Hanen have recently released a revised (5th) edition of their It Takes Two To Talk handbook. I got my first copy 9 years ago, when I trained to lead the program, and I’ve been referring to it regularly ever since.

Parents who are worried about their child’s communication skills want to know what they can do to help, and this book is filled with practical suggestions. It guides parents. The authors state clearly, and multiple times, that they recommend parents consult with a speech and language therapist: this book is not designed to replace having speech and language therapy. However, it provides strategies and techniques that can be used in the meantime, or alongside attending therapy.

I’ve happily recommended this book to friends, whose children have delayed language skills. It is clearly written, with delightful illustrations that add clarity to the text. The tone is supportive, and not at all judgemental.

Changes in this new edition include:

• An updated Stages of Communication Development checklist,
• A section on supporting children who are learning more that one language,
• More ideas about how to integrate communication goals in play.

In the bilingualism section, the authors explain different types of bilingualism and state:

The important thing about choosing home languages is that you should be able to communicate effortlessly with your child. That means being able to talk, sing, read and express love to your child in the language you are most comfortable with.

What a lovely way to say it!

This book shows parents how to use the strategies as they go about their daily lives. During daily routines, such as mealtimes, while playing, reading and singing. Parents aren’t being told that to support their child they need to find more time, instead they are shown how to make the most of what they already do.

It’s an inspiring book; after nearly a decade of using this approach, I know the strategies well. And yet when I flick through the book, a picture always jumps out at me, and I’m inspired to try the game or activity with my own kids.

Thanks to the Hanen Centre for sending me a complimentary copy of the new edition, so I could write about it here. These views are my own.

I took my first Hanen eSeminar a couple of months ago, and I’ve been able to apply what I learnt, straight away. I think this is the first eSeminar or online training, that I’ve paid for. It was easy to log in and I could watch the 2 hour video whenever I wanted with 30 days of unlimited access. There was also a handout to download. It was recorded live, so there were some parts when the presenter asked the people watching live to answer questions or vote. It looked like fun! I used this time to make notes and jot down questions.

Definitions of Late Talkers

The eSeminar was titled: Choosing Initial Vocabulary Targets for Children Who Are Late Talkers. I was interested in the topic because I’ve been seeing more and more children under 2 years old, a good proportion of whom are Late Talkers. Some of the information presented was from Hanen’s Target Word program. Cindy Earle who presented the eSeminar began by describing Hanen’s clinical definition of Late Talkers (as opposed to the research definition.) She said that children with less than 24 words at between 18 and 20 months, 40 words at between 21 and 24 months, and 100 words, with no or limited word combinations at between 24 and 30 months, (and no other major concerns in other areas), require therapy.

Communication Goals and Vocabulary Targets

The eSeminar covered risk factors and predictors of change, and then we started thinking about communication goals. I had previously worked on imitation as a goal, but never being noisy! Cindy talked about the importance of learning to vocalise with every communicative turn or “being noisy” and it’s something I’ve incorporated into my work. Cindy moved on to discussing vocabulary targets, providing a useful checklist, including: target words should be motivating for the child to say and starts with a sound in the child’s repertoire. There was also some interesting information about gestures and a discussion about having the word ‘more’ as a target. I hadn’t really considered before that ‘more’ isn’t useful for initiation. I’ve been focussing on verbs and motivating items since watching the eSeminar.

The eSeminar concluded with some video case studies so we could apply what we’d learnt. I really enjoyed the format, the information presented was relevant to my work, and Cindy easily kept my attention for the 2 hours.

Discount on Hanen’s eSeminars about Autism

April is Autism Awareness Month. Or as the folks over at Thinking Person’s Guide to Autism prefer: Autism Acceptance Month. And Hanen are offering 40% off their Autism eSeminars with the code: AAMSEM16. Check out the eSeminars available and remember the offer expires on 30th April.

Win a free eSeminar

The team at Hanen have kindly offered me a free Autism eSeminar to give away! Leave a comment on this post telling me the vocabulary targets you’ve had most success with (“Thomas?” “Up?” “Cake?”) and I’ll randomly select a winner in a weeks time.

I’ve been meaning to write about the 2016 Hanen Preschool Language and Literacy Calendar for several months, but the days and weeks fly by in a blur and it’s almost the end of the year. If you want to help your child (clients or pupils) to develop creative solutions to problems but your days are already full, and it’s hard to find the time, this resource might help.

The 2016 calendar focuses on critical thinking. Each month describes a different strategy, with an academic reference if you’d like more detail. Then there are four tips for parents and four tips for educators, divided into play types: Daily Activities, Pretend Play, Book reading, On the Go. The tips are really specific (“while washing hands together…”) So you don’t need to try and work out when you could practise them.

The calendar encourages parents and educators to notice what their children are naturally curious about. And to verbalise their own thinking: “I’m wondering why those big birds stay together in a group instead of travelling alone.” Or start the interaction by offering their own opinion followed by an explanation. Adults are reminded to introduce new vocabulary when it’s relevant, for example ‘float’ and ‘sink’ at bath time. And of how non-fiction books can be used to practise discussing similarities and differences.

The calendar is clear, easy to read and visually appealing. My one concern is the focus on asking questions. If people aren’t familiar with the Hanen Centre’s more general advice on avoiding asking too many questions, the activities recommended could become rather adult led and feel like a test, to the children.

I think the advice in this calendar is best suited for use with children aged between 3 and 8 years old. Critical thinking is a crucial skill, if you’re interested in supporting children to develop it, consider this resource (even if you no longer use a paper based calendar!)

The Hanen Centre kindly sent me a copy of the calendar to review, and a couple to give away, I’ll be bringing them to the next Therapy Ideas Live event.

The folks at The Hanen Centre kindly sent me a copy of I’m Ready – How to Prepare Your Child for Reading Success and asked me what I thought. Here in the UK advice about how to support literacy skills seems to change frequently, so I was interested to see what Janice Greenberg and Elaine Weitzman suggest.

The book has 6 chapters: Early Literacy, Conversation, Vocabulary, Story Comprehension, Print Knowledge and Sound Awareness. It’s visually appealing; the text is broken up by photographs and drawings. I read it over several days and found it easy to pick up where I’d left off. There’s a comprehensive list of recommended children’s books, coded in terms of how they can be used to support literacy. I think the ‘Try it out!’ checklists and reflection questions look useful.

The book is full of practical examples from real families, so it’s both straight forward to apply and realistic, in terms of what parents can fit into their lives. There are plenty of Hanen’s trademark memory aids, some familiar like OWLing (observe, wait, and listen) and some new (to me) like POP – point out print.

My favourite thing about the book is how clear the authors are about the importance of making reading fun by following the child’s lead. I often worry that parents go in too heavy with the flashcards approach, which can put kids off, so I was relieved that the book stresses reading needs to be fun.

The blurb on the back of the book states that the authors have taken the most current research and broken it down into fun strategies for promoting early literacy. The only thing that frustrated me is that although they’ve provided references for each chapter, these aren’t clearly identified in the text. It simply says: “studies have found….” – so it’s not clear which study they are referring to. I think some parents (and professionals) would like to read more detail from the original research paper, and the format of the book doesn’t support this.

If you’re looking for ideas about how to use books (and conversation!) to prepare a child for reading and writing I’m Ready is packed full of them. It’s easy to read, practical and fun.

If you’re in the UK, the book is currently only available directly from Hanen. Hanen hope their UK distributor will be stocking it soon.

I finished running the program for the first time in January and last week I visited the families who’d taken part, to review their progress. So what were the outcomes? All the children had moved forward with their communication; one child listened to a question and responded appropriately by nodding her head, another came up to me and initiated a game by tapping me on the shoulder — they were communicating!

The parents had also made huge, significant changes — they were waiting for their children to communicate, rather than anticipating their needs. They were joining in with activities their children had chosen, rather than trying to re-direct them to activities they’d chosen. I watched one mother notice her son was captivated by sticking pieces of damp paper to the table, and use the intrude strategy to encourage him to indicate he wanted more paper – and it worked!

The parents were overwhelmingly positive about having taken part in the program; they talked about how wonderful it was to meet parents of children with similar needs to their child. They were reassured to learn how to move their children’s communication forward. They noticed small changes and celebrated them.

Why does the program work so well?

• It incorporates what we know about adult learning and changing habits. Hanen’s 4P cycle of prepare, present, practice and personalise engages parents and gets them ready to be successful. A mother commented that although her husband had read the More Than Words book – it just wasn’t the same as attending the sessions.
• It uses video examples during the parent sessions, and video coaching at the home visits, to help the parents see what they’re doing that’s beneficial and identify the next step.
• It uses a group format, which is hugely supportive for parents. Our group was made up of parents who spoke five different languages, they really gelled and it was easy to see how reassuring the group problem solving was.
• The program is intense: we met for seven weekly parent sessions lasting three hours, and four home visits. After Lidcombe therapy, it’s the most intensive intervention package the team offers. It felt like an investment: at the end, parents were so much clearer about what they were trying to achieve, more aware of how their behaviour could support their child, and ready to co-create the therapeutic process.

More Than Words in Private Practice?

This week I’m leaving my NHS post (eek!) and heading out into the world of private practice. I’m trying to figure out how to make More Than Words part of what I offer to parents. I’ll be able to run evening sessions, so working parents could attend, although I’m not sure if logistics-wise I’ll have enough appropriate families on my caseload at the same time, to make up a group. Have you run Hanen programs outside the NHS? How did it work?

If you’re an SLT and would like to attend a More Than Words workshop, Ealing are hosting one from 29 – 31 July 2013, you can register your interest today!

I’ve recently trained several practitioners in adult-child interaction, with varying degrees of success!

Training package

The training package I offer is still evolving. I usually:

• give the practitioners some written information about adult-child interaction from Elkan Early Language Builders;
• discuss the dual strategies of following a child’s lead and commenting rather than questioning;
• model these strategies; and
• make a brief video of the practitioner interacting with a child, and give feedback.

Effectiveness

I have used this package with five practitioners over the last month. Three of them responded really well: they asked thoughtful questions, reflected on their skills as they watched the video, and were able to adapt their interaction styles to become better communication partners. Result!

What about the other two? Well, one was able to identify that she asked a lot of questions; with support she began to think about how she could use comments instead. However, at the end of the session she still seemed unaware that she was being directive. The other practitioner felt she was already using both strategies, but didn’t notice herself asking questions when we watched the video. Hmm.

Reflecting on the sessions that didn’t go so well, could I achieve more by fine-tuning how I use the video? There’s lots of useful information on this topic in the Hanen “It Takes Two To Talk” programme. After reviewing it, I’ve found three ideas to try:

• considering the adult’s stage of learning,
• using coaching methods, and
• asking rather than telling.

Stages of learning

The Hanen programme describes three stages of learning: pre-aware, aware, and active. A pre-aware learner might be able to explain the strategies, but doesn’t realise that she’s not applying them. An aware learner knows the strategies and knows that she’s not yet applying them. An active learner has applied her knowledge and changed her behaviour.

So the practitioner who thought she was using the strategies but didn’t notice that she asked questions was at the pre-aware stage of learning. I should try to move her on to the next stage: to increase her awareness of her own behaviour. The Hanen information suggests making tentative statements about what you see and then “letting the tape do the talking.” I’ll try it.

Coaching

Hanen suggests coaching as another way to support an adult’s learning process, by improving the specific interaction. You can do this while the camera is running, during a brief break in filming, or by demonstrating the strategy.

So for the practitioner who was unaware of how directive she was, I could try some coaching: while the camera is running I could say something like, “don’t suggest what to play with: wait for him to show you what he wants to do.” Something else for me to try out.

Feedback: ask, don’t tell

Reflecting on the feedback I gave, I think it started well, but could be improved. I asked what the practitioner thought about the interaction, and then offered a specific focus; for example, “let’s look at when you made comments.” So far so good. But then I told them my own observations, rather than asking for theirs! By asking rather than telling, I could provide a more active learning experience, to increase the chances of learning new skills. Looks like I’ve got lots to practise!

Any ideas?

Do you use video as a teaching tool? What techniques have you found work well with pre-aware learners?

The course was interesting, the group leader was dynamic and inspiring, and I picked up some really useful tips for running adult training sessions. The information about different adult learning styles and how to accommodate them made sense; I’ll be applying this when I give some training tomorrow! I found practising how to coach parents during the video sessions, and using the 9 steps for feedback a worthwhile exercise.

Although I learnt a huge amount that I can use in my day to day work, I have doubts about how successful ITTTT would be for most of the families I work with in a bilingual patch of inner city London.

I have to work against the medical model: ‘You’re the professional, fix my child.’ Parents often don’t understand the importance of play, or are struggling with financial, housing or health issues; playing with their child simply isn’t a priority. Some parents have limited literacy skills, or negative past experiences of education — and the use of video is an alien concept.

Therapists have tried running ITTTT in other local boroughs with limited success and struggled with a lack of attendance. Have you tried running ITTTT in urban areas with high levels of deprivation? How effective was the course as intervention? Have you successfully adapted the program for use with this type of population? At the moment, I’m planning on working with families on an individual basis, using the ITTTT principles for parent training and video feedback sessions. I’ll let you know how I get on!