Speech, language and communication difficulties in children with brain tumours

Information for schools

Following treatment for a brain tumour a child may experience a wide range of speech, language and communication difficulties. The nature of these difficulties will depend on the location and type of tumour, along with their particular treatment. Communication difficulties may also be influenced by the age of the child at diagnosis and the length of their hospital stay. It is also well recognised that children who have cranial radiotherapy will experience cognitive changes affecting their future learning and communication, with deficits often being slow to emerge and manifesting progressively over time.

Communication is an active, interactive process involving many aspects of thinking and social skills. Following a brain tumour, difficulties in any of these skills may affect a child’s ability to communicate successfully. Difficulties for some children may be obvious whilst for others their difficulties will be more subtle. In these cases children may present with clear and appropriate speech and language in everyday conversation but their difficulties only become more apparent as their thinking and learning demands increase.

Whatever a child’s specific needs, it is recognised that children with weakness in their communication skills are at increased risk of developing social and emotional problems. Children with brain tumours may also have additional challenges making it even harder for them to participate in school activities and reach their full potential. It is therefore important to identify any communication difficulties so appropriate help and strategies can be introduced to support a child’s future learning and prevent secondary problems such as frustration, low morale and social isolation.

What difficulties might you see?

Changes in speech:

• Slurred speech
• Articulation difficulties
• Slow or hesitant speech
• Altered volume
• Poor voice quality
• Poor pitch or intonation control

Changes in language

• Difficulty following verbal instructions.
• Difficulty understanding more abstract language such as metaphors, humour and sarcasm.
• Trouble finding the right word; uses lots of ‘ums’ searching for words, lots of fillers eg ‘you know’, ‘it’s the’ and non-specific words eg ‘thing’, ‘that’, ‘stuff’.
• Problems explaining or expressing more complex thoughts and ideas in words, whether spoken or written.
• Difficulty gaining information from lessons or reading for meaning, particularly with longer texts.

Changes in social communication

• Difficulty holding a conversation.
• Difficulty taking turns and understanding verbal and non-verbal cues such as facial expressions or gestures.

Behavioural problems

• Poor self-esteem.
• Problems making and maintaining friendships.
• Reduced motivation or a cumulative sense of failure.
• Anger, frustration, aggression.

It is important to highlight the likely communication difficulties which may reflect possible cognitive changes:

Attention and concentration

• Difficulty concentrating on conversations or miss important information which may lead to responding inappropriately.
• Difficulty dividing their attention between more than one activity so ignoring what someone is saying when carrying out another activity at the same time.

Memory problems

• Finding it hard to access information that they ‘know’ which may affect skills such as word retrieval or information relevant to a conversation.

Literal interpretation

• A child may interpret verbal information very literally e.g. “I’ll just be a minute” – they may become upset if you take longer than a minute.
• Missing subtle nuances of conversation, struggling to grasp humour or sarcasm.

Slowed processing of information

• Struggling to keep up with a rapidly flowing conversation, particularly in a busy environment or when more than one person is talking.
• Needing more time to respond in conversation.

Reduced verbal reasoning and problem solving

• A child may struggle to use language to think through and explain their reasoning.
• Problems understanding the logic of someone’s point of view, being inflexible in their own opinions.
• Reduced attention and concentration and they will be less able to think clearly.

Cognitive Fatigue

• This can influence other communication impairments e.g speech may become more unclear or slurred, a child may have greater difficulty finding the right words.

Poor social communication skills including

• Altered turn-taking skills, either being overly talkative and ‘hogging’ the conversation or not realising it is their turn to speak.
• Reduced ability to talk around a shared topic e.g flitting from topic to topic or having a reduced range of topics.
• Perseverating or ‘getting stuck’ on a favoured topic.
• Difficulty giving information in an orderly and organised way e.g assuming that the other person shares knowledge about the topic when they don’t.
• Struggling to understand non-verbal cues accurately, such as facial expression and body language.

Reduced insight

• A child may lack or have limited insight into their difficulties and may think they are acting ‘normally’ which can make it hard interacting with them.
• This may make changing problematic behaviours very difficult as a child may not recognise that there is a problem.

General strategies to help in the classroom:

• Speak clearly and at a steady pace.
• Make sure instructions are broken down into short and simple commands. Consider offering additional visual support where necessary such as clear, written instructions.
• Use direct rather than indirect instructions eg ‘stop talking’ rather than ‘I didn’t hear Harry because some people were talking’.
• If understanding is a particular difficulty, encourage sensitive ways for the child to indicate they have not understood.
• If a child is becoming frustrated by their difficulty in communicating, gently suggest that they slow down or try again.
• Give a child more time to think and plan what they need to say.
• Frequent praise is helpful. Encourage and reward a child if they seek help and clarification.
• When word finding is a difficulty, encourage the child to talk round the word which might help trigger its retrieval.
• Don’t pretend to understand what a child has said if you have not. Give positive feedback on what you have heard so far, gently prompting for them to fill in the gaps.

Strategies to support social communication difficulties

Remember that these children may be at risk of social isolation and bullying.

• Consider a buddy system.
• Be clear about what is expected in a given situation.
• Provide social communication skills support either individually or in groups.
• Respond promptly to intervene in situations if the child is becoming agitated or upset.
• Be more watchful on interactions in the playground.
• Try and explicitly comment on the language used and how it works and the effects that communicating in certain ways has on other people. Avoid referring to ‘right’ and ‘wrong’ ways of communicating.

Further assessment

Following treatment for a brain tumour, a child may benefit from more detailed assessment by a speech and language therapist and clinical psychologist to look at their language, communication and thinking skills. Identifying any potential difficulties will allow the appropriate support to be introduced to ensure each child has the opportunity to reach their full potential. Assessment and support by an occupational therapist or physiotherapist may also help give additional guidance to support a child’s participation and independence at school and at home.

Further questions?

If you would like any further help or advice, please contact the Brainbow service on 01223 596163.

The Brainbow service offers multidisciplinary assessment and support to children who have had brain tumours in the East of England.