Individualised programs

Speech pathologists usually begin working with a child by doing an assessment before planning a program and beginning therapy. Sometimes parents ask why this is necessary. Why not just jump in and get going with "fixing things".

Communication is a very individualized skill and every child is different.

A detailed assessment allows a speech pathologist to determine what skills the child has, what they need to develop and what strategies are likely to be most effective in teaching those skills.

Communication is a skill that has a major impact on a child's daily life and social interactions. A program needs to take into account how the child communicates in other settings and how the child's difficulties effect a child's ability to cope in different settings as well as what things in a child's life can support the child's communication development.

Toddlers often come to a speech pathologist because they are not using many words. Before planning a program and beginning therapy there are many questions that need to be answered such as:

What words can the child say? Most children begin by saying the words they have heard most often such as "mum", "dad", "drink", "car" or words that are useful when communicating such as "no". Children with a speech disorder may have a preference for words with certain sounds that they find easier to say, such as "mum", "moon", "more" but they may not be able to say "car" or "drink" because those sounds are harder for them to say. These children need a different approach to a child who has a range of words with different sounds, even though both children may have ten words that they can say. Another child may have an unusual collection of words such as "Bunnings" "exit" and "spongebob" but may not use commonly expected words and this may indicate the need for further assessment or a different approach.

How does the child say the words? Are the words produced clearly or are they hard for strangers or even parents to understand? Are the words said the same way each time the child says them, or do they have different ways of saying the same word. A child may say the word "cat" as "tat" consistently. Another child may say "ca" on one attempt and "ta", "at" ,"da" or "tat" on different attempts. A child may say the word more clearly when they are copying an adult than when they say the word on their own, or they may say a word clearly by itself, but less clearly when they put it with another word or phrase. All these things are important in planning a therapy program.

How do they use the words that they can say? Do they use words to name things they see, ask for things they want, greet people, comment on things they see? Or do they only say words out of context, for no particular reason, or do they only say a word when they are copying someone else?

What words can they understand? A child who understands many words but can only say a few needs a very different program to a child who cannot understand or use many words. For this reason the speech pathologist will assess the child's comprehension as well as the words that they can say.

How else can the child communicate? Again a child who cannot say many words but can communicate effectively with gestures, pointing and facial expressions is very different from a child who has no way of communicating effectively (except perhaps through crying or tantrums). While both children need support, the program provided will be quite different.

Preschoolers and older children also need a comprehensive assessment in order to develop the most effective program.

Assessments for older children may include:

Gathering information from parents and teachers about their concerns and the child's strengths and weaknesses.

Assessing use of speech sounds. This includes testing each sound in the beginning, middle and ends of words, as well as listening to the child's speech in conversation and talking to others about how easily they can understand the child's speech. Sounds not used by the child are then further tested to see what type of support the child needs to make the sound correctly. The pattern of sounds and sound errors can then be analysed to plan the most effective way to improve the child's speech and make them easier to understand in the quickest way possible.

Assessing language skills including understanding and use of language, as well as vocabulary, grammar, sentence structure, ability to follow instructions, understand concepts and answer questions. For older children this may include the ability to form larger language units such as stories. Children with comprehension problems need different support to those who understand well but have difficulties with using language. Children who have limited vocabulary and don't understand concepts need a different program to those that only have problems with grammar.

Assessing literacy skills including awareness of sounds and sound patterns when spelling and the child's abilities with written language such as using grammar in forming sentences and constructing larger pieces of writing such as stories. Language and literacy are closely linked and both need to be considered when developing a program to help a child who is struggling with reading and writing.

Other factors which also impact on developing a program include:

  • Characteristics about the child such as interests, attention span and personality
  • Any other diagnosis, learning or developmental issues, health or hearing issues.
  • Characteristics about the parents and family including skill level, work and family committments and time available.
  • Other environments that the child communicates in such as school, preschool or child care and the level and type of support available

A speech pathologist will gather this information by speaking with the parent, observing and assessing the child and gathering information from other sources such as teachers or child care workers. They will then prepare a program to target the child's individual needs in a way that is effective for the child but also fits with the concerns, needs, skills and commitments of the family. An individualized program based on a comprehensive assessment is the most effective way to make sure that the child is getting the help that they need for their specific skills, needs and circumstances. A program which involves the parent in supporting the child in way that takes into account the families needs, time and skills is most effective in helping a child to learn and develop.

If you are concerned about your child's communication skills a detailed assessment and an individualized program suited to you and your child's needs will help your child to reach their potential. To see how a speech pathologist can help your child browse our website or contact a speech pathologist in your area. Research has shown that early intervention is most effective so don't wait to act if you are concerned.

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