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]

mishymashy

Sorry about he destraction of ABA.

What you have described to some degree is a problem with processing sound based information.
We learn to speak by processing the speech of others, and then reprocessing those sounds as our own speech.
There are many issues which can cause Auditory problems, and some of which can be described as an auditory processing disorder(s) which can cause a wide range of communication problems for the young.
Those who have an auditory processing disorder (APD) can have a speech delay, and are not always able to process the speech of others. APD is a listening disability, and currently there is no cure.
Those who have APD can also be miss diagnosed as having ADHD, and Asperger Syndrome, such are the complexities of the areas of overlap of the so called observable symptoms.

[StarlightMcKenzie]

ICan is £1600 for a two day assessment in a peer setting with input from SALTS and an EP.

[sickofsocalledexperts]

Dolfrog - i think you should come and see some real aba in action. Then you can debate from experience rather than theory. There are mums who you are showing llittle emapthy with - by implying that they are doing wrong by their kids. My son's school (aba) do nothing wierd or wacky - just teach him the basics (talking, reading, group-work etc) using a method that gets through to him. I think this level of attack on beleaguered mums is misplaced.

[StarlightMcKenzie]

i think ICAN only take 4yr olds at the youngest though.

[dolfrog]

Agnesdipesto

Much of this research is like asking the tabacco industry to provide research regarding the dangers of smoking, the authors have a vested interest.
Independent peer reviewed research is published in research journals and available via PubMed and other recognised research libraries.
I have an online PubMed ABA research paper collection currently 51 research papers.
and I have a PubMed Autism research paper collection currently 234 research papers.
And some of my PubMed research paper collections are listed on three web pages and this is the home page

In recent years some earlier research has now been recognised as not meeting the required standard of research procedures and methodologies, especially those papers published in house regarding many remedial and support programs.

So please do check out who is writing the review, and find out if they have any vested interests, some of which can be very well concealed.

[StarlightMcKenzie]

Dolfrog, what defines a vested interest to you? A positive finding?

You linked to a site that compares interventions, that presumably you have judged to have some level of independence.

I pointed out that on that site EIBI (which is the type of ABA everyone does now) is the highest rated intervention with no hazzards and no valid studies finding against it.

Your own recommendation prefers EIBI to any other form of intervention.

[dolfrog]

StarlightMcKenzie and sickofsocalledexperts

I am not trying to say that parent who have children who have a diagnosis of ASD should not follow the recommended early intervention.
From my perspective of a parent whose children were almost miss diagnosed as being ASD, is that there is no discussion of the causes of the various traits which can result in an ASD diagnosis, or even worse no discussion of the causes of the so called traits when there is no diagnosis of ASD.

There appears to be no willingness to discuss or even consider the alternative interventions which may be more appropriate depending on the traits identified for each individual.

So for some who have a diagnosis of ASD ABA may be the best form of intervention or combined with an other form of intervention, this is the way current peer reviewed research is leading.

The leading international researchers are not saying that ABA is the only way to go.

And you also need t o understand that those who do not qualify for a diagnosis of ASD my have other related disabilities such asx ADHD, APD, Scotopic Sensitivity etc for which ABA is not even a consideration.

So this is about horses for courses or finding the right program to match a disability need. ABA is recommended for those who have an ASD diagnosis but you need to also be aware of the wide range of issues relating to other related disabilities which are not diagnosable at 3 years old, but have to wait until 7 or 8 years old.

So those who do not qualify for an ASD diagnosis will probably have one or more of the disabilities which can only be diagnosed after the age of 7 / 8 years old after the age of developmental maturation.

[dolfrog]

StarlightMcKenzie

"Dolfrog, what defines a vested interest to you? A positive finding?"

A vested interest is an income , funding, sales interest, and this can become very subtle to using parents to endorsement, to owning a research journal and having editorial control of a research journal, publishing the results from your own research laboritory.
A positive finding is good but it needs to be repeated when using research standards set out by the various advisory bodies that govern the various forms of research. But there is also a need to understand how and why a good finding works, and to be specific as to how the good thing works, both its strengths and its limitations.
You are very good at extolling ABAs strengths but you do not mention any limitations, and the official excuse it because it is more a science than a therapy. So those who claim to be ABA providers need to be more specific as to the form of support that they are qualified to provide, as it is not possible to be all things to all men, women and children, however much they would like to claim to be so.

[working9while5]

Right, I'm not getting involved in the whole debate but I do want to say WOAH THERE.

11th centile is not great and certainly if my child was at the 11th centile I
would want to do something about it, absolutely. If my child had very limited functional language or was unhappy or was not social or had any one of another range of issues, I would also want to do something pretty serious about it. However, suggesting a very intensive full-on ABA programme on the basis of the fact that a 3:3 year old has language at the 11th centile seems a bit crazy to me, sorry.

When your child has a significant communication impairment, having the individual and intense 1:1 that behaviourism can provide can really make a tremendous early impact. I understand that. However, from what I can see as a SALT on the basis of the very limited facts that have been discussed on this thread, we are talking here about a child who has language delay.

There are many other less cost- and time-intensive ways of addressing the same issue, and the Hanen course and Baby Talk provide really good ways of stimulating language without involving an entire team in your home. There are also naturalistic behavioural interventions [http://www.spiesforparents.cpd.usu.edu/ like this one here] that follow the same principles but using more structured "behavioural" techniques to support a child's developing language that you can try out yourself.

There is also the reality that statistics are not everything, in either direction. So it may well be the case that the mishymashy's child is really struggling functionally and an assessment isn't picking that up and it is a sign of an underlying communication impairment but also, it may be that verbal language is not his strong suit. I score very poorly, centile wise, in EP tests of numeracy and spatial skill but I am not disabled.

Mishymashy, your idea of more assessment is a good one.

Having said I wouldn't get involved, well...

I don't think Dolfrog's points are as inflammatory as they are being made out to be. ABA is currently producing the best intervention research in the field and this is a fantastic thing but no, it is not always impartial (no more than any research is: academia is about pushing your own agenda as much as any other job). As a whole way of approaching everything, it is not "fact" and it is certainly not the ONLY way of approaching speech and language intervention that has any validity. As a theory, behaviourism doesn't really account for the incredible complexity encompassed by the typical development of language and that is a flaw that underpins its use in language intervention. Behaviourism accounts for a fair bit of how we initially learn language (particularly in the very early stages), but it really fails to explain how much more complex language skills develop because it's not the be all and end all. No theory can explain EVERYTHING in the world.

Language development requires cognitive skills (neurologically underpinned) and life experiences (behavioural routines, if you like) to flower. For children with ASD, the fact that SALT has been shaped so much by "the cognitive revolution" has created problems, yes, as this group of children particularly seem to benefit from a behavioural approach as it makes life experiences that are cognitively challenging much more accessible to them. It strips it down and repackages it in a logical way so that it makes sense.

While all children benefit from being motivated to engage in experiences and all children benefit from adults around them knowing exactly how to scaffold those experiences, they do not ALL need to be "doing ABA", nor do the majority of children need to be "taught" language even if their language appears delayed. Structuring the environment so that they receive optimal input and feedback on their experiences is not the sole domain of ABA and not all children who are late to talk as they should require intensive intervention. Moondog has often said on this site that our efforts as SALTs should be concentrated on the children with the most severe and significant communication impairments because the vast majority of children can and do spontaneously develop language, even if they do so at different rates. I don't know enough about mishymashy's child to know what's going on based on the information provided here and I'm not sure how anyone else feels that they can recommend one approach based on what's been posted.

[working9while5]

Sorry, having said all of that mishymashy, on what assessment was your ds 11th centile? Was there a standard score? And can you just clarify that bit about the EP saying that visually he was ahead of age expected norms?

The things to be looking at in terms of making a case if it is language impairment vs delay are standard scores e.g. on the CELF.

If there is a significant difference between nonverbal and verbal skills (e.g. visual skills are very far in advance of verbal skills), it may be that your child has a language impairment.... but I am struggling to get a picture of what his language is like in terms of spoken language. A bit repetitive, very short phrases, not really doing any extended speaking etc? That seems as much a concern as comprehension. When you say that you are struggling with comprehension at home, what does this look like in real terms (apart from the social type questions that the SALT wasn't concerned about)?

I was struck having read your posts again that you say that comprehension is 11th centile but he answers you only in one word sentences? What's his centile/standard score for expressive language?

Was the SALT pleased with the 11th centile because he was previously much lower e.g. 1st or 2nd, and he has made improvements?

[working9while5]

Oh, why is there no edit button! standard scores e.g. on the CELF AND cognitive assessment...

[working9while5]

Also the CP, do you know what type it is? I am really finding it hard to read all the information you have given because of the discussion in between (and also possibly because this netbook is so tiny).

Am I right in saying..
He has mild CP
Motor development was delayed but he has been signed off physio, but this was not something that you felt reflected his skills
An EP assessment said that he was 12 months delayed, but this is quite a while ago now
He doesn't understand spatial terms like in/on/under
His language use is repetitive and in context
He doesn't really ask questions
He used to just blocks at nursery and doesn't communicate with peers but you haven't seen this behaviour at home
He can't have a conversation, only give one word responses to questions in context

Sorry, that's as much as my memory will extend to!

If you look at the norms here, does it seem that functionally his language is like that of a much younger child, or are you worried that what he's doing isn't easily describable using any of the types of behaviours mentioned in these norms e.g. it is not following a normal pattern?

[working9while5]

Sorry, that was shoddy. I have gone away and cut and pasted your responses to come up with a better summary. Is this about right?

Ds is 3.3, has a iagnosis of Mild CP, was seen by EP at 2 and was 10/12 months delayed at that stage, paed said two years ahead (visual learning?), sees Portage worker since 17 months, under care of ASD consultant paed but ASD has been ruled out as considered too social

Receptive Language
? Formal assessment for his receptive language - 11th percentile
? Cant answer questions like 'whats your name', 'how old are you
? Can?t chat
? Can?t express himself in simple terms
? Doesn?t share opinions
? Can?t get him to do anything unless it?s right there in front of him (have to show him)
? Walks away or gets distracted if an instruction is new or unfamiliar

Expressive Language
? Verbal
? Lots of repeated, learned phrases in context
? Doesn?t ask questions or ask why ? has never done so
? Makes up words and signs

Attention and Listening
? 20 mins to comply with a test
? 2 failed tests due to noncompliance
? Will roll around floor instead of sitting at the table for the SLT if that?s what he wants to do
? Follows his own agenda


Does that sound like him?

Questions:
What have you been told about the CP? Does it have a focus in the left or right hemisphere? Was it related to birth trauma and how was it diagnosed? It sounds like there was a lot of high-level concern about him early on and that this has died away. Would you mind telling your story of how you got to this point?

When you say he never asks questions, what do you mean? Do you mean he never actually says a wh-word e.g. where are x or y or that he doesn't actually request anything? Can he request using one or two words e.g. Car? More car?

When you say you have taught him language, what do you mean? In the early stages of language development, it's okay for kids to rely on "taught" language but once speech becomes grammatical e.g. they can say "daddy's shoes" instead of "daddy shoe" and use rules, it should become more self-generated. Most children will still use "learned phrases" in certain contexts, e.g. game playing but it would be a worry if the majority of his communication was learned if his language is at the grammatical stage. Can you give examples of his sentences etc that he uses in everyday life?

Do you think he is delayed in other areas, or is his delay more specific to language and communication?

There are lots more, but I have already TOTALLY mucked up my response to this by posting again and again so I will shut up now!

[working9while5]

Ha today is not my day for posting, brain jumbled. Apparently I now can't even tell the difference between receptive and expressive language so you will think I am a total numpty! Sorry, had night-time waking last night.

Receptive Language
? Formal assessment for his receptive language - 11th percentile
? Cant answer questions like 'whats your name', 'how old are you
? Can?t get him to do anything unless it?s right there in front of him (have to show him) - poor follow through on instructions
? Walks away or gets distracted if an instruction is new or unfamiliar

Expressive Language
? Verbal
? Lots of repeated, learned phrases in context
? Doesn?t ask questions or ask why ? has never done so
? Makes up words and signs
? Can?t chat
? Can?t express himself in simple terms
? Doesn?t share opinions

[mishymashy]

Working- Ds has left hemi due to prem birth followed by meningitis. He was very delayed in all milestones and even though he is very mobile now he has to wear orthotics because of constant toe walking and is moving onto braces because of muscle damage.
His speech is very clear but he uses the same phrases for whatever he is doing, ones that we have taught him. I know what he will say before he opens his mouth.
He can label everything easily if he sees it now which is a huge improvement.
He has never asked a question ie why/what/where.
If i tried to chat to him ie asking if he had a good day or what have you done, i get no response but if i said are you hungry he will run into the kitchen for food. Ask him what colour, and he can answer srtaight away.
He cannot answer questions like, what is your name, how old are you, even though we are running through them everyday as we do know that he will remember at some point!
The only term he understood on assessment was on, so everything she asked him he did the 'on' with the teddy instead of next to, under and so on.
He can make verbal demands ie drink, play games-when he wants his Nintendo DS and every morning when he gets up he always says finished bed now.
Thats why its all so confusing, he could never say a simple story or remember it, we struggle with attention span on books. When asked to identify action pics he just pointed to the ones with the right colour truck in them without actually looking for the action that she wanted. Its as though he picks out key words and it doesnt matter what you put around it in a sentence, its luck if you get the right response! He doesnt sing and point blank refuses to join in at home/school or with portage. No nursery rhymes yet either.
He can quite easily put words of 3/4 together to ask for an object but if i respond back with anything other than yes/no and with more of a conversation type answer then thats the end of that.
He was assessed by paed at 24 months for his visual skills and came out at 48 months which we were very suprised at. The rest of his development was delayed by 10/12 months in all areas. He hasnt had any formal assessment for expressive language to compare which is what i was hoping they would do, along with cognitive assessment so we could get a full picture of if it is delays or behavioural.
Sorry its so long!! The 11th centile was for receptive language, nothing else was assessed.

[StarlightMcKenzie]

Working, nobody has told the OP tembark on an intensive full-time ABA programme.

The recommendation was to research the methodology as you have yourself implied.

Dolfrog started to suggest that it was dangerous to begin any intervention until 7yrs and came out with unfounded statements and there it decended

[StarlightMcKenzie]

'The 11th centile was for receptive language, nothing else was assessed'

Working, can I ask a potentially inflamatory question? I have had some friends with children with disabilities who only have a very skewed assessment that tends to focus on their strengths. Do you think it is possible that once a child reaches the 'normal' cut off range in ONE thing, this can be used to justify their 'sign off', and that in some areas SALTS will simply focus on that in a kind of biased way?

[StarlightMcKenzie]

Btw, this thread might look like it is is 'pushing ABA' but the heavy ABA stuff is more a reaction to some of Dolfogs posts than a direct push for the OP.

The main reason ABA was mentioned was because of the OPs frustration at having no comprehensive assessment of her child's strengths and weaknesses and having no idea what she can do about it. She further says that where she lives is stark in terms of provision both NHS and private, and we all know that places WITH provision are dire enough.

ABA even done for a couple of hours for a couple of months will get her the information on both accounts.

It might be worth mentioning here too, that whilst the thread was descending, I PMed the OP with a link to an Independent Autism Consultant (not an ABA Consultant) and the Hanen books as well as Pyramid.

[working9while5]

Hi

I will say I am not a specialist in CP so what I know is only very general, but the incidence of language disorders is much higher in children with CP and with children who were born ex-prem (how early was he?).

It is really hard to get an idea of what someone is really like online, of course, but from the details you have given I would say that there appears to be a general pattern of delay with disordered features of language that need careful monitoring and attention.

Given what he's been through, it is going to be hard to determine a prognosis at this age I think (but again, no expert). The striking thing for me is that his visual skills are so advanced. This really suggests that there is some disorder going on. The fact that the rest of his development is delayed complicates things, because his reduced physical skills etc are also likely to have impacted upon his development of language (it's all interconnected) and so it makes his case more complex, because it may be that some things are following a normal pattern of development (albeit significantly delayed) and others are not. It is striking that his speech is clear and that he benefits from learning learned phrases.

Is his current SALT working in CDC or similar? It may be that because she works with a lot of prelinguistic kids with complex SN that she thinks that 11th centile is so amazing (and she sees it so rarely!) that this is clouding her judgement. This is by NO MEANS true of all CDC SALTs but it is something I have seen sometimes. It's perhaps inevitable that if you work with profoundly and multiply disabled children with no functional communication day in and day out that sometimes a child who is 11th centile can seem like a genius child even though they still have needs.

If I was in your situation mishymashy, I would be trying to access private SALT with someone with experience of CP and language disorders and a good knowledge of the early years for therapy. I am an NHS professional but unless I was very lucky, I wouldn't expect the average NHS service to provide the type of subtle, nuanced therapy based on best evidence on an ongoing basis that might be needed. I don't say this because it is right, but because it is realistic. If I could afford it or finance it, I'd rather pay but I would be as careful about getting good quality privately.

In the meantime, I would contact your NHS SALT and say that you're really confused because 11th centile doesn't really seem to be that positive and even if it is you feel don't have a good grasp on where his overall language development, receptive and expressive or how it relates to his CP etc is. Do this in writing. You can summarise your concerns as above. At this point, approach it openly as a consumer asking for advice rather than as a complaint. Say you have been reading some literature and ask if he can be assessed with a PLS or a CELF-P (I'm imagining he won't find the CELF easy but this is instructive). Say you are not comforted by the idea that some things he is doing are "normal" for his age e.g. the questions as you know too many typical kids who are meeting this milestone and from your reading of the ICAN norms, really he isn't anywhere near where he should be. Ask what her prognosis is etc and for a specific speech and language diagnosis e.g. S and L delay or disorder. What is her treatment plan?

Assessments are expensive privately and IMO are pretty valid publically. One thing NHS SALTs can do is use a formal assessment (though analysis can be hit and miss)!! Often private therapists don't have access to as many assessments either and/or are more expensive if they can. If I were seeing you privately I would be able to interpret the results of a public assessment alongside anything I did myself, although bear in mind that many of the major tests cannot be repeated within one year so if you have no faith in the NHS SALT, I wouldn't pursue this avenue.

I would want an assessment from an EP to include cognitive testing. If you can get this publically, do, as an assessment is an assessment at the end of the day. At some point, neuropsychological investigation may be relevant but I don't know enough about it to advise you at this stage.

Hope this helps. Any questions, keep posting.

[working9while5]

Starlight, I don't think that it's intentional if assessments are skewed. I think it is far more likely to be subconscious. Also, for kids on review, the assessment process tends to go like this:

Look at notes. What was done last time? Choose new assessment not done last time to investigate another area. Report on this.

It's not the practice we were taught, by the way, nor is it reflective of ebp in SALT, however, it's pretty common. A full assessment of a child with attention and listening difficulties can take up to four hours. Six if you are going to be totally comprehensive (and I would include setting obs here, so perhaps 10 hours of assessment). Realistically, most therapists don't have time to do 10 hours of assessment. It's not right, but it's reality.

My concern about ABA surfacing on this thread is that the OP's son has some significant issues going on here neurologically and though she isn't getting a good service I don't think, I would be extremely wary of seeing ABA as an answer to this. This is precisely the danger created by inadequate public services.

I would prefer to see a multidisciplinary approach to complex needs where possible. There was a little girl on a local ABA programme who had a terminal and degenerative neurological disability who regressed following an ABA "bootcamp" to target her "non-compliance" which turned out to be largely down to absence seizures. If ABA was extremely well regulated by ethical people with appropriate qualifications e.g. BCBAs I would probably have no issue with it being raised as an option as there would be assurance of ethics etc BUT that is not the case.

Trying out naturalistic behavioural interventions like the one at project SPIES that I linked to above is great, maybe having a one-off consultation with a very reputable ABA person to suggest a programme of work.. but not in the absence of finding out what's actually going on here. The OP needs to know what's happening before deciding on an appropriate intervention.

[mishymashy]

Thanks so much for that working. Can i be cheeky and ask if you know which specific assessments you would think would give the clearest picture of strengths and weaknesses as in a mini list, i have noted the CELF. Before embarking on any programme of help, i really need to establish exactly what the problems are, hence the move to private assessment.
Our initial S&lt was very young and brash, she frightened DS so he refused to open his eyes for assessment, classed as non-compliant again even though i knew it was because she was so loud. She frightened me, let alone him!! I then made a fuss with our equivalent of CDC and they arranged for senior S&lt to assess. Paed had said disordered language prior to asessment, new Salt said absolutely not, just language delay, he is doing very well and when he reaches 16th centile she will sign him off. Thats what has caused our panic if i'm honest. Paed relys on info from salt and i dont think 45 mins every 6 months gives a true picture. There lies the problem!
thanks again

[dolfrog]

StarlightMcKenzie

What i have always said and will continue to say is based on the best available medical advice and information, based on the international body of research, unless the medical consultants tell me otherwise.

And currently their research informs them about a developmental age of maturity, 7 - 8 years old, which is the age at which children stop growing out of natural development issues. There are some issues like ASD which can be identified earlier which best advice suggest early intervention is the best approach, but only for those who have an identifiable and diagnosable need, especially some of the the gene related problems.

The other issue is that in many instances there is no scientific understanding of the causes or complexity of many of these issues, working9while5 has mentioned listening, which is APD, they still do not what causes APD, in in the last 10 years the number of subtypes has improves from 4 to 13 as the researchers increase our understanding of the nature of the problems, but still lack the technology to investigate the real cause or causes. So to recommend early intervention can only be pure guesswork, which can be wrong or even harmful, due to the lack of understanding of the real causes.

So you can not apply what is recommend for a diagnosis of ASD for everyone else, early intervention is only for those who need it, those who have an ASD diagnosis or other specialised diagnosis. There are many more complex issues affecting children of parents who visit this forum and many do not have ASD, and you need to begin to understand their needs and stop telling them to get an ASD diagnosis when it may not be the correct diagnosis for their child. And you continue to fail to provide alternative advice about these other issues when they fail to get an ASD diagnosis.

So you really do need to gain a better understanding of the underlying cause of the issue on the Autistic spectrum, and how for instance 40% of those who have an ASD diagnosis also have ADHD, which is probably one of the multiple issue that cause the criteria of behaviors of an ASD diagnosis. Rather than just blandly advocating for a specific form of intervention.

[working9while5]

For me, the PLS, The Reynell (maybe, don't actually use it a lot but it doesgive scores for receptive and expressive lang afaik) and the CELF-P are it.

I wouldn't pay much attention to people you meet initially, clinic therapists tend to be just out of university and very inexperienced. Nuts, but there you go.

The CDC one needs to give you a lot more information about how she can say it is absolutely not language delay and make this crystal clear to you. I can see some of why she thinks this, but there are concerns - I would raise specifically the question of how the delay tallies with the visual skills and ask specifically could she support you by offering you references and further reading on the language development of children with a history and diagnosis like your son's.

There are a number of other things that might be helpful to do.

1. Can you write down a list of the stock phrases that he uses?
   
2. Can you keep a frequency count of these for a week to a month e.g. if he always says things exactly the same way, can you create a chart where you tick off each time he uses the same exact phrase?
   

I think that you need to present the evidence of the discrepancies he is showing here, because I can see it's not showing in snap shot assessment.

The other thing I feel is important to say to you here is that even if he is "signed off" from NHS SALT, that does not mean to say that he won't have language issues that need to be addressed. NHS SALT doesn't provide for many speech and language issues that are provided for in other jurisdictions and it is not because of the evidence, really. It's resource led (even if it shouldn't be etc etc). NHS SALT may not be the answer, no matter what you find.

A delay of language of 1 - 1.5 years at 3.3 may or may not be significant and it may or may not be something he grows out of. Realistically, a dealy of 10-12 months at 2 is not an insignificant delay.

People use the term delay to mean "following a typical pattern" e.g. features are acquired in the correct order and sequence etc but that doesn't always mean that their language "catches up" with peers and sometimes there are broader learning difficulties. These issues are not prioritised in NHS SALT but that is not to say that with therapy that there isn't room for significant improvement.

[StarlightMcKenzie]

Dolfrog.

I have never told anyone to get an ASD diagnosis. I have only ever advised if they are getting mixed messages, to go to an ASD SPECIALIST to get or rule out ASD. Quality Early intervention for a condition like ASD can make a huge difference to prognosis, and to faff around going from pillar to post with no-one properly assessing a child is delaying and quite possibly missing a golden opportunity.

'And you continue to fail to provide alternative advice about these other issues when they fail to get an ASD diagnosis'

I have and do offer advice on issues and problems that I have knowledge of and leave the areas in which I know nothing to others who do. It it is dangerous to otherwise and is why some of your posts that demonstrate very limited understanding of ABA and it's application to a variety of difficulties has been harshly responded to on this thread. It is not, and cannot be harmful to any child, regardless of difficulties (when applied properly - and I admit that this is a concern sometimes) as is shown on the very site that you linked to.

I suggest yout stop making personal accusations that are untrue.

[sickofsocalledexperts]

I think ABA can work as well for Learning difficulties (by which I mean IQ difficulties, and also speech delay) as for autism.

I've seen it work.

I'd like to tell you the story of the little boy of a pal of mine. Born with a skull and brain defect, he was lobbed into mainstream school at age 4, with an untrained LSA. She basically just contained him, didn't educate.

When I met them, he'd been in mainstream for 2 years, and could not

• talk (at all, no words, though lots of receptive understanding)
  
• read
  

-write

• do even basic sums
  
• play with other kids
  
• behave well in class
  

The mainstream school wanted to chuck him out as he was just so disruptive. The school had made zero attempt to teach him to talk/read/write, because either they couldn't be bothered or they were too busy managing his bad behaviours and stopping him from disrupting class with his noise and overactivity/violence.

They wanted to put him in a SLD school, which I know well, and which would simply babysit him till 19.

That was all that the state had offered this boy. A big fat zero. At 5, he was being effectively written off as ineducable.

I recommended an ABA tutor, who could give the family 4 hours a week.

I also told the mum all about ABA techniques (eg rewards, motivation, extinction for bad behaviour or removal of toy) and taught her how to teach him to read and write etc, using ABA techniques.

Cut to 1 year later. The kid came for a playdate with my boy this week. He is now talking in full sentences ; eg "after I have come to play with Robbie, can he come to play at my house". He had zero words when I met him, I promise you. ABA isn't magic, but no-one had given this boy the time or had worked out how to motivate him to speak in our woefully inexperienced mainstream "SEN provision".

He is now also reading at 1c level, writing, able to be in the classroom far better, behaviours right down. The boy is transformed. His life prospects are transformed. He is staying in mainstream.

Sometimes it is not just that ABA is the best thing, it's that it's the ONLY alternative to what can amount to educational neglect in our mainstream so-called inclusion system.

Sometimes ABA is best just because tutors will come to the child's home and do intensive play/work on speech and academics. In a way that one group SALT session a term just can't get near.

Sometimes it's not even the ABA, it's just the one-to-one intensive attention from an intelligent adult who is motivated to get the boy talking/reading/writing.

This boy isn't autistic, he has learning difficulties due to brain damage. But if he had waited till he was 7, to identify exactly what his condition was (though I doubt that would have happened in today's NHS), he would have been written off by the time the diagnosis dropped through the letter box..

It's not best practice and neuroimaging we should be comparing ABA to , Dolfrog, it's the woefully inadequate reality out here in the real world of both an inadequate diagnosis proces and educational offering.

That's why I think ABA can work for everyone.