How to Spot Speech and Language Difficulties in the Early Years

Picking up where we left off

Okay, so you’ve already read our previous article and hopefully learned some new ideas and techniques. Say you’re routinely doing everything we’ve suggested, but it still isn’t clicking for some children. Why not?

The short answer is that there will always be some children who will either fail to, or struggle with, acquiring language in the usual way and at the right time.

If it’s at all possible, knowing why helps us decide how we can help. Our expectations and time-scales need to be realistic and achievable, otherwise we’re just adding to the pressure these children already feel.

It’s worth being aware, however, that in some instances, the difficulties are rather grandly described as “unknown aetiology” – basically, we don’t know why! This probably isn’t the best news, but that’s the way it is sometimes. In such cases, we still can offer help and support based on what we see and hear – don’t worry, we’ll explain how to do that too.

Nature versus nurture — What could go wrong?

In the first article, we dove into what ‘nature versus nurture’ means in the context of language development. Now, we’ll talk about what challenges children could face in each category, and how we can respond to that.

Things can go awry in either the nature area or the nurture area or – perish the thought – in both. In terms of ‘nature,’ any issue with learning, cognition or hearing and sight will impact language development. Of course, the degree of compromise will depend on the extent of the difficulties.

Your immediate thoughts may be that the nurture requirements are easier to compensate for, and in many ways this is true. However, the way in which we manage the type and extent of difficulties will also make a big difference.

Addressing potential problems

In the ‘nature’ category, there are a number of conditions that can contribute to Speech, Language and Communication Needs (SLCN). Some are very rare but others, such as Down syndrome or autism spectrum disorder, are more well-known.

Sadly, the results of destructive maternal life-styles are more and more in evidence. The mother who has, for example, abused alcohol during pregnancy can inflict serious damage on her child (foetal alcohol syndrome). The subsequent problems are often around those basic core skills of attention and listening. We can’t overstate how the importance of a developed concentration span – it’s the cornerstone of all future learning, including language learning.

In terms of nurture, causes can include:

• A poor environment with little or no access to stimulation, toys and experiences
• Little or no meaningful, enjoyable interaction with others
• Noisy and disorganised lives where making sense of what’s going on is hard
• No motivation to use language (or struggling to get a word in!)
• Competing auditory overload (TV, music, phones, & devices)

This list is not ranked, and by no means exhaustive. But take heart – it’s worth mentioning at this point that just because a child has a recognised or diagnosed condition, that doesn’t mean there’s nothing to be done.

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Looking at things through a therapist’s eye…

For us to make a difference, SLCN needs to be what we call the ‘primary presenting problem’. What does that mean exactly? Basically, we need to start by identifying one of the following difficulties.

Speech, language & communication difficulties (SLCN):

• Developmental language disorder (Affecting either comprehension – i.e. understanding or expressive language – i.e. using words and sentences – or both)
• Language delay (Usually developing along normal lines but behind)
• Speech sound problems (Either how to actually produce the sounds – i.e. ‘articulation’ or how to use the sounds in the right place to make words different from each other ‘phonology’)
• Fluency (Sometimes called a stammer or stutter)
• Attention & listening problems (Remember those core skills?)

Odds are, there are already children with these difficulties in your setting. How many can you identify? Why not do something about them today? You can start to put together a plan across the whole of your setting.

What next?

Once you identify the problem, you need to make sure you understand it, and make a plan to address it. Plenty of children get referred to us from these needs, when a ‘tuned-in’ EY practitioner, parent or carer will have concerns that something isn’t developing quite as it should. Here’s how a speech and language therapist would go from there.  

Understanding the extent of the issue

1. Is there a problem? Draw upon knowledge, skills and experience to observe and assess and ask the people who know the child well.
2. If so, what? Identify one or more of the behaviours in the SLCN list above.
3. How significant is it? Can we quantify how many months behind the child might be? Are the parents having difficulty having trouble understanding the child’s speech?
4. What’s the impact? Is it getting in the way of learning or stopping the child making friends?
5. What can be done to help? Does the child need the specialised speech and language therapy help to get things started? Or, are there things that parents or educators can do to help?
6. What outcomes can we expect? What’s the potential for change?

To help us answer these questions – in particular questions 4, 5 & 6 – therapists look at other possible factors. Here’s how we break those down:

• English as an Additional Language (EAL) —
  Little or no exposure to English prior to nursery will impact on how quickly and easily language develops.
• Hearing —This is an obvious one – a severe hearing loss will affect both language and speech. Even a mild/moderate loss over only some frequencies could still create difficulties in pronouncing certain sounds.
• Behaviour and compliance —The connection is perhaps less obvious, but a child that insists on “calling the shots” is often so busy trying to be in charge, that they miss important examples of sounds and speech from others. However, it’s worth bearing in mind that behavioural problems can very often be symptomatic of the frustrations of an underlying difficulty with language.
• Physical skills & co-ordination —Limited mobility restricts children’s opportunity to explore their environment. Plus, coordinating the fine motor skills of the face come into play here. It requires physical dexterity to make accurate sounds and sequences of sounds to make oneself understood.
• Medical conditions — A poorly child is disinclined to want to do anything over and above just coping, and the same applies to the parents. Prolonged hospitalisation impacts on learning opportunities not only at home, but also in the more structured Early Years environment.
• Other — Changes of circumstances at home will also impact.

Considering secondary issues

Some of these will be short-term but others longer-term or possibly indefinite. Some can be fixed or at least helped, but others cannot. Supporting a child with SLCN in the context of any of these situations needs understanding, empathy and an ability to pitch aspirations appropriately.

You might be wondering, why am I telling you all this? Once you make that initial referral to a speech therapist, it’s out of your hands, no?

Hold that thought. Let’s summarise where we’ve been so far:

We’ve had a whistle-stop tour through the kinds of frequently occurring SLCN and the general process of a speech and language therapy assessment. At this point, we’ve decided there’s a problem and made a referral to the person best-placed to put things right.

But there are still a couple snags here.

First, there are long waits for NHS speech and language therapists (SLT) — up to two years, in some cases. For a pre-school child, this can mean half his/her early childhood can pass before there is a glimmer of opportunity for a SLT assessment. Finally, getting a referral accepted in some places is very difficult, and can be complicated.

Significant moment — it’s time to take stock!

By this point you might not realise it, but you’ve amassed a considerable amount of knowledge and are implementing lots of really great things.

Here’s what we’ve learned so far.

• You are giving the ‘prevention is better than cure’ agenda your best shot.
• You’ve looked closely at the rooms in your setting and put strategies in place to work towards a ‘total communication’ environment.
• You’ve taken on board the ‘what will help & the reasons why’.
• You know about ‘means’ you are creating ‘reasons’ and providing ‘opportunities’ for children to communicate.
• You know the problems – and the secondary issues to consider.
• You know what a SLT will do, and how they make an assessment.
• But you also know that the chance of a timely assessment and some help is probably marginally better than winning the lottery before retirement.

Don’t forget — if you’ve taken on board the universal screening advice from article 1, you also know which children are already (or at risk of falling) behind, and what to do to start to put things right.

If you weren’t convinced at the end of the first article, go back and give it another read – it might make even better sense now.

Now, we need to get right into the ‘what to do’ part of all this. But there’s just not enough room in this article to get through it all — so we’ll dive into that in Part Three. Stay tuned!

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Diana McQueen and Jo Williams are the Directors of Soundswell, an Early Years speech and langauge therapy service offering both direct therapy as well as consultancy services. You can visit the Soundswell website to learn more about their work.