Speech & Language Therapy
Understanding speech and language therapy (SLT) - what it addresses, how it works, and its role in supporting neurodivergent children.
Speech and language therapy addresses communication in all its forms - understanding language, using language, speech sounds, and social communication.
For neurodivergent children, SLT often focuses on pragmatic (social) language and finding effective ways to communicate, which may include augmentative and alternative communication (AAC).
Areas of support
Many neurodivergent children process language differently. May need extra time, visual support, or simplified language.
Interventions:
- Visual supports alongside verbal instructions
- Chunking instructions into smaller steps
- Checking understanding (not just "Do you understand?")
- Reducing verbal load in instructions
Some autistic children have delayed speech. ADHD can affect word retrieval and organisation of ideas.
Interventions:
- Building vocabulary systematically
- Modelling correct grammar without demanding correction
- Giving time to formulate responses
- Alternative means of expression when verbal is difficult
Core area of difficulty in autism. Often overlooked because vocabulary and grammar may be strong.
Interventions:
- Explicit teaching of conversational rules
- Social stories for specific situations
- Video modelling
- Comic strip conversations
May co-occur with autism/ADHD but isn't caused by them. Separate issue requiring specific intervention.
Interventions:
- Articulation therapy for specific sounds
- Phonological awareness work
- Oral motor exercises if indicated
Low-tech AAC
- •Picture cards (PECS)
- •Communication books
- •Symbol boards
- •Written words
No technology needed. Portable and reliable.
High-tech AAC
- •Speech-generating devices
- •Apps on tablets
- •Eye-gaze technology
More vocabulary options. May require training.
AAC myths debunked:
AAC prevents speech development
Research shows AAC supports speech development, not hinders it. Children often develop more speech with AAC.
You should wait and see if speech develops
Waiting delays communication. AAC should be introduced early if there are communication difficulties.
AAC is only for non-speaking children
Many speaking children benefit from AAC to reduce demands, support expression, or use when verbal communication is difficult.
When to seek SLT referral
- Not using single words by 18 months
- Not combining words by 2 years
- Unclear speech that strangers can't understand by age 3
- Difficulty following instructions compared to peers
- Difficulty with conversations despite good vocabulary
- Significant difference between understanding and expression
- Any regression in language skills
What to expect from SLT
Assessment
SLT will assess receptive and expressive language, speech sounds, and social communication.
Duration: Usually 1-2 sessions
Report and recommendations
Written report with findings and recommendations for home and school.
Duration: Within a few weeks of assessment
Therapy blocks
Direct therapy in blocks (e.g., 6-8 weeks) working on specific goals.
Duration: Sessions typically 30-45 minutes
Parent/carer involvement
You'll be given activities to practice at home. Carryover is essential.
Duration: Daily practice recommended
Review
Goals reviewed and updated. May discharge if goals met or continue.
Duration: Typically every term or block
Evidence base
| Approach | Evidence | Notes |
|---|---|---|
| Parent-implemented intervention | Strong | Parents trained to support communication in everyday activities shows strong outcomes. |
| Naturalistic developmental interventions | Strong | Following child's lead, embedding learning in natural interactions. |
| AAC for minimally verbal children | Strong | AAC supports rather than hinders speech development. |
| Social communication groups | Moderate | Can be helpful but skills may not generalise without support. |
| Drill-based articulation therapy | Strong (for speech sound disorders) | Effective for articulation issues specifically. |
Strategies to use at home
Physically get down to eye level. Follow their focus of attention.
Give extra processing time. Count to 10 silently before jumping in.
Say what they might say, rather than demanding "Say X".
If they say "car", you say "Yes, a red car!" Add one element.
Pictures, gestures, and written words support understanding.
Comment instead of questioning. "I see a dog" rather than "What's that?"
Communication is the goal, not speech. The aim of SLT is effective communication - this might be through speech, but it might also be through AAC, writing, or other means.
For neurodivergent children, understanding pragmatic language often matters more than perfect grammar or vocabulary.