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?

He didn't get asked questions. This was recounting stories from pictures.

I'm not disputing it. It is not being said to replace the ASD diiagnosis but in addition to. Just bemused that no one bothered with something like this before.

But do NHS or the LA bother with ANY formal assessments unless pressed?

No-one round here did until I started threatening private ones.

Sorry i didnt word that very well, the description i have from SALT report "The ERRNI tests a childs ability to relate a story, comprehend it and recall it without picture clues after a delay of 30 minutes or over. It also explores theory of mind, as the central character has a false belief, so the child is questioned to ascertain if they can imagine what that character might be thinking"

Sorry again, i thought you were questioning why his expressive language difficulties hadnt been picked up before now. Hence my waffle

Star, i think the LA and NHS use whatever they think will require the least help or will suit THEM best.

In ds's case, he does well in most formal assessments in so much as he scores the right centiles, but these do not reflect his function ability well at all. Informal or less conventional assessments as they used for dx or private assessment, even observations do this best in ds's case.

Claw, yes as I say I was questioning why it had never been tested before.

I suspect it was because they didn't want to confirm a problem with language skills.

My post to Star above yours was saying something similar. I believe they use tests that will hide difficulties, rather than highlight them.

Although this wouldnt explain why your private assessments didnt pick up on it, which is why i was rambling about different assessments

I think the range of possible tests increases as the children get older.

That could be it.

claw - you have pinpointed exactly my concerns about my experiences of SALT formal assessment, that a picture based assessment just doesnt pick up on the day to day conversational difficulties a child may have.

Interestingly, this S&LT has actually put that in her report and she also thanked me for being present as it helped DS engage

And she recorded that too

Thelight, thank god ive been of some use, i misunderstood what appropriately was saying

Scoring centiles on expressive language is of no use to anyone, unless you can use that language logically and effectively. Centiles do not describe functional ability. Unfortunately everyone loves a centile to prove progress.

Wow!

So, is he secret to provision for a child with HFA or AS to chose a m/s school out of county?

Well, I have to say this wasn't done intentionally, the school was recommended because of the fab head, BUT, the consequence has been that S&LT seem to act less as a lapdog of the county and more like my son's therapist.

I imagine the school feel more able to tell it like it is too as they are not subject to county pressure. However, this head is dead straight anyway.

So this erni is a reliable test of pragmatic language is it?

No, it is a test of expressive language.

We have an ABA consultant coming to see us today - it will be interesting to see what she makes of these kinds of problems too.

DS language is no where near these levels but after a year of ABA the SALT report for AR accepted he has disordered language rather than just delayed. This didn't come as a surprise to us - he had learned language typically before regression (he spoke normally from 8-22 months) and when he relearnt it, it was completely different than the first time round. He only learnt what we taught, he never picked up phrases himself, when we taught a new word he dropped previous ones and they had to be systematically reintroduced.

SALT AR report confirmed DS had to be taught every new language structure individually and this was more than being delayed, it meant his language was disordered. So I guess in theory he should now have a ASD and language disorder dx - his statement just said language was severely delayed.

In DS case the language disorder was 'hidden' by the utter crapness of NHS SALT to teach him any language - they and mainstream nursery did not manage to teach him a single new word in a year. It was only once we won ABA and he got a proper language programme and made progress, that SALT could see that the way he was learning language was disordered. Under their care he had not learnt any, so it was not possible for them to see the disorder!

I suppose there is a general shift under dx criteria to separate out things more - so there are children with ASD who learn language typically / or language is just delayed - and children like mine who have ASD and a language disorder. So in effect 2 dx.

From the perspective of one day (hopefully) getting direct payments for SALT (Our LA pathfinder has told us they have no duty to provide these they only have a power to do so and have not yet got the process up and running, bummer - not sure I can be bothered to argue this at the moment as too much else going on) its pretty useful for us to have it clearly stated that he has disordered rather than delayed language. Not that the quality of SALT input we are getting has improved since they realised this. He got a new NHS SALT in Sept and she has decided she still does not know him well enough to make any recommendations! Oh well its only been 2 terms, no hurry.

That is really interesting Agnes, but frustrating for you.

Our county is a pathfinder authority too and two senior managers have said they have not heard anything about the pilot scheme applying to SEN direct payments

Yet, the county is there on Sch 2 of the pilot order regulations. So how you are supposed to apply for these things if LA staff know nothing about it is beyond me.

They have set up a personal budget scheme aimed at .....social care and not SEN. I understood LAs already had a power to provide payments for this anyway.

I have contacted a few people to see what the national guidance is and as soon as I have anything concrete I will post here.

How did the Consultant thing go?

I think it went well. She is quite well-known and published but she was very personable and down to earth too. She got on well with DS and she really seemed to get the measure of him.

She is going into school in a few weeks to observe and then she will work out a programme for him.

But the holistic approach is very attractive when you are so used to people compartmentalising DS and trying to deal with their little bit to the exclusion of everything else.

That sounds promising.

So she's not going to turn him into a robot then?

Only after the beatings and withholding of toys and love

Oh thank goodness!

Our Pathfinder says it is going to pilot DP for over 16's in one rural minuscule part of the County. Very frustrating. Just pocketed the £150k as far as I can see. But whilst I would prefer a better SALT I can't be bothered to have the fight about it, will just wait for 2014 to come round and ask again.
Our SEN Manager also had to go and get advice on the Pilot from legal!

In some ways the crapness of the NHS is another reason for us to keep ABA. Taking 8 months to come up with a recommendation is not exactly going to help convince at the next AR.
ABA have told me they will tell me if and when we need more SALT input than they can give and we will just pay ourselves.

Yes we get social care DP