I want to "assess" where DS2 is before the SALT assessment tomorrow

[lingle]

A SALT more specialised in receptive language delay (probably from an ASD unit? who knows) will come to assess DS2 (3.2) at nursery tomorrow. I know it will be more negative than how I think about him and that's ok - doing her job, etc.

Is there any accessible information that would help me find out what kind of place on the speech centile charts he would now be on if my "mum" assessment is right? I'll probably be a bit down after the assessment so want to think it through now.

This is how I would see DS2 in a "snapshot" right now, (sorry so long). If you remember my first posts you'll see how much things have changed....and I really do think that depriving him of recorded music has made part of the difference. It's like a drug for him!

receptive speech:
DS2 understands everything I say to him about our daily routine. He understands my 3-word sentences ("give a banana to DS1")in context. He can understand simple instructions from a different room ("DS2 come back to the kitchen and put your plate away please" REPLY "ok"). Have told DS1 he no longer needs to use 1 word at a time (DS1 did this instinctively to help) but can use sentences.

expressive speech:nearly 150 "real" words now (I said 200 on here in July - I was so wrong! I was just coaching him! but now it's qualitatively different). About 20 of them verbs with 20 other more "not quite consistent" verbs coming.

combining spontaneously into 2-word sentences with more fluency and variety every day (DH noticed a difference after being away for a week). These are increasingly natural-sounding eg "whatsthematter DS1" when DS1 burst into tears or "mummy got hurt" when I say "ow!" after being jumped on by DS1.

still uses a single word to represent the word he can't think of eg when tired he will use the word "open" instead of "cut". Many examples of this. Many overgeneralisations still. eg his water words are "water" "bath" "sea" "puddle" but all other bodies of water such as rivers, waterfalls, streams, etc are described as one of these or as "splishsploshsplash". So doesn't have a word for everything in his life yet (we live by a waterfall, stream, pond etc)

names family members spontaneously with ease ("hello daddy!"). Starting to do the same for other children. But if DH says "hello DS2" will still say "hello mummy" in reply (overgeneralising again - he used to just repeat and it was hard for him to learn to say my name instead of his own). Uses own name in sentences.

Echolalia fading - appears when tired or insecure or doesn't understand someone. Rare now with me but still uses assertive tone + repeat language instead of "yes". Starting to say "yes" before the assertive repeat but this is very much learned not natural to him.

Understands the basic "who" "where" and "what" questions. Just starting to understand answers to where questions that involve "school" "work" or other places that he can't see. Progressing fast here. Always answers "what can you see?" appropriately. Nearly there with "eat" "hold" and "wear" but still muddles them when tired.

No "why"or "when" questions yet. Progressing but not there yet with "shoes on first THEN park" and other two-event sequences. Understands "it's time to" but still doesn't always understand the description of where we're going next.

Just starting to get to grips with under/over on/off etc. Good with up/down.

Lastly, the grandma test: my mum says "this child talks just as you would expect a two-year old child to" (ie she found his speech pretty "normal" but a year or so behind other kids his age when we spent a week with her).

Other areas. Doesn't initiate socially with (new)nursery peers yet. Passive and quiet there. But joins in any physical game initiated by others (involving bouncing, falling, giggling, etc) with great skill, great care for others' space and excellent turn-taking. Visited "old" nursery friend and they trotted off together up to the bedroom after 10 minutes' hesitation (it was his first time in that house) and did about 10 minutes cooperatively on the train track.

Initiates socially with family and especially brother all the time.
When alone, "role-plays" conversations with brother (hardly sings now! poor thing! his cruel mother wanted him to talk instead! My psychotherapist neighbour thinks I'm terrible!)

Understands all my tones of voice and facial expressions. Understands when I'm joking, cross, playful, teasing, etc from either of these. Switched on and engaged with me at pretty much all times even if engrossed in trains or listening to music. There is no activity I can't join in. Not in a bubble. Not in "own world"

Not the most imaginative child but happy to play along with "doggy" going to sleep, waking up, etc. Pretends objects are other objects. Now pretends to be a "monsta" by holding out arms and making monster noise. Wants me and others to look scared and scream in response. It doesn't matter if we don't run away so he understands the meaning of the game is more than physical. When DS1 is a "monster", DS2 pretends to be scared and runs to me to pretend he needs protecting from DS1 but also laughing.

Fascinated by numbers, loves looking at the second hand on the clock, identifies speed limit signs and traffic light colours all the time. Since the days got shorter, adores turning the lights on and off. Lights on and off is the obsession. Does it about 50 times a day if nothing else is going on . Also flushes the loo about 20 times a day. Will pester to be allowed to do this at other people's houses.

Apologies and thanks to anyone who got this far....

Well, we've now failed to complete the hearing test again. DS2 buried his head in my chest and shook with fear in case the loud noise that scared him last time came back. He extended his hand to obey the audiologist's instructions to place balls in a box whilst I was told off for him not playing with her. In the end I told her there was no point putting pressure on me and she replied "I know, it's just what he's like". Amazing how these people seem to think they know the slightest thing about what my child is like. Arrogant too.

Meanwhile our home and nursery "DIY Therapy" as inspired by Mumsnet and Hanen continues to go well. We've had three children from the school nursery round for playdates. Two went swimmingly (he loved distributing the biscuits - "one of DS2, one for Jack") and the other went great after DS2 recovered from DH leaving the house without warning just as the playdate came in (cue cries of "daddy gone", distraught sobbing and determination to put on shoes to look for daddy - he struggles to understand "daddy's at work" and kept saying in a hopeful tone "daddy's coming"). But then lots of contended playing on the train track together and some real cooperation - pulling his train back to let the other boy's train pass, etc.

Will I at some point come to feel more friendly towards a professional who isn't on mumsnet? Or is this divide just going to harden? I can't bring myself to video my own home. I feel I ought to be able to get advice based on my own account of the problems - which are still huge, though thankfully with a 2010 school start the hurry is not so great. "More than Words" should arrive in the next few weeks - I've got loads more faith in that and in mumsnet than in "the system" just now. It all makes me think that my benign neglect of DS1's problems wasn't so reprehensible after all.

Shame that the hearing test wasn't handled well. I suppose it makes a big difference that when DS had it done there was an audiologist plus a helper to do the explaining, so I suppose the audiologist was more patient.

In terms of the professionals - because of waits on list and general flannel/patronisingness - I also have had a bit of an "attitude" about the professionals. The NHS SALT that did the Hanen course were very very good, so restored my faith to some extent. I think it is a necessary evil though - you have to have a realistic baseline for speech and understanding levels that only a professional can provide - IME it was absolutely vital in working with him that I knew that DS had far more problems with understanding than I suspected. Also if extra support is needed over and above what nursery can currently provide then you do need to be in the official NHS system. Hopefully the work you are doing now and the late school start will be enough - but always wise to think ahead.

thanks TC. We will live in hope.
DH and I are setting one language target a week. This week it's saying "yes" instead of repeating in an affirmative manner. It's almost natural to him by Weds. so we're delighted.
Next week we'll do choices - much harder as he still repeats the choices. If we haven't cracked it in a week, I'll phone the NHS SALT and ask her for techniques. Hopefully a relationship can develop.

Video is really helpful. Really it is. I video every session I do with ds1. Most I video straight over again, but sometimes I want to check something and sometimes I want to show people something.

I'm seeing ds1's teacher tomorrow, she's lovely and she listens but I'll take my video to show her some clips if it looks like it might be useful (it might not tomorrow).

I agree with TC about getting the baseline. I was shocked recently when I did an assessment (as part of a programme we're on) as to how much ds1 wasn't understanding. I thought I was pretty tuned into it, but I had it completely wrong. Yes in context his understanding is pretty good, out of context is a different matter.

Sorry the hearing test went badly. It is hard working with professionals who don't know the whole story. Unfortunately children are judged by incomplete stories whether they are ASD or NT and you can't completely avoid that. It seems nerve wracking at first but home videoing is a great idea. If you do it regularly, you can build up a library of clips to show what DS can do at home. I do this now as often as I can and I find it very useful for myself as much as for anyone else.

The nice thing about video is that you can track progress too.

I am sorry you feel suspicious of and disappointed by the 'system' Lingle. It is a huge shock I think to educated and intelligent people to have to rely on professionals who they don't er.....respect shall we say?

You need to tell people what you want and expect from them. SALTs have huge caseloads and are often in five or six different places a week. I am. I eat my lunch in my car driving from one place to another nearly evety day, and at any one time am dealing with 50/60 people. They know they are not giving your child the attention or time he deserves and believe me they all feel bad about that. Our collective dream is to work in one place with about 5/6 children. Boy, we'd sure see some results then!

I tell parents over and over to contact me and tell me what they want. I'm physically unABLE TO CHECK ON THEM ALL on a regular basis. I give my number and e mail to everyone and promise to get back to them asap. Very few take me up (and yet they are often the same people who complain loudly about lack of SALT). It has to be a dynamic two way thing.

Think about what you want, write it out and send it to the salt, and then ask for a meeting a few day's later.She may be delighted. I would be.I can't be with someone 24 hours a day.I only see a sliver of a child's life so if parents are very clear about comm. needs in other situations, then I can help (hopefully!)

I hope this helps a bit.

Something I said to the SALT students yesterday and I was thinking back about how well it worked, was that for a while we employed a private SALT who saw ds1 every week. She met reasonably regularly with the NHS SALT to update her so that when the NHS SALT went into school (which was more frequently than most I have to admit because ds1's needs were so great and I'd been stroppy with the LEA) she knew more about him/where he was than she would have otherwise.

That private/NHS combination worked really well. And the NHS SALT was very willing to take the time to meet with her colleague to keep up to speed with ds1.

Interesting post Moondog. Do you mean that you want parents to be specific about what you need when you do get to see them? Or that if they say they need more SALT time then those that shout loudest would have a chance of getting it?

DS has had various private SALT appointments (nothing regular as resources wouldn't permit). I ended up going private as once he hit 3 and it was clear even to the HV that his problems weren't going to magically clear up by themselves we still faced an 8 month wait. A side advantage of private SALT is that I feel she doesn't have any incentive to minimise DS's problems, so I can trust her opinion on schooling etc.

Have only just discovered this thread and have spent all day abandoning children and dinner etc. to run upstairs and read more of it.

Totally fascinating and even though I'm usually just a lurker, agree with everyone that the support on here is amazing and it is a rock for me in terms of understanding where my DS is at.

Thanks for your message Shells and everyone, as ever. Thanks for challenging me to think positive.

OK team. I have left a message for my SALT. I am going to ask her advice for stripping things back to basics on choices.

And shall I ask my parents to get us a digital video camera for Christmas? Anyone got a fairly recent model they can recommend?

I think I may also look at the private SALT option. Can anyone help me locate one in my part of Yorkshire (LS29)- and how do I know if they specialise in receptive language problems? A specialist in autism would be fine because language is precisely the area where both my kids were/are so close to many austistic children.

Moondog, since I set up my own business four years ago I tend to work with 4 or 5 businesses at a time and it is wonderful. You can really get to grips with what's going on.

Type ASLTIP into google and you'll be able to find a private SALT, they list their specialities. BUt do talk to them some who list themselves as specialists aren't really - others very definitely are.

I have a canon mini DV video. It's a couple of years old now - but I wanted to be able to get the stuff on computer so wanted a mini DV format.

Most Digital Cameras now have a Video option built in. Mine can do up to 30 mins. They should all download to computer now. You don't need anything fancy or expensive - mine is quite old too but does everything I need.

'Do you mean that you want parents to be specific about what you need when you do get to see them? Or that if they say they need more SALT time then those that shout loudest would have a chance of getting it? '

A bit of both TC but you must be specific about what you want. Be part of the solution.
Even in schools i ask the staff to write out their needs termly.Just the act of writing it out makes them think more clearly about what they want and what is achievable as opposed to it just becoming constant low level complaining about 'more salt input.'

Thanks MD. I've only ever really managed that level of cooperation with the Hanen course SALT and with private SALT - I've felt very much out of control with run of the mill NHS SALT. Have taken one assertive step though - requested that DS do the Narrative Group again next year, as it was very useful indeed for helping with receptive speech as well as sequencing etc.

Lingle - I found DS's very very good private SALT through ASLTIP - I looked for experience of kids with ASD. Being a lawyer I don't imagine you'll be shy of giving a gentle grilling to make sure she has the right experience!

The NHS SALT called me back at 8.20am to say she's out all day but responded positively when I asked her if I could email her my problem list to ask for guidance. If anyone has time to comment on the draft below, I'll be grateful as ever. She's out all day so no point sending it before Monday morning.

Here's the draft...

"Dear SALT,

DS2's conversation is limited to expressing his wants, talking with me about what is happening, social niceties (eg giving another child a biscuit, saying "a biscuit for Emily") and playtalk ("DS1's joking!"). I've identified four key problem areas that I feel Ds2 is ready to start working on but am not sure what to prioritise and how to lay the groundwork.

Problem 1: "OR" Choices. DS2 just repeats them back to me in a playful way, imitating the voices and melody from an interactive DVD he used at his previous nursery. How do we go back to basics on choices? Nursery say they are now using pictures and will show me their technique.

Problem 2: Other Places. He does not spontaneously use words for rooms of the house/home/school/nursery/the station or other places. I think that understanding of the linguistic concept of places he knows about but can't see is now dawning however, because when we leave nursery each day, he asks to go on a train and reacts joyfully when I say "we're going on a train" and sorrowfully when I say "we're going home". But he does not understand if we depart from our usual route to the train station despite my reassurances. And he does not really understand "DS1's at school" or "daddy's at work" (I guess lots of children don't know what "work" is). He gets very upset when his dad or I leave him behind and can only be comforted by "daddy's coming" - but reacts to this by standing at the door/window expectantly. Similarly, he gets upset if we set off on an oft-used route but depart from it even if I have told him we are going to "Emily's house" and not into town. Should I start by taking pictures of the different places in his life and familiarise him with them? What else should I do?

Problem 3: I think he wants to talk about the past but can't. He starts interactions with "mummy?". When I say "yes" he babbles a sentence that may include one word like the name of a child who came on a playdate that day. Perhaps I should take some photos each day and show them to him at bedtime and talk about what happened?

Problem 4: He has no linguistic understanding of "first this then that". So I cannot use "first dinner, then you can go outside." However, he does understand "it's not time to [do x], it's time to [do y]" and is usually obedient in response to this. He has a good understanding generally of "not" and we can use it in jokes, etc (eg "towel's not dinner!!" for "don't chew the towel")

One solved problem: He used to respond to questions like "do you want a biscuit?" by saying "biscuit!" in an affirmatory way. We prompted with "yes? biscuit?" for a few weeks, as did nursery. Then this week we started to withhold item that we are sure he knows the word for unless he says "Yes". Within a day he had changed to saying "Yes" alone. So we feel he is ready to follow direction with his speech but would appreciate your help with where to start on the four problems outlined in this message even if it is only laying groundwork. We're also happy to buy any books or manuals that you feel might help us"

Needless to say, if anyone else has got ideas then I'd be delighted to hear them as ever.

I think some of the stuff you are trying to do will be at a level above his current level of understanding. It sounds as if he might not have that much understanding of time yet, or that people do things when he can't see them (ds1 is like this on some things but not others weirdly. He understands daddy at work and ds2 and ds3 at school but if my car moves an inch when he's out he goes mad so I think he doesn't understand my separate life- thinks I freeze as he walks out the door or something). So it's not necessarily understanding of the word work that's a problem it might be understanding the concept of a life carrying on elsewhere iyswim.

Some of your problems (Problem 2 and problem 4) might be helped by visual timetables. You could ask the SALT to help you set this up (along with a choice board which it sounds as if nursery are doing). I have a first x then y visual timetable as well as bigger ones. We haven't used them that much recently as ds1 understands verbally, but I'm actually going to go back to them as I think it will help him a lot with other problems.

Is his speech good enough to not need to use PECS? It's very good for emerging speech as well, not just for children who are non-verbal. (Just thinking if it isn't I would get yourself on a PECS course and go the whole hog iyswim). Alternatively have you used Makaton- also very supportive of emerging speech?

Re choices. Does he understand he has a choice? If he's very passive he might not. DS1 had no idea he had a choice about anything until he got to about 4 or 5. I only realised once he stopped being passive about things. You may want to ask the SALT for help on teaching the concept of choice rather than just how to choose. (Again PECS is good for this).

Photo diaries always good. Ds1 always loves me doing that for him.

The person we are working with at the moment says that past tense is always very difficult and that once children understand past tense then cognitively they make leaps and bounds. I haven't got onto the bit where she teaches it yet though (a lot of people don't teach it) so I have no idea how to do it.

I think someone mentioned this before but the Observe/Wait/Listen OWL approach in Hanen can be useful for these problems. If he repeats the choices, wait to see what he does to actually communicate the choice to you - if he does not get a response to the echo of the choices.

I came across this ebay shop yesterday Lots of ideas here for visual supports. You could ask the SALT to help you make this sort of thing up (she might not have time to do it herself, although depends on how she's set up, but she might be able to send you somewhere where people can).

If you want to do this and have problems finding someone to set it up (nursery might do it as well) I'm about to design and make a whole load for ds1. I can email a copy to you if you want if you think it might be useful (although actually might be using specialist software so if I can't pdf it I can pop one in the post if you want, I can laminate although I might leave you to cut out and stick velcro on (takes forever!)

Off the top of my head:-

Problem 1- I would go back a step, and encourage him to point to the one he wants, backed up by the word - say if it's a choice of two drinks - I always seemed to be offering DS the choice of orange or apple juice(!)

Problem 2 - sounds very twee- but to help along place names, I would say - bye bye school/shop etc. And yes, photos help.

as well as photos, you might find pictograms useful too - the do2learn site (wwwdo2.learn.com) has some useful free ones you can print off.

''The person we are working with at the moment says that past tense is always very difficult and that once children understand past tense then cognitively they make leaps and bounds. I haven't got onto the bit where she teaches it yet though (a lot of people don't teach it) so I have no idea how to do it.'

DS1 (ASD) has a generic past and future 'been' and 'going'
'been bath, going bed' He appends 'been' to everything in the past. 'Been crisps' meaning I've had a packet of crisps. If he doesn't want to go somewhere or do something he shouts 'Been shops!' or 'Been teeth !'

We use bye bye as well TC

cross posted!

re:PECs and emergent speech - on advice of private SALT, I introduced a PECs based communication book with DS to get him speaking in more sentences, and it worked a treat. before the PECs book - he had a few painfully acquired sentences of the "mummy brush hair" variety - but wasn't really generating spontaneous sentences. Within a week or so of the book, instead of a garbled "havva more juice", with the help of the book he was saying "I" + "want" + "more" + "juice". A few months after that he said to me spontaneously "I want mummy run on grass", one of my fondest memories. So cut a waffle short, I feel that having a visual of how a sentence was made up made something "click" with DS.

Even non-verbal ds1 has learned to approximate phrases from PECS. And his speech is coming on now with the literacy work we're doing. For some children the visual input really really helps speech.

Lingle that's a great list.
You are clearly identifying area of need.