If you have a child aged 0-5 who has difficulties communicating, such as not using many words or difficulties understanding your instructions, they may need additional support at home to help them develop these skills. These skills will allow them to request their...
Ugh homework – who’s kid rolls their eyes or gets frustrated if you say the dreaded ‘h’ word. We get it, homework can be boring. However, in relation to therapy – its super important. As your child makes progress in therapy, it is important to continue to build on...
The ability to have a conversation with another person is a seemingly simple aspect of life and social interaction that we can take for granted. Conversations are an important skill that help build meaningful relationships, give and receive emotional support, work...
COVID, Waiting Lists and Getting the Best Therapy As recently as July this year, there has been discussion in the media about the shortage of Speech Pathologists and lengthening waiting lists (Allison, 2021). It was suggested that many children are waiting up to 18...
This is a common question that we often find diligent parents asking when they walk through the doors at Capable Kids. The simple answer is they are here because they are trying to do the best by their child and they have realised or been told by someone that their...
At Capable Kids, we also Occupational therapy for children and young adults. Sometimes a child has been referred to Occupational Therapy alone, but other times they have been told they need to come to Occupational Therapy and Speech Pathology. Occupational Therapists...
by ckengadine | Jul 20, 2020 | Speech Pathology
The ability to have a conversation with another person is a seemingly simple aspect of life and social interaction that we can take for granted. Conversations are an important skill that help build meaningful relationships, give and receive emotional support, work with other people and sometimes even buy that morning coffee. Humans are social creatures and we find a lot of meaning in social connections. Talking is the main way we tend to build these connections with others. But what if you do not know how to have a conversation? What if the nature of this back and forth completely baffles you? How can you build the connections that you crave?
Many children with social language difficulties find themselves in this exact position. These children often have difficulty learning skills from their social They tend to experience difficulties with higher level language such as to understand abstract concepts such as metaphor and drawing inferences or reading between the lines . Conversation with another person involve abstract thinking. You need to constantly be mindful of how the other person is feeling and what they are thinking, understand when it is your turn to talk and how to change and move between topics. To make it even more complicated, the appropriate way to do this can change with every conversation. This leads to the daunting question of how do you teach these skills to someone who is unable to learn it from their environment?
Many programs and resources exist to help children learn skills such as detecting emotional cues (e.g. Secret Agent Society or Talk About), ask questions (e.g. Talking in the Green Zone) and structure a conversation (e.g. Conversation Trains or Talk About) but how do you teach a child how to move between topics? This is a question I often face in my work supporting children with social communication difficulties. After a lot of thought, I have begun to develop my own framework, which I call Conversation Stations. This framework explains the flow of a conversation by comparing it to the structure of railway track.
The Basics of Conversation Stations
I introduce the idea by drawing three stations that are next to each other on the trainline, such as Engadine, Loftus and Sutherland. The child and I then discuss how a train from Sutherland cannot go straight to Engadine – it has to go through Loftus. If a child brings up the idea of express trains, I point out that whilst the train does not stop, it still has to travel through that station. I then explain that conversation topics are like train stations: if you are at one station (talking about one topic), you can’t suddenly jump to another – you can only go to a nearby station, or a related topic. I then give the child a topic, such as the weekend. We brainstorm a related topic and draw these stations as connected by a trainline. We then work out what is related to that topic and so on. Once we have a few stations on a single track, we practice having a conversation up and down the train track. If the child needs help during their turn, I ask if they want to stay at that station or move to a new station. I then ask if they want to tell me something or ask me something.
Expanding Conversation Stations
When the child becomes used to how the basic trainline works, I introduce the idea that each station can be connected to many other stations. One of the challenging parts of a conversation if that there are often many different appropriate topics that we can move to and it is confusing and just about impossible to put them all on the conversation trainline. A conversation is also fluid, so we need to teach this. To address this, I explain how as the needs of a city change and evolve, so does the structure of the trainline. As the needs of the conversation change, we need to change and develop our trainline. We might do this by adding new stations or adding a connecting station/ trainline to a station already on the map. For example, I once asked a child what they did on the weekend and the answer was that they visited a friend. The friend station was on the map, but it was not nearby. It was appropriate for the conversation to move to the “friend” station, so we decided to draw in a train track and add a connecting station, which was “people I saw on the weekend”.
If I child brings up a topic not near the current station or even on the map, I point out the station we are at and ask, “is the [insert topic] station, nearby?” I then remind them that we can only travel to nearby stations. Some children are also quite clever and try to link in their interests to the current topic in a way that does not really fit. For example, I was once at “the weekend” station with a child who loved fitness. After I asked them “what did you do on the weekend?”, they continued the conversation by saying “how many push-ups did you do on the weekend?” When something like this happens, I talk to the child about the main idea of their question or statement and how the main idea needs to be about that conversation station.
Another issue I have encountered is when I tried to build a conversation map with a child that was different from what we used in the previous session. Some of our clients have difficulty with change. This child knew what the map looked like and any changes would make the map wrong. A way around this is to explain that every conversation is like a different city and so has a new map. The trainlines in different cities often have similarities, for example there is often a town hall or central station. The same goes for conversation trainlines – two different conversations may have a “friends” station, but they might look a bit different and connect to different stations.
Conversation Stations is a concept I have found can help children to finally understand how a conversation works. There are so many possibilities about how it can grow and be used. I am very excited to introduce this tool to the world and continue to develop and expand it. If you have any questions or would like to talk to me about Conversation Stations, please email me at email@example.com.
Parent led language intervention via telehealth
COVID, Waiting Lists and Getting the Best Therapy
As recently as July this year, there has been discussion in the media about the shortage of Speech Pathologists and lengthening waiting lists (Allison, 2021). It was suggested that many children are waiting up to 18 months to see a Speech Pathologist, and even when they are seen, therapy services are expensive or limited. These waits are placing children at risk of longer-term difficulties with social interaction and academic progression. Difficulties accessing services have been the source of frequent experiences of frustration and anxiety for parents seeking to help their children, with Capable Kids’ administration staff often fielding calls from parents who want to help with children. Add in the complications of lockdown and social distancing caused by COVID. We are in a situation where the risk of our children missing out on early intervention is even greater.
Is Telehealth right for my child?
However, in this time of frustration and uncertainty, there have been some positives. For the team at Capable Kids, the situation that COVID has presented has forced us to innovate to ensure that our Capable Kids’ families are receiving services that are as effective as if they were free to come into the clinic. Telehealth is the provision of therapy services over a secure video link. In the early intervention sector, telehealth has exploded in the past 12-18 months. For school-aged children, the initial evidence suggests that telehealth services were effective (Wales et al., 2017). While it is possible to engage a preschool or school-aged child over a video call using interactive games, pictures and videos, this was more difficult with our under three population, which required a less structured, more naturalistic intervention style.
So, what about our under 3s?
Luckily for Australian’s who were somewhat distanced from the rest of the world, we were slightly behind the rest of the world when it came to exposure to COVID and all of the risks associated with it. Canada, home of The Hanen Centre, a charitable organisation dedicated to providing evidence-based interventions for children with delays in their language development, had been innovating to adapt their well-established parent training programs to the telehealth world. Hanen Certified Speech-Language Pathologists had been implementing these online, parent training-coaching interventions around the world, with great success.
It takes how many to talk?
The It Takes Two To Talk (ITTTT) program consists of eight small-group parent sessions and three individual parent-child coaching sessions for children who are delayed in their language. This program aims to teach parents to provide intervention strategies to support their children’s language development. The research to support parent-led interventions such as ITTTT is positive, with children who completed the program showing significant improvements in communication, engagement, language and social communication outcomes (Roberts et al., 2019), as well as social-emotional functioning and behaviour (Rose et al., 2020). In some instances, parent-implemented intervention such as ITTTT was more effective than traditional, clinician-directed interventions for late talking toddlers (DeVeney et al., 2017). One of the reasons that this program has been so effective for improving toddlers’ language skills is the heavy involvement of parents, who know their child the best and can implement the strategies throughout the day. The coaching aspect of the program allows parents and Speech Pathologists to work together to find the best strategies to meet the needs of the child and parent in practical, real-life situations.
How do I get involved?
Capable Kids has decided to offer this program to all children on the waiting list for our Engadine and South Coast services to ensure that they receive a timely, evidence-based intervention. The group format means that costs are lower than individual therapy costs. The telehealth format means more flexibility for families, as after-hours times are available and can be accessed from anywhere in the country with internet access. We are very excited to start the first ITTTT telehealth group this month and regularly offer it from now on.
If you are unsure whether your toddler’s language development is delayed, Speech Pathology Australia has published a comprehensive list of communication milestones by age. By 18 months, children should understand up to 50 words and some short phrases, follow simple instructions, use between 6-20 words, name a few body parts, and copy many words and noises. By two years, they should follow two-part instructions, answer simple questions, and say more than 50 single words. If your child is not doing this, a language intervention such as ITTTT will benefit your child. If you would like to know more, please contact the team to find out about the next group.
Allison, C. (2021). Children’s speech problems could turn chronic with lengthy waits for speech therapy. Retrieved 03/08/2021 from https://www.abc.net.au/news/2021-07-16/lengthy-speech-therapy-waitlists-leave-children-vulnerable/100292818
DeVeney, S. L., Hagaman, J. L., & Bjornsen, A. L. (2017). Parent-Implemented Versus Clinician-Directed Interventions for Late-Talking Toddlers: A Systematic Review of the Literature. Communication disorders quarterly, 39(1), 293-302. https://doi.org/10.1177/1525740117705116
Roberts, M. Y., Curtis, P. R., Sone, B. J., & Hampton, L. H. (2019). Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis. JAMA pediatrics, 173(7), 671-680. https://doi.org/10.1001/jamapediatrics.2019.1197
Rose, T., Scarinci, N., Meyer, C., Harris, S., Forsingdal, S., Anger, N., & Webb, K. (2020). The It Takes Two to Talk® – The Hanen Program® for Parents: impacts on child behaviour and social-emotional functioning. Speech, language and hearing, 23(3), 180-188. https://doi.org/10.1080/2050571X.2019.1622832
Wales, D., Skinner, L., & Hayman, M. (2017). The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review. International journal of telerehabilitation, 9(1), 55-70. https://doi.org/10.5195/ijt.2017.6219
In Memory of Sophie Moronski
Sophie, our Disability Support Worker, unfortunately lost her life in January 2021.
Below is her blurb she had written for our website. This summed up her bubbly and caring personality. We will miss you Sophie.
Sophie is a Disability Support Worker who loves her clients and brings a wealth of knowledge, humour and laid back attitude to her job. She has a Diploma in Community Welfare Services and also words as a SLSO at Peterborough SSP. She is the Co-Brainchild of the Burra Café at Peterborough. Alongside the Principal and a teacher, she teaches students barista and hospitality skills. This project will provide capable students to enter the workforce once they leave school. It will endeavour to nurture their skills to gain meaningful employment and install a sense of independence and self-sufficiency.
She was the secretary for YouThink, a youth group for HeadSpace. This group was to provide a youth’s perspective and a voice for HeadSpace to aid in the development of its programs. She was also a member of the Gold Coast’s Advocacy Group.
As mentioned, I have a Diploma in Community Welfare Services. However, my professional development had predominately come from my work experience. Talking with colleagues, learning from students and clients and independent research has been invaluable in my understanding of (dis)orders. However, as I said, I am learning something new every day.
Sophie believes therapy is an ongoing process that can begin with someone crawling on a dirt track and lead them to running up a diamond incrusted highway. In the words of Rachael Hunter “It won’t happen overnight, but it will happen”. Dedication, perseverance, consistency and patience are essential, from all parties, to ensure that therapy will be successful.
She believes in trying everything and anything. If at first you don’t succeed with due perseverance, try something else. Giving up is not an option. There is a solution to any problem.
She likes to gain an understanding for the person in therapy and work with what works for them. Gauging what learning style suits the client best, be it visual, auditory, reading/writing or kinesthetic, she believes is important for the person to succeed. “I don’t try to squeeze a square peg into a circular hole”.