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'.

What anxiety looks and feels like.#anxiety #signs #mentalhealth #beaware #support pic.twitter.com/JZqxIYH6Dm

— SCS Training&Therapy (@SCStrainingLtd) March 3, 2018

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'.

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!

Secondary schools don't need speech and language therapists.... or do they?

I have a few common scenarios which show how speech, language and communication issues can be the predominant cause of behaviour problems. These scenarios are very common so could be about anyone of 6 or 7 clients currently known to me. This is the first one:

Teenage girl, second year of secondary school. No issues noted in primary apart from maybe a few 'fallings out' with other girls. No previous behaviour issues at home or at school. Perhaps she's even been a model student. 

Since starting secondary school, however  everything has started to fall apart: at home she's sulky, rude even abusive to parents, shuts herself away, won't go anywhere, friendships may have broken down, parents describe 'melt-downs' when she comes in. At school they didn't notice anything in particular and were quite surprised to hear of the behaviour at home in year 7 but this year, she is falling behind and they are constantly reporting her behaviour which is usually similar to this scenario with E aged 13 years:

Teacher presenting a  power-point which needs to be copied down
E. hasn't finished when teacher moves it on
E 'Excuse me sir can you just leave that a bit longer as I haven't finished?'
Teacher 'No E you'll have to stay at the end as everyone else has finished' E looks round and sees that 3 others haven't either
E 'No sir that's not true x, y and z haven't either'
Teacher 'E you're trying my patience, we've discussed your behaviour!'
E 'But Sir I'm not being naughty, I'm trying to do my work, I just need 2 more minutes please?'
Teacher 'That's it, you have a detention'
E 'For god's sake how stupid? I just want 2 minutes'
Teacher: That's 2 detentions young lady'
E 'I cant believe you're doing this I just want to do my work and you're treating me like this'

Sometimes it escalates further and sometimes EVEN further.

Sometimes the child is excluded.

The child may have 14 detentions in a 2 week period as in one case or 101 since xmas in another. 

Why should a child behave this way?

In the cases I have been dealing with:

1. slower processing skills
2. poor auditory memory
3. both of the above lead to difficulty understanding longer and more complex questions
4. literal understanding of language
5. lack of social skills/pragmatic ability means they don't modify their language for teachers so yell as they would to their parents
6. Rigid thinking means they cant 'let it go' because their sense of justice is so well developed they aren't wrong so the teacher must be
7. Can't see another's point of view 
7. An awareness of their difficulties but a desire to mask them means their anxiety levels are already heightened so it doesn't take much to 'set them off'

It has become a dreadful, seemingly untenable situation. School will have tried all their usual strategies for behaviour problems but nothing works. Yet the answers are simple strategies and an understanding of the problems. It amazing how we can make a HUGE difference by explaining to teachers why the child is doing what they're doing, if we now see them as struggling rather than defiant, abusive etc, we can avoid getting into many of the situations which have previously been a nightmare.

Some of these children may have undetected ASD but some will have language and communication difficulties which are not part of the spectrum. Hormones and personalities play their part too!

• A one page profile needs to explain what the child finds difficult. Just the process of completing one of these may make the child feel respected and understood which is an important start.
• Making sure all the child's staff have read and acknowledged the profile
• Everything as visual as possible including  a print out of the power-point, gestures, notes. These can all be used to make aspects of the day clearer including the timetable, what a pupil will be learning in that lesson, expected behaviour, key vocabulary and information, the sequence of steps within an activity, names of equipment and where it is stored, etc.
• Make sure the child is happy where they are sitting. I like them at the front so they can see the teacher and the teacher can see them but the child may well be uncomfortable at the front and want to be at the back. Sitting with a friend can be really helpful
• Encourage an ethos where all pupils are encouraged to ask questions and seek clarification.
• Have a code so they can let you know when thy haven't understood that no-one else will notice e.g. bag on desk, pencil case moved 
• Agree how you can check they have understood
• Expected behaviour is clearly described e.g. School ‘rules’ and ‘charters’, etc are written in simple, symbol or visual photos form so that pupils can understand them.
• Quiet space is available for time-out or individual study.
• A reflections log or journal where the child can write about what went well as well as what went wrong. Even better have  a mentor who can meet with the child regularly to discuss this

SLCN is just as big a problem in secondary school as in primary. In the secondary classroom, language is the foundation for participation in, and access to, most aspects of the school curriculum. Many aspects of written language, such as narrative or understanding what you're reading, can be limited by delayed language skills; 'by secondary age there is an increasing amount of figurative language in text books. The same is also true of ‘teacher talk’: 37% of teacher instructions in secondary schools contain multiple meanings, 20% with at least one idiom. As learning becomes more reliant on independent study, language enables pupils to make contact with others; to organise, manage and evaluate experiences; to influence and inform' (ICAN)

Last week I visited 6 secondary schools and was delighted with their positive responses. We all want whats best for the young person but we need to understand what this is to be able to do that. You may think that they don't need a speech and language therapy assessment as they speak fluently but if the usual strategies don't work, we can probably help fill in the missing links. Behaviour IS communication, we just have to work out what it's telling us.

Book review: The shyness & social anxiety workbook for teens by Jennifer Shannon

Guest Book review by Natasha Dale

 There are many different books for sale, as well as online resources, that have the purpose of helping those with social anxiety and/ or shyness, but some are better than others. After reading “The shyness & social anxiety workbook for teens” I felt quite refreshed as this book isn’t worded to over complicate anything. I think the best way to explain and describe this book is: teenage friendly. It doesn’t need to be read all at once nor does it have to be read it in order. It’s written in a very flexible way; you have the option to pick and choose which topics you read about and when. I feel this workbook has a pleasing balance of being both engaging and informative. One of the most useful and important focuses in this workbook, in my opinion, is how it takes common thoughts that have been affected by anxiety and helps you to rationalise them.

 Over all I generally think this book is great for teenagers who are letting their shyness or anxiety make decisions that they themselves wouldn’t necessarily make, such as avoiding people they want to talk to.  I enjoyed reading this book and felt it didn’t take much reading into for me to grasp the understanding that nobody is alone with struggling with social anxiety. Anxiety is common, but it can affect us all in different but similar ways. I was really pleased to see how much this workbook focuses on the reader and gives them the opportunity to engage by placing themselves, or their mind, in the different anxiety provoking situations mentioned. I think it’s a huge advantage to read though this workbook; I like how it encourages the reader to think about ways to overcome their barriers. I think this workbook gives you plenty of opportunity to involve personal situations, but on the other hand it isn’t compulsory nor does it come across too forceful. I really like how it gives you various examples of common problems associated with struggling with shyness and social anxiety, which indirectly allows you to place your own situation into the matter. I was also happy to read examples of both males and females struggling with different common anxious situations, from toilet anxiety to anxiety around speaking. There is a positive focus on the difference in how we as unique individuals react, behave and think slightly differently to one another due to our personalities and values. It’s reassuring to read this workbook and see that the aim is not to change who you are, but to change how you deal with your anxiety. In my own opinion, I think this book is definitely worth your time and effort.

Using the monkey, elephant and the crocodile to help your child relax: Relax Kids

Guest blog by Karen Horner

Research shows that more young children are being diagnosed with depression or some other mental health illness as they are subjected to a stressful life. I decided to develop my skills by studying Relax Kids. This is a 7 step fun tool that children can use daily to help them de-stress in the stressful times in which we live. Teaching relaxation techniques to young children as they also learn simple values such as respect, care, co-operation and tolerance. Relax Kids builds  self-esteem, confidence, concentration and helps children to cope with stress and anxiety as they develop their imagination and creative talents.

Relax kids was launched in 2003 by Marneta Viegas  who at the time ran a children’s entertainment business for 13 years in London.  Over that time she noticed a change in children’s behaviour.  They seemed to be lack concentration and focus and listening skills.  She set about creating a relaxation system using breathing exercises, stretches, games, positive affirmations and visualisations to help children learn these important life skills.   As well as starting Relax Kids classes, she wrote a couple of books of children’s relaxations – for parents to read to their child at bedtime and CDs to play to help children de-stress.

How can relax kids help my child?

The brain is very complex, just like a jungle, and in the jungle, there are 3 important animals the monkey, the elephant and the crocodile/meercat.

The monkey part of the brain which is at the front and is highly intelligent, curious and likes to learn new things. He takes in all the information and passes it on to the elephant who has a very long memory which is the hippocampus part of the brain. He stores all this information ready for when we need it again.

The crocodile keeps us safe from danger and is always on the lookout, this means when we get upset frightened or frustrated we freeze, flight or fight. In states of high anxiety our crocodile is always snapping therefore the monkey and the elephant part of the brain can’t work so the child does not learn.

Relax kids helps children to calm their crocodile and gives them strategies to cope in stressful situations so allowing the crocodile in them to remain in a calm state and allow the monkey and elephant to do their jobs. This results in calmer children and learning taking place.

Relax kids is now in 47 different countries helping children de-stress and giving them strategies to help cope in situations of stress and anxiety.

The seven steps take a child from high energy to a state of complete relaxation. Your child will enjoy games and songs, storytelling, movement, stretching and breathing exercises, peer / self massage, affirmations, relaxations and visualisations All these exercises have been put together to help children feel great and be confident. The action packed 6 week programme will take your child on a different adventure each week. Your child will enjoy our adventures so much they won't notice the new skills they are learning Our classes help develop children's imagination and creativity as well as build their self-esteem Regular relaxation will help your child's concentration, learning and will give them tools to manage anxiety and worries.

For more information, please get in touch.

Karen Horner

Relax Kids North 07517 970120

The delayed effect of anxiety on children: 'complete fabrication on the part of the parent'

My role is to see children with ASD, Selective Mutism and complex communication difficulties. I don't mean complex needs, I mean complicated profiles and even more complicated situations. Many of these children are very anxious. I know that the more complex the case, the more simple my explanation needs to be. Time and time again, I see parents who describe their child one way and schools who see something different and completely refute what the parent is saying, even if they have the scratches and bruises to confirm it.

It is described as a 'delayed effect' or the 'pressure cooker' situation. I like to see it as 'the bottle of pop phenomenon'. the child keeps it together, maybe doesn't like to draw attention to themselves or can 'just about manage' until 3.30pm. There might be small signs, that someone who who knows the child well or someone experienced in childhood anxiety can spot, such as slight eye or vocal tic or the picking at the skin on their thumb.Then when they get home all hell erupts. The bottle has been shaken all day and the top comes off at the door. The door where they feel safe and secure with a parent who understands them, won't judge them or hate them whatever they do.

I've had this reported 12 times in the last few months alone,  but there is little written about it which might help professionals understand that what they see isn't always the true picture:

• the child with anxiety who smiles, so can't be worried at school
• the child who is sweet and polite so can't have sworn uncontrollably at their mum last night
• the timid, quiet child who can't possibly have inflicted those bruises because the lessons changed today
• the 'normal' child who does as he's told can't be demand avoidant at home
• The child who seemed happy for a new member of staff to take the class as he didn't say anything, can't have trashed the house when he got in
• the girl who said nothing  in class can't possibly have had a melt down at home because they'd moved the cupboard to the other side of the classroom
• the kind, helpful girl can't have scratched her mum so badly she drew blood when all she was trying to do was to give the ipad to a man to take to repair
• the 'ideal pupil' who loves school can't really hang onto the door handle and fight both parents every single morning because he doesn't want a bath

These are all real cases and some of you reading this will know who I'm talking about.

It must be parenting, it must be the parent, the parent must be fabricating........ I think NOT!!! We need training for staff in spotting the (often well hidden) signs of anxiety. It can be directly related to language and communication difficulties as they struggle to cope to understand or fit in......bit like a swan paddling away furiously underneath. It's exhausting for the swan and he needs a break after  a short time. It may also be related to sensory issues or both.  One thing is for sure, the parents need support not disbelief.

www.private-speech-therapy.co.uk