Wednesday 20 September 2017

Assessing the SLCN of a child with PDA

When I did the PDA webinar for the PDA Society recently (to listen click here), a SLT asked me for tips for assessing a  child with PDA. I said that they usually weren't too bad for initial assessment as children with PDA often enjoy being centre of attention and novel situations. It is often much  worse when trying to engage with  therapy. I usually use a dog in the sessions so he makes life easier.

However, I was reminded at the weekend, that this is not always the case and that we need tips and strategies to get us though these potentially trickier situations.

Just remind ourselves of the main features of PDA:

·         obsessively resisting ordinary demands
·         appearing sociable on the surface but lacking depth in their understanding (often recognised by parents early on)
·         excessive mood swings, often switching suddenly
·         comfortable (sometimes to an extreme extent) in role play and pretending
·         language delay, seemingly as a result of passivity, but often with a good degree of 'catch-up'
·         obsessive behaviour, often focused on people rather than things.

We need to assess them to get an accurate picture of strengths, be able to give strategies for family and staff and to be able to devise a programme of work to address their issues and  to maximise their potential. Obviously,  the 2 areas we are concerned with are language processing and social communication.

We need to be aware that they do not like people to know they are struggling so they may
pretend/hide/disguise, distract or get angry..... or all 3.

1. Pretend, hide, disguise:
This is  a key factor in PDA. A parent may ask them to do something very simple such as turn off the TV but they will have a wide range of reasons why they can't e.g. my legs don't work, I can't find the remote, I can't reach the remote, I'm too tired etc. This can escalate if pushed. You may find similar issues when trying to assess. They might say, 'I'm not doing your stupid tests and you cant make me' or 'you're only being nice to me so I'll work with you and I'm not falling for it.' That is true, so we need things in our tool box to ensure we can get a full picture of SLCN.
2. Distract verbally or physically:
Many of the children with PDA I have worked with, have either tried to shock or frighten me. I have lost count of the times I've been asked 'the worse thing they can think of' (Boringly similar with tween/teenage boys) and even had one boy who said 'you can't go yet because you haven't had sex with my dad.' The key is to be very nonchalant and either ignore or pretend you hear that everyday: 'Ah, No thanks, I'm a bit busy'.
One poor 10 year old lad who had been in a secure unit for 3 months, enjoyed scaring visitors by poking their eyes. This was also because he had a deep sensory-seeking need which wasn't being addressed and he got what he needed from firstly the fear of the visitor but then the 2 burly male nurses bundling him to the floor as he manically laughed in their faces. Of course they thought he was some possessed devil child and didn't see him as the frighted,very anxious boy he really is.
3. Get angry with themselves or others:
The anger may come out of the blue and may not be seen coming. They may look perfectly happy, even relaxed but remember they have cultivated hiding their difficulties. The anger may take the form of them hurting themselves such as banging their heads on the table or may be at you or your things.
So what can we do:
1. Realise that it is anxiety based and keep calm. Never take it personally, never be offended. Ignore wherever possible. I have 3 rules: no hurting themselves, no hurting me and no damaging property. Other then that, I go with the flow.
2. Use all the strategies you would for making language simple that we preach to others. 
2. Give choices e.g. of which room to use, which order for the activities, which assessments even. This will help them feel in control. You may find a schedule of the session useful; picture photos or the written words.
3. Scale back demands by some of these strategies based on the 'Positive PDA' booklet:

Using indirect language

e.g instead of saying we're going to say “I wonder if we can...”

 “Shall we see if we can beat the clock...” ,“Maybe we could investigate…”
This means avoiding direct language such as“It’s time for you to...” ,“You’ve  got to...”, “You  need to...”
Allow take up time 

Plant the seed of what you would like to happen at the start of the session, but don’t expect it to happen straight away. 

Use the child’s interests
Using characters of interest can help de-personalise demands, as you are not personally asking them to do something. For example, if the child loves Peppa pig, get Mummy Pig to make the requests. Older ones may like a Starwars character or even the queen who  makes the  rules, so it isn't your rules. 
Use humour. 

If you feel the tension rising, humour is a fantastic distraction. You could try making jokes, using physical humour (exaggerated facial expressions, or silly walks), being silly or feigning ignorance.
Use distraction

Distraction can be a handy way to temporarily press ‘pause’ and ease the child’s anxiety.

Add other activities into the mix 

e.g. bubbles, popping balloons or blowing up and letting go, a feelie bag of sensory materials. 'If we just finish this, we will be able to do .....'.

The main thing to remember, especially as you feel exhausted at the end, is that this is for  a short time. Their parents live with this all the time! 

So good luck! Let me know how you get on.

Tuesday 12 September 2017

We don't want you to teach colour, shape and size yet!

As you know we have just launched our new parent hub so we can  offer our advice and support to more parents.  We've done that because I believe all parents want the best for their child but if they don't know what that is, how can they?

As school has just started, I've heard so many conversations about what child can do. The clear favourites are counting, colours and shapes because that's what parents think they need to be teaching their little ones. However, teachers can do that when they're ready. They need to child to be at the right level to do that but there's important things that are needed first, language and  communication wise.

What teachers need little Johnie to be able to know, is the right vocabulary for his everyday needs, to be able to answer simple what, where questions and to be able to listen.

We use the Blank levels to explain the right order. We need to be able to answer blank level 1 questions before blank level 2

Blank level 1

  ·         Matching  e.g. Find one like this

·         Identifying a Source of noise e.g. what can you hear? 

·         Naming objects e.g. what is it?

·         Naming people e.g. who is that?

·         Naming actions e.g. what are you doing? 

·         Imitation e.g. Say this 

Blank  Level 2 

  ·         Describe scene e.g. what’s happened? (still in view)

·         Remembering information e.g. Who/what/where?

·         Finishing sentence e.g. Finish this ….

·         Identify and describe characteristics of objects e.g. what size is it? What shape? What colour? How many? How does it taste/smell/feel? Where is it?

·         Identifying object functions e.g. Show me the one we use for …

·         Identifying differences e.g. how are these different?

·         Naming object from category  e.g. Tell me something that's a type of

It makes the teacher's life a little easier if they can answer these questions. Oh yes, plus be able to go to the toilet by themselves and certainly be out of nappies!! Let me know what you think.

Consultant Speech and Language Therapist

Friday 8 September 2017

Help for parents: join the club

The Communication Trust estimates that over 1 million children in the UK have speech, language and communication in the UK difficulties yet the number of speech and language therapists is falling. More and more parents are being left to fend for themselves but where do they look? Where can they go for help?

We been moved to action due to serious concerns that parents of children with speech are not getting sufficient access to good quality evidence based advice. We have become increasingly worried when we see parents who are on NHS waiting lists asking for advice and then being told they should be doing X Y or Z from other parents. Others are using ‘Dr Google’ which we all know can be very alarming and point us in a completely wrong direction, in many instances’. At Small Talk Speech and Language therapy, we know that language and communication targets should be integrated into everyday routines as much as possible. Children learn language in the situations where they need to know the words so no amount of flashcards or worksheets can do that. Other children have problems generalising what they learn so again, it must be in the real situation.

Activities which are done everyday that both motivate and interest the child are always going to work better than things that the child isn’t interested in. Snack time, meal-times and bathtime or even getting onto the car. Parents are busy so it can’t be extra work for them.

We have created a membership club for parents so that they can have access to real live speech and language therapists so they can ask the questions and have good, evidence based advice. They have webinars and short ‘how-to’ clips plus lots of other tips and tricks to help. There will also be a forum so other parents can talk about what they found useful.

They will have a monthly podcast show, the Smart Talkers Super Saturday Show, to look in depth at  current topics and interview relevant expert in the field. They will also have parents who have been in similar situations  talk about their family’s journey.

My blood pressure rises every-time I see bad advice being given. It’s well meant but wrong and is not in the best interests of the parent or the child. Self esteem in the child and parent confidence are so important.

We have launched the Parent Hub and hope to be able to support many more parents.

Consultant Speech and Language Therapist
Small Talk Speech & Language Therapy