The First Assess Communication Tool (FACT) has been produced by a range of professionals working with children and young people with speech, language and communication needs (SLCN) in Milton Keynes. It has been created to support the Milton Keynes Inclusion Strategy, with the intention of helping settings and schools to meet learners’ speech, language and communication needs. 

Early Years FACT 

Early Years FACT Plus 

KS1 - KS2 FACT 

KS1 - KS2 FACT Plus 

KS3 - KS5 FACT 

KS3 - KS5 FACT Plus 

Think about a child's behaviour a bit like an iceberg - you can only see the tip but there’s a lot more underneath that you can’t see. There can be underlying reasons for challenging behaviour. So, you need to ask why is the child behaving like this? Not, what is the child doing.

Reasons for challenging behaviour can include:

• sensory issues
• poor communication skills
• frustration
• fears and phobias
• misunderstanding of social rules
• literal understanding
• too much language being used by someone
• not enough time to process what’s been asked - some children can take up 2 minutes to process a single instruction
• lack of knowledge or understanding of how to behave appropriately
• pressure to do tasks which are too difficult at the time
• fear of the situation
• difficulties with making themselves understood
• difficulty in understanding what’s being asked of them
• environmental influences
• changes in routine

A solution 

Use an ABC chart to find the trigger points for the behaviour:

• A - antecedents - what happened before?
• B - behaviour - what was the behaviour observed?
• C - consequences - what happened next and how did the adult deal with the situation?

Behaviours of Concern - Chris White, Specialist Teacher with the Inclusion Specialist Teaching Team, presents these videos looking at behaviours of concern, why you may see them and strategies to support.

1. Why You May See Behaviours of Concern 

2. Strategies To Support Behaviours of Concern 

A full day can be stressful and difficult to manage for some young children especially if they have additional needs and they may need quiet time for themselves at different points of the day.

A quiet space can be set aside for a child to use when he or she feels overwhelmed, upset, or tense. This serves as a protected place where children can be taught to go to in order to relax, calm down, or take a break. A parent or carer or, if in an early years setting, a teacher, can join the child, if he or she needs support in calming down or feeling secure.

This is particularly important for children with Social Communication Difficulties or Autistic Spectrum Condition when they become over stimulated by the busy, noisy, bright environments.

A solution

Here are some simple and quick suggestions to create a quiet area:

• a table with a cloth over it with some cushions and a box with calming sensory toys/toys the child likes to play with
• a small tent with some cushions and calming sensory toys/toys the child likes to play with

Take a picture of the calm area or box of calming toys and show it to the child as they use it.  Eventually they will link the picture to the area or box. Once this has been established they learn to go to the quite area or box when shown the picture.

This space must not be used as a consequence area or timeout.

The child can choose when to use the area or be encouraged by an adult when they are becoming anxious.

Some children with SEND find concentrating on activities without a clear ending challenging. 

A solution

Here are some ideas for activities that can be adapted to have a clear ending:

• puzzles - put pieces into a bag, take them out and name, offer choice of two
• posting - give choice of two pieces and name before posting
• threading - thread a particular number of reels
• colour matching into trays
• picture lotto games
• post balls into a tube
• sorting for type, size and colour
• share a book
• peg boards
• flatten some playdough, press marbles into it
• Mr Potato Head
• make a car from a construction material (eg Duplo) give child same piece and ask them to copy it
• collage with particular number of pieces to stick
• scissors - snip along, or make consecutive cuts along given line
• use items to count and numerals - count the items and find the correct numeral to match the total

All these ideas can be used to help a child's attention skills.  It also helps them to get into the habit of completing a task that an adult has chosen.  You will need to adjust your expectation accordingly.  For example: 

• if the child does not sit for very long, you place eight pieces of a 10 piece puzzle and ask them to add the last two - this can then be adjusted next time so that they do increasingly more of the puzzle themselves

You will need to provide a reward when they have done the task(s) - this could be a toy they find motivating, or chance to choose the next activity.

The idea is that they can start to complete some tasks independently, so do not make them too challenging.

The issue

Children with SEND can often find it stressful not knowing what is going to happen next and/or moving on from an activity they are enjoying.  

A solution

Now and next boards are a visual support which are often used prior to the introduction of a visual timetable. They are used for a short sequence to help a child to understand what will happen now and then next (sometimes called first and then). Using them can help:

• children understand a sequence of events
• support understanding about what is going to happen now and then next - remember to use motivating activity as ‘next’ as the child is more likely to carry out the ‘now’ activity if it is less appealing to them and they know a treat is coming ‘next’
• children understand when something is finished
• alleviate frustration
• language skills by supporting vocabulary with pictures (word finding)
• children associate a picture with the corresponding activity - this supports auditory/visual memory and cognitive association
• support a child’s focus at an activity or sequence of activities

Keep and display the board at the child’s level in the same place or have it with you when you are doing the activities, preferably in a quiet area. This is so that the child knows where to find it in the future and may be in future access this independently. A quiet area allows limited distraction to aid concentration.

To start with a child will need adult direction to learn what it is for and how to use it, with possible hand over hand assistance to pull off the picture when finished (one at a time) and post it into a finish box/pouch.

• use simple language and point to each picture explaining what will happen ‘Now and Next’ - remember to always use motivating activity (what the child likes) as the Next, it will be a reward for the child and likely to be successful next time you use it
• then, show the first picture and carry the activity out
• when it is complete encourage the child to remove the picture and post it into the finished box/pouch (optional)
• continue with the sequence until it is complete

The Occupational Therapy team have put together a now and next advice sheet for parents and carers.

The issue

Along with learning to feed and dress oneself, becoming toilet trained is an important step in personal independence.  Socially, it opens up opportunities for interacting with others and taking part in a wider range of activities.  In addition, there are practical benefits for parents and caregivers, including time and financial savings connected with nappy changing and the cost of related supplies.

Toilet training can be more challenging for children with SEND because:

• parents and carers of children with developmental delays cannot rely on the typical timelines for guidance about toilet training - instead, they must continue to watch for signs of readiness, even after the toddler years
• children with delays often have difficulties with language, both in understanding spoken directions and in verbally expressing their toileting needs
• where children have difficulty with change in their routines, they may be resistent to the steps involved in toilet training, such as taking away their nappy or sitting on the toilet for several minutes at a time
• children may also have a high activity level, be anxious in new situations and have difficulty feeling when they need to go, or have sensory sensitivities - for example, they may overreact to the sound of loud flushing, the sight of the flourescent lights, the feel of the toilet seat, or the smells associated with bathrooms

All these issues may combine to make toilet training a challenge - but it can be done.

Is my child ready?

Beginning toilet training too soon may make the process more frustrating for both you and your child.  However, if your child is around three years or older, look for some of the following signs of readiness:

• notices when their nappy or clothing is wet or soiled
• shows interest in self-care like dressing, hand-washing and toileting
• shows interest in other people's toileting behaviour
• completely empties bladder when having a wee and stays dry about two hours at a time
• has bowel movements that follow a regular and predictable pattern
• has the balance to sit on the toilet for two to five minutes
• follows a few simple directions like "sit down"
• indicates the need to go to bathroom through facial expressions, postures, gestures, pictures or words

Even if your child is not yet showing all these signs, there are parts of the toilet training process you can begin to help prepare your child.

Am I ready?

Since you will be guiding this process, you need to be ready to begin.  This means that toilet training is a high priority for you, and that you have adequate time to commit to it.  It also means that the other people in your child's life - family members, babysitters, pre-school providers, are ready to help. 

Toilet training will go more smoothly if all the people caring for your child use the same approach.

What can I do to prepare?

Before beginning toilet training, it may be helpful to keep a 'toileting diary' for up to two weeks that will capture information about the timing of your child's urination or bowel movements each day.  This will provide you with clues about the appropriate times to take your child to the toilet.  Depending on your family's comfort level, you may want to provide opportunities for your child to observe another person using the toilet to model undressing, sitting on the toilet, wiping, washing hands and so on.

Select the specific words you will use consistently (for example, pee and poop).  Choose words you will feel comfortable hearing your child use in public when he or she is older.  During this preparation phase, set up the environment to promote success.  This may include purchasing a potty chair or adapted seat for the regular toilet, removing distractions, purchasing pants.

How do I begin?

• keep a toileting diary - this will hopefully give you good information about the best times to take your child to the toilet
  For example, if the diary indicates that the child is consistently dry at 9.30am, but consistently wet at 10am, a good time to have the child sit on the toilet is right before 10am
• develop a visual schedule - this may decrease language demands and promote understanding of each step of the process
  For example, you can present your child with a sequence of drawings or pictures depicting the specific steps: enter bathroom, pull down pants, sit on potty, wipe, flush, pull up pants, wash and dry hands - you can use these pictures to help
• if your child is in the early stages of toilet training, you may have to begin by scheduling trips to the bathroom that only involve certain steps of this process, like being in the bathroom or sitting on the toilet for a few seconds - deciding where to start will depend on how comfortable and compliant your child is with these first steps of the toileting process

Other helpful strategies

• increase liquids and high fibre foods to increase the chances of 'catching' your child when they need to go to the bathroom
• make the bathroom a positive place (music, soft lighting, pleasant scents etc.) and decrease things about the bathroom that may be seen as negative or anxiety provoking for your child
• decrease discomfort or fear of sitting on toilet by providing foot rests for stabilisation and a toilet seat insert
• plan clothing for ease of undressing
• assemble a basket of favourite toys for your child to use while sitting on toilet
• use a timer to increase length of time sitting on toilet
• create a 'now and next' board to communicate to your child the reward he/she will receive for going to the toilet - for example,  'First sit, then bubbles' - as a reward 
• remember to provide rewards for the behaviours you want your child to do during the toileting process
• use social stories to describe each step of the process through a simple story format
• create a picture card for your child to communicate the need to use the bathroom, if your child is nonverbal or has a hard time using his/her verbal abilities in stressful situations.

Setbacks?

It is common for all children to experience setbacks in toilet training, particularly when they go through transitions or other stressful experiences; you may therefore need to repeat some of the earlier steps of toilet training to get back on track.

Children can feel anxious about what is happening next when they are out and about or on the move. 

Visual prompts are pictures, photos or symbols of activities that are a handy size worn on a Key Fob attached to a belt or a lanyard that are very useful for staff or parents organising their daily routine. The visual prompts can be used to:

• help children understand what is about to happen next when out and about or on the move
• help children to feel less anxious and alleviate frustration
• help language skills by supporting vocabulary with pictures (word finding)
• associate a picture with the corresponding activity - this supports auditory/visual memory and cognitive association
• support a child’s focus at an activity 

How do I use them?

Keep the cards on your person, either on your belt on a key ring or on a lanyard. Communicate to a child what is about to happen by showing them the card a few moments beforehand. This gives the child a moment to process what you are about to do.

Communication cards can also be used as a now and next strategy by showing a card of what is about to happen and then what will happen next. Remember to show motivating activity (what the child likes) as the ‘next' so that the child is more likely to follow the sequence.

Download some commonly used visual prompts.

The issue

Children with SEND can find it difficult to understand daily routines and what is expected of them. This can make them anxious and/or frustrated. 

A solution

Visual timetables are made up of sequences of pictures (photos or symbols) which represent the plan for the day or a sequence of events in the order they will happen.

The pictures are often attached with Velcro to a strip (which is in the timetable) so the list can be changed each day.  The list can be read from left to right, or from top to bottom and a finished box or pouch is at the end of the timetable enabling the child to 'post' the picture activity. Using a visual timetable can help children:

• understand the routines and what is expected of them
• understand what is going to happen now and later
• understand when something is finished which helps with transitions
• feel less anxious and frustrated
• develop language skills by supporting the spoken or written word with pictures (visual support)
• associate a picture with the corresponding activity - this supports auditory/visual memory and cognitive association
• focus at an activity or sequence of activities for longer periods of time, thereby developing attention and listening skills

Display the timetable at the child's level in the same place, preferably in a quiet area.  This is so that the child knows where to access it.  A quiet area allows limited distraction to aid concentration.

To start with the child will need adult support and direction to learn how to use their timetable with possible hand over hand assistance to pull off the picture and post it into a finish box/pouch if required.

• at the beginning of the day/sequence, use simple language and point to each picture explaining the routine/timetable from start to finish
• show the first picture and carry the activity out
• when it is complete encourage the child to remove the picture and post it into the finished box/pouch
• continue with the sequence until the time table is complete.

Download some common visual timetable images.

For other specific visual schedules around health and routine please visit the Occuptional Therapy teams site.

Here you will find a list of useful resources and activities to try at home, with visuals. 

• activities to help attention skills
• basic cooking for children and young people
• song cards
• making moon sand part 1
• making moon sand part 2
• practice make up from YouTube
• planting and decorating your pot part 1
• planting and decorating your pot part 2
• play doh visuals
• build a robot visual
• going on a winter walk checklist
• shaving foam visuals
• decorating biscuits visuals
• finger painting templates
• making a pasta necklace visuals
• nursery rhyme choosing board

Your child may find it difficult to understand their emotions or how they are feeling. We would always advise you to speak to your SENDCO at your school or setting to see how they can support your child whilst at school.

Below you will find some resources that can be used to support your child in understanding their emotions and feelings. 

• emotion picture cards
• today i am feeling template
• zones of regulation visuals and strategies
• zones of regulation advice sheet for school staff

As adults it is important to role model our own feelings and emotions. Use your feeling template or zones of regulation check in to tell your child how you are feeling, don't be afraid to say that you aren't feeling happy all of the time. 

Understanding and Managing Anxiety 

Amy Segui, Specialist Teacher with the Inclusion Specialist Teaching Team, presents this video about how you can support your child to manage their anxiety 

1.  Supporting Your Child To Manage Their Anxiety 

We all have different ways of communicating and it is important to recognise this and support our children and young people with opportunities to communicate. Communication does not always have to be verbal, communication can be through noises, body language, visual cards, pointing, eye contact and more.

Milton Keynes Speech and Language Therapists (SALT):

• Milton Keynes Early Years Speech and Language Therapy Team - working with pre-school-age children with speech and language difficulties in addition to feeding and swallowing difficulties.
• Milton Keynes Early Years Complex Needs Speech and Language Therapy Team - a specialist team which develops the communication, eating and drinking skills of pre-school-age children with longer term difficulties.
• Milton Keynes Schools Speech and Language Therapy Team - provides services to all primary and secondary schools within Milton Keynes, including some with specialist education provision.

How to make a referral, resources and support can be found on each of the above links. For further advice and support (for example, visual helpers, objects of reference and choices) from Speech and Language, please see our Speech and Language pages.

Using visuals to support understanding 

Sally Ahmad, Specialist Teacher for the Inclusion Specialist Teaching Team, presents these two videos about how to support understanding through the use of visuals.

1. Comic Strip Conversations 

2. Social Scripts 

Supporting Siblings and Encouraging Socialising 

Chris White, Specialist Teacher with the Inclusion Specialist Teaching Team, presents this video about how to support the siblings of children diagnosed with ASC or with SCN, as well as how to encourage socialising, while recognising the individual personalities of our children 

1. Supporting Siblings and Encouraging Socialising

Phoebe Caldwell:

Phoebe Caldwell is a practitioner working with and supporting people with autism. You may find her resources around communication below useful. 

• Speak to me -  a simple guide to using intensive interaction
• Can we talk - getting in touch with people with severe learning disabilities who have little or no speech

The Hanen centre:

The service offers two highly successful training programmes for parents to help their children’s communication development:

• It Takes Two to Talk, for parents of children with speech and language difficulties
• More Than Words, for parents of children with social interaction and communication difficulties

• lecture 1 - characteristics of autism
• lecture 2 - overview of structure 
• lecture 3 - communication
• lecture 4 - overview of visual structures
• lecture 5 - assessment
• lecture 6 - structured play and leisure
• lecture 7 - behaviour
• lecture 8 - independence
• lecture 9 - partnership
• lecture 10 - implementing TEACCH 

Activity breaks are an opportunity to be physically active for a short period of time. Activity breaks might be used between learning, or when you feel your child needs a sensory break.

Here are two examples of activities break you could use:

• activity break example 1 
• activity break example 2

Sensory play is a great way to support your child's sensory needs through fun and engaging activities. Sensory play can be added through out your child's day to help keep them regulated. We have produced some ideas and resources to support with sensory play, which you will find below.

• sensory play activities - a booklet full of sensory play ideas
• sensory toy box ideas - images of types of toys to include in your child's toy box
• play strategies - exploratory play - produced by NHS Hillingdon Talks
• messy play - sensory activities to support children speech, language, communication and interaction skills
• play time - five tips for talking

Some children experience sensory processing difficulties which impact on participation and function in everyday activities. Many children with Neurodevelopmental difficulties including ASC and ADHD experience these difficulties. If you think your child has sensory processing difficulties, please talk to any healthcare professional already working with your child. They can help you to unpick your child’s behaviours and whether they are sensory or have another cause.

The Milton Keynes Occupational Therapy Service have created some free information and resources to support parents, carers and professionals to understand sensory processing. For example, chew toys, head banging, planning wheels and videos to support different sensory needs. 

Milton Keynes Children and Young People’s Occupational Therapy Team support children and young people (CYP) who have significant difficulties with everyday functional skills due to a physical, motor or sensory-based need that impacts on their independence and ability to participate in everyday activities. 

Sensory sensitivities 

If you think your child may have sensory sensitivities, please use this this checklist to determine the area of need, alongside this you will find a list of strategies to support your child and their sensory sensitivities.   

• sensory sensitivities checklist - an editable checklist to support sensory sensitivities 
• sensory sensitivities strategies - Sensory integration issues and strategies 

New- Health’s Occupational Therapy Professional Lead delivered a really informative 1.5 hr presentation on Sensory Needs as part of CNWL’s Year of the Child. This training gives a great insight into sensory needs, strategies to use and how sensory needs affect anxiety levels.

The information pack and recording for sensory awareness are available on our website. Find out more, and watch back the recording here

A copy of the PowerPoint presentation is also available.

Please find the application form to apply for Inclusion Grant Funding 

Carers MK supports unpaid carers of all ages, from all backgrounds and in all caring roles. This includes young carers, young adult carers, parents of children with SEND, adult and older carers, carers from diverse communities, LGBTQ+ carers and those looking after someone with a mental health condition. Carers MK also provides support for unpaid carers and the person they care for whilst in Milton Keynes University Hospital.

What We Provide

• Up-to-date information and advice 
• Help with knowing carers' rights and entitlements and information on carers' issues 
• Guidance on health and social care services
• Help to create an emergency plan
• Carer support groups, workshops and activities
• An opportunity to meet other carers
• A listening ear and someone to talk to in confidence
• A free counselling service
• Carers support at at Milton Keynes University Hospital
• Referrals to other services
• Bi-annual 'Carers News' newsletter
• Carefree Short breaks for carers - Carers MK 
• Information on grants 

Information from Carers MK on training and workshops 

Information on money and legal matters 

Milton Keynes Centre for Integrated Living

The organisation was opened as a charity set up to support people with a disability in 1992. Originally called Milton Keynes Disability Information Service the organisation later changed its name to Milton Keynes Centre for Integrated Living. Originally set up to provide information, advice and support to people with a disability about equipment, MK CIL had an adapted flat that allowed people to look around and see what equipment was available to them.

Their website has information on:

• Advice services 
• Disability equipment 
• Room hire 
• Directory 
• News and information 
• Training services