Sunday, 5 November 2017

How should we interact with a child with SM in early years and primary?




Look out for one on secondary coming soon based upon our survey of young people which will be in the Royal College of SLTs Bulletin soon.

We have more short videos and how-to's in the parent hub. Let us know what you would like us to cover next.


Tuesday, 31 October 2017

Can Sleep Loss Affect Children's Ability to Process Speech?


Guest blog from Sarah Cummings

The impact of sleep deprivation in the cognitive performance of adults is a well-researched field. And rightly so. Unfortunately, conducting the same research on children is often a little more complicated – with difficulties arising due to ethical worries around depriving our little ones of sleep. Fair enough. We can’t keep the little beggars up all night, can we?!

Still, sleep loss in children is a vitally important field. Especially considering the staggering amount of cognitive development that takes place at a young age.

Thankfully, more research is being done – with parental consent, I should hasten to add – and we’re slowly beginning to understand the impact of poor-quality or insufficient sleep on children, especially in regards to speech development.

Below are a few ways in which sleep loss seems to impact a child’s ability to process speech.

Speech Perception

A number of studies have been conducted into how sleep-deprived children are able to perceive speech.

One study looked at how sleep-deprived children performed against their well-rested compatriots in a test of speech perception. The experiment compared how well participating six-year-olds were able to identify the beginning sounds of syllables; a test that is predictive of language development in later life.  

The sleep-restricted children were shown to respond significantly slower and brain scans showed considerable differences in brain activity across five separate areas.

What was most revealing about this particular study was that the difference in sleep duration between the sleep-deprived group and the control group was just one hour less a night for a week. Yep, one hour was all it took.

While this is, of course, just one study, the implications are nonetheless important. If a noticeable impact can be made after just one week of one hour less sleep a night, what about children who are chronic poor sleepers? Just imagine the effect on their ability to concentrate in class.

Processing Power

A further study compared a group of 7–11-year-old children, who had been diagnosed with sleep apnea, against a control group.

This experiment involved setting the two groups a cognitive task that involved the identification of words.

While on the face of it both groups’ performance was comparable, when the fMRI results were compared the brain activity of the children with sleep apnea was shown to be greater in the areas of cognitive control and attentional allocation. In plain English, their brains were being put under greater stress – effectively working harder – to achieve the same results as their well-rested friends.

Napping Effects

The systems that connect learning and sleep are becoming increasingly well known.

A process known as ‘consolidation’ takes place when we are asleep – this is where the brain reactivates and replays information from our waking hours, strengthening the neural connections triggered during the information acquisition/learning process.

Although this takes place at night, it can have the same effect during an afternoon nap, or as it is aptly called, a ‘power nap’. This is also true for an adult studying Japanese…but it’s more essential for a child learning new verbs.

In fact, when it comes to children, the effect of napping is even more pronounced. One study conducted around word learning and napping showed that children who were encouraged to sleep shortly after hearing new words retained their newly acquired knowledge significantly better than other children who remained awake.

Both sets of kids were tested a couple of hours afterwards, then a day and then a week after, and the power of the nap was shown to remain true on all three occasions.

Rebecca Gomez, Associate Professor at University of Arizona, agrees with the power of both a good night’s sleep and regular napping:

“Preschool-age children should be getting 10 to 12 hours of sleep in a 24-hour period, whether it’s all at night or a combination of nighttime sleep and napping.”

So, maybe it is time to bring back the afternoon nap – for both you and your little one.

Final Thoughts

As we’ve seen even a difference of just one hour can negatively impact a child’s ability to perceive and process words. Conversely, an hour’s afternoon nap can impact positively on their ability to retain new words. So there is little doubt that a link between sleep and a child’s speech development exists.

Fortunately, there are a number of sleep-related activities that encourage speech development, such as reading your children bedtime stories, but still the most helpful thing for speech development is getting a good night’s sleep. Followed, of course, by a few well-placed daytime naps.

Unfortunately, encouraging a child to do anything they don’t want to do is, as we all know, hard – but little things like setting a consistent bedtime routine and creating a relaxing bedroom environment can make a big difference.

For more advice on how to encourage sleep in children and in adults, check out the expert advice from the guys at the sleep advisor blog. When it comes to nodding off, they really know what they’re talking about.

In the meantime, make sure your kids get enough sleep – night and day – and you can rest assured that their development will respond accordingly.

Sarah Cummings

sarah.sleepadvisor@gmail.com


Saturday, 28 October 2017

Communication problems are no laughing matter!

I went to  play at the weekend. It was well directed, superbly acted and every bit as funny as had been advertised: Talking Steps by Alan Ayckbourn. 

The blurb had described: 'When tongue-tied solicitor Tristram is sent along to oversee the sale of a large and crumbling house, reputedly a haunted former brothel, he may have bitten off more than he can chew'.

However, what I didn't find funny was the way the poor solicitor stammered and had word finding difficulties. I found that part really uncomfortable and was surprised that everyone else appeared to find it tremendously funny every time he opened his mouth.

In the end the character gets not just one girl but two and has the last laugh but even so, I didn't like that element.

I had to remind myself that it was written for a 1970s audience who would have laughed at speech impediments. I felt hopeful  that we have moved on since then and that no-one with a speech or language difficulty would be made fun of in any play written today.  

People have studied what makes something funny since time began. Philosophers, such as Aristotle and Plato, alluded to the idea of the superiority theory thousands of years ago. It suggests that all humour is derived from the misfortunes of others – and therefore, maybe our own relative superiority. Thomas Hobbes also alluded to this theory in his book 'Leviathan,' suggesting that humour results in any situation where there's a sudden realisation of how much better we are than our direct competition.

Am I right to be offended or do I just fully realise the huge impact when society doesn't fully understand the major impact of having a communication difficulty?

What do you think?


Thursday, 26 October 2017

What does it feel like to have Selective Mutism? How you could start a discussion with your child


Guest blog post by Clair Maskell

As an ex nursery nurse, I had done various special needs courses and Selective Mutism was only briefly discussed. I had not encountered it within my 11 years of childcare work and then a few years ago, I was lucky enough to meet E.




E was in my daughters preschool and they started school together. I became friendly with her Mum and through her, I started to get a picture of what life was like for a child with SM and how it effected the family.
It was soon clear that there wasn’t enough understanding of SM. Many teachers seemed to be unaware of strategies to help E and it was also difficult for other children to understand her too.

The more I learnt about E and her anxieties, how she couldn’t cry if she hurt herself at school yet was a live wire at home, how she would bottle up her worries and feelings and leg them all out at home.....I just felt I needed to do something to help people understand her better and also to make her feel like someone somewhere understood.

I had been dabbling with writing for children for a while, self publishing a book in 2013 and wanting to do more. E’s Mum and I had the same thought at the same time.....why not wrote a children’s book??!!!

And that is how The Loudest Roar cake about. It follows the lovely character Angus, the lion who has the most fantastic Roar, but it didn’t work when he left his home. 

I chose a lion because I was so touched by E’s bravery. Imagine getting up every day and going to school without being physically able to express yourself. That’s bravery and what braver animal to portray that then a lion!

I have been so honoured to have E’s Mums support in writing the story, which my husband Dean illustrated for me. The story is really helping to raise awareness not just here in the UK, but in the US, Canada and Australia too!! 
The whole point of the story is to explain to children what having Selective Mutism feels like and not only is it doing that, but it also is resonating with children with SM, who have given feedback to their parents to say Angus is “just like me”

You can get The a Loudest Roar on Amazon and also follow me on Facebook 


Clair Maskell 
Children’s Author.


Tuesday, 24 October 2017

Some children thrive from whole word recognition but some of our children need targeted intervention

Guest blog from Georgina Smith, Dyslexia Expert



Over the years of assessing and teaching I so often see students of all ages who have  ‘gone under the radar’ as they appear to be students who are functioning with reading and spelling, some at an age appropriate level.

At times when I assess I see a student who appears on the surface to read reasonably well, with some flow and whole word recognition, however when they spell their written responses can default to a phonetic response and not be on a par with their reading.

There are also the children who practice so hard during the week only to forget the 10 spellings in Friday’s test.  Some recall many but then as time goes on, they can’t continuously recall those spellings they recollected only a few weeks or day ago when they write.

Whether a child is dyslexic or not, whole word recognition is not always the answer, all the time, for all children.  Some children thrive from whole word recognition but some of our children need targeted intervention.

I have found over the years showing students, of all ages, how to sound out, blends, breakdown, and learn the component parts of a word, to be able to transfer to less familiar words which are not high frequency enables them to develop reading and spelling.  The structured system of learning when to use patterns in words (i.e. mid/end) can often unlock the key to learning.  This logical way of learning in CodeBreakers suits many of learners I have encountered as a dyslexia tutor.

The system of over learning is also not one our schools cannon often afford time for when curriculum targets need to be met.  The joy of CodeBreakers allows student to work at their own pace with opportunity for over learning.
When a child learns to read by whole word recognition, often they will learn to spell that way too, recalling what a word looks like, rather than being able to sound it out and encode the word.

Today was a prime example of this, teaching a young leaner that ‘ea’ say SV /e/ as in ‘bread’.  He surprised me that he could tell me very quickly all the letter names.  So I asked him to make me the word ‘bread’ using the wooden letters and then show me what made the SV /e/ sound.  He couldn’t answer. So I asked him to move each letter to represent the sounds I said.  He moved ‘br’ for /br/, then ‘e’ as I said SV/e/, then he moved the ‘ad’ and I said /d/.  Clearly he has not identified that the ‘ea’ make the sound as only ‘d’ says /d/.

You may ask why I put this child through sounding out this word when he could spell it.  The answer, because I wanted him to recognise the letters which made this sound and be able to transfer this to other words he may not be familiar with and to learn to sound them out.

Too often when testing and teaching I find student cannot sound out using only the sounds (not letter names and letter labelling) and this impedes their ability to encode words.

Of course it’s true to say that every word will not be spelled with ‘ea’ and that’s why we need dictionary skills but that’s a narrative for another day.

If you would like to know more about CodeBreakers and receive a FREE sample contact us:



ST-NOV17

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 (www.littlesignersclub.co.uk).  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.