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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 our the communication difficulty your child may have and what you can expect.



What is bilingualism?

We refer to children who understand 2 or more languages as ‘bilingual.’

Does it have any benefits in language development?

Yes. Children with bilingualism have opportunities to communicate with their extended family and community and experience different cultures. It can also increase their confidence.

Good foundation skills in one language can support learning an additional language. There’s no evidence that bilingual children speak later than children who only speak one language.

Bilingualism does not increase or decrease the chances of a child having speech or language difficulties.

Tips and strategies to support a bilingual child

Use your home language(s) with your child

This may be the language you feel most comfortable with and will provide the best language model for your child.

If children know the home language(s) well, it’ll help them learn an additional

Use both languages daily

Your child will need interaction in both languages on a daily, or almost daily basis. This should include talking, reading and playing and not from TV or films.

Language develops through interaction. Children will develop a language if they
feel they need it. Interacting with others creates that need.

Encourage your child to feel proud of their languages

This will help them to develop a strong cultural identity. Make sure your child knows the name of the languages they use.

Tell stories

Share nursery rhymes, books songs and stories in your child’s home language(s).

Mix different languages

If you speak two languages it’s ok to mix different languages in the same sentence. It’s natural among bilingual speakers and will not cause language difficulties.



What is it?

DLD is a speech language and communication difficulty that affects the way children understand, learn and use language. A child with DLD may never catch up spontaneously.

Some children have DLD associated with:

  • autistic spectrum conditions
  • a hearing impairment
  • other sensory impairments
  • general learning difficulties.

In this case we refer to it as ‘Language Disorder associated with x’, where X is the known condition. A child may have a Language Disorder associated with autistic spectrum disorder, for example.

Other children may not have any of the above conditions or associations but have DLD. They may have more persistent language difficulties than other areas of learning and development. It’s unlikely these difficulties will resolve by 5 years old.

DLD is a long-term condition and difficulties can persist into and throughout adulthood.

What does this mean for the child?

Children with DLD may also develop communication skills in a different way to other children. They may not make the expected progress despite targeted intervention.

What causes DLD?

It can be hard to understand as there’s no known cause. We do know that emotional difficulties or parents not talking enough to their children does not cause DLD.

Children with DLD can have co-occurring difficulties such as dyslexia, ADHD and speech sound difficulties. On average around 2 children in every classroom have DLD. It’s hard to spot and often described as the ‘hidden’ disability.

How does DLD affect children?

Children with DLD might find it difficult to:

  • follow or remember spoken instructions
  • organise ideas to verbally express what they want to say
  • tell or re-tell a coherent story
  • find the right words (vocabulary) to say at the right times
  • understand what they hear or read.

They may also:

  • interpret things over literally and miss the point
  • talk a lot but engage poorly in reciprocal conversation.

As well as affecting learning and developing literacy skills, DLD can impact on:

  • making and keeping friends
  • having a healthy mental and emotional wellbeing
  • achieving academic success at school.

Sometimes difficulties and anxieties linked to DLD may be wrongly interpreted as misbehaviour.

I’m a parent. What signs of DLD should I look out for?

There may be a family history of language and or/literacy difficulties.

At 1 to 2 years old, you may notice your child:

  • does not babble
  • does not respond to speech and/or sound
  • is a late talker with poor understanding of language
  • makes minimal or no communication attempts
  • gestures poorly, for example, fewer than 16 gestures at 16 months.

At 2 to 3 years old, you may notice your child:

  • shows minimal interaction
  • has no intent
  • can not put two words together
  • shows minimal reaction to spoken language
  • regresses or stalls their language development.

At 3 to 4 years old, you may notice your child:

  • has inconsistent or abnormal interactions
  • only says 2 to 3 word utterances
  • has difficulties understanding simple instructions and using verbs.

Close relatives may not be able to understand what the child says.

At 4 to 5 years old, you may notice your child can not repeat nonsense words.

They may have words and talk in sentences but strangers can not understand much of what the child says. Close relatives can not understand more than half, even without speech sound difficulties.

Your child’s DLD is more likely to persist if:

  • their difficulties are more severe
  • more areas of their language development are affected.

I’m a teacher in a primary or secondary school. What should I look out for?

You may notice children/young people with DLD struggle with:

  • following instructions, particularly if they’re long or contain complex vocabulary
  • understanding and answering questions, including more complex forms, for example, why? How?
  • remembering, recalling and understanding vocabulary
  • using words in the right context
  • constructing spoken and written sentences accurately with correct grammar and meaning. They might use shorter sentences than peers and produce sentences with tense and pronoun errors
  • understanding and generating narrative, including sequencing.

You may also see difficulties in:

  • using language in social situations, for example, understanding unwritten rules of conversation, non-literal language, idioms and inferencing
  • word finding
  • understanding concepts, especially maths and science words that relate to time, size, comparison and measures.

Watch the video below about DLD and what every teachers needs to know:

Download our presentation from our 2020 Developmental Language Disorder Awareness Day. It’s a helpful CPD tool for staff in schools.

I work in a school with additionally resourced provision (ARP). What can I expect?

Children who attend an ARP with DLD may benefit from intensive and flexible speech and language therapy and specialist teaching on site, according to their needs.

These children will join mainstream classes. At times, they may have specialist small group teaching as part of their ARP provision.

Watch the video below and hear from children, parents and adults with DLD:

Watch the video below to hear Lily’s story who was diagnosed with DLD when she was 15 years old:



What are they?

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.

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 assess the child/young person’s suitability to use ICT to access the curriculum. We do this in collaboration with Bucks Learning Trust Specialist Teaching Service

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.

Who we work with

We work with children and young people from 5 years to 25 years with complex medical needs (see who we work with for early years above).

For both early years and school settings, we work within a multi disciplinary team including:

  • class teachers
  • support assistants
  • occupational therapists
  • physiotherapists
  • paediatricians
  • dieticians
  • specialist teachers
  • other professionals that may be involved with your child’s needs.

We also work alongside other members of our own service for example therapists specialising in hearing impairments.

How to access our teams for complex communication needs

Contact Theresa Drake, Highly Specialist Speech and Language Therapist, Clinical Team Lead at



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).


  • 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?

If you’re concerned about any of the above signs, please contact your GP or consultant to get a referral. We can only accept referrals from medical professionals for this area of difficulty.


Who we work with

We work with children with different types of hearing loss including:

  • congenital (present at birth, sometimes as a result of a virus)
  • acquired sensorineural (develops later in life sometimes due to aging, 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 hearing difficulties they may have.

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 hearing difficulties.

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 ‘Language for Littl’uns’.

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



What is it?

It’s 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 and a psychological problem related to fear of others hearing the child speak.

It’s not due to shyness or stubbornness. Selective mutism affects more girls and boys and usually starts between the ages of 3 and 5.

How can I tell if a child has selective mutism?

Your child will be silent in an environment (such as at school or nursery) for at least one month.

Some children may appear ‘frozen’ in some social settings, and can not interact. Other children may seem happy to communicate non-verbally, for example, through pointing, gestures or facial expressions, but will not talk.

Reluctant speakers may talk but in a very limited way, for example, by only whispering single words to a trusted adult.

How we help children with selective mutism

It helps to identify the problem early. We can then support the child more effectively.

We arrange to talk to parents and may see them without the child. It can help to bring along a video to this meeting. Make sure your child knows you recorded them and will share this with us.

We’ll explain how settings such as schools can make small changes to help the child or young person. We also support key workers to follow a structured programme and help a child gain confidence in speaking.

How you can help

Parents and school staff usually work directly with the child. They’re the best people to follow the programme on a daily basis.

It’s important that those working with the child:

  • understand what selective mutism is
  • openly acknowledges the child’s difficulties but understands these are temporary
  • removes pressure on the child to speak
  • encourages and accepts communication by any means (not just speaking)

Useful resources

Find out more about selective mutism in an illustrated guide book

Get advice, support and access additional resources

Watch our video below to understand more about selective mutism:



What are social communication difficulties?

Children and young people with social communication difficulties struggle to communicate with other people, which can affect all aspects of their academic and social lives. It can affect their ability to make friends, understand and manage emotions, and follow social rules.

Children with social communication difficulties may also have problems understanding and using non-verbal communication, for example, body language, and non-literal language such as sarcasm and jokes.

They may need help to communicate using a variety of different methods, such as pictures, signing, and/or spoken language.

What is autism?

It’s a lifelong condition that affects how people communicate and interact with the world. Children with autism:

  • find it hard to communicate and interact with people
  • find it hard to understand how people think and feel
  • take longer to understand information
  • get anxious about unfamiliar situations
  • may experience over sensitivity to lights, sounds, tastes and touch.

Find out more about autism

What are the similiarities between social communication difficulties and autism?

They both involve difficulty with social communication skills. Children and young people may also have developmental issues such as language or cognitive difficulties.

What are the differences?

Autism has the additional defining characteristic of restricted and/or repetitive behaviours. This may include intense interests in specific areas, or sensory processing difficulties, for example, finding certain noises or textures uncomfortable.

How can I tell if a child has social communication difficulties or autism?

You may notice apparent social communication difficulties before or around 3 years old. Some children’s difficulties may be more subtle and may not be picked up until they start school.

Early warning signs

These may include a lack of:

  • big smiles or other warm, joyful expressions by 6 months or soon after
  • back-and-forth sharing of sounds, smiles or other facial expressions by 9 months
  • babbling by 12 months
  • back-and-forth gestures such as pointing, showing, reaching or waving by e months

You may also notice fewer than 16 gestures used by 16 months, and a loss of speech, babbling or social skills at any age.

What else might I notice?

Children with social communication difficulties may:

  • have difficulty sharing attention
  • using and understanding non-verbal communication
  • lack creative play
  • have sensory difficulties.

In older children, you may notice:

  • comprehension difficulties
  • monotonous speech
  • literal understanding
  • poor perspective taking
  • inflexible thinking
  • limited friendship skills.

How we support children with social communication difficulties and autism

We support children’s social skills in areas such as:

  • understanding and following common social ‘rules’ (how to take turns in a game, or answer a question in the classroom)
  • developing understanding of emotions, facial expressions and body language
  • working and socialising with others.

Some children with social communication difficulties will have a diagnosis of autism spectrum disorder.

We use a variety of methods such as pictures, symbols, signing, low or high tech communication devices and/or spoken and written language.

We often use visual and organisation supports such as visual timetables and colour-coded activities.

How to get help for your child

Contact your child’s GP, nursery, school or our speech and language therapy team.



What is stammering?

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 is 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


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 from the British Stammering Association.

I’m a parent, carer or young person who stammers. Where can I get further advice and support?

You can access resources and strategies and a helpline if you need to talk to someone at the Michael Palin Centre.



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.