Rachel Watt Speech Pathology is taking a break from end of term 1 (April) 2024. It's been an honour and a pleasure to be welcomed into so many homes and schools over the last 2 decades.

Diagnosing and treating disorders of communication and learning is a complex and highly personal journey to walk with a client. That's why this has been such an interesting and rewarding job that has kept me learning and striving for so long. 

However, I've decided it's time to take a break from private practice, to reflect on all you've taught me and see where I should direct those skills and knowledge in the next phase of life. I wish all past clients and blog readers the very best. 

Most doctors, teachers and parents haven't heard of Developmental Language Disorder (DLD), even though it's just as common as ADHD and more common than Autism.

DLD is a neuro-developmental disorder that describes a lifelong difficulty understanding others and expressing yourself. It can look like a child is not listening or is shy to speak, it can cause frustration and low confidence or difficulties with behaviour.

Children with DLD often struggle at school and socially. They are more likely to experience mental health difficulties and later unemployment and economic disadvantage. Up to half of young people in the Australian youth justice system have DLD and associated disorders.

DLD is under-diagnosed and sometimes mis-diagnosed as Autism, Dyslexia or ADHD. A Speech Pathology assessment is necessary to determine whether DLD accurately describes a child's difficulties. 

Speech Pathologists can do a lot to improve a child's language functioning, through language therapy and by supporting teachers, parents and others to communicate more effectively with the child. Here are some resources to share:

Some of us get the news out of the blue from a teacher, doctor or other caring person that maybe something isn't quite as it "should" be with our child. Some of us slowly come to this understanding ourselves because our child isn't thriving or doesn't seem like the other children somehow. 

If you've found yourself wondering what's going on with your child, the prospect of them be "labelled" or even just exploring their strengths and challenges can leave you feeling vulnerable. Sometimes we even experience some niggling signs that we're grieving the child we thought we had, whilst really wanting to keep a positive outlook about the child we really have. 

It can take time to settle into acceptance and curiosity about our child's differences and to help them find that really authentic self-awareness where confidence can flourish. 

In this interview, Debbie Steinberg Kuntz from brightandquirky.com and Debbie Reber from tiltparenting.com offer their insights to support us through this process:

Grieving and Accepting Your Child’s Diagnosis, with Debbie Reber (brightandquirky.com)

Over the course of 2020 and 2021, I've had to significantly increase my use of telehealth. Some common concerns about this service delivery have been:

• can my child engage across a screen?
• will they learn anything - is this type of therapy effective?
• should my child be spending more time on a screen, as well as online school?

These are all really valid concerns as many children have struggled with remote learning for school. It has been difficult for students to clarify things they don't understand, and to produce written work independently. It has also been difficult for teachers to monitor and evaluate student engagement and progress.

The benefit of telehealth appointments, in contrast to online school, is that we are working 1:1. Each client has specific goals so data is gathered from each appointment, to track whether they are moving towards achieving those outcomes. This can be reassuring and motivating for the student, parents and speech pathologist. It also allows for a dynamic approach to learning - we can see if something isn't working and change what we do. 

There are lots of ways to deliver therapy remotely, so that screen time is interactive, understanding is consistently monitored and independent work is achievable. The key to effective teletherapy is collaboration and communication, to bridge the gap between home and therapist. 

In their systematic review of the research, ASHA found online Speech Pathology services "to be at least as effective as therapy delivered face-to-face, with both parent and client satisfaction reported". Concluding that "The findings from the seven reviewed studies revealed that telehealth is a promising method for treating children with speech and/or language difficulties." 

Positive attitudes and experiences from clients' perspectives of online Speech Pathology have also been reported in the research. In their systematic review of the research, ASHA reported "All included studies indicated high levels of participant satisfaction with telehealth-delivered speech and language interventions." 

While these are really positive findings, we all look forward to meeting in person whenever this is safe and geographically possible. See you soon I hope :)

The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review (asha.org)
A Scoping Review of Australian Allied Health Research in eHealth (asha.org)

Across the globe, parents have had some really mixed and interesting insights into their child's education as we all tried to juggle work and home life through the uncertainty of the coronavirus pandemic. 
For many, having their children home from school brought a new appreciation of the expertise and patience of teachers. For some, there was a new realisation that their child was really struggling with learning. 
Some people looked to tutoring to fill this gap and others looked to health professionals. So what's the difference and how do you decide what kind of help your child needs?

• If your child has fallen behind due to difficulty studying at home, or missing lessons; their issue is missed content but not necessarily learning ability. The right tutor can accelerate their learning with 1:1 attention, targeting the gaps in their knowledge. 
• If your child has lost motivation to study due to the change in routine and missing school; their issue is the change in learning environment, but not necessarily learning ability. The right tutor can re-engage them 1:1 with goal setting, organisation and managing time, or in a small group working on a particular subject. 
• If you've noticed your child has difficulty paying attention, writing, reading or understanding the question, then getting an assessment by a health professional is a great idea. An Educational Psychologist, Speech Pathologist or Occupational Therapist can assess whether there are underlying difficulties that prevent your child from learning as easily as their friends and siblings. ​

High school and tertiary teachers often voice concerns in person and in the media, that their students' writing skills are not strong enough to clearly and flexibly communicate the ideas they have learned. Subject specific teachers neither have the time nor the training to teach writing skills, so students can be left behind just because they cannot show their knowledge in writing. So how do we get students' writing skills ready for high school?

The early years of school from Kindergarten to Year 2, are broadly considered the years when students are learning how to use spoken and written language. Instruction is focussed on developing competence and fluency in speaking and writing at 3 levels: 

• words - building vocabulary and learning to spell
• sentences - sequencing words effectively too communicate ideas, using grammar and punctuation
• texts - sequencing sentences effectively to link ideas in conversations, in stories, in factual reports

The later years of primary school are when spoken and written language skills are increasingly expected to be competent and fluent enough to act as a tool for learning content. Instruction is more topic focussed, for example:

• using subject specific long words that are not commonly used at home eg. marsupial, system, divide
• using longer sentence structures to compare, contrast and analyse ideas, using questions and statements to persuade, infer and discuss topics from different perspectives
• organising and sequencing ideas effectively in paragraphs and longer written texts

For High School all these primary skills are needed, at a high standard, as well as:

• well developed spelling and handwriting skills
• fluent typing and familiarity with software used in class and homework
• independent research skills - how to search independently for relevant information, how to critically evaluate sources of information
• note taking from spoken and written information, summarising from notes
• ability to engage with multiple forms of assessment such as multiple choice, short answer questions, long answer questions, essay assignments, multimedia presentations

High school can be an exciting opportunity to learn new subjects and become a more independent learner. When oral and written language skills are well developed in preparation for high school, this frees up cognitive resources for learning new subjects, new routines, higher level organisational skills, making new friends and coping with puberty!

The obvious first stop if you are concerned about your child's spoken or written communication skills is their school. Class teachers, support teachers and school psychologists should all be able to provide you with specific information on your child's literacy development. If you still have concerns, a Speech Pathologist can provide a comprehensive assessment of spoken language, reading and writing skills.

Word Finding Difficulty (WFD) otherwise known as Dysnomia or Anomic Aphasia is difficulty recalling words correctly. In children it is more commonly part of a developmental difference rather than as a result of injury to the brain. WFD is most commonly identified as part of language based learning disabilities such as Developmental Language Disorder (DLD) and Dyslexia.

A person with WFD often has difficulty recalling the exact word they want to use in conversation. They may get around this by using less specific words like 'thing' or 'stuff', using umms, aahs and pauses or describing what they mean in a round about way. Sometimes the person is aware they can't think of the right word, and sometimes they just use the wrong word or mispronounce the word without realising, even when the correct word is part of their normal vocabulary.

In normal development, children build their vocabulary through lived experiences and what they hear and read. Not knowing the correct word for something is normal if we have not come across that word many times in life. For children with WFD, the difficulty can occur even with common everyday words, such as not remembering the name of their teacher, or saying 'mango' or 'lemon' instead of 'melon' by accident.

If your child seems to have difficulty using the correct words when talking about everyday things, or makes obvious errors on words they know, they would benefit from assessment by a Speech Pathologist.

Statistically every classroom in Australia has at least one child with Dyslexia, and yet Australian teachers are not provided with any standardised training to recognise Dyslexia or provide appropriate teaching for children with Dyslexia. Often, it is parents who are looking for answers to their child's learning difficulties, and find mixed messages about the causes and treatments for Dyslexia.

What is Dyslexia? 
The International and Australian Dyslexia Associations' definition of Dyslexia:
“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Dyslexia is a genetic, life-long difference in the way the brain processes language. Dyslexia can be improved with appropriate intensive instruction in the core difficulties of reading and spelling. 
​​
​But wouldn't it make life easier if you could put on a magic pair of glasses that enabled you to read and write like a non-dyslexic person?

The joint statement of the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists on Learning Disabilities, Dyslexia and Vision states that:
"Vision problems can interfere with the process of learning; however, vision problems are not the cause of primary dyslexia or learning disabilities."
The Royal Australian and New Zealand College of Ophthalmologists' statement on vision therapies for the treatment of specific learning disabilities such as Dyslexia is clear:
"Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions."
"There is no credible evidence to support claims for treatments such as vision training/therapy with or without combined neurodevelopmental training, Irlen tinted lenses and the Lawson anti-suppression device."

​Speech Pathologists are qualified to diagnose and treat language development problems, including reading and writing difficulties. Educational Psychologists and Developmental Paediatricians also diagnose a variety of profiles of learning difficulties including ADHD and Dyslexia. 

However, it is very important that any child with learning difficulties have their eyesight and hearing checked to make sure their eyes and ears are functioning optimally for learning.

Have you "researched" the psycho-neuro-cognitive-behavioural-braintraining methods? We've all heard and seen this jargon in marketing and popular media. "Researching" has come to mean looking something up on google (a far cry from conducting and evaluating actual academic research). Similarly, "Best Practice" has been used to describe well marketed or popular programs and methods that are widely accepted, whether or not they're effective or suitable to an individual. We also hear lots about "neuro...", "developmental...." and "cognitive...." et cetera. It seems the more jargon the higher the price tag, much like a designer logo.

The jargon was invented so academics and professionals in the field could efficiently communicate about specific concepts. It was not intended to replace Plain English and should not be used to impress, intimidate or persuade.

So, as parents, what can we do to cut through the marketing and the jargon, to find effective treatments for our children? How do we choose support services that will really make a difference for them?

1. Seek out recommendations from people you trust eg. your child's doctor, their teacher, your friends and family, people who have been through similar difficulties.
2. Use the websites of professional associations and regulation bodies to find certified practitioners eg: Speech Pathology Australia, Occupational Therapy Australia, Australian Psychological Association, 
3. Ring around services until you find someone who is qualified and experienced in treating your area of need, and can collaborate with other services as necessary.
4. Choose a service that listens to you and seeks to meet your specific needs and concerns.
5. Choose a practitioner that constantly evaluates progress and shares that information with you.

Speech Pathology is an Applied Science, so we're trained to constantly question and measure whether what we do is effective. As a health service, we also have an ethical duty to use the most effective treatments based on the best scientific evidence available. This is what I call "best practice".

As a parent you are the expert on your child, their needs and what or who they respond well to. Ask as many questions as you need to find the right service for your child, then watch them and see for yourself whether the treatment is helpful. 

However, a small but increasing number of educators are accessing training about learning disabilities and the Disability Standards for Education. These teachers are recognising students' needs and increasingly seeking out the specialist support their students need.
​
Speech Pathology Australia is advocating for funding to be based on functional needs, rather than the individualised disability funding, from which most children with communication and learning disabilities are exempt.

For more information, check out Canberra University's guide to the Disability Standards for Education.

I was recently on a webchat about "Auditory Processing Disorders (APD)", with some experts from the American Speech and Hearing Association.
The label 'APD' is hotly debated in the research and amongst the allied health and medical practitioners who support children with learning disabilities. Many symptoms of APD overlap with disorders of language processing, sensory processing, behavioural and attention disorders, so a process of elimination is required for accurate diagnosis and effective treatment

What to do: Assessment

1. Audiology assessment

• a functional hearing test checks the ear function to make sure hearing is normal
• an auditory processing test checks whether the brain is registering what the ear is hearing

    2.  Speech Pathology assessment

• a language assessment checks whether the sounds and meaning of the message is understood and whether the child can remember and use the information

    3.  Psychology assessment

• a cognitive assessment checks whether the child is able to pay attention to the message and compares different processes used for learning

On the search to figure out what's going wrong with their child's learning, some parents find their child receives multiple diagnoses.

Symptoms of many learning disabilities overlap and multiple assessment perspectives can lead to multiple diagnoses.

Sometimes this happens when communication between parents, teachers and health professionals is not as clear and collaborative as it should be.
There's an old Indian parable about six blind men who each touch a different part of an elephant.
The man who touches the leg says the elephant is like a pillar.
The man who touches the tail says the elephant is like a rope.
The man who touches the ear says the elephant is like a fan.
You see where this is going.....

Receiving multiple diagnoses can be confusing and unhelpful to determining which therapies to prioritise.
Some aspects of development and learning are precursors to others. A delay or disorder in one area of development can affect therapy progress in other disciplines. So make sure the people assessing and treating your child have all the information they need from you and other professionals. That way you should get more holistic advice.

Any service that is worth a parent's investment cannot work in isolation, or claim to be the only answer to your child's difficulties, especially if it sounds like a quick fix.

My advise is, when you receive multiple reports and opinions, ask yourself "what is the main area of functioning that is holding back my child's learning?", then prioritise one step at a time.

I am often asked what a Speech Pathologist does. Some people have come across Speech Pathology in hospitals or rehabilitation when their relatives suffer strokes, illnesses or injuries that affect their communication or swallowing. Some people think of a child they once knew whose speech was delayed, or someone they knew who had a stutter. Speech pathologists assess and treat anyone whose communication or swallowing is causing them difficulty in everyday life.

Communication skills include spoken and written communication. Spoken communication includes understanding and remembering what you hear and responding appropriately with clear speech that is easy for others to understand. Difficulties with understanding and expressing your thoughts can show up in reading and writing during the school years when these skills are developing and needed for academic learning.

The majority of learning difficulties that emerge in the school years are in part due to underlying problems with language processing, even in children who seem to understand and speak well enough. So, why a Speech Pathologist? Speech Pathology Australia's Literacy Factsheet explains how and why  we play a crucial role in helping with literacy development.....

In Australia I'm called a Speech Pathologist, overseas we can be called Speech Therapists or Speech-Language Pathologists. Whatever the name, we provide assessments, diagnoses and therapy for more than just speech difficulties. Some 'speech therapy' is actually for language and literacy difficulties and even for swallowing and eating difficulties.

The 'who, where, when and how' of your therapy therefore depends very much on your needs. Traditionally, speech therapy was often a once a week appointment, mostly in a therapy room, sometimes with parents and teachers kept somewhat in the dark about the process.

In my practice I find I can make so much more of a difference to a child's language and literacy with the support of teachers and parents. It seems I'm not alone in my experience - the research clearly supports collaboration, and therapy that reaches into the child's daily life. So who is involved, where, when and how?

Who is involved? The research tells us that effective therapy is collaborative. When the therapist works closely with the parents and teachers who care for the child every day, that child has the support they need to practise their new skills daily.

Where does therapy happen? When therapy happens in a clinic room, the therapist has an extra job of working on how the child will transfer their new skills to their daily life at home and school. Gold standard programs such as the Lidcombe Program and the Hanen programs train parents and preschool teachers to do the 'therapy', because they are with the child in the places where he/she needs to communicate. For school age children, research shows the same principle applies - when specialist support is provided in the classroom, then skills are being taught and used right where they are needed. Some skills do need to be introduced in a quiet environment, sometimes in a group, sometimes individually, before they can be transferred to a busy classroom with background noise and other distractions.

When should therapy happen? Early intervention whenever possible gives the child the best chance of preventing difficulties from accumulating and providing strong building blocks for the next stage of development. The frequency of therapy is one of the keys to effective therapy and goes hand in hand with the 'who' and 'where'. Effective, evidence based programs are intense. They rely on daily practice, patience and motivation. When therapist, parents and teachers are consistent in their support of a struggling student then a child's skills and confidence can soar.

How is therapy done? Therapy can take the form of direct individual appointments, parent training, teacher training, group therapy, tele-therapy or any form that best meets the child's needs. Therapy goals are based on a thorough assessment of the child's needs. They are individualised to suit the strengths and weaknesses in the child's speech or language processing, which means no time or effort is wasted on tasks that do not affect improvement. Therapy is dynamic, even within one activity the therapist will shift the difficulty of the task to the correct challenge level for that moment, if something isn't working or could be more efficient, then changes are made accordingly. Motivation is key with any learning, so therapy tasks must be fun and achievable.

Speech Pathologists work in many different settings and specialise in different problems, so I recommend you consider the 'who, where, when and how' when deciding on the therapist that will best fit your needs. Finally, be sure to check your speech pathologist is registered with our professional body "Speech Pathology Australia" as a "Certified Practising Speech Pathologist" (CPSP). This means they are bound by our code of ethics and professional standards, and are using current evidence based methods in their practice.

If a child is struggling with writing then they need more practice with pen and paper, not more screen time, right? Well, that depends how they're using the screen time. There are new apps coming out all the time that can really be a great help to students who struggle with writing, by allowing them to record their ideas using text, voice and illustration all in one document. While this may not make their handwriting neater or their sentences more complex, it will help them record their ideas and share their knowledge. Isn't that what writing is really all about? So here are a couple of writing apps for iPad that I like:

Little Bird Tales for iPad
This app is a great creative tool for a child who likes to draw and tell stories. With a very simple layout and toolbox they can create a multi page book that can be shared by email.
Using the touchscreen they can draw and write straight onto the page, or upload and edit photos and draw or write on them, and type text onto the page. But best of all, they are not restricted to writing or typing because they can make a voice recording for each page. 
The program can be used on a wide range of devices including desktop computer which is great for collaborative classroom work or homework, just go to www.littlebirdtales.com for all the options.

PaperPort Notes for iPad
Some students find that writing takes so much effort, they forget or mix up what they intended to say. That's when 'speech to text' or dictation software is a great assistant. This app stands out above others because it uses Dragon voice recognition software, so even if you don't have a newer iPad with a built in dictation function, your child can still use the 'speech to text' option to make a voice recording that will be converted to text on the page. This may seem like a soft option, but they will still need to read and edit this text when the iPad inevitably mishears a word or phrase. Just like many note-taking apps, you can also upload and edit documents or photos to annotate, highlight and illustrate. Just like "little bird tales" you can also make an audio recording for each page and print or share the whole document or individual pages via email, google drive, dropbox or box.

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Today I'm having a go at becoming a new blogger for learning, language, literacy and all things that inspire my field of Speech Pathology. If you're reading this then please comment and share..... :)