A child starts to babble at seven months. The first words come between then and 18 months, and by two years of age he or she is usually able to say two-word sentences, like: “Drink gone.”
As pronunciation improves “tar” will become “car” and by three to four years of age, someone unfamiliar with the child should be able to understand what they’re saying.
These are the developmental milestones that parents watch out for, but sometimes there may be some delay in a child’s language development.
Niamh Davis is a speech and language therapist (SLT) and chair of the Irish Association of Speech and Language Therapists (IASTI). “Early intervention is key,” she says, “so as soon as you have concerns, you should seek help.”
Red flags are things like your child not understanding instructions, having a stammer or a hoarse voice or not beginning to talk at all. “We’d expect a child of 18 to 24 months to have around 50 to 100 words and be combining them into two-word sentences,” she says.
“Also if they’re having difficulty playing with other children or aren’t interacting well … If there is an existing difficulty like Down’s Syndrome, help would be needed too. For example all children with Down’s Syndrome can have a language disorder and can benefit from speech and language therapy.”
PATTERN IN SOUND DEVELOPMENT
There is a pattern in the development of sounds, she says. “Some sounds are more difficult to enunciate than others,” she adds. “‘S’, ‘F’ and ‘K’ sounds might be later to develop than ‘B’ or ‘M’ or ‘D’ sounds, for example. ‘De’ is often the first sound that a child makes.”
“Usually by the age of three-and-a-half a child should be understandable even to unfamiliar people. That’s often a good marker but parents might have concerns well before that stage,” explains Niamh.
WAITING LISTS
What about free help from the HSE? Is that readily available? “My experience is that public system waiting lists vary from area to area,” she says. “As soon as you’re concerned, you should look for a referral. If you do need a service, the earlier your child’s name is on the list the better.”
Going to a GP or public health nurse is not necessary, however. “Parents can self-refer,” she says. “While they can talk it through with their GP or public health nurse, they can also simply fill out a primary-care referral form on the HSE website (or get this form in their local HSE clinic and post it off).”
CHOOSING PRIVATE THERAPY
If, for whatever reason, you decide to seek therapy privately there is a list of private therapists available on websites like that of the IASLT and the ISTI (Independent Speech-Therapists Ireland). “There is a cost for this, but you can claim tax relief on what you pay on your Med 1 form at the end of your tax year,” Niamh says.
While the IASLT is prohibited by law from discussing prices, an Irish Country Living check of private SLTs’ websites suggests that prices for full assessment, with a report, vary from €250 to €370. A half-hour therapy session costs €55 to €60, a 45-minute session costs between €70 and €80, and a one-hour session costs €100.
A home programme with written materials may cost €80 to €250 and a home or school visit is €100. Prices vary according to the complexity of the case and the experience of the therapist, of course.
“The assessment would usually be more expensive than treatment, because there’s more work for the therapist, analysing all the information that has been gathered,” she says.
WHAT AN ASSESSMENT INVOLVES
Assessment could take place in a clinic, at home or/and in school and usually lasts 30 minutes to an hour. A history from the parents is taken, and they are asked what their concerns are and what the child’s development has been like up till the present.
“It’s not just about speech and motor development, but also about play and how the child interacts. Hearing, of course, is very important, too.” Depending on the age of child, a lot of the assessment will be done through play. “The therapist will watch them doing different tasks to see what the child can do and how they interact and if they can follow simple and more complex instructions.
“Sometimes a therapist can carry out a more formal assessment with an older child. They will be using published, standardised assessments, so the child will be compared with others of the same age. This will show us if they are developing as they should be or if their speech or language is delayed,” explains Niamh.
Assessment may take more than one session if the child has more complex needs or a specific disability, however, and could involve a school assessment.
What happens after that?
“The therapist will then feed the outcome of the assessment back to parents and the recommendation based on that. If a problem is identified, some form of SLT therapy would be recommended,” says Niamh.
Therapy might involve a block of six to eight sessions in the clinic (one each week), from a half hour to 45 minutes for one-to-one therapy. Group sessions are also available.
PARENTAL INVOLVEMENT
For very young children, a lot of the research is showing that, in terms of early intervention, collaborating with parents and coaching them to do the intervention themselves at home is showing the best results, she points out.
“Programmes might involve a group of parents coming to a session together at first and listening and learning from the therapist and then later attending one-to-one to practise the strategies.
“It might be simple strategies: like getting down face to face with your child, observing what they are showing interest in and watching and looking. When you’re both engaged together you’re providing the language for them, so if the parent and child are both focussed on the one thing – usually what the child is interested in – that’s the optimal time then to hear the words, take them on board and learn them,” Niamh explains.
HOW MANY SESSIONS ARE NEEDED?
“If it’s a simple speech sound difficulty it might be just a few sessions,” she says, “with a review maybe a year later. If it’s a language disability, you’re looking at long-term intervention.”
The IASLT sees communication as vital. “Communication can affect all aspects of life: employment, making friends. Sometimes we find children with a language disorder who don’t know the rules for a game or can’t follow the rules, for example, so they are not able to participate in the yard because they can’t join in the game.
“In that case we might work with the special-needs assistant to help them to teach the child how to join in and make that bridge.”
It’s not a case of parents coming in to a SLT session to have their child fixed, she says. “That’s not the way it works. Most communication opportunities take place outside of the (clinic) setting. Parents are the experts on their child, and we collaborate with them rather than just do work with their child.
“Some children will need more help than others, but in most cases we’ll be able to provide the parents with the skills and they’ll go away and do the work and just link with us again to monitor progress, if necessary.” CL
preparing for an assessment
Try to brainstorm ahead of the assessment, as the therapist may ask the ages that your child started: babbling (making sounds); using their first words; using two words together; crawling; walking; dressing independently; feeding independently; using the toilet independently; how many words your child currently uses. Ahead of the assessment keep a notebook nearby and jot down the words your child says. Every time a new word is used add it in. Bring this log to the SLT assessment.
What can you do daily as a parent?
• Get face-to-face so your child can tune into your facial expressions.• Talk as you go through normal daily routines, play games like peek-a-boo and sing nursery rhymes – all important for speech and language development.• Talk about what’s happening, for instance, “Look! John is having juice!”• Play alongside your child to encourage interaction.• Introduce reading together from an early age. Name the pictures.Why too much telly isn’t good
For children under two, no more than a half an hour watching television per day is recommended and an hour per day for three- to five-year-olds. Television does not talk back – it is passive, rather than interactive, so it doesn’t help a child’s vocabulary or communication skills, experts say. TV also doesn’t help because people don’t talk while it’s on. “One study found that, on average, parents say over 900 words an hour, but when the TV is on they hardly talk at all,” says Niamh.
professional SLT organisations
The Irish Association of Speech & Language Therapists (IASLT) is the recognised professional association of Speech and Language Therapists in Ireland.
Independent Speech-Therapists Ireland is an association of experienced Speech and Language Therapists practicing independently in Ireland. All are registered with CORU, the professional regulatory body of Ireland.
Note: Some members of the ISTI are also members of the IASLT.
USEFUL LINKS
www.iaslt.ie
www.isti.ie
www.hse.ie
http://www.sicp.ie/en/ReferralsClinics/ReferralForms/PDFFile_17574_en.pdf
Ask for the referral form at your local HSE clinic.
A child starts to babble at seven months. The first words come between then and 18 months, and by two years of age he or she is usually able to say two-word sentences, like: “Drink gone.”
As pronunciation improves “tar” will become “car” and by three to four years of age, someone unfamiliar with the child should be able to understand what they’re saying.
These are the developmental milestones that parents watch out for, but sometimes there may be some delay in a child’s language development.
Niamh Davis is a speech and language therapist (SLT) and chair of the Irish Association of Speech and Language Therapists (IASTI). “Early intervention is key,” she says, “so as soon as you have concerns, you should seek help.”
Red flags are things like your child not understanding instructions, having a stammer or a hoarse voice or not beginning to talk at all. “We’d expect a child of 18 to 24 months to have around 50 to 100 words and be combining them into two-word sentences,” she says.
“Also if they’re having difficulty playing with other children or aren’t interacting well … If there is an existing difficulty like Down’s Syndrome, help would be needed too. For example all children with Down’s Syndrome can have a language disorder and can benefit from speech and language therapy.”
PATTERN IN SOUND DEVELOPMENT
There is a pattern in the development of sounds, she says. “Some sounds are more difficult to enunciate than others,” she adds. “‘S’, ‘F’ and ‘K’ sounds might be later to develop than ‘B’ or ‘M’ or ‘D’ sounds, for example. ‘De’ is often the first sound that a child makes.”
“Usually by the age of three-and-a-half a child should be understandable even to unfamiliar people. That’s often a good marker but parents might have concerns well before that stage,” explains Niamh.
WAITING LISTS
What about free help from the HSE? Is that readily available? “My experience is that public system waiting lists vary from area to area,” she says. “As soon as you’re concerned, you should look for a referral. If you do need a service, the earlier your child’s name is on the list the better.”
Going to a GP or public health nurse is not necessary, however. “Parents can self-refer,” she says. “While they can talk it through with their GP or public health nurse, they can also simply fill out a primary-care referral form on the HSE website (or get this form in their local HSE clinic and post it off).”
CHOOSING PRIVATE THERAPY
If, for whatever reason, you decide to seek therapy privately there is a list of private therapists available on websites like that of the IASLT and the ISTI (Independent Speech-Therapists Ireland). “There is a cost for this, but you can claim tax relief on what you pay on your Med 1 form at the end of your tax year,” Niamh says.
While the IASLT is prohibited by law from discussing prices, an Irish Country Living check of private SLTs’ websites suggests that prices for full assessment, with a report, vary from €250 to €370. A half-hour therapy session costs €55 to €60, a 45-minute session costs between €70 and €80, and a one-hour session costs €100.
A home programme with written materials may cost €80 to €250 and a home or school visit is €100. Prices vary according to the complexity of the case and the experience of the therapist, of course.
“The assessment would usually be more expensive than treatment, because there’s more work for the therapist, analysing all the information that has been gathered,” she says.
WHAT AN ASSESSMENT INVOLVES
Assessment could take place in a clinic, at home or/and in school and usually lasts 30 minutes to an hour. A history from the parents is taken, and they are asked what their concerns are and what the child’s development has been like up till the present.
“It’s not just about speech and motor development, but also about play and how the child interacts. Hearing, of course, is very important, too.” Depending on the age of child, a lot of the assessment will be done through play. “The therapist will watch them doing different tasks to see what the child can do and how they interact and if they can follow simple and more complex instructions.
“Sometimes a therapist can carry out a more formal assessment with an older child. They will be using published, standardised assessments, so the child will be compared with others of the same age. This will show us if they are developing as they should be or if their speech or language is delayed,” explains Niamh.
Assessment may take more than one session if the child has more complex needs or a specific disability, however, and could involve a school assessment.
What happens after that?
“The therapist will then feed the outcome of the assessment back to parents and the recommendation based on that. If a problem is identified, some form of SLT therapy would be recommended,” says Niamh.
Therapy might involve a block of six to eight sessions in the clinic (one each week), from a half hour to 45 minutes for one-to-one therapy. Group sessions are also available.
PARENTAL INVOLVEMENT
For very young children, a lot of the research is showing that, in terms of early intervention, collaborating with parents and coaching them to do the intervention themselves at home is showing the best results, she points out.
“Programmes might involve a group of parents coming to a session together at first and listening and learning from the therapist and then later attending one-to-one to practise the strategies.
“It might be simple strategies: like getting down face to face with your child, observing what they are showing interest in and watching and looking. When you’re both engaged together you’re providing the language for them, so if the parent and child are both focussed on the one thing – usually what the child is interested in – that’s the optimal time then to hear the words, take them on board and learn them,” Niamh explains.
HOW MANY SESSIONS ARE NEEDED?
“If it’s a simple speech sound difficulty it might be just a few sessions,” she says, “with a review maybe a year later. If it’s a language disability, you’re looking at long-term intervention.”
The IASLT sees communication as vital. “Communication can affect all aspects of life: employment, making friends. Sometimes we find children with a language disorder who don’t know the rules for a game or can’t follow the rules, for example, so they are not able to participate in the yard because they can’t join in the game.
“In that case we might work with the special-needs assistant to help them to teach the child how to join in and make that bridge.”
It’s not a case of parents coming in to a SLT session to have their child fixed, she says. “That’s not the way it works. Most communication opportunities take place outside of the (clinic) setting. Parents are the experts on their child, and we collaborate with them rather than just do work with their child.
“Some children will need more help than others, but in most cases we’ll be able to provide the parents with the skills and they’ll go away and do the work and just link with us again to monitor progress, if necessary.” CL
preparing for an assessment
Try to brainstorm ahead of the assessment, as the therapist may ask the ages that your child started: babbling (making sounds); using their first words; using two words together; crawling; walking; dressing independently; feeding independently; using the toilet independently; how many words your child currently uses. Ahead of the assessment keep a notebook nearby and jot down the words your child says. Every time a new word is used add it in. Bring this log to the SLT assessment.
What can you do daily as a parent?
• Get face-to-face so your child can tune into your facial expressions.• Talk as you go through normal daily routines, play games like peek-a-boo and sing nursery rhymes – all important for speech and language development.• Talk about what’s happening, for instance, “Look! John is having juice!”• Play alongside your child to encourage interaction.• Introduce reading together from an early age. Name the pictures.Why too much telly isn’t good
For children under two, no more than a half an hour watching television per day is recommended and an hour per day for three- to five-year-olds. Television does not talk back – it is passive, rather than interactive, so it doesn’t help a child’s vocabulary or communication skills, experts say. TV also doesn’t help because people don’t talk while it’s on. “One study found that, on average, parents say over 900 words an hour, but when the TV is on they hardly talk at all,” says Niamh.
professional SLT organisations
The Irish Association of Speech & Language Therapists (IASLT) is the recognised professional association of Speech and Language Therapists in Ireland.
Independent Speech-Therapists Ireland is an association of experienced Speech and Language Therapists practicing independently in Ireland. All are registered with CORU, the professional regulatory body of Ireland.
Note: Some members of the ISTI are also members of the IASLT.
USEFUL LINKS
www.iaslt.ie
www.isti.ie
www.hse.ie
http://www.sicp.ie/en/ReferralsClinics/ReferralForms/PDFFile_17574_en.pdf
Ask for the referral form at your local HSE clinic.
This is a subscriber-only article
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