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Music Workshop - Banes Parent Carer Forum

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Run in conjunction with our friends at West of England Music and Arts (WEMA) these workshops are a wonderful chance to explore different musical instruments

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Choir cancellation - Extreme Heat 24.6.26

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Choir cancellation - Extreme Heat 24.6.26

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Dear Parents and Carers,

As you may be aware, the Met Office has issued a Red Extreme Heat Warning for Wednesday and Thursday this week. Temperatures are expected to reach approximately 39°C.

After careful consideration, we have decided to cancel our SASS Community Choir session tomorrow.

Due to the risks posed by extreme heat, particularly for vulnerable pupils and those who experience differences in heat sensitivity, we believe this is the safest course of action for the young people attending our SASS choir.

Thank you for your understanding and we encourage all families to follow government advice on staying safe during extreme heat.

Becca Tranter,

SASS Service Lead

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New SASS and WEMA May half term music event for families

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New SASS and WEMA May half term music event for families

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May - SASS Music half term session poster - MSN Library A3

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This card is a great way for you to let people know that you are autistic, and might need some extra time or help in certain situations.

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Free Parent Webinars with Neurodiversity Experts - 6th/13th/20th May 2026

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Free Parent Webinars with Neurodiversity Experts - 6th/13th/20th May 2026

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The National Autistic Society has teamed up with Access Social Care, a charity that specialises in legal advice for people in England with social care needs, to help autistic people and their families access easy-to-understand health and social care information at the click of a button.

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AccessAva - Free legal information about your rights to social care

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The National Autistic Society has teamed up with Access Social Care, a charity that specialises in legal advice for people in England with social care needs, to help autistic people and their families access easy-to-understand health and social care information at the click of a button.

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NEW SASS and WEMA half term music event for families

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NEW SASS and WEMA half term music event for families

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SASS Music half term session poster - MSN Library A3 (1)

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Eventbrite - Bath & North East Somerset Libraries presents Relaxed Storytime in the Sensory Space - Thursday, January 15, 2026 at Bath Central Library, Bath, England. Find event and ticket information.

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Register here: https://autisticgirlsnetwork.org/group-registration-under-18/

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AccessAva - Free legal information about your rights to social care

# data[].attributes.attachment_link.description
The National Autistic Society has teamed up with Access Social Care, a charity that specialises in legal advice for people in England with social care needs, to help autistic people and their families access easy-to-understand health and social care information at the click of a button.

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SASS Choir - New Venue: Midsomer Norton Library!

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SASS Choir - New Venue: Midsomer Norton Library!

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Support for Families (even without an accepted referral to SASS)

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Support for Families (even without an accepted referral to SASS)

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SASS Universal Support for Families QR-2

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B&NES Parent Carer Forum Support Line Info

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B&NES Parent Carer Forum Support Line Info

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B&NES Parent Carer Forum Peer Support Line

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B&NES Parent Carer Forum Peer Support Line

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Agreement to engage SASS Inclusion and SEND Advice Service FINAL September 2025 (1)

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See our SASS Updated Documents Padlet for more...

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The Older Child or Teen with Selective Mutism
Ricki Blau
Selective Mutism in the Older Child

Selective Mutism (SM) is usually noticed when a child begins pre-school or kindergarten, if not before. So when a student in the upper elementary or secondary grades has SM, it's safe to assume that he or she has been living with Selective Mutism for many years. Within the lifetime of today's teens, researchers and treating professionals have learned much about this anxiety condition. Young children who receive prompt and appropriate treatment now make great strides. But information about SM is still not as widely available as it should be-educators, doctors, and psychologists often fail to recognize SM or understand how to help affected children. Consequently, many children do not receive early diagnosis or appropriate support.

Older students with SM may have received no treatment or may have suffered years of inappropriate treatment and negative reinforcement. Instead of being helped to control their anxiety and become more comfortable at school, they may have been pressured to do the things they feared, such as speaking. Over the years they have developed ingrained behavior patterns and maladaptive coping mechanisms by which they avoid situations that make them anxious. Not speaking has become a habit that is difficult to break. They begin to see themselves as "the kid who doesn't speak" as do many people around them. The fear of receiving attention if they should start to speak makes it harder to imagine changing. They may also have developed phobias about speaking or having their voice heard. Older children with SM often lag behind their age peers in social competence because they've had less experience with peers and adults. Treatment plans for the older child must take these complications into account. 1

Students with SM are, in general, extremely sensitive individuals. Older children and teens are acutely aware of their differences and the responses they elicit from their teachers and other adults. People have been trying to get them to talk for years! They understand that they repeatedly fail to meet standard expectations in the school setting. Consequently, they are wary and keenly aware of the most subtle pressure to communicate. Wanting to avoid attention, they typically have learned to hide the appearance of anxiety; while younger children may freeze and show a blank expression, older students more commonly appear relaxed and "ok," even when they're not.

In summary, older children have developed more complicated profiles, influenced by their experiences and environmental stressors. Their individual profiles tend to show more variation than with younger children, and treatment needs to be tailored to the individual.
Helping the Student Make Progress
For all of the above reasons, you can expect progress to be more difficult and slow once a child has reached the age of eight or nine. Different strategies and interventions are needed for older children or teens. Consider, for instance, a fading strategy, in which a child first talks with a parent in a private room at school, and over time other individuals are gradually drawn into the conversational group. This often succeeds with a very young child. Older children, on the other hand, have developed a self-image as a noncommunicator and would recognize the situation as a set up aimed at getting them to talk.

The fading strategy doesn't work for them. As experienced treating professionals have found, the older child or teen needs to be actively involved and in control of their therapy, which aims to help them recognize their anxiety and take small, controlled steps in real life situations. In younger children, medication to reduce the anxiety often produces quick and dramatic results. With older students who have many habits to unlearn, medication is often an important adjunct to behavioral therapy but many treating professionals have found that it not as effective on its own.

For older children, the thought of changing longstanding habits and exposing themselves to anxiety-provoking situations is frightening, and they can become quite resistant to therapy. Dr. Elisa Shipon-Blum, the Medical Director of the Selective Mutism Group/Childhood Anxiety Network, has observed that if a child is not verbal in school by the age of eight or nine, he or she is unlikely to talk at school until at least high school, and possibly later. For students in this age range, she has suggested that the emphasis be on helping the student realize his or her academic potential and remain socially connected. This will usually require flexibility about assessment and participation.

The student's self-consciousness usually extends to situations beyond speaking and commonly affects non-verbal as well as verbal communication. In general, the student with SM finds it much easier to respond to another individual than to initiate communication. A student who is able to respond to a teacher's question, (verbally, in writing, or with a gesture) may be unable to initiate with that same teacher to ask a question or contribute to a class discussion. He or she may be unable to take a note to the attendance office, check out a library book, or make a purchase at the snack bar. SM has an impact both academically and socially, and students can feel left out because of their inability to interact with ease.

If teachers can help decrease anxiety at school and increase the student's self-confidence, there will be a greater chance of progressing communicatively, both non-verbally and verbally. Perhaps the student will interact with new work partners, carry notes to the office without a friend, or respond more easily, in writing, to discussion questions. It is important to recognize even small improvements and not become discouraged! Measure success by how well the student functions at school in general, and not by his or her communicative relationship with the teacher. Even the most empathetic and skilled teacher is an authority figure, and students with SM are commonly more inhibited with teacher than with other people. At the beginning of a new school year, new teachers should start allow for plenty of "warm-up" time. Start slowly with the goals of getting to know the student, gaining their trust, and helping the student become as comfortable as possible at school. Emphasizing or pushing for communication in any form, non-verbal, written, or oral, is likely to cause the student to withdraw. Communication will develop as the student becomes less anxious.

Helping the student make and maintain social ties is vital. It is, unfortunately, too easy for a socially anxious individual to become isolated and depressed. Depression is more likely as a child enters adolescence and can lead to more severe anxiety, social isolation, lower performance in school, suicidal thoughts, and self-medication with alcohol or drugs.
It's More than Not Talking
Studies have shown that over 90% of children with SM have Social Anxiety Disorder, also known as Social Phobia. 2 3 4 5

In fact, some experts have suggested that SM may be a manifestation or variant of social anxiety. These students are excessively selfconscious. They are afraid of being embarrassed, judged or criticized, and of receiving scrutiny or attention. 6

Social anxiety does not make a child anti-social or even asocial. A socially anxious child can be very social and enjoy the company of family and friends when in a familiar and comfortable setting. Many students are more comfortable with their peers (this is more common), but others are more comfortable with a trusted adult.

Some students, who may have partially overcome their SM, do speak at school. Most likely, these students still experience anxiety, even though it is less obvious. 7 8

They may not be able to speak in all situations or with all people. A student who is able to respond to a teacher's question or even contribute to a discussion may be completely unable to ask a question or express a concern.

Anxiety can affect academic performance in many ways, even in a student who begins to talk at school. Not talking is only the tip of the iceberg! Other manifestations of anxiety include:

Perfectionism; worry that work is inadequate in quality and/or quantity

Procrastination and avoidance

Problems with test-taking and timed testing; may rush for fear of not finishing in
time; may panic; may be too anxious to check answers or may check answers repeatedly and not finish

Problems with open-ended or unclear assignments; worry that they don't know what the teacher wants or that they will do the wrong thing

Unable to ask for help or clarification; unable to express worries or complaints

Afraid to express an opinion, even to express likes or dislikes

"Blanking," or panic-like reactions

Easily frustrated

Illegible, tiny, or faint writing to obscure answers they're unsure of

Difficulties with group work; may be unassertive or passive; conversely, may be a "control-freak" if worried that the group's work is inadequate

School refusal or faked illness to avoid social situations at school or because of worries about schoolwork

The first step in helping a student with these difficulties is to recognize that they are manifestations of anxiety. The student is not choosing to behave this way and is neither unmotivated nor oppositional. Then,

work to build the student's self-esteem and self-confidence,

increase the student's comfort and reduce anxiety at school,

back off on all pressure to speak, and

make accommodations, such as those suggested in the following section, that allow the student to progress academically.

Mild expressive language difficulties may be more common in students with SM, and they can be a source of added self-consciousness and anxiety.9 10 Subtle effects on oral and written expression can include: word retrieval glitches, terse writing with few descriptive details, and the use of non-specific language (e.g. "that thing" instead of a precise noun). A screening by a Speech and Language Pathologist or Neuropsychologist may be appropriate if there are concerns about language difficulties.
Accommodations and Classroom Strategies
Listed below are suggestions for strategies and accommodations that may be helpful for the older student with Selective Mutism. 11 Accommodations and modifications may be specified in an IEP or 504 Plan (in the US). Some accommodations are appropriate for almost any student with SM:

Training for teacher(s) covering the nature of SM and classroom strategies; training before the start of the school year followed by on-going support

Brief training so that all adults who might have contact with the student understand SM and how to interact with the student.

No grading down for not speaking or for any failure to communicate that is due to the anxiety condition.

No pressure to speak. No teasing, threatening, limiting the student's participation, or punishment for any failure to participate that is related to the anxiety condition.

Alternative forms of assessment and participation to substitute for speaking, such as: written work, non-verbal communication, audio- or video-taping, collaboration with friends, practice at home under parent's supervision, the use of a computer, or the use of another person as a verbal intermediary. Individual work may be allowed for a student who is unable to participate in a group.

Warm, flexible teachers who understand SM as an anxiety condition

Avoid singling out the student or calling attention to any differences.

Avoid calling attention to any new steps the student makes, such as talking in a new situation; other students should be told, without the student present, to not comment if the student with SM talks

Do not attempt therapeutic interventions except under the guidance of an authorized treating professional or as specified in the IEP or 504 Plan, and keep written records of interventions.

In general, except as specified in the IEP, treat the student as much as possible like any other student.

Other accommodations and strategies to consider, depending on the individual student, include:

Clear, specific assignments and expectations; detailed grading standards or rubrics that reduce the student's worries about what is expected

Clear and specific prompts and questions for written work and discussion topics, rather than open-ended topics

Place trusted friends in the same class(es). In secondary school, this probably will require hand scheduling.

Frequent opportunities for small group activities, preferably with at least one trusted peer.

Frequent opportunities for hands-on activities, since many students are more engaged and less distracted by worries when physically active.

Frequent opportunities for gross-motor activity (not only organized physical activities, but also informal opportunities to get up and move around) to help the student with self-regulation.

Teachers initiate a regular check-in with student to compensate for student's difficulty in initiating verbal or non-verbal communication; ask if the student has any questions or anything they want to communicate.

Seating in less conspicuous locations: back half of the room, towards the sides, and away from the teacher's desk

Seating next to a trusted friend and near students identified as good work partners

Vary modes of participation for the entire class to include non-verbal communication, e.g.: students write on individual small white boards, students signal "thumbs up" or "thumbs down," students indicate a numerical response by raising the corresponding number of fingers, students write a question or comment (possibly anonymously) to hand in

Advance preparation for class discussions; present questions to the student the day before or earlier in the day. If the student is unable to respond, move on rather than waiting for the student to answer.

Extended time for testing and assignments, or non-timed testing.

Advance notice for large projects; help break projects into smaller chunks to avoid overwhelming the student.

Alternative forms of participation in school performances. Some students with SM enjoy acting and find it easier to speak in the role of a character, and some sing or do cheerleading in a group.

Many are too self-conscious to appear onstage even in a non-speaking role but contribute as a writer, publicity artist, set designer, or lighting technician.

A private location to dress for PE

Support social connections: identify potential friends and work partners; initiate activities with those students and monitor as necessary; teacher assigns partners rather than let class choose

Encourage the student to tell others how he or she would like to be contacted, for instance if they are working together on a project that requires some contact outside of school

Set aside an area within the classroom where a pair or small group of students can work more privately, so as to encourage more easy communication. The area might be equipped with small whiteboards, office supplies, etc.

Social support at lunchtime, on field trips, and at other unstructured times

Support for participation in extracurricular activities

A steady adult, such as a trusted teacher or counselor, responsible for maintaining a continuous relationship with the student from year to year

Disability awareness and sensitivity training for other students; monitoring for bullying; be prepared to answer questions from other students, help them understand SM, and address their

Regular and frequent communication with the parents and outside treating professionals; communication mechanisms, such as email or voicemail, so that the parents can alert the school to immediate problems

Support for the student's goals in behavioral therapy under the guidance of an outside (or in-school) treating professional, including: communication with treating professional (possibly through the parents), record keeping and reporting, and carrying out the specified communication activities. Examples of activities: send student on an errand to the office with or without a buddy, student "interviews" teacher with written questions, student mouths words while class recites poem.

With appropriate support the older student with SM can achieve academically and develop social relationships. Helping students gain comfort and confidence at school fosters an environment in which they experience less anxiety and can increase the level and variety of communication at school.

1 The discussion in this and the following two sections are based on a series of lectures given by Elisa Shipon-Blum, D.O. at the conference Speaking Out for Our Children. Quality Resort Hotel, San Diego, California. 17-18 January 2004.

2 Bruce Black and Thomas W. Uhde, "Psychiatric Characteristics of Children with Selective Mutism: A Pilot Study." J. Am. Acad. Child and Adolescent Psychiatry 34:7, July 1995: 847-856.

3 Denise Chavira et al., "Selective Mutism and Social Anxiety Disorder: All in the Family?" J. Am. Acad. Child and Adolescent Psychiatry 46:11, November 2007: 1464-1472.

4 E. Steven Dummit III et al., "Systematic Assessment of 50 Children with Selective Mutism." J. Am. Acad. Child and Adolescent Psychiatry 36:5, May 1997: 653-660.

5 "Practice Parameters for the Assessment and Treatment for Children and Adolescents With Anxiety Disorders." J. Am. Acad. Child and Adolescent Psychiatry 46:2, February 2007: 267-283.

6 Ibid.

7 R. Lindsey Bergman, John Piacentini, and James T. McCracken, "Prevalence and Description of Selective Mutism in a School-Based Sample." J. Am. Acad. Child and Adolescent Psychiatry 41:8, August 2002: 938-946.

8 Bruce Black and Thomas W. Uhde, op.cit.

9 Hanne Kristensen and Beate Oerbeck, "Is Selective Mutism Associated With Deficits in Memory Span and Visual Memory?: An Exploratory Case-Control Study." Depression and Anxiety 23:2, 2006: 71-76.

10 Katharina Manassis et al., "The Sounds of Silence: Language, Cognition, and Anxiety in Selective Mutism." J. Am. Acad. Child and Adolescent Psychiatry 46:9, September 2007: 1187-1195.

11 School accommodations for younger students are discussed in Elisa Shipon-Blum, The Ideal Classroom Setting for the Selectively Mute Child (Jenkintown, PA, The SMART Center, 2003) and in Angela E. McHolm, Charles Cunningham, and Melanie K. Vanier, Helping Your Child with Selective Mutism (Oakland, CA, New Harbinger, 2005).

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The Older Child or Teen with Selective Mutism Ricki Blau Selective Mutism in the Older Child Selective Mutism (SM) is usually noticed when a child begins pre-school or kindergarten, if not before. So when a student in the upper elementary or secondary grades has SM, it's safe to assume that he or she has been [...]

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Autism and Selective Mutism: A Neurodiversity-Affirming Look | NeuroSpark Health

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Explore the connection between autism and selective mutism in adults and teens. Learn why it’s not defiance—and what affirming support can really look like.

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This workbook provides hands-on Activities, Strategies, planning sheets and progress trackers for use with children with selective mutism at home, at school and in the wider community. Written by selective mutism expert Maggie Johnson and parent coach Junhua Reitman, the workbook includes first-hand accounts of how children can overcome SM successfully using the Activities and Strategies described in this book. Activities are organised around the daily routines of school and family life and each Activity is broken into a progression of small steps with appropriate Strategies and an accompanying record sheet to track progress. Activities include:

Using the toilet at school

Attending social gatherings

Organising a successful playdate

Initiating conversation

Talking in the classroom

Eating with peers

This workbook is essential reading for parents, professionals and anyone who is looking for a toolkit for selective mutism. It also provides a useful extension to The Selective Mutism Resource Manual, 2nd edition, focusing on the 'how' to complement the manual's 'what' and 'why'. Small steps really do lead to big changes but taking the first step can be the most difficult. This book helps you make that first step.

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The Selective Mutism Workbook for Parents and Professionals: Small Steps, Big Changes

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This workbook provides hands-on Activities, Strategies, planning sheets and progress trackers for use with children with selective mutism at home, at school and in the wider community. Written by selective mutism expert Maggie Johnson and parent coach Junhua Reitman, the workbook includes first-hand accounts of how children can overcome SM successfully using the Activities and Strategies described in this book.

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Selective Mutism Information & Research Association (SMIRA)

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Selective Mutism (SM) is a communication anxiety disorder. This site contains information on and support for parents, people with SM, and professionals.

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Guidance for working with students with SM

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Guidance for working with students with SM

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All About Situational Mutism: A Guide for Allies - Reframing Autism

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This guide on situational mutism for allies by Jen Goodwin explores the the emotional and sensory factors that contribute to situational mutism, clarifies common misconceptions, and shares practical, respectful strategies for allies — such as providing alternative communication options, reducing pressure, and creating supportive environments — to help Autistic individuals feel safe and empowered to communicate in their own time and ways.

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Video - young people share their journey with autism

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Video - young people share their journey with autism

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y2mate.is - Young People Share Their Journey With Autism _ Me, My Stuff and I _ Channel 4-lOg5X-PxyYY-720p-1697529088

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y2mate.is - Young people explain autism _ Ambitious about Autism-xTLUYda-0O8-720p-1697529345

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Hannah Hobbs - MBACP Registered Integrated Counsellor: hannah@healing-pathways.co.uk

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The Know Yourself series offers free resources (videos, PDFs, worksheets) to support autistic teenagers in understanding what being autistic means to them.

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How to support the siblings of a child with a disability

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We’re taking a look at the challenges the siblings of a child with a disability can face, and the things you can do to support them.

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Rebecca Duffus is an Advisory Teacher working with students and educators in mainstream and specialist schools, plus local council and education services. Here, Rebecca discusses the importance of supporting young people to understand their autistic identity.
Research shows that having a positive understanding of your autistic identity is an indicator of higher self-esteem and wellbeing as an adult. (Corden, Brewer & Cage, 2021 and Cooper, Smith, & Russell, 2017). Yet, when do we teach this?

So often, autistic young people are told to stop stimming, taught neurotypical 'social skills' and disciplined because of characteristics directly related to their autistic identity. We need to be actively promoting autistic pride and creating communities where autistic young people can understand their strengths and have their needs catered for.

What is autistic identity?

Many autistic individuals discuss the term 'autistic identification' as affirming and valid, in place of 'diagnosis', which is steeped in medicalised language (and often difficult to access) (Sandland, 2022). Referring to autistic identity means an individual can acknowledge all the parts that make up their identity as a whole, and the core autistic characteristics that are integral to who they are.

There is also strength and solace in a shared identity. Much of what has been shown to increase wellbeing and reduce anxiety is finding your place in a community of like-minded people, such as with other autistic or neurodivergent folk.

However, so often I will meet a young person who is at crisis point, and ask the team around them if they have an understanding of their autistic identity, to be told 'No'. They may have been told about their diagnosis but been given little support to understand what this means, nor had the opportunity to meet other autistic young people, therefore being left feeling isolated, which can also impact their mental health.

What can we do to increase understanding of autistic identity in young people?

When a young person gets a diagnosis, the parents may be offered parent programmes, and the school may be offered training, but what does the actual autistic person get? In many cases, young people are not given the opportunity to explore their autistic identity. In an ideal world, a young person would be aware of autism at the start of their autism assessment process and then be able to build their understanding on this topic gradually and over time, with the support of understanding adults.

It is never too late to support a young person in developing a better sense of self. I have worked for a number of years doing just this, through clearly structured sessions, together creating a personalised book all about them. The Autism, Identity and Me Workbook for young people was created to become the individual's unique story, using visual prompts to positively explore their personality and interests, feelings of difference and what this means to them. The book also features other autistic individuals, providing peer representation, and a template toolkit.

When to have these conversations?

Children have different rates of cognitive development, and 'identity' is an abstract concept that can be challenging. Many children will start to notice differences between themselves and their peers and this often shows they are ready to have these discussions, but some children, won't ever talk about this.

Claire Sainsbury states 'any child who is old enough to understand a simple explanation.... is old enough' (Sainsbury, 2010). Likewise, research has found that when children know nothing about their diagnosis, they can have a very negative perception of themselves (Miller, 2015 and Punshon et al 2009).

Who is best placed to have these conversations?

If you are the young person's parent or carer, it is likely that you will have your own thoughts and feelings about this whole process. You may have battled for years to try and get an autism assessment or are carrying the weight of comments from 'well-meaning' family members or professionals. There may be layers of guilt or worry over whether you are doing the best for your child. I have worked with many, many families over the years and I can tell you this is all 'normal', whatever that means!

Remember our emotions are often contagious: if we are feeling highly anxious, those around us may well mirror these feelings or behaviours. Always consider whose needs you are meeting - if you are doing this because you feel you ought to, but really don't feel prepared - it might be best to let someone else take the lead (perhaps someone from school), while you access support and develop your own understanding of autism. The Autism, Identity and Me Guidebook explores this in detail and could be a good starting point.

It is important that the supporting adult is able to keep calm, give enough processing time and speak about autism very positively.

The role of the chosen adult should be:

a reassuring presence (with reduced verbal input)

to support with processing (providing additional visual tools or methods that work for that young person)

to provide examples to help the young person identify with the features discussed.

If you are a professional leading these conversations (in advance of the session), you should start planning and information gathering alongside parents. The resources section of the Guidebook has tools which can be used in an informal meeting with parents/carers and key adults.

Top tips to consider:

Choose the right time: if the young person is absorbed in their interests, or

focused on something that has happened, it may not be the right time.

Allow processing time

Don't talk too much

Use the young person's name to cue them in

Sit side by side

Consider the environment: would they prefer to be somewhere familiar? Think about the sensory input such as lighting and sounds.

Use visuals to support complex concepts

Use specialist interests to engage your child/young person in the topics

Have a plan for follow up questions : It's OK to 'park' the question or give the young person a kind of 'holding message' - better this than to give a rushed answer that they later find confusing or unsettling.

Adapt your plan for your young person: consider concentration and processing times. Some young people may prefer to sit down for an hour, others may want short 10-minute bursts of information. Be flexible!

Giving young people the space and time to explore and embrace their autistic identity, in a way that is positive and empowering, is essential for their sense of self and belonging.

Further information

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Helping young people to understand their autistic identity

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Rebecca Duffus discusses the importance of supporting young people to understand their autistic identity

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A parent told me how amazing this place is.

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A parent told me how amazing this place is.

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Imperial Sports Ground's Super Sense facility - one of the largest sensory rooms in the UK - was specifically developed to provide a safe sanctuary for children with special educational needs and disabilities (SEND children).

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Welcome to our Neurodiversity Hub which we hope you will find helpful. The Hub aligns to Cornwall & the Isles of Scilly Neurodevelopmental Profiling Tool, but it can be used by everyone. It forms a part of our early help offer of support for children, young people, and their families. The contributors to the content of the profiling sections are varied and include those with lived experience and professionals working with neurodivergent children and young people.

For more information about the ND Profiling Tool please see the first red section.
The blue sections cover the 9 areas of the Profiling Tool.
The green sections are other areas of need that may come up in your Profiling Tool guided conversation.
The orange sections have been developed to provide further information:

Families can find information to support a child's and their own needs including "Preparing your child for adulthood", "Parent Space" and "Hiding in Plain Sight".
Schools can find more specific information in the Reasonable Adjustments zone. You may also like "Hiding in Plain Sight".
Teenagers have their own Teenage Zone under almost every section. You may also like the "Hiding in Plain Sight", "Friendships" and "Siblings" zones.
Young adults also have their own section called "My Independent Life".

To feedback or for enquiries please email cft.ndcornwall@nhs.net

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Welcome to our Neurodiversity Hub which we hope you will find helpful. The Hub aligns to Cornwall & the Isles of Scilly Neurodevelopmental Profiling Tool, but it can be used by everyone. It forms a part of our early help offer of support for children, young people, and their families.

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Our NEW SASS Community Choir!

Come and sing with us!

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The Autism Couple’s Workbook, Second Edition

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Buy The Autism Couple’s Workbook, Second Edition Workbook by Aston, Maxine (ISBN: 9781785928918) from Amazon’s Book Store. Everyday low prices and free delivery on eligible orders.

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*NEW* B&NES Occupational Therapy Advice Line

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*NEW* B&NES Occupational Therapy Advice Line

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When I first started working in education 20 years ago, I can remember a pupil who was regularly absent, and the parents were struggling to get them into school. In meetings with other staff, we would describe the pupil as a 'school refuser'. The word 'refuser' had powerful, often negative, implications for understanding the situation and subsequently the support that was provided to the pupil. The term implied that the pupil was actively choosing not to attend school and placed an emphasis and unconscious judgement on their apparent poor behaviour. The term did not encourage us staff to be curious about the underlying thoughts and feelings that were resulting in the pupil's absenteeism.

A brief history

In 2014, the Special Educational Needs and Disabilities (SEND) Code of Practice introduced the term 'social, emotional and mental health (SEMH)'. This replaced the terms 'behavioural, emotional and social difficulties' and 'emotional and behavioural difficulties'. The new abbreviation, SEMH, was the first term to drop the word 'behaviour', in an attempt to emphasise that behaviour is a way of communicating underlying barriers and difficulties. This marked a turning point in understanding the behaviour of absenteeism and helped us understand the term emotionally-based school avoidance (EBSA) which we use today.

This move also encouraged schools to view regular absenteeism as a potential emotional, mental health or wellbeing difficulty, something that should be explored before implementing sanctions for non-attendance. This is a message that has been reiterated in the Education Committee's report on persistent absence and support for disadvantaged pupils, which states that mental health difficulties should be a valid reason for pupils to miss school, with fines aimed at parents being a "last resort".

Anxiety is often the emotion that is considered as part of EBSA, and is often linked to school avoidance. The pupil may experience anxious and fearful thoughts around attending school and their ability to cope with the perceived demands to engage or perform. These feelings may be accompanied by physiological symptoms of anxiety such as nausea, vomiting, shaking, sweating and even start days before having to go to school.

Is emotionally-based school avoidance on the rise?

British psychotherapist and author, Philippa Perry, wrote in an article in the Guardian stating, "Not Fine in School is a support group for families with children who find it hard or impossible to attend school. It launched in 2018 with 100 members. Post lockdown, they now have more than 30,000".

The government's Education Committee published a report on persistent absence and support for disadvantaged pupils, which states:

"The most recent full-year statistics (for 2021/22) showed an overall absence rate of 7.6%, up from around 4-5% before the pandemic. In that [pandemic] year, 22.5% of pupils were persistently absent, meaning they missed 10% or more of school sessions - around double the pre-pandemic rate. 1.7% of all pupils were severely absent, meaning they missed more than half of sessions, compared to less than 1% pre-pandemic."

In response, the Education Committee Chair Robin Walker MP said "The increase in children suffering from mental health problems is deeply troubling and it is evident that our health service can't meet this growing demand, leaving schools to fill the gaps.

A major cross-government review of how to overcome this challenge is needed and greater resources both inside and outside schools will be required".

What factors lead to emotionally-based school avoidance?

There are a range of factors, including school, family, friends and the post-pandemic recovery, that can contribute towards the experience of emotionally based school avoidance.

In 1990, Christopher Kearney and Wendy Silverman wrote a paper on the subject which suggested four main reasons for school avoidance. Although we no longer use the term 'school refusal', the factors they identified are still helpful considerations:

to avoid uncomfortable feelings brought on by attending school, such as feelings of anxiety or low mood

to avoid situations that might be stressful, such as academic demands, social pressures and/or aspects of the school environment

to reduce separation anxiety or to gain attention from significant others, such as parents or other family members

to pursue tangible reinforces outside of school, such as going shopping or playing computer games during school time.

EBSA is highly complex, has many different aspects and causes, and there could be a range of contributing and intersecting factors in play at any one time. Nevertheless, thinking about the four reasons above can help staff explore each factor and how it may be contributing to potential problems.

Once the underlying reasons behind school avoidance have been discovered, a network of tailored support for the pupil can be implemented to reduce the emotional barriers and increase the incentive to return to school. The training provided by Gloucester House Outreach Service explores these themes in further depth, as well as the possible interventions that you could consider implementing to address them.

Where to begin?

The SEND Code of Practice makes it clear that the views of pupils are paramount at every stage of the SEND graduated approach. Social, emotional and mental health, which EBSA falls under, forms one of the categories within this code of practice. Therefore, to address an individual's EBSA, we must find ways to gather a pupil's voice and the underlying reasons for the school avoidance.

In my role as an Advisory Teacher, a regular challenge that I've seen staff experiencing is that they are unable to identify the reasons for the pupil's absenteeism, despite their best endeavours. Pupils may often find it hard to communicate and express their thoughts and feelings, leaving staff feeling "stuck".

At Gloucester House Outreach Service, we have recognised this issue and offer EBSA training to help staff explore how they can gather a pupil's thoughts and feelings. A range of creative and non-verbal strategies can be effective in this exercise, by reducing the perceived demand on the pupil to talk and increasing the chance of gathering insights into the way the pupil is perceiving the world around them. Staff can then learn what is required to generate an appropriate plan of support.

Reframing, reflecting and responding to the challenges of EBSA

As I write this blog, I think back to the pupil from 20 years ago that had been labelled as a "school refuser". Helping the staff reconsider that school avoidance was not as simple as a pupil just refusing to attend school began a change in thoughts and feelings. I am sure it was not a novel concept, but I used to ask members of staff to consider both the "fruits"and "roots"of children's behaviour. I would point out to my colleagues that they would be describing the "fruits", but invite them to consider the "root" reasons for why the pupil was displaying challenging behaviours.

I chuckle to myself and see that I was trying to find a visual way to illustrate the "presentation"vs "unconscious", or the "seen"vs "unseen" which derives from a psychodynamic approach. Often we are drawn to the surface level of behaviour (in this case being absent from school) and find it difficult to be curious about the deeper underlying factors that are at play. We often fail to appreciate that this behaviour is not simply a child or young person's "choice"but possibly a coping mechanism for underlying issues. These issues are not always resolvable between the child and their parent/carer, but can require a wider network of support from professionals.

Sometimes people are curious about the underlying factors behind school avoidance but do not feel equipped with the tools to discover what underlying factors are at play. Addressing the behaviour head on with a question such as "Why do you not want to come to school?" often results in a typical response of a lowering of the head, a shrug and a monotone response "I dunno". Therefore, creatively having the tools to gather the views of the child are paramount to slowly achieving our goal - in my case, getting the pupil from 20 years ago back into school. After all, how can you help if you are unable to uncover the roots of the emotionally-based school avoidance?

In the training that we deliver, we explore creative ways to capture the pupil's voice. For example, the 'Drawing the ideal school technique' can be used to elicit children's important or core constructs about themselves and how they view the world in a visual way. Drawing pictures in response to given prompts can help gather insight about a child's needs without a demand on the child to talk.

Another non-verbal, visual activity is the use of EBSA risk and resilience cards. These help children externalise behavior by ranking cards that they associate with to help professionals uncover the possible risks and functions of their EBSA. Ranking other cards that highlight environmental or sensory support can guide professionals on towards personalised strategies that can help build the resilience in the child to cope with their EBSA. Ultimately, this interactive card sorting activity creates a low demand as the pupil does not have to come up with ideas or put forward verbal thoughts, just respond to images and ideas that resonate with them and move them around.

These resources can also help spark conversations and elicit a child's view of the world. Through this we can start to make sense of the factors contributing to EBSA and develop the foundations of an effective support plan.

Creating a personalised, coordinated plan

Gathering a pupil's voice is essential to creating a personalised and coordinated plan. Below I've suggested some things to consider when developing your own:

1. A range of factors can be at the root of EBSA and they all have to be addressed simultaneously with a coordinated plan of support and regular 'assess, plan do, review' cycles.

2. The plan needs to be broken down into very small steps and always negotiated with parent/carer and pupil.

3. Using a personalised Mapping Landscape of School (also known as Landscape of Fear) resource - similar to CBT's systematic desensitisation approach - will play a big part in developing the hierarchy of steps for a pupil so they feel in control and not overwhelmed with the fear response.

4. Professionals might need to do most of this work in the home and be open to having much lower expectations for attendance to school increasing quickly.

5. A range of professionals need to be involved and allocating all the work to one staff member should be avoided.

In summary, a team approach is required for supporting a child with EBSA. Yes, there will be a key-worker(s) that will be tasked to building, maintaining or establishing a rapport with the child and providing support throughout the process. However, other professionals must be involved in coordinating and overseeing the plan. The plan must take a child-centered approach, focusing on meeting the child's needs and their perceived reasons for school avoidance.

Finally, although it may be easier said than done, professionals should avoid being driven by external pressures such as meeting targets, improving attendance data and adhering to attendance and behaviour policies. Instead, by focusing on the child, the ultimate aim will eventually come into fruition.

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The Cognitive Shuffle Do-It-Yourself Instructions

mySleepButton uses The Cognitive Shuffle (SDI)

The Cognitive Shuffle- Serial Diverse Imagining (SDI)-is a technique designed by Dr. Luc P. Beaudoin to help people get to sleep. It scrambles your thoughts. This helps you keep your mind off issues that prevent you from sleeping. Also, because The Cognitive Shuffle gets you to imagine random objects, the sleep regulators in your brain may be tricked into thinking that it's time to fall asleep. The Cognitive Shuffle is designed to induce "super-somnolent" mentation.

The Cognitive Shuffle involves thinking of random items that are easy to visualize, non-threatening, and conducive to sleep. Thinking up such items without software is difficult, unless you know some tricks. The best trick is to use mySleepButton. It takes care of selecting appropriate words for you. With mySleepButton, all you need to do is imagine the words it speaks to you.

But suppose for some reason, you can't use mySleepButton one night because you don't have access to your iPhone. Or you don't own an iPod Touch, iPhone or iPad. This is where our Do-It-Yourself Cognitive Shuffle technique comes in. It's described next.

Cognitive Shuffle DIY Technique

First, get yourself into bed, ready to go to sleep.

Second, think of a random, emotionally neutral word consisting of at least 5 letters. "BEDTIME" is a good word. Try not to use one with many repeating letters. "BANANA" isn't a great DIY-SDI word because "BANANA" has only 3 unique letters, B, N, A. "BEDTIME", in this case is a "seed" word.

Third, gradually spell out the seed word (e.g., "BEDTIME"). For each letter of the word, think of a word that start with that letter. Then imagine the item represented by the word. Repeat this many times for each letter. I.e., think of many words that start with the letter and imagine each one of them.

Here's an example: "BEDTIME" starts with B. So, repeatedly think of a word that starts with B and then imagine it. For example,
B...

BABY. Imagine a baby.
BALL. Imagine a ball rolling down a street.
BLINK. Image someone blinking a lot.
BANANA. Imagine a bunch of bananas hanging from a tree.
BEANS. Imagine green beans in a produce store.
BERRY. Ooops! There's a theme here, banana, beans and berries are all produce. They and beer are all ingestible. So just skip this word.
BELGIUM. Imagine the flat lands of Belgium.
Bob. Imagine a person named Bob that you don't dislike. (Notice that it's fine to imagine people.)

Once you get bored of the letter ( B, in this case) or you can't find another word starting with that letter, just move on to the next letter.

The next letter in BEDTIME is E. So think of words beginning with E and then imagine them.
E...

EAST. Imagine the eastern part of the place where you live.
EAGLE. Imagine an eagle flying high.
EGG. Imagine an egg.

If you have difficulty coming up with words that start with E, either skip this letter, or use this trick: tack on an extra letter to E and see if that helps. For example, if you try ED... you might think of EDEN and then EDINBURGH.

Continue generating E_ words until you get bored of the letter E or you can't find words starting with B anymore. Then proceed to the next letter in the seed word (BEDTIME, in this example).

If you happen to make it to the end of the seed word, BEDTIME without falling asleep. Just pick a new seed word, such as SATURN, and repeat the entire process. I.e., for each of its letters, think of words that start with that letter, and imagine those words.

Some tips:

If you produce a word that you can't easily imagine, just reject it.

If the word you produce stresses you a bit, that's okay. You have the choice of staying with the word, using mindfulness to accept the emotions it generates. Keep in mind that the next word will replace the content of your 'working memory' and you will likely feel calmer, because human emotions are mainly the result of our thinking. Please note that muchpsychological research suggests that acceptance of emotions is healthy and beneficial for sleep. Compare mySleepButton's mindfulness pack.

If you can't think of any more words for a given letter, just move on to the next letter.

It is sometimes helpful to imagine a few contexts for the same object (e.g., if the word is 'mountain', you could imagine, one at a time, several different mountains you know).

If you produce a good word that doesn't start with the given letter, you can still imagine it. These are not rules, just principles to facilitate the generation of mental content.

Limitations of DIY-SDI

DIY-SDI is not effective in the following conditions:

You are too tired to conjure up words, but not drowsy enough to fall asleep. (For example, when you wake up in the middle of the night.)

You don't like to think deliberately when you are trying to fall asleep.

You find it difficult to come up with words that start with a given letter, despite practice.

You find spelling tedious.

In these and other situations just lay back and shuffle your thoughts to sleep with mySleepButton.

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