2-step instructions at 3.3 (DS2, 3.3, receptive speech delay). Any ideas SALTs?

[lingle]

DS2 is now 3.3. Totalchaos posted this useful link

http//speech-language-therapy.com/devel2.htm

the other day. He does everything in the "2-3" age group (at home - nursery is different though progressing) for both receptive and expressive speech except for following two-stage commands.

So yesterday I said "get your shoes and sit down on your stool". He sweetly sat down on his stool without having got his shoes!

Moondog or other lovely SALTS - can I help him achieve this next milestone and if so how? How about if I said "First get your shoes next sit on your stool"? I feel he's "in the zone" for this one as he's so tuned-in to language now and finds instructions useful even when engaged on a task like getting dressed (so if struggling to find the sleeve I can say "put doggy down" and he drops doggy to free up his hand then continues the struggle - seems very encouraging as a month or two ago I would have needed to give the instruction when he wasn't doing anything else).

In other lingle news, we have a paediatrician's appointment on Monday. Cue choking emoticon. Some of you know that I'm in the "cheerful denial" camp because DS2's elder brother completely outgrew similar difficulties without professional input. Or should I rename it the "Dad camp" as I identify so much with other language-delay mumsnetters' reports about their partners' optimistic attitudes? "Dad camp" it is then. DH doesn't want us to go. But I'm reminding myself that some of you would be bloody glad to have the appointment for your own child so I have a responsibility to make the most of it. [chastising myself emoticon]

I'm thinking I might not make any attempt to prepare for this appointment as I probably overprepare usually. Otherwise I'll just irritate the doctor by presenting a "case" to her.
It's a community paediatricial - odd as I thought it would be developmental. Never mind - will be too stressed about Christmas to analyse this one to death.

re:appointment - only preparation I would suggest would be (if you don't already) to have a good idea of milestone dates for everything. Otherwise - don't present a case - just answer everything fully and honestly - that way you won't ever think in future - oh, if only I'ld said/not said x,y,z, would it have made a difference. Also - bear in mind that these appointments should not be at all bothersome for your child - they should just see it as that doctor talking to mummy/looking at them play with some toys - it's for us parents that they are stressful!

In terms of the instructions -obv I'm an interested amateur rather than a SALT - but I would work on simpler things than that - as in the example you give it's got sequencing mixed in with the vocab - when DS wa assessed at that age it was always things like "put DOLLY in the BAG" for 2 word level,(there would be a choice of objects and containers), and then for 3 word level it would be "put DOLLY UNDER the BAG/ON the TABLE", and for 4 word level "put the LITTLE DOLL UNDER the CHAIR/put the BIG AEROPLANE on the BLUE CARD"

Could you simplify it down to 'shoes then sit down '. DS1 could follow a 2 step instruction like that particularly if I stress 'then'. Also can he discriminate in a 1 step instruction. 'Give me the green card' (but not any of the other colours).
Don't worry too much about the appointment, the appointment itself won't change anything. Do you know what the purpose of the appointment is? Is that what is worrying you ?

Sorry just say title of thread - I'm not a SALT. Look before you leap or something like that 1

should have said "SALTS and other friendly people" . Seems like I still haven't got my thread title mojo back!

Thanks very much both of you. All other advice very welcome.

Total - I think you have "got my number" re the paed and I will try to follow your advice. It's probably a great thing to have it just before Xmas - perfect for an over-analyser like me. I've got DH to agree to come. Now I just have to persuade him not to say "I have no worries about this child and don't understand why I'm here". Ah well, there's still the weekend.

Cyber - briefly - DH and I found previous assessment a very negative experience so were tempted to remove ourselves from the system altogether. Shocking I know but there must be hundreds of parents who feel the same out there - they just don't post on this board! We wanted to run for the hills.

I agree that it's not a good idea to over prepare or to present a case at the assessment. Could you just go and listen and then present your own arguments later ? I don't think paeds have an agenda to over diagnose anything and if it's a borderline case, they too may want to allow the child more time to develop - which is roughly what you want as well.

yes I think you're right cyber. We will try not to think of anything as an argument. She might diagnose language delay which is obviously fine - completely self-evident! She won't be diagnosing ASD because there's a big process for that......

Total, can you remember the likely milestones they'll be wanting to hear about? does it include physical things like walking/jumping/riding a bike? or just talking? It's our first "official" doctor's visit so not quite sure what to expect.

Might print off my earliest mumsnet threads to remind myself.

yes, she will want to know physical milestones as well, and will probably go back as far as the PG and birth in doing a history!

I would agree with simplifying the 2 step instruction right down to begin with - shoes then sit down, etc. That's the bits he needs to get in the right order, the rest of the sentence is window dressing, imo. Once he has the hang of doing things in the order which he hears them, then you can add the filler words back in.

We had to (and still have to - just moved house so have a new set of paeds to see!) know all milestones. back when dd1 was first in the system (at 20 months, suspected gdd/language delay - apparently definitely NOT autism pmsl ) they ran through absolutely everything.

From first smiles etc to sitting/crawling/walking, then on to walking up/downstairs (and when she did it "step-together" and when cross tread) and so on. you wouldn't believe the things I was asked. But then dd1 does have physical difficulties too (dyspraxia), although not anything I would have said was out of the ordinary age wise (eg she does still have difficulties pedalling a trike/bike, but she is not the only just 4 year old to have these difficulties).

The appointments can be quite gruelling (because of the level of detail they ask - dd1 was my pfb, and I knew everything about her, or so I thought. Then I went to assessments, and found ou there were a lot more milestones than I'd been looking out for!) so do be prepared for a lot of detailed notetaking. And, in my experience they don't stop asking questions even when they've guaged what level your ds is at - they go on to ask a few more above that level, checking for peaks and troughs in development (although that could be dd1 - she has a ridiculously spiky profile, so at 2 was scoring from 6 months to 6 years for different types of language)

I have never got out of an assessment in under 90 minutes (apart from the one where we refused to stay because the paed was not qualified to set the test they wanted done, so wasjust going to collect background info again - we told her to read the notes).

Most of all I have found them very useful in that they highlight areas I may not have thought of, so give me something new to work on - and dd1 has a habit of picking a new skill at each assessment, so i sit there saying "oh no, she can't do that yet" while dd1 either exhibits the skill perfectly behind my back, or walks out of the assesssment and does something new - I love assessments for this reason

lingle

I have the denial thing(2 years and counting)
... which makes all the people involved in my ds's care shake their heads, esp his early years support teacher... then there are the ones who sort of tip-toe around us (salt and clinical psychologist and consultant paed)... who make me waver between denial and wanting ds to get a dx and I get tied up in knots there... and the ht of the ms school (ds is at nursery there) who just sends out information that says your "child with ASD" and has put my non-dx'd son in a box already.

Good luck with your appointment, tbh I have found the Paediatrician loathe to dx, prefers the "wait and see" approach, whilst supporting ds in nursery as if he does have an asd.

we know our ds is a lot different form his peers, language delay and all that involves, but I am trying to admit to myself it is more than that, but still wavering - he is 4.6 and due to start school in August 09.

HI lingle, good luck with your appmnt. Love your posts by the way!

I'm not a SALT either, but what I did with DS to encourage the two word instruction is get lots of small toys/objects and put them on a table.
For example I had a flower, a toy chair, a toy table, several cups of different colours, cars, playmobile figures, all sorts.

Then played games with him using the objects in context. So for example, if we were going to give tea to one of the playmobile mums, it would go something like this:

Put the spoon in the cup, Pour some tea in the cup, Hide the cup under the table (then made a game of it trying to make the mummy find the cup), give the mummy a flower, now give some milk to teddy, etc, etc

The key is to vary the instructions everytime you play with these toys, because these clever kids learn to expect what you are going to ask and not really listen to the instruction. So if you say the word "shoe" for example, maybe they are expecting you to ask them to find their shoes, or put their shoes on, but if you say "hide your shoes" they are lost.

Does that make sense?? Sorry if I'm not very clear.

I would still love to know what percentage of children who go into the ASD diagnosis process, leave without a DX ? I have a friend whose child does not really tick any boxes for ASD except for slight language delay for a 3 year old. It has got to the stage of the child being observed at home by paeds but other than that I've no idea what the outcome will be - though if it was ASD, the child would be one of the highest functioning in the world - as far as I can see anyway. Getting to a DX is a long process so there's no need to worry about being hijacked early on in the process - at least that was my experience.

Aefondkiss, hurray, not just me then! You might enjoy DH's various sayings about this whole process to date(he is a professional historian and philosopher of science). My favourite:

"When they say it, it's evidence; when we say it, it's anecdote".

Am stunned re level of detail required on milestones!!!! That will keep me quiet - I'll be so shamefaced at not having a clue (second-born child and all that). LOL at little Silverfrog. Maybe DS2 will use the toilet for the first time during the assessment? Will the paed. have access to the health visitor's records, does anyone know?

Assessing is so grim isn't it? They learn through context. Then you pull away the rug from under their feet by removing the context!

Cyber it is a very interesting question about how many children never get diagnosed. Jimjamshaslefttheyurt is probably the person who might know if anyone does. But I'd be surprised if anyone had any idea. The closer you get to the borderline, the more social background and parent's attitude is going to determine whether you even start the process. And then I think that most people just stop going to the professionals once they feel happy and the NHS isn't resourced to follow up. And even if you did follow up, the reports might not be reliable. Re your acquaintance's child: you sound mildly sceptical and tbh I'd don't blame you! I think similar thoughts about my DS1 who is very similar to some autistic children but has no social problems whatsoever.

I've got a few minutes of film of DS2 at nearly 1 doing the cute crawling babbling "Da Da Da" thing. Maybe I'll take that to the paediatrician's appointment. It's so embarrassing - I have acres of film of DS1 and almost none of DS2!

I've also realised that I inadvertently misled the health visitor at both children's checkups about "does he bring you things to show you?" I thought they did, but since using mumsnet, I've got a bit more aware of norms and I've observed typical 1-year-old children "bringing their parents things to show them." Gosh- they really do bring it to mum and show her!!!! I don't think either of mine did that. oops. Not sure if either of them pointed with index fingers before 2 1/2 either. double oops.

I don't ask questions about what they are assessing for but language delay and some behavioural problems have been mentioned. However the child can use pronouns and tenses correctly and has normal understanding and the parents aren't worried so i was surprised that the assessments were happening - but as always you never know the whole story.

true, you never know......appreciate you aren't judging that particular case.....

obviously pure speculation over the internet - but sounds like language isn't the main issue, possibly the kid is having a lot of trouble coping in a nursery setting.

I feel as if I'm gossiping about them now ! even though I hardly ever see them and they don't use MnNet !. I think what I meant was that being assessed does not mean that massive problems are suspected, it could be something more subtle and that could self resolve in time as with your other son.

complete lack of knowledge never usually stops me speculating

Building up instructions is something I've been working on with ds2 (5). The SALT went through a process of:

1. Set out a teddy bear and a doll. In front would be one cup between them. The SALT wouldthen say "Give teddy cup" or "Give dolly cup". It meant that ds would have to start listening for the correct toy.

2)Next stage would be the same two toys but this time with a cup and a plate. The SALT would use different combinations of "Give teddy/dolly cup/plate" so that ds would have to concentrate on 2 different things: which toy and which object.

Depending on your ds' understanding of nouns you can also do pointing at objects in pictures, eg "Point to horse then cat".

It's definitely a good idea to keep instructions short though, as others have said.

lingle, use pics to help aid understanding.ie pics of shoes then stool. use the pic to reinforce what you are asking. use simple language. use gesture.
get a teddy and dog or soft toy he likes. ask him to find dogs nose, teddys feet, dogs tummy,teddys eyes etc. can he do this?

thanks coppertop and littlemisschatalot.

We need a searchable speech and language archive, you know. This stuff is great.

Yes, he can find dog's nose, etc. He also adores laying the table and saying "a plate for mummy, a plate for daddy, etc" and then "a spoon for mummy, a spoon for daddy" as we puts the plates/spoons in each person's assigned "place". So I think he's in the zone.

By the way, Great Little Trading Company stocks some good photo holders from cleverlittleideas.com or picturepockets.com. I've got the "over the door" one and have hung it up near the back door. It's terrific for making sure he knows where we're going next. The stress levels have plummeted now he's not feeling "tricked" when we go somewhere he wasn't expecting. Obviously you could do exactly the same thing for free by just pritt-sticking a selection of photos of common destinations to your back door.....

ok, so can he do object to person? dog/teddy, and selection (3)objects, give the cake to teddy, give the cup to dog,
can he do person/action? make dog jump, make teddy sit, make dog lie, make dog walk?
can he do person/place? teddy in bath, dog on bed, teddy on chair, dog in box, etc?
try 2 step commands with just objects, ie get hat and coat, get book and teddy, give me ball and car form a selection of 6 objects.hth

thanks!! will do a check on that at the kitchen table today......

he likes to make toy animals go to sleep then wake up.
So it's "mummy go sleep!" "doggy go sleep". "Ds2 go sleep".
then when we're all "asleep" he chooses who's going to wake up first. So it's "doggy wake up", "DS2 wake up" "mummy wake up".
And each of us "wakes up" in turn.

All rather enjoyable.