Difficulty detecting and using speech sounds 

This could be presented as consistent mistakes in pronunciation, particularly of longer or more complex words. They may also make inconsistent errors. They can find this difficult to understand which can interfere with healthy interactions with adults and peers. 

Strategies to support:

• Give extra time for the child to express themself. 
• Accept any form of communication that helps them to get their meaning across. This could include but is not limited to gestures, pointing or drawing. 
• Make sure the child knows that what they are saying is important to you. 
• Be kind but honest when you don't understand what they are trying to say. 

Difficulty generating speech sound patterns and manipulating the speech sound structure of words 

Presenting as difficulty imitating and manipulating speech sound sequences, referred to as expressive phonological skills. 

Phonological skills are needed to replicate words (sound sequences) accurately, blend sounds to read, generate rhyme and use rhyme in classroom tasks and use sounds in “word play”.

Success in phonics learning, vocabulary learning, reading and performing functional classroom tasks using speech sounds are all dependent on good phonological skills.

• Be aware of points of breakdown in expressive phonological skills. 
• Give multiple opportunities to imitate words or sound sequences. Support to build towards success. 
• Once the pattern can be held, give multiple opportunities to say the word or sound sequence independently. 
• Support individual difficulties and build skills. This includes manipulating sounds, sound blending, and generating rhyme. 
• When generating rhyme, provide consonant sounds and blend 'onsets' to put in front of spoken 'rhyme' elements or words.  
• When generating rhyme provides semantic cues to aid a feeling of success, but also give tasks that are reliant on phonological skill only. 

Difficulty storing and retrieving the meaning of words or the speech sound patterns that make up words 

A child may have 'word-finding difficulty', this is where they have trouble retrieving words that are wanted and needed to express themselves. This can result in the use of non-specific words such as "thing" or "stuff" or can result in long-winded descriptions but still unable to find the target word. 

This can lead to anxiety or frustration when it happens regularly. 

Strategies to support: 

• When learning words learn them thoroughly. Analyse the speech sound structure and the meaning. Practise and then apply the word. 
• Teach the strategy of self-cueing by thinking about the meaning of the word, or by describing it. 
• Play games to help with description skills, so that if a word can't be retrieved it can be described. 
• Give the child time to think and search. Ask if they want help.
  • If help is wanted give sound or meaning cues to help the child retrieve the word. 
• Point out when you have difficulty recalling a word when you speak. This helps them see it can happen to everyone. 

Difficulty with Rote Learning

This may be presented as being unable to recite rhymes or language sequences, such as counting or the days of the week. For example, a child may be unable to join in with 'lines' in a school play. This can leave them feeling exposed and helpless. 

Strategies to support:

•  Practise this skill by starting small and building up gradually. 
• Let them reflect on what they couldn't do, and what they are now able to do after practising. 
• Provide supporting visuals and gradually remove them, helping the child picture the resources in their heads. 
• Target simple rhymes. 
• Help to learn specific choruses or repetitively used phrases so the child can contribute to acting out, or singing in school plays. 

Difficulty in using age-appropriate vocabulary 

May be presented as the use of immature/less sophisticated and specific/expressive words. This can lead to difficulty in conveying the intended meaning. Learning, remembering and using new subject or topic vocabulary will be especially difficult. Attempts to use new words may be inappropriate if not fully understood.

Read this in conjunction with the 'Difficulty learning, understanding and retaining new concepts and vocabulary' section above. 

Strategies to support:

• Build on receptive vocabulary strategies outlined. 
• Gap fill as well as teach selected vocabulary in support of the curriculum. 
• Ensure the child verbalises new words at every available opportunity. 
• Build activity contexts in which you and the child will use the target word/s repeatedly. 
• Draw and label, or position labels on the drawing. 
• Give simple definitions for the child to retrieve the word you are defining. 
• Play pairs games and their definitions.  
• Teach simple synonyms and build. 
• Have 'boring' to 'interesting' competitions finding better words for simple words, spoken by the adult about a picture. For example, playing to exploring. 
• Give pictures to support the child to build a sentence in which the target word is included. 
• Work in word groups to heighten awareness of types of words. For example, targeting verb expansion, or adverbs. 
• Use Widgit symbol conceptual pictures in bingo games without written words to trigger word retrieval. 
• Keep logs. Record when the child had to put an omitted word in the sentence from a selection, or without a selection present, matching a plausible word to the context. 
• Give cloze exercises where the child had to put an omitted word in the sentence from a selection, or without a selection present, matching plausible word to the context. 
• Set challenges to use words in their writing without prompting.

Difficulty applying words to new contexts

A child may present this by using valid words but in an inappropriate context. It may be presented as a qualitative difference in word learning as well as a quantitative difference. 

For example, the word 'tranquil' may have been taught but then applied as 'tranquil grass' rather than a 'tranquil scene'. It is obvious the concept has been partially learnt but their understanding is narrow. (Actual example). 

Strategies to support:

• Interpret this as a sign that the child needs more explicit teaching of vocabulary. 
• Pre-teach vocabulary before exposure to it in the classroom context. 
• Focus on the teaching and activation stages of word learning more thoroughly.

(Word Aware Programme stages of teaching vocabulary described above: Select - Teach - Activate - Review) 

• Praise for use of the word and support to use the word more appropriately. 
• Encourage to verbalise understanding of the word and add to this. 
• Supply multiple examples or stories where the word is applied. 

Difficulty defining words, learning word definitions and retrieving them

A child may present by using non-specific words such as 'thing' and 'stuff' and convey only the vaguest meaning of the target word. They may present as having a weak ability to provide a category word to start their definition. For example, "A chair is a thingy you sit on". They may also have difficulty retaining set definitions within the curriculum, such as adjectives and habitats. 

Strategies to support:

•  Develop category word knowledge (Furniture, habitats, buildings). 
• Play category games to reinforce and increase competence and knowledge. 
• Teach what a definition is and that all definitions should start with a category. 
• Practise defining words by starting with a category and saying anything else you can about it. 
• For object words practise adding in a function, a location (where you find it), a key feature and any other details. 
• Practise using this definition framework until the format is internalised. Use visuals to support at first. 
• Move on to teaching abstract word definitions teaching a small range of categories and building (events, qualities, processes). 
• Being able to define words supports better word knowledge retention. 

Difficulty remembering names

This may be presented as a failure to learn the names of key adults and peers, or a struggle to retrieve them. This could also create a barrier to making relationships. 

Strategies to support:

• Assess whether names are known but can't be recalled or are not even known. 
• Create a lotto game of photos and play the game on a regular basis. Encourage imitation at first. 
• Create a photobook limited to a small number of children or key adults at first. Build on this. 
• If possible use a talking book where the name can be recorded and the child presses a button to hear the name if they cannot recall it. 
• Play name games in a social group.
• Give cues such as the first sound of a particular name, or clap the syllables. 
• Provide opportunities for names to be verbalised frequently to reinforce them.  

Difficulty in explaining things that have happened, or telling a story 

Presenting as having difficulty sequencing ideas and being coherent. Individual words are clear but it might be difficult to make sense of what is being told to you, and to understand because spoken ideas are jumbled or incomplete. 

Strategies to support:

• Allow extra time for the child to express themselves. 
• Repeat back in a positive way to provide a correct model to affirm they have been understood. 
• Accept any form of communication such as accompanying gestures. 
• Encourage the child to talk about the day's events in sequence.  
• Help them structure a spoken story or recount by saying "tell me again what happened first" and "then what happened". This will help the child to organise chunks of information. 
• Teach to order sequencing cards that make up a story for them to re-tell using the pictures as prompts. Start with 2 pictures and build up. 
• The child can re-tell their favourite stories with some exact repetition and some of their own words. For example, 'Going on a bear hunt' uses repetitive phrases such as "going to catch a big one". 
• Read a story. Go over the story supporting the re-tell and ask what happened next. 
• Ask the child how to do something, such as make a cup of tea, or clean your teeth. Later move on to explaining the rules of a game. 
• Use visuals such as "wh" cue cards. 
• Use templates to break the story into sections. 
• Start to tell a story, then let the child take over. 
• Older children might listen to a YouTube clip which they then have to write up as a newspaper report. 

Difficulty using sentences 

A child may present this by using short sentences, often with words missing or in the wrong order. This can make the sentences sound muddled, incorrect or unusual. 

Using only simple sentences means only simple information can be expressed. 

Strategies to support:

• Show what they have to say is important by giving undivided attention to what has been said.
• Say what you have understood to check what you have understood, and validate the child's contribution. 
• Recast giving good model and extend. 

Difficulty using grammar

This could be presented by using immature or incorrect sentence structures. There may be particular difficulty with using verbs, and features of grammar that indicate tense. 

There is often difficulty learning grammar rules that do not form a regular pattern. For example, plurals that do not end in 's', such as children and mice. There is also difficulty using words that connect ideas together, such as 'because', 'so', 'until' and 'while'. These allow for more complex ideas to be expressed. 

Strategies to support: 

Support can be given that is implicit: meaning that grammatical support is given without specific explanation.  

• Imitation: A target structure is given with pictorial support where the adult models and the child imitates. Support is gradually reduced until the child can produce the structure to similar stimuli given independently, maintaining the target structure.  
• Modelling: This alone only requires the child to listen. It merely directs the child’s attention to the target structure. The modelling is given as a specific intervention.
• Recasting: Here the support is designed to be non-intrusive and conversational. Play or verbal activities can be designed to increase the chances of the child using the target structure, and when the incorrect form of the target structure is used by the child the adult follows it with a recasted correct structure.
• Combined Approaches: Evoked production, modelling and recasting can be effective in generalising newly learnt rules and structures.

Support can be given that is explicit: meaning that a rule or target structure is specifically taught through explanation, using words demonstration and visual means. The approach is meta-linguistic. 

Comparisons might be made with the child's structure and the correct structure. These approaches are based on the hypothesis that children have had grammatical difficulty learning the rules implicitly, therefore they need explicit teaching of the rules. 

Examples include:

• Explicit teaching of individual rules.
• Colour coding: colours can have a positive impact on memory and attention, and can be used to highlight grammatical features. 
• Shape coding: uses a visual coding system to show how words are put together in sentences to develop understanding and use of grammar. The primary focus is on spoken language, but it can also be used for written language. It uses colours and shapes. 

A combination of both explicit and implicit support can be given. 

Difficulty generating ideas

Presented as searching but unable to retrieve ideas to carry out specific tasks. Support and cues may be needed to trigger stored knowledge. 

Strategies to support:

• Provide activities on a regular basis that require some support but ultimately the independent generation of ideas. 
• Take turns to generate lists. For example, of colours or boys/girls names. 
• Practise generating single ideas using an association game. The child has to provide the first word that pops into their heads when given a target word. For example dog - bark, and explain (if able to) why they thought of it, or the adult verbalises the link. 
• Provide visual contexts that suggest ideas to the child through pictures. 
• Provide sentence starters for the child to complete. 
• Give talks on topic targets. 
• Provide a story sequence for the child to generate what is going to happen next. 
• Provide templates with starter words or ideas that help the child generate subsequent ideas. 

Difficulty with verbal reasoning 

Presenting features of difficulty with reasoning have been described already under receptive skills.

These underlying difficulties will impact how thoughts and reasoning can be expressed.

(see “Difficulty with reasoning skills”)

• When carrying out picture matching tasks, detection of similarity and differences tasks and categorisation tasks support the child to verbalise the reasons on which they base their choices. 
• Carry out the tasks yourself, taking turns with the child in order to verbalise your reasoning, as a model. 
• Provide one-off tasks to detect and verbalise similarities, differences and categories. 
• Encourage simple "why because" reasoning using picture pairs of effect and cause. For example, the girl is crying because the boy popped her balloon. 
• Encourage expression of statements with the explanation following. For example, the car has got a puncture. That's why the driver can't go home. 
• Develop cause and effect reasoning where one is provided and the other is to be provided by the child. 
• Systematically build up reasoning skills. 
• Continue to use visuals. 
• Continue to make explicit the steps of your reasoning. 

Difficulty using language in conversation

Presenting as a barrier to making and maintaining friendships. Many features already mentioned may also contribute to this difficulty. Early on the child may not have the words to join the conversation, or the understanding to respond, even though they are keen to communicate with their peers. 

They may not be understood when they speak, and they may not be able to generate ideas or keep on topic. 

In late primary, or teenage years difficulty may be experienced understanding and keeping up with what is said, social cues innuendo, slang, jokes, sarcasm and meaning conveyed by intonation. 

Strategies to support: 

• Build towards conversations through paired activities. 
• Create opportunities for supported interaction with peers. 
• Introduce a buddy system. 
• Help learn specific phrases that can be used in social situations. 
• Set up paired interactions and games where the language required is limited and specific to the activity. 
• Set up paired interactions where there is a specific goal. For example, the pair has to find out each other's favourite food and relay this information to the adult. 
• Build up to using collaborative tasks where a conversation will be needed to achieve a goal, such as solving a problem. 
• Build to talking on a topic, giving opinions and finally discussion. 

Difficulty using language to negotiate and explain

A child may present this as an imbalance or difficulty to have their say, have their ideas accepted or come to a compromise with their peers. 

When conflict in the playground occurs, there may be difficulty explaining to the adult what has taken place, often leading to unjustified self-incrimination. There is an imbalance where a highly verbal peer can take advantage of the situation. 

Strategies to support:

• Keep the child's language difficulties in mind as you try to determine what has happened. 
• Give the child time and space to explain, without the other child interrupting. 
• Monitor your own language used to find out what has happened. Remember phrases such as "on purpose" or "accidentally" might not be understood by the child. 
• Keep question forms simple. 

Difficulty using language to convey feelings and emotions

This may be presented as frustration or difficulty managing emotions, as feelings cannot be fully expressed. Alternatively, there may be a passive acceptance and internalising of emotion. 

• Specifically, teach the vocabulary of feelings and emotions. 
• Explore feelings and emotions in the context of what is happening in pictures so that the feelings and emotions are initially those of other people. 
• Have conversations about how the child is feeling today. Help them find the words to express this. 
• Give verbal scenarios and discuss how the characters might feel. 
• Encourage the use of feelings and emotions in storytelling. 
• Give time and space for the child to express feelings and emotions relevant to themselves when incidents have occurred, or they are upset. 

Difficulty being verbally assertive 

This difficulty may be presented as the child being quiet and well behaved, but furtive in their use of their eyes to watch for non-verbal queues, follow the lead of peers and copy their ideas/work. Here there is a desire to blend in, and if needed they may not ask for help. 

The child may be withdrawn, passive or showing a desire to go under the radar. Here there can be a desire to hide. They may present helplessness where they have decided they cannot cope and become dependent on the adults around them. Here there are signs of having given up and they may wait to be noticed and for help to come. 

This can also be presented as being self-aware with resultant low self-esteem, impacting social and emotional wellbeing. 

The child will likely have anxiety. 

Strategies to support:

• Give 1:1 attention. 
• Build up a relationship. 
• Let the child know they are important. 
• Teach active listening skills where the child is empowered to approach an adult in some way to seek help. This might be by looking to the adult or passing a help card to them. 
• Directly teach active listening skills in relation to understanding, starting with asking the meaning of words.  

Resource: "Active Listening for Active Learning", published by QED Publications. Designed primarily for 4 to 12-year-olds. 

Resource: "Active Listening for Active Learning" Designed mainly for ages 4 to 12 years. 

Difficulty coping with comprehension, verbal difficulties or associated academic difficulties resulting in verbal or physical outbursts 

A child may show frustration/anger resulting in verbal/physical reactions or disruptive behaviours.  They may come across as being unwilling to be helped and may reject tackling the features of learning they are having difficulties with. 

This self-awareness may also result in low self-esteem and impact their social and emotional wellbeing. 

Strategies to support:

• Ensure that others understand the underlying cause of verbal or physical outbursts so that the child is not disapproved of. 
• Teach the vocabulary of feelings and emotions. 
• Give time and space for the child to express themselves when they have calmed down and are ready. 
• Encourage cooperation with games, small steps and recognition of success. 
• Analyse the triggers and whether they are related to the child's language deficits. 
• Continue to address the underlying language difficulties. 

Combined difficulties of all the previously described areas

Presenting as effortful or unclear expressive language. 

• Expressive language difficulty may be so severe that alternative methods of communication may be needed. For example, Makaton signing, ICT, communication books and boards. 

The use of conceptual symbols such as Widgit symbols will always be of benefit to children with expressive language difficulties. 

• Why? They can support communication for routines, behaviour, conceptual understanding, vocabulary learning, providing prompts to use specific features of language and providing supporting frameworks where children do not have the literacy skills to follow written directions. 
• In summary, they enhance access to learning and verbal expression. They motivate to communicate, support behaviours and emotions, develop independence and improve confidence/self-esteem.