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.

Littlemisschatalot and other helpful posters, thank you again for all the advice on this tricky issue

Christmas overwhelmed us, but I spent last night making notes on the advice given on this thread. I've now drafted a long email to my speech therapist setting out what he can do on receptive speech and how he reacts to (1) two-step instructions and (2) descriptions of sequences of events and asking her for her advice. I'm feeling a bit more able to deal with her now she has seen both sides of him.

I've got a feeling we need to go right back to basics and present two photos without words eg one of shoes and one of stool. I'll see what she says.

Below I have set out the advice I got back from the SALT. Now, she's a busy lady, and I appreciate her taking the time to reply, but having met me twice she should have guessed that "We will be working on building up his understanding through a structured programme" is not the help I'd hoped for, especially as I won't see her again for another couple of months.
DS2 is coming along brilliantly and NOW is the time I need help progressing from one-step to two-step, not April!
Does anyone know if this stuff would be in "more than words" or any other Hanen or similar books? The Derbyshire Language Scheme I looked at earlier seems to fall into the trap of assessing rather than teaching - a story I hear again and again in mumsnet SN.

Here is what she said.

"1 Explaining sequences of events
At this stage DS2is still at the level of things being very specific so a First Then board with pictures of what is going to happen is really the best thing, as you are already doing. Of course there will be times when he does not like the proposed sequence, but that is life!
The next step here is to have picture symbol cards for all family activities e.g. walk, swim etc. I can do you a set if you email me a list. These will need to be taught in each situation, once this has happened then you will be able to build up a simple 3 card sequence e.g.

breakfast
walk
park

some good examples of this can be found on the website www.dotolearn.com
I will go through this in more detail once we have done the visuals training for school so that we can aim to use the same symbol set for common themes.

2. Two -Step instructions the fact that DS2 is only following the last part of a two step instruction shows that at the moment he is not able to process language at this level. It is important therefore to break things down one step at a time in the order in which things are going to happen e.g. "sit stool" "Shoes on", only saying the next part of the instruction once DS2 has followed the first. We will be working on building up his understanding through a structured programme. I will bring this with me next time I visit.

Great advice here!
God there are some really on the ball parents out there.So impressed!
Lingle, I agree with working on stuff now. Unfortunately that is the way it is for the overburdened NHS SALT.

I take everyone's point about constant assessing and little intervention.It is one of my main bugbears!

Derbyshire Language Scheme (DLS) is a programe and not just an assessment too. Any chance of you going on the course yourself? It is old fashioned and the materials a bit dated but it is good and someone like you who has a clear understanding of processing separate pieces of info. would twig on very quickly.

If you have the energy to carry it out yourself (it's very structured-just a case of disciplining self to do it) then it could be great.I've used it extnesively but never have the time to carry it out properly.

Here's the link

This is probably of no help but my DS1 was struggling with commands and a couple of home-grown games have really helped.

The 1st one really focuses on the positioning words in/on/under but it has evolved over time.

It started off with an object being "hidden" either by him or me. If I do the hiding he does actually know where it is but he enjoys the charade of looking for it. e.g. hiding a ball under the sofa and we go looking for it. To begin with he just followed me round as I said things like "is the ball under the chair -(over-dramatic searching under the chair) NOOO" and it has progressed to me saying is the ball under the chair and he will go and look and say "noooooo!"

For the tea-party set-up I have found he will play this if the tea party guests emit a loud burp after eating the delights served up! (I do tell the guest its rude and they must say pardom me ). I think we started off with just one food item and 1 tea party guest then burp and he has now progressed on to a couple of food items, a couple of different coloured plates and a couple of guests.

Thank you so much for posting moondog. The response does scream out "too busy" doesn't it? You mentioned Derbyshire to me before. I had a good look and printed out the course description - I learnt a lot from that alone. They said the pack cost £130 but perhaps I should call them. I did fear that doing this scheme might tempt me to "play SALT" and start "assessing" instead of "helping" in my own home!

I think I have a slightly wider issue here. Which is that I have figured out how to assess his receptive speech (thanks to the excellent guidance from littlemisschatalot and others earlier in this thread). The SALT complimented me on my detailed descriptions of discriminating x3 between doggy/bear, kiss/tickle and body part in the "kiss doggy's toe" game. And I know how to teach this particular child expressive language because simple Hanen techniques work brilliantly for him. But how do I teach him to understand more? It's so much harder! I feel like I need some more theoretical understanding to back up the exercises. Anyone got any ideas?

Moondog, shall I have a go using photos and no words? ie show picture of shoes and stool at shoe-putting-on time. Then start to accompany it with words. Then eventually drop the pictures? I'm so NOT a visual learner myself but my SALT is convicned that DS2 IS. It was visuals that helped him crack (1) choices and (2) descriptions of destinations and it has transformed his little life

Don't do anything without words.
Use pictures by all means to scaffold language but never alone. Did I mention the book Using Visual Strategies to improve communication. Googling it,I note the author now has a site which I haven't seen before.
Check it out. She's great.
Here

I have found that using visual strategies and (when older) writing and reading both improve understanding.The writing as an aid to improving communication is roughly the topic of my MSc (which encompasses a lot of other issues too). Interesting as a lot of people won't start reading until they fell understanding there but I have found starting it gives something for language to hook onto.

I see it like this

SALT requires understanding before embarking on new tasks
Behaviour Analyst (ABA bod) buils up fluency in task and understanding then develops.

I'm moving between the two which is exciting.

wow lots of fab advice here. My DS has just had his development review, deferred till oct 09 as they can't decide whether Specific language impairment or ASD. Am going to jot some of the ideas down now.
TBH, we have found that we have got no where with our NHS speech therapist, we just have never had enough input with her, but have learnt loads from a private therapist we employed. We were like the OP, we wanted to learn strategies we could use NOW, not when the NHS SALT was next in school. good luck everyone, we know how hard it is.

If there's any ideas you can jot down on this thread novacane I'd love to read them.

I think my SALT is mainly focussed on trying to help nursery.

Moondog - you're a star. I'm going to start selling "I heart mumsnet salts" merchanise.
I have bought the "Using Visual Strategies" book following your recommendation. Review will follow soon! It was a choice between that and the Hanen "More than Words" but the main reason I was interested in "more than words" was the visuals. "It takes two to talk" gives him enough skills to initiate communications and take turns so I suspect he doesn't need the additional support on that front so much - save that he's overwhelmed and not communicating well at nursery.

Have never actually read More than Words, only general info about it, but the impression I get is that it focuses on the early stages of communication - e.g. on how to get your child's attention - so would imagine a specific visual strategies book would be more useful to you.

Agree with Moondog - always accompany everything (sign/photo/gesture) with the appropriate words.

In terms of improving understanding - what worked with DS was lots and lots of visuals along with the words - I feel that the visual cues helped him make language connections. Afraid that's not really the sort of technical tip you are after though!

"I feel that the visual cues helped him make language connections. Afraid that's not really the sort of technical tip you are after though! "

It's just what I'm after . So job for today is to get new batteries in camera and take photo of shoes and stool.

Will run out of money soon as am doing more speech help than professional work just now!

Hi lingle, some quick thoughts on this - we have had to be very visual with ds to improve his understanding. He seems to learn about 75% through visual and 25% through aural cues imo so I tap into any visual learning opportunity available. He still has a processing delay which often means I have to repeat myself with 2 step instructions before he responds. I can see that ds2 is reacting quicker and he's 2 yrs younger at 17 months.

Have you made your ds a people and places photo book? I did a book full of pictures for ds1 and labelled them all underneath. He loves to look through at bedtime and label the people, places and actions "ds2's sleeping," "mummy's driving the car" etc. (Like the GLTC hanging photos idea, will do that) Anytime we're driving anywhere, I ask the ds' where we're going and who we're going to see. They love the game and are starting to take in more information.

We use a teddy to illustrate verbs in action - I get him to make teddy dance, jump, sleep, drive, push etc. That has greatly increased his use and understanding of verbs.

Flashcards and pictures from the Early Learning Centre have been great. ds has started to match the written word to the picture of the object and that's helped his vocabulary.

Have you got the Baby Bumblebee dvd's? Have some spares if not, will stick one in the post to you.

Will be following this thread. I am at the stage where I think I need to increase ds' receptive language before I think his expressive csn develop much more so am very interested in others ideas!

Lingle, it's a shame we aren't nearer or I'd split the cost of the Derbyshire pack with you - we could run mini SALT sessions for the ds'!!

oh yes the teddy/favourite toy idea is a good one. and you can get him to take turns and ask you to make teddy do stuff too.

in terms of sequences/time - boots sell a nifty little jigsaw toy called "step by step puzzles". It has a selection of 3, 4 and 5 piece jigaws showing kids at different stages of various activities - eating dinner, growing a plant, making a cakes. It's a very handy toy for all manner of vocab. Oh and also the do2learn site (www.do2learn.com) has got some nice videos on it of people doing things in various stages - another good one for sequencing/time words.

Also, if you have a school/home book that is great but it is for adults, not kids.
We have picture diaries going to/from school (parents and school staff have a stash of piccies) and a big part of the routine is finding out what has been going on at home/school in a way they understand.

Also, any pictures/props will help
eg shoebox full of objects/pictures related to w/end activities (eg swimming clothes, cinema ticket,dvd watched)

Kettle yes I would appreciate those bumblebee spares. Thank you very much.

We're hitting an interesting problem. We are starting to get sentences with two nouns and a verb as follows: "pour the pasta into the colander". This is amazing for a child who couldn't combine words in September. Trouble is that, because his prepositions aren't that sound he sometimes says "pour the colander into the pasta". He never made this mistake when "pour the pasta" was the limit of what he could say.
I'm not sure whether to backtrack to simple noun+verb sentences or to keep modelling these more complex sentences in the hope he'll pick up on the meaning of "in", "on" "behind" more clearly. He doesn't seem to get muddled if someone's name is involved eg "DS1 is getting out of the bath" is ok.

Moondog, I'd be interested in learning a little theory about how children acquire language - stuff aimed at parents doesn't cover this much. Any suggestions? How about your work?

Lingle, David Crystal is your man. Top bloke, world expert,yet hugely entertaining.
One of the most influential people in this field.

He lectured to me in my first degree (French/Linguistics) and set me on the road to becoming a SALT.

Here is his website which is touchingly unassuming, just like him!

Click on books or child language and yuo have a choice, from books for layperson to heavy duty research.

oohthank you that's my evening's browsing sorted

havejust seen notfromaroundhere's earlier post - am definitely going to try that "hiding" game. We will hide his doggy in various places. Have been reading a book called "I see a monster" tonight (4 times) where the answers are all in the form "under the bed", "behind the door" "in the bath" etc but it's actually counterproductive because the illustrator has taken a very liberal interpretation of "behind" and you can't tell the difference between "under", "behind" and "on" from the pictures. DS2 just relies on his prodigious memory without actually learning.

Derbyshire is all this type of stuff Lingle. although one you have the idea of ICWs, it is easy to adapt with personal highly motivating stuff.

cool. have bought my first David Crystal book "Listen to your Child". We'll work up to more complicated stuff later!

Yes, it's a goody to start with.You will whizz through it and be sniffing in the heavy duty journals before long.

Anyway, back to my research.

I'm going to do that hiding game too - good idea! Today's task is to teach over, under and behind so I think I'll do that with something at the table at teatime.

Finally just ordered your Hanen bible, Lingle! Looked on amazon to start with and was at the price - £68 I think! Then I remembered you'd linked to the UK distributor and breathed a huge sigh of relief when it was cheaper. Do you have the DVD which goes with it? Almost ordered it but £46 for a dvd.. need to hear it works first!

I haven't got the DVD.

I think that (assuming it's suitable for your child which it will be for Kettlecrumb) the biggest problem with following Hanen is remembering to Observe, Wait and Listen.

DH went through a bad phase recently of playing with DS2 only when I'd had enough. So he would approach DS2 with a big "hail fellow well met" remark and push him off whatever he was doing which understandably isn't really the best way to start a conversation.
Then we had a row. Then he reread the "OWL" bit.
Then the next day DS2 was drawing (new skill, we are chuffed to bits). So DH sat down next to him and started drawing DS2's doggy without looking at him. Sure enough DS2 was interested and started a conversation.

Lingle re the muddling of "pour the pasta in the to colander" as "pour the colander into the pasta" I found with my DS that by actually going along with what he said (trying to pour the colander) it gave him a visual representation of what he had said.

It would all be done in a theatrical way "pour the colander into the pasta (physically try), oh dear what is wrong here this isn't right is it? what should we do? (prompt we need to pour the p...)! Oh we need to pour the pasta into the colander (show the right way round). that's better, we're a good team!" etc. DS1 is way less bothered about making "mistakes" than I had thought he would be, valuable lessons and all that.

thank you.

your life sounds like my life!

Exhausting isn't it. Do they run courses to help mothers return to speaking to people who don't require visual cues I wonder? Recently I had to go away for a few days without the children and it was very strange not to Laurel and Hardey it through a conversation! . Still whatever it takes...