Adam is 5 years old. Although he tries hard with his work, he finds it difficult to remember words and learn new vocabulary. He “muddles” his word order when making sentences and struggles to understand what he has to do in class unless verbal instructions are simplified.

However, language is not Adam’s only need. He often misses out sounds, or uses the wrong sounds, when talking; this makes him very difficult to understand when he speaks. During phonics, he cannot produce speech sounds with the accuracy of his peers.

Unlike children with an isolated speech or language difficulty, Adam is demonstrating features of speech and language difficulties. So how can we help Adam in the classroom?

Adam fits the profile of developmental language disorder (DLD). This is a common condition affecting an estimated two children in a class of 30. It is characterised by persistent difficulties with talking and/or understanding spoken language, with no obvious cause. DLD can be differentiated from other neurodevelopmental disorders that have a known impact on communication, such as autism.

Due to the persistence of these challenges being a key factor for diagnosis, the condition may not be formally diagnosed until a child is well into their schooling; however, a younger child can still present with strong features. A child with a DLD profile may present with isolated language difficulties or, like Adam, have difficulties with producing speech sounds as well.

Double trouble

The relationship between language and speech difficulties is more common than you might think: a longitudinal study by Eadie et al (2015) found that among a large cohort of four-years-olds with significant speech needs, 40.8 per cent also had co-occurring language difficulties. This co-morbidity was twice as common among boys. Further to this, 36 per cent of these boys had no letter knowledge (in contrast to none of the girls).

We might wonder why there is this link between speech, language and literacy skills. Prior research has indicated that the underlying causes are complex and multi-factorial, with some shared underlying deficits, such as phonological processing (Pennington and Bishop, 2009). A shared genetic basis, overlap in cognitive deficits and commonality in environmental risk factors all result in a child with one area of need being at a higher risk of having needs in the other areas.

It is also natural to ask whether these issues will begin to resolve through attending school. Unfortunately, this does not tend to happen with children who fit a DLD profile, particularly when they have both speech and language needs as a part of this.

A recent longitudinal study by Hayiou-Thomas et al (2017) investigated the relationship between speech, language and literacy skills in children at three-and-a-half years old, five-and-a-half years old and eight years of age. For children with isolated speech needs at three-and-a-half years old, the impact on later literacy skills was found to be relatively modest and short lived. However, boys and girls with both speech and language difficulties at three-and-a-half years old were at a much higher risk of longer-term literacy needs. They were more likely to struggle with poor word level literacy at five-and-a-half years old and with poor word level literacy and reading comprehension once they were eight years old.

With these skills being integral to classroom performance and the further development of higher-level literacy skills, the literacy outlook for children like Adam may appear bleak.

However, there are ways we can use the knowledge we have now to identify and support young children who present with co-occurring speech and language difficulties. Such support can include preventative measures against future literacy difficulties.

In order to provide such support, children with this co-occurring presentation need to be identified sooner rather than later.

As a teacher working in collaboration with your local speech and language therapy service, you could ask for more information regarding the child’s ability with both their speech and language, regardless of their current intervention targets. You can then get a better idea of their current needs. A speech and language therapist (SLT) may recommend working on either speech or language because this is the child’s most pressing need; however, that you know the child experiences both speech and language difficulties is an important step.

For teachers with limited access to an SLT, the Communication Trust’s “progression tools” are invaluable in supporting staff to identify whether a child may have speech needs, language needs, or both.

Positive steps

However, what’s the point in having this information? How will it benefit the child? Although research on intervention for this group is not as established as for those with isolated speech or language needs, there are still positive actions that we can take to support these children.

Having this information alone will enable teachers to monitor the progress of the child more closely. If we know that a child as young as 3-4 is at particular risk of future literacy difficulties, they can be prioritised for early access to pre-literacy interventions and regular progress checks.

This is not to say that such support would “cure” future literacy difficulties. However, it would provide these children with the best start possible and potentially lessen the impact of later literacy needs.

We must also remember that phonological awareness is relevant to speech, language and literacy, with recent evidence also highlighting that phoneme awareness mediates the relationship between speech and later reading ability (Burgoyne, Lervag, Malone, and Hulme, 2019). Therefore, the development of early phonological awareness skills could be particularly beneficial for children with this co-occurring presentation.

Collaboration with an SLT and specialist teaching services would be highly valuable here, with this being a shared area expertise. Teaching staff may also access the What Works database from the Communication Trust, which provides helpful information regarding SLCN interventions, including those that focus on phonological awareness.

This may sound relatively rudimentary, but research supporting specific interventions for children with co-occurring speech and language needs is still in its infancy. This is a great start, however, and our ability to apply specific, targeted interventions for this particular group will surely evolve as the evidence base grows.

But children like Adam cannot wait for the research to catch up - we need to do what we can now by identifying these children and implementing our best guess at what might work.

Lucy Rodgers is a specialist speech and language therapist and researcher, University of Kent. She tweets @lucy_r_slt

Find full references for this article and links to guidance and support at tes.com

This article originally appeared in the 13 March 2020 issue under the headline “How to help when words really do fail