Expressive language problems

[appropriatelyemployed]

DS's new NHS S&LT came into see him recently.

She has actually reported back that he is below the accepted range for his age in expressive language test she did.

Why has no one picked this up before? We have had a leading S&LT consultant (who seems mainly to do Tribunals) and two NHS therapists.

DS's statement has always said his concrete language skills are good but he has the social communication problems that go with ASD

How does this differ?

I think it's a new trend AE to do with the recategorisation of ASD that is encouraging SALT problems to be seen as additional to and separate from ASD.

This is good news for SALTs who are losing their jobs and who have until now been a part of the 'SALT' doesn't work for ASD because the SALT issues are really ASD issues so need ASD experts instead.

Also, as your DS develops he becomes more 'testable' and the SALT things can be detached from the ASD better and concretely assessed rather than best guesses.

But mainly, I just think it is a new trend.

But she says this as an additional to the communication issues as if the language issue and ASD communication issues were distinct.

Or is that what you are saying?

Like the name change btw

Yes it's what I'm saying (or trying to) and it has happened to us just recently.

And like you I spent a few months like and and wondering how on earth it could have been overlooked given the sheer amount of fighting for and paying for assessments - then I eventually got over it. It is just one more ridiculous thing to process.

DH went to a presentation thing at DS' new SLT school just recently and reported back that the HT was saying that this was currently happening a lot.

I'm still trying to get my head around it myself though because all my 'expertise' was on how to improve ds' receptive communication and now I have to learn something else.

SAL issues as separate from ASD means in many PCTs, children still meet the criteria for SALT.

If the SAL are only ASD caused then many PCTs are changing their criteria for therapy as the cost-benefit is being re-calculated iyswim.

Sorry, I'm really not being very articulate tonight.

Very interesting. My battle was for them to take on DS as initially the S&LT service in our county said 'we don't do ASD kids only language issues'.

I had to fight really hard to persuade them that ASD communication issues come under their mandate.

Now we have S&LT delivered by another county, and they say ASD communication issues and a separate language issue.

But if PCTs were weeding out ASD kids and discharging them because they didn't wanted to deliver provision, why are they potentially picking them all back up? Isn't this increasing their workload?

Or are you saying they are trying to increase workloads to keep jobs?

AE, I'm not really sure of the motivation behind the trend, and I am in absolutely no doubt, now pointed out to me, that my DS has expressive language problems that were not picked up before. I do believe the assessment is correct.

I wonder perhaps if it has suddenly become important to find NOW for some a difficult parents and it is easier to find a reason to keep them on the books rather than deal with the subsequent paperwork. Not sure.

Is new SALT funded for your DS from different LA to their usual LA? Is his funding 'extra'?

I mean is the SALT you are now dealing with 'independent' of their usual funding arrangements?

Yes, she is from a different county service.

Ah well. Perhaps that is part of the answer in your case.

Do you agree with the expressive language problems? (in our case it was mainly to do with word finding).

Yes, it makes perfect sense. In fact, it is what I have been trying to explain to other people - like his toxic 'he looks alright to us' last school.

I think it depends on what assessments they use too, for example ds scores something like 50th centile for expressive skills in some formal assessments (depending on the assessment)

But when tested using tests which 'cover aspects of communication not readily assessed by conventional language assessments' coherence for example he scored 1 centile.

So for ds formal assessment he can answer test questions, but a lot of the time his social or informal speech is not logical.

Does this new SALT specialise in ASD or have more knowledge or experience of ASD?

She used formal assessment - the ERRNI.

Her title is 'highly specialist S&LT' for what that's worth!

She seems much more straight than the last shower though who acted as if they were the tools of thedevil LA.

What does ERRNI stand for AE?

What were the tests called that your dcs had claw and starlight?
According to salt/ed psych assessments my ds has above average expressive language .

Expression, Reception and Recall of Narrative Instrument (ERRNI)

Oodles, sorry I can't remember. Definitely CELF but others too.

It was actually the EP that identified the problem though and this was then backed by SALT.

She showed me clearly. There were pictures with missing things or things that were wrong in them. DS could giggle and point but just could not explain.

Now I know what I am looking for I see these problems with him all the time.

appropriately Is ERRNI the only test they have used throughout?

Oodles Ds has had lots and lots of assessments, i have reports to hand and can name them if this is helpful. But i will try and explain what i am trying to say as best i can, sorry if its long winded! (I know where ds gets it from now )

In my experience the assessments used by NHS SALT for dx were 'designed' to bring out difficulties in order to give dx, since then (when it comes to giving help) i have found their assessments are 'designed' to play them down.

Examples of expressive skills during dx assessment:-

"Ds understood my direct questions about his family and everyday life and responded using spoken output that was grammatically well structured. However, his replies were difficult for me to follow as he frequently mumbled, used a quiet voice or produced responses that were "off track". Some of the info he gave about his siblings was difficult for me to understand. When we discussed his brothers he said "ive got loads" and in fact gave me the names of his brothers friends"

"When i withdrew from asking questions, he sat silently, never initiating any engagement with me. Throughout the assessment he followed his own agenda"

"when i introduced the subject of computer games, he became more animated. He produced a greater level of expressive language but this became long winded and monologue in style"

"Pets another area of interest, he again produced a lot of spoken language. However he became fixed on various areas, giving me facts and repetitively asking if i wanted to know his pets ages. He showed a systematic style of questioning rather than being flexible and socially responsive"

Now i would say he had delayed expressive language based on this, when asked questions which are not formal you cant understand him and he will not talk unless its of interest to him or will sit silently if not being asked questions.

It was then passed to NHS SALT to go into school and decide what help he needed. All she used was formal assessments

"Expressive Skills - using RAPT the child is asked to answer questions about ten different pictures. The language produced is scored according to both the amount of information conveyed and the grammar used. He scored 8.5 years (he was 6 at the time)

SALT concludes no difficulties, no help needed!

Appropriately Just had a thought i remember from your previous posts about how your ds is getting very anxious in school, hiding under the table etc. Could it be he was having a very sensory or anxious day on the day of testing?

Ha ha claw, that sounds about right.
Thanks for the names of the assessments AE and star.

The EERNI has never been used before. I don't know why.

Ds has had the EERNI, they ask questions after a delay of 30 minutes of more, could it be more to do with memory?

This test was also quite different from the previous RAPT test that ds had too, as it requires recall and for ds to comprehend the story. With the RAPT, he was just required to give details of the picture being shown.

So RAPT he scored 8.5 years. EERNI he struggled to grasp the underlying meaning, he did not describe the main ideas of the story, spoke about irrelevant details, didnt understand the relationships of the characters or the emotions etc, etc.