Can a SALT diagnose?

[blossomhill]

Guess what I am worrying again!!!! I just wanted to know how much weight would a SALT have with making dx? I am just checking as I had a long chat with the SALT who works at dd's language unit. The SALT explained in detail dd's difficulties and that the dx was a non-specific language disorder. Obviously the SALT sees dd up to 3 times a week so must have a good idea of dd's difficulties. Please can someone reassure me.

I'm sure someone will correct me if I'm wrong and, this is only a feeling from my experience, not something I KNOW. I think you need a medical Dr to diagnose which is why it should be a Paediatrician or Psychiatrist. I think they would have to be the person who pronounces and puts it in writing with contributions from SLT, OT, Ed Psych etc. That doesn't mean that someone else couldn't detect the correct dx, but I think a formal, clinical diagnosis would be from Paed of Psychiatrist (i.e. "consultant)
This idea has only just occurred to me so I'm happy to hear if I'm wrong!

agree with davros on this one even, if the salt knows the dx they are not supposed to dx.

I now realise that our SALT almost certainly suspected autism when ds1 had his first SALT session. However she didn't make any kind of dx. She sent several reports to the Paed as ds1 progressed and these were considered during ds1's assessment.

I suppose as dd's difficulties are specifically speech and language a SALT would be the most qualified maybe????

same here coppertop, i am sure a few others knew too, but they kinda hedge round it when you ask if its autism, they say something vague like they are showing possible signs of autism, course then you go away thinking great that means they dont actually have autism, i think its a warm up routine that they do round here. then you start reading up and decide for yourself.

Maybe BH (although my experience of SLTs at that stage is dire) but I still think they can't GIVE the diagnosis or make a diagnosis to access services iyswim. Plus they are looking at one aspect and there may be others from OT/pysio etc and the Paed/Psych oversees the whole thing

We have seen unerous professional who have all agreed dd is not on the autistic spectrum. I just worry as she is "quirky" and I am not sure if a language disorder would cause quirkiness. The professionals (too many including numerous visits to the paed., pysch.,pyschologist have all said definitely no. That to have an asd you have to have a triad and dd only has one part of that triad being language. Maybe as she has a language problem and lots of autistic people do that the similarities are that?
Sorry to go on... Just had a few bad days with dd and her problems have been magnified. It is also her birthday party (20 children!!!) so maybe that's why I am feeling anxious!!!!
Thanks for listening!

Her party is tomorrow.

Good luck with the party bh and happy birthday to your dd! In my experience, SALTs, PTs do tend to hedge around the issue as mentioned before, while the paed is the one who makes the pronouncements. What are the other parts of the triad ?

Happy birthday to your dd, BH! I hope she has a brilliant party.

Thanks everyone. She is going to look so gorgeous as I have bought her this lovely outfit. She just loves anything girly and insisted on a skirt!

I think the triad is:
language
imagination
social/communication

Please correct me if I am wrong!

nope SALT can't diagnose. I specifically asked a SALT her view on ds1 re diagnosis and she told me she wasn't allowed to dx. A paediatrician would take into account a SALT's report- but only a pead can diagnose.

Can an SALT tell if a child is on the spectrum or not? It's just that she confirmed (although I have had confirmation from paed. etc) that dd isn't. I think that someone who has worked so closely with dd, 3 sessions a week, must have a good idea. I must say though that a different SALT dx the language disorder at 3.

Where we live the Paed diagnoses asd and is the only person qualified to do so. However, for language disorders and related problems such as APD the SALT seems to have the final say. My paed knows very little about complex language problems and IMO he would not be suitably qualified to diagnose language difficulties.

I would feel that the SALT who sees your dd must know her the best and would be able to give you the most accurate overview of her needs.

Just to add the specialist SALT did tell us that ds3 was on the spectrum as did the Portage teacher. The first SALT we saw said she could not comment but passed us on to the specialist SALT right away. WE did not get an official diagnosis until everyone met together, however it must have been a forgone conclusion as we had already done a NAS early bird course.

It is quite possible for your dd to have traits of asd without having enough to qualify for a diagnosis. My ds3's best friend has many behaviours that are on the spectrum but actually has a chromosome deletion. I also know children with a diagnosis of dyspraxia who have asd traits.

I was told by 2 different SALTS that DS1 "definitely is not autistic" and one was the specialist SALT for communication disorders (same one as maddiemo maybe?) She cocked up there! We saw a consultant a few months later re verbal dyspraxia and she was horrified that we had been told that.

I know I've said this before but I'm still not sure why you are so worried about the actual dx as you seem happy with the input that your dd is receiving and it sounds as if she is making good progress. I can't see the point of pushing for a particular dx unless it would bring additional or more suitable resources.

I'm going through this too at the moment Ds (almost 4) has been to see a paed but she couldn't begin to dx as he was v tired from a long haul flight.
I didn't know about the triad? I'd say my ds has one (language) but he's fine with the other two. He echo's though and if he can't follow a convo he just copies.
One thing she did say was that a lot for a lot of young children autistc behaviour is a normal part of development, something I had no idea of.

jumiper- have to say I think the paed is a bit mad! I have an NT 2 year old and sure he went through a lining up stage, and he sounds like a parrot at times, but at no time has his behaviour been anything like his autistic brother's in an overall picture. For starters everything I do with him is 100 times easier than doing it with his brother. Did the paed seem good in other ways? Because whilst an NT child may do odd bits of auti stuff here and there the intensity and difficulty with it and length of time it perseveres is totally different.

I have noticed some things that are classed as "autistic" behaviour were things that my NT ds1 did but at a much younger age. So for example, he used my finger to point to pictures in books but well before he was 1. He also went through a phase of mixing up pronouns but again before he was 2. I think there is a phase of language development for most children where they refer to themselves by their name instead of "I" but again they grow out of that. I think there is a clearly defined milestone in child development where they become aware of themselves as a separate person from you and I suppose before that time you might get some behaviours similar to autism.

I read a sociology study of 4 year olds in the 60s recently and it was interesting how obsessive many of them were about e.g. bedtime routines and this is also something I have seen with my ds1 but again I think this is something associated with a phase of development.

Obviously I am no expert, but I wonder if that is what the paed meant? I am not saying that there are not loads of other things that are different about an autistic child, and that as a parent you don't have loads more to deal with (that is abundantly clear from your posts, Jimjams ), but I suppose some of the behaviours can overlap.

oh certainly they overlap saker. My 2 year old has his routines and likes things done in a certain order. The difference are his routines aren't a problem in the way his brothers are. For example ds1 had diarrhoea today and was desperately trying to get to the toilet but he still had to tap each carpet twice before changing rooms (this is a new one) and it tok him about 3 goes to get down the stairs (kept on having to go and start again). Likewise ds2 lined stuff up, but he had other play as well whilst he was going through his phase of doing that. DS1 meanwhile would turn a ball over and over in his hand, and would watch the wheels on a car go round, but had no other play. DS2 copies a lot of what we say- but he is 2 and echolalia is normal between 2 and 3- however it's not really echolalaia as he can also do things like change you to I appropriately. He only ever copies word for word if its appropriate otherwise he'll change the relevant pronoun etc. He would never do what ds1 did age 4 and say "ill get the keys" if he wanted me to open the car boot for example.

I just think its a dangerous thing for a paed to say as I think it gives the wrong impression, and doesn't actually tell a parent whether their child's behaviour is something you see in a checklist but perfectly normal (right age for it, isn't getting in the way of other things, hasn't lasted too long) or whether it actually is a symptom of autism. I've been flicking through Lorna Wing's book today and she makes the point that autistic behaviours are seen in NT children as well- but she also clearly makes the point that there is a big difference in the intensity and the length of time they last.

When we talked about the ferry last week with some family members we said "ds1 had to walk round and round the whole time he would not stay in the cabin" and they said "oh that's his age all 5 year olds are like that" - well I watched other 5 year olds on the boat and sure they were lively- but they circulated in small areas from the same spot, they wanted to sit down and eat, they wanted to play with machines, in the soft play area, watch videos, watch the children's entertainer etc and they could sit down and talk, play with their toys, colour, look out the window. DS1 only wanted to walk blankly around the boat (in a set pattern after the first time- here first, look out of this window for 5 seconds, move in that direction for so long etc, double back and touch that chair etc). Superficially the behaviour sounds similar ("oh no 5 year old boys can keep still") but in reality the behaviour is completely and utterly different.

I get sensitive to professionals saying things like this as I think they should know better. Most parents with a young autistic child have their fears brushed off in this way by well meanining relatives for a long period of time (often even after diagnosis- we still get it) and if parents are genuinely worried then that sort of comment placates for about 2 hours then you are left scratching your head again. In Juniper's case it sounds as if no assessment was possible- it would have been more helpful for the pead to have explained the sorts of things to look out for etc and to have explained the difference - what the checklists actually mean if you like- and for Juniper then to be able to decide whether or not her son's behaviour did fit the pattern or not. Otherwise you can be left almost feeling as if it's your fault if these things don't go away.

Couldn't have put it better myself Jimjams, very good post! The "triad" is the baby of Lorna Wing, a goddess in the autism world to some but not accepted by everyone by any means. In fact, her triad has in recent years been the cause of quite some differences of opinion rather than being just accepted as the gold standard for dx (not that I expect she's aware!).

Jimjams Oh yes same SALT. Coming to our school in September to give some training to our staff.
I think the quality of the staff be they SALT or paed varies hugely, cetainly{imo} the staff at my cdc have made some howlers with mis diagnosis both under and over diagnosing.
Jimjams is right. A NT child may have many autistic behaviours but the intensity is very different. I think that as the spectrum of diagnosis has grown it has actually made for more confusion. Diagnosis varies depending on where you live. What one paed cosiders to be on the spectrum another would not.
I am not sure what I am trying to say. BH, I think your dd is getting the education and support that is right for her. Sometimes you can get bogged down thinking about labels etc. I know I do.
I hope dd's party goes well.

Take your point completely - it may be an academic point in terms of where behaviours overlap but it is probably only going to confuse the worried parent and is probably best left alone. And I agree about the reassurance thing. It's not helpful in the end because as a mother you are not convinced but you become scared to speak out. To be fair to my HV she referred me immediately though so I never had to do a lot of convincing from that point of view.

Thanks everyone for your input. I know I must sound like a stuck record and I am sorry! Yes I am very happy with the help that dd gets and the progress that she is making but for some reason every now and again I get my doubts and I only have to have 1 off day in 50 for this to happen. I then start thinking oh god she's autistic and feel very panicky. I know dd is not autistic in the true sense of the word as I know lots of autistic children and there is no comparison. Even the SALT when explaining that dd was not on the spectrum explained that they do have children in the unit with autism. The difference is that dd wants to communicate, please and enjoys working with her etc and is generally a lot easier to work with. When we had the discussion I explained my general concerns which were basically the echolalia and the SALT said that to think why dd was doing it, it is a way of processing. Dd has never had immediate echolalia. I also then went on about dd's reading which is very advanced (probably about the age of a 7-8 year old) and although it's good it's a bit too good. The SALT said that they would only worry if dd didn't understand (hyperlexia) but as dd understands what she is reading to see it as a real bonus. I should take what the SALT says on board really as she has worked with dd since January, 3 times a week. I am sure that she knows her stuff. We have also seen a dev. paed about 7 times since dd was 2 and he has reassured me. I think it is that I haven't really met many children with language disorders and although I do understand about language disorders I don't think I do enough. My dd is very quirky at times, possibly like a mad scientist and that's when I worry that it may be more than a language disorder but maybe children with lanuage disorders are quirky? God I am rambling again. I apologise again!!!!! Thanks for listening

Hi all,
the paed who said autistic behaviour can be a usual stage of development did stress that it's when they're very young. My DS2 doesn't really line up things but he does play alone for a long time doing very mundane things (he's 4 next week) and he likes wheeled toys. He does make up stories with his engines though and plays fairly well with other children, albeit roughly sometimes. He's started screaming when frustrated again. This stopped after seeing a CO so maybe another visit may help? I can only try.