The document provides a comprehensive overview of speech, language, and communication needs (SLCN), highlighting their classification, prevalence, and the impact on children’s educational and social development. It discusses the complexity of SLCN, barriers to effective communication, and the necessity for early identification and targeted interventions. Additionally, it reviews research findings on effective strategies for supporting children with SLCN in educational settings, emphasizing the importance of a systematic, evidence-based approach.

1. Speech, Language and Communication
Professor Geoff Lindsay
EQ927 session 5

2. ·Language, speech and communication
·Language problems: classification systems, needs
presentation
·Prevalence
·Sources for intervention information
·In depth: the Better Communication Research Programme
·Complexity of SLCN
·Co-occurring difficulties and needs (comorbidity)
·Parents’ concerns and disagreement resolution
Today

3. 1. Language
• The use of words and vocalisations to communicate
• Language is distinct from communication
• Language: Comprehension (receptive language) and production (expressive
language)
• Communication development starts at birth (before?)
• For the majority of children, language development will take place without
major problems
• BUT opportunities for optimal development

4. 4
Successful
Communication
Speaking the same
language/accent volume
Understanding
(Words, Signs,
Symbols, Written
Words)
Memory
Body Language
Proximity/Mood/Facial
Expressive
Sharing a subject &
keeping to a topic
Listening/ hearing/
background noise &
volume
Social Skills – taking
turns, confidence,
motivation,
knowledge of person
Eye contact looking
Memory/ Concentration
skills
Health

5. 5
Receptive language/comprehension
• Hear, listen,look
• ATTEND
• Remember
• Understand words
• Understand sentences
• Understand meaning (literal and non-literal)
• Understand NVC

6. 6
Expressive language
• Have an idea to express
• Choose words
• Choose sentence structure

7. 7
……Speech
• Choose sounds
• Organise and coordinate instructions to articulators
• Produce sounds
• Speak fluently

8. 8
Decide what is appropriate:
• Vocabulary (semantics)
• Grammar (syntax)
• Rate, pitch, intonation, volume (prosody)
• Nonverbal communication, eg gestures

9. 9
Language Development Pyramid
Speech
Expressive
Language
Understanding
Play and Interaction
Attention & Listening

10. 10
2. Language difficulties
• Classification systems: 2
• International Classification of Diseases (ICD-10)
(World Health Organisation)
• ICD-11 published but operable from 2022
• Diagnostic and Statistical Manual (DSM-V)
(American Psychiatric Association)

11. 11
These are clinical systems and used by researchers
• Speech, language and communication needs (SLCN)
• UK government category for England
• Used in school census and UK research
• Broader than the ICD-10 and DSM-V as the latter subdivides.

12. 12
Common terms for language difficulties in UK
• Language delay
• Mainly for children < 5 years
• Ambiguous
• Developmental language disorder (DLD)
• Generally has now replaced ‘specific language impairment’
• Language is significantly delayed compared with peers
• SLI also included discrepancy criteria (eg low language despite
‘normal’/’average’ intelligence) but research challenged these
associations
• SLCN – used in SEN Code of Practice and in school census in
England
• Also used in UK research
• Broader than DLD but large overlap

13. ICD-10
F.80 Disorders of psychological development
F.80 Specific Developmental Disorders
of Speech and Language
F.81 Specific Developmental Disorders
of Scholastic Skills
F.82 Specific Developmental Disorder
of Motor function
F80.0 Phonological disorder
F80.1 Expressive language disorder
F80.2 Mixed receptive-expressive language
disorder
F80.4 Speech and language developmental delay
due to hearing loss
F80.8 Other developmental disorders of speech and
language
F80.81 Childhood onset fluency disorder
F80.82 Social pragmatic communication disorder
F80.89 Other developmental disorders of speech
and language
F80.9 Developmental disorder of speech and
language, unspecified

14. DSM-V: Communication Disorders
·Language Disorder
·Speech Sound Disorder
·Childhood-Onset Fluency Disorder
(Stuttering)
Difficulties in both receptive and
expressive language
Significant delays for the age
·Social (Pragmatic) Communication
Disorder (new: social use of
communication)

15. What might you see in the classroom?
SLCN Behaviour
Speech Difficulty making sounds
Stammering/stuttering
Voice quality or intonation
Language Difficulties following verbal instructions (complex);
Simple(r) sentence structure; difficulties linking main clauses with connecting
words
Misunderstanding of idioms
Fluent speech that does not mean much
Communication
Limited eye contact or too much physical proximity
Turn taking in communication; interruptions
Does not understand or respond to non-verbal feedback from other person about
communication episode
Type of language used is the same no matter what the context is

16. SLCN in the secondary classroom
·Poor / limited vocabulary (SES impact to be considered as well)
·Understanding and using complex and abstract vocabulary.
·Changing the type of language to match the communication context (who the
other persons is).
·Using longer sentences.
·Constructing longer or complex sentences.
http://www.ican.org.uk/~/media/Ican2/Whats%20the%20Issue/Evidence/ICAN_TalkSeries10.ashx

17. Prevalence
SLCN
• 23% of all pupils with SEN (highest)
• 23.4% of pupils with SEN support (highest)
• 15.0% of pupils with an EHC plan (second highest after ASD,
29.0%)

18. Why language matters?
·Predicts English achievement, literacy achievement, Maths
achievement at school
·Association with social, emotional and behavioural problems in
childhood; young offending behaviour
·Social skills and social relationships are largely based on language and
communication
·Reading difficulties in adulthood, mental health problems, and
unemployment (Law et al., 2009).
·50% of UK prison population has literacy difficulties

19. What matters for language – and therefore
language difficulties?
·Socioeconomic disadvantage: 30 million word gap by age 3
between low and high income HHDs (Hart & Risley 1995). In UK, 19-
month language gap at school entry between high income and low
income children.
·Social context/environment (how others in the child’s
environment use language; for early development)
·Sensory processing problems (e.g., hearing loss)
·Learning problems (e.g., intellectual disability)
·Developmental disabilities (ID, autism)

20. 3. Complexity of SLCN
• Language and communication are fundamental to human behaviour
• Therefore, they are implicated in all types of SEN
• The Better Communication Research Programme (Lindsay et al, 2009-12) was the
largest UK study of this complexity, through 10 different research projects.

21. Bercow Review (2008)
• 2007-08, led by John Bercow (then just an MP), currently Speaker of the House of
Commons
• His concern about provision for SLCN
• Persuaded Secretary of State for Education to commission him to conduct a review
• Review group, wide ranging gathering of evidence through visits, meetings, expert
views
• And research by Lindsay et al. to provide research evidence
• Review (Bercow, 2008): all recommendations accepted by the Secretary of State
(Ed Balls); policy and practice, funding of initiatives plus further research: BCRP
• 19 research reports available plus research papers

22. Policy origins
• Bercow Review (2008) recommendations:
– Communication is crucial
– Early identification and intervention is essential
– A continuum of services designed around the family is needed
– Joint working is critical
– The current system is characterised by high variability and a lack of
equity
• All were accepted
– Better Communication Action Plan, including a
research programme: BCRP (also Communication Council,
Communication Champion etc)

23. BCRP: main issues investigated
• Trajectories of children with SLCN over time, in differing
contexts.
• Support and interventions being offered currently by schools
and by speech and language therapists.
• Evidence base for current practice including indicative costs.
• Perspectives of parents and children regarding the services
they use and the outcomes they value.

24. Methodology
• Multi-faceted combined methods programme comprising 10 main
projects, including:
• Prospective study over 3 school years
• Systematic review of effectiveness of interventions and cost
effectiveness
• Cohort study – children that stammer
• Analysis of national data sets (e.g. School Census)
• Development of Communication Supporting Classrooms
observation tool
– Interviews (parents, SLTs, EPs, children); focus groups and workshops
– Surveys (SLTs, EPs, SENCOs)
– Classroom observations

25. Understanding speech, language and communication
needs:
– Needs versus diagnosis
– Provision
• National data sets
• BCRP prospective study

26. Prevalence of SLCN
• National pupil database (state schools in England, around 93% of all children of
compulsory school age 5-16)
• Annual national statistics; 2019:
• Of those pupils with an Education, Health and Care (EHC) plan, (or Statement of SEN)
23.1% had SLCN as their primary need.
• 23.4% of pupils at SEN support
• 15.0% of pupils with an EHC plan
• SLCN is highest SEN group for a) SEN support but 2nd
highest for b) EHC plan
• SLCN - a) 23.4% b) 15.0%
• ASD - a) 6.2% b) 29.0%
• MLD - a) 22.8% b) 11.5%

27. Prevalence of SLCN and other SEN

28. So, major SEN group
Also, many children with other SEN types have SLCN as secondary need.
AGE (Lindsay & Strand, 2016)
• Prevalence of SLCN reduces with age
• Steeply for SEN support group between Reception and Year 6, then less
steeply Year 7 – 11.
• But is relatively flat Reception to Y11 for those with EHC plans/statements

29. Prevalence of SLCN by age
Statemented and School Action Plus

30. • Depressed language and communication skills in
both LI and ASD cohorts compared with nonverbal
ability
– but for ASD structural language ability (grammar and
morphology) was higher than LI
– substantial variation within cohorts
• but more varied in ASD
– ASD greater social and communication impairment
LI and ASD: similarities/ differences?

31. Overlap of language and social interaction
Impaired social
interaction
Impaired
language
Depressed vocabulary

32. SLCN and SEMH
• Higher prevalence of SEMH overall among children
with SLCN
– Mainstream and clinic samples
• But level varies with type of SEMH
– Main issue is peer problems, emotional symptoms
• Higher in ASD
– Conduct problems are less concern
– Children with ASD more affected
• Parents agree
• Not related to level of language ability

33. What we observed in classrooms
• Pupils observed to be engaged with the lessons
• Task differentiation and off task behaviour varied within and
between cohorts.
• Differences in the pupils’ scores on assessments did not
account for this variation
• Little evidence of disruptive behaviour or pupils being engaged
in irrelevant tasks
• However, pupils with ASD were significantly more likely to be
working with a LSA or to be working outside the classroom

34. Support and pedagogical approaches (Dockrell et al., 2019)
Teaching & Learning
• High levels of support from
learning support assistants
(LSAs)
• ASD = 3X TA time than
LI
• SLT for a significant minority of
pupils
– reduced for pupils in
secondary schools
• More SLTs with ASD than LI
• Very little contact with EP or
other services.
• Little use of specialist
programmes
• Teachers reported on 12
different strategies
• Few differences
between LI and ASD
cohorts

35. Communication Supporting Classrooms observation tool
(Dockrell et al., 2015)
• Development of a tool to assist teachers
– Review of literature for what supports
communication in classrooms
– Development and validation of a tool

36. Objectives
• Examine evidence base of elements underpinning
communication and identify
– effective processes/strategies/modifications
• Develop these into a Communication Supporting Classrooms
(CSC) framework
• Produce an observational tool designed to monitor classroom
environments and learning spaces that can be used by school
staff
• Develop such a framework into a training schedule

37. Research evidence translated to a tool to be used in
schools
• Captured
– Language learning environment ...
» Elements identified as necessary prerequisites to
allow teaching and learning e.g. Labelling in
classrooms, quiet corners
– Language learning opportunities ...
The what of learning e.g. Small group work
– Language learning interactions ...
The how of learning e.g. the ways in which staff talk
with children

38. What were we seeing?
(101 classrooms)
Environment Opportunities Interactions
.00
.20
.40
.60
.80
Reception
Year 1
Year 2
Mean
proportion
of
ratings

39. What works?
• Development of a ‘best evidence’ of the
effectiveness of interventions – all SLCN
• A What Works for SLCN? database

40. Best evidence: effectiveness of interventions
• From the published evidence
• From the BCRP:-
– Best evidence SLT survey (536 respondents)
• We explored use of published programmes,
intervention activities, and principles/
approaches.
– Cost effectiveness activity
– Development of the “What Works for SLCN”
resource

41. Some key messages – best evidence
• We identified 58 interventions either currently in use or
published in the research literature
• Criteria were:
– Strong evidence: 1+ systematic reviews
– Moderate: 1+ RCT or quasi-experimental studies
– Indicative: good face validity but limited research, e.g. case
studies or ‘before and after’ studies.
• Of those that we have identified
– 5% had strong level of evidence
– 56% had moderate evidence
– 39% had indicative evidence

42. Cont’d…
• Five were Universal interventions, 13 were targeted and 16
Specialist
• Sound emerging evidence base with relative strengths in
some areas;
• Too few large scale intervention studies to draw firm
conclusions about how services should be delivered
– but plenty of positive evidence about individual techniques;
• Not yet sufficient evidence to suggest that any one of the
interventions could readily be scaled up and rolled out
– but there are many areas where larger effectiveness
studies would be warranted.

43. Later developments
• Now published online by The Communication
Trust
• Review group which reviews new interventions
and adds to the What works for SLCN? Online
resource

44. English as an additional language (EAL)
• Children with SLCN are over-represented
• Comprise a substantial proportion of children in R-Y6
• Why is this?
• Schools identifying SEN rather than second language learning needs
Gender
• Boys consistently more likely to be identified with SLCN, 2019:
• 25% of boys v 20% of girls

45. Interactions
• Several studies by Strand & Lindsay have shown that prevalence is a function of a
complex interaction of:
SEN type, age, gender, ethnicity, EAL, (eg Lindsay & Strand, 2016)
• And these relationships - prevalence per se and interactions – patterns are
consistent over time
• But the overall proportion of children with SLCN has risen steadily.
• But also, prevalence has also risen for some other SEN types (most particularly
ASD), but not all (eg MLD)

46. Other relationships from BCRP (NB. Focus is DLD rather than
SLCN as a whole)
Behaviour problems
• Higher than expected in Developmental Language Disorder
• But primarily for peer problems whereas much smaller increase for conduct
problems (Charman et al., 2015)
• And this is similar over age (Lindsay & Dockrell, 2012)
Self concept
• Lower academic and social self concepts, relatively stable over time, but not
necessarily other self concepts (Lindsay & Dockrell, 2012)
Health related quality of life
• Moods and emotions, social acceptance/bullying, victimisation (Coates et al., 2019)

47. Overlap with ASD
• Although there are significant differences between ASD and DLD in general, there
are also substantial overlaps (Dockrell et al., 2015)
Parents’ perspectives
• Concern about late identification
• ‘He’ll get over it’ (Lindsay et al., 2016)

48. Interventions
• As SLCN is complex (eg different aspects of language, co-occurring difficulties,
overlap with eg ASD) action needs to be varied.
• Early identification
• No simple, effective screening test or method
• Developmental, so always a function of child and their environment
• Requires systematic approach
• Universal, targeted, specialist
• SLCN and ASD (Dockrell et al., 2019)
• Children with ASD received more provision including speech and language therapy
than children with LI
• Equity?

49. Interventions range from
Universal - joined up services
- improved awareness for teachers, early years staff to meet all children’s
needs
- ‘good teaching’ – expectations, flexible, relevant curricula
Targeted- universal plus: effective and cost effective interventions (eg specialist
programmes)
- support to early years, schools eg speech and language therapists, educational
psychologists, SENCOs, specialist teachers
Specialist - universal plus targeted plus more specialist help, greater intensity,
greater frequency

50. • Link with Bronfenbrenner’s model: universal, targeted and
specialist:
Universal,
Targeted and
Specialist support
Children with
severe, complex
and long term SLCN
requiring Specialist
support in addition
to Targeted and
Universal provision
All children benefiting from
good language environments
as part of early development
Children with significant primary
SLCN requiring Targeted and / or
Specialist support in addition to
Universal provision
Specialist

51. BCRP examples
Communication Supporting Classroom Observation Tool (Dockrell et al., 2015)
• Conducted by teacher (Reception –Y2, though could be older) to identify the quality
of communication support.
• Primarily universal but can be used for targeted also
• Can work with colleague or SLT.
• SLTs can train staff (also useful for their intervention/prevention)
• Available from Communication Trust (
https://www.thecommunicationtrust.org.uk/resources/resources/resources-for-practit
ioners/communication-supporting-classroom-observation-tool.aspx
)

52. What Works for SLCN?
• BCRP evaluated > 50 interventions
• Communication Trust now delivers by its website
https://www.thecommunicationtrust.org.uk/whatworks
• And also supports a development group to consider new evidence, interventions
• Available from Communication Trust
• To be discussed at seminars.

53. Conclusions
• Speech, language and communication are fundamental to human development and
consequently are prevalent to any children with SEN as the primary special need
• And also many children as secondary need
• SLCN are complex, with different subtypes, different classifications, and contentious
attempts to produce distinguishable ‘subtypes’
• In England ‘SLCN’ is a broad term for policy
• Be aware of the different types of evidence – from clinical (small) studies; studies of
‘subtypes’ with changing terminology; and national data
• Intervention requires a systematic universal/targeted specialist approach
• Evidence is developing as effectiveness (and cost effectiveness) but is problematic

54. TheCommunicationTrust- What X
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