Donate your Voice!

Donating your voice to help Motor Neurone Disease sufferers

Did you know that you can ‘donate’ your voice for the benefit of adults who suffer from Motor Neurone Disease? The Voicebank Project has been set up by the University of Edinburgh in conjunction with the Euan MacDonald Centre for Motor Neurone Disease Research. This research project aims to create a library of voices that can be used to ‘reconstruct’ patients’ natural speaking voices, including accent, for voice output communication aids.

Why is the Voicebank Project necessary?

Perhaps the most famous voice output communication aid (or ‘VOCA’) user and MND sufferer alive today is Professor Stephen Hawking. I think most of the modern world is familiar with the very synthetic and unnatural voice that his VOCA, The Machine, produces. Whilst professor Hawking’s device has been upgraded over the years, it seems that he has come to see the synthetic voice it produces as his own and has refused an upgrade to more natural sounding speech. In fact, I believe he has even copyrighted his synthetic voice, that means if you hear his voice on anything from The Simpsons to Big Bang Theory, yes, it really is him! You can find out more about Professor Hawking’s voice and The Machine on Professor Hawking’s website if you are interested.

Although Professor Hawking has come to accept his synthetic voice, the vast majority of people are devastated by the prospect of losing their natural speaking voice and having to replace it with something so robotic. Being diagnosed with MND or another neuro-degenerative disease is devastating enough without the indignity of having to ‘speak’ with a voice that you don’t feel belongs to you. After all, as I have described in a previous post right here on this website, Your Voice is your Auditory Face.

This is where the Voicebank Project comes in. The aim is to create a database of natural male & female voices with a variety of regional accents which can be used in conjunction with recordings of the patient’s own voice and those of their close relatives so that  VOCA users can choose a voice for their communication aid that they are comfortable with and that they feel reflects their own identity. You may wonder why the patient’s own voice can’t simply be recorded and used in the VOCA. Well, the fact is that for many people, one of the first noticeable symptoms of a neurological condition is in fact changes to their speech. By the time they are diagnosed, the patient’s speech is often significantly affected which is why a degree is of voice reconstruction is usually necessary. Do be aware though that at this stage, Voicebank is a research project only and not a fully-fledged and widely available service. Hopefully it will become part of the standard service for all VOCA users before too long!

I’m interested! What do I do now?

If you are interested and are over 16, have no reading or speaking difficulties and are a first language speaker of English, email to find out how to donate your voice. In particular, the project is needing male speakers from all over Scotland and from the areas shown on the leaflet here:

Leaflet from Voicebank giving details of accents requiredRecordings take about one hour and are done either at the New Royal Infirmary in Edinburgh or via the mobile recording team (Scotland only). You will need to wear a set of headphones and a little microphone and you will be asked to read a selection of sentences from a computer screen. Don’t worry, the text is big and easy to read! I recommend bringing a bottle of water as you’ll get a dry throat from all that talking. Go! Donate your voice!

If you would like to find out more about Motor Neurone Disease, visit the UK’s MND Association.

The Smarties Tube Test of Theory of Mind

Just the other day, I did the Smarties Tube Test for the first time in ages. Understandably, the parent of my client was somewhat surprised when I duped her child with my Smarties tube full of buttons! As I was explaining the reason for the test afterwards (best to do it afterwards to avoid any bias), I thought it would make for an interesting web post about theory of mind. Before I go on, please don’t worry, the client in question got a tube of real Smarties afterwards!

What is The Smarties Tube Test?

The Smarties Tube Test is a really simple but effective way to test Theory of Mind. Please understand that it is not a ‘quick and easy test for autism’ although it is helpful in combination with A LOT of other information in the process of diagnosing autism and other developmental conditions. First I’ll explain what Theory of Mind is then I’ll tell you how you do the test and what it tells you.

What is Theory of Mind?

Theory of mind is basically ‘putting yourself in someone else’s shoes’. It’s the skill we human beings use to ‘mind read’ other people so that we can figure out how others are feeling, what their intentions are, what they believe and what they are likely to know or not know. Theory of mind is what tells you how much background information to give another person when you are telling them about something that has happened to you. It is what makes us wince when someone we care about hurts him/herself. It is what helps us figure out when someone else is being sarcastic and it is what helps us to deceive others. Typically, theory of mind starts to develop about 3 and a half to 4 years old.

Who has trouble with Theory of Mind?

As theory of mind usually develops around 4 years old, you can expect that any child younger than 4 will not do well at mind reading! In addition, theory of mind is typically a core area of weakness for people who have a diagnosis on the autistic spectrum, so much so that it is widely regarded as an essential characteristic of autism.

How do you do the Smarties Tube Test?

First and out of sight of the child, put some buttons (or some pencils) into an empty Smarties tube. When you see the child, show him/her the Smarties tube (you can shake it!) and ask ‘what do you think is in here?’. The child will most likely say ‘Smarties’. Next, you open the tube, show the child what is inside and ask him/her ‘On no! What is inside?’. Hopefully he/she won’t cry and will say ‘Buttons’. You put the buttons back into the tube and ask the child ‘Can you remember what is inside?’, most likely they will say ‘Buttons’. Now for the clever bit. Tell the child you’re going to play a trick on someone who isn’t with you, it could be a brother, sister, mum, dad, teacher, whoever. Ask ‘If we give this to your brother (or whoever!) later, what will he think is inside?’ If the child has theory of mind and understands that his/her brother won’t know the tube is full of buttons, he/she will say ‘Heh heh! Smarties’. If the child does not have theory of mind, he/she will not be able to put aside his/her knowledge that the tube has buttons in it and will say that the brother thinks there are buttons inside.

I hope that all makes sense but, by way of further explanation, this video gives a nice summary of theory of mind and how you do the Smarties Tube Test. It also explains the more widely known ‘Sally Ann Test’:

Theory of Mind Testing

I find that the Smarties Tube Test is a quick, unambiguous and easy way to establish whether a child has developed theory of mind or not.


New Study Suggests that Music Training Supports Self Organisation!

I came across an interesting new piece of research into the benefits of musical training the other day on a music teacher Isla's Guitarfriend’s website – click here to see the article. This functional MRI study suggests that there is a link between early music training and improved executive functioning in both adults and children. So what does that really mean?! Read on to find out…

What is Executive Function?

Basically, Executive Function is the brain’s system for planning stuff, controlling inhibitions, thinking flexibly and generating new ideas. I like to think about it as a wee ‘executive’ guy in a pin stripe suit who sits in the front of your brain organising things. Executive function allows you to do 4 key things:

  • Plan stuff – for example, planning ahead for a PE lesson and organising all the things you need to pack into your bag the night before, planning a shopping list or planning an essay.
  • Transfer your attention between tasks – so that you can finish one task then switch your attention on to the next task which might be totally different from the first.
  • Inhibit inappropriate impulses – Executive function is what stops you from reading a text that makes your phone vibrate in the middle of a conversation with your mother in law. It also stops you doing things like pointing out the massive spot on the end of your friend’s nose or telling your teacher that her new haircut looks like someone put a bowl on her head and cut round it with their eyes closed!
  • Be creative – for example coming up with a new recipe idea, thinking of a fun day out for your friends or writing a song.

Who has difficulty with Executive Function?

Probably the biggest groups of people who typically have issues with weak executive function throughout their lives are those who have a diagnosis of Autism (ASD), Asperger’s Syndrome and/or ADHD. Other groups are also affected though,for example, those with head injuries or degenerative brain conditions. Even without a specific diagnosis, you can still have weak executive function.

What Does the Boston study say about Music Training and Executive Functioning?

First and foremost, no-one is saying that if you get your autistic child into music training they will be cured of all problems relating to executive function! Do not misunderstand this as yet another ‘miracle cure’! What the researchers found is that adult musicians and musically trained children got better scores on tests of executive function than a non-musically trained control group. The researchers carried out functional MRI scans (also called fMRI – click here to learn more) on musically trained children & controls while they completed a test of executive function skills. The scans showed more activity in the brain areas associated with executive function in the group of musically trained children than in the brains of the non-musically trained control group.

While this study does show evidence of better executive function in musically trained people, it does not establish whether the improved skills are definitely due to the musical training OR whether people with better executive functioning are simply drawn to learning music. More investigation is required to clear this up! Whatever the outcome of this line of research, the benefits of music training for a whole range of cognitive skills, including language development, are well documented. So expose your child to music when you can. If they are interested in learning to play something, let them have a go. erhaps pay a visit to my friends at Morningside School of Music for some lessons. Apart from anything else, MUSIC IS FUN!

A Further Note to Music & Communication Development!

Back in May 2013, I posted an article called Music & Communication Development which talked about the many benefits of learning with music. I was therefore very interested to read on the BBC website about some recent research which found a link between strong rhythmical ability and better language learning & literacy skills in teenagers. Click here to go to the article. Whilst I couldn’t necessarily see a causal link in the information presented on the BBC website, there certainly seems to be a strong correlation between performance on a rhythm tapping task and reading skills. Children who were better at the rhythm task were the best readers and those who struggled were the weaker readers.

As a speech & language therapist, this doesn’t really surprise but it is nice to see some concrete evidence of a hunch. Spoken language is just a continuous stream of sounds – imagine the last time you listened to someone speaking a language you don’t know. I’ll bet you couldn’t tell where one word ended and the next began. To be able to read and write our language down successfully, we need to break that continuous stream of sounds into words, syllable and individual sounds. How do we do that? Largely by using the rhythms generated by the stress and intonation patters of our first language to help us guess where the word & syllable boundaries are. It’s therefore no great surprise that enhanced rhythm awareness is helpful!

Autism Related Training in Scotland

It’s nice to see 2014 starting off with a couple of high quality autism related training sessions in Scotland. The first of these is the Level 1 introductory Picture Exchange Communication System (PECS) course which is running at the Novotel on Lauriston Place in Edinburgh on Thursday 6th & Friday 7th February. I can thoroughly recommend this training to anyone who is new to using PECS with someone on the autistic spectrum and also to people who have been using the system but haven’t had any formal training.

The course is suitable for parents, carers and professionals alike with reduced course fees for parents. The cost is £174 for parents and £315 for parents including VAT. Over the 2 days you’ll learn everything you need to know about how to use PECS and why the system is set up as it is. If you are interested in attending, please click here to go the event details on the Autism Network Scotland website where you can register.

The second event is the Autistic Intelligence Conference on 2nd May in Glasgow. The speakers include the world renowned psychologist Tony Attwood and Wendy Lawson who has autism herself and has done a wealth of research and written several books on the subject of autism. I have seen Tony Attwood speak on a number of occasions now and he has always got a lot of worthwhile information to share, I would highly recommend listening to him speak bout the autistic spectrum! I’ve got my place booked already. Click here to go to the conference webpage where you can register to attend. Again, reduced rates are available for parents/carers and further reduction for individuals who have autism.



MMR and Autism

In light of the recent measles outbreak in Wales, I feel compelled to post an article on the subject of the MMR vaccine and autism. The first and most important thing to note here is that there is NO SCIENTIFIC EVIDENCE of any link between the combined MMR vaccine and autism. Please do take the advice of your local health board and make sure you have your child vaccinated. Measles is a serious disease with a high risk of nasty complications many of which are life changing (for example, deafness) or life threatening (for example, meningitis). No-one wants this for their child.

The reason that vaccination rates dropped dramatically in the 1990s and early 2000s is a small and now thoroughly discredited study by Dr Andrew Wakefield and his colleagues which resulted in a media frenzy around the suggestion that there may be a causal link between the combined MMR vaccine and autism. The key things to note about this study are:

  • It was a fundamentally flawed piece of work with a tiny research group of 12 children.
  • It did not even set out to study the effects of the MMR vaccine, a possible link was merely implied in the discussion.
  • Most of the authors have now retracted their involvement in the study.

Since the Wakefield study was published, there have been a variety of very large, scientifically sound studies which have categorically shown that the MMR vaccine is not a primary cause of autism. Key points of these studies are:

  • The number of cases of autism with and without developmental regression have continued to rise in countries like Japan where the combined MMR vaccine has been withdrawn.
  • There was no sudden jump in the number of cases of autism diagnosed after the MMR vaccine was introduced in the UK in 1988. The rise is smooth and gradual.

Almost all researchers now agree that, while autism is certainly being diagnosed more frequently, its causes are complex and unlikely to be down to one single factor, even from a genetic perspective.

You can find more information about MMR & Autism on the website of the National Autistic Society.

The Minefield of Autism on the Internet!

When your child is diagnosed with autism or Asperger’s Syndrome, there is a very high risk of information overload. There is a vast amount of information of varying quality out there on the internet and, in my experience, one of the biggest challenges families of children with a new diagnosis of autism face is sifting through it all! I hope that this post will help to guide you to some trustworthy and helpful starting points in your quest for information. Don’t forget that you are welcome to email me if you have a specific question! Here are the websites that I generally recommend as reliable starting points:

The National Autistic Society – is a UK charity serving the needs of the population affected by autism spectrum conditions. It really should be your first port of call as it is a reliable source of information and you will be able to find out about a variety of support networks, new research and awareness raising campaigns.

Lothian Autistic Society – For those of you living in Edinburgh and Lothian, this is our local autism support organisation. There are other similar local organisations across the UK and you will find their contact details in the National Autistic Society’s Autism Services Directory.

Scottish Autism – this is Scotland’s equivalent of the National Autistic Society and provides similar support and information.

Research Autism – Research Autism is a charity run website which is collecting and evaluating the evidence to support (or not!!) treatments and therapies for autism spectrum conditions. There is a ratings page which lists most of the interventions currently in use around the UK and gives you an ‘at a glance’ view of what is well evidenced, what is not and what can be harmful. It is well worth a look on here as there is a scarily large number of interventions out there for autism spectrum conditions that do not have a strong evidence base! Please check before you fork out lots of money for an intervention!

The specific information, support services and interventions you will need will vary depending on your or your child’s needs but these websites should be able to point you in the right direction to get you started. And, as I said before, don’t forget that you can email me to ask any specific questions you might have!

Always remember that your child is an individual. There are many websites and approaches out there professing to be better than all the rest. In my experience one size never, ever fits all. The most important thing you can do is look at your child and his/her needs as objectively as you can. You may find that one approach fits your child’s pattern of needs particularly well – that’s great! Equally, you may find that you need to use bits and bobs of a variety of approaches to support your child best. There is no right or wrong here, just be prepared to give things a good and fair try, use what works and bin what doesn’t!



The Fundamentals of Communication

If you have a child or are working with a child who doesn’t speak yet, then this post is for you. I often hear comments like ‘He doesn’t have any communication’ in relation to these children when I think, in reality, what people actually mean is ‘He doesn’t speak yet’. Before we think about the Fundamentals of Communication, it’s very important that we understand that speech and communication are not the same thing.

The communication chain

The communication chain is all about getting an idea from one person’s head into another person’s so that both people end up with the same idea in their minds.

Communication is essentially about getting a thought from your head into someone else’s head. To do this, we make our thoughts into messages that other people can understand. Those messages take many different forms from gestures and facial expressions to noises like laughing or spoken words. Speech is simply one of many forms of communication that are available to human beings.


Communication development represented as a tower.Typically, human communication is a rich and complex thing. Communication is a skill that we typically learn and use subconsciously. Like any other complex skill, communication requires a strong foundation of basic skills to support the development of increasingly complex skills. I like to think of it like a tower, without strong and established foundations, a tower will fall down. In the same way, adult communication relies on a solid foundation of basic skills. If the basic skills don’t develop, the more advanced skills won’t either. As you can see, the first level of foundations is where the Fundamentals of Communication need to be. The most amazing thing to my mind, is the fact that we learn all of those fundamentals through simple exposure to interaction with others. No-one ever sits us down and formally teaches us these skills, we just pick it up and typically we’ve learned the Fundamentals of Communication before we say our first words at 18-24 months.

Before we look at the Fundamentals of Communication in more depth and define what they are, I think it is important to consider a couple of key stages in early communication development.

Pre-intentional Communication

Pre-intentional communication is really communicating by accident. This is what babies do in their first days of life. What happens here is the baby responds to some discomfort (maybe hunger or pain) by crying. Typically, the baby’s parent will respond by doing something to comfort the baby, perhaps feeding them or giving them a cuddle. Clearly some communication has occurred here because the parent has realised that the baby needs something. It is important to understand that at this stage the crying is simply a response to the feeling of discomfort and not a calculated attempt at communication. The fact that something happens to fix the problem is simply a happy accident.

Intentional Communication

Over time the baby starts to make the connection between crying and something positive happening. Because the parents respond to the baby’s crying by doing something to comfort him/her, the baby starts to realise that crying (cause) makes something happen (effect).  Here we have the beginnings of intentional communication. The baby now starts to cry with the specific intention of communicating the message ‘I need something’.

The Fundamentals of Communication

The Fundamentals of Communication are woven into this process of pre-intentional and intentional communication development. They are not learned in a sequence, rather they are learned alongside one another as part of the process of communication.

The Fundamentals of Communication are a set of basic communication skills that form the foundations of more advanced communication skills, including speech. If these fundamentals are missing, it is unlikely that more advanced communication can develop. Sometimes children develop most but not all of the fundamentals. When this happens, spoken communication may be achieved but it is likely to be unusual. For example, a child who fails to pay attention to others may speak at length about things that no-one else is interested in without realising that they have lost their listener’s interest. The key Fundamentals of Communication are as follows:

  • Enjoying being with another person – quite simply, communication requires you to enjoy being with other people. If you do not want to be around other people, you will have very little motivation to communicate at all.
  • Developing the ability to attend to another person – paying attention to other people is an essential learning skill. As I said earlier, we learn the fundamentals of communication and indeed all the communication skills we acquire in our preschool years through simple exposure to communication situations. To learn in this way, we have to be able to pay attention to other people, recognise that they are different from objects, take interest in what they are doing and to have a go at copying what they do.
  • Concentration and attention span – In order to learn from an activity or an interaction we have to be able to sustain attention to it. If we flit between activities too quickly, we miss learning opportunities. For communication to be successful, we have to be able to pay attention for long enough to receive and understand messages that are coming to us and to concentrate for long enough to pull together what we want to communicate ourselves. As we develop and grow, we learn to maintain attention for the full course of a conversation, sometimes over a period of days in the case of email or text conversations!
  • Learning to do sequences of activity with another person – For example, a sequence of causes and effects like [mum tickles, baby laughs, mum laughs, baby waits, mum tickles again]. This sort of play sequence reinforces cause and effect understanding as well as turn-taking. It is also fun for both parties and reinforces the idea that communicating is a satisfying and rewarding thing to do. Let’s also not forget that a spoken conversation is essentially a sequence of activities that we share with another person.
  • Taking turns in exchanges of behaviour – this is linked to the idea of completing a sequence of activities with another person. To take part in a sequence of activities, you have to be able to give and take turns. Turn taking is an essential skill for communication as all successful communication relies on one person being able to take a turn to communicate their message and their listener being able to wait until the message is finished before responding.
  • Sharing personal space – in communication, particularly in the early stages of development, we are usually seeking to form some sort of bond or relationship with another person. In order to do that, we usually need to be physically close to that other person and depending on the type of relationship, to engage in some form of physical contact. For example, family members may hug each other or friends may nudge each other to share a joke.
  • Using and understanding non-verbal communication – by non-verbal communication here, I mean things like facial expressions, eye contact and gestures. Basically the messages we send to each other without using words. We typically learn to understand these messages subconsciously and without formal teaching and they allow us to ‘mind read’ how our conversational partner is feeling so that we can modify our communication accordingly. They also influence the unwritten ‘rules’ of conversation, for example eye contact helps us to know whose turn it is in a conversation because the speaker will usually stop talking and look at the person whose turn it is next.
  • Using vocalisations with meaning – following on from that earliest stage of intentional communication is the realisation that different noises can be used to communicate different things. This understanding is essential for the development of spoken language because words are essentially unique collections of noises with specific meanings attached to them.
  • Learning to regulate and control arousal levels – self-regulation just means the ability to know if you are getting either over excited or bored and being able to do something constructive about it. It’s an essential communication skill. In very young children, overexcitement can result in overstimulation unless the child has a way to show you ‘I need a break’.
  • Cause and Effect – I mentioned this when I talked earlier about pre-intentional and intentional communication and it is simply the understanding of ‘I do something and something else happens’. Communication does not develop without some understanding of cause and effect.
  • Anticipation – developing anticipation in familiar routines is essential for communication development. It helps to build understanding & use of language as well as reinforcing the idea that communication is a rewarding and fun thing to do. The repetitive nature of anticipation routines like ’round & round the garden, like a teddy bear, one step, two step…***PAUSE***… tickle you under there!’ means that the child gets to hear the same words and see the same nonverbal communication used over and over again without it becoming boring.

Therapy to Develop the Fundamentals of Communication

So now you know about the Fundamentals of Communication, what do you do about supporting their development? Well, a speech & language therapist will be able to give you lots of guidance here. Most therapists will advocate either or both of the Hanen approach or Intensive Interaction. Hanen is an approach developed in Canada for children with delayed communication development. It is based on specially trained therapists providing training and coaching for parents to support them to get the best from their child’s communication skills. It is a very effective and popular approach which is offered by most NHS speech & language therapy teams. Go to the Hanen official website for more information.

Intensive Interaction is more specifically aimed at the population of people who have severe and complex learning difficulties however it has much in common with the Hanen approach. It encourages a very naturalistic approach to communication where the ‘teacher person’ uses their knowledge of the Fundamentals of Communication to provide a communication situation that promotes and supports their development in the ‘learner person’. Many speech & language therapists are trained to use Intensive Interaction and Isla at Blethers is trained to an advanced level which means she can not only use Intensive Interaction with clients but can deliver detailed training for parents and care staff. You can find more information about Intensive Interaction on the Intensive Interaction website or in my post called Intensive Interaction Video.

Scottish Autism Strategy

As some of you may be aware, the Scottish Government is funding some places on an Open University course called Understanding the Autistic Spectrum. This is part of the national autism strategy which aims to improve services and support for individuals with autism across Scotland.
I’ve been wanting to formalise my knowledge of autism for a while now so when I got an email last week telling me about the course I thought I’d register my interest and see what happened – nothing ventured, nothing gained! Well on Thursday morning, the registration papers dropped through the door. To be quite honest, I didn’t quite believe my eyes so I had to ring up to check. The lovely lady I spoke to confirmed that I do indeed have a place on the course. Hooray!
I’m really looking forward to refreshing my knowledge and formalizing what I’ve learned on the job over the last 11 years. It all starts on 3rd November and the course lasts 20 weeks. Time to get organised and buy a lever arch file!

BBC Radio 4’s book of the week – Thinking In Numbers by Daniel Tammet

I was pleased to see this week that Daniel Tammet has a new book out. Daniel is an adult who has an autistic spectrum disorder and this is his third book. He is lucky enough to have special talents for foreign language learning and numbers. His new book is called Thinking in Numbers and is this week’s BBC Radio 4 Book of the week. Click here to listen to James Anthony Pearson reading the first of 5 excerpts from Daniel’s fascinating book on BBC Radio 4. I really enjoyed listening, not just because of my respect for Daniel’s many talents but also because I found his discussion about the linguistics of counting systems in various world languages genuinely fascinating! But I am a self-confessed language geek after all! Enjoy…