Apologies for taking a whole month’s break from writing blog posts: four kids and returning to work is HARD!

I was invited into a long conversation with some fellow SLTs on Twitter earlier today that I HAD to share on the topic of Language Disorders and therapy.

Now I know the consensus for providing direct Speech & Language Therapy is a huge postcode lottery in the UK and I know that parents are often ‘fobbed off’ with arguments from their local services as to why their child’s Speech, Language and Communication needs would be best met at school via a Teaching Assistant HOWEVER the evidence base is building strength against this argument.

Earlier today Dr Susan Ebbels shared a link to an article she and four other colleagues wrote under the title Evidence-based pathways to intervention for children with language disorders. To access the article for free go to: https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12387.

The authors make reference to “Important ‘red flags’ in the pre-school period [that] are listed in Bishop et al. (2016) based on those in Visser-Bochane et al. (2017) and are repeated here for ease of reference:

  • 1–2 years: no babbling, not responding to speech and/or sounds, no interaction;
  • 2–3 years: minimal interaction, no display of intention to communicate, no words, minimal reaction to spoken language, regression or stalling of language development; and
  • 3–4 years: at most two-word utterances (in their first language), child does not understand simple commands, close relatives cannot understand much of child’s speech.

Children with any of these red flags should be referred for an SLT assessment.“

Further, the authors describe the 3 Tiers that Speech & Language Therapists work in:

(Tier 1) Awareness raising and public engagement.

(Tier 2) Advice, support, training and coaching for parents and professionals working with children at risk of or failing to make expected progress.

(Tier 3) Individualised direct or indirect intervention for children with severe and persisting language disorders.

In conclusion the authors state “The evidence indicates that children with complex and pervasive language disorders and those with additional complex needs require the specialist skills of SLTs at Tier 3 in order to make progress. SLTs need to have adequate time to work directly with these children, and collaboratively with their families and educators, to improve their skills and reduce the functional impact of their language disorder. Thus, we argue that Tier 3 is the core part of our service, while acknowledging that we also have roles supporting schools, pre-schools, families and communities at Tiers 1 and 2, particularly via close, collaborative working relationships with all those who work with and care for children.”

As discussed on Twitter it is important to acknowledge that often the treating SLT does not have the option to recommend a therapy approach (ie direct vs indirect) and a dosage (ie one introduction session vs weekly sessions) as these are typically determined by local service clinical pathways (that are determined not only by evidence based practise but also by how much provision is physically available due to cuts across the service) however it is also important to consider Dr Ebbels below tweet:

Therefore, in these times of service cuts, surely the most ethical way of writing recommendations would be to be honest and write: “Jimmy has a severe language disorder and requires ‘30 minutes’ of direct speech and language therapy twice per week in school. Unfortunately our service can only provide ‘30 minutes’ of direct speech and language therapy twice per term in school”.

As ever comments are welcome!