functional language is behind...he can't ask for a drink or to join in a game....he has no real grasp of "under" or "on"....he loves people though and is sociable.

How can we help him to begin communicating his needs more? And to learn how to approach other children....currently he will just play close to other kids or if they leave, he might grab them. sad this doesn't help him when it comes to making friends.

His functional language is not good and he can’t join in play - a common issue for children with ASD. The National Autistic Society has some great advice on how to support social skills, so this is a brilliant starting point.

Everyone in your nephew’s life needs to be involved in this so support his parents to involve nursery staff (if he attends). Social skills are something that most children just pick up along the way but he’s likely to need issues like sharing and playing together explicitly taught and practised with him. His nursery probably has some experience with this.

Once given a diagnosis of ASD, or not, as the case may be, the health and education systems have teams in place which would support him eg speech and language therapy if required or nursery visits from specialist teachers to help staff support him.

Meanwhile, you can help by:
• Using clear and simple language with him (don’t use jokes, sarcasm or idioms like ‘cry your eyes out’, he may not understand these).
• In everyday situations, talk about the differences in what people like and think (this is tricky for children with ASD)
eg ask him to help you pick snacks out from the kitchen based on what he knows about family members’ likes/dislikes). This helps him think about what others think and like.
• Read books together and talk about what the characters are thinking/feeling.
• If a difficulty arises when he’s trying to play with others, talk to him openly but kindly about why it went wrong e.g. ‘Sam is sad because you grabbed him. He wants to stop playing now. It’s ok he’s still your friend’.

FionaBarry Wed 25-Sep-13 16:03:11

halfwayupthehill

Ds2.2 had a few words at around sixteen months, then stopped talking except for mama. He was eventually diagnosed with glue ear in the spring. This cleared up by the start of this month but he has never recovered the words he had and only says me or mummy. He has no consonents except for mmm and bbb. He does not copy eg. Animal sounds.
His passive understanding is fine and he seems to hear ok.
I am very worried.

Yes, I can imagine that you’re really concerned. Firstly, make sure his hearing is being monitored by the Audiology team to ensure normal hearing levels have returned. You say that the glue ear has resolved, but once a child gets glue ear they can be prone to recurrent bouts so do make sure the GP and Audiology are following him up. We don’t know if his hearing has returned to normal levels yet although you say he seems to hear ok. Some of the sounds used in speech are of a high frequency and only an Audiologist can check if he is hearing within all the frequency ranges needed for speech.

Even if his hearing is now ok it could be that he hasn’t had time to ‘catch up’ yet. By the age of 2 a child should have at least 50 single words and be joining them together to make 2 word combinations e.g. ‘Daddy car’ or ‘more milk’.

They should also be copying sounds and words form adults. You say that he’s not doing this and only has a few single words.

Refer him to your local speech and language therapy service, in most areas you can refer yourself without having to go through the GP. They’ll check his language skills and are used to seeing children with this type of problem. It’s important to ask for support now rather than leaving it as we know that early intervention is always best for language and hearing problems.

Thank you. I'll have a look at those links.

FionaBarry Wed 25-Sep-13 16:01:31

sweetiepie1979

Hi my daughter is 2.2 and has a vocab of 30 words. Sheuunderstands so much though and she can put 2/3 word sentences together. She babbles a lot and lives speaking on the phone and pretending to gave conversations. But I am worried about her pronunciation. For example milk and cot she finishes with a ch. I have not counted these in the words she can say. Any advice.?

She’s doing well! If a child is putting 2-3 words together in sentences its likely they have more than 50 single words. At her age it’s important to include all words even if they’re unclear or baby-ish (‘choo choo’ for train), we expect them to sound immature. It’s great that she’s using pretend play, it’s linked to language development so no worries on that score for her.

Speech sounds develop gradually over time during the preschool years and have a set pattern of how they emerge. Most young children make mistakes and this is normal. Roughly speaking by 18 months parents can understand 25% of what their child is saying, 50-75% by 2 years of age and 75-100% by 3 years old.

By 2 children use a limited number of sounds in their words and may miss the ends off words e.g. ‘cu’ instead of ‘cup’. By 2 ½ they will add a sound on but this may not be the right sound. This is probably what she’s doing now.

By 3 her speech should become clearer, but she may shorten longer words, e.g. nana for banana. Clusters of sounds where 2 or 3 sounds happen together will be tricky, e.g. ‘boo’ instead of ‘blue’ as well as other sounds like s, f, sh, ch, th, and l, r,w, y. It sounds like her speech is within normal limits for her age. You can help by repeating back words correctly to her so if she says ‘coch’ you say ‘Yes, it’s your cot’. Don’t ask her to repeat the word back. A good rule of thumb is to refer her if unfamiliar people can’t understand her by age 3.

Jellyandjam Wed 25-Sep-13 16:01:03

Thank you for the ideas, I will check out those links now. Yes we tend to work on the sounds being targeted by the therapist each week and like to add more activities on those sounds. Thanks again smile

FionaBarry Wed 25-Sep-13 15:59:43

Lorajay

I feel I should be a bit concerned about my 17 month old. She does babble, not so frequent with mama or daddy though I do believe I've heard her say them. She does seem to say one, two, three, go but only we could understand it. She does point and say 'what's this?' Not clearly, sometimes she doesn't even open her mouth to say it but just sounds it. I'm also pretty sure she can say hi and bye. Why I'm concerned is she just doesn't seem to be very clear, doesn't have many words and very rarely wants to try talking. My 3 year old talked so early and has great language skills and vocabulary. Am I being a bit premature at being concerned? Should I be doing something to encourage her?

My response to you and Keznel:

By 18 months children can generally say around 20 simple words (daddy, ball) and understand some single words like (shoe, car). They can follow simple instructions like ‘clap hands’ or ‘kiss teddy’.

Write down all the words she can say, even those that are mispronounced. If it’s a sound she uses that is consistent for that item every time then include it as well as ‘baby’ words like noises for animals (‘moo’ for ‘cow’).

Her speech sound system is in the early stages of development. The first sounds to emerge are p, b, t, d, m, w. Do you hear any of these in her babbling? Are you hearing strings of babble like ‘bababa’ or ‘goo-ee-yah’ with the sing-song style of adult talk? This is an important stage that comes before real words emerge.

It’s good that she uses pointing alongside her babble. Is she starting to use early pretend play like pretending to talk on the phone? If so, this is a good sign as pretend play is linked to language development.

Lastly, do you have any concerns about her hearing? Doe she have frequent colds? Sometimes children suffer from ‘glue ear’, an ear infection which causes periods of fluctuating hearing loss which can affect language development. If so speak to her GP.

If she’s not doing most of these things then refer her to your local speech and language therapy service. Our ?Wise Words? video has loads of tips to encourage language at this stage. You clearly know what you’re doing as you 3 year old is a chatterbox! Keep up the good work by playing, chatting, singing and sharing books with her.

FionaBarry Wed 25-Sep-13 15:57:02

Bronteshoes

Hello Fiona,
DS is 4 and has some issues with clarity of speech. His phonology and language are good, but he speaks quietly, quickly and tends to mumble. DH and I are quite attuned to his speech, but children tend to ignore him when he talks and adults usually smile and nod without acknowledging (to DS) that they can't understand. I sometimes ask him to repeat himself slowly and louder but he seems not to be able to monitor or adapt his speech (and I've modelled fast and slow speech etc.) He has no known issues with hearing. Do you have any ideas on what we could do to help?

This is a fairly common issue - are you sure he doesn’t need a phonology assessment? Sometimes parents are so ‘tuned in’ to their child’s speech they may ‘tune out’ speech errors. It’s possible that he’s making errors that are affecting his intelligibility but you’re not hearing them. I really like this articulation guide by Linda Welsh, for parents to check where their child is at.

There are no known issues with his hearing but it may be useful to get this checked as sometimes children suffer with glue ear, an ear infection which causes fluctuating hearing loss. Periods where hearing isn’t tip-top can affect speech development. Speak to his GP about this.

He‘s a bit too young to be aware or modify his speaking skills - even primary school aged children this difficult. It’s likely to improve with age. However you cold try the following to work on his volume and rate:

• Play games where you try being ‘Mr Noisy’ and ’Mr Quiet’, read the Mr Men books and find pictures to help with this.

• Let him see you being Mr Noisy and Mr Quiet – then let him try – lay out the Mr Noisy/Quiet pictures and drive a car nearer to Noisy or Quiet as he speaks to give him visual feedback on his volume.

• Try the same games with pictures of a hare and a tortoise for rate. Read the story then practise talking fast and slow. Once he can identify when he’s being too quiet/ fast practise in pretend play eg shopping.

Don’t expect generalisation into everyday talking straight away, it’s tricky!

FionaBarry Wed 25-Sep-13 15:54:25

Dysgu

My youngest daughter is 4.8 years old and has just started Reception. She is a happy, chatty girl at home but is VERY quiet in a school setting - this was the same at pre-school where she went for 2 years. She is a very well-behaved child and no one at the pre-school noticed that she did not tend to volunteer any speech. She would respond to a direct question and was never rude but was perfectly happy playing and doing what she was supposed to.

Her speech development was fairly normal although we were concerned as she did seem to be behind (but we were comparing with a very verbal DD1 who spoke full sentences by 18 months) and were reassured that all was fine. She made huge leaps forward when she reached the age of 2 (and started wearing glasses - linked?)

She mispronounces many words and sounds.
She misses off the beginning of words: computer becomes '-tuter'.
She mixes up b/v so very becomes 'bery'.
These are just two examples but her speech can be hard to understand even for her dad (who lives with us and is very hands-on).

She is bright and taught herself to read CVC words this summer as she knows all the letter sounds and can say them all individually.

When I asked pre-school about this (in April of this year) they accepted that they had not noticed it as she does not volunteer to speak. They did a lot of work, putting her in 'talk groups' to build her confidence to speak. She quickly became the demo kid in these groups as she CAN say all the sounds correctly, she just doesn't/can't in normal speech.

I spoke the to Reception teachers who are aware of things. But what else should I be pushing for? Should I contact our GP and ask for a referral or wait and see what school thinks? As I said, she is academically bright (as far as 4 year olds go: can read (at a simple level), count to 100, solve addition sums to 20) and I don't want her to go unnoticed because she won't make a fuss and will do everything she is told - and there are some much more needy children in her class.

Yes, the quiet child can get overlooked in the classroom! She sounds like a bright little button with some age-appropriate speech sound errors occurring. It could be that she’s finding it hard to due to shyness, what do you think as you know her best?

However, she may be displaying some features associated with a term know as ‘selective speaking’ (or Selective Mutism). Have you heard of this or considered it yourself?

This is where a child fails to speak in specific social situations (school) even though they are able to speak in other more familiar settings (home). It’s only diagnosed once a child has failed to speak for at least a month after they’ve started school/ nursery (although she responds to direct questions which is positive). It’s widely thought to be linked to anxiety rather than stubbornness (old-fashioned view). It usually starts between the ages of 3 and 5 and can have a gradual onset (starting as shyness) as well as sudden (triggered by an emotional event). It may be that she’s showing a mild form?

We’re seeing an increase in ‘selective speakers’ clinically. This may be due to an increased pressure to get our kids talking in schools (kids start school very young and teachers have targets for speaking in groups), some children are just not ready for this and need adults to expect less but support more.

Early support is essential. Talk to her teacher and share the leaflets on The Selective Mutism and Information Research Association or ?The Selective Mutism Resource Manual? by Maggie Johnson and Alison Wintgens.

Ask for a referral to see an Educational Psychologist to find out the root of the problem and advise on support, SLTs do not usually treat Selective Mutism.

FionaBarry Wed 25-Sep-13 15:49:34

StarlightMcKenzie

Hi,

My ds is almost 7 and has asd. He desperately wants friends and can start conversations with his NT peers by asking them how old they are and telling them his age. And then he gets stuck.

Sometimes children put up with him for a little bit but quickly move away as he'll ask another question that makes him appear odd like 'what boring things are you interested in' and he often gets laughed at as well as picked on by younger children who want to look 'big' in the eyes of his peers.

He is extremely capable of learning and, should I find WHAT to teach, he'd both work hard at learning and practice, but where do I start? What resources are out there to support him. In addition to his ASD he has been dx with a Speech an Language disorder over and above this and this manifests mainly in his expressive language (his receptive language skills are very good) which gives the impression that he understands a lot less than he does (and I understand is fairly unusual for children with ASD).

TheLightPassenger and HairyMaclary had similar queries.

It sounds like your DS needs some direct teaching on how to start, maintain and end conversations? Have you tried giving feedback to him on his communication skills? Make your feedback kind but direct – this will avoid him not understanding a point that you are trying to imply or infer. Try not to compensate for his difficulties by struggling to make sense of what he’s saying. Instead say outright ‘I don’t understand what you’re saying’ or ‘You’ve already told me about that’. That way he’ll learn ways to repair breakdowns in conversations.

Openly teach him how to choose children who might be compatible friends with similar interests. Some children with ASD assume that everyone is into what they are - help him narrow down his search. You could teach and rehearse with him a bank of scripted questions to use in conversations,
e.g. questions about people’s weekends or music/sport/TV

Carol Gray’s ?Comic Strip Conversations? could be really useful to highlight ‘good’ and ‘bad’ questions. Keep the language in the questions simple if his expressive language is particularly affected by his language disorder.

How about using an app? There are many that work on conversational skills for children with ASD. Autism Apps is an app which lists and reviews apps which would make your search a lot easier. Also, ?The Conversation Builder? is certainly worth looking at.

There are lots of board games available to work on this such as ?The Talkabout Game? by Winslow or ‘Communicate Junior’ by Super Duper Publications – here?s one of their videos showing how it works.

FionaBarry Wed 25-Sep-13 15:43:40

hedgerooni

Hi Fiona. My ds, 3.2 is outgoing, confident and chatty with an impressive vocab etc.. Two weeks ago he started stammering which has become progressively worse since. At its worst each word at the start of a sentence takes over ten attempts. The latter part of sentences come out fine, as does any singing or reciting stories from books. It feels that this has come out of the blue. What should we be doing to help him? Many thanks.

Here is my answer to you and Ohcrapwhathaveidone:

About 5% of young children experience some trouble with fluency as their language develops. For most of these children this will resolve, either with or without therapy. But for about 1% of these children problems will carry on into adulthood. Stammering can be really stressful for parents. It’s painful for them to watch their child struggling and stammering can come and go - because its unpredictable parents are often unsure of when to ask for help.

We don't fully understand the causes of stammering yet, but we do know that parents do not cause them. We also know that there are things parents can do that will help their child be as fluent as possible. Listen to your DS and give him plenty of time to finish what he wants to say in his own time – don’t be tempted to finish sentences off for him. Try to take the pressure off around talking by avoiding asking lots of questions and making sure he has time and space to talk to you without being rushed or interrupted. Try setting up 5 minutes of ‘Special Time’ in the day when you can play and chat with your child in this way. Our ?Champion Chat? video shows lots of these tips.

It’s best to ask for advice sooner rather than later. Preschool children can go through a normal stage of dysfluency as their skills are developing but if this continues for more than a couple of months, or if there is a family history of stammering, then you must ask for advice from a speech and language therapist ASAP.

These sites are useful: British Stammering Association and The Michael Palin Stammering Centre. It’s common for stammerers to find their stammer reduces when they’re reading aloud or singing (Gareth Gates is one of many examples).

FionaBarry Wed 25-Sep-13 15:39:07

Minimimimi

My DS is 2y2m. He is able to understand a wide range of vocabulary but is able to speak only a handful of words in English. (approx 25)
He has a tendency to invent vocabulary even when he knows its not the word. Eg. He calls aeroplanes eet eet, ducks quack quack ect. How can this be corrected? We always say aeroplanes and ducks but he seems to ignore us.
His obsessed with cars and have been saying cars for a few months, however recently his been calling cars, car b (have no idea why)

He does have difficulties pronouncing words, as when he wants a treat i would always get him to repeat please/ thank you- which he attempts but he doesn't pronounce it correctly.

We read a great deal at home and I limit the use of tv and iPads, even though my mil is convinced that every word which he has learnt were from those devices. Am I correct to limit the use tv and iPad?

My husband speaks English to him and I speak Cantonese with him during the day with a 30 minute mandarin session. He watches 20 minutes of CBeebies and 15 minutes of mandarin cartoon each day.

Should I be concerned over his lack of communication? Am I confusing him with the multiple languages?

Many thanks

You’re doing lots of things right! Recent guidelines suggest no more than an hour a day of screen time for 3-5 year olds and less than half an hour for under 2s.

Also speaking more than one language with your child gives him a great start in life. Benefits include: ‘thinking’ advantages (bilinguals can think more flexibly because they’re used to storing 2 or more words for each object/idea) and increased employment opportunities (we now live in a ‘global village’ and many employers actively seek bilingual candidates).

Many parents worry that speaking another language will make their child have a language delay. But there is no evidence that bilingual children learn to speak later. Some children, whether bilingual or monolingual, learn to speak later than others.

By 2 years & 2 months a child can usually say at least 50 single words and will be starting to join two words together e.g. ‘more juice’. You say he has 25 words in English – it’s important to know how many he can say in Cantonese and to establish his language levels in BOTH languages so refer him to your local service.

DO NOT stop talking to him in Cantonese (as long as this is your first language). Children need to learn their first words in the languages of their home. The Mandarin sessions may be less useful at this stage if this isn’t your first language, but it’s fine as long as the sessions are fun without any expectation on him to repeat words back to you.

FionaBarry Wed 25-Sep-13 15:37:23

turkeyboots

DS has had severe glue ear (now has grommets) and at almost 4 has very poor speech. Any suggestions now how to support him before starting school?

Speech therapist we saw just told us to talk to him... Like that hasn't occurred to us!

The advice I would give depends on whether your DS has had a recent speech and language assessment to establish if there is a delay.

However, you do say that his speech is poor – if this is the case and he hasn’t been assessed recently then refer him again– usually parents can self-refer but check your local service. Hopefully his hearing levels will be approaching normal limits again –make sure this is monitored by the Audiology team.

If his speech sounds are the problem then always say words back to him in the correct way if he says them inaccurately. Don’t to ask him to say the word back to you – he’s likely to say it incorrectly again –hearing a good speech sound model from you will really help. However, he may need specific speech sound therapy so do get this checked.

If it’s his language that is the issue (how well he can use and understand words and sentences) then the same advice applies – get him re-assessed. But you can do many things to help with his language at home which are explained in our ?Talented Talk? video.

Also practise lots of listening games – even if hearing levels have returned his ears may need to be ‘retrained’ to listening to sounds again. Have quiet times in the day when you listen to sounds around - who can hear the most and guess what they are (doorbell, car driving etc)?

Focus on speech sounds with him – lay out some toys and ask him to find a toy beginning with different sounds like ‘s’ or ‘t’. ‘I Spy’ is good too. Encourage him to look at you when you talk to him so he can watch how your mouth makes all the different sounds in speech.

FionaBarry Wed 25-Sep-13 15:34:33

Kewcumber

Another lisp question DS is nearly 8 and lisps "S" in all situations, he has other articulation problems (eg pronounces "bowl" as "boule") but we seem to slowly working on that between he and I.

I'm almost certain its not a physical issue as he pronounced S's in his first 6 months of speech then lost it.

He was delayed in speaking (about 3) for a variety of reasons - very premature (26 weeks) changed languages at 12 months from Russian to English and adopted from an institution (speech delays common in institutionalised children)

School have agreed for two years running that he should probably be assessed but still no referral. He no problem with general communication and is graded significantly above national average in "speech" of Speech and Literacy.

What exercises can we do at home for him - he is terribly self conscious about his lisp.

To complicate matters his front teeth have recently fallen out!

queenebay had a similar question.

Yes, this can be a real issue for the older child if they’re still lisping.

There are three types of lisp:
• A lateral ‘s’ which sounds a bit like the Welsh ‘ll’.
• The palatal ‘s’ where the middle part of the tongue raises to the roof of the mouth instead of just the tip.
• But the most common is the ‘interdental’ lisp where the tongue tip sticks out between the teeth instead of staying tucked behind the top teeth – ‘th’ instead of ‘s’.

It’s important to find out what type if lisp your son has. Lisps are very common and most children grow out of them - sometimes the arrival of adult teeth stops ‘Mr Tongue’ poking out in the case of the interdental lisp. When his teeth arrive that may help – in fact it might be a good idea to hold fire until they do.

We don’t worry too much about preschool children with lisps, but if it persists after this then it’s wise to seek advice from a therapist. You may only need one or two sessions just to establish what type of lisp he has and get him stared with tongue positioning.

A neat trick to see if he can say ‘s’ accurately is getting him to say ‘t t t t t t’ as fast as he can so it turns into a ‘ssss’ sound. This gets the tongue in the right place. Or you could ask him to close his mouth with his tongue behind his teeth. Now smile. Now blow out. Try it – a ‘ssss’ sound should appear.

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