Appendix 6]

Department of Speech and Language Therapy Referral

Guidelines

Department of Speech and Language

Stanhope Parade Health Centre
Gordon Street
South Shields
NE33 4JP
Asset No. 5884 Version: June 2015 Review: June 2017. Sharon Scott Clinical Operations Manager. Children’s Integrated Therapies
 Tel: 0191 2832484
Fax: 0191 451 6101

Contents

3. Language development

6. Normal development of speech sounds

9. Attention and listening and social skills development

13. Stammering

14. Appendix 1: General strategies to help support children with language delay

15. Appendix 2: General strategies to help support children with speech sound errors

21. Appendix 3: General strategies to help support children with attention and listening difficulties

24. Appendix 4: Signs and symptoms of possible Autism in preschool children.

26. Appendix 5: General strategies to help support children with social communication concerns

27. Appendix 6: Referral Form

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Age Comprehension
1 year  Shows understanding of
frequently used words in
context e.g. “car”, “drink”, “cat”,
“all gone”
 Understands simple
instructions associated with a
gesture e.g. “give it to Daddy”,
“come to mummy”
1½ years
 Hands familiar objects to adult
when requested, e.g. “give me
teddy”
 Responds to simple instructions
e.g. “get your shoes”, ‘shut the
door”
 Points to own or others body
parts on request e.g. Daddy’s
eyes, nose, feet
 Understands many more words
than uses expressively
2 years
 Understands many more than  Uses 1 – 2 words together, e.g.
50 single words - including
familiar nouns and action words 
 Follows a series of two simple
but related commands, e.g. “get
Language Development
Expressive Language
 Responds to familiar songs by
vocalising
 Imitates adult playful vocalisations
e.g. “uh oh!”
 May use a few words with
meaning
 First true words develop – these
may still be embedded within
jargon
 Uses around 6-20 recognisable
words
 Demands a desired object by
pointing and vocalising, or single
words
 Attempts to sing and join in with
action songs and rhymes
“daddy car” “want drink”
Uses around 50 recognisable
words appropriately – mainly
familiar nouns
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Refer if
Referral not appropriate. Refer family to
health visitor and websites such as:
 www.ican.org.uk
 www.literacytrust.org.uk/talk_to_your_baby
 www.talkingpoint.org.uk
Referral not appropriate. Refer family to
health visitor and websites such as:
 www.ican.org.uk
 www.literacytrust.org.uk/talk_to_your_baby
 www.talkingpoint.org.uk
The child is not
 using 50 single words
If the child has 50 words but is not yet word
pairing discuss the strategies in appendix 2
 teddy and put it in the box”,
“where’s dolly’s nose?”
 Understand words for absent
object.
2½ years  Understands 2-3 word
instructions without visual
prompts e.g. gesture or pointing
e.g. “give teddy drink”
 Can select pictures of actions,
e.g. “who is eating?”
 Recognises general family
name categories, e.g. “baby”,
“mother”, “granny”
3 years  Understands 3 word
instructions without visual
prompts e.g. gesture or pointing
e.g. “teddy drink milk”
 60% of 3 year olds understand
“who”, “what” and “where”
questions?
 Understands descriptive
concepts such as “big”, ‘same”,
“wet”, “hot”
 Can identify objects by function
e.g. “which one do we eat
with?” (spoon)
 Increased understanding of
difference between present,
past and future events
3½ years Understands 3 - 4 word
instructions without visual
prompts e.g. gesture or pointing
e.g. “give teddy spoon and cup”
 Constant asking of object names
and people e.g. “what dat?”
 Will frequently talk to self during
play
 Uses 2 -3 words together e.g.
want drink milk” “me want daddy”
 Has a vocabulary of around 250
words
 Uses prepositions “in” and “on”
 Uses present progressive –ing
e.g. “Daddy running”
 Uses 3 -4 words together e.g.
“mammy me want milk” “me go
daddy car”
 Uses regular plural ‘s”
 Uses personal pronouns correctly
 Asks many questions, beginning
with “what” and “where?”
 Able to briefly describe present
activities and past experiences
 Knows several nursery rhymes to
repeat
 Uses 3 -4 words together e.g. “me
want a drink” “me go daddy car”
 Uses regular 3rd person ‘s” e.g.
“she runs”
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“How you can help a child put 2 words
together”
The child is not
 Able to select familiar objects by name
 using 80 single words
 using a selection of verbs
 word pairing, such as “daddy car” “juice
gone”
The child is not
 Following simple instructions
 Using 2-3 words in a sentence
 Using verbs in a sentence
 ECAT: Following all the instructions at 2
word level.
 Please refer to the listening and attention
section BEFORE making a referral.
The child is not
 Following simple instructions containing
verbs
 Using 3 words in a sentence
  Understands “behind, over,
near and in front”
 Understand some colours
 Understands past, present and
future
4 years Understands 4 word
instructions without visual
prompts e.g. gesture or pointing
e.g. “teddy sleep big bed”
 Understand some abstract
concepts e.g. “one of”, “before”,
“after”, “if”
 Beginning to understand “why”,
“when”, and “how” questions
 Uses regular past tense “ed” e.g.
“I played cars”
 Uses articles “a” “the” e.g. “look
the bus” “I see a cow”
 Uses 4 – 5 words together
 Uses uncontractible auxillary “he
is”, “they are”
 Uses contractible auxillary e.g.
“the boy’s jumping”
 Uses contractible copula e.g.
‘she’s happy”
 Using verbs in a sentence
 ECAT: Following over half the instructions
at 3 word level.
 Please refer to the listening and attention
section BEFORE making a referral.
The child is not
 Following conversations
 Understanding questions
 Using 4 words in a sentence
 Using language in a variety of ways e.g. to
comment, ask questions, tell stories.
 ECAT: Following the instructions at 3
word level. If only one error – reassess a
few days later.

5 years  Understand 4+ part instructions
 Understands time and
sequence concepts, such as
“first, then, last”
 Understand question words
such as “why”, “when”, and
“how”
 Able to follow a story without
pictures or props
 Uses 5 or more words together
 Uses uncontractible auxilary “he
is”, “they are”
 Uses contractible auxilary e.g. “the
boy’s jumping”.
 Uses contractible copula e.g.
‘she’s happy”
 Uses terms such as “first, next,
last”
Refer to earlier referral recommendations
AND
 Having difficulty following instructions
independently
 Echoing back what is said to him
 Having problems understanding concepts
 Frequently has difficulty recalling words
 Is over-reliant on familiar topics in
conversation
 Using jumbled up sentences.

*** ECAT (Every Child a Talker) is an assessment provided by the Local Education Authority to nurseries.

Refer at any age if the child:

 Frequently uses lots of empty language and pauses e.g. “I went to the erm erm erm shop”, “put that thing there”, “do that” Please
consider the size of the child’s vocabulary and whether the child is bilingual.

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  Has a good understanding of vocabulary but struggles to use the correct word when he/she needs to e.g. “can you pass me the ……”
and frequently can’t remember the word
 Misnames words that the child is familiar with and understands such as animals, clothes e.g. naming a pig as a cow
 Seems to talk using learned phrases or talks like an adult and doesn’t seem to understand as much as they say

Normal Development of Speech Sounds

Age Sounds used within Description of normal speech errors Refer if
words
9 months - mn Misses of the ends of words e.g. “do” for Not making any sounds
2 years pbtd “dog”
a range of vowels Restricted or incorrect vowels used
Reduces the syllable structure e.g. “efant”
for “elephant”
Please also refer to language guidelines.
May harmonise the syllables e.g. “dada” for
“daddy”

2 – 3 years m n ng Still may be missing off the ends of words Not making any sounds.
pbtdwh
May swap the k/g sound for t/d e.g. say Only using vowels or a very restricted range of
“tar” for “car” or “dirl” for “girl” consonants.
New sounds: w h
Reduces the syllable structure e.g. “efant” If replacing other sounds with a “k” or “g”
for “elephant” sound
May harmonise consonants e.g. “gog” for
Missing off the initial consonant in words, when
“dog”
it’s not part of a consonant blend.

3 – 3½
years m n ng May replace Using a very restricted range of sounds
pbtd  The “f” sound with a “b” e.g. “bour”
ywh for “four” Replacing other sounds with a “k” or “g” sound
fs  The ‘s” sound with a “t” or “d” e.g. If consistently reducing all words down to one
“dun” for ‘sun” syllable e.g. “helicopter” to “li”

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 New sounds: y f s  The “k” or “g” sound with a “t” or “g”
e.g. “tar” for “car”, “dirl” for “girl” Missing off the ends of words
Still misses off the weak syllable in words.
e.g “ephant” for “elephant”
3½-4 m n ng May make the following sound changes: Refer to earlier referral recommendations AND
years pbtdkg
“t” for “k” e.g. “tar” for “car”
ywh Replacing the “f” sound with a “b” e.g. “bour”
“d” for “g” e.g. “dirl” for “girl”
fvsz for “four”
Replacing the “k” or “g” with a “t” or “d” e.g.
Consonant blends are reduced. e.g. “tain”
New Sounds: k g v z “dun” for ‘sun”
for “train” or ‘seep” for ‘sleep”
Substituting different sounds for “f”, ‘s” or “k”
other than those shown in the previous column
(when not part of a consonant blend)
4- 4½ May make the following sound changes: Refer to earlier referral recommendations AND
years
“w” for “r” e.g. “wed” for “red” Replacing the “k” or “g” sound with a “t” or a “d”
“y” for “l” e.g. “yight” for “light” e.g. “tar” for “car”, “dirl” for “girl”
‘s” for ‘sh” e.g. ‘sue” for ‘shoe”
“t” for “ch” e.g. “tair” for “chair” Not using the following sounds in words (when
“f” for “th” e.g. “fumb” for “thumb” not part of a consonant blend)
“d” for “th” e.g. “dis” for “this”  s, z, f, v.

Still reduces consonant blends e.g. “poon” It is still OK to miss these sounds off in
for ‘spoon” consonant blends, such as ‘spoon”, “clown”,
“flower”.
4½-5 New Sounds: l Same normal errors as at 4 – 4 ½ years. Replacing the “k” and “g” sounds with a “t” or
years “d” sound

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5 years and New Sounds :
over sh 5:0 – 5:06 years
ch j 5:06 – 6:00 years
r up to 6:05 years
th up to 7:00 years
Up to 6 years may still make the following
sound changes:
“y” for “l” e.g. “yight” for “light”
‘s” for ‘sh” e.g. ‘sue” for ‘shoe”
“t” for “ch” e.g. “tair” for “chair”
Up to 7 years may still make the following
sound changes:
“w” for “r” e.g. “wed” for “red”
“d” for “th” e.g. “dis” for “this”
“f” for “th” e.g. “fumb” for “thumb”
Refer to earlier referral recommendations AND
At 5½ years if not producing both sounds in
consonant blends.
At 5½ years if not producing ‘sh” consistently
within words
At 6 years if not producing “ch” consistently
within words.
At 6½ years if not producing “l” or “r”
consistently within words
At 7 years if not producing “th” sound within
words.

Refer at any age if the child:

 Produces the same word in different ways e.g. “cup” is sometimes “pup”, “cus”, “tup” and “puc”
 Produces vowel sounds incorrectly e.g. “bed” produced as “bad”
 Produces the sounds expected for their age, but with an unusual quality e.g. ‘s” sounds slushy and inaccurate
 Speech clarity deteriorates in sentences
 Is making speech errors other than the examples given in the normal speech errors section e.g. producing m as b, b as g, f as h etc

It is important to establish why the child is making the sound errors. Guidelines from audiology are that any child over 3½ with an
identified communication difficulties have a hearing assessment. Please refer for a hearing assessment at the same time as referring
to our Department.

If you are unsure you can always contact the department on 0191 2832484 and a therapist can discuss the referral with you.

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 Attention and Listening and Social Skills Development
Age Typical Development of
Attention and Listening
1 year
 Fleeting attention
 Child is very distractible
 Looks at you when you speak
 Listens to different sounds e.g.
telephone, door, clock
 Enjoys action songs and rhymes
1½ years
 Single-channelled attention –
cannot attend to two sets of
incoming information
 Will choose own activity and can
attend for a longer period of time
 Absorbed in own play, cuts self off
from other stimuli
2 years
 Attention remains single
channelled
 Child focuses on an activity of their
choice, but finds it difficult to be
directed by an adult
 Use of the child’s name is
beginning to help them to attend to
an activity e.g. ‘sally get your coat”
 Attends when spoken to and
listens with interest to general
Typical Development of Refer if
Social Skills
 Uses gestures such as waving and
pointing to communicate  Only refer if there are concerns
 Shows affection to familiar people regarding other areas of
 Smiles at people who are smiling at communication development.
them See social communication
 Takes turns in interactions using babble section.
 Like to be in sight and hearing of
familiar people  See to note at bottom of table for
referral advice.
 Plays alone but likes to be near familiar
person
 Frequent squabbles with peers over
possession of toys
 Still very emotionally dependent on
familiar adults – alternating between
clinginess and resistance
 May take turns but has little idea of
sharing either toys or attention of adults
 Needs must be met immediately or child
becomes frustrated / tantrums – but can
often be distracted
 Resentful of attention shown to other
children by familiar adults
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 conversation
2½ years
 Attention is single-channelled but
begins to attend to adults
 Child can listen if stops activity and
looks at adult. Needs adult
support to do this
3 years
 Attention is single-channelled but
begins to attend to adults
 Child can listen if stops activity and
looks at adult. Needs adult
support to do this.
3½ years
 Attention continues to be single-
channelled but begins to attend to
adults
 A child is learning to
spontaneously alternate their
attention between the speaker and
the task
 Little idea about need for sharing
playthings or adult attention
 Watches other children at play with
interest may join in briefly
 Tantrums, but less easily distracted
than previously
 More readily able to understand the
need to wait until a later time (to fulfil
needs)
 Less dependent on familiar adults e.g.
can pull own pants down and up
 Shows affection for younger siblings
 More readily able to understand the
need to wait until a later time (to fulfil
needs)
 Less dependent on familiar adults e.g.
can pull own pants down and up
 Shows affection for younger siblings
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 Social interaction and
communication difficulties are
evident. See social
communication section.
 Refer to general listening and
attention strategies
 See note at bottom of table for
referral advice.
 Social interaction and
communication difficulties are
evident. See social
communication section.
 Refer to general listening and
attention strategies and include
the child in the BLAST
programme at nursery
 See note at bottom of table for
referral advice.
 Social interaction and
communication difficulties are
evident. See social
communication section.
 Refer to general listening and
attention strategies and include
the child in the BLAST
 programme at nursery

 See note at bottom of table for

referral advice.

4 years  The child’s attention is developing
to two- channelled
 They are beginning to listen and
copes with spoken instructions
related to this activity without
interrupting their attention to the
task
 The concentration to adult led task
will still be limited
 Can listen to longer stories
 Can now be taught in a small
group
5 years  The child’s attention is now two-
channelled
 They can cope with spoken
instructions related to an activity
without interrupting their attention
to the task
 Concentration to adult-led tasks
can still be short
 Can listen to longer stories
 Can be taught in a small group
 Independent and strong willed
 Needs companionship, can be co-
operative or argumentative
 Shows concern for younger siblings and
sympathy for peers in distress
 Enjoys jokes and verbal absurdities
 Aware of consequences of actions
 Beginning to become competitive
 Enjoys jokes and verbal absurdities
 Tends to see the world from their own
perspective (does not have empathy
skills yet).
 Social interaction and
communication difficulties are
evident. See social
communication section.
 Refer to general listening and
attention strategies and include
the child in the BLAST
programme at nursery
 See note at bottom of table for
referral advice
 Social interaction and
communication difficulties are
evident. See social
communication section.
 Refer to general listening and
attention strategies and include
the child in the BLAST
programme at nursery

 See note at bottom of table for

referral advice.

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NOTE: You will need to have a discussion with the parent regarding the reason for the referral and also consider a referral to a
Paediatrician, as well as Speech and Language. You will need to inform the child’s Health Visitor of your concerns and call an
Early Years meeting to decide the appropriateness of the referrals. Please make the reason for the referral i.e. social
communication explicit on your referral form, providing detailed observations.

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 Stammering (“Bumpy Talking”)

Please refer immediately. It is important that parents receive appropriate advice to reduce the impact of the stammer without delay.
You do not need to hear the child stammer before referring, a parental report is sufficient for you to action a referral.

Also consider if the child has areas of need, such as attention and listening, language comprehension, use of language or speech sounds.
Universal services, such as education, can continue to support these, as part of their role, as well as the referral to SLT to offer further
advice regarding the stammer.

Please note on the referral form

 If the child is opting out of talking
 If the child is showing any signs of awareness e.g. breaking off eye-contact, getting frustrated or upset when he/she cannot get her
words out, giving up on their talking turns and reporting that they are finding talking difficult.
 If the child has any additional developmental needs
 If the child has any additional speech and language needs
 The types of “bumps” you have heard (if indeed you have heard any): part word repetition, whole word repetition, stretching out
words (I want a ssssssstory) or blocking words (where the child cannot seem to get started and no sound comes out initially (“… I
want a biscuit”)

What can you do to help?

Remember there is no evidence that parents or teachers cause stammering, but they are part of the solution.

 Focus on what the child says, not how they say it. Look at the child when he talks, then he knows you are listening and is less likely
to rush his speech
 Follow the child’s lead in play, playing with what he wants to play with and taking turns to talk.
 Slow down you own speech a little, making it easier for him to follow what you are saying. This helps to make your child feel less
rushed and is more helpful than telling him to slow down.

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 Appendix 1

General strategies to help support children with language delay

There are many things universal services can do to support children with communication delay. This includes increasing access to play
opportunities e.g. attending Toddler Groups, early nursery placements.

Ways to help a child develop their first words:

 Follow the child’s lead in play. If the child is already interested in something he/she is more likely to pay attention to the language
you are using.
 Talk about what you are doing together using simple language, e.g. ‘up stairs’, ‘down stairs’, ‘wash your hands’.
 Name objects when you do everyday tasks as this will help the child to understand words.
 Repeat new words often and in different situations, as children need to hear a word many times before they can use it.
 Give the child chance to talk by offering him choices e.g. “do you want an apple or a banana?”

How you can help a child use sentences:

 Copy back the child’s word or sentence and add a word. e.g. if the child says ‘ball’, you could say ‘kick the ball’.
 Songs and stories help me learn – Use tunes to help the child learn and build on language e.g. singing nursery rhymes together,
doing the actions and encouraging the child to join in. Help develop a love of books by sharing them together. Look at the pictures
and pages and talk about what you can see.
 At this stage, if the child makes an error in their sentence, it is important to model back the correct sentence and NOT to make the
child repeat it e.g. if the child says ‘Ben goed wimming’ – you would say ‘yes Ben went swimming’.

Strategies available to use in the early years settings:

Boosting Language Auditory Skills and Talking 1 (BLAST 1 - Nursery age)

Boosting Language Auditory Skills and Talking 2 (BLAST 2 - Reception age and Year 1)
The Narrative approach (Black Sheep Press) (available for Nursery, Reception and Key stage 1)

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 Appendix 2

General strategies to help support pre-school children with speech sound errors.
Lots of pre-school children will have difficulty making certain sounds, which may be associated with their normal development. Others may
have more persisting difficulties and may require speech and language therapy. Below are some common questions and strategies:

Should I correct the child’s speech?

All children make mistakes as they are learning to talk. It’s a normal part of development. You CAN help.

 Get FACE to FACE and at EYE LEVEL as you talk and play.
 ECHO BACK correctly what the child has said so that they can hear the grown up version. This also tells them you are listening and
trying to understand.
 DON’T CORRECT and AVOID asking them to “Say it again” or “Say it like this …”

What should I do when I just don’t understand?

Don’t panic! Just follow these steps.

1. Get FACE to FACE and at EYE LEVEL as you talk and play. This shows the child that you are listening and gives you extra clues about
their message from facial expression and gestures
2. ALLOW THE CHILD TO REPEAT what they said ONCE. If they say a word or a sentence the same way again then it’s unlikely they will
be able to correct themselves no matter how many times you ask them to try.
3. If the child is talking in sentences, try asking them … “Tell me about it?” Perhaps you will be better able to understand other words they
use to send the message.
4. If you still don’t understand, say “Show me” and encourage them to lead you by the hand, to gesture or point to show you what they
mean.
5. If you still don’t understand, say “Sorry, I didn’t understand you that time. Try to tell me again later”. It might help to distract them with an
activity they enjoy so that they don’t dwell on the problem
6. DON’T PRETEND TO UNDERSTAND. It’s unlikely that the child will be fooled by this. They might just think that you are not listening and
that their message isn’t important to you.

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How to model speech effectively:-

Providing a good model all the time requires adults to use:

 An unhurried speech rate
 Clear speech
 Short sentences
 A quiet environment
 Vocabulary suited to the child’s age
 More repetition and re-stating than we would use when talking to another adult

Ineffective modelling Weak modeling

Child: That’s a bid bird Child: That’s a bid bird

Adult: Not a bid bird Adult: It is. It is a big bird
You don’t say ‘bid bird’
You have to remember to say ‘big bird’ It comes naturally to model this way, it is OK for a typical
language learner but not powerful enough for a child with
Child tunes out. Child heard ‘bid’ three times and ‘big’ once (if speech sound disorder
he/she was listening)

Exaggerated modelling Effective conversational modelling

Child: Pease can I have one? Child: I like his punny pace
Adult: You mean puh-leeze Adult: I like his funny face
Puh-leeze may I have one? It’s a really funny face
A funny face
This exaggerated sort of modeling is unadvisable. It distorts the Do you know what that guy with the funny face is
sounds, so that the child does not hear the target properly. called?

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Activities and game ideas to support sound awareness skills

 Play games/activities which involve single words so the child can hear the beginning, middle and end sounds of words more
clearly. This can include looking at picture books and encouraging the child to take the lead to point to pictures, playing snap,
pairs or lotto games. Each gives opportunities for single word naming in focussed activities. Children can also be supported
in everyday situations. Encourage parents to name individual items put in the shopping basket, vehicles seen on the roads
or even when sorting the washing at home e.g. “Tom’s socks”, “daddy’s socks”.

 Songs and stories help children learn – Rhyme and rhythm will help them learn about how different sounds are needed to
make different words. The tune and repetition will support them to remember which sounds are needed for the words
in the song. Phonic stories are often available which may target a specific sound. Again allow for repetition and try leaving
gaps for the child to fill as they become familiar with the story. Model back errors appropriately.

 Provide opportunities to listen to target sounds within naturalistic play. This repeated exposure to sounds can support children
who are easily distracted, especially in activities they perceive as difficult. Spend time modeling target sounds in more
engaging tasks. Try getting children to pick items out of a bag which start with a target sound. The focus of these activities
is to model the target sounds repeatedly in words. As the child selects items from the bag they may attempt to name them,
expect their productions to have speech errors. The adult shouldn’t correct these errors but model back the word. As child plays
with the items the adult should talk about what they are doing using the target sounds repeatedly within the words.

 Jolly Phonic Sound Pictures – These can be a great way of introducing sounds alongside picture, actions and graphemes (letters)
to help children learn. Introduce the sounds with the pictures and actions. Remember to keep quiet sounds quiet e.g. ‘s’ not ‘suh’,
‘t’ not ‘tuh’ and ‘k’ not ‘kuh’ (other quiet sounds include ‘p’, ‘f’, ‘sh’, ‘ch’). Play games where the child needs to identify sounds,
using actions to help them initially. Try having the same sounds on each side of a barrier, select one sound and use as
many cues as needed for the child to identify the sound on their side. Reward and remodel correct responses.

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How to help in the classroom

It is important to get used to a child’s speech pattern if he is unclear. Try and talk to him in context where you have plenty of clues
about what words he might be using. You could use picture books or talk about the work he is doing.

If you do not understand something it may be worth asking the child to try again, show you or give you more detail. Ask questions
such as “What else happened?” “Who was there?”

Repeat back to the child when you have understood. This encourages him to keep talking.

If you have to give up it is helpful to say to the child that he has been telling you a lot so that you are acknowledging that he has
been trying to communicate.

If you have a child in your class who is difficult to understand it is useful for parents to provide you with a list of words related to
family members, pets, their favorite games and so on. These are often words which are difficult to understand out of context.
A home school book in which parents and you write down events which have happened at home and school can also help you
to tune in when the child is talking.

In general, unless specifically requested by the Speech and Language therapist, it is better to not directly correct the child. If he
says something incorrectly you can acknowledge his attempt and give the correct version without any implied criticism e.g.

Child “There’s a tat”

Adult “Yes, it’s a cat”

This works well with reading as the child is already focused on the written words and this can help him to link speech sounds
with written forms.

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There are many ways that school staff can support children's developing awareness of sounds in words without working directlyon their
speech production.

Some General Tips:

Try not to:

 ask the child to repeat words after you
 ask the child to repeat what s/he says too many times
Why not?
 The child may not have the necessary sounds in his/her system
 The child may not be able to produce these sounds to order
 The child may be able to produce the sounds in isolation, but not within a word or phrase
 The more times the child repeats his/her incorrect version of the word the more this representation may be reinforced
 The child probably knows s/he is failing and this will lower self-esteem
Try to think of other ways of finding out what the child wants to say.
 'Can you show me?'
 'Take me to it'.
 Use forced alternative questions such as 'Do you mean your coat or your shoes?'
 Use a home/school diary to give you a clue when listening to news
 Offer models of speech back to the child
 Child: 'Witti ta'.
 Teacher: 'A little car? Yes, it is little'.

Why?
 These methods should reduce anxiety levels and promote self-esteem
 Contextual clues aid communication by enabling the child to show or point to the thing they are referring to in the classroom
 Modeling back reinforces the correct representation of words
 Communication is sustained rather than a problem being highlighted

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Is it ever appropriate to ask the child to repeat words and phrases?

Be sensitive to the child and the context. Such situations might include:
 1:1 times, such as when the child is reading aloud (as long as the repetition does not interfere with the meaning of the text)
 rehearsing rhymes and songs in a group - everyone can practice speaking clearly together
 practicing for class assemblies or plays, if the child is happy to take part
 as guided by the speech and language therapist, if one is involved
How can school staff actively help children to improve their speech?
 By working on the crucial listening skills that underpin speech production which include listening and attention, general sound
awareness and listening for speech sounds via jolly phonics.
 Jolly phonics is currently use with South Tyneside Speech and Language Department. Helping the child to learn the symbols and
actions for the sounds via listening and identification tasks would be advised rather than working on speech production until a
therapist has assessed the child.

Strategies available to use in the early years settings:

Letter and Sounds Phase 1 Phonics.

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 Appendix 3

General strategies to help support children with attention and listening difficulties

Helping children with Attention and Listening

Listening and paying attention are important for children’s speech and language development and their learning. Listening is more than just
hearing – we can hear that the TV is on, but not be listening to it because we are focused on something else. When we hear new or
complicated information we have to listen hard to be able to understand. Some children are too easily distracted to listen and learn
effectively. Babies and young children develop their listening and attention skills in recognisable stages, and some children need help to
move through these stages. If a child’s listening and attention skills are poor, they may not always understand what is said to them. This is
really because they aren’t listening properly to the words, rather than not understanding the words. Sometimes, this may make them seem
naughty or wilful. They may seem to ignore you when you speak to them, or forget what they have been told. They may not be able to play
with any toy for more than a few moments and quickly lose interest in activities.

These tips will help improve your child’s listening and attention skills.

 Try to have some quiet time each day when you can play and talk with the child
 Make sure you have the child’s attention before speaking to them - say their name or touch them to gain their attention
 Face the child, make eye contact to help them listen to you
 Reduce background noise, e.g. other people talking, radio, television etc, it is a distraction - try to reduce it where possible
 Talk slowly and clearly
 Keep tasks and instructions short
 When you hear a noise during the day, e.g. phone ringing, dog barking – draw their attention to it and show them what the sound was
 Look at books or catalogues, talking about the sounds that things in the pictures make, encourage the child to imitate the sounds
 Play short specific games and gradually increase the time you expect your child to concentrate – one minute may be enough at first,
then increase with an extra page of a book, or a few pieces of a jigsaw
 When your child’s attention begins to wander, encourage them to “do just one more then we’re finished”
 Remember, games that are too hard or too easy will make the child lose interest more quickly
 Remember, the child’s attention will be affected if he is tired or unwell
 Praise the child for concentrating and listening well e.g. “good listening”

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Listening and attention games for young children

 Finding a sound – hide a noisy toy or musical toy in the room and ask the child to find it
 Play simple “peek a boo” games
 Have pictures of animals, make the sound of one and ask your child to point to the picture
 Hold a car and say “Ready….steady….go”. Encourage your child to look and then roll the car to them on “go”
 Build a tower of bricks together and then say “Ready…steady….go” before you knock the tower down. Gradually make your child
wait for longer before you say “Go”
 There are lots of other different ways to play “Ready, steady, go” games, e.g. “ready, steady….. jump” or “ready, steady…… boo!”
 Collect lots of different noisy toys or objects e.g. bells, squeakers, bunch of keys, rattles and encourage your child to play with them
and listen to the different sounds
 Hide the noisy toys in a box and make a sound with one of them – ask the child to guess which toy made the sound
 Musical statues – dance to some music with your child. Listen for when the music stops and then stand still or sit down
 Sing songs e.g. “ring a ring a roses” or Humpty Dumpty” where the child has to listen for the word “down” before they fall to the floor,
or leave out the last word for your child to fill in or use the wrong word and wait for your child to notice e.g. “Humpty Dumpty sat on a
……donkey”
 Make musical “instruments” and listen to their different sounds e.g. a metal spoon on a pan, a wooden spoon on a plastic cup
 Ask your child to copy a simple rhythm on the instruments, e.g. two quick beats, a pause, one quick beat
 Practice clapping or marching to the beat of music at different speeds
 Go on a “listening walk”, stopping to listen and talk about all the sounds you can hear

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More difficult listening and attention games

 Lay out musical instruments or noisy toys and play one. See if your child can identify which one you played.
 Build this up into a sequencing activity – play 2 or 3 instruments and see if your child can repeat the sequence, in the correct order.
 Now repeat these activities but with the toys hidden so that the child cannot see which ones you play
 Make noisemakers out of 6 identical pots e.g. margarine tubs. Make 2 sets of shakers by filling them with materials that make
different sounds e.g. 2 with rice, 2 with corks, 2 with screwed up tinfoil. Ask your child to find the matching pairs by listening to the
sounds they make when he shakes them. You can add more pairs of pots or make the noises more similar e.g. sugar, rice, pebbles,
to encourage the child to listen harder
 Make up a story with your child’s name in it. Ask them to clap their hands every time they hear their name.
 Clap out the beats of words e.g. 2 claps for “table”, 3 claps for “elephant” etc
 Ask your child to carry out simple actions after hearing a musical instrument, e.g. run to the door on the bang of a drum.
 Ask for different actions for different sounds e.g. clap hands when a bell rings, jump up and down when a whistle sounds. You will
need to demonstrate this first.
 Asking for objects - make a shoe box or cereal box into a monster face with a hole cut out for a mouth, and collect pictures of food.
Ask your child to feed the monster e.g. “give him a biscuit and an apple”. You can increase the number of things you ask for
 Play a shopping game using a shopping bag and a range of objects. Ask your child to go shopping for you – “buy me a ball, a teddy
and a pencil”
 Ask for help when loading the washing machine, e.g. “give me your T-shirt”, “find me mummy’s jeans and daddy’s socks” etc
 Play Simple Simon Says
 Play “I went to market and I bought……” building up a list of objects which the child has to remember
 Put a screen between you and your child and each have a set of identical pictures. Sit either side of a screen or a cardboard box,
each with a sheet of paper and some crayons. Take it in turn to tell each other what to draw, e.g. draw a house, put a red roof on it,
and draw a blue door. Draw what you are asking the other person to do. At the end compare your drawings – they should look the
same.
 Games like Lotto, pairs, snap, sleeping lions can all help children learn to concentrate

Strategies available to use in the early years settings

Boosting Language Auditory Skills and Talking 1 (BLAST 1 - Nursery age)

Boosting Language Auditory Skills and Talking 2 (BLAST 2 - Reception age and Year 1)

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 Appendix 4

Signs and symptoms of possible autism in preschool school children (or equivalent developmental age)
Use this table to alert you to the possibility of autism if concerns have been raised

The signs and symptoms in this table are a combination of delay in expected features of development and the presence of unusual features,
and are intended to alert professionals to the possibility of autism in a child or young person about whom concerns have been raised. It is
not intended to be used alone, but to help professionals recognise a pattern of impairments in reciprocal social and communication skills,
together with unusual restricted and repetitive behaviours.

Social interaction and reciprocal communication behaviours

Spoken language
 Language delay (in babble or words, for example less than ten words by the age of 2 years)
 Regression in or loss of use of speech
 Spoken language (if present) may include unusual:
 non-speech like vocalisations
 odd or flat intonation
 frequent repetition of set words and phrases (“echolalia”)
 reference to self by name or “you” or ‘she/he” beyond 3 years
 Reduced and/or infrequent use of language for communication, for example use of single words although able to speak in sentences
Responding to others
 Absent or delayed response to name being called, despite normal hearing
 Reduced or absent responsive social smiling
 Reduced or absent responsiveness to other people’s facial expressions or feelings
 Unusually negative response to the requests of others (demand avoidant behaviour)
 Rejection of cuddles initiated by parent or carer, although may initiate cuddles themselves
Interacting with others
 Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
 Reduced or absent social interest in others, including children of his/her own age – may reject others; if interested in others, may
approach others inappropriately, seeming to be aggressive or disruptive
 Reduced or absent imitation of others” actions

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 Reduced or absent initiation of social play with others, plays alone
 Reduced or absent enjoyment of situations that most children like, for example, birthday parties
 Reduced or absent sharing of enjoyment

Eye contact, pointing and other gestures

 Reduced or absent use of gestures and facial expressions to communicate (although may place adult’s hand on objects)
 Reduced and poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people’s eyes when speaking)
and speech used in social communication
 Reduced or absent social use of eye contact, assuming adequate vision
 Reduced or absent joint attention shown by lack of:
 gaze switching
 following a point (looking where the other person points to – may look at hand)
 using pointing at or showing objects to share interest
Ideas and imagination
 Reduced or absent imagination and variety of pretend play

Unusual or restricted interests and/or rigid and repetitive behaviours

 Repetitive ‘stereotypical” movements such as hand flapping, body rocking while standing, spinning, finger flicking
 Repetitive or stereotyped play, for example opening and closing doors
 Over-focused or unusual interests
 Excessive insistence on following own agenda
 Extremes of emotional reactivity to change or new situations, insistence on things being “the same”
 Over or under reaction to sensory stimuli, for example textures, sounds, smells
 Excessive reaction to taste, smell, texture or appearance of food or extreme food fads

*NICE Clinical Guidelines 128 – Autism: Issue date: September 2011

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 Appendix 5

General strategies to help support young children with social communication concerns

 When starting an interaction say the child’s name to help get their attention.
 To encourage interaction with the child let them take the lead. Notice what draws their attention and use that to start the interaction.
Let the child take control of their game or their interest. You could name, or comment, on the child’s interest as you play.
 Extend their play by finding a similar toy and adding an action.
 Be face to face and down at eye level as you play. This tells the child you are paying attention and are a part of their world. It might
be difficult for the child to make eye contact with you; you can make this easier for the child by crouching down in front of them.
 Wait and give the child some time to think and respond. The child may then respond in their own way.
 Listen to what the child says. You can then expand on what they are saying, e.g. the child says “out” and indicates ‘out’, and you say
“out to the park”.
 Use “people toys”. These are those which need an adult to operate them, like bubbles, balloons or windup toys. You could blow
bubbles then put the lid back and wait for the child to let you know they want “more.” They might put the toy in your hand or look at
you or say a word.
 Give the child repeated opportunities for communication. Offer choices.
 Engage in simple turn taking games e.g. roll a ball to each other, take it in turns blowing bubbles for themselves and another adult,
sibling or peer, taking turns with a toy. The child may need physical support to do this (e.g. stopping them putting their car down a
click clack track by blocking it with your hand if it is not their turn.
 If the child struggles to play with peers encourage them to play alongside them.
 Promote awareness of themselves and others by focusing on body awareness. Name body parts in daily routines. Sing songs such
as “head, shoulders, knees and toes”, “If you’re happy and you know it”, “This is the way we brush our hair…”
 Label the child’s and your own emotions as they and you are feeling them e.g. “hungry” at dinner time, “happy” when playing with a
favorite toy.

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Appendix 6]

Referral to STFT Children’s Speech & Language Therapy Department

NB: All information must be completed or the referral will be returned

N.B.*Mandatory fields for NHS staff

Patient Details: (Please Print and circle yes/no options)

First Name/s:

Surname: NHS No: *

D.O.B: Male / Female: Ethnicity: Religion:

Address:

Post Code:
Mobile: Home: School / Nursery (attends AM / PM ):

GP: GP Address: *

Is an interpreter required? Language:

Yes / No
Reason for Referral (please tick)
Speech Sounds: Stammer: Hearing Impairment: Language Development:
Feeding/ Swallowing: General Development: Social communication/interaction:

Details of concerns:

Asset No. 5884 Version: June 2015 Review: June 2017. Sharon Scott Clinical Operations Manager. Children’s Integrated
Therapies
Additional Information:
Are there any Safeguarding Social Worker & Contact Details:
concerns?
Yes / No
Has the child been referred/under care of a Paediatrician?* Yes / No / Don’t know
Name of Consultant/s* Hospital:*

Has the Child had a hearing test? * Yes / No / Don’t know

Result:
Relevant Medial history:*

Other Professionals Involved: (Name & Role e.g. Physiotherapist, Portage Worker, Psychologist)

1. 2.

3. 4.
Strategies/Measures already in place:

Please attach any relevant information e.g. developmental checks, school attainments.
Parental consent:
Person with Parental Responsibility: Relationship to child:

I do /do not consent to information being shared and obtained from other relevant professionals involved in my
child’s care. Parental consent given by (signature)

______________________________________________________________Date:___________________
NB: Referrals cannot be accepted without signed parental consent
Referrers Details (Please Print)
Name: Designation:

Address:

Post Code :
Signature: Date:

Please return to: Speech & Language therapy Department, Stanhope Parade Health Centre, Gordon Street,
South Shields. NE33 4JP : : 0191 2832484

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