Child Speech Therapy Singapore

According to the Allied Health Professions Council (AHPC)’s Annual Report 2020, there were 727 registered Speech-Language Therapists (SLTs) as of 31 December 2020. This represented 11% of the 6,326 allied health professionals in Singapore, which also include Diagnostic Radiographers, Occupational Therapists, Physiotherapists and Radiation Therapists.

The AHPC is a professional board under Singapore’s Ministry of Health (MOH). It regulates professional standards for practice and the conduct and ethics of registered allied health professionals under the Allied Health Professions Act (AHPA). All SLTs working in Singapore are governed and regulated by the AHPC.

SLTs can be found in various healthcare and education settings in Singapore. Public healthcare institutions, which include hospitals and polyclinics, are the largest sector of employment for SLTs, followed by the private sector (hospitals/clinics/centres/schools).

Based on the same annual report, as of 2020:

• 33.8% of registered SLTs are working in the public healthcare sector;
• 24.2% are in the private sector;
• 23% are in Social Service Agencies/Voluntary Welfare Organisations (VWOs); andpicky eater – only eating certain foods
• The remaining percentage is in other sectors, such as community hospitals and statutory boards.

“In the longer term, an ageing population and rising chronic disease incidence will drive demand for healthcare manpower.” Calvin Yang. (December 10, 2020). Close to 5,500 jobs available in S'pore's healthcare sector; 3 in 4 are long-term positions. The Straits Times.

SLTs are specially trained to help individuals with speech, language, and/or other communication challenges, including those with swallowing difficulties. These therapists provide a range of specialised care services, such as assessments and therapeutic interventions, among others. Given the important role they play and the impact they have on people’s lives, it is not surprising that SLTs are in demand in Singapore. The AHPC has also reported a 6% increase in the number of registered SLTs since 2019.

For those interested in pursuing a meaningful job as an SLT, here is some useful information:

Salary: The pay of an SLT in Singapore ranges from $2,800-S$8,000 per month, depending on qualifications, experience and seniority level.

Working hours: Work hours are typically within normal business hours, with some variations due to the sector they are in and/or other specific job requirements.

Qualifications: To practise as an SLT in Singapore, one would need to complete a degree-level course in Singapore or overseas at the undergraduate (4 years) or post-undergraduate (2 years) level. The AHPC recognises these qualifications.

Training Programmes: There are also training programmes and support available to equip an individual with the knowledge and skillset for social work, such as the Social Service Institute (SSI)’s Continuing Education & Training (CET) courses. The Workforce Singapore’s Professional Conversion Programme (PCP) is a good starting point for those who are considering a mid-career switch to the healthcare profession.

Registration of allied health professionals: Upon successful registration with the AHPC, a new SLT can start practising in Singapore.

At Dynamics Speech, we have 12 (and counting!) highly motivated AHPC-registered Speech Therapists. They all have a wealth of experience in providing effective holistic therapy and support to children and adults, and are driven by the purpose to positively impact individuals and their families. Meet our dynamic team here!

A: There can be many reasons why a child would need a feeding assessment. If your child has any of the following issues, a feeding assessment might be needed.

• frequent gagging, choking or vomiting during meals
• refusal to try new foods
• picky eater – only eating certain foods
• food range of less than 20 foods
• difficult to feed

The symptoms of stuttering typically appear between the ages of 2.5 to 4 years. It is also possible for stuttering to start during primary school. About 5% of children display stuttering behaviours and stuttering is more commonly observed in males than females. Preschoolers may have little or no awareness of their fluency difficulties, especially so when they first start to display stuttering behaviours. However, most people who stutter become increasingly aware of their fluency difficulties and the responses they receive when they do not speak fluently.

It is important to have regular checkups with developmental and hearing specialists to ensure your child’s development is progressing appropriately. Concerns may be raised by your family doctor, professionals who work with your child, e.g. teachers and support staff, or from your friends and family regarding your child’s ability to; understand/follow instructions, communicate their thoughts/feelings/wants/needs or their ability to interact with their peers (social communication).

As parents you may also seek speech and language therapy for your child if you have concerns that your child is not reaching their language and communication milestones in the way that their siblings, friends and peers do. If you have any concerns, our clinicians will be able to perform an initial assessment to determine whether speech and language therapy may be beneficial for your child.

Children who stutter exhibit poorer educational and social outcomes than their normally fluent peers; it is therefore of importance to commence with therapy to reduce stuttering behaviours. Clinical evidence shows that children who stutter can benefit from treatment provided by speech therapists. Intervention approaches that appear to have the greatest efficacy for reducing the frequency of stuttering behaviours in children include behavioural treatments (e.g. Lidcombe Program).

Amounts and frequency of therapy varies greatly between each child and can last from weeks to many years. It is rarely possible to give an exact time frame for intervention as this changes due to the cause of communication difficulties, the child’s ability to build new skills and the severity of the delay or disorder.

Following the initial assessment, the therapist will plan both long and short term goals for your child. They will also seek you input for these goals. The therapist will then work with the child on achieving these goals which will be reviewed when necessary. This way, both the therapist and family can monitor the child’s development in a meaningful way, ensuring all skills are achieved before moving to the next stage of communication.

Each children develops in his own pace. The following table describes the age by which most children will accomplish various speech-related skills (taken from ASHA website).

If you observe your child’s tongue going past his/her teeth as he says words such as “sea” or “zebra”, he/she might have an interdental lisp. Those two sounds, ‘s’ and ‘z’ respectively, are quite tricky to produce and tend to develop quite late. Therefore, it is ok for children to produce them with the tongue popping out at a young age. However, if this persists past the age of 4½, seeking a speech therapist’s assistance will be necessary to teach a correct production. Be mindful of those ‘s’ sounds produced in a “noisy” way, when you feel that you are hearing saliva bubbles forming, or just too much air coming out, specially from the sides of the mouth. This might be a “lateral lisp”, which is not a typical error in the sound development continuum. A speech therapist’s assessment and assistance will be required, the earlier the better.

At that age, you would expect your child to start playing with other children. If he/she interacts better with you, it might be because you provide a better structure, understand his/her non-verbal communication and easily know what he/she means, while the other children he/she plays with will not. He/she should be able to request from peers “gimme ball” and comment on situations eg “bear fell down”. A speech therapist will assist with the development of language and social skills.

“Augmentative and Alternative Communication” (AAC) encompasses all forms of communication (other than speech) that are used to express an individual’s wants, needs, opinions and ideas. AAC can be divided into 2 main categories – unaided communication systems and aided communication systems. Unaided communication systems include: body language, gestures, sign language (and Key Word Signing). Aided communication systems include: using pictures, writing, communication books or boards, switches, and also speech generating devices (both specialised devices and apps). Use of AAC can help reduce communication breakdown and frustrations. Research currently demonstrates that use of AAC will not keep a child from learning to talk. Children will choose the most effective method to communicate, whether that be speech or AAC or a combination.

Speech and language therapy may begin at any age. In babies, it may be needed to address feeding or swallowing difficulties which can cause difficulties in early development and well being. Communication (understanding and using language) therapy for children whose language is delayed from an early age will typically begin from 18-24 months, though children are often seen at a later stage as difficulties become more apparent. Children with speech difficulties are usually seen from the age of 3 years, though this depends on the nature of the difficulty.

If you have concerns with your child’s speech, language and communication at any point in their development we recommend you have an appointment with one of our clinicians to learn more.

Both Hanen programs are delivered by a Hanen Certified Speech-Language Therapist. They can be delivered in individual therapy sessions or in group sessions. Both programs focus on communication in the everyday environment and using daily routines and activities to support communication.

The “It Takes Two to Talk” Program is designed specifically for parents/caregivers of young children (birth to 5 years of age) who have been identified as having a language delay. Parents/caregivers are supported to interact in ways that support the development of their child’s language and interaction.

The “More Than Words” Program is designed specifically for parents of children ages 5 years and under on the autism spectrum. The program provides parents/caregivers with tools, strategies and support to help their children reach their full communication potential. The program does this by teaching strategies to help improved social communication and back-and-forth interactions, improved play skills and improved imitation skills.

Pragmatics or the rules for social language is another area in which speech and language therapists may work with children. Pragmatics involves using language for specific purposes, such as greeting, informing, demanding, promising, or requesting; changing language according to the needs of the listener or situation, such as talking differently to a peer than to an adult or giving context to an unfamiliar listener; following rules for conversations and storytelling, such as taking turns in conversation, introducing topics, or rephrasing when misunderstood, using appropriate verbal and non verbal gestures , facial expressions and eye-contact.

A child with pragmatic difficulties/disorders may use complex language but still have a communication difficulties such as saying inappropriate or unrelated things during conversations, telling stories in a disorganized way or have little variety in their language use and topics.

The exact cause of stuttering is currently unknown. Recent studies have suggested that genetics plays a role in the development of the disorder and that abnormalities in speech motor control, such as timing and sensory and motor coordination, are implicated.

A: You will be asked to bring certain foods from home to trial in the session with the therapist. After a thorough interview with the therapist, she will observe your child’s feeding and drinking abilities. During the assessment, she might trial some strategies that might improve your child’s feeding skills. Depending on the outcome of the assessment, feeding therapy might be recommended.

PROMPT Therapy

– Prompts for Restructuring Oral Muscular Phonetic Targets
Developed by: Deborah Hayden CCC/SLP

What Is PROMPT therapy?

PROMPT is a language–based treatment approach.

It provides tactile information to the oral musculature (jaw, lips, tongue) in an attempt to guide a child’s movements for speech production.

Sensory feedback from the movements is then stored and progresses as the child is provided multiple opportunities for practice. Muscle memory builds (this takes at least 6-8 weeks), and movement patterns for speech become more and more automatic.

There is a PROMPT for every sound in the language, vowel or consonant.

Why does it work?

Practice and feedback are integrated.

In PROMPT therapy, a child receives tactile cues as well as auditory feedback (two extremely important sensory systems required in learning to talk).

- Motivation is the key! It is very important to encourage a child so that they can maintain attention and effort required to make changes in speech production.
- Target sounds, words and phrases are practiced in a variety of interactions, both in therapy sessions and in the child’s natural environment.

How does it work?

First a motor assessment is carried out by our PROMPT trained therapist (Clare Hegarty at Dynamics Speech).

Target sounds are then selected to be developed and a lexicon (group of words containing these sounds) is then devised and used as the base line for therapy.

Practice Makes Perfect!

There are two types of practice:

Drill Practice - Sounds, syllables and words are practiced with high levels of repetition at the beginning of therapy sessions to stimulate a motor warm up
Distributed Practice – Retrieval of the sounds, syllables and words in a functional context (home and school etc)

Stuttering is a fluency disorder. It is also known as ‘stammering’ in some parts of the world. Stuttering is characterized by disruptions in the production of speech sound, which may be in the form of repetitions, prolongations or blocks. One or any combination of these behaviours may be observed consistently or variably. The frequency, duration, type, and severity of disfluencies vary greatly from child to child and from situation to situation.

There is no single right way to raise a bilingual child. Sometimes parents are advised to separate the two languages when talking to their children. For example, when parents talk with their children, one parent speaks one language and the other speaks in another. Although children can learn more than one language in this way, this is not the only option. It is also recommended that when speaking to a child that the parent/carer does not “code switch”. This means that you complete your conversation/sentence in one language and do not change mid conversation. This allows the child to build up a mental dictionary of words specific to the language but also to learn the grammar and sentence structures for this language. What really helps is to surround your child with a rich and valuable language.

In general, children who grow up in the U.S. learn English quickly because they have been exposed. However, learning the language of the home can be more difficult. It is important to offer children frequent opportunities to use their native language in meaningful and enjoyable ways.

Quite often parents and teachers will report concerns about a “speech delay”. However, during assessment it may become clear that the child has a language delay. Are they not the same thing? No. Speech and language are very different.

Language is made up of socially shared rules that include the following:

• What words mean (e.g., “star” can refer to a bright object in the night sky or a celebrity)
• How to make new words (e.g., friend, friendly, unfriendly)
• How to put words together (e.g., “Peg walked to the new store” rather than “Peg walk store new”)
• What word combinations are best in what situations (“Would you mind moving your foot?” could quickly change to “Get off my foot, please!” if the first request did not produce results)

Speech consists of the following:

– Articulation
How speech sounds are made (e.g., children must learn how to produce the “r” sound in order to say “rabbit” instead of “wabbit”).

– Voice
Use of the vocal folds and breathing to produce sound (e.g., the voice can be abused from overuse or misuse and can lead to hoarseness or loss of voice).

– Fluency
The rhythm of speech (e.g., hesitations or stuttering can affect fluency).

In general, children who grow up in the U.S. learn English quickly because they have been exposed. However, learning the language of the home can be more difficult. It is important to offer children frequent opportunities to use their native language in meaningful and enjoyable ways.

Before you attend your first appointment/assessment, have a think about your child’s developmental history and complete the Child History Questionnaire (CHQ). Some of the questions you will be asked in the assessment would be:

• When did your child first babble/use first words/string 2 words together?
• Has your child received any diagnosis?
• Is there a history of speech and language difficulties in the family?
• Have they attended speech and language therapy before?

If your child has attended an assessment or therapy elsewhere (another speech and language therapist, occupational therapist, psychologist, etc), it would be useful for you to bring reports or share the information from such sessions with your speech and language therapist also.

Speech is the ability to use your lips, tongue and other parts of your mouth to produce sounds. To produce clear speech children need to be able to produce the different sounds of speech, as well as understand the rules for putting those sounds together in their language.

Most children have mastered the following sounds by the following ages:

• around 3 years: b, p, m, n, h, d, k, g, ng (sing), t, w, f, y
• around 4-5 years: f, sh, zh, ch, j, s
• around 6 years: l, r, v
• around 7-8 years: th, z

Most children make mistakes in their speech during the first few years of speech development. But by about three years, most children can be understood by their main caregivers.

If you’re worried that your child might have a speech disorder, think about how often people who don’t know your child have trouble understanding your child.

• around 2 years about 50% of your child’s speech should be understood by a stranger
• around 3 years about 75% of your child’s speech should be understood by a stranger
• around 4 years about 100% of your child’s speech should be understood by a stranger

It’s best to consider seeking help if your child:

• is six months or more behind the approximate age ranges for using speech sounds
• uses speech patterns that are delayed for his/her age, or speech sounds that are immature compared with peers
• gets frustrated about speaking – for example, he/she gets upset when he/she isn’t understood and has to repeat himself/ herself frequently.

No. There are some common myths about multilingual development. It is been said to many parents that multilingualism will cause children to develop language at a slower pace. But there is no scientific evidence to support that belief. Many children around the world learn more than one language at the same time and don’t show language delays.

A social conversation requires many areas, all of which we are supporting your child in developing. These areas are not limiting but include, vocabulary, concepts, memory, organizing, sequencing skills, to support your child in being able to have a conversation.