My previous post on the topic was here. These are just some quick notes and observations, in no particular order.

Professionals pathologizing normal kid behaviors

Here are a couple descriptions of a thing that I have definitely experienced.

Source 1: Late-Talking Children by Camarata [great book!] page 8 (emphasis added)

When children are late in beginning to speak, many people begin to scrutinize their every action, seeing “symptoms” and “red flags” of something wrong in things that might otherwise be seen as typical of the odd things toddlers often do, which are regarded as cute when the child is not a late talker.

As an example, one little preschooler that I was treating for his speech delay liked to pick fuzz off a carpet and play with it. A psychologist said that this was one of the signs of autism. I then showed him a videotape of 13 children in that toddler’s preschool class, 6 of whom were picking fuzz off the carpet and playing with it. But none of the other 5 children were regarded as having a symptom of autism, because they were talking.

Source 2: A random twitter thread (lightly copyedited):

When a child is struggling at school, often they are seen by professionals (like me!) who assess, write reports and make recommendations. As this process goes on, something strange happens. Here’s what it is:

The things that the child does are scrutinised, compared to others and framed as in need of intervention. Do they get annoyed when the internet stops working? Maybe they need anger management or to work on their emotion regulation?

The child is compared to some fantasy person, who never shouts when they lose their progress in a game and definitely doesn't refuse to put their shoes on or leave the house when their parent asks.

Then everything is framed in the language of reports, which exists in an odd world of its own. “Elodie accesses her local community with support” when another child just goes to the shops and playground with her mum.

Things which make life easier for the child's school are framed as being for the child's own good. Following adult instructions is one of my (not) favourites; a goal in many reports. Useless in adult life, and dangerous when applied indiscriminately. Not all adults are right.

And let's not forget the recommendations to make children less different. More eye contact, confine activity to movement breaks, squashing themselves more efficiently to fit in with everyone else.

When I read reports, I wonder how I’d measure up.  I get frustrated when I lose my work or the internet goes down. I get bored with small talk - maybe I need social skills training? I’m really bad at following instructions when I can't see the point (what's wrong with that?)

I worked with one boy who just couldn't stop moving.  He would tap his pencil on the desk and it irritated the other children. One of the goals was for him to stop and “listen quietly in class”. He couldn't do it. He got in trouble instead.

He moved school and the next school took a different approach. They wrapped a piece of foam around his pencil and he tapped away. No one minded anymore and the goal wasn't necessary.

So let’s ask ourselves, who are these goals really for? Are we actually asking for compliance, rather than thinking about the long term interests of this young person? Are the goals those of the child, or those of the adults around them?

And are we pathologising this child, by framing everything they do through a lens of deficit and ignoring context? Could we use plain English - and might our reports start to make a different sense if we did?

“Kai gets angry when his game crashes” sounds quite different (and more logical) than “Kai becomes dysregulated when he is allowed screen time”. In the first case we might think, well, games which crash are annoying, is Kai the problem, or does the game need an update?

How would it feel to be told, next time you meet friends for a drink, that you're “interacting with peers in a community setting”? Or when you get frustrated because something is really annoying, you have problems with “emotion regulation” and need to “develop resilience”?

We're in danger of losing touch of the ways in which (particularly young) humans respond to the world. Let's see our young people's behaviour in context. Let's always start with, why is this person responding this way - and might I not do the same, in their place?

(Not all the professionals are like this! Some are great!)

How to engage with less-social / less-verbal kids (including autistic)

There’s a whole art to it. The book Play To Talk is great. The short version is: get down to their level (figuratively and literally), join them in whatever activities they’re already doing and enjoying, do fun things and talk about them using appropriately-simple language, and generally avoid asking questions.

I keep thinking back to a page in Play To Talk where they ominously warn that “[social] play is not optional, and a little bit is not enough”. Umm, jeez, we're doing the best we can here, OK?? 😰

“ASD has won” [versus diagnosing Specific Language Impairment]

On the Amazon page for Late-Talking Children by Camarata (again, excellent excellent book) I found this book review, which is long and extremely valuable. This quote in particular was interesting (emphasis added):

ASD has won. Camarata makes it sound like the controversy is still alive, but almost all professionals will now diagnose autism level 2 or 3 if your child doesn’t talk and won’t comply with testing. [Speech-Language Pathologists (SLPs)] no longer diagnose much (or any) [Specific Language Impairment (SLI)] in children—I’ve asked 7 of my son’s 8 SLPs, and none have ever diagnosed a case of SLI. One cruel result of this diagnostic substitution is that a 5-year-old with 1st-percentile expressive language and immature testing behavior is now presumed to have a general intellectual disability. You’ll be buffeted on all sides by earnest professionals whose checklists ignore such crucial assets as open-heartedness with family, ability to intuitively “read” people, nonverbal problem-solving speed, and visual and spatial memory. “My child’s core deficit is language, and his social avoidance is largely because people keep harassing him to talk and treating him like he’s stupid”—this utterance will make clinicians and educators think you’re desperately splitting autistic hairs. But YOU’RE NOT, and the über-experts like [Stephen & Mary] Camarata, [Darold] Treffert, [James D.] MacDonald, [Stanley] Greenspan, [Robert & Lynn] Koegel are with you.

Just to be clear, ASD is not a shameful label to avoid. I feel very strongly that kids with ASD should get diagnosed with ASD. But I also think that kids without ASD should get diagnosed as non-ASD. I presume that ASD is simultaneously under-diagnosed and over-diagnosed, in the sense there are both regrettably many false negatives and regrettably many false positives. Just like everything.

By the way, that book review is from someone in the USA, I think. Not sure how much it generalizes.

“Recasting”

Recasting is a neat approach for caretakers (and speech therapists, but caretakers spend way more time with their kids) to help kids learn language and/or articulation. Most of what I know about recasting I learned here. Here’s an example of language recasting:

KID: [points to toy car while looking at adult] “Car!”

ADULT: [gives toy car to kid, smiles] “Want car!” (then pauses)

KID (sometimes): “Want car!”

The adult more-or-less repeats what the kid was saying to them, but with an extra word or two, to make the sentence a bit more sophisticated. (As a special case, a wordless communication could be recast into a one-word communication.) This is clever because

1. You know that the kid is paying attention to the adult right now,
2. You know that the kid is thinking about how to communicate a desire for the car right now,
3. You know what level of language complexity the kid is comfortable with right now—and thus you can reliably offer something for the kid to try saying which is pushing the kid’s capabilities, but not beyond what they’re capable of. (Or in the lingo, you can hit “the zone of proximal development”.)

(If you’ve never met a SLI/SCD/ASD/whatever kid, you might be a bit confused by the importance of (1) and (2) above. Well, some SLI/SCD/ASD/whatever kids will spend 99%+ of their time ignoring other people. Even when an adult is literally right in front of their face, trying to talk to them, and the kid is not doing anything in particular, the kid will still ignore the adult. So it’s really critical that the first step of recasting is to jump on those rare opportunities where the kid initiates communication. And the zeroth step of recasting (if necessary) is to help those opportunities come more often by following the Play To Talk advice as discussed above.)

(The above example was the language version of recasting. If I understand correctly, the articulation / phonemic version of recasting would look like: The kid says “car” pronounced poorly, then the adult gives them the car and smiles and says “car” pronounced very clearly, and then the adult pauses for a bit and sometimes the kid will jump in and try again to say “car” better, and if they do then the adult might repeat “car” and pause again, etc.)

The literature evidence on the efficacy of recasting—e.g. this review (cited here)—seems fine, I think? I haven’t looked at it very carefully. The idea of recasting is sufficiently common-sensical-to-me and endorsed-by-people-I-trust that I’m not too concerned. ¯\_(ツ)_/¯