Lets Communicate
March 2012, ECIS Athens
Pippa Kerr
Speech and Language therapist
Session Plan
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Facts & Figures
Communication pyramid
How language and speech skills typically
develop
Spotting a potential difficulty
Promoting a language enriched
environment
Walkabout
The Importance of Speech and
Language Development
“The acquisition of a first language is the most complex skill
anyone ever learns. And this task needs to be virtually
complete by the time a child reaches school age.”
David Crystal - Cambridge Encyclopaedia of Language, 1987
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The ability to understand and use language is the key to
all future education.
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Children need language not only to communicate but also
as a tool of thought.
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The ability to communicate is the basis of social and
emotional well - being.
Facts and Figures…..
2.5 million people in the UK have a known communication
difficulty
42 million people in the US have some type of communication
disorder
According to National Institutes of Health, it is estimated that
between 8 and 10% people have a communication disorder
SLI is one of the most common childhood disorders, affecting 7%
of children
5-7% of children in UK (1-2 in each class) may have difficulties
understanding or using speech/language (Speake 2005)
Communication difficulties are found in 4:1 boys:girls
45 - 50% of children with developmental problems are not detected
prior to school entry
Wider impacts of Speech and
Language difficulties
These figures indicate communication difficulties are the
most common neuro - developmental condition in early
childhood (Goodyer 2000)
Difficulties with communication are a predominant feature
in reducing access to education, employment and social
integration
Most can be helped if recognised early on……..
Session Plan
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Facts & Figures
Communication pyramid
How language and speech skills typically
develop
Spotting a potential difficulty
Promoting a language enriched
environment
Walkabout
Pronunciation/
Speech
Sounds / Articulation
Expressive
Language
Talking
Attention:
Looking and Listening
Adult-Child Interaction
Understanding Receptive
Language / Comprehension
Play
Pronunciation
Expression
Understanding
Play
Attention
Adult - Child Interaction
Session Plan
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Facts & Figures
Communication pyramid
How language and speech skills typically
develop
Spotting a potential difficulty
Promoting a language enriched
environment
Walkabout
Normal Communication Development an outline
Normal Communication Development an outline
And when speech and language
development don’t follow this pattern?
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In normal speech development, sounds are learned in a developmental
order as a child develops mastery of their neuromusculature. Children
acquire the majority of their phonological system by 4 - 4.6 years of age
(Grunwell in Fletcher and Hall, 1992), sufficient for their speech to be
intelligible to those within their immediate social circle
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Children with language impairment have specific difficulties in learning
language form, content and use. The difficulties experienced can be in
comprehension and or expression affecting all modalities – spoken
language, reading, writing, signing, and social use of language.
The impairment may involve the form (sounds - phonology), grammar
(syntax) & word endings (morphology), content (meaning (semantics)
and use of language (intended meaning (pragmatics) to differing degrees.
Language initially presents as a delay in the child’s developmental
language milestones. This delay can resolve with maturation, respond to
intervention or the impairment can be evident in the emerging pattern of
involvement in respect of form, content or use and these can change with
age and development.
Deficits can be also evident in verbal short-term, in working memory and
in visuospatial short-term memory (Archibald & Gathercole 2006).
Initially, the impairment may be in the form of a delay with slow
emergence of language milestones.
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How does it feel to have a
Communication Difficulty ?
Once
O a time
O upon
in Athens.
O
Social Communication
Field of semantic-pragmatics (i.e. language meaning and language use).
 Social communication abilities develop from birth as a child learns turntaking, reciprocity, to request, to comment and to read a situation
 Difficulties manifest in the individual:
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Inappropriate eye contact
Inappropriate use and reading of facial expressions
Failure to understand rules of conversation, e.g. changing or staying on topic
Echolaelia & repetition
Difficulties with empathy
Different language for different needs of the listener or situation
Indirect requests and ambiguous statements
Inflexibility with routine
Social withdrawal
Difficulty with
– understanding non-verbal behaviours, such as body language
– understanding puns, idioms, riddles, jokes, sarcasm and slang
– expressing thoughts
– organizing information
Social communication difficulties generally become increasingly
apparent as the individual’s communication skills develop
Session Plan
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Facts & Figures
Communication pyramid
How language and speech skills typically
develop
Spotting a potential difficulty
Promoting a language enriched
environment
Walkabout
Supporting Attention and Listening
• Preferred seating – to reduce distraction
(light/noise/other...)
• Manipulate environment to minimise sensory overload
• Set clear expectations
• Say child’s name (and touch gently) to gain attention
• Ask child to repeat back instruction before carrying it out
• Offer regular visual clues – see Listening Lizzie
• Consistent gestures/ object of reference e.g. drum for
tidy up time to support spoken word
• Trial use of a small fiddle toy (small, soft, quiet) in story
time / listening activity
• Physical activity before seated task and small breaks e.g.
brain gym, stretching, stamping
Attention
SUPPORTING UNDERSTANDING
Activity: Do what I say!
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Use visual timetables
Finish shelf or “finish box”
Use photos or reminders of events (show field trip social story
books)
Provide structure; work in clear topics, make visible links between
new and old information
Multi-sensory approach e.g. verbs (you show, they try, they try and
say it)
Reinforce verbal language with visual aids e.g. prepositions
Sequence instructions with gesture to support, repeat, emphasise
key words
Check for understanding (e.g. the window was open just a crack…)
Encourage child to recognise (and admit) they are not sure. Often
they think its their fault so won’t tell you that they don’t understand
Repair strategies – encourage can you help me?
Model correct response rather than telling child they are wrong
Understanding
SUPPORTING EXPRESSIVE LANGUAGE
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Teach vocabulary within topics e.g. animals, clothes, weather, festivals
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Vocabulary building (pre-teach & review vocabulary, use new words in a
story, Descriptive games)
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Model clear, accurate language structures e.g. plurals, pronouns
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Repeat back child’s utterance and add 1 word
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Reduce questions instead of What is it? offer a forced alternative e.g. is
it an apple or an orange? Or use more opened questions…. E.g. tell me all
about your holiday?
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Reduce pressure on speaking by commenting and leaving a sentence to
be finished e.g. I can see a…….., look there are lots of birds flying in the
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KEEP QUIET! Give space for expression (leave 5 seconds) Observe Wait
Listen (OWL)
Expression
Supporting Vocabulary Building
location
function
appearance
Initial/final
sound
What is it?
sensory
category
syllables
Create a
sentence
same category
members
Supporting Speech Development
Promote awareness of different sounds
◦ Copying different musical instruments patterns
◦ Environmental/sound lottos
 Help the child recognise the difference and give positive feedback
 Do not correct, instead give the right model
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Oro-motor skills
◦ To increase child’s awareness of their articulators (e.g. tongue, lips,
teeth)
◦ Use a mirror, make different faces with your partner, face paints, food
moustaches
◦ To promote muscle strength and range of movement - blowing, sucking,
stretch tongue in different places
◦ Swallowing – lisps, tongue position
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Phonological awareness / pre-reading skills
◦ Identifying/sorting objects by initial/final sound
◦ Identifying/generating rhymes
◦ Clapping syllables
Pronunciation
Practicing oral motor skills
Supporting Social Communication
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Get down to child’s eye level & encourage eye contact
Encourage child to take responsibility e.g. show me your good
listening.
Explain what is unacceptable & give example of preferred way
e.g. not interrupting if someone is talking but explain we have to
wait and watch for person be available
Highlight good behaviour models in others
Keep your language simple and clear e.g. “Kate, inside please”
not “Kate, can you please go inside now”
Avoid questions which can be answered negatively
◦ e.g. Will you sit on the carpet? Invites a “No” instead either
carpet time, sit on the carpet. Move on to offering a choice –
you can either sit here on the carpet or on the blue mat.
◦ Are you going out tonight? To encourage more information
What are you plans for tonight? Where are you going tonight?
Supporting Social Communication
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Open-ended questions, 6 second rule, reduce complexity
Encourage participation in groups
Point out good role models
Positive instruction
State the obvious
Writing a social story (Ref: Carol Gray)
http://www.thegraycenter.org/socialstories
Social rules poster – looking at the person, waiting for a
pause before taking your turn etc.
Inference and predication skills
Focus on problem solving a situation
Encourage self-advocacy skills e.g. how to ask for
repetition or further explanation
Role-play different social situations to practice
communication required e.g. what to say in a restaurant
PRAISE appropriate behaviour
Pronunciation
Expression
Understanding
Play
Attention
Adult - Child Interaction
Activity
To support
Monkey Tongue
Pronunciation
Story telling
Expression
Construction
Understanding
Listen for errors
Attention
Eye contact game
Social
Interaction
ESL v Language Impairment
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Multi-lingualism can impact language acquisition (positively
/ negatively)
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Difficult to reach a differential diagnosis
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SLTs work with children who are experiencing difficulties
with receptive and expressive language in BOTH/ALL of
their languages.
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Not as concerned about children’s ability to acquire a
second language if they are proficient and fluent in their
first language.
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Specific to each individual situation
Table Feedback
Resources & Websites
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“How to identify and support children with speech and
language difficulties”. Jane Speake. LDA
“Listen to your child” David Crystal.
“Take Time” Mary Nash-Wortham & Jean Hunt.
Talking point website www.talkingpoint.org.uk
RCSLT RESOURCE MANUAL FOR COMMISSIONING
AND PLANNING SERVICES FOR SLCN
http://www.rcslt.org/speech_and_language_therapy/
commissioning/sli
Several Apps targeting Speech and Language therapy
Lets Communicate
March 2012, ECIS Athens
Thank you
Pippa Kerr
Speech and Language therapist
pippa@letscommunicate.eu
Language Pyramid Terms
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Attention - Looking and Listening
◦ The ability to attend and concentrate on an activity
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Expressive Language/Talking
◦ Formulating ideas into words and sentences in order to
get your message across. This can be verbal (i.e. using
words/noises) e.g. “want drink” or non- verbal (i.e.
using body language, gestures, actions) e.g. points to
cup or pushes toy away
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Play
◦ Develops as the child matures and ranges from
exploring the environment and relating objects together
to pretend play and complex imaginative role-playing
Language Pyramid Terms
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Pronunciation/Speech Sounds/Articulation
◦ Using your mouth, lips, tongue, teeth, voice and breath to
articulate sounds that make up words e.g. c-a-t
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Adult-Child Interaction
◦ Two-way communicative exchanges between an adult and
child. These can be non- verbal e.g. eye contact or verbal
e.g. turn-taking in conversations.
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Understanding/ Receptive Language/
Comprehension
◦ Decoding information at a word and sentence level, i.e.
understanding and following spoken or written instructions