Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

Language

Light Up Language With Idioms

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In this video blog, we discuss idioms: why they are important for primary and high school students (including children with developmental language disorders), which idioms to learn, and how to teach them.

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.

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The High-Frequency Verb Library

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Parents, teachers, speech pathologists, lend me your ears! I have come to PRACTICE verbs, not to guess at them.

Introducing our High-Frequency Verb Library. 28 no-preparation, verb-based workouts at the sentence level. More than 650 pages: bit.ly/verblibrary

Come. See. Conquer! 

Access The High-Frequency Verb Library

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Early Prepositions: A FREE audio-visual resource for anyone who wants it!

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From around 18-24 months of age, typically developing children start to understand and to use words like “on”, “off”, “up”, “down”, “in”, and “out”. As their language improves, children start to understand and use other words like “over”, “under”, “between”, “in front”, “behind”, “beside”, “next to” and “through”.

All these words are “prepositions”. Early “prepositions” are all about the positions of things in space, or relative to other things. This makes sense: the word “preposition” comes from the Latin praepositio(n- ), from the verb praeponere, which in turn is made up of:

  •  prae ‘before’ + 
  • ponere ‘to place’.

Many children – including some children with developmental language disorders, and some children learning English as an additional language – have difficulties understanding and using early prepositions.

As any experienced speech pathologist will tell you, lots of children struggle to pick up prepositions from passively looking at worksheets or books. It’s much better to show children what the words mean, for example, in natural play activities.  

Many children with preposition difficulties needs lots (and I means LOTS) of repetition. And some children struggle to learn words in play activities – for example, children who have difficulties with joint attention and/or play.

To make things easier for families, preschool teachers, child carers, speech pathologists, students, assistants, and others working with young children, we have put together a library of short early preposition videos. For each preposition, we provide ten examples of the preposition in action using familiar objects. We then invite children to “show us” the preposition in question by having a go at showing it.

Go to the Early Prepositions Video Library

Important thanks and credits

The videos in this free resource were made by:

  • our wonderful first year speech pathology Masters students from the University of Technology, Susannah and Joe;
  • Cherie – our hard-working, multi-tasking administrative assistant and fourth year University of Sydney speech pathology undergraduate student. (Cherie made some of the trickier videos, and helped me oversee the project – all in between answering phone calls); and  
  • some of our busy Banter clinicians between therapy sessions.

Now, none of us will be challenging for Best Director at this year’s Oscars. Different speech pathologists and students used slightly different ways of modelling the prepositions, and our editing is a little rough and ready in places. However, this project was not about slick perfection; it’s about giving children multiple exposures to each preposition in as little time as possible while showing what it means. 

These videos can be used within our learning platform, or downloaded to your preferred storage spot. They are designed to be watched during everyday activities, e.g. at the start of mealtimes, in the car, or while waiting in lines.

Bonus

We’ve added in some evidence-based tips you can use to help children to understand and learn prepositions. These include overviews of techniques like following the child’s lead, focused stimulation, modelling and recasting.

Thank you!

We’ve had great feedback on the videos from clients and their families, and wanted to share them with others as a free resource.* 

We hope you find these videos as useful as we do!

*Licence details: These resources are published under a standard Creative Commons Attribution-NonCommercial (CC BY-NC) License. You can read more about this kind of license here. 

Related articles:

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.
Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification. David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

My child has ADHD. Should I get his/her language checked?

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Yes.

And here’s why.

We’ve written before about the complex relationship between Attention-Deficit Hyperactivity Disorder (ADHD) and language development, based, in part, on some terrific research published back in 2015. But there is growing, higher quality evidence that children with ADHD have a higher prevalence of language difficulties than their typically developing peers. 

A systematic “meta-analytic” review was published in 2017 by Dr Hannah Korrel and colleagues. The researchers painstakingly reviewed peer-reviewed, published research on children with ADHD that included standardised language testing measures. The research team concluded that:

  • children with ADHD had significantly poorer language functioning compared with other children, including overall, with expressive language, receptive language, and pragmatic language, also known as the social use of language; and
  • although the evidence is a bit mixed, in general, there was a pattern of larger deficits in children with ADHD as the processing/narrative requirements became more demanding (e.g. Luo & Timler, 2008).

Taken together, these results provide strong evidence that:

  • ADHD is associated with weaknesses in several language areas; and
  • difficulties with expressive, receptive and pragmatic language should perhaps be considered “core” elements of ADHD deficits.

Why are language problems so common in children with ADHD?

We don’t know!

  • Some researchers think that ADHD and language disorders – although different things – often co-occur, and have some common symptoms. Interestingly, some of the diagnostic criteria for different kinds of ADHD include things we often seen in children with developmental language disorders, e.g.:
    • “Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).”
    • “Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).”
    • “Often talks excessively.”
    • “Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).”
    • “Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities).”   
  • Some researchers think that ADHD symptoms – (e.g. poor concentration and attention, or working memory deficits) – may affect language performance on tests (e.g. Barkley, 2014), which is why we find the research identifying some tests we can use to help distinguish issues so useful, clinically.
  • Some researchers look at the fact that ADHD affects children with low socio-economic status and/or learning disorders disproportionately, and observe that both low socio-economic status and learning disorders are known to have a secondary impact on language skills (e.g. Neville et al., 2013).
  • There is some interesting research looking at developmental brain differences in children with ADHD and children without ADHD, which may be associated with language issues – though this research is still in its infancy (e.g. Kibby et al., 2009, Miller et al., 2006).

Why is this an issue?

Three main reasons:

  • Language problems are not currently included as a core diagnostic criteria of ADHD in current clinical classification systems like the DSM-5 (although, as noted above, language-related symptoms are certainly included).
  • Past research indicates that language deficits are not currently being appropriately identified or treated in many children with ADHD. One study showed that less than half of children diagnosed with ADHD and language problems had accessed speech pathology services, with only a quarter accessing language therapy at the time of the study (e.g. Sciberras et al., 2014).
  • Lots of studies that did not include standardised testing (and were therefore not included in the systematic study) suggest that many children with ADHD have marked language impairments that continue into adolescence and may even persist into adulthood – even if they don’t warrant the label of “language disorder” (e.g. Englehardt et al., 2012). So we might be underestimating the size of the problem.

Clinical bottom line

Children with ADHD should have their language assessed, including their receptive, expressive and social use of language. At the very least, children with ADHD should be screened by a speech-language pathologist so that potential language issues can be identified, then investigated and treated, as early as possible. 

Related articles:

Principal source: Korrel H., Mueller, K.L., Silk, T., Anderson, V., and Sciberras, E. (2017). Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder – a systematic meta-analytic review. Journal of Child Psychology and Psychiatry 58;6, 640-654.

Special thanks to Associate Professor Natalie Munro from the University of Sydney for bringing this important research to our attention.

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Lifting our game: using language sampling to improve language therapy

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Earlier this year, a family came to me for a second opinion about their child’s language development. Ahead of my first appointment with the family, the parents sent me a two-page, undated report from the child’s speech pathologist. It consisted of a computer-generated table setting out the child’s scores on the CELF-5 (a language test), a one-line “diagnosis” of a moderate developmental language disorder, and a recommendation to start weekly “language therapy” with no information about goals.

Yes, most speech pathology services are short on time and resources. Yes, detailed assessments and report writing take up time that can be used to treat clients. But, as a profession, we owe it to families to do better assessments and to provider a higher quality of care to children with communication challenges.

Some well-known limits of norm-referenced standardised tests

When assessing a child’s language skills, norm-referenced, standardised language assessments have their place. But, on their own, they are woefully inadequate to measures a child’s true language strengths and challenges. For a start, norm-referenced standardised tests like the Clinical Evaluation of Language Fundamentals Fifth Edition (CELF-5):

  • provide just a snapshot of how the child performed at a single point in time;
  • are often administered in the first session, when the child has just met the speech pathologist;
  • are usually carried out one-to-one, in a quiet “clinical” space with few distractions;
  • rely on the child’s cooperation and engagement;
  • are not reliable for people learning English as an additional language;
  • can be of limited use for some people with Autism Spectrum Disorder and other people with social or pragmatic language disorders (see, e.g. Speech Pathology Australia, 2009);
  • focus, in the main, on language at the word and sentence levels; and
  • do not take into account lots of personal and environmental factors that can affect how the child interacts with others (Australian Institute of Health and Welfare, 2003; Filipek, 1999; National Research Council, 2001).

Language assessments: some good practices

In addition to standardised testing, language assessments should also include:

  • a pre-asessment case history that gathers information about known risk factors for language disorders, and important other factors like other diagnoses (e.g. hearing issues, ADHD, Autism Spectrum Disorders);
  • for children who are learning more than one language, a detailed understanding of the child’s language exposures, in the context of our knowledge of bilingual language development;
  • a detailed interview with the family about their concerns and input from other people that spend time with the child, e.g. grandparents and other carers, preschool/childcare educators, and teachers;
  • criterion-referenced tests that probe specific areas in which the child is reported to having difficulty, e.g. in word-finding or following instructions at school;
  • observations of the child in a more naturalistic setting, e.g. in play; and
  • continuous observations and probes over time, so that we can monitor a child’s language development dynamically.

Good language assessments should also include language sampling at the “discourse level”. Let me explain why.

Language sampling at the “discourse level” and the importance of calculating an “MLU”

By “discourse level” assessments, we mean tasks that require the child to understand and/or say a connected series of “utterances”, e.g. in a “text” (e.g. a story, description, or a recount), or in a conversation. By “utterances” we mean more than one uninterrupted “chain” of language – preferably that the child says spontaneously.

For almost a century, we’ve known that a child’s average sentence length is a good way of assessing language development (e.g. Morse, 1925). In the 1970s, Roger Brown and colleagues established that the average number of words or morphemes in a child’s spontaneous utterances – the so-called mean length of utterance or “MLU” – as a benchmark for describing children’s language abilities (e.g. Brown, 1973).

More recent research has shown that MLU is a reliable and valid way to measure language acquisition. It’s also shown that a significantly lower than expected MLU is a marker for a language disorder (e.g. Rice et al., 2010). 

MLU norms for clinical use

Here are some MLU norms we use in our clinic:

(Source: Rice et al., 2010.)

Some examples of discourse-level assessments

Ideally, speech pathologists should seek to collect 50-200 complete and understandable utterances (Rice et al., 2010). This can often take up to 30 minutes and is obviously easier to achieve with chatterboxes than children who don’t talk much!

One way to collect spontaneous language samples from children is through play-based conversations using age-appropriate toys, e.g. toy people, household objects, toy animals, or “sets” of toys or equipment associated with different scenarios, e.g. medical emergencies or camping (e.g. Rice et al., 2010). “Best practice” guidelines to get a good sample include following the child’s conversational lead, engaging in parallel talk about familiar household activities, sharing personal anecdotes and experiences, and introducing topics related to past and ongoing events during conversation. Speech pathologists are trained to minimise “yes/no” and “wh” questions, and to avoid “taking over” conversations – although some of us (me included!) struggle at times.

Westerveld & Gillon (2002) have published a great free protocol covering three discourse-level contexts: (1) a conversation, (2) personal narratives, and (3) a story retell task. See below for details.

Another – fairly efficient – way to collect a discourse level sample is with a standardised story retell task like the Bus Story Test. But we always try to get a conversational sample as well, as it gives us useful information about the client’s language forms, content and use.

How to work within resource and time constraints

Outside of research, most speech pathologists I know (including us) struggle to find the time to transcribe and analyse language samples in exhaustive detail. It can take several hours to analyse a 200 utterance sample to research standard. The professional time needed to do this work would make assessments unaffordable for many families. And most of our clients and speech pathologists would prefer we use our time to deliver therapy.

Clinically, we can use software and databases like the ones listed below to save time. We are very excited about trialling the relatively new SUGAR resources (see below) in 2020. But, to date in our practice, our language sample analyses have been directed at identifying functional language targets that go directly to the concerns of the family. For example, we can listen back to recordings of the language samples and:

  • calculate the MLU and compare it to the Rice et al., norms;
  • analyse, say, the longest 10-15 utterances for length and complexity;
  • analyse verb use and marking (an important marker for language disorders);
  • analyse coordinating and subordinating conjunctions as proxies for sentence complexity;
  • look at the recall and use of language content (e.g. word finding, and verb knowledge); and
  • compare sentence structures/varieties against developmental norms and scales or frameworks like LARSP (see below).

Clinically – even when using rules of thumb like those above – we have found that language sampling analysis provides us with more functional and useful therapy targets than simply looking at the word and sentence errors in norm-referenced, standardised tests.

Clinical bottom line

Discourse skills are an important:

  • source of variance in children’s language abilities; and
  • additional dimension for studying growth in language skills over the course of childhood (Language and Reading Research Consortium, 2015).

In language assessments, we need to include language sampling in our assessments to improve the quality of our work. More tools, resources and technologies are now available to support us to do language sampling. Part of our job is to keep an eye on these developments – including by trialling the new SUGAR resource – to ‘up our game’.

Some resources for speech pathologists looking to do more language sampling

  • Sampling Utterances and Grammatical Analysis (SUGAR) (Pavelko, Owens, Ireland and Hahs-Vaughn, 2016). SUGAR is a tool for enabling speech pathologists to use language sampling as a regular part of a comprehensive assessment of children with possible language disorders. On its website, you will find SUGAR video training modules, sub-analysis forms, norms, handouts, and intervention materials to enable you to collect, transcribe, and analyse a 50-utterance child language sample in approximately 20 minutes. Within another 20 minutes, you can identify possible intervention targets. Intervention resources are also available.
  • The Systematic Analysis of Language Transcripts (SALT) (Miller & Chapman, 2008). This software standardises the process of eliciting, transcribing, and analysing language samples, and includes a transcription editor and a reference databases for comparison with typical peers. It’s used a lot in research. However, it is not free and can be very time consuming to use in practice.

Principal sources:

Rice, M., Smolik, F., Perpich Travis Thompson, D., Rytting, N., and Blossom, M. (2010). Mean Length of Utterance Levels in 6-month Intervals for Children 3 to 9 Years With and Without Language Impairments. Journal of Speech, Language and Hearing Research, 53, 333-349.

Language and Reading Research Consortium. (2015). The Dimensionality of Language Ability in Young Children, Child Development, 86(6), 1948-1965.

Related articles:

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Language Tip of the Week: More Pointing!

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Point more often to stimulate your child’s concept and vocabulary development. 

For more on pointing and language development, read our article.

language stimulation tip of the week more pointing
Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.