Free course: Speech, Language and Communication Needs (SLCN) in children with mental health difficulties

With Melanie Cross, Royal College of Speech & Language Therapists

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One of the most common elements of additional needs is speech, language and communication needs (SLCN). If a child also has social, emotional and mental health needs (SEMH), it can be difficult to decipher what's going on.

Help is at hand from the Royal College of Speech and Language Therapists (RCSLT). The RCSLT has developed a new, free online course for people working or living with children and young people who have SEMH. It is the only training course that explores the links between these issues that is available for free in the UK.

Speech and Language Therapist, Melanie Cross, from the RCSLT is here to explain more.

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Help to solve behaviour and communication difficulties by Melanie Cross, RCSLT

Everyone has heard the phrase ‘Behaviour is Communication’, but what if the behaviour is saying ‘I don’t understand you and I don’t have the words to explain that to you?’  

Pupils with Social Emotional and Mental Health needs (SEMH) are very likely to also have Speech Language and Communication Needs (SLCN). However, their SLCN is often unrecognised. The scale of this is huge. One study[1] suggests that 81% of those with SLCN might have unrecognised SLCN! Also, having SLCN is a risk factor for mental health difficulties. 

The impact of having SEMH and SLCN can also be significant.  A pupil who has unrecognised SLCN spends their life being misunderstood and perhaps criticised or punished for things they can’t help, for example;

 ‘sometimes it can be hard to put the words together’, 

‘I put in the wrong words’ 

‘it’s hard to tell if people are being sarcastic or not’ , or

‘it’s hard taking in a lot of things, I get frustrated.’  

Mental health problems affect around one in 10 children and young people and they are at additional risk of having speech, language and communication needs, as there are links between these issues:

  • 81% of children with formally identified emotional and behavioural disorders had significantly below average language abilities[2]
  • 45% of young people referred to mental health services had higher order language impairment (difficulties with understanding inference and abstract language) compared to 15% of young people in a comparison group[3]
  • Children with a mental health disorder report having speech or language problems five times more than those without[4]
  • Communication difficulties are a risk factor for developing mental health problems: adolescents with developmental language disorder (DLD) are more likely to have symptoms of depression and anxiety than their peers.[5]

SLCN affects a person's entire life

Having Speech, Language and Communication Needs can add to a pupil's stress levels in other ways too. SLCN can make it hard to have conversations and make friends. Less obviously though, literacy ‘floats on a sea of talk’, so if you don’t understand what you hear you won’t understand what you read. If you can’t put a sentence together in speech you won’t be able to do that in writing either.

In the context of ‘behaviour’, pupils with SLCN often have difficulty learning and remembering vocabulary, so words like ‘consequence’ or ‘negotiation’ might not be fully understood. Additionally, they might not have the language to talk about their feelings or to manage them appropriately. 

SLCN can also mean that pupils don’t have the narrative skills to explain what happened and why? Most importantly perhaps, they might not be able to understand the language we use to help them think about their mental health and behaviour e.g. ‘what do you think he was thinking?’ or  ‘what do you know now that you could not have known then?’  

Free SLCN fact sheets

The Royal College of Speech and Language Therapists (RCSLT) has produced a variety of fact sheets which aim to raise awareness of these issues and summarise the current research, you might be particularly interested in the ones on Behaviour and Communication and SEMH.

Following on from raising awareness, how can we help these pupils?

This needs to start with recognition of SLCN and an assessment of their individual needs. This can be done in simple ways, for example, does simplifying the language we use and giving them more time to respond, enable them to contribute their ideas? If so they could have unrecognised Speech, Language and Communication Needs. 

Once potential SLCN is recognised, the best way forward is through collaboration. Speech and Language Therapists (SaLTs) often work alongside others to design and deliver interventions at universal, targeted and specialist levels. There’s also a lot of creativity going on around modifying existing intervention and making environments ‘communication friendly’.

In particular, it’s important to think about how accessible are our approaches to behaviour and mental health? Do pupils with perhaps unrecognised SLCN have a hope of understanding our expectations and processes?  

Free online learning for SLCN

In order to address all these issues, The Royal College of speech and Language therapists (RCSLT) have produced a free online learning called Mind your Words. It is also available to parents/carers. The training aims to:

  • Increase awareness of the many pupils who have both SEMH & SLCN 
  • Increase collaboration amongst the various professionals who support them 
  • Help develop ‘communication friendly’ environments; schools, CAMHs, social care etc
  • Increase the use of evidence-based interventions for SLCN and SEMH 
  • And help make teaching and interventions more accessible to pupils with SLCN

“The ‘Mind your Words’ eLearning provides an accessible and easy way for those working with children and young people to recognise how mental health needs often go hand in hand with communication difficulties. 

“By undertaking the training those working with children and young people will gain a greater understanding of this area and be better equipped to support them. This has become increasingly important during the pandemic, which has had a significant impact on children’s mental health. So we should all be looking at ways we can better support children to develop the communication skills that enable them to express themselves, form positive relationships and build their resilience.”

RCSLT chief executive Kamini Gadhok MBE

How the SLCN training works

You have to complete the first five modules then after that its pick and mix, access the ones that are most relevant to your work. The modules take between 10-20 minutes depending on how much of the additional reading you choose to do. The modules are detailed here 

  • Module 1: Introduction – Find out what this learning journey will cover, how to use it, and how it was written and created.
  • Module 2: What are SLCN and SEMH? – Find out what speech, language and communication needs are, what social, emotional and mental health needs are, and how to recognise them.
  • Module 3: Risk and resilience – Investigate the benefits of good communication skills on resilience, and the impact of communication difficulties on mental health and skill development.
  • Module 4: What if young people have SLCN and SEMH? – Explore why language skills are necessary for good mental health, and how SLCN can bring additional risks and problems for mental health.
  • Module 5: Universal strategies for SLCN – Find out what universal strategies are and how to use them to support children and young people.
  • Module 6: What speech and language therapy (SLT) can contribute – The role of the speech and language therapist, the settings they work in and sort of work SLTs do, evidence based interventions and the benefits of SLT.
  • Module 7: Collaboration – What is collaboration? Why and how to collaborate? Why doesn’t collaboration always work?
  • Module 8: Identification and assessment of SLCN – Why assess a child or young person’s speech language and communication skills? Who should we assess? Types of assessment used by SLTs, and problems with assessment. Things to notice (indicators of SLCN), and how to include the views of children and young people.
  • Module 9: Becoming a communication accessible setting – Adopting the Communication Access Standards, meeting the 5 Good Communication Standards
  • Module 10: Asking the right questions – Why questions can be problematic for children and young people (CYP) with speech, language and communication needs (SLCN). How to make answering questions comfortable and how to ask questions that a child or young person with SLCN can understand and answer.
  • Module 11: Communication in de-escalation and de-briefing – What do stress and conflict do to the brain and communication skills? How can we communicate to help someone feel safe and to calm down? How to help a child or young person develop the language skills to cope in stressful situations.
  • Module 12: SLCN, SEMH and risk assessment – Revision of the general risks of speech, language and communication needs (SLCN). Thinking about specific risks for children and young people with SLCN in relation to behaviour that challenges, and how to design a risk assessment including SLCN.
  • Module 13: Developing a service for SLCN and SEMH – A model of interventions in services. What speech and language therapy can contribute. Including the views of children and young people in planning support and ways to help them better engage with support.
  • Module 14: What’s the story? The importance of narratives for mental health – Why is storytelling important? What skills are needed to tell a story? The impact of speech, language and communication needs (SLCN) on stories/narratives, and how we can help children and young people develop narrative skills.
  • Module 15: Making interventions accessible – Why do we need to make interventions accessible? How does language make things inaccessible or accessible? Some solutions and examples.

You can access the elearning here

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References


  1. Hollo, A., Chow, J. C., & Wehby, J. H. (2018). Profiles of Language and Behavior in Students With Emotional Disturbance. Behavioral Disorders, 019874291880480. https://doi.org/10.1177/0198742918804803
  2. Hollo, A, Wehby, J.H. and Oliver, R.M. (2014). Unidentified Language Deficits in Children with Emotional and Behavioral Disorders: A MetaAnalysis. Exceptional Children, 80(2), 169-186.
  3. Cohen, N., Farnia, F. and Im-Bolter, N. (2013). Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry, 54(7), 733-44
  4. NHS Digital (2018). Mental Health of Children and Young People in England, 2017: Multiple conditions and wellbeing. [Online]. Available at: https://files.digital.nhs.uk/42/9E0302/MHCYP%202017%20Multiple%20Conditions.pdf
  5. Botting, N, Toseeb,U., Pickles, A., Durkin, K. and Conti-Ramsden G. (2016). Depression and Anxiety Change from Adolescence to Adulthood in Individuals with and without Language Impairment. PlOS One, 11(7)

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