Lets CommunicateLets CommunicateMarch 2012, ECIS AthensMarch 2012, ECIS Athens

Pippa Kerr Speech and Language therapist

Session Plan Session Plan

Facts & FiguresCommunication pyramid How language and speech skills

typically developSpotting a potential difficultyPromoting a language enriched

environmentWalkabout

The Importance of Speech and The Importance of Speech and Language DevelopmentLanguage 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

The ability to understand and use language is the key to all future education.

Children need language not only to communicate but also as a tool of thought.

The ability to communicate is the basis of social and emotional well - being.

Facts and Figures…..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 disorderSLI 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 Wider impacts of Speech and Language difficultiesLanguage 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 Session Plan

Facts & FiguresCommunication pyramid How language and speech skills typically

developSpotting a potential difficultyPromoting a language enriched environmentWalkabout

Expressive LanguageTalking

Understanding Receptive Language / Comprehension

Attention: Looking and Listening

Play

Pronunciation/Speech Sounds / Articulation Adult-Child Interaction

Adult - Child Interaction

Attention

Play

Pronunciation

Understanding

Expression

Session Plan Session Plan

Facts & FiguresCommunication pyramid How language and speech skills typically

developSpotting a potential difficultyPromoting a language enriched environmentWalkabout

Normal Communication Development - Normal Communication Development - an outlinean outline

Normal Communication Development - Normal Communication Development - an outlinean outline

And when speech and language And when speech and language development don’t follow this pattern?development don’t follow this pattern?

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

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.

How does it feel to have a How does it feel to have a Communication Difficulty ?Communication Difficulty ?

Once upon a time in Athens.

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Social Communication Social Communication Field of semantic-pragmatics (i.e. language meaning and language use). Social communication abilities develop from birth as a child learns turn-

taking, reciprocity, to request, to comment and to read a situation Difficulties manifest in the individual:

◦ 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 Session Plan

Facts & FiguresCommunication pyramid How language and speech skills typically

developSpotting a potential difficultyPromoting a language enriched environmentWalkabout

Supporting Attention and ListeningSupporting Attention and Listening

Attention

• 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

SUPPORTING UNDERSTANDINGSUPPORTING UNDERSTANDING

Understanding

Activity: Do what I say!

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

SUPPORTING EXPRESSIVE LANGUAGESUPPORTING EXPRESSIVE LANGUAGE

Expression

Teach vocabulary within topics e.g. animals, clothes, weather, festivals

Vocabulary building (pre-teach & review vocabulary, use new words in a story, Descriptive games)

Model clear, accurate language structures e.g. plurals, pronouns

Repeat back child’s utterance and add 1 word

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?

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

KEEP QUIET! Give space for expression (leave 5 seconds) Observe Wait Listen (OWL)

Supporting Vocabulary Building Supporting Vocabulary Building

sensory

category

same categorymembers

appearance

locationfunction

Initial/finalsound

Create a sentence

syllables

What is it?

Supporting Speech DevelopmentSupporting 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

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

Phonological awareness / pre-reading skills◦ Identifying/sorting objects by initial/final sound◦ Identifying/generating rhymes◦ Clapping syllables

Pronunciation

Practicing oral motor skills

Supporting Social CommunicationSupporting Social Communication

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 CommunicationSupporting Social Communication 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

Adult - Child Interaction

Attention

Play

Pronunciation

Understanding

Expression

Activity To support

Monkey Tongue Pronunciation

Story telling Expression

Construction Understanding

Listen for errors Attention

Eye contact game Social Interaction

ESL v Language ImpairmentESL v Language Impairment Multi-lingualism can impact language acquisition (positively

/ negatively)

Difficult to reach a differential diagnosis

SLTs work with children who are experiencing difficulties with receptive and expressive language in BOTH/ALL of their languages.

Not as concerned about children’s ability to acquire a second language if they are proficient and fluent in their first language.

Specific to each individual situation

Table FeedbackTable Feedback

Resources & Websites Resources & Websites

“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.ukRCSLT 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 CommunicateLets CommunicateMarch 2012, ECIS AthensMarch 2012, ECIS Athens

Pippa Kerr Speech and Language therapist pippa@letscommunicate.eu

Thank youThank you

Language Pyramid Terms Language Pyramid Terms

Attention - Looking and Listening◦ The ability to attend and concentrate on an activity

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

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 Language Pyramid Terms 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

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.

Understanding/ Receptive Language/ Comprehension◦ Decoding information at a word and sentence level, i.e.

understanding and following spoken or written instructions