Guidance for Early Years Settings: Social Communication and Interaction Difficulties (2013)

Contents

Chapter / Page Number
Introduction / 3
What are Social Communication Difficulties? / 4
What are Social Interaction Difficulties? / 4
Pen Pictures – How might a child present if they have social difficulties? / 5
Why might a child have Social Communication and Interaction difficulties? / 6
What is Autism? / 8
What documents will help me assess a child’s typical development? / 11
What resources should I have regard for? / 11
Following a Graduated Response / 12
Individual Play Plans / 13
Requests for Services / 14
Applications to SENRAP / 16
Specialist Provision / 17
Where can Parents get support? / 18
Further Reading / 20
Appendices / 22
Introduction

It is hoped that this guidance will provide information, advice and strategies for practitioners working with children in the early years who have identified social, communication and interaction difficulties.

This guidance is intended for children with social communication and interaction difficulties, as well as those with a formal diagnosis of Autism Spectrum Disorder (ASD). Practitioners may be supporting children who have had a diagnosis of Aspergers Syndrome or Pervasive Developmental Disorder, Not Otherwise Specified (PDDNOS). Although children typically receive a diagnosis of ASD, some peopleprefer the term, Autistic Spectrum Condition (ASC). This guidance will refer to the terms; social, communication and interaction difficulties and Autism (as an umbrella term for ASD and ASC).

It will be important for practitioners to use this guidance in conjunction with professional advice, books and websites to ensure their knowledge and skills are kept up-to-date and in line with current legislation.

This guidance has been developed by a range of professionals;

Dr Beth Cartwright, Educational Psychologist

Rachel Denney, Speech and Language Therapist

Vicki Easton, Occupational Therapist

Stephanie Hathaway, Manager, Swindon Portage and Koalas Opportunity Group

Jill Heyes, Teacher, Nyland Campus Outreach Team

Penny Seymour, Advisory Teacher for Social, Communication and Interaction Difficulties

What are Social Communication Difficulties?

Social communication is the exchange of ideas or information between individuals. Children who have difficulties with social communication may struggle to understand what others are trying to communicate to them. They may also struggle to successfullycommunicate with other people. This may be communication using words or non-verbal communication, such as using eye contact, facial expression, body language and tone of voice.

Common characteristics include:

Echolalia – repetition of words spoken by other people (echoing or parroting others).
Repetitive talking about their own narrow topics of interest.
Difficulty or differences in response to and use of facial expressions.
Difficulty using language to initiate interactions with others.

What are Social Interaction Difficulties?

Social interaction is engaging with others to form social relationships which are reciprocal, involving some give and take. Children with social interaction difficulties may find it hard to understand the thoughts, feelings and motivations of other people. They often struggle with forming successful friendships.

Common characteristics include:

Difficulty understanding social rules. They might often want other peers to play their game and get cross when others don’t want to play it exactly the way they think it should be played.
Absent or delayed response to name being called, despite normal hearing.
Difficulty paying attention.
Turn-taking skills are challenging.
Difficulty with pretend play and imaginative games.

Pen Pictures - How might a child present if they have social difficulties?

Ben: Typically developing 3 year old child

Ben enjoys a range of activities (e.g. small world, outdoor play, trains, looking at books), and is often observed playing with his friends. Although he can become upset when his friends don’t share, they generally play well together; they talk about what they’re doing and take it in turns to share their ideas and role play. Ben is able to follow pre-school routines, as well as instructions given to him by adults and children.

Sally: Higher functioning child with Social Communication difficulties

Sally is happy to come to Pre-school, but always seeks out small world animals, specifically, whales. She likes to hold them as she moves around the setting, and enjoys telling adults facts about whales. Although she can be persuaded to move to a different activity, she finds it hard to concentrate and her language often refers to whales, rather than the activity she should be doing. Sally also likes to dress up, but she does not act out scenarios as the person she has dressed as. When Sally is with other children, she likes to tell them what to do, and can become upset when they don’t follow her rules/instructions. Staff at the Pre-school have noticed that Sally does not like to eat ‘wet’ foods; she’ll only eat dry crackers, as opposed to a filled sandwich.

Tom: Social Communication and Interaction Difficulties/Autism

Tom comes to Pre-School and separates well from his Mother, but he does not follow the usual Pre-School routines (e.g. putting his lunchbox away, sitting on the carpet). Rather, he prefers to pick up any toy and walk with it around the room. Tom does not play with other children, and finds their or adult presence near him, very uncomfortable. When people do get near to Tom, he either pushes them away or walks away from them. Tom likes to build towers with bricks, and create intricate models. When it gets noisy in the Pre-School, Tom puts his hands over his ears and he prefers to wear sunglasses on bright days.

Why might a child have Social Communication and Interaction Difficulties?
Condition/Difficulty / Impact on Social Development
Difficulties Understanding and Using Language / The impact of their language difficulties means they can find it difficult to interpret more subtle, implied language. They are also likely to have difficulties interacting with other children their age.
Global Delay / Children with delays in all areas of their development are likely to show a delay in their social development
Autism / This developmental condition is specifically related to difficulties with social communication and interaction
Down Syndrome / Many children with Down Syndrome experience significant delay learning to talk, which may affect their social communication
Hearing Impairment / Children may not be able to hear their peers appropriately and therefore may not be able to respond appropriately. A hearing impairment can also impact on their speech and use of language which can in turn affect their social interaction
Children with attachment difficulties / When children have not developed a secure bond with their caregiver, they can display difficulties in their social interaction skills
Children with English as an Additional Language (EAL) / Learning English as an additional language means children will not have had the same exposure and practise of using English, so their English will not be at the same level of their peers whose native tongue is English
Chromosome Difficulties / A chromosome abnormality reflects an abnormality of chromosome number or structure. There are many types of chromosome abnormalities which can affect a child’s development
Limited Early Experiences / If a child has not had appropriate early access to social experiences, it’s likely their social development may be delayed

To help you begin to identify reasons for a child’s social communication and interaction difficulties, it will be important to gather background information from parents/carers. Professionals will be able to identify a child’s needs more accurately and explore in more depth, the reason why a child is presenting with social communication and interaction difficulties.

What is Autism?

NB: This is not a diagnostic checklist.

There are many people with autism in England, Scotland, Wales and Northern Ireland. 1 out of every 100 people has autism. You cannot always tell that someone has autism just by looking at them. Because of this, autismis sometimes called a ‘hidden’ disability. Autism lasts for all of a person's life. But they can still do a lot of things and learn a lot of skills.

Some people with autism find these things difficult:

They find it difficult to tell people what they need, and how they feel.
They find it difficult to meet other people and to make new friends.
They find it difficult to understand what other people think, and how they feel.

Not everyone with autism will find these things difficult. This is because everyone with autism is different.

What causes Autism?

No one currently knows why people have autism. More than 1 person in a family may have autism. It can be genetic. This means autism can pass from parents to their children.

How do people with Autism behave?

Here is some information about people with Autism:

They may not speak. But they may use things like pictures or sign language to communicate.
They may not understand what other people say.
They may copy what other people say.
They may only talk about their favourite subject.
They may not take part in games or activities with other people.
They may like to play the same game or do the same thing every day.
They maybe very interested in one thing and know a lot about it.
They may be good at remembering information.
They may do wellat school,college and work.
They may find co-ordination difficult. This means that they may find it difficult to do things like use scissors, use knives and forks, or ride a bike.
They may have learning disabilities.
They may have other difficulties. For example, dyslexia or Attention Deficit Hyperactivity Disorder (ADHD).

What else is special about Autism?

They may be very good at something. For example, they may be very good at maths, art or music.
They can be good at learning how to do something when they see someone else doing it.
They may be good at concentrating on one activity.

How can play be affected if a child has Social Communication and Interaction Difficulties or Autism?

A child with social communication and interaction difficulties can find the world confusing, so they need to feel in control. They crave predictability and like to keep things the same, so change (even of a toy or a game) feels too risky, too scary for them.

Much more time is spent on simple manipulative play (mouthing, waving, banging, spinning) than on more functional and symbolic play (like pushing a car to and fro or dressing up as a fireman) even taking into account the fact the child is developmentally young. Even when it happens, functional play is not as frequent or varied as you might expect.

They may lack imitation skills and not look to an adult for a demonstration of how an object works. Because they may not see being with other people as fun, they can have difficulty with joint attention, which would help them develop skills. Sometimes their own sense of order and logic may prevent participation in pretend play and, children with autism in particular, often have an eye for detail at the expense of the ‘big picture’. They may not realise other people are interested in what they are doing so they don’t bring things to show you or get you to watch their game. They sometimes have difficulty in pointing and following the direction of your gaze too.

Children with social communication and interaction difficulties may be more comfortable in solitary play, and so not develop through the stages of play to parallel and co-operative play with others. Alternatively, they may wish to play with others but lack the communication skills to be able to understand how to do so.

The three core areas of development affected in Autism are:

Difficulties with social communication
Difficulties with social interaction
Difficulties with social imagination; repetitive, inflexible behaviour and interests, e.g.

Repetitive or stereotyped play, for example opening and closing doors.
Repetitive ‘stereotypical’ movements such as hand flapping, body rocking while standing, spinning, finger flicking.
Over-focused or unusual interests.
Excessive insistence on following their own agenda.
Extremes of emotional reactivity to change or new situations, insistence on things being 'the same'.
Over or under reaction to sensory stimuli, for example textures, sounds, smells.
Reduced or absent imagination and variety of pretend play.

There is great variability in the repetitive behaviours that children exhibit, with some children having more sensory or motor focus and others little sensory focus but strong interest in special topics (that is, their behaviour and thinking, rather than their movements, are repetitive and inflexible).

Behavioural characteristics do change over time, with some behaviours disappearing, often replaced by other behaviours.

Autism

What Documents will help me assess a child’s typical development?

Early Years Foundation Stage (EYFS) 2012.
Bristol Surveillance of Children's Communication (BRISC) – speech and language assessment.
Early Support developmental journal (can be downloaded from

What resources should you have regard for?

The following documents should be available on Schools Online (

SBC SEN handbook.
National strategy material:
Inclusion Development Programme. Supporting children with speech language and communication needs: Guidance for practitioners in the early Foundation Stage
Inclusion Development Programme. Supporting children on the autism spectrum : Guidance for practitioners in the early Foundation Stage.
Inclusion Development Programme. Supporting children with Behavioural, Emotional and Social difficulties : Guidance for practitioners in the early Foundation Stage.
School and Parent Advice Regarding Kids – Early Years (SPARKEY) - Paediatric therapy advice for children with motor and sensory difficulties
Entitlement Document.

In addition:

Early Support Autism - accessible from the NCB website.

Special Educational Needs and Disability Code of Practice 0-25 years and SEN a guide for parents

Following a Graduated Response

Refer to SENCo handbook, Section 4: The Graduated Approach which outlines the four stages of action; assess, plan, do, review

Further Information

Through observation, discussion and assessment, identify a child’s Strengths and Needs

Using the EYFS, over time, identify the child’s strengths and difficulties. Share your views with the SENCo/colleagues. You might want to consider completing a ‘My Plan Profile’ (see Appendices Page 22)

Discuss the child’s strengths, difficulties and next steps with parents/carers

Once you have had time to monitor the child’s progress, and if you still have concerns, arrange a meeting with the child’s parents. Help to structure your meeting using the EYFS, highlighting the child’s strengths and identified difficulties.

Consider discussing the child with your Early Years Consultant

Seek support from your EYC to support you in carrying out a graduated response

Individual Play Plans (IPPs)

Once a child’s Strengths and Needs have been identified, with the support of parents, draw up an IPP.

Having identified what type of support an adult might provide to support a child, spend some time thinking about when that support will take place within the session. Ensure that other staff members are aware of the IPP targets, and strategies that should be followed, if they interact/work with the child.

Reviewing a child’s IPP:

Record the child’s progress against the targets.
Consider developing a new/revised target. This might be done in conjunction with outside agencies, or at this stage, you may consider referring to an outside agency.
Consider ending the IPP process if the child has made good progress.

Refer to the Appendices Section for an example IPP

Requests for Services

Referrals to Individual Agencies

With parental agreement, consider making referrals to outside agencies. Referrals can be made to separate agencies, using appropriate paperwork:

Speech and Language Therapists. Using documents like the Child Monitoring Form, BRISC, and ARMMS will help you decide whether a child’s language is delayed, and whether to make a referral to SALT. Further information can be found at:

Advisory Teacher, Autism/Social Communication and Interaction difficulties (AT/SCID). If you are concerned about a child’s social communication difficulties, contact yourEYC who will be able to advise you whether a referral to the AT/SCID is appropriate.
Nyland Campus Outreach. An Early Years Consultant will be able to discuss with you whether a referral to the Behaviour Support Team (Nyland Campus Outreach Team – NCOT) would be appropriate. If the child is showing significant behavioural difficulties, despite the setting consistently using best practice strategies, NCOT involvement may be appropriate. The NCOT worker will help to identify a child’s specific needs, agree strategies, and help to identify further support, including supporting transition into school.
Educational Psychologists (EPs). An Early Years Consultant will be able to discuss with you whether a request forEducational Psychology Service (EPS) would be appropriate. If the child is showing significant social communication and interaction difficulties, with delays showing on their EYFS profile, EP involvement may be appropriate. The EP will help to identify a child’s specific needs, agree strategies, and help to identify further support, including supporting transition into school.
Occupational Therapists (OTs). A Health Professional would usually make the referral to an OT.

Referrals onto Pathways