Learning Disability Today
Supporting professionals working in learning disability and autism services

Talk it out

Specific language impairments affect a person’s ability to understand language, but can be easily missed – with detrimental effects to the sufferer, as Maxine Frances Roper explains.

“Meek as a bleedin’ lamb.” These are the words of an 18-year-old man to a speech and language therapist, describing his feelings upon finally receiving the right support at college, after being blighted by underachievement and behavioural problems throughout secondary school. His inappropriately glib speech is typical of someone with a type of language disorder known as specific language impairment (SLI), which affects the ability to understand spoken language.

People with SLI are often able to reel off linguistic clichés and stock phrases in parrot fashion without actually knowing what they mean, and so may appear eccentric, rude or inconsiderate, disguising a fundamental problem with language processing. Although they may be flagged up as problem children when first learning to read and write, the root cause often remains undiagnosed for longer, and can be masked by social factors, such as bilingualism or deprivation.

“The language problem is often only first identifiable through a child’s attempt at literacy and is confused with a spelling problem,” says speech and language therapist Maggie Johnson.

SLI is thought to occur with about the same frequency as dyslexia, a better-known condition affecting phonological processing, which leads to reading and spelling difficulties. There is some overlap with dyslexia in regards to weak short-term memory and the ability to identify composite sounds in words. However, unlike dyslexics, who typically struggle to sound out words but have good reading comprehension, a child with SLI may read fluently but understand little of what they have read.

A child of nine or 10 may recognise common expressions but lack understanding of grammar, word boundaries or synonyms. For example, they may write the phrase ‘I went away’ as ‘I wenta way‘, or not know that ‘went’ is the past tense of ‘go’. They may know the word ‘choose’ in the context of an instruction, such as: “Choose a snack from the canteen at lunchtime”, but not recognise that the word ‘select’ means the same thing.

Late talkers

Where SLI is identified early, it is usually through difficulties with expressive language, such as producing speech sounds. About 88% of SLI children are late talkers, who produce only a handful of sounds by the age of two. These speech problems are relatively easily treated if a child is referred to a speech and language therapist.

A Newcastle-based follow-up study of children aged four to 15 with language impairment found that those with purely speech articulation difficulties fared best in the long-term, and often caught up with their peers by the age of five if they received appropriate intervention. But for those whose problems were mainly receptive – to do with understanding what is being said to them – the outlook was considerably bleaker.“

Children who’ve got primarily expressive language difficulties are at least fortunate in that their difficulties are recognised because they can’t make themselves understood and they will attract sympathy and help,” says Johnson. “Receptive language problems tend to attract negative attention and it comes over much more as a behaviour issue than a language impairment. Their language doesn’t sound like a mistake. These children have got comprehension problems masked by their apparently fluent speech. But in a way, that fluent speech is not doing the child any favours because it’s giving a misleading impression of what the child truly understands and is capable of.”

Confusing and hostile

talking headFor SLI children, a mainstream school classroom is often a confusing and hostile environment. Unable to access language, they rely almost entirely on visual input and re-enforcement from others to make sense of the world around them. This causes problems in the later primary and secondary school years when teachers tend to adopt the ‘chalk and talk’ approach to lessons rather than doing practical and group-based activities. SLI children cannot follow instructions or class discussions, or produce the required amount of written information in the time given. They may lose their place in a book and need to be reminded what they are supposed to be doing, creating impatience in teachers and peers if their difficulties aren’t properly understood.

A particular problem is that children who have been identified at a young age are discharged from speech and language intervention services when they leave primary school, only to find their problems increase later on with the demands of the curriculum. Further studies indicate that receptive language problems are present in around three quarters of young offenders, and many affected struggle to access further education or employment.

As with other specific learning difficulties, such as dyspraxia, children with SLI develop a variety of avoidance and coping strategies to compensate for their difficulties. They can excel at visual-spatial tasks such as puzzles. Nouns and topic vocabulary where there is a visual stimulus are easiest for them to learn, and they will often memorise chunks of factual vocabulary based on a topic of special interest. As with the ability to pick up ‘street’ phrases and swearing, this can give teachers and parents the wrong impression of their capabilities.“

The reason they’re so good at vocabulary in their specialist subject is that they’ve had a manual, an instruction booklet, or they’ve looked it all up on the internet. They’re not having to process language, they’re just telling you what they know,” Johnson explains. “It’s when you question them; they get confused, don’t answer or give an off-target answer.”

Johnson believes SLI children learn best from computer programmes and from lessons delivered in the manner of a computer, with information presented visually and broken into small steps, with the option for children to navigate between steps at their own pace.

Managing expectations

Meanwhile, others maintain that despite the value of recognition and intervention, managing expectations is also important.“

One of the things we should be doing is not just finding ways to fix the problem, but finding ways to help them succeed,” says Dorothy Bishop, professor of developmental neuropsychology at Oxford University. “For a lot of these kids their entire time at school is failure, and however hard you work with them they are doing nothing but struggle.“

Speech therapy when children are younger makes a difference, but when they get older and when there are comprehension problems, I think you should anticipate some of them are still not going to be terribly good at anything to do with language by the time they leave school.“

My attitude to intervention is you wouldn’t try and make a blind child see, you would structure their environment and teach them to cope.” This involves encouraging children into hobbies such as sport, music and animals, that don’t involve their problem area, and which can be worked into careers as adults.

With recognition and encouragement, a language barrier need not be a lifelong barrier.

Guidelines for supporting an SLI child in the classroom

  • Make sure they are seated near the front of the class, facing the teacher
  • Break down instructions as far as possible
  • Communicate using normal pitch and volume, but keep sentences short
  • Encourage them to repeat back instructions to ensure they are understood, and write them down so that they are retained
  • Use plenty of visuals and games to aid their learning
  • Make use of teaching and learning support assistants. SLI children need continuous one-to-one support during regular lessons, not just speech and language therapy.

About the author

Maxine Frances Roper is a freelance journalist.

This article first appeared in Learning Disability Today, February/March 2012.

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