Speech and Language Therapy - Children

We support children from birth to 19 years old who have an identified or suspected speech, language and communication need. This includes:

• Speech
• Language
• Stammering
• Voice
• Eating, drinking and swallowing

These difficulties could be, but are not always, associated with: 

• Mild, moderate or severe learning disability
• Developmental delay
• Physical disabilities
• Hearing impairment
• Cleft palate
• Autism
• Head injury
• Degenerative conditions

Our team is based at Peasley Cross but we offer services in a number of different locations including:

• Clinics
• Nurseries
• Mainstream schools
• Specialist units attached to mainstream schools
• Special schools
• Homes
• Specialist early years providers
• Specialist care providers

We have an open referral process, this means that anyone can refer to the speech and language therapy service.

This may include professionals working with the child or young person, parents or carers, GPs or education staff.  Education, health and social care professionals must gain parental consent for the referral and complete the service referral form.

Parents who have concerns about their child's communication skills can make a referral by phoning 01744 415 609. Referrals are received and processed at Speech and Language Therapy, Birch Unit, Peasley Cross Hospital, Marshall Cross Road, St Helens, WA9 3DE.

Once a referral is received, parents/carers will receive a letter to confirm that the referral has been received. This letter will also ask you to contact the department to confirm that you still need an appointment for your child/young person. If there is no response within 10 working days, your child/young person will be discharged from the service.

The service has a waiting list for first appointments and all children are seen within 18 weeks of referral.
There is no cost to use the Speech and Language Therapy service.

When your referral is accepted by the service, we will contact you to offer an initial assessment with one of our speech and language therapists. 

At the appointment, we will:

• Discuss your history and gather information 
• Carry out an assessment with one of our speech and language therapists
• Discuss a diagnosis or description of needs. 

Following the assessment, advice will be provided and, if appropriate, children will receive support from our team. This may be directly from the speech and language therapist or indirectly through advice/training provided to the parent or professional working with the child.

What are attention and listening skills?

• They are the foundation for learning and understanding language. 

• Attention involves concentration on a given task. 

• Listening is an ‘active’ process and information is processed.

What do attention and listening difficulties look like?

A child may be showing the following:

• Difficulty sitting still

• Appears to ignore you

• Talking when they should be listening

• Distracted by noises/easily distracted

• Difficulty moving attention from one task to another

• Does not settle on one activity but flits between them

• Difficulty following more than one part instruction

What you can do to help 

• Get down to the child’s level 

• Call their name first—make sure they are looking at you 

• Go to a quieter room or try switching the TV off 

• Only introduce one activity at a time 

• Use gestures and objects as clues to gain attention and help your child understand 

• Use visuals such as timers, now/next boards and visual timetables

• Talk about what your child is doing, using short, simple sentences 

• Break down instructions into smaller parts 

• Repeat instructions if not understood first time

What are early communication skills?

• Attention and listening

• Eye contact

• Turn taking

• Play skills

• Imitation

• Understanding simple instructions with or without gestures

• Using single words/simple phrases

When to refer to the service

Refer to the service if your child:

• Flits from activity to activity

• Has limited eye contact

• Struggles to take turns

• Has limited non-verbal communication (for example pointing and gesture) and no verbal communication.

• Doesn't interact/play alongside others

Contact your health visitor regarding a referral to Chatterbox if your child is aged between two and three years old and:

• Has no verbal communication but communicates using gestures.

• Is not able to understand simple instructions.

What are receptive language difficulties?

Speech and language therapists use the word ‘receptive’ to describe understanding or comprehension of language. 

It involves understanding the words, sentences and meaning of what others say. 

Some children have difficulties with understanding and following language. This is called a ‘receptive language difficulty’. 

What do receptive language difficulties look like?

Receptive language difficulties can sometimes be the only difficulty that children present with or they can be secondary to other conditions. Speech and language therapists will use various formal and informal methods to assess a child’s language to identify areas of difficulty, as well as the impact of these on a child’s development. 

A child with receptive language difficulties may present with the following:

• Attention, listening and/ or memory difficulties

• Auditory processing difficulties (how the brain identifies and understands sound information)

• Difficulty following instructions and completing tasks within the classroom

• Difficulty understanding words at different levels i.e. the key words within a sentence

• Respond to questions with unrelated answers

• Difficulty understanding different concepts (words that depict features of an object or activity)

• Difficulty with inferential comprehension (the ability to understand things that are not concrete)

• Difficulty with semantic skills (the ability to understand the meaning of individual words, words together in a sentence and the relationship between words)

• Difficulty with grammar (the formation and structure of words and how they come together to create sentences)

What we offer

Our speech and language therapy service can provide specific therapy activities to increase a child’s understanding of language. 

Therapists will work with a child, along with their parents/carers and teachers, to create a programme that is individual to their needs and areas of difficulty. 

Therapy can be carried out using naturalistic approaches as well as direct focused intervention. 

Speech and language therapists work to provide a holistic approach to intervention by providing the most effective management. Intervention for receptive language difficulties may include:

• Assessment of language skills

• Individual or group therapy

• Intervention programmes with personalised targets

• Advice, support and strategies for parents, teachers and other professionals

• Visual aids to support understanding of language

• Environmental adjustments

• Universal and targeted training packages for schools.

What do expressive language difficulties look like?

• Child may have difficulties asking for things from adults and peers

• Over reliance on gesture, and other forms of non-verbal communication

• Little or no participation in simple conversations

• The child becomes frustrated when trying to speak to their peers (this may have an impact on behaviour)

• Has a limited vocabulary or more basic vocabulary compared to children of a similar age

• Uses non-specific vocabulary such as ‘this’ and ‘thing’

• Has difficulty re-telling a story

• Makes grammatical errors such as leaving out words and uses incomplete sentence structure

What we offer

Speech and language therapy can provide specific therapy activities to support a Child’s expressive language to develop. Therapists will work with a child, along with their parents/carers and teachers, to create a programme that is individual to their needs and areas of difficulty. Therapy can be carried out using naturalistic approaches as well as direct focused intervention. 

Speech and language therapists work to provide a holistic approach to intervention by providing the most effective management. Intervention may include:

• Assessment of language skills

• Intervention programmes with personalised targets

• Advice, support and strategies for parents, teachers and other professionals

• Visual aids to support understanding of language

• Environmental adjustments

• Universal and targeted training packages for schools

What do speech sound difficulties look like?

• Child uses a limited range of speech sounds

• Their speech is difficult to understand

• The child’s speech may only be understood by close members of family/friends

• Substituting one sound for another sound, for example using ‘g’ for ‘d’ as in ‘gog’ for ‘dog’

• Inconsistently substituting sounds for other sounds

• The child misses out certain sounds in their speech

• Uses predominantly one sound for most sounds, for example preferring ‘d’ and using this predominantly in their speech

What we offer

• Assessment of speech sound skills

• Be involved in setting personalised and specific targets

• Provide a programme for completion at home and in school

• Provide intervention as appropriate

What do social communication difficulties look like?

These can include but are not limited to:

• Limited eye contact 

• Limited use of non-verbal communication 

• Difficulties with pretend play

• More formal than expected use of language for the child’s age

• Difficulty with initiating conversations/interaction

• Difficulty seeing others points of view

What we offer

• Assessment

• Specific personalised target setting

• Advice to parents/carers and school settings

• Social stories and comic strip conversations can help children with social communication difficulties gain a greater understanding of social situations. You can find out more about social stories and comic strip conversations, and how to use them on the National Autistic Society website. The website also includes useful information on supporting children and young adults with social communication difficulties and autism.

What is stammering?

Between the ages of  two and five years old, it is normal for a child to repeat words and phrases, and hesitate with "um's" and "er's", when they are sorting out what to say next. We call this normal non-fluency.

However, about five in every hundred children stammer for a time when they are learning to talk. Many find it easier to talk fluently as they get older. Others continue to find talking difficult and often get stuck.

Stammering is mainly characterised by frequent repeating or prolonging of sounds or words (examples below). It can also affect an individual's thoughts, feelings and behaviour (such as their willingness to speak). 

Stammering varies in severity over time. It also varies across in different situations. 

Parents might report it, however professionals may not always hear it.

How it may present

Children who stammer may:

• repeat whole words, for example "and-and-and then I left"
• repeat single sounds or syllables, for example c-c-come h-h-here mu-mu-mummy"
• prolong or stretch sounds, for example "sssssssometimes I go out"
• block, where the mouth is in position, but no sound comes out
• look as though they are tensing up or pushing hard.
• try to physically push the word out by making other movements. e.g. stamping a foot, nodding their head, screwing up their eyes, tapping with their finger etc.
• do things because they are feeling self-conscious about stammering, e.g. looking down or away or covering their mouth
• breathe in an unusual way for example, hold their breath while speaking or take an exaggerated breath before speaking
• stop what they were saying half way through the sentence.

These examples vary from child to child - you may hear some or all of these when your child talks.

What we offer

If you child presents with a stammer, it would be useful to complete a referral to our service so that individual assessment, support and advice can be provided. The initial appointment is usually complete with parents only so that a detailed case history can be complete. Following this, a follow-up appointment will be arranged for the therapist to meet the child. This appointment often involves the therapist doing further assessments and perhaps a child interview (dependent on child's age and ability).

For younger children, a lot of the support involves manipulating the child's environment and equipping parents / teachers with the skills and strategies to support the child's fluency. 

For older children, the support may involve giving the child their own strategies to work on. The aim of therapy is to educate the child and parents about stammering, reduce any anxiety around stammering and help the child to communicate more confidently and fluently.

Useful links and further information

• British Stammering Association - provide advice for parents/professionals as well as contact details for private speech and language therapists.
• Michael Palin Centre - a specialist stammering clinic based in London, they offer a helpline and provide lots of useful information, advice and resources.
• Action for Stammering Children - a UK charity helping the 150,000 children and young people who stammer.

What are communication aids?

Communication aids are also referred to as augmentative and alternative communication devices. You may see this written as the acronym AAC.

This covers a large range of methods which support or replace speech. There are different types of devices: 

Unaided:

• gesture
• signing

Aided (low tech): paper based symbol systems:

• symbols
• charts with pictures, letters or words
• communication books

Aided (high tech): voice output communication aids where a device speaks for the child using pre-recorded messages when a symbol is pressed.  

• simple single message voice output devices
• applications that run on tablets and mobile phones
• complex dedicated communication devices including a range of access options such as joystick, switch and eye gaze. 

When is the use of a communication aid considered?

Communication aids are considered for children who have no speech or for those whose speech cannot be understood by others. There can be many reasons for this such as:  

• Cerebral palsy
• Learning disability
• Autism
• Stroke
• Head injury
• Voice difficulties

What we offer

• Assess the child's speech and language to find strengths and difficulties
• Gather information about the child from people who know them well such as family and school staff
• Set targets based on the child's current level of communication
• Demonstrate targets to school staff/ family
• Advise family and school staff on how to support communication aids
• Produce low tech symbols and communication books
• Referral to the AAC hub in the North West for trial of high tech communication aids
• Review progress and monitor targets.

Speaking two (or more) languages does not typically create a need for speech and language therapist intervention. However, many principles used in speech and language therapy can be used to support the development of language generally, particularly with those learning a second language. 

If a child is having difficulty across both/all languages then a speech and language therapy assessment should be considered.

The Children's Speech and Language Therapy Service in St Helens has an open referral system, which means that any person in the child's life can refer with permission from the child's legal guardian.

Our service can receive referrals from a wide range of sources, including:

• Parent(s)/carer(s)
• Teachers and teaching assistants
• Special educational needs coordinators (SENCo)
• Education services
• Nursery teachers
• GPs
• Paediatricians
• Health visitors
• Social workers.

To make a referral, please email: mcn-tr.sthelens-slt@nhs.net

If you have any queries or need any help when making a referral please call us on 01744 415 609.

Our Speech and Language Therapy Service offers a wide range of training relating to speech, language and communication needs.

More information about the training we offer can be found on our training page.

On this page we share links to resources that you may find useful.

General advice

• Afasic
• Ican
• Talking Point
• Literacy Trust
• The Communication Trust – Every child understood
• The Hanen Centre – Helping you help your children communicate

Specific areas 

• National Autistic Society
• Autism Education Trust
• Research Autism
• Downs Syndrome Association
• Auditory Verbal
• National Deaf Children's Society 
• Action for Stammering Children
• Cleft Lip and Palate Association (CLAPA)
• Communication matters
• British Stammering Association

Speech and language therapy - professional bodies 

• Royal College of Speech and Language Therapists
• HCPC – The Health and Care Professions Council

What is speech and language therapy?

Speech-language therapy is the therapeutic treatment of speech and language difficulties and disorders.
This therapy that helps to prevent, diagnose and/or rehabilitate an individual's speech and language difficulties.

What happens if my child needs speech and language therapy?

Speech and language therapy is provided through a consultative model and therapy input will be agreed according to your child's assessed needs.

We help family members and school staff to develop strategies that they can use to support the child's communication development in all aspects of home and school life.

In many cases the therapist will not work directly with your child but will focus on developing the skills of parents, teachers and carers to enrich the language environments, to encourage and develop talking and learning.

Pre-school and school aged children with speech and language difficulties at a level requiring speech and language therapy input will have an individual play/education plan written by their class teacher.

The speech and language therapist will provide input into this plan as required. This may be through advice on broad strategies or specific tasks to be rehearsed and practiced daily by parents and key workers.
The speech and language therapist will monitor the child's progress and adjust the programme to reflect your child's changing needs.

This approach to therapy will enable your child to develop communication in the most natural and meaningful way in their everyday environment.

How long will my child have speech and language therapy support for?

For many children speech and language therapy is not a cure, as they may have long term communication difficulties.

Children are usually discharged from our service when the therapist feels confident that the child is learning language skills in line with his/her general development and that the recommended environmental strategies to support communication are being used effectively.

The therapist will discuss the discharge process with parents and support staff and agree the procedure for re-assessment or further consultation as appropriate.

This will be confirmed in a written discharge report.

What can parents do?

• Talk to your child and name objects, people, and events in the everyday environment.
• Repeat your child's strings of sounds (for example dadadada or bababa) and add to them. Talk to your child during daily routine activities such as bath or mealtime and respond to his or her questions.
• Get down to your child's level when talking
• Follow your child's lead when playing. Introduce new vocabulary words during holidays and special activities such as outings to the zoo, the park, and so on
• Engage your child in singing, rhyming games, and nursery rhymes.
• Read with your child
• Model back the correct words without pressure for the child to correct themselves.

How will speech-language therapy benefit my child?

The benefit of speech-language therapy for children with communication difficulties are numerous, the main reasons are highlighted below:

• Your child will be easier to understand.
• It will be less frustrating interacting for both parent and child.
• Increased self-esteem.
• Reduction of parent's anxiety
• Better communication at school, resulting in better learning.
• Improved social relationships.

My child often doesn't seem to follow what I'm saying or asking him to do. How do I know if he has a problem with his understanding?

If a child doesn't seem to follow what you say or ask him to do, it could be due to a difficulty with hearing, understanding or attention.

The only way to know which difficulty, or combination of difficulties a child may have is to:

• Investigate if the child has any hearing difficulties, or has a history of ear infections or glue ear. Glue ear can affect the way a child hears speech sounds – some say it can be like listening to someone talking under water. As many as 25 per cent of children can experience some element of hearing loss at some stage due to glue ear or ear infections
• Assess a child's understanding of language to see if it is at a level expected for their age
• Assess a child's level of attention and listening. This is done by observation whilst the child is playing and/or during the assessment of understanding of language

My child can't say some words properly. How do I know if my child's speech errors need therapy or are just part of normal development?

All children make speech errors as they are learning how to talk. Most children tend to make the same types of errors and correct them at about the same ages. However some children don't seem to be able to correct their errors and some make speech errors that don't follow a normal pattern of speech development.

Some children also have speech disorders that are caused by neurological difficulties. Examples are dysarthria and verbal dyspraxia.

A speech and language therapist can assess your child's speech sound system and let you know if their errors are normal for their age or if they would benefit from speech therapy.

Why is early intervention so critical?

Emergent literacy instruction is most beneficial when it begins early in the preschool period because these difficulties are persistent and often affect children's further language and literacy learning throughout the school years. Promoting literacy development, however, is not confined to young children. Older children, particularly those with speech and language impairments, may be functioning in the emergent literacy stage and require intervention aimed at establishing and strengthening these skills that are essential to learning to read and write.

My child has literacy difficulties. Do speech and language therapists help children who are finding it difficult to read and write?

Speech and language therapists can help with phonological awareness skills (sound awareness), which are a pre-requisite for literacy development. Phonological Awareness consists of a child's ability to:

• Recognise and generate rhyme
• Manipulate sounds such as blending, segmenting and deleting sounds
• Segment words into syllables
• Identify the first, middle and last sounds in words

Research suggests a strong link between a child's phonological awareness skills and a child's potential reading development. Consequently the UK's National Curriculum's Literacy Strategy currently focuses on phonological awareness skills in the development of children's reading and writing. There is evidence to suggest that a few hours of phonological awareness training can increase a child's readiness to read by up to two years.

My child's Teacher says that she is disorganised at school, and her behaviour is beginning to be challenging. She says that she would like her to be referred for a speech and language therapy assessment. How can disorganisation and behaviour difficulties be linked to speech and language difficulties?

Behaviour is communication. Often children that are 'acting out' are doing it because they are frustrated. Frustration can be due to difficulties in understanding what is being said to them, and/or difficulties in being able to express their thoughts and feelings. It is actually quite common for children to appear 'naughty' in class when the reason they aren't following the teacher's instructions is simply because they haven't understood what they're being asked to do.

Children can also appear disorganised at school because they aren't sure what they should be doing, or what is expected of them in an activity. They may try and copy other children or simply give a few things a try to see if they can get it right. They may miss important information like knowing what books they need to take home with them, and what activities to do for homework.

My child doesn't seem to be talking the same as other children his age. Is he just a 'late talker' and will catch up in time?

Some children are 'late talkers' and do catch up with other children of their own age, but some don't. It really depends on the child and what type of talking difficulties he/she might be experiencing. If a child isn't communicating at a similar level to his/her peers, it is always best to have the child's communication assessed to see if there are any difficulties that can be helped.