SALT question - what should we be doing?

[wordsandmusic]

Hi all, please forgive my long post. I'd really appreciate any thoughts on what we can do to help my dd, who will be 4 in Jan. She has always spoken lots but she's pretty unintelligible to strangers a lot of the time. From what I understand, the pronunciation errors she makes include:

• Fronting (ie says t for c; d for g; s for sh; t for ch; d for j)
• Final Consonant deletion (does this a lot esp when talking quickly, when tired, when excited)
• Cluster reduction
• Gliding ie says y for l; says w for r
• She also has odd pronunciation of certain vowels - eg oo sounds more like or; e sounds like a (egg is "add"); ai sounds like i (so bake is "bite")
• Her speech sounds very nasal and often too loud

She has had two hearing tests - the first showed mild conductive hearing loss (low frequencies) and some fluid in the ears. The follow-up a few months later was fine.

Her brother has ASD. His speech was never as severely affected as hers but, aged 6, he still cannot pronounce r or sh properly.

She had an NHS S&L assessment the other day, in which they asked her to say single words. It was clear she couldn't say certain consonants (see above) but they felt this was normal for her age. They said they would refer her for some therapy to work on the vowel sounds but we're likely to have to wait months. They didn't listen to her speaking in sentences at all so didn't get an overall impression of how unintelligble her speech is (unfortunately her name includes three sounds she can't make properly so nobody even understands her name).

Anyway, I was wondering whether anyone had any thoughts on what we could do to help while waiting for therapy. Also, any ideas what the problem is? Does it sound like verbal dyspraxia? Or something else? Her vocabulary is big for her age and her grammar and sentence structure is very precise (I do have some concerns that she's on the spectrum).

Thanks for reading and thanks in advance for any insights

Are you sure your waiting list is months? Can you get a exact time frame? If it really is months ( I waited six months) I would consider if you coul afford a private slt if any to get a fuller picture of the problem to show the nhs when you see them. Bit I know they are expensive so not for everyone. There are some good books out there on speech - but my son has word finding issues so not sure they would have with pronouncing words.

Slt normally tell you to model correct language. So when she says 'bite' you say 'yes we bake them' that kind of thing

Your dd sounds a lot like my ds.

• He also does consonant deletion.
• A few months ago he could not make the correct mouth shapes for f, s, l, n etc and so these sounds where either replaced or missed out altogether.
• He also does gliding.
• He does cluster reduction (which from when I watch him seems that he is not moving his mouth much when talking so the sounds are not coming out correctly or being missed completely). He is very unintelligible but is a bright boy with a large vocabulary and excellent language skills. Anyway!! He started some group therapy last year and made a little progress but since Sept has been having individual therapy (and we also now have weekly private therapy) and is making lots of progress. Definitely modelling it back in the correct way but without asking them to repeat is one thing to do. If you want to do any specific work with her whilst you are waiting I can highly recommend the website www.mommyspeechtherapy.com I discovered this when looking for ways to support my ds in between sessions and during waiting times. It talks about the process of therapy for articulation difficulties and also has a whole set of free worksheets with pictures you can use for each sound in each position. Our private therapist actually recommended it too but I had already found it by then! For cluster reduction getting her to slow down and count the syllables in the word, using clapping or hitting a drum etc so e.g. mummy would be mum- me (2 claps). The waiting times are rubbish. We waited almost 5 months the first time and then moved areas and had to wait another 4 months. And even then each block is only 5 weeks long with a gap of 3-5 weeks in between each block! (hence why we have gone private as well now as he is about to turn 5 and we really want to speed up the progress of his intelligibility. Good Luck

Great - thanks for your replies. Jellyandjam, I'll check out that website - sounds good. I think I need a clear picture of what's happening and why - and the SALT I saw didn't really give that. I do model correct pronunciation (I hope) all the time - obviously while trying not to make it sound like correcting.

The waiting lists are terrible - we raised it with the GP a year ago and were sent for hearing tests first before they would consider referral to SALT. We went back to the GP who said we had to go to HV for a referral (no idea why). Did this, then had to wait 18 weeks for the first assessment (which was last week) and we're now on a further waiting list for therapy. The SALT specifically said the wait from now will be months. I think we might have to look for some private therapy but can't really afford it (and annoyed that we have to....)

Jelly.. my dd also does that thing of not moving her mouth properly. Has the therapy you're having addressed this? Has the SALT explained what's happening and why? I just wondered if my dd might have some issue with her palate (hence the "fronting" and nasal sounding speech).

It worries me that she is becoming self conscious about her speech and I think it's making her more shy and reserved - both with adults and with other children. She isn't very sociable with other children anyway and I think this is making it worse....

Hi,
I wouldn't say the speech therapist has particularly explained why, in his initial assessment she just said that some children find it harder to talk and in many cases they don't know why (especially when like in these cases understanding and language is good). She did tell me that one of the things is was doing was harmonisation so he used to always say pime for time, pummy for tummy and apparently that is because p and m are made in the same part of the mouth and so he was making it easier for himself by using similar sounds (he doesn't do this anymore (YAY) apart from the odd word, he still has trouble with jump).
The theory I came up with after much reading is that it seems to be related to his severe silent reflux as a baby. He spent most of his time crying and in pain so didn't spend as much time babbling as a baby normally would and didn't develop the muscles and ability to make the shapes in the same way. I discussed this with his private SALT who agreed that it could be a reason.
I think that the initial group therapy worked more on the mouth shapes (although I didn't see any of this as we were not allowed in the room) but from the homework given it seemed to be the case. For this we also used an ipad/iphone app called bigmouth sounds. There are two, one has games and stories and the character is shown with different mouth shapes for the different sounds. The other one is a short exercise program where bigmouth 'exercises' his mouth muscles/practises putting his tongue behind his teeth (something I hadn't realise my son was unable to do at first). We did this everyday for a few weeks and it really helped.
Private therapy has been a real push for us too but I have to say it is well worth it.
My ds hasn't had a hearing test yet!!! They kept telling me if I hadn't noticed any signs of a problem then there probably wasn't one. I have had a nightmare trying to get a referral but the SALT did one for us last week and we finally have one booked (although it is 9 weeks away)!!

Oh I should also add that yes in his therapy now when introducing a new sound they do look at how the mouth should look/move and use pictures to reinforce- so he has been working on f for which they have a bunny picture and he is told to put his teeth onto his lips like a bunny.
DS's name also has two sounds he cant say in it!! Did well there!