Speech impediments can ruin a child's education and self-esteem. Eleanor Caldwell watches language therapist Susan Fisher as she works to untie the tongues of tomorrow's orators
Consonants, epicentres and dynasties are all in a day's work for school children, but for some they cause particular difficulties. And while teachers may have a professional understanding of children's learning problems, they have less skill in dealing with severe problems of vocabulary.
Susan Fisher is chief speech therapist for West Fife, in charge of 23 therapists based at the Carnegie Clinic in Dunfermline. Her working week is split between clinical and managerial tasks. "We're not grammarians or elocutionists. I think our best title would be communication therapists - improving communication is our main aim," she says.
Although she works in the education system, she and her colleagues are health service employees. Most children will have been referred to them before starting school and will have attended clinics since nursery or pre-school years. Some older children will also have attended special speech and language classes in Crossgates primary.
"5-14 language has raised the profile of oral language and it's a great enhancement to our work to get involved early with the child and contribute to individual education programmes," she says. "We're also starting to work with early intervention schemes such as Fife's Stepping Stones."
Today is a fairly typical one for Susan with visits to St Leonard's primary, St Columba's High and Queen Anne High, seeing five pupils in total. Armed with notes, worksheets and visual aids - "My car is my office and it can get into a bit of a state!" - she arrives at St Leonard's, and makes for the learning support base, decorated with Mr Happy posters. "It's so important to have a nice room like this to work in," she says.
The first boy she sees suffers from speech and language difficulties. In his early years he could make only limited sounds. She has been working with him since he was in nursery. Arriving from class, he looks serious but relaxed and Susan's instruction to "switch on your ears and listen carefully" is greeted with a broad grin.
Her focus today is to differentiate between words with one and two consonants at the beginning, for example, see and ski. Concentration takes over as he pronounces words from picture cue cards: store and tore, sweep and weep. He's doing well and enjoying Susan's cheerful encouragement. Confusing car and scar, she jokes that he should "turn up the volume on his ears".
In a game of Snap, he stumbles only on a couple of words. Circles indicating the number of consonants on the back of the cards allow him to check his own work, which gives obvious satisfaction. There's a sticker too for his picture-based homework, for which he gets great support at home. "I work hard at making contact with home and try to see the mums at lunchtime if possible," says Susan. Making a note in the boy's diary, she reminds him to practise his word games.
"I identify the specific problem and the teacher lets me know where this is causing difficulties in the curriculum," she says.
Susan's next client comes in with an enormous smile, obviously idolising her speech therapist. This girl is focusing on pronouncing single consonants at the start of words, using a colour coding system. She has problems with motor control in the mouth.
Susan produces a picture of an enormous open mouth and asks for a reminder about each part. "There's the red lippy sounds (pop), the blue tonguey sounds (top) and the yellow wobbly bit sounds (cop)," the girl explains.
With pronounced articulation, Susan offers a list of words to be categorised as lippy, tonguey or wobbly. There are few problems until the girl chooses the wrong colour for "toe" and "top" and says "coe" and "cop". In her diary, Susan writes: "Please practise sorting the words into yellow wobbly and blue tonguey sounds."
After a coffee break, Susan heads for the nursery to assess a child. "With younger children, assessment is less structured and is based on observation, looking at gesture, understanding, fluency, range of vocabulary and so on." She also asks for an update on a selectively mute pupil who has begun to "speak gently".
Nursery teacher Janette Hennem says: "We know some of the strategies, but we value Susan's expertise, so we can back up what she's doing." Headteacher Jennifer Patrick agrees, referring to the P1 boy: "He's making such good progress with Susan, I can see him being discharged soon.
"Speech therapists in my experience are all very hard-working, special people."
Next stop is St Columba's High. Susan is told that one of her clients is off school. The girl has quite a severe stammer and Susan was going to help her prepare a talk - "a very daunting prospect for her". With Susan's help, the girl's self-esteem is much improved, according to learning support teacher Mary Ruane. Staff have also been helped by guidelines Susan gave them for working with children who suffer fluency disorders, or stammers.
In the next session, an S3 boy struggles to cope with geography. Susan tries to use core curricular subjects, because "there's always a huge amount of new vocabulary". After work on pronunciation with the colour coding system, the boy reads aloud a passage about earthquakes. For him, words like "crawled", "heave" and "shake" are as challenging as "epicentre", "shockwaves' and "focus". Although his definitions are over-simplified and their meaning unclear, it is obvious that he knows what he wants to say because he has the right words, but in the wrong order and poorly pronounced.
At Queen Anne High, Susan's S2 pupil is working on history. The words "dynasty", "reign", and "regent" provide the verbal focus. There's a lot of banter between Susan and her pupil. Asking who reigned in one era, Susan teases "I bet you a tenner it begins with 'E'." He rejects Queen Elizabeth:
"I'm not saying that one!" Before leaving the learning support department, she arranges next week's case meeting with the principal teacher and other staff.
"I love the autonomy of my job, and get satisfaction working with children and building up relationships. I see it as a shared responsibility with teachers," says Susan.
A DETAILED DAY'S DIARY
8.45am Arrive at the clinic and pick up equipment and case notes.
9.00 Go into St Leonard's primary school for two half-hour sessions with P1 pupils and a visit to the nursery.
11.00 Quick coffee while writing up my notes. If possible I try to catch up with the teachers on a weekly basis.
11.30 Up the road to St Columba's High where I liaise with learning support staff and then see two pupils.
1.15pm Back to the clinic to pick up any paper work and collect my notes for the afternoon. I have time for a quick lunch.
1.55 Off to Queen Anne High for a session with one pupil.
3.00 Back again to the clinic to write up case notes and reports for all my clinical work. I then do any managerial work, which means liaising with parents, sorting out staffing, looking at budgetary planning and so on.
5.00-5.15 Set off on my hour's drive home, looking forward to seeing my little boy.