Evidence needed for 1:1 SALT - Tribunal help please.

[tryingtokeepintune]

Hi,

I was told there is no scientific evidence to support my pte SALT recommendation for 1:1 in the case of ASD children. In this situation, the tribunal panel will have to decide on the basis of competing opinions from the SLTs present. The LA SALT has recommended a range of groups therapies etc. and ds will be going into a unit. However, some of the children are given 1:1. I would like ds to have 1:1 as recommended by pte SALT.

Does anyone know of have any evidence that would support 1:1 in the case of ASD children with severe receptive and expressive language skills?

The ASD dx is irrelevant here I think.

The issue is the severe receptive and expressive language skills.

The ASD dx should not prevent the language disorder from being treated.

Can you give a little bit more information about what's on offer and what they say their evidence is?

Do an FOI on their care pathway for language disorder. It may be specifically aimed at specific language disorder but it's good to know.

They need to describe - in detail - what his difficulties with understanding/spoken language/communication are and break these down into tiny, minute bits.

This will make it easier to find evidence. It is discriminatory to say that children with one disorder can have one type of therapy and another one can't because there simply isn't enough evidence to compare e.g. individual with group for these clients based on what is typically offered.

So what you need to do is to go through THEIR reports for details of what his difficulties are and then literature search each of these e.g.

"receptive difficulties" + "autism" + "intervention" + ("[his age range]") in google scholar.

If you can give me more information I can see if I can root out something but I have a very dodgy laptop at the moment thanks to a toddler dropping a cup of tea on it!

Thanks working. I will do the research as you suggest. Have called AFASIC too.

On offer is:

small group activites which may be led by specialist therapist , and/or specialist teacher, planned and resources jointly (up to 20 hours annually).

ds will have daily programme of support for social communication skills and the development of language and understanding.

there will be a social skills programme that includes daily, small group stuctured play at playtimes, so that ds is directed in ways of socialising with peers.

resourced activities collected, modelled and demonstrated (1.5 hours annually).

individual, termly sessions to monitor progress, develop programmes and contribute to IEP and Annual Reviews (up to 10 hours annually).

and other backgroud stuff.

Their report says:

in optimum condition, ds, who is 9, is able to maintain an appropriate level of attention to adult-led activities for 30 minutes or longer. This is however, variabel and is linked to both internal factors and extrinsic factors.

understanding of language - 4-5 year level.

expressive language - word knowledge in 4 - 5 year.

sentence length -rminiscent of 4 year old.

Just realized they did not give me Appendix A of the test scores - hmmm.

My SALT report says:

concepts and following instructions - age equivalents 5.06

word classes receptive - age equivalents 6.09

Is this information useful? Please tell me if more would be useful.

word classes receptive - 6.09

Forgot to say that ds will be going to an ASD unit attached to ms. and the provisions will be delivered through the unit.

Do not accept age equivalents. Say that you want the scaled/standard scores and percentiles - this is much easier to work with. An age equivalent doesn't really tell you much really, it's not as valid a measure.

What does "reminiscent of a 4 year old" mean for sentence length ???? Ask them to calculate his mean length of utterance and tell you at what Brown's stage he is on here. This is not a big ask, they should be able to do this easily enough.

Ask them to provide you with an evidence based rationale of their assessment process. It sounds like he did a few subtests of the CELF. The CELF is a four level assessment if done to gold standard - it involves key subtests being administered first to get a core language score. This is 3-4 subtests. If there are any discrepancies between subtests in this (e.g. one subtest is a 1 and another is a 6) it requires further testing - this is all discussed in the manual. There is a pragmatic/social skills checklist that comes next and the fourth is that all of those scores are looked at in context e.g. there is a functional assessment in meaningful settings etc.
Ask them if they have followed the protocol as in the manual and can they give you more detail as you don't feel you have the full picture.

You will definitely need a full write up of all their scores etc. FOI their file if necessary, but for speed, ask for a verbal run through too. It sounds like he did the CELF? There are ASD specific statistical adjustments in the manual - ask have they done these (and I will be shocked if they have if they are giving you age equivalents).

What you are also looking for in terms of your argument is scores in the severe range.

These are - 2 standard deviations from the mean. Look for the standard score. It should be expressed as something like 70 or 100 or 120. 100 is the mean. 70 is - 2 SD, which shows severe impairment.

It may be that they haven't done enough testing to give you a full standard score which a number like this - so you may get a number from 0 - 14 e.g.
Word Classes Receptive - 2

Here you are looking for scores of 3 and under to indicate severe impairment.
This is before it is adjusted for an ASD diagnosis though which I can't really remember the ins and outs of as I don't really do this type of work much at the moment.

Anything that has a severe impairment or a score that indicates impairment, ask them to provide you with evidence that speech therapy isn't appropriate for that particular issue. At the same time you can literature search it as well and come back to me too.. there will most likely be evidence for various types of therapy.

Can't guarantee it will be individual that's mandated but at least you will have given them a run for their money and if the evidence isn't there, you will be sure of that.

my ds was diagnosed with receptive/expressive impairement two years ago, has social interaction and communication difficulties and has recently had an ADOS which confirms ASD, so you can have both. He is able to answer direct questions but struggles with spontaneous conversation/interaction. i must say AFAISIC have been a great help to me over the years. in my experience he needs a celf4 with all subsections completed including pragmatic profiling which will highlight difficulties with inferencing. my ds assessment picked up on difficulties with working memory and auditory processing. he has had inconsistent support due my own lack of understanding. ask that all sections are completed, are they age appropriate and check the age recommendations for language support materials given to school. i always ask for a copy to be sent home now.

children with these difficulties need time to process information and time to formulate appropriate responses.

Thank you for your responses.

Aaargh - why must everything be such a battle?