The challenges of a speech and language therapy student

by Gemma Biles

Recently Libby contacted me and asked me if I would like a chance to write a guest blog for the Smart Talkers blog and without a second thought I jumped at the opportunity. Then I realised I had no idea what to blog about. When discussing this with friends they said “Gemma, isn’t your blog about the challenges you have as a SLT student? Why don’t you write about your experiences in a way that reassures other SLT Students that they aren’t alone in this”. So my experiences as a SLT student didn’t start the day I begin this degree, it all started with the day I wanted to become a SLT. 

Back in 2004 when I was 15, I went to a careers day intending to listen to a woman talk about her experiences as a teacher. The thought of working with 30 children everyday made me nervous and doubt this was the career for me. It was at this point of doubt that a lovely lady took to the stage and stated "I am a speech and language pathologist, I work 1:1 with children" - anything more she had to say was interesting yet irrelevant, she already had me at her opening line. So over the years doing my GCSEs and A Levels I worked with many children within the disability sector and shadowed many SLTs attempting to gain experience in order to apply for my place on a SLT degree programme. 2 years ago I had the opportunity to sit for an interview for a place on a degree programme, and I can safely say that was the last time I felt confident that I knew what it was to be a SLT. I was asked questions that I had no answer to and posed scenarios that I was unaware were SLT related. When I found out I had a place on the course I was gobsmacked. Now 15 months in to my course I realise that not having an answer to something does not mean you are any less of an SLT. The same feeling of lack of confidence and uncertainty in my answers has occurred over and over, both in lessons and on placement. These moments have however been more of a learning curve than the moments when I did feel confident and did know the answer, and these are what have defined me as a SLT student. 

I recently read a quote by Bruce et al. (2005) who stated that students should be "thrown in the deep end" in order to develop SLT skills and I can safely say that a degree in SLT does just this. On a recent placement I admitted that I had a lot of observation experience and little hands on experience, I was then given a “caseload” and asked to go away and informally assess, formally assess, write therapy programmes and discuss all this with other professionals. Well at the time I can safely say I was drowning - but now in hindsight, that was the best opportunity I have had throughout my 15 months as a SLT student. I was pushed and challenged beyond belief. But more importantly I realised I COULD be a SLT and that I was more likely to be able to survive when I wasn’t being “hand-held”. At the end of this placement I discussed how I had felt with a wonderful SLT that had supported me over the 5 weeks and asked her how it was she managed to be so competent in so many areas, having recently graduated herself. 

She gave me some knowledge that has been beyond reassuring and continuously useful – “always know your evidence base, always be critical in your decision making and more than anything, always be the swan – graceful on top, paddling like mad underneath, never let anyone see how fast your feet are paddling”. It is at this point that I am about to begin my first placement of my 2nd year – where I have no doubt that I will begin my first day saying “I would like a chance to get hands on” and I would encourage any SLT/SLP2B to tell their placement educators this, no matter how scary it may seem! I’m sure I shall be endlessly tweeting and blogging my swan like paddling throughout this placement in January 2013 – so follow me @GemSLT or view my blog at http://speechandlanguagethera-peers.blogspot.co.uk/ 

Reference Bruce, C. Parker, A. and Herbert, R. (2005) ‘The Development of a Self-Directed and Peer-based Clinical Training Programme’ International Journal of Language & Communication Disorders, 36(Suppl) 401-405.

Christmas - No Surprises Please: I have ASD!

by Geoff Evans, Head of Quality Improvement, Options Group

Introduction

If asked what we like about Christmas many of us would reply with "the surprise presents", "the many different foods", "not having to engage in normal daily living routines", "socialising" and "meeting different people".

These are the things that make Christmas so special. For the individual with autism these are the very factors that make Christmas so difficult and a time to get through as quickly as possible. I recently asked a friend with Asperger’s Syndrome what we could do to make Christmas a better experience for him. Without smiling, he replied "cancel the b****y thing".

1. The Countdown To Christmas

It seems that Christmas starts earlier and earlier each year. This year I saw decorations on sale in August. This can make it very difficult for the individual with autism who often struggles with the concept of time and deferment of gratification, to wait for presents and the actual day to arrive. Using a variation of the traditional advent calendar can be a good way of helping the individual understand that Christmas is coming.

Some parents have used their child’s special interest for example, Thomas’s journey towards Christmas. This consists of a cut out Thomas the Tank Engine that moves towards Christmas a station at a time (each station represents a day or a week). The calendar or method chosen needs to reflect an individual’s level of understanding.

Other parents try to play down the coming of Christmas and keep it a secret for as long as possible. Obviously this is easier said than done. They could try to set Christmas within a time frame, for example we start preparing for Christmas when we put the tree up or after some other significant event. It is equally important to have a set time when Christmas is over.

2. No Surprises Please

Whilst some individuals with autism love surprises, others find them difficult to cope with and prefer to know exactly what they are getting for Christmas. One young man I talked to recently said he found it difficult to understand why anyone would want to buy him presents that he didn’t want or need. Also he said he found it impossible to pretend to like something that he did not. It is important to involve this young man in the selection of the present and the wrapping of it. Doing this reassures him that he will not be getting any unwanted items on Christmas Day.

When choosing presents, parents often feel under pressure to buy items that they would buy for an individual without autism of a similar age, they also feel that they should spend significant amounts of money. For me, it is about buying presents that will bring the maximum amount of pleasure to the individual and will have meaning for them. If this means buying unusual objects or wrapping up different types of household bricks - it’s OK.

3. Maintaining Structures and Routines

A parent told me that one Christmas her son with autism came into the kitchen whilst she was putting the turkey into the oven. In an anxious and confused voice he asked her "mummy, why are we having turkey for breakfast? I want bacon".

It is easy to forget that even the little changes can cause misunderstanding and in some cases this will lead to difficult behaviour.

A parent from Lincoln told me that she has experienced many difficulties with her child due to the change in Christmas day routines. For her the solution was to cook the dinner a few weeks prior, freeze it and then on the big day all she had to do was defrost and cook it, enabling her to keep more closely to the normal routines. This strategy was successful in reducing the difficulties.

If the individual normally needs a supportive schedule, don’t forget that they will require it over the Christmas period and you will also need to ensure that you have the appropriate symbols or pictures available.

4. Giving The Opportunity To Opt Out At Social Gatherings

Christmas is often a time for family gatherings, meals out and other social events. All of these can be a source of stress and anxiety for the individual with autism. Levels of stress can often be managed by providing a safe place for them to retreat to when it all becomes too much. A favourite object can also be a life saver at such events.

Encouraging the individual to flick though an Argos catalogue can mean that they remain calm and you get to stay longer.

Final Comment

When I used to run a sibling support group, I asked them to talk about what was the best thing about having a brother or sister with autism. One seven year old boy said "Christmas is great! I get two lots of presents. First I have my own presents, and then I have my brother with autism’s because he only wants the wrapping". I hope that this inspires us to always look for the positives over the Christmas period. I hope you all have a wonderful Christmas.

To read Geoff's regular words of wisdom, it's definitely worth subscribing to the Options Group Newsletter.   Visit the website www.optionsgroup.co.uk, to find out more about this and their ASC services.

Happy Christmas

Happy Christmas to all our friends, clients and followers!

We don't send out Christmas cards, as for several years, we have done a monthly donation to Cancer Research UK instead. We hope you understand.

We are looking forwards to an exciting year with lots of new plans. Watch this space!

Love from Libby, Franky, Helen, Georgina, Nicky, Nikki, Dee, Deb, Alison, Kirsty and Tasha!

Looking for a quality activity for a Monday morning in Stafford? Come to Stories and Songs

We are delighted to announce  a new group suitable for all pre-school children: 'Stories and Songs' on Monday mornings 9.30-10.15 at Stafford Children's Centre from Monday 14th January 2013.. 

The programme is written by language experts and delivered by Nicky Johns, a Mum of 4 and experienced Smart Talkers professional.

The sessions are exactly what they say i.e Stories and Songs but with lots of language and communication aims: attention, listening, turn-talking, choice making and more.

You are never too young for stories and songs so bring your little one along. £2.50 per child (discounts for more than 1 child per adult).

No need to book just turn up, we'd love to see you!

When a child has a statement that is not being followed

We've got a case at the moment where we know that a  school is not keeping to the recommendations of the child's statement.Our difficulty is that the teacher and TA have confided in the parent but the head and the authority are adamant that the little girl is getting what she needs.  They are so adamant that they are refusing to let the NHS SLT in the classroom (although she is welcome after school) and I am not allowed in at all, at the moment. The Head Teacher cant see what we can add as 'we know what we're doing'.

The statement is for 1:1 support but the TA is required elsewhere for some of that time. The girl is reception and has ASD and is non-verbal. She also needs help with the toilet but school say that the the class teacher can  ask the secretary for help or ask the headteacher (imagine the practicalities of leaving your class of 30 4/5 year olds to go to find HT or secretary??)

I would appreciate any advice anyone can give us please to ensure that the programmes are being carried out but keep the school on board at the same time?  We feel we can't tell the authorities at this stage what we know, without losing the support of the classteacher and TA.

I read with interest this week about Bromley council which made serious failings with a teenager’s special education needs. In her report Dr Jane Martin, the ombudsmen, recommends the council pays a total of £7,000 to the boy, who is named as N, and his mother Miss Peters because of its failures. N has selective mutism and severe anxiety so has a statement documenting his special education needs (SEN). Dr Martin, however, found the council failed to put all the required elements of the statement in place. It failed to provide speech and language therapy for N for 12 months and failed to provide a key worker for him for 10 months. 

However, this £7,000 is nothing compared to the effect on the child. No amount of money can replace the lost opportunities or feeling of extreme anxiety and failure the child might have experienced.

Read more: http://www.thisislocallondon.co.uk/news/10033794.Bromley_Council_fails_special_education_needs_teenager__ombudsman_rules/

New Children Centre Groups

We have started some new groups in children's centres in an area which is considered to be in the lowest 20% according to socio-economic studies. The children are delightful but have language levels which are way below the average expected. I spoke to a reception classteacher who reported that the OFSTED Inspector last week had been shocked at how low the over-all profiles were. If speech, language and communication skills are delayed, it has a knock-on effect to all learning.

We are working with children who have been identified as  lagging behind even this level. Their attention, listening, short-term memory, understanding and expressive language skills are delayed and the incidence of speech sound difficulties is really high (especially those associated with dummies). The other thing they all shared was low confidence and self esteem issues.

Talking to their parents revealed a similar profile of low confidence, little self esteem and an inbuilt distrust, boardering on hostility, to any form of establishment or professional. They are mostly third generation of unemployed and have worries about finances, housing, relationships and more, which are forming a barrier to successful interaction with their children. They all want the best for their children but just don't realise what they need to do. It is interesting that they are spending far more than me on Christmas presents this year and the pressure to have the latest fashion for themselves and their children is much greater than mine will ever be i.e. they want the best with no compromises.

It used to be instinctive to talk to children to develop their communication skills and without interaction they won't these skills develop properly. However, this has been lost some time ago with many families so that they just don't know any different.

Studies show that how a parent feels about themselves has a huge bearing on their interaction with their children (Roulestone et al 2011). How can we change the behaviour without appearing to criticise and thereby further destroy any remaining confidence?

It's a difficult task to change what they are doing (or not doing). Our Smart Talkers groups use demonstration to show what works for us. It's hard to feel intimidated by a woman sitting on the floor with her hand up a puppet, singing so they tend to feel almost superior, to begin with, at least. The hope is that parents will see what works and copy this themselves as their trust in us develops. We do have really good feedback to show that this works.

We show that by positive encouragement the children will achieve more e.g. when we are working on listening, we describe the behaviour we want i.e. good sitting and good looking, then we praise those who are doing it so that the ones who aren't, want to please, so they do it too. We also show how confidence can be encouraged, for instance, yesterday was the first time I had had one group and they all had very low self esteem. This manifested itself in 5 not looking at me or making eye contact and looking very worried and one who talked all the time in the hope I wouldn't ask him anything he couldn't answer. By the end of the session, with stickers proudly emblazoned on their chests, all were looking at me, smiling and waiting for my next instruction!

We use simple games and stories which can easily be copied by parents. Afterwards, we discuss what we did in the session, why it worked and what they could try at home. All done in a  non-threatening, non-critical way.  

There are other agencies involved, who are all doing their bit too such as family support workers, parent support workers, Book Start, Home Start, Health Visitors and the NHS SLTs. I'm looking forwards to seeing the progress of the children over time. 

We are commissioned to running the groups until April. After that will depend on how well I've filled the tender documents in. Lets hope I didn't miss of a tick box!

Physical development: Tips for parents by parents

  

It is with a touch of sadness that we have come to the end of Chuckle Talkers 2. This has been a project with our Smart Talkers pre-School Communication groups in conjunction with Chuckle productions with the fantastic Sara Christie and some lovely families from Silkmore Children's Centre in Stafford. We started in June to look at communication and how to incorporate communication opportunities into everyday activities. The course since September  has looked at how to develop children's physical development and address other issues which the parents had requested. The parents report that have leaned so much which in turn has a knock on effect on their children. They feel that they have improved knowledge about how to help their  children’s communication and physical development which has given them more ideas to help at home. They also say it has made them feel more confident to talk to other professionals.

They have put together their own tips for other parents, which I can share with you:

1. Through play encourage all types of child development

2. Give your child opportunity

3. Encourage independence skills e.g. walking, dressing

4. Give children time to practice their skills

5. Encourage gross motor skills in conjunction with fine motor e.g. catching a ball before they write

6. Encourage co-ordination skills by dancing, swimming and other physical activities

7. Core stability must be strong (tums, bums, back and shoulders). Improve with games such as bridges, big arm movements with ribbons, mark making on easels, row row the boat and other action games

8. Encourage fine motor control by threading activities, drawing, sticking, cutting, ripping, different textures e.g. rice, pasta,play dough

9. Spatial and motor planning are important for development to encourage by jigsaws, inset puzzles, sticker work, throwing, catching balls, shape sorter

10. Be aware of the amount of fat, salt and sugar in foods especially ready meals and drinks!

It's been a privilege to work with them and a delight to see how far they've come. We'd love to do a third course but with all the cut-backs this is probably un-likely. They would love the outcome of the project to be  a book for other parents to share what they have learned.  

So keep your fingers crossed or find us a wealthy sponsor!

You can read more about Chuckle at http://chuckleproductions.com and Smart Talkers at www.smarttalkers.org.uk

Libby and Nicky

More than a third of five-year-olds are struggling to communicate

More than a third of five-year-olds are struggling to communicate – or understand the basics of reading and writing – because of key failures in early years care, it was revealed in OSTED's annual report earlier this week. Record numbers of young children – some 96 per cent – were currently in some form of pre-school education but it warned that “significant weaknesses” remain in terms of how well providers use the Government’s early years curriculum to “prepare children for school”.

In a damning conclusion, it was claimed that children from the poorest fifth of homes were on average 19 months behind wealthier classmates in their use of vocabulary by the age of five.

The gulf between rich and poor was wider than in most other major English-speaking nations, it was revealed.

From this it appears that the situation hasn't moved on despite the best efforts put in place since the Bercow report.

Our Smart Talkers pre-School Communication Groups  run in Children's Centres and also nurseries to help develop  language and communication skills to reduce the gap between these children. We have excellent results. We will be reporting on a project in the Lichfield area that we are currently doing, soon.

www.smarttalkers.org.uk

http://www.telegraph.co.uk/education/educationnews/9706275/Ofsted-third-of-five-year-olds-not-ready-for-school.html