• Altophobia- fear of height
• Aviophobia – fear of flying
• Arachnophobia – fear of spiders

…to the uncommon:

• Alliumphobia – fear of garlic
• Allodoxaphobia – fear of opinions
• Amathophobia – fear of dust

And those are just a few of the “A’s”! There are literally thousands of recognized phobias; some are culture-specific and some are considered just superstitions.

The point is, it doesn’t matter where it came from, or how silly or ridiculous it seems; if it is true to you, it is very serious. I have had a client so afraid of cats that she ran into traffic to avoid one, literally putting her life in danger.

The great news about phobias, for the majority of people, is that they are very easy to treat. With a few simple techniques, you can learn how to get a hold of the fear, change it and get back on track with your life…minus the fear.

Marygrace Anderson and Michael Gorbell offer hypnotherapy for adults and children at the Putney Clinic of Physical Therapy.  For more information about phobia treatment, contact Marygrace on 07931 547 414 or visit the MG Hypnosis website

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Support for Parents

Homestart is a national charity with local branches.  They provide support to parents who have at least one child under five, and who are struggling to cope for various reasons.  These might include depression, debt, disability, or the isolation that many mums (or dads) feel at times.  I have two children of my own and although like most people I’ve been through some ups and downs as a mum, I feel pretty lucky with my lot, and feel I’d like to give something back while I’m in a position to.

Training

The training course was made up of volunteers from all sorts of backgrounds, but with one thing in common – we’ve all had children, some still babies and some grown up and left home.  The course topics included listening skills, safeguarding policies, parenting skills, and crucially, exploring and understanding our own attitudes and values and learning the importance of being non-judgmental.

Giving children the best start

Many people hesitate to approach Homestart for support because they think their need isn’t great enough, especially if they live in a nice house with a decent income.   Homestart is there to make sure children are getting the best start in life, whatever the family’s background, and circumstances like bereavement, redundancy or depression can affect anyone’s ability to parent their children.  The only criteria to qualify for support are that you live in the borough and have one or more children under 5.  Parents can refer themselves to Homestart or be referred via their GP, health visitor, or child’s school.

What does a volunteer do?

Homestart volunteers provide first-level intervention and support and are not replacement social workers.  The service they provide is very different to that of health visitors or social workers as they spend two to three hours with the family each week, and have time to listen to and get to know the people they are supporting.  And of course they are volunteers, not paid professionals.  Almost all the volunteers have had children, so they know about the highs and lows common to all parents.

Volunteers might encourage a mum who is feeling low or lonely to come out to the park to get the children (and mum) some fresh air and exercise, and the chance for a good chat, or they might signpost them to local support services they could benefit from.  Other ways volunteers can help include accompanying parents to appointments, providing practical help at home, or giving advice on parenting.  The focus is very much on getting the parents back into a position where they can give their children their best.  Perhaps the most important thing Homestart volunteers do is listen, and reassure parents that they know it’s a tough job and that things do get easier.

I’m now waiting to be matched with a family that the Homestart team thinks I will be able to support, and once I’m matched I will visit the family every week for long as they and the Homestart team thinks I’m needed.  It’s quite a commitment, but feedback from families is very positive and many have said that a weekly visit can really help them get back on their feet.  The volunteers that came to speak to us during training have all said that they find volunteering with Homestart to be extremely rewarding and I’m sure I will feel the same.

If you would like to receive support from Homestart, or become a volunteer, you can find out more at www.homestart.org.uk .

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Apps – the future for Speech and Language Therapy?         

One of the biggest challenges for speech and language therapists is keeping children motivated and engaged with their learning activities during therapy. Traditional table-top activities involving pictures, cards and games keep children interested for a limited time but we are always seeking more creative resources. I recently introduced iPhone apps to my therapy sessions for some of the listening activities.  The children responded so well to apps as a therapy medium that I decided to invest in an iPad, which has the advantage of a bigger screen.

It is worth noting here that therapy apps are suitable for children who can learn from computer-based activities; in my experience they are best suited for children over 3 years, with no upper age limit.

Higher level of engagement

Hamaguchi App Fun With Directions

Interestingly children are able to focus on the app activities for longer than on the traditional table-top games. I know children can play videogames for hours at a time and this seems to activate a different part of the brain to the ‘attention to homework’ pathways; I wonder if the use of computer-based language activities taps into the additional focus needed to follow an activity for 15-45 minutes?  One child I see would often try every distraction possible to avoid having to focus on listening skills tasks, because this is an area of difficulty for her. I introduced the same activities in an app and she focused for 30 minutes. She asks to do the activity now and wants to keep going even when we run out of time.

Specific Speech and Language Apps

Articulation Pro App

I have ‘generic’ apps to target speech sound and phonological development, grammar, listening skills, vocabulary, semantic knowledge and sequencing, and this list expands every week as more apps are developed and released. There are also companies who design specific apps especially for speech andlLanguage therapy such as Smarty Ears and Doonan Speech Therapy. Be good to add a little description of these apps and how they help achieve the goals of speech therapy.

The Royal College of Speech and Language Therapy Bulletin reviewed the app ‘Splingo’s Language Universe’ alongside the usual academic books and paper-based resources and was given a high 4-star rating for developing listening skills.  At Children’s Therapies we also like ‘Fun with Directions’ by Hamaguchi Apps and ‘Tilly’s Petting Farm’ for listening and language skills.

Using traditional methods, SLTs and parents spend hours printing, cutting and sticking paper-based pictures to aid with learning target sounds and words.  Now there are speech-sound apps with target sounds and words at all levels of difficulty, and large, bright, colourful and interactive images.

Speech Therapist Supervision

Splingo App

As with traditional table-top activities, it is important that a speech and language therapist is with the child when they use therapy apps. The right target needs to be selected from each app and more importantly the therapist is needed to facilitate the child’s success and learning. The same facilitation techniques are used and cues introduced and withdrawn as the child develops. The child needs to hear and see the therapist talking so that they learn language and speech sounds through interaction.  Apps are great for providing interesting stimulus targets for this learning, but do not take the place of a therapist.  Activities also need to be adjusted according to the child’s level, a skill that cannot be done by the app itself.

Super Dooper App for learning personal pronouns

Apps for therapy homework

Getting kids to do their therapy homework is a battle for parents and therapists alike. Recommending apps to download is easy and economical if the family has access to an iPhone or iPad.  We can advise parents on which targets to focus on and how to help the child achieve and learn during the activities. The children enjoy the games and I find they are engaging more because it doesn’t look line traditional homework. Hopefully we can develop a successful homework programme for each child using apps in the future.

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‘Some feelings can be so confusing, disturbing or painful that they are very hard to manage, let alone think clearly about, or work through. Yet, like food, such feelings need to be properly digested. If they are not, they can live on to haunt us in some way. They can spoil our relationships or interfere with our being able to function properly. They can bring too much unhappiness. This is because the energetic charge of these too difficult or too strong feelings does not just go way. Instead it gets bottled up inside…and can leak out in neurotic symptoms, body symptoms or destructive behaviour.’

- Margot Sunderland, Child Psychologist and Director of the Centre for Child Mental Health (London), from her book Using Storytelling as a Therapeutic Tool with Children (2000)

Reason for Referral

Sophie[i] (aged five) was referred for Dramatherapy after she moved from her family home with her mother and younger sibling following a difficult period of domestic violence. The contributing factors included violence in the home, parent conflict/separation and the transition to a new environment. At the time of referral, Sophie made little reference to these events and had a tendency to mask or distract from her feelings.

Assessment

I met with Sophie’s mother (Ann) and carried out an initial needs assessment in order to put together a clearer picture of the family history and to think about her hopes for the work. She expressed concern for her relationship with her daughter and was worried that her capacity to parent in positive ways had been affected by the violence. Ann also commented that Sophie would express her feeling via her facial expressions but very rarely related her feelings or anxieties in words. She was also experiencing recurrent nightmares and was waiting for long periods to use the toilet; this frequently resulted in accidents. We talked about how repressed thoughts or feelings can give rise to other symptoms. I explained that the Dramatherapy sessions would aim to provide Sophie with a consistent space in which she could begin to share her feelings via her creative engagement (in play or art for example), thereby helping to alleviate their impact, and to make sense of difficult past events.

Therapy

I met with Sophie to introduce Dramatherapy and the room within which the sessions would take place. Based on this meeting and the above assessment, a twelve-week intervention was agreed. A child-led approach was utilised for the majority of the sessions; this allowed Sophie to engage at her own pace, and to develop confidence in the independent choices she made during the sessions. From the outset, Sophie invested considerable importance in the sessions. At first, she engaged in tentative ways and looked for me to reassure her. Via sand and water play, Sophie began to gain confidence and to rediscover her spontaneity. These sensory explorations seemed to provide Sophie with a safe and indirect way to be in touch with those feelings that had become blocked.

Play figures and role-play

As Sophie began to gain confidence and trust in our relationship, she instinctively looked for more direct ways to relate her feelings and experience. In the third session, she chose to use the play figures to act out aspects of the violence she had witnessed. This allowed her to relate her own perspective and to clarify her understanding of what had taken place. In the initial stages of this process, Sophie identified with the role of carer and explored how she had acted to look after her younger sister and to protect her mother. I was able to empathise (through the play) with how hard this must have felt when she was also feeling scared and in need of protection. From then on, Sophie returned to acting out these real incidents for the first part of each session. She would then indicate her readiness to move on and either return to sand and water play (as a way of regulating her feeling) or initiate a role-play scenario. The role-plays allowed Sophie to master previous situations within which she had experienced a lack of power.

Joint mother and child session

A conjoint session (for mother and child) was arranged for midway through the process in order to support their attachment relationship. In this session, a story was used to help Sophie to think about her relationship with her mother. The central character in the story found that his worries and fears were alleviated when he discovered ways to share and manage them with a trusted friend. We thought about the importance of ‘together’; Ann was able to reassure her daughter and to identify with the trusted character in the story. Sophie aligned herself with the central character and reflected that she had found ways to share her worries in the therapy sessions. Ann and Sophie went onto create an image of a special place, which reflected their want to restore their closeness. At the end of this session, Sophie and her mother chose to exchange written words that reflected their love and enjoyment of one another.

After this experience, the role-plays that Sophie directed within the sessions shifted to reflect more balance and harmony. Sophie continued to use the play figures to make sense of past events but she was better able to relate her vulnerable feelings and to identify with her individual needs (as opposed to the needs of her mother and sister). She was able to grieve for the absence of her father and to separate his actions (as wrong) from a more rounded sense of him as a person (and as her father). She began to recall positive family memories and was able to integrate these into a more coherent life story.

Outcome

In the final review meeting, Ann appeared noticeably more relaxed and commented positively on the changes that she had noticed during the course of the intervention. Sophie appeared brighter and more confident; she was communicating her thoughts and feelings to her mother in words and their relationship had improved considerably. Ann also reported that Sophie no longer waited to use the toilet and that the accidents had ceased altogether. She was also sleeping better and had experienced relief from nightmares and fears associated with the dark. Sophie was no longer having to contain the frightening after effects of the trauma; she had learnt that it was safe (and that she felt better) when she found a way to share her feelings. In this final meeting the changes in their relationship were strongly evident; they interacted at an intimate level and engaged reciprocally in conversation.

Case Study of a 3-year-old girl with a developmental speech sound delay.

Therapist:  Sophie Latanowski, Speech and Language Therapist.

Reasons for referral

Lilly was referred for speech therapy by her parents and school due to concerns over her difficulties pronouncing certain speech sounds. These difficulties were making it hard for others, especially those outside her family, to understand Lilly. Lilly had suffered from hearing loss and had grommets inserted at age 3.

As children develop their speech sounds they progress through a certain number of ‘speech processes’ which are essentially ‘normal error’. These resolve naturally by certain ages. However, for many reasons, including hearing loss, some children have delayed speech development and benefit from speech therapy to resolve this.

Assessment

Lilly was seen for an initial assessment to look at her current speech profile and to provide information as to whether intervention was needed and what kind.  Assessment results revealed that Lilly had difficulties with the ‘t’ and ‘d’ sounds and was replacing these with ‘k’ and ‘g’ so ‘letter’ was ‘lekker’ and  ‘bed’ was ‘beg’. This process is called ‘backing’ whereby sounds that should be produced at the front of the mouth are produced at the back instead.  This is not a process found in typically developing speech and therefore was targeted in therapy.

Lilly also showed difficulties with other early developing sounds ‘s’ and ‘v’. These sounds that are produced with a long flow of air were being cut short so ‘f’ was ‘p’  -therefore  ‘fish’ was ‘pish.’ This process is called stopping which is expected to have resolved by the age of 3 years and so was also targeted in therapy.

Therapy

Lilly was seen for individual therapy sessions. The sessions focused on developing Lilly’s awareness and production of the above speech sounds and processes.  For each sound visual materials were used to help Lilly learn them including a picture card with the grapheme and cued articulation (similar to a gesture/sign). Before asking Lilly to produce any of the sounds she had difficulties with, Lilly was provided with many opportunities to hear these sounds being produced correctly (this is known as auditory bombardment). Lilly then completed tasks in which she had to discriminate between a target sound e.g.  ‘t’ and the sound that she replaced it with e.g. ‘k’ to ensure she could tell the two apart.

Therapy then moved on to production. How each of the sounds is produced in the mouth was explained to Lilly using words accompanied by diagrams.  The first step was to get Lilly to have a go at producing her new sounds in isolation (e.g. ‘t’) and then combined with a vowel (e.g. ‘tee’). The next steps were to practice new sounds at the start of words (e.g. ‘tiger’), followed by the end of words (e.g.’boat’) and then in the middle of words (e.g. ‘bottle’) and finally onto sentences.  These were incorporated into fun games. Parents and school staff were given activities to practice in between weekly sessions and advise on how to support Lilly’s new speech sounds in natural conversations was also given, for example if Lilly made an error with one of her new speech sounds, others were to provide her with options e.g. is it a ‘kiger’ or a  ‘tiger,’ emphasizing the correct sound.

Outcome

Lilly made fantastic progress with her target sounds and her parents were very pleased with the difference therapy made to her speech.

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It is very common to see children with ASD complaining of digestive problems such as stomach ache and diarrhea or constipation.  This is usually because many of them will have low levels of digestive enzymes and intolerances to certain foods containing gluten and caseins.  These foods include bread, milk, fast and processed foods (look out for ingredients such as lactose and milk solids).  Foods containing chemicals called salicylates can also be an issue for some children and these are found in a wide variety of foods in varying levels (you can see some examples here http://salicylatesensitivity.com/about/food-guide/).  Testing or elimination is the best way to see if salicylates are affecting your child.  With an elimination diet, results should be seen within six months and symptoms may improve even before that time.

Testing

I will usually recommend that we use some diagnostic tests to establish the child’s nutritional status and gut health.  In particular we may test stools, saliva and urine because these will indicate if the digestive tract has a bacterial imbalance or if food intolerances are present.  It is thought that 92% of autistic children will have heavy metal toxicity, which contributes to their symptoms. This can be tested and improved over time.

Nutrition plan

Whilst every child is unique and will need a bespoke approach, a typical nutrition plan for autism will focus on the following areas:

• Improving digestion – following the test we can identify which bacteria levels need to be reduced or enhanced and we can supplement digestive enzymes to improve the breakdown of foods, which in turn may reduce symptoms like stomach aches, constipation and diarrhea.  The digestive system is the foundation for health so it will always be the first thing that I look at before we move on to other areas.
• Improving detoxification – this will ensure that the child is breaking down toxins and eliminating them properly so that they are not circulating in the system and causing more problems.  One of the simplest things you can do to improve detoxification is to use Epsom Salts in the bath.
• Eliminating trigger foods – as I explained earlier certain foods are likely to contribute to symptoms and by eliminating them we can see marked improvements
• Boosting key nutrients – essential fats, magnesium, vitamin A and vitamin D are all likely to need supplementation in children with ASD, and used in the right way they can improve speech, focus, sleep and immunity

NB: parents should only embark on an in-depth nutrition plan under the guidance of a nutritional therapist.

Fussy eaters

More often than not children with ASD will be very particular about how and what they eat, so I work with parents to give them ideas for lunch boxes and meal times that will improve their nutrition and be acceptable to the child.  Later on this year I hope to release a recipe book that will provide inspiration and ideas to parents of children with ASD.

Joanna’s practice Nutritio is in Balham and you can find out more about her services at www.nutritio.co.uk.

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Experts in child development agree that three things optimise brain development:

• face-to-face interaction with parents or carers
• learning to interact with or manipulate the physical world
• creative problem-solving play.

TV or computer-game screens do not provide any of this.   Watching TV is a passive activity and does not provide real life experience.  Time spent watching TV has a displacement effect and stops children spending time on other, more valuable brain-building activities, such as reading a book with a parent or carer.

When reading a book with their children, parents use a more active communication style, bringing the child into contact with words they may not hear in every day speech, thereby improving their vocabulary and grammatical knowledge.  Children also learn to build relationships through this type of interaction.  In contrast, watching TV is a passive activity that results in significantly fewer descriptions and positive responses from the parent.

 No TV for Under-Twos

The American Academy of Pediatrics recommends that under-twos are not exposed to any television time at all.   Dr Dimitri Christakis at Seattle Children’s Research Institute found that for every extra hour watching DVDs, 8- to 16-month-olds learned six to eight fewer words than children who spent no time in front of the screen. Marie Evans Schmidt at the Centre for Media and Child Health found that even just having television on in the background while under threes play with their toys disrupted their attention span even when they appeared to pay little attention to it.

The French government has even gone so far as to ban stations from showing programmes targeted at under-threes. Last year it also insisted that overseas cable channels must incorporate a tobacco-style warning: “Watching television can slow the development of children under three, even when it involves channels aimed specifically at them.”

And it’s not just very young children who are affected; too much time in front of the TV has been linked with ADHD in older children, and one study showed a link between excessive TV watching in middle age and Alzheimer’s.

Tips for Managing TV Time:

In reality most of us do let our children watch television sometimes, but do think twice about letting under-threes watch TV, and bear in mind the following tips as they grow older:

• Limit the amount of TV your child watches.  About 2 x 30 minutes a day should be the absolute maximum for older children.
• Sit and watch with your child – talk about what you have seen, so you turn the experience into something s/he can learn from.
• Do not have TV on in the background.  Ensure that you are really watching or else turn it off.
• Once the programme or video ends – turn the TV off.
• With older children, make an agreement as to which programmes they will be able to watch.
• Don’t feel guilty about occasionally bending these rules.  We all need to make that urgent phone call sometimes!

Download our Factsheet TV and Your Child Fact Sheet (PDF)

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Changing children’s attitude to food can take a long time so don’t expect immediate results.  Persevering really pays off so follow the steps below and find out for yourself.

1. Get as much as possible prepared ahead of time so that you can sit with your child(ren) during the meal. Eat together as often as possible. Let them see you enjoy your food.
   
2. Get the children involved in some of the preparation and let them experience, as well as talking to them about, textures, colour and smells.  Have them taste the raw ingredients and discuss their likes and dislikes (without judgement).   Look at recipe books with them and discuss the different recipes.
   
3. Decide what rules you want for the table and write them down (or have them in picture form).  Things like ‘Sit with your bottom on the chair;’ ‘Leave toys behind’; ‘Taste food even if you think you won’t like it’; ‘Eat with a fork and spoon/knife’; ‘Keep your plate in front of you; ‘Say please and thank you’ or ‘Ask to get down from the table’. Use a tick-chart to acknowledge them for the rules they are following. Ask your child what the rules are before the meal.
   
4. Praise even the tiniest steps in the right direction: ‘You came and sat down and the four legs of your chair are on the floor’, ‘You didn’t say ‘yuk’, even though this isn’t your favourite food’, ‘you put your fork in a carrot – that’s a brave start!’
   
5. Give a variety of foods during a meal and give quite small portions to start
   
6. If you have children who push the vegetables aside then make the vegetables a first-course that either has to be tried or finished (depending on your rules) before the next course comes along.
7. If your child doesn’t like a food, don’t give up.  You might need to present it to them quite a number of times before they feel brave enough to try the food or before they decide they actually like it.
8. If you feel yourself getting wound up by your child’s behaviour remember they have not yet learnt the behaviour you want from them and  walk away for a minute or two or take some deep breaths.
9. Above all aim to make mealtimes pleasant with some nice background music, lots of praise and  interesting conversation to take the focus away from negative behaviour.
10. Reward good behaviour during mealtimes with a game or story or other non-material, non-food reward immediately afterwards. If you offer sweet things as a reward children will regard these as the treat and other foods as something to be endured rather than something pleasurable in their own right.

Elaine Halligan works at www.theparentpractice.com helping parents to bring out the best in their children.

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“In 2001, the technology magazine Wired coined the phrase “geek syndrome” to describe the threefold increase in autism diagnoses in California’s Silicon Valley over the space of a decade.

The rumour that Bill Gates himself, founder of Microsoft and figurehead of the world IT industry, displays the traits of Asperger’s syndrome, the high-functioning form of autism, spread like wildfire, across – appropriately – the internet.

More than a decade later Cambridge University’s Autism Research Centre is now running a study investigating the previously established link between parents working in hi-tech, scientific and mathematical industries and an increased incidence of children on the autism spectrum. The National Autistic Society reports in its latest member’s magazine that the number of software packages and apps designed specifically for people with autism is rocketing. IT companies in the UK and beyond are actively recruiting an autistic workforce for its highly technical and concentration skills…

Read the full article here

“It’s going to be a challenge, both physically and mentally, especially my stints at 1am and 4am!  The team will be there for the full 24 hours to support each other, and provide the motivation to keep going.  The Starfish Greathearts Foundation is a fantastic charity and we’re determined to raise as much as we can for them.”

If you would like to sponsor Karolina’s team, you can donate at http://www.justgiving.com/teamspin247