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Calling all SALTS - help please!

(128 Posts)
TheTimeTravellersWife Fri 08-Jul-11 14:49:28

I have just had what I can only describe as a bizarre conversation with DD's SALT. She called me out of the blue, to update me on DD. Great, I was really pleased that she had taken the time to call me to talk about DD.

BUT, she then proceeded to say that as DD's progress had slowed, she would be recommend at our AR that her SALT provision is reduced from weekly to termly! The reason she gave for this reduction was that DDs social communication difficulties were due to her autism, that she would have life-long difficulties with social communication and that further weekly SALT sessions would not help.

DD has also been diagnosed with a speech and language disorder, that is separate from the difficulties caused by the ASD, but apparently, that has now been overcome and all the difficulties now are with social communication which is ASD related and cannot be overcome by weekly SALT sessions. She said that her speech was now "age appropriate" but she had on going difficulties with social communication.

I maybe a bit thick, but unless you are talking to yourself, isn't all communication social?! Therefore, she has communication difficulties, therefore she should continuing having regular SALT sessions.

Can any SALTs out there point me in the direction of some research on SALT and ASD to that I can use to counter the argument that as her progressed has slowed, she should have less SALT input.

Surely, she should at least retain the same level of input if her progress has slowed.
I just don't accept that because she has ASD, she cannot make further progress with her communication skills.

She caught me "on the hop" cooking lunch for DS, so I didn't think to ask her for copies of her latest assessment tests.
But I did try to explain that 1:1 with someone she knows well she will perform much better than with a stranger or in a group situation.

Just looking for evidence to counter her recommendation that DD's SALT is significantly reduced.

drivemecrazy63 Fri 08-Jul-11 16:35:07

someone will be along shortly but i felt i needed to add that my dc is asd at ss and obviously has social and communication problems hence salr is contant weaved in throughout everything they do and he also has 3 weekly sessions on top of that 1-1 with the salt and a couple sessions in a mixed group with the salt, my point is surely if your dd has s&c problems due to her ASD shouldnt she have MORE not less salt or maybe im the crackers one. hope you get it sorted and someone on here can advise seems like madness to me

working9while5 Fri 08-Jul-11 19:22:55

I think two things...
1) her profile has "flattened" e.g. there aren't specific areas of strength and weakness. This can be a sign that progress is plateauing and there is controversy about what this means

2) I wonder if maybe their clinical care pathway (e.g. what their service "does" for children with autism) has changed.

It is a hard time at the moment in terms of the NHS and efficiency savings.. so a lot of things are going.. we have been told that we can't suggest any new innovations or service developments without saying what we would cut in its place. It is likely we are about to be stopped writing complex reports and standardly reporting on assessments, using tick box reports instead.

Before you go to the trouble of rooting out references yourself, ask HER for what evidence underpins HER decision. You don't have to be confrontational at this stage.. say that you want to talk it through and you'd like an appointment as you couldn't really listen at home with everything going on so it was too hard to process. Ask if she can explain it and give you some information to read on the decision and say that for your own interest, you really want to know what her progress will be like so can she share the research that shows that she won't really benefit from SLT now etc etc

There are a number of places in the country with specialist provisions for ASD with speech and language support - submit a FOI to the Department of Education asking for all specialist provisions for children with ASD at primary and secondary and then FOI all of their LEAs for info re: what speech and language therapy is provided. It's a very easy thing to do and may prove useful.

That, in itself, is proof that blanket recommendations shouldn't be made. I can get you references if you need them but it is thin on the ground in the UK... very thin. But that goes for everything...

sickofsocalledexperts Fri 08-Jul-11 20:13:02

If you want to look into ABA, I found it far better than traditional SALT at getting my autistic boy talking. V interesting that SALTS are now throwing in the towel on autism speech defictis - ie finally admitting they've got not much to offer on the key task of MOTIVATING the autistic child to speak. That's where ABA has the answers, imho. You could advertise on VB community or Gumtree for ABA therapists (or the new ABA Tutorfinder) , but you would probably have to pay yourself, at least at first.

TheTimeTravellersWife Fri 08-Jul-11 20:28:15

Thank you for replying. "Plateauing" was the exact word that she used. I think that a meeting is a very good idea and I will definately ask her for HER evidence to support her recommendations.
I will try to get DH to come along to the meeting with me as I have learnt that it is best to have someone with you. Also thanks for the advice re: FOI.
The school are using TEACCH and I am not familiar with the principles of ABA but will definitely look into it.
But I think that the reason behind all this has nothing to do with progress or lack of progress; it all comes down to budget cuts and pressure to reduce provision.
I have noticed improvements in DDs ability to communicate, but it is far from what I would consider to be "age appropriate" and she still has significant difficulties in expressing herself and responding appropriately.

cansu Fri 08-Jul-11 20:43:55

I was wondering if your dd has a statement? The only way I managed to maintain a reasonable level of SALT for my dc is by ensuring the provision is written into part 3 of their statements. This meant that when the NHS withdrew their services, the lEA were obliged to fund the SALT for them.

sickofsocalledexperts Fri 08-Jul-11 20:46:02

What drives me mad about the autistic system in this country is that it persists in using the useless, unresearched system called TEACCH, whereas all the research points to ABA as the far more effective methodology. If you go on the NAS-linked website, ResearchAutism.net, behavioural interventions like ABA get 3 ticks (highest score) yet TEACCH gets a paltry 1 tick. I asked the Chairman of ResearchAutism directly, at the recent Autism Fair in London, how the state can justify using the worst methodology in all our autistic schools and units, and he looked baffled too. Can you IMAGINE the outcry if it were discovered that "normal" kids were being given, say, a substandard way of teaching maths or English. The papers would be all over it! There would be questions in parliament, campaigns, change. Yet every day mums of autistic kids are being told, effectively , "sorry, your kid will never talk much because they're autistic. Stop trying, grab a few makaton books, and at least he's happy, bless him". It's not enough, it is shoddy and patronising.

Sadly, if you raise ABA with your school I will tell you what they will say, so at least you could amuse yourself and DH playing anti-ABA buzzwords bingo!

They will say

- ABA is very rigid and tough on the child
- It does not promote real speech, but trains the child as if they are a dog
- It will ruin your family life because it is so intensive
- It will probably lead to divorce (ok, they won't actually say that , but there will be dark hints made about "pressure on the whole family"!)
- ABA is nasty and horrible and will try and change every little quirk of your autistic child, in the end denying his true identity.
- Let the poor child be happy, let him be his own sweet little autistic self, trying to change him is cruel and won't work anyway.

All of the above, which I was told, is bunkum of the highest order.

ABA is the only methodology that understands you need to teach the ASD child not just how to talk, but also how to WANT TO talk.

In the US, Canada and Scandinavia, ABA is the norm. It's only over here in the UK that we are still in the dark ages.

Sorry, rant over, but it really could help your child, as it helped mine. With both the mechanics of speech and the social desire to communicate. And I think it is quite horrifying that a so-called speech expert is saying "sorry, your child is unteachable , so I won't bother".

Lougle Fri 08-Jul-11 21:05:53

Sickof, your sentence here:

"ABA is the only methodology that understands you need to teach the ASD child not just how to talk, but also how to WANT TO talk."

I struggle with that. It seems to me, that ABA doesn't teach the ASD how to want to talk, but rather teaches them that they get further by talking than not talking. It's a transactional method of teaching.

OP, I don't think the SALT's thinking is that your child can't be taught the mechanics of communication, it's that your child can't be taught the function and benefit of communication.

I don't agree with it, incidently. But it is always good to know what you are fighting. You can walk in with 1000 research papers showing that children with ASD have the ability to learn how to speak. However, if the central argument is that teaching these children how to speak is a wasted use of resources, because they still won't use them functionally in life, due to a lack of understanding of the function of social communication, the research papers won't do anything. Far better to focus on the knowledge base that the SALT service thinks it has, that there is no benefit for teaching these children 'why to talk' as well as 'how to talk'.

DD1 is in special school, and they use a whole-day curriculum for SALT. She also has small group sessions with a SALT, but no direct 1:1 therapy. I don't blame them, tbh. The 1:1 sessions she had were the most stressful waste of time. She has her own agenda. She doesn't attend to adult-directed tasks willingly, although school have improved that massively (using TEACCH approach, incidently). It is by far better to incorporate subtle therapy throughout her day.

TheTimeTravellersWife Fri 08-Jul-11 21:06:45

Yes, DD has a Statement, with SALT provision in Part 3. It was hard won by going to Tribunal.

Earlier on,I used to trust NHS professionals, but not any more. I have encountered too much underhand behaviour and collusion with the LA. The NHS SALT has been trying to reduce her provision since she started working with DD, but I politely told her that it HAD to be provided, as it was in her Statement. The Annual Review of the Statement is only a couple of months away, and I think that this is the start of trying to reduce DDs provision, as she wanted me to agree over the phone to termly visits!

I just will not accept the low expectations the professionals have of what my DD is capable of achieving. If she has hit a plateau then they need a different approach, rather than throwing in the towel.

working9while5 Fri 08-Jul-11 21:31:03

Sickofsocalledexperts, I'm really sorry you had a bad experience with SALTs but it's not really true that the entire profession is throwing in the towel on children with autism and in the States, a great many SALTs work closely with ABA professionals and publish in ABA and have VB training.

In this country, there is extremely scant speech and language provision relative to what international clinical research (as opposed to research done on this model in this country) suggests should be given. It is not just kids with autism who are denied the best approaches to their education - in general, kids with SN get a very raw deal from "inclusion".

The fault is not with SALT in and of itself as a profession as there are a great many SALTs internationally who contribute usefully to educational and therapeutic programmes for children with autism and others. There is a massive problem with understanding and application of EBP in SEN provision in this country though..

dolfrog Sat 09-Jul-11 01:16:06

TheTimeTravellersWife

I am in the middle of re-cataloging my research paper collection, and found an research paper which is now freely available as a Google do which may help explain a few things.
Autism and Asperger Syndrome: A Spectrum of Disability which together with Management of Children With Autism Spectrum Disorders may explain a few issues.

dolfrog Sat 09-Jul-11 05:27:36

I just rediscovered these useful research papers as well
Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review and Screening for Speech and Language Delay in Preschool Children: Systematic Evidence Review for the US Preventive Services Task Force there are some useful tables and diagrams in both.

Starchart Sat 09-Jul-11 08:45:03

We have this exact same issue. The SALT says that ds' problems are all communication and that is his autism and as such is not relevant to the SALT and her therapy. She says she just doesn't KNOW what to do about his communication problems

SO, you really do have to evaluate the benefit of that therapy. I don't agree with ds' SALT, but since he hasn't made any progress in communication skills in a year with her weekly sessions, I do have to wonder what the point would be of fighting her for more of the same just because I disagree with her. I think I have to accept that SHE cannot address his communication problems. I will NEVER accept however, that his communication problems can't be addressed. But the two are seperate things and I need to think about where my fight is and where my resources should be best directed.

moondog Sat 09-Jul-11 10:18:37

'I think I have to accept that SHE cannot address his communication problems. I will NEVER accept however, that his communication problems can't be addressed. But the two are seperate things...'

This is exactly it.SALTs are not miracle workers. Some children will continue to have significant communication eithere irrespective of how much SALT therapy they have.

A lot of people misunderstand what it can and can't do.In the context of an NHS session once in a blue moon, not much frankly.

In the context perhaps of a whole school committing to changing their everryday practice and receiving a regulalar amount of high quality evidence based data driven intervention, quite a lot actually.

Unfortunately, 90% of offered therapy fits the above category, not the lower one.

Pointless in my opinion (as aSALT) to fight for somethnig just so that you can mentally check it off a list. Ask what benefits you are your child are getting from it. If nothing, then let it go.

The same applies to any of the other interventions you have been offered.I know kids who can't move for the amount of 'professional input' they receive from lots of differerent people. In practice it often does little more than confure schoo lstaff, generate lotsd of paperwork and meetings and create a large network of people who invariably don't get told important things.

TheTimeTravellersWife Sat 09-Jul-11 11:57:28

Thanks for the links dolfrog, I will take a look and have a read.
Star, I do agree that it is probably fruitless to argue for SALT provision, if what is provided is not helping. I have seen an improvement in DDs communication and I believe that she is capable of further improvement, but the attitude of the SALT is that all the "easy" targets have been met and that any further improvements will be much slower.

She told me that she is finding it increasingly difficult to set targets that DD can achieve. I personally believe that a different SALT, with a different approach would be better for DD, but I am made to feel grateful for receiving SALT at all.

That's part of the problem of the system. You may win SALT provision at Tribunal, as we did, but then have no control over who or how it is delivered.

In terms of the benefit to DD, maybe you are right, and it isn't worth fighting to retain it. In an ideal world, I would like to be able to ask for another SALT, but that's not very likely to happen.

working9while5 Sat 09-Jul-11 12:00:31

"In the context perhaps of a whole school committing to changing their everryday practice and receiving a regulalar amount of high quality evidence based data driven intervention, quite a lot actually."

And this is a key point.

The school has to commit to change for anything to happen.

There are endless stories on this board of settings where people are unwilling to make even very simple changes to normal practice because of professional pride. Unfortunately a lot of them relate to SALTs, but a lot also relate to schools. "I know best" etc even though I have no evidence to underpin my knowledge.

I work in two settings on a regular, week-in and week-out basis. In one I have been able to make huge changes this TERM to how therapy is delivered. In the other, progress has been slow as there is no clear chain of accountability for who will support basic changes e.g. ensuring that a child accesses 5 minute daily practice sessions with the same person and so the basics required for an intervention that (quite frankly) a monkey could carry out are not in place. Same interventions, same school set up in terms of staffing/timetabling/resources etc/same me.. but very different results. And that's across two schools where I have solid relationships with both kids and staff when most NHS therapists have to try to get people across 20+ schools to do an intervention having had a phonecall and maybe a 45 minute meeting with a child and a 45 minute meeting about the child, when they're not really sure what to offer for some of the more complex cases anyway because they're generalist rather than specialist therapists.

I am campaigning within my service to get our schools therapists who are not specialist to STOP WRITING TARGETS just because they feel they have to. My bottom line is if you're not sure of what the value of the target it and you can't and aren't going to measure the effectiveness, it is a waste of public money to write a target relating to it. It just winds everyone up, including the peope who write them and can't work out why they're not working.

There is still value in giving evidence-based information related to what a child can and can't do on assessment but it is a nonsense that so much time is wasted on meaningless targets by itinerant consultants who don't really know a child and who haven't the first clue of what to DO with them.

I can write targets easily and quickly and I can tell you how to measure them without a huge amount of assessment etc because I have a lot of experience of doing and delivering on targets myself.. most SALTs don't get this experience because of the current model and so while they can spot issues e.g. that a child has trouble making eye contact or doesn't understand non-literal language, because they've never done the therapy they don't know what to do. Without having their head round it, they try and explain what to do to some poor support assistant who doesn't even have a GCSE without any information on how to record progress and surprise, surprise, it doesn't work!

Starchart Sat 09-Jul-11 12:12:23

Well, you can ask for a SLT with a specialism in ASD or in Communication development or something. Or you can ask for a completely different model, perhaps an expert TA with social skills development knowledge to work under the guidance of a SALT, or social skills groups/sessions run by an Autism Advisory Teacher or something.

The thing is, I can suggest these things but whether or not it is worth your effort in fighting for them is quite another thing.

You would assume that this was your child's entitlement, but I promise you will be looked at as if you have two heads if you start making these suggestions as they will not have heard of them being done before.

I am not wishing to sound defeatest, and I am currently battling for a model that no-one has any understanding of, and are quite afraid of in some cases, and certainly dyametrically opposed to. But I suppose that I know three important things.

1) You have to have an absolutely outstanding case for what you want with evidence coming out of your ears, and
2) Despite this, you may not get what you are asking for and
3) Even if you get what you are asking for in principle, the delivery of it may well have not been worth the fight.

I'm not telling you not to bother. I have weighed up the pros and cons and in my particular case, right now, I feel it is worth my effort. However, I have done similar in the past which, with hindsight were truly NOT worth the effort. Only you will know.

If the school are accommodating and you can afford it, some independent advice might be more resource-effective.

working9while5 Sat 09-Jul-11 12:24:54

"If the school are accommodating and you can afford it, some independent advice might be more resource-effective."

This would be what I would do, I think, if I am ever in the situation. I would also want the supports working with my child to have had pretty decent training. We do ELKLAN 11-16 in our settings and it has really helped us all to speak the same language e.g. what is speech, what is understanding, what is spoken language, what is social skills, what is meant by vocabulary etc (there is a primary version) - there's a lot of good in it.

www.elklan.co.uk

(I am not involved in selling this product, by the way!)

working9while5 Sat 09-Jul-11 12:25:45

Oh and that would not be instead of an independent person doing more targeted stuff, but additional to.. just so that staff had a good understanding of the basics to underpin any other intervention etc.

dolfrog Sat 09-Jul-11 16:25:25

Starchart
"I think I have to accept that SHE cannot address his communication problems. I will NEVER accept however, that his communication problems can't be addressed. But the two are seperate things and I need to think about where my fight is and where my resources should be best directed."

I do know exactly what you mean, this was where we were 12 years ago, when we were told that our DS1 had CAPD (as it was known then). The real problem is that these issues are still at the cutting edge of research, and they still need to develop various technologies to really understand the real underlying nature of the problems, which in turn will enable researchers to understand and inform those who try to provide support how to bes go about providing the required support.
We have had to work withe research professionals the consultants, audiologists, SALTs, psychologists, teachers, schools, policticians etc. And it is only some 11 years down the line that our DS3 is now gaining the benefit and getting the support he needs.
As you say doing the research and finding out what you need to focus on is important, so that you can try to get the help and understanding your DS needs. We have to be our childrens advocates, and it may be a life times job lol

Wordswell Sun 10-Jul-11 14:58:21

The most effective way of challenging it is to get an independent SLT assessment and report and good legal advice so that it is written into parts 2 and 3 of the child's statement. To find an independent SLT who has the expereince to do this go to www.helpwithtalking.co.uk and do an advanced search for your childs age, diagnosis, postcode and medico-legal.

BialystockandBloom Sun 10-Jul-11 16:06:41

Lougle: It seems to me, that ABA doesn't teach the ASD how to want to talk, but rather teaches them that they get further by talking than not talking. It's a transactional method of teaching.

That is true, but the behavioural analysis behind ABA tells us that everyone develops communication in this way, essentially. We get what we want in a restaurant (service/food) by asking the waiter. We get what we want from our parents when children (attention, food, comfort) through communication of one sort or another. Socially, we find conversation rewarding for various reasons (exchange of information, sharing feelings, learning, releasing emotions etc).

All ABA does is reinforce the appropriate forms of communication. Eg at basic level, tantrums are an inapprorpriate means of communicating, so they are ignored. Speech (or the nearest a person comes to it) is appropriate so it is reinforced. And the better you are at something, the more you'll enjoy it, and come to do it for the benefits of the activity itself.

We all learn by a transactional means of teaching, ABA is just much more explicit.

Sorry OP this is off-topic, and not helpful to your current situation. Can you get an independent SaLT report?

Lougle Sun 10-Jul-11 16:09:21

Bialy, I'm not disagreeing. I am just saying that there is no point pushing the point that your child can be taught how to talk, if the actual argument of the SALT service is that they can't or won't teach why to talk smile

Starchart Sun 10-Jul-11 16:15:07

I think that is the crux of it actually. The SALT model we have here can teach children HOW to talk, but not WHY they should.

There is no point labouring after more HOW to talk time. There may be some merit in arguing that they need support with the WHY and can they please find someone to teach it, although I can tell you now that the preferred answer will be that it can't be taught because they have ASD which is lifelong, but I can also tell you that that is bollox, it's just because they don't KNOW how to.

Find someone who CAN teach the HOW. Collect evidence on it, and then either sell it to the school or sell it to a tribunal to order it of the school.

TheTimeTravellersWife Sun 10-Jul-11 17:06:28

I agree, an independent SALT assessment is required, but I am going to wait and see how the AR goes; as I am expecting to have the provision that we fought so hard for at the Tribunal "stripped away" by the LA, which means that we will be back at Tribunal again, and will need to submit independent reports for our case.

Ridiculously,we had an AR only weeks after we won our Tribunal and the cheeky b*ggers from the LA were trying to say that DD didn't need the support in the Statment then! They then tried to set a date for a 6 month review of her Statement (in other words, another opportunity for them to reduce her provision) but I managed to successfully argue against this.
TBH the AR was a complete waste of time (and money, if you take into account how much it costs per hour for the professionals to attend a useless meeting) and the only reason for it was to have "a pop" at amending her Statement.
Not sure what the Tribunal would make of two appeals so close together; I hope that they see the LA as unreasonable and vexatious, rather than us as parents!

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