Developmental Language Disorder

Welcome to The Talking House Speech and Language Therapy service.

Your child’s school has chosen to commission a speech and language therapy service from The Talking House in addition to the core NHS speech and language therapy service.

At The Talking House, we believe that successful therapy outcomes come from building good relationships. It is important to us that parents, carers and young people know what to expect when working with The Talking House and that you are kept up to date, every step of your journey.

What about the NHS?

If your child has an identified speech, language and communication difficulty, they are still entitled for consideration of an NHS service. Any help your child receives from The Talking House is additional to your NHS service.

We aim to work in partnership with the NHS therapists in order to achieve the best possible outcomes for your child. This is done through sharing information, with your consent, and sometimes seeing your child together, so that we are working towards a shared goal for your child.

What is DLD?

Developmental Language Disorder describes a persisting problem with language that emerges in the course of development, and which is not associated with another biomedical condition.

Historically, a set of exclusionary and discrepancy criteria were used to support the formulation of a diagnosis of DLD, however this has changed, and individuals no longer requires:

  • A discrepancy between the child’s language skills and his/her non-verbal abilities
  • Language disorder can be attributed to another cause (i.e. Autism Spectrum Condition, Hearing Impairment, Cerebral Palsy)
  • In the past DLD was known as specific language impairment (SLI) but the name has changed so that it better reflects the types of difficulties children have.

    A child can be diagnosed with DLD if their language difficulties: are likely to carry on into adulthood, difficulties have a significant impact on progress at school, or in everyday life and they are unlikely to catch up without any help.

    Signs of DLD

    Your Speech and language therapist will consider and explore:

    • Risk Factors (family history)
    • Co-occurring Disorders (Intellectual disability, ASC, hearing impairment, genetic conditions e.g. Down Syndrome)
    • Difficulties persisting to 5 years of age
    • Areas of Speech Language and Communication Needs:
      – Need support of gesture to understand
      – Limited expressive language
      – Use of echolalia
      – Little use of communicative gesture and babble
      – Limited inventory of sounds used
      – Late emergence of two-word combinations
      – Poor word retrieval and limited vocabulary
      – Poor phonological awareness
      – Difficulty following instructions
      – Difficulty initiating and sustaining conversation

    What we need from you.

    In order to work with your child in school, we need consent from you as parent or guardian. We can’t see your child without your permission. It is therefore vital for you to complete the Informed Consent pages of the form.

    It is important for you to fill out the General Information on the consent form so that we have correct details for you and your child.

    The ‘Speech and Language Skills’ section of the form helps us to build a picture of your child, which enables us to plan our intervention. It is very useful for you to fill out this section with as much detail as possible.

    Once the consent form has been returned to school, your therapist may contact you via the phone to gather further information from you or to discuss certain areas in further detail.

    If you need help with any of the above or have any questions about what information we are keeping about your child then please do contact us.

    Information gathering within school.

    It is important for us to collect information about your child from school staff and any other relevant professionals. This may involve the following:

    • Discussion with school staff
    • Discussion with other professionals as appropriate, for example: Educational Psychology, SENIT, STARS, paediatrician, NHS therapists (SLT, OT, Physio), DAHIT, CAMHS
    • Viewing records such as Educational Health Care Plans, previous speech and language therapy intervention from the NHS, relevant information from other professional and school records such as annual reviews

    Assessment and Intervention

    There may be a short wait between you completing the consent form and your child being seen in school, however we try to see children as soon as possible.

    The assessments will vary from child to child. Sometimes, assessment can be completed through the above information gathering process and a single session with the therapist. At other times, assessment may be carried out over several sessions in order to get a really clear picture.

    Your child may have already had lots of assessment. It is useful for us to know this, because we don’t want to waste time redoing the same assessments. It is, however, very useful for us to carry out our own evaluation so that we can get to know your child and set new targets.

    It is really important that we hear your views, discuss any hopes and wishes that you have for your child, as well as any concerns you have regarding their speech, language and communication skills.

    Standardised assessment tools cannot capture the full extent of a child’s language difficulties and their impact on overall functioning and should only be considered to be one aspect of a comprehensive assessment process (Bishop et al., 2016). Identification of DLD will be based on a combination of:

    • Case history
    • Formal and informal language assessments – object or picture based tasks usually focusing on following instructions, recalling information, vocabulary, use of language including respond to questions
    • Comprehensive observation – observation may take place in the classroom, on the playground and in other social situations such as the dinner hall. It is important for us to carry out observation in a range of different situations and across a time scale in order to evaluate possible differences in presentation dependent on time of day, activity etc.
    • Response to interventions and consideration of risk

    An individual’s needs will change over time depending on the demands placed on the individual, therefore it is desirable to consider ongoing assessment and monitoring in response to input as part of dynamic assessment as well as the changing priorities for the individual.

    Your therapist will gather information from the child, young person through conversation and discussion to explore their likes, interests and motivations. This may be achieved through questionnaires and/or rating scales and talking mats, if appropriate.

    In some cases, a member of staff who knows your child well may interact with the child under guidance of the therapist. It is important for your child to feel as relaxed as possible in order for us to gain an accurate picture of their skills. In some cases, this is working with a member of staff they have a good rapport with. The therapist can gain a lot of information through observing these interactions and by giving specific instructions/ tasks for the member of staff to carry out with the child in order to observe specific skills.

    Assessment may need to take place over a number of sessions in order for us to gain a true reflection of your child’s skills. Yourself and/or school staff will play an important role in helping us to understand whether what we have seen is a typical presentation of skills.

    After Assessment

    After the initial session, the therapist will give you feedback and there is opportunity for you to ask any questions.

    Following assessment the therapist may:

    • Provide a report, classroom strategies and specific speech, language or communication targets.
    • Arrange a meeting with you if this will be beneficial to talk through your child’s targets in more detail/ support you with strategies to develop your child’s speech, language and communication skills at home.
    • The therapist will provide resources for school staff to carry out your child’s targets as part of the curriculum/ daily routine. If you wish to work on targets at home, the therapist will also provide you with resources and advice around completing the activities.
    • Your child may be included in a therapy group set up by the speech and language therapist and delivered by school staff – these groups follow set programmes in order to support a specific area of need.
    • Training is provided to school staff at regular intervals throughout the year and if specific training is required to support staff in delivering your child’s targets then this is carried out.
    • The therapist will continue to provide advice and resources to support your child’s development as required and provide reviews at the request of staff and/or parents throughout the year as appropriate.
    • Provide whole school support in the form of environmental and classroom strategies.
    • Attend meetings at the request of school/ parents (such as EHCP reviews). If the therapist is unable to attend meetings, a summary report will be provided as appropriate.

    Additional processes that may take place:

    • No further action- if assessment highlights that your son or daughter’s speech, language and communication skills are within the expected range for their age, the therapist will recommend no further action or intervention required.
    • Onward assessment to further investigate/ support your child
    • Onward referrals – at times assessment highlights a problem that requires further investigation from other professionals. These services can include audiology, Ear Nose and Throat, Child and Adolescent Mental Health Service (CAMHS), occupational therapy, paediatrician or specific areas of NHS speech and language therapy such as the feeding team.

    Storing Information

    After each contact with you or your child we will need to write and keep records of what has happened. This is a legal requirement of all health and care professionals. We store all our records in line with data protection laws and keep them for the length of time required by our regulatory body, in case they are needed at a later time in your child’s life. You are entitled to see these records.

    These records are intended to show a timeline of what has happened during your child’s therapy, and why.

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