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!

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.

Play is an Assessment Tool!

I thought I’d write a little bit today about the importance of play in the speech & language therapist’s arsenal of assessment tools. You’ll probably find this post useful if you are a speech and language therapy student, a newly qualified SLT or a parent wanting to know more about how SLTs work.

It’s very easy to watch a speech therapist(or, for that matter, occupational therapist, psychologist or teacher) at work and to say ‘But they’re just playing! What’s so special about that?’. Simply playing with a child is not something that most people immediately think of as an assessment tool. In fact you can learn a HUGE amount about a young person’s communication and interaction skills if you know what to look for! This is where the professional training and skills come in.

Play is an essential part of development and it is where we learn thousands of fundamental skills that relate to language development, motor skills, social interaction, physical skills, imagination and understanding of the world. It is so natural and ‘everyday’ that it’s very easy to dismiss as ‘just playing’ without understanding that engaging play offers endless opportunities to observe the development of a massive range of skills. Play starts to develop within weeks of being born and almost all children engage in play at some level. This means that play based assessment is accessible to almost every child unlike more formal assessments which require well developed joint attention, listening skills, understanding of the basic test instructions (eg ‘point to…’), co-operation, auditory memory and indeed the desire to please.

As well as being a useful way to assess a child who cannot engage in formal assessment, play can also give you access to the ‘bigger picture’ of a child’s use of communication in a real life, functional context. So, what is a speech and language therapist assessing while a child plays?

  1. The play itself! – Play itself has a developmental order and can be broken down into several different social categories (that’s a separate post in itself!). A speech and language therapist will look to see what level the child’s play is at because play skills underlie communication development. The broad stages are Exploratory Play (touching, feeling, mouthing), Relational Play (banging things together, dropping them, stacking etc), Pretend Play (simple pretending like feeding teddy) and Imaginative Play (truly imaginative play using objects to represent other things or involving imagined objects or characters). Pretend play is an important stage in communication development as the abstract thinking processes involved are also necessary for increasingly abstract and creative use of language. Play development is also divided into levels of social development, the broadest divisions being; Solitary play (completely alone), Parallel play (plays alongside but not with others), Co-operative play (plays jointly and interactively with others). Observing the social stage of a child’s play gives a good insight into their social communication – eg a child who prefers solitary play is less likely to engage in communication with others.
  2. Expressive language – most children talk or vocalise while they play. They are usually quite relaxed as they do this so you get a representative view of their abilities. An SLT will be looking first to see if the child does talk or vocalise while playing. If they do, the SLT will look to see what vocabulary is used, whether the child combines words, what sort of sentences are used and what language functions they express (eg, greetings, requests, refusal, comments…).
  3. Understanding – while a child is playing, it is possible to get an idea of their level of understanding. Speech and language therapists are highly trained to do this as it is not as easy as it sounds! To ensure that the child truly understands the language used, you must ensure that there is a choice for every key word in the sentence. For example, if you give a child a dolly and a hairbrush only, they don’t need to understand any words to follow the instruction ‘Brush dolly’s hair’ because the situation gives it away. However, if you had a dolly, a teddy, a brush and a sponge and you said ‘Brush Teddy’s feet’, the child would have to understand 3 key words: ‘brush’ (not wash), ‘Teddy’ (not dolly) and ‘feet’ (not hair, tummy or other body part).
  4. Social skills – Play gives away a lot of information about social interaction. In addition to the social level of play (solitary, parallel or co-operative), play also allows the therapist to observe eye contact, turn taking and non verbal communication like use of gesture and facial expression. The skill of the SLT here is to break each of these areas down and ‘put a finger on’ the problem area. For example, most people will be able to tell you if a child’s eye contact is unusual or not but in most cases won’t be able to pinpoint why they think that. It is not enough to say that a child makes more or less eye contact than usual, after all, natural eye contact isn’t measured in minutes and seconds! A more important consideration is what functions eye contact is used for. A speech and language therapist is trained to recognise and specify the subtle functions of eye contact such as reference to another person, specific communicative functions (eg, your turn, help me, more), and direction of communication.

There are many advantages to assessing a child through play. First and foremost is that it is fun for the child! Secondy, the child usually does not realise they’re being assessed and this creates a relaxed atmosphere which builds trust and rapport with the therapist. Finally a comfortable and relaxed atmosphere is more conducive to communication and often allows you to see things you may not get in a more formal setting. An added advantage is that building that trust and rapport early on means that you have a better chance of getting the child to constructively engage in formal assessment at a later date if you need to.
So there you go! Play, it’s not rocket science, but it is!

Is it true that some people just don’t communicate?

In 10 years of working with some of the most profoundly disabled people, I have never met anyone who does not communicate at all! Some individuals don’t have any speech which leads people to say things like ‘they don’t have any communication’, but a closer observation reveals that they usually have a huge range of non verbal methods of communication. There is so much more to communication than just speech – please see the About Communication page for more details.

Will using sign language or symbols for communication stop my child from talking?

No, in fact many studies have shown that using sign language and symbols actually helps bring on a child’s talking. Indeed, many nurseries now use signed English routinely to support the development of the children in their care.

If you are interested to learn more, you can find an easily readable review of a scientific paper reviewing the effect of signing on speech & communication development by clicking here.

Are signs and symbols the same thing?

No they are not. In terms of communication, signs are shapes or gestures usually made with the hands as part of a ‘sign language’ like Signalong, Makaton or British Sign Language.

Symbols are simple pictures that stand for words. There are lots of different symbol ‘vocabularies’, a bit like there are different alphabets for some of the world’s languages. It doesn’t really matter which one you use as long as you are consistent.

Is there more than one kind of sign language?

Yes. There are many different formal sign languages including Makaton, Signalong, Canaan Barrie, British Sign Language and American Sign Language. There are 2 kinds of formal sign language:

  • Key word signing – here only the key words of a sentence are signed to support understanding of the main spoken language being used. If you are speaking English, this can be called ‘signed English’. Sign languages like this have large vocabularies of naming, action and describing words but very little by way of grammar. Examples are Makaton, Signalong and Canaan Barrie signs.
  • Sign Systems that are languages in their own right like British Sign Language (BSL) and American Sign Language (ASL). These have their own grammar, word order and culture associated with them. BSL is as different from English as Greek or Spanish are. Interestingly, BSL and ASL are also completely different from each other, much moreso than British and American English. There are also different ‘accents’ and regional variations within sign languages like BSL and ASL.

What’s the difference between expressive & receptive language?

  • Expressive language is the ability to use vocabulary and to put words together into sentences to express yourself. It covers vocabulary, use of grammar and reasons for communication (asking for things, making comments, getting attention…)
  • Receptive language (or comprehension) is about understanding what is said to you. In typical development, understanding always develops ahead of expressive language. For example, a child who understands 3 key words in a sentence may only speak in single words.

My child has difficulty pronouncing certain sounds, will this affect his/her school work?

It can, yes, although this does depend on the type of speech problem your child has so do ask your child’s speech & language therapist for their opinion. Phonology problems are more likely to and often do go along with difficulty reading and spelling. As described in the previous question, Phonology is a bit like a computer program that tells your brain how to break down words and how to add sounds together to make words. If there is a ‘bug’ in that computer program, you are likely to have problems first with speech, then with reading and writing.

Early treatment by a speech & language therapist can help reduce the impact of a speech problem on literacy learning.