I was diagnosed with ADHD at the age of 31. Growing up in a country in Asia, my parents didn't know what ADHD was. I was often labelled the 'naughty', 'careless', 'wreckless' and 'messy' child.
However, after learning more about ADHD, I can now reflect back on different stages of my childhood and adolescent years and understand how the signs, symptoms and behaviours for my case have presented themselves and how it affected me.
When people think of a child with ADHD, many think of the stereotypical ‘hyperactive wall climber’ running from room to room causing havoc. But this wasn’t me. For me, I struggled with sitting still and paying attention. As a kid I needed to move and fidget. Even when tasks required me to sit, I could not. I can recall memories when a primary school teacher called my mother to inform her that I couldn’t remain seated during my exams. My parents dismissed the incident saying that I just wanted to play. In another occasion when my parents enrolled me in a performing arts school to learn to play an instrument, they found me in the back of the dance class. The school principal noticed my inability to stay seated or focused on repetitive tasks and felt my energy was better suited in the dance class...
Needless to say, on many occasions, my inability to remain still and pay attention meant I was strongly disciplined for being ‘naughty’ and was often punished by my parents. Throughout my schooling, I recall challenges learning subjects that involved abstract concepts, organisation, prioritisation and problem solving, particularly science and maths. Organising complex ideas for essays and university assignments were troublesome, in my case essay writing took longer than my peers to complete. I felt as though I had to work extra hard just to get the job done. Poor self image and self esteem began to creep up on me, leading me to feel shame and anxiety. While I confided in friends and family to discuss my challenges, I often found it difficult to sustain my train of thoughts to resolve them.
It wasn’t until I found myself in a stressful working environment where I really struggled to cope, that I decided I really needed to get to the bottom of my issues. I decided to see a psychiatrist for what I thought was work related stress. However, as our sessions continued each week, we explored the reasons behind my stress. It became apparent that the difficulty I faced at work was compounded by my struggle to concentrate, remain focused on the task, prioritise, organise and manage my time. It also didn’t help that I can be forgetful, messy, and impulsive; suffered from poor self image and mood swings from time to time. While these traits can often point to other mental health conditions such as anxiety or depression (conditions to which individuals with ADHD are vulnerable to) my diagnosis for ADHD was confirmed after completing the TOVA assessment under the advice of my psychiatrist.
Reflecting on my experience, my message to parents and teachers is: take notice of the signs and behaviours your child exhibits. If you suspect that your child is suffering from the challenges associated with hyperactivity, inattentiveness and impulsiveness speak to a qualified therapist and have your child assessed. Not doing so could mean that your child will struggle to live up to their true potential, or take advantage of some the positive qualities associated with ADHD.
Fortunately for me, I now understand my struggle and also enjoy the unique qualities that come with my ADHD. But that is perhaps a topic for another day!
As a parent, you can use books to develop some of your child’s important social and language skills.
Here are five skills you can work on using books:
1. Joint Attention
You can use books to develop your child’s ability to attend to you and the object of their interest (in this case a book). Joint Attention is such an important skill to work on because it is necessary for any learning to happen.
How to do this: Sit face to face with your child and place a book in the middle, with the book upside down to you. To increase your child’s engagement, follow your child’s lead with the book, allow them to spend as much time as they like looking at pages of interest while you make comments on what they can see. Occasionally, raise the book to your eye-level to guide your child’s gaze towards you during the interaction.
2. Sustained Attention
Sustained Attention is another important skill you can work on with your child using books. To improv your child’s Sustained Attention, engage your child in activities involving books and gradually increase the length of these activities over time.
How to do this: You can start with reading one page of a book your child is interested in on Monday, increase it to two pages by the middle of the week, then three pages the following week, and continue to increase the number of pages over time.
3. Early Social Skills:
Books are great for teach in your child early social skills like turn-taking and sharing items.
How to do this: You can take turns with your child to hold the book, turn the pages, point to pictures, make comments on what you see and to read words.
4. Receptive Language (Understanding Language):
Books can be used to expand your child’s understanding of words, concepts and the world around them.
How to do this: As you look through a book with your child, describe / comment on what you see while pointing to the pictures. You can use emphasis and repetition to help your child understand new concepts. For example, if your child points to the picture of a dog inside a box, you can say “dog in the box... in”.
5. Expressive Language (Using Language):
You can use books to improve your child’s phrases and increase the length of what they say.
How to do this: While you look through a book with your child, model words which your child may not have yet, and expand on what your child says. For example, if your child points to the Humpty Dumpty in the book and says “fall”, you can expand on this with a longer phrase like, “Humpty Dumpty fell”.
Books can be very useful for teaching your child many social and language skills. In this post, I’ve included just a few of them.
The Expat Speechie
Applied Behaviour Analysis (ABA) is a controversial therapy approach. Some parents and therapists love it because of the positive outcomes they have seen on behaviour, but others don’t want anything to do with it (to put it nicely!) because of its structure and ridgidity.
“What I want to tell the world about Autism is that there is so much more to Autism than what meets the eye. The problem with Autism is that it does not have a face. It looks NORMAL . What you see is just the tip of the proverbial iceberg...”
Anonymous parent of a child with Autism.
“NO WORDS can describe how I felt when I knew that my son has Autism.
But being depressed about it won’t change anything. So my husband and I tried to get all information of what to do. My son had a communication and social problem. We were really lucky to have started with really supportive Therapists. We did the early intervention really fast, but we also learned that we as parents and everyone around our son had to help out too. For 3 years our son was in his own little world, he was stimming, singing and avoiding all eye contact. But slowly he started to change. I believe he has been trying. He needs a little time to find his way towards us. I believe that he had, and still has sensory issues from noise, touch and taste. All of that is quite overwhelming for him. So we did our best to get all the help he needs.
It has been 3 years going to Speech, Floortime, OT, Sensory Integration and Social Therapies. Every month, our son started to change, bit by bit. Yes, there were up and downs. But his hard work paid off. He started from telling us what he wanted, toy, apple, toilet and of course, iPad. Every single year he improves. But this year is his eye contact. I guess only parents who have a special, beautiful child would understand how I feel.
Every single case is different, so please to every single parents who is going through this stressful path, hang in there and please have hope and believe in our child. They need us to believe in them and give them patience and lots of comfort and love for them to find their way to reach to us (they are trying really hard to let us know that they do love us but just cannot express the way that we do).”
Anonymous parent of a child with Autism.
“Don’t feel sorry for people with Autism and their family. Admire them for their effort to live in a world that doesn’t always accommodate to them. Be curious and open-minded. Let them teach and show you about their Autism.”
Dr. Kwan Hansongkitpong
Founder of Autism Awareness Thailand & Clinical Director at Little Sprouts Children’s Centre.
“What I want to tell the world about Autism is.....there’s a person behind the diagnosis,
get to know them.”
Parent of a child with Autism.
Founder & Director of Steps with Theera, a vocational training centre for young adults with special learning needs.
“For me, Autism is more a quality that some people have which makes them see the world in a different way, not the wrong way, just different. We need to be able to recognise what this group of people can teach us about ourselves and the world around us. Embrace different.”
Speech Pathologist Advanced Clinician,
Therapy Focus, Australia.
“What I want to tell the world about Autism is that the saying is true, once you have met an individual with Autism, you have only met one individual with autism.
It is important to remember that individuals with Autism see the world differently which may lead them to communicate in various ways. It is imperative to communicate in a way in which they can understand by being clear and concise, and also understand that they may be trying to tell you something with the behaviors they are engaging in.”
Centre for Autism Recovery & Education (CARE).
“What I want the world to know about Autism is that no matter how different individuals with Autism may seem, they are the same as every other individuals. We all need love and understanding to strive in this world we share.”
Kiratinoot Luanganggoon (Kira)
Pediatric Occupational Therapist.
“In my opinion, we can never completely understand Autism, because individuals with Autism are so different from one another - they teach me something new about Autism every day. Instead, we can endeavor to be life-long students of individuals with Autism, by watching, listening and thinking about the BIG picture when it comes to Intervention, rather than focusing on isolated skills; and most importantly, shaping our own approach to each individual.”
The Expat Speechie
Advanced Certified Autism Specialist & Speech Language Pathologist
It is truly amazing what parents will do for their child.
Last year, I met a family in Thailand who told me that they had moved to the US for one year so that their child could receive a specific therapy called PROMPT. When we met, PROMPT was not available in Thailand, so this family asked if I was willing to travel overseas to do the training. A couple of weeks later, I found myself on a plane to Australia to get trained in PROMPT.
Fast forward to a few months later, I am now using PROMPT with many of the children and teenagers who I’m working with. Some of them have made absolutely incredible progress. For example, after just a few months, a non-verbal teenager can now say a range of words and even combine two-to-three words together in phrases!
So, what is all the fuss about PROMPT? Here is what you need to know:
What is PROMPT?
PROMPT is a type of speech therapy. PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. Basically, the Speech Therapist uses touch and pressure specific points on your child’s face to activate certain facial muscles, and guide the movement of their jaw, lips and tongue. There is a different PROMPT for each sound in English, and in most cases, a sound can have more than one type of PROMPT. PROMPTs can be used to ‘re-write’ old motor-speech patterns or develop new motor-speech patterns.
What makes PROMPT different to other therapies?
Compared to other therapies, PROMPT works better to improve speech because it gives more support through the additional element of touch. Not all children respond equally well to learning speech by listening (auditory cues) or by looking (visual cues). But when these two cues are combined with PROMPTs (touch cues), the child has something which they can feel, physically guiding their face to move from one sound to another to make words.
How is PROMPT used in a session?
Firstly, your child will learn to say target words with the support of PROMPTs applied to their face. This is done through repeated practice, which re-writes old motor-speech patterns and allows them to learn new ones.
Then, your child will learn to apply these words practice in activities which require turn-taking. This second step helps them to apply what they have learned to interactions with others and will help them generalize their new speech skills to daily interactions.
Who can benefit from PROMPT?
The great thing about PROMPT is that it can improve the speech of both children and adults with a range of difficulties. I use PROMPT with children and teenagers with Speech Sound Disorders, Autism, Developmental Delays, Apraxia, as well as non-verbal children and teenagers. PROMPT can also be used to improve the speech of children and adults with a hearing impairment or to modify accents.
I am really thankful for this family who helped bring PROMPT to Thailand and for the wonderful impact it has made here so far.
The Expat Speechie
Introduction to PROMPT Technique Workshop: Manual Australian Version. (2014). The PROMPT Institute. P.H.C Inc.
Happy New Year parents!
My first post this year is about a holistic outlook on your child’s early communication goals. Life is busy and working on your child’s communication for hours each week is just not realistic. But there are certainly things you can work on which you don’t even need to sit down for.
Here are five things that you can teach your child to say which will go a long way:
1. To ask for help
This is such an important skill and it is surprising just how many children do not have it. Teaching your child to say, “I want help” enables them to get the help they need if you are not with them, or, in the case of an emergency.
2. To refuse things
Giving your child words like, “no” and “I don’t want” enables them to express their dislikes and opinions. This will reduce unwanted behaviors like those spectacular tantrums, which are often a result of not being able to verbally express themselves.
3. To ask for things they want
Teaching your child to do this makes it more likely that they will get what they want and less likely that they need to whine, cry, scream or show aggression to do so. One way you can encourage this at home, is to place your child’s favorite toys on a high-shelf and wait until your child asks for it or points to it.
4. To ask for ‘more’
When your child can ask for ‘more’, they will be able to sustain wanted and preferred activities. This will also reduce unwanted behaviors like snatching.
5. To express their emotions
When children don’t have the words to describe how they feel, this usually comes out through non-verbal behaviors. For example, when your child shows self-harm behaviors or aggression towards others, what they might be communicating is “I’m frustrated.” Teaching your child to verbally express their emotions will likely replace problem behaviors.
So how can you teach your child these skills?
It is much simpler than you think!
You are your child’s main language model, and over time, they will likely learn to say what you say. So, the next time you reach for the juice in your fridge, try thinking out loud by saying, “I want juice.” You can also think out loud in front of your child by saying things like, “I want more”, “I feel happy / sad / mad” in the moment or “I don’t want” to refuse items. It might feel strange at first, but eventually, you won't even realise you're doing it anymore!
The Expat Speechie
Copyright © 2018. www.theexpatspeechie.com. All rights reserved.
I have heard some crushing stories from local Thai and Expat parents describing how their child received an Autism Diagnosis in Bangkok. Far too many times, their stories sound like this:
“We were in the room with the doctor for less than five minutes, when suddenly they told us that our child has Autism”.
One parent even told me, “when I asked what this meant, they said Google Floor Time”.
What is even MORE shocking is that, many times, the child DOES NOT actually meet the criteria for Autism!
Parents often ask me, “do you think my child has Autism?”. As a Speech-Language Pathologist and a Certified Autism Specialist, I believe that there is a due Assessment process which must be followed before providing an accurate and reliable diagnosis. If you suspect that your child might have Autism, here are five things your child's Assessment process should involve:
1. Firstly, information will be collected
A reliable diagnosis will consider your child’s skills and ability in a range of environments, not just the clinic. For this reason, information about your child needs to be collected. As a parent, you know your child best and spend the most time with them – you can provide a wealth of insight about them. During a pre-Assessment consultation with the person assessing your child, you will be asked many questions about your child’s development history up to their current skills and ability. Information will also be collected about your child from other people. This is likely to include your child’s classroom teacher and any current or previous therapists who work with your child.
2. Diagnosis is a multi-disciplinary process
It is very likely that either a Pediatrician or a Clinical Psychologist will lead your child’s Assessment and make the diagnosis, as they are specialized to do so. These individuals will ask questions about your child’s overall development, observe your child and administer formal Assessment tools such as checklists and observation scales.
Professionals who specialize in different areas of development should also be involved in the evaluation. The Assessment should involve a Speech-Language Pathologist to evaluate your child’s communication, if there are concerns in this area. Also, an Occupational Therapist can evaluate your child's sensory needs, motor skills and emotional self-regulation.
3. Criteria must be met in two specific areas
For a child to be diagnosed with Autism, they must meet the criteria listed in the Diagnostic and Statistical Manual – Fifth Edition (DSM-V) in BOTH areas outlined below.
A. Social Communication Deficit:
This includes the verbal and non-verbal aspects of social communication or the ‘unspoken rules’ of social interactions.
· These verbal aspects include difficulty with back-and forth conversations, initiating conversations, maintaining conversations or ending conversations. For instance, I have worked with a child who did not give others a chance to speak during conversations.
· The non-verbal aspects which children find difficult include interpreting emotions, making eye-contact, engaging in imaginative play and gestures.
B. Repetitive and Restricted Routines:
This includes verbal and non-verbal repetitions.
· Children with Autism may repeat things over and over verbally, which is referred to as ‘echolalia.’ For instance, I have worked with a child who recited the same YouTube video repeatedly.
· They usually display repetitive movements such as hand-flapping and rocking.
· They tend to become very upset and have very low tolerance for a disruption or change in their routine.
· They are either much more sensitive to sensory stimulus around them, or they do not seem to respond to sensory stimulus. For example, I once worked with a child who repeatedly walked around my office to run their hands across all the furniture.
· They might seem ‘obsessed’ with a certain topic of interest which they insist to keep bringing up and talking about.
It is crucial to understand that if your child has one or more of the characteristics above, this does not necessarily mean that they have Autism. In fact, many children and adults have one or more of the characteristics outlined above. An Assessment is crucial for an accurate and reliable a diagnosis.
4. The Assessment will take a while
The Assessment process is lengthy because as well as formal tools being administered, your child will also be observed informally in the clinic and outside the clinic (e.g. at school). Children behave differently in different settings and different variables must be accounted for (e.g. if they are in an new environment, your child’s mood that day, if they are unwell or tired). Reliable conclusions can be drawn by collecting a wide sample of observations, which can take multiple sessions.
5. Finally, results will be reported and explained
The results of the Assessment will be written in a report, which will also include recommendations for supporting your child in their areas of need. The results and observations will also be discussed with you during a post-Assessment consultation. I understand that this is a very tough discussion for parents to have and can often be emotionally overwhelming. However, it is important to remember that you have taken the first (necessary and brave) step towards helping your child. This post-Assessment consultation will help you further understand your child’s skills and needs as well as how to best support them moving forward. Here are some questions which you can ask during this discussion:
“What does Autism mean?”
“What areas will my child need support in?”
“What are your recommendations?”
“What is my role in intervention?”
“What is the next step to support my child?”
I hope this information has been helpful to you, dear parent, who is reading this post. Please help to empower other parents to understand more about obtaining an Autism diagnosis for their child by sharing this post.
The Expat Speechie
Autism: The 'A' Word
How Can I Support My Child Who Has Autism
Small Changes Can Make A Big Difference: Shaping the home environment to promote your child’s communication
I am excited about this month's post, which has been written by our guest, Mui Kometsopa, Centre Manager of The Rainbow Room Foundation, Architect and mum. Mui has merged her expertise in architecture with her experience of working with families who have children with special needs to bring you these practical tips below.
As an architect, I strongly believe that physical environment can influence human behaviour, especially social interaction within that space. With just minor arrangements and a few adjustments, you can actually set up home environment that fosters interaction and improves your child's communication. The keys to shaping the home environment are to maximise opportunities for a child to communicate their needs and to minimise sensory distraction.
Here are 9 tips for parents:
1. Open up living space
Light up the room, ideally with natural sunlight. Removing partition or furniture that blocks the flow of space will help to create visual connection within the room. The open living space will encourage people to see what others are up to. The more we see each other, the more opportunities there are for social interaction.
2. Identify specific areas for specific activities
A well-structured and organised environment will enable a child to predict the situation and tasks they have to do in a certain area such as dining, reading, homework, play, etc. Clear structure will help to reduce anxiety and promote self confidence.
3. Re-position furniture
When we need a child’s attention, the position recommended to maximise interaction is to sit directly in front of them. For example, rather than push your child’s working table up against a wall, float the table to allow extra seat on the opposite side.
4. Use padded flooring
In play areas, a padded floor is recommended not only for your child safety, but also for your own sake. Since the best position to create ‘joint attention’ is at your child’s eye level, you will be spending a lot of time on the floor, rolling, crawling - playing with him. A padded floor will be more comfortable for you and safer for your knees.
5. Put the shelves up high
High shelves can certainly help to minimise visual distractions. When toys and other objects are out of a child’s reach, they will need an adult’s help to reach them. This provides more opportunities for communication. Open shelves are better since they allow a child to clearly see what is available to play, which helps reduce anxiety.
6. Categorise toys
Toys can be categorised conceptually or thematically. You can put pictorial or written labels on the boxes so they are easy to use and maintain. Toy boxes can be rotated to reflect interest of your child in that day. Toy grouping can encourage a child to build a connection between related toys and create a story while playing. Thematic play also motivates expressive language and social interaction.
7. Label up!
Labels are handy. Not only can they help to expand your child’s vocabulary, but they also can help you organise the entire house! Labels on enclosed containers such as storage boxes or solid cabinet doors can reduce anxiety for some children (and adults).
8. Ensure safe exploration
As a parent, you probably realise how much kids love to explore household items. While your child is roaming the house to learn new things, make sure your space is child-safe. Cover electrical outlets, and store dangerous or breakable objects up high. Locking unsafe items away can reduce situations where you have to use the word ‘no’ or ‘don’t’, allowing you to interact with your child in more positive and enjoyable ways.
9. Create display wall
A little wall of your child’s art, writing or print display at home is a powerful reinforcement to promote his self esteem. The wall should be located where everyone can clearly see it and talk about it. This can be placed along the hall way, in the living room, or on the fridge door. Be as creative as you like but be aware not to bombard the space with pictures which might cause visual over stimulation.
Many children with hyper-sensitivity experience sensory overload which can be distracting and interfere with their focus. The basic principle is to remove or reduce sensory disturbance from the environment. It is essential to be aware of your child’s sensory sensitivity and how the environment might affect them.
I hope you enjoyed reading this article as much as I did and took away these practical tips to apply at home!
The Expat Speechie
Last month, I attended a workshop held by Michelle Garcia Winner, the founder of Social Thinking. To say I was excited is an understatement. Social Thinking is my preferred approach when working with children who have multiple speech and language needs. As Michelle emphasized, Social Thinking goes far beyond just teaching “social skills”. She explained that it involves applying language and cognition (thinking) to social skills and solving social problems.
Interestingly, the longest research study ever conducted on happiness, found that people who have strong and lasting social relationships are generally the happiest. Social Thinking is so important for forming and maintaining these social relationships with others.
Why is Social Thinking so important?
There have been many times during my speech therapy sessions when I think to myself, “I really wish this child knew how to tell me (and others) that they did not understand what was just said to them” or “if only they knew what to do when someone does not understand what they have said”. At that point, I will usually stop the activity we are working on and we will practice these skills instead. Skills like these are often over-looked because most children learn them naturally. However, some children do not and need to be taught these skills in a structured setting such as therapy. Communicating that they have not understood what was said to them and knowing what to do when others have not understood them are just two examples of the endless skills which the Social Thinking approach promotes.
What does Social Thinking involve?
In my opinion, Social Thinking forms a bridge between Speech Therapy (as language is needed to communicate) and Psychology (as communicating with others involves attention, thinking and perspective taking).
Social Thinking is quite complex and it involves many skills including:
• Expressive Language (using language) and Receptive Language (understanding language)
• Social skills
• Problem solving
• Short-term memory
• Meta-cognition (thinking about thinking)
Will my child benefit from the Social Thinking approach?
This approach is mostly suitable for children with moderate-to-high level of language and thinking skills. Your child can benefit from this approach if they have social learning difficulties or need support in their social communication skills. This approach often teaches the ‘hidden curriculum’ as Brenda Myles writes about in her book, which some children do not learn naturally. I have personally seen many children who have Autism, Down Syndrome, social learning difficulties in elementary, middle-school and high-school make fantastic gains from using this approach.
What will my child learn through this approach?
Your child will learn skills in the social communication areas where they require support. To determine these areas, a Speech Therapist will gather information from you and possibly your child’s teachers. The therapist will then assess or observe your child’s social communication skills to identify areas of need.
Based on the findings from the assessment, a plan will be put together outlining the social communication areas where your child needs support.
During therapy, your child might then work on skills such as perspective taking, where they learn that two people can look at the same thing and have different thoughts about it. Your child might work on “whole-body listening” where they are taught to pay attention with their bodies. This is such an important skill for social interactions as well as for learning in classrooms. Another skill your child might work on is thinking about others and how to start conversations based on their interests. They might then learn how to maintain these conversations.
Social Thinking is a great approach for working with children with social learning difficulties. I hope to see more of this approach being applied in Bangkok within the coming years, to equip children with such important life-skills.
The Expat Speechie
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