Suffolk Community Healthcare Paediatric Speech and Language Therapy: guidelines for referral April 2014

PAEDIATRIC SPEECH AND LANGUAGE THERAPY SERVICE

GUIDELINES FOR REFERRERS

Please see enclosed tables for guidelines for referrals.

If you have the Welcomm screening tool please use this to aid your decision making.

  • We operate an open referral policy and children are offered an appointment within 18 weeks of receipt of the referral.
  • Parents consent must be obtained.
  • All children must be registered with a GP within Suffolk Community Healthcare or Thetford in Norfolk.
  • Referrals are screened by a Senior Speech and Language Therapist and will only be accepted when all necessary information is received (e.g. any reports from paediatrician, audiology, EAL service, Educational Psychologist). Please provide a detailed description of difficulties with examples whenever possible. If unsure please phone to speak to a therapist.
  • Once referrals are accepted parents/carersare sent information about how to book an appointment for an initial assessment which can take place in any of our clinics across Suffolk/Thetford (occasionally in school if this is appropriate/possible)
  • NB: If child is not talking in an educational setting but is at home, consider using the information on the Suffolk County Council website for reluctant talkers/selective mute
  • If a child is acquiring English as an additional language but their skills in their first language are age appropriate then there is no need to refer- use your EAL school team for advice.

Contact details and to request up to date referral form:

East Suffolk: West Suffolk/Thetford:

St Helen’s House Child Health centre

571 Foxhall Road Hospital Road

Ipswich Bury St. Edmunds

IP3 8LX IP33 3ND

01473 321225 01284 775081

WHEN TO REFER FOR FLUENCY DIFFICULTIES (STAMMERING)

Age
/ When to refer
2- 4 ½ years / Any/all of:
  • Significant parental anxiety
  • Awareness of dysfluency ( repetition of sounds and words; stretching sounds in words; getting stuck on sounds/words) by child
  • Family history of stammering
  • Associated body movements (Twitch, tension, flaps hands, eye blinking)

4½ + / Ongoing dysfluency

WHEN TO REFER FOR VOICE DIFFICULTIES

Age
/ When to refer
At any age / Persistent husky voice or Frequent loss of voice- referral to ENT first may be required

WHEN TO REFER FOR FEEDING DIFFICULTIES

When to refer / Example
Feeding difficulties at birth as a result of specific medical problems / Prematurity, Syndromes, Cerebral Palsy
Suspected aspiration (food/fluids entering airway) / Coughing/choking/respiratory distress during or after feeds; Recurrent chest infections
Significant oral motor difficulties associated with eating and chewing / Inability to chew; Tongue thrusting
Ongoing gagging on solid foods
(where normal Health Visitor advice has not alleviated difficulty) / Detailed discussion with parents is essential to rule out behavioural feeding.

WHEN TO REFER FOR SPEECH AND LANGUAGE DIFFICULTIES:

Please use the following tables as a guide along with your own assessment (e.g. Welcomm/SOGS/Speechlink)

AGE / UNDERSTANDING LANGUAGE- NORMAL DEVELOPMENT / SPOKEN LANGUAGE
NORMAL DEVELOPEMNT / SPEECH SOUNDS
NORMAL DEVELOPMENT / REFER IF:
12 - 18 months /
  • responds to name
  • responds to sounds
  • turn takes
  • enjoys peek-a-boo
/
  • laughs and coos
  • babbles e.g. makes repetitive noises (da, da, da, da)
/
  • not making any sounds- (consider a hearing test)
  • not babbling
  • not enjoying communication through eye contact, peek-a-boo, response to sound
  • not responding to own name

18 months – 2 years /
  • points to many common objects when asked
  • Understands 1-2 key words
/
  • can name approx 20 familiar objects when asked ‘what’s this?’
  • will be imitating parents’ words
/ Uses: m – n – p – b – t – d
Normal processes:
  1. making syllables in one word the same e.g. ‘bobo’ for ‘bottle’
  2. final consonant deletion e.g. ‘boa’ for ‘boat’, ‘ta’ for ‘tap’
  3. making sounds the same e.g. ‘gog’ for ‘dog’
/
  • not understanding simple words or selecting objects if asked, e.g. “Give me the cup”
  • does not pay sustained attention to an activity of their own choice
  • has very few or no words
  • poor social interaction
  • limited symbolic play
  • not using the listed range of sounds

2-2 ½ years /
  • understands 2 key words in a sentence e.g. ‘give the ball to teddy’
/
  • 50+ words and beginning to link words together
/ See above /
  • cannot get 2 items when asked – as above

2 ½ – 3 years /
  • understands simple instructions including words like ‘big / little’
  • understands functions of objects
/
  • combines 3+ words to form simple sentences e.g. ‘me want juice; mummy go shop’
  • beginning to ask questions e.g. ‘where’s mummy?
  • participates in rhymes and songs
  • a normal period of whole word / phrase repetition
/ Uses: m – n – p – b – t – d – k – g – w – h
Normalprocesses:
  1. consonant clusters reduced e.g. ‘poon’ for ‘spoon’
  2. long sounds still stopped e.g. ‘dun’ for ‘sun’
3. fronting ‘t/d’ replacing ‘k/g’
e.g. ‘tar’ for ‘car’ /
  • not following simple instructions e.g. “Give teddy a drink”
  • constantly echoing speech with little understanding
  • not putting 2-3 words together

AGE / UNDERSTANDING LANGUAGE-NORMAL DEVELOPMENT / SPOKEN LANGUAGE
NORMAL DEVELOPMENT / SPEECH SOUNDS
NORMAL DEVELOPMENT / REFER IF:
3-3 ½ years /
  • understands up to 3 key words e.g.: “put the spoon under the box”
/
  • puts 3-4 words together
  • starting to use sentences with small words such as “a, the”
/
  • F & s emerging
  • fronting still evident e.g. k & g to t &d
/
  • not putting 3 words together
  • speech is difficult to understand
  • not taking part in early conversations

3 ½- 4 years /
  • follows longer instructions containing different types of words e.g. ‘Put the teddy in the bag and give the doll to mummy’; ‘Put mummy’s new shoes in the wardrobe’
/
  • uses fairly complete sentences filling in the small words such as ‘a’ and ‘the’
  • uses word endings e.g. ‘ing’, plural ‘s’
  • links simple sentences with ‘and’
  • describes simple events
/ Uses: m – n – p – b – t – d – k – g – f – s – w – l – y – h
Normalprocesses:
  1. consonant clusters are still reduced
/
  • unable to follow longer instructions with two parts e.g. “Give me the plate and ball”
  • not understanding stories with pictures
  • not using sentences
  • speech is difficult to understand

4 – 5 years /
  • understands many questions e.g. ‘why?’
  • understands prepositions ‘behind / in front’ etc.
  • understands spoken instructions related to an activity without stopping what he is doing to look at the speaker
/
  • can hold a conversation with an adult
  • starting to master irregular nouns and verbs e.g. ‘mice, men, drank, fell’
  • can explain the meanings of simple words
/ Normalprocesses:
  1. s-clusters are developing- l / r clusters may still be reduced
  2. ‘th’ is substituted by ‘f’ e.g. ‘fank you’
  3. ‘r’ is substituted by ‘w’ e.g. ‘rabbit’ becomes ‘wabbit’
/
  • unable to use the speech sounds: k/g/s/sh or s blends
  • not understanding WH questions
  • not linking sentences in expression
  • may produce language unrelated to the topic
  • unable to retell a simple story

5- 7 years
(KS1) /
  • able to learn within the verbal setting of the classroom
  • able to learn and understand new vocabulary and concepts related to the curriculum
/
  • able to take part in discussions related to the curriculum
  • can hold a conversation.
  • some grammatical features are still incorrect: (e.g.: felled/buyed)
/ Occasional errors with complex clusters e.g. str, and some multisyllabic words.
‘r’, ‘th’ developing /
  • failure to access national curriculum in core subjects due to suspected language disorder
  • proven discrepancy between verbal and non verbal skills greater than 18 months
  • difficulty learning new vocabulary and concepts
  • difficulty recounting complex events
  • intelligibility is poor and not using ch, j,v, z, l. by age 7

AGE 8-19 YEARS

REFERRAL NOT NECESSARY / REFER TO SPEECH AND LANGUAGE THERAPY
  • The young person’s language abilities are in line with their other cognitive/learning abilities and their needs are able to be met through the curriculum
  • The young person does not wish to work on their communication difficulties
  • The young person is acquiring English as an additional language but their skills in their first language are age appropriate
/
  • There is a proven discrepancy where the young person’s comprehension and/or expressive language difficulties is significantly below the level of other non-verbal cognitive/learning skills or one area of language ability is significantly below other areas
  • Increasing demands of the curriculum have revealed difficulties with specific areas of language processing such as difficulty understanding concepts, difficulty processing lengthy instructions without visual support, difficulties with word finding (e.g.: young person struggles to select words)
  • Difficulty understanding humour or non-literal language
  • Young person’s speech difficulties are impacting on their self esteem and ability to make peer relationships and they are keen to work on their speech
  • Young person requires support with augmentative or alternative communication (AAC)

A service delivered on behalf of the NHS by Serco,
South Essex Partnership University NHS Foundation Trust
and Community Dental Services.