Please or to access all these features

SN children

Here are some suggested organisations that offer expert advice on special needs.

Advice from a SALT re verbal/ memory problems

42 replies

XxAlisonxX · 21/01/2011 09:32

It has been suggested to me to start a new thread to ask for advice re my DD she has no short term memory / working memory and cant comprehend verbal or text. she will be 10 in July

The WISC test result was bizzare thats what the ed psyc said. she is very low on all apart from picture concepts. The scores are,
Verbal Comprehension 5,5,7 ( IQ 75 5th perc)
Perceptual Reasoning 10,10,15 (IQ 110 75th)
Working Memory 5,6 (IQ 74 4th)
Processing Speed 9,10 (IQ 97 42nd)
Total IQ 87 percentile rank 19th

Her NC levels are
Reading 1c, writing 1c, numeracy 1b, reading age 5.04 (neales) spelling age 6.4( vernons)

OP posts:
IndigoBell · 21/01/2011 14:01

Moondog? Working? Can you improve verbal comprehension? If not a SALT - who would be the best person?

working9while5 · 21/01/2011 17:26

She needs to have a full language assessment.
Has she had a CELF-4 done? It looks to me from these scores and what you are saying like she might have a receptive language disorder (Specific Language Impairment)(although Processing Speed is often impaired in this population so more information is needed).

There is a lot of information on SLI available on the ICAN and Afasic websites but I can also answer questions if you have any.

Can you tell me some more about her? Has she got a SALT? What are your concerns (other than the obvious e.g. can you tell me what she's like, or paint a picture of her needs?).

To me, with this profile, I would be hypothesising that she is likely to:

  • be quite visual/tactile in her approach to things
  • have difficulties understanding and processing longer instructions (slow reaction times etc, needs information broken down into chunks, lots of reminders etc)
  • have limited vocabulary relative to her peers
  • struggle to learn, say and remember longer words
  • have possible difficulties with sentence cnstruction (orally and in writing) although these might not be obvious to many
  • struggle to follow information in class, organise herself, carry through tasks to completion etc.

I'd expect she might have some social difficulties but I can't tell from this to what extent, or what they might "look" like e.g. withdrawn and reticent or doing unusual and unexpected things or being volatile. All possible.

These are the first things I would look to prove/disprove if I received a report like this and hadn't met your daughter (but I would keep a very open mind, as tests don't tell you everything of course!)

If she has a CELF-4 done, I would again hypoothesise that she would have subsections with standard scores of 3 and that overall scores would be at least -1.5 to -2 standard deviations from the mean. I would expect poor performance in Concepts and Following Directions and Recalling Sentences in particular, with maybe better performance in other areas e.g. Understanding Spoken Paragraphs.

I could be TOTALLY WRONG.. which is why I say I would be hypothesising that these are the kinds of things I would see on an assessment and in real life.

This would inform my thinking in terms of planning an assessment. I would want

  • to do the CELF-4 to get more of an idea about strengths and weaknesses in language processing
  • find out more about how she is at home and in school and what concerns there are socially and academically (though I can tell from the levels a bit about this already)
  • do some sort of narrative assessment (e.g. get her to tell a story) - and I would probably want her to do it orally and in writing
  • I would want to get an idea of how she responds to different types of questions about things "in the here and now" vs things she doesn't know a lot about or have experience of (verbal reasoning)
  • I would want to have a look at how she goes about spelling real words (like cat) and nonsense words (like nol)
  • I would want to see how she produces longer multisyllabic words and how she defines them (which I would probably do informally on the CELF)
  • I would want to know a lot about her speech and language history and whether or not she has any "residual" speech difficulties e.g. she sounds mumbly or indistinct
  • I would want to know what kind of strategies she uses to cope with any language difficulties in class and at home: can she ask for help, does she rely on others to help out when she gets stuck etc.

There's probably more, but I can't really think of anything else right now?

Usually children with severe difficulties in understanding have difficulties in all areas of language functioning which is why I would take such a broad approach to working out exactly what's going on.

Obviously, the number one piece of advice here is to ensure that she has a full and comprehensive language assessment as soon as possible from a suitably qualified professional

Hope this helps (and is not too overwhelming!). I don't really know where you are at with all this right now - if this is new to you or you have been struggling to get help for a while and know most of this inside out. I suppose what I am saying is that there is more information needed to get a full picture before anyone could suggest strategies etc? If that makes sense!

XxAlisonxX · 21/01/2011 17:48

If this helps this is an explanation of my DD, She has no sence of time, danger, hazzards, road/ traffic awarness, she cant use a phone, tv or dvd, or turn the channels over, she cant recognise or remember numbers, her phonics is very poor which makes her hard to understand, speach is very immature, has no sence of her surroundings and wonders, has to be supervised all the time at home to prevent her from harm. she cant listen, process and then answer verbal, she cant read or write without great difficulty, she has been on the SAP now for 4yrs and failed 9 IEP's, she forgets where she is or going, she has erratic sleep patterns, struggles with fastenings and sorting her own clothes, she screams, paddy throws tantums, her behaviour and manorisum is immature for her age, no idea over money and its value, or know what day of the week/ month it is, cant tell you where she lives or even say her full name. wouldnt be able to shout for help and doesnt understand when her body is telling her something like a hungry tummy, she thinks it is tummy ache and then refuses to eat. this is just a general idea i could go on,

iv not heard of a CELF without sounding stupid what is it??? please,

OP posts:
XxAlisonxX · 21/01/2011 17:49

she has never been seen by a SALT and the school only sent in the referal for her to see one a week ago

OP posts:
working9while5 · 21/01/2011 18:18

Right, okay... you and she are having a really hard time of things! Sad

A CELF is a language assessment. Unfortunately, the one for her age is going to be too hard for her from what you say.

Can you give me an example of how she would communicate something to you e.g. the type of sentence she would use?

Is she in mainstream school?

When you describe her, she sounds like a little girl who has severe learning difficulties but her WISC doesn't tally with that. Not only is her overall IQ too high at 87 but two subsections are within the normal range. This suggests that there is something underlying all of this.

Has she has an assessment for autism? Many people with autism also have severe receptive language disorders e.g. severe difficulty understanding language even when they have good skills in other areas.

Has she any medical conditions that may have caused/be causing her difficulties? Has a Paediatrician ruled out a medical reason?

I am a bit horrified that she has been on SA for 4 years and has not had a full evaluation at this point. I really wouldn't have expected her to have the difficulties you have described and for you to be just going through this assessment now.. I would have thought you would have had a diagnosis of something.

working9while5 · 21/01/2011 18:23

There are lots of things that need to be ruled out.

It is really striking that she can't do things like use a phone/DVD etc but yet is scoring highly on subsections of an assessment.

She needs an urgent multidisciplinary assessment with Paediatrician, EP, Clin Psych and SALT (at minimum) to include a full medical.

I am really appalled for you that she has this level of difficulty and you don't have a diagnosis at the age of 10. How do people explain her difficulties?

working9while5 · 21/01/2011 18:34

By the way, did she do Block Design on the WISC? If so, what was her score for this?

XxAlisonxX · 21/01/2011 18:40

Yes she is a main stream school, and no she hasnt been tested for anything, the referal for the pead went in a week ago aswell,

example of her speach is " tat wa daf"
should be "that was daft" or

she skips letters and misses out words, alot for the time she has to be asked to repeat what she says and sometimes it is totally impossible to figure out what she is saying. we have know for years that something was wrong but the school wouldnt listen. and only now since she had the WISC test they have decided to do something. when the ED PSYC told us about the results she said they were very bizzare. The SEN has now decided to do the assessment for a statement. and we are pushing for her to go to a SNS instead of a MS high.

she has no medical conditions that we know of and is very rarley poorly.

OP posts:
working9while5 · 21/01/2011 19:02

Oh my word, I am so cross for you and for her! I really, really am.

The more I look at the pieces of evidence here, the more I feel that language processing is going to be a big part of the picture.

I will give you an idea of what I am thinking, but please do remember that I have never met your daughter and though I have knowledge in this area, what you need is an appropriate team of professionals who have met and assessed your daughter to work through these issues with you. I am just giving you an idea so that you can be an informed consumer and so that you are no longer feeling as in the dark about her difficulties and can ask questions of your providers.

From the results of assessments you have given, she is quite severely language impaired. You have evidence for this. Working out why is a different story. Perhaps her language difficulties are primary e.g. they are causing all the difficulties she experiences. They may be secondary e.g. arising from another difficulty. There may be a number of things going on at once.

You have described four subtests of a specific test - two of these relate to nonverbal intelligence and two are very closely associated with verbal intelligence. To those of us who work with Specific Language Impairment low verbal + working memory difficulties combined with high perceptual reasoning/block design and/or processing speed scores would strongly indicate a severe and specific language disorder. However, lots of things need to be ruled out before this would stand as a diagnosis so I am flagging it up as a possibility, not telling you this is the case.

The difficulties that you describe with sequential information - days of the week, time, organising herself etc - fit this profile.

Difficulties dealing with mechanical objects e.g. switching channels are not really clearly associated with this profile. Usually, children with good scores in things like perceptual reasoning tend to be quite good at doing things that don't have any language e.g. working out where a dvd goes etc, building items with lego, drawing etc.

However sometimes, there are more entrenched difficulties with sequencing information and organising the muscles to carry out sequenced actions. You may sometimes see people on this board talk about "dyspraxia" or "developmental co-ordination disorder". These difficulties need to be looked at in relation to your daughter as they may explain some of the areas that don't "fit" with the language processing issues. These might also account for difficulties with self-care and dressing and certainly need to be investigated. Poor handwriting and drawing abilities can be related to these types of difficulties.

It is not unusual to have difficulties with co-ordination and language disorder combined. The fact that your daughter has speech difficulties fits both profiles potentially.

Explaining poor hazard perception is more difficult. This is something that might suggest that your daughter has a poor sense of herself in her environment, which might fit with some of the difficulties above. However, there would need to be a careful assessment undertaken to establish if she truly has no awareness of danger and if she doesn't understand consequences or if she just doesn't know how to move her body out of the way. It sounds from what you are saying that her attention and impulse control are quite poor. These things might lead a team to consider more profound and pervasive challenges to her learning e.g. autism spectrum conditions, some types of learning disability etc.

The immediate things that a team will probably look at are:

  • any underlying medical conditions that might not have been diagnosed e.g. chromosonal and genetic issues, epilepsy
  • Language Impairment, Dyspraxia/Developmental Co-Ordination Disorder and Autism.

There is considerable overlap between many of these disorders and it is very difficult to know without a full multidisciplinary what is going on.

I would strongly suggest that language impairment is taken into consideration as a primary factor, however. It may well be ruled out but the combination of the scores you describe on the WISC, the functional difficulties she is experiencing and the speech and phonic difficulties all suggest that this is something that really needs to be seriously considered.

Again, I am not telling you this is going to be a final diagnosis as there are many, many factors to rule out. However, I would request that whoever assesses your daughter has a specialism in this area. If I were you would ask the EP to forward the referral to the SALT team and I would contact them myself to ask if you can submit information to the referral to help them allocate your daughter's case to someone who is appropriately qualified (many trusts have newer members of staff as the first point of call and it might be unusual for them to have met a child of your daughter's age with your daughter's profile).

Please also contact Afasic and ICAN and discuss what you have discussed here. They may have further helpful information to share.

I hope this has been of some help! Again, I am so so sorry that you are in this position and I hope you get answers soon.

Any questions, please keep them coming and I will do my best to answer (as long as you promise to bear in mind that I am not able to give you anything other than general advice as I don't know your daughter and she needs a full professional assessment etc).

working9while5 · 21/01/2011 19:11

By the way, if you need me to explain anything, do say! I am posting quickly in between things but can give you examples if you need them. Lots of this is probably new to you.

Some of the terminology can be a bit confusing. If I was telling you this I would draw things and use my hands a lot and not use so many words! It is harder online!

XxAlisonxX · 21/01/2011 19:43

there is a few things i didnt put which might help, im not sure, she loves drawing, art, cutting and sticking, she has only been on 2 wheels on her bike about 18mth and is still very wobbly and unsteady on it, she has swimming lessons with school once a week, they have been taking her 2.5 yrs now and she still cant swim unaided. she also has these moments where she switches off, when this happens it is totally random and can last from seconds to minuets ( longest was 1hr) when this happens she stares into space, stand infront of her and its like she is looking threw you with no movement nothing not even a blink, you can shout, bang, people in/out and nothing, but touch her a she will reply with !"wat" she never jumps just turns round. she cant watch a film all the way through or follow a story line or tell it back, or play a board game to the end without a squarking tantrum.

if there is anything else you would like to know please ask, for any advice or info is greatly apriciated.

OP posts:
working9while5 · 21/01/2011 19:52

She definitely needs to have a medical investigation e.g. for epilepsy if she is blanking out. However, she may be blanking out because it all just gets too much and she withdraws to cope with it all.

I would ask for a referral to the Occupational Therapy team in your area (if there is one for children).

The things you describe all appear to fit in with her having:

  • severe language problems (she wouldn't be able to follow a film or story because of this, or play a game as you say)
  • co-ordination problems which might fit in with the difficulties I described above

What's her art like? Would you say it's about what another girl her age could do? Or is it more like that of a much younger child?

XxAlisonxX · 21/01/2011 20:06

Her art varies at times it can be of a younger child and then sometimes it can be of an older child but then sometimes its a mix of both, its hard to describe without actually seeing it for yourself.

OP posts:
XxAlisonxX · 21/01/2011 20:35

very sorry i missed your question over the block design, yes she did on. the perceptual reasoning section of the test the results were

block design score 10 ( age 9yr 2mth)
matrix reasoning score 10 ( age 9yr 2mth)
picture concepts score 15 ( age 16yr 9mth)
that is the one that totally gobsmaked the EP because of how high it was.

OP posts:
working9while5 · 21/01/2011 20:57

So right, basically the only scores that were bringing down the overall IQ were the verbal comp and memory, yes?

This very much sounds like a Specific Language Impairment in that case (although again, needs full assessment/medical etc). It looks to me like a very classic case of SLI. Do you know anything about it as a disorder/diagnosis?

Don't worry too much about age equivalents. People often report these as e.g. a "eight month delay" but really, they're not. They are sort of an estimate of an age but are not, in themselves, a reliable indicator of whether performance is normal or not.

If the score you have there is a scaled score, 10 = perfectly normal for her age.
Do you have percentiles and IQ's for those as you did for the others?

What has the EP said?

justaboutfrayingattheseams · 21/01/2011 20:58

This reply has been deleted

Message withdrawn at poster's request.

XxAlisonxX · 21/01/2011 21:53

no i have not heard of that. the EP was totally shocked by the results and had to speak to her boss about it, she made some recomendations to the school but then the SEN decided to go ahead and assess her, so now they are all waiting on that outcome. erm iv either confused my self with taking all this in or iv just got a bit lost so iv copied all the key points in the rest of the report

verbal comprehension
similarities score 5
vocabulary score 5
comprehension score 7

all 3 scores are well below and show she has a particular difficulty when tasks are language based with no additional visual clues

working memory
digit span score 5
arithmetic score 6

had difficulties with both tasks which assess her working short term memory.

this assessment shows that she has some verbal difficulties as well as a marked inefficiency in her working memory
when tasks demand she has to listen, process and answer verbally it is an area of particular difficulty in addition to her poor short term memory will lead to problems with carrying out instructions and following verbal input. indicating that she has a SLD and has great difficulties in both reading any texts as well as demonstrating her abilty level through her own written recording.

OP posts:
working9while5 · 21/01/2011 22:40

Okay

I really would clarify this terminology with the EP.

She does have severe learning difficulties in a functional sense e.g. she has severe difficulties learning. This is important to note.

However, that is a functional description of her learning not to be confused with having a "severe learning disability" e.g. what most of us think of when we think of someone who has severe learning difficulties and who might go to a special school.

Her whole IQ is in the low average range (85 - 100) but it is a normal IQ.

She has pockets of cognition or "intelligence" if you want to think of it like that (horrible term!) which are like any typically developing person of her age. Quite a lot of them, actually.

Her scores on
Perceptual Reasoning
Block Design
Matrix Reasoning
Picture Concepts

all indicate that her nonverbal intelligence is within normal limits for her age.

These scores, coupled with an IQ of above 85, suggest that an SLI is highly likely. See
http://www.ican.org.uk/about%20slcn/about%20sli.aspx here for an explanation of what SLI is and what is required for a diagnosis

She may also have other difficulties however, so everything I've said about a multidisciplinary team assessment still stands.

The EP should be able to provide you with a "Performance IQ" and a "Verbal IQ" - are these on your report? I can tell you from the scores you have reported that she appears to have average performance in one and impaired performance in verbal, indicating a specific language impairment. Again, this may be in addition to other difficulties but it does seem likely that it may well be her primary difficulty.

A lot of EP's I have worked with know very little about SLI and confuse it with other types of speech and language difficulties, like speech and language delay or issues with speech and language that arise because of lack of stimulation or poor exposure to language. SLI is not like this. It is a complex difficulty that causes all the types of issues you describe. If your daughter does have SLI, you must know that it requires specialist therapy - don't let anyone tell you that just chucking a few visuals into her class or talking to her a specific way will be good enough.

SLI used to be called developmental dysphasia because it is really like the type of difficulty that some old people have after a stroke.

Although a lot of people don't know about it, it is a serious diagnosis and children and young people with these difficulties need a lot of help and support. Although there is no cure for SLI, happily, there is good evidence that individuals with this diagnosis can make progress at this age (and don't let anyone tell you otherwise).

Having such a specific profile of difficulties and the hallmarks of a complex communication disorder should really entitle your daughter to a statement.
If there is a secondary language unit attached to a mainstream school within your area, your daughter would be likely to qualify with these scores if no other reason for her difficulties could be found.

Again, your daughter still requires a full multidisciplinary team to assess all aspects of her language and learning. However, I hope that this gives you an idea of what needs to happen next.

working9while5 · 21/01/2011 22:42

The link broke!

Here it is again

mariamagdalena · 21/01/2011 22:54

working, can an EP do a celf4, or is it a SLT only test?

working9while5 · 21/01/2011 22:57

SLT only, mariamagdalena. It's one of the few that are restricted AFAIK.

working9while5 · 21/01/2011 23:00

XxAlisonxX, having seen all her scores, she should actually be able to attempt a CELF-4 but she won't do very well on it and it might not yield a lot of useful information about differences between areas of language functioning (though it might, hard to tell). It would, however, give a score that would give a lot more information about how her language was relative to her peers than these tests on the WISC (many of which, as the EP says, rely on language anyway - though I don't think picture concepts does, which really does highlight the extent to which her difficulties are based on language processing).

mariamagdalena · 21/01/2011 23:02

ta... another one for the distant wish list then. DS is 'too verbally fluent' for a SLT assessment.

mariamagdalena · 21/01/2011 23:04

Oh and XxAlisonxX, my friend's dd's EP report looked almost the same as your dc's. She struggled through school despite a statement, but thrived in her part time jobs and is now at uni, where she has the right level of support.

superfantastic · 21/01/2011 23:17

Wow what a thread! :)

I recognise similar scores for my DD, she was given a dx of ASD but the verbal IQ was the suprise. She is beginning to improve and recognise a few more common phrases, Im just not sure school realise her difficulties and simplify their language enough. Our NHS SALT put IEP targets in report in October...school are avoiding my requests for an IEP review and started looking at materials sent by SALT this week, agreed to two 15min sessions with a TA a week. Although could not confirm if a quiet space away from the other 59 dcs could be found on a regular basis!
OOPs...ranty rant! Blush

Good luck with your DS Alison. Thanks for the info Working....you should be employed by MN! Grin