If your child has been referred for an Autism assessment it can be a daunting prospect. It is difficult to know what professionals are looking for and what it all means. It is usually because there concerns about their ability to interact and communicate.
Why has my child been referred for an Autism Assessment?
Let me be straight with you, usually a child is assessed because there concerns about certain areas of their development. A speech and language therapist will refer if they are worried about your child’s ability to interact and communicate with others or because their play skills might be different from other children of the same age. An SLT might also refer if your child is showing some atypical or difficult behaviours.
Who will be at the Autism Assessment?
Autism assessment will involve a child development team – two or more professionals which could be made up of, a paediatrician, a speech and language therapist, a psychologist, an occupational therapist, or a physiotherapist. Although it can seem like there are a lot of people involved, it is good to gather the opinions of as many professionals as possible. They will all be looking at the results from slightly different viewpoints and will challenge each other’s thought processes to come to a more robust outcome.
What will happen during the Autism Assessment?
During your assessment, the child development team will ask you lots of questions and will be observing your child’s behaviour. in order to make a diagnosis of Autism – your child must show difficulties in all three of these areas.
- This could be in their understanding of words, following instructions and interpreting other people’s gestures. communication can also relate to your child’s expressive language; the types of sentences they are using and the ay their speech sounds.
- This means how your child responds to others, their interest in interacting with the people around them and the purpose of their interactions. Professionals will also be observing ‘how’ the interaction is taking place and will be looking at behaviours such as eye contact and communicative gestures.
Rigid or inflexible thinking
- This means how they are playing and using their imagination – often children with autism with demonstrating repetitive or stereotyped play. They might prefer to follow certain patterns or rituals, or have overfocused or unusual interests.
A person with autism can have more difficulties in one particular area, but all three will form part of the diagnosis. Most children with Autism also have some issues with sensory integration, their senses constantly sending them confusing messages. Children often have challenges with sleeping and can be highly selective in their choice of food.
Remember, whatever the outcome, it will not change who your child is. They are still your baby, with the same likes, dislikes, smiles and cries. If your child has been given a diagnosis and you are confused about next steps, contact the National Autistic Society for more information and support.
There is immense pressure on teachers to meet the needs of children with Speech, Language and Communication Needs (SLCN). At the same time, support services in the NHS are becoming more and more scarce.
NHS speech and language therapists are doing their absolute best, I know they are…until October last year, I was one of them. I certainly didn’t go to University for four years to print off a stack of Black Sheep Press, come in once a term and tell you to get on with it.
No, of course not. NHS therapists are stressed and often have caseloads that are unmanageable – they are desperate to meet the needs of children but don’t have the resources to provide the level of intervention that is needed.
So, what’s the answer?
Well, some forward thinking schools such as Ivy Bank in Macclesfield and Haworth School in Bradford are beginning to adopt teletherapy as a way of meeting pupil’s speech and language therapy needs. Teletherapy has been effectively used in Australia and the U.S for years and seems to be finally making its way over to our shores.
But what is it?
Teletherapy or Telehealth as it is described by the Royal College of Speech and Language Therapists as the remote delivery of professional health services via the use of telecommunications technology – take a look at this video to see how it works.
In short, it means that If your school has an internet connection, pupils now access to unbridled audio and video interactions in real time with speech and language therapists, it allows an array of speech, and language services to be provided remotely.
Ok, but does it really work?
There is a growing body of research into the clinical effectiveness of teletherapy. I have been writing the new telehealth guidelines for the Royal College of Speech and Language Therapists and have collated some of the main research for you here:
Research shows “Diagnoses and assessment performed remotely is equivalent to those conducted in traditional face-to-face settings” (ASHA 2015). Validity and reliability has been established for the use of telehealth in a number of screening and formal language, oromotor, articulation and literacy assessments 1. it has also been successfully used by multidisciplinary teams to assess young children with multiple disabilities 2.
The use of telehealth in speech and language therapy with school-aged children has been reported, with a randomised controlled trial providing evidence for the provision of speech sound treatment 3. and other speech and language interventions 4.
Remote training has also been studied extensively, with parents and teaching staff supporting children with Autism feeding and swallowing difficulties and communication impairments 5 Research shows gains obtained were maintained for longer and even exceeded in effectiveness by using a treatment model that used telehealth. In addition, parents reported that they perceived telehealth sessions to be as valuable as those delivered directly by a therapist.
Anecdotally, teachers have reported that they love the convenience of accessing teletherapy sessions with a real speech therapist; having measurable baseline data and the comprehensive outcome tracking. If you would like to try teletherapy in your school contact me 0800 024 86 46
For full reference list contact email@example.com
- Ciccia, Whitford, Krumm, & McNeal, 2011; Crutchley, Dudley, & Campbell, 2010; Eriks-Brophy, Quittenbaum, Anderson, & Nelson, 2008; Fairweather, Parkin, & Rozsa, 2004; Waite, Cahill, Theodoros, Busuttin, & Russell, 2006; Waite, Theodoros, Russell, & Cahill, 2010a, 2010b, 2012)
- Pearl et al., 2014
- GroganJohnson, Schmidt, Schenker, Alvares, Rowan, & Taylor, 201
- Gabel, GroganJohnson, Alvares, Bechstein, & Taylor, 2013; Grogan-Johnson, Alvares, Rowan, & Creaghead, 2010; Grogan-Johnson, et al., 2011
- Baharav & Reiser 2010, Suess et al 2014, Kobak et al 2011, Vismara 2013
He’s playing with his Ninja Turtles: Donatello and Raphael are immersed in an exhilarant adventure. Or maybe he’s watching TV eyes glued to the screen.
You call his name and he doesn’t respond, you call again, still…nothing. A third time and he doesn’t even flicker.
You feel a flash of anger, ‘I can’t believe he’s ignoring me!’ Then a feeling of worry, ‘is something wrong with his hearing?’
If you identify with this scenario you are not alone. Sometimes it can be difficult to figure out whether to be mad, or concerned in these situations.
More specifically, whether this is an expression of defiance; or just part of normal development.
For most kids up to the age of 4 this type of behaviour is completely normal. At this age they are still developing their attention skills. Their attention is what they call ‘single channelled’.
Ok so let me explain, single channelled means they can only attend through one ‘sensory’ channel at a time. They can concentrate on something they have chosen to do. But, in order to do this they have to ignore outside stimulation so they can organise their thoughts, and concentrate.
Here’s the thing, when the turtles are on an adventure, it is taking up all of his sensory brain power. He doesn’t have any left, to attend to you calling his name.
Simply stated? he is ignoring you… but it’s not his fault.
Of course, as children get a bit older between 4-5 they begin to develop dual channelled attention. They can understand verbal instructions related to what they are doing without interrupting what they are doing to look at the speaker
So, at this age, They should start to be able to listen to instructions about what they are doing without needing to shift their full attention to you.
By 6 Their auditory, visual and manipulatory channels are fully integrated and attention is well established and sustained. They can sure hear you when you call them to lay the table!
Let me switch gears here for a moment: I am describing typical development of attention here. There are Red Flags you should be aware of that may indicate a child has a hearing loss or attention difficulty. If you are at all concerned at all about your child’s hearing you should take them to you GP and ask for a referral to Audiology.
Some things to look out for.
- Speech/language delay or differences
- Says “what?” or “huh?” often
- Difficulty understanding speech in background noise
- Difficulty hearing in one or both ears on the phone
- Increased TV/stereo volume compared to rest of family
- Not startling to very loud sounds
- Attention or behavioral problems
- Academic difficulties
- Unable to detect where sounds are coming from
For strategies for how to gain the attention of a younger child – read next week’s blog post
The Health Visitor has told you not to worry, that she might be a little bit behind but she will catch up in a few months. So you wait…and wait but you still feel like her language is not developing as quickly as other children. Her speech is not as clear as others at nursery and she is not progressing as fast as her older sister.
Sound at all familiar? If the answer is yes, there are a couple of things I would recommend you try to fast track a referral to a Speech Therapist
Get a hearing test.
If your child cannot hear it – then they won’t be able to say it. Nearly 80% of children under the age of 8 will suffer with glue ear which can affect their hearing and access to speech sounds. It is always worth getting this checked out before doing anything else.
Get your facts straight.
The more you know about child development, the more you will understand about your child’s difficulties. Often, the more you find out about your child’s delay, the less concerns you will have.
But don’t take my word for it, take a look at the Talking Point website and the Cochlear’s Integrated Scales of Development to get an idea of where your child is up to. It may surprise you, what is ‘typical’ for a child at 2 years.
Let me explain, if you go to your GP and say, her speech doesn’t sound like the others at nursery this doesn’t give the doctor enough information about what’s going on and whether to refer to a Speech therapist or not.
if you say:
She isn’t using any functional words to request and she is playing on her own agenda or
She seems to be replacing all of her initial consonants with a ‘t’ or a ‘d’
This gives the Doctor much more information to go on. And a more specific reason to give you a referral to a Speech therapist.
Think about it, if you are vague about what the problem actually is, it’s difficult for the health visitor or doctor to know what you are concerned about.
Vitally important, last and final point:
Be the expert.
You may have a ‘gut feeling’ but you will get a lot further into the referral process if you have facts and examples to show to your Health visitor, GP and paediatrician to back-up your concerns.
Demonstrate your child’s knowledge and skills and track their progress on this ‘talking point chart’
Have videos demonstrating behaviour in situations other than the GPs office. Show the Doctor what they are like at home; in a crowd or at nursery.
Gather as much information as you can from nursery staff or their childminder. Ask them to write a note or short letter to support your concerns.
It is a shame we have to go to such lengths as parents to get an NHS referral to Speech and Language Therapy. But, honestly, it is worth doing if you are concerned.
If you don’t want to wait, you can call me at Mable or sign up for a free consultation when we Launch in October – I will be happy to talk things through and advise on assessment and therapy options.
For all of you trying to get a referral to a Speech Therapist I hope this is useful! – Let me know how it goes
We’ve seen it all! crying, laughing, whinging, hitting, pinching, squealing – Children can make it quite clear how they are feeling by their actions…. and noises!
The good news is, as children begin to pick up new words they can communicate about things that upset or fascinate them and so learn new ways of regulating their behaviour.
Too often, the vocabulary we teach our children to describe feelings is often restricted by what we think will be easier for them to learn.
So what does this mean? – It means we limit their vocabulary to usually happy and sad – these two words are very powerful, but simply not diverse enough to cover all the emotions and feelings our children are experiencing.
More importantly, if we limit what words our children are learning, we limit their ability to describe their life and environments. Wouldn’t it be nice if our children had a couple more words to describe how they’re feeling?
So how do I get started?
Help her to understand her emotions by giving her the feeling names
Encourage her to talk about how her mood – for example, ‘we are going to pizza express with Amy later, you look like you are excited!’
By giving her a label for how she is feeling she makes a connection between the word she hears and the emotion.
This starts to build up her vocabulary which will allow her to talk about feelings in the future.
Give her lots of opportunities to identify feelings in herself and others
You might say ‘you hurt your knee but you didn’t cry, because you are very brave!’
Or you might point out a situation they would remember ‘ Do you think mummy was brave when she hurt her toe this morning?’
The best way to teach appropriate ways to react to things is be modelling good behaviour ourselves.
Your child learns from your behaviour. They see your facial expressions and body language when you get angry, or frustrated.
‘When daddy gets angry he will sometimes leave the room, take a deep breath and come back when he feels calm’ This provides them with a strategy to use when they feel the same way. It also supports their understanding of recognising emotions in others.
Don’t restrict her vocabulary – the early years are the best time to teach new words. Here’s some inspiration:
- Words: confused, brave, curious, disappointed, generous, friendly, jealous, bored, surprised, proud, calm, shy,
- Phrases: I think, I feel, I wonder, I want
Resources to help
This website has a huge amount of resources including an excellent book list covering lots of different emotion words and feelings
Centre on the Social and Emotional Foundations for Early Learning (CSEFEL)
You’re already running late, it’s time to get to nursery and she is glued to CBeebies. Without a thought, you reach for the remote – flick the off button and you enter….
But, don’t lose your rag, just remember these 3 top tips for keeping it together ….when she is losing it!
As you may have noticed, some children do not have the words to talk about how they are feeling, instead they will act out these emotions in very physical, and sometimes inappropriate ways:
“When my two year old gets really angry she will throw toys around the room or bump her head on the floor– I’m always worried she will hurt herself” – Carly, Macclesfield
In this situation there are 3 key things you can do to stay sane during toddler tantrums.
1. Stay Safe
Two year olds are unable to hit their heads with enough force to actually hurt themselves, unless it is against a sharp surface. Make sure your child is safe, but don’t fuss. You could try putting a pillow under their head or moving them to a carpeted area of the house.
If possible, ignore the behaviour. As your child learns they are not getting what they want from exhibiting anger in a physical way, they are more likely to stop
You may choose to leave a favourite toy or blanket with them – so they can use it to soothe themselves. Keep an eye on your child but indulging the behaviour, or getting angry and frustrated yourself will make it worse.
2. Stay calm
it is difficult not to become, frustrated upset or angry when your child is behaving in this way. But you must try and keep a cool head.
Here’s how: go into another room, take a deep breath through your nose (count to 8). Let the breath go slowly through your mouth. Do this at 3 times while concentrating on creating a space between your head and your shoulders.
Feel calmer? return to the situation with a level head, make sure she is safe and then acknowledge her emotions.
3. Acknowledge how she feels
It is so important that you acknowledge her feelings. If the toddler tantrums are started by you turning off the TV. Say, ‘I know you are angry, it’s ok to feel angry but we need to turn off Peppa because we are going to nursery’.
- Here, you have acknowledged her emotions – I know you are angry
- Provided her with a label for her emotion ‘angry’
- Used repetition to reinforce word and concept learning – said angry more than once
- Given her a reason: ‘because we need to go to nursery’ if you explain why you have done this in a reasonable way she will develop her understanding of how others around her are thinking and feeling.
A final thought? – Children are less likely to have a tantrum and act out in a physical way when we teach them how to tell us how they feel.
You pick your child up from nursery and it seems all the other children are chattering away telling their mums and dads about their day while you have to ask your little one hundreds of questions just to get a single word response.
It doesn’t matter how many times professionals say, ‘children just develop at different rates’ it does not put your mind at ease.
So what will?
Understanding the process of speech and language development can help to ease your anxiety. It will also help identify whether or not you child has language delay and what are the right strategies to support your child to progress.
“Learning to speak is one of the most complicated physical actions that humans can perform, It requires the coordination of more than 70 muscles and many different body parts. Until children are able to gain control over these muscles and body parts, they start with the simplest, most basic activity: opening and closing the jaw to simulate the speech they hear around them.” Dr Barbora Davis (2011)
The pyramid below illustrates the stages of language development:
Try and Identify the level at which your child is having difficulty and look for strategies to support development in specific areas. Have a look at these fantastic ideas from Leeds NHS
Understand your child’s diagnosis and the prognosis attached to this. Don’t expect more than your child is currently capable of. Work at their pace.
But, what else can I do to help catch them up with their peers?
Children’s early language environments profoundly impact their ultimate life-course trajectories, affecting not only their linguistic development but also their educational attainment and cognitive outcomes. A famous foundational study by Hart and Risely (2003) demonstrated a significant correlation between the number of words a child hears and his or her IQ and later educational attainment.
However, it is not merely the quantity of words that matters: the qualitative aspects of parent language also significantly affect child development and outcomes, including complexity of speech, responsive caregiving, and adult–child interaction.
- Parents have more impact on children’s outcomes than any other factor
- The amount and type of language used at home has an effect on children’s overall language development
- Good early communication sets the pattern for later childhood and adolescence
What strategies can I use to encourage their language development?
- Support the language development using these strategies in everyday communication based around everyday routines.
- Body language;
- Look at where they are looking;
- Talk about things they are engaged with
- Try to follow their lead in the conversation
- Think about why you are asking questions:
What have you been painting today’, ‘is it a monkey?’ ‘is he eating a banana?’ ‘do you like bananas?’
- You already know the answers. More importantly your child already knows, you know the answers. They are less likely to respond if they feel as though they are being tested
- Swap your questions for comments and use it as an opportunity to enrich language
‘ Wow! what a beautiful painting’ ‘ its a cheeky brown monkey’ ‘he’s eating a delicious banana’
- Here we have exposed them to new words: beautiful, cheeky, brown, delicious
- Take turns
- As well as commenting think about taking turns. make sure you wait, giving a chance for your child to respond.
A:‘Wow what a beautiful painting’
look expectantly at the child, count to ten in your head
(sometimes a child will take a turn without speaking. look for their conversational turn. It might be a smile, eye contact, or a vocalisation)
A: its a cheeky brown monkey ….etc
I would love to know how easy these techniques were to try and whether the article has been useful for any parents or teachers. I have more strategies for language delay so feel free to leave your comments and questions below.
You want to know what your child can do; what they can say; and you want everyone else to know it too!
But this can mean that you end up constantly testing your child’s abilities rather than teaching them new skills.
Ok so, Imagine this. At Sunday Lunch, out of the blue, your partner leans towards you expectantly and asks you to ‘SAY APPLE’. When you don’t answer, they ask again, ‘come on, SAY APPLE’ . You’re confused. There’s no apple around, there is no conceivable reason you can see for ‘saying apple’. It’s just come… completely… out of nowhere.
Now imagine this , you and your partner are in a sunny orchard, surrounded by fruit trees, drinking delicious freshly pressed juice. Without anyone asking, you might comment on the apple trees, the apple juice the colour of the apples.
Context is so important for supporting speech and language learning. When we create a naturalistic context for communication and learning our children are much more likely to offer language spontaneously.
Rather than testing their language. Enrich the language environment with new experiences. If you want to get your child talking concentrate on these top tips
Swap questions for comments:
- Swap ‘where’s the horse?’ to ‘There’s a horse!’ use it as a teaching opportunity ‘look its galloping and eating grass’
- Talk about what’s going on around you, use a running commentary to teach new words
- Don’t jump in, give him time to comment, Count to ten before making another comment. This gives him time to process what you have said and to formulate a response.
- 10 seconds feels like forever – but stick with it, it works
It is our natural instinct to protect our children when we see them having difficulty. When other people are struggling to understand our child’s speech it can be difficult to stand by and not help them out.
But remember , when under pressure, our kids can surprise us with their resilience and their resourcefulness. I have often seen children at school or nursery use alternative ways to make their voices heard. They will lead others by the hand to what they want, mime what they are trying to say, use pictures and show objects, write things down and try and rephrase things to make it easier for the other person to understand.
Repairing communication breakdown in these ways without our help is a great skill to learn, and something we should encourage. When children can achieve this, it builds confidence in their own abilities to problem solve. So if you can, be patient and resist the urge to jump in straight away.
But what can I do if I see them upset?
The key here is to empower your child rather than translate for them. This means, use techniques to support and scaffold the conversation, like recasting.
Recasting can be a really powerful tool. It refers to repeating an error-utterance back to someone, but with the error corrected. Here an example
Child: Him’s tar talled Batmobile.
Adult: That’s right, his car’s called Batmobile? thats a cool name for a car
This also models the correct pronunciation to your child – without drawing attention to the error or putting them under pressure to repeat correctly. The more a child hears correct language models, the more likely they are to self correct.
Don’t be embarrassed and try not to draw attention to your child’s articulation difficulties. This can lead to frustration or your child ‘opting out’ of communication all together.
Stay calm and educate those around you about how best to support them.