Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

Language

Communication is everyone’s right: Speech Pathology Week 2021

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Communication is everyone’s right. But what does that mean?

For those of us in lockdown, and for everyone else dealing with the challenges of 2021, communication has never been more important for staying connected, informed, included, healthy, and safe. 

Happy Speech Pathology Week 2021 everyone!

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Lockdown and oral language therapy: practical things we can do to make things better for everyone in these tough times

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Seven weeks of lockdown in Sydney – and counting – have given us ample time to reflect on our therapy systems and practices. To protect our clients and staff, we’ve had to close our physical clinic temporarily to clients and families. We’ve been operating 100% by telehealth, six days a week. We couldn’t be prouder of our talented team for being so adaptable. We are so grateful to our clients for sticking with us through thick and thin.

Despite all the service-delivery changes, some things have stayed the same. As with many speech pathologists, our waiting lists remain longer than we would like them to be.  

In these difficult times, children with developmental language disorders and other learning disorders are particularly at risk. We are all under pressure to improve our practices so we can:

  • help our clients and families to get the most from therapy in the shortest amount of time; 
  • help more children on our waitlists; and
  • avoid wasting anyone’s time on things that don’t work or aren’t efficient.

Recap: Key elements of providing good quality language therapy 

For years, we’ve read peer-reviewed studies to figure out how to improve language therapy outcomes for clients. We’ve learned a lot about:

  • language as a complex system with a social purpose;
  • the importance of joint attention and interaction;
  • how to deliver the right the amount (or dose) of therapy;
  • giving children the right kinds of feedback and rewards;
  • the benefits of targeting multiple goals and mixing up language activities;
  • the evidence for distributed or spaced practice;
  • building retrieval practice and self-explanations into every session; and
  • introducing facts about the real world into therapy.

We’ve learned to work with our clients and their families to choose:

  • language goals – rather than subskills like auditory processing or working memory – to improve language outcomes;
  • functional goals – things that matter most to families, and things that get in the way of the child following their interests and participating in the real world; and
  • complex goals that promote system-wide change to language skills, rather than simply following a developmental sequence or targeting isolated goals that don’t have a noticeable effect on language as a system.

We’ve realised that many evidence-based therapy techniques share common elements, including:

  • an explicit focus on the skill you are working on;
  • clear language models to reduce the noise and to increase the signal of the target for the client;
  • repetition and repeated opportunities for learning skills; and
  • responsiveness to the child’s attempts.

We’ve come to understand the importance of:

  • collaborating with families, educators, health professionals and others to support the whole child; and
  • including natural play, conversation, dialogic reading, and storytelling activities into therapy to encourage transfer of language skills to the real world.

You can read more about these elements of therapy and how we think about them in our therapy here. 

So what else can we do to make language therapy more effective? 

As waiting lists for services have increased, and as we’ve pivoted to telehealth, we’ve been looking for other ways to improve the efficiency of our language therapy further. Specifically, we’ve been looking at ways to improve the transfer of language gains in one area of language to other areas of language to give clients and their families more value for their time and money. 

Transfer of learning happens when one set of skills transfers to another set of skills. When looking at the evidence for transfer, it helps to be clear about what kind of transfer you mean:

  • Near transfer is transfer between skills that are very similar. For example, if you do working memory training, you can improve your performance on tests that resemble the tasks that have been trained.
  • Far transfer is transfer between domains that are rather different, e.g. chess to problem solving, or working memory to language and reading. 

Many researchers think that far transfer is rare, or question whether far transfer is even possible. Different studies of working memory training, music, and video games have found a lack of, or very limited, transfer from one domain to another. This is why we do not recommend working memory training for language disorders. 

Other researchers think that transfer is possible between tasks that are quite different in content if they share the same basic underlying structure, or if the tasks (and the skills underpinning them) are interconnected in the learner’s mind. 

Within the language domain, a group of researchers thinks that transfer can occur when a new word is related to similar words that are already known (e.g. “parched” and “thirsty”); and that learning new words improves the learner’s understanding of words they already know. Vocabulary studies typically show large gains for words that have been taught or trained, but limited gains for words that are not trained. 

In 2019, Dr Melby-Lervåg and colleagues looked at transfer within the domain of language in more detail and concluded that transfer is possible within the domain of language, although direct transfer – as measured by improvement in one specific task to another – is difficult to obtain (see citation below). 

Despite its rather intimidating title, the paper includes some very practical guidance for front line speech pathologists and others working with children with language disorders during lockdown. Here are some of the main things we learned from the paper, followed by some examples of how we are seeking to apply the research recommendations in our practice within the constraints imposed on us by lockdown:

(1) Focus therapy on expressive language goals

A review of the evidence suggests that most of the effects of language interventions are generated through expressive language measures. This means we should focus on complex expressive language skills in functional ways, such as having clients:

  • construct sentences;
  • retell stories; 
  • make up their own stories; and
  • finish stories already started.

(2) Smaller groups are better than big ones   

On the whole, small group language interventions are more effective than large group or whole-class interventions. This is probably because children have more opportunities to speak and practice their expressive language in smaller group settings.

(3) Target words should be presented in context

We should not work on new vocabulary in isolation, e.g. by teaching word lists with definitions. Instead, we should introduce and explain new vocabulary in sentences, in stories, as well as in other texts. The ways in which different words can be used in different contexts should also be emphasised.

(4) Therapy should focus on the procedures that are used to complete language tasks, not just the content of each task

We want children to become aware of the procedures they use when solving a task so it is more likely they will use them in other tasks. For example, rote learning the definition of a cactus is less useful to children than learning the process of describing a cactus by features like category, function, location, shape, size, colour and its parts – an approach that can be transferred to nouns, generally. 

(5) We should tell children what they are working on and why it matters

We should prime children with knowledge of what we are working on and why, and be specific about what we are trying to achieve. We should tell children that we are working on their language skills to make them more conscious of how they use language and the language that surrounds them. This may make it more likely that the effects of therapy will transfer out of the clinic and into the child’s “real world”.

Our efforts to date to translate research into practice when delivering therapy by telehealth 

In response to research, we have developed a range of language tools for our clients that are explicit in their goals, and focused on expressive language in context. We’ve also adapted some of our resources to make delivery by telehealth easier for clients. For example, we’ve written:

Having used these tools with clients, we are now much more conscious of the need to work on expressive language for social purposes as part of a complex system, and the importance of making sure we collaborate with children and their families through therapy planning and delivery so that we all understand what we are working on, and why.

Bottom line

Effective language therapy can increase children’s participation and success at home, at school, and in life. Regardless of all the other things going on in the world right now, speech pathologists and others working with children with language disorders should keep a close eye on research developments so that we can continue to improve our practices by focusing on therapy tasks that make a positive difference to clients and their families outside the clinic. 

Related articles:

Principal source: Melby-Lervåg, M., Mjelve Hagen, A., and Lervåg, A. (2020). Disentangling the far transfer of language comprehension gains using latent mediation models, Developmental Science. 23:e12929. See: https://doi.org/10.1111/desc.12929.

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Oral language: what is it and why does it matter so much for school, work, and life success?

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Oral language is a wonder. Across time and cultures, most people develop oral language skills without much conscious effort. As a species, oral language has helped us to survive, reproduce, and to cooperate with each other, even in very hostile conditions. As individuals, oral language is crucial for social development, reading comprehension, learning, academic participation, and for work and life success.  

But what is oral language?

As a speech pathologist who works with people with Developmental and other Language Disorders, one of the most frustrating things about oral language is just how hard it is to explain to others in Plain English. I’ve tried a few times, without much success.

I’m going to have another go now!

A. Not just complicated.

Some things are made up of many interconnected parts. We describe these things as “complicated”. Cars and coffee machines are good examples. Often, the parts of complicated things work together in defined and limited ways to produce a result, like letting me drive down my street, or producing a hot cup of coffee. 

Language is made up of many connecting parts. But it is not like a car or a coffee machine. Oral language is not just complicated: it’s a complex system. 

B. What do we mean by a complex system?

Not only is language made up of lots of parts, but the parts interact with each other in lots of different – and often unpredictable – ways. This makes language complex, like weather or the health system.

Oral language involves listening (receptive) skills; and speaking (expressive) skills. It also includes different forms, content, and uses, as shown in this famous model:

C. Everything is connected! 

This sounds like something from James Cameron’s Avatar or something to be discovered on a life-changing meditation retreat. But, with oral language, it happens to be true.

Some children have language problems that affect primarily one sub-system or part of language. For example, many children with language disorders have difficulties with word forms (e.g. past tense verbs, like “jumped” or “flew”) or syntax (e.g. understanding and using complex sentences like “The boy ordered a pizza because he was hungry”, “Before you have breakfast, make your bed”, and “The dog was walked by the man with the grey hair”). But everything is connected, and language problems do not segregate into neat subtypes. 

As a practical example, consider the word “because”. If a 6-year-old child does not understand the word “because” and how it’s used, he or she will:

  • be unlikely to understand or use the word correctly as part of his or her vocabulary (a language content deficit);
  • have difficulties understanding or using the word as a subordinating conjunction in complex sentences (a language form deficit); 
  • have difficulties understanding or explaining cause and effect relationships in words, meaning they may not be able to answer questions or follow instructions from a teacher that include the term (both examples of language use deficits);
  • perhaps be perceived by the teacher and the child’s peers as unintelligent, impolite or disobedient (an example of the social stigma and low expectations that often accompany language difficulties); and
  • perhaps become reluctant to engage in future interactions and situations requiring knowledge of “because” (an example of how language deficits can reduce participation and inclusion over time).

Focusing on one aspect of language difficulty – e.g. receptive syntax or expressive vocabulary – in isolation doesn’t make a lot of sense when all aspects of language interact and feed into each other. Language difficulties in one area can have serious, systemic knock-on effects. 

Rather than trying to sort language problems into arbitrary categories or leaky buckets, it’s better to just use the term “language disorder” and think about treating the system. (You can read more about language therapy here.)

D. Typical language development

Given its complexity, it’s incredible that so many of us learn to understand and to use oral language without much direct instruction. But some people aren’t as lucky. It’s useful to know about typical patterns of language development so that people with, or at risk of, language disorders are picked up and helped as early as possible.

Note that this section summarises typical language development for monolingual children. For information about bilingual language development, please check out our separate article here.

Language development typically follows this pattern:

  • Understanding of language usually comes before speaking.
  • From the first months, most children develop native speech perception and production skills based on the language or languages the child is surrounded by.
  • Speech production starts with single words, followed by word combinations, to simple sentences and then more complex sentences.
  • Between 18 months and 6 years of age, children learn lots of new words: around 50 words at 18 months to around 10,000 words by 6 years. Word and sentence syntax skills also develop rapidly.
  • In infant, toddler and preschool years, most of the language a child hears is oral language. 
  • When literacy begins in late preschool or early school years, an increasing amount of language input comes from printed words, e.g. in books. 
  • Early oral language skills are a good predictor of early reading development. But, later, reading and spoken language development piggyback off each other. For example, quality books often contain more sophisticated vocabularies and sentence structures than conversational speech. 
  • During the school years, language skills continue to develop and be refined into adolescence, alongside various forms of “meta-linguistic awareness” (the conscious awareness of oral and written language and how it is used). 

E. Things that are known to affect language development

Oral language development is influenced by many factors, including:

  • genes. In children aged 2-4 years, the heritability of language is about 30% but this rises to around 60% by the age of 12 years. The genetic correlation between oral language and reading comprehension is above 0.80;
  • socioeconomic status (e.g. factors like parental education, income, and housing). On average, children aged 30 months-3 years from professional families are exposed to 11 million words in a year, compared to an average of 3 million words for children from the poorest families. Parent-child interactions for children from high socioeconomic backgrounds are, on average, more conversational than for children from low socioeconomic backgrounds. On average, parents with lower socioeconomic backgrounds tend to be more directive with their children, though, of course, there are many examples where this is not the case. Poverty has a big impact on reading outcomes too: you can read more about why poor kids are more likely to be poor readers here;
  • home learning environment. This includes the language and literacy skills of parents (which are of course also affected by genes), as well as the number of books in the home and the parents’ reading habits. You can read more about the importance of the home learning environment here;   
  • the interaction between your genes and your environment. For example, if you are good at using language, you will probably seek out more language-based activities. If you have poor social language skills, you will probably have less satisfying social interactions and socialise less; and
  • other known risk factors for language disorders: we’ve summarised some of the main known risk factors here.

F. This is interesting. Tell me more!

My favourite response, and why we write this blog! 

Here are my recommendations for further reading about different aspects of oral language. For each article, we include references to peer-reviewed research:

(1) Language Form

For information about phonological (speech) development, check out:

For information about early morphological development, check out:

For information about syntax, check out:

(2) Language Content

For information about vocabulary, check out:

For information about categories, semantic development, sequences, and inferences, check out:

(3) Social Use of Language (also called pragmatics)

We use oral language to communicate in different places with different people and for different purposes (pragmatics). For more information, check out these resources:

(4) Language Disorders and the importance of focusing on strengths, participation and inclusion

People with language and other communication difficulties are not broken and don’t need to be “fixed”. People are not their disorders. 

Lots of researchers, speech pathologists, psychologists, teachers, families and people with language disorders are focused on learning more about language and how to mitigate the effects of language difficulties. 

It is never too late to seek help! Find out more:

Key source for the information in Parts D and E: Hulme, C., Snowling, M., West, G., Lervåg, A, and Melby-Lervåg, M. (2020). Children’s Language Skills Can Be Improved: Lessons from Psychological Science for Educational Policy. Current Directions in Psychological Science, 29(4), 372-377.

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Locked down with preschoolers? Free language and reading information and resources to help make things better for everyone in the family – including you!

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Times are stressful for many of us in lockdown. Lots of things feel out of control, mainly because they are! And things are even tougher for many working parents with preschoolers at home.

But, while you can’t do much about the virus, the genes (and personalities) of family members, or the constant juggle of work and parenting tasks, you can take some simple, concrete steps to improve your home literacy environment to help your preschoolers’ language development, reading skills, and readiness to learn.   

What on earth is a “home literacy environment”? 

It means the reading and writing activities you engage in with your children, the reading resources you have at home, and your own attitudes towards reading and writing. It includes:

  • informal literacy interactions: reading storybooks with your children and bringing their attention to written words, e.g. from TV shows and ads, Netflix and Nintendo menus, on food packaging, fridge magnets, bedroom wall posters, and car bumper stickers;
  • formal literacy interactions: directly teaching reading or print-related skills to your children, e.g., by teaching them how to write their names, the letters of the alphabet, or the links between letters and speech sounds; and 
  • your indirect reading influence: being a role model for your children by reading and writing in front of them (including when typing those work emails and text), having lots of books and magazines in the house, and helping children to see good reading and writing skills as part of your family’s “identity” and value system.

Why does your home literacy environment matter?

It’s an important predictor of preschoolers’ language and literacy development. It has a significant effect on school readiness. Along with family stress levels and child health factors, the home literacy environment is a predictor of children’s attention and behaviour at the end of the preschool period.

Free information, resources and tips to improve your preschooler’s home literacy environment

1. Read quality picture books with (not just to) your children

  • Here’s why to do it.
  • Here’s a summary of how to do it.
  • We’ve made some specific book recommendations here and here and here and here, although any book your child is interested in is better than none. 
  • It might be hard to access free physical books at the moment with many government libraries closed. Free videos of many books recommended can be accessed on YouTube and other places. 
  • If you are reading books off a screen, e.g. on a Kindle or iPad, try to keep the experience interactive – e.g., by pausing at the end of each page to discuss what’s happening, to describe the pictures, to point out the printed words, to explain and demonstrate interesting words, and to predict what might happen and why. 

2. Make storybook and other reading a daily habit 

Use these tips from the science of habit-formation to help make reading together a daily routine that forms part of your identity as a “reading family”:

(A) Make reading obvious: 

  • When opportunity strikes, draw attention to printed words around you, e.g. when watching TV together, preparing dinner, or if you are putting together presentation slides for work. Point to the words as you read them. Read more about increasing your child’s print awareness here. 
  • Scatter storybooks around the house, in multiple rooms – not just in a dusty corner or in the “good room”. 
  • Use “habit stacking”. Tie your daily reading habit to an existing everyday event, e.g. “AFTER [bathtime], I will immediately read a storybook with my kids for 15 minutes.”
  • Let children see you reading and writing through the day – one of the benefits of working from home.

(B) Make reading attractive: 

  • Bundle reading with another activity your children love. For example: “After we read a storybook together, my children can:
    • play [Minecraft or other game] for 20 minutes; or 
    • will make [a Lego creation]; or 
    • have a [favourite snack].” 
  • Bundle reading with an activity you love. For example: “After we finish reading a storybook together, I will leave them to their reward and:
    • watch [my favourite TV show]; or
    • enjoy [my favourite dinner or drink] [with my partner]; or
    • scroll through [Instagram, Twitter, TikTok, etc] for 20 minutes. 

(C) Make it easy:

Decrease the number of steps to get started, e.g.:

  • by having your children pre-select the books they want to read and having them ready; and 
  • putting the book on your child’s pillow or bed, e.g., if your habit you have established is bedtime reading.  

(D) Make it satisfying: 

  • Reward yourselves for finishing each book. 
  • Track how many books you’ve read together on a reward chart. 
  • Use a habit tracker (app or paper and pen) to track “hot streaks” (consecutive days of reading together). 
  • Never miss twice: if you miss a day, don’t feel guilty, but get back on track immediately.
  • Team it up with some of the real world language stimulating activities we suggest here. 

3. At home, or in the car, listen to quality audio books or make your own as a project 

  • Read specific audiobook recommendations with free links to audiobooks: here and here and here.

4. Teach your children to write their names 

  • All you need is paper, pencils or crayons and lots of practice! 
  • Need some help with pencil grip? We’ve got you covered here.

5. Teach your children the alphabet, as well as their letter-sound links

  • Read more about teaching the alphabet to your child (including suggested sequences) here.
  • Make, download (e.g. from Pinterest), and/or buy, then stick up an alphabet chart or runner in your children’s room(s), and refer to it daily, e.g. during story time. 
  • Teach your child basic letter-sound links using our free videos, here. 

6. Don’t let things get too regimented or routinised!

Encourage your children to play with abandon!

7. Look after yourself!

It’s hard to look after preschoolers if you are struggling with your own mental or other health issues. Be kind to yourself. Don’t try to be perfect – we all have bad days. Sleep. Exercise. Eat well. Stay connected with friends and family, even if you can only do so electronically or on the phone. 

Don’t hesitate to seek help from health or other professionals if and as you need it.

We’re all in this together!

Key sources: 

  • Dilnot, J., Hamilton, L., Maughan, B., Snowling, M.J. (2017). Child and environmental risk factors predicting readiness for learning in children at high risk of dyslexia. Development and Psychopathology, 29, 235-244.  
  • Puglisi, M.L., Hulme, C., Hamilton, L.G., Snowling, M.J. (2017). The Home Literacy Environment is a Correlate, but Perhaps Not a Cause, of Variations in Children’s Language and Literacy Development, Scientific Studies of Reading, 21:6, 498-514. 
  • Clear, J. (2018). Atomic Habits: An Easy and Proven Way to Build Good Habits and Break Bad Ones. Random House Business Books, London, Great Britain.

Related articles:

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Another lockdown freebie: Letter-Sound Video Models for Beginning Readers

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As we settle into another week of lockdown in Sydney, we thought it would be useful to share another free resource to support early reading development. ⁠

In this free video modelling resource (available as a PDF or in Google Slides), we introduce high frequency grapheme-phoneme correspondences (GPCs) following a sequence aligned with the popular Sounds Write synthetics phonics program. We introduce the GPCs in small groups, starting with <a, i, m, s, t>. 

Each video includes a model, followed by a grapheme review to check for knowledge and recall. Each subsequent video builds on the last by introducing a new group of sounds, and then reviewing all sounds previously introduced. 

click to access free video modelling resource

For more on how early letter-sound relationships, check out our articles:

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

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