Thursday, 27 November 2014

Language Development on the Snowdrop Programme.

Another highlight from last week on the Snowdrop Programme, as one mother writes;

"We saw ----- paediatrician for the first time since starting Snowdrop. She said that he often surprises her with his progress but this time she was blown away by him. She was actually speechless for a moment. Last time she saw him (6 months ago) he was just able to say a few sounds but this time he was saying numerous recognisable words and answering questions!"

So how do we produce results like this?  How is it possible to take a child from being "just able to say a few sounds," through to producing words and answering questions?

It is normal for parents to want their child not only to be able to understand them, but to be able to communicate with them too. Interaction is fundamental to humanity and, in a way, I think it defines who and what we are. Naturally, then, when a person cannot use language, it can cause immense distress. So why does the language and communication development of children with developmental disabilities so often fail? Let's examine some of the major reasons.

Many difficulties with the development of language and communication begin very early on, when the parents bring their child home from hospital after birth. Naturally, the parents are often weighed down by the worry and crippling stress of having to cope with their child's unexpected problems. Often, they are also reeling from the shock of being informed that their child has problems.

What frequently occurs then is that parents do not interact with their child as they would have done had they had an uninjured baby. They may miss the communicative signals given out by the child and consequently may not supply the baby with input appropriate to the development of language. This is no fault of the parents, who are invariably doing an heroic job in caring for their baby's needs and helping them to survive despite sometimes overwhelming difficulties; it is merely the result of a set of circumstances produced by the extremely stressful situation in which the parents find themselves.

So, having missed the early communicative opportunities provided by normal parent/child interactions, the baby's language and communicative skills fail to develop. Instead, the baby sometimes completely fails to develop a communicative understanding with mum and dad, with the consequence that an understanding of language fails to develop. In the absence of an understanding of language, the child also fails to produce language. In other cases, where some appropriate but incomplete interaction has taken place between parents and baby, a partial understanding of language develops, with little or no production of language.

A second reason for the failure of language to develop is when the child experiences distortions of sensory processing. The brain injuries which produce many developmental disabilities, can adversely affect the functioning of several structures within the brain, which are responsible for the processing of incoming sensory information from the environment. Obviously, we all know that successful development of spoken language is largely dependent upon successful auditory development; essentially, if the child's ability to process sound is poor, then their development of spoken language will be poor. If their ability to process sounds is non-existent, their development of spoken language is likely to be exceptionally poor. It is a matter of successful sensory reception leading to successful motor output (language is an output skill after all). In other words, it is a sensory/motor loop, the successful development of the motor part of the loop being dependent upon the successful development of the sensory part of the loop. So, if we have a child who hears nothing, we are likely to face a NINO situation (nothing in, nothing out), or if we have a child who is experiencing sensory distortions, whose hearing is hypersensitive or hyposensitive, or who is experiencing difficulties in regulating their auditory attention, we could well be facing a CICO situation (chaos in, chaos out).

The third factor which will affect language development is direct injury to the left hemisphere of the cortex, around the regions known as Wernicke's area (responsible for our ability to understand language) and Broca's area, (responsible for our ability to produce language). The connotations for injury in these areas is obvious and does not need to be discussed in depth here.

A fourth factor to consider is that when a child has a brain injury, the ability of their brain to process information is slowed down. As a result, they may not be able to process the content or meaning of interaction quickly enough, and even if they can, they might be unable to respond quickly enough. The development of such conversational turn taking is a vital precursor to the development of spoken language. If they keep missing their turn, this can be very frustrating for the child who is desperately attempting to interact, and their consequent frustration may lead them to simply stop trying.

The question is, then, what can we do to assist the language development of the child with developmental disabilities? What we need to do is to treat these four major causal factors sequentially.

To deal with the first problem, we need to take parents and their child back to the patterns of initial interaction, which they might have missed. We need to teach parents to look for communicative signals given by their child and how to respond to these signals in order to encourage the child to repeat them and to further expand them. Very often, these simple procedures can kick start language development and we can then guide the child through the next stages.

With the second problem, we need to address any distortions of sensory processing the child might be experiencing. This might mean the construction of an adapted developmental environment as a temporary measure in order that we might train the parts of the brain which are responsible for sensory processing to re-tune their activity to a more normal level. Again, we find that this can often provide a boost to language development.

The third problem, which involves direct injury to the areas of the brain involved with language comprehension and production can be more problematic, but is certainly not hopeless. The reason these areas of the brain are not functioning correctly is because out of the millions of neural networks involved with these functions, many have lost cells due to injury. Therefore, individual networks are operating without their full complement of brain cells. The effect of this is that they operate less efficiently and language comprehension and production is constrained. We can, however, use stimulatory techniques to train these networks to operate more efficiently and can utilise methods to encourage sprouting (dendrites forming new connections, thereby enhancing neural network function), and neuroplasticity in order to encourage neural networks to recruit new cells.  The brain responds to demand and if we create the demand for language to develop, then as the recent study by MIT shows, - parts of the brain can switch functions.

The final problem, relating to the slower speed of processing, is perhaps the most easily addressed. Quite simply, children must be given more time to process information, more time to plan a response and more time to respond. In this way, they will not miss their turn in an interaction and will not withdraw into themselves in frustration at their failure.

So, whilst the difficulties faced by the child with developmental disabilities might seem great, indeed sometimes they might seem insurmountable, parents should not lose hope. If we can take children back through those vital early stages of language development, stages which they might have missed and provide a demand for the brain to change, then it can be surprising what can be achieved.  This is precisely what we do at Snowdrop and it is how we achieve results such as that quoted by the mother at the top of this page.  Anyone wanting to know more about the Snowdrop programme can email me directly at

M.I.T. News. – Parts of the brain can switch functions. -

Sunday, 23 November 2014

Correcting a Squint, (Strabismus).

The reason children have a squint, (a strabismus) is that the brain is not yet using the eyes as a single functional unit.  The brain creates two images, ignores one and focuses on the other.  The 'ignored' image causes that eye to either drop inwards or outwards.  When a child crawls, a demand is made upon the brain to percieve depth and in order to do so, it is forced to use both eyes together and so the child develops binocular vision.  At Snowdrop, many of our children are delayed in crawling and so we must find other ways of stimulating binocular vision.  We have devised a series of activities designed to do this and we are increasingly successful in doing so.

One highlight from a week on the Snowdrop Programme. As one mum wrote.

"James had an eye appointment today at the hospital. The first since starting The Snowdrop programme in September. They could find no evidence of his squint which previously has been very apparent!!! Thank you very much Andrew this shows the Snowdrop exercises have made a big difference in a short time!"