4 year old only saying 10 words. Is this because of ASD or verbal dyspraxia?

[adrianna1]

Hi smile

I'm new to this site.

My son has just turned four year old. He has a severe speech delay, only saying about 10 words the other words are not understandable at all. He mainly communicates using non-verbal communication and made-up signs.He has been assessed for autism, his results came back inconclusive. As my son has a severe speech delay I am wondering if the fact he has autism is the reason for his severity of language or he may have severe autism. My son is having speech therapy…my old speech therapist thought my son had a learning disability… verbal dyspraxia. But my new speech therapist is not willing to do this till his 6 as my son ha a short attention span, not saying enough words to test.

Here is a background of my son and you can tell me what you think.

• Has good joint attention skills, shows me things out of interest

-Used made- up signs/ gestures to communicate i.e. hand sideways on mouth means train ( he has about 30 made-up gestures)… this is also part of his learning style where he gets the gestures i.e. if he sees someone reading a physical book in his hand….he would imitate the gesture of opening a book, without having a book in hand. Like the gesture he uses for train, he figures that the choo chop sound is a sound coming from the mouth area, so he puts his hands sideways on mouth to indicate noise of train. Hope that makes sense.

• Has good functional play skills- though he does this new thing that he will line up 3 of his cars and then asks me what colour they are ( he would not ask what is the colour, but he would look at me and point to the cars) he has never lined up things before so I was worried, though he has not done it again.

• He has good imaginative skills, though this is still delayed.

• Has two friends that understand him, most of the kids in nursery don't understand that my son can't say a lot of words, so they would usually just snatch toys from his hand. It was to the point that my son's key worker was like every time a child goes near my son he would turn away but I politely told her it was because every time my son has a toy the kids always snatch it off him, so anytime a kid goes near him, he automatically thinks that they will take his toy. Though has these two friends that understand him and would not snatch toys off him and they are always playing together when I collect my son from nursery.

• Is toilet trained- took him 3 weeks to train he also has good self care needs skills, can put clothes on..though finds socks hard to do

• He stims when he is excited, so he would flap his arms when he is angry, smile and make low noises when excited. Every time he sees something scary on TV, he would put his hands over his ears and then shut his eyes. Plus when I brought my new hair dryer, when I turned it on, he covered his ears but after a second or two he started to play with my hair dryer not minding the noise…( that is confusing).

• Gets excited easily, like colouring something really fast he would tense

-Is always on the go, gets excited a lot. He also has lack of attention.

• good eye contact

• severe language delay, it seems like his mouth cannot say the words. Like since he was a baby he could not imitate speech, he would just grope his mouth. Though I was not concern at the time since he can swallow, suck, though he was two and over a half since he could blow something. He was three till he can imitate speech, though this is not clear at all, cannot say even the simple words or letter like 'c'. Plus he has started to say the sss sound but cannot do this within a word 'saw'

• Has no routine or obsessions infact I was worried at the time because every kid has some kind of comfort toy…the toy that they cannot leave home without…but my son did not have this. He loves his all his toys and plays with every kind of toy that he owns…but the only thing to give him comfort was me.

• Has a melt down if I do not give him what he wants..mainly treats, mcdonalds. I even cut my shopping time to a minimum and quite reluctant to take him out shopping with me

• I mainly eat carbohydrates with something i.e. spag bol with mince, pasta, toast etc so it's obvious that my son would eat what I eat. But every time I introduce a new meal that we have never tried before, he is reluctant to try it or he would fiddle with it, take a lick but would not attempt to bite it.

• Understands well, good with instructions, though the understanding is still a bit delayed

• every time his about to take something which he is not allowed to take, he would look back at me and the minute i turn around, he runs upstairs

• still but occasionally put things in his mouth

• uses the same meaning in different situations, but with the same context i.e. he knows that waving means bye, as he waves bye back to people, but he would also say wave bye to me if he wants me to go away i.e. if I tell him off that is not allowed to go into the kitchen, he would frown his face and wave.

• Even though he is hardly saying words, he does communicate to me.. it's not just about what he wants that he is only talking to me…but it's also at a deeper level too.

• Does not listen to me when he is obedient.

What do you guys think? I am sick of worry.

Thanks

Is he under peadiatric care still? What does his salt think?

It's impossible to say but it could be more than one thing going on.

It's good that he wants to communicate and can do so. My son has dyspraxia and other things going on. He had no need or desire to communicate for a long time. No he is talking its still very delayed - but it only came when he had to talk. When he started school.

All you do is keep pushing back for diagnosis and guidance from health services. I was told son was complex, but that doesn't mean he can't be unpicked to discover his needs

some of your comments really do not fit with Asd, and some of the things you are fitting into the Asd mould can be found in neuro typical. especially in a child who is frustrated at their inability communicate.

speech and language disorders can have very similar "symptoms" to Asd.

He could have ASD but I it will be hard to know for sure.

You need a really good SLT right now

Bump

Is he due to start school in September? What are your plans? Are there any pre-school language nursery units near you? Are you being supported to apply for a statement for him?

I agree with paperlantern that a good (and pushy) SLT is really important. Has he been seen by a consultant paediatrician?

Hiya my DS is 3.5 with verbal dyspraxia and ASD diagnoses. A lot of the stuff you put above applies to my son. He only has about 4 clear words and most of the time everything starts with d, eg one two three is dun doo dee...

With him, the VD is severe and the ASD is relatively milder. I also really really worry about my DS. I guess we are lucky we have the formal diagnoses which were made by an NHS consultant paed, it does seem its a bit of a lottery whether you get the diagnoses or not.

A bit difficult to know what to advise, I guess you've seen a paed if he's been tested for ASD? Do you have a follow up appointment to review his progress?

In a way the diagnoses in themselves don't matter, the main thing is he gets the speech therapy and the support in pre school / school that he needs - the diagnoses really help with this especially with the latter. If you havent already done so i would strongly urge you to apply for a statement and start thinking about what school you would want him to go to if he hasn't started school yet. My DS starts school in sept and we are hoping he will get a place at a mainstream primary with an attached speech and language unit. If your DS has VD he will need regular and intensive therapy (which is incorporated in his IEP) over a sustained time period and it seems the best place to get that is at a speech and language unit.

Have you looked at private speech therapy? We get DLA which just about covers the cost of private speech therapy. We started out with one private therapist but have recently moved to an ex Nuffield therapist specialising in VD. Shes so much better than the other therapist DS used to see - there's a big difference in their style and experience so shop around if you go down this route. A private therapist with the relevant experience and qualifications may be able to make the VD diagnosis.

One other thing you may want to try is look at getting a referral to the Nuffield centre in London. They would also diagnose VD.

Finally there are a couple of great VD Facebook groups, just ask to join the, for a wealth of info and support.

Bit of a brain dump hope it helps...

By the way when I said "apply for a statement" i meant you need to apply to your LEA for a statutory assessment of your sons special educational needs. Loads of advice here about that and a template letter or IPSEAs website. Time is tight for getting this in place by sept so I would suggest you fire off the standard letter ASAP, don't worry about making it perfect your LA will write back to ask you for more info, the priority is to start the clock ticking ASAP.

Hi ahhthink...

Thanks for replying.

Yes we have seen a developmental ped, plus went to an asd clinic for DS to get tested. Both said that they weren't sure if he had asd, so having a re- assessment.

We have just started to write up the statement. We would like DS to go to a speech unit school. Though, we know nothing about these specialist schools and didn't want to seem in a rush to randomly pick a speech unit school. I really want to be productive about this, visit the speech unit schools, see how their curriculum is, talk to people etc. I would of done this earlier or even thought about it, but I assumed he would be saying more words and I was too worried about the autism.

Luckily, DS will be going to my mainstream primary school that I went to as a child, I had a severe language delay and they really helped me. Plus we have already started on the statement process. While my son is at school. I would use my time to visit speech unit schools, talk to people, ask professionals that work with my son for advice Etc.

Yes, I was booked an appointment to see my GP about referral to Nuffield. Though was a bit worried as my sons says so little.

Wasn't sure my son would get DLA. As his main issue is really just speech. Did your son have other priority issues that he could get DLA?

I would really like my son to have private speech therapy. He has speech therapy under the NHS too.

Cool, sounds like you are on to all the relevant things, isn't the internet amazing giving access to so much relevant info, don't know what parents did before...

It's not necessarily too late to get your DS in a school with a speech unit. We have just applied to our local primary schools, none of which have any "enhanced speech and language provision", ie speech unit, as part of the "normal" process, and DS will be allocated a place at one of these. Parallel to this is the statutory assessment process and if this gives the answer we are hoping for, ie he needs a place at a speech and language unit, this will override the place he gets at a local school.

Def go and visit the relevant school(s). We didn't really go with any expectations (went cos DS' SLT said such a setting might be appropriate for him) but were blown away by the set up of the school with speech unit about 20 mins drive away for us. Basically they spend the mornings in the class with all the kids with speech disorders (high adult to child ratio, lots speech work and teaching tailored to fact they have the spech and language difficulties) and the afternoons in the relevant mainstream class, ie reception, year 1 etc. It had such a friendly and inclusive feel and we thought it would be so nice for DS to mix with other kids like him. Now we are desperate for him to go there even though we have pretty good local primary schools.

I guess my DS gets DLA cos of the ASD diagnosis as well as his speech disorder. However he doesn't have any significant issues as far as that's concerned, he's at a normal nursery with no extra support, and has no behavioural or sensory problems.

It would prob be worth applying especially if your DS is showing some ASD characteristics as well as the speech disorder. We get middle band, about 55 quid a week. Lower band is maybe 20 or 25 quid a week which would still be good and reduce the cost of private speech therapy!

Hi ahh....

The issue is also that the speech unit that is around my area wants a statement report. We have to have that in order for them to consider our son for a place.

We have just literally started the statement process. Though would be finished on time before DS goes to school.

Since you've been through the speech disorder assessments... I assume. How was the testing like for your DS? Plus regarding the autism, in what way did the symptoms distinguish between a pure speech disorder and autism?

Hi

Only a parent, so not an expert, but my DS has ASD, and had a similar number of words to your DS at that age. The things that don't sound like ASD are your DS's good joint attention, his seeming desire to communicate? His made up signs would be very alien to my DS. I had learnt BSL due to my godson's deafness but my DS wasn't interested in communicating anything beyond his most basic wants. His lack of need for routine of obsessions don't sound particularly like my DS's ASD. My DS also has sensory issues, he is under sensitive to most things, so likes exaggerated speech, lots of movement, being pressed, squashed and cuddled, liked sand and mud. Likes strong tasting food.

One thing I've learnt, though, is that if you've met one child with ASD, you've met just one child with ASD. They can be more different to each other than a NT DC is to another NT DC. So while your DS isn't like my DS was that doesn't mean he doesn't have ASD.

My DS had a statement at 5, not until Y1. The EP testing showed a typically 'spiky' profile for ASD with strong skills in non verbal areas, like pattern recognition etc and a (by then) good naming vocabulary of concrete nouns, but poor pragmatics (use of language) and very literal thinking. His scores ranged between 99th percentile to 5th percentile. I don't know how these would compare with a language disorder only. At his first paed appointment at age 3 they couldn't decide between a language disorder or ASD but within a few months ASD was DXed.

one thing i would say about a speech unit attached to a mainstream is that will 1:1 be required for your dc to cope and learn in a mainstream environment - even if its just in the afternoon?

You see even though my ds is largely non verbal but can repeat words now, he woudn't cope in a normal mainstream environment regardless if it was for a few minutes or an afternoon. He would drift off and stim and he needs a constant 1:1 to keep him motivated and divert his attention to cognitive exercises.

I also would say that whilst your dc don't have issues with drifting off and staying on track - remember that a school environment is very different to a nursery and home provision. My ds didn't exhibit half as many sensory issues till he started school with 32 children around him.

The speech unit attached to a ms i looked at specifically said they only help children with speech issues- not children on the spectrum as their needs are often greater. Definitely worth checking if your dc do get a dx of asd if the school would still be supportive.

Hi Adrianna, I'm afraid I'm not really sure exactly how they diagnosed the ASD and VD. they were diagnosed at the same time at the social communication clinic where DS was assessed by a paed, a SLT (specialising in ASD) and a clinical psychologist. The SLT played with DS for 1.5 hours while me and DH answered lots of questions from the paed.

Since then, following a recommendation from his SLT that a school with a speech unit would likely be appropriate for DS, he has been seen by the lady in charge of the speech unit at the nearest school which has one. They seemed to want to confirm that there is a gap between his expressive and receptive language levels and to confirm that speech was his "primary need" (even tho he has the ASD diagnosis).

Even if you have only just applied for a SA, it need not be too late for the speech unit (as long as the LA doesnt drag it out which is always a possibility) It's weird here, the lady in charge of the unit has confirmed she is happy for DS to go there, now we just need the statementing process to get to the same conclusion (like your one, our one requires a statement fr a child to go there). Maybe you could give them a call and see if you can look round on the basis that it may well be the appropriate place doe your DS. the SENCO at our local one was more than happy to show us round. Or could you ask your SLT for her views and or referral if she has links to any of the units? I know of a little boy who started school last sept who only was allocated the place in the unit a coupe of weeks before.

Lesley - your comments are interesting if a little scary. Any thoughts how we could work out whether DS would be ok in the mainstream class? He is ok at nursery (only 12 kids in his room tho) but he does sometimes dislike busy places when we are out and is a bit scared of hand dryers.

Hi

Thanks for the advise.

@Lesley 25… I understand what your saying about even though he may be able to cope in a nursery, doesn't mean he won't be able to cope in nursery.

Though at the same time, no-one really know's for sure how he would cope. He may cope well, or not so great or not at all. So, I'll see how it goes with DS at a mainstream school for a year and in the meantime still doing lots of research about specialists schools etc. I have spoken with two of my son's mainstream schools and they both suggested that DS would spend one day a week off from school to attend speech therapy.

• My head is going all around the twist.

DS is still to be assessed again for autism and hopefully for verbal dyspraxia.

Hi Ellen james- Yes your right. When you meet one child with autism, you meet one child with autism.

• Apprantly I could be wrong… but there was this lady who says she is a speech therapist, who I met at the hospital with my son. Her DS was about the same age as my son, the daughter's speech was un- recognisable. Though, the mum ( speech therapist) kept looking at my son… maybe thinking that he was odd or too quiet and sounded like a baby when he spoke. But, when she saw him doing his signs, she then came up to me and asked if my DS was deaf, because of his signs and baby-like speech. Plus, asked me if he has learnt Makaton before. I told her that no DS is not deaf but has a very severe speech delay and the only Makaton sign he knows is 'sorry' and 'more'. The rest are made-up.

She then was telling me that her DS has verbal dyspraxia and also used those made-up signs, but stopped because she gained a lot more words to communicate and that it is quite common for children who have verbal dyspraxia to use made-up signs.

lesley- It's a shame that most speech centres don't cater to kids who have an ASD diagnosis. If my son did get an ASD diagnosis. I would really like him to go to a speech unit as speech is his main issue. I'm not sure is ASD has that full on primary need of speech there. I know they bring in speech therapists into the school. But not as intensive.

Hi my son is 4 years old and he is very similar to your son. I’m extremely worried about his future.
I’m wondering how your son is now?

Hi Noah2811, sorry to jump on your question but I am wondering how your son is getting on?
I have too found all above sounding just like my son and desperately trying to hear some positive stories.
We had NHS SALT assessment who said ASD assessment needed and it's just speech delay and saw private SALT today who said its not a speech delay but possible Asd with language disorder...

Might be best to start your own thread. Language disorders are very common with asd and no 2 little ones will be the same.