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anyone here have a child with both asd & verbal dyspraxia (or another speech disorder)

(13 Posts)
Firawla Sun 18-Nov-12 15:22:35

how do you handle speech therapy with your child?

i have a ds nearly 3 yrs old with dx of asd & dcd, so not an official dx of dvd (im thinking now to try and get that assessed and clarified..) but when they gave the dyspraxia diagnosis i asked the pediatrician and slt whether this would also be affecting his speech and they said yes. i had felt for quite a while beforehand that he does have dvd as he seems to fit all the criterea.

the speech therapy hes had so far on nhs was based on attention and listening type skills, shared attention etc. hes waiting for further group sessions which will also be more social communication, attention listening etc type thing from the info ive been given so far. which is fine, im happy for him to do this BUT from what i know of ds his difficulties in communication is coming more from the dyspraxia side I think, and they are just not treating that

I had a private slt out yesterday for first session and i spoke to her about this and that i am thinking to try and persue a referral to nuffield for him once hes 3 and she basically said forget that idea, they wont take an asd child and that it will be better to start trying picture exchange - but thinking about it im just not sure?

ds is quite communicataive considering hes not very verbal, he signs so well & has improved really quickly in that from where he was not long ago. he has grasped now how to ask for things so he comes and signs for drink and tries to show me things

if he does definitely have dvd, which i need to properly confirm but i think he does, then treating him just in the same way as a child with a speech delay will not help him enough though will it? as its a specific disorder not a delay?

is the more than words course or others like that, suitable or not? as slt mentioned it and ive heard it here really recommended, then ive heard for others its not suited for children with verbal dyspraxia?

hope my q makes sense basically im confused how we are supposed to balance the speech therapy when he has 2 different types of problems affecting speech

sickofsocalledexperts Sun 18-Nov-12 16:22:35

My boy has both - I would ignore the salt and approach Nuffield. The only thing that helped my boy's Verbal dyspraxia was constant 'echoic' practise by our ABA tutors - that is, making him copy sounds and phonemes face to face or in front of a mirror, so he could see what mouth and tongue movements were required to produce certain sounds. Your boy sounds pretty switched on if he is signing etc already so he should respond well.

The problem is that over here DVD is very poorly understood, and where there is help on offer, it tends to be unassociated with autism.

But if you are charming and persistent, you can get some help.

Have a look at ABA too. Good luck!

beautifulgirls Sun 18-Nov-12 16:58:22

I also second the idea of pushing for Nuffield anyway. DD has ASD with verbal dyspraxia (& other issues too). In her case her major issue was her speech production however and we ended up at Nuffield after I pushed for it, to try and clarify if her speech issues were underlying her other symptoms or if they felt her speech was her only problem. They were so good up there and very thorough even having us back specifically to see one of their psychologists for further assessment. It allowed us to get enough evidence to finally convince local ASD services to take us seriously and have her properly assessed. I know Nuffield do have referral criteria, but in this case you are referring to try and get an assessment for verbal dyspraxia which is their speciality. The case of your son is complicated by the known ASD and therefore this makes them a sensible choice to be able to look at the whole picture and try to differentiate the various factors contributing here and then advise how best to proceed with helping him. I would give them a call to check the situation so you hear first hand re the criteria and then you should hopefully be able to push the right people to make the referral for you.

moondog Sun 18-Nov-12 17:09:11

The unfortunate truth is that many children with ASD also have dyspraxia.
The average NHS s/lt simply does not have the time to deal with other presenting issues if one is the one causing most concern.

Whilst completely understanding a parent's desire to get speech sounds sorted out, in a hierarchical assessment, the ability to make one's needs known must take precedence.

You'll see some improve,ment at least if you have tonnes of energy and are extremely disciplined about practicing exercises over and over and over, in your own time. Most people aren't like this however.

Firawla Sun 18-Nov-12 17:18:30

moondog i am happy to do the exercises over and over at home if i could just get hold of a slt who will show me these techniques. i feel like it has to atleast be worth a try

think i will still keep my plan of trying to push for a referral to nuffield then. was just a bit suprised yesterday but the slt saying not to

i will look into aba too, I keep hearing about it but i still dont quite understand what it is, how it works so will have to read a bit more

thanks everyone

SummerRain Sun 18-Nov-12 17:30:18

We're in the opposite situation. Ds1 has verbal dyspraxia but I believe that he may have AS as well but no-one is willing to admit that any of the sensory, social or behaviors issues ate separate to the dyspraxia.

It's very frustrating.

His salt has done some of the Nuffield programs with him with mixed success... They really do require willingness to participate from the child. Ds2 does not have that so she's shelved them for the time bring and we're mostly just doing echolaic repetition if sounds now. He'll do them for her occasionally bit wont practice at home so progress is slow but considering this time last year he was non verbal and now he chatters away (even though 80% of the time no-one can understand a word) things could be worse

saintlyjimjams Sun 18-Nov-12 19:00:38

Yes, but my son's verbal dyspraxia is very severe (he can only produce a few consistent sounds). His ASD is severe as well so when he was younger the NHS SALT refused to work with him anyway hmm

He was eventually dxed with verbal dyspraxia aged 8 (I had been asking for assessment for that since he was 2).

Now he uses a communication aid (which has done more to improve his speech sounds than anything else tbh - he often speak as he presses the buttons for the word and the sounds are getting closer to the target and more varied).

moondog Sun 18-Nov-12 19:08:25

That is a huge advantage of a communication aid-the child hears the target sounds over and over as they are responded too-very reinforcing.

(It's the same with online reading programmes too, for children who can cope with them. Our research shows great outcomes time and time again with Headsprout on not just reading but also articulation as well of course as imporved comprehension and independent learning.)

The child hears sounds over and over and over again and is primed to repeat them over and over and over again in a fun naturalistic manner.

Firawla, if you can commit you should see good results (and I speak as someone who has committed huge chunks of my time to imporving my own child's communication skills. I have seen enormous change but we never let up.)

saintlyjimjams Sun 18-Nov-12 19:34:15

We did do some intensive sound work before moving onto a communication aid (we were looking at developing a core vocab). Ds1 eventually reached a stage where he was enthusiastic about cooperating, but we found he'd learn to produce a sounds like 'da' for example but then it would slip and we'd lose it and it'd become 'na' again. Other sounds such as 'ku' just seemed impossibly for him.

But his problems are very severe indeed. His communication aid is helping, although he tends to concentrate on vowels still.

jomaman Sun 18-Nov-12 19:43:39

Hi Firawla,

Here is my twopenneth, having been in a similar situation with ds1 who is now almost 5, with autism and according to the final letter from Nuffield 'features of verbal dyspraxia'.

I think if you suspect dvd, and know they also have social communication issues, it does help to think of it as a two pronged attack.

1) Going on More Than Words course, and considering an ABA programme are great for establishing functional communication for your ds (whether it be sign, symbol or word approximations).

2) Separately, trying to get your ds to be able to produce speech sounds deliberately at will as a skill on its own, and if they have dvd it will take lots of intensive and repetitive practice, overseen by SLts who understand the condition.

In order to get the best help, you would need to be referred to and assessed by the Nuffield. In practice this can take lots of time (especially if your ds also has ASD), so the approach I took was to pursue the referral but in the mean time assume he has dvd and do the exercises accordingly as best I could.

It might be different now, but for us we needed to prove that ds had 20 word approximations and a certain degree of 'compliance' with instructions before Nuffield would accept the referral. Due to ABA intervention he was very compliant but could produce ANY sounds when I first was seeking help.

Our first attempt to get a referral was half-heartedly supported by our local SLT and got turned down, but 6 months later we reapplied with full support and were accepted. By the time the referral and then the 6 month later followup appointment came through, he got the label but had overcome the bulk of the speech sound problems due to our efforts with the exercises. They didn't offer any follow up help anyway, (rightly) pointing out that now his biggest communication barrier was now the ASD and not articulation.

I'm not trying to make out that he has/had the most severe case of dvd, I just want to show that there are things you can do on your own before you get the 'official' input.

ABA was and still is invaluable in terms of teaching him listening skills and being able to focus on a task.

More specifically for his speech sounds, we worked on:

- phonological awareness, i.e. listening out for a phoneme and identifying it (have a big picture of a butterfly and a pig and make the sound 'b' and they have to touch the butterfly, that kind of thing). its not going to be possible to get him to repeat the sound if he can't differentiate what sounds he's hearing.

- awareness of his mouth and speaking apparatus. its not backed by much research at the moment, but we used TalkTools and i think it had a big effect on his ability to round his lips, keep his jaw still and place tongue around his mouth in order to produce sounds. alongside this we did standard oral-motor exercises like blowing, smacking lips, sticking tongue out etc.

- sound production. for this we found that cued articulation was really useful. there is a dvd and a book, each sound has a hand signal that mirrors what the mouth does to make the sound. we picked a few sounds to target each month and just exposed him a lot to the actions and sounds. later we used it to cue him in if he was saying a word wrong.

-echoics - once he build up a repertoire of sounds he could produce, we practiced them daily, especially in combos like getting him to follow a line that said "t b t b t b t" I think Nuffield use pictures for this but my ds finds pictures distracting so he preferred just the letters.

- word approximations - finally when he was confident with echoics, we made a target list of items he wanted to request and kept notes on his best approximation and only accepted that, using cued articulation to help him. Btw we had tried this much earlier, before he was really able to produce sounds confidently and consistently, and it backfired, causing him to try to interact and 'request' less and upping the frustration levels.

In the beginning we also tried the PROMPT method, in the end his sounds took off and we didn't pursue it, but its worth checking out too.

Sorry this has turned into a rambling essay. I'm not a SLT but I am just saying what I think helped in our case...

Firawla Sun 18-Nov-12 19:59:21

thanks this is all really helpful info!

moondog Sun 18-Nov-12 22:43:06

It woulod be worth seeking out the very lovely Risca Solomon at
Skybound Autism Therapies who is doing a lot of interesting work with TalkTools.
I had the good fortune to meet her at an interneational ABA conference (after lots of chatting on MN) and was very interested in her work as well as being very impressed by her attitude. Tonnes of energy and belief in being able to make a difference.

saintlyjimjams Sun 18-Nov-12 23:56:51

Yes Risca is great - have spoken to her at some length. Her videos on Youtube are pretty inspiring.

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