A Plea for Early Intervention
Communication is a key part of being human. All children are able to communicate in some way, but many require additional support to give them a voice. Around 10% of all children in the UK have some form of Speech, language and communication need. Children under five years are remarkably receptive to treatment and many difficulties can be significantly reduced and sometimes eliminated altogether.
Despite the well documented importance of Early Intervention, Speech and Language Therapy Services have been patchy and under funded since well before the recession. The focus on immediate savings without regard for the long term consequences will have a dramatic impact on our future society. Even a few months delay on treatment or low quality and insufficient treatment can have significant implications for the child’s later academic success, mental health, ability to form relationships and economic success, all of which affect the future prosperity of our country.
In this blog post, we describe an alternative future, where each child receives early and high quality support and discuss how you can help us to make this vision a reality.
An Alternative Future
At present up to 80% of children from areas of disadvantage are entering school delayed language and Speech, Language and Communication difficulties are the most common SEN in primary schools.
With high quality early support for all children with language difficulties, we would see a dramatic reduction in the number of children entering school with delayed language within 2 years. Entering a typical classroom, you would see more happy, engaged children ready to learn the basic literacy and numeracy skills required for academic success.
Within only a few years, you would see decreased need for intensive 1:1 teaching assistant support among children whose language delay would leave them lagging behind peers. In addition, Children with severe speech difficulties, are more likely to succeed in mainstream school with early and high quality support, reducing costs of specialist placements.
In 3-5 years time, you would find calmer, happier classrooms, with teachers able to focus on teaching rather than disciplining pupils. Currently around ¾ of children with behaviour difficulties also have significant language deficits. These children are at risk of being diagnosed with behaviour problems rather than the underlying speech and language difficulty (Snow and Powell, 2012) which often goes untreated. Behaviour difficulties affect not only the child, but also impact on the learning environment of their peers.
In our alternative future, you are likely to see a reduction in childhood mental health difficulties. Children with Speech and Language difficulties tend to have a withdrawn interaction style and are less liked by peers, impacting on self esteem. Left untreated, one third of children with Speech, Language and Communication difficulties will go on to develop mental health problems (Heritage et al, 2011) and research has found that 62% of children in psychiatric populations have speech and language difficulties (with 34% previously undetected).
Fast forward to teenage years, you are likely to find more young people in education, employment and training upon leaving school. Our economy is becoming increasingly centred around communication based job roles. 88% of young unemployed people present with a language impairment and in a recent study 100% of those not in Education, employment or training have a communication difficulty (Lanz, 2009). With early support, our communities would be filled with young men and women who have the skills to apply for jobs, succeed in interviews and develop successful working relationships with colleagues. We would see fewer young people in queues at jobcentres and more engaged in productive work, positive about the opportunities available to them in future.
Early intervention across the country is likely to have an effect on overall crime rates. Speech and Language difficulties are a risk factor for offending (Tomblin et al, 2000) and over 60% of young people in the criminal justice system have a communication disability (Bryan et al, 2007). Reoffending rates for under 18's are around 67% within a year of release and are higher for young people with Speech and language difficulties. Studies have found that addressing communication disabilities and providing therapy significantly reduces the risk of reoffending.
If we can make an impact on reoffending rates by working with an offender whose communication difficulty has become entrenched, imagine the difference we could make if we worked with the individual before they even began school. If we prioritised early intervention today, within 15 years our children would feel safer walking down the street and would be significantly less likely to be the victim of a crime. Our prisons would be emptier, saving a minimum of £40,000 - £250,000 per offender, per year.
How you can help
Realise the important role Parents can play in Intervention
Governments, charities and speech therapy services have often looked to nurseries and schools to support language development, particularly in at risk populations. Parental involvement Is often neglected. Parents are the prime educators of children and should be seen as a key part of the intervention process.
As a private company, we receive regular contact from distressed parents, desperate to learn how to support their child. Regardless of background, we should begin with the presumption that parents are willing and able to help their children's language development when given the right training and support.
Understand Assessment is not Intervention
Early Identification of language difficulties is crucial, but needs to be accompanied by prompt and high quality support. We regularly receive contact from concerned parents on a long waiting list for treatment, or whose children have been discharged following insufficient therapy. Although the UK is making big strides in terms of early assessment, we need to ensure there is funding available so that every child identified with speech and language difficulties receives the support they deserve.
Support Innovative new approaches
We need you to support innovative new approaches to parental involvement, with a focus on pre emptive solutions that skill up parents and carers.
We run two programmes that focus on getting out in to the community and engaging with parents. Our' Twinkleboost' classes are fun and engaging baby and toddler groups, where parents can learn key techniques to promote and enhance speech and language development. These classes are run by a Speech and Language Therapist but are designed to compete with commercial classes such as TumbleTots and JabberJacks. Our second programme, Chatter Away, is a not for profit project, where our therapists visit local baby and toddler groups to chat informally with parents about techniques to support language development.
Although these initiatives are effective at a local level, we need support to grow and opportunities to work together with local children's centres to deliver our interventions to the most vulnerable families.
We know there is a budget deficit and there are difficult decisions to be made, but please do not take a short sighted approach to Early Intervention. Prompt and early support is not a luxury, reserved for times for economic prosperity, but is essential for avoiding unnecessary disability and the enormous costs of late intervention.
As a profession, we have the tools, knowledge and passion to dramatically improve the lives of millions of children in the United Kingdom but we cannot do this without sufficient funding and support. Please leave a legacy that will give so many children the voice they deserve.
Hannah Broughton and Caspian Jamie
Early Intervention Champions and Directors of The Therapy Adventure Limited
Bryan K, Freer J, Furlong C. Language and communication difficulties in juvenile offenders. International Journal of language and communication difficulties, 2007; 42, 505-520.
Crew M, Ellis N. Speech and Language Therapy within Bradford Youth Offending Team, 2008
Heritage, M., Virag, G. and McCuaig, L. (2011). Better outcomes for young offenders. Exploring the impact of speech and language therapy in youth offending teams. NHS Derbyshire Report.
Lanz, R. Speech and language therapy within the Milton Keynes YOT, a four month project. 2009
Snow, P. and Powell, M. (2012). Youth (in)justice: Oral language competence in early life and risk for engagement in antisocial behaviour in adolescence. Trends & issues in crime and criminal justice: No. 435. Canberra: Australian Institute of Criminology.
Tomblin J B, et al. The association of reading disability, behavioural disorders and language impairment among second-grade children. Journal of child psychology and psychiatry 2000; 41:4, 473–482.
Caspian and I had a fantastic evening this week at The House of Commons, through our work with The Early Intervention Foundation.
The Early Intervention Foundation is a charity set up to champion and support the effective use of Early Intervention. Their mission is for every child to realise their potential.
We are incredibly proud to be Early Intervention Champions for the Foundation and were delighted to have the chance to talk about our work with such knowledgeable and passionate professionals. Through the Foundation, we will have the chance to work alongside some of the UK's leading figures in Early Intervention, sharing good practice and supporting each other in our common goal.
For more information on The Early Intervention Foundation, visit the charity's website and facebook page.
Asking for help is a difficult skill to master, particularly for children with social communication difficulties. It requires the ability to understand that help is required, to initiate interaction appropriately and to structure a sentence. Here are some simple tips to encouraging your child or a child in your class to ask for help.
1) Make a simple cue card and place it on the child's desk. On the cue card should be a simple phrase 'I need some help' and a picture of a person they can ask for help.
2) Begin to demonstrate when the child may need some help and model the request for them. Show them how to ask by giving the card to them and saying 'I need some help'.
3) Help the child to learn to recognise when they need help and prompt them to use the card.
4) Accept use of the card in any form. At first children are likely to simply hand the card over. Do not worry if they do not use the correct language at this point. Model the language for them 'I need help' and reward them for initiating interaction using the card.
5) Ensure you use the card in many settings so the child has chance to generalise the use of the cue card and become confident in asking for help.
For more tips, visit out twitter page :-)
Climbing Therapy: A promising new approach to Speech Therapy for Children with Autistic Spectrum Conditions
The benefits of Rock Climbing to individuals with Autistic Spectrum Conditions has been known for some time. Rock Climbing is now emerging as a potential tool for developing communication and social skills.
What is Climbing Therapy
Occupational Therapists use Climbing as a form of therapy due to its benefits to typical area's of weakness in children with Autistic Spectrum Conditions. Climbing targets the vestibular system (balance), proprioception (spatial body awareness), muscle tone, gross and fine motor skills and interhemispheric integration (communication between the two sides of the brain).
Speech Therapists are now recognising the benefits of rock climbing for Children with Autism. An indoor rock climbing wall is an ideal environment to teach vital communication skills that are essential for positive interaction with others. Climbing sessions tend to be predictable and based on routines allowing children to feel safe and in control. Speech Therapists use photo social stories and visual schedules to help prepare children for the climbing sessions. The physical side of climbing makes it very engaging, motivating and helps to meet the child's sensory need for movement.
The link between motor skills and social development
The link between motor skills and social skills in Autism has been documented in numerous studies. Research has suggested that developing motor skills is crucial for children and can help them to develop better social skills. Scientists have recommended that motor skill development be incorporated into early interventions for children with Autism. However, Climbing Therapy by a qualified Speech Therapist is currently the only therapy available that works on motor skills and social skills simultaneously.
How does it work?
A typical Climbing Therapy programme consists of targeted games and activities to develop Social Communication, Emotional Understanding and Attention and Listening Skills.
Taking Emotional Understanding as an example, many children with Autism find it difficult to imagine and discuss abstract concepts such as emotions out of context. This means that working on Emotional Understanding in an office with a Speech Therapist can be difficult for a young person with Autism. In Climbing Therapy, the climbing wall provides an emotionally stimulating environment to discuss emotions in context, from the elation of completing a climb, nervousness at a difficult route or tiredness after a particularly long climb. Rather than identifying happy, sad, angry faces on worksheets, Games are used to help identify emotions, for example, 'climb to the happy face' and 'Wall Scrabble' to find hidden letters on a climbing wall as a method of introducing Emotional Vocabulary. Children are taught coping strategies to help manage anxiety when climbing and parents are supported to apply the same strategies in the home.
Climbing Therapy is also used to develop social skills, most commonly as part of a social skills group.
Research has found that typical social skills group interventions are only 'minimally effective'. Groups have been criticised for their contrived nature and anecdotal evidence indicates that many young people do not find the sessions engaging or motivating. In contrast at climbing social skills groups the social setting is naturalistic. The focus is not on the children's deficit in social skills, but their shared interest, and competence, at rock climbing. Climbing groups help children to develop their turn taking skills, provide scaffolding for conversations, build confidence and independence and nurture the development of new friendships. Climbing groups such as these are also a method of encouraging children with Autism to get out into the community and engage in age appropriate leisure activities.
Potential for Earlier Intervention and application to lower functioning children
Research shows that children who receive earlier and more comprehensive intervention had greater advancements in social communication symptoms. Traditional Social Skills groups or 1:1 Direct teaching of social skills tend to target older children with high functioning Autism or Aspergers Syndrome. Younger children or those towards the lower end of the Spectrum are often unable to successfully access speech therapy due to its high demand on their language abilities. Climbing Therapy can be used on children as young as three who would otherwise have to wait years for formal social skills training. Climbing Therapy also has potential to be used as a method of delivering Speech Therapy to pre or minimally verbal children who would otherwise have limited access to Social Skills interventions.
When finding a Therapist, ensure they are a qualified practitioner and are registered with the Health Care Professionals Council. You can check whether they are registered here. Ask whether there are any introductory offers or taster session to ascertain whether the therapy is right for your child. This gives your child a chance to see whether they enjoy rock climbing. You can find more information about The Therapy Adventure's Climbing Therapy programme here.
Children with Autistic Spectrum Conditions experience great difficulty communicating and understanding the communication of others. Speech Therapy can help these children to gain skills to improve their functioning in every day life. This post explores the efficacy of conventional Social Skills Interventions and looks at promising new approaches to Speech Therapy for Children on the Autistic Spectrum.
The prominence of Social Skills Groups
Speech Therapists often target Social Skills. Around 70% of these Social Skills Interventions are taught in group format. Group Therapy is typically taught in a therapy office or the classroom, often using role play and work sheets to directly teach social skills such as Greetings and Starting a conversation. Around 14 percent of all Autistic Children are currently using a social skills group. This figure almost doubles when looking at children with Higher Functioning Autism or Aspergers syndrome.
Are they working?
Unfortunately, there has been a major lack of research into the efficacy of Social Skills Interventions. This is a major omission, considering the widespread use of social skills groups for children with Autistic Spectrum Conditions. The most major review, a meta analysis of 55 studies found that they are 'minimally effective'. Considering this is currently the main method of teaching social skills to children with Autistic Spectrum Conditions, this is a concerning finding.
What's the problem?
Research suggest that generalisation of skills from one area to another is poor. Children with Autism find it difficult to transfer skills they have learnt from one setting to another. Social skills are taught in artificial settings that do not come close to replicating real social experiences. Children are taught to apply social skills mechanically, for example, learning scripts such as 'What did you do this weekend' in a quiet, controlled environment. Although these are valuable skills, they do not tend to transfer easily to real life contexts.
Lack of engagement may also be a contributing factor. Research has failed to explore whether children are enjoying and engaging with social skills sessions. From our experience as therapists, social skills groups can be unpopular with children with Autism. Just as children who struggle with numeracy often dislike maths lessons, children with social skills deficits tend not to enjoy group work and forced social contact. If we are serious about supporting children to make progress with their social skills, we need to trial new approaches to delivery that make the experience a more positive and engaging one.
What are the alternatives?
Video modelling uses film to model appropriate social behaviour. It works with children with Autism's typical strengths in visual learning and a preferred leisure activity (watching visual media). Research has found it to be an effective direct teaching strategy when used to deliver a social skills programme to children with Autism. For more information on video modelling click here.
A recent study has found that training peers has led to greater gains in social inclusion than traditional 1:1 Social Skills Training with a Speech and Language Therapist. Peer Training involves teaching classmates of children with Autism how toengage and interact with children with social communication difficulties. Training sessions lasted for 20 minutes, twice a week for six weeks
Rock Climbing Therapy is a promising new approach to teaching Social Skills. Rock Climbing has traditionally been used by Occupational Therapists to improve motor skills and co-ordination. It is now beginning to be utilised for its social communication and psychological benefits. Through Climbing Therapy, children work on topics such as understanding emotions, turn taking skills and how to start a conversation in a naturalistic environment. Climbing Therapy is a particularly exciting approach for children with limited language who are unable to access conventional talking therapies. Climbing Therapy is delivered by Specialist Speech Therapists who also hold a climbing instructor qualification.
Looking to the future
Social skills deficits have wide ranging implications for children with Autistic Spectrum Conditions. Social demands increase as a child gets older, resulting in social isolation and commonly, associated mental health difficulties. Direct teaching of social skills through groups is likely to remain an important aspect of Speech Therapy for children with Autism. However, it is essential that we continue to investigate engaging methods of delivery that provide support and opportunities to apply newly learnt social skills to real life contexts.
Auditory memory involves listening to information, processing that information, storing it and retrieving it when required. Auditory memory is very important for language development and learning. It has been found to be linked to academic achievement, particularly literacy skills.
The following fun and engaging games will benefit any child, but are particularly helpful for children with conditions that often impair auditory memory such as ADHD and Dyslexia.
Treasure trail is a particularly popular game with young children. Hide goodies around the room, for example, stickers, balloons and edible treats. Ask your child to stand in the middle of the room and listen for instructions to find the hidden treasure. Start with a simple one-part instruction and build up slowly to more complex two or three part instructions. Use plenty of prepositions e.g under the sofa, behind the cushion. This game will improve your child's listening skills and alert you to commonly used language such as prepositions they do not yet understand.
Deep Sea Divers
Deep Sea Divers is a game that teaches your child to use rehearsal strategies. Tell your child that you are Deep Sea Divers on a trip to the bottom of the ocean. Leave some special items on the floor e.g a teddy, crayons, a ball. Give your child a list of items to pick up and tell him you will count down from ten before he can dive into the ocean. In this time encourage your child to recite the list of items out loud. Begin with one or two items and build up to more and more items the more confident they become.
This game helps to teach your child visualisation as a memory strategy. Ask your child to imagine you are wizards, a Harry Potter theme is often popular. Get a cauldron (you can use a bucket or something similar) and say that you are going to do a magic spell. Give them a list of ingredients to remember for the spell (use glitter, toys and other bright and appealing items). Ask your child to close their eyes and picture each ingredient in their head to help you both remember, before collecting the ingredients. With success, increase the number of ingredients.
These games teach the strategies of rehearsal and visualisation. Keep checking our blog for further games to teach memory strategies such as chunking and the use of physical supports.
New research has been published this month, shedding light on how toddlers learn verbs. The research found that two year old children can learn verbs after hearing them only twice. It also found that the way adults talk to toddlers can affect the likelihood of children learning new verbs. This post details strategies and activities to encourage your toddler to learn action words.
MODEL ACTION WORDS IN COMPLETE SENTENCES
Children learn vocabulary best when they are immersed in a language rich environment. Research has found that children are more likely to learn verbs when they are presented in complete sentences. For example, 'The boy is waving at the man' rather than 'He is waving'.
COMMENT RATHER THAN QUESTION
Many parents are tempted to ask their child questions to help them learn. For example 'What is the dog doing?'. It is more helpful to use a commenting strategy. As you walk down the street comment on what is around you, emphasising the verbs in the sentence. For example 'Look at the man sitting on the bench' or 'The boy is jumping up and down'.
GIVE EXAMPLES OF THE SAME VERB BEING USED IN DIFFERENT CONTEXTS
Recent research from the University of Liverpool has found that verbs are harder for toddlers to learn as they are different each time the child sees them. Their study found that parents can help toddlers language skills by showing them a variety of different examples of different actions. For example, show toddlers brushing hair, brushing teeth and brushing shoes. Also show your child similar actions to show how they are different, for example washing a toothbrush or washing your hair.
SLOW DOWN THE ACTION
Verbs are more difficult to learn than nouns as they happen so quickly. For example dropping an object or jumping. In order to help your child learn verbs, try to slow down the action. When playing with toys get the action figures to sit down very slowly, exaggerating the action. Repeat the language whilst performing the action.
LEARNING THROUGH PLAY
Children learn best through play. Sit down with your child and their favourite teddy or toy and use action words to describe what teddy is doing. For example teddy could be washing, jumping, brushing his hair or eating a biscuit.
LEARNING THROUGH SONG
Action songs are a great way of teaching verbs. Children can learn a lot of language through songs such as 'This is the way we...' and 'The wheels on the bus'. These songs highlight and repeat verbs giving children plenty of opportunities to learn language.
A recent 15 year study has found that early attention skills are a major predictor of success later in life. Children who had higher rated attention skills at age 4 were significantly more likely to finish college by age 25. Attention was a bigger predictor of success than early literacy or maths skills.
Attention and Listening skills can be taught through fun and engaging group games that are perfect for circle time. Here are five Attention and Listening games that kids will love.
FOLLOW THE CLAP
In this game children must attend and listen whilst a clap is passed around the circle so they can join in on their turn. Make things a little trickier by changing the direction of the clap when a teacher, or student, blows a whistle. Once kids have the hang of this, they can pass different actions round the circle, like a wave or a click.
Children sit in a circle with a blindfolded 'Dragon' in the middle. Keys are placed next to the dragon. One child quietly steals the keys from the dragon. The dragon then has to guess who stole the keys, using their listening skills to follow the sound.
Have two of each musical instrument e.g two tambourines, two maracas. Play one instrument behind a screen and get the children to guess which instrument was played. You can split the children into teams to see who can score the most points.
JACK IN A BOX
Get all the children to crouch down on the floor. Then when a drum or other instrument is played, everyone jumps up. Make this harder by using different instruments. For example, children should jump only on triangle sound, not on the tambourine.
COPY THE ACTION
Similar to copy the sound, children are sat in a circle and the leader does an action, for example, a wave or clicking fingers. Everyone must watch and copy the action until the action changes. The leader changes the action multiple times and the children must watch carefully to keep up. Children can take turns to be the leader.
For more information on our attention and listening intervention for schools and families in Manchester, click here or contact us.
This blog is created by Hannah Broughton and Caspian Jamie. Caspian is a Private Speech Therapist and Hannah is a Child development Specialist We have our own company, The Therapy Adventure Limited and live in Ramsbottom, Manchester with our daughter.