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.

Why do you get panicky about the thought of her being autistic BH. A dx of autism is not exact- every autistic child is extremely different and has a different prognosis. Many (Einstein/bill gates etc) do extremely well- a diagnosis of autism wouldn't change your dd at all. Your dd isn't autistic, or a language disorder iyswim, she's just who she is.

My son wants to communicate as well (picked up by everyone who has worked by him), hjas always responded well to social praise and wants to please but no-one has ever really disputed the fact that he's autistic (BIBIC came the closest although settled on him being a bit unusual). At the end of the day it doesn't really matter, providing he's receiveing all the help he can then his chances of an independent life (which seem pretty remote to me) are the same whether he's called, autistic, severe language disorder, or even- as I guess he would have been in the past- mentally retarded.

JJ _ I don't know. I think it was in the early days when I suspected dd had problems and although she hasn't ever really had any autistic behaviours (apart from fingers in ears and echoing) I thought she may have had it. I was very open and prepared for her to be dx with that, nearly 3 years ago now. I was reassured that no dd wasn't and felt glad TBH I just thought dd would grow out of whatever it was. I carried on reading up about autism and other such subjects and reassured myself that dd didn't have it but still wasn't 100% as obviously it is a broad spectrum.
As dd had become older lots of her problems have dissappeared and she has become far more sociable than say 1 year ago. Even going to friends for tea and having them around. Dd is still different from her friends but it's funny if you was to watch her in a playground,park etc you would not be able to tell that she had sn. It's only when she speaks that she seems different IYSWIM
Sorry if this is long winded JJ but I just think if someone had said to me let's wait and see I could have dealt with that but when you have people like dd's portage worker saying if dd was dx with an asd she would resign you kind of want to believe them.
It's so hard to explain really how I feel unless you have been me for the past 3 years.
The bottom line is I am worried about dd and scared for her future. I just want dd to have a "normal" life, whatever that is?

But her diagnosis isn't going to alter her chance of a normal life either way. Before ds1 was dxed we were told by maddiemo's SALT that he wasn't autistic, but if he may have some mild traits that were never going to be a problem. A year later he was diagnosed and we were told that he was high functioning, now its clear that although he may be high functioning in terms of IQ etc, he's very very unlikely to live an independent life. So I wouldn't clal him high functioning.

His diagnosis hasn't changed at all though (autistic spectrum) (once we'd got past maddiemo's SALT!). If someone gave your dd a dx of autism (and I don't think anyone is suggesting it are they?) then I don't see that it would change your dd's future at all. Diagnoses are often changed as a child develops (eg in George and Sam, George's was changed from Asperger's to autism) and a clearer picture emerges. My friend's dd has collected diagnoses as she's grown- initially it was autism but it now appears that the majority of her problems are caused by learning difficulties which have become worse as she's grown due to uncontrolled epilepsy. My friend spent some time investigating whether there was a "syndrome" which fitted her better than a list of different dx. What I'm saying is that dx are changed to fit a child. A child doesn't change to fit a dx.

That's very well said and very true. Thank you! Infact that's what the SALT said more or less. Don't dwell on an asd dx as she doesn't have one but concentrate on dd's real difficulties. The fact that the school know what they are and are targeting them is the only thing to worry about. I opened up a lot to the SALT that day. Ended up in floods of tears, as I sometimes do and most mums of sn kids do! I promised her that day I wouldn't bring up asd again and here I am rambling on about it. I promised her that I wouldn't trail the internet looking at autism and aspergers but I still do and don't know why really. Trying to find things that fit but they don't. A dx fits a child and that is very true and I promise to remember that when I worry. As the music therapist said my dd may not squeeze directly into a dx box, most children don't.

Jimjams Sorry to ask in such a crude way, but how do you know that ds1 is high functioning in terms of IQ? My ds3 was assessed has having a verbal IQ of 60 but a non verbal of 80. I asked if he would be considered high functiong and told no, but that he may become so by adulthood. We are on a diagnosis of autism although your son sounds far more ritual bound than mine. Possibly my son is on this dx as he is quite remote and lacks initiative to do anything for himself.
At the moment school and ourselves are wondering if ds3 needs either a additional diagnosis {maybe APD} as it is becoming clearer that he is being held back by his very weak short term memory(long term not v good either though). However I am only interested in this for the sake of making his statement and provision more accurate.

BH Sorry to take over your thread there. I think it is natural to worry when your dd has sn. I try to balance it up by realising that any of my children could have problems at various points in their lives. DS3 school say that the best thing is to be prepared, keep on top of things and find a niche for your child in life. I don't expect ds3 to marry or leave home. I hope he will be able to manage a job at some stage but if not it will not be the end of the world.

sorry maddiemo- meant it in a very crude way myself- in that he doesn't have additional learning difficulties. Compared to my friend's dd for example- who has to be taught things over and over and over again before she can begin to remember them and use them(and then she has to keep using them or the new skill will be forgotton) If he can be presented with information in a way that makes sense to him he will remember it and use it. It's impossible to measure his IQ with thier tests as he won't do them (and his verbal ones would be really poor whilst visual would be very good I guess- but I meant IQ as a measure of general intelligence rather than the strict defintion sorry).

People who work closely with him describe him as very bright. Of course all completely irrelevent when you can't even say yes or no. When he was 2- because he was sociable, and friendly and keen to communicate (and not particularly fussed by routines- although he was a bit OCD) the now obvious HUGE difficulties he had with language were not apparent. A 2 year old with the language development of a 15 month old isn't that noticeable as being different from normal, whereas a 5 year old with the language development of a 15 month old is.

TBH the only criteria I look at with him now is whether he will live independently or not- that's all I'm interested in. I'm pleased that his LSA and SALT think he is bright as it means they are more willing to try stuff with him I think. And something I like about intellikeys is that it shows how much he understands. At the moment I can't imagine that he will ever live independently, but that doesn't mean it won't I guess. Although I think its unlikely. His actual diagosis doesn't bother me all that much anymore- all the autistic children I've met have been very different from each other, and it also seems difficult to predict who will do well.

Thenks very much Jimjams

BlossomHill, I just want to say that I understand a bit why you would be worried about a diagnosis of autism, because I feel the same myself, that that would be a worse diagnosis to get than e.g. dyspraxia. I see exactly what you are saying, Jimjams, that in the end the outcome isn't changed by the diagnosis, but I suppose at the beginning (ny ds2 is only just 3) you don't know what the outcome actually will be and the only pointer towards that outcome is the diagnosis and hearing about the experience that other people who have that diagnosis (and I accept that that might not always be helpful). But it seems from reading this board and other stuff that I have read that an autistic child might have more problems and be significantly harder to cope with than children with other diagnoses and that is why I would find it more scary to be told that is the label for my child.

We are still "diagnosis-free" , and I think the general feeling is "global developmental delay". I had a visit from the OT last week who was very helpful with ideas of things to do with ds2. I asked her if she thought he was dyspraxic and she said not, that he was too delayed in his language as well and also that he played too well. It gets a bit frustrating with the language thing - she is basing that on the SALT report which was done back in Feb. I feel his language isn't quite right in content, - he does sort of echo although always as a prompt to make you say things to him - and I don't think he always understands what is said but I wouldn't say his language is delayed in the sense that he is just like a two year old instead of a 3 year old. I don't think a "normal" two year old would talk like he does. Anyway I have started trying to write down conversations etc because it seems the only way to show what I mean.

Sorry totally digressing. I am not saying it's completely rational but I do see where you are coming from BH.

I can see that the diagnosis is scary if it's not your child, but if you are actually living wiith autism on a daily basis then to be honest its a relief...........

Saker my dd's language is now age appropriate in most areas as the SALT tested her for the annual review:- receptive, expressive and vocab but she is still different from other children her age in the "way" she speaks as quite often she appears a bit odd, but you can't quite put your finger on. I suppose that as she has a language disorder it will affect the way that she comes across. Athough the SALT said that dd had a mild language disorder so hopefully she will carry on improving! How much do I wish I had a crystal ball???? Luckily there is also a really good SALT secondary school (ICAN) that dd could go to if she still needs to!
jj - I think it someways it's easier if things are more clear cut. I have a friend and before her ds was dx with autism everyone just knew what the dx would be even though my friend was in denial. He had classic symptoms and is quite severe but with children like my dd the problems are subtle, but all the same there. This makes it harder in some ways to deal with as it lots of ways dd can do things that most children her age can do quite independantly and then there are other simple things that can be hard work. Hope this makes sense but I am rambling on a bit.

A Paed is the only one to diagnose isnt he?

Although the PT told me my daughter had Retts symdrome and would never walk, which at the time was horrendous and I just cried and cried in front of her! she didnt have retts and walked a few weeks later. I find it quite worrying that this woman actually said that to me

Fio2- my friend was told by her portage worker that her dd would never have more than 3 words. She talks really well now- can make her needs understood quite easily. I've already said how I was told by 2 SALTS that ds1 "definitely wasn't" autistic and in fact my friend with the '3 words' dd was told by the SALT at christopher place that she "definitely wasn't" autistic. I think that's why they insist on paeds diagnosing- half these other people don't know what they're talking about ( eg someone I know was told recently by an Ed pysch that their son dxed with AS- didn't have Asperger's, as he was 'too happy' and "has a sense of humour'. Another family I know have been told - by the then acting head of SALT, that their son was not on the autistic spectrum with verbal dyspraxia (dxed by paed) but in fact they had traumatised him when his uncle died!!!!)

God these people are simply dangerous- never trust anything unless its from a pead! I actually think Ed psychs are the worst for the collection of stupid comments I've heard.

BH I'm not sure it easier if its clear cut. I was much happier and more hopeful of ds1's future when I though he might live an independent life. The last 6 months - when we've accepted that that is very very unlikely- have brought with them a very real sense of loss- which I doubt will ever go away.

I just wouldnt trust anyone other than a paed tbh. Those comments are just ludicrous.

Incidentally my friend was told by her salt a few weeks ago that her son wasnt talking because she didnt talk to him enough. My friend was livid

I was told that by DS1's first "evil" nursery fio. When I said I was they said that I "must be talking over him". FFS.

One lovely thing about his assessment (took place over 6 weeks- mulitdisciplianry) was that I was told by a lot of people (everyone except the ropey SALT) that I was doing a good job and managing his behaviour and obsessions well. Repaired a little bit of the damage tbh. My MIL's constant refrain at the time was 'they all do that if you let them get away with it" and "I think that's becase someone said no to him for the first time".

Now I take comfort from the fact that people who make those sorts of comments wouldn't last 2 minutes with him!

My mum always says that ds1 has never needed SALT because she talked to him so much(she looked 3 times a week until he was 2.5 years old whilst I worked)
Ds2,3 and 4 have all needed SALT, and that is obviosly,iho, because I don't talk or sing to them enough.

Not talking to them enough!!!?? What a crock of s*!

It's not just the SALT who has dx dd we have seen numerous professionals since dd was 2 including ed. pysch visits, CAMHS, paed. many times and obviously the school that she goes to has something like 60% of children with sn. I do think that in my dd's case with the SALT it is more reliable then say people who only see one every few months. As I have said before dd sees the SALT about 3 times a week and obviously SALT are trained in this area. We will be seeing the paed. who is attached to the unit next month as he comes in annually to see all of the language base children. I also believe that a SALT is far more trained to deal and dx language impaired children. CAMHS didn't even know what semantic pragmatic language disorder was (although we are not sure if that is what dd has anymore)

JJ - Sorry about the clear cut comment. I meant in my case sometimes I wish it was more clear cut and that if you know exactly what you are dealing with it can be easier in some ways to accept. I also understand how difficult it is for any mum with a sn child and all of us are the same in that we seriously wish our children didn't have sn. Hope that makes sense!

Wow, this thread is like all the jumbled up thoughts in my own head set down in writing!

I asked my SALT what the difference is between a speech/language disorder and an asd. Her 'in a nutshell' definition was that in a sp/lang disorder, a child wants to communicate but doesn't have, or can't access the words. With an asd, the child doesn't see the point of communication, because they don't have clear understanding of themselves as a separate entity or that you can't read their mind/share their thoughts. This isn't very sophisticated I guess, but it did help me make sense of the distinction a bit.

She also told me that she is definitely not allowed to diagnose, it must be the paed clinic. Having said that, it was her referral report that set off alarm bells for us, it was very clear what she suspected....when I asked her straight out if she thought asd, she said she wasn't allowed to say, but went on to talk at length about 'children with similar problems'. I was absolutely FURIOUS with her at the time, but now several months later I am actually grateful to her. Her report has made us push everything forward - without it we would still be languishing at the bottom of some NHS waiting list and losing valuable time. We are still waiting for a definite dx too.

I've just looked at the ASD 'Aid to Diagnosis' by Lorna Wing which is supplied by the NAS. She says the four features that must be present for a diagnosis are:

1. Impairment of social interaction 2)Impairment of social communication
2. Impairment of imagination
3. Repetitive stereotyped activities

I don't know if this is a tool used by paeds though. Someone told me recently that if you ask the paed if your child qualifies for an asd diagnosis under DSM IV they must give you a yes or no answer - I'm going to try this and see what happens .

I'm not even sure about that though beccaboo as everyone who has worked with my son has commented on how hard he tries to communicate- he just can't. The only person who has said he wasn't trying to communicate at all, and he wasn't trying to speak - I was imagining it (!!!! yeah right!!!) was a really useless SALT down here- every parent I know who has come across her hates her. (lots of pros moan about her as well).

I think there are extra's with ASD- more fundamental differences- the difficulties in imitation, the lack of interest in things other kids are interested in, the strange interests. The sensory issues- that's a BIG one- often overlooked. At a NT property this morning my friend's dd spent ages watching water drip from her hand (dipping it in a pond), and ds1 ran round the same poind, inspecting the fountain from all sorts of angles. Most children just couldn't spend 20 minutes doing that. Neither of ous could spend 20 minutes watching a magician.

Lorna Wing completely misses out sensory issues which is where she gets critiscised. Also the imagination thing is not true in AS ime. It was also an SLT who claimed that our DS was not autistic all those years ago, because he had shared attention.. How wrong she was and luckily the Paediatrician agreed with us. She was fine about it and we became quite good friends, I helped to educate her!
BH, I'm still not sure where you're going with this, you've had a lot of really good advice and opinions/experiences on this thread. Being terrified of ASD isn't going to make it go away if its there (which it probably isn't). I don't want to sound rude, but have you considered counselling to try to sort out how you feel about having a child with SN? I did it years ago when I was at a very low ebb and this issue does seem to be troubling you.

Davros don't worry you are certainly not being rude. It is something that Ihave considered but am not sure of how to go about it. You are also right in that I am also obsessed and almost scared of an asd dx and don't know why? Sorry if it seems that I have been going over the same old thing but I have found your advice and information very useful, so thanks to everyone who has given advice

As usual, I found the first port of call to counselling was my GP. They actually have a counsellor attached to the surgery. By the time I saw her I was feeling fine but I went out of curiosity and would say it can definitely be helpful. Also, finding some other parents who have children with SN/disabilities can be a godsend, MN can't fill every gap! Good luck, hope you can sort out your feelings and get to the bottom of DD's dx which will no doubt help or decide that you'll never know.....

I just want to add blossomhill that we have all been there, terrified of a diagnosis yet desperate to have one. I was completely paranoid when my dd was first having problems that she had autism too, dont really know now what exactly I was scared of tbh. having no diagnosis at 5 is really hard and I wish I knew something. Serves me right for being a control freak!

Fio - Thank you so much. You have hit the nail on the head with how I feel. It is so nice to know I am not the only one (although wouldn't wish it on anyone IYSWIM).
I really hope people realise that I am taking everything that has been said on board and that I really appreciate the comments and advice that has been given.
Sometimes I just find the whole thing upsetting and hard to deal with

I am the first to admit that I know very little about ASD or indeed many other forms of SN (but I'm learning a lot from reading on here) but I think it is important to remember that AFAIK a lot of syndromes, disorders, conditions have a name because at some point some doctor looked at a whole load of people with a bunch of similar problems and decided to group them together and give them a name. That is certainly the case for my dd and Aicardi Syndrome. There are certain things that typify the condition e.g absent or very thin corpus collosum, infantile spasms, lacunae on the retina but beyond that there are a whole host of other things which may or may not affect them, and in varying degrees of severity.

Not sure where I am going with this... just that I think it is important to remember that each child is unique, and they may have enough things in common with a group of children to give them a diagnostic label or they may not but that doesn't change their 'needs'.

I know in some ways this is easy for me to say because I do have a diagnosis for my dd. But the other thing BH is this - the label I have for my daughter gives me no more indication of what to expect than if I didn't. I think that is what you mean when you say it is easier if it is clear cut i.e you know what to expect so can prepare for it. My dd's diagnosis is as clear cut as anything but I still have no idea what the future holds. Because Aicardi's is a spectrum disorder and all the girls vary enormously, and I mean enormously, and range from girls who only live a few months to those who are able to walk, talk and have relatively 'normal' lives.

Still not sure exactly what I am saying but I think I'm trying to say I don't think a diagnosis will give you what you need. I'm reading between the lines a bit here but I think what you are thinking is this: you want your dd to be happy, you are worried about an ASD diagnosis because you are scared that means your dd will never be 'normal' and therefore somehow never happy, you are desperately hoping that she has a more straightforward language disorder because that means she has a greater chance of becoming 'normal' and therefore have a greater chance of leading a happy 'normal' life. However you see things about her which you don't think are 'normal' and therefore you can't get the possibility of autism out of your head.

Please forgive me if I am completely misinterpreting here and please do tell me to bugger off if I am overstepping the mark but I don't think it is autism you are scared of, it is that your dd will not be/is not 'normal'. That is a whole other issue and one you probably need help with coming to terms with, but it really has nothing to do with a diagnosis for your dd.

I think in a very long winded way round I've just kind of repeated some of what jimjams and davros were saying - sorry, I wasn't even sure where the post was going when I started it!

Sorry too if I am sounding harsh - I do understand where you are coming from and I do sympathise .