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

[SpeechandLanguageTherapist]

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.

Is private SaLT input affordable for you?

Hi
Our little boy (just turned three) has initial constontent deletion. He's on a waiting list but i get the impression it will take a while. On the plus side he has a decent vocabulary and it doesnt seem to affected his confidence in speaking- at least within the family. I can't be sure in nursery. But he is hard to understand sometimes and gets very frustrated when we don't get it. Would you advise trying to go private? Or will he kind of grow out of it on his own? Thanks

Sounds like he's made amazing progress with his language!

If he's substituting 'd' with 'g' this is much more of a concern than the 'l' error. This is called backing and would benefit from direct speech and language therapy. It's a disordered process which is a little more concerning than a delayed process (like 'l' to 'y'). If it's the other way round ('g' to 'd') that's much less of a concern.

I misread and thought he was 5 already. At 4, gliding 'l' to 'y' isn't even delayed.

@SpeechandLanguageTherapist thank you very much for your reply and advice, it's very much appreciated.

for the issue around D & G sounds, it's usually when he's saying "dog" it'll be "gog" - due to the waiting list being 12 months long in my area for NHS speech and language therapy, do you think it's worth going privately?

Both of those are delayed error patterns (fronting and gliding). He's a little old to grow out of them (especially fronting which should have resolved a number of years ago). That doesn't mean he won't, it just becomes less likely the older he gets. He could do with some input, but it's very tricky if his parents aren't on board, there's only so much you can do unfortunately.

No, I never feel under pressure to minimise communication difficulties and never would. Even if our service can't provide the level of support needed, I would never be anything other than completely honest about my assessment of a child's level of need. My managers would never ask me to.

Yes, I feel frustration on a daily basis about the limitations of the service we provide. I would love nothing more than to provide weekly ongoing therapy for every child who would benefit from it. However I do think the team I work in provides a much better service than a lot of other areas, going by some of the posts on this thread!

Absolutely not. If this were the case there would be a lot of confused children out there!

Sounds spot on for 14 months!

You're right, context is extremely important when it comes to communication! There's no point in having 'amazing language skills' if you can't use them functionally at all!

It's also extremely easy to make this kind of mistake though, when you're chatting to a child or young person and you don't know the context of what they're talking about. I'm sure I've done similar myself, especially when managing a large caseload and pushed for time. I have to be honest, I don't have the time to phone parents after every assessment to check that everything a child told me is correct 😬

With twins do you find one develops speech significantly faster than the other or do they both hit milestones around the same time?
Thankyou

Is/has makaton fallen out of favour for non verbal asd children? DS is at a special school where they are using pictures/symbols (soundswell possibly?) alongside signing makaton but there has been no training offered to parents. I'm going to do a makaton course myself and looking into putting a book/folder together with actual photographs of objects/places for ds to help him communicate but I feel completely in the dark about how best to support him.

It's also extremely easy to make this kind of mistake though, when you're chatting to a child or young person and you don't know the context of what they're talking about. I'm sure I've done similar myself, especially when managing a large caseload and pushed for time. I have to be honest, I don't have the time to phone parents after every assessment to check that everything a child told me is correct 😬

I appreciate that - I work in Send education.

But I was there! I told her these things on the day and they were dismissed because he speaks really well.

He still does now - but grammar and use of words in spread of pronouns is dreadful because he knows what he means 🫣🤣🤷‍♀️

I actually did loads myself in the end - we did language for thinking but I think having specialist teacher advisors to work with through my job helped and the lady who ran the Lego therapy through local autistic society was asked to write his report for his EHCP.

So it turned out well but I was astonished they thought that being able to use words meant he could communicate effectively.

I have to say though some of the therapists I've met over the years have been incredible and we wouldn't be where we are now without them.

It's another really challenging job to do what you want to do with the resources you are provided i with.

Hi,

Have a son who will turn 3 in August. He communicates well and speaks non stop at home, however he does not speak in nursery. He has attended this nursery since he was 1 and appears to really enjoy it. We are not sure what the reason for not speaking there could be. We have discussed this with GP and Heath visitor, referral for a speech and language assessment has been made but we will not be seen until he turns 3 and have been advised they may not offer support until he starts school at age 4... the waiting list is long and resources limited in our council. Any advice on what we could do? Considering looking for private options but feeling lost as we are not sure what support we should be looking for.

Appreciate any advice anyone can offer.
thanks.

Hey @SpeechandLanguageTherapist would really be grateful if you could please advise on my concerns 🙏🏻🙏🏻 it appears you're like gold dust in your profession

Hi thanks for doing the thread, it's very kind of you. Can I please ask, If one parent can't say "th" but substitutes "f"or "v" (despite having had some kind of SALT as a child), and does daily barftime, teef clean and counting practice one two free etc is this likely to affect our toddler's speech and is there anything the other parent can be doing to help toddler avoid developing the same problem? Toddler is currently very advanced in speech with quite long phrases while not quite age 2 yet, does come out with f/v instead of th but I know that can be normal at this age, not sure when to worry! Should one parent correct the other in front of the child? Thank you.

Yes

Thanks so much for replying!

Hi my son is 27 months and only has 3 words. He babbles a lot but doesn't make any animal noises or anything. We've been referred to salt and he's had a hearing test which came back fine. Is it common to just have a speech delay with nothing else i.e autism, adhd? At what point should I be worried? I've taken all the advice and nothing I do helps and we're both getting extremely frustrated as unable to know what he wants a lot of the time

What would you recommend for an 11 year old with high frequency hearing loss whose "s" sounds are still quite slushy. Will we ever get them sounding crisp?

Using pronouns correctly 90% of the time at 2;10 is pretty exceptional to be honest (in a good way)!

Repeating is completely normal for toddlers and how they learn language. I'd be worried if a two year old wasn't repeating. I wouldn't even refer to this as echolalia, as this is generally associated with more atypical patterns of language development.

Nothing you've written is remotely concerning at all.

Thank you so much!! Really appreciate that ❤️

There's huge variation in early language development, and I mean huge. Some children will be speaking in full sentences by their second birthday and some will have 40 single words. Both are not a concern. There's a weak relationship between very early language skills meaning and later language skills - meaning there's no reason to think that at the age of 8 the child with 40 single words would have any worse communication skills than the child talking in full sentences.

And yes there's some limited evidence to suggest that the more older siblings you have, the slower your early language will be to develop. This is only a small effect size though. Interestingly, younger siblings tend to have slightly lower IQ scores than older siblings even into adulthood!

Many services (including the one I work for) won't accept a child under 2 other than in exceptional circumstances, for example if they have a known genetic disorder which will certainly impact on their communication. I can't answer for why the referral was rejected but it may be that. If he has known hearing difficulties, make sure you're face to face when communicating and he can see your face and mouth clearly when you're modelling vocab. You could try using some Makaton signs to support his understanding, or even cued articulation to help him to differentiate between speech sounds. These can both be learnt using YouTube etc.

Nothing concerning in this at all 😊