Speech and Language Therapy Service Redbridge
Notes for Guidance when completing a Speech and Language Therapy Referral form for a child.
______
Speech and Language Therapists work with children who have difficulties in the following areas:
Understanding Language – Refers to ability to follow verbal instructions in and out of context.
Expressive Language – Refers to child’s ability to express themselves via single words extending into full grammatical sentences.
Articulation – Child’s ability to physically produce and use all speech sounds to produce clear and intelligible words.
Fluency – Many children between the ages of 2 – 5 will go through stages of non-fluency often related to their growing language development. Most children will grow out of this after a few months however if parents express on-going concerns this would indicate the need to refer. A stammer which starts in an older child may need specific advice, a referral is strongly indicated.
Voice – children who present with persistent huskiness, hoarseness or loss of voice can benefit from speech and language therapy input. Children should be referred to an ENT prior to being seen by the speech and language therapy service.
Social Communication Difficulties – Refers to child’s ability to form social relationships and communicate appropriately to the situation.
Please see attached the typical pattern of speech and language development indicators or when to refer to the service.
Before referring, please remember to discuss the referral with your designated Speech and Language Therapist, who can provide pre-referral advice, as needed. Please note that referrals that have not been discussed may not be accepted.
You can also contact our main Speech and Language Therapy office on 0208 822 4116 or the Team Lead for Mainstream Schools on 0208 822 3215.
Age / Normal Development / Referral Criteria2 / Understanding
· Names of simple objects, daily actions
· Simple instructions eg go and get your coat and shoes
· Can find picture in a book on request
Expression
· First words
· Possible joining 2 words eg more drink, go car play
Play
· Simple pretend play eg feeding doll, brushing teddy
· Likes an object to represent another object eg uses a banana for phone
· Builds a simple tower
Sounds
· N,m,b,p,d,w,t used in babble and words
· May omit ends of words
· May repeat a syllable eg ‘bibi’ for biscuit / · No response to own name or common object name
· Initially to assess comprehension
· No pointing or waving ‘bye’ ‘bye’
· Little pretend play
· Few vocalisation
· Few or no words
2 ½ / Understanding
· Simple instructions
· Simple body parts eg hands, feet, nose
· Functions eg ‘where do you sleep’?
· Enjoys simple, familiar stories
Expression
· Increasing vocabulary eg words for objects, action names
· 2-3 word phrases eg daddy work, teddy gone
Play
· Accepts miniature toys as representing objects
· Pretend sequences acted out eg washes teddy and puts to bed
Sounds
· Speech sounds are consistent for objects named
· Still may not use ‘f’,’s’,’k’, ‘g’,’sh’,’ch’ / · Unable to follow simple instructions eg ‘brush teddy’;give mummy a kiss
· No words are joined together
· Only using a limited range of consonants eg overuse of ‘d’
· Is unintelligible to mother/close family
3 / Understanding
· Longer and more complex instructions, but not following every word
· Size – big/little
· Preposition in/on/under
· Objects by function eg which one barks?
Expression
· Simple phrases eg me go in daddy’s car
· Begins to use pronouns ‘me’, ‘you’, ‘he’
· May miss small words eg is, a , the
Play
· Usually matches colour
· Basic imaginative play eg, picnics, teddy, dolly
· Developing better concentration for puzzles, stories, game sounds
Sounds
· Words should have ends
· More sounds developing, still problems with ‘s,l,k,sh, ch’
· Should be understood by carers / · Struggles to follow instructions without cues eg pointing or copying others
· Only uses single words or learnt phrases
· Cannot attend longer than a few minutes
· Speech is not improving by 3 years
· Vowels are distorted
· No ‘kor ‘g’ at 3 ½ years old
· No final consonants used eg ta – tap
· Stammers/stutters
4 / Understanding
· Simple conversation
· Events being part of future
· ‘Wh’ questions – “What? Where? Who? Why”
· Colours
Expression
· Sentence now joined with ‘and’ ‘because’
· May still confuse pronouns and tenses
· Ask ‘when’ and ‘why’
Play
· Enjoys longer stories and imaginative play
· Co-operative play with other children eg plays doctors and nurses
Sounds
· Developing greater range of sounds
· May make errors with blends eg spoon=boon, blue=bue
· Difficulties with ‘l’ , ‘r’, ‘th’ are normal / · Cannot respond to conversation or gives ‘strange’ answers to questions
· Utterances are echoed or repetitive
· Struggles with basic concepts eg size, colour, shape
· Only using simple phrases of 3 or 4 words
· Not using ‘f’, ‘sh’ or ‘s’ at the beginning of words
· Stammers/stutters
5 / Understanding
· More detailed conversation
· Cause/effect (why/because)
· A wide range of concepts
Expression
· Long and appropriate utterances
· Some errors still made with grammar e.g. irregular plus/past tense e.g. mouses, felled , catched
Sounds
· Residual sound errors remain eg ‘r’, ‘l’ consonant blends
· Intelligibility can deteriorate when upset or excited / · Needs constant repetition of instructions
· Looks to see what the others are doing before acting or requires visual cues
· Word retrieval problems
· Poor ability to describe events
· Is unintelligible to you much of the time
· Stammers/stutters
6 / Understanding
· Follow a range of instructions without difficulty
Specific/complex time concepts (e.g. yesterday,
tomorrow)
· Simple Jokes
Expression
· Uses a wide range of sentence structures and vocabulary
· Initiates and maintains conversation
Sounds
· Mirror sound errors e.g. r=w
· Individual way of articulating words e.g. helicopter, lellow / · Needs constant redirecting towards task
· Interprets things very literally
· Does not answer/ask questions
· Difficulties with interaction with peers and adults
· Restricted vocabulary and use of grammatical markers
· Stammers/stutters
7+ / Speech and Language skills continue to develop – Please refer to the ‘Universally Speaking’ booklet for further information. / · Poor phonological awareness
· Difficulty with reasoning and problem solving
· Poor sequencing skills
· Stammers/stutters