Social Interaction

26th October 2023

Difficulties with social interaction is a criterion that is used to diagnose autism. However, as autism is a spectrum, this can present differently in each individual. For example, someone may enjoy social interaction when initiated by others, some may seek social interaction but feel anxious or unsure about how to initiate it themselves, others may be content not pursuing social interaction at all. 

Difficulties with social interaction could also look like: 

• Difficulty expressing emotions 
• Difficulty recognising other people’s feelings 
• Finding it hard to form friendships 

However your child feels about social interaction, it is an unavoidable part of everyday life, and building social skills is important for building relationships, making friends and learning.  

Why is social interaction important? 

• Improved Communication: Social interaction is a key platform for communication development. Encouraging your child to interact with others can enhance their ability to express thoughts, feelings, and needs. 

• Enhanced Empathy: Social interactions teach children to understand and empathise with others' emotions and perspectives, which is an essential skill for building relationships. 

TIP: As struggling with empathy is seen as a feature of being autistic, people can forget that empathy goes both ways. Without having lived experience of autism, it may be hard to understand why autistic individuals act the way they do. Part of supporting your autistic child could also include extending your empathy to increase awareness of their sensitivities or struggles. 

• Reduced Isolation: Developing social skills can reduce feelings of isolation and improve a child's overall well-being. 

• Practical Life Skills: Many practical life skills, such as taking turns, problem-solving, and conflict resolution, are developed through social interactions. 

• Preparation for Independence: As children grow into adolescents and adults, social skills are vital for independence and success in various aspects of life, including education and employment. 

How can I support developing my child’s social interaction? 

Activities 

Planned/structured Play 

This is play structured by adults. During structured play you provide recourses and give clear guidelines about what to do when. This means tasks have clear steps and goals, making it a lower-stress environment for autistic children to practise interaction skills. 

Structured play can help develop early play like sharing and taking turns.  

Examples of structured play activities include: jigsaw puzzles, card matching activities, board games, lego, colouring or painting by numbers.  

Tips: 

• Make the play motivating by choosing an activity that centres your child’s interests. For example, if they love animals you could begin with an animal matching game, or an animal jigsaw puzzle. 
• Choose an activity that is developmentally appropriate. This activity should be low stress to increase engagement, so ensure it is something your child is able to do. 
• Reward your child for completing each stage of the play. When your child successfully completes a task offer praise, or an action they love (e.g. blowing bubbles, clapping your hands).  
• Use visual aids to support with explaining the order of tasks. Represent each stage of the activity with a cue card (this could be a word, an image or both). Arrange these in order, and remove them as your child completes a stage. Try to gradually withdraw the visual aids as they get more used to an activity. 
• Keep structured playtime short. 

Role-play 

You can use role-play before social events to test out conversations and ideas of play. For example, you and your autistic child could: 

• Do a role-play of an initiating play exchange. Pretend to be another child, and support your child to start a conversation and suggest a game to play.  
• Play the games that the children might play together.  
• Practise talking about things like what you’ve been watching on YouTube, or what you did at the weekend. Model asking questions and turn-taking. 

For older children you could try setting up problem solving solutions. For example, set up a scenario where two people both want to play with the same toy. Role-play possible conflict solving options – for example, how to politely ask someone if you would like a turn, or how to fairly share the toy by playing together or evenly distributing your time. 

Visual aids and resources 

Visual aids can be a helpful tool to support social interaction. Visual aids support individuals by removing the stress of having to memorise tasks and ensuring the individual knows what’s coming next by displaying information in a structured way.

Visual aids can also be used to support children who struggle with imaginative play.

Examples of visual aids include: 

• Social stories 
• Social Scripts 
• Feelings wheel 
• Visual timetable 

View our information page about communication here.

View our current communication resources here.

Other support 

Autism-specific or inclusive social groups. 

Having an understanding peer group can help support social interaction.  

Browse our directory of support services in Leeds, or check the Leeds Local Offer to see what is available.

If your child has a particular hobby or interest but may need support accessing a mainstream club – see if they are eligible for support through Scope’s Activities for All scheme.  

School support 

Speak to your child’s school or setting if you are concerned about their social skills – you could do this by setting up a meeting with their class teacher and school SENCO. School may be able to offer some interventions during school time that can help. This could include 1:1 interventions or group interventions to practise structured play, or a break/lunch time club. 

Additional support and resources:

This information is not affiliated with Leeds Mencap

The Hanen Centre Autism Corner

National Autistic society page on supporting your autistic child to make friends

Supporting your Child with Speech and Communication

26th October 2023

Introduction

Speech and communication is a critical part of a child’s development and many parents have concerns about their child. Although children do develop at different rates, there are key milestones when young children begin to communicate.

The Royal College of Speech and Language Therapists report that 5% of children enter school with speech and language difficulties and some children will need help and support from a speech and language therapist.

Speech and language therapists assess and treat a person with specific speech, language and communication problems to enable them to communicate to the best of their ability.

Speech and language therapists can support children with a wide range of speech and communication issues, from speech sound issues to specific language disorders.

Early speech and language milestones

Children learn to talk at different rates however, it is natural to feel worried if your child seems to be a later talker compared to children of the same age. The following are some key milestones which can help parents to how talking develops and what happens when.

• By 6 months babies will usually watch your face when you are talking and smile and laugh with you
• By 1 year of age, babies will try and get your attention and and point or shout for something. They will start to understand words like ‘bye bye’ and will look at you when you speak
• By 18 months, toddlers will understand some simple words/phrases, point to familiar objects when you ask them too and enjoy games such as ‘peek a boo’
• By 3 years, toddlers will speak in sentences, stop relying on pointing at things and will understand ‘who’, ‘why’, and ‘what’ questions
• By 5 years, children will be able to have conversations, will talk to other children, will be able to put longer sentences together and adults will be able to understand what they are saying

The charity Afasic, which supports and provides information for children and young adults who have speech, language and communication needs recommends watching out for:

For babies/toddlers:

• Poor eye contact
• Sometimes doesn’t seem to hear or pay attention when you talk
• Not pointing at simple familiar objects
• Understands and says fewer words than other children the same age
• Not being able to understand anything or very little that your child says

For primary school aged children:

• Needing to repeat things lots of times or you need to make instructions much simpler
• Speech that is regularly difficult to understand
• Regular frustration or giving up trying to tell an adult something
• Regularly forgetting the words or missing out important pieces of information
• A child of this age sounding muddled and disorganised in their talking
• A child who doesn’t speak outside their home to certain people or in certain settings, and this continues for at least one month (2 months in a new setting)

    For older children:

• Watches others carefully to know what to do
• Always takes things literally
• Has difficulty learning and remembering subject specific vocabulary
• Talks in short sentences
• Finds it hard to keep a topic of conversation going
• Doesn’t adapt the way they talk to different listeners, for example friends, teachers.

Click here for overview of speech and communication milestones from Afasic

Types of speech and communication difficulties

Attention and listening difficulties

Some children have difficulty focusing on a specific task or concentrating on what they are hearing. These skills are important in the development of language. Children with attention and listening difficulties may:

• Have difficulty sitting still
• Appear distracted
• Be constantly moving
• Find it difficult to follow directions

This can impact on a child’s ability to learn and develop social skills.

Understanding language difficulties

This is also known as receptive language difficulties. Children will struggle to understand and again meaning from things they hear or read. Difficulties can include:

• Struggling to follow instructions
• Misunderstanding what has been asked or said to them
• Struggling to understand what they have been taught in the classroom
• Developing spoken language more slowly

Expressive language difficulties

This is also known as spoken language difficulties. Children expressive language difficulties may:

• Be late to develop or have an absence of babbling or using words
• Use a limited range or small number of words for their age
• Use simple sentences
• Have difficulty using grammatical rules in speech such as past tense

Developmental Language disorder (DLD)

A severe ongoing difficulty with talking and/or understanding what other people say – and for which there is no obvious cause. DLD can affect children across all areas of language and communication e.g. attention and listening, speech sounds, social interaction and the use and understanding of language.

The main difficulties include:

• Struggling to find the words they want to say and structuring sentences. Children may sound as if they are muddled up when talking and may be difficult to understand
• Struggling to understand the words used and instructions given
• Retaining spoken information. It can take a long time for children to process and respond top what they have heard
• Significant impact on a child’s ability to learn and access the curriculum, express themselves, participate in conversation, follow instructions and develop friendships

Selective mutism

An anxiety disorder characterised by a child being fearful to talk in certain situations. A child may be chatty at home but unable to talk in other places such as at school. If this is persistent and the child’ s inability to speak interferes with their education and development and the lack of spoken language is not as a result of a communication disorder, they are likely to be diagnosed with selective mutism.

This can impact a child’s learning as it will be difficult for school to accurately assess their learning, such as reading, for example. It also impacts a child’s ability to develop socially.

Social communication and interaction difficulties

Social communication and interaction refers to the ability to communicate and interact with others, for example taking turns in conversation, listening, use of appropriate gesture/body language/eye contact and playing with others. Children with a diagnosis of Autism often have social communication and interaction difficulties.

Children with these difficulties can:

• Struggle to interact with children their own age and/or develop friendships
• Misinterpret meaning through not understanding body language, tone of voice etc.

Speech sound disorder (SSD)

A child with a speech sound disorder has difficulty producing speech sounds accurately or difficulty using the correct speech sound in the right place.

Main difficulties include:

• Having trouble producing specific sounds, long after children og the same age can produce them
• Using a specific sound in the wrong place, for example, may use the ‘s’ sound also for all ‘d’ sounds
• Impact on a child expressing themselves clearly or being understood
• Impact on child’s literacy development particularly spelling
• Child being frustrated or embarrassed when they can’t be understood

Stammering

A neurological condition that impacts the fluency of speech. A stammer typically develops in early childhood – around 2 to 5 years. Around 8% of children will stammer at some point, but most will go on to talk fluently. Up to 3% of adults have the lifelong condition.

Stammering can impact a child’s willingness to speak, which in turn impacts all aspects of their life, including socially and academically.

Speech and Language therapists can also support children with a:

• Hearing impairment
• Cleft palate
• Learning difficulty
• Dyslexia
• Swallowing difficulty

What you can do

If you are concerned about your baby or child’s developing communication, there are steps you can take:

• Talk to someone who can help

This could be your GP, Health Visitor or school SENCO. They should be able to make a referral to speech and language therapy if they think it is necessary

• Helping your child

There are resources and advise available for you to help your child and your GP, Health visitor or School SENCO may be able to signpost you to appropriate resources.

• Leeds Children’s Speech and Language accepts referrals from parents and carers and anyone who has sought parent/carer consent for a referral to be made. There are guidelines to help: find your child’s age and consider their needs. The red row tells you if you should refer to Speech and Language.

CSLT Referral Guidelines update 2023.pdf

LCH SLT Contact and Referral (leedscommunityhealthcare.nhs.uk)

• The Leeds Community Speech and Language Therapy toolkit has resources and advice for all aspects of speech and communication difficulties. Leeds Community Healthcare NHS Trust - Speech and Language Therapy Toolkit
• The charity Afasic has advice for helping your child. Helping your Child to Talk - Afasic

How are children with speech and communication difficulties supported in Leeds?

Children that are under 5 are usually seen at a clinic at one of the health centres across the city. School age children may be seen at a clinic but are often seen in their school setting. Many schools across Leeds buy in NHS speech and language services or pay for a private speech and language company to assess and work with children who have speech and language needs. This always needs parental consent.

The NHS speech and language offer is for children who have been assessed as needed speech and language therapy to be given a block of intervention, then discharged and can then can re-access services if needed.

Additional support from Leeds MENCAP

Speak to other parents with children with SEN and disabilities on our closed Facebook group.

Follow us on Facebook to hear about our upcoming events.

Check out the rest of our Family Support offer. We have:

• Weekly Chats and Tots coffee morning
• Family Support workers who can offer advice, signposting and support
• Lots of tips and resources about speech and language on our website

Additional support and Resources:

This information is not affiliated with Leeds MENCAP.

Read about the role of a Speech and Language therapist here: Factsheet – Role of the Speech & Language Therapist - Communication Matters

Access Afasic’s website here: Home - Afasic

Objects of reference

20th October 2023

How to introduce an object of reference

1. Begin with just 1 object of reference and introduce additional objects of reference gradually.
2. Start with motivating objects to engage your child. Think about what is most important to them, and which objects of reference will increase their independence? Food, snack or drink is often a good place to start!
3. Say your child's name, and ensure you have their attention. Hold up you object of reference, let them hold it or explore it if necessary, and accompany it with a few words or your set phrase. For example, hold up the cup and say "drink". Repeat the word again, and then lead your child to the relevant activity, or provide them with the relevant object.
4. Repeat this every time you are about to engage your child with the activity or object. Regular repetition is essential for building the connection between the object and its meaning.

The videos below help illustrate how you could use objects of reference.

Tips on how to use objects of reference

• Be consistent! Use the same words to accompany the object every time. If a teddy bear represents going to bed and the set phrase is 'bed time', stick with this. Don't change to 'time to go to bed' or 'night time.'

• Ensure objects of reference are consistent across settings. If your child is at school or nursery it will help to have the same objects of reference there. You could keep your objects of reference in their own bag so they can be transported easily.

• Be prepared that the process of introducing objects of reference may take some time. Don't be disheartened, stay consistent.

• Choose visually distinctive objects. Using a towel to represent bath time and a blanket to represent bed time might be confusing as they look and feel quite similar.

Additional resources

The following videos help illustrate how objects of reference can be used.

Additional support from Leeds Mencap

Follow us on Facebook to hear about our upcoming events.

Check out the rest of our Family Support offer. We have:

• Weekly Chats and Tots coffee morning
• Family Support workers who can offer advice, signposting and support
• Lots of tips and resources about communication.

Intensive Interactions

8th September 2023

What are intensive interactions?

Intensive interactions are a way of supporting social engagement. This is most commonly used for people with learning difficulties and/or autism.

Intensive interactions are responsive in nature – there should be no focus on goals or targets. The essence of an intensive interaction is engaging with behaviours, sounds or motions that your child enjoys so that you’re doing them together or side by side.

The aims of intensive interaction include: increasing connection, working on foundational communication skills, building relationships and increasing confidence in communication. Ultimately, it’s about enjoying interaction and having fun with your child!

How do I practice intensive interactions?

The key to intensive interaction is following the other person’s lead, this means no expectation to meet demands they cannot cope with are being placed on the individual. The aim is to make the individual feel engaged, empowered and in control of the communication environment.

Begin by observing what your child is interested in - what activities, objects, motions or sounds are they currently engaging with? Remember, this is not a time to be working on communication goals or targets – the key is meeting your child where they are.

Once you’ve identified what your child is enjoying, you want to get down to their level – ideally face-to-face or side-by-side and engage with the child.

The following is a list of intensive interaction ‘techniques’ however the practise is very free-flowing and you’ll likely do multiple techniques during one session. Reading through these techniques, you’ll probably find you already naturally do many of them while engaging with your child!

• Making or exchanging eye contact – e.g. make a game of looking at each other and then looking away. You can use a mirror to encourage this.
• Behaviour mirroring –  e.g. copy your child’s motions or behaviour.  
• Sharing personal space –  e.g. lie down next to your child, sit closely to them.
• Exchanging facial expressions – e.g. make clear, exaggerated (ideally positive!) facial expressions at your child.
• Vocal echoing – e.g. copy their words or sounds. Don’t always mimic, try and vary your tone.
• Joint focus activity – engage in the same activity as your child, but on your own. E.g. sitting down next to them building a tower and building your own tower.
• Physical contact – e.g. holding hands, clapping hand together, rubbing noses, rhythmic stroking of hands.

Finally, watch for your child’s response and respond accordingly. They may deliver a verbal or non-verbal sign that they want to continue the interaction.

Remember: consider all behaviour as a communication, even if you're not quite sure what it means. Respond to every communication attempt - whether it's an eye movement, vocalization or body motion. Being tuned into all these cues allows for your child to feel like a valued communication partner. This activity is about speaking your child's 'language' - whatever that may be!

Tip: You may have to alter your usual communication style to make yourself seem less intimidating. Try to limit your speech, and experiment with altering your body language, gaze and tone of voice. Put aside all your pre-conceived ideas of what you think a communication exchange should be.

When can I practice intensive interactions?

You can practise intensive interaction at any time. Ideally, try and take the opportunities when they arise. Follow your child’s lead with it – as they may spontaneously show you moments when they are in the mood for being social. You may also spot opportunities during quiet moments, during care tasks or meal times.

It can also be helpful to plan some time into your day where quality interaction is the primary focus. Remove all distractions and give intensive interactions your full attention. However, during these less spontaneous times don’t be discouraged if your child doesn’t engage – sometimes we simply aren’t in the mood to be social! Still continue with the practice.

Tip: Be patient! Don't expect instant results. You may have to slowly build up the length of time you dedicate to intensive interactions .

Further support

Recording Intensive Interactions

Visit the Intensive Interaction website

This video by Kingfisher school shows some good examples of what intensive interactions can look like.

The resources are not affiliated with Leeds Mencap.

Now & Next Boards

12th April 2023

How to start using the board

When making your board, consider your child's level of understanding. It's important the visual cues work for them - so consider if you want to use real-life images, words or Widgit, Makaton or Boardmaker symbols. If you would like help creating a personalized pack of activity cards please get in touch and we'll happily put one together for you.

Print out your board, print and cut out your symbol cards. They can be attached to the board with bluetack or velcro strips.

To start with, use two engaging, motivating and short activities in both the 'Now' and 'Next' section on the board - this is to help engage the child and help them feel in control.

Use the board like this regularly for your child to get used to it.

Once your child is used to using the board, you can start introducing less engaging activities in the 'Now' section. Keep the 'Next' activity enjoyable and engaging.

Use language to support the use of the board. Point to the symbols and state "Now it's [activity]. Next will be [activity]."

Tips for using your Now & Next board

• Use a timer to support transitioning from one task to another.

• When your child has completed their 'Now' task, engage them in removing the picture card. They could put completed tasks in a postbox or envelope.

• If you're using a Now & Next board at home then speak to your child's school or nursery about using one too - consistency across all settings and environments can really help support engagement.

Downloadable Resources

Download our templates and communication card packs to get you started.

School, Nursery or a local library should be able to help you print and laminate these resources.

Communication

20th September 2022

Children and young people with learning disabilities have a range of communication needs. Some communicate using speech, others using body language or facial expressions and some need support to communicate.

There are various methods and tools that support communication. Some of them use pictures, gestures or pointing while others help with more complexcommunication difficulties.

Watch Mencap’s video to understand why communication is important to people with learning disabilities:

Tools and types of communication

Find out about different types of communication and any training we provide at Leeds Mencap.

Makaton

Makaton is a language programme that uses signs, symbols and speech to give different options for people when communicating. Using signs can help people who don’t use speech, and symbols can help people who have limited speech or prefer to sign.

Makaton can allow people with communication difficulties to express themselves independently which can also ease frustration and give them confidence as they develop language skills.

Watch Mencap’s video explaining what Makaton is:

At Leeds Mencap, we sometimes run ‘Introduction to Makaton’ courses. They’re fun and friendly sessions designed to help you learn more about how Makaton can help children to communicate and we’ll event show you some signs and symbols to use at home. Get in touch with us to find about upcoming dates: 0113 232 1331.

The Makaton charity have a library of free resources for personal use including signs and symbols for events, songs, and stories. Make an account to access their resources here.

Picture Exchange Communication System (PECS)

PECS is a technique that supports communication skills using pictures. It’s an easy programme to follow that starts with simple pictures to communicate needs and builds to the person forming complex sentences.

There are 6 PECS stages that should be introduced slowly:

1. How to communicate – The person learns to exchange single pictures for items or activities they really want.
2. Distance and persistence – Continuing with single pictures, the person learns to use this in different places, with different people or with more consistency.
3. Picture discrimination – The person learns to select from two or more pictures to ask for their favourite things. These are placed in a communication book, often a ring binder with Velcro strips, where pictures are stored and easily removed for communication.
4. Sentence structure – The person learns to construct simple sentences on a detachable sentence strip using an ‘I want’ picture followed by a picture of the item being requested.
5. Answering questions – The person uses the detachable sentence strip to answer questions using an ‘I want’ picture followed by their answer.
6. Commenting – Now the person is taught to comment using the sentence strip to start sentences with ‘I see’, ‘I hear’, ‘I feel’ and ‘It is’ in response to questions such as:
   • What do you see?
   • What do you hear?
   • What is it?

If you think an alternative communication aide would benefit your child speak to their school or nursery. They should be able to support you to introduce this, and ensure consistency across settings.

Objects of Reference

An object of reference is a whole physical object, or part of an object that you hold or touch to represent a person, an object, a place, an activity, or an idea. Objects of reference are a useful way to communicate if you have sight loss, hearing loss, multi-sensory impairment, autism spectrum disorder, learning disability or short/long term memory difficulties. Objects of reference are helpful for parents, family members, friends, therapists, and school staff to use to communicate with people with complex disabilities. It’s good to start with a few objects for activities that happen often or for people you see all the time, regular repetition with a few objects makes it easier to make the connections between the object and its meaning.

Visual Timetables

A visual timetable, timeline or visual activity schedule is a way of supporting a child to predict what will happen next. It enables children to know the things that must happen first, before they can do the activity that they are often focused on. It helps children who have difficulty understanding languages as it gives them extra processing time. Using symbols and visual timelines as part of a multisensory teaching approach helps children become more independent. It benefits children’s thinking skills by making other people’s thoughts, feelings and intentions more concrete. It puts less demand on remembering and allows more resources for thinking about the task and identifying the ‘goal’ of the task where it might be hard to complete.

How do I start using a communication aid?

1. Meet your child where they are. The introduction of a new system will take lots of patience, consistency and repetition. Start with just one or two motivating symbols or signs to engage your child in the system, and introduce new symbols or signs gradually.
2. Remember communication is a two-way street. These aids aren’t only to help you communicate with your child, but for your child to communicate with you!
3. Consider how to make the system as helpful and motivating for your child as possible. For example, accompany visual timetables with a sand timer, or encourage your child to remove completed tasks from the board themselves.
4. Always accompany these with language! These are all communication aids and are not intended to replace speech, rather they should support your child’s development. It’s essential that speech is used alongside Makaton, and many people will just sign key words from a spoken sentence. Visual timetables should be accompanied by simple language to support understanding. Many people choose a ‘now’ and ‘next’ format to convey the meaning of the board. For example, repeating the simple phrase “Now, brush teeth. Next, play outside.”
5. Speak to your child’s school or nursery setting. Teachers or SENCO should have knowledge on your child’s ability, readiness to engage with a new communication system as well as knowledge and experience of implementing them. Consistent communication tools across home and school will help support your child’s engagement.

Resources

We’ve put together some communication packs and cards for different situations like attending a hospital appointment or getting a good night’s sleep. We are happy to create bespoke packs of communication symbols for specific situations or events – just get in touch with us.

Visit our Communication Resources area here.

Visit our Sensory Resources area here.

Additional support

Our family services team here to help with any communication questions you might have. Contact us on 0113 235 1331 or info@leedsmencap.org.uk