What do you meme, you aren’t using photocopied worksheets in your social skills sessions?

This year I have been working with an increasing number of young people, who due to such high levels of anxiety, are struggling to engage:

                        - To engage in school expectations

                        - To engage in home expectations

                        - And to engage in ‘traditional’ speech                             therapy sessions

So you do what you know is essential, spend time getting to know the individual, rapport build, offering a reward..

But… what if the YP is still finding it difficult to follow the ‘adult-led’ agenda because there is the underlying demand to comply?

What do you do now?

Well most enthusiastic therapists know the importance of using a child’s interests within therapy sessions to engage them…

But.. what if the YP has limited interest in anything beyond sitting in their bedroom playing computer games all day?

Well of course we could use this as a reward to try and entice them into completing the therapy activities first

But… why would the YP ‘buy-in’ to completing your activity just because you want them too, when they are already happily enjoying their interest without needing to ‘earn it’ first?

            I myself, don’t have to adhere to persuasion of doing something I find difficult, like running a marathon, just on the promise of a ‘glass of wine’ reward at the end, just because someone said it would be in my best interest to do the exercise. I would still find it anxiety provoking to conform to their wishes, however much I liked the person and especially if I was already able to go to the fridge and pour myself a glass without. No exercise necessary!

So… faced with the dilemma of how to support my YP to ‘buy in’ to my sessions I had a serious head scratching moment until I thought about the likelihood of me running a marathon at the same time as drinking wine.

Now that is an interesting concept indeed!! Why does one action necessarily need to precede the other?

Well… despite the complicated logistics of this, I have to admit that the probability of me going for a run has significant increased.

‘Lightbulb moment’ – how can I embed my speech and language targets into the actual activity the child enjoys?

Despite my significant lack of gaming talent, one thing I found I did have in common with the YP I was working with, is enjoying the humour of memes.

So… where to start? Well after having fun sharing our favourites and discussing what we found funny about them I soon realised the previously highly anxious YP, who struggled to engage in any reciprocal social conversation, was soon confidently and spontaneously talking me through the steps of how to create my own Tumblr account.

Now, I must admit those sessions that are completely unscripted, when the therapy plan has gone shooting way off the map, is the most enjoyable part of my job and I’m happy to be a passenger to a student who feels motivated enough to take the lead.

But…what actual speech and language targets am I working on when using memes?

Well to be honest, we were actually working on a lot of therapy goals simultaneously!

Social Thinking Goal 1: initiating communication that is not routine

            When she is not anxious, Emily has no difficulties in engaging in conversations about something she is interested in. However, where before she would just talk ‘at me’, now during the sessions she can confidently initiate a narrative of talking me through the Tumblr sign up process and displayed the best turn taking skills so far; even pausing and allowing me the opportunity to ask for clarification.

Social Thinking Goal 2: Listening with your eyes and brain

When Emily was anxious, she would cover her face with her hair and squeeze herself between the sofa cushions. But now she uses ‘whole body listening’ with confident posture, joint attention and initiation of eye contact when she is communicating.

Social Thinking Goal 3: Understanding abstract language

Most of the language we use is peppered with idioms, metaphors, sarcasm and inferences and each generation of teenagers and young adults leave a trail of new slang for consumption - most of which is abstract. Through memes, I am able to teach Emily how to make a ‘smart guess’ to interpret the abstract language based on her previous knowledge, the context of the picture and the non-verbal communication clues.

Social Thinking Goal 4: Understanding perspective:

The ability to interpret others’ perspectives, thoughts and feelings is critical to social learning. Looking at memes with Emily created the opportunity to work on her Theory of Mind skills by discussing the point’s of view of not only the people in the memes but each other and our individual interpretation of the jokes. Whilst Emily was narrating how to set up my Tumblr account, I reminded her that I had no prior knowledge of the website. She was able to effectively use her own analogies to link these new concepts to the social media knowledge that my ‘inferior brain’ as she called it, already knew so that I could understand her.

Social Thinking Goal 5: Getting the Big Picture

If a picture is worth a thousand words then a ‘meme’ must be worth a million and the opportunity to share an imagination with other people is priceless. These therapy activities focused on teaching Emily to infer how to link individual pieces of information into an overall idea – to get the ‘bigger picture’.

Social Thinking Goal 6: Humour and Human Relatedness

Establishing human relatedness is essential before advancing in any therapy sessions; which is why rapport building is essential, especially with our most anxious students. Emily has a fantastic sense of humour and a very dry wit! But she often feels too anxious to use her humour successfully with others. So starting the therapy process with memes has helped to minimise some of her social anxiety.

Last year, Emily was a very anxious young lady, isolated at home and had little to no social interaction outside her immediate family. Now, although her socialising is still largely from the safe space of her house, her anxiety has decreased enough that she is interacting online with other YP with similar interests and is beginning to leave the house to visit local attractions. Everyday Emily is one brave step closer in gaining social confidence to engage in reciprocal conversations with new people.

We’ve since extended our sessions from also decoding magazine adverts and T.V. commercials to creating our own memes. It was surprisingly easy to embed all of my therapy targets into these activities; the only confusing thing was why I hadn’t tried this idea sooner!   

So what I ‘meme’ is that therapists need to stop thinking about what they think speech therapy ‘should’ look like and instead about what is the most functional and meaningful skills for the YP to learn to help them interpret social information and interact effectively with others. And not a photocopied worksheet in sight!

Makes me so sad........

One of the things we do at Small Talk, is to see children who are having behaviour issues at school or at home and people are seeking the answer as to why they behave as they do.

It's so sad how so many children are being misunderstood. Time and time again, we see this scenario: 

The child who doesn't understand social clues and cues, may not be good at reading facial expressions, doesn't understand abstract language such as sarcasm, or people's intentions. They probably don't always remember that they need to modify their language according to the listener i.e. you don't talk to the teacher like you would your mum. They develop a strong sense of right and wrong to help them cope. They may be aware of their difficulties and be anxious.

Then, at lunchtime, someone knocks into them, they refuse to say sorry as it was 'an accident', they may try to explain that or just run off laughing. The child knows that you must tell if someone does something wrong but is sent away by the dinner lady or teacher on duty as 'he didn't mean it'. This upsets the child who gets more frustrated and wants to get his point across. He ends up shouting at the member of staff and is then sent to the headteacher. He is really fed up, frustrated and down right angry, so shouts at the headteacher too....... result: excluded for the next 2 days!

These children may be on the autistic spectrum but they might not. Social understanding is hard for many children.

The solution is simple:

1. A Social thinking programme with behaviour mapping for the child (Garcia Winner)
2. Training for staff

Why is that so hard to understand?

Impaired Perspective Taking: as seen on Born Naughty? Channel 4 28th May 2015

If you saw Thomas on Channel 's Born Naughty on Thursday, you will have seen that he has impaired perspective taking, he cannot put himself in others' shoes (Theory of Mind). I tried the first session of Social Thinking on him where I lay on the floor of the classroom while still talking. This usually promotes gasps, stares and makes the average 10 year old feel very uncomfortable ......and think I'm slightly weird. I then get up and we discuss my behaviour and their reaction. Thomas, however, didn't notice I had laid on the floor and when I got up and asked what he thought of my behaviour he said 'Nothing', I asked if he thought it was odd, he replied, 'No!' Normally, we go onto discuss expected vs unexpected behaviour and how these make people feel. It's a great way of introducing children with social communication difficulties to the idea that there is a point to conforming to expected behaviour.

The best person to tell you more about this is Michelle Garcia Winner, the founder of Social Thinking:

 https://www.socialthinking.com/images/stories/ST%20SCP%20%20Ver%20%206.12.pdf

Small Talk Speech & Language Therapy use Social Thinking as part of their daily work

www.private-speech-therapy.co.uk

I lay on the floor and carried on talking....he didn't notice!: Thomas from Born Naughty episode 3

Most people have an idea of what a person with Autism might be like. This will depend on their previous experience or what they've watched for instance when Rain Man with Dustin Hoffman was shown, people assumed all children with ASD were like that with extra abilities in one area. Many teachers tell me they've worked with children with autism before when I'm discussing a potential new one, as if that makes them experts. The real truth is that the spectrum is so wide and each individual so different, that its very hard to be an expert in all aspects of ASD: 'when you've met one person with autism, you've met one person with autism' is by far the best quote I've come across. We must be aware of the aspects of ASD and potential strategies to help but each will require their own individual programme.

Diagnosing ASD can be very straight forwards with some children because the red flags are so numerous while others can be very difficult because they have become skilled at coping and the right questions must be asked in the right situations. Dr Ravi from 'Born Naughty' says that for  some children, its like appraising fine art' so just like some of us may look at a Picasso and think that's definitely NOT art, others would be able to admire the subtle messages portrayed within.

When you first met Thomas, you don't see any red flags initially: non verbal communication, language skills and even pragmatic skills can  look to be within normal limits to the un-trained eye. I saw him in a clinic situation at first, we chatted, played a little and did some formal and informal language assessments. He coped well with the filming and having to do things again for the camera angle. We'd dedicated the entire afternoon to the initial part of the assessment so we had a tea-break in the middle.

At this point, I hadn't spoken to his mother very much as my plan was to see her after Thomas so he could get something to eat and so we weren't talking in front of him. While we were in the kitchen area, she showed me her phone with a video of Thomas having a temper tantrum. It wasn't a major one, in fact as a mother of a child the same age, I would say it was  5/10, BUT my son would be absolutely mortified if he thought I'd told anyone let alone, videoed and shown it. Was Thomas bothered? No way, he didn't see that I would think anything.... he has impaired perspective taking, he couldn't put himself in others shoes (no theory of mind) and I needed to explore that route.

I saw him at his special sports club with his instructors: he didn't follow any instructions yet told everyone else what to do. The other children all attended special, schools but he didn't notice their differences.

I spent some time at home before doing the first session of social thinking (Garcia-Winner) which is about being  a social detective. I introduce the session and then lie on the floor while I'm still talking...... did he look shocked, look to see where I'd gone, say anything about an adult lying on a classroom floor? NO, he carried on talking!! I got out the ASD assessment!

Sure enough he scored a profile which together with the parental interviews and Ravi's observations, would suggest mild to moderate ASD.

With the programme, you get a  snapshot of the assessment, which actually took several days over a  month. Thomas was seen at home, in a school setting, sports group setting and in a clinic by me and at home by the Paediatrician. I interviewed parents on three separate occasions too. ASD diagnosis needs to be thorough to be sure.

Perspective taking and high level ASD is fascinating and we'll look at that more another time.