Children’s Therapy Services - Speech & Language Therapy Team

Children's Therapy Services - Speech & Language Therapy

We support children who have speech, language and communication difficulties. We help them to achieve clear and fluent speech and understand spoken language. Communication is a complex skill and we use communication aids, signs, symbols and gestures to support children and young people.

Overview
Available Locations
Contacting us and opening hours
How do I register for this service?
Waiting times

Type

Children's Therapy Services - Speech & Language Therapy Team

We're here to support children and young people (from birth to 18 years old) across Northamptonshire who have difficulties with speech, language, communication, or swallowing.

Our team is made up of experienced Speech and Language Therapists and Support Practitioners. We work closely with children and young people, their families, and the important adults in their lives - because we know that the best outcomes happen when we work together.

We believe that every child and young person deserves to feel understood, confident, and empowered in their communication. That's why we aim to help them reach their unique goals and full potential.

You know your child best. Our role is to support you, giving you the tools, strategies, and understanding to help your child thrive every day.

Together, we'll find what works best for your child and how to build on their strengths in a way that's positive, supportive, and tailored to them.

Who is this service for? Children and young people from the age of 0 to 19.

Find waiting time information about this service

Contacting us and opening hours

Telephone: 03000 273 789
Email: childsalt@nhft.nhs.uk

Children's Speech and Language Therapy
Sudborough House
St Mary's Hospital
Kettering
NN15 7RJ

Opening hours

Monday to Friday
9am to 5pm

How do I register for this service?

Referrals to the Children's Speech and Language Therapy service can be made by a range of education, social care and health professionals. All referrals to children's services are made through the Referral Management Centre (RMC).

Access the Referral Management Centre

Referral criteria

Children / young people aged 0-19 years
Consent from the person with parental responsibility
Registered with a Northamptonshire GP*
Children / young people with an identified speech, language or communication need who would benefit from specialist assessment and support

If a child is not registered with a Northamptonshire GP, even if they are resident in Northamptonshire or go to a Northamptonshire school, an extra-contractual referral agreement may be required. Please liaise directly with the service for advice.

Looked-after children placed in Northamptonshire, or Northamptonshire children placed elsewhere, may be seen where practically possible. Please liaise directly with the service for advice.

* Some GP practices on the boundaries of Northamptonshire and neighbouring counties may also meet the referral criteria. If you are unsure, please contact the team by emailing childsalt@nhft.nhs.uk for advice.

What information is needed to make a referral?

If you are considering making a referral for specialist support around a young person's talking or communication needs, please provide some personalised information about their current strengths and needs, including:

How they are communicating to get their wants and needs met (e.g. leading parents, bringing them things, using single spoken words)
If they are using spoken language, what do they enjoy talking about (with examples of what they might say / phrases they might use in different contexts throughout their day)?
Is your child's language difficulty impacting on their learning, social interaction or well-being? If so, how?
What is being sought or hoped for from specialist assessment and intervention?
What do you and parents feel you are already doing that is supporting their language / communication needs? How are they responding to this?

Speech screen

If the concerns are around a difficulty with saying certain sounds or the clarity of a child's speech, please refer to our Speech Screen [pdf] 1MB resource. Write in the boxes what the child says for each word so we can analyse the speech more accurately and determine if specialist support from our service is required. Look at the left-hand column, which indicates when sounds emerge and when sounds are delayed and require specialist assessment. A referral is appropriate if sounds are more than 6 months delayed.

Selective mutism pathway

For young people who might speak more freely at home but are unable to speak when outside the home (or there are people present who aren't immediate family), please refer to the Selective mutism pathway referral checklist [docx] 37KB.

Dysphagia

For dysphagia referrals, we require detailed information from a medical professional outlining specific eating and drinking challenges the child is facing, such as:

Are they displaying signs of aspiration?
Frequent chest infections?
Difficulty with weaning (if so, what specific difficulty)?
Failure to thrive?

Re-referrals

If a child has previously received assessment or an episode of care from the service and there are any changes in their communication or language skills which require problem-solving and collaboration with family regarding the home environment, then a new episode of care could be considered.

Families can contact the service by emailing childsalt@nhft.nhs.uk should this be something they wish to discuss in the future.

Waiting times

There are a large number of new referrals to the Children's Speech and Language Therapy service each month. Unfortunately, this means that waiting times for first assessments are longer than we would like. We know waiting can be difficult and we are sorry that it will take longer to be seen than you might have expected.

The current average waiting time for a first appointment with this service is 46 weeks (updated February 2026). This means that, for most people being referred into the service now, it usually takes around 46 weeks before they are seen for the first time. However, some people may wait longer than this as everyone's needs and circumstances are different.

We are actively working on reducing our waiting lists and waiting times are improving. In the meantime, here are some resources you can access while you wait.

What we do

We're here to support children and young people (from birth to 18 years old) across Northamptonshire who have difficulties with speech sounds, language communication, stammering or swallowing.

Our team is made up of experienced Speech and Language Therapists and Support Practitioners. We work closely with children and young people, their families and the important adults in their lives - because we know that the best outcomes happen when we work together.

We believe that every child and young person deserves to feel understood, confident and empowered in their communication. That's why we aim to help them reach their individual goals and full potential.

You know your child best. Our role is to support you - giving you the tools, strategies and understanding to help your child thrive every day.

Together, we'll find what works best for your child and how to build on their strengths in a way that's positive, supportive and tailored to them.

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How we support you

We hope to provide the right support that you and your child need at the right time, based on their current needs.

Episodes of care

An episode of care is the complete journey of care your child receives for a specific speech, language or communication need - from start to finish. It begins when your child's needs are first looked at by a therapist, and it ends when everyone who knows your child and supports them closely feels happier and more confident in supporting those needs.

Each episode includes time for assessment and therapy or support sessions, followed by a break so you and other key adults can put the strategies into practice in everyday life.

Working together

We start by getting to know your child and understanding their communication strengths and needs. Together with you, we'll decide on what your or your child's hopes are and build a plan around them.

Practising in real life

During the episode of care, we'll help you learn and use strategies that support your child's communication. When you feel confident, we can also share these with other adults in your child's life (like nursery or school staff).

Then, it's time for us to step back from direct sessions so you have space to make the strategies a part of your daily routines - at home, in school, and in the community.

Completing an episode of care

Once the key adults around your child feel confident using strategies we have shared - and these are being used regularly in everyday routines - we will gently step back and hand their care back to you and your child's educational setting.

At this point, their episode of care with us will come to a close. Ending an episode of care doesn't mean that all of your child's speech, language or communication needs are completely resolved. Instead, it means that you and the adults who support them now have the tools and the confidence to help them continue making progress in the ways that matter most.

Our aim is always to make sure that everyone involved in your child's care feels supported, confident and equipped to help them thrive.

What if more help is needed?

If your child has had an assessment or an episode of care with our service before, and you notice new changes in their speech, language or communication that you're worried about, we may be able to offer a new episode of care to support you with this. If, at any point, you'd like to talk things through or solve a current problem, please email us at childsalt@nhft.nhs.uk and we will be happy to discuss the next steps with you.
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How best to support your child

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For parents

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My child is not talking yet and likes to spend lots of their time moving around and exploring by themselves

Ways you can support your child

We know that your hope is to hear your child's voice but the more we try and push our interactions on to children, the more they will prefer time in their own space and world.

Our focus at the start is very much on supporting moments of connection, where your child feels safer and happier to allow you to share their space. From here they may begin looking towards you more to share their special interests and moments of connection.

Spend time focusing on being present while your child is playing and exploring their own space. Just sit there and watch them without feeling any pressure to do anything or involve yourself or say anything at all.

You might spend lots of time sitting on the floor, near to your child. Drop down onto your elbows or lie down on your side or front and think about being level with or below where there eyes are focused and looking.
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My child is not saying many words but likes to play with me and to show me things
Ways you can support your child

Get down on the floor with your child while they play

Try to spend some time watching your child. Look at how they play with toys and what their game involves

If your child speaks to you, copy back what they have said, to show that you are listening. You can add an idea on too, so if your child says "doggie!" you can respond with "hello doggie!" or "doggie is jumping!"

Try not to ask your child lots of questions about their games. Questions aren't a useful way of helping children to learn more words. Instead, talk about what you can see and what they are playing with

Some extra ideas to help you

These online resources from the BBC can help you to learn more about what kind of words and talking to use with your child at different stages of their language development:

How to respond to your child's way of communicating - BBC Tiny Happy People

Play park fun with toddlers - BBC Tiny Happy People

SuperPenguin

SuperPenguin is an app for carers. Support your child with free and clinically approved information that you can use today.

Download SuperPenguin from the Apple App Store, the Google Play Store, search 'SuperPenguin: Waiting Well' on your mobile device, or scan the QR code.

Open the app, type in the activation key RR53M8 and then create your account.
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My child is struggling to say some sounds

All children's speech sounds progress at different rates. If your child has been a bit later with learning to say words and sentences, you might find that it takes them a little longer to perfect certain speech sounds. It can be quite normal that children can be unclear with their talking in the early years and sometimes only their main care givers understand them. However, we would expect to understand most of what a child says by the time they go to school.

The table below highlights at what ages sounds usually develop. All children are different, so this is just a guide.

Sounds	Acquired by 90% of children by
p,b,m,w	2 years
t,d,n	2 years 6 months
End sounds in place, for example, cup, bag, mat	3 years
h,f,v,s,z,y,ng	3 years 6 months
k/c, g, l	4 years
Consonant blends including 3 element blends, for example, sp, st, fl, spl	5 years
sh, ch, j,zh	5 years
R	6 years
Th	7 years +

Ways we might support your child

If you are worried about your child's speech sounds, complete our Speech Screen [pdf] 1MB tool to record the sounds they can and can't use. You can do this at home or in their school, nursery or education setting.

Sometimes children can use sounds in some parts of a word but not in others, like being able to say 'bus' but not using 's' at the beginning of words like 'sun'. This is a sign that the sound is emerging and it should develop by itself over time. We would not accept a referral to our specialist service unless a child was at least 6 months delayed with their sounds.

If a child does not reach our threshold for referral but you are still concerned, we would suggest completing some 'phonological awareness' work. Phonological awareness is a child's understanding that spoken words are made up of sounds and how these sounds come together to form words. Doing this phonological awareness work will help give structure and develop the underlying skills needed for speech.

The Newcastle Assessment of Phonological Awareness (NAPA) and Newcastle Intervention for Phonological Awareness (NIPA) are great resources which we suggest you share with your child's school, nursery or education setting. We would then suggest you try our speech screen tool again in 6 months' time to monitor their progress.

Ways you can support your child

Let your child know you're really listening. If they're having trouble explaining something, encourage them to show you. They can point, use a gesture, act it out, or even draw a picture to help you understand.

Repeat your child's words back to them in the correct way so they always hear a clear model. You don't need to point out the mistake or ask them to say it again. For example, if your child says, 'Look, a pider!' you can respond with, 'A spider! It's a big spider!'

To help your child avoid getting frustrated at not being understood, repeat the part of their sentence you understood and wait. This way, they only have to work on communicating the missing pieces, not the whole thing again.

Talk about sounds in everyday activities, like the sounds at the start of your family's names or your child's favourite TV characters. Play simple sound games like a sound scavenger hunt, where you find as many items as you can beginning with different sounds around the house, on a walk, in the garden or at nursery. Talk about the words together each time your child finds one, modelling the sound for them to hear.

Some extra ideas to help you

Start your child's speech and language journey with speech sound support

SuperPenguin is an app for carers. Support your child with free and clinically approved information that you can use today.

Download SuperPenguin from the Apple App Store, the Google Play Store, search 'SuperPenguin: Waiting Well' on your mobile device, or scan the QR code.

Open the app, type in the activation key THA8M0 and then create your account.

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I think my child might be stammering or stuttering

Ways you can support your child

Give your child time to talk, get down to their level and listen.

Don't be tempted to advise them how to talk or tell them to take a breath, slow down or think about what they are saying. This just gives them more work to do.

Just keep eye contact and keep your body language and your tone of voice calm and focus on what they are saying, not how they are saying it.

What you can look at to support you

SuperPenguin

SuperPenguin is an app for carers. Support your child with free and clinically approved information that you can use today.

Download SuperPenguin from the Apple App Store, the Google Play Store, search 'SuperPenguin: Waiting Well' on your mobile device, or scan the QR code.

Open the app, type in the activation key U5CESM and then create your account.

Stamma

Help If Your Child Stammers | STAMMA

Action for Stammering Children

Support for Parents - Action for Stammering Children
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I am worried about how my child eats and drinks
Ways you can support your child

If your child is coughing and spluttering a lot when eating or drinking or they often go red or their eyes water, you need to think about seeking a referral for a dysphagia assessment. Dysphagia means having problems swallowing. You can speak to your GP about this.

Some extra ideas to help you

If the first stages of weaning your child are not going well or as you would expect, these links are really useful:

First line advice sheet - The Feeding Trust

Feeding Developmental Milestones leaflet - The Feeding Trust

Eating well in the first year - First Steps Nutrition Trust

Baby-led weaning: Is gagging normal?

Fussy eaters leaflet

Weaning your premature baby - Bliss

Bite and dissolve foods for children - Great Ormond Street Hospital

Recommended cups and bottles

Tum Tum 3-way trainer cup (free flow)

Tum Tum Tippy Up free flow sippy cup

Munchkin C'est Silicone open cup

Munchkin Splash toddler cup with training lids

Babycup Sippeco mini open cup

Please note that the organisations listed above are provided for illustrative purposes only. NHFT has no affiliation with any of the companies mentioned and alternative suppliers are widely available.
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While my child is a confident communicator at home, they cannot find their voice when we leave the house
Ways you can support your child

Usually, children want to speak, but in certain places or with certain people their body goes into freeze mode and they feel unable to use their voice. Their silence is a sign of anxiety, not refusal. It is called 'selective mutism' when there is a consistent pattern of not talking outside the home.

The most helpful early support you can give is to reduce the pressure on your child and help to build their sense of safety, calm, and connection. Before speech can happen, your child needs to feel relaxed and unpressured. Reassure your child that they do not have to speak unless they are ready.

Adults outside of the home can help them feel safe, calm and understood by focusing in on their play and playing alongside them without speaking or expecting them to speak.

Let them settle into new environments at their own pace and accept any way they choose to communicate (e.g. pointing, gestures, drawing). Try to avoid the following, which can make the child feel more anxious and harder for them to speak:

Avoid asking them questions

Avoid asking them to talk (say hello, tell them your name, etc.)

Avoid putting them on the spot

Avoid commenting on their silence

Avoid asking others to get them talking.
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My child sounds nasal when they speak and I am not sure if it is coming through their nose
Choose which of the following options best describes your child.
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- My child sounds like they have a cold or blocked nose all the time
  
  What is hyponasality?
  
  Hyponasality happens when a child is trying to make a 'nose consonant' sound (m, n, ng) but their nasal airway is blocked. This means the air cannot flow into the nose.
  
  So 'mummy' sounds like 'bubby' or 'nanny' might sound like 'daddy'.
  
  Hyponasality can also change how your child makes vowel sounds (a, e, i, o, u). This means their speech sounds blocked or congested, or like they have a cold when they do not.
  
  Hyponasality can be related to your child's accent and it can be normal for that accent. If hyponasality is not linked to the child's accent, it is often linked to:
  
  Allergies, like hayfever
  
  A cold or flu
  
  Enlarged tonsils or adenoids
  
  A deviated septum or other medical issues
  
  Ways you can support your child
  
  Please book an appointment with your child's GP practice to discuss your concerns. Be sure to ask about enlarged tonsils or adenoids and mention if your child has a history of snoring, disturbed sleep or frequent ear infections.
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- When my child talks I can hear air coming through their nose
  
  What is hypernasality?
  
  Hypernasality happens when a child is trying to make a 'mouth consonant' sound (like b, d, g, t, k, s, v, ch) but their soft palate is not closing the nose off fully and/or at the right time. This means air escapes into the nose when they are talking.
  
  Ways you can support your child
  
  Please book an appointment with your GP practice for a hearing test.
  
  Please also ask them to make a referral to the Speech and Language Therapy service for a more detailed assessment. Before the appointment with your GP, please think about the following things and ask them to include the details in their referral:
  
  Any recent hearing tests
  
  Any family history of speech or language difficulties
  
  If your child has had any difficulties with eating or drinking, either when they were first feeding from a bottle / breast or later when weaning
  
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- My child makes a snorting sound when talking
  
  What is nasal turbulence?
  
  Nasal turbulence, also called a nasal rustle, is usually heard when a child is trying to make a consonant sound, (like b, d, g, t, k, s, v, ch) but their soft palate is not closing the nose off fully and/or at the right time.
  
  This means air escapes into the nose when the child is talking. As the air pressure goes through, there is friction and bubbling of secretions above the opening. This bubbling is what you hear when the child is speaking.
  
  Ways you can support your child
  
  Please book an appointment with your GP practice for a hearing test.
  
  Please also ask them to make a referral to the Speech and Language Therapy service for a more detailed assessment. Before the appointment with your GP, please think about the following things and ask them to include the details in their referral:
  
  Any recent hearing tests
  
  Any family history of speech or language difficulties
  
  If your child has had any difficulties with eating or drinking, either when they were first feeding from a bottle / breast or later when weaning
  
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For schools, nurseries and educators
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- Supporting non-speaking children and young people and their key adults to have more frequent and meaningful moments of connection
  
  Aims for supporting the young person
  
  For the young person to have meaningful two-way interactions with important people in their lives
  
  For the young person's unique communication and interaction skills to be recognised, celebrated, and valued equally by important people in their lives
  
  For key adults to feel empowered and more confident in recognising and responding to all of their child's communication and knowing how to join their child's world
  
  We can do this by
  
  Helping key adults to understand how to hear and see all their child's communication
  
  Helping key adults to feel more confident in knowing how to respond to all of their child's communication
  
  Offering an opportunity for the child's parents / setting / therapist to bring together the views of all key adults on what best supports communication and interaction and what everybody needs to continue doing to best support this
  
  Creating a personalised communication passport that clearly outlines all of the key information for supporting meaningful and responsive interactions and communication
  
  What you can look at to support you
  
  Training for individuals and organisations - Intensive Interaction Institute
  
  About intensive interaction (video) - Kingfisher Special School
  
  An intensive interaction session (video)
  
  Intensive interaction - Sasha and Riana (video)
  
  The "what, how and when" of intensive interaction - MacIntyre
  
  Our link to i-discover on-line training - BCT type training offer
  
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- Supporting minimally speaking children and young people with using symbols to support their communication
  
  Aims for supporting the young person
  
  For the young person to have meaningful two-way interactions with important people in their lives
  
  For the young person to feel supported to communicate via range of means and share their messages, when they want, with whoever they want and in the ways they want to, and for them to feel better heard and understood
  
  For key adults to feel empowered and more confident in modelling without expectation and responding to more of the child's communication, using symbols to reflect this back
  
  We can do this by
  
  Helping key adults to understand how to hear and see all their child's communication
  
  Helping key adults to feel more confident in knowing how to respond to all of their child's communication
  
  Offering an opportunity for the child's parents / setting / therapist to bring together the views of all key adults on what best supports communication and interaction and what everybody needs to continue doing to best support this
  
  Creating a personalised communication passport that clearly outlines all of the key information for supporting meaningful and responsive interactions and communication
  
  What you can look at to support you
  
  Core Word Programme - Sensory Classroom
  
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- Supporting children and young people whose spoken language is gradually developing and who need help to build more phrases
  
  Aims for supporting the young person
  
  The aim is to support key adults to create high-quality communication and language learning environments and use high-quality language models in order to develop their child's language skills.
  
  We can do this by
  
  Helping key adults to have the tools to support and offer high-quality language modelling and respond in the best ways during play situations
  
  Helping key adults to feel more confident in reflect on how these strategies feel in practice
  
  Problem-solve how you might embed these into daily life in the school environment and support a high-quality language learning environment
  
  What you can look at to support you
  
  BBC Tiny Happy People
  
  NHS Best Start in Life - learning to talk
  
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- Supporting children and young people with speech sound difficulties
  
  Aims for supporting the young person
  
  For them to communicate as effectively as possible and feel better listened to and understood
  
  For key adults to feel empowered and more confident in building phonological awareness skills and helping the child to hear and recognise the difference between their productions and the way the word should sound
  
  For key adults to feel empowered and more confident in modelling speech sounds back to the child and positively helping them to re-shape their productions
  
  We can do this by
  
  Meeting with you and the young person to understand everybody's views about their speech
  
  Talking about what will happen next and how we can work together as a team
  
  Talking about strategies and activities that can help the young person and help adults to understand their speech process (or the area they are finding difficult or why they are struggling with the sounds they are struggling with) so we can best support them. Not all children need support in the same ways and we can tailor that approach
  
  Meeting with parents and teachers to discuss the most appropriate next steps if your child's speech is making progress OR it is not having a significant impact on their communication and ongoing speech sound input is having a negative effect on their wellbeing
  
  What you can look at to support you
  
  Do you work with children and young people with speech, language and communication needs in a mainstream school in Northamptonshire? Looking for a friendly forum to discuss concerns, problem solve and share knowledge and resources with other schools and an NHS Speech and Language Therapist? Join us for our online speech, language and communication network sessions.
  
  Find out more
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- Supporting children and young people who have difficulties with understanding and using spoken language
  
  Aims for supporting the young person
  
  Helping adults to understand the young person's speech and language skills, their strengths and needs
  
  Helping key adults to feel confident in supporting the young person's language skills
  
  Supporting the young person to understand their own speech and language skills
  
  We can do this by
  
  We might discuss diagnoses such as speech and language difficulties, developmental language disorder and language disorder in association with other diagnosed conditions (e.g. autism, brain injury, cerebral palsy, Down's syndrome)
  
  Supporting key adults in school to recognise the strategies and support in place and providing advice and recommendations to support specific areas of speech and language (e.g. how to learn new words, use grammar, and help them to understand what has been said to them)
  
  We will then close the episode of care with this ongoing advice in place
  
  What you can look at to support you
  
  RADLD - Raising Awareness of Developmental Language Disorder
  
  RADLD - YouTube
  
  Afasic - support and information
  
  Speech and Language UK: Changing young lives
  
  DLDandMe - developmental language disorder
  
  The DLD Project - developmental language disorder information and training
  
  NAPLIC - language and communication development
  
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- Supporting children and young people who stammer
  
  Aims for supporting the young person
  
  For the adults around the young person to understand what stammering is and how to talk neutrally and openly about stammering
  
  For the adults around the young person to see the bigger picture: that stammering is just one part of the young person's life and development
  
  For the young person to struggle less by identifying what makes it easier for them to talk and making adaptations to the talking environment
  
  We can do this by
  
  Helping key adults to move towards acceptance and minding less about stammering and to help the child or young person to achieve their goals in life
  
  Empowering adults to support the young person by signposting to useful tools, advice and sources of information
  
  Working with some families of younger children using videoing to help parents identify what works for the child
  
  For older children, working with them on a one-to-one basis or in a group to help them to mind less about stammering and develop their confidence in communicating
  
  What you can look at to support you
  
  Support for Schools - Action for Stammering Children
  
  In Education - STAMMA
  
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- Supporting children and young people struggling to break down food, control liquid in their mouth or safely swallow food and or drink - dysphagia
  
  Who is this for?
  
  Children and young people who are at risk of aspirating - food or drink going down the wrong way into their lungs
  
  They may have difficulties with preparing, chewing and swallowing food or drink, in consideration of what is appropriate for their broader developmental level
  
  There may also be young people who have oral aversion due to early negative oral or feeding experiences, linked to an associated medical conditions or interventions (e.g. intubation)
  
  Aims for supporting the young person
  
  For the child or young person to have safe and enjoyable mealtimes and responding to what they need to keep them as safe and healthy as possible
  
  Empower families and other key adults to feel more confident in identifying when their child may be struggling with food and/or drink and feel confident in being able to respond to these needs
  
  We can do this by
  
  Face-to-face assessment and discussion to find out how drinking and meal times are going, including what is working well and what the young person finds more challenging that is contributing to a risk of aspiration (food or drink going into the airway / lungs)
  
  Helping key adults to understand how to recognise when difficulties are occurring and the potential risk of these
  
  Helping key adults to feel more confident in knowing how to respond to their child's dysphagia and make adaptations to reduce risk and keep them as safe and healthy as possible
  
  Face-to-face sessions to practice texture modifications or feeding techniques together and opportunities to reflect on how the child responds to these
  
  Offering an opportunity for the child's parents / setting / therapist to bring together the views of all key adults on what best supports meal times to be safe and enjoyable, and what everybody needs to continue doing to best support this
  
  Creating a personalised set of eating and drinking guidelines that clearly outline all of the key information for supporting safe and enjoyable mealtimes
  
  What you can look at to support you
  
  As part of a wider project to make our training more accessible and available to all, we are currently in the process of writing and recording training sessions to be accessed online. They will be available in the coming months so please do keep an eye on this section of our website for updates.
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About your referral and first assessment
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- My child has been referred to the service
  
  Once your child's referral to our service has been accepted, they will be allocated on to our waiting list for the most appropriate pathway or area of support.
  
  There are a large number of new referrals to the Children's Speech and Language Therapy service each month.
  
  Unfortunately, this means that waiting times for first assessments are longer than we would like, and we are sorry that it will take longer to be seen than you might expect.
  
  Although we publish information about current waiting times, we are not able to work out when you might be seen and will not be able to provide this information if you contact us.
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- How can I support my child while we are waiting?
  
  While you are waiting to be seen you can find useful information about how you can support your child in the 'Ways we might support your child' section of this page.
  
  Ways we might support your child
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- What might happen in the first appointment?
  
  Your first visit to the speech and language therapy clinic will usually last around 45 minutes to 1 hour.
  
  We want you and your child to feel relaxed, so there will be plenty of play opportunities. Feel free to bring a favourite toy or book to help your child feel more comfortable.
  
  During the session, we will:
  
  Spend time getting to know you and your child
  
  Ask about your child's communication and early development
  
  Play and do some fun activities to see all the ways your child communicates
  
  Talk with you about their strengths and any areas where support may help
  
  Think together about the next steps and try out some helpful strategies that you can use at home with your child
  
  Our aim is to make the initial assessment a positive and reassuring experience for both you and your child. We want you to leave the session feeling supported, and with at least one practical idea or strategy that you can start using straight away in your everyday routines.
  
  You know your child better than anyone, and you're in the best position to support them in those important little moments throughout each day. Our role is to work alongside you, offering tools, strategies and understanding to help your child grow and thrive. Together, we'll explore what works best for your child, building on their strengths in a way that feels positive, supportive and truly tailored to them.
  
  What a communication assessment might look like
  
  What a speech or language assessment might look like
  
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- What happens after the first appointment?
  
  In your child's first appointment, our main aim is to assess their speech, language and communication needs. At the same time we will focus on working together with you to explore strategies that you can use right away at home. Therapy starts with you and what you can do at home.
  
  What happens after the appointment will depend on a range of factors that we will discuss with you, including the pathway of support your child is on.
  
  This may include:
  
  Further assessment sessions
  
  A supportive online workshop with you and your child's educational setting to explore your child's needs, review what support is working well, offer further advice and answer any questions
  
  Being added to a waiting list for more support, such as for speech sound therapy or communication coaching
  
  Further support with strategies for your child's needs
  
  Considering other referrals (e.g. hearing) or an assessment with the team for different clinical support
  
  Closing the episode of care
  
  How long might you be waiting for an episode of care?
  
  For a number of reasons it is very difficult to calculate waiting times for further support sessions or an episode of care, following your initial assessment. At the moment, waiting times for some episodes of care are more than 24 months and, in some cases, longer than this. There is already a high number of of children across the county with similar needs waiting for further face-to-face support or an episode of care.
  
  We are genuinely very sorry that the wait for face-to-face support sessions or an episode of care is so long. Families are waiting far too long following their initial assessment. We aim to prioritise meaningful support for every child and family and a complete episode of care, as opposed to just superficial reviews.
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What we do NOT do
There are lots of areas of support we do provide, but there are also areas of support that we do not provide. Please read below for more information about why we offer the support we do, why our service may sometimes not be the most appropriate service to support you or your child, and why our support may sometimes look different from what you were expecting.

Some children who have an education, health and care plan (EHCP) have direct speech and language therapy (SALT) provision specified in Part F of their EHCP. This direct provision is not provided by the NHFT SALT Core Team and it is the responsibility of the local authority to meet the provision documented or find an alternative independent provider.

If your child has an EHCP, please visit the Children's Speech and Language Therapy EHCP Team web page for more information or email EHCSalt@nhft.nhs.uk

Strengths-based focus

Everyone has different strengths and difficulties in their communication. We work to build on your child's existing strengths to support their communication. This might mean we do not focus on what you might expect or want us to focus on, as we have to spend time building solid foundations.

For a non-speaking child, this may mean focusing on all the ways they communicate and working to strengthen these, instead of focusing on getting them to speak. Or, for children who are finding certain sounds tricky, we might focus on their listening skills and their ability to tell the difference between different sounds before trying to get them to say tricky sounds.

Neurodiversity affirming

We work in a way that accommodates, celebrates, and adapts to neurodivergent communication styles and ways of thinking. As a neurodiversity affirming service, we would not look to assess and change neurodivergent communication differences.

It may help you to look at these resources which explore how communication difference may appear and how this can be supported:

AutisticSLT - Supporting autistic children's communication

ADHD Chatter Podcast - YouTube

A guide to neurodiversity in the early years - Anna Freud

Autism Level UP! - Tools and support

Working With My Mental Battery - NeuroWild

Northamptonshire now has a range of services to support autistic children, young people and their families. These include:

EnFold a charity run by autistic people and those with lived experience to support autistic children, young people and their family members. EnFold offers a range of workshops and groups for children, young people and their families. Support includes information regarding a wide range of autistic differences, including communication, sleep, eating, training packages and support regarding finances. EnFold can also support parents seeking autism assessment themselves

SEND Support Service - Courses for parents and carers | North Northamptonshire Council

Specialist SEND support services | West Northamptonshire Council

If your child has sensory differences that affect the way they interact with or process sensory information in their world, they are likely to benefit from a sensory assessment with an independent occupational therapy provider.

National Sensory Network - further advice and free sensory courses

Empowering YOU

We aim to provide the resources and strategies that parents, caregivers, and education staff need to encourage their child's communication, alongside time in clinic for you to practise these and feel more confident in using these strategies to support your child at home.

Research shows that those who are closest to children are the ones who can have the biggest impact on their communication.

What we also know is that 'little and often' input is better when supporting your child at home. You are the best person to grab 3 minutes when your child is in the bath, or 5 minutes when their little brother is asleep and you have the chance to offer these short bursts each and every day.

This is what will make the biggest difference. It isn't coming to see us every week to 'fix' their talking - it is equipping you with the skills you need to support your child every day.

Other specialist services

Parents and key adults can have the biggest impact on their child's communication. We involve parents, carers, education staff and other professionals to have an equal say in and responsibility for care, working as partners to enable positive changes wherever your child spends their time.

We will share information about your child's needs if they were very clear during our time together. If those needs need support that we cannot provide, we will recommend other specialists or services that are better suited to help.

For example, we might notice sensory differences that affect the way your child interacts with or processes sensory information in their world. In that case, we would write down what we have seen and the impact this appears to be having and recommend you see another specialist, such as a sensory assessment with an independent occupational therapy provider.

For neurodivergent children and children who are on the pathway for autism spectrum disorder or ADHD, there is a countywide agreement in place for SEND support services to provide this support.

Children with swallowing difficulties which put them at increased risk

Our role is to support those with the highest risk, particularly in relation to ill health or poor chest health as a result of eating and drinking difficulties (dysphagia).

The Community Speech and Language Therapy Eating and Drinking Service supports children who are struggling to break down food down or control liquid in their mouth to then swallow safely, and so are at a higher risk food or drink going down the wrong way.

Children who can safely bite, chew and swallow their preferred foods - even if these foods are very limited - are not vulnerable to having poor chest health. While a limited diet can be very worrying for parents, there is unfortunately not a service available to support children aged under 5 years with a restricted diet or sensory-based feeding difficulties. This child should be monitored by their GP for any lack of nutrition or growth concerns.

If you are worried about problems with early weaning without any associated early medical history which might increase vulnerability, contact our 0-19 service for support

If you are worried about a possible tongue-tie, contact our Infant Feeding team (for children up to six weeks of age) or your GP practice (for older children)

If you are worried about your child eating non-food items, please contact your GP practice

If you are worried about a potential feeding disorder and your child is over the age of 5 years, they can be referred to our Community Eating Disorders service (assessment only service) - please contact your GP practice in the first instance
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Preparing for adulthood

Your child may have long-term communication differences that need on-going support and awareness from key adults who interact and support them, after they have reached the age of 18.

Although they will always have high levels of adult support in the wider community, it is likely that they will be interacting with different adults, in different settings.

Because of this, a clear communication passport is needed to make sure that everyone who interacts with your child can make their interactions successful and well supported.

We may help to compile all the key information and write a personalised communication passport for your child as part of our support package.

If your child has a learning disability and we are part way through supporting them when they turn 18 years old, then an onward referral to the Community Team for People with Learning Disabilities Speech and Language Therapy service would be suggested so that they can continue to get the support they need.

Communication passport

Children's SALT - Communication passport completed example [pdf] 344KB

Children's SALT - Communication passport - template [pptx] 51KB

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Resources for schools, nurseries and educators

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Speech and language therapy toolkit for schools

In the UK, one in ten children need support with speaking and understanding language. In some areas of the UK, this increases to one in four. Without essential skills in speaking and understanding, children may struggle to make friends, learn, have good mental health and get a job in the future.

Speech and Language Therapists work with children who experience:

Little or no speech
Difficulties understanding and using language
Unclear speech
Differences in the way they interact and form relationships with others
Eating and drinking needs

This toolkit provides guidance and information for universal and targeted support for children with Speech, Language and Communication Needs (SLCN) and information regarding when to refer a child to the Speech and Language Therapy Services for specialist support.

Using the information in this toolkit you will be able to:

Understand the different areas of SLCN
Identify children with SLCN
Plan wave 2 interventions to address their needs from suggested resources
Know when to refer to Speech and Language Therapy Services

Early intervention, as soon as a need is identified, will help to prevent future problems.

Please note this is a working content and is regularly updated in accordance with departmental changes, new research and resources.

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Speech and language therapy provision model
The Bercow report (2008) identified that children and young people with SLCN should be supported across three levels - universal, targeted and specialist. The SEND reforms (2014) state that all children with SLCN (with or without an EHCP) should be supported in schools and there should be an inclusive approach to practice.

Specialist (few pupils) 10% of pupils have long-term, persistent SLCN and may need specialist support

Targeted (some pupils) 50% of pupils have identified SLCN in some areas of deprivation and may need targeted suppor

Universal (all pupils) 100% of pupils benefit from universal good practice in the classroom to develop these crucial skills

Universal level

All pupils should have support to develop speech, language or communication skills within the classroom and school setting as part of good practice. Sometimes, it is referred to as 'quality first teaching' or 'whole school approaches'. This level should also enable effective early identification of pupils who may be struggling. This may be known as Wave 1 in schools.

Targeted level

For some pupils requiring additional support when a need is identified. Pupils may be included in individual or group interventions. This may be known as Wave 2 in schools.

Specialist level

A few pupils may require specialist support to make progress. Pupils are likely to be known to the speech and language therapy service and receive support in the form of an assessment, advice, recommendations, or intervention. This may be known as Wave 3 in schools.
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Areas of speech, language and communication needs

English as an additional language
Many languages are spoken in Northamptonshire. Speaking more than one language is a positive and beneficial skill. There is no evidence to suggest that learning more than one language will cause speech and language difficulties. It is important to be aware that on first exposure to a new language a child may go through a 'silent' period.

As educators you should:

Value the child's first language and encourage families to continue to speak their strongest language at home to support the foundations in acquiring a language

Ensure these children have opportunities to mix with proficient English speakers in the classroom

Researchers agree that basic conversational language skills are acquired within about 2 years of initial exposure to the language, whereas it takes at least 5-7 years to catch up to the levels attained by native speakers in academic aspects of the language (J. Cummins (1979) ref in: RCSLT).

We know that identifying speech, language and communication needs (SLCN) in these children can be more challenging. It can be hard to know if a child's language abilities are due to them having English as an additional language or having underlying SLCN.

Investigating the following areas may be helpful in establishing if the child could have SLCN:

What languages is the child exposed to, by whom and for how long?

How much experience has the child had of English?

What language does the child communicate in mostly?

Are there any concerns about the child's first language?

Have they reached expected milestones generally?

Is there attention and listening appropriate for their age?

Do they show an interest in interacting with others?

Have they made progress with their English since being in school?
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Assessing speech and language skills
It is important to collate information about a child's presentation if you have concerns about their speech, language and communication (SLC) skills. Observations can be helpful in identifying what the child's needs are. The link to the observation record can be found in the useful link section.

Accessing a developmental assessment tool or checklist may help to collate information about a child's current SLC skills and identify those that may require additional support. The language checklist which can be found on the useful links and resources page may be useful in identifying the child's current strength and needs.

'Universally Speaking' are checklists that are free to download from the Speech and Language UK website. These help to assess a child's current speech and language skills:

Universally Speaking ages 0-5

Universally speaking ages 5-11

Universally speaking ages 11-18

More comprehensive assessment can be undertaken by teaching staff using 'The Progression Tools' (available for children aged 3 to 18 years). These can be purchased from Speech and Language UK:

Progression Tools from The Communication Trust for Primary Years Set

Progression Tools from The Communication Trust for Secondary Years Set

These assessments support staff in monitoring progression in 6 areas:

Understanding spoken language

Understanding and using vocabulary

Sentences

Storytelling and narrative

Speech

Social interaction

Not all children will need onward referral to the Speech and Language Therapy service. Those children who have mild speech, language and communcation needs (SLCN) or are 'vulnerable learners' may only require wave 2 interventions to boost their skills in school. As a specialist service we should be more highly involved with those experiencing more significant and specific SLCN.
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Referral information
Referrals can be taken from:

Nurseries / preschools, mainstream and special schools (with legal guardian's consent)

Other professionals such as a Health Visitor (with legal guardian's consent)

We accept referrals for children who are registered to a GP practice in Northamptonshire, irrespective of address or school

We do not accept referrals from parents and we do not advocate referral via a child's GP as they may not have all the information we need (it may even slow down the referral process).

There are 3 additional groups of children that we will see:

Children who attend a Northamptonshire special school who have an out-of-county GP

Children who have a GP from Wansford Surgery which is linked to Peterborough but located in Northamptonshire

Children who are already accessing other NHFT services, such as Physiotherapy, Occupational Therapy or Paediatrics

We advise schools to try to find out where the child's GP is based before referring them to NHFT. This will ensure the child accesses the correct service.

Referrals have to be made via our web-based form. Please visit the Referral Management Centre to make a referral (click make or retrieve a referral).

Referrals to the Speech and Language Therapy service are received by the Referral Management Centre and triaged by a Speech and Language Therapist.

Accepted referrals are acknowledged and parents or carers are invited to 'choose and book' their initial assessment date when slots are available.

Key guidelines for making referrals

It is important that the referral form is completed as fully and clearly as possible. Incomplete forms (for example, no NHS number, no date of birth, etc.) or forms without the requested supporting information where appropriate, will not be accepted and will be returned to the referrer for completion

Identify what area of SLCN you are concerned about and why you are referring them to the service, for example, speech sounds, language, stammering (see area of speech, language and communication needs and speech and language therapy referral process flow chart for guidance)

Include their current strengths and needs (using a checklist can be helpful)

Where possible, describe how their SLC is impacting on their daily life, social or emotional development and access to learning opportunities

Clearly document what support, interventions or strategies may have been trialled already for children experiencing language difficulties - we require evidence of 12 weeks of support before the referral will be considered

Outline any relevant medical or developmental information, such as there being a family history of SLCN, being known to ENT, awaiting assessment for ADHD, etc

Include any other professionals who are or have been involved with the child, their assessment findings and what their advice has been

As a service we need to demonstrate that the referral has been discussed with the parent or guardian and that they agree. It is imperative that the 'consent for referral' tick box is checked after discussion with the parent or guardian. A Speech and Language Therapy service leaflet can be given to parents or carers at the time the referral is discussed. This ensures parents are fully informed about the service and reason for referral

Once the referral form has been received, screened at the Referral Management Centre and accepted, the child's parents or guardian will be contacted and invited to phone the department to arrange an initial assessment when appointments are available. Parents have two weeks to contact the department to arrange this appointment. If no contact is made within this time frame then the child is discharged from the service. Similarly, if parents contact to arrange the initial appointment but then do not attend, the child will be discharged

As per Government guidelines, we aim to see all new clients within 18 weeks. We are currently experiencing long waiting times due to increased demand on the service but strive to see families as quickly as we can

If you are keen to support the child before their first appointment useful advice and resources can be found on the Balanced System website.
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- General referral advice
  
  For referrals for children with an additional language the referral must consider if the child has language difficulties in their first language/s before a referral is made. This should be established through discussion with parents or guardians where possible (see English as an additional Language (EAL).
  
  If the referrer has concerns about the child's hearing status please ensure that parents or guardians are advised to contact their GP or School Nurse for advice regarding a hearing assessment.
  
  If a child has previously been discharged from the Speech and Language Therapy Service, it would be appropriate to check the discharge report for any relevant on-going advice and the reason for discharge, before a re-referral is considered.
  
  Children are assessed face to face in clinic most commonly although some assessments may take place in school or via a telephone consultation. There is also the option to see children virtually if felt to be appropriate.
  
  When a child is seen for the first time information will be collated via parents or carers and the child's setting. Formal and / or informal assessments will be undertaken to identify any SLCN's.
  
  Some children will be discharged if they can communicate functionally or have appropriately developed speech and language skills for their age.
  
  If any SLCN's are identified the following interventions may be offered as appropriate:
  
  Direct 1:1 or small group therapy
  
  Training workshops and coaching for parents and teaching staff
  
  Specialist feedback and advice for parents and teaching staff
  
  We work in episodes of care to ensure children get the right support at the right time. This may include their case being closed when their main need is the support care givers need to embed into everyday situations. A child can be re-referred to the service at anytime in the future if concerns arise or further support is needed.
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- Northamptonshire Speech and Language Therapy referral process flow chart
  
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  Do you think your child has speech, language and communication needs?
  
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  Yes
  
  What areas are of concern?
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  Stammer or situational mutism
  
  Refer to Speech and Language Therapy service via Referral Management Centre with parents' or child's consent.
  
  Referral Management Centre | NHFT
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  Speech, language or communication
  
  Have you used a checklist or development tool to gather more information?
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  Yes
  
  Has the Speech and Language Checklist [pdf] 140KB or development tool identified difficulties?
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  Yes, speech difficulties
  
  Refer to Speech and Language Therapy service via Referral Management Centre with parents' or child's consent.
  
  Referral Management Centre | NHFT
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  Yes, language difficulties
  
  Has the child made expected progress over 12 weeks of intervention or strategies?
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  Yes
  
  Do not refer to Speech and Language Therapy service.
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  No
  
  Refer to Speech and Language Therapy service via Referral Management Centre with parents' or child's consent.
  
  Referral Management Centre | NHFT
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  No speech or language difficulties
  
  Do not refer to Speech and Language Therapy service.
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  No
  
  Complete observation, Speech and Language Checklist [pdf] 140KB or Speech Screen [pdf] 1MB to gather more information.
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  No
  
  Do not refer to Speech and Language Therapy service.
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Education, health and care plans

As part of a child's statutory assessment, the NHFT Speech and Language Therapy Core Team are asked to assess and determine a child's current needs and specify the provision to meet those needs. If an education health and care plan (EHCP) is then issued, the provision is documented under section F of the plan (Special Educational Needs Provision).

For those children who have an EHCP with direct speech and language therapy (SALT) provision specified in section F, the NHFT SALT Core Team is not commissioned to provide this direct provision and it is the responsibility of the local authority to meet the documented provision or find another independent provider.

If your child has an EHCP, please visit the Children's Speech and Language Therapy EHCP Team web page for more information or email EHCSalt@nhft.nhs.uk

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Advice sheets

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The language pyramid

The language pyramid is used to demonstrate the developmental process of language learning for children who learn language using a word-by-word approach (analytical language processors) as opposed to those who may learn language in chunks or gestalts (Gestalt language processors).

Attention, listening and play are the foundations of understanding, talking and speech sounds. Each layer scaffolds the next area of development.

For example, if a child presents attention and listening needs, they may be at risk of being late language learners or if a child has expressive language difficulties (talking skills) they may be late in developing some of their speech sounds.

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Attention and listening skills
An increasing number of children are starting their reception year with attention and listening difficulties and may present in the following ways:

Easily distracted

Fidgety

Require a high level of support to complete tasks

Unsure how to start a task

Can distract others verbally / or physically

May be passive and quiet

Struggles to follow instructions

Most children acquire attention and listening in an identified pattern. Children pass through distinct stages in their development of these skills. Children with ADHD or suspected ADHD should not be compared to these norms:

Level 1 (0-1 years): Child is easily distracted by things they hear or see in his environment. By nine months, shared attention has developed. This is where parent and child share a focus on the same object. It coincides with starting to use pointing.

Level 2 (1-2 years): Child can focus on something that they choose but finds it difficult to follow direction from an adult. Attention is single channelled. This means that the child can only take in information from one modality (listening, hearing, touch and manipulation) at a time, so the child can listen or do, but not do both. The child may appear to be ignoring you but is likely to be engrossed in what they are doing.

Level 3 (2-3 years): Attention is single channelled. With adult assistance, the child can shift his attention from what they are doing, to what the adult it is talking about. This means that your child needs to stop what he is doing before he can listen to you.

Level 4 (3-4 years): Attention continues to be single channelled, but the child can switch between doing something and listening without adult assistance.

Level 5 (4-5 years): It is not until this stage that attention becomes two channelled. This means that the child can be busy doing a task but be able to listen to someone else at the same time. This is an important skill for school.

Level 6 (5-6 years): Listening is now well established and sustained. The child can integrate information from the different modalities of looking, listening, touch and manipulation.

Reference: Reynell, 1977, & Cooke, J., and D. Williams. (1987)

Strategies for teachers and practitioners

Ensure that you have the child's attention before giving an instruction

Say the child's name and make sure that they are looking towards the speaker

Keep language short and simple

Support spoken instructions with visual cues wherever possible

Reduce noise levels and distractions, (for example, do not have construction toys next to the mark-making area)

Use a visual prompt to monitor classroom noise levels - a volume barometer would work well

Use gesture and animation to gain and maintain attention; change your voice, facial expression, clap, put up hands or ring a bell, etc.

Explore the usefulness of fiddle toys and movement breaks for children
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Common types of play
Exploratory

Water play

Pop-up toys

Play dough

Button toys

Sand play

Physical

Rough and tumble

Hide and seek

Bikes and trikes

Ball games

Fine motor activities

Constructive

Model making

Jigsaws

Craft

Lego or bricks

Large doll

Dolls or teddies

Farm animals

Dolls house

Train set

Pretend

Dressing up

Imaginative play

Role play
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Understanding of language - receptive language
When children have difficulty understanding spoken language they will experience difficulty understanding verbal instructions, understanding explanations and interpreting questions. They are also likely to have difficulty learning relevant curriculum vocabulary and concepts.

A child with receptive language difficulties may present in the following ways:

May need verbal instructions to be repeated and / or simplified

May not respond, or give inappropriate responses to questions

May follow other children and look to them for cues

May have difficulty understanding changes in routines and expectations

May appear confused or upset

May only be able to follow parts of instructions

Strategies for the teacher or practitioner

Ensure you gain the child's attention before giving verbal instructions

Use signs and symbols, pictures, objects, and natural gesture to support spoken language

Use clear and concrete language, giving instructions in the correct order

Be aware of using non-literal terms, like "Pull your socks up", "It's nippy outside" and explain these in context

Reduce longer and more complex verbal instructions to short simple and specific 'chunks' of information

Use vocabulary that the child is familiar with

When introducing new vocabulary use lots of repetition and support these with a visual prompt where possible

Make sure adults explain and frequently repeat new words in different contexts

Slow down and pause often

Repeat instructions if necessary

Allow extra time for responses and processing verbal information

Monitor understanding by asking the child to repeat back what you have said

Encourage the child's attempts to seek clarification by asking for help
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Use of language - expressive language
It is often the case that when children have difficulties using language that they have underlying attention and listening and / or receptive language needs (see communication pyramid link). When children struggle to express themselves effectively they are at greater risk of having difficulty participating in speaking and listening activities, answering questions, and expressing their needs and thoughts.

Children with expressive language needs will require support to help them to build and maintain friendships and to interact and converse on a level with their peers. It should be recognised that the child's spoken language difficulties will be reflected in their written language.

A child with expressive language difficulties (difficulties using spoken language or talking) may present in the following ways:

Uses only a small amount of words

Has difficulty using new words and / or using them appropriately

Uses non specific words such as 'thingy'

Frustration leading to anger, upset and withdrawal

Difficulty joining words and sentences

Confusion with grammar

Has difficulty initiating and maintaining conversation with adults / peers

Strategies for the teacher or practitioner

Reduce competing noise

Provide opportunities for talking, for example, circle time and home school diary

Consider the balance of speaking and listening opportunities within the setting

Use gesture or pictures to support expressive communication

Encourage any means of communication, for example, eye-contact, gesture, pointing, pictures, etc.

Concentrate on content of what the child is saying and then model the appropriate sentence structure - for example, Child: "I wented playgroup morning", Adult: "Yes, you went to playgroup this morning"

Repeat and expand upon what the child says - for example, Child: "Mummy car", Adult: "You went in Mummy's blue car". Do not ask the child to say it again but focus on providing a clear model

Give forced alternatives - for example: "Did you go with Grandma or Mummy?", "Do you need the sellotape or the scissors?"

Give opportunities for sentence completion. Start a sentence for the child to finish - for example: "I am sitting on a big chair and you are sitting on a..."

Allow extra time for the child to express what they want to communicate

Build in lots of opportunities to use new words. Make sure adults model and frequently repeat new words in different contexts and provide opportunities to pre-teach up-coming vocabulary
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Developmental language disorder
Due to changes in research and terminology the use of language 'delay' is no longer readily used by therapists.

Children under the age of 5 experiencing expressive and / or receptive language needs would be described as having language 'difficulties'. If a child has persisting language needs over the age of 5 years that is affecting their education and social function it is called developmental language disorder (DLD).

DLD is a lifelong condition. There is limited awareness of DLD currently in the general public however, it affects 2 children in every classroom.

DLD commonly occurs alongside ADHD and dyslexia. Children with more severe language needs can sometimes experience mental health difficulties.

The label Language Disorder in association with 'x' is used for children with other biomedical conditions, for example, Autism and Downs Syndrome.

More information

RADLD - Raising Awareness of Developmental Language Disorder

DLDandMe

The DLD Project | Developmental Language Disorder Information & Training
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Speech sounds

As with language, children acquire speech sounds in a typical pattern. It is often not as easy as we think! To be able to speak clearly a child has to be able to:

Hear, attend and listen to speech
Physically move the muscles that are used to make speech sounds
Co-ordinate the right movements to make the different speech sounds
Learn and use all the different speech sounds in the language(s) used around them
Listen to themselves to make sure the sounds are used clearly in everyday talking

Learning to use the correct sounds is a complicated skill that develops gradually from birth when babies start to 'coo' and babble and continues developing throughout the pre-school years and beyond.

This table outlines speech sound development norms. However, it is important to remember that all children are different.

Sounds	Acquired by 90% of children by
p,b,m,w	2 years
t,d,n	2 years 6 months
End sounds in place, for example, cup, bag, mat	3 years
h,f,v,s,z,y,ng	3 years 6 months
k/c, g, l	4 years
Consonant blends including 3 element blends, for example, sp, st, fl, spl	5 years
sh, ch, j,zh	5 years
R	6 years
Th	7 years +

Dodd et al 2003

Children with speech sound problems may:

Use a limited number of sounds and use a favoured sound like 'd' or 'h'. Listen to what the child is trying to say rather than how they are speaking
Swap sounds around - for example, saying 'tup' instead of 'cup'
Miss sounds out from words - for example, saying 'ed' for 'bed, 'boon' for 'spoon' or 'bu' for 'bus'
Have difficulty saying long or complicated words like 'elephant' or 'aeroplane'
Be able to say single words clearly but have reduced clarity in their connected speech

Strategies for the teacher or practitioner

Reduce competing noise
Listen to what the child is trying to say rather than how they are speaking
Repeat back clearly what the child has tried to say. Provide a good model. If you do have to ask the child to repeat themself, try to ask them only once
Do not ask them to copy your speech - for example: "It's car. Now you say it"
If you can't understand, say so and ask the child to try to tell you in a different way - for example, sign, point or show
Praise the child when they speak well or use different ways to get their message across
Provide visual supports in the classroom - for example, photos, pictures, symbols, and encourage their use of gestures and signs
If you use gestures and signs, the child will be more inclined to use them with you too
If you and the child get really stuck, move onto something else and try again later. For younger children, explain you have "not switched your ears on" or "have silly ears today". For older children, explain that you are finding it difficult to understand but that you can come back to it later
Work on attention, listening and phonological awareness as these will support the child with their awareness of speech sounds
Allow the child plenty of time to speak

Use NHFT's Speech Screen [pdf] 1MB to help you identify if a child has any speech sound issues and if onward referral to the service is needed. If the child is showing difficulties, there is NO need to do any intervention before referring to the service due to the specialist nature of this therapy.

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Social communication
Social communication refers to the skills needed to interact with others across a range of social contexts. Judy Singer highlights that there is natural variation in how humans think, feel and experience the world and this can be reflected in our social communication skills.

Neurodiversity

Neurotypical - those whose brain follows typical development regarding language and learning (the majority)

Neurodivergent - those whose brain diverges from the dominant population regarding language and learning - for example, Autism and ADHD.

Historically, autistic people and their style of communication and interaction have been viewed as impaired or needing to be 'improved' - however, this stems from a 'neurotypical' point of view.

We now know that all individuals may show differences in their social communication profile such as how they communicate, their desire to communicate with others, use language and socialise. It is important that we don't judge these from a neurotypical viewpoint and seek to alter or improve these.

Some of these children will benefit from support to:

Build mutually enjoyable and safe interactions and share their world with key people in their lives

Develop a functional communication system which may not focus on spoken language

Self-advocate

More information

AutisticSLT | Emily Lees | Supporting autistic children's communication

BBC Two - Inside Our Minds

Tiny Happy People - children's language development and parenting advice

Intensive Interaction - Fundamentals of Communication

These resources are useful even if you do not know if the child or young person is autistic as they open our minds to what is important and how we can best support.
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Selective mutism
Selective mutism is an anxiety disorder. It affects an individual's ability to verbally participate in some situations due to anxiety. They may speak freely at home but remain silent in other situations (most commonly in their setting). It is known to affect approximately 1 in 140 children and is more than 'shyness' or a reluctance to talk.

It is vital to create the right environment at school in order to put a child at ease and facilitate their communication:

Build rapport via nonverbal activities that do not place any pressure onto the child to speak

Introduce alternative forms of communication - for example, pointing, or holding up a picture in certain situations

Provide the opportunity rather than the expectation to verbally join in and try not to be hurt or offended if the child is silent

Prepare the child well in advance of any changes to the timetable or sequence of the day using pictures, symbols, etc.

Do not beg, bribe or challenge the child to speak and do not go over the top with praise if the child does suddenly speak

Do not ask the child direct questions which put them on the spot but make statements like "I wonder what you are painting?"

Do not reward silence, but instead reward every effort the child makes to communicate, help or participate in whatever form that takes

(Advice taken from 'Selective Mutism - Resource Manual' written by Maggie Johnson and Alison Wintgens)

We do not require schools to carry out interventions if they feel a child is selectively mute before referring to our service (they need to be in your setting for at least a month before you might consider this possibility). Due to the nature of selective mutism, we don't always meet the child on initial assessment. We offer routine training for parents and teaching staff.
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Dysfluency, stammering and stuttering
Children who are stammering can be referred to the service straight away if the child or family have raised concerns and would like some advice. There is no need to carry out any intervention with them before putting in a referral but, we ask that you complete a checklist to ensure they have no other speech and language difficulties.

The following websites provide information and good quality advice for parents or guardians, teachers and early years practitioners regarding dysfluency:

STAMMA home page

Michael Palin Centre for Stammering

Action for Stammering Children
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Communication-friendly environments
A communication-friendly environment is not just about the building that you are in, or the resources that you provide to the children. It is an environment that includes all learners and enables them to access and share information in the most appropriate way.

Things to consider to create a communication-friendly environment

The physical environment

The opportunities children have to communicate and involve planning activities that interest and excite the children and encourage their motivation for communicating with others

The way the adult talks, listens and plays with children

Teacher or practitioner awareness and training in SLCN

Key features of a communication friendly environment

Adults supporting children's communication needs (both in small group and 1-to-1 situations) using appropriate levels of language for all children according to their stage of development

Non-verbal communication such as gesture, signing, facial expression and eye contact are used to reinforce spoken language

Adults responding positively and valuing all attempts at communication, which may include non-verbal communication as well as spoken language

Ensuring the physical environment reflects the culture and ethnicity of the children

Using a range of multi-sensory approaches to support spoken language, such as, symbols, photos and real objects

Physically organising the physical environment to encourage good attention and listening

Adults simplifying and repeating verbal information and instructions, as appropriate, and seeking clarification from children that they have understood

Adults providing plenty of time for children to respond

Provision of some quieter area where children can talk to one another and form relationships

Opportunities for staff to share information and knowledge about SLCN
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Intervention resources and advice leaflets
The list below shows resources that are currently used in various schools around the country. This is only a list of suggestions and many other resources are available. Any resources used should be checked to ensure they are appropriate to support the child or children. It should be noted for children with SLCN in association with other identified learning difficulties, the rate of progress expected with interventions will vary.

Attention and listening skills

(Not suitable for use with children with a diagnosis or suspected ADHD)

Teaching Children to Listen, Spooner and Woodcock

Language interventions

Language Steps, Amanda Armstrong

Language for Thinking, Parsons and Branagan

School Start: Programmes for Language and Sound Awareness, Catharine Lowry and Catherine de la Bedoyere

Language for Learning: A Practical Guide for Supporting Pupils with Language and Communication Difficulties across the Curriculum, Sue Hayden and Emma Jorden

Understanding & Using Spoken Language, Catherine Delamain and Jill Spring

Speaking, Listening & Understanding, Catherine Delamain and Jill Spring

Languageland, Black Sheep Press

Speaking and Listening Through Narrative, Black Sheep Press

Word Aware, Parsons and Branagan

Blanks Levels of Questioning, Marion Blank

Speech

Letters and Sounds Publication, National Strategies

Caroline Bowen - Speech Language Therapy

Consonant worksheets, Blacksheep Press

Secondary school aged children

Secondary Language Builder, Elklan

Language for Learning in the Secondary School, Sue Hayden and Emma Jorden

Narrative Intervention Programme, Vicki Joffe

Vocabulary Enrichment Programme, Vicki Joffe

Language for Behaviour and Emotion, Stephen Parsons, Anna Branagan and Melanie Cross
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Useful links and resources

Speech and Language UK - Changing young lives

ICAN charity - helps children communicate

Afasic - voice for life

Early Words Matter Conference - National Literacy Trust

NALDIC - EAL National Subject Association

NAPLIC - professionals supporting language and communication development

RADLD - Raising Awareness of Language Learning Impairments - YouTube

STAMMA - we make space for stammering

Action for Stammering Children

Black Sheep Press - speech and language resources for schools, therapists and parents
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Masterclass workshops

Winning with Words - effective vocabulary teaching in the school environment

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Online speech, language and communication network sessions
Do you work with children and young people with speech, language and communication needs in a mainstream school in Northamptonshire?

Looking for a friendly forum to discuss concerns, problem solve and share knowledge and resources with other schools and an NHS Speech and Language Therapist?

Join us for our online speech, language and communication network sessions

"The network sessions are a great opportunity to discuss concerns with a therapist for advice about possible interventions or referrals and to gain updates about any changes within the service. It is also so useful to have recommendations from other people who have used a resource before you purchase it and to gain ideas from them."

SENCO, Northampton

Dates for 2026

Wednesday 15 April, 2pm to 3.30pm

Theme: English as an additional language and speech, language and communication needs

Wednesday 1 July, 2pm to 3.30pm

Theme: Supporting children and young people who stammer in schools

Wednesday 16 September, 2pm to 3.30pm

Theme: Supporting children and young people to generalise speech sounds in everyday talking

Wednesday 2 December, 2pm to 3.30pm

Theme: Language strategies for the classroom environment

How to book

Book your place by emailing SALTtraining@nhft.nhs.uk and please specify which session(s) you would like to attend.
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Area	Definition
Speech sound difficulties	Speech which is difficult to understand Difficulty in making and sequencing sounds into words An unusual voice quality
Use and understanding of language	Difficulties with: Following spoken instructions consistently Understanding and answering questions Learning and using vocabulary or finding the right words Sentence construction and use of grammar Sequencing sentences to tell stories, retell events, share news, talk about their likes or dislikes, negotiate, etc.
Social communication	Use of verbal and non-verbal communication skills to share space with others and send desired messages
Stammering or stuttering	A disruption to an individual's fluency (e.g. sound or whole word repetitions)
Selective mutism	An anxiety disorder in which affected individuals speak freely in some situations but remain silent in others

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