DS 2.10 - questions about nursery and speech delay/possible ASD?

[fuzzpig]

DS starts at the school nursery in September. He does not talk a lot and is still very unclear, leading to a lot of frustration, although this is slowly improving. He has had initial assessments with a SALT and did a 6 week group course a while ago. Upshot is he's got an audiology assessment (just to rule hearing problems out, they don't suspect anything along those lines) and a joint paediatrician/SALT observation (I think they will be doing 3 sessions). So not overtly an ASD assessment - I guess he's too young for that anyway as his problems are not really severe - but they just want an overall picture I think as he is definitely below where he should be.

I am worried with how he will do at nursery - I know the school and they are very caring with loads of staff doing one-to-one, nurture groups etc, it is amazing but DD did not go to that nursery so I don't know it yet. I just wondered if there is anything particular I should be discussing with the staff there? He has a short stay and play session next week so I guess that will be a good chance for them to see how he is. They do home visits just before term starts but I don't want to leave the questions til then! Or should I just wait and see what they say?

The other thing I'm wondering about is, what happens if they are concerned about him? Would they involve an EP or is he too young? And how would it all fit in with what we are already doing with the hospital?

I am totally new to all this, so would really appreciate any advice!

Why do you suspect ASD?
I think he's awfully young to be sure of anything, but SLT exercises won't hurt.

TBH we aren't as worried as we were, because he is communicating more (non-verbally as well as with speech) now than he was when he saw the SLT. I wouldn't go looking for a dx or anything as he is still little. The SLT was really good though and listened to everything about the repetitive behaviour, anger at break in routine etc which could obviously just be regular toddler stuff but she didn't dismiss it - it was that which led her to suggest a referral to the CDC but more to get an overall picture. She also wrote down that I recently got my own referral for AS when I finally approached the GP about my own problems. Obviously that is playing on my mind, I admit I may be worrying for nothing, I hope so because I don't want him to struggle as I have. But then on the off chance there is something wrong then of course the earlier the better as lots of parents have told me it takes a long time.

As I said I am not concerned with a dx but I am worried that he will struggle at nursery because he can't communicate all that well. He is really gentle but lashes out when he is frustrated, which happens a lot. I am worried he will hit other children because he can't talk to them. This all sounds quite normal writing it down so hopefully I am worrying over nothing, he is my wonderful little boy though and I can't quite shake the feeling that he won't get his needs met. Or should I wait and see? I don't know, this is all new to me as I had no worries at all with DD.

They also said in the nursery handbook that they want their pupils potty trained before they start! They can't insist on that can they? He will turn 3 just before starting and I don't think he will be ready though we will give it a go in summer.

fuzzpig, I'm an Early Years SLT. All nurseries will be used to having children with a range of different needs, including communication difficulties. It's really good that you've got a positive impression from the nursery already. Have a chat with them when you go to the settling session next week and feel free to ask them any questions you have.

Did your SLT give you any written advice or a program of activities? If you have any written information, bring it with you so the nursery can take a copy of it (the SLT may already have sent them a copy). And no, they can't insist on toilet-training if the child has additional needs - not every child is ready to toilet train at 3 and they have to accommodate that. One more thing - do you go to your local Children's Centre? That's another terrific place to get loads of advice and support and there should be a SLT you can speak to informally if you need to.

Thank you lotta :)

Didn't get any exercises, as it was basically an assessment, though she did make informal suggestions about how to set out instructions/telling him what's happening etc so that he can understand it better. She did write a brief report though so I guess we could show them that?

TBH I barely get to do anything with DS anymore as I work FT, DH is now a SAHD but this is because he is injured and waiting for surgery, it is difficult for him to take him out at all. We were also referred to family outreach. A new autism resource centre has opened in my town so I'm hoping we can pop in if they don't specify that you need a dx.

Follow whatever advice she gave you. There are no 'exercises' as such - children develop their communication skills through playing and spending time with others so it's about following your DS's lead during play, rather than taking the lead and feeling that you have 'teach' him, he's not ready for that at his age. Use visual cues as much as possible when talking to him - actions, signs, gestures, pointing - as well as the words so he can 'see' what you're saying as well as hearing the word. When you use words with him, don't think of it as helping him to 'talk' - you're helping him to understand words first. Children have to understand a word before they can say it, so don't worry if he's not copying or repeating words after you.

Hope that helps. Don't be afraid to ask questions of the nursery!

Thank you, I am hoping that being around other children will encourage him to speak more. The few times we have left him in a crèche he has been ok so hopefully he will take to it :)

Having been in a similar position at a similar age, I broadly agree with lotta - except I think that lotta must live in a better resourced area than mine to have SALT drop-in available!

The huge issue I think is whether your DS's receptive understanding is delayed, as that will have a huge impact on concentration/behaviour if he's not understanding what is expected of him, you may notice him trying to deduce from visual clues what happens next.

In terms of what to discuss: explain the background and that you are think he will be assessed for ASD in the near future. and then ask them what they do to support children with communication problems?

In terms of EP involvement - depends on what the usual ASD diagnosis procedure is in your area - in mine the EP is automatically part of the multi-disciplinary assessment. The EP is I think more part of the LEA than NHS system, and wouldn't diagnose on their own, so I wouldn't worry about how it fit with the hospital. In first instance if nursery had concerns, I would expect nursery to liaise with local early years inclusion services, who will have their own advisory teachers, before an ed psych was involved.

PS - the main SN board probably gets more traffic than here, so you might want to repost this on there as well.

I work in a nursery and we have lots of children with speech/communication problems for various reasons - we use various communication methods like makaton signing, symbols and photos, choice boards etc to reduce frustration and include all children.

Being around other children will be great for him and I'm sure he will have a lovely time. But please don't underestimate the importance of what's going on at home - he's learning way more from you and his dad than he will from other children who are at an early stage of development themselves, so please do follow any advice you've got!

Rubirosa, that sounds like a fab nursery! Good for you

Hopefully it is very ordinary and all nurseries would be doing the same.

Rubirosa, I wish that were true too but it's not

I feel guilty because (a) things are completely shit at home and have been since DH got hurt (just after DS turned one) so he's not getting as much attention or stimulation as he should and (b) if we both have an ASD then he's got it from me and it's my fault. I do know how ridiculous b is but the feeling is still there, I guess I am just coming to terms with my own issues.

I am happy that as nurseries go this one is excellent, I am sad because he isn't going to the community Playgroup that dd went to (he got a space at both but we turned the latter down as it is hard for DH to get to) and they were a lot more 'open door' in that you could volunteer etc. OTOH this nursery seems better resourced and there will be continuity with the school.

We do some signing with DS, we started it at 18m as he hadn't spoken at all then and it really helps.

We've been asked to put a scrapbook together - I didn't bother with DD's but I think it would be very helpful with DS so any suggestions would be good.

at TLP :)

on counts a) and b), life happens, and happens to us all. guilt is pointless. am sure you and DP are trying v hard to improve his communication.

re:scrapbook - I think it's useful to have photos of special people/places, as it will help introduce them in conversation if he has a visual as well.

The scrapbook is a great idea. Don't worry, he doesn't need anything terribly intensive - just chatting with him when you or DP are doing his everyday things (bathtime, mealtimes, shopping etc) will help loads

And by the way, in my experience with probably over a thousand parents, everyone feels guilty. Not saying that you are wrong to feel that way - you can't help how you feel - but other parents feel the same. You're not alone.

yes, definitely agree re:guilt. I feel guilty that I didn't realise DS was unusually placid/passive, just thought he was a v chilled baby. Though when I was first concerned about his language I was fobbed off by several professionals initially so I can't exactly take all the blame!

:) am trying. Guilt is a default setting for me I struggle with things like chatting and imaginative play, thankfully DH is brilliant at it especially the silly stuff that makes me want to run away! So it has been nice realising there's a reason that I struggle with this stuff but I haven't managed to stop feeling like a crap mum yet. It helps me to have instructions like the SLT gave.

the whole get down on the floor stuff never came naturally to me either, I was/am far better at the out and about going to park/zoo/library/museum type of thing. If you outsource the pretend play to your DH, there's still the benefit of the reading/singing/general chatting. You will chat more than you realise to your DS when going about the daily routine - here's your coat, now let's get your arms in, here's your dinner, etc. obv depending on your DS's understanding of language you may need to tweak wording a bit, mind. Ask SALT if your area runs Hanen or equivalent courses - they are courses where SALT help you help your child come on language wise.

Wow that is very young. I always thought high functioning in particular would not be dx until later (no idea why I thought that though!). It must be good to get that done so early.

DS has the CDC assessment tomorrow, I won't be able to go because I am sick, but is there anything I should remind DH to mention/ask? I assume the only knowledge they will already have of DS is the brief report from the SLT (argh too many acronyms!) I also am assuming they wouldn't really say anything at the end of the assessment but would do another write-up?

to mention; the doctor should be able to ask the right questions, but apart from the language and pretend play issue, you would expect to cover:-
1)developmental history from PG onwards
2)physical development - any delay walking/sitting etc
3)whether diet/self-care/sleep are what you would expect for this age group
4)any difficulties with changes in routine
5)social skills
6)basic skills with simple jigsaw

I would say the most important thing to remember to ask is - what the professionals are planning to do next, and in what time scale - i.e. to keep on top of things in case the professionals don't!

Assessment done. Feel a lot better as paediatrician said she's not worried about ASD at all as his social communication has vastly improved since the previous assessment (I agree). He was chatty (in a babbly way) and cooperative unlike last time!

She was really nice and not at all dismissive that we had been worried, and said that the behaviour problems are from frustration. Development is normal (and "very impressive" for the puzzle/coordination bit ) so the only thing she is concerned about is the speech and language - she said in that aspect he is like a 14-20 month old, so over a year behind where he should be. That was more than I thought tbh :(

She's going to refer back to SLT so they can be more involved (thank goodness as I feel out of my depth in that respect). She was very reassuring about the nursery though saying that while some frustration will be inevitable he will probably be encouraged and should start to catch up.