Sunday, 4 November 2018

My saddest case: helpless 10 year old child with ASD/PDA/ADHD

The story of Bethany has been in the news recently and even Parliament are at last asking questions about the treatment of children in Acute Treatment Units (ATU). It reminded me of something that really upset me last year:

I was asked to assess an in-patient on a mental health ward in an NHS hospital: a 10 year old boy with diagnoses of ADHD and ASD. We'll call him Paul. Paul also had many signs of PDA, although this hadn't been explored further. He had been at a special school for children with ASD, where he had been getting on reasonably well for a while but his anxiety levels had been rising. One weekend his melt-down at home had resulted in his mother feeling at at total loss as to what to do and she had been persuaded by her partner to call the police.

A child who is having a meltdown is not able to be reasoned with, they have moved beyond any basic reasoning plus.

  • A child with ASD will not be able to understand reasoning at the best of times as it's  a higher-level language skill, never mind the worst moments. 
  • They may not have any idea that you have to adapt your language or behaviour for different people in different situations, so even when calm, will not see that they need to be 'respectful' to the local policeman who walks through the front door.
  • They may have sensory issues which means when that policeman fails to reason with them and decides to remove them from the situation, they will automatically react in a defensive  manner

Then, they're in the secure ward 'for their own and others' protection' because no-one really knows what to do. This was 'just for the weekend'; in Paul's case.

Paul was scared, worried about  his mother, still angry (because the initial problem was still there and his sense of justice is huge), in a strange place with strange people; so how is he going to react? Will he calmly listen to reason, apologise profusely or will he more likely go into self protection mode? Just like a cornered, terrified animal would! How will this change when he is just 10 with no idea of what is happening, why he's there, why he can't go home to his mum, why he can't go to school.

The demand avoidance meant that he could not do as they directed while appearing more socially able than he was. He could also use language to try manipulate those around him and if that didn't work he would try to shock them into getting what he wanted.

Go forwards 3 months and I walk in:
Paul had nothing but a TV with no remote, as that's a potential weapon, and a settee. The ward was just a room with a wall of glass where the staff could observe at all times. The nurse told me he'd been been smearing faeces over the glass and remained unmoved when I said I couldn't guarantee not to do the same in the circumstances after 3 months. Look what happens on Big Brother or I'm a celebrity when people are watched continuously, and they choose to be there!

Paul is sensory-seeking in an environment where there was no sensory stimulation. He had taken to satisfying this need partly by hitting the top of his head, so he now looked like a small Friar Tuck with a bald patch, he also hit his chin so had developed sores all along his jaw-line.

The other very effective way of getting his sensory needs satisfied was to provide the guards, oops sorry, nurses, to tackle him to the floor and the best way to do this was to poke any visitors in the eye. This resulted in 2 large, burly men pinning him to the floor where he then laughed manically because he had his sensory needs satisfied. This had gone on repeatedly so was a cycle of behaviour which was keeping him there. They didn't see him as an anxious 10 year old boy with needs, they saw him as a demented Damion character who was dangerous and must be contained.

They allowed me to go in to see him but weren't happy when I asked Paul if I could sit next to him, I introduced myself and  we started to talk about what he liked to do. He told me he loved football, trampolining, x-box games, school, playing tag, drawing, painting.... pretty similar to any 10 year old boy to be honest .......only he had been denied any of these for months!

After ten minutes, he (probably) wanted to get out of the situation and tried to poke my eye, I moved my head away so he just scratched my face and I calmly reminded him that I wasn't there to hurt him and that I would be polite and kind to him so would be grateful if he could do the same. One of the nurses tutted because he thought I was mad and the other said if he moved towards me again I'd have to leave. I moved to the other side so he couldn't see my scratched face, so we could move on but five minutes later he tried to poke my other eye. He was then on the floor, pinned down and I was bundled out of the door.

The staff weren't to blame as they didn't understand him, they were all agency workers who don't normally even work with children, who were doing their best. The saw him as a dangerous, deranged creature who called them names they'd never been called before, never mind from a  ten year old. The way they described him showed they didn't see him as human in many ways. They had no training on ASD, PDA, anxiety or sensory needs.

His poor mother was helpless to do anything. Representatives from residential schools came in to assess him but were given the  same warnings as me, so didn't go in and decided  they couldn't meet his needs.

I attempted to discuss how I saw the situation but quickly became aware that they were not interested as they were temps. I wrote it in the report instead. Although I had done what I'd been asked to do, I felt as if I'd failed him because I couldn't get anyone to change their views. I felt my ideas were seen in the same light as if I was proposing witchcraft!

He ended up in a ATU.


Thursday, 1 November 2018

How we use low arousal techniques to support a person with autism and Selective Mutism

Guest post by Rachel Tenacious

Low arousal can be used with any person who is having difficulties meeting the expectations of those around them as far as I am concerned but it works especially well with people who need to be in control of their life as much as possible as a way to keep their anxiety at a manageable level. Demand avoidance is a reaction to fear, facing scary situations all day every day is too much for any person, when a person is demand-avoidant it is their way of stopping the world just for a short time so they can breathe.

Our lives are full of demands but many of them can be avoided with a bit of skill and determination. When H was 5 we were told she was controlling us and we have been told this many times over the last 11 years and guess what, yes she is and yes she does but not for the reasons that most of  the so called "professionals" were suggesting. H controls her world because it is very scary. Speaking away from home became scary for H sometime after she started school and this was when she stopped doing it. We believe that she tried asking for help by crying at school but her voice was invalidated so she stopped asking.

Removing H from school allowed us to give her a break from the massively demand heavy environment that she was in every day. Learning about low arousal has helped us to give H a voice and to allow her to live a life of much lower anxiety levels.

The first and most important thing to remember is something first written by Ross Greene who wrote "The explosive child" he said "Kids do well if they can". This is the root of everything!

Before we can genuinely improve that lives of people like H we have to properly understand that. We have to remove blame, we have to believe that the person who is struggling is not making a choice, we have to have a good understanding of Fight, Flight, Freeze and most of all we have to think outside the box.

Living a low arousal lifestyle is completely different from anything else we have ever known, we have to throw away the "Traditional parent, parenting handbook" and we have to get creative. We have developed our own toolbox of strategies and techniques for getting through each day. We are led by H, we never punish, we never cajole, coerce or bribe her. If she needs us to speak for her we do, if she feels able to speak for herself we celebrate [secretly].

We have days with massive successes where she is able to order food or buy a drink verbally. We have lots of days when she can’t do those things but we step in and make sure she doesn’t miss out. We build in loads of downtime and never make direct demands about anything including speech.

We would never expect her to use social greetings but she will occasionally look at people to acknowledge them and sometimes say a quick “Hi” and we always say a general thanks, goodbye etc.

Because initiating a conversation is a massive demand for H and maybe something she never does away from home we sometimes give people information about things that she is interested in. If she is comfortable and talking about a subject she is interested in she can talk freely. And if she isn’t comfortable she can at least answer questions or nod.

We are actually ok with SM and the actually act of speaking has become a less important aim for us. We would like to get H to a place where she is able to be more independent and I think  we are already moving in that direction but whether speaking away from home will be a big part of that I don’t know.

H wants to learn to drive next year so that she doesn’t have to use public transport which is a sign she is  thinking about her future. Finding an autism/SM friendly driving instructor might be a challenge but we are used to challenge.

There is lots of info about low arousal strategies available, we particularly like Bo Hejlskov Elven because he is clear and concise and his book "Sulky, Rowdy, Rude" is easy to read. "The Explosive Child" by Ross Greene is also an amazing book but I found it a little harder to read.

I guess for me the whole basis of low arousal is making life more positive, working together to find out how we can help to overcome the anxiety that causes the challenges and respecting that actually its ok to avoid some situations, we need to look deep into ourselves and think about the things we avoid as adults that we were forced to do as a child and extend that out into our children and into our whole lives.

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.

Thursday, 25 October 2018

My thoughts on selective mutism as part of a demand avoidant profile.

Guest Blog by Rachel Tenacious


As background, H had been described as being "Unable to talk when she is anxious" by an Educational psychologist when she was 11. I went further when she was falling out of the mainstream school system and described it as "Effectively Non-Verbal when stressed". Another parent first used the term Selective mutism to describe her difficulties when I  described  H to them.

Sophie Harding and Libby Hill from Small Talk  agreed that H does have SM when she was 15.
I had begun to learn about demand avoidance and low arousal before I had heard the term selective mutism.  At fist I was unsure whether H fitted the PDA profile but I needed to gain a better understanding of her if we were ever to attempt formal learning again so I headed off to the NAS PDA conference in Brum in November 2016.

What I learned there was going to be life changing for us. The experts talked about a group of autistic people who demonstrated extreme demand avoidance but were not explosive or aggressive physically.

This was my lightbulb moment. H fitted this group perfectly and always has.
H avoid  everything that makes her anxious and everything she perceives to be likely to make her anxious. 

When she started school H did not have SM but she was massively anxious and was demand avoidant.

At preschool she never managed a whole day because it was too much for her but when school started she suddenly had no choice.

She screamed, kicked, ran away, begged, sobbed and clung onto us in an attempt to stop us from making her go. Unfortunately we didn't listen to her, she was we believe told to put up and shut up by school staff so she did.

I am not sure that H ever initiated a conversation with an adult in school ever and she certainly didn't ever ask for help.

When H is anxious she freezes, she makes it her mission in life to be invisible away from home and yet that is not her true personality. At home and with a  small group of very familiar and chosen people she is loud, funny and very outgoing.

The person that most outsiders see is not the real H, it is the H in self preservation mode. All demands are difficult and speaking is one of the most challenging.

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.]

Wednesday, 10 October 2018

About masking autism and why I think we should think past it


Guest blog post by Rachel Tenacious


This morning as often happens I saw a poster/meme about masking and what do we know about it. People are so much more knowledgeable about this part of many people's autism but yet we don’t seem to be moving forward in solving the problems caused by it.

These are just my thoughts as an autistic person who "masks" and the parent of an autistic person who "masks".

The thing is I don’t actually believe H does mask, I can see the struggles, the stress, the anxiety but often others can't, won't, don't!

I think we need to move beyond thinking about masking as a thing and look at the way we view the person we are thinking about:

Does the person have a diagnosis of autism?
What do we know about them?
Have we been told what signs of stress to look out for?
If the answer to my first question is yes then I want you to stop thinking about that person in terms of masking and start thinking about what you can do to support them.

My point is that all people with autism need support in school, at work etc whether they mask or not and by saying we can’t help them because they are masking is the same as blaming them for not asking for help.

I have a perfect although hopefully extreme example of where schools can make a critical error in terms of supporting a child with autism. My child's school didn’t support our appeal for her to be statemented in fact they were adamant that she was "fine" in school and to prove their point they made a video of H doing drama!

The video showed H rocking from foot to foot while standing in a circle of other children, twisting her hands, licking her lips and rubbing her face with the sleeve of her jumper [something which had caused her to draw blood in the past, you wouldn't believe the harm that can be done by acrylic, luckily we were able to buy 100% cotton jumpers for this school]. Yet H was taking part in in the lesson and was engaged. Apparently that was enough for the school. It wasn’t for us and thankfully not for the tribunal either who didn't view the video on the day of the hearing but had clearly watched it and had also noted the clear evidence of anxiety.

Sharing and understanding information about what anxiety looks like in each individual with autism or suspected autism is massively important. So many of our children are being failed by the system, the stats for the number of autistic people out of school or work make very depressing reading and yet with some simple skills eg listening and looking carefully there could be a way forward.

I have seen evidence that this is possible, H after three years of home ed to recover from the trauma suffered in school has tentatively dipped a toe into the world of college. She is doing eight hours a week and has a 1:1 LSA. This LSA has already shown after seven sessions that she is intuitive enough to spot the signs of stress in H. Yes it was subtle, shuffling around in her chair, sighing, pulling at her t shirt but it was noticed. The LSA was uncertain what action to take but that doesn’t matter at this time, its very early days and no one knows what action to take really. The fact is that by coming and telling me at the end of the session that there had been a noticeable difference in body language I was able to get some more detail later on on the evening and can begin to help to solve the problem [which turned out to be a noisy fan on a laptop that was preventing H from being invisible and which she has become hyper focussed on.] In the old days that would have been missed and H would have quite likely school refused the next day but here we are well on the way to fixing the fan and at any rate talking about other options.

It is so important to me that we stop almost blaming these children, young people and adults for not letting us see how much they are struggling. They do this because they want to fit in, they want to do well and its hard work. We need to give them permission to receive help, we need to help them to understand that being helped is a positive thing and that they don’t need to hide their autism anymore.

 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.]


Tuesday, 28 August 2018

'He is stubborn and unco-operative!'

Guest blogpost by Karen Horner:
Stubborn and un co-operative! Oh how many times have I heard that working in mainstream schools. We have come along way in the last 15 years to understand autism yet some schools still continue to use words like stubborn, unco-operative, own agenda, daydream ........need I go on?

Funding has been cut so much that children who need the help and support in schools are either not getting it or are given 1-1 support with teaching assistants who are not trained or experienced in autism. I could tell so many stories but one that really got to me happened a few years ago. I observed a child in a mainstream school and was pleased to see at carpet time that the teacher was ok with the child looking out of the window as she was talking.
When carpet time ended she asked the child what she had been talking about and he duly answered word for word. She then asked him what she had requested him to do and again he answered positively. Going back to his seat he picked up his pen and continued to sit for a while. The T.A approached him and reminded him he needed to put the date on and the learning objective showing him where to put that. He complied and proceeded to also write the title. Then he sat and sat, the teacher reminded him what he needed to do and continued sitting with the higher group. The child got up and began walking round the classroom where by the teacher calmly asked him to sit down and get on with his literacy.
One again he just sat and looked perplexed. He then got up and went into the reading corner where by he began to tidy the books, once again the teacher now with an edge to her voice asked him to sit down reiterating that he had work to be getting on with and she hadn’t asked him to tidy the books. I observed the expression on the child’s face as he continued to tidy them. The teacher then becoming more agitated approached him with an edge to her voice again telling him to leave the books and go and do his work. The child’s arm shot out striking the teacher whereby he was then excluded from school for being stubborn, unco-operative and aggressive. So what really happened here? I spoke to the child in his home with his Mum present and it did take a long time to work through what happened but for here in a nut shell, he got back to his seat and didn’t know how or where to start his literacy so he wandered around the classroom looking at the work of others to try and work out how to do it. He knew what he had to do but not how. As he was then not allowed to do this it struck him that his teacher liked the book corner tidy and as it wasn’t he decided she might be pleased with him if he tidied it. When she asked him to leave it he felt he couldn’t as he hadn’t finished it so he continued with the aim of finishing then going back to his seat. He put his hand out as the teacher approached because she was coming (in his eyes) at such a speed it made him apprehensive so he wanted to stop her.
In this one scenario any teacher or T.A experienced would understand why all this had occurred moreover how to deal with it. To me, this was classic difficulties with theory of mind, executive function and visual difficulties. You could also add central cohesion into that mix as he was unable to see the bigger picture of what would happen if he didn’t comply. This exclusion could have been avoided if trained and experienced staff were on hand to help him. So many times I hear negative things such as, 'He is lazy so don’t intervene', 'He knows it he just wont do it' etc. It does make my blood boil. These children are tomorrow's adults and the system is failing them right, left and centre.

Karen Horner

Karen runs Gateshead Autsm Support, which supports families and children living with ASD, click here for the Facebook page. She also runs Relax Kids in the North East

Gateshead Autism Support

Tuesday, 21 August 2018

A New Way Parents Can Support Their Child’s Development


Guest blog post by Oisin Hurley

As a new parent it is normal to be anxious. There are many stresses involved such as; is my child crying too much? Are they eating too little? Will I bond with them or will they bond with me? What if I forget my child while shopping in Aldi and only realize when I get home! All of these are genuine concerns new parents have voiced.

There are external pressures to manage such as what school should her or she go to? Where is best to live in order to provide for a family? All of this along with keeping yourself and a little one alive and well. There are many things that are beyond our control, keeping germs away, teething, nappy rash, tumbles and injuries are part and parcel of growing up. Many parents say they often wonder what their child will become, what kind of personality will they have, will they have enough friends in school, will they be happy, will they be successful in what they set out to achieve?

Education is a huge area of concern for parents, particularly in relation to their own. Often times when a problem arises for a child around the area of Speech and Language development it takes a long time to see a therapist to diagnose a problem. For example, figures from 2015 report showed 15,000 people were waiting for a speech and language therapy assessment. Thankfully these numbers are moving in the right direction over the past few years. Yet it still remains much too high for a service of such critical importance.

What if I were to tell you that there is a simple action that can be taken that requires very little time and effort that can help your child’s ability to learn and develop? While there is no silver bullet, you can start by spending a small portion of your day (30 minutes) exposing your child to more language by reading, singing, and playing with them.
Research shows that the more words your child hears in the first 3 years, the more likely they will be to succeed in school. Spending this time engaging with your child not only increases there vocabulary but it strengthens the bond between the two of you. What’s more is that 1 in 10 children are now at risk of experiencing early learning difficulties, which has shown to be reduced by exposure to increased language in the home environment.

To combat these striking statistics Talk2MeMore have developed a new app that is effectively a Fitbit for words. The app monitors the amount of words your child is exposed to each day delivering feedback on what a child has just heard. It also offers practical suggestions of how to enrich your child’s environment such as what books could be read in order to expose them to more. It is a tool to allow the parent to know what their child is experiencing with incentives to improve their language environment. This revolves around quality and quantity. This can help relieve anxiety and set your child up for when they are ready for school. Reduced anxiety in this department can lead to a better relationship between you and your child. This researched app is showing early signs of attributing positively into developing a more language rich environment for children.
Talk2MeMore are offering a 7-day free trial of this exciting new app. To find out more visit their website to get started today.


Oisin Hurley

photo sources: Shutterstock

Tuesday, 14 August 2018

Independent speech and language therapists do tribunal work too


The Association of Speech and Language therapists in independent practise (ASLTIP) has a website where you can seek out Speech and language therapists who carry out medico-legal work. This is based upon their guidance. They may cover the following situations:
  • SENDIST (special educational needs and disability tribunal) – cases where a child’s education is affected by a communication problem and extra specialist assistance is being sought.
  • Medical negligence (such as birth injury affecting a child’s development), or trauma (such as a road traffic accident resulting in head injury and communication problems) – cases where the aim is to determine costs for therapy when seeking compensation.
  • Occasionally an assessment is necessary to assess whether or not a problem exists.
Recognised characteristics of medico-legal work:
  • We will review medical notes and other important documents.
  • Assess  the client’s speech and language skills to determine whether a problem exists and, if it does, how severe it is.
  • Writing a detailed report of findings, diagnosis, prognosis and recommendations for further therapy. In SENDIST cases there is a need for very specific recommendations quantifying the amount of ongoing therapy considered necessary.
  • Appearance at Tribunal/Court as an expert witness if applicable.
Some points you may wish to discuss with any therapist you contact:
  • The therapist’s specialist credentials and experience in the area of medico-legal work e.g. writing expert witness reports and giving evidence at SENDIST/Court.
  • As a detailed communication assessment must be made, the therapist needs a background of experience with the relevant population (i.e. adults or children), and with any specific conditions in the case (e.g. autism in children).
  • The timescale for when the report is needed and the reports/information the therapist will need prior to the assessment; how liaison with other professionals (e.g. a solicitor if one is involved) can be maintained; who else can provide qualitative information about how the client functions in everyday communication situations.
  • How much experience the therapist has with similar medico-legal work.
  • Where the therapist will see the client for assessment. Sometimes the therapist will wish to see the client in more than one situation.
  • How much the therapist charges. The therapist may have a fixed charge for the assessment and subsequent report. However, it may be that the therapist charges an hourly rate and guidance on average overall charges can be requested. Because each case will be different, it is important to discuss specific details which are relevant, so you are aware what the therapist will provide and what the likely fee will be.
We do medico-legal work at Small Talk and are prepared to travel so please let us know if we can help or look on ASLTIP's website www.helpwithtalking.com



Sunday, 12 August 2018

Therapy is about Engagement, not Compliance!

I’ve been using the Attention Autism programme (Gina Davies) pretty much every day for the past two years and I can honestly say I don’t know how I did speech and language therapy without it. The basic principles of Attention Autism such as; the activities needing to be motivating, visual, appealing etc are our bread and butter skills as therapists but ensuring that everything I deliver is an irresistible invitation to learning is a completely new challenge.

Attention and listening are pre-requisite skills to language development and the time and effort we need to invest in supporting children both with and without Autism with this cannot be underestimated. After all, we need to ensure that our activities are indeed worth communicating about!

The Attention Autism programme consists of four stages:

-          Stage 1: ‘the Bucket’ – Focus

-          Stage 2: ‘the Attention Builder’ – Sustain

-          Stage 3: ‘the Interactive Game’ – Shift

-          Stage 4: ‘the Table activity’ – Transition
 


“I’ve got something in my bucket, in my bucket, in my bucket, I’ve got something in my bucket whatever can it be?”

 
Stage 1 is all about ‘the Bucket’! A bucket filled with simple, motivating and appealing toys that will capture the child’s attention. The main aim at this stage is to teach the child to independently focus on the adult-led agenda and to take the risk of trying something new.
As a ‘speech’ therapist the trickiest thing I found when I started was to try and not talk. Many children with speech and language difficulties find too much verbal information overloading which can result in ‘tuning out’. When delivering Attention Autism, I am now more confident to rely on the activities to bring the child’s engagement, not the language.

Now of course at the beginning, things went terribly wrong. Children kept getting up from their seats, others found it hard to transition to the activity and however prepared you are, you need to trust that it is ok for mistakes to happen. We cannot take the child’s cooperation, for, however short a time, for granted. The supporting adults need to resist trying to herd the children back to their chair as Attention Autism is about working on engagement not compliance. Remember: ‘if it’s Fun, they’ll come!’. Make your targets realistic, at Stage 1 aim for your children to attend for 1 minute initially and then build up slowly each day. If you deliver a fun and appealing session the children will learn to naturally and spontaneously self-regulate to the adult-led learning.

If we are expecting the child to tune in and attend straight away, then we need to ensure we are ‘selling the bucket heart and soul’.

Fun doesn’t mean Unstructured. Follow the rules.

1.       ‘It’s Tish’s bucket, it’s Tish’s toys’.

It may seem mean but only the leading adult is allowed to touch the toys. Many children have single challenged attention (Cooper, Moodley and Reynell 1997), so if they are playing with the toys, they are not focusing on you. Keep your distance so little hands don’t feel tempted to pick up the toys.

2.      Show first, add words later.

If you’re like me this part may be tricky to begin with. We may instinctively want to start adding in language, but it is important to stay quiet and allow for thinking time. Then gradually increase the language.

      3.      Everyone one is joining in – no exceptions!

Supporting adults need to keep modelling expected behaviours. If we begin talking amongst ourselves or getting up to ‘do a job’ we are only modelling to the children that it is acceptable to get up and leave the activity if you feel like it. Our children attend to the most dominate stimulus in the room – make sure it’s ‘the Bucket’.

     4.      Keep Calm it’s only a bucket.

However prepared you are, you’ll never be prepared enough for the unpredictability of working with children, which I tend to love about this job. Don’t get distracted by louder children, you’re the adult you dictate the start and finish of the session. Don’t let children getting up and wondering off fluster you, trust your supporting adults to bring them back silently. Rushing adds anxiety, so keep calm and enjoy the shared experience.

5.      Focusing leads to sustaining.

Aim to carry out the session 4/5 times a week, start at 1 minute and build up slowly. When 80% of your group can attend for 5 minutes, you’re ready for Stage 2 and remember

“if it’s fun, they’ll come!”

 

 



 

Saturday, 11 August 2018

assessing a demand avoidant child...... yes you may look stupid but who cares?

I've just handed over a new case to one of my colleagues and as I was telling her about him, I also discussed that I'd had a new student with me when I met him. Having someone else observing made me reflect on how we interact with  children who are harder to engage but there's not much written about it as a guide for school aged, especially, if they are demand avoidant. I saw myself through her eyes and realised I definitely did look stupid and it probably wasn't how she was expecting a 50-something professional to behave! However, it was exactly what the situation demanded. If I can use the dog, it really helps but on this occasion, he was scared of dogs so Ralph wasn't there.

Many of the pre-school Hanen tips still work well:

1. Observe, wait, listen: ask parents what they're interested in and watch and listen closely. He used sound bites and little scripts acting out situations, as the main part of his expressive language. These included zombies, teleporting and fighting. We hadn't finished what I needed to cover when he'd thrown me out of the play room as he hated me and 'couldnt stand' me any more, I crept out out of a second door and burst in telling him I'd teleported. He forgot he was cross with me and asked me to 'Do it again!'. Of course, I  can only do it once a day, so maybe next time.  A little while later, he ran outside and wouldn't come back when we asked, so I pretended to be a horse, crying 'Jump on I'll save you from the zombies!' He did and we piggy-backed back into the playroom.

2. Get down on their level: you can see their facial expressions so much better if you're on the floor with them but they're level, so you are seen as more equal. This is far less stressful for them and you're more likely to get them talking if they feel equal. Sitting at a desk would have been impossible anyway! We did an expressive language sample while we were both colouring our pictures in.

3. Follow their lead, follow their interests: I didn't direct him very much really, I used books, toys and games he wanted to use. I asked him to choose each time. I had the Dewart and Summers pragmatic checklist his mother had completed and was able to interview her at length so it didn't matter that I couldn't do anything formal. I got a really good measure of his abilities and what he needs help with

4. Use a low-arousal approach. This Approach emphasises a range of 'strategies that focus on the reduction of stress, fear and frustration and seeks to prevent aggression and crisis situations'. The low arousal approach seeks to understand the role of the ‘situation’ by identifying triggers and using low intensity strategies and solutions to avoid punitive consequences. I keep calm whatever the situation throws at me (physically and verbally). His mother uses humour as part of this approach, brilliantly to deflect, move him on and get him on-side.

5. Never take things personally. Demand avoidant children may call you names (I know I'm 'old, fat and ugly' so nothing new there), may try to shock you verbally or physically or threaten you. We need to see it for what it is, an attempt to get out of a stressful situation.

6. Have the confidence not to mind what other people think: just as with pre-school ones you can burst into song, do unexpected silly things, pretend not to know.... As long as you can justify it....do it if the situation demands! Fortunately the student turned out to be brilliant and she didn't see me as some crazy old woman. She understands we have to do what it takes!

I was able to report on his attention, listening, understanding, vocabulary, expressive language and social thinking skills. The real hard SLT work will be done by my colleague as she sees him for therapy. The real hero? His mother.
Hanen www.hanen.org
Low arousal http://www.lowarousal.com/

Tuesday, 7 August 2018


PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding. See more at https://www.promptinstitute.com

Therapists begin by helping patients produce certain phonemes. A phoneme is the smallest increment of sound in speech. For example, the “d” sound in the word dog is one phoneme, the “o” is another and the “g” is yet another. Each phoneme requires different muscle contractions/retractions and placement/movement of the jaw, lips, tongue, neck and chest to produce. All of these things have to happen with the proper timing and sequence to produce one phoneme correctly.  The therapist attempts to “teach” the patient’s muscles to produce a phoneme correctly by stimulating all of these through touch. With the timing and movement of more than 100 muscles involved, you can see why the training needs to be very thorough.
PROMPT therapy is appropriate for a wide range of patients with communication disorders. The most common patients have motor speech disorders, articulation problems or are non-verbal children. Many patients with aphasia, apraxia/dyspraxia, dysarthria, pervasive development disorders, cerebral palsy, acquired brain injuries and autism spectrum disorders have benefitted from PROMPT therapy. An evaluation by a PROMPT-trained speech therapist is the only way to find out if a patient is appropriate for the therapy. 
We are delighted that Sophie Harding, speech and language therapist has completed her 3 day training. This means she  has been trained how to make the “touch cues” to the articulators to help patient’s produce a phoneme. She can also properly evaluate a patient (from a motor perspective) to identify if PROMPT therapy will be beneficial.
If you feel that our child needs an assessment please get in touch office@smalltalk-ltd.co.uk
  

Saturday, 4 August 2018

Welcome Alison to the Small Talk team



We are delighted to have a new addition to our team: welcome Alison Phipps, speech and language therapist. She has recently qualified from Birmingham City University with a first class degree. However, we have known Alison for many years as she used to work part-time as a speech and language assistant for us running groups in the Tamworth area. She was actually a graphic designer but wanted a change!

Alison is working across the staffordshire area. She has a particular passion for working with children and families with ASD and has already been on the Attention Autism course and is confident with SCERTS, Intensive Interaction, PECS and using visual support. She helped to run Hanen's More Than Words and Elklan's verbal children with ASD.   

She will be contributing to the blog soon!

Thursday, 2 August 2018

Is it just delayed talking or is it more?



As speech and language therapists we need to look at a toddler who isn't talking to determine whether we think it is delayed or disordered language or whether we need to refer on for further assessment. Remember, it doesn't have to be ASD, as there are so many more children with speech, language and communication difficulties than children with ASD. 


What are the red flags we are concerned about?......
  • Eye Contact and Eye Gaze – difficulty paying attention to faces and following your point after 12 months
  • Responding to their Name – inconsistent responding to own name most of the time by 12 months
  • Pointing to or Showing Objects of Interest – does not point or show objects to others by 15 months
  • Pretend Play – does not demonstrate how familiar objects are used by 15 months and doesn’t show true “pretending” in play such as feeding a baby doll or using one object to represent another object by 24 months
  • Imitation – does not watch other people to copy their actions and body movements such as waving; does not imitate sounds and words by 16 to 18 months
  • Nonverbal Communication – does not understand and use a variety gestures by 16 months; displays “flat” affect or limited facial expressions or body language
  • Language Development – exhibits delays and differences in both language comprehension and expression as compared to same age peers; may talk but not communicate with others. Expressive skills may be at a higher developmental level 
  • than receptive skills in autism. 
If you are concerned about your child, please see a speech and language therapist, as early intervention is really important!

www.private-speech-therapy.co.uk     To book an appointment at our clinic click here

Monday, 30 July 2018

THE 2019 SHINE A LIGHT AWARDS LAUNCH SOON

I had a lovely afternoon at this year's awards. If you'd like to nominate someone for next year's awards please read on.......

Pearson and The Communication Trust have once again joined forces to launch the seventh Shine a Light Awards. Entries for this year open in September with the awards ceremony taking place on Thursday 21st March 2019. Britain’s Got Talent winner, Lee Ridley, also known as the Lost Voice Guy will be performing at the event alongside a soon-to-be-announced celebrity host. 

The awards not only celebrate the hard work and determination of children and young people with SLCN but also seek to recognise the incredible contributions of teams, schools, settings, young people and individuals across England who champion innovative work and excellence in supporting children and young people's communication development. 
The award categories available for teams, settings and individuals to enter will include:

·      The Katie Rough Memorial Award for innovative or excellent practice when working with children and young people affected by Selective Mutism 
·      Early Years Setting of the Year Award
·      Primary School of the Year Award
·      Secondary School or College of the Year Award
·      SEN School or Group of the Year Award 
·      Child / Young Person of the Year Award
·      Youth Justice of the Year Award
·      SLCN Innovation of the Year Award
·      Communication Champion of the Year Award
··      Outstanding Achievement Award

The Shine a Light Awards website will be open to receive applications soon. Bookmark the website at www.shinealightawards.co.uk or follow the hashtag #awards_SAL