Case studies: Early Years

Jayden is male and was aged 2 years 7 months (31 months) at the time of screening.

Jayden’s key worker carried out the WellComm screen with his mum once he had settled into nursery. It was noted that Jayden was able to follow simple instructions within the nursery (e.g. ‘Go and get your coat and your water bottle’) without any non-verbal prompting and was starting to interact well with his peers. Jayden was able to use two-word phrases to communicate with others most of the time (e.g. ‘Want ball’).

There was no evidence of general developmental delay. Jayden’s motor skills were developing well and he demonstrated that he was able to kick a large ball, run confidently and climb easy nursery apparatus. There were also no concerns regarding his fine motor skills (e.g. pencil control). His attention and listening skills appeared to be age appropriate and Jayden was able to focus on an activity of his own choosing for at least a few minutes and was happy to change the activity with prompting from an adult.

Jayden was screened on the age-appropriate section of the WellComm (Section 5), scoring 6/10. Using the score guide located on the Score Sheet, Jayden’s key worker recorded an Amber code. This indicated that Jayden presented with a mild language delay.

In order to find where Jayden would achieve a Green code, he was then screened using the section below. Jayden achieved a Green code on this section. The purpose of this was to guide the key worker to the appropriate advice and activities to help support and develop Jayden’s language skills. As Jayden achieved a Green code on Section 4 of the Screening Tool, staff then followed the advice and activities in Section 5 of The Big Book of Ideas. The WellComm screening results for Jayden, aged 31 months, are shown below:

Jayden’s WellComm scores were further discussed with his parents and their comments endorsed the findings. Nursery and home were then able to work collaboratively to support Jayden’s language development through using the activities in Section 5 in The Big Book of Ideas.

Expressive language activities were the focus of intervention as Jayden had achieved 4/5 correct for ‘What the child understands’, but only 2/5 on ‘What the child uses’. The following sections of The Big Book of Ideas were focused on within individual and small group sessions. As the screen highlighted that Jayden struggled to understand and use ‘where’ questions (items 5 and 8 in Section 5), this was therefore a focus using the signposted activities in The Big Book of Ideas. He also had difficulties using more than two words together and using the preposition ‘under’. This also signposted Jayden’s key worker to follow specific activities encouraging the development of these language skills.

Other early years practitioners in the setting also used some of the ‘general strategies’ found in Section 5 of The Big Book of Ideas to help promote Jayden’s expressive language skills. For example, when Jayden used two words in a sentence, staff repeated back the words he used and added another word as a model (e.g. Jayden: ‘Mummy home’ ; adult: ‘Mummy’s gone home’).

Jayden was re-screened on the WellComm Screening Tool after three months of intervention in nursery. He scored 8/10 on Section 5 which was a Green score on his age-appropriate section.

Early years practitioners and Jayden’s parents reported that The Big Book of Ideas activities were easy to follow and to carry out within the setting and at home. This gave them the confidence to support Jayden’s needs without involving any outside agencies. The WellComm Toolkit enabled staff to identify Jayden as having a mild language delay, provide a targeted intervention plan using The Big Book of Ideas, and monitor subsequent change.

Tamika is female, aged 4 years, 5 months (53 months) at the time of screening.

Tamika had moved to the Reception Year of her local primary school and, after a short initial settling in period, was routinely screened using the WellComm Toolkit. Tamika was a happy and contented member of the class and did not exhibit any particular behaviours that could give cause for concern.

She joined in all the class activities and was described as ‘a quiet, thoughtful child’. Her ‘Transfer to Reception Classes – Year R’ form which had accompanied her from nursery showed an even profile across all six areas of development within the Foundation Stage, with no concerns raised.

Tamika was screened using Section 8 of the WellComm Screening Tool, scoring four out of ten, which gave her a score in the Red band. The class teacher was initially surprised at these findings, but continued with the screening to achieve a Green score, and eventually placed Tamika within Section 5.

Discussion with Tamika’s parents, combined with closer observation, indeed revealed that she had a number of strategies for appearing that she had understood something which in fact she had not. She was able to use her visual skills to great effect and would look to see where an adult or another child was inadvertently looking before joining in. Thus she was adept at masking her comprehension difficulties.

Looking at the errors Tamika made revealed an uneven profile between comprehension (what the child understands) and expression (what the child uses). This analysis led to the class teacher being able to set targets for her from Section 6 and from Section 7. Tamika’s errors fell primarily within the area of understanding and using language to reason and solve problems.

As Tamika was learning through watching her peers closely and she was able to cope with group work, she was placed within a WellComm group that would specifically target linguistic concepts, thus building her comprehension skills through carefully structured activities where she had the benefit of peer modelling. The group was run three times a week and had five children in it. They were all at a similar level as measured by the WellComm Screening Tool. This enabled focused teaching of the concepts selected. Tamika benefited from watching the other children and from the repeated practice opportunities afforded.

To begin with, the group focused on the concrete concepts relating to position and size (e.g. ‘in front’/‘behind’ and ‘long’/‘not long’/‘short’). The use of gestures/Makaton signs also helped build Tamika’s understanding. Each group lasted for approximately 15–20 minutes and was run by the class teacher three times a week.

Additional activities were selected from The Big Book of Ideas and the class teacher demonstrated how to carry out these activities to her parents so that they could support Tamika at home. This practical focus provided the foundations for a strong partnership so that Tamika received both focused teaching in the group and more naturalistic intervention at home.

Given the Red score and the uneven profile, Tamika was referred for speech and language therapy assessment. Further assessment showed that she had a specific language disorder and that the WellComm Screening Tool and profile had facilitated her getting specialist input as soon as possible. Identification and intervention as early as possible were critical to a successful outcome for Tamika, who subsequently made steady progress with group-based teaching.