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SALT help?

(18 Posts)
feynman Mon 27-Jun-11 11:22:30

Can any salts (or anyone else), please tell me what formal assessments you would do on young children and what age would you look to diagnose. As background my son has problems pronunciating words. He substitues back of the mouth sounds ie g's etc for front of the mouth sounds eg b so book is gook etc. He muddles words up misses some out and has great problems articulating words or sounds in words when in part of a sentance. He can say b on it's own but not in some words although he can in others. e.g he can say baa but ball would be gall and boo is goo.
His ulvula is deviated and he has horners syndrome (one pupil doesn't dialte properly). He also seemed to have a weakness down one side of his body when a baby but you cannot see this now, although he does have poor fine and gross motor skills.

He has had salt involvement since being about 2 but has never had any 'formal' assessments nor a diagnosis. Just 4 and 2 months now. I get given things to work on with him but there is no long term plan and no-one has said 'this is the problem and this is how we think he will progress'. Are we at that stage or is he still too young? Just wondered what anyone else thought.

Thanks

working9while5 Mon 27-Jun-11 19:21:34

There are a variety of assessments that can be done. Usually, an assessment of receptive and expressive language skills would be important. This might be something like Derbyshire Language Scheme assessment (Rapid Screening Test) to work out how many words he can understand and say in sentences. A Renfrew Action Picture Test might be used to look at sentences (and/or what speech sounds like in sentences). More comprehensive assessments that would be used to really "dig deep" might include the Preschool Language Screen (I think it's 2 or 3 now!), the CELF-P (Clinical Evaluation of Fundamentals - Preschool) or the Reynell Language Development Scales.

Speech can be assessed using anything really. Often there is enough data available in free play but really you want to look at all sounds in all positions at a minimum. The South Tyneside Assessment of Phonology or Phonological Screening Assessments are good starts, but for more comprehensive assessments, the DEAP (Diagnostic Evaluation of Articulation and Phonology) or Nuffield programme assessment might be indicated.

Using a back sound instead of a front one is a disordered feature and not typical. When you say "gak" instead of back, it's really the back sound assimilating with the front one and this can happen but it sounds like he is substituting /b/ with /g/ which is less typical. Backing is a tricky thing to sort and would require some therapy IMO.

However, it depends where his language is at? Very few SALTs will give structured speech sound therapy for individual sound subtitutions if a child's language is delayed or disordered as that's usually a bigger priority.

On the other hand, the evidence for disordered language says that it's best to intervene from 3-4 years of age (the evidence for delay says later)

Hope this helps!

Starchart Mon 27-Jun-11 19:25:46

Hi working, do you have any links at all, or key words that I can research that says disordered language should be worked on from 3-4. Our SALT says that disordered language is caused by ASD and cannot be addressed.

working9while5 Mon 27-Jun-11 20:10:04

That was supposed to be disordered speech sorry!

As for your SALT's suggestion.. where's the evidence for that?

Starchart Mon 27-Jun-11 22:37:02

As always - her professional opinion.

feynman Mon 27-Jun-11 23:12:24

Thanks working. They have said he has a slight delay but severe speech disorder. One salt said phonological disorder with dyspraxic tendancies but none have done any sort of formal assessment that I know of. He has just been statemented and I have now got direct salt 4 times per term and daily stuff with this ta written in. I was told he wouldnt be a candidate for a unit as he has other issues. (I.E he was referred to social and communication panel for asd, this panel will meet to decide next month but Im am sure, as are others that he is not asd, although he had many traits when refered but I think these were related to dcd etc).
I have really had to fight for this level of slt but am now wondering whether I should push again for a unit. I have asked if she will refer him to Nuffield but wondered whether she may feel put out by me asking this? I just feel this might be my best chance of pushing for a unit place.

Thanks again

feynman Mon 27-Jun-11 23:15:41

Also would you expect her to have down any assessments with him? I just feel if she did then its easier to know where we're are and where we need to go iyswim. At the minute we get short term targets but these seem all over the place depending on whether the slt or the assisstant slt who comes. Just feel a bit lost really.

Thanks

moondog Tue 28-Jun-11 00:01:43

Good link for you, Star

moondog Tue 28-Jun-11 00:02:45

Evidence based practice briefs. Excellent and very readable

moondog Tue 28-Jun-11 00:03:58

Good old NHS Evidence website

Please excuse me Feynman. smile

working9while5 Tue 28-Jun-11 08:34:31

Yes I would expect assessment!!! They need to do a percentage consonant correct score and a full inventory of all constraints, an independent and relational analysis - basically everything he can and can't do in every word type and every syllable shape. I will get back to you on this later as on phone now!

feynman Tue 28-Jun-11 19:58:21

Thanks working- not really sure what all those things are but how do I get her to do them?

No worries moondog- looks really useful

working9while5 Tue 28-Jun-11 20:37:59

Hi sorry I was in a rush to post this am from the phone so couldn't really explain.

The things that need to be looked at –
• What the child attempted to produce (independent analysis of adult form)
• What the child actually produced (independent analysis of child form)
• What was produced correctly (relational analysis)
• What was produced incorrectly (relational analysis)
• The nature of errors (e.g. if they represent typical or atypical processes in speech development)
• Percentage Consonants Correct
• Connected speech – looking for errors of prosody (tone) or the ways words work together in sentences (coarticulation)
If using a free sample (e.g. just sampling in play), at least 200 words should be included. Otherwise, the DEAP or similar should be used.

Any assessment should include a range of syllable types e.g.
• cv – boo
• cvcv – booboo, baba, mama, nana (same consonant, same vowel) – then same consonant, different vowel e.g. bobby, then different consonant, different vowel e.g. digger
• cvc – cat, man etc
• ccvc – spin and cvcc pits etc
• Then multisyllabics

It may be a good idea to look at ddk rates (diadokinetic - not sure how to spell) which basically looks at rapid sequencing of sounds in words e.g. d/k/d/k

It's also important to do a stimulability test - this looks at the sounds that your child isn't making in their speech. Essentially, different techniques are used to check if your child can make these sounds e.g. on their own /k/, in a vowel frame /aka/ in a cv or vc structure e.g. eek or boo (some sounds are easier to produce with certain vowels etc).

That's not all though! An assessment should also look at how your child perceives sounds - can they tell they are making the errors they are making e.g. if they say dak for cat, can they let you know if you point to a picture of a cat and say dak that this is not the expected form. There are a variety of tasks that tap into this and there are different ways of training kids to accurately perceive sounds in words.

Phonological awareness skills should also be assessed - there are a variety of assessments for this but I can't think off the top of my head what the best for a child of your son's age is.
It may be a good idea to look at ddk rates (diadokinetic - not sure how to spell) which basically looks at rapid sequencing of sounds in words e.g. d/k/d/k

In terms of getting them to do it – just tell them that your understanding of EBP for child speech disorders is that all of the above are required. Ask what they are going to do about it. If there are any issues, I can get you evidence – I'd also recommend you access the phonologicaltherapy list on yahoo. It’s not a site for parents but if you join and search for evidence for apraxia/dyspraxia/child speech disorders/phonological impairment (another name for a type of speech disorder) etc, you will find lots. They don’t tend to like questions from “consumers” but a valuable resource nonetheless - all of the major big bods in speech disorders nationally post –and argue fiercely—on it.

feynman Tue 28-Jun-11 21:45:50

Thats brilliant thanks. I've got lots to get my head around now. Do you think it's possible they've done any of this without me knowing? They do do and see him ocassionally at school but I'm usually there. I no the therapist sometimes makes notes when shes doing things with him but I've never had sight of anyof them and have not had any reports mentioning specific tests etc. She has done a report for a statement but its more xxxxxx will need help with this and this and it will affect his abilty to communicate etc etc but nothing that actually says this is where hes at really. Does this make any sense?

Going to look at the yahoo group now. I've also asked if she'll refer him to nuffield.

Thanks ever so much for all that. Will talk to her re assessments. One more thing if I may. Do you know anything about the social use of language programme? Specifically who would normally run such a programme in school etc.

Many thanks once again

working9while5 Tue 28-Jun-11 22:01:23

SULP is a programme by Wendy Rinaldi - you can see some of it at www.rinaldi.com

It was written for children with learning difficulties originally but is often used by SLT services. It is often delivered by school staff. It's not my favourite programme but many SLTs do put it in place.

A lot of this assessment may have been done but I do think you need to push, at a minimum, to ensure that a percentage consonants correct (PCC) score and stimulability testing have been carried out. This isn't routinely done in every area to my knowledge but it really should be and I would have no qualms about asking for it.

Be explicit that you want more information and a diagnosis and prognosis (although they will not be able to tell you an exact prognosis as every child is different) . How much information you've been given probably depends heavily on the procedures and policies of the local service. Many services do provide only summary reports because to write a comprehensive report on every client detailing all intervention is not always necessary. However, in your case where you have been told that your child has a very severe difficulty, you really do need more facts and a very comprehensive write up.

working9while5 Tue 28-Jun-11 22:01:48

www.wendyrinaldi.com

feynman Wed 17-Aug-11 13:39:36

Sorry to drag and old thread up but just wondered if working was still around (or anyone else who can help?). SLT has been to do the 'formal assessment'. I think she tried to do Derbyshire Language Scheme assessment and Renfrew Action Picture Test, or parts of anyway. My son was'nt terribly compliant. From this she has set some targets for school but I have nothing in writing in terms of what the assessment means etc. My question really is should I have? If you do some sort of assessment like this, is it usual to report to parents? Should I be asking for results etc?
Thanks

dolfrog Wed 17-Aug-11 14:54:15

feynman

If you do get a report, the following table may help with some of the Terminology used.
Screening for Speech and Language Delay in Preschool Children: Systematic Evidence Review for the US Preventive Services Task Force TABLE 1 Definitions of Terms which comes from Screening for Speech and Language Delay in Preschool Children: Systematic Evidence Review for the US Preventive Services Task Force 2006 which is included in my PubMed Speech and Language Pathology research paper collection

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