Receptive language assessment-need help please!

[mishymashy]

Hi, Ds aged 3.3 has just had his formal assessment for his receptive language as we have huge problems at home with his understanding, his results came in at 11th percentile. S&LT has said that these were very good results and if we can get him to the 16th she will be able to sign him off as within normal range. I'm very confused as i have a ds who cant answer questions like 'whats your name', 'how old are you' which she has said she wouldnt expect from a child Ds's age. I am surrounded by children younger who can chat, express themselves in simple terms, have opinions and definately follow instructions like put something on,under,next to or in, none of which Ds can do. I think S&LT was annoyed at me because i wasnt jumping for joy, if anything i'm more worried now because the sole aim seems to be to sign him off asap. Am i expecting too much from Ds and are expectations so very low now. DDs are much older so expectations for them appeared to be much higher at this stage. I'm thinking of getting private assessments done for my own sanity as i'm sure the S&lt thinks i'm a pushy overbearing mum who isnt satisfied with her own child which couldnt be further from the truth. He starts school in Sept 2012 and time is flying. It took her 20 mins to get him to comply with the test, i cant see a teacher with 30 other children in her class being able to allow him this time to settle for every activity. The specialists dealing with Ds were all interested when it looked like he had ASD but now he is sociable its as though they are bored with him!! I should add, me and family never thought he had ASD. Is the 11th percentile good and am i neurotic. Can you get private assessments, because she didnt bother doing anything for his expressive language. Should i be happy with these results?
Thanks

[dolfrog]

silverfrog

I have had to push UK researchers to carry out research into Auditory Processing Disorder, like taking on the Medical Research Council back in 2000 - 2003 and eventually win, so may be i ma ahead of my time with regard to the general awareness of these issues.

ABA is based on the cutting edge of scientific research of the 1980s, before the technology of neuroimaging was developed. As you are keen on saying not many support people in the UK are adequately trained in regard of the support our children need, and the cognitively based support programs especially, so because in the UK we are so far behind in training those who provide the support, ABA would appear to be a good option.
Waht very few of the parents on this form provide is the degree of severity of autism their children have whether they are low functioning, high functioning , have aspergers, etc, or define the 6 or more out of 12 diagnostic criteria their child may have been identified as having.

Current research his talking about subtypes of autism or "autisms" as thye identify the neurology of the causes of the wide range of issues on the autistic spectrum.

So why am I so interested in Autism, Well our eldest son was almost miss diagnosed as having autism, back in 1998, and quite by accident the pead concluded he has waht was then called Central Auditory Processing Disorder (CAPD) which in now known as APD. And ABA is definitely not the correct way to help anyone who has APD. You have to understand the nature of the cognitive disability, and how to develop alternative cognitive skills to work around the problems. which is not ABA. So how many others have been miss diagnosed as having ASD when all they have is APD.

[StarlightMcKenzie]

Mishy, I sent you a private message about someone independent of all approaches, that might be able to help you. She's extremely generous with her phone time and there is never any obligation.

[dolfrog]

silverfrog

If a child is diagnosed as having ASD at 3 years of age then ABA may be appropriate, but only as a last option.

If there is no diagnosis of ASD then the natural development processes should be allowed to take their cause until the age of maturation. when children usually stop developing their cognitive abilities. ABA is an intervention not a development aid.

So this is about having a good understanding of the nature of each child and not intervening and creating more problems during the natural development process. Those who has an ASD diagnosis may have problems with regard to what some may consider natural development, in such cases ABA may be a useful tool.

[StarlightMcKenzie]

Blimey Dolfrog, you should send in your CV to our LA.

I really don't think you are qualified to enter a debate on ABA. Your assumptions and understanding are very skewed and your research appears to have been done with a very narrow and specific hypothesis in mind.

ABA is the best there is. It is suitable for all children on account that it is an individualised programme. First do a very detailed assessment of a childs strenghts and weaknesses, then target their weaknesses by breaking them down into the very tiniest steps and making sure they are mastered solidly before building on them. Measure progress. Keep data on what works and what doesn't. Do more of what works and less of what doesn't. Believe the decades of research that say when the child is enjoying themselves, motivated and successful, progress will happen faster than if they are bored, upset or resistant.

Read the above paragraph and tell me what could possibly be wrong with a programme like that. Stick ONLY to the information in the paragraph.

[silverfrog]

dolfrog, I am not sure whether your liberal misinterpretaion of what ABA is, and what it can do are wilful or not. I will give you the benfit of the doubt on that.

But what you are saying is not true - none of it.

I know you have been instrumental in setting up the APD stuff in the Uk. and well done for that.

but you cannot delineate in the way that you clearly want to.

there is nothing in ABA that would hinder a typical developmental path. nothing at all. there is no way that a properly applied ABA programme woudl hold back any child, whatever their dx. ABA is not actually just for people with ASD, and it is certainly not jsut for severe ASD, or HF ASD, or any other distinction you would like to make.

[dolfrog]

Hi Sick

"And yes, Dolfrog, I would love to reach a stage where they can neuroimage my boy's brain and pinpoint the exact deficits (at a guess, his speech centres and particularly his grammar centres are defective) - even better would be a day when they can also pinpoint exactly what will help my son with those deficits."

funny you should mention that, a research paper published this month may be showing the light in going the right way.
obviously it is dyslexia related and you have to know the code to understand that they are talking about APD and dyslexia
Human Voice Recognition Depends on Language Ability but what is interesting is a power point presentation the research team did some months before, some of which technically goes over my head, but you can get the general drift,
Optimized design and analysis of sparse-sampling fMRI experiments of speech and hearing.

[dolfrog]

StarlightMcKenzie and silverfrog

There is no methodology regarding ABA, whic his why it can not be independently assessed.
It has to be purely behavior based, as that is what the research of the 1970 and 1980 was about that is the basis of ABA.

Teaching is not about behavior it is about being able to cognitively being able to understand issues, discussion, debate, convincing etc,. And not behavior based solely on reward, which is what ABA is all about.

Using neurology, research is now understanding how we react tot various forms of stimili, or if you have a deficit how we may not react to stimuli, and identifying areas of activity when we try to use alternative compensating cognitive skills to work around an information processing deficit.
So waht you are not doing is trying to understand the information processing deficit(s) or disorder(s) your children may have and trying to identify and understand the alternative communication skills and abilities they may have to try to communicate on their terms.
ABA is a way of avoiding investigating these issues.

[StarlightMcKenzie]

'So waht you are not doing is trying to understand the information processing deficit(s) or disorder(s) your children may have and trying to identify and understand the alternative communication skills and abilities they may have to try to communicate on their terms.'

You are wrong. But where a child is capable, it is better that they learn a communication system that is recognised by most of the people that they will have to interact with.

[dolfrog]

"silverfrog"

"there is nothing in ABA that would hinder a typical developmental path."

ABA is an intervention, and by definition would interfere with the natural development path. you need to do some research.
You could start with my "Communication and Neurology" research paper collections.
It may help your understanding of these issues

[StarlightMcKenzie]

'There is no methodology regarding ABA, whic his why it can not be independently assessed.'

There IS methodology regarding ABA and it has been independently assessed many times. Often it is assessed against a child's progress on other interventions, and often against matched peers.

The research can be complicated and it has to be wide, but there is certainly enough of it now to point very strongly to its effectiveness.

It is a bit like insisting that we prove that breastfeeding is better for a baby than not. All babies are individuals. At some point though, you have to accept that even with a large number of variables, the research points to the same thing.

[StarlightMcKenzie]

'It has to be purely behavior based, as that is what the research of the 1970 and 1980 was about that is the basis of ABA.'

The research of the 1970s and 1980s has no place in modern ABA, except in a historical context.

[dolfrog]

silverfrog

"I am not sure whether your liberal misinterpretaion of what ABA is, and what it can do are wilful or not. I will give you the benfit of the doubt on that."

There is no recognised methodology, it claims to be a science, and that is all it is. Anything goes provided it works and is ethical, so really in theory anyone could set up in practice as an ABA provider especially if they had a novel idea for a therapy which might work.
And that is the big problem ABA is just a concept, based on trial and error. Some of the more practiced practitioners may have less hit and miss than those just starting out.

[StarlightMcKenzie]

'ABA is an intervention, and by definition would interfere with the natural development path.'

It intervenes in a developmental path that would otherwise lead the brain to fail to make and keep active social neural networks in a child with ASD.

Once these are fixed they are harder to change (around age 7 - i.e. natural age of maturity), and the relience on coping strategies rather than developmental ones may have more relevance.

[silverfrog]

"ABA is a way of avoiding investigating these issues."

hahahahahahhahaahhahahhahahahahahahahahahahahahahahahahahahahaha

oh please.

you know what - until you have actually understood what ABA is, and what is does, there is little point in continuing this discussion.

it is all very well having nice pictures of the brain, and the neurons firing - this actually means very little when it comes to teaching on the ground, as it were.

I have studied those nice coloured pictures. I have taken part in the research.and it is undoubtedly fascinating to know which areas of the brain are firing at stimili (or not firing, as the case may be) and which areas are being used to compensate.

what I am trying to do, and for the most part succeeding, is to help dd1 function well in the world around her. we have reduced her response time drastically - it is now typical. we have improved her concentration, and receptive language, immeasurably. her expressive language is beyond our wildest dreams now. her interaction, and her motivation to interact is quite simply unbelievable - she wants to play with other children. and can now get by in doing so - so please tell me, what part of "avoiding investigating these issues" has led to these successes? hr "reward" for these interactions? the game she gets to play - just like for dd2.

just about everything we do on a daily absis as humans is based on a reward structure. our interactions with each other, our ambitions and hopes, our academic pursuits - you name it, it is based ona reward structure. teacching is very much based on a reward structure. and our nature is behavioural - like it or not.

I htink you are fundamentally misunderstanding the concept of rewrd and reinforcement, tbh.

[silverfrog]

"ABA is an intervention, and by definition would interfere with the natural development path."

sorry - not sure what point you are answering here.

I said there is nothign in ABA that would hinder a typicl developemntal path.

everythign we do each day alters the natural developmental path - each interaction, each stimulus, each experience, everything we see, hear, do. but they do not hinder a typical development.

please try actually adressing thepoints that are put to you, and not making it up as you go along.

[StarlightMcKenzie]

'Anything goes provided it works and is ethical, so really in theory anyone could set up in practice as an ABA provider especially if they had a novel idea for a therapy which might work.'

Okay, at last you're beginning to make sense. Unfortunately ABA is unregulated in this country. This is because the government has refused to engage with it and support shoddy ineffectial interventions with no evidence base, - and parents are forced almost underground to get an alternative where there are, unfortnately, cowboys trying to sell magic cures.

However, there are widely accepted curriculums and assessments and Behaviouralists are in the process of setting up a regulatory body that monitors and regulates practice to ensure that those representing the profession are properly trained and experienced to offer the advice and intervention. In this system a therapist cannot suddenly come up with an idea. Having said that, even in the current system any idea that is come up with has roughly 3 days to see if is making any difference before it is changed, so still you don't get the endless labouring of an intervention that doesn't work by people who blame the child rather than the therapy as you do with current LA/NHS provision.

[dolfrog]

StarlightMcKenzie
most of the research is in hose based and there is very little independent research which is why Research Autism rate it "N/A Not Applicable" because you can not rate something which is not definable
All the independent research discusses many forms of support and intervention and ABA is only one of many. have a look at
Management of Children With Autism Spectrum Disorders
Now if you were to discuss this along these lines of research then we would nave no reason to disagree.
And trying to get UK support professionals trained properly in the provision of all of these required options

[dolfrog]

StarlightMcKenzie

"You are wrong. But where a child is capable, it is better that they learn a communication system that is recognised by most of the people that they will have to interact with."

you are beginning to go into an area of disability discrimination, it is society that has to understand the communication needs of the minorities, who have different communication needs. And this is more about educating the general public about these issues, and breaking down their ignorance and prejudices

Re the threads about people not understanding ASD children and inappropriate comments.

[StarlightMcKenzie]

Dolfrog, that website says:

'However there is very strong positive evidence for some individual interventions that use applied behavioural analysis, such as early intensive behavioural intervention'

and when you look at the intensive behavioural intervention rating it gets the highest rating available plus not a single hazzard warning and no crosses.

It is the most highly supported intervention on the whole page in fact!

[StarlightMcKenzie]

Here

www.researchautism.net/autism_treatments_therapies_intervention.ikml?ra=13

[dolfrog]

silverfrog

As yet we do not have the scientific technology and understanding to fully understand the how and why, how, and when, regarding the links the various neurons make as part of our individual genetic blue print has mapped out for us.
So any intervention is an interference or hinderence as it is not part of the planned natural development.

So for those who do not have an ASD diagnosis then natural development should progress as per our individual genetic blue print. After the age of Maturation 7 / 8 years old when developmental issues become considered a disability, that is when some form of intervention can be introduced.

But to do this you have to have a very good understanding of neurology, and not the hit and miss approached employed by Local Authorities, and many support service providers.
Otherwise they are interfering with issues with which they have very little or no understanding. Or trying to get a quick fix for a very complex set of issues.

[TotalChaos]

getting back to the OP, I have no experience of ABA, but understand it is meant to be effective, and certainly the basic principles around detailed data collection and motivation would benefit any child with a language problem. If you google for the mariposa school california, they have a verbal behaviour manual online (particular type of ABA geared towards language), which you might find useful reading.

Is your SALT very young/inexperienced out of interest? as it seems quiet shocking to me that she was happy to imply it was OK for him not to be interested in your answers to questions at 3...

In terms of NHS SALT, 2 things it might be worth asking for:
1-Hanen course/ELKLAN course - if your area actually runs it

1. ASD specialist SALT

[Jaxx]

The speech therapists in our area also focus on "normal range" - it is probably worse here as they don't report the percentiles and his school didn't recognise that "just below normal range" in our SaLT speak was actually the 9th percentile!

My son was diagnosed with autism at 3.5. He does have a high level of social interest, but this has been recognised as largely attempts to get others to follow his agenda. His speech at this time was largely echolia mixed with jargon (speech like sounds). He was improving on the surface - more stock phrases, less jargon, but the foundations weren't solid - when tested he really didn't understand simple concepts like fast and slow. The first time he was assessed by an EP, he couldn't do the block design subtest as he didn't get what copying was.

When we realised that the only intervention we were going to get by SaLT was a termly observation and an A4 sheet of paper with suggestions for the children's centre staff, we started to look elsewhere for what we could do. We started a VB program (12-15 hours a week) in January 2010 when he was a 3.11 and the improvement, particularly with his speech, has been brilliant.

He wasn't formally assessed by SaLT therapists prior to the start of the program as in our area they prefer more informal observations (probably so no one can measure progress or lake thereof). With a little pressure though, they did formally assess him in October 2010 and July 2011 using the CELF Preschool test (slightly different versions but I think you can make comparisons). I got the results this morning and I've shared them below:


Concepts and Following Directions (Last test this was Split into Linguistic Concepts and Basic Concepts).

DS scored 12. In October he scored 6 for Linguistic Concepts and 7 for Basic Concepts. He has moved from the 9/16th percentile to the 75th.

Recalling Sentences

DS scored 9. In October he scored 6. He has moved from the 9th to the 36th percentile.

Sentence Structure

DS scored 10. In October he scored 7. He has moved from the 16th to the 50th percentile

Word Structure

DS scored 12. In October he scored 8. He has moved from the 25th to the 75th percentile.

Expressive Vocabulary (Last test this was Formulating Labels)

DS scored 13. In October he scored 8 for Formulating Labels. He has moved from the 25th to the 84th percentile.

As you can imagined we are over the moon. It is such a shame we don't have the pre-VB scores as his rate of improvement definitely seemed faster in the first 10 months of the program.

I have no idea where the Dolfrog vs ABA discussion has got to while I have typed this - but I thought I would share what worked for us as light relief from the scientific journals.

[StarlightMcKenzie]

Yes, dolfrog it is disability discrimination to refuse to teach a capable child the skills to function in social world and follow the social norms.

It is disability discrimination to prevent them from accessing a treatment that can enable them to navigate their way through life independently and negotiate their own terms, on the basis that we should really just accept their deficits.

Many typically developing children would never learn to read without being taught. Teaching children to adapt to the world that the majority live in is essential for all. Where this cannot be done, tolerance and acceptance is vital. But tolerance and acceptance must not be used as an excuse to refuse provision and education.

[Agnesdipesto]

Dolfrog I have read many assessments of current research over the past 3 years and ABA comes out as the gold standard of treatment for under 5's with ASD every time. This large US study homepage.mac.com/leigharmistead/SchoolPsychologyResources/attachments/NAC_Findings_and_Conclusion.pdf
among other similar reviews, confirmed that ABA was the the treatment of choice.

My DS regained his functional speech within days of starting ABA.
I also know of 2 of the best ABA providers in the USA who say that their success rate in getting children to talk is now practically 100% if they get them young.
how may SALT dept in UK even know what their success rate is?
ABA has also helped DS ability to process information, to process it more quickly and improved his memory

There is also evidence that gaining functional language by 5 is important to be able to catch up with peers, and children who do not have functional language by 5 have a higher chance of never catching up / never developing an understanding of the subtleties of language.

MM, Aba can work on compliance / co-operation for children whether they have ASD or not. DS is on a programme but tbh i often use the same techniques on his brothers when they are being unco-operative! Just positive behaviour techniques applied consistently and teaching expectations of behaviour

However if we are talking about a child who may not have ASD but a language problem then I would seriously think about an ICAN assessment. From what I have gleaned on here they last 2 days and look at language in depth and you should emerge the other side with a really detailed assessment of your child's language and a report which (as ICAN is very well regarded) your own NHS SALT will find it hard to ignore. Because it is true that language disorders can manifest as a bit ASD but once the language improves the ASD symptoms can subside. ICAN schools often take in children who may have ASD or just a language problem and it only becomes clear which it is over time.

If you post a thread about ICAN you should get responses from people who have used it. I doubt its cheap but a charity may help pay for it