A Speech and Language Therapist (SALT) is qualified to work with children, young people and adults who have some form of communication disorder. It is often thought that a Speech and Language Therapist is only able to help with actual speech production problems, but in fact the range of services is much wider.

What does a Speech and Language Therapist do?

A therapist working with children and young people will initially assess both comprehension (understanding of language) and expressive language (how language is used).

Comprehension

The Therapist will look at various areas where difficulties might occur including:

* Vocabulary - types of words such as nouns (naming words), verbs (actions) and prepositions (in, on, under etc.)

* Understanding language structures such as following instructions - eg. "brush dolly's hair", "give me the yellow pencil"

Expressive Language

Spoken language may be assessed for the following:

* Speech sounds - often termed phonology. The child or young person may not have certain speech sounds in their vocabulary, or may use them inappropriately eg. "dog" becomes "dod" (termed fronting) or "glove" becomes "glub" (termed stopping)

* Articulation difficulties - the production of speech sounds may be difficult, possibly due to a physical problem such as cleft lip/palate or poor dentition or even a co-orindation problem - Dyspraxia

* Fluency - is there any evidence of dysfluency (stammering) or general hesitancy in speech

What can be done if the child/young person has little or no speech?

Language is not only the spoken word but can include communicating by various alternative methods. Some of the more common ways are:

* Symbol systems - a simple line drawing is used to represent an object or concept eg. Makaton, Rebus, Mayer Johnson

* Pictures/photo systems - actual pictures or photos are used to indicate objects, activities etc.

* Signing systems - include British Sign Language (BSL) and Makaton. These systems use manual signs to convey meaning

* Eye pointing - by using a special board with symbols or pictures, it is possible for a parent or carer to interpret what the child/young person wants to communicate by following their eye gaze until it stops at the item they want. This can be useful for children or young people who have physical difficulties and no speech.

* Communication aids - these can range from simple picture boards to complex computers with voice synthesizers

What other aspects of communication are assessed?

Other areas which Speech and Language Therapists might look at and which underpin communication are:

Listening and attention skills/concentration - can the child or young person attend to a task? Not to be confused with a hearing impairment - the child or young person may hear what is said but cannot concentrate sufficiently to process the information

Play and imagination - can the child play alone, alongside others (parallel play) or take part in group play? Is imaginative play present ? eg. putting doll to bed, pretend tea parties

Social communication - can the child or young person interact with others? Do they understand the rules of conversation, such as turn taking, repairing conversations, keeping on topic and appropriate greetings?

Functional use of language - can the child/young person use whatever system of communication is appropriate to them to make choices, comment on events, question or refuse?

Behaviour - an inability to communicate can be very frustrating for the child/young person and may result in agitated or challenging behaviour patterns.

How does the Speech and Language Therapist carry out the assessment?

The Speech and Language Therapist will look at all areas in which the child/young person is experiencing difficulty.

* This may include observation or direct working with them in various settings, such as the home, school or college.

* Liaison with people who come into frequent contact with the child/young person is also very important. As well as parents, teachers, carers, other health professionals etc. may be consulted.

What happens after assessment?

After a thorough assessment, therapy options are discussed which could include one or more of the following options:

- Direct therapy - the therapist working with the child/young person on a 1:1 basis

- Indirect therapy - a programme of work is carried out by a named person eg parent, carer, teaching assistant under the guidance of a Speech and Language Therapist who monitors progress and reviews the programme as necessary

- Changes to communicative environment eg. ensuring an appropriate symbols system is used in the home/classroom etc., advising on effective communication and training staff how to use alternative methods of communication

Is the Speech and Language Therapist qualified?

All Speech and Language Therapists will have undertaken a three or four year degree course at university. Some therapists may have completed a post graduate course after following a previous degree. Candidates require three A levels to enter the course, although mature students may be accepted with equivalent qualifications.

The courses are intensive and consist of both theoretical work and clinical placements and all students experience working with a wide range of communication disorders.

All practising therapists must be registered with the Royal College of Speech and Language Therapists (RCSLT) and the Health Professions Council (HPC). Therapists working in the Independent Sector may also be registered with the Association of Speech and Language Therapists in Independent Practice (ASLTIP).

You may be wondering if your child will have difficulty learning in school because she has had difficulty as a preschooler learning to talk and use language. You are wise to be wondering about this.

A child is at a higher risk of having difficulty learning reading, spelling, and written language if she has (or has had) trouble or difficulty:

• Learning to make speech sounds.
• Speaking as clearly as same-age peers.
• Learning grammar.
• Using vocabulary.
• Organizing what she wants to say.
• Saying what she means to say.

Is every such child going to have academic difficulty? No.

Though there isn't a 1:1 (one to one) correspondence between early speech-language difficulty and eventual academic learning, there is a high correlation between the two, and you are wise to watch more closely than you might for a child who didn't struggle with early speech-language skills. Make sure your child isn't just "passed along" in the early grades (Kindergarten, 1, 2, 3).

Why is there a correlation between these areas of skill development?

Research tells us that dyslexia (reading disorder or disability) derives from language disorder (also called Specific Language Impairment). It was previously believed that people who were dyslexic "saw words backwards" which suggested a visual perceptual impairment. This is not the case for most individuals. Rather than being a visual problem, dyslexia is a verbal or speech-language-based problem.

If a child's speech sound production ability is disordered because the phonological "rules" for sound production are not correct, then the ability to learn the sounds made by letters, the ability to sound out words, the ability to blend the sounds in a word can all be disrupted. Such a child would likely have difficulty spelling correctly, too, because a strong phonetic base would not have been established.

If a child has difficulty learning vocabulary or remembering specific words, if a child makes grammar errors, or if a child's thought processes are disorganized, then organizing thoughts to write down ideas can be very challenging. Learning to write correct sentences with good sequential ideas can be very difficult. This would result in a problem with written language.

What preventative steps can parents take? How can parents help?

First of all, I do recommend preschool for 3 and 4 year old children. Early exposure to learning readiness activities and early interactions with peers in a controlled play and learning environment are good preparation for kindergarten and future school experiences.

Later, as your child grows and develops, he may need extra opportunities to read and write with you. He may need to have a variety of experiences, such as multi-sensory experiences with letters and sounds. He may need to work with a reading or learning specialist in the early school years. Ask at school for an assessment, or seek a private assessment if you think your child is struggling but the school doesn't think there is a significant enough discrepancy in his skills. Why wait for extreme failure? By the second half of the kindergarten year or midyear in first grade, a learning specialist can test your child and identify any signs or symptoms of true learning difficulty.

Early identification is wise. Trust your instincts. Explore your child's learning needs early before he encounters failure.