Unveiling the hidden spectrum: Why girls and autism often go unseen
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Unveiling the hidden spectrum: Why girls and autism often go unseen

Unveiling the hidden spectrum: Why girls and autism often go unseen
Image by Freepik

Autism is a complex neurodevelopmental condition characterised by social-communication challenges, restricted and repetitive behaviours, and sensory processing difficulties. While the prevalence of autism is estimated at 1 in 54 children, research suggests a significant disparity in diagnoses between genders. Boys are diagnosed with autism roughly four times more often than girls, leading us to question: Why are girls so much harder to diagnose with autism?

The answer lies in a complex interplay of factors, including:

1. Different presentations of autistic traits:

  • Socialisation: The stereotypical image of autism often portrays boys with aloofness and a lack of interest in social interaction. However, autistic girls may exhibit more subtle social difficulties. They may appear interested in socialising but struggle with understanding social cues, maintaining eye contact, or navigating complex social dynamics. This ability to ‘camouflage’ their challenges can lead to misinterpretations of their intentions and abilities.
  • Restricted interests: While autistic boys may have intense interests in stereotypically ‘masculine’ topics like dinosaurs or trains, girls might gravitate towards interests traditionally associated with girls, like specific characters or activities. These interests, often deemed ‘typical’ might be overlooked as potential indicators of autism.
  • Repetitive behaviours: Repetitive behaviours are another core diagnostic feature of autism. However, autistic girls may exhibit these behaviours in more subtle ways, such as intense focus on specific routines, scripting conversations, or engaging in repetitive social interactions. These subtle expressions can easily go unnoticed.

2. The ‘camouflage’ effect:

Autistic girls, particularly those with higher cognitive abilities, may develop coping mechanisms to mask their challenges in social situations. This ‘camouflaging’ can involve mimicking social behaviours they observe in others, leading to significant internal distress and exhaustion. This effort to appear ‘normal/typical’ can further hinder accurate diagnosis.

3. Societal biases and diagnostic tools:

  • Gender bias: The current diagnostic criteria for autism were largely developed based on studies of boys, leading to a potential bias towards male presentations of the condition. This can result in girls who don’t exhibit the ‘typical’ symptoms being missed altogether.
  • Lack of awareness: Healthcare professionals and educators may have limited awareness of how autism manifests differently in girls. This lack of understanding can lead to misinterpretations of their behaviours and missed opportunities for diagnosis and support. I must say that this is really common in my working day. I see a child—girls or boys in this case to be fair, but mainly girls—where parents tell me: the doctor/health visitor/paediatrician has said it was ‘just a little delay’ and I am thinking ‘Really!??? What did they look at? How did they not see X Y Z’… It really is still very common.

4. Co-occurring conditions:

Autistic girls are more likely to experience co-occurring conditions like anxiety and depression, which can overshadow the core features of autism. This makes it even more challenging to identify the underlying autism diagnosis.

The consequences of missed diagnoses and this goes of course for both, autistic girls AND boys!:

The consequences of undiagnosed autism can be significant. Children may experience:

  • Lack of access to appropriate support: Without a diagnosis, children may miss out on crucial interventions and therapies that can help them manage their challenges and thrive.
  • Increased vulnerability to mental health issues: The stress of masking and navigating social complexities can lead to anxiety, depression, and other mental health challenges.
  • Difficulty forming meaningful relationships: Social difficulties and communication challenges can hinder their ability to build and maintain healthy relationships.

Moving forward: Towards a more inclusive diagnosis:

To ensure all individuals on the spectrum receive the support they need, it’s crucial to:

  • Increase awareness and education: Healthcare professionals, educators, and the general public need to be educated about the diverse presentations of autism in girls and of course also in boys. Let’s not forget that we are still seeing older autistic boys with diagnoses given aged 12 years and older who have slipped through the net.
  • Develop gender-neutral diagnostic tools: Diagnostic criteria and assessments should be revised to encompass the broader spectrum of autistic traits, regardless of gender.
  • Encourage open communication: Parents, caregivers, and individuals themselves should be encouraged to voice their concerns and seek evaluations, even if their experiences don’t perfectly align with stereotypical presentations of autism.

By acknowledging the complexities of diagnosing autism, particularly in girls, and working towards a more inclusive approach, we can pave the way for earlier diagnoses, appropriate support, and a brighter future for all individuals on the autism spectrum.

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Creating your calm: containment strategies for Sensory Processing Difficulties
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Creating your calm: containment strategies for Sensory Processing Difficulties

The world can be a beautiful and stimulating place, but for individuals with Sensory Processing difficulties (SPD), it can also be overwhelming and even painful. Everyday sights, sounds, smells, touches, and tastes can be amplified to uncomfortable or even unbearable levels. This can lead to anxiety, meltdowns, and a constant feeling of being on edge.

One important coping mechanism for SPD is containment. Containment strategies are techniques that help individuals manage their sensory experiences and create a sense of calm and safety.

Understanding containment needs:

Containment needs vary greatly from person to person. Some individuals might find comfort in deep pressure, while others might crave quiet and solitude.

Common containment strategies:

Here are some examples of containment strategies that can be helpful for individuals with SPD:

  • Deep pressure: This can involve activities like wearing weighted vests, using weighted blankets, getting firm hugs, or applying deep pressure massage.
  • Movement: Engaging in rhythmic movements like rocking, swinging, or jumping can be calming for some individuals.
  • Proprioceptive input: Activities that involve proprioception, the sense of body awareness, can be grounding. Examples include yoga, stretching, and proprioceptive toys like chewy necklaces or fidget spinners.
  • Visual calming: Utilising calming visuals like nature scenes, dimmed lights, or fidget toys with visual patterns can provide a sense of peace.
  • Auditory modifications: Noise-blocking headphones, earplugs, or white noise machines can help block out distracting or overwhelming sounds.
  • Oral motor activities: Chewing gum, crunchy snacks, or chewy toys can provide sensory input and help regulate emotions.
  • Sensory bottles: Watching calming visuals move within a liquid-filled bottle can be visually stimulating and promote focus.
  • Creating a safe space: Having a designated quiet area at home or school where individuals can retreat to self-regulate can be invaluable. This space should be free from clutter and overwhelming stimuli and can include calming sensory items.

Additional tips:

  • Be patient and understanding: It takes time and practice to find what works best for each individual. Be patient with yourself or your child as you explore different strategies.
  • Consistency is key: Once you find effective strategies, use them consistently in different settings to create a sense of predictability and comfort.
  • Communicate openly: Talk to teachers, caregivers, and others about individual needs and how they can support containment strategies.
  • Celebrate progress: No matter how small, acknowledge and celebrate successes in managing sensory experiences.

Remember:

Containment is not about suppressing sensory experiences altogether. It’s about creating a sense of control and reducing overwhelming sensations to a manageable level. By exploring different strategies and working with a qualified professional, individuals with SPD can develop the tools they need to navigate the world and experience life to the fullest.

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Stage 2 NLA
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Stage 2 NLA

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Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

So for example we hear phrases like:

  • ‘let’s go’+ ‘downstairs’
  • ‘it’s’ + ‘downstairs’
  • ‘I see it’ + ‘downstairs‘
  • ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)

To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

What we can now do on a daily basis to help and support at this time:

1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

Good phrases:

  • It’s … raining / cooking / eating / washing / brushing
  • That’s … great / cool / amazing / wow / so good
  • Let’s … see / look / go / run / chase
  • How’bout … some food / playing / I’ll chase / sleeping / we read a book
  • I see a … bird / large car / fire engine
  • I wanna … have a biscuit / have a book / have a snuggle
  • We’re … going out / going home / going in the car / going upstairs

Here in my video clip of train play I use:

  • Let’s go
  • It’s going up the hill
  • It’s coming down
  • Ooops it falls!
  • It’s stopping
  • Let’s put on another parcel
  • Ready steady go
  • Off we go
  • It’s come off!
  • Let’s fix it
  • I can do it
  • I don’t need help

You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

2. Watch out for Pronoun confusion or reversal:

Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

Instead model from a:

  • first person perspective: ‘I’ / ‘Our’ / ‘Us’
  • joint perspective: ‘We’ / ‘Let’s’ or a
  • neutral perspective: ‘It’

You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

So instead of saying, ‘Do you want to go to the park?’

You could say:

  • We wanna go to the park?
  • Let’s go out?
  • Shall we go out / to the park?

3. Start providing ‘variation’ in your language modelling:

Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

Repeat: ‘it’s raining!’

Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

Then later think of other combinations for ‘it’s’ + ‘something’:

  • (rice) ‘It’s’ + ‘cooking’
  • (water/tap) ‘It’s’ + ‘running’
  • (radio) ‘It’s’ + ‘singing
  • (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’

In my train video clip:

  • Let’s go
  • It’s going
  • Let’s make it go
  • Ready steady go
  • Oops its gone

4. Use natural intonation that shows you really mean what you’re saying.

You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—

  • ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
  • ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
  • ‘I’m’ + ‘catching up with you!’ (animated goofy)
  • ‘I’m’ + ‘gonna get you!’ (animated goofy)
  • ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)

5. USE SILENCE!

Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

You will see this works wonders!

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

You can also check my friend’s lovely handmade jewelry on her website.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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How do we know our Gestalt Learner is moving to Stage 2?
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How do we know our Gestalt Learner is moving to Stage 2?

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Is our student ready to move to NLA 2 (Natural Language Acquisition stage 2)?

We know that the GLP (Gestalt Language Processor) will move into the next stage when they are ready. But are they now ready you might think? When are they ready? How do I know? If you are not sure whether your child is ready to move forward then go and see your GLP trained Speech Therapist. Together you can work out what the next steps are and how to help your child settle into NLA 2. It’s very exciting!!

Tip

The first useful tip: keep a language sample of phrases your child says. This is very helpful!

You might want to check with your Speech Therapist and offer some language sampling you have taken so they can help you figure out where your child is currently. Always keep an Utterance Journal that you can share with your Speech Therapist and with others who look after your child.

Basically, we want to listen out for phrases our child says that you or nursery don’t say routinely; that way you can presume that this is not an echo but a mixing together of two chunks of gestalts. Watch out for those coco melon phrases though: double check it really isn’t an NLA 1 gestalt that is copied verbatim from a favourite you tube video.

You can best support your child best by listening, and thus figuring out what your child is TRYING TO SAY. Often your child might skip over the parts of gestalts they don’t want to say. This is common in older kids who have long gestalts, sometimes even whole episodes or whole stories!

Try and tease out their shorter mitigations and then focus on practicing and modelling those as they are so much more useful!

So back to our question: are they ready?

Are their gestalts covering a variety of situations and contexts?

Make a note in your journal to see what the backgrounds are to each phrase you ear, so for example:

  • Transitioning: ‘it’s time for the park’ ‘what’s next’ ‘shoes on’
  • Bed Time: ‘we need to wash’ ‘let’s get in (bath/bed)’ ‘ready for our book’
  • Toilet/nappy: ‘we need the potty’ ‘where’s the potty’ ‘let’s wash hands’
  • Mealtime: ‘time to eat’ ‘go get a spoon’ ‘yummy num num’
  • Park/going out: ‘look at the squirrel’ ‘funny doggy’ ‘I wanna swing’
  • At the shops: ‘let’s get the trolley’ ‘lots of veggies’ ‘no tomatoes’ ‘ooh long queue’ ‘back to the car’

And… does the child use the phrases for a variety of functions?

  • labelling
  • providing information
  • calling out
  • affirming
  • requesting
  • protesting
  • directing

We need to offer lots of similar language models so that in their own time our children can extract/mitigate useful phrases for what they want to express. The more similar utterances a child hears around him the more he/she can discover the communalities. Once the child has a small range of phrases, he/she can mix them up and create semi-original own phrases.

If the answer is YES!! our child has perhaps not all but a range of functions and a range of situations where they use a variety of easily mitigable gestalts then yes they are ready for moving to stage 2 of NLA!

Hurrah!

Keeping a journal of what your child is saying and in what circumstance is crucial to help with our ongoing detective work!

Next time I will be looking at how we can help our NLA 2 GLP produce even more of their own mix and match phrases.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Autism – Benefits of Early Assessment and Intervention
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Autism – Benefits of Early Assessment and Intervention

I think my child might be autistic – how can we help?
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Consulting a Specialist Speech and Language Therapist can help you in several ways: assessment, informal and formal observation, discussion and advice, onward referrals, direct intervention, parent coaching, educational support and much more, all geared towards supporting you the parents, and helping your child to flourish and thrive.

First up, we can help you with assessment and advice: with a wealth of expertise in observing childrens’ play and communication, as well as knowledge of the latest research we can see a child’s strengths and areas of struggle very quickly indeed.

Within a short space of time, we can identify the areas we need to focus on and start guiding you towards helping your child to connect, respond, react and feel better.

Early detection is key

If autism is detected in infancy, then therapy can take full advantage of the brain’s plasticity. It is hard to diagnose Autism before 18 months but there are early signs we know to look out for. Let’s have a brief look at the sorts of things we look at.

The earliest signs of Autism involve more of an absence of typical behaviours and not the presence of atypical ones.

  • Often the earliest signs are that a baby is very quiet and undemanding. Some babies don’t respond to being cuddled or spoken to. Baby is being described as a ‘good baby, so quiet, no trouble at all’.
  • Baby is very object focused: he/she may look for long periods of time at a red spot/twinkly item further away, at the corner of the room for example.
  • Baby does not make eye contact: we can often see that a baby looks at your glasses for example instead of ‘connecting’ with your eyes.
  • At around 4 months we should see a baby copying adults’ facial expressions and some body movements, gestures and then increasingly cooing sounds we make; babies who were later diagnosed with autism were not seen to be doing this.
  • Baby does not respond with smiles by about 6 months.
  • By about 9 months, baby does not share sounds in a back-and-forth fashion.
  • By about 12 months baby does not respond/turn their heads when their name is called.
  • By around 16 months we have no spoken words; perhaps we hear sounds that sound like ‘speech’ but we cannot make out what the sounds are.
  • By about 24 months we see no meaningful two-word combinations that are self-generated by the toddler. We might see some copying of single words.

24 months plus:

  • Our child is not interested in other children or people and seems unaware of others in the same room/play area.
  • Our child prefers to play alone, and dislikes being touched, held or cuddled.
  • He/she does not share an interest or draw attention to their own achievements e.g., ‘daddy look I got a dog’.
  • We can see our child not being aware that others are talking to them.
  • We see very little creative pretend play.
  • In the nursery our child might be rough with other children, pushing, pinching or scratching, biting sometimes; or our child might simply not interact with others and be unable to sit in a circle when asked to.

What sort of speech and language difficulties might we see?

Our child might do any of the following:

  • have no speech at all, but uses body movements to request things, takes adults by the hand
  • repeat the same word or phrase over and over; sometimes straight away after we have said it or sometimes hours later
  • repeat phrases and songs from adverts or videos, nursery rhymes or what dad says every day when he gets back from work etc.
  • copy our way of intonation
  • not understand questions – and respond by repeating the question just asked:
    • adult: Do you want apple? child: do you want apple?
  • not understand directions or only high frequency directions in daily life
  • avoid eye contact or sometimes ‘stares’
  • lack of pointing or other gestures

Common behaviours:

  • Hand flapping
  • Rocking back-and-forth
  • Finger flicking or wriggling/moving
  • Lining up items/toys
  • Wheel spinning, spinning around self
  • Flicking lights on and off, or other switches
  • Running back-and-forth in the room, needing to touch each wall/door
  • Loud screaming when excited
  • Bashing ears when frustrated or excited
  • Atypical postures or walking, tip toeing, can be falling over easily, uncoordinated
  • Can be hyper sensitive to noises, smells, textures, foods, clothing, hair cutting, washing etc.
  • Being rigid and inflexible, needing to stick to routines, unable to transition into new environments
  • Food sensitivity, food avoidance, food phobias

I mentioned this to be a ‘brief’ look at the areas and it is: each topic is looked at very deeply and each area is multi-facetted therefore a diagnosis is rarely arrived at very quickly. We want to make sure we have covered all aspects and have got to know your child very well before coming to conclusions.

Early detection is key, because we want to start helping your child to make progress as quickly as is possible. If you feel /know that your child is delayed in their speech and language development and you would like a professional opinion then please do contact me, I look forward to supporting you. It is important to know at this point, that if your child only has one or two of the above aspects it may mean that your child is simply delayed for reasons other than Autism and if that is the case, we will be able to help you iron out a few areas of need so that your child can go on thriving.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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How do we play with our Gestalt Language Processors?
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How do we play with our Gestalt Language Processors?

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Child-led therapy

When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

Monotropic minds

Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

A few pointers below which help with child-led play:

Introduce a few new toys and see what happens

Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

Rotate toys and don’t offer out too many toys

I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

Some children are not yet ready to play with toys

Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

Copy/Imitation is so important – try getting two identical or similar play items

When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

References:

Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism9(2), 139-156.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Developing Joint Attention
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Developing Joint Attention

Image by Freepik

Joint attention skills what are they and how can we facilitate those?

Most of us want to make friends, connect with others and bond with a friend or be part of a community. To do so we need to develop an important social skill which is: initiating, responding to, and maintaining ‘shared/joint attention’ with another. When we can do this, we are able to focus on the same thing with another person or a group of people: music, hobbies, sport, art, books, toys, games or memories: remember when we did x y z…

Many children who struggle with speech and language development are not able to share or hold attention with another person very easily. My latest blog is all about what we can do to help our children develop Joint Attention.

So to re-cap, joint or shared attention happens when one person gets the other’s attention by either words, or gestures like pointing to something and saying ‘OMG look over there!’ – both people look at that same thing.

What does it take to have or develop this skill?

We need to first of all find something of interest that captivates our own attention. This part is usually not difficult for most people or children.

Then, crucially, we need to direct our focus away from what we find interesting, for long enough to get another person’s attention onto the same topic. This could be just seconds or it could be longer if we are very determined and good at embracing others into our experience. But if we are not then it must not take longer than seconds!

Let me give an example: if someone is in the room with me whilst I see something strange out the window, I would take that second to draw their attention to it. However, I might not be bothered to run upstairs and find someone only to show them something odd outside in the road. If I am very bored, I might do! But as I am rarely bored it is unlikely. So, unless someone else is right here with me, they are not going to be part of that particular experience, I would not share it.

Back to our child: if we make it difficult for a child who is not naturally inclined to share an interest then it is not going to happen. We must be ready, and right there for our child to have that fleeting second to look at us before returning to their hobby/interest.

This skill ‘to share a moment’ tends to develop around 12 months of age and starts with a child pointing to things. Prior to that, our child might give us something or come to show us a thing. Joint attention underpins language skills and is strong predictors of later language development (Law et al, 2017).

What are the signs that my child is struggling with Joint Attention?

  • Tunes out or does not respond when I call their name
  • Cannot follow my suggestions for games or toys/play activities
  • Does not point to anything of interest, like a truck passing by, or an aeroplane in the sky
  • Ignores or does not respond to what I say, does not follow instructions, only when he/she wants to

What can I do to help with this?

Here are some ideas you can follow in no particular order – see which one sticks:

  1. Get down to your child’s eye/face level, we call it ‘face to face’. It does not require your child to make eye contact with you but they might just do so more easily if you are ‘just there’ and don’t have to crook their neck to look up at you. When reading a book with your child, instead of sitting behind try sitting opposite him/her.
  2. Mirror play – making funny faces together in a mirror can be fun.
  3. COPY your child: top tip!! Imitate your child’s vocalisations and actions. Even if these are repetitive, just enjoy the ride.
  4. Follow your child and let your child take the lead in the play activity. What does that look like? The adult has no agenda, does not want to teach, to ask questions (see point number 9) does not want to direct or show the child how to ‘do it better/differently’ – instead accept that the child is the boss when it comes to their play and take their lead in how a toy should be played with.
  5. Hold up objects to your face or at eye level so that your child can see your face and the item at the same time.
  6. Be the ‘funniest thing’ in the room; be hugely entertaining, watchable and offer the ‘irresistible invitation’ to look at you or play with you.
  7. Offer PEOPLE TOYS (any toy where another person is needed to have fun) so: wind-up toys, bubbles, anything that needs opening or holding or doing which is tricky for the child to do alone. I always try and hide the buttons that make something ‘go’ so that my child needs to come back to me for ‘more/again’.
  8. Do PEOPLE GAMES – as above really but games that do not need a toy, that need another person to have fun: being swung round, row row the boat, being pushed on a swing etc.
  9. REDUCE ASKING QUESTIONS – this is my favourite top tip!!! Instead of asking lots of questions try and make simple statements/comments on what is happening so there is absolutely no pressure on your child to ‘perform’. Equally, silence is actually golden sometimes! An odd bit of advice from a speech therapist? Try sitting with your child, next to them or opposite and just don’t talk but simply BE… yes easier said than done, I do know this. Turn off your phone (OMG did I just say that!?) yes, please turn it off and just be with your child for a little while, just like a comfy buddy who is just enjoying their company with no agenda. You might be very surprised how your child suddenly seeks you out!

I will write about more ideas on this in my next blog so look out for more play ideas to encourage Joint Attention.

Most important, try and have fun with your child. Think about what is fun for her or him. And make it EASY for your child, remember unless you are ‘right there’ it might not happen so easily.

Happy New Year!

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Are the Gestalts I model easy to mix and match later on?
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Are the Gestalts I model easy to mix and match later on?

Image by bearfotos on Freepik

Here are some examples of great phrases and Gestalts that we could use:

  • Let’s get a banana / Let’s go out / Let’s play lego / Let’s go see daddy
  • That’s nice! / That’s really good! / That’s a green one / That’s a submarine
  • Need more help / Need a wee wee / Need that / Need to run
  • How about a biscuit / How about a cuddle / How about watching tv
  • We love bananas / We love a monkey / We love a cuddle

Why or how could these examples be mixed and matched?

You can see I have given several examples for each, that is how later a child can take one chunk (let’s) and add another (go out) or (need) + (go out).

What about our own grammar? Should we be using grammatical phrases?

In general for NLA 1 (Natural Language Acquisition stage 1) we want to use short phrases and keep them quite generic, something like:

‘Let’s go’ or ‘let’s play’ and pick 2-3 phrases per communicative function (see next point below).

And if we are going to say longer sentences, for example: ‘let’s go and feed the ducks now’, then we should do so with good grammar and really varied intonation. It sometimes helps me to make up a little song/jingle on the spot that has a lot of intonation, more than I would perhaps use just by speaking.

How many varied communicative functions do we cover with our modelling?

We want to model a variety of Gestalts other than just requesting for example. In general, we are looking at our child having one or two Gestalts in the following areas before they are ready to move on into stage 2.

These are the most common ones I see in my practice:

  • Requesting ‘want a banana/biscuit’ ‘Wanna play ball’
  • Transitioning: ‘what now?’ ‘what next?’
  • Ask for help: ‘need help’ ‘help me’ ‘mummy help’
  • Commenting: ‘it’s big’ ‘it’s red’ ‘it’s fast’ ‘too loud’
  • Speak up for self: ‘not that one’ ‘go now’ ‘stop it’

Is the Gestalt I am modelling meaningful to my child?

We don’t use all available Gestalts for every child. It has to be meaningful to the individual and has to match their interests. If our child is a big fan of feeding the ducks in the park then we can think about Gestalts like:

  • I see ducks!
  • They’re over there
  • Let’s feed them?
  • Let’s get some seeds
  • They’re coming!
  • They want food / They wanna eat!
  • That’s a big one
  • It’s so hungry
  • It loves the seeds!
  • No more! All done! Finished! Let’s go home

What is my child actually trying to tell me?

We have to be become word/phrase detectives! Is the phrase/script/Gestalt they are using right now actually meaning what they said or does it mean something else, and if so, what?

Here is an example from my own personal experience in my practice:

The little boy I was working/playing with was building a tall tower with blocks. When it finally fell with a great big bang he said in a sing-song voice ‘ring-a-ring-a roses’ … then he began to collect the blocks again to make a fresh tower. I sat there and thought: why ‘ring-a-ring-a roses’? What does that mean in this context? I then sang the song (silently) to myself with my detective hat on and realised as I came to the end that it finishes with ‘we all fall down’! it was a real AHA!!! moment for me as I saw right there what the meaning of his Gestalt was. He sang the first line of the song to say ‘all fall down!’

So realising this I waited for the next tower to fall, and there it was again, he sang the first line of the song. I replied thus, copying him at first:

‘RING-A-RING-A ROSES – WE ALL FALL DOWN!…

FALL DOWN

WE LOVE IT FALLING DOWN.’

The process to find what we should say is not always straight forward or easy at all, and often we don’t quite know in the moment what our child is trying to say. But we can try and get to know their interests and then gradually we do know more and more what the meaning behind the Gestalt is or could be.

What pronouns should we use?

This can be a tricky one.

We don’t want to use language that uses the pronouns ‘you’ or ‘you’re’. The reason is that our child will likely copy us exactly as we have said it. Therefore, using pronouns ‘you’ and ‘you’re’ will then sound wrong.

Always try to model language that is from the child’s perspective or in other words how they would say it if they could.

Alternatively, you can model using WE or US. For example, if the child is tired, rather than saying ‘you are so tired’ model language from his or her point of view: ‘I’m tired’ or ‘let’s go have a lie down’.

There is so much more to talk about. Stay tuned for a blog on NLA stage 2 coming soon.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Neurodiversity affirming Speech and Language Therapy
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Neurodiversity affirming Speech and Language Therapy

Introduction

I am a neurodiversity affirming therapist and I love and endorse play-based therapy. I use it alongside a strengths-focused approach in all my sessions. Find out why we should use these transformative therapy methodologies in all our work and play with our children.

I always have a range of different toys and activities up my sleeve so that when one toy is no longer interesting, that’s fine. ‘Look here’s a new one, how about we try this one?’ When therapy feels like play, children are more likely to be engaged and attentive, which leads to better outcomes.

By using play as a context for Speech and Language Therapy we can create opportunities for children to use and practise their communication skills in a natural, real-life setting. This helps bridge the gap between the therapy room and everyday life.

Goals and targets

What about goals and targets I hear you say? Of course, as Speech and Language Therapists we always have our goals for any particular child. They can be speech goals (we want Bobbi to produce a ‘k’ sound at the end of words) or communication goals (we want Fatima to ask for something by pointing to it rather than grabbing it). And these goals can be achieved where there is a reciprocation and a positive, playful relationship between the adult and the child. That relationship comes through play and fun.

Play and fun

Play is how a child interacts and learns. If it’s fun, interesting, exciting or pleasurable then that is where the magic happens. And that is what we need to return to repeatedly and then see if we can fold our targets into the activity as we go.

As soon as we expect our child to do something and we try and shape their behaviours towards a certain outcome we no longer ‘play’. We are now in teaching mode, where we direct and where we are ‘in charge’. As a neurodiversity affirming therapist, I believe that all play is valid. We must not get into the trap of thinking that only functional play is valid, that there is only one way to play with that car ramp/puzzle/potato head. Our autistic children often need to play in a particular way to navigate their world and we must not try and stop that.

When we affirm and validate our child’s play and copy their play with enthusiasm and respect then, in my experience, all children regardless where they are on the neurodiversity spectrum will begin to engage with us, copy us, and learn how to communicate effectively about things that matter to them.

Play-based therapy allows therapists to tailor interventions to each child’s unique interests and abilities. This individualised approach increases the likelihood of success and progress.

Strengths-Focused Speech Therapy

Strengths-focused therapy emphasizes a child’s strengths and abilities rather than their deficits. It recognises that every person has unique strengths that can be harnessed to overcome challenges.

Focusing on strengths helps us build a positive self-image. This is especially important for children with communication disorders, as it can boost their confidence and self-esteem.

When we encourage children to play in ways that they enjoy and are good at they feel empowered and more in control of their lives and play. This can lead to increased motivation and a sense of ownership over their progress.

Now, imagine the powerful impact that can be achieved by combining play-based therapy and strengths-focused therapy in speech therapy sessions. This dynamic combination brings out the best of both worlds. It creates a therapeutic environment that is not only effective but also enjoyable for children and their families.

As Speech Therapists we can use the child’s strengths and interests as a foundation for play-based activities. This personalisation not only makes therapy more engaging but also more effective.

An example

Charlie, a 3-year-old with social communication challenges, had a deep interest in anything that spins. We used this strength and interest to create a variety of spinning activities. As he is allowed to engage in his spinners, we can practise lots of speech and language and provide great phrases alongside his interest and activities: Ready steady go! Stop! ‘another one’ ‘the red one’ ‘again again’ ‘I love it’ ‘it’s a spinner’ ‘Charlie loves this toy’ ‘it’s going fast’ ‘it’s so fun’ etc..

Over time Charlie started to copy some of these word models and then used them to create his own little phrases, such as ‘the blue one again’. When this occurred, we felt like celebrating because it had come naturally and appropriately to the situation without any coercion or direction. That is what communication is about! Well done Charlie!

Conclusion

Play-based and strengths-focused speech therapy approaches are powerful tools and by combining these approaches, we create a therapeutic environment that is not only effective but also enjoyable and empowering for our clients.

Contact me if you would like your child to have neurodiversity affirming speech and language therapy.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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AAC Systems and Speech and Language Development
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AAC Systems and Speech and Language Development

Introduction

I see a lot of minimally speaking or non-verbal children in my practice. Some children are autistic and others are severely challenged with motor planning and some are both. Some children are simply delayed in their spoken language for reasons that we don’t quite know yet.

Regardless of the causes, what is always apparent pretty quickly is that apart from the odd gestures or Makaton signs (mainly ‘more” ‘finished’ and “biscuit) we don’t have a robust alternative for speech in place. Instead, what we often have is a child with lots of frustration and tantrums and some behaviours we really don’t want like: hitting, biting, pushing, grabbing and often throwing… There are others, too many to mention, but we don’t enjoy watching our children in these states. And we are often fearful of what might happen next if we don’t find a way to calm our child.

Fear not

In my work, before I get to offer an alternative means of communication, I often have to work with a fair amount of resistance on the parents’ side as parents tend to feel that allowing such a system into their lives will prevent their child from speaking. They fear that their child will so enjoy pressing those buttons that they will become lazy and not talk at all.

I totally get it!

Parents often feel overwhelmed by the task of getting their own heads round how to use AAC, either in paper form or a computerised system. This can be a great turn-off for lots of people who feel they are not very “techy” – like myself actually! Indeed, it is true to say that I resisted operating in this field for a long time as I didn’t feel able to navigate electronic devices. But fear not. Truly, most systems are very user-friendly. The support is great. And I have managed to become quite proficient in one or two of these systems, through using it daily. It really is as simple as that.

Alternative and Augmentative Communication (AAC)

There is plenty of research on the efficacy of Alternative and Augmentative Communication (AAC). It is now very well understood and proven that, once we introduce our child to a good, attractive way of communicating that they can actually do, in time children who can speak will speak. Speaking is more effective than any AAC system. It is more versatile, more fun, and when human beings have discovered how to speak, most will do so in favour of any other system.

Many children and adults, for many reasons, were never going to speak an awful lot, or with great difficulty. Or they were not going to like to speak. Or they were going to like to speak some times but not other times… And for all those people an AAC system is invaluable and a wonderful resource.

Neuro-diversity affirming means that we do not impose one system of communication on our children (speaking with our mouth) only because it is the one we are using and most people we know too.

Of course, we want the best for our children, and we want them to have the easiest and most straight forward existence on Earth. Of course we do. Speaking with our mouth does help with that. But we must come to understand that not all children and people feel like that and they struggle to use their mouth for talking.

Personal experience

I have difficulties understanding this myself, I will be very honest here. And I will say that – shoot me down in flames SLT fraternity – but I am learning to accept that using an AAC system proficiently is a very good alternative for when speech is not coming. I am learning to accept that some people are perfectly able to speak, and might do so but not always and only when conditions are right. I came into the profession as a speech therapist with the idea that I would help anybody that came to me to speak with their mouth. But I have changed my stance on that and now am happy to help anybody that comes to me to communicate most effectively with whatever works for them. I will always try for speech if I can … Just because it’s easiest!

Acceptance

Now I will equally celebrate a child pointing to a symbol or making a sign for something. It is a fantastic moment when it happens for the parents and me and the child! And we can always hope for more speech to come as we go. Nothing wrong with our aspirations, is there?

The basic premise is this: accept any mode of communication as valid, as long as your communication partner understands what it means. Don’t require individuals to repeat themselves in another modality. Do model the response in the modality you are trying to teach. So, a child can point to a symbol and I will respond with speaking (with my mouth) but I will also respond by pointing to a symbol because that way I am signalling that both are ok and that I have understood and am encouraging the person to say some more.

Here is some research;

Binger, C., Berens, J., Kent-Walsh, J., & Taylor, S. (2008) The effects of aided AAC interventions on AAC use, speech and symbolic gestures. Seminars in Speech and Language, 29, 101-111.

Sennott, S.C., Light, J., & McNaughton, D. (2016). AAC modelling intervention research review. Research and Practice for Persons with Severe Disabilities, 41, 101–15.

Dada, S., & Alant, E. (2009). The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech. American Journal of Speech-Language Pathology, 18, 50–64.

Contact me if you would like your child to have neurodiversity affirming speech and language therapy.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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