What I can do for you

Advice and support on the basis of 10 years experience as an NHS speech and language therapist

I treat and advise only in the area of my expertise: What is the essence of a child’s problem with speech or language? What is the best I can do to fix it? How long might this take? How likely would it be for the problem to fix itself?

Before I do any work I need to get an idea of what the problem is. For this I need to do some investigation. For some children, the investigation itself is therapeutic. And for soime children, one of the most useful investigations is from a diary which parents can keep of their child learning to talk. I explain how to do this in Being special

It is always useful to know what you think the problem is. If you like, I can give you some pointers about some things which you may find useful to think about.

Support is sometimes the most important thing I can offer.

Treatment

Speech and language are incredibly complex capacities. It normally takes around ten years to learn the basic structures. It seems to me not surprising that this learning should be problematic for some children. The muscular actions and their co-ordination are obviously complex. But I am surprised by the expectation that the core problem of the hard-to-understand child is likely to be in muscular co-ordination. It may be to some extent. But only to some extent. Talking is about saying things and understanding what others are saying as well as moving the tongue and the lips.

There is an obvious possibility: that that the core problem is in the natural process of of learning itself. I believe that this should be investigated clinically before any other assumptions are made. I find that a linguistically motivated intervention often produces the fastest results.

Wagging and waving

There are many energetic and convinced proponents of what they call ‘oral motor treatment’ or OMT involving a variety of exercises for ‘jaw stability’ or the strength of the tongue, flicking it up and down, wagging or waving it from side to side or moving it round in circles. Various devices are on sale to help in such endeavours. But as far as I know there is no evidence from phonetics for any of these things. I believe that the claims made for these treatments are either mistaken or fictitious.

It is, of course quite possible that there will be improvements after a sensitively administered program of exercises. And this may be taken to justify the exercises. But it is also possible that the critical factor here is the sensitivity of the administration rather than the exercises themselves. 

Brain-power

Although the act of speaking is often to achieve some goal, to interest, to persuade, to endear, to get information, and so on, which may work or not work, as the case may be, the way we order the words is quite remote from any goal we have in the utterance in which these phrases occur. The ordering is crucial. We say ‘good person’ and ‘someone good’ but not ‘person good’ or ‘good someone’. Person and someone are different sorts of words. What we do with words can be funny or honest or deceptive. But that is not behaving in the ordinary sense. So I do not think of either speech or language as intrinsically forms of behaviour.

So I do not believe in Applied Behavior Analysis, or ABA, as a way of helping children who have problems putting words together or pronouncing them.

Neither OMT nor ABA are new. But the treatment possibilities by a linguistic approach range more widely than by either OMT or ABA.

I believe that speech and language are by a capacity which expresses the power of the human brain, rather than mere behaviour or what’s happening or not happening in the mouth.

Fees on a sliding scale

I offer a free initial one hour consultation. From then on, my fee is £150 per hour, but on a sliding scale.

To the best of my knowledge I am the only clinical linguist working in London. 

Privacy

If you give me your Email address and any other credentials, these are not used or accessed for any other purpose, and not disclosed to anyone for any predictable purpose of any sort.

Privacy is strictly maintained. No parent or child is publicly identifiable in any way.

Clinical records bear on research in unpredictable ways. New research questions pop up all the time. So I keep the records indefinitely.

Social distancing

Normally I only work face to face. But now I sometimes use social conferencing instead, putting toys on the table, discussing with the child what can be done with them or what the child is doing wherever he or she is. Or we can make a picture – of whatever emerges from the conversation. Of course, I may also need to discuss the situation with one or both of the parents.

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Contact Dr Aubrey Nunes