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Lets Communicate March 2012, ECIS Athens Pippa Kerr Speech and Language therapist.

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1 Lets Communicate March 2012, ECIS Athens Pippa Kerr Speech and Language therapist

2 Session Plan Facts & Figures Communication pyramid How language and speech skills typically develop Spotting a potential difficulty Promoting a language enriched environment Walkabout

3 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 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.

4 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

5 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……..

6 Session Plan Facts & Figures Communication pyramid How language and speech skills typically develop Spotting a potential difficulty Promoting a language enriched environment Walkabout

7 Expressive Language Talking Understanding Receptive Language / Comprehension Attention: Looking and Listening Play Pronunciation/ Speech Sounds / Articulation Adult-Child Interaction

8 Attention Play Pronunciation Understanding Expression

9 Session Plan Facts & Figures Communication pyramid How language and speech skills typically develop Spotting a potential difficulty Promoting a language enriched environment Walkabout

10 Normal Communication Development - an outline


12 And when speech and language 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.

13 How does it feel to have a Communication Difficulty ? Once upon a time in Athens. O O O

14 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

15 Session Plan Facts & Figures Communication pyramid How language and speech skills typically develop Spotting a potential difficulty Promoting a language enriched environment Walkabout

16 Supporting 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

17 SUPPORTING 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

18 SUPPORTING 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)

19 Supporting Vocabulary Building sensory category same category members appearance location function Initial/final sound Create a sentence syllables What is it?

20 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 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

21 Practicing oral motor skills

22 Supporting 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?

23 Supporting 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) 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

24 Adult - Child Interaction Attention Play Pronunciation Understanding Expression

25 ActivityTo support Monkey TonguePronunciation Story tellingExpression ConstructionUnderstanding Listen for errorsAttention Eye contact gameSocial Interaction

26 ESL 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

27 Table Feedback

28 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 RCSLT RESOURCE MANUAL FOR COMMISSIONING AND PLANNING SERVICES FOR SLCN commissioning/sli commissioning/sli Several Apps targeting Speech and Language therapy

29 Lets Communicate March 2012, ECIS Athens Pippa Kerr Speech and Language therapist Thank you


31 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

32 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

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