Speech, language and communication development

Research has shown that infants begin to develop communication skills very early in the pre-natal stage.

Many vital skills need to be acquired and practiced before the infant is born:

  • touch
  • movement
  • hearing and listening
  • memory
  • the ability to practice 'silent crying'
  • sucking

These skills directly contribute to the development of speech, language and communication.

Parents can interact and communicate with their unborn child in many ways, and enhance their experiences in the womb.

Communication Support Needs (CSN) and inequalities in pregnancy

A child's speech and language development depends on its development in the womb and the health of the mother, but parental communication support needs can present serious barriers to accessing services.

Reducing health inequalities requires service providers to make their services 'communication accessible' to parents with communication support needs.

Quick links:

What are health inequalities?

The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups." For a discussion of health inequalities and their relation to pregnancy, please see Inequalities in antenatal care.

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Policy context

Activity in this area is consistent with commitments and priorities detailed in The Early Years Framework (external link), Equally Well, Achieving our Potential (external link) a range of NHS Scotland's Quality Indicators and is relevant to Scotland's national practice model for child-centred services: Getting it Right for Every Child (external link).

Under the terms of the Disability Discrimination Act, public sector service providers must discharge their Disability Equality Duty to promote equality of opportunity for people with disabilities, including those with communication support needs or communication disabilities.

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What are Communication Support Needs (CSN)?

People with CSN can have difficulty with one or more of the following:

  • understanding verbal or non-verbal, or written communication
  • expressing themselves
  • expressing all they want to get over in a meaningful, appropriate or socially acceptable way
  • interacting with others in socially accepted ways

Their CSN may be due to many factors such as a physical problem, sensory impairment, learning disability or difficulty, mental illness or low educational attainment. Other factors contributing to CSN may include the individual's personal circumstances and history, such as having been a looked-after child, poor parenting, drug or alcohol misuse or poor health.

How do inequalities relate to CSN in pregnancy?

A 2007 review of literature (external link) concluded that people with CSN are more likely than the general population to:

  • be unemployed or employed at an inappropriately low level
  • have difficulties interacting with or understanding information needed to access services
  • live in socially deprived areas

Approximately 50% of children and young people in some socio-economically disadvantaged populations have speech and language skills that are significantly lower than those of other children of the same age, compared with 7% of all children. (The Bercow Report) (external link).

Women from these same vulnerable groups are less likely to access antenatal services and other sources of support before and during pregnancy - a high risk factor for maternal and infant mortality (Growing Up in Scotland 2011) (external link).

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Identifying those at risk

Because those at risk can be difficult to identify, it's important to link with other professionals who may know more about the family and their circumstances and communication needs, e.g. Speech and Language Therapists, carers, Health Visitors, GPs, social workers, teachers and other education professionals, and voluntary sector agencies.

A range of risk factors should be considered, including socioeconomic circumstances, literacy and education levels, substance misuse, mental illness and relationship issues. For a fuller discussion of inequalities risk factors, see Inequalities in antenatal care.

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.

CSN indicators

People with CSN often do not or cannot describe their communication support needs to service providers. They may be unable to comprehend invitations to attend or details of where and when services are available and so may not engage with services at all.

People with CSN may present in the following ways:

  1. fail to access, avoid or withdraw from services
  2. fail to respond or 'comply' to all or parts of advice
  3. appear bored, disinterested or have difficulty maintaining attention
  4. irrelevant, nonsensical, vague or rambling responses to questions
  5. difficulty describing past or future events, negotiating or planning using verbal language only
  6. difficulty with 'why' and 'when' questions
  7. challenging behaviour e.g. will only see certain staff, appear inflexible, unpredictable or unreliable
  8. express strong emotions - anger, frustration, embarrassment or anxiety - which appear to be inappropriate to circumstance
  9. unclear speech
  10. attended 'special education provision', been excluded from school or left prematurely

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Articles in this topic



  • External Resource

    Growing Up in Scotland Study

    The Growing Up in Scotland project (GUS) gives statistics and data on the developmental phases in children's lives - early years and the transition into adolescence.

    • When was this published? 2/7/2011
  • External Resource

    The Bercow Report

    This report looks at communication support needs among children in various socioeconomic groups.

    • When was this published? 1/9/2012

Professional support materials

Information for the public

  • External Resource

    Before words [266KB]

    A cartoon-based resource with the key messages for parents to support speech and language development before words. 0-12 months. Developed by Gretel McEwan, Lynn Jones & Foundrymedia

    • When was this published? 11/23/2010