verbal dyspraxia/ASD

[sphil]

When we took DS2 to BIBIC for his reassessment earlier this week, we had a long discussion with the SALT there, who seems pretty sure that DS2 has verbal dyspraxia as well as ASD. In fact, she said that to her, he presented as a child whose language production,word retrieval and sequencing problems were paramount. She's recommended speech therapy once a week from a professional (bit different from the once every 3 months offered by our NHS SALT then!) + 30 mins a day speech games/exercises with us (including something very dodgy sounding called 'Mr Tongue'...)

Two things to ask really. I know dyspraxia/ASD overlap is very common, but would be grateful for any advice from anyone whose child has a similar 'mix'.

Secondly, what do we do about his proposed statement? At the moment the LEA will ask his NHS SALT for recommendations and she refuses to budge from the once every three months position. To be fair, I think she's absolutely snowed under, but she is also very inexperienced and hasn't once mentioned verbal dyspraxia to us, whereas the BIBIC SALT has 17 years experience working with children with ASD. The BIBIC one is sending us a report - can we use that instead of the NHS recommendation?

Yep- ds1 similar. In our case I kind of came to the conclusion recently that a lot of ds1's verbal dyspraxia is because of very poor imitation skills, so I just work on imitation now - occasionally he comes out with a perfectly pronounced word- 'Mummy" today poinitng at a photo of me!!!!

As regards SALT, we gave up with the NHS and paid for private. We did use the BIBIC report to ensure that SALT was written into parts 2 and 3 of the statement- which was important as his NHS SALT went on maternity leave and eventually the LEA agreed to fund the private SALT. He still didn't get much though tbh. If they're experience forget it.

Worth looking at Nancy Kaufman's site (speech teach or somehting- you'll get it on google). She has a lot of exoerience in autism and verbal dyspraxia- I went to one of her workshops when she gave one in the UK- useful.

sorry NOT Experienced.

sorry sphil can't help re dyspraxia, but just found an interesting article re language and RDI, scroll down to myths and facts about RDI here

RnB and I would be happy to meet up for a coffee sometime too

Thanks Monica - very interesting reading. I am strongly considering RDI for DS2 -or possibly a combination of ABA/RDI. Would really like to meet up with you and RnB - when/where best for you? (I am in Lewes.)
Baka - DS2 does that too! The best one ever was 'bakery'- about six months ago and never heard since. I like Nancy Kaufman's term for this - 'pop-outs'. Describes it perfectly! Glad to hear you were able to use BIBIC report for statement. We learnt more from the SALT there in an hour and a half than we have in a year from our NHS one. She is going to contact a colleague of hers who works as a private SALT in our area - apparently fantastic.

I've read that before and don't get this:

"They were easy to draw into an interaction and were very excited to play simple, mostly non-verbal games. They displayed fairly normal eye contact and other social behaviors, provided the interaction was simple and distractions were minimal."

Ds1 isn't remotely easy to draw into games or excited to play simple games- he;s rather stare out of the window, stim or wander off. Keeping him involved is really really difficult unless he's sat on our lap having a cuddle.

The other thing that annoys me about that extract (when I read it before) is that it says we will debunk myth number 1 but then doesn;t say how. Jus say's its good for non-verbal kids. How? How? How? I really want to know! 99% of the RDI exercises I ahve seen are for verbal kids. The limited ones that are for non-verbal kids appear to assume that your child will become verbal and move through the levels. There's no alternative for if they don't. Still I have been unable to get to what happens if that doesn;t happen (this is one of my biggest bug bears with Son-Rise as well incidentally- no proviso is made for your child remaining non-verbal and severe).

Firstly JJ all of the obstacles you mentioned ie stimming,wandering off/stare out of window are obstacles for any ASD child verbal/non verbal and are certainly apply to my verbal aged 10 dd.

We have been given strategies that work for addressing these ie. SID to reduce stimming, choosing a zone of connection to draw attention, working in an non distractive environment etc.

Also most of the activities we are doing,now at stage 5 are mostly non verbal, although she has language the whole point of RDI is motivating her to use it to communicate socially. We have to draw her to reference our non verbal language,by using exaggerated facial expressions/wow/oh no etc.

The how how how bit would best be answered by watching the dvd/attending a workshop, that's what they are there for. However I would surmise that working at stage zero many of the activities would be similar to Intensive Interaction/S and L anticipation games, ie blow your cheeks out, have ds pop with hands(hand over hand if necessary) the reward would not be tangible like with ABA,but an exaggerated expression/jump etc. the popping of your cheeks would be the bit you spotlight and emphasise as the focus of the shared experience. It could also be done with lots of rough and tumble games where ds would have to reference you non verbally for the interaction to continue.

I have joined the RDI mid atlanta group and there are loads of non verbal kids my dd's age working up through the higher stages.

I think the point the parent on the forum was trying to make is something that was a poignant part for me during the RDA, the consultant showed dd a photo of his dog, for 10 mins she stared at him whilst he used non verbal gestures and other short declarative comments to indicate to her that he wanted to share his love of his dog with her. My point being that although dd has age appropriate language, could probably name hundreds of different facts about dogs etc but cannot use the language stored in her semantic memory to have a simple social interaction with someone, similar to a child of age 2/3 would. Language is pratically useless if you cannot reference, if you think at 9 month old baby starts to reference faces for reassurance/enjoyment etc. many asd kids although have language don't do this.

I have the DVD and the book- and I just have seen very little I can apply to ds1. A handful of activities- that's it. I get the stuff about referencing, but so many of the activities just do not/will not work with ds1. I can't afford the workshop, we certainly cannot afford a consultant.

TBH having looked at it all I'm introducing Floortime as the relationship extra bit I want- lots of the ideas behind it seem the same as RDI but it seems far more suited to a severely autistic child - in that it is desgined around severe autism and they talk a lot more about how to incorporate it with ABA etc More publications as well, and a lot lot cheaper. And the video excerts are of children who look like and act like ds1so far easier for us to apply at home.

I'm sure there are children out there that RDI is fantastic for, but I've never got to the bottom of how to use it with ds1.

I like the idea of floortime JJ too, it isn't worlds apart from RDI, particularly the wooing the child into interaction, finding a way to make being with others pleasurable/interesting, following the child's lead, keeping the interaction going, looking for a change in expression to check if connection has been made etc. I have very limited knowledge of it but I know it is very good for SLD children too. How easy is it to access in the country I wonder? Wishing you lots of luck

Cheers- will report back. I have a DVD coming, and there is a consultant in Cardiff, apparently they quite often give lectures, so will have to get myself along to one if we go down that route!

Baka -Is the DVD you mention the Play Project one, or a separate Floortime one? I'm being rather stingy and not ordering the Play Project DVD (or is it a CDROM?)until you've got yours and tell me what you think of it!!

I've been doing a version of Floortime with DS2 since he was 2.5 - mainly because the Stanley Greenspan book was the only one I'd read then! However, I was getting further and further away from the model - initiating too much, getting up to make a cup of tea (noooo!) etc. Looking at the Play Project and Floortime websites have rekindled my enthusiasm - so I'm doing more Floortime with DS2 while I research RDI and ABA more thoroughly. I've only read the book and looked at the site, but it does seem to work with DS2 if I really make the effort to do it properly. But I'm not doing anything like as much as they suggest - probably no more than an hour a day (split into 2x30mins). Would agree it works for non-verbal child - it seems to encourage DS2 to use more gestures, eye contact etc. Although bit difficult to tell this week as all his Floortime sessions have been conducted under a duvet...

Baka -Is the DVD you mention the Play Project one, or a separate Floortime one? I'm being rather stingy and not ordering the Play Project DVD (or is it a CDROM?)until you've got yours and tell me what you think of it!!

I've been doing a version of Floortime with DS2 since he was 2.5 - mainly because the Stanley Greenspan book was the only one I'd read then! However, I was getting further and further away from the model - initiating too much, getting up to make a cup of tea (noooo!) etc. Looking at the Play Project and Floortime websites have rekindled my enthusiasm - so I'm doing more Floortime with DS2 while I research RDI and ABA more thoroughly. I've only read the book and looked at the site, but it does seem to work with DS2 if I really make the effort to do it properly. But I'm not doing anything like as much as they suggest - probably no more than an hour a day (split into 2x30mins). Would agree it works for non-verbal child - it seems to encourage DS2 to use more gestures, eye contact etc. Although bit difficult to tell this week as all his Floortime sessions have been conducted under a duvet...

Sphil,

Sorry a bit late coming to this one. Ds2 has some autistic and dyspraxic features but no diagnosis. His speech is very unclear and we have been told he has a speech sound disorder. It is probably not verbal dyspraxia (which is to do with the signals from the brain being misinterpreted) rather oral dyspraxia (which is to do with the muscles of the mouth and the ability to use the tongue etc). I think with verbal dyspraxia you can get a lot more variation in the way words sound, so a word might be pronounced differently by the child every time, whereas DS2 is quite consistent in his pronounciation but it is often wrong.

We try to do things like blowing instruments, recorder, whistles etc, blowing through straws etc. We also had Mr Tongue which Ds2 found more or less impossible. A good starting point might be to try smearing honey or jam around your Ds2's mouth and trying to get him to lick it off. I have found it hard to get Ds2 to co-operate with specific speech sound exercises and I think that is a problem with having a child with SN and oral dyspraxia rather than just the speech problems. I am seeing the SALT at his new school on Tuesday and I will be interested to know if she has been working much on this and what she has been doing as his speech does seem to have improved a bit.

Yes, DS2 pronounces words differently every time - sometimes within a space of minutes! A few months ago I would have laughed if anyone had suggested Mr Tongue as he showed no interest in imitating, but he's just starting to do so now, so we are having limited success (sticking tongue out and doing a couple of the speech sounds - but only when in the mood...) He is able to make a much wider range of sounds now though - six months ago he could only do the initial sound of a word, and now nearly always says first syllable (usually has to be prompted for subsequent syllables). Consonants are clearer and more differentiated too.

Am going to talk to our Key Worker tomorrow about getting him dx with verbal dyspraxia as well as ASD - think it may help us to get more SLT.

I hope you get a diagnosis, then you really ought to get some SALT. I don't know where you are but I remember thinking this \link{http://www.dyspraxiatherapy.co.uk/index.html\SALT} looked promising when we considered private speech therapy - unfortunately we are not in London.

Yes, she looks ideal. Unfortunately we're in East Sussex! Might e-mail her to see if she knows anyone in our area. Having said that, we are having an initial meeting with a speech therapist on Thursday - experienced in ASD and dyspraxia - so we'll see how that goes.

On the dx front, our Key Worker has suggested that she asks our paed to refer us on to Guys (Gillian Baird's team) to pursue the verbal dyspraxia issue.

If you want a dx of verbal dyspraxia then the best place to get referred to is the Nuffield Ear Nose and throat hospital at King's Cross. Pam Williams (principal SALT and Dr Lim). Have you ever heard of the Nuffield dyspraxia programme that speech therapists uses?? Well Pam helped design it.

Update on this one - would be interested to see what you think.
Saw private speech therapist for first time today. On the positive side, DS2 responded to her immediately and was quite interactive for a first meeting.She is def more experienced than our NHS SALT. On the more negative side, she's not a specialist in ASD/verbal dyspraxia, as I thought (it's listed as her 'special interest' on the ASLTIP website and I'd misinterpreted that as meaning she was a specialist). She's not trained in PECS, only Makathon.
At the moment we have arranged a 6 week block of sessions and we'll then review. She is very amenable to 'seeing how it goes'. Am I daft to pay someone £50 an hour who isn't an ASD specialist? Or is it enough that she seems the sort of person who can engage DS2 and can see him regularly?

Are you using PECS or Makaton? If you're using PECS I think you need someone PECS trained as it will be such an important part of your son's communication. Lack of PECS trinaing was one of the biggest problems we had with the NHS therapists.

We're using Makathon at the moment. Only using PECs in the sense that we've got a board up in the kitchen with about 5 different pictures on that he exchanges with us when he wants snacks. He's getting the idea of this well, which is interesting as he didn't take to PECS at all when we first tried it a year ago. We're going on a course in June which will help us decide whether to do it properly and I don't think we'll try to do any more than the snacks board until then. So in a sense it doesn't matter short term that SALT isn't PECs trained, but it might long term, iyswim.