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Speech and Language Therapy

We often receives calls from parents who are concerned about the level of their childs speech and language. This fact sheet is a guide to speech, language and communication and the services and resources that parents/carers can access for their children with regards to their speech and language.

Development of speech, language and communication

Speech is a large part of a language that people use on a daily basis. However, language is more than speech alone. It encompasses elements of communication such as body language, gesture and eye-contact. As a child develops, so does their use of language to communicate. The speech and language development of a child would normally be as follows:

A childs acquisition of language can be broken down into different segments:

Phonology - a persons use of speech sounds, for example, /t/ in the sound /tea/.

Syntax - the rules of grammar, for example, knowing which order to place the Subject, Object and Verb in a sentence, (Subject) Daddy (Verb) jumped over the (Object) chair".

Semantics - a persons ability to understand and create the meaning of language.

Pragmatics - the ability to use language for the purpose of communication.

Breaking down language into these different segments allows professionals to clarify to what extent and which aspects of, the language and communication of a child with ADD/ADHD is impaired.

Reasons for a delay in speech, language and communication in a child with ADD/ADHD

Children with ADD/ADHD often find that their child fails to communicate using speech or any other type of language, for example, eye-contact, hand gestures, body language. If a child does not wish to communicate intentionally (a trait of AD/HD) they will not explore their ability to vocalise, learn new sounds or listen to the language spoken around them. This will ultimately result in a delay in their language acquisition. Without this means of communication a child will find it difficult to express themselves this often leads to frustration for the child.

A child with ADD/ADHD may not see any reason to communicate with other people, without a reason there is no point in communicating or no need to communicate.

A child with ADD/ADHD may also remove themselves from situations that require communication, limiting their opportunities to communicate without opportunities there cannot be a development in communication.

The following diagram explains the complexity of how people use communication and highlights the limitations of a child who does not adhere to the model.

Means, reasons and opportunities model

Common speech, language and communication problems in children with ADD/ADHD

A. Social Communication

A child with ADD/ADHD is often unable to use or understand social communication. The term Social Communication encompasses both verbal and non-verbal communication. For example, gestures, facial expressions, tone of voice, rate and fluency of speech.

B. Echolalia ("parroting")

This is when a child repeats what they have heard rather than giving an appropriate response to what has been said to them.

For example:

Mother: "Hello Tommy"
Tommy: "Hello Tommy"

When a child is using echolalia they are copying speech alone and showing no understanding of what has been said to them. Therefore it is most likely that the echolalia is not being used to show communicative intent.

C. Idiosynchratic Language

This is when a child associates a particular word or phrase to an event or object in such a way that it is inexplicable to the listener. Uta Frith, 1989, uses the following anecdote to explain this phenomenon:

"Paul was two years old when his mother used to recite to him the nursery rhyme Peter, Peter Pumpkin Eater. One day, when she was doing this she dropped a saucepan. Paul, from that day on chanted Peter Eater whenever he saw anything resembling a saucepan."

D. Literal Language

A child with ADD/ADHD will often find it difficult to understand sarcasm or metaphorical phrases. For example, if a child with ADD/ADHD is told to "pull your socks up" or that its "raining cats and dogs" it is likely that they will take the phrase very literally.

The role of the Speech and Language Therapist when working with people with ADD/ADHD

Speech and Language Therapists work to assess, diagnose and develop a programme of care to maximize the communication potential of the people under their care. When working with people who have ADD/ADHD, a Speech and Language Therapist (SALT) will adapt the therapy given according to the presenting problem. It is likely that the SALT will work on one of the following when giving therapy to a person with ADD/ADHD:

Listening and Attention Skills
Play Skills
Social Skills
Social understanding
Understanding of language
Expressive Language

The above list may seem far removed from actually "teaching a child to speak". However, what must be remembered is that children develop, and learn to use speech appropriately through skills such as play and listening/paying attention to other peoples use of communication.

It is also important to remember that a child who does not communicate is unlikely to speak. Therefore, any therapy offered by a SALT is initially likely to focus on getting the child to communicate using something such as a signing system, symbols system or picture system, rather than focusing on speech alone.

How to obtain a referal to a Speech and Language Therapist

For an NHS appointment you can ask the G.P. to refer you to the Speech and Language Therapist. If you would like to contact a SALT in your area without going through your GP, contact The Royal College of Speech and Language Therapy and they will give you the contact details of the appropriate person in your area. After an initial contact with SALT they should be able to them let you know the best route for the quickest referral - via: G.P., School, Mental Health Services, School Nurse, Educational Psychologist

For a private Speech and Language Therapy appointment you can contact Association of Speech and Language Therapists in Independent Practice, who will be able to supply you with the SALTs who are working in your area.

Access to a SALT can also be gained through a Statement of Special Educational Needs. If the Local Educational Authority recognise that the child needs the input of an SALT as an educational provision in order to meet their educational needs, this should be written in part three of the childs statement. 2004

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