How would a SALT assessment differ with children of different ages ???

[ChristmasCracker]

Ds had his 2 yr development check today. All in all they were very pleased as he did most things he was asked very well.

They asked if i had any concerns and i said i was slightly concerned about his speech> They said he should know 50-60 seperate words by now, but doesn't and some of the ones he does know are unrecognisable to anyone other than me.

They have said that they will refer him for a speech assesment (also a hearing test just to check), but i was wondering what they will do with a child of that age.

Dd had one at age 4 and she was asked to point to things and then name them etc, but Ds wouldn't be able to do this and if asked to say a particular word he wouldn't (even if he could).

Anyone elses child had their speech assessed at this age ???

[coppertop]

Ds1 had his assessment at 2yrs 6mths. Mizmiz will probably be able to tell you more but it was mostly a case of watching ds1 with the toys while I answered questions. She was looking to see if/how he used language. She was also testing his understanding by saying things like "Fetch the X" and "Where's the X?"

I think she also had picture books and asked ds1 to point to certain things. At the time he couldn't do this.

When ds1 had his 2yr check-up we were told that he should have at least 20 words but that they would consider 6 words to be at the bottom range of normal.

[ChristmasCracker]

Ahh right, well i would say he has 20 words i think, about that many any way.

She seems to think he is probably just a little late with it because he has two older sisters to talk for him, and i think i agree.

Thanks Coppertop

[Jimjambells]

Both of mine have been assessed in their twos. They were asked to point to things (both of them) or say what they saw (ds2- ds1 is non-verbal). With ds1 they had to give up pretty quickly and moved on to assessing things like his joint attention (non-existent then) and play skills (non-existent) so just questioned me instead (this is NHS- private ones then worked with him a bit- depending on their brief). In ds2's case it was pretty clear early on that his "problems" were very minor so they didn't bother asking about playskills, or watching them, just had a quick chat about ways to encourage different tongue movements etc.

Wouldn't hold your breath though- we've just waited a year for ds2's SALT assessment and that's with a family history of severe speech and language problems (at 2 he had no recognisable speech at all- at 2 and a half was assessed by ds1's private SALT and found to have a speech disorder- all the sounds were coming in in the wrong order, and by the time he was seen by the NHS had largely sorted himself out- with a little bit of guidance/practice from us- so maybe there was a point in waiting a year to see him- he's no on 3 monthly reviews, but there's not much wrong with his speech and nothing wrong with his language at all).

[mizmiz]

Some good advice here.
In a nutshell,an older child can usually undertake a standardised test, that is one that allows us to compare him to other children of his age, so that one gets a general idea of where he is in relation to others.
These would be tests like the Reynell Developmental Language Scales Renfrew Action Picture Test LARSP Test for Reception of Grammar, CELF and so on.

One would not generally expect a 2 year old to sit and cooperate(much less understand what was required of him) in such a situation so info must be gathered by other means.
A detailed case history taking note of parent's perceptions is very very useful.
The therapist will indeed watch your child playing, noting aspects such as attention, eye contact, resoponse to instructions/suggestions, willingness to turn take and so on. Also what kind of games they like will be noted.
The WAY they play is massively massively important.

Play is essentially 'work' for children in that it prepares them for using language. It is actually an incredibly complex area where there are many different levels of play. Therapists spend a great deal of time learning about this. There is also another issue namely that of whether they play separately or with someone, whether they are able to play AND listen to and rtespond to someone else (very important step as the child goes from a 2 way interaction, a dyad, involving him and the toy, to a three way interaction, a triad, involving him, the toy and another person.

The most important aspect of play is whether it is symbolic or not (also known as imaginary play)
In other words is the child able to imbue imaginary qualities into a toy/object

Eg pretends a box is a house
combs a doll's hair
feeds a teddy
pretends a stick is a plane

This starts at a basic level (eg feeding teddy) and then becomes highly complex and orderd (eg a 5 year old playing 'shop' with toys, toy shop and maybe other friends.

ABILITY TO USE SYMBOLIC PLAY IS THE SINGLE MOST POSITIVE INDICATOR THAT ALL IS GOING WELL WITH A CHILD'S LANGUAGE DEVELOPMENT ESP. AT THE AGE OF TWO.

This is why a therapist will spend a lot of time encouraging you to play like this with your child if there is evidence of some sort of deay.
As you may know it is often one of the first worrying signs that a child has an ASD (not always, unless anyone reading is panicking!)

There is one very simple lovely little standardised assessment that you CAN administer to a very small child namely the Symbolic Play Test, which is simply a range of toys which are given to the child. As it is a standardised test, we know what children of various ages should be doing with them, so the therapist observes and simply ticks off target behaviours as they occur.

The toys are initially large and simple (eg biggish dolls and brushes, then become more sophisticated, ending with a small detailed scenario involving tractors, a driver, a trailer and a load of wood!

Incidentally some parents don't like this test as one of the scenarios involves a cup and a saucer and a table and a tablecloth. Most people say that as they rarely/never use such things, their child has no idea what to do with them! Don't worry, the therapist will have heard this a million times and it will be taken into account
(no doubt the test will be restandardised in the future because of this!)

Many parents say 'I took my kid to see the salt and all she did was play with him!'
Hope now that you understand why!!

If people asked me what were the most useful things to do with a child with lang. problems (mild) I would say

Turn the tv/video off as much as possible

Sing lots of nursery rhymes to him (brill for language, for many many different reasons)

Read to him a lot and encourage an interest in books
Play in an imaginative way as MUCH as possible

Bin or hide the all-singing all-dancing very sophisticated toys that demand nothing from the child in terms of creativity or imagination

Involve them in a wide range of activities in which you/they will use as wide a variety of language as possible (eg cooking, cleaning the house (!) gardening, painting and so on. Good lang. opportunities are everywhere!!

Hope this has helped.

[Jimjambells]

Really interesting mizmiz. That's how I knew ds2 was fine- and why I never worried about him. He had to play from the moment he got up to the moment he went to bed. Still does. It's absolutely inate in him- he just cannot, not play- even in a room without toys he will play. The strength of his need to play still surprises us- one of the things we sit open mouthed about when watching him.

DS1 on the other hand hasn't got a clue. Stick him in a toy shop and he doesn't even look at anything unless he happens to see a washing machine or something. But stick him in comet..... Head in every washing machine. I used to get really annoyed with SALTS who tried to get his attention using toys when he was obviously stuck on sniffing the sink (and yep I was still told he definitely wasn't autistic )

[mizmiz]

Exactly Jimjambells!
If sniffing sinks is your thing then so be it! Little point trying to get the child interested in marble runs or trains then!
That's why I like PECS very much-very into using the child's likes/obsessions as a way of tuning into them.
You can't fight it!!
Saw one fantastic PECS consultant using a sort of magnet board and magnets (all Thomas the Tank characters and scenery) to get a child to ask for 'the little train' 'more track' '3 clouds' '1 shed' and so on.
Fantastic example of the above!!!

We are intrigued as to why kids with ASD seem so keen on Thomas. Does it make sense of the whole train spotter theory? Someone suggested to me that it is because the human characters are inanimate which I thought was very very interesting!

[Saker]

Mizmiz

I was also interested in what you say about play because my ds2 has quite limited imaginative play. He has no diagnosis but has a global developmental delay with his motor skills more severely affected than his language. He is not thought to be autistic and I think it is his problems with motor planning that make it hard for him to play. For example he told me a story this morning about how he went to the zoo and met a baby penguin who was sad because he couldn't find his daddy and ds2 went and found his daddy in the story and the penguin said "thank you ds". He can tell me that (admittedly his stories are to a bit of a formula but they are not the same everytime) - however he couldn't act that out with his toys. And he has never yet pretended that something is something else (e.g. stick is a sword etc). But I was going to say what Jimjams said, that it's really difficult to play imaginatively with a child that can't or won't do it. You either end up in monologue on a theme that they are just not interested in or just watching them do the same game that they always do. Ds2 does want to play though and he doesn't sniff things or lick or play inappropriately with toys. So I would be really grateful for any suggestions on the best way to play with him.

[maddiemo]

Saker, I know how you feel. My ds4 also 3 is unable to play and we have been told that he does not have asd but has language based problems. He takes toys out of boxes and puts them back in and resists any attempt for me to join him.
The only game we have made any progress on is his Thomas train set. He can now say "hello Thomas" but I have taught him that. My SALT has said to read simple books like lift the flap spot types, which I already do but he can not sit still or will only look at the book on his terms. It is so ahrd to interact with a child who will either not reciprocate or only on their terms.

mizmiz, My autistic ds3 has only shown an interest in Thomas since ds4 has started to like them. However it is ds4, not ds3 who is obsessed by trains. Although ds3 went through a phase of screaming every time we went to the local shops as there is a train station and he wanted to go on the train.
mizmiz
Saker Has anyone said why they think your sons imagination is delayed? When I ask the SALT hedges round the question and tells me that its the level he is at.
MizzMizz

[maddiemo]

Don't know where all the extra mizmiz came from, I must like your name. Sorry message below is garbled, just on way to xmas play.

[mizmiz]

Saker
How old is your child?
Although you suspect motor problems, that story sounds rather good!
Completely agree with your point that it is hard to play with a child who can't/won't and yet it is so easy with a child who does.

For a while I've felt that traditional salt is not effective with a certain percentage of children who will effectively block all/most efforts/approaches from an adult. Sometimes, the more you push, the more they close up because they either can't or don't want to.

What can be really useful (also speaking from personal experince-have a 4 yr old dd with significant language problems) is to vary your approach to stop them becoming 'lazy' Some days I am very 'full on' others I will deliberately pay very little attention to her so that she has to come to me for play or even simple things like having a drink, opening a cupboard, whatever. In other words, make 'em work!

Also good to be absorbed in something quietly on your own (eg jigsaw, game). Again, many children will then itch to join in.

For children with more severe difficulties, it is useful to engineer more extreme/incongruous situations that will often encourage involvement.

Sometimes,I will plan a 'topsy turvy' day with teachers. here are some of the things we've done:

-Adults arrive in pyjamas
-Dye their lunch blue (eg beans!!!)
-Put jelly in their cups instead of liquid
-Ring a bell after which something odd happens such as adults all being absolutely silent for 10 mins, or pretending to be animals for 10 mins.
-Removing the handles from doors and cupboars
-Introducing a clockwork mouse or spider, but not commenting on it.

Most are shocked into play/interaction!!

Hard as it is, you must persevere, even if the child initially shows very little interest, otherwise it becomes a self defeating prophecy. They're not interested, so neither are you, and there is a downward spiral. In my own case, dd was very unintersted in sitting a playing a game with me. I was very keen to develop her attention span and joint interest.After 8 weeks of daily sessions, she now really WANTS to 'work' and will do activities with me for an hour at a time. Initially it was hard, but worth the effort.

Maddiemo, re your salt skirting around the issue of why your child's imagination is delayed. If someone asked me that,I would have to answer that neither I nor anyone else really knows the answer BUT we do know that there is a correlation between imaginative play and language so to develop the latter, we must do all we can to encourage the former.

[Jimjambells]

ALthough ds1 is a nightare to play with he's always liked table top work. So when he was younger he used to like posting things, simple jigsaws etc. Used to do a lot of that (until ds2 turned up he liked books as well- although was never interested in the story- liked to listen to rhymes). His ABA therapist has now taught him some simple play sequences (will build a train track, push a train around, get a play person to walk) and he's started to occasionally play spontaneously for 5 mins or so. The problem we have now is that if I sit down to play with him them ds2 crashes in to join in and ds1 just gets up and walks off. I can only play with him when ds2 is elsewhere.

Same in our house re Thomas. DS1 quite likes him but ds2 (nt) really loves him.

[Saker]

Mizmiz,

sorry forgot to say he is 3y 3m. It's really hard to explain exactly what I mean about the play skills because there is no doubt he wants to interact - he will actually say "Mummy play with me", but he finds it really hard to actually carry out the game. So for example he wants to join in when I play doctors with his older brother but he can't even manage quite basic things like pretending to give him a spoon of medicine, so he climbs on top of the patient instead! I think this may be motor planning, but not sure - like Maddiemo no-one has given me much explanation and I can see there may not be one! He definitely does have some language problems - the story he told was told in short chunks that I had to repeat back to him and also there was some prompting from me as to what happened next. His articulation is poor and I think he is never convinced that you have understood him so he expects everything repeated back before he will carry on. Sometimes his language is very muddled and disorganised, but I don't know if this is due to motor planning or some sort of language disorder. I just get told it is delayed but to me it seems wrong as well.

I love your methods for shocking children into interaction. With ds2 I don't think he needs this - he is keen to interact but on his own terms really - it is hard to get him involved in a game he doesn't feel "safe" that he knows how to do.

Sorry I'm really rambling and not making much sense, this is probably why I don't get much advice about how to play with him because no-one knows what I'm on about

[Saker]

I have read what I wrote and don't think I really got to the point as usual. What I'm trying to say is that my ds2 does have some basic imaginative play (e.g. pretending to take his doll to the zoo, putting his animals in the bath), but it is mostly speech rather than actual play. So he will tell me he is taking his doll to the zoo and sort of push her a little way down the hall, but he won't really act anything out, just talk about it a bit, and then it gets stuck and doesn't go beyond that. Whereas my NT ds1 would have been much more involved in actually playing the game, taking the doll in and out, pointing out imaginary animals and would have been very receptive to suggestions from me as to which way the game could go if he did get stuck. Are there any ways that I can take Ds2 beyond this basic play or is it just a case of time and further development? Thanks for reading all this if you have managed to get to the end

[binkie]

Very intrigued by your "topsy turvy" ideas too, mizmiz. Presumably it's part of the process to see how children cope generally, as well as encouraging communication? Per my usual points of reference, dd (about whom I have no concerns) would think all the oddnesses immediately hilarious and would eg start in teasing the adults about being in their pyjamas; while ds would be "spooked", quite definitely, and need reassurance - which he would accept fairly easily, and would ultimately see the funny side - but his innate reaction wouldn't be humour.

(PS first SALT appointment this Friday pm - therapist very keen to take him on, thought he sounded "most interesting" - which of course he is )

[ChristmasCracker]

Thanks for the advice.

I do think it is mainly because he is so used to everyone talking for him.

Dd got an assesment appointment within 2 mths of refferal so i'm hoping it won't be that long. The h.v also said that if his speech has improved so much byb the time i get it that i can cancel.

[maddiemo]

Thanks Mizmiz. I guess as a parent you want answers when sometimes you have to wait and see.

My SALT keeps reminding me that he has made a lot of progress, in June he had no joint attention, but can now concentrate on an activity that is of interest and allow interaction for a couple of minutes.

My main concern is school. I know where I live he has nowhere near the level of need required for a statement. He is at about an age two level for speech and comprehension. He is 3.2 years. Is it possible for him to catch up?
He is very echolalic and repetitive. I am just told he is delayed and to treat him as if he is a two year old.

Sorry for hijacking thread CC.

[mizmiz]

Yes Maddiemo, children with this sort of delay can and do 'catch up'. It is, as you say very hard to take the 'wait and see' approach.
Good luck with the assessment.

Jimjam, it fascinates me that your ds liked rhymes as opposed to the story when you read to him. What rhymes I wonder? How did you know that this was what he enjoyed?
Proves the point that different aspects of language are processed in different parts of the brain.
BTW, do you know that music and language (eg a song as opposed to speech) are processed differently? I have heard of Units for Autistic children where instructions are sung rather than spoke.
Would love to experiment with this-unfortunately never worked with anty teachers who are radical/brave enough!!

Saker, I think you are worrying unduly about the play aspect. He sounds as if his language is coming on. He obviously understands the concept of imaginary play. Some children are just not that 'into' it. That's ok!! Lack of imaginative play can be a pointer to poor language skills, but if the lang skills are coming on fairly well, there isn't the same sense of urgency.
Know what you mean however about children relying on prompts. A great deal of my time is spent showing parents/school staff how much the child is relying on subtle cues (eg nods,smiles, filling in the 'gaps' and so on.) Once we start to really analyse it they see how much they are doing for the child. it's very hard not to and I do it for my dd!! (Really should know better!)
It's so hard to learn not to do this so I wouldn't try and advise you without seeing your interaction.
You are at least aware of it so that is great (I have worked for years with people who just can't see this AT ALL despite it being pointed out diplomatically hundreds of times!)

Hope this helps a bit.

[mizmiz]

Sorry Binkie! Good luck directed at YOU for the assessment!

[coppertop]

I've noticed that as ds1's language has improved he has been losing some of his musical abilities and wondered if the two could be connected. Ds2 is very good at singing without words. The tune is instantly recognisable. I can't help wondering whether he too will lose this skill.

Ds1's imaginative play has really improved since starting school. He still needs a lot of work with role play but likes to tell me the games he's been playing in the playground with the other children. Apparently this latest one is about dragons and soldiers. As these are two of ds1's big interests I would love to find out if he was the instigator.

[Saker]

Thanks Mizmiz, for your reassurance and advice. My ds1 is very imaginative and articulate and it is so hard not to compare ds2 and think he is way way behind even though I know ds1 was probably well ahead for his age and so the gap isn't so big.

It is interesting what you say about singing and rhymes - ds2 also loves any sort of rhyme and song as well and will laugh and laugh at the silly rhymes ds1 makes up (which are typical sort of 5 year old nonsense). He enjoys stories and story tapes too, in many ways more than he enjoys videos.

Sorry I have hijacked this thread a bit, I hope you got the answers you need ChristmasCracker.

[Jimjambells]

Hi mizmiz- well his favourite book is "hand hand fingers thumb"
hand hand fingers thumb one foot one foot drumming on a drum, one hand two hands drumming on a drum dum ditty dum ditty dum dum dum. etc etc etc.

He knows all the words- although being nonverbal he fills in with the correct intonation and a vague approximation of the words. He's never had any problemw tih intonation etc- ime that seems to be more a problem for HFA/AS kiddies- although weird accents can definitely go with autism.

I've noticed when visiting his new school that his new teacher from January sings a lot of instructions.

Interesting coppertop- when ds1 lost words he started to sing- perfectly in tune (at 15 months). I didn't realise how unusual that was until seeing ds2's dreadful attempts at singing He still has perfect pitch- although I think that language and words would be more useful He used to sing twinkle twinkle whenever he saw a star- I used to say he sang in context

[Jimjambells]

Oh I know he likes the rhymn as he'll sit and listen to books like hand hand, whereas he won't listen to plain stories (just wants to stim by turning the pages and sniffing the book). He'll actually turn the pages in the correct place for a rhyming book he's familiar with.

[Socci]

Message withdrawn

[mizmiz]

Really very interesting what you say Jimjam.
I would love to see your little lad in RL! Hey, great that the teacher sings! Have you asked her about it?

Socci, yes the eye contact is v encouraging (actually incredibly difficult to coordinate this with play (the triad I talked about) and an important developmental stage.
Yes, so difficult to involve a child in the sort of play you describe if it's not their thing.
Do you try and 'teach' him, not in a heavy handed way, just doing stuff like including teddy in breakfast or serving him make belive food just for about 5 mins at a time?
Us therapists spend a LOT of time teaching children how to play!
(You wouldn't believe how many 'tea parties' and 'bath times' I've presided over in my time!)

[mizmiz]

Sorry Socci, her not him.