Speech and Language Assessment

[JJ]

My son, 2.4 yo, has just been given a conditional "all clear" by the ENT. He has a bit of glue ear but the doctor said it shouldn't affect his speech and language development. I'm not sure I believe this guy and certainly didn't like him, so I'll get a second opinion in a month or two from a guy I like in London.

The thing is, my son far behind in those two areas, I think. It's hard to tell with language as he is having a tantrum half the time, no matter what's said. And I'd like to get his speech and language assessed. I've got no idea how to go about it, but would like it done in London as I'm not sure of the quality of the fluent/native English speaking SALTs here. Soo.... any suggestions? It has to be private, obv, and I can get a referral if that's necessary. If you have any more suggestions about assessments, please feel free to give them to me. I'm thinking of a child psych, also... but don't know.

And if you know of a nice, comfy, quiet mental hospital for me when I finally lose my grip, post that also. I'll give the number to my husband so he can ship me off when it happens.

[Jimjams]

sorry to hear about this JJ. contact me off list if you want- you'll see below that ds2 is going through a series of short assessments at the moment (he's just 2). The problems with assessing such young children is that it can all be a bit hard to do. I can give you some pointers that would suggest a need to see a child psych (or how about developmental pead- they can be better sometimes) rather than just SALT.

There is a place called Christopher Place in London - BUT I have heard very mixed reviews about it, and even the person who liked it there - they misdiagnosed her dd!

I can also recommend some private SALTS but they would just tend to give you tips- which you may well know already- rather than go into further detail iyswim.

[jmg]

JJ - I had exactly the same problem as you with my DS now nearly 4. He had glue ear as a baby which cleared up after I took him off dairy foods.

I used this website to find a private speech therapist. Ds has been having speech therapy for over a year now and is progressing very well now. Like your DS though he was a long way behind and still has a way to go until he catches up.

Our hearing consultant also told us incorrectly that the glue ear would have no impact on his speech!

[jmg]

JJ - I should also have said that the SALT we use sees a lot of children with SN. She has told me that if she sees a child whose parents think only has a speech disorder she will subtly prod them in teh direction of getting other things ruled out.

So a speech assessment might be a good starting point even if there may be other issues IYSWIM.

Also worth bearing in mind that speech delayed children can get extremely frustrated at not being able to communicate properly. So the tantrums may just be a by-product of the delayed speech.

[binkie]

JJ, at my (I think) very knowledgeable gp's advice I took my son (older than yours, 5 in April) to this practice when he was just 4, very much for a completely general assessment in all speech/language/communication development areas. My only doubt about it is that it is of course a treatment centre, so it is in their interests to say there is a problem. But that wouldn't be relevant if you already are aware he has difficulties. Also it is expensive. Oh, and I think they did say that if difficulties are subtle (as ds's are) assessments can't really be sensibly made till 4-ish.

My son then did some SALT group sessions over the summer, and absolutely loved them - still asks if he can go back and do some more - we haven't just because it's difficult to combine with school hours and also because his difficulties are perhaps as well helped by being around loads of similarly aged but fluent children. But if you're thinking of treatment at all, I did think the young jolly therapists were a real advantage of that practice.

[JJ]

Thank you. I think I'll just assume that something's wrong and start from there. Would a developmental paed be able to point me in the right direction? I can come over to London for a few days and, ideally, meet with him and also a SALT. And hopefully the ENT guy I know and love. Of course, the trick would be to get three appointments within 3 days of each other. Hmmm...

Jimjams, so sorry to read about your ds2. I hope the nursery works out well for him! What are the pointers to a child psych/dev paed?

jmg, I'm hoping the tantrums are related to the lack of communication. One of the teachers at my other son's school used to teach kids with hearing difficulties and she said it sounded like they were caused by an inability to communicate, also.

He really just doesn't understand things, though. What are PECS cards?

I'm going out of town this evening, so if I stop replying, that's why. Thank you, thank you, thank you for the info. Sorry for being a little babbly and confused... it's not been a good day.

[Davros]

I was just about to suggest Ruth Jacobs! Agree too that you need to be careful you don't get "sold" sessions if you don't want them. We went there for a couple of years quite a while ago and we were lucky to be placed with a fantastic student on placement and it only cost £17.50 ph!!! IMHO CHristopher Place is lovely but no good if there's any hint of autism or other development disorder. I have a list of private Ed Psychs all recommended by parents, I've only met Albert Reid from the list though and thought he was great and he's highly recommended

Albert Reid Tel: 0207 4333069
Alan Willis is in London on 0208 202 9935
Mary Robertson in Kent on 0208 462 4396
Adder 0208 4800391
Rosemary Thornton - 01372 464 371 [email protected]
Richard Alexander - has 2 practices in Northampton and elsewhere in the East Midland but makes home visits. 01604 638784/ 0116 2824441
Gillian Willis - 0208 651 5334 [email protected]
David Urani - 0208 455 3977 : mobile: 07958 733161

[Jimjams]

A developmental paed that I know davros has used it Gilly Baird (is she a pead? I think she is). I aslo met a mother of a child with verbal dyspraxia who had seen her and spoke as highly of her as Davros does.

Pointers that you need to see someone other than just a SALT would be the usual ones I mention. Lack of pointing, difficulty in following a point, lack of bringing things to show you, inability to follow simple instructions - eg "go and get your shoes", lack of ability to copy. For example I was trying to do an exercise with ds1 called "copy me" where you say "copy me" and then do an action. DS1 still can't do it, he just doesn't get it, ds2 storms up and joins in immediately (which is an easy way to test his speech sounds/speaking ability). Also lack of constructive play. DS2 doesn't go a minute of the day when he's not looking for something to play with- ds1 just kind of wanders around. Also things like difficulty with adult directed attention- so on your part that would show as a real difficulty in getting your son interested shrieking "ooh look look" and the child isn't remotely interested (this is ds1! )

[Jimjams]

Agree with davros- christopher place told my friend that her dd "definitely wasn't autistic"-less than a year later dxed with autism (and she's moderately so not all that easy to miss!).

[Jimjams]

PECS are pictures that are used to exchange for things you want. They're good as they ease frustration (child doesn't have to be able to talk or sign) and encourage communication. Have a look \limkwww.pecs.org.uk/welcome.asp\here{}, althoguh pyramid products are ludicrously expensive- you can make your own using A4 files, a laminator and velcro.

We use PECS a lot in this house. DS1 uses them all the time at school and home and funnily enough ds2 has started to use them (without being taught- just from watching ds1)- he's just used one to ask for a carrot- usually he appears with the cake card.

This morning ds1 started shouting something I didn't understand- I told him to use PECS and he came back with "I want car" (a favourite toy) - tantrum stopped in his tracks when that could have gone on for ages.

PECS is quite hard to set up without training, unless you're used to ABA techniques. I'm going to go on the training course next June (or whenever the next SW one is) - mainly to drag dh along and get him more involved with PECS.

You can also use the symbols to structure the day whcih can help. School use this method every day so ds1 knows what he is meant to be doing and can follow the sequence of activities they want him to do.

[Jimjams]

Let me try that link again!

linkwww.pecs.org.uk/welcome.asp\here{}

[Jimjams]

Last time here

[fio2]

sorry to hear this JJ, but his lack of communication may be causing the tantrums. Sorry you are feeling so down about it.

We are having the pecs cards/folder sent home now for dd. It has been established at school now and she is using a few symbols spontaneously. I cant helping feeling worried about, that I am going to do it wrong and she will stop using them at school.

Jimjams is the course independant or run through pecs? I have had phase 1 (ans some 2) training but dh has had none. I feel a bit lost.

[Jimjams]

pyramid do the training course- the link below gives the workshop dates. it's not cheap! Have you seen the PECS video? You may be able to borrow it- I think it really helps know what you're meant to be doing. Once it's established I don't think you can do it wrong really- and it has to be altered to meet your child's needs. For example at school I told them to remove the coat symbol if he kept asking repeatedly for his coat. You're not really meant to remove symbols, but I don't call asking for a coat repeatedly communication. A couple of days of removing the symbol (with a "bye bye coat" when he started aking over and over for it, and the behaviour had stopped totally.

[fio2]

thanks jimjams I will ask the school if they have the video, if so i will borrow it. I had noticed how expensive the pyramid course was thats why I asked if it was a different one you were going to! Mind you I suppose if it is going to be our childrens main communication for the next few years (or more) then it is not that much of a price to pay.

[Jimjams]

yeah- it's why I've avoided it so far (the price) but it's working out to be the way of actually teaching language to ds1 as well. He is learning so much language from using PECS. it makes sense fo us to go now- and aso the higher phases look a bit confusing, but I think ds1 will probably still need them (ie his language isn't just going to kick in).

Did you check the parents price. It's cheaper for parents than professionals.

[RexandBen]

Gillian Baird (yes, she is a developmental paed) and Auriol Drew (speech and language therapist) do private joint sessions at the Ashtead Hospital in Surrey. We went in November and it was fantastic. The session lasts 3 hours and they are very thorough and honest with you. Gilly Baird does not hesitate to give a diagnosis (unlike some paeds who are worried they will upset you!)and she is a world expect in the field of communication disorders.

The reports we received were excellent and very detailed and outlined the best course of action for DS1.

The best of luck to you JJ. I know what you're going through.

PS If you DO here of a good mental hospital can you let me know

[fio2]

I will go and check the price. I know what you mean our dd is just not developing language as quickly as she should. It is in the right order but just very very slow. But bless her she does try The only thing that has been a positive thing just lately is that she has started to mimic and copy more - her brother mainly, the only bad part is she copies his bad behaviour too, cant win!....I dont want to go on about whether I think she will ever communicate or not because I just start getting down about it, I have got to pack and stop worrying for a while.

[fio2]

she does communicate I just meant communicate in the normal sense, you know what I mean dont you?

[JJ]

Thanks guys. RexandBen, thanks! I will call them and set something up with them. Hopefully I'll combine it with a trip to the ENT, as I'm convinced this is a result of him not being able to hear very well.

Or at least that's my current thinking.

Thanks for the info on PECS. Depending on how fast things get done (and I'm guessing it'll be a few months?), maybe I'll see some of you at that workshop.

Ok, I've got to go -- will be back on Monday at the latest. Thanks for all the current and future advice!

[Jimjams]

JJ I think even private appointments with Gilly Baird get booked up way in advance so worth booking asap if you want to see her.

[Davros]

We saw Gilly Baird in 1998!! I also saw her speak at an NAS event just this week. She is fantastic and her report helped us with our own thinking and with our statement too. I didn't suggest her before because I thought it was almost impossible to get to see her now. The NAS has a diagnostic centre, I think its Harper House, you'd get info from their website or help line but I'm not sure your'e thinking on the lines of autism (to any degree) at all????? Have you seen your local Developmental Paediatrician? I think you only mention ENT?
As for PECs, the Pyramid workshop is definitely worth going on, its extremely good (and I agree expensive). There are some great books around about using visual scheduling and activity schedules, I could dig out more info if anyone is interested. Even verbal children have been shown to benefit from some form of visual schedule, prompt etc to reduce stress, help processing and memory.
I would also highly recommend using Makaton as well as PECs. I wouldn't suggest introducing them at the same time, but I think they are extremely complementary. There is a view out there that you can only do one or the other or one is better than the other but we all use more than form of communication according to the situaion don't we? Each has advantages and disadvantages but communication is the target, not whether you support one "method" or another, but consistency is important and therefore it is a good idea to use recognised methods. These are also the methods used by most SLTs so it makes sense to stick to these recognised systems. With Makton you don't have to cart a book around with you and its more spontaneous. However, once a sign is made its gone whereas with PECs it is still there. Both are always accompanied by the spoken word and I really believe that Makaton prompted my son to make his first serious attempts at vocalising but, unfortunately, it plateaud as did his motivation to really discriminate between a great number of signs. Therefore his vocabulary in Makaton is more limited that the vocab potentially available to him in PECs, especially as he learns very easily what each picture represents, I suppose the classic visual learner! Doh! SOrry to ramble as usual....

[Jimjams]

The NAS place is Elliot House in Bromley (used to walk past it a lot- growling as I wanted to go there- but they don't see UK residents now unless referred by a consultant). You may well be able to get a referral there jj as they do see overseas people. You spend a day there and its meant to be very good. They are mainly focused on ASDs though, although I know they also are happy to dx that its NOT an ASD and send people in the right direction.

Gilly Baird is also good at knowing when problems aren't autism iykwim. The person I met who had seen her had a son with verbal dyspraxia, but he had been wrongly diagnosed as autistic. Gilly Baird's report meant that after years of going in the worng direction she actually had the ammunition to get him the help he needed (ie lots and lots of specialised SALT).

Think you are definitely right about the waiting lists Davros. We wanted to take ds1 to her about 2 and a half years ago, Her NHS waiting list was 2 years, her private one was 6 months, and we needed to be seen faster than that. Also we couldn't afford her!

[Jimjams]

should add- she's expensive as she spends lots of time with you, together with a SALT, so you're paying for 2 professionals for a number of hours.

[Davros]

You're right, its Elliot House. I just looked at the website and it says how they take referrals. So what is Harper House? I'm fairly sure that's an ASD diangosis centre or did I make it up? Didn't someone on here recently go for a full day assessment somewhere that sounded great, not BIBIC, somewhere else though not sure for what disorder/disability.... sorry so vague.

[dinosaur]

I think that might have been Coppertop (?)