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moondog or other SALT's help please- kaufman or Nuffield for ASD and verbal dyspraxia?

24 replies

cansu · 08/04/2012 09:58

Posted yesterday about concerns over dd aged 7 ASD and possibly verbally dyspraxic and her new SALT. had some good advice but was suggested I post asking for Monndog's help. Basically old SALT and ABA consultant (DD used to do home programme) felt her poor expressive language was due partly to verbal dyspraxia (says some words but only first bit eg hou for house and can't say some sounds at all) DD therefore did some work daily on sound patterns. New SALT does not think verbal dyspraxia and is more leaning towards communication side and dd using ipad etc. I am worried about this as have always felt that her inability to sequence the sounds etc was key. Plus she doesn't seem to have other learning difficulties and is cognitively quite bright. Am considering speaking to new SALt about this but want to be sure of what I am saying first. Any advice?

OP posts:
moondog · 08/04/2012 11:44

Cansu, many children have dyspraxia in addition to deeper language and communication issues. Thus thy may have difficulty planning and putting language together and then also have difficullies with motor execution (ie physically stringing thouse sounds together).

The clinical decision always has to be one of what one prioritises when working with a child with complex communication problems. That is something that I can't possibly tell you over the Internet. What you could do is ask these people in turn what her issues are and in what priority they consider they should be addressed. You may get different answers.

SALT and ABA have different strengths and weaknesses. S/LT s are better than anyone at separating out the different issues and categorising them. ABA folk are better at getting down to business and working on a presenting issue using data to show if a difference is being made or not. What some ABA folk don't fully appreciate is that there is a lot more to language than simply being able to string sounds together.

cansu · 08/04/2012 12:55

Thank you for your advice Moondog. I think I will get different answers and already have one SALT which said my dd had verbal dyspraxia and one who says she isn't convinced of this. This kind of makes it difficult to address. I feel very frustrated that having fought for SALT input and worked very hard to integrate SALT recommendations into daily ABA sessions, we seem to be in very wishy washy waters again. DD has a fab 1:1 who is willing and capable to work with her everyday. Her sounds were improving and becoming clearer. I need to have a proper conversation with the new speech therapist and get her take on dd's issues. I can't imagine that working on her sounds on a daily basis will do any harm.

OP posts:
moondog · 08/04/2012 13:08

No, not at all.
It will be excellent practice.A pressed for time NHS s/lt might nudge you towards the alternative communication route partly because s/he hasn't the time to supervise and intensive speech improvement programme.
But if you have great staff, use an ABA approach (ie take into account ensuring activities are reinforcing and also take data) and are highly disciplined, then no reason why you can't achieve grea things.

What I am trying to say is that with the best will in the world, an NHS s/lt intervention is not gonig to be state of the art.

BlueberryPancake · 08/04/2012 17:20

In my experience, I think that some speech therapists have received more information about dyspraxia and can diagnose it more accuratly - but this is only my opinion, I don't know for sure. I was told very categorically by DS's SLT that 'your son does not have developmental verbal dyspraxia.... His symptoms do not fit the check list of symptoms' (in writing, in a report). I self referred to the Nuffield as I was not convinced by that answer, and DS was assessed and although some of he didn't fit in with some of the criteria (he has excellent balance, fine and gross motor skills) he was poor in other areas such as muscle tone, had problems imitating facial movement, couldn't point his tongue, had problems with sequencing, and obviously couldn't pronounce many sounds correctly, including all vowel sounds (ee, ar, ah, o, oh, etc they all blended into one single vowel sound which sounded like ah). and most of his consonate sounds were wrong.

He has responded exceptionally well to the Nuffield program, which he did (and still doing) with the help of the speech therapist who say he didn't have DVD in the first place. She was excellent at delivering the program - I just think she got the diagnosis wrong.

My opinion is, if you can get an assessment with the Nuffield, you will have a much better idea of what the problem is and which program to go for. The waiting list is long though, it took us 6 months to get initial appointment but since we have had the reports, all his speech therapy has been very focused, excellent quality, consistent, and lots of help at school.

cansu · 08/04/2012 18:14

Thanks Blueberry. Does you ds also have ASD? I ask because from looking at Nuffield web site they seem less than keen to see dc with ASD.

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PleasantSpice · 08/04/2012 19:45

Not personally a SALT but a behaviour analyst who works with a number of SALTs to develop functional speech with individuals with ASD. We use a combination of approaches including oral placement therapy, tactile cueing, Kaufman, Wordflips and have recently invested in Nuffield. It is always a very difficult balance regarding augmentative communication and speech. We have seen some amazing things happen using the iPad as a communication device, such as children being able to communicate in full sentences when they only currently had a few speech sounds they were able to use functionally, so I wouldn't rule it out. However we have seen amazing things happen with a number of children with ASD who had very limited speech. Using a combination of the right approaches we have seen children who had no speech develop speech and children who were difficult to understand become more understandable.

beautifulgirls · 08/04/2012 19:59

My DD was seen at the Nuffield. We went with the question for them "do you think DD's difficulties are all down to her speech problems or is there more than a speech issue here?" She had a diagnosis of verbal dyspraxia from her private SALT which they confirmed while we were there, but they were excellent, took a comprehensive history and asked a lot of questions. On the basis of that they then referred her to their own pyschologist for an appointment about a month later who spent two hours with her and concluded that DD did need a full ASD investigation and then referred on to our local ASD service. We did this in part to jump through hoops for the local service who seemed less than interested initially, and also the school Ed Psych who seemed to be off on a tangent at the time about DD's problems. Fast forwards 18months and DD now has a diagnosis of dyspraxia, verbal dyspraxia and ASD, currently also waiting on APD conclusion from GOSH too.
We found them patient at the Nuffield, helpful and understanding that we had wide ranging concerns and needed someone to help us ensure we were going in the right direction from there.

moondog · 08/04/2012 20:27

It would be great if you could access the services of someone like Pleasant. People like her are few and far between and I personally am looking forward very much to meeting her and seeing her work presented at an international ABA conference we are both attending next month.

Smile
cansu · 09/04/2012 08:01

where do you work Pleasant???

OP posts:
PleasantSpice · 09/04/2012 09:29

Thanks Moondog, that's really kind but I just had to find out the information to help our own foster child, just lucky I work in the field and can help others too! I am looking forward to meeting you. Getting closer now! I must finalise the workshops I want to go to!

Cansu, I have replied to your PM.

working9while5 · 09/04/2012 10:16

At 7 years old, if your dd is omitting final sounds her speech intelligibility is likely to be very poor, with a disorder within the severe range. Whether this is called dyspraxia or severe phonological disorder or inconsistent phonological disorder is only of marginal importance. In all cases, at 7, she needs intensive speech and language therapy input using a structured programme in order to make progress. This would be true even if she didn't have ASD.

In addition to this she needs a suitable alternative or augmentative communication advice. Contrary to what people sometimes think, AAC is not a poor man's substitute for speech therapy - it's actually pretty vital.

The key to everything in speech, language and communication disorders is isolating what needs to be worked on, working on it intensively and systematically and ensuring frequent opportunities for that skill to be used functionally. While speech may present as the most pressing issue, I can almost guarantee you that if your daughter is struggling to communicate because her speech is unintelligible, this will reduce her opportunities to use language and to communicate with others which will have a knock-on effect across all domains of speech and language.

In the Nuffield programme (as you may know) targets are multilevel and multitarget so you are working on lots of different things at the same time e.g.
k - single sound level
b - cv level (ob, ib, ub etc)
d, t, s - cvcv level (and here you can have same or alternating vowels so split it further e.g. tata or tatee etc).
then cvc, ccvc, cvcc and multisyllabic targets, then including these in sentences etc.

In the same way, you can have spoken language/communication targets that are multilevel and multitarget. I can't give extremely effective examples because I don't know your daughter. However, with the secondary students I work with, some of them would use AAC only for very specific reasons e.g. in science lessons where certain multisyllabics are too challenging in speech, but they would try these through low tech means first e.g. writing/drawing, using AAC as the final resort. The rest of their communication would be speech only. Typically higher tech AAC is used more frequently by my clients with non-familiar people or in non-familiar situations where a transaction has to happen more quickly than they have strategies to manage e.g. on the bus where there may be queuing and it's too hard to get across that you need extra time (and you probably won't be given it anyway).

What this means is that if your daughter can communicate some things effectively in speech only, these don't need to be targeted with a high tech AAC device. However, without an AAC device and given the rate of progress with severe disorders of this type, if she doesn't have AAC it is likely that there will be things that are beyond her ability to currently communicate. If she can't do it with speech and has no other options, opportunities to say things or to practice language skills may be unnecessarily limited. Someone with very unintelligible speech as their primary issue may be able to string words together in sentences but because they are poorly comprehended by listeners, there is no motivation to really persist with this and the person will almost always reduce the complexity of their language to get a message across. This may still be true for your daughter, or like some other children with ASD/dyspraxia, she may not realise and just power on and not really even realise that people aren't understanding her which in itself is not helpful.

It's all interlinked. AAC is not perfect, it has a long way to go and it requires extremely careful planning to be used effectively alongside speech programmes but if it were my child, I would be very insistent on it AND appropriately intensive speech therapy. I have unfortunately seen the fall out of intensive focus on speech only and even where speech has almost resolved at secondary, there is still fall out if language and communication haven't also been prioritised.

For dyspraxia or severe speech disorders, optimum input is something like about about 2-3 hours of therapy a week and daily carryover of 20 mins with someone following through in class and at home. This is usually only achievable in specialist speech and language units and unfortunately access to these is erratic.

Hope this helps.

cansu · 09/04/2012 14:10

Thank you very much working for taking the time to give me so much great advice. dd currently has one hour every fornight from SALT plus she works daily with TA who is fab. I think I may ask the SALT to set up a speech sounds programme that can be done daily alongside dd using her i pad in the classroom and at home when necessary. I can totally see your point about needing the device also.

OP posts:
moondog · 09/04/2012 19:48

Fantastic advice from 9-5 (as always). Smile
Pleasant, this will be a cracking workshop. (I'm discussing this online as opposed to privately as it will be of interest to other people here too.

Workshop 8 with Joanne Gerenser an s/lt and a behaviour analyst.

I went to noe of hers last year and she said and discussed everything i want to say and would if I was a million times smarter. Worth every penny. She does a lot of work with actual speech (as opposed to general language) and kids with ASD and discussed this extensively. She also has a great paper on it that I can pass onto anyone who is interested which is of particular relevance and importance to those who understand both s/lt and ABA.

Another unmissable one is the basic intro to Standard Cleration Charting and Precision Teaching with the cxream of the field.
Workshop 17

So much other unmissable stuff too thoguh. I'm in a similar quandry.

sazale · 09/04/2012 19:58

I've found this thread very informative, thanks OP for starting it and to everyone else for their input. My DS is 5 and has final consenant deletion and disordered phonological speech. He has just finished his second round of NHS speech therapy. He has had two sets of 6 weekly 30 min sessions with a three month break inbetween. He is now on a 3 month break and will have a 3rd set. He has no support in school. I'm meeting with SENCO after Easter break and wondering if he should be having input in school. His salt said she felt he should be on early action but she's not too sure. Thanks

PleasantSpice · 09/04/2012 20:12

Thanks Moondog, good to have recommendations on presenters! I am looking forward to the speech workshop, it looks great, shame there are two others that I would love to go to at the same time! Will have a look at the standard celeration chart one now.

moondog · 09/04/2012 20:17

I will drag you along to the chat share evening with us. Grin
Utterly mad and quite quite compelling.
Peopel chart everything and anything!

PleasantSpice · 09/04/2012 20:20

Moondog, can I have the paper please?

moondog · 09/04/2012 20:22

[[http://portal.abainternational.org/Public/ProgramOnTheWeb/frmWorkshopSubmissionDetail.aspx?intConvID=23&Search=Workshop&strPBID=17 There is no Vowel at the end of D O G:
Considerations for Teaching Speech Production
Joanne Gerenser]]

Here is the link to her paper in SPABA (page 180)
Journal of Speech Pathology and ABA

moondog · 09/04/2012 20:24

The Experiences of "Autism Mothers" who become Behavior Analysts: A Qualitative Study

  • Mary Lynch Barbera

Another interesting paper in that issue.

PleasantSpice · 09/04/2012 20:25

Ah, yes I have read the Mary Barbera article!
Thanks Moondog.

working9while5 · 09/04/2012 23:35

That is just the type of workshop I wish I could go to! I know I have banged on about the importance of targeting vocabulary beyond initial stages on these boards before but this workshop looks like it will explain all that in a more cohesive and integrated way than I can!

However, as I expect I will be 38 weeks pregnant then, fairly sure I won't make it ;)

moondog · 10/04/2012 09:03

Oh she's amazing, 9-5.
Brings these two disciplines together so brilliantly, and she is so down to earth and utterly unpretentious.
How exciting about the baby.
I had no idea!!

working9while5 · 10/04/2012 11:14

I have the same due date as Star Grin

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