Monday, 13 January 2020

What do you meme, you aren’t using photocopied worksheets in your social skills sessions?

This year I have been working with an increasing number of young people, who due to such high levels of anxiety, are struggling to engage:
                        - To engage in school expectations
                        - To engage in home expectations
                        - And to engage in ‘traditional’ speech                             therapy sessions
So you do what you know is essential, spend time getting to know the individual, rapport build, offering a reward..
But… what if the YP is still finding it difficult to follow the ‘adult-led’ agenda because there is the underlying demand to comply?
What do you do now?
Well most enthusiastic therapists know the importance of using a child’s interests within therapy sessions to engage them…
But.. what if the YP has limited interest in anything beyond sitting in their bedroom playing computer games all day?
Well of course we could use this as a reward to try and entice them into completing the therapy activities first
But… why would the YP ‘buy-in’ to completing your activity just because you want them too, when they are already happily enjoying their interest without needing to ‘earn it’ first?
            I myself, don’t have to adhere to persuasion of doing something I find difficult, like running a marathon, just on the promise of a ‘glass of wine’ reward at the end, just because someone said it would be in my best interest to do the exercise. I would still find it anxiety provoking to conform to their wishes, however much I liked the person and especially if I was already able to go to the fridge and pour myself a glass without. No exercise necessary!

So… faced with the dilemma of how to support my YP to ‘buy in’ to my sessions I had a serious head scratching moment until I thought about the likelihood of me running a marathon at the same time as drinking wine.
Now that is an interesting concept indeed!! Why does one action necessarily need to precede the other?
Well… despite the complicated logistics of this, I have to admit that the probability of me going for a run has significant increased.
‘Lightbulb moment’ – how can I embed my speech and language targets into the actual activity the child enjoys?

Despite my significant lack of gaming talent, one thing I found I did have in common with the YP I was working with, is enjoying the humour of memes.
So… where to start? Well after having fun sharing our favourites and discussing what we found funny about them I soon realised the previously highly anxious YP, who struggled to engage in any reciprocal social conversation, was soon confidently and spontaneously talking me through the steps of how to create my own Tumblr account.

Now, I must admit those sessions that are completely unscripted, when the therapy plan has gone shooting way off the map, is the most enjoyable part of my job and I’m happy to be a passenger to a student who feels motivated enough to take the lead.
But…what actual speech and language targets am I working on when using memes?
Well to be honest, we were actually working on a lot of therapy goals simultaneously!

Social Thinking Goal 1: initiating communication that is not routine
            When she is not anxious, Emily has no difficulties in engaging in conversations about something she is interested in. However, where before she would just talk ‘at me’, now during the sessions she can confidently initiate a narrative of talking me through the Tumblr sign up process and displayed the best turn taking skills so far; even pausing and allowing me the opportunity to ask for clarification.

Social Thinking Goal 2: Listening with your eyes and brain
When Emily was anxious, she would cover her face with her hair and squeeze herself between the sofa cushions. But now she uses ‘whole body listening’ with confident posture, joint attention and initiation of eye contact when she is communicating.

Social Thinking Goal 3: Understanding abstract language
Most of the language we use is peppered with idioms, metaphors, sarcasm and inferences and each generation of teenagers and young adults leave a trail of new slang for consumption - most of which is abstract. Through memes, I am able to teach Emily how to make a ‘smart guess’ to interpret the abstract language based on her previous knowledge, the context of the picture and the non-verbal communication clues.

Social Thinking Goal 4: Understanding perspective:
The ability to interpret others’ perspectives, thoughts and feelings is critical to social learning. Looking at memes with Emily created the opportunity to work on her Theory of Mind skills by discussing the point’s of view of not only the people in the memes but each other and our individual interpretation of the jokes. Whilst Emily was narrating how to set up my Tumblr account, I reminded her that I had no prior knowledge of the website. She was able to effectively use her own analogies to link these new concepts to the social media knowledge that my ‘inferior brain’ as she called it, already knew so that I could understand her.

Social Thinking Goal 5: Getting the Big Picture
If a picture is worth a thousand words then a ‘meme’ must be worth a million and the opportunity to share an imagination with other people is priceless. These therapy activities focused on teaching Emily to infer how to link individual pieces of information into an overall idea – to get the ‘bigger picture’.

Social Thinking Goal 6: Humour and Human Relatedness
Establishing human relatedness is essential before advancing in any therapy sessions; which is why rapport building is essential, especially with our most anxious students. Emily has a fantastic sense of humour and a very dry wit! But she often feels too anxious to use her humour successfully with others. So starting the therapy process with memes has helped to minimise some of her social anxiety.

Last year, Emily was a very anxious young lady, isolated at home and had little to no social interaction outside her immediate family. Now, although her socialising is still largely from the safe space of her house, her anxiety has decreased enough that she is interacting online with other YP with similar interests and is beginning to leave the house to visit local attractions. Everyday Emily is one brave step closer in gaining social confidence to engage in reciprocal conversations with new people.
We’ve since extended our sessions from also decoding magazine adverts and T.V. commercials to creating our own memes. It was surprisingly easy to embed all of my therapy targets into these activities; the only confusing thing was why I hadn’t tried this idea sooner!   

So what I ‘meme’ is that therapists need to stop thinking about what they think speech therapy ‘should’ look like and instead about what is the most functional and meaningful skills for the YP to learn to help them interpret social information and interact effectively with others. And not a photocopied worksheet in sight!

Monday, 23 December 2019

The Joys of silly season! December 2019

The demands of Christmas are sometimes completely overwhelming.  Buying the right
stuff, in the right shops at the right time for the right people. But the difficulties go beyond that.
Many autistic people are able to feel the weight of social expectation. For me it feels like a
suffocating pressure squeezing me into the neurotypical world. A world where I know I will
struggle, where I have struggled and where I have more recently spent much less time.
The pressure to engage in traditions that mean nothing to me. I don’t believe in Christmas
in the biblical sense of the word but I don’t inflict my opinions on others and am not
planning to start today because not even that is the most important thing to me.
The absolute most important thing to me is doing Christmas in our way. Doing what I can
to avoid the fuss and keep our version of normality at the forefront of everything we do.
Just because its Christmas doesn’t mean that outside influences should be forced upon
us. Christmas is an event created by people who don’t fit into our normal and who quite
frankly would probably hate it and that's ok.

Despite being an adult and being able to make choices for myself I still feel that overwhelming weight of expectation. It stops me from sleeping well, from focussing on the things that are important to me, it disrupts everyone's routine.

And for our children these expectations are greater still so it is our job as parents no
matter what our issues are to make sure that these expectations don’t become coercion or
guilt trips for our children. It is very easy for others to think it is ok to "encourage" our
children to join in with, do or say something that makes them feel uncomfortable. We have
to stay vigilant.

For years and years I conformed to social expectations around this time of year.
Repeating the process year after year did not make Christmas easier for me, in fact as
each year went by it became harder and harder. Yet, it is only since I began my journey
towards empowering H that I have learned to empower myself.

So now I say no, I want to shout it from the rooftops, no, no, no, no more. I am putting an end to complying to traditions that mean nothing to me and by being brave enough to say no I hope I can empower H and other autistic people to be brave enough to put themselves first and keep themselves and their mental health safe.

Why would we spent so much time empowering H to have a voice only to have someone
coerce/guilt her into something that is purely based on the social expectations of others?
From today I am saying no more.

Rachel Tenacious

A little bit about me, I am a late
diagnosed autistic parent with three
children aged between 31 and 17. H is
my youngest child she was diagnosed
with autism at age 9 and selective
mutism at 15.
We removed H from the education
system in 2015 after she had what we
now know as an autistic burn-out.
The school system didn’t suit H at all
but home ed has been amazing.
Since my diagnosis I have begun to
share some of our experiences at
support groups and am hoping to
expand this out to schools, colleges
and anywhere people will listen

Sunday, 17 November 2019

When is inclusion not inclusion?

When your child/young person with SEND who has struggled in the system starts a new setting, you have all the hope in the world that this time it will be different. To begin with it seems possible that you may have finally found the place that will genuinely understand inclusion.

For us, this was mainstream number four after four years of home ed. 
After attending a course specifically designed for home ed students for year 11, we decided that this was possibly the best chance for H at post 16 in mainstream.

H had to audition for the course she wanted to do in December of the year before she was due to start. At the audition she was told that the college would definitely offer her a place on a music course. With hindsight, that was the point at which it went wrong. The reason I think this is that from that point forward we should have requested transition plans would be made and transition started especially as H was already on campus 2 afternoons each week.

We got to spring and GCSE season took over, the music department was busy with their music festival which we visited one afternoon and enjoyed. We had meetings to discuss which level course would be appropriate and to review H's EHCP, still no transition plan was made.
At this point alarm bells should have rung for us, H was having a massive wobble about attending college but we assumed it was the stress of exams and the pressure that she was feeling.

It was agreed that the level 3 course would be most appropriate for H based on her musical ability. We looked at the syllabus online but didn’t get to speak to anyone about the expectations of the course.

Then we reached summer, there was an open day for new students but for some reason H didn’t get invited. We think that it was because she was registered as a student at college already but it was another missed opportunity to begin to familiarise H with the department she was due to join and the course she was due to start.

September arrived, H had passed her maths and English GCSE which was an incredible achievement. 

H was offered an induction day alongside all the other students. It was a full day but as soon as we told the staff that a full day would be too much the length day was reduced. Which was fine but it meant that H didn’t get access to all the information she needed. She was overwhelmed and stressed and couldn’t absorb anything that was said to her.

Then college started, H's timetable was reduced as a reasonable adjustment and if there were sessions that she couldn’t cope with she didn’t have to go but....

Is this inclusion? 

I have found myself asking this question many, many times over the past 4 weeks since H stopped attending college. Yes, after 4 weeks she stopped attending and there is no hope at all of her reintegrating.

Inclusion to me means making a course accessible to all students not offering a course and then simply expecting the students to fit in with the expectations. 

H had 1:1 learning support staff, they were not responsible for including her in the course, their role was to communicate for H when she was unable to and help her remove herself if she was feeling uncomfortable or stressed, to help her to move around college if she needed to and many other things but I don’t believe that it was their role to make the course accessible to H.

From the very first day H was put into a group and had to work on exactly the same topic as all the other students, she was following exactly the same programme as others, if there were things she couldn’t cope with she was allowed to skip them. But this is not inclusion, in fact, it is exclusion. By telling H she doesn’t have to do things she is effectively being excluded from parts of the course and from college life.

When things started to go wrong and I requested work for H to do at home nothing arrived, when I requested a meeting it became clear that the staff hadn’t met a student like H before and it was obvious to me that we had reached the end of the road with mainstream.

This is how it is, the course is the course and H either needs to fit in and cope with it or she doesn’t but if she can’t there is no alternative,  there is no plan B there is no inclusive version of the course that can be adapted for H so that she can attend and achieve.

I wonder if mainstream colleges can ever be truly inclusive?

There are courses that H could do with other disabled students but that isn’t inclusion, that is segregation!

Having a 1:1 to navigate the staff and the ups and downs of day to day is integration and is part of the way there but it's still not true inclusion.

Now we are looking at specialist colleges, can they be inclusive? I don’t know.

Maybe they can be inclusive in terms of developing a package that will support H to begin to build her confidence and trust in adults away from home. They maybe inclusive within themselves and that is brilliant, but H will still be excluded from mainstream, her disability has once again prevented her from accessing a mainstream setting and in my world that shows how far we still have to travel for our disabled children and young people!

Rachel Tenacious

A little bit about me, I am a late diagnosed autistic parent with three children aged between 30 and 16. H is my youngest child she was diagnosed with autism at age 9 and selective mutism at 15.

We removed H from the education system in 2015 after she had what we now know as an autistic burn-out.
The school system didn’t suit H at all but home ed has been amazing.

Since my diagnosis I have begun to share some of our experiences at support groups and am hoping to expand this out to schools, colleges and anywhere people want to hear me really.


Monday, 19 August 2019

Are we ensuring we are using a carrot and not a stick? Low Arousal: a non-aversive approach to behaviour management

Image result for low arousal book studio 3

“In crisis circumstances, we have to ‘ride out the storm’ and to use the sailor’s term, ‘batten down the hatches’. You are not going to be able to prevent the storm and there is no point in wishing it away!”.

Professor Andrew McDonnell’s new book, The Reflective Journey: A practitioner’s guide to the Low Arousal approach, is a fabulous ‘how to’ guide enabling families and professionals, supporting highly anxious and challenging people, to apply low arousal strategies in their everyday practises.
With child anxiety and mental health issues more prevalent than ever, families are being left significantly vulnerable from not receiving the provision they need in trying to raise a child with such challenging and individualised needs.
Working with both adults and children with extremely ‘challenging’ behaviour myself over the past 10 years, I have always had the belief that ‘all behaviour is communication’. Yet, the power of this book is that it instantly flips this narrative on its head and made me realise what Psychologist Albert Bandura had claimed: ‘all behaviour is about perception’. How the adult ‘perceives’ what the person is trying to communicate. As you may have noticed I have already referred to the term ‘challenging behaviour’ several times in this review; however, McDonnell takes a new stance and I am going to follow suit and from now on refer to it as ‘behaviours of concern’. This choice of words provides a more ‘neutral’ definition and therefore inevitably changes how we begin to observe these actions. 

As so many of the current literature in the Speech and Language Therapy and Psychology fields focuses on assessing ‘why’ a person is behaving in an aggressive or unexpected way, The Reflective Journey takes a refreshing approach by probing the reader to first look within themselves at their own actions. If we as parents and professionals are going to support the individual to adapt their behaviour, then it has to start with us!

But what is the Low Arousal Approach?

The Low Arousal philosophy advocates interaction, distraction, diffusion and physical avoidance strategies to manage, rather than change the undesirable behaviours. 
As an eternal student to my profession, I’m continually on the look-out for new therapy techniques to add to my ever expanding toolkit, but I have to be honest and admit that I am usually the person on the training workshop who is thinking, just get to the bit where you tell me the strategies, so I can ‘get going’ on the therapy side of things.
What was so thought provoking about this book, is the due to the two clear parts it has been divided into, the strategies to use with my students were not introduced until the second half and until that point had somehow, surprisingly, managed to restrain my own eagerness into first considering how essential reflecting on my own behaviour is, before trying to support the behaviours of the people I am working with.

I should have guessed that was the journey the book would take me on because the clue was in the name ‘Reflective’ and highlights the importance of ‘thinking’ before ‘doing’!.
I cannot remember a time when a work-related or ‘educational’ book as it were, kept me so engaged. By the end of the first chapter my head was already buzzing with questions about how my own actions, tiredness, tolerance levels and stress etc. over the years may have subconsciously leaked into my interactions with my students. Now, I do pride myself on my ability to ‘leave my personal issues at the door’ so to speak and to put my work face on each day – but I am only human after all! What was great about this book, is that it pulled all of those influential factors to the forefront of my Speechie brain and has since reading it, made them a lot more prominent when I am managing behaviours of concern. In my personal life, as well as my professional one!

I felt that the overall aim of The Reflective Journey was to empower any reader, regardless of experience, to be able to apply the low arousal approach by the end of reading a series of simple steps and I don’t feel it disappointed in achieving this.

Prof. Andrew McDonnell is an amazing Clinical Psychologist who has over 30 years’ experience testing low arousal techniques in countries across the world and after founding the Studio 3 organisation in 1992 is continually advocating for practitioners to move away from the more traditional ‘hands-on’ strategies towards a more humanistic and person-centred style. Low arousal is now the chosen approach in many services throughout the country.

In crisis situations our primary focus is always to ensure that everyone around is safe; though now, rather than just feeling we can merely ‘batten down the hatches’, this book has provided both parents and professionals supporting children with ‘behaviours of concern’ with easy, effective and empathic strategies to ‘ride out the storm’.

A final point to take away: Our children and students can be very hyper-vigilant, they are constantly on the look-out for any perceived threat, which inevitably increases anxiety and arousal levels. So always remember, they can sense how we feel about them! And how we ‘perceive’ them!

The Reflective Journey: A practitioner’s guide to the Low Arousal approach can be purchased from the Studio3 website for £17.99

Image result for 5 out of 5 stars rating

Other products related to the Low Arousal approach and managing behaviours of concern that I would highly recommend include:

-          Managing Family Meltdowns: the Low Arousal approach and Autism (Woodcock and Page 2009) £12.99

-          No Fighting, No Biting, No Screaming: how to make behaving positively possible for people with Autism and other Developmental Disabilities (Hejlskov Elvén 2010) £14.99

-          Managing aggressive behaviours in care settings: understanding and applying low arousal approaches (McDonnell 2010) £30.99

and don’t forget to check out Bo Hejlskov Elvén’s amazing Youtube series on implementing Low Arousal strategies

Highly Specialist Speech and Language Therapist
Small Talk Speech and Language Therapy

Thursday, 15 August 2019

Carer or career?

Guest blog from Jodie Isitt

It started late on night, you know those nights when everyone is asleep but you daren't close your eyes because as soon as you do someone WILL wake up screaming. Life as a carer for three autistic children was busy and oh so tiring, but in those days I was surviving on a couple of hours sleep a night and pushing my body daily to meet the caring needs of my children whilst attending hundreds of appointments a year! Was this it? Was I destined to be a carer for my children all of my life? Would I spend my days researching new conditions, learning sen law and attending umpteen IEP meetings a month? I loved working, I have been a career girl all my life, starting out in catering and following the birth of my children becoming the accounts manager in my family building business. I was good at it. I enjoyed it. I love learning new things. Unfortunately due to the extensive health needs of my family and becoming increasingly unwell myself through exhaustion and stress I had to stop working. It was too much. It consumed me. To be honest if I had been employed by anyone other than my own family business I wouldn’t have lasted that long at all. Pretty sure I had become unemployable due to the time I needed to take off work just to simply attend meetings and see the children’s psychologists. It was a full time job and one that paid lousy! Carers allowance was something like £62.00 and I was working over 300 hours per week! Okay okay there aren’t 300 hours in a week, but when you’re a parent of three autistic children and a disabled fiancée there sure as hell needs to be because I was fitting in 300 hours of stuff in a week that only has 168 hours. Parents like myself are saving the government thousands with their caring - but alas that’s another post for another day way in the future. So there I was, tossing and turning unable to switch off and in that instant when everything was quiet just the soft sound of the trees blowing in the wind, my daughters 18 bubble lamps and youtube ocean music playing on repeat I had a brainwave. For months I had been on-line actively advocating for people to learn more about autism, speaking to adults, trying to make them understand, hell even some family members didn’t quite ‘get-it’ Advocating for understanding and acceptance and I realised that when I was a child I was NEVER taught about disabilities. Disabled people scared me, unnerved me, and made me anxious. I didn’t know what they were thinking, were they violent, why were they behaving in this unsociable manner? What was wrong with them? It wasn’t until I had my children that I fully understood disabilities as a whole and teaching myself everything I needed to know about them I could finally accept them for who they were. We don’t need to teach adults about autism, or disabilities or neurological conditions. We NEED to start teaching children. Thats where it will count. Incorporating awareness into their daily routine would be invaluable for generations to come. Creating the most understanding, diverse, accepting and kind individuals of the future would change the lives of millions of disabled people and what better way to do that than through storytelling using the most cutest and relatable of characters. A journey through mainstream school, using my daughter Lola as inspiration I developed the next children’s book series designed to help children understand and accept differences in the classroom. Drawing on her own experiences and her own difficulties I have written four children books using a Badger as one of Lola’s trusted friends to give the children the tools they need in order to be a kind and helpful friend to someone less like themselves without compromising their own wellbeing in the process. The books were primarily designed and written for children who don’t have neurological condition, a social story for the ‘normal’ child some might say, however following the amazing reviews and feedback from hundreds of customers its clear to me that they are more than that. They are a double whammy! They are not only helping children understand and accept other children. They are helping children understand and accept themselves. One child’s mum reports that she wore her ear defenders to school for the first time in months and was proud to be like Lola Rabbit. Another describes her child wanting to dress up, spending ages choosing an outfit complete with hair bow to look exactly like her. Some children have opened to their parents and admitted they felt like Lola, lonely and scared of the noise. Giving parents the opportunity to finally realise what kinds of things they were struggling with in the school environment. I am so excited about this project, and I cannot wait to release the second book - Lola’s wobbly lunch time where Lola gets very stressed out during lunch time and has a breakdown in the lunch hall describing the smells and sounds and the extreme busyness of the lunch hall dev

Additionally and because I'm not 'professional' I asked expert speech pathologist Molly Dresner and Occupational Therapist Lucy Bates to contribute in the book and they have done amazing job at explaining the difficulties and giving teachers and parents ideas on how to help children should they present like Lola Rabbit. This is a very unique addition to children's books and I am super proud and honoured to be able to bring these books to schools and homes near you!

Jodie x
Autism with love publishing