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!

It’s a shame that funding has that impact. There needs to be more objectivity and distance from the people who pay. This has spawned an entire private report industry which is adding to the trauma and cost for parents.

I don’t blame the SALTA but the collusion between LEA and NHS and the conflict of interest.

Hi @KeepSmiling89 ,

I have some questions about my 2.5 year old dd if you don't mind.

She isn't talking - she can say 'where' and 'there' but that's it. She says 'there' 90% of the time both in context with pointing, but also out of context. She does babble.

She uses gestures and intonations in her sounds such as when she beckons us if that makes sense, and sometimes she'll sort of 'shout with purpose' but not say anything other times, such as when waving goodbye. She has lots of other gestures to communicate with us, otherwise communicates (sometimes really fervently!) with lots of pointing and leading. She understands most of what we say to her, I would say.

Her two older brothers were slow with their speech. They didn't talk reliably until they were 3 but even they had more words at this stage than she does now, I think. They would say 'no' 'yes' etc.

I'm concerned because she has seemed to hit all of her milestones slowly - she was slow to feed, roll, crawl, clap etc - she didn't walk until 21 months. I guess this is a huge part of my concern about her speech - but could it be that she will just hit this milestone later too?

She has recently been found to have glue ear at a hearing test a couple of weeks ago and I don't know if this might account for some of the reason for her delay. Her attention span is not what it should be.

She is on the waiting list now for SALT. I have done lots of research and am trying the 'obvious' techniques with her but don't seem to be getting anywhere. Eg. Turn taking, get down on her level, repetition of simple words, child-led play.

Over the past few weeks she seems to have learnt a few more 'signs' for words and will now shake her head to mean the word no. So I guess there is a tiny bit of progress?! 😩

Is there anything you suggest I should be trying that I may not have thought of?!

Thanks so much.

@EmmaAmeliasMum
It sounds like you're already doing everything you can be doing. It is frustrating when you're not seeing a lot of progress but she is on the waiting list so she'll get the support when she reaches the top if she still needs it. My 2.5 year old is on the SLT waiting list as well. She's saying a lot more words and starting to put some together so, if she reaches the top and doesn't need anything, that's fab and if she does still need some input, she'll be in the right place at the right time instead of waiting another year!
Using signs and gesture is definitely a positive indication of progress. My DD signed for "more" for a long time until she actually said it. I was thrilled and so proud of her at the time (and so excited to share a video of her to my work's WhatsApp group chat!)
She might well just be a late talker like her other milestones. Has she had her 27-30 month review with the HV?
Do you know any Makaton signs? If she's using gesture etc she might be up for using those as well. They'll also support her understanding of language.
Other than that, it's the "obvious" things you're probably already doing that will keep making a difference. Reading books, nursery rhymes. Does she go to nursery or toddler groups? I feel my DDs language took a wee spurt when she'd settled into nursery just after she turned 2.
If her progress plateaus, you're in the right place in terms of being on the SLT waiting list so it'll just be a case of playing the (very frustrating) waiting game!
Sorry I can't help any more than that!

He struggles pronouncing his "L" will say a "y" instead.

This is a process called 'gliding' where the 'r' and/or 'l' sounds are produced as a 'w', 'y' or 'l' (if it's the 'r' sound they're substituting). It is very common and usually resolves by about age 6 or 7. How old is he?

Thanks @KeepSmiling89, so much appreciated.

We're not officially doing Makaton or anything but more using her/our made up signs. She is at nursery and has been for 6 months now. I take her to toddler group each week too. It's sad to see how she's so behind the others her age 😔

I've heard good things about Miss Rachel for speech so just yesterday tried her with some episodes - she doesn't usually have the attention span for TV but happily watched some for a while and joined in with some actions for songs she knows and clapping when prompted etc. I think I'll build a little of that into our days!

So nice of you to take your time out to reply to everyone, thank you x

Are you still happy to Answer Anything you are asked? I want to help very dear GS, not quite 7; severe cleft; 3 or 4 ops, not fully successful, with another likely "soonish"; speech difficult to understand. Performing well academically, but not integrated socially and is frustrated. Whatever can we do?

Yes, absolutely.
Cleft lip or palate (or both)?
This is a very specialised area of SLT and not something I have a lot of experience in unfortunately. From what I can remember, cleft speech often impacts nasal resonance and airflow (speech may escape from the nose instead of the mouth for some sounds often "fricative" soubds like 's' ,'f' and 'sh'). Are there any sounds he's struggling with specifically?
Is he already open to SLT? Being open to a cleft team would make me assume that an SLT would be aware of him (especially after having a few surgeries already). If not, I would definitely try to put a referral in for him (or ask his parents to) so he can get the specialist help he needs ASAP.

Sorry I can't help more than that!

I don't know if this is the kind of "anything" you had in mind, but here goes

DP has speech therapy as a kid half a century ago to correct several speech sounds. Most people would never guess, and he now has very comprehensible, typical south-east England accented speech that never causes any difficulties with understanding him.

Except when it comes to computers. He has an absolute nightmare getting Alexa to consistently understand him, and often has to repeat himself and comically over-exaggerate enunciation, in ways I never have to do. I'm female (sometimes used to be a problem with some speech recognition software) and have a non-south-east regional accent (ditto), and have a much easier time than him, even though he has what would seem like the ideal "standard" voice that should make it a breeze for him.

All I can think is that his therapised speech sounds are maybe produced slightly differently compared to if he'd learnt them naturally, and while they sound pretty much indistinguishable to a human ear, the computer isn't interpreting the sound waves in the same way. Is there anything in that theory, or does Alexa just have a grudge against him?

@KeepSmiling89 Cleft lip, upper jaw, and palate. A scar and other structural aspects affect his facial appearance. Managed by Cleft Service since birth, but that is so stretched that he is not having sufficient therapeutic input. SLT teacher attached to hospital as part of Cleft Team is very good; the one he now sees occasionally 'in the community" less so. His appointments seem erratic and infrequent; and take him out of school for half a day.

Understandably, he is sometimes very angry - he has a lot to manage.

To my mind, ideal provision wd be a visiting specialist teacher once a week in school; and this teacher wd liaise with an EP and Cleft Service. (He will need an operation around Y6 to implant a chip of bone from hip into jaw.)

I suppose my question is: is my scenario pie in the sky? How can we find both an EP and a SLT teacher to help this little boy? It's a problem I am prepared to throw money at.

@BetterWithOrWithout thank you for replying. My bro, now in his 60s, had some speech and language lessons before he started school. My feeling is that then it was easier to access support than it is now.

Your message heartened me; I worrry about how my little GS's life will turn out, and your DH's is obviously going well. Big hug to each of you - tho perhaps not to Alexa!

@BetterWithOrWithout voice recognition is the bain of my personal existence! I'm Scottish, so I sometimes have to put on an English accent for some softwares to understand me! Check out the voice recognition lift sketch from a Scottish sketch show called "Burnistoun" (Scottish guys trying to get it to undersrand them saying "eleven"). It's hilarious!
There are some sounds with some regional variations (the 'r' sound in particular is produced differently by different people...also impacted by where it is in the word - the start, middle and end of the word).
Technology still has a long way to go (in my opinion) for this reason. As frustrating as it is (damn Alexa!) it's nothing to worry about.

The important question of the day.

In my team (I work with adults after career changing in my early 40s - highly recommended by the way) it's generally pronounced "OK who's got the blooming kelf in their car boot" (we like to take our assessments out, see a bit of the county, experience new horizons and not leave them on the shelf in the office where they need to be)

As for the adult choking/food textures queries.

Our adult team would look at a dementia patient and see if there are ways to modify the texture of meals to reduce the risk of choking down - waiting lists are horrid though; and the comment that someone's swallow has improved - yes, we would reassess with the view to changing someone's texture modification level - I've got a few people on my caseload at the moment where we're looking at if we can move them up an IDDSI level for various reasons (usually hospital SLTs placing them temporarily on very modified diets while they're unwell and then they're back in the community and still on puree).

Drawback of my currently quite dysphagia heavy caseload ... I end up eating lunch at stupidly random times of day as I'm out doing lunchtime observations - like today at 3pm!

My dd has a host of issues, main ones are a lisp as r/w mix up. Which do I tackle first? Can I do it alone or do we need a SALT?

ENT said she'd need a SALT but gave no advice about how to get one!

How old is your DD and what other issues does she have? Is it just speech sounds or is there anything else you're concerned about (language development etc?)
Is her lisp causing her 's' to become a 'th' (i.e. tongue sticking out) or causing the 's' to become a 'slushy' sound (also known as a lateral lisp)?
Producing 'r' as 'w' is very common and tends to resolve by about 7 years of age.

Depending on DD's age, you can ask school/nursery/health visitor to put in a referral or you can do a wee bit of research and see if you can put in a self-referral. If you're not sure how to get in touch, I'd go through school/nursery/health visitor and they're bound to have contact details for you.

4, about to go to school. It's a th lisp (or should I say lithp). Diagnosed with glue ear and has grommets. General language seems fine, wide vocab, even some lovely swearing 😝also says f not th but I realise that's a regional thing. Don't think she has a health visitor. Nursery couldn't suggest anyone when I asked.

My ds got referred on his 2nd birthday. He's now 3.7 and has only had 3 sessions of verve with someone who's not a speech therapist in a year and a half. I've been told he's still on the waitlist, what can I expect next? Verve did not help, have you found this a good method?

My DD is 23, non-verbal with severe LD due to a rare genetic condition. Several others with this condition are having success with AAC on iPads. She has tried a couple of programs but isn't interested - she doesn't find it motivating. Is there a particular ASC app you would recommend and is there a good book to help with trying to introduce it? We don't have any SLT at the moment. Thanks.

I'm hearing our head of the AAC team in my voice here - no one is going to magically pick up an AAC device and start using it, the family all need to use it WITH her to start to model conversations (so don't just set the device up with nouns because you can't have a conversation just naming stuff), for her to start to understand the role of the device. It's not so much the app that matters - but how grids are set up really which I'm not much of an expert on as we have a specific team who do all of that... https://www.assistiveware.com/support/proloquo2go/vocabulary-grammar/introduce-core-words shows the kind of progression when you start with a few words and build up on that (and you could do that with any AAC app in your price range - because Prolo is painfully expensive one-off or on a subscription model which I personally hate)

I know when our assistants go out they'll spend time with a client on activities, and they'll use the device to model what they're doing - so one visit I shadowed on - he was playing with those horrible sensory worms (that make me shudder cos I can't stand the feeling of them) and our fab assistant started modelling "big worm" "yellow worm" etc building up to "I like green worm" and the like and the client rapidly picked up on echoing that - that's the kind of way to think about it, rather than assuming someone is going to immediately start with "I want biscuit" just from the pictures on the tiles. In my service we talk a lot about means/reasons and opportunities for communication - a device is just a means to communicate - you need the reasons and the opportunities as well (even if it's just a good chat).

Makaton is usually worth considering as well - but again, the whole environment needs to start using it before someone is likely to begin to acquire it and echo it back to you. Huge number of resources online to start to build up basic signs and just signing the key words in the sentence also highlights what those words are to the listener, and forces you to slow down your speech a lot which makes it more accessible to your listener as well.

Thank you - I have been modelling for a long time using Grid for iPad but with single nouns rather than phrases. Without any SLT help on this I haven't known what I'm doing! I will have a look at the link and try with small phrases. Thanks for your help. DD is quite competent at finding music she likes on the iPad so I feel she could do this if she sees a point!

Do you actually get to do any therapy in your borough?

I work as a SLTA but in my trust, we do all the therapy sessions and the SLTs do initial assessments, reports, reviews, groups, etc but no actual therapy.

I love my role and have been debating whether I would like to train to be a SLT but it puts me off that if I stayed in my trust, I wouldn't actually get to do any of the "fun" stuff!

That's interesting. I'm a Band 5 SLT so I like to think I'm still building up my clinical experience so I tend to arrange to see children for their blocks of therapy myself. If I've got a few children at the same school, I'll sometimes ask one of our SLTAs to see them for a block of therapy but, at the moment, all my cases are spread across different schools so haven't been able to do that really. We're a very rural area as well and only have 2 SLTAs for about 6 different clinical bases so it also depends on their availability.

I think the main thing that differs between being an SLTA and an SLT is the clinical decision making - we're the ones responsible for diagnoses and coming up with evidence based therapy plans. One of our SLTAs actually said that she loves her job in terms of working with the children but can't imagine what it's like in terms of the decision making process (she's excellent though and so interested in it so she's a real asset to our team!)

I don't actually mind doing the "behind the scenes" stuff like reports, therapy plans, reviews etc as it builds up my experience and, the more I do it, the more confident I become and it reassures me that I do know my stuff (believe me, there are SO many times I doubt my abilities!) and that I am good at my job. It can get a bit monotonous, but it also helps me slow down a bit and take stock of everything to do with my caseload.

I had to look up "Verve" as it's not something I've heard of before. It's definitely not something we use in our team (or the 2 other teams I've worked with in the last nearly 10 years). From what I gather, is it to support children with social communication difficulties?
What were the concerns raised when your son was referred and what are your main concerns at the moment? Do you have any expectations of what you're hoping to get from SLT input?

@Withswitch I wouldn't worry too much about the lisp. Unless there are other speech sound issues going on impacting her ability to be understood (intelligibility), it will likely resolve on its own over the next year or so. If you like, you could try some visualisation tricks (mentioned them in a couple of earlier posts) - look in a mirror with her and ask her to pretend her tongue is a snake or a lion and it has to stay behind the cage door (her teeth) while doing the 's' sound.
If you still want a bit of support, you could find out how to contact your local SLT directly or go to your GP and see if they'll put a referral in for you.