Edinburgh, Lothian and Borders’ Mobile Speech & Language Therapy Service!
Welcome to the Blethers Speech & Language Therapy website! My name is Isla Davies and Blethers is my private speech & language therapy practice. Working throughout Edinburgh, Lothian and the Borders I offer a unique mobile speech therapy service providing assessment and treatment for children and young adults who have speech, language and communication difficulties. In addition I offer specialist services for people who have Autism, Asperger’s Syndrome and learning difficulties. Please have a look through the website for more information about Blethers & The Blethers Mobile Therapy Room, communication and Speech & Language Therapy more generally. If you can’t find what you are looking for please try the search button at the top of the page will hopefully help.
Clients who have used Blethers’ services said:
‘As a parent you only want the best for your child and after realising our 3 year old was suffering with some complicated speech and language problems, we turned to Blethers. Isla Davies has now been working with our son for just over 15 months and she has become an invaluable part of his development. After initially starting her sessions at our home, Isla now visits my son’s school once a week and works hand in hand with his teachers. My son has made great strides in the last 12 months and this is solely down to the hard work and commitment of Isla. She’s one of a kind and we know our son is in safe hands. If you want the best for your child, there is no one better than Isla Davies’
‘I would highly recommend “Blethers Speech and Language Therapy”. Isla Davies is extremely well qualified and dedicated to helping children with all levels of speech difficulties. My son thoroughly enjoyed the classes as they were always different, interesting and fun. Every achievement is rewarded and learning is achieved through play appropriate to the child’s age and ability. He looked forward to his weekly sessions and loved the Mobile Therapy Room (Isla’s office) which she brought to our house, making it as easy as possible for us to attend. I don’t think you will find a better speech therapist.’
‘We weren’t sure what to expect but Isla went out of her way both in traveling distance but also in all communications to support us. She was knowledgeable, related well to our 3 year old son, was incredibly friendly and insightful in her assessment. We’re delighted to have found Blethers and would be happy to recommend.’
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- Understanding Language Comprehension March 19, 2017
As a speech and language therapist, I often have children referred to me because their language is late to develop. Whilst those who know the child may feel that the main issue is lack of spoken words and may say he/she ‘understands everything’, it often becomes apparent during assessment that things are not what they seem. Children are great little detectives! In day to day life, they are constantly scanning their environment for clues that will help them understand. It is possible for a child to understand an instruction like ‘Go and put your coat and shoes on then wait by the front door’ without understanding a single, solitary word! But how? The answer is ‘Situational Understanding‘.
What is Situational Understanding?
From a very early age, we start to make links between things that happen around and to us, starting with cause and effect. Babies quickly learn that crying (cause) usually results in comfort of some kind (effect – often food or cuddles). As we grow and learn, we start to associate related things and we use this information to make sense of the world. Often, before children can speak much at all, they will do things like go to the table when you open the fridge or the cupboard where the snacks are. This is situational understanding – the child has learned that when you open the fridge or cupboard, the next thing that usually happens is that they get a snack at the table. The child does not need to understand any words to react appropriately, they are using the information from the situation to understand. Situational understanding is an essential skill that we all use throughout our lives. Ever been to a party which features folk dancing you’re not familiar with? Usually we watch what other people do and copy – we use what we see in the situation to understand what to do. That is what situational understanding means.
Let’s think now about our instruction ‘Go and put your coat and shoes on then wait by the door’. Your child will most likely have noticed that when you put your coat on and get the buggy ready, the things that follow are that you put their coat and shoes on then go out through the door. If you deliver the instruction while you are standing in the hall with your coat on and getting the buggy sorted out, your child doesn’t need to process any of the words you have said, they can follow it simply by using their knowledge of the situation they see.
To assess and work on true understanding of language, you need to consider how many words in the sentence the child HAS to understand in order to follow it, these are usually called either Information Carrying Words (ICWs) or Key Words. That means taking into account the environment, the situational information available and the choice of related objects on offer. It sounds mind-bending, but once you get into the swing of it, it’s fine!
What is an Information Carrying Word or ICW?
Quite simply, it’s a word (or short phrase) that gives you the information you need to follow an instruction without any situational clues. Let’s take the instruction ‘Go and put your coat and shoes on then wait by the front door’ and alter the situation to make some of the words carry essential information, i.e. turn them into Information Carrying Words.
First of all, the instruction needs to be given BEFORE you, yourself start getting ready and while you are away from the door. Secondly, words that have a grammar function don’t count when it comes to information carrying words! So we can get rid of a few words straight off: ‘Go and put your coat and shoes on then wait by the front door‘. Now we have 4 candidates to become ICWs! In the examples below, I’ve highlighted the ICWs in red and the things the adult does to support understanding of the additional words in blue.
1 ICW – ‘Go and put your coat (give the child the coat) and shoes on then wait by the front door (point to the door)‘. Here the child has to understand the phrase ‘shoes on‘ to follow the instruction. The situational prompt of being given the coat should be enough to prompt putting it on and pointing at the front door will prompt the child to go there. We’re going to assume that waiting is what the child usually does at the door, so there’s no new information in that word either.
2ICWs – ‘Go and put your coat and shoes on then wait by the front door (point to the door)‘. Here the child needs to understand both ‘coat‘ and ‘shoes on‘ but the point gives a clue as to where to go.
3 ICWs – ‘Go and put your coat and shoes on then wait by the front door‘. This time, you haven’t pointed to the front door so, not only does the child need to understand which items to get but also ‘front door‘ (as opposed to back door) so that they go to the right place.
I hope this isn’t too confusing! The easiest way I find of sorting out how many ICWs I’m giving a child is to think ‘is there a choice for each word in this instruction?’.
If I give the child the items in the picture plus the instruction ‘make Igglepiggle jump on the bed‘, I can be confident that it is a 3 ICW instruction because of the following choices:
- Igglepiggle or Upsydaisy
- Jump or any other action
- Bed, table or chair
Your speech and language therapist will help you to ascertain how many ICWs your child can understand at a time and will help you see if there are any patterns within each level of understanding. For example, a child may understand 2 ICW instructions made up of a person plus an object (eg ‘Give Igglepiggle the chair’) but not ones made up of a person plus an action (eg ‘Make Upsydaisy sleep‘). Usually speech and language therapists will work in 4 levels with ICWs – 1, 2, 3, and 4 ICWs in a single instruction. Beyond 4ICWs, things start to get more complex!
Bridging Between Levels
Once your child consistently understands a variety of instructions at the level you are working on, your SLT will advise you on how to ‘bridge’ to the next level. That usually involves using real objects, visual aids like pictures, sign language and/or pointing to give your child a clue about the extra ICW you have added. For example, if you are wanting to help your child get from 2ICWs to 3 using the materials in the picture, you might do the following to support understanding of ‘make Igglepiggle jump on the bed’:
- Give the child Igglepiggle first
- Sign ‘jump’ as you say it
- Give the child the symbol for ‘jump’ as you say it
- Point to the bed
The choice of materials is still there because you’d use all of the objects to maintain the choice for each ICW but you are making it a little easier by helping the child with one of the choices.
I hope that this article goes some way towards demystifying the concept of Information Carrying Words or ICWs ! Please leave me any comments or questions and I will do my best to answer them!
As well as the news page, make sure you visit the Blethers Facebook page and You Tube channel where Isla also posts lots of helpful information about new research, useful links and informative videos. Isla loves to hear from you so please get involved with the discussions, stay up to date and express your opinion!