Friday, 20 October 2017

My child talks well, why does he need a speech and language therapist?

(Guest blogpost)

It’s not about the talking, it’s about the social interaction.

My son is 10, he has the vocabulary and speech an adult would be happy with but (and I can hear you waiting for it), but he struggles to communicate.

Hmmmm, that’s almost like a double negative, he can talk but he can’t communicate, what the heck does she mean?

My son struggles with social skills, he can’t tell people how he feels, he misses social cues, he wants to play with other children, but can't find the way in, he can’t communicate.

He wants to join in the games but can’t ask to be let in, so he gets too excited and ruins the game not maliciously but because he struggles to read the group, he can’t interact.

Worse still my strapping 10-year-old is a prime target for bullies. He lacks the social skills to stand up for himself, he has no idea how to be assertive, how to say no, or even how to go to another person and tell them how he feels or that he is hurt or scared.

Despite having a beautiful grasp of the spoken word and sounds totally confident, he has no knowledge of the art of communication.  The subtle nuances of facial expressions and voice inflections.

This is a social world, full of people, of all different kinds, some friendly, some not, and what my son needs to cope, no thrive in this world, is speech therapy, because what my son needs to learn is, ironically enough is small talk….the art of getting on with people.

A K Turner parent  

Tuesday, 17 October 2017

You’re not listening’ were the words that seemed to be repeated over and over as my daughter sat, patiently, not quite understanding what was required of her from the specialist audiology department at Great Ormond Street Hospital.

Guest blog by Shelley Ensor:

If I had heard it once, I had heard it a thousand times.  My daughter WAS listening. Listening harder and more intently than anyone else in the quiet testing room. Looking back, I should have intervened.  My daughter had, after all, been referred for testing for Auditory Processing Disorder and the Audiologist was a specialist for the APD clinic. 

It got worse.  My daughter was diagnosed with APD at the 0.4 centile.  This is classed as hearing deaf.  But ‘don’t worry’ said her consultant, cheerily, ‘she is a pretty girl, it’ll be fine’.  The implication being that as my daughter was fair of face, it didn’t matter that she was disabled.  It added insult to injury.

And that was the end of the five year journey that had culminated in the visit to GOSH - but the beginning of a new life.  

The previous five years had been one long fight trying to get my daughter the services she required - from the paediatrician blinkered only to his specialism of ASD to the arduous justification to the GP that a referral to GOSH was needed – and why.  I’d like to say that our story is unusual, but I fear it is all too common.  The cross overs between Aspergers traits in girls and APD is high.  No one believed me but I knew, I just knew, that Aspergers was not what the issue was.

Post diagnosis nothing much changed.  We had been left high and dry; no specialist support and an NHS SLT who didn’t have the time to research my daughter’s condition and was trying to discharge her from services. 

I researched and researched and researched some more. 

I grieved.  I still grieve.

And I hurt.  I hurt for my clever, kind, thoughtful and compassionate girl who was – and is – treated as though she is stupid because she doesn’t quite catch a word or needs to have things repeated, with no redundant language, over and over again.

There are days when you would think that there is little wrong.  These are days that are quiet, where she feels safe, when she is rested.  She can hold a conversation then and is her beautiful, delightful, innocent, highly intelligent self.

But the days where it is all too much mean that she can barely understand one short task at a time. When she is tired and overwhelmed even the sound of the wind in the trees is too much and totally unbearable.  She finds life impossible and this is characterised by angry outbursts now - but when she was younger she would self harm in utter frustration.

There are things that she may never do. Right now she is unable to sequence, making everyday tasks so hard, let alone the complex curriculum requirements for subjects like Maths.  She cannot access a foreign language and at 11, is only just beginning to like music.  She finds peer relationships and social situations very hard indeed.  She becomes so tired, working at 200% just to be able to roughly follow a conversation with a group of people.  She is not safe crossing a road. She wouldn’t be able to follow directions if lost. People become impatient, talk over her, won’t let her finish her sentence. She sometimes stutters as a result, never quite sure if she is welcome to join in. Childhood games change rules quickly – she is left playing one game whilst the others involved have moved on to another with a different set of rules.  No one has explained this; she stands alone, unsure, desperate to belong.

These are painful parenting observations, no one ever wants to feel that their child is being excluded.
And then there is the telephone.  There are no private telephone conversations in our house.  My daughter’s relationship with her grandparents, whom she loves dearly, is held over speaker phone with either myself of my partner repeating the conversation so that she can respond.  In the end she simply gives up, with a shrug and a shake of her head.  Fortunately Skype and Facetime make these conversations possible as she can see their faces, read their lip patterns at the same time as processing what she is hearing.  It’s not perfect, but its better.

The fatigue that children who are deaf suffer is well documented; children with APD suffer this fatigue too and in addition there is the constant, unrelenting need within the family dynamic to constantly repeat conversations, ensure safety and to keep a watchful eye on how other people behave towards her. 

It is exhausting.

 What hurts the most is that my daughter has no idea when people are being unkind and can’t process it quickly enough to respond. She is yet to learn to advocate for herself - and her condition is difficult enough for an adult to explain.  As my daughter approaches her teens and young adulthood, I confess I have deep fears for my girl, who is highly vulnerable.

There is no cure for APD although the condition can be supported.  Strategies that we have found useful are:

1.       Signing – we use British Sign Language in English word order, which is known as Sign Supported English.  (I little knew when I started my baby signing organisation some years ago as to how much a part of my life it would become and I feel very fortunate to know that my daughter has always had this support since babyhood)  Using signing relieves a lot of distress and stress for her and for me.
 I was shot down in an APD group for suggesting the use of signing to support children with APD as ‘they need to learn to get on in the real world’.  Well I firmly believe that the real world needs to make communication as accessible as possible for everyone and with BSL now being pushed for inclusion in the National Curriculum I have high hopes that it will benefit so many children and young people, not just those who are deaf.

2.       Short, clear instructions or tasks or conversations.  Never any more than two points that need to be remembered. 

3.       Visual cues and reminders

4.       Talking through our day, slowly.  What is happening, now and next.

5.       Creating downtime and quite spaces in our day for processing and recovery.

6.       Expert support and strategies for helping our daughter to be the best she can be, such as the gentle, practical and patient support of Libby at Small Talk.

7.       Taking things slowly

8.       Advocating for our daughter and helping her learn to advocate for herself.

   Shelley Ensor

Shelley Ensor is the founder of Little Signers Club (  When she is not sharing her love of signing, and how it benefits children of all ages, she can most often be found with a cup of hot chocolate around a campfire.  She journeys through parenthood accompanied by three small people of 11, 10 and 5, the eldest of whom was diagnosed with Auditory Processing Disorder at 0.4 centile via Great Ormond Street Hospital in 2015.

Sunday, 15 October 2017

'Auditory processing disorder': a real condition or another middle class excuse for a child who isn't achieving?

What is Auditory Processing Disorder?

 I overheard an older teacher on the train last week say that they were 'fed up these days of hearing about these modern excuses for little Hector or Hermione' not being able to do their work well or achieve better in lessons. He suggested that the parents should spend more time on helping with their homework than researching these possible causes! He wasn't talking to me, he was talking to a younger man who was nodding knowingly but I couldn't just sit there. After I had gulped and reminded myself to be polite, I leaned forwards and managed to say, 'Really, I'm so surprised you say that as most teachers these days look for the reasons behind a child's difficulties so they can help'. 

I am a parent of two children with dyslexia and Auditory Processing Disorder, that's not an excuse but it is the reason they find school difficult and have to try harder.

      “APD is a deļ¬cit in neural processing that is not due to higher order language, cognitive or related factors” (ASHA 2005)
      However, APD may lead to difficulties with higher level language processing, learning and communicating
      “APD is characterised by poor perception of sounds, has its origins in impaired neural function, and impacts on everyday life
      primarily through a reduced ability to listen, and respond appropriately to sounds.”

What are the symptoms?
It can affect a child's ability to:

  • understand speech – particularly if there's background noise, more than one person speaking, the person is speaking quickly, or the sound quality is poor
  • distinguish similar sounds from one another – such as "shoulder versus soldier" or "cold versus called"
  • concentrate when there's background noise – this can lead to difficulty understanding and remembering instructions, as well as difficulty speaking clearly and problems with reading and spelling
  • enjoy music -Many people with APD find it becomes less of an issue over time as they develop the skills to deal with it.Although children may need extra help and support at school, they can be as successful as their classmates.
What can we do about it?

         Environmental Modifications:
Preferential seating in the classroom, as close as possible to the teacher, will make facial expressions clearly visible, and maximise the ratio of direct sound to reverberant sound. The seating position should also be away from noisy equipment, such as overhead fans, to maximise the signal-to-noise ratio.

         Teacher-Directed Strategies
A number of strategies may be implemented by the child’s schoolteacher to assist children with listening difficulties to extract as much information from the auditory signal as possible. These strategies include:
1.       speaking in short, simple sentences
2.      repeating a message if not comprehended
3.      slowing the speed of delivery 
4.      providing visual cues and hands-on demonstrations, as multi-modal cues add to the auditory information so that the whole message can be understood
5.      pre-teaching new information and vocabulary so that the child has a greater chance of inferring missed information from the context of the message
6.      gaining attention prior to speaking
7.      frequently checking for comprehension; using positive reinforcement generously
8.       planning regular listening/concentration breaks to avoid auditory fatigue

A personal FM system may help. This is a wireless system designed to help someone better identify and understand speech in noisy situations and over distances of up to 15 meters (50 feet). The person speaking wears or holds a transmitter microphone. This transmitter picks up important speech sounds and uses harmless radio waves to send these to a FM receiver, which a child wears behind the ear. This results in the speaker’s words going directly directly in their ears, without any distracting background noise.  Unfortunately, most teenagers wouldn't want to do that as they make it their life's mission to fit in and not be different!

It needs appropriate and thorough screening to make sure it is APD and there is not some other reason for the difficulties. Screening using assessments such as a Scan 3 and LISN-S and formal and informal tests of receptive and expressive language are essential.  

If you are concerned about your child, please get in touch, we'd love to help.

To book a screen please click here

Thursday, 12 October 2017

I couldn't possibly go to University at my age... Why you shouldn't be afraid to become a mature speech and language therapy student.

Going to University as a mature student is a big decision to make. It has financial and time implications and could also impact on friends and family.  It is daunting to face studying and revision for exams all over again. What if you fail? 

However, there are many upsides to being a mature student as you probably already possess many more transferable skills than you realise.

Ability to organise
Everyone has different ways of organising themselves. Anyone who lives independently, looks after a family or is employed will have learnt what techniques work for them. Whether this be a diary, post-it notes or copious to-do lists. This will be a huge advantage when juggling studying and assignments.

Being able to talk to people
Mature students have usually had more experience of meeting different people from different walks of life.  Even if you are naturally shy, the day to day experiences of adult life will have meant you have developed coping strategies when thrown into new situations.  This not only makes it easier to make friends on the course but will also help you contribute to lectures and will be a real asset on clinical placement.

You can take a flexible view
As you go through life you realise that you can learn about situations but that life doesn't always play by the book. This can help when you learn that individuals don't fit into neat boxes and that professionals can have different views on almost everything.  It will also make you more understanding towards parents and carers.

You will appreciate the support available at University
From the lecturers who will give extra tutorials, to the library staff who will talk you through accessing journal articles, it is lovely to be in an environment where people will help you. This is not something that we always experience in the workplace, so you will be more likely to seize these opportunities and really appreciate them. 

There’s mature and then there's mature
Don't worry about being the only mature student on your course. You will be amazed at the age range of speech and language therapy students. From 18 year olds through to 50+ year olds. But everyone has something in common - the desire to work as a speech and language therapist.

And finally...

You get discounts
While you will be studying because you are passionate about becoming a speech and language therapist, a student discount card is a lovely bonus and takes some of the guilt out of buying fancy stationery.

Becoming a mature student is daunting, particularly as speech and language therapy is a very demanding course, but it might just be one of the best decisions you’ll ever make. 

Written by a brave lady who took the plunge and does not regret it!

Wednesday, 20 September 2017

Assessing the SLCN of a child with PDA

When I did the PDA webinar for the PDA Society recently (to listen click here), a SLT asked me for tips for assessing a  child with PDA. I said that they usually weren't too bad for initial assessment as children with PDA often enjoy being centre of attention and novel situations. It is often much  worse when trying to engage with  therapy. I usually use a dog in the sessions so he makes life easier.

However, I was reminded at the weekend, that this is not always the case and that we need tips and strategies to get us though these potentially trickier situations.

Just remind ourselves of the main features of PDA:

·         obsessively resisting ordinary demands
·         appearing sociable on the surface but lacking depth in their understanding (often recognised by parents early on)
·         excessive mood swings, often switching suddenly
·         comfortable (sometimes to an extreme extent) in role play and pretending
·         language delay, seemingly as a result of passivity, but often with a good degree of 'catch-up'
·         obsessive behaviour, often focused on people rather than things.

We need to assess them to get an accurate picture of strengths, be able to give strategies for family and staff and to be able to devise a programme of work to address their issues and  to maximise their potential. Obviously,  the 2 areas we are concerned with are language processing and social communication.

We need to be aware that they do not like people to know they are struggling so they may
pretend/hide/disguise, distract or get angry..... or all 3.

1. Pretend, hide, disguise:
This is  a key factor in PDA. A parent may ask them to do something very simple such as turn off the TV but they will have a wide range of reasons why they can't e.g. my legs don't work, I can't find the remote, I can't reach the remote, I'm too tired etc. This can escalate if pushed. You may find similar issues when trying to assess. They might say, 'I'm not doing your stupid tests and you cant make me' or 'you're only being nice to me so I'll work with you and I'm not falling for it.' That is true, so we need things in our tool box to ensure we can get a full picture of SLCN.
2. Distract verbally or physically:
Many of the children with PDA I have worked with, have either tried to shock or frighten me. I have lost count of the times I've been asked 'the worse thing they can think of' (Boringly similar with tween/teenage boys) and even had one boy who said 'you can't go yet because you haven't had sex with my dad.' The key is to be very nonchalant and either ignore or pretend you hear that everyday: 'Ah, No thanks, I'm a bit busy'.
One poor 10 year old lad who had been in a secure unit for 3 months, enjoyed scaring visitors by poking their eyes. This was also because he had a deep sensory-seeking need which wasn't being addressed and he got what he needed from firstly the fear of the visitor but then the 2 burly male nurses bundling him to the floor as he manically laughed in their faces. Of course they thought he was some possessed devil child and didn't see him as the frighted,very anxious boy he really is.
3. Get angry with themselves or others:
The anger may come out of the blue and may not be seen coming. They may look perfectly happy, even relaxed but remember they have cultivated hiding their difficulties. The anger may take the form of them hurting themselves such as banging their heads on the table or may be at you or your things.
So what can we do:
1. Realise that it is anxiety based and keep calm. Never take it personally, never be offended. Ignore wherever possible. I have 3 rules: no hurting themselves, no hurting me and no damaging property. Other then that, I go with the flow.
2. Use all the strategies you would for making language simple that we preach to others. 
2. Give choices e.g. of which room to use, which order for the activities, which assessments even. This will help them feel in control. You may find a schedule of the session useful; picture photos or the written words.
3. Scale back demands by some of these strategies based on the 'Positive PDA' booklet:

Using indirect language

e.g instead of saying we're going to say “I wonder if we can...”

 “Shall we see if we can beat the clock...” ,“Maybe we could investigate…”
This means avoiding direct language such as“It’s time for you to...” ,“You’ve  got to...”, “You  need to...”
Allow take up time 

Plant the seed of what you would like to happen at the start of the session, but don’t expect it to happen straight away. 

Use the child’s interests
Using characters of interest can help de-personalise demands, as you are not personally asking them to do something. For example, if the child loves Peppa pig, get Mummy Pig to make the requests. Older ones may like a Starwars character or even the queen who  makes the  rules, so it isn't your rules. 
Use humour. 

If you feel the tension rising, humour is a fantastic distraction. You could try making jokes, using physical humour (exaggerated facial expressions, or silly walks), being silly or feigning ignorance.
Use distraction

Distraction can be a handy way to temporarily press ‘pause’ and ease the child’s anxiety.

Add other activities into the mix 

e.g. bubbles, popping balloons or blowing up and letting go, a feelie bag of sensory materials. 'If we just finish this, we will be able to do .....'.

The main thing to remember, especially as you feel exhausted at the end, is that this is for  a short time. Their parents live with this all the time! 

So good luck! Let me know how you get on.

Tuesday, 12 September 2017

We don't want you to teach colour, shape and size yet!

As you know we have just launched our new parent hub so we can  offer our advice and support to more parents.  We've done that because I believe all parents want the best for their child but if they don't know what that is, how can they?

As school has just started, I've heard so many conversations about what child can do. The clear favourites are counting, colours and shapes because that's what parents think they need to be teaching their little ones. However, teachers can do that when they're ready. They need to child to be at the right level to do that but there's important things that are needed first, language and  communication wise.

What teachers need little Johnie to be able to know, is the right vocabulary for his everyday needs, to be able to answer simple what, where questions and to be able to listen.

We use the Blank levels to explain the right order. We need to be able to answer blank level 1 questions before blank level 2

Blank level 1

  ·         Matching  e.g. Find one like this

·         Identifying a Source of noise e.g. what can you hear? 

·         Naming objects e.g. what is it?

·         Naming people e.g. who is that?

·         Naming actions e.g. what are you doing? 

·         Imitation e.g. Say this 

Blank  Level 2 

  ·         Describe scene e.g. what’s happened? (still in view)

·         Remembering information e.g. Who/what/where?

·         Finishing sentence e.g. Finish this ….

·         Identify and describe characteristics of objects e.g. what size is it? What shape? What colour? How many? How does it taste/smell/feel? Where is it?

·         Identifying object functions e.g. Show me the one we use for …

·         Identifying differences e.g. how are these different?

·         Naming object from category  e.g. Tell me something that's a type of

It makes the teacher's life a little easier if they can answer these questions. Oh yes, plus be able to go to the toilet by themselves and certainly be out of nappies!! Let me know what you think.

Consultant Speech and Language Therapist

Friday, 8 September 2017

Help for parents: join the club

The Communication Trust estimates that over 1 million children in the UK have speech, language and communication in the UK difficulties yet the number of speech and language therapists is falling. More and more parents are being left to fend for themselves but where do they look? Where can they go for help?

We been moved to action due to serious concerns that parents of children with speech are not getting sufficient access to good quality evidence based advice. We have become increasingly worried when we see parents who are on NHS waiting lists asking for advice and then being told they should be doing X Y or Z from other parents. Others are using ‘Dr Google’ which we all know can be very alarming and point us in a completely wrong direction, in many instances’. At Small Talk Speech and Language therapy, we know that language and communication targets should be integrated into everyday routines as much as possible. Children learn language in the situations where they need to know the words so no amount of flashcards or worksheets can do that. Other children have problems generalising what they learn so again, it must be in the real situation.

Activities which are done everyday that both motivate and interest the child are always going to work better than things that the child isn’t interested in. Snack time, meal-times and bathtime or even getting onto the car. Parents are busy so it can’t be extra work for them.

We have created a membership club for parents so that they can have access to real live speech and language therapists so they can ask the questions and have good, evidence based advice. They have webinars and short ‘how-to’ clips plus lots of other tips and tricks to help. There will also be a forum so other parents can talk about what they found useful.

They will have a monthly podcast show, the Smart Talkers Super Saturday Show, to look in depth at  current topics and interview relevant expert in the field. They will also have parents who have been in similar situations  talk about their family’s journey.

My blood pressure rises every-time I see bad advice being given. It’s well meant but wrong and is not in the best interests of the parent or the child. Self esteem in the child and parent confidence are so important.

We have launched the Parent Hub and hope to be able to support many more parents.

Consultant Speech and Language Therapist
Small Talk Speech & Language Therapy