Voice therapy for transgender individuals

By Speech and Language therapist Wai Seng Thong

Finding your authentic voice

While I was living and travelling around in East Asia, I met a variety of gender diverse people and I was astonished to hear that most of the Asian countries had no integrated care pathway in their health services for trans individuals. Trans people are a minority group in most societies who are facing severe discrimination. Their needs have been poorly understood, especially in East Asia.

Growing up, I had a couple of transgender friends and I saw them struggling, undergoing both physical and emotional stresses, making me constantly worried for them and wishing that I could help them through the crazy roller coaster ride of transitioning and struggling to find their authentic voice. I could not imagine how hard this must have been for them to confront this, while also having to face a lack of support from their families and prejudice from people in their communities. Becoming skilled at supporting trans people to find their true authentic voice became a goal in my career as a speech and language therapist.

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Assessment

As a trans person, assessment of your voice, carried out by a speech and language therapist, will highlight which areas need to be focused on in voice therapy. You may already be aware of changes in your voice. The aim of therapy is to work towards a voice that is compatible with your chosen gender while bearing in mind the physical limitations of the vocal tract.

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Therapy for Transmen (Female to Male)

One of the effects of testosterone is to deepen the voice. This deepening is a direct result of the vocal cords increasing in bulk. During the early stages of hormone treatment, the voice may be unpredictable and the muscles around the vocal cords will feel the strain. Voice therapy is therefore important to help achieve a smooth transition from the female to male pitch.

Therapy for Transwomen (Male to Female)

Oestrogen treatment has no significant impact on the voice as once a person who was born male has gone through puberty, the larynx will have lowered in the neck and increased in size, otherwise known as our voices ‘breaking’. Likewise, the testosterone that influences other bodily changes during male puberty also thickens the vocal cords which makes the voice sound deeper. This cannot be reversed with oestrogen treatment after a person has gone through puberty.

Although there are many challenges surrounding voice modification from male to female, with the right support and guidance from a speech and language therapist, any issues with the voice can be reduced and corrected.

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I have found it to be very rewarding to work with transgender individuals in helping them to find a voice that matches the true them. Changes in voice can be achieved through specialist vocal exercises carried out under the guidance of your speech and language therapist. There are many aspects of the human voice that make listeners perceive it as either masculine or feminine.

These include:

  • Articulation patterns: the way we say certain sounds.

  • Intonation patterns: the ‘tune’ of our speech i.e. the ups and downs.

  • Volume: loudness or quietness of our voice.

  • Resonance: the sound quality of the voice and how it is filtered using our speech producing mechanisms in the face and other parts of the body.

  • Pitch: how high or low the voice is.

  • Communication aspects: timing and non-verbal skills e.g. eye contact, gesture etc.

A speech and language therapist will be able to support you by giving you a good understanding of how to look after your voice to achieve the most positive results and help you to understand how your voice works. Knowledge is power and these learnings should help you understand the rationales behind the vocal exercises and how they work. We aim to increase your knowledge, awareness and your expertise in your own voice and how to train it. As speech and language therapists one of our goals is to give you the autonomy, skills and knowledge needed so that you can make informed choices about how to proceed and progress effectively and healthily with your personal exploration of your own unique voice.

If you have been searching for your authentic voice, the voice that you feel most comfortable with, then speech and language therapy could be the right choice for you.

Find out more here https://www.magicwordstherapy.co.uk/transgendervoice

Stammering and the Iceberg Beast

By Specialist Speech and Language Therapist Frankie Paterson

I was interested to learn about a proposed new way of thinking about aspects of stammering as a ‘beast’ that can be strengthened or weakened. Dr Rick Arenas thinks of a stammer as an ‘Iceberg Beast’ that can be slain. Rick, associate professor at the University of New Mexico, researches developmental stammering and is himself a person who stammers.

The idea of the Iceberg Beast originates from the iceberg analogy that’s been used to describe stammers since 1970 (J Sheenan).

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The top of the iceberg, that’s visible above the water’s surface, represents stammering behaviours such as repetitions of sounds, words or syllables. This is the part of a stammer that is visible for others to see. The part of the iceberg that is submerged under the water is vastly bigger than top part. This underwater part represents the underlying aspects of a person’s stammer that tend to be invisible to others. These include anxiety about speaking, avoidance of speaking or of situations, emotions about speaking and stammering and beliefs about yourself and your place in the world as a result of the stammer.

Although Dr Arenas thinks this iceberg analogy is effective in portraying what being a person who stammers is really like, he has built on this iceberg idea using his own experiences as someone with a stammer and experiences that other people with stammers have shared with him. Dr Arenas has observed that for a person who stammers, the unseen part of the iceberg can be like a living entity that has the power to hold them back from living their life as they’d like to, and that it can grow, shrink and change over time. He has come to identify these undelying parts of his stammer as the Iceberg Beast, that can feed on certain types of things that give it fuel to grow and get stronger. At the same time, there are things that he can do that he knows will weaken and shrink his Iceberg Beast.

Rick explains “the beast is a cohesive collection of beliefs about stuttering that we allow to negatively impact how we live our lives”. Rick believes that as a person who stammers there are specific choices you can make that will make your iceberg beast either grow or get smaller. These choices are not ones you are stuck with and are destined to make forever. You can decide to make different choices.

What types of things allow the beast to grow?

· Not talking about your stammer with others or being open about it.

· Avoidance. Of words, situations, thoughts or truths about yourself and your stammer.

· Not accepting that you have a stammer.

· Being in denial about the stammer as being something that affects you or how much it affects you.

Rick believes that negative thoughts and feelings about stammering that are harboured for a long time and not talked about openly can ultimately transform into core negative beliefs about yourself and your stammer that your iceberg beast loves to feed upon, helping it to grow. For example, believing that you will always be too slow to get your words out, that people will always get impatient and bored when you try to talk or that you are weak or faulty because of your stammer.

Weapons Against the Beast

Rick lists ‘weapons’ that people who stammer can use to weaken and shrink the iceberg beast and so reduce the control that the stammer has over them:

· Daring to be open and vulnerable about your stammer.

· Allowing yourself to stammer openly and freely.

· Being honest with yourself about the impact the stammer has had on the way you’ve chosen to live your life.

· Self-Acceptance. Accepting all parts of your identity, including that you are a person who stammers.

· Authenticity with yourself and others.

· Talking openly with others about your stammer and thoughts, feelings and beliefs surrounding it.

Dr Rick suggests that useful questions to ask yourself are:

· What would you ideally be doing in your life that you currently are not doing because of the stammer?

· What do you avoid because of the stammer?

· In what ways is this actually impacting on how you live your life?

Dr Arenas believes that real lasting change comes from an exploration of your attitudes and beliefs about the stammer as opposed to focusing on the stammering behaviours themselves. He emphasises the fact that it is your beliefs and reactions to your stutter rather than the stuttering behaviours themselves that negatively affect your life. This echoes an idea from the stoic philosopher Epictetus that I have personally found invaluable in my own quest to change negative thoughts and the beliefs that underlie them. Epictetus stated that “Men are disturbed not by things, but by the views which they take of them.” To bring this back to stammering, it could be said that the act of repeating words is not the cause of your pain as a person who stammers, the root cause of pain are the negative beliefs you hold , e.g. that stammering somehow makes you a lesser person or that other people seeing you stammer will make them dislike you or think you are weak.

Being brave enough to be vulnerable

The qualitative research professor Bréne Brown pioneered the idea of vulnerability being a powerful act that can be immensely healing and galvanising in her viral TED TALK . So what’s vulnerability all about for people who stammer?

· Daring to be truthful with yourself and others about your stammer.

· Being brave enough to show things to others you’d really rather hide from them because you are ashamed, namely openly stammering.

· Daring to really look inward at yourself and to share those observations with others.


Unicorn or Beast?

I think this idea of imagining the internalised part of a stammer as a fluid entity that can increase or decrease in power depending on choices within your control could be incredibly liberating for many people who stammer. Giving limiting core beliefs an identity, so that you can put them under the microscope can be an empowering and healing exercise.

This is very much in the spirit of an exploratory assessment I often use where the client is asked to draw their stammer. The results are of course unique to each person and can be hugely valuable in understanding a client’s relationship with their stammer.

I think it’s important to recognise that each person’s core beliefs about their own stammering will be unique to them and so the identity they give them will be unique as well. For one person their internal stammer might well be visualised as a beast to be slain. But someone else might see theirs quite differently, for example as a majestic but troubled and misunderstood unicorn, to be tamed and calmed! Warlike imagery of using weapons to destroy a beast could be negative and unhelpful for some people who stammer. I wonder if for some people, attaching a more neutral image to their stammer could be somehow helpful in reducing the negative hold it might have over their lives.

If you want to hear more from Dr Arenas he is interviewed about his Iceberg Beast theory on the excellent podcast Stutter Talk.

What have Cleopatra and children with listening difficulties got in common?

by Wai Seng Thong (Speech and Language Therapist)

 

Attention and listening – the foundation of communication

When I think about communication, I always imagine the Egyptian pyramids which, like communication skills, need to be built on a solid foundation. Also, both the pyramids and communication are really amazing things! For communication skills to develop, the solid foundation you need is attention and listening skills and just like those builders of old, if you are not listening or paying attention things can go awry (Check out the pyramid of Sneferu, it went awry big style!)

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What are attention and listening skills all about?

‘Attention and listening skills’, is a concept that we as speech and language therapists talk about regularly. So I decided for this blog, I will talk about this foundation of the communication pyramid (and no you don’t need to be Cleopatra to make sense of it!) 

Often I hear parents and teachers use commands such as ‘Sit down!’, ‘Stop!’, ‘No!’, ‘Don’t do that!’ when children are not listening and running around like headless chickens. This can be during meal times at home or even in the classroom during reading lessons. We all know how daunting it can be when children don’t listen. This can be so stressful for parents and teachers. It can even cause emotional tensions within families. Well let me tell you this, if you struggle with children who don’t listen; you are not alone.

Does my child have problems with attention and listening?

Have a think about these questions:

·         Can your child sit still?

·         Can they keep their hands still e.g. without fiddling?

·         Does your child look at the teacher or at you when you are talking?

·         Can they concentrate when there is a lot of background noise like TV or music?

·         Can they repeat an instruction back to you?

·         Can they sound out words?

·         Can they remember long words?

·         Do they seem not settle with one activity, but tend to flit from task to task or toy to toy?

·         Does it often look like they are tuning out?

 

If you have answered ‘yes’ to any of the questions above, your child may have difficulties with their attention and listening skills.

 

You may be wondering why are these skills so vital? Or do we really need this skill nowadays as humans? To answer these questions lets go back to the desert in Egypt. Imagine the builder wasn’t paying attention or listening and cut the first stone for the foundations of the pyramid to the wrong size. This would obviously be disastrous. Difficulties with attention and listening can have an impact on all areas of learning; if a child is not able to listen and pay attention, they will find it difficult to process and then utilise important information in lessons when it is given to them. And then success in their classroom learning will be very hard to achieve.

How to assess?

 

Based on Reynell’s research there are six levels of typical development of attention and listening, these levels may be used to assess and understand the child’s development of attention and listening skills in relation to the developmental norms. Remember; there is a huge variation on what is considered ‘normal’ and I would urge people to question whether the term ‘normal’ is really fair or useful anyway? Levels like these are useful for the most part as they help us to see a sequence of levels of attention and listening development. For example, if a child is at a particular level, these levels help us by telling us what that child needs to be able to do next, to push on forward with their skill development and to reach the next level. These levels are:

 

Level 1 (typically birth to 1 year): Child’s attention is fleeting, shifting from one object, person, or event to another. The child will get distracted immediately by any new event such as someone walking by.

Level 2 (typically 1 – 2 years): Single channelled attention and the child can concentrate on a concrete task of their own choosing, however, will not tolerate any verbal or visual intervention from an adult.

Level 3 (typically 2 – 3 years): Child’s attention is still single channelled, but the child is not able to shift their attention away from the current task and then go back to the original activity with adult support.

Level 4 (typically 3 – 4 years): The child can alternate his/her full attention (both visual and auditory) between the adult and the task and now does this spontaneously without adult support.

Level 5 (typically 4 – 5 years): Double channelled attention. The child understands verbal instructions related to the task without interrupting the activity to look at the adult. Concentration span can still be short; however, they can cope with group situations.

Level 6 (typically 5 – 6 years): The child’s attention is well established and sustained.

How to support?

Due to the huge importance of attention and listening skills, I am often asked by both parents and teachers about how they can support children to become better at paying attention or listening to them. So I tell them this true story:

One day a good friend of mine shared her super-secret mouth-watering ‘Honey Mustard Chicken’ recipe, something I had tried for years to get to her to share. She really quickly told me all the ingredients, how to cook and prepare the chicken. Once I got home and tried to cook it, I found I had completely forgotten some of the ingredients and was hazy on the method, leading to a somewhat disappointing chicken dinner. However, when I went back grovelling again for the recipe, she told me the recipe step by step with great instructions and even with pictures and videos of her making it (such a kind friend she is). Then I went home and made the dish, following her instructions and step by step guide and as you can imagine it was YUM.

What would you rather do? Attempt to remember a long stream of complex instructions or remember a simple step by step set of instructions, with pictures? You are probably like me and would opt for the second method. Well it’s the same for children following adult instructions as it is for us as adults who are given a recipe or a set of directions to get to a place; too much information and no structure or visual support and we can all fail.

Now I am not saying this is easy. I do realise it’s hard to find ways to keep children focused especially in this busy and fast-paced Netflix and iPad era we now live in. So below I have shared with you my nine easy tips to support your child’s attention and listening skills:

1.       Always call your child’s name to gain attention. Like in a football match a player will call their teammate’s name when they want to pass the ball and get their attention.  

 

2.       Make sure you get your child’s eye contact before pointing to something, giving an instruction or asking a question as this not only shows them the good behaviour of eye contact but also helps to keep them focused.

 

3.       We sometimes forget children are smaller than us, so crouch down and get down on your child’s eye level to make sure they can focus on you.

 

4.       No one can focus on anything for too long. We as adults have our limits as well. We all need breaks from having to concentrate. So break times are important! This needs to be negotiated breaks with the child, for example giving 5 minutes’ free time once they have achieved a certain amount or focused on reading a book with you.

 

5.       Praise! Everyone loves praise so give specific and positive feedback to the child about their listening skills with phrases such as ‘Thank you for looking at me’, ‘Well done for waiting your turn.’  Sticker rewards are an amazing and cheap incentive to help children to be motivated for good listening. I have been reliably told smiley face stickers are their favourite (so a group of my preschool children told me!).

 

6.       In this manic world of noise and distraction try and create a quiet environment by reducing background noise such as TV before trying to get your child to listen to you.

7.       If a child looks confused or you’re not sure they understood what you have said to them, encourage ‘active listening’ by asking if they have understood or listened. You can help children use this as a strategy to compensate for their difficulties with attention and listening.

 

8.       Most vitally, like with my friend telling me the recipe, break longer instructions into short steps and leave plenty of time for children to process the information. Giving visual support to what you are saying is also highly useful.

 

9.       As adults, talking about things we are interested in with our friends means that  conversations flow. So when you’re talking to a child try to follow the child’s lead by talking to them about what they’re interested in or focused on. They will be more focused on the conversation if it’s interesting to them than if it’s not.

If you only remember only two pieces of advice from this blog, let it be these. Firstly: be like Cleopatra and make sure your child’s communication pyramid has a solid foundation. Without this structural base skill of attention and listening, everything else we try to build on it can end up wonky like poor Pharaoh Sneferu who has gone down in history as the Pharaoh who couldn’t build his pyramid straight! Secondly take heart in the knowledge that the Great Pyramid of Giza was not built in a day. It took many years and great patience to build. In the same way, developing a child’s attention and listening skills can take great perseverance and time, so do not worry if you do not get overnight success.

Working memory in school aged children

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By Sonali Dutta, Speech and Language Therapist

 

WORKING MEMORY IN SCHOOL AGED CHILDREN

As a speech and language therapist I come across younger and older children who struggle with classroom-oriented tasks in school. When assessed by specialists, a good proportion of these children are found to have working memory difficulties. Working memory is responsible for retention and manipulation of information. As children get older, the learning-based tasks in school become more structured and complex, demanding high cognitive skills. Therefore, working memory plays a crucial role in determining children’s ability to handle learning challenges effectively. At home or in other social situations outside school, the environment is more play-based and relaxed and so the demands on working memory are likely to be less.

 WHAT IS WORKING MEMORY?

Working memory is one of the key cognitive processes required for effective learning and is often confused with short term memory. Short term memory is related to short-term storage of information. Whereas, according to recent research, working memory is a component of fluid reasoning i.e. ability to effectively identify key information from the task/environment and apply that knowledge. We use our working memory to register, maintain and manipulate information we see (visual) and hear (auditory) making it an integral part in our decision-making ability and behavior. Therefore, we can see how working memory skills can be closely related to achievement and learning in school aged children.

The Wechsler Intelligence Scale for Children (WISC) measures working memory in one of its subtests for measuring intelligence. However, we should bear in mind that although working memory affects how a child learns and performs in tests, it is not a measure of a child’s overall intelligence and that the IQ (Intelligent Quotient) also has non-measurable components which do not correlate to working memory.

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WHAT ARE THE SIGNS OF WORKING MEMORY DIFFICULTIES?

Working memory deficits have been linked to attention difficulties, learning difficulties (e.g. dyscalculia i.e. problems with arithmetic) and language difficulties (e.g. following complex instructions) in children. Children with working memory deficits have difficulty in tasks involving memory demands in retaining and processing specific or structured information. Therefore, subjects such as maths, reading and science may be particularly difficult for these children. Attention, auditory and visual perception and concentration are required for successful processing of information.

The article ‘Working memory in the classroom’ by psychology professor Susan E Garthercole highlights a study where the teachers described children with working memory problems as having attentional problems. This shows that the underlying working memory issues in children can be masked as attentional problems and are likely to remain unidentified and unaddressed. The article further mentions that ‘zoning out’ or ‘mind-wandering’ are common behaviours in children with low working memory capacity when performing a highly demanding cognitive task as they cannot cope with the information overload and fail to complete the task.

Children with working memory difficulties may show the following signs:

·         Struggles to follow complex verbal instructions in a classroom.

·         Has problems in the area of maths, reading (comprehension) and science.

·         Takes longer than peers to complete tasks or does not completing tasks.

·         Has attentional difficulties.

·         Gives delayed responses to complex questions/instructions.

·         Provides non-specific answers.

·         Comes across as being disorganized

·         Comes across as being forgetful.

 

WHAT YOU CAN DO TO HELP

Speech and language therapists or educational psychologists can assess children’s working memory using formal or informal assessments involving specific recall/repetition tasks e.g. digit span (backwards and forwards repetition), picture span, letter/number sequencing etc. It is important to share with the child that they will have to work harder than most children to attend and concentrate in classroom tasks.

In our practice as speech and language therapists we always find that using visuals in  learning helps children retain and process information better. Being a mum with the knowledge of a speech and language therapist I know that hands on practical input and visuals helps my kids learn better. Recently I have used the hot kettle in my kitchen, a metal plate with ice and hand drawn diagrams to demonstrate the evaporation-condensation-precipitation to my 9-year-old daughter who was struggling to understand the water-cycle taught in school. She then went on to make her own illustration of the water-cycle and could not wait to show it to her teacher.

The following are some of the strategies teachers and parents can use to help children with working memory difficulties:

·         Eliminate distractions as much as possible during tasks (e.g. remove background noise, e.g. music, TV)

·         Gain the attention of the child by establishing eye contact with them.

·         Prepare the child for the task beforehand (e.g. provide an outline of what is going to be taught in the lesson). This will help information to go from short-term memory to long-term memory.

·         Provide clear and simple instructions.

·         Break down tasks and instructions into small chunks (not more than two-part instructions at a time).

·         Give the child the opportunity to rehearse or record the instruction (e.g. writing down the instruction).

·         Ask them to repeat the instruction to check if they understood.

·         Encourage the child to ask for repetition if they have not understood.

·         Encourage your child to keep notes, make outlines and use other brief reminders.

·         Encourage good organizational skills by using folders and dividers to keep work easily accessible and in order.

·         In school, providing notes and handouts will be useful when a child struggles to copy due to visual memory difficulties.

·         Visuals will help them understand and retain information better (e.g. visual timetable, flowcharts, diagrams, pictures, illustrations, videos).

A sensory approach to learning involving practical input and visuals will consolidate retention and learning (e.g. visual timetable, flowcharts, diagrams, pictures, illustrations, videos, demonstrations, hands on practical tasks).

My final week in Kisumu with Yellow House

By Catherine Clancy, Speech and Language Therapist

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Unfortunately, I fell ill at the beginning of this week and it took me some time to get back to my usual self. However, I was able to attend a Communication Camp that had been organised by Yellow House to support parents of children with Cerebral Palsy. This post will be focused on the content of the camp and how Yellow House are raising awareness of cerebral palsy and empowering parents to support their children.


On the left is Florence and the right is Duncan (with Gregory translating), who explained what communication is and ways in which children with cerebral palsy can successfully express themselves when speech is unclear or not present. The communication house is a lovely way to understand the foundations that need to be put in place before you can expect a child to understand spoken language, and then begin to express themselves using gestures and speech.

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There was a specialist talk from an Occupational Therapist who discussed ways parents can support their child’s fine and gross motor skills through daily exercises. Here, John is demonstrating how to support a child’s ability to stand with support.

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Here are some of the toys that the parents made for their children using those materials that are easily accessible to them – a very creative way of recycling waste into something kids can enjoy!

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Whilst the parents were busy attending the talks within the camp, the children were taken into a separate room where they had the opportunity to play, sing and dance – it was a lot of fun and it was lovely to see the supporting adults interacting so freely and easily with the children – the children were in their element!

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After the camp and on my final day, I said bye to a client and his mother who has been supported through the use of Alternative and Augmentative Communication (AAC). A symptom of cerebral palsy for this client is stiff muscles and exaggerated reflexes (spasticity). Unfortunately, this means spoken language is extremely difficult for this boy and direct access to a communication board (e.g. pointing to a picture) is not possible. For this reason, eye gaze (looking at the picture) has allowed this client to communicate a preference when given a choice. This has given the mother a new way to communicate with her son and the joy that this brings to the both of them is wonderful to see!

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My time working with Yellow House has been eye-opening, rewarding and enjoyable. I have met a team of people who are raising awareness of speech, language and communication needs in Western Kenya and are working hard to support children and their families. The stigma around disabilities is still very much present and during the camp many mothers expressed their sadness around the fact that friendships and relationships had ended simply because they had a child with a communication disability. However, seeing these parents come together and pro-actively learn about their child’s condition and how to best support them was very inspirational, which is heightened by the fact that these families are doing their best to integrate their children in their communities to reduce social stigma and normalise their child’s differences.

Goodbye Kisimu!

Goodbye Kisimu!

It has been lovely to see parents and families so invested in supporting their children.

By Catherine Clancy, Speech and Language Therapist

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Week 3.

29.07.19: On Monday I spent the day at Russia working with the team to complete a triage. This is to support the management of new referrals who are seeking support for their child. Here, I completed case history questionnaires to find out the child’s strengths and difficulties, and as a team we discussed how to prioritise the new referrals seen. There are many people seeking support from Yellow House which can unfortunately mean long waiting times for clients to be seen. However, the triage gave us the opportunity to meet face-to-face with families and offer advice.

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01.08.19: It’s August already! On Thursday I continue to see clients for their weekly therapy sessions. Above are some of the resources I made with the team to help children express their wants/needs and interests if they are finding spoken language difficult. When lunch time came around I thought I would try something new and ordered the local vegetables with chapati and beans – YUM!

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30.07.19: On this day I continued to see clients for their weekly therapy sessions. The picture above shows a mother supporting her child through parent-child interaction strategies that aim to promote language development. The mother was focusing on following her child’s lead and using 1-2 key words to comment on her play. Videoing was used as a therapeutic tool to empower the mother to continue using those strategies that she used positively to support her child.

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31.07.19: How was it Wednesday already?! (the weeks fly by!). I travelled to the EARC centre and continued seeing clients for their weekly therapy sessions. The photographs above show parents interacting with their children and supporting the use of low-tech augmentative communication. For these children, they were unable to communicate successfully using only speech and therefore a total communication approach has been adopted where we are using speech, gestures, key signs and a communication board to help them express their wants/needs/interests etc. Parental education is fundamental to the success of therapy as parents have to feel invested and motivated to use the strategies advised by us in order for therapy to have positive outcomes. Fortunately, both parents are open to learning to ways to communicate with their children and they are now aware that the belief ‘signing/pictures with stop my child from talking’ is only a myth!!

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This week has been empowering and also eye-opening. It has been lovely to see parents and families so invested in supporting their children as ultimately, they are the experts on their child and have the opportunity to make the biggest impact - I have found videoing a great way of supporting this! However, the policies and procedures within the care system are very different to those we experience in the U.K. and it has required me to adapt a very flexible way of working to continue supporting children with the limited access to resources and early interventions.

My second week working for Yellow House

By Catherine Clancy, Speech and Language Therapist

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19.07.19: On Friday I said goodbye to Maggie, one of the volunteers who has spent 10-weeks working with Yellow House Health and Outreach Services as a Speech and Language Therapy student from Torono University. It is great when students complete their clinical placements with Yellow House as it is a fantastic opportunity for clinical development, not only for the students but for the team themselves.

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23.07.19: David (one of the Senior Speech and Language Therapists employed by Yellow House) and I spent the day working in the Speech and Language Therapy clinics situated within Russia, a hospital in Kisumu which is government funded. Here, I was working with children and their parents with a focus on augmentative and alternative communication (AAC). This is about supporting children and their families to implement other forms of communication which is building on the child’s strength. An example might be using key word signing alongside speech as well as supporting the child to communicate through symbols on a communication board. Parent education plays a critical role here as it is vital for parents to be invested in the therapy for it to prove beneficial for the child!

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The team work alongside other professionals in the hospital including occupational therapists who support patients in their own clinic (see picture above).

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24.07.19: I travelled from Kisumu to the EARC (assessment and resource) centre on a matatu (local mini bus) which takes around 45 minutes. Here, I saw more clients for therapy, again focusing on the use of AAC. I incorporated the use of videoing with parents to support their interactions with the children and it was lovely to see parents getting down on the floor and supporting their child in the best way they knew how. After a busy morning, Duncan (one of the Speech and Language Therapists employed by Yellow House) and I enjoyed a local lunch of chapati, skumowiki (green vegetables) and green grams (lentils) – it was delicious!

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26.07.19: After another busy day supporting clients from Russia, I went back to the office and caught up on paperwork and resource making. This is the office for Yellow House and where the team carryout all the administrative duties, including planning for communication camps – this is when they invite children and their families to a 2-day training camp where they learn all about different diagnoses, the impact on communication and how to support their child using a total communication approach.

My second week on working with Yellow House as a speech and language therapist has really allowed me to get ‘stuck in’ and see clients and their families for therapy. However, it has been essential for me to collaborate with the therapists working for Yellow House to support their clinical development and to ensure the interventions I am suggesting are realistic and functional for this setting. It has been great to learn from the team working here and I hope that I have supported them to feel more confident using AAC within their own practice!

My first week in Kisumu, Kenya

By Catherine Clancy, Speech & Language Therapist

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14.07.19: Just before I flew out to Kisumu! 

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23.07.19: My first day! I visited Russia, the hospital in Kisumu where Yellow House support clients with speech, language and communication difficulties. This is where I had a lunch of chapati and cooked greens during my lunch-break.  

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24.07.19 The Educational Assessment & Resource Centre (EARC) in Vihiga, a 45-minute journey from Kisumu on a Matatu. Here, I supported assessment for new referrals to the service. 

I have had a busy but very eye-opening and rewarding first week with Yellow House! It was lovely to hear from families about how the use of Alternative and Augmentative Communication (AAC) has given them a new way to successfully communicate with their child. Recently, a client with cerebral palsy was taught to communicate using eye gaze with a symbol communication board and the mother has been overjoyed with how this has enabled her to talk with her son which for the past 8 years has not been possible. This mother is very proactive and supportive of her son and does her best to raise the awareness and acceptability of disability in her local community by ensuring her son is treated with respect, compassion and integrity. 

WARNING! The following blog will make you sing a song in the supermarket when you see a BUCKET!!!

By Wai Seng Thong (Speech and Language Therapist)

 

What is Attention Autism?

One of the things I love about visiting schools is the expressions of joy on the faces of the children I work with. When they know it is bucket time some children can barely stay sitting down. In case you have never heard about Attention Autism, it’s an intervention designed by Gina Davies, Specialist Speech and Language Therapist, aiming to develop natural and spontaneous communication through the use of visually based and highly motivating activities for children with Autism Spectrum Disorders (ASD).

Attention Autism is one of my favourite activities as it makes learning fun and memorable for children. Before I start, NO you don’t need to be an X Factor level singer, but you do need to be able to hold a tune as this helps the children sing along. You also need to prepared to collect strange and fun toys to make the activity differ from week to week. I tend to use eBay and pound shops to add regularly to my collection.

All you need to do is have fun, as it engages the kids with your activity. If you are engaged, they will be too. It’s all about engagement, fun, motivation and showing them something worth communicating about.

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Benefits of Attention Autism

Attention Autism is a regular part of my week. In the school I work in the children are always desperate to know what is in the bucket and jump up and down trying to look inside (this makes me think of children trying to take a sneaky peak in Santa’s toy bag on Christmas Eve!).

What is fascinating about this programme is that it sparks their curiosity and therefore creates reasons for them to communicate by asking questions, commenting and guessing what might be coming out of that mysterious bucket. From my experience of using this programme, it does not merely work on the children’s attention and listening skills, but also on their language skills (both receptive and expressive language skills). These can be a challenge for children with ASD. The sessions can be tailored to build on their vocabulary knowledge, for example, they can be themed around dinosaurs or superheroes etc.

 

What a session looks like and example activities

A myriad of themed activities can be incorporated into an Attention Autism programme. For example, bucket time can be filled with dinosaur toys (from sensory to wind up dinosaur toys etc).

I start with the song, ‘I’ve got something in my bucket, in my bucket, in my bucket. I’ve got something in my bucket, and I wonder what it is. Let’s look and see!’. The children sing along transfixed on the bucket, wondering what might be inside. Just a warning this song will take over your mind and at times I can hear it when I am mopping the floor or shopping! You then demonstrate the toys one by one and the idea is the kids watch, pay attention and do not touch. Hard to imagine, but it is surprisingly easy to achieve when following the attention autism programme.

The activities ‘Sleeping dinosaurs’ and ‘Roll the dinosaurs’ involve the children pretending to be asleep and rolling each other along the floor and more song singing. There are also more hands-on activities where children make dinosaurs with Play-Doh or arts and craft materials with big googly eyes. My kids love it all!

Useful tips when running an Attention Autism group

Always remember these useful tips when you are running an Attention Autism group:

•       Say less.

•       Use lots of pauses.

•       Exaggerate gestures and facial expressions.

•       Give time for thinking and stay quiet!

•       Show first then add words.

•       Have a clear idea of your objective.

•       Make sure your activity is the most exciting thing in the room! Cover up or remove distractions.

•       Turn disasters into ‘part of the plan’. It doesn’t matter if it doesn’t work out, this is a great way to model ‘uh oh’ and ‘oops’ etc.

 

As Gina Davies says: ‘let’s create an irresistible invitation for learning’. Attention Autism principles can be generalised into curriculum activities, for example, literacy and numeracy to facilitate learning and skills development.

Let’s really think about the activities we plan for kids. Is the activity irresistible? Is our activity worth communicating about? Fun and engaging activities create good memories. Let’s create a shared experience that is memorable and share laughs with our kids to help them learn.

For further information and more ideas on Attention Autism, take a look at these:

Facebook page - Gina Davies Autism Centre

https://www.youtube.com/watch?v=nFYnc4xcZ6k

https://www.youtube.com/watch?v=NMEhkD0W5Z8

 

 

How to survive and flourish in your first year as a speech and language therapist

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By Faye Nugent - Magic Words Level 1 Speech & Language Therapist

Your NQP year is a big learning curve, both clinically and emotionally.  I have come to the end of my NQP year and it’s been a journey!  I have a varied caseload across mainstream schools, general clinic and complex needs clients which I am thoroughly enjoying.

Here are some of the things that have helped me in my NQP year.


You’re not expected to know everything

I remember finishing university feeling the following: I can assess a child very well but what next? What therapy do I do? I had some experience from placement about different types of therapy but there is only so much you can fit in at university.

When I started my NQP role here at Magic Words Therapy I thought I was supposed to know all the assessments, therapy approaches and resources I should be using with all my clients.  Speech and language therapy covers such a wide range of client groups; from dysfluency to ASD to speech sound difficulties and developmental language disorder – the list goes on!  It would be impossible to be an expert in everything.

I have learnt lots different therapy techniques and strategies either from CPD training days, speaking to my colleagues and supervisor and reading up on the different therapy approaches out there.  Working alongside more experienced therapists has also really helped me take the pressure off myself and to realise that speech and language therapists are always learning in their careers and that no therapist knows everything; there is always something to learn!

My confidence has definitely grown through experience.I might not always know the answers, but I am learning the places to look for them and the people to speak to.I am always open with parents and teachers; if I don’t know the answer I will tell them so and I will research it and get back to them about it.It is okay to not know everything.I’m always looking out for ideas and inspiration to make therapy more fun and interactive for the children too – Pinterest, Twinkl and the shop ‘Flying Tiger’ have been life savers for me!

No one knows you’re a Newly Qualified Therapist

Nope, no one knows unless you tell them.  That goes for teachers, parents, SENCOs and other speech and language therapists.  A parent won’t know that it is your first ever initial assessment, and the school SENCO won’t know it is your first MDT meeting, unless you tell them.

In my first few weeks as an NQP, I thought everyone would know this was my first job and that I was inexperienced.  It did feel strange not having a clinical placement tutor with me all the time and having to make clinical decisions on my own.  With time I have become more confident in my clinical knowledge and decision making and now feel like a ‘proper’ speech and language therapist, not a student anymore! 

Everyone has to start somewhere: trust the process.In fact, other speech and language therapists find having NQPs in the team helpful; it’s good having someone on the team with fresh eyes, and recently trained up in the profession.Be confident in what you know, and the skill set you have. Remember you are qualified!

‘A problem shared is a problem halved!’

Being a speech and language therapist is a very busy role and it can become very overwhelming, particularly in your first year.  I have found it so helpful to speak to colleagues and my supervisor.  They’ve helped with advice regarding assessment, therapy and caseload management as well as listening to how I am feeling, both the positives and the challenges. 

Clinical supervision is an essential part of your professional practice, it gives you the chance to discuss your work with someone who is experienced and qualified.  Regular supervision meetings have helped me to develop my clinical knowledge and skill set.  My supervisor has guided me to the appropriate next steps to take with challenging cases or situations.  The meetings also provide the opportunity to reflect on how you are coping and feeling.  I have found that discussing any problems, big or small, has always been helpful.  Sometimes it is just good to get something off your chest!

Supervision sessions are also a chance go through and more importantly sign off your NQP competencies.  It is a big document, but I found it helpful at the beginning of my NQP year to read through each competency and think about how I was going to achieve it and the evidence required.  It meant I had an idea and plan of what I needed to do.

It has also been useful to speak to my NQP colleagues.Most of our questions and queries have been similar so it has been good to support each other on the journey!

‘Have a go!’

I am a kinesthetic learner so after doing some reading I always learn best by just having a go.  I particularly remember feeling very nervous about running my first dysfluency group session; What do I do?  What is this ‘Tortoise Talking’? Will the children know this is my first dysfluency group? 

After I did my first session I felt so much more confident; the children responded well, they had no idea it was my first session.I was able to reflect on what went well and what I could improve ready for the following week.

Be flexible

Things change all the time: fire drills halfway through therapy sessions; ‘Viking day’ at school and the whole school is off timetable, parents not turning up for meetings.  Initially, I found it difficult when plans changed, especially when I was nervous about the session or had taken a long time to plan and prepare resources.  Now, I try to plan ahead and I ask parents their preferred method of communication (face-to-face meetings, emails, phone calls) and find out about events going on at school (sports day, whole school assemblies) etc. 

However, you can’t plan for everything and sometimes you just have to roll with it.For example, doing observations of the client instead of a therapy session on ‘Viking Day’ or using the therapy time to complete client-related work.

Breathe!

It's important to take time and ensure you are getting a good work-life balance.  We are very busy day-to-day in our roles as speech and language therapists and it can be easy for this to spill over into our spare time: thinking “I’ll just finish the notes at home” or finishing a report in the evening.  I try to keep work in the work environment and once I get home to take the time to relax and do things I enjoy.  I feel I am able to do a better job because I have kept a clear distinction between work and home and not running myself into the ground. 

My confidence and clinical expertise have grown with time and experience.I like that in our profession we are always learning and developing.Coming towards the end of my NQP year it has been great to look back and reflect on how far I have come.

What's the effect of screen use on the development of children’s speech, language and communication skills?

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By Frankie Paterson - Specialist Magic Words Speech and Language Therapist

As speech and language therapists we are concerned with anything that could be affecting how children's speech, language and communication skills develop. We have been wondering about how lots of screen time is affecting children. We are keen to look into this issue as, with millions of children now using tablets for several hours a day from as young as 18 months old, we worry that this could be having an affect on how many of their early cognitive skills are developing, including language development and the development of their attention and listening skills.


I recently listened to a programme on Radio 4 called ‘Why Can’t Our Children Talk?’.

I was very interested to hear on this programme that many teachers across the UK are voicing concerns about screen time. This echoes the concerns that I am hearing from the teachers I work with in schools in Luton. Many of the teachers who are voicing concerns have been working with children of 4 or 5 years old for many years and they are struck by recent marked differences in how children of 4 or 5 are presenting in terms of their language and attention skills.  Here's what one teacher had to say on Radio 4 about her own experience with children and screens:

 “Our children.. over the past 3 or 4 years, if you’ve got the interactive whiteboard on in the classroom they find it impossible to do anything apart from look at the screen… If there’s you to look at as the teacher.. telling them a story or there’s a screen, even if there’s nothing on it, they’re naturally pulled to look at the screen…They.. struggle with making eye contact because often when they’ve been hearing nursery rhymes.. it’s obviously been on a tablet where it’s been a.. brightly coloured screen they’ve been looking at rather than looking at somebody’s face”- Lorraine Boothe, Reception class teacher and assistant head at Chaul Lane Infant School. 

The Radio 4 programme featured a study that has recently been carried out on 900 toddlers in Canada. A clear link was found between language development and screen time in children under 2. It was conducted by Professor Catherine Birkin, a paediatrician in Toronto. She said:

“Children who used mobile devices.. had a higher risk of an expressive language problem at 18 months of age”

Apart from this one study in Canada there is no other evidence as yet about whether screen time is adversely affecting children's development or not. Much more clinical research needs to be conducted into this question before firm conclusions can be arrived at. However I think this question is hugely important as it has implications that we need to take seriously as a society

The Benefits of a Fidget Toy

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By Danielle Allen - Service Administrator

In today’s modern age, many of us with children do find ourselves letting them watch YouTube from time to time. The videos more often than not, consist of unboxing of toys, some of which are fidget spinners. I could never understand why my children found these entertaining which is why I took it upon myself to research these types of toys. The more research I did either online or speaking to my son’s nursery teacher, I came to the positive conclusion that there is a benefit to the use of these toys.


My son has struggled with poor attention and listening which can cause disruption in his nursery activities. With him moving into reception this year, I decided to further my research into fidget sensory toys to see if they could be of use for my son and other children who struggle with similar behavioural issues. I found that not only do they help with attention and listening but also ASD, anxiety and many more. From fidget spinners to fidget cubes, putty to taggy blankets, sensory balls to squishies. The list is endless on the variety of sensory toys available which allow families the ability to do trial and error for which one works best for your child.

A recent purchase for my son was a sensory fidget bag with a variety of toys inside. I actually found this from a fantastic online store on Facebook called Once Upon A Time. I showed my colleagues who have now purchased these for their children they see in clinic and at school. There has been great feedback from both the children and parents.

So, what exactly is a fidget toy and how do they help? Fidget sensory toys are tools which can help boost attention through the use of the toy which could allow him or her to focus more at school or at home. As I had mentioned before, there are a variety of different toys available from the way they look, to the way they feel, and in the general use. The fidget spinner for example, has a central disc on ball bearings with extended wings allowing you to spin the device. Or there is the fidget cube which has sensory tools on each face of the cube such as, a roller ball or a spring action button.

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Overall, there are numerous benefits using these toys to address certain struggles a child faces at school or at home. The biggest is increasing the concentration and focus of a child. Studies have shown that using the left and right hemispheres of the brain is required for learning and carrying out task. Fidget toys have been proven to help these as movement and sensory input are essential and allow this to happen. Case studies have assisted this research in confirming that increased focus in a learning setting was achieved in a student who was using a stress ball.

Another huge benefit is using these toys to reduce anxiety. Fidget toys, although not a cure, can have a calming effect of those who suffer with anxiety or sensory issues, such as ADHD and ASD. It can help relieve the symptoms the user gets notably in the hands and fingers, they keep their hands busy. Some parents and teachers have raised concerns of it becoming more of a distraction however with children with ADHD or ASD for example, a situation can become overwhelming causing more disruption and potential harm. Fidget toys allow the child to fidget which can be a minor disruption at first, but can have a vast amount of benefits such as a soothing or calming effect. This can then develop to increased concentration and focus which boosts the productivity and learning for the child and classmates.

From a personal perspective, I have found fidget sensory toys highly beneficial for my son and am hoping he will continue to improve when he starts reception. It is a working progress which I will take at his pace as after all, it is going to be beneficial for him growing and building up his skills with attention and listening. I am looking forward to trying the variety of fidget toys we have and testing which ones help him focus more.

Top 10 Language Apps

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By Faye Nugent, - Magic Words Level 1 Speech & Language Therapist

There is a huge variety of apps available to support a child’s language development.  Here is a selection of 10 of the top apps:


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SPLINGO LANGUAGE UNIVERSE

Splingo Language Universe is an app that helps develop a child’s comprehension (understanding of language) by exploring the number of keywords a child can understand in a sentence.  It is an entertaining and motivating game that helps develop your child’s understanding of different aspects of language such as verbs, nouns, prepositions and adjectives. 

The app can be used with children at a developmental level of 18 months to a developmental level of 4 years and upwards.  It is customisable, so you can adapt the app to your child’s developmental level.  The app builds from single key word (e.g. ‘find the apple’) to more complex four key word instructions (e.g. ‘give the big red apple to the boy’). 

The app is available to download on Google Play (£2.39) and iTunes (£2.99).


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GRAMMAROPOLIS

Grammaropolis helps develop knowledge and understanding of parts of speech.  Each part of speech is explored using a map which includes a variety of games and activities to explain the item.  As the child explores each map their understanding is assessed by quizzes throughout.

The free download offers games and activities for nouns.  Within the app you can buy access to other resources such as; verbs, adjectives, adverbs, pronouns, conjunctions, prepositions, interjections.

The app is suitable for children aged 7-8 years onwards. 

The app is available to download on Google Play (free with option to buy extras) and iTunes (free with option to buy extras).  You can find out more information at: https://grammaropolis.com/


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VERBS NEWS - VIRTUAL SPEECH CENTRE

Verbs News helps support the development of a child’s understanding of different verb tenses (simple present, present continuous, simple past and simple future). 

The app introduces Andrew who is a news presenter, he explains the four verb tenses via an animated video.  There are a variety of options as you can select the words you would like to work on and the type of activity for example auditory bombardment (hearing the accurate model of the verb used in a sentence), fill in the blanks or make up sentences.  For each correct response, the child is awarded with an anchor microphone. At the end of the session, children can take the role of an anchor, record their own news, and watch it in the newsroom.

The app works best with an adult supporting the child as this gives the opportunity to discuss each verb and provide an accurate model if the child has any difficulties.

The app is available to download on iTunes (£9.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/verbs_news


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PRONOUNS WITH SPLINGO

Pronouns with Splingo follows Splingo the speech and language alien helping to teach the understanding and expressive use of a variety of pronouns.  The app is engaging and motivating, after 5 correct responses the player gets to select three items to place in their virtual bedroom. 

The app is fully customisable giving you the option to choose the pronouns you work on, a UK or US voice for instruction and whether the verbal instructions are written down too.

The app is available for download on iTunes (£2.99)


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PREPOSITIONS JOURNEY - VIRTUAL SPEECH CENTRE

Prepositions Journey is a fun and interactive app. With adult support the app can be used to develop your child’s understanding of prepositions, as well as giving them the opportunity to use prepositions to expressively respond to ‘where?’ questions.  The app allows the player to record their responses, replay them and see if they are correct. 

The app can be adapted to the child’s needs as you can select the specific prepositions you would like to work on.  The app creates reports following completion of a game which collates the scores together for each player.

 The app can be downloaded on iTunes (£9.99). You can find out more information at: https://www.virtualspeechcenter.com/app/prepositions_journey_app


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MAGICAL CONCEPTS - VIRTUAL SPEECH CENTRE

The Magical Concepts app follows Mago the Magician as he guides the player through a variety of concepts.  The game is highly motivating and makes ‘drilling’ activities more engaging as the player earns a star for each correct answer.  With enough stars the child is rewarded with a magic show.

You can select from a wide variety of concepts making each game specific to your child and their needs.  The app focuses on the understanding of concepts, however with adult support can be adapted to work on the expressive use of concepts within the game.

The app is available for download on iTunes (£9.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/magical_concepts_app


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SENTENCE WORKOUT - VIRTUAL SPEECH CENTRE

Sentence Workout is a useful app to help support the development of the written form and expressive use of a child’s sentence structures.  It focuses on a variety of sentence types including nouns, pronouns, adjectives and verbs in a variety of sentence types.

The app is flexible to your child’s needs.  You can adjust the target sentences, whether you work on them by saying or writing the sentence, and the number of correct answers required before the reward football game.

The app is suitable for children aged 6 years and older.  It is available for download on iTunes (£12.99).  You can find out more information at: https://www.virtualspeechcenter.com/app/sentence_workout_app


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WH QUESTIONS - SUPER DUPER PUBLICATIONS

The app works on a variety of ‘wh’ questions, it initially offers the ‘who?’ question pack, however within the app you can buy additional resources such as ‘what?’ or ‘why?’ questions etc.  In each question pack you can choose between 4 games to play as a single or multi-player game.  For example, in the multiple-choice game players can either answer the question or select the appropriate question for the answer given.

The app uses bright and fun images and sounds that are engaging.  This is a useful app that can be adapted dependent on your child’s needs.

The app is available to download on iTunes (free with option to buy extras).


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CATEGORIES - I CAN DO APPS

As the name suggests ‘Categories’ focuses on organising information into their appropriate category. A variety of skills can be developed including a child’s vocabulary, understanding, spoken language and problem solving and linking ideas and concepts.  The app offers 5 activities; identifying an image relating to a category with an option of 2 or 3 images to select from, finding another item in a category, finding two images that go together and identifying the ‘odd one out’.

The app uses images of real objects and is simple and easy to use.

It is available for download on iTunes (£4.99).  You can find out more information at: http://www.icandoapps.com/


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WH QUESTIONS WHY? PUZZLE GAME - SPEECH AND LANGUAGE DEVELOPMENT, ONUR TEKIN

This app focuses on understanding and answering ‘why?’ questions which develops a child’s receptive and expressive language skills and problem-solving abilities.  The player can complete a short jigsaw of an image and then answer a ‘why?’ question, for example ‘why is the child’s ice cream melting?’. You can record your answers using the iPad’s microphone and compare these to the answer given.   

This app can be used with children aged 4+ years.  It can also be adjusted to your child’s needs and levels.

It is available for download on iTunes for Free with some In-App Purchases.  You can find out more information at: https://learnwhquestions.com/en/why/

Glue ear. So, you have been told your child has this, now what?

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By Carolyn Fox - Service Lead for Hearing Impairment & Specialist Speech and Language Therapist in Hearing Impairment

What is glue ear?

Glue ear is also known as Otitis Media. If you have heard of these terms before, it is likely that either your child or a child of someone you know has suffered with it.  But what exactly is it, how does it affect your child and how concerned do you need to be? Well in this blog, we will be looking at this sticky subject and providing you with some answers and advice. 

Your ear is a clever little listening device that is made up of three parts; the outer, middle and inner ear. For us to hear sounds, the sound must pass from the outer ear, into the middle and inner ear and it then sends the sound information to the brain for processing. However, in a child with glue ear, the sound has a bit of difficulty passing through. It enters the outer ear but when it gets to the middle ear it meets an obstacle; sticky fluid, hence the name ‘glue ear’. A child with glue ear is therefore unable to ear all the auditory information that they should due to this trespassing substance in the middle ear. 


Glue ear is common in young children 

Glue ear is most common in children between ages 2 and 5, this is also an optimum sound and language learning period! Around 15-20 percent of this age group will suffer from it at some point (Peer, L, 2005). Older children can get it too, although this is less common.

Signs to look out for if you are worried that your child may have glue ear

Knowing what to look out for is very important as glue ear will come and go. This means that children with glue ear will at times have no problems hearing and at other times they will struggle.

Watch out for:

  • Lots of yawning?? Does your child seem more tired these days?

  • Complaints of ear pain. If glue ear is present it may be causing some discomfort. 

  • Is your child waking you up in the night (more than they usually do?)

  • Does your child seem like they always have a cold? Are they breathing through their mouth?

  • Does your child seem to ignore you when you ask them to do something? (More than they usually do?!) Do they generally seem like they are finding it hard to hear?

  • Is your child angrier? Frustrated?

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Will glue ear have an impact on my child’s ability to learn?

All children will respond and behave differently when they have glue ear. There are many ways it can impact upon their ability to stay focused. Look at the list below to get informed and if you notice any of these things, it may be worth getting your child’s ears checked. 

Your child may:

  • Need more repetitions of words and instructions or generally be slow to learn new information.

  • Get confused or mishear information. 

  • Have trouble staying on task or focused at school.

  • Have limited vocabulary knowledge or they may not be learning words at same rate as their peers.

  • Find it hard to join in games or follow the rules of a game.


What can I do to support my child’s hearing?

If you are concerned, the first thing you should do is get a hearing test for your child. From there, there are some things you can do to help your child focus and support their hearing potential.  

  • Talk about what it means to listen. Raise your child’s awareness to this e.g. the importance of facing the person, looking at the speaker, telling an adult when you don’t understand.

  • Obtain your child’s full attention when you are speaking to them

  • Where possible, reduce background noise e.g. mobile phones, television.

  • Talk to your child at their level so they can see your face and lips. This will give them invaluable extra information about the words and sounds that you are saying. 

  • Give your child the time that they need to process what you are saying. If needed, break down your sentences in to chunks. 


If in doubt, check it out

In some cases, the sticky fluid will go away without treatment, but it is best to get your child checked out just in case. 

Speak to your GP and tell them what you have noticed and what you are worried about. There are different ways forward in terms of treatment. Your child may be given antibiotics. If this fails to resolve the sticky issue, then grommets may be offered. These are placed into the ear and will drain out the fluid.

Early identification is always better. In the case of glue ear, the earlier the problem is identified, the sooner your child can be given treatment. Early treatment will decrease any adverse effects on language learning and general development.

For more information and support, contact one of our Magic Words therapists for a chat or take a look at the NCDS website: www.ncds.org.uk

Mummy-hood and Speech and Language Therapy

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By Hannah Heslam - Speech and Language Therapist

As a speech and language therapist and a Mum it can be handy to have all this knowledge about speech and language development. It’s been useful to be able to see where my children are in relation to the developmental milestones I have used so much in my role as a therapist. I felt absolute fascination when each of my little ones finally started talking which was a delight and a worry, as for any Mum. 

When I was 32 weeks pregnant with my second child I became concerned that my baby was not moving. I was encouraged by my other Mummy friends to seek advice, and by the evening I was in the hospital having an emergency C-section.  It was a scary time and I was presented with some challenging prospects for my baby, a beautiful boy.


My Journey

Having had a relatively easy pregnancy with my first little boy I wasn't prepared for or expecting to have my second child born early. It was a difficult time being swept into the delivery room and told by doctors it was going to be a hard journey ahead. He was born weighing 3lbs 4oz and spent just under 4 weeks in intensive and special care.  However, he has just turned 5 years old and is surprising us all the time with how well he is doing, achieving in line with or above expected levels at school and with his happy, cheeky personality. I’m sure he couldn’t have done so well without all the support of our family and friends.

At around 2 ½ years old, despite being able to put words together, his speech was at times difficult to understand. Wanting the best for my son and for him to be able to communicate as effectively as possible with other children, I started to carry out some speech activities through play. This really improved his intelligibility.  At about 3 ½ years old he did still make some sounds by releasing air through his nose instead of his mouth and he received some excellent therapy from a specialist speech and language therapist which resolved this issue.

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"Being a speech and language therapist and a mum, I'm extremely passionate about how early intervention really does work. I've seen the results in children I work with and in my own little one of course"


Some words of advice about speech and language

I feel that my speech and language knowledge has supported me with my own children and I know that not everyone will have this wealth of knowledge.  With Magic Words our goal is to support children with speech, language and communication needs. Below are a few key pieces of advice for you:

Repeat and Expand:

To help with your little one's language development, repeat and expand what they say. This helps to show them how they can build their sentences and to value what they are interested in communicating about e.g. Child: ‘I have car’. Parent: ‘Yes, you have a blue car’

Commenting is great:

As parents we naturally want to ask our child lots of questions to check how they are getting on. A great way to develop language is to reduce the pressure of questions and to model language to our children by asking 1 question to 4 comments. Think of a hand, 1 question (your thumb) to every 4 comments (your fingers). 

Use modelling:

If your child has unclear speech, when they say a word that isn't clear, instead of correcting them, model it back to them so that they can hear a good model of how it should be said. For example, Child: ‘I have a dat’. Parent: ‘Yes, you do have a cat’.  This allows your little one to hear how to say the tricky word but takes away the pressure of having to say it themselves.


If you would like to get in touch for any support with your child’s speech, language & communication development then please contact us.

‘A’ is for ‘Autovocabiography’…

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By Elen Wales - Service Lead for Milton Keynes and Specialist Generalist Speech and Language Therapist, Developing Specialist in Hearing Impairment

Your vocabulary is a product of who you are, where you’re from and what you’ve done. No-one else will have the same vocabulary as you and I think that’s kind of cool. If you imagine all the words you know were written down it would be like your autobiography, your ‘autovocabiography’.


One of my favourite books, being an unashamed speech and language geek, is Dialects of England by Peter Trudgill. He talks about the different words used to mean ‘truce’ by children in games in different parts of the UK, and has a map labelled with which were used where:

‘Truce’: barley, keys, skinch, kings, crosses, exes, cruces, cree, scribs, fainties

Sure enough my Dad used ‘kings’ in Scunthorpe and my Mum ‘skinch/skinchies’ in Sunderland. 

Most children hear about 45 million words by the age of 3. To develop a typical-sized vocabulary, between the ages of 18 months - 6 years, they need to learn about 8 new words a day. And that’s learn. Not just hear, or be exposed to, or say once, but to fully understand and be able to use appropriately - crikey. 

Vocabulary development is affected by:

  • experiences: things we see and do, either in our own lives, or with others

  • memory: ability to remember and retain the word

  • opportunities: to practise and hear the word repeatedly

  • motivation: how important / interesting is learning the word to the child?

  • cognitive abilities: any learning difficulties or cognitive impairments

Research shows a child’s vocabulary is one the best predictors of educational achievement and employment. It’s our job, as parents, teachers, therapists and adults working with these kids, to help them write their own autovocabiography.

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'No one else will have the same vocabulary as you and I think that’s kind of cool.'


So how can we do it, how can we nurture them to be best-sellers? Well, there’s lots of ways and you don’t need a whole load of resources to do it. Firstly, we need to acknowledge that words are more than their spelling. If you want to sound clever you can call it ‘semantics’, but this just translates as ‘word meaning’. The overall goal is to develop a child’s semantic network, or web, of what the words mean and how they link to one another.

Consider the word ‘spoon’. We know that:

  • it has 1 syllable and rhymes with ‘moon’

  • it can be made of metal, plastic and sometimes wood and come in a range of different sizes

  • it is in the same family as the words ‘knife’ and ‘fork’, and that word family is called ‘cutlery’

  • we use a spoon for eating, stirring, measuring and serving

  • it has a handle part and bowl part, and is normally hard and sometimes shiny

  • spoons are often in drawers in kitchens and on tables or in hands in the dining room

  • the word can also be used as a mild insult implying someone is stupid

 Imagine a word like a spider on a web in the brain. When the spider has a strong web, and is linked to lots of different information about the word, if the child forgets a few of these links the spider is safe and web can still hold the spider in the brain. If the spider has a weak web, and is only connected to a few bits of information about the word, then if these few bits are forgotten the web cannot hold the spider and he falls out of the brain:

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To build strong webs we need to approach the word and learning process from lots of different ways, utilise the power of repetition and keep it fun. You can try the following:

  • ‘Word of the Day/Week’: stick it on the fridge as reminder for them and you, see who can use the word the most, maybe keeping a tally on the fridge as you go

  • Read: support the child to read, read to them, get them to track the words as you read them - it’s all good

  • ‘I-spy’: play I-spy but instead of using clues about what letter the word begins with, use information clues, e.g. “I-spy something made from metal…found in the kitchen…we can use to eat with…”

  • Word stickers: It is notoriously hard to get kids to do extra work outside of school, but a bit is better than nothing. I send kids home with stickers on which have a word we have been working on, and if parents only have time to ask the kids why they have a bizarrely large sticker with a random word on, on the way to the car, then it’s a good start.

  • Make it multisensory: turn it into a cheerleading song, e.g. “give me an S…S!...give me a P…P!...” 

  • Word associations: start with a word and the next person needs to name something related and continue around everyone, e.g. ‘spoon - soup - bread - butter - cow - black and white - newspaper - book - paper’. Because everyone’s word webs are linked in different ways, it’s always surprising when someone links something to a word you never would have!

  • Don’t give all the information straight away: cajole them into a conversation with you, e.g. rather than saying “I went to a party at the weekend”, just offer a teaser such as “You’ll never guess where I went at the weekend…”

Lastly - don’t underestimate the capacity of these kids. I’ll never forget the time a 5-year-old boy, with a language delay I might add, used the word ‘googolplex’ in a session with me. It took me a good few seconds to pick myself up off the floor and dig around in my brain for a vague meaning of the word, which I recognised, but would never have remembered to use. I’ve now listed him as co-author of my autovocabiography - I’m hoping it’s going to be a best seller.

Trudgill, P. (2000) Dialects of England, 2nded. Wiley

Social Stories Help Reduce Anxiety in Children with Autism

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By Sarah Kassam-Hirji - Speech and Language Therapist

Social stories are exactly what their name suggests; very short and simple stories that illustrate a particular social scenario, often in picture format. They aim to help increase a child’s understanding of how to behave and what is expected of them in a given social situation. 

Visual strategies are highly effective tools to support language skills, and social stories can provide support to help children who struggle in social situations.  Examples may be using a social story to help a child line up, lose a game or stay in bed through the night.

It is important for a social story to be short and focused to keep the child’s attention. They are frequently used with children on the autistic spectrum to help them understand social cues and reduce anxiety, especially in unfamiliar settings.


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A social story should provide the basics of what will happen in that setting/situation, and how the child should ideally behave.  The idea is to write out exactly what happens and why, how it makes the child feel and the expected response.  Symbols are used to show these language concepts, but for some children it can be useful to have photos of themselves in the situation as well.  

As with all things in life, there will be unexpected variables that a parent/caregiver won’t be able to control for, but the story should provide a basic foundation of support and understanding.  


Key points to remember when writing social stories:

  • target one specific situation at a time

  • keep language simple

  • keep it positive

  • remain consistent

  • Children thrive on repetition and learning takes time

My experience has been that all children with language difficulties benefit and respond really well to the visual cues and prompts that are provided within each story.  We all struggle at times with how to behave in social situations and social stories can help give a child the ability to maintain emotional wellbeing as stress and anxiety are reduced when understanding increases.

A story that I have used time and time again with my children is ‘When I’m Frustrated’. Please note that the word ‘frustrated’ can also be substituted for ‘cross’, ‘upset’ or ‘mad’ – whichever the child will relate to best.   The story helps support understanding of the emotion of anger and has been useful across many social situations.  In general, emotions are difficult to understand and explain, and stories that help target emotions in relation to stressful scenarios can be very beneficial.

This story in particular illustrates the idea that sometimes situations will make us feel upset or angry, but there are different strategies that we can use, such as counting or breathing, that can help regulate our feelings once again. This then helps us return to the social situation and ask for what we need.  It also shows that these feelings pass and that we will feel better soon enough.

As  a wellbeing expert and speech and language therapist, this is a vital story for me to use with children that struggle with maintaining and regulating emotions when social situations become highly stressful for them. I believe stories that help children understand emotions can really impact how much a child continues to be motivated for peer engagement. This can then help develop other key skills such as turn taking and problem solving.

The colour of language! Making language colourful

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By Carolyn Fox - Service Lead for Hearing Impairment & Specialist Speech and Language Therapist in Hearing Impairment

What is colourful semantics?

Speech and Language therapists work with children who find communicating tricky. This may be because they can’t produce some speech sounds, understand social rules for interacting or perhaps they have trouble putting words together to form sentences. Your speech and language therapist will be able to give you information on how to support your child’s language using different strategies. In this blog however, we will look at one therapy approach used by many speech and language therapists, Colourful Semantics (CS), created by Alison Bryan. Have you heard of it? Perhaps you and your speech and language therapist are already using it or some of its principles.

CS uses a colour coding system to highlight words within sentences. Splashing words with a little bit of colour helps children identify them, increases the predictability of what is coming next and makes it more likely that they will, after enough practice, be able to independently make the sentences following the colour coding rules.


Let’s paint the scene for you

Having visual information helps children tune in to what they see as well as what they hear. Using colour gives children an additional hook to pin the language on to while they learn, providing them with the language boost they need. 

Still a bit blurry? Let’s paint a sentence for you!

Carolyn is eating an apple at home.

There are different parts that make up this sentence:

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Why we love colourful semantics

  • Giving your child a structure for supporting their word order can help them express themselves and it will also help when it comes to writing. We love CS because it offers an easy to use way to do this. One colour follows another, so your child can do this themselves once they have learnt the colour coding rule and then you can check together that the words are in the correct order.  Using a sentence strip like the one below can prompt your child to put the pictures in the right order:

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  • This approach to language learning can be used at almost any stage. Your little language learner might just be starting to understand the concept of ‘who’, perhaps they are putting two words together or they may even be constructing more complex sentences. CS provides a flexible approach and can help expand your child’s sentences regardless of where they are on their journey. 

  • You can spend time focusing on the important concepts such as ‘who’, ‘where’ and ‘what’ before you begin putting sentences together. This can be lots of fun and ensures your child has a good grip of these concepts before moving forward. For example, if you are teaching your child ‘who’, take a blank orange (the who colour) sheet of paper and find lots of different pictures of people or animals. You can have fun cutting these out from magazines or looking through family photos. As you look through the pictures place them on the orange card. It is important to emphasize the words ‘who’ and ‘orange’ so your child makes the link between the two as this will help with sentence building later. You can say things like ‘Who is this?’, ‘It is grandma’, ‘That is who it is’, ‘Who is orange, I will put it on the orange card’

  • You can follow the method described above for ‘who’ with all the different coloured parts of a sentence e.g. ‘doing’, ‘what’, ‘where’. Once your child is confident, you can mix up the pictures and see if you can sort them on to the right coloured cards. 

  • CS not only helps children learn the sentence components and construct sentences, it also supports them in understanding questions and asking them. Whilst using this approach, as you emphasize the key words and colours, they will learn to pay attention to questions e.g. ‘Where did she go?’, ‘Can you find the blue word?’, ‘That is right’, ‘she went to the cinema’, ‘you found the blue word’, ‘where’.

  • You can get as creative as you like! Once your child is confident, help them to expand their vocabulary by prompting for alternative orange, green and blue words. This will teach them that sentences change and are flexible. They can explore sentences and change words all within the safety of this neat colour system! Eventually this will support storytelling, making up alterative endings and beginnings and helping them order their story!

  • Get a little silly! An important part of learning language is to make sure it is as fun as possible. We all learn the most when we can have a good giggle. Have words for each part of the sentence written on different coloured card that your child can chose randomly, then following the order of the colours, they can make their own silly sentences. 

Need more inspiration?

In August we are running a training course on how to use Colourful Semantics to support language development. If you would be interested in attending please go to the link below for more information: 

https://bookwhen.com/magicwordsspeechtherapyforschools

Alternatively, if you would like any more information on how to use colourful semantics or think it might be a useful approach for your child, then why not contact one of our therapists at Magic Words! 

Have fun!

My Love for AAC (Augmentative and Alternative Communication)

By Melissa Mcilhiney - Highly Specialist Speech and Language Therapist and Complex Needs Specialist

When training as a Speech and Language Therapist you learn about AAC (Augmentative and Alternative Communication) methods in lectures. I have always been a more visual and hands on learner than one that can sit in a lecture theatre and take in what it being said.   So my love for AAC did not begin straight away but has evolved over the pathway of my career. It has shaped the therapist I have become and the type of client group I specialise in. This may sound cheesy, but it gave me a purpose and a role doing something I love. 


When I was at university I was adamant I would be working with adults on stroke wards or on the head and neck cancer wards in acute hospital settings. How wrong I was! Don’t get me wrong, I had placements on both of these types of ward and I did enjoy them and learnt lots, but this type of work just wasn’t me. To this day, I can’t really explain what was missing from either of these fields for me. I then went on a placement in a DSP (Designated Specialist Provision) attached to a mainstream school I knew this is where I belonged.  I was placed with an amazing Speech and Language Therapist called Sue. She showed me a completely different way of working. I learnt Makaton (signing), was introduced to visuals such as visual timetables and ‘now and next’ boards. I was encouraged to use all of these within my practice with the children I was working with. It was here that my love for AAC began and my career pathway totally changed.  This placement impacted so much on me that I walked away knowing that kind of setting was where I wanted to be. To this day I don’t regret that decision one bit. Seeing the way children can progress and communicate with others, become more independent with their communications and seeing things individualised to each child’s needs lead me to start applying for Specialist Provision posts.  

As a newly qualified therapist you don’t normally even start thinking about a specialism, but I had no doubt that I was taking the right route! It felt natural. So, I applied to a special school and got a job in an MLD (Moderate Learning Difficulties) school working in an Autism base. Here my love for AAC continued to grow. I was introduced to PECS (Picture Exchange System) and we used this daily to take a very functional approach to communication. We used regular visual aids and worked on sensory difficulties at the same time. Therapy there took a very holistic approach and to this day my therapy style is still very holistic. This holistic view of therapy is now supported by the Department of Health and research supports the premise that looking at the child as a whole results in the most progress in their development.   


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I’ve been involved in a few cases where we had to use PECs and visuals to support the communication of children who were going into hospital or in one case had to be interviewed by the police. I remember people saying, “they won’t be able to tell us what they have seen”. How wrong they were!

This role marked the beginning of my dedicated mission to ensure that all children have a “voice” whether via signing, PECS or another method. I was adamant that every child must have a way to communicate. We just need to find the method that works best for each individual child. We know that not everyone is the same and communication (and aids) need individualising around the child’s needs. For example, A child with Retts syndrome who can only eye gaze will need different aids to a non-verbal ASD child.   

After the special school placement I joined the NHS for 6 years and worked in mainstream, pre-school special needs and eventually ended up back in special schools, my most loved environment to work in. I continued to use all different types of no and low-tech AAC devices here and then saw another therapist introduce an electronic aid with a child. I wasn’t directly involved with the child but it sparked my interest and another branch to my love for AAC started to develop. 

I remember sitting in front of the TV one night and seeing an interview with the late Stephen Hawking. I listened intently to every word he said. Not because I understood a word of what he is was on about (quantum physics is just not my thing!) but because I was astonished by the hi-tech aid he was using. The way he was controlling it through eye movement and how quickly and intricately he could explain black holes!  I then got really into researching his story but also the other types of hi-tech aids like Stephen’s there were out there ranging from I-pads to eye gazing machines.  In looking into them I realised that I had children on my caseload these would benefit hugely. We started putting them into the therapy of two children on my caseload. They made amazing progress! I have continued to use these types of aids with suitable children on my caseloads ever since.  


Children are a lot more tech-savvy nowadays. A child on my current caseload was introduced to his aid last term and within days was able to order exactly what he wanted in Pizza Express without having to rely on an adult interpreting his wants and needs as he always had in the past. Children do not normally catch on to their new aids this quickly, but seeing how well children can progress with the right equipment makes this job worthwhile and again highlights the importance of giving each child their “voice”. 

Can you imagine living in a word where someone else speaks for you? Interprets what you want, what you need? Where you literally have no voice? To me this would be the ultimate nightmare and for the children I work with it leads to extreme frustration and behavioural issues. AAC methods give individuals a lifeline, a way of being able to communicate with others without requiring another person to interpret for them. It decreases frustration and most importantly gives people their “voice”. Research supports the use of AAC devices and has shown that using them increases the use of spoken language. Some parents are scared that AAC devices will replace speech this and from my many years of experience this is not the case. But that’s a whole other can worms that I will certainly open in a future blog!  

"I can’t think of a more rewarding job than giving someone their “voice”. And that is why I love AAC and my job"

HAS THE WORLD OF SOCIAL MEDIA CREATED A WHOLE NEW GROUP OF HEALTH & EDUCATION PROFESSIONALS?

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By Sunita Shah - Service Lead for North West London and Specialist Speech and Language Therapist in Bilingualism

Early Intervention is Key

Who Am I?... My Reflections...Reality

I have been a practicing Speech and Language Therapist for over 20 years; and an Author; a mother of two crazy boys aged 18 months and 5 years. Oh, how my practice changed overnight seeing the other side.  Before eyebrows would be raised if patients were late or if homework was not done but seeing the other side of the coin of what parents must do in their daily routine opened my eyes.  I simply ‘’’respected my parents for getting to the appointment to support their child. I remember the first day back at work I saw a child who had transferred to our Trust the child’s mother had left; the father had special needs and the child was severely Autistic and nonverbal at 4 years old.  The family were homeless; as soon as they left the clinic, the waterfall of emotions took hold.  Suddenly it was not about the hour in clinic supporting the child’s communication it’s the reality of what the parents experience 24-7.


My degree was intense but fascinating. I am so blessed to have worked with such wonderful children and amazing parents.  I once read “A child with special needs does not come with a manual... it comes with a parent that does not give up”.  I studied for over 3 years too gain my qualification as Bachelor of Science in Clinical Language Studies (Speech and Language Therapy).  I studied so many modules within the course, Child development, child psychology, neurology, various therapy models etc. I was fortunate to work in the NHS system for over 20 years and gained so much knowledge, skills and experience which I feel so grateful for.  I left public sector in 2017, and now work independently.  This was an extremely hard decision to make but I have enjoyed life post NHS so much.  The flexibility to not follow unrealistic expectations, KPI’s, endless growing waiting lists for assessment and therapy.... to give the family the type and frequency of intervention they REALLY need, which makes a difference... and quicker.... Early intervention is key.

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Has Social Media Made A New Breed of Health Care &Education Professionals?

 I have been following various national and local groups on social media for parents. It’s a humongous network that supports parents in so many ways, from advice on sleeping, toilet training, weaning, behaviour, chicken pox, and overall development etc. There is nothing like having support from another parent about what they have gone through.  For many parents this is the first point of call.  Within the network there are parents who are Health Care Professional too.  It’s that comfort factor, to put the anxious parenting mind at ease.

My Concerns... Because I Care

Recently I have started to get slightly alarmed with some responses especially regarding communication development. Over a year ago I saw a parent who came to me when their child was 3 years old, it was evident this child had severe communication needs. I asked the mother when she started noticing when things were different the mother replied from 10 months old.  I asked why she waited so long, she reported she followed advice from her NCT friends and other people to just let him develop and in time the child would talk. The mother missed 18 months of vital intervention which would have made such a difference. I’ve seen this on several social media posts recently when people are asking about communication advice, a child of 2 years SHOULD be talking, if there are not they need support. Please see the ages and stages section on my website: www.tlc-speechtherapy.co.uk. Using the wait and see approach can miss vital months of support. Also, children have come to me at 4 years old with severe stammers, they started stammering at 2 years old.... why refer now? The parents said they waited as they thought the child would “grow out of it” .... no… again Early intervention is key. If you are concerned particularly about your child’s communication consult your Children’s Centres, GP’s Health Visitors, Early Years consultants, they are all very experienced, and they will always support you in the steps to taken.  Always remember the walk-in clinics and 111.

I see so many pictures of children’s rashes and suddenly the world of social media can be quick to diagnose, but in a quick snapshot post there is no medical history taken how can advise be given on what to do, when the child’s rash may look the same as what your child had, but the child may have other health concerns or allergies to take into account.  A parent has the most unique gift called “Gut instinct” parents never under estimate this. You know your child more than anyone in the world, if you think there is something wrong.... see a professional.  Please do not wait.

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Use Your GUT instinct... Don’t Always Wait and See....

I guess what I’m trying to put across is although there is a place for support on social media... and some useful articles and advice, please be vigilant... The people of social media are not all qualified Health Care Professionals, go with your gut instinct. Also remember Early Intervention is key.  Certain advice I have seen from members on groups goes against what we practice as clinicians and concerns me. Medical and development histories are very important in the treatment and diagnostic process.

Keep doing what you AWESOME parents are doing.... it’s the best gift in the world being a parent and it’s our job to make sure our children stay happy and healthy.