SALT Specialist Specific Pathway - Deafness, stammering, speech, sound disorder
Deafness Pathway
What is Deafness?
Deafness, or hearing impairment, refers to a hearing loss that is impacting on a person in everyday life. In children, deafness may impact on them educationally and/or socially. The hearing loss may be congenital (from birth) or acquired (become deaf later on in life), sudden or progressive.
There are at least 53,900 deaf children across the UK (CRIDE UK-wide report, 2019). More than 15,000 children under 16 years old have moderate to profound deafness in the UK, and each year, there are about 840 children who are born with moderate to profound deafness (MDSP). These children have the potential to develop high level language and communication skills if they receive the right support at the right time.
How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?
The service for deaf children within Barking and Dagenham is provided for children from 0 to 19 years old who have a diagnosed moderate (or greater) bilateral sensorineural, permanent conductive, mixed sensorineural/conductive hearing loss, and/or Auditory Neuropathy Spectrum Disorder which is affecting their acquisition of speech, language, and/or communication skills and where hearing loss is the child’s primary need.
The primary aim of this service is to ensure equity of provision for the population and to ensure the delivery of the highest quality care.
Our service is delivered within local clinics, nurseries, mainstream schools and specialist provisions by specialist Speech and Language Therapists (SLTs) who have additional training and experience of working with hearing impaired/deaf children.
We work closely with other SLTs, Audiologists, Teachers of the Deaf (TODs), SENCos, Teaching Assistants / Communication Support Workers, and parents to ensure that each child’s needs are met as effectively as possible.
How do you refer to the Deafness team?
We accept appropriate referrals from parents/carers, health professionals (such as Health Visitors, GPs, Audiologists), and other professionals (such as Teacher of the Deaf, SENCOs). We ask that you complete an age-appropriate checklist along with the referral form and include the results of the most recent hearing test and any details of technologies used so that we can identify the most appropriate care for each child.
What can you do at home in the meantime?
You can visit the following websites for more information:
Royal National Institute for Deaf People (RNID) https://rnid.org.uk/
National Deaf Children’s Society https://www.ndcs.org.uk/
Speech Sound Disorder Pathway - Deafness, stammering, speech, sound disorder
What is a Speech Sound Disorder?
Speech and Language Therapists use the term ‘speech’ to refer to the individual sounds that make up words. Children develop different sounds at different ages, so it is not unusual for young children’s speech to be unclear. For example, it is common for pre-school children to pronounce the ‘k’ or ‘c’ sound as a ‘t’. If your child is having difficulty pronouncing the sounds expected at their age, they may have a speech sound disorder. This normally makes a child difficult to understand. Children with a speech sound disorder may also have difficulties listening and identifying the difference between sounds.
There are different types of speech sound disorders which can have a variety of causes. Some children may be able to pronounce the sounds on their own but find it difficult to use the sound within words. Other children may not be able to produce the sound at all. Most children’s speech sound difficulties are not caused by a physical problem.
How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?
The therapist will assess your child’s speech sound system to identify what sounds are difficult to pronounce, and see if these are appropriate for your child’s age. They will use this assessment to determine which type of speech disorder your child has, and, if needed, what type of therapy will help your child. The therapist will also check your child’s language (understanding, use of words and sentences) and social skills, as your child may need help with other skills before working on their speech sounds.
Following assessment, if your child needs further help with their speech sounds, we may:
- Provide strategies and targets for practice at home and school
- Offer a block of therapy sessions, based on individual need (following therapy it will be decided if further therapy is needed)
- Liaise with school to provide them with activities for further practice
During therapy you will be provided with activities for practice at home and advice on how to carry these out. It is essential to your child’s progress to continue practice at home.
The speech sound disorder team works mainly with primary aged children. Appointments usually take place in your local clinic.
How do you refer to the speech sound disorder team?
We accept referrals from parents/carers, health professionals (such as Health Visitors and GP), and other professionals (such as school staff). We ask that you complete an Early Years checklist or school age screener (depending on your child’s age) so that we can identify the most appropriate care for each child.
What can you do at home in the meantime?
Before seeing the speech and language therapist, it is important to have your child’s hearing checked. If your child has not had a hearing test since birth contact your GP, health visitor or school to ask for a referral to audiology for an up to date hearing test.
Rhyming skills can help your child’s awareness of sounds. Frequently singing nursery rhymes together is a great way to help your child learn about rhyming and clapping out the syllables of words can also help your child’s awareness of sounds. Choose key words in books or from nursery rhymes and clap the syllables of the word together.
You can visit the following websites for more information:
Stammering Pathway
What is a stammer?
- Stammering is a neurodevelopmental condition, which affects a child’s speech.
- About 8%* of children will stammer at some point, but most will go on to talk fluently.
- In the UK the term stammering is mostly used. Other countries use the term stuttering. But there's no difference between them, it's the same thing.
- There is no link between stammering and intellectual capacity.
- Like other neurological conditions, it covers a spectrum. Everyone stammers differently and varies in its severity.
- Stammering affects mainly boys and every ethnicity.
- You find some individuals stammer less over a period of time and other stammer more over a given time. Not one person is the same as another person who stammers.
- Many find that as they get older, they stammer less.
Characteristics of stammering
Children who stammer may:
- Repeat the first sound or part of a word e.g. ‘m-m– mummy’
- Prolong the first sound in a word e.g. ‘I want a ssstory’.
- Block (get stuck) on the first sound in a word so that no sound comes out when they first start to speak e.g. ‘...I want that’.
They may also:
- Put extra effort into saying certain sounds
- Make other body movements when trying to speak e.g. tapping
or, they may try to hide their stammer and find ways to avoid speaking or using certain sounds.
- Every child’s stammer is different, and every child will feel different.
- Up to 3%* of adults will be a lifelong condition.
How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?
The therapist will assess your child’s stammer by using a framework using the demands and capacity model. This views the child’s stammer within a holistic framework, which includes physiological, speech & language development, environment, and family dynamics factors.
The therapist will also assess your speech and language skills and identify areas of where further support may be required.
Following assessment, if your child needs further help with their stammering, we may:
- Provide strategies and targets for practice at home and school
- Offer a block of therapy sessions, based on individual need (following therapy it will be decided if further therapy is needed)
- Liaise with school to provide them with activities and/or advice for implementation to work with the child
During therapy you will be provided with activities for practice at home and advice on how to carry these out. It is essential to your child’s progress to continue practice at home.
The stammering teamwork with children from the ages of 2-18 years of age. Appointments usually take place in your local clinic.
How do you refer to the stammering team?
We accept referrals from parents/carers, health professionals (such as Health Visitors and GP), and other professionals (such as school staff). We ask that you complete an Early Years checklist or school age screener (depending on your child’s age) and specify what stammering characteristics the child is exhibiting and how this is impacting their confidence and social participation at school and outside of school.
What can you do at home in the meantime?
Before seeing the speech and language therapist, it is important to have your child’s hearing checked. If your child has not had a hearing test since birth contact your GP, health visitor or school to ask for a referral to audiology for an up-to-date hearing test.
Stammering advice
- Give your child time to finish what they are saying. DON’T finish it for them.
- Keep making easy eye contact with your child
- Make sure everyone in the conversation gets a turn to speak
- Listen to what your child says NOT how they say it
- Slow down your own rate of speech
- Avoid asking too many questions
- Find three or four times a week you can spend 5 minutes’ ‘special time’ together.
Special Time
- This is a time where you can give your child your undivided attention
- Allow your child to choose what they want to play with and follow their lead.
- For younger children this might be a train set or dolls’ house. For older children this could be a board game.
- Wait for your child to begin to communicate with you first.
- Avoid asking questions and instead comment on what they are doing.
You can visit the following websites for more information:
Voice Pathway
What is a voice disorder?
Voice disorders are fairly common in children, with about five per cent of children experiencing a chronic (long-lasting) voice disorder. A voice disorder is when the quality of a person's voice is noticeably different to the voices of others who are the same age and sex. Children with voice disorders may have harsh or hoarse voices, or voices that are too high or low, too loud or too nasal. Most voice disorders are harmless and disappear on their own, though some require the help of a specialist.
Signs and symptoms of voice disorders
If your child has a voice disorder, their voice may sound:
- harsh or hoarse
- too high or too low
- too loud or too quiet, or they may have 'lost' their voice entirely
- as though they are speaking through a blocked nose
- as though too much air is coming down through the nose during speech.
Children with voice disorders often have voices that tire easily or they have difficulty projecting their voice. Poor voice quality may make it hard for your child to communicate effectively, and may make them lose self-confidence or affect the way other people see them. Infants with voice disorders may have a cry that is weak or has a harsh or hoarse quality, or they may have noisy breathing.
When to see a doctor
If your child has a hoarse voice that is getting worse or not getting better, or if you are concerned about your child's voice for any reason, see your GP for advice. Your child may be referred to a speech pathologist or specialist doctor, such as a paediatrician or ear, nose and throat (ENT) specialist.
What causes voice disorders?
A person’s voice is the sound produced by the vocal folds in their larynx (voice box). The vocal folds are thin muscle bands that produce vibrations (sound) used for speaking. Voice disorders often involve problems with the vocal folds.
Voice disorders in children are usually caused by:
- excessive shouting or loud talking
- excessive use of harsh voice 'sound effects' during play
- common childhood infections.
There are also some rare medical conditions that may cause voice disorders in children.
Hoarse voice
Hoarseness is quite common in children. If your child has a hoarse voice, a joint assessment by an ENT specialist and a speech pathologist in a voice clinic may be needed. Hoarseness is usually related to the way children use their voices, rather than a serious illness. Other common causes of hoarseness in children include:
- Vocal nodules/cysts/polyps: these are known as benign lesions (areas of damage that are not cancer) of the vocal folds, and they are caused by tissue stress during excessive voice use, such as screaming or prolonged loud talking or crying. Encourage your child to rest their voice by not talking loudly or shouting. In some instances, lesions may need surgical removal.
- Infections: a hoarse voice often happens when a child has a viral infection, such as a cold or laryngitis (inflammation of the voice box). This hoarseness will be temporary and usually disappears when the infection clears. Encourage your child to frequently sip fluids and rest their voice until they get better.
A weak voice is often the result of poor vocal fold movement or incomplete closure of the vocal folds during speech. Causes may include vocal fold paralysis or narrowing of the larynx. Children who have had a breathing tube during a period of illness (or due to prematurity) are at higher risk of weak voice, and may experience long-term voice problems.
There are some surgical procedures that are used to correct vocal fold paralysis in adults, but these are not commonly done for children. Voice therapy is sometimes used for children with weak voices.
How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?
The therapist will assess your child’s voice using a perceptual assessment (the clinician’s ear). This includes listening to a voice recording of child’s speaking voice and their reading voice. The child’s perception of their voice is also considered by using a rating scale.
The GRBAS is also conducted where the child’s voice is graded based upon the following areas: grade, roughness, breathiness, weakness, and strain.
- It is important for the child to be referred to Ear Nose and Throat (ENT) team for investigation prior to referral to the voice disorder pathway.
At present, we only offer an assessment and advice as a voice disorder service .
How do you refer to the voice disorder team?
We accept referrals from parents/carers, health professionals (such as Health Visitors and GP, ENT specialists), and other professionals (such as school staff). We ask that you complete an Early Years checklist or school age screener (depending on your child’s age) and specify what voice characteristics the child is exhibiting and how this is impacting their confidence and social participation at school and outside of school.
What can you do at home in the meantime?
- Encourage your child to get closer to the person they want to speak to instead of yelling across distances.
- Schedule short periods of voice rest or quiet time during the day and night.
- Play around with different voices with your child so they become more aware of different levels of loudness, pitch and clarity. For example, start speaking very softly to them, and then build up gradually until your voice is loud. Talk about voice sounds being very soft, a bit louder and loud, and discuss which level of loudness is the best to use for talking in different situations. Use the same method to contrast gentle and harsh/rough voices.
- Praise your child when you hear them using their gentle voice.
- Discourage yelling, screaming, excessive shouting, talking over people or background noise (e.g. the TV) and speaking in a screechy and harsh manner.
Other factors which have a negative effect on the voice:
- smoky, dusty and polluted environments
- not drinking enough fluids – encourage your child to have regular, small sips of water, rather than the occasional guzzle
- Reduce consumption of fizzy drinks
- excessive coughing and throat clearing
- increased stress/anxiety.
Key points to remember
- Most voice disorders are harmless and disappear on their own or with the help of a specialist.
- Encourage your child to rest their voice by not shouting or talking loudly and keeping their throat moist by frequently sipping on fluids (especially after an infection).
- Your child may need an assessment by an ENT specialist and a speech and language therapist if they have a hoarse or weak voice that is getting worse or not getting better.
- Some voice disorders need surgery, although this is uncommon.
You can visit the following websites for more information:
http://www.elearningforkids.org/health/lesson/respiratory-system/
https://www.rch.org.au/kidsinfo/fact_sheets/Voice_disorders/