Here are some suggested organisations that offer expert advice on SN.
Opinions of the best SALT in the country?(25 Posts)
My DS (4.5) has a speech disorder. I've not been given any kind of diagnosis or a name to the disorder as I have been led to believe he is quite unique with his particular problems. He has no other special needs.
He has 1:1 SALT (NHS) and has had this for the past 15 months. His speech has improved a lot in the past 6 months and although I would like to think this is because of the SALT he has been having, I'm not entirely convinced of this. He has seen a few different speech therapists now and not one really knows what they are doing as they don't have a full understanding of my DS's speech problems. Each therapist tries something different every time but there doesn't seem to be one particular approach that works better than others. There just isn't any continuity.
My DS normally has a block of 10 sessions then about a 12 week 'consolidation' break before being re-assessed and then another few weeks before the next block of 10 start. You can imagine how frustrating this is!
Anyway, after finding out that the 12 week break is more than likely going to be about 16 weeks this time due to the SALT department running behind schedule for their assessments, I have decided to look into private SALT's. (The fact that he will start primary school in September is also on my mind). My lovely GP's have offered to pay for any speech therapy he needs anywhere in the country, no matter the cost.
So, now I am asking for advice/opinions/recommendations of the best SALT around! Have you seen or heard of anyone that excels at treating children with speech disorders or is the best in their field? I am more than happy to travel anywhere to have him assessed. If not local to us, we would then need the SALT to hopefully recommend someone local and liaise with them for future therapy. We really want to help him before it's too late.
different slts tend to be good at different things. so i had a truly brilliant slt in renfrewshire, but her specialty was feeding and communication, so we were allocated to her at birth and she kept seeing us until we moved a few years later. we've seen others who were great with other issues, but not with dd2 (cp, poor oromotor. told she wouldn't be verbal. history of severe feeding problems).
your slt experience so far actually sounds very good. you have been getting very regular support, waiting lists not too long, pretty much bog standard gaps between therpay (those consolidation breaks). it all sounds fine, but i understand your frustration that it isn't working.
there is no real 'one size fits all' approach to any child with any issue - and a lot of the therapy offered is 'try it and see' - if it doesn't work, try something else. this scientific malarkey isn't in truth very scientific at all. therapists just have to go on their own experience and go through the things that have worked with other similar children etc. we were reasonably lucky in that at around 5 the nuffield verbal dyspraxia programme started to help dd2, so her 1-1 at school used the programme daily with her for 5-10 minutes. it made a big difference. it wouldn't have been suitable earlier though.
looking for the 'best slt in the country' is a bit of misnomer, really. how are you going to get regular sessions with a slt at the opposite end of the country?
i can see why you need continuity. this isn't going to be found in nationwide search.
once you hit primary, it's likely he will be transferred to the slt who deals with the primary school, and receive 1-1 or small group therapy through school. maybe you could find out who that slt is? ask the ht what the provision is like?
good luck with finding a local private slt who can provide the continuity you are seeking. be aware that if you later use the private reports as evidence to seek additional support in school, etc, it might be more problematic than sticking with the nhs.
Dr Debbie Sell. Speech Pathologist at Gt Ormond Street.
I've been very happy with our I dependant salt (bucks) but then we have been offered nothing through Nhs so have nothing to compare really. Not sure if it's relevant but we as also about to take a 12 week break at salts recommendation.
We too used Jackie Harland of LCP. She's amazing. We've seen 3 NHS SALTs and 3 private, and she was absolutely wonderful at working out what the issues are.
Thanks for your responses.
madwoman Thanks for your detailed response. I know the provision we are getting is not at all bad in the sense that he is seeing a SALT 1:1 weekly. When put like that it seems great - in theory only though, not in practice! I understand that there is no exact science to speech therapy but when they have been trying different approaches for the past more than 2 years you would have thought they could have found something that works. That's why have decided to go private, to see if there is an excellent SALT out there that may get a little closer to a treatment plan (and maybe even a dx if there is one). It obviously wouldn't be feasible to travel to the end of the country and back every week so my hope is that the SALT we see can devise a plan and liaise with a local private SALT who we would continue treatment with.
sally Thanks for that recommendation but she seems to specialise in speech problems associated with cleft palate's so I don't think she would be right for us.
I'll look up Jackie Harland now and see if I can find out some more about her.
I've also found the names Auriol Drew and Gillian Baird - anyone have any experience with these?
Whereabouts are you? I would whole heartedly recommend getting a referal to the Nuffield in London. My ds 4 has severe verbal dyspraxia and was assessed there at 3 and we got a block of 10 sessions there from that. I will forever be in awe at the therapy he received there - it was amazing I just wish he could have it there all the time. It is NHS- Has dyspraxia been mentioned to you?
janx I am in South Wales so would not be able to attend any therapy anywhere else but local but would like my DS to be assessed by an expert. I doubt we would get a referral to London on the NHS :-(
Dyspraxia hasn't been mentioned. I have asked the SALT's about it as I have a friend whose DS has dysprxia and his speech his affected. They seem quite sure that he doesn't have it and we have googled it ourselves and it doesn't seem to fit. I have just been reading other threads today though and have discovered verbal dyspraxia, as you mention. Is it just the speech that is affected and nothing else or does it always come with other symptoms as well? (if that makes sense!?!).
The verbal dyspraxia stuff worked brilliantly for dd2. She doesn't have verbal dyspraxia.
My son doesn't have any other issues apart from his speech..This link explains the condition very well and was written by the head at Nuffield. I am pretty sure you can refer yourself if you think it would help. People come from all over for an assesment. Although I don't like labels - it is very frustrating when know one can tell you what the problem is
Janx, I don't think you can self refer to Nuffield- we were referred by a private paed, with copies of neurologist's report attached which stated verbal dyspraxia- and were refused. They said in the letter which they sent us that they would only accept referral from NHS.
OP, yes, verbal dyspraxia can come isolated, without any (or very little) motor difficulties.
This might not be applicable to your child but it is a document which looks at different SALT approaches and discussed their validity, title is 'Communication and people with the most complex needs: What works and why this is essential' (July 2010) by Juliet Goldbart and Sue Caton, its downloadable from www.mencap.org.uk
Apologies I thought you could self refer. Just looked at website - here are guidelines
I have looked into verbal dyspraxia a little and still don't think it completely fits but not convinced it doesn't (if that makes sense?!). The way I sometimes describe it is it's as if his tongue can't get around words, like it can't move between different sounds easily. He can say each letter/sound individually, the problem comes when putting them together. A lot of words he can say no problem at all - like yesterday said 'titanium' without even really thinking about it (even surprised me with that one!) but can't say some really simple words, such as 'dog'. He can say 'do' and 'og' and 'dod' and 'gog' but can not say 'dog'. Most of his problems are words with 's', 'f', 'w' and 'l' in them although not always. For example he can say 's' when in 'lisa' but can't say the 'l' at the front (he says 'y') but can't say 's' when in 'lasso' (I know, random word but best example I can think of!), he says 'y' for the 'l' and the 's'! I think this is what is making him difficult to treat, there's not really any uniformity in his difficulties, if you see what I mean.
Sorry rambled on a bit there! Just trying to give the general gist of his disorder. Does this sound similar to some of your children or others you have met? I would obviously prefer him not be unique so he can be treated easier, possibly.
Summer - thanks for the info on the document. I'm going to take a look at that and more about verbal dyspraxia and it's treatment when I have more time.
I wouldn't rule out dyspraxia ( verbal) as it is about the co-ordination. What you describe sounds like a milder version of my dc.... And interesting you should talk about him saying a difficult word without thinking about it and that is often true of my son.
I never really thought about speech production until my son had problem but if you think about the amount of co- ordination it takes to make a sounds blend together it is amazing how we do learn to speak.... Btw does anyone in your family have dyspraxia? .. Or dyslexia? My dp is dyslexic
It really does make you think about the way your mouth and tongue change shape to make individual sounds doesn't it.
The other thing that has always struck me is that my DS has a different shaped mouth to my other 2 DC, my DH and myself. His mouth seems quite small and he doesn't seem to have much give in his lips - his teeth don't show much when he smiles or opens his mouth as his lips don't seem to give way as much as they should. I'm not sure if that makes sense, it's hard to explain! This has improved as time has gone on but still not completely right. He has been seen by ENT and they have said that his mouth structure is completely normal but I'm not convinced tbh, just doesn't seem normal to me.
My DH's late brother was dyslexic but not sure if he had dyspraxia also. Nobody else on my DH's side and no one on my side is dyslexic.
I had problems bf my son - his latch was never right...had no problems with my daughter. I saw every bf counsellor going and none of them could help. I knew there was a problem and even mentioned it when he speech wasn't developing ... But again it was dismissed until I met a slt who knew what she was talking about- I think instinct is always worth trusting... Totally believe you know your child best
Janx - you say that DS had difficulty latching on. Did they investigate his Soft Palate?
Op, can your DC say the words consistently or is he saying them differently each time? Will a cake be a cake every time, or will it be cape, cane and occasionally cake?
Also, http://www.asha.org/public/speech/disorders/dysarthria.htm does this ring any bells?
janx never any problem breast feeding luckily, but I do think you're right about knowing your child best. It's a shame the professionals don't always follow this.
paribus he's fairly consistent in the way he says words (thank god, makes him much easier to decipher!). Just had a look at that link and I don't think dysarthria fits my DS. Although I've said he seems to have difficulty getting his tongue around words, I do think he has full movement of his tongue just that he finds it difficult to move his tongue in between each sound fast enough.
Just a quick update...
I decided to have a local SALT that I liked the sound of come and assess my DS. She came to the house this morning, was here for about 2 and a half hours and carried out quite a thorough assessment. She also used the Nuffield Dyspraxia tool (although didn't manage to get through all of it, it's quite comprehensive isn't it!).
In her opinion, she recognises that DS has a few traits of oral dyspraxia (rather than verbal or motor) and although she can't be 100% certain, everything else points to him not having dyspraxia. Due to the one or two things that relate to oral dyspraxia though, she has said that it is a small possibility and that if he does have it, it's so mild that we shouldn't direct all of our focuses there.
She has come up with a plan that she believes in and has used before with success where the usual approaches don't work. Whilst demonstrating it to me my DS managed to say the number 4 (normally says 'chor') without too much effort! This gives me confidence and a glimmer of hope!
She has also said that if it looks as if it's working she is quite happy to go into DS's nursery to discuss with the nursery staff there so they can help with doing 5 minutes a day. Nursery have always been more than happy to do this but NHS SALT haven't been willing to liaise with them so it's been a bit of a game of chinese whispers so hasn't been at all effective. Spoke with the main nursery teacher this afternoon who sounded quite excited and eager to meet with the SALT, said "we want to do whatever we can to help".
So, all-in-all, I have been left feeling quite positive about what she can offer DS. Fingers crossed we see some improvement within the next few months.
Hello, having seen nearly 10 salts, i would NOT recmmend someone who,s surname is savage. She works just off harley street, i dont remember where.
She was rec. to us but i had a dire experience, consistently, for 4 sessions.
Hello, I'm a Specialist Speech and Language Therapist in Oral and Verbal Dyspraxia who worked at the Nuffield Centre for a long time, my name's on the Nuffield programme! If you'd like any info on oral and verbal dyspraxia please look at my website www.dyspraxiatherapy.co.uk
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