Feel like I'm being fobbed off by SALT

[TotalChaos]

DS has progressed from severe language delay at 36 months to moderate language delay at 50 months and is now 56 months. His social communication has improved but there are still very visible differences in his speech/ability to answer simple questions, let alone converse between him and his peers. So I am a bit cheesed off to have received ostensibly good news - that according to CELF, his expressive and receptive language are now within normal range (50th percentile and 37% percentile respectively), as I just feel that this isn't an accurate picture of his speech skills in day to day life. So he is waiting for group therapy (which may be during Xmas hols, but I suspect will be Easter hols), and she isn't planning to see him again till after that. So it could easily be 6 months before next SALT appointment.

Am I being unreasonable in being a bit disconcerted by all this?

yoohoo TClanger!

thanks for the reply. I've not had the written report through yet. From what I can gather the focus of the CELF was on concepts. I will be getting private SALT to see him at some point in the next month or two, to see what she thinks. I suppose I shouldn't be too cross with NHS SALT, as he's under the team that deals with Social Communication Problems, and he has really come on in those areas, so by rights she probably could have booted him from her caseload. Oh I dunno, I just have this lingering feeling that they aren't looking closely enough at possible semantic pragmatic and/or auditory processing problems.

I'd be disconcerted. Could you ask them to explain why they felt he was within normal range? Ds1 has made some great improvements but his language is still very different from a typical five year old, its things like he's never told me if he has a stomach ache for example, never told me about a dream or nightmare he's had, never said whether he likes or doesn't like children in his class, never said what he wants to be when he grows up. There's far more to it, but it can be difficult to describe. I'll try and transcribe some of what he says later so you can look and go "that's it with S!"
Expressive language can fool people as to the extent of difficulties regarding receptive language.

I think it's very much of - computer says yes - as in - if he comes out within normal range of their testing then they treat him as normal. The receptive language problems do have a knock on effect on concepts - DS speech does tend to be very concrete - so he wouldn't say what he wants to be when he grows up either or talk about dreams (not even sure he knows what a dream is, how the feck do I explain a dream?)

I don't know if Ds1 has any idea about dreams either. He will also say things out of context, did you ever read "Witches Abroad" and read about Old Mother Dismass? That's Ds1 a lot of the time .

Well, I thought I'd talk to Ds1 about "In the Night Garden" as he loves that programme. iIt went like this:

Me: "T, what does Iggle Piggle look like?"
Ds1: "Iggle Piggle look a blanket. And Makka Pakka walk by self with da blanket."
Me: "Can you tell me what Iggle Piggle looks like? Does he wear green shoes?"
Ds1: "Iggle Piggle wear da shoes and da slippers and da BARE FEET! And he roll over in da mucky patch! IGGLE PIGGLE ROLL OVER DA MUCKY PATCH! And we not in EY4 any more. Mummy, I gorgeous one and J gorgeous two" (this gorgeous bit might actually suggest he understands his birth place and that he's older than Ds2, it refers to a book called "Gorgeous").
Ds1: "Aaah HIT! HIT! HIT! HIT! HIT!"
Me: "No, hitting is naughty. No hitting."
Ds1: "HIT DA THOMAS! HIT DA THOMAS!" (duvet cover). Climbs on to my shoulders, grasps my round the neck then falls backwards. "HA! HA! HAAAAA!"

DS2 has delayed language although seems to have dropped off of SALT books altogether.
His receptive language i would say is pretty good but his expressive language is still very much just a practical tool. " I want a drink please" type of thing.
Although he has a good vocabulary there is nothing conversational or descriptive at all about his speech.
He also has problems with word recall.

I was thinking about a private SALT assessment, what type of specialism/SALT should I be looking for?

His dx is GDD, ASD & CP.
Sorry for the hijack tchaos, just couldn't resist so many knowledgable people in one place.

That example's pretty good for him to be honest, a lot of it on topic.
Other examples:
Ds1 talking about going into town:
"And we go up da big hill and we go to number 20 and we not go to number 19."

Talking about what he did in school:
"I went for a walk" (this refers to the sentence he wrote). "And poor W and poor T. Poor W and poor T" (he can't expand on this).

Talking about "Bee Movie" that he'd just seen thirty seconds earlier.

Ds1: "Bees make honey" (he already knew this to be fair) "and bees see sun."
Me: "T, who was Vanessa."
Ds1: "Bee!"
Me: "Vanessa was a woman. And Vanessa sold ...?"
Ds1: "SUN!"

anon - look at the helpwithtalking website, and look for someone in your area who specialises in children with ASD. Then phone them up, and see if their experience meshes with your DS's problems.

Bullet - am knackered now, will try and do a sample of DS's "conversation" tomorrow.

Another thing I can say about my Ds1's conversation and talking is that it is very difficult to get him to stay on topic. Does that refer to S as well?

thanks Totalchaos, will look at that site.

credit where credit's due, NHS SALT just phoned, there's a place come up on the group therapy starting next Wednesday . (someone has dropped out)

soory to sound daft but what is Clef asessmentst im strugling for finding reasonsy why my 3year olf does not alkl or baby bable apart from global delay , we do have salt sort of every 8 weeks mind shes leaving and so be none tillfeb some time.

www.pearson-uk.com/product.aspx?n=1316&s=1319&cat=1326&skey=3293

more info on CELF above. But from what I can gather, they show a series of pictures to a kid, and assess their language based on what a kid says about the picture - it's both expressive language and understanding that gets assessed, the kid will also be asked questions about the picture

So I think it's more useful once a child has a reasonable amount of language, and wouldn't be particularly useful to answer your questions. I've never had any answer as to a reason for dS's speech delay, as they don't think he is autistic. Sometimes (not in DS's case though) kids can have physical problems with their mouth muscles that make it hard for them to speak. (called verbal dyspraxia or apraxia).

Has anyone suggested trying signing or PECs alongside speech with your boy?

Just to update - having had the report through now, she has addressed social communicational as well, and has pointed to DS having some echolalia still, and that needing monitoring. The areas assessed by CELF were linguistic concepts, basic concepts and formulating labels.

So now I've had the report through I am a lot happier that SALT is looking at DS's problems more fully.

Thats a very narrow application of CELF. The linguistic concepts section is useless and the formulating labels section tells you bugger all, TBH.

You cant get a "language age" or any proper information by doing three subtests.

Thanks for the info mogwai. So seems that my first concerns were justified about a normal range result in this test not proving all that much. . think I will be getting private SALt back involved.

Can i ask what the term "integrated attention means" btw?

hmmm actually to be fair to SALT, DS did have some formal testing of sentence length/structure mid August by a different nhs salt (Renfrew Picture action test measuring Info and Grammar) So possibly that's why she only did those selected elements of CELF.

bumping as da clanger is in da house