What is mindfulness?

Guest blog post by Jude Brown

Being busy is, at times, unavoidable. Family, work, friends, eating, shopping, cleaning to name a few of the daily tasks we need to squeeze into the hours before we can finally sleep and hopefully ‘switch off.’

Two years ago I began to look for space within this ‘busyness’ and this arrived in the form of mindfulness. A modern day meditation practice which allows us to stop, be present and create the emotional and mental space we all deserve.

Initially, I used mindfulness to literally just stop and I found that by practising simple mindfulness techniques for a few minutes, several times a day, I begun to relieve some of the pressures of the never-ending to do list. But now mindfulness is becoming much more than just a ‘pause’ button. Its simple strength comes through regular practice and has changed the way I view life, its pressures, people; even the way I eat and walk!

Following training, I used my personal experience and teaching skill to introduce mindfulness into schools. I wanted children to understand its benefits and to realise that once learnt, it was a tool for life. It was during a search for resources I came across Smiling Mind and once I started using it, realised its potential it not only teaching children Mindfulness but also supporting and developing the knowledge and skills of adults who work with children.

Smiling Mind is a web and App-based program developed by a team of psychologists with expertise in youth and adolescent therapy, mindfulness meditation and web-based wellness programs. Having launched three years ago, the app has been downloaded over 1 million times and is now used by over 9000 schools in Australia.

In recent years’ mindfulness meditation has risen in popularity for use in the treatment of anxiety, depression, stress and other physical and mental illnesses.

Well respected institutions such as UCLA, Harvard, Oxford, Monash and Melbourne Universities have developed clinical studies into the positive impacts of mindfulness meditation.

“The world needs mindfulness and in this fast-paced, stressed and distracted world, the children of today probably need it more than any previous generation," said Dr. Craig Hassad, Smiling Mind ambassador.

"Smiling Mind is taking Mindfulness Meditation to where it is needed most -- into the hearts and minds of young people. It’s more than just a technique, and more than just a life-skill. Mindfulness is a way of life." Co-founder Jane Martino agrees. “Our vision is for mindfulness meditation to be on the curriculum by 2020."

Smiling Mind offers a preventative tool to support mental health, increase the ability to focus, and pay attention to the present. When you consider that the average office worker check their email 30 times every hour, and that the typical mobile phone user checks their phones more than 150 times per day, learning how to be in the present is imperative.

“Smiling Mind took something which was a bit fringe -- meditation -- and packaged it in a way that used technology far more effectively," said James Tutton, Co-founder of Smiling Mind. Smiling Mind is free to download and is now pleased to announce that Professional Development Workshops are available in the UK from 2016. The workshop will be supported by the “5-week Smiling Mind Adult Meditation Challenge". Staff will be supported by a weekly online training program. This involves interesting information sent out each week, to support their knowledge of the subject. It includes reminders and tips, links to articles and interesting research, visuals and quotes. 

More information can be found by contacting jude@smilingmind.com.au

Selective Mutism: today's brief success story

Selective Mutism (SM) is very prevalent in the UK. A recent survey showed up to 1 in 150 children may suffer. There's huge debate about who should work on it: some speech and language therapy departments say it's them, others refer straight to CAHMS, as its seen as a mental heath issue.

It may be an anxiety based disorder but Speech and Language Therapists are trained to deal with all kinds of speech, language and communication problem and CAHMS are not. Where the two can work together that's great. At Small Talk, we see lots of children with SM and work with a counsellor and clincal psychologist where necessary. I've also studied both CBT and animal assisted therapy which adds more strands to our thinking/therapy.

I met a very anxious child in July before the schools broke up. She talked to her mother and sister only, no other family members. She wouldn't look at me and I did not attempt to talk directly to her. Her shoulders were hunched and she hung her hair over her face. She had no voice even for laughing (her dog found dog biscuit in my jacket pocket and pinned me to the settee, which was funny!). I decided to go into school in September to arrange a small steps programme. I was a little worried because it was an enormous primary with over 100 children per year group. I thought they might be too busy to support my plans.

I met with the SENCO and the TA in September to discuss a small steps programme. I asked for 3 weekly slots of 10 minutes each where she could form a  relationship with the TA. To begin with they'd use non-verbal games to build confidence etc. They were very keen to help and to do anything which would make a difference.

In October, I reviewed the situation and was very pleased; she was now talking in a whisper to one of her teachers. The TA and I discussed activities, aims and how to build on this.

Today, I went in again and she is talking freely to both her teachers in class to ask for help, make requests, comment and even for fun! She looks confident, smiles a lot and joins in everything she's required to. She still doesn't talk to her peers in school, so that's the next steps. I'm going in again in February but they know they can ring me anytime.

It just shows what a major difference can be made if we break the problem down into small manageable steps and put appropriate plans in place. Congratulations to the school and especially the TA!!

Top 100 speech therapy/pathology websites and blogs

Have a look at the top 100 speech pathology/therapy websites and blogs from Kidmunicate. There are 2 UK blogs on there: ours and SpeechblogUK
http://kidmunicate.com/best-speech-pathology-websites-and-blogs-2016/#sthash.2MZ5U3vh.dpbs

‘APP’-Y FAMILIES - Parenting Expert Sue Atkins releases free ‘Parenting Made Easy’ app

We really like Sue Atkin's practical, down to earth approach to parenting, especially the way she understands that parenting is not easy; Natasha Hallam at Small Talk said the other day, 'Even if they came with a  manual, the child wouldn't have read it!'

It is the hardest job in the world and we all need help to be better, we are delighted, therefore, that Sue has released an app about her 'parenting made easy' approach. This is what she says:

“I know how tough being a parent can be. But I also know what a wonderful role it is too. Parents deserve to have the right tools and techniques for their family, so they can promote a happy and healthy environment at home”, says Sue.

Providing users with access to free parenting tips, and exclusive information and resources that builds on her existing repertoire of ‘Parenting Made Easy’ products, the aim of the app was to make Sue’s expert knowledge more accessible to users, by providing them with a wealth of information at their fingertips. The app equips parents with clarity, direction and confidence to successfully raise their children.

In the app, Sue offers advice through various mediums, including pages on parent coaching, tips and tricks on good parenting techniques, videos, audio podcasts, as well as direct access to her blog, links to stories and more. Each week Sue will also post a question for parents to ask themselves, accompanied by some background experience, in an attempt to get users to reflect on their own techniques and how to improve them. . TO DOWNLOAD THE APP CLICK HERE: 

Sue Atkins is an internationally recognised Parenting Expert, Broadcaster, Speaker and Author of the Amazon bestselling books Parenting Made Easy: How to Raise Happy Children and Raising Happy Children for Dummies

My child understands everything I say but the speech therapist says he has little verbal understanding:who is right?

Answer: you both are, but you are looking for different things. I hear this said so often that I though it would be a good idea to try to explain it .

1. There is a difference between verbal understanding and understanding the situation (situational understanding). Imagine you are in the middle of Russia but you only know a handful of words of Russian. You'd actually be OK most of the time as you would follow clues and cues, watch carefully what others were doing and follow, look at facial expression and body language including gestures. It would break down if someone asked you a question without any visual referent, no context or idea of what they were saying. 

It's like this for children. If you say, 'we're going in the car' but you have the car keys in your hands, you could say, 'ibbly dibbly doo.' and get the same result:the child knows what's happening. If you say, 'Fetch your red shoes from your bedroom cupboard next to your bed,' and they come back with them, ask yourself which bit the child understood. If they always wear those shoes for going out and they're kept in the same place, then the word 'shoe' could perhaps be the trigger rather than anything extra. I'm not saying situational understanding is bad, it's just different to actually understanding the words. It is also a big strength because it shows the child is aware. Situational and verbal understanding together is what we aim for.

2. Information carrying words (ICW):

When we talk about information carrying words, we mean the number of words in a sentence or phrase which the child has to understand in order to be able to carry out the command. It's about the choices given (thank you to Jayne Waterman at Little People Nursery for that description). If I have a  these pictures (from Black Sheep press Barrier games pack) and asked 'can you show me the little green ball?' They would only need 2 information carrying words as the choices are size and colour.

If we had the 2 sets of pictures and asked 'show me the little green ball' they now have 3 choices colour, size and object so the task is 3 information carrying words:

 

If we cut up those 2 sets of pictures and added the monkey and the flower:

The request 'put the little green ball on the monkey' would now be a choice of size, colour, object and place so 4 ICWs. This is school entry level!

We'll look at another example next time to make sure it's clear as it's such a  great concept which gives you an understanding of where the child is but also how to tailor what you say to make it easier for the child to understand.

http://www.blacksheeppress.co.uk/

Talk to your Baby

We are delighted to be able to run this lovely course, free of charge to Staffordshire families. 75% of a baby's brain develops before the age of 2 years which makes the first 12 months crucial. Come along to 'Talk to your baby'. These are interactive sessions for parents/carers of babies aged 3 -12 months.

This course covers:

·         What is communication?

·         Adult-baby interaction

·         Play; the link between play and language.

·         Using words 

·         Play skills and sharing books

The sessions are very practical, there are opportunities to:·         Think about your baby's communication·         Try new ideas·         Choose activities specifically for you·         Discuss a range of related issues·         Practise using ideas at home

These are being held starting w/c 2nd Nov at:

 Charnwood Childrens' Centre in Lichfield mondays at 10.00 am, 

Cannock Chase Children's Centre mondays 10am

Silkmore Childrens Centre 10.00am wednesdays from 11th Nov

East Staffordshire on fridays at 1.00

Landywood Children's Centre on 1.00pm Thursdays

Just turn up, no need to book

Calling Staffordshire Parents of pre-school children with social communication difficulties!!

We're delighted to be able to run Hanen's More Than Words for parents with pre-children with social communication difficulties, ASD or ASD tendancies? It's  free of charge for parents or professionals from staffordshire http://www.hanen.org/Programs/For-Parents/More-Than-Words.aspx

We really like this course as it empowers parents to use everyday routines, play, toys and songs at home/out and about. Forget the worksheets and flashcards, this shows you how to use real situations to develop real communication. We learn language best in functional situations and if you have trouble generalising, then its got to be in everyday real-life situations.

Thursday 5th November at Uttoxeter Fire Station 7-8.30 pm

Monday January 11th Chase Terrace Fire Station 7-8.30 pm

Landywood Chidren's Centre, Gt Wyrley Wednesday 13th January 6.30-8.00. 

Courses run for 10 weeks. 

Just turn up on the first session or email info@smalltalk-ltd.co.uk to book a place. If you need any more information, just let me know.

'He doesn't need speech therapy he talks fine!' When speech and language therapy assessments are a problem solving exercise!

My job could never , ever become boring as I meet the most fascinating characters every day. The more complex cases I do, the more referrals of complex cases I get. Each one one is different with completely distinct profiles but there is a thread which runs through everyone: a communication difficulty is an enormous barrier for children and leads to awful consequences in many of the cases I have seen. I used this quote "The ability to communicate is central to all that we do, to who we are, how we learn and how we relate to others. Communication problems of any kind, however mild, will certainly lead to isolation, frustration and an inability to fully integrate into society. Children will have a harder time making friends and fitting into nursery or school" (Ross, Leeds Metropolitan University, 2007). I was berated for making the issue sound so series, yet it's so very true for so many children.I see children who are struggling every day yet no-one has thought to refer to speech and language therapy as they 'talk fine'. Its usually because they know someone else in the same boat who has recommended us to be honest.If you have a child who sees things in a black and white manner, is quite literal, has problems getting on with staff and other children, has melt-downs or is very anxious, please see a speech and language therapist who is used to working with complex children. We can assess their pragmatic/social use of language and their receptive processing along with their expressive language to provide a full picture.If we have a profile of their needs we can look at strategies which can help enormously. If we can explain their behaviour, its so much easier to understand it and therefore cope better. Behaviour is just the symptom, if we can address the cause, the symptoms will diminish or in some cases disappear altogether. Obviously there are other causes of behaviour problems but a language and communication issue cannot be ruled out for many children.

October is SM Awareness: please help

The ‘Make a Noise for Selective Mutism Awareness Campaign’ is the social media arm of SMIRA’s Awareness Campaign for October 2015.  It involves an activity that we hope all ages can take part in, from grandparents to toddlers and even the family dog! Groups, school classes, etc. can also participate in any way they feel appropriate and it can also be expanded for use as part of a fundraising event, even without the video element.  Just be creative in what you do!

SMIRA’s aim is to raise awareness of selective mutism generally but also to raise funds to provide much needed training opportunities, particularly for health and education professionals and anyone who may be involved in the care and welfare of selectively mute children.

 Let’s help ‘our’ children find their beautiful voices!

How to take part in the ‘Make a Noise’ campaign:

·         First of all, think of creative ways to make a noise.  This could be using homemade musical instruments, household items, machinery or anything at all, then prepare to make a short video.  Wear fancy dress if you like, or do anything that might liven up your recording.  Our Music Therapist friend Kate Jones has provided some suggestions for making a noise – see below.

·         At the start, participants could say to camera that they are ‘Making a noise for selective mutism awareness, and ask (or nominate) xxx to do the same’.  Feel free to add any other comments that you feel might be relevant.

·         After completing the ‘noise making activity’ please either speak, hold up a card or add information under your video, saying ‘To donate, please text MAKE 15, followed by the amount, to 70070.’  (Our suggested amount is £3 but of course the donation can be for any amount).

·         SMIRA has a special ‘Makeanoise4SM’ page on facebook where you can upload your video, or use your chosen social media outlet adding the hashtag #MakeaNoiseforSM  or tag @InfoSmira  on Twitter.   

·         If you are too shy to appear in a video, you could if you prefer post a photo along with a text description of the event.

If you wish you can copy, paste and edit this underneath your video or photo:

·         Thank you XXX for my ‪#‎makeanoise4SM nomination. I have donated £3 to SMIRA. Now I would like to nominate XXX and XXX to make a noise for Selective Mutism awareness. Please text MAKE15 to 70070.
For more information on the campaign and Selective Mutism click here:http://www.smira.org.uk/

Thank you for taking part in our campaign!

Using Compound Words to Introduce Syllables

Guest post by Margot Edwards 

 

Teaching a child to understand the underlying structure of spoken language is a key component in the child’s development of phonemic awareness, a crucial skill for children who are learning to read.

It can be difficult, however, to explain the concept of syllables to a preschooler. Even small children are intimately familiar with the meaning of language. Sentences and words have meaning. But a syllable may have a meaning of its own (such as run- in running), or it may not (the al- in alligator). If a syllable has no independent meaning, many children simply don’t notice it as a unit of speech apart from the meaning of the whole word.

I recommend easing children into this tricky concept with a series of compound word activities. Compound words are multi-syllable words that are made up of smaller words, such as snowball, dollhouse, and horseshoe. Because each syllable of a two-syllable compound word is a word on its own, children are better able to notice the syllables and to understand what you mean when you talk about dividing a word into parts.

Recent research has shown us that synthesis (blending separate syllables into words) is easier for children than analysis (dividing words into syllables). So start with two synthesis activities. In the first, Making Compound Words, say two one-syllable words for the child (such as pop and corn), with a big pause in between, and the child will combine them to make a compound word. In a follow-up activity, Making A Longer Word, you give the child the two parts of a three-syllable compound word (e.g., blue and berry), to combine into a longer word.

Analysis of compound words is a more difficult skill, so I’ve created a series of six activities to teach the concept bit by bit. In Part 1, the child must identify the first part of a compound word (“Say fishbowl but don’t say bowl”), using a picture card as a visual clue. On the card are four pictures, one of which is the correct answer.

Part 2 is exactly the same activity but without any picture clues. Without pictures, the child will have to work harder to remember the word, divide it into parts, and say only the part you ask for.

Part 3 requires the child to pick out the second syllable (“Say rainbow without rain…what’s the last word in rainbow?”), with picture cards as clues. Part 4 is the same but with no picture cards.

In Part 5, give the child a mix of words. Sometimes you will have him tell you the first part of the word, and sometimes the second part. This is a big challenge for his memory and listening skills, but we provide picture cards to help him. In the sixth and final activity, the child must identify either the first or last syllable of a compound word, with no picture clues.

Start with the first of these activities, play it with the child for 10-15 minutes a day until he’s mastered it, then move on to the next activity. Before you know it, the child will be ready to dive into learning about syllables.

Margo Edwards is the Director of Content Development at SightWords.com, a website dedicated to the promotion of child literacy through a variety of free online resources. SightWords.com is proud to be sponsored by the Georgia Preschool Association. 

Help, what can I get to work on my child's speech, language or communication skills at home?

There is no substitute for direct work with a speech and language therapist but sometimes the waiting list is very long or the availability is poor in your area. If your child is struggling with a speech, language or communication issue, what are you supposed to do? You could 'google' the problem, but how do you know what you find is credible or value for money?

We decide to set up a site where we could sell books, activity packs, games and ideas, which are written by, or certainly endorsed by, practicing speech and language therapists. Parents can search by age or the 'problem' to find materials which will help at home. www.speechtherapyactivities.co.uk

There are old favourites such as Toddler Talk from ICAN alongside new materials such as the Auditory Memory pack. We'll be adding more very soon such as Hanen's More Than Words and It Takes Two to Talk. If there's any area in particular you'd like something for, please let us know. We're already working on a phonological awareness pack for pre-reading or pre-speech work skills and a word finding pack for those who struggle to access the words they know.

 

Get in touch at the usual address  info@smalltalk-ltd.co.uk or enquiries@speechtherapyactivities.co.uk We look forwards to hearing from you.

Communication Leaders

This new initiative from the Communication Trust looks excellent. 

Communication Leaders is a peer-mentoring approach to supporting the language and communication development of primary and secondary pupils. It allows children and young people to take on a unique leadership role in communication within their schools and homes. 

You can choose how to implement this approach in your school. You'll find everything you need in the link below, including a training session for staff to introduce the approach and resources to the chosen Communication Leaders, the resource packs, and a video showing staff and Communication Leaders talking about their experiences from the pilot project.  
Click here

Smart Talkers in East Staffordshire!

Celebrating the official opening of our clinic

Please make this go viral!! It's a great cause

Last week, AFASIC  launched #HumForAfasic social media campaign to raise awareness of speech, language and communication needs. In an effort to ‘go viral’ and spread the word on SLCN and the work of Afasic, they are using Facebook as a tool and hope that many of their members, supporters, friends and staff will get involved.

The idea of the challenge is to video yourself humming a song, upload it to Facebook and nominate some friends to guess your song and do their own video. This is also a great opportunity to raise some much-needed funding for Afasic, so we have set up a text code where people can donate £3 by texting ‘HUMA50 £3’ TO 70070.

They chose humming to demonstrate the difficulties many children with SLCN face on a day to day basis, while also being a fun challenge.  We'll be uploading our attempt shortly!

Please join in with the #HumForAfasic challenge. Let’s get humming!

For any questions about how to get involved, please email Victoria Ward or call on 0207 490 9410.

Sequencing - not just writing stories!

Every week I receive phone calls from parents asking me to work with their child, often stating that they can talk 'fine' it just some speech sound errors. On first meeting the child I can see that yes the child does have some problems with speech sounds and is talking in full sentences, but on closer inspection realise that much of what the child is saying doesn't make a lot of sense. Children often struggle to plan and organise their ideas in a logical way, which results in the listener finding it difficult to follow what they are trying to say and is often the result of a sequencing problem. The ability to sequence doesn't just correspond to narrative skills, but encompasses all areas of language development including; speaking, understanding, thinking, reading and writing.

To keep up with the increasing demand from children to include some technology based activities in therapy I have recently discovered some fabulous iPad Apps from Colorcards, which help me to target sequencing problems and the interactive activities are both motivating and engaging for children of all ages.

When working with either a group or individual children I like to use the 'Everyday Objects' app first to ensue the child is able to describe the pictures accurately, as a foundation skill to sequencing. All three sequence apps ie 'Basic', '4-step' and '6&8 step' are definitely worth investing in, as it is vital to ensue the child fully understands the concepts of first, next and last in a simple three part sequence, before you can expect them to build up to large sequences and then eventually prediction. The added extra of an accessible report template is quick to use and enables me to comprehensively track progress throughout the therapy process.

Each app has the great ability to set up multiple student accounts which can be tailored to target individual difficulties and goals. Differentiating between three levels (easy, medium, hard) is fantastic for building confidence with even low level abilities and being able to input your own images supports the child to be fully engaged in their own learning. Often some of the children I come into contact with have had limited and varying life experiences, so the option of creating your own story sequences ensures these apps are accessible to everyone.

Natasha Hallam

Myths and mis-information:tongue tie

1. 'Tongue-tie (ankyloglossia) happens when the string of tissue under your baby's tongue (frenulum), which attaches her tongue to the floor of her mouth, is too short. If your baby has tongue-tie, her tongue can't move freely, and this can cause problems (NICE 2005a)'
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3. I had a conversation this week with teacher who was saying that a child should have had his tongue tie snipped ages ago because now its been done, he can talk. She attributed his recent progress to that fact. Trouble is, he wasn't saying anything but a  few single words before and had an understanding at around a single word level, aged 5.Therefore, it was a language issue and nothing to do with his tongue tie!
4. I also saw a child today who had speech sound difficulties which had been attributed to a tongue tie.Trouble is, he has no word initial sounds and can say 't' and 'd' beautifully. Therefore, its a speech processing issue not the articulation problem of not being able to move his tongue. 
5. I see a boy with a tongue tie who is silent ...but he has Selective Mutism so the tongue tie is irrelevant!
6. The NHS website has lots of information but in essence, if it is severe enough to restrict the baby's ability to breast feed then its worth having it snipped but otherwise, there's probably no real point, in most cases. The movement required to successfully breast feed is more than enough to produce the placement necessary for speech sounds.
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Our new Speech, Language and Communication Centre is now open!

We are happy to have a new centre, to which families can come to see us from further away. We already have  families from West Yorkshire, North Wales, Sussex, Surrey and Buckinghamshire booked in. I've just taken  call from someone in France who wants to come too!

We will have an official opening ceremony soon but meantime here's a preview:

 Can you spot Ralph, the therapy dog waiting at the door. He's happy to welcome anyone but especially enjoys working with children with ASD and Selective Mutism. There's a safe place for him if you don't like dogs though.

 This is the reception area where you can wait with a coffee. There's toys and books for the children and magazines for the adults.

From reception you go through into the  therapist's room. Its full of toys but these can be screened off if they're too distracting.

This is the training room below but it's also a multi-purpose room as the tables fold away. We might use this room for very distractible younger ones or for older ones who don't want to be in a play-type room.

We are happy to see people from all over so please get in touch if you think there's anything we can help with.

June 2015 SEND Reforms Survey

The Communication Trust is committed to supporting all those working within the reformed SEND system to meet the needs of children and young people with SLCN and their families. As part of this work, they undertook two online surveys in June and November 2014 to find out how practitioners, service providers and commissioners were preparing for and implementing the SEND Reforms. They used the valuable information gained from these surveys to ensure we are able to offer relevant support to those working with children and young people with SLCN in the areas they report needing it most.
 

They are now running a third survey  across June 2015, to find out more about the perceived opportunities and remaining challenges of the reformed SEND system for children and young people with SLCN, almost a whole academic year on from the reforms coming into effect. The survey will take less than 10 minutes to complete and we would be extremely grateful if you would take the time to complete it and pass the link on to your colleagues and networks to help get the broadest response possible.
 

The survey will be open from 29th May - 29th June 2015 and is available here: www.surveymonkey.com/s/sendreformsforslcn2015.

Billy: Born Naughty? Channel 4 series 1 episode 4

 I was asked to assess Billy as part of the programme 'Born Naughty?' to see what might be causing his bad behaviour at home and more recently at nursery. He had already been seen by the Paediatrician Dr Ravi Jayaram who had made some important observations.

Billy aged 3 years, along with his Mum and Grandmother came to a children's centre which was local to me but was a good 3 hours drive from their home. I played with him a for a short time and then screened his spoken language skills. I was looking for: his attention level, listening ability, auditory memory, understanding level (information carrying words), vocabulary, verbal reasoning and expressive language. I was also looking for his social communication/pragmatic skills which includes three major communication skills:

        Using language for different purposes, such as

§       greeting (e.g. hello, goodbye)
§       informing (e.g. I'm going home)
§       demanding (e.g. Take me home)
§       promising (e.g. I'm going to take you home)
§       requesting (e.g. I would like to go home, please)

Following rules for conversations and storytelling, such as

§       taking turns in conversation
§       introducing topics of conversation 
§       staying on topic
§       starting conversations appropriately
§       finishing conversations e.g. not walking away mid-sentence
§       how to use and read verbal and nonverbal signals
§       how close to stand to someone when speaking
§       how to use facial expressions and eye contact

It also includes Modifying language according to the needs of a listener or situation (for older children but Billy is too young for this), such as
§       giving background information to an unfamiliar listener
§       speaking differently in a classroom than on a playground
 

He coped really well with the assessment and scored highly on everything. I'd also put out a variety toys to see what the level of his play was like. His pretend play was amazing: he used lego as soup, made Batman and Robin from square shapes and pretended with imaginary toys too.

His family were concerned that he might have Autism as his uncle has  a diagnosis of ASD. They were worried that his behaviour was due to this. However, if we look at the older way of looking at ASD: i.e. the triad of impairment of language ability, social communication and flexibility, Billy scores so highly as to void any suggestion of ASD, this, together with Ravi's observations, meant I did not therefore do any formal ASD assessment. His mum is to be congratulated on a fantastic job done!

We needed to look for an different explanation of the behaviour and called in the wonderful Deb Sugden, sleep expert. 

www.libbyhillspeechtherapist.co.uk