ABA PECS and SALT

[mizmiz]

Just looked through this for the first time. Fascinating for me as I am an SALT for people with special needs. Feel that I am getting an insight into parents' minds , something that isn't always easy.

Do any of you use PECS at home, with/without ABA? I have been working on this for a while and consider the two to be the most exciting stuff I have come across in 12 years in this field (although as some of you note, some SALTS are suspicious of it, which drives me nuts as I don't think they understand what it is about.)

Do ypu find using these methods at home sustainable, or is it too much bother and fuss? I would love to know. I have introduced it with some dramatic results to some of the families and schools I work with, but now that I have gone abroad to live, I worry about their ability to carry on.

BTW if you have any questions about SALT, I would be glad to try and help. help. Time lies heavy on my hands in a new country.......

[Jimjams]

Hi mizmiz- we use it- but found it hard to set up initially- in the end we took ourselves on the pyramid course- and it is great. Has transformed home life to be honest.

We also do part time ABA (just on Saturdays at the moment- ds1 is in full time school). We've been doing that since last March and he is now beginning to imitate spontanously He really enjoys it, especially as he really can't fill his time by himself. Also for us as a family it provides some respite (ds2 is 2 and we have a number 3 due soon).

We've spent today looking at a special school (despite being non-verbal- ds1 is in mainstream). Really liked it- and they are very supportive with helping out with PECS at home.

[mizmiz]

That's great! I know how exciting it is! What stage are you at do you reckon, and do you need a lot of support to maintain it or are you able to just get on as a family with minimal intervention?

[Davros]

First, Jimjams! DS beginning to imitate, major! Pleased you liked the school
Mizmiz, we did a fulltime ABA program with our DS and still use lots of ABA techniques. We use PECs at home as well as school. Like Jimjams, we restarted PECs having started it and lost track, stopped working on truly functional things and promoting conversation. I think its quite typical to have to do it badly and then start again

[mizmiz]

Yes, I've ballsed up plenty, but with PECS it really is a case of RTFM. I love that, because its all in there, all you have to do is read and apply.
Felt this really important for the people on the Autistic spectrum that I work with where a lot of the usual vague SALT advice just won't wash.
Those people really do seem to need a rigorous and fairly prescriptive approach.

[Jimjams]

Yes the imitation is big isn't it. Hope its a case of the penny slowly dropping iykwim. COuld remain limited though.....

Mizmiz- DS1 freely brings "i want....." sentence strips. A bit adapted for his needs (to understand that language consists of seperate words rather than long streams of sound) so we use seperate cards for I and want. I've also extended that in places so if he has a set phrase (for example if I ever turn our bedroom side light on he'll shout "ine-ung" (light off) but now I make him PECS "I want light off". That seems to help his speech a bit and slow him down (this btw has all come from his private SALT- we didn't think of it )

[binkie]

Yes please!! mizmiz on your offer about SALT questions. Exactly what I've been hoping for!

Ds is 5 and has a variety of mostly minorish peculiarities, the oddest of which (to me) is his enunciation - among other oddities, he can't say certain vowels without giving them an extra accented syllable - says "row-wud" for "road", "lay-yudee" "bay-yubee" and "may-yubee" (very labouringly) for "lady", "baby" and "maybe"; can hardly manage "whale" or "quail" at all. It makes talking very hard work for him, and understanding him v difficult too. A very kind friend gave me some ideas of vowel-consonant games to play with him, but what I'd love further info on is:

• is there anywhere on the net where I can print off pictures of what his mouth should look like when he tries his sounds? and
  
  
• how weird a problem is this one? Do loads of kids have it? (I've not heard any other child sound like him, and we get some quite odd looks from strangers.) Is it "typical" of any other problem?
  
  PS I've been listening carefully to his speech recently and eg "parents" comes out completely fine. So it's just certain enunciations.
  
  Many TIA.

[mizmiz]

Well Binkie baring in mind the following:

I would need a formal assessment to give a proper answer to you.

I am not answering as a woking SALT

My area of expertise is with children with minimal/no speech/language not phonolgy (the area this falls under) although we are all trained in this areaa.

I will do my best to help.

Sounds like he has some problems with diphthongs and tripthongs (basically strings of vowels without consonants to break them up.)

From my past work in this area I would not be overly concerned about speech irregularities in such a young child. Most therapists would advocate modelling back a target reponse to him, not correcting overtly
Eg He says 'A lady is outside'
You say very calmly, 'Yes that's right, there is a lady outside. Look, she's lost her bag!' (or some such relevant naturalistic comment.

There are lots of diagrams and exercises available, a lot would depend on whether or not your child is the kind who likes that kind of thing. Some love it, some hate it. For example we get a lot of parents who want us to do speech drilling type stuff with their kids in my field (SN) particularly kids with DS, and mostly I have to say 'Look, they are not enjoying this. The pressure and boredom far outweigh any measurable improvement in speech.We are turning a confident communicator (not always the same thing as someone with clear speech!) into a nervous wreck.

However if I have a kid who likes this kind of stuff and motivated parents who are happy to do this stuff at home, I can give them armfuls of exercise. You cannot expect massive improvements if you only working on this v. occasionally in a clinic with an SALT (or at least only in rare cases.) You must do stuff yourself!!

Have you had an assessment? If so what did the SALT say? If not are you waiting? Are you in a position to pay for a few sessions with an SALT? If you ask from the start for materials he/she should sort you out. Contact the Royal School of Speech and Language Therapists, ask them for the website for independent practitioners then choose one close to you who specialises in and is interested in child phonolgy (will say this on their profile.)
Does that help?
Hope so!

[mizmiz]

What kind of accent do you (or those around you) speak with btw?

I have known many kids with very odd speech patterns, you name it, i've seen it but then that is the nature of the job!

[mizmiz]

Sorry, me again.
Just to say, would advise against finding stuff off the net and using it without the guidance of a SALT. If so inclined, by all means,print it off and take it to show the SALT when you see one.

[binkie]

mizmiz, great response, thank you very much indeed.

We had a private SALT assessment 18 months ago - when the problems were different - findings were: big difference between v good receptive language and not so good expressive; and "what we would call verbal dyspraxia if it were worse" - word-finding difficulties, very tangled syntax, etc. He had some sessions of group SALT but was noticeably more able than the others - and since then school seems to have done him much more good - expressive language (as opposed to speech) I don't think is a problem now.

Don't really want to take him back to the practice where we were assessed - felt rather a pressure to book sessions - but would be very happy to pay for a private SALT who would give us projects and monitor us. He's a very compliant & inquisitive chap, likes to know how things work - so I think he'd like exercises - and I'm very keen to be involved.

So with your suggestion I'll go and find someone!

PS: accent: central London, very international school, so yes lots of opportunities for getting muddled. But I also have a dd (who's 4) with all same exposures, and no problems there.

[mizmiz]

Well I'm very glad to have been of some help. The private route sounds good, especially if you are indeed willing to do stuff at home and the little fella will enjoy it (often amazed in clinics to find how little kids sometimes really enjoy the most unspeakably dull stuff!)

Accent response interesting and as you surmise, probably of no relevance. Seems to be a network of subtle language problems all influencing each other but good to know that things are going well.

BTW was the last SALT private? You mentioned 'pressure to book' (sorry if I haven't read it properly, bambino needs a feed). If NHS I am amazed. Pressure to book? pressure to get people off the massive waiting lists by discharge more like!
Best of luck!

[maddiemo]

mizmiz, I would like your opinion if you have time.

My ds3 has autism but the question is about ds4.

He is three years and had an assessment two months ago that put his language at two years and comprehension at eighteen months. His speech has improved considerably in the past six weeks and he speaks in sentences. However, his comprehension is not improving so well and lags a fair way behind. He can follow basic rountine requests, get your shoes etc. He is very repetitive. He is not able to understand choices. He is very echolalic and tends to reverse pronouns. He will say "Shall I carry you?" when he wants to be picked up.
On the other hand, he knows colours, numbers letters really well.
Although he has many asd traits in his behaviour he does not seem to have an asd personality.
We have been on the waiting list for NHS SALT for eight months. I have been told he may qualify for some additional support from an assisstant at Nursery but the waiting list for this is over a year long.
I think I am concerned that he has a receptive language disorder.
Sometimes I think he may catch up by school age other times I think he may need support.
The problem is compared to other children he has less needs. He is far more able than my autistic son was at this age.
His comprehension being lower than his speech does worry me and I worry that there may be a more long term problem.
Any advice welcome.

[mizmiz]

Very intersting post, not least because I have a 4 year old dd who sounds very similar to this in spite of (because of?!) the fact that I am an s/lt.

Most unusual that expressive language is better than receptive language (ie that speaking better than understanding. As far as I know only one syndrome of which this is a salient feature, this being Williams' Syndrome, but then distinguishing physical features attached to this so easy to diagnose.

The stronger expressive skills may point to some sort of ASD. (May, note! As in the other case face to face assessment needed) As you probably know what are often perceived to be 'good' language skills are actually often quite fluent echolalic routines.
eg A child may talk 'well' but is often repeating the same thing over and over.

It seems encouraging that the assessments (which ones I wonder? Does it say on the report? Should do!!) dont show too great a delay and that they are already talking of extra assistance.

In my own case, I am trying to follow the advice I so often dole out to people-lots of special time with me, reading stories, playing games (dominoes, lotto, snap, adjective and verb naming, what goes with what?, fuzzy felt,jigsaws, why?/because?) chatting, basically 100% attention and I encourage dh to do so too (is reading her bedtime story to her as I write!) I can see that things are improving, albeit slowly.
Could be more difficult for you, as you obviously have 4 kids but I would urge you to make some time every day for him.
When you see the s/lt take a notebook and ask (demand!) a list of viable activities. Don't be fobbed off by vague pointers such as 'Make more time for him'

Might be helpful if you can to note all that he says over a period of a few hours (even a day if you can stand it!) and note context. Would help an SALT enormously to pinpoint what situations/grammar/emotions cause particular difficulty

Hope this helps too.

[blossomhill]

Hiya Mizmiz

I would be very interested if you had any idea what could be wrong with my dd. She is 5 and attends a SALT unit.
Her dx at present is language disorder. Her main area of difficulty being pragmatics as her basic langauge has developed very well and is now at a normal age level. She is very "quirky" and does echo a bit still although not as much as she used to. She sometimes talks to herself as well. Obviously having problems with pragmatics affects her social skills to a degree too. I am worried that we do not have a proper label for her but the school and all of the other pro's feel a language disorder is the best dx at the moment. Is there really sucha thing as a straight language disorder diagnosis (dx)
Sorry if I ahve rambled and thanks for listening

[maddiemo]

Thanks mizmiz.
It is interesting that you have a similar dd as no one seems to know what to make of ds4.

It was the local portage team that carried out the assessment recently, prior to that we had a NHS SALT assessment in June at which he was very poor and they were unable to get joint attention. So the progress he has made recently has been significant.

I have been to ds3 SN unit to watch derbyshire language scheme being used and am doing activities at home based around that.

I think he has strong traits of asd but not enough for a diagnosis. He has always brought items to show and I believe he has empathy appropriate to his age.

Thanks again mizmiz

[mizmiz]

I understand your concerns about a 'proper label'. So many of 'my' (can I say that? they are very dear to me) parents say things to me like 'I really need to know exactly what is wrong with him/her so that I can tell people when they ask.'

Unfortunately speech and language and problems associated with them are very difficult to pigeon hole. We often think of them in a sort of medical way, but they do not start and finish in a particular geographical location like the body. We can't pinpoint an s/l disorder in the same way as we could say pinpoint a problem with a knee.
Extremely frustrating for us all I know but that is the present situation, although things are moving very fast and what is true now won't be in 10 years.

This is what is so great about the SN field, things move on at a cracking pace, virtually unrecognisable now compared to what was known/on offer 20 years ago.

I am prone to think this way to. With dd I often think, what exactly is wrong, but then I have to remind myself that she is as she presents. That is the label if you like! (ie she talks to herself, is often echolalic and so on)
I would be very encouraged by the fact that your child is in an SALT unit and would be greatly comforted by the fact that she is under continual scrutiny. Work on building up (if you haven't aleready done so) a really good relationship with her staff, ask what you can do at home to complement their work and remind yourself that if she is happy then you are 99.99% of the way there.
Ultimately that is what we all want for our kids isn't it?

Sorry a bit vague I know and maybe not the answer you want but still useful I hope.

PS A 'definite label' can often be more of a hindrance than a help. I'm sure many people here who have a child with DS or CP for example will tell you that people make assumptions about them because of their condition, which is often maddening, as the label obscures the individual.

PPS Another point. When I trained, our fantastic SN lecturer drummed it into us that we must always mention the person first and the condition second for this precise reason.
eg 'girl with DS' instead of a 'DS girl'
I have never forgotten that and cringe when I hear it said by others.

[blossomhill]

Thanks Mizmiz - I just feel, and have said so many times on here, that I feel dd must have sort of asd. Everyone that works with her says no that she doesn't have the triad. So why is she so quirky? Can children with language disorders be quirky too?
Thanks in advance

[mizmiz]

Sorry yes blossomhill, there is such a thing as a straightforward lang. disorder (although it is still very much an all embracing term.

Re other post, very encouraging that your ds has alawys brought things to show you. Very very enmcouraging in fact.

[mizmiz]

I think there is a massive overlap between asd and lang disorder. In fact am always reminded that we talk about a spectrum of autism (ie a wide range) and that in fact we are all on it somewhere in terms of quirky behaviour. Interesting question is when does the behaviour get quirky enough to merit comment?
Context is important.

For example, my family think that I am weird because I am so tidy and organised but to dh (ace housekeeper that he is!) I am a vague and lazy slut.
(Ask youself what behaviour of yours could be considered 'autistic'in certain contents. You will be amazed to find that the answer is probably quite a lot!)
Who is right?!

BTW I love the quirky ones. Do sometimes feel that in assessments any idiosyncratic behaviour can be pounced on and read into too heavily.
What's the big deal about being a bit different anyway? Makes life far more intersting for us all!

[mizmiz]

I think there is a massive overlap between asd and lang disorder. In fact am always reminded that we talk about a spectrum of autism (ie a wide range) and that in fact we are all on it somewhere in terms of quirky behaviour. Interesting question is when does the behaviour get quirky enough to merit comment?
Context is important.

For example, my family think that I am weird because I am so tidy and organised but to dh (ace housekeeper that he is!) I am a vague and lazy slut.
(Ask youself what behaviour of yours could be considered 'autistic'in certain contents. You will be amazed to find that the answer is probably quite a lot!)
Who is right?!

BTW I love the quirky ones. Do sometimes feel that in assessments any idiosyncratic behaviour can be pounced on and read into too heavily.
What's the big deal about being a bit different anyway? Makes life far more intersting for us all!

[mizmiz]

I think there is a massive overlap between asd and lang disorder. In fact am always reminded that we talk about a spectrum of autism (ie a wide range) and that in fact we are all on it somewhere in terms of quirky behaviour. Interesting question is when does the behaviour get quirky enough to merit comment?
Context is important.

For example, my family think that I am weird because I am so tidy and organised but to dh (ace housekeeper that he is!) I am a vague and lazy slut.
(Ask youself what behaviour of yours could be considered 'autistic'in certain contents. You will be amazed to find that the answer is probably quite a lot!)
Who is right?!

BTW I love the quirky ones. Do sometimes feel that in assessments any idiosyncratic behaviour can be pounced on and read into too heavily.
What's the big deal about being a bit different anyway? Makes life far more intersting for us all!

[mizmiz]

I understand your concerns about a 'proper label'. So many of 'my' (can I say that? they are very dear to me) parents say things to me like 'I really need to know exactly what is wrong with him/her so that I can tell people when they ask.'

Unfortunately speech and language and problems associated with them are very difficult to pigeon hole. We often think of them in a sort of medical way, but they do not start and finish in a particular geographical location like the body. We can't pinpoint an s/l disorder in the same way as we could say pinpoint a problem with a knee.
Extremely frustrating for us all I know but that is the present situation, although things are moving very fast and what is true now won't be in 10 years.

This is what is so great about the SN field, things move on at a cracking pace, virtually unrecognisable now compared to what was known/on offer 20 years ago.

I am prone to think this way to. With dd I often think, what exactly is wrong, but then I have to remind myself that she is as she presents. That is the label if you like! (ie she talks to herself, is often echolalic and so on)
I would be very encouraged by the fact that your child is in an SALT unit and would be greatly comforted by the fact that she is under continual scrutiny. Work on building up (if you haven't aleready done so) a really good relationship with her staff, ask what you can do at home to complement their work and remind yourself that if she is happy then you are 99.99% of the way there.
Ultimately that is what we all want for our kids isn't it?

Sorry a bit vague I know and maybe not the answer you want but still useful I hope.

PS A 'definite label' can often be more of a hindrance than a help. I'm sure many people here who have a child with DS or CP for example will tell you that people make assumptions about them because of their condition, which is often maddening, as the label obscures the individual.

PPS Another point. When I trained, our fantastic SN lecturer drummed it into us that we must always mention the person first and the condition second for this precise reason.
eg 'girl with DS' instead of a 'DS girl'
I have never forgotten that and cringe when I hear it said by others.

[mizmiz]

I understand your concerns about a 'proper label'. So many of 'my' (can I say that? they are very dear to me) parents say things to me like 'I really need to know exactly what is wrong with him/her so that I can tell people when they ask.'

Unfortunately speech and language and problems associated with them are very difficult to pigeon hole. We often think of them in a sort of medical way, but they do not start and finish in a particular geographical location like the body. We can't pinpoint an s/l disorder in the same way as we could say pinpoint a problem with a knee.
Extremely frustrating for us all I know but that is the present situation, although things are moving very fast and what is true now won't be in 10 years.

This is what is so great about the SN field, things move on at a cracking pace, virtually unrecognisable now compared to what was known/on offer 20 years ago.

I am prone to think this way to. With dd I often think, what exactly is wrong, but then I have to remind myself that she is as she presents. That is the label if you like! (ie she talks to herself, is often echolalic and so on)
I would be very encouraged by the fact that your child is in an SALT unit and would be greatly comforted by the fact that she is under continual scrutiny. Work on building up (if you haven't aleready done so) a really good relationship with her staff, ask what you can do at home to complement their work and remind yourself that if she is happy then you are 99.99% of the way there.
Ultimately that is what we all want for our kids isn't it?

Sorry a bit vague I know and maybe not the answer you want but still useful I hope.

PS A 'definite label' can often be more of a hindrance than a help. I'm sure many people here who have a child with DS or CP for example will tell you that people make assumptions about them because of their condition, which is often maddening, as the label obscures the individual.

PPS Another point. When I trained, our fantastic SN lecturer drummed it into us that we must always mention the person first and the condition second for this precise reason.
eg 'girl with DS' instead of a 'DS girl'
I have never forgotten that and cringe when I hear it said by others.

[mizmiz]

Sorry yes blossomhill, there is such a thing as a straightforward lang. disorder (although it is still very much an all embracing term.

Re other post, very encouraging that your ds has alawys brought things to show you. Very very enmcouraging in fact.

[mizmiz]

Sorry, laptop gone completely bonkers