Social immaturity in very bright six year old with S&L delays.

[Giblet]

Hi all, I am posting in the hope that someone will be able to offer some advice. My just turned six year old has finished her first year in primary school. I was aware from an early age that her language was not developing at the same rate as her siblings. At the time we were overseas and when I moved back I contacted the public health nurse and after an assesment she referred her for a S&L assessment. Turns out DD was diagsnosed with significant receptive and expressive language delays. We started an internsive SLT programme and at age four she had caught up in terms of ticking the boxes but still had difficulites in expressing coherent sentences. She was assessed by a multidiscipliinary team and was diagnosed also with mild SPD. Her psychological assessment suggested possible Aspereger's (she was in the 95th percentile for performance IQ but in the 16th percentile for verbal IQ) but the CAHMS team said that she was fine, no problems whatsoever and her difficulties were due to the fact that she was in a bilingual household and this was having an impact on her socially but it would all sort itself out when she started school. I completely disagreed with this and felt the team were not listening to my concerns. Her AON officer and SL therapist also disagreed with CAHMS.

Anyway one year on and she has finished her first year in school. She is generally a very happy little girl but this past year has been hard on her socially. The school did an assessment on all kids to identify if they needed support. She again hit the top mark on the performance but was way down on social skills (not quite at critical but closer to it then I would like) and she doesn't qualify for an resources or support. She does ok on strucutred one to one play in the classroom but not so well on the unstructed play in the playground. She doesn't make eye contact, cannot modulate her tone and her general speech tends not to be spontaneous but rather learned off phrases and sentences. She is often on her own in the playground and comes home crying that the other kids don't like her and don't want to play with her. I have been in close contact with her teacher who has been very supportive but the fact remains that socially she is struggling. She has already participated in a social skills programme in CAHMS and the SLt also recommended Carol Gray's social stories which I have done with her. I have tried play dates but the other kids don't stay engaged with her for long and rarely return the invite. She has been so sad about this for the past few weeks and my heart is broken for her. She is due to be reviewed by her SLT soon but I suppose I am just wondering if any of you have had similar experiences and if so how did you address them or what advice can you give?

Sounds as if you are concerned that it is Aspergers?
If so, could you afford to go the private route for a diagnosis?

She does seem to be ticking a lot of the boxes. I found this very useful though it does throw the work around social skills back to you.

Thank you for replying porridgelover. II will certainly get a copy of that book. Sometimes it is so hard to know what to think, what to do or how to seek help or even if help is warranted? I think you are right, I do feel that there is still a diagnosis there to be made. It may or may not be Aspergers's but there is something. When I do talk to those close (family and friends) those with younger children themselves will agree that something is going on with her - it is subtle but it's there. The older family members just say 'she will grow out of it'. I don't want the label - I just want to help my little girl.

I would go back to your doctor with a written list of concerns and ask to be referred again. If you are concerned about AS or ASD rather than Semantic Pragmatic Disorder (which is believed by many to be on the autistic spectrum, BTW) I would have a look on the NAS website, for instance, get a list of all the behaviours in the triad and give an example of each one that is relevant to your DD. Does she have any sensory issues? Remember that DC with ASD can be under sensitive to stimuli as well as over sensitive.

Thank you Ellenjane. Semantic Pragmatic Disorder has never been mentioned so I just googled it and I think it fits perfectly. Her SLT has said that language will always be black and white for DD. She has some sensory issues and has had lots of sensory meltdowns but to a lesser degree now. We have also noticed that lately she has develped a tic like habit - as if she has a lot of salivia in her mouth and is pulling it down her throat - results in a kind of slurping noise (if that makes any sense ). Since my last post I spoke to a colleague who is an audiologist. She is going to test her hearing and we can then eliminate or identify any potential problems there. Since school broke up she has become really attached to me and wants me around all the time. when I ask her to tell me what is wrong all she can say is 'my heart is broken' and when I try to get her to explain the why and how she just can't - she is simply not able to articulate her feelings or put it into her own words :(.

Sorry, Giblet, I assumed SPD was Semantic Pragmatic Disorder. Was it a sensory processing disorder? Doesn't seem to have done any harm, though. Maybe have a look around ASD as well? There are so, so many overlapping symptoms in these developmental disorders, that you really need a good professional to investigate. Diagnosis by internet or google can be a minefield. I'd still rather do a bit of research myself, though.