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alternative approaches

Removing the obstacles


Read this
if you have clients who avoid situations where they will fail rush before their memory fades become flustered then panic and shut down

ur profession remains undecided about our role in the field of literacy problems and dyslexia. But should we say that it is not our area, that there are other experts? To turn ones back on literacy problems is to miss a huge opportunity. When, equipped with full understanding, we correct or prevent reading and writing problems in school aged children, we frequently remove obstacles to progress in speech and language. Many a time a parent has approached me saying, My child needs help with his speech. His teacher says its holding him back with his reading. I usually offer to tackle the problem the other way round. I work on the literacy difficulty and find that the speech and language improve simultaneously. Many parents who are anxious for speech and language therapy would be much less concerned about their childs speech if they did not fear that it would inhibit his or her progress in reading and writing. Why should rectifying literacy problems have such an effect on speech and language? Attention to letters and written words can help the spoken form and comprehension, but another - and in my opinion more important - factor to consider is tension or anxiety. Many speech and language difficulties are related to tension and anxiety, and so is dyslexia. Common signs for dyslexia, as listed by the British Dyslexia Association, can be related to tension and anxiety (Sims, 2000), and the tension or anxiety does not have to be out of the normal range to create problems. Children learning to read or write may become flustered, panic and experience some shut-down. Problems with connection (Paulesu et al, 1996) may become pro-

grammed and the status quo, arising without signs of unease. Difficulties in absorption and retrieval of words ensue. Whilst reading problems can be caused or exacerbated by tension and anxiety, they naturally cause additional anxiety. When confidence and a sense of well-being is restored by sensitive attention to the literacy problems, there can be a noticeable spin-off in the direction of speech and language, since anxiety can also, and often for the same reasons, be a major factor in slow, disconnected, confused, disjointed, and dyspraxic speech, and in inattention to ones own speech or that of others. On the other hand, working directly on speech and language difficulties while selfesteem is lowered by literacy difficulties is likely to be less productive, because a literacy problem pervades almost all school work and affects ones confidence with peer groups. It is generally perceived by the child to be their greatest problem; they may well be relatively unconcerned or unaware of any speech and language problem.

Positive experiences
I have devised a No Failure Method to help children with, or developing, literacy problems or dyslexia; it can be adapted for older children and adults. A fuller account of it and reasons for its particular format are given in Reasons and Remedies (Sims, 2000). The method replaces programmed and conditioned negative experiences with positive ones. It enables the child to maintain concentration so that they can better make connections, memorise, and reinforce their memory and retrieval of words. Children who truly lack motivation, such as those with a pathological demand-avoidance

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002

alternative approaches

An independent speech and language therapist specialising in the prevention and treatment of literacy difficulties, Patricia Sims believes that many speech and language difficulties and dyslexia are related to tension and anxiety. Using her no failure method, she works on literacy difficulties and finds speech and language improve simultaneously. In a profession undecided about its role and boundaries, she argues we should be saying YES to literacy therapy.
problem (Newson, 1989), are unlikely to benefit, and care should be taken with autistic children to ensure that reading skills are accompanied by full comprehension. Generally, however, children with a literacy difficulty really care about their inability to read, and their anxiety over their failure exacerbates the problem. They may well avoid reading and writing but, once given empathetic help, and hope, they are keen to improve and are stimulated and motivated by the progress they make. To avoid the problems it is necessary to avoid all the things which trigger the negative reactions which lead to shut-downs. Initially, the chief of these triggers is being asked or expected to read a word. This trigger can be removed by following these steps: 1. If the child is in the infant school years, utilise a very basic reading scheme which has a lot of carry-over of words from one book to the next, and a lot of repetition thereafter. It is best to liaise with the school in this matter. The One Two Three and Away! scheme is excellent (McCullagh, 1978). 2. Read the book to the child, pointing to the words. Help them to become a little familiar with and take some notice of individual words by encouraging them to point to a word you have just pointed to while you were reading a sentence aloud. Point to all the words as much as seems necessary to help them, and encourage them to ask you to point to a word they choose, too. Let the child count how many times a particular word occurs in the book. 3. Write the first word of one of the short (perhaps three word) sentences, and tell them what it says. Then ask them to look at it for as long as they wish and tell you when they are ready to write it. When they think they are ready to have a go, remove the word, giving them a blank piece of paper and pencil. Paper can be exchanged for keyboards and computers for children with a physical impairment. 4. As soon as the child begins to make a mistake or hesitate for more than a second, show them the word (and name it for them) again so they can repeat the exercise in absorption. Repeat this as often as necessary, keeping quiet and relaxed yourself. Avoid any pressure or lavish praise. Try not to give any message that you are eager for them to succeed quickly, and avoid additional instructions. Try to make it seem like a game or little challenge, but do not imply that it is easy. NEVER ALLOW THE CHILD TO STRUGGLE when writing a word; observe them carefully and always be ready to jump in and show them the word again as soon as they need help. Do not allow them to correct a mistake; always remove their effort and start the absorption process again. When they decide they are ready for it, present them with blank paper again - their mistake can be folded over. 5. Once the child has written the word successfully, move on to the next word in the sentence. When they are successful with this one too, name and let them view the two words of the sentence together and write them both when they feel ready. Should they make a mistake on the second word, they view both words again and begin once again to write both words, starting with the first. This gives extra, relaxed practice with the first word and reinforces it. 6. When they have written both words together correctly, introduce the third word of the sentence, following the same procedure. When they have written it correctly, give them all three words to view together. Remember that as soon as the child makes a mistake they must view the entire sentence again and begin it again on more blank paper. 7. NEVER TEST THE CHILD to see if they have remembered the words. The aim is to change habits by allowing them to relax, absorb words and their sounds, and maintain concentration. They will not be able to remember and retrieve words instantly. Their confidence and belief in their own ability has to be gradually built up. 8. Practice can be varied by mixing words from different sentences or encouraging the child to rearrange words written individually on separate pieces of paper (for example, here is Ben can become Ben is here). A picture of Ben might be drawn and labelled. 9. When the child has become really familiar with the words, they can be written on individual pieces of paper and hidden around the room, a few at a time. Allow the child to choose which to hide. Their task is to find each one and say what they have found, if able. If they dont instantly know the word, they are told it immediately; for example, Good, youve found has. The child may feel more relaxed, and hence be more successful, if they play this game with an older sibling who can read. Take turns to hide and find.

Children learning to read or write may become flustered, panic and experience some shut-down.

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002

alternative approaches

Figure 1 - case examples

Alice
Alice came to me when she was six years old and failing to read at school. Her teacher had suggested that speech and language therapy to correct some sounds might help her to read. Alices speech was found to be satisfactory apart from her lack of affricates and some voicing of initial voiceless phonemes. Administration of a Personality Checklist (Sims, 2001) revealed some early and current tension and anxiety. She had always been restless and excitable but her behaviour had recently become more difficult, she was more distractible, and she was sleeping more fitfully. She had begun to hide her school reading books as soon as she returned home from school. It transpired that she no longer followed a reading scheme at school, often being allowed to choose her own books from a selection. She tended to learn sentences by heart but the only word she could read reliably was her own name. She was able to sound letters competently. A visit was paid to the school where Alices difficulties were discussed, and it was agreed that she should return to a basic reading scheme while the No Failure Method was implemented. Initially it was to be implemented only by me and her parents, since there was little opportunity for Alice to receive individual attention in the classroom. But her teacher was happy to remove any pressure on her to read aloud and she was willing to renew her reading book only when it was entirely finished with. Within a few weeks Alices reading ability had developed and her confidence had grown. She was delighted to be awarded a certificate for achievement during a school assembly. After 14 weekly one hour visits, regular therapy was discontinued; it was sufficient that the method was maintained each evening at home. I did give her some incidental help with her speech during her weekly visits but I have little doubt that her increased confidence in reading and writing and her enhanced self-esteem were largely behind improvement in her speech.

10. Once the childs confidence and ability to absorb, retain and retrieve information has grown, some words might be casually sounded during the practice. The adult should, however, be wary of offering detailed instruction concerning letters and their sound combinations too early.

Absorb and practise


For a child whose main difficulty is writing and spelling, the chief trigger is being left to struggle to retrieve the impression of words or their parts. A variety of appropriate sentences can be given to older children and adults, utilising this no struggle and no failure approach. The same words may be placed in different sentences for their reinforcement. Words from school spelling lists can be included in suitable sentences for children to absorb and practise. Should the person forget the sentence itself as they are writing, it should be repeated for them in its entirety, not word by word as they write. With this method we eliminate the possibility of failure. The child is not encouraged to read a word unless it becomes apparent that they can recall or retrieve it with ease. They dictate their own pace and do not experience the harmful negative feelings brought about when progress is tested or monitored. They can therefore relax and absorb the information, and new learning pathways are opened up. You may be asking, How much of the progress could be attributed to individual, focused attention? Most of the children I see have previously had an enormous amount of individual attention, often from enthusiastic and caring learning support classroom assistants. The children were only too aware that everyone was making a huge effort and that they were failing in spite of it. The more practice they have had at failing, the worse the problem. It is the nature of the intervention that is critical. The four case examples (figure 1) illustrate the use of the basic method and its adaptation for older clients with writing rather than reading difficulties.

Robbie
Robbie came for help at six and a half. He was highly sensitive and keen to succeed but a basic problem with absorption and retrieval of information was affecting his comprehension, speech and self-expression, and his progress in literacy. He had always tended to switch off at times, and could become panicky. He was clumsy and had been late with milestones and slow to develop his left-handedness. In spite of a generous period of time allocated to him in the classroom with a learning support assistant, Robbie was unable to read and write words, though he could sound any letter. As with Alice, the No Failure Method was implemented with the support of Robbies school. His mother was taken aback by his immediate new level of concentration during the procedures, just as Alices mother had been. As he relaxed, he gradually became able to pay more attention to the sounding of the words. His confidence, enthusiasm and belief in his own ability rose as his literacy, sequencing and speech and language difficulties faded. One hour sessions had been given weekly for the first three months, fortnightly for the next month, and then more sporadically as the need diminished, home practice having been well established.

Rupert
At the age of thirteen, Rupert was receiving extra support for dyslexia at his comprehensive school. He displayed obvious anxiety and some disturbed behaviour. The same trouble with absorption and retrieval which lay behind his spelling problems created comprehension and self-expression difficulties. Utilising vocabulary from the school curriculum subjects, appropriate whole sentences were shown individually to Rupert for him to absorb and write according to the No Failure Method. Care was taken to ensure that the challenge was enjoyable and never excessive. Frequently occurring words which Rupert misspelled were also targeted and incorporated into various sentences, but never tested. Each sentence was re-read for him if he needed to be reminded of it whilst he was writing, so that his auditory memory was not taxed or tested. Rupert enjoyed the procedures and the challenge, feeling relaxed and in control. As his spelling ability developed, he made fewer word repetitions and omissions in his writing. At the same time, Ruperts learning support assistants broke down his work tasks into small sections which did not appear daunting to him. His goals were welldefined and essay writing and organisation was facilitated by this approach. At the end of a year, after 24 one hour sessions and additional weekly practice provided by a learning support assistant, Ruperts speech and language had noticeably improved, along with his literacy skills. He was absorbing more information and initiating conversation in the classroom, which he had failed to do hitherto. word shape and visual impressions and she had tended to rush her writing before her memory had the chance to fade. The new method of absorbing an entire sentence in her own time and writing it correctly in its entirety without making corrections or permitting any struggle encouraged and enabled her to slow down and pay attention to the word and sounds she was writing, instead of rushing ahead and attempting to correct mistakes afterwards. Janine developed a new sense of purpose and her literacy skills and powers of selfexpression went from strength to strength.

Research needed
Research is needed to test the robustness of my clinical experience and theory, and a challenge goes out to any speech and language therapist interested in research. There is a need to acknowledge that high levels of tension and anxiety are commonplace and natural in childhood and form a positive component of the human race. But even when within the normal range, tension or anxiety can be responsible for, or a contributory factor in, developmental difficulties of all kinds, depending upon its mode of expression. While we await appropriate research in this area, we will find it illuminating to speak in some detail with adults and older children who experience literacy and speech and language difficulties, and to make use of a personality checklist (Sims, 2001).

Janine
Janine was a highly sensitive and self-critical lady aged 30 years. Her undiagnosed dyslexia, complicated by some depression, caused her a great deal of distress at work, and she was quite unable to express herself well verbally at meetings. Janines difficulties were explained to her in terms of the disconnection she was programmed to experience. She embraced the No Failure Method of writing sentences. Lists of appropriate sentences were given to her. Generally, she successfully carried out her routine nightly practice alone. She had always relied heavily on

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SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2002

alternative approaches

The role of my Personality Checklist in the literacy field is to highlight behaviour such as worrying, panic, sensitivity to failure, and switching off. When parents link their childs personality to his or her problems, they are enthusiastic about the No Failure Method, the reasoning behind it having been explained to them. So the checklist has an educative role and inspires enthusiasm in parents who may have been feeling quite desperate. As long as the therapist, parents and teachers are aware of the programmed problems which cause or aggravate the difficulties, the implementation of the method becomes sensitive and it is not in the least difficult to go at the appropriate pace for the child. A sample from the 30 groups of questions in the Personality Checklist is in figure 2. The thinking behind the list is explained in Reasons and Remedies (Sims, 2000). At first sight, some questions may seem to address a purely physical problem, but the checklist is designed to help link groups of traits and reveal heightened tension and anxiety in fears, switched off behaviour, emotional and physical hyper- and hyposensitivity, attention deficits, distractibility and excitability, obsession and compulsion, and manifestation of tension and anxiety through speech and language. Having fully considered the childs tension or anxiety, the parent or carer may be able to take steps to remove, where possible, any environmental influences which may be contributing to it. The checklist has a diagnostic purpose and helps to pinpoint the main problem for a child (although there is considerable overlap of symptoms); for example, They may be a worrier and fearful, and this may underlie literacy and speech/language problems, or give rise to depression or obsessional behaviour, stammering and tics. They may be rather globally switched off, as in autism. Tension may take the form of attention deficit hyperactivity disorder, possibly with additional symptoms of dyspraxia. Obsessional demand-avoidance may be the main problem. When we properly understand what young children are experiencing with their early reading and writing difficulties, a heavy burden is removed from their shoulders and, with relaxed and confident adults helping them, they are able to move forward with confidence and reassurance. Their resultant success is manifest in their speech and language, too. This literacy therapy is straightforward, enjoyable, successful and very rewarding. Perhaps forwardlooking speech and language therapy departments might appoint a specialist therapist for literacy problems - who will be simultaneously reducing the speech and language problems for other

members of the department. Grasp any such opportunity and brighten your days! Patricia Sims has worked principally within the NHS. She is now an independent speech and language therapist specialising in the prevention and treatment of literacy difficulties. She is willing to demonstrate her No Failure Method to groups of therapists (e-mail dandtsims@ukonline.co.uk).

2. Does he flit from one activity to another and have difficulty sustaining his interest in, for example, a toy? Can he sit still and concentrate? Can he concentrate when he is really interested in something? If so, how well? Is he impulsive? Does he fiddle with ornaments, etc., in peoples houses or with things in shops, despite being told not to? Does he always seem to be restless and does he keep fidgeting? Is he always in a hurry to do things? Does he become bored easily? Does he become very excited? Is he easily distracted? Is he very impatient? Does he look where he is going - is he properly aware of obstacles in his way?

References
McCullagh, S. (1978) One, Two, Three and Away! London: Harper Collins. Newson, E. (1989) Pathological Demand Avoidance Syndrome: diagnostic criteria and relationship to autism and other developmental coding disorders. University of Nottingham. Paulesu, E., Frith, U., Snowling, M., Gallagher, A., Morton, J., Frackowiak, R.S.J. & Frith, C.D. (1996) Is developmental dyslexia a disconnection syndrome? Evidence from PET scanning. Brain, 119, 143-157. Sims, P. (2000) Reasons and Remedies. Barnstaple: Mortimore Books. Sims, P. (2001) Personality Checklist. An A4 Reproducible version. Barnstaple: Mortimore Books.

The child is not encouraged to read a word unless it becomes apparent that they can recall or retrieve it with ease.

3. Is he easily frightened? Does he become terrified of anything? Is he anxious in an unfamiliar place? Does he worry? Does he panic?

Resources
British Dyslexia Association, 98 London Road, Reading RG1 5AU, National Helpline 0118 966 8271, www.bda-dyslexia.org.uk. Patricia Sims A4 photocopiable Personality Checklist, used in conjunction with Reasons and Remedies, helps the professional and parent or carer to see any relationship between a childs difficulties and tension or anxiety. It may be completed by the professional or an informant. An additional set of questions for the child of school age is included. 8 Available from bookshops, STASS or direct from: Mortimore Books, PO Box 156, Barnstaple, EX33 1YN, 8, p&p free, ISBN 0953620913.

5. Is he sensitive and easily hurt by criticism? Does he sulk? Is he very shy? Is he weepy?

Reflections
Do I recognise how anxiety can influence progress? Do I allow clients to dictate the pace of therapy? Do I give clients practice at failing - or gradually build confidence and self-belief?

23. Does he listen well? Does he listen well when he is being addressed in a group? Does he switch off or seem switched off from his surroundings - perhaps appearing deaf without being deaf? Does he remember nursery rhymes?

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Figure 2 Sample from Personality Checklist (Sims, 2001)