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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)

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XxAlisonxX · 21/01/2011 23:42

No i havent got those on my report. I will definatly chase this up as soon as i get an appointment with Pead or SAL. we have wondered and asked many times regarding an autism assessment but like everything else it got ignored by the HT and EP, even though it is very clear that she has problems the school simply chose to ignore everything we told them. all this has only just come about in there eyes due to me taking it so far. it had got to tribunal and was due in court the week after they decided to do something.

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eclipse · 22/01/2011 11:15

With your daughter's broad range of difficulties I would suggest pushing for a neuropsychological assessment as part of the multi-disciplinary assessment. This would include measures of executive functioning (children who have poor hazard awareness, adaptive skills and planning usually have a degree of executive weakness) and a more in depth look at memory (e.g. memory for her own daily experiences as well as factual learning).

EPs can administer CELFs but few would do and, with such a complex presentation, you should be looking for SALTs with a specialist background in paediatric neurology so that their analysis ties in with the overall picture.

XxAlisonxX · 22/01/2011 11:40

Thankyou all so very much this has opened my eyes even more and a lot to take in, I will be back on the phone on monday chasing up apointments and will be demanding that these tests/assessments are done, i feel so sorry for my DD at times cause i cant do more for her, It gets me down and iv made myself ill with all the worry over her, she can be very hard work at times and the only break i get from her is when she is at school, but even than im constanly on the phone trying to get help which never happens.

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working9while5 · 22/01/2011 12:02

Eclipse, I'm interested in why you would suggest that a SALT with a specialist background in paediatric neurology would be important in addition to a neuropsych assessment?

Specialisms in SALT, to my mind, are a tricky thing. Really, if the purpose of an assessment is diagnosis, a variety of SALTs with a variety of specialisms may have different perspectives to offer.

You have reminded me that a student of ours with a profile like Alison's daughter's was sent out of area for an assessment at GOSH as her profile was as stark. This might be an option to push for if there aren't suitable professionals in the area.

However, what I wanted to do in responding to Alsion was to make the case that among the many things that may be looked at, Specific Language Impairment needs to be very seriously considered. Clear presentations that meet the research criteria (with an IQ over 85, a full scale performance IQ and a severely impaired verbal IQ) are actually quite rare and when they come about, there is often a suggestion that it must be "something else".

Obviously, it is a diagnosis of exclusion so a full medical and multidisciplinary team involvement is required in order to rule out any other issues. This would involve investigation of underlying causes, including neurological exam etc. A neuropsychologist would be a very valuable addition to this team and a great angle to consider. I'm just not sure why a SALT would need to have a specific specialism in paediatric neurology unless something was identified by a neuropsych or on investigations that suggested this as a root cause?

The reason I'm asking, I suppose, is it's quite a rare specialism and might be hard for Alison to track down. Many trusts wouldn't have specialists in this area and among the ones I know of, they would have more experience in the acute field e.g. acquired brain injury etc. Did you have someone in mind that you think would be good?

superfantastic · 22/01/2011 12:14

I dont want to hijack the thread but can I just ask...

As I mentioned last night my DD, age 5, (ASD) has a performance IQ of 93 32nd percentile but her verbal IQ was 61 0.5th percentile. Is this rare? Should I be more concerned? We have limited SALT at school but recently arranged to meet another SALT on a regular basis.

eclipse · 22/01/2011 12:17

Whenever a child has such a mixed picture, there's a danger each professional will 'diagnose' whatever is within their area of specialism and the child ends up with a long list of diagnoses that do not help their parents or teachers to understand the cognitive profile that's underpinning the overall range of difficulties. The OP's child does have unusual behaviours in the context of good nonverbal abilites and there are a number of possibilities for that. It seems sensible to try to relate test profiles to brain integrity as that would strongly inform intervention. I certainly agree an SLI highly likely.

working9while5 · 22/01/2011 12:38

It's not necessarily rare to have a spikey profile in a range of disorders. There's a lot of overlap between some difficulties (ASD/SLI/Dyspraxia in particular) and some suggestion that they are all along a continuum, much like ASD is viewed to be. There are also other potential reasons for these profiles (hence the need for full medical/blood testing etc, which you will have had in securing a diagnosis for your dd).

Here is where it gets a bit complicated, really. Some of the subsections we have been discussing on the WISC are very language based, and "verbal comprehension" in particular requires a lot of understanding of social rules/conventions etc. A lot of students with ASD seem to score extremely poorly on this subsection because of the nature of ASD (as you can imagine!). A lot of individuals with ASD are also quite visual learners, so there is often a disparity between their scores on some performance and verbal subtests (if you think about it, as language/communication are a key diagnostic indicator, this makes sense). I have met children on the spectrum with lower verbal IQ's whose language is functionally perfect e.g. they score highly on language assessments like the CELF despite having scores like the above and have good levels at school with reference to literacy etc.

Psychometric assessment is a guide to thinking but it always has to be placed in context of what the child can do and what is known about various disorders. It is also why a multidisciplinary team needs to work together to put the pieces of the puzzle into place, so to speak. Each member will have a "slant" on data which they contribute - I have contributed my "slant" on data above. However, you need the whole team to come together and thrash it out to really get something more conclusive.

On the other hand, if your dd has difficulties reading (particularly the mechanics of it) or pronunciation difficulties or difficulties constructing sentences, I would be pushing for a lot more SLT and I would want someone who has a lot of experience of a variety of language disorder to assess all areas of language functioning in some detail to devise a programme.

To be honest, if I'm truthful, I think most ASD specialists should have a specialism in a range of language disorders e.g. primary and secondary complex communication disorder. If they could have specialism in other related areas (like paediatric neurology or Auditory Processing Disorder) that would be even better. The difficulty is that ideally you want someone with breadth and depth of experience and that's much harder to get these days as so many "specialists" have limited "hands on" experience in their fields.

If I were a parent, I would be wary of accepting generic strategies without a thorough rationale of why they are relevant to my child. I think it's okay for people to say: "I'm trying this out because of x and y and z and I think it might work" (as there's rarely a clear cut answer and a lot of it is detective work like the above - have a hypothesis, work it out a bit, try something out that fits that hypothesis to prove/disprove the theory) but it's not okay to have someone say "Children with autism learn language in x way so therefore you must do this social story/comic strip conversation" just because. Does that make sense?

There's no easy answer but I bet you knew that..

working9while5 · 22/01/2011 12:39

I cross posted with you eclipse!

working9while5 · 22/01/2011 12:43

Sorry, post at 12:38:33 was for superfantastic

XxAlisonxX · 22/01/2011 14:32

Im not sure if this is any relevance but my DH sugested me to tell you anyway.

My DD is like a magpie, if something catches her eye ( stone, leaf, bottle top, wrapper, anything) she has to pick it up and in her ocket it goes, now her bed is the worse thing for it takes me an hour every day to clear everything off it, and by the end of the day when she gets home back it all goes now this is something that is getting out of hand for here is a list of the stuff i move on a daily basis,
cd's, book's pens, leafs, sticks, stones, paper, teddys, shoes, clothes, bottle tops, loo roll tubes, batterys, coins, beads, bobbles, bands, string, pencil shavings, used scratch cards, anything she has picked up from outside, now these are a few things and it isnt always the same things, but it all ends up in her bed.

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XxAlisonxX · 22/01/2011 14:33

oops sorry over spelling iv got a p that likes to stick. Blush

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superfantastic · 22/01/2011 14:34

Thanks working. :)

DD is good at reading, mainly due to memorising words quickly but as you say comprehension is an issue. She can speak quite well now...when she wants to but on her terms, DD does not like questions and does struggle with constructing sentences properly and pronunciation. She is a visual learner. The SLT from NHS said assessment once a term in school was all they could offer...school agreed to half an hour TA support a week.

The SLT who wants to 'study' DD offered to help with pronunciation, concepts and sentence structure...not sure how specialised she is but she teaches so heres hoping.

Thanks for the advice.

superfantastic · 22/01/2011 14:36

Sorry I x posted with you Alison....sorry for the Hijack.

XxAlisonxX · 22/01/2011 14:40

Its ok, i dont mind lol xx

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superfantastic · 22/01/2011 14:42

:)

working9while5 · 22/01/2011 20:42

Hi Alison

Collecting things obsessively is one of those things that people tend to associate with people being on the autistic spectrum.

Again, you really need a full team to consider all these angles, sift through the info and decide on a "best match" diagnosis. As a SALT, all I can say for definite is that whatever label your daughter gets she will need a lot of support with language and communication.

That may sound like a stupidly simplistic thing to say in the face of all the information we have discussed, but in the end of the day, hold fast to the most simple and most true things: your daughter has a complex communication disorder in the context of having an average IQ for her age and difficulties with engaging with her environment in the way a typically developing girl of her age might be expected to.

You finally have hardcore evidence for that, so it can not be fobbed off any longer. As you know, there are big decisions on the way with reference to high school. What she needs most of all is as much and as best a quality help as you can get for her. You are her advocate in all of this, trying to work out what The Answer is... it's not an easy place to be. Ideally, you would be able to pass it over/delegate it to a team of professionals to work to find a fantastic package on your/her behalf.. but it's not always a straightforward thing, as I'm sure you know, and you have to have your wits about you.

The picture may change rapidly as the information appears to change.. e.g. now you have the EP report, which points to one type of "answer" but a SALT report may change that, and a Paediatrician report may change that. It can be a very uncertain time as you hear about different types of difficulty and wonder if your daughter fits and what that might mean for her future. I wish that it was something that I could just say - "it's definitely X and here's what you need to do" but her case, like that of many older children who have not had a full evaluation, is complex and has proved full of twists and turns even here. 10 year olds pick up a lot of history! The thing to hold onto is that no matter what "label" she eventually gets (or labels, as it might be) she is still your daughter and you know her difficulties in great detail already. It's just about getting a name for it now, and hopefully the right type of help from this point forward!

XxAlisonxX · 14/05/2011 18:33

Hi all, i have an update. my dd statement is now in the process and should be done this month hopefully, she has now see a SALT and diagnosed as severe SLI. and is 5yrs behind. her CELF-4 scores were 0.1st centile to the 9th. her core language score 1st centile. and her working memory score 0.2nd. The SALT has recommend that she goes to a SNS and im also waiting on her EEG results, the pead put her on melatonine to help her sleep it worked for the first few weeks but now its not working aswell as it was. so now waiting for app to discuss all ov this.

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