'Auditory processing disorder': a real condition or another middle class excuse for a child who isn't achieving?

What is Auditory Processing Disorder?

 I overheard an older teacher on the train last week say that they were 'fed up these days of hearing about these modern excuses for little Hector or Hermione' not being able to do their work well or achieve better in lessons. He suggested that the parents should spend more time on helping with their homework than researching these possible causes! He wasn't talking to me, he was talking to a younger man who was nodding knowingly but I couldn't just sit there. After I had gulped and reminded myself to be polite, I leaned forwards and managed to say, 'Really, I'm so surprised you say that as most teachers these days look for the reasons behind a child's difficulties so they can help'. 

I am a parent of two children with dyslexia and Auditory Processing Disorder, that's not an excuse but it is the reason they find school difficult and have to try harder.

•      “APD is a deficit in neural processing that is not due to higher order language, cognitive or related factors” (ASHA 2005)

•      However, APD may lead to difficulties with higher level language processing, learning and communicating

•      “APD is characterised by poor perception of sounds, has its origins in impaired neural function, and impacts on everyday life

•      primarily through a reduced ability to listen, and respond appropriately to sounds.”

What are the symptoms?
   
It can affect a child's ability to:

• understand speech – particularly if there's background noise, more than one person speaking, the person is speaking quickly, or the sound quality is poor
• distinguish similar sounds from one another – such as "shoulder versus soldier" or "cold versus called"
• concentrate when there's background noise – this can lead to difficulty understanding and remembering instructions, as well as difficulty speaking clearly and problems with reading and spelling
• enjoy music -Many people with APD find it becomes less of an issue over time as they develop the skills to deal with it.Although children may need extra help and support at school, they can be as successful as their classmates.

What can we do about it?

•         Environmental Modifications:

Preferential seating in the classroom, as close as possible to the teacher, will make facial expressions clearly visible, and maximise the ratio of direct sound to reverberant sound. The seating position should also be away from noisy equipment, such as overhead fans, to maximise the signal-to-noise ratio.

•         Teacher-Directed Strategies

A number of strategies may be implemented by the child’s schoolteacher to assist children with listening difficulties to extract as much information from the auditory signal as possible. These strategies include:

1.       speaking in short, simple sentences

2.      repeating a message if not comprehended

3.      slowing the speed of delivery 

4.      providing visual cues and hands-on demonstrations, as multi-modal cues add to the auditory information so that the whole message can be understood

5.      pre-teaching new information and vocabulary so that the child has a greater chance of inferring missed information from the context of the message

6.      gaining attention prior to speaking

7.      frequently checking for comprehension; using positive reinforcement generously

8.       planning regular listening/concentration breaks to avoid auditory fatigue

A personal FM system may help. This is a wireless system designed to help someone better identify and understand speech in noisy situations and over distances of up to 15 meters (50 feet). The person speaking wears or holds a transmitter microphone. This transmitter picks up important speech sounds and uses harmless radio waves to send these to a FM receiver, which a child wears behind the ear. This results in the speaker’s words going directly directly in their ears, without any distracting background noise.  Unfortunately, most teenagers wouldn't want to do that as they make it their life's mission to fit in and not be different!

It needs appropriate and thorough screening to make sure it is APD and there is not some other reason for the difficulties. Screening using assessments such as a Scan 3 and LISN-S and formal and informal tests of receptive and expressive language are essential.  

If you are concerned about your child, please get in touch, we'd love to help.

To book a screen please click here

I couldn't possibly go to University at my age... Why you shouldn't be afraid to become a mature speech and language therapy student.

Going to University as a mature student is a big decision to make. It has financial and time implications and could also impact on friends and family.  It is daunting to face studying and revision for exams all over again. What if you fail? 

However, there are many upsides to being a mature student as you probably already possess many more transferable skills than you realise.

Ability to organise

Everyone has different ways of organising themselves. Anyone who lives independently, looks after a family or is employed will have learnt what techniques work for them. Whether this be a diary, post-it notes or copious to-do lists. This will be a huge advantage when juggling studying and assignments.

Being able to talk to people

Mature students have usually had more experience of meeting different people from different walks of life.  Even if you are naturally shy, the day to day experiences of adult life will have meant you have developed coping strategies when thrown into new situations.  This not only makes it easier to make friends on the course but will also help you contribute to lectures and will be a real asset on clinical placement.

You can take a flexible view

As you go through life you realise that you can learn about situations but that life doesn't always play by the book. This can help when you learn that individuals don't fit into neat boxes and that professionals can have different views on almost everything.  It will also make you more understanding towards parents and carers.

You will appreciate the support available at University

From the lecturers who will give extra tutorials, to the library staff who will talk you through accessing journal articles, it is lovely to be in an environment where people will help you. This is not something that we always experience in the workplace, so you will be more likely to seize these opportunities and really appreciate them. 

There’s mature and then there's mature

Don't worry about being the only mature student on your course. You will be amazed at the age range of speech and language therapy students. From 18 year olds through to 50+ year olds. But everyone has something in common - the desire to work as a speech and language therapist.

And finally...

You get discounts

While you will be studying because you are passionate about becoming a speech and language therapist, a student discount card is a lovely bonus and takes some of the guilt out of buying fancy stationery.

Becoming a mature student is daunting, particularly as speech and language therapy is a very demanding course, but it might just be one of the best decisions you’ll ever make. 

Written by a brave lady who took the plunge and does not regret it!

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.

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

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. www.smalltalkparenthub.com

Consultant Speech and Language Therapist

Small Talk Speech & Language Therapy

www.private-speech-therapy.co.uk

Developing a parent hub

We aim to support the parents we see through the process of speech and language therapy. While we aim to do this the best way we know how, there are many who do not have access to a speech and language therapist at all.

We are setting up a membership club to aim to do this for people we don't see. To make sure it is exactly right, we would really appreciate your help.

Please see the survey for the parent hub by clicking here

Thank you very much!

Short-term gain vs quality outcomes

The Royal College of speech and language therapists commissioned a cost-saving matrix to help services demonstrate the value of SLTs to national and local decision makers, while at the same time showing evidence of efficiency and value for money. All public services, and the professionals who deliver them, are under increased financial scrutiny and the pressure which ensues. As you no doubt know, there is more pressure than ever before to show how taxpayer funded services are cost-effective and how they meet local and national priorities.

The language unit at Flash Ley in Stafford has been a great example of specialist provision for children who are bright but have disordered speech and/or language skills. Specialist teachers and speech and language therapists have worked together to maximise the child's potential and they then return to mainstream school to be with their peers when they are more able to cope. I know several who have been. I met them when they were in nursery and knew they'd find it hard to cope in mainstream schools but they had normal learning ability so a generic special school would not be the answer.


Flash Ley had teachers who were more qualified and experienced in SLCN plus enhanced input from specialist SLTs. Working together gives the best way forwards.

Having worked for 30 years, I witnessed the first language units and the fights to have more. We knew then, as we know now, they are the answer for many children with disordered speech and language.

When I first worked, my NHS head of department was a lady whose views were never questioned. Partly because counsellors or managers daren't but also because she was the professional so she knew best. That's a long-gone scenario and, I for one, would never have managed a typical Judith Waterman peer over her glasses, half as well as she did. It said 'stupid man' without need for words!

There are 2 reasons why closing language units are not a good idea:

1. It's not good for the long term outcome of the children. These children have great potential.

2. The savings are only short term. For every £1 invested in enhanced speech and language therapy for children with SLI generates £6.43 through increased lifetime earnings.

This is in comparison to routine speech and language therapy, where enhanced therapy results in an additional 5,500 students achieving five or more GCSEs A* - C (or equivalent).

The resulting benefit of providing enhanced therapy for all children aged six to 10 who currently have SLI exceeds the cost of the speech and language therapy by £741.8 million.

Further analysis shows the estimated annual net benefit is £623.4m in England, £58m in Scotland, £36.1m in Wales and £24.2m in Northern Ireland.

 PLUS: parents will fight to take up specialist school places out of county (it's one of the few clinical areas where there is an evidence base to say they need enhanced!) so the LEA will have to pay thousands in legal fees to fight this. If and when parents win, these are the figures they might need the LEA to cough up:

Alderwasley  From £57,689.00  

Bladen House £82,223

Dawn House 25k (2013 figures)

 (figures from google so may not be up to date)

What will the provision look like for the children who should go to a language unit? It maybe a half-termly visit from  a SLT to school with extra TA support. This is not what the evidence say works best: the children who require the most specialist teaching are in the charge of the least qualified members of staff (absolutely no disrespect to the TAs but that's the fact).

As an independent SLT, whose team can offer weekly or more regularly, I'm not complaining as we can offer what they need BUT it's short sighted. Let's hope the other language unit in Staffs is more successful at fighting it.