ABA PECS and SALT

[mizmiz]

Just looked through this for the first time. Fascinating for me as I am an SALT for people with special needs. Feel that I am getting an insight into parents' minds , something that isn't always easy.

Do any of you use PECS at home, with/without ABA? I have been working on this for a while and consider the two to be the most exciting stuff I have come across in 12 years in this field (although as some of you note, some SALTS are suspicious of it, which drives me nuts as I don't think they understand what it is about.)

Do ypu find using these methods at home sustainable, or is it too much bother and fuss? I would love to know. I have introduced it with some dramatic results to some of the families and schools I work with, but now that I have gone abroad to live, I worry about their ability to carry on.

BTW if you have any questions about SALT, I would be glad to try and help. help. Time lies heavy on my hands in a new country.......

Mizmiz - do you know what the long term effects, or could you rec. a good book, for people with language disorders. I am thinking in terms of being a teenager. My dd is v. bright and confident (that's what the unit SALT said!)so apparently that is a bonus!

BH kiddies with autism can be quirky too. For example if you look at ds1's 'deficits' (for want of a better word)- he has everything you would expect to find in a child with an asd, but the majority are mild. However he is so off the scale with langauge problems that he is severely disabled. I often get comments from the pros that despite his asd diagnosis (and the fact that it fits) he is a little different. TBH I think all the children I've met with an asd diagnosis differ from each other enormously - and the good professionals take then individually. I've been less impressed with the ones who see the autism before the child - they often read him incorrectly.....

Am abroad at present and obviously not surrounded by my stuff and colleagues, so cant pass on a personal recommendation.
However suggest you get in touch with ICAN (v good charity for children with s&l disorders to ask their advice-if you haven't already done so) They will have a good website.

Also, if you are very interested, the catalogues used by the profession have some great books which are very parent friendly but for reasons of economy/obscurity generally not available in bookshops or libraries.
Try Wimslow (or Wilmslow?) Press and Psychological Corporation for starters. The catalogues should be in your child/s school/unit. Ask if you can have a flick through.
Also maybe your SALT or her dept. have books you could borrow.
Very hard to gauge how much people want to take in. I used to give people mounds of photocopied articles, chapters etc and then found out that 95% of them don't read the stuff, so now I wait until someone asks then bombard them!

I wish someone wpuld bombard me mizmiz. When dd was first dx with a ld she was just 2 (3yrs ago). I had never even heard the term ld before and was really frightened (and still am) The SALT gave me a 2 page leaflet with about 20 words on it. I have had to find everything out for myself. I go on a good ld website which has been a lifeline and a very good source of support. I am also part of my local afasic which has also been very helpful!

Well, I'm really sorry to hear that but it sounds as if you have been very proactive in seeking out help and support.

I know that in such a case, I would (and do!) want to read absolutely everything going.
Thank God for the Internet eh, imagine what it was like not so long ago.
I am going home for Christmas and will see my colleagues and would be very happy to ask the relevant ones for useful reading recommendations.

Sounds silly but have you told your SALT that you want more to read? Spell it out to her. You ask for what you get for, something I learnt recently when seeing another health professional. From the start I spelt out (politely!) exactly what I wanted from her and why, and came away very happy!

Thanks mizmiz

mizmiz, so glad you've posted here, this thread is fascinating. Love your comment about loving the 'quirky ones'!

i wanted to ask your advice if that's OK. my ds, who will be 3 next month, has a suspected asd, but no firm diagnosis as yet. His language was delayed, but is now nearly age appropriate, talks in short sentences and understands most of what we say to him. He does sometimes get his word order muddled though, and our SALT told me this is a sure sign of a s/l disorder. Is this a hard and fast rule?

He does echo quite a lot, but never what's just been said to him - it tends to be chunks of TV dialogue from CBeebies, although he will often act this out at the same time so it becomes part of a role-play. Is this a pattern that would never been seen in a 'typical' child?

Finally, the SALT and others have suggested PECS at least four times. I've been resisting this, as I think his speech is coming on in leaps and bounds and PECS could be a backward step. But am I wrong? It just seems to me that he has been put in a 'box' and now they think they know what's wrong, PECS is the automatic answer. I feel it's not necessarily the right answer for his particular problems.

Thanks so much in advance - hope I'm not stretching the bounds of your generosity with all these questions

Not at all Beccaboo. Glad to be of (limited) help. First time in abvout 10 years I've had a chance to just while away the day.

Order confusion is not always (although can be) a sign of a lang. disorder. For example, bilingual children may do it in one of their languages, and also part of normal lang. devpt to a certain extent.
(To answer properly, would need copious examples. Ipresume your SALT has, therefore has come to this conclusion.

Yes,repetition being part of role play or some sort of 'aberrant' behaviour. Have thought a lot about this over the years. Again, question of degree and frequency. Iwould go with a mother's gut instinct. You know if it is a reenactment or just repetition.
May be an example of what Isaid earlier about too much being read into behaviours. (Often find that once you decide a child has a certain 'condition' you are always looking for examples/incidences to prove your point. I do it myself, although really try not to. Remember once spending ages trying to analyse and interpret one particular kid's behaviour with the mum and teacher, then suddenly it struck us that like all kids he had simply decided to be a bit of a pain in th bum that day!
Nothing more, nothing less!
Sobering lesson in looking more and brandishing the clipboard less!

i must tell you unequivocally that any form of alternative or augmentative communication (eg signing, PECS, Bliss, Rebus) will not, repeat will NOT hinder your child's development in any way. Masses of research to back this up which Ifrequently allude to as Ifind it is the most common misunderstanding about this field.
(A lot referred to in the PECS folder if you want to look at it. Also check out their website-loads of parent interaction)

To put it simply, language is coded information-mastery depends on cracking the code. all of these methods aid someone having difficulty on their way.

If you have a kid who may not use speech as a main method of communication, alternatve means (eg PECS,signing) provide them with a lifeline to the rest of the world. They can communicate reducing the terrible rage and frustration that often results in challenging behaviour.

If you have a child who will use speech as a main means of communication, but is having problems, then things like PECS can be thought of as an aid to get them there-like a bridge across a river or scaffolding on a building. They need the extra support for a while. To deny it is cruel. Icould weep when i think of all the people I know who would really benefit from an A/AC method but dont because their families have the wrong idea about it. I'm getting wound up thinking about it!
I have used PECS with quite a few children with good speech, for example children with Downs Syndrome, who are generally confident communicators with lots to say, but whose memory and sequencing problems prevent them often from saying it all out loud and in the right order!

Similarly, Ihave seen it really help dyspraxics and lang disordered children. The logic and order gives them time to slow down, work it out a bit better in their heads, get it out right and increase confidence.
Obviously children of this ability will whizz through the stages very quickly(ften getting to the highest one in a day or so!) and then work at that same high level. It is still important that they go through the levels (however odd it may seem to you, because they need to learn the principles of reinforcemnt) You can get into this very deeply if you are intersted, but you dont need to, another great thing about PECS. You can just do it, or you can also view it at a very 'highbrow' level as it is based on behaviourism)

We have been able to leave PECS behind as children develop and believe me that is a very happy day for all of us! Similarly if it continues to be needed, the child still has his communication tool. Either way, things are good!

I don't think (sorry, dont think, I KNOW!) that noone would be labelling your child. on the contrary, be glad that intervention is available 9be it to your tast or not.) 10-15 years ago, most people wouldn't even have realised that someone could have an l/d!

Check out the website and see if you can talk to other families doing PECS. It sounds like he is doing really well, and i hope it continues, whatever your choice!

Can I sneak in with a question too? Ds2 (21mths) is due to see the Paed at the CDC next week for a possible ASD. We got into the system so early because ds1 (4yrs) has HFA. What is the earliest age you would usually start giving SALT to children?

Ds2 has a couple of words but doesn't use them for communication purposes at all, eg he says "Oh noooooooooo!" as a set phrase if he drops something but doesn't say "no" to mean "I don't want that".

Coppertop, v sorry to talk over your question. (PS hope next week goes well!)

mizmiz, you are an amazing resource. From the website you suggested I've identified a couple of private speech therapists local to us and have sent them e-mails. Haven't got any response though - do you know if it would be more usual just to phone them up? Would they expect first contact in some other way - via doctor's letter?

Fascinating what you say about PECS, and beccaboo, about muddled word order. I wonder if my ds would benefit from that too - he simply adores anything that helps him order information, and although no one has ever diagnosed a language disorder per se, in his assessment when he was 4 he said of a picture of a dog on a lead "neck to the tied all the way there". I've just been showing him how to do "thinking spiders" with spokes radiating out from a circled central idea, and he LOVED it, to a degree I wouldn't have thought typical of children his age.

Wow! Thanks for fantastic advice mizmiz.

Word confusion - SALT noted this after one example, so I think I'll take up your earlier suggestion of writing down what he says over the course of a few hours and giving this to her at next appointment.

She has tailor-made a visual timetable for us which I'm just starting to use.

Echolalia - he does often act out scenes from programmes, but on the other hand his repeated phrases are often things like 'coming next on CBeebies on BBC2!' - my feeling is that this is definitely not 'normal' speech. The SALT is also concerned about his poor eye contact - which I think deterioriates when demands are placed on him, eg. in the SALT's room - so she sees him at his worst.

Thanks for all the info about PECS, this has allayed some of my concerns, will ask for more info when I next see SALT. Good point about being glad that intervention is available, you're right of course. Is there a specific PECS website that's useful?

beccaboo:

One example of word confusion is not enough. V. good idea to note those you hear and take them too her.

Visual timetables are absolutely brilliant and great fun(you will note that things like those velco-ed weather and weekday charts for kids that you can get from places like GLTC are the same sort of thing.)
You can also just get an ordinary calendar and get the child to cross off the days as they pass, and draw in little pictures of important forthcoming events (eg birthday cakes, people swimming, planes to denote holidays etc.)
Again great for everyone. Did it with one family who have a little girl with ds. So simple and costs nothing but they say it has changed her life, so much better oriented in time now!
If you want to get very adventurous you can buy a package called 'Widgit Working with Symbols' from a brilliant company called Inclusive Technology (deal in IT and switches for people with s/n)
Allows you to do groovy little pictures, make timetables, do things like write words alongside relevant pictures-great for learning things like songs. You type in a word (eg 'cat') and a picture of a cat comes up automatically.
Costs about £60 and a great resource for any child.
The example of echolalia you cite is a bit worrying and suggests that (as you are doing) attention really needs to be paid to how he is processing stuff. Sure sign that is not understanding all said to him and placing it in appropriate context.

Avoidance of eye contact typical of someone feeling pressured (kids have an uncanny knack for sussing out this stuff) One very useful technique is for the adults/older kids in a situation to become absolutely enthralled by something and to rave about it without calling the child over. Eventually their curiosity gets the better of them (95% of the time!) and they come to join in or at least see what is going on.
At present I am playing many exciting games of Tweenie snap with dh for precisely the same reason. (Haven't shrieked so enthusiastically since.....yes, well best not go into that!)

binkie

Phone the therapists direct. They are in business and expect you to! If they don't respond asap, sod 'em. Find someone else.
No you need no referral other than your own (all respect to GPs but generally know nothing about s/l. Indeed, why should they? It's not medicine.)
Word of warning, as I said, go for someone interested in and dealing in child phonol. Beware of long lists of areas they purport to deal in/know about. s/l too complicated to know everything. We tend to develop our own specialisms. For example, beyond basic training, i know very little about strokes, and if I was asked to deal with a stroke patient, I would decline and refer on.

Your 'thinking spiders' example illustrates a point perfectly. People with lang. problems often fall with relief on something tangible and comprehensible. He knows what is good for him, sounds like a very 'visual'child. Calendar or timetable may be good for him, also daily picture diary (we use loads where I work/ed)

Your dog and lead example is very telling. (God, how many times have i administered that one?)

Hope this helps again

beccaboo, don't have my addresses to hand, but the official PECS website should be east to find. There is a parents' discussion thing on it.

(I just think PECS is the most brilliant thing ever, and their consultants are top notch. I was blown away by their intelligence, logic, and ability to deal quickly and effectively with some of the most severely challenging (for a variety of reasons)children I have ever seen.

mizmiz, me yet again. On specialisms, I think I ought to add that there are some continuing Asperger's/ASD ??s about ds (though it's a bizarrely mild presentation if it is that at all) - presumably I should mention that to potential SALTs?

Promise no more questions for at least a day!

Yes do mention it. The more info the better (we are also finding more and more that s/l probs don't occur in isolation-often lots of things going on at once.
Let me/us know how you get on, won't you?

Hi Mizmiz, me again

I just wondered how common it is for a child with a language disorder dx to eventually go on to have an asd dx?

Thanx BH

Crikey that's a tough one!
I wouldn't even begin to presume that I was in a position to answer unfortunately. Don't even know if there are any figures available (although perhaps an org. like the Autistic Society might have some stats.)
However, from my own experience I would say quite a few. When I go through the files of quite a lot of the older people (ie 15 ++) people I see with an ASD diagnosis, I note that a lot have been referred to community clinics with lang difficulties at about 3-4.The asd diagnosis comes later.
(However I am of course only seeing people with s/n who continue to need help. Obviously many others are seen with lang problems at an early age who are then discharged and get on fine!)

Sorry I couldn't be of more help.

mizmiz, when you're at work can you generally tell whether a child has an ASD having spent a short amount of time with them? In my area, SALTs aren't allowed to diagnose (apart from one specialist, who is allowed) but you must see so many kids that you know exactly what to look for? I'd be really interested to know what you think marks out a child with an ASD rather than a SLD - or is that impossible to say?

I guess I'm kind of repeating Blossomhill's question in a different way.

Thanks again.

Sorry Coppertop, just seen yours.
Children are generally seen earlier and earlier (when resources and staff levels allow!) because we now realise that so much of the foundations for language are established months (even years) before they speak their first words.

Great that you are being seen as early as this.
(what is HFA btw, sorry if I seem thick, just not an acronym I know but then it may be, just that my brain is mush since having the baby!)

I personally have seen children from as early as 6 months, often those with ds and those with severe pmld who are in danger of slipping back at a very early stage.

This is an area that is really going to develop over the next few years as we learn that early intervention is going to make a massive difference to many babies and their families.

Hi Beccaboo

I have infact had experience of this with the unit SALT. At dd's annual review she said that dd definitely wasn't asd but had bits of it as she didn't have the triad. She worked closely with dd for 6 months and said that she could tell if a child had asd and that I shouldn't worry. She was so convincing and made me promise not to worry about it again and that dd had a language disorder. Here I am worrying so should I have been reassured by the SALT's comments please Mizmiz

I need to be careful here as these are the $64000
questions that can't be answered quickly or easily.

No beccaboo I woudn't say that anyone worth their salt (unintnended pun-sorry!)would diagnose an ASD after a short time. One could only come to this conclusion after a lengthy assessment, informal observation,case history, and liaison with other health professionals and the child's family.
(As a salt,you might privately have suspicions straight away, but you would never voice them until above had been completed-it would be extrememy unprofessional.)

There are differences between asd and ld but there is also a huge grey aree where the two merge.
Couldn't possibly do justice to this here (more of a Ph.D topic) but can tell you that someone experienced in the field will develop a 'feel' for it. Ask your SALT what she thinks.

blossomhill, please don't be worried. If your salt has said that your child does not have an asd, I would imagine that there is absolutely no room for doubt.
She would not say something like this unless she felt very very confident.

We all have quirky traits that could be defined as 'autistic'! See what I said earlier about the autistic continuum. I know that in my s/n team it is a sort of standing joke that everyone we come across (dh's,petrol attendants, council workers, neighbours etc) is autistic to a certain extent (and we include ourselves in that, naturally!

Thank you mizmiz, it was an unreasonable question to ask! But your answer is exactly what I wanted to know.

The reason I asked is that I feel our SALT made up her mind about ds at our first meeting, and is not really taking into account the huge progress he's made in the last 5 months. As she is part of the diagnosis team, this is just playing on my mind a bit.

Where have you moved to? Perhaps you should take this up, start doing on-line SALT consultations!

HFA is High Functioning Autism by the way.

Thanks Mizmiz, your comments have been very helpful. I must add that it is very kind of you to do this