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Removing the obstacles.

Removing the obstacles.

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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.
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.

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Published by: Speech & Language Therapy in Practice on Jul 04, 2013
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grammed and the status quo, arising withoutsigns of unease. Difficulties in absorption andretrieval of words ensue.Whilst reading problems can be caused or exac-erbated by tension and anxiety, they naturallycause additional anxiety. When confidence and asense of well-being is restored by sensitive atten-tion to the literacy problems, there can be anoticeable spin-off in the direction of speech andlanguage, since anxiety can also, and often forthe same reasons, be a major factor in slow, dis-connected, confused, disjointed, and dyspraxicspeech, and in inattention to one’s own speech orthat of others. On the other hand, working directlyon speech and language difficulties while self-esteem is lowered by literacy difficulties is likely tobe less productive, because a literacy problem per-vadesalmost all school work and affects one’s con-fidence with peer groups. It is generally perceivedby the child to be their greatest problem; theymay well be relatively unconcerned or unaware ofany speech and language problem.
Positive experiences
I have devised a No Failure Method to help childrenwith, or developing, literacy problems or dyslexia; itcan be adapted for older children and adults. Afuller account of it and reasons for its particular for-mat are given in
Reasons and Remedies
(Sims, 2000).The method replaces programmed and conditionednegative experiences with positive ones. It enablesthe child to maintain concentration so that they canbetter make connections, memorise, and reinforcetheir memory and retrieval of words.Children who truly lack motivation, such asthose with a pathological demand-avoidance
alternative approaches
SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
8
Removingtheobstacles
ur profession remains undecidedabout our role in the field of liter-acy problems and dyslexia. Butshould we say that it is not ourarea, that there are other experts?To turn one’s back on literacy problems is to missa huge opportunity. When, equipped with fullunderstanding, we correct or prevent reading andwriting problems in school aged children, we fre-quently remove obstacles to progress in speechand language. Many a time a parent hasapproached me saying, “My child needs help withhis speech. His teacher says it’s holding him backwith his reading.” I usually offer to tackle theproblem the other way round. I work on the literacydifficulty and find that the speech and languageimprove simultaneously. Many parents who areanxious for speech and language therapy wouldbe much less concerned about their child’s speechif they did not fear that it would inhibit his or herprogress in reading and writing.Why should rectifying literacy problems havesuch an effect on speech and language? Attentionto letters and written words can help the spokenform and comprehension, but another - and in myopinion more important - factor to consider is tensionor anxiety. Many speech and language difficultiesare related to tension and anxiety, and so isdyslexia. Common signs for dyslexia, as listed bythe British Dyslexia Association, can be related totension and anxiety (Sims, 2000), and the tensionor anxiety does not have to be out of the normalrange to create problems. Children learning toread or write may become flustered, panic andexperience some shut-down. Problems with con-nection (Paulesu et al, 1996) may become pro-
 
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if you have clients whoavoid situations wherethey will failrush before theirmemory fadesbecome flustered thenpanic and shut down
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problem (Newson, 1989), are unlikely to benefit,and care should be taken with autistic children toensure that reading skills are accompanied by fullcomprehension. Generally, however, children witha literacy difficulty really care about their inabilityto read, and their anxiety over their failure exac-erbates the problem. They may well avoid readingand writing but, once given empathetic help, andhope, they are keen to improve and are stimulat-ed and motivated by the progress they make.To avoid the problems it is necessary to avoid allthe things which trigger the negative reactionswhich lead to shut-downs. Initially, the chief ofthese triggers is being asked orexpected to read a word. This triggercan be removed by following thesesteps:1. If the child is in the infant schoolyears, utilise a very basic readingscheme which has a lot of carry-overof words from one book to the next,and a lot of repetition thereafter. It isbest to liaise with the school in thismatter. The One Two Three and Away!scheme is excellent (McCullagh, 1978).2. Read the book to the child, pointingto the words. Help them to become alittle familiar with and take somenotice of individual words by encour-aging them to point to a word you have justpointed to while you were reading a sentencealoud. Point to all the words as much as seemsnecessary to help them, and encourage them toask you to point to a word they choose, too. Letthe child count how many times a particular wordoccurs in the book.3. Write the first word of one of the short (per-haps three word) sentences, and tell them what itsays. Then ask them to look at it for as long asthey wish and tell you when they are ready towrite it. When they think they are ready to have ago, remove the word, giving them a blank pieceof paper and pencil. Paper can be exchanged forkeyboards and computers for children with aphysical impairment.4. As soon as the child begins to make a mistakeor hesitate for more than a second, show themthe word (and name it for them) again so they canrepeat the exercise in absorption. Repeat this asoften as necessary, keeping quiet andrelaxed yourself. Avoid any pressure or lav-ish praise. Try not to give any message thatyou are eager for them to succeed quickly,and avoid additional instructions. Try tomake it seem like a game or little challenge,but do not imply that it is easy. NEVERALLOW THE CHILD TO STRUGGLE whenwriting a word; observe them carefully andalways be ready to jump in and show themthe word again as soon as they need help.Do not allow them to correct a mistake;always remove their effort and start theabsorption process again. When theydecide they are ready for it, present themwith blank paper again - their mistake canbe folded over.5. Once the child has written the word successful-ly, move on to the next word in the sentence.When they are successful with this one too, nameand let them view the two words of the sentencetogether and write them both when they feelready. Should they make a mistake on the second
SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
9
alternative approaches
An independent speech and language therapistspecialising in the prevention and treatment ofliteracy difficulties,
Patricia Sims
believes thatmany speech and language difficulties anddyslexia are related to tension and anxiety.Using her ‘no failure’ method, she works onliteracy difficulties and finds speech andlanguage improve simultaneously. In aprofession undecided about its role andboundaries, she argues we should be sayingYES to literacy therapy.
Childrenlearning toread orwrite maybecomeflustered,panic andexperiencesomeshut-down.
word, they view both words again and begin onceagain to write both words, starting with the first.This gives extra, relaxed practice with the firstword and reinforces it.6. When they have written both words togethercorrectly, introduce the third word of the sen-tence, following the same procedure. When theyhave written it correctly, give them all three wordsto view together. Remember that as soon as thechild makes a mistake they must view the entiresentence again and begin it again on more blankpaper.7. NEVER TEST THE CHILD to see if they haveremembered the words. The aim is to changehabits by allowing them to relax, absorb wordsand their sounds, and maintain concentration.They will not be able to remember and retrievewords instantly. Their confidence and belief intheir own ability has to be gradually built up.8. Practice can be varied by mixing words from dif-ferent sentences or encouraging the child torearrange words written individually on separatepieces of paper (for example, ‘here is Ben’ canbecome ‘Ben is here’). A picture of Ben might bedrawn and labelled.9. When the child has become really familiar withthe words, they can be written on individualpieces of paper and hidden around the room, afew at a time. Allow the child to choose which tohide. Their task is to find each one and say whatthey have found, if able. If they don’t instantlyknow the word, they are told it immediately; forexample, “Good, you’ve found
has
.” The childmay feel more relaxed, and hence be more suc-cessful, if they play this game with an older siblingwho can read. Take turns to hide and find.
 
alternative approaches
SPEECH & LANGUAGE THERAPY IN PRACTICE
SUMMER 2002
10
10. Once the child’s confidence and ability toabsorb, retain and retrieve information hasgrown, some words might be casually soundedduring the practice. The adult should, however,be wary of offering detailed instruction concern-ing letters and their sound combinations tooearly.
Absorb and practise
For a child whose main difficulty is writing andspelling, the chief trigger is being left to struggleto retrieve the impression of words or their parts.A variety of appropriate sentences can be given toolder children and adults, utilising this no strug-gle and no failure approach. The same words maybe placed in different sentences for their rein-forcement. Words from school spelling lists can beincluded in suitable sentences for children toabsorb and practise. Should the person forget thesentence itself as they are writing, it should berepeated for them in its entirety, not word byword as they write.With this method we eliminate the possibility offailure. The child is not encouraged to read aword unless it becomes apparent that they canrecall or retrieve it with ease. They dictate theirown pace and do not experience the harmful neg-ative feelings brought about when progress istested or monitored. They can therefore relax andabsorb the information, and new learning path-ways are opened up.You may be asking, “How much of the progresscould be attributed to individual, focused atten-tion?” Most of the children I see have previouslyhad an enormous amount of individual attention,often from enthusiastic and caring learning sup-port classroom assistants. The children were onlytoo aware that everyone was making a hugeeffort and that they were failing in spite of it. Themore practice they have had at failing, the worsethe problem. It is the nature of the interventionthat is critical.The four case examples (figure 1) illustrate theuse of the basic method and its adaptation forolder clients with writing rather than reading dif-ficulties.
Research needed
Research is needed to test the robustness of myclinical experience and theory, and a challengegoes out to any speech and language therapistinterested in research. There is a need to acknowl-edge that high levels of tension and anxiety arecommonplace and natural in childhood and forma positive component of the human race. Buteven when within the normal range, tension oranxiety can be responsible for, or a contributoryfactor in, developmental difficulties of all kinds,depending upon its mode of expression. While weawait appropriate research in this area, we willfind it illuminating to speak in some detail withadults and older children who experience literacyand speech and language difficulties, and tomake use of a personality checklist (Sims, 2001).
Alice
Alice came to me when she was six yearsold and failing to read at school. Herteacher had suggested that speech andlanguage therapy to correct some soundsmight help her to read. Alice’s speech wasfound to be satisfactory apart from herlack of affricates and some voicing of initialvoiceless phonemes. Administration of aPersonality Checklist (Sims, 2001) revealedsome early and current tension andanxiety. She had always been restless andexcitable but her behaviour had recentlybecome more difficult, she was moredistractible, and she was sleeping morefitfully. She had begun to hide her schoolreading books as soon as she returnedhome from school.It transpired that she no longer followed areading scheme at school, often beingallowed to choose her own books from aselection. She tended to learn sentencesby heart but the only word she could readreliably was her own name. She was ableto sound letters competently.A visit was paid to the school where Alice’sdifficulties were discussed, and it wasagreed that she should return to a basicreading scheme while the No FailureMethod was implemented. Initially it wasto be implemented only by me and herparents, since there was little opportunityfor Alice to receive individual attention inthe classroom. But her teacher was happyto remove any pressure on her to readaloud and she was willing to renew herreading book only when it was entirelyfinished with.Within a few weeks Alice’s reading abilityhad developed and her confidence hadgrown. She was delighted to be awarded acertificate for achievement during a schoolassembly. After 14 weekly one hour visits,regular therapy was discontinued; it wassufficient that the method was maintainedeach evening at home. I did give her someincidental help with her speech during herweekly visits but I have little doubt thather increased confidence in reading andwriting and her enhanced self-esteem werelargely behind improvement in her speech.
Robbie
Robbie came for help at six and a half. Hewas highly sensitive and keen to succeedbut a basic problem with absorption andretrieval of information was affecting hiscomprehension, speech and self-expression,and his progress in literacy. He had alwaystended to switch off at times, and couldbecome panicky. He was clumsy and hadbeen late with milestones and slow todevelop his left-handedness. In spite of agenerous period of time allocated to him in theclassroom with a learning support assistant,Robbie was unable to read and writewords, though he could sound any letter.As with Alice, the No Failure Method wasimplemented with the support of Robbie’sschool. His mother was taken aback by hisimmediate new level of concentration dur-ing the procedures, just as Alice’s motherhad been. As he relaxed, he graduallybecame able to pay more attention to thesounding of the words. His confidence,enthusiasm and belief in his own abilityrose as his literacy, sequencing and speechand language difficulties faded. One hoursessions had been given weekly for thefirst three months, fortnightly for the nextmonth, and then more sporadically as theneed diminished, home practice havingbeen well established.
Rupert
At the age of thirteen, Rupert was receivingextra support for dyslexia at his comprehensiveschool. He displayed obvious anxiety andsome disturbed behaviour. The same troublewith absorption and retrieval which laybehind his spelling problems createdcomprehension and self-expression difficulties.Utilising vocabulary from the school curricu-lumsubjects, appropriate whole sentenceswere shown individually to Rupert for himto absorb and write according to the NoFailure Method. Care was taken to ensurethat the challenge was enjoyable and neverexcessive. Frequently occurring words whichRupert misspelled were also targeted andincorporated into various sentences, butnever tested. Each sentence was re-read forhim if he needed to be reminded of it whilsthe was writing, so that his auditory memorywas not taxed or tested. Rupert enjoyed theprocedures and the challenge, feelingrelaxed and in control. As his spelling abilitydeveloped, he made fewer word repetitionsand omissions in his writing.At the same time, Rupert’s learning supportassistants broke down his work tasks intosmall sections which did not appeardaunting to him. His goals were well-defined and essay writing and organisationwas facilitated by this approach.At the end of a year, after 24 one hour sessionsand additional weekly practice providedby a learning support assistant, Rupert’sspeech and language had noticeablyimproved, along with his literacy skills.He was absorbing more information andinitiating conversation in the classroom,which he had failed to do hitherto.
Janine
Janine was a highly sensitive and self-criticallady aged 30 years. Her undiagnoseddyslexia, complicated by some depression,caused her a great deal of distress at work,and she was quite unable to express herselfwell verbally at meetings.Janine’s difficulties were explained to herin terms of the disconnection she wasprogrammed to experience. She embracedthe No Failure Method of writing sen-tences. Lists of appropriate sentences weregiven to her. Generally, she successfullycarried out her routine nightly practicealone. She had always relied heavily onword shape and visual impressions and shehad tended to rush her writing before hermemory had the chance to fade. The newmethod of absorbing an entire sentenceinher own time and writing it correctly in itsentirety without making corrections orpermitting any struggle encouraged andenabled her to slow down and pay attentionto the word and sounds she was writing,instead of rushing ahead and attemptingto correct mistakes afterwards.Janine developed a new sense of purposeand her literacy skills and powers of self-expression went from strength to strength.
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