ParentWise Podcast Series

Language Development
in children with cerebral palsy

INTRODUCTION

Hi and welcome to The Cerebral Palsy Foundation’s ParentWise Podcast series. I’m Robyn
Cummins.

Learning to communicate with others, and ensuring that you’re understood, is a vital part of
any child’s early development. In this podcast, speech pathologist, Alana Bain, explains how
children develop language, what’s different about that process for children with cerebral palsy
and what parents can do to help their children develop language skills effectively.

WHAT IS LANGUAGE AND COMMUNICATION

Hi. I’m Alana Bain.

Communication is about being able to give and receive messages. There are five main areas of
communication:

ƒ Speech – which is the physical production or process of making sounds

ƒ Pragmatics – which refers to the social rules of how we interact with each other
ƒ Fluency – which is the rhythm and pattern of talking
ƒ Voice – which is the production of sound from the vocal cords, and
ƒ Language.

Language is our ability to express ourselves in a way people understand (for example being
able to put sentences together) as well understanding information which is given to us. When
you know a language, you are able to speak or communicate and be understood by others.

There are two main parts of language:

Receptive language is how we understand information that is spoken, written, signed or

communicated visually to us. Receptive language involves being able to follow instructions in a
classroom, being able to understand and answer questions and learning routines and activities
happening in our environment.

Then there’s expressive language which enables us to communicate a message using

speech, writing, sign or picture symbols. Expressive language allows us to do things like tell a
story, give an instruction, make a statement or ask a question. We use our expressive
language to interact with others in different situations and for different purposes.

When we learn a language there are certain rules that we need to follow:

ƒ We need to understand how sounds go together to make words (also known as phonology)
ƒ We need to understand the meaning of words and use a range of vocabulary (called
semantics)
ƒ We need to understand and use a range of basic concepts (such as in, under, on, beside)
ƒ We learn the rules for how words go together to make sentences (also known as syntax).
For example, we know that, ‘The girl patted the dog’ is not the same as ‘The dog patted
the girl’
ƒ We also learn how to change what we say and to whom, depending on the situation. For
example we know to say, ‘Ouch’ when someone steps on our toe rather than, ‘I like to
sing’. This is called pragmatics.

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There is also a creative aspect to language. You can make up sentences you’ve never used or
heard before, and you can understand sentences you’ve never used or heard before.

LANGUAGE DIFFICULTIES

Most children’s language development will follow a similar path and there are certain
milestones that we look out for. Although the path of development is similar, children’s
language development may progress at different rates. The important thing to watch is that
language development is steady, not whether it is fast or slow.

Some very general guidelines from the American Speech Hearing Language Association
(ASHA) for typically developing children include:

ƒ First words are spoken somewhere between 12 and 18 months

ƒ A spurt of language development occurs before 2 years
ƒ Children are using 4-5 word sentences by about 4 years
ƒ Grammar is mostly correct by 4 years
ƒ Other people should understand what your child says by the time he or she is 4.

Studies indicate that language delays may impact upon school achievement and may be
associated with behavioural, social and/or emotional issues. Therefore, it is important to have
your child assessed if you have any concerns about their language development.

If you are concerned about language, also ensure that you have had your child’s hearing
tested. If they have recurrent middle ear infections (which can lead to conductive hearing loss)
this could impact on their language development as they are not hearing speech and language
clearly during that time.

Children with cerebral palsy may also experience difficulties with communication in areas such
as speech, the development of gesture and facial expression, receptive and expressive
language and voice production.

The prevalence of these disorders has not been fully established, but it is estimated that
approximately 65% of people with cerebral palsy have a speech and/or language impairment
with 21% of people being non-verbal – that is, unable to speak at all.

Researchers are currently working on a communication classification scale which may assist us
to track the communication needs of children with cerebral palsy more in the future.

WHO CAN HELP?

So, who can assist with the language development of your child?

Language skills are assessed by a speech pathologist. They use standardised assessments as
well as interviews and observations to assess your child’s skills. Once skills have been
assessed and any problem areas identified, an intervention plan can be put in place for your
child.

Language interventions may include a variety of teaching methods and tools. There is some
research evidence to suggest that children benefit from more interactive learning. Some
children however, with more severe difficulties, may benefit from a more directive approach.

Whichever approach is taken, interventions must be matched to the needs of your child.

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The aim of intervention is to provide your child with the skills to make communication
effective, efficient and rewarding. There is no single intervention that will be used for all
children. The most appropriate strategies are matched to the needs of your child.

Research shows that there is a positive effect of language therapy for children with expressive
vocabulary difficulties. There is some evidence supporting interventions for expressive syntax,
and more research is required to investigate interventions for receptive language difficulties.

The interventions suggested for your child will probably also include some parent involvement.
For example, looking at how to maximise interactions with your child to promote their
language development.

Techniques include language stimulation, facilitation and modelling of appropriate language.

One important thing you can do when interacting with your child is to follow their lead. Be
guided by what they are interested in and match your communication to their level.

Modelling appropriate language can include strategies such as:

ƒ Self-talk – As you play with your child, or complete activities, you talk about what you are
doing and provide a language model for your child.
ƒ Parallel talk – This is where as your child does and activity, you talk about what is
happening. For example if your child is playing with blocks you can say, ‘You’re building.
You put on a block. Uh oh, it fell over!’
ƒ Imitation – As the name suggests, this involves imitating what your child says and
reinforcing their use of language.
ƒ Expansions – This is when you take what you child has said and add in more language. If
you child says ‘dog’ you could model ‘big dog’.
ƒ Extensions – This is when you add in more information to something your child has said.
For example if your child says ‘dog’, you could say, ‘The boy is patting the dog’.

Additionally, you can create opportunities for communication and language by not doing
everything for your child. It gives them a reason to communicate with you. For example, give
them a Texta that doesn’t work, or put their favourite toy out of reach so they need to ask for
it. When using these techniques it is always important to be aware of whether your child is
becoming frustrated and, if so, changing your strategy.

Encouraging social skills and interactions, like turn taking and shared play experiences, will
also help your child to develop receptive and expressive language and build more confidence in
interactions, especially with their peers.

CLOSE

Thanks for listening. We hope you’ve found these strategies and ideas useful.

You can download or listen to more episodes in the ParentWise Podcast series at the Cerebral
Palsy Foundation’s website - www.cpfoundation.com.au

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