Is lingle around?

[Landladymews2]

Hi I was wondering if she is still around as o wanted to ask her about her DS1 and his receptive language delay. I hope she’s still around!

the pointing thing used to really depress me.

they would always go on about "typically developing" chidren who spontaneously pointed

but if you taught your child to point they would then use a "gotcha" and say it wasn't genuine shared attention.

DS1 is 18 soon and I'm convinced he's ever pointed in order to share attention with me. So that ship may have sailed :) :) :)

I've had a name change but I'm the SALT who posted earlier.

Your post makes total sense @Landladymews2

I have 2 DC. My first needed to be explicitly "taught" communication in the way you're describing. My second appeared to develop their communication skills completely by osmosis. They were both "programmed" totally differently from the get go.

@lingle Yes I was getting super worried about pointing as I’ve heard the same about it being spontaneous. I think if my son had any other red flags for autism I would still be concerned about it.

@GetTheBread Thanks for posting again. That’s really interesting! Is it something you have seen much of in your practice? Was your child delayed with receptive language too? You mentioned that one of your children has SN do you think the need to be taught language was linked to that? Sorry for so many questions!

@GetTheBread I would also be curious to know whether you have ever seen kids who you think just need a lot of ‘pushing’ in order to get their language flowing?

Keep asking questions if they're useful to you!

I've definitely experienced many many children in my work who needed structured support and encouragement to develop their language skills. It's quite common

What my DC struggled with learning by themselves was not only language, but social communication. I had to overtly teach them to point, to share joint attention, to direct language to me in a meaningful/functional way.

This was a sign of underlying difficulties, in fact they are autistic. I have to say that they did learn all these things, but they just needed to be directly taught. It didn't come naturally for them. (They are also the most caring and kindest person I know, but obviously I'm bias)

@GetTheBread Thank you for answering my questions
Were there other social issues like lack of eye contact, inability to play social games etc or was it simply those things that you mentioned?

No, their eye contact was good, clapped, played peekaboo etc as expected. A happy, content baby.

I started to be concerned around 14-18 months. It was only small, subtle things I noticed. But my job was part of the team carrying out autism assessments with children so I did have a bit of insider knowledge!

@GetTheBread Interesting! What signs of autism did they have as they grew up?

Would also be interested to know what you mean by teaching joint attention is that bringing things to you, gazing at the same thing, both of those things? Also if you can explain a bit about directing language that would be helpful too! Thanks!

Signs of autism as they grew up -
Difficult to describe really as it's so untwined with the person they are, it's hard for me to separate it all out, if you know what I mean? Autism is an information processing difference, so it affects how my DC experiences the world.
Certainly they have strong interests which they love talking about (their pets, particular TV programmes). They have friends but are probably more content to enjoy their own company or be with family. They can struggle to work out other people's thoughts and feelings, but are very kind and caring. They live a happy and fulfilling life. It's different to mine (I'm NT) but that doesn't make it "less" in anyway.

As a young child, they had sensory sensitivities to certain noises (hand driers, leaf blowers, tractors) but these haven't really been an issue since they were about 7.

Joint attention -
Sharing a focus on something with another person. Sharing being the crucial aspect.
I taught my DC1 to point but they found it difficult to use it in the social way my DC2 (NT) spontaneously did.
There are different ways pointing can be used to communicate. The purely social way (which many children with ASD struggle with) is pointing as if to say "wow, look at that!" To share interest.
Pointing to make a request is easier for children with ASD to learn, because it lacks the social element.
Does that make sense?

Directing language -
My DC developed language very broadly within the average range (10 words by 18 months, 2 word joining by 2 years etc) but it took quite a lot of effort from me. Bearing in mind I'm a SALT, I had to use all the strategies at my disposal and it did pay off.

However they struggled to use those words functionally/communicatively. They would use a word because they wanted something but they wouldn't do the other social communication stuff around that - like get my attention first, direct the word to me, ensure their message had been understood.

I had to specifically teach them to do that. It took time and perseverance but again, it was successful and they "got" that skill.
But as you can see, it was something they didn't just "know" instinctively in the way a NT child would have.

Sorry for all the posts, I'm using my phone so it's a bit fiddly!

@GetTheBread Thank you for the info! Did you ever consider social communication disorder rather than autism? I think SCD is a
relatively new diagnosis. The reason I ask is because you don’t mention repetitive behaviours and I think that’s considered to be a key difference between the two. From your description they sound like they have certain traits that you do also see in NT people eg strong interests and introversion but perhaps these are more pronounced in someone with ASD. The struggling to work out people’s thoughts and feelings seems like the most ‘autistic’ of the traits you have described. I understand though that it’s probably not easy to explain as you said but thank you for trying!

I do feel like some of your description sounds a bit like my son. He points to request rather than to show interest. However he does bring me things throughout the day that he doesn’t ‘need’ me for so I don’t know if that would also count as sharing interest. That’s something I haven’t taught him.

I’m obviously having to put in the effort to teach him language in the way that you described you had to. At the moment the words he is using milk, food, shoes etc all seem to be related to something he wants or needs but that probably makes sense for now. The only one that isn’t is his current favourite ‘oh no’ when he drops something or trips up. I guess it’s still too early to say anything about that as his vocab is still so limited.

It’s hard to imagine that he could be autistic because he is very sociable and doesn’t have any of the ‘classic’ autism signs but at the same time his development is behind so I guess I should really keep an open mind. My gut feeling is going off doing the MChat screen on which he scores low and also the one child that I know well who is a HFA. I knew her from when she was 15 months and picked up immediately on the lack of eye contact and interest in people. I think I’m fairly good at picking up things (Obviously aware that I have no qualifications in this area though!) At the time she hadn’t been diagnosed and the parents seemed to be totally oblivious to it until she was diagnosed at 4/5. I don’t want to be like that so I’m open to all possibilities at the moment. If there’s an issue I don’t want to be in denial, I want to know what it is and work on it.

Oh no, they're definitely ASD. As I said, I work in ASD assessment so was confident about the diagnosis (which was made by a different team to the one I worked in just before they were 4 years old). It's difficult to fully capture how they presented as a toddler/young children in these messages. They are a fully rounded and complex individual, as we all are.

I definitely flip flopped in my thinking about the nature of their underlying difficulties from 18 months - about 2 and 1/2. Did they just need a bit of extra support or was it something more? And then things became clearer to me.

They did have all elements of the triad of impairment and it did affect their functioning in the world, particularly when they were younger. In assessment we look at the quality of communicative behaviours. So it's not necessarily whether a skill is present or not but rather the quality of it - how frequently or successfully it's used.

I guess my feeling is that my DC's autism doesn't define them but it's an important part of who they are. If I hadn't been a specialist professional, I probably wouldn't have picked it up so early but it would have been there all the same.

What you're doing for your DS is exactly what he needs. You're providing the communication environment to encourage his skills as much as possible. And it's paying off. Keep doing what you are doing. He is making progress and that is a positive indication for future prognosis. Autism or no autism, you are building his communication skills.

Thank you. Im sure you must remember that it’s very hard being at this stage of wondering whether they just need extra support or if there is something more! I’ve had a look at the triad of impairments and it’s seems like it would be easier to apply to a slightly older child. I suppose that’s why diagnosis cannot be made early.

I guess the question I’m really left wondering about is whether having to be taught language and taught pointing on their own without any of signs of any the other factors commonly associated with autism (no lack of imaginative play, no repetitive behaviours or rigidity, no sensory issues, no issues with interacting with people etc) are enough on their own to indicate autism or whether there is more to it then that. That’s the million dollar question for me!

Autism can only be diagnosed as autism with difficulties in all 3 areas. Without that, it's something else (social communication disorder as you mentioned earlier or sometimes language/global delay can "look" a bit like autism in younger children and less like it as their skills develop).

I remember so well how stressful it was worrying about what was going on for my DC1. It's what drew me to comment in the first place as you're a natural puzzler and problem solver like myself. Knowledge is power but I can get a bit stuck on looking for answers to questions that are impossible to answer.

But I hope my answers to your questions haven't overwhelmed you. Your DS has got a mum who is doing the very best for him

So repetitive behaviours can be quite natural at a certain stage - its known as 'enveloping' in the EYFS, e.g. my DD used to open and close the fridge door as a toddler trying to figure out the light.

I don't think a language delay on its own qualifies as autism, and I only ever saw my totally NT dd point once so I'm starting to think that this innate pointing thing is a red herring.

Also I don't want to be pedantic but language delay and global delay are not always the same thing, in fact children with mild learning difficulties may not develop speech typically but they may not be late either.

But OP only time or possibly an MDA/ADOS test will give you reassurance, If I were you I would have an assessment with a SALT who is very experienced with pre-schoolers.

Thank you, it’s really kind of you to share your insights with a total stranger over the internet! The more I know and the more I discuss it with you lovely ladies the more I understand and as a result I feel much better. It has been so useful for me and I’m sure someone will come across it in the future and find it helpful too :)

This discussion has made me realise that I should keep an eye on things and not just assume that it’s a language delay. I think if I hadn’t taught him to point and if he wasn’t simply pointing to request I would feel more confident that it was just a language delay. On the other hand I know that he’s pretty good with the showing and gazing aspect of joint attention and that makes me wonder if it’s just something about pointing instinctively that isn’t coming to him and whether it could be an isolated trait (I guess kind of like the echolalia that my NT husband has). I imagine there probably are children with language delays who have struggled with pointing to show interest or were delayed in it for whatever reason. I think that was @lingle experience. If my son turns out to be one of them I really hope I remember to post an update here so other anxious mums like me can read about it!

@essexmum777

Thank you! That’s interesting about your NT daughter hardly pointing.

I think global delay is pretty unlikely if I’ve understood it correctly. He comes up ok on all other areas of the ASQ such as fine motor, problem solving etc. He was on the late side of normal with walking (17months) so I was actually starting to worry a bit about GDD as it would have suggested a delay in two areas if he hadn't started walking soon. As with his receptive language which only came on at 18 months I think he does things as late as he possibly can in order to make me panic!

With the SALT assessment, I keep going back and forth on this. I don’t know if an assessment at this stage could tell me more than I already know at which is that his language is delayed and that we need to work on the receptive language piece. I wonder whether Hanen, Teachmetotalk resources etc are enough for now especially as I have already seen some progress. At the same time I know what enormous value a true expert can bring with tailored advice (having been recommended a brilliant sleep consultant who did things that I wouldn’t have been able to achieve with just a book!) I need someone fairly local to me in SW london and I haven’t been able to get any personal recommendations. The only pre school expert I found told me that she’s too busy for any new clients!

@essexmum777 sorry I should have added the reason an assessment couldn’t tell me much more is because of my sons age. I think he’s too young for ADOS? I think only MCHAT is appropriate at 18 months and he comes out low risk on that

Measuring an 18 months old understanding of language is tricky, if you sit by the door with your coat on and ask him to get his shoes chances are he will guess that's what you are saying because that's the same situation where he puts his shoes on every day, ask him to fetch his shoes when you are sat on the toilet and he might not follow - my point is its incredibly hard to know what's going on without being a specialist, he is very young though, my dd only had one word at 17 months and i had no clue what her receptive language was like, it probably wasn't on par with other kids at that age because she was incredibly busy following her own agenda.

There are many many kinds of speech and language disorders, as well as austism/gdd/mdd etc plus there is the good old fashioned late developers who catch up - in my DS's case, i think I've mentioned that's he's gifted in certain academic areas - his ADOS assessor picked up on that but wasn't allowed to share it, I watched the whole thing and didn't really follow it at all - that's why i think its important to either wait as your DS is so young, and many speech/language do resolve by themselves at this age or get a professional SALT and not drive yourself crazy with Dr Google.

ADOS is from 12 months upwards btw

Scrap that, just realised there is a module for younger children. Maybe I do need to have him assessed now then.

@essexmum777 You’re right. That’s why whenever we ask him for something we try do it totally randomly to catch him by surprise. I won’t ask for the shoes at the door, I’ll ask in the middle of a game and he always gets them because he loves to go out or I’ll warm up his milk and leave it in it’s usual place in the kitchen where he can’t see me and then wait some time before saying milk and watch him wander off into the kitchen. The understanding of some words is definitely there now but I’d say he understand about 6 words, maybe 10 at a real push (which is behind where he should be) and he only consistently follows instructions that he’s really motivated about (food, going out and opening the toy box) and those that don’t interest him as much eg pointing to body parts he will only do if he’s in the mood.

At what age did you do the ADOS assessment?

We did it as part of the MDA, the paediatrician scheduled the MDA at age 3 and i held off until 3.5 - bear in mind that certainly where i live there is at least a years waiting list, i choose not to do privately because the paediatrician had already put the legal notices in place with the LEA from when she first saw him at 2 which meant that ds got 1-1 funded support in nursery or could have gone to a special needs nursery - the LEA can be a bit difficult so an NHS diagnosis can make things easier.