Is Charlie racist and rude? Does he need excluding for his behaviour? Or is Charlie struggling in a neurotypical world where he is mis-understood?

I wrote this blog a couple of years ago https://www.smarttalkersblog.com/2019/02/doesnt-listen-is-rude-homophobic-racist.html In many ways this could be Charlie about whom I’m talking. It wasn’t, I hadn’t met him, but I meet hundreds of Charlies a year, and I have done since 1986. Charlie is autistic and a part of him being autistic is that our neurotypical world does not suit him. He appears just like his peers: bright, chatty and able but Charlie is actually from a different culture. In the autistic world, the typical rules of politeness or saying ‘how it is’ do not apply. As part of being a neurotypical adult working with autistic teenagers it is our duty to understand this and to deal with it. 1. Say it as it is: the bluntness of autism If a 14-year-old teenage boy told me I was fat and ugly I might be offended if he was neur0- typical. If he was autistic, I would thank him for pointing it out and realise that he was just telling me the truth. This descriptive bluntness may also apply to people’s obvious ethnic backgrounds or other neurotypical ‘sensitive’ topics. But that's what it is; it's a description, it is not an insult. So, if an autistic teenager calls you a ‘black idiot’ then you could be offended perhaps by the ‘idiot’ but not by the black descriptor, if you are of Afro-Caribbean origin. He doesn’t mean anything derogatory. 2. The wanting to fit in Other autistic teenagers will want to be seen to fit in so may use phrases or sayings that they have heard of the children use. These may be ‘cool’ children, who autistic teenagers would like to emulate . They may want to impress these cool children or indeed other children . However, it does mean they will be using phrases or words they don't necessarily understand and certainly don't understand the full implication of using. Therefore, the consequences of this sort of language used in school should not be the same as for neurotypical children, it is part of reasonable adjustment. A child like Charlie responds well to discussion about such issues . He does not want to offend or to be rude. He does want to fit in. 3. Neural response By the time a neurotypical child is a teenager, we expect them to have control over their emotions and their emotional outbursts in school. However, non neurotypical children cannot be expected to have this same control. It is unrealistic. Professionals must understand the difference between cognitive control and neural response. Neural response is automatic, so children and young people are likely to do things in the heat of the moment without actually being in control of what they do. It’s a typical stress response e.g. the fight as part of fight, flight or freeze. Trauma informed schools are extremely good at understanding the neural response of an autistic child which may lead to seemingly undesirable behaviour. A neural response is the key difficulty of a child with demand avoidance and MUST be seen as an anxiety or panic attack. As with anxiety or panic attacks, the child needs supporting not punishing. 4. Executive function We must know more about executive function as professionals working with ND children and teenagers . When we do, we realise that they may have no filter, so this will be another reason to ‘say what you see’ without the typical ability to think twice before you say anything. This is an issue with the prefrontal cortex so shouldn't be punishable but can be guided when there is a rapport and trust between professional and child. I could go on but I'm short of time this morning however it is imperative that Charlie’s behaviour is understood. His behaviour is communication; he's communicating to us that he's having a hard time. Professionals must, as part of reasonable adjustment find a way of dealing with this and not seeing his responses as illegal, unlawful or punishable. I actually find Charlie to be a completely delightful young man!

But they have no problems in School: Autistic Masking The Hidden Trauma of Our Children

Guest blog by Jodie Smitten

As a Post Grad student I have recently submitted a 5000 word assignment on this subject, so I will be attempting to avoid going in quite so deep and stick to the main points…not an easy task when I feel so passionately about this topic!

I know there will be many parents that will read this and learn nothing new. For many children and their families this is their everyday lived experience; feeling misunderstood, trapped, unsupported, and isolated. Alongside this many families are fighting for help for their child who is struggling with mental ill health as a result of masking.

But this piece isn’t aimed at those families, it’s FOR these families. Raising awareness of masking amongst professionals is vital for the mental well-being of our autistic children. The aim is to save children from distress, save children from trauma and save lives.

Masking, also known as social camouflaging is the ‘performance’ put on by an autistic person in order to ‘fit in’ with surrounding people, often by supressing autistic tendencies or hiding the difficulties they experience in the non-autistic world.

So how can this look?

A person who; is suppressing excited jumping and flapping, doesn’t voice the distress caused by the lights being too bright, mimics the fashion, speech and interests of a peer or continues a conversation about football despite being bored senseless! It can look like a child who appears calm and happy all day at school, but the minute they meet the safety of Mum or Dad ‘lift the lid’ of their emotions and spiral into a meltdown, it can be the child who has numerous meltdowns in the morning over socks feeling wrong or hair having too many bumps in it, yet the second they cross through the school gates appears to ‘click into character’ and appear ‘fine’ and maintain that façade for yet another day. 

Now I’m sure many non-autistics reading this may well think ‘well that’s not so unusual, we all do that from time to time’ and yes that’s absolutely correct. But for the autistic person the extent of masking is deeper and more labour intensive than that of the non-autistic. It involves intense focus and holding back what is natural, overriding ALL of one’s true self.

So, why am I so concerned with autistic masking?

Simply put masking hinders autistic life, actually that’s an understatement. It hinders access to assessment and identification, it hinders access to adjustments and support in education and it hinders others (including parents) understanding of a child’s needs and therefore a child won’t have adjustments made in any of their environments. Now if we consider Beardon’s (2019) ‘golden equation’ autism + environment = outcome…… an autistic child with no environmental adjustments or support will not be able to reach potential and the outcome is dismal to say the least.  In short masking causes high levels of stress and exhaustion, autistic burn out and mental health difficulties (Hull, et al., 2017; Cage, Monaco & Newell, 2018).

So if masking is so bad for self, why would anyone do it? Survival is the simplest answer. Protection from being picked on by peers, protection from adults ridiculing, and sometimes from their own parents who know no better. Yes, I’m guilty of trying to insist my child just ‘wears the blinking socks’ before realising she was autistic and wasn’t just being a ‘fuss pot’. Many autistic children learn from an incredibly young age that it’s easier to just try and ‘fit in’ and ‘not make a fuss’ if you don’t want any unwanted negative attention. If I had a pound for every time someone told my 4 year old he ‘needs to get his hair cut’ I would be rich. These aren’t nasty people, these are just fleeting comments to them. Little do they know that he is petrified of having his hair cut and even sitting in the barber’s chair is enough to cause him to shake and drop his bottom lip. Why should he be subjected to that just to ‘fit in’? But sadly for many children the comments and ridicule become too much and they buckle and submit to the ‘norm’. 

So Let me break my concerns about masking down:

Masking hinders assessment and identification

You take your child to the GP, you tell the GP you think your child may have autism, the GP takes a look at your child who is dutifully sat there, asks them a few questions which they answer. The GP then states he needs ‘evidence’ of difficulties in school, (and yes some professionals will still state that if a child is autistic it will ‘show’ in all environments!) The school say they have no ‘issues’ and that your child is fine is school. And there you have it, you can’t even get a referral for the assessment pathway let alone an identification! But let’s pretend you make it that far and your child is offered an assessment, your child is then encouraged into a room with unknown people to answer a set of questions. As these people are unfamiliar to your child and your child is keen to please your child masks, acting perfectly non-autistic. The second you get back to the car your child shuts down or meltdowns from exhaustion. The result; no identification of autism and a distressed child…. brilliant!

Identification of autism is important on so many levels, it is summed up perfectly (and much better than I could write!!) by Zwanenberg

‘As without a diagnosis this can make so many areas of life difficult, distressing and bewildering for the undiagnosed person. This can result in difficult behaviours, social isolation and young people who do not attain their best ability in school. Once diagnosed, the young person can understand themselves better and realise that are not alone in the way they feel. Their parents and the professionals working with them can all learn how best to help them. The right services can be accessed and adaptations can be put into place in the educational setting. A diagnosis can prevent so much distress as the child develops and can stop further psychiatric illnesses developing’

Self- identity and ‘finding your tribe’ are so so important for our autistic children. If a child can find her tribe (those she feels connected and at ease with) then they are not burdened with social differences or a lack of understanding about their needs. Research shows that social ‘deficits’ aren’t apparent between two autistic people! Yes that’s right, the deficit isn’t necessarily a ‘defect’ of the autistic individual but actually the non-autistic person has a deficit in autistic social skills! I am a big advocate for teaching non-autistic people about how autistic prefer to communicate rather than expecting autistics to learn ‘social skills’.

The very sad fact is that often children aren’t actually identified as autistic until that mask drops. The mask becomes too heavy to bear any longer, the long term suppression has caused mental ill health, severe anxiety, incredibly high levels of stress and the mask tumbles dramatically. Your child didn’t make it to the car and had a gigantic meltdown at school, your child couldn’t manage the monstrous amount of energy needed each day to get into school with a smile on their face and they hit a wall and point blank refused to go anymore, your child started to self-harm, your child attempted to take her own life. Even then often children are ‘treated’ using a mental health intervention! You are told its anxiety, depression and your child is prescribed drugs or even worse given a course of CBT! You are told that by keeping her home you are ‘feeding’ her anxiety and that avoidance will only make it worse! This is autistic burnout. If you don’t know about autistic burnout please look it up and read some of the amazing blogs by autistic adults such as Kieran Rose (The Autistic Advocate).

Anyway….. I digress. At this point your child’s autism may be recognised. The problem with this is when identification comes at a point where a child is rock bottom, they can misinterpret symptoms of a secondary mental health condition as autism. This results in many children rejecting their autistic identity and/or despising it. Heppel (2019, pp21) who was identified late in life, described this as ‘I have to separate the autism itself from the wounds that have been inflicted by people over the years- some well-meaning, some not - in response to the way my autism expresses itself’. Positive autistic self-identity is necessary for good mental health, (Cooper, Smith & Russell 2017).

Identification should not and must not be based on outward struggles. Masking must be understood by all, parents themselves but also the gatekeepers to assessments (Teachers, SENCo’s, GPs, health visitors etc.) and those that assess for autism. The Lorna Wing centre do autism assessments that last all day, during breaks when away from unfamiliar eyes the child is being observed. As a child is in clinic all day it is likely that by the end of the day the mask can slip. This gives the clinicians a good opportunity to witness a child unmasked. Equally during my daughter’s assessment we ensured that she was as comfortable as possible. The clinicians had details of my daughter’s special interests which they used to engage her and make her feel at ease. My daughter had seen pictures of the clinicians and she met them in a familiar and known place. The assessment was conversational in style and she doodled as she talked and showed them pictures of her pets. She was made to feel comfortable enough to un- mask and speak her truths. These clinicians heard about aspects of my daughter’s inner world that even I wasn’t aware of!

Parent blaming

Ok so your child is ‘perfect’ at school, but at home you have a child who is distressed, explosive and seems unable to control their anger.  This is the Jekyll and Hyde phenomenon (Attwood, 2009). When you approach school they are shocked by the child you are describing, when you speak with the GP they too don’t believe that the child sat still and quiet in their surgery can be the same one you are describing. Not only that, but because they behave well at school, the issue must lie at home……with the parents! Parents are advised to go on a parenting course, aimed at teaching parents to have tighter boundaries, be more consistent and regain control! This approach is damaging for an autistic child.

If a parent protests this and makes several visits to the GP, insists on second opinion and fiercely refutes that her child difficulties are down to her parenting and demands autism assessments they are deemed to be trying to ‘label their child’. Or in more extreme case accused of fabricating illness (known as FII, Fabricating or inducing illness). Particularly at risk are autistic parents (including those not identified as autistic).  According to the NHS a child is more at risk of FII if the mother has borderline personality disorder, which a common misdiagnosis associated with autism (Pilling, Baron-Cohen, Megnin-Viggars, Lee, Taylor, 2012). The NICE Guidelines (Child maltreatment: when to suspect maltreatment in under 19’s, 1.2.12) states presentations that may indicate FII, some of which raise concerns if we consider autistic masking, such as ‘symptoms and signs only appear when the parent is present’, ‘reported symptoms are only observed by the parent’. The National Health Service (2019) suggest considering FII when ‘the parent has good medical knowledge’, which considering many autistic parents knowledge of autism will be good, this is a concern. All of these ‘red flags’ could be attributed to a child that masks. Children have been known to be wrongly removed from parents, I know from my role that some parents are fearful of being deemed over anxious and/or neurotic by professionals when they try to fight for their child.

 Masking hinders in school adjustments and support

So without identification and without any signs of difficulty (due to masking) getting adjustments in school can take some fighting (not in all schools, I do work alongside some amazing SENCo’s) but sadly not every child and family has a ‘me’ and not all schools are as aware and supportive.

If your child does have a formal identification of autism, masking can still hinder access to support. Again, if a school doesn’t ‘see’ any unmet need or difficulties and/or the child isn’t causing any disruption or upset to others then why would they (if they aren’t aware of masking that is!). As well as denied adjustments, children are denied access to additional services such as advisory teachers or educational psychologists (that schools are gatekeepers to).

In my role I have witnessed schools having the attitude ‘we can’t refer because we don’t have any issues’, ‘she’s fine here so it’s the parent’s problem’ and ‘we don’t actually believe she has autism’.

I truly believe that every autistic child should have a support plan. This should be developed in collaboration with parents, the child and a trusted adult in school. This should be based on a child’s differences, difficulties and presentation in ALL settings and not purely based on how they appear in school.

Without this a child that masks will burnout. Very often these children become our school refuses and develop mental ill health. Once a child hits that wall and refuses or becomes burnt out its incredibly difficult for them to return. Trust is lost, trauma is long lasting and recharge is a long process. The support has to be there from the beginning. Success from the start, not intervene when things start to fail.

And finally…….

Ok so other than poor self-identity due to delayed assessment and/or identification, lack of understanding of self, no tribe, unmet needs in school, autistic burnout, inappropriate parental responses to needs or parents being deemed neurotic the other factor that risks the mental health of an autistic child that masks (just in case you needed additional ammunition!!) lies with others mis-perception of a child’s masking behaviour!

I have experienced people who deem masking behaviour as a child being ‘manipulative’.  Implying that the discrepancies in behaviours between settings and between care givers is down to a child trying to ‘get their own way’. This can lead to the mistreatment of a child. I have experienced those who disbelieve parents’ concerns and resent any ‘special’ treatment a child maybe receiving. I reframe ‘manipulation’ as a child ensuring their needs are met to prevent trauma. Poe (2019) writes about a teacher who deemed her manipulative. During her time in secondary school Poe was emotionally abused by this adult to a horrific level due to the teacher’s incorrect beliefs about Poe’s presentation. Professionals having a greater depth of knowledge of masking would increase understanding and encourage a more open dialogue between parents and professionals. 

What else needs to change……

All professionals working with children need to be aware of masking, but not only aware but a deep understanding of the depth of it, the reasons for it and how to support a child in feeling safe enough  to share their inner self.

Our children need to be allowed to say ‘no’ without the fear of punishment or ridicule. How often when a child doesn’t want to kiss grandma or share with a friend do we insist or persecute them for going against others wishes. How can our children learn the essential self-care needed to manage being autistic in a non-autistic world if we don’t teach them to say ‘no’ when it all feels too much! As an adult people often preach ‘self-care’ to me, I don’t even what my own self-care looks like! We have to advocate and teach our children this through validating and accepting when they express themselves.

Behaviour policies in schools go against self-advocacy. Many children I have met have a deep fear or phobia of being singled out or told off in school, therefore they will stick to the rules even if this is to their own detriment. Just recently I read a school policy that insisted children showed ‘good listening behaviour’ this involved sitting still, looking at the teacher and hands on laps! I work with many incredibly bright and able children, yet if they are required to follow through with these 3 demands they have little mental energy left to actually process what is being said to them. Yet they are too scared to act out their natural neurology of fiddling and looking away from people while concentrating as this will result in being seen to ‘break the rules’ or being ‘naughty’ with terrifying implications i.e. being told off.

The Sunflower lanyard has been helpful on our journey, my daughter uses hers and feels that when wearing it people don’t judge her negatively for her differences. She feels it offers her a green card to act herself. Autistic behaviours needs to be understood and accepted, the responsibility lies with every adult. Educate your children, educate yourself! All children should be taught specifically about difference. Diversity makes up the amazingly rich tapestry of life and of humans. No child should feel less for who they are, no child should be denied identification and expression of their true self.

A bit about me!

I am a parent to 3 children, 2 goats, 6 hens, a gecko and a dog.

I am also an independent autism specialist based in Wiltshire. I support families on their autism journey from assessment, identification, advocating for school adjustments, advising on parenting approaches and supporting the emotional literacy of autistic children. I also offer training to schools. Working alongside families on their journey is an absolute privilege. Every child I meet teaches me something new. Autism is my special interest and I am passionate about my role.

Jodie

jodie.smitten@behaviourservices.co.uk

https://m.facebook.com/Childrens-Behaviour-Support-Wiltshire-606003673066792/?ref=bookmarks

My saddest case: helpless 10 year old child with ASD/PDA/ADHD

The story of Bethany has been in the news recently and even Parliament are at last asking questions about the treatment of children in Acute Treatment Units (ATU). It reminded me of something that really upset me last year:

I was asked to assess an in-patient on a mental health ward in an NHS hospital: a 10 year old boy with diagnoses of ADHD and ASD. We'll call him Paul. Paul also had many signs of PDA, although this hadn't been explored further. He had been at a special school for children with ASD, where he had been getting on reasonably well for a while but his anxiety levels had been rising. One weekend his melt-down at home had resulted in his mother feeling at at total loss as to what to do and she had been persuaded by her partner to call the police.

A child who is having a meltdown is not able to be reasoned with, they have moved beyond any basic reasoning plus.

• A child with ASD will not be able to understand reasoning at the best of times as it's  a higher-level language skill, never mind the worst moments. 
• They may not have any idea that you have to adapt your language or behaviour for different people in different situations, so even when calm, will not see that they need to be 'respectful' to the local policeman who walks through the front door.
• They may have sensory issues which means when that policeman fails to reason with them and decides to remove them from the situation, they will automatically react in a defensive  manner

Then, they're in the secure ward 'for their own and others' protection' because no-one really knows what to do. This was 'just for the weekend'; in Paul's case.

Paul was scared, worried about  his mother, still angry (because the initial problem was still there and his sense of justice is huge), in a strange place with strange people; so how is he going to react? Will he calmly listen to reason, apologise profusely or will he more likely go into self protection mode? Just like a cornered, terrified animal would! How will this change when he is just 10 with no idea of what is happening, why he's there, why he can't go home to his mum, why he can't go to school.

The demand avoidance meant that he could not do as they directed while appearing more socially able than he was. He could also use language to try manipulate those around him and if that didn't work he would try to shock them into getting what he wanted.

Go forwards 3 months and I walk in:
Paul had nothing but a TV with no remote, as that's a potential weapon, and a settee. The ward was just a room with a wall of glass where the staff could observe at all times. The nurse told me he'd been been smearing faeces over the glass and remained unmoved when I said I couldn't guarantee not to do the same in the circumstances after 3 months. Look what happens on Big Brother or I'm a celebrity when people are watched continuously, and they choose to be there!

Paul is sensory-seeking in an environment where there was no sensory stimulation. He had taken to satisfying this need partly by hitting the top of his head, so he now looked like a small Friar Tuck with a bald patch, he also hit his chin so had developed sores all along his jaw-line.

The other very effective way of getting his sensory needs satisfied was to provide the guards, oops sorry, nurses, to tackle him to the floor and the best way to do this was to poke any visitors in the eye. This resulted in 2 large, burly men pinning him to the floor where he then laughed manically because he had his sensory needs satisfied. This had gone on repeatedly so was a cycle of behaviour which was keeping him there. They didn't see him as an anxious 10 year old boy with needs, they saw him as a demented Damion character who was dangerous and must be contained.

They allowed me to go in to see him but weren't happy when I asked Paul if I could sit next to him, I introduced myself and  we started to talk about what he liked to do. He told me he loved football, trampolining, x-box games, school, playing tag, drawing, painting.... pretty similar to any 10 year old boy to be honest .......only he had been denied any of these for months!

After ten minutes, he (probably) wanted to get out of the situation and tried to poke my eye, I moved my head away so he just scratched my face and I calmly reminded him that I wasn't there to hurt him and that I would be polite and kind to him so would be grateful if he could do the same. One of the nurses tutted because he thought I was mad and the other said if he moved towards me again I'd have to leave. I moved to the other side so he couldn't see my scratched face, so we could move on but five minutes later he tried to poke my other eye. He was then on the floor, pinned down and I was bundled out of the door.

The staff weren't to blame as they didn't understand him, they were all agency workers who don't normally even work with children, who were doing their best. The saw him as a dangerous, deranged creature who called them names they'd never been called before, never mind from a  ten year old. The way they described him showed they didn't see him as human in many ways. They had no training on ASD, PDA, anxiety or sensory needs.

His poor mother was helpless to do anything. Representatives from residential schools came in to assess him but were given the  same warnings as me, so didn't go in and decided  they couldn't meet his needs.

I attempted to discuss how I saw the situation but quickly became aware that they were not interested as they were temps. I wrote it in the report instead. Although I had done what I'd been asked to do, I felt as if I'd failed him because I couldn't get anyone to change their views. I felt my ideas were seen in the same light as if I was proposing witchcraft!

He ended up in a ATU.

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.