Live chat with language therapist Helen Cain

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Here is our 31st chat write-up with Helen Cain, Speech and Language Therapist and PhD student interested in children’s language development and developmental communication impairments such as Autism Spectrum Disorder (ASD) and Specific Language Impairments (SLI).

Also, if you are fascinated by this topic, you might like to have a read of some of the live chats we’ve had in the past about language development in babies, like this one on family-based shared reading, or this one on language development, or this on babies’ early gesture.

Q: What are ASD and SLI?
Helen: ASD stands for Autism Spectrum Disorder and SLI stands for Specific Language Impairment. Both are communication impairments that start in early childhood. Autism Spectrum Disorders cause impairments of communication and social interaction skills, and also cause children to have restricted and repetitive behaviours, which can cause delays in play skills, difficulties with changes, need for routines etc. Specific Language Impairment is diagnosed when a child has difficulties with developing language skills with no known cause, when the child’s general development is age-appropriate and there is no hearing impairment, physical disability, learning difficulty, autism, environmental deprivation that could explain the language difficulty. It can affect understanding and expressive language, or just expressive language.

Q: Do we know what causes SLI? Or is that the million dollar question?
Helen: That is the million dollar question! We don’t even really know how to spot it in children less than about 3 years old, as many children have language delays that resolve on their own, but an SLI won’t resolve without help from a speech and language therapist. One of the aims of my research is to look at early markers for these conditions and whether children can be spotted as young as 12 months old, and intervention put in place to help develop their early communication skills.

Q: What are the signs that a child is not making headway with language development?
Helen: that’s a really good question! It would depend very much on the age of the child. For example, at 2 years old, most children will be starting to put two words together when speaking. They can usually understand and follow simple instructions and understand concepts such as big and little. They usually have some pretend play. At 12 months old, when I see babies for my research, we’d expect that a baby would be interested in people, would respond to their name, might follow instructions with a gesture and in a context. They may or may not have said a first word. They should be interested in toys and should show they can use for example a cup or a spoon for their intended function. Failure to comprehend can manifest as difficulties with following instructions, but at nursery and school age it can also show up as problems with behaviour or listening/attention.

Q: Do you see a difference between boys and girls? People often say that girls are better at talking and just generally develop a bit faster but I don’t know how much of that is myth and legend.
Helen: Yes, there are definitely differences between boys and girls in language development! In fact, a lot of assessments for preschool children have separate norms for boys and girls because girls tend to have bigger vocabularies. I was wondering whether that would still be true, but my research still shows that girls tend to have better language skills at each age. However, by school age, most assessments only have one set of norms so I think the assumption must be that the gender difference levels out by age 4.

Q: I wonder how big is the variation within gender and how big is the difference between the genders?
Helen: Variation in early language development is massive! So there is very big variation within gender. For example, I have seen some boys of 12-18 months with enormous expressive vocabularies. As an example, for the 10-20 month old babies in my research study, expressive vocabulary sizes range from 0 to over 200.

Q: Given that boys, on the whole, perform less well at school, is that a fair assumption?
Helen: I’ve never thought about that but it’s an excellent point, and I’m not sure whether anyone has ever researched in detail whether boys really do catch up with girls in their peer group. If not, we’re doing them a disservice in the way we currently assess language formally.

Q: I wonder if they have different types of vocabulary. I remember my son having 17 transport nouns before anything other than milk, more and mammy showed up.
Helen: I also think that may be true. I haven’t looked in detail at that yet in my data but I will be able to as I have vocabulary inventories for each child filled in by parents. It’s also true that there are different language learning styles in early vocabularies: some children learn more object labels, others learn more social words such as “more”, “hello”, “no”.

Q: What is the best way to promote bilingual development?
Helen: all research suggests that it’s easier to learn a language if you already have a solid language system, so for example children who are not exposed to English until nursery but have good language skills in their first language catch up with peers quite quickly. For children who are truly bilingual from birth, the research says that they may be slower to develop expressive language, but that there are advantages to being bilingual as you grow up, as it increases your cognitive flexibility. As a speech and language therapist, we always promote parents speaking to their child in the language that the parent is most comfortable with, as that gives the child the best language model, which is going to be best for them to learn from.
@Helen: Thanks. It is sometimes difficult to get parents to appreciate that to talk in their own language is the best way to help their child. They are often obsessed with the need to learn English and they are not sufficiently competent to provide that solid language base!
Helen: That’s totally correct. For a parent who is not confident in English, it’s far better that they provide a child with a great language model in their first language to develop their language skills. That can transfer into learning English later.

Q: When you’re assessing vocabulary, do noises count? My son, for example, would say “baa” if you pointed to a sheep in a book, “woof woof” for dog, “rarr” for giraffe, but it took him a while to get the actual names (we didn’t correct him about the giraffe because we’ve never heard one and he could be right!)
Helen: Yes, in early vocabulary we count things like animal noises because the child is learning them in a word-like way. They’re much easier to learn than the animal names!

Q: Have you noticed any negative correlations between moving early and talking early? People always say babies do one or the other, presumably because being able to do one solves immediate problems making the other one less useful. Is that just an old wives tale or do you think it might be true generally?
Helen: That’s a great question and I have looked at this in my data as I ask parents to report the age at which the child met motor milestones, and also the age at which they said their first words. From everything I’ve looked at so far, there’s no relationship between their age of sitting/crawling /walking and their age of first words, or of motor milestones to later language skills. But parents often talk about their child focusing on movement/speech at different points in their development, and I think based on my clinical experience, one skill may shoot forward quite a lot at one point in development, while the other develops more slowly. But then that may change later!

Q: You look at the language development of children who have an older sibling with a language problem. What’s your thinking, are you looking for a genetic aspect? Or is a sibling’s language extra important to a baby? I think my older son’s name is the first word that my 6 months old has learned to recognise, and he looks at him so much.
Helen: yes that’s right, my study is particularly interested in babies who have elder siblings with communication difficulties. That’s because we know from previous research that because they share genetic material, siblings are at particularly high risk of difficulties with communication. For example, a child who has an elder sibling with autism is 10-20 times more likely to also have autism than a child in the general population. I think for language delay/impairment the risk is about 5-6 times higher than the population prevalence. There are also environmental factors, but often they are protective in nature – so for example, parents who have an elder child with difficulties who have had help from an Speech Language Therapist are usually providing an environment very rich in language and communication opportunities, so their later babies may be faster in development!
@Helen: Do you know that that increased risk is because of genetics rather than exposure to a ‘faulty’ example in the sibling?
Helen: that’s hard to disentangle. However, it’s still true that most siblings of children with communication difficulties develop typically, so it seems unlikely that the environment is so important. There’s also been a lot of research using twins to look at this. The usual method is to compare identical twins (who are 100% genetically identical) with fraternal twins (who are as genetically matched as any other sibling) – and it has been found over and over again that identical twins show more “concordance” in language skills – meaning that the chance of one being affected by language difficulties if the other is, is far higher in identical than fraternal twins. That suggests a strongly genetic component. The risk is also higher for full siblings than half siblings, which also implicates genetics!

Q: Please will you give some ideas to create a rich language environment?
Helen: Yes of course! What age of child are you thinking of? The most important thing in enriching the environment is to give the child the most exposure to language that is possible, but keeping that language at a level the child can understand.
@Helen: Currently I spend my time with siblings. The girl is just 3 and the boy is 15 months.
Helen: So, for a baby, you might use single words to label objects and activities at every opportunity! For a child who is talking, you can provide commentary on almost anything at a level they can understand. You can also repeat their utterances back to them in a more adult way, or add a word to what they have said. So, for example, if the child says “car!” you can say “Yes, car driving” or “Yes, red car”. The most powerful thing parents can often do to enrich the environment is to comment, rather than ask questions. So, you can just provide a narration of the child’s play or whatever activity you are engaged in as they are doing it. Those language models are most powerful when they relate to what the child is doing/looking at at the time they hear the language, rather than trying to change the child’s focus.
@Helen: Yes, questions can bring a rapid shut down to conversation as anyone who asks a child out of school “what did you do today?”!

Q: Can I ask about what you mean by “at a level the child can understand”? When working in an ASD nursery we learned to use short single clause sentences with no extraneous words, like “Shoes on mat” instead of “Everyone put your shoes on the mat now.” But I wondered if the size of the word matters. Are big, multi syllable words harder or not?
Helen: Yes, of course. Long words might be harder to understand, but it depends on what they refer to. For example, elephant or crocodile are quite long words, but refer to things a child might see a lot in books and find engaging. But definitely, using only essential words is something I would recommend for any child who has difficulties with understanding.

Q: How do you manage when you are dealing with a small group of children where one needs the essential information, without depriving the others of the richness of language?
Helen: that’s a really interesting question. I think I would provide the language model but stress the key words for the child who has less understanding. You could also support those key words through signs/gestures/pictures to help that child.

Q: Television – good or bad for language? Since the new baby arrived, my big boy has had a lot of telly. Strangely though now he has loads of new vocabulary and his imaginative play is much richer. Coincidence?
Helen: It very much depends on the programme! TV is not a substitute for interaction but actually some children’s programmes contain a lot of vocabulary and concepts that are good for development.
@Helen: My son often comes out with words or phrases that I’m sure he has learned from TV. He also believes all trains go to Pencaster.
Helen: Haha, great example! I’ve also seen children with autism learn from TV in a way they would never learn from people because they don’t find people so engaging.
@Helen: Learning from TV! I am working with an elderly chap who I am sure functions within the autistic spectrum. He’s obviously completely disengaged in school with consequent difficulties, but he has learnt so much from the telly. Encyclopedic!
Helen: Absolutely! Exactly the kind of thing I was thinking of. Children’s programmes often have a lot of really great features for teaching: they are engaging, they involve repetition, the characters often speak at the same level as the child, they introduce new vocabulary and show examples of what it means etc. And we all learn best from things that capture our attention.
@Helen: He also cannot converse and only recount “stories” or information.
Helen: that’s very typical of somebody with high-functioning ASD. Their language skills may be intact so they can formulate utterances well, but what they don’t understand is how to use that language for social interaction.
@Helen: A lot of men are like that though…
Helen: There are actually theories that refer to ASD as the “extreme male brain”!

Q: Do songs and rhymes have any special significance?
Helen: yes songs and rhymes are great and this is where TV often does well! They’re great for learning because they often involve repetition – and also because the pitch and melody engages children.
@Helen: I also spent a lot of time with an aunt with dementia. She could barely communicate verbally but had a song repertoire that appeared infinite and could recite Lady of Shallot if you could just keep the flow going!
Helen: I don’t know a lot about dementia but that also seems quite common from what I do know. The long term memory is better preserved, so things like songs will be well remembered. However, the short term e.g. what someone has just said to you, is much more difficult.

Q: I remember there was controversy over Teletubbies because they used ‘baby talk’ with naive grammar and clumsy pronunciation but I think The Experts said that was a good thing. My son always identifies with the one in the Tweenies who speaks most babyishly. Jake?
Helen: We discussed Teletubbies during my undergraduate SLT degree and concluded that it was actually quite good, due to repetition. Children obviously need good adult language models but they also do hear other children speak in real life, whose language is at the same level as theirs.
@Helen: My daughter has just turned 2 and loves Danger Mouse. It might not be age appropriate (seems ok but she is very little), but she loves talking about it. I make myself feel better about leaving it on while I’m washing up because it seems to encourage her. Although she talks a lot anyway.
Helen: I agree, TV can be a great thing to talk about. Any experience which engages a child will encourage them to communicate.
@Helen: My son pointed out something that Jake Tweenies mispronounced and said, “He can’t say certificate just like I can’t say Ebrinder (Edinburgh).”
Helen: that’s great, it shows that he can hear and understand the difference between different pronunciations

Q: You mention adult language models. What’s your opinion on ‘parentese’? Someone I know was insisting that it’s much better for babies to hear ‘normal’ adult language from birth and we shouldn’t talk to infants in a ‘special’ way.
Helen: Not all cultures use parentese, and children in all those cultures develop language at about the same rate. However, parentese does have a lot of features which engage children and should enhance language learning. For example, short sentences that emphasise key words, more varied pitch which is more interesting to the baby and the research does show that babies learn language better when they are engaged while they are hearing it. Interstingly, it’s not just adults who do “child directed speech” or parentese. Elder children often do it as well. To me, the fact that we seem to do it quite naturally suggests that it is adaptive in some sort of way from an evolutionary perspective.
@Helen: It’s something I found myself doing so completely instinctively that I assumed it’s an actual instinct. I’m really amazed to find out there are cultures where it’s not done.
Helen: Absolutely! There are cultures where it’s not that common for adults to spend lots of time talking to children. Those children may get more sibling interaction though. I wouldn’t recommend that people adopt it though if it isn’t natural or comfortable to them. It’s much better that parent is comfortable in interaction with baby rather than worrying about what they SHOULD be doing.
@Helen: If it ISN’T an instinct, how did I know how to do it? Had some part of my brain stored it away from my own childhood? And if it is an instinct, are the people in the ‘no parentese’ cultures constantly fighting the urge to say, ‘Look, TRAIN! BIG train. Choo choo!’
Helen: I agree. It’s so instinctive to me as well, even though I’m not a parent. People also use parentese to animals, especially dogs.
@Helen: So are the cultures without parentese also the cultures where adults don’t talk to children much?
Helen: I can’t remember specifically but I think that’s probably true. But I’m not sure that anyone has ever researched whether siblings in those cultures use parentese – they may do.

Q: Are there any other things that are different in other cultures that would surprise us?
Helen: The one that most interests me is that not all languages have words for specific numbers – all have quantities like more, a few, none, but not all have numbers like 1, 2, 3 etc.
@Helen, I’ve read that. I read about a South American one, a farming tribe, where numbers are only spoken for livestock, not anything else.
Helen: That’s a really good example. Languages also express concepts very differently. For example, in English we use the same word “on” for “on the wall” and “on the table” – whereas in other languages those are different words and thus different concepts. I always use that example when teaching language development to illustrate that we don’t just use language to label what is out there in the world, it determines how we think about and interpret our world.

Q: My friend who lives in Spain and had Spanish in-laws gets frustrated that she tries to teach the boys to for example ask nicely. “Can I have a biscuit, please?”, but their Spanish family are perfectly happy if he goes “I want biscuit!”. In fact, they think it’s mad to expect children to be polite. They just want to know what the child wants.
Helen: Things like politeness are definitely culturally determined. In some cultures children aren’t encouraged to make eye contact with adults, for example.

Q: do we know if language disorder is more or less common in different cultures?
Helen: that’s a great question. I’ll try to find out!

@Helen, Thank you so much for tonight, it’s been great!
Helen: Thank you, I’ve enjoyed it! Happy to answer any other questions. This is my «email» if anyone wants to ask any further questions.

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