Language/ASD

[Handywoman]

I managed to video dd2 (8yo) playing with various bits and bobs: marbles, shells, bottle tops. This is her default style of lone play. I joined in a bit, dd2 remained captivated by her game and was absorbed in play and unaware of the recording (on iphone).

During this scenario she was describing the 'treasure' and saying a moshling 'had stolen it'. I asked 'what is he going to do with it' several times, to which dd2 repeats 'he stole it'. This happened again later in the convo, too, same question ('what is he going to do with it') same answer 'he robbed it'

I sent this to our private EP who is going to do a full diagnostic assessment including observations in school/ADOS/ADI-R. I thought it was very representative of dd2's style of play, how absorbed she gets and the sometimes parallel conversations we have. Dd2 is having private SALT, her therapist thinks dd2 has quite severe difficulty with semantics/pragmatics and with relevant responses (assessed many times over the years). EP thought it was unremarkable.

Do you think this EP has missed something? Or are part parallel conversations normal aged 8? Or does it point to the likelihood that dd2 has isolated language issues rather than ASD?

Your thoughts, please......

Sorry, posted minus a subject... Oops!

Now fixed, thanks MN!

Bump

Thanks, zzzzz, I appreciate your reply.....
The "game" was not a copy of something, it was her own crafting. She is not short of imagination, no way siree.
Her language was NOT acquired in the normal way. She had severe receptive and expressive difficulties (more than 3 standard deviations from the mean) diagnosed aged 4 and then had intensive private SaLT. her language profile at this point showed atypical development (expressive markedly ahead of receptive, so, 'disordered').
Her language skill profile is still spikey with: difficulties describing things (issues with semantics and pragmatics, assessed Sept 2012) as well as a very literal understanding of language (idiomatic language understanding: 1st centile, assessed Sept 2012). Hence there is something definitely happening with her language development. She continues private SaLT.

She learned to read and write quickly but not particularly early. Although she remains a very reluctant writer (for reasons such as understanding 'the bigger picture' organising and planning thoughts and output reasons more than fine motor skills, her writing is actually very very neat). HOWEVER, without ever attempting to write a letter on its own aged 36months wrote her name in full at first attempt.

2 or 3 step commands are a bit hopeless, she needs concrete unambigious instruction, preferably reinforced with visual prompts.
Her hearing issues continue to rumble on (ongoing ENT problems) but are mainly compensated for (hearing aid) and her speech sounds have always been very, very clear. She is very distractible and often needs to be re-focussed back to the task by teacher. Paed thinks no ADHD because she can concentrate well when it interests her. She can be tearful and anxious at school at these times demanding 'absolute silence' in class. She has been given ear defenders to help with this. She can hyperfocus (might be reading a book and not hear her name being called, teachers say she is slow to respond to her name).

She has what her Paed describes as a 'rigid outlook' generally. This is something her teachers agree on. Superficial relationships with peers, has dropped out of all after school activities. Some minor sensory issues (hyperacuity co-ocurring with hearing loss) and hates wearing socks and jeans (issues with things on her waist). She has never played with dolls, she doesn't 'get' that sort of play at all but will use other, completely unrelated objects as characters e.g. stapler and rubber and 'mummy and baby'.

Not easy to unpick. I am tying myself in knots about it. Over and over. Any thoughts MOST GRATEFULLY received.

I would add about the writing.... after writing her full name in neat, well-controlled, perfectly-formed letters, on first attempt at age 36months, she barely ever wrote again until the age of 5 or 6 (at school and under duress the whole time). She was 7 when she first wrote anything of length. Her writing is über neat but getting something out and onto the page now is a tricky business, partly because of anxiety/perfectionism and partly due to problems we often have with just 'understanding the task' and what is actually EXPECTED.

Socially she is very immature. Having her friends round is frequently a toe-curling experience. A friend of hers came round the other day. I said 'Why don't you show X how to play Kerplunk' to which dd2 replied: 'why, don't you know how to play it?' this kind of thing is typical. As are meltdowns over 'big changes'.

I need to unpick her because she has no dx but she is undeniably underachieving at school. I want to get the best support in place and therefore the most suitable dx. School are dragging their feet.

I realise that sentence is complex. Her language is problematic in certain areas only.

I am also ? about the value of SaLT at this stage of the game. I feel it's more about identifying transferrable strategies than direct development. But we'll see how it goes.

Yes yes, zzzz only a year ago did she straighten out why/because. Pronouns not sorted til 4yrs 6months, 'wh' questions fraught with difficulty. Problems with word order. I am no expert but I thought receptive was generally ahead of expressive language in normal development.

My gut tells me her needs will change over time but will always be there. Hence I want a dx for her. We have been under Comm Paed twice (a year of waiting for ADOS to date). I can't face the thought of having to start over with CAMHS if she gets no dx this time.

Paed from NHS says 'probably on the spectrum' pending ADOS and remains officially on the fence.

SaLT thinks she should be diagnosed with ASD given her knowledge of dd2 over four years, dd2's inflexibilities and her language profile.

SaLT has not put forward a diagnosis of language disorder. But then I have never broached the subject.

She is lagging in both NC and in terms of her not inconsiderable intelligence. She has a lot of knowledge but generally fails to demonstrate it.

Fair enough. SaLT has always used the term language 'difficulties'. Don't know if it's to avoid controversial terminology.

I will ask her. I think when dd2 was 4 I could understand the hesitation to distinguish between delay/disorder. But now I think delay is out of the question. Her grasp of use of grammar and vocab, for example, is good.

'Specific Language Difficulties' is the current diagnosis from SaLT.

Thanks, zzzz I do appreciate all your input here. I think in looking for clarity the SaLT needs to throw us a rope. Thanks.