What a Speech and Language Therapist does

We help children and young people who have a variety of needs. Below lists the areas of need we can support with. Scroll down for more information on areas of Speech, Language and Communication need. 

  • Developmental Language Disorder (DLD)

  • Difficulty understanding or following what is said
  • Difficulty talking in words and sentences (expressive language skills)
  • Difficulty saying words clearly
  • Communication problems associated with learning difficulties
  • Social Interaction Difficulties and Autism
  • Feeding and Swallowing Difficulties
  • Cleft Lip and Palate
  • Speech and language problems associated with hearing impairment
  • Cerebral Palsy
  • Voice Disorders
  • Stammering



Developmental Language Disorder (DLD)

You might hear Speech and Language Therapist's and other professionals refer to Developmental Language Disorder (DLD). Please click here for a leaflet describing what this means. 


Difficulty understanding or following what is said

Understanding what people say involves many different skills. A child may have difficulties in one or more of the following areas.

If you are concerned about your child's hearing ask your GP or Health Visitor to refer him for a hearing test.

Listening and attention skills
We need to be able to pay attention and listen when someone is talking to us in order to understand.  

Auditory skills
We need to be able to distinguish between different speech sounds (auditory discrimination) and remember what is said (auditory memory). 

Understanding words
We need to understand the meaning of the words.

Understanding sentences
We need to understand grammar, which is the way we put words together in sentences. 

Non-verbal information
We also convey a lot of meaning through the tone of our voices (intonation) and the facial expression and gestures we use (body language).  

A child who has difficulties understanding what is said to them may do some of the following: -

  • Have a short attention span
  • Find it difficult to listen to someone who is talking without being distracted
  • Have difficulty following instructions
  • Find it difficult to understand new words
  • Find it hard to understand sentences with lots of information
  • Be slow to develop their own talking skills.

You may notice that you have to repeat what you say or simplify how you say it.

Difficulty talking in words and sentences (expressive language skills)

Saying what you want to say involves many different skills - you have to:

  • Choose the right words
  • Put those words together into a sentence that makes sense (using grammatical rules)
  • Organise your ideas into the appropriate order.

A child who has difficulties with expressive language skills may do some of the following:

  • Find it hard to learn or recall words - so they don't have the right words to say what they want
  • Have difficulty putting words together into sentences
  • Use sentences typical of a much younger child
  • Miss words out, e.g. 'teddy in bed' instead of 'put the teddy in my bed'
  • Make mistakes, e.g. 'I blowed the candles out' instead of 'I blew the candles out'
  • Have difficulty choosing the right words to use - sometimes this is called 'word-finding difficulties'
  • Find it difficult to organise their thoughts, so they are unable, for example, to tell you about something that has happened to them
  • Seem to need more time to plan and organise their thoughts and language.

If you are concerned that your child is not talking and expressing their ideas as they should, go to What to expect in Speech and Language Development for more information (and to find out how to refer to Speech and Language Therapy).


Difficulty saying words clearly

To be able to speak clearly a child has to be able to:

  • Hear the range of speech sounds - if you are concerned about your child's hearing please ask your Health Visitor or GP to refer him/her for a hearing test
  • 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 English sound system.

It 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.  

Most children are using a range of speech sounds and can be easily understood around the age of 5 but they may still be making mistakes, for example saying "fum" instead of thumb.

Children with speech sound problems may: -

  • Use a limited number of sounds
  • Swap sounds around for example saying 'tup' instead of 'cup'
  • Miss sounds out e.g. saying 'poon' for 'spoon' or 'du' for 'duck'
  • Have difficulty saying long or complicated words like 'elephant' or 'aeroplane'

If your child appears to have a physical difficulty with the muscles that are used to make speech sounds, go to Speech Problems associated with physical disabilities e.g. cerebral palsy for more information   


Communication problems associated with learning difficulties

'Learning difficulties' is the term used by the education and health services to highlight when children require additional support to help them develop and learn. Sometimes the terms "global" or "developmental delay" may be used to indicate that a child's progress is slower than might generally be expected. The terms 'mild', 'moderate' and 'severe' may also be used to indicate the degree of difficulty the child has.

Many children with learning disability experience some difficulty with communication skills. A Speech and Language Therapist may work as part of a multi-disciplinary team and can advise parents and education staff on both feeding and communication development. Alternative methods of communication may sometimes be required.

Some children with learning disability have an identifiable syndrome which means that a number of medical and physical symptoms occur together.

There are many syndromes which are associated with speech language and communication difficulties - these are the most commonly occurring ones:

  • Down Syndrome
  • Prader-Willi Syndrome
  • Fragile-X Syndrome.


Social Interaction Difficulties and Autism

There are some subtle rules about how we use language to communicate and interact with other people. As adults we use them without realising it - we know what to say, when to say it and how to say it to other people.

Some children have difficulties in this area, which are sometimes referred to as 'pragmatic difficulties'.

Children with pragmatic or social interaction difficulties may also have problems using non-verbal skills, such as:

  • Making appropriate eye contact
  • Knowing how close to stand to someone
  • Using appropriate body language and facial expression
  • Interpreting someone's facial expression or tone of voice
  • They may also have difficulty with conversational skills and may
  • Interrupt more than is acceptable
  • Make little effort to keep conversations going by listening and responding
  • Randomly change the topic
  • Be unaware of what their conversational partner needs to know and give too little or too much information
  • Some children also take things very literally and misinterpret common expressions such as 'pull your socks up' or 'run on the spot'.

For more information on social interaction difficulties go to www.talkingpoint.org.uk/parentpoint and follow the links to 'Difficulties with using Language Appropriately in Context'.

Autistic Spectrum Disorder
Some children with these sorts of difficulties may have a form of Autistic Spectrum Disorder (ASD). If you're concerned that your child is showing characteristics of ASD talk to your health visitor or GP. You can also contact The National Autistic Society Helpline on 0845 070 4004 or atautismhelpline@nas.org.uk


Feeding and Swallowing Difficulties

Many Speech and Language Therapists are trained to assess, diagnose and treat children's feeding and swallowing difficulties, as well as their communication skills.

The infant and toddler forum website has some information around feeding development stages. You can access the site here

If you are concerned about your child's feeding development you can discuss this with your health visitor or GP.

Cleft Lip and Palate

  • This is a condition in which a child's lip and/or palate do not form properly before birth, leaving a gap in the palate and/or upper lip.


  • The Cleft Lip and Palate Specialist Team at the Royal Manchester Children's Hospital support babies born in this area of the North West with this problem. Specialist health visitors give advice on feeding and the surgeons carry out repairs to the lip and palate when appropriate.


  • Many children develop good speech following repair to their palate. Those who do need help will be referred to the Salford Speech and Language Therapy Department - where therapy will be offered at a local clinic. The Salford Therapist will work closely with a Speech and Language Therapist from the Cleft Lip and Palate Specialist Team to provide coordinated help.

You can find further information, advice and support at the Cleft Lip and Palate Association at www.clapa.com


Speech and language problems associated with hearing impairment

Hearing difficulties can affect development of all or just some areas of speech and language, depending on the type and severity of the deafness.

Our Speech and Language Therapist may have a role in helping you and others develop your child's:

  • Awareness of speech sounds
  • Understanding of spoken and sign language
  • Talking and signing skills.

Hearing impairment can vary from mild through to profound. The National Deaf Children's society explains the difference between the two main types of deafness as:

Sensori-neural deafness, or nerve deafness as it is sometimes called, is a hearing loss in the inner ear.

Conductive deafness means that sound cannot pass through the outer and middle ear into the inner ear. This is often caused by blockages such as wax in the outer ear or fluid in the middle ear (glue ear).
For more information visit: 

The Speech and Language Therapist's Role
Many children with conductive deafness are unable to hear certain speech sounds clearly, which in turn, affects their ability to say the words clearly. They may also have problems listening and concentrating, so their general language development may be delayed as well.

The Speech and Language Therapist will decide whether treatment is appropriate after obtaining up to date information from the Audiology or Ear Nose and Throat (ENT) department, and discussion with the other specialists involved such as the Teacher for the Hearing Impaired.

If you have concerns about your child's hearing ask your health visitor or GP to refer them for a hearing test.

Specialist Teacher's Role
Teachers who have specialist skills in supporting children with hearing impairment are available to support children with significant hearing difficulties, including children who wear hearing aids.  The Special Needs Coordinator at your child's school will know if it is appropriate to contact this service regarding your child.

Cerebral Palsy

Cerebral palsy is an umbrella term covering a group of non-progressive, but often changing, motor impairment conditions that affect children in different ways causing impairment in posture, movement and co-ordination.

Children with cerebral palsy need the support of a team of professionals, including a Speech and Language Therapist, who will work together to look after all the child's development needs. The Speech and Language Therapist will be able to advise on feeding, as well as communication skills.

Some children may need to use a communication system other than speech to support their speech and language development - our Speech and Language Therapist will also be able to offer advice on this.

For further information on cerebral palsy go to www.scope.uk

Voice Disorders

A child who has voice problems may have the following symptoms:

  • Husky or breathy voice
  • Hoarseness
  • Sore or dry throat
  • Discomfort when speaking
  • Sound very loud when they are speaking or speak very softly so they are hard to hear
  • Being too high or too low in pitch.
  • Excessive shouting, screaming, yelling, making funny noises, throat clearing and talking can lead to voice problems. Other factors such as exposure to cigarette smoke, emotional problems or medications may also cause voice difficulties.