Issue 25, Page 16-17: Ask a Therapist: Profound speech difficulties

QUESTION: Where do we start with a child with profound speech difficulties?

ANSWER: It’s daunting when a pupil has such severe speech sound difficulties that you can’t understand what they are trying to say. It can be hard to build a rapport with that child; do you ask them what they got up to at the weekend or is it just putting you both in a difficult position when you then can’t decipher their response?

Some children’s speech sounds are so severe that they are diagnosed with Developmental Verbal Dyspraxia (DVD). This is when a child has trouble placing and co-ordinating the muscles in the precise positions needed to produce clear speech. The messages the brain sends to the muscles are affected and these children can be particularly challenging to work with as their speech can be quite unusual. They often have a ‘preferred sound’ they use lots of the time, and they make inconsistent errors, so their attempt at a word may vary each time they try it. These children are going to need lots of support.

So where do we begin with speech sound difficulties?

1) Ask the family for pointers – do they know which sounds the child struggles with and what they substitute instead? Are there any key functional words that we might be able to learn to recognise?

2) A home-school contact book is an oldie but a goodie! Record things that have happened at home and things from the school day that the child may be bursting to share.

3) Use pictures and symbols to indicate the most important functional things like needing the toilet, being hungry, thirsty, or feeling poorly.

4) Use some basic signs with the child and encourage them to use them too.

5) Select sounds to work on that are going to have the biggest impact. Your SaLT might be able to help with this! If the child can see they are improving, they will be more motivated.

6) Have a ‘speech book’ with key words for that child… practice these daily and reward with stickers!

7) Do lots of listening work and check the child can hear the difference between sounds. I love using my giant foam thumbs-up for this and letting them be the teacher by telling me if I am saying sounds or words right or wrong. Don’t underestimate the importance of the listening stages!

8) There are loads of cool tricks to help elicit particular sounds e.g., for ‘k’ try putting their finger on their tongue to depress it and encourage the tongue into the ‘back’ position that is required, or even try lying down flat on their back as gravity will help the tongue back!

9) Sequences of sounds. We roll my giant dice to select a vowel sound (V) and then add their target consonant (C) either before or after it – CV or VC. Try consonant sound sequences too.

10) Nonsense words are great as the child doesn’t already have (an incorrect) stored way of saying the word – bizarrely, for the same reason, brand new vocabulary can be easier too as they will be learning it correctly from the start!

11) Minimal Pair pictures are a great way for the child to realise that the word they said, sounded different for their listener e.g., key-tea.

12) Start with segmented words; they don’t need to be perfectly blended straight away. It’s more important that they get the sounds right and don’t insert any extra sounds.

13) A child won’t be able to correct their speech errors if they don’t realise they are making any. Gently support them to identify their errors and monitor their own speech more.

14) It takes time for a child to generalise a new sound into their everyday talking but if all involved know the target then we can support the child to begin to correct their own errors.

Top Tips

• Have rewards; bribery always motivates!
• Get on the move! I get the children finding items around the room or jumping on their target word or throwing a beanbag onto their word and saying it.
• Feelie bags containing items with sound are great or, if you can cope, hide items in glittery sand to find!
• Speech work can be done successfully in groups too; the children can share a joint activity but just have different target sounds or words.

A bit about me

I have been a SaLT for 20 years and have worked in the NHS in both Bradford and Ashford. Soon after having children, I decided to set up my own independent practice, Speech4Schools. We support over 50 schools across Kent with SLCN. I also run two clinics in Kent called Speech4Kids offering private assessment and therapy for children with a wide range of SLCN.

Get in touch at: sidonie@speech4schools.co.uk

Watch a wonderful before and after video of a delightful girl with DVD. I promise it will be the most uplifting thing you see all day! This is how much of a difference our speech work can make. https://m.youtube.com/watch?v=rP3QsNSLj-0