first salt app, bit of a waste of time

[skydance]

My son has been on the waiting list for 10 months and we went to his first SALT appointment last week.

But I was very disapointed, she was very young and obviously inexpereienced, she said that his understanding wasn't where it should be based on the fact that he

pointed to the big key rather than the small,
pointed to mummy on a ladder rather than daddy,
and pointed to somebody cutting their hair rather than brushing

He definately knows all of these, defintely, I can remember instances before and I have checked since the appointment. He wasn't overly engaged with her she was very patronising even to a 3 year old, I felt like saying 'he has a speech delay, he's not stupid lovey'

I then get a 3 line 'report' through the post, stating that he is developing language but that his understanding is not where it should be, that's it basically the whole 'report'.

Is this it, does it get better? She also mentioned some group therapy sessions, he's very shy and will spend the whole time in a group session glued to my side not saying a word.

Very dissapointed, his pre-school claimed they were waiting for this report to decide what help to give, but there is nothing in the report I've written pretty much the whole 'report' down above, and it's not even accurate.

I stated what I was doing at home to help him and asked for some other suggestions, she got all flustered and muttered something about putting some suggestions in the post, well they arrived with the 'report'. Suggestion number 1 - leave a pause after you have spoken to allow the child time to respond, 2 - make language fun! you get the idea, absolute patronising rubbish.

Tell me it gets better please and any experience of group sessions?

It didn't get any better for us

they tried to push us towards group sessions - much cheaper for them.

LOL. Oh poor you. No. It doesn't get any better if you just sit still.

You have a choice:

1. Figure it out yourself. Inform yourself. Ditch the SALT.

2. Figure it out yourself. Inform yourself. Turn up at the next SALT and control the appointment asking direct questions of things that she can do to support/change what you are already doing to make it more effective. If she is rubbish, complain, get a better SALT. Repeat. Get an even better SALT. Repeat. Get an even better SALT.

thanks all of you, what I suspected then it's down to me

I'll carry on with what I'm doing already and will also get tougher with salt and pre-school.

Will look into the book and also some private salt for him.

3. Do what the SALT suggested and your own thing at home -> happy supportive if none the wiser SALT... one less thing to need to battle over

Agree with justa (sorry Lunar), but you can't tolerate a flippy floppy SALT.

Either get rid or get a better one. The thing is that a flippy floppy SALT will take the credit for all your hard work and you'll have difficulties in the future trying to get provision or get anyone to believe you over her. You need someone to work with you.

And quite frankly time spent at a flippy floppy SALT session is time that could have been spent doing something productive.

Also, surely you knew that you'd have to do most of the work!? SALT isn't magic.

that's very true stark, I did know it would be mostly down to me and have to admit before we went I certainly wasn't expecting a magic cure and in fact I do wonder if the therapy isn't a waste of time and that what he really needs is of course my attention and in fact mainly time, which is why I have researched and have been doing what I can at home to help him, I mean how much can be done in one weekly appointment for 5/6 week blocks.

But what I was hoping for, were more suggestions for me at home to improve on what I'm doing, more directed excerises etc. and also the report, I really wanted to know what is going on and why and what are we looking at longer-term, those are the points that I felt really let down on, although I did realise I wouldn't get immediate answers I was expecting more to be honest.

'And quite frankly time spent at a flippy floppy SALT session is time that could have been spent doing something productive'

completly agree with you, that's exactly what I was thinking whilst in there, that what I do at home with him is better than this and in fact more effective.

I did challenge her at the time over his understanding, and do have the name of her superior, I was waiting for her 'report' before contacting and complaining.

That is a very good point about her taking the credit for what I am doing at home and I have to admit just what I was thinking.

I will look into the Hanen book - It Takes Two To Talk, I had heard this recommended before but think I will order it now, I could with a boost with all this to be honest and perhaps some new ways to help him.

thanks all for confirming that he deserves better than this, will keep fighting.

Initial appointments are often with the least experienced staff (they are cheapest).

In terms of the issue with understanding, are you saying you disagree that it made a difference that he understood/didn't understand these words? To pass the particular assessment the therapist used, your son needs to be able to respond to these key words without additional cues in a whole sentence e.g. he may understand big vs little on their own but if he can't follow the instructions in context in this heavily supported, scaffolded task (as a Derbyshire language assessment invariably is) it is not passed it is highly likely that his understanding is compromised in real life (wich is a lot less structured and subject to more interference). I can explain more if this isn't clear..

I'm not a fan of the assessment you did as anything more than a screen - but I will say that IME while it may not tell you much if you pass it, if you don't pass it, it means it's unlikely that you have no comprehension/attention etc issues. Even if you are totally and utterly uninspired by a therapist etc, if the task is second nature it usually doesn't cause any issues e.g. if I called your name out loud, you might not like me, but you will still understand and react to your name. Did she mention what level he was at - 2 or 3 WL?

If he is 3 and made minor errors at 3 word level (Give the big spoon to Daddy) she will have categorised him as low risk/likely for spontaneous recovery which is why you got basic language stim advice. I know it sounds patronising when you are a highly educated professional or middle class person but bear in mind that there are strict guidelines to keep thing in "plain English". I know that "playing to the lowest common denominator" in written communication is frustrating (I find it frustrating when I am a service user) but it is the nature of corporate communication in the NHS.

The therapist you met with is most likely an entry level therapist with a massive caseload who has about ten minutes to write a report and not a lot of thinking time.

I'm NOT defending the system here, btw - it's crap and believe me, as a therapist I never enjoyed it one bit - but if you're unhappy with it, and you would like someone senior to assess your son, request this of the department. Certainly in ours the management will usually oblige.

working thank you that has made it all a lot clearer and given me some points to think on before I go further.

Regarding his understanding, he definately seems to understand those words and quite frequently uses them in real life situations correctly, but to be honest they were near the end of the book full of boring black & white pictures and I think whilst he was trying to co-operate he had rather lost interest, but what you say is really interesting and I would have loved her to have explained more, rather than just sort of nervously muttering that all she could do is record what he did whilst he was there, as you say it all comes down to funding, time restraints and the system, I would say she certainly seemed rather newly qualified so what you say makes perfect sense.

The appointment was in a community centre in the middle of a large estate at the other end of the city, she got flustered several times during the appointment and clearly didn't quite know what to say to me at times, which wasn't terribly reasuring. I have requested that any further appointments are closer to our home and she has transfered his file so that's good, should make further appointments much easier to get to, it was quite a way to go, so I really was pleased about that.

I am wondering after what you have said about the first appointment being thought of as a screening tool if I should wait for the next appointment as I believe it will be with the lady who runs the clinic over here and see is she seems more experienced and can get to the bottom of where his difficulties actually are - mainly is he understanding what I'm saying to him, as he certainly seems to, I do use some makaton with him and think I do tend to mime/gesture quite a bit so what she said about him picking up on visual cues did make some sense, just not with those particular words, mummy/daddy, big/small, but perhaps I should take that up with the new lady and see what she thinks - and how I can help him, perhaps if this therapist seems no better it would then be time for me to take issues higher.

And thank you for saying that if we just got the basic advice he's likely to be low risk, I will hold onto that and ask next time, he has certainly started to make some progress.

What you have said has really helped clear my thoughts and clarify some issues for me.

I would say that if she was flustered she is quite new. I remember the feeling, back in the day .

Let me explain a bit more about key words. Basically, if you take a sentence like:

"Give daddy the big spoon"

it has five words in it.

However, context and visual cues mean that to comply with this instruction you don't need to understand each word fully. So, if you say to your son:

"Give daddy the big spoon"

while he is sitting at the table with daddy with nothing on the table but the (big) spoon and daddy has his hand expectantly reached out, then really, your understanding of those words doesn't have to be all that. Arguably, you might not really have to understand anything but the give gesture - you could work the rest of it out yourself if you were quite aware of cues.

If you had a set of big spoons AND big forks and Daddy and Nana were sitting at the table - and you said "give the big spoon to Daddy", your son would need to understand SPOON (to differentiate spoon and fork) and DADDY (to differentiate daddy and nana). He wouldn't need to know big in this context though, as all the spoons and forks are the same size, so the information is redundant. This would mean that to carry out this instruction, he needs to be able to listen to, understand and act on TWO key words - spoon/daddy.

If you had a set of big and little spoons and forks and Daddy and Nana were sitting at the table and you said "give the big spoon to daddy", THEN your son would need to listen to, understand and act upon THREE key words - BIG SPOON and DADDY.

So, it's all about context and listening to the whole direction without additional cues
and (importantly) without splitting up or repeating the instruction.

Parents tend to instinctively give instructions at or just beyond the level of a child's understanding so if, in the last example, you said: "give the big spoon to daddy" and your son paused in confusion, you might:

• repeat the instruction and emphasise the word you thought confused him - give the BIG spoon to daddy
• chunk the instruction - Get the spoon. Give it to daddy (reduces memory load)
• use a visual cue (point, gesture etc).

These are not bad things to do in everyday life - they are the RIGHT things to do to support developing understanding. However, because you may be doing these things instinctively, it may be a bit of a surprise to find that without these supports, instructions that you would expect him to carry out (as you know that he understands all the individual words) might pose a bit more of a struggle.

Sometimes children can understand and respond to instructions with, say, four key words when the vocabulary is very high frequency but not when they are words that are less secure in their understanding (without cues). Sometimes it's the length of the instruction that stumps them. Sometimes it's attention control etc.

At 3, the fact that he is broadly understanding the majority of instructions is a good thing (did you get more detail about what his result was? A lot of trusts send general initial reports due to time constraints but they will of course talk through actual results as they will all be on file).

Having said that, if you are very concerned about his language development and didn't have faith in the SLT who saw him, I would be inclined to contact and say you don't really understand the results as they are and would like a full assessment e.g. the Reynell, PLS-III or CELF to reassure you things are developing along normal lines.
I would be happier with a full assessment against standardised norm if it were my child if I had concerns.

The only other thing to say is that I would agree with posters who tell you to learn how to do it yourself, really. SLT services are extremely dilute in this country as, well, we see everyone. In my trust, when I started, we gave quite a lot of clinic-based individual therapy but as a result waiting lists were 18 months! It's easy to be cynical about cost etc in the NHS and yes, groups are definitely suggested as they are cheaper and a more efficient way of dealing with caseload demands, but unfortunately resources are extremely stretched, largely because the vast majority of people attending SLT either a) don't really want to be there or b) don't really need t be there. Children with very severe communication impairments who warrant ongoing weekly intensive therapy sometimes only get half-termly visits - e.g. so little it becomes absolutely pointless to have the service at all. The way SLT has gone in this country is to assume that any old person can understand and carry it out after a 40 minute consultation with an inexperienced therapist regardless of complexity of intervention. Why? Because the pressure was to get waiting lists down: quantity of appointment over quality. This, of course, also dilutes the experience that new therapists get which means that skills that SLTs used to demonstrate have been eroded rather than developed.

I can only tell you here unofficially what I couldn't tell you if I saw you in clinic: it's a mess and I fully understand why so many posters on this board think SLT is a waste of time. However, as a profession, I don't think it is. There are also some real gems of therapists in the NHS, but it is luck of the draw who you get.

If I had significant concerns about my child, I would push for the fullest assessment I could get (very politely if I could, but I wouldn't hesitate to be less polite if this was what was needed with the people involved) and if it seemed that further help was warranted after this, I would probably shop around for someone who could do some intensive 1:1 training with me as a parent to teach me what needed to be done with my son. If it's speech delay, I would recommend a proper course of Hanen with a good therapist, if you could get it? A colleague of mine (who is a very decent therapist) has just done this and was really amazed at what the video revealed.. because even though she "knew it all", being a parent means your instincts sometimes fight with your head so she was "overtalking" and not giving him space. The individually tailored suggestions made a tremendous difference to her son.. which I think is a good advert for the programme!

Oh my God, it is an essay! Sorry

No, really don't apologise working, I am so grateful for you taking the time to explain, as birthday said it's so useful and interesting to hear from the other side.

I will ask for more details next time now I know what I should actually be asking! I was expecting more details in the report, not an essay but things like you have said, whether it was minor errors, if he's likely for spontaneous recovery that sort of thing, so I will certainly ask, as I say I only didn't because I thought it would be in the report that I was being sent and she didn't say anything at the appointment other than yes he is delayed and his understanding isn't where it should be.

I will certainly keep looking for new ways that I can help him and really was expecting to do that anyway, it was the report I was hoping for more than anything, hence I think why I was so disapointed when it arrived and wasn't a proper report at all.

Oh and I am trying not to take the patronising 'ways to help develop your childs language' sheet so personally since you have explained that is standard and has to be pitched low!

Yes, please don't. It will be a cut and paste job, not a reflection on you at all.

In terms of the basic advice, it's hard to believe when you talk to your child, but there will be people who go to their first session who have never read a book to or sung a nursery rhyme with their child. I did a block of sessions with a young mum once where we worked out how we could build more talk into her day. She kept a diary for a week and realised that on three days she hadn't spoken to her child at all before lunchtime. She would do laundry upstairs while he was strapped into his buggy in front of the television and really only spoke to him when changing his nappy/feeding him. He had no toys and never had a dummy out of his mouth. In terms of outcomes, a child with speech delay due to language disadvantage/socioeconomic deprivation in the early years is much more likely to suffer long-term literacy and language sequelae than a language-matched child with speech and language delay from a higher socioeconomic bracket/with parents who are literate and educated. Children with this type of speech and language delay also form the bulk of our caseloads and believe me, some of the most basic advice is quite radical to some of our clients.

However, not all the parent-child interaction/language stimulation advice is inapplicable to those of us who are not socially or economically disadvantaged.
The less helpful things that more-educated/socially advantaged parents tend to do with speech delayed kids include absolutely and totally overloading them with language and overanticipating their needs, giving them little space to try out what they need to experiment with in language. Both are often simplified as the need to "balance turntaking". I have an 11 month old and I know all this stuff and I still do it! There's a constant stream of commentary in my house, everything a learning opportunity:"oooh, cow! Look at the cow! Cows say moo!" yada yada, And then, every once in a while, I'll think.. ooooh, did I give him ANY chance to communicate with me verbally there? Hmmmmmmm.... The other classic is trying to get language out instead of putting it in. My friend I mentioned, who is a Speech therapist, realised that when she was worried about her son's delay and "red flags" for language disorder that she was doing the one thing we would tell all parents not to do and trailing around the house pointing at stuff and asking "what's that?" and getting frustrated when he didn't know. Educated parents tend to overask when worried, becoming a tester. I don't even have a son with delay and I recognise that I do this - testing, testing, testing. If everything progresses well with speech and language development, it doesn't make much difference - there are times when it is important for the parent to talk more to establish a language model, and besides, it counts as language socialisation. We prioritise a particular level of language and conversation we expect at a given age based on our own "norms" for our kids based on our given experience and cultural expectation.. and when they can't do it for whatever reason, it can strain the dynamic, increasing anxiety for both parent and child.

This is absolutely what my friend found, despite her training etc. and why she was glad to undertake Hanen. What should happen in Hanen (which is an adult-child interaction approach) is that you watch videos of how you interact and work out what strategies you have developed together to communicate - sometimes some become redundant but because they were initially useful, parents continue to use them and the child relies on them iyswim. Unfortunately, despite the fact it is one of the most useful approaches to basic speech and language delay, it is either not offered or watered down beyond recognition in most trusts due to the number of sessions required, leading to parents getting leaflets telling them what to do instead of engaging them in working out their own solutions with reference to child language development literature. It is very difficult to analyse your own behaviour in interaction without video, I think.

I think you'd be hard pressed to find many therapists working longer than a year or two who think that initial appointments and general clinics are well-run in this country. Everyone wants out of clinic because it is a bit soul-destroying to process people conveyor-belt like and, essentially, be caught in an unending cycle of high paperwork/poor quality work. Sigh. This thread has reminded me why I have given up community clinic! Horrible old job!

End of second essay

working, sorry to highjack this thread, but i have been reading your posts on and off for a while now, and have to say how impressed i am with your explanations, and your answers to questions.
love a fellow SALT XXX

'She kept a diary for a week and realised that on three days she hadn't spoken to her child at all before lunchtime. She would do laundry upstairs while he was strapped into his buggy in front of the television and really only spoke to him when changing his nappy/feeding him. He had no toys and never had a dummy out of his mouth.'

Wow, that actually brought a tear to my eye, that's so sad.

Some people have never read their child a book or sung a nursery rhyme I actually went back and read your post a few times to check that is what you had put, I think some days mine look at me and think not another singing session, really mother again , but I suppose I do need to bear in mind as you say that not everyone does and so you have to check.

'There's a constant stream of commentary in my house, everything a learning opportunity:"oooh, cow! Look at the cow! Cows say moo!" yada yada'

umm yes ok guilty, I do this
"oh look red, it's a square, a red square",
"pig, pig says oink, oink",
"what's this?, what noise does this make?, what colour is this?" - whilst holding/pointing at random items
hmmm do I allow him a chance to catch his thoughts or answer me back, I'm not sure, I know that I certainly tend to talk all day long, constanly naming items in the house and when we are out and about,
"oh look, a bus, a big bus, big red bus, van, blue car, tree, bush, baby, blah, blah, blah
I thought I was helping but maybe it's all a bit overwhelming for him at times, will be more aware in future.

This is all so interesting, as you say I would imagine there is quite a bit I do that I could improve but don't realise.

working, sorry to highjack this thread, but i have been reading your posts on and off for a while now, and have to say how impressed i am with your explanations, and your answers to questions.
love a fellow SALT XXX

completly agree digbert, working you really are helping me so much, and I am so impressed and grateful that you are taking so much time to try and help me and explain everything so clearly.

i often open the dialogue box...and start to type..then think....i cant type whats in my head...i'm an experienced SaLt but its hard to give advice when you dont know the full picture, only a parents perception of whats happened in a session......working, you dont give advice per se, but try to highglight things from our perspective, i like that. you acknowledge everything thats wrong in our profession, but try to see it also from the service users prespective.
SkY - so much of our time is helping ppl who dont dont really want to be helped. or dont have the capacity to change, i love it when i get a family who are interested and i can talk on a level with.
sometimes, less is more with langauge...remember to match your language level with your child's and offer opportunities for them to have a turn. definatly get on a hanen course or buy the book. x

'sometimes, less is more with langauge...remember to match your language level with your child's and offer opportunities for them to have a turn. definatly get on a hanen course or buy the book'

I will bear that in mind digbert when speaking and will definately order the book, as I say I had heard of it but wasn't sure whether it was a good one or not, but if 2 SLT who seem to be very knowledgeable have recommended it, I'll order it and will certainly look into the course which actually I hadn't seriously considered before.

'working, you dont give advice per se, but try to highglight things from our perspective'

that's exactly what has been so useful and very interesting, I have printed off thread for future reference!