Communication difficulties are common in children and young people following a stroke. They might be obvious right away, or they may emerge over time. It can be hard to see your child experiencing difficulties in this area, but for many children communication develops and improves over time. There are things you, and the professionals working with your child, can do to help.
How can stroke affect communication skills?
Stroke can cause problems with communication in two ways:
Stroke can damage the areas of the brain that control language processing, as well as the muscle coordination needed for speech. It can also affect memory, concentration and other aspects of communication. Social communication may also be affected.
Having problems with speech and using language might have a major impact on a child's confidence and self-esteem. They may feel ashamed, scared and lonely. They may also feel frustrated and angry, anxious or low. This could be due to the communication problems, but emotional changes can also make it harder to communicate. See our page on emotions and behaviour.
It can be an awful time with communication barriers and not hearing your own voice or not being able to maintain a simple conversation or even a simple word... It can be extremely lonely at times.Young stroke survivor
Types of communication difficulties
Aphasia is a language processing problem which can affect all aspects of language including:
Speaking and understanding speech.
Reading and writing.
All of these problems can have a major impact on a child at home and school. Aphasia can be receptive (difficulties understanding language) or expressive (difficulty using language to express yourself). Problems can be mild or more severe.
Dysarthria causes slurred speech due to weakness in the muscles of the throat or mouth.
Dyspraxia of speech
Dyspraxia of speech is when the brain cannot fully coordinate the muscles in the throat and mouth. A child might mispronounce words, speak slowly or have trouble making sounds. Because it affects the ability to plan muscle movements, a child may not be able to speak when they want to, but they might be able to say something which does not demand conscious thought, such as 'goodbye'.
Do not speak for them - let them speak, at their pace.Parent
What to look out for
A child or young person may have one or more types of communication problem. It can be tricky to spot difficulties in children, especially if their language skills are still developing.
If you are worried about your child's communication, speak to the special needs coordinator at their school or childcare setting or ask your GP to refer them to a speech and language therapist.
Some signs of communication problems include:
Not using much speech.
Using the same words repetitively such as 'yes' to every question.
Being unable to name some people or items, instead using words like 'thing' or 'that'.
Slurred speech, saliva escaping, difficulty swallowing.
Use of language that is not characteristic for them such as swearing.
Emotional signs like frustration, withdrawal and moodiness.
Not concentrating when someone is speaking to them.
What could communication difficulties mean for my child?
Communication is at the core of all our relationships and learning, so difficulties in this area can change things in many ways.
Friendships: it may become harder to join in with games or get to know new people.
Home: it may change family life in multiple ways as you all learn to adapt, depending on how your child is affected. Therapists may help you learn to use other ways to support family communication such as visual aids, signing, pictures or symbols.
School: children may have difficulties understanding lessons, reading and writing, using numbers or joining in with group discussions. The school should support your child, such as making adjustments to your child's need to write.
Help and support
The main treatment for communication problems is speech and language therapy. A therapist can help the child or young person to improve their communication and confidence.
Communication often improves quickly in the first days and weeks after a stroke, but recovery can continue for years after a stroke.
A speech and language therapist can help you communicate with your child, and give you resources like augmentative and alternative communication (AAC) such as symbols, charts, photographs and electronic aids which can be very helpful. Other things to try might include sign language, singing and drawing.
A child might need an educational psychologist assessment, or support with emotional problems such as counselling.
Read more about finding support.
Reading, writing and using numbers
At primary school, your child might need more help with phonics and numeracy. Later on, a young person might be given extra time in exams, or a laptop to use in class. They may be able to have a scribe to write for them. The school Special Educational Needs Coordinator (SENCO) should request support from professionals to assess your child if they have problems.
It can sometimes be complicated trying to get help and support for your child, but you can read our basic guidance about finding support.
It takes time and patience, but the more practice for me the better I got.Young stroke survivor
Social communication problems
As well as verbal communication, stroke may affect social communication, such as the ability to read social cues or understand body language. Some signs to look out for include:
Difficulty using appropriate body language such as eye contact.
Using inappropriate language or making unfiltered comments.
Not using an appropriate tone of voice or speaking too loudly or quietly.
Not respecting another person's physical space by standing too close.
Not picking up when their conversation is not of interest to others.
Speak to your child's teacher or school Special Educational Needs Coordinator (SENCO). Your child may need some help from a speech and language therapist or an educational psychologist.
Supporting friendships with communication problems
A stroke can affect relationships. Here are some practical things to try with your child, depending on their age and abilities:
Help your child to find friends who make them feel good about themselves.
Prepare them for social situations by talking through plans and practising conversation openers. For younger children this might be 'Can I play?' or for older children 'What have you been up to?'
If a child is coming for a playdate, you may need to set up some activities for them and keep the interaction between them going. If your child goes to another child's house, explain to the parent what kind of support your child will need.
If your child is struggling with relationships, try to set up social opportunities through clubs or family friends. It can be anywhere your child will feel welcome and accepted for who they are. Parallel play (doing things side by side) can be easier than direct interaction. Depending on their interests, you could try craft activities, puzzles, watching a movie or gaming.
For an older child or young person, you could discuss ideas together, and talk through any worries they may have about trying something new.
A buddy system in school may help. A mature member of the class or even an older child can spend time with them in the playground, read or play a board game with them.
Everyone needs friends especially when life is changed traumatically, but after acquired brain injury, it can be very hard to maintain friendships as before or make new friendships.Young stroke survivor
Say their name to get their attention.
Use short sentences.
Give them plenty of time to respond.
Keep it simple, and avoid giving several pieces of information or instructions in one go.
Use gesture, facial expression and visual cues to help, such as holding up a cup to explain the steps in making a drink.
Ask them to repeat the instruction. For example: 'It's bath time. What's it time for? [Bath] That's right! Let's go!'
Use visual aids, such as cards showing words or pictures, symbols or words.
Listen to what your child is trying to say, not how they are saying it.
Let your child lead the conversation.
Find what works for your child. If their processing speed is affected, they will need instructions to be repeated or given in a different way.Parent