Oh, why didn't you TELL me! (when telling doesn't work)

One of my favourite young people to work with is a young girl with autism who, although able to say many things, usually gets by through non-verbal means. She has taught me a lot over the past few years. Although at times challenging, the rewards have been plentiful.
One thing that has struck me on more than one occasion is how she learns what to do - and what not to do. Let me tell you two short stories:
One day we were at home and the kitchen was locked. She really wanted to go into that kitchen, but no-one else was around and we both didn't know the code for the door. It started off as just a little irritating, but in time things escalated. My hand was taken to the lock and I entered numerous combinations of numbers - none of which worked. The tension mounted, feet stamped, vocalisations got louder and more intense. Having exhausted all other strategies - distraction, ignoring, reducing sensory input - I decided to join in. I stamped my feet, screamed and jabbed at the numbers, shouting 'I want to go in the kitchen!!!' .... there was a pause, and with a small smile, she looked at me. Then, clear as day 'I want a drink'. Wow!
The second occasion was a day when the slightest thing seemed to be the cause of major upset. It's possible that she was unwell but not able to say, so there were frequent unhappy faces and noises and unconvincing cries. I tried saying things like, 'It's ok', or 'what's the matter?' but nothing helped. However, when I was face to face I tried copying the facial expression and sounds. Again, this did the trick. She stopped, looking very intently and then grinned.
When we know the auditory channel so easily gets blocked, let's try to use the visual channel instead. Mirroring back someone's feelings tells them that we understand and gives them a glimmer of insight into another person's perspective. It might not work for everyone, but it worth a try. Visit my website to find out more about my work.

To prepare or not to prepare: that is the question!

This is a debate that has aired in a number of places recently and it has inspired to me share it with you, as I think it is something that comes up quite a lot in the world of autism. So often we are told that we need to prepare people who are on the spectrum for what is going to happen; particularly if there is going to be a change to the usual routine or a big event looming. We can go to town (in a manner of speaking) preparing social stories, putting together photo albums, using role play and good old chat about the change, giving opportunities for questions and discussing feelings.

But for some people on the spectrum this seems to make them more anxious. They have far too many questions for us to possibly answer. So what at first seems like a kind and indeed the right thing to do ends up being an opened can of worms. In fact they may then do all they can to avoid the new event. Perhaps 'surprise' might be a better option and, hey, they may even enjoy it. You could provide a social script at the time of the event just in case.

What are your experiences? Get in touch via Twitter @KarenMTherapies or send me an email to admin@karenmasseytherapies.com and let's discuss this further. I do believe, like anything else, each individual is different and careful consideration of past experiences is really important so that life is as smooth and happy as it can be.

The Importance of Visuals

I have just come back from a relaxing swim. Have you been to a swimming pool recently? If you have, you may have noticed just how many visuals are available to help. How normal it is to use visuals. How essential they are for us all to function successfully. I hadn't been to this particular pool before, so I was especially grateful. The first 2 doors were clearly labelled as either Male or Female changing rooms. Then, a sign on the toilet door as opposed to the shower door. Next up, a sign pointing the way to the pool. At the pool, a clock on the wall so you could tell the time, signs to show the depth of the water. Visuals to show the pool rules - no dive bombing, no pushing, no dunking etc. Also, a warning visual to weaker swimmers, showing them which end of the pool to stay in. Then there were 5 lanes labelled with numbers 1-5. Often you then see diagrams showing you to either swim clockwise or ant-clockwise. This last visual was missing, so I had to rely on contextual cues, ie the person swimming towards me!

The next time you question how important it is to put visuals in place for a young, or not so young, person with autism, take a look around you, and take note how much you yourself use visuals throughout the day. You might be surprised at just how many you find!

If you have any questions about visuals or any other aspect of speech and language therapy, visit my website www.karenmasseytherapies.com or send me an email to admin@karenmasseytherapies.com and I will be in touch.

Child using PODD activity board lights up the whole classroom :-)

I love my job anyway. Each day brings something new, even if it is small, or just the fact that a child grins or runs up to give me a hug.

But today I witnessed something extra special. And it wasn't just me that saw it; it was a whole class that got inspired and amazed and awed.

So I happened to be in our therapy room catching up on some quick note writing when the phone rang. It was the nursery teacher asking for my colleague. "She's out doing a visit," I replied. She nearly ended the call, but then changed her mind and asked me if I wanted to come in and see something wonderful, maybe as it was one of my classes before the summer.

I am so glad I said yes. I went straight to the classroom and walked in to see everyone crowded round near the water tray. The teacher filled me in on how things had happened up to that point. Child had gone to the water tray and seen it empty of water with just a few blocks in. He took the blocks out then looked round the room until he found the PODD activity board for the water tray. He took it to a nursery nurse and led her to the water tray. He pointed to 'pour' then 'water' so she poured water in the tray. He then pointed to 'boats' so she got out the boats. When I joined the scene they were having a two-way conversation about splashing and getting wet!

The child looked so happy. He has very unclear speech. I was told how, without the board, he would have remained very frustrated, had some unsuccessful attempts at communication then settled for play in a different area.

It was definitely a 'wow!' moment. What a privilege.

If you would like to know more about PODD activity boards and how you can use them to support your child's communication, get in touch.

PDA: anxiety based demand avoidance or 'oppositional' and 'stubborn'?

Pathological Demand Avoidance is often met with mixed emotions by professionals. Some believe it doesn't exist. Others explain it as part of the autistic spectrum. Yet others argue it deserves a separate diagnosis that should be recognised in diagnostic criteria such as the DSM or ICD manuals.

Whatever you believe, I want to share my thoughts. Thoughts based on real life experiences of meeting young children in mainstream and special school settings; based on my trialling different approaches - and of course the responses I have had.

One young boy, probably 6 or 7, was in a mainstream school. He struggled so much in class that his school employed a teaching assistant to work 1 to 1 with him in a separate classroom. I went in to carry out a series of assessments. I was advised in advance it was difficult to instruct or direct him. So I went in the room and joined in with what was already going on. I gently and gradually unpacked my first assessment materials and went back to play. I then invited the adult to come over an have a look. After a while I started to 'test' the adult but we ensured she got things wrong. We then wondered out loud "I wonder if anyone else can help..." He came over immediately and before we knew it he was willingly completing the assessments. Eureka! I went back to the office and looked up advice and strategies but was disappointed to find only descriptions of this condition, not practical tips. I then typed up some ideas and sent them off with my report.

Roll on a couple of years and I am in a special school. I have worked with 2 or 3 young people who, although with more significant learning needs, also appear to have the same difficulty - coping with demands. Everything is great during relaxed, child-led play. Interaction is rewarding, language flows and there is a great sense of calm. But the minute you decide to take control and suggest going somewhere else or doing something else, it is a trigger for a very unhappy child who absolutely will not do as you say. No amount of bargaining or insistence seems to work. Autism friendly strategies such as countdowns, traffic lights and visual timetables don't seem to help much or at least not consistently.

So what do we do? I firmly believe that these are a group of people with very real anxiety disorders. Their anxiety levels get raised very quickly and very high whenever they feel control disappearing. The more demands placed on them, the worse the anxiety. It can spiral and spiral. So do we all get anxious from time to time. And when WE get anxious, we expect people around us to understand. We need people to be calm, to reassure us, to pamper us, to do things for us, to give us things we like, things that will help us relax. So, I figure, we really need to do the same for these children.

Approaches that are non-directive in nature include Intensive Interaction and Hanen. In my experience they really do work. And, once you have followed the child's lead there is no reason why you can't feed in language and education in a non-threatening way. Get in touch if you would like support with your child who has significant demand avoidance behaviours.

Let's make a deal - getting the job done

Yesterday I had the task of completing 3 assessments with a 6 year old boy. We only had an hour, so I needed to get it right. On a previous classroom visit I noticed him looking at a book about trains (mental note to self - he likes trains). When I walked in to get him, he was just starting quite a large jigsaw.

Uh-oh, I thought. This could take a while. I suggested we go to do some 'special' work, but he said, 'No, I need to do this jigsaw'. Hmmm, I thought, I need to think of something else. 'Why not bring your jigsaw with you? We can do it together. We could even see if we can find a train to play with.' It worked. He put the pieces back in the box and willingly came along the corridor. We chatted about transport on the way and he relaxed. 

First hurdle tackled successfully.... now for the assessments. Unfortunately, on reaching the room, he wanted to get back to the jigsaw straight away. My rather boring looking assessments just couldn't compete. So what next? Give up? Engage in a battle?

No. I used the 'Let's make a deal' strategy. Quite a verbal little boy, all he needed was a verbal approach (but you can make a it visual for children who learn best that way). 'Let's make a deal,' I said, 'Do 3 pages of my book and then we do 3 pieces of jigsaw, 3 more pages of the book then 3 more pieces of jigsaw,' and I held out my hand to shake on it. It worked! He liked the idea, and for the next 30 minutes we stuck religiously to the deal. He even jumped up after every 3rd jigsaw piece, keen to get on with the assessment. 

Why does this strategy work so well? Well, it allows the child an element of control. He doesn't have to give up what he wants to do completely. It is also quite an adult way of dealing with a situation. We do it all the time with other adults, e.g. 'I'll cook and you can wash up'. Children like to be treated like grown-ups. Another child I know will do anything for the chance to carry my fob and lanyard as it makes him feel special and in charge. We don't always have to be the 'teacher' telling them what to do.

Give it a go and see how you get on. I find it works well for most children, especially those on the autistic spectrum who both love being in control and have a special interest you can use as the deal maker.

Understanding Apraxia of Speech or Verbal Dyspraxia

Apraxia of Speech (American terminology) is known in England as Verbal Dyspraxia. It describes a condition in which speech clarity is affected by decreased co-ordination of the oral muscles.

In other words(!) the jaw, lips and tongue don't quite work together and get it right. Children - and adults - can be affected to differing degrees. Some will respond to just a small amount of therapy if their difficulties are very mild. However, for most children with this diagnosis, it is a long road of regular therapy and practice.

So dyspraxia is when co-ordination of the muscles is impaired. Dyspraxia can also occur on top of a muscle weakness (dysarthria). When this happens, it is really important that therapy addresses the muscle weakness first, rather than simply trying to get better co-ordination - as this would only achieve better co-ordination of weak muscles.

I have seen features of dyspraxia in many children who are on the autistic spectrum. This isn't surprising when you consider that motor planning difficulties are common in children with autism.

Traditional therapy for verbal dyspraxia focuses on auditory and visual methods of input followed by lots and lots of practice. If this approach works, then great! That is all that is needed. There are different published programmes such as the Nuffield Dyspraxia Programme (UK) that do the job.

But what traditional therapy does not do is account for those children who learn best through tactile methods. They need auditory, visual AND tactile input in order to learn what to do with their mouth. That is where Talk Tools comes in. It offers an approach that helps this particular group of children transfer their muscle skills (muscle strength) into speech. It also allows us to provide a more holistic therapy environment, considering eating and drinking skills as well as speech (they are all joined up).

Visit my website for details of how to get in touch for an in-depth assessment or treatment.