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Whilst you are supporting the nation by staying at home, Apple Tree is now delivering speech and language therapy online (known as Teletherapy). We have been learning new strategies to keep children engaged in online sessions and have received encouragingly positive feedback from parents. 

Even young children have been amazingly attentive and enjoyed interacting with the therapist through the screen such as feeding online puppets cakes and tea!  Although it looks a bit different from regular therapy, we are able to carry out all the usual speech and language therapy games as well as adding some extra digital activities.  ​

​We are offering different types of therapy to children of differing ages with a wide range of difficulties. Some of the approaches we are using include:

• Online parent coaching using video clips or live play sessions at home. This is particularly suitable for very young children.
• Direct therapy with children using toys at home and with the therapist modelling activities using her toys.  
• Direct therapy sharing interesting online activities and paper resources such as pictures and books through screen sharing and a digital camera.
• Online parent workshops. We are offering Hanen courses in supporting speech and language for groups of parents and carers.

 
Contact us to find out more about online therapy.

Parents and other professionals frequently ask where they can get hold of the toys and books I use in my speech and language therapy sessions with their children.  In order to make it easier to find some of the activities,  I have created, Apple Tree Amazon shop with links from my website to  similar products in Amazon.

I will be adding to the shop gradually over time. Please let me know  what you think of the books and activities suggested and I would love to hear about any ideas that may be helpful for other children. ​

Here at Apple Tree Speech and Language Therapy we often see children, who are having difficulty making themselves understood to others. It can be very frustrating for your child and for you as parents when you are struggling to understand what your child is saying.  Children may have difficulty producing speech sounds for a variety of reasons. The majority of children have a straightforward delay in their speech production and are using speech sound substitutions typical of a younger child. 
Additional reasons for speech difficulties include:

• Perception and discrimination of sounds. 
  
• Articulation of certain sounds. Lisps such as on the sound “s” are a common articulation difficulty. 
  
• Coordination of lip and tongue movements for speech.
  
• Structural problem such as a cleft palate. 
  
• Hearing problems past or present will impact on speech development.
  

Children continue to develop speech sound up until 6 years of age. By 3 to 4 years children should be more than 75% intelligible

Kindly friends and relatives may offer reassurance and suggest you wait and see, when you instinctively know your toddler or young child has difficulties starting to talk and interact with others.
Research shows that early intervention is key to help a child who is late talking or delayed communicating. Children's brains are developing rapidly in the first  three years and they are particularly responsive to language and interaction from their parents at a young age. The Hanen website has great information on the importance of early intervention. 

Interaction begins between a baby and a parent at birth and speech and language therapists are trained to assess communication in babies and infants as well as older children. A speech and language therapist  will assess your child's gestures, eye contact, vocalisations, social interaction, attention, play and understanding, which are the skills your child needs to develop before he starts to use words.

For more information on  when to seek help the charity ICAN's Talking Point offers guidance on what to expect at different ages.

If you are concerned about your child's communication or interaction at any age, a speech and language therapist  can provide advice and  give you ideas of how to help your child.
There is no need to get a doctor's referral, You can contact an independent or NHS speech and language therapist direct to arrange an assessment.

If you would like to discuss your concerns with  a speech and language therapist further or arrange an appointment contact Apple Tree Speech and Language Therapy. 

I am often asked by parents, teachers and nursery practitioners about children who have poor eye contact, so here are a few thoughts  about why they don't make eye contact and how to help.

Some children seem to avoid looking at you directly.  This may be in particular situations or with less familiar people. It may be when they are focused on a task, listening or trying to talk. There is so much information from a face with eye contact, movement of the head and facial expression and it can be hard for some children to process this information at the same time as to listen, or to formulate their own words. This can be sensory overload for children who need to process one thing/ sense at a time.

Making the right amount of eye contact is a subtle skill which most children absorb from their interactions with those around them. However, some children struggle to  develop the right balance of eye contact for communication. They may not realise that they can communicate with you by looking at you or that there are things to learn by looking at your face.

Several parents have contacted me recently with concerns that their child is able to talk but doesn't talk in certain situations. For example, he or she may talk freely and confidently at home, or with close family, but not at school or in front of strangers. If this has been continuing for several months, an assessment by a specialist is recommended following which the child may be described as having selective mutism. 

Reluctance to speak in certain  situations is usually accompanied by extreme anxiety, although the child may be happy to speak at other times. It can be very frustrating for the child and can prevent  them participating in activities. It is  sometimes misunderstood by others as awkward  or uncooperative behaviour, which results in further upset for the child. 

I have updated my website with new information on selective mutism.
Find out more about:
What causes selective mutism?
When to seek help?
What to expect from treatment?

It takes a bit of organisation to get started with visuals, but hopefully you will see the benefits for your child straight away. Keep it simple to start. Remember there are no real wrongs and rights. It is what works for your child.

• Start with a few simple pictures to help your child understand daily activities and instructions such as “hold hands”, “nursery” and “bathtime”.
• You can use photos, line drawings, or coloured pictures.
• Write the word below the picture and always say the same word. If “TV” is the word you use for television, write “TV” below the picture. This helps everyone use the same word for television and the repetition will help your child to learn the word.
• Make duplicates of all the pictures. They will get lost!
• Always say the word with the picture.

PORTABLE KEYRINGS
Put about six of the instruction pictures on a key ring to carry around with you and use throughout the day. Make up several sets to give to teachers or other family members. Key rings can be purchased in packs on Amazon.

VISUAL TIMETABLES
A visual timetable can be created for a whole morning at nursery or full day at school. It may include up to about 6 activities. It can be used be for a specific activity such as getting ready for bed, going to the toilet or getting out to school. As each activity is completed the child can take the picture off and post into a finished box. Children usually really enjoy this!

“NOW AND NEXT”/ “FIRST AND THEN”
Some children cannot manage a long timetable or need activities broken down into small parts. Two part timetables are ideal. Choose whether to use “now and next” or “First and then”. This is often a useful way of moving a child on from a favourite activity and is not meant to be a reward scheme. Use the finished box to post the cards when the activity is finished.

• It is usually much cheaper and more flexible to make your own resources. Here are a few tips to get started.
  

• Buy a laminator. A4 size should be fine. These are available on Amazon, Tesco etc and should not be too expensive (about £20)

• Laminator wallets vary in quality and the ultra cheap ones are not as good for certain tasks as they are very thin.
  

• You may need card that is longer than A4 for timetables. I put A3 card into a wallet and then cut this in half lengthwise before putting into my A4 laminator.
  

• Finished box: Make a finished box from a washing tablet box and then cover blue Peter style with sticky back plastic which again can be purchased on Ebay or Amazon. You can buy a posting box such as from ELC or Special Direct if you prefer.
  

• You can make a blank template using a table in word for your pictures  so that you can create new ones and keep them all the same size.  Then add your own photos, clip art or pictures from the internet as you wish.

WHAT PICTURES SHOULD I USE?
You can use photos, line drawings, or coloured pictures. Please look at the visual resources page of my website for more information on what pictures to use and where to find them.

See my previous blog on the Magic of  visual resources to understand how visual supports can help your child.

Children with speech and language difficulties or autistic spectrum disorder often have difficulty responding to spoken words and tend to learn visually. A word disappears in split seconds, but an object or picture is permanent giving the child longer to process the information. Visual supports help us adults to slow down, use simple language and keep our choice of words consistent. This will help your child to understand what you are saying and to learn new words. 

Visual supports can be objects, photos, pictures or drawings. You can use an object to support your spoken language e.g. a cup to show your child it is time for a drink. Pictures or photos can be used once a child is able to recognise these. Photos are easier for children to recognise than pictures. Always say the word with the object or picture.

Visual supports help a child:

• Respond to language and follow instructions.
• Learn new words.
• Fit in with family or school activities.
• Understand what is going to happen and anticipate change.
• Make transitions from one activity to another more easily.
• Learn how to do things independently.
• Make choices.
• Understand emotions and feeling.

Even when your child is able to use words to communicate, visual supports are great if your child has a strong need to do things their own way.  Using visual timetables will enable your child to understand and fit in with your timetable such as for bedtimes, getting out to school, or joining in with family routines.

Most children love them immediately because they like the predictable structure and they feel less anxious about what is going to happen next. However the occasional child may not like them at first, because they are a change from normal routines. Persevere so that the child has a chance to get used to the new schedules. Remember that this is about the child learning to fit in with others and not for them to choose the pictures themselves!

Look out for  my next blog on how to get started with visuals.

The book “More Than Words,” by Fern Sussman available in the UK  from Winslow Press has an excellent chapter on using visual supports called “Visual Helpers”

Recently I have been finding out more about sensory integration disorder. Parents often ask my advice about aspects of their child’s behaviour that they feel are unusual or challenging. Sensory integration often helps to explain children’s behaviours and offers practical ideas to help if needed.  

Sensory integration is the brain’s organisation of both the input from the senses and output such as for movement and speech. It allows all the sensory systems to work together, so a child can function well in their environment.

Sensory information is taken in from the sensory systems including the senses of:
Touch, sight, hearing, taste, smell, position, balance, gravity and movement

In normal development, children gradually learn to integrate sensation as they understand the world. However some children have difficulty with the processing of sensory information and  it can interfere with their development and learning. 

The sensory systems usually work together in a co-ordinated way.  However a sensory processing disorder can occur in any or several of these systems. Sensory integration disorder often occurs with other developmental disorders such as an autistic spectrum disorder, or ADHD. It may exist independently of other conditions. Sensory processing disorders can affect modulation or praxis or a combination. These terms are explained in more detail in the sensory integration section of my website.

Children with sensory processing disorder may have a wide range of sensory sensitivities. These can be mild and only you may notice, or more severe and impact on your family life such as preventing you going out or getting to sleep at night. A child may be over or under sensitive to sensations such as touch, sounds, lights, food taste and textures, or seek out sensations and movement with extreme activity or spinning, or chewing toys and clothes. If you suspect your child may have some of these sensitivities and they occur more than other children their age, it may be helpful  find out more about sensory integration.

When my 18 month old son did not respond to our voices as we came into his bedroom in the morning,  and then startled when we came into view, I suspected that he was not hearing us. 

After passing his Health Visitor hearing screen and making several visits to the GP we finally reached Audiology  for a professional hearing test and he was diagnosed with glue ear. I also noticed as he got older that he frequently said “What?” or "Pardon" when he wasn’t hearing us!

Other signs that a child may have glue ear are a short attention span, speaking excessively loudly, wanting the TV turned up, becoming withdrawn and sometimes ear infections, although not every child will suffer from all of these symptoms.

One of the effects of glue ear that I come across frequently in my work as a speech and language therapist is delayed speech and/or language development. Children may be late acquiring words and phrases, or have difficulty with producing sounds for intelligible speech. 

Glue ear is the accumulation of sticky fluid (or glue) inside the ear. This prevents the tiny hair like cells in the inner ear from moving adequately and can reduce the hearing. See the Hearing Research UK website for more detailed information on glue ear.  Glue ear tends to cause a mild to moderate hearing loss. It may “muffle” sounds, a little bit like wearing cotton wool in your ears. However it can have a significant effect on the way a child is learning to speak because it occurs at such an important age for development. It may also impact on their ability to concentrate and learn in the classroom.

About three quarters of young children will suffer from a bout of glue ear at some point, but some children, who have a persistent problem may need treatment with grommets. The Great Ormond Hospital website has more information on treatment. The insertion of grommets is an effective, although short-term treatment, as eventually the grommets will fall out. My son had grommets inserted twice, each lasting about two years. Parents (with advice from the Ear Nose and Throat doctor) need to weigh up the benefits of significantly improved hearing against concerns about submitting their child for a minor operation.

• Get face-to-face

Position yourself in front of your child so that they can watch your facial expressions and lips when you are talking.

• Use a loud voice

However avoid shouting.

• Turn off background noise

Be aware of the noises in the environment including washing  machines, dishwashers, radios, TV, which will make it hard for your child to distinguish speech.

• Keep your language simple so that your child can understand what you're saying

• Break down your sentences into shorter units e.g. Instead of saying

“Go upstairs, get your coat and hat and wait by the door”
 split this up into four phrases giving your child a chance to respond to each one before saying the next one.
“Go upstairs” ...Pause while your child goes upstairs... “Get your coat” ...Pause....“Find your hat” ...“Wait by the door”

• Use pictures and objects to help your child understand

E.g. hold up a cup when you ask “Do you want a drink?” Giving your child as many visual cues as possible will also help them learn to speak  through understanding.

• Use natural gesture or Makaton signs to illustrate your language

• Check that your child has understood what you have said
  

 

• Give you child extra time to listen and to process what you are saying.

• Pause and give your child lots of opportunities to tell you things in their own way.

At school or nursery

• Ensure that your child’s teacher knows he or she has a hearing difficulty

• Your child may need language made specific so that they can hear and understand it.

• Your child may need instructions for the whole class repeated for them individually.

• Make sure the child is sitting at the front of the class so that everything can be easily heard.

   The above recommendations need to be carried out sensitively so that the child doesn't feel singled out from the other children. The Hearing Research UK website has helpful information for teachers.

ICAN and the Hearing Research UK website also provide useful communication tips.