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Original poster

I'm a paediatric speech and language therapist... AMA!

264 replies

SpeechandLanguageTherapist · 28/01/2023 18:30

12 years NHS experience working with children aged 18 months to 18 years.

Acutely aware that actually being able to speak to an NHS therapist these days is getting harder and harder.

Happy to answer anything I feel able to - I've worked with most areas of need over the years, but if not in my remit I'll say I'm not sure 😊 Maybe someone else who has more experience will be able to answer instead.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:37

Finlaggan · 28/01/2023 20:13

DS 10 still doesn't pronounce L properly (uses a W sounds instead) he can make the L sound but doesn't. Will it rectify naturally? Thank you so much

At 10 I'd say it's unlikely to resolve spontaneously.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:39

Monkeyrules · 28/01/2023 20:17

Why did you choose paediatric instead of adult speech therapy? How did you know which type you preferred?

When you train you cover both, so I had both paeds and adult placements and am qualified to work with either. I really didn't enjoy my adult placements. Personally I found them too depressing (lots of death and dying) and very different to the joy of working with little ones.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:41

Haribo16 · 28/01/2023 20:18

How easy is it to unlearn an incorrect way of speech. My son had a massive speech delay which coincided with covid so never got to see a speech therapist. He is 6 almost 7 and has issues with his 'r" sounds but it's mostly his "s" sounds which actually come through his nose. Any ideas of things we can work on to correct this. Thanks 😊

If his 's' sound is being produced out of his nose he needs to see a speech and language therapist. That's very unlikely to resolve without specialist input.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:43

doadeer · 28/01/2023 20:20

I've been so deeply shocked at how minimal the support is for my non verbal autistic child who is 4. We have two short blocks a year where the SLT just tells me to do everything we are already doing. Do you think it's just a case of patience, can experts actually help in this case? Or would it only help if we say someone much more often? What can be achieved by such little contact?

So sorry to hear this. No it's not a case of just wait and see with a non-verbal autistic child. Do you have the means to seek private therapy? If so, look for a therapist who specialises in non-verbal children with complex communication needs.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:46

Zeebeededodah · 28/01/2023 20:20

Ohhh - would love your opinion on my child. Has moderate to severe hearing loss in one ear - doesn't hear the high and low sounds. Doesn't enunciate all sounds with a bit of a "lazy tounge" (as mentioned as a pre-schooler pre diagnosis), especially r's. Child is now 10 - would speech therapy benefit?

Obviously under NHS for hearing but SLT is hard to get and not sure it's severe enough to justify under current climate. Lucky to be able to afford private just haven't wanted to rock boat as child happy, would hate for them to be conscious later in life and not stepped in earlier!

Thanks - sounds like a rewarding job

Who used the phrase lazy tongue?! I'm not even sure what that means!

If you have the means you might as well take your child for an initial assessment and see what's said. It's hard to give any specific advice without hearing the child's speech.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:50

Hoowhoowho · 28/01/2023 20:21

How should a parent support a child with a developmental language disorder?

What do I need to ask/understand to help him?

Are there any resources/books you’d recommend ?

Wow, such a big topic. Are you aware of RADLD? If not, take a look at their website. Is your child receiving regular SaLT input?

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itsgettingweird · 29/01/2023 06:51

Do you just look at speech and language at face value or do you look at how the language is used?

My ds has asd. He's now 18!

One of the assessments he had from a SALT was full of praise about his SAL. About how he could discuss his holiday to X, what he did etc etc.

Except he'd not been on that holiday yet, the activities are things he liked and was looking forward to from the social story type preparation we'd done. The timescales were years out - last years trip he discussed was years previous to that for example.

None of the information was incorrect he just didn't (he's still terrible at!) understand that things like timescales etc being accurate matter in communication to get the point across because others don't know that information just because he does!

Took me months of trying to actually get them to understand he may speak beautifully and apparently way beyond his years but the words don't actually have much meaning in reflecting reality!!!

I'd really like to know that things have moved on from the days of him being refused salt input "because he speaks well" to actually supporting children to understand the importance of language as well as speech?

Original poster
SpeechandLanguageTherapist · 29/01/2023 06:54

Rosiefifi · 28/01/2023 20:21

I'm a HCP so have a keen interest in the MDT. What percentage of children with language delay turn out to have a learning Disability? What percentage of language delay is down to neglect ?.

Thank you

I can't give a percentage I'm afraid, but language delay is not usually due to a global learning disability. It's one of the less likely causes in my experience.

In the vast majority of cases, language delay isn't caused by neglect, or anything in the child's environment. In cases of extreme neglect, this can result in language difficulties. But it would never be a conclusion we would jump to without evidence to suggest it's the case.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 06:57

Whowhatwherewhenwhynow · 28/01/2023 20:23

Can there be a generic cause to SAL needs? I had SALT as a child and both of my children did too. We all have a very good level of intelligence and comprehension but it was the actual clarity of our speech that was an issue. We spoke and read loads to our children, and despite feeling paranoid that maybe my children were picking up my bad speech, I’m told I speak normally.

Are there just some families where clarity of speech comes later than usual. Both my children now are above average in their speech and use of language- yet at 4 were not able to be understood by adults they didn’t know.

Yes, there's a strong genetic link to both speech and language difficulties, and communication difficulties and disorders tend to run in families.

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ELW85 · 29/01/2023 06:58

My DS 2.10 uses pronouns well 90%+ of the time but he still might occasionally mix them up. Is this normal?
Also, I think he’s got typical developmental immediate echolalia which has dropped off a cliff in the last few months (it’s at the point where he doesn’t do it anymore unless it’s a brand new word or concept but even then not all the time) but when he’s going through a language burst he’ll do it more for a couple of days then stops. Is that typical?
I have seen his friends (older) repeat in the same way he does and he has no delayed echolalia at all.
Finally, he’s really good at stringing sentences together and holding a back and forth conversation but I don’t understand why he doesn’t always use acquired words in his sentences.
eg he’ll say “I don’t like it” but only rarely says “I don’t want it” but will often say “I want x”

Thank you for all you do!

Original poster
SpeechandLanguageTherapist · 29/01/2023 06:59

LemonDrizzles · 28/01/2023 20:24

There are a number of sounds my 3 year old cannot make. Any video that help show bridge sounds to get to the actual sounds?

Sorry I'm not sure of any videos that might help. Have you checked whether the errors they're making are age appropriate (there are lots of sounds that it's normal for a 3 year old not to be able to make)? Have they been referred to SaLT?

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freezingpompoms · 29/01/2023 06:59

This is a wonderfully interesting thread.

I'm interested in how vocabulary is acquired. I kept a list of my eldest child's words as they added up, right up until they were two. I just did it for fun as her speech seemed off the scale. By her second birthday I stopped as she had over 500 words and full rambling sentences and made up stories.

I thought that was incredible but maybe I was being biased at my precious first born.

My youngest child has had mainly the same home life experience except she had a sibling to play with and not just me. Also my speech was being directed more to the oldest child so not at a baby level.

At 2 the youngest had 50 words so quite normal for their age but very different to the eldest. I know all children are different.

My questions are:

Have you heard of children being so fluent on their second birthday?

Is there evidence that younger siblings have slower language acquisition?

Original poster
SpeechandLanguageTherapist · 29/01/2023 07:00

Monkeyrules · 28/01/2023 20:24

How hard is it to get accepted on a speech and language assistant apprenticeship? Is this route just as competitive as applying for a degree and doing the full qualification?

Sorry I have no idea about the apprenticeship at all. It's very new!

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Original poster
SpeechandLanguageTherapist · 29/01/2023 07:02

Rovinonmars · 28/01/2023 20:32

@PaPaturday the 'j' sound is just d-y together. For example 'd..yam' for jam. It's just that we say it faster. You could try working on j words like this for a while, slow it down and see if it helps at all.

Unfortunately not quite. 'J' is the sounds 'd' and 'zh' (as in treasure) put together.

@Paturday

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Original poster
SpeechandLanguageTherapist · 29/01/2023 07:05

RosesAndHellebores · 28/01/2023 20:35

Do you think lazy language such as teaching babies to say "ta" rather than thank you leads to language development problems.

Also how many children with significant ear problems but clear language despite it, are overlooked?

I wouldn't recommend it, but it's unlikely to lead to communication needs in a typically developing child.

And I have no idea as we would never come into contact with these children!

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Original poster
SpeechandLanguageTherapist · 29/01/2023 07:07

DoctorDonna20 · 28/01/2023 20:36

How do your prepare patients/parents for the sudden drop in service when they enter adult services when there is no longer maintenance therapy and only goal related input?

Honestly, we don't...

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Original poster
SpeechandLanguageTherapist · 29/01/2023 07:09

MotherOfDragon20 · 28/01/2023 20:36

26 month year old easily has over 300 words and can say up to 7 word sentences but struggles with answering questions other than yes and no questions
eg.

what did you have for lunch at nursery today?
yes!!
did you have spaghetti
yes! I love spaghetti! I had spaghetti at lunch.

age appropriate?

Completely normal at 26 months! Sounds like they're doing very well!

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Teddybearspicnic3 · 29/01/2023 07:54

My little boy will be 2 in March. Currently under ENT and awaiting grommets. He had his hearing checked a few weeks ago and struggles to hear at a big and low pitch according to the test. I feel he's very behind with his speech- currently says Dada, Nanna, car, all gone and no. Seems to have a decent level of understanding. We've been referred to spoech and language twice (by GP and HV) and they have refused the referral but wouldn't give a reason. His ENT consultant was shocked that they declined the referral. Would you suggest pushing for another referral now or waiting until his grommets have been done? Also any tips on how to help with his speech- currently read to his as often as possible and constantly pointing out things and naming them. Thankyou :)

Original poster
SpeechandLanguageTherapist · 29/01/2023 07:56

Mummatobefeb2022 · 28/01/2023 20:39

Sorry I'm a first time mum here. My daughter will be 1 next week and she kind of babbles, noisily squeals, grunts etc but has shown no interest in attempting to repeat words (dada, mama etc). She will look at me when I say "can you say.....) but then just looks away or makes a random noise. She can understand these words but is the normal? And if it isn't, is there anything else I can do to encourage her? I talk to her all day long Smile

Show quote history

She's not even 1 yet, please don't worry! First words tend to come some time around the 1st birthday but there's very normal variation of a few months either way. Talking to her all day long is perfect!

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Original poster
SpeechandLanguageTherapist · 29/01/2023 08:00

Gagagardener · 28/01/2023 20:39

5-y-o grandchild, who seems fairly bright, was born with cleft lip, jaw and palate. GC has had three ops to repair lip and palate; because of concerns over hearing, grommets were also fitted. Third op and grommets were delayed because of Covid; speech therapy was postponed until after third op. GC now has speech skills that lag well behind language skills, and does not seem to have close school friends.

(Even mum cannot always make out what is being said, and this is in part because GC wants to use big words and complex sentence structures.)

With such a history, how much professional input do you think is needed? GC now has fairly frequent appointments with speech therapist attached to cleft team, but each visit results in loss of at least half a school day. I wd be happy to pay for private therapy, if appropriate therapist cd be found. Might such a speech therapist be willing and able to see child in school?

Advice, please..

It's important she carries on seeing the cleft specialist SaLT even if that is alongside a private therapist - they should work together to come up with a therapy plan. She may well benefit from more regular input, so if you have the means to seek private therapy then there's no reason not to. Try to find someone with experience working with cleft related speech disorders. A private therapist should see her in school or at home outside of school hours.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 08:01

LicketySquid · 28/01/2023 20:54

How long would you expect it would take for a child to catch up after grommets surgery? He's turned 3 late last year, had grommets put in at 2yrs 7month. Speech has picked up but I'd say he's still about a year behind peers. He's attending SALT weekly, just hoping he picks up before school starts next year

Hard to say - I've seen some children whose development has exploded once their grommets have gone in. Others can be slower to progress and need more support. Great that he's having weekly SaLT input!

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WellTidy · 29/01/2023 08:42

Thank you very much for your reply @SpeechandLanguageTherapist 😊

Original poster
SpeechandLanguageTherapist · 29/01/2023 09:28

LicketySquid · 28/01/2023 20:56

Also, in your expensive can glue ear mimic autism? There were a few concerns which have now largely disappeared as his speech and general responsiveness have improved but just wondering if glue ear is sometimes mixed up with autism

There might be some similar traits between glue ear and ASD like not responding to their name and a language delay, but there are lots of traits we might expect to see in ASD that definitely couldn't be attributed to glue ear. An experienced practitioner knowledgeable about ASD would be unlikely to confuse these.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 09:31

AnuSTart · 28/01/2023 20:57

My 7 year old is bilingual but can't say sounds in one language and it's really causing friendship issues in school.

Like 'loff ness' instead of Loch Ness.

'Ish' instead of 'ich'.

Vaaarzen instead of raaasern

(German and English)

Is this a bilingualism issue which will solve itself or should I be worried?
Getting a SALT here is hard and I wondered if I am over-worrying.
Thanks so much!

Unfortunately as these aren't speech sounds we have in standard British English (including the ch in loch, as I've never worked with Scottish accents) I really can't comment. I know nothing about the typical development of these sounds. Sorry.

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Original poster
SpeechandLanguageTherapist · 29/01/2023 09:43

WhatIsNapTime · 28/01/2023 21:02

Hi, I'm not sure if this is actually a speech area or an autism area but my ds is 5 next month and has autism. He's non verbal but he does occasionally learn a word and pronounces it very much as a baby learning a word, says it for a month or 2 and then never says it again. Do you know why he 'loses' his words?

Also sorry to bombard you but every few months he gets 6 sessions with a speech and language therapist and they always encourage macaton (never progressed past more, stop) He doesn't really focus so I don't think he really takes it in and I feel terrible but I have an awful memory so I'm not very good at learning the signs myself but it's always recommended.
Do you think that's the only way to go or do you find some children do still progress without it? Thanks for your help appreciate you taking the time Smile

In order for his Makaton to progress he needs to have the same signs modelled to him regularly every day. Makaton sounds like a great option for him, so I'd advise you to really commit to it and do some work yourself to learn the signs and use them reliably with him. Is there an online course you can sign up to? Follow the official Makaton social media pages and try to learn and use a new sign every week? This sort of intervention relies on parents committing - there's only so much impact a SaLT can have when they don't spend every day with the child.

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