I am a speech and language therapist. AMA

[KeepSmiling89]

I like to have a browse on here during my lunch break at work and whenever I get a spare minute so please feel free to ask me any questions. Will get back to you when I can!

My 9yo may be having a neurodevelopmental assessment soon. They have said SLT is a must as part of this, largely I believe more to look at language understanding and social communication. He has no speech issues and speech developed perfectly normally. We've never had concerns around communication. Is this sort of thing within normal SLT remit? I've always thought it was more as for children struggling with communication eg mute or struggling with speaking and language. The involvement of a SLT in the assessment seems to be standard as opposed to specifically advised for him. I'm trying to figure out if it's entirely necessary as its £££ more and also more professional involvement for him.

Yes, absolutely. A big part of my caseload is children with language difficulties (receptive and expressive) and social communication difficulties so issues with initiating communication, interacting with others, understanding how others feel, emotional regulation, verbal reasoning skills. They'll probably want to do a full language assessment mixed with observations in clinic and school to gain a full picture if his skills. Sometimes difficulties are more subtle and might not be picked up even by those closest to the child (I.e. their parents). You'll know him inside out so it can be more difficult to see if he does need some support in different situations.
Are you doing this via a private SLT or can you get it on the NHS?

That is unacceptable.

Really interesting AMA thank you.

My nephew has a genetic disorder which means he will have learning difficulties and possibly autism. He will very likely find learning to speak difficult, but learning to communicate will obviously impact enormously his quality of life.

His parents have been advised to start with Makaton, and talk to him lots, which they would do anyway.

Do you have any other ideas which may help while he is still young for SALT?

He is 17 months old.

Hi keepsmiling

Could I ask if a 4 year old has pronunciation issues with g and c should I worry and anything you would recommend as a fun way to help? The g sounds like d and the c like t.

Many thanks

I'm pretty sure my little boy has tongue tie. Does this this affect speech? He can't pronounce some sounds.

Hi!
This is called velar fronting (sounds made at the back of the mouth are made at the front of the mouth) and a very common error in speech development. It usually resolves at about age 4/5.
Keep modelling the k and g sounds when speaking to her. So if she says "oh look, it's a tat" say "oh yes, it is a cat, it's a big/small cat" or "oh yes, the cat's sleeping" emphasising the target sound. She doesn't have to say it though. Just model it for her. If you want to practice, ask her to open her mouth nice and wide and let her attempt it. Can also help if she tilts her head back a bit to let the tongue fall back into position. Try in front of a mirror so she can see her mouth open and her tongue going back.
Don't spend too much time on it if she gets frustrated though. Just try it as a bit of fun. If you need more support, just get in touch with your local SLT service for some advice (don't know what other areas offer so this might just be a referral...you should be able to do a self referral)

How old is he and what sounds is he struggling with?
Tongue tie can impact speech sounds but not all the time. One sounds it can impact is "L" as this involves the tongue tip touching the top of the mouth and the tongue tie wouldn't allow the tip to reach this far.
When he sticks his tongue out, does it go into a slight heart shape (known as "bowing")?

He is still young but there's still plenty to do to support him. A lot of that involves coaching parents in using early language strategies to support language development.
Language stimulation and makaton are fab. Other things I recommend are:
Follow his lead in play - children are more likely to communicate when they're interested in something.
Create opportunities to communicate - put toys out of reach, only give one piece of a puzzle at a time, put pieces in a container they can't open themselves. This seems cruel but it teaches them that they need to communicate with you to get what they want. Wait and see what he does and respond when he let's you know he needs something (see next point for what to do next).
Respond to non-verbal means of communication - this includes when they give you eye contact, when they point, use gesture, put your hand on or take your hand to something or when they give sonething to you. When they do this, model at single word level.
Keep language simple - if your child isn't using any words yet, model at single word level, if they're using single words model 2 word phrases and so on
Use gesture and pointing (similar to using Makaton) to support understanding of language.

This kind of stuff forms the majority of my caseload these days!

Thank you very much for the detailed reply, really great. I'll pass it along. 🙂

Not sure if you see this very often.

My grandson, who has epilepsy, GDD and significant speech delay, (also waiting for grommets and tonsillectomy) had a significant seizure last week which left him very confused and with one sided weakness. He managed to stumble downstairs afterwards and was in a very poor state. The seizure wasn't witnessed but he was behaving as he does in a postictal state. The confusion and weakness lasted for a few days and resolved. His speech regressed.

He was just up to stringing three to four words together. These could only be understood by close family as the words didn't sound correctly pronounced. E.g. 'Nana bi tru ban me ed' - nana the big truck which my brother just threw at me banged me on the head.

He now has no speech at all apart from screeching 'mama' - he pronounced it mumma before the seizure. He blurts out sounds now which have no resemblance to words. He gets very upset/frustrated that no one has a clue as to what he's saying. He shouts these sounds at full volume - no control over volume.

He missed a day of nursery and when he went back the teacher said that he had stayed inside all day and wanted to sit in her knee. He had not attempted to speak but seemed to enjoy looking at books. He would normally play outside all day in the mud kitchen and come home 'caked' in drying mud.

His mum reported the seizure and its effects to the epilepsy nurse who, several days later, rang back to say that she'd spoken to the consultant and they wanted to see him today. They have just said that regression can happen.

We don't know whether he thinks he is speaking the same as before that seizure but he certainly does not sound the same. The difference is very concerning.

He saw a speech therapist six months ago who was convinced that he was simply delayed and 'it will come eventually'. He was pointing to objects in books during the appointment but not saying the words. He said 'woof', 'qua' (quack) and 'ba bye' to the speech therapist during the appointment. This does not appear to be the case now as what little vocabulary he did develop afterwards is completely gone.

Do we wait until his next review appointment comes through or is there a way to get in contact with the speech therapist and expedite another appointment? Will he be able to recover what he had?

He is three years and seven months. He is having increases on his second epilepsy drug at the same time as decreases on his first epilepsy drug. They don't appear to have worked up to now.

He is eating/drinking/playing/following instructions as normal. He still waves goodbye but blurts out a random sound whereas it was a clear 'ba bye' before.

Hopefully this is not permanent?

And never happens again?

It's just as if he had a 'brain storm' and wiped a chunk of memory.

My daughter said that the consultant didn't appear concerned.

Boys are more likely to require SLT input than girls and the majority of my caseloads are usually boys.
There's a higher percentage of boys with developmental language disorder (DLD) than girls as well.

No idea why but that's what all the research says and my own personal experience.

What are your thoughts on DLD? I’ve heard this being used as an ‘excuse of a diagnosis’ when nothing else can be found as a cause of language disorders but also the opposite as a valid explanation. Also conflicting opinions on if it can co-exist with autism.

Gosh this is amazing timing to see this.

My DD is currently awaiting her first SALT appt having been referred by the school. They've noted some issues with her speech clarity - for example she can't say yellow (she says lello).

They've also suggested it could help with her emotional language - I'm intrigued more about this. She is also being referred to OT and paeds due to struggling with her emotional regulation and sensory seeking behaviours. When upset she can't communicate at all - just screams no and retreats into herself.

I'm open to anything in order to help DD but I'm really interested to understand how SALT can help her develop her emotional language as the school have suggested. I've obviously googled but I'm still not really any wiser! Thank you!

Hi, my 6 yr old is waiting for ASD and ADHD assessments. I suspect he also has a PDA profile. He really struggles with emotional and social communication (and I've really struggled to argue for SALT involvement because he's very eloquent otherwise!) We've got an initial SALT appointment in a couple of months but do you have any general pointers for things I can do with him at home (currently homeschooling)? I find it really hard to get certain things to stick with him (like waiting for a turn to speak before info dumping, anything feelings or danger related). I sometimes use PECS with him when he's dysregulated but it's difficult to get him into using them when he's ok. Any insights helpful. And good luck with the move!

Thank you for starting this thread. Very interesting.

My DD is 18 months old and has a handful of words she says consistently. More, door, llow (yellow), Daaaad, ball, please. I have no worries at all about her comprehension or physical development. She can follow instructions and seems to understand most things I say to her. Emotionally she’s a very happy child.

I’m on the fence about if I should be seeking help for her speech? I don’t want to start an intervention if she just needs more time, but likewise if she needs some help then I wouldn’t want to disadvantage her. My DM is a teacher so am aware the waiting times are horrendous. Is it reasonable to wait a bit longer or would I be best to get the ball rolling?

I work with a lady who has Parkinson's. She was quite ill a year ago and was assessed by SALT in hospital. She has improved over the last 6-9 months and can manage food at a higher level. Her family aren't interested in getting her assessed again because she is so good but I worry as a carer that if she choked I could be held responsible. Is this correct?

I have a question I hope you can answer.

How does the motivation of the person you are working with impact the effectiveness of the support.

For example an older teen who has previously found engaging with SALT challenging but has now felt they are in a place where they are ready to accept support and is now very driven to improve their speech?

Hey, my 4 year old has always been an excellent talker. 300 words and full sentences at 18 months etc. She's pretty much always been understandable and clear. We've noticed recently she is changing the pronunciation of some words and almost stuttering a bit repeating herself at the beginning of sentences which she never did before. It's not all the time but she does do it, is this normal? I've not had anyone at preschool say anything. She starts school in September so I'm hoping that they'll pick up on any issues if there are any but I just thought I'd ask about it since you posted. Thanks if you get chance to reply :)

Flippant question here: why do all SALT sessions involve Pop-up Pirate? Is this something you get told to use at college?

My ds was really cross that he never got to play Pop-up Pirate, as his three sisters all had speech therapy, and thought it was great.

My dds, btw, are now late teens/early twenties, and have no speech issues. I think we were lucky to have NHS speech therapy. So many thanks to you and your colleagues.

It's an evidence based diagnosis for children with language difficulties that don't resolve by the age of 5 years old. Its definitely not an excuse but an explanation as to why these children are struggling. What else would we call it? It's invaluable for children, parents and education staff as it means they can put strategies to support these children on a regular basis. It can also empower children as they can say "I have DLD, and I need help" as opposed to letting them suffer without knowing what's going on and why.

In terms of links with autism I think there are a small minority of children who might have both but it is rare. In my own experience, children I've worked with have had either one or the other but not both.
It is interesting though as children with DLD would exhibit some social communication difficulties which would look like autism but it's because they have receptive or expressive language difficulties they might have behavioural issues or appear withdrawn etc.
It's very interesting and there's lots of info out there about it I'm sure!

Hey
At 3.5 it's not a cause for concern and a common speech error which usually resolves by 5 years old. If she's still got it at 5, try visualisation in front of a mirror pretending her tongue is a snake or lion to be kept behind the cage (her teeth).

Hope that helps!

How old is your DD?
I've got a 2.5 year old and she has some sensory seeking behaviours particularly when she's tired and before going to bed so we do a lot if rough and rumble play before bed (letting her climb on top of me, crossing a "bridge" of pillows, crashing into a pile of pillows). I follow an OT on instagram to help with this. She's called Courtney English and I love her ideas.
SLT can he'll with emotional regulation but depends on your child's age. There's sonething called the 5 point scale and zones of regulation. They're both colour coded and help children understand when they start to feel anxious and what to do when this happens before they reach boiling point. Just looked it up on Google and there's loads of pictures etc with explanations on this.

Hope this helps!

In terms of taking a turn when talking, try using a "talking object" (a stick/wooden spook or even a sign saying "my turn" or "I'm talking)" explaining that he can only talk when he's got the talking object.
When children are dysregulated it's VERY tricky to get them to use their usual means if communication so it's best to give them space or put into place strategies to help him regulate (does he like deep pressure/cuddles or is he better left to himself for a while?)
The 5 point scale might be more helpful so you can both identify when he needs strategies put into place before he becomes dysregulated and hits boiling point. Check out the 5 point scale on Google for info. There's loads of info and visuals you can print off and use straight away.

Hope that helps for now!

If you're on the fence, I would get in touch with your local SLT service for a bit of advice or do a self-referral. At least then, by the time her name comes to the top of the waiting list, she'll either have made progress or will receive the input she needs at the right time.
My 2.5 year old DD is currently on the waiting list in my area as she was a later talker. She's speaking more now and might well catch up but I feel comforted knowing she'll get input in about a year if she needs it. If she doesn't, she'll just come off the list and that's fine as well.