Autism: Not Child’s Play

World Autism Awareness Day on 2nd April marked the start of a month of activities aiming to develop understanding of autism and Asperger Syndrome. So I have decided to dedicate this month’s blog to talking about the work I do as a Speech and Language Therapist with and for people with autism spectrum conditions.

One of the things that often surprises people is that I work with autistic adults. Autism is something children have isn’t it? Certainly many internet searches and much media coverage could lead to you this conclusion, but strangely enough autistic children grow into autistic adults, and for many people, particularly with Asperger Syndrome, it is not until adulthood that the diagnostic process begins. This doesn’t mean that they have somehow acquired autism, but rather that it is not until adulthood that their differences start to interfere with living a “normal” life. Quirks are no longer considered “a phase he is going through”. Academic promise does not necessarily translate into vocational success. The shy girl who was praised for keeping her room immaculate is now told she has anxiety problems and OCD. ¬†You get the picture.

The autistic adults I meet are accessing mental health services, so on that basis they are usually struggling with their mental wellbeing. Most often this is the result of living either with an undiagnosed autism spectrum condition, or with a poor understanding of the diagnosis they have received earlier in life. As a result, these individuals have not learned why they act, think and communicate in the ways they do, and have failed to develop a positive sense of self. They can feel that they are the only person who experiences these challenges, and have no or few strategies to deal with the confusing and complicated world around them.

As a Speech and Language Therapist I play an important role within our Community Mental Health Teams for not only diagnosing autism spectrum conditions in adults, but also in providing support after that diagnosis and promoting improved mental wellbeing. One of the most exciting developments I am currently involved with is a post-diagnostic group aiming not only to educate but also empower, and to create a supportive social network of people with Asperger Syndrome in a local area. It is early days yet with this pilot project but the feedback from participants so far is good and relationships are beginning to develop. Ultimately, people living with autism spectrum conditions will learn the most from other autistic people because they will always know more about how it really feels and what really works, but if I can play a part in helping people make those connections then I can be proud of doing my job well.

Simply the Best: Nurture

My 3 best things about being a mental health SLT this week appear to have a nurturing theme – conversations that nurture understanding, nurturing the learning of others, and nurturing skills and self-reliance…

1. Talk to Me – When a client walks in to clinic distressed and is able to walk out calmer and with a sense of direction and achievement I know what I do is worthwhile. There are times when we need to talk through our difficulties in order to sort things out and to feel better but this is much more difficult if you also have a communication difficulty. When you cannot find the words to express how you feel or explain why you are feeling that way, others find it that much harder to help you find the right solution. When you cannot organise information in a meaningful way you can feel that others are not listening to you or even find that you get yourself even more confused than before. John* arrived for his appointment this week in a very flustered state. He had been feeling overwhelmed in recent weeks and this was impacting on his ability to discuss his worries with his family and friends. By creating a structure around the conversation and providing appropriate feedback, John was able to organise his thoughts and we were able to work through his problems, and he left his appointment much happier and calmer than before.

2. Look to the Future – As part of my job I am involved in the clinical education of student Speech and Language Therapists from Queen Margaret University. My current student is approaching the end of her placement and it makes me so happy to watch her confidence grow and her skills develop. This is one of the very few adult mental health placements available in Scotland currently and it is wonderful to be involved in developing clinical interest and skills for this client group in our emerging workforce.

3. First Steps – Our new group for clients who have recently been diagnosed with Asperger Syndrome started this week. The purpose of the group is to provide information about Asperger Syndrome; helping these individuals to have better understanding about the ways in which they communicate, think and act differently from others, to develop coping strategies, and to establish relationships and gain support from peers who are “the same as me”. First sessions are difficult for everyone – especially people with Asperger Syndrome – but by creating an Asperger friendly environment and pacing information and demands correctly our group was a great success.

John* is a pseudonym to protect client confidentiality

Simply the Best

It’s been a good long while since I last blogged. This has been partially due to being extremely short on time recently, but also because I had slightly lost direction and was unsure what stories I still had to tell. However, it seems that despite my recent silence, interest in my blog has remained with almost 600 “hits” since my last post. This has reminded me why I started this blog…

…there are still very few Speech & Language Therapists working in the field of adult mental health [so] The purpose of mentalhealthslt is to share my experiences not only with other Speech & Language Therapists but with anyone who works in or has an interest in mental health.

So it’s about time I got back to doing just that!

One of the things I regularly do with people is help them to focus on positive situations and work to their strengths rather than dwelling on negatives and difficulties. A friend of mine also writes a blog which is titled “Rachel’s Three Beautiful Things” which does exactly what is says on the tin. Rachel writes about three beautiful things that happened to her that day – an idea I love. So I am going to borrow the concept (which she also borrowed so I don’t think she will mind) for the next wee while to help get this blog back on track.

By highlighting the three best things each week about being a Speech and Language Therapist working in mental health services, and hopefully encouraging other colleagues to do the same, I believe that I can continue with my mission to spread awareness and develop understanding of the unique and valuable role we play.

So here goes. Here are here the 3 best things about this week…

1. The Sweet Sound of Success – About 18 months ago I met a lady called Sarah* who had become mute following a significant psychological trauma. She had not uttered a word for over 10 years and had become completely socially isolated and reliant on her family for even basic tasks. This week marked my final session with a now very talkative Sarah* who is living her life to the full having rediscovered herself and her role as wife, mother and grandmother.

2. Group Fever – There are a significant number of people with Asperger Syndrome who access mental health services. Many have very little understanding of their diagnosis and can find it difficult to participate in mainstream groups run by the community mental health teams. From next week I am running a group along with an Occupational Therapist and a Support Worker specifically to meet the needs of these clients. We had our final planning meeting this week and everyone is so positive, excited and enthusiastic – it’s infectious!!

3. All for One – This week I have been working in partnership with a broad range of people including a University Disability Advisor, staff in the local library, family members, nurses and psychologists to name but a few. These partnerships help me to ensure that my clients get the best possible service from me and from others, and being able to do that is one of the best things about my job.

*Sarah is a pseudonym to protect client confidentiality

A Tweet in the Life

I saw an interesting use of twitter recently. NHS Highland use their account (@NHSHWhoWeAre) to showcase services by having members of staff tweet about their working lives for a week. The “week in the life” that caught my eye was by the Caithness & Sutherland Speech & Language Therapy Team. I was interested to read about the diversity of roles members of the team undertook so, in a similar vein, I have decided to blog about my own clinical week “twitter-style” – each entry 140 characters or less!

Tuesday

Working on research proposal this morning: my first attempt at a qualitative study. Great support from NHST and SDHI – hope I get funding.

Two multi-disciplinary sessions this afternoon – first with Dietitian and second with Clinical Psychologist. Teamwork in CMHT is essential.

Joint initial assessment with Dietitian – teenager with suspected ASD and a long standing food phobia. Sharing knowledge and resources.

Working with Psychologist supporting young man with Asperger’s – blunt communication style having significant impact on family relationships.

Wednesday

Met with Social Worker from Early Years Service this morning – having difficulty communicating with young mum with post-natal depression.

Lunch meeting to organise Phase 2 of Communication Champions training with Richmond Fellowship. More staff want to do training – RESULT!

Visit to client with PTSD – mute for 10 yrs. Been using iPad to communicate for 3 months: family relationships and confidence improving.

Thursday

Quick visit to some Communication Champions first thing to provide guidance on support plan for resident with complex communication issues.

Meeting with young woman new to CMHT – CPN and Psychologist want a second opinion re: Asperger’s Syndrome. Difficult differential diagnosis.

Start afternoon with home visit. Client with Bipolar Disorder has language difficulties following ECT. Conversation flowing more easily now.

Off to local library for afternoon clinic: clients love this city centre venue – library staff even provide tea, coffee and biscuits for us.

Friday

Getting ready for a long clinic this morning – 9:30 to 1:30 – looks like lunch will be optional again!

Client with schizophrenia referred with very poor speech. Change of antipsychotic medication and speech much improved. Happy I’m not needed.

Assessing young woman with Asperger’s: confused because information doesn’t seem to apply – direct her towards resources for women with AS.

Seeing client with PTSD and low self-esteem. Dissatisfaction with voice contributing to problems: working to improve acceptability.

Client with history of alcohol dependency and anxiety reports sudden expressive language difficulties. Minor impairment having major impact.

Finish day meeting with student nurse who wants to learn about Asperger’s Syndrome – mutual love of The Big Bang Theory useful for examples.

And that was the week (or the tweet) that was.