Sequencing - not just writing stories!

Every week I receive phone calls from parents asking me to work with their child, often stating that they can talk 'fine' it just some speech sound errors. On first meeting the child I can see that yes the child does have some problems with speech sounds and is talking in full sentences, but on closer inspection realise that much of what the child is saying doesn't make a lot of sense. Children often struggle to plan and organise their ideas in a logical way, which results in the listener finding it difficult to follow what they are trying to say and is often the result of a sequencing problem. The ability to sequence doesn't just correspond to narrative skills, but encompasses all areas of language development including; speaking, understanding, thinking, reading and writing.

To keep up with the increasing demand from children to include some technology based activities in therapy I have recently discovered some fabulous iPad Apps from Colorcards, which help me to target sequencing problems and the interactive activities are both motivating and engaging for children of all ages.

When working with either a group or individual children I like to use the 'Everyday Objects' app first to ensue the child is able to describe the pictures accurately, as a foundation skill to sequencing. All three sequence apps ie 'Basic', '4-step' and '6&8 step' are definitely worth investing in, as it is vital to ensue the child fully understands the concepts of first, next and last in a simple three part sequence, before you can expect them to build up to large sequences and then eventually prediction. The added extra of an accessible report template is quick to use and enables me to comprehensively track progress throughout the therapy process.

Each app has the great ability to set up multiple student accounts which can be tailored to target individual difficulties and goals. Differentiating between three levels (easy, medium, hard) is fantastic for building confidence with even low level abilities and being able to input your own images supports the child to be fully engaged in their own learning. Often some of the children I come into contact with have had limited and varying life experiences, so the option of creating your own story sequences ensures these apps are accessible to everyone.

Natasha Hallam

Myths and mis-information:tongue tie

1. 'Tongue-tie (ankyloglossia) happens when the string of tissue under your baby's tongue (frenulum), which attaches her tongue to the floor of her mouth, is too short. If your baby has tongue-tie, her tongue can't move freely, and this can cause problems (NICE 2005a)'
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3. I had a conversation this week with teacher who was saying that a child should have had his tongue tie snipped ages ago because now its been done, he can talk. She attributed his recent progress to that fact. Trouble is, he wasn't saying anything but a  few single words before and had an understanding at around a single word level, aged 5.Therefore, it was a language issue and nothing to do with his tongue tie!
4. I also saw a child today who had speech sound difficulties which had been attributed to a tongue tie.Trouble is, he has no word initial sounds and can say 't' and 'd' beautifully. Therefore, its a speech processing issue not the articulation problem of not being able to move his tongue. 
5. I see a boy with a tongue tie who is silent ...but he has Selective Mutism so the tongue tie is irrelevant!
6. The NHS website has lots of information but in essence, if it is severe enough to restrict the baby's ability to breast feed then its worth having it snipped but otherwise, there's probably no real point, in most cases. The movement required to successfully breast feed is more than enough to produce the placement necessary for speech sounds.
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Our new Speech, Language and Communication Centre is now open!

We are happy to have a new centre, to which families can come to see us from further away. We already have  families from West Yorkshire, North Wales, Sussex, Surrey and Buckinghamshire booked in. I've just taken  call from someone in France who wants to come too!

We will have an official opening ceremony soon but meantime here's a preview:

 Can you spot Ralph, the therapy dog waiting at the door. He's happy to welcome anyone but especially enjoys working with children with ASD and Selective Mutism. There's a safe place for him if you don't like dogs though.

 This is the reception area where you can wait with a coffee. There's toys and books for the children and magazines for the adults.

From reception you go through into the  therapist's room. Its full of toys but these can be screened off if they're too distracting.

This is the training room below but it's also a multi-purpose room as the tables fold away. We might use this room for very distractible younger ones or for older ones who don't want to be in a play-type room.

We are happy to see people from all over so please get in touch if you think there's anything we can help with.

June 2015 SEND Reforms Survey

The Communication Trust is committed to supporting all those working within the reformed SEND system to meet the needs of children and young people with SLCN and their families. As part of this work, they undertook two online surveys in June and November 2014 to find out how practitioners, service providers and commissioners were preparing for and implementing the SEND Reforms. They used the valuable information gained from these surveys to ensure we are able to offer relevant support to those working with children and young people with SLCN in the areas they report needing it most.
 

They are now running a third survey  across June 2015, to find out more about the perceived opportunities and remaining challenges of the reformed SEND system for children and young people with SLCN, almost a whole academic year on from the reforms coming into effect. The survey will take less than 10 minutes to complete and we would be extremely grateful if you would take the time to complete it and pass the link on to your colleagues and networks to help get the broadest response possible.
 

The survey will be open from 29th May - 29th June 2015 and is available here: www.surveymonkey.com/s/sendreformsforslcn2015.

Billy: Born Naughty? Channel 4 series 1 episode 4

 I was asked to assess Billy as part of the programme 'Born Naughty?' to see what might be causing his bad behaviour at home and more recently at nursery. He had already been seen by the Paediatrician Dr Ravi Jayaram who had made some important observations.

Billy aged 3 years, along with his Mum and Grandmother came to a children's centre which was local to me but was a good 3 hours drive from their home. I played with him a for a short time and then screened his spoken language skills. I was looking for: his attention level, listening ability, auditory memory, understanding level (information carrying words), vocabulary, verbal reasoning and expressive language. I was also looking for his social communication/pragmatic skills which includes three major communication skills:

        Using language for different purposes, such as

§       greeting (e.g. hello, goodbye)
§       informing (e.g. I'm going home)
§       demanding (e.g. Take me home)
§       promising (e.g. I'm going to take you home)
§       requesting (e.g. I would like to go home, please)

Following rules for conversations and storytelling, such as

§       taking turns in conversation
§       introducing topics of conversation 
§       staying on topic
§       starting conversations appropriately
§       finishing conversations e.g. not walking away mid-sentence
§       how to use and read verbal and nonverbal signals
§       how close to stand to someone when speaking
§       how to use facial expressions and eye contact

It also includes Modifying language according to the needs of a listener or situation (for older children but Billy is too young for this), such as
§       giving background information to an unfamiliar listener
§       speaking differently in a classroom than on a playground
 

He coped really well with the assessment and scored highly on everything. I'd also put out a variety toys to see what the level of his play was like. His pretend play was amazing: he used lego as soup, made Batman and Robin from square shapes and pretended with imaginary toys too.

His family were concerned that he might have Autism as his uncle has  a diagnosis of ASD. They were worried that his behaviour was due to this. However, if we look at the older way of looking at ASD: i.e. the triad of impairment of language ability, social communication and flexibility, Billy scores so highly as to void any suggestion of ASD, this, together with Ravi's observations, meant I did not therefore do any formal ASD assessment. His mum is to be congratulated on a fantastic job done!

We needed to look for an different explanation of the behaviour and called in the wonderful Deb Sugden, sleep expert. 

www.libbyhillspeechtherapist.co.uk

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.