Speech and language difficulties we work with
We see children and young people with a range of speech and language challenges and specialise in specific areas.
Find out more about the communication difficulty your child may have and what you can expect.
DLD is when children have problems understanding and/or using spoken language, but there isn’t an obvious reason for these difficulties. For example, it isn’t associated with hearing impairments, autistic spectrum disorders or more general learning difficulties.
There’s no known cause and it’s often described as a hidden disability. Your child may have co-occuring problems with dyslexia, ADHD and speech sound difficulties.
How might it affect my child?
They might struggle with:
- following or remembering spoken instructions
- organising ideas to verbally express what they want to say
- telling or re-telling a coherent story
- finding the right words (vocabulary) to say at the right times
- understanding what is read or listened to
- over-literal interpretation, missing the point of what was meant.
- talking a lot but engaging poorly in two-way conversation.
Watch the video about the impact DLD can have in the classroom
It’s when parts of a baby’s face didn’t join together properly during development in the womb. Some children can have a cleft lip (a split in their upper lip), a cleft palate (a split in the roof of the mouth) or both.
It can cause problems with speech, feeding and hearing.
Find out more about cleft palate
How we support your child
We work with the regional cleft lip and palate centres that border Buckinghamshire. Most children living in Buckinghamshire have care from the Children’s Cleft Palate and Craniofacial service. Or from North Thames cleft lip and palate centre or South Thames Cleft Service (St Evelina’s)
These regional services provide specialist information, assessment and therapy for children and young people with cleft lip and palate and/or velopharyngeal dysfunction, from birth into adulthood.
Our speech and language therapy service therapists work locally to support the work of the cleft centres.
They’re a result of conditions including:
- cerebral palsy
- genetic conditions
- severe epilepsy
- muscular dystrophy
- acquired brain injury, for example, head injuries including road traffic accidents and degenerative neurological conditions.
How we help early years children with complex communication needs
We support children’s communication development using spoken language, signing, symbols, and a range of other communication methods.
We assess and support children in early years settings and their homes.
Who we work with
Our therapists work with children aged from birth to 5 years with complex medical needs including:
- physical/motor impairment
- visual impairment
- neurological impairment, for example, epilepsy
- degenerative medical conditions
- chronic health needs
- acquired disorders following head injury or stroke
- social communication difficulties or autistic spectrum conditions
We also work with children who have:
- learning difficulties/global delay, including profound and multiple learning difficulties
- genetic diseases such as tuberous sclerosis
- significant additional or alternative communication needs and use a communication book/ switches/ communication aids.
Our team also works with children and young people from 5 years to 25 years with complex medical needs.
For both early years and school settings, we work within a multi disciplinary team including teachers and dietitians.
We also work alongside other members of our own service for example therapists specialising in hearing impairments.
How we help school aged children with complex communication needs
We assess and support children in mainstream schools, special schools and specialist settings known as additionally resourced provision (ARPs). We help children with physical disabilities to develop functional communication within the context of their needs.
We help develop the child or young person’s communication skills and access to the curriculum through:
- spoken language
- signing
- symbols
- visual timetables
- topic boards
- ICT (where appropriate).
We also support children and young people who find communicating verbally difficult by identifying augmentative, alternative communication systems (AAC). We personalise these for each individual’s current needs.
How to access our teams for complex communication needs
Contact Theresa Drake, Highly Specialist Speech and Language Therapist, Clinical Team Lead at buc-tr.cyptherapies@nhs.net.
Who we work with
We work with children with different types levels and causes of Deafness of including:
- congenital (present at birth, sometimes as a result of a virus)
- acquired sensorineural (develops later in life sometimes due to ageing, sudden trauma or malformation of the inner ear)
- permanent conductive (caused by a blockage of the ear canal)
- auditory neuropathy/dys-synchrony (unknown cause but children with a family history of the condition or who were born prematurely may be at higher risk).
We also work with hearing children of Deaf parents who use British Sign Language (BSL) as their home language.
Our team has experience of children who use cochlear implants, hearing aids and bone conduction aids to give them access to sound. The children we see often have a range of difficulties in addition to their hearing impairment.
If the child gets support from a different team within our service, we give advice about any needs they have which are related to their Deafness.
Watch the video below about a parent’s experience of a child with hearing loss:
What we do
We assess and support children and young people in their homes, early years settings, schools and Further Education (FE) colleges. We help them to develop effective communication within the context of their Deafness.
We use a range of communication approaches including spoken language, sign supported English, and/or BSL as appropriate.
Family support
We support families through regular visits, joint working with other professionals and groups such as ‘Little Ones’ group.
We encourage families to access local support, for example through Young Deaf Activities (YDA) and the National Deaf Children’s Society (NDCS). These organisations offer information and opportunities to meet other families and share experiences and ideas.
School and education support
We work with hearing support teachers from the Specialist Teaching Service, audiologists and specialist teams at Cochlear Implant Centres.
We see children and parents at home, and visit staff in mainstream preschools and schools. We also support in additionally resourced provisions (ARPs).
Staff can also benefit from our training sessions on working with hearing impaired children in a variety of educational settings.
How to access our team for advice and support
Contact Sarah Adams at sarah.adams4@nhs.net
We work with colleagues who have specialist clinical knowledge and experience in the difficulties associated with Down’s syndrome.
These include:
- hearing impairment
- eating and drinking difficulties
- visual impairment.
How we support children with Down’s syndrome
We help by:
- developing the child’s communication environment and promoting the use of visual cues such as pictures, symbols and signing
- training parents, carers and setting staff in the use of Makaton signing
- assessing the child’s speech, language and communication needs
- providing advice and specific communication targets
- using the child’s individual learning profile and areas of strength to develop their communication skills.
Schools and education settings
We also work in the child’s school or education setting alongside staff on specific areas of communication including:
- speech production
- auditory memory
- vocabulary
- spoken sentence structures.
Our therapists work alongside the Specialist Teaching Service for children with Down’s syndrome.
What signs should I look out for?
Also known as ‘dysphagia‘, your child may have problems with chewing and swallowing certain foods and drinks. They may also show difficulties including:
- problems with oro-motor movements of eating, for example biting, sucking and chewing
- frequent chest infections
- coughing and choking whilst eating or drinking
- ‘gulpy’ swallowing actions
- watering eyes
- indifference to eating or drinking
- failure to thrive.
How we support children with eating, drinking and swallowing problems
Our team work closely with other professionals such as dieticians, health visitors, and child and adolescent mental health services (CAMHS).
We:
- assess eating and drinking skills and make judgements about swallowing safety
- suggest appropriate textures and consistencies of food and drink to support safe eating and drinking
- develop oro-motor skills to aid chewing
- provide advice and strategies, including referring onwards if appropriate.
How can I get a referral for my child?
Contact your GP or consultant to get a referral. We can only accept referrals from medical professionals for this area of difficulty.
LCN is an umbrella term for the difficulties experienced by children with:
- language disorder
- developmental language disorder (DLD)
- problems acquiring language and communication skills.
Monitoring your child’s development
Children develop language skills at very different rates and abilities can vary significantly in the early years. Many young children who have a limited vocabulary at 18 to 24 months will catch up with their peers over time.
Unless there are specific risk factors for DLD, or the child has language difficulties alongside another condition, research suggests monitoring your child at age 2 to 3 years.
Previous research indicates that about 40% of children identified with problems acquiring language by 4 years of age spontaneously resolve by school entry.
Difficulties may be more short-term than persistent.
School age children
At school age, we use the term LCN to describe difficulties experienced by children who do not have language disorder (associated with another biomedical condition) or DLD (severe persisting difficulties).
A child with LCN may have some language difficulties which they need help with so they can thrive in an educational setting. Schools in Buckinghamshire screen for these difficulties and resolve many of them through quality first teaching and targeted support. They may approach us for additional guidance.
How to support a child with LCN needs
See our resources to help your child develop at each stage of communication development.
You’ll find age milestones, what to expect and a range of activities to help support your child in that area.
What is it?
Also known as ‘situational mutism’, it’s a condition where children can talk comfortably in some situations, for example at home, but not others (such as playgroup, preschool or school).
Selective mutism is a form of anxiety disorder which can be thought of as akin to a phobia of speaking in specific situations.
Selective mutism usually starts at around the age of 3 to 5 when a child first starts school. It’s important to note that children aren’t choosing not to speak – they’re unable to.
How can I tell if a child has selective mutism?
The child will consistently speak less freely in some environments.
The situations where they are unable to speak may vary with the location, type or number of people around, or type of talking.
Some children may appear ‘frozen’ in some social settings and can’t join in. Other children may seem happy to communicate non-verbally, for example, through pointing, gestures or facial expressions, but will not talk.
When the child feels comfortable, such as at home, they will be able to speak freely and confidently.
How we help children with selective mutism
The priority is to help children speak to those in the day to day environment, so train those around them. The most important thing is to change the environment to ensure:
- everyone knows about SM
- there’s no pressure on the child to speak
- people talk openly about speech anxiety
- we build the child’s confidence more broadly.
We offer guidance and training for settings with no referral necessary. Where concerns persist following this, children can be referred to us through the school advice clinic. We can also offer bespoke meetings to review targets and troubleshoot.
We also offer group sessions for older children over the holidays. This provides a valuable opportunity for young people with SM to meet others in the same situation, and to learn more about their condition.
How you can help
Watch our video on selective mutism and download our Settings Pack which contains initial guidance.
For some children (particularly those under the age of 5) following the advice given in the above webinar consistently for a term or two is usually enough. Selective mutism is likely to resolve without further input.
Some children need more support such as a formal Small Steps programme covered in the video. School staff should book onto a school advice session to discuss any continuing concerns. Equivalent sessions are also available for early years children.
At these sessions, we’ll make a referral to the selective mutism team where appropriate. You should also do a Language Link assessment before your school advice session.
Useful resources
How selective mutism is supported in Bucks
Get advice, support and access additional resources
Watch our video below to understand more about selective mutism:
We work with young people from nursery age through to further education (FE) who have social communication difficulties or with a diagnosis of autism.
Autism is a lifelong, developmental disability which affects how people communicate and interact with the world.
You can also view 12 fast facts about Autism below:
What we do
We assess and support children and young people in their homes, early years settings, schools and Further Education (FE) colleges. We help them to develop effective communication within the context of their communication differences and neurodivergence.
We work with young people who communicate using:
- behaviour (for example, pulling and leading by the hand)
- vocalisations (sounds which might not be clear words)
- gestures (for example, putting their hand up to communicate ‘stop’)
- pictures (this may be through paper resources or high-tech devices)
- sign language (such as Makaton)
- ecolalia (repeating words or whole phrases)
- speech (single words through to complex sentences)
We use a total communication approach and find the type of communication that is most accessible to the person you’re supporting.
The young people we work with may need support to engage, interact and communicate with others. We work with the individual on these areas through child-led, meaningful activities which are motivating and relevant to the young person’s priorities.
Family support
We support families/ carers to understand their child’s communication skills and preferences. This is delivered through the coaching of adults in how to engage with their child in a way that fosters mutual enjoyment and connection.
We encourage families to access local support through the Early Bird program and the NAS (National Autistic Society). These organisations offer information and opportunities to meet other families and share experiences and ideas.
School and education support
We work with teachers and education staff, paediatricians, educational psychology, specialist teaching service, occupational therapy and CAMHS to provide a team around the child/ young person.
We see young people and parents/carers at home and visit staff in mainstream preschools and schools. We also support in additionally resourced provisions (ARPs).
Our work involves
- supporting educational settings in adapting the learning environment
- developing the knowledge, confidence and skills of education staff working with young people
- providing therapy for specific speech, language or communication needs occurring alongside social communication needs/autism
- training early years and school staff.
How to access our team for advice and support
See our resources or to speak to a speech and language therapist to request a virtual advice session
They’re the difficulties that some children have with pronunciation. It covers difficulties with making the right speech sound (articulation), using sounds in words (phonology) as well as using the right rhythm and emphasis/stress on words in conversation.
You might also hear the terms speech delay and speech disorder, and in some cases, dyspraxia.
How can I tell if a child might have a speech sound disorder?
You may notice that your child:
- talks but is very difficult to understand
- has only a few consonant speech sounds compared with what might be expected for their age, for example they may only be using “d” or “g” sounds
- misses out lots of sounds or parts of words (syllables) when they talk
- doesn’t say the right vowel sounds (says “bad” instead of “bed”)
- seems easier to understand when they say single words but is much harder to understand when they talk in phrases or sentences.
- can copy lots of individual speech sounds, but can’t say them in words.
See our resources for more information about speech sound development.
How we help children with speech sound disorders
We identify whether the child’s speech isn’t within the typical range expected for the child’s age. We then diagnose the type of speech sound disorder, decide with the parent whether the child would benefit from intervention, and provide appropriate intervention.
Some children have difference in speech development that resolve with advice and maturity.
If your child hasn’t yet started school
We offer support and information through our early years speech and language therapy virtual advice sessions. This may be the only speech therapy support that some children will need. But if their speech doesn’t develop as anticipated following advice, or if there are signs of unusual or restricted speech development we may offer your child a screening assessment.
If your child is at school
Their school can use the SpeechLink resources to assess and treat a wide range of speech sound difficulties. Schools can get advice and support from the school advice clinic to compliment the SpeechLink support or request additional help.
We may discuss a referral to the Speech Sound Disorders team. You can also look at our speech and language therapy virtual advice sessions.
What happens if my child has a speech disorder?
More complex or persisting speech disorders do best when supported by parents, nursery/school staff and speech and language therapists. Our speech sound disorders team provides therapy from our health clinics for children with these types of speech sound disorder.
How you can help
Do any activities recommended either in the advice session, via your child’s school from the SpeechLink programme, or any parent programmes sent home by your child’s school.
Also known as stuttering or ‘dysfluency’, stammering is when someone:
- repeats sounds or syllables, for example, saying “mu-mu-mu-mummy”
- make sounds longer – for example, “mmmmmmummy”
- gets stuck on a word or it does not come out at all.
It’s a complex difficulty that can vary at different ages, in different situations and for different children. It’s relatively common for children under 5 years old years old to go through a short phase of stammering, especially when they feel under pressure to communicate.
Early intervention
It’s less likely that older children who stammer go through a short-term stage. Early intervention is beneficial for children who stammer. We advise you to refer a child who stammers for more than a couple of months, or if you’re concerned.
How we help children who stammer – what to expect
Assessment
When you bring your child to us for the first time, we’ll discuss your concerns find out a little about your child’s medical and developmental background. We may check language development and, for older children, talk to them about their feelings about their speech.
We will then discuss the next steps with you, including what you can do to help which. For younger children this will include special time.
Telephone monitoring (for children under 7)
Research shows that young children under 5 can stammer for a few weeks or months and then stop without needing any therapy. Research also suggests there’s no risk in waiting 12 months after a child has begun to stammer before beginning therapy.
We offer a telephone review service for young children to check their progress. We’ll discuss how you are getting on with special time and ask if your child’s speech has changed.
If we can not call you, we’ll ask you to complete a questionnaire. More than half of the children who come to our clinics with a stammer never need therapy.
Individual therapy
If we recommend therapy, we’ll call you to arrange an appointment with you and your child. We usually offer children under the age of 7 Lidcombe therapy or Parent-Child Interaction therapy.
We’ll explain these to you fully when therapy begins. Both approaches involve lots of play and need a commitment from parents to attend therapy sessions and work with their child at home.
Block therapy sessions
We may offer children aged 7 years and older a block of 6 individual therapy sessions. Therapy for older children is more direct. We help them to change the way they speak by teaching them speech techniques, but also work on their communication and confidence.
Parents attend these sessions and will need to help with home practice.
We may offer Skype sessions to some older children. You can discuss this with your therapist.
Group therapy
We offer 3 different groups depending on a child’s age:
- Smoothies for children aged 7 to 9 years
- Blockbusters for children aged 10 to 12 years
- Teen Challenge for children aged 13 to 15 years.
We help improve communication and confidence as well as helping with speech techniques. Parents do not attend these sessions but we expect them to help with home practice.
The Smoothie and Blockbuster groups take place during school hours. Each group lasts 5 weeks with Smoothie sessions lasting 1 hour and Blockbusters 1.5 hours. We then follow up a few months later.
The Teenage group usually takes place during half-term and holidays. We usually run 2 sessions during each holiday break (excluding Christmas).
Stammering in older children is relatively uncommon so we do not run groups throughout the year. You may need to travel for our group sessions but we try to place children in suitable locations.
I’m a teacher. How can I support a child who stammers?
Get advice and resources on how you can support children who stammer. Or email bht.stammering@nhs.net to attend out termly training for teaching staff.
I’m a parent, carer or young person who stammers. Where can I get further advice and support?
Book on to either an early years or school age virtual advice session to discuss your concerns. You don’t need a referral.
Voice refers to the way we produce sounds for talking using our lungs and vocal cords (or vocal folds).
How we can help
We give advice to help children and young people look after their voices. Disorders of the voice involve problems with volume and quality.