Picture this: now and next

Hands up who owns a diary? 

How about a to do list? 

As a mum, a therapist and everything in between, I often feel like my whole life is made up of lists upon lists. Also, if I don't have my diary to hand, or up to date with everything planned In half hour slots, my world would seem to crumble around me! Ok, I'm not quite that bad, but I do need to know what has to get done that day.  

Children are similar.  They need structure and routine (anyone who's heard of Gina Ford will know about that!).  Littlies also need to be able to make their own choices within their routine and to gradually become more independent.  The same applies to children who are non-verbal, or who have significant language delay or communication difficulties, and that's where pictures or symbols (or objects) can come in handy. 

Not all children will need pictures to understand their routine, but they might need things simplifying. Instead of suggesting "lets get our shoes on, then we can visit granny once we've done the shopping and got your tea sorted" you could say "shoes first, then shops". Once at the shops you can move on to the next part of the day "shops first, then granny's". The same can be done with pictures in a 'now and next' board. 

For those who have more understanding but struggle with changes in routine or find it hard to switch from one activity to the next, a visual timetable can be very helpful. It helps reduce anxiety, and provides reassurance to children who can take themselves back to check what is happening next. 

Other children need to use pictures to help them make a choice. They are unable to retain the information to be able to choose the activity from several that might be on offer. A lot of the children I work with do not have the verbal skills to say what they want and so they need a system that others can easily understand. That's when a choice board with several pictures of activities can be useful. 

What if the child doesn't recognise pictures? 

Last term, I spent a lot of time introducing pictures to different children (about 3 on my caseload) who did not seem to recognise what they represented. The aim of introducing pictures was to provide a choice board for the activities at nursery. I worked with nursery settings and between us, we followed the child round, and 'slid in' the photos or symbols that matched with what the child was playing with to their eye-line and named it e.g. "sand, Tommy's playing with sand". That way, even if i didnt get eye-contact, they saw the photo and would start to relate it to what they were doing. All of the children ignored the pictures at first, but now are happy to handle the laminated pictures and some can now be led to the next activity, once given the relevant picture, from their timeline. 

So how do I do it?

Just remember when introducing pictures and symbols that one set, the visual timetable is for us as adults to tell the child something, but a choice board (or communication book) is for the child to tell us their news, and not to be quizzed! Also, don't worry about what it looks like, I've used hand drawn pictures on sticky notes many times, particularly when I don't know what the child is going to be interested in during my therapy session. 

For real detail on how to set up now and next boards, choice boards and visual timetables, visit A Version of Perfection  which is written by 'JC's mum'. JC has sensory processing disorder and ASD. In her blog, JC's mum has explained very clearly the methods to put visuals together. Just don't forget to pop back here to tell me how you got on!

Hope to see you again soon! 

Katie 

Lost in translation

Having helped your child tune in and develop their listening skills (see Listen as you walk), and by slowing down to give your child a chance to try to speak (see Stop look listen )it's now time for you to tune in and acknowledge your child's attempts at speech...

"Mummy...mummy...MUMMY! You weren't listening to me!"


For those children who can't yet talk, or who haven't learned the importance of doing so, we need to encourage them and build their confidence that every sound (or gesture) is important and can be understood. They need us to translate, to bring them into the world of chats, communication and interaction. So we need to listen!

Have fun on those sound walks?? Hear some things your littlie said that you hadn't noticed before?

It's not always easy to translate for a non verbal child.  But context gives tons of clues, so watch what your littlie is doing, looking at, or pointing towards.  Don't worry if you're not sure what they 'said', better to have a guess based on what you see them doing than to stay silent.  It doesn't matter if you get it wrong, I have many times, but just think how rewarding it will be when your littlie smiles and confirms that you have got it right after all...

"Uh" he says with his arms outstretched... "Up, you said up!" You say.

Often children who are late to talk, are looking for reassurance that they are doing the right thing and are being understood.  By 'translating' you are not only showing that you've heard them, but that you understand and are going to respond straight away.  You are also providing the child with a template of the correct sounds to help them develop their pronunciation, as well as reinforcing the child's understanding of the word they are trying to communicate.

The same style of commenting and translating can be done with children who are using movements or gesture and who are unable to develop speech in the same way.  For example a reach towards something could mean "more" or if your littlie stiffens/stills to something, it could mean either "more" or "stop", depending on the context.

If you are trying to develop language, and your littlie is not using many spoken words, try to keep it simple and only say one or two words back to them.  

Try to make a conscious decision to listen to your child this week. Translate every sound they make that you think should have been a word.  What have they ended up telling you?  I'd love to hear...

Katie

Listen as you walk

Ever been listening to the radio for the weather forecast and missed it because you were washing up?

That's because we as adults, have learned to filter out background noise. Our children have sometimes learned to block out all of the sounds before they know which are the important ones.

Listen, don't just hear
To help our children to listen to the sounds around them and not just hear them, we need to let them know they are important and point out that they have meaning.

When you're walking down the road, or in the park, or just pottering at home getting all the jobs done (ha! Yea right!) you can listen to all the noises and point them out to your little one. Some are loud - Hoover, shower, lawnmower, tractor, aeroplane, lorry etc. some are quiet - birds cheeping, boiling kettle, tap dripping, clock ticking, bicycle, etc.

Have fun with listening

Remember Stop Look Listen?  My previous post was about pausing before speaking, and similar principles apply now: "oh," you gasp! "What was THAT noise? ... Listen... ..." Then, kneel down to be at the same level as your little one, and just point. 

By doing that and not constantly commenting on everything you can hear, helps littlies focus on those important noises and automatically makes it a game. 

Switch it off!

None of this will be easy if you have the telly or radio on, even quietly.  So sorry if you're addicted to the Radio in the morning, or Reality TV during the day, but you're going to have to turn it off. Not down, but off!

What to expect

Recently, I've suggested this type of activity to a few families whose children aren't speaking. After focusing on this pre-speech activity for 6-8 weeks, the children are now much more vocal in nursery, they are using a wider range of sounds at home, and are attaching meaning to those sounds (i.e. pointing and making a noise). The children are involving the adults much more, and have developed shared attention - they want to involve others in their world and activities. Once children are tuning in and have a level of shared attention, they may be ready to start to listen to sounds for speech...

What other listening games do you play?  Leave me a comment below to let me know!

Hey Baby - Pre-verbal and pre-intentional skills

When my eldest child was just a few weeks old, I had a call from a good speechy friend from uni who had also just had a baby. "What do I do with her?" We both asked. "How do you talk to a six week old baby?"

There was no social smile, no reciprocal interaction and no response to singing - yet.


                                


After lots of lullabies, cuddling, imitation of her coos and squeaks, there was suddenly a smile! Not wind - but a real social smile, showing she'd recognised her mummy!  Many of the families I work with are still looking for their equivalent of that social smile - 18 months on, or more.

How will I understand her?

Being a baby is stressful! They need to learn your touch, your voice, your breath, your smell. All of this is reassuring, and helps them learn.

As parents we also need to learn our baby's communication. Was that a hungry cry, a tired whimper, a strop (yes - I believe that my daughter had her first tantrum at around 12 weeks because she didn't want her nap!), or an 'I want to be left alone' cry?!

We need to be consistent.  If you think a sound or movement means something, trust your instinct.  Teach your child what he or she has just said by repeating the song or cuddles you were giving.  

Repetition, Repetition, Repetition

Children learn through repetition and reinforcement. They make a sound or cry, and as we respond to them, they learn they can have an impact on their environment. And so they do it again. And there you have your first communication! Ta dah!

Children with complex neurological conditions may not 'cry' in the same way.  They may respond to their environment more by stiffening or making a movement, or an involuntary noise.  Any of these reactions may become meaningful, if we can keep a log of what the child does to indicate likes and dislikes, and then try to repeat and reinforce their response to us.  This is also true for children with little or no language such as severe developmental and communication disorders.  

Don't give up

With normally developing babies, we see progress sometimes within a few days or less. With children with severe complex needs, these changes may take months. However, I believe that by tuning in to your child and understanding what each of their sounds or movements means, you can help them to become more interactive and transform those accidental interactions or noises into purposeful communications. All children have potential, if we can adjust our expectations, and set very tiny, but achievable aims.

Let's pretend

Hands up who remembers running around the playground with just one toggle of your duffle coat done up, pretending to be a superhero?

Now, who wishes they still could get away with it?!

I, for one, would love to and I do! Granted, I do have my own two small children to give me an excuse, but it is so very liberating (not to mention I've probably burned loads of calories running round in the freezing cold this Easter so feel fine to have another one of those Easter eggs!!).

SPEECH THROUGH PLAY

So much of speech and language is learned through play. Obvious, once you think of it, isn't it? Little minds are programmed to learn through experience. When we're at the park, or even when we're at home, we might see or hear an aeroplane and then race around trying to catch each other. Add in vocabulary like "plane", "fast", "zoom", "sky", "high", "look" (I could go on...) and you can see how many new words your little one can learn in a quick 5 mins of excitement.

KEEP IT SIMPLE

Your little one won't mind if you haven't found the picture cards which match the topic. They won't notice if you make a mistake, and you won't notice if they get the answer or the pronunciation a bit muddled. Just use one or two words for everything you want to tell/ teach them and you've got it. I am talking about those children whose language is at the two word level or below, or those who are developing at around the 18month stage.

LOCATION LOCATION

Of course, you don't have to be outdoors and running around to introduce language through play. You could just as easily be lying on the floor with your child who perhaps doesn't walk. Or, have them on you lap helping by holding their arms to make the actions and model the sounds required within the game.

Some favourite games in our house are pretending to be animals and nibbling at imaginary bones; making cups of tea with or without utensils; rescuing each other onto the sofa boats from crocodiles living in the rug swamp!

THE SOUND OF IT

Remember to include some exciting phrases such as "uh-oh" and "where are you?" Which have great sing-song intonation. Some children who find it hard to learn language, might find the tuneful pattern easier to copy rather than the specifics involved in pronouncing the words correctly. These phrases are also very exciting and motivating.

FUTURE PLAY

This post is my first on play, I am planning on covering more ideas for playing with children who have a range of impairments such as hearing, visual, and physical. If you would like to hear about those, leave me a comment below!

Katie

Dear Zoo

We all have our favourite children's books, ones we remember being read to us, and the ones we could read for ourselves. Among my favourites were 'the Tiger Who Came to Tea' and 'The Very Hungry Caterpillar'! 

One I have grown to love as an adult and read frequently to my own children is 'Dear Zoo'.  I love the repetition and predictability, and for this reason it is also a great therapy tool! 

The flaps make it perfect for anticipation as well as encouraging child participation.  Also, who hasn't made all the animal sounds? By the way, what is the sound a camel makes?!

So, how can we make it accessible to those children with communication difficulties?


PICTURE MATCHING


I have used picture matching along with a book, or a lesson in one of the severe learning difficulty special schools I worked in, it really helped to keep the child (who had severe autism) focused to the teacher, even where he had severely impaired auditory processing skills.  

With the children I work with, I would start with teaching the animal vocabulary and give them a choice of pictures to match up with the animal under the flap.  Start with showing two, and asking "where's the ...[animal]?" 

As you can see, I found some similar pictures from a Noah's ark story book I had at home to use for picture matching, and didn't need to use pre-prepared symbols or photos. 

RECORDED MESSAGES

Repetitive stories are great for children who use AAC devices, particularly when first introducing them.  Big mack switches are very simple to record with a single message e.g. "So they sent me a..."  

Other devices with more switches or buttons, or some of the iPad apps can be recorded with other phrases from the book so that you and your child can take it in turns to read together.  What a lovely way to be able to share a bedtime story with your 'non-verbal' child?!

What other books would you like to use, or do you use in therapy?  How else would you use my choice of book?  I would love to hear your thoughts below!