Referral Guide to York Teaching Hospitals Children's Therapy Services

Quick reference: Referral guide to York Teaching Hospitals Children’s Therapy Services: Quick reference: Referral guide to Children’s Therapy Services: Speech and Language Speech and Language Therapy Referral Is the child under 5 years Old ? Yes Is the Child over 5 years Old? No Either route below: Direct referal form Direct referal form Parent self referral form Professional via Professional or can be be completed by Integrated Therapy Parent via parent and sent to: Referral Form Integrated Therapy Referral Form Scarbrough Whitby and Ryedale Complete additional Parents: information SLT form and if there are also feeding York and Selby Parents: Children's Therapy Team, Beck House, West Parade Road, York Hospital, Wigginton Road, York, YO318HE and swallowing Scarbrough , YO12 5ED difficulties complete the feeding additional form Send to: [email protected] Or by post: (Please see Children’s AHP Therapy Service Access Routes for York Selby, Scarborough Whitby, Ryedale Flow Chart in the Quick reference section. Further information: • For Scarborough, Whitby and Ryedale Speech and Language Therapy call 01723 342472 • For York and Selby Speech and Language Therapy call 01904 726599 Quick reference: When to refer to Speech and Language and when to watch and wait Refer at any age if the child has : unintelligible speech speech skills that seem significantly delayed (see the chart below) verbal comprehension and/or expressive language impairments that are noticeably outside the expected range and affecting access to the curriculum a stammer lost communication abilities ‘nasal‘ sounding speech and/or over uses ‘m’, ‘n’ or ‘uh’ sounds a croaky or husky voice not attributable to a cold a very varied speaking profile (parent/carer reports child talks easily at home but is silent in the EY or school setting) By 18 months • A vocabulary of first • Child has a few • Poor attention e.g. words is emerging words (10-20) unable to sit with adult (around 50 words or • Possibly using jargon for short period more) or nonsense • Does not make eye • Child understands language for the contact or show what others say in main part interest in adults or familiar situations • Looks with interest other children • Understands more when hears language • Not saying any words words and phrases but no attempts to • Not using words for than they can say copy words communication (e.g. • Child copies words • Only understands may just say words for and possibly some very familiar words no apparent reason) short familiar phrases in known situations • Doesn’t look to people e.g. “what that?” e.g. “You want or objects when • Parents understand juice?” named the child’s speech • Looks with interest • Does not seem to more than unfamiliar when hears language understand what is listeners but no attempts to said much at all. • Words may be made copy words • Doesn’t turn to look of small range of • Words are not used where sounds are sounds, often used in for a few coming from (hearing?) babbling e.g. b, d and communication • Has lost social or m (and vowels). functions language skills • Words are short e.g. “beh” for ‘bread’ DO NOT refer Do not refer. Review at 23 Refer to Speech and months (if not improved Language Therapy then refer to Speech and Language therapy) Also see advice sheet/s; See SLT advice sheet; ‘Gesture’ ‘Advice for Early Years- delayed language’ sheets BY 2 YEARS • Vocabulary increasing, • 20-50 single words • Little pretend play possibly hard to list all • Some simple • Poor attention and/or words said. pretend play. can’t share attention • Still mostly single • Able to concentrate e.g. looking at a book words, but some 2 for short spells with an adult word phrases may be • Possibly jargon • 0-20 single words heard. (nonsense speech) • No apparent • Speech intelligible to used with one or comprehension skills close family two words • Or, can only • Understands some interspersed understand stressed words out of context • Responds to familiar single words in familiar • Can understand some instructions and contexts short phrases without language only • Not responding to clues their name • Child using language • Has lost speech or in more ways e.g. not language skills just to ask for things • Not sharing attention or comment by pointing to or following point to things of interest • Attempts at words are unintelligible • Words used repetitively e.g. just to name items • Speech sounds ‘nasal’ and child may use ‘uh’, ‘m’ and ‘n’ a great deal DO NOT refer Monitor in home/setting Refer to Speech and Language Therapy See SLT advice sheet; ‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Gesture’ BY 2½ YEARS • Using some two word • Has an increasing • Poor comprehension of phrases e.g. “Daddy vocabulary of single language shoe” words, but no signs • Few or no words used • Understands some yet of linking these. although other skills questions e.g. “What?” • Comprehension of appear better (e.g. (‘is it’ and ‘doing’) language seems play, attention and • Understands basic good, but there are problem solving) instructions when concerns regarding • Vocabulary is not clues are absent e.g. number of single increasing or when “Put the bear on the words used new words are added chair” expressively others are lost. • Short ‘telegrammatic’ • Loss of language skills phrases used previously there. • Still most intelligible • Memorised speech to family and others used rather than 1 to 2 familiar with the child. word level phrases • Child can keep on a ‘made up’ by the child subject for a little • The child ‘echoes’ what while is said a great deal • Speech unintelligible to most, even close family • If the child is stammering • Child has varied speaking profile e.g. uses words to ‘chat’ at home, but is silent in early years setting • Speech sounds ‘nasal’ and child may use ‘uh’, ‘m’ and ‘n’ a great deal DO NOT Refer Monitor in home/setting Refer to Speech and Language Therapy See SLT advice sheets ‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Dysfluency in the Early Years’ ‘Situational fear of talking’ ‘Gesture’ By 3 YEARS • Producing two to • Little sign of/only a • Poor comprehension of three word phrases, few words linked, language e.g. “me want juice” but child appears to • Only saying single • Understands basic have better words, (or learnt position words such as development in phrases) although ‘on’, ‘in’ and ‘under’ other areas e.g. play other skills are good • Welcomes and or attention • Limited pretend play responds to adult • Not understanding • Cannot attend for suggestions most of more than basic longer than a few the time ‘what’ questions e.g. minutes • Child using language “where?” • Child is stammering to accompany play • Frequently • Child has varied • Some speech can be unintelligible to speaking profile e.g. difficult to understand, other people than uses words to ‘chat’ at but child is mostly close family home, but is silent in intelligible early years setting • Language used repetitively • Speech very unintelligible DO NOT Refer Monitor in home/setting Refer to Speech and Language Therapy See SLT advice sheets; ‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Dysfluency in the Early Years’ ‘Children who have unclear ‘Situational fear of talking’ speech- speech delay’ ‘Gesture By 4 YEARS • Utterances are • Child finding it • Noticeable difficulties developing to be at difficult to with comprehension of least 5-6 words long understand language and used questions • No evidence of 5-6 appropriately • Child has short word utterances • Child is developing phrases of up to 4 (although other skills knowledge of words good) concepts of size and • Child’s phrases are • Odd phrases; words shape developing but seem muddled • Child is intelligible to sound ‘young’ for • Unintelligible even to most people the child’s age family most of the • In speech, ‘fricative’ • Child’s speech time. sounds, f v s z are sounds ‘young’ (may • Shows an unusual used but may be be accompanied by speech pattern, e.g. missed in blends e.g. immature language omits all initial ‘pider’ (spider) development). consonants, vowel • The child may still • Child’s social skills abnormalities, over use have difficulty with sh, seem immature and of one consonant zh, ch and j sounds in line with general sound or mixes up • The sounds t and d developmental level sounds in words can be used for k and • Child uses odd or g (e.g. tar for car), up ‘sing-song’ intonation until around 3 ½ years pattern • ‘l’ may only be • Child has heightened developing by the end vocabulary in area of of this time frame too interest but poor • Child developing vocabulary in other ability to reason and areas report outside the • Child is not using ‘here and now’ about language for basic e.g. past events conversation • Child uses language repetitively • Child uses odd or ‘sing-song’ intonation pattern • Child is stammering • Child has varied speaking profile e.g. uses words to ‘chat’ at home, but is silent in early years/school setting • Child has significantly gruff or husky voice that does not change over time (gain referral to ENT prior to referral) DO NOT Refer Monitor in home/setting Refer to Speech and Language Therapy See SLT advice sheets; ‘Language comprehension’, Also see advice sheet/s; ‘Expressive language’ ‘Dysfluency in the Early Years’ ‘Children who have unclear ‘Situational fear of talking and speech- speech delay’ Selective Mutism’ ‘social communication skills for pre-school children’ BY 5 YEARS • Utterances are long

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