Eco Team at Magic Words Therapy

We'd like to introduce you to Susan Woodley, our new Eco Rep. Sue is one of our speech and language therapists and like the rest of us here at Magic Words Therapy she cares greatly about our planet and preserving our natural environment.

Sue is going to be spearheading Magic Words Therapy's campaign to make our organisation as eco-friendly as we can possibly be by making changes big and small. We want to reduce our waste, reduce our carbon emissions and possibly even plant a Magic Words Therapy garden. Watch this space!

Voice therapy for transgender individuals

By Speech and Language therapist Wai Seng Thong

Finding your authentic voice

While I was living and travelling around in East Asia, I met a variety of gender diverse people and I was astonished to hear that most of the Asian countries had no integrated care pathway in their health services for trans individuals. Trans people are a minority group in most societies who are facing severe discrimination. Their needs have been poorly understood, especially in East Asia.

Growing up, I had a couple of transgender friends and I saw them struggling, undergoing both physical and emotional stresses, making me constantly worried for them and wishing that I could help them through the crazy roller coaster ride of transitioning and struggling to find their authentic voice. I could not imagine how hard this must have been for them to confront this, while also having to face a lack of support from their families and prejudice from people in their communities. Becoming skilled at supporting trans people to find their true authentic voice became a goal in my career as a speech and language therapist.

Assessment

As a trans person, assessment of your voice, carried out by a speech and language therapist, will highlight which areas need to be focused on in voice therapy. You may already be aware of changes in your voice. The aim of therapy is to work towards a voice that is compatible with your chosen gender while bearing in mind the physical limitations of the vocal tract.

Therapy for Transmen (Female to Male)

One of the effects of testosterone is to deepen the voice. This deepening is a direct result of the vocal cords increasing in bulk. During the early stages of hormone treatment, the voice may be unpredictable and the muscles around the vocal cords will feel the strain. Voice therapy is therefore important to help achieve a smooth transition from the female to male pitch.

Therapy for Transwomen (Male to Female)

Oestrogen treatment has no significant impact on the voice as once a person who was born male has gone through puberty, the larynx will have lowered in the neck and increased in size, otherwise known as our voices ‘breaking’. Likewise, the testosterone that influences other bodily changes during male puberty also thickens the vocal cords which makes the voice sound deeper. This cannot be reversed with oestrogen treatment after a person has gone through puberty.

Although there are many challenges surrounding voice modification from male to female, with the right support and guidance from a speech and language therapist, any issues with the voice can be reduced and corrected.

I have found it to be very rewarding to work with transgender individuals in helping them to find a voice that matches the true them. Changes in voice can be achieved through specialist vocal exercises carried out under the guidance of your speech and language therapist. There are many aspects of the human voice that make listeners perceive it as either masculine or feminine.

These include:

• Articulation patterns: the way we say certain sounds.

• Intonation patterns: the ‘tune’ of our speech i.e. the ups and downs.

• Volume: loudness or quietness of our voice.

• Resonance: the sound quality of the voice and how it is filtered using our speech producing mechanisms in the face and other parts of the body.

• Pitch: how high or low the voice is.

• Communication aspects: timing and non-verbal skills e.g. eye contact, gesture etc.

A speech and language therapist will be able to support you by giving you a good understanding of how to look after your voice to achieve the most positive results and help you to understand how your voice works. Knowledge is power and these learnings should help you understand the rationales behind the vocal exercises and how they work. We aim to increase your knowledge, awareness and your expertise in your own voice and how to train it. As speech and language therapists one of our goals is to give you the autonomy, skills and knowledge needed so that you can make informed choices about how to proceed and progress effectively and healthily with your personal exploration of your own unique voice.

If you have been searching for your authentic voice, the voice that you feel most comfortable with, then speech and language therapy could be the right choice for you.

Find out more here https://www.magicwordstherapy.co.uk/transgendervoice

Stammering and the Iceberg Beast

By Specialist Speech and Language Therapist Frankie Paterson

I was interested to learn about a proposed new way of thinking about aspects of stammering as a ‘beast’ that can be strengthened or weakened. Dr Rick Arenas thinks of a stammer as an ‘Iceberg Beast’ that can be slain. Rick, associate professor at the University of New Mexico, researches developmental stammering and is himself a person who stammers.

The idea of the Iceberg Beast originates from the iceberg analogy that’s been used to describe stammers since 1970 (J Sheenan).

The top of the iceberg, that’s visible above the water’s surface, represents stammering behaviours such as repetitions of sounds, words or syllables. This is the part of a stammer that is visible for others to see. The part of the iceberg that is submerged under the water is vastly bigger than top part. This underwater part represents the underlying aspects of a person’s stammer that tend to be invisible to others. These include anxiety about speaking, avoidance of speaking or of situations, emotions about speaking and stammering and beliefs about yourself and your place in the world as a result of the stammer.

Although Dr Arenas thinks this iceberg analogy is effective in portraying what being a person who stammers is really like, he has built on this iceberg idea using his own experiences as someone with a stammer and experiences that other people with stammers have shared with him. Dr Arenas has observed that for a person who stammers, the unseen part of the iceberg can be like a living entity that has the power to hold them back from living their life as they’d like to, and that it can grow, shrink and change over time. He has come to identify these undelying parts of his stammer as the Iceberg Beast, that can feed on certain types of things that give it fuel to grow and get stronger. At the same time, there are things that he can do that he knows will weaken and shrink his Iceberg Beast.

Rick explains “the beast is a cohesive collection of beliefs about stuttering that we allow to negatively impact how we live our lives”. Rick believes that as a person who stammers there are specific choices you can make that will make your iceberg beast either grow or get smaller. These choices are not ones you are stuck with and are destined to make forever. You can decide to make different choices.

What types of things allow the beast to grow?

· Not talking about your stammer with others or being open about it.

· Avoidance. Of words, situations, thoughts or truths about yourself and your stammer.

· Not accepting that you have a stammer.

· Being in denial about the stammer as being something that affects you or how much it affects you.

Rick believes that negative thoughts and feelings about stammering that are harboured for a long time and not talked about openly can ultimately transform into core negative beliefs about yourself and your stammer that your iceberg beast loves to feed upon, helping it to grow. For example, believing that you will always be too slow to get your words out, that people will always get impatient and bored when you try to talk or that you are weak or faulty because of your stammer.

Weapons Against the Beast

Rick lists ‘weapons’ that people who stammer can use to weaken and shrink the iceberg beast and so reduce the control that the stammer has over them:

· Daring to be open and vulnerable about your stammer.

· Allowing yourself to stammer openly and freely.

· Being honest with yourself about the impact the stammer has had on the way you’ve chosen to live your life.

· Self-Acceptance. Accepting all parts of your identity, including that you are a person who stammers.

· Authenticity with yourself and others.

· Talking openly with others about your stammer and thoughts, feelings and beliefs surrounding it.

Dr Rick suggests that useful questions to ask yourself are:

· What would you ideally be doing in your life that you currently are not doing because of the stammer?

· What do you avoid because of the stammer?

· In what ways is this actually impacting on how you live your life?

Dr Arenas believes that real lasting change comes from an exploration of your attitudes and beliefs about the stammer as opposed to focusing on the stammering behaviours themselves. He emphasises the fact that it is your beliefs and reactions to your stutter rather than the stuttering behaviours themselves that negatively affect your life. This echoes an idea from the stoic philosopher Epictetus that I have personally found invaluable in my own quest to change negative thoughts and the beliefs that underlie them. Epictetus stated that “Men are disturbed not by things, but by the views which they take of them.” To bring this back to stammering, it could be said that the act of repeating words is not the cause of your pain as a person who stammers, the root cause of pain are the negative beliefs you hold , e.g. that stammering somehow makes you a lesser person or that other people seeing you stammer will make them dislike you or think you are weak.

Being brave enough to be vulnerable

The qualitative research professor Bréne Brown pioneered the idea of vulnerability being a powerful act that can be immensely healing and galvanising in her viral TED TALK . So what’s vulnerability all about for people who stammer?

· Daring to be truthful with yourself and others about your stammer.

· Being brave enough to show things to others you’d really rather hide from them because you are ashamed, namely openly stammering.

· Daring to really look inward at yourself and to share those observations with others.

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Unicorn or Beast?

I think this idea of imagining the internalised part of a stammer as a fluid entity that can increase or decrease in power depending on choices within your control could be incredibly liberating for many people who stammer. Giving limiting core beliefs an identity, so that you can put them under the microscope can be an empowering and healing exercise.

This is very much in the spirit of an exploratory assessment I often use where the client is asked to draw their stammer. The results are of course unique to each person and can be hugely valuable in understanding a client’s relationship with their stammer.

I think it’s important to recognise that each person’s core beliefs about their own stammering will be unique to them and so the identity they give them will be unique as well. For one person their internal stammer might well be visualised as a beast to be slain. But someone else might see theirs quite differently, for example as a majestic but troubled and misunderstood unicorn, to be tamed and calmed! Warlike imagery of using weapons to destroy a beast could be negative and unhelpful for some people who stammer. I wonder if for some people, attaching a more neutral image to their stammer could be somehow helpful in reducing the negative hold it might have over their lives.

If you want to hear more from Dr Arenas he is interviewed about his Iceberg Beast theory on the excellent podcast Stutter Talk.

What have Cleopatra and children with listening difficulties got in common?

by Wai Seng Thong (Speech and Language Therapist)

Attention and listening – the foundation of communication

When I think about communication, I always imagine the Egyptian pyramids which, like communication skills, need to be built on a solid foundation. Also, both the pyramids and communication are really amazing things! For communication skills to develop, the solid foundation you need is attention and listening skills and just like those builders of old, if you are not listening or paying attention things can go awry (Check out the pyramid of Sneferu, it went awry big style!)

What are attention and listening skills all about?

‘Attention and listening skills’, is a concept that we as speech and language therapists talk about regularly. So I decided for this blog, I will talk about this foundation of the communication pyramid (and no you don’t need to be Cleopatra to make sense of it!) 

Often I hear parents and teachers use commands such as ‘Sit down!’, ‘Stop!’, ‘No!’, ‘Don’t do that!’ when children are not listening and running around like headless chickens. This can be during meal times at home or even in the classroom during reading lessons. We all know how daunting it can be when children don’t listen. This can be so stressful for parents and teachers. It can even cause emotional tensions within families. Well let me tell you this, if you struggle with children who don’t listen; you are not alone.

Does my child have problems with attention and listening?

Have a think about these questions:

·         Can your child sit still?

·         Can they keep their hands still e.g. without fiddling?

·         Does your child look at the teacher or at you when you are talking?

·         Can they concentrate when there is a lot of background noise like TV or music?

·         Can they repeat an instruction back to you?

·         Can they sound out words?

·         Can they remember long words?

·         Do they seem not settle with one activity, but tend to flit from task to task or toy to toy?

·         Does it often look like they are tuning out?

If you have answered ‘yes’ to any of the questions above, your child may have difficulties with their attention and listening skills.

You may be wondering why are these skills so vital? Or do we really need this skill nowadays as humans? To answer these questions lets go back to the desert in Egypt. Imagine the builder wasn’t paying attention or listening and cut the first stone for the foundations of the pyramid to the wrong size. This would obviously be disastrous. Difficulties with attention and listening can have an impact on all areas of learning; if a child is not able to listen and pay attention, they will find it difficult to process and then utilise important information in lessons when it is given to them. And then success in their classroom learning will be very hard to achieve.

How to assess?

Based on Reynell’s research there are six levels of typical development of attention and listening, these levels may be used to assess and understand the child’s development of attention and listening skills in relation to the developmental norms. Remember; there is a huge variation on what is considered ‘normal’ and I would urge people to question whether the term ‘normal’ is really fair or useful anyway? Levels like these are useful for the most part as they help us to see a sequence of levels of attention and listening development. For example, if a child is at a particular level, these levels help us by telling us what that child needs to be able to do next, to push on forward with their skill development and to reach the next level. These levels are:

Level 1 (typically birth to 1 year): Child’s attention is fleeting, shifting from one object, person, or event to another. The child will get distracted immediately by any new event such as someone walking by.

Level 2 (typically 1 – 2 years): Single channelled attention and the child can concentrate on a concrete task of their own choosing, however, will not tolerate any verbal or visual intervention from an adult.

Level 3 (typically 2 – 3 years): Child’s attention is still single channelled, but the child is not able to shift their attention away from the current task and then go back to the original activity with adult support.

Level 4 (typically 3 – 4 years): The child can alternate his/her full attention (both visual and auditory) between the adult and the task and now does this spontaneously without adult support.

Level 5 (typically 4 – 5 years): Double channelled attention. The child understands verbal instructions related to the task without interrupting the activity to look at the adult. Concentration span can still be short; however, they can cope with group situations.

Level 6 (typically 5 – 6 years): The child’s attention is well established and sustained.

How to support?

Due to the huge importance of attention and listening skills, I am often asked by both parents and teachers about how they can support children to become better at paying attention or listening to them. So I tell them this true story:

One day a good friend of mine shared her super-secret mouth-watering ‘Honey Mustard Chicken’ recipe, something I had tried for years to get to her to share. She really quickly told me all the ingredients, how to cook and prepare the chicken. Once I got home and tried to cook it, I found I had completely forgotten some of the ingredients and was hazy on the method, leading to a somewhat disappointing chicken dinner. However, when I went back grovelling again for the recipe, she told me the recipe step by step with great instructions and even with pictures and videos of her making it (such a kind friend she is). Then I went home and made the dish, following her instructions and step by step guide and as you can imagine it was YUM.

What would you rather do? Attempt to remember a long stream of complex instructions or remember a simple step by step set of instructions, with pictures? You are probably like me and would opt for the second method. Well it’s the same for children following adult instructions as it is for us as adults who are given a recipe or a set of directions to get to a place; too much information and no structure or visual support and we can all fail.

Now I am not saying this is easy. I do realise it’s hard to find ways to keep children focused especially in this busy and fast-paced Netflix and iPad era we now live in. So below I have shared with you my nine easy tips to support your child’s attention and listening skills:

1.       Always call your child’s name to gain attention. Like in a football match a player will call their teammate’s name when they want to pass the ball and get their attention.  

2.       Make sure you get your child’s eye contact before pointing to something, giving an instruction or asking a question as this not only shows them the good behaviour of eye contact but also helps to keep them focused.

3.       We sometimes forget children are smaller than us, so crouch down and get down on your child’s eye level to make sure they can focus on you.

4.       No one can focus on anything for too long. We as adults have our limits as well. We all need breaks from having to concentrate. So break times are important! This needs to be negotiated breaks with the child, for example giving 5 minutes’ free time once they have achieved a certain amount or focused on reading a book with you.

5.       Praise! Everyone loves praise so give specific and positive feedback to the child about their listening skills with phrases such as ‘Thank you for looking at me’, ‘Well done for waiting your turn.’  Sticker rewards are an amazing and cheap incentive to help children to be motivated for good listening. I have been reliably told smiley face stickers are their favourite (so a group of my preschool children told me!).

6.       In this manic world of noise and distraction try and create a quiet environment by reducing background noise such as TV before trying to get your child to listen to you.

7.       If a child looks confused or you’re not sure they understood what you have said to them, encourage ‘active listening’ by asking if they have understood or listened. You can help children use this as a strategy to compensate for their difficulties with attention and listening.

8.       Most vitally, like with my friend telling me the recipe, break longer instructions into short steps and leave plenty of time for children to process the information. Giving visual support to what you are saying is also highly useful.

9.       As adults, talking about things we are interested in with our friends means that  conversations flow. So when you’re talking to a child try to follow the child’s lead by talking to them about what they’re interested in or focused on. They will be more focused on the conversation if it’s interesting to them than if it’s not.

If you only remember only two pieces of advice from this blog, let it be these. Firstly: be like Cleopatra and make sure your child’s communication pyramid has a solid foundation. Without this structural base skill of attention and listening, everything else we try to build on it can end up wonky like poor Pharaoh Sneferu who has gone down in history as the Pharaoh who couldn’t build his pyramid straight! Secondly take heart in the knowledge that the Great Pyramid of Giza was not built in a day. It took many years and great patience to build. In the same way, developing a child’s attention and listening skills can take great perseverance and time, so do not worry if you do not get overnight success.

Working memory in school aged children

By Sonali Dutta, Speech and Language Therapist

WORKING MEMORY IN SCHOOL AGED CHILDREN

As a speech and language therapist I come across younger and older children who struggle with classroom-oriented tasks in school. When assessed by specialists, a good proportion of these children are found to have working memory difficulties. Working memory is responsible for retention and manipulation of information. As children get older, the learning-based tasks in school become more structured and complex, demanding high cognitive skills. Therefore, working memory plays a crucial role in determining children’s ability to handle learning challenges effectively. At home or in other social situations outside school, the environment is more play-based and relaxed and so the demands on working memory are likely to be less.

 WHAT IS WORKING MEMORY?

Working memory is one of the key cognitive processes required for effective learning and is often confused with short term memory. Short term memory is related to short-term storage of information. Whereas, according to recent research, working memory is a component of fluid reasoning i.e. ability to effectively identify key information from the task/environment and apply that knowledge. We use our working memory to register, maintain and manipulate information we see (visual) and hear (auditory) making it an integral part in our decision-making ability and behavior. Therefore, we can see how working memory skills can be closely related to achievement and learning in school aged children.

The Wechsler Intelligence Scale for Children (WISC) measures working memory in one of its subtests for measuring intelligence. However, we should bear in mind that although working memory affects how a child learns and performs in tests, it is not a measure of a child’s overall intelligence and that the IQ (Intelligent Quotient) also has non-measurable components which do not correlate to working memory.

WHAT ARE THE SIGNS OF WORKING MEMORY DIFFICULTIES?

Working memory deficits have been linked to attention difficulties, learning difficulties (e.g. dyscalculia i.e. problems with arithmetic) and language difficulties (e.g. following complex instructions) in children. Children with working memory deficits have difficulty in tasks involving memory demands in retaining and processing specific or structured information. Therefore, subjects such as maths, reading and science may be particularly difficult for these children. Attention, auditory and visual perception and concentration are required for successful processing of information.

The article ‘Working memory in the classroom’ by psychology professor Susan E Garthercole highlights a study where the teachers described children with working memory problems as having attentional problems. This shows that the underlying working memory issues in children can be masked as attentional problems and are likely to remain unidentified and unaddressed. The article further mentions that ‘zoning out’ or ‘mind-wandering’ are common behaviours in children with low working memory capacity when performing a highly demanding cognitive task as they cannot cope with the information overload and fail to complete the task.

Children with working memory difficulties may show the following signs:

·         Struggles to follow complex verbal instructions in a classroom.

·         Has problems in the area of maths, reading (comprehension) and science.

·         Takes longer than peers to complete tasks or does not completing tasks.

·         Has attentional difficulties.

·         Gives delayed responses to complex questions/instructions.

·         Provides non-specific answers.

·         Comes across as being disorganized

·         Comes across as being forgetful.

WHAT YOU CAN DO TO HELP

Speech and language therapists or educational psychologists can assess children’s working memory using formal or informal assessments involving specific recall/repetition tasks e.g. digit span (backwards and forwards repetition), picture span, letter/number sequencing etc. It is important to share with the child that they will have to work harder than most children to attend and concentrate in classroom tasks.

In our practice as speech and language therapists we always find that using visuals in  learning helps children retain and process information better. Being a mum with the knowledge of a speech and language therapist I know that hands on practical input and visuals helps my kids learn better. Recently I have used the hot kettle in my kitchen, a metal plate with ice and hand drawn diagrams to demonstrate the evaporation-condensation-precipitation to my 9-year-old daughter who was struggling to understand the water-cycle taught in school. She then went on to make her own illustration of the water-cycle and could not wait to show it to her teacher.

The following are some of the strategies teachers and parents can use to help children with working memory difficulties:

·         Eliminate distractions as much as possible during tasks (e.g. remove background noise, e.g. music, TV)

·         Gain the attention of the child by establishing eye contact with them.

·         Prepare the child for the task beforehand (e.g. provide an outline of what is going to be taught in the lesson). This will help information to go from short-term memory to long-term memory.

·         Provide clear and simple instructions.

·         Break down tasks and instructions into small chunks (not more than two-part instructions at a time).

·         Give the child the opportunity to rehearse or record the instruction (e.g. writing down the instruction).

·         Ask them to repeat the instruction to check if they understood.

·         Encourage the child to ask for repetition if they have not understood.

·         Encourage your child to keep notes, make outlines and use other brief reminders.

·         Encourage good organizational skills by using folders and dividers to keep work easily accessible and in order.

·         In school, providing notes and handouts will be useful when a child struggles to copy due to visual memory difficulties.

·         Visuals will help them understand and retain information better (e.g. visual timetable, flowcharts, diagrams, pictures, illustrations, videos).

A sensory approach to learning involving practical input and visuals will consolidate retention and learning (e.g. visual timetable, flowcharts, diagrams, pictures, illustrations, videos, demonstrations, hands on practical tasks).

My final week in Kisumu with Yellow House

By Catherine Clancy, Speech and Language Therapist

Unfortunately, I fell ill at the beginning of this week and it took me some time to get back to my usual self. However, I was able to attend a Communication Camp that had been organised by Yellow House to support parents of children with Cerebral Palsy. This post will be focused on the content of the camp and how Yellow House are raising awareness of cerebral palsy and empowering parents to support their children.

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On the left is Florence and the right is Duncan (with Gregory translating), who explained what communication is and ways in which children with cerebral palsy can successfully express themselves when speech is unclear or not present. The communication house is a lovely way to understand the foundations that need to be put in place before you can expect a child to understand spoken language, and then begin to express themselves using gestures and speech.

There was a specialist talk from an Occupational Therapist who discussed ways parents can support their child’s fine and gross motor skills through daily exercises. Here, John is demonstrating how to support a child’s ability to stand with support.

Here are some of the toys that the parents made for their children using those materials that are easily accessible to them – a very creative way of recycling waste into something kids can enjoy!

Whilst the parents were busy attending the talks within the camp, the children were taken into a separate room where they had the opportunity to play, sing and dance – it was a lot of fun and it was lovely to see the supporting adults interacting so freely and easily with the children – the children were in their element!

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After the camp and on my final day, I said bye to a client and his mother who has been supported through the use of Alternative and Augmentative Communication (AAC). A symptom of cerebral palsy for this client is stiff muscles and exaggerated reflexes (spasticity). Unfortunately, this means spoken language is extremely difficult for this boy and direct access to a communication board (e.g. pointing to a picture) is not possible. For this reason, eye gaze (looking at the picture) has allowed this client to communicate a preference when given a choice. This has given the mother a new way to communicate with her son and the joy that this brings to the both of them is wonderful to see!

My time working with Yellow House has been eye-opening, rewarding and enjoyable. I have met a team of people who are raising awareness of speech, language and communication needs in Western Kenya and are working hard to support children and their families. The stigma around disabilities is still very much present and during the camp many mothers expressed their sadness around the fact that friendships and relationships had ended simply because they had a child with a communication disability. However, seeing these parents come together and pro-actively learn about their child’s condition and how to best support them was very inspirational, which is heightened by the fact that these families are doing their best to integrate their children in their communities to reduce social stigma and normalise their child’s differences.

Goodbye Kisimu!

It has been lovely to see parents and families so invested in supporting their children.

By Catherine Clancy, Speech and Language Therapist

Week 3.

29.07.19: On Monday I spent the day at Russia working with the team to complete a triage. This is to support the management of new referrals who are seeking support for their child. Here, I completed case history questionnaires to find out the child’s strengths and difficulties, and as a team we discussed how to prioritise the new referrals seen. There are many people seeking support from Yellow House which can unfortunately mean long waiting times for clients to be seen. However, the triage gave us the opportunity to meet face-to-face with families and offer advice.

01.08.19: It’s August already! On Thursday I continue to see clients for their weekly therapy sessions. Above are some of the resources I made with the team to help children express their wants/needs and interests if they are finding spoken language difficult. When lunch time came around I thought I would try something new and ordered the local vegetables with chapati and beans – YUM!

30.07.19: On this day I continued to see clients for their weekly therapy sessions. The picture above shows a mother supporting her child through parent-child interaction strategies that aim to promote language development. The mother was focusing on following her child’s lead and using 1-2 key words to comment on her play. Videoing was used as a therapeutic tool to empower the mother to continue using those strategies that she used positively to support her child.

31.07.19: How was it Wednesday already?! (the weeks fly by!). I travelled to the EARC centre and continued seeing clients for their weekly therapy sessions. The photographs above show parents interacting with their children and supporting the use of low-tech augmentative communication. For these children, they were unable to communicate successfully using only speech and therefore a total communication approach has been adopted where we are using speech, gestures, key signs and a communication board to help them express their wants/needs/interests etc. Parental education is fundamental to the success of therapy as parents have to feel invested and motivated to use the strategies advised by us in order for therapy to have positive outcomes. Fortunately, both parents are open to learning to ways to communicate with their children and they are now aware that the belief ‘signing/pictures with stop my child from talking’ is only a myth!!

This week has been empowering and also eye-opening. It has been lovely to see parents and families so invested in supporting their children as ultimately, they are the experts on their child and have the opportunity to make the biggest impact - I have found videoing a great way of supporting this! However, the policies and procedures within the care system are very different to those we experience in the U.K. and it has required me to adapt a very flexible way of working to continue supporting children with the limited access to resources and early interventions.

My second week working for Yellow House

By Catherine Clancy, Speech and Language Therapist

19.07.19: On Friday I said goodbye to Maggie, one of the volunteers who has spent 10-weeks working with Yellow House Health and Outreach Services as a Speech and Language Therapy student from Torono University. It is great when students complete their clinical placements with Yellow House as it is a fantastic opportunity for clinical development, not only for the students but for the team themselves.

23.07.19: David (one of the Senior Speech and Language Therapists employed by Yellow House) and I spent the day working in the Speech and Language Therapy clinics situated within Russia, a hospital in Kisumu which is government funded. Here, I was working with children and their parents with a focus on augmentative and alternative communication (AAC). This is about supporting children and their families to implement other forms of communication which is building on the child’s strength. An example might be using key word signing alongside speech as well as supporting the child to communicate through symbols on a communication board. Parent education plays a critical role here as it is vital for parents to be invested in the therapy for it to prove beneficial for the child!

The team work alongside other professionals in the hospital including occupational therapists who support patients in their own clinic (see picture above).

24.07.19: I travelled from Kisumu to the EARC (assessment and resource) centre on a matatu (local mini bus) which takes around 45 minutes. Here, I saw more clients for therapy, again focusing on the use of AAC. I incorporated the use of videoing with parents to support their interactions with the children and it was lovely to see parents getting down on the floor and supporting their child in the best way they knew how. After a busy morning, Duncan (one of the Speech and Language Therapists employed by Yellow House) and I enjoyed a local lunch of chapati, skumowiki (green vegetables) and green grams (lentils) – it was delicious!

26.07.19: After another busy day supporting clients from Russia, I went back to the office and caught up on paperwork and resource making. This is the office for Yellow House and where the team carryout all the administrative duties, including planning for communication camps – this is when they invite children and their families to a 2-day training camp where they learn all about different diagnoses, the impact on communication and how to support their child using a total communication approach.

My second week on working with Yellow House as a speech and language therapist has really allowed me to get ‘stuck in’ and see clients and their families for therapy. However, it has been essential for me to collaborate with the therapists working for Yellow House to support their clinical development and to ensure the interventions I am suggesting are realistic and functional for this setting. It has been great to learn from the team working here and I hope that I have supported them to feel more confident using AAC within their own practice!

My first week in Kisumu, Kenya

By Catherine Clancy, Speech & Language Therapist

14.07.19: Just before I flew out to Kisumu! 

23.07.19: My first day! I visited Russia, the hospital in Kisumu where Yellow House support clients with speech, language and communication difficulties. This is where I had a lunch of chapati and cooked greens during my lunch-break.  

24.07.19 The Educational Assessment & Resource Centre (EARC) in Vihiga, a 45-minute journey from Kisumu on a Matatu. Here, I supported assessment for new referrals to the service. 

I have had a busy but very eye-opening and rewarding first week with Yellow House! It was lovely to hear from families about how the use of Alternative and Augmentative Communication (AAC) has given them a new way to successfully communicate with their child. Recently, a client with cerebral palsy was taught to communicate using eye gaze with a symbol communication board and the mother has been overjoyed with how this has enabled her to talk with her son which for the past 8 years has not been possible. This mother is very proactive and supportive of her son and does her best to raise the awareness and acceptability of disability in her local community by ensuring her son is treated with respect, compassion and integrity. 

Attention Autism Bucket Time

By Wai Seng Thong (Speech and Language Therapist)

What is Attention Autism?

One of the things I love about visiting schools is the expressions of joy on the faces of the children I work with. When they know it is bucket time some children can barely stay sitting down. In case you have never heard about Attention Autism, it’s an intervention designed by Gina Davies, Specialist Speech and Language Therapist, aiming to develop natural and spontaneous communication through the use of visually based and highly motivating activities for children with Autism Spectrum Disorders (ASD).

Attention Autism is one of my favourite activities as it makes learning fun and memorable for children. Before I start, NO you don’t need to be an X Factor level singer, but you do need to be able to hold a tune as this helps the children sing along. You also need to prepared to collect strange and fun toys to make the activity differ from week to week. I tend to use eBay and pound shops to add regularly to my collection.

All you need to do is have fun, as it engages the kids with your activity. If you are engaged, they will be too. It’s all about engagement, fun, motivation and showing them something worth communicating about.

Benefits of Attention Autism

Attention Autism is a regular part of my week. In the school I work in the children are always desperate to know what is in the bucket and jump up and down trying to look inside (this makes me think of children trying to take a sneaky peak in Santa’s toy bag on Christmas Eve!).

What is fascinating about this programme is that it sparks their curiosity and therefore creates reasons for them to communicate by asking questions, commenting and guessing what might be coming out of that mysterious bucket. From my experience of using this programme, it does not merely work on the children’s attention and listening skills, but also on their language skills (both receptive and expressive language skills). These can be a challenge for children with ASD. The sessions can be tailored to build on their vocabulary knowledge, for example, they can be themed around dinosaurs or superheroes etc.

What a session looks like and example activities

A myriad of themed activities can be incorporated into an Attention Autism programme. For example, bucket time can be filled with dinosaur toys (from sensory to wind up dinosaur toys etc).

I start with the song, ‘I’ve got something in my bucket, in my bucket, in my bucket. I’ve got something in my bucket, and I wonder what it is. Let’s look and see!’. The children sing along transfixed on the bucket, wondering what might be inside. Just a warning this song will take over your mind and at times I can hear it when I am mopping the floor or shopping! You then demonstrate the toys one by one and the idea is the kids watch, pay attention and do not touch. Hard to imagine, but it is surprisingly easy to achieve when following the attention autism programme.

The activities ‘Sleeping dinosaurs’ and ‘Roll the dinosaurs’ involve the children pretending to be asleep and rolling each other along the floor and more song singing. There are also more hands-on activities where children make dinosaurs with Play-Doh or arts and craft materials with big googly eyes. My kids love it all!

Useful tips when running an Attention Autism group

Always remember these useful tips when you are running an Attention Autism group:

•       Say less.

•       Use lots of pauses.

•       Exaggerate gestures and facial expressions.

•       Give time for thinking and stay quiet!

•       Show first then add words.

•       Have a clear idea of your objective.

•       Make sure your activity is the most exciting thing in the room! Cover up or remove distractions.

•       Turn disasters into ‘part of the plan’. It doesn’t matter if it doesn’t work out, this is a great way to model ‘uh oh’ and ‘oops’ etc.

As Gina Davies says: ‘let’s create an irresistible invitation for learning’. Attention Autism principles can be generalised into curriculum activities, for example, literacy and numeracy to facilitate learning and skills development.

Let’s really think about the activities we plan for kids. Is the activity irresistible? Is our activity worth communicating about? Fun and engaging activities create good memories. Let’s create a shared experience that is memorable and share laughs with our kids to help them learn.

For further information and more ideas on Attention Autism, take a look at these:

Facebook page - Gina Davies Autism Centre

https://www.youtube.com/watch?v=nFYnc4xcZ6k

https://www.youtube.com/watch?v=NMEhkD0W5Z8

Social Stories Help Reduce Anxiety in Children with Autism

By Sarah Kassam-Hirji - Speech and Language Therapist

Social stories are exactly what their name suggests; very short and simple stories that illustrate a particular social scenario, often in picture format. They aim to help increase a child’s understanding of how to behave and what is expected of them in a given social situation. 

Visual strategies are highly effective tools to support language skills, and social stories can provide support to help children who struggle in social situations. Examples may be using a social story to help a child line up, lose a game or stay in bed through the night.

It is important for a social story to be short and focused to keep the child’s attention. They are frequently used with children on the autistic spectrum to help them understand social cues and reduce anxiety, especially in unfamiliar settings.

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A social story should provide the basics of what will happen in that setting/situation, and how the child should ideally behave. The idea is to write out exactly what happens and why, how it makes the child feel and the expected response. Symbols are used to show these language concepts, but for some children it can be useful to have photos of themselves in the situation as well.  

As with all things in life, there will be unexpected variables that a parent/caregiver won’t be able to control for, but the story should provide a basic foundation of support and understanding.  

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Key points to remember when writing social stories:

• target one specific situation at a time

• keep language simple

• keep it positive

• remain consistent

• Children thrive on repetition and learning takes time

My experience has been that all children with language difficulties benefit and respond really well to the visual cues and prompts that are provided within each story. We all struggle at times with how to behave in social situations and social stories can help give a child the ability to maintain emotional wellbeing as stress and anxiety are reduced when understanding increases.

A story that I have used time and time again with my children is ‘When I’m Frustrated’. Please note that the word ‘frustrated’ can also be substituted for ‘cross’, ‘upset’ or ‘mad’ – whichever the child will relate to best. The story helps support understanding of the emotion of anger and has been useful across many social situations.  In general, emotions are difficult to understand and explain, and stories that help target emotions in relation to stressful scenarios can be very beneficial.

This story in particular illustrates the idea that sometimes situations will make us feel upset or angry, but there are different strategies that we can use, such as counting or breathing, that can help regulate our feelings once again. This then helps us return to the social situation and ask for what we need.  It also shows that these feelings pass and that we will feel better soon enough.

As a wellbeing expert and speech and language therapist, this is a vital story for me to use with children that struggle with maintaining and regulating emotions when social situations become highly stressful for them. I believe stories that help children understand emotions can really impact how much a child continues to be motivated for peer engagement. This can then help develop other key skills such as turn taking and problem solving.

*Edited blog post

HAS THE WORLD OF SOCIAL MEDIA CREATED A WHOLE NEW GROUP OF HEALTH & EDUCATION PROFESSIONALS?

By Sunita Shah - Service Lead for North West London and Specialist Speech and Language Therapist in Bilingualism

Early Intervention is Key

Who Am I?... My Reflections...Reality

I have been a practicing Speech and Language Therapist for over 20 years; and an Author; a mother of two crazy boys aged 18 months and 5 years. Oh, how my practice changed overnight seeing the other side.  Before eyebrows would be raised if patients were late or if homework was not done but seeing the other side of the coin of what parents must do in their daily routine opened my eyes.  I simply ‘’’respected my parents for getting to the appointment to support their child. I remember the first day back at work I saw a child who had transferred to our Trust the child’s mother had left; the father had special needs and the child was severely Autistic and nonverbal at 4 years old.  The family were homeless; as soon as they left the clinic, the waterfall of emotions took hold.  Suddenly it was not about the hour in clinic supporting the child’s communication it’s the reality of what the parents experience 24-7.

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My degree was intense but fascinating. I am so blessed to have worked with such wonderful children and amazing parents.  I once read “A child with special needs does not come with a manual... it comes with a parent that does not give up”.  I studied for over 3 years too gain my qualification as Bachelor of Science in Clinical Language Studies (Speech and Language Therapy).  I studied so many modules within the course, Child development, child psychology, neurology, various therapy models etc. I was fortunate to work in the NHS system for over 20 years and gained so much knowledge, skills and experience which I feel so grateful for.  I left public sector in 2017, and now work independently.  This was an extremely hard decision to make but I have enjoyed life post NHS so much.  The flexibility to not follow unrealistic expectations, KPI’s, endless growing waiting lists for assessment and therapy.... to give the family the type and frequency of intervention they REALLY need, which makes a difference... and quicker.... Early intervention is key.

Has Social Media Made A New Breed of Health Care &Education Professionals?

 I have been following various national and local groups on social media for parents. It’s a humongous network that supports parents in so many ways, from advice on sleeping, toilet training, weaning, behaviour, chicken pox, and overall development etc. There is nothing like having support from another parent about what they have gone through.  For many parents this is the first point of call.  Within the network there are parents who are Health Care Professional too.  It’s that comfort factor, to put the anxious parenting mind at ease.

My Concerns... Because I Care

Recently I have started to get slightly alarmed with some responses especially regarding communication development. Over a year ago I saw a parent who came to me when their child was 3 years old, it was evident this child had severe communication needs. I asked the mother when she started noticing when things were different the mother replied from 10 months old.  I asked why she waited so long, she reported she followed advice from her NCT friends and other people to just let him develop and in time the child would talk. The mother missed 18 months of vital intervention which would have made such a difference. I’ve seen this on several social media posts recently when people are asking about communication advice, a child of 2 years SHOULD be talking, if there are not they need support. Please see the ages and stages section on my website: www.tlc-speechtherapy.co.uk. Using the wait and see approach can miss vital months of support. Also, children have come to me at 4 years old with severe stammers, they started stammering at 2 years old.... why refer now? The parents said they waited as they thought the child would “grow out of it” .... no… again Early intervention is key. If you are concerned particularly about your child’s communication consult your Children’s Centres, GP’s Health Visitors, Early Years consultants, they are all very experienced, and they will always support you in the steps to taken.  Always remember the walk-in clinics and 111.

I see so many pictures of children’s rashes and suddenly the world of social media can be quick to diagnose, but in a quick snapshot post there is no medical history taken how can advise be given on what to do, when the child’s rash may look the same as what your child had, but the child may have other health concerns or allergies to take into account.  A parent has the most unique gift called “Gut instinct” parents never under estimate this. You know your child more than anyone in the world, if you think there is something wrong.... see a professional.  Please do not wait.

Use Your GUT instinct... Don’t Always Wait and See....

I guess what I’m trying to put across is although there is a place for support on social media... and some useful articles and advice, please be vigilant... The people of social media are not all qualified Health Care Professionals, go with your gut instinct. Also remember Early Intervention is key.  Certain advice I have seen from members on groups goes against what we practice as clinicians and concerns me. Medical and development histories are very important in the treatment and diagnostic process.

Keep doing what you AWESOME parents are doing.... it’s the best gift in the world being a parent and it’s our job to make sure our children stay happy and healthy.

Makaton: signing your way to successful communication

By Eleanor Harris - Director of Magic Words Therapy and Specialist Generalist Speech and Language Therapist

Want children to understand you better in the classroom? Increase your gesture and use key word sign!

As a Speech and Language Therapist working with children with Speech, Language and Communication Needs (SLCN), I use key word signing whenever I speak to my clients to help to support their understanding. I also use key word signing to scaffold their spoken sentences, cueing them in with sign for the next word or idea in their spoken sentence. 11 years of experience tells me that this works really well and benefits the children, but what is the evidence to support this?

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The answer is that there is a lot of research that confirms my clinical experiences – there is a neat summary of this evidence here. 

Why does it work?

Imagine you can’t hear at all, or you can hear but you can’t make sense of the sounds you are hearing, as though you are hearing an unknown foreign language. You can see your teacher is talking, but her hands are still, and her face is expressionless. You don’t understand one word of what she says. You feel a rising sense of panic, what are you supposed to do? Everyone is looking at you. Your body begins to go into fight or flight mode. You don’t know what is expected so you have an emotional reaction. Perhaps you freeze, absolutely terrified. Perhaps you hit the table and run from the room. Perhaps you internalise this feeling of panic and never want to communicate at school again.

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Now imagine you still can’t hear or process the sounds that you hear, but this time your teacher is pointing at the things she is talking about AT THE SAME TIME that she says the word, for some words she is doing a SIGN at the same time that she says the word and the sign looks like the object or action. She is gesturing where things start and finish and she has a really expressive face so I can tell when her words are a question rather than an instruction, and I can tell how she is feeling when she says them. As she signs each key word, her speech is slowed down, giving me a chance to process the sounds and words a bit better. I understand 2 or 3 pieces of information from each sentence, I am learning what some words mean because the sign is said at the same time as the word, I learned a new word because the rounded circular outline you just mimed with your hands when you said the word ‘balon’ gave me a clue to understand that it means ‘ball’. I can see you want me to put the ball in a particular place behind me, I can tell because you pointed there after you said ‘balon’. I feel comfortable, I know what to do, I’ve learned new words and I achieve success. I want to communicate again next time.

We know key word signing and increased gesture doesn’t just help SLCN children, but also helps an increasing number of English as an Additional Language children in our schools, as well as typically developing children – listening to a person that uses more gesture is much easier than listening to a person who stands still and expressionless.

For further information on MAKATON, take a look at their website

True Colours

By Natasha White

February. The month when all that mushy emotional stuff is celebrated. An overwhelming amount of Valentine's Day cards and gifts line the shelves of the shops and what colour strikes us most? Red. Maybe pink. Clearly, we have come to associate a particular colour with love, just as we load all other colours with meanings and feelings.

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Anna Llenas, a Barcelona based illustrator and author, explores this in her beautiful book, The Colour Monster(Templar Publishing). 

A rather confused little monster is feeling a little muddled inside. Luckily, he has a friend, a little girl, who helps him sort through and focus on each emotion separately. As they work to place each emotion in a jar, Llenas cleverly provides several perspectives from which to explore the feelings in greater depth:

Label: the emotion is given a name

Describe: uses a metaphor or simile to create a comparison to a concrete object or noun

Action: shows how it can manifest and what it can feel like

Once the feelings are sorted and understood, the monster begins to feel better. He even starts to feel a warm and cosy feeling. He is surrounded by a mixture of pink flowers and hearts and the reader is asked: 'But what's this?' Something I think we can all recognise... 

Importantly, the monster's private feelings are linked back towards seeking social engagement. The little girl suggests ways in which he can 'deal' with the different emotions and most of them stress the importance of 'togetherness', such as holding hands.  

As a result, the book could be used as a classroom or therapy tool; The Colour Monster provides a fun platform to teach emotional literacy. 

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Some tips for teaching your child emotional literacy skills:

 For the younger ones:

• Create and colour your own colour monster and label the feelings

• Make colour cards for the child to signal how they are feeling today

• Make your own jars and put coloured counters or items in to describe feelings

• Contextualise: think about times when they felt the different emotions. There is also an official activity book available, which puts the colour monster in different situations and asks you to colour him in to illustrate his emotion. 

• Discuss practical strategies to cope with emotions 

For the older ones: 

• Consider empathy: learn that you can inspire feelings in other people too 

• Explore why did the little girl want to help her monster friend

• Explore what happens when more than one feeling gets mixed up together