Need SALT advice please!

[TheTimeTravellersWife]

DD has previously been assessed using CELF as having severe expressive and receptive language difficulties, 0.5th centile.

We know this is the case, but a new SALT has just assessed her using ACE Assessment of Comprehension and Expression and announced that she now has "age appropriate" language.

She hasn't and this is reflected in her Statement and IEP's. She HAS a speech and language disorder.

She is 7 years old with ASD, speech and language disorder (in addition to communication problems due to ASD) dyspraxia, and dyslexia.

I am worried that they will try to take her SAlT away!

This is in the context of an Annual Review of her Statement. I am deeply suspicious.

Looking for advice on how to defend her SALT provision - for example,is the ACE test appropriate for a child with ASD?

I have been looking at the general area of SALT tests, have you googled the ACE test and interpreting results? [[
www.itl.nist.gov/iad/mig//tests/ace/ace07/doc/ace07-evalplan.v1.3a.pdf]]

www.pearsonassessments.com/NR/rdonlyres/3D98AA3A-5E1E-4F29-8D91-4A98A3F53087/0/CELFP2_PRESCHL_Case_Studies.pdf I was looking at documents like this to understand CELF tests to.

HTH

I'm an SLT.
The ACE is divided into 7 subtests - sentence comprehension, inferential comprehension, naming, syntactic formulation [using grammar in sentences], semantic decisions [spotting similarities in word meanings, eg is wasp similar in meaning to whisk/bee/2 other things], non-literal comprehension, narrative [retelling a story].

I haven't done one for a while (been on mat leave) but I'm fairly sure the scoring for the ACE is left separate for the 7 subtests, and is plotted on a graph to show the centiles (whereas for the CELF you can jig them about to get overall receptive/expressive/total language scores and age equivalents too.)

Have you seen what your daughter achieved for the subtests in terms of the centiles? I'd be asking for specifics, not just 'age appropriate'.

It's not an inappropriate test to use with a child with ASD, but depending on your daughter's specific difficulties it might not be the best to show them - she could achieve age appropriate or above scores on most of the subtests as they are mostly concrete/right or wrong answers. I would expect lower scores in the inferential/non-literal comprehension subtests in a child with ASD.

Out of interest, given your daughter's age, was she assessed using the CELF-4 or the PreSchool CELF-2? If it was the CELF-4, although it can be used with children from aged 5, to me it seems geared towards older children (has age equivalents up to age 17) in terms of tasks and presentation so can be hard for the younger ones to engage with.

In terms of defending provision, they key thing to remember is how your daughter uses the language she has functionally - a child may have perfect language from a technical point of view but if they can't use it appropriately then it aint functional and they still needs support.

Hi Woolytree,

I did try "Googling" for a comparison between the two test, but TBH, it was all a bit technical for me!

I will have a read of the links you posted though - thank you.

Thanks Triplechoc that's very helpful and a very good argument for me to make, her functional language is very poor, regardless of how she performs during 1:1 tests.

She has been assessed using the CELF pre-school twice, with very low scores.

I haven't been given the sub-test results of the ACE test.

It is all to technical and difficult to understand. All I know is the DD often finds it hard to express herself, for example, she has difficulty telling you about what has happened and often doesn't understand what people say to her.

It should be very clear, even without formal assessment, that she has a speech and language disorder and needs SLT.

I'm glad I could be of help.

I would definitely go for the 'functional' argument as well as finding out the specifics of how she did in the formal assessments.

Are school on-side with the need for ongoing input? Strength in numbers and all that.

Also to add, the assessments were done in a (presumably) quiet room, on a 1:1 basis - that is not reflective of the classroom environment.

Even if your daughter can understand a complex instruction in that setting, how is her understanding affected by the noise and distraction in the classroom? By teachers giving instructions to the class as a whole and not getting her attention first?

In a classroom environment she tends to "zone out" and cannot follow general instructions given to the whole class. The teacher needs to address her personally by name. You need to get her attention first. So that is a very good point!

I will ask for the sub-test results, but hope that I can argue my corner for her SALT to continue.

It would appear that there has been some highly selective testing going on. Ask for a re assessment using the same tests as the original investigation. That way you can get a like on like comparison.

Ask for the Standard Score and the Centile score for each test and the age equivalent, that should make it a little clearer to you. If you cant understand what you are being told then you are not an informed partner in the education of the child. Therapists and teachers have a professional duty to ensure that they communicate their results in a manner that the parent can understand.

The other thing that occurred to me last night after I logged off, was that they cannot simply 'take her SALT away'.

YOU have the power in this relationship (although it may not always feel like it). If you are not happy about decisions that are being made about your DD's SLT provision, then you have to say so, and keep saying so. If needs be, request a second opinion.

Nigel1 makes a good point about getting a like on like comparison. I don't think the age equivalents etc on the PreSchool CELF go past 7yrs, so the norms won't be totally accurate, but it'll be close enough for comparison.

Good luck!

Triplechoc, i have just written down your 'functional' arguement that is brilliant. I could have done with you on my SALT thread, can i post a link to it, rather than hijack this one?

Have to go out, will post the link to my thread, would really appreciate your opinion triplechoc hope you dont mind

Have replied on your other thread Claw. It's a bit convoluted but hopefully will be of some help!

Thank you - great advice!

My concern is that this sudden dramatic improvement which is only on paper, not in real life will be used by the LA to removed her SALT provision through the Annual Review of her Statement, but I am much more confident now that I can put a good case forward for not removing it.

We had to go to Tribunal to get it in the first place, and I am not giving it up lightly!

TTW: does it say "age appropriate concrete language"? Or maybe it was meant to, but doesn't?

I am not a fan of the ACE as an assessment for clients with ASD. I am also on mat leave but as far as I recall, the target sentence structure is given as an example and then again with blanks to "fill" with heavy-duty picture support. So it plays to the strengths of those verbal students with ASD who have good auditory recall and/or are supported by visuals.

I would ask for her to be assessed using the CELF-4 which does have a section in the manual on adjusting to take ASD into account. Above all, focus as triplechoc has said on functional language use and use in the classroom, not in an artificial testing environment.

TTTW - is your SLT provided by NHS or employed by LA? If NHS, then the LA has no say in the provision - NHS has a duty of care regardless of statement funding.

Triplechoc - her SALT (and her OT) are provided by the NHS - I presumed that the LA still paid for them because it was in the Statement?

TBH, I have no interest in who provides or pays for her SALT, as long as she receives it, but can see from the LA's point of view, that it matters and may influence them to seek to reduce/remove it from the Statement if they are responsible for it.

SALT is in Part 3 of her Statement, so I thought that the LA had to provide it.

I will remember the term "duty of care" to go with "functional language"

In terms of the ACE, DD is very visual and the school use a lot of visual prompts/supports, so this would definitely influence the outcome of the assessment.

I don't want to appear too difficult, but I will suggest that when the SALT assesses DD again, it would be good to use CELF, for a proper comparison of her progress.

If they are NHS, the LA do not pay for them.

If the NHS cannot meet what is listed in the statement, then the LA must step in to provide whatever is necessary to meet the child's needs (eg private therapist's time) - hence why you need it quantified in part 3, to give the LA some responsibility.

In terms of funding, if a child was discharged from SLT then the LA could theoretically have a case for altering the statement to reduce the hours if the child has gone from needing lots of 1:1 time purely working on SLT targets, but I've never seen that happen in practice - even if the main 'reason' for the child's statement is S+L, chances are they have other ongoing issues that continue to require the same level of support.

And don't worry about appearing 'difficult' - this is your DD's education! You have a valid reason for suggesting the other assessment, it's not like you're just doing it because you don't like the results.

triplechoc, this is an interesting debate but isn't it the case (AFASIC told me this just this week) that the NHS has no legal duty to provide speech and language therapy when they lack the resources to do so and this is essentially so for most non-statemented children and statemented children if the statement isn't written correctly.

However, a local education authority does have a legal duty in the cases of children with statements where the SALT provision is written into part 3 of the statement and specified and quantified in term of who is to deliver the therapy, how often and when. When the statement is written correctly even if the local NHS says they cannot provide a therapist to meet the need, the LA must provide it.

The NHS are not under any similar obligation.

Yes, but this tends to stand in the favour of parents with statements (not so much those without, sadly :(). The LA is duty-bound to provide as a result of the Lancashire judgement which states that prime responsibility for SLT rests with the NHS but ultimate (e.g. financial) responsibility with LA's.

If the NHS can't provide and you can make a case for SLT for a child legally, the LEA has no option but to externally fund it.

One of the good things about this is that it means NHS SLT's have no reason to be anything other than objective in assessing and reporting on a child's current level of functioning. There is some legal mumbo-jumbo at the bottom of most statement reports to this effect e.g. 'this reflects the needs of X child not necessarily the resources available to X District Care Trust' etc. In reality, it's not always so straightforward as therapists tend, over time, to assume that what a patient needs is what is available. Yet, in my experience, this sometimes is more reflective of what they feel the child will be able to gret and trying to write a report to ensure that vs a political desire to engage with the LA. Certainly in our trust, there is no real love lost between the LEA and SLT. This is a bad thing, in some ways, but it does mean that reports are not written by SALT to some LEA agenda.

Don't know if any of this makes sense!

arses - in our area our SALT team is joint NHS and LEA. They are a combined, county wide team. SALT is not available without a referral through education. Our community paediatrician tried. The SALT we saw fro my son's SA was very 'political' and I had to argue very hard for her to stay involved at any level as she didn't want to know.

She then even had to send her suggestion of basic consultative SALT to her head of dept to get agreement on resources.

I have an indpeendent report whic says DS needs direct and indirect therapy but there is no question that the LA/NHS SALT team will agree to provide direct 1:1 for a child with ASD who does not have what they call a 'language problem' i.e. scores poorly on CELF.

There is a 'pathway' they follow which says they discharge children with ASDs who do not have 'language issues'. Pragmatic language skills (am I right in thinking this is functional language) can be worked on by ASD outreach and untrained TAs.

So, I cannot see a SALT on the NHS (the ASD diagnostic team referred and my community paediatrician wrote to them and they referred back to the SEN pathway) and I cannot get a SALT in school despite the fact that there is evidence of clear need.

The SALT who wrote my son's report knows that if she says he needs direct therapy, it will mean a statement.

Debs40 - as far as I am aware you are right about LA being legally obliged to step in to provide SLT if NHS cannot provide if it is quantified in part 3 of the statement.

I can't comment on the NHS's legal obligations as I don't know!

Your situation sounds very difficult to deal with Debs40, and unfair.