Understanding Language Comprehension

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?’.

Here are some toys that I might use to work on developing understanding Information Carrying Words

Here are some toys that I might use to work on developing understanding Information Carrying Words

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:

  1. Igglepiggle or Upsydaisy
  2. Jump or any other action
  3. 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!

A Beginners Guide To Grammatical Terms

User Friendly Dictionary of Grammar

My well-loved copy of TUFDOG

If you are either a parent of a child who has a language disorder or you’re planning to train as a speech & language therapist in the future, then this post is for you! When I went to my very first Linguistics lecture way back in October 1992 the lecturer, one Professor Jim Hurford (you’ll find his biog here if you are interested!), handed us all a bundle of paper which he dubbed ‘The User Friendly Dictionary of Grammar’ or ‘TUFDOG’. This document contained definitions of pretty much every grammatical term you could think of from ‘noun’ to ‘relative clause’. Prof Hurford’s reasoning was that, since schools had moved away from teaching the meanings of such terms and a clear understanding of such vocabulary is essential for students of linguistics, he’d best make sure we all knew our adverbs from our adjectives. Over my 4 Years studying Linguistics at Edinburgh, TUFDOG was invaluable and, as you can see, I still have my well-thumbed copy!

I am happy to tell you that TUFDOG was formally published in 1994 in much flashier format as ‘Grammar: A Student’s Guide‘ and it is still available from Amazon!

Anyway, getting to the point of this post, it occurs to me that if you are not someone who uses grammatical terms on a daily basis (so pretty much the whole world except for SLTs, language teachers, journalists, writers and editors) then I thought it might be helpful to have a brief explanation of the basics. This will be particularly useful if you are the parent of a child who has a language disorder as you will most likely be asked to work on one or more of these areas with your child.

Noun – a noun is the name of something. ‘Common nouns’ are the names of objects like ‘ball’, ‘sock’ or ‘house’. A good way to check if something is a common noun is to see if it makes sense if you put ‘the’ before it. For example ‘the house’ makes sense but ‘the drinking’ feels like it’s not finished and ‘the beside’ just plain doesn’t make sense! The names of people and places are also nouns but form a subgroup called ‘proper nouns’. Proper nouns don’t make sense with ‘the’ and typically have a capital first letter; eg ‘Isla’, ‘Edinburgh’, ‘Scotland’

Pronoun – a pronoun is a short word that you can use to replace a noun in a sentence so that you don’t end up repeating yourself all the time.

By way of example, you could say the following: ‘I saw James at the park yesterday. James said James was at the park to meet Polly. James and Polly were planning to go for ice cream together. Polly loves ice cream, Polly says ice cream’s Polly’s favourite food’ however, that sounds a bit repetitive with all the ‘Jameses’ and ‘Pollys’. Most people would probably use some pronouns to make it sound a bit better ‘I saw James at the park yesterday. He said he was at the park to meet Polly. They were planning to go for ice cream together. Polly loves ice cream, she says it‘s her favourite food’.

As you can see, we have different genders of pronoun: male, female, gender neutral as well as plural pronouns. There are also variations on each of these depending on where they come in a sentence. This can be really confusing for children who have a language disorder and they generally try to simplify the system by using only one gender and typically only one variant. In my experience, it is typically the male pronouns a child like this will stick to and if there is only one variant used, it will be either ‘he’ or ‘him’ (eg ‘him is washing him hands’). In English our pronouns are:

A list of English pronounsAdjective – quite simply, an adjective is a word that describes a noun. Some examples of adjectives are colours, sizes like ‘big’ or ‘enormous’ and attributes like ‘nice’, ‘long’ or ‘soft’. If you’re not sure if a word is an adjective, try it with a noun and see if it works; ‘the chair is soft’ works but ‘the chair is in’ sounds unfinished and ‘the chair is quietly’ doesn’t make sense.

Verb – ‘verb’ is another word for ‘action’, it is something you do. Examples of verbs are ‘love’, ‘run’, and ‘eat’. Verbs form the core of a sentence and they dictate what roles (see below) or positions need to be filled to finish that sentence so that it makes sense. For example ‘give’ is a verb. To use ‘give’ in a sentence we first need to have someone to do the giving but ‘Sue is giving’ isn’t a complete sentence. So give also needs something to be given but ‘Sue is giving the cake’ still isn’t a complete sentence. It turns out that ‘give’ also requires someone to receive whatever has been given so our complete sentence is ‘Sue is giving the cake to Bob’. By way of contrast, the verb ‘sleep’ needs only someone to do the sleeping to make a complete sentence ‘The dog is sleeping’ , you can add other things but these are optional. This is why it is so important for children to learn verbs as well as nouns as part of their early vocabulary. Without verbs, it is impossible to build grammatically correct sentences.

Roles – ‘Roles’ are the slots in a sentence that need to be filled to make the sentence complete. As described above, the verb you use dictates which roles need to be filled. The main roles to be aware of are ‘Subject‘, ‘Object‘ and ‘Indirect Object‘. There are others but you only need to know about those if you are studying in detail! The subject is the ‘doer’ of the action and in English, all verbs require at least a subject to make a complete sentence – The boy is drinking. The object is whatever the action is done to and many verbs require an object as well as a subject – The boy is drinking juice. You will also come across indirect objects which are typically the beneficiary of the action – The boy bought some juice for his brother. In English, the order of these roles in a sentence is usually subject, verb, object, (indirect object) or SVO(Oi).

Tenses – verbs in English have different endings and sometimes other words used with them to show when the action happens in time. Examples are:

  • James has tidied his room or James tidied his room – past
  • James is tidying his room or James tidies his room – present
  • James will tidy his room or James is going to tidy his room – future

There are many distinctions of different types of past, present and future tense but discussion of those in detail here will just get confusing! For the purposes of early language development, the most important thing is to ensure a child is able to express the basic 3-way past/present/future distinction.

Adverb – An adverb is a describing word much like an adjective but it describes a verb rather than a noun. Adverbs describe how something is done and very often end in ‘-ly’, examples are: gently, quickly, carefully. You can often turn an adjective into an adverb by adding ‘-ly’ to the end. For example in the sentence ‘Your dress is nice’, the word ‘nice’ is an adjective which describes the dress. On the other hand, in the sentence ‘Your dress is nicely made’, the word ‘nicely’ is an adverb which describes how the dress has been made, ‘made’ being the past tense of the verb ‘make’.

Preposition – a preposition is a word that tells you about a location or position. Examples are: in, on under, between, behind, in front. Many children who have language delays or disorders need some help to learn these. Prepositions are essential for daily understanding and are also fundamental building blocks for sentences.

Plural – a plural simply means ‘more than one’. Typically in English, we put a ‘s’ on the end of a word to show there is more than one, this is called a ‘regular plural’ because it is a regular pattern. Examples of regular plurals are ‘houses’, ‘socks’, ‘plants’. In English there are a subgroup of plurals which don’t follow this pattern and these are called ‘irregular plurals’. Examples of irregular plurals are ‘mice’, ‘geese’ and ‘sheep’.

That just about covers the main ‘parts of speech‘ that you are likely to come across if you are working with a speech and language therapist. Incidentally the term ‘part of speech‘ is a term that means a group of words which share the same characteristics in language. Basically, parts of speech are the building blocks you need to make sentences. Nouns, verbs, adjectives, pronouns, prepositions, adjectives and adverbs are all parts of speech. It’s important to keep parts of speech in mind when you are working with a child who has language problems, particularly if they do not speak in sentences. In order to build sentences, it’s essential for a child to have a variety of words from various parts of speech in their vocabulary. A mix of nouns, verbs, adjective, adverbs and prepositions makes many more combinations available than just nouns and adjectives.

I hope that this article is useful and please do leave me a comment if you’d like further explanation or you’d like me to add something which I haven’t included!

Language Building Apps for iPads and Tablets

Arguably slow on the uptake, I have just discovered the Splingo group of apps from the Speech & Language Store. I’m glad I found some time to look into Splingo as the apps have already been a big hit with several of my clients!

Designed by speech & language therapists, Splingo is a set of apps aimed at teaching children at developmental levels of around 18 months – 4 years the following core language skills:

Splingo’s Language Universe – Understanding instructions with 1, 2, 3 and 4 Information Carrying Words (post explaining ICWs coming soon…) plus listening and attention. This App also targets understanding and using different types of word – nouns, adjectives, prepositions and so on.

Actions with Splingo – Understanding and use of action words (verbs).

Pronouns with Splingo - Understanding and using pronouns like she, I, them, we and so on.

Categorisation with Splingo – Categorisation of vocabulary and building links between word meanings.

Screenshot from Categorisation With Splingo app by Speech & Language Store

Screenshot from Categorisation With Splingo

As the adult, you can set up the apps at the appropriate level of complexity for your child, you can even choose between an American or British voice. I love that last feature as so many language apps are very Americanised!

Each app sets up a series of instructions based on the areas you have specified (for example, using and understanding the pronoun ‘she’) and your child works through the activities in a game format with integrated rewards. The animations and characters are attractive, fun and motivating for children.

Screenshot from Pronouns With Splingo app by Speech & Language Store

Screenshot from Pronouns With Splingo

The learning apps are available for anyone to use, although it’s probably worth getting some advice from a speech & language therapist or teacher first, especially if your child has any sort of additional needs. If you are reading this as a speech and language therapist, I should point out that there is also a Splingo Receptive Language Assessment App which is available for use by SLTs. So far, I have found this extremely useful, particularly for clients who have limited attention for picture-based activities and especially those who are unable to accept enough direction in their play to be assessed with toys.

At the time of writing, all Splingo Apps are available from the iTunes App Store and you can find Splingo’s Language Universe and Pronouns with Splingo on Google Play. Of course, if you would like some advice on using any of the Splingo Apps with your child, feel free to contact Isla at Blethers, email is usually the best way to catch me: blethersslt@gmail.com

Remember, you can find out more about Splingo from the creators, Speech & Language Store!

Pre-Literacy Skills for School Starters

In a few short weeks, thousands of 5 year olds will be starting in P1 at school. Central to success at school and in later life is learning to read and write. Did you know that the key skills for successful literacy development are built on our speech processing skills?

Photo of popular childrens' books , Zog, Bear Hunt and Dinosaurs Love Underpants

Some popular children’s books used in schools across the UK

Most young pre-school children are aware of words as whole chunks and that words help them communicate with others, however, they are not typically aware that each word is made up of smaller bits like syllables and individual speech sounds. As they approach school age, they start to become more aware that there are divisions within words and might start to experiment with syllables and rhyming (word endings). These broad divisions are the beginnings of phonological awareness for literacy.

Our spelling system in English is ‘alphabetic’ which means that there is a letter or sometimes a group of 2 letters like ‘sh’ that corresponds to each spoken sound. To be able to match sounds to letters for literacy, children need to be able to divide words up into individual parts, a bit like taking apart a jigsaw to see how many pieces there are. Because the first sound in a word is emphasised by virtue of being the first one you hear, children typically learn the concept of ‘begins with’ as the first step in this process. They then go on to break the word down further and start to realise that there are sounds at the end and in the middle too. It is easier for children to pick sounds out of a word if it is said on its own rather than in a sentence. There is now a lot of research which shows that well developed phonological awareness is linked strongly to later success in learning to read and write.

So, what skills does phonological awareness involve? Well, for typically developing pre-schoolers about to go into P1 or reception class, the following are core skills:

  • Attention & listening – it may seem obvious, but before we can do any form of learning at all, we need to be able to pay attention to what we hear! Related to this is the ability to listen to spoken information and to discriminate between sounds that are the same or different from one another.
  • Auditory memory – before we can start to break what we hear into smaller chunks, we must have enough capacity in our short term memory to hold onto what we’ve heard while our brains process it. Most 4 year olds will be able to remember a spoken instruction with up to 4 key parts. If you would like to look at auditory memory/attention/listening averages in more details, click HERE to go to Ellen A. Rhodes’ Auditory Developmental Scale: 0-6 Years.
  • Segmentation – when we are talking about spoken language, segmentation means breaking long strings of spoken language into smaller parts. Unlike written language, spoken language does not typically have nice, clear spaces between words. The first thing we need to do as language learners is to be able to break the speech stream into separate words. Once we have established where the word boundaries are (most typically developing children can do this well before starting school), we can start to break words into smaller parts like syllables, onset/rime and individual speech sounds.
  • Speech sound discrimination – in order to match a sound to a letter, you need to be able to hear it and know which sound it is. Some of the speech sounds used in English are clearly acoustically distinct from one another, like ‘s’ and ‘m’ or ‘k’ and ‘b’. Others are much harder to distinguish between on the basis of sound alone like ‘m’ and ‘n’, ‘s’ and ‘f’ or ‘d’ and ‘g’. Obviously, you need to know which sound you are hearing to be able to match it to the appropriate letter and therefore read and spell correctly.
  • Sound Sequencing & Manipulation – In order to read and spell, we need to know what sound a word begins with as well as which sounds follow and in what order. Another essential skill is the ability to manipulate sounds and sections of words to do things like swap a sound to make a new word (eg swapping vowels to give foot, fat, fit, fight and so on) or swap the first sound or syllable to make a rhyme, for example, if we take ‘f’ away from ‘fight’ to leave ‘ight’, we can add ‘l’, ‘n’, and ‘r’ to make rhyming words ‘light’, ‘night’ and ‘right’. Knowing ‘tricks’ like swapping initial sounds like this helps us to be more efficient in our reading and spelling.

This is by no means a definitive list of phonological awareness skills, however these are the core skills that children rely on when learning to read and write. If you are concerned that your child is not developing these skills and their speech is still difficult to understand at 4-5, then I would recommend requesting an assessment by a speech and language therapist so that any problem areas can be identified and addressed.

If you are happy that your child’s speech is developing well but you’d like to give him/her and extra boost with those pre-literacy skills, check out Top Tips for Early Phonological Awareness & Pre-literacy Skills on my website for some simple and practical ideas.

Making Speech & Language Activities Easier or Harder

I was asked recently about how to make activities easier or harder for clients. When you’re training to be an SLT or indeed working as a newly qualified SLT, this can be one of the hardest parts of the job as you often have to make adjustments on the spot. With experience this gets easier but even the most seasoned SLT will have moments where they realise a re-think is required. The bottom line is, there is no magic list of incremental steps, knowing how to step therapy activities up and down is the very essence of the specialist skills that we learn when we become SLTs. That’s what all that theory is for and one of the reasons why “Speech & Language Therapist” is a protected professional title! Having said that, understanding a few key points is helpful when doing your planning especially while you are training or in your probationary year.

Before we continue…

First and foremost, 2 important things to remember are:

  1. If a task is clearly way too hard for a child, you can just stop doing it! Better to stop and do something easier than to continue with something that sends a message of failure. If you have no easier therapy task, there is nothing wrong with just playing a game together to regain the child’s trust and build rapport.
  2. There is absolutely nothing wrong with throwing an easy task into a therapy session. It gives the child experience of success and helps them feel comfortable. So if you do find yourself with too easy a task and no way to step it up, don’t panic!

The importance of thorough and ongoing assessment

To my mind, the most important part of being able to step activities up or down for a client is to have a very clear understanding of what their individual strengths and weaknesses are. That is why doing a detailed and comprehensive assessment is always my first port of call with any client. If that takes 2 or 3 or even 4 sessions, then so be it! Therapy will always be more effective when it is based on a clear set of assessment findings.

Of course, no assessment is foolproof and an assessment only gives you a snapshot of the child’s skills on a particular day. With that in mind, constant observation of the child during therapy sessions is also essential. Their strengths and weaknesses may vary depending on external factors like the amount of sleep they had last night, the time of day, whether they’re coming down with something, perhaps they’re excited about an upcoming event and so forth. You may find that they may learn the new skill you are teaching either more quickly or slowly than you anticipated and you need to account for this too.

Planning Therapy

Obviously it best practice to plan your therapy ahead but I would advise against over-planning. By ‘over-planning’, I mean doing something like sitting down and writing a detailed plan of exactly what you are going to do in each session of a 6 week block. By all means, have an overall outline plan for the 6 weeks based on your assessment and therapy aims but I’d advise adding specifics into your individual session plans no more than one or maybe 2 sessions ahead. That means that you have your overall ‘map’ of what you are doing in the block to keep your therapy focused but you have the flexibility to alter your weekly plans session to session based on the child’s performance each time. Here’s an example of a plan that I have actually used from the start of a 6-week block.

Example Speech & Language Therapy Plan

One of my pre-block plans. As you can see, I have only done specific plans for sessions 1 & 2 of the block at this point.

Something I have not shown here is how to step up or down these activities. That’s because I know this child really well and have various tricks up my sleeve based on my previous experience as an SLT and with this child in particular. And here’s the rub! As I said at the start, I cannot give a definitive list of what to do to make things easier or harder for clients because that list will be different and individual for each child. However, I can share the key things I take into consideration when planning and working out how to step activities up or down. These are:

  1. What CAN the child do? Are there stronger areas of their language/speech processing that we can use to support weaker areas?
  2. What is the child likely to find more difficult but still achievable?
  3. What scaffolds can I use to support learning of more difficult skills? (Modelling, visual supports, signing and so on) How will I fade out the use of these scaffolds?
  4. What things are going to be outside of the child’s current skill set developmentally?
  5. What things are going to be outside of the child’s skill set based on their disorder?
  6. Given each activity I have planned for the next session, how can I make each activity one step easier or harder based on what I know of the child and the answers to questions 1-5?

Obviously keeping accurate notes of your sessions comes into its own here because you can then use the information you recorded to see how the child did, which supports worked and which supports you can try fading out next session.

I hope that this is helpful for those of you having trouble with stepping up and down. You are not alone! If you have questions about specific clients, do feel free to email me at blethersslt@gmail.com I will get back to you as soon as I can but do bear in mind it can take a couple of weeks!


A Day In the Life of a Speech & Language Therapist

A Typical Day as a Speech & Language Therapist

I was asked recently to describe a typical day working as a Speech & Language Therapist. A simple question, right? WRONG! After quite some deliberation and a few false starts, I had a dawning realisation. I was struggling to describe a typical day as an SLT because THERE IS NO SUCH THING! In fact, the unpredictability and variation is exactly why I enjoy being a speech and language therapist. I can say with complete honesty, I have never, in 14 years as a speech and language therapist, been bored at work. How many people can say that, hand on heart? At work I have been amazed, stressed, amused, overwhelmed, challenged, excited, sad, worried, fascinated…. and the list goes on, but never, ever bored. It’s a bit of an emotional rollercoaster this speech & language therapy lark!

Why is Speech & Language Therapy so Varied?

There are several reasons why it is difficult to be bored at work if you are a speech and language therapist. First and foremost for me, is the beautiful diversity of people. Now, as a paediatric SLT, I can only really comment on children but I’m sure my colleagues in adult services will agree the following observation: Genuinely and without exception, every client is different. As we train to be SLTs we learn about groups of clients like “neurotypical children”, “children with autism” or “late talkers”. There’s nothing wrong with this, it helps us to learn, but when you actually get out there and meet a few clients who share a diagnosis, it immediately becomes obvious that NO TWO ARE THE SAME! This is all part of the fun! Meeting a new client for the first time, figuring out what motivates them, building a rapport, problem-solving their communication difficulties, watching them progress is the whole point of what we SLTs do and it is endlessly interesting.

Then there is the fact that most speech and language therapy jobs involve working in at least 2 different locations throughout the week. We SLTs can be found in health centres, clinics, hospitals, schools, nurseries, clients’ homes, specialist schools/units, private clinics and even prisons (working, not generally detained at Her Majesty’s Pleasure!). Obviously each separate workplace involves a different set of challenges, colleagues and clients.

As well as the range of clients and working environments, and SLT must also make use of a huge variety of skills and roles. In addition to the ‘therapist’ role you signed up for, you often find yourself wearing any combination of heads including, but not exclusively, some of the following:

  • trouble-shooter – The usual strategies aren’t working for this particular child (they’re all different remember!), why is that and what are you going to do next?
  • artist – No-one else is going to make the reward chart you need to help your clients stay focused in that social skills group next week…
  • counsellor – You have a distraught parent in your treatment room because their child has just been diagnosed with autism…
  • logistics manager – Exactly how are you going to drive between 4 home visits and still be back to your clinic in time to write up all the case notes? What’s the most time-efficient route? Where will you park?
  • child – Yes, if you’re going to build a relationship and get the best out of a child, you need to be able to play like one!
  • sneaky sabotager – How are you going to get wee Johnny to ask for that toy car using his voice? You know he can say it but he doesn’t realise that the word gets him a go of his favourite toy. Yes, you’re going to sabotage his favourite car-run game by giving him the track but no cars!
  • writer and author – so you know what ‘Phonological Awareness’ means, how are you going to explain clearly what it is in a report for a parent with no prior knowledge of linguistics? And furthermore, who else is going to write you a story crammed full of words beginning with ‘s’ for little Julie’s session tomorrow?
  • researcher – a child with a diagnosis of Angelman Syndrome has just landed in your clinic room. What on earth is that?
Cleaning the carpet in the Mobile Therapy Room

Typical day in the life of a speech therapist? Working for yourself means you have to do EVERYTHING!

As a speech & language therapist, you will find yourself in all sorts of roles and, to be fair, any good SLT training course will have prepared you (at least in part!) to take on the many faces of an SLT. If you are considering applying for SLT training, it’s important to be aware that you will have very varied roles to fulfil and to appreciate that you will need to be very flexible in your thinking at all times.

So there you have it. There is no ‘typical’ day in the life of a speech and language therapist and that is exactly why it is such a great vocation to have! You can find out more about training to be a speech and language therapist from the Royal College of Speech and Language Therapists.


Top Tips for Pre-Literacy Skills & Phonological Awareness

What is Phonological Awareness?

‘Phonological Awareness’ basically means the awareness of how words can be broken down into parts and how sounds can be put together to make words. Phonological awareness is essential for literacy. Most young pre-school children are aware of words as whole chunks that help them communicate with others. They are not typically aware that each word is made up of smaller bits. As they approach school age, they start to become more aware that there are divisions within words and might start to experiment with syllables and rhyming (word endings). These broad divisions are the beginnings of phonological awareness for literacy.

Why do we need Phonological Awareness for Literacy?

Our spelling system is ‘alphabetic’ which means that there is a letter or sometimes a group of letters (like ‘sh’) that correspond to each spoken sound. To be able to match sounds to letters to read & spell, children need to be able to divide words up into individual parts, a bit like taking apart a jigsaw to see how many pieces there are. Because the first and last sounds in words are emphasised by virtue of being the first & last sounds you hear, children typically learn to pick these out first. They then go on to break the word down further and start to realise that there are more individual sounds in the middle too. There is now a lot of research which shows that well developed phonological awareness is linked strongly to later success in learning to read and write.

This sheet gives you some suggestions for some simple phonological awareness activities that should fit easily into everyday activities and routines. You will not need to find a ‘special time’ to do them.

Top Tips for Pre-Literacy & Phonological Awareness

Finding Speech & Language Therapy Work Experience

How can I get work experience with a speech & language therapist?

I am often asked if I can provide work experience for people who are planning to pursue a a career in Speech & Language Therapy. Unfortunately it is very difficult for me, and indeed most other independent SLTs, to provide work experience placements. This is down to issues of client consent, client confidentiality and the implications for insurance and legal business status. Sometimes it is possible to get some experience with your local NHS team but, again, these placements are very few and far between and are difficult to get.

While most of the higher education institutions understand that getting work experience directly with a speech & language therapist is very difficult, it does definitely count in your favor if you have some related practical experience under your belt when you apply. So what can you do about it? Well, I have highlighted the word ‘related‘ here because a little bit of ‘out of the box’ thinking can help you out significantly.

What sort of work experience is related to Speech & Language Therapy?

To get started, it will help you to think about the different client groups that speech & language therapists typically work with. Some examples are:

  • Stroke patients (usually adults but occasionally children)
  • Head injury patients (children & adults)
  • People who stammer (children & adults)
  • Children who have developmental communication disorders like Specific Language Impairment, Verbal Dyspraxia or Phonological Disorders
  • Children and adults who have communication disabilities related to conditions like Down’s Syndrome, Cerebral Palsy or Autistic Spectrum Disorders.

I’m sure you can see that a list like this will help direct you towards organisations that support these client groups. More often than not, these organisations are charitable and rely heavily on the support of volunteer workers – see where I’m going with this? Using my list above, which is not exhaustive, some (and there are many, many more!) related organisations that may be able to take volunteer placements are:

As you can see, with just a little bit of thought, we have generated quite a long list of organisations who support people with all sorts of communication difficulties and who work with volunteer staff. Time for you to get on the phone and make contact!

Working in schools

Whilst it is helpful to have experience specifically with people who have communication difficulties, do not rule out the possibility of spending some time working in a mainstream classroom. Interacting with typical children, forming rapport with them and understanding how their communication skills develop is also an essential part of being a speech & language therapist. Even if you plan to work with adults when you qualify, you will have to do practical placements in paediatric settings as part of your training. If you plan to take a year out before starting your training or are going in as a mature student, it is definitely worthwhile looking around for temporary or short term contract teaching assistant or nursery assistant jobs in your local area. With that in mind, volunteer work with playgroups, youth groups & children’s clubs like Brownies or Cubs are also worth considering and are perhaps easier to fit in for future SLTs who are still at school.

What if I have a family member with a communication difficulty?

Many people come into speech & language therapy because they have some personal experience of communication difficulties. That could be because they have a friend or relative with a communication disorder, or indeed because they themselves have needed support with communication in the past. Whilst this is valuable experience, you should be aware that it is also a very narrow and subjective experience of the issue in question. It will certainly count in your favor if you seek to expand your knowledge of the communication disorder in question by seeking the type of work experience described above. Doing so will help you to broaden your understanding and gain a better perspective on the wide range of experiences that a group of people with the same diagnosis can have.

Well, I hope that this post has provided all of you budding speech & language therapists with some helpful and creative ways of getting some work experience that is relevant to speech & language therapy. Good luck and do feel free to contact me with any comments or questions!

Review of the Mobile Therapy Room in Winter

So far, this winter hasn’t brought any major extremes of weather (except excessive rain!!) but we have had a couple of cold snaps that have let me evaluate the performance of the mobile therapy room in winter conditions. Overall, I have been pleased with it and have found working inside to be comfortable and easy.

The cuddly slug draft excluder in actionI have certainly appreciated all the efforts we put in to insulation! The Celotex insulation board and bales of wool that are stuffed into all available spaces behind the panels mean that the van heats up quickly and stays warm with the odd top-up from the heater. The one problem I did find was that there is a tiny air gap between the back doors where the back step which was creating quite a nasty cold draft. That was easily solved with the addition of a cuddly slug-shaped draft excluder and the cunning use of a household sponge to well and truly plug the gap!

The Eberspacher heater that is fitted in the mobile therapy room has done a great job of keeping us all cosy on even the coldest days. I went for the D4 model which is quite a big heater. The reason I went for the D4 was that I wanted to be able to heat the workspace in the mobile therapy room quickly. On the coldest day I have had so far, the thermostat in the therapy area was reading a chilly -9C when I switched the heater on. Thankfully, within 15 minutes, it was up to a very pleasant +18C. Mission accomplished!

The mobile therapy room with the LED lights on in the dark.Lighting is a big consideration when you are working in Scotland through the depths of winter. Through December, it gets dark as early as 3-3.30pm on the dreichest (that’s grey and miserable for the non-Scots out there!) days. The mobile therapy room is fitted with 9 soft LED ceiling lights and I have found that these provide a gentle but bright light for working when it is dark outside. Because they are LEDs they don’t flicker or hum like fluorescent strip lights which was a key reason why I chose them. I’ve also found it handy to have LED strip lighting round the step recesses as that makes it easier to see where the step is in the dark.

In terms of winter safety features, my high visibility vests have proven a big hit. I think getting them on for heading out to the van just adds to the whole adventure! I have an adult sized one plus two paediatric sizes so that no-one is left out. So far, I haven’t needed to use my Snow Socks but it gives me great peace of mind to know they are there. Snow Socks are canvas wheel covers that are easier to put on than snow chains and give you extra grip when you need it in snowy conditions. I’ve used them on my car before and they’re remarkably effective.

One of the biggest challenges I’ve had over the winter has been keeping the mobile therapy room clean inside and out when the weather is wet and grotty. The way forward so far has been to remove shoes if necessary when we go in and to make sure I give it a clean each week which I do anyway.

So all in all, I can conclusively say that the mobile therapy room has consistently given me and my clients a safe, warm and comfortable working environment through the worst of the Scottish winter! Mission accomplished :-)


What goes into a speech therapy session?

As with so many things in life, the key to a really good speech therapy session is good planning and preparation so I thought I would write a post about how I plan and prepare for each session that I do.

The first thing any speech therapist will do when they see a child for the first time is assess them to figure out what the underlying difficulty is.  Assessments come in the form of standardised assessment and informal assessment. A standardised assessment is a published ‘test’ which compares a child to other children of the same age using standarised scores. Informal assessment is used either where a standardised test does not exist or will not work well for the client in question. It takes the form of activities planned by the speech therapist to elicit certain language structures or simply consists of observation of the child during play or other day to day activities. Once the initial assessment is done,  I will analyse the results and use these to guide what we will work on in subsequent therapy sessions.

Next, I come to the planning stages when I decide on our overall targets to work on over the block of sessions as well as what to work on in each individual session.  This is always based on the assessment of the specific difficulty in question and my first aim is to form a rough ‘road map’ for a block of therapy sessions.  At this initial planning stage you never know how quickly a child will pick up on different topics or strategies. Having a  good understanding of the underlying problem and a clear idea of which areas to work on and in what order it makes it easy to move on as needed to keep the client engaged.

Simple speech therapy S game

A simple speech therapy game working on S

Once I have my over all therapy road map I move onto the planning of individual sessions and this is where I use all my skills and experience as a speech therapist to tailor each activity to the specific needs of the child. Even though I may sometimes see children with exactly the same speech difficulty and consequently quite similar therapy road maps, each individual requires quite different activities as their personalities, interests and ages may be quite different.  For example, one child may work well with a board game where another would work much better with an interactive game like crocodile dentist.

In all sessions, making it relevant, fun, enjoyable and interesting is the most important challenge. This often involves making materials of some sort and modifying the rules of toys, games  and activities so that they are relevant to the session. It is important to make sure that the difficulty of the game and the rewards of the game are tailored for each different client so that they stay engaged with the task, finding it neither too easy or too hard. I know I’ve got it right if they are looking forward to the next session!  For older children toys and games are often less suitable and this is where the interests and hobbies of the child or young adult are used to guide activities.

After the planning and making materials, the next thing I do is assemble all the materials into different boxes for each therapy session.  These fit neatly into my speech therapy cupboard so that I have all I need for the day whilst I am out and about in East Lothian and Edinburgh. In each of the boxes I always have to pack a back up plan just in case a session isn’t going as planned and I need to make the activity easier or harder to keep a child engaged.

Just before each session I also have to think about the work environment in the mobile therapy room.  Sometimes it needs to be very interactive, making full use of Velcro and magnets and sometimes it needs to be quite plain if a child is easily over stimulated or has a lack of focus.  The layout of the therapy room is important to make sure that you get the most out of the session.  Sometimes this involves working on the floor and sometimes working at tables. In addition I have to remember the obvious but easily forgotten things like making sure that the therapy room is warm enough and light enough for a good therapy session.

Once it gets to the actual session, hopefully everything will go like clock work and look to a casual observer like little more than structured play or an informal conversation. The more relaxed and natural the interaction in the session, the better as it gives me the best insight into the problem, what is being taken in and what needs to be done to move forwards.  It is really important for me to stay relaxed and playful on the outside but really focus my mind on observing the child so that I can pick up on all the subtle non verbal clues that give insight into the progress that is being made.  It’s always important to remember that sometimes activities do not work as well as you had hoped and if this happens there really is no point in flogging a dead horse! At this stage the most important thing is observation, thinking on your feet and reflection afterwards to see if there is anything else you can do differently next time.

Once the speech therapy session is over, it is essential for me to write up my notes promptly. My notes detail my observations (subjective as well as objective) from the session and are a continuous informal assessment.  The observations I make of the child’s response to the activities in the session are then used to guide the planning of the next session. My observations allow me to provide guidance and activities for parents to use at home and to other professionals such as teachers, other therapists or nursery staff.  Working outside of the session is the most important part of any child’s speech therapy support as this is where practise and the the generalisation of skills happens! After all, you wouldn’t expect to become a guitar virtuoso if you only practised for thirty minutes or an hour each week with your teacher!