Thursday, 15 March 2018

Don't rely on the test score alone

I read this interesting article today which mirrors my beliefs:

We cannot rely on standard testing alone, we need a measure of what the child or young person is doing in 'real-life' everyday, functional ways. As a great example, I've got an annual review this week where the 14yo has scored age-equivalently on everything on the CELF-4 BUT that does not mean he needs to be discharged.

I see him on a one-one basis where he sees me as an equal. There's no anxiety so I can push him to his absolute best, he wants to both please me and beat me at tasks. His memory has wikapaedic qualities! However, in everyday situations he cannot put his skills into place as he has auditory processing issues, anxiety, difficulty reading people's cues and clues and he acts as a much younger child (as a safety devise?). His anxiety affects his processing and his language and communication difficulties remain a huge barrier to accessing the curriculum, making friends and 'fitting in' with his peer group. Fortunately, he has a parent who knows all this and will fight to the nth degree to make sure he receives the support he needs.

I've also seen numerous children who score well on tests but in context cannot use these skills demonstrated in the one-to-one, quiet situation with the very nice lady/man who is skilled at getting the best out of children for the short time they're there. We only get a snap-shot of the child in that situation, at that time.

Instead of relying on just a score, we also make use of checklists and interviews with people who know the child best, so parents and teachers; we use tools such as the CCC2 and the Dewart and Summers Pragmatic profile. We also use a dynamic approach so we're looking at everything from the initial 'Hello' to the sight of the back of their head on the way out!

Formal assessments have a place, of course (I'm not stupid!) but we need to listen well to the important people in the child's life and be more confident in our skills as clinicians! What do you think?

Monday, 12 March 2018

How to get help for Selective Mutism

Smira has worked hard to produce an excellent flowchart about where/how to get help for SM:

Links given on page 1 above:

Search for Private Therapist
Check that the therapist has SM knowledge and is registered with

Links given on page 3 above:

Additional Reading
Details and purchase links for all of the books below are on the Recommended Reading page on the SMIRA website.
  • “Selective Mutism Resource Manual 2nd Edition” (Johnson & Wintgens). Most changes in 2nd Edition are for older people with SM and generalising outside school
  • “Tackling Selective Mutism” (Sluckin & Smith, ISBN-13: 978-1849053938, ISBN-10: 1849053936)
  • “Can I tell you about Selective Mutism?” (Johnson & Wintgens, ISBN-13: 978-1849052894, ISBN10: 1849052891)
  • “Can’t Talk? Want to Talk!” (Jo Levett, ISBN-10: 1909301310,ISBN-13: 978-1909301313)
Selective Mutism Information flowchart p4

Have a look at the SMIRA website

Friday, 9 March 2018

What’s inside Tasha’s Toolbox!

I’ve been so busy lately with all the new children on my caseload on and of course the launch of our Parent Hub Membership Club; that it got me thinking back to many years ago to when I was a student at Smalltalk. I remember Libby telling me on the very first day that as a Speech Therapist there will never be enough hours in the day and that I always had to be prepared for anything the job may decide to throw at me. And of course, she was right! On that day she assigned me one simple task! – to create an ‘Initial Assessment Kit’ that, when working with any child on the caseload, I would be able to use to carry out a complete assessment screen of their communication development. After a small moment of panic (that of course I didn’t admit to at the time) it occurred to me that, no matter what child comes through the door, regardless of the difficulty or diagnosis there are still underlying factors we need to target.

And so, my Mini Assessment Toolbox was created and nearly 8 years later I am still using the same kit, if not with a little wear and tear and a few new additions. Though one thing hasn’t changed; there are still not enough hours in the day and I still need to be prepared for anything. If like me, you are continually dashing between appointments, have little time to remember all the resources you need beforehand or get thrown into a new assessment at the last minute, it may be a good idea to have your own handy Toolbox that you can keep with you containing all the essentials!

Today I thought I’d write a helpful post showing you what’s inside my Assessment Toolbox.

 1.      ‘Now and Next’ Visual Timetable whiteboard
2.      Session Activity pictures
3.      Short story book (with accompanying Blank Level Question)
4.      Bubbles
5.      Balloons
6.      Balloon Airplane and (a fun and engaging turn-taking toy)
                                                              i.      Wind-up - Toy “Dancing Robot”
7.      Information Carrying Word (ICW) pictures
8.      Matching Rhyming Cards
9.      Everyday objects: (for Auditory Memory and Vocab)
                                                              i.      Cup
                                                             ii.      Ball
                                                           iii.      Spoon
                                                           iv.      Car
                                                             v.      Bear
                                                           vi.      Pencil
                                                         vii.      Glasses

10.  .and of course, Stickers
So next time you are rushing between appointments, just remember to keep you Toolbox close by, and you’ll be surprised by how many areas of speech and language you can work on with just a few everyday objects!

Wednesday, 7 March 2018

What is a lateral lisp?

A lateral lisp is a type of functional speech disorder, where a child or adult has difficulty producing specific sounds.


The term “lisp” is not typically used by speech and language therapists as it is not very specific - there are actually four different types of lisp as well as all the other speech sound errors. Instead we may say “lateralisation of s” or “s articulation difficulties” depending on what the error is.

What is a lateral lisp?

As mentioned, a lateral lisp is a type of functional speech disorder. Unlike some other lisps, Lateral lisps are not found in typical speech development. The tongue position for a lateral lisp allows the air to flow over the sides of the tongue instead of over the front. This is the reason this sort of lisp is sometimes referred to as a 'slushy lisp'.


There is no known cause of a lisp. However, some professionals suggest that excessive or long-term use of dummies could be a contributing factor. This is not the case for all, as some children who have never used a dummy still go on to develop a lisp.


There are many different ways to work on Lateralised sounds, depending on what the sounds are.  Typically it will include listening activities, production of the sound in isolation (the sound alone) progressing onto words and sentences.

Sophie Harding
Speech and Language Therapist

Sunday, 4 March 2018

But she looks fine when she's here!

How many times have I heard this yet the parents KNOW their child is anxious?! Maybe they've had to drag them kicking and screaming into school, maybe the child has tried to self harm or attacks their parents on a regular basis. I saw this on twitter and it sums up how anxiety is not one thing. We don't always see it. A child can mask: hide their issues at school but all the time building the pressure til they get to the save haven of home or maybe just the carpark in some cases. It's called the 'delayed effect'.

It's not right just to say, 'it's parenting,' We need to listen, we need a team approach not 'them' vs 'us'.

Please help spread this word as it's a HUGE problem and children's mental health depends on more people being aware that anxiety does not have just one 'look'.

Sunday, 11 February 2018

Bad behaviour? no, just a lack of awareness and understanding of SLCN

Many of the children I work with get in trouble because they have language and social communication difficulties which impact simple, everyday interactions. This is just a typical one from last week:

A lovely young lady I met recently, Ruby aged 12 years, was very upset to receive a detention for something that had happened in school. The teacher was one she knew but was a maths teacher, who was covering a science lesson. 

This is what Mr Jones, the teacher reported and says happened in lesson:
He'd asked the class to be quiet, Ruby 'decided to continue talking'. He asked her if she understood what he'd said, and she said, 'Yes,' but carried on talking. He became cross and told her to 'be quiet.' She was shocked and said, 'But it was quiet working and if you wanted the class to be silent, you should have said.' Mr Jones felt that Ruby was being difficult and disrespectful for no reason.  He discussed this with her, but due to her response he felt he was unable to get anywhere and had no option but to give a detention for her poor attitude.

Teacher who was normally in maths covered science

Ruby dislikes change and hadn’t been prepared
Teacher asked the class to be quiet
Ruby carried on talking
Ruby has a literal interpretation of language, so he didn’t say ‘silent’
Teacher probably looked at Ruby and pulled a face to indicate he wasn’t pleased
Ruby carried on talking
She can’t read facial expressions and would not be able to interpret his intentions
He asked her if she had understood
She said, 'Yes.'
In her mind she had got the right interpretation
He said, ‘I meant silence!’
 She said, 'you didn't say that!'
She has difficulty with word definition and is sure she knows, whereas she might be slightly off or way off
She also cannot read inference
She said, ' You should have said that then.'

Ruby has little understanding of the rules of modifying language to teachers. She doesn’t know it's rude
Teacher thought she was being disrespectful
As she would be if she was of typical social understanding and /or pragmatic ability
 She hasn't got the language or pragmatic skills to interpret the situation

Ruby wouldn't let the subject drop
She has a clear fairness rule/sense of justice which she thinks the teacher was being unfair as she didn’t understand
Teacher discussed it
Ruby didn’t give the response he expected
She doesn’t understand as she thinks she didn’t do anything wrong
Teacher would be upset with her and may be was possibly feeling a bit under-confident as he was not teaching his subject

She can’t put herself in others shoes/see their point of view

 That's not the worst one I heard this week either!

We need so much more awareness about language and social communication difficulties, it's NOT just children with ASD!

Please support the campaign to save the Communication Trust as they are working hard to help schools understand more see more here

Tuesday, 30 January 2018

What does anxiety look like in a pre-schooler?

I work with a fabulous nursery who have just taken over a pre-school too. I'd like to say who but it might identify the child so I won't. They have such a great balance of professionalism and caring. They also really understand children.

I saw a 4 yo chap today who sat in my little group and pretty much did everything that was asked of him. He joined in, answered questions, volunteered answers, helped another boy who was struggling. Only a minor protest when he didn't get a gold star first, in fact.

Last time I'd seen him was before xmas when his behaviour was awful: I'd even managed to be hit around the head with my own boot! He'd ripped things, stole things, grabbed items out of my bag and ran off with them, tipped the bubbles on the floor while maintaining eye contact in some sort of act of defiance, refused to co-operate, etc etc

In many nurseries he would have spent hours on the naughty step, been told off, been discussed by staff as the 'really naughty one'. In this one, however, they knew better: they knew that his behaviour was actually as a result of low self-esteem, poor confidence  and a desire for attention which didn't matter if it was positive attention or negative attention.

They've given him a good routine with firm boundaries, ignored what they don't want to re-inforce and praised what they want to encourage. He's really doing well and is miles away from the boy he was before xmas! I'm sure they're will be a few hiccoughs along the way but with the right support and understanding he's doing fantastically!

Friday, 12 January 2018

Working with demand avoidance needs a different approach!

I had a break through today! I won't get complacent as it might not happen again or at least not the next time I try the same things but.........

F is a beautiful, funny, witty, gorgeous little princess who is like a ray of sunshine...... until you ask her to do something, when she can turn into 'a monster from your worse nightmares' (parental quote, not my words but I do know what they mean). 

I have used demand avoidance strategies on her for a while but the session might go something like this:

Me: 'Ok, thank you for choosing the order of the session F, let's see, you chose the memory game first.'
F: 'yes, but I'm not doing your stupid game now........I'm playing with the plastic fruit'
Me: 'No problem, let's use the fruit for the game.'
F: 'Ok, but I'm not playing on the table.'
Me: 'No problem, let's sit on the floor to do it, we'll have more room anyway.'
F: 'NO and you can't make me!'
Me: 'Where shall we do it because look, (pointing at her written list) you said we'd do it and it's on the list?'
F: 'On the floor under the table.'
Me: 'No problem,' but actually wondering if I'll get out from under the small table she's referring to!

This might happen for all 4 planned activities or we may only manage 2!

Today I 'wondered' (alot!) and did not tell her to do anything at all. I acted as an equal, discussing her favourite things, commenting on her new shoes, drawing on a white board next to F drawing on her white board. I asked no questions but made lots of comments:

'I wonder where F would want to work' (she chose somewhere different to usual)
'I was wondering what F had for xmas'
'I wonder what order we should do these'
'I wonder if F could show me..'
'I wonder if F wants to carry on drawing while we do this activity'
'I'm not sure I know what to do here...'
'I think I need help with this...'

We managed all the activities and both of us looked far less stressed at the end. I will try that again but F may have changed the goals by next week!

We need a different approach, we can't be the adult and tell them what to do. We need to pick battles and  make different priorities but above all we need to understand that this child is very anxious and the anxiety means she needs to feel in control. She doesn't need reprimanding, she needs compassion and support. The children who need the greatest help may ask for it in the most unhelpful way (I don't know who said that, but it works for me)!

I love the ideas and activities  in Understanding Pathological Demand Avoidance Syndrome in Children: A Guide for Parents, Teachers and Other Professionals 
by Phil Christie ,‎ Margaret Duncan ,‎ Ruth Fidler ,‎ Zara Healy. If you work with someone similar to F, I'd highly recommend this book.