Frequently asked questions
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Speech and language therapy
Terms associated with special educational needs (SEN)
When Afasic was set up in 1968, it was called The Association for all Speech-Impaired Children, or A.F.A.S.I.C for short. The acronym seemed particularly apposite because children with speech and language impairments were at that time often described as being aphasic or having aphasia (or dysphasia). The term aphasia is derived from Greek and means ‘lacking speech’ or, in the case of dysphasia, ‘lacking proper speech’. The terms aphasic and dysphasic were first, and are still, used to describe people who have impaired speech and language as a result of an illness such as a stroke or accident involving severe head injury.
The same terms were then also used to describe children with developmental speech and language impairments, whose speech in many ways resembled that of people with acquired dysphasia. Nowadays, most practitioners make a clear distinction between people with a developmental (innate) disorder, and those whose impairment is acquired. Generally, the term ‘speech and language impairment’ is used for children with developmental difficulties, but some paediatricians still talk about ‘developmental dysphasia’.
Some professionals do seem to use these terms interchangeably to mean the same thing. Others will use just one of these terms for any type of speech or language difficulty. However, many speech and language therapists make a clear distinction between the three terms which parents often find helpful. Where the distinction is made, speech refers to the ability to articulate the sounds that make up language (‘b’, ‘w’, ‘sh’ etc.) clearly and accurately. Language is about understanding and using words and putting
them together to make meaningful sentences and larger chunks of language.
Communication refers to the appropriate use of language to facilitate effective interaction between people. Many people with communication difficulties have poor non-verbal communication skills, as well as difficulty with communication through language.
This means having a difficulty with one or more aspects of speech and/or language.
Where a child’s difficulties are solely with speech or language, this is generally described as a primary and specific speech and/or language impairment or specific speech and/or language impairment. Specific in this context means that the difficulties are confined to speech and/or language. Where a speech and language impairment is associated with other problems such as intellectual or physical disability, hearing loss, emotional problems or social deprivation it is often described as a secondary speech and/or language impairment.
Strictly speaking, a delay means that children are learning to talk normally, but at a much slower rate than other children, whereas a disorder means that speech or language is developing in an unusual or abnormal way. Having said that, some professionals do not make a clear distinction between speech and language delay and disorder, while others use the term delay
to describe any type of speech and language difficulty.
It should be noted that in some cases, especially where very young children are concerned, it can be impossible to be sure if a language difficulty is a delay or a disorder. In this situation, the term specific speech and/or language impairment might be used as a handy ‘catch-all’. However, some professionals use the term specific speech or language impairment exclusively to refer to a speech or language disorder.
Receptive language means the ability to understand or comprehend language heard or read. Expressive language means being able to put thoughts into words and sentences, in a way that makes sense and is grammatically accurate. If children have a speech and language impairment, it might affect their expressive language or their receptive language, or both, to a greater or lesser degree.
The Afasic glossary sheets nos. 5-27 describe a range of specific speech and language impairments, and a number of other conditions that impact on the development of speech and language impairment.
Speech and Language Therapy
Speech and language therapy is an intervention service for children and young people (and adults) with communication difficulties, (and also eating and drinking difficulties). The aim of therapy is to enable children and young people to reach their fullest potential in terms of their speech, language and communication development, which in turn will enable them to function and participate more fully in all aspects of daily life.
It is sometimes mistakenly thought that speech and language therapy is only for children with articulation difficulties or conditions such as a stammer. In fact, speech and language therapy can benefit children and young people with all types of speech, language or communication impairment, including difficulties with understanding language or maintaining conversations.
Speech and language therapists are trained to diagnose and treat speech, language and communication impairments in children or adults, though the majority work with children. Practising speech and language therapists must have qualified by studying an accredited course at a university or other higher education institution, and must be registered with the Health Professions Council. Most speech and language therapists work for the NHS, in local trusts, but some work privately and a few work in hospitals or special schools.
Children can be referred by:
- Their parents or carer
- Their health visitor or GP
- Their school
Professionals should seek the permission of the child’s parents before making a referral.
Terms associated with special educational needs (SEN)
Children have special educational needs if they have a learning difficulty or disability which means that they need educational provision that is additional to, or different from, the educational provision that is generally available in local mainstream schools. Children below 5 are also considered to have SEN if they either:
- Already need support that it is additional to, or different from, the provision generally available in mainstream nurseries
- Would need extra support or different provision at school if they did not receive it sooner
It is thought that up to 1 in 5 children has SEN at some point during their time at school. As a speech and language impairment usually makes it harder for children to learn and to interact effectively with other children and adults (which is a fundamental part of school life), most children with speech and language impairments would be considered to have SEN.
In Scotland, the term additional support needs (ASN) has replaced the term special educational needs. The principal difference is that ASN is not confined to children whose need for special attention arises from a disability or learning difficulty but could result from a range of factors e.g. having been in hospital a long time, or been traumatised by the death of a close family member.
Children with SEN are described as receiving support through School Action if the special provision they receive is provided from within the school’s own resources. This might include:
- The implementation of a programme of special strategies
- Additional training for staff
- The use of specialised learning materials or equipment
- Some small group work
- Some individual support, perhaps from a learning support assistant
Parents should be always be consulted and kept fully informed about any decision that their child has SEN, what action is taken to support their child, and the outcomes of that action.
Where a child attends a state-funded early years setting (pre-school or nursery) the term Early Years Action is used rather than School Action.
When children receive support through School Action Plus, outside specialists work closely with the school in assessing the children’s needs and progress, drawing up an individualised programme for them, and possibly providing support directly. In the case of a child with speech and language impairments, the specialists most likely to be involved are one or more of the following:
- Speech and language therapist
- Advisory teacher of children with speech and language impairments
- Educational Psychologist
As with School Action, parents should be fully informed and consulted about their child’s progress and the support they receive.
Where a child attends a state-funded early years setting (pre-school or nursery) the term Early Years Action Plus is used rather than School Action Plus.
In Northern Ireland, there are three school-based stages of support.
- At Stage 1, teachers identify and register a child’s SEN and, consulting the school’s SEN Co-ordinator, take initial action.
- At Stage 2, the SENCO takes lead responsibility for collecting and recording information and for co-ordinating the child’s SEN, working with the child’s teachers
- At Stage 3, the teachers and SENCO are supported by specialists from outside the school
Parents should be fully informed and consulted at all stages of the process. State-funded pre-school settings (nurseries, playgroups) should use the same stages as schools. Private nurseries and schools are not obliged to use the school-based stages, though they may choose to do so.
The new Code of Practice: Supporting Children’s Learning describes three school-based stages of support.
- Internal Support – support and/or planning provided from within the school’s own resources, although a multi-agency team might be involved in monitoring and reviewing the effectiveness of the support.
- External Support from within Education – support and/or planning provided from other education professionals not based within the school, e.g. educational psychologist or advisory teacher. As with internal support, a multi-disciplinary team might be involved in monitoring and reviewing the effectiveness of the support.
- External Support – Multi-agency – support and/or planning involving professionals working for other agencies, e.g. speech and language therapists. All professionals involved in delivering the support should also be involved in monitoring and reviewing its effectiveness. Parents should also be included in this process.
Schools and nurseries should draw up an IEP for all children identified as having SEN (or ASN in Scotland) detailing any support they should receive specifically to address their special needs. IEPS should be reviewed regularly, generally 2 – 3 times per year, and parents should be fully involved in the process of issuing and reviewing IEPs.
In Scotland IEP stands for Individualised Educational Programme rather than the English/Welsh Individual Education Plan. Apart from its name, however, it is a broadly similar document.
In N. Ireland the term Education Plan (EP) is used to mean much the same thing as IEP. The Code of Practice advises that children on stages 2 and 3 should have an EP, and it is generally considered good practice for schools to draw up EPs for children with statements as well.
A statement is a legal document issued by the local education authority (LEA) or Board (in N. Ireland) for children whose SEN cannot be met by the resources generally available to local mainstream schools. As few mainstream schools are able to access more than occasional speech and language therapy, children with speech and language impairments who need regular and ongoing therapy will in most cases be entitled to, and should have, the protection of a statement.
The statement should set out what a child’s SEN are, and what support the LEA/Board will provide to meet those needs. It is legally binding on the LEA/Board, and so carries far more force than IEPs (or EPs in N. Ireland), which are just internal working documents for schools.
Before drawing up a statement, the LEA/Board must first go through a process known as statutory assessment (q.v.). This is a legal requirement. There is no lower age limit for statements. Children as young as two and, in some cases younger, can have statements if their needs mean that they qualify. Statements do, however, cease when a child leaves school and LEAs/Boards may cease to maintain a statement sooner than that if they consider that the child no longer needs one.
In Scotland education authorities are required to draw up a similar document known as a Co-ordinated Support Plan (CSP) for children who have ongoing ASN arising from multiple or complex factors and who need support from other services as well as education. This should include many children with speech and language impairments, as speech and language therapy is
generally provided by the health service.
LEAs or Boards (in N. Ireland) must carry out a formal or statutory assessment of a child’s SEN, if it seems likely that his or her needs cannot be met by a local mainstream school from within their own resources. The statutory assessment process is designed to establish exactly what the child’s needs are and whether or not he or she requires a statement (q.v.).
In Scotland, EAs should also follow a formal assessment procedure to establish whether a child or young person requires a CSP and, if so, its contents.
If, after carrying out a statutory assessment (q.v.), the LEA/Board decide not to draft a statement (q.v.), they may issue a note in lieu, or, more fully, a note in lieu of a statement. A note in lieu may resemble a statement, setting out in some detail a child’s special educational needs and the support he or she should have. Unlike a statement, though, it has no legal force, and does not necessarily provide any additional funding to meet the child’s needs. Parents who are unhappy about the decision not to issue
a statement for their child have a right of appeal to the Tribunal (q.v.).
LEAs and Boards must review all statements of special educational needs (q.v.) at least annually (or every 6 months in the case of a child under five). The purpose of an annual review is to obtain and integrate a variety of perspectives on a child’s progress, to ensure that he or she is achieving the desired outcomes and, if necessary, to amend the statement to reflect newly identified needs and provision.
If the statement’s objectives have been achieved, the LEA/Board will in most cases conclude that they should
discontinue the statement. The annual review in year 9 is particularly important as it begins to prepare for the young person’s transition to further education, the world of work and adult life.
Similarly, in Scotland education authorities must formally review Co-ordinated Support Plans at least every 12 months to determine whether the child still needs a CSP and, if so, whether it needs to be amended.
The term transition can be used to mean any change in phases of education, e.g. from primary to secondary school, or from infants to juniors. It is often, however, used to refer specifically to the period from year 9 or about the age of 14 onwards, when preparations start to be made for the young person’s move from school and other children’s services to adult life.
England, Wales, N.Ireland and Scotland each have their own Tribunal, which hears appeals (or references in Scotland) from parents against education authorities’ decisions about issues relating to statutory assessment (q.v.), statements (q.v.) and co-ordinated support plans (q.v.). In England, Wales and N. Ireland, the Tribunal also hears claims of disability discrimination against schools.
Tribunals are independent bodies. Appeals or references are heard by a panel comprising a chair (or convener in Scotland) who is legally qualified and two members who have experience of SEN (or ASN in Scotland). The tribunals have a permanent location, where some hearings take place, but hearings are held at various locations around the country, and are arranged so that parents do not have to travel too far to attend a hearing. It is possible to claim travel expenses incurred in attending a hearing.
During the hearing, both sides are given the opportunity to present their case, and the panel will ask questions. Hearings are generally allocated half a day, and most are completed within this time. Some more complex cases, though, might take a whole day.
Appeals (or references in Scotland) to the Tribunal must be lodged within 2 months of the decision that is the subject of the appeal being made. The Tribunal’s decision is notified to both parties in writing about two weeks after the hearing. The decision is binding on both parents and education authority and must be implemented within certain time-scales that are set out in law.
A language unit, resource or base provides the specialised teaching and speech and language therapy that children with severe speech and language impairments need. A traditional unit caters typically for 8-10 children and is staffed by a specialist teacher, a skilled learning support assistant and a speech and language therapist who provides the intensive therapy the children need.
In recent years, however, language units have become more diverse, often varying considerably in their levels of staffing, the number of children they cater for and the amount of time children spend in the unit. Language units aim wherever possible to enable children to progress to a mainstream school with or without support as required.
Some children, however, need to attend language units throughout their time at school, and others might go on to special schools for children with speech and language impairments, or other types of special school, if their diagnosis or learning profile changes.
Disability Living Allowance (DLA) is a social security benefit designed to help pay for the extra costs that having a disability entails. It is not means-tested and can be claimed by both adults and children. In the case of children, parents are generally responsible for applying for the benefit and receiving the payments.
A significant speech and language impairment is a sufficiently severe disability to qualify for DLA. However, demonstrating this on an application form is not necessarily straightforward. So Afasic has published a leaflet to guide parents through the application process, called Claiming benefits for children with speech and language impairments.