When you are concerned about your child’s development, it can be worrying and difficult to know where to go for support. I often have conversations with people who are unsure whether they should be concerned about their child’s language development or not. Alternatively, people know that they are concerned but are unsure how to refer their child or access any support. This is a huge topic and it’s difficult to be too specific since things vary across the country, but hopefully I can offer a few ideas of where to start:-
Does my child need to see a speech and language therapist?
Language development can be so varied and there are so many elements included (speech sounds, comprehension, attention and listening skills, vocabulary, sentence structure, social skills....).
As a parent, you may have a niggling concern about your child's language development and can't quite put your finger on what exactly it is. Or perhaps someone else is concerned and you don't understand why. Either way, it might be useful to get an idea of what is expected at different ages to give you a clearer picture of whether or not you feel your child needs to be assessed by a speech and language therapist.
Please bear in mind, however, that these should be read with some caution, because as with all areas of development, there is an "average range". This means that, just as children take their first steps at quite different ages, for example, it is quite usual for two children of the same age to have quite different language skills in some ways. These lists give a good guide to what is expected at different ages. Have a look at some of them and see how your child is doing. If you are worried, you should seek a referral.
If your child is being referred to speech and language therapy, this information might also help you to be more specific about what the concern is. I can guarantee that the Speech and Language Therapist will find it really helpful to have a specific referral and it will make the assessment session more useful.
For example, if I receive a referral for a 10 year old that just says, concern about language skills, it's hard for me to plan specifically which assessments to use and what activities to try with them. We could be there all day if I assess every single thing I would expect them to be able to do! It's much more useful to focus on the areas that there are concerns about (eg following instructions, or explaining things or answering questions).
Who can refer and where to?
If your child is of preschool age, your Health Visitor is usually the best person to speak to. Even if you haven't had much contact with them so far (I've seen mine once in the four years since my daughter was born!) you can still call them and say you think your child needs to be referred to SLT. If there are concerns which suggest that your child might need to see other health professionals as well (eg paediatrician or Occupational Therapist) they will also be able to do that.
They can also help with accessing other services, if appropriate, such as Portage. If your child is at nursery, the nursery can refer, though some nurseries will have more experience of this than others.
If your child is of school-age, the SENCO (Special Educational Needs Co-ordinator) is usually the best person to make the referral, and they should be aware of your local service’s guidelines and procedures. If accessing these people proves too difficult for any reason, most departments will still take a referral directly from a parent. You can hopefully find an address and/or phone number through Google. I do suggest calling first to make sure you are sending it to the right place - referrals can get lost in the ether sometimes if they've arrived on the wrong person's desk. I would also call a couple of weeks later to check it has arrived if you haven't heard.
You can also refer your child to an independent speech and language therapist, though you will have to pay for this.
Go to the ASLTIP website and search by postcode and the age of your child. I recommend calling several therapists that come up in the results to find the best fit for you and your child. All qualified speech and language therapists have to be registered with HCPC (Health and Care Professions Council) and they check if a therapist has the relevant qualifications etc.
ASLTIP will only register people who are registered with HCPC. Most independent therapists will have a good chat with you on the phone to see whether they feel they can help and they will be more than happy to answer questions. Different therapists have different specialities and different pricing structures - find out what's available in your area.
Even if you can't afford regular therapy, a one-off assessment can be really useful to give you ideas of how you can help at home. Unfortunately, private health insurance will not often pay for speech and language therapy for children, though it is always worth asking.
Of course, different health insurance companies and plans have their own rules, but at times they will pay for a limited amount, especially if it is perceived to be a medical rather than a developmental need (e.g glue ear). There are also some charities that will give funding for speech and language therapy in certain circumstances. Cerebra is one that I know of but there may be other smaller charities local to you or specific to certain diagnoses – do have a look around.
What if I can't get my child seen or can't get a follow-up appointment?
Since the NHS is working with a finite budget, speech and language therapy managers around the country have the very difficult job of setting criteria to make the best possible use of the available money and staff. It's a difficult job and one I'm glad I don't have to do. This does mean that there are times when a child may not meet the criteria for input, or may be assessed and then discharged with suggestions of how to help. This can be really frustrating, but here are a few suggestions of what you might do.
- Work closely with your child's school and/or nursery. Most will have some previous experience of speech and language difficulties and they may have suggestions of things you can do to help, especially if you have already had the child assessed and have specific goals to work on.
- Read. Of course we should all be a little wary of things we find on the internet, but there are some websites which offer great advice and suggested activities. Here are a few that I recommend - Talking Point, The Communication Trust, ICAN, Playing With Words 365, AFASIC). Some really useful stuff is available online these days. Take a look at our Blogs and Websites page for more ideas of places to look.
- Language skill groups. If your child is of pre-school age, there are often groups which run to encourage children’s language skills. Sure Start Centres often run these and there are other privately run classes such as Talking Tots or Tiny Talk (baby signing). These are often not run by speech and language therapists but they can be great for encouraging communication skills.
- Keep a record of your child's progress. Sometimes it's hard to see progress when you are interacting with your child every day. Keep a little notebook and write down new things that you notice about their language (eg asked lots of questions today or shared toys with another child or whatever it is). This will help you to see where they are making progress and where they perhaps need more help.
- Try again later. Criteria change. Children change. If you are still concerned after 6 months or a year and especially if your notebook suggests that your child isn't making progress, you should seek a re-referral. Even if a child has already been discharged, they can sometimes be re-referred if there are new concerns.
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