Supportive Technology

What's the effect of screen use on the development of children’s speech, language and communication skills?

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By Frankie Paterson - Specialist Magic Words Speech and Language Therapist

As speech and language therapists we are concerned with anything that could be affecting how children's speech, language and communication skills develop. We have been wondering about how lots of screen time is affecting children. We are keen to look into this issue as, with millions of children now using tablets for several hours a day from as young as 18 months old, we worry that this could be having an affect on how many of their early cognitive skills are developing, including language development and the development of their attention and listening skills.


I recently listened to a programme on Radio 4 called ‘Why Can’t Our Children Talk?’.

I was very interested to hear on this programme that many teachers across the UK are voicing concerns about screen time. This echoes the concerns that I am hearing from the teachers I work with in schools in Luton. Many of the teachers who are voicing concerns have been working with children of 4 or 5 years old for many years and they are struck by recent marked differences in how children of 4 or 5 are presenting in terms of their language and attention skills.  Here's what one teacher had to say on Radio 4 about her own experience with children and screens:

 “Our children.. over the past 3 or 4 years, if you’ve got the interactive whiteboard on in the classroom they find it impossible to do anything apart from look at the screen… If there’s you to look at as the teacher.. telling them a story or there’s a screen, even if there’s nothing on it, they’re naturally pulled to look at the screen…They.. struggle with making eye contact because often when they’ve been hearing nursery rhymes.. it’s obviously been on a tablet where it’s been a.. brightly coloured screen they’ve been looking at rather than looking at somebody’s face”- Lorraine Boothe, Reception class teacher and assistant head at Chaul Lane Infant School. 

The Radio 4 programme featured a study that has recently been carried out on 900 toddlers in Canada. A clear link was found between language development and screen time in children under 2. It was conducted by Professor Catherine Birkin, a paediatrician in Toronto. She said:

“Children who used mobile devices.. had a higher risk of an expressive language problem at 18 months of age”

Apart from this one study in Canada there is no other evidence as yet about whether screen time is adversely affecting children's development or not. Much more clinical research needs to be conducted into this question before firm conclusions can be arrived at. However I think this question is hugely important as it has implications that we need to take seriously as a society

Top 10 Language Apps

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By Faye Nugent, - Magic Words Level 1 Speech & Language Therapist

There is a huge variety of apps available to support a child’s language development.  Here is a selection of 10 of the top apps:


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SPLINGO LANGUAGE UNIVERSE

Splingo Language Universe is an app that helps develop a child’s comprehension (understanding of language) by exploring the number of keywords a child can understand in a sentence.  It is an entertaining and motivating game that helps develop your child’s understanding of different aspects of language such as verbs, nouns, prepositions and adjectives. 

The app can be used with children at a developmental level of 18 months to a developmental level of 4 years and upwards.  It is customisable, so you can adapt the app to your child’s developmental level.  The app builds from single key word (e.g. ‘find the apple’) to more complex four key word instructions (e.g. ‘give the big red apple to the boy’). 

The app is available to download on Google Play (£2.39) and iTunes (£2.99).


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GRAMMAROPOLIS

Grammaropolis helps develop knowledge and understanding of parts of speech.  Each part of speech is explored using a map which includes a variety of games and activities to explain the item.  As the child explores each map their understanding is assessed by quizzes throughout.

The free download offers games and activities for nouns.  Within the app you can buy access to other resources such as; verbs, adjectives, adverbs, pronouns, conjunctions, prepositions, interjections.

The app is suitable for children aged 7-8 years onwards. 

The app is available to download on Google Play (free with option to buy extras) and iTunes (free with option to buy extras).  You can find out more information at: https://grammaropolis.com/


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VERBS NEWS - VIRTUAL SPEECH CENTRE

Verbs News helps support the development of a child’s understanding of different verb tenses (simple present, present continuous, simple past and simple future). 

The app introduces Andrew who is a news presenter, he explains the four verb tenses via an animated video.  There are a variety of options as you can select the words you would like to work on and the type of activity for example auditory bombardment (hearing the accurate model of the verb used in a sentence), fill in the blanks or make up sentences.  For each correct response, the child is awarded with an anchor microphone. At the end of the session, children can take the role of an anchor, record their own news, and watch it in the newsroom.

The app works best with an adult supporting the child as this gives the opportunity to discuss each verb and provide an accurate model if the child has any difficulties.

The app is available to download on iTunes (£9.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/verbs_news


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PRONOUNS WITH SPLINGO

Pronouns with Splingo follows Splingo the speech and language alien helping to teach the understanding and expressive use of a variety of pronouns.  The app is engaging and motivating, after 5 correct responses the player gets to select three items to place in their virtual bedroom. 

The app is fully customisable giving you the option to choose the pronouns you work on, a UK or US voice for instruction and whether the verbal instructions are written down too.

The app is available for download on iTunes (£2.99)


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PREPOSITIONS JOURNEY - VIRTUAL SPEECH CENTRE

Prepositions Journey is a fun and interactive app. With adult support the app can be used to develop your child’s understanding of prepositions, as well as giving them the opportunity to use prepositions to expressively respond to ‘where?’ questions.  The app allows the player to record their responses, replay them and see if they are correct. 

The app can be adapted to the child’s needs as you can select the specific prepositions you would like to work on.  The app creates reports following completion of a game which collates the scores together for each player.

 The app can be downloaded on iTunes (£9.99). You can find out more information at: https://www.virtualspeechcenter.com/app/prepositions_journey_app


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MAGICAL CONCEPTS - VIRTUAL SPEECH CENTRE

The Magical Concepts app follows Mago the Magician as he guides the player through a variety of concepts.  The game is highly motivating and makes ‘drilling’ activities more engaging as the player earns a star for each correct answer.  With enough stars the child is rewarded with a magic show.

You can select from a wide variety of concepts making each game specific to your child and their needs.  The app focuses on the understanding of concepts, however with adult support can be adapted to work on the expressive use of concepts within the game.

The app is available for download on iTunes (£9.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/magical_concepts_app


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SENTENCE WORKOUT - VIRTUAL SPEECH CENTRE

Sentence Workout is a useful app to help support the development of the written form and expressive use of a child’s sentence structures.  It focuses on a variety of sentence types including nouns, pronouns, adjectives and verbs in a variety of sentence types.

The app is flexible to your child’s needs.  You can adjust the target sentences, whether you work on them by saying or writing the sentence, and the number of correct answers required before the reward football game.

The app is suitable for children aged 6 years and older.  It is available for download on iTunes (£12.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/sentence_workout_app


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WH QUESTIONS - SUPER DUPER PUBLICATIONS

The app works on a variety of ‘wh’ questions, it initially offers the ‘who?’ question pack, however within the app you can buy additional resources such as ‘what?’ or ‘why?’ questions etc.  In each question pack you can choose between 4 games to play as a single or multi-player game.  For example, in the multiple-choice game players can either answer the question or select the appropriate question for the answer given.

The app uses bright and fun images and sounds that are engaging.  This is a useful app that can be adapted dependent on your child’s needs.

The app is available to download on iTunes (free with option to buy extras).


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CATEGORIES - I CAN DO APPS

As the name suggests ‘Categories’ focuses on organising information into their appropriate category. A variety of skills can be developed including a child’s vocabulary, understanding, spoken language and problem solving and linking ideas and concepts.  The app offers 5 activities; identifying an image relating to a category with an option of 2 or 3 images to select from, finding another item in a category, finding two images that go together and identifying the ‘odd one out’.

The app uses images of real objects and is simple and easy to use.

It is available for download on iTunes (£4.99).  You can find out more information at: http://www.icandoapps.com/


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WH QUESTIONS WHY? PUZZLE GAME - SPEECH AND LANGUAGE DEVELOPMENT, ONUR TEKIN

This app focuses on understanding and answering ‘why?’ questions which develops a child’s receptive and expressive language skills and problem-solving abilities.  The player can complete a short jigsaw of an image and then answer a ‘why?’ question, for example ‘why is the child’s ice cream melting?’. You can record your answers using the iPad’s microphone and compare these to the answer given.   

This app can be used with children aged 4+ years.  It can also be adjusted to your child’s needs and levels.

It is available for download on iTunes for Free with some In-App Purchases.  You can find out more information at: https://learnwhquestions.com/en/why/

My Love for AAC (Augmentative and Alternative Communication)

By Melissa Mcilhiney - Highly Specialist Speech and Language Therapist and Complex Needs Specialist

When training as a Speech and Language Therapist you learn about AAC (Augmentative and Alternative Communication) methods in lectures. I have always been a more visual and hands on learner than one that can sit in a lecture theatre and take in what it being said.   So my love for AAC did not begin straight away but has evolved over the pathway of my career. It has shaped the therapist I have become and the type of client group I specialise in. This may sound cheesy, but it gave me a purpose and a role doing something I love. 


When I was at university I was adamant I would be working with adults on stroke wards or on the head and neck cancer wards in acute hospital settings. How wrong I was! Don’t get me wrong, I had placements on both of these types of ward and I did enjoy them and learnt lots, but this type of work just wasn’t me. To this day, I can’t really explain what was missing from either of these fields for me. I then went on a placement in a DSP (Designated Specialist Provision) attached to a mainstream school I knew this is where I belonged.  I was placed with an amazing Speech and Language Therapist called Sue. She showed me a completely different way of working. I learnt Makaton (signing), was introduced to visuals such as visual timetables and ‘now and next’ boards. I was encouraged to use all of these within my practice with the children I was working with. It was here that my love for AAC began and my career pathway totally changed.  This placement impacted so much on me that I walked away knowing that kind of setting was where I wanted to be. To this day I don’t regret that decision one bit. Seeing the way children can progress and communicate with others, become more independent with their communications and seeing things individualised to each child’s needs lead me to start applying for Specialist Provision posts.  

As a newly qualified therapist you don’t normally even start thinking about a specialism, but I had no doubt that I was taking the right route! It felt natural. So, I applied to a special school and got a job in an MLD (Moderate Learning Difficulties) school working in an Autism base. Here my love for AAC continued to grow. I was introduced to PECS (Picture Exchange System) and we used this daily to take a very functional approach to communication. We used regular visual aids and worked on sensory difficulties at the same time. Therapy there took a very holistic approach and to this day my therapy style is still very holistic. This holistic view of therapy is now supported by the Department of Health and research supports the premise that looking at the child as a whole results in the most progress in their development.   


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I’ve been involved in a few cases where we had to use PECs and visuals to support the communication of children who were going into hospital or in one case had to be interviewed by the police. I remember people saying, “they won’t be able to tell us what they have seen”. How wrong they were!

This role marked the beginning of my dedicated mission to ensure that all children have a “voice” whether via signing, PECS or another method. I was adamant that every child must have a way to communicate. We just need to find the method that works best for each individual child. We know that not everyone is the same and communication (and aids) need individualising around the child’s needs. For example, A child with Retts syndrome who can only eye gaze will need different aids to a non-verbal ASD child.   

After the special school placement I joined the NHS for 6 years and worked in mainstream, pre-school special needs and eventually ended up back in special schools, my most loved environment to work in. I continued to use all different types of no and low-tech AAC devices here and then saw another therapist introduce an electronic aid with a child. I wasn’t directly involved with the child but it sparked my interest and another branch to my love for AAC started to develop. 

I remember sitting in front of the TV one night and seeing an interview with the late Stephen Hawking. I listened intently to every word he said. Not because I understood a word of what he is was on about (quantum physics is just not my thing!) but because I was astonished by the hi-tech aid he was using. The way he was controlling it through eye movement and how quickly and intricately he could explain black holes!  I then got really into researching his story but also the other types of hi-tech aids like Stephen’s there were out there ranging from I-pads to eye gazing machines.  In looking into them I realised that I had children on my caseload these would benefit hugely. We started putting them into the therapy of two children on my caseload. They made amazing progress! I have continued to use these types of aids with suitable children on my caseloads ever since.  


Children are a lot more tech-savvy nowadays. A child on my current caseload was introduced to his aid last term and within days was able to order exactly what he wanted in Pizza Express without having to rely on an adult interpreting his wants and needs as he always had in the past. Children do not normally catch on to their new aids this quickly, but seeing how well children can progress with the right equipment makes this job worthwhile and again highlights the importance of giving each child their “voice”. 

Can you imagine living in a word where someone else speaks for you? Interprets what you want, what you need? Where you literally have no voice? To me this would be the ultimate nightmare and for the children I work with it leads to extreme frustration and behavioural issues. AAC methods give individuals a lifeline, a way of being able to communicate with others without requiring another person to interpret for them. It decreases frustration and most importantly gives people their “voice”. Research supports the use of AAC devices and has shown that using them increases the use of spoken language. Some parents are scared that AAC devices will replace speech this and from my many years of experience this is not the case. But that’s a whole other can worms that I will certainly open in a future blog!  

"I can’t think of a more rewarding job than giving someone their “voice”. And that is why I love AAC and my job"

HAS THE WORLD OF SOCIAL MEDIA CREATED A WHOLE NEW GROUP OF HEALTH & EDUCATION PROFESSIONALS?

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By Sunita Shah - Service Lead for North West London and Specialist Speech and Language Therapist in Bilingualism

Early Intervention is Key

Who Am I?... My Reflections...Reality

I have been a practicing Speech and Language Therapist for over 20 years; and an Author; a mother of two crazy boys aged 18 months and 5 years. Oh, how my practice changed overnight seeing the other side.  Before eyebrows would be raised if patients were late or if homework was not done but seeing the other side of the coin of what parents must do in their daily routine opened my eyes.  I simply ‘’’respected my parents for getting to the appointment to support their child. I remember the first day back at work I saw a child who had transferred to our Trust the child’s mother had left; the father had special needs and the child was severely Autistic and nonverbal at 4 years old.  The family were homeless; as soon as they left the clinic, the waterfall of emotions took hold.  Suddenly it was not about the hour in clinic supporting the child’s communication it’s the reality of what the parents experience 24-7.


My degree was intense but fascinating. I am so blessed to have worked with such wonderful children and amazing parents.  I once read “A child with special needs does not come with a manual... it comes with a parent that does not give up”.  I studied for over 3 years too gain my qualification as Bachelor of Science in Clinical Language Studies (Speech and Language Therapy).  I studied so many modules within the course, Child development, child psychology, neurology, various therapy models etc. I was fortunate to work in the NHS system for over 20 years and gained so much knowledge, skills and experience which I feel so grateful for.  I left public sector in 2017, and now work independently.  This was an extremely hard decision to make but I have enjoyed life post NHS so much.  The flexibility to not follow unrealistic expectations, KPI’s, endless growing waiting lists for assessment and therapy.... to give the family the type and frequency of intervention they REALLY need, which makes a difference... and quicker.... Early intervention is key.

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Has Social Media Made A New Breed of Health Care &Education Professionals?

 I have been following various national and local groups on social media for parents. It’s a humongous network that supports parents in so many ways, from advice on sleeping, toilet training, weaning, behaviour, chicken pox, and overall development etc. There is nothing like having support from another parent about what they have gone through.  For many parents this is the first point of call.  Within the network there are parents who are Health Care Professional too.  It’s that comfort factor, to put the anxious parenting mind at ease.

My Concerns... Because I Care

Recently I have started to get slightly alarmed with some responses especially regarding communication development. Over a year ago I saw a parent who came to me when their child was 3 years old, it was evident this child had severe communication needs. I asked the mother when she started noticing when things were different the mother replied from 10 months old.  I asked why she waited so long, she reported she followed advice from her NCT friends and other people to just let him develop and in time the child would talk. The mother missed 18 months of vital intervention which would have made such a difference. I’ve seen this on several social media posts recently when people are asking about communication advice, a child of 2 years SHOULD be talking, if there are not they need support. Please see the ages and stages section on my website: www.tlc-speechtherapy.co.uk. Using the wait and see approach can miss vital months of support. Also, children have come to me at 4 years old with severe stammers, they started stammering at 2 years old.... why refer now? The parents said they waited as they thought the child would “grow out of it” .... no… again Early intervention is key. If you are concerned particularly about your child’s communication consult your Children’s Centres, GP’s Health Visitors, Early Years consultants, they are all very experienced, and they will always support you in the steps to taken.  Always remember the walk-in clinics and 111.

I see so many pictures of children’s rashes and suddenly the world of social media can be quick to diagnose, but in a quick snapshot post there is no medical history taken how can advise be given on what to do, when the child’s rash may look the same as what your child had, but the child may have other health concerns or allergies to take into account.  A parent has the most unique gift called “Gut instinct” parents never under estimate this. You know your child more than anyone in the world, if you think there is something wrong.... see a professional.  Please do not wait.

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Use Your GUT instinct... Don’t Always Wait and See....

I guess what I’m trying to put across is although there is a place for support on social media... and some useful articles and advice, please be vigilant... The people of social media are not all qualified Health Care Professionals, go with your gut instinct. Also remember Early Intervention is key.  Certain advice I have seen from members on groups goes against what we practice as clinicians and concerns me. Medical and development histories are very important in the treatment and diagnostic process.

Keep doing what you AWESOME parents are doing.... it’s the best gift in the world being a parent and it’s our job to make sure our children stay happy and healthy.