articles on speech and language disorders

Language and Speech Disorders in Children

Helping children learn language, what to do if there are concerns.

• Detecting problems

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as

• Responding to the first sounds, gurgles, and gestures a baby makes.
• Repeating what the child says and adding to it.
• Talking about the things that a child sees.
• Asking questions and listening to the answers.
• Looking at or reading books.
• Telling stories.
• Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Parents can also observe the following:

• How their child hears and talks and compare it with typical milestones for communication skills external icon .
• How their child reacts to sounds and have their hearing tested if they have concerns .

Learn more about language milestones .  Watch milestones in action.

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Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Not hearing the words (hearing loss).
• Not understanding the meaning of the words.
• Not knowing the words to use.
• Not knowing how to put words together.
• Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Difficulty with forming specific words or sounds correctly.
• Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
• Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Learn more about language disorders external icon .

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety . Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. Learn more about hearing loss, screening, evaluation, and treatment .

A language development specialist like a speech-language pathologist external icon will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) external icon and Section 504 external icon , an anti-discrimination law.

Get help from your state’s Parent Training and Information Center external icon

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities external icon , including language or speech disorders.

More information

CDC Information on Hearing Loss

National Institute on Deafness and Other Communication Disorders external icon

Birth to 5: Watch me thrive external icon

The American Speech-Language-Hearing Association external icon

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
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Volume 21 Supplement 1

Defined preventive interventions for children under five years of age: evidence summaries for primary health care in the WHO European region

• Open access
• Published: 08 September 2021

Screening for language and speech delay in children under five years

• Sophie Jullien   ORCID: orcid.org/0000-0001-5587-626X 1  

BMC Pediatrics volume  21 , Article number:  362 ( 2021 ) Cite this article

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We looked at existing recommendations and supporting evidence on the effectiveness of universal screening for language and speech delay in children under 5 years of age for short- and long-term outcomes.

We conducted a literature search up to the 20th of November 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported on the accuracy of the screening tests for detecting language and speech delay, the efficacy of existing interventions for children with language and speech delay, and the potential harms associated with screening and the associated interventions.

Several screening tools are used to assess language and speech delay with a wide variation in their accuracy. Targeted interventions improve some measures of speech and language delay and disorders. However, there is no evidence on the effectiveness of such interventions in children detected by screening with no specific concerns about their speech or language before screening. There is no evidence assessing whether universal screening for language and speech delay in a primary care setting improves short and long-term outcomes (including speech and language outcomes and other outcomes). Finally, there is no evidence on the harms of screening for language and speech delay in primary care settings, and there is limited evidence assessing the potential harms of interventions.

Introduction

The World Health Organization (WHO) European Region is developing a new pocket book for primary health care for children and adolescents in Europe. This article is part of a series of reviews, which aim to summarize the existing recommendations and the most recent evidence on preventive interventions applied to children under 5 years of age to inform the WHO editorial group to make recommendations for health promotion in primary health care. In this article, we looked at existing recommendations and supporting evidence on the effectiveness of universal screening for language and speech delay in children under 5 years of age for short- and long-term outcomes.

Why is the detection of language and speech delay important?

Language is the coding system that permits conceptualisation, reasoning and understanding, while speech is one vehicle for expressing language through combined sounds [ 1 ]. Language or speech delay refers to cases where the development of the ability to understand and speak is correct but slower than what is accepted as normal, whereas language or speech disorders refer to cases where the speech or language ability deviate from what is expected as normal development [ 2 , 3 ]. Language disorders can involve the form (phonology, morphology, syntax), the content (semantics), and the function of language in communication (pragmatics), or in any combination [ 3 ]. Speech disorders refer to difficulty with forming specific words or sounds and/or with fluency, needed to communicate with others [ 2 ]. Language and speech disorders can exist by themselves or combined [ 3 ].

School-aged children with language or speech delay may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Children with such conditions may also be at higher risk for behaviour and psychosocial adjustment, which may persist into adulthood [ 4 ].

The median prevalence of isolated speech and language delays and disorders (this is without associated developmental delay, autism spectrum disorder or intellectual disability) was estimated at 6% (range from 5 to 12%) among children between two and 5 years of age in the United States [ 3 , 4 ].

Language and speech are two of the main domains of child development, or neurodevelopment, together with gross and fine motor skills, social and personal skills, activities of daily living, and cognition. These domains are characterized by continua, this is that one end of the diagnostic spectrum has a border with normality [ 5 ]. Language and speech disorders can occur with other developmental disabilities, such as autism spectrum disorder, or with emotional or behavioural disorders, such as attention deficit hyperactivity disorder (ADHD), and might be detected as early manifestations of such disorders [ 2 ]. Early identification of children with language and speech delay and disorder would allow interventions at an early stage, before these problems interfere with learning abilities and behavioural adjustment, to reach better health, academic and social outcomes [ 3 ]. Universal screening of all preschool children has been suggested to this end, for early detection and intervention and potentially better outcomes [ 6 ]. However, the identification of children with language and speech delay through universal screening is challenging. Cultural, socioeconomic and contextual factors make these children a variegated group, which is difficult to evaluate with a simple screening tool [ 7 ].

As reminded by the Canadian Task Force on Preventive Health Care, “screening differs from developmental surveillance, which refers to ongoing monitoring by clinicians of a child’s development, identification of risk factors and elicitation of parental concerns” [ 6 ].

Finally, although hearing loss is related to language and speech delay, we do not address universal screening for hearing loss in newborns in this document.

Key questions

How accurate are the screening tests for detecting language and speech delay in children under 5 years of age?

Are the interventions for children identified with language and speech delay effective for improving (short- and long-term) language and speech outcomes?

Does screening programme for detection and early intervention of language and speech delay in children younger than 5 years improve short- and long-term outcomes?

What are the potential harms of screening and interventions for language and speech delay for children and their family?

Search methods and selected manuscripts

We described the search methods, data collection and data synthesis in the second paper of this supplement (Jullien S, Huss G, Weigel R. Supporting recommendations for childhood preventive interventions for primary health care: elaboration of evidence synthesis and lessons learnt. BMC Pediatr. 2021. https://doi.org/10.1186/s12887-021-02638-8 ).

The search was conducted up to the 20th of November 2019, by manual search and by using the search terms “language” and “speech”. We included any document that addressed at least one of the key questions. We did not find any relevant document from the WHO. We found recommendations and their supporting evidence from the United States Preventive Services Task Force (USPSTF) (2015). The Centers for Disease Control and Prevention (CDC) addresses “Language and speech disorders in children” in their website, mainly addressed to the general public. They promote observation of the children by their parents concerning the developmental milestones and provide recommendations on what should be done for children identified with speech or language concern. However, we did not find any recommendations from the CDC regarding universal screening. The current recommendation from the UK National Screening Committee (UK NSC) is based on an external review published in 2005. According to their website, they are currently reviewing the recommendations on this topic, although it is also stated that the updated review is estimated to be completed by November 2013.

The Royal College of Paediatrics and Child Health (RCPCH) dedicates a whole chapter on child development in their recent book, which includes a section on screening and speech and language disorders. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) (2017) and the Canadian Task Force on Preventive Health Care (2016) developed documents with recommendations and supportive evidence on developmental delay with generic measures covering all aspects of development, but do not address language and speech delay as a single domain for universal screening. For the feasibility of this review, we cite these sources as reference for readers, but we did not summarise them.

The search in the Cochrane library by using the search terms ‘language’ OR ‘speech’ in titles returned 11 reviews and one protocol. By screening the titles and abstracts, we included one review (Law 2003) and one protocol (Law 2017). Although published earlier than 2010, we included the Law 2003 review as we judged it was relevant for this summary document. The protocol we identified is for updating the Law 2003 review. We identified one additional systematic review (Kasper 2011) by hand search of the references of the manuscripts identified by the above methods.

All the included manuscripts for revision in this article are displayed in Table  1 .

Existing recommendations

We summarized the existing recommendations and the strength of recommendations as per their authors in Table  2 .

Existing evidence

The USPSTF commissioned a systematic review of the latest evidence on screening for speech and language delays and disorders in children under 5 years of age, to update their 2006 recommendations of screening in a primary care setting [ 3 , 8 ]. The review focused on screening children under 5 years of age who have not been previously identified with another disorder or disability that may cause speech or language impairment. The review authors assessed screening instruments specific to speech and language conditions, but also more general developmental screening tools with speech and language components. Another inclusion criterion was that screening tools needed to be feasible and interpretable within a primary care setting [ 4 ]. The review authors included randomized controlled trials (RCTs), systematic reviews, and cohort studies of screening and surveillance for speech and language delays and disorders, where children who screened positive received formal diagnostic assessment for speech and language delays and disorders by the age of 6 years. The literature search was conducted up to July 2014.

Another systematic review aimed to evaluate the effectiveness of universal screening for specific language impairment in preschool children in German [ 12 ]. To this end, and similarly to the methodological approach of the USPSTF review, the question was divided into a review of the evidence from studies evaluating screening programmes, diagnostic tools, and speech and language interventions. The literature search was conducted up to May 2008.

In the RCPCH book, the authors described general points regarding the diagnosis, screening and other considerations on developmental delay. They focused on several domains of child development that they considered were needed to be checked [ 5 ]. The first domain they addressed is “Speech and language disorders”.

Risk factors

Although a focused research question on the identification of potential risk factors for speech and language disorders is beyond the scope of this summary document, we judged it relevant to report those identified by Wallace et al., the review commissioned by the USPSTF [ 3 ]. The USPSTF systematic review included 31 cohort studies (24 with multivariate analysis to control for other factors) and one review of studies on characteristics of late-talking toddlers. The review authors identified male gender, family history of speech or language impairment, lower levels of parental education, and various perinatal risk factors (e.g., prematurity, birth difficulties, and low birth weight) as potential risk factors for speech and language disorders.

Accuracy of the screening tests for detecting language and speech delay in children younger than 5 years

The systematic review conducted by Wallace et al. evaluated four key questions to assess the accuracy of screening tools for the identification of children in the primary care setting for diagnostic evaluations and interventions: (1) “What is the accuracy of these screening techniques and does it vary by age, cultural/linguistic background, whether it is conducted in a child’s native language, or by how the screening was administered (i.e., parent report, parent interview, direct assessment of child by professional)?”; (2) “What are the optimal ages and frequency for screening?”; (3) Is selective screening based on risk factors (i.e. targeted screening), more effective than unselected, general population screening (i.e. universal screening)?; and (4) “Does the accuracy of selective screening vary based on risk factors? Is the accuracy of screening different for children with an inherent language disorder compared with children whose language delay is due to environmental factors?”

The review authors found no studies addressing the key questions 2, 3, and 4. They included 24 studies addressing the first key question, five good- and 19 fair-quality studies. The included studies evaluated the accuracy of 20 different screening tools, seven screening tools administered by parents, and 13 by trained examiners. Studies were conducted in the US (14 studies), the UK (six studies), Australia, Canada, Germany and Sweden. The review authors summarized the characteristics of included studies in supplementary tables and present the accuracy of findings separately for screening tools administered by parents and by trained examiners [ 3 ]. The performance characteristics varied widely. Overall, the screening tools administered by parents performed better than those administered by trained examiners. Screening tools for detecting a true speech and language delay or disorder reported by parents presented a median sensitivity of 81% (range from 50 to 94%) and a median specificity of 87% (range from 45 to 96%). Positive predictive values (PPV) ranged from 18 to 92%, and negative predictive values (NPV) ranged from 67 to 98%. When reported by trained examiners (nurses, primary care providers, teachers or paraprofessionals), the screening tools showed a median sensitivity of 74% (range from 17 to 100%) and a median specificity of 91% (range from 46 to 100%). PPV ranged from 6.6 to 100% and NPV ranged from 89 to 100% (except for one study with a reported NPV of 15%).

In conclusion, “the USPSTF found inadequate evidence on the accuracy of screening instruments for speech and language delay for use in primary care settings” [ 4 ]. “No one instrument clearly demonstrated the best characteristics or one age as optimal for screening” [ 3 ]. In addition, the authors highlighted the difficulties in comparing the performance of screening tools because of the heterogeneity in terms of screening tools used, populations screened and settings [ 4 ].

Kasper et al. found no studies that evaluated diagnostic instruments for specific language impairment in the German language [ 12 ].

For the RCPCH chapter on “Developmental reviews and the identification of impairments/disorders”, the authors reviewed the literature up to 2019 [ 5 ]. It is worth citing a paragraph from this chapter: “To date, no neurodevelopmental assessment beyond the neonatal period has been generally acknowledged to meet the WHO/Wilson and Jungner criteria for screening programmes. Screening approaches have been examined in relation to autism, language disorders, and conduct disorder, but key criteria have not been met: in particular, the requirements for a sensitive and specific screening test, for cost-effectiveness, and for evidence that early intervention produces better outcomes than waiting until problems manifest themselves before intervening. This lack of evidence for early intervention may appear counterintuitive in the context of knowledge that brain plasticity and thus potential gains are greater in younger children. In general, neurodevelopmental screening has failed to meet the WHO screening criteria because of lack of evidence of effectiveness, rather than evidence of lack of effectiveness. While it is possible to evaluate how well a screening test functions in a relatively small constrained population, it is much more difficult to carry out gold standard tests in large populations and it can also be challenging to follow up large groups of children to establish the productivity of a screening procedure over time” [ 5 ]. Finally, “while it is tempting to focus on the accuracy of the assessments employed for the identification of difficulties, it is important to stress that the conversations between professional and parent or carer about a child’s development should, if possible, be founded on an existing trusting relationship between the two parties” [ 5 ].

Effectiveness of interventions targeting young children with language and speech delay in short- and long-term outcomes

There is a wide range of interventions for children with speech and language delay and disorders, which include speech-language therapy sessions and assistive technology [ 4 ].

Wallace et al. identified 13 RCTs and one systematic review that evaluated the effect of speech and language interventions on speech outcomes. Four RCTs were conducted in the US, three in Australia, three in the UK, two in Canada and one in New Zealand. Two RCTs were judged to be of good quality, and the remaining 11 and the systematic review of fair quality. The review authors summarized the characteristics of the included studies and outcomes in supplementary tables. They found that most of the included trials showed significant positive results of treating young children with language delays and disorders (6 of the 11 trials) or speech sounds problems (6 of the 8 trials) and treating toddlers and pre-school children for fluency problems (2 of the 2 trials) [ 3 ]. However, the review authors described multiple factors that limit their confidence in the interpretation of these findings. The evidence comes from small trials, with a lack of replicated positive findings for most treatment approaches and a lack of data regarding compliance to treatment. The review authors could not perform a meta-analysis because there was a high degree of heterogeneity between the trials regarding the age of the children, the interventions (different agents, intensity, content and strategies), the outcome measures, and the way results were reported. In addition, the applicability of this evidence to universal screening in a primary care setting is also limited. Indeed, the identified trials “did not report treatment effectiveness in children whose speech and language delay had actually been detected by screening; instead, the delays had often been identified as a result of parent or teacher concerns”, and most studies were conducted in populations with a high prevalence of speech and language disorders [ 3 ]. The USPSTF also looked at the effect of speech and language interventions on other outcomes. They identified five studies with inconsistent findings on outcomes including socialization, reading comprehension, parental stress, and child well-being or attention level [ 3 ]. In conclusion, the USPSTF authors found evidence that interventions improve some measures of speech and language for some children. However, they found inadequate evidence on the effectiveness of such interventions for speech and language delay and disorders among children detected by universal screening, and on their effectiveness on outcomes not specific to speech (e.g., academic achievement, behavioural competence, socioemotional development, and quality of life) [ 4 ].

An older Cochrane review was conducted to examine the effectiveness of speech and language interventions for children with primary speech and language delay and disorder [ 11 ]. This review is currently being updated [ 10 ]. In the review published in 2003, authors included RCTs evaluating children or adolescents with primary speech and language delay/disorder who received “any type of intervention designed to improve an area of speech or language functioning concerning either expressive or receptive phonology (production or understanding of speech sounds), expressive or receptive vocabulary (production or understanding of words), or expressive or receptive syntax (production or understanding of sentences and grammar)” [ 11 ]. They identified 36 papers, of which 25 contributed to the meta-analysis. Eight of these papers were also included in the systematic review conducted by Wallace et al. (the remaining seven trials included in the Wallace review were published after the 2003 Cochrane review). Law et al. found that speech and language interventions are effective for children with phonological or vocabulary difficulties but that there is less evidence concerning the effectiveness of these interventions for children with receptive difficulties, and mixed findings concerning the effectiveness of expressive syntax interventions. There were no significant differences between intervention administered by trained parents and professionals. Like the review conducted by Wallace et al., they found a high degree of heterogeneity between included studies, and applicability of the findings to children with speech and language delay detected by universal screening is limited (all included studies were conducted in children already diagnosed with a speech and language delay or disorder).

The German review identified 16 RCTs, including seven trials already included in both reviews by Wallace et al. and by Law et al., and five trials included in one of the two reviews [ 12 ]. Overall, the review authors found positive effects from language therapies in the short term, but no evidence of benefits from earlier treatment initiation.

The RCPCH did not identify more recent evidence to add on the findings from the USPSTF review, but “Gillberg makes the valuable point that it is not good enough to ‘wait and see’ how developmental problems will unfold: around two-thirds of children with significant language delay at 30 months will manifest a range of significant associated neuropsychiatric problems as they grow older and many of these problems are likely to benefit from early intervention” [ 5 ].

Benefits of universal screening programmes and early intervention

Kasper et al. identified one study (reported in two manuscripts) evaluating speech and language screening, although authors “did not explicitly report results for children with specific language impairment” and therefore “it is not clear to what extent the study results apply to the children in the focus of this review” [ 12 ]. Overall, the review authors concluded that there was no evidence of benefits of universal screening of preschool children with specific language impairment [ 12 ].

Wallace et al. identified no study that determined whether universal screening for language and speech delay improves language and speech or other outcomes [ 3 ]. There is a “critical need for studies specifically designed and executed to address whether universal screening for speech and language delay and disorders in young children in primary care settings leads to improved speech, language, or other outcomes” [ 4 ].

On this aspect, authors from the RCPCH say: “One area where screening is recommended by some authors is universal screening for speech and language followed by appropriate targeted intervention. The problem is that there is still insufficient evidence to support the recommendation of screening. There are a number of reasons for this including the variability of the gold standard measures against which screening tests are evaluated, the tendency for such measures to both under-refer (low sensitivity) and over-refer (low specificity), and the difficulty of establishing predictive validity when the trajectory of language development can be so variable especially in early years – exactly when such measures are commonly recommended” [ 5 ].

Potential harms of screening and interventions for language and speech delay for children and their family

The potential harms of screening and interventions for speech and language disorders in young children in primary care “include the time, effort, and anxiety associated with further testing after a positive screen, as well as the potential detriments associated with diagnostic labelling” [ 4 ].

We found no studies that assessed the potential harms of screening for language and speech delay and disorders. Wallace et al. identified three studies that examined adverse effects of interventions and reported no negative impacts on children or parents [ 3 ]. None of the studies included in the systematic review conducted by Kasper addressed side effects or undesired effects of speech and language interventions [ 12 ]. The USPSTF found inadequate evidence on the harms of universal screening and interventions for speech and language delay and disorders in children aged 5 years or younger [ 4 ].

Summary of findings

Several screening tools are used to assess language and speech delay in primary care settings, with a wide variation in their accuracy. The USPSTF found no single screening tool with the best characteristics for screening.

There is evidence that targeted interventions improve some measures of speech and language delay and disorders. However, there is no evidence on the effectiveness of such interventions in children detected by universal screening, this is screening all children with no specific concerns about their speech or language before screening.

There is no evidence on whether universal screening programmes for detecting language and speech delay for early treatment improves short and long-term outcomes (including speech and language outcomes and other outcomes).

Potential harms of screening for language and speech delay include burden for the families in terms of time and resources. However, there is no evidence on the harms of universal screening for language and speech delay, and there is limited evidence assessing the potential harms of interventions.

Well-designed trials evaluating the most accurate screening tool and looking at benefits of universal screening for language and speech delay in young children are needed.

Availability of data and materials

Not applicable.

Abbreviations

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Acknowledgments

I am very grateful to María Jesús Esparza, Laura Reali, and Gottfried Huss for carefully reviewing and providing valuable feedback for each article. I am also grateful to Ralf Weigel and Gottfried Huss for proofreading the final version of this document.

About this supplement

This article has been published as part of BMC Pediatrics Volume 21, Supplement 1 2021: Defined preventive interventions for children under five years of age: evidence summaries for primary health care in the WHO European region. The full contents of the supplement are available at https://bmcpediatrics.biomedcentral.com/articles/supplements/volume-21-supplement-1 .

Publication charges for this article have been funded by the Friede Springer endowed professorship for Global Child Health at the Witten Herdecke University, Germany.

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SJ was identified as the researcher in the development of the synthesis of evidence and writing the report. For each selected topic on preventive interventions, SJ defined the key questions, established and run the literature search, screened the returned manuscripts for eligibility, extracted data and summarized the existing recommendations and supporting evidence. The principal advisors of this project were Dr. Gottfried Huss, MPH General Secretary of ECPCP, Project- Coordinator and Prof. Ralf Weigel, Friede Springer endowed professorship of Global Child Health, Witten/Herdecke University (scientific advice). The author(s) read and approved the final manuscript.

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Jullien, S. Screening for language and speech delay in children under five years. BMC Pediatr 21 (Suppl 1), 362 (2021). https://doi.org/10.1186/s12887-021-02817-7

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DOI : https://doi.org/10.1186/s12887-021-02817-7

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• Language delay
• Speech delay
• Preschool child

BMC Pediatrics

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Tasman’s Psychiatry pp 1–27 Cite as

Neurodevelopmental Disorders: Speech and Language Disorders

• Michelle L. Palumbo 10 ,
• Maria Mody 11 ,
• William M. Klykylo 12 ,
• Kirrie J. Ballard 13 ,
• Christopher J. McDougle 10 &
• Frank H. Guenther 14  
• Living reference work entry
• First Online: 11 August 2023

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Psychiatric practice is founded upon communication, and knowledge of communication disorders is thus crucial to the psychiatric team. This is especially true for the care of children, since communication impairments are deeply interwoven in all aspects of normal development, psychopathology, and the functions of daily life. Neurodevelopmental communication disorders are classified according to the affected system (speech, language) as well as behavioral manifestations. Language disorder is characterized by lasting difficulties in language acquisition and use as a result of deficits in the production or understanding of language. Speech sound disorder (SSD) is characterized by failure to use speech sounds in a manner appropriate for one’s developmental level. Childhood-onset fluency disorder (COFD), commonly known as stuttering, is one of the most widely recognized disorders of speech and is characterized by interruptions in the normal flow of speech, including blocks, prolongations, and repetitions of words or part-words. Social (pragmatic) communication disorder (SCD) involves impaired pragmatic or social aspects of language, such as inferring humor or sarcasm during conversations or interpreting body language. All of these disorders must develop during childhood and must not be fully explainable by another medical, neurological, anatomical, psychiatric, or sensory condition. The communication disorders as a whole have a male predominance and are often familial. The evaluation and management of these disorders requires a multidisciplinary team, including a speech-language pathologist working with the psychiatrist and other team members.

This chapter is an update from the 4th edition. Previous edition authors were Michelle L. Palumbo, Maria Mody, William M. Klykylo, Christopher J. McDougle and Frank H. Guenther

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Palumbo, M.L., Mody, M., Klykylo, W.M., Ballard, K.J., McDougle, C.J., Guenther, F.H. (2023). Neurodevelopmental Disorders: Speech and Language Disorders. In: Tasman, A., et al. Tasman’s Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-42825-9_86-1

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​How can a speech-language pathologist help?

Communication is a pivotal part of making connections and experiencing the world around us. When people lose the ability to adequately express themselves or understand those around them, they are often left feeling as though a part of them is missing. May is Better Hearing and Speech Month and a perfect time to bring communication to the forefront.

What do speech-language pathologists do?

Our ability to hear and understand those around us, as well as express our thoughts, feelings, and ideas can be impacted by a variety of disorders experienced from infancy into adulthood and old age. Speech-language pathologists (SLPs) help people with communication disorders in a variety of ways. Articulation therapy focuses on shaping appropriate pronunciation of the sounds used to form words (e.g. getting rid of a lisp or saying “r” correctly). Stuttering is treated by teaching strategies to improve the fluency of speech, and voice therapy targets disorders of the vocal cords and other body parts that are needed to speak with a clear voice.

Comprehension of language can also be a focus of speech therapy, whether it be developmental, following placement of a cochlear implant to restore hearing, or as the result of a stroke. Although some patients receiving speech therapy services have the ability to communicate, some can have a difficult time using appropriate communication skills. These difficulties range from to playing their friends and forging relationships, due to issues related to autism, or successfully returning to a job, for example, after a traumatic brain injury. SLPs work to foster development of social communication skills and improve an individual’s ability to carry out tasks necessary for successful daily living.

Some people with communication disorders may not be able to use their own voice, gestures, facial expressions, or writing to express their ideas. SLPs work to find other ways to bring the power of communication to all, based on each person's unique situation. Some of these approaches include using a communication board with pictures of different toys a child can select from while playing, a device to restore voice after placement of a tracheostomy tube, a computer that can recognize eye movements for a person with Amyotrophic Lateral Sclerosis’s (ALS) to allow them to tell a loved one their wants and needs, or an alternate means of voice production after having the voice box (larynx) surgically removed.

How can we improve our communication with others?

Difficulties with communication happen to everyone from time to time. It is important to remember that there are individuals in our communities who struggle to simply talk to family members on the phone, play with a friend, or place an order at a restaurant every day. Reducing background noise and distractions, using simple language with an age-appropriate tone of voice, allowing extra time to respond, repeating yourself as needed, and, most importantly, putting yourself in the other person’s shoes can help establish a strong relationship and allow for a better communication experience.

A team approach to care

At the  University of Chicago Medicine , we take a specialized approach to serving patients with communication difficulties. Our speech-language pathologists work alongside audiologists, occupational and physical therapists, nurses, and physicians as part of a multidisciplinary team to provide optimal communication during critical periods, such as after a cochlear implant placement or following a stroke. In addition to communication, speech-language pathologists focus heavily on the diagnosis and treatment of swallowing difficulties (oropharyngeal dysphagia).

Effective communication enhances our ability to express our basic needs and desires, to create, play, work, and love, and it prevents isolation, misunderstandings, and confusion. During Better Hearing and Speech Month, we are all reminded to use the gift of communication and help those who are working hard towards developing their voice in this world.

Center for Speech & Swallowing Disorders

The Center for Speech and Swallowing Disorders provides diagnostic and therapeutic services for individuals of all ages who have problems with speech, language comprehension and production or swallowing function.

Am Fam Physician. 2024;109(4):361-362

As published by the USPSTF.

The full recommendation statement is available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/speech-and-language-delay-and-disorders-in-children-age-5-and-younger-screening .

The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

This series is coordinated by Joanna Drowos, DO, contributing editor.

A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf .

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PERSPECTIVE article

This article is part of the research topic.

15 Years of Frontiers in Human Neuroscience: Social Cognition and Discourse Processing

Transdiagnostic Considerations Are Critical to Understanding Childhood Neurodevelopmental Disorders Provisionally Accepted

• 1 University of Vermont, United States

The final, formatted version of the article will be published soon.

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attentiondeficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

Keywords: Transdiagnostic, Neurodevelopmental disorders, Early Childhood, assessment, screening, developmental delay, Language, social functioning

Received: 13 Feb 2024; Accepted: 19 Apr 2024.

Copyright: © 2024 Hoza and Shoulberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Betsy Hoza, University of Vermont, Burlington, United States

People also looked at

[Analysis of language and influencing factors of children with speech disorder in Beijing]

Affiliations.

• 1 Center of Healthcare, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China.
• 2 College of Chinese Minority Languages and Literature, Minzu University of China, Beijing 100081, China.
• 3 Hainan Boao Bethel International Medical Center, Qionghai 571400, China.
• PMID: 38623011
• DOI: 10.3760/cma.j.cn112140-20240105-00015

Abstract in English, Chinese

Objective: To investigate the features and influencing factors of language in children with various types of speech disorders. Methods: A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children's Healthcare, Children's Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin-comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi-square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors. Results: There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs. 96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F =5.46, 4.69, 3.68, all P <0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P <0.01) and the overall language score was lower than that of children with stuttering ( P <0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ 2 =7.93, 10.28; both P <0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder ( OR =1.87, 2.18, 2.01; 95% CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P <0.01). Negative family history are protective factors for the progress of language ability ( OR =0.37, 95% CI 0.17-0.81, P <0.05). Conclusions: Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.

目的： 探讨不同类型言语障碍患儿的语言能力发育特征及其影响因素。 方法： 病例对照研究，选取2021年1月至2023年11月在首都儿科研究所附属儿童医院保健中心语言-言语门诊初次就诊并诊断为言语障碍的262例患儿，其中语音障碍患儿作为语音障碍组、言语流畅障碍患儿作为语畅障碍组。选取同期于儿童保健中心体检的100名健康儿童作为健康组，均进行梦想普通话听力理解和表达能力标准化评估（DREAM-C）检查及问卷调查。采用单因素方差分析和LSD检验比较3组儿童整体语言、听力理解、语言表达、语义、句法能力的发育水平；根据DREAM-C评估结果将言语障碍组患儿分为语言发展正常组及落后组，通过 χ 2 检验、多因素Logistic回归分析言语障碍患儿语言能力发展的影响因素。 结果： 语音障碍组患儿145例，其中男110例、女35例，年龄（5.9±1.0）岁；语畅障碍组患儿117例，其中男91例、女26例，年龄（5.8±1.0）岁；健康组儿童100名，其中男75名、女25名，年龄（5.7±1.2）岁。3组儿童在DREAM-C评估中整体语言、语言表达、句法分数差异均有统计学意义（92±18比96±11、98±11，81±18比84±14、88±13，87±16比89±11 、 91±10， F =5.46、4.69、3.68，均 P <0.05）；两两比较显示语音障碍组整体语言、语言表达、句法能力均低于健康组儿童，差异均有统计学意义（均 P <0.01），整体语言能力低于语畅障碍组儿童，差异有统计学意义（ P <0.05）。语音障碍组、语畅障碍组和健康组整体语言、语言表达能力落后发生率差异均有统计学意义［15.9%（23/145）比20.5%（24/117）、7.0%（7/100），46.2%（67/145）比39.3%（46/117）、26.0%（26/100）， χ 2 =7.93、10.28，均 P <0.05］，其中语畅障碍组整体语言落后发生率最高，语音障碍组语言表达能力落后发生率最高。言语障碍患儿语言发展落后的发生率是44.3%（116/262）。无亲子阅读、每日屏幕时间≥1 h、过早屏幕暴露（小于1.5岁）均为言语障碍儿童语言能力发展的危险因素（ OR =1.87、2.18、2.01，95% CI 1.07~3.27、1.23~3.86、1.17~3.45，均 P <0.05）；无家族相关病史为语言能力发展的保护因素（ OR =0.37，95% CI 0.17~0.81， P <0.05）。 结论： 言语障碍患儿容易并发语言发展落后，以语言表达和句法能力落后为主，其语言发展与家族相关病史、亲子阅读、屏幕时间等因素有关，应关注言语障碍患儿语言能力发展。.

Publication types

• English Abstract

Grants and funding

• 82273645/National Natural Science Foundation of China
• 7232235/Beijing Natural Science Foundation
• DFL20221103/Beijing Hospitals Authority's Ascent Plan
• AL-02-19/High-level Public Health Talents Training Program of Beijing Municipl Health Commission
• L232121/Beijing Natural Science Foundation Haidian Original Innovation Joint Fund
• PX2022053/Beijing Municipal Administration of Hospitals Incubating Program

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Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals

Annabel hancock.

1 Division of Psychology and Language Sciences, University College London, London UK

Sarah Northcott

2 Division of Language and Communication Science, City University of London, London UK

Hannah Hobson

3 Department of Psychology, University of York, York UK

Michael Clarke

Associated data.

Data are available on request due to privacy/ethical restrictions. The data are not publicly available due to privacy or ethical restrictions.

While the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co‐occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas.

To explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co‐occurring SLCN and mental health difficulties.

Methods & Procedures

Semi‐structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data.

Outcomes & Results

Participants felt that SLCN and mental health difficulties frequently co‐occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial.

Conclusions & Implications

Future research should explore and evaluate current services and service set‐up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population.

WHAT THIS PAPER ADDS

What is already known on the subject.

• Research suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well‐being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under‐researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties.

What this paper adds to existing knowledge

• SLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co‐occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined.

What are the potential or actual clinical implications of this work?

• This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention‐based studies.

INTRODUCTION

The relationship between speech, language and communication needs (SLCN) and mental health is interwoven and highly complex and often poses real problems for speech and language therapists (SLTs) and mental health professionals to understand, diagnose and treat. SLCN is a broad category that covers a wide range of conditions affecting speech, language and communication (Bishop et al., 2017 ). For simplicity and consistency, the term ‘mental health’ or ‘mental health difficulties’ will be used to refer to children and young people (CYP) with social–emotional and mental health needs, anxiety and depression.

The aim of this study was to explore the views of SLTs and mental health clinicians about their experiences of working with CYP with SLCN and mental health difficulties and, if identified by participants, to explore issues around language and social communication disorders. We begin by first reviewing the existing evidence on the links between language, communication and mental health.

Language, social communication and mental health

There is extensive evidence that language and communication problems co‐occur with mental health problems, although the mechanisms behind this relationship remain unclear. Poor language skills are common in CYP with emotional–behavioural disorders. A 2014 systematic review reported that four out of five children with emotional–behavioural disorders had at least mild language difficulties that had not been previously identified (Hollo et al., 2014 ). Poor mental health can present as challenging behaviour, and is associated with disorders of social communication and language (Georgiades et al., 2010 ). In addition to externalizing problems, children with social communication difficulties (SCDs) are likely to experience anxiety (Moree & Davis, 2010 ). Cohen et al. ( 2013 ) and Wadman et al. ( 2011 ) reported that anxiety symptoms frequently occur in individuals with DLD in young adulthood. DLD can severely impact on mental health, and an increased risk for depressive symptoms has been consistently reported in this group. For example, clinical levels of depression range from 20% to 39% in children and adolescents with DLD compared with 14–18% in peers without DLD (Conti‐Ramsden & Botting, 2008 ). Difficulties with language and communication can affect daily living and extend across the lifespan to affect life outcomes. For instance, young offenders with language impairment are at a higher risk for mental health problems (Snow & Powell, 2004 ) and one of the biggest predictors of reoffending is unrecognized DLD (Winstanley et al., 2019 ).

It is possible that certain aspects of language and communication hold particular relevance for mental health. Van den Bedem et al. ( 2018 ) reported specifically more semantic problems in individuals with DLD and the contribution of this to the prediction of depressive symptoms. Children with pragmatic language difficulties also appear prone to emotional and psychosocial difficulties (Cohen et al., 2013 ). For example, in a community‐based longitudinal study, Sullivan et al. ( 2016 ) reported an association between poor pragmatic language in childhood and adolescent psychotic experiences, and that poor pragmatic language skills preceded early adolescent depression. Some children with pragmatic language impairments also show difficulties recognizing facial emotions (Merkenschlager et al., 2012 ), which may impact on their ability to respond appropriately to others and to form close relationships with those around them (Merkenschlager et al., 2012 ). Van den Bedem et al. ( 2018 ) suggested that children with social communication problems are more likely to adopt maladaptive emotional regulation strategies. These maladaptive strategies may contribute to the prediction of higher levels of depressive symptoms. Children with SLCN are also more likely to be the target of bullying and to experience emotional difficulties compared with their typically developing peers (Lloyd‐Esenkaya et al., 2021 ). SCDs are thought to predict social anxiety, and those who experience peer victimization are likely to present with SCDs (Pickard et al., 2018 ).

In clinical practice, those commonly diagnosed with SCDs and/or autism spectrum disorder (ASD) may also present with pragmatic problems. Research shows that CYP with ASD and SCDs meet the diagnostic criteria for co‐morbid diagnoses of depression and anxiety disorders (Hofvander et al., 2009 ). The prevalence of mental health disorders in ASD is high. For example, in an interview study of 54 young adults with Asperger syndrome, 70% reported experiencing one major episode of depression and 56% reported experiencing anxiety disorders (Lugnegard et al., 2011 ). Furthermore, children with SCDs as part of ASD experience attention and challenging behaviour disorders (Moree & Davis, 2010 ; Georgiades et al., 2010 ) and this may lead to poor mental health.

Another factor that may link language, communication and mental health is the role of emotions and the impact of language and communication upon emotional processes. The ability to effectively vocalize feelings and thoughts relies heavily upon robust language skills, especially in relation to gaining a sense of self‐expression, self‐control and emotional insight (Unsworth & Engle, 2007 ). Neuropsychological evidence also highlights that damage to classic language areas in the brain affects emotion processing. Computerised tomography (CT) scans of patients who had sustained a traumatic brain injury found that damage to the inferior frontal gyrus (i.e., Broca's area) was associated with increased alexithymia scores (difficulties identifying and describing one's own emotions) (Hobson et al., 2018 ). Similarly, communication problems of people who have had a stroke are associated with high alexithymia scores, even after accounting for depression and anxiety (Hobson et al., 2020 ). Such research has led to the proposal that the link between language and identifying emotions is intrinsic, and that language impairment could contribute to alexithymia and/or vice versa. This has been coined as the alexithymia language hypothesis (Hobson et al., 2020 ). While these studies reflect data from acquired language disorders (i.e., following traumatic brain injury or stroke), Hobson et al. ( 2020 ) suggests that individuals with developmental language problems are also likely to experience difficulties with alexithymia. Indeed, initial examinations of levels of alexithymia in DLD suggest that, at least according to children's parents, children with DLD have higher alexithymic traits and problems with recognizing and expressing their own emotions (Hobson & van den Bedem, 2021 ). If language problems lead to greater alexithymic traits, it would be expected that such emotional problems will increase the risk for mental health problems and impact on treatment.

Interventions for mental health and SLCN

There are clear links between language and communication problems and mental health, and plausible models for how these two domains interact. It is thus pertinent to ask: What can interventions do to help and are current interventions suitable for CYP with SLCN? The use of appropriately modified talking therapies for CYP with language and SCDs is lacking evidence. Nonetheless, deficits in speech, language and communication would be expected to negatively impact the effect of talking therapies as CYP with SLCN would have difficulties with understanding pragmatic and inferential language, understanding and using narrative language, and understanding and interpreting emotions. Furthermore, difficulties communicating abstract concepts in verbal and non‐verbal children have been identified as limiting factors to effectively access psychological therapies (Lang et al., 2010 ). Thus, social communication and language difficulties may reduce the accessibility and therefore efficacy of traditional talking therapies.

There appears little acknowledgement about the role of language and communication in modifications of talking therapies. The National Institute for Health and Care Excellence (NICE) guidelines for the use of psychosocial interventions with adults with ASD (NICE, 2013 ) recommend using plain English during therapy sessions and avoiding the use of metaphors. In addition, much of the research in this area has focused largely on the use of cognitive behavioural therapy (CBT) in children and adolescents and often with overt SLCN such as voice disorders, stammering and selective mutism (Bercow et al., 2016 ; Menzies et al., 2008 ). There is also a growing body of research on the use of adapted talking therapies for adults with SLCN. For instance, the Solution Focused Brief Therapy (SFBT) in Poststroke Aphasia SOFIA trial (Northcott et al., 2021 ) applied modified SFBT so that it was accessible to language‐impaired stoke survivors. There is no direct evidence for the use of adapted talking therapies in CYP with DLD or language impairments.

Without knowledge about the nature of the SLCN, suitable access to a talking therapy may be ineffective. For instance, individuals with ASD have more trouble understanding psychotherapy concepts than non‐autistic controls (Hall et al., 2015 ). Furthermore, differences in social communication may mean a lack of social chat, difficulties initiating and maintaining conversations and interpreting language literally, all of which would significantly impact upon effective accessibility to talking therapies (Bliss & Edmonds, 2008 ).

In summary, despite the evidence for a relationship between SLCN and mental health needs, there are considerable knowledge gaps in understanding the impact of SLCN on the efficacy and accessibility of treatments, and the role of SLCN in traditional talking therapies has been largely unexplored. Little is known about clinicians’ perspectives of SLCN and mental health difficulties. Therefore, to inform and build the evidence base, the current study explored the views and experiences of clinicians assessing and treating CYP with SLCN and mental health difficulties. The aim of the study was to explore clinicians’ experiences of working with CYP with SLCN and mental health difficulties. The study addressed the following research questions:

• With what difficulties do CYP with SLCN and mental health needs typically present?
• How do clinicians experience assessing and delivering therapies to CYP with SLCN and mental health difficulties?
• What treatments are thought to be clinically useful for CYP with SLCN and mental health difficulties?

Research design

A qualitative research design using reflexive thematic analysis (TA) was chosen for this study in order to obtain a richness and depth to the data set that would appropriately answer the research questions. This approach facilitated an exploration of clinician experiences, observations and knowledge. A reflexive approach to TA was chosen due to the emphasis placed on the importance of the researcher's subjectivity as an analytic resource, and the reflexive engagement with theory, data and interpretation (Braun & Clarke, 2020 ). A reflexive approach is compatible with experiential qualitative research and was fundamental to the research questions. The approach adopted was an active and flexible process with the acknowledgement of theory. This process ensured a quality demonstrated in gold standard TA (Braun & Clarke, 2020 ). Interview questions were semi‐structured in nature; an interview guide and questions were constructed (see in the additional supporting information ) and followed from a flexible and dynamic perspective. The questions were designed to be open‐ended to facilitate flow of conversation with the aim to build rapport and encourage participants to talk about issues pertinent to the research questions.

Participants and recruitment

This study received ethical approval from University College London (LCD‐2020‐10). This study involved 14 clinicians: eight SLTs and six mental health professionals (Table  1 ). Inclusion criteria were that participants should be qualified allied health professionals in the field of speech and language therapy or mental health. Participants had to have sufficient professional experience (at least one year post‐qualification) working with CYP. Participants were provided with an information sheet written in plain English regarding the research area, interview procedure and research aims. Informed consent was obtained before each interview and participants were given the opportunity to ask questions.

Participant characteristics

Data collection

Interviews lasted for up to one hour and were conducted by the first author online via Microsoft Teams video conferencing software. Video‐audio data were collected. Online interviews were chosen for participant convenience and to ensure that the research could take place despite COVID‐19 pandemic restrictions. Each interview was recorded and transcribed verbatim by the first author and field notes were taken. Personally identifying information such as names and places of work were not transcribed to ensure participant anonymity. Video recordings were securely stored under encryption and deleted after analysis.

Data analysis

The transcribed interviews were subjected to an inductive thematic analysis. An inductive approach to thematic analysis was chosen due to the acknowledgement that epistemological assumptions would inevitably inform the analytic process (Braun & Clarke, 2020 ). However, the recognition that thematic analysis is a theoretically flexible approach was accepted and informed the analytic process. Therefore, the approach was descriptive but not wholly atheoretical. A flexible, active and interactive approach was central to the data analysis to support the process of theme generation, as opposed to theme emergence which could be deemed as not reflective of the data and the positionality of the researchers (Braun & Clarke, 2020 ).

NVivo 20 software was used to support line‐by‐line coding of all transcripts. A reflective diary was used to support the identification of themes from codes. Online team coding was conducted with two postgraduate research students and three senior researchers to support the process of reflexivity and refinement of theme generation. The first author presented raw data, identified codes and initial generated themes to the coding group; these were discussed, challenged and refined.

Reflexivity

As reflexive TA captures the skills the researcher brings to the process (Braun & Clarke, 2020 : 6), it is necessary to consider the researcher's perspective. The lead author is a female clinical academic SLT specializing in paediatric ASD, DLD and challenging behaviour. She is also a solution‐focused therapist and practices hypnotherapy with children and adults. The current project formed part of the lead researcher's pre‐doctoral clinical fellowship funded by The National Institute of Health Research. The co‐authors are senior researchers with experience in the fields of speech and language therapy and psychology with research in aphasia and solution‐focused brief therapy, alexithymia and SLCN. Participants were informed about the lead researcher's occupation, background and research aims. The lead researcher's interests and aims were not shared with the participants, and the researcher attempted to maintain a neutral stance throughout the interviews in order to obtain a true picture of clinicians’ experiences and understanding of specific subtypes of SLCN and their relationship to mental health.

Four main themes were generated from the data: (1) boundaries around professional relationships, (2) knowledge of SLCN and mental health, (3) being misunderstood: how CYP are perceived by others and (4) blended interventions. These are summarized in Figure  1 . We unpack each theme and its subthemes below.

Summary of the main themes and subthemes [Colour figure can be viewed at wileyonlinelibrary.com ]

Note: SLT, speech and language therapy; MH, mental health; MDT, multidisciplinary team.

In addition, data were gathered regarding how participants characterize this population. SLCN and difficulties with mental health were identified by participants as frequently co‐occurring. These data are presented following a discussion of the four themes under Figure  2 : SLCN and mental health difficulties: typical difficulties reported in this population.

Speech, language and communication needs (SLCN) and mental health difficulties: typical difficulties reported in this population [Colour figure can be viewed at wileyonlinelibrary.com ]

Theme 1: Boundaries around professional relationships

This theme describes observed discrepancies in the identification of children with SLCN and mental health difficulties, and discrepancies in approaches to working with this population between mental health professional participants and SLT participants. Differences in service provision, professional practice and lack of multidisciplinary team working were cited by participants as contributing factors to the observed discrepancies.

One subtheme concerned marked differences in the organization of SLT and mental health services. SLT and mental health services were not only considered differently organized but also highly variable depending upon postcode, funding and service set‐up. How services were set‐up was construed to play a large part in the appropriate management, or perceived mismanagement, of children with SLCN and mental health difficulties. Service boundaries were identified as contributing to a range of difficulties working across and between disciplines. For example, SLTs discussed difficulties referring to services such as child and adolescent mental health services (CAMHS), often receiving referral rejections from CAMHS with limited or no feedback. Other examples cited by participants were related to limited feedback or acknowledgement to receiving patient reports, a physical distance between services, and difficulties identifying appropriate treatment pathways for CYP with SLCN and mental health difficulties, particularly in mental health services. ‘Lots of referrals get rejected, so many referrals that we really feel as a team need CAMHS support’ (participant (P)5: SLT).

Participants described how services are often entirely separate and working in respective isolation. This was interpreted to contribute to a limited or total absence of joint working, resulting in a lack of knowledge of each profession's discipline and of discipline protocols, for example, referral systems, use of screening for appropriate referrals and confidentiality policies. Service level differences were also cited as causing difficulties identifying which discipline should assess and manage CYP. ‘It was sort of, oh no, that has to be CAMHS, CAMHS has to deal with them, and if they were under seven, then CAMHS would say, oh no, that has to be speech therapy, speech therapy is dealing with them’ (P3: SLT).

A second subtheme was limited multidisciplinary team (MDT) working. An MDT is a group of health or social care workers and professionals who are members of different disciplines, each of which provides a specific service to service users (Hodder Education, 2021 ). Differences in service provision and service funding resulting in a separation of professionals, both at a geographic and organization level, was construed as a contributing factor to limited MDT working between mental health and speech and language therapy. Participants described how SLTs and mental health professionals are often not part of the same MDT and therefore have fewer opportunities to provide integrated care. SLT participants commented that their profession is often unaccounted for within acute mental health services, and one mental health professional considered her role under the safeguarding team as being cut‐off from the SLT's role which was under the SEN team. In addition, some participants attributed limited MDT working to policy level differences such as psychological services not sharing information with SLT due to confidentiality policies and differences in patient note systems:

‘we're often funded by different streams and funded by different people, we work in different health trusts quite often, and that actually has massive implications for the fact a) that you're not physically in the same building, so you don't get to see these people very often, but that even things about how we collect data, our electronic patient systems, we often use very different data technology that, that can make things very difficult in terms of information sharing’. (P13: mental health professional)

SLT participants also described a lack of approachability from mental health professionals which was seen as alienating and limiting from a diagnostic and therapeutic perspective, further contributing to limited MDT working, collaboration and cohesion between these professional groups.

‘because you've talked about an incident or challenging behaviour or something like that, certain psychology colleagues see that as inappropriate or you've overstepped a boundary because you're talking about a kind of emotion when that's something that they do, or they perceive themselves as doing quite exclusively’. (P7: SLT)

Theme 2: Knowledge of SLCN and mental health difficulties

The first theme ‘Boundaries around professional relationships’ directly interacts with the second theme ‘Knowledge of SLCN and mental health difficulties’. A perceived lack of shared knowledge was seen to be related to limited opportunities for multidisciplinary experiences and the clinical service set‐up overall.

The first subtheme concerned the ‘visibility’ of SLCN. It was construed that potentially less immediately obvious SLCN, such as DLD, are less likely to be identified by mental health professionals than more visible SLCN, such as stammering and selective mutism. Visible SLCNs discussed more frequently by mental health professionals as opposed to invisible SLCNs. This discrepancy was described by participants as potentially contributing to unidentified SLCN and mental health difficulties within mental health services, and the lack of knowledge universally with assessment and treatment of this population.

‘I don't think that's typical for mental health practitioners (to consider language difficulties). No, I would definitely think I know my team, the teams that I've worked in, most people would not think about language, particularly language disorders in a young person as part of the part of their (psychology) assessment, unless a parent disclosed something like that, or unless they were very, it was very clear evidence that there were quite obvious difficulties’. (P13: mental health professional)

Difficulty teasing out SLCN from mental health issues (and vice versa) was also interpreted as contributing to a lack of knowledge regarding appropriate diagnosis of CYP with SLCN and mental health difficulties. It was construed that a lack of understanding of the relationship between SLCN and mental health often impacts upon which professional should and would assess and treat this population. Participants discussed how social skills historically have been explicitly taught by SLTs but that mental health professionals are increasingly using this approach as an intervention strategy. Participants discussed a general lack of clarity around role boundaries which could sometimes lead to perceptions of overstepping a professional role or boundary. ‘In my kind of experience, I find certain psychologists very much see emotion, or kinds of challenging behaviour as their domain and they don't like anyone stepping into it’ (P7: SLT).

Barriers to accessing talking therapies was the second subtheme. Knowledge around diagnosis was construed as relating directly to providing appropriate interventions for this population, particularly regarding talking therapies. Traditional talking therapies were interpreted as being potentially inaccessible and inflexible for individuals presenting with SLCN and mental health difficulties, particularly if language difficulties were unidentified. SLTs and some mental health professional participants viewed psychological therapies as language heavy, involving higher level language and concepts that CYP with SLCN would struggle to comprehend and verbalize.

‘I might go and observe a psychology session with them and then the language they're using is far too complex the, the psychological language, the therapy materials, they often use a metaphorical language, they're using kind of these images and symbolism, which is far too complex for the person in general and then they're not really understanding’ (P7: SLT).

Due to a perceived lack of knowledge, identification of CYP with less visible SLCN might be missed by mental health professionals and unaccounted for within traditional psychological therapies. SLT participants described how in such instances appropriate accessibility and efficacy of talking therapies for CYP with SLCN may be compromised. ‘I'm not sure how much they know about these particular children's language needs and like how therefore their intervention with DEAF‐CAMHS‐H [CAMHS for the hearing impaired] is delivered effectively’ (P2: SLT).

Theme 3: Being misunderstood/labelled as naughty

Both SLT and mental health professional participants construed CYP presenting with SLCN and mental health difficulties as misunderstood and often perceived negatively by staff, carers, parents and the wider environment. In particular, difficulties with challenging behaviour, dysregulation and disengagement were interpreted by participants as being misunderstood and perceived as ‘naughty’. Participants considered the high prevalence of behaviours such as disengagement, a distrust of professionals and school refusal as contributing to this perception. Participants interpreted this population as commonly using non‐typical social communication skills that may result in difficulties building and maintaining relationships with peers, staff, parents and carers, further contributing to a negative perception. Difficulties with understanding and expressing language were seen to be related directly to instances of challenging behaviour.

‘We tend to get a lot of young people who are presenting at school, with quite significant behavioural difficulties and we tend to find that being viewed as a behavioural child, rather than a child that's got underlying language needs that have been un‐diagnosed’ (P5: SLT).

Theme 4: Blended interventions

The final theme concerns blended interventions. This theme describes participants’ descriptions of optimum interventions for CYP with SLCN and mental health difficulties. It was construed that working with the systems and environment around CYP is clinically useful for this population.

The first subtheme concerns working with the environment. The use of positive behavioural support systems, emotional regulation strategies and programmes, staff training, and the involvement of parents within interventions were deemed as clinically useful interventions for CYP experiencing SLCN and mental health issues. Parent–child interaction therapy (PCIT) is used by SLTs with the aim of improving interactions between children and their parents/carers (Falkus et al., 2016 ). Theraplay is used by psychotherapists to support healthy child/caregiver attachments (Institute of Theraplay, 2021 ). Both PCIT and Theraplay offer similar programmes where parents are involved as part of the intervention process. Participants discussed the potential of combining or utilizing such approaches in a more joined‐up manner for future targeted interventions. A functional approach to mitigating SLCN was also construed as beneficial for this population. Participants discussed how targeting specific aspects of SLCN may not be as beneficial as focusing on increasing overall functioning and well‐being of CYP.

‘So, I think in terms of delivering therapy, lots of it is about that environmental to therapeutics, so sort of, let's see if we can normalize the environment as much as we can in this environment and support behaviour through communication’ (P3: SLT).

The second subtheme concerned supports for communication. This theme was discussed universally by participants. The need to adapt language and consider therapist delivery within all diagnostic and therapeutic processes was seen as paramount for CYP experiencing SLCN and mental health difficulties. Using simple or no language to take the pressure off a requirement for verbal communication was interpreted as being necessary within any intervention for this population. Other visual supports, such as talking mats (Murphy et al., 2013 ) and communication systems, such as visual timetables and ‘now and next’ boards, were considered useful.

‘The use visuals, the use of visuals full stop. Whether that's visual or written timetable, even if the child has literacy so implementing a sort of routine on a timetable and consistent use of that across the day, I think works well’ (P4: SLT).

Play therapy or the use of play as a vehicle for access to psychological therapy for CYP with SLCN and mental health difficulties was considered a potentially useful psychological approach for this population due to the lack of emphasis upon verbal communication:

‘So, I think the use of toys and play can help bring their outer world about what's going on when, what they see inside and speech doesn't need to be, it doesn't need to be a part of that’ (P12: mental health professional). ‘I think the therapy it's different because I'm not expecting, they don't have to talk’ (P11: mental health professional).

Explicitly teaching higher level language was deemed an important intervention strategy, particularly in relation to comprehending and expressing emotions. One SLT participant described how they had combined a cognitive developmental theory of emotion and a psychotherapy model, with a vocabulary intervention directed through talking mats (Murphy et al., 2013 ) to facilitate communication. This was discussed and explored as a potentially useful way to develop emotion vocabulary comprehension and processing with this population.

‘You give people labels to understand what they're feeling physically, and then you move it onto more cognitive levels where that's the more kind of established sort of CBT, that kind of approach where they're thinking about their emotions and their thoughts … then you move on to the word level stage (of the vocabulary intervention) and that's very much around introducing kind of very basic semantic understanding of the word of the meaning and then you're building in the syntax and you're trying to get a really deep, you're trying to get there because they often have a vague notion of what certain words mean, but their understanding is very poor so you're trying to really reinforce a particular meaning or understanding of an emotion word’ (P7: SLT).

Merging interventions drawing upon practices from speech and language therapy and mental health was discussed. For instance, an SLT talked about how they had successfully combined shape coding (Ebbels, 2021 ), which is an established intervention used by SLTs, with social communication, emotional regulation, and transactional support (SCERTS), which is a behaviour intervention (Prizant et al., 2006 ). Participants also interpreted the use of relatable, non‐hypothetical language, and teaching how emotions look and feel in the body as being clinically necessary for this population. Participants advocated for the need to modify and adapt traditional talking therapies such as cognitive behavioural therapy and using an individualized approach. ‘Lots of more sort of explicit ways of doing things and using lots of examples from his own his own life and things that he would bring to the session rather than me coming up with example’ (P13: mental health professional).

Common difficulties reported by interviewees to be seen in CYP with SLCN and poor mental health

In addition to the themes described above, participants generated discussion regarding how they characterize this population. In answer to the question ‘can you tell me about some of the difficulties these CYP experience?’, participants described a range of difficulties this population typically present with. This is not a diagnostic criterion; it is a set of descriptions used by participants to describe their experience of this population (Figure  2 ).

Participants felt that characterizing the overall presentation of this population is often problematic. Participants reported that it is difficult to determine what is specifically a SLCN and what is a mental health need. SLCN and difficulties with mental health were identified by participants as frequently co‐occurring. Key aspects of development were identified by participants as being typically delayed or disordered with CYP experiencing SLCN and mental health difficulties. Participants reported that CYP in this population would commonly experience difficulties across these areas. The first area identified was emotional well‐being. Participants felt that this population significantly struggle with feelings of self‐consciousness, low self‐esteem, and anxiety, often about the presence of a communication impairment, and the impact of their communication difficulty on their experiences with the world around them. Participants felt that difficulties with self‐esteem and anxiety could sometimes result in poor emotional resilience. One participant described how young offenders are at particular risk of developing low self‐esteem because of multiple exclusions from education and therefore a sense of rejection that they may experience throughout life. Another participant described how difficulties with SLCN could impact on their well‐being and levels of anxiety and distress and behaviour. ‘We definitely see those children, they're often very anxious and there is definitely an impact of some of their difficulties on their well‐being, self‐esteem and their mental health’ (P5: SLT).

The second common characteristic was challenging behaviour. Participants described this population as typically experiencing difficulties with engagement, staying on task, and finding it hard to comply with work in the classroom or, with other professionals. Typical behavioural difficulties were problems with emotional regulation and the presence of anger or aggressive behaviours. Participants described how CYP can be disruptive or conversely appear withdrawn and isolated in social situations. Other reported difficulties in this area were with attention and listening and with building and maintaining relationships, particularly with peers.

‘We see quite a lot of, we describe it as anxiety for the children that, that I work with and dysregulation is a term that I've been using much more recently, so that can present as very elevated, it can present us physical aggression, some self‐harm and behaviours, yeah, sort of, socially inappropriate behaviours in terms of removing clothes and smearing and that sort of thing’ (P10: mental health professional).

The final area identified as characteristic of this population was language and cognition. Participants felt that this category of CYP experience difficulties with general language comprehension, processing of spoken language and with their expressive language. ‘Verbally he (a patient) appeared to understand things very well or he had a good, he had a good vocabulary, but actually his understanding was limited so he could be quite misleading’ (P13: mental health professional).

Difficulties with executive function was also discussed, often in relation to CYP being able to appropriately plan and organize themselves. One participant cited how it is common for CYP to arrive late to lessons, getting lost en‐route and forgetting school equipment. Difficulties with verbal reasoning were also described as commonly present with this population. ‘They're breaking their curfews and they end up in trouble with the police and things because they can't tell the time’ (P5: SLT).

Difficulties with metacognition (thinking about thinking) was also highlighted by participants as a typical difficulty seen in these CYP. Difficulties with insight, being able to monitor their communication and planning how to approach a learning task were all discussed as typical problems for this population. ‘They may not have insight into their own language use or behaviour’ (P2: SLT).

‘Difficulties with higher order language and the use of sophisticated, abstract and emotional language was also reported. Participants reported CYP in this population often experience difficulties understanding and using emotion language, particularly labelling emotions. They don't know what it means when somebody uses those words (emotional words), or is sarcastic’ (P5: SLT).

The misunderstanding of negative constructions was discussed as being a barrier to understanding emotions:

‘You might conceive that someone's doing something to you because you can't understand negative constructions, for instance, you just you assume everyone's just doing things to you but you're the one who's not quite understanding like the word no, or negative things’ (P7: SLT).

Difficulties with being able to understand abstract language and using language in a more abstract way to make predictions, use hypothetical language and humour was also cited as a typical difficulty in this population. ‘He would struggle with transferring that knowledge from a discussion about a hypothetical person to himself’ (P10: mental health professional).

The current study explored the experiences and views of SLTs and mental health professionals working with CYP with SLCN and mental health difficulties. Discussion around CYP with SCDs such as ASD, and developmental language disorder (DLD) was of particular interest. SLTs and mental health professionals in this study perceived certain subtypes of SLCN to commonly co‐occur with mental health difficulties. Findings suggest that there are organizational and service set‐up boundaries between SLTs and mental health clinicians, which has implications for the efficacy of assessment and treatment of this population. Findings also suggest that this population is often misunderstood and misidentified. The current research indicates that combined approaches in SLT and mental health may be beneficial for CYP who present with co‐occurring SLCN and mental health needs.

The current research has also identified that distinct barriers exist between mental health clinicians and SLTs which has led to boundaries between these professional groups. The most significant barrier was found to be around service organization and set‐up. Participants described how, as professionals, they felt organizational difficulties led to feelings of ‘failing’ this cohort. Findings suggest that mental health professionals and SLTs are often not in the same MDT and that SLT is often not a recognised professional group within children and adolescent mental health services. SLT and mental health services appear to be functioning in parallel, working under different teams, services, NHS trusts, local authorities, and sometimes entirely different organizations. Service set‐up and organization limitations were deemed to result in fewer opportunities for MDT working which has a negative impact on the knowledge professionals have of CYP with co‐occurring SLCN and mental health difficulties. Within the United Kingdom there is currently an ongoing consultation process with The Royal College of Speech and Language Therapists (RCSLT) and CAMHS to recognise the role of SLT within mental services and to increase SLT roles within core CAMHS services.

The current research highlights how a lack of understanding of this population is a clinical concern and has been described by participants in this study as having implications for effective diagnosis and treatment. The current study also illustrates that availability of joined up and multidisciplinary services for this population is scarce. This has resulted in a lack of shared knowledge about this population, leading to challenges with diagnosis, particularly with CYP who exhibit invisible SLCN and mental health difficulties such as DLD. The current research highlights that CYP with co‐occurring SLCN and mental health difficulties may be undiagnosed or misdiagnosed by professionals. This may mean CYP in this population fail to receive appropriately modified and evidence‐based treatment. The current findings resonate with other recent investigations of parents’ experiences concerning mental health support for their children with SLCN. Parents have reported concerns that mental health treatments were not accessible for their children and lacked adaptations necessary for them to work for children with conditions such as DLD (Hobson et al., 2021 ).

Typical behaviours and characteristics of CYP with co‐occurring SLCN and mental health needs are often misunderstood by parents, carers and professionals resulting in this population being misinterpreted and often labelled as ‘naughty’. Behaviours that are typically misunderstood include anger or emotional outbursts due to difficulties with emotional regulation, disengagement, language difficulties and problems with building and maintaining adult and peer relationships. Participants reported that children in this population are frequently ‘angry’ or show aggressive behaviours, and experience difficulties with friendships, can be distrusting of professionals, and are likely to show poor school attendance. Participants observed that CYP in this population are also likely to experience school expulsion, attendance to pupil referral units, and in some cases youth offending institutions/team (YOT).

A key finding was that interventions used in both speech and language therapy and psychotherapy are perceived as clinically useful if combined. Other research (Bercow et al., 2016 ; Menzies et al., 2018 ) has applied mental health interventions to specific subtypes of SLCN such as stammering, selective mutism and ASD, but little in relation to DLD. Participants discussed how they have successfully blended behaviour and emotion programmes with language and communication interventions. Similarly, participants discussed how combining traditional talking therapies, such as CBT, with modifications to account for communication difficulties, such as using visual supports, can be beneficial.

Hollo et al. ( 2014 ) has called for the development of interventions to ameliorate the effects of these dual deficits. Findings from the current study show that some existing or modified interventions are anecdotally effective. A good starting point for future research would be with the exploration of adapted traditional talking therapies and psychological therapies combined with SLT. A preliminary finding from the current research is that play therapy could also offer a potentially useful psychological therapy for CYP with co‐occurring SLCN and mental health difficulties due to its child‐led nature and lack of emphasis upon language and communication. Interestingly, play therapy was also raised by parents of children with DLD in the study by Hobson et al. ( 2021 ) as an approach that they felt would be worth pursuing. This has yet to be directly explored in individuals with SLCN but could offer further direction for future research into interventions for this population.

Findings from the current research show that it is not typical for mental health clinicians to consider language and communication skills within their assessment and treatment processes. The potential impact of this omission was described by participants as limiting CYP with co‐occurring SLCN and mental health needs to therapies that would likely be inaccessible. The current study has found that traditional talking therapies may not be modified for this population, unless the CYP have an obvious or diagnosed SLCN. This has implications for the efficacy of treatments provided, highlighting that traditional talking therapies, if not appropriately modified, are likely to be suboptimal for this cohort. Participants felt that traditional talking therapies could be reasonably adjusted to be accessible to individuals with SLCN. In a recent intervention study where aphasic adult patients received SFBT, Northcott et al. ( 2015 ) concluded that modifying question forms of therapy enabled greater accessibility.

Clinicians identified that CYP with SLCN and mental health difficulties most commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Fundamentally, participants considered that it is typical for CYP to present with co‐occurring SLCN and mental health difficulties, that is, difficulties across speech, language and communication and mental health. Previous research reports that children and adolescents with DLD and ASD are likely to experience difficulties with anxiety and depression (Cohen et al., 2013 ; Hofvander et al., 2009 ; Wadman et al., 2011 ). Results from the current study reflect this, indicating that difficulties with language and social communication are likely to interact with mental health difficulties. In addition, participants felt that SLCN can profoundly affect a person's social and emotional well‐being, and this can lead to poor mental health.

Participants described how CYP typically experiencing difficulties with higher level language are likely to find understanding and expressing emotions challenging. This supports existing frameworks such as the alexithymia language hypothesis (Hobson et al., 2020 ) which proposes that because of the intrinsic relationship between language and emotions, CYP with conditions such as ASD and DLD may be more likely to experience co‐occurring difficulties with mental health.

A limitation of the current study was that some of the participants were recruited from the researcher's professional network. Thus, a convenience sample was used and therefore potential selection bias may have been present, resulting in a failure to capture important perspectives from hard‐to‐reach participants. However, it is important to note that the range of participant specialities, knowledge and skill set was heterogenous and diverse.

Clear directions for future research have been identified from the results of the current study. The service organization, set‐up and service provision for this population is problematic. Future studies could explore and evaluate current services, set‐up and structure across and between SLT and mental health. The findings from the current study have important implications for the efficacy of treatments provided to this population, suggesting that more research needs to be done in this area. There exists a large gap in the evidence base for intervention‐based studies with this population. Larger scale intervention studies could also provide evidence for the efficacy of psychological approaches with this population. Future studies could also explore the adaptability of traditional talking therapies, combining approaches drawn from SLT and psychological therapies and the exploration of play therapy. Intervention studies analysing the efficacy of psychological therapies in children and adolescents with SLCN should arguably be conducted in part with SLT to provide input regarding SLCN. Modifications to talking therapies in young people with SLCN are therefore necessary in order to reflect and treat the presence of SLCN and mental health difficulties. Research from Solution Focused Brief Therapy (SFBT) in Poststroke Aphasia SOFIA trial (Northcott et al., 2021 ) suggests that modifications to SFBT is a promising psychotherapy approach for adults with aphasia, and that it is possible to adapt a language‐based psychological intervention for people with language disorders. In addition, behavioural activation therapy has also been shown to be successfully modifiable for adults with aphasia (Thomas et al., 2013 ) but further evidence, especially in a paediatric population, is scarce.

The current study aimed to describe typical presentations of this population, clinician experiences treating this population and clinically useful treatment approaches. The findings present a picture of the problems CYP with SLCN and mental health needs commonly experience and has enabled the documentation of a range of clinician experiences and views to inform and build a limited evidence base. Findings suggest that there are distinct organizational and service set‐up limitations with implications for the assessment and treatment of CYP with SLCN and mental health difficulties. Interventions drawing upon SLT, and mental health approaches may be beneficial for this population.

Supporting information

Supporting Information

ACKNOWLEDGEMENTS

Annabel Hancock thanks The Owl Therapy Centre for their invaluable support and for making this project a reality. She also thanks her supervisors and The NIHR for funding this project as part of the Predoctoral Clinical Academic Fellowship. She is also grateful to the participants who took part in this project, without which this research would not have been possible.

Hancock, A. , Northcott, S. , Hobson, H. , & Clarke, M. (2023) Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals . International Journal of Language & Communication Disorders , 58 , 52–66. 10.1111/1460-6984.12767 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

The NIHR funded this project as part of Annabel Hancock's Predoctoral Clinical Academic Fellowship.

DATA AVAILABILITY STATEMENT

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