Jacob (aged 11) had been receiving support for Developmental Language Disorder from SLTs as part of the in-house Speech and Language Therapy service that we provide for his school when his parents approached us as a private customer to receive some additional help and advice on how best to support him.
Sam worked closely with Jacob, his parents, teaching staff and other professionals to gain a holistic overview of Jacob’s strengths and needs as part of a complex assessment. This involved observing Jacob in a series of settings (in lessons, at playtime, in a 1:1 setting), carrying out a formal language assessment, gathering a case history from parents and school staff, and liaising with Jacob’s Educational Psychologist.
Following this process, it was determined that Jacob presented with language and communication difficulties in the following areas:
Use of language
Word finding: Difficulties retrieving the word you want to say.
This is often described as feeling as though the word is ‘on the tip of your tongue’. Jacob used lots of ‘empty’ language when he was unable to think of the word he wanted to say, for example, he would say ‘you know’ and ‘thingy’. When he was stuck, Jacob had difficulties with describing the word- a useful strategy to give the listener clues as to which word we are thinking of and want to say. As Jacob wasn’t able to give this information, it made it difficult for the listener to know which word Jacob was wanting to say.
Sequencing: Difficulties with re-telling stories or events in chronological order.
When a child has difficulties with sequencing their thoughts and ideas, it can often be quite difficult for the listener to understand what happened/where/when etc., and as a result, their story telling can be hard to follow. When talking about his summer holidays, Jacob struggled to re-tell the events in the right order, meaning that the spoken account (narrative) of his holiday sounded ‘jumbled’. This made it difficult for the listener to fully understand what had happened on Jacob’s holiday.
Grammar: ‘Grammar’ is the term used to describe the rule system for how words and word-endings are used within a language. The use of grammar changes the meaning of the word.
Children may struggle with a range of grammar, including: use of auxiliary verbs (be/do/have), use of the correct verb tense (past/present/future) and use of plural endings (-s). Jacob struggled particularly with the use of past tense irregular verbs. For example, he would used ‘falled’ for ‘fell’ and ‘swimmed’ for ‘swam’. This impacted on his ability to express himself clearly and was also impacting on his ability to access SPaG (Spelling, Punctuation and Grammar) lessons in school.
Understanding of language
Following multipart instructions: Difficulties listening to, retaining, and following spoken instructions containing more than one part.
When a child has difficulties with the retention of spoken information, it can impact on their ability to follow classroom instructions and recall curriculum information. Jacob’s difficulties with retaining spoken information often meant that he felt ‘lost’ in lessons, as he was unable to follow the lesson input. He also struggled to follow longer instructions in the classroom, and didn’t want to ask for help due to fear of embarrassment.
Understanding figurative language: Difficulties with the comprehension of non-literal language, such as similes and metaphors.
Difficulties with understanding figurative language can result in reduced comprehension of a person’s message, or difficulties understanding what someone is trying to express.
Jacob struggled in particular with understanding jokes, which impacted on his ability to form and maintain social relationships, as jokes are often used as a social mechanism. Jacob often masked his difficulties with understanding by laughing, even when he hadn’t understood a joke, as he didn’t want to be seen as ‘different’ by his friends.
These difficulties can be represented using ELKLAN’s ‘Communication Chain’ diagram, as seen below. Items that are highlighted as red are things that Jacob either found difficult or couldn’t do, items highlighted as green are things he could do and items that are blue were planned to be assessed further following the initial phase of intervention.
The impact this was having on Jacob
Jacob’s language difficulties lead to:
Limited access to the curriculum due to difficulties with understanding and using spoken language.
Loss of concentration within the classroom due to effortful comprehension of spoken language.
Frustration, masking of difficulties, low self-esteem and withdrawal
Reduced social interaction due to difficulties with comprehension and expression.
Based on the information Sam had gathered, Jacob’s needs were indicative of Developmental Language Disorder (DLD). This is a common childhood condition which affects approximately 2 children in every class of 30 and affects how children and young people understand and use spoken language. DLD was previously known as “Specific Language Impairment” (SLI).
How we helped Jacob:
Sam was keen to ensure that everyone in Jacob’s environment was equipped with the skills required to support him. Intervention for Jacob therefore was multifaceted, and involved:
Direct intervention from the SLT
Training of teaching staff in strategies to support Jacob in the classroom, such as use of an ‘asking for help card’, ‘task plans’ which visually demonstrate the steps required complete a task, and a pocket vocabulary book.
Training of support staff in specific therapy approaches to support the delivery of intervention in school throughout the week.
Supporting parents and school staff with their understanding of DLD through attendance at and involvement in a DLD awareness day workshop.
To improve Jacob’s understanding and use of grammar (particularly irregular verbs), Sam used the ‘Shape Coding’ system. This approach, developed by a Speech and Language Therapist, uses a visual coding system of shapes and colours to explicitly teach the rules of grammar. Sam combined this approach with Jacob’s love of films to support him to accurately describe a series of pictures using past tense irregular verbs. For example, when talking about ‘Charlie and the Chocolate Factory’:
To begin with, Jacob said: ‘Augustus is fall in the river’
With support from the Shape Coding intervention, Jacob was able to say: ‘Augustus fell in the chocolate river’
To support Jacob’s difficulties with word-finding, Sam used a range of games, including ‘Head Bands’ (where one person has a picture on their head and the other person describes the word). At first, Jacob found it really difficult to describe the words, and struggled to generate information such as the category and the function of the item i.e. what we use it for. Sam worked with Jacob to use ‘word maps’ to support him to generate information related to a word. This helped Jacob to think about the semantic features of a word (e.g. ‘where would you find it?’ and ‘what’s it made of?’) and the phonological (sounds) features (e.g. ‘what does it begin with?’ and ‘what does it rhyme with?’), which he could then use to describe a word he was struggling to retrieve.
Following multi-part instructions
To work on Jacob’s ability to retain and follow multi-part instructions, ‘barrier game’ style activities were used. In this activity, a physical barrier was placed between Jacob and the SLT. The SLT had a completed picture and Jacob had an incomplete picture. The SLT then gave instructions, for example: ‘colour the star, draw a line around the sun and cross out the moon’ before removing the physical barrier and comparing the two pictures to determine whether Jacob had followed the instructions accurately. During this activity, Jacob was also supported through the use of an ‘asking for help’ visual, which supported him to seek clarification when he had difficulties following the instruction. The sheet gave specific examples of how to ask for help, for example ‘can you repeat that?’ and ‘what does X mean?’. Jacob could then use this to support him to independently ask for help.
Jacob’s narrative sequencing skills were targeted throughout the use of story sequencing activities, and explicit teaching of time markers, such as ‘first’, ‘next’, ‘after that’ and ‘then’. Within these activities, Jacob was required to order a set of 3/4 pictures before using time markers to coherently re-tell a story. Once Jacob had achieved this, he was supported to be able to use time markers within his own personal narrative, for example when talking about his ‘weekend news’.
Outcomes for Jacob
Jacob worked really hard in 1:1 sessions with Sam, and has continued to make progress through intervention delivered in school by the trained Teaching Assistant. As a result, he is now able to independently use strategies to support his word-finding difficulties and can now sequence his spoken language using time within conversation, meaning that his expressive language is much easier to follow. Jacob is also beginning to use irregular past-tense accurately within structured activities and is much more independent in his ability to ‘self-correct’ his written work, through identifying errors in verb tense. Jacob is now able to use strategies to support his ability to follow multipart instructions and can ask for support/clarification when he is experiencing difficulties.
Within the classroom, Jacob shows increased confidence through his contributions to whole-class discussions. Jacob is also able to identify when he hasn’t understood something, and is able to ask for help where appropriate, which is a massive achievement for him!
As a result of the support he has received, Jacob even had the confidence to speak at a Development Language Disorder (DLD) workshop that we hosted for local teachers and parents about what it is like to have DLD.
Well done Jacob!
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