I am an NHS speech and language therapist AMA

[starbrightstar]

Inspired by a similar-ish thread. AMA

Thank you for this thread. It’s been so interesting to read. Your passion and expertise shines through. Those that get to work with you are lucky.

Im interested to hear about your thoughts about the 18month old above. My daughter is a bit older.

Once a term is ridiculous for a child who has a severe language disorder. I would push for more SALT or get a private SALT (preferably one with tribunal experience) to recommend more hours for her and when her EHCP annual review comes up, use that opportunity to have the increase in provision written up in her EHCP. Does she has a diagnosis of having a language disorder associated with her diagnosis of ASD, it is important to get that recognised on her EHCP.

It could be Echolalia... but does he only echo when asked a question or does he do this on any occasion? Generally, a child who repeats back questions when ask does not always understand what is being asked of him. If I was you, and everything is appears fine, I would ask an SLT to assess his understanding of language.

I would also push to get a high tec assistive technology device or have her assessed at an assistive technology service hub. At 9, and non verbal, it is important that she is understood by everyone and can communicate to her maximum Potential. Signing, although useful and should continue to be encouraged, is just not enough. She need a system where all are able to understand her.

Thank you for this. I can afford to self fund a device but have been told not to by SALT because they will fund one when they deem it appropriate. I felt uncomfortable going against the advice of the experts but I think it's what is best for my son. I'm just frustrated that they don't seem to listen. They gave him a trial of a device for one session at school but they said he didn't show a preference for it over the pecs. I feel he wasn't really given a proper chance with it. He likes to learn independently, indicating when he needs help. He will watch an adult do something and copy but he does this when he is ready, he doesn't really take direction. I feel if they let him explore it in his own time and watch someone model for a decent length of time he would pick it up very quickly.

He is 6 and can spot a Mcdonalds sign from a mile off. When SALT came into nursery when he was younger he stole her ipad from her bag and had youtube open before she even realised he had it. He can pick out and find the apps he wants on any device, even if they are hidden in folders and has taught himself to recognise letters, numbers, do matching, jigsaws and simple sums on either electronic devices or apps.

ASD presents quite differently with girls and I have worked with a number of Autistic children who are sociable and have great eye contact. Just to highlight this.

My initial thoughts were- well if she can repeat phrases then how is she using her language. Is she able to using language functionally? Does she comment, make requests? Tells you what she sees in her day? Protest? Etc. So the issue may not be her not combing words together but how is she using her language. Very tricky to determine without an assessment.

Specific Language Impairment. My son was diagnosed when he was five, he is 16 now still struggles with speech and language compared to his peers and siblings when they were his age. SLT stopped when he left primary school. He is bright and happy is there anything I can do to help.

I am a TA in a primary school and I have expressed an interest in SALT. I've been able to observe a few sessions with a private therapist organised by the school, and had discussions on next steps with her re. sounds to focus on.
I'm keen to get it right of course. Can you suggest any courses/books/websites for resources so I can be better equipped and more knowledgeable?
A friend has started the ELKLAN training - would you recommend this?
Thanks

@Ifeellikedancing I don't see myself as an expert. All SALTs are learning and exploring different practices, therapies etc and unfortunately not all are clued up on AAC. Their reasoning behind not giving your son an AAC device because they feel he prefers PECS is silly. He needs to be taught to use an AAC device!

I would bite the bullet and purchase one. I have a feeling they are worried about recommending an AAC device due to funding.

Please read this article and show this to your SALT. As it stands, research shows that there are no prerequisites of having an AAC device:

www.assistiveware.com/learn-aac/roadblock-aac-users-are-required-to-prove-themselves

www.asha.org/njc/aac/

High tec AAC is like Makaton/signing/pictures/pecs/... it's just another form that assists language.

I would get a reassessment as the term specific language impairment is no longer used and the term is now developmental language disorder. It is strongly recommended that children with Developmental Language Disorder need intensive speech and language therapy. Has your son got an EHCP, I would apply for one as soon as possible and seek a private SLT assessment (preferably tribunal trained) so that SALT provision can be inputted into your sons EHCP so he can get speech and language therapy support for when he goes college.

Another possibility, if his language difficulties are a huge concern, there are specialist colleges that specialise in educating children with developmental language disorders. You can look into this option for when your son is due to start college.

Hello ! The EKLAN is very good at how to support those with speech, language and communication difficulties.

The Hanen programme- more than words is a fantastic course. It teaches you how to support those with ASD and communication difficulties.

The book: A career in speech and language therapy by Janner Wright, gives you an oversight on what it's like to be an speech and language therapist.

In all honesty though, I would look into branching your experience and consider volunteering in different areas within SALT, I.e. observing a therapist in a special school, volunteering at a stroke association group, being a communication support partner to adults with degenerative disorders. Books can tell you only so much, but are not everything.

Hi, my ds for the first year was taught my home language and then we switched to English as it happened without realising which I later continued with English. He is a late developer in terms of pointing (pointed at 18 months but had joint attention with eye contact and sharing interest before the pointing came along although he was a extremely busy boy) had 5 words by 18 months and then 100 by 2 years old. Now he is 3 and has hundreds of words. He has been requesting, demanding, sharing interest with words, gestures and pointing for over a year now but still behind his peers. He turned 3 recently, started going nursery 3 mornings a week recently and is learning a lot but is behind his peers by up to 12 months in some areas including speech. Would this situation warrant a speech therapy as the HV and nursery said there's no other concerns? And also what does protest mean? Thank you.

Thanks so much for your reply and advice I was given very little information about this at the time.

Oh yes definitely. I've said before that the quality of service really does depend on the individual SALT. Also, taking into account service pressures and funding cuts. Also, with ASD, there was and still is a tendency to blame everything on the ASD, which meant that some therapists did not think it is worth to carry out an additional assessments if ASD was the diagnosis. There has now been a slow shift in recognition that you can have an ASD and a language disorder+ADHD+Dyslexia+Selective Mutism.

Do you enjoy your job? (Sorry if that's already been asked)

My daughter has a moderate speech delay '12 months' delay. I was told that she doesn't qualify for help with the NHS community centre because it's not severe and they can't help everyone.

Is this something that you have to tell parents often?
Where should I go from here?

She's 3, in pre school 3 mornings a week, we go to a local childrens centre where they do bucket time but it's hard not to feel left behind somewhat.

I don't get the reasoning behind it, it feels like " it's bad, but it's not bad enough yet, let's wait until it's really bad to help!"

What would you suggest for an adult who after being constantly shouted at as a child and mocked for 'gabbling like a turkey' and would stammer when trying to slow down so the shouting would stop, still trips over words when tired, stressed, busy or put on the spot and is rather fed up of sounding like they don't know what they're talking about or being assumed to be lying?

There's only so many times one can brazen it out by rolling their eyes/tapping their jaw as a reset and saying 'losing the ability to speak here. Try again' before people make it clear they think one is an idiot or is taking the piss out of them.

Im also wondering about the impossibility of rolling R sounds as that was given up as a lost cause by dropping GCSE French. Much to the amusement of the parent, who would roll their Rs at full volume to make a point at every opportunity. (Although how exactly does one do it? It's supposed to be something anybody can do, according to both the French teachers and the parent concerned).

I suppose that these might count as a speech impediment?

DD2 is 14 and has ASD. Going through EHCP process. A bit of a stammer. Rarely talks to teachers in school. Uses one word but means another. Used to have odd syntax, still does a bit. SALT won't see her because they say it's not functional and is just her ASD. LA won't ask for SALT advice. We feel that she has huge issues understanding her teachers, which will be missed without assessment*

From this description alone I would pick up a referral like this. Again it depends entirely on what comes out of the assessment. The fact that she rarely talks to teachers is a concern and again could be part of her ASD or some sort of speaking anxiety (selective mutism) or in anxiety due to stammering. Even if it was apart of her ASD, this still warrants treatment!

It would be unethical of me to give a diagnosis over the internet. She would have been assessed by an SLT during the EHCP assessment. What were their conclusions?

I do enjoy my job but it feels quite restrictive.

Does she have a language delay or a speech delay (articulating certain words). It wasn't clear.

As he was brought up in a bilingual household and his first language he was exposed to was in his home language (?) then the SALT will need to assess both his home language and English. If they are difficulties in both languages, then a child has a language difficulty. If a child has difficulties in English but not in the home language, then we would count that as learning English as an additional language.

Again, it would be unethical of me to try and give a diagnosis over the internet. But typically, children who are brought up in bilingual households and then start nursery in another language- the second language develops much slower. We would expect a child to be fully proficient in learning the second language for 3- 5 years.

Keep speaking to your child in your home language. There are so many advantages of being a bilingual speaker including cognitive development!

Sorry- protest means that a child uses words like "no, don't like, not want" when given an item/ thing that he/she does not want to do.

This sounds very hard and I'm sorry you went through this during your childhood and assuming adulthood. When we work with adults/children with stammer, we do focus on developing fluent speech (if that's what the client works) but we also work on mindfulness and getting the person to accept stammering and developing self advocacy. I am wondering if you are part of an adult stammering group? There is a stammering service where adults can self refer. Where is your whereabouts? Feel free to PM me.

@starbrightstar Thanks for replying.
So she understands absolutely everything, I think it's more of a language delay. She has improved a lot in the last few months, she is saying more. Some words she doesn't say correctly but I'm not sure if that's just that she's new to trying to pronounce them or there is a problem.

She is also been assessed for SCD.

Thank you so much for your response @starbrightstar and thank you for starting this thread as I've learnt a lot by reading through it. Basically, ds until he was 1 yo was exposed to my home language and in fact he had a couple of words for boob (bf at that point) and mum. And then lockdown hit, me and dh worked from home and we just spoke English from then onwards (both DH and I come from the same home country and both bilingual and work in the same job). So this meant that ds was just exposed to English as we were talking in English whilst working, cocomelon on English and then talking to ds in English without realising. Ds understands a few words in our native language and a few basic commands but the rest are all in English. So my question is, was switching the languages may be the reason for the delay? Also ds is the biggest protester . For 6 months now (since 2.5yo) would say "no I don't want it, I didn't want it, no no no" and in fact that's all he says.

Sadly- the memorable ones are the ones who have been failed by the service and the schools, not receiving enough support and expected to venture into early adulthood with minuscule support.

Provision should not be bounded by what a service or school says that it could be provide but rather provision should be according to the child needs. I'm paraphrasing here but it clearly says that on the SEN code of Practice. A child attending a special school, who has an SALT on site or wherever, does not mean determine whether or not a child should or should not receive direct speech and language therapy input. I would challenge the SALT about this.

Clearly- and as you pointed out beautifully. Her functional language skills are a concern. Your daughter clearly has strong expressive language skills but is having great difficulty with her functional use of language. Int his case, it's going backwards, it's working on developing language through play, commenting on what the child is doing, sabotaging the environment so that the child has to request to get the item that she wants, modelling language, showing her that you can use language in different ways.

props pig but can’t ask for a drink! Have you met any children who at year 3 cannot string 2 words together and have they eventurally been able to have some sort of conversation skills?

Yes many! But conversational skills are varied and are relative to the individual.