Speech and Language Assessment

[JJ]

My son, 2.4 yo, has just been given a conditional "all clear" by the ENT. He has a bit of glue ear but the doctor said it shouldn't affect his speech and language development. I'm not sure I believe this guy and certainly didn't like him, so I'll get a second opinion in a month or two from a guy I like in London.

The thing is, my son far behind in those two areas, I think. It's hard to tell with language as he is having a tantrum half the time, no matter what's said. And I'd like to get his speech and language assessed. I've got no idea how to go about it, but would like it done in London as I'm not sure of the quality of the fluent/native English speaking SALTs here. Soo.... any suggestions? It has to be private, obv, and I can get a referral if that's necessary. If you have any more suggestions about assessments, please feel free to give them to me. I'm thinking of a child psych, also... but don't know.

And if you know of a nice, comfy, quiet mental hospital for me when I finally lose my grip, post that also. I'll give the number to my husband so he can ship me off when it happens.

eulalia did- but that was NHS (and sounded brilliant) A weeks assessment.

Not sure about Harper House

Elliot House used to be 5 mins walk from my house. I usedto push ds1 past in his pushchair thinking "oh how awful it would be to have an autistic child". Hmmmmmm

Thanks again. Can you tell me if this sounds crazy? I am convinced all of this is due to his hearing. Even if he gets that sorted right away, he'll still need speech therapy? I think for my sanity, that I need to get it assessed. But I know he's not ASD or Asperger's or verbal dyspraxia. I think it's because he can't hear.

Anyway, I need to see the one ENT I really trust and he's in London. And I want to get his speech and language assessed by someone who's been recommended to me and is a native English speaker, also. So, in that case, is a dev paed ott? I'm in Switzerland, so choice is limited here.

If I sounds nuts or deluded please please let me know. I've f&%ked up my elder son's health management a couple of times by underreacting and keep going back and forth on what's needed here.

Must go. Child calling from bath....

JJ friend's 2 children have had severe glue ear. In both cases it has affected speech but not understanding. They haven't needed speech therapy after having grommits fitted, just a couple of assessments.

You need to seea dev paed if your son is having problems communicating. For example ds2 doesn't have much expressive speech that can be understood, but he understands everything said to him and has absolutely no problems letting us no what he wants -even complicated things - eg this morning he was able to let me know that he wanted to go downstairs and have his breakfast.

Who you should see depends on where your son's problems l;ie. If it's just lack of speech then stick to a SALT, but if its lack of language as well then I would want to see a paed as well if I was in your position.

I think it's both. But I've just found a thread I was searching for .. it was posted when he was about 2 months old and I thought he couldn't hear. It's here www.mumsnet.com/talkarchive/138/1498.html

Can't do links atm as am having too hard of a time typing on this keyboard. Sorry!

But I will do the whole nine yards, then. I'll give some of the people recommend here a call and see what they can do when.

Thanks again for all your advice. Sorry for being so damn wishy washy.

does he hear things like his favourite tv show starting, or you opening th food cupboard- or anything like that. if he responds to those sorts of noises then I think it safe to assume that there's enough hearing there to not be a major problem for understanding (although speech could be a different matter).

My friend's ds1 with severe glue ear was the same age as my ds1 so it was easy to compare them. ALthoguh he didn't start speaking until after he'd had grommits fitted at 3 he never had trouble following instructions whereas ds1 did. They were quite similar in lots of ways though.

Should add that's only in my experience. Trying to think back to what my friend's little boy was like at 2.

He had no speech (or very litle- some as he go towards 3). We used to go to a music class together and he would join in with all the actions and things. He used to follow the teacher's instructions as well (whereas ds1 would be compliant but didn't do the actions and didn't really follow the teacher's instructions- had to be dragged around by me).

When I say they were quite similar that may just have been personalities as they are both quite quiet and gentle for boys iyswim.

I would say if you have any doubt about understnading go to see a paed- they would be the best place to start and they consider hearing etc as well.

You can get pretty state of the art hearing tests done at The Nuffield speech and hearing clinic. We had ds1 tested there. I wouldn't particularly recommend the consultant we saw though

Sorry for not replying to you earlier, Jimjams. Last night when I offered him a movie, he didn't respond until I said it right into his ear and then was excited to go see one (um, downstairs, not at the theatre). He understands words he knows better than those he doesn't, if that makes sense, so it's not like he can't hear, I just think it's all muffled to him. It comes and goes, too, although I don't know that it's ever been good.

I'm going to try getting an appt at Ruth Jacobs first.. will they tell me if there's something more I should do? And this is a serious question: if nothing is wrong, will they make me feel like a crap, ineffective mother? Hopefully whoever we see will have some suggestions for the tantrums, too. (I've tried all the techniques usually mentioned.)

Thanks again.

JJ my DS had both glue ear and possibly (SALT now not sure) verbal dyspraxia. I have to say I agree with Jimjams - although his speech was very poor at 2.5 his understanding and use of language was very good. Glue ear is normally a sparodic condition you would expect him to have near normal hearing at times and then bad hearing at others - not constantly bad.

Also in testing young childrens hearing the results are often unreliable, but it is usually under estimated rather than overestimated. (The way the tests work it is more usual for a child to not respond properly when they hear a sound than to figure out how to respond to something they don't hear. The typhanogram sp? (which they do to test the degree of mobility of the ear drum) is a fairly difficult test to get wrong as well.

Hope you find the answers you need to put your mind at rest, but I do think you are doing the right thing by following up all the different options. It is so easy to be reassured by others when you think something is not right - I'm very glad that I followed my own instincts in the end and booked the appointments!!

jmg, so do you think it's ok just to get his speech checked out for now?

Today has been one of those days where I feel like the worst mother ever. Why won't he stop screaming all of the time?

Sigh...

JJ I would go the whole hog in your position. You're obviously worrying about it- and once you've made the appointments you'll probably feel a lot better and be able to relax until the day. If they just give you a clean bill of health at least you'll be able to relax. It's horrible horrible horrible to be analysing everything your child does (for you I mean, not him) - and really very stressful.

JJ, on your questions - from my experience with the Ruth Jacobs practice this summer:

• I am entirely sure that you would not be made to feel like an over-anxious or ineffective mother, whether or not they think anything is wrong; and

• they did have lots of ideas to offer, on speech-related things and also on the kind of behaviour that results from the frustration of not being able to communicate easily. Even when we were no longer going to sessions there, when I asked if they could give me a few pointers for his reception teacher I got an extensive, imaginative (and unstuffy - recommended "lots of jokes" ) list.

JJ - its always hard to say what someone else should do!!

But I think I would agree with Jimjams - it sounds very different to my experience of glue ear and I would therefore go the whole hog and get as many things ruled out in one go as possible. I also think that private (and NHS) SALTs vary enormously in ability and involvement in different disorders. The one I have just happens to have dealt a lot with SN children and was fairly confident early on that my DS's problems were limited to speech production issues. However some SALTs may not have the breadth of experience or even inclination to point you in the right direction!

So, yes, if it were me I'd be lining up the appointments - ENT specialist, SALT, developmental pead and child psych. Once you have feedback from all of these then you can consider all of the results in the round - and be prepared they may not all come back with the same diagnosis! Then you will either have your mind put at rest or be in a position to move forward in the best way for your DS.

Thanks all. Sorry it took so long to get back to you. My mom was here, then I had some friends (sb34 and kids!) here for a week. Her daughter seems to have been a great influence on my son.

But I've made the appointment with Ruth Jacobs and am going there 23 March. I'll probably combine it with an ENT visit and a talk to his GP and maybe his paed there.

Thank you so much for all of the help. The developmental paed was too hard to book, so this is my starting (and, I hope, my finishing) point.

And, esp, binkie, thanks for mentioning they're not too judging of moms. I don't think I could have booked it without that.

Thanks again for all your help. We saw Jackie at Ruth Jacobs yesterday. She was great! Very reassuring, warm, helpful and understanding. I don't have the report yet, so I might be mis-remembering this: he has the speech skills of an 18-20month old (about 10-12 months behind) and understands a little less than a 2 year old should (about 6 months behind). She said it's only language-- doesn't seem to be anything else going on. He's not processing it quite right and he has trouble physically making some of the sounds. And that it does explain his tantrums!

So good news. He needs speech therapy and she highly recommended Makaton (he responded to it well with her).

It'll be great to be doing something actually productive!

And we got a lovely couple of days in London with friends out of it.

glad it has gone wel (?) and have a nice time!!

Makaton is great

Fio, yep, all has gone well. And my son has already learned "waiting, waiting.." which they taught me there. Doesn't mean he likes it, but he UNDERSTANDS!

Whoo hoo!

Thanks again to everyone, esp Binkie and Davros who recommended the Ruth Jacobs. Honestly I couldn't have done it without you. Sorry for my waffling.

I'll let you guys know the final report. Jimjams, I hope your ds2 is doing well -- haven't had the chance to keep up with him, but know you were worried about him, too! (And he's the same age as my son.)

Hello, I've read the whole of this thread with great interest...and wondered if I could get any advice please? DD is 2y3m and says virtually no words at all. There isn't a 2 year check in our area any longer (just a questionnaire) but I got the HV to come round and do a 2 year check because I was concerned about her lack of speech. She rated her as having the speech of a 15 month old...everything else she checked (jigsaw ability, social skills etc etc) was all on target or slightly above in some cases. So now we are on an 8 month waiting list for SALT, and I can't help worrying. Do I listen to all the anecdotes about other people's children not speaking until age 3 and then coming out with full sentences, or do I try and get something done privately and sooner? What if the 3 year "miracle" doesn't occur?
Incase it helps, DD merely points to what she wants or uses one of the actions she has made up (including "orange", "cup of tea" and "rewind the video"!!!). She is very even tempered and doesn't have tantrums to speak of at all. Its just very lonely and frustrating to spend all day hearing only "nenenenenenenene" which is what I get if I try and encourage her to say a specific word.

Judd, I wish I'd done something sooner. I'm not on the NHS (we live in Switzerland and my insurance doesn't cover stuff like this, so it doesn't matter where we get it done) but.. I'd go private if it means a shorter waiting time. I think it would have been easier to deal with sooner rather than later.

If you ask, I'm sure someone will know good places in your area. If you're in London, I can confirm that Ruth Jacobs is a good place!

Your daughter sounds like my son -- although my son was Mr Tantrum. I think he would have been like that anyway, but without the added stress.

Judd, I'm also of the get it looked into persuasion - but really just because for me the worries eat away so dreadfully otherwise. All a matter of personal preference - some mothers might prefer to focus on the moment & be able to set aside the what-ifs. I do think that, at her age, if you aren't worried about aspects like relating to people, sociability, and so on, you aren't losing valuable time by doing a wait & see if that feels more natural to you.

JJ, delighted to see your update, so glad it all went so well and that you have a plan for action. All the best for you and ds (and so very interesting about the signing route).

Pointing is very good judd. It's my personal "key assessment"- especially pointing out of things of interest (pointing develops in stages and pointing out things of interest should be developed by 18 months- and then the whole pointing development is complete).

If understanding is there I think you can afford to wait a little. Hmmmmm although I always hesitate telling people to wait as for us the magic 3 didn't happen - and at almost 5 still hasn't happened (and actually I hate all that uncles' brother spoke at 3 stuff).

Certainly if she is communicating well without speech I wouldn't worry too much. HAs she had her hearing tested? If she is making up signs etc it sounds as if her language development is kind of going on ahead of her- could she have glue ear or something?

My younger son is the same age and his speech is very poor, but he communicates extremely well without much clear speech (continual stream of babble). He has been referred and as I suspect verbal dyspraxia in his case i'm off to do a days course in it myself (the NHS help for verbal dyspraxia is generally crap so I may as well learn it now). So I guess I'm not waiting.

If she is lacking speech sounds (as my sons are) then it would be worth looking up apraxia and verbal dyspraxia on google. You will find lots there to help you. If you suspect verbal dyspraxia then it is worth starting to do something about it asap. Look up Nancy Kaufman- she's running 2 workshops in April in the UK. I'm going on the leatherhead one. I got so desperate for help with my first son that I ended up emailing her in the states for advice. This time I'm going on the workshop ready armed for ds2

Sorry this is very incoherent - I'm very tired tongiht- and I seem to have told you to both wait and not wait.

JJ - glad the trip was useful. Have you been given any Makaton resources? I'd highly recommend Makaton Dave video - you can get it from Amazon.co.uk Both my boys love it.

sorry that's probably very confusing- my elder son is autistic with verbal dyspraxia (he wasn't pointing at 2 though- and he's the one who the magic 3 didn't happen for)- we faffed around with stupid "mild language delay" diagnoses for about a year longer than we should have- so he's the reason I'm inclined to say go for assessment. My younger son was 2 in January and he's not talking clearly but communicating well (? verbal dyspraxia) and he's the one I'm half doing something about and half watching.

Hope that makes more sense- sorry am very tired.

Check out Nancy Kaufman though if you suspect verbal dyspraxia- I wish I'd been more on the ball with courses for ds1- lots from the states that I'm not waiting to go on- when I could have gone on them a year and a half ago.

now waiting to go on. Agggghhhh I give up

BTW your average HV or community speech therapist wouldn't recognise verbal dyspraxia if it danced around in front of them - sites like apraxia-kids are very good- they give recordings that you can download of children with verbal dyspraxia talking- so you can compare......

Thank you all very much. Have just shown DH, and we're going to have a serious talk. We're in Stockport so would try and look for a SALT in this area, but do have a friend of a friend who would be able to point us in the right direction. I think sometimes that just taking the plunge is the hardest bit, because it involves accepting something you've been avoiding!!

For private SALT look here at ASLTIP

Nancy Kaufman is doing one of her workshops in Manchester- can't remember the date- something like the 22nd or 23rd April. I can find out if you are interested.

JJ, I don't want to be a dampener, but aren't you curious to find out WHY he has these language delays? I know I suggested Ruth Jacobs but they are not qualified to diagnose, they are doing exactly what they should do, suggest and provide intervention for speech and language problems. Personally I would still want to see a development paediatrician to make sure this is all there is to it. Sorry if I sound a misery.