Service changes and visiting during the COVID-19 pandemic

During this COVID-19 pandemic there may be changes in the way some of our services work. Contact the service directly to check how services are being delivered and follow their advice.

Some of our services now offer video consultations. You should speak to your clinician if this is something you would like them to consider. You can find out more about video consultation here.

 

Visiting

Contact the ward you wish to visit in advance for guidance and instructions for a safe visit.

You can read some general  NHS guidance on visiting healthcare inpatient settings.pdf [pdf] 89KB

If you need help in a mental health crisis during the COVID-19 pandemic outside office hours please contact our crisis team: Help in a crisis

For other medical advice and support contact your GP or visit NHS 111

Only visit your local Emergency Department for serious life-threatening conditions that need immediate medical attention including persistent severe chest pain, loss of consciousness, acute confused state, severe breathlessness, severe blood loss, serious burns or suspected stroke.

Autism

Children’s Speech and Language Therapists work with children who have a diagnosis of Autism. Or where children’s communication and interaction is developing differently. See the 'What is autism' section below.

We see children for assessment and provide advice to parents and settings. We ask parents and settings to follow the advice at home and at nursery/school. This is to help your child communicate and interact with others. This is so that we work together to help your child to achieve their best.

What is social interaction and social communication?

Mother engaging with toddler

Communication is more than just talking. Whenever two people send messages of any kind to each other, even without words, they are communicating. 

Babies communicate long before they start to talk by crying, making sounds, moving their bodies or reaching for something.

They learn to look at faces and give eye contact, focus on the same thing as you are and follow your gaze.

This is interaction.  As children grow, they let you know what’s on their minds in other ways, such as through gestures and spoken words.

 

Children's Speech and Language Service

 

Interaction is like a see saw at a playground. You need two people to take turns to interact.  

This keeps the see saw going back and forth. If each person isn’t taking equal turns, the see saw moves up and down.

Watch this video more information:

Image by Dung phan from Pixabay

What is autism?

autism triad of impairmentsAround 1 in every 100 people in the UK have autism.

In Nottinghamshire and Nottingham City autism is diagnosed by a paediatrician. Speech therapists support paediatricians to assess social communication and interaction. Autism is a spectrum as it affects people in different ways. All people with autism have differences with:

Social communication - This means that children often have delayed language that may not follow the typical pattern. This means that children often need help to understand how and why to communicate. For example a child does not greet people, does not get your attention to show you or point to something.

Social interaction - This means that a child may not know how to play with adults or children. For example, don’t give eye contact or use gesture and facial expression and does not share interests or enjoyment with a person.

Social imagination - This means that they may not play with toys in a pretend way. It may also mean that they have behaviors which they repeat. They may also have restricted interests. For example different interests and activities, rigid routines and fascination with objects rather than toys

Some people with autism have very mild difficulties whereas other people need lots of support.

The importance of working on sharing the moment together

Baby playing with parents Between 6 and 12 months, babies begin to coordinate their focus of attention with their parents to objects or events in their environment. For example, they might look at a toy, and then look to their parent and then back to the toy. This suggests that they enjoy know that their parent is looking at the same thing as them. This involves eye contact and switching your gaze and is called 'joint attention' or 'shared attention'. It usually occurs in playful situations with parents, for example, finding hidden objects together or pretending to eat and drink.

Joint attention is a really important skill. Click here to find out more: http://beforefirstwords.upf.edu/precursors-of-language/joint-attention/

When two people share the enjoyment, we refer to two-way interaction which is the ability to share focus on and with another person.

The youtube video shows an example of a game involving two way interaction, the child is working towards giving the parent eye contact.

 

Three way interaction refers to the ability to share focus on another person and a toy.

The youtube video shows a child with typical three way interaction.

 

Sharing attention is the foundation on which children understand that gestures and words refer to objects and events.

If children do not develop joint attention, their ability to interact with others is reduced.  In turn, this impacts on their ability to learn and use language successfully.

How does social interaction and communication typically develop?

First few months of life - Eye contact established between the parent and child.

3 months – A child’s gaze follows adult’s, this lead to joint attention of objects.
Takes turns with the parent cooing, making sounds and copying facial expression e.g. sticking tongue out. The baby learns to tell the parent what he/she needs by sounds, facial expression and body, learns to communication how feeling.  When the parent responds to the child’s noises this establishes an early back and forth conversation.

6 months - Turn taking games like “peekaboo” have developed - these are important for develop parent child interaction.

9 months - A child may give and shake head gestures/body language Learn to also reach, raise arms, hold up and show objects, wiggle hand to wave.
Might like to meet new people but need time to get comfortable

12 months - A child responds to another person’s attempt for joint attention – response to shared attention. A child may use an open hand point to show you and tap you to get your attention, learn to wave, clap, and blow a kiss or show ‘sh.’

18 months – A child initiates with another person. He/she uses gestures (points to the toy, holds up the toy) He looks at the parent and then back at the toy as if to say to the parent “hey, look at my toy!”

These are key milestones. If you notice that your child hasn’t started doing these things try some of the activities in the next section called 'Activities to support your child'. 

Activities to support your child

Father kissing baby foot

People Games

Games without toys are called ‘people games.’ They help your child to focus on you and the interaction. Examples include: blowing raspberries chasing, tickles, peekaboo and nursery rhymes. People games are:

  • Often repetitive so the child can predict what’s going to happen.
  • Work best when they suit your child’s interests. This gives them extra motivation to interact with you because it’s using the thing they enjoy doing most. If they like to run, try chasing games.

If they like songs and music, try nursery rhymes. If they like swinging or rocking, try swinging them     

in a blanket.

A Speech and Language Therapist will give advice on more games to try.

We use strategies from the Hanen centre and the autism corner.

Here is an advice sheet from the Hanen centre around people play.

https://www.hanen.org/SiteAssets/Helpful-Info/Articles/people-games-handout_1-0-1.aspx

 

father playing with daughter

Focus on faces to help develop your child’s eye contact

Eye contact is important:

  • Absence of eye contact can mean a mismatch between knowing a word, e.g. a child was looking at the door and heard bye, child now says bye when someone is at the door.
  • Eye contact shows who the message is being sent to
  • Eye contact helps children to understand that facial expressions link with emotions

 

How you can help

  • Be face to face and down at your child’s level
  • Position your head/face in your child’s eye line
  • Without toys, try to get child’s attention in some way, e.g. be silly, make your child laugh
  • Be animated with your voice
  • Remember to pause and wait for eye contact
  • Games such as peek a boo, blowing raspberries on your child’s skin or nursery rhymes on your lap are great to help with eye contact

 

Once your child gets better at giving eye contact in people games, learning how to switch their eye contact from you to a toy is also important.

You could try ready steady go with bubbles and waiting for eye contact before blowing the bubbles https://www.bbc.co.uk/tiny-happy-people/ready-steady-go-12-18/zdfvscw.

You could try anticipating with ready steady go https://www.bbc.co.uk/tiny-happy-people/blowing-bubbles-12-18/zj63y9q.

You could try a game of copy cat to show your child what he/she does is fun and you can do it too https://www.bbc.co.uk/tiny-happy-people/copycat/zb2bvk7.

 

Follow your point and helping your child to point

Follow your point and helping your child to point

You can try and help your child to point by taking his / her hand and for example point to something on a shelf or out of reaching, singing wind the bobbin…point to the ceiling, point to the floor’ song and point to books.

Show your child that you use pointing to show him / her how to point. You could try saying biscuit, as you point to biscuits and wait for your child to follow your point. When your child follows your point and looks at the biscuit, say biscuit and give him / her a biscuit. You could try this with anything that is motivating for your child and is out of reach.

What happens if social interaction and social communication don’t develop typically?

For more information about getting an assessment for autism from a paediatrician, speak to your nursery, school, GP or healthy families team.

If you have tried the advice above and you would like a Speech and Language Therapy referral. Please click here.

 

Find out about the lifelong disability called Autism from the national autistic society: https://www.autism.org.uk/advice-and-guidance/topics/what-is-autism

 

 

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