Speech Sound Difficulties by Hannah Sullivan

Speech Sound Difficulties

This month we are thinking about speech sound difficulties.

Typical Development: As a Practice we often work with children who experience “speech sound difficulties”. This is a very broad term and is used to describe when a child has difficulty producing sounds. The degree to which a child can be affected can vary from mild difficulties affecting maybe one sound, to severe difficulties meaning the child has a high level of unintelligibility.

Typically children learn sounds by hearing them being used around them. Young babies will experiment with making different sounds and begin to string sounds together, we call this babble. A child’s speech sound system develops gradually with most children following a similar pattern of speech sound acquisition. They begin by learning easier sounds first e.g. “p, b, t, d” followed by more complex sounds such as “sh, ch, j, th, r”. Along the way they will also master the art of producing two or more sounds together, we call these clusters or blends (tr, sl, str).

Children gradually learn numerous sounds and how to organise them into words. Most children will make some mistakes as they learn to produce new words. Every sound has a different range of ages by which it should be used correctly. A child would be considered to have speech sound difficulties if they continue to have a problem producing sounds, which continues after the typical age of acquisition.

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Key Words

This month we have been thinking about ‘key words’.

These are sometimes called ‘information carrying words’ or ICWs. The concept was devised by Knowles and Masidlover (1978) and underpins the Derbyshire Language Scheme – an intervention programme often used by speech and language therapists to support children with delayed language.

As speech and language therapists we are often talking about ‘key words’ when it comes to assessing a child’s understanding of language – but what do we actually mean? And why do we work on them?

In simple terms a key word is a word that carries meaning within a sentence, most often in the form of an instruction. Many of the words that we use within a sentence are redundant. This is particularly true of the highly predictable world of a small child. For example, if everyone is going outside for playtime and the teacher holds up a child’s coat and says, “Put your coats on”, the child does not need to understand any of the words because they can see what is needed from the context. So, in this example, there are no key words as the meaning of the sentence is implied by the context and visual clues – all of the information the child needed to understand was available for them in the environment.

Of course instructions are not always given like this. Very often, particularly within a classroom setting, there will be other distractions, noises and more importantly choices or differences between tasks that a child is asked to do. The time of day, activity and context will all impact upon what is required of the child when following instructions given to them.

In order for a word to be ‘key’ it requires an element of choice e.g. with the following objects set up

Teddy Dolly Chair Table

When giving the instruction ‘put dolly on the chair’ there are 2 key words – dolly and chair

This is because the child would have to understand these words in order to accurately follow the instruction. They have a choice between picking the dolly or the teddy for the first key word and between the chair or the table for the second key word.

So at what point should children be developing these skills? As a general rule children are typically able to understand the following:

2 key words at 2 years

3 key words at 3 years

4 key words at 4 years

It’s important to be aware of the level at which we should pitch our instructions and what to expect of children of different ages and levels. It’s also important to bear in mind the situation in which you’re giving them and the concepts that may be involved e.g. using before, after, behind etc. as these may be things that the child does not yet understand.

So why work on them? Instructions are an ever present and integral part of a child’s life – particularly at school. Working on them allows us to support children in accessing the language of the classroom and to improve their understanding of the language we use – even if they don’t always want to follow them!

Look out for an upcoming blog focusing on instructions and concepts in more detail in the Autumn term!

Rachel Baker

Speech and Language Therapist



This month we are thinking about Makaton.

Makaton – what is it and why do we use it? Makaton is a language programme that uses signs and symbols to support communication. Unlike signed languages such as British Sign Language (BSL), Makaton is used alongside spoken language rather than instead of it. We use Makaton as an additional visual tool to support children and young people’s understanding of what is being said to them as well as their ability to effectively express themselves.

How do we use Makaton? Makaton is always used alongside spoken language, which means that we always speak as we sign. We do not sign every word that we speak and instead focus on the words that carry the most information – the key words. Take the sentence “the boy is running“, for example. As we are speaking this sentence, we would sign the words “boy” and “running” as these are the two words that carry the most information. Signing provides an extra visual “clue” and the child will begin to link the word they are hearing with the visual sign. They may then even begin to start using the signs themselves! Supporting children to use Makaton signs to communicate can be especially powerful for those who have difficulty communicating using spoken language alone.

Who do we use Makaton with? Here at Sarah Buckley Therapies we use Makaton with the children that we work with in schools and nurseries. But Makaton is not just limited to use with children in these settings! Almost every activity that we carry out throughout the day involves communication of some form or other, whether we are playing with friends, asking someone what they did at the weekend, or buying food from the supermarket. Makaton can be used in all these situations to support communication with children, young people and adults.

Have a go yourself! Below is a link to the Makaton Charity website where you can find out more information about Makaton.


Kate Saunders

Speech and Language Therapist

Research News

Lego Therapy MSc Project – Blog update

We are undertaking a Masters level research project at City University London. This project is a novel piece of research which looks at whether LEGO® Therapy can support children with language difficulties in repairing communication when it has broken down. Children with speech and language difficulties frequently experience communication breakdowns both in the classroom and in social settings. This may be that the child has not understood something or that the person they are speaking to has not understood him/her. Children who have a range of strategies to repair communication breakdowns are less likely to experience frustration and more likely to successfully clarify something they have not understood in the classroom.

LEGO® Therapy has historically been used with children on the Autistic Spectrum to develop social interaction skills. However, the nature of this therapy lends itself particularly well to developing a range of other language and communication skills, including developing communication repair strategies.

Check back later to find out the results of our research!

Caitlyn Chandler and Shelley Parkin

Attention and Listening Skills

This month we are thinking about attention and listening skills.

You’ve probably met a child like this. The one who can’t sit at the table at lunchtime and keeps running off to play with toys. The one who wriggles around on the carpet at story time. The one who is so engrossed in making a Lego car that he doesn’t answer when you call his name. Children like this all have something in common: they have difficulties with attention and listening.

When we think of a child with attention difficulties, we often think of that wriggly child who can’t sit still. But there’s a bit more to it than that. Attention skills typically develop through certain stages. A child that is younger than 4 years old will typically have something called single-channelled attention. This means they can only attend to one thing at a time. If you ask them a question when they are doing something else, like playing with a toy, they will not be able to answer! A child that is between 4 and 5 will typically start to show integrated attention. This means they can play a game and listen to someone talking, without needing to look up. Beyond 5 years, children typically demonstrate integrated attention for longer and longer periods.

Why does all this matter? It matters a lot to a child’s speech and language development. If a child’s attention and listening is delayed, they may not tune in to speech as much as a typically developing child. This may mean they miss out on all the input that is so important for speech and language learning.  It also matters a lot to how a child gets on at school. If a child does not have integrated attention, they can’t hear the teacher call them to carpet time when they’re playing a game with friends. They can’t hear the teacher ask them a question when they’re reading a book. Children like this might look as though they’re being ‘naughty’, and not doing what they are told. This is not true. They simply didn’t hear.

So what can we do to help? You can’t teach a child to have integrated attention! But you can support them to make the most of the attention skills that they DO have.

  • If a child is having difficulty with their speech or language, then a referral to speech and language therapy can help figure out whether attention difficulties are at the root of the problem.
  • If you think a child is still at the single channelled stage, you can help them by using gentle touch, calling their name, or moving into their field of vision when you want to talk to them.
  • Keep your instructions simple, and break long instructions down into chunks, e.g. ‘Where are your shoes? OK, great. Now let’s put them on’.
  • Check that the child has heard you and understood, by saying ‘What did I just ask you to do?’
  • If a child finds it difficult to maintain attention for long periods of time, you can help them by giving them a movement break, e.g. ‘We’re going to sit at the table for 5 minutes, then you can get down and jump on the trampoline.’
  • You can also use visuals, such as the timer on your phone, e.g. ‘You can run around for 2 more minutes. When my phone makes a funny noise, it will be time to sit down.’

You may also have heard talk of the term joint attention. This is a bit different! We will talk about joint attention in a later blog, so keep checking in.

Lucy Pollard

Speech and Language Therapist

Research News

Accurately repeating a sentence can be hard for children with language difficulties… Is this task more complex than we first thought?

Many researchers have noted that children with language impairment have great difficulty accurately repeating a spoken sentence that they have heard. Why is this? What exactly is the child required to do during this task? These are the questions that I am looking to investigate in my Master’s research project. This type of repetition task is called sentence repetition or sentence recall. It turns out that this task doesn’t just rely on a child’s ability to remember the sentence, but it also draws on his/her memory for language that they have already learnt. A child cannot repeat a sentence accurately if they haven’t learnt and stored the language previously! This is a useful tool for identifying children with language difficulties, however, there are still unanswered questions about what exactly this task is testing. A greater understanding of this task could help with early identification of language difficulties and is a simple, cost-effective way of screening children for any difficulties. I will have to see what the results suggest… watch this space!

Becky Harrison

Speech and Language Therapist

Research News

The team at SBT are committed to keeping up to date with current research related to all aspects of Speech and Language Therapy. Research keeps us up to date with new therapy approaches and helps us to do a better job in supporting children with speech, language and communication needs.

Some members of our team are currently participating in their own Masters research projects in association with City University, London. Watch this space to find out more. As always, we welcome any questions or comments!


What’s in a question?

This month, we are looking at the subject of questions- why are some questions trickier for our children to answer than others? The answer to this particular question is a subject studied in detail by Dr Marion Blank, a leading educator and researcher.

Marion Blank determined that there were four basic levels of questions typically used by teachers in the classroom, ranging from the simpler levels one and two, to the more abstract levels three and four.

Level one questions are the most basic, and usually ask your child to name a thing or an action that they can see or hear.

e.g. ‘What is that?’ or ‘What is he doing?

Level two questions still refer to subject matter that can be seen or heard by your child, but ask them to look a little more closely, e.g. ‘Who is that?’ ‘How many legs does it have?’ or ‘What shape is it?’

Level three questions now move away from what your child can see, and require the use of their thinking skills. The child can no longer rely on a picture for the answer, but instead needs to link the subject to what they know about the world, e.g. ‘What does ‘share’ mean? ‘What might the boy be saying to his friend?’ ‘What could be in the girl’s bag?’

Level four questions are the most abstract, and require your child to think carefully. They cannot see the answer in front of them, and must use reasoning, inference, prediction and problem-solving skills. ‘Why do people wear hats on sunny days?’ ‘How do you think Joe felt when the teacher asked him that question?’ ‘What will Sam do now instead?’

What you may notice is that level four questions sound like the kind of questions children are asked when they have misbehaved in some way. ‘Why did you do that?’ ‘How do you think Ravi feels?’ ‘What should you do next?’ If your child is not yet able to understand questions at this level, then they may not be able to provide with you with the answers you are expecting.

Children’s understanding of different question types develops over time along with their general language and learning. Children usually begin to answer Level four questions from the age of five to six years old- of course some children will develop this skill a little earlier or later than others.

What can we do to help our children develop this skill? The first thing we can do is give them some time to think! Children need a little bit more time than we do to think about what they’ve heard and plan their answer. Secondly, let’s link the answer to something they already know or something they have experienced. This will build their confidence and provide the scaffolding to learn new information.

One of the most useful tools to help your child understand questions is to ‘think aloud’. Let them hear how you worked out the answer! This way you are modeling the thinking process needed to reach the answer, and showing them how to link the information. For example, you ask a question such as ‘Why did Tom ride his bike to the shop?’ Now, talk through your thought process- ‘The shop is quite far from Tom’s house. It’s too far to walk. Riding a bike will be much quicker. Maybe that’s why Tom rode his bike’.

So, what’s in a question? Possibly more than we first thought!

Shelley Parkin

Speech and Language Therapist

Speech and Language Therapy ideas and advice

I am really pleased to introduce our speech and language therapy blog!

Every month, a member of the team will write an entry about one of the many speech, language and communication difficulties we work with. We are hoping to provide information, ideas and advice to help support children and young people to develop their communication.

Is there a specific area that you would like information about? If so, please let us know. Just leave a comment on our blog and we will add your topic to our list! We can’t give advice about individual cases, but we are more than happy to give general advice and top tips.