When do speech problems end and ASD begin?

[roadkillbunny]

Hi, I would really appreciate some wisdom on this!

We are in the early stages when it comes to possible dx for ds, he is 4y9m old and the ball has really started rolling since he started school in September.

He has huge speech and language problems, his speech is very delayed and unintelagable. The SaLT finally did some assessments with him over the last few weeks and the results are that his comprehension of sentence structure is at 5 years (50th centile) his comprehension of concepts and directions is 4.05 years (37th centile) but his expressive vocabulary is at 3.11 years (16th centile) and expressive word structure is less then 3 years (0.4th centile).
So you can see he has problems, he doesn't use linking words, like and, if, then etc and he uses no expressive language. He also doesn't use any grammar.

Ds has also got big issues socially, he really has no clue how to act within a group of peers. He has good relationships with adults and can cope better with peers on a 1-1 level.
Some of the observations in the EPs report are:
He becomes frustrated if he can not make himself understood which leads to behaviours such as scratching. Break times are a flashpoint.
He repeats back 'no hit' but often uses this phrase more generally when he has done something wrong rather then just when he has hit someone.
He will parochial a group of children and walk through there activity as he does not know how to join in.
The other children have tried to include him in group games but he doesn't understand what to do unless supported by an adult.

We are due our first appointment with a paediatrician early in the new year and although I am obviously not qualified I do feel that ds most likely has HFA but I don't want to turn the doctors off by going in and telling them there jobs.
The other issue I have that occupies and confuses me is where does ds problems with language end and where do other issues start. Among the school and profferionals this far involved I get the feeling that they think that all ds's issues are routed in his speech problems. That the social problems come from lack of speech and loss of confidence due to not being able to make himself understood. I agree that the speech problems play a huge roll in the social issues but I just can't seem to detanggle the two, the support plan at school is to concentrate on the speech and language while using 1-1 in the morning to guide (and then step back) in social interaction. I am more then happy with this plan however when it comes to the question of does ds have an ASD I wonder if I would still feel the same if his speech was fine, would he still have these traits? There are some I think he would have like him liking lam posts and his obsessive interests (they do change but while one interest is running everything else in the world is forgotten and everything is brought into that interest although his love of all things computer doesn't change, he would be the happiest boy if you let him sit at a computer 24/7!).

I know this post is muddled, my mind is right now, the simplified question is can a speech and language problem imitate ASD and once the speech and language problems are being treated and moving forwards does it move things like social skills forward to?
Or, is the speech and language problem an intrinsic part of ASD and it can not be detangled as it is part of the fabric of the condition?
I keep getting myself tied in knots trying to work this out! I am as certain as I can be as a lay person that ds has HFA but often when I come out of a meeting with school and at other random times I find myself wondering if it is all down to a speech and language delay.
Any ideas, expirance or antidotes?

"the simplified question is can a speech and language problem imitate ASD and once the speech and language problems are being treated and moving forwards does it move things like social skills forward too?"

The simple answer to this is yes even if there is ASD but social skills will lag long term with ASD (of which language problems can be a part and parcel) especially among peers, so clearly the two are closely related which is why a Paed needs to be involved. I would urge to you consider private SLT if you can possibly find a way to afford it. You will possibly have a long wait to find out because often it doesn't become easier to unpick the language/social deficits until kids are in Juniors. Having said that you may have an insightful and perceptive Paediatrician who can see what's what (including the obsessions) and fast-track a diagnosis if there is one to be had, this may depend on what the Paediatrician sees in your ds when he is seen in January. Are there any sensory issues or repetetive/stereotyped behaviours? Given that your ds has quite a marked expressive language problem you will find that everyone at school focuses on that, because it is so obvious. This will be frustrating & you will have to have the patience of a saint while the issues are unpicked. Good luck for January, you are right to ask the question and I hope that you get some clarity on it soon.......... honking for you.

Handywoman x

Yep, what handy said. They are massively intertwined. And progress on speech will lead to progress on social skills, etc etc. Maturity can also play a huge part - my DS 'speech' is more or less caught up but there is a massive black hole round his social communication.

It can help to separate speech - the mechanics of talking, the building blocks of grammar, the physical things that mouth and tongue have to do from communication - the desire to speak, the benefits of speech (ie social interaction when you're trying to unpick it all in your head. They are actually two different things (albeit with a massive overlap in verbal children) - does that make any sense?

The other thing is investigations almost always start with a speech assessment to get a 'baseline' - my pead said they needed to understand how much DS could understand before doing ADOS, for eg. But we were able to access speech therapy before we got our dx so it's worth asking if there's anything SALT can do meantime.

Finally (god, epic post) - I think this is changing, but one of the diagnostic criteria for Asperger's was or is that there was no speech delay age 3. So a child could have no delay and still be on the spectrum.

Thank you for taking the time to reply :)

SALT have been terrible up to this point, my older dd has speech problems and was under the same team before getting in school help at Y1 and they completely missed and failed to investigate the congenital physical problems within her mouth that were the route of her problems, we aren't talking highly rare stuff here either but a complete (routed at multiple points) tongue tie was biggest factor. It wasn't until I had banged my head on every table I could find trying to get proper help for dd that desperation led me to reply to an advert from a production company looking for children for Embarrissing Bodies: kids. They took on her case and changed her life. She know has therapy that works at school with the fab in schools team. So my starting point with ds SaLT was not from a positive or trust worthy place and they did nothing to change that opinion. When I begged them to see him in the summer before he started school the therapist said they couldn't do anything until his speech had matured. I felt like I was banging my head on walls all over again. It has taken ds's class teacher and the SENCo insisting during conference calls for her to pull her finger out and do something for ds and now her attitude has about turned and she has properly assessed him (part of the results I posted above) and ds will now be having weekly speech therapy in school and they will train the other teaching staff (and his TA when appointed) so he can have targeted daily speech therapy at school as well as the work we do at home.
I have the CAF, speech report and EP report which I am planning to take with me to the paediatrician in Jan. I was also planning on writing examples of ds difficulties within each of the triad of impairments so I don't miss out any vital information. I don't know if the paediatrician will read the reports in the appointment though, is it worth seeing if I can send copies in advance of the appointment or would they just roll there eyes at me?

Repetitive behaviours I am not sure on, he likes things to always be done the same way but I can't think of anything I would particully class as that but I have found sometimes you stop noticing behaviours because you get so used to it and adjust around without even realising you are doing do, do you have any examples for me to give my mind s jolt?

Sensory wise he used to have hugge problems with loud noises of a certain pitch and we had to take ear defenders with us everywhere but it suddenly stopped in August and fingers crossed hasn't returned. He has to have his covers completely over his head when he sleeps, he is like a dog in a nest in the middle of his bed, I have to go in once he is asleep and gently untangle him as I worry he will suffocate himself however by morning he will be in his nest totally covered again! He dislikes crowded places but not sure to what degree it is as we just aren't in bust places often at all (country bumpkins lol!). He also has a real thing for soft toys, will always have one of his three favourites with him at home but no home toys allowed at school and as that is a school rule he doesn't have an issue with it.

I am a bit worr
There was a typo (well there were lots but one inparticular) in my first post, he doesn't like lam posts, he has a thing for licking lamp posts if you don't catch him, he is very oral in that he is still in the 'everything goes in their mouth' stage.
Sorry seem to have gone on, just have so many questions and nobody in rl really to ask who would know as school and education professionals can't comment about a particular condition as they are not qualified to diagnose. They do know my opinion as they pushed me into saying what we were hoping for from paediatrician I said how I had my suspicions but in was early days and the whole how much in speech delay etc etc. so here is the only place I have to ask these questions of people who can actually give me knowledgable constructive answers!

Sorry posted too soon, second to last parra was meant to say how I am a bit worried at the paediatrician won't see much of ds's behaviour in the environment of a doctors office with his parents. It is mainly in a group of peers that the behaviour is most evident, surely the docs are swear of this problem? It was just when Handy said it depended on what the doc sees in the day.

Sorry for the mammoth post as well!

Yes roadkill, your ds may not demonstrate anything unusual at the Paed's office so you are right to jot everything down under the triad, collate and send ahead of your appt. Certainly the sensory issues with noise and lamp post thing need to be conveyed.

The Paediatrician will most likely (hopefully) read all the info on file before the appointment so that you can make the most of the allotted time rather than spend it dictating every worry, only to have it regurgitated back in a Paed's report.

I am not in any way surprised to hear how NHS SaLT have been. Sadly in my experience they are just not up to the task where developmental problems are concerned.

In our case we have spent the last 3-4 years unpicking the language/ASD conundrum. We are still going! We started out with severe receptive and expressive language difficulties aged 4. The thing that made the biggest difference was private SaLT. This did not so much improve but transform my dd2's language skills and unlock access to the curriculum. She is now achieving well at school ? it could have been so different. I would describe our SaLT as absolutely our biggest ally. She is a perceptive, skilled and consistent advocate. Costs £££ but worth every single penny.

We are awaiting formal assessment for ASD (14month wait!) and our private SaLT is still in the picture. It's a long and emotional journey but you are among friends here.

Handywoman xxxxxx

sorry roadkill I should have been clearer. I meant the speed of diagnosis (should it be appropriate) might depend on what the Paed sees on the day in addition to evidence from other sources (school, SaLT). It could be quick or take months/years.

From what i can see there is enough evidence there to keep your ds under the Paeds, and if they don't have a strong incling re: ASD after taking a full developmental history and list of concerns in Jan, then what they should do is watch, wait +/- put him on the list for a multi-disciplinary assessment.

You are doing all the right things, honking for you.

Handy x