We've been given S&LT apptmt for DS but he doesn't have S&L problems

[Jacksterbear]

DS (6.6) was referred by GP to child development centre for ASD assessment (mainly due to extreme anxiety, meltdowns/refusals/inflexible controlling behaviour, plus sensory issues), and we have been waiting months for a response/appointment from them.

In the meantime, we have had him assessed privately by a neurodevelopmental paed who has dx'd him with SPD plus anxiety (but not ASD) and referred him for PDA assessment at our request.

An NHS appointment letter has just come through for DS to be seen by a S&LT. However DS couldn't be further from having speech or language problems. The first word used by the GP to describe him in his referral letter is "articulate". The letter from DS's school (attached to the referral) describes him as "very eloquent and mature in the way he speaks and discusses things". And (not that the NHS system would be aware of this but) his language score on the Griffiths development tests was "to the ceiling of the scale".

So my concerns are:

1. Why have we been given this appointment when it's clear that speech and lang is not an issue for him? I assume the answer is that we are going through a set process that involves him being seen by a number of specialists in turn? Does it just depend on which appointment happens to come up first, which specialist you happen to be sent to first?
2. Should we attend the appointment (which seems like a giant waste of everyone's time) or should I phone and explain that he doesn't need it? Do I need to have him "cleared" by the S< to "get through the hoop" to the next stage of the process?
3. The letter says that it will be decided at the appointment whether he needs further intervention or not. If they see him and it's clear to them that he doesn't have problems in this area will he therefore be dismissed altogether? He desperately DOES require intervention, but not in this area!

As a more general vent, I'm just a bit annoyed that we have waited months for NHS help only to be offered something that isn't going to help him and is going to waste everyone's time and use up an appointment that could be helping someone else! I suspect you are going to tell me that I need to suck it up and have to go along with the set process though!

TIA for any thoughts.

Thanks Poltergoose, that's interesting. Guess we go with an open mind then!

Btw I didn't mean to sound quite so dismissive of the nhs as I realise I did in my op!

ime SALT assessment is part of the diagnosis procedure for ASD, not to rule out SLCN but because a DC with an ASD will tend to have particular problems not with speech but in understanding language and are likely to score lowly for higher level language skills and the functional/pragmatic use of language (such as requesting). SALT are not only concerned with verbal communication skills but also non-verbal communication skills such as eye contact, appropriate distance etc.

When DS1 was assessed at 12 he was found to have higher level skills of a 7 year old and yet none of his teachers had noticed this. There are also problems with understanding inference and in understanding feelings and motivations in text that is read. Idioms (eg I'm all ears, raining cats and dogs) can be incomprehensible to DC with ASD.

Social skills and understanding emotions also comes under SALT x

My Aspie DS is also very articulate but I had a real eye-opener when I took him to the SALT (when he was 6). First he showed her a map (one of his interests!), and they talked about maps together. It was a lovely conversation, to and fro, eye contact, great vocabulary, co-operative, the works. After a few minutes the SALT gently changed the subject. And my DH went silent. He absolutely could not cope with talking when he was not in control of the conversation.

Kids with Asperger?s tend to have a lot of problems with language, even when they are highly articulate. There are many non-verbal parts of language: body language, voice tone, facial expression, knowing whose turn it is to speak, knowing how much to say and when to stop talking(!), knowing when someone is joking. They may take language extremely literally - ask my DS ?can you tell me what time it is?? and he would politely answer ?yes? ? and easily get confused and distressed by metaphors like ?raining cats and dogs?. Aspies can also find it very difficult to express feelings and emotions in words. And they may not be able to use different language to different people ? they may not understand that you can swear in front of your friends but not in front of the teacher. So those are some of the problems a SALT might pick up on.

The SALT referred my DS for social and communication skills therapy, in a group with other ASC kids from mainstream schools, run by a SALT with a lot of experience. It was very helpful for him.

Ime, you have to see a whole range of specialists before you get a dx. DS has DCD/AS and saw a SALT. They weren't worried about his vocab or his expression, which are excellent but on the way he used language.

Being mature in speech is sometimes an indicator of ASD. Children with the condition can be pedantic and speak like 'little adults' which of course is, in a way, a good thing except that it can also be an indicator of AS. Language is much more than what we say but how we say it and I think for some children, if they are extremely articulate it can actually get in the way of relationships with their peers plus if adults don't know if they have a condition it can make them look precocious.

Speech and language is very much a social activity and the Salt will look at that too, as others have said.

Don't be so quick to write it off as a waste of time. It might appear to be a case of ticking a box but it can be more revealing than you seem to think and even if they find nothing wrong that might help in making sure that they get the right dx.

Thanks so much for all the replies. You have all really made me think. On reflection DS does have quite a few "quirks" in his communication, which I'd assumed were either "just his personality" or a result of his anxiety/need to control/emotional insecurity, rather than problems with communication itself iyswim.

• he takes things very literally. Often a meltdown results from something not being EXACTLY as you have described or promised: "BUT YOU SAID...!"
• he can't cope with vague or ambiguous phrases, eg "in a moment"/"soon" etc; he needs to know an exact number of minutes etc.
• at school, he needs instructions broken down into very small manageable tasks otherwise he will get totally overwhelmed and refuse to embark upon a project (even so he often refuses and melts down). At home, he needs instructions to be very clear, not vague.
• he often uses incorrect but "grammatically logical" verb forms, eg "I hided", "I sitted" etc (could be normal for a 6yo; not sure?)
• he often comes out with phrases that sound odd coming from a 6yo (too adult/old-fashioned), eg he might say "I don't much care for ice cream". He is generally more comfortable talking to adults. And he certainly likes to control the conversation.
• he often takes a whole to get to the point, needing to start from the beginning of a story and getting annoyed if you try to hurry him on to the point of what he's saying.

-he blurts out made-up words and animal-like noises, sometimes repetitively. He likes to string together and repeat rhyming words eg "monkey flunky punky dunky" or whatever. -personal-space-wise, he tends to get too close to people's faces to communicate, even grabbing people by the face to turn and look at him. He generally likes and craves eye contact, except when he is mid-meltdown, when he will scream at you not to look at him.

Do any of these sound familiar/ like things a SALT would be interested in?

oops - DS not DH

I'm sure the SALT will be interested in the things you've observed. The anxiety and the communication problems are bound up together. Finding it hard to understand others and make people understand him, may make your DS anxious in itself. If he doesn?t understand ?soon? then he?ll feel anxious when someone uses the phrase ? when will it happen? Two minutes? Ten days? Next year? He may not be able to guess from the context. My DS?s skills have improved a lot but I still have to say ?well the show is due to start at 9.30 but it might be five or even ten minutes later? And we have schedules and timetables all over the place. It sounds as if you?re doing a lot of the right things already, like giving clear concrete instructions.

And my DS hates to be interrupted and couldn?t stop talking! It?s one of the things the social skills tutor worked on --- ?just tell me one fact?

Thanks Kleinzeit yes, tendency to interrupt others but hating to be interrupted himself, and not knowing when to stop talking, could definitely be added to my list for ds!

Oh and that should have said takes a while to get to the point, not whole!

If you PM me your email I will send you my salt reports. All Dc are different in specifics but you need to pay attention to the big picture.

People have already said the stuff I was thinking but I just wanted to agree that a good vocab and being articulate doesnt always equal no communication difficulties.

Dd3 was talking in sentences really early and has a very large vocab but she has massive communication issues in as much as she cannot conversation share or understand when people arent interested in what she is saying.
She struggles with taking things literally and with idioms and sarcasm. Although she had recently begun to use her literal thinking as humour which can be very funny although can be rather blunt.

Salt has been very beneficial to her and recently she was in a group of children all the same age with similar diagnosis, they looked at what their diagnosis meant to them and how it effects them. It has given her a great insight into her condition and how it impacts on her life and it also helped her to begin to explore how her condition impacts on others.

I hope your salt team prove as helpful as ours have

Thanks Ineedmore, and omg yes, re not understanding when others are not interested in what he's saying! I am forever having to tell him not to accost the cashier/waitress/other random stranger to tell them in grest detail about something he's found/done/is interested in!

keepon, thanks.

Yes monologing [sp] at people is one of Dd3's favourite pass times, at the moment it is constant quizzies and facts about Harry Potter, ho hum!

For some reason checkout ladies used to be favoured targets, she used to tell them our lifestory, she has changed as she has got older though

Jacksterbear

DS has ishoos with receptive language. This was totally missed by nursery, teachers etc and only picked up by a SALT, as he was streaks ahead of his peers in learning to talk, use of vocab, grammar etc when young. When tested his expressive language was ahead of his age yet his receptive language (what he understood) was miles behind.

Even when he did understand the complex instructions of school (as Mums we unknowingly adapt our language to fit our individual child, school dinner ladies and peers etc don't!) his delay in processing meant he was always the last to line up etc. Until he was diagnosed by SALT teachers etc just thought he was naughty.

SALT helped considerably, both the hard won NHS interventions, and the fantastic advice on here (check out moondog threads). His general quality of life is so much improved it's really been worth it. This includes the ability to make and maintain some really nice friendships, not just formal school stuff. He spends far less time in an anxious confused fug than he did just a couple of years ago.

Some of his language issues are directly linked to his sensory processing disorder as his hearing is supersensitive and this makes it harder for him to filter unwanted sounds etc.

If your child has sensory issues, then checking his language out just makes so much sense to me, based on my own experience.

Same as everyone else has posted we always thought Ds's S&L was fine. It was like having a tiny little adult around the house when he was small. Ds has just turned 8, now we can see the difficulties when we watch him interact with other Dc the same age.

Communication is made up of the following skills:

Have an idea/decide what to say
Choose words=Semantics
Choose appropriate sentence structure=Syntax
Select the sounds=phonology
Co-ordinate instructions to the speech muscles
Articulate sounds
Speak appropriately=Pragmatics
Self monitor
Look/attend
Interpret non-verbal communication
Listen/hear
Remember=auditory memory
Understand words=Semantics
Understand sentence structure=Syntax
Understanding the meaning-literal and non literal.

My Ds struggles with all of these in one way or another some of the time the enviroment he is in can cause the difficulties e.g too much back ground sound affects his listening and auditory memory, after having a test in school when he had just turned 6 his phonology was on the level of a 10 year old. He also has delayed echolalia.

Thanks so much again everyone.

Am quite that I have gone from stating categorically that he doesn't have any S&L issues in the thread title, to a whole list of them! I was thinking of S&L in much too narrow a context, rather than the wider ability to use communication skills to interact effectively with others.

I have to fill in a questionnaire for the appointment so have included the things from my list below as well as a couple of others, including the sensory-related stuff (eg gets distracted and annoyed by background noises, when trying to speak / listen).

One thing that I've been thinking about is what a few posters have said about metaphors (raining cats and dogs) etc. DS actually loves that kind of stuff - he loves metaphors that conjure up visual images (once you have explained them to him); loves puns and word-related jokes (again, once you have explained them) and seems to love using quite rich descriptive language, including metaphors, when talking.

However he does take some stuff literally e.g. if he starts pestering for something when you have just arrived home and you say to him "Let me just get through the door first" he will say "But you are through the door" (not in a smartarse way; genuinely cross and puzzled that you are being so obtuse); and if you say to him "in a second" he will count "One - now can you do it?" (again not in a backchatty way, just a literal interpretation of what you've said).

That's a lovely report comment to have received, Poltergoose!

At the very top of the list of ?Things I Wish I Had Known When DS Was Diagnosed? is ?what does SALT have to do with Asperger?s? . I knew DS had some communications problems but I had no clue that the SALTs could help.

DS?s class teacher told me that she had taught an older boy who had been to a group for kids with social difficulties, and she thought it would be good for DS. So I asked everyone I came across - I asked the GP, the paed, the psychologist and none of them had heard of it. I asked the SALT, and it was their social-communications skills group. The SALT also lent me a book on "social stories". Helpful people