SALT - ADVICE RE REYNELL/RENFREW SCALES PLEASE

[wornoutmummy]

hi, am a new poster, though long time lurker.
DD1 (3.10) has speech difficulties caused by combination of cleft palate (repaired at 6 months) and hearing loss (mild-moderate conductive loss caused by glue ear and we were told recently, a mild high frequency sensori-neural loss).
She has had 3 blocks of local SALT with a view to deciding whether further cleft surgery (pharyngoplasty) necessary or if problems are solvable via SALT alone. Her audiologist is also considering whether a hearing aid is helpful/necessary.

I have followed posts re speech and language difficulties with great interest and have seen refs to Reynell/Renfrew scores. Can anyone tell me if these scales assess pronunciation/clarity of speech?

DD1 was diagnosed with an expressive language delay when she was assessed at 2.0 (can't remember exactly, either 6 or 12 months) but since then she has totally caught up and I do not believe her speech is delayed as such at all now but she can be difficult to understand. She has "active nasal fricatives" with s, sh, ch, j etc, some sounds eg "l" and "n" are transposed and she can also have a strange intonation making comprehension difficult.
I find it difficult to assess how "bad" her issues are as I am used to her speech and I pretty much know what she is going on about and her nursery are pretty good too.
We are going for a big SALT assessment at GOSH this week and I would like to ask for some sort of measure of where her speech clarity is in relation to her peers. Is this covered by Reynell/Renfrew or is there some other scale I can ask for?

I would love to hear from anyone else with DC with similar difficulties. DD1 has dx of Sticklers Syndrome and all attendant eye probs if this means anything to anyone !

Apologies for message heading being in caps. Its my first time and I've just seen my thread in list and it looks really shouty and rude!

Hello and welcome. As far as I know the Reynell and Renfreew scales don't look at pronunciation in any detail, just the content of speech and understanding of speech; speech sounds are looked at separately. When DS speech sounds were looked at, at his first NHS appointment, the lady did have a test for it (he was given a series of picture cards to talk about), so don't worry, they will have a test for the speech sounds.

hi TotalChaos.
Thanks for that, I kind of thought Reynell/Renfrew didn't cover pronunciation.

We have had regular SALT assessments at GOSH as all DD1's care (except the Sticklers eyes bit) is there. In past reports they have set out in some detail all her speech sound difficulties but what interested me in the Renfrew/Reynell scales was the ranking by percentiles.

I am trying to get my head around how much of a speech impediment she is really facing, in particular as her voice matures and the baby tone of it disappears how intelligible she will be to others. Am looking for a crystal ball I guess!
It's just with her starting school in September I want to try and anticipate what SEN may/may not arise from her speech as currently is.

IME the percentiles ratings aren't that informative - as the "normal range" is surprisingly large - for the expressive/receptive speech the normal range is 17th to 84th percentile(!) - so it tends to be a case of whether your kid has hit the normal range or not. DS's sounds are OK - so I've only really got experience of the other stuff - but there are ladies on here with experience of palate problems and/or speech sound problems.

The run-up to school starting is very stressful, I do sympathise. Have you had a chance to talk things through with the senco and/or head of your first choice school?

Wornout, I'm a salt and as you have been told, Reynell/Renfrew don't cover this.A detailed phonological assessment will thoguh, which all salts are trained to do. I do less of this work now as most peopel I deal with are non verbal but I use/used something like Metaphone.

I love doing phonological assessments actually. 95/100 the child is working to his own idiosyncratic set of rules which just need to be worked out.Then it is easy to predict what they will say before they say it (and great fun to watch parents' jaws drop in amazement when you ask 'Does he pronounce X Y and Z like A B and C?')

hi TC, sorry I only get to come on here at night after kids in bed......Thanks for taking the time to reassure me.
Yes, I am stressing a bit about impending school start.
Our first choice school (practically opposite our house) is a faith school. We don't have a vicar's ref so are quite a way down the entrance criteria so don't know if we'll get a place (grrrrr but that's another blardy story). If we don't get in then we may consider a non-selective independent school - I can't help feeling a smaller class might mean more attention for DD. But then there's the whole thing about whether if we opt out of state sector we lose access to NHS SALT. Currently DD's SALT is part of specialist cleft services and not our local SALT team so we travel to see her in her clinic in another town. (When they first got referral from GOSH the local SALT said they didn't have expertise to deal with DD's issues and referred us on.) When I asked our SALT about this she said "as things stand at the moment" our current SALT provision would be unaffected if we opt out of state education as only SALT services that go into schools to deliver therapy won't go into independent schools here (Surrey) but we would lose the option of her care being transferred to local SALT and delivered at her school if it was deemed appropraie some time in the future.

When we went to look around local faith school I did really like it and I spoke v briefly to SENCO who said if DD was offered a place they would come out and discuss things with us in detail.

The thing is I felt like a bit of a numpty when talking to the SENCO as currently at nursery DD has no real issues - she is a very sunny, gregarious and sociable little girl. A while ago when she started the nursery they raised the issue of whether she had problems with gross motor skills - running/jumping etc but they have never initiated any discussions about her speech. The nursery manager actually upset me by suggesting, when I raised DD's issues with her, that I was making a mountain out of a molehill or that it was all in my head . But then when I spoke to the nursery SENCO she said that she thought whilst DD would have no problems at school intellectually/academically she felt she would need extra support of some kind. Currently DD is unaware that she has any speech issues as are the other children but this is likely to change as she gets older. She does get very angry if she is not understood.

I had always thought that the speech issues were wholly palate related but it now seems her hearing is not all it could be. She has always had severe glue ear - 4 sets of grommets so far, 2 years on prophylactic antibiotics and definite damage to her eardrums but now there appears to be a separate high frequency loss that is permanent and could be a major factor in some of the poor quality/confusion of speech sounds. We have another hearing test at end of this month and her audiologist thinks a hearing aid/soundfield system in the classroom may be beneficial.

I just feel like I have to get all these things in place before she starts to give her the best possible start come September.

Thanks for reading if you've got this far.

Moondog - I am a very slow typer and x-posted. Yes, I have been trying to work out the code to deciphering DD's sounds!
It's interesting as where e.g. L = N and N = L I think this is as a consequence of dd's poor hearing but the active nasal fricatives and problems with CH, S, SH, J etc are, I think, a consequence of poor muscle tone in palate (cleft was whole of soft palate and 2/3 hard palate, repair was successful but we still have some nasal regurgitation of food). DD has very poor blowing skill and almost no dry suck ability.
Would you think hearing is also root cause of strange intonation - other day DD had screaming paddy because I failed to understand the word "collar" - she said it as "colour" - even when words are correctly modelled to her she seems unable to change her pronunciation ?

Could be.Impossible to say without seeing her but obviously a complicated relationship between the CP and HI.

Hope you get the help you need.