I've finally got DD2's SALT report

[lougle]

I've sent a reply to the SALT, Paed and SENCO.

Basically, in a nutshell, all the things I say about DD2 were observed during the assessment, but they were deemed insignificant because school don't report difficulties.

Why? to me that just means school don't notice and need help recognising!

all the things I say about DD2 were observed is good news, cos it means that they can see what you see, and it's in the file

deemed insignificant because school don't report difficulties
not necessarily a big problem (yet), maybe her compensatory strategies are sort-of-working, and school are sort-of-coping, plus you've not wasted your time in the stacks of SLT work done at home.

Am I right in remembering you moved her from an awful school into a helpful one? Are they still helpful> and if not, does the main obstacle seem to be malice, ignorance or overload?

If you have a dc with invisible crutches, who has had a lot of home physio, a single-story mainstream school will probably only notice their impairment on sports day. Even if they fall over quite often.

It's all true.

Yes, Maria, I did move her from a school which couldn't support her to a new school. They are helpful, I think, but it's very difficult to see needs in a child who isn't disruptive and can keep up academically (for now). She got 1a/1b for Y1, so about 'right'.

What I need to convey is that I don't much care about whether her needs affect her function in academic subjects. I care about whether she survives life as a result of trying to cope with school.

Her difficulties are 'hidden' and 'complex' (imo), and school aren't likely to see them. The effort that you and importantly she put into the school day to enable her to be on an even keel with her peers in order to enable the school to not report difficulties is very likely substantial and at times exhausting for both of you.

She might be coping there with huge effort, but some of that burden could be relieved if she were supported in some of the areas of difficulty that you and the professionals have observed.

Long-term difficulties like these unsupported are often what (not saying this WILL happen) leads to intolerable anxiety levels in the future and eventual school refusal. Also her abilities might be superficial with gaping holes that don't matter now but will cause significant issues later.

Sorry Lougle, I'm not meaning to upset you or encourage you to throw your weight about demanding things. You obviously keep tabs on her and think about her lots. I think you need to keep in mind her mental wellbeing in a few years and consider what you can do NOW to head off any possible problems, even if that conclusion is that she doesn't need any support right now for that to be achieved.

x post.

You're on to it.

Let me know if there is anything I can do to help.

Thank you. You'd be proud of me, Star. My last paragraph in my email is:

"You mentioned to me on the telephone, that you thought there may well be issues with Year 3 or Year 4, given what you'd observed, and that I could re-refer then if necessary. I am concerned that effectively, I am being told that she should 'fail' before she gets help. I have clear and valid concerns about her difficulties and how this will impact on her as the expectations of the curriculum get more abstract and focus on independent learning. You noted yourself that DD2 only gives the bare minimum answer to questions and does not take 'hints' about further information needed. This is in line with my observation that she needs explicit explanations of expectations.

I am, overall, disconcerted and concerned that despite noticing Jasmine's pragmatic difficulties you have considered them ‘insignificant.’ They have a significant, ongoing impact on DD2's ability to function and her self-esteem. I do not disagree with your assessment that DD2 does not need specific input from the Speech and Language Therapy department, but I do think that further assessment of her pragmatic language skills would be warranted. I would appreciate it if you would consider carrying out further assessment in this area. I note the Children's Communication Checklist (CCC-2) screens for children who are likely to have language impairment, identifies pragmatic impairment in children with communication problems and assists in identifying children who may merit from further assessment for an autistic spectrum disorder. Is this something that you use at X X NHS Foundation Trust and would you consider using this screening test with DD2?"

two paragraphs*

9 months after seeing the Paed, she's still no. 20 on the waiting list for OT 'Tis marvellous.

I do wonder how bad you have to be to qualify for NHS SaLT intervention. Asking for a CCC-2 screen is an excellent idea. Perhaps the key thing is that the Paed will take on board the difficulties with pragmatic language, and put her forward for assessment for ASD? Although that, of course, is a whole other ball game

When's your next Paed review?

The Paed has also read my document. As I said before - over 23 specific examples of pragmatic difficulty. When I spoke to him in passing (he's one of the Paeds that visit DD1's school and DD1 is under him) he said 'yes, DD2 does tend to the literal, doesn't she?' in response to something I said.

Paed review was meant to be June/July but we missed the appointment because they sent the appointment to our old home address despite having the new one (it was a system error). We informally agreed that I'd phone the secretary in Oct for an appointment in November because she hadn't been seen by SALT or OT. However, she still hasn't been seen by OT so I've asked him if he wants us to wait until we see OT.

Grrrrr, I doubt even a request for a SA would help give them a kicking.

TBH I'd still go for the paed appointment. It doesn't hurt to have an excuse for another if this next one doesn't go how you think it ought, and the paed might be able to make things happen that you cannot.

If you can convince them to test for an ASD you might get a more efficient service, though no idea if you actually would want this test or think it is warranted. However, even if it isn't, if the paed agrees to do it, it should at least give you and the paed and the school a whole heap of information that you may be able to then act upon.

I think is assessment for ASD is instigated, it wil keep your dd2 in the system but if anything like here will involve 16months of limbo. So I think pressing NHS service for more is warranted in any case.

He did offer to refer for ASD assessment on our first appointment, but he offered with the caveat that he felt she may 'fall short of the threshold'.

I don't know what I think any more, tbh. I know that there's something wrong. I know that she is not developing normally. I suspect that the real damage will be seen when she's a self-harming teenager with mental health problems. Then they won't be denying it

Same here Lougle today's conclusion from Ed Psych: social communication problems caused by: residual language issues as a result of glue ear.

Last Fridays gem: instead of saying she 'fancied' lemonade she asked me to 'get lemonade because I feel offered, very offered...'

I would still take her regardless of threshold. It means you get a good thorough investigation. You're not dx-chasing you're information-chasing.

And by going through the investigation you can see for yourself how appropriate the investigative tools used are to your dd's difficulties and from there, if you feel it is merited get a second opinion from someone who specialises in girls.

Requesting the CCC2 shows you still have enough of a concern to a)not be fobbed off and b)get to know stuff the average parent doesn't. Hopefully they'll not ignore you now.

What makes me frustrated for you is that your dd may well not need much, but that 'not much' could be the difference between her 'thriving' or simply 'surviving'. And if she does need much, well then they blimmin need to get a move on in identifying it and then providing it.

I'm not sure she is surviving right now. DD1's carer was shocked by her behaviour today. It was like she was stimming or something. Just making noises and exaggerated singing with her eyes closed, but it was like the world was drowned out - she couldn't hear us, until I patted her shoulder.

She's sucking her hand a lot more right now. She's so anxious. She's started sleep walking. She's hitting, kicking, pinching and sometimes biting her sisters more than ever.

Does she talk about school, Lougle?

She does Handywoman. Her report is generally positive. School is 'fine' or 'great'. It used to be 'double double thumbs up' before September. Not now. But then, when she relaxes, her anxieties come out and she tells me that she doesn't seem to find many friends to play with at break times, or that the friends don't really want to play with her. That the 'big write' is too big and she isn't fast enough and can't write enough. That she's worried about changing for PE, etc.

You'll know I don't put much store by school action plus normally. And I almost never suggest expensive private therapist input (barring reports for tribunal). So for a change I will suggest both

Can you somehow scrape together funds for someone like margo sharp or another pragmatic-specialising-SLT to see your dd in school? And give them specific, helpful, but relatively simple/cheap suggestions? This would also give the paediatrician some 'classroom observations' done by someone who actually knows what they are looking for. Generic NHS SLTs don't usually know much anything about pragmatic language impairments, especially in girls.

Cos my suspicion is that it's mostly ignorance holding the school back... and teacher education delivered by a lowly parent is never very effective.

doesn't seem to find many friends to play with
the 'big write' is too big
worried about changing for PE

You will know half a dozen easily implemented solutions for these, which is why it's so hideously frustrating. The collective unconscious wisdom of SN parents could solve most of the problems in minutes. But unless the suggestions come from the teacher's own brain, or from a professional, it's unlikely they'd ever be done consistently.

I really can't afford private assessments right now. I feel embarrassed saying it. Don't get me wrong, we're not struggling for money, but there is no spare cash floating around. We moved house almost 2 years ago and still don't have curtains

I know I'll have to do it one day, though.

The frustrating thing for me, is that her anxieties are often factually unfounded. Copied from my email (because I'm lazy):

"DD2 is already increasingly anxious at this point in the school year. Her anxieties are mainly unfounded, based on her own unique interpretations of words spoken. For instance, she was convinced that she had to have 'posh shoes' for a masked ball at school and if she didn't, she wouldn't be allowed to perform on stage in assembly. When I raised it with her teacher, she clarified that a) there was no assembly b) there was no stage performance and c) there was no need for posh shoes. Another time, she came home and said that she was far too slow in changing for PE and that her teacher had a timer. Again, a discussion with her teacher revealed that her teacher does not use a timer (but the adjacent class teacher does), that her teacher reads the children a story until everyone is ready, and that DD2 is by no means the last to get changed."

Right. Your senco is quite good? How might she feel about downloading a free pragmatics profile suitable for use by school staff? here