Speech Pathology for children focuses on assessing and treating a child’s ability to communicate effectively with others and may also look at a child’s eating and swallowing skills.

Speech Pathology is interested in all aspects of communication and looks carefully at the way a child is interacting and playing with adults and their peers; how they are attending to activities and tasks; their ability to listen to auditory information in particular speech; how they are understanding their environment, routines and what others are saying; the way they relay information non-verbally (e.g. facial expressions, gestures etc) and verbally (e.g. use of words, sentences etc); how they are using the language and words they have with others; how they are communicating socially with their peers; the pronunciation (articulation) and quality of their speech and how well they are understood, and finally, their literacy skills including reading and writing.

Skills expected of children change rapidly with age. A two year old is not expected to pronounce words precisely, but is expected to be using different sounds during play and be attempting to say words which may contain errors (e.g. saying “tat” for “cat” etc). In doing so they are developing the foundation for future skills.

At kindergarten/Pre-school, a child will be attending and listening for longer periods of time and will be able to engage in a task while listening to a teacher at the same time. They will engage in a lot of imaginative play, be able to understand longer instructions, use longer more complex sentence forms which are generally grammatically correct and have clear pronunciation.

A couple of years into school, children can understand and use complex language about past events. They should also be beginning to understand humour; be able to follow lengthy instructions; be interacting successfully with their peers; be able to read and understand what they are reading and be able to write stories etc.

In order to perform all these activities, a range of hidden skills are required. It is here that Speech Pathology focuses on ensuring children demonstrate age-appropriate abilities across a range of tasks required in their day: from academic performance to playing and interacting with friends, to talking in front of an audience.

Children’s skill development is like building a pyramid. There must be a solid foundation upon which to build. If there are “gaps” in the foundations, the structure of the pyramid will be weak and more gaps will occur aas each layer is added to the foundation.

For children, the necessary foundation for the development of good communication skills is good adult-child interactions. The reason for this is that the adult provides information about what the child hears/sees/does and helps the child to make sense of the world, develop good attention and listening skills and appropriate development in play.

It is upon these foundations that attention and listening skills continue to develop and understanding of words and language becomes possible. A child must be able to understand words and language before they will be able to use words and language and express themselves effectively. The tip of the pyramid is where the fine tuning is done and the pronunciation of sounds and words become important.

Speech Pathology helps when a child is having difficulty developing a new skill (especially over a longer time than considered typical for their age). It also helps children in developing age appropriate social skills and behaviour. In particular, where difficulties occur, Speech Pathologists ask “why is the skill difficult?” (that is, “why is communication breaking down?”). The Speech Pathologist will then review the underlying foundations and layers to determine where the origin if the challenge is, to then deduce appropriate strategies to resolve the problem.

The areas of development that Speech Pathology focuses on include:

Play and Interaction Skills (early interaction and play with adults and peers, and attention and listening skills)

Understanding of Words and Language – Receptive Language (understanding of gestures, symbols, language e.g. the ability to follow instructions, understanding a story, reading, etc).

Using Words and Language –Expressive Language (e.g. naming, putting words together into sentences, telling a story and using language socially with others, written language, etc).

Pronunciation and Talking- Articulation (e.g. producing and blending sounds together into words and sentences, quality of speech in terms of voice and fluency and understanding that sounds carry meaning and being able to identify and hear different sounds in words etc).

PLAY AND INTERACTION are skills that are developing from the moment a child is born. They include things like gaining eye contact; responding to a smile with a smile or sound; sharing information by gesturing towards the airplane in the sky, enjoying a game of “peek a boo”, etc. These are the foundations upon which verbal language and communication are built.
The areas within play and interaction include:

Adult-child Interaction: This is how the child and the adult communicate and interact together. It is looking at how information is exchanged verbally and non-verbally and how the adult is providing the information about what the child hears/sees/does, to help them to make sense of the world. There are many ways of interacting with a child to enhance communication development. For example: getting face to face when speaking with them helps give them more information about what is being said to them (as they can see an adult’s face).

Play: Play is the way the child learns about the world around him. Children need to have a variety of play experiences to help them to acquire language for thinking, learning and communicating. Pretend play (e.g. pretending to have a tea party, pretending to go shopping, etc.) is particularly important. The symbolic nature of play is linked to the development of symbolic thinking which is essential for language development. Many children with language difficulties have problems with pretend play.

Attention, Looking and Listening: Attention develops alongside other skills. A child needs to be able to attend to something for long enough to be able to process the information and gain meaning from it. Without this skill, a child will not be able to match the language he hears to what he is looking at.

You can tell if there are problems with play and interaction if the child displays difficulties with:

• Starting and completing activities, where they might flit from one activity to the next.
• Responding to loud or unfamiliar sounds by looking (e.g. looking up for the plane in the sky, turning towards a clap, etc.).
• Gaining eye contact with the parent.
• Responding to their name.
• Engaging in age-appropriate play.
• Responding to an angry, happy, sad tones of voice non-verbally or verbally (e.g. looking worried or crying if being talked to in a stern voice etc.).
• Copying facial expressions (e.g. smiling when you smile, etc.).
• Engaging with or communicating with others.
• Engaging in constructive play (e.g. tends to throw, crash down, tear, etc.).
• Engaging in turn taking (e.g. taking turns to put the block on a tower, etc).
• Responding to attempts by others to communicate.
• Moving from one activity to the next.

Implications for these difficulties on play and interaction skills:

• Fidget a lot and find it hard to sit still.
• Be easily distracted all of the time.
• Appear to day dream.
• Look fleetingly from place to place, paying only brief attention to each new stimulus.
• Flit from activity to activity without engaging in any one.
  
• Avoiding eye contact when speaking.
  
• Be unable to focus on a task as long as the majority of their peers.
  
• Need constant prompting from adults to remain focused.
  
• May have difficulties sitting and attending on the mat at group times.
  
• May have preference for physical activities (e.g. riding bikes or for passive activities such as computers and T.V.).
  
• May have difficulty learning new things (e.g. how to play differently with a toy).
• May have difficulty initiating play with others.
  
• May have difficulty engaging in play with others.
  
• May have difficulty responding to adults and/or peers.
  
• May have difficulty coping in new situations.
  
• May cling to a familiar adult when in a play or social environment.
  
• May pull toys out, throw things, knock things down, tear books without engaging in constructive play, etc.
  
• May push, hit other children for no identifiable reason.

UNDERSTANDING OF WORDS AND LANGUAGE (Receptive Language Skills) involves being able to attend and listen, process and understand words and sentences. It relies on understanding of the world, environment, routines and visual information. Speech Pathology looks at the skills required to be able to understand language to an age appropriate level.

The areas within understanding words and language include:

Non-verbal Understanding: Understanding of facial expressions, body language, tone of voice and gestures. Ability to make eye contact, understand routines and environmental information.

Understanding of Words: Understanding of the vocabulary (e.g. naming words, action words, describing words and concepts).

Understanding of Word Structure: Understanding grammatical markers that change the meaning of words (e.g. word endings and structure finished – indicates it happened in the past, don’t – indicates negative, cars- indicates plurality etc.).

Understanding of Word Order and Sentence Structure: Understanding how words are ordered (e.g. There are rules which govern which order words go together. For example in the English language a common word order is subject-verb- object (“The cat (subject) sat (verb) on the mat (object)”). It is also the understanding of all the words in the sentence, as to begin with children only understand the key content words in the sentence.

Understanding of Written Language: Being able to read the text and gain meaning from the written word.

Factors Affecting the Development of Understanding:

1. Attention and listening skills.
2. Type and amount of language input received from adults in the child’s environment.
3. General learning difficulties (cognitive skills). This will affect the child’s ability to gather, interpret and remember information.
4. Sensory impairment e.g. vision or hearing. This will affect child’s ability to gain information from looking and/or listening.
5. Physical disabilities e.g. Cerebral Palsy. This makes it harder for them to explore their environment.
6. Prolonged sickness.

You can tell if there are problems with understanding Words and Language (Receptive Language) if the child displays difficulties with:

• Attending to what is being said.
• Following requests and directions.
• Attending to a speaker within group times at pre-school or school.
• When older following longer more complex instructions.
• Behaving appropriately within group situations.
• Answering simple questions (e.g. what? where? who?).
• When older, answering more difficult questions (e.g. how? why? when?).
• Understanding age appropriate stories.
• Reading and understanding written instructions.

Implications of these difficulties on a child’s daily functioning and behaviour:

• May appear “naughty” as though they are not listening or doing what they are told.
• May be very active or disruptive in structures situations or may be overly quiet.
• May echo what is said to them instead of giving an answer.
• May try to control the conversations with others and divert discussions to things they know about.
• May give inappropriate answers.
• May seek out younger children to befriend.
• May dislike reading.

USING WORDS AND LANGUAGE (Expressive Language) incorporates the use of facial expressions, gestures, words, language and writing to convey meaning and information to others.
The use of language also covers the rules of communication, and the reasons why we communicate.

Learning about the rules of communication develops from birth. The child learns the rules from the adult, through adult-child interaction e.g. turn-taking, eye contact, listening etc. In order to become competent communicators and fully understanding of a social situation, there is a need to understand, interpret and use non-verbal and verbal information.

Initially babies will only have a few basic needs that they will want to communicate and they will do this non-verbally e.g. hunger, boredom, excitement, pain etc. As they explore and learn more about the world, they will have more to communicate about. They will communicate non-verbally and verbally. It is important to note that non-verbal skills are the foundations for verbal (using words) communication. Non-verbal skills continue to be important through life.

The areas of using Words and Language (Expressive Language) include:

Non-verbal Expression: The use of facial expressions (e.g. smiling, frowning etc), body positions (e.g. upright, slouched etc), voice and tone, gestures (e.g. waving, pointing etc.) which holds meaning and relays information to others.

Vocabulary: The ability to access meaningful words that are stored in the brain and use them in flexible ways (e.g. by themselves, within sentences, in different contexts) to provide information to others.
Grammatical structure of words and sentences: The way in which the elements of language are combined in certain patterns which influence the meaning of what is said. For example the word “fish” by adding the “ing” to the end it can change the word from a noun to a verb i.e. “ I love fish” to “I love fishing”

Grammar is the structural foundation of our ability to express ourselves. The more we are aware how it works, the more we can monitor the meaning and effectiveness of the way we and others use language. It can help foster precision, detect ambiguity, and exploit the richness of expression available in English. And it can help everyone - not only teachers of English, but teachers of anything, for all teaching is ultimately a matter of getting to grips with meaning. (David Crystal, “In word and Deed,” TES Teacher, April 30, 2004).

Social use of language: The rules that children follow to use language socially. These rules may vary across cultures and within cultures. It is important to understand the rules of your communication partner. The rules are often implicit and not explicit.

A child may say words clearly and use long, complex sentences with correct grammar, but still have a communication problem if he or she has not mastered the rules for social language known as Pragmatics.

Pragmatics involves three major communication skills:

1. Using language for different reasons and functions including greeting (e.g. “hello”, “goodbye” etc), informing (e.g. I’m going to eat an apple), demanding (e.g. give me an apple), promising (e.g. I will get you an apple), requesting (e.g. I would like an apple please) etc.
2. Changing language to meet the needs of the listener or situation, for example: talking differently to a baby vs. an adult; giving background information to an unfamiliar listener and speaking differently in a noisy vs. a quiet environment etc.
3. Following rules for conversations and storytelling, for example: taking turns within a conversation; introducing topics of conversation; remaining on topic; when not understood rephrasing; knowing how to use verbal and non-verbal signals; how close to stand to someone when speaking and how to use facial expressions and eye contact etc.

It is not unusual for children to have difficulty with social use of language in some situations. However, if problems in social language use occur and seem inappropriate considering the child’s age, they may be considered to have social communication difficulties. Social communication difficulties often exist alongside other language problems, such as vocabulary development or grammar. Social communication difficulties can mean it is harder for children to make friends and be accepted by their peers.

Written Language: This is the representation of language using symbols and signs (writing). A child needs to have well established oral language skills before he or she can develop good written language skills.
You can tell there might be problems with use of words and language (Expressive Language) if the child:

• Forgets or misuses words or uses “empty” words (e.g. “thingy”, “whatsit”, “this”, “that” etc.).
• Gives muddled explanations.
• Uses immature grammar and simple sentence structure.
• Is disruptive in speaking situations.
• Sticks to preferred topics and phrases.
• Moves from one topic to the next and is difficult for the listener to follow.
• Uses lots of gesture and other non-verbal communication.
• “Goes blank” when asked questions.
• Avoids speaking situations.
• Gets in trouble in the classroom because of poor negotiation skills.
• Is socially isolated or choose only younger children as friends.
• Does not use language in a variety of ways (e.g. questions, statements, greeting etc.).
  

Implications of these difficulties on the child:

• Difficulty establishing friendships.
• Difficulty accessing the curriculum within educational setting, as most learning activities rely on understanding and use of language.
• May affect confidence and self-esteem.
• May cause child frustration and anger.
• Behavioural difficulties.

PRONUNCIATION AND TALKING (physical production of sounds) skills involve the ability to: listen to and identify sounds in words and language; to be able to move and co-ordinate the apparatus involved in producing sounds (e.g. breathing, lips, tongue, palate, vocal chords etc.) and to understand that sounds convey meaning.

Other important aspects of talking and speech include the quality, pitch and resonance of the voice as well as the fluency.

It also involves awareness of what sounds are and how they come together to make words (phonological awareness). Skills include the ability to rhyme, segment words into syllables and single sounds, identify sounds within different positions within words, etc. This is one of the key skills required for successful reading and writing.

Although there are a number of underlying skills necessary to be able to produce and sequence sounds to talk in a way that is understood by others, the following are the key skills which can be easily observed:
Listening and discriminating between sounds involves being able to attend to sounds in the environment and speech sounds and to be able to determine whether those sounds are. For example: to be able to hear and recognise the sounds of a plane vs. a vacuum cleaner or to hear the difference between the “b” sound and the “d” sound.

Oro-motor Skills involves looking at the structure and the movement of the muscles in the lips, tongue, palate, lungs (breathing), vocal chords, cheeks, etc. The strength, co-ordination and control of these structures are the foundation for feeding related tasks including sucking, swallowing, chewing and licking, as well as production of sounds and sequences of sounds.

Production of sounds and sequences of sounds is the production of early sounds (cooing, babbling, etc.), environmental and high interest sounds (e.g. making the sound of a car or aero plane, animal sounds, etc.) through to the production of speech sounds and sequences of speech sounds to make words and sentences. Children start playing with sounds from a very early age. However, it takes time and practice in order to use all these sounds correctly in words. Vowels develop before consonants.

Phonological Awareness skills: Knowledge of word structures and the ability to listen to and identify sounds. Skills in this area develop between the age of 3-5 and involve such skills as being able to identify and use rhyme (e.g. cat, hat, mat, etc.); identify first sounds in words (e.g. “bat” begins with the “b” sound, etc.); segment words into syllables by clapping or drumming (e.g. “el…e…phant” - 3 claps, “bu…tter” - 2 claps etc); syllable blending or ability to blend syllables together to produce a word (e.g. “fi” and “ish” make the word “finish”, etc.).

Phonological awareness skills are an important pre-cursor to reading and writing. Children with poor phonological awareness skills will often show difficulties with reading and writing.

Voice is the sound that is produced from the throat or voice box. The chords are bands of muscles found in the voice box which close to make a voice and open to allow air in and out the lungs when breathing. When producing speech sounds, they close and vibrate and then the sounds is modified by the shape of the lips, tongue, jaw to produce speech. The voice has the following features; pitch (varies from high to low during speech); volume (loud and soft); quality (can be described as clear, croaky, hoarse, breathy, etc.) and resonance (e.g. hyper-nasal when too much air is coming through the nose and hypo-nasal when not enough air is coming through the nose and the child sounds as though they have a cold).

Fluency of Speech refers to the smoothness or flow with which sounds, syllables, words and phrases are joined together when speaking. Difficulties with fluency are often called “cluttering” or “stuttering” and refer to speech where there is a fluency breakdown of repetition of parts of speech. Fluency difficulties are often complex in nature and they attend to occur more in boys than in girls.

You can tell if there are problems with pronunciation and talking if the child displays difficulties with the following:

• Locating and hearing sounds in the environment.
  
• Attending to speech.
  
• Hearing differences between sounds.
  
• Dribbling (if not appropriate for age).
  
• Keeping mouth closed at rest.
  
• Chewing different textures.
  
• Swallowing age-appropriate food.
  
• Fluid coming through the nose when drinking.
  
• Moving lips and tongue.
  
• Eating without lots of mess.
  
• Whistling and blowing (in an older child).
  
• Being understood.
  
• Producing correct sounds in words for age.
  
• Spelling.
  
• Reading.
  
• Producing clear voice.
  
• Losing voice.
  
• Producing speech without lots of repetitions of sounds and phrases.
  
• Getting stuck on words or sounds.

Implications of these difficulties depending on the nature and severity on the child:

• May have difficulties with eating a variety of textures and restricted diet.
  
• May have difficulty being understood by others.
  
• May show frustration and anger due to not being able to get messages across.
  
• May result in breakdown in communication with others especially peers if not being understood and hence difficulty making friendships.
  
• Possible lack of confidence generally and especially within talking situations.
  
• May have difficulty with spelling due to sound production difficulties.
  
• May have difficulty with reading and spelling due to poor phonological awareness skills.
  
• May have difficulty with learning at school (especially literacy based activities).
• Voice and fluency difficulties may result in teasing from peers.