I am an NHS speech and language therapist AMA

[starbrightstar]

Inspired by a similar-ish thread. AMA

Answer. Sadly no. Therapist can negotiate hours, which I have done on many occasions, but the decision firmly lies with the manager and/or the service lead.

I think you should seek a referral ASAP. Not to alarm you. The longer a stutter persists the more ingrained it can get.

I would warrant a referral to speech and language therapy. It does sound like he has some mild articulation and phonological errors but difficult to say without an assessment. But the fact that he is 5 and is still making those errors do warrant a referral.

he isn’t eligible to start until he is 3.4 years. If he is under speech therapy, can they request he starts nursery earlier than 3.4 years to help with his speech? Thank you very much

In the UK- no. I'm not sure about Scotland. However, we can make referrals if we feels a child benefits from a specialist nursery (i.e. ICAN) at a certain age. I would definitely ask your SALT.

Thanks for responding - that's really encouraging to hear. This thread is so interesting!

My nearly 6 year old has been in speech therapy for 30 minutes once a week for 18 months. Is this enough? He mainly has problems with pronunciation.

Dh can’t swallow after thyroidectomy and his vocal chords are paralysed.

Hes only 4 weeks post op but still in hospital, is it worth me pursuing private SALT for this? The nhs ones are still seeing him and giving him exercises to do.

'Most schools feel that SALT is the magic wand and we can help solve all their students difficulties. A huge amount of schools and I mean huge, are not willing or "don't have them time" to do the extra leg work to support their students or make changes to their environments'

Former NHS SLT here and just wanted to say that I heartily agree with this. Same for most parents in my experience. Everyone thinks it's a wonder service that will 'make children talk', as if the therapist has a magic wand (as you say), the child is a problem to be fixed, and all gets sorted without any input from anyone else who has a relationship with the child. I was a SLT for 17 years and just had to get out, for various reasons. It sounds like you genuinely enjoy your job, despite the very many frustrations. I'm genuinely glad for you. Those parents and children are lucky to have you

No-as it so varied because it's dependent on the needs of the child. Typically toddlers who are delayed in their language skills are expected to catch up when they are roughly 5 years of age. At this age group, it's more about increasing communication opportunities at home and implementing parent child interaction to support the young childs speech, language and communication development. This is different if you have a child who stammers who would be seen much earlier.

Hello! Children are expected to say the /v/ sound by 6 years but your son or daughter seems like he has some difficulties articulating some sounds which are acquired much earlier- like the /f/ sound. In this case, I would self refer to speech and language.

@littlebluetrain SLT as a profession is extremely diverse though. I work with adults who have swallowing disorders in a hospital - very medical / very acute / I've saved many lives - completely different to the OPs field. If you're interested in SLT as a career, there are SO many areas that have nothing to do with what the area you have concerns about.

Hmmm it may be worth seeking a private therapist who is trained and experienced in voice disorders. This is not my area or remit. 4 weeks post op is still too soon to determine whether therapy he is currently getting is benefitting but I have no idea. It you are still worried, it may be worth to seek a private therapist who is trained in Voice disorders.

Speech sound work typically needs to be worked on, for at least, times per week and adopting a little and often approach. It is expected that school staff will carry over and do the additional speech sessions. However, the SALT is expected to provide training to the school staff or designated person who is carrying out the therapy, on a regular basis.

@Fluffycloudland77 voice SLTs are amazing and usually can offer a decent service. A bilateral vocal cord palsy following surgery (did they cut the laryngeal nerve?) won't heal quickly - the fibres are like waiting for hair to grow - takes months. Quite often (as frustrating as it is) therapy doesn't speed that recovery up - but can help maintain function and learn compensatory techniques. Have a chat with the SLT treating him if you can.

Thank you for coming onto to the thread. What do you now do if you don't mind me asking. I do believe, as a service, we are very stretched but it's difficult as I don't believe this should dictate how much a support we should give to a child. I think schools need to take a huge amount of responsibility to support their students and not leave this entirely to the SALT.

@Li60

4 times per week it should say!

Thanks 😊 I love working with language so I do think working in rehabilitation after acute brain injury/stroke would be really interesting

@lowerlodges I don’t think they did no.

I read it was a slow process but they said everything is permenant already. He’s peg fed now. It feels too soon to write him off as we’re not old.

If his trachy gets blocked he can talk, not like before but easily understandable.

Thanks for this. My son is 4years 3 months. We have just started private therapy in addition to nhs so 30-40 minutes a week between the two. The private therapist initially thought apraxia of speech but recently thought again and now thinks he has a problem with retaining the words so homework has been lots of repeating the same words to lodge them in his memory. Current goal is to work up to 50 functional words and hope this will be a threshold amount as a base to trigger his language development. He has until recently struggled with speech sounds but we have been working on this and had some improvement. He has always hit his milestones late. He can say perhaps 10-15 words correctly so strangers could understand.

My question is, is this an indicator of any other development issues? There are traits of autism in the wider family. He never babbled. Communicates relatively effectively using gestures, simple sounds etc. No obvious red flags seen according to the professionals. I suppose I am asking what his prospects maybe according to your experience with similar cases.

His understanding is good, nearly where it should be. He starts school in september and I am very concerned that he will struggle socially and with learning generally.

Hello :)

Again. It is very very difficult for me to say without seeing your child and conducting an assessment.

In practice, a child who has difficulties retaining words either have a learning disability and or a language disorder. But your son is still quite young to determine whether he has a language disorder or a learning disability (in my opinion).

If you are worried about his general communication skills has the therapist assessed this?

Hi starbrightstar, I've worked in a non clinical corporate NHS role for the past 4 years. It's a much better fit for me, and I haven't missed clinical work for one second since I left! I have huge admiration for front line clinicians- it is so tough, never enough of anything (staff, time, resources), and the demands are never ending

Could not agree with you more about schools needing to take more responsibility, but would include parents in that too.

How interesting! If you don't mind me asking. What non-clinical stuff do you do. I did consider going into research after a few years in the field but we'll see.

Parents are a tricky one. I blame more the service and the schools than the parents. I find that parents are not only frustrated but have no idea how to navigate the SEN system- and that's not even including parents who first language is not English and have their own need. Not only that but very few clinicians tell or inform parents what they are eligible or are entitled to. But I do agree, in a general sense, that parents should not rely on a school and/or a service to support their child but again this comes with the above issues.

@starbrightstar ilo is inducable laryngeal obstruction, or vocal cord dysfunction as it used to be called.

I'm under resp for asthma. He picked it up and refered me to SALT for that. It's something he says a lot of asthmatics have.

They refer to mine as severe. I always wonder what makes it severe, but not enough to remember to ask.

@Unsure33 I’m an adult SLT. For your mum I would advise looking for an SLT trained in LSVT (Lee Silverman Voice Treatment) - it’s designed for and is an evidence based treatment specifically to increase volume of speech in people with PD. I am trained in this (though don’t practice privately.) My NHS trust offers this as a treatment. If you want to DM I can look into treatment in your local area.

Thanks for starting this starbrightstar.

DS is 3, and I've found it fascinating watching his language develop. Could you recommend any books / resources that explains how language is developed?