My feed
Premium

Please
or
to access all these features

AIBU?

That Neurodiversity is becoming an issue

360 replies

mamainlove · 25/09/2022 21:05

Sorry about the thread title:

I have been umming and arrring posting this thread. I'm not able to be speak about this with family/friends (due to lack of knowledge about the area) and some colleagues, as I may seem like a monster if I shared my views.

But I currently work as a speech and language therapist for NHS. The Neurdiversity trend has really changed our practice which I feel may be detrimental to our young people with ASD.

To point out. The support for neurodiverse peopje is minuscule. Children with ASD receive the least amount of provision and if you have a co-morbid conditions, even less so as it's about changing the environment and not about specialist interventions.

Currently, my team are scrapping some of the "typical" interventions that children with ASD usually receive. The idea behind this is that we shouldn't be using interventions that follow a neurotypical path.. for example, if a child with ASD likes to stim with cars, we shouldn't change this (agree) but we shouldn't model and try to teach the children functional play skills, imaginative play, turn taking, "social skills", conversations as that is neurotypical expectations.

I am happy that there is an awareness of neurodiversity but I'm worried that there's a harm in reducing services for children with ASD. A little bit frustrated with the team as it appears that we all have to conform and it's making me reconsider my career choice.

I'm not sure how I could go around this or is the problem with me?

OP posts:
Report
goldfinchonthelawn · 27/09/2022 18:06

AntlerRose · 25/09/2022 21:22

I think learning how a conversation works is a useful skill for a child who might not pick it up naturally.

I dont mean 'nice weather today' but role playing and rehearsing buying something in a shop or order a meal.

Is that the type of thing you mean you are stopped from doing?

I agree. I think there's an important differentiation between encouraging children to mask and teaching them things they don;t pick up instinctively. DS (ASD) is now an adult and is always asking me "How do you know if someone...?' He just doesn't pick up non verbal cues but that doesn't mean he doesn't want to interact socially and fit in. Ideally without masking but with sufficient learned behaviour which he has chosen to learn.

Report
5zeds · 27/09/2022 18:06

Hmmm I’m not sure what you’re trying to communicate @Neurodiversespeechies are you saying you think nonverbal autistics don’t need as much input from salt because you won’t see them communicate independently but only with focused training for their support workers?

Report
Neurodiversespeechies · 27/09/2022 18:59

No, what I’m saying is, in order to support those non verbal teenagers with autism, the approach I will take is different and will often not involve what you perceive as ‘direct therapy’.

in order to make progress and develop functional communication skills those teenagers need to be in a home and school environment where they are provided opportunities to practise their communication within everyday activities. Good quality coaching for parents and school staff is what will achieve this.

Seeing them 1:1 for ‘direct therapy’ would not achieve functional communication skills that would generalise to every day activities.

The type of autism they have, combined with their learning difficulties means they need to be supported in a very specific way. Thanks to that support they are making progress.

Report
5zeds · 27/09/2022 19:13

I’m sorry I appear to have used a term that means something more specific than I intended. I meant “delivered for that individual” not what I think you mean which I gather is “direct therapy” means coaching of that individual???

Report
5zeds · 27/09/2022 19:17

Out of curiosity have all these individual teens been given cognitive tests they can access or is it assumed they have these difficulties in addition to their communication disability and autism?

Report
mamainlove · 27/09/2022 20:54

@Lovelyricepudding

So you consider Autism as a condition that needs treated, like anxiety? In this situation I would say they were an autistic person who needs to be treated for anxiety. If they had learning disabilities and autism as well as anxiety then I would say they are an autistic LD person who needs treated for anxiety. In both cases their anxiety treatment needs to be tailored to the person. You cannot discount their autism or their LD whilst treating their anxiety. Or treat them the same as someone or have only one of LD and autism

Do I think Autism needs to be treated? My analogy was quite simplistic and it depends whether you see Autism as a disability vs difference or both. But you may have an Autistic child who... I don't know.. need support navigating and understanding different social situations or recognising/figuring out emotions and that same Autistic individual has anxiety. What I am saying is that I would treat both conditions wherever lies their difficulty. However, whatever treatment I give of course would affect my style of therapy in which I have to take into account the persons Autism/LD- therefore therapy is individualised and personalised.

But what usually happens in services- including SALT. If you have an Autistic individual who has mental health needs, some services would deny the referral from Autistic patients as their Autism is seen as the main culprit for their mental health needs and if they have some support with their 'Autism' then that will solve the mental health needs ifyswim.

whatever and Ifyswim. I think we are on the same page but probably I'm not explaining myself well.

OP posts:
Report
mamainlove · 27/09/2022 20:58

Neurodiversespeechies · 27/09/2022 18:59

No, what I’m saying is, in order to support those non verbal teenagers with autism, the approach I will take is different and will often not involve what you perceive as ‘direct therapy’.

in order to make progress and develop functional communication skills those teenagers need to be in a home and school environment where they are provided opportunities to practise their communication within everyday activities. Good quality coaching for parents and school staff is what will achieve this.

Seeing them 1:1 for ‘direct therapy’ would not achieve functional communication skills that would generalise to every day activities.

The type of autism they have, combined with their learning difficulties means they need to be supported in a very specific way. Thanks to that support they are making progress.

Seeing them for direct therapy would immensely improve their language disorder. The whole 'well we need to teach them functional skills in the everyday environment' is more or less just treating their social communication difficulties aka 'Autism' but not the language disorder- it may have some impact but you won't see a huge impact. Children with a comorbid language disorder (depending on severity) do require intense, tailored and direct therapy to remedy or improve their language disorder.

OP posts:
Report
mamainlove · 27/09/2022 21:02

I feel a bit sad reading comments by SALT's like @Neurodiversespeechies. Have you not read the up to date research on treating and regimes for language disorders? There is a saying, mainly for children with Down Syndrome but I think I've read the same thing for ASD, that they need at least 2 years of 1:1 direct therapy in order for it to generalise in their everyday environments.

OP posts:
Report
5zeds · 27/09/2022 21:03

Seeing them for direct therapy would immensely improve their language disorder. The whole 'well we need to teach them functional skills in the everyday environment' is more or less just treating their social communication difficulties aka 'Autism' but not the language disorder- it may have some impact but you won't see a huge impact. Children with a comorbid language disorder (depending on severity) do require intense, tailored and direct therapy to remedy or improve their language disorder.
this is my experience too, but I am aware that my young person has a very severe language disorder and so I don’t know how sensible it is to generalise our experience.

Report
mamainlove · 27/09/2022 21:04

@5zeds

It appears to be a common place for a child, with significant language difficulties, to be given a diagnosis of a Learning Disability, without proper assessment. I have come across many reports which state the child she 'learning difficulties' but not report from an Ed psychologist or assessment to asses the learning needs, have been undertaken.

OP posts:
Report
5zeds · 27/09/2022 21:10

It’s been hugely problematic for us @mamainlove and don’t honestly know what the solution is. Understanding of how it needs to drive support is so limited that sometimes we get a better outcome if we don’t try to explain.

Report
Neurodiversespeechies · 27/09/2022 21:44

@mamainlove
Out of interest have you ever done 1:1 direct therapy with a a pre verbal teen with autism for prolonged periods of time and has it been more effective in achieving functional communication than aac within a classroom.

If you could link a study that proves that you can successfully treat a language disorder in a preverbal teen with autism in a way that successfully generalises to everyday activities i’d be really interested to read it!

The teens I saw today have successfully transitioned from pecs (which I would not consider a robust or functional language system) to an iPad. One was typing sentences using the keypad (the sentences showed little sign of ‘language disorder’), one was using a combination of typed words and symbols and may have a language disorder and need some work on structuring this to make it more functional and one was just beginning to join sentences.

All 3 are making progress, all 3 have more communication than they did a few months ago and none of them are appearing stressed by the implementation of this communication system.

I agree that Down’s syndrome is a different kettle of fish and direct language therapy is needed alongside work in all other domains of communication and interactions. Interestingly what I’ve never managed to find and would be really interested to read is a study that compares results when therapy is delivered directly by a salt with therapy that is delivered by a well coached/ trained parent/ teacher/ TA with supervision from a salt.

Report
LottiePa · 27/09/2022 21:51

NHS SALT is an absolute waste of time.

We waited 16 weeks for an hour appointment to be told they would Give DS targets and review in 6 months (he is 3 next month and has 5 words but SALT don’t seem to care / want to help)

I’ve been fighting for help for DS for 18 months. Everyone goes on about early intervention but no one intervenes!

Report
Neurodiversespeechies · 27/09/2022 21:53

@5zeds they have been assessed by an Ed psych though, not being a trained Ed psych myself, I can’t comment on what exactly that assessment will have provided.

I think a tricky thing is though that autism is a disorder not a delay. This means that every person with autism has a spiky profile of strengths and needs and therefore intelligence can’t be compared in the same way as it would to a neurotypical person. You can be a highly intelligent person with autism and still have significant needs in multiple other areas. This does not always mean that we are able to bring all skills in line because if that was possible we would be curing autism and unfortunately that’s something we just can’t do. We need to build on what we can with the resources we have.

im not someone who is buying into the neurodiversity movement in all ways. I fully believe that the type of autism I work with every week is very different to those who are able to articulate themselves so well on line to argue that much of my work is wrong or cruel or ablest.

Report
Neurodiversespeechies · 27/09/2022 21:57

An unfortunate accidental posting too soon there…

and because I believe that there’s such a wide gap between the people shouting for neurodiversity affirming therapies and those I am seeing for therapy I try not to base my practise on those opinions.

Report
Neurodiversespeechies · 27/09/2022 21:59

@mamainlove I’d also be interested to hear what your 1:1 direct language therapy for preverbal teens with autism would look like?

any ideas for activities are always welcome

Report
5zeds · 27/09/2022 22:05

You can be a highly intelligent person with autism and still have significant needs in multiple other areas.
obviously

If you don’t understand what the Ed psych assessment provided, how does it inform your practice? My experience would suggest that group teaching with multiple teens with differing needs and multiple support workers receiving training and a trainer would not be ideal in anyway and I can’t imagine how it would be better for any of the teens involved.

Report
mamainlove · 27/09/2022 22:27

@Neurodiversespeechies

Interestingly what I’ve never managed to find and would be really interested to read is a study that compares results when therapy is delivered directly by a salt with therapy that is delivered by a well coached/ trained parent/ teacher/ TA with supervision from a salt

I don't want to out. myself on this thread and don't wish to link the research articles as THAT will definitely put me. But there is a recent paper on this very comment you are querying about it.

In a short answer, for children who have significant language disorders therapy is better when it is delivered by trained speech and language therapists.

There is some evidence that therapy is also effective (communication wise) when it's delivered by a parent. But that's only when they have very close supervision with the the SALT and there is regular coaching from a qualified therapist. 3 or 10 visits a term from an SLT, training teachers and parents is not going to cut it, even if the parent has some training here and there. Parents and TA's require regular ongoing coaching, training and modelling an SLT. If you have very clued up parent, then that's amazing and something different.

Having Therapy done by a TA would not yield much results for children with significant language disorders,the evidence pointed out that children with mild language disorders benefited actually were the ones who benefited from therapy where your average TA's had modelling, guidance from an SLT.

The qualifications and experience of the TA is crucial and will lead much better results for children with significant SLCN. So if you have a TA who has a number of years experience working with children with SLCN, has a degree or advance education status, has conducted trained suited for those with SLCN and is given regular support, coaching and guidance from an SLT, then that is gold and that's when you would really see a difference in the children with SLCN. I used to work with an ex dyslexia trained now TA who was Amazing. Any interventions, she took it on the chin, she knew exactly what she had to do, how to step up/down.

... I have worked with pre verbal teens but that's not really my area. Would I do 1:1 therapy with a preverbal teen on a weekly basis-no, it would be much more functional but I would argue that he should have received 1:1 weekly SLT in his younger years (even if he was non verbal). I also would not expect a pre verbal teen to transition from PECS to an high tec AAC. The implementation of an high tec AAC should have been implemented way way sooner- rather than the child reaching some level of "competency" before moving onto PECS.

OP posts:
Report
mamainlove · 27/09/2022 22:31

*moving onto a high tec AAC that should say- I'm on my phone so my grammar is all over the place with the stupid autocorrect.

OP posts:
Report
5zeds · 27/09/2022 23:03

The implementation of an high tec AAC should have been implemented way way sooner- rather than the child reaching some level of "competency" before moving onto PECS. there’s a lot of gate keeping of skills that impedes progress.

Report
Neurodiversespeechies · 27/09/2022 23:21

Any chance you’d be able to private message me the study? I’d be really interested to read

Report
Neurodiversespeechies · 27/09/2022 23:30

As I said in my post I don’t consider pecs to be a functional commutation method. One of the things I actually agree with the neurodiversity movement about!

I also haven’t said anywhere that I required these teens to do pecs/ gain certain skills before they were allowed high tech aac. Gate keeping of skills isn’t what has happened,

In this case I have don’t the best I can for the teens whos’ care has been recently transferred to me and that has involved introducing high tech aac.

I think you’ve also misunderstood my definition of coaching. I wasn’t providing training as such. What I did was spend time in their classroom modelling to the adults how they could be using the iPad more in the lesson. I also took each teen separately with a TA and modelled an example of an activity where they could be reinforcing the core vocabulary words (functional words such as help, want, more, stop etc). I’ve left the class with a clear guidance of what to practise before my next session. That’s what functional speech therapy is looking like for that little group of young people with autism at the moment. It’s not less, it’s not worse quality because it’s not ‘direct’ or taking place 1:1 away from the classroom. It’s based around their current needs and maximising their use of the tools they have available to them in functional ways.

Report

Don’t want to miss threads like this?

Weekly

Sign up to our weekly round up and get all the best threads sent straight to your inbox!

Log in to update your newsletter preferences.

You've subscribed!

Neurodiversespeechies · 27/09/2022 23:31

forgot to tag @5zeds in that previous post

Report
5zeds · 27/09/2022 23:48

I assume the pecs bit wasn’t aimed at me?

Most autistics find focus extremely difficult in crowded environments, most language disordered people find hearing what is said when delivered by multiple voices, with other voices muddled in and and over and changes in who is talking to who very challenging. I can only speak from my own experience which is with one individual over a couple of decades, so more hours than a professional but without the breadth. I’d express similar concerns if someone was attempting to teach a reception class to read in a busy train station.

Report
mamainlove · 27/09/2022 23:49

Neurodiversespeechies · 27/09/2022 23:21

Any chance you’d be able to private message me the study? I’d be really interested to read

Yes!! I'll be happy to Smile

OP posts:
Report
Please create an account

To comment on this thread you need to create a Mumsnet account.