DLD & Education

Today there has been a web chat run by @DLDandMe all about the impact having a language disorder has on a child’s education. It is part of their wider work to raise awareness of Developmental Language Disorder  (DLD) and to spread the word to a broader audience, about what DLD is, how to recognise it etc. I joined in a little, although late, but I thought it might be useful to share more detail about this topic, from our own personal experience.

As most readers already know, I am both a speech and language therapist and Mum to our seven year old son – LB – who has DLD. There is a complication to our story, which is that LB experienced early neglect and didn’t come into our lives until he was three and half. It is pretty impossible to pick apart the different impacts of neglect and DLD, with both having made their mark. However, it was clear from fairly early on that the communication difficulties LB experienced were more significant than delay alone and where progress was quite quick in some areas, speech and language has always proved more challenging for him. As much as possible in this post, I’m going to focus on the specific ways DLD has affected LB’s educational progress, notwithstanding the separate effects trauma has had.

LB’s DLD impacted on all areas of his communication development when we first met him – including his ability to understand language (comprehension), his auditory memory, his ability to use words and make sentences (expressive language), his ability to listen and pay attention, his ability to speak clearly and his social communication. When I talk about his presentation back then, in workshops and the like, I can see that it shocks people. And it was shocking, because LB’s language system just couldn’t do what he needed it to – not one part of the complicated whole functioned as it should have. He was very much trapped inside of himself and he wasn’t left with many options other than to express himself through his behaviour.

In the early stages of his pre-school education, this impacted him in a myriad different ways. He was certainly delayed in learning concept words such as his colours, size words, same/different etc. which meant he just couldn’t follow much of the teaching or express answers to what nursery staff would likely consider easy or every day questions. That said, with specific teaching of one concept at a time and plenty of reinforcement in everyday activities and play, LB was able to close the gap pretty quickly. It isn’t that LB can’t learn, because he has developed phenomenally quickly, it’s just that he couldn’t pick these concepts up from the ether, as children with typical language skills would. He required specific teaching, repetition and showing, to get them to stick.

Obviously, struggling with comprehension made it even harder for LB to learn new things. There must have been much of what went on in Nursery that he couldn’t follow. This no doubt exacerbated his difficulties with listening and attention, because it is extremely hard work for anybody to focus on language they don’t comprehend. Imagine having to listen to French or Urdu or Finnish or any other language you aren’t familiar with, for large swathes of each day. It would be exhausting and it wouldn’t take long until you stopped listening. Therefore, in some ways, LB’s DLD exacerbated his DLD. He certainly coped better on a 1:1 and thankfully we were able to provide him with this because I was on adoption leave and he just went to pre-school for a few sessions (and now he has TA support). Keeping distraction levels down and matching our language to the level LB could cope with, was imperative. It meant we could keep language accessible for him most of the time and choose which concepts or structures we wanted to stretch him with. I guess this is where my professional background came in – I suspect creating these ideal learning conditions would be much more difficult for a child whose parents are new to the idea of DLD and whose pre-school setting don’t get it.

Certainly as LB’s comprehension developed, so too did his ability to learn. I know it sounds a bit ridiculous but he did appear to be growing cleverer. I maintain that had he have had a cognitive assessment at the beginning, and one a couple of years later, he would have climbed the percentiles. This is because learning and education is generally acquired through the currency of language. As he acquired more words, he knew what more things were. He was able to express how things work. He was able to enquire and find more information out. The more language you have, the better you become at gaining it. Initially, we just couldn’t have talked about complex ideas such as electricity or natural disasters or endangered animals or health conditions. LB didn’t have the vocabulary to access a discussion or explanation about such things so he essentially wasn’t able to learn about them. It was only when he had gained sufficient depth and breadth of vocabulary and could listen to and follow longer structures, that he was able to develop his knowledge of the world around him. And when this did happen, it was amazing to witness the world opening up to him.

Vocabulary acquisition was a huge ongoing challenge for LB (and me) for a long time. Initially, even though we used lots and lots of modelling strategies, he didn’t seem to be growing a larger vocabulary. Again, like with other aspects of his language system, the more he heard a word used and the more times he managed to store a new one, the better his language processing system got. He has certainly got quicker at acquiring new words, even if this continues to be hard for him. Evidently LB’s language processing system (the bit of our brains that hears words, de-codes them, decides what sounds are in them, and their meaning, and stores them in an organised way, ready to be spoken) was not well-developed. It was laborious for him to use it, meaning that getting his vocabulary as big as he needed it to be must have been an exhausting task for him.

Where LB would once have needed to hear a word used around him for several months, with a high level of repetition, before being able to store and use it, he can now store a new word almost immediately. This has had a huge impact on his ability to be able to keep up with the curriculum. Each new topic brings a cornucopia of new words, which children are expected to immediately absorb in order to follow teaching. If you can’t understand the new words, it’s extremely difficult to follow the new lessons.

Although speedier, LB’s processing system remains inaccurate – he struggles to de-code words so that, without help, he might store ‘Corvette’ as “courgette” or ‘submarine’ as “subramine”. He is aware of this so often requests help – just having someone break a word down into bite-size syllables is a huge help to him and allows him to store a new word correctly. At school he has word webs for new words and is building up a personalised dictionary with his TA.

Despite all the hurdles, LB’s comprehension skills have caught up. He seems able to access the vast majority of teaching in his year 2 classroom without too much difficulty. He does cope better with multi-sensory teaching and visual supports (such as narrative grids, Mind Maps etc.), not least because they help to hold his attention. When LB is tired, his skills in this area do diminish a little and he might need a bit more repetition but overall I think his progress underlines what the right speech and language therapy input can achieve for children with DLD.

LB’s difficulties with auditory memory have impacted in several ways – most notably on his ability to blend sounds together and to learn listed information. Literacy acquisition was always going to be a challenge for LB, as his speech continued to be unintelligible well into year 1, with vowel distortions, and his sound awareness skills (identifying the first sound in words, rhyme, syllables etc) were poor. Even the pre-reading task of describing what’s happening in a picture was ridiculously difficult, because LB didn’t have the sentence structures or vocabulary he needed in his expressive language – something else we taught specifically.

We worked hard on sound awareness in a stepwise manner – identifying the first sound of short words then longer words, then the last sound of short words etc., alongside attending speech and language therapy. Again, I feel that good phonological awareness skills are something LB wouldn’t have been able to acquire organically, but he was very much capable of achieving on a 1:1 basis with a personalised approach.

We stumbled at the point of blending sounds together – a critical final step before literacy could be gained. The difficulty it turned out, after a bit of ‘diagnostic therapy’ (again, thank goodness for my career) was the blasted auditory memory which was struggling to hold three sounds, let alone stick them together. Once more, practise paid off and eventually LB could blend. Which, having already learned his letter shapes – pretty easily, it was a visual task – meant he could read. Progress has been steady since that point, with him progressing through the reading levels as you’d expect. In my opinion, a good phonics approach is essential for a child with DLD. It was a challenge to establish that strong foundation but once it was in place, it served LB well. He is not yet meeting the expectations of the curriculum but his reading is good; he understands text and he can apply his phonic skills to decipher most words. Crucially, he loves books and listening to stories. Keeping things as fun and engaging as possible is another essential tool in encouraging a child with DLD.

However, LB is not yet ready to apply his phonic skills to writing, finding this laborious. The addition of SPAG requirements such as including a noun phrase, or adverbial, pretty much renders writing the very worst aspect of school life for LB and, in my humble opinion, totally takes the fun and imagination out of it for all children.

It is hard to get LB’s teachers to understand just how many demands writing places on the language system of child with DLD. My hunch is that when his reading skills are better still and he’s had more specific phonics teaching, his ability to spell will improve. I suspect that expressing himself on paper, with appropriate grammar, will always have its challenges.

The other area auditory memory difficulties have impacted is LB’s ability to learn listed or sequential information such as the days of the weeks, months and, perhaps most crucially, how to count. Learning the numbers to ten proved extraordinarily challenging for LB so that when he started school, aged 4 and half, he couldn’t count to three in the correct order. The knock on effect of this was that Maths was pretty much impossible. How can you do sums when you haven’t the basic language for it? When “4” or “732” are just as meaningless and unquantifiable? This certainly held LB back and for the first year, perhaps two, of his education, his literacy skills appeared better than his numeracy ones, which lagged significantly behind. However, all the repetition and visual representation eventually paid off and LB learned to count to 10. And then 20. Very soon after that, probably because he could use his logic and ability to see patterns, he could get to 100. Once he had the language, Maths wasn’t so hard at all. In fact, it looks as though LB will meet the expected levels of the National Curriculum for the first time this year, which is no mean feat, given his starting point. Now that he has the language, even the reasoning SATS paper is accessible to him, despite the problems being presented in word form.

Having DLD has made every aspect of LB’s education more challenging for him. However, with the right support, LB has proved over and over again, what children with DLD can achieve and how crucial getting that support in place is. Language underlies all learning and we ignore that at the peril of children with DLD.

 

 

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Speak Up For Communication

With absolutely no mention of decorating downstairs toilets this week, I am back talking about the serious matter of children’s speech, language and communication needs – SLCN.

Last year, I wrote this post – Ensuring Children’s Speech and Language Needs Are Met: A Call to Action– about The Bercow10 report – a damning reflection of the state of speech and language therapy services in the UK and the enormity of unmet need. RCSLT and ICAN last week began a new campaign highlighting the changes that have been successfully brought about in the year since Bercow10 and asked for renewed efforts to speak up for SLCN.

Of the 47 recommendations made in last year’s report, 17 have already been fully actioned, which is a promising start.

You can see some of the key successes here:

I mentioned the petition begun by @GillianRudd at the end of last year’s blog post. Following an incredible effort, this was successful, gaining 11,622 signatures and leading to a debate in Parliament. The government have stated they are committed to meeting the needs of children with SLCN, and Teresa May herself has committed to change during Prime minister’s question time.

However, there is widespread agreement within the speech and language therapy profession that this is not enough. Budget cuts have decimated speech and language services up and down the country. Yesterday, there was an article in the Daily Mirror about children languishing on waiting lists for as long as a year before getting any sort of meaningful help (see Mirror Article). The NHS department I used to call my professional home no longer exists – its contract having been lost to a private provider – and those children I work with in independent practice talk of long waits, minimal input and quick discharge in their NHS services. I never thought I would have to end up working privately to be able to give children the quality therapy they deserve and part of me is still saddened by it, not least because private services are out of reach for so many vulnerable children who need them.

Pressure on NHS speech and language therapy departments has been growing over a number of years, with an increase in need and a decrease in funding. Clinicians are under pressure to move children through services as quickly as possible and to be inventive with the budgets they do have. The department I worked for, put a heavy emphasis on others, such as speech and language therapy assistants and teaching assistants, carrying out therapy with children. This was part of being ‘lean’ and making savings but ultimately I think it has devalued the work and knowledge of speech and language therapists and contributed to the demise of services. We also worked to an ‘episodes of care’ model, in which children were seen for a block of therapy to target a specific aim and then discharged, with the plan for them to come back again when they needed more. Although this was effective for some children – the ones whose parents or school would make sure they did come back – I’m sure it put vulnerable children with poorer support networks at increased risk. Although the service was designed for children to come in and out of, I think it gave the message to some people that nothing else could be offered and that children’s needs had resolved, where they hadn’t, and were unlikely to for their lifetime. In trying to be frugal, I suspect some services have inadvertently misrepresented the severity and long-term nature of some SLCNs as well as lessening children’s chances of getting the additional support they needed at school (funding is difficult to justify if a child isn’t actually under any external services).

As it stands, Little Bear has also been discharged from speech and language therapy. He too could be re-referred but that would require energy I’m not sure I have. I would need to prove his needs were severe enough to get through referral criteria and no doubt start back at the beginning of the initial assessment to waiting list process again, which took a year last time. He clearly does have ongoing needs – he has Developmental Language Disorder – but proving the daily impact on him would be difficult now his needs are more subtle. Like any parent of a child with SEND, I am already pretty stretched with managing behaviour, seeking funding, trying to get school to understand his needs etc. etc. I’m not sure that I should have to jump through hoop after hoop to get him the help he needs. Yet I would have to. And so too do parents of children with SLCN in all corners of our country.

For me, it has been far easier to create a speech and language therapy programme for Little Bear myself and to train his TA to carry it out myself. Clearly this is a perk that other parents cannot rely on.

The majority of clinicians want what’s best for children and many are deeply frustrated by the limits of the services in which they work. In an unprecedented move, RCSLT and ICAN wrote an open letter to government last week, asking for SLCN to be given the attention it deserves. It was countersigned by 60 organisations, ranging from Autism charities to fostering and adoption charities, who share a deep concern about the future of children with communication difficulties. You can find it here: Open Letter

Five key areas requiring change have been identified as priorities for action and are the five areas the open letter asked the government to act upon. They are:

Joint commissioning of Services – as SLCN impacts upon children’s emotional wellbeing, education, future employability and likelihood of involvement with the criminal justice system, a joined up approach to meeting need would be ideal. It is hoped that this would also help to iron out the postcode lottery which currently exists in the provision of speech and language therapy services.

Long-term support for SLCN – although support has improved in the early years, support for the 10% of older children and teenagers who will have ongoing needs continues to be poor.

Professional Development – there is a pressing need for all teachers and those working in the field of childhood mental health to be aware of SLCN and the many ways it might present. Professionals need to be able to identify SLCN and be aware of clear pathways to support.

Incentivising schools – budget cuts are impacting on education settings too. In these times of reduced funding and fewer EHCPs, it is imperative that schools are supported from the top down to identify and meet SLCN. The anniversary report asks for provision for SLCN to be considered during Ofsted inspections.

Supporting vulnerable groups – as children who have been excluded from school, those in Care, those with mental health difficulties and those who are involved with youth justice are more likely to have SLCN and are more at risk of their needs going unidentified, improvements need to be made to the support available for these groups as a priority.

This is the main area where I have tried to make an impact – providing training workshops for adopters and prospective adopters to arm them with knowledge of communication development; how to identify red flags and what to do to best support SCLN at home. Myself and another speech and language therapist adopter have also written a social communication group specifically for children with trauma backgrounds which is currently being advertised. It is good to see that work is beginning to happen with children who have experienced, or still are experiencing the Care System in other areas, and training for speech and language therapists in this previously neglected area is becoming more common too.

There are pockets of hope but in short, our work is far from done. RCSLT and ICAN are asking for our ongoing activism. We need to continue speaking up for communication and for children with speech, language and communication needs. We cannot stand by and do nothing.

If you would like to help, here are some things you can do:

• Use the hashtags #SpeakUpForCommunication and #SpeakUpForSLCN on social media
• Make a Vox Pop clip to pledge your commitment to speaking up for SLCN and share on social media (advice here: Vox Pop Guidance ) . I’m still pondering how I can get involved with this anonymously…
• Visit the website here: www.bercow10yearson.com where you can download speech bubbles and get tips on other ways to join in
• Write to your MP, or tweet them. Are they speaking up for communication? They are our representatives in Parliament – we need them to know about SLCN and Bercow10. We need them to speak up most of all.
• Retweet and share this blog
• Tell anyone who will listen about SLCN

Perhaps if we all shout loud enough, real change will happen.

Alternative Gift Guide

In a temporary departure from my usual content, I’ve decided to put together an alternative Christmas gift guide this week. I appreciate my usual audience probably don’t visit an adoption blog to go shopping but bear with me, it’s sort of relevant. This isn’t one of those posts somebody has paid me to write – instead it is a collection of links to companies/people/ items that I have discovered over the last couple of years that I think are doing something good (I don’t get anything out it other than the warm glow of being able to spread the word). Amidst the hyper-commercialism of Christmas, it’s nice to be able to give a gift which gives to someone else or to support a small business. Here are my alternative suggestions:

Masato’s Beanies

If you are after a warm, hand-knitted beanie for yourself or a friend, this is the place to go. We bought one each last year. They’re great quality and kept us snug as bugs in rugs even when it was minus 25 degrees in Lapland. The best part of the deal is that for every hat you buy, one goes to a person living on the streets. Imagine how chilly that would be.

You can also buy socks and a pack goes to someone homeless.

I know some people worry about transparency but the website lists which other companies they work with to get the hats to the people who need them. A very genuine charity, doing it’s bit.

Here’s the link: www.masato.co.uk

Madlug

Did you know that for many children who move about the Care system, their belongings are moved in black bin bags? Madlug, like many of us, don’t think that’s appropriate and that young people should have the dignity of proper luggage at such a vulnerable time.

This is another ‘buy one, give one’ scheme – you buy a rucksack (lots of funky colour choices) and a rucksack goes to a young person in Care. You can also get gym bags or carry-on luggage. What’s not to like?

Here’s the link: www.madlug.com

Centrepoint

Centrepoint is a charity for homeless young people. Unfortunately Care leavers are amongst the most vulnerable to becoming homeless – with as many as 14% spending time on the streets. On the Centrepoint website you can choose to give a gift to a vulnerable young person at Christmas. You can give anything from a hot meal to a jumper to a box of useful utensils to a room for a night. There is a wide range of options, from a £10 donation to much, much more for those who feel able.

www.centrepoint.org.uk

Buddybox

I think the idea behind these subscription boxes is brilliant. They are dubbed ‘a hug in a box’ and are intended for people who are depressed or having a shit time for any reason. As a friend I tend to feel quite helpless if someone I know/ love is in a situation like that. I tend to want to do something but often, there is nothing practical you can do, especially if you are far away from that person. This is the solution to that uncomfortable feeling: send them a Buddybox.

You can send a one off box, as I have tended to, or you can buy someone a subscription for 6 months or a year. I heard about it because someone has bought a subscription for my friend whose baby had died. It was such a lovely thing to have done at such an awfully sad time.

You can even gift one to a stranger.

The contents are different every month and are always designed with self-care in mind. They describe the contents as ‘gender neutral and ageless’ so they are inclusive for all.

The perfect gift for a struggling adopter?

A lovely way to say ‘I’m thinking about you’ or ‘you are not alone’.

And if all else fails and you feel fed up, order one for yourself.

www.blurtitout.org/buddybox

Steph’s Sock Monkey Store

This one is not so much a charitable cause as a small business trying to survive in tricky times. I found these sock monkeys totally by accident, fell in love with them and ordered one each for the boys last year. They’re great quality, bigger than you might think and make gorgeous presents.

There are currently some for sale whose profits are going to Marie Curie and ones where you can sponsor Yorkshire Air Ambulance. You can also buy gift vouchers so the recipient can choose their own monkey during the year.

www.stephssockmonkeystore.co.uk

 

Books

I have read a couple of books recently which are relevant to my blog content – both to do with communication and both an excellent read. The first is this one by Cynthia Pelman:

It is an account of a young boy, Joshy, who has DLD. It is told from the perspective of his speech therapist, his mum and him. It’s the only published account of DLD that I’m aware of at the moment.

 

The second book is written by an inspirational young man, Jonathan Bryan, who painstakingly wrote the whole thing by eye-pointing to an alphabet chart. This is a must-read for anybody interested in communication (especially alternative or augmentative communication) or those working in special education. It is also an inspirational read for anyone who is fascinated by people and overcoming adversity. Some proceeds from the sale of the book go to Teach Us Too – Jonathan’s charity which campaigns for schools to assume learning competence in children with profound disabilities and to give them the opportunities to become literate.

You can follow Jonathan on Twitter @eyecantalk or read his blogs at www.eyecantalk.net

I’m not going to add links for buying the books because I don’t want to just assume Amazon is the only option. There are other booksellers out there!

Baby banks

Up until a couple of weeks ago I had absolutely no idea what a Baby Bank was or that they even existed. Think Food Bank but for baby essentials – nappies, formula, clothes, equipment such as prams and cots. It’s heart-breaking that in England in 2018 we have the need for such a thing but we do. Apparently it tends to be mothers fleeing violent relationships or those who are refugees and cannot access benefits who require the services. However, a recent documentary highlighted that women who work in low-income jobs can struggle to meet the costs of living and having a new baby can be the tipping factor into crisis. One family had been reliant on the Dad’s job as a painter and decorator. He was unfortunately in a car accident which meant he could no longer work as much/ do such heavy jobs and then a baby came along. Baby Banks are there for such situations.

I think many of us have a loft full of no longer needed baby or little people gear – perhaps this would be a good way of getting it to people who really need it. I know they don’t just want tiny things – coats for toddlers are particularly needed over winter. Some are also doing a Christmas campaign where you can help struggling families with Christmas gifts for their children.

I know that when I can finally face sorting out the clutter of my loft, this is where my pre-loved items will go.

Check out www.babybanknetwork.com   (they have centres in Bristol, Exeter, Aberdeenshire & Isle of Wight) or  www.baby-basics.org.uk who have many centres across the country. Both websites have maps which allow you to find similar services close to you.

 

Thank you for persevering with my alternative post if you’ve read to the end! Do let me know if you know of any other organisations who are doing brilliant things – I particularly like the buy one, give one schemes so would love to hear about others if they exist.

Happy gifting!

DLD Awareness Day 2018

It’s been a hefty week for blog-fodder with both National Adoption Week 2018  and International Developmental Language Disorder Awareness Day (Friday 19^th October) landing at the same time – two events I am always keen to talk about.

This year’s theme for DLD day is the ‘ABCs of DLD’. The ‘A’ represents assessing our understanding of DLD. If you want to test how much you know, you can take this handy  Quiz

When I reflect on what I know about it, my professional experience as a speech and language therapist has mainly been usurped by my experiences at home, parenting my son who has DLD. He is currently 6 years old and in Year 2 at school. He has been discharged from speech and language therapy because his scores for both comprehension and expression of language now measure within the expected range for his age. A key thing I have learned is that with the correct intervention, children with DLD can make incredible progress and can catch up (see Speech Therapy Works  for more detail).

Although Little Bear has made unbelievable progress, he does still have DLD. He largely copes well day to day but there are specific times when I notice a difference in how his language system works compared to other people. One time is when he tries to learn a new word or a new name. Little Bear requires much more repetition of unfamiliar vocabulary and often needs me to break new words down into syllables so he can learn them in manageable chunks. He is very good at learning and retaining new words now but the processing part of his speech system isn’t as smooth as it should be and he would struggle to store new words without some specific teaching. If he doesn’t have help to ensure he understands what a word means and what all the bits of it are, he might struggle to say that word correctly e.g. ‘Emily’ recently came out as “Elle-uh-me” and ‘Joseph’ as “Jo-Fitz” or he might mis-store the word e.g. when Little Bear puts on a tall pointy hat, he says he’s being a ‘lizard’ (he means wizard) or he tells me to find things on the ‘window sledge’. Little Bear also uses ‘about’ instead of ‘without’ so will say, “It’s hard to sit on this chair about falling off it.”

Little Bear has good awareness and he knows he’s making the sound errors (he isn’t always aware of the naming errors). He often looks to me at these points to do a bit of speech therapy on the fly to help him. Children with DLD are not un-intelligent. They can learn and retain information like other children, as long as the information is presented to them in an accessible way and/or suitable strategies are employed to help them.

Little Bear’s DLD is also noticeable when he is tired or when he is faced with too much auditory information. He still copes better if large chunks of information are broken down for him and in a conversation it helps him if you are willing to repeat some parts of what you’ve said. He does generally understand the concepts you are talking about and any explanations you give to help him but he can need a little longer to process them, more pauses and sometimes a second chance to listen to the information. If words sound very similar, Little Bear can struggle to differentiate between them e.g. fourteen vs forty, which can impact on his understanding of what he’s heard.

Most of the time, Little Bear can express his thoughts and ideas competently with language, even if they are complex. Occasionally he forgets to reference what he is talking about and we have to ask a few questions to catch up with him. There are some parts of grammar that he makes occasional errors with. We still use modelling strategies at these points.

I think it can be difficult for people who don’t know him well or teachers to see his DLD straight away. Now that his speech sounds are much more accurate, his language difficulties appear more subtle. It isn’t a surprise that DLD is a hidden condition and is widely underdiagnosed or misdiagnosed (see Ensuring Children’s Speech and Language Needs Are Met: A Call to Action for more info).

This brings me to the ‘B’ of the ABCs of DLD – build knowledge.

If you’d like to read more about what Developmental Language Disorder (DLD) is, you can read this previous post: Developmental Language Disorder

DLD is much more prevalent than most people think – 7 times more common than Autism. If you want to estimate how many children are likely to meet the criteria for DLD in your school, you can use this calculator tool: Calculator Tool

A particularly useful source of information to expand your knowledge of DLD is the new RADLD website: www.radld.org

As DLD is often hidden or missed and the consequences of lack of diagnosis/misdiagnosis are so concerning (increased likelihood of unemployment, mental health difficulties and involvement with the criminal justice system) it is imperative that we work together to raise awareness, hence ‘C’ is for create awareness and is my main focus for the day.

Here are some of the things I will be doing to create awareness:

• Emailing my children’s school to share information about DLD and the RADLD website
• Sharing information on my social media channels including tweeting with the hashtag #DLDABC throughout the big day and sharing #my3forDLD
• Sharing this blog
• Wearing my newly printed RADLD campaign t-shirt and hopefully explaining what it’s all about to people who ask me
• Our local newspaper has agreed to print an article I’ve written about DLD on the 18^th. It is going to include a photo of me wearing my campaign t-shirt (their idea, I’m a bit scared and frankly too many people have seen my face this week already!).

 

If you’d like to join in with the fun and make a difference at the same time, you can:

• Use the hashtags #DLDABC and #my3forDLD on Twitter, sharing knowledge, thoughts or ideas
• Share this blog far and wide
• Tell one person what DLD is
• Contact your children’s school to let them know about DLD Awareness Day and the RADLD website (feel free to send them this post)

 

If you have any concerns about your child’s language development or a young person you are working with, contact your local speech and language therapy service. Getting the right support has made an enormous difference to Little Bear. I asked him what difference it had made: “A lot. A big difference because I wasn’t good at talking. It was tricky. My talking is lots better than before. Miles better! I’m good at writing now.” He went on to say that speech therapy was fun and he missed ‘the lady’.

It is never too late to put support in place. Ideally, identification of DLD would be early and support would be tailored and intensive but if the signs have been missed, it isn’t too late. Support in the teenage years continues to be effective.

Teachers, health visitors, social workers, the police, lawyers, people who work in public services (amongst others) all need to know about DLD. They need to know it exists so they can be better at spotting the signs. When we see disruptive behaviour, particularly in classrooms, we need to consider DLD. If we want to improve outcomes for children like Little Bear, we need to spread the word; we need people talking about DLD. Let’s see if we can make that happen…

The Bears’ Summer Writing Challenge

Every summer, libraries do their Summer Reading Challenge to encourage children to read more books. I think it’s a really good idea but this year I had decided we wouldn’t participate*. We do alright on reading here, I really can’t complain. Big Bear will be getting some new books for his birthday and I know he will read them during the holidays, now that he has discovered the pleasure of reading for fun. Little Bear has a well-stocked book shelf, having inherited Big Bear’s picture books as well as acquiring a good collection of his own. He loves reading and we religiously read three books each night, as well as Little Bear reading to me (I have invested in a pack of Oxford Reading Tree books of the right level from The Book People to keep practise up over the hols).

I’m not complacent about reading and I definitely place a high value on it, it’s just that I have already given it a whole heap of my attention and I think we can afford to shift our focus elsewhere now, leaving reading ticking along nicely in the background.

I suppose I have always felt fairly confident in how to support and develop reading at home. Being a speech and language therapist, knowing about phonological awareness (the awareness of the sound structure of words) and how to teach it, is crucial. Phonological awareness underpins speech processing and development but it also underpins literacy. Therefore my career has armed me really, with the tools to help my children learn to read.

Irrespective of teaching the mechanics of reading, I have always believed that it is crucial for a child to feel successful at something and to truly believe they can do it in order for them to develop a confidence in their skills. When it comes to reading, that lightbulb moment often happens when children go out and about and realise they can read signs and labels and text they just happen upon in their environment. It is important to practise reading in a school book but I think children need more than that to truly develop a love and desire for reading. Where possible, at each stage, I have tried to pick books from Little Bear’s shelf that I knew he could read. He often didn’t believe he could because they weren’t colour-banded school books, but once I’d persuaded him to try, the fact that he really could was powerful for him. As was being able to read made up stories we hand wrote on a piece of paper or bits of a cereal packet or words on the TV.

Obviously Little Bear is not yet reading War and Peace but he has the foundation skills in place and is making good progress. As yet, the same cannot be said for writing.

I have to admit that I have been somewhat neglectful of Little Bear’s writing development. There are a few reasons why. Firstly, I do think reading is more important to start with and writing is a skill that can follow. That’s just my opinion: I’m not a teacher, so I may well be going against some sort of law of teaching or other. Secondly, I don’t have the same confidence to support Little Bear’s writing development. What on earth do I know about teaching writing?

As we have now got to the point where Little Bear is pretty happy and confident to read but frequently says he hates writing and that he’s rubbish at it and might sabotage his written work and is what school would term “a reluctant writer” I can no longer hide behind my excuses. The Eureka moment we have all been hoping for has not materialised.

I think what I mean to say is that the Eureka moment has not happened through school input alone. Now, I absolutely do not believe that my ability to teach Little Bear is better than schools. We have already established that I have zero knowledge of teaching writing and I love the Bears’ school and think they do an amazing job. The problem, and I think there is one, is with the curriculum and the pressure on our children to meet all sorts of crazy standards. I haven’t the energy for politics but all I know is that if I were a ‘reluctant writer’ and I found within me the effort to put pencil to paper and immediately as I did, were told my starting letter should have been a capital and that my ‘S’ was incorrectly formed, I probably couldn’t be arsed to try again either.

In considering a way to give Little Bear his Eureka moment, I had a little one of my own. I am no teacher but I am a writer. I don’t profess to ‘know my craft’ as I’m pretty new to it really and am certainly still developing my skills, but I do love it. I had a little think about what I love about it and the answer I came up with definitely wasn’t punctuation or grammar. Whilst I do understand punctuation and I think use it appropriately it really doesn’t excite me and despite studying Linguistic modules at degree level, the more I consider how to craft a piece of writing, the more I fear I know nothing about grammar. Grammar is starting to scare me, but that’s another story. I concluded that my love of writing comes from the fundamental concept that it allows me to take ideas from my brain and put them on a piece of paper. It allows me to express myself. I can say whatever I like. Anything, in the whole world.

That freedom is what I want to gift to Little Bear. I want him to write. I don’t care what he writes, how he forms his letters, if it’s massive or tiny, if it’s in pencil or biro, if he adheres to the rules of grammar or not. I don’t think it is possible, for a child lacking in self-esteem, who struggles so much with rules, to learn to love writing when there are just so many constraints placed upon how he can do it. I know that he will need to go on to learn the rules, of course he will, but it feels like there should be a stage before that in which he can experiment and figure out the whole raison d’etre of writing.

On Friday, the day school ended for summer, I got a couple of little things for the boys to keep them entertained in the holidays. I got them each a notepad and pens and I set them a writing challenge. When I did this I wasn’t too sure whether it might be one of those things Mum comes up with which she thinks is a fabulous idea but actually the children can’t believe what I’m doing to them. I did make my purchases as appealing as possible because every writer needs good stationery and I needed as much help as possible with marketing my idea. Little Bear has a notebook with sequins on it that can be brushed backwards or forwards which he LOVES and Big Bear has a green furry one that smells of apples and who could need anything else? I also provided new pens, in a delectable range of colours.

I set the challenge: to write every day for the whole holiday. Effort and commitment will be rewarded at the end of the holiday. If you don’t write, your chances of reward dwindle. The rules? There are no rules. You can write anything; a story, a list, a diary entry, a song.

I didn’t say this part out loud but I made a deal with myself that anything that got written would not get corrected and would not have to be copied out again. At school they do this ‘purple polishing’ thing which is about checking your work and drafting and re-drafting to achieve the best version of the work you can. I get it, obviously in my writing life I draft and edit and tweak and tinker until the cows come home, but I’m a grown up and I’m trying to get published and if I were a child I would be BORED. Like Little Bear, I would also be disgruntled that I had already tried my best and I simply didn’t have the energy left to do it all again.

On Saturday, after tea, the boys dutifully sat down to write in their books. Big Bear wrote a diary entry in lumo-green. Little Bear began making up a story, every few lines changing colour so it looked like a rainbow. Little Bear wrote a whole paragraph without any sort of encouragement which was more than I’d ever observed him write. We made a big fuss of how well he had done and he was made up when the other three of us each trooped over to read his words aloud.

I feared that my hands-off approach would hamper progress and development but I was heartened to hear Little Bear sounding his words out as he went and applying some of his phonic knowledge. When he got to bigger words he asked for help and I either helped or encouraged as necessary.

On Sunday, when I got up, Little Bear, ever the early bird, was already up and seated at the kitchen table. Apparently he fancied carrying on his story and had covered another page and a half in rainbow writing. It doesn’t make total sense. Some words are missing and I can’t decipher some of it but I am absolutely over the moon at his enthusiasm.

Later on, Big Bear chose to play a computer game and Little Bear chose to write some more.

After tea, Big Bear sat down to do his writing and I told Little Bear he didn’t have to as he had already written plenty, yet down he sat and more story appeared.

On Monday, Tuesday, Wednesday and today, Little Bear picked up his sequined notebook at random points in the day and he wrote. I have not reminded him to do so on any occasion.

I don’t know whether this is his Eureka moment but he has never hitherto shown this level of interest, so I’m feeling optimistic. The curriculum feels quite restrictive to me at times. Why do we need to push our children into complex grammatical structures at such a young age? As if to prove my point, we have homework about extended noun phrases. The power of creativity feels massively undervalued in today’s schooling. Little Bear has a wild imagination. He could be a fabulous writer, but only if we can inspire him.

Having Developmental Language Disorder makes all aspects of literacy harder for Little Bear. He is already pushing a boulder up a hill before he picks up his pencil. I know he can achieve a good level of literacy despite this, but does he?

The whole point of the writing challenge is to ignite his self-belief because, unfortunately, his formal education doesn’t seem able to.

 

 

*When we popped to the library the boys decided they did want to do the Reading Challenge after all so we have challenges come out of our ears!

Ensuring Children’s Speech and Language Needs Are Met: A Call to Action

As most of you know I am a speech and language therapist and my son, Little Bear, has Developmental Language Disorder   (DLD) so it is no surprise that meeting children’s communication needs is kind of a big deal for me. A recent report has come out reviewing speech and language therapy services for children and the findings are a little damning. It is called Bercow10 as it is written by John Bercow (of MP and having-a-bit-of- a-naughty-wife fame) in partnership with ICAN and the RCSLT and is a follow up to the original Bercow report which was written 10 years ago. It is a very important document and I want to share some salient points with you. As many of my readers are involved with adoption in some way, I am going to focus in particular on the bits of the report that are relevant for looked after children, children with mental health needs and children who become involved with youth offending. However, this is something that EVERYBODY needs to know about so please don’t look away, even if you don’t have any obvious connections to the content.

The report begins with an important message: “The most fundamental life skill for children is the ability to communicate” but it goes on to say that “as a nation, we have yet to grasp the significance of this”. This certainly seems to be the case as there are more than 1.4 million children in the UK with speech, language or communication needs (SLCN) yet it is not something we really hear talked about and most people have never heard of DLD despite it being one of the most common disorders of childhood. We hear a lot about the ‘obesity epidemic’ as it has a physical impact on children and a financial impact on the country. Bercow says that SLCN has a developmental impact on children as well as a social and economic impact and should similarly be considered an issue of public health. Being as SLCN impacts upon a child’s education, social, emotional and mental health and their future life chances it is a much bigger issue than it is given credence for.

A good starting point is to raise awareness of SLCN and what that means and what it looks like. If you want to know more about how Little Bear has been impacted by his language difficulties, see these previous blog posts: Living with Speech and Language Difficulties, Communication Difficulties: Update

Children from disadvantaged backgrounds, whether that is due to social disadvantage or maltreatment, are disproportionately affected by SLCN: in some areas as many as 50% of children have language disorder and Looked After Children have poorer language on school entry compared to those who are not Looked After. Children considered high-risk for harm, such as those on a Child Protection Order face a higher risk of SLCN as do children who live with domestic violence. Across the care system as a whole, 63% of children have SLCN, compared to 10% in the non-care experienced population. This makes our most vulnerable children even more vulnerable to poor life outcomes. Children with SLCN in early years are twice as likely to develop social, emotional and behavioural difficulties and are at greater risk of depression or anxiety. Children with poor vocabularies are twice as likely to be unemployed as adults compared to those with age-appropriate language skills.

The statistics are pretty scary. What is also very worrying and makes my heart break a little is that many children’s difficulties are missed or misdiagnosed. Studies have shown that 81% of children with social, emotional or behavioural difficulties, including those with conduct disorder or ADHD have significant undiagnosed SLCN. If we extrapolate that a little, the picture seems even worse. These children, who cannot learn in school (because the curriculum is not accessible to them and teaching is not differentiated for them), often go on to engage is risky behaviours – drug-taking, crime etc. and unfortunately many will go on to find themselves in the youth justice system. Another study shows that 60% of children in the youth justice service have low language skills, often lower than an average 11 year old. Imagine having to be interviewed and appear in court when you cannot access classroom language let alone legal jargon. Many of these young people are then expected to engage with various programmes to aid with their rehabilitation. Statistics suggest that 40% of young people cannot access the content of these ‘verbally mediated interventions’ due to their language difficulties.

If children do not get their needs identified at any early stage and do not receive the therapy they require, the consequences can be dire. This is what Bercow means when he talks about social and economic impact. I think this particularly upsets me because had life been a little different for Little Bear, he could all too easily have fallen victim to this pattern. His behaviour did come before him and had we not been able to see beyond that and not recognised his DLD (and developmental trauma), things could have been very different. Before Little Bear was adopted at the age of 3 and a half, although there was a vague indication in his paperwork that he might have some language delay, he had not been formally assessed by a speech and language therapist. I was shocked at the severity of his communication needs the first time I met him and his language was later assessed as being more than 2 years delayed. I’m not quite sure what other signs would have been needed for a referral to have been triggered but he was certainly at risk of falling through the cracks.

I think there are two key things here. Firstly, if a child is presenting with social, emotional or behavioural difficulties, they should have a speech and language assessment as a matter of course. Behaviour itself is a communication and people in general need to get much better at looking beyond it. The second thing is that other professionals need to become more knowledgeable about SLCN; teachers, health visitors, the police etc. all need to be aware of the ‘red flags’ and seek help to prevent life escalating away from vulnerable children.

The bleak picture I’m painting could possibly all come good if there were excellent speech and language therapy services available to meet need once children were referred. However Bercow is pretty damning about this too. There continues to be a post-code lottery when it comes to availability and quality of services: of all the 2500 respondents, only 15% felt services were available as necessary. More than 50% of people had waited longer than 6 months to receive the therapy they needed and 34% had waited more than a year. This is a statistic I can empathise with as we had to wait over 8 months for Little Bear to be seen for the first time and a year for therapy to begin (see A bit of a rant).

This isn’t good enough. I was lucky to have my professional knowledge to fall back on and could begin helping Little Bear from day one. However, most adopters or foster carers do not have that level of knowledge and couldn’t be expected to. A year is too long to wait for a child who has already been neglected and needs immediate support. Due to Little Bear’s behaviour, our adoption began at crisis point. Thankfully we were able to identify there was a communication element to his needs, as well as developmental trauma, and could begin to tackle it. As most adopters do not happen also to be speech therapists, they would be unlikely to be pre-armed with the knowledge and strategies required. The impact of not receiving support in a timely fashion could be catastrophic.

Our story does provide some good news though, thankfully. The thing is that when quality speech and language therapy is provided, it is extremely effective (see Speech Therapy Works). Despite starting pre-school at the level of a 16 month old across all areas of development, with communication being one of the most difficult areas for Little Bear, by the age of 6 his language levels had improved to within the expected range for his age. Admittedly he received a high level of input, both at home, in clinic and at school but that input was effective. Our story shows that as bleak as this situation seems to be, it doesn’t need to be hopeless. If change can be brought about, services can be improved and awareness can be raised, we can literally transform lives.

Bercow 10 doesn’t just highlight problems, it makes practical recommendations for change under the following headings: communication is crucial; a strategy for system change; an accessible and equitable service for all families; support that makes an impact; early identification and intervention are essential. You can read the full recommendations document here: Bercow10 recommendations

And if you are feeling very keen, you can read the whole report here (it’s really well written and a lot more accessible than I expected): Bercow10 whole report

What can you do to improve outcomes for children?

In order for change to happen, people need to know about the current situation. They need to know about Bercow 10 and its contents. @GillianRudd has begun a petition to bring discussion of Bercow10 to the government to ask them to ensure the implementation of the recommendations so that children’s communication needs can finally be met appropriately. 10,000 signatures are needed for the government to respond to the petition and 100,000 for it to be considered for debate in Parliament. You could help by signing the petition and asking one person you know to sign it too. Just follow this link: petition

Please share this post far and wide to get the message out there.

It is essential that schools, health visitors, psychologists, CAMHS services, doctors and the Police know about Bercow10. Could you share the link with your child’s school or other professional?

If you want to get even more involved than that, see the Calls to Action section of the website: Calls to Action 

Thank you very much in advance for signing petitions and sharing etc. Change has to happen.

 

 

*This post is based on my personal reading and interpretation of the Bercow10 report. If you want to know the sources of my statistics, please see the report.

Unwanted Changes

Things have been going really well for a few weeks here. That way where you begin to think you might have cracked it and that having no specific difficulties is the new normal way of life. I wasn’t getting complacent about it; if anything it was making me feel a bit uncomfortable and suspicious, not because I want to have difficulties but because it seemed a bit too good to be true. About a day after having that thought, some problems predictably began to arise. I don’t think it is anything major at this stage, hopefully not, but we are at the point of thinking Little Bear’s behaviour might be escalating and we are keeping a close eye on what’s going on.

There are two issues, both school based. At the start of the school year we had some School Worries and then various things happened to resolve them (see Alleviating School Worries). Since then there have been niggles but generally an upward trajectory with Little Bear and Mrs C, his TA, getting to know one another better. Over the past two months or so I would say they have got into their groove. Little Bear feels safe with Mrs. C; he listens to her and accepts her authority. Mrs. C has come to understand Little Bear and what he needs and how to help him. Consequently Little Bear’s behaviour has been very settled and he has made fabulous progress. We have been very pleased with how everything has been going.

Unfortunately, Mrs. C is now experiencing some personal issues; a member of her family is very poorly and understandably she needs to take time out to care for them. She is still coming in most days but sometimes only helping Little Bear for an hour before leaving. Obviously I know it can’t be helped and I really feel for her, having been through it all last year with Supergran, but at the same time, with my parent hat on, I’m a bit gutted. Consistency is so important for children who struggle with attachment and trauma. It has taken a long time for this relationship to be properly established and just as things have settled seems an unlucky time for disruption to happen. Mrs. C is Little Bear’s safety net at school now. He knows she is there to help him and without her I suspect he is a little lost.

We are lucky in that Little Bear has made good progress and can now cope with a bit less support and still get some work done, where he couldn’t have managed to earlier in the term and would have become very disruptive. However, we are all too aware that things can escalate quickly when much needed support is taken away. We are keeping an extra close eye on how Little Bear is and checking in with his teacher more frequently.

The school are not currently covering Mrs C’s time when she isn’t there as it likely to be a short term situation but we are concerned that they may need to if Little Bear shows us he isn’t coping.

When I picked Little Bear up yesterday he appeared dyregulated and really struggled to listen on the way home. He did daft things like hide in someone else’s front garden and tried to put a Hula Hoop in his ear that he would not normally do these days. Could this deterioration in behaviour be a sign he isn’t coping quite so well as we thought?

Well, it could, but equally it could be due to the other school issue that we are also concerned about. For some reason that I can’t fathom, the school have changed the entire dinner menu. They have changed it on the premise of it becoming healthier. In practise, they have removed all carbohydrates. Cauliflower rice or celeriac mash anyone?

I’m all for healthy eating and children having their vegetables, of course I am, but I do think this menu has gone about three steps too far. Little Bear loved buying some toast at break time and I always encouraged it because he gets very hungry and I felt it was regulating for him. I am sure there is some evidence about children who have experienced trauma needing more fuel because they expend so much energy trying to stay within their window of tolerance (if anyone knows what I’m on about please point me in the right direction). I also think Little Bear has to work harder due to his Developmental Language Disorder, another reason to keep his energy levels up.

Anyway, needless to say he can’t buy toast anymore because bread is the food of the devil or some such nonsense.

The lunchtime menu now has one choice only so I guess you eat it or you don’t. Previously there were always two choices and personally I feel there still should be – aren’t children allowed to have preferences? My feeling about the food now is that it would probably be delicious for me, a grown up with developed taste buds, who is conscious of my waistline but either I have failed as a parent or my children are lacking in some way as they are very unlikely to eat it. I don’t know many children who would eat harissa lamb or Greek salad or greek yoghurt and berries for every pudding, to be honest. Apparently they have done it on purpose to get the children tasting more things.

The thing is I feel as though they have misunderstood the function of a school lunch. In my eyes yes, it should be as healthy and fresh as possible, but it should be appealing to most children because the most important thing is that they eat it, fill their tummies and are able to approach the afternoon well-regulated and able to concentrate. I think that pushing boundaries and trying things can happen at home or during special events at school but the last thing I want is for Little Bear to push his posh nosh round his plate, not eat any of it and spend the afternoon swinging from the lampshades. Being well-fed is crucial for Little Bear’s behaviour regulation. If he is hungry he will not be able to control himself and he certainly won’t be able to learn.

I feel as though the school has inadvertently created a very exclusive menu which will inevitably exclude many children. There has been no consideration for children who may have restricted diets due to underlying conditions such as Autism or children who have had limited life experiences. Before Little Bear came to us, he didn’t eat any vegetables and perhaps only one or two fruits. The fact that he will happily eat a range now feels like a success to me; I don’t feel the need to push him beyond his comfort zone and I don’t appreciate the inference that my child (or my parenting) is somehow lacking by him not wanting to eat anything on the exclusive school menu. I feel as though it has somehow become an elitist basis on which to separate the parents – those who have succeeded in getting their children to eat like grown-ups and those who haven’t. Bring back jacket potatoes and roast dinners I say, are they really that detrimental to our children’s health?

As an aside, the children are no longer allowed to bring a cake in when it’s their birthday either which I find very sad. I know we are meant to be concerned about childhood obesity but neither of my boys sits still and Little Bear has a six pack to be jealous of. I think he can eat a slice of cake now and again without any of us getting too concerned.

Anyway, menu-related rant aside, I am mainly concerned about Little Bear’s wellbeing and him pushing his friends about and trying to shove crisps into his ears could well be due to hangry-ness. Little Bear not eating his lunch could well be a disaster and could easily lead to an escalation in his behaviour. I am trying to keep a close check on whether he is eating at school, though it is proving difficult as, according to him, yesterday’s lunch was soup and porridge which even by the new menu’s standard seems unlikely.

I know change is unavoidable but on this occasion I really wish they’d left things well alone. For our children, those who have been through enough already, small things can be big things and medium-sized things like not having your trusted adult or being expected to survive a day without carbs can be enough to upset their wagons completely. Here’s hoping this is just a small bump in the road and not the next dip on the rollercoaster.

Books

With it being World Book Day this week, I thought it might be a good time to share some of our favourite children’s books and the reasons they have become important to us.

First Books

The board book pictured was Little Bear’s first book. I know this because we gave it to him during introductions when he was 3 and a half years old. The average 3 and a half year old is likely to have progressed beyond board books quite some time ago and is most likely enjoying a range of picture books with maybe a couple of sentences on each page. I’m going to assume that Little Bear had seen a book somewhere and on occasions someone had read one to him. However, he certainly didn’t own any books and a bedtime story was not part of his bedtime routine, which appeared to involve wrestling him into his pyjamas and beating a hasty retreat, shutting the double height stairgate behind you.

There has been some recent Twitter chat which would suggest that Little Bear was not alone in not having a bedtime story during foster care. This makes me incredibly sad. I know the majority of foster carers work extremely hard and give the children in their care everything they could possible need but evidence suggests they don’t all. For me, a bedtime story (or a story at some other part of the day) is not a pleasant add on, it is an essential part of childhood. Books have so much to offer children, not least in terms of their language development, and not having a bedtime story is a huge opportunity missed, particularly if the child in question has Developmental Language Disorder

The lack of books felt like such a fundamental omission to me that I couldn’t wait until we got home to introduce them. Thankfully I had popped this one into our packing and read it to Little Bear the very first time I put him to bed (after the wrestling into pyjamas part). I was surprised by how quiet he was and how much it held his attention, considering his behaviour the rest of the time. He LOVED it and asked for it repeatedly in the days and weeks afterwards. From there on in he has had a bedtime story. In fact, I feel as though so much time has been wasted for him, he actually has three bedtime stories every night.

Transition Books

We read Little Bear board books for as long as he needed us to and he still has them on his shelf in case he fancies one now. However, when I felt the time was right to move him on, I needed something that bridged the gap between board books which usually have few words on a page and proper picture books which have quite a lot more. The books pictured here and others like them are the ones that bridged the gap nicely. They held Little Bear’s attention well and were good for extending his vocabulary with words that would be within his grasp.

The length of these books was just right at the time, helping to stretch Little Bear’s attention span little by little.

I especially love the bright pictures in the Meg and Mog books and they contain a good level of drama too!

First Picture Book

We’re Going on a Bear Hunt is an important book to us because it was the first book from which Little Bear started to learn parts of the text. The repetition really helped him and he loved anticipating seeing the bear (he has always enjoyed an element of peril!). I remember being so chuffed that he could recite parts of it and fill in blanks when I paused because it was such a leap in language skills. It’s always a pleasure to see a child enjoying a book but especially so when they have been denied the opportunity sooner. It has been an honour really, to be able to take Little Bear by the hand and gently guide him into the world of literature. It’s been an exciting and lovely expedition for both of us.

This is a book that has spilled into our play too and we have been on many walks and adventures looking for bears and chanting “we can’t go over it, we can’t go under it, we have to go through it” and getting very muddy.

Books about Lions and Tigers

The thing about books is that you can get them about anything. ANYTHING. The infinite possibilities are brilliant for a child with a wild imagination (see Fantasy versus Reality) and I love the way you can use a child’s interests to engage them with learning without them really knowing it’s educational. Little Bear is partial to a book with a lion or tiger in it (the element of danger again) and we have built up a bit of a collection. In fact on World Book Day, he will be dressing as a lion and taking The Lion Inside by Rachel Bright as his favourite book.

Never Tickle a Tiger is a relatively new one but it’s a good one as the main character can’t help but fiddle with everything and she really does remind me a lot of Little Bear! He did notice the similarity too.

This collection also shows that Little Bear has progressed with his attention span and can now listen to three of this type of book at bedtime without difficulty. Moreover, he can follow the more complex texts and vocabulary in them which he previously would not have been able to. Books have certainly played their part in his progress.

Books that Rhyme

I think the go-to rhyming books are usually those by Julia Donaldson. We do like those and several feature in our book collection but they generally have quite a lot of text and it has only been more recently that Little Bear has been able to engage with them. For maximum exposure to rhyme and lots of repetition in a short space of time, I don’t think you can beat the Oi Frog books. They are just a little bit naughty too which appeals to boisterous boys. We have read these a lot and they have definitely resulted in laughing out loud. They have also been great for helping Little Bear learn to rhyme (a fairly recent development) which has helped him with his vowel work and with beginning to spell at school.

The Cat in The Hat has been a surprise contender for favourite book. Big Bear never really engaged with it when he was younger but something about it has really grabbed Little Bear. It is also a long story but for some reason he manages it (if he chooses it, it’s the only time we don’t have three stories because we’d be there all night). I suspect he likes it so much because the cat is so naughty. It is a good book for phonic development though and sometimes Little Bear has read some of it to me, helping to build his confidence that he can read other things, not just his school book.

Books that Have Issues

These are books that tackle big emotions and might help with adoption-related things. I Will Love You Anyway is a really lovely book that I struggle to read without a lump in my throat. It is about a dog that keeps running away and is difficult to look after. He hears his humans saying that they can’t cope with him and he’ll have to go. He runs away at night and gets lost and scared until the boy comes and finds him. The message is that no matter what the dog does his humans love him anyway and want to keep him. I suppose its art reflecting life and it really does talk to a child’s insecurities. We like this one.

Where the Wild Things Are is quite an out-there, random book. I’m not really sure how much it speaks to me but it does speak to Little Bear. He seems to really understand the analogy of the boy becoming angry and going off somewhere in his head and I think it makes him feel better that he is not the only one it happens to.

There are quite a few other books like this available. All the ones by Sarah Naish and things like The Big Bag of Worries. We just haven’t dabbled much yet and where we have dabbled, these two are clear favourites.

Books that Get Us Talking

These You Choose books are a recent addition after a teacher friend got Little Bear one for Christmas. They’re absolutely brilliant for language development and I’m going to invest in at least one more for Little Bear’s birthday. On each page there are lots of choices like which job you want to do on the rocket, what you’re going to wear and where you’re going to go. It means that each time you read the book you can make different choices and have a different adventure. They are great for vocabulary development, generating narratives, developing imagination and formulating questions. You could also work on turn-taking, listening and following instructions if you wanted to.

We have been known to use the book to generate verbal sentences which we have then written down for writing practise. I really think they are a fabulous resource and can’t believe I’ve only just found them. They would also be good in a work capacity for building relationships with children you don’t yet know well – it would give you a shared context to begin chatting.

More to the point, Little Bear loves this book and chooses it frequently.

Books for Big Bear

         

Big Bear is an independent reader now. He’s a good reader but rarely reads for pleasure. We have tried all sorts of different books to engage him but to my surprise it has been The Goosebumps Horrorland series that have really grabbed him. He discovered them at school and has taken to disappearing to his room to read one which is pleasantly surprising. He also enjoys Michael Morpurgo books and we went through a phase of devouring all things Roald Dahl.

He has always enjoyed non-fiction, leaving picture books behind at quite an early stage and still does to some extent. We got him a subscription to The Week Junior for his birthday which has encouraged him to read more (though it’s a newspaper not a book) and has led to some interesting conversations. Just tonight he was getting hot under the collar about Donald Trump (he has a point).

His football information books have really held his attention too, though he likes me to read them to him. I’m secretly very pleased that my big boy isn’t too old for a bedtime story yet.

 

These are just some of the books we have enjoyed together and some of the benefits we have gained from them. I haven’t even mentioned that reading together is great bonding time – Little Bear likes a good snuggle-in at story time and it has been a way for other family members like grandparents and aunties and uncles to spend some quality time with him. It is also a predictable and familiar part of his routine now, which may well have contributed to his sleep settling down.

I wonder what books are popular in other people’s houses. Do you have any recommendations for us?

Happy World Book Day everyone,

The Bears xx

 

 

 

Speech Therapy Works

As a Speech and Language Therapist it shouldn’t really be a revelation to me that speech and language therapy works. Obviously I have always believed in it otherwise I wouldn’t have stayed with it as a career for over 14 years. It’s just that trusting something works because you understand the theory behind it and actually experiencing something on a practical level, within your own home, with your child, is quite different.

Obviously I have experienced success in my professional life, but that has been within the confines of a large caseload and various time and resource pressures. In the latter part of my NHS career, as a more senior clinician, my main role was assessment and report-writing. I rarely did any therapy as we had a structure where skilled assistants carried out care plans under our supervision. It meant I didn’t get to know children as well as I’d have liked and I didn’t get to share in their small steps of progress week by week. I re-assessed and reviewed progress, seeing improved assessment scores but that isn’t the same as cultivating progression yourself.

Now that I’m an independent therapist I’m really enjoying being able to properly get to know the children I work with. I’m completely invested in their therapy and am just as pleased when they move forwards or overcome something as I am when Little Bear does. I do see (and feel) therapy working now.

However, what we have experienced at home has taken my belief in speech and language therapy to a whole other level.

I was recently running a communication workshop (for adopters, prospective adopters & professionals) when somebody asked me a question that made me realise the examples I talk about in it, from Little Bear’s communication profile, paint a bleak picture. The picture is totally accurate and reflective of his communication skills when we first met him, aged 3 and a half. The picture, detailing significant difficulties with attention and listening, comprehension, expressive language and speech sound disorder was bleak. At the time I was fairly overwhelmed by his level of need and the magnitude of the task ahead of us.

Here is a very brief summary of Little Bear’s presentation then:

Little Bear was not tuned into language at all and did not respond to verbal instruction, including his own name. His comprehension was better than it appeared but significantly delayed for his age. Little Bear had a very small vocabulary that didn’t meet his needs. He did not have words for common, everyday objects such as cow, train, television, food items etc. Little Bear couldn’t answer ‘what’s your name’, his only size word was ‘big’, he couldn’t name colours or count and he couldn’t put more than about 3 or 4 words together. The words that Little Bear did have were unintelligible. Little Bear was extremely frustrated and he was often left with no other option but to express himself with his behaviour.

I quickly realised this wasn’t a straightforward language delay and that Little Bear’s needs met the criteria for Developmental Language Disorder

At the time I had no idea what the prognosis would be but I suspected it wasn’t rosy and that speech and language therapy would be a big part of our lives for years to come. It was hard to know where to start and easy to become overwhelmed by priorities. There were times I really questioned my faith in what I was doing and wondered if we’d ever get to where we were hoping to go.

I did not expect, in my wildest dreams, that 2 and a half years later a speech and language therapist would observe Little Bear in his mainstream classroom and say there was no discernible difference in language skills between himself and his peers and deem him ready for discharge. Yes, his attention and listening skills still mark him out and there are some minor speech errors but his comprehension and expressive language skills are now within the expected range for his age.

This near miraculous improvement is due wholly to one thing: speech and language therapy.

Admittedly our circumstances are unusual: most children with DLD do not have a parent who is a speech and language therapist and able to provide targeted intervention on tap 24/7. Little Bear has essentially undergone an intensive 2 and a half year block of therapy. Strategies have been used by the whole family and are an automatic part of the way we talk with Little Bear, not something we use for just a couple of minutes each day. The key strategies have included: using environmental sounds to capture Little Bear’s interest as a way in to listening to language; reducing our language; modelling of vocabulary, sentence structures and sound patterns; repetition; showing, explaining & checking understanding of complex concepts or new words as well as seizing every possible communication opportunity. We have done some direct work on auditory memory, phonological awareness (initial sounds, syllables, rhyme, blending sounds together) and speech sounds.

I suppose at any one time I have always had a current communication aim in mind, whether it has been a specific language concept or speech sound and I have found ways to weave this into play or our usual day to day lives. I have very rarely, if at all, asked Little Bear to sit at a table and ‘do speech therapy’, it has been a much more holistic and inbuilt approach than that.

Little Bear has also been seen by an NHS speech and language therapist throughout the past 10 months or so. She has taken the lead on sorting out Little Bear’s disordered vowels which have been complex to assess and set goals for. Generally she has started us off with a sound or activity and we have carried it on between sessions.

The NHS therapist has also set language goals for school and has provided them with programmes to carry out, which they have done.

All of these strategies, techniques and approaches have worked. Their effectiveness is inarguable. Yes, the sum total of the input Little Bear has had is massive and yes, me being a speech and language therapist does make things different. However, I truly believe that a similar impact could be gained by providing parents with good quality, strategy based communication training alongside regular sessions with a speech and language therapist, who could do the assessing and target setting bits, as well as providing resources and guidance. Similarly, if speech and language techniques can be embedded into teaching and used holistically as part of the curriculum (not here and there for 10 minutes) that too can be highly effective and impactful.

Little Bear is living and breathing proof of the efficacy of speech and language intervention. Prior to treatment when I’m almost certain that no strategies were in place, he made negligible progress. In fact, on entering pre-school shortly after coming home, Little Bear was assessed as having a delay of more than 2 years in all areas of his development, with speech and language and numeracy being the most delayed areas. Within 2.5 years of therapy, that gap has closed (meaning that Little Bear has essentially made 4.5 years’ worth of progress) and his comprehension and expression now measure within age expectations on standardised assessment.

Speech and Language Therapy works.

Whilst his progress has been phenomenal, I should point out that speech therapy is not a panacea. Little Bear still has DLD and I suspect it will impact him to a greater or lesser degree into adulthood but what therapy has done for him is allowed him to reach his communication potential, despite having DLD. Little Bear still finds it difficult to learn new vocabulary and to figure out the sound patterns in new words but we know what to do and the strategies work. The approaches that we have built into our daily lives will continue as Little Bear is still going to need them and it is imperative we continue to strive for that meeting of full potential. As the demands of the curriculum increase, we might find we need to access formal therapy again and that would be okay too.

I feel extremely proud of Little Bear’s progress and find myself constantly marvelling at the things he can say now. Last week he took part in his second school assembly. He learned more than double the words he managed last time and was able to recite them in front of the school without any prompts at all. The naughty streak in me did notice that other children in his class had to read their lines or forgot them completely (I don’t mean that badly, it’s just he has never been able to keep up with them before, let alone outshine anyone and he’s more than earned his moment of glory). Not only that but he sat really well throughout, no teacher attached to his side like previously, and he spoke loudly and clearly. Several people came to me afterwards to comment on how well he had done, the difference being so stark in comparison to previous public appearances.

I am truly grateful to speech and language therapy for not only giving me a career I love but for unlocking my son.

 

 

I think I had better make some changes to my workshop too. Although people need to see the bleak picture, they also need to see the sunshine over the rainbow picture that can be gained by using the strategies and applying them diligently. Little Bear’s prognosis appeared extremely poor so his progress really is a beacon of hope.

 

 

Football: A Yardstick for Progress?

Back in the summer of ’15 (no, I am not re-inventing a song) Little Bear had just arrived. It was both a blessing and a curse that this momentous event had taken place during the summer holidays. It was great because it answered the question of how we were going to possibly manage meeting our youngest son a couple of hundred miles away whilst also managing the needs of our elder school-age child.

However, once we were back, the days stretched out interminably ahead of us. Grizzly and I were both on leave and there was no school or pre-school to give some much-needed structure to our days. There was just us and a very unruly seeming energetic mass of a child who at the very minimum needed to be kept out of immediate danger all the livelong day. With the benefit of hindsight I can say that he was traumatised and emotionally at sea. At the time I don’t think we quite knew what had hit us and I’m pretty sure we had barely a second to think about it.

We discovered, within the first hour of his arrival, that being inside the house with Little Bear was kind of difficult. He could not be contained in one room and wandered, nay prowled about, seemingly looking for the most dangerous or unwanted (by adults) tasks to engage in. He was everywhere: up shelves, in cupboards, under furniture. Little Bear was not in any way tuned into language so didn’t respond to any verbal means of trying to shape his behaviour. We spent the first weeks trailing after him, like a Police dog trailing a criminal, trying to anticipate what he might do next, trying to keep up with him, trying to offer distraction. We had to physically remove him from dangerous situations, which triggered his fight response and we were often bitten, scratched, hit or kicked.

It quickly became apparent that we might fair slightly better outside. Wide open spaces were good because there weren’t many things you couldn’t touch and Little Bear could be freer. Obviously the not responding to language thing was tricky, especially when you wanted him to come back. There was many an occasion when Grizzly had to sprint after him but notwithstanding that, things were easier.

You cannot actually live your life in a field though so we did have to try to make do with our small-ish back garden some of the time.

Left to his own devices, Little Bear would have spent the whole day watering the garden with the hose until a flood came and we would have needed Noah on speed-dial. We did of course allow Little Bear some hose time but it was essential we introduced some parameters if we were ever going to gain a modicum of order. As an aside, on one occasion of supervised hosing, Little Bear accidentally caught the sunlight at just the perfect angle to create a rainbow. It was one of the first times he responded to my communication to “look” and together we shared the same reference point and together marvelled at the amazing rainbow. I remember feeling more happy than you might think about that because I had actually reached him. After that we often tried to make a rainbow collaboratively and he began to see the point of me in an interaction. He also learned the word “rainbow” which was a big deal in his otherwise depleted vocabulary.

While the rainbow moment was a mini-turning point, I still did not want a flooded garden and knew that Little Bear needed help to engage with other outdoor activities too. Big Bear was 6 at this point and had recently got very into football. He was keen to be outdoors and was never far from a ball. Little Bear was also interested in the ball and generally ran straight though the middle of a kick-about with the sole purpose of nicking said ball. This was incredibly annoying from Big Bear’s point of view.

We tried to explain that Little Bear was little and didn’t understand games yet or that there were rules and he was really just trying to play. Big Bear could entertain this type of reasoning and would try to follow Little Bear’s lead. Little Bear would pick up the ball and run off, saying ‘catch me’ and looking for you to chase him. Big Bear or one of us would oblige. As he was shouting ‘catch me, catch me’ that’s what we tried to do. Only, when we did catch him, all hell would break loose. I guess because when the catching actually happened he decided he didn’t want it after all. I suppose being grabbed by people you aren’t sure if you trust yet is pretty frightening.

Little Bear would cry, we would be scratched. We would try some reasoning but Little Bear couldn’t process it. Five minutes later Little Bear would be running off with the ball shouting ‘catch me, catch me’ and the whole merry-go-round would begin again.

It was very difficult to manage or to see how to manage it a different way. All we knew was, it was a very inauspicious start to a footballing career and we probably had not just adopted the future David Beckham.

In the summer of 2016, things had developed a little. Big Bear was now getting good at football and wanted to practice properly. Little Bear had fallen totally in love with his brother and wanted to do whatever he was doing. If Big Bear was playing football, Little Bear was close by. Unfortunately he still had a penchant for ball-snatching and though Big Bear is extremely patient with him, it really did push his patience to breaking point. Most football games ended in one or the other or both in tears or storming off.

By this point Big Bear was pretty knowledgeable about the rules of the beautiful game and both he and Grizzly did their utmost to teach the basics to Little Bear. There were a few problems. One was that Little Bear could be (and still can be at times) rather oppositional so rules were like a red rag to a bull. If you told him he wasn’t allowed to pick up the ball, his first urge was to pick up the ball. Another problem is that Little Bear had very poor resilience then and the smallest knock or comment or his own perception that he had done something bad would be enough to cause him to purposefully kick the ball out of play or boot it at someone or call someone a name or hit them. Football continued to be a source of stress, distress and very little enjoyment for anyone involved.

Thankfully for Big Bear, he played football at an after-school club and he joined a club outside of school so he could get his fix somewhere. Interestingly, he had had a rough time because he didn’t like football when he was younger and it had really impacted on his ability to be accepted by the other boys. We had been reluctant about allowing him to join a club as it can be so competitive and the last thing we wanted was for his confidence to take a further knock, for example by being kept on the bench if he wasn’t perceived to be good enough.

Grizzly researched all the options and found a club with an inclusive ethos where all children get an equal go, irrespective of how good they are. Despite our reservations, it was a fantastic experience for Big Bear and did wonders for his confidence, both inside and outside of school. He continues to play for them now and apart from a recent appearance of nerves (a whole other tale, there is always something!) he loves it.

By the summer of 2017 a glimmer of football-related hope began to appear. Little Bear was beginning to tolerate the rules. He accepted they were there but was often in conflict with himself over sticking to them. He was still easily upset and something like the other team scoring a goal could be enough to cause a bit of a situation. However, the situation was generally less dramatic than before and mostly involved him stropping off to a corner of the garden for five minutes.

Alongside this, Little Bear’s language skills had now developed unrecognisably. We could start to talk about how he was feeling and what might be causing his behaviour. We could say things like “I think you are feeling a bit frustrated because the other team scored. That’s ok. Sit there for five minutes then join in again when you’re ready”. We generally didn’t make too much of a fuss and often if we ignored the outburst he would just join in again a few seconds later by himself. We always praised the good decision he had made to come back. We also tried some other techniques like bringing a squidgy stress toy outside with us and Little Bear would go and squeeze that if he was getting annoyed, rather than shouting at somebody or running off with the ball.

Football still had its moments but as the summer wore on I realised that the boys were starting to have a kick-about on their own after tea, while I did the washing up (handily positioned in front of the back window where I could keep a watchful eye). More often than not, the game would go without hitch and I would silently count my blessings when they came back in. They even started to set each other up for specific bits of play e.g. Little Bear would throw the ball so Big Bear could volley it in. Maybe football could be fun in the Bear household after all?

Not long after term started again, Little Bear began asking to join the after school football club that Big Bear attended. I had a lot of concerns. He is extremely tired after school, making listening harder than usual. We were having a very rough phase in the classroom and Little Bear was frequently in trouble for being disruptive. The guy who runs the football is lovely but not especially firm and I’d always rather suspected the children ran amok. Little Bear is not a child who should be allowed to run amok. It is not wise. It could be extremely detrimental.

Little Bear clearly wanted to go though and I had to listen. I decided this was a rare time that a sticker chart might work. I was clear with Little Bear that I couldn’t let him go to the club if he wasn’t going to listen to what he was told because that could be dangerous. The rules would be there to keep him and his friends safe. He gained stickers by doing what he was asked in school, at home and if he was with others like his grandparents. If he didn’t manage to do as he was asked, nothing happened. If he did manage to, a big fuss was made about his ability to make good decisions and he got a sticker.

By October half term the chart was full and I kept to my word and signed him up. I did speak with the football coach about Little Bear’s needs; that rules need to be clear and consistent for him and that he needs to know that the coach and I will talk and if things are not going well, the coach will tell me.

I knew I had to let him try but I was worried.

Last week, out of the blue, I received this message:

Just a quick one, I know you were unsure about signing Little Bear up for football but he has been amazing! I love coaching him, football or PE, just wanted to drop you a message to let you know. And then Big Bear is something else, great kid that doesn’t get the credit he deserves, he’s fantastic.

And my heart melted.

How lovely of the coach to take the time to send me that? I wonder if he really knows how much that means?

I couldn’t possibly have predicted, back in 2005, mid back garden flood, that my little dude would be able to overcome so many hurdles that he would be able to not just cope but flourish in a football club only 2 years later. He’s a phenomenon.

Maybe we did adopt the future David Beckham after all?!

 

And as for Big Bear, he is an extremely patient and lovely big brother and I hope that I at least give him the credit he deserves.