Established care
Speech, language and communication
Speech and language therapy, AAC, communication aids
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Either a medicines regulator has licensed it for this use, or clinical practice guidelines recommend it on the strength of controlled trials. This is the standard everything else on the scale is measured against — and for most children, the treatments at this level are the ones that will actually change their day.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Augmentative and alternative communication (AAC) | Established care | Well supported. Evidence indicates AAC does not inhibit speech development and is often associated with gains in speech. |
| Speech and language therapy in cerebral palsy | Established care | Standard care, including for eating and drinking safety. |
| Language intervention in autism | Established care | Naturalistic developmental behavioural approaches have the strongest support. |
| Oral-motor exercises to improve speech | Early research only | Non-speech oral exercises have not been shown to improve speech sound production. |
What it is
This covers understanding, expression, speech clarity, and — critically — alternative routes to communication: signs, picture systems, and speech-generating devices from simple switches to eye-gaze computers.
It also covers eating and drinking safety, which in children with significant motor disability is often the more urgent half of the referral.
AAC is not a last resort used when speech has failed. It is introduced alongside speech work, early, as a way of giving the child a voice now.
How it is meant to work
A child without a reliable way to communicate has no way to object, choose, ask or joke. That shows up as behaviour, withdrawal and underestimated intelligence — and all three improve when communication is restored.
Giving a means of expression also drives language development, because the child can finally participate in the exchanges that teach it.
What has actually been tested
- The most useful finding for families to know: the common fear that AAC will prevent a child from learning to speak is not supported. Reviews of AAC intervention report no evidence of inhibited speech, and frequently the opposite.
- Naturalistic, developmentally based approaches that build on the child's own initiations have the best support in autism.
- Dysphagia management reduces aspiration risk and is one of the few interventions here with a direct effect on health rather than function alone.
- By contrast, non-speech oral-motor exercises — blowing, tongue drills — have not been shown to improve speech sounds, despite being widely delivered.
What we still do not know
- Which AAC system suits which child, and how early is too early — current practice is pragmatic rather than evidence-settled.
- Optimal intensity of language intervention.
Risks and costs
- A device issued without training for the family and the school is money wasted, and this is extremely common.
- Delaying AAC while “waiting for speech” costs the child years of communication.
- In eating and drinking, the risk is the opposite of overtreatment: unrecognised aspiration.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- If my child is not communicating reliably, what are we putting in place now, in parallel with speech work?
- Who trains us and the school to use it?
- Is eating and drinking safety being assessed?
More in this section
Early detection and early intervention
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Established careGoal-directed, task-specific training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Established careEarly behavioural and developmental intervention
Early structured support for an autistic child is recommended care. Which kind, how many hours, and towards what goal are all still genuinely argued over — and the arguing is the useful part.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established carePhysiotherapy and strength training
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Established careOccupational therapy
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsTechnology-assisted rehabilitation
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.