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!