Speech and language therapy

Also called SLT, Speech therapy, Speech and language therapist

Two jobs in one profession: helping people communicate, and keeping people safe when they swallow. Most people only know about the first.

What it is

Speech and language therapists work on communication and on swallowing, and the second surprises almost everybody.

Communication covers a very wide range: developmental language disorder and speech sound difficulties in children; stammering; selective mutism; aphasia after stroke; the voice and speech changes of Parkinson's disease and motor neurone disease; voice problems; and communication support for people with a learning disability or autism, including communication aids.

Swallowing is the other half. Dysphagia after stroke, in dementia, in Parkinson's and in learning disability is assessed and managed by speech and language therapists, and unsafe swallowing is a leading avoidable cause of death in people with a learning disability. The therapist decides food and drink textures, positioning, and whether eating is safe at all.

They are also the profession behind augmentative and alternative communication: symbol boards, signing, and speech-generating devices for people who have little or no speech.

Signs you might notice

Signs to ask for a referral for communication: a child not talking as expected, being hard to understand beyond the age peers are clear, or losing words they had; an adult whose speech has become slurred, quiet or effortful; anybody who has lost words or the ability to follow conversation after a stroke or brain injury; frustration and behaviour that changes when somebody cannot make themselves understood.

Signs to ask for a swallowing assessment, urgently: coughing or a wet, gurgly voice during or after eating or drinking; food or drink coming back down the nose; meals taking a very long time; repeated chest infections; unexplained weight loss; a fear of eating in front of others.

Repeated chest infections in somebody with a learning disability, dementia or Parkinson's is a swallowing assessment until proven otherwise.

How it can affect day-to-day life

Communication difficulty gets read as behaviour, as rudeness, as confusion or as lack of capacity, and the person is then treated accordingly. A great deal of what is labelled challenging behaviour is somebody with no reliable way to say no, or to say it hurts.

Aphasia after stroke is particularly badly misread: intelligence is intact, and being talked over, talked about, or handed a form is humiliating in a way that is entirely avoidable.

Waiting lists for children's services are long in many areas, and what happens between appointments does most of the work. Ask for a programme the family and school can actually run.

Texture-modified diets are frequently prescribed and rarely reviewed, and people stay on them long after they need to. They should be reviewed, and so should the person's own view about the risk they want to take.

Communication aids get abandoned when nobody around the person learns to use them. The device is the easy part.

Supporting someone well

Ask for a swallowing assessment urgently for coughing on food or drink, a wet voice after swallowing, or repeated chest infections. Do not wait.

Ask for a communication assessment before concluding somebody lacks capacity. Capacity is decision-specific and it depends on how the information was given.

Give time. Do not finish sentences, do not raise your voice, and do not switch to talking to the person's companion.

Use whatever works: writing, pictures, gestures, objects, a communication book. Nothing about that is undignified.

Learn the person's communication system yourself. If only the therapist can use it, it does not exist.

Ask for the recommendations in writing, so they survive a change of school, staff or setting.

Ask for review. Both swallowing and communication change, in both directions.

Where to get help

A GP practice, health visitor, or the school for children. Many NHS children's services accept referrals from parents directly.

The stroke, neurology or learning disability team for adults already under a service.

Royal College of Speech and Language Therapists explain what the profession does and hold a directory of independent practitioners.

Speech and Language UK have excellent parent material and a helpline.