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!

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.

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

Building Communication Out and About

Wow, this year is passing quickly! I can’t believe it’s nearly May already. It’s been a busy couple of weeks for Blethers what with Little Listeners Group running in North Berwick and getting out and about across Edinburgh & East Lothian to see clients and visit nurseries.

As the weather improves, there are lots of opportunities to enjoy being out and about with your children in the lovely Lothians. Why not try adding a few language building activities into your days out! Here are a few suggestions:

  • Play ‘I Spy’ – this is a brilliant and versatile game for building language skills which is really easy to play on the bus, in the car or while walking somewhere. You can do lots of variations like ‘something beginning with…’, ‘something that rhymes with…’, ‘something that is (add a colour)…’, ‘something that (add an action)…’
  • Bubbly Buss, East Lothian

    A day out at the beach gives lots of opportunities to learn new vocabulary!

    Scrapbooks or Treasure Boxes – if you go on a trip somewhere, collect objects, tickets, photos etc that remind you of the trip. You can stick these into a scrapbook or put them in a ‘Treasure Box’ when you get home. Encourage your child to draw pictures of the things they enjoyed about their day out. As you talk about the things you saw, did and found on your day out, you (or your child if they want to and are able to) can write the story in your scrapbook. This sort of activity helps children to learn and remember new vocabulary as there are some physical reminders of the new words and a real story to use them in. You will also build your child’s ‘narrative’ or story telling skills. As well as being an essential literacy skill, telling stories is how we communicate our experiences to other people and in turn form relationships, solve problems and develop understanding of our personal experiences.

  • Twenty Questions – This is a good game to help older children to develop their focused questioning, categorisation and descriptive skills. One of you secretly chooses an object, famous person, animal, place or food. The other has to ask up to 20 different questions to try and guess what it is. Encourage your child to summarise the information they have before asking the next question, eg ‘So, it’s something you can eat, it’s a fruit and it’s yellow. Is it curved?’. To make the game a little easier, you can write down some key questions to be used each time like: ‘Is it a living thing?’, ‘Is it a place?’, ‘Can you eat it?’…

Have fun giving these games a go and enjoy being out and about!

 

How do speech & language therapists help people with autism?

The short answer is that the possibilities are endless! A speech & language therapist can help someone who has autism with any aspect of communication as well as play skills and self-organisation. How a speech & language therapist helps a person on the autistic spectrum depends very much on what their specific needs are. For this reason, the first step for any speech & language therapist working with someone on the spectrum is to complete a comprehensive assessment of their communication skills.

Once the therapist has gained a clear understanding of where their client is up to with their communication skills development, the necessary support can be put in place. Support is offered in many ways, not just in the form of face to face therapy sessions (for example, it may be more effective for the therapist to train key people in their client’s life). The nature of support depends very much on the individual and their specific needs.

What follows will give you a flavour of the massive range of things a speech & language therapist might provide support with for someone who is on the autistic spectrum.

Before spoken language develops…

  • Understanding the value of communication – For more severely autistic clients, the first thing a speech & language therapist will often do is to help their client to start to see the value of communication. This is important both from the point of view of asking for (and getting) what you need and forming positive, enjoyable social relationships with other people.
  • Developing the fundamentals of communication – things like using and understanding facial expression, eye contact and gesture, taking turns with others, enjoying being with another person are all fundamental communication skills. Babies start learning these skills from a very early age in face to face interaction with their parents and other adults. Speech and language therapists will use the principles from this early parent child interaction to help people with complex needs and autism (or other conditions) learn these skills through approaches like Intensive Interaction.
  • Developing play skills – Play is were children learn to share experiences and objects with others which is an essential learning skill. Imaginative play is also strongly linked to the development of something called ‘symbolic understanding’. Symbolic understanding is what ultimately allows us to realise that a collection of funny sounds (a word) relates to a real life object or action. Speech & language therapists help clients to develop interactive and imaginative play skills.
  • Alternatives to speech – Often, a speech and language therapist will recommend using a picture, symbol or object-based communication system for people who are not developing useful spoken language. For many people the Picture Exchange Communication System (PECS) is very effective but this does not suit everyone. A speech & language therapist will work with their client (and family) to establish a system that works for them.

Once spoken language starts to develop…

Autism brings with it idiosyncratic learning patterns and unusual language processing. As a result, children who are on the spectrum often have problems developing spoken language. Many young people with autism learn spoken language in chunks without breaking what they hear down into individual words and sounds. That means they can often repeat long chunks of favourite stories or TV programmes without really understanding what they’re saying or being able to use any of the words in the chunk independently. A speech and language therapist will help with all aspects of spoken language development including:

  • Speech errors – pronouncing words so that others can understand.
  • Learning and recalling vocabulary.
  • Putting words together to make phrases and sentences.
  • Putting sentences together into stories (narrative) to express experiences to others.
  • Understanding spoken words and sentences.
  • Understanding specific vocabulary groups. Many children with autism have great difficulty with time concepts, abstract language and vocabulary that depends on context for meaning.
  • Understanding language associated with reasoning skills.
  • Understanding non literal language like idioms, hints and indirect instructions.

Using language socially…

For many young people on the autistic spectrum, social communication presents a massive challenge. Speech and language therapists can provide help and support to help negotiate the social minefield under the following headings:

  • Self awareness – what are my hobbies, what am I like, what are my strengths and weaknesses…
  • Awareness of others – what do others like/dislike, what are their strengths and weaknesses, what are their interests…
  • Friendship skills – developing and maintaining friendships
  • Feelings and emotions – understanding the vocabulary of emotion, reading and using facial expression, reading and using body language.
  • Conversation skills – starting conversations, taking turns in conversation, staying on topic, how to change topics, active listening, ending conversations…
  • Assertiveness in communication – saying ‘no’, asking for help…
  • Developing self esteem.
  • Understanding and making sense of real social situations – SLTs can ‘coach’ young people through problematic situations using a variety of approaches like Social Stories or Comic Strip Conversations to break the situation down, see what goes wrong and provide corrective strategies.

Other bits and bobs…

Speech & language therapists can provide advice and support to help clients use visual supports like visual timetables or organisers to help them with organisation and planning of daily life.

Speech & language therapists who are autism specialists are often a helpful resource when a client is becoming aware of and learning about their diagnosis and what it means.

So, as you can see, there is a huge range of support that SLTs can offer clients who have a diagnosis of autism. There will be some things I’ve missed out but hopefully this post will give you a flavour of what an SLT can do for you or your child.

Will my child ‘grow out of it’?

There is a normal pattern of development that children go through when learning to communicate. As part of this process, there are mistakes a child will make that are typical and you can expect these to disappear as he/she develops. However, if there is a specific and unusual communication problem, then it is very unlikely that the child will simply ‘grow out of it’.

Sometimes a typical error pattern persists for longer than expected (called a ‘delay’) and this to will usually need some treatment to ensure that it does not impact on other areas of development. A good example of this would be a 5 year old child who says ‘d’ for ‘s’ so instead of ‘sun’ they say ‘dun’. This is a typical error pattern called ‘stopping’ but it usually disappears by about 3 years. If left untreated, a 5 year old who is starting to learn to read and write at school will most likely have difficulty with spelling because they will sound out words like ‘sun’ as ‘d-u-n’.

If your child has a communication problem, it is better to get help from a speech & language therapist sooner rather than later. There are various ways to do this; you can speak to your health visitor or GP to access services through the NHS or you can check the ASLTIP website for details of your local independent speech & language therapists.

Should I tell my child if he/she makes a mistake when talking?

Correcting your child successfully is all about doing it the right way. Try to avoid saying things like ‘No that’s wrong, it’s…’. Instead, try to give a positive model to develop your child’s confidence and provide an example of the correct way to say it. For example, if your child says ‘Mummy toat’ you could say something like ‘Oh yes, that’s right! It’s mummy’s coat!’.

This sort of positive correction is what is called ‘modeling’ and it is effective because it helps support your child’s confidence in communication as well as giving an example of the right way to say something. Lots of negative correction makes children lack confidence to communicate and in some cases, may even put them off talking altogether.

If your child is making mistakes with their talking that make it difficult for you and other family members to understand them or the mistakes are not disappearing on their own, you should seek advice from a speech & language therapist, your health visitor or your GP.