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Non-verbal communication skills in ASD. A question... please.

(23 Posts)
genieinabottle Thu 16-Dec-10 15:02:53

Hello, i have just received the report from the EP who went to observe DS (5, ASD) in the classroom for about 30 mins last month.

Most of the letter reports his actions as observed by EP. She didn't do any assessment as the purpose of the visit was to check how well he has transitioned into MS reception.

Anyway, i'll get to the point now (sorry for rambling on)
EP wrote a fair bit about his speech and language delay and his unclear speech sounds.
Then she says DS makes very good use of his non-verbal communication skills (he often points, takes ppl by the hand, nods yes or no,... that kind of things).
I must say even at home he will sometimes replace talking with pointing, noise making,...etc, although not as much as before but he still does it.
She mentions she saw him use facial expressions (lots of smiling and eye contact), to aid his communication.

She then says "his non-verbal communication skills are an asset for him, as a significant proportion of children with autistic spectrum difficulties have few effective skills in this area which is central to the DX."

I'm a bit hmm about this last bit.
Firstly DS has been dx with autism and not 'asd difficulties' (he is HF or more 'able' as the SALT said the other day). Secondly as far as i'm aware impairment with non-verbal communication is only a part of the triad.
I'm a bit miffed over this as this same EP was telling me last year that DS would likely not get a dx as he made good eye contact when communicating. (he can do but not always! there are times when his eye contact is fleeting or totally avoidant).

So my question is: are some of your dc with ASD able to make good use of the non-verbal skills they do have?
Or is the statement the EP made (that i wrote above) is true, and very few children with ASD have non-verbal communication skills?

I'm asking as for so long before he was assessed and given the DX, we were dithering and pondering whEther he had asd or a speech and lang. disorder + (strong) asd traits.
And when i read stuff like this being written in a report about my son, it all brings it back again. I start questioning his DX and it's 'torture' again because i cannot let it rest and fully accept it once and for all. sad confused

I forgot to say, when DS was assessed and DX, his non-verbal comm.skills were of course looked at and noted, it was concluded that although he did make good use of what non-verbal skills he has, the range of these is more limited and not as varied as you would expect for a child of his age.

Thanks for reading if you've made it this far.

mariagoretti Thu 16-Dec-10 15:43:59

EP sounds as if she is trying to undermine the diagnosis (but without officially questioning it as she knows fine well that is not her job). This is hazardous to his provision whether she is just so wedded to her original ideas and 'trying to help' or doing her best to get the diagnosis removed.

Alternatively she may just be very poor at writing reports clearly, and querying it may result in a re-wording.

Smiling, pointing and eye contact are nice, but they don't stop someone having autism. And, if his 'true' issues are SLD with very strong asd traits, intensive help provided under the label of HFA won't hurt him!

genieinabottle Thu 16-Dec-10 15:54:02

Thanks Mariagoretti.

I'm just not happy with this statement she has written.
If she knew my son well, i'd be more happy to accept her views but in the whole she has been involved with him, she has seen him twice, only for 2 short observations of 3 mins, and has never assessed him.
She knows bollocks nothing about him, imo.

So what if he can give eye contact when he chooses too, and so what if he smiles a lot and points (we had to teach him to point btw as when he was gone 2 y old he still wasn't pointing).
The bottomline is he still has some delays regardind reading facial expressions, body language, emotions,... especially the more complex or subtle ones, he just doesn't pick up on these.

Do you think an EP could have the power to get a dx removed?
That is worrysome... confused

genieinabottle Thu 16-Dec-10 15:54:41

30 mins not 3 mins. ooops!

mompa Thu 16-Dec-10 16:19:39

My DS 3 years old tomorrowow has ASD and rarely makes eye contact at all and never points. How did you teach him to point? I have tries and would love him to since he has so little language and none of it functional.He does smile and laugh alot

genieinabottle Thu 16-Dec-10 16:31:32

DS was about 2 y old and a bit, i can't remmber exactly his age but he still wasn't pointing. So this was a problem as he was non-verbal at the time and had huge tantrums if he wanted something.

We spend months of modelling it for him. For instance if he took our hand and dragged us to the kitchen and stopped by the sink (because he wanted a drink) we used to pick him up, sit him on the side, show him with our own pointed finger to the bottle of squash and said 'drink' then we'd take hold of his own finger and point it at the bottle and we said 'show mummy/daddy, point!'.
Same thing with his dvds, ...etc then we moved onto giving him 2 choices and again we'd hold his pointed finger and we'd say 'point/show mummy'.

It took a few months, i know when i had DD he was 2.5, he would sometimes point to things but we still often had to remind him to point and show us.
It didn't happen overnight but through sheer repetition it worked for my DS.
HTH.

genieinabottle Thu 16-Dec-10 16:40:05

Also i will add that when he started pointing by himself, his pointing was unclear he'd use his whole hand or 3 fingers curved. He did that for a longgg time, until about age 4, 4.5 or so.
He has just recently turned 5 and it is only the last few months that his pointing is more or less always clear with a straight pointed index finger.

mompa Thu 16-Dec-10 16:58:09

Thanks so much - wonderful that it works - will keep trying then -almost given up hoping he wwould get it. I have tried getting his finger to point and have asked nursery for it to be one of his IEP targets because I feel it will help him. Will persevere

FrostyPhlebas Thu 16-Dec-10 17:04:21

Genie my ds (4.2yo) has ASD diagnosis & has good non verbal communication skills, he also doesn't have any strange or repetitive movements at all which is something else that people tend to talk about with ASD (he has dyspraxia & has low tone so his gait is quite babyish though). People (ed psych/ABA consultant/nursery) often remark that if you made a film of him with no sound he'd appear pretty much NT.

He was pointing, waving, shrugging etc as I would expect at 2 years old (we have films of him), but lost those skills and I had to re-teach them the following summer. I'm sure that's significant - ASD diagnosis doesn't require the absence of triad skills just their impairment. It's a developmental delay - just because they get the skill eventually or get there in a disordered way doesn't mean that there isn't/wasn't an issue.

silverfrog Thu 16-Dec-10 17:06:05

genie,

dd1 is 6.6, dx of ASD - she is pretty severely ASD. Her social skills are excellent. Honestly.

She is fully aware of the whole range of emotions in both her and other people. She is skilled at reading social situations, and can manipulate circumstances to sit her purpose - all done by subtle non-verbal cues, as well as tailorign her speech to suit as well - standard small child wrapping around little finger stuff.

she has a huge language delay/disorder as well, and I am convinced that if she hadn't been dx'd so early (she was dx'd at 2.6) we would have had a huge fight as to whether SLI or ASD.

as maria pointed out, her having these social skills does not stop her being ASD, nor does it make up for her language delay.

jg3kids Fri 17-Dec-10 10:40:18

Hi
Pointing to share (not to request) and eye gaze following etc are very important skills that only humans have. Likewise, being able to read expression. If you bear in mind that 97% of communication is non verbal, then the fact your son can do this is great news.

Jane
X
P.s merry Christmas all

tryingtokeepintune Fri 17-Dec-10 12:12:40

Genie - ds, ASD, started pointing to show share by the time he was 2. He would only look at people he knows in the eye or when he chooses to. When ds went for the multi-disciplinary assessment, the clinical psychologist did not dx him as ASD because he had a very challenging and strong eye contact. However, the pead and SALT backed ASD as a dx and that is what ds has now.

genieinabottle Fri 17-Dec-10 14:08:21

jg3kids, i wasn't saying that the fact that my DS can do non-verbal communication isn't great news.

Pointing to share is still only 50-50 with DS as even if he can point at what interest him, he won't check that we are on the same 'wave length' as him.
I mean we could walk down the road and he can point at 10 cars in a row while saying 'look mummy a red car,...a blue car,...etc' but too often he won't care about my response.

Also eye contact is not the same as eye gaze following.
Emotions and reading subtle facial expressions on others is another area that DS struggles with.

What i'm saying is that DS has mastered some elements of non-verbal communication and it is indeed very good that he can use so well the skills he does have.

Decentdragon Fri 17-Dec-10 22:03:03

I’d definitely object to her comment about central to diagnosis, as fundamentally undermining the diagnosis which is not helpful to the child. If she believes it wrong she needs to take that up correctly, not seek to undermine it.

although he did make good use of what non-verbal skills he has, the range of these is more limited and not as varied as you would expect for a child of his age sounds like a valid observation.

Decentdragon Fri 17-Dec-10 22:08:26

ASD son’s 16. I’ve taught him lots of useful N/T tricks.
He can apply them very well until things go wrong. Can give good eye contact most of the time, and will point, though it’s directionally vague.
When he was your son’s age, eye contact fluctuated a great deal according to how stressed he was. It still does but he’s more self aware of it.

At 13 life fell apart for him and he stopped looking at people at all. We’re back on track now, and he’s accessing all he knows to get through life, but the point is he’s actively working at what the rest of us do without thinking, every minute of the day. Exhausting and gets in the way of processing.

(I’ve found explaining to people that if they try working at breathing for just one hour, let alone one day, they might have more idea of the difference.)

He’s very bright and has learned hundreds of metaphors and idioms in order to survive, and can superficially pass himself of as N/T, but he’s still needing help to wash, dress, do hair etc and organise himself through the day, has non functional writing speed, still using a mathematical formula to measure if you’re smiling, still can’t tell the difference between a smile and a sneer, or have any idea of how another person actually feels, especially when he’s bombarding them with info about what interests him, (I hate maths!) but his eye contacts not bad …..biscuit

Hope the comparison's of some use.

purplepidjbauble Fri 17-Dec-10 22:11:42

IME, eye contact in people with ASD is "inappropriate". That doesn't always mean avoidant. Some people I have met with ASD don't look at you at all ever. Some glance fleetingly. Some will only look at you when you're not looking at them. Some stare unblinkingly, resulting in what could feel like an uncomfortable silence.

It's all down to the individual hmm

mariagoretti Fri 17-Dec-10 22:23:29

Hi OP. No, the EP can't get the diagnosis removed. She can convince the LEA that it's irrelevant to his educational needs though. One way of doing that is by subtly undermining it, and if possible disparaging the team making the diagnosis. Or saying "well, it's just not really apparent in a school context, it's so unusual for these mild cases to be diagnosed young".

So if the NHS think he has ASD, he has ASD (unless there's later emergence of very strong evidence to the contrary of course... but from your post I'd be v surprised). But you're right to be wary of that letter.

zzzzz Sun 19-Dec-10 00:29:40

^"She then says "his non-verbal communication skills are an asset for him, as a significant proportion of children with autistic spectrum difficulties have few effective skills in this area which is central to the DX.".......
I'm asking as for so long before he was assessed and given the DX, we were dithering and pondering whEther he had asd or a speech and lang. disorder + (strong) asd traits.
And when i read stuff like this being written in a report about my son, it all brings it back again. I start questioning his DX and it's 'torture' again because i cannot let it rest and fully accept it once and for all. "^

I don't think she has any agenda at all. She is not a Dr so she cannot change his dx, in much the same way that she could not diagnose in the first place. What she is, is a trained observer and her observation is that your son has better non-verbal skills than most people with his dx. You say you dithered about asd versus speech and language disorder yourselves so you must get where she is coming from? I would say this was an affirmation of what you believe his profile of ability/disability to be, and surely is a good thing? I don't think that highlighting this strength is negative, because with limited time and resources, you want them concentrating on supporting his weaker verbal skills not his stronger non-verbal, surely? This is the whole point of having him observed in his setting, so help can be tailored to him. As for not being able to relax into his dx, I'm not sure why her stating that some things are better than would normally be hoped for is bad, it's either a fact or it isn't.

genieinabottle Sun 19-Dec-10 01:22:16

zzzzz, i think she has an agenda and that is writing rosy reports, minimising his difficulties thus hindering our path should we decide to apply for a statement.

From the word go, this EP was trying to tell us he would likely not get a DX as he was 'too mild', 'too young', 'had too good eye contact',... and of course she said his needs don't warrant a statement.
Then a few months later he was DX.
How can i now trust her judgement and her expertise?

This was only the second time she saw him, and again she writes this rosy report which seems to subtly undermine his DX. When we spoke to her she gave us the impression she didn't believe in his DX.

One of the things that makes me also cross is that she talks as if she knows my son well.
She may well be a trained observer, but all she has ever saw him was for two 30 minutes of observations in a whole year. That isn't near enough to get a clear picture of his issues and difficulties.

He may have some better non-verbal skills than most children with his dx, but he still has some issues with this area, but nothing is mentioned in the report. If she would have taken the time to spend more time with him other than 30 mins, she would have seen that. But then again it seems she sees what suits her.

And as for me not liking it when professionals do not seem to see what issues and difficulties he has because it makes me wonder again. That i'm afraid is down to me probably not having yet fully accepted his DX. Me still hoping that maybe it was all a big mistake somehow, even if i don't agree with the rosy views of the EP. I just wish all the professionals who see him would all sing from the same hymnsheet really, that would probably bring the closure i need regarding the DX.

zzzzz Mon 20-Dec-10 06:31:58

I keep thinking about a letter Temple Grandin published in her book Emergence [if you haven't read it I would recomend it]. Her Mother was 19 when Temple was born and I was enormously impressed by the letter she wrote to the Dr after Temple was diagnosed with Autism, describing how she knew her child first and was in it for the long haul. I also found both Thomas Sowells books brilliant because of all the case studdies, it was incredible reading such vivid discriptions of how it feels to have a child that is so different and how stressful it can be dealing with the diagnosis stage.
In our case [my little boy is 5] I can see that the diagnosis is really so dependant on the discipline of the specialist concerned, Specific Language Impairment, Semantic-Pragmatic Disorder, High Functioning Autism, Non-verbal Asbergic, .....enough to make you spin on the spot. I don't think they can all come to the same conclusion.
I'm sorry if my take on this is maddening, I suppose it is because I would love it if someone would actually say something positive about my little man, instead of hamming up his problems so they can dramatically tell me how difficult it is to have him around. Why would she want to stop you getting a statement if he needs one? If she has only observed him for two 30 min slots and the results are damageing to the statement application can't you either not cite them as evidence, or provide further evidence of the deficits as you see them?
You say from the word go she thought he would not get this dx. To me that only means she feels he communicates better than other people with that dx that she has had contact with. My son's therapists are always telling me that he does not respond in a typical asd way to therapy [I'm thinking of music and slt]. It always makes me smile because they are all so adamant that's where he is when they first meet him.
Perhaps rather than trying to poo-poo his difficulties, she is actually trying to champion his strengths. If you want to use her affectively it would probably be a good idea to talk through her report and raise the concerns you have.

genieinabottle Mon 20-Dec-10 13:51:51

I see your point zzzzz.
And i know how devastating it is to read negative reports or being told your child can't do this or that,... We have had this too and it is crushing.

What i want to see is professionals who get the full picture about my DS. I prefer reports that states accurately both his strenghs and his difficulties too. But she hasn't done that, she has written about 'his Specific Language Impairment' (which he has not got as he has autism, his difficulties are not just specific to language) and then does not mention his other issues.

This can only mean 3 things imo. Either she is incompetent at spotting HFA and isn't specialised enough in ASD, from discussions we have had with her she appears to have a very stereotypical and generalised view on ASD she keeps on saying "all autistic children..." hmm autistic children are not a job lot imo; or she believes he is 'too' HFA to warrant support, which is totally wrong; or she is so set in her ways and still believes she was right, that DS has not ASD but simply a language disorder, so she will continue dismissing his other issues regardless of his DX.
All 3 options are scary thoughts.

You ask in your last post "Why would she want to stop you getting a statement if he needs one?" ... possibly because she might be under pressure from the LEA who wants to cut down on statements due to funding issues.
This is just an hypothesis. I just don't know if that is the case.
Either ways the EP trying to champion his strengths while dismissing his weaknesses (apart from the language delay which as i said, seems to be the only thing she does mentions and for which he already gets SALT in school) isn't going to help him access to further support for his other problems.
And her opinions and views of DS are so different to the recent assessments that were done on the day of his DX 5 months ago.

I have received a letter yesterday and it looks like we are heading for a referal to a CAF now. I'm hoping this will help and that all the professionals will agree on a good plan for DS's needs, including the EP. wink

anonandlikeit Mon 20-Dec-10 16:37:19

He may have good non verbal skills himself, but how is he at interpreting other peoples non verbal communications??
It is possible to have passable non verbal skills but still have ASD

Maybe the EP just needs to understand that EVERY PERSON WITH ASD IS DIFFERENT - nobody is a bloody text book & it makes me cross when profs look so closely at labels and meeting criterea that they skim over the needs of the child.

genieinabottle Mon 20-Dec-10 16:53:37

"He may have good non verbal skills himself, but how is he at interpreting other peoples non verbal communications??"

Yep, he has progressed with some elements of non-verbal communication but reading other's ppl emotions, expressions, body language,... he struggles a lot with.

I mean my dad passed away 2 weeks ago, and DS didn't pick up on anything at all. We didn't tell him as he has never met my dad, (which i haven't seen in years). I was quite down and was not my usual self for a few days, all that went straight completely over his head.

He also doesn't seem to see when someone is getting fed up, annoyed and this has led to other children pushing him and being nasty just so they can get away from him. He can see when someone shouts or cries that something is wrong but he has trouble picking up the more subtles clues.

"Maybe the EP just needs to understand that EVERY PERSON WITH ASD IS DIFFERENT - nobody is a bloody text book & it makes me cross when profs look so closely at labels and meeting criterea that they skim over the needs of the child."
Absolutely!! I agree 100%.

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