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

243 replies

lingle · 16/11/2008 22:22

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....

OP posts:
moondog · 04/12/2008 09:08

Yes,it is a pain in the arse to make this stuff I agree. I have a permanent RDI in forefinger and thumb.

Again, I've sussed that even the kids that 'don't look' often actually are.

I would just work on crossing out first for a good long time before even thinkning about symbols (although for those kids who get Christmas, now is a great time to introduce that.)

How about reinforcing crossing off behaviour?
(Sort of like a chocolate advent calendar with a twist!)

lingle · 04/12/2008 10:39

It must be so much harder jimjam with an older child who's figured out his own way of thinking already. But what with all his exciting recent progress with "mummy" and being able to tell you which book he wants....who knows! Do you ever feel like a detective looking for clues to figure out "ways in" to help him make new connections?

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jimjamshaslefttheyurt · 04/12/2008 10:44

It's not so much that he doesn't look (although he won't) .It's that he totally resists anything he perceives as being work or instruction. He is very resistant to learning, and still have very few reinforcers. (Very little he cares about more than being naughty (by which I mean refusing to do work)). So I think whatever I do will need to be active on his part (my thought about the symbols/photos was because photos are a HUGE reinforcer for him, he loves them a great distance more than anything else so a chart that ends up full of little photos would be a delight for him). He can't really cross either (scribbles), although he has started to like colouring in, so maybe I could get him to colour in each day (perhaps with a the correct colour of the day). He used to do that with his worksheets when he was younger at school.

Today is (mark with a green pen) day.

lingle · 04/12/2008 10:50

So once he recognises something as a "lesson", it's unlikely to work?

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jimjamshaslefttheyurt · 04/12/2008 10:55

He resists any interaction that he thinks is trying to teach him or direct him in any way. It's very common amongst children like him. So he hums, looks the other way, refuses to make eye contact, pinches etc etc. I would say his resistance to being taught or instructed is his biggest problem and holds him back more than anything else.

He can be very switched on and engaged at other times. Just as long as there's no suggestion that you're trying to instruct him.

lingle · 04/12/2008 10:58

So you have to think outside the box 24/7.

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jimjamshaslefttheyurt · 04/12/2008 11:02

He's profoundly autistic. I've been up since 1am this morning with him. He experiences the world in a totally different way. TBH I need 24 hours inside his body so I can understand how he tries to make sense of the world, then I would be more effective.

Reading the very few books written by the people like him who have learned to type has been very helpful in working out why he behaves certain ways.

But resistance to learning is quite common I think. I see it a lot in my research. Same children can be very engaged indeed (to the point where you can hardly tell they have ASD) in more social or playful interactions.

lingle · 02/01/2009 17:02

Just wondering how we are all getting on a month after all the good SALT suggestions on this thread.

Does anyone else want to confess to having been so chuffed with the "Organised Mum" calendar that you stole it for yourself? That's what I did . But have got both boys calendars for Christmas. Such is my faith in moondog that I'm going to start building the "crossing off" into DS2's nighttime routine even though understanding days seems light years off.

The talking photo album is very cool. I made up a story about his day - pictures of the weetabix, microwave, toilet, etc.
But predictably, DS2 wants to be the one pressing all the buttons. And sometimes the "wrong" message plays for the wrong photo.

I got a digital photo frame for Christmas. You can put it into "slideshow" mode and then DS2 can see footage of his life. I think it will pay its own way as printing out all those photos gets expensive.... the controls are on the back so he tends to let the show run without interruption. So I'd recommend this as a visual aid also.

The photos of destinations all over the place work brilliantly. DS2 now understands the concept "we're going to...+place". Coincidence or result of the visual aids? It has improved his quality of life enormously because he now knows when we set off where we are going. Big big reduction in tears. He's started ASKING to go in other children's cars instead of freaking out when he discovers at the last moment that he's going in someone else's car.

No more problems with choices. It's lovely to see him considering two alternatives then selecting one. The visual aids clearly helped him to cross that bridge too.

DS2 has grasped "yes" which makes him sound much more natural. Can do "yes" or "no" answers till the cows come home. But this has revealed that the pronouns are not as solid as I thought a month ago. Tends to say "mummy/DS1, do you want ....?" intead of "can I have?". A raised eyebrow turns it into "I want some..." instead though.

Interesting vocabulary now seems to get hoovered up as never before eg "sweets""biscuit""cake" are all self-taught. "Rug" and other boring words take much longer. I notice a new word every day which is lovely, especially if it's one I laboured over for months. And he's learnt "I don't want/I don't want to..." which he finds very very empowering, especially when refusing to complete his course of penicillin. I have 300 words on my list which means he definitely has about 200-250 now.

Still not doing great on understanding those two-step commands. That is what I'd like more than anything.

Lovely socialising with family at Christmas. Initiated play with another (strange) child yesterday at a party.

Still inarticulate when very emotional. Tantrums every fortnight or so - no more so than big brother. Screams when sees babysitter but enjoys grandparents (whom he hadn't seen for 8 months) taking him out for trips. Still likes flushing the toilets. Seeks out the toilets in new houses. After weeing or pooing, goes upstairs and does a flush. Then I sit him on the toilet and nothing happens.

Meanwhile I get to see my pessimistic "knowing" SALT again on Tuesday. Must, must stay positive. I need her help to "design" a programme to help him interact with other children at nursery which is something he just doesn't do. She must be cynical about me because there is always a "maternal optimism" error factor in my assessments - I can always see that looking back - but they are still about 80% accurate so I hope she'll listen a bit more ......maybe we'll get on better this time. I'll close my eyes and pretend she's a mumsnet SALT. Who knows, maybe she is!

Don't suppose Father Christmas gave you those 24 hours inside your ds's body jimjams by any chance? Hope your Christmas went ok. I have appreciated your guidance in 2008.

OP posts:
TotalChaos · 02/01/2009 17:17

I got a very similar one to the Organised mum in the sales at Borders LOL. I'm going to do the crossing off as well. I've also been toying with getting the talking photo album and/or picture frame, there's a dinky little one for #25 in PC world.

He does sound to have made very good progress indeed in a few months. Keep plugging away with the visual images - IME the understanding does eventually improve. And bear with the SALT - it's part of the job to look at what he can't do, and, on getting him to be able to do that, rather than patting him on the back for what he can do.

Tclanger · 02/01/2009 19:13

This reply has been deleted

Message withdrawn at poster's request.

kettlechip · 02/01/2009 21:50

Happpy new year everyone!
Hope Tues goes well for you lingle, try to get a rapport going with your SALT if at all possible.

I have the organised mum calendar and have snaffled it too! I think ds will like the stickers which come with it.

We've had developments on expressive and receptive language since my last post. ds is now constantly linking 2 or 3 words with ease, sometimes more. It makes such a difference to how fluent he sounds "shoes off daddy," "back in the bath" etc. I've suddenly noticed we can have a very basic conversation about what he wants for tea, usually "eggy toast" - he is answering at the relevant moments with something appropriate. He is also commenting far more on what's going on - "it's dark, the lights are on" when the streetlights come on outside.
He's also suddenly discovered the art of negotiation, when ds2 comes to sabotage his jigsaw, he runs to get something to offer ds2 as an alternative distraction and says "there you go ds2." He wants to share things too, "one for ds1, one for ds2" etc.

Still lacking clear pronouns and I have concerns over his empathy - ds2 can be sobbing his heart out and he really doesn't seem bothered. There might be the odd "oh dear" if he falls over, but nothing in the way of comfort iyswim.

RaggedRobin · 02/01/2009 22:06

i'm now an organised mum too

we're also making good use of the "now next later" visual timetable that someone recommended from ebay. i'm hoping that this will help ds with activity transitions at nursery and have made up a nursery based timetable that i hope they will find useful.

i really relate to jimjam's description of her ds being resistant to instruction. ds does have a lot of language but switches off entirely as soon as he realises we are doing any kind of activity directed by me. i find myself trying to slip in SALT tasks by stealth and we only usually get a minute or two of co-operation, if any, before i get any infinite variation on "no, NOT put teddy on top of the castle/ jump on square/post picture," etc etc, which makes it difficult to tell where we are.

i've been using a thomas the tank engine aqua draw mat to draw various shapes etc to try to get ds to carry out two step instructions. i think we had fleeting success (jump on the circle then the triangle) before ds realised what i was up to and started just running round all the shapes.

i do find it upsetting how actively resitant he is to communication. when communciating on his own agenda i can see how much he is capable of, but as soon anyone else tries to interact with him, the shutters come up immediately. today he was literally yelling "lalalalala" when i tried to speak to him.

lingle · 02/01/2009 23:16

sounds tricky Ragged. I remember your SALT saying his biggest issue was that he follows his own agenda but as soon as we do direction then we are asking them to accept our agenda so resistance is predictable - I can identify with wanting to shy away and regain control in this situation....
Have other parents managed to overcome this "own agenda" issue at this stage? It would be interesting to see what Amber or Bullet thought about this problem.

Kettle, you are much better than I am at relationships with the professionals - any chance you could pop up here and pretend to be me next Tuesday ? Anyway, here's hoping we move from the beard scratching stage to the suggestion stage and bypass the "I am a learned professional and wish to assert my authority and have the last word" stage altogether. .

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cyberseraphim · 03/01/2009 07:09

'Own Agenda' is the name of the first stage in Hanen - although the assumption also is that the child has no language. We discussed the stages at one of our meetings and agreed that the categories bleed into each other to some extent as the the 'Own Agenda' never really goes away - you just learn to work with it. How would he react if the activities were ones he wanted to do rather than being completely directed by you? If you knew he wanted to go swimiimg but had to comply with instructions about preparations? DS1 can be 'programmed' to carry out tasks like the ones you describe but it's still not easy to get him to do a task the first time you ask him. In the early stages I had to ask him to sort shapes (or whatever) over and over again. One piece of advice that I got from an autism expert was to be 'as repetitive' as the autistic child.

RaggedRobin · 03/01/2009 11:12

that's really interesting advice, cyberseraphim. i think i'm fairly repetitive when asking ds to do something, and, as you say, if the instructions relate to something he wants then he is more likely to be responsive.

i think i may give up too quickly with SALT type activities when ds becomes unco-operative. repetition, here i come!

lingle · 07/01/2009 15:09

alert the media, breaking news....lingle has had a positive encounter with a health professional!

The SALT came to our house today and DS2 was on tip top form. He did all his talking and interacting and let her rock him in a marble run box and pretend it was a boat and gave her biscuits and reminded her to eat them, etc,......

It was so nice that someone finally saw the child I know. I feel much more positive now about the advice she can give nursery to help him with his social interactions there.

Anyway, she was delighted with his expressive speech, noticed a couple of gaps in comprehension when there were no visual clues and gave me some more tailored advice on comprehension of two-step commands which we are making slow progress on.

SALT feels that the Jim Rose report on primary school starting age is a retrograde step so we had a good moan about it together....she was very complimentary about my techniques with him.....I couldn't bring myself to acknowedge all the help on mumsnet just in case she looked it up and found me here!

I asked her about delay versus disorder...she said more towards the delay side.

OP posts:
moondog · 07/01/2009 18:13

Excellent Lingle!

Honestly there are some very good salts out there-promise!

Keep at it all you calendar people.It will come but be prepared to put in a lot of work first. Do it religiously. Never miss a night even if child going away for an evening. I never miss ours even if away/ill/in transit/or hammered!

lingle · 07/01/2009 19:34

Thanks. She is also going to do a training session at nursery. This is much needed. We talked about how some very simple-sounding instructions that involve 3 units of meaning are presently beyond DS2 - but to an adult teaching assistant they would sound very basic and easy.

I think there is some progress with 2-steps. DS2 followed instructions to "tickle grandma's toes" then "tickle grandad's knees" at Christmas. But they kept giving him cues....

OP posts:
moondog · 07/01/2009 22:16

Have you seen Derbyshire Language Scheme (DLS)Lingle?

It works on this stuff.Old fashioned and dated but good. If you have a parent as committed as you,it would be really easy to follow and use (essentially what you are doing but in logical steps, building up slowly.) The main focus is on ICWs (Information Carrying Words).

There is a DTC (detailed test of comprehension) which places the child at the level of ICWs they can deal with, then lots of scripted activities tie in with that.

Ask your SALT about it.

lingle · 08/01/2009 09:23

Information Carrying Words - that was it moondog. She mentioned something like that and said she'd photocopy it and send it to me. It wasn't Derbyshire but presumably "classic" schemes get updated and renamed from time to time. Will let you know when I get it.

What was interesting was that for us "tickle grandma's toes" (when grandpa is next to grandma and both have a full set of potential body parts) carries only 2 units of information ("grandma" and "toes")because we do so much tickling - it's our default "friendly" activity so Ds2 doesn't need to discriminate between words to know he has to tickle. But for another child who usually does kisses or squeezes, then "tickle grandma's toes" might have 3 units of meaning ("tickle", "grandma" and "toes").

No wonder poor little DS2 is unable to respond to little girls coming up and saying "DS2, do you want to play outside?" with no visual clues and a child's "flatter" tone of voice.

OP posts:
moondog · 08/01/2009 16:51

'What was interesting was that for us "tickle grandma's toes" (when grandpa is next to grandma and both have a full set of potential body parts) carries only 2 units of information ("grandma" and "toes")because we do so much tickling - it's our default "friendly" activity so Ds2 doesn't need to discriminate between words to know he has to tickle. But for another child who usually does kisses or squeezes, then "tickle grandma's toes" might have 3 units of meaning ("tickle", "grandma" and "toes").'

Exactly Lingle (very astute of you and when I read your earlier stuff assumed you sussed this out when you talked of it as being a 2 step (or if you like a 2ICW command.)

It is often incredibly difficult for people to grasp this stuff but I know you are a smart cookie!

Aefondkiss · 08/01/2009 16:59

I love the calendar idea, brilliant! even if I am a bit late in reading about it

Tclanger · 08/01/2009 17:44

This reply has been deleted

Message withdrawn at poster's request.

lingle · 08/01/2009 18:23

thanks T. If we're not going to miss a calendar night, I'm going to have to convert DH to the cause......hmm!

OP posts:
Blossomhill · 08/01/2009 18:47

what is the calender?