Language disorders at primary age

Squid has done marvellously well. ‘Just outside the range of normal’ for understanding, grammar and language. Her NHS speech therapist wants to move her onto only speech sound targets for the next block.

Apart from ‘just outside the range of normal’ means that on every test they administer she scores between 5% and 10% less than lower bound of the very wide range of normal for a child her age. And she still struggles. So I think it would be wrong to consider this the end of language intereventions. But possibly it might be the right point to view her as receiving support ‘in context’ – i.e. parents and school.

 

I copied the below from http://www.asha.org. Does anyone have any other thoughts to add for a good flight-plan to support a language disordered primary school aged child?

Intervention For Elementary School Children (Ages 5–10)

The focus of language intervention for elementary school children with language difficulties is to help the child acquire the language skills needed to learn and succeed in a classroom environment. Interventions are curriculum-based, that is, goals address language needs within the context of the curriculum where these skills are needed. 

Interventions may also address literacy skills (e.g., improving decoding, reading comprehension, and narrative and expository writing), as well as metacognitive and metalinguistic skills (e.g., increasing awareness of rules and principles for use of various language forms, improving the ability to self-monitor and self-regulate) that are critical for the development of higher-level language skills.  See the treatment section of the Written Language Disorders Practice Portal page.

For children who speak a language other than English in the home, it may be necessary to use the home language as a mechanism for transitioning the child to using the language of the school. Planning and implementing an effective language intervention program is often a coordinated effort involving the SLP, classroom teacher(s), and other school specialists. 

Areas targeted for this population typically include 

phonology 

  • enhancing phonological awareness skills, 
  • eliminating any residual phonological processes. 

semantics 

  • improving knowledge of vocabulary, including knowledge of curriculum-related vocabulary, 
  • improving depth of vocabulary understanding and use, including
    • subtle differences in meaning, 
    • changes in meaning with context, 
    • abstract vocabulary, 
    • figures of speech; 
  • understanding figurative language and recognizing ambiguities in language (e.g., words with multiple meanings and ambiguous sentence structures); 
  • monitoring comprehension, requesting clarification; 
  • paraphrasing information. 

morphology and syntax 

  • increasing the use of more advanced morphology (e.g., monster/monstrous, medicine/medical, school/scholastic); 
  • increasing the ability to analyze morphologically complex words (e.g., prefixes, suffixes); 
  • improving morphosyntactic skills (e.g., use of morphemes in simple and complex clauses, declarative versus questions, tag questions and relative clauses); 
  • improving the ability to understand and formulate more complex sentence structures (e.g., compound sentences; complex sentences containing dependent clauses); 
  • judging the correctness of grammar and morphological word forms and being able to correct errors. 

pragmatics 

  • using language in various contexts to convey politeness, persuasiveness, clarification; 
  • increasing discourse-level knowledge and skills, including
    • academic discourse, 
    • social interaction discourse, 
    • narrative discourse, 
    • expository discourse, 
    • use of cohesive devices in discourse; 
  • improving the ability to make relevant contributions to classroom discussions; 
  • improving the ability to repair conversational breakdowns; 
  • learning what to say and what not to say; 
  • learning when to talk and when not to talk.”

Baby Sid #1 

Baby Sid came to play today. Squid as Baby Sid wears a babygrow and does the craziest things. He climbs on the table. He pours sand in his hair. He sucks pennies. He likes to be settled down in a cot with a bottle of warm milk. Most of all – Squid as Baby Sid doesn’t talk. Baby Sid comes to play most days after school. 

Fido the doggie also comes to play. Squid as Fido eats from the floor and walks on a leash. Squid as Fido also doesn’t talk. Sometimes we get a cat to visit. Squid as a cat likes to be stroked and drinks milk from a saucer. Squid as a cat also doesn’t talk. Cats don’t talk (of course).

They’re quite fun – but I don’t think you have to be a psychologist to observe how hard she must be working at her speech every day. 

Speech therapy without words

Squid doesn’t talk; her brother doesn’t listen. I suspect they are showing sides of the same traits – somehow those brain connections that register words seem to form more slowly and be more fragile than the average.

I found an interesting article by Nina Kraus In Nature Neuroscience Reviews studying the effect of music training on listening skills. There is a logical link that the authors describe: “At the acoustic level, music and speech use pitch, timing and timbre cues to convey information. At a cognitive level, music and speech processing require similar memory and attention skills.”.  They substantiate it with convincing arguments about how longterm focussed music training changes the structure of the brain and its responsiveness to sounds.

A paragraph that I found to be particularly relevant for us was the claim that music training improved the ability to discriminate speech in a noisy environment. The argument is that musicians are trained to be tuned into discriminating accurately between ‘regular’ and ‘irregular’ parts of their soundscape. So the skill for the conductor to hear one dud note in an orchestra is closely related to the skill of picking out the words of your friends against the background regular drone of a party.

The context of the article seems to mainly be classical music training. The same principles should apply to any focused musical development including singing and guitar. The results were much better if music training began before the age of seven and sustained over a long time in a focussed way.

Squids do music lessons. One benefit I’ve seen for sure is the verbal-lite social activity of sharing music with others. I’m thinking of the big kids in the orchestra – but I’m also remembering little Squid in her first year at school. Stuck for words and struggling to engage; dancing, twirling and bubbling as soon as the music came on.

Free Printable Flip Up Pronoun Speech Cards

Today Squid is poorly home from school, and Mum is low on inspiration, so we will be working though some activities gleaned from the Internet.
I found these beautiful free printables on pronouns. The link explains them, but I had to go to ‘teachers pay teachers’ to download it (for free). I hope she loves them as much as I think she will!

I was enthusiastic enough about them to laminate them. Junior’s reading is not sufficiently advanced to mention the whole sentence, so I cued her in with questions: Q“Who is reading? ” A “She is” or “She is reading” (led by how confident Junior was with the rest of the sentence).

The genius is folding up the bottom of the cards so the answer was on the back. She was shameless about ‘cheating’ – but it really reduced her anxiety. It also passed the ‘distracted facilitator’ test – I had to leave the room and on my return she’d carried on working with the cards.

Source: Free Printable Flip Up Pronoun Speech Cards

Words wanted; will pay biscuits 

My speech therapist advises Hanen inspired approaches which involve a lot of pregnant pauses to give your child the opportunity to speak, without ever pressuring them. My mother-in-law, however, won’t hand over biscuits without a credible attempt to request it politely.
A standoff. Subliminal calculation of grandmotherly intransigence versus grandmotherly generosity. Then she acquiesces. She really tries.
Then, with crumbs still spilling out of her mouth, she is back asking for another one. She doesn’t ask me – she knows I only pay in apple slices.

Psychology of keeping going 

Supporting a child with speech delay is a long and often frustrating journey. Here is a list of a some tactics that help me. I’d love to hear other people’s ideas in the comments!

  1. Reasonable expectations of attention span  10 minutes on a single activity is fine for a preschooler
  2. Routines when things happen at the same time every day, exhausting tantrums are less likely. There is another reason routines help – they define what ‘good enough‘ is.
  3. Set the bar to ‘winable’ define an achievable workload for yourself and your child – and make sure to take a moment to pat yourself on the back for sticking with it. It is easy to get overwhelmed looking at everything your child has to catch up with.
  4. Holidays Your kid’s speech therapist has holidays. Your kid’s teacher has the whole weekend without having to be patient or encouraging. Parents are allowed holidays too – even if their kid has extra needs. Accept offers of help when they come – even if ‘help’ sticks your kid in front of the TV for eight hours with a bag of crisps.
  5. Forgive yourself 
  6. Let your support crew in Invariably there is a ‘primary caregiver’ who is disproportionately involved in the therapy, planning and decisions. It’s so easy to become isolated and rigid though. Talking to other people, and taking time to keep your own friendships is important to keep you sane and motivated.
  7. Fun strengthens your bond Silly fun with your kid strengthens your bond and helps you progress more effectively when you work.

I see the past 

I see the little boy who would get so angry that he wouldn’t be understood – but I need to blink him away. The real boy is up on stage projecting his voice so that the whole hall can hear him.

I see the little boy who would be too shy to socialise – but he’s grown. He’s leaving pauses in the speech so that the audience can laugh. A confident, perfectly timed arched eyebrow knowing he’ll get a response.

We’ve worked with him for over 8 years on his speech. While I was worrying about each little milestone, I didn’t realise that underneath it all we were growing a confident communicator.

He still has a lisp. Not all his sounds are consistent. But I’m the only one that hears that now. Everyone else saw the young thespian loving every moment on stage.

I need to make an effort to see that too. I remember the little boy – but I see the big boy too – and I will take a moment to be so proud of all of us for leveraging a weakness into a talent.