I am a speech and language therapist. AMA

[KeepSmiling89]

I like to have a browse on here during my lunch break at work and whenever I get a spare minute so please feel free to ask me any questions. Will get back to you when I can!

Thank you for your reply! She turns 5 in July.

The referrals are quite recent - first suggested just before the Easter break so it's all very fresh and we haven't seen anyone yet so I feel very lost in knowing she needs help but not knowing what kind of help or where to look.

She progressing well academically at school and has lots of friends etc but she really struggles emotionally. School have implemented lots of tools for her - now/next cards to help with transitions (it's a trigger) and also a picture chart to help her communicate when she's upset. All having varying degrees of success. She can go from 0-100 in seconds emotionally and if you miss the opportunity to calm the situation, it can be up to an hour before she's calm enough to communicate. Happens at school, at home, out and about.

The school also highlighted that she tip-toe walks, W sits and she hates loud noises/crowds. She often has lunch separately with a small group of kids because the canteen is too much for her.

I will check out the OT recommendation and look into zones of regulation too! Thank you!

I don't work with adults but I would maybe push for a reassessment to see, at least, what to do if she declines again or needs adjustments made. It's important to follow SLT advice especially with eating abd drinking.
I would get in touch with your local adult SLT for a bit of advice on what to do here if you can!

The tiptoe walking abd crawling could be signs that she is self regulating as they are sensory behaviours. Keep an eye out for when she does these things so you can meet these needs before she becomes dysregulated.

Ooh amazing I’ve just seen this thread!
DD is 3 next month and whilst she can say about 40 words they’re not very clear annd often shortens them for some reason eg “mama to ma”. I’ve requested a referral via preschool and we have had a hearing test (showed slight glue ear in one), but I’m wondering if there’s anything I can do meanwhile? She’s getting quite frustrated when we don’t understand her and she gets upset when trying to play with other children because she can’t answer them back. Her understanding is good. She has a dummy that I keep pushing to remove but DH (& I!) are quite scared to as she really does loves dummy when tired or upset. Any advice please?

Thanks so much amazing advice so kind of you and really reassuring

Why do NHS SALT suggest different levels of SALT need then private SALTS. As an example my son was on the below 1 percentile with semantic and pragmatic on 0.8 percentile. I felt that he was abandoned and even though we won direct therapy when it can to the next review the SALT removed it. We then paid for SALT ourselves ( which is why we are thankful for DLA !) and we also put him into as much 1:1 Drama and Drama as he could manage. He was doing nursery rhymes at aged 9/10 for Drama. At the end of all this we managed to get him to talk quite well although he has false starts and a stutter with loss of chain in long sentences. I accept that the receptive language can never be cured due to working memory of 2 and 4 % but why did SALT always seem to want to abandon him at various staged eg at aged 5 and then at aged 7 and then a big tribunal at aged 10 and then abandoned him again at aged 12. The constant fighting was soul destroying. I had to do so much on my own to help him with his expressive language with memory games, picture dice etc

We had to be told by Dr Sirimanna Great Ormond Street that his scores indicated a severe receptive language impairment - the SALT never even said that they just gave some scores.

It impacts massively, especially if its an older child. If they're motivated enough they'll not only be more willing to give therapy tasks a go in sessions, they'll also be more likely to do practice at home which definitely makes a difference.
Sometimes children just aren't ready for direct therapy, but when they are it's very effective and rewarding for them and the SLT.

What a poor wee soul! Sounds like he's going through a lot.
Due to the fact that he's regressed, I would try to get in touch with your local SLT department for a bit of advice and to see if he can even be added to the waiting list for a bit of support. It might be a bit if a wait but at least ge would be on their books.
Don't have a lot if experience in terms of epilepsy and seizures and the impact this has om language development but it sounds like there could well be a link. Either way, a regression is usually a sign that they would need some SLT support.

Some children experience what's known as a developmental stammer, which usually happens when they have a language spurt...so they've got lots to say but their motor programming just can't quite keep up so they trip up over their words a bit.
If it persists for a whole pr starts to distress her, I'd get in touch with SLT for some support. A lot if support would likely be parent child interaction and environmental strategies so lots that you can put in place at home but school can also be given some strategies as well.
Check out the British stammering association website for info as well
https://stamma.org/

Hope that's helpful!

I never used pop-up pirate until I started my current job about 3 years ago!
It's such a versatile game and targets so many things in therapy - turn taking skills, speech work (saying a target sound/word before taking a turn), modelling language, social interaction and initiation skills. I played it with a wee boy recently who said "sword" after I modelled "blue sword" for him. His mum was impressed as he'd never said that word before.
It's also just a great reward game for the end of sessions as well.
My other personal favourites are Monkey Business, shopping list (orchard toys), tummy ache, crocodile dentist, Mr potato head, fishing games and bowling.

Hi, thanks for this AMA. My how 11 year old was diagnosed with DLD last year by NHS SALT after a year + long wait. No therapy was offered, just a few recommendations for school about breaking down instructions and some visual representation of material. However, he seems to be very impacted socially and emotionally, although is doing quite well at school at present. I am really disappointed for him that nothing else was offered. Aside from private SALT (none available at present in our area), what would you suggest I do to get help?

To help with her frustration of not being understood, encourage her to use non verbal means of communication like pointing, using gesture and taking you by the hand. If you can't understand her, simply ask "show me/mummy" and let her take you by the hand. Once you've worked it out, model back the language at her level. If she's just using single words, stick to single words, if she's using 2 word phrases, stick to these and so on.
I would keep the dummy use to bed time if possible. My 2.5 year old still has a dummy too but only at bedtime. If she asks for it now (usually if she'd tired), I let her know it's time for bed then. Make sure she's not got her dummy in when she's trying to talk as this will impact the range of movement of her tongue (imagine trying to talk with a carrot stuck in your mouth...it ain't easy!) I'm not against dummies as they're a very helpful tool...I'll have the joy of weaning my DD off her dummy soon as well. Waiting til after we've moved though!

Is it typical for a 4yo to replace 's' sounds with 'f' , for example finkles instead of sprinkles? He can make an s sound bit often doesn't at the start of words. Now I think of it it may just be words that start 'sp'.

Very common and tends to only happen for "sp" in my experience. The other ones usually end up missing the initial 's' so "smile" becomes "mile" and "snail" becomes "nail". No idea why "sp" becomes "f".
It's called cluster reduction and tends to resolve at around age 4-5 so it might go away developmentally quite soon.

Great thanks so much!

I'm so pleased to find this thread.

My DH has a stammer (for context).

My DS (almost 6) has a stammer. He's got a date for grommets, tonsillectomy and adenoidectomy. My DS2 sometimes stammers.

Questions are, could SLT do anything to 'treat' the stammer and is 6 too old to start? Is this genetic?

He is very articulate but gets 'stuck' on a single word and also the start of a sentence.

Thank you

Thank you @KeepSmiling89, that is really interesting! I will keep an eye and get help if needed! Thanks again!

Family history of stammering is considered a "risk factor" so there is a family link but I'm not sure what research says about genetics specifically.
No, he's not too old at all. There is more of a movement towards accepting stammers instead of trying to "fix" or "cure" them, but there are treatment methods to reduce the negative impact they have on children as well as strategies to reduce rate of speech etc if this is an issue. Other approaches look at parent child interaction strategies and environmental factors that parents can use on a daily basis to support their child.
I would definitely put in a referral for some SLT input though as early intervention is key to success.
Here's a link to the British stammering association website for some helpful info in the meantime
https://stamma.org/

How much of your job is gatekeeping limited resources? Do you ever have to attend EHCP tribunals? How do you feel about this part of your job?

I ask because o have an autistic child who needs SALT. During the NHS assessment he hid under the table tried to escape through the window got out the room ran down the corridor and jumped to hit the exit button and was in the car park before I caught him. He mostly refused to talk (situational mute) just yes and no or one word answers with a lot of support from me. He had a meltdown because she was looking at him. Essentially he was clearly a child with needs and a lot of his needs are processing and understanding language his vocabulary when he can speak is above average. The report that was written up said he made appropriate eye contact (he didn't!) and highlighted a couple speech sounds he gets wrong and recommended a small block of therapy to work on the speech sounds. I actually don't think the speech sounds are a big deal he just sounds a bit younger than he is everyone can understand him fine. He needs support processing language and help to use language for the things he does not yet have a grip on eg emotions. The report made no mention of the fact he refused to do most of the tasks amd was written up like there were no problems in the areas they didn't check.

I got a private report done and she came to our house and spent a lot mort time with him and managed to test some things the NHS report has implied we're fine and he has significant struggles. He was completely misrepresented by the NHS report. Maybe it's my area but when I speak with other parents of kids similar to mine my experience is more common than actually getting help. Everything is a battle. My youngest child is now 2 and still non verbal and I can't even get him a referral to SALT with the HV fobbing it off as learnt behaviour due to his older autistic brother (who while situational mute at times is fully verbal at home so it's not learnt behaviour!!). I work in early years I know how important help at young ages and in a timely manner as sooo important but that's not how services run.

To top it off during the EHCP writing process the LA insisted on their SALT attending multiple meetings. She lost a days worth or work hours to the process. And I firmly stood my ground that my son needed help as per the independent report. Waste of her time. She then had to attend tribunal as an expert witness where the judge ripped her apart for her stance and blocking my son from the help he needs. I hate the woman but watching her sit through that was uncomfortable what a horrible thing to have to go through as part of your job. And that took a day out of her ability to work. Waste of time and money trying to block my son from the help he needs.

I just could not do a job where I see kids who need help and I'm being pressured to block that help because there isn't the money or staff to provide it. How do you manage it? Do I love in a particularly bad area or is this national?

Thanks so much! Hadn't thought about a talking stick! I'll give that a go. I've just invested in a laminator so in the process of making various signs for the house and was planning a character themed 5 point scale based on his special interest - so reassuring to know I'm on the right track with that :)

So sorry to hear you had a negative experience with NHS SLT input. I can't speak for other NHS trusts but the only thing I can think of is funding issues and constraints placed on the service at the time. Whenever we feed back on assessment results, we give a diagnosis and make a plan for input/strategies to be put in place etc.

Wow! I'm so sorry you've had to go through that negative experience. That's absolutely not what we're about at all. We're constrained due to staffing and funding issues as well as extensive waiting lists and waiting times. However, we're all about looking at what's having the biggest impact for the child at the time and how we can best support them whether that's direct therapy in clinic/nursery/school, providing strategies and resources to home and education.

Based on your child's first appointment, sounds like a mix of social communication difficulties (autism), selective mutism, language difficulties and speech sounds. Speech sounds would be the absolute last thing I would be thinking about. I'd have arranged an observation in school to see how he was presenting there and, likely, would've looked at social communication skills mixed with a bit of language assessment - possibly focussing on his understanding of language first if he wasn't up for talking in the first few sessions.

It's so frustrating that we can't give the "gold standard" evidence based service delivery, but we always do our best to get as close to that gold standard as possible. We also have an advice line and options for parents to get back to us if they need any support while they're waiting.

As I said in a previous reply, I can't speak for other NHS trusts but it's tough and we do what we can - doesn't sound like your SLT wasn't looking at what was having the biggest impact for you child at the time and, again, I'm sorry you had to go through all that.

In what ways is it impacting him socially and emotionally? Is he having trouble making and maintaining friendships? Bullying? Difficulty understanding their language or maybe non-literal understanding of language? Is he able to talk to you about this or is it just something you've noticed as time has gone on?
I would get in touch with your local SLT for a bit of advice on how to support him through this if you can.

Hi, thanks so much for your reply. That's really helpful and interesting. Definitely a part of the assessment then. It's interesting too to read that as parents we may not notice subtle difficulties.

We're doing it a privately. Though still on the fence about the whole thing. Initially sought private therapeutic help due to school refusal in the mornings but he's cried and struggled to go in his whole life from nursery, it just hit a peak in year 3. Now he's year 4 with his own way into school and does go. But we have some other behavioural challenges at home, not major but tricky, and the person we were seeing has recommended a full. Multi disciplinary neurodev assessment. I'm scared of pathologising and potentially labelling a kid that's just sensitive and maybe a bit quirky. Equally don't want to miss information that could be useful for him. Sorry, way off slt now!! It is interesting to hear that's a big part of what you do though. Do you find a surprising amount can be revealed? An observation at school where he is unaware would be part of it.