Explore the topic of Speech, Language and Communication

The most common speech disorders are Articulation Disorder, Apraxia of Speech, Stuttering, Language Disorders, and Receptive Language Disorder. Please find an explanation of each below.

Articulation Disorder (commonly in the form of a “lisp” – when a child does not pronounce the S sound correctly – or when a child cannot pronounce the R sound correctly. He may say “wabbit” instead of “rabbit” or “buhd” or instead of “bird.”) 

Apraxia of Speech is a communication disorder affecting the motor programming system for speech production.  Speech production is difficult – specifically with sequencing and forming sounds. The person may know what he wants to say, but there is a disruption in the part of the brain that sends the signal to the muscle for the movement necessary to produce the sound.  That leads to problems with articulation as well as intonation and speaking stress and rhythm errors.  

Stuttering occurs when speech is disrupted by involuntary repetitions, prolonging of sounds and hesitation or pausing before speech. Stuttering can be developmental, meaning it begins during early speech acquisition, or acquired due to brain trauma. No one knows the exact causes of stuttering in a child.  It is considered to have a genetic basis, but the direct link has not yet been found. Children with relatives who stutter are 3 times as likely to develop stuttering. Stuttering is also more typical in children who have congenital disorders like cerebral palsy. A child who stutters is typically not struggling with the actual production of the sounds—stress and a nervousness trigger many cases of stuttering. Stuttering is variable, meaning if the speaker does not feel anxious when speaking, the stuttering may not affect their speech. 

Language disorders can be classified in three different ways: Expressive Language Disorder (ELD), Receptive Language Disorder (RLD) or Expressive-Receptive Language Disorder (ERLD). Children with Expressive Language Disorder do not have problems producing sounds or words but have the inability to retrieve the right words and formulate proper sentences. Children with Receptive Language Disorder have difficulties understanding spoken and written language. Finally, children with Expressive-Receptive Language Disorder will exhibit both kinds of symptoms. Grammar is a hard concept for them to understand, and they may not use of articles (a, the), prepositions (of, with) and plurals. An early symptom is a delay in the early stages of language, so if your child takes longer to formulate words or starting to babble, it can be a sign of ELD. 

Children with Receptive Language Disorder may act like they are ignoring you or just repeat words that you say; this is known as “echolalia.” Even when repeating the words you say, they may not understand.  An example of this is if you say, “Do you want to go to the park?” and they respond with the exact phrase and do not answer the question. They may not understand you or the fact that you asked them to do something. Children with Expressive-Receptive Language Disorder can have a mix of these symptoms 

Please note that though these are some of the most common speech disorders in children, no child is the same and you know your child best. If you feel that your child has a speech disorder, contact your paediatrician to discuss treatment options.

Causes are very often unknown. We do know that some are passed on within families; others are delayed in line with cognitive development; and some are an acquired or environmental problem, for example, speech sounds distorted by a dummy.

Hearing loss, physical difficulties and a host of other associated conditions like dyslexia have an impact on language learning. Speech, language and communication needs are also known elements of some neurodiverse conditions, including autism.

A person is diagnosed with a speech disorder following a thorough assessment by a specialist speech-language pathologist (SLP). The SLP will evaluate a person for groups of symptoms and will work to rule out other speech and language disorders or medical conditions. The SLP will also take a family history and may examine how the person moves their lips, jaw and tongue and examine the muscles of the mouth and throat. To gain a diagnosis for a child, the first step is either to speak to the school nurse, who may help with making a referral to an SLP or through the child’s GP.

Communication developmental milestone to watch for include, but are not limited to:

• At 6 months, the child does not laugh, squeal or look towards sounds.
• At 9 months, the child has limited or no babbling or does not indicate when they are happy or upset.
• At 12 months, the child does not point to objects or use gestures such as waving or shaking their head.
• At 15 months, the child has not spoken their first words and does not respond to “no” or “bye bye.”
• At 18 months, the child does not speak at least 6-10 words consistently.
• At 20 months, the child does not use at least 6 consonant sounds or does not hear well or discriminate between different sounds.
• At 24 months, the child has a vocabulary of less than 50 words or has decreased interest in social interactions.
• At 36 months, strangers have difficulty understanding the child or my child uses simple sentences.

There are treatments available for speech and language disorders which include speech therapy. The type of therapy offered would depend upon the severity of the disorder and its underlying cause. This therapy would consist of exercises to build familiarity with certain sounds and words and physical exercises to strengthen the muscles which produce speech sounds.

Common types of speech therapy includes Target selection, Contextual utilisation, Contrast therapy, and Oral motor therapy. Please find an explanation of each below. 

Target selection: Practising specific sounds to build familiarity with particular speech sounds and targeting particularly difficult words or sounds.

Contextual utilisation: Exercises to recognise speech sounds in different syllable-based contexts.

Contrast therapy: Focusing upon words that contain one or more different speech sounds, for example, “beat” and “feet.”

Oral motor Therapy: Building muscle strength and breath control to encourage greater fluency and the ability to make smoother speech sounds.

Speech Sound Milestones by age: 

• At 4-6 months, babies start to “coo”, squeal , growl, make “raspberries” or vowel-like sounds such as “oooo” and “eeee”.
• At 5 months, they begin to hear consonant sounds paired with a vowel such as “ba” or “ga."
• At 7-9 months, babies repeat and use reduplicated syllables such as “bababa” “mama” etc.
• At 10-12 months, they will babble and use variegated or mixed sounds such as “bagabaga” with a variety of developmental sounds.

Language Milestones:

• At 12 months, their first word
• At 18- 20 months, young children will use about 20 words
• At 24 months, they will use around 50 words and emerging two-word phrases (e.g., “me go,” “more please”)

Communication Milestones:

• At 4-6 weeks, children should begin to smile
• At 4 months, a child should begin to look towards voices they hear.
• At 6-7 months, children begin to pay attention to caregivers and reach upward to be picked up.
• At 8-9 months, they begin to “take turns” making babbling sounds.
• At 11 months, they point at objects that catch their interest.
• At 13 months, they may begin to shake their head “no”

Often a parent only recognises that their child is not talking like their peers and this is impacting on their learning, behaviour and confidence. What they don’t realise is that a parent’s talk is music to a child’s ears. Parents are the ones best equipped to teach children how to talk, having been hot-wired by nature with the skills. Mothers naturally use a form of simple language, in a musical tone of voice and sing to their children, all of which, research has shown, stimulates a child’s language development. In addition, they naturally extend their child’s understanding of spoken language to just the right degree, as the child learns to speak, to continue the learning process. The problems happen when this natural relationship breaks down, either because the child has an innate difficulty with communication or when the parent ceases to stimulate the child’s language effectively.

When a child is showing signs of a language delay, relative to their peers, or has difficulties listening or responding, it is time to seek help from a speech and language therapist. While many speech and language patterns can be called ‘baby talk’ and are part of a young child’s normal development, they can become a problem if they are not outgrown as expected. In this way, an initial delay in speech and language, or an initial speech pattern, can become a disorder which can cause difficulties in learning.

Supporting resources 

Communication Strategies
Expressive Language 
Lego Therapy
Vocabulary and Word Finding 

• Give your child time! Try to make as much time to as possible for communication.
• Present good models of speech and language for your child to copy.
• Simplify instructions and be prepared to repeat them.
• Support speech with visual prompts, signs or gestures.
• Use pictures/symbols to aid understanding in the form of visual timetables or signing.
• Encourage good listening.
• Encourage regular, constant reinforcement of skills introduced at speech and language sessions.
• Make use of books, role play, drama, singing, social stories to support understanding of language.
• Encourage imagination – can your child think of games to play? Songs to sing? Can they make up their own songs? Can they think of a story starter? An alternative ending to a story?

Supporting resources

The activities below have been developed to promote language skills with helpful hints and tips for you too. 

I Need Help!
I Want More!
Let's Pretend 
Mystery Box
The Sorting Letters Game
What Does the Pig Say?

A language disorder is defined by the challenges that a person has in learning words, communicating successfully and understanding what others are saying to them. This can interfere with the ability to learn, understand, and use language. A language disorder is usually diagnosed when these challenges are not explained by other conditions, for example, autism or hearing loss.

Difficulties can include impaired comprehension of spoken or written language and comprehending the form or function of language. Examples can include receptive language disorder. This means difficulties understanding the meaning of words a person sees or hears and expressive language disorder, which results in difficulty using Language.

A language disorder can be quite wide-ranging and impacts a number of areas, a language impairment is more specific and relates to one or more specific areas of language development. Examples of a language impairment can include challenges with phonology. This means difficulties understanding the sound system of language and the sound combinations that make up words or syntax, which is the ability to recognise combinations of words which make up sentences.

Always trust your instincts; you are with your child the most. Some may say that a child will “outgrow” a speech or language delay. In some cases this is true, however it is impossible to know which child will outgrow their delay and which will need support from a speech and language therapist. Seeking out early intervention allows you to find answers through a speech and language evaluation to diagnose and recommend treatment for therapy services if needed.

A speech and language therapist is the first stop for a child with language difficulty. They can identify the difficulty and treat the child’s communication themselves or refer on to a further clinician or specialist. The therapist will liaise with the child’s teacher or special educational needs co-ordinator (SENCo) to provide support either in class or individually. If necessary, a specialist in hearing impairment, stammering, phonology or another expert may be involved. In some cases, a paediatrician or medical professional will want to assess the child.

You can contact your local NHS Speech and Language Therapy service or speak to your GP, Health Visitor or school staff about a referral.

Parents, GPs, health visitors, and school or early years staff can make a referral to a therapist.

Children may be referred for speech and language therapy for a variety of reasons, including:

• Language delay
• Language disorder
• Specific language impairment
• Specific difficulties in speech and producing sounds
• Hearing impairment
• Cleft palate
• Stammering/dysfluency
• Autism/social interaction difficulties

Witherslack Speech, Language and Communication Resources

We have recently refreshed the Advice and Support area of our website, a hub of knowledge we are very proud of. This section can now be filtered by our five specialist SEN areas of expertise:

Speech, Language and Communication support
Mental Health support
EHCP support
Autism support
ADHD support

From events and webinars to articles, e-books and case studies, Here you can find a wide variety of resources providing parents, carers and professionals with advice, support and guidance.

External Speech, Language and Communication Resources

The following is a list of websites and organisations that can help you. While we have done our best to list the most up to date and relevant information on speech, language and communication, please be advised that all the sources are constantly changing and new information will be added regularly. 

Downloadable resources to support speech, language and communication needs | Speech and Language UK
Downloadable Children's Speech and Language Therapy Resources | Herefordshire and Worcestershire Health and Care NHS Trust
Speech and Language Therapy Toolkit | CPFT NHS Trust
Speech, Language, and Communication Resources for teaching | Twinkl