Written by Advanced Clinician, Occupational Therapy, Emily Greenwood
Our occupational therapists work with people living with disability to support them to participate in everyday life.
To celebrate World Occupational Therapy Week and give us a glimpse into all the varied and exciting work our OTs do, we’re sharing “a day in the life of an OT” from one of our advanced clinicians, Emily Greenwood.
8.00am: Once I arrive at the office I start getting prepared for my day and making sure I have everything I need for client visits. As I’m based at Durham Road School I’ll spend some time confirming my appointments with the classroom teachers and looking over individual treatment plans and therapy goals.
I also use this time to catch up on some admin, answer emails and check in with my colleagues and team leader.
9.00am: At 9am I have my first client for the day. Today it’s a home visit for a 2-year-old with fine motor delays and low muscle tone. We use play therapy to work on his postural strength and control, as well as his hand strength.
Using motivating play positions such as standing at a table and pushing through his hands to play with play-dough is such a great way to develop the arches in the palms of the hand and shoulder strength. This is so important for further fine motor skill- development later in life, such as doing up buttons and holding a pencil. It’s a win-win as my client is having so much fun, but I’m also getting him to engage in an age appropriate therapy activity which will help him to achieve his developmental mile-stones.
We always take the time at the beginning or end of an appointment to talk to the parents about what we’ve been covering, and how things have been tracking at home. By working with parents to let them know the strategies we’ve been using, children are able to receive support throughout the week, not just during their therapy sessions.
10.30am: Once I’m back in the office, I write up my notes from the session I‘ve just had and start planning for the next one. I see this client every week, so between appointments I look over the progress he’s making, evaluate how he’s progressing towards his goals and brainstorm what we can try next week.
11.30am: My second client today is a 19 year-old girl transitioning into employment. We work together on updating her resume with her recent volunteer work, practising her interview skills and using the Transperth journey planner. We also spend some time consolidating the skills she’ll need in her new office like organising her workload and using certain computer programs.
12.30-1.00pm: Lunch time! Back in the office I have lunch with the rest of my team. We’ve been celebrating Occupational Therapy Week and today we had a team lunch.
1:00pm- 2:00pm: As I’m based at Durham Road School (an independent public school catering to children with a disability) I have a lot of clients with physical disabilities such as Cerebral Palsy.
This client is 15 years-old and has all 4 of his limbs affected, so he mobilises in a wheelchair. Wheelchairs can be grown as people grow, but normally after 4-5 years it’s time to get a new one.
Luckily I’ve spent my free time over the last few months meeting with the family, completing the assessments and trials for different wheelchairs and comparing the quotes from the different suppliers. I use this time after lunch to sit at my desk, write the necessary reports and submit the wheelchair application to the NDIS to obtain funding for my client.
2.00pm-3pm: I’m off to do a school visit for an eight year-old girl with autism. A key part of our role with school aged kids is to provide strategies that promote inclusion in both academic and extra-curricular activities within schools. Today we’re focussing on increasing her attention span in the class room. I use some visual supports and some fun movement breaks to assist my client to stay on task.
3.30-4pm: Once I’m back in the office I finish up my admin for the day, filling out client cases, responding to emails and preparing as much as I can for tomorrow.
Occupational therapy is an exciting and varied role. I love that I get to work with a wide variety of people every day and assist them in enhancing their ability to live the life they want to live.
Written by Advanced Clinician; Occupational Therapy Alix Combe
Changes can be daunting, especially at key life transition points like starting kindy, primary school, high school and higher education or work.
Our team of therapists and support staff help children, adults, their families and carers to manage these new environments every day. While each person is different and will use unique strategies, we’ve put together some of our most frequently asked questions to get you started on the right path to a smooth transition.
Can parents stay at kindy to help initiate routines?
While increasing your child’s independence and adaptability are key parts of starting kindy, many kindies will invite or allow parents to stay for varying periods of time during the first couple of weeks. Having a chat to the teacher before your child’s first day is a good way to make sure you’re all on the same page and know what to expect. It is also a great opportunity to have a discussion regarding any concerns you may have for your child, and what strategies you currently use to support them in their daily activities.
Having this information in advance will also help you prepare your child in the lead-up to the first day. You’ll be able to tell them how long you’re staying for, so they don’t get a surprise when you leave.
Remember to be calm and reassuring when you are with your child at kindy and saying goodbye (even though this might be really emotional for you)- children will easily pick up on feelings of anxiety or worry.
What’s the best way to prepare for the transition to kindy?
There are lots of different ways to prepare your child for kindy.
It’s very important in the lead up to starting kindy that you encourage your child to feel excited about the upcoming change in their routine. Talk about the fun activities they will get to do at kindy, the children they will get to play with and the play equipment they don’t get to play on at home. You could even show them a picture of their kindy teacher and go for a walk to school to show them what their kindy looks like. If you are worried or scared, your child will likely pick up on these feelings and copy them.
Working on a morning routine in the weeks before hand can help your child to feel safe and in control within their new environment. Once you’ve established what needs to be done in the morning (getting up, getting dressed, eating breakfast, cleaning teeth) try and do these in the same order every morning.
Toileting is often a stressor for parents and their children before going to kindy. As much as possible, start early in teaching your child to pull up and down their pants/underwear without you, wipe their bottom and wash their hands. If your child is reliant on you to do these things they might be anxious if they then need to rely on a kindy teacher or education assistant to help, rather than their parent.
Children with trouble processing verbally delivered information or trouble with focusing will often benefit from a visual schedule. This is like a step-by-step flow chart using images to show tasks, and the order they need to be completed in.
Your child may also benefit from kindy-readiness playgroups. These focus on teaching children to sit and attend to a teacher, follow instructions, play with other peers and engage in different fine motor activities i.e. cutting & gluing, painting, writing and doing puzzles.
Social stories are often excellent tools to help prepare your child for kindy and can include specific information about your child’s own kindy such as what to expect on their first day, who their teacher will be, what their kindy room will look like and who they can talk to if they need help. Your speech pathologist or occupational therapist will be able to help you create these social stories and discuss further strategies to help best prepare you and your child for the kindy transition.
Starting primary school
Public or private school?
Both public and private schools have support services for children with disabilities. In a public school you, the school staff and your child will create an individual education plan. This is a plan written specifically for your child, taking into account their individual educational and personal needs. Your family may also be eligible for additional government funding to support your child’s education.
Children with a disability in independent schools are also eligible for government funding, however it is at a lower level than their counterparts at government schools.
Independent schools all operate slightly differently, and so provide a variety of pathways and strategies. If you’re considering a private or independent school, be sure to set up a meeting with the school to talk to them about what sort of supports they offer. If possible, also request a tour around the school to determine any possible access issues for your child such as classrooms up stairs if they have mobility issues. This will also allow you to get a general feel about the atmosphere of the school, and how it fits with your family. Some good questions to ask are:
How many children are in each class?
Will my child have access to an Education Assistant and how many support hours will they get?
What does the support from an Education Assistant look like?
Will my child be able to access specialist equipment if they need it? i.e. specialist seating, a wheelchair, assistive technology like a laptop with reading/writing software on it?
Do you have inclusion policies in your school?
If my child needs a specific education plan, what is the process for this?
Does the school have written policies in relation to students with disability?
How many students with a disability (or receiving additional funding) does the school currently have?
What are education support centres and education support schools?
Some children with a disability will be eligible to attend an education support centre or school.
Education support centres are located alongside primary and secondary schools. They deliver individualised programs with specialist staff in addition to supporting the child to participate in programs with mainstream peers. The frequency of mainstream integration is different in each education support centre, and is a really important question to ask a school.
Education support schools are separate primary and high schools with on-site access to specialist staff and facilities. Some schools also have onsite therapists.
Both have a strong focus on linking in with employers, training organisations and the Disability Services Commission to make future transitions (such as going to high school and onward from there) easier.
Starting high school
How do I support the transition to high school?
There are many things you can do at home to get ready for the transition to high school.
Start preparing for the transition to high school in year 6. This could include meeting with the school to ensure they are aware of your child’s needs and organising transition visits so your child can go and spend a few days at the high school with other peers from their class or a familiar support person. Your therapists will be able to attend these introductory meetings with you, if you would like their support. Transition visits will give your child the chance to work out the layout of the school i.e. where their lockers will be, where the canteen and lunch area is, the library and gym and where their main classrooms will be etc.
Talking about the new school and routine in advance, visiting the school and working out practicalities such as how to get to and from school can all be done before your child gets to high school. You can also create a high school booklet that includes pictures of the school, their teachers, education assistants and friends that might also be going to school with them. Include information such as how they are getting to and from school and what subjects they will be doing. Doing a lot of preparation in advance will help reduce your child’s anxiety or fears around the ‘unknown’.
Be prepared for ups and downs, especially in the first term. By continuing to communicate with the school staff and your therapy team, you’ll be able to work together to support your child through this transition.
Will my child get special conditions for tests and exams?
Students with a disability that could disadvantage them in timed assessments may be granted special conditions during exams. This could involve extra reading and working times, rest periods, special instructions, use of a computer or scribe and many more. Assessments to determine the type of special conditions your child needs can be completed by school staff and your therapy team.
The school may then need to submit this to the Education Department in advance for approval prior to big exams i.e. WACE exams. Your therapy team and school staff can work together to set up the best learning environment for your child.
Leaving high school
What are my child’s options after high school?
Whether the next step for your child involves building on life skills, engaging in leisure activities, gaining employment or continuing their studies, there are many options and ways to go about this.
High school graduates may be able to go to university, TAFE or study online. This will give them the opportunity to earn a certificate, diploma or degree of higher learning. If your young adult would like to test the waters of higher learning, a short course or holiday course may be a good option for them.
Alternatively, if they’re seeking employment there are many options including supported employment, customised employment, starting a micro-business or working in a full time, part time or casual capacity in a local business (open employment).
Start planning for your young adult’s transition to the workforce in Year 10 so you can discuss work experience options with your high school and link into Disability Support Services in Year 12. Your therapy team can help you with information regarding this.
Ticket to Work is a great resource for school leavers looking for employment. The program helps people with a disability as they prepare for the world of work and provides them with an open employment pathway in their transition from school.
How your child’s vision affects their movement
Written by Therapy Focus Physiotherapist, Jenine Davis
It is very difficult to get along in a world where you can’t tell where you are, where other people are, where objects are, or even where your body ends and the outside world begins.
This is the reality for many children with disability.
Vision involves the brain and the eyes, and so when the two aren’t able to communicate, vision is impaired. Because 80 percent of the information we receive from our environment is visual, understanding what we see is very important.
Poor vision can also result in problems such as difficulty with movement and balance or even social skills.
Vision professionals trained under the medical model mainly look at the structural problems that occur in the eye. A vision problem within the eye will impact a child’s ability to identify objects. This is called focal vision and can be impaired by cataracts and other “hardware” problems. These problems are usually treated with glasses or with surgery.
Behavioural optometrists look at focal vision as well as how we understand what we see. This includes peripheral vision, which takes in the entire visual field. This is a lower-resolution system that operates largely on a non-conscious level, and it works correctly only if the “software” of the nervous system is working properly.
If the peripheral vision system is not working properly, simple activities that you take for granted like climbing stairs, watching TV, or talking with another person can become very difficult and stressful. Objects will appear closer or farther away than they really are, causing you to be clumsy or disoriented. Other people’s body language may be hard to read, making social situations frightening. Catching a football or walking through a crowded hallway can be scary.
In response, seemingly strange behaviours may develop in order to cope. These behaviours are logical responses to sensory input that they don’t understand. Many people with autism walk on their toes, “stim” with their hands, or touch walls as they move through a room. All of these behaviours may stem from their inability to handle both themselves and space at the same time.
Because peripheral visual problems affect the “software” of the visual system, we can’t address them effectively with surgery or standard glasses. However, they can respond well to intervention in the form of vision therapy. Vision therapy can therefore be a valuable form of therapy when treating problems with a child’s movement or behaviour patterns.
If you are concerned about your child’s sensory processing or movement skills, talk to your child’s occupational therapist or physiotherapist.
Pictured: Yoga and stretching class at Therapy Focus’ Goollelal School office
Kaplan, Melvin, 1929. Seeing through new eyes : changing the lives of children with autism, Asperger syndrome and other developmental disabilities through vision therapy / Melvin Kaplan; foreword by Stephen Edelson.—1st American pbk. ed.
Why do kids walk on their toes?
Written by Therapy Focus Physiotherapist, Laura Martin
Toe walking is something many children do while learning to walk. For some kids it’s a completely normal part of development and is quickly out grown, while for others it can be a sign of a bigger problem that requires the support of a multidisciplinary therapy team.
As physiotherapists, toe walking is something we are asked about all the time. While the causes and treatments will be different for everyone, knowing the basics about toe walking can help you understand whether it is a normal part of development, and when you need to speak to a therapist.
What is toe walking?
Toe walking is exactly what it sounds like, walking up on your toes rather than having your heel make first contact with the ground in each step.
Up until the age of 2-3, toe walking is a normal part of learning to walk. If toe walking persists after this age, then it can be classified as idiopathic toe walking, or it could be related to disability.
What causes it?
There are three main areas of the body that may cause a child or adult to toe walk. These are the musculoskeletal system (muscles), sensory system (sensory processing difficulties) or neurological system (muscle tone, reflexes or proprioception).
For children with cerebral palsy or muscular dystrophy, toe walking can be in response to tight muscles and tendons around the calf and heel. This feeling of tightness makes it very uncomfortable to place the sole of the foot on the ground.
Some children with autism will continue to toe walk long after the usual 2-3 year-old point. This can either be a learned habit, or it may relate to sensory processing or motor coordination difficulties. For some children with autism, walking on the whole foot causes over-stimulation and toe walking is an easy way to avoid this.
Should you seek help?
If your child is over the age of 2 and toe walking regularly, it is worth flagging this with your paediatrician or a therapist.
How is it treated?
Toe walking involves a multidisciplinary approach using input from occupational therapists, physiotherapists and speech pathologists to determine why the toe walking is occurring. This will ensure the most effective therapeutic intervention is chosen.
Treatment can include strengthening exercises, stretching, walking retraining, serial casting, botox injections and orthotic management. There’s no one size fits all treatment. Your therapist will look at your child’s individual case and make recommendations based on their findings.
Concerned about your child’s development? Contact us today for more information about the services Therapy Focus can provide to improve movement and mobility for children with disabilities and developmental delays.
If you are already accessing Therapy Focus services, speak with your therapy team.
Pictured: Physiotherapist Laura Martin applying casts to Michael’s legs to help develop his walking
Communicating your goals
Written by Advanced Speech Pathologist, Julie Tan
Goal setting is something we should all practice. Goals give us focus and direction to achieve what’s most important to us.
As Western Australia transitions to the National Disability Insurance Scheme (NDIS), effective goal setting and being able to communicate goals is becoming increasingly important. The planning stage is centred on each NDIS participant’s statement of goals and aspirations, which provides the foundation for their selection of supports.
At Therapy Focus we often use a tool known as the Strengths for Life Profile to help people with disabilities and their families set meaningful, functional, participation-based goals. The profile focuses on what you’re already good at and interested in, and finds ways to develop these strengths and interests into more complex abilities.
By empowering you to focus on your strengths when planning new goals, the Strengths for Life profile supports a positive, upbeat journey to gaining new skills. For example, if a child identifies playing as a strength, this could be used as a building block to achieving goals like talking with others and making friends.
Our therapists developed the Strengths for Life Profile in collaboration with a local artist to create a visually accessible tool that captures a person’s experience across varied contexts. For example; home, school and community.
Once you, your family and your therapist have used the Strengths for Life Profile to identify the broader goal you’re striving for, your therapist can help you make sure your goal is SMART – specific, measurable, attainable, relevant and time-based. When your goals meet these criteria, not only will you be able to better understand what you’re working towards, but you’ll also be able to explain and communicate your goals to those around you.
Setting and achieving goals is an exciting part of life. It’s a continuous process that we’re able to regularly build upon as we grow and progress. By taking time to set the SMART goals and ensuring you’re communicating them effectively, you’ll be setting yourself up for success.
If you’re a current Therapy Focus client, talk to your therapy team about using Strengths for Life. If you’re interested in starting services with Therapy Focus, contact us for more information.
The home modification collaboration
Written by Equipment Funding Team Admin Officer, Simona Gilmore
From completing everyday tasks to seeing family and friends or just relaxing; the safety and accessibility of your home can have a big impact on your daily life. For many people living with disability, home modifications can increase independence and accessibility, and help them make the most of their home.
The first step in the process of a home modification is working with you, your family and carers to identify any barriers or hazards that are currently present in your home. We then discuss your goals for your living space, and what sort of home modifications could help you achieve these.
Modifications might include:
Modifying bathrooms to make them more accessible, usable and safe (e.g. slip resistant flooring)
Installing ramps to make accessing your home easier
Installing rails to provide you with more stability in the home
Widening doorways to provide easier access to the house and rooms inside the house
Installation of sliding doors to provide easier access
Modifying taps to make them easier to turn on and off
Adjusting lighting in the kitchen for better visibility
Adjusting kitchen benches/cupboards to be more functional
Levelling floors within the home
Our Project Manager, Jenny Greensmith, has previously worked as an architect and brings a wealth of knowledge from the disability sector having worked as a Family Connect Worker at Therapy Focus for many years. Jenny can work with you and any builders or tradespeople to ensure your home modifications are exactly what you need.
For more information about how Therapy Focus can help with home modifications, click here.
PEBBLES celebrate World Continence Week
Written by PEBBLES Clinical Program Manager, Deborah Gordon.
This year’s World Continence Week theme, ‘incontinence- it’s no laughing matter’ is one that will resonate with many of us. Bladder and bowel health problems, including leakage (incontinence), are more common when a child or adult has a disability, and can be tricky to navigate.
The good news is, the PEBBLES Team are here to help. With a bit of detective work, we can find out what is causing the problem and we can work with you to overcome or lessen the challenges.
Constipation is a very common bowel problem in both children and adults. Constipation means that the poo is hard, dry and often lumpy. It can hurt to do a poo when it is dry so children may “hold on” and refuse to go to the toilet. This makes the problem worse, as the poo dries out more the longer it says in the lower bowel (colon and rectum). This can result in the rectum becoming overstretched, resulting in a loss of the sensation of fullness and “the need to go” and poo can leak out.
Common causes of constipation include not drinking enough fluid, not being physically active and not eating enough fruit and vegetables.
For some, laxatives are essential to help soften the poo and assist in helping it to pass through the bowel. Laxatives are not habit forming and are an important part of improving bowel health when used under the direction of a health care professional.
My top tips for a healthy bowel are:
Go to the toilet when you feel the sensation of needing to do a poo
Eat two servings of fruit and five servings of vegetables every day
Be as physically active as possible
When sitting on the toilet make sure the feet are supported – preferably on a stool, so that the knees are up higher than the hips. Lean slightly forwards so that the elbows rest on the thighs
Having a full bowel can also stop the bladder from working properly and aggravate problems like bladder leakage and bed wetting. Our PEBBLES Team will try to resolve bowel issues first because we know that this will help the bladder too.
To keep your bladder healthy there are some easy steps you can take. Drinking plenty of water, taking the time to empty your bladder properly without straining, and going when you need to go (not “just in case”) is a good place to start.
Whilst incontinence is not a laughing matter, achieving better bladder and bowel health is definitely something to smile about.
Written by Therapy Focus Speech Pathologist, Tania Muscat.
At Therapy Focus we use what’s called a ‘Key Worker model’ when delivering therapy services. The model ensures that the people we work with have one main contact at Therapy Focus, but access to a team of clinicians with diverse skill sets and knowledge to achieve the best outcomes.
A Key Worker is one therapist within a team, and is responsible for coordinating a client’s therapy services. The Key Worker establishes a relationship with the client, their family and/or carer(s), and supports the development of therapy goals. They keep in regular contact to ensure needs are being met and all stakeholders (team clinicians, general practitioners, other service providers) are kept up-to-date on the progress of goals.
Key Workers empower clients and their families to engage in therapy and utilise the network of supports around them. They provide information and advice to the client, their family and/or carer(s) on behalf of the broader therapy team, and assist with implementation of strategies that promote learning and development.
The Key Worker model is vital when clients are widely spread geographically, like in the Mandurah/Peel area for example. To ensure consistent and regular therapy, the Key Worker will collaborate with clinicians in the broader therapy team before and after a visit to discuss and model potential strategies. As a client’s therapy goals change, therapy teams will explore whether the Key Worker needs to change to best support the client.
“The relationship that forms between a family and a key worker is a dynamic one, characterised by mutual acceptance, respect, trust, commitment, openness and shared responsibility” – Alexander, S., & Forster, J. (2012) The Key Worker: Resources for Early Childhood Intervention Professionals (Ed. 1st), Noah’s Ark Inc: Malvern VIC.
Written by Therapy Focus Occupational Therapist, Celine Windsor.
“What opportunities does my child have to keep learning after high school?” This is a common question parents ask. The following article by Therapy Focus Occupational Therapist Celine Windsor outlines the various options for post-school study as well as what supports may be available.
There are many ways that people with disabilities can continue to learn after high school, whether the goal is gaining life skills and/or finding employment. Your young adult may be able to go to university, TAFE or study online with a Registered Training Organisation (RTO), which could lead to a certificate, diploma or degree of higher learning. There are also many holiday or short courses on offer.
Most providers of tertiary studies are very accommodating and willing to do what they can to help people with disabilities to complete the requirements of their course. Each learning centre will have an Abilities Coordinator or Disability Support Officer available to provide information about:
Scholarships or grants
Campus tours with a focus on accessibility
Support services including advocacy, counselling, mentoring, AUSLAN interpreters or scribe
Study, exam and assignment techniques and workshops
Where to go for help
Options for support such as negotiating course loads, exam condition and liaising with teachers on the student’s behalf
Even if they are not able to finish their studies, having the opportunity to learn can still be helpful for personal growth and self-discovery.
For more information
Career Centre – A great starting point to find out more about pathways to different jobs or careers.
Written by Therapy Focus Social Workers, Amanda McKinnell and Jo Andrews.*
In our experience, there are many assumptions and a lot of confusion about what social workers actually do. Often we’re seen as people who simply have a chat over a cuppa for example.
But there is so much more to our role than simply talking with others. Social workers help people manage difficult relationships, overcome challenging situations they’re unable to cope with alone, and help get lives back on track.
Building effective working relationships is at the heart of what we do. Social workers work with people to help them find solutions to their problems and support them to manage things more independently. In instances of families where a member has a disability, we understand that some problems cannot be solved. In this case our goal is to assist the family to remain strong and hopeful. We believe that the situation is the problem, not the person.
Social workers also work for people by advocating on their behalf. We work to ensure their voice is heard and that they have access to the services and resources they need. We also work collaboratively with other health professionals to ensure service systems work effectively for the people we support.
In summary, social workers can provide support in the following areas:
Identifying support requirements
Linking families to useful services
Information and referral for:
If you’re a Therapy Focus client and would like support from a Therapy Focus Social Worker, please speak to your therapy team (please note that at present we are only able to support clients in the Southern and Eastern suburbs). For more information about Therapy Focus’ range of therapy and support services, contact us on 1300 135 373.
*This article was written in consultation with Dr Brenda Clare.
What is Central Auditory Processing Disorder?
Written by Therapy Focus Speech Pathologist Ruyi Tong.
“Everyone, please get your homework from your bags outside, put it on my desk, then come to the front with your blue maths book. Today we will talk about fractions, which are on page 5 of your book.”
Sam takes out her maths book and looks around, confused. She can’t understand why the rest of her classmates are leaving their desks and heading outside.
Is Sam being defiant? Why isn’t she following instructions? Her hearing has been tested and there is nothing wrong with it. Perhaps Sam has heard her teacher, but finds it difficult to process or understand what was said?
As a therapist, situations such as this set off alarm bells that signal there may be central auditory processing issues.
Central auditory… what?
Central Auditory Processing Disorder (CAPD) is the inability to understand verbal language in a meaningful way, in the absence of a hearing loss. In other words, there are issues with the way the ear talks to the brain, and the brain has trouble interpreting what the ear is trying to tell it. The disorder may also be referred to as auditory comprehension deficit, word deafness and auditory perceptual processing dysfunction. This problem is commonly experienced when complex language is used, long instructions are given, speech is too rapid, and when there is a lot of noise.
What can be done?
There are 2 treatment approaches for Central Auditory Processing Disorder.
The first focuses on training certain listening skills such as word discrimination (e.g. telling the difference between peas and bees), identifying where sounds are coming from (e.g. is it from the left or right side of your body), putting different letter sounds together to form words, or identifying a sound in the presence of noise (e.g. being able to focus on the ticking of a clock in a noisy room).
The downside of this approach is that some individual may not be able to use these skills in everyday environments.
Therefore the other approach focuses on modifying the environments the individual is regularly in. Examples include:
Sit the individual away from auditory and visual distractions. In the classroom, for example, choose a seat close to the teacher and white/blackboard and away from any windows and doors.
Reduce external visual distractions like busy bulletin boards
Place mats on the floor and walls to absorb noise
Ear plugs may be useful to distract from ambient noise such as the air-conditioner or a pencil sharpener
See an audiologist to discuss the use of an FM system. These systems work by transmitting the teacher’s voice directly to the individual’s ear, minus any background noise.
Gain the individual’s attention before speaking
Speak slowly and clearly
Break lengthy instructions into a few shorter instructions that follow a logical order
Emphasise key words
Use visual aids such as written instructions (depending on the individual’s literacy level)
Central Auditory Processing Disorder can affect reading and spelling, therefore early identification, typically by a speech pathologist or audiologist, is beneficial.
Therapy Focus offers a range of assessments to help identify difficulties in a number of developmental areas, including auditory processing. For more information visit www.therapyfocus.org.au/assessments.
How is autism diagnosed?
Written by Therapy Focus Speech Pathologist Christine Bosch.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects three main areas of an individual’s life: communication, social interaction and repetitive and restricted behaviours.
Approximately one in every 88 people has autism and, although the cause is unknown, genetic factors have been identified. But how is it diagnosed?
The ‘gold standard’ in terms of diagnosing autism is a comprehensive assessment conducted by a paediatrician (children) or psychiatrist (adults), and a clinical psychologist and speech pathologist using the criteria outlined by the Diagnostic Statistical Manual (DSM-5). All three medical professionals have to be in agreement with the findings of the assessment before the paediatrician/psychiatrist makes the final diagnosis. The diagnostic process involves a detailed observation of the individual’s behaviour as well as a detailed parent interview. An individual with autism may or may not also have a language impairment and/or intellectual disability.
If you are concerned that your child may be presenting with signs of autism, contact your paediatrician and they will make the appropriate referrals according to the findings of their initial assessment. Once a diagnosis is confirmed, an individual with autism is eligible for various services relating to school, therapy and assistance in the community depending upon the needs of the individual and the severity of the diagnosis.
Signs of autism can include:
Difficulty with the flow of conversation, including reverting conversations back to self- interests, difficulty listening, frequent interruptions or lack of engagement
Language difficulties such as speech delays or difficulty with abstract reasoning
Difficulty using and interpreting others’ body language, gestures and facial expressions
Problems with play including difficulties with imaginative and pretend play, as well as engaging in play routines with peers
Difficulty making and maintaining relationships with friends or significant others
Difficulty with processing sensory stimuli such as an oversensitivity to noise
Behaviours that are repetitive or ritualistic and the child has to complete that ritual before moving onto another task
Difficulty with making transitions
‘Black and white’ thinking and an inflexibility regarding rules or routines
There is a significant body of evidence that suggests that early intervention is the best solution and leads to the best outcomes in terms of therapy. An appropriate diagnosis also means that a child can receive additional assistance at school as well as have access to community supports.
If you are concerned that your child might be showing signs of autism, contact your paediatrician and they will guide you through the diagnostic process.
Mealtimes can be sense-ational!
Written by Therapy Focus Speech Pathologist Lisa Hargraves and Occupational Therapist Alice Kettle.
Mealtimes can be very stressful for parents of children with tricky behaviours and fussy eating habits.
But an approach called ‘Sense-ational Mealtimes’ developed by Gillian Griffiths and Denise Stapleton is helping parents better understand mealtime challenges and supporting them to set realistic goals.
The approach is aimed at children who:
eat a small range of foods
avoid entire food groups
refuse to sit and eat with the family at mealtimes
react negatively when presented with new foods and/or
insist on the same food at each mealtime
All of which are commonly experienced by children with autism.
The Sense-ational Mealtimes approach includes strategies such as:
How to prepare your child’s senses for mealtimes
How to put a time limit on mealtimes
How to position your child so s/he is supported during mealtimes
How to talk about feelings and sensations during mealtimes
How to increase your child’s appetite
How to adapt favourite meals to suit each member of the family
Initially an information session is provided to families using the Sense-ational Mealtimes approach, which helps parents explore their child’s nutritional needs, feeding behaviours and sensory experiences at mealtimes.
One of the most useful tools to support parents to understand the process of food acceptance is a visual diagram called the ‘Sensory Whirlwind’.
The Sensory Whirlwind supports parents to identify how their child is currently experiencing a particular food and how to take steps toward their child eventually eating that food.
For example, a child who dislikes carrots may have learned to accept seeing the food on their parents’ plates but is not yet ready to touch it. In this scenario, the parents are encouraged to talk about the food and show enjoyment when eating it, without pressuring their child to touch it or try it. Once the child is comfortable seeing it on their parents’ plates, parents may then try placing the carrot on the child’s plate. Again, there is no pressure for the child to touch it or try it. Over time, as the child becomes comfortable with the carrot on their own plate, they may take the next step of touching it and maybe even bringing it to their lips.
The time a child takes to move through each step of the Whirlwind will vary greatly. It can be a slow process, but taking it gradually can help to develop trust between the child and parents at mealtimes.
Another aspect of the approach encourages parents to reflect on their own past experiences of food when they were growing up. It is important for parents to know and understand their own feelings and sensory preferences around food in order to help their child.
When a child feels safe and supported by their family to explore foods, there is a greater chance of success at building up the range of foods that they will accept at mealtimes.
Written by Therapy Focus Occupational Therapist, Deanne Coleman.
As I live and work in the Cockburn area my family and I have been eagerly looking forward to visiting the new Bibra Lake Regional Playground, which opened on Saturday 12 November.
We visited on opening weekend, so it was busy! Despite the madness, we were able to find a car park relatively easily. I was also pleased to see that there were a couple of disabled car bays close to both entrances of the playground.
The first thing I noticed about the playground is that it’s able to be locked and gated! Tick! This is a must for my mother’s group, as most of us have more than one child and it’s much more relaxed when we’re at a park where the kids can roam around (relatively) safely!
The playground boasts many different activities aimed at all abilities and ages, and I have to say I was impressed. The playground is surrounded by paving, grass or soft form the whole way around. There are a lot of sensory and water play activities, which is great for children with disabilities. Also very popular with the kids was the accessible swing set and flying fox!
The playground offers plenty of amenities including ambulant toilets and a fully fitted out disabled toilet with a ceiling hoist and adjustable adult sized change table. Unfortunately this is not ready for use yet, but it will be soon.
The lush and plentiful trees provide plenty of shade in which to enjoy sitting on the grass with little ones. Another thing I love about this playground is the use of nature in the design. There are rocks to climb and saw dust to play in!
Unfortunately we ran out of time trying to look at everything this playground has to offer, but my family and I will be back soon! I am keen to try out the in-ground trampolines, water play, giant turtle splash pad and pole maze just to name a few! I am looking forward to using this playground with the clients I work with. There seem to be endless opportunities for therapy and play.
Written by Therapy Focus Adult Services Coordinator, Celine Windsor.
Social inclusion is an important part of feeling happy and healthy, growing stronger and becoming the person we want to be. So what is social inclusion? And how can we achieve a healthy social life?
Social inclusion is:
Feeling connected to other people
Feeling supported when things are tough
Feeling important enough to be considered by others, have a say and be listened to
Feeling like you are part of something bigger than you
Consider the following: Do, Be, Become, Belong:
What can I do, where and how can I do it? Think art, archery or acting; bike-riding, bocce or ballet-dancing; collecting, craft or canoeing. The opportunities are endless!
What can I be? Are you a student, friend, neighbour, employee, team member, volunteer or a citizen?
Who can I become? Every day the choices we make and the experiences we have help to shape who we become.
Where can I belong? Develop and share your interests with others. Committing to a project or group helps to build relationships with like-minded people. This helps us to feel like we connect with others and belong.
If you’re looking for ways to feel included, try having a conversation with a family member, friend or your therapist. They can help identify where new opportunities might lie and what support you might need. Below are some questions you might like to discuss:
Do you think you are healthy as you can be? If not, what might help you to improve in this area?
How do you feel about yourself? What are your positives and strengths you’d like to build upon?
Do you let people know when you want to do something or do you keep quiet? What might help you to improve in this area?
Do you have enough help to do the things you want to do?
Would you like to have more choice and be able to make more decisions about your life, what, where, when and how you do things?
How are your relationships with family, friends and others? Are there people that you would like to see more of?
Would you like to get out more and meet new people and build a circle of friends?
If you were to go out, where would you like to go?
Is there anything stopping you from going out? If yes, what can be done to make it easier to get out?
Would you like to change where you live or who you live with?
Are you still learning? Is there something that you would like to learn?
Do you have a job that you enjoy? If not, what work would you like to do?
How can you make a difference in your world and in lives of others?
Finding your ‘just right’ level of social inclusion might give you a new reason to jump out of bed in the morning with a spring in your step!
Tips for parents and carers:
Be a role model
Knock on doors, ask questions
Seek advice, ideas and support from your children’s school, service providers, other parents, employers, communities and decision makers
Open the door to new opportunities for your child
For more information about social inclusion visit the following websites:
In celebration of World Cerebral Palsy Day on 5 October 2016, we invited a family receiving services to share their story.
Cerebral palsy is the most common physical disability in childhood. It is an ‘umbrella’ term used for a group of movement and posture disorders caused by damage to the developing brain.
Most people with cerebral palsy are healthy and can expect a normal life span, participating in meaningful studies, hobbies and employment. However, children with cerebral palsy may require extra support and encouragement, and this takes a lot of dedication from their family and others around them.
The following is written by Jessie-Lee, who is Mum to six year-old Shakira.
Shakira was diagnosed with cerebral palsy when she was 2. She has since received physiotherapy from the wonderful team at Therapy Focus. They have been able to help Shakira reach goals that I never thought imaginable.
With her calf being constantly tight she couldn’t ride a normal bike but with support from Therapy Focus, we were able to work with Dream Fit to modify a bike for her. Shakira can now the ride the bike without the heel cups that used to hold her feet in place! She wears an Ankle Foot Orthosis (splint) daily to help stretch the calf. This can be challenging some days as she sometimes just wants to wear her special ballerina shoes, but with a lot of encouragement she agrees to wear it daily. Some of the things Shakira has used to manage her CP include daily stretches, splint, Botox, tilted foot step, hop scotch, trampoline, Dream Fit bike, squats, and swimming.
Shakira started Botox injections at the start of the year and I have seen a fantastic difference in her range of movement. Daily stretches take place at home and school and with the help of the injections Shakira has come so far in her physical activities. At last year’s sports carnival she had to stop and jump side legged over the hurdles; this year she is jumping with both legs together in a forward motion. The school captured a fantastic shot of her leaping over them with all the joy in the world.
She is a beautiful spirited little girl and will give anything a go. As a mother with a daughter with special needs you have to stay focused, happy and encouraging as I believe they feed off you a lot and if you show a slight sign of “they can’t do it” or “that might be a bit hard” then you’re instantly setting them up to fail. Stay positive and if they give it a go and it doesn’t work that’s ok, they gave it their best shot.
Shakira’s school has been an amazing support to her. In addition to assisting with her stretches, the school recently participated in ‘Steptember’, a fundraising event for the Cerebral Palsy Alliance. Calling themselves ‘Shakira’s Stepparoos’, four of her teachers took on the challenge of completing 10,000 steps a day for the entire month in order to raise vital funds. It was a big challenge but it was for a very worthy cause.
One in two people with cerebral palsy are in chronic pain due to the tightening of their muscles. Many will never be able to take a single step without assistance. If you would like to support the Wanneroo Primary School Team “Shakira’s Stepparoos” visit their fundraising page. Any amount you contribute will make a huge difference to children and adults living with cerebral palsy.
For more information about World Cerebral Palsy Day visit the website.
Pictured: Shakira with ‘Shakira’s Stepparoos’.
Spina Bifida Awareness Week: Michael’s Story
September 1-7 marks Spina Bifida Awareness Week. To help people gain a better understanding of the birth defect, which causes varying degrees of disability, we asked 10 year-old Michael McDonald to share an insight into what it’s like living with spina bifida.
My name is Michael McDonald. I’m 10 years old and in Year 5 at Poseidon Primary School. I have lots of friends at my school and my favourite sport is soccer. My favourite soccer team is Perth Glory and I like watching them play. I also have spina bifida, which I’ve had since I was born.
Spina bifida is the incomplete formation of the spinal cord which happens during the first few months of a baby’s development in the womb. Spina bifida affects everyone differently and can cause paralysis or weakness in the legs, bowel and bladder incontinence and specific learning difficulties. I don’t like having spina bifida because I can’t run fast like my friends.
Even though I don’t like having spina bifida, I can still do lots of things. Every Saturday I play wheelchair sports. I do a different sport each week like basketball, badminton, laser tag, rugby, hand ball, tennis and volleyball. My favourite wheelchair sport is basketball which I am the best at.
Because of my spina bifida I am also really good at using my wheelchair. I can do wheelies and turn corners really fast. I have also ridden quad bikes and horses which was fun.
At the start of the year I was super lucky to be chosen to toss the coin at the start of a Perth Glory match, which was very exciting. Every year I go on a spina bifida camp in Rockingham. While on camp I play soccer and footy with my friends. It’s really fun! Last year I got an iPad from Therapy Focus to help me with my schoolwork, but I also have some games on it that I can play. When I found out that i was getting an iPad i was happy and excited!
Even though I have spina bifida I can still go to my friend’s house on the school holidays. When I am at my friend’s house we like to play the Wii, which I am really good at. I really like going to my friend’s house to play.
Finally, even though I really don’t like having spina bifida and it means I can’t run fast, I can still do lots of fun things like tricks with my wheelchair and go to my friend’s house to play.
Pictured: Michael about to toss the coin at a Perth Glory home game.
What does a speech pathologist do?
Written by Therapy Focus Speech Pathologist Monique Moreno.
What does a speech pathologist actually do? This is a question I am regularly asked by members of the community.
Common perceptions of our work include correcting articulation difficulties in children (e.g. lisps) and working with people who stutter. Speech pathologists do work to support these client groups – and so much more! Speech pathologists complete a university degree to support children and adults with two fundamental life skills; communicating and eating. Speech pathologists possess the drive and passion to support people with these skills in order to engage across all aspects of daily living.
Who do speech pathologists work with? Speech pathologists assess, diagnose and treat communication and swallowing difficulties in children and adults. Communication difficulties refer to challenges with speaking, understanding and/or using language, listening, social skills, stuttering, reading, writing and using voice. Speech pathologists also help people who have difficulties eating and drinking safely.
Where do speech pathologists work? Speech pathologists work in many different settings including schools, hospitals, aged care homes, mental health services, rehabilitation centres, community health centres and private practice. Speech pathologists often work collaboratively with occupational therapists, physiotherapists, dietitians, audiologists, psychologists, doctors and teachers.
How can a speech pathologist help? Speech pathologists can support people in the following areas:
Speech delays and disorders – articulation and producing speech sounds
Expressive language – using language to share thoughts, feelings and ideas
Receptive language – understanding language, word meanings and instructions
Augmentative and alternative communication for people with difficulties speaking and writing e.g. using pictures, communication boards or assistive devices to support understanding and expression of language
Fluency – supporting people who stutter to speak more fluently and with confidence
Feeding and swallowing difficulties – supporting infants, children and adults who have difficulties eating, drinking and swallowing safely
Pre literacy and literacy skills – learning to read, write and spell
Voice – disorders of the voice including pitch, quality, volume
Social communication difficulties – communicating for social purposes and following the rules for conversation
Cognitive-communication disorders – organising thoughts, planning, reasoning, paying attention, remembering and problem solving
Aural rehabilitation for people who are deaf or hard of hearing
Therapy Focus’ qualified speech pathologists provide government funded and fee-for-service speech pathology to children and adults. Find out more.
Where can I find out more information about the work speech pathologists do? Speech Pathology Australia is the professional body who represent speech pathologists across Australia. To find out more about the work speech pathologists do in the community, view this video.
Written by Therapy Focus Behaviour Support Team (BeST) Clinician (Clinical Psychologist) Rachael Tan.
Kids play make-believe because it’s fun, but did you know it is also a vital component of normal child development and should be encouraged?
What is imaginative play? Imaginative play, or make believe as it is sometimes referred to, occurs when a child role plays experiences that are of interest to them, such as playing ‘school’ with their toys. Children may engage in imaginative play alone or with others. There are a number of benefits that imaginative play contributes to a child’s development.
The benefits of imaginative play:
It fosters creativity by providing a safe space for children to act out scenarios of their choosing, including situations that they may not be able to experience in real life. For example, a 5-year-old who is unable to go to a restaurant without her parents can, through imaginative play with her friend, create a pretend tea party they can both enjoy at home.
It promotes physical development in a fun way. Activities such as fitting doll’s arms through the sleeves of her jacket are great for hand-eye coordination, as is learning to move and control her hands in different ways.
It provides an opportunity for kids to practice and develop their language and social skills simply by being with and talking to other children.
It boosts development of problem solving and self-regulation skills. Imaginative play with peers can create situations in which not everyone gets what they want. For example, when more than one child wants to be King of the castle, the child who doesn’t get what he wants needs to learn how to manage unpleasant emotions in order for play to continue.
It gives parents a fun way to teach positive behaviour to their kids. Parents can introduce situations into play to create “incidental learning” opportunities. For example, when giving their doll a shower, the parent might ask the child questions (e.g. “what happens next?”), make comments (“the water is nice and warm”), and discuss dilemmas (“Oh no, Dolly ran out of soap!”). These teach the child important functional skills and the ability to work through tricky situations with guidance.
Tips to encourage imaginative play: Because imaginative play is such a healthy contributor to a child’s overall development, parents should actively encourage their child when they engage in imaginative play.
Provide plenty of props, play partners (both similar-aged peers as well as adults) and play time.
Dress-up parties are also a great way to both promote imaginary play and keep children entertained!
Involve them in your daily chores and incorporate incidental learning into these situations. For example, while you are preparing dinner, you might invite your child to cook alongside you with their play items.
What’s the right age to introduce imaginative play to a child? There is no set age to introduce imaginative play into a child’s world. You can start by introducing simple items that are safe for the child, such as a soft toy. Create situations to engage that item in play, like having your child’s doll give them a kiss on the cheek.
Are there any disadvantages to imaginative play? Absolutely none! But, if a child often behaves in a way during play that causes harm either to themselves or others, or if a child develops a strong preference for solitary imaginary play at the expense of social play, it may be worth seeking the advice of a qualified child development professional.
Find this article helpful? Visit our blog for more useful tips and insights from our therapists.
Continence Week: Tips for a Healthy Bladder & Bowel
This year World Continence Week is being held from June 20-26 with the theme ‘Improve your bottom line’ encouraging people to adopt healthy bladder and bowel habits to prevent and improve incontinence.
But what are healthy bladder and bowel habits? Our PEBBLES continence support team have shared some tips to help parents of children with disabilities support their child’s bladder and bowel health:
Encourage your child to drink enough fluid to for their age and body weight
Encourage a diet rich in fruits and vegetables
Consider other options if your child has difficulty swallowing or has sensory preferences for other fluids or high liquid / frozen foods
Being physically active will encourage bowel activity and reduce the risk of constipation. If you child has mobility problems abdominal massage may be helpful
Keep a check on your child’s bowel movements. Ideally poo should be soft and easy to pass (think of a ripe banana)
Commence a toileting program with your child. Occupational therapists and the PEBBLES team can provide advice on toileting equipment to ensure that your child can sit comfortably and safely on the toilet
If your child has sensory issues around toileting speak with their Occupational Therapist, or make a referral to PEBBLES for more information on how to address these issues
Discuss your child’s bladder and/or bowel problems with their doctor
Not sure where to start? Therapy Focus’ PEBBLES team provide specialist advice and support to children with a disability who experience bladder and bowel health issues, continence issues and those who require support with toilet training. Find out more.
For further information and support contact the National Continence Helpline on 1800 33 00 66 or visit www.continence.org.au.
Are you ready to vote?
Written by Therapy Focus Speech Pathologist Emma Pannell.
A federal election has been called for Saturday 2 July 2016. All Australians, including people with disabilities, had to be enrolled to vote by 8pm Monday 23 May 2016.
I wonder how many people with disabilities will vote this year? Sadly, in my 16 years of working with adults with disabilities, I have never met anyone who was enrolled to vote.
Why aren’t people with disabilities voting?
I believe there are three reasons:
Societal expectations Many Australian Electoral Commission (AEC) marketing campaigns may not have included people with intellectual, behavioural or communication challenges and thus the broader community is not aware of their rights. I think society also questions whether people with disabilities are able to make an informed and independent selection of a candidate. It is my professional opinion that we shouldn’t underrate their competencies, as the people with disabilities I have worked with can tell me in great detail about the qualities of the players and coaches from a variety of sporting teams, so they are more than capable of learning about a couple of political parties.
Education The AEC does have educational resources for people with disabilities, but how many schools, work places and agencies are aware of them? The AEC also only sends enrolment forms and information to people over 18 who have a driver’s license or bills in their own name, which often excludes people with disabilities who live at home and don’t drive.
Accessibility The information provided by AEC and the political parties is not easy to understand. The AEC has only recently been adapted for people with vision impairment, but with advances in technology I feel this could easily be rectified to make it accessible for people who have other challenges. There are other accessibility issues to do with transport to the polling booth, casting a postal vote and the actual selection of the candidates.
Why should people with disabilities vote? I firmly believe it’s a fundamental human right as an Australian citizen to be part of the democratic process. As nearly 20% of Australians have a disability and the majority of those people are in the bottom 20% of wage earners and reliant on social support for quality of life, it is vital that they are empowered to lobby the Australian government to improve the services and policies of this nation (Australian Bureau of Statistics, Survey of Disability, Ageing and Carers 2012).
Wouldn’t it be great if we were the first place to make voting truly accessible and equitable for all Australians?
Written by Therapy Focus Speech Pathologists, Lauren Redman and Kym Jefferies.
Social Thinking® is a practice devised by Michelle Garcia Winner to help people understand how our thinking affects our social behaviours and skills.
The practice is aimed at people who have strong academic capabilities, but who struggle with social processing and social emotional learning – something often experienced by people diagnosed with a learning disability or Autism Spectrum Disorder.
What is Social Thinking?
Social Thinking is the ability to understand that we each have thoughts and feelings that may be the same or different from other people’s. Our thoughts affect our emotions, which are tied to our behaviours and the way we act or react to other people.
When we do what is “expected” in a certain social situation, people around us feel comfortable. When we do what is “unexpected” in a social situation, people may feel anxious or uncomfortable. Both expected and unexpected behaviours affect how people think about us and, in turn, act toward us.
How is Social Thinking taught?
Teaching Social Thinking is different from teaching social skills. It focuses on teaching an individual how to think about a particular social situation, and the expectations of the people in that situation, and adapt their social skills based upon their interpretations.
For example, Social Thinking can help an individual figure out what greeting to use in different social situations: “Hey, what’s up?” – For an interaction with a peer. “Hello, nice to meet you.” – For a more formal encounter.
This same thinking helps individuals:
decide when and how to initiate a conversation;
understand what people may be thinking based on what they are looking at;
make predictions; and
understand motives and intentions.
By uising Social Thinking we are able to be flexible in our interactions based on the expected/unexpected behaviours and “hidden rules” of the situations and people around us. Well-developed Social Thinking involves understanding other people’s point of view, and the ability to interpret the obvious and not-so-obvious social clues and cues.
How is Social Thinking used in everyday situations?
Social Thinking happens 24/7. Even when we are not around others, we are still using Social Thinking to interpret storylines and characters in a book or television program, think about past or future social encounters, or to problem solve a social dilemma we are involved in.
For this reason, social-emotional skills should be nurtured and developed across all areas of our life, at home, school, work and in the community. Some examples might include:
Sitting next to someone in class or on the bus and being aware that we are sharing the space with them
Children interacting in the playground responding to others’ behaviours;
Being able to effectively work as part of a group in a classroom, on a sports team, or with colleagues
Having a conversation with our friends and being aware of their points of view and their feelings, and being flexible in how we respond to them
Reading a book or watching a movie and being able to understand the perspective of the characters
Interpreting literature, creating written narratives, comparing and contrasting motives and intentions as part of academic work.
Our Social Thinking matures over time as we continue to use and get better at these skills. Our Social Thinking and related social skills help us to be able to form and maintain friendships, join in and participate in the community, and understand academic learning – which is integral to our overall quality of life.
If you have questions or would like more information, please visit www.socialthinking.com. If you are receiving support from Therapy Focus and wish to learn more, contact your therapy team.
Written by Therapy Focus Occupational Therapist Natasha Maseyk
Many parents ask: What is autism? Why does my child have autism? What can I do to help my child now they have a diagnosis?
Autism is characterised by three common traits, difficulties with social interaction, impaired verbal and nonverbal communication and repetitive behaviours. To what degree a person is affected by autism varies, and it is important to remember that no two people living with autism are the same. The good news is that, due to the increase in the diagnoses of autism, there is a lot that can be done to support the people who live with it.
Early intervention is key when supporting a person with autism and evidence proves that supporting a child through play is the best way for them to learn. Play is more than leaving a child to play with toys, the root of play is social interaction and engagement with people. From early experiences of play, children learn to understand body language, eye contact, joint attention, initiation, sharing, problem solving and referencing skills. Play helps children to develop important skills that they will need for the rest of their lives.
Play takes many different forms and there are many different patterns of play including:
Attunement play: This is the basic grounding for play and involves a backwards and forwards interaction between the child and the adult. This form of play also supports emotional regulation.
Body play and movements: This play includes leaping, climbing, crawling and jumping. It helps prepare the brain and ready the child for the unexpected and unusual. Interestingly, children with autism often do not engage in this form of play and have difficulties with dealing with unexpected change.
Object play: Manipulating objects in different ways such as banging rocks, this type of play leads to the development of sound problem solving skills.
Social Play: This includes rough and tumble play and celebratory play. This type of play leads to the development of social awareness, co-operation, self-esteem and pride.
Imaginative and pretend play: playing house, doctors ects. This plays leads to the development of mind and understanding of others, innovation and creativity and trust in others.
Narrative play: Storytelling, reading together and retelling the day’s events. This leads to the ability to make sense of the world and your place in it.
Children with autism often find play confronting and challenging because it is unstructured and forces them to do things they have difficulties with, such as socialising. Experts recommend that a child with autism receive 15-20 hours of social engagement a week to support their development, but this can be difficult to achieve in this increasingly busy world.
Here are some tips to help you support your child with autism to learn and socially engage through play:
Watch your child; follow the natural pattern that they create in their play, as this will support them to engage with you on their level.
Once you and your child know the pattern, change it slightly to challenge them and to promote problem solving and social engagement. This is called introducing variation to the play.
When playing with your child try to create a positive memory catchphrase. This is something that stands out from the interaction to make it memorable, and it can be used to start play again. This can be a song, rhyme, gesture or object.
When playing with toys, make sure you retain a role in the activity so that your child does not only focus solely on the object.
Frame your face by holding your hands or objects up to your face to help your child understand that referencing people faces is important.
Include siblings and other children as much as possible.
Look for opportunities to play in day to day life like sorting the washing, reading, colouring, walking to school.
For more tips on how prompt learning through play please speak to your therapist.
Written by Therapy Focus Speech Pathologist Natalie Elias
We live in a digital age, where communication is just a mere swipe away. Advances in technology have allowed us to be more connected than ever before, with a variety of gadgets at our disposal. This has been hugely beneficial in providing a voice to people with communication difficulties. The possibilities can seem endless with so many voice output devices and apps on the market. So where does this leave our other communication tools? And what happens when technology fails?
When we adopt a total communication approach, we use different communication systems depending on the situation. Just as we might choose to text or to call, to write a letter or an email, we need multiple tools in our ‘communication toolbox’ to suit our communication partner and the message we want to share. It remains as important as ever that people with communication difficulties continue to have access to a rich and varied range of tools. It is not a case of which tool is best, but rather what is the most powerful and effective method for every unique situation.
Key Word Sign, formerly referred to as Makaton, is a simplified form of manual sign and a highly effective form of communication. It extends on natural gesture and body language, which forms so much of what we communicate day to day. In Australia we borrow from the signs of Auslan, the language of the Australian deaf community. Key Word Sign may be used with both children and adults. Key Word Sign may benefit communicators who have difficulties with attention, comprehension and/or developing speech.
The main principles of Key Word Sign are: :
sign and speech go together
speak in regular, complete sentences
sign only the key words in your sentence e.g. “Do you want to play?”
use facial expression and body language to add meaning
teach signs that are relevant and interactive to allow the communicator to comment, question, request, protest and share their feelings and opinions
Key Word Sign has benefits for both expression and understanding. Some of the benefits include:
providing visual information alongside speech, which can assist visual learners
lasting longer than speech, which can assist communicators who need more time to process information
encouraging a good language model where we slow our speech rate, simplify what we say and stress the most important words
more opportunities for communicators to have successful interactions as signs are easier to produce than speech
promotes the extension of language skills while speech is still developing
reduces frustration as communicators have a tool for expressing their needs
It only takes one sign and a willing communication partner to get started with Key Word Sign, though it’s important to create a signing environment. You can do this by:
choosing to model signs which are going to be powerful, motivating and allow the communicator to interact in different settings
modelling sign in all parts of your day. Communicators will not use sign if they don’t see it being used in real life
creating opportunities to sign. Try to offer choices, make some deliberate mistakes and keep items of interest in sight, but out of reach. Most importantly, make sure you pause to allow the communicator to have a turn
accept any attempts to sign, keep the communication positive and rewarding
Key Word Sign Australia app – allows you to print signs from interactive vocabularies, create sign dictionaries and visuals and to view videos of how to produce a sign. Available on iPad only.
Take it outside! The benefits of outdoor play
Playgrounds are more than just a place to have fun; they also provide a great opportunity for your child to develop their gross motor skills through play. There are many parks around Perth which have a variety of equipment that can help your child develop their balance, lower limb strength and fitness.
In this article, Therapy Focus Advanced Clinician Physiotherapist, Sulin Ng, suggests activities to incorporate into your child’s play routine next time you’re at the park.
Activities that challenge your child’s balance:
Kicking a ball
Walking along steeping stones. Your child may need a helping hand initially. As they improve, decrease the amount of hand held assistance, until they can complete this activity independently
Activities to develop your child’s leg strength and fitness:
Walk to the park, or park your car a distance away from the park and walk from there
To progress walking ability, increase distance walked and decrease time taken to walk the distance
Chase after birds
Ride to the park or bring the bike and do a few laps along the paths
Ride up slopes to improve leg strength
Encourage your child to be as independent as they can on the stairs. Provide as much assistance as they require so that your child is safe on the stairs, such as one hand held by parent, one hand on the rail. Allow them more independence as they improve
Remember that children tend to develop the ability to walk upstairs before they can go down
Start with static and simple ladders, then slowly progress onto challenging ‘wobbly’ climbing ropes
Provide hand over hand assistance and lots of verbal encouragement
“He just won’t pay attention”. “If only she could focus better”. These are both things we often hear from parents and carers. The following article by Therapy Focus Speech Pathologist Kate Darwent explains why attention skills are vital for the development of language and social skills.
When we pay attention we focus on one thing in particular and ignore distractions that are competing for our awareness. The ability to pay attention is important for a child’s development, as it allows them to engage in tasks long enough to learn various skills.
Attention and listening skills form the foundation of the Communication Pyramid (pictured below). A child must first be able to pay attention before they can develop an understanding of words and how to use them properly.
For example, a child must pay attention to someone showing them a cup and saying the word ‘cup’ in order for them to understand what it is and refer to it correctly.
The ability to share attention with another person towards the same object or activity is referred to as joint attention. This is also a skill a child needs to learn language and develop social skills. Indicators that your child has developed joint attention skills include:
Reaching to be picked up by a caregiver
Pointing to an object or item they want
Looking at an object of play and then at the person playing with them
Requesting an object or items from another person
How to help your child develop their joint attention skills
Do something unexpected. Make your actions a point of interest by doing something unexpected or funny. For example, put a sock on your head instead of your foot.
Interact with your child using objects that are particularly interesting for them. For example, a toy that makes sound, flashes or moves.
Follow your child’s lead. Tailor activities to suit your child’s interests to motivate them to interact.
Copy what your child is doing. This may result in you being able to take turns with your child and lead to them imitating you.
Talk to your child whilst they play. For example, make comments like “you are playing with the car” while you point to the toy. Use simple language, speak slowly and show them what you are talking about.
If your child finds it difficult to understand spoken language, use visual supports to capture their attention and make things clearer. Examples of visual aids include timetables with images, activity displays or objects themselves.
Give your child a reason to communicate. Encourage them to express their needs through their body language (pulling you towards an object, pointing, reaching) or their voice (making a noise, using AAC or using words).
In summary, when helping your child develop their joint attention skills remember:
Make it fun and engaging
Follow what your child is interested in
Copy your child’s movements
Comment on what your child is doing
Use visual cues
Give your child a reason to communicate
For more information about how to support your child to develop their attention skills, contact your Therapy Focus speech pathologist or key worker.
So, what is AAC?
AAC is a term used a lot by our therapists and it can often leave parents wondering just what it means. The following article by Therapy Focus Speech Pathologist, Freya Allen, explains AAC and how it is used in speech therapy.
AAC is a way to communicate without speech (alternative) or where speech is used together with another form of communication (augmentative). A speech pathologist may recommend AAC to any person whose daily communication needs are not met by speech or writing, including young children who are delayed in their speech development.
The purpose of AAC is to provide the person with a form of communication. This helps them to communicate their needs, wants and feelings. It may also positively influence their social skills, school performance, self-esteem, and generally improve their quality of life. AAC users should continue using speech if they are able to, as the system is used to enhance existing speech and only replace speech that is not yet developed.
A speech pathologist may suggest AAC:
if speech is slow to develop
as a back-up if speech is difficult to understand
as a way of communicating most of the time if speech ability is very limited or non-existent
to help develop understanding of delayed language.
Types of AAC systems
There are two types of AAC systems: aided and unaided. Unaided communication systems rely on non-verbal methods to convey messages. Aided communication systems require some form of external support in addition to the user’s body. The table below provides examples of each system:
AAC can also be divided into ‘low-tech’ and ‘high-tech’. Low-tech requires the person to use something external to them, either non-electronic or a simple electronic device. ‘High-tech’ types of AAC use electronic devices similar to computers. The table below provided examples for each system:
Finding the right device
A speech pathologist will help you decide which AAC system best suits your needs. They will consider:
Family & culture
Level of development
Communication skills of the individual
Level of assistance required
Finding the right AAC system takes time and trial and error. The system may need to be modified as the person’s skills, needs, wants and context change. To assist the process, ensure you communicate your family’s everyday routine to your speech pathologist– AAC must occur naturally in the individual’s life to be effective.
Things to remember:
AAC may be either a short or a long-term solution to communication difficulties
AAC takes time and patience
Make sure you have the person’s attention
Model using the AAC yourself
Be consistent in your responses
Make sure communication is integrated as part of everyday activities
Respond to any attempts to communicate
Choose activities that are intrinsically motivating to the student
Use a range of communication strategies on a daily basis (eg speech, vocalisation, sign, gesture, writing, body language)
Choose vocabulary that reflects what the child already knows and what he might want to discuss
The selected communication system should support and encourage interaction with peers
A common question many parents ask is at what age their child should be tying their own shoelaces? The following article by Therapy Focus’s Durham Road School Team, offers practical strategies for assisting children with this important developmental stage.
A variety of factors influence a child’s capacity to tie their shoes, including: exposure, hand dominance, attention, concentration and fine motor development. The table below provides approximate age guidelines for the stages of shoelace tying:
Can pull the laces tight
Ties a knot
Ties a bow
(Source: Activity of Daily Living Checklist)
It can be difficult to teach an unmotivated child to tie their shoelaces. Try to keep it fun and practise for short periods of time throughout the day. If your child is really struggling to tie their laces, focus on activities that develop their fine motor skills before progressing to the more complex task of tying laces.
These activities may include:
Complete play activities by first using both hands together, then progress to use hands separately to perform different movements. For example, catching balls, rolling play doh, tearing paper, pouring, drawing, threading.
Encourage your child to use the small muscles of the hands, fingers and wrist. Some fine motor activities to practice this are finger painting, using pegs, squeezing water sprayers, paper crumpling, drawing and cutting.
Help your child improve their hand eye co-ordination through activities such as throwing and catching, cutting along a line, colouring in, completing a maze worksheet or using an etch-a-sketch.
Many children find it difficult to tie their shoelaces, so the following helpful hints may be useful. You may also like to speak to an Occupational Therapist or your Key Worker for further assistance.
Helpful tips when teaching your child to tie their laces:
Ask your child to practice threading their laces through the holes of their shoe or through fun activities such as animal lace cards.
Make sure the shoelaces are long enough to pull the bow through.
Colour in one side of the shoelace to help your child distinguish between the sides of the laces. You could also use two different coloured laces (cut two laces and tie them together) so your child can easily see which colour is on top.
Tie your own shoelaces at the same time whilst talking through the steps.
Determine which shoelace tying method best suits your child. The method below is good for children who have difficulty pinching both sides at the same time as your child only has to make one bunny ear and pull the other lace around the back.
The most common method of shoelace tying is the ‘Bunny Ears’ method, which involves making two loops, crossing the loops, threading one side through, then pulling tight.
Place dots on the laces to show your child where to position their hands and how long they need to make the loops.
Place the shoe or a practice board in front of your child on their lap, or a table. It is much harder to start tying when the shoe is on your child’s foot, so starting in an easier position is the first step.
Use stiffer laces for practicing. This helps to hold the loop in place whilst your child is learning.
Ribbon with wire in it works a treat!
Take advantage of any opportunity to practice tying – i.e. wrapping presents and tying ribbon, tying ribbons in hair of other people or dolls, tying apron strings before cooking.
The most important tip is to allow your child to experience success. In shoelace tying, the first part is the easiest, so teach your child to cross the laces over and then pull tight, or alternatively start them off yourself and let them do the last step so they feel successful. Once they have mastered this, move onto the next step. With increased confidence, your child will continue to improve and be more motivated to practice.
Helpful resources include:
Red lace, Yellow Lace. Mike Casey and Judith Herbst (1996). A rhyming story with a step by step guide to tying shoelaces.
One Two Tie Your Shoes! Lorraine Gregory (2010). Learn to tie shoelaces using a familiar song with different words
There are also numerous instructional YouTube videos available which explain shoelace tying in a fun and entertaining manner.
Speech Pathology Week: Sawyer’s Story
At Therapy Focus we currently employ 50 qualified speech pathologists who work closely with people who have a range of disabilities to help them achieve their communication goals. In celebration of Speech Pathology Week, which is held from the 23rd – 29th of August, we invited a family receiving services to share their story. The following is written by Aasta, who is Mum to five year-old Sawyer.
When my daughter Piper was born I didn’t think about speech as a ‘thing’. I talked, she didn’t. I talked, she burbled. I talked, she talked. Simple. When my son Sawyer was born and diagnosed with a rare chromosome abnormality at six months, I still didn’t think about speech. We were lucky enough to secure therapy services, including Speech Pathology, almost immediately, though I was still naive enough to think ‘what on earth is a Speech Pathologist going to do with a six month old? He is far too young to learn his ABCs!’ At the time I really had no concept that he would be unable to simply ‘absorb language’ and speak as his sister did. And I had no idea that Speech Pathology would become a lifeline in Sawyer’s communication journey.
Sawyer is now five and a half and I would like to state something that I wish hadn’t taken me so long to learn on this journey: Speech is not language, and speech and language are not communication. It was a long road to that realisation for Sawyer and me. Sawyer’s communication is now truly multi-modal. He gestures, points, intonates, grunts, laughs, signs Auslan, uses a Pragmatic Organisation Dynamic Display (PODD), the Picture Exchange Communication System (PECS), and an Augmentative and Alternative Communication (AAC) device called an Accent 1000. Sawyer doesn’t speak. His receptive language skills (his ability to take in language, understand and comprehend) are much stronger than expressive language skills (his ability to convey a message and form language). But so long as the people in his life are aware of all his methods of communication, his communication is rich.
We have been very lucky to have had two amazing speech pathologists from Therapy Focus help Sawyer achieve the level of communication he currently has. When we joined the Therapy Focus team four years ago, Sawyer’s speech pathologist, Jessie Diamond, cleverly taught me to view communication as a holistic process well before she broke the news that it was unlikely that Sawyer would ever speak clearly. And because of the knowledge and tools Jessie provided us with (PECS, PODD, AAC devices, Auslan signing and how to recognise the subtle ways he was communicating) it wasn’t such a crippling blow. Sure, if Sawyer woke up tomorrow talking I would thank every God ever named. But he does communicate, and he does it extremely well!
Sawyer shows his Speech Pathologist, Elena Petropulos, how he uses AAC.
When Sawyer did start verbalising I took him to a speech pathologist who specialised in PROMPT [an approach that uses touch cues to the jaw, tongue and lips to manually guide targeted words, phrases or sentences] in the hope that she would have a different opinion. But when it became clear that if Sawyer learnt to speak using this intervention his vocabulary would be very unclear and only consist of a few ‘power words’, both Sawyer and I realised he didn’t need unclear words as a social convention. Again, my ever-supportive Therapy Focus speech pathologist was on the same page, and we started heavily pursuing Auslan signing and AAC as Sawyer’s main means of communication with ‘any communication is good communication’ as our underlying mantra.
Jessie sourced AAC devices for Sawyer to trial and helped me find Auslan signing courses. She also provided us with a PODD and numerous push-button devices that said words and sentences to help Sawyer make himself heard. Most important of all, she provided support. We had home visits, Therapy Focus office visits, day-care visits and plenty of phone calls with endless ideas. Jessie truly provided me with the strength and advice I needed to navigate this new world where I was required to actively ‘teach’ language and communication.
Then we had to change speech pathologists. I was so scared. Luckily our new (current) speech pathologist, Elena Petropulos, is just as wonderful, dedicated and supportive. She has continued to actively pursue ways to help Sawyer with his transition into schooling and is an encouraging adviser when I question myself and my abilities to improve Sawyer’s communication. She’s also an understanding ear when I grieve the limitations to the richness of Sawyer’s communication. She sends me regular emails with words I might add to Sawyer’s AAC/Auslan vocabulary and helps me network with parents of kids with similar communication needs. She provides me with posters, booklets and worksheets that may help Sawyer in communicating with new people, and she liaises with his teachers so that we’re all working towards the same communication goals. She also works on strategies to help hearing/speaking people (as clueless as I used to be) to communicate better with Sawyer!
Without our speech pathologists breaking down the complexities of speech, language and communication into learnable steps I could replicate, I dread to think how I would have helped my son. Without them helping him helping him realise the power of communication and the many different ways of communicating, he wouldn’t have developed into the happy, confident boy he is now.
So where is Sawyer’s communication now? I’m both proud and excited to be witnessing what I believe to be a ‘communication explosion’ in Sawyer at the moment. Recently a child asked me ‘can I have a go on Sawyer’s iPad?’ Sawyer turned to him and signed ‘ask me to share.’ He’d never before spoken up for himself. A COMMUNICATION FIRST! Today at Princess Margaret Hospital he was able to convey to the Orthopaedist that his new casts were causing pain and pointed out where so she could fix it. A COMMUNICATION FIRST! When I picked him up from school not long ago he played a sentence he constructed himself on his AAC device telling me about his day at school which informed me about ‘making dog and cat masks.’ He has never before told me what he did at school. A COMMUNICATION FIRST!
And most importantly to me: Tonight I sat with Sawyer in a restaurant where we had a meal and a conversation. We talked about the dinner. He asked who was picking him up from school tomorrow. He asked why the plans had changed to collecting his sister from Scouts instead of Grandma. He complained that he wouldn’t get to see Grandma if we picked her up. He told me that he liked the noodles but didn’t like the rice. He shared some fears he has. I asked him about the masks he made at school (the cat one was orange and the dog one was brown and Zac made a kangaroo in case you were wondering). And this was all communicated to me in Auslan signing and gestures. A COMMUNICATION FIRST! Sawyer is five and a half and this was absolutely the first rich, two-way conversation we have ever had. There are no other words to describe how having a Speech Pathologist has positively impacted our lives: We are so thankful.