Summer 2002

Articles from the Summer 2002 Issue

Attention – your firm and flexible friend.

Nibbhaya. (2002)

Joint (or shared) attention is required for children’s education, since they need to attend to the topics chosen by teachers. Some children lack this, and children with autism have single-channelled or tunnelled attention. A descriptive model of attention control is presented for clinical use, describing the four qualities of attention: (1) light and rigid, (2) light and flexible, (3) firm and rigid, and (4) firm and flexible. The first three do not involve other people in communication, but the fourth quality is required for interaction. Attention difficulties in autistic spectrum disorder may have different underlying aetiologies, including (1) weak central coherence, (2) executive dysfunction, (3) weak Theory of Mind, or (4) high anxiety. These are discussed in relation to intervention strategies including meditation. Some ideas for intervention under different qualities of attention: light and flexible, firm and rigid, and light and rigid are suggested, based on their use in autistic children.

Removing the obstacles.

Sims P. (2002)

This article suggests that many speech and language difficulties and dyslexia are related to tension and anxiety. The use of a ‘no failure’ method to help children with, or developing, literacy difficulties or dyslexia results in simultaneous improvement in speech and language. The article describes ways of avoiding things which trigger negative reactions and shut-down and provide positive experiences rather than reinforcing failure. Four case examples illustrate the use of the basic method and its adaptation for older clients with writing rather than reading difficulties. A personality checklist is given which helps to pinpoint the main problem behaviour such as worrying, panic, sensitivity to failure, and switching off.

This is IT.

Wade J, Woodward S. (2002)

The range of specialist software available for people with aphasia is limited. Software designed for other groups may nonetheless be useful to people with aphasia, and this article describes an evaluation protocol for clinicians to assess software and provides a review of a limited selection of seven software titles (My House, Smart Start English, Speech Sounds on Cue, Jigsaw, Co:Writer, Clicker 4, and Out and About). Ten questions were used in developing the protocol: (1) what language tasks are targeted?, (2) which client group will benefit? (3) hardware/software requirements and costs, (4) the ability required of the client, (5) clarity of visual presentation, (6) the feedback provided for correct/incorrect answers, (7) how are the results recorded and presented? (8) are software menu options customisable? (9) does the software have an authoring component to allow the clinician’s exercises to be developed? and (10) Does the program allow different input devices to be used? A case example is provided, illustrating the use of the protocol to select appropriate software for a 73 year old aphasic and dyspraxic lady.

On the right track?

Robertson T, McKenna W. (2002)

An audit of the pattern of care provided to preschool children referred for delayed speech and language development revealed variations in the delivery of care to individual clients. A comprehensive literature review was undertaken to examine whether a care pathways approach to the problem would provide a more reliable and consistent service for preschool children, while leaving sufficient flexibility in the system to respond to clients as individuals. The review suggested a number of variables which influence the therapist’s decisions on the management of a client, and a flow chart was designed by the team to help therapists make decisions to provide treatment or discharge children with phonological delay/disorder. The removal of client review with advice (monitoring) as an option is explored. Removing the ‘hidden waiting list’ would provide a more equitable spread of workload amongst therapists, since 94 per cent of children needing therapy are accurately identified by therapists at the initial assessment. The effectiveness of therapy is discussed in the light of the STEP randomised controlled trial (Glogowska et al., 1998), and factors influencing the results of that trial suggested. Criteria for discharge are also briefly examined. It was concluded that a care pathway may be a way forward, but that due to local factors review with advice (monitoring) should be retained at present.

The right people for the job.

Wood L. (2002)

In a profession with recruitment and retention difficulties, there is a need to be proactive in encouraging the right people into the profession. This article describes the author’s experience in coordinating observation requests, providing information to prospective speech and language therapists, and coordinating student placements at King’s College Hospital. The content of a two day “Speech and Language Therapy as a Career” course, costing ú40, which is offered to local people is decribed. A total of 33 people have attended two courses, mainly female postgraduates. The responses received from questionnaires filled in at the end of the courses are listed. Direct observation was felt by participants to be the most important part of the course. A follow-up questionnaire was sent to participants six months after the first course. Nine of 13 questionnaires were returned, and showed that all but one of those who replied had applied to study speech and language therapy, had been offered interviews, and seven were offered places (one interview was “too late”). Suggestions of things departments can do to attract people who are right for the job are made, even when they are not in a position to run courses.

Clueing up for inclusion.

Kersner M, Coxon A. (2002)

Legislative change means that more children with communication difficulties are now being educated in mainstream schools. This article reports a small-scale study of speech and language therapy managers to discover how they were meeting the challenge of providing services to this group. The implications of inclusive education were investigated with regard to the impact on local services, changes in services in response to these developments, and the nature of the changes on staff and the service structure. The major impact was an increase in caseload and in the diversity and complexity of children’s needs. Other issues were the effect on waiting lists and prioritisation. There was an increase in multi-agency working and a change in style to indirect intervention. Many teachers and parents are dissatisfied with this form of intervention, and much collaboration is between therapists and learning support assistants rather than teachers. Despite the importance of collaboration and training, few had a written policy about collaborative working practices. Half the managers felt that working in mainstream schools should be viewed as a ‘specialism’ in its own right, and that staff with specialist expertise displaced from special schools might be re-deployed into mainstream as a central resource for a multi-site service. Understaffing was a serious issue, with newly qualified staff lacking appropriate skills to work in mainstream, and student education seen as an issue which needs to be addressed. Increased funding was suggested as a change which might make services more effective.

How . . . I manage stammering in adults.

Getting to know you.

Wright L. (2002)

Stammering therapy is a long-term process of change that may impact on many areas of a stammerer’s life. The first of three articles on this topic examines questions of the client’s readiness to accept change, the support available in the workplace and home, and the best treatment approach(es) for that individual. These are explored with the client in an initial semi-structured interview, the Wright and Ayre Stuttering and Self-Rating Profile (WASSP, 2000), and these may be followed up later with other personality and attitude assessments. At the end of the first meeting possible therapeutic options which will help clients to achieve their aims are described, including the three main approaches: Van Riper, Conture, and Sheehan. WASSP is used to monitor progress. The aim in all therapy is to empower clients to manage their stammer long-term by helping them to acquire understanding, therapy tools and confidence to cope with changing needs and circumstances.

Tipping the scales. 

McNeil C. (2002)

What does a stammer mean for an individual? And what inner resources do they have which will guide therapy? This article describes a range of approaches, particularly neurolinguistic programming and brief therapy which can bring about change. Striking a balance between identifying the problems and looking for solutions early on in therapy is important, avoiding to much analysis too soon. Using brief therapy scales helps to set goals, and using neurolinguistic programming in a supportive environment helps to soften the impact of addressing negative memories and feelings.

Fighting fire with fire. 

Bligh A. (2002)

Rather than looking for a non-existent cure for stammering, the Starfish project offers small, intensive three-day courses and unconditional support to recovering stammerers seeking effortless speech. This article describes the nature of the courses, which involve small groups of people (around 10) working for the most part on a one-to-one basis in an intensive, residential setting. Diaphragmatic retraining is employed, as well as long-term rebuilding and adjusting of the plans of the stammerer which will have been designed around word, situation and relationship avoidance. Social support for rebuilding is provided through a nationwide phone list of recovering stammerers available day or night, local Starfish support groups, group supported practise in real life situations, and the option to come back on any course at any time to refresh. Speech and language therapists are welcomed, and many have attended the course and learned the techniques and are able to offer advice and backup to clients who attend the courses.

My top resources.

Marsh T, Brookes C. (2002)

The authors work within the community paediatric team in clinics, homes and educational settings , seeing children with a wide range of communication difficulties. Dealing with an unpredictable caseload requires flexibility, and the need to work closely with other early years professionals. Ten resources for this situation are suggested, including screening tools, selected books, team meetings and joint visits, as well as health promotion through displays, advice sheets and a quarterly newsletter.