Specialist Areas

SALT - Specialist Areas

• Alternative and Augmentative Communication (ACC)

  Children with special needs can have complex physical and communication difficulties and might need assistance to develop their potential to communicate. The speech and language therapist can give advice on how to develop the communication potential of your child, support the school to implement strategies to develop communication and investigate alternative and augmentative forms of communication.

   

  Assisted forms of communication can be:

  • Signing and gesture
  • Objects
  • Pictures and symbols
  • Technology and communication aids.

  Signing and gesture
  Some children benefit from using signs and gestures to develop their communication and become more independent at interacting. For some children spoken language is too fast, signing key words with speech helps to slow down the interaction, gives extra visual clues to support understanding of spoken language and also helps them to remember what has been said. Examples are Makaton signing (used in CBBC programmes such as Mr Tumble), British Sign Language(BSL) and finger spelling.

   

  Objects

  Using real objects with children with communication difficulties can encourage them to make choices and interact. Holding up an orange and an apple and letting the child choose which one she would like, by pointing or looking at it, can be a powerful way to communicate for some children.

  Objects can also be used to help children anticipate and understand what will happen next. Showing a favourite bath toy indicates its bath time.

   

  Pictures and symbols

  As the child learns the meaning of pictures and symbols an effective way to communicate can be achieved by pointing with fingers, hand or eyes to photos, symbols or words. Photos, symbols or words can be used individually or grouped in a page, chart or stored in a book.

   

  Communication charts and books are useful to be used in any environment, don’t need any batteries and can be organised by topic pages.
  
  

  Communication aids and technology

  A communication aid helps a person to communicate with others around him/ her and can range from simple picture charts, letter/alphabet boards, battery operated devices with recorded messages to complex software and technology.

  
  

  Before selecting a communication aid the speech and language therapist will evaluate the child’s individual needs and abilities and discuss personal preferences. Sometimes other professionals might also be involved when there are physical and sensory limitations which can limit the use of a communication aid.  

• Autism

  Autism is a developmental disorder where a child has difficulties in three key areas of development:
  
  

  1. Communication and language
  2. Social interaction
  3. Limited imagination or increased insistence on sameness.

  
  

  Autism is often described as a continuum, from mild to severe, and different labels may be used such as Autistic Spectrum Disorder (ASD), or Autistic Spectrum Condition (ASC).

  
  

  The term ‘Asperger’s Syndrome’ is often used to describe children who have better developed language skills, but still have social interaction difficulties.

  
  

  Children with autism can present with a wide range of communication, language and speech difficulties. Some children may have little or no speech at all while others may have well-developed vocabularies, but can only talk about topics that interest them. Many children show difficulties with understanding what is said to them. Autistic children of all ages have problems at some level with joining in socially. Autism is more common in boys than girls.

  
  

  Speech and language therapists can play an important role in recognising features in a child’s communication that might be the result of autism and they can refer a child on to appropriate people such as a paediatrician, school doctor or the Child Development Team, so the right diagnosis can be made. It may seem unusual for a speech therapist to see a child who talks a lot, but this is very appropriate if the child has some social communication difficulties.

  
  

  A diagnosis of autism is now often made when children are between 2 and 4 years old, but some children’s difficulties may not be recognised this early, especially if they are mild. Asperger’s Syndrome is often not diagnosed until junior school age, or even into teenage years.

  
  

  Children with autism will need extra help to develop their communication and other skills. Speech and language therapists work with parents and other professionals, particularly teaching staff in school. Therapists may often advise adults around the child rather than working with the child directly, so that the child’s communication environment is adapted to his or her needs.

  
  

  Therapy

  
  

  Therapists will work with children at home, in a preschool setting, at clinic, mainstream primary or secondary school or special school. Not all children with autistic spectrum disorders will need input from a speech and language therapist and professionals will work in line with the autism best practice guidelines.

  
  

  “Play Circles” and “PlayTogs” are examples of groups run in Cambridge and Huntingdon for preschool children with communication difficulties, and social skills and other groups may be held in schools.

  
  

  Some therapists are licensed by the National Autistic Society to deliver the “EarlyBird” parent programme, which is run regularly in Cambridge and Huntingdon. Other specialist training includes Alternative and Augmentative Communication (AAC), such as using visual symbols, Picture Exchange Communication System (PECS) or signing, if this is needed.

  
  

  Although autism is a long term condition, it is likely that a child will not need speech and language therapy support indefinitely. When it is appropriate, and a setting such as school can meet a child’s communication needs, a therapist will discharge a child from therapy.

  

  External websites

  National Autistic Society [www.autism.org.uk]

  The National Autistic Society is the UK's leading charity for people affected by autism (including Asperger syndrome).

  
  

   

  Disclaimer
  

  We are not responsible for the contents or reliability of the linked web sites and do not necessarily endorse the views expressed within them. Listing should not be taken as endorsement of any kind. We cannot guarantee that these links will work all of the time and we have no control over the availability of the linked pages.

• Stammering

  This page will give you information about the nature of stammering, therapy options in this area, and useful links to other related websites.
  
  

  What is Stammering?

  
  

  Stammering refers to a problem resulting from a disruption in the flow and timing of speech.

  
  

  This disruption can take a number of different forms and include:
  

  • Repetition – a particular part of speech may be repeated a number of times.
  • Prolongation – sounds may be lengthened.
  • Hesitation – may be pauses in the child’s speech.
  • Freezing – as if the child’s speech muscles become frozen in time.
  • Fillers – extra words may be added which do not contribute to the meaning.
  • Forcing – a child may be heard to push some sounds out forcefully.
  • Incompletion – words or sentences may be left unfinished.
  • Airflow problems – breathing may be disrupted.
  • Gestures – extra facial or body movements become associated with talking.
  • Eye contact – child may be unable to look at his listener.
    

  The different terms used:

  
  

  The Americans refer to the same mode of speech as 'stuttering'. The term is sometimes used in Britain, but usually ‘stammering’ is the accepted label.

  
  

  Speech and language therapists talk about stammering in terms of a loss of the fluency of speech.

  
  

  This is different from the popular sense of the word “fluency”, in which language Is perceived as a continuous stream of interesting words spoken with apparent ease and speed.

  
  

  Speech and language therapists may use the word non-fluency or dysfluency to describe stammering.

  
  

  Developmental non-fluency/dysfluency refers to the type of disrupted speech many children use when they are developing their communication skills. This mainly happens between the ages of 2 and 7 and generally lasts less than a year.

  
  

  Hidden stammering

  
  

  This is not so easy to identify and relates the thoughts and feelings a child may have regarding speaking.

  
  

  Hidden stammering may include:

  
  

  • Speech avoidance – Where the child avoids saying a sound or word which he thinks is difficult to say.
    • He may substitute words or even opt out of talking.
    • It is better, he may feel, to be thought of as less intelligent, less sociable than for others to think he is a stammerer.
  • Situation avoidance - Where the child perceives that his speech in certain contexts is not as good as in others.
    • So he avoids placing himself in those situations.
    • For example, he may come in late for school regularly so he can avoid answering the register.

  Diagnosis pathway
  
  Parents or professionals who are concerned about a child’s fluency should refer to the local speech and language therapy department. A full assessment will be carried out, resulting in:
  

  • Advice – leaflets may also be obtained from the British Stammering Association- BSA (see link below) .
  • Therapy – which may include the Lidcombe programme – or Parent Child Interaction therapy

  or
  

  • For older children, group therapy – usually during school holidays.

  

  External websites

  Australian Stuttering Research Centre [sydney.edu.au/health_sciences/asrc]

  The Australian Stuttering Research Centre (ASRC) was established in 1996 in the Faculty of Health Sciences (Cumberland Campus), The University of Sydney. The purpose of the ASRC is to establish and disseminate knowledge about stuttering and its treatment.

  
  

  British Stammering Association [www.stammering.org]

  Website for the British Stammering Association

  
  

  The Association for Research into Stammering in Childhood [www.stammeringcentre.org/s-index]

  "Our main aim is to support the specialist speech and language therapy service which is offered at the Michael Palin Centre for Stammering Children in London.

  
  

  Disclaimer
  

  We are not responsible for the contents or reliability of the linked web sites and do not necessarily endorse the views expressed within them. Listing should not be taken as endorsement of any kind. We cannot guarantee that these links will work all of the time and we have no control over the availability of the linked pages.

• Hearing Impairment

  A child’s speech and language development may be delayed by a hearing loss.
  
  

  There are different types and severity of hearing loss: -

  
  

  Conductive deafness

  
  

  This is when sound cannot pass efficiently through the outer and middle ear to the cochlea and auditory nerve. The most common type of conductive deafness in children is caused by ‘glue ear’. Glue ear (or otitis media) affects about one in five children at any time.

  
  

  Sensori-neural (or nerve) deafness

  
  

  This is when there is a fault in the inner ear (most often because the hair cells in the cochlea are not working properly) or in the auditory (hearing) nerve. Sensori-neural deafness is permanent.

  Children who have a sensori-neural deafness can also have a conductive deafness such as glue ear. This is known as mixed deafness.

  
  

  Presenting difficulties

  
  

  There are some common signs that might indicate a hearing loss: -
  

  • The child does not respond when called.
  • There is a delay in learning to speak.
  • There is a lack of clarity in speech.
  • Unstressed words in speech may be missed or misinterpreted.
  • The child watches faces/lips intently.
  • The child is reluctant to speak freely.
  • The child displays inappropriate behaviour.
  • There are difficulties in listening and attending to speech.
  • Constantly asking for repetition.
  • Failure to follow instructions straight away or misunderstanding/ignoring instructions.
  • Requiring repeated explanations.
  • Watches what others are doing before doing it themselves.
  • Continues with an activity when the rest of the class has stopped.
  • Inattentive and daydreaming.
  • Doesn’t pick up information from overheard conversations.
  • Attempts to control and dominate the conversation through talking.
  • Becomes withdrawn.
  • Shouts or talks too loudly.
  • Makes little contribution to group or classroom discussions.
  • Speaks very softly.
  • Complains of not being able to hear.
  • Frequently seeks help from peers.
    

  (N. B. There can also be other reasons for a child having these difficulties that are not related to a hearing loss.)

  
  

  Hearing assessment

  
  

  The Newborn Hearing Screening programme means that now newborn babies are screened for a hearing loss. This has the advantage that a hearing loss may be identified at a very early age and appropriate management of the hearing loss can be arranged. This can help minimise the impact of the hearing loss on the child’s development of speech and language.

  
  

  At other times when a hearing loss is suspected the child will be referred for a hearing assessment. A range of different hearing tests may be performed depending on the age of the child, their ability to co-operate in an activity and their individual needs. If a hearing loss is found the parents will be advised on how this can best be managed.

  
  

  The Audiology Department and the Ear, Nose and Throat (ENT) department at the hospital will be involved. Where a hearing loss is likely to be permanent, hearing aids are usually fitted. Where appropriate children will referred on to be assessed regarding their suitability for a cochlear implant.

  
  

  Intervention

  
  

  Once a child has been identified as having a hearing loss then it will depend on the level of hearing loss and the level of need regarding their speech, language and communication as to the intervention they will receive. There may also be some variation as to when intervention will begin depending on when the hearing loss is identified.

  
  

  In the case of a child with a sensori-neural loss, the hearing loss may be picked up soon after birth and as soon as it is appropriate, a teacher of the deaf will be involved to help support the family in understanding the hearing loss and in managing the hearing aids and the child’s development of language. The specialist speech and language therapist for hearing impairment will also be involved, when required, to offer advice and support as part of the multi-agency team supporting the family.

  
  

  In the case of a child with a conductive loss or glue ear the child may be slow to develop their speech and language and their hearing loss may not be identified until there are concerns regarding their development. The health visitor may refer the child for a hearing assessment at the same time as referring to speech and language therapy. In some cases a referral for a hearing assessment may follow assessment by a speech and language therapist if there is any doubt or concern regarding a child’s hearing.

  
  

  Intervention will be based upon the child’s level of need and may involve individual or group therapy, advice to pre-school or school. Sometimes it will be appropriate for the child’s needs to be met within the pre-school or school setting and speech and language therapy will not be indicated.

  
  

  Strategies for good communication with a hearing impaired or deaf child: -
  

  • Make sure that you have the child’s attention before starting to talk.
  • Speak clearly and at your normal pace.
  • When changing the topic of the conversation let the child know.
  • Do not shout as this will distort your lip patterns.
  • Keep your face clear and try not to cover it with your hands.
  • Try to keep your hands free so that you can use natural gestures to support what you are saying.
    

  To help a deaf child understand: -
  

  • Repeat
  • Re-phrase
  • Explain
  • Simplify
  • Clarify

  

  External websites

  National Deaf Children's Society [www.ndcs.org.uk]

  The Website of the National Deaf Children's Society

  
  

  Royal National Institute for the Deaf [www.rnid.org.uk]

  Royal National Institute for the Deaf
  

  
  

  The British Deaf Association [bda.org.uk]

  The home of the largest UK Deaf organisation run by Deaf people for Deaf people

  
  

  The Ear Foundation [www.earfoundation.org.uk]

  A charity providing independent information, training and support for deaf children and young people with cochlear implants, their families and local professionals

  
  

  Disclaimer
  

  We are not responsible for the contents or reliability of the linked web sites and do not necessarily endorse the views expressed within them. Listing should not be taken as endorsement of any kind. We cannot guarantee that these links will work all of the time and we have no control over the availability of the linked pages.

• Speech Difficulties

  Children can present with a range of difficulties with their speech sounds. Some may be unable to pronounce one or two sounds in their speech and others may have more difficulties so that others find them hard to understand. Sometimes the child will substitute one sound for another so that 'cat' becomes 'tat' for example or they miss out sounds altogether so that 'bus' becomes 'bu'. 
  
  Children may have a simple delay with their speech so that the sounds are following a normal pattern of development, but slightly later than usual. Sometimes there is a disordered pattern of development where the child may use atypical speech sounds. Occasionally children have difficulties coordinating their lips and tongue. Delayed or disordered speech sounds may have an impact upon the child's ability to make themselves understood and on their literacy development. Further information on the normal development of speech sounds can be found here
  
  Therapy
  
  Children are usually seen at a Drop in clinic by the speech and language therapist. Sometimes the therapist will give advice to families or school and will not need to see the child again or will suggest that the child is seen again in a few months

  Sometimes further support will be needed. This may be take the form of a group called speech circles for nursery and reception aged children or there may be other input such as individual or group work in schools. It is important that any therapy that takes place is followed up by home and school to help the child improve. The therapist will provide activities to help with this.

• Eating and Drinking Difficulties

  Developing good eating and drinking skills are necessary as a pre-requisite to developing clear speech.
  
  

  Presenting difficulties

  
  

  A baby or child may have difficulties with any of the following components of eating and drinking:-
  

  • Sucking
  • Swallowing
  • Chewing
  • Drinking
  • Food aversion/fussy eater
    

  If your child takes a very long time to feed, frequently coughs, cannot manage to chew solid foods at an appropriate age or spits food out rather than swallow, you can refer to a speech and language therapist.

  
  

  The feeding difficulties will often be in addition to other diagnosed difficulties e.g cleft palate, cerebral palsy, developmental delay, an acquired brain injury, autistic spectrum condition.

  
  

  Diagnosis

  
  

  A diagnosis of eating and drinking difficulty will be made from observation, checklists, listening to your child’s swallow with a stethoscope and if necessary an x-ray of your child eating.

  
  

  Intervention

  
  

  The speech and language therapist works as a member of a team. Physiotherapy, occupational therapy, dietician, nursing, health visitor and medical advice may also be required to manage your child’s eating and drinking difficulty.

  
  

  Treatment options include modifying your child’s food textures to ensure safe eating and drinking.

  
  

  Activities and exercises can also be recommended to encourage particular muscle movements such as lip closure or side to side tongue movements.

  
  

  Advice can also be given to help children who are very sensitive to certain textures, tastes and smells and are ‘fussy’ or ‘averse’.

  
  

  Outcomes:

  
  

  Safe eating and drinking.

  
  

  Mature eating and drinking skills as far as possible for each child.

• Bi-Lingualism

  Speech and language therapists work with bilingual children who have additional speech and language difficulites. 
  
  Please see my child is learning two languages.

• Cleft Palate

  Some children are born with a cleft palate which affects their speech.

   

  What is a Cleft Palate?

   

  A cleft palate occurs when the roof of the mouth does not join together properly. It happens during early pregnancy but we do not know why. It may occur on its own or with a cleft lip. 

   

  The cleft can range from a small hole at the back of the throat (in the soft palate) to a complete separation of the roof of the mouth (soft and hard palate). The lip may also be split.

   

  Most cleft palates are picked up during antenatal scans and the child will be referred to the specialist Cleft team at Addenbrookes hospital (East of England Cleft Lip and Palate Network). Families are given advice on feeding and surgical procedures. 

   

  Sometimes a submucous cleft can occur which may not be discovered until the child is older. This is when the skin grows over the cleft and it’s more difficult to detect. 

   

  How does a Cleft Palate affect speech?

   

  When we speak the soft palate moves up and down to create different sounds. For example when we make sounds like p and b the palate moves up and closes the nasal passageways to ensure air flows through the mouth. However when we make sounds like m and n the palate stays down so that the air flows through the nose. 

   

  If the palate does not work properly then it may be difficult to make particular sounds which require a build up of pressure in the mouth or it may be difficult to direct the air through the mouth when necessary.

   

  There may also be a problem with the way speech sounds – it may sound nasal and you may hear air escaping from the nose.

   

  The speech and language therapist will carry out a detailed speech assessment to listen to exactly how words and phrases are pronounced.

   

  Any other problems?

   

  Babies born with a cleft palate may have difficulties with feeding. They may have reduced sucking strength and there may also be some nasal regurgitation. The specialist cleft team can provide advice and equipment to help with this.

   

  Children with a cleft palate may also have hearing difficulties associated with glue ear. This is because for these children the muscles which open the tube to allow liquid to drain from the middle ear do not work efficiently. Please see the section on glue ear for more information.

   

   

  What happens at speech and language therapy?

   

  If a child is born with a cleft palate they are referred to the Specialist Cleft Team immediately. The speech and language therapists in this team can provide advice and therapy on babble, speech and language development. The child’s case will be primarily managed and monitored by this team.

   

  If the Specialist Team feels the child requires more regular therapy or if the child starts to attend school they may become part of the community speech and language therapy caseload. There is good collaboration between the two teams and the specialist therapists will provide and advice and suggest targets for the community therapist to work on with the child and their family.

   

  Sometimes children may have nasal speech when they are older. This may be a learned habit or there may be a structural problem which was previously undetected (submucous cleft palate – see above). Sometimes speech can sound nasal after tonsils and/or adenoids have been removed but this usually goes away after a few weeks. If the community therapist is concerned about a child with nasal speech, she may refer them to the Specialist Cleft Team.

   

  If your child is a preschooler and you are concerned that they have nasal speech, please come along to one of our drop-ins. 

   

  External Websites

   

  www.clapa.com

  Cleft Lip and Palate Association

   

  http://www.cuh.org.uk/addenbrookes/services/clinical/cleft/cleft_lip_and_palate_index.html

  East of England Cleft Network

• Language Difficulties

  Children may present with problems with their understanding or expression when learning language or sometimes a combination of both. 
  
  Difficulties in understanding may range from the inability to follow simple sentences and difficulties in the recognition of vocabulary  to difficulty following complex and abstract language
  
  Difficulties with expressive language include an inability to put words together to make a sentence, difficulties with grammar such as using the correct word endings in verbs and problems sequencing several sentences to express a more complex idea.

  Therapy

  Therapy often takes the form of advice to families and the setting or school that the child attends. Children can also be offered a group or an individual session as appropriate.

  When support is in place and it is appropriate the child will then be discharged from speech and language therapy