Talking points

Children with language difficulties may also experience associated difficulties, in-cluding what might often appear to be non-compliant or challenging behaviour. This was true of Freddie, Samira and Mohammed who exhibited very different types of behaviour in their settings but all were found to have underlying language difficulties.

Freddie, three-and-a-half years

Freddie was always on the go - running around inside and outside the nursery, over tables and toys and sometimes over the other children! Staff observed that Freddie often slipped or fell even when no obstacle was in his way. Story time was an endurance test. When he did settle it was for just a few minutes, usually at the sand tray or on the trikes.

Freddie was struggling to learn how to play with, rather than alongside, his peers, despite attending nursery for a year. He was often absent with coughs and colds and always seemed to have a runny nose. This was interfering with his ability to make friends.

Samira, four years

Samira appeared wary of adults. She regarded them with a distant gaze and generally ignored any requests to join them at activities. Observations of Samira with her peers revealed a more chatty child, eager to share fun and excitement.

Which picture was correct? Staff reported periods of significant regression with toileting - or was it deliberate soiling? No one was ever sure. Her parents' description could have been a different child. When we visited Samira's home we learned that a difficult start in life was a significant factor in the equation, and that temper tantrums were an ongoing feature, following significant, early, global delay.

Mohammed, three years

Mohammed was referred by the clinic speech and language therapist, who observed him struggling in nursery. He was so quiet that staff only noticed him when he lashed out, or became overwrought, and were unable to explain why.

His speech was mostly sounds, 'Aa aa, ooo ooo'. Staff thought he was learning a second language. However, Mohammed was the third child of a fluent bilingual family, whose older siblings were bilingual.

Observations indicated that Mohammed had some good non-verbal skills, such as drawing, bike riding and singing. He could 'play the clown' once he became settled in the nursery environment.

Observationand assessment

Detailed observation and assessments were carried out by a speech and language therapist and education psychologist to look at each child's individual levels of attention and listening, play, comprehension and expressive language and other non-verbal skills. This allowed us to compare the child's chronological age with their developmental age, to make sense of their behaviour.

Children with behaviour and language difficulties are often mistaken as 'naughty', 'lazy', or 'just learning English' but in reality they are like a younger child in some aspects of their development. Establishing this understanding of the child's struggle to do what other children find effortless helps the adults in their lives to adjust and adapt. This is the first step in supporting their learning.

Freddie required careful observation by all working with him in order to identify his needs. He had single words, but with a lot of 'roaring'. It became apparent in the summer months that he was more alert and responsive to language. When he had a cold, staff described him as looking 'bewildered'. They reported that they couldn't keep his attention, as he gave fleeting eye contact and appeared unaware of the purpose of some toys.

Speech and language assessments found a big discrepancy between his language levels on different days. Freddie was diagnosed as having glue ear and was recommended for hearing aids. No wonder he couldn't concentrate, nor understand the purpose of speaking and listening.

Samira waited two months before letting any of the team hear her speak. We visited her at home when she had a friend to play and listened in and then joined their game. Only after becoming more familiar with the speech and language therapist would she allow her to attempt assessments. It became apparent that her language levels were below average, though following the usual developmental pattern. A language delay alone would not usually accompany such different behaviour, and we realised that there was an underlying emotional issue, closely linked to her family history.

Mohammed was able to demonstrate that his non-verbal skills were developing quite well, despite language difficulties. Bilingual assessments with his mother revealed a difficulty in both of Mohammed's languages - this was a disordered pattern of language development, not the 'silent period'.

Intervention

For each child, we devised appropriate intervention, selecting strategies that are known to work for children with language problems. We also offered the settings' staff training in managing behaviour and language difficulties.

Strategies included:

Visual support Use photographic labels creatively, for example showing the child a photo of their coat before they go out. Use objects of reference (for example a spoon for lunch time) and/or symbols to show the child what's expected.

Use natural gestures and/or Makaton signing to help the child understand an instruction.

Before giving an instruction, kneel down and encourage the child to look at you. Remember the child's positioning at group times. Have them seated near the speaker and make sure they can see pictures and props.

Adjusting language If the child uses mostly short phrases or single words, then reduce your language. Give information in 'chunks', emphasising key words, for example, 'Water play is finished', 'Take your apron off'. Help the child follow through with instructions using gentle physical guidance.

Praise peers who are doing what's asked of them, such as, 'Look Mohammed, John's sitting nicely.'

Use the 'firstInext' strategy during transitions. Explain what's happening using simple language, for example, 'First it's storytime and next it's lunch', or 'Play is finished, now it's circle time.'

Reducing the pressure to talk Children typically don't like answering questions when they know you already have the answer. Instead of saying, 'What's this?' while holding a teddy use a lead-in, 'It's aI' and wait for the child to fill in the word.

Offer the child choices wherever possible, 'Do you want to play with bricks or a puzzle?' This allows the child some control and gives a clear model of language.

Adding structure Children with language difficulties find it hard to organise themselves because of trouble concentrating and predicting.

Support them by making the daily schedule clear by making a timetable with photos or symbols.

Additionally, core skills like turn-taking, listening or sharing can be taught in one-to-one opportunities or small structured group sessions and later carried to nursery sessions.

Extra support Have sessions with the child and one or two other children in an area with few distractions. Also have one-on-one 'special time' with the keyworker and child playing together, with the child leading. This gives the child a positive experience of being listened to and in control.

Work with parents

During our intervention we also worked with the children's parents. In Freddie's case we needed to explain to his mum the importance of clearing up his congestion, and were able to demonstrate the difference it could make to his progress and behaviour. Mum was referred to, and attended, a workshop for parents of children with glue ear organised by the local health authority.

In Samira's home we introduced the idea of allowing her some control over things in her life. This included Samira using a symbol timetable to get her familiar with daily routines; mum offered restricted choices of clothes for nursery and removed snacks between meals.

In Mohammed's case we were able to lift his self-esteem to a point where he would 'clown' at appropriate times, and would participate in a wide range of activities. He became motivated to communicate and attempted much more.

However, his language progress was slow and we were able to use specialist assessments to show that his language disorder was going to need long-term support in a mainstream language unit.

It can be very interesting investigating the causes of children's difficulties. It is rewarding when we can make a real difference, as with Freddie. However, the nursery year is short, and not everything can be accomplished in just one year of a child's life. Sometimes we can move them forward and ensure the transition to school takes their needs into account.

* Camden Early Years Intervention Team was established in 1998. The team includes two teachers, an educational psychologist, speech and language therapist and area special educational needs co-ordinator, offering a service to all early years settings in Camden EYDCP, London.

Unfortunately, the team cannot enter into personal communication with readers, but letters for publication in Nursery World can be sent to the address on page 3.