Saturday 24 July 2010

Is it always autism?

NO!!! We're too quick to jump to conclusions when a child doesn't tick all the boxes for 'normal'! (Can you tell this is another of my personal bug bears?!)
Everyone has heard of autism but few know anything about receptive language difficulties or other language disorders which can mean that the child has trouble making sense of the world, fitting in with his peers and communicating his needs and thoughts. These are all symptoms of autism but do not necessarily mean the child has ASD. My own clinical case-load has several children who have been referred for ASD assessments by their school but actually have language based disorders. As they've already been referred when I pick them up it's too late to stop the parent needlessly worrying.
This is why  proper assessment for a differential diagnosis of ASD needs to be very thorough and requires Paediatrician, highly specialist speech & language therapist and expert Clinical Psychologist. At Small Talk our assesments follow the NAS guidelines. A one-off assessment in clinic is not sufficient to label a child for a life-time.
We used to have a term called semantic-pragmatic disorder: Semantic refers to the meanings of words and phrases while Pragmatic refers to the use of language in a social context (knowing what to say and when and how to say it to other people). We now try to separate the two so that we can work on the exact needs of the child. 
The Charity AFASIC have lots more information and they describe it in a way I can't improve upon. The following is from their website © Afasic 
"Children with semantic difficulties:
  • Struggle to understand the meaning of sentences or words. 
  • Words which refer to abstract concepts such as feelings (sad, puzzled, jealous) or status (important, official) can be especially hard for these children to understand. 
  • They misinterpret and take literally phrases such as "Cut it out!", "Stop it" or "He's a push-over". 
  • Often it can be difficult for children with a semantic disorder to work out the topic or key information in a sentence. 
Children with pragmatic difficulties struggle:
  • To use language socially. 
  • They do not understand how we take turns when we talk. 
  • They interrupt more than is acceptable. 
  • Their conversation often seems inappropriate or irrelevant. 
  • They can seem to be unaware of what their conversational partner needs to know - and can therefore say too much or too little about a subject. 
Some children have both semantic and pragmatic difficulties" other children might have significant receptive language impairment which lead to problems understanding spoken language. I met a 15 year old earlier this year with severe behaviour problems... he had an auditory memory of just 2 items, no wonder he punched first, he knows what outcome is expected from that type of interchange! Imagine how frightening it would be to live in a world when you 'just don't get it' all the time (to use his words).
One of the only benefits of the long wait for ASD diagnosis in Staffordshire (up to 90 weeks for some) has been that it's now clearer when the child's problems are more language based than autistic spectrum based. The difference lies mainly in the rigidity of thinking.
I can highly recommend the AFASIC web site for any parent or professional who wants to know more.
We know more about autism as society now so its time to spread the word about other disorders and problems that affect our chidren's ability to communicate. 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.

Wednesday 21 July 2010

Who are Small Talk?

Small Talk Paediatric Speech & Language Therapy team work independently and treat children privately. We see children who have:
We are based in Hednesford at the Keys Business Park but cover most of Staffordshire by seeing children in nurseries, schools and their own homes.

We can offer one-off assessments or regular therapy.

We can also offer many in-set opportunities for parents and teaching staff: half-Day or full-day courses on any aspect of speech, language or communication issue. We can tailor-make these for individual need.

For more information  or 0844 704 5888

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Sunday 18 July 2010

Word finding frustration

I went to a great party at the weekend, it started early and went on til late. I'm not sure how much I had to drink but this morning I didn't feel too bad. Not really so much as a headache. What I did experience, through the combination of alcohol and lack of sleep probably, was a temporary word finding difficulty. I was trying to tell some-one how funny I'd found Chris Evans' stand-in on the radio 2 breakfast show last week. Try as I might I couldn't think of his name: I could picture his face, his suits, I knew he was small, Irish and proudly gay but for hours his name eluded me. I had to google 'breakfast show stand-in' to get it...... Graham Norton of course! Then I wanted to say the name of a place: I could recall the letter it began with, the number of syllables etc. but not the actual name. I was angry, frustrated and bewildered. The more I tried the harder it was!

We all get this tip-of the tongue experience from time to time and people have probably heard about stroke patients suffering this difficulty. There are however, so many children who have this problem most of the time. I have 4 regular clients with this difficulty on my current caseload, they use a lot of 'thingy', 'whatsit' or words similar to the one they want e.g. one child said, 'I'm going swimming and I don't need my armpits now!' They might talk around the word e.g. elephant, 'You know it's grey and got a long thingy'. They look normal, are bright and chatty but have a problem which gets in the way of them being able to express themselves fully. Sometimes they have other language based issues which compound things. They are probably aware of their problem and have associated anxiety. The problem is the more stressed they are, the harder it will be. As with the tip-of-the-tongue experiences we all have, when we're relaxed the elusive words are recalled. It's definitely a problem that's getting worse. One of the NHS Therapists has 2 in one school and she does a course specifically to share our approach.

I've always sympathised with them and done my best to teach them strategies to help but today I could really empathise. I'll be OK tomorrow but they have to live with this all day everyday and people just don't understand.

Sadie Lewis' work is widely respected in this area.
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Saturday 17 July 2010

Brief mention..........

Although the Smart Talker groups were designed for everyone, not just children with identified difficulties, we have several children with very significant problems who come along. I write the programmes so they can be tailored to each child. The others who run the groups are either Speech and Language Therapists or experienced, capable individuals with early years backgrounds. It's more important for prospective franchisees to be the right type of person than the qualifications they have. All the children make progress but some are worthy of a special mention:

Louis began to attend the Small Talker group in September 2009 with some of his nursery peers and others. He had no speech but was known to have a small repertoire of signs that he understood. However, he was so withdrawn that he did not appear to have the confidence to look at a person when they spoke to him, let alone reply. Communication was extremely difficult with foster parents and nursery staff having to guess what he wanted. Even pointing was a problem. He was reported to be a single word level for understanding but this was not evident in his performance. Mainstream schooling appeared to be ‘out of the question’. He was almost 4.

He has been attending the group weekly since and his nursery teacher has worked very hard with him. He is not recognisable as the same child: he appears, happy, confident and relaxed in the group. He takes turns and gives responses both vocally and by sign. He spontaneously points things outs and names items. Comprehension is now 2-3-word level. He initiates interaction with children and adults. He does everything I expect of the others.

It gives me a lump in my throat to see how much he enjoys the group and how he has come on…… and he’s going to mainstream school!!!' YESSSSSS! It will be tough and he'll need a great deal of support but how fantastic!

Thursday 15 July 2010

Active listening

We tend to get quite poor results if we say "Behave!" to our little ones. It means very little, whereas if we describe the behaviour we want. they are more likely to understand what we require of them and then we might have some chance of them doing what we've asked. For example, if we want them to be quiet, sit still and not run around in the GP waiting room it better to tell them that than ask them to 'Behave!' Many parents and lots of teachers know this and act accordingly. However, we often and repeatedly say "Listen!" But what does that mean to a 3 year old?
Listening is not a passive skill, it's an active one and therefore one that needs to be learned. Just like behaviour we need to break it down and describe what we want from them.
Active listening is actually:
  • good sitting
  • good looking
  • good waiting
  • good thinking
You wouldn't expect good thinking until school age and it's very hard to do good waiting as a 3 or 4 year old (its hard enough for this 47 year old to wait if she's got something to say!) Which is why they find it hard to wait for their turn or to let others answer a question to which they know the answer.

Our Small Talker groups (for 3 and 4 year olds) work on active listening. We use a puppet to demonstrate 'not good' sitting so that he actually mirrors some of their behaviours e.g. picking the carpet to picking their noses. They are asked to help the puppet 'because he's not naughty, he's just got to learn'. They have to look for the 'un-required' behaviour and say 'stop, do good sitting'. They are usually excellent at identifying the behaviour in the puppet although they may still be doing the same themselves for a while. Afterwards. I put the puppet where he can 'watch' them do good sitting so he can learn by example. I then monitor the behaviour in a  very positive way so that I praise good sitting (and the wriggly ones usually sit up in  an aim to please) or if that doesn't work I ask the wriggly ones to help the puppet by showing him 'good sitting'. If they are constantly nagged to sit still or to listen, they will switch off. It's amazing how well they respond to this approach. I have had a few run-ins with TAs and parents who have been completely peed off with  my approach because they are itching to dictate 'Will you sit still, now!' However, I've asked them to trust me and watch what happens even if I am irritating them....  we've had some great results!

Maggie Johnson has done a great deal of work with listening skills especially with children with ADHD. I can wholeheartedly recommend her book: 
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Tuesday 13 July 2010

Buddying at its best in Stafford

Thanks to the Buddying scheme and the local Community and Learning partnership, the nursery and the pre-school at Doxey Primary in Stafford were able to participate together in a joint project of Languageland Training. This is a package which was developed to provide a complete programme to improve the speech and language skills of children in Primary and nursery education. It works by demonstration training to support nursery & class teachers in adjusting their teaching practice through demonstrated language lessons, and to achieve collaborative practice.
Uniquely, Doxey also invited parents to attend so they could see what I was doing and to have the opportunity of discussing language activities they could do at home. Each week they had materials they could take with them. 
When this idea was first mooted, I wasn't sure it was good one, as it meant 8 children, 8 parents and 8 staff. It can be quite difficult to keep the children's attention, control the group and be discussing what you're doing with staff but to have to then also present it in a way that's readily understood by the parents too was quite daunting. 
The activities were delivered  to children from the nursery and pre-school via Circle Time style sessions and targeted language basics such as: General interaction/social skills, Good listening, Sound awareness skills, Vocabulary and Comprehension. The children just thought we were having fun playing games, singing songs and pretending to ride on a magic carpet but each session was structured to show staff ideas for activities.
I needn't have worried as it worked very well and feedback was 100% positive from staff and parents. Jo Upton from the pre-school said  that the staff were 'inspired', they also signed up for our next project on signing training.
We are hoping to do more with the Buddying project as its a great way of sharing good practise. The next one is in Stretton near Burton with staff from Lansdowne nursery and the Stretton pre-school. Helen Stretton  will aptly do that one!
We're also writing our own version for younger children of around 2 yrs. Watch this space!!

Languageland is avialable to buy from 

Sunday 11 July 2010

Why I hate shopping!


Is it the hassle of handling the shopping so many times.... into the trolley, out again at the till, pack the bags, load the car?
NO! Its the rantings of other parents that make me mad. I get so irritated by the, usually loud 'Stop it!!', 'Come here!', 'I told you before!', 'Pack it in!' In short, the supermarket is a reflection and huge reminder of today's poor interaction between parent and  child. The parent is frustrated, hassled and completely fed up by the ordeal and the child, who has long switched off to his parents ranting, is just pain bored. The negativity from both sides is almost palpable.
It could be an ideal place for language stimulation and meaningful exchange: Consider 'Do you want red or green apples?', 'What would you like for tea?','Can you get me the Shreddies then the Cheerios please?' The above would have helped the child's attention, co-operation, listening, sequencing and more plus their self esteem because they would feel their contribution is valued. It takes no more time or effort and means that everyone would be happier.
Communication between adults is probably at an all time low but between parent and child it is frighteningly poor. I'm not tarring everyone with the same brush, I'm talking in general terms. The supermarket, however is an ideal place to observe a whole cross-section of society. It's not just a lack of education that is causing this..... look around and you see all walks of life falling into the same trap.
I've got two little boys who like to help and we chat all the way round the aisles. They enjoy going and feel they are helping .*
I know adults today are very stressed and they have a lot on their plate. I can sympathise but I can't understand why they can't just take a step back and look a how they are interacting with their children. What message are they giving them? It's a fact that the levels of language and communication skills in children are declining: around 40,000 start school each year without the necessary levels to cope with the written language tasks ahead. These are not children with speech or language disorder, these are children with transient difficulties through lack of appropriate stimulation.
What can we do about it? It needs a huge drive to emphasise what problems we are creating by not interacting and to show its an actually easier and much more pleasant option to communicate with your child. One of the main aims of the Smart Talkers Pre-school groups is to help to address this issue The development of human communication is amazing, fantastic, awesome... there aren't enough superlatives to describe it. We need to recognise it and know what part we can play in helping our own children.
In the meantime, I prefer to avoid the supermarket so I don't feel stressed by the other parents....
Tesco man here between 10 and 11!! .

*apart from they can't resist the shiny floors for knee slides but hey no ones perfect! There's probably another parent writing her blog about irresponsible parents who allow that sort of behaviour!

Saturday 10 July 2010


It's great publicity to be nominated for National Awards and I've been persuaded to enter the 2010 Every Woman Awards 2010:
It feels slightly wrong because I enjoy what I do so much it doesn't feel like work!

'The NatWest everywoman Awards celebrates inspirational business women who have achieved significant success - particularly those who've had to overcome adversities such as financial constraints, social disadvantages or skills gaps. The Awards play an invaluable role in both recognising success and inspiring other women to venture into the field of business'.

The NatWest everywoman Awards
I think most people would like to have their own business but there are many perils and pitfalls which have to be over-come on the way to success. It's certainly not the easy route! It is even harder if you are the only bread winner AND a single parent. I'm entering this competition because it might inspire other women to do the same.  That is: decide what they want to do and then find a way to achieve it despite set-backs and uncertainty, financial worries and family commitments.

There's still along way to go as I want to have at least 10 franchises for the Smart Talkers groups by this time next year and a further 10 by the end of 2012.

Wednesday 7 July 2010

Are you really a good listener?

People today have difficulties listening and it's not just the children. This is a real problem and one of the issues the Small Talkers Groups, in the Smart Talker Range are designed to address. 

The key to being a good listener is to get the person with whom you are talking, to talk.  I  was reading 'Raising Happy Children' by Parker, J., & Stimpson, J. (1999) and I realised that I fall into some of the communication traps, when I should know better.

How many do you do?? Are you a good listener? 
It may help to check that you are not doing something else instead:

  • Advising - “Tom wouldn’t let me play with him today.”   “I’d take no notice if I were you, go and play with Peter tomorrow instead”.
  • Criticising - “Joe took my book and lied and said it was his and my teacher believed him!”   “Well I told you not to take it to school”.
  • Dismissing - “Emily broke my bracelet.”   “Oh, it doesn’t matter. We can just get another one when we go shopping”
  • Correcting - “It wasn’t fair at tea time, you are always nicer to Sally than you are to me!”  “You mean Breakfast time.”
  • Ignoring - “I need mummy to take me to Claire’s house after school.”  “Come and help me to do the dishes”
  • Distracting - “I’ve not been picked to be on the netball team and all my friends have.”   “Come and look at what I brought at the shops today and try not to think about it.”
  • Reassuring - “I’m scared of the monsters under my bed.”  “There’s nothing to be scared of.”
  • Praising - “I hate it when she comes into my room.”  “I’m sure you don’t mind because you are such a good big sister.” 

Everyone falls into one of these traps from time to time, but using replies such as these won't get the same results as really listening. Sometimes parents use these communication traps because they have run out of patience or time  or sometimes because they dont know any better. Whatever the reason, they can be very effective at stopping a child from talking.

Listening has the opposite aim - it encourages your child to talk. Encouraging your child to talk will help them to become a confident and effective communicator, a skill that will help them for their whole life. 


Sunday 4 July 2010

Ditch the Dummy!

I've just had another conversation with a parent of a 4 1/2 year old with poor speech about the use of dummies as a huge contributory factor to his problems. He had one until well over 3 years of age because the mother-in-law  said it would 'ruin his personality' if it was taken off him!! What complete and utter rubbish (I've calmed down now so I'm more polite because that wasn't what I was thinking at the time!). 

He's now left with no 'l' sound, 'ch' and 'j' are wrong and his tongue protrudes for 's', 'z' and 'sh'.  He's going to need months of therapy with lots of practise at home.

For the mother-in-law and anyone else who is unsure:

During your baby's early months a dummy can help to soothe. This is understandable, as most babies have a strong sucking reflex and the dummy can, in many cases, help to settle the child. It may not, however, be necessary even then! My babies didn't have one but if it helps to 'pacify'  at sleep times, then I see no real problem for up to a year old. After that, it should be dropped because the child needs to be able to make use of a full range of sounds which can only be achieved by letting the tongue move freely around the articulators (lips, gums, palate etc.) They should NEVER be used when the child is talking.

Using the dummy can lead to the following problems:

  • incorrect positioning of teeth so that the bottom and top teeth at the front don't meet properly
  • tooth decay (especially the front teeth) if the dummy is dipped into sweet things
Mouth breathing:
  • your child may tend to breathe through their mouth rather than their nose. This is often linked to long-term dribbling
Speech and language problems:
  • your child may not use the full range of tongue movements that are necessary for making all the speech sound your child has fewer opportunities to babble and use sounds to communicate with you
  • much higher risk of acquiring speech sound difficulties 
I see lots of children dropped off at nurseries and who's dummies go in their bags at the door. They have quickly learned that they don't have a dummy there so they don't usually even ask for it. I also see a lot of parents collecting from nursery who retrieve the dummies from bags and install in the child's mouth before they've even said 'Hello'.

I know I hate them and you're probably thinking I'm being too harsh but I think we need to look at WHY they have them when they are able to talk. Are parents trying to shut up their child? 
We need to talk more, not less and anything that gets in the way of this should be discouraged.

I have an A4 'Dummy Free Zone' poster if anyone would like one

Friday 2 July 2010

'Signing is not recommended,' says the Royal College of Speech & Language Therapists' Councillor for Research and Development

I'm very angry that  the Royal College of Speech & Language Therapists have made a decision on a matter of importance without recognising ANY proper research or the views of members and their experiences on the subject. On this occasion it's Baby Signing coming under their radar. They have stated that the RCSLT does not recommend signing with babies despite decades of Speech & Language Therapists using it with children and families with very positive outcomes.

The RCSLT refute the evidence by Karen Pine and her team, from the university of Hertfordshire, who showed without doubt that it helps children from disadvantaged backgrounds. She doesn't make wild claims e.g.that it enhances IQ as some of the American studies, but makes valid and sensible conclusions from suitable regulated and professional research.

It is a fact that we need to hi-light and reinforce ANY and every positive communicative practise between parent and baby and its this which is so makes signing so powerful. If a parent is signing (and talking at the same time) they are more likely to be watching and listening to their child and being more aware of both their interaction and their child's response.  This should be praised and encouraged and not condemned.

It looks like I need to write to Nursery World with a case study proving that its very positive to use sign with your baby! I don't need the RCSLT's approval or their recognition to be confident that it works... I KNOW IT DOES as a parent who used it with her own children and as a fully qualified, very experienced professional. Watch this space!

P.S. Thank you RCSLT for publishing the article about me in this months Bulletin.... lol!