SALT help please

[Claw3]

I have just received a copy of ds's SALT programme and im worried. He is on the 0.04 centile for semantics links and 3 years behind vocab, the programme is to help in those areas. I have never had a SALT programme before, just assessments.

Aims: to develop ds vocab.

Methods:
Odd one out

Chatterbox things that go together activities

Ds would benefit from pre-teaching of some key vocab covered in topics in class. See sematic links sheet.

Objectives: Ds will be able to id the odd one out from a choice of 3.
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Aims: to develop ds's higher level thinking

Method: Think it say resources

Objectives: To to able to give sensible answers for all think it say questions.

Ive never had a SALT 'programme' before, but this looks like a pile of crap to me?

It's badly worded, sounds like someone quite newly qualified to me. It's hard to comment without knowing full details etc but developing vocabulary sounds like a sensible target.. and preteaching of key vocab is a core part of school-based vocabulary curriculums. Think it Say it is not the worst in the world either although arguably there is more going on here than it can reasonably cover. It's just very badly constructed as an actual target and obviously not very "SMART" or with appropriate outcomes.

What do you want from this programme? If developing semantic links is suggested, there are many ways of targeting this.. but I do think work on vocabulary and on curriculum key words will be a useful thing. Most school-based SALT programmes are very much like Ed Psych recommendations, truth be told.. just cut and paste stuff vaguely linked to the assessment results. It is useful, however, to know what you need to work on..

Im not sure what i want, im still trying to make sense of it, i was hoping that SALT would know!

The problem with ds is in most areas he scores within the average range, but when anaylised ds struggled to grasp the underlying meanings or the key issue. No theory of mind. He doesnt understand things such as relationships of things or people. He has difficulty with processing language, that is sequential or abstract. He is literal with his understanding of language.

Severe difficulties with understanding word meanings, vocab 3 years behind, semantic links on 0.04 centile, semantic links expression and comp 1 centile. Residual difficulty producing a few sounds.

At home for example he cannot name common household things, such as a kettle, washing machine, microwave, light, lamp. He doesnt know what they are called, he would describe what they do. Peoples names, he can never remember anyones name. He uses 'big' words, but doesnt know what they mean.

He has no concept of time, before or after, doesnt know days of the week, months of the year, past or future, we have to do everything in how many sleeps.

The above programme is SALT's only advice for school, i was hoping for a bit more.

The more I am on here, Claw, the more I think that the most sensible advice I can give of most SALT services in their current incarnations is not to expect too much but to appreciate that the majority of NHS led or LEA led services are basically assessment and cut and paste advice.... the important information you have here is the assessment, which is as good as if it were done by any private therapist for lots of money..

If your son was in our unit, we would be putting about 5-7 targeted hours of therapy into dealing with these issues. I can't say exactly what we would do because a lot of it would depend on your son's most pressing functional needs, but might include, e.g. naming functional vocabulary by working out which strategy was most helpful for him and working strategically and intensively on it.

It sounds to me from what you have written that his comprehension deficit is quite severe - functionally as well as in terms of the standardised assessment - and that actually, the vocab is just an offshoot of this. This will make it difficult to really deal with some of the most disabling of his difficulties.. if he had no concept of human relationships and how they work yet doesn't have the comprehension or ability to make links to enable him to access therapy on this, it will be tough for him..

I'm not going to defend this "offer" except to say that, well, I don't know if I would be bothered with pursuing extra from this service. If I were in your shoes, I would invest in some private therapy if that's at all financially feasible and/or campaign for an ICAN assessment which would have more comprehensive and workable suggestions. Are there any language and communication units in your area?

Claw, with advice like that even I can see that your ds really does need some proper SALT input, that is just not going to be delivered by anyone who knows what they are doing.

I know you are saving up for stuff. Find an indpendent SALT that has an inkling how to motivate a child with ASD and set them to work. Learn as much as you possibly can for them and get them to set and explain targets for you to carry out yourself.

You know that I am an ABA advocate, but a lot of what is in your targets can be learned, possibly easily, with the more 'drill' side of ABA, which actually requires the least expertise and can be learnt by a parent in about 20mins if properly taught.

Thanks very much Working, I had a private assessment done and i was thinking along similar lines, going private (if i can afford it, that is) part of what i had written above was from her findings. She just did an assessment, she didnt write a programme. NHS SALT just literally did standard tests and didnt give any conclusions, just centiles and focussed on 2 most severe, sems and vocab.

Private SALT also observed ds in the classroom, struggling to understand what was expected of him. You are spot on with what you have written. Private SALT's recommendations were nothing like the NHS SALT programme.

What is an ICAN assessment?

I will have to find out about language and communication units.

CLaw you could put your case to Cerebra under their SALT £500 voucher scheme.

I remember hearing about that before Agnes, it might have even been from you. I will look into that. Thanks.

Seems all roads lead to private and DIY. Ds desperately needs some OT intervention too, something else i will have look into. I still have the sensory diet from Bibic, but its not written specifically for ds.

ICAN is the national charity for children's speech, language and communication and they do these massive assessments apparently (v pricey) but you don't sound as if you need it with a private assessment.

ABA is definitely worth looking into though I would want a very comprehensive vocabulary/conceptual development programme as part of this (not all ABA providers focus on this). Verbal behaviour people apparently do but although I have done the training I don't have much experience of it in practice. We are learning about precision teaching which is another application of behaviour analysis and trying to implement it in our unit but Moondog is the expert on this, not me.

Star, that is my plan of action i think. Ive been thinking long and hard over the past few days about what i actually want from all this.

Ds is clearly struggling in school with understanding, which is also the main cause of his anxieties, along with sensory difficulties too. Any idea how much a private SALT costs? It wont get ds the 'high level' of 1:1 support he needs in the classroom or for all language to be broken down and recast for him, but its a start.

Have you every heard of a school accepting help from a private SALT?

Yeah Claw, it's no problem whatsoever to have a private SALT. I have never seen an issue with it anyway... working in schools as an outsider can be hard depending on the school but it is very doable and any decent school will welcome any support they can get.

Private SALT costs vary but it is pricey.. regular sessions should be a lot less expensive than an assessment. Depends on where you are too..

Thanks Working, youve been really helpful, i kind of have a rough plan of action now, i feel better for it

I don't want to dampen your spirits but neither of the two settings that I have tried to get a private salt into have allowed it. The repeat over and over 'we are fully equipped to deal with ds language issues and have access to expert advice should we need it. Your salt therefore is not necessary.

The issue being, I guess, is that if independent salt makes a difference it will be evidence at tribunal for the la to fund. Having said that, the salt that I was thinking of hiring though that they would be able to convince school, partly be emphasising joint working with NHS salt so that might be an angle to try.

Can you remind me where in the country you are?

I am in Kent.

1st NHS SALT recommendations were ok, as far as NHS SALT recommendations go, he was specialist ASD SALT and part of the dx process, so he also observed ds and did assessments. He recommended things such as ds will need a level of one to one in the classroom to enable him to follow higher level classroom teaching and also to focus on social understanding/social communication. An adult to break down instructions, to repeat and recast language etc, etc. He also said that he agreed totally with everything that a previous SALT had assessed 2 years previously, so ds still have the same difficulties 2 years on.

Its all gone pair shaped since he passed it over his colleague to 'investigate further and provide programmes for school'

I will bear the the working with NHS SALT in mind. Ds's school also have an outreach SALT team, i have no idea of the qualifications of the person who assessed ds in July or it doesnt state which assessment tools she used, but i have a copy of her report where she states he had no difficulties in any of the areas she assessed (all which have been previously assessed and assessed again after) So when she assessed ds for example he had no difficulties with semantics links, although a few months earlier he was assessed to be on 0.04 centile, and reassessed after her assessment and still found to be on the 0.04 centile.

I dont hold out much hope of working alongside them, but still ind SALT might be about to 'teach' them i suppose.

Star, I do think your settings and LEA seem particularly obstructive... and arrogant...

Claw, it sounds to me that your son was initially seen by a specialist ASD therapist who will have been a Band 7 or 8 and was then passed to a schools therapist who is perhaps both less qualified and less specialist (Band 5 or 6). This often happens. Find out who is manager and ask for review with HIGHLY specialist ASD therapist. Explain your concerns about lack of progress.. That may help.

Yes Working.

One of the charities called them 'hostile'.

Thanks Working, i will do as you suggest, once ds school file arrives.

Given the whole personal budget thing is apparently just around the corner I don't see how they can refuse private input for much longer as parents will allegedly get to choose the provider in years to come.

I also don't see anything wrong with flattering the previous SALT and ask for his input again on the basis you feel the programme has stalled. They would rather deal with a request than a complaint - well you would hope so anyway.

It would also help with school if they are not implementing it to have a more senior person involved.

Thanks Agnes good point, in my experience its always better to start off requesting too. Ive just got to wait for paperwork, then i can hopefully start to get this sorted, well best i can for now anyway.