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…

Goals aren’t just for Olympic athletes!

Lots of people get very intimidated and bogged down in setting targets or goals so I thought I’d do a little guide to make you (hopefully) feel a bit calmer about it. For the sake of simplicity, I’ll talk about ‘goals’ in this article but you could equally call them targets or aims.

Setting goals is really important for lots of things including working on speech and communication skills. You don’t have to be an Olympic athlete to need goals! Even children benefit from having clear goals although they may need an adult to set them, especially if they are younger. That’s what sticker reward charts are all about! So what’s so great about goals then? Well, having one in mind helps both adults and children to:

  • know and remember what they’re trying to achieve
  • stay motivated and focused
  • feel good about achieving something

There are two main types of goal, long term and short term. A long term goal is something ‘big’ that you think will take a long time to achieve. Short term goals are smaller things that can be achieved quickly and are often steps on the way to reaching your long term goal. So how do you set a good goal then? Well, much as I hate acronyms, this one is actually quite handy. All goals, long term or short term, need to be SMART:

S – Specific. If you choose something that is to ‘big’ or vague, it will be very difficult to achieve so make sure you chose something clear and defined.

M – Measurable. Make sure you have a way of knowing if you have achieved your goal or not. How you do this depends on what your goal is. Do not get too bogged down in counting or trying to put arbitrary numbers on things. Sometimes a measure can be as simple as a statement like ‘Next time granny visits, we are aiming for her to understand most of what little johnny says to her.’ You can answer yes or no to this and you will have measured whether or not the goal was achieved!

A – Achievable. Everything we want to achieve needs to be broken down into steps. You may have a very large long term goal but in order to get there, you will have to break it down into smaller, easily achievable chunks. Achievable goals maintain motivation and help build confidence.

R – Realistic. There is no point in having a goal that isn’t realistic for you or your child, really this is a bit like making sure it’s ‘achievable’.

T – Time-limited. Set yourself a review time for your goal. Hopefully by the time you chose, you or your child will have achieved what you set out to do but if not, it gives you the chance to look at why not and make adjustments if necessary. It’s ok if the goal isn’t achieved within your time-limit, the time limit is just there to remind you to take a rain check and review what you’re doing.

It’s really important to remember that any goals you set for you or your child are flexible. That means it’s ok to change them!!! Sometimes you have to make a best guess at what will be a good goal and it becomes apparent that it’s either too easy or hard. Don’t flog a dead horse, change it!

When working with younger children, I find that a ‘working for’ card like this is a really good way to translate my goals into a language that is clear for them.

Working for card that Isla usesThe idea is that the child chooses what they’d like to work for from a choice of options and they then have to collect either 3 or 5 tokens to get it, depending on the child. During the session, I’ll give them a token each time they complete a specified task (goal!) until they have filled their card. Once their card is filled, they get the reward immediately. Some children will need smaller targets so you may find that you need to give them tokens very frequently. If that’s the case, just let them fill the card and get the reward then start again or, if you need to, work in shorter sessions. You can download the working for card that I use from the downloads page or by clicking the link below if you’d like to give it a go yourself.

Working for card

Please email me with any questions!

Practise routines for Speech & Language Therapy

When I’m working with clients, lots of people ask me ‘how much should we practise?’. The answer to this questions varies depending on the individual but there are some general principles that always apply.

When you are learning a new sport, craft or, like me, you are learning to play a musical instrument, you will make better progress if you are focused about your practise time. You need to practise slowly, often and repeatedly. You should also have a goal in mind for your practise session. The same is true for communication skills. Let’s look at each element of practise in turn:

  • Set a goal – lots of us forget about this one or think it’s not important! Having a specific goal in mind when you practise is REALLY important. If you set a goal, you know what you are trying to achieve. Most importantly, working to a goal will give you (and your child) a sense of achievement which maintains motivation. If you are working with young children, the goal you give them may be different from your own and it doesn’t need to be complicated! For example, your goal may be for the child to produce ‘s’ at the start of 10 different words by the end of your session but you might tell the child that they have to tell you about 15 pictures before you finish. Goal setting is a big topic so I’ll be doing a post next week about how to set goals in more detail…
  • Practise often – A little bit of practise every day is much more effective than saving it all up and doing it in a one-er once a week. This is why SLTs are always telling people that weekly sessions are not a magic cure! Your SLT session is the starting point, the most important stuff is what happens between SLT sessions. As a general rule, try to do 10 minutes at least once but preferably twice or 3 times every day. This will vary depending on what you are working on but your speech & language therapist will give you some guidance on how often and when to practise.
  • Repetition is good – when working with children, it’s easy as an adult to get bored with the same activity. Repeating the same activity is actually helpful when practising your communication skills. It means that you don’t need to waste lots of energy learning a new game then learn the new communication skill on top of that. Also, make sure that you don’t move on to the next stage until your child can do what you were working on correctly 80-90% of the time.
  • Start slowly – Working on speech is essentially learning a new motor skill just like any other. You wouldn’t pick up a guitar for the first time and immediately expect to be able to play like Eric Clapton! You have to start slowly, making sure that you get each movement of your fingers (or mouth!) exactly right. As you practise, you will find that the movements get easier and you can then get faster and faster. It’s much better to slow speech down and achieve the correct pronunciation than it is to speak quickly and have no-one understand you.

Finally, and above all, MAKE IT FUN!! If you get stuck, your speech & language therapist should be able to give you some ideas of fun activities to use to help you practise…

Intensive Interaction Video

If you work with people who are at a pre-verbal stage of communication development or you have a family member whose skills are at this level, I strongly recommend that you check out an approach called Intensive Interaction. I’ve been using this approach for 10 years and in 2007 completed Dave Hewett’s Intensive Interaction Co-ordinator training (in my maiden name!). Isla's Intensive Interaction Co-ordinator certificate

Intensive Interaction was developed in the 1980′s by Melanie Nind and Dave Hewett in Harperbury Hospital School, an establishment for young adults with severe learning difficulties. It is a way of communicating with someone who is at an early, often pre-verbal, stage of their communication development and of developing their communication skills further. Often this is someone who may be considered ‘difficult to reach’ or communicate with. Intensive Interaction is based on principles of natural parent/baby interaction and is very well supported by a wealth of academic research.

Between being born and the age of about 5 years, humans typically go from being unable to communicate intentionally (on purpose) to becoming highly complex and versatile communicators using and understanding not just speech but a massive range of non-verbal and social communication skills. The most amazing thing about this is that we typically ‘just pick it up’ without ever being explicitly taught. Between birth and our first words at 18-24months we learn a huge amount about what are called ‘The Fundamentals of Communication‘, skills which include:

  • Enjoying being with another person
  • Using and understanding eye contact
  • Using and understanding facial expression, gesture and personal space
  • Joint attention or sharing an activity with someone else
  • Taking turns
  • Using and understanding physical contact
  • Playing with vocalisations and realising that vocalisations have meaning

These skills are essential for learning to use more complex communication and spoken language later on. All of this learning takes place during natural face to face interaction with other people, primarily our parents. Interactive games like peek-a-boo, tickling games like ‘Round & Round the Garden’ and just babbling and copying your child’s sounds are all part of this complex learning and teaching process. Intensive Interaction is a way of continuing this sort of stimulation for people whose communication remains within this pre-verbal or early verbal stage of development.

The core principles of Intensive Interaction are:

  • Let the learner lead the interaction which means that you as the teacher need to be prepared to join in with your learner’s activity. By doing this, you ensure that the interactive activity is familiar and comfortable for the learner which means that they do not have to expend concentration on learning a new game before they can focus on the communication learning. It also helps to build trust between you as the learner develops an understanding that you are not going to overwhelm them and that you are prepared to do the early communication equivalent of listening to them!
  • Respond to what the learner does – you can do this in a variety of ways. You may like to copy what the learner is doing or reply with a ‘celebration’ like an exaggerated facial expression, sound or comment. If you respond using some spoken language, keep it simple, short and clear so that it is easily understandable to your learner.
  • PAUSE! – This is so important! You must pause after a burst of activity to allow your learner to process your response and to give them an opportunity to reply to you in some way. Slowing the process of communication down in this way has many benefits. It allows you a chance to observe carefully and it allows the learner to demonstrate skills that may already be there but that they usually do not get to show because the pace of communication is usually too fast.

 

For more detail about Intensive Interaction, latest news from practitioners and upcoming training courses, visit the Intensive Interaction website. And finally, because the most effective way to see the impact of Intensive Interaction is to watch someone do it, click here to watch a You Tube video of some Intensive Interaction practitioners working with children in Romania. Suzanne Zeedyk, a well respected researcher in the field of early communication, provides a commentary. Sadly the picture quality is not as good as it could be but it should give you a flavour of the approach in action. You can also find this and other useful videos on the Blethers You Tube Channel. I hope you enjoy!