Royal College of Speech & Language Therapists Clinical Guidelines: 5.3 School-Aged Children With Speech, Language & Communication Difficulties
Taylor-Goh, S. (ed). (2005).
Bicester (United Kingdom): Speechmark Publishing Ltd., 25-33.
This evidence-based guideline pertains to the assessment and management of school-aged children with speech, language, and communication difficulties. This guideline is intended for speech-language pathologists.
Royal College of Speech & Language Therapists (United Kingdom)
"Children with language impairments have difficulties interpreting non-verbal communication and verbal language in social contexts. The Speech & Language Therapist should provide strategies to facilitate the child's understanding of social aspects of language" (Grade B Recommendation, Level III Evidence; p. 30).
The speech-language pathologist can "advise on appropriate strategies for classroom management to enable pupils to access the curriculum. Language within the classroom should be interactive, and the correct questioning will develop thinking skills. The classroom environment can be modified and strategies [can be] used to enable pupils with speech, language and communication needs to access the curriculum and to reach their potential" (Grade B Recommendation, Level III and IV Evidence; p. 31).
Assessment of the communication ability of school-age children with speech, language, and communication difficulties should include assessment of the use of social rules of communication (Grade C Recommendation, Level IV Evidence; p. 26).
"Where a Statement of Special Educational Needs exists [for school-aged children with speech, language, and communication difficulties], the Speech & Language Therapist will contribute to Individualised Education Plans (IEPs) and target setting, and will consider the speech, language and communication needs of the child within the context of the curriculum" (Grade B Recommendation, Level III Evidence; p. 26).
"In addition to phonological production, consideration will be given to phonological processing and development of literacy skills [in school-aged children with speech, language, and communication difficulties]. This should be assessed where there are overt speech difficulties and also where there are vocabulary problems, whether or not these coexist with speech problems" (Grade B Recommendation, Level IIb Evidence; p. 32).
The speech-language pathologist may "also work on teaching strategies to overcome skill deficits and support teaching staff in reducing the impact of a child's difficulties with comprehension and expression of language on the child's access to the curriculum. The therapist should ensure that other symbolic forms of communication (signs, objects of reference, photographs, symbols and communication aids) are used appropriately to improve comprehension and expression where necessary" (Grade B Recommendation, Levels IIa, III, and IV Evidence; p. 29).
The speech-language pathologist will "need to consider the child's ability to understand connected speech and oral narratives, and devise ways to enable them to interpret correctly" (Grade B Evidence, Levels IIa and III Evidence; p. 30).
"It may be necessary to target understanding of basic concepts that may underpin [core vocabulary and vocabulary specific to subject areas or topics].... The child should be given access to strategies for learning and recalling words, including signing (both for whole words and for phonology) and memory aids" (Grade B Recommendation, Level III Evidence; p. 28). "Strategies should be employed to develop the child's skills at interpreting figurative language (both spoken and written) as this forms a substantial part of understanding language" (Grade B Recommendation, Level IIa Evidence; p. 30).
"Children with speech, language and communication needs have been shown to benefit from the use of sign language and/or symbols. The Speech & Language Therapist needs to consider the development of opportunities for the child with these needs to use signs and symbols to communicate, with training and support for school staff, peers and parents as communication partners" (Grade B Recommendation, Level III Evidence; p. 31).
<p>In school-aged children with speech, language, and communication difficulties and within an appropriate context, consideration needs to be given to the development of the following:</p>
<ul>
<li>"phonological system;</li>
<li>phonological processes;</li>
<li>intelligibility;</li>
<li>phonetic system;</li>
<li>phonetic errors;</li>
<li>self-monitoring;</li>
<li>pre-literacy skills; [and]</li>
<li>literacy skills" (Grade C Recommendation, Level IV Evidence; p. 32).</li>
</ul>
The speech-language pathologist (SLP) will "work collaboratively with the teacher and plan lessons that may include whole class delivery, small group, paired and individual work" (Grade B Recommendation, Level III and IV Evidence; p. 31). The SLP will also "provide a consultation service for school staff, which may include the provision of language programmes" (Grade B Recommendation, Level III and IV Evidence; p. 31).
<p>"Development of a range of tools to aid organisation may include:</p>
<ul>
<li>writing frameworks for report writing;</li>
<li>use of [information and communications technology] ICT [e.g., computer based interventions]; [and]</li>
<li>symbol systems" (Grade B Recommendation, Level III and IV Evidence; p. 31).</li>
</ul>
<p>"Both comprehension and production should be considered for all areas of grammar. Particular attention should be paid to the following:</p>
<ul>
<li>word order;</li>
<li>argument structure;</li>
<li>morphology, especially tense and aspect inflections;</li>
<li>syntactic movement, especially passives and 'wh' questions;</li>
<li>coordinating and subordinating conjunctions; [and]</li>
<li>expanded noun phrases" (Grade B Recommendation, Levels IIa, III, and IV Evidence; p. 29).</li>
</ul>
<p>"Intervention should always establish comprehension of structures before or in conjunction with work on production. Correct syntactic rules should also be established. A Speech & Language Therapist may work on developing the skills in these areas using supports such as colour and shape coding" (Grade B Recommendation, Levels IIa, III, and IV Evidence; p. 29).</p>
<p>"Children make sense of the world through the language they use. Difficulties with language can contribute to problems with self-organisation and can limit the use of strategies for learning. The Speech & Language Therapist should suggest or provide:</p>
<ul>
<li>learning strategies-'thinking skills' programmes such as mind mapping;</li>
<li>memory strategies-memory files;</li>
<li>strategies for understanding and using timetables, and use of organisers;</li>
<li>study skills-identifying key information; [and]</li>
<li>revision strategies" (Grade C Recommendation, Level IV Evidence; p. 30).</li>
</ul>
"When the [school-aged] child [with speech, language, and communication difficulties] has a discrete production problem, the clinician will need to assess both phonological processing and articulation" (Grade B Recommendation, Level III Evidence; p. 32).
"Communication ability in a range of contexts should always be addressed [in school-aged children with speech, language, and communication difficulties]. However, it may not be necessary in every case to assess phonology, articulation and language" (Grade B Recommendation, Level III Evidence; p. 26).
<p>"Modifications of methods of information presentation include:</p>
<ul>
<li>practical experience of handling equipment to provide kinesthetic information;</li>
<li>visual support;</li>
<li>mind maps to highlight vocabulary, establish semantic links within topics and aid organization of information;</li>
<li>modifying the language of instruction, e.g., simplifying vocabulary or rephrasing; [and]</li>
<li>asking questions at varying levels (Bloom's Taxonomy of Thinking Skills)" (Grade B Recommendation, Level III and IV Evidence; p. 31).</li>
</ul>
The speech-language pathologist should consider the child's ability to process speech sounds that are heard, discriminate the sounds accurately, and interpret them correctly as a critical skill for speech and language development (Grade B Recommendation, Level IIa Evidence; p. 28).
"A wide range of assessment procedures are available and the Speech & Language Therapist should select from these, bearing in mind the child's cognitive, physical and perceptual abilities. A combination of formal and informal procedures will be used to assess the impact of any difficulties [in the comprehension and expression of language, including grammar and vocabulary] on the child's learning and socialisation" (Grade C Recommendation, Level IV Evidence; p. 27).
<p>"Children who struggle with the process of developing expressive language frequently have problems acquiring literacy skills and require specific teaching. The Speech & Language Therapist should target oral language skills as a prerequisite to the development of written narrative skills. Methods to be used by the Speech & Language Therapist can include:</p>
<ul>
<li>explicit teaching of story grammar using story maps;</li>
<li>retelling;</li>
<li>role play;</li>
<li>close activities using story picture cards;</li>
<li>story frameworks; [and]</li>
<li>use of discourse in giving" (Grade B Recommendation, Levels III and IV Evidence; p. 29).</li>
</ul>
