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

[RachelMumsnet]

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

And not to be left out!

My DS is 6 months old. He was tongue tied but that was snipped at 5 weeks. He does seem to be lip tied where his top lip is joined to the bottom of his gum. This has never really caused problems - he is formula fed and we use anti-colic/wind bottles. He has just started weaning and eats off a spoon fine.

I showed the HV who didn't know what it was and thought it was probably normal and would separate as he grows. Will it? Should I take it further (we are seeing his consultant next week - all my DC were prem so start life under consultants but both girls were discharged by age 2 with no problems beyond vision problems...) Is is worth asking paed consultant? GP? Doing nothing?

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!

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?

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

what resources/books do you recommend for a 9 year old with subtle social communication difficulties,with a history of language delay, but whose language is more or less at an age appropriate level these days, so would be unlikely to qualify for NHS SALT?

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.?

My son is nearly five and has a diagnosis of verbal dyspraxia and a phonological disorder.

He has made progress this year and using a combinations of signs and speech, I can mostly understand him when he asks for something. Even so, much of the time even I don't understand what he is telling me. Tests show that his vocabularly is normal.

We pay for speech therapy twice a week. My problem is that my son is very unwilling to practise his speech therapy. I am very unsure about how much I should push him to practise (I have even used sweets to bribe him for every word/sound he has practised) or should I relax and just continue to encourage every day speech. He is very shy and well behaved in general. He talks with me almost constantly, but very little with other people.

My second question is: is there a genetic link between verbal dyspraxia and a stammer? My father has a bad stammer and I suspect a type of dyspraxia.

My dd is 3.5, talked early and well and is a real chatterbox. She has never pronounced her f and v sounds properly. F is more like s and v is more like b. we have recently started to correct her on this and try to get her to make the correct shape with her mouth and correct sound. With a lot of effort she can get a near f sound out at the start of the word fish but seems to struggle with putting her teeth on her bottom lip. Firstly is this anything to be concerned about at this age or is she likely to get it in her own time? Secondly are we right to try and get her to say it properly or might this make her feel self conscious and do more harm than good?

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).

Hello,
My 4 year old son has autism. He doesn't really talk as such although he does verbally request some things. However, he is only able to use the first part of a word 'ray' for raisin or 'buh' for bounce for example. A private SALT suggested he had signs of verbal dyspraxia but said it was difficult to get a diagnosis in this country particularly if autism were present. He appears to have oral motor planning difficulties and is still very flabby cheeked like a much younger child. He can echo many single sounds on request but cannot elongate any.
Can you suggest anything to help?

Same question as Starlight. I have a 8.5 year old with cerebral palsy,he is academically bright (top group in mainstream etc) and his language has always been good but his communication less so, especially with peers but adults too.

I'm a natural introvert so struggle to know how to explicitly teach the social communication skills he needs. I know what's wrong but can't really break down what's right!

He has SALT in his statement and receives a social skills group session in a block every term at school, this is with a SALT, a TA, and another boy with ASD and very different communication needs to my son. He hates it and I can't see what good it's doing in spite of asking for the objectives etc of these sessions.

What can I do/ resources can I use to help him gain fluent social communication?

Or - starlight - shall we devise our own?!

Another child with an issue with /r/.

Ds1 is 6.10 and still pronounces the r sound as a sort of /w/. He has problems with some other sounds (/th/ comes out /f/ for example, and he has something of a lisp) and in general sounds to me like a much younger child.

People who don't know him quite often don't understand what he's saying first time, and as his name has two Rs in it I'd really like to try to help him. "get" this sound. We're Scottish so sound the /r/ more than some accents..

I've also noticed some of his mispronunciations affecting his spelling.

I got the HV to see him before he started school (aged 4.6) and she didn't see much of a problem. She assessed him (using notes from local SALT team) and apparently he had all the sounds he should have had at that age and she said the /r/ often came much later, but I'd be grateful to know about anything we could do at home, and whether there are particular issues that would suggest another assessment (I guess privately since resources are so stretched).

I'd also be interested in how tongue tie can affect articulation since there are various things that suggest ds1 may have a posterior tie.

Does Fiona know if there are any moves for the SALT profession to join up with the ABA profession on autism speech problems?

I found that the ABA professionals understood better the motivation problems behind autism speech problems, and also the need first to teach skills of imitation.

All the SALTs I saw for my boy just jumped straight into their "normal" child speech techniques. It simply didn't work, which I think even NICE is now acknowledging in its new autism guidance: often behavioural work is needed.

But SALTs know so much about speech production, oral problems etc.

A combining of skills could be good. If Fiona hasn't heard of any such plans, could she suggest them to the powers-that-be?

My DS1 is 2.5 and has a lisp, can't pronounce 'L' or 'R' sounds and dribbles/spits - his mouth always seems to be full of saliva.
He also has issues with a constant runny nose - don't know if this is related.
Ironically, his actual language is amazing and he's very advanced for his age it's just it's not clear, which causes him some frustration and is holding him back to some extent.
I mentioned the lisp/pronunciation etc at his 2 year check but nothing has been followed up. Is there anything I need to do/can do to help? Will he grow out of it? Will he need some sort of physiological investigation for the mucus/saliva production - he has literally had a runny nose for over a year (!)
Thanks :)

Whilst I know there are SALTs that specialise in feeding/swallowing problems. Do other nhs SALTs specialise?

Whilst ds doesn't have an autism diagnosis, he does have social communication difficulties. I have found a similar thing to Sick, in that the first input we had from SALT came from the point of view, of all the standard advice about encouraging your child to talk, whilst all of that applies, it seemed inappropriate at the time, when ds couldn't eat solid food, or sit upright, and showed no interest in toys or pictures.

The same continued when ds saw a SALT in an opportunity centre setting, they seemed to be trying to squeeze him into a box that he was never going to be squeezed into. Someone sitting showing ds pictures of a cow and a doll and saying, 'wheres the cow?' 'where's the doll?' seemed completely pointless when ds wouldn't even look at them, or the keyworker (who was doing the SALT's exercises) and I don't actually think ds knew what a cow was!

I find it odd that when dd2 had a very pronounced stammer, we had an nhs salt visit us every week for over a year, teaching us The Lidcombe Programme, it was amazing. When it was obvious that ds had lots of various problems I assumed we would be getting a good input from SALT as we had had such a positive experience first time round.

Despite the fact that ds's problems are so severe, it seems that he is given generic advice that isn't tailored particularly to him, delivered by keyworkers and rarely seeing an actual SALT. I have been so angered and disappointed by the SALT service as delivered to my son, it really makes me fear for the future for him, because he will always need support, especially in this area, and I seem to be fighting constantly to get him that support.

There seems to be a disparity between the 'encouraging your child to talk and develop good communication skills' side of SALT and the 'child with ongoing speech and language problems which will need lots of input' side of SALT. Personally I feel as though the latter group are being seriously let down.

sorry that turned into a rant, rather than a question - ignore me. I am coming from a seriously frustrated position!

I really like it that Fiona is keen to give practical tips for parents as that has not been my experience of SALT so far. The SALTs we have seen have handed very badly photocopied worksheets with limited or no instructions and only after being badgered for some months.

As parents we are in a position to deliver therapy daily. Hourly if needed. But we need an expert to firstly carry out a decent assessment to see what the issues are and then tell us what to do.

Attending a clinic bimonthly with a different SALT each time who just attempted unsuccessfully to get my ds to communicate with them was a waste of resources and a waste of my time plus travel and childcare arrangements.

Like the poster above, we found once we had a behavioural therapist involved, ds motivation to communication drove his successful therapy. I am therefore quite resentful that the SALTs ds saw in the early days represented the wasted opportunity for development and wish above all else that those SALTs had been trained, or are very soon going to be trained in Verbal Behaviour.

"Or - starlight - shall we devise our own?!"

Me too please if you want to start a thread on Sn. Tlp are you in?

I think starlight knows my old name - i have indicated it on recent sn threads.

Yes Starlight, that has been our experience as well wrt worksheets (makaton pecs etc). Without the proper support being handed a pile of pecs cards, or being directed to a website to print out your own, as we were, is pointless.

Zzzzz - ahh you put into question form, very succinctly one of the things i was trying to ask, when my rant got the better of me!

The frustrating thing with ds is that he is extremely keen to communicate, given the tools he would be such an eloquent little boy, honestly, even if he never utters a word. But being handed a squeaky, gotalk communicator -with no sheets (I have made my own) and no support, it just becomes another instrument of frustration.

I get the feeling that the attitude is, 'well there is no speech to work with, so what is the point of speech and language therapy'

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?

I have just googled you Fiona - your speciality is articulation and phonology?

Why do so few salts specialise in receptive communication problems.

My dd2 turned 4 last month and has just started reception.

She has difficulty saying 'r' and 'w' so rings and wings sound the same and 'th' so thought sounds like fought.

What should I do? Go to GP, talk to my health visitor, get a referral?

Thanks in advance...

My feeling is that SALTs are great on "mechanical" speech problems, but less good when the problem is neurological or social. But if they could liaise with ABA professionals on getting past the autism blockages, they have lots to offer on clarity and speech production. Horses for courses.

An early speech tis thread sounds great!

Tips!