Question re:diagnosis of speech disorder

[TotalChaos]

Was told that the criteria for diagnosis of speech disorder vary from area to area. Can this be correct?

Probably.
They make it all up as they go along anywaqy.

lol - not cynical at all then Moondog! I meant language disorder rather than speech disorder

Yes
(They make that up too. Never assume the head of dept. knows much. She's a managet not someone at cutting edge. Actually, you'd do well to ask her when and where she trained and what subsequent qualifications she has. If it's 1966 from some two bit FCE then she doesn't have a clue.)

I always naively assumed that there would be some equivalent to DSM criteria for language disorder, not that it would be so flexible (and I guess potentially political!). is there likely to be any real practical difference between a dx of delay or disorder?

I'm a being a bit mean actually (bad day yesterday.)There are criteria but I don't often think they are adhered too. Criteria are hard to define anyway for something that is not actually a physical affliction.

SALT seems to get forced into a medical model and I (and other salts) are not always happy about that.
What does 'language disorder' mean anyway?
Trouble with using and understanding language presumably.
If so, what is the point of the label if it is only another way of describing difficulties?

Behaviourism (which is influencing me greatly at present due to MSC)rejects a lot of these largely meaningless labels. They are often used as a way of denying/withholding help I find. It troubles me deeply.

Very interesting perspective, and one that explains why language disorder seems to be such a flexible term. From a parent's perspective - you feel that with some sort of label there might be a better chance of getting help and/or getting taken seriously by schools etc. But it can be a double edged sword if the "wrong" sort of label can be used to justify excluding kids from services as not being "treatable" enough.

Exactly TC. You are gettting precisely what i am driving at.

bump

"SALT seems to get forced into a medical model and I (and other salts) are not always happy about that"

I strongly agree with this moondog and thoroughly dislike the bulk of the language used.

There is always a whiff of the medical in the info. websites. They make it sound as though your child had an illness like tonsillitus that untreated could be a problem and required antibiotics.

I feel that this adherence to the medical model could also be a reason for the absurd way in which parents' evidence is treated as mere anecdote. There should be plenty of ways of using the parents' evidence - flawed in its own way - in a respectful way.

I really do feel that language disorders are dx when the pros aren't sure whether an asd is there or not.
SO say for example the head of the speech/language/communication school dd is going to said that they use the labels to get the specific help that child needs. To the point that they know referring the very same child to one pro will get an asd dx and the other a language disorder

It's good that they share that with you Blossomhill - keeps you empowered and all that.

Yep - diabetes or tonsillitus it aint.

interesting - further confirms there is a very fine line indeed between language disorder and ASD. suppose in an ideal world help would be tailored to each child's needs, such that the "labels" would become less relevant.

A SLT friend of mine gave me these pointers that if it helps anyone (I don't know how up to date/accurate they are) :

Semantic Disorders
(may occur as part of dyslexic profile, receptive language disorder, central auditory processing difficulty or dyspraxia (D.C.D.), independently of pragmatic disability)

1. Difficulty following instructions.

1. May repeat all/part of complex question/instruction rather than respond.

1. Looks hard for non-verbal clues to aid understanding.

1. May use survival strategies to cover up poor understanding e.g. conversational fillers (?oh, what was it again...??), change of subject, opting out.

1. Poor verbal memory (auditory memory span may be closer to C.A.) as such poor understanding of language involved. Affects reasoning, deduction.

1. Often very slow to process language - extra time can make a difference.

1. Poor attention - better if 1:1, and when activities do not rely on language.

1. May read without true understanding and write but not spell. (Poor phon. awareness)

1. May have good mechanical ability for maths (can learn a strategy and manipulate numbers) but very poor at mathematical reasoning and mental arithmetic.

10. Uses other peoples ideas - cannot generate new ideas/alternatives easily.

11. Poor knowledge of word-meanings, particularly abstract concepts.

12. Tends to learn extreme concepts with few shades in between e.g. uses happy and sad, but not pleased, excited, disappointed.

13. Poor awareness of time-orientation and time-sequences though may have some rote-learning without true understanding. Relies on copying others to follow routine.

14. Poor semantic-links (affects classification, association, analogy, word-relationships and inference).

15. Word-finding difficulties - may appear dysfluent, use neologisms, circumlocute, make phonological errors or over-use vague vocabulary and pronouns e.g. thing, those.

16. Off-target responding - poor comprehension of question words; latches on to key-words rather than whole sentence-meaning. Difficult to maintain conversation.

17. Poor syntactic comprehension leading to syntactic errors at clause rather than phrase level. e.g. leaves sentences incomplete or incorrectly sequenced.

18. Uses word-endings but inconsistently e.g. changes verb tense during continuous narrative. Morphological errors increase as sentence becomes more complex.

19. Lack of saliency - can?t see main point of passage or use language concisely. Poor organisation of ideas (and often has general organisational difficulties).

20. Prefers to play with younger children or alone as can?t keep up with peers.

Asperger?s Syndrome

? not usually recognised in infancy before 3 years
? walking is generally delayed and gross motor problems are common
? little facial expression except in strong emotional states, such as anger or despair
? gestures are limited and may be clumsy and inappropriate
? poor understanding of non-verbal communication , such as body language, facial expression, intonation
? understands concrete, ?here and now? language, but difficulty dealing with abstract language, inference and reasoning
? poor audience appreciation and interaction
? may not realise that they are included, when class instruction is delivered to the whole group
? naive or peculiar social behaviour
? initiate and want social contact, but unable to carry it out successfully and have an awkwardness in social interactions
? lack of common sense and imagination
? obsessional or intense interests
? repetitive routines and resistance to change
? grammar is reasonable but may have difficulty with pronouns when young (especially ?I. me, you?)
? content of speech is lacking - pedantic and often restricted to a lengthy discourse on a favourite subject , such as dinosaurs
? content of speech is often inappropriate for the social context

Thanks very much for that description Wassup - early on and now DS's language really fits many of the points on the description you give above.

Blossomhill has years and years of experience with her DD and the related reading around on these issues TClang - I really don't think that any difference in opinion is going to be due to her oversimplifying things or not taking non-verbal stuff communication into account.

This subject interests me. My DS is definitely not on the autistic spectrum. He has a general delay, including a severe delay in his speech and language. He is 4.

I have recently been told he has a disorder rather than a delay. The points you mention wassup are definitely problems with DS (specially poor attention, poor auditory memory, slow to process language), but as far as I can see all these points are also relevant for a child with a language delay and not a disorder.

1. Difficulty following instructions.

1. May repeat all/part of complex question/instruction rather than respond.

1. Looks hard for non-verbal clues to aid understanding.

1. May use survival strategies to cover up poor understanding e.g. conversational fillers (?oh, what was it again...??), change of subject, opting out.

1. Poor verbal memory (auditory memory span may be closer to C.A.) as such poor understanding of language involved. Affects reasoning, deduction.

1. Often very slow to process language - extra time can make a difference.

1. Poor attention - better if 1:1, and when activities do not rely on language.

Actually TC, my DD is not great with gestures and often won't communicate even when she could, but she's not AS or ASD. That's my gut feeling based on what I've read, what other people on here say about their DCs, and what several different therapists have assured me. Doesn't bring me any closer to what she HAS got but I think Moondog's point about labelling is very valid. The labels also change between countries. I get the impression that one of the BIG problems in the UK is that the "label" is what gives you access to services. The services here ain't always as good but they do at least try and look at what the child needs rather than what specifically ought to be applied to them according to their label. I do like Wasuup's list, though.

Thanks Totalchaos After reading the replies on here I shall step back I think. I actually feel quite hurt by your comments Tclanger.
Last thing on here and this matter my dd uses lots of gestures....