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Phonological Disorder

(21 Posts)
themoos Wed 01-Dec-10 13:28:27

My 3 1/2 year old ds2 has been under a SALT for the past year, and up until now, both NHS and private SALT said it was probably just be a delay - although my gut instinct knew it wasn't.

He has very poor articulation, to the point that it's hard to understand any of what he says out of context. He usually uses a consonant at the beginning of words (not always the right one) and then mostly vowel sounds (again, not always the right ones). His expressive language skills aren't quite where you'd expect a 3 year old, but I think this is only because he is so unintelligible that it isn't worth him trying anything too complicated. He has occasionally improved his pronunciation of a word, only to "lose" it. It's always three steps forward and two steps back. He talks a lot, but I still can't have anything resembling a proper conversation with him.

Therapy so far hasn't helped massively. He did a weekly session with a private therapist for a couple of months when he was just over 2 1/2. His language skills did noticeably improve at this time, but I'm not sure if it was due to the therapy or something that would have happened anyway. We decided to hold back on further therapy as it was clear what he needed was speech work, but he didn't yet have the maturity or concentration for it.

Just after this, we finally got our nhs therapy course through which was "Parent Child Interaction". This was very much based on language, and again didn't make much difference as language isn't where his true problem lies. It did help reassure me to have a second opinion, though, as the nhs therapist said much the same as the private one, ie he was too young for specific speech work.

The nhs SALT did another assessment in October where ds2 barely said anything. SALT had to largely go on my description of his speech, but did agree to reassess a month later and said he'd be down for a "group therapy" course in January. We had this follow up assessment last week, and the SALT has finally said that it's a phonological disorder and not a delay. She does want him to be assessed further by a more specialist SALT and has now said that group therapy is unsuitable and he needs 1-2-1 instead. She warned me that he would need speech therapy for many years.

Ds2 is due to start school next September, and it's clear that he's going to need a lot of support. I'm wondering if anyone has any experience or advice about what level he might need and how I go about ensuring he gets it? His receptive language is normal and he doesn't have any behavioural issues (at present!), so I ideally want to keep him at the same ms school as ds1 and where he is already at nursery. However, I do know that there are speech/language units in our borough - would these be suitable for a child with problems like ds2?


maxybrown Wed 01-Dec-10 18:01:34

Hi, my DS is under SALT - has been for a year now and he is 3.3 almost.

He cannot join two words together but never ever shuts up! It is very very difiicult to type what he sounds like.

My DS is having very specific speech work though - maybe it depends on the child and adults opinion? I don't know? I have to say my SALTS have been fantastic and right from the start they mentioned the speech unit as a possibility - now they say he is high priority.

He is also under a paed, which we see again in January. He has been tested for landau kleffner syndrome (which came back clear, but he had words when he was much younger and lost them) had hearing tests, dental checks and even visited cleft lip and palette place No one really knows at all and he has stumped everyone - though his one on one salt now, is def "treating" him as if he has some sort of verbal dyspraxia, though the paed is not convinced. he said it is something very very specific and def not just normal speech from your description, I am surprised no one has mentioned a unit to you? Though areas sure do vary!

Sorry I probably haven't been very hepful blush

Boboma Wed 01-Dec-10 20:56:33

Hi, We don't have any speech units in our LEA so we are forced to go mainstream. My DD is the same age and has a expressive language delay (+ cleft palate) that sounds more severe than your son's, but it is a similar type (phonologial disorder/verbal dyspraxia - not clear yet). We are applying for LEA funding which should come through quickly, and have also submitted an application for a statement. We currently have 1:1 weekly with NHS SALT and nursery trained in signing. I am hoping for lots of school support, but don't know how the statement application will go yet. AFASIC are very helpful - they have a booklet "Accessing SALT for your child: A guide to the Law" which you can order on the web. The lady I spoke to on the phoneline is great too. Hope that's of some help!

bubble2bubble Thu 02-Dec-10 09:40:24

Yous DS is exactly the kind of child Speech & Language units are intended to help. DD1 has severe verbal dyspraxia and a phonological disorder( and yes, I was also told for a while that she had a speech delay ) and is in her second year in a S & L unit.

We agonised over sending her away - age 4 - to a school 40 minutes from home when there is a great primary school within walking distance but she could never have made the progress she has had we not made that decision.
Whatever support your DC may ( or may not ) get in mainstream school the key with this kind of language disorder is intense, regular therapy and only this can make the difference.
The other factor to consider is that invariably children with language disorders will struggle with literacy at least for while. A Language unit teacher is prepared for this but chances are your Dcs mainstream teacher may be completely at a loss how to deal with it. This issue was mentioned to me a couple of years ago but I at the time I didn't realise just how important it was.

If you haven't seen it already there is a lot of information here - look under publications & there are downloadble information sheets

September is not very far away in terms of getting help in place - unfortunately you need to start pushing now, starting with the specialist SLT smile

themoos Thu 02-Dec-10 10:27:09

Thanks for all the advice.

Kind of not what I wanted to hear as I really so want to be able to send ds2 to the local mainstream school (it's literally over the road and fantastic) - but I had a suspicion that a speech unit might be what I should be pushing for.

Bubble2bubble - how long do you think your dd will need to stay in the speech unit? Will she need it all the way through primary, or just for infants? Do you get help with transport? The speech units aren't that far away in terms of distance, but would be a drive away - and I will still have ds1 to get to the local school so not sure how this all works?

I've now looked up the specialist SALT that is going to assess ds2 (in Jan) and I see that her specialism is in "children with severe speech disorders including verbal dyspraxia" - so that pretty much confirms to me that his regular SALT is thinking along the "severe" end of the disorder scale.

maxybrown Thu 02-Dec-10 10:49:26

themoos when it was first mentioned to me, I was distraught. I am normally a teaching assistant in primary and my Husband is a teacher - so I felt we had failed him somehow.

Now obviously I do not, and after seeing him struggling so much am so relived he may get a place at our unit. He was referred in September for his place, and they will assess him for it afer Easter. He will start part time in Sept to ease him in the go full time - he will go for potentially his nursery year and reception year, but at anytime could be integrated back into mainstream.

Having had many SALT children through primary's I have worked in, it is so hard to work with them properly, as we are not trained for that and so the specialist helo will be fantastic. Sometimes, when he is around other children, they stare at him with constant fascination, becasue he sounds so odd hmm but when we went to visit the soeech centre, no one batted an eyelid at him, it was lovely. If we are in a queue ina shop, people stare at us, sometimes they ask how old he is because I know they think he sounds strange, and it's heartbreaking sometimes - so am keeping everything crossed that my DS gets his place!

Ours is in town, about 3 miles away and I don't drive so I will have to take him on the bus everyday. He could have a chaperone and taxi if needed though- so you would need to ask?

bubble2bubble Thu 02-Dec-10 17:44:50

Themoos I know it is upsetting - you never imagined you would find yourself in the realms of special education. We were in exactly the same position- Dd1 has been accepted into the much sought after local school and people who knew nothing about her condition were happy to advise us that this would be great for her. Thank fully we had a visit organised at the speech unit by our Ed Pysch and the SLT there introduced me to two other parents who had had an equally hard decision ( long distance to travel, other siblings already in local schools etc). This was what convinced me we had to do everything we could to get her a place.

In answer to your question - she will leave at the end of this year as they only give a maximum of two years placement. In this area children with dyspraxia are 'cured ' when they are seven grin .
I would be more than happy for her to stay where she is for another five years...
She does have transport provided. In the beginning I couldn't bear the thought of it & drove, but it meant Dd2 spending so much time in the car every day that it was very unfair to her, and also once dd1 realised that everyone else went in a taxi, she wanted to be like them! So again, it's not what you want or envisaged for your child, but it is a solution smile

themoos Thu 02-Dec-10 20:56:22

maxybrown - I really hope your ds gets his place, it sounds like both you and the professionals have a pretty clear idea that it's the right thing for him.

bubble2bubble - although your dd hasn't the option of staying at the speech unit, and it's obviously what you'd prefer, has the communication gap between her and mainstream children reduced? I just so hope ds can be "cured"(!) - at least sufficiently that he can keep up with other children!

It would have been very hard to imagine when my bright and cheeky ds was a baby or young toddler that he would have SENs. That was always other people's childrenblush. Having said that, I'm acutely aware that however serious a condition a speech disorder is, it really doesn't compare to some of the problems that other children have to overcome such as asd and genetic syndromes. So I know I can't complain too much - at least there's a good chance ds will end up properly in mainstream at some point.

bubble2bubble Thu 02-Dec-10 21:23:15

Well exactly, it's not life threatening but it's very hard to watch a child who cannot commiunicate even though she clearly wants to. It's not all gloom & doom - these children can be helped but it's just a very long process. And yes, the gap has narrowed with dd's peers - I remember sitting in on an assessment when she was 3.5 when she scored zero on expressive language ( I wept blush), BUT when she was assessed in October she actually came in at the lower end of the 'normal for her chronological age' scale!!
She is still missing some speech sounds & her use of language is quite poor - understandable given that she missed out on a good 2 years of talking & using language. But yes, she can make herself understood even to strangers, which, given that this time last year she couldn't even say her name, is amazing. Do have hope.

themoos Thu 02-Dec-10 23:04:10

Ooh - I'd so love for ds to be able to say his name - but perhaps giving him a 5 syllable one was a bit cruel in hindsight! (He does have a one syllable diminutive that he can't say either, mind...)

It's great to hear that your dd is catching up to some extent, even if as I'm guessing her speech/language probably isn't in keeping with the rest of her abilities. And I can totally relate to your experience of sitting through the earlier assessment; even when you already know what they can/can't say, you don't see it in quite such black and white terms when it has become part of your every day.

madwomanintheattic Fri 03-Dec-10 03:18:06

dd2 has attended group therapy for children with phonological difficulties from mainstream - they use the nuffield dyspraxia programme. lots of homework. grin

every time she does a group, the clarity of her speech improves hugely - and it slips a little when she doesn't/ and we don't keep up with the worksheets etc.

dd2 has always been in mainstream - she didn't talk until v late ( we started with makaton as it felt she was unlikely to be verbal at all) and she has always had marked dysarthria.

she's 7 now. she has days when her articulation is rubbish, and it slips if she is excited or upset, but she's pretty darn good. she's still a bit monotone but can vary it a little.

i love the nuffield programme - it works wonders for dd2.

madwomanintheattic Fri 03-Dec-10 03:19:22

i should add - the nurserys she attended were brilliant - they sent keyworkers on slt training etc etc. one learned makaton and taught it to other staff and the children were all taught to sign and sing etc. smile

bubble2bubble Fri 03-Dec-10 09:15:01

Oh yes Themoos, why did we give dd a difficult 4 syllable name which she always insisted we didn't shorten?
We then have dd2 a very, short easy to say name which happened to start with one of the sounds she had most difficulty with....
the benefit of hindsight is a wonderful thing grin

maxybrown Fri 03-Dec-10 15:54:04

Oh the name thing seems really major doesn't it? DS is called James, nice and easy you might think, but he cannot do J for love nor money or a when it makes the a sound as in James - seems to depend on which consonant is before it. Anyway he has taken to calling himself Babba blush Everytime we go out now though we get "ooh what's your name" I know most people don't know, but he is so with it and looks so grown up sometimes they just think he is being rude, it's a fine line between stepping in too soon and offering them a chance to try. The father Christmas at the church fete was a bit stumped when i eventually had to tell him that he couldn't talk - I am not entirely sure he believed me hmm

themoos Fri 03-Dec-10 19:00:50

If I ask ds his name I get "Ma-ee-oo-ah". This isn't quite the name I'd chosen for him... He won't generally say anything at all to people he doesn't know very well, so I do end up speaking for him. I find myself constantly apologising to people "Oh, he doesn't talk much" when they ask him a question. I'm sure I shouldn't do this, but it's hard to deal with the awkward silence otherwise!

I'm not really noticing any particular sounds that he can't do - it's more that he can't do them in different words/sentences/word positions. He can do some quite advanced sounds, for example he does "th" properly in the word "there". This fascinates me as even I didn't do "th" until I was about 8 grin

maxybrown Fri 03-Dec-10 19:46:34

wow that is good themoos. Mostly James sounds like this "gnn gnn gnn gnn gnn gnng gnng gnn" you get the idea! But with some very good intonation, just recently he keeps puttng his hand near his mouth as if saying thank you in speech language and saying NO - meaning he has no words there or they won't come sad

maxybrown Fri 03-Dec-10 19:47:05

I meant sign language sorry, eek! blush

bubble2bubble Fri 03-Dec-10 19:55:10

I used to stress terribly about DD not being able to speak to strangers until I realised that a lot of 3 year olds won't answer questions from random people, whether they are capable of speaking or not.

Themoose - when you see the specialist SLT she should be able to identify which sounds, if any, your DS is missing. If he has a good range of sounds then that's a great start - just needs some help in putting them together - a much better option than having to learn each sound from the start

Maxy your DS sounds very like DD. She definately had a few words before she was 2, but by 2.5 was completely silent. Then after a few months of therapy she started constantly babbling but it was incomprehensible and took a long time to get to the 2 word stage. I saw the other kids in her group therapy go through the same phases at different times. Then very very gradually a few words at a time started to get clearer. Having words & then losing them again is pretty typically dyspraxic ( and soul destroying sad)

SummerRain Fri 03-Dec-10 19:58:45

Gosh, how annoying having to wait so long.

My ds2 is only 21 months and has already been assessed by paeds and SALT as having oral dyspraxia of some form. That being said ds2 has a tongue tie, upper lip tie and overbite which combined with some sort of oral processing issue have caused massive feeding issues and a complete lack of speech and very few sounds... none of which are ever used together.

He's been calling me 'Mama' only since last week... before that it was 'mamamamam' and only once or twice a month. He's learned and promptly forgotton 'Dada' a few times and the same with 'Baba' and has no other consonants.

His language skills are excellant for his age though, he understands almost everything we say and follows two and three part instructions easily.

Good luck with the SALT, ds2 has had one block of sessions already and there was a definite improvemnet in how much babbling he does and how well he copies our behaviour (hopefully this wil at some point translate to him copying sounds)

maxybrown Fri 03-Dec-10 20:33:03

That is good summerRain - my DS has been under SALT a year and they still don't know - even the paed is puzzled by him! But most areas won't refer til 2 and some much later. I guess maybe with your DS's other needs he has gotten into the system quicker. But that's really good as when my DS was referred at 2 I don't think he could say anything at all. He certainly wasn't saying anything that resembled Daddy, maybe he was saying mamamamamam, not sure now blush

He too understands everything etc very very well, and learning new things - how things work etc, you show him once and that's it, he's got it. That's why it intrigues me to see him having to be shown over and over and over and over how to say a single sound.

My DS did have an expressive language group therapy but that really was a waste of time.

I am now looking into cued articulation as his SALT showed him a little and it has really helped, but one sound at at time, then blending, so obviously slow but progress all the same.

This last week we have all been ill, me the most. I have had no patience to try and work things out blush and he has less patience to try and explain and so we have not understood him most of the week - just shows what does go into to translating and working speech out.

madwomanintheattic Fri 03-Dec-10 21:50:39

we used to have to tell people to use 'owl' if waiting for a response - observe, wait, listen etc. and i always used to say to people, wait until you think you are going to get no response at all, and then count to another ten before you ask again/ give up.

i wasn't keen on makaton to begin with, but it was definitely the one thing that opened up communication for dd2. (not keen because i thought it would delay her speech further, that is. but it actually helped)

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