Difficulties – what can go wrong?

• Most children develop speech, language and communication without any difficulty, but some do need extra help.
• Childhood communication difficulties often result from a number of contributory factors. An interaction of elements within the child and in their environment might underlie speech, language and communication difficulties.
• Conditions affecting wider aspects of development such as learning difficulties or autism can give rise to communication problems. Some children might have a specific difficulty acquiring speech or language, with no other developmental difficulties. Other children might acquire a communication difficulty at some point in their childhood, for example as the result of an accident or injury. Some children might just be a bit slower than other children to develop their speech or language – some of these will catch up on their own, but others will need help.
• Development of these skills might follow a similar pattern to other children but at a slower rate; also the development might occur in a different or unusual way, compared to other children. There may or may not be delay affecting other aspects of development, for example walking, social skills or play.
• Most communication difficulties arise due to factors over which we have no control. Parents might need reassurance that they are not to blame for their child’s communication difficulty.

Difficulties – how might children be affected?

• Motivation – Some children seem not to want to communicate with people in certain circumstances or settings.
• Social development might be immature or unusual. Poor knowledge about social behaviour and communication affects a child’s ability to relate to others. They will experience difficulties in understanding and responding appropriately to communication and in using language to express their needs.
• Conversations – the ability to share conversations can be limited. Some children might have learned to talk but are unable to communicate very well with others…they might have a wide vocabulary and adult-sounding sentences, but find it hard to make friends and their understanding of what others say is not as good as might appear.
• Limited imagination is apparent in some children’s play; these children might have problems developing abstract concepts and language – there is a strong association between imaginative play and language development.
• Attention and listening – poor attention and listening skills can affect speech and language development. These children might have problems with motor skills (for example clumsiness), levels of activity or perception.
• Understanding what others say might be poor – evident in inability to follow directions or instructions and low appreciation of stories.
• Expressive skills – thinking of words, putting words together, making sentences, telling about own experiences and story-telling might be weak.
• Speech and language difficulties can be associated with reading and writing difficulties. There is a close link between speech, language, spelling and reading.
• Speech sound system – speech might be unclear, even to people who know the child well.
• Movements of the lips, tongue and face muscles might be weak, slow or not very well coordinated.
• Some physical disabilities can impact on communication. Some less obvious language and communication difficulties might coexist with speech problems which have an ‘obvious’ physical cause, for example cleft palate.
• Emotional – the child might have low self-esteem.
• Behaviour might be disruptive or distressing, due to poor communicative ability.

What are the risk factors?

The following factors place children at higher risk than others for developing speech, language or communication difficulties:

• Sensory impairments (especially hearing loss)
• Prematurity
• Exposure to infections or toxins in utero or during early childhood
• Maternal disease influencing normal growth of her unborn child
• Birth trauma
• Positive family history of communication difficulties (including reading / writing difficulties, speech problems, language problems and autism)
• Medical and congenital conditions associated with communication impairments (for example, cerebral palsy, Down’s syndrome, Fragile X…)
• Environmental deprivation (i.e. severely reduced opportunities to learn about the world, to play and to interact) and / or abnormal environmental input (for example child abuse and severe neglect)
• Multiplicity of adverse factors.

What to do if you are worried about your child’s speech, language or communication

• Discuss your concerns with your child’s Health Visitor, teacher or SENCo (Special Educational Needs Coordinator). Any of these professionals can make a referral to your local NHS Speech and language therapy service.
• Alternatively, you can refer your child yourself, as all UK Speech and language therapy services accept referrals from parents. This is true for NHS and private speech and language therapists (sometimes called ‘Independent speech and language therapists’). You can find the contact details of your local NHS service through the Royal College of Speech and Language Therapists (R.C.S.L.T.). If you wish to find an independent therapist, have a look at the Association of Speech and Language Therapists in Independent Practice (A.S.L.T.I.P.) website
• Speech and language therapists would always prefer to be in the position of reassuring parents that all is well, rather than risk missing a child who does have a problem. Remember – early intervention is very important for children with communication difficulties. You do not have to wait until you think your child should be talking to contact a therapist if you have concerns about their communication.
• Have a look at the links on this website for addresses of organizations which might be able to help you and provide more information.