SALT attitude to ASD

[linksandsmileys]

We're in the midst of a statement battle and we saw the SALT again today.

She is very much against direct SALT intervention. It's part of the local service agreement only to provide direct SALT for children with technical language difficulties but she as upped the monitoring visits.

However, what concerned me most was the willingness and openess with which she expressed her dept's view that these children had core deficits which were not going to be 'cured' by SALT so there was little point in applying limited resources.

I asked her about a behaviourist approach and she was hugely dismissive of this and ABA generally - although with the mighty Moondog's insight, I was able to argue about this.

She also said there was no evidence in favour of specialist as opposed to TA support - but as I understand it there is no evidence the other way around either.

Should a child's assessment of need be limited by the dept's view of their local service agreement and should it be limited by a SALT's low expectation of what a child with Asperger's can achieve?

I thought all SALTs tackled communication difficulties. How strange!

Put it this way - the DCs speech isn't going to improve spontaniously without it.

No a child's assessment of need should not be limited. Goodness, if all professionals took that view we might as well not bothering to help our kids at all...
sheesh!

I have come across this attitude also.

1. I have never come across any evidence which says children with ASD do not need direct SALT. My experience at tribunal has shown that tribunal panels do not share this view.
2. It may be that she and her team have very little expertise in treating children with autism and it may also be that they don't wish to be pushed out of their comfort zone.
3. What is she monitoring if there is no programme in place to be monitored? If she believes there is no point in treating children with ASD why is she monitoring a non existant supposedly useless programme./ Sounds like a massive cop out to me.

If you can possibly afford it I think you will need to get an independent assessment of your ds's needs and the provision he will need.

Links, I've come across this too. The research shows (And it does, I looked some of it up once) that SLT make harmdly any difference to children with asd.

Now the results are what they are, they are good studies. However, the REASON SLT doesn't make much difference with children with asd is because you can't get a non-complient child who can't follow instructions to cooperate with therapy........................

except that you and I know that you can

If a SLT cannot use a behaviourist approach to deliver therapy it doesn't matter much IF there is a support worker who can. She can be an expert in SLT and advise, but the person who can get the child to do the work should really deliver it.

Did you ask her how the TA was going to know what to do without observing sessions of direct therapy?

In a sense she is right in that what will change things for a child with problems like this is a radical change in the environment and by the environment I mean all in it too.

Broadly speaking that means constant engagement, consistency and a very high rate of meaningful reinforcement combined with precise data.

An effective SALT needs to work with others to ensure that this takes place.

Unfortunatley, there are very few SALTs who can do this. They can be great at lots of other stuff but finiding one who is good at this is nearly impossible.

So what the SLT is saying is not that there is nothing that can be done, just that she or no-one in her team can do it!?

Wish they'd bloody say that then!

Thanks. We have got an independent report whic said direct therapy supported by indirect.

Good questions there which I will put to her.

She was very 'anti-behaviourist' and she is supposed to be a 'specialist ASD SALT'.

Moondog..do you have any handy references I can quote? I am submitting an extra piece to Panel and would like to reference it.

We talked briefly about ABA and she was very dismissive about a behaviourist approach being used with Asperger's.

I dunno links. DS's SLT is 'trying' really really hard to please me and I can't be too critical otherwise I will destroy the relationship with the first professional that is really listening, but honestly, - she hasn't got a clue.

It has taken her 3 weeks and counting to do the PLS 3 assessment because ds is unfocussed apparently.

It took our ABA-friendly 45 minutes with me there.

So, if there is no-one out there who knows what to do, and the rare ones that listen and try still can't do it, well then I'm not sure I even know now why I bothered to fight so hard for it at tribunal.

Too true Star, too true.

I also think it is always demoralising when you meet the best professional they have on offer and you don't come away feeling informed at least about why something wouldn't be a good idea!

Yes, I know. The behaviourism thing is a bit like stepford wives. Everyone knows it is BAD, but no-one knows why. There can be some mutterings about robots and inability to generalise but any argument to the contrary is met with pittying looks wrt your delusion.

It's very strange.

Keep going though. I know I said I didn't know why I bothered, but I do know really, and even though I'm totally disastisfied with the quality of SLT it was still the right thing to do.

I can't afford it at the moment, but when I can I might hire an independent SLT to work with us in a behaviourist way, because by her own code of conduct she is expected to liaise with the NHS one we have so may have some influence or credibility when she says that it is indeed possible to deliver the PLS3 in 45 minutes with ds etc etc and back up the rest of what I have been trying to tell her i.e. that ds does talk in long sentences, even though she has only ever heard him put 2 words together.

Well that's the issue isn't it?
If people can't deliver it and don't want to learn (or to be fair, have the means and opportunities to learn) then what indeed is the point?

It's often how I feel when peopel talk of 'fighting' for a statement.It's extremely unlikely that a statement will turn lacklustre input into good input, even with all hands on deck. Actually, all hands on deck is often the worst thing possible. Too many cooks and all that.

I often don't post saying what I want to say as I would sound so bloody negative and you peopel have enough on your plates but honestly, most DN provision is completely shite and the sad thing is it doesn't have to be. It could so easliy be fabulous but it would involve a sea change in attitiude.

Links, I can provide you with info if you want to contact me but the fact remains that is would involve a lot more thna somoeone reading it and then saying 'Gosh, you're so right. I shall change everytrhing I do and work like this with your child henceforth.'

Thanks Moondog - it's to inform myself really so I can make informed choices for DS.

I completely understand what you're saying though, I really do. I don't take the view that statementing provision will change everything, cure everything, make shoddy professionals decent, or lazy teachers more involved.

It is all we have though! It is a balance between wrecking your life for a bit of crap provision and surrendering too early when something useful could be obtained I suppose. And that comes down to being informed.

I think your posts are helpful and if you feel negative about stuff, then please say it, I really appreciate your view from the coalface!

'It is a balance between wrecking your life for a bit of crap provision and surrendering too early when something useful could be obtained I suppose. And that comes down to being informed.'

Yes, exactly.
I'm glad you find the posts useful but I worry I raise more problems than I can hope to help with. I just wish i could scoop you all up, all you magnificent people working so hard for and with your children and show you what we have managed to achieve where I work. It's not perfect but we are all unanimous in our opinion that it blows anything else we have ever done into the water.

I've done more useful work in 2-3 years knowing what I do now than I did in 10-12 ocmbined.

Most people in this filed are good and try hard. They are overworked and undertrained and under a hell of a lot of pressure form all sides. I don't want to slag them off unnecessarily and it can't be the responsibility of one or tow individuals to change a system that is well past its 'best before' date.

I have though, been through all this myself as a parent and it was absoulte hell, porobably the worst year of my life so i really really feel for you all.

I agree and the woman I spoke to today clearly felt constrained by a whole host of policy, resource and knowledge issues. She did at least listen though and say she would do the same as me in my position.

Can I PM you for references?

Yes.

Think of it from 'their' point of view.
Working bloody hard, dealing with tonnes of kids, vast majority of whom probably have lacklustre support nad parents who don't do what is suggested/turn up for apppts and so on.

Someone comes in, a bit pissed off at what you have to offer and starts gonig on about something called 'ABA' that you have neither the time nor inclination to find out about beyond having heard it is a.) weird b.) expensive c.) something that snotyy parents demand.

You're not going to be best pleased are you?

Actually links I feel quite strongly about this particular issue.

Nobody can argue that I have been to hell and back securing a statement and provision for ds. However, hell sure taught me some lessons.

As I have become more and more disappointed in what was being offered, I have become more and more confident in what I can offer.

You can't for example, complain that someone is doing something wrong, unless you have some kind of idea what the right thing would be. Often you don't have a clue what this might be, just a niggling feeling that some provision isn't making any difference, or that you disagree with the assumptions that underpin a type of therapy.

But this can motivate you to reflect on what it is that is disappointing you and what the solutions might be.

I'm an expert in my ds. I'm a relective practitioner. I was neither before I began my journey through this hostile pit of snakes. I resent many aspects of the past 18 months but I would never hand it back. As well as being an expert in ds I am an expert in THEM now.

I suppose what I am saying is that this has been the biggest learning curve of my life and (thank god) it didn't kill me but made me a better person, mother, therpist and strategist. I believe in my ds and I believe in myself, and the rest have the chorus parts.

"However, what concerned me most was the willingness and openess with which she expressed her dept's view that these children had core deficits which were not going to be 'cured' by SALT so there was little point in applying limited resources."

And there is truth in this: a harsh and a bitter truth about how poorly these kids have been treated by the system.

45 minutes once a half term - or even 4 times a term - is not going to achieve much, she's right.

I have a lot of training and knowledge and I am working with one student at the moment that I feel totally and utterly lost with because if I wanted to really make an impact with my therapy I feel I would need to change everything about his educational setting, his home, his life. And you know what, he's actually improved loads in the last year with targeted work on basic language skills a mere once a week when half the time he was slouched in the chair saying "boring!" or skipping around the room and flapping his hands.. but if I could just motivate him better or inspire others to want more from him, it would be so different. But I can't establish a reinforcer for him that's more powerful than his desire to stim and there's nothing I can really do about it.

I need a behavioural analyst to help. I know what he needs, communication wise and I could deliver it if I could just get him to sit with me. I am currently bribing him with chocolate - I won't pretend it's even a reinforcer, it's a bribe. I just don't have the skills to make him comply.. so expectations are low for him, yes.

Yet still higher than if he were in some other settings.

that I haven't been to hell - obviously

Moondog, I get it, I really do and I wasn't 'pissed off' with her suggestions but constructive and genuinely wanting to know more. In fact, given the difficult circumstances, we got on very well and were very polite to each other wilst acknowledging the wider presssures of the worlds in which we both operate...BUT

....if you don't know something, or aren't sure what might work, you should be prepared to say so as a professional. You really should.

I don't know what the answer is for DS but I don't think she does either and that for me is the problem.

It's a sad world for all involved but professionals are grown ups and even us mums can cope with the crap we deal with. But kids deserve honest assessments of need.

I would argue out SALT has been the single most effective therapy we have put in place for our DS (ASD)

He has experience with ASD kids, which helps. He has got my 20-nouns-at-3-yrs son to a constantly-chattering-in-sentences-6yr-old. Of course, DS may have managed to do that without his intervention, but we weren't going to take that chance.

This guy was private, and we paid him for 2 years. He was instrumental in getting DS a statement. Worth his weight in gold and more besides. He is now paid by the LEA to deliver the SALT requirement from the statment (NHS SALT too busy, apparently).

Clearly it's the quality of the therapist is important here.

'if you don't know something, or aren't sure what might work, you should be prepared to say so as a professional.'

But what if you have no doubt that nothing can be done? What if you KNOW that low expectations are realistic expecations?

That's where a lot of professionals seem to be.

Others, well they KNOW a bit more, but quite honestly don't the ability to say it because of the implications. What would be the point of someone telling a parent that their child needs something that he will never in a million years get? (of course you and I know that point would be that the parent would either fight for it or resource it privately, but many parents would descend into despair and possibly give up).

What I think you might need to realise is that we are a developing country in terms of many SNs, and in a developing country you just can't get your needs met a lot of the time. What is criminal is pretending that we are a developed country but that is the way it is?

I'm not defeatest. No-one can challenge more than I have, can demand basic rights more than I have, can have higher expectations of my ds AND those charged with meeting his needs. What has changed though from all this battling?

Well, quite a bit. It has improved. However, by far the biggest change has been in me, and I don't expect them to meet his needs any more. THEY can't however much THEY want to (and some of THEM really do).

That isn't to say I'll ever give up. I have been accepted as a volunteer for the NAS tribunal preparation helpline and I am also a part of a team setting up a free school in our county that will have an ASD specialism. Parents need to keep demanding, and keep their expectations high for sure, but you have to accept too, that those expectations and demands are never going to be met for your ds and get yourself as many plan B's, alternatives, compensatory action as possible.

I think there is MASSIVE potential with the whole free/charter school to blow away all of this stuff and start from afresh.
Energy directed into this i think will be so much better spent than trying to change peopel who can't or won't change.

I would love to work in one.

I can't talk much about it Moondog but it is an interesting project because it is people from the LA setting it up , in liaison with the LA.

I think there is motivation for it to be as close to an LA school as possible, with admissions and equal opportunities
policies etc. but at the same time unrestricted by the more tedious policies that go with being a LA school.

I think a school being set up by frustrated LA workers that is not regulated by the LA is very interesting indeed!

Yes, plenty from within 'the system' are pissed off with it.