PhD dedication

[appropriatelytrained]

I'm getting my PhD bound. I'd like to dedication to all of you brave folks forced to battle for our kids. You've absolutely kept me going and got me through this

I'm looking for a pithy quote or saying from someone of note to sum the whole thing up

So far, I'm considering
Truth is mighty and will prevail. There is nothing the matter with this, except that it ain't so. ~Mark Twain, Notebook, 1935

Any advances!!!

Star, yes, we need both.. that was the gist of the idea of having the individual and the community aspects. If you simply focus on the skills of the individual with a communication impairment, you can miss out on broader skills that are also essential. And the individual should always be at the heart of it as if you just apply knowledge about the community, you miss meeting the unique needs of the person and their unique path of development.

The disabling notion we need to get rid of is not related to generalisation per se but more to do with the idea that a diagnosis (of any type) results in the same sets of behaviours among all people with that diagnosis whether that's generalisation or difficulties with understanding gesture or rote language use or idiosyncratic vocabulary or.. or.. or. Yet that doesn't mean that knowledge of typical features of a community or of language and social development is irrelevant either..

Both sides are needed.

Working I just want to say whilst you're here what an incredible difference you have made to my ds' development from your considered and knowledgable posts. Moondog has given me sharp, blunt tools to deal with all kinds of things (which usually creates blood) but you give me cake and hope and I probably don't say it much but I do change the way I do many things with ds as a result of your posts, to his gain.

Most recently, in some situations he has learned to do the appropriate face to accompany something he says, which he has practised in the mirror and which he LOVES learning about. He is learning to 'be dramatic' for effect (and I of course engineer the effect, and now I'm getting a bit fed up of the dramatic) which his 2.8yr old sister does so naturally and manipulatively.

I'm lucky though. My ds can learn ANYTHING and quickly but so few people seem to know what to teach him next, how or why. THAT is what is holding him up, not his ASD. Your posts nearly always give me something to consider or observe, test or try and then teach. I cannot possibly be the only one, so I wanted you to know how valuable your contributions are.

Thank you so much for the time you have spent posting on this. Honestly, it is helpful to read what you have to say which very practically pulls together some obviously complex concepts.

I started thinking about all this when DS recently sat through the TOPL test. At 8, he has clearly learnt many right answers in what seemed to be a very loaded test e.g. jenny is late for mum when she comes to pick her up, mum says 'good job you are on time' - what does mum really mean?

But, if this sort of thing was said to DS in real life, it would go over his head.

Equally, if asked how 'Tom' should ask to borrow a pen from a friend, he is able to parrot (in his 'polite' voice) please may I borrow a pen please.

Yet, he is not likely to do this in practice and would probably just go without rather than ask or he wouldn't even notice that someone else had different pens!!

So if you don't even acknowledge this (which I got the S&LT to do), what hope have you got for doing anything constructive?

I find that you also have to be very explicit which many S&LT/teachers etc don't get - this is what you say and why.

Yes, round our way they get away with reducing SALT provision because HFA children can perform brilliantly in 1:1 tests, particularly the concrete concepts tests and have 'average' profiles for the S&L, but this doesn't map onto their functional use or classroom use, yet is used as an excuse to reduce provision.

But then, why fight for increased support based on lack of functional use, if the SALT hasn't got a clue what to do? Which they don't because children that need it have been discharged due to their test performances.

And ds is only 4. Under 5's SALTs may well study to a high level in many things but when it comes to experience, most have done barely more for years than see a child once in a blue moon and blow bubbles at it. They don't know what to do with ds who can talk at length about motorways and where they are in the country without having any grasp of geography.

Gosh, so many interesting and relevant pointsraised by all when I was off climbing a mountain this afternoon.
Where to begin?

9-5, no behaviourist (as in someone with an MSC or PhD or board certified status) would argue against the fact that we are operating under ontogenic and phylogeni stimuli (that is some facotrs in our behavious arise from contingencies with the environment and some are directly attributable to something in us as part of an evolutionary process.

The issue is, which is which and what can we change? BAs have mroe in common with s/lts than they think as any s/lt will tell you that the environment in which a language impaired person has to change if the person is going to. That is exactly what a BA does-tinkers with contingencies and schedules of reinforcement.

The points you raise about odd inflexible 'programmes' for language facilitation in kids with reasonable language are good. I work very closely with the BA who works with my child. I tend to be the one who tells her what it is she needs to work on (making ample use of trusty old work horses like the TROG and TALC) and she tends to devse the data collection techniques and rearrange the contingencies to make it all possible. I like to think that we are a dream team.

Similarly I can be very about some of the early work BAs do on eliciting sounds.For a start they have no clue as to the physiological aspects of phnology and how the holy trinity of voice/place and manner work. An s/lt whose workshop I attended on s/lt/ABA for kids with ASD (bloody brilliant) in the Startes pointing out that in VP-MAPP the sound orthographically notated as 'ng' is worked on as two differnet sounds, 'n' and 'g' wherease any s/lt with a rudimentary knowledge of Phonology knows it is one phoneme!

So I see well meaning BAs picking up randowm phonemes from all over the place to work on with no understanding of how they fall into natural clusters.

AT that whole vagueness abouit your child learning idioms is a good example of how unacceptable and vague everything has become and sadder still ,the parties involved have no idea how to address it.

Getting that right is so easy it is laughable. With a system like SAFMEDS (PT) you could spend no more than 10 mins. a day and churn throguh literally dozens of idioms in a way that is fun, fast paced and shows very clearly where a child started and where they got to and how long it took.

Mind you, as 9-5 says, one has to be careful re idioms. Working on something like 'tickled pink' would be daft (as she says, what kids says that anyway??) but 'pulling your leg' would be good.

S/lts can get very precious and demand to be taken seriously as a profession, My argument is this;how seriously can you really excpect peopel to take you if you can not measure how effective your intervention has been and prove that, as a result of your being around, the child has acquired x, y and z. these being entities he didn't have before you came on the scene.

I am mortified at the quality of much of my work before I learnt about data collection and analysis/I always worked hard and tried my best but streuth!!!
The less said, the better.

Why are programmes so inflexible?

My SALT says she has done the Speech and Language and ds tests 'normal' for receptive and expressive and that his difficulties are all 'communication' which is to do with his ASD and as such is not anything she can address, - therefore recommended a reduction in SALT provision.

On the other hand I am requesting double the provision, and for it to occur in the classroom to model to the TA and other staff how to engineer communication practise opportunities.

This is the crux of our tribunal. No idea if it will be worth the effort though.

Well to be fair Star, it is a limited resource and no s/lt can claim to be able to 'cure' anyone.
The focus of NHS s/lt is to maximise communication and minimise distress and difficulty.
We have tough decisions to make on juggling enormous caseloads and making sure everyone gets access to us as we spread ourselves as thinly as possible.

Noone claims it is a gold star service or a cure all.
It' can't ever be.

I know that Moondog. Me of all people.

But Intensive, front-loaded intervention WORKS with ds. He CAN catch up with his peers if properly supported which will mean he needs far less support/SALT later.

I never did send you that video, but if I can figure out how to do it you'll see what I mean.

I've also experienced this 'we don't do communication' attitude and although I understand enormous workloads and scant resources, it seems to me that not supporting children's communication with sound measurable intervention just stores the problems up for the future and increases the distress

I'm communicating with my bright 8 year old with pictures when I'm trying to get him to express his feelings. He writes notes to me and runs away. He sends letters to his TA about worries that he is sometimes too scared even to write down.

This causes massive distress and is his primary need. What point are good language skills if you can't use them?

And yet it should be so simple to sort out. If 'communication' was properly worked on in the Early Years and a bit beyond and if TA's were properly trained in relevant strategies. All children would benefit.

Well yes.
This means systemic change on a grand scale and that is a huge task.

I think the present structure of SEN provision is slowly crumbling as peopel realise how ineffectual (albeit well meaning) it is.

PECS is a good example of an effective intervention possible with limited resources.
A lot of BAs don't want ot know about PECS.
I never understood why but now I can see the reason.

With a traditional intensive ABA programme with armies of therapists, they are after speech and if speech doesn't happen, then they look to augmentative/alternative strategies.
An s/lt, with a caseload og 100s hasn't the time or resources to do intensive work of this nature. PECS (done properly) elicits purposeful communication which may or many not be accompanied by speech. Even so, the child is communicating and that is our remit. (Many peopel don't evne know how to teach PECS properly but that';s a whole new story.)

Hey Star, I went to a presentation by Sally Rogers today-Early Start Denver Model of course, which I know about throguh your consultant.

Very interesting and a nice woman.

(They don;'t go after PECS either.)

Hey, I like PECS. I am critical, VERY critical of how it is taught, used and delivered in my LA though.

We didn't do an awful lot of the ESDM stuff as ds had progressed beyond some of the playbased stuff that it can offer and was directing himself to the table demanding to work, reinforced by other work by the time our Constultant was qualified but it sounds like it might appear a more palatable model to those who are ignorant of ABA.

You and my friend/Consultant are not alike in any respect save the drive to move forwards in the same direction. I see you more as directing from the front with her hanging about at the back trying to collect up all the stray and lost people, but still going the same way iyswim. I hope you keep an eye on each other.

Blimey AT, what a derailing of a fantastic thread beginning.

Hope you are really proud of what you have achieved with all the craziness you've had to deal with at the same time.

ESDM seems like a very user friendly non scary play based style of ABA (as it should of course be) that isn't going to scare the horses.

I talked to Prof. Rogers about your friend.She told me she is the only one trained (or rather, training) in the UK.
She invited me to California too!
Now, if the NHS would just cough up....

I did wonder about ESDM and your ds as from sounds of it, he is a long way from that.

V impressed with the data thoguh.

Well PECS should be done behaviourally. My ABA provider used it and used it fantastically because it is a behavioural programme that is informed by some of the principles of joint attention.

Moondog, I agree with you completely. Essentially, it's because some of the sound stuff hasn't been task analysed accurately.. there are smaller features than the phoneme e.g. voice, manner, place.. and these all need work too. I suppose what I am saying is that I suspect that similar happens in language.

I am in the position of watching my 18 month old figure out language and I can see that he does a lot of what the literature says he does, it is not all just academic.. and I can see that there is a complex layering of communication behaviour from those first smiles and gazes to beginning to use gesture and performatives e.g. blowing a cup for "hot" or repeating a word like "car" over and over to see what I will do with it (is this an intraverbal?). I just don't think that communication has been accurately broken down into its minutest steps yet either.

But yes, that is a million miles from where an SLT who advises work on "idioms" as a main component of a programme is at!

Basically, targets need to be SMART. If they are SMART, they are in essence behavioural and so it makes sense to design them and monitor them using behavioural tools. It's not rocket science! However, it's a lot more sophisticated than just following that format of SMART, isn't it? The technology is so much more advanced.

Moondog, I pm'd you. I have much to learn about standard celeration charts but I have started!

Well, my Autism Advisory Teacher swears blind that PECS is in fact TEACHH and won't hear a word suggesting otherwise. I have been bad-mouthed to ds' teacher and TA about my 'delusions'.

The school have also been 'banned' from using any ABA as it was ruled by the tribunal s being bad for my ds - apparently. I wonder if the attached SALT base subsequently has been stopped from using PECS? - oh no of course not, because it's TEACHH.

Honestly. This would be awful if it wasn't so blimmin useful for the next tribunal.

Crackers.

Erm, maybe point out to her that one of the authors is a BA? She can swear all she likes, but I've listened to the man speak and she's just WRONG.

Oh I know that. I discovered ABA principles by attending a PECS course because I couldn't figure out why the blimmin eck ds' SALT was refusing to give him a biscuit when he was asking for one in full sentences, because he was holding a picture of a crisp (which he didn't like at the time whilst he LOVED bisuits, - which he was asking for).

I satisfied myself that yes, the SALT was bonkers and ds shouldn't be using PECS the way she was trying to get him (i.e. only at snack time and by simply holding it in his hand), but yes he could learn a lot about communication from exchanging tokens as he would make his requests to the air, but handing something over - anything, meant he had to direct his request AT SOMEONE.

It meant I had to go home and start ds at phase 1, but we got to phase 4 in an afternoon and then recruited for an ABA programme proper.

As a quick update on the measurability bit. S&LT was not happy with the suggestion in SENCO's attendance note that she would advise on making her crappy idioms target measurable. She says it is 'objectively measurable within the programme'.

I have asked her to explain what this means and why she things him learning loads of idioms serves any purpose. To be honest, I let them keep this target initially as they seemed keen on it as it seemed to be more within their comfort zone.

But, she has not advised on why we are working on this target, she has not explained to staff how they are to record progress (e.g. is a target acheived when he 'knows' x number of idioms or when he uses them?) and she does not work with him when she comes in to check progress.

She spent an hour testing him on the TOPL crap (for developing the targets in the programme she said - it was for her Tribunal report) but didn't cover anything within his current programme and hasn't taken any baseline asessments.

I really want to get this to Tribunal now just to make this department explain how they think they can help him. Really it will be interesting.

They won't even comment on the training his TA requires even though the statement says she should 'appropriately trained' and LA say that is for S&LT dept to advise on. S&LT dept say 'it's up to the head' to decide what it means.

I think we need to bring back the Twilight zone!

Aaargh! What in God's earth does that waffle mean? HPC and RCSLT say we should be measuring and should be providing appropriate training to ensure our programmes are carried out.

working - do you know where that guidance comes from precisely (not para but relevant document)?

The key document is HPC's Standards of Proficiency for SLTs as this is the one with the legal weight e.g. HPC are the agency who you would deal with if you felt someone wasn't fit to practice, like the GMC.

Standards of Proficiency for SLTs here

The Monitoring Standards are:
2c.1 be able to monitor and review the ongoing effectiveness of planned activity and modify it accordingly
? be able to gather information, including qualitative and
quantitative data, that helps to evaluate the responses of service
users to their care
? be able to evaluate intervention plans using recognised outcome
measures and revise the plans as necessary in conjunction with
the service user
? recognise the need to monitor and evaluate the quality of practice
and the value of contributing to the generation of data for quality
assurance and improvement programmes
? be able to make reasoned decisions to initiate, continue, modify
or cease treatment or the use of techniques or procedures, and
record the decisions and reasoning appropriately

I know HPC have something about training others but I can't find it, it must have been in an addendum.

RCSLT have this document which outlines delegation of tasks to support staff which I think includes people in school.

It mentions that the following service standards in Communicating Quality 3 are also relevant as they relate to the provision of training to others 9, 12, 16,
21, 33
Delegation of tasks is covered in section 1.7.8 p28-30 and
on page 108

Communicating Quality 3 is here and is RCSLT guidance on SLT practice

Wow, that's great. Thanks so much.