Features

SLCN - communication breakdown

05 June 2018

Many children with speech and language difficulties are slipping through the net, writes journalist John Windell.

Communication Breakdown

A recent report from the children’s charity I CAN and the Royal College of Speech and Language Therapists (RCSLT) has found that thousands of children and young people with speech, language and communication needs (SLCN) in England are not getting the support and treatment they need.

As reported in the last issue of Community Practitioner, the findings in Bercow: ten years on (I CAN and RCSLT, 2018) revisit the original Bercow report chaired by House of Commons speaker John Bercow (I CAN and RCSLT, 2008), which highlighted the importance of identifying SLCN early and the need for a joined-up response. It also found that services, which are provided locally across England, were inconsistent.

The new report, drawing on the views and experiences of 2500 parents and carers, children and young people, practitioners, employers and commissioners, says that while SLCN among children and young people is now more widely recognised, budget cuts and poor planning mean services are as variable as ever. ‘It is a bit of a lottery,’ says Mary Hartshorne, evidence manager at I CAN. ‘Some areas are fantastic, but others not at all.’

 

The problem

Bercow: ten years on concludes that strategic approaches to supporting SLCN in England are rare, and too many children and young people with SLCN are still being missed. However, it had praise for the national strategic approach in Scotland, where the government committed to a communication summit with the RCSLT. As a result, the deputy first minister and cabinet secretary for education and skills called for an action plan for systemic change and growth of the country’s SLCN assets.

Children’s SLCN are sometimes linked to other conditions, such as autism, dyslexia and hearing problems, but these account for only 2.3% of cases (Norbury et al, 2016). Another 7.6% have what has recently become known as developmental language disorder, which is a purely behavioural condition (Norbury et al, 2016). SLCN also takes in more routine conditions, such as stammering. Overall, SLCN are among the most common childhood disorders – the estimated number in the UK with SLCN is 1.4 million, which equates to nearly 10% of all children and young people (Norbury et al, 2016). It is often worse in socially and economically deprived areas, where up to 50% of children can start school with poor language and communication skills and related difficulties (Law et al, 2011; Locke et al, 2002).

‘If children are very quiet or their behaviour starts to worsen, that is a warning sign’ 

Why is language and communication so vital to children’s development? ‘Plenty of evidence and statistics show the impact on learning,’ says Kamini Gadhok, chief executive officer of the Royal College of Speech and Language Therapists. ‘For example, at the end of primary school only 15% of children with SLCN achieve the standard for reading and maths, while for other children it is 61%. That is significant.’

SLCN are also strongly linked to other issues. For example, over 80% of children with emotional and behavioural disorders have language difficulties as well (Hollo et al, 2014). ‘We also know that children who refer to mental health services are three times more likely to have speech and language difficulties,’ says Kamini.

What’s more, their SLCN will continue to affect their lives well beyond childhood: those with language difficulties are twice as likely to be unemployed as adults (Law et al, 2009), while 60% of young offenders have poor vocabulary skills (Bryan et al, 2007).

 

Early warning signs

So by the time they reach adolescence it’s often too late for many of those with SLCN. This means the time to identify their difficulties and support them is when they are still young, before they even get to school. According to the report, early intervention gives children the best chance of overcoming their difficulties. It is also the most cost-effective approach.

‘The critical time is before they are two to two-and-a-half years old,’ says Kamini. ‘At this stage, you should be looking for non-verbal development as well as verbal. Babies give eye contact and start to babble very early on. An early red flag is a child’s inability to gesture. Even when pre-verbal, most children are pointing at things. These are all precursors to words.’

It pays to be observant because children with SLCN are usually the ones who don’t call much attention to themselves. ‘We often talk about children’s SLCN as a hidden disability because they don’t stand out,’ says Mary at I CAN. ‘They might look the same as other children, but they can really struggle in the early years. I think there is a perception that children just learn to talk and don’t really need to be supported in the same way they would for reading or other skills.’

Kamini agrees: ‘It is often the quiet child who disappears into the corner. We have to look out for these children. For example, if they are very quiet or their behaviour starts to worsen, that needs to be seen as a warning sign and a prompt to investigate the underlying cause.’

The key is to understand what good communication looks like at the different stages of a child’s development and to use that to pick up the early indications of any problems. ‘It’s particularly vital that the early years workforce helps to identify any difficulties as quickly as possible,’ she adds.

 

A new approach

Among the report’s recommendations is for a systematic approach to the issue, locally and nationally, that uses proven methods of identifying and supporting children and young people with SLCN. Community practitioners have a major part to play in any system, though in terms of how it currently works, the gap between the SCLN demands and their ability to meet them is large.

For example, Bercow: ten years on shows that while 74% of health visitors have seen a rise in the number of children with SLCN, around 2000 posts have been lost since local authorities became responsible for health visiting. In addition, changes to the Healthy Child Programme mean that health visitors do not always include checks for SLCN during the early years.

To remedy this, the report calls on Public Health England to reinforce the speech, language and communication elements of the Healthy Child Programme, and to develop training for health visitors on how to identify and support SLCN.

‘Community practitioners do valuable work, but they are also under a lot of pressure,’ says Kamini. ‘How can we be constructive and think of solutions for children who need help, especially in deprived areas?

‘Another red flag is when children are excluded from school. These children should be followed up as they might never have been referred, and so a speech and language therapist wouldn’t necessarily know about them. If any child is having behaviour problems, it’s about asking what has created that, is there an underlying SLCN that hasn’t been identified?’

Mary believes that while Bercow: ten years on pushes for systemic change, community practitioners can help in the meantime simply by pointing parents in the right direction. ‘A lot of parents told us they just didn’t know where to begin, but there are lots of practical sources out there’ (see Resources, below).

Kamini agrees that community practitioners have a role to play, but accepts there are limits: ‘Speech and language therapists often work very closely with nurseries and early years settings, so it isn’t just about relying on the health visitors.’ 

 


Resources

  • The full Bercow: ten years on report and resources for practitioners and parents bercow10yearson.com
  • I CAN is the children’s communication charity, and its website offers lots of information and support. It also runs an enquiry service for parents and practitioners ican.org.uk or 020 7843 2544
  • Accessible information for parents, HVs, GPs and teachers on children’s SLCN talkingpoint.org.uk
  • Royal College of Speech & Language Therapists rcslt.org

 

Picture Credit | iStock

 


 

References

Bryan K, Freer J, Furlong C. (2007) Preliminary study of the prevalence of speech and language difficulties in young offenders. International Journal of Language and Communication Disorders 39(3): 391-400.

Department for Education. (2017) Early years foundation stage results: 2016 to 2017. See: gov.uk/government/statistics/early-years-foundation-stage-profile-results-2016-to-2017 (accessed 4 May 2018).

Department for Education. (2017) National curriculum assessments: key stage 2, 2017 (revised). See: gov.uk/government/statistics/national-curriculum-assessments-key-stage-2-2017-revised (accessed 4 May 2018).

Department for Education. (2018) Revised GCSE and equivalent results in England: 2016 to 2017. See: gov.uk/government/statistics/revised-gcse-and-equivalent-results-in-england-2016-to-2017 (accessed 4 May 2018).

Hollo A, Wehby JH, Oliver RM. (2014) Unidentified language deficits in children with emotional and behavioral disorders: a meta-analysis. Exceptional Children 80(2): 169-86.

I CAN and Royal College of Speech and Language Therapists. (2018) Bercow: ten years on: an independent review of provision for children and young people with speech, language and communication needs in England. See: bercow10yearson.com (accessed 4 May 2018).

I CAN and Royal College of Speech and Language Therapists. (2008) The Bercow report: a review of services for children and young People (0-19) with speech, language and communication needs. See: webarchive.nationalarchives.gov.uk/20130321050419/https://www.education.gov.uk/publications/eOrderingDownload/Bercow-Report.pdf (accessed 9 May 2018).

Law J, McBean K, Rush R. (2011) Communication skills in a population of primary school-aged children raised in an area of pronounced social disadvantage. International Journal of Language and Communication Disorders 46(6): 657-64.

Law J, Rush R, Schoon I, Parsons S. (2009) Modelling developmental language difficulties from school entry into adulthood: literacy, mental health, and employment outcomes. Journal of Speech, Language and Hearing Research 52(6): 1401-16.

Locke A, Ginsborg J, Peers I. (2002) Development and disadvantage: implications for early years and beyond. International Journal of Language and Communication Disorders 37(1): 3-15.

Norbury CF, Gooch D, Wray C, Baird G, Charman T, Simono E, Vamvakas A, Pickles A. (2016) The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry 57(11): 1247-57.

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