What is your goal? Begin with the end in mind

We are obsessed these days with setting goals. Sometimes the goals get in the way of the whole thing, we get stuck on the detail and miss something really great that has happened while we took our eye off the prize, while we were busy with the paperwork or the checklist.

It is a really difficult one. Do we set goals? Do they need to be specific or is it ok to be general? I remember when I was still a student that I assumed that for every child I saw the goal would simply be 'for the child to have age appropriate skills' in whichever area we were working, be it speech clarity, understanding or expressive language. Simple right? Hmm that's ok and is probably in the background of most cases, and that's ok if it means we are looking for progress - we should be looking for progress unless we are aiming to maintain skills. Aim high and you will move higher, but aim low and you will certainly stay low. But goals in reality end up being much more personalised and varied, depending on people's motivation, expectations, standards, hopes and dreams; depending on medical conditions or diagnosed learning difficulties; depending on people's values - is there a trade-off between determined focus on skills and relaxing and being happy?

I have always struggled to fully buy into the goal-setting culture. This is my reason: what if you set amazing specific, relevant goals that are easy to measure etc. etc. but 8 weeks down the road the child doesn't meet them, BUUUT they do make progress in a completely different area? Does that still mean they 'haven't achieved'? or does it just mean we set the wrong goals? Let me explore the technique of Intensive Interaction in this way. I am passionate about Intensive Interaction and its benefits. But if we apply goal setting we end up saying things like, 'my goal is to get more eye contact', or 'my goal is for him or her to copy me when I say "more". For me that limits the approach and misinterprets the philosophy of the approach in one big double-whammy. Do the approach with no strings attached and you will definitely get results. They will be big and they will be general. The child's whole social interactive ability will improve. Not just eye contact or repetition of a word, but enjoyment, joint attention, improved concentration, calm behaviour and many many more skills.

I do agree with the need to know where you are going though, not just aimlessly wandering along. That does help. Know what you want to achieve, not just 'we want lots of therapy', ask the question, 'why? why lots of therapy? what will that achieve?' and you will be much more positive along the way, working towards a meaningful objective.

Tips for Correcting Speech

Unclear pronunciation is very common, particularly among pre-school children. Often, with a few clues and context, although a few sounds may not be clear, you can still understand your child's general message. If you have understood, but you noticed a sound that was missing or different, e.g. he says 'bish' when he means 'fish', there are a few options for what to do. One option is to emphasise the correct sound in your response, 'that's right, it is a fish' - that way he will hear the word in the right way, but you haven't told him off. Another option is what we call 'forced alternative', where you present the word in 2 ways - the way your child said it and the correct way - 'ok, is a bish or a fish?' So your child has the chance to listen to both words and make a judgement. If he is physically able to produce the 'f' sound, he can repeat the word correctly. You might want to vary which technique you use, and try to not to pull him up all the time. These things don't change over night and require a little patience on both your parts.

Choosing an Alternative Communication System

I am currently working with a young group of children who are at the beginning of their communication journey. Some have made excellent progress with their interaction, many have picked up how to use PECS (Picture Exchange Communication System), and can use it to ask for things they really want or need, some have made the leap to using verbal language. So far, PECS has been the only alternative communication system (AAC) that has been trialled. But there are other ways in which communication can be supported. So we are now turning to other strategies. Signalong (similar to Makaton of Mr Tumble fame) can be helpful for children who are visual learners and are also able to copy hand movements. Other options these days tend to involve technology. A lo-tech aid such as PODD will be given a chance. Other aids such as Go Talk and ProLoQuo2Go might feature. The aim is to leave no stone unturned, or no aid un-explored, until each child has his or her system in place. Indeed for some of the children, they show preference for a combination of 2 or 3 different systems (Total Communication). Trial and error will eventually lead to results. Once a child has a sound, robust communication system, there is nothing to stop him or her from achieving full potential. That is a powerful gift. Communication, a human right, not to be taken for granted. Visit my website if you would like more support with PECS or any other aspect of communication.

Bilingualism and Language Development

Young children simultaneously mix languages, separate languages and segment languages according to the situation. All 3 approaches are typical. In terms of development, however, the following sequential stages are usually noted. First, use of the child’s home language. Then, there is often a non verbal period or ‘silent period’ at the time of entering the 2^nd language environment, e.g. nursery. When enough confidence has been built, the child will at first be telegraphic in the 2^nd language before being productive with some errors. The final step in the journey is to be competent or fluent. This is usually achieved 18 months – 2 years after the child first enters nursery or school. It is important that children are supported and encouraged to develop basic interpersonal communication skills in their home language; not to be discouraged from using this language. This will help them to develop their language skills in all languages at a later stage. Remember that Bilingualism is not a disorder. It is an advantage and does not cause communication difficulties. Indeed it should be celebrated! If you are concerned that your chid's communication skills are not developing along the typical lines, get in touch - admin@karenmasseytherapies.com 

What is Intensive Interaction?

Intensive Interaction is the name that has been given to a technique used to help children develop their interaction skills with others. It is also a technique that nearly every new parent uses when interacting with their baby, which makes it one of the easiest techniques to learn and use. It is also, in spite of its simplicity, one of the most powerful and effective tools you can have up your sleeve. One of the reasons why it works so well is that the child leads, doing the things they likes to do. The atmosphere is relaxed. There is no pressure. Results are natural not forced. Skills such as eye contact, social smiles and joint attention are not 'worked on' in 'therapy sessions'; they develop naturally, often when you are least expecting, so that the child experiences REAL feelings, REAL emotions, REAL joy. Initially the technique may involve the adult imitating a sound or an action then pausing to look for a response. This then leads to a 'conversation', where the child has a turn and the adult answers. Turns are not necessarily speech. Sometimes they are a tap on the table, a flick of a light switch or a vocalisation. I LOVE this technique and never tire of its use. To see the technique in action, we recommend a visit to www.intensiveinteraction.co.uk or look up some clips on youtube. We use the technique with children of all abilities, not just those with a severe learning difficulty. Send us an email if you have any questions.

What Are Oral Motor Difficulties?

That's a good question to ask. Oral Motor is, in my opinion, an area of Speech and Language Therapy that gets frequently under-assessed. This leads to children being under-diagnosed with oral-motor difficulties. Therefore, this leads to under-treatment of oral motor difficulties. The worst thing is, just because it's not an area many therapists choose to study further or develop into specialisms, if impaired, oral-motor skills will have a knock-on effect on both feeding AND speech. It is like trying to build a house starting with the walls, adding the roof, windows, doors etc., but ignoring the need to first look at foundations. Oral-motor skills include the muscles of the jaw, lips and tongue. In infant development, the jaw is the first to gain strength, stabilise and allow for chewing to develop. Next come the lips and the speech sounds that go with them - think mama or baba.  Lip skills also help an infant to drink from a cup and then from a straw, or to blow bubbles and give kisses. The lips and jaw should begin to separate their movements, allowing a child to drink without biting down on the cup or the straw. Finally, the finest motor movements are given to the tongue - responsible for many many speech sounds. Oral motor difficulties are common in the following conditions: Down Syndrome, Cerebral Palsy, Verbal Dyspraxia and Autism. To find out more, we recommend a visit to www.talktools.com or look up some clips on youtube. Send us an email if you have any questions or would like an assessment.

How Often Do You Need to Practise?

This is such a difficult to question to answer in a quick sentence, hence the blog rather than a tweet!
But there are some ways of coming up with a frequency that works for you and, more importantly, for your child.
1) What kind of difficulty does s/he have? If it is a social communication or social interaction difficulty, then the answer really has to be, 'practise all the time!' 'Seize the moment'. You can be modelling, using strategies, supporting or encouraging in real-life social situations. If it is a language difficulty, you might want to do short structured activities daily but model and reinforce when the language structures naturally occur. For a speech difficulty, you will need to do structured activities as many days per week as you can, then model and help your child to generalise recently learned sounds throughout the day.
2) How easy does your child find it to sit still and concentrate? If the answer is, not easy at all, then you are probably going to be practising in very short bursts and using play to teach skills rather than follow a structured sit-down-at-a-table programme. If s/he can concentrate for 10 minutes, then practise for 10 minutes; 20 minutes? Guess what, practise for 20 minutes!
3) Is your child motivated to do his/her therapy? If the answer is yes, that's great. You can take advantage of this motivation to practise one or two times per day. However, if motivation is lacking you may need to limit the number of times per week you sit down to practise; you may need to use play or lots of motivators/short breaks/bribes! You might also need to consider offering your child a therapy break so that therapy does not become too much of a chore.
There really is no hard and fast rule, although research evidence does mean there is general guidance for therapists to consider. Try to agree the frequency with your therapist and your child, and be prepared to alter or tweak the arrangements every so often. For more advice, visit my website.