The Speech and Language Therapy profession is arguably one of the most important in Irish healthcare today. Its combat against the prevalence of communication disorders in this country – especially for young children up to five years of age, in their crucial development stage, is fundamental in enabling those that could not otherwise manage it themselves, participate normally in society.
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But the last decade has seen a steady rise in such cases accessing public speech and language therapy services and the resources are currently not meeting existing and future demand. In fact quite the opposite is happening; public resources managed by the HSE are in decline as cuts to HSE budgets have been a constant since the beginning of the recession.
Waiting lists for the public services are at an all-time-high and demand for private services have risen as a consequence but overall, children with speech and language needs are in a state of neglect and these needs will become more complex and problematic the longer they wait.
There are a lot of problems in our health system today that are apparently being addressed by the concept of reform. But somewhere within this system in reform – there is an immerging issue of pretty dire proportions.
Communication in human beings is a fundamental and natural skill that shapes the very world we live in. To not be in possession of such a seemingly basic skill would to essentially, be left out of society. Hard to imagine, yet thousands of children in the country each year present with communication difficulties.
Speech and Language Therapy addresses these difficulties and with great success however such difficulties left untreatedâ€¦â€¦
What is Speech and Language Therapy?
Classified as a healthcare profession – Speech and Language Therapy aims to assess, diagnose and manage those who have difficulties with their communication skills. Speech and Language Therapy enables those with such difficulties to achieve their full potential to communicate and therefore integrate properly into society. Children with speech and language issues are among a very common group that are at a risk of developmental, learning, behavioural and social difficulties. Between 50-90% of children aged three with communication deficiencies will continue to have difficulties throughout their childhood. (HSE.ie – Speech and Language Therapy. 2013).
Image www.arcspeech.ieSpeech and Language skills are vital to a child’s development – which happens through communication. Language forms the very basis of communication – for which reading, writing, speaking and listening are all part of. The ability to communicate is crucial for children to communicate with their peers. Children with delayed language development entering their first year in school are at risk of not being able to access the school curriculum. (ARC Speech & Language Therapy Clinic 2013).
The key to a more successful outcome for communication disorders is early intervention.
When Would a Child Need Speech and Language Therapy?
There are general guidelines for parents who may suspect that their child might be in need of or may benefit from speech and language therapy.
For example, if the child has difficulties understanding instructions compared to other children, is late in development of talking, has a hoarse voice, has a stammer or stutter, finds playing with peers challenging or is not interested in interacting with others or is 3 and there is difficulty understanding their speech. (Irish Association of Speech & Language Therapists. 2013).
Typical stages of speech and language development for parents to understand at what stage their child should be at are outlined in the table below.
Figure : Typical Stages
6 to 9 months
9 to 12 months
12 to 15 months
15 to 18 months
18 to 24 months
2 to 3 years
3 to 4 years
4 to 5 years
Babble a long string of syllables aloud
Point and imitate. Say “yes” and “no” and shake head accordingly
Understand and respond to simple instructions.
Be able to say 6 to 20 words and understand even more.
Have a range of up to 50 phrases. Ask for food and drink.
Understood 50 to 75% of the time. 3 to 4 words together in a sentence.
Understand opposites. Ask Why questions. Understood 80% of time. 6 word sentences.
Recognise some words in books/signs. More complex sentences with few errors.
(Catriona Lysaght – Speech and Language Therapist. 2013).
My Child is Not Following the Typical Stages.
All children develop at different rates and a parent knows their child best (Catriona Lysaght 2013) but a parent whose child does not seem to follow or ‘fit’ the typical development stages, should have reasonable cause for concern and talk to their G.P. who can form their own opinion and refer to a Speech and Language Therapist if necessary.
The very first step to the Speech and Language process is always the initial assessment in which to gauge the child’s speech and language skills in relation to the typical stages of speech and language development. The assessment is child age and ability specific and the parent normally will have completed a questionnaire to give the therapist a good understanding of the child’s skills.
Some of the general things that the therapist assesses during the initial assessment may include:
Figure : Assessments
The sounds that the child uses to make words and how the child uses those words themselves as part of their language.
The child’s ability to move the mouth muscles for both speech and non-speech tasks.
Receptive Language Skills
The child’s understanding of language used by others around them.
Expressive Language Skills
How the child uses words to expresses themselves.
The therapist examines the characteristics of the child’s stammering.
Feeding, Eating, Drinking and Swallowing (FEDS)
Only for children with difficulty in the area, the therapist observes the child’s eating to assess things like chewing skills, drooling and ability to feed independently.
(Irish Association of Speech & Language Therapists. 2013).
Once the initial assessment has been completed the therapist will give the parent verbal feedback on their findings and discuss the results of the assessment. A plan for moving forward to best suit the needs of the child is also discussed along with whether or not the need for a block of speech and language therapy is required. (Irish Association of Speech & Language Therapists. 2013).
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Speech and language issues for a child could also indicate other potential issues for that child that otherwise could not be determined at an earlier stage of their development. While most children who attend speech and language therapy benefit greatly from the intervention, for some parents – it can mean the realisation on an underlying issue such as Autism or Attention Deficit Hyperactivity Disorder (ADHD).
Prompt assessment and early intervention is critical if the long-term implications of a speech and language impairment is to be successfully reduced. (HSE.ie – Health Service Executive Website – Speech and Language Therapy. 2013).
The earlier a child is assessed and diagnosed for treatment, the earlier that treatment can begin and the more successful the treatment will be. Children have a window up to the age of five of prime time for brain development and ideally any therapy treatment should be during this time. The older the child, the least effective the therapy is – so early intervention is key.
Services: Public vs. Private.
Public speech and language therapy services are free in Ireland but there are private alternatives for a family who wish to have their child seen to much more quickly than they could be seen to by the public service. Private services can also offer more regular, specialist services with more flexible hours and the associated costs are mostly covered by many of the health insurance companies – but the outlay can be expensive overall.
Parents who simply cannot afford to have their child seen privately have little alternative but to join the public waiting list.
Speech and Language Therapy Demand in Ireland.
It is estimated that over 5% of children will experience a Speech and Language delay which means that up to 6,000 children each year will have a specific speech or language impairment by the time they reach the school-going age. (Cluas.ie | Speech and Language Therapy| Language Development. 2013).
With the increase on birth rates in Ireland today, this figure is likely to increase.
The demand for speech and language therapy in Ireland has been steadily rising over the last decade as figure 3 shows:
Figure : People Accessing Primary Speech and Language Therapy in Ireland
(Department of Health, 2012)
Speech and Language Resources in Ireland.
Public resources for Speech and Language Therapy have drastically reduced since the beginning of the recession where recruitment bans across the Health Service have impacted heavily on the patient-to-therapist ratio that have seen waiting lists grow longer and longer – up to 2 years in some areas (Irish Examiner 2013).
Desperate parents have been flocking to their local TDs as a last resort and a number of them have pleaded on their constituent’s behalf in the Dail for a lifting of the ban – specifically for Speech and Language Therapists e.g. (Patrick Nulty 2013).
Therapists themselves are feeling the stresses and strains of the system where the long waiting lists are the main source of frustration (HSE.ie – Speech and Language Therapist 2013). They are only too aware of the ticking clock that is the development window of each child on the list.
All of this in contrast to the promises made by the Minister for Health in 2011 for radical reform across the health sector (James Reilly 2011).
With the rising demand for speech and language therapy coupled with reductions in public services, the very foundation of speech and language development; early intervention has become a contradiction in terms. Paradoxically, the relatively small savings currently being made with recruitment embargos in the health service are very likely to be overshadowed by the future costs that will be associated with developing the children whose needs are not currently being met. This might make some economic sense to those who maintain that the funds simply are not there now to meet current demands – but on a human level, it’s simply unjust to expect children to delay their own learning development for the sake of economics.
Resources for speech and language therapy need to be restored to appropriate levels to handle current demand – with priority given to the areas in most need; with the longest waiting lists and lower patient-to-therapist ratios.
Similarly – reforms within the health service, especially in this field are desperately required and long overdue. The Government and HSE must deliver on their reforms promised in 2011 to reduce waiting lists across the health system (James Reilly 2011).