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Film review – Life, Animated

sidebyside : 9th March 2017 22:55 : ASD, blog, review

Regressive Autism

One thing that ‘Life, Animated‘ has in common with the book ‘George and Sam’, which I reviewed here a couple of months back, is the idea of an ‘autistic crash’ – a regression, where parents ‘lose’ the child that they thought was growing up in their home, and inherit an obviously autistic child with a very different developmental outlook. Charlotte Moore describes her son Sam as having had a significant crash at around the age of 6. Owen Suskind, at the centre of ‘Life, Animated’, had his crash at the age of 3, which is much more typical according to what little research there is on the topic.

In ‘Regression in Autistic Spectrum Disorders’ (Neuropsychology Review, 12/2008), the author, Gerry Stefanatos, talks about the utility of home video in supporting the ‘enigmatic scenario’ of autism following after a period of normal development. We are lucky enough to have some in this film, as Owen’s early course of development is described through interviews with him, with his parents, and in home videos.

‘Regressive autism’ is a contentious idea, tied in as it is with ‘acquired autism’ through immunisation and also with gut-flora theory (which is actually not entirely outside of the academic mainstream). As such it is extremely interesting to see that there exists video of a young Owen playing rough and somewhat imaginatively with his dad, with fairly speedy turn-taking and some sensitive adaptions and adoptions of his father’s words and actions. The contrast with later videos of Owen, with his now unusual gait, his head-down demeanour and his ‘slow-or-no’ response to social stimuli, is strong, and frankly rather compelling for those like me who wondered whether regression in ASD is really a thing or not.

This film is part biopic – showing him making his way in the world as a young, autistic adult; part fantasy animation – taking his ideas about the autistic mind and animating them; and part documentary – as he makes his way in the world as a young adult.

Stay in character

Owen’s dad says that ‘Owen vanished’ at the age of three. He stopped sleeping. His motor skills deteriorated. His language processing broke down and he started reciting gibberish. Owen now recalls that people were ‘garbled’ and he could not understand what they were saying. He was diagnosed with autism and therapy commenced, with his parents utterly devastated. The only thing that calmed the young Owen was watching animated Disney films. 

[d͡ʒusə vəʊs] – “Just your voice”. This is what the little mermaid had to exchange to become human. These were also Owen’s first recognisable words in this era. The paediatrician called it echolalia, which of course it was. 

Then after one of his brother’s Walter’s birthday parties, Owen commented that ‘Walter doesn’t want to grow up, like Mowgli or Peter Pan’. This is the moment that Owen’s magnificent dad realised that Disney was not just a refuge for Owen, but that it was something that he was starting to use as a mirror for his own feelings. A window opened, and the whole family began to speak to Owen in Disney dialogue.  

Cue Owen’s dad acting out the role of Iago, the villian’s sidekick in Aladdin. He is incredible. What a playmate he must have been for Owen. 

The film shows how Owen has interpreted the films – Hercules is about not giving up. The Jungle Book is about wanting to have friends. Pinocchio is about wanting to be a real boy. The Hunchback of Notre Dame is about persecution and self-identity. Dumbo and Bambi are about breaking out on your own. The Little Mermaid is about being broken hearted. 

Owen has internalised every moment of the films, he lives the emotions, and he replays them to make sense of his own life. He finds that the exaggerated expression and emotion in the animations assists him in his interpretations. 

[From a speech therapy specific perspective, it’s interesting to meet Michelle Garcia Winner (she of the brilliant You Are A Social Detective book) as she delivers some input to the adult Owen as his ‘Social Thinking Evaluator’.]

Making an impression

For autistic kids, words, interactions, social thoughts, they all run by at a rate of knots, like a dizzying ride on a roller-coaster. The sheer simplicity of an animated social encounter, say between Simba and the threatening Scar, is what makes it so irresistible to the autistic mind. Add in the fact that it can be replayed, unchanging, as many times as you like and you have a useful learning tool for autistic kids.  

Crystallising social thoughts is at the heart of a range of approaches that aim to help autistic kids understand why people do the things they do, including Superflex, Friendship Terrace, and Comic Strip Conversations. Even outside of these formal approaches, adults working with children with autism are always having to find ways to get the child to chase back the vapour trails of social thought. They do this by choosing good play partners for the child, emphasising what that child was thinking, why they thought that what they did, why they did and said what they did and said, what they want them to do, and so on. Different children need a different slant to make this information interesting and meaningful, and we need to be alert to that child’s social references if we are to make an impact on their thinking. 

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Book Review – George and Sam by Charlotte Moore

sidebyside : 5th December 2016 16:46 : blog, books, review

Published in 2003, George and Sam is a record of family life with two autistic boys, hugely different from one another, along with one “neurotypical” child. Charlotte Moore, the boys’ mum, is an excellent writer, a writer first (with an Observer column), who has a wealth of home experience to talk about. Her recollections are funny, touching and extremely thought provoking, for parents and therapists alike.

Her descriptions of her boys define the range of autistic behaviours that I have experienced in practice. Like many of the parents of autistic children that I have worked with, she is forever worrying about what makes for ‘normal’ and trying to minimise her children’s stress. She doesn’t want them ‘stimming’ all day, but she also doesn’t want them to be ‘programmed’ to the hilt, or to have empty lives.

One aspect of the book is her description of the various therapies and approaches that she tried with the boys. These included:

  • Auditory Integration Therapy – which she says was helpful for George, but not for Sam. Her reference gives www.auditoryintegration.net for this, but that doesn’t seem to be up anymore – try here instead.
  • Applied Behavioural Analysis – which she says she wishes she’d started earlier for both of the children. There is more information at www.peach.org.uk. She also calls it ‘Verbal Behaviour Therapy’
  • Dietary intervention – the GF/CF diet, for which the main reference given is the Luke Jackson book.
  • She often mentions the ‘central coherence’ model, which is the rationale behind the ‘Visualising and Verbalising’ programme.

My interests are naturally on the linguistic side, and as such we have in this book some brilliant, sparkling gems of autistic thought and language such as the following.

George’s obscure lyricism:

  • What have you been doing today George? ‘Watching the shadows dance’ (music and movement session).
  • George, pulling out the slimy slice of dill pickle from a hamburger and saying ‘mum, this is my conscience’.

George’s fantastically intelligent delayed echolalia:

  • Pointing at his mum and saying ‘she was a wonderful writer, artist and countrywoman’ – picked straight out of a Beatrix Potter biopic.
  • Saying ‘he jumped into the bath with a tremendous splash’ as he did exactly that.

Sam’s habit of spotting visual correspondences:

  • Regarding a plate of tagliatelle, he said ‘I like seatbelts, mmm, ‘licious’.

Literal interpretations running wild.

  • Charlotte eventually came to the conclusion that one of the reasons George was not eating was because adults were telling him that eating food would make him big and strong. He did not want to change at all.
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Developing language processing skills (3)

sidebyside : 7th April 2016 08:45 : blog, therapy approaches, therapy materials

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I’ve written already about the tasks that I use to develop semantic skills and phonological skills. In these pieces I’ve gone on at great length about how I don’t think there is such a thing for us to target as ‘auditory memory’ per se. This is because it is my view that ‘limited auditory memory’ is just another way of saying ‘impoverished semantic and phonological knowledge’. There is however one further skill that I do develop to support children’s language processing though, and that is visualisation.

Using visual imagery to anchor interpretation isn’t the be-all and end-all of verbal comprehension, but it is a good place to start. Higher-order abilities depend on it. By higher-order abilities, I mean the ability to struggle on, and to draw some kind of interpretation, where the context is only vaguely understood, where nouns and verbs are not familiar to the child, and where possible interpretations are forced into a duel, to be scrubbed and absorbed into the growing proposition. A proposition which needs to embody stability and fuzziness in equal measures, and which is somehow able to snap into a new shape upon the turn of a word or the flicker of a grin.

Back at the most basic level though, some of the children I work with have not learned the art of combining ideas that they hear together into a coherent whole. Descriptions and instructions just become a salad of ideas to them. Language goes ‘in one ear and out the other’. Working on visualisation teaches them to build their interpretations on something concrete, not on sand.

I use elements of a very clever programme called Visualizing and Verbalizing for this work.

The Visualizing and Verbalizing® (V/V®) program develops concept imagery—the ability to create an imagined or imaged gestalt from language—as a basis for comprehension and higher order thinking.

This material is difficult to come by in the UK, and postage is prohibitively expensive. I came across one of the ‘stories’ books in a clinic I used to work in, and loved it. I recently got to buy my own copy of Visualizing and Verbalizing Stories 2, for £15 plus £11 delivery from Abebooks. Compared with what’s available at the moment, that was a bit of a bargain. It’s worth keeping an eye open though.

The book has an impressive 108 stories which range from stories of 4 short sentences designed for preschool children, up to stories composed of three fairly long paragraphs designed for children in year 8. Each story is followed by five questions which probe the child’s ability to extract detail, to give the main idea, to infer, to draw conclusions and to make predictions. The stories are rich in colour and movement, and this, along with the gradual progression in complexity through the book, helps the child develop a strategy for listening that is as effective as it is simple. The scenarios all have very well thought through intentions, consequences, humour and feelings for the child to mull over, alongside the literal comprehension element.

I can’t recommend V/V enough. Hopefully the publishers won’t mind me including an example of a story from the lowest level of complexity to give you an idea of how the stories and questions work:

The little yellow fish swam slowly in the water. Then he darted into a small cave. A big red fish swam by the cave. Soon the little fish swam  out.

  1. What colour did you picture the big fish?
  2. Why do you think the little fish darted into the small cave?
  3. How do you thik the little fish felt when he saw the big fish?
  4. What might the little fish do if the big fish comes back? 
  5. What is the main idea of all these images?
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The ultimate speech therapy word list

sidebyside : 5th April 2016 17:34 : blog, how to, therapy materials

man-29749_960_720Therapists have some rather specific requirements when choosing words for speech work. We’re not just looking for words that end with /k/, we want to contrast these with a sound, say /s/, in word final position – so everything else in the word must be the same. And we only want VC, CVC or CCVC words. Oh and let’s have the vowel as a back-ish vowel to facilitate the /k/. And the onset should be something within the child’s inventory. And of course, each word in the pair should be imageable, functional and known to the child.

Are there any pairs like this? Intuition can only get us so far. The answer to all questions of these sorts can be found in the rather user-unfriendly MRC Psycholinguistic Database. I use it quite a bit in my work – here are some tips for how to get the best out of it.

Let’s run the example from the first paragraph. You could use the box towards the bottom of the search page called ‘Rough Phonetic Transcription’ (RPT) to set the basic word shape that you require, e.g. by typing CVC. You would need, in our case, to run the search a second and third time, with CV, and then CCVC typed into this box. A better alternative, which I will use here, is just to set the number of syllables to 1 by typing in the final box ‘Stress Pattern’.

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Screenshot 2016-04-05 at 15.56.38All of the heavy lifting is going to be done in the box called ‘Precise Phonetic Transcription’ (PPT). Type *[ks] in there. This means ‘one or more phonemes, then either k or s’. Press the ‘Go’ button. We will be returned a list of one-syllable words which have /k/ or /s/ in word final position. 614 of them. We need to filter these to look for useful pairs.

Although there are fields for imageability / age of acquisition / concreteness, etc, they are of no real use, unfortunately. Try it – go to section 1 at the top of the search page, click on the ‘Concreteness’, ‘Imageability’ and ‘Age of Acquisition’ tick boxes, and run the search again. You will see that many of our 614 words have these ratings against them, but many don’t (all of the dashes represent missing data). A search with the age of acquisition set to be no higher than 300 would yield 34 very child-friendly words, but words with no rating, such as ‘bike’, ‘dice’, ‘hiss’, and ‘muck’ would not be included.

Back to our 614 word list then. We want only back-ish vowels, so this means that we can limit our output to words with the following vowels – /ɒ/, /ɑ/, /æ/, /ʌ/,  and /ɔ/, which are known as 0, A, &, V and O here.

You could add these as alternatives, using square brackets again just as you did with [ks], but the words will still be sorted alphabetically, so pairs, not necessarily orthographically related, would still be tricky to dig out*. A more elegant way to look for word-final pairs is to run a separate search for each vowel that you are interested in. Here then are the strings for the PPT field, and the possible pairs that are returned. I have filtered out the useless words manually:

  • *0[ks] – flock / floss; lock / loss; rock / Ross
  • *A[ks] – bark / baas; park / pass
  • *&[ks] – back / bass (the fish); pack / pass
  • *V[ks] – buck / bus; pluck / plus
  • *O[ks] – fork / force; hawk / horse

When you interpret the results, always be on the alert to words that you could use, that might be missing, such as real names, and words that have come into use only in the last few years. You will need to think of these yourself. You will also need to make allowances for how certain vowels are produced in your region (‘park’, ‘pack’, ‘puck’ etc).

There aren’t many great pairs here, but you can be pretty confident that this is about as good as it gets for /k/ versus /s/ WF one-syllable contrasting pairs of words which feature back vowels.

One problem with the approach I have detailed above is diphthongs. For example, a search for words which have /ə/ as their vowel will also show up words that feature /eə/ and /iə/. If you want to eradicate these, do it manually, or you could try specifying that the vowel should be a monophthong in the RPT, by typing in CMC (not forgetting that CCMC and MC, must be run on a separate search).

Anyway, here are some more example searches, off the top of my head, to show what can be done with the database:

Description of searchRough Phonetic TranscriptionPrecise Phonetic TranscriptionStress PatternOutput
/t/ initial CVC words, followed by facilitative /i/, /ɪ/, /aɪ/ and /eɪ/ vowels-t[iIsIaI]*-36 words, including take, tape, teach, team, tin, tip and type
VC wordsVC--101 largely useless words
CVCC words with /sp/, /st/ and /sk/ word finallyCVCC??s[ptk]-106 words, including gasp, nest and mosque
VC, CVC and CVC words that have a diphthong followed by a velar stop*DC*[gk9]-42 words, including ache, spike and 'yoick'. There are no examples of words which have a diphthong followed by a /g/ or an /ŋ/
Two syllable words with /t͡ʃ/ WM, surrounded by facillitative high vowels-*[iI]tS[iI]*??8 words, including itchy and kitchen
CVCVC words with /f/ word-medially, surrounded by vowelsCVCVC??f??-43 words, including barefoot, defeat, coffin, puffin, refill and roughage

* Tricky, but not impossible. If you’re looking for pairs, just go to the alternative which has the fewest examples, and then generate its counterpart in your head. If it’s a word, you have a pair. This is the only way to look for pairs that are contrasted at the initial sound.

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Free Download – “Meaning to Rhyme” activity

sidebyside : 30th March 2016 07:50 : blog, resources, therapy materials

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I have designed this monster resource (a 36 page pdf with 67 examples to work through and full instructions) to help children aged 5-10 who have phonological impairment and poor language processing skills. Click here to download (5MB).

I wrote about this task last week. Essentially it involves asking the child to do something such as ‘think of an animal that rhymes with house‘, while presenting the child with a few possible onsets to work through. As the child learns how to freely generate rhymes, with increasing independence, the task forces her to simultaneously consult her semantic store. This dual activation (essentially, top-down, and bottom-up) makes for deeper learning, about sounds and meaning, and supports language processing.

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I would absolutely love to hear any opinions from therapists, teachers or parents on how this activity is working out for their kids. All of the clipart is in the public domain, downloaded from the excellent openclipart.org.

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Review: CLEAR phonology screen

sidebyside : 28th March 2016 07:00 : blog, review

There are speech sound assessments for all sorts of budgets and purposes: from the £355 DEAP – so good you have to administer it three times; to the £55 STAP-2 – as ugly and as effective as ever in its second edition. I’ve used both, but my preference has always been for the £60 CLEAR from Clear Resources.20160327_203156

20160327_203439The CLEAR’s unique selling point is that each sound is probed, roughly in developmental order, in each position (i.e. word-initially, medially, and finally). The assessment form is then presented in this order, with rough ages of mastery for each sound.

This means that normal and delayed development can easily be demonstrated to parents and teachers by means of the clinician ticking the sounds that the child has mastered, and transcribing in the boxes where the child is making substitutions or errors.

As a means for showing a parent that their 4 year old, who is stopping /s/ to [d], is doing roughly OK, the CLEAR cannot be bettered. It doesn’t have a focus on establishing the aetiology of the problem in the way that the DEAP does, nor does it walk you thorough a phonological analysis like the STAP does. However experienced clinicians will know how to focus their efforts, to do these things when required, using this set of pictures as a foundation.

20160327_203258As far as the choice of pictures goes, things are a little mixed. There are words which I wouldn’t have chosen personally, some because they are too familiar and tend to have odd, islanded productions, such as dog and cat; and other, less familiar words that children often can’t name spontaneously, such as teapot, dice and t-shirt (the kids just say ‘top’). The pictures themselves are quite fun. I love the cat picture, described recently by one of my kids as ‘a cat having a sunbathe’. There’s also some wonderfully dramatic pictures that appeal to all, such as treasure and dragon. 

The CLEAR is well-constructed, double laminated, well-bound, fit to be pulled out of phonology bags for years and years to come.

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Free Download: Colourful Semantics Resource

sidebyside : 25th March 2016 07:15 : blog, resources, therapy materials

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This pack of pictures makes the Black Sheep Verbs pack (reviewed on Monday this week) infinitely more useful. Included are individual, colour-coded pictures of all of the subjects, verbs, direct objects and locations in the example pictures, as well as some sentence frames for arranging the pictures into. I’ve used clip art from a range of sources on the internet for this (copyright free material as far as I could ascertain).

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By having the individual pictures to break down the sentences into their component parts, we can:

  • Support children who miss out grammatical words and morphemes such as ‘the’, ‘is’ and ‘-ing’.
  • Put the focus on the verb for children who have limited verb knowledge.
  • Show children how to systematically think about ‘who’,’ doing what’ and ‘what to’ as they go about describing an event.
  • Give children forced alternatives when they are stuck and unable to name an object or action.

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The resource comes in two parts:

  • A 20 page pdf file with the subject, verb, direct object and location pictures.
  • single page pdf file to be printed on A3 paper which has sentence frames that you can use with the pictures.

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Developing language processing skills (2)

sidebyside : 24th March 2016 07:15 : blog, therapy approaches, therapy materials

neural-pathways-221719_960_720Last week I posted about developing processing skills when the focus is on enhancing the child’s semantic knowledge. This week I’ll look at the phonological side of the coin. There are certain things we know about word sorting / word learning / word finding which play into how we tend to go about boosting phonological form and metaphonological skills:

  • Words are ‘sorted’ in the brain by initial sound, giving us that tip-of-the-tongue feeling when we’re searching for a word. This means that we highlight initial sounds when we’re talking about words with learners, and we require them to do tasks such as ‘I spy’ and initial-sound odd-one-out.
  • Words which rhyme share phonological features. The words ‘hat’ and ‘mat’ have more in common with each other than not, and they therefore share some neural architecture (in terms of their production and in their recognition). Working on rhyme is one thing – showing the child how they can break the onset off from the rest of the word, and swap different onsets in and out. But the real trick is to get them to access their store of meanings as they go about such a task. This is what the task I have been developing is about.
  • Words can be long or short. Traces of word-length and syllable-structure do also seem to come into play in the tip-of-the-tongue feeling. We therefore work on children’s ability to count syllables, to complete words with missing syllables, and to delete syllables from words.
  • Words are composed of individual sounds, or phonemes [fəʊnimz]. Older children are encourage to identify medial sounds, final sounds, to append sounds, to delete sounds, robot talking, and so on.

These are tasks that are designed to support a child’s phonological awareness. Countless studies have proven the link between metaphonological knowledge and reading skills, and there is evidence that working on these kinds of tasks can pay into a child’s development of speech sounds as well.

My new task doesn’t seem particularly innovative, but it is working. Essentially I ask the child ‘think of a word that rhymes with bear which is a piece of furniture’. I also give the child a number of possible onsets to work through (i.e. s, gr, sp, ch, l). The idea is that the child will centre in on the correct answer from both directions at once – one part of the brain is thinking of different bits of furniture and checking them against ‘-air’, while the other is blindly spooling off ‘-air’ rhymes, guided by the onsets that are provided, and checking whether they are a member of the category furniture. I will share the resource just before Easter.

 

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Babies talk and listen through their dummies

sidebyside : 22nd March 2016 07:15 : blog, research

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The current state of the thinking around mirror neurons is a little up in the air, but anyone who works with children will have seen behaviour that points to the theory holding some truth. Children huffing and puffing during bubble-blowing, partially in request, and partially in sympathy; and children with phonological disorder who cannot hear distinctions that they cannot realise themselves are two examples that spring to mind.

There is no other way for a child to make a theory about how an adult is moving their articulators other than to refer to their own anatomy. And if a part of that anatomy is disabled (as anterior movement of the tongue is when a child is using a dummy), then the dummy-using child will basically assume that we are all speaking through dummies as well. This has always been my inkling, and it has recently been confirmed in the paper “Sensorimotor influences on speech perception in infancy” published in November’s Proceedings of the National Academy of Sciences of the United States of America.

“This study indicates that the freedom to make small gestures with their tongue and other articulators when they listen to speech may be an important factor in babies’ perception of the sounds” Prof. Janet Werker, senior author of the study.

The study adds to the evidence that we can point to when we talk to parents about their use of dummies. Although the evidence is somewhat mixed regarding the impact of dummy use on language development, there is at least evidence that extended use is a risk factor for multiple ear infections. I’ve never met a Speech Therapist who didn’t recommend ditching the dummy as early as possible.

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Review – Black Sheep Press Verbs Pack

sidebyside : 21st March 2016 07:15 : blog, review, therapy materials

Colouring in. Page after page of black and white resources. This isn’t mindfulness, this is mindlessness. Luckily for speech therapists who don’t have access to SLTAs (or to teenage kids who need to get back in their good books), Black Sheep Press are going through their resources and colouring them in for us. One of the classic Black Sheep press resources is the 3rd edition of Verbs, which is available for download as a 33 MB pdf file for £15 (£18 including VAT).

LIP1_3Verbs-7In their choice of verbs, BSP have found a good mix between words that are acquired early, and those that are imageable. The pack features transitive, intransitive and ‘locative-type’ verbs, specifically: walking, running, standing, crying, waving, pushing, hiding, climbing, throwing, jumping, falling, kicking, cutting, washing, carrying, brushing, eating, reading, sleeping and sitting.

There are six pictures for each verb. The transitive verbs feature the same subject with different objects (so all pushing pictures feature a bear, pushing a pig, a car, a bed, and so on; all washing pictures feature the mum, washing the car, her face, her baby’s face, and so on). The transitive verbs, such as waving, sittingwalking and running, all have contrasting subjects.

LIP1_3Verbs-8Helen Rippon’s art is clear and fun. She chooses what to put in and what to leave out with the type of confidence that can only be found in someone who has presented a lot of picture material to children. On one hand, she puts things in that will stimulate discussion: the bear is running away from a fierce-looking lion, the people and the animals who are being washed and brushed have very cute sad looks on their faces. On the other hand, the pictures are free from the types of spurious, complicating details that tend to make the children get hung up when you use the pictures to stimulate language.

These pictures are so versatile. I use them to:

  • Develop vocabulary and phrase building. Ask the child ‘who is doing something?’, ‘what are they doing?’, ‘where are they doing it?’, ‘what are they doing it to?’
  • Develop use the pronouns he, she and it.
  • Develop use of the prepositions in, onunder and off.
  • Develop use of simple past tense. Simply ask / model ‘what did she do yesterday?’
  • Get the child to think about sequencing, picking up on clues / inferencing, thinking about ‘what might happen next?’

LIP1_3Verbs-6The pictures are introduced with a host of suggested activities such as lotto games and barrier games that can be played with the cards. I find the pictures useful for children aged upwards of about 3 and a half (as long as they have good attention skills). One thing I often do is to marry the pictures with corresponding toys and act out some of the scenarios, in a small group, modelling the language as I go.

Another big part of how I use these pictures is to mix in the Colourful Semantics approach to developing children’s phrase-building. To this end, I have created a resource which has separate, colour-coded pictures of all of the subjects, verbs and objects from these pictures. I’ll share that on Friday.

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