Is my teenager too old for speech and language therapy?

Is my teenager too old for speech and language therapy?

No. I work with children and young people from 18 months to 16, so a 13-year-old who finds it hard to explain what happened at school is exactly the sort of person I see.

The research is thinner for older children than for toddlers, and I'd rather say so. One of the better studies followed 72 students aged 9 to 17 at a specialist school for children with language disorder. Over one term, therapists worked one-to-one with each student on specific targets. Those targets improved significantly more than areas that weren't treated, and progress didn't differ significantly between school years.¹ Their conclusion was that direct one-to-one therapy can be effective for older children, including those with receptive language difficulties (trouble understanding).¹

It was one school and the therapists designed the measures, so it doesn't prove therapy will work for every young person. The RCSLT says speech and language therapists can support young people through the move from primary to secondary school, and from secondary school into further education.²

If your young person is 17 or older, I'm not the right therapist, because I see children and young people up to 16. Speech and Language UK suggests talking to their school or GP, or using its free advice line with a speech and language therapist.³

What can language and communication needs look like in secondary school?

Often they look like something else. Speech and Language UK lists these among the things to look out for in teenagers:³

• difficulty giving specific answers or explanations
• difficulty telling ideas in the right order
• understanding single instructions better than group ones
• missing hidden meanings, and taking what people say literally
• finding long, complicated instructions hard
• trouble learning new words
• taking a long time to organise what to say or write

In a secondary classroom those can become very practical problems. Fast talk across a room full of people is hard to follow. Each subject has its own vocabulary, and words like "evaluate", "compare" and "justify" turn up in exam questions without anyone explaining them. Explaining yourself to a teacher who's in a hurry is difficult, and friendships depend on quick, shifting language, including slang, jokes and sarcasm. A leaflet from an NHS therapy service lists trouble with idioms, puns and sarcasm, and with making and keeping friends.⁴

The subject examples are from what I see in clinic and not from a study, so treat them as examples.

Why are language needs often spotted late?

Because language difficulties are easy to miss. Speech and Language UK says DLD can be hard to spot and may stay hidden for a long time.⁵ A young person can talk fluently and still lose the thread of what's being asked.

They also tend to look like attitude. The secondary-school leaflet warns that language difficulties may sit underneath low self-esteem, anxiety or misbehaving in class.⁴ Speech and Language UK suggests that when a young person has difficulties with learning, literacy, behaviour, friendships or mental health, it's worth looking more closely at their speech, language and communication.⁶ In my experience, a child who coped with the smaller, more predictable world of primary school can come unstuck at secondary school, where there are many teachers, quicker talk and more abstract language. That's my observation, not a research finding.

Telling a language difficulty from ordinary teenage quietness isn't something I can do in a paragraph. I'd look for difficulty that's been there a long time, shows up across subjects and with different people, and that your teenager is frustrated or embarrassed by. If that fits, it's worth asking.

What does therapy look like when the young person sets the goals?

It starts with a conversation with your teenager, and not with a list of what's wrong. I ask what they want to be able to do. That might be asking a teacher for help without freezing, following the instructions for a coursework task, explaining a disagreement with a friend, or joining in at lunch. Those become the goals, and I'd talk them through with you too.

Sessions are built around those goals and use the things your teenager cares about, whether that's football, a game or a subject they're stuck on. I say what I'm doing and why, because a fourteen-year-old can tell when they're being "worked on". Teenagers can say no, ask for a break or tell me something isn't useful.

If your teenager is autistic, or finds social communication hard, my autism and social communication page explains how I work. I don't aim to make anyone look less autistic. Sessions are at my clinic in Wanstead, or at school if that's agreed. I don't offer therapy online.

What can school do?

Quite a lot, and much of it costs little. Speech and Language UK suggests adults support understanding by talking slowly and clearly, pausing often and using simple words, and by using visual supports.⁶ From my own practice, I'd add:

• give instructions one at a time, and in writing as well as out loud
• teach the key words for a topic before the lesson
• check understanding by asking your teenager to say it back or show you
• allow extra time to organise an answer
• pass on information about a young person's needs when they change teacher or year

Ask for a chat with the SENCO (special educational needs coordinator) and say specifically what you've noticed. I can visit a school to talk this through with staff, and the schools page has the details.

When should I ask for help?

If something's worrying you, ask. The free routes come first: your teenager's school SENCO, your GP, and Speech and Language UK's free advice line with a speech and language therapist.³

If there's a sudden change, such as your teenager losing words or skills they had, or speaking very differently, ask for an urgent GP appointment or call NHS 111. Low mood or anxiety are worth raising with your GP too, whether or not language plays a part.

What happens if I get in touch?

The free 15-minute call is a chance to describe what you're seeing, and no GP referral is needed. After that comes an assessment at my clinic in Wanstead, east London, which costs £270. Seeing me doesn't take your teenager off any NHS waiting list. The language and communication page explains how I work, the fees page lists every price, and for autistic young people there's a page on autism and social communication.