ASD SALT Strategies unchanged is it the right therapy?

[2006hildy]

DS aged 6 Dx High functioning Autism delayed expressive language. His speech is similar to a 2 year old and has not really changed since he was 2.

The progress has been so slow the SALT is using her in house Communication Framework as the numbers would be so small on the Standardised tests.

DS has had SALT for over three years but the strategies have hardly changed. I could probably quote one that was used in the first and last reports.

We're in the midst of an appeal for refusal to Statutory Assessment.

SALT is very much against direct SALT intervention. Is it the right therapy?

Soo frustrated.

If the SALT has made such little difference to his progress, then don't waste time fighting to keep or increase it. IMO

SALT is very much against direct SALT intervention? Sorry but I can't quite get my head around that! Self fulfilling prophesy springs to mind. Is there a school of thought that SaLT doesn't work for kids on the spectrum?

Sorry nothing helpful to add. I just find that very strange.

'Is there a school of thought that SaLT doesn't work for kids on the spectrum?'

Afraid so.

"SALT is very much against direct SALT intervention"

It's called policy and money. You'll probably find that the local SLT service have a contract to provide only indirect SLT so there is no way they are going to work directly with the child. The sad reality is that, even if you fight for this, the chances are that they won't know what to do with your child precisely because they never work directly with children!

How can they refuse statutory statement when he is 6 with the speech of a two year old?

Add HFA into the equation and WTF?
Am angry and confused on your behalf.

Okay. The NHS (who are allowed to withold services due to cost/efficiency have found that children with ASD do not make as much progress with SALT intervention and stay on caseloads for a long time, compared with children with minor speech issues who can be dealt with and dismissed faster. Therefore, you can tick off much more children with less profound difficulties if you refuse SALT to children with ASD.

Add into the mix that the majority of SALTs might know what the child's problems are, and how to address them but have absolutely NO skills in how to get a child with ASD to 'engage' in the therapy.

It is not about the facts or evidence of need Poshcat: it is about who is left standing when they have made you jump through hoops to get for your child only what your child deserves.

The system is a disgrace but it has nothing to do with logic or evidence and everything to do with money.

It has also quite a bit to do with the particular LA the OP is dealing with

An average s/lt has a caseload of dozens.
Mine is well over 100.
These will be spread out over many classes and areas.
It is impossible to give face to face time to all those children.
If I did, each child would have about 5 mins. every 3 weeks which is pointless.
Add to the mix the travel, the admin, the meetings.....
There isn't a lot of time.
The profession pushes for a 'consultative model'.
I think this is a good thing.
The issue however is whether the 'consultative' model works.
If those working directly with the child have a defined data driven programme to be getting on with, all is good and well. If they don't, then it's obviously not good enough.

I see some teachers and assistants less than once a term and often barely see the children at all but I know exactly what they are working on and first thing I do on meeting staff is to review the data. This tells me all I need to know.

Most s/lts would love to do more face to face work with children. I would.
Most s/lt is not terribly effective in dealing with ASD.
Most paediatric s/lt is not terribly effective at all.
This is an uncomfortable fact that s/lts are gonig to have to deal with if they want to make a case for continued funding of their profession.
Cochrane Review (2009)
?The existing research literature is insufficient to act as a base for a robust estimation of the costs and benefits of investments in services to children with S, L & C needs. Far more research is required to understand for whom and under what circumstances treatment is effective?

This is not a comment on individuals but on the status quo and I think they are facts worth knowing.

Wow. That is interesting, Moondog.

My dd2 (who quite possibly is on the spectrum) had weekly intensive (45 min sessions reinforced by activities at home) for 9 months from age 4 with private SaLT. Her language skills improved enormously across the board. To the tune of 18 months of development in receptive/expressive (compared with previous severe lag in development) plus enormous development in non verbal skills in listening and eye contact.

Dd2 is going to have further SLT to target conversational/idiomatic language skills.

Is it therefore more about skilled therapists working more intensively for short bursts. Is it more about NHS SaLT working in an ineffective way, papering over the cracks only?

Genuine question. Because I am surprised there is so little ambition in NHS SaLT for developmental problems, as that has not been my experience of private SaLT.

I mean instead of papering over the cracks only

How can they refuse statutory statement when he is 6 with the speech of a two year old? I agree.
Does your ds have behavioural issues due to frustration?
we were told that it was the behavioural issues and inability to access the curriculum that got us our statement. although our current statement has no reference to S&LT.

I can't generalise about the profession Handy and by definition a lot of people post here because they are not happy with thier children's SEN provision.

There is nothing wrong with a consutative model but two things need to happen for it to be successful.

1. A definable measurable programme is drawn up
2. School adhere to it
3. Home adhere to it

1. and 3. keep some sort of formal record of progress to discuss when consultant returns.

On paper this look pretty achievable. in reality it is more difficult for myriad reasons.

Good to hear your private s/lt is delivering the goods.

Behavioural issues affect other children you see.

If a child's needs only affect him, well, that's when you've got problems.

Handywoman - I think it is because children with ASDs often have multiple communication problems and SLTs don't always know what to do with them. Together with their heavy caseloads.

Outcomes are much less measurable for such difficulties using traditional SLT methods so you will get lots of 'he seems to be much better at x,y and z' usually based on sitting in a group talking about x,y and z.

it also drives me mad that they sit kids in groups and don't tell the child what skill they are trying to teach as if they can just work it out by osmosis.

'it also drives me mad that they sit kids in groups and don't tell the child what skill they are trying to teach as if they can just work it out by osmosis.'

This is so true of so many of the therapies.
No definition or explicit instruction.

DS did something called 'narrative therapy'. He was appalled when he discovered this was speech and language therapy and was supposed to be 'teaching' him something!

It seemed to consist of watching newsround. He thought it was a bit of a skive out of the classroom

Well this may sound narky but if watching news round is supposed to count as SaLT then you hardly need a systematic review by Cochrane to kick that idea into the long grass!

But apparently this has generalisable outcomes even though DS hadn't a clue what he was supposed to be achieving in the group!

That's ridiculous! If watching TV (a pretty passive process) is SaLT all our kids would have genius language levels! How was your ds supposed to demonstrate measurable learning from it?

Oh hello moondog I am so pleased you replied.

Although he has known the SALT for four years. The subjective progress has been so slow as far as I can see. The SALT now is using her in house Communication Framework as the numbers would be so small on the Standardised tests. Is this a definable measurable programme/normal? It has only been drawn up last term since I requested a P scale for Speaking and Listening. It is P5 whereas other scales for numeracy and literacy are P8. To me his triad of impairments are holding him back shouldn't their targets be ahead of the academic progress. So those working directly with the child have a defined data driven programme to be getting on with, all is good and well. But they didn't for so long, then it's obviously not good enough. It?s only since I have appealed through tribunal things seem to be happening.
The strategies have hardly changed. I could probably quote one that was used in the first and last reports. Apart from using a describing word to an action word. Is this normal? She says some are lifelong.

Thank-you

Would this be why the SALT won't actually DO any direct therapy with DS3? Because he is having assessment for Autism in May? They claim they no longer do direct therapy for under 3's, but DD had direct Speech Therapy under 3yo, in the same area, though that was 12/13 years ago.

I thought early intervention was the most helpful thing, yet this policy seems to contradict this.

And it's odd how, out of my 3 DC's with the SAME SALT difficulties, presenting in the same way, the ONLY one of them with near normal (though immature for 15) speech is DD, who DID get face to face therapy, for an hour each week, for 6 months between 2yo & 3yo.

DS2 got seen once, the SALT couldn't go into school to deliver therapy, and the only appointments available were during school run times when my DS1 was only 18 months older...

DS3 is SEEN and observed by the SALT, around every 3 months, he's just had his third appointment at 2y2mo. Still no formal assessment. Still no strategies other than giving him carrot sticks to chew on ( ) , singing songs and reading, and continuing with the Makaton.

I want to know WHAT his SALT issue IS, and what specific therapy can help THAT issue.

No such luck though.

No offence, Moondog, but compared to the direct, face to face approach used with DD 12/13 years ago, this consultative approach STINKS IMO.

'The strategies have hardly changed. I could probably quote one that was used in the first and last reports. Apart from using a describing word to an action word. Is this normal? She says some are lifelong.'

Ask for the component target parts then. What can you expect your ds to achieve or progress in say the next 3 months, how can you measure that this expected progress has occurred and what can you do at home to either increase his chances or speed up his meeting of the target.

Bloody Herts!!!!!!

I personally don't think Essex are any better - discharging a 6yo from SALT entirely despite him only having the speech ability of a 2.5-3yo...

It's taken me a further 3 years to get him to get re-referred and seen by then again!