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New measure identifies toddler speech & language delay

By Newcastle University
Toddler practising speech

Local areas across England can now use the new Early Language Identification Measure (ELIM) and Intervention to identify speech, language, and communication (SLC) problems in very young children.

Early speech and language delays can be a worry for parents and professionals alike, and researchers have been looking for ways to accurately identify children who would benefit from help.


Making a difference to little lives

In 2018, Public Health England (PHE) and the Department for Education (DfE) commissioned Newcastle University to develop a measure of language skills, and an accompanying intervention for children attending their health visitor review at 2 – 2 ½ years of age.

A team led by the late Professor James Law, who was Professor of Speech and Language Sciences at Newcastle University, conducted research* to create a new measure. Co-design with end users (parents/carers, health and early years practitioners) was a key element of development.

The project ran between January 2019 and July 2020 and involved health visitors, early educators and speech and language therapists in five areas - Derbyshire, Middlesbrough, Newham, Wakefield, and Wiltshire. More than 800 children were assessed and the ELIM identified 94% of youngsters who needed support.

When a child was identified as needing support, the health visitor spoke with their family to discuss the best ways to help them. Support offered ranged from using online resources to including exercises in everyday life.

A three-step process to supporting families

The research, highlighted in a Summary Report, concluded that the best way to identify need - and support families - was a three-step process:

  • Step 1 – a needs assessment by a health practitioner to identify any SLC needs in a child
  • Step 2 – a conversation with the parent/carer to discuss the assessment results, and ways to support their child’s using existing local and national resources
  • Step 3 – an intervention for those children who need further support, designed by the health visitor with the parent/carer, which can be supported by local early years practitioners

A referral to specialist services, such as speech language therapy, where needed is made in accordance with local SLC pathways.

The new measure supports collaborative working between parents, heath visitors and other professionals to support children.

“When we worked with health visiting teams on our intervention design we found there was a real appetite and enthusiasm to support children's speech language and communication development however they felt they needed more guidance as to how to do this successfully," said Cristina McKean, Professor of Child Language Development and Disorders at Newcastle University, who designed the intervention. "And when we spoke to families it became very clear that whatever support was offered needed to be personalised to consider the specific circumstances of each family. Our intervention model supports health and early years practitioners to tailor their approach with families and to find ways to help them to support their children's language development as part of their daily routines."

Speaking at the time the research into the effectiveness of the ELIM toolkit was published, Professor Law explained the theory behind the process – “Once the right children have been identified, the key is for parents and other professionals, such as health visitors and early years practitioners, to work together to find out what would most help the child. For children with the most marked difficulties this may be speech and language therapy but it may be finding out more about the languages the child uses or pointing them to resources that help them better understand their child’s needs”.

“As every family’s needs are different what is required is a carefully constructed conversation looking to match the child and families’ needs with the resources that are available. Every conversation is different. The key thing is for the practitioners and parents to work together to provide solutions so that the child can be ready for school when the time comes.”

Rolling out the new measure

In 2021 Public Health England (now Office for Health Improvement and Disparities) provided training in the use of the new measure to health visitors, early years practitioners, speech language therapists and other professionals across England. This training is now being shared amongst peers in some local areas.

A number of these areas have started to implement the ELIM and Intervention at the 2 – 2 ½ year health visitor review to aid early identification of local speech, language and communication needs. This will also enable them to provide timely and appropriate support to families and their children.

Numerous research studies have shown that children with delayed language development do worse at school and have poorer outcomes later in life. It can also signal other developmental conditions such as autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD).

If speech, language, and communication need are identified earlier, families can be supported by their local systems to improve their children’s future education and life outcomes.

*The research was carried out by researchers at Newcastle and Aberdeen Universities, the Bristol Speech and Language Therapy Research Unit, the Institute of Health Visiting and Robert Rush, an independent education researcher.

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