Please look at 3.5yo DS's SLT report and tell me what you think

[WaveorCheer]

I'm going to split it up cos it's enormous...apologies in advance.

Attention and listening

X’s attention and listening skills are reduced and variable, he appears to be more engaged at home than at Nursery, possibly due to the busy, stimulating environment at Nursery which is naturally more distracting. X is able to sit and play with toys such as wooden building blocks for a considerable length of time, however he requires adult support in order to remain engaged.

X often flits from one activity to another and can find it difficult to settle at a task even if he usually enjoys it, he can often appear to be in his own world. X sometimes appears to really want to concentrate but may find an activity too difficult or intense, he usually removes himself briefly from the activity, engages in self-stimulating behaviour such as hand flapping and then re-engages in the activity with adult support.

X is able to remain focused and motivated for short periods on activities that he does not enjoy (such as the language assessment) when it is broken down into small sections and he knows he can have a small immediate reward such as a chocolate button after each small section.

X displays some repetitive and self-stimulating behaviours, he often engages in hand flapping and makes repetitive noises, he usually does this in response to stress, change, under or over sensory stimulation. X also engages in stereotypical play such as acting out television programmes or trips on the underground, when he is engaged in these repetitive behaviours it can be difficult to gain X’s attention, although he will sometimes respond to his name. X is more likely to respond to very familiar adults such as his parents but may not respond to others’ attempts to gain his attention.

Understanding of Language

X appears to understand a lot of the language that surrounds him at home and at Nursery, however his reduced attention and listening skills will impact on his ability to understand language. X could possibly take some of his understanding from the social context and his daily routines rather than actually understanding the language that he hears. X often follows his own agenda and may simply not want to listen or participate.

The Reynell Developmental Language Scales (RDLS) were administered to assess X’s understanding of language, although he was able to concentrate for a lot of the assessment, it can be presumed that his attention and motivation to participate were reduced at times, which will have impacted on his performance. Overall X scored a standard score of 32 when the average is 100, he scored a percentile rank of 4 when the average is 50. X was able to follow instructions relating two objects together, for example “put the apple on the bed” and he was able to follow attributes such as “show me the blue box” X’s understanding (along with his attention) decreased when following longer sentences such as “put all the white buttons in the cup” X was able to follow some simple locative relations such as “put teddy on top of the truck” but he continued to place him on top when asked to place him “under” or “behind” X was generally able to follow and identify the key words in a sentence but was not always sure how to relate them. X had some difficulties identifying who was being naughty in a picture or who would get their food next in a dinner line, however this skill would only be emerging at his age.

Speech

X’s speech appears to be developing normally and around 90% of his speech can be easily understood by strangers.

Expressive Language

X’s expressive language is emerging, although he started talking later than typically expected, aged 24 months. X’s expressive language is restricted in social settings such as Nursery, where he is more likely to use single words or set phrases within an appropriate context. X appears to use a lot of language but this is often repetitive and restricted, for example saying phrases and sometimes whole sections from a television program. X will sometimes join in with games and songs at Nursery and he will answer some questions. X does not generally ask many questions, however he seems to be learning how to ask questions within a play context by copying adults, for example “where is the ball? I can’t find it” X is more likely to comment rather than question, for example “Daddy, Y and Z were playing with the ball” or “Z sneezed” X can use attributes such as colour and size when describing objects, he can also use regular plurals, for example “balloons” and third person inflections, for example “they dance” X does not use any past tense markers such as “walked” X’s use of pronouns appears to be emerging, he will refer to himself as X but will sometimes use “I” he will often use “you” for example he told his Nursery teacher “you had chips” meaning he had chips for lunch. X does not always function to the best of his language abilities, possibly due to other factors such as attention and social skills.

Play and Social Skills

X likes to follow his own agenda, he has a number of interests but these generally centre around looking at books, building towers and public transport such as the Underground. During the Nursery observation X did not engage with any of his peers and even when approached by another child who was interested in the same books as him X ignored him and turned slightly away. X was more engaged with the adults in the room and clearly showed enjoyment in communicating with a number of the staff, showing them books and commenting on the pictures. X did not seem fazed by the other children in the room but he did engage in much more frenzied hand flapping when he entered the room and tended to gravitate towards empty spaces. X does not usually follow the social rule of sitting with the group, however his Father reported that recently he has been sitting with the group and joining in more.

At home X also likes to follow his own agenda and can become cross if his family do not act in the way he wants or expects. X finds it difficult to cope with and comply with demands, he usually passively avoids the demands placed on him but may occasionally get upset. X can play very nicely with adults when they engage in tasks he has chosen or wants to do, such as building towers or making porridge, then he can make lots of comments. X sometimes passes and receives objects during play but he may prefer to choose his own toys. X will take turns during some activities such a rolling a ball back and forth, however he will often say “no, take it” and run away rather than roll it back, he does not do this in order to be chased, chasing and tickling games do not seem motivating for X. As mentioned above, X tends to engage in repetitive and stereotypical play, usually acting out parts of favourite television programs. X is a very sensitive little boy, he will often become quite upset if he feels he has been told off, when he has not, or if people laugh at or with him unexpectedly. When he is upset X will sometimes seek comfort from a hug but this might need to be offered to him, for example “would a hug make it better?”

Thank you polter. You've offered me advice and comfort before under other names so I really appreciate you taking the time to read and comment. I think I'm ready to join the community now so hopefully this nn is going to stick for a while :).

I think her views could only have been clearer if she'd headed it "I think your child had ASD", really. It's what I believe is going on, and his nursery, although they don't use the term, think it too. DH is still hopeful that he's just 'slow' or that it's a product of our bilingual household. It's not.

My interpretation of her report is:
I think your child has an ASD. He may also have some kind of language or learning disorder, but I haven't been able to get to a true picture of his language skills because I think attention problems and social communication problems may have got in the way.

Can I get a private OT assessment? Is there an equivalent to the help with talking website? He is waiting to see the community paed and SLT next month, but any detail we can supply them in advance of that would be helpful.

RE school, his current nursery has strong links with the local infants school and think we should get him in there if possible. There's another local primary with a speech and lang unit, so I guess that's also a possibility, although I have no clue how it works or what kind of DC they take.

Has not had

I agree with polter that some of the behavioural responses to communication are in line with an ASD. For example remaining engaged on own task and not responsive to name and seeking own agenda.

I also agree there seems to be a lots of sensory things - such as nursery is noisy and this affects his comfort there and ability to engage.

However it's great your DS is able to disengage, re centre himself and re engage himself in an activity. That's a skill some children with an ASD can find hard to learn.

Fwiw you sound very supportive of him and accepting (iyswim?) of the fact he has clear SN and so whatever the end result your DS will benefit from having you totally and realistically onside.

Hi Waveour, thanks for posting about your son's report.

• I was a bit worried when I read that even though your DS speech is around age appropriate, that he struggles with attention and listening.

Usually, it's mainly the kids who have quite significant speech delays usually have issues with attention etc. So I guess this is classed as atypical development or it could be just a delay.

• It does seem that your DS has a a few sensory issues.

I think it may be worth for your DS to be referred to a developmental paediatrician.

Yeah I sort of maybe think I've kind of almost accepted it :o

There's a group for children with disabilities that meets locally and I've been umming and ahhing about going along. I'd really like to meet some other parents in the same boat but keep telling myself that we shouldn't go as he doesn't have a diagnosis, so he doesn't officially have a disability, right? And then something comes along like the above. Seeing things written down brings home the fact that he's really quite significantly impaired :(

Hi Waveour

My son does not have an official diagnosis. But I have been to the special needs play groups and for the first time..I actually felt like I belonged. The other mums were so nice, we were giving each other advice..some mums knew a lot of things, like assessments, school etc.

You don't need a diagnosis to attend a special needs group.

You can have a disability without a diagnosis! A disability is not having the same skills as expected due to DNA, birth defect, brain damage or developmentally which impairs your ability in everyday life. That can be physically, socially and mentally.

The current paraolympians are all disabled - it doesn't prevent achievement just means you need adjustments for it to happen.

WaveOrCheer - does your ds start school this September or next September? If it's this September then I would start having conversations as soon as possible with the SENCO at the school. It would be helpful to have someone from the nursery and the speech and language therapist there too to talk about the things your ds is likely to find difficult to start with.

The things that I noticed from the report which may impact first on his transition are:

• Finding the nursery environment overly stimulating so he would benefit from having a quiet withdrawal space he can choose to go to

• Having difficult complying with demands - there tend to be more of these in reception than in nursery, so the school will need to think about how to limit or present these demands in such a way that avoids unnecessary stress for your ds.

• Lack of engagement with peers - what will happen at play and lunchtimes etc.

i would also phone the S&LT and push for more information about the language unit.

Thank you everyone, this is so helpful.

Littlefish, thankfully he isn't did to start until next September. I'm starting to push everything along now because I'm so aware that it will be a real crunch time for him. He isn't yet potty trained, for eg (he has no interest or aptitude currently).

Wave - that's really good news about school. Please don't worry about the toilet training - there's plenty of time! I think you're absolutely right to be pushing things forward now. Is the local authority inclusion team involved with his nursery?

Hi Yes attention and speech is linked.

If the child hasn't got the attention skills, then language is delayed. My speech therapist told me this many many times.

It goes... attention & listening, then play, then understanding of words, then the words come, and then the production of words. But this relates to kids who have speech delays.

But I thought 'normal' speech but impaired attention/listening/comprehension were quite common parts of some ASDs, ie aspergers?

With DS, he can pull his trousers down and take his nappy off, he just doesn't care. If you ask him if he'd prefer to wear a nappy or 'big boy pants' he'll choose the latter but then totally ignore any urge to wee and give us no indication he's about to do so.

Pooing is different as we have withholding issues that mean he's had to sit on the potty in order to go. Even now it's a right old palaver as he actively avoids the potty, hides when he needs to poo, denies he needs to poo, refuses to sit on the potty etc etc. he finds using it traumatic and won't sit on it unless one of us physically sits on the floor encouraging him. Hes also terrified of toilets and hates the noise of the hand dryer (I assume this is typical sensory defensiveness).